Chandigarh

DF-II

CC/694/2017

Roop Singh Chowdhary - Complainant(s)

Versus

The ICICI Lambard General Insurance Co. Ltd., - Opp.Party(s)

Gurmukh SinghAdv

02 May 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

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Consumer Complaint  No	:	694 of 2017
Date  of  Institution	:	14.09.2017
Date   of   Decision	:	02.05.2018

 

 

 

 

Roop Singh Chowdhary s/o Sh.Nagahhya Ram, R/o # 2611, Sector 47-c, Chandigarh.

             …..Complainant

Versus

1]  The ICICI Lombard General Insurance Co. Ltd., through its Manager, Plot No.149, Industrial Area, Phase-1, Chandigarh.

2]  The ICICI Lombard General Insurance Co. Ltd., through its General Manager, 4^th Floor, Interface II, Off Malad Link Road, behind Gurgaon Sports Club, Malad (West), Mumbai 400064  

   ….. Opposite Parties 

 

BEFORE:  SH.RAJAN DEWAN             PRESIDENT

         MRS.PRITI MALHOTRA             MEMBER 

                               

 

 

Argued by :- Sh.Vikram Tondon, Adv. and Sh.Gurmukh Singh,              Adv. for the complainant.

             Sh.Gaurav Sharma, Adv. for the OPs.

 

 

PER PRITI MALHOTRA, MEMBER

 

         Briefly stated, the case of the complainant is that he is having insurance policy Ann.C-1 from Opposite Party.  It is averred that the complainant went to Fortis Hospital for breathing problem and he was admitted there on 15.3.2017 and was discharged after treatment on 19.3.2017 (Ann.C-2 & C-3).  It is averred that the complainant paid the bill amount of Rs.1,88,977/- to Fortis Hospital towards the said treatment (Ann.C-4) and thereafter lodged a claim with the OPs for reimbursement of the medical bill.  However, the OPs reimbursed only an amount of Rs.25,000/- against the bill of Rs.1,88,977/- and did not pay the balance amount of Rs.1,63,977/-.  It is submitted that the complainant wrote letters to the Opposite Parties for payment of the balance claim amount, but they did not pay any heed.  Hence, this complaint has been filed alleging deficiency in service on the part of OPs.

 

2]       The Opposite Parties have filed reply stating that the present complaint is not maintainable before this Forum on account of territorial jurisdiction. It is stated that the policy in question was issued at Mohali and the complainant got treatment at Fortis Hospital Mohali, therefore, this Forum at Chandigarh does not have the territorial jurisdiction to try & entertain the present complaint.  On merits, while admitting the factual matrix of the case, it is stated that on detailed scrutiny of the claim, the company find that the claim falls under the preview of the policy clause All Medical Expenses for any treatment not involving surgery/medical procedure Sub-limits is Rs.25,000/- as the verification of claim documents reveals that the complainant was diagnosed of “Acute pulmonary thromboembolism” and underwent treatment of the same.  It is also stated that any medical/surgical expense incurred on the said treatment are fall under the preview of Mandatory Extension HC-4 – Sub Limits on Medical Expenses/Illness/ Surgeries/Procedures has been specifically mentioned that for all Medical Expenses for any treatment not involving surgery/medical procedure Sub-limit is Rs.25,000/- and therefore, the complainant was rightly paid the due amount.   Pleading no deficiency in service and denying rest of the allegations, the OPs have prayed for dismissal of the complaint.

 

3]       Rejoinder has also been filed by the complainant thereby reiterating the assertions as made in the complaint and controverting that of the reply filed by Opposite Parties.

 

4]       Parties led evidence in support of their contentions.

 

5]       We have heard the ld.Counsel for the parties on the point of admission of this complaint.

6]       Before deciding the complaint on merits, we deem it proper to decide the objection taken by the OPs about territorial jurisdiction of this Forum, so that the maintainability of the complaint be seen.

 

7]       The objection of the OPs is that this Forum has no territorial jurisdiction to entertain the present complaint as no cause of action has taken place at Chandigarh.  It is argued that the Health Insurance Policy of the complainant was issued at Mohali and the treatment was also taken by the complainant at Fortis Hospital, Mohali, therefore, no cause of action arises in favour of the complainant at Chandigarh and thus, this Forum does not have the territorial jurisdiction to try & adjudicate the present complaint. 

 

8]       We find force in the contentions of ld.Counsel for OPs. Ann.C-I is the copy of policy which reflects that it has been issued by Agent ICICI Bank Mohali.  Ann.C-2 is the Discharge Summary which also proves that the treatment taken by the complainant was at Fortis Hospital, Mohali. 

 

9]       Section 11 of the Consumer Protection Act, 1986 clearly stipulates as under:-

11.     Jurisdiction of the District Forum.—(1) Subject to the other provisions of this Act, the District Forum shall have jurisdiction to entertain complaints where the value of the goods or services and the compensation, if any, claimed ''does not exceed rupees twenty lakhs. 

(2)     A complaint shall be instituted in a District Forum within the local limits of whose jurisdiction,—

(a) the opposite party or each of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides or carries on business or has a branch office or personally works for gain, or

(b)     any of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides, or carries on business or has a branch office, or personally works for gain, provided that in such case either the permission of the District Forum is given, or the opposite parties who do not reside, or carry on business or have a branch office, or personally work for gain, as the case may be, acquiesce in such institution; or

(c) the cause of action, wholly or in part, arises. 

 

 

10]      Mere exchange of correspondences with Chandigarh Branch of OP Company or making bill payment through Chandigarh bank account of the complainant itself would not confer any right in favour of the complainant to file the complaint at Chandigarh without proving any cause of action accrued at Chandigarh.  Thus, it is proved that no cause of action has accrued to the complainant at Chandigarh. Also, there is no cogent documentary evidence from the side of the complainant to rebut the assertions of the OPs, which draws an adverse inference against the complainant and the objection of the OPs is held to be right that this Forum has no territorial jurisdiction to try & adjudicate the present complaint as no cause of action has accrued to the complainant against the OPs at Chandigarh.  

 

11]      For the above decision, we are also guided by the judgment of the Hon’ble Supreme Court in Sonic Surgical Vs. National Insurance Co. Ltd.-IV (2009) CPJ 40 (SC) and the operative part of the same reads  as under :-

 “4.     In our opinion, no part of the cause of action arose at Chandigarh. It is well settled that the expression cause of action means that bundle of facts which gives rise to a right or liability. In the present case admittedly the fire 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. Thus no part of the cause of action arose in Chandigarh.

          XXX                         XXX                     XXX

8.       Moreover, even if it had application, in our opinion, that will not help the case of the appellant. Learned Counsel for the appellant submitted that the respondent-Insurance Company has a branch office at Chandigarh and hence under the amended Section 17(2) the complaint could have been filed in Chandigarh. We regret, we cannot agree with the learned Counsel for the appellant. In our opinion, an interpretation has to be given to the amended Section 17(2)(b) of the Act, which does not lead to an absurd consequence. If the contention of the learned Counsel for the appellant is accepted, it will mean that even if a cause of action has arisen in Ambala, then too the complainant can file a claim petition even in Tamil Nadu or Gauhati or anywhere in India where a branch office of the Insurance Company is situated. We cannot agree with this contention. It will lead to absurd consequences and lead to bench-hunting. In our opinion, the expression branch office’ in the amended Section 17(2) would mean the branch office where the cause of action has arisen. No doubt this would be departing from the plain and literal words of Section 17(2)(b) of the Act but such departure is sometimes necessary (as it is in this case) to avoid absurdity [vide G.P Singh’s Principles of Statutory Interpretation, Ninth Edition, 2004 P. 79].”

 

The principle of law, laid down, in the aforesaid case, is fully applicable to the instant case.  Hence, from the above scenario, it is clear that no part of cause of action has accrued at Chandigarh so as to attract the territorial jurisdiction of this Forum.

 

12]      In view of the above discussion, we are of the opinion that the present complaint is not maintainable for want of territorial jurisdiction. Accordingly, without touching the merits of the present complaint, the same is hereby dismissed. Parties are left to bear their own costs. The complainant shall be at liberty, to approach the appropriate Forum, having territorial jurisdiction in the matter and the time spent herein would stand commuted/condoned for the purpose of limitation.

         Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

2^nd May, 2018                                                                                Sd/-

(RAJAN DEWAN)

PRESIDENT

 

 

Sd/-

 (PRITI MALHOTRA)

MEMBER