JAYA ELIZABETH MATHEW Vs. STATE OF KARNATAKA

JUDGEMENT

(1.) The petitioners are before this Court calling in question order dtd. 29/3/2021 passed by the 1st respondent/Insurance Ombudsman declining to accept the insurance claim of the petitioners, sought quashment of letter of repudiation dated 14-12- 2020 issued by the 2nd respondent/Insurance Company and a consequential direction of issuance of a writ in the nature of mandamus directing release of an amount of Rs.28,43,684.00 being the Insurance claim of the petitioners.

(2.) Heard Sri Apoorv Khator, learned counsel for the petitioners and Sri S.Krishna Kishore, learned counsel for the 2nd respondent.

(3.) Shorn of unnecessary details, facts in brief, as borne out from the pleadings, are as follows:- The petitioners are wife and husband respectively. 1st respondent is the Insurance Ombudsman and the 2nd respondent is the insurer/HDFC Ergo General Insurance Company ('the Company' for short). The petitioners having a desire of building a house opted for home loan through the 2nd respondent/Company. The loan came with "Home Suraksha Plus' dtd. 29/4/2017 and was to be for a period of 5 years from 29/4/2017 to 28/4/2022. The policy covered major medical illness and procedures to an amount of Rs.56,87,368.00 jointly for both the petitioners. On 10/8/2020, it appears that the Doctors at Vikram Hospital diagnosed the 1st petitioner to be suffering from Multiple Sclerosis and started treatment immediately. After the treatment, the insurance claim was made on the strength of the insurance coverage that was given by the 2nd respondent/Company in its policy dtd. 29/4/2017.