SRI M v. SURESH KUIAR

petitron under Article 226 of the Constitution of lndia praying that in the circumstances stated in the affidavit fired therewith, the High court may be pleased to issue a writ, order or Direction, more particurarry, one in the nature of writ of Mandamus, decraring the action of the 4th respondent under their retter dated 03-1'r-202, withhording the amount of Rs. 1,61,321l_ out of the craim preferred by the petitioner under claim dated 21-og-2o22, as illegal, arbitrary, u nconstitution a r, against the principres of naturar lustice, and consequenry direct the respondents 2 to 4 to release the amount of Rs. 'l 61 ,3211- in addition with other amounts like legal expenses, conveyance, pain anl suffering, damages, attendant charges, etc., as fixed by the Hon'ble Court. lA NO: 1 OF 2022 Petition under Section 151 CPC praying that in the c rcumstances stated in the affidavit filed in support of the petition, the High court rniry be pleased to direct the respondents to release the amount of Rs. 1,61,321r- in addition with other amounts like legal expenses, conveyance, pain and suffer n,3, damages, attendant charges, etc., pending disposal of the case, in the interest ,rf lustice. lA NO:'l OF 2025 Petition under section 151 cPC praying that in the circumstances stated in the affidavit filed in support of the petition, the High court rray be pleased to fix an early date for hearing the W.P.No.46423 of 2022 in the intererst of Justice Counsel for the Petitioner: SRI KOTA SUBBA RAO Counsel for the Respondent No.1: SRI M. V. SURESH KUIAR Counsel for the Respondent Nos.2 & 4: -- Counsel for the Respondent No.3: SRI p. SRINIVAS RAO, STANDING COUNS;EL Counsel for the Respondent No.S: GP FOR LAW & & LEC,ISLATIVE AFFAIRS The Court made the following: ORDER HON'BLE SRI JUSTICE NAGESH BHEEMAPAKA WRIT PETITION No. 46423 OF 2o22 ORDER: The case of petitioner is that he is the Member of Telangana Bar Association (TS 1398 of 1988, dated 08-09- 1988) and the Member of Telangana High Court Advocates' Association frorn 2014. It is stated, Telangana High Court Advocates' Welfare Trust provided insurancc coveragc lor accidental death and accidental injuries to the members of High Court Advocates' Association. As such, coverage is providcd to petitioner, his wife Smt. P. Kalyani and son PVS Talpa Pai (Card Numbcrs are 5202419OO474582, 5202419OO47458C and 52024I9OO47458O respectively) and Policy Numbers were valid trom 30-05-2022 to 29-05-2023. It is also stated, insurance covcrage is provided by Respondent , tJnited Inclia M/s lnsurance Co. Ltd. which is under the control of Respondent No.1 - Insurance Regulatory Development Authority (IRDA).

1. 1. As the matter stands so, petitioner's wjfe underwent Hystcrectomy operation on O8-O9-2O22 for which, he incurrcd Rs. 2,57,080/- . However, Respondent insurance Company had paid only Rs. 95,759/- as against the said claim by way of dircct credit to his Account No. 06O41O011035682, Union Bank of 2 - \ India, Vidyanagar Branch, Hyderabad, withorrt giving any reasons for not paying the entire claimed amcunt. It is the bounden duty ot thc Insurer to give reasons mu:h less valid reasons and they cannot choose the amount arbitrarily without giving any opportunity. Hence, petitioner is slzited to have addressed the lnsurance Company on 14-11-202')-, requesting release of balance amount. The Insurance Compaelr gave on line reply saying that amounl was paid towards fi-rll and final settlement; further under letter dated O3- 1 | 2:,022, it was informed that room rent includes nursing charfles, ] % of the sum insured. It is totally absurd to attach the c aim of room rent for the amounts claimed under different heac s.

7.2. According lo petitioner, it is settled law that insured should be cxplained all the terms in detail. I{e therefore, approached the gricvance ccll but they have senL routine reply & dated 17-12 2022 reilerating their stand. R,:spondent Insurance Company in their letter dated O3-lI 2'022 referred the terms of policy u'ithout disclosing them, hen<:e they are not binding on petitioner- The 1st respondent-IRDA which is the controlling authority over all insurance companies, though informed, did not respond. Hence, the Wrir Petitior:..

2. Thc l.tresponclcnt IRDA hled counler stating that thcy were never inlormed about the contract ,tf Insurance i J between Petitioner and Respondents 2 to 4. They have not played any role in any of the transaction entered into between Petitioner and the 2"d Respondent and also in partial settlement of medical claim made between [hem. The onus to resolve the grievance and settle the claim of petitioner as per the terms and conditions of the insurance contract is on Respondents 2 to 4, by virtue of mutual contract between them. II pe titioner is aggrieved by the action of the 2".r Respondent, it is open for him to sue them for dehciency of service cr breach of tcrms and conditions of con tract entered before the Consumer Commissions established under the Consumer protection Act, 20 19; Insurance Ombudsman established under the Insurance Ombudsman Rules, 20 17, etcetera. This Respondent is not involved in partial settlement of the claim. Hence, Lhe present Writ Petition against this Respondent is misconceited and is liable to be dismissed.

3. Based on the averments in the 3.d respondent,s counter, Iearned Standing Counsel Sri p. Srinivas Rao submits that there is no privity of contract between petitioner and Insurance Company as the Insurance policy ,Unio Group Health Insurance Policy' was obtained by Telangana State Advocates Welfare Trust rn hich had taken a group policy for value of Rs.2,00,0O0/- for each member subject to conditions of the iI 1 policy as agreed by the Bar Council' Medsav Hea th Insurance TPA Limited was appointed by responder I No-3 as Administrator.

3. 1. It is submitted that petitioner availed the services of Respondent No.3 claiming that he is a member arrcl beneficiary of the Welfare Trust. Since the Trust agreed for terms and conditions of the policy and being a benehciary o''lrust' terms and conditions of policl' are binding on petition:r' It is also submitted thal petitioner made a claim for reirr bursement of Rs.2,57,08O/ but the sum insured is only Rs' 2lar:s subject to condi[ions. Since, as pcr thc policy conditions petitioner is entitled to Rs.95,757/ only, the same was creditec t-o him based on the calculation made accordingly. When petitioner addressed letter dated O1.12.2022 dcmanding to pay remainirLg amount of Rs. 1,61 ,32 1 / , the 3'd respondent informed throrrfih a detailed letter dated 03.11.2022 ancl e mail dated 17' 12 2oi'2 the details , and calculation and their enlitlement under each head such as room rent and nursing charges, etcetera- 3 .2. Accor<ling to Iearncd Standing Coun ;e l, as per the policy, petitioJrer is entitled for 17o of the surn insured i.e. Rs.2OOO/ pcr day, q'hcreas he opted for betterr room and hospital charged Rs.5,5OO/ per day, as such. pcr his cntitlernent at Rs.2,OO0/- petrtloner was x 11 days : 5 Rs.22,000/-; similarly other heads also, he claimed more arnount for which he is not entitled to. He relied on the judgment of the Hon'ble Supreme Court in National Insurance company v. chief Electoral ofrrcerr and submits thar the terms of the contract musI be construed strictly.

3.3. Learned Standing Counsel also urged that Writ Petition is not maintainable as petitioner is having alternative remedv. Hc rclied in this regard on the judgments of the Hon,ble Supremc Court in LIC of l,tdirr a. Smt. Kiran Sinha2, LIC of Ind.ia u, Asha GoeI3, N. Venkateshuarlu u. United Ind.ia Insurance Co. Ltd.4 I I is submitted that to enforce insurance contract i.e. polic,y, writ would not lie as it involves disputed questions of facr. In this regard, he also relied on the judgments of the Supremc Court in Ch-Narq.simhului o. Untted. India fnsutdnce Co. Ltd.s and j\L Jaga Krishna o. The United Inidq Insurance Co. Ltd.a

4. At this juncture, learned counsel for petitioner Sri Kota Subbarao submits that there is no alternative remedy before the consumer court and the remedy provided under the Consumer Protection Act is an additional remedy and not ' (lo2i) 6 sCC 4.1I '(t986): scc si.i t :oo ti21 scc too ' :ooo1s1 aLo to: '1008(6) Ar-u 350 6 1994 SCC onlrnc n p l0l 6 --\-- ! alternative rt:medy. Policy t'as obtained by the 5 r' respondent for the welfare of the a<ivocates concerned, as sttc:J't, p<:titioner has not directlv hirecl the services, hence thc 'irlurl s under Consumer Protcction Act cannot entertain th': claim of petitioner. The Writ Pctition is therelbre, maintain:rble. Further, he relied on the judgmcnt of the Hon'ble Supremr' (lourl in AIR SC 2021 2774 to submit that alternative remedl s not a bar to entertain the Writ Petition.

5. Lcarned counsel for pe[itioner also rt']r:s ot:' Merry Anne Lamaire u. National Insurance Co.Ltd.? ltnd submrts that writ pe tition is rnaintainablc. Hou'ever, lcitrtrcd Standing Counsel argues that in the said judgment, writ petition was preferred against the order of the Insurance Otnl ,r- <isman, writ is maintainable, as t hcre is no appeal provisio r agilinst the order of Ombudsman, whereas in this case, pctrtlilncr directly approached this Cor-rrt as such Writ P< t l on is not maintainable -

6. Be that as it may, since the policy it st lf is rneant lor the beneht of the advocates like petitioner, resltorrlcnls should act like a model insurer and should not hi rp ttpon the technicalities. Admittcdly, fercts are noL in disputt. Writ Petition is hled onlv uith regard to u'rong calculation. Ev<:n if the t0l7(5) n LI) 5ll 7 calculation of room rent as was done by respondents were to be accepted as true which came to RS.22,OOO /- and that sum insured is only up to Rs.2,OO,OOO/-, this Court, in the facts and circumstances of the case, deems it appropriate to direct the respondent Insurance company to restrict the claim to Rs.2 lacs and grant balance amount, duly taking into consideration room rent at Rs.22,0O0/- only. Since Rs.95,759/- has already been credited to petitioner's account, respondent Insurance Company is directed to pay the balance amount restricting the claim to Rs.2 lacs.

7. costs.

8. The Writ Petition is disposed of accordingly, No Consequently, miscellaneous Applications, if any shall stand closed. SD -AHM S ABDULLAH KHAN TANT REGISTRAR //TRUE COPY// SECTION OFFICER To 1 2 3 4 The Telangana State Advocates Welfare Trust, 8th Floor' Law Department, Seiretariit"euilding, BRK Bhavan, Hyderabad One CC to SRI KOTA SUBBA RAO, Advocate [OPUC] One CC to SRI lvl. V. SURESH KUIVIAR, Advocate IOPUC] One CC to SRI P. SRINIVAS RAO, Standing Counsel IOPUC] Two CCs to GP for Law & Legislative Affairs, High Court for the State of Telangana at Hyderabad. [OUT] t) Two CD Copies I\4P BS HIGH COURT DAT'ED:2911012025 ORDER WP.N,c.46423 ot 2022 1HE sf4 / .-t \ or3. ( ',,i\ t t 2 t ttov P5 a * sA PA HCT eO DISPOSING OF THE IMRIT PETITION WITHOUT COSTS A