TaxTMI 
TaxTMI 
2010 (9) TMI 214
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....-2004 and 26-4-2005 of the Insurance Ombudsman by accepting the requisite premium for the period 30-7-2003 to 14-4-2004 on pro rata basis from the Petitioner and process the claim in respect of the medical expenses incurred by him during that period, and pay him the admissible claim amounts. 2. The facts leading to the filing of this petition are that on 30-7-1999 the Petitioner took a mediclaim policy from National Insurance Company Ltd. ('NICL'). This policy was regularly renewed till 29-7-2002. Thereafter, the Petitioner switched over to Respondent No.1. The policy was to expire on 28-7-2003 and on 10-7-2003 the Petitioner deposited a cheque of Rs. 10,129 with Respondent No.1 for renewal of his mediclaim policy. It may be mentioned th....
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....for not renewing the mediclaim policy of the complainant had been summarized. 6. The first reason given by Respondent No.1 was that in the very first year itself the Petitioner had made five claims and, therefore, had taken a policy 'only with a view to making claims.' This was rejected by the Insurance Ombudsman by pointing out that during the previous years the Petitioner had a policy with the NICL i.e. from 30-7-1999 till 29-7-2002. He had made no claim and in fact had earned a cumulative bonus of 15%. The second reason was that the Petitioner had concealed material facts in his proposal form that he was suffering from hypertension and bronchitis. This was also rejected by the Insurance Ombudsman. It was noticed that in a covering let....
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....ny has not valid reason at all for refusing to renew the Mediclaim policy of the complainant." Consequently, the directions as set out in para 4 above were issued by the Insurance Ombudsman. 8. It is not in dispute that Respondent No.1 accepted the above Award dated 18-3-2004 of Insurance Ombudsman. However, the Petitioner's policy was renewed from 15-4-2004 to 14-4-2005. The Petitioner then wrote to Respondent No.1 on 24-4-2004 pointing out that this failure to renew the policy from 30-7-2003 onwards may have been because of an inadvertent error and that the necessary endorsement should be made on the renewed policy. He followed this by reminders on 28-4-2004 and 12-5-2004. When there was no response, he was compelled to again approa....
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.... policy for the period 30-7-2003 to 14-4-2004'. This was followed by several letters to which no reply was received. Thereafter the present petition was filed. 13. During the pendency of this writ petition, the Petitioner expired and his legal representatives were brought on record by an order dated 11-2-2008. 14. The submissions of Mr. Salil Paul, learned counsel for Respondent No. 1 have been heard. He submitted first that although Respondent No. 1 had not challenged the Award dated 18-3-2004 or subsequent directions dated 26-4-2005 of the Insurance Ombudsman, Respondent No.1 had in fact partly implemented the said Award by renewing the mediclaim policy from 15-4-2004 to 14-4-2005. When asked why the policy was not renewed with effe....
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....e companies to challenge such Award to the Insurance Ombudsman. The mechanism of an adjudication by the Insurance Ombudsman is an alternative dispute redressal mechanism envisaged in the RPG Rules, 1998. Therefore, a claimant under a policy has to necessarily go before the Insurance Ombudsman in the first place for redressal. The insurance companies have themselves devised this dispute redressal mechanism. They have also bound themselves unconditionally to honour such Award of such Insurance Ombudsman. It is too late in the day for Respondent No.1 to seek to wriggle out of the Awards dated 18-3-2004 and 26-4-2005 of the Insurance Ombudsman on any ground whatsoever. The decision in B. Krishna Bhat's case (supra) was in a different set of fac....