BEFORE THE III ADDITIONAL BANGALORE URBAN

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

                               BENGALURU – 560 027.

DATED THIS THE 24^th DAY OF MAY, 2022

CONSUMER COMPLAINT NO.151/2021

PRESENT:

SRI.RAJU K.S,

SMT.REKHA SAYANNAVAR,:MEMBER

Arogya Swamy V.A

S/o Late Muniswamy Velu Arul Das,

Aged about 33 years,

R/at 7, 3^rd Cross,

S.P.Naidu Layout,

Ramamurthy Nagar,

Doorvani Nagar,

(Rep by Sri.M.V.Vishwanath, Adv)

V/s

“M/s Manipal Cigna Health

Insurance Company Limited”,

(Formally known as “CIGNA TTK

Health Insurance Company Limited”),

Rajat Tower, 2^nd Floor,

4/21, 11^th Main, 4^th Block,

Rep by authorized Signatory.……OPPOSITE PARTY-1

(Opposite party Rep by Sri.Dwaraka A.Karaj, Adv)

India Bulls Home Loans,

Ground Mezzanine and

Richmond Road,

Richmond Town,

Rep by authorized Signatory.…….OPPOSITE PARTY-2

(Opposite party Rep by Sri.Prutha Bharathi, Adv)

******

//JUDGEMENT//

BY SRI. RAJU K.S, MEMBER

The complainant has filed this complaint u/s 35 of the Consumer Protection Act-2019 seeking for a direction to the opposite parties to freeze the loan account No.HLAPBGM00437929 Dt.26.03.2018 standing in the name of late Mr.Muniswamy Velu Aruldas and direct the opposite party no.1 to settle the assured amount to the insured person late Aruldas.  Further direct the opposite party no.2 to refund the EMI paid by the complainant after death of borrower late Mr.Muniswamy Velu Aruldas. 

2. The case of the complainant is that his father one Mr.Muniswamy Velu Aruldas had availed loan of Rs.46,00,000/- from the opposite party no.2 “M/S INDIA BULLS HOME LOANS” against his property.  The said late Mr.Muniswamy Velu Aruldas had also obtained life and Non-life insurance from opposite party no.1 under certificate No.200100003643/00/00 dt.22.05.2017, by paying Rs.17,110/- premium.  The said insurance policy covers accidental benefit and the sum assured under accidental death to the extent of Rs.46,00,000/- with emergency road ambulance of Rs.10,000/- and caring benefit of Rs.2,00,000/- in all total Rs.48,10,000/-.  Further the opposite party no.1 had duly activated the said insurance policy by sending welcome letter to late Mr.Muniswamy Velu Aruldas.  The said Mr.Muniswamy Velu Aruldas had paid monthly EMI of Rs.88,740/- every month till his death without default.  On 20.07.2019 at about 11.00 a.m the complainant’s father had accidentally fell down from a tree situated in front of his house, while pruning few branches and sustained head injury.  Immediately, he was shifted to a nearby “Koshys Hospital” situated T.C.Palya Main Road, Bengaluru.   In the hospital the said Mr.Muniswamy Velu Aruldas was succumbed on 20.07.2019 due to the injuries sustained.  The complainant lodged a police complaint with Ramamurthy Nagar Police Station, Bengaluru and the said police had registered a case under UDR 48/2019 dt.20.07.2019.  The post-mortem was conducted by Mr.B.R.Ambedkar Medical College and hospital Kadugondanahally, Bengaluru, and post-mortem report is submitted with this regard. 

3. The complainant informed the death of his father late Mr.Muniswamy Velu Aruldas by way of email on 29.07.2019 to opposite party no.1.   The complainant furnished details of policy number, certificate of insurance and the matter was assigned to health relationship manager, who had to assist the complainant in resolving the issue.  Further on 30.07.2019 the opposite party company sought some more documents and the same was furnished by the complainant. Subsequently, on 15.10.2019 the opposite party company had sought some more documents with regard to the death of complainant’s father and the same was also furnished.  Further the complainant submits that the opposite party company on 16.02.2020 once again sought for additional documents from the complainant and the complainant informed the opposite party that the documents sought for have already been furnished on 13.01.2020 and requested to settle the matter immediately.  In spite of repeated requests, the opposite party company did not settle the claim immediately.  Finally on 04.03.2020 the opposite party company had repudiated the claim of the complainant by sending letter through post and stated that “as required under the policy, insured has failed to take reasonable care to safe guard against injury.  Hence, the claim was rejected under policy conditions. The 1^st opposite party had given flimsy reason in rejecting the claim of the complainant and it is not sustainable and not permitted under law.   Hence, this complaint.

4. After service of summons, the opposite parties appeared through their counsel filed their version, admitted the averments of the complaint towards insurance policy took by late Mr.Muniswamy Velu Aruldas and uphold their stand in rejecting the claim of the complainant, that the insured person violated conditions of the policy.  Further opposite party states that the policy holder/insured person understand and agreed to take all reasonable steps in order to safeguard against any accident or injuries or illness that may give raise to under this policy.  Further the opposite parties state in their version that on verification reports it appeared that insured had head injury due to fall from tree while cutting branches.  As per policy, insured should have took care to safeguard against the injury.  Hence, claim was rejected under policy clause-IV.3.  Hence sought for dismissal of complaint.

5. To prove the case of the complainant, the complainant (PW1) had filed affidavit in the form of his evidence and got marked EX.P1 to P19 documents.  The opposite parties are also examined as RW1 and RW2 by filing affidavits in the form of their evidence and got marked EX.R1 to R6 documents.

       6. Heard the arguments of both the sides.  Counsels for complainant, opposite party no.1 & 2 have filed their respective written arguments.  The points that would arise for consideration are as under:

i) Whether the opposite party no.1 is liable to pay the insured amount and deficiency in service towards dishonouring the claim of the complainant ?

ii) Whether the complainant is entitled for refund of EMI’s paid to opposite party No.2 after death of his father ?

iii) What order ?

     7. Our findings on the aforesaid points are as follows:

Point No.1 :  In affirmative

Point No.2 :  In affirmative

Point No.3 :  As per the final order for the following;

REASONS

8. POINT NO.1:- It is undisputed fact that the father of the complainant late Mr.Muniswamy Velu Aruldas had availed loan to the tune of Rs.46,00,000/- under EX.P2.  The complainant’s father also agreed to pay 72 monthly EMIs in each instalment of Rs.88,740/-. It is also undisputed fact that the complainant’s father was insured by opposite party no.1 M/s Cigna TTK Health Insurance Policy later called as M/s Manipal Cigna Health Insurance Company Limited, under certificate No.200100003643/00/00, dt.22.05.2017 for the period from 29.06.2018 to 28.06.2023 (EX.P3). As per EX.P4 the complainant’s father and thereafter the complainant had paid EMIs regularly to opposite party no.2.  EX.P8, UDR No.48/2019 reveals the death of late Mr.Muniswamy Velu Aruldas on 20.07.2019 due to accidentally fell down from the tree.  EX.P5 to P11 undisputedly describes death of the complainant’s father.  EX.P12 is the claim form submitted to the opposite party no.1 along with copies of Ex.P13 to P15.

9. From scrutinization of exhibits it clearly appears that the complainant’s father had availed loan of Rs.46,00,000/- from opposite party no.2 and opposite party no.1 was insurer who has to indemnify in case of accidental death accrued to insured.  This fact has not been disputed by the opposite parties.  The only objection raised by the opposite parties was that the complainant’s father had violated the policy condition IV.3.  Condition in Ex.P16 email communication dated.04.03.2020 reads as under;

     Denial reason:-

As claim documents and verification reports, insured had head injury due to fall from tree while cutting branches.  As per policy insured should take reasonable care to safeguard against injury.  Hence, the claim is rejected under Clause-IV.3.

The policy condition IV.3:- Reasonable Care

  The policy holder/insured person understands and agrees to take all reasonable steps in order to safeguard against any accident or injuries or illness that may give raise to any claim under policy.

10. EX.P3 and EX.R1 are one and same.  As per EX.P3 policy condition IV.3 reads as under;

Alteration in the policy:-

This policy constitutes the complete contract of insurance between the policy holder and us.  No change or alteration will be effective or valid unless approved in writing which will be evidenced by the written endorsement, signed and stamped by us.  All endorsement requests will be made by the group policy holder only. 

11. From bare reading of the above contentions in EX.R1 and P3 clearly shows discussion about the alteration in the policy.  But as per EX.P16 email correspondence dt.04.03.2020 enumerates the denial of the claim of the complainant and also reasons for denial was that the insured person failed to take all reasonable steps in order to safeguard against any accident or injuries or illnesses that may give raise to under this policy.  By referring the contents of EX.P16 email dt.04.03.2020 the opposite party No.1 company simply denied the claim of the complainant without valid reasons and has wrongly mentioned the provision of law in question.  This act of the opposite party no.1 clearly attracts, the deficiency in service to the complainant. Instead of honouring the claim of the complainant the opposite party no.1 company denied the claim without valid reasons.  The opposite party no.1 should have given valid reasons to repudiate the claim of the complainant.  In the present complaint, the opposite party no.1 has denied the claim without proper reasons.  From the above discussions, we safely come to conclusion that the opposite party no.1 has to indemnify the complainant.  Hence, we answer point No.1 in affirmative. 

12. POINT No.2:- So far as the point No.2 is concerned the complainant had paid EMIs upto date even after the death of his father.  Ex.P4 account statement of opposite party no.2 reveals this fact.  To avoid future disputes the complainant has made these payments to opposite party no.2. The opposite party no.1 should have settled the claim of the complainant and close the loan account immediately after death of complainant’s father.  The complainant is entitled to all EMI paid towards his father’s loan account. The opposite party no.1 has to reimburse all the payments made by the complainant towards loan account.  Hence, we answer point No.2 affirmative.

13.  POINT No.3:- In view of the discussions made above, we proceed to pass the following;

The complaint is allowed in part.

The opposite party No.1 is directed to pay the due of the complainant under the loan account No.HLAPBGM00437929, Dt.26.03.2018 to the opposite party no.2 and close the loan account. 

The opposite party no.1 is directed to pay the complainant total EMIs paid by complainant after the death of his father i.e., after 20.07.2019 with interest at the rate of 9% p.a.

Further the complainant is entitled for a sum of Rs.20,000/- towards mental agony and litigation cost.  

 In case, the opposite party fails to pay the above said amount of Rs.20,000/- within 30 days, the complainant is entitled for interest at the rate of 9% p.a. from the date of order, till realization.  

Supply free copy of this order to both the parties and return extra copies of the pleading and evidence to the parties.

  (Dictated to the Stenographer, typed by her, the transcript corrected, revised and then pronounced in the open Commission on 24^th day of May, 2022)                                            

• REKHA SAYANNAVAR)  (RAJU K.S)   (SHIVARAMA, K)    

MEMBER MEMBERPRESIDENT

//ANNEXURE//

Witness examined for the complainants side:

Sri.Arogya Swamy, the complainant has filed his affidavit.

Documents marked for the complainant side:

1. Certificate u/s 65(b) of Evidence Act.
2. Copy of the loan sanction letter dt.20.04.2018.
3. Original insurance papers of Mr.M.Velu Aruldas.
4. Copy of account statement of complainant.
5. True copy of medical certificate of cause of death.
6. True copy of discharge summary dt.20.07.2019.
7. True copy of Koshys hospital medical bills.
8. True copy of intimation first intelligence received describing and an accidental or unnatural death on 20.07.2019 in Ramamurthy Nagar P.S.
9. True copy of Death certificate of Mr.M.Velu Aruldas(complainant’s father).
10. True copy of charge sheet dt.23.01.2020.
11. True copy of postmortem report dt.20.07.2019.
12. True copy of claim form dt.13.08.2019.
13. Doctor letter dt.17.01.2020.
14. True copy of intimation of first intelligence received describing an accidental or an unnatural death on 20.07.2019 in Ramamurthy nagar P.S.
15. IT return acknowledgement 2019-2020.
16. Mail communication between complainant and opposite party. 
17. True copy of adhar card of complainant.
18. True copy of adhar card of Mr.M.Velu Aruldas (complainant’s father).

 Witness examined for the opposite party side:         

Sri.Purushotham N, Deputy Manager of opposite party-company has filed his affidavit.

Mrs.Usha M, Authorized representative of opposite party-company has filed his affidavit.

Documents marked for the Opposite Parties side:

1. Copy of the policy with terms and conditions.
2. Xerox copy of the home loan application submitted by the complainant.
3. Xerox copy of the loan agreement dt.16.05.2018.
4. Xerox copy of the sanction letter dt.20.04.2018.
5. Xerox copy of the disbursal request form dt.16.05.2018.
6. Xerox copy of particular of home loan.

• REKHA SAYANNAVAR)    (RAJU K.S)         (SHIVARAMA, K)    
•