BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.424 of 2020
Date of Instt. 23.11.2020
Date of Decision: 01.10.2024
Pushpa Rani aged about 45 years W/o Late Raj Kumar R/o Ram Mandir, Mohalla Kohlian, Nurmahal, Tehsil Phillaur & District Jalandhar, Punjab.
..........Complainant
Versus
1. M/s H.D.F.C. Life Insurance Company Limited Lodha Excelus, 13th Floor, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai 400 011 through its Managing Director.
2. HDFC Life Insurance Company Limited, Sanchay, Branch 362/363, Shakti Mall, 4th Floor, Lajpat Nagar, Opposite Gymkhana Club, Jalandhar through its Manager.
3. The Manager, HDFC Life Insurance Company Limited, Sanchay, Branch 362/363, Shakti Mall, 4th Floor, Lajpat Nagar, Opposite Gymkhana Club, Jalandhar.
4. Bimla Rani W/o Late Sh. Kashi Ram (C/o Sh. Darshan S/o Late Sh. Kashi Ram) R/o Village Pandori, Tehsil Nakodar& District Jalandhar.
5. Sonika D/o Late Raj Kumar & Wife of Sh.Amit Bhargav R/o Ram Mandir, Mohalla Kohlian, Nurmahal, Tehsil Phillaur & District Jalandhar, Punjab at present R/o Saharanpur Chow, Dehradun (Uttrakhand)
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Present: Sh. Gurvinder Arora, Adv. Counsel for Complainant.
Sh. A. K. Gandhi, Adv. Counsel for OPs No.1 to 3.
OP No.4 dismissed.
OP No.5 Performa Party.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the husband of the complainant had taken insurance policy from OPs No.1 to 3 bearign No.21171031 HDFC Life Sanchay dated 16.02.2019 and paid the premium of the said policy for a period 15 years from the date of commencement and the premium paying term was 5 years. The husband of the complainant had paid all the premium which were due towards him without any default. As per the terms and conditions of the policy, it was agreed that a sum of Rs.5,00,000/- shall be paid in the even of death of the husband of the complainant which is also clearly mentioned in the policy. Unfortunately, the husband of the complainant expired on 02.03.2019 due to sudden cardiac arrest. The husband of the complainant also remained admitted at Kaura General & Children Hospital, Goraya Road, Jandiala, District Jalandhar from 26.02.2019 till his death which took place on 02.03.2019, the certificate dated 11.05.2019 issued by Dr. S. K. Kaura of the said hospital in this regard. The complainant intimated the OPs No1 to 3 regarding the death of her husband and requested them to give claim of insurance to her and submitted all the documents regarding the death of her husband, but the OPs No.1 to 3 have not reimbursed the claim of the complainant, which caused deficiency in service and unfair trade practice on the part of the OPs 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 pay the amount of Rs.5,00,000/- alongwith interest @ 12% per annum from the date of filing the complaint till its realization. Further, OPs be directed to pay a compensation of Rs.10,00,000/- for causing mental tension and harassment to the complainant.
2. Notice of the complaint was given to the OPs and accordingly, OPs No.1 to 3 appeared through its counsel and filed written reply whereby 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 OPs No.1 to 3 by misusing the process of law and to avail undue advantages. It is an attempt to waste the precious time to this Commission as no cause of action has been arose against the answering OPs No.1 to 3 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 OPs No.1 to 3 and the same is liable to be dismissed. The claim of the complainant is suspended by the answering OPs and the same is not adjudicated by the OPs No.1 to 3 as the complainant failed to supply the certain documents required by the OPs for adjudication of the claim. As per record of the OPs No.1 to 3 the complainant was failed to supply the past medical record of life assured, all biopsy records and lab test records, past medical records of AIIMS hospital, Rishikesh where Life Assured was treated, any other policy details if any and mediclaim details etc. even the letters were sent to the complainant by the answering OPs. Due to non submission of the require documents to the OPs No.1 to 3, the OPs were not able to adjudicated the claim of the complainant and due to which the claim of the deceased suspend by the OPs. So, the present complaint is premature one and is liable to be dismissed. It is further averred that the complaint is false and vexatious to the knowledge of the complaint. On merits, it is admitted that the deceased Raj Kumar had taken insurance policy from OPs No.1 to 3 for period of 15 years from the date of commencement and premium term was for 5 years. It is also admitted that the claim was lodged by the complainant 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.
3. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
4. Notice was sent to OP No.4 by way of ordinary process and then by way of publication, but the complainant was not deposited publication fee since last so many dates and ultimately, the complaint of the complainant qua OP No.4 is dismissed u/O 9 Rule 2 CPC for non prosecution. OP No.5 was declared as a proforma party, vide separate statement of OP No.5.
5. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
6. We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.
7. It is proved that the husband of the complainant had purchased the insurance policy from the OPs No.1 to 3. The insurance policy has been proved Ex.C-1. The insurance was valid from 14.02.2019 till 14.02.2034. The policy term was 15 years. The sum assured was Rs.5,00,000/-. The husband of the complainant expired on 02.03.2019 due to sudden cardiac arrest and admitted at Kaura General & Children Hospial, Goraya Road, Jalandhar from 26.02.2019 till his death and this fact has been proved from Ex.C-2 i.e. certificated issued by Dr. S. K. Kaura of the said hospital. The complainant has alleged that she submitted all the documents to OPs No.1 to 3 alongwith the claim form, but the OPs have failed to reimburse the claim of the complainant on the ground that the complainant failed to supply the past medical record of life assured, all biopsy records and lab test records, past medical records of AIIMS hospital, Rishikesh where life assured was treated. In the written statement the OP in Para No.2 of the preliminary objections have alleged that claim has not adjudicated for want of document. In such circumstances, the complainant is directed to furnish the documents/information, which was required by the OPs for settlement of the claim within 10 days from the date of receipt of the copy of order, if these documents are in possession of the complainant and inform the OPs accordingly. The OPs cannot force the complainant to produce the documents which are not in their possession as per law laid down by the Hon’ble Supreme Court, in a case titled as ‘Gurmel Singh Vs. National Insurance Co. Ltd.’, 2022 SCC OnLine SC 666, decided on 20.05.2022. The OPs themselves can verify from the doctor, concerned, if need be, after enquiring from the complainant. The OPs are directed to settle the claim of the complainant within 15 days from the date of receiving documents or information from the complainant, failing which the OPs will be liable to pay a compensation of Rs.20,000/- to the complainant. It is further ordered that if the complainant is not satisfied with the settlement of the claim made by the OPs, then she is at liberty to file a fresh complaint. Thus, the complaint of the complainant is disposed of. This complaint could not be decided within stipulated time frame due to rush of work.
8. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
