DISTRICT CONSUMER DISPUTES REDRESSAL FORUM FATEHGARH SAHIB

Consumer Complaint  No.     :        60 of 03.10.2017

Date of Decision                      :         15.04.2019

1. Jagjit Singh aged about 20 years son of Sh. Parvinder Singh.
2. Parvinder Singh aged about 49 years son of Sh. Piara Singh, both residents of village Rattangarh, Tehsil Khamanon, District Fatehgarh Sahib.

...........Complainants

Versus

1. M.D. India Health Care Services (TPA) Private Ltd. Max Pro Info Park, D-38, First Floor, Phase-1, Industrial Area, Mohali, District SAS Nagar, Mohali-160056, through its M.D./Manager.
2. The Rattangarh Multipurpose Corporative Association Service Society (MPCASS) Rattangarh, Tehsil Khamanon, District Fatehgarh Sahib, through its Secretary.
3. ICICI Lombard having its office at Phase-9, Sahibzada Ajit Singh Nagar, Mohali, 160062 through its Manager/M.D.

Complaint Under Sections 12 to 14 of the Consumer Protection Act 1986.

Quorum

Sh. Kuljit Singh, President

Sh. Inderjit, Member

Present:       Sh.T.S.Kang, Adv. counsel for the complainant.

Sh. Vinay Sood, Adv. counsel for OPs No.1 &3.

Opposite Party No.2 ex-parte

ORDER

By Kuljit Singh, President

Complainant Jagjit Singh has filed this present complaint against the Opposite parties Under Section 12 to 14 of the Consumer Protection Act 1986. The brief facts of the complaint are that Parvinder Singh – complainant-2 is a member of OP No.2 and member of Bhai Kanahiya Health Service Scheme, Punjab and his whole family is covered under the said scheme. Previously, complainant had filed complaint against OPs.  In the said complaint, this Forum vide its order 15.02.2017 has also directed to decide the Insurance Claim of complainant within 30 days from the date of receipt of claim filed by complainant with permission to file fresh complaint on same cause of if he is not satisfied with the decision of OPs. As per said directions, the complainant has sent registered post to OPs but the OPs neither gave any claim amount to complainant nor sent any reply to the same.  The complainant No.2 had paid Rs.1300/- for membership/necessary fee for Bhai Kanahiya Health Scheme through cheque in favour of OP-2.  Complainant No.1 remained admitted in the Civil Hospital, Khamanon upto two days due to fever (Dengu). The doctors of said Khamanon have referred complainant No.1 to DMC, Ludhiana.  Complainant No.1 remained admitted there for six days.  Complainant No. 2 has shown the documents regarding the insurance but the employee of DMC Ludhiana refused to take the said documents and directed for payment.  Total cost of Rs.1,00,000/- has been paid by complainant -1 for his treatment as well as medicine in DMC Ludhiana and Civil Hospital, Khamanon. Complainants have approached to OP-2 and asked to deliver the payment for said treatment bud they refused to do so.  They also approached to other officials but all in vain.  On 21.11.2016, complainant -1 served a legal notice to OP to make payment of treatment but nothing was done by Ops. Lastly, it is prayed that OPs be directed to pay Rs.1,00,000/- medicines alongwith interest @ 24% P.A. till realization. Rs.1,00,000/- as damages for harassment.

3. Upon notice,  OPs appeared and filed joint reply by taking preliminary objections it is stated that complaint false and has been filed to harass the OPs by misusing the process of law, complaint is not maintainable, this Forum has no territorial jurisdiction, complainant has not come to this Forum with clean hands; complainant is estopped by his own act and conduct from filing the present complaint; no cause of action has been arisen against OPs; complainant is not a consumer with the definition of Section 2(d) of Consumer Protection Act; complaint is bad for mis-joinder and non-joinder of necessary parties; this complaint is barred by limitation; as per averments of complainant cause of action has arisen in month of July 2013, so complaint can be filed by 2015 but the present complaint has been filed beyond the period of limitation; complaint contains complicated question of facts and law and voluminous evidence is require by this Forum to reach at just and final conclusion and complaint should be relegated to its remedy before the Civil Court of competent jurisdiction for redressal of grievances of the complainant.  On merits, it is submitted that complaint is premature as no claim was ever lodged with answering OP nor was repudiated by answering OP. Even, this Forum had ordered vide order dated 15.02.2017 to file the claim on prescribed Performa, but no such prescribed performa has been filed. Lastly prayer has been made for dismissal of complaint.
4. In order to prove the complaint, the complainant-2 has tendered in evidence his affidavit Ex.CW1/A alongwith copies of documents Ex.C-1 to Ex.C-30, then tendered copy of order dated 06.10.2017 Ex.C-31 and closed the evidence. In rebuttal, the counsel for OPs has tendered affidavit of Nishant Gera Ex.OP-1 and then closed the evidence.
5. We have heard learned counsel for the parties and have also examined written arguments of both the parties and the record of the case very carefully.
6. The question for determination before the Forum is that whether this Forum has jurisdiction or not.  From the record, it is transpired that earlier complaint has been filed before this Forum and OP No.2 has also run their business in the District Fatehgarh Sahib.  So this Forum has territorial jurisdiction to decide the dispute of present complaint.
7. Without touching merits of the case it is crystal clear that despite directions of this Forum through its order dated 06.10.2017, the complainant has failed to lodge the claim with OPs.  As such, this complaint is premature.  Accordingly, the complainant is directed to file the claim alongwith requisite documents shortly and further OPs are directed to decide the claim of the complainant within a period of two months from the date of receipt of claim from complainant.     
8. In view of the above facts and circumstances, the present complaint is disposed of. 
9. Copy of this order be supplied to the parties as per permissible under rules.

Pronounced: 15.04.2019

                                                              (Kuljit Singh)

•                                                                            President

                                                                                 (Inderjit)

                                                                                  Member