Before the District Consumer Disputes Redressal Forum, Nuh (Mewat).
Complaint No. : 15/2017.
Instituted on : 10.11.2017.
Decided on : 04.01.2019.
Shri Devender Sharma son of Shri Rajender Sharma, R/o Ward No. 3, Tawru District Nuh.
………..Complainant.
Vs.
- Oriental Insurance Co. Ltd., Hanuman Shoping Complex, Bhiwadi through Authorized person.
- Divisional Manager, Oriental Insurance Company Limited, 70 Panchvati, Alwar.
- Manager, Oriental Insurance Company Limited, Office at: Near State Bank of India Nuh Mewat.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.RAJBIR SINGH DAHIYA, PRESIDENT.
MS. URMIL BENIWAL, MEMBER.
Present: Sh. Rajesh Kumar, Advocate for the complainant.
Sh. R.D. Sharma, Advocate for the respondent.
ORDER
RAJBIR SINGH DAHIYA, PRESIDENT:
1. Brief facts of the complaint that complainant had taken a Mediclaim Policy from the respondent company vide policy no. 242396/48/2016/2017 and TPA ID YA0000000341. The wife of the complainant was hospitalized at Sai Hospital Bhora Kalan from 28.04.2016 to 02.05.2016. That the complainant had spent Rs. 26,000/- on medical treatment and when he informed to the respondent company no. 1, respondent no. 1 ignored to him and thereafter, he file the written application on dated 18.11.2016 to respondent no. 2 for claim but the respondent company did not pass the claim of the complainant and afterwards, the complainant through his counsel sent the legal notice to respondent on 03.03.2017 but the respondent do not reply the legal notice of complainant. When the complainant inquired the claim from the respondent company on dated 08.08.2017, the respondent company has flatly refused to complainant for passing his claim. Hence, this complaint with prayer to direct the respondents to pay amount of hospitalization bill of Rs. 26,000/- alongwith a sum of Rs. 10,000/- on account harassment.
2. After registration of complaint, notices were issued to respondents. Respondents in their reply has submitted that this forum has no jurisdiction to try and entertain the present complaint as the medi-claim policy has been issued by the branch office Bhiwadi and same does not comes under the preview/jurisdiction of the forum and the complainant has no cause of action to file the complaint against the answering respondent, therefore, the petition is not maintainable. The claim petition is bad for mis-joinder and non-joinder of necessary parties. That without prejudice to the preceding objections, it is submitted that the liability of the answering respondent is limited and subject to the terms and conditions of the insurance policy, if any. It is submitted that the policy obtained by the complainant is subject to the terms and conditions of the Happy Family Floater Policy. It is denied that wife of the complainant fell ill and was admitted to Sai hospital, Bhorakalan on dated 28.04.2016 and remains there till 02.05.2016. It is denied that the complainant bears an amount of Rs. 26,000/- during hospitalization of his wife. It is further denied that complainant has given any application to respondent no. 2 for clearing of the claim amount. It is denied that complainant has sent a legal notice dated 03.03.2017 to the respondent. It is submitted that this forum has no jurisdiction to try entertain and decide the present complaint as the policy in question has been issued by the branch office Bhiwadi of the respondent and it is well settled law that any dispute, is subjected to the jurisdiction of the forum from where the policy has been issued. Hence complaint is not entitled for any claim and complaint of the complainant may kindly be dismissed with costs.
3. Complainant has tendered affidavit Ex.PW1/A and documents Ex. PW1/B and Mark-A to Mark-R and closed his evidence. Ld. counsel for the respondents closed the evidence after tendering the documents Annexure R1 & R2.
4. Arguments heard and filed perused.
5. At the outset there is no dispute regarding the merits of the complaint between the parties except an objection by the respondent regarding jurisdiction of this forum. Legal notice Mark-Q was sent to respondent company at Nuh. As is evident from the title of the complaint that the respondent company has a office at Nuh. This is settle law of the land that any company or establishment can be sued where there is a branch office of that concern. Hence, in this case the complainant is a resident of Tauru District Nuh. She also fell ill at Tauru. The respondent company has a branch office at Nuh, So, in our opinion this forum has jurisdiction to entertain the present complaint.
The respondents have relied upon a judgment of the Hon’ble Supreme Court of India titled as Sonic Surgical Versus National Insurance Company Ltd. 2010(1)RCR(Civil). The facts of the present case do not attract this judgment.
Since, there is no dispute regarding the expenses incurred for hospitalization of the wife of the complainant amounting to Rs. 26,000/- spent between 28.04.2016 to 02.05.2016. In view of the above discussion,we allow this complaint and award a sum of Rs. 23,400/- after deduction of Rs.2600/- as per policy terms and conditions.”Silver plan 10% co-pay” it comes to Rs.23400/-(Rs.26000-2600=Rs.23400) with interest @ 9% per annum w.e.f. 02.05.2016 till the date of realization alongwith Rs. 5,000/- towards compensation and litigation to the complainant within one month from the date of receipt of this order.
6. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced on: 04.01.2019 (Rajbir Singh Dahiya)
President
District Consumer Disputes
Redressal Forum, Nuh (Mewat).
(Urmil Beniwal)
Member
District Consumer Disputes
Redressal Forum, Nuh (Mewat).
