DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BARNALA, PUNJAB.
Complaint Case No : 47/2015
Date of Institution : 09.03.2015
Date of Decision : 18.11.2015
Mohinder Singh Gulati son of Ram Singh, resident of H.No. 61, 22 Acre Scheme, Near Fountain Chowk, Barnala, Tehsil and District Barnala.
…Complainant
Versus
Bajaj Allianz General Insurance Company Ltd., through Branch Manager Bajaj Allianz, General Insurance Company Ltd., Opposite Parbhat Cinema Barnala, Tehsil and District Barnala.
Bajaj Allianz General Insurance Company Ltd., through Divisional Manager Bajaj Allianz Insurance Company Ltd., Feroj Ghandhi Market, Ludhiana.
Bajaj Allianz General Insurance Company Ltd. Registered Office, G.E. Plaza Airport Road, Yarwada, Pune through General Manager, Bajaj Allianz General Insurance Company Ltd.
…Opposite Parties
Complaint Under Section 12 of Consumer Protection Act, 1986.
Present: Sh. R.S. Mehta counsel for the complainant.
Sh. N.K. Garg counsel for the opposite parties.
Quorum.-
1. Shri S.K. Goel : President.
2. Vandna Sidhu : Member
ORDER
(SHRI S.K. GOEL PRESIDENT):
The complainant namely Mohinder Singh Gulati has filed the present complaint under Consumer Protection Act, 1986 (hereinafter called as Act) against Bajaj Allianz General Insurance Company Ltd., and others (hereinafter called as the opposite parties).
2. The facts emerging from the present complaint are that the complainant's son is resident at 2886 Cross-E-1 DR Abbotsford BC V2T5H3 for the last many years. The complainant visited him in Canada about many times and on every journey he insured himself with insurance company, for the period of stay in Canada. The complainant further averred that he last time visited Canada from 13.5.2011 to 9.11.2011 and he obtained an insurance policy from opposite parties on 11.6.2014 vide policy No. OC-15-1203-9910 00000405 and insured Travel/Super Age Elita (US $ 50,000), which was valid from 9 July 2014 to 4 January 2015, from the agent Ravinder Gupta having agency code 10012902. It is further averred that before obtaining the policy, his medical was done by the opposite parties from their doctor.
3. It is alleged that during his stay at Canada, he got some problem and got examined from FRASER HEALTH AUTHORITY AT ABBOTSFORD REGIONAL HOSPITAL and remained admitted from 3rd October 2014 to 6th October 2014. Various tests were done during his stay in the hospital and he had to pay Rs. 18,882.62/- Canadian Pounds for his treatment. The complainant left Canada on 21st November 2014 and came back India. The complainant lodged his claim with the opposite parties for the amount, spent by him on his treatment in Canada, but the opposite parties refused to pass the claim on the ground that the claimant has a history of Hypertension for the last 20 years. The Ischemic Attack was due to hypertension. It is further alleged that Dr. D. Ross MD, Dr. H. Moodloy MBCHB, Dr. C. Moodloy MBCHB of Dr. Clifford Moodly MBCHB Kothi No. 204-2825 Clearbroot Roat BC V2T6S3 had opined that Ischemic Attack has no concern with hypertension. It is further alleged that his son made many e-mails to the opposite parties and explained every point asked by them. However, the opposite parties refused to pay the claim. Hence, the present complaint is filed seeking the following reliefs:-
To pay 18,662/- Canadian dollar which is equal to Rs. 9,50,000/- the amount for treatment of complainant.
To pay Rs. 50,000/- for mental agony and harassment.
4. Upon notice of this complaint, the opposite parties appeared and filed a joint written version taking legal objections interalia on the grounds of claim does not fall within the purview of the insurance policy, this Forum has no jurisdiction, complainant has not come to the Forum with clean hands and the complainant suppressed the material facts. On merits, it is submitted that the complainant had obtained Insurance Plan Travel Super Age Elite (US$ 50,000). No medical from the opposite parties by paying a premium of Rs. 44,438/- valid for the period 9.7.2014 to 4.1.2015 or date of return of insured was done. It is further averred that the said insurance policy subject to terms, conditions, exclusions and limitations. As per terms and conditions of the policy, the policy does not cover pre-existing illness or disability or condition arising there from. Further, this policy does not extend coverage for any expenses incurred on, attributable to, arising out of or traceable to pre-existing ailment and as per exclusion of policy. The company shall be under no liability to make payment hereunder in respect of any claim directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the medical condition or complication arising from it, which existed before the commencement of the policy period or for which care, treatment or advice was sought, recommended by or received from physician. It is further averred that the opposite parties have rightly repudiated the claim of the complainant as he had past medical history of Hypertension since 20 years and current ailment is complication of the same, therefore present ailment is pre-existing in nature as the major complication of ailment existed before policy inception date and the policy did not cover any expenses occurred by the complainant. It is further pleaded that at the most if this Forum comes to the conclusion that the complainant is entitled to get claim from opposite parties then in that case (though the question of the same does not arise at all) the liability of opposite parties is not more than USD 8400, which can be multiply with dollar rate prevailing at the time of lodging the claim. They finally prayed for the dismissal of complaint.
5. In order to prove his case, the complainant tendered in evidence copy of passport of complainant Ex.C-1, copy of policy Ex.C-2, copy of patient history dated 3.10.2014 Ex.C-3, receipt 945$ Ex.C-4, receipt dated 2.11.2014 Ex.C-5, receipt dated 20.11.2014 for 75$ Ex.C-6, receipt Fresher Health dated 6.11.2014 Ex.C-7, official reception receipt dated 6.10.2014 Ex.C-8, official reception receipt dated 10.11.2014 Ex.C-9, copy of bill dated 30.10.2014 Ex.C-10, copy of receipt of 296$ Ex.C-11, copy of receipt of 175$ Ex.C-12, copy of credit receipt dated 11.12.2014 Ex.C-13, Fraser Valley MRI dated 12.11.2014 Ex.C-14, opinion letter dated 19.10.2014 Ex.C-15, copy of Overseas Travel Insurance Claim Form Ex.C-16, copies of E-mails Ex.C-17 to Ex.C-31, copy of letter of Dr. Stephan Botha dated 16.11.2014 Ex.C-32, copy of FINAL Diagnatoc Imaging Report dated 12.11.2014 Ex.C-33, Invoice dated 10.10.2014 Ex.C-34 and his own affidavit Ex.C-35 and closed the evidence.
6. To rebut the case of the complainant, the opposite parties tendered in evidence affidavit of Navjeet Singh Ex.O.P1.2.3/1, copy of insurance policy Ex.O.P1.2.3/2, copy of receipt Ex.O.P1.2.3/3, copy of terms and conditions Ex.O.P1.2.3/4, copy of claim form Ex.O.P1.2.3/5, copy of attending physician statement Ex.O.P1.2.3/6, copy of opinion of Doctor Ex.O.P1.2.3/7, copy of Medical record Ex.O.P1.2.3/8 & Ex.O.P1.2.3/9, copy of E-mails Ex.O.P1.2.3/10 to Ex.O.P1.2.3/43, copy of repudiation letter Ex.O.P1.2.3/44 and closed the evidence.
7. We have heard the Ld. Counsels for the parties and have gone through the documents.
8. Firstly, the Ld. Counsel for the opposite parties has contended that this Forum has no territorial jurisdiction to entertain and try the present complaint. He has further contended that the policy has been issued by the Ludhiana Branch of Bajaj Allianz General Insurance Company. Moreover, there is no office of Bajaj Allianz General Insurance Company at Barnala. The alleged medical treatment was got by the complainant in Canada. However, the complainant has wrongly made the opposite party No. 1 as the party through Branch Manager Bajaj Allianz General Insurance Company at Barnala just to make the jurisdiction of this Forum, which is misuse of process of law.
9. On the other hand, Ld. Counsel for the complainant has contended that the office of the Bajaj Allianz General Insurance Company is at Barnala and cover note was also issued at Barnala and therefore this Forum at Barnala has the territorial jurisdiction to try this case.
10. It is relevant to refer the cover note placed on record by the complainant Ex.C-2. Perusal of the same shows that the complainant has got insurance for the period from 9.7.2014 to 4.1.2015. It further shows that the Registered Office is mentioned as “GE Plaza, Airport Road, Yerwada, Pune-411006 (India)”. The said cover note has been signed by the authorized signatory and the same is bearing Ludhiana Branch stamp. This mean that the cover note has been issued by the Ludhiana Branch Office of the opposite parties. The onus to prove that the cover note was issued by the Barnala Branch is upon the complainant, but he has miserably failed to prove on record that the cover note was issued at Barnala. Moreover, there is no receipt showing the payment of the premium at Barnala Branch. Even no cogent evidence has been produced by the complainant to prove that the cause of action has arisen at Barnala.
11. It was laid down by the Hon'ble Apex Court of India in case titled Sonic Surgical Vs National Insurance Company Ltd. reported in 2010 (1) CLT 252:
“when the insurance policy was taken at Ambala and the claim for compensation was also made at Ambala and since no cause of action arose at Chandigarh, the State Consumer Disputes Redressal Commission, Chandigarh, has no territorial jurisdiction and State Consumer Disputes Redressal Commission, Haryana alone will have jurisdiction to entertain the complaint. The Hon'ble Apex Court further observed that Expression 'branch office' is amended Section 17(2)(6) would mean the branch office where the cause of action has arisen”.
12. Similar observation was also observed by the Hon'ble National Commission in the case titled Ram Murti Smarak Institute of Medical Sciences & Anr. Vs Radhey Sham & Anr. III (2015) CPJ 151 (NC).
13. In view of above discussion, the complainant has miserably failed to prove the jurisdiction of this Forum. Therefore, the complaint is ordered to be returned to the complainant against valid receipt with the liberty to file the same in the Appropriate Forum, if so advise as per rules. Copy of this order be supplied to the parties free of costs.
ANNOUNCED IN THE OPEN FORUM:
18th Day of November, 2015.
(S.K. Goel)
President.
(Vandna Sidhu)
Member.
