| Complaint Case No. CC/75/2024 | | ( Date of Filing : 05 Jun 2024 ) |
| | | | 1. Baba Vikram Patwa | | S/o Late Ram Shankar Patwa, Residing at 48, Burtolla Street, Burrabazar, Kolkata-700007(W.B.), Posta P.S. |
| ...........Complainant(s) | |
| Versus | | 1. Chairman & Managing Director, National Insurance Company Ltd. | | At Premises No. 18-0374, Plot No. CBD-81, New Town, Kolkata-700156, P.S.-New Town P.S., with CIN-U10200WB1906GOI001713, IRDA Registration No.58. | | 2. Deputy General Manager, CRO-I Kolkata | | At National Insurance Building, 8, India Exchange Place, Kolkata-700001, P.S.-Hare Street P.S., With CIN - U10200WB1906GOI001713, IRDA Registration No. 58. | | 3. Senior Divisional Manager, Divisional Office VI under CRO-I | | At National Insurance Building, 8, India Exchange Place, Kolkata-700001, P.S.-Hare Street P.S., With CIN - U10200WB1906GOI001713, IRDA Registration No. 58. | | 4. Ms. Antonet John, Chief Manager | | National Insurance Company Ltd., At Premises No. 18-0374, Plot No. CBD-81, New Town, Kolkata-700156, P.S. - New Town P.S., CIN-U10200WB1906GOI001713, IRDA Registration No. 58. | | 5. Heritage Health TPA Private Ltd. | | Head Office, Fifth Floor, Nicco House, 2, Hare Street, Kolkata-700001, P.S.-Hare Street P.s., CIN-U85195WB1998TC088562, IRDAI License No 008(Valid till 20/03/2026). |
| ............Opp.Party(s) |
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| Final Order / Judgement | Order no. 2 The complainant is present in person. The case is taken up for admission hearing. Perused. Considered. Heard the complainant. The complainant submits that he took the Health Insurance policy of his father (presently deceased) from National Insurance Company Ltd. for the period on and from 20.11.2016 to midnight of 19.11.2017 on payment of premium of Rs.10,279/- (Rupees ten thousand two hundred and seventy nine) only. His father was hospitalized at Marwari Relief Society Hospital on and from 13.08.2017 to 18.08.2017 within the period of policy. Claim was submitted with the opposite parties. Vide letter dated 31.08.2017, the opposite parties repudiated the claim on the grounds that the patient was diagnosed with Hypertrophic Obstructive Cardiomyopathy (HOCM) with LRTI and Hypertension (HOCM) is a genetic disorder and the claim was not admissible under the clause 4.11 of the Mediclaim Policy. Thereafter IRDA issued circular vide reference IRDA/HLT/REG/CIR/046/03/2018 dated 19th March, 2018 in view of the observation made by the Hon’ble High Court, Delhi in M/S United India Insurance Company Ltd. (UIICL) –vs- Jai Parkash Tayal. Thereafter, on 29.02.2024 the complainant requested the opposite parties to settle the claim afresh but the opposite parties vide reply dated 19.03.2024 repudiated the same on the ground of limitation. It is crystal clear that the opposite parties repudiated the claim vide their letter dated 31.08.2017. Thereafter, the complainant lodged a complaint online on 20.04.2024 which was about after 7 (seven) years from the date of repudiation of claim. The Insurance Ombudsman rejected the complaint on the ground of limitation. In view of section 69(1) of the Consumer Protection Act, 2019 the complainant ought to have preferred to file the complaint case within 2 (two) years from the date on which the cause of action has arisen. This complaint application is hopelessly barred by limitation. As such the same is not maintainable in law. Hence, it is O R D E R E D that the complaint case be and the same is dismissed as not maintainable in law. | |
