Madras High CourtWP(MD)/2503/2023disposed of

Anbarasan. S v. Insurance Ombudsman

2023-02-08Honourable Mr Justice M.Dhandapani6 pages

BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT DATED : 08.02.2023

CORAM

THE HONOURABLE MR.JUSTICE M.DHANDAPANI S.Anbarasan ... Petitioner Vs.

1. Insurance Ombudsman, State of Tamil Nadu and Puducherry, 4th Floor, 453 (Old 312), Anna Salai, Teynampet, Chennai, Tamil Nadu - 600 018.

2. The General Manager, Insurance Regulatory and Development, Authority of India (IRDAI), Consumer Affairs Department, Grievance Redressal Cell, SY.No.115/1, Financial District, Nanakramguda, Gachibowli, Hydrabed - 500 032, Telugana State.

3. The Grievance Redressal Officer, Corporate Grievance Department, Star Health and Allied Insurance Company, MKM Chambers, 5th Floor, No.42, Kodambakkam High Road, Nungambakkam, Chennai - 600 034.

4. Star Health and Allied Insurance Company, Branch Office at No.74, A.D.R. Tower, 1st Floor, Kalavasal, Madurai - 625 016.

... Respondents PRAYER : Petition filed under Article 226 of the Constitution of India praying for issuance of Writ of Mandamus directing the first respondent to issue suitable direction to the fourth respondent to reimburse the medi-claim in favour of the petitioner based upon the petitioner's representation dated 13.12.2021.

For Petitioner :

Mr.S.C.Herold Singh

O R D E R

This Writ Petition has been filed for a direction to the first respondent to issue suitable direction to the fourth respondent to reimburse the medi-claim in favour of the petitioner, based upon the petitioner's representation dated 13.12.2021.

2. The case of the petitioner is that the petitioner was working as a Teacher in De-Britto Higher Secondary School, Ramnagar, Devakottai, Sivagangai District. He had took a Corona Rakshak Policy and paid a sum

of Rs.2,451/- towards premium for the year 2020-2021. Subsequently, the said policy has been renewed by the petitioner on 07.05.2021 by paying the renewal premium to the fourth respondent. Thereafter, the fourth respondent issued a policy certificate for the period from 13.05.2021 to 21.02.2022. Since the petitioner took treatment for COVID-19 and incurred an expenses of Rs.1,02,123/-, (Rupees One Lakh Two Thousand and One Hundred and Twenty Three only), he applied for medical reimbursement to the fourth respondent. But the fourth respondent rejected the petitioner's claim vide order dated 20.07.2021. Aggrieved by the order of rejection, the petitioner has filed an appeal dated 25.07.2021 before the third respondent and the same has not been considered. Hence, the petitioner has submitted a representation on 13.12.2021. But, till date, no order was passed. Therefore, the petitioner has filed the present Writ Petition with the aforesaid prayer.

3. The learned counsel appearing for the petitioner would submit that it would suffice, if the first respondent is directed to consider the representation of the petitioner, dated 13.12.2021, on merits and in accordance with law, within a specified period.

4. Heard the learned counsel appearing for the petitioner and perused the materials placed before this Court.

5. Considering the limited request made by the learned counsel for the petitioner, this Court, without going into the merits of the matter, directs the first respondent to consider the petitioner's representation, dated 13.12.2021 and pass appropriate orders, on merits and in accordance with law, within a period of twelve weeks from the date of receipt of a copy of this order.

6. With the above direction, this Writ Petition is disposed of. No costs.

08.02.2023 NCC: Yes / No Index : Yes / No Speaking Order : Yes / No vji

1. Insurance Ombudsman, State of Tamil Nadu and Puducherry, 4th Floor, 453 (Old 312), Anna Salai, Teynampet, Chennai, Tamil Nadu - 600 018.

3. The Grievance Redressal Officer, Corporate Grievance Department, Star Health and Allied Insurance Company, MKM Chambers, 5th Floor, No.42, Kodambakkam High Road, Nungambakkam, Chennai - 600 034.

4. Star Health and Allied Insurance Company, Branch Office at No.74, A.D.R. Tower, 1st Floor, Kalavasal, Madurai - 625 016.

M.DHANDAPANI,J.

vji 08.02.2023