Delhi

New Delhi

CC/457/2015

Jasbir Kaur - Complainant(s)

Versus

HDFC ERGO - Opp.Party(s)

22 Aug 2016

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI),

 ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE,

 NEW DELHI-110001

 

Case No.C.C./457/20145                                Dated:

In the matter of:

JASBIR KAUR

Bharat Properties,

RZQ 93, Nihal Vihar,

New Delhi-110041

 

AGRIEVED PERSON

 

        ……..COMPLAINANT

VERSUS

MANAGER CLAIMS

HDFC ERGO,

No. 14, Ground Floor, Amadeep Building,

Kasturba Gandhi Marg,

Connaught Place,

 NewDelhi-110001.

 

       .... OPPOSITE PARTY

 

PRESIDENT: S.K. SARVARIA

ORDER

 

        Complainant is one of the policy holder of OP Insurance Company vide policy No.5142814 named as “Serv Suraksha Policy”.

        It is alleged by the complainant that she is the widow of late Sh. Satbir Singh who expired in as railway accident on 14/2/15.

        It is alleged by the complainant that as she and her late husband was insured with OP Insurance Company under ‘Serv Suraksha Policy’ covering personal accident for a sum insured of Rs. 10,00,000/- she filed a claim with the OP Ins. Co. but he OP Ins. Co. repudiated the same vide its letter dated 23/4/15 on the false and frivolous grounds.

        Complainant visited several times to the office of OP Ins. Co. to re-consider her claim but all in vain. The complainant therefore approached this District Forum for redressal of her grievance.

        Notice of the complaint was sent to the OP through Regd. AD Post for 31/8/15. Adv. Anuj Chauhan appeared on behalf of OP and filed vakalatnama as well as collected the copy of complaint.   OP has choosen not to contest the case, since none appeared on behalf of OP it was ordered to be proceeded with ex-parte.

        Complainant has filed her evidence by way affidavit wherein she has corroborated the contents of the complaint.

        We  have heard ex-parte arguments advanced at the bar and have persued the record.

        Complainant has placed on record the copies of Insurance Policy, copy of Death Certificate, Copy of the repudiation letter dated 23/4/15, copy of final inquest report in support of her case.

        We have carefully gone through the complaint as well as the annexure filed with it.

        OP Insurance Co. has repudiated the claim of the complainant on the following grounds:

        “ SPECIFIC EXCLUSIONS APPLICABLE TO SECTION 2

Any deliberate or intentional, unlawful or illegal activities with criminal intent, error, or omission of the insured person.

Since the losses claimed under are not covered as per above policy wording, we treat the claim as “No Claim” and close in our records.

The bare perusal of the first inquest report makes it clear that Late Sh. Satbir Singh expired due to injuries sustained in train accident. No where it is mentioned in the FIR that Lt. Mr Satbir Singh expired while he was crossing railway track as alleged by the OP Insurance Company in its repudiation letter dated 23/4/15.

Complainant and her husband was insured with OP Insurance Co. from the last 4 years and were regularly paying the premium vide policy No. 5148154 OP Insurance Company had insured Late Sh. Satbir Singh and his wife under Serv Suraksha Policy for personal accident.  The husband of the complainant expired in railway accident. As per the first request report of OP Insurance Co. ought to have paid the claim to the complainant but it failed to do.

From the un-rebutted testimony of the complainant as well as the documents placed on record, we are of the considered opinion that OP had repudiated the claim for the complainant as on false & frivolous grounds.

          We hold OP guilty of deficiency in service and direct it as under :

1. Pay to the complainant a sum of Rs. 10,00,000/- alongwith 10% interest from the date of filing of complaint.
2. Pay to the complaint a sum of Rs. 5,000/- for pain and mental agony suffered by her which will also include the cost of litigation.

 

The order shall be complied with within 30 days of the receipt of the copy of the order. If the said amount is not paid by the OP within a period of one month from the date of receipt of this order, the same shall be recovered by the complainant along with simple interest at the rate of 10% per annum from the date of this order till recovery of the said amount of Rs. 5000/–. This final order be sent to server (www.confonet.nic.in ). A copy each of this order each be sent to both parties free of cost by post.

 

File be consigned to the record room.

Pronounced in open Forum on                     .

(S K SARVARIA)

PRESIDENT

 

                                                   (H M VYAS)                                    (NIPUR CHANDNA)

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