Star Health and Allied Insurance Co. Ltd. Vs Priya Nandy and Ors. — Calcutta HC (2024) — LawSathi Research

Star Health and Allied Insurance Co. Ltd. Vs Priya Nandy and Ors. — Calcutta HC (2024) — LawSathi Research

What the court decided

AI extract

Outcome

Delay in filing the appeal condoned (CAN 1 of 2024 allowed); appeal disposed of; all observations and findings of the learned Single Bench vacated with all issues (including maintainability of the writ petition against the insurer and interpretation of policy terms) left open; expenses incurred prior to 11.05.2024 declared eligible for reimbursement per policy terms; learned Single Bench requested to pass appropriate orders in the contempt proceedings so that Insurance Company officials need not be physically present in court.

Issue for consideration

Whether the delay of 16 days in filing the appeal should be condoned (CAN 1 of 2024). +2 more

Court's answer

The delay in filing the appeal was sufficiently explained and the appellant was prevented from filing within time on account of bona fide reason; CAN 1 of 2024 is allowed and the delay in filing the appeal is condoned.

Ratio / Principle

Since the issue raised by the writ petitioner now stands resolved (cashless facility sanctioned on 11.05.2024), all observations and findings recorded by the learned Single Bench are vacated and all issues are left open, including whether a writ petition was maintainable against the appellant/Insurance Company with regard to the interpretation of the terms and conditions of the insurance policy.

Key takeaways

Since the cashless facility was extended to writ petitioner no.2 on 11.05.2024, expenses for Lab Test and other matters incurred by the claimant prior to 11.05.2024 are also eligible for reimbursement in accordance with the terms and conditions of the policy.ratio¶¶23
Taking note of the above order, the Division Bench requested the learned Single Bench to pass appropriate orders in the pending contempt proceedings so that the officials of the Insurance Company may not be required to be physically present in court.ratio¶¶24

Detailed headnote1 paragraphs

Intra-court appeal (MAT 501 of 2024) by Star Health and Allied Insurance Co. Ltd. against a learned Single Bench direction in a writ petition requiring the insurer to provide cashless facility for surgery to the second writ petitioner. During pendency, the cashless facility was sanctioned on 11.05.2024. The Division Bench condoned the 16-day delay in filing the appeal (CAN 1 of 2024), found the matter resolved, vacated all observations and findings of the learned Single Bench, and expressly left open all issues, including whether a writ petition is maintainable against the insurer with regard to interpretation of the terms and conditions of the insurance policy. The Bench directed that expenses for Lab Test and other matters incurred by the claimant prior to 11.05.2024 are eligible for reimbursement in accordance with the policy terms. As a Contempt Rule was pending before the learned Single Bench, the Division Bench requested the Single Bench to pass appropriate orders so that officials of the Insurance Company need not be physically present in court. Appeal disposed of.

16.05.2024 Item No.11 gd/ssd

MAT/501/2024 IA NO: CAN/1/2024, CAN/2/2024 STAR HEALTH AND ALLIED INSURANCE CO. LTD. VS

PRIYA NANDY AND ORS.

Mr. Krishnendu Gooptu, Mr. Soumendra Nath Ganguly, Mr. Vivekananda Das ..for the Appellant.

Mr. ……………………………… ..for the Respondent/ Writ Petitioners.

Mr. Rajesh Singh ..for the Respondent No.3.

Re: CAN 1 of 2024

This application has been filed by the appellant seeking condonation of delay of 16 days in filing this appeal.

Learned counsel for the appellant has referred to the explanation which has been furnished in the application and also has made submission in respect of the explanation for the delay.

We find that the delay in filing this appeal has been sufficiently explained and the appellant was prevented from filing the appeal within time on account of bona fide reason.

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Hence, CAN 1 of 2024 is accordingly, allowed. The delay in filing the appeal is condoned.

Re: MAT 501 of 2024

This intra court appeal by the Star Health and Allied Insurance Co. Ltd. is against a direction issued by the learned Single Bench in a writ petition filed by the respondents herein where a request was to provide them with cashless facility for undergoing surgery.

The learned Single Bench has interpreted the terms and conditions and has come to the conclusion that the appellant/Insurance Company cannot refuse the cashless facility to the second respondent herein, the second writ petitioner.

The learned advocate for the appellant contended that the writ petition was not maintainable, the contract was a private contract.

The learned advocate for the writ petitioner submitted that during the course of argument the learned advocate for the Insurance Company has given up this issue regarding maintainability of the writ petition. Thereafter the matter was heard and disposed of.

In this appeal several grounds have been raised not only with regard to the maintainability but also with regard to the interpretation of the terms and conditions of the insurance policy.

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We are informed by the learned advocate for the respondent/writ petitioner that last Saturday i.e. on 11^th May, 2024 the cashless facility has been sanctioned to the patient/writ petitioner by the appellant/Insurance Company.

In the light of the above, we are of the view that a quietus can be given to the matter.

However, bearing in mind, the grounds which have been canvassed before us, since the issue raised by the writ petitioner as now stands resolved, we are inclined to vacate all the observations and findings recorded by the learned Single Bench and leave all issues open including whether a writ petition was maintainable against the appellant/Insurance Company with regard to the interpretation of the terms and conditions of the insurance policy.

Since the cashless facility has been extended to the writ petitioner no.2 on 11.05.2024, in respect of expenses for Lab Test and other matters which was incurred by the claimant prior to 11.05.2024 is also eligible for reimbursement in accordance with terms and conditions of the policy.

Since the Contempt Rule has been issued in the contempt proceedings by the learned Single Bench, taking note of the above order we request the learned Single Bench to pass appropriate orders so that the

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officials of the Insurance Company may not be required to be physically present in court.

With the above observations, the appeal

stands disposed of.

(T. S. SIVAGNANAM) CHIEF JUSTICE

(HIRANMAY BHATTACHARYYA, J.)