Haryana

Charkhi Dadri

CC/06/2020

Smt. Sunil Devi, - Complainant(s)

Versus

The Manager -Claims, HDFC ERGO General Insurance Company Ltd, - Opp.Party(s)

Sh. P. K. Yadav

23 Oct 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, CHARKHI DADRI.

                              

                                                                   Complaint No.: - 6 of 2020.

Date of Institution: - 09.01.2020.

                                                                   Date of Decision: - 23.10.2024.

 

1. Smt. Sunil Devi, aged 42 years,wd/o Sh. Sandeep S/o Late Sh. Karan Singh,
2. Kalpana, aged 12 years, minor daughter of Sandeep,
3. Riya, aged 8 years, minor daughter of Sandeep,

Minors through their natural guardian and next friend being their real mother.

4. Narayani aged 70 years, wd/o Late Sh. Karan Singh,

All residents of Village Misri, Tehsil & District Charkhi Dadri

                                                                             ….Complainant.

                                      Versus

1. The Manager- Claims, HDFC ERGO General Insurance Co. Ltd. 6^th Floor, Leela Business Park, Andheri Kurla Road, Andheri (East), Mumbai-400059.
2. The Branch Manager, HDFC Bank, Charkhi Dadri, Tehsil and District Charkhi Dadri.                                                                                                                                                                   …...Opposite Parties.

 COMPLAINT UNDER THE CONSUMER PROTECTION ACT.

 

BEFORE: -   Hon’ble Shri Manjit Singh Naryal, President

                    Hon’ble Shri Dharam Pal Rauhilla, Member   

 

Present: -    Shri P.K.Yadav Advocate for complainant.

Shri Vinod Kumar Chahar, Advocate for Op no.1.

Shri Rajender Verma, Advocate for OP no.2.

 

ORDER: -

1. The case of the complainant in brief, is that her husband had taken a personal loan for an amount Rs.6,6,4000/- and actually disbursed the loan amount Rs.6,54,383/- on dated 23.08.2016 and to secure the repayment of the loan got issued life insurance policy as Corporate Sarv Suraksha and received the one time premium from the husband of the complainant and issued insurance policy no.2950201480884800000 valid from 25.8.2016 to 24.08.2021. The OP no.2 has made total 60 installments and EMI amount was made as Rs.15,797/- for loan amount. The deceased had deposited 7 installments. Sandeep, husband of complainant no.1 had expired on 7.4.2017. After the death of Sandeep, bank employee had approached to the complainants to deposit the EMI amounts and also told them for claiming the insured amount. It was further averred that the complainants have lodged the claim with the OPs alongwith all the required documents. After receiving the letters dated 11.7.2017 & 01.08.2017, the complainant no.1 came to know about the fact that Karan Singh, father in law of complainant no.1 was nominated as nominee of deceased Sandeep. The name of Sh. Karan Singh was nominated only due to clerical mistake and inadvertently, because Sh. Karan Singh had already been expired on 28.10.2005. The complainant no.1 has submitted all requisite documents with affidavit of the complainant no.4 regarding no objection for paying the claimed amount to the complainant no.1 and affidavit of complainant no.1 regarding mentioning legal heirs of deceased Sandeep S/o Sh. Karan Singh. After sending the abovesaid requisite documents, the investigator of the OP no.1 visited to the house of complainants in March 2018 and enquired about the death of Sandeep and also received all requisite documents i.e. Aadhar Card, Ration Card, Bank Account No. ,DDR, PMR , Death Certificate, Details of legal heirs of the deceased and Visra Report etc. After getting the requisite documents and completing enquiry in the village as well as in police station, the investigator assured that their case is genuine and fit for claim. The complainant no.1 has submitted some representations regarding the claim but the OP no.1 failed in settling his claim. Pending settlement of claim, the complainants had deposited the loan installments to avoid becoming the defaulter and NPA case. It is averred that the complainants have settled the loan amount in lump sum with the OP no.2 on dated 30.11.2018. The counsel for the complainant got issued a legal notice on 04.11.2019 for settlement of insurance claim but there was no reply from the OPs.  The complainant further alleged that due to the act and conduct of the OPs, she suffers mental agony, financial loss and physical harassment, which amounts to deficiency in service on the part of OPs and as such he had to file the present complaint.
2. On appearance, the OPs no. 1 has filed written statement stating that the policyholder had full knowledge of the terms and conditions of the policy and only after going through the application for insurance thoroughly and properly had agreed for taking the same. That believing the abovesaid declaration, information and details provided in the proposal form to be true, correct and complete in all respect, giving due credence to the under writing  norms of company, Sarv Suraksha Policy bearing No.29502014808800000  was issued for the period from 25.8.2016 to 24.8.2021. It is submitted that the opposite party no.1 had received a claim application on 17.6.2017. The same was sent for investigation. It is further alleged that OP no.1 made requests  for submission of documents for the purpose of verification and processing of the claim, however the complainant failed to provide the requisite documents. It is pertinent to mention here that these documents were important, in order to reach any decision and for further settlement of the claim. The documents required are:-

1. Notarized NOC required from other legal heirs other than claimant, chemical visra report
2. Police Investigation Report

It is further averred by the OP no.1 that the competent authority after due application of mind and papers available on the file and taking into consideration that the complainant had failed in clarifying the queries of the company, tHence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of opposite party no.1 and prayed for dismissal of complaint with costs.

3.  

4.                Both the parties in support of their respective averments tendered in documentary evidence their respective affidavits and adduced certain documents. Reference of relevant record shall be given in this order.

5.                We have heard both the counsel for parties and gone through the case file thoroughly and after hearing the rival contentions of both the parties, we are of the convinced view that the present complaint has merits and the same deserves acceptance, for the reasons mentioned hereinafter.

6.  

1. Notarized NOC required from other legal heirs other than claimant, chemical viscera report
2. Police Investigation Report

That on 7.4.2017, the brother of the deceased lodged a complainant with the Police Station Bond Kalan, District Charkhi Dadri and police registered a GD No028 dt.07.04.2017 (Ex.C2). The Post Mortem was conducted by the Medical Officer, General Hospital, Rohtak vide PMR No. generated by software: M406000161700140 & PMR No.(Given by doctor):-197/GH/2017 dated 08.04.2017 (Ex.C3). Doctor handed over dead body after  PMR and sealed the envelop for chemical analysis and these envelope were handed over to Surender Singh, ASI Belt No.105, Police Station, Bond Kalan. The Regional Forensic Science Laboratory, Haryana, Sunaria Rohtak on examination on the said sample of Sandeep S/o Karan Singh gave the report bearing no.RLSL (H) no. 17/Su/Toxi-652dt. 14.8.2018 (Ex.C20) and in their report they have sent a one sealed parcel containing PMR No.197/GH/2017 dated 18.04.2017, visera of deceased: Sandeep S/o Karan Singh Exbt-1a, Exbt-1b., Exbt-1c, Exbt-1d. The result of the examination mentioned in the report is as under:-

1. Aluminum Phosphide was detected in exhibits-1a and 1b
2. No common poison  could be detected in exhibit-1C

The OP no.1 did not settled the claim on the pretext that the claimants have failed in furnishing required documents viz. notarized  NOC required from other legal heirs, Chemical Viscera Report and Police Final Investigation Report . All the relevant documents are already available in file. The death of the insured has been because of consuming aluminum phosphide inadvertently (as mentioned in GD No.28 dated 07.04.2017 (Ex.C2)) which has not been contested by the OP no.1. As regards legal heirs of the deceased and affidavit has already been given (Ex.C7/A) and all legal heirs have filed the  present complaint. Therefore, we are of the considered view that the repudiation of claim made by the OPs is totally illegal and arbitrary. It has been observed that no any other ground (except non submission of relevant documents) for repudiation has been taken by the OPs. The insured/deceased viz. Sandeep S/o Karan Singh had availed loan for Rs.6,64,000/- and disbursed the loan Rs.6,54,383/- from HDFC Bank (OP no.1) repayable alongwith interest in 60 installment @15,797/- each commencing from October 2017. The deceased paid installment for Rs.1,10,579/- till 07.04.2017 (Ex.C11 & Annexure R1). The insured had expired on 7.4.2017. The outstanding balance of the loan amount on 07.04.20017 was Rs.543,804/- (i.e. disbursed amount of Rs.6,54,383/- minus Rs.1,10,579/- repaid by the insured/deceased. To secure the loan, the OP no.2 had arranged insurance policy vide certificate no.295020148088480000 dt.25.8.2016 (Ex.OP-1). The policy has inter alia coverage for “Credit Shield Insurance” Rs.6,64,000/- & Accidental death for Rs.4,00,000/-. As per terms of the policy the major covers, inter alia comprise:-

Accidental Death: Pay the full sum insured in case of accidental death

Credit Shield:    Pay the balance outstanding loan amount upto maximum                                     sum insured in the event of accidental death or permanent                           total disability.

The death of the insured was accidental death. Hence the claimants are entitled for payment of accidental death claim for Rs.4,00,000/- and payment of outstanding amount of Rs.5,43,804/- at the time of death of insured. Accordingly, the claimants/legal heirs of the insured/deceased are entitled for Rs.9,43,804/- under the policy

7.                In the light of above mentioned facts and evidences and arguments advanced by the counsel of both the parties, the death of the insured Shri Sandeep was accidental death. Hence, the present complaint is allowed for amount of admissible claim for Rs.9,43,804/- (Rs.4,00,000/- accidental claim and Rs.5,43,804/- outstanding loan at the time of death of insured Shri Sandeep on 07.04.2017) as insurance policy against claimed amount of Rs.11,64,000/-. Therefore there is nothing on record to establish that the life assured-deceased’s death was not accident death and rejection of the insurance claim of the complainant’s ignoring important documents viz. Post Mortem Report, Regional Forensic Science Laboratory Report and GD no.28 dated 7.4..2017 in Police Station, Bond Kalan, Dadri amounts to deficiency in service and thereby it is proved their deficient actions caused the complainant to undergo severe mental agony.

8.                In the result, the complaint is allowed. Accordingly an award is passed against the OP no.1 as under:

1. To pay sum assured amount of Rs.9,43,804/-  with interest @9% p.a. from the date of repudiation i.e. 28.06.2017  till the date of realization.
2. To pay Rs.10,000/- towards compensation for mental agony.
3. To pay Rs.5,000/- cost of litigation.

All the above amount shall be disbursed in all complainants in equal share and in case of minor legal heir in that situation their amount shall be deposited inNationalized Bank in the shape of FD and withdraw after attaining the age of maturity.

          The above order be complied within 45 days from the date of order failing which further interest @12% per annum from the date of default till the date of realization.

9.                If the order of this Commission is not complied with, then the complainant shall be entitled to file execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the defaulting party will be liable for prosecution under Section 72 of the said Act which provides punishment of imprisonment for a term which shall not less than one month, but which may extend to three years or with fine, which shall not be less than twenty-five thousand rupees, but which may extend to Rs. one lac or with both. Copies of this order be sent to the parties free of costs as per rules and this order be promptly uploaded on the website of this Commission. File be consigned to the record room after due compliance.