1. Ashesh Kumar Bhattacharyya,

                M/s Supreme Legal Services & Tax Consultants,

                NICCO HOUSE,  2^nd Floor,

                2, Hare Street,  Kolkata-1.                                                                  _________ Complainant

____Versus____

1.       M/s Royal Sundaram Alliance Insurance Co. Ltd.         

                Chirakoot Room No.42, 4^th Floor,

                230A, Acharya Jagadish Chandra Bose Road,

                Kolkata-20, P.S. Bhowanipore. 

2.       S.B.I. Credit Cards and Payment Services P Ltd.

Customers Correspondence Unit,

DLF Infinity Towers, Tower ‘C’, 12^th Floor,

Block 2, Building 3, DLF Cyber City,

Gurgaon 122002 (Haryana).                                                                            ________ Opposite Parties

Present :                Sri Sankar Nath Das, Hon’ble President

                          Dr. Subir Kumar Chaudhuri, Member.

                                Smt.  Samiksha Bhattacharya, Member

Order No.   20    Dated   31-07-2015.

          The case of the complainant in short is that complainant had in response to the request over telephone by the telecaller appointed by o.p. no.2 in the year 2009-10 have taken Health Shield Insurance  and Hospital Cash Insurance of o.p. no.1 for the complainant and his wife Smt. Gouri Bhattacharyya, which according to the said telecaller would over the reimbursement of actual expenditure to be incurred for medical treatment in hospital up to Rs.2 lakhs per annum as well as Rs.3000/- per day of such hospitalization.

                The insurance premium have always been collected by o.p. no.1 directly through credit card from o.p. no.2 for the complainant and his wife and the payment for Health Shield Insurance (Master Policy No.HLSBIL0023 & Certificate No. HS00240967000103) and Hospital Cash Insurance (Master Policy No.HCSBIL0015 & Certificate No.CSD0000167000103) for the period 2011-12 was also collected in the same manner from o.p. no.2.

                O.p. no.1 had not issued any policy certificate in respect of year 2009-10 even though the payment of premium for the year 2009-10 was collected from o.p.no.2 on 31.3.09 and as such the claim in respect of Hospitalization of complainant’s wife in the hospital run by Brijlal Hospital & Research Centre at Holdwani in Nainital District of Uttarakhand during 20^th to 24^th Sept. 2009 was sent directly to o.p. no.2 and no payment has been yet released.

                On receipt of the policy certificate complainant had pointed out the defect that even though the certificate for Hospital Cash Insurance (Master Policy No.HCSBIL0015 & Certificate No.CSD0000167000103) was duly issued in the name of both the complainant and his wife, the certificate for Health Shield Insurance (Master Policy No.HLSBIL0023 & Certificate No. HS00240967000103) the name of the complainant has been omitted. Further the title of the complainant was written as “BHATTA’ instead of “BHATTACHARYYA”.

                On receipt of the information of the defect on Mr. Krishnendu  Ghosal, (having mobile no.9836565465), an officer of o.p. no.1 visited the office of the complainant and assured that the defect in the certificate shall be corrected and the outstanding claim for hospitalization and medical treatment of complainant’s wife during 20^th to 24^th Sept. 2009 would also be disbursed. It was further stated that since the incidence of hospitalization was happened in Holdwani of Nainital District in Uttarakhand where there is no local contact office of o.p. no.1 the settlement might take some more time.

Decision with reasons:

                O.p. no.1 had entered itsr appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. Ld. lawyer of o.ps. in the course of argument submitted that the case has got no merit and the same is liable to be dismissed. O.p. no.2 did not contest the case by filing w/v and matter was heard ex parte against o.p. no.2.

                We have gone through the pleadings of the parties, evidence and documents in particular. It appears from the record that the case is not maintainable in view of the claim being barred u/s 24A of C.P. Act, 1986 as the case has been filed by complainant after two years from the date of cause of action. It further appears that complainant’s wife Mrs. Gouri Bhattacharjee was admitted in the hospital on 31.3.09 at Brijlal Hospital and Research Hospital at Nainital and the case has been filed on 31.10.12 and the limitation for such filing expired on 30.10.11. It is further seen from the record that complainant had taken two insurance policies namely one Health Shield Insurance Policy and another Hospital Cash Insurance Policy for the period commencing from 6.4.12 to 5.4.12 covering the insured for a delay benefit of Rs.3000/- for every 24 hours of hospitalization. This covering o.p. has provided cover subject to specific terms and conditions as stipulated in the policy which governs the instant claim. It further appears from the record that complainant never made any claim under both the policies held with o.p. either for hospitalization of the complainant’s wife at the said hospital or complainant’s alleged hospitalization on 20.9.11 at Ms. ILS Hospital and it also transpires from the record that there was no policy in the name of complainant at all.

                In view of the above findings and on careful scrutiny of the entire materials on record we are constrained to hold that complainant has failed to substantiate his case and is not entitled to relief.

                Hence, ordered,            

                That the case is dismissed on contest against o.p. no.1 and ex parte against o.p. no.2 without cost.

                Supply certified copy of this order to the parties free of cost.