PRAKASH MEHTA vs THE INSURANCE OMBUDSMAN FOR STATE OF GOA AND MUMBAI METROPOLITAN REGION NAVI MUM. AND THANAND ANR

Judgment text excerpt

Neeta Sawant WP-18745-2024-JR-FC IN THE HIGH COURT OF JUDICATURE AT BOMBAY CIVIL APPELLATE JURISDICTION WRIT PETITION NO.18745 OF 2024 Prakash Mehta ...Petitioner -Versus- 1. The Insurance Ombudsman for State of Goa and Mumbai Metropolitan Region 2. Care Health Insurance Ltd. ...Respondents ______________________________________________________________________ Mr. Akshay Patil with Ms. Girija Balkrishnan, Mr. Jarin Doshi and Ms. Devika Mahadekar i/b. M/s. Malvi Ranchoddas & Co. for the Petitioner. Mr. Rajesh Kanojia with Ms. Deepika Prabhala, Ms. Sangita Upadhyay i/b. M/s. Res Juris for Respondent No.2. _____________________________________________________________________ CORAM: SANDEEP V. MARNE, J. Judgment Reserved on: 5 May 2025. Judgment Pronounced on: 9 May 2025. JUDGMENT : 1) Rule. Rule is made returnable forthwith. With the consent of the learned counsel appearing for parties, the Petition is taken up for final disposal. 2) The Petitioner has filed the present Petition challenging the Award dated 10 June 2024 passed by the Insurance Ombudsman, Page No. 1 of 32 Friday, 9 May 2025 Neeta Sawant WP-18745-2024-JR-FC Mumbai, thereby rejecting the complaint preferred by him, in which he had challenged repudiation of claim by the second Respondent- Insurance Company. The claim of the Petitioner was towards expenditure incurred by him towards medical treatment of Rs.17,77,147/-. 3) Briefly stated, facts of the case are as under:- Petitioner had secured Health Insurance Policy from M/s. Royal Sundaram General Insurance Company Ltd. (Royal Sundaram) having policy cover of Rs.3,00,000/-, which commenced from 3 September 2003. Under the policy, Petitioner and his wife were covered under health insurance. Policy was renewed every year till 2020 and with no-claim bonus, the ins