In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, Kolkata-700087.

CDF/Unit-I/Case No.   238 / 2011.

1)                   Sri Bhabatosh Banerjee,

Flat no. B-10, Sand Head Co-operative Housing Society Ltd.,

164/78, Lake Gardens, Kolkata-700045.                                                  ---------- Complainant

---Versus---

1)                   Divisional Manager, The New India Assurance Co. Ltd.,

Divisional Office-510600,

18/2, Gariahat Road, Kolkata-700019.                                                     ---------- Opposite Party

Present :           Sri Sankar Nath Das, President.

                        Dr. A. B. Chakraborty, Member

Order No.  8     Dated  13/02/2012

The petition of complaint u/s 12 of the C.P. Act, 1986 has been filed by the complainant Bhabatosh Banerjee against the o.p. New India Assurance Co. Ltd. The case of the complainant in short is that complainant took mediclaim no.510600/34/08/11/00003756/2009 dt.31.12.09 with the o.p. On 15.12.08 the wife of the complainant, 58 years old, was admitted to Woodlands Medical Centre, Kolkata and was diagnosed as chronic lever disease with ascitis. She was discharged on 20.12.08. On 4.3.09 complainant lodged a claim of Rs.55,842.52 through the agent of the company. On 16.4.09 complainant was asked to supply addition al papers and documents which were duly supplied by complainant. It was noted that the agent made some unauthorized changes in the papers and however the agent thereafter conceded their mistake. On 30.12.09 TPA repudiated the claim and this was followed by o.p’s letter dt.31.12.09. Complainant sent legal notice on 14.12.10 and to it o.p. did not respond. Hence the instant case lodged by the complainant with the prayer contained in the prayer portion of the petition of complaint.

            O.p. had entered its appearance in this case by filing w/v and denied all the material allegations labeled against it and prayed for dismissal of the case.

Decision with reasons:

            We have gone through the pleadings of the parties and evidence and documents in particular. It is seen from the record that o.p. repudiated the claim for misrepresentation on the basis of clause 5.1 and perhaps it will be made clear from the letter dt.12.5.09 issued by the agent of o.p. Mr. R. Duttagupta (758/49042) wherefrom it reveals that the said agent wrote a letter to the complainant stating his mistake in the forwarding letter and the other accompanying documents in case replacing the work chronic by acute and the said agent in the said letter admitted that it was done by him due to misconception and the said agent forgot to mention about such change in the document and perhaps that is the reason for repudiation. Besides from the certificate issued by Dr. Kalyan Bose of Woodlands dt. 20.4.09 it clearly reveals that the wife of the complainant was suffering from chronic lever disease and as such we find no reason for repudiation of the claim of the complainant. Besides the very principle of insurance policy is to cover the expenses incurred by incumbent and further it is an admitted position that the insurance commences follows from the date of first premium and mere citing clause of insurance policy will not help such repudiation. That being the position we find no justification for repudiation of claim of the complainant and it amounts to clear deficiency on the part of the o.p. being service provider to its consumer / complainant and complainant is entitled to relief as prayed for.

            Hence, ordered,

            That the petition of complaint is allowed on contest with cost against the o.p. O.p. is directed to pay Rs.55,882.50 (Rupees fifty five thousand eight hundred eighty two and fifty paise) only together with interest @ 9% p.a. from the date of repudiation till the date of realization.  O.p. is further directed to pay compensation of Rs.20,000/- (Rupees twenty thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% p.a. shall accrue over the total sum due to the credit of the complainant till full realization.

            Supply certified copy of this order to the parties.

   _____Sd-_____                                                    _____Sd-______

     MEMBER                                                           PRESIDENT