Bablu Dey v. The Union of India and 5 Ors

O R D E R

18.07.2023 The case of the petitioner herein is that the petitioner opened a critical care policy from the ICICI Lombard General Insurance Company Ltd. The said policy was valid for the period from 28.03.2012 to

27.03.2013. It has been stated in the petition that all the material information was supplied at the time of taking the policy.

¶2It has been alleged in the writ petition that while the policy was in force, the petitioner suffered CVA (Ischemic) in right side Hemisparesis on

04.10.2012. The petitioner took treatment at Jorhat initially and thereupon Page No.# 3/4 the petitioner was admitted at Assam Medical College on 06.10.2012. The petitioner, thereupon, continued to undergo treatment at Assam Medical College till 09.10.2012. Thereupon, the petitioner lodged a claim before the Manager P.A. Claims/respondent No.4 for Rs.6 lakh being claim No.GEN 000075681. The said claim was repudiated by the respondent ICICI Lombard Insurance Company Ltd. on the ground of concealing preexisting disease. The petitioner being aggrieved approached the Insurance Ombudsman. However, the Insurance Ombudsman vide an order 01.11.2013 observed that the petitioner suppressed the materials information regarding his illness at the time of filling his proposal form and as such was guilty of non-disclosure of material facts and thereby violated the principle of contract of insurance by not maintaining utmost good faith. It is under such circumstances that the Insurance Ombudsman held that the insurer had rightly repudiated the claim of the above policy and no interference was called for.

¶3It is against the said order dated 01.11.2013 that the instant writ petition has been filed for setting aside the order dated 01.11.2013 and for a direction upon the Insurance Company to pay an amount of Rs.6 lakh as compensation to the petitioner.

¶4It appears from the record that the Insurance Company, i.e. the respondent Nos.3, 4, 5 & 6 have jointly filed an affidavit stating inter-alia that the writ petition involves disputed question of facts, and as such, the same cannot be adjudicated by way of a proceedings under Article 226 of the Constitution. It has also been mentioned that the insurance claim was rightly repudiated in view of the suppression of preexisting disease. It further appears that the respondent No.2 had also filed an affidavit Page No.# 4/4 supporting the decision dated 01.11.2013.

¶5A perusal of the materials on record, therefore, reveals that the question as to whether the petitioner had disclosed the preexisting disease at the time of filling up the proposal form is a question of fact or for that matter as to whether the petitioner had a preexisting disease at the time of taking critical care insurance policy is also a pure question of fact. These aspects of the matter cannot be adjudicated by way of a writ petition, and accordingly, this Court is of the opinion that the instant writ petition cannot be entertained. However, this Court is also of the opinion that if the petitioner is aggrieved, the petitioner can very well approach the Consumer Forum or the Civil Court claiming entitlement on the basis of the said policy wherein the facts could be adjudicated on the basis of the evidence.

¶6In view of the above, this Court is not inclined to entertain the instant writ petitioner, and accordingly, the instant writ petition stands dismissed.

¶7However, liberty is given to the petitioner to approach the appropriate forum and in the event of approaching the appropriate forum, the period during which the instant writ petition was pending, i.e. from

22.09.2014 till date, shall be excluded while computing the period of limitation by the concerned forum.

JUDGE Comparing Assistant

PageoNo.#o1/4 GAHC010127302014 ooooooo ooooooooooooooo ooooooooooooooooTHEoGAUHATIoHIGHoCOURTo (HIGHoCOURToOFoASSAM,oNAGALAND,oMIZORAMoANDoARUNACHALoPRADESH)o CaseoNo.o:oWP(C)/5124/2014o BABLUoDEYo S/OoLT.oNARAYANoDEY,oDAILYoBAZAARoROAD,oW/NO.2,oNEARoSHIVo MANDIR,oP.O.oandoP.S.oDERGAON,oDIST-oGOLAGHAT,oASSAM,oPIN-785614 VERSUSo THEoUNIONoOFoINDIAoando5oORSo MINISTRYoOFoFINANCEoDEPTT.oOFoECONOMICoAFFAIRSoINSURANCEo DIVISION,oREP.oBYoITSoSECY.,oNEWoDELHI,oGOVT.oOFoINDIA 2:INSURANCEoOMBUDSMAN oGUWAHATIoCENTRE oO/OoTHEoINSURANCEoOMBUDSMAN oJEEVANoNIVESH o5THoFLOOR oSoSoROAD oPANBAZAR oGHY-01oASSAM 3:ICICIoLOMBARDoGENERALoINSURANCEoCO.oLTD. oICICIoBANKoTOWERS oBANDAoKURLAoCOMPLEX oMUMBAI-81 oINDIA oREP.oBYoTHEoDIVISIONALoMANAGER 4:ICICIoLOMBARDoGENERALoINSURANCEoCO.oLTD. oMAYURoGARDEN oABCoBUSoSTOP oG.S.oROAD oGHY-5 5:THEoMANAGER Page No.# 2/4 P.A. CLAIMS SMS CLAIMS IL HEALTH CARE ICICI LOMBARD GENERAL INSURANCE CO. LTD. ICICI BANK TOWER PLOT NO.12 FINANCIAL DISTRICT NARAKRAMGUDA GACHIBOUL HYDERABAD-32 6:THE MANAGER HEALTH CARE ICICI LOMBARD GENERAL INSURANCE CO. LTD. ICICI INTERFACE BUILDING NO.11 401/402 4TH FLOOR NEW LINK ROAD MALAD W MUMBAI-6 Advocate for the Petitioner : MR.T C CHUTIA Advocate for the Respondent : MR.R GOSWAMI BEFORE HON'BLE MR. JUSTICE DEVASHIS BARUAH