[2026:RJ-JP:15392]

HIGH COURT OF JUDICATURE FOR RAJASTHAN BENCH AT JAIPUR S.B. Civil Writ Petition No. 1816/2026 Star Health And Allied Insurance Company Limited, Having Its Registered And Corporate Office At 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai- 600034 And Its Corporate Claims Department Office At No. 15, Sri Balaji Complex, 1St Floor, Whites Road, Royapettah, Chennai-600014 Through Its Constituted Attorney ----Petitioner Versus

1. Mahesh Chand Ajmera, S/o Shri Chand Mal Ajmera, R/o B 43 Talwandi, Kota, Rajasthan

2. The Insurance Ombudsman, Ground Floor, Jeevan Nidhi-Ii, Bhawani Singh Road, Jaipur-302005 ----Respondents For Petitioner(s) : Mr. Prakhar Agarwal with Mr. Vaibhav Sharma For Respondent(s) :

HON'BLE MR. JUSTICE SAMEER JAIN

Order

13/04/2026

1. Heard and perused the impugned order dated 12.12.2025 passed by learned Ombudsman, relevant extract of which is reproduced as under:

“The Complainant and the Insurance Company attended the hearing and reiterated their contentions as mentioned above. The Complainant further submitted that he had taken the first Mediclaim policy from the Respondent Insurance Company in 2017 and continuously renewed it until 2021. The Respondent Insurance Company further submitted that in 2021, he had taken a policy from another Insurance Company named M/s HDFC Ergo, which was active until 21.07.2023. The Complainant further submitted that, as per the advice of a representative of the Respondent Insurance Company, he again took a policy from the Respondent Insurance Company for the period 12.07.2023 to 11.07.2026. The Complainant further stated that since he was a member of a group policy in HDFC Ergo, he was unable to port the same policy to the Respondent Insurance Company as an individual policyholder.

On perusal of the documents placed on record and submission made during the hearing, it is observed that the Respondent Insurance Company bad repudiated the claims on the grounds of non-disclosure of ILD at the time of inception of policy. It is further observed that Insured patient was treated for Vulval Hematoma and ACS which do not have direct relation with Interstitial Lung Disease (ILD). Further, it is also observed that the Insured is having the Mediclaim policies since 2017 without any break and due to technical reason, he was unable to port the existing policy, hence he had taken a new policy from the Respondent Insurance Company in July, 2023. In view of all above the Respondent Insurance Company is directed to settle all the claims to the Complainant in accordance to the terms and condition of the policy.

Accordingly, an Award is passed with the direction to the Respondent Insurance Company to settle all three claims for an amount Rs. 540754/- to the Complainant in accordance with the terms and conditions of the policy.”

2. Learned counsel for the petitioner has submitted that the patient was admitted on 03.02.2025 and discharge summary dated 10.02.2025 reflects that the insured was finally diagnosed with Acute Coronary Syndrome, known as ILD and thereafter he has filed his claim. It is submitted that it was analyzed on the basis of record that the petitioner was having ILD which confirms the prior incident of medical insurance policy and he was having the said disease and therefore, the policy was attained on account of misrepresentation and immaterial facts.

3. Upon perusal of the observation and conclusion, it is analyzed that the said point was duly considered. The learned Ombudsman has categorically observed that insured patient was treated for Vulval Hematoma and ACS which do not have any direct relation with ILD.

4. Considering the reasoning given by learned Ombudsman being self-explanatory and being passed after considering vital aspects of the matter at hand, it is opined that no interference is called for.

5. Accordingly, the present petition is dismissed. Pending applications, if any, stand disposed.

(SAMEER JAIN),J CHANDAN /28