Introduction
Imagine meticulously paying your health insurance premiums for years, "porting" your policy to a new insurer for better service, and then facing the nightmare of a rejected claim when you need it most. 💔 This is exactly what happened to the family of Mr. Haresh K. Joisar.
In a powerful verdict that champions the rights of the common man, the Bombay High Court has delivered a crushing blow to insurers who try to hide behind technical glitches to deny valid claims. The message is loud and clear: If you accept the premium, you accept the risk! 🚫💸
Brief Case History 📜
The story begins with Mr. Haresh Joisar, who was originally insured with Star Health and Allied Insurance Co. Ltd.. Unfortunately, life threw a curveball, and he was diagnosed with carcinoma (cancer) on his tonsils, for which he underwent chemotherapy in 2021. 🏥
In January 2022, seeking a change, he applied to "port" (transfer) his policy to Care Health Insurance Ltd. The new insurer, Care Health, accepted his application and his premium. But when Mr. Joisar was hospitalized later, and a claim was filed, Care Health repudiated (rejected) it! their reason? They claimed they didn't know about his cancer history. 😲
The Claimant’s Arguments 🗣️
For the policyholder's family, this rejection was a shock. They had followed the rules of "migration" set by the regulator (IRDAI). Their argument was simple yet profound:
"We ported our policy in good faith. My history was already on record with the previous insurer. Migration is supposed to be seamless! Why should we be penalized now?" 🤷♂️
They contended that the new insurer had a duty to check his records before accepting him as a customer. Accepting the policy and the money, only to reject the claim later, felt like a betrayal of trust. 🤝❌
The Respondent’s Defense 🛡️
Care Health Insurance (the Petitioner) took a defensive stance. They didn't deny accepting the policy, but they had a unique excuse: "The System Was Down." 💻📉
They argued that the Insurance Information Bureau (IIB) portal—the official digital platform where insurers share data—was dysfunctional at the time of porting. Because of this technical glitch, they couldn't see Mr. Joisar's medical history. They insisted that the insured should have voluntarily told them everything all over again, invoking the principle of "Utmost Good Faith." 🙏
The Court’s Observations ⚖️
Justice Somasekhar Sundaresan was not impressed by the "glitch" excuse. In a detailed order, the Court dismantled the insurer's defense point by point:
- ⚖️ Portability is Hassle-Free: The Court noted that regulations are designed for "simply moving from one insurer to another without the hassle of opening a new risk assessment all over again." ✨
- 🛑 Eyes Open Acceptance: The Judge remarked that Care Health accepted the porting request with its eyes wide open. If the portal was down, they could have simply rejected the request or asked for more info!
- 🧐 No Excuse for Lack of Diligence: "Having happily accepted the premium, the breakdown in the IIB portal cannot be the reason for excusing Care Health from exercise of diligence."
- ⏳ The 15-Day Rule: The law gives insurers 15 days to decide. If they don't reject it within that time, they are deemed to have accepted it.
Final Judgment and Conclusion 👩⚖️🎉
The High Court DISMISSED Care Health's petition, upholding the Insurance Ombudsman's award in favor of the policyholder! 🏆
This ruling is a massive victory for every policyholder in India. It ensures that insurers cannot treat the "portability" process casually. They must do their homework before taking your money. Once they issue the policy, they cannot turn around and say, "Oops, we didn't know!" 🙅♀️
For Manjula Joisar and her family, this isn't just a legal win; it's a validation of their honesty and a reminder that the law stands firm to protect the common man against corporate negligence. 💪❤️
Case Name: Care Health Insurance Ltd vs. Manjula Haresh Joisar And Anr (Writ Petition No. 9028 of 2024)
Date of Decision: January 23, 2026
Court: High Court of Judicature at Bombay
This article is for informational purposes only and does not constitute legal advice. Please consult a qualified legal professional for advice on specific cases.
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