West Bengal

Kolkata-II(Central)

CC/184/2021

Abha Neotia - Complainant(s)

Versus

Religare Health Insurance Co. Ltd. - Opp.Party(s)

Prasanta Banerjee

08 Oct 2021

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION
KOLKATA UNIT - II (CENTRAL)
8-B, NELLIE SENGUPTA SARANI, 7TH FLOOR,
KOLKATA-700087.
 
Complaint Case No. CC/184/2021
( Date of Filing : 23 Feb 2021 )
 
1. Abha Neotia
EC 13,Salt lake City,Kolkata-700064.
...........Complainant(s)
Versus
1. Religare Health Insurance Co. Ltd.
5th Floor, 19,Chawla House,Nehru Place, New Delhi-110019 and Local office 11/1,Sarat Bose Road, 3rd Floor, Room no.311,Kolkata-700020,P.S. Bhowanipur.
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. Swapan Kumar Mahanty PRESIDENT
 HON'BLE MRS. Sahana Ahmed Basu MEMBER
 HON'BLE MR. Ashoke Kumar Ganguly MEMBER
 
PRESENT:Prasanta Banerjee, Advocate for the Complainant 1
 
Dated : 08 Oct 2021
Final Order / Judgement

Order No. 09   Date - 08.10.2021

 

This Miscellaneous Application has been filed by the complainant praying for condonation of delay in filing the complaint.

The brief facts of the case are that the complainant had taken a Health Insurance Policy bearing No. 10392940 on 16.09.2018 for herself from the OP/Religare Health Insurance Company Limited and had preferred an insurance claim under the said policy which was reputed on 02.11.2018 on the ground of Non Disclosure of Material Facts. Complainant further requested the OP to make payment of claim amount and the OP upheld the earlier repudiation letter.

On the contrary, the case of the OP is that they had issued a policy bearing No. 10392940 to the policy holder Mr. Dinesh Neotia covering himself, his two daughters and his wife (hereinafter refer the “complainant”) with effect from 16.09.2015 to 15.09.2016 policy was renewed yearly till 15.09.2020. The sum insured for the inception year was Rs. 15,00,000/-. Complainant  alleged that on 21.09.2018 she was admitted at Parkview Super Specialty Hospital, Salt Lake and diagnosed with Cholelithiasis with Cholecystitis, Laproscopic Cholecystectomy, Diabetes Mellitus Type – 2. The claim of the complainant was rejected on 02.11.2018 on the ground of non disclosure of material facts/pre existing ailments at the time of proposal. Cause of action of the instant complaint arose on 02.11.2018 when the OP repudiated the claim of the complainant and the complaint has been filed on 23.02.2021 after a laps of 100 days. Complaint is barred by limitation complainant failed to satisfy the cause of delay in filing the complaint.

Heard the Learned Advocate for the complainant who submitted that the claim was repudiated by the OP/Insurance Company, vide letter dated 02.11.2018, complainant submitted representation before the OP for reconsideration of the matter. However, the OP again confirmed the repudiation vide letter dated 24.11.2018. Learned Advocate for the complainant argued that the final decision of the OP/Insurance Company rejecting the claim came only on 24.11.2018 therefore, the limitation should be counted from this date.

Heard the learned Advocate for the complainant who submitted that after the claim was repudiated by the insurance company vide letter dated 02.11.2018, the complainant submitted a representation before the insurance company for reconsidering the matter. The insurance company however, again confirmed the repudiation vide letter dated 24.11.2018. Learned Advocate argued that the final decision of the insurance company rejecting the claim came only on 24.11.2018 therefore, the limitation should be counted from this date.

     Learned Advocate has further mentioned that the cause of action is to be related to bundle of facts which lead to filing of the complaint. In this regard, learned counsel for the appellant has relied upon the judgment of the Hon’ble Supreme Court in the case of Transport Corporation of India Ltd., vs Veljan Hydrair Ltd., - (2007) 3 Supreme Court Cases 142, decided on 22.02.2007, wherein the following has been observed:

11. xxxxxxxxxxxxxxxxxxxx The term "cause of action" is of wide import and has different meanings in different contexts, that is when used in the context of territorial jurisdiction or limitation or the accrual of right to sue. It refers to all circumstances or bundle of facts which if proved or admitted entitles the plaintiff (complainant) to the relief prayed for. In the context of limitation with reference to a contract for carriage of goods, the date of cause of action may refer to the date on which the goods are entrusted, date of issue of consignment note, the date stipulated for delivery, the date of delivery, the date of refusal to deliver, the date of intimation of carrier's request to wait for delivery as the goods are being traced, the date of intimation of loss of goods, or the date of acknowledgement of liability.

Section 69(1) of CP Act, 2019 read as follows:-

Section 69(A) 1. The District Commission, the State Commission or the National Commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen.

2. Notwithstanding anything contained in sub-section(1), a complaint may be entertained after the period specified in sub-section(1), if the complainant satisfies the District Commission, the State Commission or the National Commission, as the case may be, that he had sufficient cause for not filing the complaint within such period:

Provided that no such complaint shall be entertained unless the District Commission or the State Commission or the National Commission, as the case may be, records its reasons for condoning such delay.

          It was further argued by the Learned Advocate for the complainant that the Hon’ble National Commission in the case of Japjeet Singh Chadda vs United Insurance Company Ltd., and Anr. decided on 6th May 2014 in RP No. 2387 of 2012, has taken the view that if the review/ representation has been submitted before the insurance company after the repudiation, this will be considered as a continuing cause of action and therefore, the complaint filed even after two years from the date of repudiation will not be considered as barred by limitation. The relevant portion of the order reads as under:

 “11. On analysis of the facts of this case in the context of the above observations of the Hon’ble Supreme Court that cause of action first arose on the date on which alleged burglary took place, the cause of action for filing of the complaint again arose when the insurance claim was repudiated by the insurance company vide letter dated 29.03.2004. The respondent, however, before the expiry of limitation of two years from the date of repudiation vide its letter dated 28.12.2004 registered the protest of the complainant against the repudiation of the claim and intimated him vide letter dated 28.12.2004 that his claim file was being reviewed. This obviously gives an impression to the petitioner that his request for review was accepted and his claim file was under consideration. Therefore, he was justified for awaiting the outcome of the review instead of rushing for judicial remedy. Since the review has not been decided, we are of the view that given the peculiar facts of this case, the cause of action is still continuing. The State Commission has failed to appreciate the above aspect of the matter and consequently fallen in error. Thus, in our view, the order of the State Commission dismissing the complaint as barred by limitation in view of section 24-A of the Act and also in view of violation of the term of the insurance contract, is not sustainable particularly when the final decision to disclaim the liability to the insured is yet to be taken”.

   We have carefully considered the arguments advanced by the learned Advocate for the complainant and examined the record. The Hon’ble Supreme Court in the case of Kandimalla Raghavaiah & Co. versus National Insurance Co. Ltd. and another, 2009 CTJ 951 (Supreme Court) (CP) has observed the following:-

13.  The term “cause of action” is neither defined in the Act nor in the Code of Civil Procedure, 1908 but is of wide import. It has different meanings in different contexts, that is when used in the context of territorial jurisdiction or limitation or the accrual of right to sue. Generally, it is described as “bundle of facts”, which if proved or admitted entitle the plaintiff to the relief prayed for. Pithily stated, “cause of action” means the cause of action for which the suit is brought. “Cause of action” is cause of action which gives occasion for an forms the foundation of the suit. See: Sidramappa vs Rajashetty and Ors. 4 MANU/SC/0396/1969: [1970] 3 SCR 319. In the context of limitation with reference to a fire insurance policy, undoubtedly, the date of accrual of cause of action has to be the date on which the fire breaks out.”

   The Hon’ble NCDRC in V K Appliances vs New India Assurance Co. Ltd., - IV (2013) CPJ 419 (NC) decided on 01.10.2013 has observed as under:

“3.    Instead of touching the heart of the problem, the learned counsel for the complainant attempted to skirt it. It is well settled that letters, notices do not extend the time of limitation. The case must be filed within two years’ from the date of repudiation of claim”.

   The Hon’ble Supreme Court in the case of State of Tripura & Ors. Vs. Arabinda Chakraborty & Ors., decided on 21.04.2014 (SC), has also observed that no amount of further communication between the parties can extend the period of limitation. The Hon’ble Apex Court has observed as under:

“10.     In our opinion, the suit was hopelessly barred by law of limitation. Simply by making a representation, when there is no statutory provision or there is no statutory appeal provided, the period of limitation would not get extended.  The law does not permit extension of period of limitation by mere filing of a representation. A person may go on making representations for years and in such an event the period of limitation would not commence from the date on which the last representation is decided. ……..”

   The Hon’ble NCDRC in Panipat Thermal Power Station HPGCL, Panipat through its Executive Engineer/LRE-7 Vs. New India Assurance Co. Ltd., (2013) 1 CPJ 114 (NC) has held that:-

“6.  …………It is well settled principle of law that after repudiating the claim or making some payment under claim as final payment subsequent correspondence between the parties does not extend period of limitation and complaint has to be filed within the prescribed statutory period of two years. ………………………………………………………..”

    The same view has been taken by this Commission in Mahesh Nensi Shah Vs. Oriental Insurance Co. Ltd., III (2006) CPJ 414 NC. It has been observed that:-

“3.   …….. The cause of action for filing the complaint arose in 1992 itself because it is by now settled law that repudiation itself is the ‘Cause of Action’.  No amount of correspondence between the parties can extend the period of limitation, whereas in the present case the complaint was filed after almost 5 years of the ‘Cause of Action’.  No sufficient ground, except exchange of correspondence between the parties, has been shown to us to satisfy us that there were sufficient grounds for filing the complaint with such great delay.  The State commission has rightly dismissed the complaint as barred by limitation for the simple reason that any amount of correspondence does not extend the period of limitation as per settled law.  ……………………………..”

   In the present case, the repudiation was made on 02.11.2018. The complainant started sending representation to the opposite party/ insurance company, however, the insurance company again vide letter dated 24.11.2018 repudiated the claim. This means that the representation of the complainant was taken into consideration by the insurance company and they replied just after 22 days that they uphold their earlier repudiation dated 02.11.2018.

On the contrary the Ld. Advocate for the OP/Insurance Company submitted that there is no justified reasons for delay as given in the application for condonation of delay. She further contended that exchange of correspondence between the parties, does not extent the period of limitation as per settled law. In support of her contention, the Ld. Advocate for the OP referred a decision of Hon’ble NCDRC in connection with First Appeal No. 2081/2019(Gujrat State Fertilizers & Chemicals Ltd. –Vs- New India Assurance Co. Ltd.). We have gone through the above cited decision.

   From the above discussion, it is clearly brought out that the complaint has been filed after 100 days from the date of repudiation, and therefore, it is barred by limitation as no amount of further correspondence between the parties can extend the limitation period.

   Based on the above examination, we do not find any cogent ground to condon the delay in filing the complaint. Moreso, no documentary evidence if forthcoming before this Commission that Mr. Pawan, Advocate was entrusted to prepared draft of complaint and his health condition was not good. Accordingly, complaint is rejected at the admission stage.

Thus MA being No.278/2021 is disposed of.

 

     
 
 
[HON'BLE MR. Swapan Kumar Mahanty]
PRESIDENT
 
 
[HON'BLE MRS. Sahana Ahmed Basu]
MEMBER
 
 
[HON'BLE MR. Ashoke Kumar Ganguly]
MEMBER
 

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