HON’BLE SRI JUSTICE NAGESH BHEEMAPAKA WRIT PETITION No. 46423 OF 2022

O R D E R:

The case of petitioner is that he is the Member of Telangana Bar Association (TS 1398 of 1988, dated 08-09-1988) and the Member of Telangana High Court Advocates’ Association from 2014. It is stated, Telangana High Court Advocates' Welfare Trust provided insurance coverage for accidental death and accidental injuries to the members of High Court Advocates’ Association. As such, coverage is provided to petitioner, his wife Smt. P. Kalyani and son PVS Talpa Pai (Card Numbers are 52024190047458Z, 52024190047458C and 520241900474580 respectively) and Policy Numbers were valid from 30-05-2022 to 29-05-2023. It is also stated, insurance coverage is provided by Respondent - M/s United India Insurance Co. Ltd. which is under the control of Respondent No.1 - Insurance Regulatory Development Authority (IRDA).

1.1. As the matter stands so, petitioner’s wife underwent Hysterectomy operation on 08-09-2022 for which, he incurred Rs. 2,57,080/- . However, Respondent insurance Company had paid only Rs. 95,759/- as against the said claim by way of direct credit to his Account No. 060410011035682, Union Bank of India, Vidyanagar Branch, Hyderabad, without giving any reasons for not paying the entire claimed amount. It is the bounden duty of the Insurer to give reasons much less valid reasons and they cannot choose the amount arbitrarily without giving any opportunity. Hence, petitioner is stated to have addressed the Insurance Company on 14-11-2022, requesting release of balance amount. The Insurance Company gave on line reply saying that amount was paid towards full and final settlement; further under letter dated 03-11-2022, it was informed that room rent includes nursing charges, 1% of the sum insured. It is totally absurd to attach the claim of room rent for the amounts claimed under different heads.

1.2. According to petitioner, it is settled law that insured should be explained all the terms in detail. He therefore, approached the grievance cell but they have sent routine reply dated 17-12-2022 reiterating their stand. Respondent - Insurance Company in their letter dated 03-11-2022 referred the terms of policy without disclosing them, hence they are not binding on petitioner. The 1st respondent-IRDA which is the controlling authority over all insurance companies, though informed, did not respond. Hence, the Writ Petition.

2. The 1^st respondent – IRDA filed counter stating that they were never informed about the contract of Insurance between Petitioner and Respondents 2 to 4. They have not played any role in any of the transaction entered into between Petitioner and the 2^nd Respondent and also in partial settlement of medical claim made between them. The onus to resolve the grievance and settle the claim of Petitioner as per the terms and conditions of the insurance contract is on Respondents 2 to 4, by virtue of mutual contract between them. If petitioner is aggrieved by the action of the 2nd Respondent, it is open for him to sue them for deficiency of service or breach of terms and conditions of contract entered before the Consumer Commissions established under the Consumer Protection Act, 2019; Insurance Ombudsman established under the Insurance Ombudsman Rules, 2017, etcetera. This Respondent is not involved in partial settlement of the claim. Hence, the present Writ Petition against this Respondent is misconceived and is liable to be dismissed.

3. Based on the averments in the 3^rd respondent’s counter, learned Standing Counsel Sri P. Srinivas Rao submits that there is no privity of contract between petitioner and Insurance Company as the Insurance Policy ‘Unio Group Health Insurance Policy’ was obtained by Telangana State Advocates Welfare Trust which had taken a group policy for value of Rs.2,00,000/- for each member subject to conditions of the policy as agreed by the Bar Council. Medsav Health Insurance TPA Limited was appointed by respondent No.3 as Admi