Chandigarh

DF-I

CC/110/2021

Jaswant Kaur - Complainant(s)

Versus

The Managing Director, TATA AIG General Insurance Co. Ltd. - Opp.Party(s)

Rupesh Kumar

22 Feb 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

 

                   

Consumer Complaint No.	:	CC/110/2021
Date of Institution	:	19.2.2021
Date of Decision	:	22.2.2023

 

Jaswant Kaur wife of late S. Sarabjit Singh aged 46 years r/o H. No.4, Baba Deep Singh Nagar, Badi Nadi Paar, Patiala (Pb) 147001.

.

… Complainant

V E R S U S

1.    The Managing Director, Tata AIG general Insurance Company Ltd. Regd. Office 15^th floor tower, A, Peninsula Business park, Ganpatrao Kadam Marg, Mumbai, Maharashtra 400013.
2.    The Branch Manager, TATA AIG General Insurance Company Ltd. SCO 232-234, 2^nd floor, Sector 34-A, Chandigarh.
3.    Sh. Manoj Kumar, agent TATA AIG general Insurance Company SCO 232-234, 2^nd floor, Sector 34-A, Chandigarh.
4.    The Branch Manager, Axis Bank Ltd., Baradari, Tehsil and District Patiala (Pb).

 .  … Opposite Party

 

CORAM :	PAWANJIT SINGH	PRESIDENT
	SURESH KUMAR SARDANA	MEMBER

                        

ARGUED BY		Sh. Rupesh Kumar, counsel for complainant. Sh. Sahil Abhi, counsel for OP No.1 to 3. OP No.4 exparte.

Per Suresh Kumar Sardana, Member

1. The present consumer complaint has been filed by the complainant against the opposite parties  (hereinafter referred to as the OP/OPs). Briefly stated,  the complainant purchased a Maruti Dzire car from OP No.4  on term loan/finance basis and to secure the loan amount an insurance policy for a period of 5 years was purchased from OPs No.1&2 through OPNo.3. The insurance policy was valid for the period from 30.11.2019 to 29.11.2024. A premium of Rs.11,971/- was paid towards the policy in question by the husband of the complainant. It was assured at the time of taking policy that in case of any casualty to the insurer due to natural death or accidental death the entire loan amount of the vehicle was to be borne by the insurance company. Unfortunately, on 21.8.2020 the husband of the complainant expired due to dengue fever. After death the complainant filed claim but the Ops No.1&2 repudiated the claim of the complainant on flimsy ground  that the cause of death was due to sickness and as per policy the insurer claim is declined, due to beyond the coverage’s available under the policy.  The complainant issued legal notice dated 4.11.2020 to the OPs but to no avail. Alleging the aforesaid act of Opposite Parties deficiency in service and unfair trade practice on their part, this complaint has been filed
2. The Opposite Parties NO. 1 to 3 while admitting the factual matrix of the case stated that the claim was lodged with the TATA AIG General Insurance Co. Ltd. on account of death of husband of the complainant the insured, due to dengue fever. After receipt of the documents and scrutinizing the same in terms of the insurance policy and after due application of the mind by the officials of the insurance company the claim of the complainant was repudiated as no claim on the ground that the death due to sickness is beyond the scope of coverage. It is averred that only accidental death is covered as defined in Section 2 of the policy and that too if comes under the purview of the terms and conditions of the policy. It is further averred that dengue fever due to mosquito bite is not covered under the definition of accident which is defined in the policy. It is vehemently denied that the loan amount was secured under the policy. All other allegations made in the complaint has been denied being wrong.
3. OP No.4 did not turn up despite due service, hence vide order dated 16.06.2021 it was proceeded against exparte.
4. Rejoinder was filed and averments made in the consumer complaint were reiterated
5. Contesting parties led evidence by way of affidavits and documents.
6. We have heard the learned counsel for the contesting parties and gone through the record of the case.
7. The main grievance of the complainant is that in spite of having proper insurance cover of her late husband, the legitimate claim was not paid by the OPs.
8. We have perused the policy opted by the insured. The policy has the following coverages:-

1. Accidental death
2. Permanent total disability
3. Permanent partial disability
4. Key replacement coverages
5. Monthly EMI benefit
6. Accidental IPD
7. Loss of job.  

9. It is the admitted case of the complainant itself that her late husband died due to dengue fever and whereas the policy covers only accidental death as mentioned above, hence, the claim of the complainant that death of her husband due to dengue fever is also cover under the policy is not tenable.  
10. We are of the opinion that the cause of death of the insured i.e. the husband of the complainant is beyond the scope of coverages available under the policy. Hence, the OPs have rightly denied the claim of the complainant.
11. In view of the aforesaid discussion, the present consumer complaint, being devoid of any merit, is hereby dismissed leaving the parties to bear their own costs.
12.     Certified copies of this order be sent to the parties free of charge. The file be consigned

Sd/-

			[Pawanjit Singh]
			President
			Sd/-
			[Suresh Kumar Sardana]
mp			Member