Tamil Nadu

StateCommission

A/144/2023

The Branch Manager, HDFC Life at Health Claims Department & Anr. - Complainant(s)

Versus

M. Gandhi, S/o Maran - Opp.Party(s)

M/s. M.B. Gopalan Associates

23 Jun 2023

ORDER

IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI.

 

Present:   Hon’ble THIRU JUSTICE R. SUBBIAH  : PRESIDENT

                 THIRU R  VENKATESAPERUMAL          :    MEMBER

 

F.A. No.144 of 2023

(Against the Order passed in C.C. No.26/2021 dated 05.09.2022 on the file of the D.C.D.R.C., Erode)

 

Dated the 23^rd day of June 2023

1. The Branch Manager,

HDFC Life at Health Claims Department,

HDFC Life Insurance Company Limited,

11^th Floor, Lodha Excelus,

Apollo Mills Compound,

N.M. Joshi Road,

Mahalaxmi,

Mumbai – 400 011.

 

2. The Branch Manager,

HDFC Life Insurance Co. Ltd.,

Gokulam Enclave,

First Floor, No.16/1, Kumarasamy Street,

Erode – 638 009.                  .. Appellants / Opposite Parties 1 & 2.

 

- Versus –

Mr. M. Gandhi,

S/o. Mr. Maran,

D. No.1/142, Nagappagoundenpalayam

Kampuliyampatti (Po.),

Vijayamangalam,

Perundurai,

Erode District.                            .. Respondent / Complainant.

 

Counsel for Appellants / Opposite Parties 1 & 2 :  M/s. P.D. Selvaraj

Counsel for Respondent / Complainant             :  M/s. Revathi     

                                                                        Manivannan      

 

                The Respondent as complainant has filed a complaint before the District Commission against the opposite parties 1 & 2 praying for certain directions.  The District Commission had passed an ex-parte order, allowing the complaint.   Against the said ex-parte order, this appeal is preferred by the opposite party praying to set aside the order of the District Commission dt. 05.09.2022 in C.C. No.26/2021.

 

                This petition came before us for hearing finally, today.  Upon hearing the arguments of the counsel appearing for appellants, perusing the documents, lower court records and the order passed by the District Commission, this Commission made the following order in the open court.

           

ORDER

 

JUSTICE R. SUBBIAH ,  PRESIDENT  (Open court)

 

1.     The opposite parties 1 & 2 before the District Commission are the appellants herein.

 

2.     The case of the complainant before the District Commission is that the complainant took a Health Insurance Policy namely; HDFC Life Group Health Shield Insurance Policy on 29.11.2019 from the opposite party.   As per the terms of policy, the coverage period is from 29.11.2019 and it is extended upto 60 months and the policy expires on 28.11.2014 and the sum assured is Rs.4,00,000/-. The complainant is running a tyre repair and puncture shop at Vijayamangalam.  On 30.11.2019, the complainant met with an accident due to the burst of a tyre in his shop and as a result of which, he had sustained severe injuries and fracture.   Therefore, the complainant was hospitalized  from 30.11.2019 to 11.12.2019.   Due to the said incident, the complainant had lost vision in his Right eye and was unable to recover till date.   Further, the vision in his left eye is also affected to a small extent.  The complainant also spend Rs.4,00,000/- towards hospital expenses.  As per the terms and conditions of the opposite parties insurance policy, they are liable to pay the assured sum to the complainant as the policy is under force on the date of incident.  But they have not paid the policy amount.  The act of the opposite parties had caused great mental agony to the complainant.   Hence, the complainant sent legal notice dt.23.04.2021 to the opposite party but the opposite party has not come forward to rectify the defects.  Thereafter, alleging deficiency in service on the part of the opposite party, the complainant had filed a complaint before the District Commission claiming the amount of Rs.4,00,000/- and cost to the complainant.

 

3.     Though the opposite parties entered appearance through a Counsel and filed Vakalat but subsequently failed to file written version in time before the District Commission and hence, the opposite party was set exparte.  Consequently, the District Commission passed an ex-parte order directing the opposite parties to pay a sum of Rs.4,00,000/- towards compensation and cost to the complainant along with interest at the rate of 7.5% from the date of complaint till realization to the complainant.

 

4.     Aggrieved over the said order, this appeal is preferred by the opposite parties 1 & 2 praying for setting aside the order and for a chance to contest the case on merits.

 

5.     Before this Commission, the counsel for the appellants/ opposite parties 1 & 2 submitted that there is no deficiency of service on the part of them and that they have got valid defence and a fair chance of succeeding in the complaint.  Further, the appellants/ opposite parties 1 & 2 submitted that the appellants have misplaced the relevant papers and hence, they were not in a position to file written version before the District Commission. Therefore, they sought to set aside the order of the District Commission and prayed for an opportunity to contest the case on merits.

 

6.     When the case had come up before this Commission on 12.06.2023, after hearing the submission of the both parties, this Commission had felt that irrespective the reason stated by the complainant, in order to give a chance to the opposite parties 1 & 2 to agitate their right on merits, was inclined to allow this appeal by remanding the matter to the District Commission, to dispose of the case on merit.   However, considering the lethargic attitude of the opposite party, in not appearing before the District Commission, we imposed a cost of Rs.3,000/- to be paid to the Legal Aid Account of the State Commission on or before 22.06.2023.   Today, when the matter appeared in the list it was reported that the condition imposed by this Commission has been complied with.    Hence, this appeal is allowed today by remanding back the complaint to the District Commission for fresh disposal according to law.

 

In the result, the appeal is allowed by setting aside the order of the District Consumer Commission, Erode in C.C. No.26/2021 dt.05.09.2022, and the matter is remanded back to the District Commission, Erode for fresh disposal according to law and on merits after hearing both sides.

 Both parties are directed to appear before the District Commission, Erode on 24.07.2023 for further proceedings.  The appellants / opposite parties 1 & 2 is directed to file Written Version, proof affidavit, written arguments and documents if any on the same day itself.

 The District Commission is directed to dispose of the complaint on merits within three months after hearing both parties as expeditiously as possible as per law.  

 Both parties shall abide by the order of the District Commission regarding the mandatory deposit already made by the appellants / opposite parties 1 & 2 before this Commission.

 

 

 

   R  VENKATESAPERUMAL                                        R. SUBBIAH

                 MEMBER                                            PRESIDENT

 

 

Index :  Yes/ No

 

KIR/SCDRC/Chennai/Orders/June/2023