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2017 DIGILAW 782 (CAL)

Life Insurance Corporation of India v. Insurance Ombudsman

2017-09-15

NISHITA MHATRE, TAPABRATA CHAKRABORTY

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JUDGMENT : Tapabrata Chakraborty, J. 1. Life Insurance Corporation of India (hereinafter referred to as LICI) and its Zonal Manager has come up in appeal against an order dated 22nd March, 2017 passed by the learned Single Judge in a writ petition being W.P. No.2299 (W) of 2016. The said writ petition was preferred by the appellants herein challenging awards dated 23rd October, 2015 and 29th October, 2015 passed by the Insurance Ombudsman under the provisions of the Redressal of Public Grievances Rules, 1998 (hereinafter referred to as the said Rules)on complaints preferred by the nominees of a deceased insurance policy holder under LICI. 2. In the said writ petition the learned Judge framed the following issues: (1) Can an insurance company be a person aggrieved by an award passed by the insurance Ombudsman discharging powers under the Redressal of Public Grievances Rules, 1998 ? (2) Is a writ petition maintainable by an insurance company against an award passed the Insurance Ombudsman under the provisions of the Redressal of Public Grievance Rules, 1998 ? (3) Are the subject five insurance policies vitiated due to breach of principles of uberrimafides ? (4) To what reliefs, if any, are the parties entitled to ? 3. After answering the first two issues against the appellants, the learned Judge proceeded to decide the third issue and answered the same also against the appellants and disposed of the fourth issue directing the first appellant to settle the death claim in favour of the nominees of the deceased. 4. Mr. Basu, learned advocate appearing for the appellants submits that the said rules only provide for issuance of recommendation by the Ombudsman through mediation and when such settlement cannot be effected, the Ombudsman may pass an award to cover the loss, if any, suffered by the complainant upon considering the objection of the respective parties. In the instant case there had been suppression of material facts by the policy holder. Even after being satisfied that the policy holder had suppressed the fact of execution and subsistence of earlier policies in the subsequent policies, the learned Judge erred in law in dismissing the writ petition on a purported plea that the burden of suppression stands shifted upon LICI as it was incumbent on its part to ascertain such suppression upon appropriate scrutiny of the policy papers. 5. 5. He further submits that the proviso to Rule 16 (2) provides that compensation by way of any award should be restricted to Rs.20 lakhs (including ex gratia and other expenses) and as a corollary it follows that the said rules would not apply in cases where compensation claimed is more than an amount of Rs.20 lakhs. In computing such compensation the Ombudsman is required to consider the effect of the aggravating and the mitigating circumstances involved in the lis. Such determination of an adversarial claim cannot be immune from judicial review. 6. According to him, no one can possibly fault the LICI for persistently pursuing the matter up to this Court because they are dealing with public money. If they have discovered that such public fund, in a whopping measure, would be knocked off fraudulently through a fake claim, there is full justification for LICI to approach the writ Court. At any rate the learned Single Judge ought not to have refused to consider the grievances of the appellants. 7. Per contra, Mr. Bhattacharyya, learned senior advocate appearing for the respondent nos. 2 and 3 submits that the said Rules have been framed by the Central Government in exercise of the powers conferred by Section 114(1) of the Insurance Act, 1938 (hereinafter referred to as the said Act of 1938) with an object to resolve all complaints relating to settlement of claim on the part of the insurance companies in a cost – effective, efficient and impartial manner. By the said Rules a Governing Body of Insurance Council consisting of LICI, General Insurance Corporation of India its four subsidiaries and other insurance companies has been set up and has been conferred the jurisdiction to appoint one or more persons as Ombudsman for the purpose of the said Rules. Having prescribed such mechanism towards alternative redressal, the insurance companies cannot shirk their obligation to comply with the recommendations and the awards passed by the Ombudsman. 8. He further submits that upon considering the circulars issued towards compliance of decision rendered by the Ombudsman and particularly in view of the fact that the Rules are silent with regard to the right of the insurance company to challenge an award of the Ombudsman, the learned Single Judge has rightly observed that LICI cannot challenge the said award and cannot be a person aggrieved to file a writ petition challenging such award. 9. 9. Heard the learned advocates appearing for the respective parties and considered the materials on record. 10. Under the scheme which has been provided for in the Rules of 1998, the binding character either of a settlement before the Ombudsman under Rule 15 or of an award under Rule 16 emanates from the complainant indicating in writing an acceptance of the recommendation (in the case of a mediation) and of the award in other cases. In the case of an award under Rule 16, if the complainant does not indicate his acceptance as required under Rule 16(5), the award may not be implemented by the insurance company. The words “may not be implemented” do not confer a discretion on the insurance company to implement the award even where the complainant has not indicated an acceptance of the decision. If the complainant accepts the decision, which has been done in the instant case, the insurer has to comply with the award of the Ombudsman as stipulated by Rule 16(6). The binding character of the recommendation or as the case may be, of an award of the Ombudsman arises only when the complainant has accepted the decision. 11. In the present case, there has been a fundamental fallacy in the approach of the appellants to the recommendation of the award of the Ombudsman. Once the nominees of the deceased has unequivocally accepted the award, LICI ought to have treated the said award of the Ombudsman as a binding edict and any attempt on their part to wriggle out of the same would be derogatory to the scheme framed by themselves and would tantamount to procrastination of the statutory mandate. 12. In view of the in-built mechanism provided under the said Rules, the scope of judicial review under Article 226 of Constitution of India, in the considered opinion of this Court, is very limited and unless the findings and conclusions arrived at by the Ombudsman are patently unfair and palpably perverse and suffer from jurisdictional infirmities and violation of the principles of natural justice, the awards passed by the Ombudsman are not amenable to the jurisdiction of this Court under Article 226 of the Constitution of India. In the writ petition there is also no averment supported with cogent and convincing material alleging fraud. In the writ petition there is also no averment supported with cogent and convincing material alleging fraud. The proviso to Rule 16 (2) provides that the Ombudsman shall not award any compensation in excess of which is necessary to cover the loss suffered by the complainants. In the instant case the awards are not in conflict with the said proviso inasmuch as by the awards the orders towards repudiation of the nominees’ claim by LICI have been set aside. 13. The expression aggrieved person denotes an elastic and an elusive concept. It cannot be confined within the bounds of a rigid, exact and comprehensive definition. Its scope and meaning depends on diverse, variable factors such as the content and intent of the statute. Considering the object and purpose of the rules, the alternative dispute redressal mechanism as provided under the said rules and the scope of the words “aggrieved person” in the context of the rules which have been framed on the rudiments of a beneficent scheme, the learned Judge arrived at a correct finding that LICI cannot be a person aggrieved against the award passed by the Insurance Ombudsman. 14. The argument advanced to the effect that LICI is not statutorily bound to implement the award passed by the Ombudsman was rightly discounted by the learned Single Judge placing reliance upon circulars issued in reiteration of the norm that it is not open for the insurer to challenge the award of the Ombudsman. The scheme towards alternative dispute redressal has been devised by the insurers themselves and accordingly they are bound unconditionally to honour such award delivered by the Ombudsman. 15. For the reasons discussed above, we do not find any infirmity in the order impugned in the present appeal. The appeal and the connected application are, accordingly, dismissed. There shall, however, be no order as to costs. Urgent Photostat certified copy of this judgment, if applied for, be given to the parties, as expeditiously as possible, upon compliance with the necessary formalities in this regard. Later Ms. Soma Roy Chowdhury, learned advocate appearing for the appellants prays for stay of operation of the judgment. Such prayer is considered and rejected.