SUSHMA SAREEN Vs. INSURANCE OMBUDSMAN

JUDGEMENT

(1.) This petition has been filed seeking a writ of certiorari for quashing the order dtd. 12/4/2017 (Annexure P-4) passed by the Insurance Ombudsman regarding claim submitted by the petitioner/insured's wife towards Policy No.15512190 (commencement date 12/10/2012, and conveyed on 17/10/2012) and Policy No.16464208 (commencement date 3/12/2013, issued on 26/12/2013, and conveyed on 27/12/2013). the claims were repudiated by the respondents/Insurance company on account of suppression of relevant information at the time of taking the life insurance policies. Further, the petitioner is seeking a writ of mandamus directing the respondents to pay the insurance amount in terms of the aforesaid policies with interest at the rate of 18% per annum from the due date, i.e., death of the petitioner's husband, till realisation.

(2.) Facts of the case in brief are, the petitioner's husband filled-up the proposal forms (Annexures R-2/1 and R-2/3 respectively), and the aforementioned two insurance policies (Annexures R-2/2 and R-2/4) were issued to him on 17/10/2012 and 27/12/2013 respectively. The insured/petitioner's husband died on 3/8/2015. The petitioner approached the Insurance company by submitting a 'death claim form' dtd. 24/8/2015 alongwith requisite documents, including the Doctor's Certificate as also the discharge summary (Annexure R-2/5). The claim was, however, repudiated by the Insurance company on the ground of concealment of relevant information. The Doctor's Certificate submitted alongwith the 'death claim form' revealed that the deceased was a chronic patient of diabetes and hypertension (hereinafter referred to as 'the chronic disease') for the last fifteen years. This shows, at the time of taking the insurance policies he was suffering from pre-existing illness, which was not disclosed to the Insurance company.

(3.) The repudiated claims were approved by the Claimants Review Committee of the Insurance company. The petitioner was, thereafter, asked to approach the Insurance Ombudsman/respondent no.1. Death claims in respect of the two policies were submitted before the Ombudsman on 24/3/2016 (Annexures P-6 and P-7). The same were, however, rejected by respondent no.1 vide order dtd. 12/4/2017 (Annexure P-4), accepting the ground of repudiation of the claims by the Insurance company.