1. OP 1 is a public sector general insurance company incorporated in 1938. It obtained the business of Mediclaim Insurance for the CanCard Holders under group insurance from the year 2005-06. Earlier, CanCard management utilized the services of M/s. New India Assurance Co. Ltd., New Delhi, for the same medi-claim insurance.

2. At the time of filing of the information, the Third Party Administrator for OP 1 was stated to be M/s. E-Meditak (TPA) Services Ltd. (OP 2). Prior to year 2005-06, the TPA for New India Assurance Co. Ltd was M/s. Medi Asst India (P) Ltd., Bangalore.

3. TPAs were introduced by Insurance Regulatory and Development Authority (IRDA) in the year 2001 to ensure better services to policy holders. Their basic role is to function as an intermediary between the insurer and the insured and facilitate cashless service at the time of hospitalization as well as processing of claims. Insurance companies, in order to improve the processing of claims, appoint TPAs, licensed by IRDA. The selection of TPAs from amongst the licensed rests with the Insurance Company and no criteria / procedures are specifically laid down for such selection by IRDA. The selection of TPAs and terms and conditions of the Agreement between the Insurer and TPAs are decided by the respective Insurance Companies only.

4. Accordingly, OP 1 appointed OP 2 as its TPA. As per the information, the agreement entered between OP 1 and OP 2 ('the agreement') didn't contain any clause to fix the responsibility to collect data of the existing policy holders inclusive of Group Insurance policy holders at the time of obtaining Mediclaim Insurance business in 2005-06. The processing of claim applications was being carried out by OP 2 with the current status of the applicants without considering the past insurance policies for continuation, claims paid, inclusion and exclusion of members within the family etc.

5. As per the informant, OP 2 failed to fulfil its obligations stated under various clauses of the agreement with OP 1 which benefited the policy holders. The Informant pointed out certain clauses in the agreement not being complied by OP 2. The clauses pertained to renewal/termination of the policy, denial of preauthorization, claim intimation, repudiation of claim etc.

6. The informant did not appear to present his submissions on the scheduled date of hearing before the Commission despite notice.

7. It was alleged in the information that OP 1 abused its dominant position and there by contravened section 4 of the Act. The dominance of OP 1 and OP 2 as contended by the informant seems misconceived. The Informant alleged that since OP 1 was the only and dominant service provider to CanCard Group Medi insurance policy holders, all CanCard holders who opted for these medi-claim policies were necessarily required to carry out all the transactions through the OP 2 and OP 1 only. Hence, OP 1 was Dominant for the Group Medi Insurance policies for CanCard holders who opted for this group insurance scheme.

8. In Kaushal K. Rana v. DLF Commercial Complexes Ltd. [2013] 117 SCL 512, the Commission observed that the relevant market in every case must be determined after giving due regard to the relevant geographic market and relevant product market as required by the provisions under Section 2(r) read with section 19(5) of the Act. Section 2(t) defines relevant product market as 'a market comprising all those products or services which are regarded as interchangeable or substitutable by the consumer, by reason of characteristics of the products or services, their prices and intended use'. Further section 2(s) defines relevant geographic market as 'a market comprising the area in which the conditions of competition for supply of goods or provision of services or demand of goods or services are distinctly homogenous and can be distinguished from the conditions prevailing in the neighboring areas'.

9. Considering these provisions of the Act, the relevant market presumed by the inf