Complaints filed on: 22-03-2022
Disposed on: 28-09-2022
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, TUMAKURU
DATED THIS THE 28th DAY OF SEPTEMBER 2022
PRESENT
SMT.G.T.VIJAYALAKSHMI, B.Com., LLM., PRESIDENT
SRI.KUMARA.N, B.Sc. (Agri), LLB., MBA., MEMBER
SMT.NIVEDITA RAVISH, B.A., LLB. (Spl)., LADY MEMBER
CC.No.75/2022
Smt.Shilpa W/o Late Narasimhamurthy .N
Aged about 35 years, Residing at
Mathrushree Nilaya, 1st Main Road,
Behind Sumathi School, C.M.Extension,
Kythasandra, Tumakuru.
……….Complainant
(By Sri. Harish Babu, Advocate)
V/s
The Manager/Policy issuing Officer in-charge,
TATA AIG General Insurance Co., Ltd.,
2nd Floor, Balaji Towers, Above Lakshmi Vilas Bank,
Tumkur-572 101.
……….Opposite Party
(By Sri. N.V.Naveen Kumar, Adv.,)
:ORDER:
SMT.G.T.VIJAYALAKSHMI, PRESIDENT
This complaint is filed against the OP U/s 35 of the Consumer Protection Act 2019 with a prayer to direct the OP to settle the claim under the valid policy No.0236120911, Certificate No.017704, Application No.TCHHF0808000100003965 with interest @ 12% from the date of refusal of the claim i.e. 10.05.2021 till realization along with Rs.25,000/- towards compensation for mental agony and harassment and Rs.10,000/- towards cost and such other reliefs, this Commission is deems fit to grant.
2. The brief facts of the complaint as under:-
The complainant’s husband late Narasimhamurthy .N obtained policy from the OP vide policy No.0236120911, Certificate No.017704, Application No.TCHHF 0808000100003995 in connection with the housing loan availed from OP sister company namely Tata Capital Housing Finance Ltd. which is effect from 30.07.2019 to 30.07.2024. The insurance has been taken on the condition stipulated by OP as protection is extended to the customers who avail such housing finance so that on occasion of any untimely death due to accident or to severe unforeseen bodily disease the borrower’s family i.e. complainant should be protected so that future installments will be not burdened on the dependents and in order to overcome such immediate unforeseen circumstances insurance will be taken wherein complainant is also one among them. When such being the case, during the second wave of pandemic COVID, the complainant’s husband died on 10.05.2021 due to COVID after undergoing hospitalization at Sridevi Hospital, Tumakuru. Thereafter the complainant approached the OP for the claim of insurance and also issued notices to the OP, but the OP did not even bother to reply the same nor advised anything. It is further contended that in the policy under the category sickness or disease (unforeseen), wherein the complainant got issued legal notice to the OP for early settlement for the reason that the total housing loan availed by the complainant’s deceased husband was Rs.20,00,000/-, wherein the complainant is not in a position to repay and now the Tata Housing Finance Ltd., which has sanctioned the housing loan initiated legal action under SARFESI Act, wherein in-fact this has caused irreparable damage and serious mental agony to the complainant. But in spite of receipt of legal notice, the OP remained silent and thereafter repudiated the claim. Hence, without any alternative, the complainant has filed this complaint.
3. After service of notice, the OP appeared and filed the version, wherein the OP admitted about obtaining policy from the OP, but contended that the liability of the policy is limited by its terms and conditions stipulated therein.
3(a). The OP further contended that the complainant’s husband N.Narasimha Murthy has taken the policy vide No.023120911017704 valid from 31.07.2019 to 30.07.2014 and the said policy product name is “Group Credit Secure Plus” subject to terms and conditions, exceptions and limitations thereof and the confirmations of compliance of section 64 VB of the Insurance Act, 1938. The policy obtained by the complainant’s husband cover the risk as follows:
- Accidental death – Rs.20 Lakhs
- Permanent total disability – Rs.20 lakhs,
- House alternation and vehicle modification benefit Rs.50,000/-
- Add on – standard fine & special perils – Rs.20 lakhs
- Monthly EMI benefit, upto 3 EMI or sum insured whichever is lower,
- Permanent partial disability – Rs.20 lakhs
- Key replacement coverage’s Rs.1,000/-
- Home Protection benefit Rs.20 lakhs,
- Accident IPD, Rs.25,000/-
- Loss of job – upto 3 EMI’s or sum insured whichever is lower.
3(b). The OP further contended that they have received claim intimation from the deceased brother-in-law Mr.Raghavendra, and after due verification and as per company norms , the claim was processed by the registering the claim and on 03.06.2021, they have rejected the claim in respect of the policy as there was no coverage of insurance and it is stated that “as per the documents submitted by you, it is noted that cause of death was COVID-19, Bronchopneumonia, Type2 DM which is a sickness related ailment and the said insured not covering any death which was caused to any sickness. The hospital certifies that the death of the husband of the complainant due to suffering from Covid-19, which is death, caused due to sickness. Therefore, repudiation made by them is just and proper. Hence, the OP prays to dismiss the complaint.
4. The complainant has filed her affidavit evidence and marked the documents at Ex.P1 to P11. One Manjunath G., AVP, Legal Claims has filed affidavit evidence on behalf of OP and marked the documents at Ex.R1 to R3.
5. We have heard the arguments from both parties.
1) Whether there is any deficiency in service on the part of OP?
2) Whether complainant is entitled for reliefs sought for?
6. Our findings to the aforesaid points are as under:
Point No.1: In the Negative
Point No.2: As per the final order
:REASONS:
7. On perusal of the averments of the complaint, objections of the OP and affidavit evidence, documents of both parties, it is an admitted fact that the complainant’s husband late Narasimha Murthy .N obtained policy from the OP vide police No.0236120911, Certificate No.017704, Application No.TCHHF0808000100003965 in connection with the housing loan availed from OP sister company namely TATA Capital Housing Finance Ltd., and the said policy was valid from 30/07/2019 to 30/07/2024. It is also an admitted fact that, the complainant’s husband died on 10.05.2021 due to COVID and the said policy was in force at the time of death of complainant’s husband. The complainant claimed the amount under the valid policy bearing No.0236120911, Certificate No.017704. To substantiate the above said facts, the complainant has produced Ex.P1 to P11.
8. The OP submitted that the complainant’s husband has taken the policy and it was valid from 31/07/2019 to 30/07/2024. The said policy product name is “Group Credit Secure Plus” subject to terms and conditions, exceptions and limitations thereof. As per the discharge summary issued by Sridevi Medical Institute of Medical Sciences and Research Hospital, Tumkur, the insured was died on 10.05.2021 due to COVID-19, which is not covered as per terms and conditions of the policy. As per Ex.P3, the policy obtained by the complainant’s husband cover the following risks only:
Base Policy Coverage and Benefits
Sr.No. | Benefits | Insured Person |
1 | 2 | 3 | 4 |
1 | Accidental Death – Sum Insured (Rs.) | 20,00,0000.00 | | | |
2 | Permanent total Disability | 20,00,000.00 | | | |
Additional Covers
Sr.No. | Benefits | Sum Insured (Rs) |
1 | Loss of Job | Upto 3 EMI’s or Sum insured whichever is lower |
2 | Permanent Partial Disability | 20,00,000.00 |
3 | Fire & Special Perils including Earthquake: 1) Earthquake – Building 2) Fire – Building 3) Riot Strike Malicious Damage – Building 4) Storm Cyclone Typhoon Tempest - Building | 8,00,000.00 |
4 | Accidental IPD | 25000.00 |
5 | Accidental dismemberment | 20,00,000.00 |
6 | House Alteration and Vehicle Modification Benefit | 50,000.00 |
7 | Monthly EMI Benefit | Upto 3 EMI’s or Sum insured whichever is lower |
8 | Home Protection Benefit | 2,00,000.00 |
9 | Key replacement coverage | 1000.00 |
9. On perusal of Ex.P6, dated:10.05.2021 issued by Sridevi Medical Institute of Medical Sciences and Research Hospital, Tumkur, wherein it is clearly stated that the cause of death was “Acute Respiratory Distress Syndrome ” and final diagnoses as “COVID-19, BRONCHOPNEUMONIA, Type-2 DM”, it is sickness related ailment and the insured not covering any death which was caused by any sickness. Hence, repudiation made by the OP is just and proper and there is no deficiency of service by the OP. Therefore, the complaint is liable to be dismissed. Accordingly, we proceed to pass the following:-
:O R D E R:
The complaint filed by the complainant is dismissed. No costs.
Furnish the copy of order to the complainants and opposite parties at free of cost.
