Haryana

Panchkula

CC/245/2021

PARMINDER KAUR. - Complainant(s)

Versus

UNIVERSAL SOMPO GENERAL INSURANCE CO.LTD. - Opp.Party(s)

DR.SUMATI JUND.

15 Jun 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,  PANCHKULA.

                                                                       

Consumer Complaint No	:	245 of 2021
Date of Institution	:	28.05.2021
Date of Decision	:	15.06.2021

                                                                                           

 

Parminder Kaur D/o Sudesh Kumar aged about 32 years R/o C/o Kailash Medical Store Rupnagar Tehsil and District Rupnagar.

 

                                                                                                ….Complainant

 

Versus

Universal Sompo General Insurance Co. Ltd. SCO No.72, Ist Floor, Mansa Devi Complex, Swastik Vihar, Sector-5, Chandigarh, Haryana. 

 

                                                                              ….Opposite Party

COMPLAINT UNDER SECTION 35  OF THE CONSUMER PROTECTION ACT, 2019.

 

Before:                   Sh.Satpal, President.

                               Dr.Pawan Kumar Saini, Member.

                               Dr.Sushma Garg, Member.

 

For the Parties:      Dr.Sumati Jund, Advocate, counsel for the complainant.                      

ORDER

(Satpal, President)

1.                  Today the case is fixed for consideration on the point of territorial jurisdiction. Briefly stated, the facts shorn off unnecessary details, are that the cashless health care insurance policy bearing no.USGI/WEBAH/ 0029468/00/000 was issued by OP to the complainant valid from 10.03.2019 to 09.03.2020. The insured sum was of Rs.20 lakhs. In the proposal, it was specifically mentioned that the complainant has no pre-existing disease. A sum of Rs.2,557/- was deposited by way of cheque as premium and a premium certificate was issued by the OP acknowledging the receipt of the said amount of premium. Copy of the policy dated 09.03.2019 have been enclosed with the complaint. The complainant got injuries in her left knee as she allegedly fell on 20.03.2019 in her bathroom and thereafter, the complainant visited the OPD(Ortho) in Civil Hospital, Ropar(PB) where she was advised to undergo MRI  of left knee. The complainant has advised got the MRI for her knee from Tagore Hospital and Heart Care Centre(P) Ltd., Jalandhar(PB) on 27.03.2019 and as per MRI, her ACL(Anterior Cruciate ligament injury) was found torn. Thereafter, the complainant visited the Parmar Hospital, Ropar(PB) where the knee reconstruction surgery was undertaken.

          The OP was requested to provide the cashless facility qua her proposed knee surgery but the same was denied on the ground that the detailed evaluation/verification of the facts was required to assess the cashless claim. However, the complainant underwent the knee reconstruction surgery in Parmar Hospital, Ropar(PB) on 30.03.2019. The complainant remained hospitalization from 11.04.2019 to 14.04.2019 as per discharge summary (Annexure C-11). The claim was lodged on 09.05.2019 for the reimbursement of the expenses incurred by the complainant during her treatment with the OP but the same was denied vide its letter dated 20.08.2019 on the ground that the complainant was suffering from the pre-existing disease/ pre existing injury. In the present complaint, reimbursement of the expenses incurred by the complainant during her knee surgery has been claimed. A sum of Rs.2 lakhs on account of mental agony and harassment and Rs.50,000/- on account of litigation charges has also been claimed. The complaint is supported with affidavit of the complainant as well as documents Annexure C-1 to C-22.  

2.                 A complaint before it is admitted for adjudication is required to qualify, inter alia, various parameters, which may be enumerated as below;

1. That the complainant falls under the category of a consumer and that there exist a consumer dispute.
2. That the complaint has been instituted within the period of limitation as required under Section 69 (1) of CP Act,2019.
3. That the relief claimed do not exceed the pecuniary jurisdiction of this Forum.
4. That this Commission has territorial jurisdiction to entertain and decide the present complaint.

3.                  In the present complaint, there is serious issue with regard to the territorial jurisdiction of this Commission to entertain and try the present complaint. The complainant is the resident of Tehsil and District Rupnagar (PB), which is outside the territorial jurisdiction of this Commission. The complaint has been filed before us on the ground that there is a branch office at Panchkula of the said insurance company i.e. Registered Office(Head Office): Universal Sompo General Insurance Co. Ltd.,401, 4^th Floor, Sangam Complex, 127, Andheri-Kurla Road, Andheri(E), Mumbai (MH)-400059, which has issued the insurance policy bearing no.USGI/WEBAH/0029468/-00/000 to the complainant.

4.                  Admittedly, the said policy has not been issued from the branch office i.e. OP. As per photocopy of Ist page of the Insurance policy in question, it was issued from Andheri East, Mumbai. The premium certificate acknowledging the payment of Rs.2,557/- as premium by the complainant qua the policy in question has also been issued from Andheri East, Mumbai. Transcript of proposal for policy has been sent through online, whereas the payment of the premium of Rs.2,557/- has been made by cheque. In the transcript of the proposal, the address of the complainant has been shown in Rupnagar (PB). Admittedly, the treatment qua her knee injury has been taken by the complainant in Punjab. Cashless claim has been denied by the insurance company from its office at Mumbai vide letter dated 03.04.2019. As per said letter dated 03.04.2019 following is the details of address of insurance company (i) Health Claims Management: (i) Universal Sompo General Insurance Co. Ltd. Assotech One, 5^th floor, C-20/1A, C-Block, Sector-62, Noida, Uttar Pradesh-201309 and (ii)          Registered Office (Head Office): Universal Sompo General Insurance Co. Ltd.,401, 4^th Floor, Sangam Complex, 127, Andheri-Kurla Road, Andheri(E), Mumbai (MH)-400059. Reimbursement claim has been lodged by the complainant from her address at Rupnagar in Punjab. The e-mail correspondences have also been made from the said address by the complainant. The complainant has made the correspondence with the insurance Company at its address i.e. (i) Health Claims Management: Universal Sompo General Insurance Co. Ltd. Assotech One, 5^th floor, C-20/1A, C-Block, Sector-62, Noida, Uttar Pradesh-201309, (ii)Registered Office: Universal Sompo General Insurance Co. Ltd.,401, 4^th Floor, Sangam Complex, 127, Andheri-Kurla Road, Andheri(E), Mumbai (MH)-400059. Claim has been repudiated by the insurance company i.e. Universal Sompo General Insurance Co. Ltd. vide its letter dated 20.08.2019. The said repudiation letter was sent by the insurance company to the complainant at its address in Rupnagar(PB). As per repudiation letter dated 20.08.2019, the address has been shown at Noida and at Mumbai. From the above narrated facts, it is clear that no part of cause of action has happened in the territorial jurisdiction of this Commission. Neither the policy of insurance in question has been issued from the branch office i.e. OP nor the claim has been repudiated by the said branch office of insurance company. As per Section 34(2) of the Consumer Protection Act, 2019, a complaint can be filed in the District Commission within whose jurisdiction the complainant resides or carries on business or has a branch office or the head office of the service provider is located where the cause of action has occurred.

5.                  The complainant has filed the present complaint on the plea that branch office of the insurance company is located in the territorial jurisdiction of this Commission. The learned counsel hotly argued that the branch office of the insurance company is very well within the territorial jurisdiction of this Commission and hence, as per provision contained under Section 34(2)(a) of CP Act, 2019, the present complaint is maintainable in the District Commission, Panchkula. It is contended that the basic objective of the Consumer Protection Act, 2019 is to safeguard the interest of the consumers.

6.                  The plea of the branch office was thoroughly examined by the Apex Court in the case title as Sonic Surgical Vs. National Insurance Co. Ltd., (2009) CPJ 40 (SC), the  relevant part of the judgment is reproduced as under:-

                     “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   an 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] In  the present case,  since the         cause of action  arose at Ambala, the State Consumer Redressal Commission, Haryana alone will have jurisdiction  to entertain the complaint”.

7.                  In view of the provisions of the Consumer Protection Act, 2019 as contained in Section 34(2)(a) as reproduced above  as well as the law laid down by the Apex Court  in case  title supra, the present complaint is not maintainable before this Commission.

8.                  The learned counsel for the complainant took the shelter of order dated 07.12.2013 passed by Meghalaya State Consumer Disputes Redressal Commission, in support of her contentions that the policy was availed by the complainant online and payment was also made through net-banking. The plea is liable to be rejected as the payment towards premium was made by the complainant from Rupnagar(PB) by cheque towards premium. The law laid down by the Meghalaya State Consumer Disputes Redressal Commission vide its order dated 07.12.2013 is not disputed but the observations made therein were based on the premise that there is no definite residence or/place of the business of the consumer. In the present case, the complainant has availed the services of the insurance company, whose registered office is at Mumbai and Health Claims Management office is at Noida.

9.                  In view of the aforementioned factual as well as legal position, it is concluded that we have no territorial jurisdiction to entertain and adjudicate the present complaint; hence the same is accordingly dismissed in limini with liberty to the complainant to approach the competent authority/court if she is so advised. A copy of this order be sent to the complainant free of costs and file be consigned to the record room after due compliance.

Announced on: 15.06.2021

 

 

Dr.Sushma Garg               Dr.Pawan Kumar Saini                      Satpal

                Member                                 Member                         President

 

 

Note:            Each and every page of this order has been duly signed by me.

 

 

                                                   (Satpal)

                                                         President