PER SHRI. S.S.PATIL - HON’BLE  MEMBER :

1)        This  is  the  complaint  regarding  the  deficiency  in  service and unfair trade practice by the Opposite Party as it has not settled the mediclaim of one Mr. Anthoni M. Gomes, the employee of the Complainant as alleged by the Complainant.

2)        The facts of the case as stated by the Complainant are that, the Complainant has obtained Mediclaim Policy to cover the medical expenses of the personnels during their foreign voyage. The Policy No. was 6F2/141800/80147.  Under this policy, employee Mr. Anthony Gomes was insured.

3)        During the validity of the above said mediclaim policy the insured Mr. Gomes was admitted at Singapore in East Shore Hospital PTE Ltd. during the period from 19/12/2001 to 21/01/2002. Mediclaim for his hospitalization was filed with the Opposite Party alongwith all necessary documents.  The Opposite Party admitted the claim.  The Opposite Party has vide its letter dtd.10/10/2007, has communicated to its agent that the Company has already paid £ 11952.37 on 22/07/2002 and asked the agent as to why the hospital is asking for payment when it has been already settled (The Complainant has annexed the letter of Opposite Party dtd.10/10/2007).

4)        The agent i.e. Tower Assistance Ltd. has written a letter dtd.21/03/2002 (Exh.‘C’) to the insured clearly stating that as per another agent who is the international claim settling agent, the following amounts are approved for payment –

            East Share Hospital Sing$               $ 3292.10

            M/s. Saikripa Catering IRS             Rs.25021.

5)        The Complainant has further stated that at the time of discharge from the hospital i.e. on 21/01/02, the Shipping Corporation of India stood as a guarantor for the payment to the hospital as the hospital bills were not paid.

6)        It is further alleged by the Complainant that the Opposite Party has not paid the amount of claim to the said East Shore Hospital Ltd. till date.  It is further stated that, it is learnt that the East Shore Hospital Ltd. initiated recovery proceedings against SCI in Singapore Court. Therefore, SCI has been demanding the money from the Complainant.  As the Opposite Party has not paid the hospitalization charges as per mediclaim policy it is a clear deficiency on the part of Opposite Party as alleged by the Complainant.  In support of this averment the Complainant has attached the letters dtd.19/09/07, 21/09/07 and 18/02/08.

7)        The Complainant has further stated that it has written numerous letters to the Opposite Party and has been following up the matter with the Opposite Party continuously.  The Opposite Party has been assuring every time that the matter could be settled by their claim settling agents.  Even the Opposite Party has represented at one time that the claim has been paid on 22/07/02 by M/s. Mercury International Assistance & Claims Ltd. of U.K. vide their letter dtd.10/10/07. However, it is the contention of the Complainant that it is not true as the SCI is facing the threat from the said hospital of seizure of its vessel in Singapore waters. 

The Complainant has attached the letters dtd.18/11/07, 14/09/07 and 17/09/07.  The letter dtd.18/11/07 is from Alan Shankar& Lim, an Advocates & Solicitors to the M/s. Far Eastern Services Pvt. Ltd. regarding claim by M/s. Seacare Maritime Medical Centre PTE Ltd.,

The letter dtd.14/09/07 is from SCI to Sagar Sandhani.

The letter dtd.17/09/07 is from ONGC to the Complainant.   

8)        The Complainant has further stated in para 11 that the Opposite Party has paid a part of the claim but the claim of the hospital is not settled to the satisfaction of the hospital. The cause of action is continuous. The Complainant sent a legal notice dtd.05/04/08 & 15/04/08, but there is no response from the Opposite Party.

9)        The Complainant has therefore, prayed that the Opposite Party be directed to pay the sum of Singapore $ 32092.10 (@ Rs.32/- per Sing $) with any interest from 01/03/02 till realization, & sum of Rs.9 Lacs towards compensation and Rs.25,000/- for the cost of this complaint.

10)      The complaint was admitted and notice was served on the Opposite Party.  Opposite Party filed its written statement wherein it denied the allegations of deficiency.  However, it has admitted that the Overseas Mediclaim Policy was issued to the Complainant.  The policy was in the name of Complainant’s employee Mr. Anthony Gomes who was working on vessel Sagar Sandhani of ONGC being operated by Shipping Corporation of India.  It is stated by the Opposite Party that the insured was hospitalized at Singapore during the validity of the policy.  After discharge from the East Shore Hospital PTE Ltd., the claim was submitted to the agent of Opposite Party  i.e. Tower Insurance Services Pvt. Ltd., The Opposite Party has further stated that the Opposite Party’s agent had settled the claim.  From the record it is observed that Opposite Party has paid 11952.37 on 22/07/02. The Opposite Party is so negligent in drafting this written statement, that even it has not even mentioned whether this amount of 11952.37 is a dollar, Rupees or any other currency. 

11)      The Opposite Party has further stated that the policy being Overseas, Mediclaim Policy, the claim is settled by the agents authorized in prescribed countries.  Accordingly the claim should have been followed up in Singapore with Mercury International Assistance & Claim Ltd.  The claim setting agent from Singapore had already made the payment. The Opposite Party has specifically averred in para 5 of the written statement “Here to annexed and marked as Exh.‘A’ is the copy of the payment details.” However, there is no such Exhibit ‘A’ attached to the written statement.  This is not only negligence on the part of Opposite Party but it is a clear misleading of this Forum by the Opposite Party.

12)      The Opposite Party has further stated that the cause of action has arisen at Singapore. Hence, this Forum does not have the jurisdiction to entertain the complaint.  Further, it is also averred that the complaint is barred by limitation as the cause has been arisen in 2001.  Finally it has prayed that the complaint be dismissed with cost.   

13)      Thereafter, the Complainant has filed one document wherein the facts in the complaint are reiterated but it has not been signed therefore, it cannot be taken in to consideration.

14)      The Opposite Party has then filed its written argument wherein also the facts mentioned in the complaint are reiterated. The Opposite Party filed its written argument wherein it reiterated the facts and points mentioned in the written statement.   

15)      We heard the Ld.Advocate for both the parties and perused the papers submitted by them and our findings are as follows –

            It is an admitted fact that the Complainant has obtained a Overseas Mediclaim Policy from the Opposite Party for his employee one Mr. Anthony M. Gomes.  During the validity of this Mediclaim Policy No.6F2/141800/180147, the insured was hospitalized at Singapore in East Shore Hospital PTE Ltd. from 19/12/01 to 21/01/02.  After discharge from the Hospital, a claim was submitted to the agent of the Opposite Party.  The dispute started at this point of time.  As per the Complainant the Opposite Party has not paid the claim.  At one place the Complainant alleges that the Opposite Party has not paid the entire claim of 32092.10 Singapore $, but it has paid Rs.25,021/-.  However, he has not mentioned the date on which he has received the sum of Rs.25,021/-.  The Opposite Party’s contention is that the entire claim has been paid in 2002 only.  In this respect we have gone through the papers submitted by the Complainant.

16)      The Seacare Maritime Mediclaim Centre PTE Ltd. had raised a medical bill of 32092 dtd.31/01/02.  this medical authority also has not mentioned the currency but as it was raised by a Hospital in Singapore it should have been in the Singapore currency only.

17)      The Complainant has attached Exh.‘B’, is the letter from Opposite Party to its agent Tower Insurance Services Pvt. Ltd. which states that, as per the letter of Mercury International Assistance and claim Ltd. dtd.22/06/04, the Company has paid 11952.37 £ on 22/07/02.

18)      In the letter dtd.21/03/02, from Tower Assistance Ltd., it is stated that “We understand from M/s. Mercury International Assistance & Claims Ltd. that the following amounts are approved for payment –

            East Shore Hospital Sing$ 32092.10

            M/s. Saikripa Centre IRS 25021.00

19)      In the letter dtd.19/09/07, the Complainant himself has written to the Shipping Corporation of India, that “this matter has already been settled with East Shore Hospital. This matter was cleared to ONGCL in the year 2004 vide copy of correspondence ad necessary details is closed herewith.”             

20)      Immediately after above letter dtd.19/09/07, the Complainant has again written a letter dtd.21/09/07 i.e. after two days informing the SCI that as per the confirmation letter of Tower Assistance, they have received Rs.25,021 and the East Shore would have received its payment of Sin. $ 32092.10.

21)      From these correspondences it is seen that though the Opposite Party is the insurer, the Complainant has not done direct correspondence with the Opposite Party till 21/09/07. In this letter the Complainant has stated about the non payment of Singapore $ 32092.10 and Seacare Maritime Mediclaim Centre PTE Ltd. has legally proceeded against SCI for non receipt of said amount.  It has further asked the Opposite Party to give details of payments.  But there is no document to show that the Seacare Maritime Mediclaim Centre PTE Ltd. has proceeded against SCI in the Court of Law at Singapore.

22)      The Complainant has also attached at Exh.‘F’ the notice dtd.18/11/04 from Alan Shankar & Lim on behalf of Seacare Maritime Medical Centre PTE Ltd. addressed to M/s. Far Eastern Services Pvt. Ltd. demanding $ 32083.14. It is demanded from M/s. Far Eastern Services Pvt. Ltd., Singapore.

23)      The Complainant has further attached the letter dtd.14/09/07 from SCI to ONGC informing that SCI’s agent at Singapore has informed that he had received a notice from the Hospital to arrest the Ships of SCI if no payment is forthcoming within 15 days.  This notice of the Hospital issued to SCI is not produced by anybody.

24)      The Complainant has also attached the fax document which appears to be dtd.15/02/05 in which SCI has written that the medical bill is not paid by anybody.  In this respect there is no mention of the notice purported to be received by the SCI.

25)      The Complainant has also attached one letter dtd.14/01/03 written by the Complainant to Mercury International Assistance & Claim Ltd. stating that M/s. East Shore Hospital at Singapore has not received the bill of Singapore $ 32092.10 towards the settlement of mediclaim in respect of policy 6F2/41800/80147.

26)      The Complainant has also attached his letter dtd.29/11/04 addressed to ONGC, wherein he has mentioned that the said payment has been released in favour of East Shore Hospital on 22/07/02 and this has been confirmed by the Tower Assistance Ltd. the agent of Opposite Party.  In the same letter while addressing the copy of this letter to Tower Assistance Ltd. the Complainant has instructed to this agent that “East Shore Hospital has served a legal notice to our Principal agent at Singapore for receipt of the above said claim, we request you to urgently take put the matter with Mercury International Ltd.   

27)      It is also mentioned in letter of the Complainant dtd.21/09/07 that M/s. Far Eastern Services Pvt. Ltd. is his principal agent at Singapore and it received the notice for non payment of the said disputed claim.  Letters dtd.03/10/07, 29/10/07, 02/12/07, 15/01/08 ad 18/02/08 are the reminders to the Opposite Party informing about no payment of the said claim to the hospital.

28)      From all the above correspondence it is seen that the Complainant has obtained a mediclaim policy from the Opposite Party.  It was the liability of the Opposite Party to reimburse the medical expenses incurred for the hospitalization of Mr. Anthony Gomes.  The insured was hospitalized in the East Shore Hospital at Singapore from 19/12/01 to 21/01/02.  The mediclaim was submitted to the agent of the Opposite Party.  the correspondence between the agent of the Opposite Party and the insured shows that Mercury International Assistance & Claims Ltd. has approved the claim of the insured but the payment has not been received by the concerned Hospital.  

29)      Non receipt of the payment of the claim by the concerned hospital is the cause of action which gave raise the right to file the complaint before the proper authority.  The above said correspondence particularly the letter dtd.29/11/04 of the Complainant himself clearly shows that the concerned hospital has not received the payment of the disputed claim.  Even the advocates & solicitors on behalf of concerned hospital had sent a legal notice dtd.18/11/04 to M/s. Far Eastern Services (Private) Ltd. which is the principal agent of the Complainant indicates that the dispute arose in November, 2004 when it was confirmed that the claim amount was not received by the concerned hospital and it was going to take a legal action against the concerned person.  Therefore, taking into consideration these facts, the Complainant should have been diligent in filing the complaint within 2 years from November, 2004. The Complainant is silent between 29/11/04 till 21/09/07 i.e. for about 3 years and then on 27/06/08, this complaint has been filed by the Complainant.

30)      In this complaint the first cause of action arose on 21/01/02 when the insured was discharged from the Hospital. Again the cause of action arose when it was communicated to the Complainant that the claim is approved as on March, 2002 and the final cause of action arose when the Complainant knew that the Opposite Party/its agent did not pay the claim to the concerned hospital.  In our candid opinion, the Complainant knew on 29/11/04 that the Opposite Party/its agent has not made the payment of the settled claim and it was the final date on which the right to file the complaint emerged in favour of the Complainant. The complaint has been filed on 27/06/08.  Therefore, there is certainly a delay of one year and 210 days.  The Complainant has not filed any application for condoning the delay. Only the Complainant has mentioned in the complaint that the cause of action is continuous.  But in view of the above facts and circumstances it cannot be said that the cause of action is continuous.  The cause of action arises when any right is infringed for which a legal remedy is provided.  In this case the Opposite Party is not paying the mediclaim since the claim was being submitted to its agent i.e. from January, 2002.  Therefore, the deficiency in service on the part of Opposite Party started from January, 2002.  It has certainly come to the knowledge of the Complainant on or before 29/11/04. Since that time the Complainant has not taken any step to file the complaint. The Ld.Advocate for the Complainant has filed compilation of judgement vide 2013-(TC2)-GJX–0145–NCDRC, in Prabhodh J. Kothari V/s. The Oriental Insurance Co. Ltd., dtd.28/02/2013.  We perused the said judgment.  However, the said judgement is not applicable to the complaint in hand as the facts & circumstances widely differ. Therefore, in our candid view the complaint is barred by limitation under Sec.24A of the Consumer Protection Act, 1986.  Hence we pass the order as follows –

O R D E R

1.         Complaint No.109/2008 is hereby dismissed as barred by limitation under Sec.24A of the Consumer Protection Act, 1986.

2.         There is no order as to cost.

3.    Certified copies of this order be furnished to the parties.