1.      The present Revision Petition has been filed by the Petitioner under Section ­­­21(b) of the Consumer Protection Act, 1986 (the “Act”) against impugned order dated 28.11.2016, passed by the State Consumer Disputes Redressal Commission, Delhi (‘for short ‘State Commission’) in First Appeal No.893 of 2012. In this, the Appeal filed by the Petitioner/OP-1 was dismissed, thereby affirming the Order dated 29.08.2012, passed by the District Consumer Disputes Redressal (V), North-West District, Shalimar Bagh Delhi (“District Forum”) in CC No.986 of 2009, wherein the Complaint filed by the Complainant (Respondent No. 1 herein) was allowed.

2.      There was 5 days delay in filing of the Revision Petition. For the reasons stated in IA No. 3192 of 2017, the same is condoned.

3.      For convenience, the parties in the present matter are denoted as per their positions in the Consumer Complaint before the District Forum. Parveen Kumar Garg is identified as the Complainant (Respondent No.1 herein). Meanwhile, Sputnik Medical Research Foundation is identified as OP-1 (Petitioner herein), Genins India Ltd. is identified as OP-2 (Respondent No.2 herein) and Oriental Insurance Co. Ltd. is referred to as the Respondent No. 3.

4.      The brief facts of the case, as per the Complainant are that he purchased a "Group Mediclaim Policy" from OP-1, covering himself and his wife. Subsequently, his wife underwent a delivery followed by an emergency operation to remove her uterus at DR Maternity and Nursing Home Pvt. Ltd., Delhi, on 11.01.2009. The Complainant incurred expenses totaling Rs. 75,350/- and thereafter, submitted a claim to OP-1 through OP-2 (TPA), but it was not settled. Being dissatisfied, he filed Consumer Complaint No. 986/2009 seeking the claim of Rs.75,350/-, Rs.50,000/- for physical and mental distress, and Rs.5,000/- as costs, totaling Rs.1,30,350/- from OPs. Top of Form

5.      On receiving notice, OP-1 appeared before the District Forum on 18.11.2009 and sought additional time to file written statement. However, as no further appearances were made thereafter, OP-1 was proceeded ex-parte. On the other hand, OP-2 submitted a written version, asserting its role as a Third-Party Administrator (TPA) and contending that the complaint against it was not maintainable. OP-2 further contended that the Complainant failed to provide the original discharge summary and declaration wrt to the number of living children prior to his wife's pregnancy, which is essential for coverage under the Policy. As per this policy, coverage does not extend to families with more than two living children. Therefore, OP-2 sought dismissal of the complaint.

6.      The learned District Forum vide Order dated 29.08.2012, allowed the complaint with the following reasons/findings :

“….,It was imperative on the part of OP1 to have collected evidence from the maternity center in respect of the medical services taken by the complainant's wife. A claim cannot be denied merely on the plea that the original discharge summary had not been supplied as the same could have been obtained from the record of the nursing home. We are, therefore, of the considered opinion that the OP1 was deficient in providing services to the Complainant. Accordingly we direct OP1 as under:-

1. Pay to the complainant a sum of Rs. 75,350/- along with interest® 10% from the date of filing this complaint i.e. 03 07.2009 till payment.

2. Pay to the complainant a sum of Rs. 10,000/- as compensation.

3. Pay to the complainant a sum of Rs. 5,000/- as cost of litigation….”

7.      Being aggrieved by the District Forum Order, OP-1 filed Appeal No. 893 of 2012 before the State Commission. The State Commission vide order dated 28.11.2016 dismissed the appeal with the following observations:-

“6) Appellant has failed to place on record any document in support of his contention that there existed any agreement directly between the complainant and the Oriental Insurance Co. Ltd. The agreement placed on records is signed by the appellant herein and not by the Oriental Insurance Co. Ltd.

7) Perusal of the reply filed by the TPA in the District Forum shows that it has not supported the contention of the appellant herein. For these reasons, I am of the considered opinion that the appeal is devoid of merits. The same is hence dismissed.”

8.      Being dissatisfied by the Impugned Order dated 28.11.2016 passed by the State Commission the Petitioners/OP-1 filed the instant Revision Petition No. 587 of 2017.

9.      Perused the entire material on record including the Orders of both the fora. Heard the learned Counsels for both the parties.

10.    During his argument, the Counsel representing the Petitioner/ OP-1 reiterated the facts of the case. He vehemently contended that any claim put forth by Complainant/Respondent No. 1, regardless of its validity under the policy, cannot be attributed to the Petitioner as the Petitioner neither issued the policy to Respondent No. 1 nor operates as an approved insurance company under the regulations of the Insurance Regulatory and Development Authority (IRDA). The Counsel emphasized that the inclusion of Petitioner as a respondent in the complaint case is unwarranted, as the Petitioner is a medical and research foundation that merely facilitates membership and procures insurance policies on behalf of its members. He argued that the responsibility for scrutinizing and settling claims lies with the insurer, and it is incumbent upon the insured (Respondent No. 1) to correctly name the parties in any legal proceedings. The failure to implead Oriental Insurance Co. Ltd. led to an erroneous ruling against the Petitioner by the District Forum. The Petitioner is not involved in the processing or scrutiny of claims submitted by its members, either to the insurance company or to the Third-Party Administrator (TPA). The Petitioner does not engage in insurance business and cannot be held liable for any service deficiencies or claim payments solely based on the issuance of a membership certificate. The responsibility for claim coverage lies with Oriental Insurance Co Ltd, as confirmed in their reply before the State Commission, where they admitted repudiating the claim of the Complainant due to non-submission of required documents. Thus, the Insurer is solely responsible for providing coverage under the Group Mediclaim Policy, not the Petitioner. He argued that the Petitioner's involvement in the litigation is unwarranted and that the focus should be on directing Oriental Insurance Co. Ltd. and Genins India Ltd. (TPA) to address the concerns raised by the Complainant. Therefore, the Petitioner should be removed from the proceedings, and the responsibility for resolving the matter should fall solely on Oriental Insurance Co. Ltd. and Genins India Ltd. (TPA).

11.    The Respondent No.1/ Complainant has brought out that he purchased a "Group Mediclaim Policy" from OP-1, covering himself and his wife. Subsequently, his wife underwent a delivery followed by an emergency operation to remove her uterus at DR Maternity and Nursing Home Pvt. Ltd., Delhi, on 11.01.2009. The Complainant incurred expenses totaling Rs. 75,350/-. When he submitted a claim to OP-1 through OP-2 (TPA), it was not settled. Being dissatisfied, he filed CC No. 986/2009 seeking the claim along with Rs.50,000/- for physical and mental distress, and Rs.5,000/- as costs from OPs.

12.    The Ld. Counsel for Respondent No. 3 (Oriental Insurance Co. Ltd.) strongly contended that the Revision Petition be dismissed with respect Respondent No. 3 for not being a party before the District Forum, where the complaint was filed. Any decision/ award against Respondent No. 3 cannot be challenged at this stage, as they were not a party to the original proceedings. He further emphasized that Respondent No. 3 had repudiated the claim of the Complainant due to non-submission of required documents, a fact which was not fully disclosed in the Revision Petition. They clarified that the maternity benefits cover under the policy was limited to Rs. 25,000, as clearly outlined in the policy terms and conditions. Respondent No. 3 did not engage in any deficiency of service or unfair trade practices, and there was no cause of action against them. The Counsel further argued that the Petitioner was negligent and cannot now seek relief for their own negligence. The Revision Petition lacked substance and the petitioner was not entitled to any relief from the Commission.

13.    The concurrent finding of facts is noted from both the fora below. It is a well settled position in law that revision under section 58(1)(b) Act, 2019, (which are pari materia to Section 21(b) of the 1986) confers very limited jurisdiction on this Commission. In the present case there are concurrent findings of the facts and the revisional jurisdiction of this Commission is limited. I do not find any illegality, material irregularity or jurisdictional error in the impugned Order passed by the State Commission warranting our interference in revisional jurisdiction under Section 21(b) of the Act, 1986. I would like to rely upon the decision of the Hon'ble Supreme Court in the case of 'Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd., (2011) 11 SCC 269. Further, Hon'ble Supreme Court in 'Sunil Kumar Maity Vs. State Bank of India & Anr. Civil Appeal No. 432 OF 2022 Order dated 21.01.2022 has held that revisional Jurisdiction of this Commission is extremely limited and observed: -

"9. It is needless to say that the revisional jurisdiction of the National Commission under Section 21(b) of the said Act is extremely limited. It should be exercised only in case as contemplated within the parameters specified in the said provision, namely when it appears to the National Commission that the State Commission had exercised a jurisdiction not vested in it by law, or had failed to exercise jurisdiction so vested, or had acted in the exercise of its jurisdiction illegally or with material irregularity. In the instant case, the National Commission itself had exceeded its revisional jurisdiction by calling for the report from the Complainant-bank and solely relying upon such report, had come to the conclusion that the two fora below had erred in not undertaking the requisite in-depth appraisal of the case that was required. .....”

14.    Similarly, in a recent the Hon'ble Supreme Court in Rajiv Shukla Vs. Gold Rush Sales and Services Ltd. (2022) 9 SCC 31, it was held that:-

As per Section 21(b) the National Commission shall have jurisdiction to call for the records and pass appropriate orders in any consumer dispute which is pending before or has been decided by any State Commission where it appears to the National Commission that such State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise a jurisdiction so vested, or has acted in the exercise of its jurisdiction illegally  or with material irregularity. Thus, the powers of the National Commission are very limited. Only in a case where it is found that the State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise the jurisdiction so vested illegally or with material irregularity, the National Commission would be justified in exercising the revisional jurisdiction. In exercising of revisional jurisdiction the National Commission has no jurisdiction to interfere with the concurrent findings recorded by the District Forum and the State Commission which are on appreciation of evidence on record.

15.    Based on the discussion above, I do not find any merit in the present Revision Petition and the same is dismissed. Consequently, the impugned Order passed by the State Commission is upheld. Keeping in view the facts and circumstances of the present case, there shall be no order as to costs.

16.    All other pending Applications, if any, stand disposed of.