NCDRC

NCDRC

RP/213/2013

HDFC BANK LIMITED - Complainant(s)

Versus

VIR BHAN SHARMA - Opp.Party(s)

MRS. CHETNA BHALLA & MR. PUNIT K. BHALLA

03 Mar 2014

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
REVISION PETITION NO. 213 OF 2013
 
(Against the Order dated 21/08/2012 in Appeal No. 1250/2008 of the State Commission Maharastra)
WITH
IA/392/2013,IA/393/2013
1. HDFC BANK LIMITED
THROUGH ITS AUTHORISED REPRESENTATIVE ANIL KUMAR SHARMA, 7TH FLOOR, ANSAL PLAZA CLASSIQUE TOWER, PLOT NO-1, J-BLOCK COMMUNITY CENTRE, RAJOURI GARNDEN.
NEW DELHI
...........Petitioner(s)
Versus 
1. VIR BHAN SHARMA
A-5/14-3, MILLENIUM TOWERS, SECTOR-9, SANPADA,
NAVI MUMBAI - 400 705
MAHARASTRA
...........Respondent(s)

BEFORE: 
 HON'BLE MR. JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER
 HON'BLE MR. DR. B.C. GUPTA, MEMBER

For the Petitioner :
Mr. Punit K. Bhalla, Advocate
For the Respondent :
In person

Dated : 03 Mar 2014
ORDER

PER JUSTICE K.S. CHAUDHARI, PRESIDING MEMBER This revision petition has been filed by the petitioner against the order dated 21.08.2012 passed by the Maharashtra State Consumer Disputes Redressal Commission, Mumbai (in short, he State Commission in Appeal No. A/08/1250 HDFC Vs. Vir Bhan Sharma by which, while dismissing appeal, order of District Forum allowing complaint was upheld. 2. Brief facts of the case are that Complainant/Respondent is an Advocate and purchased a primary and add on mediclaim policy for his family including his wife and minor daughter for Rs.2,00,000/- from OP/petitioner and paid Rs.950/- vide cheque dated 12.7.2004. OP issued two credit cards bearing No. 5176358010146727. On 26.8.2004, complainant wife Dr. Savita Sharma undergone Angioplasty and was discharged from hospital on 7.9.2004. Hospital raised bill for Rs.1,58,786.71 ps. Complainant could not avail mediclaim facility due to non-receipt of third party administrator Identity Card. OP sent three identity cards for the period 26.7.2005 to 25.7.2006, after more than a year from the receipt of the application. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that OP is not a service provider. It was further submitted that due to non-joinder of parties; namely, National Insurance Company and Family Health Plus Ltd. and the Third Party Administrator, complaint was not maintainable against the OP. It was further submitted that complainant declaration is to be read along with the Credit card. Complainant did not obtain pre-authorization before availing the Health Plus facility as per terms and conditions and prayed for dismissal of complaint. Learned District forum after hearing both the parties allowed complaint and directed OP to pay Rs.1,58,786.71 ps. along with 9% p.a. interest and further awarded Rs.2,000/- as litigation cost. Appeal filed by the petitioner was dismissed by learned State Commission vide impugned order against which, this revision petition has been filed. 3. Heard learned Counsel for the petitioner and respondent in person and perused record. 4. Learned Counsel for the petitioner submitted that even without coverage on the date of operation of complainant wife and without impleading necessary parties and without any liability of the petitioner, learned District Forum committed error in allowing complaint and State Commission further committed error in dismissing appeal; hence, revision petition be allowed and impugned order be set aside. On the other hand, respondent in person who is an Advocate submitted that order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed. 5. It is admitted fact that complainant wife had undergone Angioplasty on 26.8.2004 for which bill was raised by the hospital which was not paid by OP. Nowhere in the complaint any document pertaining to coverage of mediclaim on 26.8.2004 has been placed on record. In paragraph 8 of the complaint three identity cards for the period from 26.7.2005 to 25.7.2006 have been mentioned. As per averments in the complaint cheque of Rs.950/- for coverage was issued by complainant on 12.7.2004 and OP issued two credit cards, but nowhere it has been mentioned that any credit card covering medical facility from 26.8.2004 has ever been issued. Merely by making payment by cheque on 12.7.2004, no liability can be fastened for reimbursing expenditure of hospital on 26.8.2004 as no medical policy was in force on that date. Learned Counsel for the petitioner submitted that policy was issued from 27.8.2004 to 26.8.2005 and if so, there was no coverage for 26.8.2004 and in such circumstances, OP was not under any obligation to make payment of hospital charges. 6. Health Plus declaration was signed by the complainant which contains following clause: also understand that the HDFC Bank Health Plus Credit Card and National Insurance Company (NIC) and other preferred partner services are independent of each other and that HDFC Bank (Cards Division) is not responsible or liable for any service and/or billing deficiencies or inadequacies of NIC and/or other partners or agents as the case may be. I understand that the offers of such partners could change from time to time, without prior notice. Furthermore, I affirm that any grievances with NIC or such partners will not adversely affect my Credit Card payment commitments Perusal of aforesaid clause clearly reveals that HDFC Bank petitioner was not responsible or liable for any service or deficiency or inadequacy of National Insurance Company or other partners or agents of it. In such circumstances, no liability can be fastened on OP for any deficiency of service. Strictly speaking, no service has been provided by the petitioner and service if any was to be provided was only by the Insurance Company and third party administrator M/s. Family Health Plus Ltd. 7. Perusal of tailor made group mediclaim insurance policy for HDFC Health Plus Cardholders issued by the National Insurance Company reveals that claim was to be submitted by the complainant to the National Insurance Co. Clause 6.3 runs as under otice of Claim: Preliminary notice of claim with particulars relating to Policy Numbers, Name of insured person in respect of whom claim is made, Nature of disease/illness/injury and Name and Address of the attending medical practitioner/hospital/Nursing Home should be given to the TPA/Insurance Company within seven days from the date of Hospitalisation/Outpatient treatment. Final claim along with hospital receipted original Bills/Cash memos, claim form and list of documents as listed in the claim form etc. should be submitted to the TPA/Company within 15 days of discharge from the Hospital. Also give the company such additional information and assistance as the Company may require in dealing with the claim. As per this clause, complainant was under an obligation to submit his claim to the Insurance Company and learned respondent has not placed any document on record to prove that he has submitted claim to the Insurance Company. Even without submitting claim to the appropriate authority i.e. Insurance Company, complainant was not entitled to recover any amount from OP for hospitalisation of his wife and learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal and impugned order is liable to set aside. 8. Learned Counsel for the petitioner submitted that necessary parties have not been impleaded in the complaint. Admittedly, complaint was filed only against the petitioner whereas insurance coverage was given by National Insurance Co. and Third party administrator Family Health Plus Ltd. issued identity cards. Both these parties were necessary parties as claim was also to be submitted to National Insurance Co. Complainant has not impleaded aforesaid two parties as OP in the complaint and on account of non-joinder of necessary parties, complaint is liable to be dismissed. 9. Consequently, revision petition filed by the petitioner is allowed and impugned order dated 21.08.2012 passed by the State Commission in Appeal No. A/08/1250 HDFC Vs. Vir Bhan Sharma is set aside with no order as to costs.

 
......................J
K.S. CHAUDHARI
PRESIDING MEMBER
......................
DR. B.C. GUPTA
MEMBER

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