In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 21 / 2007. 1) Smt. Sarmistha Saha, 112-P, Sarat Ghosh Garden Road, Kolkata-700031. ---------- Complainant ---Verses--- 1) United India Insurance Co. Ltd., 2, Gariahat Road, Kolkata-700068. 2) The Sr. Divisional Manager, United Insurance Co. Ltd., Division Office-VIII, 2, Gariahar Road, Kolkata-700068. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattacharya, Member Order No. 2 8 Dated 2 3 / 0 2 / 2 0 1 0 . Smt. Sarmistha Saha, the complainant on 15.1.07 by filing a petition of complaint u/s 12 of C.P. Act, 1986 has prayed for directing the o.ps. to make payment of the claim of Rs.83,021/-, compensation to the tune of Rs.20,000/- and passing further order/orders as deemed fit and proper (by the Forum). Fact of the case in short is that the complainant’s husband Sri Gautam Saha on payment of requisite premium became a mediclaim policy holder being the policy no.041700/48/03/-1515 along with his (1) wife Smt. Sarmishtha Saha, (ii) daughter Ayoshna Saha and (iii) son Ayonjan Saha for the period from 2.1.04 to midnight of 1.1.05 under the o.p. United India Insurance Co. Ltd. (annex- page 11 @ 12). She, the complainant, suffered from cartilage problem consequent to her falling down from the stairs at her changed residence at 112-P, Sarat Ghosh Garden Road, Pantadeep Housing Society, Flat no.B-1, Kasba Rathtala, Kolkata-31 (annex- page 3) and made contact with Dr. Kalyan Mukherjee, the eminent doctor attached with Lansdowne Nursing Home, Kolkata and for her proper treatment by him, she was admitted in the said nursing home on 28.5.04 and discharged on 11.6.04 (annex- page 13 & 14). Complainant’s husband informed the o.p. on 30.9.05 that he did noit receive he FHP cards and as such, requested the o.p. to send the said FHP cards at the earliest, since 1½ years have already been elapsed vide his letter dt.30.9.05. The complainant submitted her claim on 11.10.04 along with all documents as per requirement, but the o.p. kept the same pending for long (annex- page 13 & 15). The complainant submitted her claim on 11.10.04 and contacted the o.ps., but finally on 30.9.05 the o.p. no.1 informed the complainant at their Gurgaon address that they could not pay the claim due to delayed submission of the claim and non-submission of past treatment records and discharge certificate (annex-page13-15 of the petition of complaint). But in spite of the contact made by the complainant with the o.ps., the o.p. no.1ultimately on 30.9.05 informed the complainant from their Gurgaon address that they could not pay the claim due to delayed submission of the claims and non-submission of past treatment and discharge certificate. The o.ps. denied the claim on the ground that as the complainant has already stated that though the o.ps. have not supplied the FHP cards and as such, the rules and regulations were not in the knowledge of the complainant. Moreover, the complainant submitted all necessary documents to the o.p at their Kolkata Branch on 28.10.04 and as such, the allegations of the o.ps. have no merits at all. The o.ps. did not consider the papers and documents filed by the complainant in respect of her claim carefully and due to such reasons they denied the claim arbitrarily and whimsically without any rationality. In view of the situation above, the ld. Advocate on the instruction of the complainant issued a notice on 31.10.06 sent by a regd. post with a/d and the said letter was duly received by the o.p., but no reply or respond was made on the part of the o.ps. (annex-page 18-22). And since there was no response to the lawyer’s letter from the o.ps., the complainant has filed this case. O.ps. though appeared by filing vakalatnama but did not file any w/v was evident from the records, but they raised the question of territorial jurisdiction of this ld. Forum to adjudicate this case vide their petition filed on 26.2.09 and BNA dt.19.6.09. The complainant, of late, prayed for impleading the Delhi office of the o.ps. as a necessary party which was not done inadvertently. Since this inclusion shall not change the character and nature of this case, no objection was raised on behalf of o.p. nos.1 and 2. Accordingly, the proposed amendment was allowed, vide order no.7 dt.20.8.07 and in accordance with order no. 8 dated 5.9.07 the address of the o.p. no.3 was corrected. It is evident from the perusal of the petition of complaint that o.p. no.2 Sr. Divisional manager, United Insurance Co. Ltd., Division no.VIII has been impleaded in their local address at 2, Gariahat Road (S), Kolkata-68. In view of the position, it cannot be said that the present case is not maintainable on the ground of territorial jurisdiction. Moreover, the argument put forward by o.p. no.2 in his pettion dt.26.2.09 that o.p. no.3, the policy issuing office situated at new Delhi is an independent unit having no connection with o.p. no.2 is not only funny but also baseless, since they are working under the same umbrella of United India Insurance Co. Ltd. Again, it appears from the documents on record that the complainant suffered from cartilege problem and was admitted in Lansdowne Nursing Home under Dr. Kalyan Mukherjee, FRCS on 28.5.04 and discharged on 11.6.04 (annex-P-13, P-14 of the petition of complaint) and the claim form duly filled up was submitted at the office of o.p. no.2 on 11.10.04). If o.p. no.3 policy issuing office is an independent unit, then how the claim for reimbursement has been repudiated by the insurance company. This apart, the complainant in her letters as well as her advocate’s letter, has well explained the reasons for which delay (not much) in submitting the claim occurred (annex-P-1 & P-19 to 22 of the petition of complaint). In this connection, the observation made by the Hon’ble Supreme Court of India (CP) p 794 in United India Insurance Co. Ltd. v. Manubhai Dharmasinghbhai Gajera and others is worth mentioning, which is as follows – “No escape from the fact that the appellants are ‘State’ within the meaning of Article 12 of the constitution of India – Being a State, they have a different role to play – Fairness or reasonableness on their part must appear in all their dealings – Functions of the insurance companies are also governed by their statute – Insurance Act applies to them – Public Sector insurance companies also bound by the directions issued by the General Insurance Corporation as also the Central Government – A contract of insurance, therefore, must subserve the statutory provisions – It must also necessarily be construed having regard to the larger public policy and public interest”. It is evident from the documents on record that the o.ps. are all along silent about non-despatch of FHP card which should have been sent to the complainant immediately after the receipt the premium of the mediclaim policy. Moreover, the o.ps. have neither filed any evidence, oral or documentary whatsoever. They have filed only BNA wherein they have admitted that the mediclaim policy was issued to the complainant by them. But their contention that the complainant did not annex the policy before the ld. Forum is just a wishful thinking since the copy of the said policy is annexed with the petition of complaint (annex-P11 & 12). The complainant has stated in her BNA that she submitted the claim for reimbursement of the amount for medical expenses which was whimsically repudiated by the o.ps. On going through the pleadings, documents on record and records, we are of the opinion that he documents are corroborative in nature with the pleadings and accordingly the complainant is entitled to get the relief as prayed for. Hence, ordered, that the petition of complaint is allowed on contest. The o.ps. are directed to make payment jointly and/or severally Rs.83,021/- (Rupees eighty three thousand twenty one) only within 45 days from the date of communication of this order and in default, the amount will carry interest @ 10% p.a. till full realization of the amount. The complainant does also get an award of Rs.10,000/- (Rupees ten thousand) only as compensation and Rs.5000/- (Rupees five thousand) only as litigation cost. The o.ps. are directed to make payment of these compensation amount and litigation cost within 45 days from the date of communication of this order and in default, the above amounts will carry an interest @ 10% p.a. till full recovery. Fees paid are correct. Supply certified copy of this order to the parties on payment of prescribed fees. _____Sd-____ _____Sd-______ MEMBER PRESIDENT | 
