In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, 4th Floor, Kolkata-700087.
CDF/Unit-I/Case No. 33 / 2008 .
1) Ashok Kumar Tewari,
General Manager, Shree Hanuman Jute Works,
Ghusuri, Howrah-711107, West Bengal. --------- Complainant
---Versus---
1) Royal Sundaram Alliance Insurance Co. Ltd.,
Shubham, 1st Floor, 1, Rawdon Street,
Kolkata-16, P.S. Park Street.
2) Standard Chartered Bank,
Credit Card Division, 19, N.S. Road, Kolkata-1. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri, Member.
Smt. Samiksha Bhattacharya, Member
Order No. 37 Dated 04-06-2013.
The case of the complainant in short is that complainant had been approached by one the representative of the o.p. no.1 over telephone while he was employed as G.M. The said representative of o.p. no.1 told the complainant that he will contact him at a later date in connection with a mediclaim policy of its company. Some time in the month of May 2005 the said representative of the o.p. again contacted the complainant over telephone and explained that the policy offered by o.p. no.1 is much better than the other Govt. and non Govt. general insurance companies. The complainant is further assured that in case of claims arising out of sickness / accident the same will be settled in quickest possible time after observance of necessary formalities.
Complainant being impressed by the offer applied for a medical insurance cover and fulfilling all the conditions and as such the policy number HLSTCB0024 was issued to the complainant. Complainant in instant case is a credit card holder of o.p. no.2 having card no.4129 0586 8002 1843. It is submitted that o.p. no.1 has collected insurance premium in respect aforesaid policy amounting to Rs.6791/- in respect of the complainant. Sri Ashok Kumar Tewari, his wife Smt. Uma Tewari and his daughter Miss Kanak Tweari through the aforesaid credit card of the complainant for Rs.1.5 lac mediclaim for each for the period 23.5.05 to 22.5.06.
The same insurance company was renewed again on 23.5.06 but the terms and conditions of the policy was never supplied to the complainant. The complainant in good faith continued the policy in 2nd year also. Premium of said the o.p. had been collected by o.p. no.1 by debiting the credit card no.4129 0586 8001 1843 issued by o.p. no.2.
Complainant some time on 12.9.06 was hospitalized under Dr. S.K. Gupta a renowned orthopaedic surgeon of Calcutta and had been operated in the left leg as advised by the same doctor. Complainant was operated and some times in 13.9.06 and was released by the said doctor subsequently. And returning from the nursing home on 13.9.06 and after obtaining the relevant papers and materials the complainant submitted claim amounting Rs.14,399.40.
O.p. no.1 rejected the claim of the complainant alleging that the complainant had suppressed the material facts and had allegedly violated the condition no.6 and 11 of the mediclaim insurance policy, where as no such condition even had been supplied to the complainant.
Complainant submitted that the surgery to the left leg was performed on 12.9.06 is in no way connected with the accident which took place on 23.5.1992. Complainant h as receipt of an intimation of rejection of claim by th e o.p. no.1, subsequently complainant requested o.p. no.1 vide a letter dt.2.3.07 through an advocate Sri Sujit Kr. Sharma. Hence the case was filed by the complainant with the prayer contained in the petition of complaint.
O.p. no.1 had entered its appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case. Ld. lawyer of o.p. no.1 in the course of argument submitted that the case has got no merit and the same is liable to be dismissed. O.p. no.2 did not contest the case by filing w/v and matter was heard ex parte against o.p. no.2.
Decision with reasons:
We have gone through the pleadings of the parties, evidence and documents in particular and we find that complainant had been approached by one the representative of the o.p. no.1 over telephone while he was employed as G.M. The said representative of o.p. no.1 told the complainant that he will contact him at a later date in connection with a mediclaim policy of its company. Some time in the month of May 2005 the said representative of the o.p. again contacted the complainant over telephone and explained that the policy offered by o.p. no.1 is much better than the other Govt. and non Govt. general insurance companies. The complainant is further assured that in case of claims arising out of sickness / accident the same will be settled in quickest possible time after observance of necessary formalities.
We further find that complainant being impressed by the offer applied for a medical insurance cover and fulfilling all the conditions and as such the policy number HLSTCB0024 was issued to the complainant. Complainant in instant case is a credit card holder of o.p. no.2 having card no.4129 0586 8002 1843. It is submitted that o.p. no.1 has collected insurance premium in respect aforesaid policy amounting to Rs.6791/- in respect of the complainant. Sri Ashok Kumar Tewari, his wife Smt. Uma Tewari and his daughter Miss Kanak Tweari through the aforesaid credit card of the complainant for Rs.1.5 lac mediclaim for each for the period 23.5.05 to 22.5.06.
It transpires from the record that complainant some time on 12.9.06 was hospitalized under Dr. S.K. Gupta a renowned orthopaedic surgeon of Calcutta and had been operated in the left leg as advised by the same doctor. Complainant was operated and some times on 13.9.06 and was released by the said doctor subsequently. And returning from the nursing home on 13.9.06 and after obtaining the relevant papers and materials the complainant submitted claim amounting Rs.14,399.40.
It is seen from the record that the same insurance company was renewed again on 23.5.06 but the terms and conditions of the policy was never supplied to the complainant. The complainant in good faith continued the policy in 2nd year also. Premium of said the o.p. had been collected by o.p. no.1 by debiting the credit card no.4129 0586 8001 1843 issued by o.p. no.2.
Further we find that o.p. no.1 rejected the claim of the complainant alleging that the complainant had suppressed the material facts and had allegedly violated the condition no.6 and 11 of the mediclaim insurance policy, where as no such condition even had been supplied to the complainant.
It also transpires that complainant submitted that the surgery to the left leg performed on 12.9.06 is in no way connected with the accident which took place on 23.5.1992. Complainant has receipt of an intimation of rejection of claim by the o.p. no.1, subsequently complainant requested o.p. no.1 vide a letter dt.2.3.07 through an advocate Sri Sujit Kr. Sharma.
In view of the findings above and on perusal of the entire materials on record we find that o.ps. had sufficient deficiency in service being service provider to their consumer / complainant and complainant is entitled to relief.
Hence, ordered,
That the case is allowed on contest with cost against o.p. no.1 and ex parte with cost against o.p. no.2. O.ps. are jointly and/or severally directed to pay a sum of Rs.14,399/- (Rupees fourteen thousand three hundred ninety nine) only to the complainant being the insurance claim and compensation of Rs.40,000/- (Rupees forty 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.
Supply certified copy of this order to the parties free of cost.
