DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (CENTRAL)

                                        ISBT KASHMERE GATE DELHI

CC/254/2019

No. DF/ Central/                                                                    

1. Mr. Jitender Kumar Sharma

S/o of Shri Ram Kishor Sharma

2.  Mrs. Raj Kumari wife of Shri Ram Kishor Sharma

Both Residents of:

First Floor, H. No. 23/1, Bholanath Nagar,

Behind Geeta Bhawan, Shahdara Delhi -  110032                                                                                           

                                                                                            …..COMPLAINANTS  

VERSUS

M/s. Max Bupa Health Insurance Company Limited

Through its Managing Director

3^rd Floor, 39, Pusa Road,

W.E.A. Karol Bagh, New Delhi 110005      

                                                                                                                                       …..OPPOSITE PARTY

Coram  : Ms. Rekha Rani, President

                Ms. Manju Bala Sharma, Member

                Shri R.C. Meena, Member

                                                              ORDER                

Mrs. Manju Bala Sharma, Member

1.     Instant complaint has been filed by the complainant under section 12 of the Consumer Protection Act 1986 alleging therein that complainants have paid consideration for availing service of OP for health insurance policy for the period 30/05/17 to 29/05/2018.  At the time of the inception of the policy complainants

declared the pre existing condition viz ‘Diabetes Melllitus’ for complainant no. 1 and 2 both.  The complainants got the policy renewed for the period from 30/05/2018 to 29/05/2019 for the insured sum of Rs. 11 Lacs.  It is further alleged that on 23/07/2018 complainant no. 2 was admitted in Max Super Speciality Hospital Patparganj for severe headache, chest and hand pain.  OP approved the pre authorization request of the Hospital for Rs. 28400/- on 24/08/2018.  However OP cancelled and backtracked this pre-authorization on 28/08/2018 alleging that complainant no. 2 was suffering from asthma prior to inception of policy.  Complainants again made pre authorization request to the OP but the same was denied through email dated 30/08/2018 accusing the complainants of concealing material facts. Complainant submitted the claim  reimbursement form on 19/09/2018 and OP sent email on 20/10/2018, 26/10/2018, 29/12/2018 and 29/01/2019 asking the complainant to share the exact duration of Asthma, all past treatment records since first diagnosis and indoor case papers with admission notes, medication chart etc.  Complainant No. 1 sent e-mail on 05/01/2019 informing OP that complainant no. 2 had never been medically diagnosed with asthma and Max Bupa field representative wrongly took consent for pre existing disease as diabetes and asthma instead of diabetes only and informed OP that complainant no. 2 has never been admitted in the past for asthma treatment or any other disease. 

4.       Our State Commission in  Prem Joshi Vs Jurasik Park Inn & Anr.  First Appeal No. 488/2017 while dealing with this point vide order dated 01.11.2017 has held that:

                      ‘’6. Now coming to the point of Delhi being one district, it may be mentioned that appellant has relied upon decision of this Commission dated 31.10.07 in RP No. 07/18 titled as Singhs Dental Hospital vs. Shri Amrit Lal Dureja and decions of this Commission dated 17.03.10 in FA No. 10/220 titled as Holy Family Hospital vs. Amit Kumar, decision of this Commission in FA 216/2012 titled as Mahesh Ram Nath vs. the Secretary cum Commissioner (Transport) and other and decision in Saranjeet Singh vs. Anil Kumar Dixit III (2010) CPJ 181.

7.   The District Forum distinguished the above decision on the ground that the Hon’ble Lt. Governor of National Capital Territory of Delhi vide notification dated 20.04.99 divided Delhi in 10 districts defining their respective area.  Notification was issued for being complied with instead of being flouted.

8.   Obviously the purpose of defining jurisdiction was to regularize and distribute the work to bring certainty instead of creating chaos.  If all the litigants prefer to chose one forum, that forum would be overburdened and remaining nine forums would become idle.  

9.  Over and above that we may mention that appellant of FA 216/12 namely Mahesh Ram Nath preferred Revision Petition in National Commission which was registered as No. 2816/2012.  The  said petition came up for hearing on 17.08.12.  National Commission called for report from President of this Commission as to whether there was any demarcation of territorial jurisdiction and if so whether the same was being followed or not and if not for what reasons.  On 27.09.12 it was observed that territorial jurisdiction of various district forums of  Delhi was a matter of great public importance.  Therefore Secretary & Commissioner, Deptt of Consumer Affairs, Govt. of NCT of Delhi was directed to appear in person on 10.10.12 so that position can be clarified as to implementation of the notification.  Mr. Shakti Bangar, Asstt. Director assured the National Commission to communicate directions of the National Commission to officers concerned for compliance.  National Commission was informed by some advocate that notification relating to distribution of jurisdiction in various consumer fora functioning in Delhi was not being followed in its letter and spirit.  Deptt of Consumer Affairs was directed to furnish reports from all the district forums as to whether they were strictly following the notification and if not, they were to give the number of cases which have been entertained/ decided contrary to the stipulation contained in notification.

10.       The Director, Consumer Affairs issued a circular No. F.50(21)/2003/F&S/CA/1053-1054 dated 07.11.12 conveying the feelings of National Commission regarding not following the notification in its letter and spirit.  It was also conveyed that National Commission took a very serious view and stated that inspite of notification promulgated by Govt. of  NCT of Delhi on 20.04.99 clearly demarcating jurisdiction district wise, District Forums were violating the order.  On the basis of the said letter Registrar of this Commission wrote a letter No. F.1/(Misc.)/SC/2012/5045 dated 08.11.12 advising President, District Forums to strictly comply with the directions i.e. notification.

11.       It is a different matter that on 09.09.14 none appeared for the petitioner in National Commission and the petition was dismissed for non prosecution.  But still the fact remains that National Commission took a serious view about not following the notification defining territorial jurisdiction.  The same leads us to hold that notification has to be complied.’’

5.     Since no part of cause of action arose within the territorial jurisdiction of this forum  the complaint be accordingly returned to the complainant along with an endorsement containing the date of presentation and date of return of the complaint, name of the complainant presenting the complaint and brief statement of reasons for returning the complaint for its presentation before Forum having jurisdiction within one month from the date of receipt of copy of this order after retaining a copy of the same on record.  Copy of this order be sent to the complainant as per rules.  File be consigned to record room.

Announced this 06^th day of  Nov.  2019.