In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 97 / 2008 1) Sri Sahadeb Poddar, 324, Swami Vivekananda Road, Kolkata-700026. ---------- Complainant ---Verses--- 1) United India Insurance Co., Divisional Office : 011100, Sudarshan Building, Old No. 14, Whites Road, Chennai-600014. 2) Family Home Plan Ltd. (TPA), 16/2, Lake View Road, Kolkata-29. 3) Indian Overseas Bank, Lake Market Branch, 89, Rash Behari Avenue, Kolkata-26. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattachatya, Member. Smt. Dipa Sen (Maity), Member. Order No. 1 5 Dated 2 4 / 1 2 / 2 0 0 9 . This is a case filed by one Sri Sahadeb Poddar of 324, Swami Vivekananda Road, P.S. Jadavpur of Kolkata-26, u/s 12 of C.P. Act, 1986 in respect of insurance claim on the ground of deficiency of service. Brief facts relating to the case is that the complainant bought a policy no.2006/484100198/31 from o.p. no.1 United India Insurance co. through o.p. no.3, Indian Overseas Bank; on 24.3.06 towards medical insurance for a period from 24.3.06 to 23.3.07 for sum insured amount of Rs.50,000/- only. The complainant earlier had the policy with national Insurance Co. since 20.11.03 till 31.5.06 and due to some administrative disorder he switched over to o.p. no.1 United India Insurance Co. The complainant was admitted in Woodland Medical Centre on 25.12.06 and his TUR Prostrate was operated on 26.12.06 and finally discharged on 30.12.06 after payment of Rs.54,391/- only. After that on 11.1.07 the complainant approached to the o.p. no.1 with a claim of Rs.50,000/- by filing the claim form. But on 17.1.07 o.p. no.2 (TPA) sent an intimation letter to proforma o.p. Indian Overseas Bank, stating that the claim has been repudiated. Thereafter, the complainant approached several times regarding his claim and being extremely dissatisfied send advocate’s letter to the o.p. no.1 and without getting any redressal came before the forum for redressal of his grievances. On the other hand, in spite of proper service of notices o.p. nos.2 and 3 not appeared or not taken any step. O.p. nos.1 has appeared but not filed any w/v or not present at the time of hearing. As such, the case was heard ex parte against all o.ps. Let us see whether the complainant is able to prove his own case or not. Decision with reasons :- The complainant has stated that he was admitted in Woodland medical Hospital for operation of his TUR Prostrate gland. And after that he has lodged his claim of amount of Rs.50,000/- along with all supporting documents. But the insurance company sent an intimation to the o.p. no.3 that the claim is repudiated under exclusion clause 4,3 . At the time of hearing the ld. Advocate of the complainant submits that in spite of several request and in spite of submission of all document his client’s claim was repudiated. As the o.ps. has not taken any steps, the statement made by the ld. advocate of the complainant remain unchanged and unconverted. On perusal of the petition of complaint and from the materials on record it appears that the complainant has taken the mediclaim policy after payment of premium. As such, we can consider that as he has hired the service of insurance company after payment of consideration money and he is a consumer within the purview of C.P. Act, 1986. On perusal of the discharge summary it appears to us that the complainant was admitted in Woodland medical Hospital for treatment of his TUR Prostrate gland on 25.12.06 and was discharged on 30.12.06 and the claim form was lodged by the complainant and the same was received by the o.p. insurance company on 11.1.07. On 17.1.07 the o.p. insurance company intimated o.p. no.3 about their repudiation of claim under the 1st year exclusion clause. But from the letter of o.p. no.2 dt.5.2.07 addressed to the o.p. no.1 we find that the policy no.2006/48100198/31 is a continuous policy of earlier policy with National Insurance Co. Ltd. bearing no.101900/48/05/8500001003. That the same policy of National Insurance Co. was taken on 20.11.03. From the letter dt.15.2.07 of o.p. no.3 it became clear to us that the complainant has charged over to United India Health Policy only due to their solicitation and the said policy is a continuous policy. Moreover, from the letter signed by the Senior Manager, Indian Overseas Bank , Rashbehari Branch dt.4.7.07 it has been stated that the photocopies of health cards issued by United India Insurance Co. were already faxed to the o.p. no.3. From the records we also find those Xerox copies of health cards since 2003. Considering the facts and circumstances we are of the view that the complainant’s insurance policy is a continuous policy. As such, repudiation of the claim on the ground that the claim fall under the 1st year exclusion clause is unconstitutional, arbitrary and unethical. Hence, Ordered, that the case no.97 of 2008 is allowed ex parte. The o.p. nos.1 and 2 are directed to pay the sum assured amount Rs.50,000/- (Rupees fifty thousand) only along with 10,000/- (Rupees ten thousand) only as compensation for his mental agony and harassment suffered by him along with cost of Rs.2000/- (Rupees two thousand) only within sixty days from the date of this order, failing which o.ps. will pay the interest @ 8% p.a. till the date of realization. Supply certified copy of this order to the parties on payment of prescribed fees. _____Sd_____ ____Sd-_____ ______Sd-______ MEMBER MEMBER PRESIDENT | 
