DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

WEST TRIPURA :  AGARTALA

 

CASE   NO:   CC- 23 of 2023.

 

1. Smt. Jyotsna Shil,

W/O. Lt. Nagendra Shil,

Of Sripalli, Badharghat,

P.S.-A.D. Nagar, Agartala,

Tripura(W).

 

 

2. Shri Rajdip Shil,

S/O.Lt. Nagendra Shil,

Of Sripalli, Badharghat,

P.S.-A.D. Nagar, Agartala,

Tripura(W).

 

3. Shri Abhijit Shil, 

S/O.Lt. Nagendra Shil,

Of Sripalli, Badharghat,

P.S.-A.D. Nagar, Agartala,

Dist. West Tripura....................…....….................Complainants.

 

-VERSUS-

 

1. The General Manager, 

HDFC ERGO General Insurance Company Ltd.

1st floor, HDFC House, 165/166 Back Bay,

Reclamation, HT Parekh Marg, Churchgat, 

Mumbai, 400020. 

 

2. The Senior Vice President Accident & Health Claims, 

HDFC ERGO General Insurance Company Ltd.,

6th Floor, Leela Business Park, Andheri Kurla,

Road, Andheri(East), Mumbai-400059. 

 

3. The Branch Manager, 

HDFC ERGO General Insurance Company Ltd., 

Agartala Branch, Mantri Bari Road, Agartala. 

 

4. The Branch Manager,

HDFC Bank, Netaji Chowmuhani, Agartala, 

Dist.-West Tripura, …......................................Opposite Parties.

 

 

    __________PRESENT__________

 

 SRI GOUTAM DEBNATH

PRESIDENT,

  DISTRICT CONSUMER  

DISPUTES REDRESSAL COMMISSION,

      WEST TRIPURA, AGARTALA. 

 

DR (SMT) BINDU PAL

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL COMMISSION, 

  WEST TRIPURA,  AGARTALA.

 

SRI SAMIR  GUPTA

MEMBER,

  DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA. 

 

C O U N S E L

 

For the Complainants : Sri Debasish Datta,

  Sri Samar Das,

  Advocates. 

 

For the O.P. No.1, 2 & 3: Sri Sampad Choudhury, 

   Advocate. 

 

For the O.P. No.4 : Sri Mridul Kanti  Arya,

  Advocate.  

 

FINAL ORDER  DELIVERED  ON: 01/02/2024.

F I N A L     O R D E R

Nagendra Shil, husband of the Complainant No.1 and father of Complainant No.2 & 3 respectively had purchased one Maruit vehicle in the year, 2019 taking finance from the HDFC Bank, the O.P. No.4. Nagendra Shil was a Police Constable.

   Being advised by O.P. No.4 Nagendra Shil since deceased, purchased one health insurance policy from O.P. No.1, 2 & 3, so that in case of any accidental death, the loan amount may be recovered from the Insurance.  

3. Unfortunately, on 22/09/2021 Nagendra Shil suffered heart-attack and he was shifted to ILS Hospital, Agartala but he died.   

4. The accidental death was informed to the O.Ps. for payment of the insured amount of Rs.5 lakhs but the O.P. No.1, 2 & 3 asked for detail information in the form of questionnaires which were supplied. Ultimately, on 06/09/2022 the Complainants sent a notice to O.P. No.1, 2 & 3 but O.P. No.1, 2 & 3 asked for “treating doctor's certificate for exact duration of diabetes in DD/MM/YYYY format along with past consultation papers and treatment records”. O.Ps. were informed that Nagendra Shil never suffered from diabetes but to no good. Hence this case.    

5.  O.P. No.4 submitted written objection that they are only financier of the vehicle as such not necessary party.

6.  O.P. No.1, 2 & 3 in written objection pleaded in Para No.13 that Nagendra Shil suffered from diabetes and suppressed his health condition which revealed during investigation by the Insurance Company.  

7.   All the parties submitted evidence on affidavit with documents. 

8. Hearing arguments the following points emerge for discussion and decision:

     (i). Whether Nagendra Shil suppressed his health condition?   

       (ii).  Whether the O.P. No. 1, 2 & 3 are guilty and deficiency in service?    

9. Both the points are taken up together for discussion and decision. 

DECISION AND REASONS FOR DECISION:-

10.    We consider the policy of insurance of Nagendra Shil and also letter dated 26/09/2022 issued by the O.P. No.1, 2 & 3 seeking additional documents for processing the claim and answer of the questionnary. It was clearly mentioned in the questionnary that Nagendra Shil took his break fast in the morning and was doing some work. Suddenly, he fell down so he was shifted to ILS Hospital wherein Doctor confirmed heart problem.  

11.  The O.P. No.1, 2 & 3 have made out a story of diabetes from the blue without any medical documents of previous diabetes or any other cogent evidence. This  story is nothing but with intent to get rid of their liability. Hence, the O.P. No.1, 2 & 3 are guilty of deficiency in service. 

12.       This is two points are decided in favour of the Petitioners.       

13.  In the result, it is ordered that the O.P. No.1, 2 & 3 are jointly and severally liable to pay the insured amount Rs. 1 lakh for critical illness as per the policy condition to the Complainants with interest @7.5% P.A. from today till the date of actual payment and they shall also pay further sum of Rs.25,000/- which is inclusive of compensation and litigation cost. 

          The case stands disposed off.  

         Supply a certified copy of this final order to both the parties free of cost.                    

 Announced.

 

 

SRI  GOUTAM DEBNATH

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA

 

 

 

DR (SMT)  BINDU  PAL

MEMBER, 

DISTRICT CONSUMER DISPUTES 

REDRESSAL COMMISSION, 

WEST TRIPURA,  AGARTALA

 

 

 

 

SRI SAMIR  GUPTA

MEMBER,

 DISTRICT CONSUMER  DISPUTES  

REDRESSAL COMMISSION,

WEST TRIPURA,  AGARTALA.