Judgement MR. AYAN SINHA MEMBER This is a complaint u/s 35 of the CP Act, 2019 made by Smt. Shalini Tewari alleging mental harassment caused to her by the OP, The Branch Head SBI General Insurance Company Limited and accordingly prays for a direction upon the OP to consider the inception of her policy date as 16.07.2021, to pay the entire claim amounting to Rs.71,048/- and pay compensation and litigation cost of Rs.5,000/-. FACTS IN BRIEF The facts of the instant case is that the Complainant had purchased a health insurance policy being no.0000000023648052 from the OP against the payment of premium amount of Rs.11,074/- which was paid on 16.07.2021 from the SBI account of her husband. The Complainant thereafter was admitted in Kothari Medical Centre on 16.04.2022 in connection with maternity issue and was discharged on 19.04.2022. The hospital bill expenses of Rs.71,048/- was repudiated by OP, the SBI General Insurance Company on the ground that she joined the insurance policy on 17.07.2021 and as per the policy terms, she will not be entitled for any maternity expenses for the first nine months from the date of joining of this policy. As stated in the complaint petition by the Complainant that the Insurance Regulatory and Development Authority Regulations, 2002 dated 16.10.2002, the “Commencement of Risk” when the premium is paid in cash and in all other cases the insurer shall on risk only after the receipt of premium by the insurer as alleged in the complaint petition. Complainant requested to the Insurance Company to consider the date of inception of the policy as 16.07.2021 on the date which she had paid the premium instead of 17.07.2021 as mentioned by the Insurance Company. It is also stated in the complaint petition that although the Complainant was present at her working place at Canara Bank, filled in form bearing her signature existed on the last page of the policy. So the main grievance of the Complainant is that, had the policy be mentioned as 16.07.2021 instead of 17.07.2021 then it would have crossed nine months as per policy term and she could have availed the claim of the maternity expenses raised by the hospital. The Complainant also approached to the Insurance ombudsman, Kolkata, where her case was dismissed without providing any relief. Although, the notice was served upon the OP on 29.11.2022 and the OP entered appearance on 23.12.2022 by filing Vokalatnama and prayed for time for filing written version on the next date i.e. 13.01.2023. OP did not file written version on 13.01.2023 and so the case proceeded ex parte against the OP, since the stipulated period for limitation for filing written version had exhausted. Complainant by filing a petition prayed to treat the complaint as their evidence and finally the matter was fixed for argument. So, only Point requires Determination is to whether the Complainant is entitled to the relief(s) as prayed for? DECISION WITH REASONS We have carefully perused all the documents and the annexures available with the record. There is no doubt that the Complainant had purchased one policy in her name for a sum insured of Rs.10,00,000/- as mentioned in the copy of the policy and the issue date is 21.07.2021 as mentioned in the policy. The commencement of policy starts from 17.07.2021 (16:14 hrs.) to 16.07.2022 (midnight) and the date of inception of the policy shown as 17.07.2021. On further perusal of the copy of the insurance policy in Clause (v) 3 “exclusions” “maternity expenses insurer shall not be liable to make any payment under this policy in connection with or in respect of the maternity expenses within first nine months from the date of inception of this policy. However, these nine months exclusion shall not be applicable in case of fixation renewal within grace period, paid sum insured and/or limit under previous policy.” Now, main crux of the case is that the Complainant is not entitled to avail for maternity expenses if the maternity expenses are raised within 9 months from the date of inception of the policy, to which the SBI Insurance had mentioned as 17.07.2021 and Complainant raised the point during the course of hearing that it should have been 16.07.2021 entitling her to come under the coverage of the maternity expenses which were to be paid by the said OP. On scrutiny of the copy of the insurance policy in receipt page/ collection particulars (receipt no.19763967), duly signed by the OP, it is clearly stated that the OP had received the payment of Rs.11,074/- through EFT no.194547573 dated 16.07.2021 drawn on the State Bank of India and they have already generated deposit id. As 0000000034334511 dated 21.07.2021. So, going through the receipt of the SBI General Insurance, we found no where the said premium amount was paid through cheque which could have taken a day or two for realization, that means, OP had already received the payment as mentioned that the payment was made through EFT and the said fund was also transferred to OP’s account for which the said receipt was issued. But the OP had repudiated her claim on 30/04/2022 on the above mentioned reasons. The Complainant had also filed a RTI copy from where it is revealed that the SBI General Insurance was credited with the same amount of Rs.11,074/- on 16.07.2021. We have also gone through the copy of the IRDA notification as annexed with the complaint petition where it is clearly stated that the Commencement will start from the time it has been paid in cash except in all other cases, the insurer shall be on risk only after the receipt by the insurer. It is also stated in case the remittance made by the proposal or the policy holder is not realized by the insurer, the policy shall be treated as void ab initio. We also found that the complainant has filed Hospital Bill No. INVKMC- 2200198 dated 19/04/2022 along with annexures for Rs.71,048/-. The complainant had not agitated on the said Bill except claiming for reimbursement of the said amount. Then in that case it would be just and proper if the said bill can be paid by the OP subject to terms and conditions of the policy So, considering the facts and circumstances and the discussions made above, the repudiation of the insurer on the ground of policy inception date as stated by them on 17.07.2021 cannot not be entertained and so we opined that the policy inception date should have been mentioned as 16.07.2021, for which the Complainant would not have been harassed by the OP rejecting her claim, amounting to Rs.71,048/-. Therefore, we are of the view, if a direction be given upon the OP to mention the policy date as 16.07.2021 and pay the claim of Complainant for as per terms and conditions as guided in the said Policy along with interest @9% and Rs.5,000/- towards cost of litigation, it would be just and appropriate. Since the interest is allowed on the amount of Rs.71,048, we are not inclined to pass any order towards cost of compensation. In the end, Complainant has succeeded in proving her case. Hence it is ORDERED That the instant case be and the same is allowed ex parte against the OP. OP is directed to modify the date for the policy no.0000000023648052 as 16.07.2021 instead of 17.07.2021 as mentioned by them earlier and issue of the copy of the same to the Complainant. OP to pay the cost of maternity expenses as raised in the Hospital Bill No. INVKMC- 22001958 dated 19/04/2022 for Rs.71,048/- (Rupees Seventy-One Thousand Forty-Eight Only) subject to terms and conditions as provided in the policy No. 0000000023648052 dated 16.07.2021 along with 9% interest to the Complainant from the date of repudiation of her claim i.e.30/04/2022 within 45 days from the date of this order, until realization in full. If the aforesaid order is not complied with the OP within the stipulated time as directed above, the Complainant is at liberty to proceed in accordance with law. Dictated and corrected by me | 
