District Consumer Disputes Redressal Forum, Near F.C.I. Godowns, Muradpura Tarn Taran (Punjab)

Consumer complaint No : 41 of 2015

Date of Institution                   :23.07.2015

Date of Decision            :19.02.2016

1. Paramjit Kaur widow of Jagir Singh,
2. Rajbir Singh,
3. Shamsher Singh both sons of Late Jagir Singh,
4. Ranjit Kaur,
5. Navneet Kaur both daughters of Jagir Singh all residents of H.No. 363 A, Gali Bajigara Wali, Nanaksar Mohalla, near Civil Hospital Tarn Taran Tehsil and District Tarn Taran.

                                                                   …Complainants

Versus

1. HDFC. Ergo., III Floor, Nagpal Tower, S.C.O. 128 Ranjit Avenue Amritsar through its Manager,
2. HDFC. Bank, Branch Jandiala Road Tarn Taran through its Branch Manager,
3. HDFC Ergo, General Insurance Company Ltd. having its Corporate Office at 6^th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E) Mumbai-400059, through its MD.

…Opposite Parties

Complaint Under Section 12  & 13 of the Consumer Protection Act, 1986.

Present:      

For complainants                     Sh. H.S. Sandhu Advocate

For Opposite parties No. 1, 3 Sh. Rajpal Singh Advocate    

For the Opposite party No. 2  Sh. Anil Sharma Advocate

Coram:      Sh. S.S. Panesar,  President.

Smt.Jaswinder Kaur, Member

(Sh. S.S. Panesar, President)

1. The complainants Paramjit Kaur and others have brought the instant complaint under Section 12 & 13 of the Consumer Protection Act, 1986 (herein-after called as ‘the Act’) against HDFC. Ergo., III Floor, Nagpal Tower, S.C.O. 128 Ranjit Avenue Amritsar through its Manager and another (herein-after called as ‘Opposite Parties No. 1, 3’) and HDFC. Bank, Branch Jandiala Road Tarn Taran through its Branch Manager (herein-after called as ‘Opposite Party No. 2’) supported by various documents leveling allegations of deficiency of service on the part of the opposite parties.
2. Briefly stated, the facts of the complaint are that the complainants are legal heirs of Jagir Singh (deceased), who was covered by insurance policy of opposite parties, vide policy No. 29502004005311800000 as he had availed loan from H.D.F.C Bank Jandiala Road Branch Tarn Taran vide loan account No. 23172323. As per condition of the policy, one time premium of the policy was paid by Jagir Singh (deceased) amounting to Rs. 1,387/- vide Cheque/DDR No. UI_311212_P1_2588 dated 31.12.2012 through HDFC Bank Ltd. At the time of issuing of policy to Jagir Singh (deceased), opposite parties No. 1 and 2 told that the life assured will be covered up to sum of Rs. 4,00,000/- in case of his death, so the deceased preferred and availed the insurance cover from opposite parties No. 1 and 2.  On 13.8.2014, policy holder Jagir Singh son of Kundan Singh died after he experienced sudden chest pain. After his death, all the paper work regarding the cause of death, post mortem report and report under Section 174 Cr.P.C. was prepared immediately by the police as well as concerned authorities. The complainants knew about the insurance cover of Jagir Singh with opposite parties No. 1 and 3, so they immediately informed the opposite parties regarding the death of policy holder and also supplied them with required documents immediately so as to process and release the insurance claim to them, separately or to complainant No. 1 widow of the policy holder who was made nominee in the insurance policy by deceased Jagir Singh. The complainants have been visiting opposite parties No. 1 and 3 and have also been in contact with them through telephone as well as correspondence, but opposite parties No. 1 and 3 promised them to release the claim within few days.  The complainant No. 1 also sent a legal notice to opposite party No. 1 on 29.4.2015 requesting it to release the claimed money within 15 days from the service of registered notice but instead of releasing the claim, opposite party No. 3 sent a letter dated 22.5.2015 to her in which, the claim of the complainants was repudiated. The reasons given in the repudiation letter caused a set back to the complainants and the genuine claim of the complainants has been repudiated without any reasonable cause. Opposite parties No. 1 and 3 are guilty of imperfection, ineffective service, unfair trade practice in refusing the claim of the complainants. Hence, this complaint.
3. Upon notice, all the opposite parties appeared and contested the claim by filing written version. Opposite parties No. 1 and 3 filed joint written version while Opposite Party No.2 filed its separate written version.
4. In their written version opposite parties No. 1 and 3 took certain preliminary objections therein inter alia that insured deceased in this case was insured under Sarv Suraksha Policy issued to him providing coverage against listed perils for the period w.e.f. 31.12.2012 to 30.12.2016. The said policy was issued subject to terms, conditions and coverage as specified under the policy. The policy in hand was issued to the insured covering three benefits:-

Accidental benefit i.e. accidental death   4 Lacs Permanent total disability/ permanent partial disability-4 Lacs Credit shield insurance      2.5 Lacs.   

The insured in this case has died in natural death due to cardiac arrest, which is not covered under three benefits stating above, therefore, the complainants are not entitled for the claim because heart attack or natural death is not covered under the policy, therefore, the claim has rightly been repudiated vide letter dated 22.5.2015; that the term ‘Accident’ or ‘Accidental Means’ has been categorically defined under the policy as a sudden, unintended and fortuitous external visible means. Further the term ‘Bodily Injury’ is defined as ‘physical bodily harm or injury, but does not include any mental sickness, disease or illness’. Hence, the cause of death of the insured in this case does not fall within the ambit of ‘accidental death’ and the claim under the policy has rightly been repudiated; that the complainants have concealed the material facts from this Forum, therefore, they are not entitled to any relief as claimed for; that the complainants are estopped by their own act and conduct from filing the present complaint; that the complainants have filed the present complaint without any cause of action against the opposite parties, therefore, liable to be dismissed and that the complainants have no locus standi to file the present complaint. On merits, it is stated that the insurance policy was issued for the coverage of risk duly mentioned therein. It is admitted that the complainants submitted the documents to the opposite parties, but after going through the documents, it was found that insured died suddenly due to cardiac arrest. As the natural death was not covered under the policy, therefore, the claim of complainants was rightly repudiated vide letter dated 22.5.2015 specifying the reasons for repudiation. It is denied that complainants promised to release the claim of insurance within few days. Since, risk of natural death was not covered and due intimation was given to the complainants, therefore, no question of either visiting the opposite parties or any assurance being given by any official of opposite parties No. 1 and 3 arises. Remaining facts stated in the complaint have also been specifically denied and a prayer for dismissal of the complaint with costs was made.

5. In a separate written version, the opposite party No. 2 has taken preliminary objections to the effect that the present complaint does not disclose any cause of action against Opposite Party No.2 as well as present complaint is liable to be dismissed against Opposite Party No.2 for want of cause of action; that Opposite Party No.2 has been dragged into unwanted litigation and for that Opposite Party No.2 reserves its legal right to take appropriate action available to them under the law; that there is no deficiency in service on the part of Opposite Party No.2, hence, the complaint is liable to be dismissed.  On merits, facts narrated in the complaint have been specifically denied. The claim, if any, relates to opposite parties no. 1 and 3. Opposite Party No.2 is a facilitator only in getting the insurance cover issued in favour of Jagir Singh (now deceased) from opposite parties No. 1 and 3 and a prayer for dismissal of the complaint with costs has been made.
6. In order to prove their case, the complainants have tendered in to evidence affidavit of Rajbir Singh son of Jagir Singh Ex. C.1 alongwith documents i.e. self attested copy of claim repudiation letter Ex. C.2, Self attested copy of legal notice dated 29.4.2015 Ex. C.3, Self attested copy of Post Mortem report dated 13.8.2014 Ex. C.4,  Self attested copy of Insurance policy dated 31.12.2012 Ex. C.5, Self attested copy of proceedings under Section 174 Cr.P.C. Ex. C.6 and closed the evidence.
7. To rebut the evidence of the complainants, the opposite parties No. 1 and 2 tendered in to evidence duly sworn affidavit of Pankaj Kumar Manager Legal Claims Ex. OP 1,3/1 alongwith documents i.e. Self attested copy of Policy Ex. OP 1, 3/2, Self attested copy of Terms and conditions Ex. OP 1, 3/3, Self attested copy of Reminder dated 5.5.2015 Ex. OP 1, 3/4, Self attested copy of Claim Form Ex. OP 1, 3/5,  Self attested copy of letter dated 13.8.2014 to Doctor Ex. OP 1, 3/6, Self attested copy of Statement of Paramjit Kaur Ex. OP 1, 3/7, Self attested copy of Statement of Shamsher Singh Ex. OP 1, 3/8, Self attested copy of Statement of Lakhbir Singh Ex. OP 1, 3/9, Self attested copy of report dated 13.8.2014 Ex. OP 1, 3/10,  Self attested copy of Post Mortem Report  Ex. OP 1, 3/11,  Self attested copy of Repudiation letter Ex. OP 1, 3/12, and close the evidence on behalf of opposite parties No. 1, 3. The opposite party No. 2 also tendered in evidence affidavit of Bhupinder Kaur Asstt. Manager(Legal) Ex. OP2/1 and closed the evidence.
8. We have heard Ld. counsel for complainant as well as Ld. counsel for opposite parties and have also carefully gone through the record as well as synopsis of written arguments filed on behalf of opposite parties No. 1 and 3.

9        It has been vehemently contended on behalf of complainants that it is not denied that Jagir Singh (now deceased) was holding insurance policy No. 29502004005311800000 which was accidental policy and in the event of death of Jagir Singh in the accidental or critical disease, the complainants were entitled to insurance claim to the tune of Rs. 4,00,000/- and copy of insurance policy accounts for Ex. C.5. It is also not denied that Jagir Singh died on 13.8.2014 and post mortem report accounts for Ex.C.4. It is further in evidence that on the death of Jagir Singh, the complainants being his legal heirs applied for release of insurance claim with opposite parties No. 1 and 3. However, opposite parties No. 1 and 3 repudiated the genuine claim of the complainants vide letter dated 22.5.2015, copy whereof is Ex. C.2 on record. The repudiation has been made wrongly without adhering to any legal or justified cause. Opposite parties No. 1 and 3 are negligent in service. To proclaim that death of insured having been caused through cardiac arrest, is not covered under the term ‘accident’, clearly shows that no application of mind was applied by the opposite parties No. 1 and 3 in repudiating the claim. Reliance has been placed upon New India Assurance Company Ltd. (Petitioner) Vs Pabbati Sridevi and Ors.  (Respondents) 2013 (1) CPJ Page 462  (N.C) wherein it has been laid down that it is well settled that death due to sun stroke is an accidental death. There is no negligence on the part of the deceased. Ex.A.1 policy covers the accidental death due to sun stroke. It is not disputed that policy was in operation on the date of death of deceased. Applying the ratio, laid down in the Judgment (supra), it has been contended that the Judgment (supra) is fully applicable to the facts of the present case on all its fours and it is therefore requested that the claim to the tune of Rs. 4,00,000/- under the insurance policy in dispute be granted in favour of complainants and against the opposite parties No. 1 and 3. Besides that, the complainants may also be awarded compensation to the tune of Rs. 50,000/- and litigation expenses to the tune of Rs. 20,000/- and complaint may be allowed, accordingly.

10      However, from the appreciation of the facts and circumstances of the case, it becomes evident that the parties are bound by the terms and conditions of the insurance cover. The insurance policy clearly lays down in Section 2 as under:-

          2.1     Coverage Part A: Death

2.1.1  The company will pay the Sum insured in the event of Accidental Bodily injury causing the insured’s death within 12 months of the Accidental Bodily injury being sustained, where after this policy shall expire.

2.1.2  The company will also, in addition to the Sum insured up to 2% of the Sum Insured or Rs. 5,000/- (whichever is lower towards the cost of transporting the insured’s remains from the place of death to the hospital/ residence and/ or burial ground.

And as per Section 4 of the Policy, the ‘accident’ or accidental’ have been defined as a sudden, unforeseen and involuntary event caused by external, visible and violent means.

11      In such a situation, the death occurring on account of cardiac arrest is not covered under the insurance policy, copy whereof is Ex. C.5 on record.  In this case, the claim was lodged by the complainants on the ground that husband of the complainant No. 1 namely Jagir Singh died on 13.8.2014 due to cardiac arrest. The claim was registered and reminder Ex. OP1,3/4 dated 5.5.2015 was given to the complainants to supply the documents, required to settle the claim. The documents alongwith form were supplied by the complainants. Claim form is Ex. OPs 1,3/5 in which it has been specifically stated that the insured suffered from chest pain. Alongwith the claim form, the complainants produced copy of letter dated 13.8.2014 forwarded by A.S.I to Doctor for postmortem, copy whereof is Ex. OPs 1,3/6, in which, it has specifically been mentioned that during duty hours, the insured suffered chest pain and died and it was natural death. Paramjit Kaur also suffered a statement stating therein that Jagir Singh insured died due to natural death after suffering pain in his chest, copy of her statement is Ex. OPs 1, 3/7. To the similar effect are the statements of Shamsher Singh and Lakhbir Singh, copies whereof are Ex. OPs 1,3/8 and Ex. OPs 1,3/9 respectively. In the rapat No. 28 dated 13.8.2014 registered under Section 174 Cr.P.C., it was also stated that the insured suffered chest pain and his death was natural and sudden, copy whereof is Ex. OPs 1,3/10. Thus, it becomes quite evident that Jagir Singh died a natural death on account of chest pain and his death was not caused by the external injury or by some critical disease. The ruling New India Assurance Company Ltd. Vs Pabbati Sridevi and Ors (Supra) cited by the complainants, is not at all applicable to the facts of the present case because in that insurance policy, death by means of sun stroke was covered under the terms and conditions of the insurance cover, whereas in the present case death by means of cardiac arrest was not covered under the insurance policy in dispute. No parallel can be drawn between present case and the case cited supra. As such, we hold that death of Jagir Singh was neither accidental nor unnatural and the same was not covered vide insurance cover in dispute entitling the L.Rs of the deceased to file the claim.

13      From the aforesaid discussion, it transpires that the complainants have miserably failed to prove their case. Repudiation of claim in the case in hand has been made inconformity with the terms and conditions of insurance policy in dispute and no fault can be found therein. Consequently, the instant complaint fails and same is ordered to be dismissed.  Copies of the order be sent to the parties free of costs immediately and thereafter the file be consigned to the record room.

Announced in Open Forum

Dated: 19.02.2016

(S.S. Panesar)

                                            President

                   (Jaswinder Kaur)                   (R.D. Sharma)

                          Member                                      Member