Chandigarh

DF-I

CC/377/2019

Dr. Navneet Kumar - Complainant(s)

Versus

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

Arunasachdeva

26 Oct 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                    

Consumer Complaint No.	:	CC/377/2019
Date of Institution	:	17/05/2019
Date of Decision	:	26/10/2022

 

Dr. Navneet Kumar S/o Sh.Darshan Kumar R/o H.No.612/2 Omax Cassia, New Chandigarh, Punjab.

… Complainant

V E R S U S

1. HDFC ERGO General Insurance Company Limited through its Senior Vice President Accident & Health Claims 6^th Floor, Leela Business Park, Andheri Kurla Road Andheri (East), Mumbai-400059.
2. HDFC ERGO General Insurance Company Limited through its Director SCO 124-125, Sector 8C, Madhya Marg, Chandigarh-160008.

… Opposite Parties

CORAM :	PAWANJIT SINGH	PRESIDENT
	SURJEET KAUR	MEMBER
	SURESH KUMAR SARDANA	MEMBER

 

                                                

ARGUED BY	:	Mrs.Aruna Sachdeva, Counsel for Complainant.
	:	Nitesh Singhi, Counsel for OPs.

 

Per Suresh Kumar Sardana, Member

1.      Averments are that the complainant took a housing loan from HDFC Bank Chandigarh. The complainant was given on insurance cover under Home Suraksha Plus Policy, after paying the total premium of Rs.1,92,913/-. He was also paying Rs.1500/- monthly towards premium for the same (Annexure C-1). The complainant was given the policy certificate and cover starting from 13.10.2017 to 12.10.2022 for the purposes of tax exemption under Section 80-D of the Income Tax Act (Annexure C-2). As per policy, complainant was covered for Major medical illness and procedures, accident and loss of job. Under head loss of job, condition is that voluntary unemployment or voluntary retirement is excluded. As per coverage details under head loss of job sum insured is 3 EMIs of housing loan i.e., Rs.37,000/-.

         The complainant is a specialist doctor in Anesthesia and his MBBS and MD degrees are from GMCH Sector 32, Chandigarh. As per complainant, his services were terminated from the ESI Hospital Baddi on the ground that he had his total two spells of SR (Anesthesia) for 3 years were over (Annexure C-3). The complainant remained without service for more than two months and thereafter he joined Max Hospital, Mohali. The complainant wrote to the OPs about termination of his services and loss of job. He had filed his claim under loss of job clause. They were settle his claim for 3 EMIs of housing loan. The OP No.1 while repudiating his claim wrote to the complainant that his claim is rejected because his job was contractual (Annexure C-4). The OP No.1 has cited that loss of job due to reasons other than retrenchment as a result of mergers and acquisition is not covered. But the complainant is a doctor by profession, therefore, such a situation like retrenchment will never arise. The complainant got tired and harassed after sending a number of emails, personal visits and by not getting any response submitted a legal notice through his counsel but the respondent did not respond to it (Annexure C-5). Hence, this complaint.

2.     OPs contested the consumer complaint, filed its written reply and they submitted that the complainant was employed on a contractual basis. Copy of the memorandum is annexed as Annexure R-6. As per the memorandum, the complainant was engaged for the post of Senior Resident (Anesthesia) on contractual basis for one year extendable upto 3 years under residency scheme in the employees’ State Insurance Corporation Model Hospital, Baddi, H.P. As per the terms and conditions of the policy, the respondent shall not be liable for any claim which is arising due to unemployment from contractual job. The claim of the complainant was repudiated, as per the settled terms and conditions of the policy, after going all the documents of the policy holder/complainant as well as the documents of the policy in question. Pleading that there is no deficiency in service or unfair trade practice on their part, OPs have prayed for dismissal of the complaint.
3.     Rejoinder was filed and averments made in the consumer complaint were reiterated.
4.     Parties led evidence by way of affidavits and documents.
5.     We have heard the learned counsel for the parties and gone through the record of the case.
6.     On perusal of the Annexure C-1 of the complaint, it is observed that complaint took an insurance policy under Home Suraksha Plus for the period from 13.10.2017 to 12.10.2022 and the payment of premium is not disputed. It is also observed that it covered loss of job also. The issue of aforesaid insurance policy was subject to the settled terms and conditions of the insurance policy. We have perused the policy schedule alongwith policy terms and conditions which are placed on Annexure R-1 to R-3. It is also observed from Annexure R-6 that the complainant was working as senior resident and he was terminated vide letter dated 10.01.2019 (Annexure R-4), from his post. Now we reproduce below the relevant portion of terms and conditions of the policy Annexure R-1:-

         “C. Exclusions Applicable to Section 5

3. The company shall not be liable to make any payment under this policy in connection with or in respect of:

         a. xxxxxxxxxxxxxxx.

             b. Any claim relating to unemployment from a job which is casual, temporary, seasonal or contractual in nature or any claim related to an employee not on the direct rolls of the employer.

             c. xxxxxxxxxxxxxxx.

             d. xxxxxxxxxxxxxxx”.

 

         As per exclusions applicable of the terms and conditions of the policy, it is very clearly mentioned therein that the company shall not be liable to make any payment in respect of any claim relating to unemployment from a job which is casual, temporary, seasonal or contractual. On perusal of the Annexure R-4 & R-6, it is observed that the job of the complainant was contractual in nature and same was excluded under the policy as discussed above. Hence, we are of the concerted view that the claim of the complainant was rightly repudiated as per settled terms and conditions of the policy and OPs were not found deficient in providing service or found to be involved in unfair trade practice.

7.     In view of the aforesaid discussion and the reasons recorded hereinbefore, we do not find any deficiency in service or unfair trade practice on the part of the OPs. Accordingly, the consumer complaint, being meritless, is hereby dismissed, leaving the parties to bear their own costs.
8.     Certified copies of this order be sent to the parties free of charge. The file be consigned.

			Sd/-
26/10/2022			[Pawanjit Singh]
Ls			President
			Sd/-
			[Surjeet Kaur]
			Member
			Sd/-
			[Suresh Kumar Sardana]
			Member