M/S Star Health Allied Insurance Co Ltd vs Insurance Ombudsman, Chandigarh And ...
2026 Latest Caselaw 2779 P&H

Punjab-Haryana High Court

M/S Star Health Allied Insurance Co Ltd vs Insurance Ombudsman, Chandigarh And ... on 20 March, 2026

CWP No. 499 of 2026                 -1-


           IN THE HIGH COURT OF PUNJAB AND HARYANA
                       AT CHANDIGARH


                                               CWP No. 499 of 2026
                                               Date of Decision: 20.03.2026

M/s Star Health & Allied Insurance Co. Limited

                                                                  ....Petitioner

                                       vs.

Insurance Ombudsman and another

                                                                 ....Respondents

CORAM: HON'BLE MR. JUSTICE JAGMOHAN BANSAL

Present:     Mr. Vishal Sharma, Advocate
             for the petitioner



               ***
JAGMOHAN BANSAL, J. (ORAL)

1. The petitioner through instant petition under Article 226/227 of

the Constitution of India is seeking setting aside of award dated 16.12.2025

passed by Insurance Ombudsman, Chandigarh (for short, 'Ombudsman")

whereby it has been directed to pay Mediclaim amount to the respondent. It

is further seeking stay of award.

2. The petitioner is an insurance company from whom respondent

no. 2-Om Parkash Gadi bought Star Group Health Insurance Policy in 2020

for a period of 2 years in the name of M/s Punjab National Bank. He

submitted fresh proposal form and bought a new policy in October' 2022 for

the period from 30.10.2023 to 29.10.2024. The insured-respondent no. 2 was

hospitalised from 17.02.2024 to 22.02.2024 for treatment of Broncho-

Pneumonia/LRTI. He submitted claim of ₹1,26,274/-. The petitioner found

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that respondent No. 2 was suffering from disease (Pulmonary Tuberculosis)

which existed prior to purchasing policy in 2022 and repudiated his claim.

Respondent no.2 approached Ombudsman which vide award dated

16.12.2025 has allowed his claim by treating his policy as a renewal of

policy purchased in 2020. Findings of Insurance Ombudsman read as:-

"Taking into account the facts and circumstances of the case, the documents placed on record and the submissions made by both the parties during the hearing under Rule 17, the forum concludes that:

1. The Complainant was hospitalised due to difficulty in breathing and spikes of fever.

2. That the Insurer rejected the claim of the Complainant stating that the Complainant was found to be a known case of Pulmonary Tuberculosis (PTB) since 2021 invoking Standard Exclusion code 1 of the subject policy which requires a waiting period of 36 months, from inception of first policy, for admissibility of claim related to treatment of pre-existing ailments.

3. That the date of inception of the first policy of the Complainant was 26/10/2020 and as such the clause of waiting period of 36 months is not applicable for the subject hospitalization or claim.

In view of the above, it is evident that the denial of the Complainant's claim by the Insurer is neither justified nor in line with the terms and conditions of the subject policy and the claim thus becomes admissible.

Hence the forum directs the Insurer to pay an amount of Rs 1,17,611/- to the Complainant.

The compliance of this award shall be made within 30 days by the Insurer.

In the event of the Insurer not honouring the award within 30 days, a penalty of Rs. 5000/- per day shall be payable to the

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Complainant by the Insurer for each day of delay as per provision of Master Circular on Protection of Policyholders' Interests, 2024 dated 05-09-2024."

3. A Constitution Bench in Syed Yakoob Vs K.S.

Radhakrishnan, AIR 1964 SC 477 and a two judge bench of the Hon'ble

Supreme Court in Central Council for Research in Ayurvedic Sciences

and another Vs Bikartan Das and others 2023 SCC Online SC 996 have

reminded us that there are two cardinal principles of law governing issuance

of writ of certiorari under Article 226 of the Constitution of India i.e. (i)

High Court does not exercise the powers of Appellate Tribunal. It does not

review or reweigh the evidence upon which the determination of the inferior

tribunal purports to be based. It demolishes the order which it considers to

be without jurisdiction or palpably erroneous but does not substitute its own

views for those of the inferior tribunal. The writ of certiorari can be issued if

an error of law is apparent on the face of the record; (ii) in a given case, even

if some action or order challenged in the writ petition is found to be illegal

and invalid, the High Court while exercising its extraordinary jurisdiction

thereunder can refuse to upset it with a view to doing substantial justice

between the parties. It is perfectly open for the writ court, exercising this

flexible power to pass such orders as public interest dictates & equity

projects. The High Court would be failing in its duty if it does not notice

equitable consideration and mould the final order in exercise of its

extraordinary jurisdiction. Any other approach would render the High Court

a normal court of appeal which it is not.

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4. The Ombudsman treated the policy purchased by respondent

No. 2 in 2022 as renewal of policy purchased in 2020 and directed the

petitioner to pay claimed amount to the respondent. There seems no

manifest factual or legal infirmity in the impugned order warranting

interference.

5. In the backdrop, the petition deserves to be dismissed and

accordingly dismissed.

(JAGMOHAN BANSAL) JUDGE 20.03.2026 paramjit Whether speaking/reasoned: Yes Whether reportable: No

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