DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
PATIALA.
Consumer Complaint No. 251 of 26.10.2015
Decided on: 13.10.2016
Sunita Rani, aged 60 years, wife of Pawan Kumar, resident of House No.436, Patel Nagar, New Mandi, Muzaffar Nagar,(Uttar Pradesh) c/o 53, Majithia Enclave, Patiala.
…………...Complainant
Versus
1. Oriental Insurance Company Limited, Divisional Office, Court Road, Muzaffar Nagar through its Divisional Officer and also through its Divisional Office, Sai Market, Patiala.
2. Shri Varunesh Dixit, Authorized Signatory, E-Meditek,(TPA) Services Limited, Corporate Office, Plot No.577, Udyog Vihar, Phase-V, Gurgaon ( Haryana).
…………Opposite Parties
Complaint under Section 12 of the
Consumer Protection Act, 1986.
QUORUM
Smt. Neena Sandhu, President
Smt. Neelam Gupta, Member
ARGUED BY:
Sh.Anand Puri,Adv. counsel for the complainant.
Sh.D.P.S.Anand, Adv. counsel for opposite party No.1.
Opposite party No.2 ex-parte.
ORDER
SMT.NEENA SANDHU, PRESIDENT
Smt.Sunita Rani has filed this complaint under Section 12 of the Consumer Protection Act,1986 ( hereinafter referred to as the Act) against the Opposite Parties (hereinafter referred to as the O.Ps.) praying for the following reliefs:-
- To pay Rs.54,151/-
- To pay Rs.25000/- as compensation on account of mental tension and harassment
- To pay Rs.10,000/- as litigation expenses
- Any other relief which this Forum may deem fit.
2. In brief, the case of the complainant is that her son namely Munish Kumar Aggarwal had purchased a Happy Family Floater policy bearing No.253900/48/2013/3429, in which she alongwith her husband , her daughter-in-law with her children were also covered.The policy has been continuing since 19.12.2009 and the premium of the same is being deposited regularly.In the month of 2013, she visited Patiala in connection with some urgent work, where she suddenly got problem in her stomach. She, immediately rushed to Columbia Hospital, Patiala where she was treated by Dr.B.P.Singh. She admitted in the hospital on 20.3.2013 and was diagnosed as a case of Right Lower Ureteric Calculus. Surgery was done on the same day. Thereafter, she was discharged from the hospital on 22.3.2013. She lodged a mediclaim through E-Meditek TPA services Limited who has having the tie-up with O.P. No.1 and the Columbia Asia Hospital. E-Meditek TPA Services Ltd, issued an approved certificate vide claim No.119031300122 vide letter dated 21.3.2013 written to Columbia Asia Hospital, Patiala. Vide letter dated 22.3.2013, Op no.2 refused to sanction the cashless request on the ground of the disease being pre existed and requested the Hospital to collect the expenses from the patient. It is also written in the aforesaid letter that the patient may submit the hospitalization papers for reimbursement as per the policy terms and conditions. Accordingly she paid Rs.54,151/- as hospitalization charges to the Columbia Asia Hospital. Thereafter, she sent a letter dated 21.4.2013 alongwith the bills for reimbursement of the amount of Rs.54,151/-to the opposite parties. A legal notice dated 20.5.2013, was also got served upon the O.Ps. Reminders were also sent to the O.Ps. for the reimbursement of the amount but till date no payment has been made by them. She never concealed any fact from the O.Ps. nor made any mis statement before them. They have illegally retained the amount which was paid by her to the hospital. She has suffered mental pain and agony .
3. On being put the notice, O.P. No.l appeared and filed its written version, while O.P. No.2 failed to come present and to contest the case. It was accordingly proceeded against exparte. In the written version filed on behalf of Op No.1, it has taken preliminary objections that the present complaint is not maintainable as the complaint No.1573/2013 dated 4.7.2013, filed before Permanent Lok Adalat, Patiala, by the complainant had since been dismissed on merits vide judgment dated 1.7.2015 and that this Forum has got no power to try the present complaint as the insurance contract was signed at Muzafar Nagar and the Insurance Policy was issued by Muzafar Nagar, UP office of the company. On merits, it is stated that the O.P. has issued Happy Family Floater policy in favor of Sh.Manish Kumar Aggarwal S/o Sh.Pawan Kumar, for the period 19.12.2012 to 18.12.2013 covering the risk of Sh.Manish Kumar, Smt.Shilpi, Sh.Davlesh Aggarwal, Kumarti Vernika, Pawan Kumar and claimant Smt.Sunita Rani, for a sum of Rs.4lacs each but it is denied that the policy is being continued since 19.12.2009.It is denied that complainant visited Patiala to see her sister and suddenly she got problem in her stomach and she got herself admitted in Columbia Asia Hospital,Patiala and was treated by Dr.B.P.Singh, who diagnosed her as a case of Right Lower Ureteric Calculus and surgery was got done on 22.3.2013.It is denied that she remained admitted in the hospital from 20.3.2013 to 22.3.2013. It is denied that complainant lodged a medi claim through Columbia Asia Hospital,Patiala with O.P. No.2 and O.P. No.2 issued approval certificate dated 21.3.2013. It is alleged that the complainant requested for cashless treatment from Columbia Asia Hospital, , which was rejected on the grounds of non-submission of adequate claim documents and the complainant was advised to file reimbursement claim after making the payment to the hospital. The cashless request was rejected by O.P.No.2 and the complainant had paid Rs.54151/- to the treating hospital as medical treatment charges. It is further stated that on receipt of claim of reimbursement of Rs.54151/-, the same was immediately sent to O.P. No.2, who is 3rd party administrator of the policy, consists of highly qualified professional team of doctors, who after examining the Medical Treatment Record, discharge slip, treatment summary and other documents, sent by the complainant, found that the claim was not payable as the complainant was suffering from Right Lower Ureteric Calculus disease, since 1992, which is pre-existing disease. The benefit of 4 years policy needed to be processed of the policy to be started from 2008-2009, but the complainant has purchased the policy, in the year 2009.Therefore, the claim was repudiated and the complainant was informed accordingly. The complainant has not suffered from mental pain and agony due to fault of the O.P. There is no deficiency of service on its part. After denouncing all other allegations made in the complaint, it is prayed to dismiss the complaint.
4. In support of her complaint, the learned counsel for the complainant tendered in evidence Ex.CA, sworn affidavit of the complainant, Exs.C1 to C4, copies of policies, Ex.C5 copy of discharge summary of Columbia Hospital, Ex.C6, copy of approval certificate, Ex.C7 copy of letter dated 22.3.2013, Ex.C8 copy of letter dated 21.4.2013, Exs.C9 & C10 copies of courier receipts, Ex.C11 copy of legal notice, Exs.C12 & C13, copies of postal receipts, Ex.C14, copy of reminder dated 20.6.2013, Ex.C15, copy of patient bill, Ex.C16 copy of order dated 1.7.2015 by Permanent Lok Adalat and closed the evidence.
5. On the other hand, on behalf of O.P. No.1, its learned counsel tendered in evidence Ex.OPA, sworn affidavit of Sh.Amarjit Singh Dhingra, Sr.Divisional Manager, Ex.OP1 copy of discharge summary, Ex.OP2 copy of letter of Meditex, Ex.OP3 copy of order , Ex.OP4, copy of insurance policy with conditions and closed the evidence.
6. Written arguments on behalf of the complainant have been filed. We have gone through the same, heard the learned counsel for the parties and have also gone through the record of the case, carefully.
7. At the outset, the learned counsel for O.P.No.1 has raised the objection that this Forum has no territorial jurisdiction to entertain and decide the complaint because in the present case, insurance contract was signed at Muzafarnagar and the insurance policy was issued from branch office Muzafar Nagar (U.P.) as is evident from the copy of insurance policy,Ex.C1. As such no cause of action has arisen to the complainant to file the present complaint before this Forum. Therefore, the present complaint may be dismissed. To this effect, the learned counsel for the complainant submitted that the insurance company is having its branch office at Patiala, which shows that insurance company is doing its business at Patiala. Not only this the complainant got operated from Columbia Asia Hospital, situated at Patiala and E Meditech TPA service i.e. O.P. No.2 has done correspondence with the said hospital As such, complainant has rightly filed the complaint before this Forum.
8. From the perusal of the Happy Family Floater Policy Schedule Ex.C1 to C4, it is evident that the policies in question from time to time were issued by the branch office Muzafarnagar ,U.P and on all the copies of insurance policies stamp of the branch office Muzararpur Nagar has been affixed. There is nothing on record to show that something has been done by the branch office, Patiala on behalf of the insurance company. Therefore, in the absence of any cogent evidence, it can easily be said that no cause of action had accrued to the complainant to file a complaint before District Forum, Patiala for redressal of her grievance. Merely, that the insurance company has its branch office at Patiala and the complainant got herself operated from the Hospital, which is situated at Patiala and further that E-Meditech TPA has done some correspondence with the Columbia hospital situated at Patiala, does not confer any right to the complainant to file a complaint against the insurance company by arraying its branch office situated at Patiala (i.e. O.P.No.1), where no cause of action has arisen. Principle of law has already been laid down by the Hon’ble Apex Court in the case of Sonic Surgical Vs. National Insurance Company Ltd. 2010(1)CLT 252, wherein it has been held that the expression ‘branch office’ in the amended Section 17(2) of the Consumer Protection Act,1986, means, the branch office, where the cause of action has arisen. It will lead to absurd consequences of bench hunting, if the complainant is allowed to file complaint anywhere in India, where branch office of the O.Ps. is situated. Further in the case of Dr.Jagmitter Sain Bhagat Vs. Dir. Health Service,s Haryana and others 2013(3) CLT 455 (SC) , the Hon’ble Apex Court has held that it is a settled legal proposition that confirment of jurisdiction is a legislative function. It can neither be conferred with the consent of the parties nor by Superior Court. If the Court, passes a decree having no jurisdiction over the matter, it would amount to nullity, as the matter goes to the roots of the cause. Such an issue can be raised at any stage of the proceedings. The finding of a Court or Tribunal becomes irrelevant and unenforceable /inexecutable, once the Forum is found to have no jurisdiction. In view of the law laid down by the Hon’ble Apex Court in the aforesaid judgments, we dismiss the present complaint, for want of territorial jurisdiction with no order as to cost. However, the complainant is at liberty to file the complaint for redressal of her grievance before the appropriate Court/Forum having territorial jurisdiction to adjudicate upon the same and to seek condonation of delay, if any, for the time spent by the complainant before this Forum as per Section 14 of the Limitation Act,1963. Certified copies of the order be sent to the parties free of costs, under the rules. File be indexed and consigned to the Record Room .
NEENA SANDHU
PRESIDENT
NEELAM GUPTA
MEMBER
Dated:13.10.2016
