In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, 4^th Floor, Kolkata-700087.

CDF/Unit-I/Case No. 230 / 2011.

1)                   Jayanta Sarkar,

            74/34, P. Majumdar Road, Baishalipally,

            P.O. Haltu, P.S. Kasba, Kolkata-700078.                                                 ---------- Complainant

---Versus---

1)                   United India Insurance Co. Ltd.,

24, Whites Road, Chennai-600014.

2)                   Regional Manager, United India Insurance Co. Ltd.,

Regional Office, Himalaya House, 2^nd Floor,

38B, J.L. Nehru Road, Kolkata-700071.

3)                   Divisional Manager, United India Insurance Co. Ltd.,

Divisional Office-VIII, C.I.T. Complex, Dakshinpara,

2, Gariahat Road, South, Kolkata-700068.

4)                   Manager / Authorised Officer, Heritage Health TPA Pvt. Ltd.,

Nicco House, 5^th Floor, 2, Hare Street, Kolkata-700001.

5)                   Tapan Dutta, Agent of United India Insurance Co. Ltd.,

C-1, (3^rd Floor), 221, Rajdanga Main Road, Kolkata-700107.

6)                   Manager representing National Insurance Co. Ltd.,

            3, Middleton Street, Kolkata-700071.                                                      ---------- Opposite Parties

Present :           Sri Sankar Nath Das, President.

                        Dr. Subir Kumar Chaudhuri, Member.

                        Smt. Sharmi Basu, Member

Order No.   17    Dated  31/08/2012.

          The petition of complaint has been filed by the complainant against the o.ps. United India Insurance Co. Ltd. and others. The case of the complainant in short is that complainant took a mediclaim policy from the proforma o.p. namely National Insurance Co. Ltd. in the Dec. 2006 for him and his parents and his sister and then one insurance agent namely Sri Tapan Dutta o.p. no.4 apprised that since there were 3 consecutive claim free three years of insurance under one insurance company and to switch over to  United India Insurance Co. Ltd. would ensure all my advantages / amenities of a continuous policy and he stated and asserted in uncertain terms that transfer of the policy from National Insurance Co. Ltd. to United India Insurance would not hamper any of the advantages of his previous policy and would be treated as a continued policy and since the year of inception i.e. 2006.

            Accordingly he paid premium to the United India Insurance Co. Ltd. in Dec. 2009 and Dec.2010 and the new policy schedule bears the earlier policy no. of N.I.C. Co. Ltd. showing infallibly the continuation of the policy chain. Thereafter, due to some eye problems creped up he took his mother Smt. Shanti Sarkar to Disha Eye Hospital and Dr. Manas Ghosh advised cataract surgery and accordingly the date of operation was fixed to be 27.12.10 and accordingly he submitted all the relevant papers for cashless facility for the operation of his mother to the United India Insurance Co. Ltd. On 24.12.10 just 3 days prior to the date of operation when we were mentally and in other ways ready for the operation on 27^th, Disha Eye Hospital informed that the TPA has declined to extend cashless benefit on the ground that their policy was less than two years duration. Hence the case was filed by the complainant with the prayer contained in the prayer portion of the petition of complaint.

            O.p. nos.1 ,2 & 3 had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed or dismissal of the case. O.p. nos.4, 5 & 6 did not contest the case by filing w/v and matter was heard ex parte against o.p. nos. 4, 5 & 6

Decision with reasons:

            We have gone through the pleadings of the parties and evidence and documents in particular and we find that o.ps. have deficiencies being service provider to their consumer / complainant and complainant is entitled to relief.

            Hence, ordered,

            That the case is allowed on contest against o.p. nos.1,2 & 3 with cost and ex parte against o.p. nos.4, 5 & 6 with cost against o.p. no.6 and without cost against o.p. nos.4 & 5. O.p. nos.1,2,3 & 6 are directed to extend cashless facility of the policy of the complainant as a continuous one since its inception and are further directed to pay compensation  of Rs.75,000/- (Rupees seventy five thousand) only for mental agony and harassment sustained by the complainant and are further directed 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% 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.