C.F. CASE No. : CC/11/11
COMPLAINANT : Samiran Saha
S/o Late Satish Chandra Saha,
Vill – Lalpur Natun Para
(Uttarlalpur) P.O. + P.S. Chakdaha,
Dist. Nadia
OPPOSITE PARTIES/OPs: 1) Manager,
M/S Iffco Tokio General Insurance Co. Ltd.
9/1 Metrotowers, 9th Floor,
1. Ho. Chi. Min. Sarani,
Kolkata – 700071.
2) Manager,
Golden Multi Service Club Ltd.
Ranaghat Branch, 12 G.N.P.C. Road
2nd Floor, Laltu Bhattacharjee
Super Market, P.O. + P.S. Ranaghat,
Dist. Nadia
- Manager,
Paramount Health Services Pvt. Ltd.
Icmard Building,
8th Floor, 14/2, CIT Road,
Scheme VIII M. Ultadanga,
Kolkata – 700007
PRESENT : SHRI KANAILAL CHAKRABORTY PRESIDENT
: SHRI SHYAMLAL SUKUL MEMBER
DATE OF DELIVERY
OF JUDGMENT : 09th June, 2011
: J U D G M E N T :
In brief, the case of the complainant is that he purchased a mediclaim policy from the OP No. 1 of which as represented by OP No. 2. OP No. 3 is the administrator to the OP No. 1 and the sum assured was Rs. 20,000/-. This policy was purchased on 15.05.05 which was valid upto 14.05.06 and it was renewed for another year up to 15.05.07. Thereafter, it was further renewed with an enhanced amount of Rs. 50,000/- for the period from 15.05.07 to 14.05.08. It is his further case that his wife Dipa Saha became ill and was examined on 17.06.06 by one Dr. I. Debnath. But she was not cured by his treatment. So finally, she was examined by Dr. G. K. Gupta and Dr. Goutam Khastagir at whose advice she had to undergo operation. During this course of treatment a sum of Rs. 52,441/- was spent. Thereafter, he filed his claim to the Golden Multi Services Club who forwarded it to the OP No. 1 on 03.07.08 and a claim payment cum discharge voucher of M/S Paramount Health Services Pvt. Ltd. for Rs. 20,000/- was settled by them though he claimed the entire amount which he spent for the treatment of his wife. As the TPA did not settle his claim as per his demand, so he gave his concurrence to take the amount of Rs. 20,000/- as settled by the TPA and accordingly sent the signed payment voucher to the agent i.e., OP No. 2. In spite of that receipt of the voucher the OP No. 1 did not settle his claim nor made payment of the said amount to this petitioner. Thereafter, he sent letters to the OP No. 1 & 2 requesting to settle his claim and to make payment, but to no effect. So having no other alternative this case is filed praying for the reliefs as stated in the petition of complaint.
The OP No. 1 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 the complainant originally purchased policy for Rs. 20,000/- on 16.05.05 and subsequently, it was renewed up to 14.05.08 enhancing the amount to Rs. 50,000/-. This OP forwarded the claim to the settlement authority to Paramount Health Services Pvt. Ltd, i.e., OP No. 3 and the OP No. 3 after scrutinizing all the documents filed by the complainant settled it to the amount of Rs. 20,000/- and sent claim payment cum discharge voucher of that amount to the claimant through the OP No. 2 which the complainant received on 03.07.08. But the OP No. 1 did not receive the specific payment voucher within one year duly signed by the petitioner and so OP No. 1 closed the above claim file. So this OP No. 1 has no latches or negligence in not making payment of the settled amount to the complainant. Thereafter the Secretary, Chakdaha Thana Consumer Protection Society sent a letter to the OP No. 1, 2 & 3 on 18.06.10 requesting them to make arrangement for payment of the agreed amount at which the OP No. 3 replied that he was ready to release the said amount but due to delay receipt of the payment voucher the OP could not pay the agreed amount in time which the OP No. 3 is always ready and willing to pay. This delay was caused on the part of the petitioner and the OP No. 2 for sending discharge voucher after more than one year. Hence the complainant has no cause of action to file this case and the same is liable to be dismissed against him.
OP No. 2, Golden Multi Services Club Ltd. has filed a separate written version in this case, inter alia, stating that the case is not maintainable against him as he has no role to play in this regard to settle the claim of the complainant. He is not at all insurer in this case. The complainant purchased the policy from the OP No. 1 through him on 15.05.05 for the first time Rs. 20,000/- which was finally enhanced to Rs. 50,000/- for the period from 15.05.07 to 14.05.08. The complainant submitted all the medical bills along with the claim application to him which he duly forwarded to the OP No. 1 for settlement and the OP No. 1 finally settled it to Rs. 20,000/- on 02.07.08, but the OP No. 3 did not issue the cheque in favour of the complainant in due time. So this OP reminded him again on 08.01.10. So it is the negligence of the OP No. 1 & 3 for not issuing the cheque in favour of the complainant in time who actually settled the claim of the complainant. So this complainant has no cause of action to file this case and the same is liable to be dismissed against him.
OP No. 3 has filed a separate written version in this case, inter alia, stating that he has no role to play in this regard in this case as the claim is to be settled by the OP No. 1 & 2. He has no liability or deficiency in service for delay in making payment. Complainant purchased the policy through the OP No. 2 and he duly forwarded all the claim application and other documents to the OP No. 2 who made delay in making settlement of the claim. Therefore, the complainant has no cause of action to file this case and the same 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 the complaint and the written versions filed by the OPs along with the annexed documents filed by the parties and also after hearing the arguments advanced by the ld. lawyers for all the parties it is available on record that admittedly this complainant purchased one health insurance policy from the OP No. 1 through the OP No. 2 of Rs. 20,000/- on 15.05.05 which was renewed on 15.05.06 and subsequently, on 15.05.07 it was again renewed to the sum assured of Rs. 50,000/-. From the documents filed by the complainant, it is also available that his wife Dipa Saha became ill on 17.06.06 when the policy was covered under the sum assured of Rs. 20,000/-. The treatment of his wife continued up to 18.12.07 and finally she had to undergo operation. All the relevant documents were filed by him in support of his claim. On the basis of the claim submitted by the complainant OP No. 1 & 3 settled it to the amount of Rs. 20,000/- and to that extent payment voucher was sent to the complainant to sign the voucher and it was sent to the complainant on 26.06.08. In this voucher it is clearly stated that in full and final settlement of claim of Rs. 20,000/- and it was signed by the complainant, Samiran Saha. But the fact is that since 26.06.08 till the date of filing in this case the OP No. 1 & 3 did not issue any cheque in favour of the complainant in order to make payment of the said amount. No reason is shown by them why they made delay for about 2 years in making payment. Ld. lawyer for the complainant has submitted at the time of his argument that the complainant is still now ready to accept the settled amount of Rs. 20,000/- and he does not press for his claim of Rs. 50,000/-. Ld. lawyer for the OPs has also submitted in course of argument that OPs are ready to issue a cheque amounting to Rs. 20,000/- in favour of the complainant. Therefore, after hearing the arguments advanced by the ld. lawyers on both sides it is available on record that the complainant is entitled to get Rs. 20,000/- as mediclaim as he singed on the claim payment cum discharge voucher on 26.06.08 in full and final settlement of his claim. At the same time, we do also hold that due to inordinate delay in making payment by the OP No. 1 and 3 the complainant is entitled to get compensation for the harassment caused to him. He has also entitled to get litigation cost. In result the case succeeds.
Hence,
Ordered,
That the case, CC/11/11 be and the same is decreed on contest against the OPs. The complainant is entitled to get Rs. 20,000/- as the insured money + Rs. 5,000/- as compensation along with Rs. 2,000/- as litigation cost, i.e., in total Rs. 27,000/-. The OP No. 1 & 3 are jointly or severally liable to make payment of the decretal amount to the complainant within a period of one month since this date of passing this judgment, in default, the 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.
Let a copy of this judgment be delivered to the parties free of cost.
