DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA

C.C. No. 288 of 24-11-2021

Decided on : 30-6-2022

Shelly Gupta aged about 45 years wife of Rakesh Kumar Bansal resident of #16797, 4, Basant Vihar, Bathinda.

...Complainant

Versus

1. Dewan Housing Finance Corporation Ltd. Warden House, 2^nd Floor, Sir P.M. Road, Fort. Mumbai through its Managing Director/ authorized signatory.

2. DHFL, SCO 123, Goniana Road, Bathinda through its Branch Manager/ authorized signatory.

3. DHFL Home Shield NHL underwritten by DHFL Pramerica Life Insurance Co. Ltd. 4^th Floor, Building No.9, Tower-B, Cyber City, DFL Phase-III, Gurgaon through its General Manager/ authorized signatory.

4. Chola MS General Insurance Co. Ltd. 2^nd Floor, Dare House, 2 NSC Bose Road, Chennai through its Managing Director/ authorized signatory.

5. Chola MS General Insurance Co. Ltd. 2907/C/10 Jindal Complex, GT Road, near Hanuman Chowk, Bathinda through its Branch Manager/ authorized signatory.

...Opposite Parties

Complaint under Section 35 of the Consumer Protection Act, 2019

QUORUM

Sh. Kanwar Sandeep Singh, President

Sh. Shivdev Singh, Member

Present

For the complainant : Sh. Sunder Gupta, Advocate.

For opposite parties : OPs No. 1 & 2 exparte

Sh. N K Batta, Advocate, for OP No. 3

Sh. Vinod Garg, Advocate, for OPs No. 4 & 5.

ORDER

Kanwar Sandeep Singh, President

1. The complainant Shelly Gupta (here-in-after referred to as complainant) has filed this complaint U/s 35 of Consumer Protection Act, 2019 (here-in after referred to as 'Act') before this Commission against Dewan Housing Finance Corporation Ltd., and others (here-in-after referred to as opposite parties).

2. Briefly stated the case of the complainant is that opposite parties No. 1 & 2 DHFL, have now been merged/changed its name as Piramal Capital & Housing Finance Ltd., allured the husband of complainant Sh. Rakesh Kumar son of Kaur Chand to take housing loan or personal loan and further allured that opposite party No.1 & 2 provide the aforesaid loan on minimum rate of interest. The opposite parties No.1 & 2 further allured that they have tie ups with opposite parties No. 3 to 5 and whosoever obtains the loan from opposite parties No.1 & 2 then they will arrange life insurance, family floater health policy and group personal accident cover policy for the loan amount.

3. It is alleged that Rakesh Kumar took a personal loan amount of Rs.14,26,876/- vide loan application No. 01458574, loan account No.24500000977, which was disbursed on 22.03.2017 with EMI of Rs.18,397/- for a period of 15 years, by opposite party No .2, which is branch office of opposite party No.1. At the time of disbursement of aforesaid loan, opposite party No.1 & 2 obtained the original sale deed of plot measuring 113 sq. yards situated at Harpal Nagar, St. No.10, Bathinda, purchased in the name of complainant vide registered sale deed No.3 dated 01.04.2015. The opposite parties No.1 & 2 also got the signatures of said Rakesh Kumar and complainant on various plain blank papers as well as on various printed forms, with the assurance that loan amount shall be sanctioned and disbursed to said Rakesh Kumar immediately. The opposite parties No. 1 & 2 further conveyed that complainant has to mortgage some property with opposite parties No.1 & 2. Accordingly, complainant mortgaged registered sale deed No.3 dated 01.04.2015 and vide rapat No.1223 dated 22.03.2017 the same has been duly entered with Revenue Authorities, Bathinda.

4. The complainant further alleged that at the time of disbursement of said loan in the year 2017, opposite parties No.1 & 2, conveyed the complainant and her husband that loan amount is repayable in 15 years, with monthly EMI of Rs.18,397/- and further offered that opposite parties No.1 & 2 have tie ups with opposite parties No. 3 to 5 for various types of insurances such as DHFL Home Shield NHL, underwritten by DHFL Pramerica Life Insurance Co. Ltd., Family Floater Insurance underwritten by Chola MS General Insurance Co. Ltd. and Personal Accident Insurance underwritten by Chola MS General Insurance Co. Ltd. for which opposite party No.1 & 2 further conveyed that they shall charge Rs.9370/- as premium for each year for DHFL Home Shield loan under life insurance, a premium of Rs.14,286/- for Family Floater Insurance issued by Chola MS General Insurance and a premium of Rs.3220/- for Personal Accident Insurance issued by Chola MS General Insurance Co. Ltd.. The opposite parties No.1 & 2 further conveyed that aforesaid premium amount is included in the EMI of Rs.18,397/- and complainant or her husband need not to pay any separate premium as opposite parties No.1 & 2 have insurance tie ups with opposite parties No.3 to 5. The opposite parties No. 1 & 2 also conveyed that said insurance policies shall continue till the whole amount of loan is repaid by the loanee/complainant.

5. It is alleged that the complainant and her husband accepted the aforesaid offer and accordingly, DHFL Pramerica i.e. opposite parties No.1 & 2 issued Insurance Certificate No. GC000006M793500 wherein a premium of Rs.9369.57 has been shown to have been paid. It has been further mentioned in the said certificate that CSI is Rs.14,26,875/- with life insurance of single life i.e. of loanee Rakesh Kumar. Chola MS General Insurance issued only Health Card disclosing policy No.2868/00115926/0046/000/00 in the name of Rakesh Kumar but no terms and conditions of insurance policy were ever supplied either by DHFL or by Chola MS General Insurance i.e. opposite parties No.3 to 5 to the complainant. The receipt of premium has been duly conveyed by opposite parties No.1 & 2 vide their letter dated 10.03.2017. As per said letter dated 10.03.2017, total insurance premium of Rs.1,09,954/- has been charged by opposite parties No.1 & 2 for issuing the said insurance policies and amount has been deducted by opposite parties No.1 & 2 from total sanctioned loan of Rs.15,09,954/-. In this way opposite parties No.1 & 2 have charged the total premium for a period of 15 years from the date of disbursement.

6. It is alleged that the opposite parties No.1 & 2 through opposite parties No.4 & 5 have also issued Group Personal Accident Cover for five years to the loanee under Master Policy Holder name DHFL with sum insured of Rs.14,17,505/- by charging premium amount of Rs.3220/- as on 22.03.2017.

7. It is alleged that Rakesh Kumar suffered from an ailment in the month of January/ February, 2019 and opposite parties No.4 & 5 reimbursed the medical bills through NEFT on 09.09.2019 to the tune of Rs.77,203/- which proves that complainant have insurable interest against all the opposite parties.The complainant alleged that her husband Rakesh Kumar used to deposit the EMI of the aforesaid housing loan regularly.

8. The complainant further alleged that Rakesh Kumar fell ill and was reported Covid positive by Aruna Memorial Hospital, Bhatti Road, Bathinda vide report dated 23.04.2021. He remained quarantined in the house till 26.04.2021 under the treatment of aforesaid hospital. Since the condition of Rakesh Kumar did not improve, he was referred to Fortis Hospital, Mohali after receipt of report of HRCT Chest dated 26.04.2021. Thereafter, Rakesh Kumar was admitted in Fortis Hospital, Mohali on 27.04.2021 vide UHID No.8746763. The complainant showed/ handed over all the above said Health policies of opposite parties No. 3 to 5 with Fortis Hospital for cashless treatment, but the opposite parties rejected the cashless treatment to said Rakesh Kumar.

9. It is further alleged that condition of said Rakesh Kumar did not improve and since his family was unable to bear the expenses of Fortis Hospital anymore, so Rakesh Kumar was got discharged from Fortis hospital, Mohali on 05.06.2021 and was got admitted in Guru Gobind Singh Medical College & Hospital for further treatment on 05.06.2021 till his death on ill fated day of 12.06.2021. Fortis Hospital charged Rs.16,20,974.74 for treatment of said Rakesh Kumar. Faridkot Medical College and Hospital issued medical certificate meantioning therein cause of death of Rakesh Kumar on 12.06.2021 due to severe Covid illness.

10. The complainant alleged that she lodged reimbursement claim of medical bills amounting to Rs.16,20,974.74 and other benefits available and submitted all the documents with the opposite parties but opposite parties have failed to pay the aforesaid claims although all the opposite parties through opposite parties No.1 & 2 have been regularly getting the insurance premium as per account statement where last EMI of Rs.20,000/- have been shown to be paid on 30.01.2021. Moreover, premium amount is covered in the EMI.

11. The complainant also alleged that she filed application under RTI Act with all the opposite parties on 27.08.2021 to supply the complete set of insurance policies/ cover notes, insurance premium receipt from opposite parties No.1 & 2, loan account statements and reason for not sanctioning the medi-claim bills of deceased Rakesh Kumar etc. But opposite parties only supplied DHFL Home Shield group credit life bearing application No.01458574 containing two pages dated 22.03.2017, Chola MS Family Floater Insurance dated 22.03.2017 and Chola MS Group Personal Accident cover for five years dated 22.03.2017 with CIS of Rs.14,17,505/- to the complainant. However, no complete policy along with the respective terms and condition of respective insurance policies have been supplied.

12. It has been further pleaded that complainant has been nominated as nominee in the certificate of insurance issued by DHFL Pramerica and Chola MS General Insurance Co. Ltd., as such, present complaint has been filed through Shelly Gupta widow of Rakesh Kumar and her interest are not adverse in any manner against the other legal heirs of her deceased husband Rakesh Kumar.

13. The complainant further alleged that intimation regarding admission of Rakesh Kumar since deceased was duly given by Fortis Hospital, Mohali, for cashless treatment which was denied by the Chola MS General Insurance Co. Ltd.. and intimation regarding ailment suffered by said Rakesh Kumar was also given to opposite parties No.1 to 3. The opposite parties No.1 to 3 were further requested to remit the loan obtained by said Rakesh Kumar from opposite parties No.1 & 2 amounting to Rs.14,26,876/-. The opposite parties were further requested to pay the medical bills/expenses incurred by said Rakesh Kumar in Fortis Hospital, but they failed to do so.

14. The complainant alleged that under the garb of above said loan documents and by misusing the signatures of complainant and her husband Rakesh Kumar, obtained by opposite parties No.1 & 2, on blank and printed forms, they are trying to recover the aforesaid loan amount illegally in a coercive method and threatening the complainant that they shall sell the house bearing MCB No.Z0404344 situated at Harpal Nagar purchased by the complainant through sale deed No. 3 dated 01.04.2015.

15. It has been alleged that complainant repeatedly requested the officials of opposite parties No.2 & 5 at Bathinda to pay her lawful claim but to no effect. The opposite parties No.1 & 2 are harassing and threatening the complainant and legal heirs of deceased Rakesh Kumar that they shall recover the loan amount paid to Rakesh Kumar along with interest by sale of aforesaid plot as well as by instituting proceedings under SARFAESI Act and they are further threatening that no medical claim of Rakesh Kumar shall be paid to the complainant and they shall recover the loan amount by any mean under coercive method. Due to said adamant act and conduct of the opposite parties, complainant has suffered mental tension, agony, harassment, botheration and humiliation, for which she claims compensation to the tune of Rs.5,00,000/-.

16. On this backdrop of facts, the complainant has prayed for following reliefs :-

    (a) To a pay a sum of Rs.16,20,974/- along with interest @ 18% from the date of payment of the aforesaid bills to the Fortis Hospital till realization;

    (b) To waive the loan amount allegedly paid to the deceased Rakesh Kumar and not to recover the same from the complainant or legal heirs of Rakesh Kumar and to return the sale deed No.3 dated 01.04.2015;

    (c) To pay an amount of Rs.14,26,875/- on account of life insurance of loanee Rakesh Kumar issued by OP No.3 on behalf of OP No.1 & 2.

    (d) To pay an amount of Rs.14,17,505/- regarding loan amount of loanee Rakesh Kumar issued by OP No.5 and further to pay an amount of Rs.3,00,000/- on account of Family Floater issued by OP No.4 on behalf of OP No.1 & 2.

    (e) To pay Rs.20,00,000/- on account of life insurance cover issued to the deceased Rakesh Kumar by all the opposite parties.

    (f) To pay compensation to the tune of Rs.5,00,000/- on account of mental tension, harassment, botheration, agony and humiliation;

    (g) To pay Rs.55,000/- as cost of litigation expenses for filing the present complaint;

    (h) To pay any other additional, alternative and consequential relief for which he may be found entitled to.

17. Registered A.D. Notice of complaint were sent to all the opposite parties.

18. In the case in hand, Sh. N K Batta, appeared and intially filed power of attorney and joint reply on behalf of opposite parties No. 1 to 3 and also tendered evidence on behalf of opposite parties No. 1 to 3. Thereafter, he moved an application on 21-6-2022, when the case was fixed for arguments for considering written statement and evidence submitted by opposite party No. 3 through his counsel Sh N K Batta on behalf of opposite party No. 3 only and not on behalf of opposite parties No. 1 & 2. He also suffered statement, recorded separately, to the effect that in view of application dated 21-6-2022, he plead no instructions from opposite parties No. 1 & 2 to proceed further in this case. Since present complainant has also filed CWP No. 9733 before Hon'ble High Court at Chandigarh and present opposite parties No. 1 to 3 have been arrayed as respondent Nos. 3 to 5 in said CWP. Hon'ble High vide order dated 16-5-2022 directed this Commission to decide this complaint after hearing all the parties by 30-6-2022. So, pendency of present complaint is in the knowledge of opposite parties No. 1 & 2. Therefore, considering the fact that this complaint is already in the notice of opposite parties No. 1 & 2 and keeping in view the directions of the Hon'ble High Court to decide the case in hand by 30-6-2022, it was not appropriate to start the proceedings of this case again from the initial stage of notice. Thus, after awaiting for sufficient time and calling the case repeatedly, opposite parties No. 1 & 2 were proceeded against exparte vide order dated 22-6-2022.

19. The opposite parties No. 1 to 3 filed joint written reply by submitting that opposite party No. 3, i.e., Pramerica Life Insurance Limited (PLIL) is a joint venture between DHFL Investments Limited (DIL), a wholly-owned subsidiary of Piramal Capital and Housing Finance Limited ("PCHFL") and Prudential International Insurance Holdings, Ltd. (PIIH), a fully owned subsidiary of Prudential Financial, Inc. (PFI). Pramerica Life Insurance Limited represents the coming together of two renowned financial services organizations with a legacy of business excellence spread over decades. Pramerica Life Insurance Limited, started operations in India on September 01, 2008 and has a pan India presence through multiple distribution channels which have been customized to address the specific insurance needs of diverse customer segments. Pramerica is the brand name used in India and select countries by Prudential Financial, Inc. As part of the implementation in compliance of the Hon'ble NCLT order dated June 7, 2021, PCHFL has been merged into and with Dewan Housing Finance Corporation Limited "DHFL" by way of an amalgamation by a scheme of arrangement, and in accordance with approved scheme of arrangement, the name of the entity has been changed from Dewan Housing Finance Corporation Limited to "Piramal Capital & Housing Finance Limited" vide certificate of incorporation issued by the Registrar of Companies, Mumbai dated 3^rd, November, 2021.

20. It has been pleaded that the opposite party No. 3 i.e. Pramerica Life Insurance Limited (erstwhile DHFL Pramerica Life Insurance Company Limited), is a corporate body duly incorporated under the provisions of the Companies Act, 1956 having its registered office at Gurugram, Haryana. The Pramerica Life Insurance Limited is primarily into the business of Life Insurance duly approved by the Government of India through the insurance regulator IRDA and has branches across India and is widely acclaimed for its reputation and services.

21. Thereafter, the opposite party No. 3 raised preliminary objections that the complaint is fake, malicious, incorrect and is an abuse of process of law. That, from the perusal of the instant complaint, it would be observed that averments made therein are vague, baseless and with mala fide intent. The complainant has made misconceived and baseless allegations of deficiency in services without any documentary evidence in support of her allegations made in the complaint.

22. It has been pleaded that husband of the complainant namely Mr. Rakesh Kumar after completely understanding the terms and conditions of the policy product "DHFL HOME SHIELD" had submitted a proposal form bearing no. 01458574 with Master Policy No. as GC000006 on 22" March, 2017, wherein the opposite Party No. 1 and complainant were appointed as nominees and a coverage to the tune of Rs 14,26,874/- was the sum assured. In response to the Proposal Form, opposite party duly processed the same and issued Insurance Policy and Certificate of Insurance bearing No. GC000006M793500 in the name of Rakesh Kumar, which provided a Coverage Sum Assured of Rs. 14,26,874/- with terminal illness benefits of Rs. 4,15,105/- for 2 years commencing from 22^nd March, 2017 to 21^st March, 2019.

23. It has been pleaded that as per policy terms and conditions and the benefit schedule provided therein, the said policy provided a coverage for a term of 24 months or 2 years only commencing from 22^nd March, 2017 to 21st March, 2019.

24. It has been further pleaded Decesed Life Insured Rakesh Kumar expired on 12th June, 2021 and as the policy expired on 21st March, 2019 from providing coverage, complainant is not entitled to any benefit as death of the DLI occurred beyond the period of the coverage of the policy.

25. Further preliminary objections are that the complaint lacks a cause of action because the deceased life assured Rakesh Kumar expired after expiry of the policy. The nominee, i.e. complainant does not remain entitled to any benefit and therefore, this complaint is liable to be dismissed on this ground alone for want of cause of action. That complaint is neither maintainable in law nor on facts.

26. On merits, it has been pleaded that Deceased Life Insured i.e. Mr. Rakesh Kumar being a member of Master Policyholder had approached the opposite party to avail life insurance policy of Rs.14,26,874/- for a period of 24 months commencing from 22.03.2017 to 21.03.2019. It has been denied that DLI or the complainant were made to sign any blank papers by the opposite party.

27. It has been pleaded that opposite party No. 3 received the Application Form and issued Policy Product namely "DHFL HOME SHIELD / PRAMERICA LIFE GROUP CREDIT LIFE+" in favour of Rakesh Kumar towards which a policy premium of Rs. 9613.99 was paid by Rakesh Kumar, deceased life Insured, which provided a coverage sum assured to the tune of Rs. 14,26,874/- for term of 2 years having coverage commencement date from 22^nd March, 2017 to 21^st March, 2019.

28. The opposite party No. 3 has further pleaded that as Rakesh Kumar, expired on 12th June, 2021 and the policy expired on 21' March, 2019 from providing coverage, the complainant does not remain entitled to any benefit as death of the DLI occurred beyond the period of the coverage of the policy. The DLI had purchased Policy Product with coverage term of only 2 years commencing from 22^nd March, 2017 to 21^st March, 2019 after which, the policy benefits stood expired. After controverting all other averments of the complainant, the opposite party No. 3 prayed for dismissal of complaint.

29. Opposite parties No. 4 & 5 put an appearance through counsel and contested the complaint by filing joint written reply raising legal objections that the claim is not maintainable against the opposite parties as there was no coverage under the Health Insurance Policy as on the date of alleged loss and for accidental death benefit claim, it was submitted that no claim was ever lodged with opposite parties so that the same could be investigated, processed and decided as per terms and conditions of the policy. Even otherwise, the deceased has died a natural death due to Corona as pleaded by the complainant which cannot be treated as an accidental death by any stretch of imagination. That the complainant has no locus standi or cause of action to file the present complaint against opposite parties. That the complainant is not a consumer. That the complaint is bad for non joinder of necessary parties as the complainant has not impleaded DHFL Pramerica Life insurance Company Limited who is otherwise a necessary party. That the complaint is bad for non joinder of necessary parties as all the legal heirs of deceased Rakesh Kumar have not been impleaded as parties to the present complaint.

30. On merits, it has been pleaded that there was no health insurance coverage/policy as on the date of alleged loss and qua personal accident death claim, no claim has been lodged and it is not a case of accidental death, hence no amount is payable. Since there was no health insurance policy of replying opposite parties for the period in question, the question of making any reimbursement of medical expenses does not arise at all. The opposite parties No. 4 & 5 denied that family floater insurance policy was for five years from 22.3.2017 as alleged, rather no such health insurance was taken after 2020. It has been pleaded that it is for the complainant to prove payment of premium and coverage under personal accident policy. The opposite parties denied that no policy with terms and conditions were supplied to the deceased. The opposite parties denied all other averments of the complainant. In the end, the opposite parties No. 4 & 5 prayed for dismissal of complaint.

31. In support of her complaint, the complainant has tendered into evidence her affidavit dated 27-5-2022 (Ex. C-1) and the documents (Ex. C-2 to Ex. C-28).

32. In order to rebut the evidence of complainant, opposite party No. 3 (OPs 1 to 3) tendered into evidence affidavit of Mritunjay Kumar Singh dated 3-6-2022 (Ex. OP-1/5) and documents (Ex. OP-1/1 to Ex. OP-1/4).

33. The opposite parties No. 4 & 5 tendered into evidence affidavit of Vidhi Passi dated 8-3-2022 (Ex. OP-4/1) and documents (Ex. OP-4/2 & Ex. OP-4/3).

34. The learned counsel for the parties reiterated their stand as taken in their respective pleadings.

35. We have heared learned counsel for the parties, gone through written arguments submitted by the parties and perused the record.

36. Admitted facts of the case are that Rakesh Kumar, Deceased Life Insured (here-in-after referred to as 'DLI') availed loan amounting to Rs. 14,26,874/- from opposite parties No. 1 & 2 and the Insurance policies are issued by opposite parties No. 3 to 5. Further opposite parties No. 1 & 2 obtained original sale deed of plot of complainant and got the property mortgaged in their favour.

37. The learned counsel for the complainant submitted that Rakesh Kumar DLI obtained loan from opposite parties No. 1 & 2. The opposite party No. 3 provided Insurance to secure loan amount and opposite parties No. 4 & 5 provided medical insurance as well as group personal acccident insurance. The opposite parties provided insurance as per their arrangement between them. Rakesh Kumar, DLI died due to Corona. He remained admitted in Fortis Hospital, mohali and at Medical College, Faridkot. The complainant submitted claim, but opposite parties neither allowed cashless treatment nor reimbursed the medical expenses incurred on the treatment of the DLI. The complainant is not liable to pay any due loan amount in view of insurance. The complainant being widow/nominee of DLI Rakesh Kumar is running from pillar to post to get justice but to no effect. Thus, learned counsel for the complainant submitted that, prayed relief be allowed to complainant.

38. The learned counsel for the opposite party No. 3 submitted that in response to the application form (Ex. OP-1/2 /Ex C-4) from Rakesh Kumar, opposite parties processed the same and issued insurance policy in his name providing coverage to the tune of Rs. 14,26,874/- with terminal illness benefits of Rs. 4,15,105/- for two years commencing from 22-3-2017 to 21-3-2019. The learned counsel for the opposite party No. 3 argued that as per policy terms and conditions and the benefit schedule provided therein, the said policy provided a coverage for a term of 24 months or 2 years only commecning from 22-3-2017 to 21-3-2019. Rakesh Kumar, Deceased Life Insured expired on 12-6-2021 whereas the policy expired on 21-3-2019, so the complainant/nominee is not entitled to any benefit.

39. The submission of learned counsel for opposite parties No. 4 & 5 is that deceased has died a natural death due to Corona as pleaded by complainant which cannot be treated as an accidental death by any stretch of imagination. Thus, opposite parties No. 4 & 5 are not liable to pay any claim to complainant. The learned counsel for opposite parties No. 4 & 5 further submitted that family floater insurance policy was not for five year rather DLI has not taken any such insurance after 2020.

40. We have given careful consideration to the rival contentions.

41. Ex. C-4/OP-1/2 is the Application duly signed by parties for DHFL Pramerica Group Credit Life +. As per this document, Master Policy name is Dewan Housing Finance Corporation Limited. Personal Details of the applicant is mentioned as Rakesh Kumar and spouse name Shelly Gupta (complainant). Loan amount is Rs. 14,26,875/-, loan against property, loan tenure 180 months, Premium funded by MPH (Master Policy Holder), Premium Rs. 9370/-, premium paying term – 01, Coverage Terms – 180 months. Thus, this application form which has been specifically referred by learned counsel for opposite party No. 3, itself speaks that coverage sum assured is Rs. 14,26,875/-, premium of Rs. 9370/- is one time and coverage terms is 180 months.

42. In the case in hand, opposite parties No. 1 & 2 vide letter of offer cum acceptance dated 10-3-2017 (Ex. C-2) offered personal loan of Rs. 15,09,954/- to Rakesh Kumar, Deceased Life Insured A perusal of this document reveals that loan was for 15 years, 180 monthly EMIs each EMI of Rs. 19,358/-. Letter of Offer Cum Acceptance (Ex. C-2) reveals that Total insurance amount of Rs. 1,09,954/- was to be deducted from total disbusement. It has been mentioned in this document that :-

    (a) DHFL Home Shied NDL underwritten by DHFI Pramerica Life Insurance Co. Ltd, The Premium amount is Rs. 9370/-.

    (b) Family Floater Insurance underwritten by Chola MS General Insurance Co. Ltd., The Premium amount is Rs. 14,286/-

    (c) Personal Accident Insurance underwritten by Chola MS General Insurance Co. Ltd., The Premium amount is Rs. 3220/-.

43. So far as aforesaid offer-cum-acceptance is concerned, this Commission is of the considered opinion that this document is only an offer which was given by the opposite parties to complainant. It is not an agreement and it does not bear signature of DLI.

44. Ex. C-3/Ex. OP-1/3 is the Welcome letter issued to Rakesh Kumar by opposite party No. 3 vide which opposite party forwarded certificate of insurance and benefit schedule to DLI. This document reveals that this letter has been issued with regard to DHFL Home Shield, A Group scheme under DHFL Pramerica Group Credit Life+ UIN 140N039V01. It has been clearly mentioned in the subject of this letter “Single Premium.” The opposite parties while relying upon this document, pleaded that policy terms is 2 years, hence claim is not payable. Certificate of insurance No. GC000006M793500 (Ex. C-3) reveals that policy details are mentioned as under :-

    Coverage Sum Assured – Rs. 14,26,874/-; Premium paid Rs. 9369.57

    Coverage Term (years) – 2 years ; Coverage commencement date 22- 3-2017 ; Coverage expiry date 21-3-2019.

Loan details are given as :-

Loan Number – 1458574; Loan Tenure/Months – 24; Loan Disbursed Date 22-3-2017 ; Loan Amount - Rs. 14,26,874/-; Loan period from 22-3-2017 to 21-3-2019. Nominee – Mrs. Shely Gupta- Wife.

Benefits Detail -

Coverage Sum Assured – Rs.14,26,874/-

Terminal Illness Benefit – Rs. 4,15,105.98

44. A perusal of this document (Ex. C-3/OP-1/3) reveals that details of Insurance and loan particulars seems to be filled in a hurried manner as the particulars of this document are not in consonance with the application (Ex. C-4) on the basis of which this document(Ex. C-3/OP-1/3) has been issued. It appears that this document has been prepared just to deny claim to complainant. The opposite party No. 3 has not produced any document to prove that Ex.C-3/OP-1/3 was even delivered to the complainant. Moreover, as per complainant, these documents were procured by her through RTI. Otherwise also, when the loan was sanctioned and disbursed to deceased Rakesh Kumar and he started paying premium, then it was also the duty of opposite parties No. 1 & 2 to deposit required premium with opposite party No. 3 to 5 as deceased Rakesh Kumar got the insurance on the asking of opposite parties No. 1 & 2. In Ex. C-3/OP-1/3, the tenure of loan was mentioned from 22-3-2017 to 21-3-2019 i.e. two years likewise period of insurance benefit was also mentioned for two years i.e. commencement date 22-3-2017 and expiry date as 21-3-2019. Thus, it further makes position crystal clear that benefit of insurance policy period provided under the policy in question was equal to the period of loan period. The opposite party did not go through the propsal form (Ex. C-4) submitted by complainant and even their own record wherein it is mentioned that loan tenure 180 months and Insurance Coverage Terms (in months) 180. Hence, it is proved on file that coverage of insurance policy in question is for 180 months meaning thereby coverage was provided during the whole period of loan. Except this document, opposite parties have not placed on file any document to prove that insurance policy in question is not a single premium policy or that the coverage is not for whole loan period. Ex. C-9 is the revised letter of offer cum acceptance wherein loan amount is shown as Rs. 14,26,876/- with EMI of Rs. 17,593/- for 15 years. Though Ex. C-9 has been issued after the death of insured and appears to be prepared just for self serving purpose but it further fortifies the case of complainant regarding payment of insurance premium i.e. Rs. 26,876/- deducted from the loan amount. As per Ex. C-8 Statement of account Rs. 26,876/- were debited from loan amount.

45. As far as policy ( Ex.C-3/OP-1/3) issued by opposite party No. 3 is concerned, it has been issued on the basis of Application Ex. C-4/OP-1/2. Ex. C-4/OP-1/2 shows that loan amount is Rs. 14,26,875/- and loan tenure is 180 months and the premium funded by MPH (Master Policy Holder). In column 'coverage information', it has been mentioned that premium is Rs. 9370/-, premium paying term '01' and coverage terms is 'months 180', but surprisingly, opposite party No. 3 relied upon policy Ex. C-3/OP-1/3 which is not in consonance with the application Ex. C-4/OP-1/2.

46. Accordingly, complainant being nominee of deceased life insured Rakesh Kumar is entitled to coverage in force as well as to terminal illness benefit as per terms and conditions of policy.

47. Ex. C-5 is the application form vide which Rakesh Kumar opted for Group Family Floater Health Insurance for Rs. 3.00 Lacs. Master Policy Holder is DHFL, The premium amount is mentioned as Rs. 12,532/- + Rs. 1754/- as Service Tax totaling to Rs. 14,826/-, but in this document tenure of policy is not mentioned.

48. Ex. C-6 is the application form for Group Personal Accident Cover which reveals that coverage was for 5 years and Master policy Holder is DHFL. The loan amount is Rs. 14,17,505/- and total premium amount is Rs. 3220/-.

49. As far as objection of opposite party no. 4&5 regarding non submission of claim is concerned is not tenable as perusal of documents Ex.C-6 reveals that the claim was to be intimated to opposite party no. 1&2 for further forwarding it to insurance companies and the complainant did so vide document Ex.C-23 & C-24. Moreover opposite party no.1&2 has not denied this fact.

50. Admittedly death of Rakesh Kumar, Deceased Life Insured took place due to Corona. Hon'ble Supreme Court in the case titled Smt. Alka Shukla Vs. Life Insurance Corporation of India 2020 (2) CPR 328 has held that :-

    “D. Consumer Protection Act, 1986, Section 23 Accidental death – Claim for insurance – In order to sustain claim under accident benefit cover – Assured must sustain a bodily injury – Injury must solely and directly result from an accident – Accident must be caused by outward, violent and visible means – Injury must solely, directly and independently of all other causes result in death of assured – Death must ensure within a period of 180 days from injury caused in accident.”

51. Therefore, keeping in view the aforesaid law laid down by Hon'ble Supreme Court, complainant is not entitled to any benefit from opposite parties No. 4 & 5 under Personal Accident Insurance.

52. Now, the question is regarding Group Health Insurance Policy i.e. Family Floater (Self + Spouse). Ex. OP-4/2 is the copies of the insurance policies for the period from 22-3-2017 to 21-3-2018, 22-3-2018 to 21-3-2019 and 22-3-2019 to 21-3-2020. A perusal of these documents placed on file by opposite parties No. 4 & 5 reveals that of course name of proposer is mentioned as Mr. Rakesh Kumar but in further details Intermediary name is mentioned as Dewan Housing Finance Corporation Limited and receipt Number of all the policies is mentioned as 1006753306. If the renewal of each policy was got done by Rakesh Kumar himself and he paid the individual premium for each year, there should be different receipt number on each and every policy whereas receipt number on all the policies is similar. This fact proved that insurance premium for Family Floater Policy was paid once and policies were to be issued yearwise till loan term i.e. 15 years. Moreover, the documents issued by the opposite parties No. 4 & 5 in connection with this policy contradicts each other. Ex. C-5 is application for Group Family Floater Health Insurance reveals premium amount as Rs. 12,532/- and Service Tax Rs. 1754/- but there is nothing mentioned regarding coverage period whereas opposite party No. 4&5 brought on file three insurance policies showing different premiums and different dates of issuance of policies.

     

53. The evidence placed on file further reveals that surprisingly, oppoiste parties No. 4 & 5 brought on file three different policies of loanee that too not for entire loan period i.e. Family Floater policies for 3 years and Personal Accident Insurance for 5 years. Therefore, this Commission is of the considered opinion that insurance coverage of loan period was to be given by opposite parties No. 3 to 5 by taking single respective premium.

54. The contention of the opposite parties that loanee has not paid the EMI loan regularly and stopped in beween payment of EMI, is also not tenable. Ex. C-7 is the account statement issued by opposite parties No. 1 & 2 which reveals that last installment of loan/EMI was paid by loanee on 30-01-2021 and paid the dues and even interest accured during covid pandemic. Statement of account further reveals that loanee has paid EMIs well in time. Deceased Rakesh Kumar was diagnosed Corona positive on 23-4-2021. Thus, last 3-4 months EMIs were not paid and on which score alone, it cannot be said that deceased Rakesh Kumar was defaulter as even during covid pandemic special instructions were issued by central government to banks and financial institutions for granting relaxation in interest on loan etc., borne by general public.

55. Hon'ble Punjab & Haryana High Court in the case titled New India assurance Co. Ltd., Vs. Usha Yadav 2008(3) RCR Civil 111 has observed that :

    “Cash rich Insurance Company indulging in luxury litigation to repudiate claim of the insured – It seems that the Insurance companies are only interested in earning the premiums and find ways and means to decline the claim.

56. As discussed above in detail this Commission is of the view that single premium was to be paid by the DLI for coverage of loan period as it is very much clear from facts and evidence led by complainant but the opposite parties instead of issuance of Insurance coverage for whole loan period, issued policies as per their whims for short period, not in consonance with the application/proposal forms. Thus, there is clear cut deficiency in service and unfair trade practice on the part of the opposite parties. The evidence placed on file proved that deceased Rakesh Kumar got issued three Insurance policies by the opposite parties i.e. DHFL Home Shield, Group Family Floater Health Insurance and Group Personal Accident Cover for whole loan period by paying single premium.Therefore, complainant is entitled to the claim under two policies as per terms and conditions of the policies. Under DHFL Home Shield Policy Coverage Sum Insured is Rs. 14,26,874/- and Terminal Illness benefit of Rs. 4,15,105.98 and Benefit under Group Family Floater Policy is upto Rs. 3.00 Lacs per year.

57. In view of above discussion, this complaint is partly allowed with Rs.10,000/- as cost and compensation against all the opposite parties jointly and severaly with further following directions :-

    a) The opposite party No. 3 is directed to pay outstanding amount of loan, availed by Rakesh Kumar, DLI, to opposite parties No. 1 & 2.

    b) The opposite party No. 3 is also directed to pay Terminal Illness benefit of Rs. 4,15,105.98 of deceased Rakesh Kumar to his nominee i.e. complainant.

c) The opposite parties No. 1 & 2 are directed to issue No Objection Certificate in favour of DLI and to return the original Sale Deed No. 3 dated 1-4-2015 to complainant on payment of outstanding amount by opposite party No.3.

d) The opposite parties No. 4 & 5 are directed to pay Rs. 3.00 Lacs to complainant under Group Family Floater Policy being reimbursement of medical expenses incurred at Fortis Hospital, Mohali, on the treatment of deceased Rakesh Kumar.

58. The compliance of this order be made by the opposite parties within 45 days from the date of receipt of copy of this order failing which the opposite parties will be liable to pay interest @ 8% p.a. on the awarded amounts from the date of this order till realization.

59. The complaint could not be decided within the statutory period due to covid pandemic and heavy pendency of cases.

61. Copy of order be sent to the parties concerned free of cost and file be consigned to the record.

    Announced :

    30-6-2022

    (Kanwar Sandeep Singh)

    President

     

     

    (Shivdev Singh)

    Member