BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, ERNAKULAM.

Date of filing : 01.03.2016

Date of Order : 5.11.2019

PRESENT:

Shri. Cherian K. Kuriakose, President.

Shri. V.Ramachandran Member.

CC.No.142/2016

Between

O R D E R

V.Ramachandran, Member

1. A brief statement of facts of this complaint is as stated below:

The complainant is the widow of late Sony Cheryan who had availed a loan for Rs. 7,06,438/- from the 3^rd opposite party after hypothecating his Toyota Innova Car with Reg. No. K-13G 78 of 2009 Model. The duration of loan extends from 05.11.2013 to 05.10.2018 and the monthly instalment was 17,588/- per month and the interest @ 17% per annum. According to the complainant, he was insisted to take ‘Sarv Suraksha’ insurance policy with the 1^st opposite party which will be in force deny the entire loan period. Assuring that in his event of death of loanee, the liability towards the liability towards the 3^rd opposite party would be settled or cleared by the insurance Company under credit scheild insurance coverage. It was further offered that the spouse of the insurance will be offered 100% benefit and shall be entitled to ‘Critical illness’. Accordingly the 3^rd opposite party default the policy premium apart from the proceeding charges and finally he was distressed with 6,95,400/. The policy schedule was provided the credit scheild coverage to the extent of 5 lakh and critical illness coverage extends to 1 lakh apart from other heads. On 26.06.2015 the husband of the complainant was admitted in the M.O.S.C Medical College Kolenchery as he was suffering from breathlessness. On examination it was detected that he was suffering from Techeopnea with pallor, high blood pressure and hypoglycemia. He died on 29.06.2015 at 1.25 pm while he was in ICU.

2) The complainant submitted a claim petition with all Medical bills for Rs.1 lakh towards critical illness coverage from the 1^st opposite party. It is also submitted that the complainant is also entitled to credit scheild coverage for Rs.5 lakh to be adjusted against the loan with the 3^rd opposite party.

3) On 25.08.2015, the 1^st opposite party informed the complainant by repudiation letter that the claim is rejected. According to the 1^st opposite party since her husband was not able to survive for the required period of 30 days it will not come under the protection of coverage. According to the complainant there was no references with respect to the credit schield coverage. It is the case of the complainant that her husband was making regular payment till his hospitalization and hence he is entitled to get the amount disbursed as claim. Without proper consideration of the claim the 3^rd opposite party is compelling the complainant to remit the loan amount which amount to unfair trade practice alleges the complaint. Hence the complainant has prayed for a compensation of Rs.1,00,000/- due to the complainant under the critical illness coverage under the policy. It is also prayed to settle the liability of the insurance towards the 3^rd opposite party against the outstanding hypothecation loan No. 25720549 after paying compensation of Rs.50000/- towards the mental agony and hardships to the complainant.

4) Notices were issued to the opposite parties and the 1^st and 2^nd opposite parties filed their version in response to the notice served on them.

5) Version of the 1^st and 2^nd opposite parties

The 1^st and 2^nd opposite parties filed their version stated that as per the said policy availed by the insured is subject to the terms and conditions of the ‘Sarv Suraksha’ Policy (Plus). As per Section 5 of the policy, in the event of Accidental Death or Permanent Total Disability of the Insured person during the policy period, the company will pay the balance outstanding loan amount to the legal heirs or the Named Insured subject tot he maximum sum insured specified in the schedule, which includes any arrears of the borrower. In the policy accident or accidental death is defined as “a sudden, unforeseen and involuntary event caused by external, visible and violent means”. In the instant case, the death of the insured is not due to any of the reasons above, ie, not accident or accidental as defined.

6) Under the lead Critical illness which is provided in the policy that if the insured person named in the scheduled as diagnosed 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 diagnosing coverage. In the instant case, the said condition is also not fulfilled and hence the complainant is not entitled to get any compensation. The opposite parties contended in their version that the complainant is not entitled to get any reliefs from the opposite parties and the complaint is filed with frivolous and vexatious and the complainant is failed to place any material or record proving her allegations and make case against the opposite parties. There is no deficiency of service on the part of the opposite parties. It is prayed that this complaint may be dismissed with costs to the opposite parties.

7) Version of the 3^rd opposite party

It is stated in the version as on 01.11.2016 an amount of Rs.6,51,628/- is outstanding in the loan amount and they are entitled to recover the same from the complaint.

8) The evidence in this case consists of documentary evidence adduced by the complainant which marked as Exbt. A1 to A9. The 1^st and 2^nd opposite parties adduced Exbt.B1 to B3 documents. No oral evidence adduced by both complainant and the opposite parties.

9) The issues to be considered in this case are as follows:

(i) Whether there is any deficiency in service or unfair trade practice on the side of the opposite party?

(ii) Whether the complainant is entitled to get any compensation from the opposite party.?

(iii) Costs of the proceedings if any?

10) On examination of the documents and the versions filed by both parties it is revealed that the policy conditions specifically defines the credit scheild insurance policy and the critical illness. On perusal of the evidence it is revealed that in this case of the complainant will not come under the said category under the policy which is supported by the decision of the State Consumer Disputes Redressal Commission in HDFC Ergo General Insurance Co. Vs. Babita Bensal case.

11) The policy conditions clearly defines the credit shield insurance policy and critical illness. On examination it is seen that the complainant’s case will not come under the said category under the policy which is supported by the decision of the State Commission Disputes Redressal Commission in HDFC Ergo general insurance Co. Vs Babita Bensal. It is established that the complainant is not entitled to the credit schield insurance coverage and the critical illness coverage as per the policy conditions. Hence point No. (i) is found against the complainant.

12) Issue Nos. (ii) and (iii)

Having found the issue No.(i) against the complainant, we do not have to consider the issue Nos.(ii) and (iii).

In the result the complaint is dismissed with no costs.

Pronounced in the open Forum on this the day of 5^th day of November 2019.

Sd/-

V.Ramachandran, Member

Sd/-

Cherian K.Kuriakose, President

Forwarded by Order

Senior Superintendent

APPENDIX

Complainants Exhibits

Opposite party's Exhibits:

Date of Despatch ::

By Hand ::

By Post ::

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