In the Court of the Calcutta District Forum, Unit-I

CDF-1/Case no. 176 / 2005

Sri Amitava Dutta,

391, Sarat Bose Road (Subhas Nagar),

Dum Dum Cantt. P.O. Rabindranagore,

P.S. Dum Dum,   Kolkata-65                                    …...     Complainant

vs.

National Insurance Company  Ltd.,

3, Middleton Street, Kolkata-71  and  others            …... Opposite parties

Present :  Sri A.K. Das,  President

                 Smt. M. Roy,  Member

Order no.   11   dt. 29.03.2007

           The petitioner /complainant has demanded reimbursement of mediclaim of Polly Dutta, amounting Rs. 5139.45 from the o.p. nos.1 and 2 in respect of policy no.100300/46/01/8500107/02/85/30073 dt.31.3.03 on the following back drop.

          It is stated by the petitioner that he deposited the premium in respect of the abovementioned policy on 10.3.03 through o.p. no.3 who in their turn remitted it to insurance company immediately.

          The sister of the petitioner Polly Dutta suddenly fell ill on 18.3.03 and she was sent to Dum Dum Municipal Specialized Hospital. She has undergone operation on 21.3.03 and also on 28.3.03. The petitioner incurred an expenditure of Rs.5139.45 for such treatment. Accordingly, the petitioner submitted the claim to the o.p. nos.1 and 2 on 11.8.03 (annex ‘D’). By letter dt.19.5.04 o.p. insurance company informed that the prayer is not admissible since policy covered granted from 31.3.03, first detection of ailment was on 18.3.03 (annex ‘E’).

          The petitioner informed the insurance company by letter dt.16.7.04 that he tendered premium of above policy on 10.3.03 through o.p. no.3 but insurance company issued the certificate after 21 days from the date of receipt of the amount and the petitioner is not liable for the consequence s and he is entitled to recover the claim amount from the insurance company. The action of the insurance company is arbitrary, illegal and deficient in service. Hence, the petitioner moved to forum for relief.

          O.p. no.3 has appeared and filed written version contending  that they received the premium amount of the above policy on 10.3.03 and sent it to insurance company immediately.

          O.p. nos.1 and 2 received the notices of the consumer complaint but they did not appear nor they filed any w/v denying the claim of the petitioner and o.p.no.3.

          It is undisputed that the petitioner’s sister Polly Dutta is a beneficiary of the policy along with petitioner and others. Petitioner deposited the premium on 10.3.03. Polly Dutta on being ill has undergone treatment in hospital for which an amount Rs.5139.45 was spent and the petitioner submitted a claim to the insurance company and they did not entertain the said claim on the ground the complainant has been suffering from the ailment before commencement of the date of insurance coverage. Policy cover granted from 31.3.03.

          Petitioner has adduced evidence through affidavit.

          It is evident from the record that the petitioner has deposited the premium on 10.3.03. But from the certificate annexure ‘A’ it appears that the policy was issued for the period from 31.3.03 to 30.3.04.

          There is no explanation as to why the beneficiaries of the policy are not entitled to benefit of the coverage from the date when they deposited the premium. There is no material on record from the side of insurance company denying the claim of the petitioner. In that case petitioner has a right to claim reimbursement of the medical expenses incurred during the period from 18.3.03 to 21.3.03. Under the  circumstances, the petitioner is entitled to reimbursement of the expenses incurred by her. Accordingly, the consumer  complaint succeeds and it is awarded in the following terms.

          O.p. nos.1 and 2 are directed to pay to the complainant Rs.5140/- (Rupees five thousand one hundred forty) only along with interest @ 8% p.a. within two months from date. O.p. nos.1 and 2 are also directed to pay to the complainant compensation Rs.1000/- (Rupees one thousand) only and litigation cost Rs.500/- (Rupees five hundrped) only within two months from the date, failing which it will carry an interest @ 8% p.a. till realization.

          Let copy of this order be supplied to the parties free of cost.

        ________________                                                                               ________________

                 Member                                                                                               President