Haryana

Ambala

CC/370/2017

Balwant Singh - Complainant(s)

Versus

HDFC Life Inss Co Ltd - Opp.Party(s)

Nirmaljit Singh

23 Jul 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

 

                                                                      Complaint case No.:  370 of 2017.

                                                          Date of Institution         :   02.11.2017.

                                                          Date of decision    :   23.07.2019.

 

Balwant Singh aged about 48 years, s/o late Shri Gurdev Singh, r/o 105, The Mall Road, Ambala Cantt.

……. Complainant.

                                                Versus

 

1. HDFC Standard Life Insurance Co. Ltd. (HDFC Life) Lodha Excelus, 13^th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai-400011.
2. HDFC Bank Ltd., through its Branch Manager, Nichleson Road, Near Geeta Gopal Chowk, Ambala Cantt, Haryana.

     ….…. Opposite Parties.

 

Before:        Smt. Neena Sandhu, President.

                   Smt. Ruby Sharma, Member.

Shri Vinod Kumar Sharma, Member.                 

                            

Present:       Shri N.S. Cheedha, Advocate, counsel for complainant.

Shri Rajiv Sachdeva, Advocate, counsel for the OP No.1.

Shri Kulwinder Chawla, Advocate, counsel for the OP No.2.

 

Order:        Smt. Neena Sandhu, President

Complainant has filed this complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

1. To release the due amount which this Hon’ble Forum deems appropriate in favour of the complainant.
2. To pay Rs.20,000/- as compensation for the mental agony and physical harassment suffered by the him.
3. To pay Rs.5,000/- as litigation charges.

 

                   Brief facts of the case are that in the year 2014, the complainant had taken the loan of Rs.2 lacs from the OP No.2. At the time of sanctioning the loan, he was insured under Group Insurance Policy bearing No.CP000003 with Member Code 28320164 for a sum of Rs.2 lacs by OP No.2 with the representations that in case of either death of the complainant or critical illness, as mentioned in the schedule of the policy, the policy holder/nominee will be ceased to pay further instalments and the due amount of loan sanctioned by the OP No.2, will be deducted by the OP No.2 from the claim amount being a Master Policy Holder. The rest of the amount, if any, will be paid to the complainant being a claimant or his nominee, in case of his death. The said policy is a single premium one and the premium was deducted at the time of giving the loan amount from the complainant. The duration of loan amount and insurance policy was 48 months. The loan amount was sanctioned on 26.05.2014 and its EMI was started from 04.07.2014 to 04.06.2018 and the policy was started from 02.06.2014 upto 01.06.2018. Till December 2016, the payment of loan by installments were made by him to the OP No.2 continuously, but in January 2017, he suffered with heart attack, brain haemorrhage and paralyse from the right side of his body. He diagnosed and treated at M.M. Institute of Medical Sciences and Research, M.M. Superspeciality Hospital, Mullana, Ambala, Haryana. The record of treatment, discharge cards and bank statement are being annexed with the complaint as Annexure B and annexure C. His wife namely Nirmaljit Kaur, being nominee, informed the OPs within the stipulated period through emails and in response to that, the OPs informed his wife through email to submit the documents i.e. medical treatment papers, his one cross cheque, copy of bank passbook alongwith claim form approved from the Master Policy Holder i.e. OP No.2. His wife had sent the documents i.e. insurance policy, through speed post on 17.05.2017 to the OP No.2 at their main head office at Mumbai. After 2-3 months when OP No.1 did not make any reply to the complainant, his wife made a reminder to the OPs through emails dated 29.08.2017 & 06.09.2017, but till today, the OPs did not pay the claim of insurance policy. The complainant is a sole bread earner of his family includes his wife and two school going children. Due to this critical illness of paralyse, he is unable to carry on his business of BDS doctor. By not paying the claim amount, the OPs have committed deficiency in service. Hence, the present complaint.

2.                 Upon notice, OPs No.1 & 2 appeared through counsel and filed their respective separate written version.

                   In the written version, the OP No.1 raised preliminary objections regarding maintainability; jurisdiction and concealment of true & material facts. On merits, it is stated that the Life Assured Balwant Singh was insured by OP No.2 with OP No.1 under Group Insurance Policy No.CP000003 having Member Code 28320164, after paying a premium of Rs.3434/-. The said policy contained Clause No.15 with respect to Optional Benefits (if chosen) for accelerated critical illness, which reads as under:-

          Clause No.15:

1. the sum assured payable on member being diagnosed any of the specified critical illness during the term of the optional accelerated illness benefit (being the term of membership or five years as chosen at the inception by the member) is as specified in the “schedule of benefits” shown in appendix A. Refer to appendix B for exclusions, terms & conditions.
2. Accidental death: the additional sum assured payable on death of the member due to accident during the term of the membership is as specified in “schedule of benefits” shown in appendix A. Refer to appendix B for exclusion, terms & conditions.

                   That as per the policy of the complainant, the said optional benefit was not chosen/opted by the complainant, as such, no amount is payable to the complainant for any critical illness suffered by him. The present complaint has only been filed with the ulterior motive just to harass and humiliate the OP No.1 and the same deserves to be dismissed with special costs. On merits, rest of the allegations levelled by the complainant were denied for lack of knowledge and prayer has been made for dismissal of the present complaint.

                   In the written version, the OP No.2 raised preliminary objections regarding maintainability; jurisdiction and cause of action. On merits, it is stated that the complainant had taken the loan of Rs.2,00,000/- from the OP. It is incorrect that the OP No.2 had issued any insurance policy for the period from 04.07.2014 to 04.06.2018 or received any premium for the said insurance policy as alleged in Para No.2. The complainant had not regularized the loan account and had violated the terms & conditions of the loan account, therefore, he is not entitled for the benefits of insurance policy as alleged. The complainant is not entitled to the benefits of the Group Insurance Policy. It is incorrect that the complainant through his wife requested to settle the claim of insurance policy. It is correct that the OP is compelling the complainant to clear the loan amount to avoid any litigation, but he instead of clearing the loan amount, has preferred the present complaint just to escape his liability. The OP No.2 is not liable to settle the insurance claim of the complainant, rather is entitled to recover the dues from the complainant by legal channel etc. No contract of insurance was executed by the complainant with the OPs.

                    On 05.06.2018, when the case was fixed for evidence of the complainant, at that stage, the ld. counsel for the complainant moved an application for summoning the medical record of the complainant and the said application was allowed on that date. Accordingly, Mamta Sharma, Record Keeper, MM Institute, Mullana was examined as CW1. Thereafter, ld. counsel for the complainant also moved an application for issuing the summon to bring the record of original file of insurance policy. Reply to that application was also filed by the OP No.1. Vide order dated 23.01.2019, the said application was allowed with the direction to counsel for the OP No.1 to place on record the original file of insurance policy, but the OP No.1 failed to produce the same despite availing several opportunities.

3.                The ld. counsel for the complainant tendered affidavit of the complainant as Annexure CA alongwith documents as Annexure C-1 to C-4 and closed the evidence on behalf of complainant. On the other hand, learned counsel for OP No.1 tendered affidavit of Shri Arpit Higgins, Executive Legal, HDFC Standard Life Insurance Co.  Ltd., Chandigarh, as Annexure RX alongwith documents Annexure R1 to R10 and closed the evidence on behalf of OP No.1. However, the ld. counsel for the OP No.2 has made a statement that written version filed by OP No.2, may be read as its evidence.

4.                We have heard the learned counsel of the parties and carefully gone through the case file and also the written arguments filed by the learned counsel for the complainant.

5.                 The learned counsel for the complainant has argued that the complainant had taken a loan of Rs.2 lacs from the OP No.2 in the year 2014. At the time of sanctioning the loan, the OP No.2 made the complainant member of a Group Insurance policy, issued in favour of OP No.2, by the OP No.1. As per the said policy, in the case of death or critical illness, the complainant being the member of the said policy, was entitled for sum assured of Rs.2,00,000/- and the policy holder/nominee would be ceased to pay further instalments and the due amount of loan sanctioned by OP No.2, would be deducted by it, from the claim amount given by the OP No.1, and the rest of the amount, if any, would be paid to the complainant (insured), in case of his death, to his nominee. The policy in question was a single premium policy and the premium was deducted at the time of giving the loan. Till December, 2016, the complainant paid the loan instalments regularly. However, in the month of January 2017, he suffered from heart attack, paralysis and brain haemorrhage. Meaning thereby, he was suffering from ‘critical illness’. The wife of the complainant (insured), being nominee, informed the OPs about the condition of her husband and also submitted all the requisite documents alongwith duly approved claim form by the master policy holder i.e. OP No.2. However, the OP No.1, neither paid the loan installments to the OP No.2 nor paid the claim amount to the complainant. The said act of OPs amounts to deficiency in services.

6.                On the contrary, the learned counsel for OP No.1 has argued that the complainant was insured with the OP No.1, through OP No.2. However, no amount for ‘critical illness’ was payable, as the said optional benefit was not opted by the complainant, at the time of taking the policy in question. The complaint filed by the complainant is devoid of merits and deserves dismissal against it with costs.

7.                The learned counsel for the OP No.2 has admitted the factum of taking the loan of Rs.2 lacs, by the complainant, from the OP No.2 but has denied about issuance of policy in question by it. He has contended that the complainant was not paying the loan installments regularly and has violated the terms & conditions of loan agreement, therefore, he is not entitled for the benefits of the policy in question and prayed that the present complaint against it, may be dismissed with costs.   

8.                From the perusal of Member’s Certificate of Insurance (Annexure C-1/R-1), it is evident that the complainant was duly insured with the OP No.1 under Group Insurance Policy for the period from 02.06.2014 to 01.06.2018. From the medical record Annexure CW1/A, CW1/B, it is evident that the complainant took the treatment from M.M. Institute of Medical Sciences and Research, M.M. Superspeciality Hospital, Mullana, Ambala, Haryana, during the subsistence of the policy in question. On perusal of Loan Application Form (Annexure R-10), it is evident that complainant had preferred to take loan of Rs.2 lacs under the head ‘Self Employed Professional’ from the OP No.2. In the statement of account pertaining the period from 21.05.2014 to 24.10.2017 (Annexure C2), it is clearly mentioned that complainant had taken self-employed professional loan from the OP No.2. In the Member Information Form Annexure R-10, it is categorically mentioned that “Optional Benefits (Only for home loan borrower)”, “Accelerated Critical Illness Benefit (ACI)”, “Accidental Death Benefit (ADB)”, are not applicable. The said Application Form has duly been signed by the complainant. As per Member Information Form Annexure R-10, the complainant is not entitled to get ‘Optional Benefits’. In this view of matter, the OPs cannot be said to be deficient in rendering services to the complainant. The complaint filed by the complainant, is liable to be dismissed, being devoid of merits.

9.                In view of the aforesaid discussion, we hereby dismiss the present complaint being devoid on merit. The parties are left to bear their own cost. Certified copy of this order be supplied to the complainant, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

Announced on :23.07.2019.

 

          (Vinod Kumar Sharma)           (Ruby Sharma)               (Neena Sandhu)

          Member                                   Member                          President