Haryana

Kurukshetra

239/2018

Ved Parkash - Complainant(s)

Versus

Star Helath - Opp.Party(s)

Shishan Dutt

03 Feb 2020

ORDER

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KURUKSHETRA.

 

                                                     Complaint Case No.239 of 2018.

                                                     Date of institution:14.11.2018.

                                                     Date of decision:03.02.2020.

 

Ved Parkash s/o Shri Lila Ram, r/o H.No.E16, Ward No.2, Hospital Area, Nilokheri Township 45/1, Nilokheri, District Karnal.

                                                                …..…Complainant.

                                         Versus

 

1. Star Health and Allied Insurance Co. Ltd., No.15, Sri Balaji Complex, 1^st Floor, Whites Lane, Royapettah, Chennai-600014.
2. Star Health Insurance Branch Office through its branch manager, SCO 94, 1^st Floor, Sector-17, Kurukshetra.
3. Kapil Dev s/o Shri Sadhu Ram, Shop No.6B, 2^nd Floor, Arya Samaj Market, Sector-17, Kurukshetra.

..….Opposite parties.

 

Before:      Smt. Neelam Kashyap, President.

                   Ms. Neelam, Member.

                   Shri Issam Singh Sagwal, Member

       

Present:     Shri Shishan Dutt, Advocate for the complainant.   

                Shri Gaurav Gupta, Advocate for the opposite parties No.1                        & 2.

                Opposite Party No.3 ex-parte.

               

ORDER

                This is a complaint under Section 12 of the Consumer Protection Act, 1986 moved by complainant Ved Parkash against Star Health and Allied Insurance Co. Ltd. and others, the opposite parties.

2.            It is stated in the complaint that the complainant took a policy bearing No.P/211114/01/2018/001968 from the OP No.1 known as Family Health Optima Insurance. The OP No.3 is the agent of Ops No.1 & 2 and has assured him regarding the soundness of the company. That he got dental injury in his lower front teeth due to an accident and got the treatment in the Dr. Dhingra’s Dental and Oral surgical centre and paid a sum of Rs.7358.40 as medical expenses. That after the said treatment, he applied to the Ops for payment of said medical expenses, but the Ops lingered on the same and refused to pay anything to him. He requested the Ops in this regard time and again, but all in vain. By not paying his genuine claim, the Ops are deficient in services. Hence, this complaint.

3.            Upon notice, the OPs No.1 & 2 appeared and filed written statement raising preliminary objections regarding maintainability; complaint is bad for mis-joinder & non-joinder of necessary parties and jurisdiction. It is stated that the complainant has not come to this Hon’ble Forum with clean hands and has suppressed the true and material facts from this Forum. The complainant has availed Family Health Optima Insurance from the Ops, covering the complainant, his wife and two sons. The terms and conditions were explained to the complainant at the time of proposing policy and the same was served to him alongwith the policy schedule. It is clearly stated in the policy schedule “THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC. ATTACHED”. The complainant has accepted the policy agreeing and being fully aware of such terms and conditions and executed the proposal form. The insured submitted claim for reimbursement of medical expensed of Rs.7359/- towards the dental treatment. On scrutiny of claim documents, it is observed that the insured underwent dental treatment on OPD basis from 24.10.2017 to 03.11.2017. The insured was claimed for the treatment of ROOT CANAL TREATMENT and CERAMIC CROWNS which is not covered under the policy terms and conditions. As per Exclusion No.5, the Company is not liable to make any payment in respect of “Dental treatment or surgery unless necessitated due to accidental injuries and requiring hospitalization. (Dental implants are not payable). Hence, the claim was repudiated and same was informed to the complainant vide letter dated 10.12.2017. There is no deficiency on the part of the OPs No.1 & 2 and the present complaint may kindly be dismissed against them with costs.

                Upon notice, none appeared on behalf of the OP No.3 and accordingly, he was opted to be proceeded against ex-parte vide order dated 21.12.2018 of this Forum.

4.             The complainant has tendered affidavit Ex.CW1/A alongwith documents Ex.C-1 to Ex.C-6. On the other hand, the OPs No.1 & 2 tendered affidavit Ex.RW1/A alongwith documents Ex.R1 to Ex.R9.

5.             We have heard the learned counsel for the parties and perused all the record carefully.

6.             At the outset, the first and foremost question arises before this Forum for consideration is “Whether this Forum at Kurukshetra has jurisdiction to entertain & try the complainant or not? The learned counsel for the OPs No.1 & 2 has vehemently argued that this Forum lacks jurisdiction to entertain and hear the present complaint as neither the complainant was resident of Kurukshetra nor he has taken the treatment from Kurukshetra. On the other hand, the learned counsel for the complainant has argued that since branch office of the insurance company is situated at Kurukshetra, therefore, this Forum has territorial jurisdiction to try and entertain the present complaint. It is admitted fact that the complainant is not resident of Kurukshetra, rather he belongs to Nilokheri, District Karnal. The complainant has also not taken his dental treatment from Kurukshetra, rather he has taken the same from Karnal, as is evident from medical documents Ex.C1 to Ex.C3, produced by the complainant. The policy in question was issued to the complainant by the insurance company from their Delhi office, vide policy documents Ex.R-1 & Ex.R-2. Moreover, the claim of the complainant, was also repudiated by the insurance company vide letter Ex.C-4 from its Chennai office. So, in this case, no cause of action has arisen at Kurukshetra. Even if, it is presumed that the branch office of insurance company is situated at Kurukshetra, but mere branch office does not create any jurisdiction at Kurukshetra, until and unless the cause of action arises at Kurukshetra. Our this view is supported by the case law titled Sonic Surgical Vs. NIC, 2010(1) CLT page 252, wherein, the Hon’ble Supreme Court has held that “Territorial jurisdiction-Insurance Claim-Cause of action-The fire admittedly broke out in the godown of the appellant at Ambala-The insurance policy was also taken at Ambala and the claim for compensation was also made at Ambala-Since no cause of action arose in Chandigarh, the State Consumer Redressal Commission, Chandigarh has no territorial jurisdiction-State Consumer Redressal Commission, Haryana alone will have jurisdiction to entertain the complaint-Do not see any reason to interfere with the impugned order of the National Commission”. In these facts & circumstances of the case, we are of the considered view that since no cause of action has arisen within the jurisdiction of this Forum at Kurukshetra, therefore, this Forum has no territorial jurisdiction to try and entertain the present complaint.

7.             In view of the aforesaid discussion as well as without going into the other merits of the case, we hereby dismiss the present complaint with no order as to costs. However, complainant is at liberty to file his complaint before the competent court of law having jurisdiction, if so advised, and in that eventuality, complainant will be entitled to the benefit of Section 14(2) of Limitation Act and the time taken during the pendency of this complaint, shall be exempted. The complainant can obtain all the original documents, if any, relied upon in this case and Assistant is also directed to handover the same, if any, attached with the complaint, after retaining photocopy of the same on the file. Copies of the order be supplied to the parties concerned, as per rules. File be consigned to record room after due compliance.

Announced in open Forum:

Dt.:03.02.2020.                                                   (Neelam Kashyap)

                                                                        President.

 

(Issam Singh Sagwal),         (Neelam)       

Member                             Member.