Smt. Syeda Shahnur Ali, Member
This is a complaint made by one Sri Manas Ranjan Pradhan against the Branch Manager, Punjab National Bank, Tamluk branch and the Branch Manager, Oriental Insurance Co. Ltd., Paschim Medinipur, praying for a direction upon the OPs to reimburse the cost of medical treatment of his wife to the tune of Rs. 1,08,905/- along with 10% interest w.e.f. 15-10-2015 and compensation and litigation cost for a sum of Rs. 2,50,000/- and Rs. 10,000/-, respectively.
The long and short of Complainant’s case is that he took a mediclaim policy from the OP No. 2 through OP No. 1 being no. 311901/48/2014/591 for self and other family members for a sum assured of Rs. 3,00,000/- and the said policy was valid from 05-07-2013 to 04-07-2014. Subsequently, the Complainant, with a view to renew the said mediclaim policy for another year, issued cheque no. 185791 dated 13-06-2014 for an amount of Rs. 4,620/-. OP No. 1 sent the said cheque to the OP No. 2 through its Circle office on 20-06-2014. It is the case of the Complainant that although he submitted the cheque in time, thanks to the gross negligence on the part of the OPs, the mediclaim policy was renewed w.e.f. 14-08-2014 (i.e. from 14-08-2014 to 13-08-2015). Subsequently, the said mediclaim policy was renewed from 14-08-2015 to 13-08-2016. It is stated that, Complainant’s wife fell ill in the month of July, 2015 for which she got admitted at CMRI Hospital, Kolkata on 27-09-2015 and went under the knife on 30-09-2015 and later on, she was discharged from there on 05-10-2015. The Complainant had to incur an expenditure of Rs. 1,08,905/- for which a claim was lodged with the OP No. 2 through OP No. 1 on 15-10-2015, but till date, OPs have not settled his same for which the Complainant is suffering from mental agony. Hence, this case.
Despite due service of notice, OP No. 1 did not turn up to defend its case. So, the case was heard ex parte against it.
On notice, OP No. 2 appeared and contested the case by filing WV. Besides denying all the material allegations, it is submitted by this OP that both the OPs jointly introduced mediclaim insurance policy, namely, “PNB-Oriental Royal Mediclaim Policy” for the account holders of PNB bank. It is stated by this OP that the Complainant started the concerned mediclaim policy in the year 2013 and the said policy was valid for the period from 06-07-2013 to 05-07-2014 (actually from 05-07-2013 to 04-07-2014). It is further stated that the Complainant renewed the said policy by issuing a cheque dated 13-06-2014 which was received by the OP No. 1 on 21-06-2014, who in turn forwarded transmission to this OP for renewal. The Midnapore branch of this office deposited the same on 12-08-2014 and issued the policy for the period from 14-08-2014 to 13-08-2015. The first policy was not renewed in time although the Complainant issued requisite cheque well in advance and deposited the same to the OP No. 1. It is candidly stated by this OP that the concerned PNB branch did not send the cheque to this OP in time. So, the first policy could not be renewed immediately upon expiry of the validity period of first policy. In terms of Clause No. 4.1 of the policy concerned, reimbursement of treatment cost in respect of nature of treatment meted out to the wife of the Complainant is payable after two years of continuous policy. Insofar as the Complainant’s claim did not meet up this criterion, he is not entitled to any insurance benefit. Thus, this OP prayed for dismissal of this case.
The solitary point for consideration is whether the Complainant is any to any of the relief(s) prayed for by him, or not.
Decision with reasons
In support of his case, Complainant filed photocopies of certain documents, viz., first two pages of policy schedule in respect of “PNB-Oriental Royal Mediclaim Policy” for three years, photocopy of one cheque issued on 13-06-2014, Discharge Summary of CMRI Hospital, Kolkata, copy of final bill dated 05-10-2015 for a sum of Rs. 97,128/-.
It is claimed by the Complainant that although the validity period of concerned mediclaim policy was slated to expire on 04-07-2014, to be on the safe side, he deposited the renewal cheque with the OP No. 1 well before the threshold time. However, the OP No. 1 sent it to the OP No. 2 through its circle office on 20-06-2014. On the other hand, it is stated by the OP No. 2 in its WV that the concerned cheque was received by the OP No. 1 on 21-06-2014, who redirected the same to the Midnapore branch of the OP. The OP No. 2 deposited the cheque on 12-08-2014 and upon encashment of the same, renewed the policy w.e.f. 14-08-2014.
Although in absence of requisite counter foil/cheque deposit slip against deposit of the concerned cheque, it is difficult to ascertain the actual date of submission of cheque by the Complainant to the OP No. 1, be it 13-06-2014 or 21-06-2014, fact remains that the expiry date of first mediclaim policy was far away when the Complainant deposited the cheque to the OP No. 1. Significantly, although the OP No. 2 has confirmed that the concerned cheque was received by the OP No. 1 on 21-06-2014, it has curiously maintained a studded silence as to the actual date of receipt of the instrument by it. It has merely stated that the said cheque was deposited by its office on 12-08-2014.
Despite such loose ends, one aspect emerges without any iota of doubt that there was no lapse on the part of the Complainant to renew the mediclaim policy. The delay occurred solely because of the lackadaisical approach of the OPs to ensure timely transmission/deposit of the instrument/cheque in question. To our mind, it is insignificant, whether the OP No. 1 was primarily responsible for such inordinate delay to encash the cheque or it was apathetic attitude of the OP No. 2 that resulted in delayed renewal of the mediclaim policy, given the admitted position of this case that the OPs jointly introduced the concerned mediclaim policy, both should be held vicariously liable for every lapses in discharging their professional responsibilities towards the customers.
Against such backdrop, we are of view that by sitting tight over the bona fide claim of the Complainant for so long in contravention of IRDA Regulations in this regard, OPs have done grave injustice towards the Complainant which is akin to deficiency in service. We, therefore, deem it fit and proper to direct the OPs to settle Complainant’s claim together with compensation and litigation cost.
We find, Complainant has staked a claim of Rs. 1,08,905/- from the OPs. However, apart from filing photocopy of the afore-mentioned final bill issued by CMRI, Kolkata for a sum of Rs. 97,128/-, no other supporting document is filed from the side of the Complainant to justify such claim amount. Accordingly, in our considered opinion, OPs should be directed to settle Complainant’s claim at Rs. 97,128/-.
Hence,
O R D E R E D
that CC/83/2016 be and the same is allowed on contest against the OP No. 2 and ex parte against the OP No. 1. OPs are directed to pay, within 40 days hence, a sum of Rs. 97,128/- in full and final settlement of Complainant’s claim together with compensation for a sum of Rs. 10,000/- and litigation cost of Rs. 5,000/-, i.d., OPs shall be jointly and severally liable to pay interest @ 8% p.a. over 97,128/- from the date of this order till full and final payment is made.
