JUDGEMENT

        Complainant by filing this complaint  has alleged that during his service period, he became subscriber of Group Mediclaim Insurance Policy of the New India Assurance Co. Ltd. for a sum insured of Rs.2 lakhs each for three persons and the premium amount of said mediclaim policy was deducted from his salary upto June, 2008 and he was an employee of the New India Assurance Co. Ltd. and his office is at 15 C, Hemanta Basu Sarani, Kolkata -700001.

          It is further submitted that he was very much particular regarding payment of premium and he never defaulted regarding payment of premium and also he paid Rs.5,944/- vIde cheque No.657326 dated 25.03.3007 drawn on Central Bank of India, RED Cross Place Branch, Kolkata-700001 for the year 2009 and against that op no.1 issued proper receipt on 27.03.2009 and he also paid the premium of Rs.5,944/- vide cheque no. 690017 dated 23.03.2010 drawn on Central Bank of India, RED Cross Place Branch, Kolkata-700001 against which op issued proper receipt on 24.03.2010.  But all on a sudden on 09.09.2010 the complainant became seriously ill for heart disease with other different ailments and was admitted in Maria Health Centre at Bankra Dakshin Polly, P.O. Bankra, Howrah-711403 for medical treatment, being advised by Dr. R.K. Majhi of the said Health Centre on 09.09.2010 and was discharged on 15.09.2010 and during that period he spent huge money for his treatment and various medicines, x-ray as per prescription of Dr. R.K. Majhi and for which this complainant spent Rs.23,202/- as medical expenses.

          After recovery on 10.12.2010, complainant submitted his claim amount claimed against that valid policy in respect of amount of Rs.23,202/- before the op along with the original documents regarding treatment and pathological tests and placed but op did not pay any heed to that and did not also send the reimbursed amount as filed against that op sent a registered letter to the complainant on 10.01.2011 by which op acknowledged the receipt of the claim form along with other documents and raised some unwanted and fabricated points to harass the complainant and to avoid the payment intentionally.  On receipt of the said motivated letter, the complainant sent a letter on 25.02.2011 to the op no.1 stating details and asked the op no.1 to settle the claim within 15 days from the receipt of the letter.  But it was a matter of great regret that since then the claim had not been matured and no payment has been made.  But subsequently, complainant also paid another premium on 17.03.2011 for sum insured of Rs.2 lakhs for the period from 01.04.2011 to 31.03.2011 and op should receive against that policy.  But surprising fact is that op received the renewal premium against the above mentioned mediclaim from complainant on 17.03.2011 without settling the previous claim.  But subsequently, he visited the office of the op no.1 on several occasions.  But complainant came to learn that his claim shall not be released and he was also threatened by the op and thereafter on 19.10.2011 the complainant sent registered letter with A/D to the op but no response was made and for which the present complaint was filed praying for relief.

          On the other hand the op by filing written statement submitted that no doubt the complainant is an ex employee of New India Assurance Co. Ltd. who obtained the insurance policy from the insurance company suppressing his actual age and same employee retired on June, 2008 on attaining the age of 60 years from the New India Assurance Co. Ltd.  But complainant after such retirement challenged before the Court of Law raising a dispute regarding his age and such dispute is subjudice before the competent court of law and at the time of obtaining his policy, he wrongly supplied his date of birth contrary to his record of the company and as such this dispute regarding his actual age has to be settled by the competent Court of Law and thereafter this matter may be settled.  It is further submitted that if the claim is right now admitted as because then the age stated in the policy shall be deemed to be admitted by the insurance company though it is contrary to the record of the insurance company regarding the age of the insured.

          It is further submitted that complainant shall be decided in the light of various prescription, bills and other documents wherein each and every document, the complainant has stated his age wrongly contrary to the record base upon which the complainant has retired from the insurance company and subsequently challenged his retirement stating that he was yet to attain the age of retirement at the relevant time, and the instant claim is admitted then voluntarily the insurance company shall be admitting that the retirement was improper moreover this point of dispute is pending for adjudication before the competent Court of Law and for which present claim cannot be settled and prays for dismissal of the case.

                                     Decision with reasons

          On proper consideration of the complaint and the written version including the entire contention of the op regarding the complainant’s challenge of his age before the competent Court of Law.  Practically this claim had not been settled on the ground that if the present claim is decided in that case age of the complainant as stated in the Service Book of the op shall be proved by this statement and in that case the present op insurance company shall have to admit his present age and in that case he shall have to get a chance to place before the Civil Court before which his age matter is under subjudice.

          Most interesting factor is that complainant has not whispered this matter in his complaint.  But it is undisputed fact that the complainant was an employee of the op and op no doubt opened an insurance policy during his service time and he had been paying yearly premium which had been admitted from his salary during his tenure ship of his service and thereafter the complainant has been paying the same yearly by cash or by cheque to the op and regarding continuation of the valid insurance policy there is no dispute.

          It is also undisputed fact that complainant became ill and was hospitalized for the period from 09.09.2010 to 15.09.2010 Maria Health Centre at Bankra Dakshin Polly, P.O. Bankra, Howrah-711403 under Dr. R.K. Majhi and no doubt he spent huge and said nursing home charged Rs.23,202/- as medical expenses and it is also accepted fact that op received the same that has not been decided by the op.  The complainant had already filed a suit before the Civil Court for  determination of his age and complainant claimed             as his age is not in the Service Book is not correct and practically the age of 60  he was compelled to retire as his date was noted in the Service Book wrongly.

          When after considering the argument of the Ld. Lawyer for the op and also hearing the complainant we have gathered from the service that the complainant challenged that practically his age was noted in the Service Book wrongly for which at earlier stage prior to 60 he was compelled to retire and for which he filed a suit for determination of his age and it is also fact that op on the ground of that case has not decided the claim.

          Considering the above situation we are convinced to hold that this Forum was not decided the age of the complainant and complainant was not get any benefit of his age what is written in different private documents or in the hospital or in the service centre or before the address is not accepted by this Forum as his genuine age and this age matter is agreed upon on decision of the Civil Court and early proper care before which same is subjudice that aspect and complainant cannot get any benefit of his age on the basis of the order of this judgement to this Forum and fact remains his age matter which are written in the different public documents or private document as filed before these are not accepted by this Forum.

          Considering his retirement we want to say that chapter is not our headache for any decision.  But our eyes are fixed in respect of the claim against the policy and the fund of the said mediclaim as submitted by the complainant before the op and after giving due consideration in respect of the act of the op, it is found that op has not disposed of the same only on the ground that if it is disposed in that case his age is noted shall be accepted but such sore of theory as adopted by the op is not at all correct or legal and for which when deciding the age matter and that accepted his age is noted in the present documents we are directing the op to release the claim amount immediately by informing the complainant that his age is noted on the papers which are not filed are accepted.  We are confirmed that it would be the best theorization not to disturb the complainant in such a fashion and at the same time the complainant may not have to file any other claim, in such a fashion for      and in respect of the age he must have not          it is disputed and pending for decision by the competent Court of Law in connection with such and such cause.  Whatever it may be the amount is regarding in nature and fact remains the complainant was an employee of the op and op must have to realize the amount without any further delay but at the same time realizing that settled amount it shall be noted in the letter of the op that age of complainant is noted in different application, claim form are not accepted as same to be subjudice.  In the light of the above observation op is directed to release the sum of Rs.23,202/- in favour of the complainant at once and without any further delay and accordingly this case is disposed of finally against the op without any cost.  On the ground complainant suppressed some disputed matter regarding his age.

          Hence, it is

                                                ORDERED

          That the complaint be and the same is decreed without any cost against the ops.

          Ops are hereby directed to release and paid the sum of Rs.23,202/- in favour of the complainant within one month from the date of this order without any further attempt to delay the matter and possibly within one month from the date of this order failing which op shall have to pay punitive damages @ Rs.500/- per day till full satisfaction of the decree and in case if it is found that repeated disobeyance claimed by the ops in that case penal action shall be taken against that for starting a proceeding u/s 27 of C.P. Act 1986.