Before the District Consumer Disputes Redressal Commission, Rohtak.
Consumer Complaint No. 361
Instituted on: 03.08.2018
Decided on: 05.12.2024
1. Sunny Kumar S/o Sh. Jagbir Singh
2. Pooja D/o Sh. Jagbir Singh
3. Sumit Kumar S/o Sh. Jagbir Singh
4. Smt. Sushila Devi W/o Sh. Jagbir Singh
All residents of Village-Garnawati, Teh.-Kalanaur, Distt. Rohtak
….Complainants
Vs.
- HDFC ERGO General Insurance Company Limited. Regd. & Corporate office 1st floor, 165-166 Backbay Reclamation, H.T. Parekh Marg, Churchgate, Mumbai through its Manager.
- HDFC ERGO General Insurance Company Limited, 1st floor, Pizza Hut, Opp. Sessions Judge House, Near Ashoka Chowk, Delhi Road, Rohtak.
- HDFC Bank SCO 153-155 Sector-86 Chandigarh through its Manager.
……Opposite Parties
COMPLAINT UNDER SECTION 12 OF CONSUMER PROTECTION ACT.
BEFORE: SH. NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. VIJDENER SINGH, MEMBER.
Present: Sh. NaseebPanghal, Advocate for the complainants.
Sh. Gulshan Chawla, Advocate for the Opposite party no.1.
Sh. Vipul Kapoor, Advocate for the Opposite party no.3.
Opposite party no.2 already exparte (VOD 20.02.2019).
ORDER
SH. NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the present complaint, as per thecomplainants, are thatfather of the complainants namely Sh. Jagbir Singh had obtained a housing loan vide account no. 611132773 from opposite party no.3 HDFC Bank Ltd. and alsoan Insurance Policy no.2918200810561600000 from opposite party. The father of the complainants expired on 21.12.2017 at Sri Balaji Action Medical Institute, A-4 PaschimVihar, New Delhi. After the death of their father, complainants got registered the claim to the opposite party vide claim no.C291817001287 and opposite parties assured the complainants for settlement of claim but later on started lingering on the matter on one pretext or the other.Opposite parties are unnecessarily harassing and humiliating thecomplainants by delaying the genuine claim of complainants and due to this act of opposite parties, complainantsare suffering from great mental tensions, agony and pain. Complainants got served a legal notice dated 11.07.2018 upon the opposite party requesting to settle their claim and waive off the balance loan amount but all in vain. The opposite parties finally refused to pay any heed to the genuine requests of the complainants. Hence this complaint and it has been prayed that opposite parties may kindly be directed to pay the balance loan and insurance amount of Rs.18,56,359/- alongwith interest, compensation and litigation expenses besides any other relief which this Commission may found deem fit and proper to the complainant.
2. Upon notice, opposite party nos. 1 and 3 appeared and filed their written statement separately. It is pertinent to mention here that opposite party no.2 was impleaded as party to the present complaint by an application moved by learned counsel for the complainants and upon endorsement of No Objection given by counsel for opposite party no.1 in this regard.However, notice sent by this Commission through registered post to opposite party no.2 got served and the counsel for complainant submitted the tracking report in this regard. But as the opposite party No. 2 failed to appear before the Commission despite due service and waited sufficiently, it was proceeded against exparte vide order dated 20.02.2019 of this Commission.
3. Opposite party no.1 in its reply has stated that the complaint is barred by the rules of Res-Judicata as the same matter has already been decided by Permanent LokAdalat (PUS), Rohtak in petition no.3486/16 on 06.11.2019. The Hon’ble LokAdalat upheld that the insurance policy was obtained by Jagbir Singh through deliberate concealment of material facts regarding his Pre-existing medical conditions such as hypertension and diabetes. Therefore, the complaint cannot be re-adjudicated. The issue involved in both the complaints was in regard to the payment of claim under the coverage of Major Medical Illness. The insurance policy provides benefits under major medical illness as the policy is survival benefit policy and the present policy has no relation with death of insured. The complainants claimed that Jagbir Singh had a housing Loan from HDFC Bank with the present insurance policy having coverage under several heads. The insurance policy does not cover the death by treatment and only covers the death by major illness. During the validity of policy period, Jagbir Singh insured expired on 21.12.2017 during treatmentand the complainants have filed the present complaint by concealing the material facts from this Commission as an application for same cause of action was already pending at that time. Moreover, present policy is not life insurance policy and only covers the accidental death but as per the case of complainants, the insured Jagbir died during the treatment in hospital. Hence, death of JagbirSingh is not covered under the policy in question and there exists no liability on the part of insurance company to make any payment. After the death of insuredJagbir Singh, the complainants lodged claim under Major Medical Illness without giving reference of earlier claim already repudiated. Said claim of present policy was closed by the opposite party due to non submission of required documents and has not been repudiated because the complainants failed to submit the requisite documents even after repeated requests. The intimation in this regard was sent to the complainants vide letter dated 18.5.2018. As such there is no negligence or deficiency in service on the part of the opposite party and it is prayed that the complaint may kindly be dismissed with heavy costs.
4. In its reply, the opposite party no.3 has submitted that opposite party no.3 is an independent entity having no control over the affairs and business operations of opposite party no. 1 and 2. However, as per the admission of the complainants in their complaint, the life assured had availed a housing loan from the respondent and it is to be repaid as per agreed terms of loan agreement. It is made clear by the opposite party that a home loan of Rs.33,66,359/- was sanctioned in the name of Jagbir Singh and Smt. Sushila Devi out of which Rs. 27,67,000/- was disbursed and as on 12.01.2021, Rs. 26,84,713/- is outstanding in loan account. It has been submitted that respondent is neither negligent in performing its duties nor has humiliated the complainants. Therefore, the complaint against the respondent may be dismissed.
5. Learned counsel for the complainants tendered affidavit Ex.CW-1 and documents Ex.C-1 to Ex. C-13 and closed his evidence on 11.01.2024. On the other hand, learned counsel for the opposite party no.1 tendered affidavit Ex. RW 1/A and documents Ex. R1/1 to Ex. R1/11in his evidence and closed the same on dated 07.03.2024. Similarly counsel for the opposite party no.3 has tendered affidavit RW3/A and documents Ex. R3/1 to Ex. R3/11 in his evidence and closed the same on 20.02.2024.
6. We have heard the arguments of learned counsels for both the parties, perused the documents placed on record and have gone through material aspects of the case very carefully.
7. We have perused the documents placed on record by both the parties. Initially the case title Jagbir Singh Vs. HDFC General Insurance Co. was filed by the life assured Sh. Jagbir Singh before the Permanent LokAdalatunder the coverage of Major Medical Illness amounting to Rs.1856359/-. The life assured Jagbir Singh had died on 21.12.2017. Thereafter, during the pendency of alleged complaint filed before the Permanent LokAdalat, the death claim has been filed by the legal heirs of the deceased on 03.08.2018 before this Commission. The alleged case filed before the Permanent LokAdalat has been dismissed by the Chairman, Permanent LokAdalat on dated 06.11.2019 on the ground that: “the deceased tried to suppress the material facts with an intention to grab the insurance cover by suppressing the facts of pre-existing diseases by the petitioner, while filing up the proposal form, which was very well within his knowledge.” Now the death claim has been filed by the L.Rs of the deceased. We have perused the terms and conditions of the policy attached with the letter placed on record as Ex.R1/2. The definition of ‘Accident’ is mentioned in condition no.1 under the head General definitions, which is as under: “Accident means an unexpected, unforeseen and undesirable event, especially one resulting in an injury or death”. We have also perused the ‘Exclusion Clause’ mentioned under Section 4(6) as per which the company shall not be liable under this section for:- “Payment of compensation in respect of death or Permanent Total Disablement arising from or resulting directly or indirectly from any illness to any insured”. As per Claim Form Ex.R1/3, the life assured JagbirSingh had died due to ‘heart failure”. Hence his death is not covered under the policy. Moreover, as per the documents Ex.R1/8 to Ex.R1/10, the claim No.C291817001287 was filed for ‘Major Medical Illness’. Meaning thereby, the death claim was not registered by the complainants. Complainants have also pleaded that claim has been registered under the death claim but they have failed to prove the same. As per policy, the accidental death is covered but the death due to illness is not covered. As such, there is no deficiency in service on the part of opposite party and the present complaint stands dismissed with no order as to costs.
8. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
05.12.2024.
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Nagender Singh Kadian, President
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TriptiPannu, Member.
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Vijender Singh, Member
