The High Court
Case Details
IN THE HIGH COURT OF ORISSA AT CUTTACK WP(C) No. 23710 of 2024 Rabindra Kumar Swain ..... -versus- ..... Bajaj Allianz General Insurance Company Ltd. & Ors. Petitioner Mr. A.C. Lenka, Advocate on behalf of Mr. P.K. Das, Advocate Opposite Parties Mr. K. Bhuyan, Advocate on behalf of Mr. G.P. Dutta, Advocate (Opp. Party Nos. 1, 3, 4 & 5) THE HON'BLE MR. JUSTICE BIRAJA PRASANNA SATAPATHY CORAM:
Decision
ORDER 04.03.2025 Order No. 06 1. This matter is taken up through hybrid mode. 2. Heard Mr. A.C. Lenka, learned counsel appearing for the Petitioner on behalf of Mr. P.K. Das and Mr. K. Bhuyan, learned counsel appearing for Opp. Party Nos. 1, 3, 4 & 5 on behalf of Mr. G.P. Dutta. In spite of due service of notice, no appearance has been made on behalf of Opp. Party No. 2, as found from the tracking report. 3. The present writ petition has been filed inter alia challenging order dtd.09.03.2020 so passed by Opp. Party No. 2 under Annexure-9. Vide the said order complaint made by the Petitioner before Opp. Party No. 2 under Rule 14 of the Insurance Ombudsman Rules, 2017 (in short Rules) under Annexure-8 was rejected. Page 1 of 5. 4. It is the case of the Petitioner that claim of the Petitioner to get the benefit when was repudiated by Opp. Party No. 1 vide letter dtd.14.02.2011 under Annexure-3, Petitioner seeking reconsideration of such repudiation approached opp. Party No. 1 time and again and last such representation was made on 07.11.2019 under Annexure-7. It is contended that when such claim of the Petitioner for reconsideration of the repudiation made under Annexure-7 was not considered, in terms of the provisions contained under Rule 14 of the aforesaid 2017 Rules, Petitioner lodged a complaint before Opp. Party No. 2 on 27.02.2020 under Annexure-8. It is contended that Rule 14 of the Rules prescribes modality to make complaint before Opp. Party No. 2 and the same reads as follows:- “14. Manner in which complaint to be made. (1) Any person who has a grievance against an insurer, may himself or through his legal heirs, nominee or assignee, make a complaint in writing to the Insurance Ombudsman within whose territorial jurisdiction the branch or office of the insurer complained against or the residential address or place of residence of the complainant is located. (2) The complaint shall be in writing, duly signed by the complainant or through his legal heirs, nominee or assignee and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against whom the complaint is made, the facts giving rise to the complaint, supported by documents, the nature and extent of the loss caused to the complainant and the relief sought from the Insurance Ombudsman. (3) No complaint to the Insurance Ombudsman shall lie unless (a) the complainant makes a written representation to the insurer named in the complaint and- (i) either the insurer had rejected the complaint; or Page 2 of 5. (ii) the complainant had not received any reply within a period of one month after the insurer received his representation; or (iii) the complainant is not satisfied with the reply given to him by the insurer. (b) The complaint is made within one year- (i) after the order of the insurer rejecting the representation is received; or (ii) after receipt of decision of the insurer which is not to the satisfaction of the complainant; (iii) after expiry of a period of one month from the date of sending the written representation to the insurer if the insurer named fails to furnish reply to the complainant. (4) The Ombudsman shall be empowered to condone the delay in such cases as he may consider necessary, after calling for objections of the insurer against the proposed condonation and after recording reasons for condoning the delay and in case the delay is condoned, the date of condonation of delay shall be deemed to be the date of filing of the complaint, for further proceedings under these rules. (5) No complaint before the Insurance Ombudsman shall be maintainable on the same subject matter on which proceedings are pending before or disposed of by any court or consumer forum or arbitrator.” 4.1. It is contended that when claim of the Petitioner for reconsideration of the repudiation made before Opp. Party No. 1 time and again and the last such request made on 07.11.2019 under Annexure-7 was not considered, Petitioner in terms of the provisions contained under Rule 14 of the Rules lodged the complaint before Opp. Party No. 2. But on the ground that such complaint is time barred and not maintainable under Rule 14 of the Rules, Opp. Party No. 2 declined to entertain the complaint with passing of the impugned rejection vide order dtd.09.03.2020 under Annexure-9. Page 3 of 5. 4.2. Learned counsel appearing for the Petitioner contended that such an application under Annexure-8 was made before Opp. Party No. 2 in terms of the provisions contained under Rule 14(1) and Petitioner made such complaint with due compliance of the other provisions contained under the said Rules. But Opp. Party No. 2 without proper appreciation of the Rules refused to entertain the complaint with passing of the impugned order on 09.03.2020 under Annexure-9. It is accordingly contended that the impugned order is not sustainable in the eye of law. 5. Mr. K. Bhuyan, learned counsel appearing for the Opp. Parties/Insurer on the other hand while supporting the impugned order contended that since the claim was repudiated way back on 14.02.2011 and Petitioner made the complaint only in the year 2020 vide Annexure-8, the same is not entertainable in view of the provisions contained under Rule 14(3)(b) of the Rules. It is accordingly contended that no illegality or irregularity can be found with such order passed by Opp. Party No. 2. 6. Having heard learned counsel appearing for the Parties and considering the submissions made, this Court finds that claim of the Petitioner to get the benefit of the claim under the policy in question so issued by the Opp. Parties/Insurer was repudiated vide letter dtd.14.02.2011 under Annexure-3. As found, seeking reconsideration of such repudiation, Petitioner made various representations before Opp. Parties-Insurer under Annexure-5 series and the last such representation was made on 07.11.2019 under Annexure-7. As the claim of the Petitioner for reconsideration of the repudiation was not considered with passing of any order, Petitioner made a complaint before Opp. Party No. 2 for redressal Page 4 of 5. of his grievance vide Annexure-8. But Opp. Party No. 2 refused to entertain the complaint so made by the Petitioner under Annexure-8 on the ground that it is time barred and not entertainable under Rule 14. 6.1. This Court after going through the provisions contained under Rule 14 of the Rules, is of the view that complaint made by the Petitioner under Annexure-8 was required to be considered by Opp. Party No. 2 in accordance with law and it could not have been rejected on the ground indicated in the impugned order. Therefore, while quashing order dtd.09.03.2020 so passed by Opp. Party No. 2 under Anexure-9, this Court directs Opp. Party No. 2 to take a lawful decision on the complaint made by the Petitioner under Annexure-8 on merit and by giving due opportunity of hearing to the Petitioner as well as Opp. Parties/Insurer within a period of three (3) months from the date of receipt of this order. 7. The writ petition is disposed of accordingly. Sneha (BIRAJA PRASANNA SATAPATHY) Judge Signature Not Verified Digitally Signed Signed by: SNEHANJALI PARIDA Reason: Authentication Location: High Court of Orissa, Cuttack Date: 08-Mar-2025 12:26:47 Page 5 of 5.