Delhi

North East

CC/321/2022

MRS. MAYA SINGH - Complainant(s)

Versus

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

12 Jun 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

Complaint Case No. 321/22

In the matter of:

 

		Mrs. Maya Singh W/o Late Sh. Pratap Singh, R/o A 8/274, Gali No. 8, Amar Colony, East Gokalpuri, Delhi 94		Complainant
		Versus
		HDFC Ergo General Insurance Co. Ltd., 6th Floor Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai 400020		Opposite Party
			DATE OF INSTITUTION: JUDGMENT RESERVED ON:                   DATE OF ORDER:		01.08.2022 30.04.2024 31.05.2024

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

 

ORDER

Surinder Kumar Sharma, President

The Complainant filed the present complaint under Section 35 of the Consumer Protection Act, 2019.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that the local agents of the Opposite Party visited the residence of the Complainant and the late husband of the Complainant was allured by the agents of the Opposite Party in the presence of the Complainant to take the life insurance cover. The late husband of the Complainant had agreed for the same and Opposite Party had issued two policies bearing no. 51593920 and 51593921 for a sum insured of Rs. 2,00,000/-  and Rs. 1,00,000/- respectively in the year 2013. Complainant stated that her late husband had paid a consideration amount of Rs. 10,579/- against both the policies and Opposite Party had issued a document covering the risk on life of Shri Pratap Singh i.e. husband of the Complainant and a duly completed proposal form was also obtained by the Opposite Party. Complainant stated that her late husband had paid the due premium of the policies till 2013 when her husband expired due to some illness. On 30.11.2013 the death claim was reported to the Opposite Party by way of letter whereby Opposite Party was requested to settle and pay the death claim as per policies. Complainant stated that she sent number of requests to the Opposite Party and also visited the office of Opposite Party and Opposite Party number of times assured the Complainant that payment of the policies would be released in her name being the nominee but the claim was not settled and paid till date. A legal notice dated 12.03.2022 was sent to the Opposite Party but it did not give any response. Hence, this shows the deficiency of service on the part of Opposite Party. Complainant has prayed for Rs. 3,00,000/- being the sum insured of the policies along with 24 % interest from the date of death. Complainant also prayed for an amount of Rs. 1,00,000/- as compensation and Rs. 1,00,000/- as litigation expenses 

Case of the Opposite Party

2. The Opposite Party contested the case and filed its written statement. It is stated that the complaint is not maintainable as the Complainant never lodged/registered any claim with the Opposite Party. It is stated that without registration of any claim, the Complainant cannot claim compensation and therefore, there is no deficiency of service on the part of the Opposite Party. It is stated that the complaint is time barred as the Complainant herself has stated that the complaint was being filed after 09 years of the cause of action. It is stated that the deceased husband of the Complainant has taken two policies. The detail of the policies is as below:

1. Health Surakha vide policy no. 51593920 was the mediclaim policy for reimbursement of treatment cost subjected to the exclusions and terms and conditions of the policy.
2. Suraksha Advantage vide policy no. 51593921 was the personal accident policy for rupees ten lakhs for death in the case of accident subjected to the exclusions and terms and conditions of the policy.

3. It is stated that the deceased husband of the Complainant had taken Personal accident policy mediclaim Floater policy for Rs. 2,00,0000/- vide policy no. 51593921 for the period from 10.07.2013 to 07.07.2015. This was for the death solely in case of accident subjected to the exclusions and terms and conditions of the policy. The allegations of the Complainant have been denied. It is prayed that the complaint may be dismissed. 

Rejoinder to the written statement of Opposite Party

4. The Complainant filed rejoinder to the written statement of Opposite Party, wherein the Complainant has denied the pleas raised by the Opposite Party and has reiterated the assertions made in the complaint.

Evidence of the Complainant

5. The Complainant in support of her complaint filed her evidence by way of affidavit, wherein she has supported the averments made in the complaint. Evidence of the Opposite Party
6. In order to prove its case, Opposite Party has filed affidavit of Shweta Pokhriyal, Manager of Opposite Party, wherein the averments made in the written statement of Opposite Party have been supported.

Arguments & Conclusion

7. We have heard the Ld. Counsel for the Complainant and Opposite Party. We have also perused the file and the written arguments filed by the Complainant and Opposite Party. The case of the Complainant is that her husband has purchased two policies bearing no. 51593920 and 51593921. The said policies were purchased in the year 2013. Her husband expired on 04.09.2013. As per the case of the Complainant, death claim was reported to the Opposite Party on 30.11.2013. Thereafter, she sent several requests to the Opposite Party to settle the claim but the Opposite Party did not settle the claim. On the other hand, the case of the Opposite Party is that the Complainant never lodged any claim with the Opposite Party and therefore the complaint is not maintainable. Its case is that the complaint is time barred. The case of the Opposite Party is that the husband of the Complainant has purchased two policies. The one policy bearing no. 51593920 had covered the followings:

1. In-patient treatment.
2. Pre Hospitalization expenses (60 days)
3. Post Hospitalization expenses (90 days)
4. Day care procedures
5. Domiciliary Treatment
6. Organ Donor
7. Emergency Ambulance Limit Per Hospitalization Upto (Rs. 2,000)
8. Ayurvedic/Homeopathis/Sidha/Unani Upto (Rs. 20,000)
9. Health Check up per family post 4 claims free year
10. Hospital Daily Cash.

 

8. The other policy bearing no. 51593921. The policy covered the followings:

1. Accidental Death
2. Permanent Total disability
3. Permanent Partial Disability

 

9. Now, the question is that whether the Complainant lodged any claim with the Opposite Party. The Complainant has filed a handwritten photocopy of a letter dated 30.11.2013 write to the Opposite Party. However, no postal receipt has been annexed along with this, nor any proof of delivery of this letter has been filed. In her complaint, the Complainant has stated that the report was lodged on 30.11.2023 whereas in the index of the list of document filed by the Complainant shows that the alleged letter was dated 03.11.2023. This is a material contradiction. Therefore, under these circumstances, the assertion of the Complainant that she lodged any report with the Opposite Party cannot be believed.
10. It is also stated by the Complainant that she sent several requests to the Opposite Party office and visited there office number of times. However, the Complainant did not file any proof that she sent any request to the Opposite Party. Nor she has given any date of such request nor any copy of the letter of proof of delivery has been filed. Therefore, this assertion cannot be believed.
11. The husband of the Complainant died on 04.09.013 but she has filed the complaint on 01.08.2022 i.e. after about 09 years. There is no explanation as to why the complaint was filed after such a long delay. The Complainant has tried to cover the limitation by issuing a legal notice dated 12.03.2022 to the Opposite Party. The issuance of legal notice cannot extend the limitation.
12. The case of the Complainant is that her husband had purchased two policies referred above. As discussed the policy bearing no. 51593920 had covered the following risk:

1. In-patient treatment.
2. Pre Hospitalization expenses (60 days)
3. Post Hospitalization expenses (90 days)
4. Day care procedures
5. Domiciliary Treatment
6. Organ Donor
7. Emergency Ambulance Limit Per Hospitalization Upto (Rs. 2,000)
8. Ayurvedic/Homeopathis/Sidha/Unani Upto (Rs. 20,000)
9. Health Check up per family post 4 claims free year
10. Hospital Daily Cash.

 

13. Thus, it is clear that this policy does not cover the death of the husband of the Complainant. The other policy bearing no. 51593921 had covered the following risk:

1. Accidental Death
2. Permanent Total disability
3. Permanent Partial Disability

 

14.  Thus, the said policy covered only the accidental death.
15. The case of the Complainant is that her husband died due to some illness. She has not disclosed the nature of the illness and the policy regarding the death of the husband covered only the accidental death. Therefore, the case of the Complainant is not covered under these polices.
16. In view of the above discussion, we do not see any merit in the complaint and the same is dismissed.  
17. Order announced on 12.06.2024.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room.

 

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma)             President