BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.170 of 2020
Date of Instt. 17.06.2020
Date of Decision: 26.06.2024
Balvir Kaur Age about 40 years Wife of Sh. Gian Chand Resident of H. No.262/2, Guru Nanak Pura East, Chogiti, Jalandhar.
..........Complainant
Versus
1. The Manager HDFC Egro General Insurance Co. Ltd. D-301, Floor Easter Business District (Magnet Mall) LBS Bhandup (West), Mumbai 400078.
2) The Branch Manager, HDFC Egro General Insurance Co. Ltd., 3rd Floor Eminent Mall, 261, Lajpat Nagar, Near Guru Nanak Mission Chowk, Jalandhar.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Sh. Jaswant Singh Dhillon (Member)
Present: Sh. N. S. Minhas, Adv. Counsel for Complainant.
Sh. Raman Sharma, Adv. Counsel for the OPs.
Order
Jyotsna (Member)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the husband of the complainant had purchased an insurance policy Sarv Surakshha from the OP No.2 bearing Master Policy No.2999201366179900 on 28.04.2016 upto 27.04.2020 and paid the requisite amount to the OP No.2. The complainant being wife of Sh. Gian Chand was the nominee of the above said policy. Unfortunately, on 13.04.2018 the husband of the complainant died and thereafter complainant approached the OP No.2 for the reimbursement of policy amount which was due on the death of husband of the complainant. The complainant has submitted all the formalities/documents as required by the OPs, but the OPs have repudiated the claim of the complainant pertaining to the death claim of the husband of the complainant on a flimsy ground, whereas the grounds for repudiating the claim is nothing but the said reason have been cited just for sake of a reason for repudiating the said claim of the complainant. The complainant sent a legal notice dated 12.10.2019 to both the parties, but all in vain and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to pay a compensation of Rs.5,00,000/-.
2. Notice of the complaint was sent to the OPs, who filed reply and contested the complaint by taking preliminary objections that the complaint of the complainant is pre mature and deserves to be dismissed on this ground alone. In the absence of the requisite documents the answering OP was not able to decide the claim on merits and therefore the same was closed and not repudiated. Therefore, it is submitted that the complainant herself is liable for the non compliance of the present claim. It is further averred that the claim of the complainant has never been rejected but has been closed due to non receipt of documents from the complainant. It is further averred that the complainant even in her complaint has failed to mention any cause of death. The policy which was issued to the deceased insured as the following coverages:-
a) Critical Illness
b) Accidental Death
c) Permanent Total Disability/Permanent Partial Disability
d) Credit Shield Insurance
e) Accidental Hospitalization
The aforementioned description is not exhaustive in nature. It is further averred that the complainant has failed to mention the cause of death in the complaint and has further failed to submit any documents to the OPs which shall enable to the OPs to process the claim of the complainant on merits. On merits, it is admitted that a policy was issued to the deceased insured, but the other allegations as made in the complaint by the complainant are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
3. Rejoinder not filed by the complainant.
4. In order to prove their respective versions, the counsel for the parties have produced on the file their respective evidence.
5. We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.
6. It is admitted and proved fact that the husband of the complainant had purchased an insurance policy from OP No.2, which was valid from 28.04.2016 to 27.04.2020, which is evident from Ex.C1. The complainant was the nominee of the said policy. On 13.04.2018, the husband of the complainant had died, which is evident from Ex.C-2 i.e. Death Certificate and the complainant approached the OP No.2 for reimbursement of policy amount which was due on the death of the husband of the complainant. The complainant has alleged that he submitted all the documents which was required, but the OPs have repudiated the claim of the complainant. The complainant sent a legal notice to the OP, but all in vain. Request has been made to allow the complaint.
7. The contention of the OPs is that the complaint of the complainant is pre-mature and the claim of the complainant has never been rejected rather closed due to non-receipt of documents from the complainant. Further, as OPs had demanded document of cause of death in para No.5 of written statement. In such circumstances, OPs are directed to give the document of cause of death and required documents, if any, within 15 days from the date of receipt of the copy of the order and then the OPs will settle the claim of the complainant within 15 days from the date of receipt of the documents/information, failing which the OPs will be liable to pay compensation of Rs.20,000/- to the complainant. It is further ordered that if the complainant is not satisfied with the settlement of the claim made by the OPs, then she is at liberty to file a fresh complaint. Thus, the complaint of the complainant is disposed of. This complaint could not be decided within stipulated time frame due to rush of work.
8. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
26.06.2024 Member Member President
