Gujarat High Court
Hdfc Ergo General Insurance Co. Ltd vs Tejpal B. Chawla on 19 March, 2025
NEUTRAL CITATION
C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025
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IN THE HIGH COURT OF GUJARAT AT AHMEDABAD
R/SPECIAL CIVIL APPLICATION NO. 17469 of 2023
FOR APPROVAL AND SIGNATURE:
HONOURABLE MR. JUSTICE ANIRUDDHA P. MAYEE Sd/-
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Approved for Reporting Yes No
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HDFC ERGO GENERAL INSURANCE CO. LTD.
Versus
TEJPAL B. CHAWLA & ANR.
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Appearance:
MASUMI V NANAVATY(9321) for the Petitioner(s) No. 1
MR VIBHUTI NANAVATI(513) for the Petitioner(s) No. 1
PARTY IN PERSON(5000) for the Respondent(s) No. 1
REFUSED SERVED (N)(10) for the Respondent(s) No. 2
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CORAM:HONOURABLE MR. JUSTICE ANIRUDDHA P. MAYEE
Date : 19/03/2025
ORAL JUDGMENT
1. The present Special Civil Application has been filed by the petitioner insurance company praying for the following reliefs:-
"15A. Be pleased to admit and allow this petition.
B. The Hon'ble Court may be further pleased to consider that the judgment/award of the Ld. Insurance Ombudsman, Ahmedabad vide complaint No. AHD-G-018-2324-0025 dated 02/08/2023 (Annexure A) is illegal, wrong and be further be pleased to quash and set aside the impugned award and/or modify the same considering merits of the case.Page 1 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025
NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined C. As an ad-interim ex parte relief, the Hon'ble Court may stay the judgment/award of the Ld. Insurance Ombudsman, Ahmedabad vide complaint No. AHD-G-018-2324-0025 dated 02/08/2023 (Annexure A).
D. Be pleased to pass such other and further awards may be deemed just and proper looking to the facts and circumstances of the case and in the interest of the justice.
2. The brief facts of the case are that, the respondents had purchased the Sarva Suraksha Policy (Plus) for the period commencing from 08.06.2015 to 07.06.2020 ["1st policy" for the sake of brevity]. That the respondent No.1 lost his job on 15.12.2017 and thereafter lodged the claim with the petitioner - HDFC ERGO General Insurance Company Limited ["insurance company" for the sake of brevity] on 26.12.2017. That the claim came to be settled by the petitioner insurance company by payment of Rs.31,371/-. That the respondents purchased another fresh policy i.e. Sarva Suraksha Policy (Plus) from 03.01.2020 to 02.01.2024 ["2nd policy" for the sake of brevity]. That the respondents lodged the claim for 2nd loss of job on 20.02.2020 in the 2nd policy. That the said claim was also settled by the petitioner insurance company by payment of Rs.40,242/- on 08.01.2021. The respondents once again intimated the claim for 2nd loss of job on 07.01.2020 under the 1 st policy. That the said claim was assessed and disallowed by the petitioner Page 2 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025 NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined insurance company as the benefit under the loss of job coverage has already been accrued by the respondents upon settlement of claim relating to the 1 st loss of job on 15.12.2017. That aggrieved, the respondents filed a complaint before the learned Insurance Ombudsman, Ahmedabad. By the impugned order, the learned Insurance Ombudsman has allowed the complaint of the respondents and held that the maximum sum insured of Rs.1,00,000/- is not exhausted as the insurance company had paid claim only to an amount of Rs.31,371/-. Therefore, the petitioner insurance company has not acted in accordance with the terms and conditions of the policy and therefore, the decision of the petitioner insurance company to repudiate the claim was set aside and the award came to be passed directing the petitioner insurance company to make payment towards the admissible claim for loss of job subject to available sum insured in the full and final settlement of the claim.
Aggrieved, the petitioner insurance company has preferred the present Special Civil Application.
3. Learned counsel for the petitioner insurance company Mr. Vibhuti Nanavaty submitted that the claim of the respondents upon assessment was disallowed as the incident of loss of job Page 3 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025 NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined had already been indemnified by the petitioner insurance company under the 1st claim. For the 2nd loss of job, learned advocate submitted that the claim for the 2 nd loss of job dated 20.02.2020 under the 1st policy is repetitive and redundant. He submits that the claims lodged by the respondents are in excess of the benefits provided in the policy coverage and since the claim for the same loss of job was already settled by the petitioner insurance company from the 2 nd policy, the claim for the 2nd loss of job could not be raised for the 2nd time under the 1st policy. He submits that technically, after the settlement of the claims of the respondents for the two loss of jobs, the same loss of job could not be granted under the 1 st policy as it would raise a 3rd claim for the two loss of jobs. He submits that the 3 rd claim of the respondents for the 2 nd loss of job under the 1 st policy was rightly disallowed by the petitioner insurance company. He submits that the learned Insurance Ombudsman has not rightly appreciated the fact that the claim for the loss of job was limited only to maximum of 3 EMIs once. The claim cannot be extended for the entire sum insured i.e. Rs.1,00,000/-. The insurance benefits is limited either to 3 EMIs or Rs.1,00,000/- whichever is lower. He submits that the learned Insurance Ombudsman has not properly appreciated the conditions to the insurance Page 4 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025 NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined company and Section 4 thereof in particular, which on a plain reading reveals that the policy will pay a maximum of 3 EMIs towards his loan account or lesser if he gets reemployed earlier. He, therefore, submits that the 3rd claim of the respondents has rightly been repudiated by the petitioner insurance company and there was no amount payable towards the 3rd claim under the policy coverage.
4. Per contra, the respondent No.1 who appears as party-in- person submits that the action of the petitioner insurance company is to deprive and delay the benefits of the insurance policy to the respondents. He submits that the respondents had purchased two policies namely, one Sarva Suraksha Policy (Plus) for the period from 08.06.2015 to 07.06.2020 and another Sarva Suraksha Policy (Plus) from 03.01.2020 to 02.01.2024. He submits that both the policies cover various risks including loss of job wherein 3 EMIs are payable by the insurer in the event, the respondent lost his job during the policy period. He submits that though 2 claims were settled by the petitioner insurance company, however, the claim of the respondents in respect of 1 st policy came to be rejected. He submits that both the policies were active and in operation and the claim was admissible under Page 5 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025 NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined both the policies as per the policy terms and conditions. He submits that the respondents had rightfully lodged the two claims since 1st policy was in operation and 2 nd policy was also in operation. The respondent submits that the maximum amount payable of 3 EMIs was not exhausted in this case as the sum insured was Rs.1,00,000/- and only Rs.31,371/- was paid under the 1st claim. He, therefore, submits that since the 2 nd claim was for Rs.40,242/-, the same was also payable as the limit of sum insured i.e. Rs.1,00,000/- was not exhausted in the 1 st policy. The respondent submits that the learned Insurance Ombudsman has rightly appreciated the terms and conditions of the policy and has directed the petitioner insurance company to pay the claim from the 1st policy. He submits that it has been rightly held that the policy terms allow further claim upto Rs.1,00,000/-. He submits that the petitioner insurance company was under contractual obligation to pay the said amount under the policy. He, therefore, submits that the impugned award passed by the learned Insurance Ombudsman is just and proper and the present Special Civil Application be dismissed.
5. Heard learned advocate for the petitioner insurance Page 6 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025 NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined company and the respondent in person as well as considered the documents on record.
6. The respondents had purchased 2 policies viz. Sarv Suraksha Policy (Plus). The 1st policy commenced from 08.06.2015 to 07.06.2020 and the 2nd policy commenced from 03.01.2020 to 02.01.2024.
7. At this stage, it would be profitable to refer to Section 4 of the policy, which reads thus:-
"SECTION 4. LOSS OF JOB (APPLICABLE FOR SALARIED PERSONS ONLY) In the event of the insured person losing his job due to retrenchment from his employer in view of mergers and acquisitions the policy will pay a maximum of 3 EMI towards his loan account or lesser if he gets re-employed earlier. For a claim to be admissible under this section the Insured person has to submit written proof towards his retrenchment."
8. The petitioner insurance company has insured the respondents for a sum of Rs.1,00,000/-. Section 4 of the policy states that the policy will pay a maximum of 3 EMIs towards his loan account or lesser if he gets re-employed earlier. In the present case, the respondents have been paid 3 EMIs in their first claim. The "Sum Insured" as defined under the policy means the amount stated in the Schedule is the maximum amount per Insured person for which the Company will make payment for any and all claims in the aggregate in relation to the Page 7 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025 NEUTRAL CITATION C/SCA/17469/2023 JUDGMENT DATED: 19/03/2025 undefined Coverage Part to which the Sum Insured relates during the Policy Period.
9. In the present case, the Insurance Ombudsman has held that no where under the policy, the restriction in number of claims for loss of job has been mentioned. The only capping under the coverage of the policy with regard to loss of job claim is 3 EMIs payable within the sum insured i.e. Rs.1,00,000/- and therefore, the respondents are eligible to get claims for loss of job till the sum insured of Rs.1,00,000/- gets exhausted with the restriction of maximum 3 EMIs in one claim. Since the respondents have not exhausted the amount of the sum insured, the petitioner insurance company has not acted in accordance with the terms and conditions of the policy.
No infirmity can be attached to the impugned order. No case for interference is made out by the learned advocate for the petitioner.
For the aforesaid reasons and observations, the present Special Civil Application is devoid of merits and is accordingly dismissed. No order as to costs.
Sd/-
(ANIRUDDHA P. MAYEE, J.) KAUSHIK D. CHAUHAN Page 8 of 8 Uploaded by KAUSHIK D. CHAUHAN(HC00197) on Wed Mar 19 2025 Downloaded on : Wed Mar 19 23:18:02 IST 2025