DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

PATIALA.

                                      Consumer Complaint No. 376 of 9.9.2016

                                      Decided on:   13.9.2019

1.       Vishali Sharma @ Vishali Bhardwaj, aged about 33 years, widow of late Sh.Sunil Kumar S/o Sat Parkash.

2.       Mitali Bhardwaj aged about 13 years , minor daughter of Sh.Sunil Kumar S/o Sh.Sat Parkash

3.       Harsh Bhardwaj aged about 8 years, minor son of Sh.Sunil Kumar, both minors through their mother and natural guardian Vishali Sharma widow of late Sh.Sunil Kumar, all residents of Flat No.306-A, Garden Heights, Tower-A, Rajpura Sirhind Bye-pass Road, Patiala.

                                                                   …………...Complainants

                                      Versus

HDFC ERGO Insurance Company Limited, SCO No.11, Ist Floor, Chhoti Baradari, Patiala through its Branch Manager.

                                                                   …………Opposite Party

                                      Complaint under Section 12 of the

                                      Consumer Protection Act, 1986.

QUORUM

                                      Sh. M.P.Singh Pahwa, President

                                      Smt. Inderjeet Kaur,    Member

                                      Sh.B.S.Dhaliwal,         Member

ARGUED BY                                 

                                       Sh.Sanjeev Garg, Advocate, counsel for the complainant.

                                      Sh.Dhiraj Puri,Advocate, counsel for OP.                    

 ORDER

                                    SH. M.P.SINGH PAHWA,PRESIDENT

1. This is the complaint filed by Vishali Sharma @ Vishali Bhardwaj and others (hereinafter referred to as the complainants) against HDFC ERGO Insurance Company Ltd. (hereinafter referred to as the OP).
2. Briefly the case of the complainant is that Sunil Kumar, since deceased has purchased flat No.306-A, situated at Garden Heights, Patiala after obtaining loan from HDFC ERGO Insurance Company Limited, in the year 2012. As per requirements of HDFC Bank, insurance policy namely Home Suraksha Plus has been purchased from the OP in the name of Sunil Kumar bearing No.2918200284480000. Premium of Rs.54,218/-  was paid by Sunil Kumar through HDFC bank.The policy is valid for 27.6.2012 to 26.6.2017.Vide this policy Sunil Kumar, loan amount and flat was duly covered and  insured for Rs.17,05,126/-.
3. It is alleged that the terms and conditions of the policy were not supplied with the insurance policy. Complainant Vishali Sharma is widow and complainants Mitali Bhardwaj and Harsh Bhardwah are children of Sunil Kumar. Sat Parkash son of Amar Nath is father and Usha Kiran is mother of deceased Sunil Kumar.
4. On 27.2.2016, Sunil Kumar has seen the movie in night with family and taken dinner in the house of his in-laws on 28.2.2016. He has taken  medicine in the morning and went to the shop at about 10AM and came back at 10:45PM. Thereafter he was feeling uneasiness  with lot of sweat. He was trying to vomit. Thereafter he was admitted in Columbia Asia Hospital, Patiala on 28.2.2016. He died on 29.2.2016 at about 2:00AM in the hospital during treatment for critical illness. The family members  of Sunil Kumar has disclosed to the doctor that Sunil Kumar had wrongly , mistakenly, inadvertently and un knowingly consumed some wrong/poisonous medicine in the morning.
5. The matter was reported to the police.Police investigated the matter.As per police report Sunil Kumar died on 29.2.2016 naturally and suddenly as he took wrong medicine by mistake and nobody was at fault.
6. It is pleaded that the loan amount and Sunil Kumar were covered under the policy of Rs.17,05,126/-. The claim was lodged with the OP on 22.3.2016.OP registered the claim vide claim No.C291815001681.They required some documents vide letter dated 22.3.2016 and thereafter vide letters dated 28.3.2016 and 20.4.2016 all the documents were supplied to the OP on 13.4.2016, 30.4.2016 and 7.6.2016. Complainant completed all the formalities and submitted all the documents as desired by the OPs. Thereafter the complainant and father of the deceased many times approached and contacted OP and requested to settle and pay the claim regarding death of Sunil Kumar .The OP assured that the claim will be  passed at the earliest. The complainant also submitted succession certificate as demanded by the OP. Even then the claim has not been passed.
7. It is further mentioned that on 20.6.2016 father of the deceased Sunil Kumar contacted the OP to know about the status of the claim and OP said that chemical viscera report of the deceased is awated. As such the OP is delaying the matter on one pretext or the other.
8. It is also alleged that the OP arbitrarily, illegally and without any reason are not settling the claim, which amounts to deficiency in service. The complainants are suffering from mental agony, harassment. For these sufferings they have also claimed compensation of Rs.55000/-, Rs.21000/-costs of the litigation , Rs.60,000/- spent for obtaining succession certificate, Rs.11000/- counsel fee total claim is Rs.18,52,126 with interest @12% per annum. Hence this complaint.
9. Upon notice, OP appeared through counsel and contested the claim by filing written reply. In reply the OP raised preliminary objections that this Forum has no pecuniary jurisdiction to entertain the complaint.The complainants have claimed relief of Rs.18,52,216/- with interest @12% per annum. The relief claimed is more than Rs.20 lac.As such the complaint is not maintainable. The complaint is false, frivolous, vague and vexatious. It has been filed to injure the interest and reputation of the OP. The complainant has failed to supply chemical viscera report of Sunil Kumar despite repeated requests and letter dated 7.6.2016.Therefore, the complaint is liable to be dismissed. Complainant has not come to the Court with clean hands. As per death summary as well as medical certificate of cause of death dated 29.2.2016 issued by the Columbia Asia Hospital, Patiala, admission diagnose, cause of death ,  and brief clinical report, it is duly proved from death summary that Sunil Kumar consumed celphos and committed suicide but the complainants in order to get undue benefit have shown accidental death. That complicated question of facts are involved in the complaint, which is not possible in summary proceedings. Only the Civil Courts have the jurisdiction to try and decide the complaint; that death on account suicide is not covered as per terms and conditions of the policy. Therefore, the complaint is not maintainable and the OP is entitled to special costs of Rs.25000/- for unnecessary dragging it to uncalled for litigation.
10. On merits, the issuance of the policy is stated to be matter of record. However, it is admitted that the policy was issued for the period 27.6.2012 to 26.6.2017 but subject to its terms and conditions. All the other averments of the complainants are denied. In the end OP reiterated his stand as taken in to preliminary objection and prayed for dismissal of the complaint.
11. In support of their case, the ld. counsel for the complainant has tendered into evidence affidavit of the complainant, Ex.CA, affidavit of Satparkash, Ex.CB, affidavit of Arun Kumar, Ex.CC, affidavit of Vishali Sharma, Ex.CD, alongwith documents, Ex.C1 copy of insurance policy ( pages 1-7),Ex.C2 copy of letter dated 23.3.2016, Ex.C3 copy of death certificate, Ex.C4 copy of affidavit of Vishali Sharma, Ex.C5 copy of ID card, Ex.C6 copy of letter dated 28.3.2016, Ex.C7 copy of receipt dated 13.4.2016, Ex.C8 copy of FIR, Ex.C9 copy of preliminary(PMR), Ex.C10, copy of PMR, Ex.C11 copy of death summary, Ex.C12, copy of  registered letter, Ex.C13  copy of medical certificate, Ex.C14 and Ex.C15, copies of letter dated 20.4.2016 and receipt dated 30.4.2016, Exs.C16 & C17, letter dated 7.6.2016 and receipt dated 7.6.2016,Ex.C18 copy of succession certificate, Exs.19 and C20 letter dated 20.6.2016 and receipt dated 20.6.2016, Ex.C21 legal notice, Ex.C22 receipt dated 12.8.2016, Ex.C23 original letter dated 16.9.2016, Ex.C24 copy of application under RTI, Ex.C25 copy of postal order, Ex.C26 receipt of application, Exs.C27 and C28, copies of messages from India First life  Insurance company,Exs.C29 to C34, payment made by LIC, Ex.C35 statement of loan account, Ex.C36 death report.
12. The ld. counsel for the OP tendered into evidence Ex.OPA, affidavit of Pankaj, Legal Manager, Ex.OP1 medical certificate, Ex.OP2 death summary, Ex.OP3 letter dated 27.6.2012, Ex.OP4 policy, Ex.OP5 prospectus.
13. We have heard the ld. counsel for the parties. They have reiterated their stand as taken in their respective pleadings. We have given careful consideration to their rival submissions.
14. The admitted facts are that Sunil Kumar availed housing loan from the OP.  Sunil Kumar has died. The complainant submitted the claim on the basis of the policy. The OP has so far neither settled the claim nor denied the claim .In paragraph 15 of complaint, the complainants  have pleaded  the OP has told that the chemical viscera report of the deceased is awaited. In written version, the OP has also pleaded that the complainant failed to supply the chemical viscera report of Sunil Kumar despite repeated requests and letter dated 7.6.2016.Therefore, it is proved that the OP required  chemical viscera report from the complainants and the complainants have not submitted the same. There is also nothing on record to prove that the complainants  are in possession of the viscera report if any.
15. In these circumstances, the OP is directed to settle the claim within 30 days from the date of the receipt of the certified copy of this order. The OP is at liberty to obtain the viscera report from the concerned authorities and if the same is not received, the claim  be decided  on the basis of other documents/material produced by the complainant and collected by the OP. Parties are left to bear their own costs. The complaint is disposed off accordingly.
16.           Certified copy of this order be sent to the parties free of cost under the rules. Thereafter, file be indexed and consigned to the Record Room.

ANNOUNCED

DATED:13.9.2019        `       

 B.S.Dhaliwal                         Inderjeet Kaur              M. P. Singh Pahwa

       Member                                 Member                                      President