This complaint case is filed by one Sri Sanjib Chatterjee and Smt. Payel Sarkar against HDFC Bank Ltd. and HDFC ERGO General Insurance Co. Ltd., praying for a direction upon the OPs to reimburse the loan amount totaling Rs. 2,32,700/- together with compensation for a sum of Rs. 1,00,000/-, interest @ 7% p.a. and costs of the proceeding.

The long and short of the Complainants’ case is that Smt. Banani Chatterjee, during her life time, took a loan against deposit of gold ornaments from the OP bank.  Subsequently, at the insistence of OP, Banani Chatterjee, since deceased, took an insurance policy, namely, Sarv Suraksha Policy vide no. 295020091707100000 that was valid for the period from 26-11-2014 to 25-05-2015 for a sum assured of Rs. 2,32,700/-.  It is stated that said Banani Chatterjee died intestate on 12-03-2015 at RSV Hospital.  As per the death certificate issued by the hospital authority, Banani Chatterjee died of lower respiration tract (infection, gastro intestinal infection, septic shock with multi-organ failure, cerebro vascular accident which is covered under the said Insurance Policy.  On 18-03-2015, Complainant No. 1 lodged a claim with the OP No. 1 along with relevant documents.  But, instead of settling such bona fide claim, final notice for sale of pledged gold dated 16-09-2015 was sent to the Complainant No. 1 along with a newspaper publication dated 24-09-2015.  Taken aback by such unexpected developments, Complainants sent a letter dated 26-09-2015 through their Ld. Advocate to the OP No. 2 urging it not to sell the gold ornaments till settlement of claim of the Complainants.  It is alleged that OPs are illegally trying to scuttle their claim.  Finding no other alternative, Complainants filed this case.

Upon receipt of notice, OP Nos. 1&2 appeared to contest the case.  By filing WV, they denied all the material allegations of the complaint.  It is further stated that the loan was sanctioned for a period of six months with maturity date on 26-05-2015.  The OP bank disbursed a sum of Rs. 30,201/- after deducting interest and other charges.  The borrower was required to pay the entire amount before the date of maturity.  In case of default, the borrower was required to apply for renewal of the loan which was subject to the discretion of the OP Bank.  It is stated that the borrower was desirous of securing the said loan facility with insurance cover and so, they choose to avail “Sarv Suraksha Policy” from the OP No. 3 which is a completely different entity and issues related to policy falls within the purview of the OP No. 3. Allegedly, after repeated reminders, the nominee of Banani Chatterjee did not turn up and was not interested to take back the gold and to close the loan.  It is also stated that these OPs have no role to play in respect of the settlement of insurance claim.  The Complainants, being the legal heirs of the deceased borrower, cannot avoid their liability to make payment of the outstanding on the plea of non-settlement of insurance claim.  Accordingly, they prayed for dismissal of this case.

OP No. 3 also contested the case by filing WV, wherein it denied and disputed all the material allegations of the complaint.  It is stated by this OP that according to terms and conditions of the insurance policy, Insured, since deceased, and her legal heirs were covered only for accidental death, permanent total and/or permanent partial disability and credit shield.  The cause of death as stated in the death certificate does not come under the ambit of the insurance policy concerned.  So, the instant claim was rightly repudiated.  Denying any negligence on its part, this OP too prayed for dismissal of this case.

Point for consideration is whether the Complainants are entitled to the reliefs prayed for by them.      

Decision with reasons

Complainant No. 2 filed Affidavit-in-Reply, where she has reiterated the facts stated in the petition of complaint.  To this, OPs filed questionnaires, and the Complainant No. 2 replied to the same by means of Affidavit-in-Reply.  Evidence of Affidavit has been filed from the side of the OPs as well and the Complainants confronted the same by putting some relevant questionnaire.  To this, OP No. 3 filed Affidavit-on-Reply. 

Undisputedly, Banani Chatterjee, since deceased, took an insurance policy, i.e., Sarv Suraksha Policy (Sarv Suraksha Advantage Gold Loan) for a period of six months.  It is not in dispute that said Banani Chatterjee died during the validity period of the insurance policy.  The dispute revolves over the fact whether the cause of death, as mentioned in the death certificate of RSV Hospital, comes within the ambit of risk coverage, or not. 

Most strikingly, notwithstanding the name of the insurance policy denotes “Sarv Suraksha”, in contrast, the policy covers only a niche segment, i.e., accidental death (Rs. 2,00,000/-), Permanent Total Disability/Permanent Partial Disability (Rs. 2,00,000/-) and Credit Shield Insurance (Rs. 32,700/-). 

It is not in dispute that, accidental death comes under the purview of the policy in question. No doubt, when we think of accidental deaths, the first impression cross our mind is that the death caused in a road accident or by the Act of God or due to natural calamity.  However, it would be unfair to paint every such incident with the same brush.  A deeper thought into the meaning of “accidental deaths” lead us to infer us that “accidental deaths” not necessarily mean mishaps caused on roads when one is hit/run over by a vehicle or any of the above mentioned eventualities – rather, all such deaths that take place unexpectedly/suddenly/unpredictably, to our mind, should be treated as accidental deaths.      In fact, the policy document also illustrates “accident” as under:-

“Accident” or “Accidental” means a sudden, unintended and fortuitous external and visible event.

          On careful scrutiny of the documents on record, we do not come across any such paper to show that the patient was suffering from any past ailment/disease.  In fact, no such claim is made from the side of the OP Insurer also that the patient died of pre-existing disease.  The deceased Insured was not too aged to become the victim of infirmity of age - she was only 58 years old at the time of her death.  Thus, it appears to us that her death was purely unexpected/accidental.   So, the cause of death, as mentioned in the death certificate, i.e., Lower Respiratory Tract infection due to a case of gastro intestinal infection, septic shock with multi-organ failure and Cerebro Vascular Accident, in our considered opinion, would certainly fall within the coverage of the insurance policy. Thus, we are of opinion that the Complainants rightly lodged their claim with the OPs.  However, by refusing to settle said bona fide claim, OP No. 3 did a ‘disservice to the cause’. OP No. 3 is, thus, liable to settle the claim lodged by the Complainant No. 1.

Although Complainants have demanded a sum of Rs. 2,32,700/-, it appears, in case of accidental death, liability of the OP No. 3 stands limited to Rs. 2,00,000/-.  So, in our considered opinion, justice would be done if the OP No. 3 is directed to pay Rs. 2,00,000/- to the Complainants or else, directly remit the proceeds to the OP Nos. 1/2 for adjustment against the loan account of Banani Chatterjee, since deceased.  Besides this, the OP no. 3 is also liable to pay compensation and litigation cost to the Complainants for gross deficiency in service on its part.

Hence,

O R D E R E D

that RBT/CC/116/2016 be and the same is allowed in part on contest against the OP No. 3 and dismissed on contest against other OPs.  OP No. 3 is directed to pay, within two months hence, a sum of Rs. 2,00,000/- to the Complainants.  Alternatively, OP No. 3 may directly remit the said money to OP No. 1 or 2 for effecting due adjustment of the same against the loan account of Banani Chatterjee, since deceased.  Besides, OP No. 3 is also directed to pay, within the afore-mentioned period, compensation and litigation cost to the tune of Rs. 10,000/- and Rs. 5,000/-, respectively.