Chandigarh

DF-II

CC/491/2020

Devendra Thakkar - Complainant(s)

Versus

M/s United India Insurance Co. Ltd. - Opp.Party(s)

Manoj Kumar

13 Nov 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	CC/491/2020
Date of Institution	:	23/09/2020
Date of Decision	:	13/11/2024

 

Devendra Thakkar s/o late Shri Kanubhai Tanna r/o House No.8, Padma Prabhu Nagar, IOC Road, Sabarmati, Ahmedabad, Gujarat-380019.

                                ...  Complainant

V E R S U S

1.M/s United India Insurance Company Limited through its Director/Authorized Officer having its office at SCO 357-358, First Floor, Sector 35-B, Chandigarh-160035.

2.M/s Medsave Health Insurance TPA Limited through its Manager, having office SCO-66, 2^nd Floor, Sector 40-C, Chandigarh 160036.

…. Opposite Parties

 

BEFORE:
	SHRI AMRINDER SINGH SIDHU	PRESIDENT
	SHRI BRIJ MOHAN SHARMA	MEMBER

 

ARGUED BY:
	Sh. Manoj Kumar, Counsel for complainant
	None for OPs

       

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

1.        The complainant has filed the present consumer complaint alleging that his father i.e. the life insured had taken first health insurance policy w.e.f. 16.4.2013 and got the same renewed from time to time.  Lastly he had taken the health insurance policy from OP-1 which was valid w.e.f. 1.10.2019 to 30.9.2020 for the sum insured of ₹2,00,000/-.  During the currency of the said policy, the life insured breathed his last at the time of his treatment in the hospital and the complainant, being his nominee, lodged claim of ₹66,250/- with the OPs.  However, instead of settling the claim, OPs raised unwarranted queries from time to time and ultimately the claim was rejected/not approved as per claim status. However, no letter/order stating the reason for claim rejection was communicated to the complainant.  The complainant also sent legal notice to the OPs but with no success. Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of OPs, complainant has filed the instant consumer complaint seeking reimbursement of the claim alongwith interest, compensation and litigation expenses.
2.        In their written version OPs admitted that the policy in question was issued by them and that the claim of ₹66,250/- was lodged by the complainant.  However, it is averred that the documents submitted by the complainant did not comply with the terms and conditions of the policy and the claim was correctly repudiated vide letter dated 21.5.2018 being not within the scope of the policy.  The remaining allegations have been denied being false. Pleading that there is no deficiency in service or unfair trade practice on their part, OPs prayed for dismissal of the consumer complaint.
3.        In replication, complainant controverted the stand of the OPs and reiterated his own.
4.        Parties led evidence in support of their case.
5.        We have heard the learned Counsel for the complainant and have gone through the documents on record, including written arguments.
6.        Admittedly, the father of the complainant namely Sh. Kanubhai Tanna i.e. the life insured was issued the policy in question by the OPs and the same was valid at the time of his death and the policy inception date is mentioned as 16.4.2013.  It is further admitted case of the parties that the complainant, after the death of his father, had lodged claim of ₹66,250/- with the OPs. 
7.        Though the defence of the OPs is that the claim of the complainant was rightly repudiated vide letter dated 21.5.2018 which was also conveyed to him but, on the other hand, stand of the complainant is that no such repudiation letter was ever communicated to him. In such circumstances it was imperative for the OPs to have placed on record a copy of the said alleged repudiation letter but they failed to do so. 
8.        Moreover, if the defence of the OPs that they had repudiated the claim of the complainant vide their letter dated 21.5.2018 is believed to be true (though not admitting it), even then they could not have done so as the claim was filed much later than that on 3.1.2020 and the policy was valid w.e.f. 1.10.2019 to 30.9.2020.
9.        Otherwise also, it is settled law that one who asserts must prove and since it is OPs who have asserted that they had already repudiated the claim, burden to prove the same lies on their shoulders only.  Here we are fortified by the judgment of the Hon’ble Apex Court in Mahakali Sujatha Vs.  Branch Manager, Future Generali India Life Insurance Co. Ltd. & Anr., II (2024) CPJ 66 (SC) and the relevant portion of the same reads as under :-

“50. …….. The cardinal principle of burden of proof in the law of evidence is that “he who asserts must prove”, which means that if the respondents herein had asserted that the insured had already taken fifteen more policies, then it was incumbent on them to prove this fact by leading necessary evidence. The onus cannot be shifted on the appellant to deal with issues that have merely been alleged by the respondents, without producing any evidence to support that allegation………. A fact has to be duly proved as per the Evidence Act, 1872 and the burden to prove a fact rests upon the person asserting such a fact………..”

10.        Not only this, it would not be out of place to mention here that in the cases of insurance claims repudiation letter is sine qua non in order to determine if the insurer was justified in repudiating the claim or not.  However, when it is evident from the documents on record that till date i.e. even after lapse of more than four years of the institution of the present consumer complaint, OPs/ insurer have failed to adduce on record the copy of the alleged repudiation letter, the same is itself sufficient to prove deficiency in service and unfair trade practice on their part and it is safe to hold that OPs do not dispute the authenticity of the claim.
11.        In view of the above discussion, the present consumer complaint deserves to succeed and the same is accordingly partly allowed.  OPs are directed as under :-
    1. to pay the claim of ₹66,250/- to the complainant alongwith interest @10% per annum w.e.f. institution of the present consumer complaint till realization.
    2. to pay lump sum amount of ₹10,000/- to the complainant as compensation for the harassment caused to him as well as litigation expenses.
12.        This order be complied with by the OPs within 60 days from the date of receipt of its certified copy.   
13.        The pending application(s) if any, stands disposed of accordingly.
14.        Certified copy of this order be sent to the parties, as per rules. After compliance file be consigned to record room.

 

ANNOUNCED 13/11/2024 hg	[AMRINDER SINGH SIDHU] PRESIDENT
	[BRIJ MOHAN SHARMA] MEMBER