Per Sri A. Hazarath Rao,  President:-

        The complainant filed this complaint u/s 12 of the Consumer Protection Act seeking a direction to the opposite parties for payment of Rs.35,920/- being the balance amount of refund claims; Rs.50,000/- towards deficiency of service and Rs.6,000/- towards mental agony.

2.   In brief the averments of the complaint are these:

The complainant took medi-claim policy from M/s United India Insurance Company Limited through MD India Health Care Services vide policy No.06060048/09/97/00022643 covering himself and his family members.  The said policy was valid from 31-03-10 to the midnight of 30-03-11.  The said policy covered the complainant and his wife, daughter and son.   The complainant underwent a cataract operation in Manas hospital, Hyderabad as in patient during            11-04-11 - 13-04-11.  The said hospital authorities issued bill for Rs.20, 000/- towards treatment charges.  The 2^nd opposite party paid Rs.12, 500/- only though the complainant was eligible for Rs.25, 000/- for cataract operation.   Shaik Ruheena Begum daughter of complainant took treatment for enteric fever in Axon hospitals, Hyderabad during 21-10-10 - 28-10-10 as inpatient.  The complainant incurred Rs.28, 420/- towards the said treatment.  The opposite parties denied payment of Rs.28, 420/- though the complainant was entitled.  Several requests of the complainant made futile and as such the complainant got issued notice to the opposite parties.  In spite of receiving notice the opposite parties kept quite.

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3.  The opposite parties remained exparte.

4.   Exs.A-1 to A-15 were marked on behalf of complainant.                   

5.     Now the points that arose for consideration are:

1. Whether the opposite parties committed deficiency of service?
2. Whether the complainant is entitled to compensation?
3. To what relief?

6.  POINTS 1&2:-     The complainant had shown (1) Unique Mercantile India Private Limited, D.No.6-4-101, 2^nd floor, Arundelpet, Guntur and (2) MD India Health Care Services (TPA Private Limited), Pune as opposite parties to the complaint.  The complainant pasted a paper describing the 1^st opposite party replacing the earlier described. There is no scope for this forum whom the complainant had shown the 1^st opposite party earlier.

 7.   This Forum returned the complaint on 02-03-12 raising territorial jurisdiction among other objection.  The relevant objection is extracted below for better appreciation:

     “The opposite parties are carrying business at Chennai       and   Pune.  Explain how this Forum has got territorial       jurisdiction         u/s 11(2) of Consumer Protection Act, 1986?”

        For the said objection the complainant incorporated the following:

        “United India Insurance Company has tie up with OP1 i.e., Unique Mercantile India (P) Limited.  Hence Unique Mercantile India (P) Limited made a party in the proceedings”.

8.         In his complaint the complainant mentioned that he took the policy at Guntur within the jurisdiction of this Forum. Allegations in the complaint has alone to be taken in to consideration to determine the territorial jurisdiction.

9.         The complainant in page (1) of his complaint mentioned as detailed infra:

                        “It is submitted that the complainant Shaik Janpeer has taken Mediclaim policy from United India Insurance Company Limited through MD India Health Care Service of under current policy No.060600/48/09/97/00022643 covering complainant and his family members.   The insurance policies cover the period from the midnight of 31-03-10 to midnight of 30-03-11.  The complainant family covered by the said policy consists of himself, his wife Noorjahan Begum, Daughter Shaik Ruhina Begum and son Shaik Mohiddin.  The sum assured under the said Mediclaim policy is Rs.1,00,000/- each.

                    The complainant underwent a cataract operation conducted at Manas Eye Hospital, Swarnapuri Colony, Motinagar, Hyderabad admitted on 11-04-11 and discharged on 13-04-11.  The Hospital issued a bill for Rs.20,000/- towards the treatment charges.  The complainant is eligible under the said policy in a sum of Rs.25,000/- for cataract operation.  Surprisingly the 2^nd opposite party had deducted Rs.7500/- and issued only a cheque for Rs.12,500/- without indicating any reasons there for”.

10.   The affidavit of the complainant is also to the same affect.  But the complainant did not refer to the policy bearing No.06060048/10/97002611 covering the period from 31-3-2011 to 30-30-12 neither in his complaint nor in affidavit though filed copy of insurance policy along with it.  The complainant filed the policy referred to in the complaint as well as in affidavit (Ex.A-1) and the other policy not referred to in the complaint or affidavit (Ex.A-2).  The treatment taken by the complainant’s daughter was covered under the policy referred to in the complaint while the treatment taken by the complainant himself was covered under the 2^nd policy (Ex.A-2).  In Ex.A-1 and A-2 name and address of the TPA (third party administrator) was mentioned.  Nowhere in the policy it was mentioned that it had tie up with the 1^st opposite party i.e., Unique Mercantile India Private Limited, Guntur. 

11.  The Third Party Administrator (TPA) can only process claims on reference by the insurer.  The complainant it appears to us added the 1^st opposite party to have territorial jurisdiction without any basis and with out adding the Insurance Company which issued the policies. .   The complainant for the reasons best known to him did not make the insurance company as a party to the claim who is answerable.

12.   The opposite parties 1 and 2 have nothing to do with settlement of claim except scrutinizing and recommending them.  There is no privity of contract between the opposite parties and the complainant.   For not making the insurance company i.e., M/s United India Insurance Company Limited as a party to the complaint, the complaint is liable to be dismissed and we therefore answer these points against the complainant.  

13.  POINT No.3:-   In view of above findings in the result the complaint is dismissed without costs.

Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 4^th day of July, 2012.

MEMBER                                             MEMBER                                         PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:    NIL  

                                                                                                               PRESIDENT