Chandigarh

StateCommission

A/116/2019

Divesh Kumar - Complainant(s)

Versus

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

Devinder Kumar Adv.

24 Nov 2021

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

UNION TERRITORY, CHANDIGARH

 

Appeal No.	116 of 2019
Date of Institution	14.06.2019
Date of Decision	24.11.2021

 

 

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.

      …..Appellant/Complainant

Versus

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.

                                   …..Respondents/Opposite Parties

BEFORE:  JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

                 MRS. PADMA PANDEY, MEMBER

                 MR. RAJESH K. ARYA, MEMBER

 

Argued by:   Sh. Devinder Kumar, Advocate for the Appellant.

                  Sh. Nitesh Singhi, Advocate for Respondents No.1 & 2.

                      Ms. Neetu Singh, Advocate for Respondent No.3.

 

                       

PER PADMA PANDEY, MEMBER

              This appeal is directed against an order dated 09.05.2019, rendered by District Consumer Disputes Redressal Forum-I, UT, Chandigarh now District Commission-I (hereinafter to be called as the District Commission only), vide which, it dismissed the complaint, with no order as to cost, filed by the complainant (now appellant).

2. In brief, the facts of the case are that the complainant is nominee of his deceased brother, Sh. Mohan Kumar. It was stated that the complainant and his deceased brother approached Opposite Party No.3 for housing loan and on the basis of the documents, Opposite Party No.3 sanctioned loan in favour of the deceased, Sh. Mohan Kumar. It was further stated that at the time of loan, Opposite Party No.3 also insisted for insurance policy of Opposite Parties No.1 & 2 and on its assurance complainant agreed to take the same.  It was further stated that Opposite Party No.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. It was further stated that the complainant was regularly paying the monthly premium to Opposite Parties No.1 & 2, but, had not received the policy document prior to 29.11.2017.  It was further stated that
   Sh. Mohan Kumar remained admitted in the PGI Chandigarh from 26.10.2017 to 11.11.2017 and at last died on 23.11.2017. It was further stated that the 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 Opposite Parties No.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 and it is not out of place to mention here that the said terms and conditions were never communicated to the complainant, therefore, there has been deficiency in service. It was further stated that the aforesaid act of the Opposite Party, amounted to deficiency in service and unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint was filed.
3.       The Opposite Parties No.1 & 2 filed their joint reply and raised preliminary objections of the consumer complaint being not maintainable. It was stated that 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 and therefore the claim has rightly been repudiated as per terms and conditions of the insurance policy. It was further stated that there was no deficiency, in rendering service, and remaining averments, were denied, being wrong, on the part of the Opposite Party.
4.       Opposite Party No.3 has filed its reply and stated that bank happens to be financier i.e. creditor and was not concerned with the insurance policy taken by the complainant from Opposite Parties No.1 & 2.  It was further stated that there was no deficiency, in rendering service, and remaining averments, were denied, being wrong, on the part of the Opposite Party.
5.        In the rejoinder, filed by the complainant, he reiterated all the averments, contained in the complaint.
6.       The Parties led evidence, in support of their case.
7. After hearing the Counsel for the Parties, and, on going through the evidence, and record of the case, the District Commission, dismissed the complaint, as stated above. 
8. Feeling aggrieved, the instant appeal, has been filed by the appellant/complainant.
9. We have heard the appellant and Counsel for the Parties, and have gone through the evidence, and record of the case, carefully.
10. After giving our thoughtful consideration, to the rival contentions, raised by the Parties and the evidence, on record, we are of the considered opinion, that the appeal is liable to be dismissed for the reasons to be recorded hereinafter.
11. We find from the record that the learned District Commission-I has rightly dismissed the complaint. The plea taken by the appellant is that the terms and conditions of the said policy were never supplied to him. The District Commission, on proper examination of the record, had relied upon the very fact that the terms and conditions of the policy were annexed alongwith the insurance cover. Annexure R-1 reveals that the policy document was issued on 19.09.2017, whereas the appellant firmly refused that he did not receive it. According to the terms and conditions of the policy, any critical illness diagnosed within 90 days of the date of commencement of the policy is excluded. In the present case, the heart disease detected on the deceased Sh. Mohan Singh, was on 26^th October, 2017 when he was admitted in PGI, Chandigarh, which was very much within 90 days of the issuance of the policy.
12. The District Commission has rightly observed that the terms and conditions of the policy cannot be changed and the appellant is not entitled to any relief since the disease was detected within 90 days of the issuance of the policy, which falls under the exclusion clause, according to the terms and conditions. Therefore, this Commission finds it fit to dismiss the appeal and to uphold the order of the learned District Commission. 
13.  No other point, was urged, by the appellant and Counsel for the respondent.
14. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, with no order as to costs. The order of the District Commission is upheld.
15. Certified copies of this order, be sent to the parties, free of charge.
16. The file be consigned to Record Room, after completion.

 

Pronounced.

24.11.2021                  

                                                                  Sd/-

                         [JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

                                                                        Sd/-

 [PADMA PANDEY]

MEMBER

 

                                                                        Sd/-

[RAJESH K. ARYA]

 MEMBER

Gp