BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.317 of 2022
Date of Instt. 29.08.2022
Date of Decision: 14.11.2023
Harjeet Kaur aged about 45 years wife of Gurjinder Singh, resident of House No.449-A, PAP Complex, Near Gate No.5, Jalandhar.
..........Complainant
Versus
1. HDFC Limited having its office at Unit 5, Link Road, Near Guru Amar Dass Chowk, Abadpura, Model House, Jalandhar.
2. HDFC Life Insurance Company Limited having its Registered Office at 13th Floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai400011.
3. HDFC Limited, SCO #11, Green Park Avenue, Canal Colony, Near Nehru Sidhant Kendra, Pakhowal, Ludhiana.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Sh. Jaswant Singh Dhillon (Member)
Present: Sh. Vivek Handa, Adv. Counsel for complainant.
Sh. Akhil Chopra, Adv. Counsel for OPs No.1 & 3.
Sh. A. K. Gandhi, Adv. Counsel for OP No.2.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the complainant is the wife of deceased Gurjinder Singh who was serving as Head Constable in Department of Punjab Police. The deceased Gurjinder Singh prior to his death availed a loan facility from HDFC Housing Development Finance Corporation Limited. An amount of Rs.28,00,000/- was sanctioned to the deceased Gurjinder Singh. So, the OPs are the service provider and the complainant who stepped into the shoes of her deceased husband is the consumer. At the time of sanctioning of the loan, the complainant stood Deceased Gurjinder also availed/purchased insurance facility to cover the risk of non-payment of loan amount in case of any exigency or death from OPs. Total sum insured is Rs.32,77,058/-. In the month of April 2021, deceased Gurjinder Singh suffered from Covid-19 and he was admitted to Joshi Super Specialty & Multispecialty Hospital, Kapurthala Road, Jalandhar. Ultimately, on 28-04-2021 he could not survived and breathed his last. After the death of her husband the complainant applied for claim of insurance amount of Rs.32,77,058/-, but the OPs illegally rejected the claim bearing No.PC 188854 of the complainant which clearly amounts to unfair trade practices and clear cut deficiency in service rendered by the OPs. Instead of acceding to the genuine request of the complainant, the OP No.3 issued a false and frivolous legal notice dated 07-07-2022 based on wrong facts and false information supplied to the counsel Sh. Hari Om Jindal. The OPs in collusion with each other illegally deducted the amount of insurance premium from the loan account bearing No. 661442956. It is important to mention here that there are two separate accounts of the deceased husband of the complainant i.e. the one regarding loan account bearing No.661442956 and other is regarding account bearing No.662305800 pertaining to the insurance availed by the deceased husband of the complainant in order to cover the risk of the repayment of the loan amount. After the date of her husband the complainant has been regularly making the EMIs pertaining to the loan account bearing No.661442956. Nothing is due to be paid into this account by his client. Moreover, as the complainant's husband availed the insurance policy in order to cover the risk in case of any exigency regarding a separate installments were being paid and due to the death of her husband on account of infection from Covid-19 the complainant is absolutely not liable to pay any EMIs regarding the loan amount and of course regarding installment of any premium. The amount has been deducted from the loan account of the deceased husband of the complainant is patently illegal and constitutes an act of fraud, unfair trade practices and ultimately malpractices as well as deficiency in services. The legal notice dated 07-07-2022 issued by OP No.3 through his counsel Sh. Hari Om Jindal. The complaint moved by the complainant to the Commissioner of Police, Jalandhar for the commission of offence of cheating and illegally deducting the amount from the loan amount by the OPs. Despite availing the insurance facility the complainant is being harassed by the OPs by rejecting the claim of the complainant without reason. The documents on record clearly reflects that deceased Gurjinder Singh was the Covid-19 patient and he died due to the Covid-19 only, but the OPs hushed up the matter simply stating that there was none disclosure of health problems by the deceased Gurjinder Singh at the time policy of issuance of the insurance policy. The complainant suffered mental and physical harassment and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to release the claim of Rs.32,77,058/- i.e. the insured amount and Rs.25,000/- as litigation expenses and Rs.2,00,000/- on account of the mental agony suffered by the complainant.
2. Notice of the complaint was given to the OPs and accordingly, OPs No.1 & 3 appeared through its counsel and filed written reply, whereby contested the complaint by taking preliminary objections that the present complaint is not maintainable, hence the same is liable to be dismissed. It is further averred that in the instant complaint, the grievance of the complainant is directed against OP No.2 i.e. the insurance company who has allegedly repudiated claim of the complainant. The answering OPs have been wrongly impleaded as OPs in the present complaint, hence the complaint is liable to be dismissed for mis-joinder of OP no.1 & 3. It is further averred that the complainant has filed the present complaint against the answering OPs with the sole & malafide objective of not repaying the amount due & outstanding in the loan account. It is further averred that the OPs No.1 & 3 i.e. HDFC Limited is an independent, distinct & separate legal entity & body, having no link, control & concern over the affairs and business operations of O.P No.2 i.e. HDFC Life Insurance Co. Ltd. The OPs No.1 & 3 are engaged in the business of providing housing loans. It is submitted that the husband of the complainant has availed housing loan from OP No.1 & 3 which is repayable in EMIs, as per the terms and conditions of the sanction letter and loan agreement. The husband of the complainant has also availed financial assistance from the answering OPs in respect to the amount of premium of insurance policy. The right of the answering OPs to recover the loan amount as per the agreed terms between the parties, is independent of any other agreement entered into by the complainant and the OP No.2. It is again reiterated that the OPs No. 1 & 3 i.e. HDFC Limited is an independent & separate legal entity & body, having no link, control & concern over the affairs and business operations of O.P No.2 i.e. HDFC Life Insurance Co. Ltd. It is further averred that the answering OPs have no link or concern with the alleged repudiation/denial of insurance claim by the OP No.2. If the complainant is aggrieved with regard to the alleged repudiation of insurance claim, then she can approach the OP No.2. The answering OPs have no privity of contract of insurance between the husband of the complainant and OP No.2. It is submitted that the answering OPs have simply granted the loan facility to the husband of the complainant and he has purchased the insurance policy out of his own free will and as per his convenience. The answering OPs has nothing to do with the said policy, being separate legal entity and having no link, concern and control over the business affairs of the OP No.2. On merits, it is admitted that the answering OPs are engaged in the business of providing housing loans and the husband of the complainant has availed housing loan from the answering OPs, which is repayable in EMIs and the husband of the complainant has also availed financial assistance from the answering OPs, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
3. The OP No.2 filed its separate written reply and contested the complaint by taking preliminary objections that the present Complaint is false, vexatious and has been filed with a malafide intention to harass the OP No.2 by misusing the process of law and to avail undue advantages. It is an attempt to waste the precious time of this Commission as no cause of action has been arose against the answering OPs and in favour of the Complainant, hence this complaint is liable to be dismissed. It is further averred that the complaint is not maintainable against the OP No.2 and the same is liable to be dismissed. The OP No.2 have rightly Repudiated the claim of Late Gurjinder Singh vide Letter Dated 22-10-2021 as the present case is a clear cut case of concealment of material facts and Misrepresentation. As per the investigation, the deceased Gurjinder Singh was suffering from Chronic sick & Bedridden CKD prior to the inception of the Insurance policy in question and the same was not disclosed at the time of the execution of the insurance contact by the Deceased. So the present case is a clear cut case of concealment of material facts and the violation of the terms and conditions of the insurance policy in question. In the present case the deceased was suffering from the Chronic sick & Bedridden CKD at the time of the execution of insurance Contract in question and the same was concealed by the deceased from the answering OP No.2 in subtle violation of the terms and conditions of the insurance policy in question. So the present Complaint is liable to be dismissed for suppression of the material facts from the answering OP as well as in light of the violations of the terms and condition of the Insurance policy in question. It is further averred that the Complainant have not come before the Court with clean hands. It was within the knowledge of the deceased that he was suffering from Chronic sick & Bedridden CKD at the time of the execution of the insurance contact, but he concealed the same from the answering opposite party at the time of the execution of the insurance Contract in question. So the legal heir's of the deceased are not entitled for any claim from the answering OP. Thus, the present complaint is liable to be dismissed forthwith on the grounds of being malafide, baseless and lacking in a bonafide cause of action. It is further averred that the Complainant is estopped by her own acts and conducts from filing the present Complaint. It is within the knowledge of the complainant that the deceased was suffering from Chronic sick & Bedridden CKD and the same was not disclosed at the time of the execution of the insurance contact by the Deceased insured. So, the present Complaint is liable to be dismissed. On merits, it is admitted that the deceased Gurjinder Singh availed loan facility prior to his death and purchased insurance policy of the OP No.2. It is also admitted that after the death of the husband of the complainant, the complainant applied for the claim and the same was repudiated, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
4. Rejoinder not filed by the complainant.
5. The parties have led evidence in support of their respective versions by way of affidavits and documents.
6. We have heard the learned counsel for the parties, carefully gone through the complaint, written version of the complainant as well as OP No.2 and evidence and documents brought on the record by the parties.
7. It has been admitted by the OPs No.1 and 3 that the deceased Gurjinder Singh availed the housing loan facility from the OPs No.1 and 3 and the loan of Rs.28,00,000/- was sanctioned to Gurjinder Singh. The documents have been proved by the complainant regarding loan Ex.C-4 to Ex.C-6/OP No.1/1 to Ex.OP1/4. It is also not disputed that the complainant, the wife of the deceased Gurjinder Singh stood as Guarantor at the time of taking loan. The complainant has proved on record that the deceased Gurjinder Singh purchased insurance facility to cover the risk of non-payment of loan and insurance certificate has been proved as Ex.C-7 and copy of member enrollment form Ex.C-8. The complainant has alleged that in the month of April 2021, deceased Gurjinder Singh suffered from Covid-19 and he was admitted to Joshi Super Speciality Hospital and on 28.04.2021, he passed away. The death certificate of the deceased has been proved as Ex.C-9, death summary Ex.C-10 and medical documents Ex.C-11 and Ex.C-12, copy of the list of the police personnel, who expired due to Covid-19 Ex.C-13. The complainant has further alleged that the complainant, after the death of Gurjinder Singh applied for claim of insurance amount of Rs.32,77,051/-, but the claim was wrongly repudiated by the OPs vide Ex.C-14.
8. The OP No.2 has alleged that the claim has rightly been repudiated as the deceased has concealed the material facts and has mis-represented the OPs. As per the investigation, the deceased was suffering from Chronic sick and Bedridden CKD prior to the inception of the insurance policy in question and the same was not disclosed at the time of execution of the insurance contract by the deceased. He has referred the investigation done by the representatives of OPs and the medical record of the DMC dated 06.03.2020, discharge summary when he was admitted in the hospital for CKD, prescriptions given by the doctor. All these documents are part of Ex.OP2/4. He has also referred the investigation report Ex.OP2/6 on the basis of which the claim was repudiated.
9. Now the point to be considered is whether the complainant was suffering from any diseased which was chronic disease and was the cause of death and that disease was never disclosed to the OPs at the time of inception of the policy. The medical record relied upon by the OP show that the complainant was suffering from CAD since 2017 and he was admitted in DMC due to hypertension and CKD. There was a Renal Biopsy of the husband of the complainant. Medicines were prescribed to the husband of the complainant as per prescription relied upon by the OPs. As per the report of the investigation Ex.OP2/6, the investigation says that Gurjinder Singh died in Joshi Kidney Hospital in Jalandhar on 28.04.2021 due to Covid-19 as well as his Chronic Illness. As per Ex.C-14, the repudiation letter, the OPs have repudiated the claim as the investigation of the OPs have established that life assured was suffering from Chronic Sick and Bedridden CKD patient report prior to issuance of policy.
10. The contention of the OP that the pre-existing disease has not been disclosed by the complainant is not tenable as as per their own letter, Ex.C-14 the complainant was suffering from Chronic Sick and Bedridden CKD patient. Once he was bedridden CKD patient, how the OPs have given him the insurance policy and insured his life as per Ex.C-7. There is no reference of the fact as argued that prior to taking the policy, he was bedridden, but thereafter he got recovered. Even if, this fact is assumed, then there should be nexus between the cause of death and the prior disease. As per the Death Summary Ex.C-10, the cause of death of Gurjinder Singh is Covid-19 infection involving both lungs and Cytokine storm because of Covid-19 infection. As per Ex.C-13, deceased Gurjinder Singh who was the employee of Punjab Police has died of Covid-19. Even the document relied upon by the OP Ex.OP2/5 shows that the deceased Gurjinder Singh was admitted in Joshi Hospital and he was suspected Covid-19 and was getting the treatment in Covid ward of the hospital. Even the report of investigation Ex.OP2/6 says that he was admitted due to Covid-19. Though, the Investigator has referred that he was admitted due to Chronic Illness also, but there is no such document of Joshi Hospital or any other hospital to show that the deceased was admitted because of Covid-19 as well as Chronic Illness. We are supported by the law laid down by the Hon’ble National Consumer Disputes Redressal Commission, New Delhi, in III (2021) CPJ 66 (NC), case titled as ‘PNB Metlife India Insurance Company Ltd. Vs. Godavariben Kalubhai Vaghela’ that ‘Insured had suffered a heart attack and he died - Complainant being nominee, claimed amount under the policy, which was denied by the petitioner on ground that insured had concealed material fact at the time of buying policy- Insured was not suffering from any heart ailment when he filled up proposal form- only defence taken is that insured had underwent treatment for T. B. and this fact was concealed – insured had died after about six months of buying the policy – Concealment of fact regarding treatment of T. B., if any, cannot be termed as concealment of material fact – There is no nexus between concealment of alleged fact and cause of death.’ It has been held by the Union Territory Consumer Disputes Redressal Commission, Chandigarh, in (2006) CPJ 270, case titled as ‘Life Insurance Corporation of India & Ors. Vs. Shiv Singh’ that ‘insured got examined from insurance doctor, found healthy – Deceased allegedly suffered from chronic obstructive pulmonary disease and chronic asthma – No nexus between cause of death and alleged ailment of deceased – Fraudulent suppression of material facts not proved- insurer liable.’
So, in view of the above referred law and considering the facts of the case, we are of the opinion that the claim of the complainant has been wrongly and illegally repudiated by the OPs and the same is hereby set-aside and further, find that the complainant is entitled for the relief as claimed.
11. In view of the above detailed discussion, the complaint of the complainant is partly allowed qua OP No.2 and dismissed qua OPs No.1 & 3. The OP No.2 is directed to pay the insurance claim to the complainant and the LRs of deceased Gurjinder Singh, if any, to the tune of Rs.32,77,058/- alongwith interest @ 6% per annum from the date of filing the claim till its realization. Further, OP No.2 is directed to pay a compensation of Rs.15,000/- for causing mental tension and harassment to the complainant and Rs.5000/- as litigation expenses. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
12. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Dr. Harveen Bhardwaj
14.11.2023 Member President
