Punjab

Sangrur

CC/284/2018

Shiv Kumar Mittal - Complainant(s)

Versus

Star Health and Allied Insurance Co.Ltd. - Opp.Party(s)

Sh.Sanjeev Garg

12 Apr 2021

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SANGRUR .

 

                                                                         Complaint No. 284

 Instituted on:   03.07.2018

                                                                        Decided on:     12.04.2021

Shiv Kumar Mittal son of Sh. Tarsem Kumar Mittal, R/O H.No.16/B, 308, Dhobia Wali Gali, Dhuri, Distt. Sangrur now resident of Tulsi Nagar, Dhuri, Distt. Sangrur.

                                                          …. Complainant.     

                                                 Versus

1.     Star Health and Allied Insurance Co. Ltd. Branch Office Patiala, SCO No.70, 2^nd Floor, Opposite Tata Indicom, New Leela Bhawan through its Branch Manager.

2.     Star Health and Allied Insurance Co. Ltd. Regd. And Corporate Office: 1, New Tank Street, Valluvarkottam High Road, Nungambakkam, Chennai 600034 through its Managing Director.

3.     Mr. Narinder Mittal, agent of Star Health and Allied Insurance Co. Ltd. Branch Office, Patiala , R/O Yash Chaudhary Market, Saban Wali Gali, Dhuri, Distt. Sangrur.

             ….Opposite parties. 

For the complainant:                   :Shri  Sanjeev Garg, Adv.              

For the OPs 1&2                 :Shri Rohit Jain, Adv.

For OP No.3                       :Exparte.

 

 

Quorum:   Shri Jasjit Singh Bhinder, President

                Shri V.K.Gulati, Member   

 

ORDER:  

Shri Jasjit Singh Bhinder, President

FACTS

1.             Shri Shiv Kumar Mittal,  complainant has filed this complaint pleading that the complainant has taken a Health Insurance policy bearing number P/21115/01/2017/001970 which was further renewed vide new policy number P/211115/01/2018/002750 for the period from 1.3.2018 to 28.2.2019 from the OPs for the assured sum of Rs.5,00,000/-.  Further case of the complainant is that wife of complainant namely Nidhi Singla who is also covered under this policy suffered from Dengue and was got admitted in Balian Hospital Dhuri on 13.11.2017 and discharged on 16.11.2017. It is further averred that for the treatment of Nidhi Singla various tests were conducted from 13.11.2017 to 16.11.2017 and the complainant spent an amount of Rs.22,454/- on the same and on this complainant submitted all the bills to the OPs for payment of the claim amount of Rs.22,454/-, but the same was not paid. As such, the complainant got served a legal notice dated 14.6.2018 upon the OPs, but all in vain. Thus, alleging deficiency in service on the part of the OPs, the complainant has prayed that the Opposite parties be directed to pay to the complainant the amount of Rs.22,454/- along with interest @ 18% per annum and further to pay Rs.50,000/- as compensation on account of mental agony, tension and harassment and an amount of Rs.22,000/- on account of litigation expenses.

WRITTEN VERSION

2.             In reply filed by the OPs number 1 and 2, preliminary objections are taken up on the grounds that the complainant has no locus standi to file the present complaint, that the complaint is not maintainable, that the complainant has not come to the Forum with clean hands and that the complainant has suppressed the material facts from this Forum.  On merits, it is admitted that the complainant obtained the policy in question from the OPs. It has been denied that the wife of the complainant suffered from dengue and was got admitted in Balian Hospital, Dhuri. The complainant intimated the OPs regarding suffering of Nidhi Singla from Dengue on 18.11.2017 i.e. two days after discharge, thereby depriving the OPs to verify the details of admission by Field Verification Officer of the OPs. It is further averred that the complainant never intimated the OPs about the alleged various tests and spending of amount of Rs.22,454/- from 13.11.2017 to 16.11.2017.  The complainant submitted some documents but thereafter the complainant was advised to submit further documents, but the complainant failed to do so. As such, the OPs have prayed that the complaint be dismissed with special costs.  The jurisdiction of this Commission was also disputed by the Ops.

3.             Record shows that OP number 3 was proceeded against exparte.

EVIDENCE AND FINDINGS

4.             The learned counsel for the parties produced their respective evidence.

5.             The learned counsel for the complainant has argued that complainant has taken a Health Insurance policy bearing number P/21115/01/2017/001970 which was further renewed vide new policy number P/211115/01/2018/002750 for the period from 1.3.2018 to 28.2.2019 from the OPs for the assured sum of Rs.5,00,000/-. The learned counsel for the complainant has further argued that wife of the complainant Nidhi Singla was also covered under this policy and she suffered from Dengue and was got admitted in Balian Hospital Dhuri on 13.11.2017 and discharged on 16.11.2017. It is further argued that for the treatment of Nidhi Singla various tests were conducted from 13.11.2017 to 16.11.2017 and the complainant spent an amount of Rs.22,454/- and the complainant submitted all the bills to the OPs for payment of the claim amount of Rs.22,454/-, but the same was not paid. The claim of the complainant was not settled despite serving legal notice upon the OPs. As such, the complainant has prayed for acceptance of the complaint.

6.             On the other hand, the learned counsel for the Ops has argued that this Commission has no jurisdiction and the jurisdiction lies with the District Commission Patiala.  The learned counsel for the Ops has further argued that the complainant never intimated the OPs that Smt. Nidhi Singla was admitted for dengue treatment and as such the OPs have prayed that the complaint be dismissed.

7.             To prove this case, the complainant Shiv Kumar has tendered his own affidavit Ex.C-1 and has deposed as per the complaint. Ex.C-2 is the policy, Ex.C-3 and Ex.C-4 are  the legal notice, Ex.C-7 is the medical certificate , Ex.C-8 to  Ex.C-13 are the reports, Ex.C-14 is the claim form, Ex.C-15 to Ex.C-26 are the medical bills, Ex.C-27 is admission slip, Ex.C-28 is the bill and Ex.C-30 is bill of Garg Mission Hospital, Patiala.

8.     On the other hand, the learned counsel for the OPs has tendered affidavit of Shri Rajiv Jain Ex.OP1&2/1 and has deposed as per the written version. Ex.OP1&2/2 is the power of attorney, Ex.OP1&2/3 is the policy, Ex.OP1&2/4 terms and conditions of the policy, Ex.OP1&2/5 to Ex.OP1&2/16 are the copies of letters and Ex.OP1&2/17 is the claim form.  So, it is clear that the policy was taken at Patiala and this case is filed under the old Consumer Protection Act, 1986.  There is no evidence on the file to show that the policy was taken at Sangrur or any of the document was filled at Sangrur.  In view of our above discussion, as per the law laid down by the Hon’ble Supreme Court in Sonic Surgical vs National Insurance Co Ltd. 2010(1) SCC 135, the complainant was to file the complaint before the District Commission, Patiala and not at Sangrur. So keeping in view the judgment of the Hon’ble Supreme Court supra, in the present case all the documents were filled at Patiala and the policy was issued at Patiala.

9.             In view of above, we dismiss the complaint of the complainant only on the ground that this Commission has got no territorial jurisdiction to try and decide the present complaint. However, the complainant is at liberty to seek remedy before the competent court of law, if so desired. A certified copy of this order be issued to the parties free of cost as per rules. File be consigned to records.

Pronounced.

                        April 12, 2021.

 

(Vinod Kumar Gulati)  (Jasjit Singh Bhinder) 

           Member                 President