Al Wakeelo
Your Digital Lawyer, Always on Duty
Initializing Secure Chambers
Your Digital Lawyer, Always on Duty
Initializing Secure Chambers
Official Citation: 2025 IHC 231355
Court / Jurisdiction: Islamabad High Court
Parties: United Insurance Comapany of Pakistan vs President Of Pakistan
Ruling Summary: This decision was rendered by the Islamabad High Court, officially reported as 2025 IHC 231355. In this matter between United Insurance Comapany of Pakistan and President Of Pakistan, the court adjudicated key questions of statutory construction, procedural regularity, and legal precedent under Pakistani law.
Core Holding: The honorable bench evaluated governing statutory provisions and judicial authorities to establish the rights of the parties, delivering the binding reasoning set out below.
COURT: Islamabad High Court (Honourable Mr. Justice Inaam Ameen Minhas) AUTHOR JUDGE: Honourable Mr. Justice Inaam Ameen Minhas DECISION DATE: 16-SEP-2025 CASE NO: Writ Petition-294-2024 CITATION: 2025 IHC 231355 PARTIES: United Insurance Comapany of Pakistan VS President Of Pakistan LAW / SECTION: - SUBJECT: Miscelleneous, Other REMARKS: Petitioner is an Insurance Company. It is aggrieved by orders of the Ombudsman and President wherein upon complaint of a policyholder, who had a policy for travel insurance fell ill but petitioner company failed to cover it and ombudsman ordered reimbursement. Petitioner claims that matter to be one of the domains of tribunal. ============================================================ JUDGMENT SHEET ISLAMABAD HIGH COURT, ISLAMABAD JUDICIAL DEPARTMENT
1. Writ Petition No. 294 of 2024 United Insurance Company of Pakistan Limited Versus President of Pakistan and others
Date of Hearing 24.06.2025
2. Writ Petition No. 2015 of 2023 United Insurance Company of Pakistan Limited Versus President of Pakistan and others
Date of Hearing 24.06.2025
3. Writ Petition No. 605 of 2024 United Insurance Company of Pakistan Limited Versus President of Pakistan and others
Date of Hearing 03.07.2025
Petitioner by: M/s Ali Ibrahim and Barrister Faiza Asad, Advocates.
Respondents No. 1 & 3 by: Mr. Muhammad Saeed Raja, DAG.
Respondents No. 2 by: M/s Anees Jillani and Abid Hassan, Advocates (in W.P No.294/2024). Rana Abdul Hafeez, Advocate (in W.P No.2015/2023). Respondent No.2 in person in W.P No.605/2024.
Assisted by: Muhammad Yahya Khan Niazi and Muhammad Fahad, Advocates.
2 W.Ps No.294/2024, 2015/2023 & 605/2024.
INAAM AMEEN MINHAS, J:- This judgment shall decide the aforementioned writ petitions, as they involve similar questions of law and facts. 2. In all the petitions, the petitioner United Insurance Company of Pakistan Limited (“Insurance Company”) has assailed the orders passed by respondent No.1 i.e. the President of Pakistan and respondent No.3 i.e. Federal Insurance Ombudsman (“FIO”). 3. The facts, in brief, leading to the filing of the W.P. No. 294/2024 are that the Insurance Company issued a travel insurance policy titled “UIC Travel & Health Guard Policy” (“Subject Policy”) to respondent No. 2 (Zarina Jillani) on 06.09.2022, effective from 10.09.2022 to 10.12.2022 for a period of 92 days, providing coverage for medical expenses and hospitalization up to US$50,000. During the currency of the Subject Policy, respondent No. 2, while in Maryland, United States, experienced pain on 24.09.2022, following which she was admitted to Suburban Hospital, Maryland, where various procedures were conducted and she was diagnosed with Acute Cholecystitis, necessitating a cholecystectomy. The surgery was performed on 26.09.2022, resulting in the removal of gallstones and the gallbladder. Subsequently, respondent No.2 contacted Mapfre Asistencia (“Mapfre”) Insurance Company’s partner, as per the Subject Policy, to inform them of her hospitalization and treatment. Mapfre assessed and processed the claim, engaged in correspondence with respondent No.2 and her children, requesting travel details, tickets and medical information, which were provided. Throughout this period, respondent No.2 persistently sought approval of her claim but the Insurance Company decided that as gallstones typically develop gradually over 10 to 20 years, the condition was a pre-existing one under the policy terms and thus the claim was rejected. Following the rejection, respondent No.2 filed a complaint before the FIO alleging maladministration and sought reasonable compensation for the operation and related hospital expenses incurred. The FIO vide impugned order dated 12.07.2023 directed the Insurance Company to pay respondent No.2 USD 7,879/- as reasonable compensation for the amount paid out from her own pocket. Aggrieved by the impugned order of the FIO, the Insurance 3 W.Ps No.294/2024, 2015/2023 & 605/2024.
Company filed a representation under Section 14 of the Federal Ombudsman Institutional Reforms Act, 2013 (“FOIRA, 2013”) before the President, which was rejected vide impugned order dated 08.11.2023 directing the Insurance Company to reimburse the claimed amount of USD 7879/-. 4. The facts, in brief, leading to the filing of W.P. No. 2015 of 2023 are that the Insurance Company issued the Subject Policy, in favour of respondent No. 2 for his father (the insured individual), covering the period from 30.12.2019 to 30.03.2020 with a sum insured of USD 50,000/- for “Medical Expenses & Hospitalization Abroad”. Father of respondent No. 2, while visiting Australia in December 2019 contracted pneumonia and was admitted at Northwest Hospital from 11.01.2020 to 18.01.2020, thereafter he was discharged but was subsequently again admitted at Blacktown Hospital from 04.02.2020 to 17.02.2020. Respondent No. 2’s sister initiated correspondence with the Insurance Company’s partner, Mapfre, seeking indemnification of the medical expenses incurred, whereupon the first claim amounting to AUD 10,117/- was accepted, whereas the second claim of AUD 57,712/- was repudiated on the ground of being attributable to pre- existing medical conditions excluded under the Subject Policy. However, respondent No. 2 persisted in contending that the second admission was a continuation of the first but upon review of the complete record, the Insurance Company maintained its stance that the second claim was not admissible. Thereafter, respondent No. 2 filed a complaint before the FIO, which was decided vide impugned order dated 15.11.2022 directing the Insurance Company to pay the full claimed amount of AUD 57,712/-, where after, being aggrieved, the Insurance Company filed a representation under section 14 of the FOIRA, 2013 before the President, which was dismissed vide impugned order dated 17.04.2023. 5. The facts, stated tersely, leading to the filing of W.P. No. 605 of 2024 are that the Insurance Company issued the Subject Policy, to respondent No. 2, on 23.06.2018 with the coverage period spanning 180 days from 01.07.2018 to 27.12.2018 and a sum insured of US$50,000. Respondent No. 2 traveled to Sudan on 08.09.2018, where he on 15.10.2018 suffered a sudden Transient Ischemic Attack/Stroke while showering in his apartment 4 W.Ps No.294/2024, 2015/2023 & 605/2024.
in Kassala, Sudan. Emergency medical treatment was administered to respondent No.2 at Rama Hospital, Kassala, followed by an urgent medical evacuation via Air Ambulance to Royal Care International Hospital, Khartoum, where he remained hospitalized until 29.10.2018. Subsequently, on the evening of 29.10.2018 respondent No. 2 was evacuated from Khartoum and entered Peshawar, Pakistan on 30.10.2018 via Emirates Airlines. On 02.04.2019, respondent No. 2 visited the Insurance Company’s office in Peshawar, where he submitted insurance documents, premium receipts, a statement regarding the incident, and other claim-related documents. However, vide letter dated 03.05.2019, the Insurance Company informed respondent No. 2 that his claim is time-barred and thus not covered under the Subject Policy. Thereafter respondent No. 2 filed a complaint with the FIO on 31.10.2019. The FIO vide impugned order dated 07.08.2023 directed the Insurance Company to pay respondent No. 2 an amount of US$7,920 and 8,850 Sudanese Pounds. Feeling aggrieved, the Insurance Company filed a representation under section 14 of the FOIRA, 2013 before the President, which was rejected vide impugned order dated 26.12.2023. 6. The learned counsel for the Insurance Company contended that FIO is not vested with the jurisdiction in the present matters, as under section 127 of the Insurance Ordinance, 2000 (“Ordinance, 2000”) the disputes between the Insurance Company and respondent. No.2 (“private respondents”) arose purely from the terms of the Subject Policy and not from any act of maladministration by the Insurance Company. He argued that there exists a fundamental distinction between section 122 and section 127 of the Ordinance, 2000, as these sections provide separate and distinct forums for the redress of insurance related grievances, section 122 of the Ordinance, 2000 empowers the Insurance Tribunal (“Tribunal”) to adjudicate claims filed by a policyholder against an insurance company in respect of or arising out of a policy of insurance, whereas section 127 vests jurisdiction in the FIO to decide complaints by any aggrieved person on allegations of maladministration by an insurance company, the Tribunal. He also argued that these matters involve factual controversy, which require recording of evidence, an exercise that cannot be undertaken by FIO or the President of Pakistan. He further added that the impugned orders passed by 5 W.Ps No.294/2024, 2015/2023 & 605/2024.
the President were not signed by a person qualified under section 14(3) of the FOIRA, 2013 rather by the Director (Legal-I). Lastly, the learned counsel submitted that all the Impugned Orders, are without jurisdiction, non-speaking, arbitrary, rushed and have been passed without affording the Insurance Company a fair opportunity of hearing, in violation of the principles of natural justice and Article 10-A of the Constitution of the Islamic Republic of Pakistan, 1973. 7. Conversely, the learned counsel for the Private Respondents raised a preliminary objection that the Law Officer of the Insurance Company was not duly authorized by the Board of Directors to file these petitions, therefore the same are not maintainable. On merits he submitted that respondent No.2/Zarina Jillani did not suffer from a pre-existing condition as she was never aware of gallstones prior to September 2022 and never experienced symptoms, diagnosis, or treatment for such a condition and that Acute cholecystitis is a sudden, emergency condition. He further submitted that the analogy drawn by the Insurance Company regarding the gradual development of gallstones applies to many acute illnesses and does not justify denial of the claim under the pretext of pre-existing conditions, when none existed or were known, is arbitrary, unreasonable and amounts to maladministration. The learned counsel further submitted that the Insurance Company’s arguments regarding the jurisdiction of the FIO are afterthoughts, as no such objection was raised during the proceedings before the FIO and that there is no factual controversy requiring further evidence or expert testimony, as the medical record from a reputable U.S. hospital is clear and undisputed. He also argued that the Insurance Company’s reliance on the Code of Civil Procedure, 1908 (“CPC”) and Qanun-e-Shahadat Order, 1984 is misplaced, as the FIO’s proceedings are designed to provide expeditious relief to aggrieved policyholders. Lastly, he contended that the impugned orders of the FIO and the President are well-reasoned, address all relevant issues and were passed after affording the Insurance Company ample opportunity to present its case. 8. I have given anxious consideration to the arguments of the learned counsel for the parties and perused the record with their able assistance. 6 W.Ps No.294/2024, 2015/2023 & 605/2024.
9. The question of law involved in all three petitions is the same, i.e., whether the Private Respondents should have made (as they in fact did) complaints for the redress of their grievances to the FIO appointed under section 127 of the Ordinance, 2000 or they should have approached the Tribunal set up under section 121 of the Ordinance, 2000. While considering the background of the petitions and the grounds raised by the parties, the following question of law needs adjudication by this Court:-
Whether the Insurance Ombudsman under section 127 of the Insurance Ordinance, 2000 had jurisdiction to entertain and decide the complaints filed by the Private Respondents?
10. In order to adjudicate the above question, it is essential to examine the legal framework governing the subject matter i.e. the Insurance Ordinance, 2000. Therefore, this Court will first examine, the scope of jurisdiction of the FIO and the Tribunal provided under sections 127 and 122 of the Ordinance, 2000. The relevant portion of these sections are reproduced as under:- “127. Jurisdiction, functions and powers of Insurance Ombudsman.—(1) The Insurance Ombudsman may on a complaint by any aggrieved person undertake any investigation into any allegation of mal-administration on the part of any insurance company: Provided that the Insurance Ombudsman shall not have any jurisdiction to investigate or inquire into any matters which. (a) are within the jurisdiction of the Office of the Wafaqi Mohtasib under the Establishment of the Office of Wafaqi Mohtasib (Ombudsman) Order, 1983, (P.O.1 of 1983); or (b) are sub-judice before a court of competent jurisdiction or tribunal or board in Pakistan on the date of the receipt of a complaint, reference or motion by him. (2) For the purposes of this section “mal- administration” includes— (a) a decision, process, recommendation, act of omission or commission which:- 7 W.Ps No.294/2024, 2015/2023 & 605/2024.
(i) is contrary to law, rules or regulations or is a departure from established practice or procedure, unless it is bona fide and for valid reasons; or (ii) is perverse, arbitrary or unreasonable, unjust, biased, oppressive, or discriminatory; or (iii) is based on irrelevant grounds; or (iv) involves the exercise of powers, or the failure or refusal to do so, for corrupt or improper motives, such as, bribery, jobbery, favoritism, nepotism and administrative excesses; and (b) corruption, nepotism, neglect, inattention, inordinate delay, incompetence, inefficiency and ineptitude in the administration or discharge of duties and responsibilities. (3) Notwithstanding anything contained in sub-section (1), the Insurance Ombudsman shall not accept for investigation any complaint which is brought by or on behalf of an insurance company and which relates to a contract of reinsurance. (4) Notwithstanding anything contained in sub-section (1), the Insurance Ombudsman shall not accept for investigation any complaint by or on behalf of an employee of an insurance company concerning any matters relating to the insurance company in respect of any personal grievance relating to his service therein. (5) For carrying out the objectives of this Ordinance and, in particular for ascertaining the root causes of corrupt practices and injustice, the Insurance Ombudsman may arrange for studies to be made or research to be conducted and may recommend appropriate steps for their eradication.”
“122. Powers of Tribunal.—(1) A Tribunal shall: (a) in the exercise of its civil jurisdiction, have in respect of a claim filed by a policy holder against an insurance company in respect of, or arising out of a policy of insurance, all the powers vested in a civil Court under the Code of Civil Procedure, 1908, (Act V of 1908); (b) in the exercise of its criminal jurisdiction, try the offenses punishable under this Ordinance and shall, for this 8 W.Ps No.294/2024, 2015/2023 & 605/2024.
purpose, have the same powers as are vested in the Court of Sessions under the Code of Criminal Procedure, 1898 (Act V of 1898); (c) exercise and perform such other powers and functions as are, or may be, conferred upon, or assigned to it, by or under this Ordinance; and (d) in all matters with respect to which procedure has not been provided for in this Ordinance, follow the procedure laid down in the Code of Civil Procedure, 1908 (Act V of 1898) or the Code of Criminal Procedure, 1898 (Act V of 1898) as the case may be. (2) The jurisdiction of a Tribunal shall not extend to appeals to which section 33 and section 34 of the SECP Act apply. (3) No Court other than a Tribunal shall have or exercise any jurisdiction with respect to any matter to which the jurisdiction of a Tribunal extends under this Ordinance, including a decision as to the territorial limits and the execution of a decree, order or judgment passed by a Tribunal: Provided that for the purposes of this section a Small Claims Settlement Committee established under section 117 shall not be deemed to be a Court.” 11. A plain reading of the aforementioned sections reveals that the legislature has established two distinct forums with separate yet complementary functions. Section 127 of the Ordinance, 2000 establishes the FIO as an accessible and informal dispute resolution mechanism, primarily focused on addressing complaints of maladministration by insurance companies. Its powers are investigatory and recommendatory in nature, aimed at ensuring administrative fairness through facilitation of mediation and issuance of corrective recommendations. In contrast, section 122 creates the Tribunal as a formal judicial forum vested with exclusive jurisdiction over substantive insurance claims and offences. The Tribunal is empowered with comprehensive adjudicatory powers equivalent to those of civil and criminal Courts under CPC including summoning witnesses, enforcing decrees and trying offences, thereby operating as a binding authority with full Court-like powers. 9 W.Ps No.294/2024, 2015/2023 & 605/2024.
12. Specifically, under section 122 of the Ordinance, 2000 the Tribunal is empowered to adjudicate claims by policyholders against insurance companies in respect of or arising out of insurance contracts. Conversely, section 127 confers jurisdiction on the FIO to entertain complaints from any aggrieved person alleging maladministration by an insurance company. The term “maladministration,” as elaborated in subsection (2) of section 127, encompasses decisions, processes, recommendations, acts, omissions, or commissions that are contrary to law, rules, or regulations; depart from established practice or procedure; or are perverse, arbitrary, unreasonable, unjust, biased, oppressive, or discriminatory. While access to the Tribunal under section 122 requires the complainant to be a policyholder asserting a claim against the insurer, the FIO’s jurisdiction under section 127 is broader, allowing any aggrieved person to lodge a complaint alleging maladministration within the defined parameters. Thus, the Ordinance, 2000 delineates a clear demarcation: the Tribunal functions as a judicial body for substantive insurance claims, whereas the FIO acts as an administrative authority addressing complaints of insurer’s misconduct or unfair administrative practices. This distinction ensures that aggrieved person has access to both judicial remedies for contractual disputes and administrative recourse for grievances related to insurer conduct. 13. The upshot of the above discussion is that the jurisdiction of the FIO is contingent upon the existence of maladministration as defined in section 127(2), which includes decisions, processes, or acts that are contrary to law, rules, or regulations, or that are arbitrary, perverse, unjust, or discriminatory. Therefore, it has to be seen whether the dispute between the parties pertains to an insurance claim, or whether the decision of repudiation of the claim under the Subject Policy amounts to maladministration. It is apparent from the record that admittedly in all three petitions the declaration part of the Subject Policy contains the stipulation “All pre-existing conditions are not covered”, however, it does not define the term “pre-existing conditions”. The terms and conditions of the Subject Policy, which are in fine print contain another exclusion clause i.e. “Any Condition or set of circumstances known to an Insured Person at the time the red Trip was booked (pre- existing conditions)”, on the basis of which the claims of the Private 10 W.Ps No.294/2024, 2015/2023 & 605/2024.
Respondents were repudiated. Thus, what needs to be seen is whether the Insurance Company’s decision of relying on “pre-existing conditions” to reject the claims amounts to maladministration. 14. Since the facts of W.P. No. 294 of 2024 and W.P. No. 2015 of 2023 are substantially similar, this Court shall treat W.P. No. 294 of 2024 as the leading case for the purpose of applying the law to the facts and resolving the common question of law arising in both petitions and address the contention of Complaint being time barred in W.P. No. 605 of 2024 at later stage. In W.P. No. 294 of 2024 the Private Respondent was diagnosed with Acute Cholecystitis (Acute cholecystitis is inflammation of the gallbladder and generally happens when a gallstone blocks the cystic duct) while in the United States, necessitating a cholecystectomy. She received surgery, resulting in the removal of the gallstones and gallbladder. The Insurance Company rejected the claim vide its decision dated 15.12.2022. The relevant portion is reproduced below:- “Kindly note that after reviewing the medical records, we found that Ms. Zarina has a Gallbladder stone and upon reaching the hospital and the necessary procedures that have been done, the treating doctor diagnosed the case with acute calculus Cholecystitis which lead to Ms. Zarina underwent cholecystectomy. The gallstones grow very gradually. It may take 10 to 20 years for gallstones to grow large enough to cause an obstruction. So based on the policy wording and the final diagnosis the case is complications of pre-existed condition (gallbladder) which is not covered under the policy: Quote “Pre-existing disease: the disease that the insured suffered prior to the date of taking out this policy, even if it wasn’t diagnosed.” 15. The above referred decision of the Insurance Company reflects twofold elements of maladministration. Firstly, the terms and conditions of the Subject Policy, which are in fine print contain the exclusion clause i.e. “Any Condition or set of circumstances known to an Insured Person at the time the red Trip was booked (pre-existing conditions)”, whereas the Insurance Company’s rejection of the claim cited a different exclusion clause which included “the diseases that the insured suffered prior to the currency of the Subject Policy, even if it was not diagnosed”. This deliberate 11 W.Ps No.294/2024, 2015/2023 & 605/2024.
use of inconsistent definition and misuse of the vague exclusion clause to deny valid claims is a dishonest act on behalf of the Insurance Company and borders on fraudulent conduct of insurance business, particularly when applied in a blanket manner without regard to individual circumstances. It falls squarely within the statutory ambit of maladministration since the decision is perverse, unjust, unreasonable and oppressive. 16. Secondly, the conclusion drawn by the Insurance Company, regarding the presence of gallstones as a “pre-existing condition” is not only incorrect but also inconsistent with the express language and intent of the Subject Policy. The record reflects that the private respondents’ gallstone condition was asymptomatic and remained undiagnosed, and therefore cannot be retrospectively construed as a pre-existing condition within the contemplation of the exclusion clause. To permit insurers to invoke exclusions on the basis of theoretical disease progression without evidence of prior symptoms, diagnosis, or disclosure would render the concept of “pre-existing condition” so expansive and uncertain that virtually any acute illness could be retroactively excluded. Every individual to whom a travel health insurance policy is offered must, in the natural course of human life, have at some stage suffered from some form of ailment or disease. To interpret such past and undiagnosed ailments in a manner so as to invariably classify them as “pre-existing conditions” and thereby repudiate claims…
Read the unabridged text and precedent citation network on Al Wakeelo Legal Research Platform.