To-day is fixed for admission hearing.
Complainant’s Advocate files hazira.
Heard the Ld. Advocate for the Complainant. Perused the complaint and the documents thereto.
The case of the complainant is, in brief, that husband of the complainant is a policy holder of PNB-oriental Group Health Insurance Scheme valid up to 14.05.2019 under OP No. 1 & 2. The complainant was treated at Mitra’s Clinic, Siliguri from 10.08.2018 to 13.08.2018 and the cost was Rs. 23,831/-. The complainant sent the original papers related to such medical treatment to OP No.3 on 08.09.2019 for re-imbursement, who did not repudiate the claim but asked for some necessary papers.
The complainant sent a legal notice dtd. 04.12.2018 to OP No. 2 & 3 who did not, however, reply. One of the Branches of O.P. No. 1 at Siliguri and the Banker of her husband were also moved but neither also paid any heed. Hence is the case.
Perused and considered. A perusal reveals that:-
- Husband of the complainant is a holder of PNB-Oriental Mediclaim Policy under OP No.1, being the Registered Office in New Delhi and the policy was issued by the OP No.2, being the Branch at Burdwan.
- OP No.3 to whom original documents relating to the treatment of the complainant were, sent runs their business in Kolkata.
- OP No.4 is the Siliguri Branch of OP No.1, but the policy was done not through this Branch. OP No.1 has such Branches not only at Siliguri but also elsewhere. So this Branch is nohow concerned with the instant complaint.
- The Husband of the complainant is an savings bank account holder of proforma OP i.e. Siliguri Branch of Punjab National Bank. It is the account holders of PNB only who are eligible for coverage of Mediclaim Policy Of Oriental Insurance Company. Thus Siliguri Branch of PNB i.e. the proforma OP is the eligibility provider only. PNB’s being tied-up with the Oriental Insurance Company proves that the Banker itself is not an Insurance company and hence not liable to settle any insurance claim. Hence the proforma OP is not concerned with the instant case.
It is thus seen that the cause of action, if any, arises not within the territorial jurisdiction of this Forum and instant complaint, being thus hit by Section 11(2)(a) & (b) of the C.P. Act., is not admitted.
