Haryana

Ambala

CC/284/2016

Gurpreet Singh - Complainant(s)

Versus

HDFC ERGO Gen Inss Co. - Opp.Party(s)

Sachin Rai Vaid

06 Mar 2018

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

Complaint Case No.      : 284 of 2016.

Date of Institution         : 21.07.2016.

Date of Decision            : 06.03.2018.

 

Gurpreet Singh son of Sh.Rajbinder Singh resident of H.No.463 Singhawala Mohalla VPO Boh.Tehsil & District Ambala.

……Complainant.

Versus

 

1. The Manager Claims, HDFC ERGO General Insurance Company Limited 6^th Floor, Andheri Kurla Road, Andheri (East) Mumbai 400059.
2. Sh.Karan Chopra, Head Retail Business Group, 1^st Floor 165-166 Backbay Reclamation, HT Parekh Marg, Churchgate, Mumbai-400020.
3. The Manager-Loans, HDFC Bank Limited, Loan Department, Nicholson Road, Ambala Cantt.

                                                                   ……Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act

 

BEFORE:   SH. D.N. ARORA, PRESIDENT.

                   SH. PUSHPENDER KUMAR, MEMBER.

                  

Present:       Sh. Sachin Rai Vaid, counsel for complainant.

                   Sh. Mohinder Bindal, counsel for OP No.1.

                   OP No.2 exparte.

                   Sh. Sandeep Chauhan, counsel for OP No.3.  

 

ORDER

 

                   The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 with the averments that OP No.3 through its representative had approached the complainant and his father that the car loan of white swift car bearing registration No.HR-01AC-7806 from HDFC can be covered by taking an insurance policy named Sarv Suraksha Policy and the said policy would also cover the car loan in case of loss of job, accidental death, permanent total disability, accidental hospitalization, critical illness, credit shield insurance, garage cash and householders coverage etc. After being influenced the father of the complainant purchased insurance policy No.2950201026915900000. On 21.11.2015 insured Sh.Rajinder Singh, since deceased, father of the complainant got critical ill and was admitted in  hospital on 21.11.2015 for SAH with IVH/Acture on CRF, Sepsis, UTI, Respiratory infection and expired on 29.11.2015. Thereafter the complainant filed a claim alongwith requisite documents to the OPs but Op No.1 repudiated the claim on vague and bizarre reason that For critical illness to be admissible under your policy the insured persons has to survive a period 30 days from the time, he was diagnosed for illness. The said condition is not fulfilled in current case and the claim was treated as “No Claim”.  At the time of selling of policy no such condition was explained to the complainant. The complainant requested the OPs to make the payment of claim amount and also got served a legal notice but to no avail. The act and conduct of the OPs clearly amounts to deficiency in service on their part. In evidence the complainant has tendered affidavit Annexure CW1 and documents Annexure C1 to Annexure C11.

2.                On notice OP Nos. 1 & 3 appeared and filed their separate replies, however, Op No.2 did not appear before this Forum, therefore, he was proceeded against exparte vide order dated 04.10.2016.

                   OP No.1 in its reply has taken many preliminary objections such as concealment of material facts, locus standi, territorial jurisdiction, and cause of action etc. The claim of insured Sh.Rajbinder Singh was duly entertained in due course on being presented by his widow and son Manpreet Singh being nominee. During proceeding it was observed that late Rajbinder Singh was admitted in Silver Oak Hospital on 21.11.2015 for SAH with IVH/Acute on CRF Sepsis, UTI, Respiratory infection and died on 29.11.2015 i.e. after 8 days of the diagnosis of his ailment and treatment. Since the critical illness coverage/benefits under this specific insurance policy, the insured person had to survive a period of 30 days from the time he was diagnosed for illness thus the reported claim was repudiated as per the policy terms and conditions and the complainant was informed about the fate of the claim vide letter dated 14.01.2016 but the complainant in order to put undue pressure filed this false complaint by exploiting the process of law.  Other contentions have been controverted and prayer for dismissal of the complaint has been made.

                             Op No.3 in its reply has taken many preliminary objections such as cause of action, locus standi, concealment of material facts, mis-joinder and non-joinder of material facts. The Op No.3 did not represent to the complainant and his father regarding swift car loan rather it was the father of the complainant who had approached the Op No.3 to get the amount financed to the tune of Rs.3,55,393/- on 24.03.2016 and as per terms of loan agreement the father of the complainant agreed to repay the entire loan amount in 48 equal monthly installments of Rs.9144/- and the said policy was obtained as per his sweet will.  The father of the complainant did not pay the installments of loan regularly and balance amount of Rs.2,00,814/- is due against the father of the complainant besides overdue amount of Rs.94870/-. The complainant has not been cheated and the OP No.3 has no liability qua the insurance claim and it is entitled to recover the loan amount back. As a matter of fact that the property of the father of the complainant has been succeeded by the complainant as the complainant is liable to clear the car loan of his father and it has every right to recover the same from the complainant. Other pleas have been controverted and prayer for dismissal of the complaint has been made. In evidence the OPs have tendered affidavits Annexure RA, Annexure RX and documents Annexure R1 to Annexure R12.

3.                We have heard learned counsel for the parties besides written submission submitted on behalf OP No.1 and gone through the case file very carefully.

4.                Learned counsel for the complainant has argued that his father had obtained insurance policy from the Op No.1 and paid regular premium therefore but he died during the subsistence of the policy and when the claim on account of his death was lodged with the insurance company then the same was illegally and wrongly repudiated on the ground that For critical illness to be admissible under your policy the insured persons has to survive a period 30 days from the time, he was diagnosed for illness. The said condition is not fulfilled in current case and the claim was treated as “No Claim”.  It has been further argued that father of the complainant was hale and hearty and was not suffered from any disease at the time of inception of policy in question.  In support of his case learned counsel for the complainant has placed on file case laws titled as  New India Assurance Co.Ltd. & Anr. Vs. Patitapaban Karan  IV (2007) CPJ 429 (Orissa State Commission), Union India Insurance Company Ltd. Vs. Suresh Kumar Tibrewal 2007 (3) CLT 607 (Orrisa State Commission) and Life Insurance Corporation of India and another Vs. Puran Chand 2010 (4) CLT 15 (HP State Commission).

                   On the other hand learned counsel for the appearing OPs have argued that the policy holder Rajbinder Singh was admitted in Silver Oak Hospital on 21.11.2015 for SAH with IVH/Acute on CRF Sepsis, UTI, Respiratory infection and died on 29.11.2015 i.e. after 8 days of the diagnosis of his ailment and treatment. Since the critical illness coverage/benefits under this specific insurance policy, the insured person had to survive a period of 30 days from the time he was diagnosed for illness thus the reported claim was repudiated as per the policy terms and conditions and the complainant was informed about the fate of the claim vide letter dated 14.01.2016. In support of his contentions case laws titled as United India Insurance Company Limited Vs. M/s Harchand Rai Chandan Lal (SC) Appeal (Civil) 6277 of 2004 decided on 24.09.2004, Bhupinder Kumar Vs. Bajaj Allianz Life Insurance Company Limited & Anr. (NC) Revision petition No.3265 of 2015 decided on 04.07.2017 and M/s Kotak Mahindra Old Mutual Life Insurance Company Limited Vs. Naresh Kumar (State Commission Haryana) decided on 25.07.2017 in First Appeal No. 148 of 2017.  Learned counsel for the Op No.1 has drawn the attention of this Forum towards condition No.1 of the terms and conditions of policy Annexure R6 which says that Critical Illness If the insured person named in the schedule is diagnosed as suffering from a critical illness which first occurs or manifests itself during the policy period and the insured survives for a minimum of 30 days from the date of diagnosis, the company shall pay the critical illness benefit as shown in the schedule. In the present case it is not disputed that the life insured Sh.Rajbinder Singh was admitted in Silver Oak Hospital on 21.11.2015 for critical illness such as SAH with IVH/Acute on CRF Sepsis, UTI, Respiratory infection and died on 29.11.2015 i.e. after 8 days of the diagnosis of his ailment and treatment, therefore, the requisite condition such as survival of insured person atleast for 30 days from the date of diagnosis for illness is not completed.

                             It is a settled principle of law that the terms and conditions of the policy are to be strictly complied. On this point reliance can be taken from the case law titled as V.K.Kariyana Store V. Oriental Insurance Company Limited III (2014) CPJ 182 (NC) Nature of Contract-Since upon issuance of insurance policy, insurer undertakes to indemnify loss suffered by insured on account of risks covered by policy, its terms have to be strictly construed to determine the extent of liablity of insurer. Endeavour of Court should always be to interpret words in which contract is expressed by parties.

                             Hon’ble Supreme Court of India in case cited as Suraj Mal Ram Niwas Oil Mills (P) Ltd. Vs. United India Insurance Co. Ltd. & Anr., - 2011 CTJ 11 (SC)(CP) wherein the Division Bench of the Hon’ble Apex Court consisting of Hon’ble Mr. Justice D.K. Jain and Hon’ble Mr. Justice T.S. Thakur, held that:

 

“22.   Before embarking on an examination of the correctness of the grounds of repudiation of the policy, it would be apposite to examine the nature of a contract of insurance. It is trite that in a contract of insurance, the rights and obligations are governed by the terms of the said contract. Therefore, the terms of a contract of insurance have to be strictly construed, and no exception can be made on the ground of equity…..”     

 

24.    Thus, it needs little emphasis that in construing the terms of a contract of insurance, the words used therein must be given paramount importance, and it is not open for the Court to add, delete or substitute any words. It is also well settled that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the policy, its terms have to be strictly construed to determine the extent of liability of the insurer. Therefore, the endeavour of the court should always be to interpret the words in which the contract is expressed by the parties.

 

It is established that the life insured was admitted in Silver Oak Hospital on 21.11.2015 for SAH with IVH/Acute on CRF Sepsis, UTI, Respiratory infection and died on 29.11.2015 i.e. after 8 days of the diagnosis of his ailment and treatment, therefore, the present complaint is barred as per condition No.1 of the terms and conditions of the policy.  The case laws relied upon by learned counsel for the complainant are not applicable to the case in hand are same are being distinguished.

7.                          In view of the position as discussed above it is clear that the present complaint deserves dismissal as the insurance company has rightly repudiated the claim submitted on account of death of the father of the complainant. Therefore, the present complaint is without any merit and the same is accordingly dismissed leaving the parties to bear their own costs. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.

 

ANNOUNCED ON:      06.03.2018

         

                        

                           

(ANAMIKA GUPTA)   (PUSHPENDER KUMAR)                (D.N.ARORA)

          MEMBER            MEMBER                                 PRESIDENT