BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
Complaint No.:142 of 2013.
Date of Institution: 03.04.2013.
Date of Decision:05.04.2017
Suman Singh Chauhan son of Shri Upendra Singh, resident of J2 Bharat Nagar, near M.C. Colony, Bhiwani.
….Complainant.
Versus
- Bajaj Allianz Insurance Co. Ltd., 2nd Floor, Bajaj Finsery Building, Survey No. 208/B-1, Behind Welkfield IT Park, Off Nagar Road, Viman Nagar, Pune (Maharastra).
- Bajaj Allianz Insurance Co. Ltd., through its Branch Manager having one of its branch office at SCO No. 226-227, 2nd Floor, Sector 12, Karnal (Haryana).
- Bajaj Allianz Insurance Co. Ltd., through its Branch Manager having one of its branch office in front Dr. Majithia, 2nd Floor, above Richlook showroom, near Bank of Baroda, Circular Road, Bhiwani.
…...Opposite Parties.
COMPLAINT U/S 12 & 13 OF CONSUMER PROECTION ACT.
BEFORE: - Shri Rajesh Jindal, President
Mr. Parmod Kumar, Member
Present:- Shri D.N. Saini, Advocate for complainant.
Shri Satender Ghangas, Advocate proxy counsel of
Shri A. Sardana, Advocate for Ops.
ORDER:-
Rajesh Jindal, President:
The case of the complainant in brief, is that the complainant had taken a health insurance policy in his name vide policy no 0G-12-12066009-00000037 dated 30.11.2011 under plan STAR-PACKAGE from the respondent insurer which was commencing from 26.11.2011 and was valid for one year till 25.11.2012. It is alleged that the policy in question was purchased from one of the branch office of the respondent insurer i.e. OP no. 2. It is alleged that during the currency of the aforesaid policy, the complainant suffered from an ailment of acute cellular rejection-biopsy proven Renal allograft Recipient and he was admitted in a hospital Medanta-The Medicity on 22.01.2012, where he underwent kidney transplant on 23.01.2012 with his mother as donor and one of his kidneys was transplanted, he remained under treatment and he was discharged on 31.01.2012. It is alleged that the complainant suffered an expenses of Rs. 3,52,724.76 as per hospital bill No. GHIPBL/12044992 dated 31.01.2012 issued by the hospital. It is alleged that the complainant lodged his claim and informed about his ailment, treatment being taken from the hospital and for cashless hospitalization. It is alleged that the Ops repudiated the claim of the complainant vide letter dated 21.03.2012 on the ground that “verification of the claim documents reveal that the patient is a known case of Hypertension & CAD since 2008 which is prior to inception of the policy but this material information was not disclosed in the proposal form to the respondent at the time of availing the captioned policy, hence the claim is not payable. The complainant further alleged that due to the act and conduct of the respondents, he had to suffer mental agony, humiliation and harassment. Hence, it amounts to deficiency in service on the part of respondents and as such he had to file the present complaint.
2. On appearance, the OPs filed written statement alleging therein that as per the documents produced by the complainant along with the claim, he was suffering from Kidney disease since 2008 but he intentionally and deliberately concealed this fact from the respondent company at the time of obtaining the policy. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of opposite parties and complaint of the complainant is liable to be dismissed with costs.
3. In order to make out his case, the counsel for complainant has tendered into evidence affidavit CW1/A and documents Annexure C-1 to Annexure C-33 alongwith supporting affidavit.
4. On the other hand, counsel for Ops has tendered into evidence documents Annexure R-1 to Annexure R-11.
5. We have gone through the record of the case carefully and have heard the learned counsels for the parties.
6. Learned counsel for the complainant reiterated the contents of the complaint. He submitted that the complainant had taken the health insurance policy commencing from 26.11.2011 valid upto 25.11.2012 from OP no. 2 having its office at Karnal. The complainant suffered from ailment of acute cellular rejection-biopsy proven Renal allograft Recipient and he had taken the treatment from Medanta-The Medicity, Gurgaon and underwent kidney transplant on 23.01.2012. The complainant suffered an expenses of Rs. 3,52,724/- vide hospital bill dated 31.01.2012. The complainant lodged the claim to Ops for reimbursement. The Ops repudiated the claim of the complainant vide letter dated 21.03.2012 on the ground of concealment of prior disease to the respondent at the time of taking the policy in question. He submitted that the claim of the complainant has been illegally repudiated by the Ops.
7. Learned counsel for the OPs reiterated the contents of the reply. He submitted that on the verification of claim documents it was found that the complainant is a known case of hyper tension and CAD since 2008 which is prior to the issue of the present policy in question but the complainant did not disclose the said information in the proposal form to the insurance company at the time of getting the policy. Therefore, the claim of the complainant is payable as per the terms and conditions of the insurance policy. He further submitted that this District Forum has no jurisdiction to try and decide the complaint because the complainant had taken the policy in question from Karnal and he has taken the treatment at Gurgaon, and no cause of action has accrued to the complainant within the territorial jurisdiction of this District Forum. The complainant relied upon the following judgments:-
I Venkata Krishna Versus United India Insurance Co. Ltd. & Ors. III (2016) CPJ 480 of Hon’ble National Commission, New Delhi.
II Kailash Chand Jain Versus National Insurance Co. Ltd. & Ors. III (2016) CPJ 57 of Rajasthan State Commission, Jaipur.
8. In the context of the pleadings and arguments of the parties, we have examined the relevant record, carefully. Indisputably, the policy in question was taken by the complainant from Karnal and the complainant has taken the treatment at Gurgaon. Therefore, it cannot be said any part of cause of action has arisen within the territorial jurisdiction of this District Forum. In view of the law laid down by the Hon’ble Supreme Court of India in case of Sonic Surgical Versus National Insurance Company Ltd. IV (2009) CPJ 40. We hold that this District Forum has no territorial jurisdiction to try and decide this present complaint. Therefore, we dismiss the complaint of the complainant on the ground of territorial without going into the merits of the case. The complainant shall be at liberty to take legal recourse before the competent Forum/Court of law, as per the provisions of law, if so advised. The complainant can take the benefit of law laid down by Hon’ble Supreme Court Laxmi Engg. Works Vs P.S.G. Industrial Institute-II (1995) CPJ-I Supreme Court on the point of limitation. Certified copies of the order be sent to the parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 05.04.2017.
(Rajesh Jindal)
President,
District Consumer Disputes
Redressal Forum, Bhiwani.
(Parmod Kumar)
Member
