Paramjit Kaur etc. Vs. MD India Heath Insurance TPA Pvt. Ltd. & Others.

Present: Sh. Asim Akhtar, Adv Counsel for the Complainant.

OPs No.1 to 3 Summon not required.

Sh. Brijesh Bakshi, Adv Counsel for the OP No.4.

Sh. Paramjit Singh, H. C. on behalf of the OPs No.5 & 6.

Sh. R. S. Arora, Adv Counsel for the OP No.7.

Sh. R. S. Mattu, Sr. Law Officer on behalf of the OP No.8.

1. We are going to dispose of an application filed by OP No.4 for dismissal of complaint in limine as non-maintainable against the applicants.

2. Brief facts of the application are that the above said complaint is pending in this Forum under the Consumer Protection Act, on account of alleged deficiency in services and unfair trade practice and sought the reimbursement of medical expenses allegedly incurred by them, but it may be seen that there is no cause of action even alleged in the whole complaint against the applicant/OP No.4, who is only a TPA and never incurred any services to the complainants. Whereas it may be seen that when there is no consumer or service provider relationship then there is no provision of law to file any consumer complaint against any OP. The OP No.4 is not liable to reimburse the complainant in any manner whatsoever and no allegation is even prima-facie alleged against the applicant/TPA and further prayed that the application may kindly be allowed and complaint filed by the complainant being not maintainable may be dismissed.

3. Notice of the application was given to the respondent/complainant, who filed a reply and contested the same by taking preliminary objections that the instant application filed by the OP No.4 is not maintainable and is liable to be dismissed. It is further averred that the applicant is estopped from filing the present application by its own act, conduct, omission and commission, even the applicant has no locus-standi and authority to file the present application. On merits, the averments made in the application are controverted and lastly submitted that the application of the applicant/OP No.4 is without merits, the same may be dismissed.

4. We have heard the counsel for the applicant as well as counsel for the respondent/complainant and also scanned the contents of the application and its reply as well as main complaint.

5. Admittedly, the complainant filed a complaint seeking insurance claim of the husband of the complainant/Paramjit Kaur, the husband of the complainant/Paramjit Kaur is a government employee, the Government of Punjab floated a Family Welfare Health Insurance, vide a notification dated 20.10.2015 covering all the employee, pensioner for indoor medical treatment expenses specify day care procedure and treatment of coronic diseases as specified and further the complainant categorically stated in Para No.4 of the Complaint that the Complainant No.2 Iqbal Singh is husband of the complainant Paramjit Kaur and the Oriental Insurance Company Limited issued a medical card in the name of the Complainant No.2 Iqbal Singh in the terms of the notification issued by the Government, where wife and husband are in Punjab Government job and treatment was obtained from CMC Hospital, Ludhiana and Tagore Hospital, Jalandhar. Admittedly, the applicant/OP No.4 is MD India Health Insurance TPA Private Limited, Phase-I, Mohali, Punjab. The applicant/OP No.4 filed an application that no cause of action accrued against the OP No.4 nor any claim has been demanded by the complainants from OP No.4.

6. Upon the argument of applicant/OP No.4, we scanned the file and find that the OPs No.1 to 3 were already ordered by this Forum not to summon being un-necessary party and further at this venture, we find that the OPs No.5 to 8 are also not a necessary party in this complaint being reason nothing is claimed from the OPs No.5 to 8 and now there remains only OP No.4, admittedly the OP No.4 is a processing agency of the insurance claim of the government employee as well as pensioner and we cannot say that the OP No.4 is not a necessary party, but it is admitted that nothing is directly or indirectly claimed from OP No.4 and moreover, as per version of the complainants themselves that the complainant Paramjit Kaur had shown the card issued by the Oriental Insurance Company Ltd. to the Tagore Hospital, Jalandhar and thereafter to CMC Hospital, Ludhiana. So, we find that the complainants are well aware that the scheme of the Government floated vide notification dated 20.10.2015 is covered by Oriental Insurance Company Limited and if the complainant filed any medical insurance claim, then it should be against the Oriental Insurance Company Limited, but the complainant has not impleaded the necessary party, though the complainant can also implead OP No.4 MD India Health Insurance TPA Pvt. Ltd. being the processing agency, but when the main party from whom the insurance claim is to be called for reimbursement, then the complaint of the complainant is not maintainable rather it will be futile exercise to give an opportunity to both the parties to lead the evidence and then to decide the matter and ultimately, the fate of this complaint will be same which will be if decided today. So, accordingly, at this stage, we find that the complaint of the complainant is not maintainable being not filed against the appropriate and necessary party and as such, the application of the applicant/OP No.4 is disposed of, in view of the above discussion, but complaint of the complainant is dismissed with no order of cost, with liberty to the complainant to file a fresh complaint, if desired by impleading the Oriental Insurance Company as one of the party. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed to the record room.

Dated Jyotsna Karnail Singh

24.04.2019 Member President