C.F. CASE No. : CC/2013/65
COMPLAINANT : Angshuman De,
S/o Lt. Harinarayan De,
Vill. Khidirpur, Hattala,
P.O. Bethuadahari,
P.S. Nakashipara,
Dist. Nadia
PIN - 741126
OPPOSITE PARTIES/OPs : 1) Branch Manager,
Star Health and Allied Insurance Company Ltd.
224 AJC Bose Road,
Krishna Building, Room No. 517, 5th Floor,
Kolkata – 700017,
2) Mr. Saikat Singha
S/o Lt. Sudhir Kumar Singha
Agent of Star Health and Allied Insurance Company Ltd.
Intermediary Code, B A 0000115384
Vill. Sahapara, P.O. Bethuadahari,
P.S. Nakashipara, Dist. Nadia, PIN - 741 126
PRESENT : SHRI PRADIP KUMAR BANDYOPADHYAY, PRESIDENT
: SMT REETA ROYCHAUDHURY MALAKAR, MEMBER
: SHRI SHYAMAL KUMAR GHOSH, MEMBER
DATE OF DELIVERY
OF JUDGMENT : 26th May, 2014
: J U D G M E N T :
This is the case under Section 12 of the Consumer Protection Act. The facts of the case to put in a nutshell, are as below:-
The complainant, Angshuman De of Khidirpur Hattala of Bethuadahari, Dist. Nadia filed the case against Branch Manager, Star Health Allied Insurance Company Ltd. & Saikat Singha, the agent thereon. The complainant, Angshuman De was approached by OP No. 2, the authorized agent of OP No. 1 for purchasing a mediclaim policy under Star Health and Allied Insurance Company Ltd. The complainant filled up the proposal form and signed the same and paid Rs. 6,242/- with the OP No. 2, the authorized agent of OP No. 1. The date of commencement of the mediclaim policy on 18.05.12 with premium of Rs. 6,242/-. The insured’s spouse was Bithi De and the child Anubrata De with basic total sum insured is Rs. 3,00,000/-. The policy was valid from 18.05.13 to 17.05.13. Suddenly after purchasing of the policy, Bithi De was attacked with fever. She consulted by Dr. A.K. Basu Mallick and took some medicines. The spouse of the complainant was again attacked with fever on 03.07.12 and was treated by doctor of Apollo Gleneagles Hospital. She was admitted as indoor patient. So the date of admission at Apollo Gleneagles Hospital was 03.07.12 and he was discharged on 09.07.12 (annexure – 3). After admission the complainant informed the OPs. The complainant spent Rs. 54,931.48 for treatment of typhoid fever and hypothyroidism of his wife. The OP No. 1 has repudiated the claim and hence the case with prayer for payment of Rs. 54,931/- and 10% interest thereon along with payment of Rs. 20,000/- for mental agony and harassment of the complainant. The complainant has also prayed for cost of the suit.
Written version was filed by OP No. 2, Mr. Saikat Singha by 15th Jan, 2014 and before that Star Health and Allied Insurance Company Ltd. filed written version on 19.11.13. The sum and substance of the two respondents mentioned above are as under.
The petition is not maintainable being misconceived. It is barred by limitation. Investigator was appointed to investigate into the facts and circumstances of the ill health of the insured, Bithi Dey. The claim was repudiated rightly as she fell ill within 30 days from the day of commencement of the policy. As per exclusion No. 2 of the policy OP No. 1 is not liable to pay the claim. The agent gave the written version only stating that he has no liability. He admitted that he approached the complaint for purchasing the mediclaim policy.
POINTS FOR DECESION
- Point No. 1: Is the complainant a consumer?
- Point No. 2: Has the claim been wrongly repudiated?
- Point No. 3: What relief the complainant is entitled to get?
REASOND DECISIONS
For the purpose of brevity and convenience all the points are taken up together for discussion.
During scrutiny of record we find a written version was submitted on 24.02.14 by the OP No. 1 before this Forum.
Examination-in-chief on behalf of OP No. 1 was filed with affidavit. Nalines Kumar De, an authorized signatory affirmed affidavit along with the written version. We find examination-in-chief on behalf of OP No. 1, Nalines Kr De stated that the patient was suffering from symptomatic two days prior to the that date and thus her fever was continuing till date of admission to the Apollo Gleneagles Hospital. We find no affidavit affirmed on the part of the complainant or his insured patient.
We have heard the argument of ld. Advocates for both sides. Perused the written arguments. We have no evidence of reply of the affidavit evidence filed by Nalines Kr De. This affidavit is dtd. 12.03.14 affirmed before a notary.
Ld. Advocate Sri Raj Kumar Mandal argued for the OPs and Sri Maqbul Rahaman argued for the complainant.
We have meticulously gone through annexure – 1, annexure – 2, annexure – 3, annexure -4 and annexure -5. It is admitted that the complainant is a consumer under the OP No. 1, Star Health Allied Insurance Company Ltd. Annexure -1 gives the clear picture of the policy document and the annexure -2 shows that Bithi Dey was treated for fever for two days on 25.06.12. Medical problem was started on 18.05.12 and 25.06.12 and Bithi Dey was first treated on 05.06.12 for fever. Thus one month’s exclusion does not apply in the instant case as the patient became ill on 25.06.12 and also on 03.07.12. Thus, we hold that the repudiation was bad in law and the repudiation is not supported by exclusion clause. The other annexures mentioned above go to show that the claim of the complainant is genuine and it is not barred by any terms and conditions mentioned in the annexures.
As the repudiation was bad in law the claimant is entitled to get Rs. 54,931/- from the OP No. 1. The complainant is also entitled to get Rs. 1,000/- as cost of the suit with compensation. Hence, all the points are disposed of accordingly.
Hence,
Ordered,
That, the case CC/2013/65 be and the same is decreed on contest. The OP No.1 is directed to pay the complainant of Rs. 54,931/- along with Rs. 1000/- as compensation with litigation cost within one month from this date, in default, the decreetal amount will carry interest @ 9% per from this date till the date of realization of the full amount.
Let a copy of this judgment be delivered to the parties free of cost.
MEMBER MEMBER PRESIDENT
