C.F. CASE No. : CC/11/81
COMPLAINANT : Dipak Kumar Saha,
Bagulathana Hanskhali,
Dist. Nadia
OPPOSITE PARTIES/OPs: 1) Branch Manager,
Bank of India,
Bagula Branch,
P.O. Bagula, Dist. Nadia
- Branch Manager,
National Insurance Co. Ltd.
Krishnagar Branch,
Dist. Nadia
PRESENT : SHRI KANAILAL CHAKRABORTY PRESIDENT
: SHRI SHYAMLAL SUKUL MEMBER
DATE OF DELIVERY
OF JUDGMENT : 25th November, 2011
: J U D G M E N T :
In brief, the case of the complainant is that he purchased one National Swasthya Bima mediclaim policy from the OP No. 2 through the OP No. 1, Bank of India covering himself and his son and its premium was Rs. 1,556/- annually. In 2011 his son Dipjoy became ill and doctor advised for hernia operation at which he had to pay cost of Rs. 9,764/-. Thereafter, he sent a letter to the OP No. 1, Bank of India for sanctioning that amount, but to no effect. He met the OP No. 1, bank authority several times with a request to release the same amount or to settle the claim through the OP No. 2, but to no effect. Thereafter, OP No. 2 intimated him repudiating the claim on the ground that the previous policy ended on 14.04.09 and the present policy started on and from 30.04.09 and as there was a gap of 16 days between the two policies so the present policy was considered as the first year policy. The OP No. 2 also intimated that only 15 days gap was allowed as per rule. On this ground the claim of the complainant was repudiated by the OP as one year was not completed to have the claim amount as per the policy rule. The complainant further submits that he deposited the premium amount before the OP No. 1 within the 15 days of the grace period on 22.04.09. So due to negligence of the OP bank his claim was repudiated by the OP No. 2. Therefore, having no other alternative he has filed this case praying for the reliefs as stated in the petition of complaint.
The OP No. 1, Bank of India, Bagula Branch has contested this case by filing a written version, inter alia, stating that the case is not maintainable in its present form and nature. It is his submission that this bank in collaboration with N.I.CL. started insurance business and this bank is the partner of the insurance business namely National Swasthya Bima. The complainant Sri Dipak Kumar Saha applied for the said mediclaim policy through this bank who is an account holder of the said bank and the bank also granted him a policy. He further submits that the second year insurance premium of the said policy was deducted by this bank within the grace period and this bank deposited the same to N.I.C.L. through his collecting agent within the grace time of the said policy. In spite of that the N.I.C.L. declared the old policy as lapse and opened a new policy in the name of the complainant due to which he is not entitled to get the benefit in the first year of the said policy. He has raised the question if the insurance amount was paid by him after the grace period why he did not refuse to accept the said amount nor the OP No. 2 intimated him or the complainant about opening of a new policy in the name of the complainant without taking his consent also. So it is a gross violation of the MOU executed by and between the OP No. 1 & 2. This bank is not a customer of the OP No. 2. Rather he is a partner of the policy with the OP No. 2 and he has right to receive the insurance amount of the complainant. So the period of limitation date should be calculated from the date of depositing the insurance amount by the complainant to this bank, i.e., 22.04.09. It is the duty of the OP No. 2 to settle the claim of the complainant to pay the mediclaim amount and this OP has not liability to pay the said amount to the complainant. So the complainant has no cause of action to file this case against him. Hence, the case is liable to be dismissed also.
The OP No. 2, National Insurance Co. Ltd. has filed a separate written version in this case, inter alia, stating that the case is not maintainable in its present form and nature. It is his submission that the complainant did not pay the mediclaim insurance amount within due time. So no question of grace period does arise. The policy of the complainant ended on 14.04.09 and the new policy started on and from 30.04.09, so there is a gap of 16 days between the two policies and as per policy rule, no claim amount is to be paid prior to completion of one year. The insurance amount was deducted from the bank amount of the complainant on 22.04.09 which shows delay of 8 days for payment of premium. The OP No. 1 deposited the said premium amount before this OP No. 2 on 30.04.09 and accordingly the OP insurance company gave effect of the insurance policy from midnight of 30.04.09 to midnight of 29.04.10. The delay was caused by both the petitioner and the bank in payment of the insurance amount to the OP No. 2. Therefore, as there is no provision to pay the mediclaim amount during the first year of the policy, so the complainant is not entitled to get any benefit from him and he duly repudiated his claim. Hence, the case is liable to be dismissed against him.
POINTS FOR DECISION
Point No.1: Has the complainant any cause of action to file this case?
Point No.2: Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
Both the points are taken up together for discussion as they are interrelated and for the sake of convenience.
On a careful perusal of the petition of complaint and the written versions filed by the OPs along with the annexed documents filed by both the parties it is available on record that admittedly this complainant purchased one National Swastha Bima mediclaim policy of the OP No. 2 through the OP No. 1 and the said policy was valid up to 14.04.09, the annual premium for the said policy was Rs. 1,556/-. From the documents filed by the complainant, it is available that the premium of the policy from 15.04.09 to 14.04.10 was debited from his bank account by the OP No. 1 on 22.04.09. From the claim repudiation statement dtd. 30.10.09 issued by the OP No. 2, it is available that a gap of 15 days was allowed for payment of the insurance premium to the OP Insurance Co. As the policy ended on 14.04.09, so for renewal the next premium was to be deposited before the OP No. 2 by 29.04.09. But here in this case from the statement of the OP No. 2, we find that the amount was received by him on 30.04.09, i.e., after a gap of 16 days. It is the contention of the OP Insurance Co. as there was a gap of 16 days, so he opened a new policy in the name of the complainant starting on and from 30.04.09 and as per policy rule he repudiated the claim of the complainant as the amount was payable only after completion of first year of policy. The OP No. 1 has agitated that he is the partner of the policy. In his contention it is stated that a MOU was executed by and between the OP No. 1 & OP No. 2. But clause 3 of the MOU it is stated that “The policy will commence from the date of receipt of premium from the Bank Branch.” Here we find that OP Insurance Co. received the premium on 30.04.09 though the OP No. 1 bank claimed that he paid the said amount to the agent of the OP No. 2 prior to that date. But to that extent no document is filed by him, nor he has stated the exact date of payment of the said amount to the agent of the OP No. 2. In the written version he has failed to disclose even the name of the agent and in which manner this payment was done. Practically, the OP No. 1 is silent on this point. But in the written version filed by the OP No. 2, it is his categorical assertion that he received the insurance amount on 30.04.09, i.e., after a lapse of 16 days delay he opened a new policy in the name of the complainant. So considering the facts of this case along with the documentary evidences filed by the parties, we have no other hesitation to hold that the OP bank failed to deposit the insurance amount to the OP No. 2 within the due time, i.e., before 29.04.09. We do also hold that the policy of the complainant was lapsed due to the negligence of the OP No. 1. So it is a gross deficiency in service on his part and due to this the complainant is deprived of having his mediclaim amount of Rs. 9,764/- which he spent for the treatment of his ailing son.
In view of the above discussions, our considered view is that the complainant has become able to prove his case against the OP No. 1, Bank of India who is liable to pay the claim amount to the complainant. As the complainant has become able to prove his case, so the case succeeds.
Hence,
Ordered,
That the case, CC/11/81 be and the same is decreed on contest against the OP No. 1, Bank of India, Bagula Branch. The OP No. 1 is directed to pay the decretal amount of Rs. 9,764/- + Rs. 1,000/- as litigation cost along with Rs. 1,000/- for compensation for harassment caused to complainant, i.e., in total Rs. 11,764/- within a period of one month since this date of passing this judgment, in default, the entire decretal amount will carry interest @10% per annum since this date till the date of realization of the full amount. We make no order against the OP No. 2 in this case.
Let a copy of this judgment be delivered to the parties free of cost.
