Assam

Dibrugarh

CC/4/2022

MD. FAZLUR RAHMAN - Complainant(s)

Versus

SRI RITESH KUMAR, CHIEF EXECUTIVE OFFICER, HDFC ERGO GENERAL INSURANCE CO. LTD. - Opp.Party(s)

Fazlur Rahman

19 Nov 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

DIBRUGARH

 

C.C. Case No.04/2022

                                                           Present –

1. Smti Kritanjali Kalita, Member,                                         Shri Palash Ranjan Kotoky, President,

2. Shri Diganta Saikia, Member,                                             District Consumer Disputes

District Consumer Disputes                                                     Redressal Commission,

Redressal Commission, Dibrugarh.                                        Dibrugarh.

 

Md. Fazlur Rahman                 

S/o Lt. Mohammad Ali

Resident of Bairagimath

Opp. Pratidin Press,

Dist. & P.S. Dibrugarh, Assam…………………………..   Complainant

 

-VS-

Sri Ritesh Kumar

Chief Executive Officer

HDFC ERGO General Insurance Co. Ltd.

Registered Office

1^st floor, HDFC House, 165-165 Backbay

Reclamation, H T Parekh Marg,

Churchgate, Mumbai-400020     ………………………..…. Opposite Parties.

Date of Argument  : 13.02.2024

Date of Judgement : 19.11.2024

            This complaint has been filed by the complainant under section 35 of the Consumer Protection Act, 2019 claiming to direct the Opposite Party to pay the balance amount of ₹37,959/- to the complainant, a compensation of ₹50,000/- in legal and incidental expenses and ₹ 5,00,000/- against the physical harassment and mental agony suffered by the complainant.

JUDGEMENT     

1. The case of the complainant is that the complainant purchased one general insurance policy from the O.P. on 04.02.2020 after paying full and total premium of ₹6761/- and the O.P. issued a certificate of insurance bearing Policy No.2950203278610000000. On 10.01.2022 the complainant filed claim against this policy under the coverage heading of Loss of Job in the policy. But getting no response from the O.P. the complainant sent an e-mail to the O.P. on 15.01.2022. On 15.01.2020 O.P. informed the complainant that the claim was incomplete and advised to fill up the attached form and share with the O.P. in order to get claim generated and processed and as advised the complainant submitted the filled up form with all relevant documents on 17.01.2022. The O.P. vide their e-mail dated 18.01.2022 informed that few more documents are required for the claim assessment. The complainant vide e-mail dated 19.01.2022 sent the required documents as advised by the O.P. In reply the O.P. vide e-mail dated 23.01.2022 asked for some more documents for claim settlement and accordingly the complainant through his e-mail dated 24.01.2022 sent all the required documents.

 

2. But surprisingly the O.P. on 25.01.2022 sent an amount of ₹ 34,617/- out of total claim amount of ₹ 72,576/-. The total sum insured under the coverage was ₹ 1,00,000/-. Hence the complainant sent an e-mail on 25.01.2022 raising his objection on less remittance. The O.P. did not respond to the e-mail and the complainant on 29^th January and on 1^st February, 2022 sent two e-mails and put forward his objection. In reply, the O.P., on 01.02.2022 vide their e-mail informed the complainant that the policy has been settled as per terms and conditions. On 2^nd February, 2022 the complainant sent another e-mail to the O.P. stating that as per documents submitted, EMI for three months was ₹ 72,576/- and the sum assured was ₹ 1,00,000/- only. The O.P. vide their e-mail dated 02.02.2022 refused to pay the balance amount and finally the complainant vide his e-mail dated 02.02.2022 informed the O.P. that if the balance amount would not be credited then the complainant would be forced to approach a Court of Law.

 

3. Being highly aggrieved and being dissatisfied with the acts of the O.P., the complainant has filed this complaint before this Commission on the grounds stated hereunder:

 

1. The O.P. deliberately and intentionally involved in dis service with its customer.
2. The O.P. intentionally harassed the customer by illegally withholding the full remittance.
3. The O.P. has no reason to withhold the money of the complainant.
4. The O.P. has compelled the complainant to waste his time and money on the whole process.
5. The acts and deeds of the O.P. are unprofessional, irrational and unjustified.

 

         4. The complainant claims to direct the O.P. –

 

1. To pay the balance amount of ₹ 37,959/- to the complainant.

 

              (ii)To compensate ₹ 50,000/- to the complainant for legal and incidental expenses.

 

(iii) To pay ₹ 5,00,000/- for the stress and strain the complainant has to go through and                                   also for the traumatic experiences and mental stress inflicted on the complainant.

 

5.  After registering the case notice was issued to the O.P. and the O.P. after duly receipt of the notice neglected to appear before the Commission for which ex-parte order was passed on 29.03.2022 and the case proceeded ex-parte against the O.P. Though the O.P. filed petition for vacation of ex-party order vide petition No.79/22 dated 09.05.22 their prayer was rejected showing grounds on 04.01.23.

 

6. In his evidence in affidavit the complainant has deposed that he is a permanent resident of Dibrugarh and he himself is the complainant in this case. The complainant has said in his evidence that he bought one insurance policy No.2950203278610000000, bearing customer ID No. l01004134841 from the O.P. after paying the full premium which gives full (100%) benefit. Sum assured value under the claimed category is ₹ 1,00,000/- as per policy. The O.P. confirmed and assured about the policy and assured the benefit thereof. The complainant lost his job and he filed claim against this insurance policy under the coverage and Loss of Job in the policy wherein the sum assured was ₹ 1,00,000/-. As requested by the O.P., the complainant on 10.01.2022 filed claim form along with all the documents and EMI confirmation statements issued by the bank authority.  The O.P. on 25.01.2022 paid the complainant an amount of ₹34,617 only instead of ₹1,00,000/-. The complainant has claimed that the amount paid by the O.P. is contrary to their proclaimed assurance in the policy, which assures payment of full sum assured against the particular coverage heading (Exhibit-1). The condition of the policy was to pay the premium in full to receive the full insured sum. The policy issued by the O.P. clearly confirms that premium was fully paid by the complainant. The complainant has further stated that he sent e-mails and requested the opposite party on dates 15.01.2022, 17.01,2022, 19,01,2022, 24.01.2022, 25.01.2022, 29.01.2022, 01.02.2022, and 02.02.2022 to pay the balance amount as per policy norms. (Exhibit – 5 are those e-mails.). The O.P. refused to pay the balance amount vide its e-mail dated 15.01.2022, 17.01.2022, 19.01.2022, 01.02.2022 and 02.02.2022. (Exhibit – 6 are those e-mails). The complainant has prayed to allow his complaint and to grant the relief prayed by him in his complaint. Complainant has filed below mentioned exhibits to substantiate his claim-

 

1. Exhibit-1 is the policy document.
2. Exhibit-2 is the confirmation letter.
3. Exhibit-3 is the claim form filled up by the complainant
4. Exhibit- 4 is the summery statement of Account.
5. Exhibit No. 5 are emails send by the complainant to the O.P.
6. Exhibit No.6 are emails send by the O.P. to the complainant

 

            .

7. In his written argument the complainant has argued that it is transparent from the payment details mentioned in the policy, full premium was paid by the complainant to the O.P. and as the premium was fully paid by the complainant he is entitled to receive the full insured sum. He has further argued that the policy purchased by him clearly states and assures that the benefit would be full (100%) and the sum assured under the claimed category is ₹1,00,000/- but the opposite party paid only ₹ 34,617/-. The O.P. has intentionally harassed the complainant and the complainant had to waste has precious time and money.

Points for decision

1. Whether the complainant is a consumer of the opposite parties under the Consumer Protection Act.
2. Whether this Commission has jurisdiction to try the case.
3. Whether the opposite party are liable for deficient and negligent services towards the complainant.
4. Whether the complainant is entitled to get the reliefs claimed in his complaint petition.

Decisions and reasons thereof

1. We have carefully gone through the averments of the complaint and the evidence produced and the documents marked as Exhibit No.1 to 6 in support of those averments as well as written argument. It is also worthy to mentioned here that though the O.P.s remained ex-parte vide order dated 29.03.2022, this Commission wants to dispose this complaint fully on merits with available materials on record. On perusal of the case record we found that the complainant had purchased “Sarv Suraksha Plus” general insurance policy from the O.P. on 04.02.2020 bearing Insurance Policy No. 2950203278610000000, after paying full and total premium of Rs.6761/-. Complainant relied upon Exhibit No.1 i.e. the certificate of insurance policy bearing No. 2950203278610000000 to prove the same and hence the complainant is a consumer of the insurer O.P.
2. After perusal of the case record it is also found that this Commission has proper territorial as well as pecuniary jurisdiction to try this case.
3. Regarding deficiency in service as alleged by the complainant, it transpires from the pleadings and documents placed in this case that the complainant had purchased Sarv Suraksha Plus Insurance Policy vide policy No. 2950203278610000000 after paying the full premium of Rs.6761/- which was valid for the period from 04.02.2020 to 03.02.2025. As the complainant had lost his job, he filed claim under the coverage heading of loss of job in the aforesaid insurance policy. Complainant submitted duly filled up form on 10.01.2022 along with all the documents and EMI confirmation statements issued by the bank authorities. After scrutiny of documents filed by the complainant, O.P. has settled the claim of the complainant and paid an amount of Rs. 34,617/- on 25.01.2025 out of total claim amount of Rs.72,576/-. Being aggrieved by this, complainant raised his objection on less remittance and sent an e-mail on 25.01.2022 but the O.P. did not respond to the e-mail. Complainant stated that the total sum insured under Loss of Job category is Rs.1,00,000/- and as per the loan statement and scheduled submitted, 3 EMIs of loan repayments Rs.34,617/-+ Rs.37,959/- = Rs.72,576/-. Complainant argues that condition of the policy purchased by him clearly states and assures full (100%) benefit and the sum assured under the claim category is Rs.1,00,000/- and the insurance policy issued by the O.P. clearly confirms that the complainant has paid full and total premium of Rs.6761/-. But surprisingly, the O.P. paid only Rs.34,617/- instead of total claim amount of Rs.72,576/. The complainant has sent e-mails and requested the O.P. on 15.01.2022, 17.01,2022, 19,01,2022, 24.01.2022, 25.01.2022, 29.01.2022, 01.02.2022, and 02.02.2022 to pay the balance amount as per policy norms. However, the O.P. vide emails dated 15.01.22, 17.01.22, 19.01.22, 01.02.22 and 02.02.2022 had refused to pay the balance as per the sum insured in the policy.

After considering the submission of the complainant we have minutely perused the loan repayment schedule (Exhibit No.3) of the complainant and found that there were two loan agreements executed by the complainant. Firstly, the complainant had availed Auto Loan of Rs. 5,54,589/- vide Agreement No. 98661708 from HDFC Bank Ltd payable equated 84 monthly instalments of Rs. 11,539/- each commencing from 05.03.2020 to 05.02.2027. Secondly, complainant executed a business loan agreement with HDFC Bank Ltd. vide Agreement No. 9807617 for an amount Rs.350,000/- to be repayable within 60 monthly instalments and each EMI is Rs.12,653/- starting from 04.04.2021 to 04.03.2026. Complainant has calculated both the loan monthly EMIs of Rs 72,576/. With the below calculation

EMI amount of Rs.11,539.00 + 12,653.00 = 24,192.00 x 3=72,576.00

It is also worthy to mention here that the complainant has made insurance claim under the coverage heading of loss of job in the aforesaid Sarv Suraksha Plus policy, but he failed to exhibit the terms and conditions of the aforesaid insurance policy. However, complainant exhibited the Certificate of insurance policy bearing policy No. 2950203278610000000 as Exhibit No.1. From bare perusal of the certificate of the aforesaid insurance policy (Exhibit No.1) it transpires that the job loss category covered only 3 EMIs wherein sum assured was Rs.1,00,000/-. Complainant filed insurance claim under the category of Loss of Job under the policy but he has not disclosed the name and particulars of his employer in his complaint petition as well as in his evidence. Complainant simply claimed the total 3 EMIs amount of Rs.11,539/- + 12,653/-= 24,192/- x 3 =Rs.72,576/- and exhibited two loan repayment statements (Exhibit No.3). But he never divulged in his pleading that he has executed two loan agreements viz auto loan and business loan wherein monthly instalments deducted from his accounts of Rs.11,539/- and Rs.12,653/- respectively. We have also not found any averment in the complaint petition that the complainant has been running any business and for such purpose he availed business loan from HDFC Bank Ltd. Moreover, complainant has not exhibited any documents to show that he had suffered loss in his business and was unable to pay his monthly EMIs. As we have already discussed above that the complainant has failed to exhibit the terms and conditions of the insurance policy, hence, it is very difficult on our part to come to a conclusion that whether business loss would come under the coverage in the aforesaid insurance policy. We have perused the certificate of “Sarv Suraksha Plus” insurance policy (Exhibit No.1), wherein the column of coverage details, it is mentioned as hrereunder-

•                                               Premium                                Sum Insured

1. Loss of Job (3 EMI)                473                                        1,00,000/-
2. Accidental Death                    547                                         5,00,000/-
3. Permanent total disability/

Permanent partial disability7295,00,000/-

4. Accidental Hospitalization      365                                        1,00,000/-
5. Critical Illness                       1276                                        1,00,000/-
6. Credit Shield Insurance          912                                         5,00,000/-
7. Garage Cash                           821                                               3,500/-
8. Householders Coverage         607                                         1,50,000/-                         

 

4. Thus from bare perusal of the certificate of “Sarv Suraksha Plus” insurance policy (Exhibit No.1) we have not found any category which include the business loss under the purview of this policy as claimed by the complainant. Whereas complainant had filed specific claim under the category of Loss of Job in the policy, probably for this reason the claim of the 3 EMIs (Rs.12,653/- x 3= 37,959/-) of business loan was not considered by the O.P.  Hence, we have not found any deficient service of the insurer O.P. for non-settlement of balance amount of Rs.37,959/- of business loan 3 EMIs, as the complainant had specific insurance claim under the category of Loss of Job which have already been paid by the insurance company. Undisputedly, preamble of the Consumer Protection Act, 2019 is benevolent in nature but it does not give any liberty to anyone who wants to take undue benefit of Consumer Protection Act, 2019. 

In view of the same the act of O.P. in repudiating the claim of the complainant cannot be termed as deficiency in service. Under the circumstances, we are of the considered view that there is no merit in the complaint and complainant has failed to prove his case and hence the same is liable to be dismissed as devoid of merits. Therefore, the complainant is not entitled for the claims made.

The complaint filed by the complainant is hereby dismissed without any cost.

The instant C.C. No.04/2022 has been disposed of ex-parte.

Copy of judgement and order be furnished to the complainant.

 

           I agree                                       I agree                                Judgement prepared by

 

 

(PALASH R. KOTOKY)             (DIGANTA SAIKIA)              (KRITANJALI KALITA)

President                                      Member                                    Member

District Consumer Disputes         District Consumer Disputes     District Consumer Disputes

Redressal Commission,               Redressal Commission,            Redressal Commission,

Dibrugarh                                    Dibrugarh                                  Dibrugarh