Present         (1)     Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                                         President

                    (2)     Smt. Karishma Mandal,

                              Member

Date of Order : 30.10.2017

                    Smt. Karishma Mandal

1. In the instant case the Complainant has sought for following reliefs against the Opposite party:-

1. To direct the opposite parties to return Rs. 2,00,000/- ( Rs. Two Lack only ) along with 10% interest.
2. To direct the opposite parties to pay Rs. 50,000/- ( Rs. Fifty Thousand only ) as compensation.
3. To direct the opposite parties to pay Rs. 25,000/- ( Rs. Twenty Five Thousand only ) as litigation costs.

2. The facts of this case lies in a narrow compass which is as follows:-

The complainant has asserted that he is a consumer of opposite parties as he has taken insurance policy with opposite parties in the year 2014 and the same has been renewed in the year 2015 for year 2016. The sum assured amount was only Rs. 2,00,000/- as will appear from annexure – 2.

It is further case of the complainant that at the time of selling the insurance, the opposite parties convinced the complainant that there is no waiting period of the policy and policy will cover the entire claim. Thereafter, the opposite parties provided a proposal form to the proposer for filling it and proposer found that the statement of opposite parties were true and thereafter proposal form was signed.

It is further case of the complainant that insurer ( opposite parties ) had not supplied copy of the terms and conditions to the policy holder and has not given opportunity for filing any objection regarding any terms and conditions of the policy in between 02.05.2014 to 20.05.2015. However, during the continuance of the policy the complainant felt some trouble and after investigation the doctor advised him for surgery, the information of which was given to the opposite parties vide annexure – 3. Thereafter the insured filed relevant documents to the opposite parties as will appear from annexure – 4. Thereafter opposite party no. 1 has repudiated the claim of the complainant on the ground “that claim is under waiting period of two years.” Thereafter the matter was referred to opposite party no. 3 who after considering the same has expressed opinion that matter should be considered in accordance with law thereafter opposite party no. 3 wrote a request letter to opposite party no. 2.

From record it appears that on behalf of opposite party no. 1 a vakalatnama was filed on 01.09.2016 but after allowing three opportunities no written statement has been filed and as such this case has been heard ex – parte.

From bare perusal of annexure – 4 it is crystal clear that the complainant has filed claim form before opposite party.

From bare perusal of annexure – 1 which is copy of the letter dated 08.11.2015 ( annexure – 1) it is crystal clear that matter regarding passing final order has been referred to Senior Divisional Manager, New India Assurance Company Ltd., by Devjani Ray V.P. operation for taking final decision. This is clear from content of the letter itself.

However, from perusal of top portion of letter it is mentioned that the claim for the ailment in question falls within two years waiting period specified in the policy and as such the same is not admissible and payable.

However, this may be an objection or opinion of the person concerned but the Senior Divisional Manager has not passed any final order with regard to annexure 0 1. This fact has been mentioned in the ground no. 1 of the complainant himself.

In our opinion as the matter is still under consideration of the opposite parties hence it would not be proper for us to express our opinion with regard to the legality of admissibility of the claim of the complainant at this stage.

However, we direct the opposite parties to pass appropriate final order on the claim application of the complainant within the period of two moths from the date of receipt of this order or certified copy of this order.

The complainant is under liberty to inform the opposite parties about this order with appropriate application.

With the aforementioned decision this complaint stands disposed of.

                                     Member                                                                      President