Karnataka High Court
The Sbi General Insurance vs Insurance Ombudsman on 16 March, 2023
Author: Ravi V Hosmani
Bench: Ravi V Hosmani
-1-
WP No. 50472 of 2018
IN THE HIGH COURT OF KARNATAKA AT BENGALURU
DATED THIS THE 16TH DAY OF MARCH, 2023
BEFORE
THE HON'BLE MR JUSTICE RAVI V HOSMANI
WRIT PETITION NO. 50472 OF 2018 (GM-RES)
BETWEEN:
THE SBI GENERAL INSURANCE
COMPANY LIMITED,
101, 201, 301 ACOCNATRAJU,
JUNCTION OF WESTER EXPRESS HIGHWAY,
ANDHERI KURLA ROAD, ANDHERI (EAST)
MUMBAI-400 069.
REP. BY AUTHORIZED REPRESENTATIVE
MR AKASH JHA.
...PETITIONER
(BY SRI M.S. RAJENDRA, ADVOCATE FOR
SRI VIVEK HOLLA, ADVOCATE)
AND:
1. INSURANCE OMBUDSMAN,
JEEVAN SOUDHA BUILDING,
PID NO.57-27-N-19,
GROUND FLOOR, 19/19,
24TH MAIN ROAD, JP NAGAR,
Digitally signed 1ST PHASE, BENGALURU-560 078.
by GURURAJ D
Location: High 2. MR. SANKAPPA SAPALANGA,
Court of NO.42, MANJUSHREE,
Karnataka K.R. GARDEN, 2ND MAIN,
MURUGESHPALYA,
BENGALURU-560017.
...RESPONDENTS
(NOTICE SERVED AND UNREPRESENTED TO R1 & R2)
THIS W.P. IS FILED PRAYING TO QUASH THE AWARD DATED
10.08.2018 VIDE ANNEXURE-L PASSED BY THE R-1 AND GRANT AN
AD-INTERIM ORDER TO STAY THE AWARD DATED 10.08.2018 VIDE
ANNEXURE-L PASSED BY THE R-1.
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WP No. 50472 of 2018
THIS PETITION, COMING ON FOR PRELIMINARY HEARING
B-GROUP, THIS DAY, THE COURT MADE THE FOLLOWING:
ORDER
Challenging impugned award bearing no.IO/BNG/A/GI/0141/2018-19 dated 10.08.2018 (Annexure- L) passed by respondent no.1 - Ombudsman, this writ petition is filed.
2. Sri M.S.Rajendra, advocate appearing for Sri Vivek Holla, learned counsel for petitioner - Insurance Company submitted that respondent no.2 herein had obtained Group Personal Accident Insurance Policy from petitioner bearing Master Policy no.150420-0000-00 and Certificate no.53123185 for a period of one year covering his family members. During currency of policy, Smt.Shwetha - his daughter was admitted to Manipal Hospital, Bangalore complaining of high fever with chills. She was eventually diagnosed with 'Dengue', but unable to recover from same. She died on 29.07.2016.
3. On account of her death, respondent no.2 filed claim application for insured amount of Rs.10,00,000/- (Rupees Ten Lakh only) on 16.07.2017 (Annexure-E). Same was rejected by petitioner vide letter dated 04.08.2017 (Annexure-G). -3- WP No. 50472 of 2018 Against said rejection, respondent no.2 approached respondent no.1 - Ombudsman.
4. Under impugned award, by referring to decision of National Consumer District Redressal Commission, in Revision Petition no.1270/2016 in case of National Insurance Company Ltd. v/s Mousumi Bhattacharjee, respondent no.1 passed impugned order setting aside rejection of claim application by petitioner and directing it to pay insured sum with interest at rate of 8.5% per annum within 30 days. Aggrieved thereby, this writ petition is filed.
5. It was submitted that very decision relied upon by respondent no.1 - Insurance Ombudsman was reversed in appeal by Hon'ble Supreme Court, in case of Branch Manager, National Insurance Company Ltd. v/s Mousumi Bhattacharjee and Ors., reported in 2019 (5) SCC 391, holding that death due to disease would not fall within insurance coverage, as risk insured was accidental death.
6. It was further submitted that insurance policy at Annexure-A specifically covered risk of only accidental death as clearly mentioned in general terms and conditions of insurance -4- WP No. 50472 of 2018 (copy of which was produced along with memo today). In said conditions, definition of accident would mean "a sudden, unforeseen and involuntary event caused by external, visible and violent means". It also pointed out that said conditions also contained General Exclusions clause, specifically excluding "any pre-existing disability, disease or any complication arising from it", which would mean that risk due to 'disease' was generally excluded from coverage.
7. It was submitted that since death summary report issued by Manipal Hospital clearly indicated that death was due to severe Dengue with multi system organs failure, even if death would be as a result of disease and not accident, therefore repudiation of claim by petitioner was fully justified and interference by respondent no.1 was totally unjustified. Based on said submissions, sought for allowing writ petition.
8. Respondents are served, but unrepresented.
9. On perusal of insurance policy, it is seen that risk covered is specified to death on account of accident. Definition of accident, contained in detailed terms of policy as stated above would include only death in accident due to sudden, -5- WP No. 50472 of 2018 unforeseen and involuntary event caused by external, visible and violent means. But as reason for death in instant case indicated in death summary report issued by Manipal Hospital at Annexure-D, clearly states that death was due to 'Dengue', a disease, it would not be due to accident covered under policy, in view of specific General Exclusions. Therefore, repudiation of claim by petitioner would be justified.
10. That apart, it is seen that very decision referred to by respondent no.1 - Ombdusman, while passing impugned award is reversed by Hon'ble Supreme Court as stated above. As there was no other basis for impugned award, same would be totally unsustainable.
11. In view of above, writ petition is allowed. Impugned order dated 10.08.2018 (Annexure-L) passed by respondent no.1 is quashed. Repudiation of claim application by petitioner is upheld.
Sd/-
JUDGE GRD