Chandigarh

DF-II

CC/673/2022

GEETA RANI - Complainant(s)

Versus

INDIABULLS HOUSING FINANCE LTD. - Opp.Party(s)

KAPIL KUMAR GUPTA

03 Jul 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	673/2022
Date of Institution	:	14.09.2022
Date of Decision	:	03.07.2024

 

                                       

 

Geeta Rani widow of late Sh. Sushil Kumar, resident of H.No.1020 A, Preet Colony, Lohgarh, Zirakpur District Mohali Punjab 140603.

...Complainant

VERSUS

1.     Indiabulls Housing Finance Ltd. through its Branch Manager SCO No. 337-338, Sector 35-B, Chandigarh.

2.     ICICI Lombard General Insurance Company Ltd. through its Manager, Registered Office: ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400025

Local address: Plot No. 149, Fourth floor Industrial Area Phase-1, Chandigarh.

3.     Federal Bank through its Branch Manager, Hitpriya Square, Patiala Road, Zirakpur, District S.A.S. Nagar Mohali.

...Opposite Parties

BEFORE:
	SHRI AMRINDER SINGH SIDHU,	PRESIDENT
	SHRI B.M.SHARMA	MEMBER
Present:-
	Sh.Kapil Kumar Gupta, Counsel for the complainant Ms.Niharika Goel, Proxy Counsel for Sh.Paras Money Goyal, Counsel for OP No.1. Sh.Kartik, Proxy Counsel for Sh.Sandeep Suri, Counsel for OP No.2. OP No.3 exparte.

ORDER BY AMRINDER SINGH SIDHU, M.A.(Eng.),LLM,PRESIDENT

1.         The complainant has filed the present complaint pleading therein that she and her husband  namely Sh.Sushil Kumar availed the housing loan of Rs.20.80 lakhs to purchase a built up House No.1020-A, Preet Colony Lohgarh, Zirakpur, District Mohali (Pb.). The said loan was secured by getting the policy in the name of Sh.Sushil Kumar by paying the premium of Rs.80,000/- (which was also included in the disbursed loan amount). The complainant was nominee under the said policy. The OP No.1 assured that in case of any mishap happened to the insured under the policy, in that eventuality the borrower or his/her legal heir will not have to pay the outstanding loan amount to OP No.1 and only OP No.2 will be liable to pay the balance loan amount.  On 06.12.2021, Sh.Sushil Kumar suffered severe chest pain and fell down from the chair and the doctor who was examining the insured stated that he had suffered heart attack and advised to take to Civil Hospital, Dera Bassi where the insured was declared brought dead.  In order to seek a ray of hope, the son of the deceased forcibly took his father from  Civil Hospital, Dera Bassi to Mehar Hospital Singpura, Zirakpur where the doctor also declared him brought dead. Due to affection, the family of the deceased Sh.Sushil Kumar did not get the postmortem done. A copy of the register of the Civil Hospital, Dera Bassi is Annexure C-4. The police registered GD No.16 dated 07.12.2021 in Police Station Dar Bassi (Annexure C-5).  OP No.1 was informed regarding the death of the insured-Sh.Sushil Kumar on 27.12.2021 and the claim was also lodged on the Toll Free Number of OP No.2. However, OP No.2 vide letter dated 25.05.2022 (Annexure C-8) repudiated the claim on the ground that the same falls outside the purview of the Major Medical Illnesses and procedures defined/covered under the policy. The complainant also moved RTI application to seek information from OPs No.1 and 2 but to no effect. It has been alleged that OP No.2 has illegally and arbitrarily rejected the genuine claim. The complainant has filed the instant complaint seeking directions to OP No.1 not to deduct the monthly loan installments from the bank a/c No.19180200000569 and to close the loan account; OP No.2 be directed to pay the outstanding loan amount to OP No.1 and to refund all the installments were paid by the complainant after the death of the insured; to return all original documents of ownership and to pay compensation for mental agony and physical harassment as well as litigation expenses.
2.         In its written version, OP No.1 while admitting the factual matrix regarding the disbursement of the loan towards the purchase of the house and insurance policy has stated that they acts as an intermediary between the customers who are interested in obtaining the insurance cover and the insurance company. The borrowers requested it to include the premium payable towards the insurance policy in the loan amount and accordingly the request for disbursal dated 16.06.2017 was executed by the borrowers and they were not a party to the insurance policy. It has further been stated that since Sh.Sushil Kumar passed away on 06.12.2021 and as such they have right to recover the total outstanding loan amount from the complainant in case of default in making the payments towards the installments towards the loan amount.  The remaining allegations have been denied, being false. Pleading that there is no deficiency in service or unfair trade practice on its part, OP No.1 has prayed for dismissal of the complaint.
3.         In its separate written version, OP No.2-Insurance Company has admitted the factual matrix of the case regarding the issuance of the policy in question to the insured-Sh.Sushil Kumar to secure the loan amount and death of the insured on 06.12.2021. It has further been stated that only specific ailments are covered and not death and the death by accident is covered. It has further been stated that after examining the documents, the claim was rejected vide letter dated 26.01.2022 on the ground that there is no evidence any of the Major Medical illness/procedures defined/covered under the policy. It has further been stated that there is no medical report/tests of the insured having suffered any of the medical ailments has been produced on record to show that the deceased had suffered from any heart ailment or suffered a heart attack.  It has further been stated that the policy of insurance is to be strictly interpreted in terms of the terms and conditions as mentioned therein as the same form the contract between the parties. The remaining allegations have been denied, being false. Pleading that there is no deficiency in service or unfair trade practice on their part, OP No.2 also prayed for dismissal of the complaint qua it.
4.         Despite due service, OP No.3 failed to put in appearance and as a result thereof it was ordered to be proceeded against exparte vide order dated 24.02.2023.
5.         Parties filed their respective affidavits and documents in support of their case.
6.         We have heard the Counsel for the contesting parties and have gone through the documents on record.
7.         The perusal of policy, issued on 27.07.2017 Ex.C-7 proves that the husband of the complainant was duly insured with OP No.2  for sum assured of Rs.19,64,889/-.   It has also not been disputed that the death of the insured has taken place on 06.12.2021 i.e. after more than 4 years of the issuance of the policy.  The complainant has specifically stated in the complaint that the death of the insured took place due to heart attack. On the contrary, the stand of OP No.2 is that the complainant has failed to furnish any medical document to prove that the death of the insured took place due to heart attack because no PMR was conducted on the dead body of the insured.  
8.         In the present case, a young person (insured) who is aged about 43 years died all of sudden and his family members took him to the hospital where the doctors declared him brought dead. Since there was no justification for the family members of the insured for conducting the PMR so the same was not got conducted.  Keeping in view the age of the insured person at the time of his death, it can safely be presumed that the insured must have died either due to cardiac failure or brain stroke. So it is safe to presume that the person died of cardiac arrest i.e. heart failure.   There is no different version of the Insurance Company regarding the death of the insured. The claim of the complainant cannot be declined merely because the PMR was not conducted on the dead body of the insured. Under these circumstances, the repudiation of the claim on the part of OP No.2 is held to be illegal and unjustified.   
9.         The very objective of obtaining an insurance policy is to secure the family of the insured person from future perils. If the insured/deceased who is only bread earner of the family died then the very purpose of obtaining the insurance policy would be frustrated in the event of the Company’s failure to disburse the insured sum to his/her family member/beneficiary.

10.           The Hon’ble Supreme Court of India in case titled as Gurmel Singh Vs. Branch Manager,  National Insurance Company Ltd. in Civil Appeal No.4071 of 2022, decided on 20.05.2022 has held as under:-

        “In many cases, it is found that the insurance companies are refusing the claim on flimsy grounds and/or technical grounds. While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control”.

10.         It is usual with the insurance company to show all types of green pasters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims.

                In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

          “It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.  The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

                The case law settled in the aforesaid judgments is squarely applicable to the case in hand. In view of the above discussion, we have no hesitation in our mind to conclude that OP No.2-Insurance Company has committed deficiency in service by not releasing the genuine claim under the policy.

11.         For the reasons recorded above, the present complaint deserves to be partly allowed and the same is accordingly partly allowed. OP No.2-Company is directed to clear the loan account of the complainant and her husband by crediting the sum assured of Rs.19,64,889/- maintained with OP No.1 on the date of death of the LA i.e. 06.12.2021 and to pay the remaining amount to the complainant along with interest  @ 9% p.a. from 07.12.2023 till the date of its actual realization to the complainant.
12.         The complaint qua OP No.1 and 3 stands dismissed.
13.         This order be complied with by OP No.2 within 60 days from the date of receipt of its certified copy.
14.         The pending application(s), if any, stands disposed of accordingly.
15.         Certified copies of this order be sent to the parties as per rules. The file be consigned.

Announced in open Commission 03.07.2024
	Sd/- (AMRINDER SINGH SIDHU) PRESIDENT
	Sd/-
	(B.M.SHARMA) MEMBER