In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 303 / 2010.
1) Gita Devi Fatesaria,
W/o Late Bishwanath Fatesaria,
3, Burtalla Street, Kolkata – 700001 ------ Complainant
---Versus---
1) United India Insurance Co. Ltd.,
United India House,
24, Whites Road, Chennai – 600014
2) Regional Manager,
United India Insurance Co. Ltd.,
‘Himalaya House’ [2nd floor]
38-B, Jawaharlal Nehru Road,
P.S. Shakespear Sarani, Kolkata – 700071
3) M/S. Medicare TPA Services (I) Pvt. Ltd.,
6, Bishop Lefroy Road, Kolkata – 700020 ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. Subir Kumar Chaudhuri ,Member
Smt. Sharmi Basu ,Member
Order No. 22 Dated 07/09/2012.
The petition of complaint has been filed by the complainant Gita Devi Fatesaria against the o.ps. United India Insurance Co. Ltd. and others. The case of the complainant in short is that complainant and her husband, since deceased, were covered under the Mediclaim Insurance Policy onward from the year 1998 till the year 2006-2007. The said mediclaim insurance policy extended benefit of Domiciliary Hospitalization treatment to the policy holders with due consideration of higher premium paid by complainant. The mediclaim insurance policy issued by United India Insurance Ltd. was covered under sum insured Rs.1 lakh as overall limit including domiciliary hospitalization limit as Rs.20,000/-. The husband of complainant Bishwanath Fatesaria since deceased was fallen ill and was advised by the family physician for hospitalization. After examining the husband of complainant he was permitted for hospitalization for a couple of days and was admitted on 12.3.07 and was under treatment in the said hospital and then he was discharged on 20.3.07. After release of complainant’s husband, since deceased, from I.L.S. Multispeciality Clinic, o.p. no.3 was under post hospitalization treatment at home and was ultimately died on 3.4.07.
Complainant has defrayed total expenses for her husband’s treatment amounting Rs.1,89,817.52 which includes the post hospitalization treatment. Complainant has lodged claim in the claim form sent by o.p. no.2 detailing the full facts of the case of hospitalization benefit. Complainant has submitted all the relevant papers and documents including the discharge certificate of attending medical practitioner to prove the bona fide of the claim lodged. On receipt of the same o.ps. have repudiated the claim by its letter dt.6.6.07. Due to gab in the policy period the policy was treated as a fresh policy starting from 13.9.06.
Complainant states and submits that policy commenced from 1.9.98 and the same continued upto 12.9.07 and in the mean time, the husband of complainant expired on 3.4.07 at his residence. Hence the case was filed by complainant with the prayer contained in the prayer portion of the petition of complaint.
O.ps. had entered in this case by filing w/v and denied all the material allegations labeled against them and interalia stated that the complaint is liable to be rejected since the policy in question cannot be construed as a continuous old policy of the complainant since policy was renewed after 12 days for the scheduled date of renewal.
Decision with reasons:
The claim of the complainant was repudiated by o.p. nos.1 and 2 on the ground that cheque for premium issued by complainant was dishonoured and complainant subsequently made payment of premium by cash after lapse of 12 days and ld. counsel of o.p. nos.1 and 2 in course of argument submitted that repudiation was made due to policy of one year i.e. new policy.
Now, we find that the policy number of complainant i.e. the original policy number and subsequently renewed policy number remains unchanged and no proposal form was offered to complainant for any fresh policy and it is admitted position that o.p. nos.1 and 2 received premium in cash even after lapse of 12 days due to dishonour of cheque towards premium of policy in question.
In view of the above position and taking into consideration of the materials on record we firmly hold that with the acceptance of premium amount after lapse of 12 days from the due date, o.p. nos.1 and 2 waived such delay while in particular no fresh proposal form was offered to the complainant and consequential result is that no fresh contract was made by the parties.
That being the position we are of the views that o.p. nos.1 and 2 had sufficient deficiencies being a service provider while repudiating the claim of the complainant /consumer and complain ant is entitled to relief.
The case laws referred to by ld. counsel of o.ps. are not applicable herein this case in the context of the facts and circumstances disclosed on record.
Hence, ordered,
That the petition of complaint is allowed on contest against o.p. nos.1 and 2 with cost and against o.p. no.3 without cost. O.p. nos.1 and 2 are jointly and/or severally directed to refund medical expenses incurred by complainant for Rs.1,00,000/- (Rupees one lakh) only together with interest @ 9% p.a. from the date of repudiation till the date of realization and also to pay compensation of Rs.35,000/- (Rupees thirty five thousand) only for harassment and mental agony caused to complainant due to improper repudiation of the claim of complainant by o.p. nos.1 and 2 and to pay litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% p.a. shall accrue over the entire sum due to the credit of the complainant till full realiastion.
Supply certified copy of this order to the parties free of cost.
