Bombay High Court

STAR HEALTH AND ALLIED INSURANCE CO LTDversusOFFICE OF INSURANCE OMBUDSMAN AND ANR

Decided: 17 August 2026
Disposal: Disposed Off

Holding

The High Court upheld the Insurance Ombudsman's order reducing the claim, finding the admission and treatment genuine and the objection to high charges insufficient to overturn the order.

Summary

The petitioner, Star Health & Allied Insurance Co Ltd, challenged an order of the Thane Insurance Ombudsman which directed it to pay a reduced claim of Rs.1,00,000 to the respondent (patient) instead of the full claim of Rs.2,18,900. The dispute arose from a discrepancy in the hospital discharge date (19 Feb vs. 18 Feb 2025) and the insurer's contention that hospital charges were excessively high. The Ombudsman, after investigating, found the admission and treatment genuine and reduced the claim based on the alleged high charges. The petitioner argued that the discrepancy warranted total denial of the claim. The High Court held that the admission and treatment were incontrovertible and the Ombudsman's reduction was appropriate, refusing to entertain the petition on the ground of high charges. Consequently, the petition was dismissed.

Issues considered

What is the effect of a discrepancy in hospital discharge dates on the insurer's liability under the policy?
Whether the Insurance Ombudsman's reduction of the claim on the basis of alleged high hospital charges is legally permissible.

Subjects

insurance claim
claim repudiation
discrepancy in discharge date
insurance ombudsman
hospital charges
policy liability

Judgment

                                                                               8-WP-4884-2026.DOC




                                IN THE HIGH COURT OF JUDICATURE AT BOMBAY
                                          CIVIL APPELLATE JURISDICTION


                                        WRIT PETITION NO. 4884 OF 2026


                      Star Health And Allied Insurance Co Ltd                      ..Petitioner
                            Versus
                      Office of Insurance Ombudsman and Anr                   …Respondents

                      Ms. Jagruti Vemula, for the Petitioner.

                                                   CORAM:         N. J. JAMADAR, J.
                                                   DATE :         17th AUGUST 2026


                      ORAL ORDER:

                      1.     Heard the learned Counsel for the Petitioner.

                      2.    The challenge in this Petition is to an order passed by the

                      Insurance Ombudsman Thane, dated 23 rd December 2025, whereby the

                      complaint preferred by Respondent No.2, against the repudiation of the
ARUN
RAMCHANDRA
SANKPAL
                      claim by the Petitioner, came to be allowed and the Petitioner was
Digitally signed by
ARUN RAMCHANDRA
SANKPAL
Date: 2026.08.20
15:00:39 +0530
                      directed to pay a sum of Rs. 1 Lakhs to Respondent No.2.

                      3.    Ms. Jagruti Vemula, the learned Counsel for the Petitioner,

                      submitted that there is discrepancy in the date of discharge. The

                      discharge summary indicates that Respondent No.2 was admitted in the

                      Hospital on 8th February 2025 and was discharged on 19th February



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                                                        8-WP-4884-2026.DOC

2025. However, in the bill issued by the Hospital the date of discharge is

mentioned 18th February 2025.

4.    The Ombudsman was not persuaded to discard the claim of

Respondent No.2 in its entirety on account of the discrepancy in the

date of discharge.

5.    From the perusal of the impugned order, it appears that even the

findings of the investigation caused by the Insurer revealed that the

name of the insured-Respondent No.2 was found recorded under IPD

No. 2186 and UHID No. OHK/6956, with a diagnose of Enteric Fever

and the date of admission was 8th February 2025 and discharge was 19th

February 2025. The Insurer further submitted before the Ombudsman

that the treatment availed by Respondent No.2 appeared to be genuine

but the hospitalisation charges were very high.

6.    In the backdrop of the aforesaid material, the Ombudsman has

taken a correct view of the matter and directed the Insurer to satisfy the

reduced claim of Rs.1,00,000/- as against the claim of Rs.2,18,900/-,

lodged by Respondent No.2.

7.    Having regard to the nature of the grounds raised to repudiate

the claim, and the fact that the admission and treatment as such, of

Respondent No.2 in the Hospital appeared to be rather incontrovertible,

this Court is not inclined to entertain the Petition against an order




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                                                        8-WP-4884-2026.DOC

which factors in the objection of the Petitioner that the treatment

charges were on a higher side.

8.    Thus, the Petition stands dismissed.



                                             [N. J. JAMADAR, J.]




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