The Oriental Insurance Company Ltd. v. The Permanent Lok Adalat (Public Utility Services) Patiala And Others

CWP No.24984-2023(O&M) -1-

IN THE HIGH COURT OF PUNJAB AND HARYANA

AT CHANDIGARH CWP No.24984-2023(O&M) Date of Decision: 05.05.2026 The Oriental Insurance Company Limited ....Petitioner vs.

The Permanent Lok Adalat (Public Utility Services) Patiala and others ....Respondents

CORAM:

HON'BLE MR. JUSTICE JAGMOHAN BANSAL

Present:

Mr. Rajiv Joshi, Advocate for the petitioner Mr. Deepak Aggarwal, Advocate for respondent No. 2 *** JAGMOHAN BANSAL, J. (ORAL) 1.

The petitioner through instant petition under Article 226 of the Constitution of India is seeking setting aside of award dated 20.07.2023 (Annexure P-6) passed by learned Permanent Lok Adalat (Public Utility Services) Patiala (for short "PLA") whereby claim of respondent No. 2 has been allowed.

2.

The respondent-insured purchased an insurance policy from petitioner-insurer. He paid premium of Rs. 6960/-. The sum assured was Rs. 5,00,000/-. The respondent-insured on the basis of policy lodged claim. The petitioner examined the matter and formed an opinion that there was suppression of facts, thus, claim is liable to be repudiated. Accordingly, petitioner rejected his claim. The respondent-insured filed an application under Section 22C of 1987 Act before Ld. PLA which sought response of the

CWP No.24984-2023(O&M) -2petitioner. Matter was tried to be reconciled, however, was finally adjudicated on merits. Ld. PLA has concluded that there was no occasion to repudiate applicant's claim, thus, petitioner has wrongly rejected the same. 3.

Learned counsel for the petitioner submits that respondentinsured was suffering from heart disease. He suffered heard attack in 1994 and got treatment. The disease of respondent-insured fell within the purview of pre-existing disease and as per Clause 4.1 of the Policy, reimbursement is not permissible with respect to pre-existing disease up to 36 months of the Policy. The respondent-insured purchased Policy on 28.05.2016 and suffered heart attack on 29.01.2017 means within 36 months from the date of Policy. In the wake of exclusion clause, the respondent-insured was not entitled to reimbursement of medical expenses. 4.

Learned counsel for respondent No. 2 submits that PLA has considered all these arguments. The respondent-insured suffered heart attack in 1994 and thereafter he lived a healthy life. He was not even taking treatment, thus, heart disease could not be treated as pre-existing disease. 5.

Heard the arguments and perused the record.

6.

    

                

 all the arguments of the parties and passed the impugned award in favour of the respondent-insured. The respondent-insured suffered heart attack in 1994 and thereafter lived a healthy life. He was not even taking treatment, thus, heart disease could not be treated as pre-existing disease. Contention of the petitioner that claim should be rejected on the basis of Clause 4.1 of the Policy is mis-conceived. The petitioner is not claiming that insured was availing treatment druing the currency of Policy or prior

CWP No.24984-2023(O&M) -3thereto. The treatment was availed in 1994 which cannot be contemplated as 'pre-existing disease'. Said Clause cannot be invoked mechanically. Facts of each case should be examined.

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4# In the wake of above discussion and aforecited judgment of Hon'ble Supreme Court, this Court does not find it appropriate to invoke its extra-ordinary writ jurisdiction.

11.

Dismissed.

12.

Pending Misc. application(s), if any, shall stand disposed of. (JAGMOHAN BANSAL) JUDGE 05.05.2026 paramjit Whether speaking/reasoned: Yes Whether reportable:

Yes