NIMAI CHANDRA BHATTACHARJEE Vs. NATIONAL INSURANCE COMPANY LTD

JUDGEMENT

(1.) THIS revision petition is against the order dated 29.10.2008 of the Bihar State Consumer Disputes Redressal Commission, Patna (in short, 'the State Commission ') in First Appeal No. 266 of 2007. By this order, the State Commission affirmed the order dated 22.1.2007 passed by the District Consumer Disputes Redressal Forum, Gaya (in short, 'the District Forum '), by which the District Forum had dismissed the complaint of the petitioner.

(2.) THE petitioner/complainant had obtained a mediclaim policy from the respondent Insurance Company for his wife and himself for the period 31.3.2003 to 30.3.2004. He underwent surgery for Benign Prostatic Hypertrophy (BPH) on 23.3.2004 at a Hospital in Kolkata and was discharged on 27.3.2004. He sent a claim for reimbursement of the expenditure of Rs. 46,890 incurred by him on this surgery on 14.5.2004. The Insurance Company, however, repudiated the claim by its letter dated 9.7.2004. Against this repudiation, the petitioner represented to the Insurance Ombudsman at Kolkata. Though a copy of the Ombudsman 's final order has not been produced by the petitioner along with this revision petition, it would appear that by communication dated 16.2.2006, the Ombudsman dismissed the complaint of the petitioner holding that repudiation of the claim by the Insurance Company was justified. Thereafter, the complainant filed a complaint on 13.10.2006 with the District Forum.

(3.) ON the other hand, before the District Forum, the respondent Insurance Company opposed the complaint both on the grounds of limitation and on merits. In particular, it contended that according to Clause 4.3 of the exclusion clause of the policy, expenses on the treatment of certain diseases, including BPH were not reimbursable. In view of the fact that the complainant underwent surgery on 22.3.2004 (i.e., within one year of commencement of the policy on 31.3.2003), the claim was not payable and hence, repudiated.