Chandigarh

DF-I

CC/88/2018

Divesh Kumar - Complainant(s)

Versus

HDFC Ergo General Insurance Co. Ltd. - Opp.Party(s)

Devinder Kumar

09 May 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

 

                               

Consumer Complaint No.	:	CC/88/2018
Date of Institution	:	08/02/2018
Date of Decision	:	09/05/2019

 

Divesh Kumar son of Sh. Ashok Kumar, aged 30 years, r/o Plot No.11, Prashant Vihar, Back Side of Shagun Hotel, Baltana, Zirakpur, Punjab.

… Complainant

V E R S U S

1.     HDFC Ergo General Insurance Company Limited, SCO No.124-125, First Floor, Madhya Marg, Sector 8-C, Chandigarh through its Branch Manager.

2.     HDFC Ergo General Insurance Company Limited, Regd. & Corporate Office : 1^st Floor, 165-166, Backbay Reclamation, H.T. Parekh Mart, Churchgate, Mumbai 400020 through its Managing Director.

3.     HDFC Bank Limited, SCO No.153-155, Madhya Marg, Sector 8-C, Chandigarh through its Branch Manager.

… Opposite Parties

CORAM :	SHRI RATTAN SINGH THAKUR	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

                                                                     

ARGUED BY	:	Sh. Devinder Kumar, Counsel for complainant
	:	Sh. Nitesh Singhi, Counsel for OPs 1 & 2
	:	Ms. Neetu Singh, Vice Counsel for Sh. Shekhar Verma, Counsel

Per Rattan Singh Thakur, President

1.         The allegations, in brief are, complainant is nominee of his deceased brother, Sh. Mohan Kumar.  Complainant and his deceased brother approached OP-3 for housing loan and on the basis of the documents, OP-3 sanctioned loan in favour of the deceased, Sh. Mohan Kumar. At the time of loan, OP-3 also insisted for insurance policy of OPs 1 & 2 and on its assurance complainant agreed to take the same.  OP-3 collected three cheques of Rs.154/-, Rs.309/- & Rs.309/-as advance monthly premium and three cheques of Rs.4,561/-, Rs.14,640/- and Rs.14,640/- as advance EMI of loan. The complainant was regularly paying the monthly premium to OPs 1 & 2, but, had not received the policy document prior to 29.11.2017.  Maintained, said Sh. Mohan Kumar remained admitted in the PGI Chandigarh from 26.10.2017 to 11.11.2017 and ultimately died on 23.11.2017. The complainant’s case is, since insurance policy was taken by the deceased, therefore, as per the policy document, in the event of major medical illness and procedures sum assured of Rs.10,06,480/-was to be paid by the insurer OPs 1 & 2, but, they had repudiated his claim on the ground that as per terms and conditions, any critical illness diagnosed within the first 90 days of the date of commencement of the policy is excluded.  The said terms and conditions were never communicated to the complainant, therefore, there has been deficiency in service.  Hence, the present consumer complaint praying for Rs.10,06,480/- as critical illness benefit alongwith interest, Rs.2,00,000/- towards harassment and mental tension charges and Rs.55,000/- on account of litigation expenses.
2.         OPs 1 & 2 filed joint written statement and, inter alia, raised preliminary objections of the consumer complaint being not maintainable. Their case is, since there were terms and conditions, which were supplied to the complainant, if the critical illness takes places within 90 days from the date of issuance of the insurance policy, the claim was not entertainable. Hence, the claim has rightly been repudiated as per terms and conditions of the insurance policy.
3.         OP-3 has filed separate written statement and their case is, said bank happens to be financier i.e. creditor and was not concerned with the insurance policy taken by the complainant from OPs 1 & 2.  On these lines, the cause is sought to be defended.
4.         Replication was filed and averments made in the consumer complaint were reiterated.
5.         Parties led evidence by way of affidavits and documents.
6.         We have heard the learned counsel for the parties and gone through the record of the case. After appraisal of record, our findings are as under:-
7.          Per pleadings of the parties, the admitted case is, terms and conditions of the policy  reflects if the person insured i.e. Mohan Kumar gets critical illness within 90 days from the date of issuance of the policy, the claim was not entertainable at all.  The grouse of the complainant is, the said terms and conditions were never supplied to him, therefore, these were one sided and as per judgment of the Hon’ble Apex Court M/s Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd., I (2000) CPJ 1 (SC), it was held  that as the terms and conditions of the standard policy, wherein the exclusion clause was included, were neither a part of the contract of insurance nor disclosed to the appellant, respondent cannot claim the benefit of the said exclusion clause.  Now the whole case hinges upon that the terms and conditions were not supplied to the complainant at the time of issuance of the policy.
8.         We shall bank upon the policy document which is on record which on the foot mentions “The policy wording attached herewith includes all the standard coverage offered by the Company to its customers.  Your entitlement for coverage/benefits shall be restricted to the coverage/benefits as mentioned in this policy schedule. For any clarification please call our toll free number.”  This itself shows that with the policy document, terms and conditions were annexed. Perusal of the record i.e. Annexure R-1 further shows that the policy document was issued on 19.9.2017 and the complainant says that he had not received it.  There is another ground to belie the claim of the complainant.  As per him, the policy document was not supplied to him prior to 29.11.2017 while Annexure R-1 shows that it was desptached on 19.9.2017 and there is reference in the policy document that the terms and conditions were supplied.  Now, per this record, it cannot be held that terms and conditions were not supplied to the complainant vide which any critical illness diagnosed within 90 days of the date of commencement of the policy is excluded.  Date of policy is 19.9.2017 while date of heart disease detected on deceased, Sh. Mohan Singh is 26.10.2017 when he was admitted in the PGI, Chandigarh.  It was within 90 days.
9.         There is reference that the cheques were issued much prior to the issuance of the policy, but, there is no record that these were issued prior to 19.9.2017. Under these circumstances, this Forum cannot change the terms and conditions of the policy and the complainant is not entitled to any relief. 
10.         In view of the above discussion, we do not find deficiency in service or unfair trade practice on the part of the OPs and the present consumer complaint, being devoid of any merit, is hereby dismissed leaving the parties to bear their own costs.
11.         The certified copies of this order be sent to the parties free of charge. The file be consigned.

	Sd/-	Sd/-	Sd/-
09/05/2019	[Suresh Kumar Sardana]	[Surjeet Kaur]	[Rattan Singh Thakur]
hg	Member	Member	President