Chandigarh

DF-I

CC/253/2018

Smt. Sadhna Sharma - Complainant(s)

Versus

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

Sanjeev Sharma Adv. & Hoshiar Singh Adv.

18 Jul 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I,

U.T. CHANDIGARH

 

                               

Consumer Complaint No.	:	CC/253/2018
Date of Institution	:	01/06/2018
Date of Decision	:	18/07/2019

 

Smt. Sadhna Sharma, aged about 55 years, wife of Sh. Rajeev Sharma, resident of House No.1043, Sector 2, Panchkula

… Complainant

V E R S U S

1.     HDFC Ergo General Insurance Company through its Managing Director, 5^th Floor, Tower-1, Steller TT Park, Sector 62, C-25, BHA, Millennium Tower Road, C Block Noida, 20130 U.P.

2.     HDFC Ergo General Insurance Company through its Branch Manager, SCO No.52, Sector 11, Panchkula, Pin Code – 134109, now SCO 124-125, Sector 8C, Madhya Marg, Chandigarh 160008.

… Opposite Parties

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

                                                                     

ARGUED BY	:	Sh. Sanjeev Sharma, Counsel for complainant
	:	Sh. Nitesh Singhi, Counsel for OPs

Per Rattan Singh Thakur, President

1.         The long and short of the allegations are, complainant happened to be the mother of deceased Sh. Darpan Kaushal i.e. class I legal heir.  Her case is, on 5.7.2016, Sh. Darpan Kaushal was on his way in the car from Panchkula to Zirakpur.  On the way he met with an accident and as a result thereof, he had expired.  The car was struck with another vehicle going ahead which had stopped all of a sudden.  Further case is, during his lifetime Sh. Darpan Kaushal had purchased a corporate card of HDFC Bank and insurance was provided by the OPs.  The said platinum master card covered accident and his life was assured in case of accidental death to the tune of Rs.3.00 lakhs and Rs.10.00 lakhs for air accidental death.  In spite of matter brought to the notice of the OPs, this amount was not disbursed to the complainant.  Even the legal notice was issued on 8.6.2017 which was ignored. Hence, the act of the OPs amounts to deficiency in service. On these allegations the complainant has filed the present consumer complaint praying for release of the sum assured of Rs.3,00,000/- alongwith interest, compensation of Rs.1,00,000/- and litigation expenses of Rs.11,000/-.
2.         OPs contested the consumer complaint and filed their joint written reply.  Their emphasis is, complaint being premature as no claim was lodged with them.  Per terms and conditions of the policy, claim was to be lodged after death within 15 days and reference to the clauses has been made.  To the rest of the averments, there has been evasive denial.  Issuance of the policy is admitted and per terms and conditions, in the event of accidental death sum assured was Rs.3.00 lakhs and Rs.10.00 lakhs in case of death in air accident.  On these lines, the cause is sought to be defended.
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. After perusal of record, our findings are as under:-
6.          A meticulous perusal of the pleadings of the parties shows, certain facts are admitted with regard to the issuance of platinum master card of HDFC Bank and the insurance cover provided under the card to the deceased Sh. Darpan Kaushal.  The terms and conditions of accidental death are admitted and the same are reproduced below :-

                        “Accidental death : In case of death in an air accident your nominated next of kin will receive a compensation of Rs.10,00,000/- and in case of death in a rail on road accident, your nominated next of kind will receive a compensation of Rs.3,00,000/-.”

7.         Now we shall switch over to the evidence brought on record regarding the accidental death of deceased Sh. Darpan Kaushal who was a consumer of the OPs and they happened to be service provider to his nominee.  The allegations made in the consumer complaint are supported by way of affidavit of the complainant and the complainant has also brought on record photocopies of master card (Annexure C-2), card usage guide which contained the aforesaid terms and conditions and further indicates of card security etc.
8.         Not only this, the claim of the complainant is further supported with a copy of post mortem report issued by the concerned doctor CHC Antala and the autopsy was conducted by Dr. Jasbir Kaur.  According to her opinion, deceased Sh. Darpan Kaushal had died due to injury leading to intracramal hemorrhage, lacerations, brain hemorrhage over area which was sufficient to cause death and all injuries were anti mortem in nature.
9.         Not only this, a translated version of copy of FIR has also been produced which shows, FIR No.211  dated 5.7.2016 u/s 283/427 & 304-A IPC, P.S. Zirakpur was registered against unknown driver of tipper bearing No.PB-32K-2755 loaded with sand and the allegations were the car was struck with the tipper as it was suddenly stopped.  It is also the case, on identification of the driver, criminal case is pending against him before the concerned court of JMIC. There is no rebuttal to this evidence on record.  Thus, per contents of the FIR, affidavit of the complainant, copy of post mortem report and in the absence of rebuttal to this evidence, the safe conclusion is deceased, Sh. Darpan Kaushal had died in an accident and there was insurance cover provided to him by the OPs.  There is no doubt about these facts.
10.         The only grouse of the OPs is, claim was not submitted to them within 15 days from the date of death.   Let us have a human approach to the facts of the case.  The legal heir/nominee of the deceased is the complainant, Smt. Sadhna Sharma who, on the date of accident, was aged 53 years and in all probability was under mental shock with the death of her young son, Sh. Darpan Kaushal aged 24/25 years. No evidence has been brought on record by the OPs that the complainant, mother of deceased Sh. Darpan Kaushal, had knowledge of deceased being holder of platinum master card which provided insurance cover on receipt of requisite fee. Hence, in these circumstances the condition of 15 days is to be given effect from the date of knowledge of the complainant that deceased had platinum master card which provided insurance cover. Not only this, even post cremation ceremonies and rituals are performed for 16 days and we have noticed that in the contents of legal notice dated 8.6.2017 (Annexure C-4), under paragraph No.6 it was mentioned as under :-

“6.    That it is pertinent to mention here that my client had also informed to your company about the same but you have not paid the same till date.”

 

11.         This shows, complainant had informed the company, but, the amount was not paid.  This notice was not replied by the OPs which means they admit the contents of the notice and the said notice contained a paragraph of complainant having informed the company much before.  Even otherwise, 15 days time in the present situation is to start from the date of knowledge and there is no record, as we have already referred, that the complainant had knowledge of such insurance cover and more so in the event of accidental death which happens all of a sudden and brings shock to the mother and family and it takes days, months and years together to get the mental balance restored and non-compliance of this condition is not fatal.  Hence, the claim of the complainant could not be denied merely on the ground that written complaint was not made within 15 days from the date of accident otherwise it would be a ruthless appreciation of the record.  In 15 days time even the rituals are not completed after cremation ceremony.
12.         It is true that OPs had not entered into investigation even on receipt of the notice dated 8.6.2017 (Annexure C-4).  The reason assigned was that they were not supposed to enter into investigation unless the claim was preferred.  In the notice, claim was asked for which was not entertained.  Even in the consumer complaint, the claim was asked for, but, the OPs did not bother to enter into investigation, even during the pendency of the instant consumer complaint.  This shows total inaction on part of OPs and having no human touch in such a situation even to hold investigation.  The OPs cannot be compelled to enter into investigation and even otherwise as per record discussed hereinbefore, the claim seems to be genuine one and, therefore, we procced to allow the same.
13.         In view of the above discussion, the present consumer complaint succeeds and the same is accordingly partly allowed.  OPs are directed as under :-

1. To pay the sum assured of Rs.3,00,000/- alongwith interest @ 9% per annum from the date of filing of the present consumer complaint i.e. 1.6.2018 till realization.
2. To pay an amount of Rs.20,000/- to the complainant as compensation for causing mental agony and harassment to her;
3. to pay Rs.10,000/- to the complainant as costs of litigation.

14.         This order be complied with by the OPs within thirty days from the date of receipt of its certified copy, failing which, they shall make the payment of the amounts mentioned at Sr.No.(i) & (ii) above, with interest @ 12% per annum from the date of this order, till realization, apart from compliance of direction at Sr.No.(iii) above.
15.         The certified copies of this order be sent to the parties free of charge. The file be consigned.

	Sd/-	Sd/-	Sd/-
18/07/2019	[Suresh Kumar Sardana]	[Surjeet Kaur]	[Rattan Singh Thakur]
hg	Member	Member	President