Karnataka

StateCommission

A/607/2021

HDFC ERGO General Insurance Company Ltd, - Complainant(s)

Versus

N Srinivasan - Opp.Party(s)

Prashanth Pandit

23 Aug 2021

ORDER

BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE

 

DATED THIS THE 23^RD DAY OF AUGUST 2021

 

PRESENT

 

HON’BLE Mr. JUSTICE HULUVADI G. RAMESH    : PRESIDENT

MR. KRISHNAMURTHY B. SANGANNAVAR      : JUDICIAL MEMBER

MRS. DIVYASHREE M.                                     : MEMBER

 

Appeal No. 607/2021

 

HDFC ERCO General Insurance Co. Ltd. Reg. & Corp. Off: 1st Floor, HDFC House 165-166 Backbay Reclamation H.T. Parekh Marg, Churchgate Mumbai 400 020 Rep. by its Authorised Signatory   (By Sri. Prashant T. Pandit) V/s	……Appellant
N. Srinivasan S/o. Late Nanjappa Naminee of late K. Anuradha No.9/1, 3rd Cross, Balaji Nagar B.R.C. Post, Bangalore 560 029	……Respondent

O R D E R

 

Mr. JUSTICE HULUVADI G. RAMESH, PRESIDENT

This appeal is filed by the OP / appellant under Section 41 of the Consumer Protection Act, 2019 being aggrieved by the order dated 09.07.2021 in C.C.No.671/2018 on the file of IV Additional District Consumer        Disputes Redressal Commission, Bangalore.

2. The brief facts of the case are that wife of complainant obtained insurance policy under the scheme “Sarva Suraksha” from OP on 08.01.2016 by paying onetime payment and premium.  The policy was valid for 60 months for a sum of Rs.4,01,561/- being the Car loan amount sanctioned.  It is submitted that wife of complainant K.Anuradha died on 28.04.2017 due to heart attack.  Thus, the complainant approached the OP for compensation, but, OP repudiated the claim on the ground that heart attack does not come under the category of critical illness under the policy coverage. Complainant after correspondence and issuance of notice, lodged the present complaint alleging deficiency in service and unfair trade practice on the part of OP. 
3. OP on appearance in its version stated that they repudiated the claim made by the complainant on the ground that the claim is not covered under the policy.  Late Anuradha K., wife of the complainant died due to sever cardio respiratory arrest.  The said ailment is not covered under the policy.  Thus, rightly repudiated the claim.  The claim of the complainant has been diligently dealt by OP and the same has been repudiated as same is excluded from the policy.
4. District Commission on the basis of the pleadings and evidence led in by both the parties allowed the complaint in part directing OP to pay the sum insured amount of Rs.1.00 lakh with interest at the rate of 9% p.a. from the date of repudiation till the date of realisation and also to pay Rs.50,000/-  towards compensation and Rs.10,000/- towards cost.
5. Heard the counsel for appellant. 
6. It is argued by the counsel for insurer that the policy coverage is not there as such appeal has to be entertained.  As per the policy conditions there is no coverage to insured.  However, District Commission has passed award which needs to be negated.
7. Perused the impugned order.  The District Commission on going through the documents produced by the complainant and terms and conditions of the policy opined that cardiac arrest can occur after a heart attack.  Heart attack increases the risk of sudden cardiac arrest.  On considering the fact that the OP has not produced any expert Cardiologist opinion to prove that cardiac arrest is different from the heart attack and on the basis of the certification of medical officer that cardiac respiratory arrest which more likely due to first heart attack of severe in nature which leads to consequence of death, concluded that repudiation made by the OP on purely technical ground in a mechanical manner is unsustainable.   There is no scope for interference.   However, compensation awarded at Rs.50,000/- is on higher side and the same is reduced to Rs.10,000/- and interest is reduced to 6% p.a. from 9%.  Rest of the order remains unaltered.  Accordingly, appeal is disposed of. 
8. Amount in deposit shall be transferred to the District Commission for disbursal in favour of respondent / complainant.

 

PRESIDENT

 

 

JUDICIAL MEMBER

 

 

MEMBER

CV*