PRESENT
Complainant – by Adv.Shri.Tushar Dube present.
Opponent 1& 2 by Adv. Smt. Bhawana Bhatt present.
Opponent 3 by Adv.Smt.Anita Marathe present.
ORDER
(Per- Mr. S. D. MADAKE, Hon’ble President.)
1. The complainant is wife of Shri. Rotangan Shankarlal Virji, who had purchased Maruti Omni Car no.MH-04/DW-7615 on 23/03/2009 for Rs.2,16,452/- by obtaining a loan of Rs.1,50,000/- from HDFC opponent no.3. Late Shri.Rotangan had taken policy no.BA-4152341 for a period between 26/03/2009 to 25/03/2010 and also “Suraksha Kavach Policy No.OG/09/1901/6014/00173391 for a period between 28/02/2009 to 28/02/2012. Later on complainant's husband expired on 19/03/2010 due to cardio-arrest leaving behind complainant and her four daughters and two sons.
2. The complainant applied to insurance company for payment of amount as per terms of insurance contract. The fact of death of late Rotangan was communicated to HDFC bank, however, bank recovered Rs.40,408/- after his death. The insurance company repudiated the claim on 01/11/2010 on the ground of breach of policy.
3. The complainant issued legal notice on 04/02/2011 against opponent. The opponents nos.1 and 2 choose not to reply and opponent no.3 replied stating the details regarding death certificate submitted to bank. The complainant alleged that opposite parties be ordered to pay Rs.5,40,408/- towards insurance contract as well as amount recovered by the bank after the death of husband of complainant.
4. The opposite parties filed written version on 01/12/2013 and stated that claim of Rs.5,00,000/- is neither covered under motor policy nor under Suraksha Policy. The motor policy provides personal accident cover and Suraksha policy covers risk including critical illness benefits upto Rs.1,00,000/-. The death benefits upto Rs.5,00,000/- are afforded when it is caused by “accidental bodily injury” caused by external accidents and not internal health conditions or mental sickness, disease or illness.
5. The opponent alleged that life of assured was not covered in case of his death for Rs.5,00,000/-, who died due to heart-attack on 19/03/2010. The claim was rejected on merit. The complaint by wife alone is not maintainable as there are other legal heirs. It is prayed that complaint be dismissed.
6. The opponent no.3 filed written version and denied all allegations made in the complaint. It is stated that no clause of the agreement executed by and between the parties allows the complainant to the vehicle loan in case of death of account holder. The intimation about sad demise was not given to bank till receipt of legal notice. The bank has only financed the vehicle.
7. We have perused the complaint, written version filed by three opposite parties, evidence affidavits filed by both sides, written submissions of both parties and all the documents pertaining to loan and two insurance policies. We have heard both sides at length in support of their respective contentions.
8. At the outset it is necessary to state the facts leading to filing of the case before this forum. The complainant initially filed the complaint no.45/2011 before Additional Thane District Forum on 28/03/2011 which was decided on 05/05/2011 on the ground of pecuniary jurisdiction. The complainant filed FA No.465/2011 before Hon'ble State Commission which came to be rejected stating that there is no substance in the appeal.
9. The documents on record indicate that complainant's husband had taken two insurance policies from opponent no.2. The complainant has main grievance against rejection letter by insurance company on 01/11/2010. The relevant part of the said letter is reproduced below-
“ On detail scrutiny of the same, we find that the claim does not
fall under the preview of the policy for reason given below”.
Captioned claim is for death due first heart-attack(myocardial infection) with 30 days from the date of diagnostic. The relevant clause of the policy is given below for reference.
Operative part-A
If the insured is diagnosed as suffering from critical illness, which first occurs on manifests itself during the policy period, and if the insured surviving for a minimum of 30 days from the date of diagnosis, the company shall pay a “Critical illness benefit”.
Hence we regret to inform you that the claim is inadmissible and repudiated the claim.
10. We have carefully perused the terms of the insurance policy which mandates that benefit on the ground of critical illness would be availed till the date of commencement of illness. The death certificate indicate that husband of the complainant died on the same day due to cardio arrest. There is stipulation in the insurance contract that on the death of insured by accident, Rs.5,00,000/- is payable. However, complainant is not entitle to said benefit due to fact that her husband died by heart-attack and not by accident.
11. The complainant is also not entitle for any benefit on the basis of policy No.BA/4152341 for 26/02/2009 to 25/03/2010 which also provides benefit only if death is on account of accident.
12. The opponent party no.3 HDFC bank stated that recovery of loan is made on the basis of terms of agreement and also stated that no one intimated the bank the death of complainant's husband till receiving of legal notice and assured the complainant to file claim after receipt of relevant documents.
13. As per Law laid down by the Hon'ble Supreme Court, the rights and obligation of the parties shall be governed by terms mentioned in the insurance contract, hence, we hold that opponents are not guilty for deficiency in service or for adopting unfair trade practice.
14. We regret to note that complainant is having number of dependents in litigating for her claim, however, as per Law, she is unable to get the relief. The insurance company may consider her case on humanitarian ground and decide to help the complainant during her difficult time.
15. In the result, we pass the following order..
Order
- RBT Complaint Case No. 527/2011 is dismissed.
2. No order as to costs.
3. Copy of this order be sent to both parties.
