In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 402 / 2007 1) Sri Dilip Kumar Senapati, 46/1/1,Kaibartapara Lane, Salkia, Howrah-700006. ---------- Complainant ---Verses--- 1) National Insurance Co. Ltd. 1, Shakespeare Sarani, Kolkata-71. 2) Golden Trust Financial Service, S.B. Mansion, 16, R.N. Mukherjee Road, Kolkata-700001. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattachatya, Member. Order No. 1 8 Dated 0 3 / 1 2 / 2 0 0 9 . Complainant Sri Dilip Kr. Senapati by filing a petition u/s 12 of the C.P. Act on 17.12.07 has prayed for issuing direction upon the o.ps. viz. National Insurance Co. Ltd. o.p. no.1 and Golden Trust Financial Services o.p. no.2 to pay a sum of Rs.24580.30 along with interest and incidental cost and for any other order as the forum may deem fit and proper. It is the specific case of the complainant that he availed a Group Mediclaim Policy being certificate no.103040243029 with the o.p. no.1 and the policy was renewed by him from 8.7.01 to 7.7.02, 8.7.02 to 7.7.03, 8.7.03 to 7.7.04, 8.7.04 to 7.7.05 without any delay or lapses. The complainant himself and his wife Manju Senapati are the insured persons and they are accordingly entitled to receive reimbursement of medical expenses. Further case of the complainant that his wife was admitted to nursing home for her gall bladder operation and she was admitted on 20.8.03 at Microlab and was discharged from the nursing home on 24.8.03. The petitioner made several attempts for reimbursement of the claim for the medical treatment of his wife and he also made several correspondence with the o.ps. But ultimately on 5.2.06 he was informed by o.p. no.1 that the petitioner is not entitled to have any claim due to violation of conditions no.5.3 and 5.4. But no such condition has been mentioned in 5.3 and 5.4 in the policy certificate. The petitioner filed this case before the Consumer Disputes Redressal Forum, Howrah and on the point of lack of territorial jurisdiction the case was dismissed with a liberty to file the petition of complaint at the appropriate forum and finding no other alternative the petitioner has filed this case against the o.ps. It appears on perusal of the record that even in spite of receipt of notice the o.p. no.1 did not appear but o.p. no.2 appeared and filed their w/v. So, the case is heard ex parte against o.p. no.1 and contested against o.p. no.2. O.p. no.2 has contested this case by filing a w/v stating therein that o.p. no.1 has authorized o.p. no.2 for providing mediclaim policy to the members of o.p. no.2. They have admitted the claim of he petitioner and they have stated that the same was insured for Rs.1 lakh for the petitioner and Rs.30000/- for his wife and those policies were obtained through o.p. no.2 as member. O.p. no.2 has also stated that on receipt of the intimation the papers was submitted by the complainant, but it was found inadequate and insufficient at the initial stage. Further, on their demand additional and adequate papers/documents were filed by the complainant. They have also stated that the provisions 5.3 and 5.4 are absolutely fallacious and erroneous because no such conditions were incorporated in the insurance certificate nor any such intimation had ever been forwarded to the insured persons and if there be any such conditions the sole responsibility lies with o.p. no.1 to intimate the same to the insured person which they did not. Decision with reasons : The main points to be decided in this case are that whether the petitioner is entitled to get the relief as prayed for. At the very outset of our discussion we must point it out that o.p. no.2 has practically supported the claim of the complainant and repudiated/denied the allegations and contentions of the o.p. no.1. We have perused the Xerox copy of the policy, annex-A, of the complainant of Rs.1 lakh and the Xerox copy of the upto date policy, annex-B. And it also appears that insured amount of the complainant is Rs.1 lakh and his wife Manju Senapati of Rs.30000/-. We have also perused the discharge certificate of Manju Senapati showing that she was at the hospital Microlab from 20.8.03 to 24.8.03. We have also perused the letter dt.31.10.03 written by complainant to the Branch Manager of o.p. no.2 making an appeal for reimbursement of the mediclaim in respect of his wife Manju Senapati. We have also perused the letter of o.p. no.2, annex-E, wherein they have acknowledged the letter of the complainant and asked him to furnish some documents including the treatment papers and test reports etc. It is annex-G dt.5.2.05 wherein the o.p. no.1 has refused the claim of the complainant for violation of conditions 5.3 and 5.4 of the insurance policy and promptly the complainant in his letter dt.14.3.05 has refuted the allegations of the o.p. no.1 contending interalia that there was no such conditions of 5.3 and 5.4 in the insurance certificate and accordingly, the question of refusal of reimbursement of the amount of the complainant does not arise at all. We have also perused the affidavit of examination-in-chief of the complainant and it appears to us that his evidence is satisfactorily corroborated with the recitals made out in his petition of complaint. We have also perused the BNA submitted by o.p. no.2 contents of which are in consonance with the w/v and supporting the case of the complainant he has also prayed for expunging his name. We have also perused the BNA submitted by the complainant wherein he has not only stated all about the fact of the case, but he has also mentioned all about the documents which are the corroborative piece of evidence. Therefore, considering the facts, circumstances and evidence on record we are of the candid opinion that the complainant is entitled to get a decree as prayed for against o.p. no.1. Hence, Ordered, That the petition of complaint is allowed on contest against the o.p. no.2 and ex parte with costs against o.p. no.1, but as no claim is prayed against the o.p. no.2 no obligatory / mandatory order is passed against the o.p. no.2. The o.p. no.1 is directed to pay Rs.24,580.30 (Rupees twenty four thousand five hundred eighty and paise thirty) only to the complainant and compensation of Rs.3000/- (Rupees three thousand) only and litigation cost of Rs.2000/- (Rupees two thousand) only positively within thirty days from the date communication of this order, failing which it will carry interest @ 10% p.a. till full realization. Fees paid are correct. Supply certified copy of this order to the parties on payment of prescribed fees. ____Sd-_____ ______Sd-______ MEMBER PRESIDENT | 
