NIMAI CHANDRA BHATTACHERJEE SON OF LATE KUMUD NATH BHATTACHARJEE Vs. SENIOR DIVISIONAL MANAGER DIVISIONAL OFFICE

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 22.01.2007 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 31.03.2003 to 30.03.2004. He underwent surgery for Benign Prostatic Hypertrophy (BPH) on 23.03.2004 at a Hospital in Kolkata and was discharged on 27.03.2004. He sent a claim for reimbursement of the expenditure of Rs.46,890/- incurred by him on this surgery on 14.05.2004. The insurance company, however, repudiated the claim by its letter dated 09.07.2004. 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 16.02.2006, 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.) THE complainant's case before the District Forum was that copy of the terms and conditions of the policy had not been supplied to him when he filled in the proposal form for the said policy. As such, he was not aware of clause 4.3 under which expenses incurred by the insured for the treatment of certain diseases like Cataract, BPH, etc., within the first year of operation of the policy were not payable. Moreover, he urged that he wrote to the local office of the Insurance Company on 27.01.2004 as well as on 17.03.2003 informing the latter of his disease and the urgent need of having to undergo the requisite surgery. There was, however, no response to these letters from the insurance company and as such he assumed that expenses on the surgery of BPH were payable under the mediclaim policy.