Delhi

East Delhi

CC/35/2019

SHANTI LAL PORWAL - Complainant(s)

Versus

MAX BUPA HEALTH INS. - Opp.Party(s)

29 Mar 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. NO. 35/19

 

Shanti Lal Porwal

R/o F-40, Preet Vihar

Vikas Marg, Delhi                                                                       ….Complainant

Vs.     

 

Max Bupa Health Insurance Co. Ltd.

Corporate Office:

Block B1/1-2, Mohan Cooperative Industrial Estate

Mathura Road, New Delhi – 110 044                                          …Opponent

 

 

Date of Institution: 23.01.2019

Date of Order: 02.04.2019

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By: Sh. Sukhdev Singh (President)

 

 

ORDER

            This complaint has been filed by Shri Shanti Lal Porwal against Max Bupa Health Insurance Co. Ltd. (OP) under Section 12 of the Consumer Protection Act, 1986 with allegations of unfair trade practice and deficiency in service.

            The facts in brief that complainant Shanti Lal Porwal, on the assurance of Shri Mahavir Aggarwal, agent of Max Bupa Health Insurance Co. Ltd. (OP), have a mediclaim policy under the plan termed as “Family First Silver 2L + 15L” which was issued to him vide policy                         no.  30314463201804, commencing w.e.f. 28.03.2018 to 27.03.2019 for a sum of Rs. 19,40,000/- on paying a premium of Rs. 57,499/-. 

            On 03.07.2017, the complainant felt some urinary complications and consulted Dr. Yogesh Jhamb at Pushpanjali Medical Centre, Karkardooma, Delhi, but his problem was not cured.  He approached Indraprastha Apollo Hospital, New Delhi where he undergone medical tests and was diagnosed as suffering from Prostate disease.  He underwent an operation which costed him Rs. 2,04,707/-.  M/s. Max Bupa Health Insurance Co. Ltd. (OP) sanctioned an amount of Rs. 1,90,000/- which was later on rolled back.  He applied for the claim of cost incurred on his treatment, but was surprised that his claim was repudiated through its report of dated 25.04.2018.  The basis of the repudiation was that complainant had history of Hypertension since 10 years which falls prior to the policy inception date which he did not disclose.  Thus, the complainant have stated that the repudiation of his claim was deliberate and intentional which amounts to deficiency in service.  Hence, he has prayed for payment of Rs. 2,36,387 towards medical expenses alongwith 18% interest; Rs. 1,00,000/-  compensation on account of harassment and Rs. 35,000/- towards cost of litigation.

 

Heard on admission.

The first and the foremost point which have arisen for consideration has been with regard to the jurisdiction of this Forum.From the memo of parties, it has been noticed that complainant have impleaded Max Bupa Health Insurance Co. Ltd. (OP) who was having is corporateoffice at Mathura Road, New Delhi.When counsel for complainant have beenquestioned in respect of jurisdiction, he has stated that he has received the repudiation letter at his residence, hence, this Forum was having jurisdiction.

Further, he has relied upon a judgement of Hon’ble Delhi High Court in Delhi State & District Consumer Courts Practitioner Welfare Association (Regd.) vs. Lieutenant Governor & Ors., WP (C)11424/2016 & CM No. 44784/2016,  where district forums have been directed to ensure that they abide by the principles laid down by the Hon’ble State Commission in their decisions.

To the first point of the complainant, his plea has been that since has received a repudiation letter at his home address i.e. Preet Vihar, Vikas Marg, part of cause of action have arisen within the jurisdiction of this forum.The jurisdiction of this forum can be invoked on the basis of cause of action or part of cause of action having arisen within the jurisdiction of this forum.Merely, by receiving a letter does not amount to cause of action or part of cause of action.Thus, this plea of Ld. Counsel for the complainant goes.

Coming to the second argument of Ld. Counsel for the complainant that the district forums have to comply with the principles laid down by the Hon’ble State Commission in their decisions, if this order is perused, it is noticed that reference has been made in this order to the judgement of Hon’ble State Commission in revision petition no. 07/18 Singh’s Dental Hospital vs. Amrit Lal Dureja, where it was observed that city of Delhi was one district and other district forums has jurisdiction over every case and if any district forum takes final decision in the matter, irrespective of having no administrative territorial jurisdiction, the order cannot be set aside. 

            The directions given by the Hon’ble High Court, in Delhi State and District Consumer Courts practitioners’ welfare association (supra) has been to the effect that the district forum have to abide by the principles laid down by the State Commission in their decisions.  The judgement which was referred in this order has been of Singh’s Dental Hospital (supra) which has been analyzed by the Hon’ble State Commission in its order in Prem Joshi vs. Jurasik Park Inn & Anr. on 17.10.2017 where  reference was made to the order of the Hon’ble State Commission in Singh’s Dental Hospital (supra) and has been laid down that notification issued by the Hon’ble Lieutenant Governor and National Capital Territory of Delhi on 20.04.1999 divided Delhi in 10 districts defining their respective area have to be complied with.  Thus, the judgement of Hon’ble State Commission in Prem Joshi (supra) over rules its own judgement in Singh’s Dental Hospital (supra). 

            Therefore, the law as stands today is that notification of dated 20.04.1999 dividing Delhi in 10 districts defining their respective area have to be complied with.  That being so, Delhi for the purpose of jurisdiction is not one district, the arguments advanced on behalf of complainant goes.

In view of the above, we are of the opinion that this forum have no territorial jurisdiction to entertain the complaint.Therefore, the complaint cannot be admitted and it stands rejected.There is no order as to cost.

Copy of the order be supplied to the parties as per rules.

            File be consigned to Record Room.

 

 

 

(DR. P.N. TIWARI)                                                                (SUKHDEV SINGH)

       Member                                                                        President