BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.201 of 2017
Date of Instt. 04.07.2017
Date of Decision: 25.07.2018
Suman Bala wife of Sh. Parmod Kumar Dua, aged about 55 years, resident of H. No.10, New Ujjala Nagar, Basti Danishmanda, Jalandhar 144002.
..........Complainant
Versus
1. Cigna TTK Health Insurance Co. Ltd. having its Corporate Office 401/402, Raheja Titanium, Western Express Highway, Goregaon (East) Mumbai-400 063
2. Indiabulls Housing Finance Ltd., through its Branch Manager/Incharge, Branch Office at SCO 8-9, 1st Floor, Crystal Plaza, Garha Road, above HDFC Bank Ltd., Choti Baradari, Jalandhar, Punjab.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Harvimal Dogra (Member)
Present: Sh. Umesh Dhingra, Adv Counsel for the Complainant.
Sh. AK Gandhi, Adv Counsel for the OP No.1.
Sh. Iqbaldeep Singh, Adv Counsel for the OP No.2.
Order
Karnail Singh (President)
1. This complaint is presented by the complainant, wherein alleged that she is working as a receptionist in Guru Nanak Mission Hospital, Guru Nanak Chowk, Jalandhar City. The son of the complainant namely Sahil Dua wanted to purchase a house in the Jalandhar City and accordingly, Mr. Sahil Dua located a House No.10, New Ujala Nagar, Basti Danishmanda Jalandhar. For purchase of raising further construction on the house, Mr. Sahil Dua had planned to spend more amount from his own sources and for the rest of the amount, he had approached OP No.2 for the financial help in the shape of home loan. The OP No.2 sanctioned home loan for an amount of Rs.12,13,761/- in favour of the complainant as well as Mr. Sahil Dua and the complainant as well as Mr. Sahil Dua executed Loan Agreement dated 28.03.2015 under loan account No.HHLJAL00221621 containing detailed terms and conditions. The loan amount was payable in 180 equated monthly installments. It was carry interest @ 10.1%. The OP No.2 have obtained the original title deed of H. No.10, measuring 5 marlas mentioned in the Jamabandi for the year 2012-13 of Basti Danishmanda, Tehsil and District Jalandhar. 2. That the OP No.2 advised the complainant as well as Mr. Sahil Dua to have an insurance in the name of Mr. Sahil Dua in the sum of Rs.12,00,000/- from OP No.1 for covering the loan amount in the event of any unfortunate happening to Mr. Sahil Dua. Based upon the advice of OP No.2, Late Mr. Sahil Dua approached by OP No.1 and by paying the premium obtained policy No.LTPRCC0200004878 with risk starting date of 29.04.2015 and end date of 27.04.2018. The total premium of Rs.7863.4 was paid by Mr. Sahil Dua to OP No.1 for obtaining the policy. The complainant, the nominee in the said insurance policy and in the event of any unfortunate incident, the claim was payable to the complainant. After sanctioning of the loan by the OP No.2, Late Mr. Sahil Dua had been regularly paying EMIs to the OP No.2 and there was no breach of any EMI.
3. That as ill luck would have been, during the intervening night of 30/31.12.2016 Mr. Sahil Dua developed a serious chest pain and in an ailing condition, Mr. Sahil Dua was brought to Guru Nanak Mission Hospital at about 03:00 AM. Mr. Sahil Dua was shifted to Guru Nanak Mission Hospital, Guru Nanak Mission Chowk, Jalandhar. Immediately upon arrival of Mr. Sahil Dua in the hospital, his ECG was conducted, which revealed acute heart attack and the treatment was started. The condition of Mr. Sahil Dua deteriorated further and the attending doctors at hospital namely Sh. Damanjit Singh became panic and Mr. Sahil Dua was referred to some cardio institute. However, while Mr. Sahil Dua was being shifted to Cardio Institute, he died on the way. Mr. Sahil Dua was just 26 years old, young and well built up boy and the entire family came under a shock and depression because of untimely and sudden death of Mr. Sahil Dua. The complainant as a mother is still under shock because of untimely death of her young son. The OP No.2 was intimated regarding the death of Mr. Sahil Dua and the OP No.2 represented that there is no necessity to make payment of the remaining EMIs as the entire EMI were being paid from the account of Mr. Sahil Dua. The OP No.2 also represented that they will have the claim from the OP No.1 and will close the Home Loan Account accordingly. Thereafter, the representative of the OPs got signed claim form for obtaining claim from OP No.1 and the complainant, who was still under a shock signed the claim form and supplied the treatment record, copy of the death certificate and other information as demanded from time to time by the representative of the OP. Now the OP No.2 has started claiming that the claim of death of Mr. Sahil Dua has been repudiated by OP No.1. Absolutely, no intimation was given by OP No.1 to the complainant or any of the family members of Mr. Sahil Dua and on inquiries being made, the OP No.2 has given a copy of the letter dated 07.06.2017, whereby the claim has been repudiated by the OP No.1 on flimsy grounds. The repudiation of the genuine claim is mainly on the ground that the timing of ECG test and the date thereof does not tally with the date of death of Mr. Sahil Dua. When the complainant made the inquiries, then Dr. Damanjit Singh told the complainant that on the relevant date, ECG machine was having some defect regarding the date and timing as well as age and he had already intimated the OP No.1 in this regard. Dr. Damanjit Singh further clarified that the cause of death as disclosed by him is that the patient had acute heart attack for which he was given treatment and he had died at 03:45 AM. The OP No.1 is taking shelter on this flimsy ground that ECG was conducted at 03:45 AM and the patient was referred at the same time and died at the same time and these things do no reconcile. Similarly, the OP No.1 is insisting that the reference slip does not bear the rubber stamp and is maintaining that after the injection of Streptokinase a regular waiting period of one hour was not given to the patient. All these grounds are flimsy grounds. The complainant and his family members are simpleton and their only intention was to save the child and they had no intention to cause the death of their own child. The grounds, which have been taken for the repudiation of the claim are flimsy grounds and the OP No.1 is liable to pay the sum insured i.e. Rs.12,00,000/- to the complainant or to the OP No.2 along with interest @ 12% per annum from the date of death of Mr. Sahil Dua till the date of payment of the claim amount.
4. The OP No.2 has started harassing the complainant and they are openly proclaiming that they will take possession of the house forcible and are not going to wait for the final decision of the matter regarding the claim of death of Mr. Sahil Dua. The complainant had been telling the representative of the OP No.2 that first of all that the complainant never received any intimation regarding repudiation of the claim and secondly, she must be given time to get the lawful claim of the death of her son Mr. Sahil Dua. The OP No.2 has also calling unnecessary the complainant regarding dishonouring of the EMIs. The genuine claim regarding the death of Mr. Sahil Dua has been repudiated on flimsy grounds and the OP No.2 is not prepared to give logical time to the complainant for settlement of the claim and the same tantamounts to deficiency of service and accordingly, the present complaint filed with the prayer that the complaint of the complainant may be accepted and OP No.1 may be directed to pay the claim under the insurance policy along with interest @ 12% per annum from the date of death, till actual payment and further OP No.2 may kindly be directed to defer the making of any demand regarding the home loan amount pending disposal of the present complaint as the insurance policy was obtained on the asking of OP No.2, from OP No.1 and further OP No.2 may be restrained from charging interest on the housing loan and further OPs be directed to pay a compensation for harassment to the tune of Rs.1,00,000/- and litigation expenses of Rs.50,000/-.
5. Notice of the complaint was given to the OPs and accordingly, OP No.1 filed its reply and contested the complaint by taking preliminary objections that the present complaint is false, vexatious and has been filed with malafide intention to harass the answering OP and further averred that the complaint is not maintainable against the OP No.1 and the same is liable to be dismissed. OP No.1 has rightly denied payment of this death claim of the deceased Sahil Dua as the present case is clear cut case of the concealment of material facts and misrepresentation. As per the investigation, the documents and history suggested that the sequence of events are not in order and are discrepant. It is clear from the documents that the patient was referred to another hospital at 03:45 AM, ECG Test as per doctor endorsement was conducted on the patient at 03:45 AM and as per record, the patient also died at 03:45 AM. All these three events are contradictory to each other and could not have happened at the same point of time. Moreover, ECG Report also shows the date of test as 4th September, 2016 and belongs to the person having age of 35 years, but the patient Mr. Sahil Dua was admitted in the hospital on 31.12.2016 and was having age of 26 years at the time of death, which causes suspicion pertaining to the ECG Report submitted by the complainant to this answering OP No.1. No postmortem of the deceased Mr. Sahil Dua was conducted by the complainant to ascertain the actual cause of death of the deceased Mr. Sahil Dua. Moreover, no ECG Report of the deceased Mr. Sahil Dua, which was conducted immediately upon admission in the hospital, was provided to this answering OP No.1 inspite of several requests made by OP No.1, but as per documents submitted to the OP No.1, the tablets and injection were administered to the patient prior to the ECG test, i.e. without diagnosis of Heart Attack. Non-submission of the documents is in violation of the terms and conditions of the insurance policy. So, the present case is clear cut case of the concealment of material facts and is liable to be dismissed in the light of the violation of terms and conditions of the insurance policy and well as suppression of material facts. It is further alleged that this Forum has no territorial jurisdiction to try and entertain the present complaint, the branch office of this OP is not situated at Jalandhar. So, this Forum has got no territorial jurisdiction to try and entertain the present complaint. So, the present complaint is liable to be dismissed for want of territorial jurisdiction and further alleged that the complaint contains intricate and complicated questions of facts and law and voluminous evidence is required by the Forum to reach at the just and final conclusion and thus, the complaint should be relegated to its remedy before the Civil Court of competent jurisdiction. On merits, the factum in regard to get an insurance policy by the son of the complainant is not denied rather the death of the insured Sahil Dua is considered under doubtful circumstances. The other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
6. The OP No.2 filed its separate reply and admitted that deceased Mr. Sahil Dua availed the loan facility from the answering OP and accordingly, Mr. Sahil Dua executed a loan agreement and signed the same and further submitted that the complainant is alleging there is a deficiency of service, but that relates to the OP No.1 not to the OP No.2 because an insurance policy was obtained by the son of the complainant from OP No.1 and further submitted that the OP No.1 is entitled to get the remaining loan amount along with interest according to the agreement and as such, there is no deficiency on the part of the OP No.2 and therefore, the complaint of the complainant against OP No.2 is without merits and the same may be dismissed.
7. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA along with documents Ex.C-1 to Ex.C-10 and then closed the evidence.
8. Similarly, counsel for the OP No.1 tendered into evidence affidavit of Sh. Nileash Ramchandani, Sr. Manager as Ex.OP1/A along with some documents Ex.OP1/1 to Ex.OP1/9 and then closed the evidence.
9. Similarly, counsel for the OP No.2 tendered into evidence affidavit of Sh. Sanjeev Kumar, Authorized Representative of OP No.2 as Ex.OP2/A along with some documents Ex.OP2/1 to Ex.OP2/4 and then closed the evidence.
10. We bestowed our thoughtful consideration to the submission made by learned counsel for the respective parties and also gone through the case file very minutely.
11. After considering the set of circumstances as elaborated in the respective pleading of the parties, it reveals that the son of the complainant Sahil Dua was admittedly insured with the OP No.1, because he had got an insurance policy from the OP after making a premium and copy of the policy is produced on the file by the complainant Ex.C-9 and further death of the insured Sahil Dua is also not denied rather it is established by the complainant by producing on the file death certificate Ex.C-3 and further for getting treatment from Guru Nanak Mission Hospital and its prescription slip is Ex.C-4 and further certificate issued by the treating doctor is Ex.C-6, which shows that the death of the insured Sahil Dua was due to cardiac heart attack, to this extent, the case of the complainant is not denied by the OP No.1 rather the OP No.1 admitted that an insurance claim was submitted by the complainant being mother of the insured and the said insurance claim was repudiated, vide letter dated 07.06.2017 proved on the file by the complainant as Ex.C-7 and same letter has been also proved on the file by the OP, which is Ex.OP1/1.
12. Now, at this stage, we have to analyze the points on which the insurance claim of the complainant was repudiated by the OP, which are as under:-
“We regret to inform you that your claim for alleged first heart attack is hereby rejected on the grounds mentioned below in this letter.”
“We have carefully examined and investigated the aforesaid claim in the light of the claim documents, other documents submitted by you during verification of history of insured's ailment. The following are the findings of our investigation:
1. Report of ECG test conducted immediately upon admission at the hospital, and prior to administration of injections and tablets, has not been submitted.
2. Invoice of injections/tablets/other medications, as may be have been administered, has not been submitted.
3. After alleged administration of streptokinase injection, a regular waiting period of around 1 hour (for the medicine to have effect) was not given to the patient. Instead, the patient was referred to other hospital within 30 minutes from time to admission.
4. Treatment paper from doctor, wherein patient has been referred, does not contain stamp and/or registration no. of the doctor.
5. ECG report, as has been submitted, shows the timing of test as 03:45 AM, i.e. only after administration of injection and tablets. ECG is prerequisite for diagnosis of heart attack.
6. ECG report also shows date of test as 4th Sept. 2016, i.e. more than 3 months prior to the date of patient's admission.
7. The age of patient is 35 years as per the ECG report which is not matching with the policy records.
8. The documents and the history suggest that the sequence of events are not in order and are discrepant. It is appearing from the documents submitted that:
a. Patient was referred to another hospital at 3:45 AM.
b. ECG test was conducted on the patient at 3.45 AM.
c. Patient died at 3:45 AM.
All the three events are contradictory to each other and could not have taken place together.
9. Death certificate, issued by the hospital, certifying the cause of death is not submitted.
10. Blood investigation, other investigation reports and indoor case records done during hospitalization, for this ailment, and death notes prepared by the hospital have not been submitted.
13. In order to reach a right conclusion, we have to deeply examine the point raised by the OP for rejecting the claim of the complainant. We have gone through the said points and find that the most of the points raised by the OP, is not to be managed by the complainant or her family members rather it is the duty of the hospital administrative or the treating doctor, moreover, if any report is not preserved or produced before the OP, then we think it have no affect on the sanctioning of the insurance claim. So, for the concern of timing showing on the ECG is different as well as showing different age, the same is get cleared by the complainant from the treating doctor that there was some fault in the ECG machine and due to that the time and date had been shown wrong, but this report of the doctor is not challenged or contradicted by the OP in any manner rather simply declined the claim of the complainant on this aspect, which is legally not considerable because we have to take into consideration whether the death of the insured was caused or not, for that purpose, the complainant has brought on the file, as well as same had been submitted to the insurance company, the insurance claim and a certificate issued by the doctor Ex.C-5, wherein it is categorically mentioned that the deceased insured Sahil Dua was died due to heart attack and further proved on the file Ex.C-4 prescription slip of the doctor, which shows what medicine was given to the deceased Sahil Dua and these documents are corroborated by death certificate Ex.C-3 and even Ex.C-5 itself show the cause of death and when death is proved to be caused due to failure of heart, then the claim of the complainant has been, wrongly, illegally and in violation of the law, rejected by the OP No.1, whereas the complainant is entitled for the insurance claim as mentioned in the insurance policy.
14. Coming to the allegation of the OP No.1 taken in the written reply that this Forum has no jurisdiction to entertain the instant complaint on the simple reason that the OP No.1 has no branch office in district Jalandhar. We astonished to see this argument of the learned counsel for the OP No.1 that this Forum has no jurisdiction, but the OP No.1 is not aware that the simply having a branch office is not basic criteria for determining the jurisdiction of any Forum rather if the cause of action is accrued in that area even then the said Forum is having jurisdiction, so, accordingly, it is proved that the insured Sahil Dua had got treatment from Guru Nanak Mission Hospital, Jalandhar and also died at Jalandhar. So, it means a cause of action accrued to the complainant at Jalandhar, therefore, this Forum has a jurisdiction and thus, we find that there is no weightage in the argument of learned counsel for the OP No.1.
15. Now, we have to determine whether there is any liability upon the OP No.2 in regard to this complaint or not. From the pleading of the complainant, it reveals that the deceased insured Sahil Dua got sanctioned a loan of Rs.12,13,761/- from OP No.2 and executed a loan agreement dated 28.03.2015 and copy of the same is proved on the file by the complainant Ex.C-1. It is alleged by the OP that the insurance policy in question was obtained by Sahil Dua at the instance of OP No.2 and as such, the OP No.2 is also liable for contributing the compensation as well as litigation expenses and also restrained itself from recovering the loan installment from the complainant till the payment of insurance amount is not made by the OP No.1.
16. We do not agree with the contention of the counsel for the complainant as elaborated above because there is no role of the OP No.2 in getting of the insurance policy. Simply, OP No.2 deposited a premium of the insurance policy on behalf of the insured Sahil Dua. The OP No.2 having its separate and independent entity and further, it is established that the insured got insurance policy independently from the OP No.1 and having an independent contract with the OP No.1/insurance company and thus, the complainant is not entitled for any relief from OP No.1 through this complaint because the OP No.1 having a right to recover the loan amount according to agreement from the loanee or his legal heir, if the complainant wants any relief in regard to claim made against OP No.2 in this complaint, then the complainant has liberty to go in Civil Court. So, accordingly, we find that the case of the complainant against OP No.2 is not maintainable and therefore, the same is dismissed.
17. So, for the concern of the claim of the complainant against OP No.1 is related, the same is already discussed above and proved, therefore, we reach to conclusion that the complaint of the complainant succeeds and accordingly, the same is partly accepted and accordingly, OP No.1 is directed to pay the insurance claim of Rs.12,00,000/- to the complainant along with interest @ 12% per annum from the date of repudiation i.e. 07.06.2017, till realization and further OP No.1 is directed to pay compensation to the complainant, to the tune of Rs.30,000/- and litigation expenses of Rs.10,000/-. The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
18. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Harvimal Dogra Karnail Singh
25.07.2018 Member President
