Haryana

StateCommission

A/971/2018

HDFC ERGO GEN.INSURANCE CO. - Complainant(s)

Versus

KRISHNA - Opp.Party(s)

VISHAL AGGARWAL

27 Mar 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                                               

First Appeal No.971 of 2018

                                                Date of Institution: 13.08.2018

                                                         Date of order: 27.03.2023

 

HDFC Ergo General Insurance Company Ltd. Registered office Ramon House, HT Parath Marg, 169 Backbay, Redamation, Mumbai and 5^th Floor, Tower-1, Stellar IT Park, C-25, Sector 62, Noid 201301 through Pankaj Kumar Manager-Legal.

…..Appellant

Versus

Smt.Krishna widow of late Jagdish S/o Ramdhari Singh, R/o H.No.845, Devipura, Ward No.1, Gohana, Tehsil Gohana, District Sonepat.

…..Respondent

CORAM:    S.P.Sood, Judicial  Member

                   Suresh Chander Kaushik, Member

                  

Present:-    Mr.Vishal Aggarwal, Advocate for theappellant.

                   Mr.Rajiv Kumar Saini, Advocate for the respondent.

 

                                                ORDER

S P SOOD, JUDICIAL MEMBER:

          The brief facts of the case are that her husband has purchased Ertiga car in the year 2016 which was got registered with Registering Authority Gohana vide No.HR11G-7832. The vehicle was got financed with the OP. The loan was to be repaid by way of 60 equal monthly installments upto Feb-221. The complainant has paid 8 installments.  The husband of the complainant purchased Sarv Suraksha policy so as to sefure the repayment of loan and premium of Rs.6561/- was also paid.  Unfortunately, in the month of 10/2016 said borrower and husband of the complainant fell ill following which he got himself admitted in Artmis Hospital at Gurugram on 03.11.2016. However he expired on 23.11.2016.  Hence being a nominee, complainant submitted the claim form with the OP to indemnify the remaining loan amount but claim of the complainant was repudiated on the ground that the problem with which he died off was not covered among the critical illness as per the policy. But there was deficiency in service on the part of the OP when it refused to allow the claim and  hence the complaint.

2.      Notice was issued to the OP which filed written statement  submitting that deceased took policy, valid from 03.02.2016 to 02.02.2021 from OP No.1. However the insured died on 23.11.2016. As per the hospital record, the patient was admitted on 03.11.2016 and was diagnosed with DM, HTM,  Cirrhosis, Decompensated with Ascites, Hepatic Encdpalopathy right leg cellulities and sepsis and some how or the other, the husband of the complainant died due to chronic liver disease with sepsis with septic shock on 23.11.2016. The ailment mentioned in the death summary was not covered under the critical illness mentioned in the policy so the OP was not entitled to pay the outstanding balance loan amount. Thus there was no deficiency in service on the part of the OP and requested to dismiss the complaint.

3.      After hearing both the parties, the learned District Commission, Sonepat has allowed the complaint vide order dated 30.05.2018, which is as under:-

“Thus, it is held that the complainant is entitled to get some relief from the respondent and thus, we direct the respondent to make the payment of Rs.five lakh to the complainant and LRs of the deceased Jagdish in their  equal share. The detail of LRs of the deceased Jagdish shall be supplied by the complainant herself. The case there is any minor LR of the deceased Jagdish (either male or female) in that event, his/her share shall be deposited in the shape of FDR with any nationalized bank for the period, the minor attained their majority. With these observations, findings and dire3ctions, the present complaint stands allowed.”

4.      Feeling aggrieved therefrom, O.P-appellant has preferred this appeal.

5.      This arguments have been advanced by Sh.Vishal Aggarwal,  learned counsel for the appellant as well as Sh.Rajiv Kumar Saini, learned counsel for respondent. With their kind assistance entire record of appeal as well as original record of District Commission including whatever evidence has been led on behalf of  both the parties has also been properly perused and examined.

6.      It is not disputed that the husband of the complainant expired during subsistence of the policy. It is also not disputed that the husband of the complainant has expired due to Chronic Liver disease with sepsis with septic shock.   The plea of the appellant was that complainant was not entitled for any claim because husband of the complainant has died due to somecritical illness which is not covered under the scope of the policy in question and hence the complainant was not entitled for any benefit.At the time of obtaining the policy, the husband of the complainant was not having any type of critical disease and since he expired during the subsistence of the policy, the nominee of complainant was entitled for claim/compensation. Ex C-7 letter of HDFC ERGO dated  03.02.2016 also reveals that insurance provides coverage and benefits to the victims of certain critical diseases.  The case law replied upon by the counsel for the appellant  of Hon’ble National Commission titled LIC vs Alka Shukla 2016(2) CPR 875  and HDFC ERGO Vs. Smt. Babita Bansal decided on 03.01.2017 by this State Commission are not relevant because the facts and circumstances of the case are different from that of the case in hand.   The case law relied upon by respondent titled Rajinder Kaur Vs. HDFC Life Insurance company in consumer complaint No.199 of 2018 decided on 17.06.2020 by the State Commission, Punjab, Chandigarh is applicable in the case in hand, because the facts and circumstances of the case are similar that of the present case.  The learned District Commission has rightly allowed the claim of the complainant. The learned District Commission had committed no illegality while passing the order dated 30.05.2018.  The appeal is also devoid of merits and stands dismissed.

7.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant- Smt.Krishnaagainst proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

8.                Application(s) pending, if any, stand disposed of in terms of the aforesaid Order.

9.                A copy of this order be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986/2019. The Order be uploaded forthwith on the website of the commission for the perusal of the parties.

10.              File be consigned to record room.                  

 

27thMarch, 2023     Suresh Chander Kaushik            S. P. Sood                                                                Member                                             Judicial Member                            

 

S.K

(Pvt. Secy.)