Complaint No: 271 of 2019.
Date of Institution: 26.08.2019.
Date of order: 26.12.2023.
1. Amandeep Singh
2. Mandeep Singh
Both Sons of Baljinder Singh Son of Surjit Singh
Both residents of Village Chuhar Chak, Sub Tehsil Nausehra Majha Singh.
….............Complainants.
VERSUS
1. HDFC ERGO General Insurance Company Limited, 6th Floor, Leela Business Park, Andheri Kurala Road, Andheri (East) Mumbai – 400059, through its Manager.
2. HDFC Bank, Branch Jalandhar Road, Batala, through its Manager.
3. HDFC Bank House, 1st Floor C.S. No. 6/242, Senapati Bapat Marg, Lower Parel, Mumbai – 400013, through its Managing Director.
….Opposite parties.
Complaint U/s 12 of the Consumer Protection Act.
Present: For the Complainants: Sh.Akash Mahajan, Advocate.
For the Opposite Party No.1: Sh.Rajinder Singh, Advocate.
Opposite Parties No.2 & 3 exparte.
Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Amandeep Singh & Mandeep Singh, Complainants (here-in-after referred to as complainants) has filed this complaint under section 12 of the Consumer Protection Act (here-in-after referred to as 'Act') against HDFC ERGO Gen. Ins. Co. Ltd. Etc. (here-in-after referred to as 'opposite parties).
2. Briefly stated, the case of the complainant is that the father of the complainants namely Baljinder Singh son of Surjit Singh has taken an Auto Loan for the purchase of HYUNDAI CRETA vehicle bearing registration No.PB-06-AN-0408. It is pleaded that the OP No. 2 financed an amount of Rs.8,067,61/-. The total amount was disbursed on 17.07.2017 and monthly 60 installments of Rs.16,550/- for repayment of the loan amount started on 05.08.2017. It is further pleaded that OP No.2 provided loan account No. 49180827 under the HDFC Bank Auto Bharat Loan. It is further pleaded that the loan was got secured by the OP No. 2 through its insurance partner HDFC ERGO General Insurance Company Ltd. i.e. the OP No. 1 vide Insurance Policy bearing No. 2999201363863001 dated 18.07.2017 and the period of insurance policy was from 18.07.2017 to 17.07.2022. It is further pleaded that as per the policy letter dated 18.07.2017 issued by the OP No. 1 the insurance policy provides coverage / benefit of accidental death and Credit Shield Insurance i.e. in case of accidental death or total disability of Insured, the balance outstanding loan amount will be paid by the insurance company and additional accidental claim for amount of Rs.5 Lacs will be given as accidental death benefit to the nominee. It is further pleaded that unfortunately the father of the complainants namely Sh. Baljinder Singh died on 05.12.2018 due to accidental fall in bathroom while taking bath due to which head injury was caused to him in which he failed to survive and died immediately. In the bathroom, there was an extra pipe lying and the father of the complainants fell due to slip from that pipe. It is further pleaded that after the accident the complainants immediately called Dr. Baljit Singh Kahlon, MBBS, MS (General Surgeon) from Baba Farid Hospital Naushehra Majha Singh, Tehsil and District Gurdaspur who examined the father of the complainants and told that he has died due to head injury caused by slip/fall in the bathroom. It is further pleaded that thereafter the complainants approached the OP’s and requested them to provide the benefits of the accidental death as per the insurance policy. It is further pleaded that complainants met with the OP No. 2 and intimated the OP No. 1 regarding the accidental death of the father of the complainants and demanded for the disbursement of accidental death benefits as per the insurance policy of the father of complainants. It is further pleaded that the OP No. 1 repudiated the claim of the complainants on the basis of wrong reasoning that insured was found to expire due natural cause. It is further pleaded that observation of the OP No. 1 regarding the natural death of father of complainants is patently wrong and against the medical record provided by the complainants to the OP No. 1. It is further pleaded that the OP No. 2 ignored the opinion of the Dr. Baljit Singh Kahlon, who has clearly opined that cause of death of the father of the complainants is due to accidental fall and was not a natural death. It is further pleaded that above said plea of the OP’s is illegal, wrong and is self-serving and against the interest of the claimants. It is further pleaded that vide letter dt. 29.04.2019 issued by the OP No.2 the legal and genuine complaint of the complainants has been illegally repudiated. It is further pleaded that complainants have been so harassed by the OP’s due to the illegal act of the opposite parties. It is further pleaded that the OP’s have illegally and erroneously repudiated the claim of the complainants, which act on the part of the OP’s is altogether wrong, illegal, arbitrary, cryptic, against the natural justice and is biased one. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainants have suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.
On this backdrop of facts, the complainants have alleged deficiency and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite party No.1 to clear the outstanding balance of loan account No. 49180827 and disburse the accidental claim benefit of Rs.5,00,000/- as per the insurance policy of the deceased insured Baljinder Singh and also to pay compensation amounting to Rs.1,00,000/- due to harassment and mental agony and litigation expenses to the complainants, in the interest of justice.
3. Upon notice, the opposite party No.1 appeared through counsel and contested the complaint and filing their written reply by taking the preliminary objections that the complaint is legally not maintainable and liable to be dismissed. It is further pleaded that present complaint is bad for mis-joinder and non-joinder of necessary parties, as all the class-I legal heirs of the deceased have not been made party. It is pleaded that the present complaint pertains to insurance claim under Sarv Suraksha Policy having policy No. 2950 2018 4494 6600 000 valid from 18.07.2017 to 17.07.2022. However, it is to be noted that the liability of the company, if any, is subject to terms and conditions of the policy. It is further pleaded that copy of insurance policy alongwith its coverage details, terms and conditions were duly supplied to the Complainant which was never been disputed till the claim of the Complainant was repudiated. It is further pleaded that on 05.12.2018 the insured slipped in the bathroom and died as a result of the fall. It is further pleaded that after the death of the insured, the complainants lodged a claim with the replying opposite party seeking benefits under Personal Accident and Credit Shield section of the policy. It is further pleaded that the complainants have concealed the true and material facts from the knowledge of this Hon'ble Court therefore they are not entitled for any claim. It is further pleaded that after receiving the claim intimation, the replying opposite party sought some material documents from the complainants to decide the claim, and as per the documents received following observations were made:-
- As per the statement of the Mandeep Singh son of the deceased insured, there was no bleeding and further there was no injury on the body of the deceased insured. It is to be noted that Mandeep Singh was the first person to see the deceased insured after the alleged fall.
- Mandeep Singh further mentioned that his father was a patient of high blood pressure and has been on continuous medication. He further stated that the deceased insured was thereafter examined by Dr. Baljit Singh. The statement further states that the Doctor had told Mandeep Singh that the deceased insured may have fallen due to high blood pressure.
- As per the certificate issued by Dr. Baljit Singh, deceased insured had a lacerated wound in left parietal region of his head and that the insured "may have" died because of the head injury.
It is further pleaded that due to discrepancies regarding the cause of death of the insured, claim of the complainants was investigated and as a result of the investigation it was found that the insured expired due to heart attack. It is further pleaded that as per the Death Certificate attested by S.M.O I/C C.H.C, N.M. Singh (Gurdaspur) the insured had died due to Heart Attack. It is further pleaded that Claim under Personal Accident: It is to be noted that the benefit under Personal Accidental is triggered only in situations where the death is caused by Accidental Bodily injury. The term "Accident or Accidental" is defined in the policy as follows:-
"Accident or Accidental means a sudden, unforeseen and involuntary event caused by external, visible and violent means." That since the death of the insured was due to Heart Attack, and not due to any accidental bodily injury, hence, the claim under Personal Accident is not payable.
It is further pleaded that Claim under Credit Shield: is submitted that as per the terms and conditions of the policy, the replying opposite party is liable to pay the outstanding loan amount only in the events of either Accidental Death or Permanent Total Disability. The relevant condition is quoted herein below:-
“SECTION 5- CREDIT SHIELD INSURANCE POLICY
Coverage
Credit Shield
In the event of Accidental Death or Permanent Total Disability of the Insured Person during the Policy Period, the Company will make payment under this policy as detailed below:-
- The Company will pay the balance outstanding loan amount to the legal heirs of the Insured or the Named Insured subject to the maximum Sum Insured specified in the Schedule.
- The outstanding Loan amount would not include any arrears of the borrower due to any reasons whatsoever. The claim to be settled only in respect of the death of the first named borrower and not in respect of the others, which may happen in case loan is taken jointly.
It is further pleaded that as per the Death Certificate, insured was found to have expired due to natural cause and as such the claim under Credit Shield is also not admissible and hence the same was repudiated and intimation to this effect was given to the complainants vide letter dated 29.04.2019. It is further pleaded that the complainants tried to convert the natural death to accidental death with the connivance of the doctor as earlier the doctor issued certificate bearing reference No. 173 dated 22.02.2019 and again the doctor issued certificate bearing reference No. 176 dated 27.03.2019 and tried to convert the natural death into accidental death. It is further pleaded that even otherwise in both the certificates, the doctor has not confirmed the death by accident as he has used the words "May Be", therefore, from these certificates, it cannot be concluded that the deceased died due to accidental death. It is further pleaded that the complainants have not provided any PMR or authentic document showing the death was accidental, therefore, the present complaint is liable to be dismissed. It is further pleaded that both the parties are bound with the terms and conditions of the policy, which are duly supplied to the complainants and no claim can be passed beyond the terms and conditions of the policy, therefore, the claim is not payable. It is further pleaded that the present complaint has been filed without any cause of action against the replying opposite party, therefore, the present complaint is liable to be dismissed. It is further pleaded that complainants are estopped by their own act and conduct from filing the present complaint and the complainants have no locus standi to file the present complaint, therefore, the present complaint is liable to be dismissed.
On merits, the opposite party No.1 have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite party. In the end, the opposite party prayed for dismissal of complaint with costs.
4. Opposite parties No.2 and 3 did not appear despite the service of notice and was proceeded against exparte vide order date 26.11.2019.
5. Learned counsel for the complainants has tendered into evidence affidavit of Amandeep Singh, (Complainant No.1) as Ex.C-1/A alongwith other documents as Ex.C-1 to Ex.C-11.
6. Learned counsel for the opposite party No. 1 has tendered into evidence affidavit of Ms. Shweta Pokhriyal, (Assistant Manager - Legal Claims, HDFC ERGO Gen. Ins. Co. Ltd.) as Ex.OP-1/1 alongwith other documents as Ex.OP-1/2 to Ex.OP-1/10.
7. Rejoinder filed by the complainant.
8. Written arguments filed by the opposite party No.1 but not filed by the complainants.
9. Counsel for the complainants has argued that father of the complainants namely Baljinder Singh had taken auto loan for purchase of Hyundai Creta vehicle bearing registration No.PB-06-AN-0408 and the opposite party No.2 had got financed amount of Rs.8,067,61/- and the said loan was repayable in 60 installments of Rs.16,550/-. It is further argued that opposite party No.2 got the said loan secured through its insurance partner i.e. opposite party No.1 vide policy of insurance as per letter dated 18.07.2017 issued by opposite party No.1. The insurance policy provides coverage benefit of accidental death and credit shield insurance i.e. in case of accidental death or total disability of the insured, the balance outstanding loan will be paid by the insurance company and the additional accidental claim for amount of Rs.5 Lac will be given as accidental death benefit to the nominee. It is further argued that father of the complainants died on 05.12.2018 due to accidental fall in bathroom while taking bath on account of head injury. It is further argued that after the accident the complainants immediately called Dr.Baljit Singh Kahlon who examined the father of the complainants and disclosed that deceased had died due to head injury caused by slip in the bathroom. It is further argued that complainants approached the opposite parties for settlement of the claim as per the policy of insurance but the opposite parties repudiated the claim with the reason that the inured died on account of natural death. Repudiation of the claim amounts to deficiency in service on the part of the opposite parties. Counsel for the complainant has relied upon judgments of Hon'ble National Consumer Disputes Redressal Commission, New Delhi reported in 2006(1) C.P.J. 29 : 2006(3) ALT 13 : 2006(1) C.P.C. 243 : 2005(47) R.C.R.(Civil) 747 in case titled as Deepak Jaiswal. Vs. Oriental Insurance Co. and reported in 2015(2) CLT 504 : 2015(22) R.C.R.(Civil) 497 in case titled as Eeta Devi. Vs. United India Insurance Co. Ltd. and further relied upon judgment of Hon'ble State Consumer Disputes Redressal Commission, New Delhi reported in 2009(1) C.P.J. 156 : 2009(2) CLT 151 : 2008(55) R.C.R.(Civil) 531 in case titled as Oriental Insurance Company Limited. Vs. Manjit Kaur and also relied upon judgment of Hon'ble Gujarat State Consumer Disputes Redressal Commission reported in 2020(1) C.P.J. 17 in case titled as Director of Insurance. Vs. Surani Kantaben Lakshmanbhai and next relied upon judgment of Hon'ble Maharashtra State Consumer Disputes Redressal Commission reported in 2010(1) C.P.J. 175 : 2010(2) C.P.R. 120 : 2009(47) R.C.R.(Civil) 394 in case titled as Bharti And Ors. Vs. National Insurance Company And Anr.
10. Counsel for the opposite party No.1 has argued that policy of insurance in respect of which the present dispute has arisen was Sarv Suraksha Policy which was valid from 18.07.2017 to 17.07.2022 and during investigation for settlement of the claim, opposite party No.1 observed that Mandeep Singh complainant No.2 stated that there was no bleeding and no injury to any part of the body and he was the first person to see the deceased after fall. Mandeep Singh had further stated that his father was a patient of high blood pressure and was on continuous medication and Mandeep Singh had stated that it was disclosed by doctor that the deceased might had fallen due to high blood pressure. As per certificate issued by Dr.Baljit Singh deceased insured had a lacerated wound in left parietal region of his head and insured may have died because of the head injury and the opposite party No.1 found that the deceased died due to hear attack and as per death certificate issued S.M.O. I/C C.H.C. N.M. Singh (Gurdaspur) insured had died due to heart attack. Accordingly, the claim was rightly repudiated by the opposite parties.
11. Opposite parties No.2 and 3 remained exparte.
12. We have heard the Ld. counsels for the complainants and opposite party No.1 and gone through the record.
13. It is admitted fact that father of the complainants had obtained loan from opposite party No.2 for purchasing Hyundai Creta Car bearing registration No.PB-06-AN-0408. It is further admitted fact that opposite party No.2 through its insurance partner i.e. opposite party No.1 secured the loan vide policy of insurance valid from 18.07.2017 to 17.07.2022. It is further admitted fact that the insured Baljinder Singh died on 05.12.2018. It is further admitted fact that claim lodged by the complainants has been repudiated vide letter dated 29.04.2019. The only issue for adjudication before this Commission is whether the repudiation of the claim is justified or not.
14. To prove their case complainant No.1 has placed on record his affidavit Ex.C-1/A, copy of Sarv Suraksha Policy annexure C-1, copy of welcome letter annexure C-2, copy of certificate issued by Dr.Baljit Sigh annexure C-3, copy of statement of claimant No.2 annexure C-4, copy of death certificate annexure C-5, copy of letter dated 21.01.2019 annexure C-6, copy of statement of account annexure C-7, copy of repudiation letter annexure C-8, copy of document dated 09.06.2019 annexure C-9, copy of form for registration of death annexure C-10 and copy of claim reminder letter annexure C-11 whereas opposite party No.1 has placed on record affidavit of Shweta Pokhriyal Asstt. Manager-Legal Claims Ex.OP-1/1, copy of welcome letter Ex.OP-1/2, copy of Sarv Suraksha Policy Ex.OP-1/3, copy of Sarv Suraksha Policy wordings Ex.OP-1/4, copy of repudiation letter Ex.OP-1/5, copy of certificate issued by Dr.Baljit Singh Ex.OP-1/6, copy of death certificate Ex.OP-1/7, copy of power of attorney Ex.OP-1/8, copy of RTI application Ex.OP-1/9 and copy of death register Ex.OP-1/10.
15. Perusal of documents Ex.OP-1/2 and Ex.OP-1/3 shows that under the Sarv Suraksha Policy issued by opposite party No.1 in case of accidental death the insured person is entitled to sum assured of Rs.5 Lac and credit shield insurance benefit upto Rs.5 Lac. and to prove the accidental death the complainants had placed on record certificate of Dr.Baljit Singh dated 27.03.2019 as per which it is stated that the said doctor had examined Baljinder Singh insured on 05.12.2018, he was found unconscious and when doctor examined him there was a lacerated wound in left parietal region of his head. No smell of alcohol or any other drug was coming out of breath of patient. He expired immediately as per history he got injury because he slipped in washroom and in my opinion he may had died because of head injury due to fall.
16. Perusal of statement of Mandeep Singh complainant No.2 annexure C-4 shows that his father was taking bath on 05.12.2018 that his father was taking bath in the bathroom and there was no door in the washroom and we heard the distracting sound on the falling of my father from the washroom. We all reached to see the cause of falling upon reaching there we have seen that my father was lying on the floor in unconscious condition also there was no injury and bleeding to my father body. We immediately called the doctor Baljeet Singh and he reached within minutes and he examined my father there and he told us that there was no possibility of surviving. He also told us that there is a head injury occurred on the left side of the head. Doctor told us that this accident may be due to high blood pressure of my father probably. My father used to take medicines to keep his health since last two years. In other view, that this accident may have occurred due to extra pipe situated in the washroom probably he may be fell down on this pipe. The opposite party No.1 has also relied upon the document Ex.OP-1/10 regarding intimation for getting the death registered as per which death was got registered with authorities. However, opposite party No.1 has taken plea that complainants have mentioned the cause of death as heart attack while getting the death registered as per Ex.OP-1/10 but the opposite party No.1 has totally ignored the certificate annexure C-3 issued by Dr. Baljit Singh wherein doctor has found a lacerated wound in left parietal region of his head and doctor has given opinion that the deceased may have died because of injury due to fall which proves on record that the death of the insured took place due to the head injury and mere fact that deceased was also patient of high blood pressure and was taking medicines is not sufficient to prove the plea of the opposite party No.1 that the death of the deceased was not accidental.
17. We have also placed reliance upon judgment of Hon'ble National Consumer Disputes Redressal Commission, New Delhi reported in 2015(2) CLT 504 : 2015(22) R.C.R.(Civil) 497 in case titled as Eeta Devi. Vs. United India Insurance Co. Ltd. in which it is held as under:-
"A. Consumer Protection Act, 1986 Section 2(1)(g) Insurance claim - Insured fall in the bathroom and subsequently died due to injuries sustained - claim repudiated on the ground that the death was on account of cardiac arrest - Hospital record clearly states that the insured did not suffer from any chest pain - Therefore, the onus to prove that the death of the insured is a natural one and not an accidental death, shifts on the Insurance Company - In absence of cogent evidence death be inferred as a natural death Revision Petition allowed". (Para10).
As per above referred case of Hon'ble National Consumer Disputes Redressal Commission, New Delhi, it is held that the onus to prove that the death of the insured is a natural one and not an accidental death, shifts on the Insurance Company and in absence of cogent evidence death be inferred as a natural death and in the present case also opposite party No.1 has failed to bring on record any cogent evidence to prove this fact that the death of the insured was not accidental and took place due to heart attack or it was a natural death. Accordingly, by relying upon the certificate annexure C-3 issued by Dr.Baljit Singh we have no hesitation in holding that the cause of death of the insured was accidental in nature and repudiation of the claim by the opposite party No.1 is totally unjustified.
18. Accordingly, present complaint is partly allowed with following directions:-
i) Opposite party No.1 is directed to pay the balance outstanding loan amount pending in account No.49180827 maintained in the name of deceased insured subject to maximum sum insured specified in the schedule Ex OP 1/3.
ii) Opposite party No.1 is further directed to pay accidental benefit claim of Rs.5 Lac as per the policy of insurance to the complainants alongwith interest @ 9% P.A. from the date of filing of the complaint till realization within 30 days from the date of receipt of copy of this order.
19. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
20. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Lalit Mohan Dogra)
President
Announced: (B.S.Matharu)
Dec. 26, 2023 Member
*YP*
