HDFC STANDARD LIFE INSURANCE Vs. JYOTHI MADHAVAN

JUDGEMENT

(1.) Appellants are the 2ndand 3rdrespondents in W.P.(C)No.29499 of 2021. First respondent filed the writ petition challenging Ext.P4 award of Insurance Ombudsman. The said award was passed on the basis of a complaint filed under Rule 13(1)(b) read with Rule 14 of the Insurance Ombudsman Rules, 2017. Grievance in the complaint was regarding non-settlement of death claim with respect to the husband of the 1strespondent. Though the Ombudsman found merit in the contentions of the 1strespondent, the complaint was rejected holding that the claim amount was above the limit stipulated under proviso to Rule 17(2) of the Insurance Ombudsman Rules, 2017. Learned Single Judge, after considering the contentions elaborately, held that the Ombudsman was wrong in rejecting the complaint and allowed the writ petition. The learned Judge set aside Ext.P4 award and directed the Ombudsman to reconsider the complaint. Aggrieved by the interference by the learned Single Judge the insurance company has come up in appeal.

(2.) Relevant facts are as follows:-

(3.) The insurance company resisted the complaint mainly relying on the proviso to Rule 17(3). Company contended that the Ombudsman is empowered to consider claims upto Rs.30,00,000.00 only and claims with respect to any higher amounts cannot be entertained. As the claim involved in the case is much above the said limit, the Ombudsman is not competent to consider the same. On merits also the company refuted the claim. Ombudsman heard the parties and examined the materials. In Ext.P4 award the Ombudsman observed that there were lapses on the part of the insurer and found that the insurer is trying to wriggle out of their obligation under the contract, after retaining the premium for 2 1/2 years. Nevertheless, the Ombudsman rejected the complaint holding that the claim amount being more than Rs.30,00,000.00, the complaint cannot be decided by the Ombudsman.