Chandigarh

DF-I

CC/95/2020

Baljinder Singh - Complainant(s)

Versus

Max Bupa Health Insurance Company Ltd - Opp.Party(s)

Rahul Bedi & Kirti Kumar Googna

01 Aug 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                    

Consumer Complaint No.	:	CC/95/2020
Date of Institution	:	20.2.2020
Date of Decision	:	1/8/2023

 

Baljinder Singh r/o House No. 149, Phase 2, Mohali Punjab 140301.

 

… Complainant

V E R S U S

1.   Max Bupa Health Insurance Company Ltd. registered office at SCO No.55,56 & 57, Sector 8C, Chandigarh through Managing Director& CEO.

 .  … Opposite Party

2.   Max Bupa Health Insurance Company Ltd. C/o B-1/1-2, Mohan Cooperative Industrial Estate, Mathura Road, New Delhi 110044 through Managing Director &CEO.

 

CORAM :	PAWANJIT SINGH	PRESIDENT
	SURESH KUMAR SARDANA	MEMBER

                       

ARGUED BY		None for the complainant.
		Sh. Gaurav Bhardwaj, Adv. for the OPs.

Per SURESH KUMAR SARDANA, Member

     Briefly stated complainant purchased a health policy from the OP having coverage of Rs.5.00 lakh. The policy covered life threatening diseases. On 22.11.2019  the complainant suddenly suffered from high fever and admitted in hospital for medical treatment and due intimation was given to the OP to this effect and the OPs received all the documents from the complainant. the complainant was discharged on 26.11.2019 from the hospital and the hospital raised bill of Rs.42415/- which was paid by the complainant. IT  is alleged that despite receiving all the documents from the complainant through its TPA and courier,  OPs repudiated the claim of the complainant on the frivolous ground that requisite documents not submitted. The complainant sent a legal notice  but to no avail. Alleging the aforesaid act of Opposite Parties deficiency in service and unfair trade practice on their part, this complaint has been filed

2. The Opposite Party in its reply stated that it received the claim of the complainant and while investigation by the claim team it was found that the claim was not genuine. The investigation revealed that the patient i.e. Baljinder Singh submitted documents for treatment in lifeline super specialty hospital  under the care of Dr. Sanjeev Garg. The investigation revealed that Dr. Sanjeev Garg left the said hospital almost 3 months prior to the admission of the complainant in the said hospital.  Thus, the complainant has not taken any treatment from the said hospital and all the documents submitted by the complainant is forged and concocted and is not admissible under any circumstances. The complainant tried to cheat the company and make fraudulent claim to cause unlawful loss to the OP Company. It is denied that there is any deficiency on its part.  All other allegations made in the complaint has been  denied being wrong.
3. No rejoinder filed on behalf of the complainant.
4. Contesting parties led evidence by way of affidavits and documents.
5. We have heard the learned counsel for the contesting parties and gone through the record of the case.
6. On perusal of the Annexure C-8 which is a reply to the legal notice, served by the complainant to OP, it is observed that the complainant claimed to have undergone the treatment under Dr. Sanjeev Garg at Lifeline Super-specialty Hospital. However, the said doctor left the employment of Lifeline Super-specialty Hospital almost 3 months before the complainant was admitted in the said hospital. Since the claim has been repudiated on the ground that claim is not genuine and is bogus and fraudulent, in our view such serious issue shall involve complicated question of facts and law, as well as voluminous evidence, which can only be dealt with by a civil court having proper jurisdiction.
7. The law is well settled that when there are allegations of fraud, forgery etc., the Consumer Forum has got no jurisdiction to try & adjudicate it and the matter is to be decided by the Civil Court.  Reliance has been placed on Bright Transport Company Vs. Sangli Sahakari Bank Ltd., II(2012) CPJ 151 (NC), wherein it has been held that :-

 

“Complaints which are based on allegations of fraud, forgery, etc. and trial of which would required voluminous evidence and consideration are not to be entertained by this Commission – This complaint is an attempt to misuse jurisdiction of this Commission only with a view to save on Court fee payable in a suit before Civil Court – Complaint not maintainable’.

 

 

8.   In view of the foregoings, we are of the considered opinion that this Commission has no jurisdiction to try & adjudicate the complaint.  Therefore, complaint stands dismissed, with no order as to costs. However, the complainant is at liberty to approach any appropriate court of competent jurisdiction for redressal of his grievance. 
9. Certified copies of this order be sent to the parties free of charge.  The file be consigned^.

			sd/- [Pawanjit Singh]
			President
			sd/-
1/8/2023			[Suresh Kumar Sardana]
mp			Member