1. Sujay Bhattacharya,

                Flat No. 503, 94, Manik Bandopadhaya Sarani, Kolkata-700040.                            _________ Complainant

____Versus____

1. National Insurance Co. Ltd.,

Represented through the Director,

3, Middleton Street, Kolkata-700071.

1. The Divisional Manager, National Insurance Co. Ltd.,

Division-VII, Brooke House, 4^th Floor,

9, Shakespeare Sarani, Kolkata-700071.

1. Bank of Baroda,

Represented through its Chairman,

Suraj Plaza-1, Sayaji Ganj, Baroda-390005.

1. Bank of Baroda through its Chairman,

Kolkata Metro Region, Through its Deputy General Manager,

Kolkata Regional Office, Baroda Tower, 4^th Floor,

GN Block, Plot-38/2, Salt Lake, Sector-V, Kolkata-700091

1. Senior Branch Manager, Bank of Baroda,

Chakraberia Branch, 23/3, Chakraberia Road (S), Kolkata-700025.       ________ Opposite Parties

Present :                Sri Sankar Nath Das, President.

                                Dr. Subir Kumar Chaudhuri, Member.

                                Smt.  Samiksha Bhattacharya, Member

Order No.   26    Dated  31-01-2014.

            The case of the complainant in short is that complainant had taken a mediclaim policy in the year 2003-2004 and the same was continuing for more than 7 years i.e. till 2011-2012 under National Insurance Co. (o.ps. 1 and 2) for himself and his wife Smt. Uma Bhattacharya and daughter Miss Soumi Bhattacharya. He had paid the premium regularly to o.p. nos.1 to 5 in due time. At the time of renewal of the said mediclaim policy for the year 2007-2008 the complainant renewed the said policy through the corporate agent of o.p. nos.1 and 2 i.e. Bank of Baroda, Chakraberia Branch, Kolkata-25 under ‘Baroda Health’. Since then he used to renew the said policy through the said corporate agent of o.p. nos.1 and 2 till 2011. Accordingly, each and every time o.p. nos.1 and 2 issued valid policy certificate to the complainant except in the years 2009-2010 and 2011-2012. At the time of renewal of the policy for the year 2009-2010 the complainant paid the annual premium through o.p. no.5. By his letter dt.4.11.09 the complainant instructed o.p. no.5 to deduct the premium amount from his S.B. A/C being no.21840100000687 lying with o.p. no.5. The said letter was received by o.p. no.5 on the same date. Previous policy would be expired on 14.11.09. O.p. no.5 deducted the premium amount on 13.11.09, but after expiry of one month no policy certificate was issued to the complainant by o.p. nos.1 and 2. In the last week of Dec 2009 complainant visited the office of o.p. no.5. As per advice of o.p. no.5 complainant sent a letter to o.p. nos.1 and 2 on 5.1.10. But no step was taken by o.p. nos.1 and 2 in this regard. In the 2^nd week of January 2010 one Mr. Sidharta Dey of o.p. nos.1 and 2 verbally informed the complainant that they have not received the said premium. Thereafter complainant immediately met with o.p. no.5 and requested them to look after the matter. O.p. no.5 requested the complainant to sign a new form such that a new health policy to be issued by the said insurance company. Complainant strongly objected the same but as per assurance given by o.p. no.5 complainant signed a new form without furnishing any documents required for new policy. On the basis of the same a policy certificate being no.100700 / 48 / 09 / 8500004549 for the period from 21.1.10 to 20.1.11 was issued by o.p. nos.1 and 2. Thereafter on 3.6.10 complainant’s wife admitted to M/s. Mohan Clinic under the treatment of Dr. Shibaji Chowdhury, Orthopedic Specialist. Complainant informed the said clinic about the said mediclaim and cashless benefits. A claim was lodged against the said health policy before Genins India TPA Ltd., 19, R.N. Mukherjee Road, Kolkata-1. But TPA had repudiated the claim on the ground that the policy was new one and the diseased was pre-existing. Complainant incurred a total expense of Rs.30,000/- including hospitalization and post hospitalization treatment of his wife’s treatment. But o.p. nos.1 and 2 repudiated his claim. The complainant being aggrieved for the grounds of repudiation wrote a letter to o.p. no.5 on 7.6.10 and requested to look after the matter. Several reminder letters were sent to o.p. nos.1 to 5 and those letters were duly received by them. But no step has been taken by o.ps. Subsequently on 19.1.11 complainant renewed his existing policy well ahead of due date and time. Complainant has been harassed without any fault of him. Thereafter complainant sent advocate’s letter on 3.3.11 to settle the legitimate claim of the complainant, but in vain. Therefore the instant application was filed by complainant praying for an order directing o.p. nos.1 to 5 to treat complainant’s mediclaim policy being no.100700 / 48 / 09 / 8500004549 for the year 2010-2011 as a continuous policy, to give all the benefits and facilities of the aforesaid health policy, to withdraw the letter of repudiation and to reimburse Rs.30,000/- for his wife’s treatment along with compensation and cost.   

                O.p.s no. 1 & 2 o.p.s no. 3, 4, 5 file separate written versions.

                In their written version o.p.s 1 & 2 denied all material allegations interalia stated that complainant’s Boroda health policy no. 100300/48 /08/8500003124 has expired on 14/11/2009 and complainant failed to reimburse the premium amount well in advance to o.p. no. – 1’s divisional office III who is not party in the instant case and complainant took another health policy being no. 100700/448/09/8500004549for the period 21/01/2010 to 20/01/2011 and the reputation was made due to preexisting disease as the policy was started on 21/01/2010. Therefore the case is liable to be dismissed.

                O.p. no. 3 to 5 also denied all allegations against them. The policy of the complainant was supposed to be expired on 14/11/2009 and o.p. bank sent the Banker’s cheque no. 707558 dated 13/11/2009 of Rs. 7079/- in favour of National Insurance co. ltd. as renewal premium of the policy. As per instruction given by the complainant o.p. Bank [ o.p. – 5 ]  issued the cheque in favour of o.p.s 1 & 2 on 13/11/2009 whereas the policy in question was supposed to be expired on 14/11/2009. So o.p. bank discharged their function duly & properly. They have not committed any negligence. So complainant’s claim against o.p.s 3 to 5 cannot sustain. So the case should be dismissed against o.p.s 3 to 5.

                Decision with reasons:

                We have gone through the pleadings of the parties, evidence and documents in particular.

                It is admitted fact that complainant took Baroda Health Policy in 2003 & 2004 and his policy was continuing through the corporate agent of o.p. no. 2, i.e. Bank of Baroda till 2011. Accordingly each and every time o.p.s no. 1 & 2 issued proper policy certificates to the complainant except 2009 – 2010 & 2011 – 2012. The policy was continuing till 2011 but the complainant did not receive the policy certificate for the years 2009/10 and 2011 – 2012. The said policy being no. 100300/48/08/85500003124 for the period 2008 – 2009 was expired on 14/11/2009. Accordingly, the complainant instructed o.p. no.  5 to deduct his premium amount of Rs. 7079/- from his SB Account no. 21840100000687 lying with o.p. no. – 5. Accordingly, o.p. no.  5 sent the amount to o.p.s no. 1 & 2. We have observed from the bank statement of the complainant that the amount was debited on 13/11/2009 for the aforesaid policy. O.ps nos. 1 & 2 did not give any reasonable explanation why the policy was not continued for the next year and henceforth. O.p. nos. 1 & 2 did not file any scrap of paper which shows that they have not received the aforesaid premium amount for the said policy before 14/11/2009. So the present policy of the complainant is a continuous policy. As the policy was running for so many years no question of pre-existing disease of complainant’s wife arises. It is not possible for the complainant that the policy would be under which division of o.p. nos.1 and 2. So, the policy in question is no way can be termed as discontinued one. So there is clear deficiency in service on the part o.p.s 1 & 2 and for that reason complainant is entitled to get relief as prayed for.

                Hence, ordered,

                That the case is allowed on contest against o.p. nos. 1 & 2 with cost and dismissed against o.p. nos.3, 4, & 5 without cost. O.p. nos. 1 & 2 are directed to treat the complainant’s policy being no.100700/48/09/8500004549 ( previously 100300/48/08/8500003124 ) as continuing policy. O.p.  nos.1 & 2 are jointly and/or severally directed to reimburse Rs. 30000/- (Rupees thirty thousand) only for treatment of the complainant’s wife and are also directed to pay to the complainant compensation of Rs.10,000/- (Rupees ten 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 @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.