Punjab

StateCommission

CC/219/2016

Kushalya Devi - Complainant(s)

Versus

HDFC Bank - Opp.Party(s)

Arvind Kashyap

11 Aug 2016

ORDER

2^nd Additional Bench

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB

DAKSHIN MARG, SECTOR 37-A, CHANDIGARH

 

Consumer Complaint No. 219 of 2016

                                   Date of institution:  22.07.2016

                             Date of Decision:    11.08.2016  

 

1. Smt. Kushalya Devi widow of Sh. Mange Ram Sharma,
2. Pankaj Sharma, aged 22 years son of Sh. Mange Ram Sharma,

Both residents of House No.29, Sec-5-C, New Shastri Nagar, Mandi Gobindgarh, Tehsil Amloh, Distt. Fatehgarh Sahib.

…..Complainants

                                      Versus

1. HDFC Bank Ltd., Branch Mandi Gobindgar, Tehsil Amloh, Distt. Fatehgarh Sahib, through its manager.

          Registered Office:-

          HDFC Bank Ltd., HDFC Bank House, Senapati Bapat Marg, Lower Parel (west) Mumabi-400013 through its directors.

2. HDFC ERGO General Insurance Company Ltd., Customer Service Office, 6^th Floor, Leela Business Park, Andheri Kotla Road, Andheri East, Mumbai, through its director.

Registered and Corporate office,

HDFC ERGO General Insurance Company Ltd., First Floor, HDFC House, 165-166, Backway Reclamation, H.T. Parekh Marg, Church Gate, Mumbai.

                                                                                              …..Opposite Parties

 

Quorum:-

 

              Shri Gurcharan Singh Saran, Presiding Judicial Member

                 Shri Jasbir Singh Gill, Member

                 Shri Harcharan Singh, Member

 

 

Present:-

 

                    For the complainants       :         Sh. Sudesh Sahi, Advocate

 

Gurcharan Singh Saran, Presiding Judicial Member

ORDER

                   The complainant has filed this complaint under Section 17 of the Consumer Protection Act, 1986 (in short the ‘Act’) against Opposite parties (hereinafter referred as ‘Ops’) on the averments that Mange Ram Sharma husband of complainant No.1 and father of complainant No.2 expired on 22.07.2015 and after the death of Mange Ram Sharma, complainants came to know that he availed the business loan facilities from OP No.2 and under that scheme he had taken the insurance policy No.2918200203254100000 dated 31.12.2011 for the period of 31.12.2011 to 31.12.2016. However, on 22.07.2015 Mange Ram Sharma was taken to hospital due to sudden collapse and he expired in the hospital at 12.00 noon. Complainants lodged the claim with the insurance company, but the same was repudiated on flimsy grounds.  Accordingly, the complaint has been filed directing the Ops to pay the insurance amount of Rs.25,00,000/- along with interest, Rs.3,00,000/- as compensation, Rs.15,000/- as litigation expenses and Interest at the rate o 24% on the Insurance Claim.

2.                We have gone through the policy under which the coverage was as under:-

 

Coverage Details
Coverage	Premiums (Rs.)	Sum insured (Rs.)
Loss of Job (3 EMI)	405	100,000
Accidental Death	467	500,000
Permanent Total Disability /Permanent Partial Disability	623	500,000
Accidental Hospitalization	311	100,000
Critical Illness	1089	100,000
Credit Shield Insurance	778	500,000
Garage Cash	700	3,500
Householders Coverage	516	1,50,000

           

Therefore, in case of accidental death, the coverage was up to Rs.5,00,000/-. Under the Insurance Policy following benefits were extended to the insurer:-

• Loss of Job (3 EMI)
• Accidental Death
• Permanent Total Disability/Permanent Partial Disability
• Accidental Hospitalization
• Critical Illness
• Credit Shield Insurance
• Garage Cash
• Householders Coverage

As per above benefits, complainants can claim accidental death coverage but as per the record of Kaushal Nursing Home, Sh. Mange Ram Sharma died due to sudden collapse at home. As per repudiation letter dated 07.01.2016 the claim of the complainants was declined on the ground that Late Mr. Mange Ram Sharma died due to Cardio Respiratory Arrest. However, these ailments do not fall within the policy purview Major Medical Illness & Procedures section of the policy covers listed Critical Illness only. The claim of the complainants is not with regard to treatment of Major Medical Illness and Procedures. His claim, as per the complaint is regarding outstanding amount of loan facilities by OP No.1 of Rs.25,00,000/- which is not covered under the policy and only accidental benefits were extended under the policy that too up to Rs.5,00,000/-  and claim of the complainants is not covered under the accidental death benefit. Therefore, we are of the opinion that the claim was rightly repudiated by Ops. Prima facie no claim is made out therefore, we dismiss the complaint in limine.  

3.                The arguments in this consumer complaint were heard on 08.08.2016 and the order was reserved. Now the order be communicated to the parties as per rules.

                                                       

 

                                                                     (Gurcharan Singh Saran)

                                                                   Presiding Judicial Member

 

 

                                                                   (Jasbir Singh Gill)

                                                                          Member                                     

                                                                                                                          

                                                                                                                                      August  11, 2016                                      (H.S. Guram)

          PK/-                                                          Member