Haryana

Karnal

CC/573/2019

Smt. Kanta Devi - Complainant(s)

Versus

HDFC ERGO General Insurance - Opp.Party(s)

S.S.Moonak

15 Jun 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                       Complaint No. 573 of 2019

                                                        Date of instt.02.09.2019

                                                        Date of Decision:15.06.2022

 

Smt. Kanta Devi, aged about 40 years, wife of late Shri Baljeet Singh son of Shri Sumer Singh, resident of Rajmal Panna, village Gagsina, District Karnal (Aadhar card no.3803 8238 0180)

 

                                               …….Complainant.

                                              Versus

 

HDFC ERGO General Insurance Company Limited, through its Branch Manager, Sector 12, opp. Mini Secretariat, Karnal.

 

                                                                      …..Opposite Party.

 

Complaint Under Section 12 of the Consumer Protection Act, 1986 and after amendment Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.

              Shri Vineet Kaushik……Member

      Dr. Rekha Chaudhary…….Member

                   

 Argued by: Shri S.S. Moonak, counsel for the complainant.

                    Shri Sanjeev Vohra, counsel for the opposite party.

 

                    (Jaswant Singh President)

 

ORDER:   

                

                   The complainant has filed the present complaint Under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that the husband of complainant namely Baljeet Singh son of Late Shri Sumer Singh was registered owner of the truck bearing no.HR-45-B-7942. The husband of complainant was having Sarv Suraksha Advantage Insurance Policy from the OP, bearing no.2999201378577302 (Master Policy) vide its certificate no.2950202114169300000, valid from 16.04.2018 to 15.10.2021. Baljeet Singh had paid Rs.1310/- as extra premium for covering the Accidental Death for a sum of Rs.10,00,000/- i.e. sum assured. The husband of complainant died in a roadside accident on 09.09.2018. The matter was reported to the Local Police of Police Station Gharaunda, bearing FIR no.0559/2018, Under Section 279/304-A IPC. His post mortem was conducted by the Doctors of Civil Hospital, Karnal on 10.09.2018. After the death of her husband, complainant submitted all the relevant documents for the settlement of the Accidental Death Claim but till today no reply has been received by the complainant from the OP, despite several visits and requests.  Complainant is a widow lady and is having minor children. The complainant has suffered great loss due to non-settlement of claim amount. All the relevant documents as demanded by the OP has already been submitted by the complainant but no response has been received by the complainant. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence, complainant filed the present complaint seeking direction to the OP to pay Rs.10,00,000/- under the policy in question alongwith interest @ 24% per annum and also to pay a sum of Rs.50,000/- as compensation for mental agony and as litigation costs.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; claim being premature; locus standi and cause of action. On merits, it is pleaded that no intimation has ever been received regarding the death of life assured. The claim of the complainant was closed by the OP on the ground of non-submissions of the requisite documents. The complainant even after various repeated requests and reminders letters failed to submit the requisite documents. In the absence of requisite documents the OP was not able to decide the claim on merits and therefore the same was closed and not repudiated. It is further pleaded that complainant lodged the claim with the OP on 03.10.2018, on receipt of intimation the claim was processed and thereafter, OP made requests vide letter dated 28.10.2018 to the complainant for submissions of documents, for the purpose of verification and processing of the claim of the complainant, however the complainant failed to provide the requisite documents. It is further pleaded that complainant failed to submit the requisite documents then OP again vide letters dated 12.11.2018 and 27.11.2018, requested the complainant to submit the requisite documents. Due to non-submission of documents, OP closed the claim, vide letter dated 12.12.2018, which was duly served upon the complainant. There is no deficiency in service on the part of the OP and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Complainant has tendered into evidence her affidavit Ex.CW1/A, copy of Registration Certificate of truck no.HR-45B-7942 Ex.C1, copy of insurance policy Ex.C2, copy of FIR Ex.C3, copy of postmortem report Ex.C4, copy of legal notice Ex.C5, copy of postal receipt Ex.C6, copy of driving licence of Baljeet Singh Ex.C7 and closed the evidence on 13.02.2020 by suffering separate statement.

5.             On the other hand, learned counsel for OP has tendered into evidence affidavit of Shweta Pokhriyal Legal Manager Ex.RW1/A, copy of letters dated 28.10.2018, 12.11.2018, 27.11.2018 by OP to complainant with regard to submissions of documents Ex.R1 to Ex.R3, copy of claim closure letter dated 12.12.2018 Ex.R4, copy of insurance policy Ex.R5 and closed the evidence on 31.08.2021 by suffering separate statement.

6.             We have heard the learned counsel for the parties and have perused the case file carefully.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that husband of complainant namely Baljeet Singh was registered owner of the truck bearing no.HR-45-B-7942. The husband of complainant was having Sarv Suraksha Advantage Insurance Policy from the OP and paid Rs.1310/- as extra premium for covering the Accidental Death for a sum assured of Rs.10,00,000/-.  The husband of complainant died in a roadside accident on 09.09.2018. The matter was reported to the Local Police as well as to the OP. Post mortem of the deceased was conducted in the Civil Hospital, Karnal. After the death of her husband, complainant lodged the claim for personal accident claim and completed all the formalities for settlement of the claim but till date OP has failed to settle the claim of the complainant despite several visits and requests. Hence, prayed for allowing the complaint.

8.             Per contra, learned counsel for OP, while reiterating the contents of written version, has vehemently argued that no intimation has ever been received regarding the death of life assured. The claim of the complainant was closed by the OP on the ground of non-submissions of the requisite documents. The complainant even after various repeated requests and reminders letters failed to submit the requisite documents. In the absence of requisite documents the OP was not able to decide the claim and due to non-submission of documents, OP closed the claim, vide letter dated 12.12.2018. Hence, prayed for dismissal of the complaint.

9.             Admittedly, the husband of complainant died during the subsistence of the insurance policy.

10.           The OP has taken a plea that complainant has not supplied the requisite documents as demanded by the OP, vide letter dated 28.10.2018 Ex.R1 and reminders dated 12.11.2018 Ex.R2 and 27.11.2018 Ex.R3 sent by the OP to the complainant, vide which OP demanded policy final report; vehicle details through which insured was carried to hospital from spot; vehicle number and owner of the vehicle; occupation (Income Proof) details of insured and claimant at the time of death, where was he working and what is the correct address where h e was employed; consent letter to retrieve medical treatment paper and other detail from hospital; insurance and RC copy of bike registration no.HR-05B 1314 involved in the accident; claim details taken to repair the bike no.HR-05B 1314..If not claimed then provide the bill and address of workshop where vehicle was repaired; driving licence of the person driving the vehicle at the time of accident; to provide the details of other policy, insured was holding, if any; details of how many claims lodged with other insurers, if any; how many bank accounts customer was holding; copy of ITR since 2014 to 2018; how the insurance wit HDFC ERGO and other insurance company was booked alongwith sharing that Account/credit card details; details of other policy, insured was holding, if any, details of how many claims lodged with other insurers, if any.

11.           As per the above letters, complainant failed to submit the documents as required by the OP. As per the version of the complainant he had supplied all the required documents to the OP but in this regard complainant has not placed on record any document/receipt vide which he had submitted the documents with the OP. If complainant had submitted the documents with the OP, then why he did not receive the receipt from the OP.  The complainant has failed to rebut the abovesaid letters of OP by leading any cogent and convincing evidence. Hence, it appears that complainant has failed to fulfill the formalities mentioned in the abovesaid letters. The claim of the complainant has not been repudiated by the OP and the same has been closed by the OP, vide letter Ex.R4 dated 12.12.2018 for non-submission of documents. Hence, we are of the considered view that, at this stage, the present complaint is pre-mature and OP is not deficient in closing the claim of the complainant.

 12.         In view of the above observation, the present complaint is disposed of with the liberty to the complainant to submit the documents as required by the OP for deciding the claim as mentioned in the letters Ex.R1 to Ex.R3, and after the completion of all the formalities, OP is hereby directed to settle the claim of the complainant within 30 days. No order as to costs. This order shall be complied with accordingly. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:15.06.2022                                                                     

                                                                President,

                                                    District Consumer Disputes

                                                    Redressal Commission, Karnal.

 

 (Vineet Kaushik)       (Dr. Rekha Chaudhary)

  Member                   Member