MS. NIPUR CHANDNA, MEMBER

ORDER

15.07.2024

1.         A complaint under Section 12 of Consumer Protection Act filed. In brief the facts are that complainant is the mediclaim policy holder of OP Ins. Co. vide policy bearing no. 112002/48/11/06/00000564 w.e.f. 22.09.2011 to 21.09.2012 covering complainant and all his family members .

2.       On 21.11.2011, complainant’s mother Mrs. Kamla Devi was admitted to Ekansh Nursing Home for the treatment of Accelerated HTN with Dyslipidemia  and discharge from the said nursing home on 24.11.2011. The intimation of the hospitalization was given to OP4 on 21.11.2011. It is alleged by the complainant that he submitted his claim of Rs. 20,740/- along with all the original medical documents to OP4 through speed post dated 01.12.2011. The complainant also submitted post hospitalization claim of Rs. 5,032/- to OP4 on 15.12.2011. Despite receiving the hospitalization bill as well as requisite medical record the OP Ins. Co. neither rejected the claim nor had released the same. Being aggrieved by the conduct of OP Ins. Com. Complainant sent a legal notice thereby calling upon the OP Ins. Co. to release the claim in question but all in vain. Being aggrieved by the conduct of OP complainant approached this Commission for redressal of his grievance.

3.       Notice of the complaint was sent to all the OPs. Despite ample opportunities OP failed to file their respective written statement as such the right to file the written statement of all the OPs stands closed vide order dated 17.02.2014. 

4.       Complainant filed his ex-parte evidence by way of affidavit wherein he has corroborated the contents of his complaint.

5.       Complainant has placed on record the copy of letter dated 01.12.2011 vide which he lodged the claim with OP, copy of policy documents, copy of claim form, copy of medical bills and record, copy of legal notice dated 27.03.2012 served upon OP in support of his contention.

6.       Written arguments filed by the complainant.

7.       We have heard  the arguments advance at the bar by Sh. Sachin  on behalf of complainant and Sh. Gurmeet Singh counsel for OP and  have perused the record.

8.       During the course of arguments OP has strongly challenged the issue of territorial jurisdiction, hence, needs to be decided first.

9.       Before adverting to the disposal of the present complaint case let us peruse the relevant perusal of CP Act 1986 which are reproduced as under:-

          Section 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 1[does not exceed rupees five 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 1[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 1[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 1[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.     Admittedly, in the present complaint case the policy was issued from Sonepat office of OP Company which does not fall within the territorial jurisdiction of this commission.  The complainant filed the claim with OP4 having its address at Gurugram, Haryana which also does not fall within the territorial jurisdiction of this commission. As per the array of the Head office of the OP Ins. Co. is of Chennai, the regional office of OP Ins. Co. mentioned is of Connaught place, the policy issuing office of OP Ins. Co. is of Sonepat and the TPA is having its office at Gurugram, Haryana as all the offices of the OP mentioned in the array of parties does not fall within the territorial jurisdiction of this Commission, hence, we are of the considered opinion that this Commission has no territorial jurisdiction to entertain and adjudicate the present complaint case.

11.     In view of the above discussion we are of the considered opinion that the present complaint is not maintainable before this commission due to lack of territorial jurisdiction, hence, dismissed.

          File be consigned to record room.

12.   Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving the application from the parties in the registry. Order be uploaded on.

Announced in open Commission on   15.07.2024.

(SANJAY KUMAR)                (NIPUR CHANDNA)                        (RAJESH)

PRESIDENT                                     MEMBER                               MEMBER