District Consumer Disputes Redressal Commission ,Faridabad.
Consumer Complaint No.664/2021.
Date of Institution:22.12.2021.
Date of Order: 16.02.2024.
1. laxmi wife of late Sh. Gajender Sharma,
2. Prachi Sharma(minor) daughter of late Shri Gajender Sharma, aged about 17 years.
3. Nishant (minor) son of late Shri Gajender Sharma, aged about 13 years.
Complainant No.2 & 3 being minors through their mother and natural guardian Smt. Laxmi wife of late Shri Gajender Sharma,
All R/o DB-1335, Gali No.2, A.D.School, Dabua Colony, NIT, Faridabad, Haryana.
…….Complainants……..
Versus
United India Insurance company Ltd., (DRO-1, Non Motor Service Hub) 43-C, Una Enclave, Mayur Vihar, Phase-1, Delhi – 110091, Mob. No. 9810950580.
Through its Managing Director, service may be effected through Branch Manager United India Insurance Company Ltd., Neelam Chowk, NIT , Faridabad.
…Opposite party……
Complaint under section-12 of Consumer Protection Act, 1986
Now amended Section 34 of Consumer protection Act 2019.
BEFORE: Amit Arora……………..President
Mukesh Sharma…………Member.
Indira Bhadana………….Member.
PRESENT: Sh. Rishipal Sharma , counsel for the complainant.
Sh. Sachinder Bhatia , counsel for opposite party.
ORDER:
The facts in brief of the complaint are that the husband of the complainant No.1 and father of complainant Nos.2 & 3 namely Gajender Sharma had taken a loan to the amount of Rs.15 lakh from Canara Bank (previously known as Syndicate Ban) having its head office at 112, J.C.Road, Bangalore and one of it sbranch office at Sector-21C, Faridabad through it s branch manager alongwith Unihome Care Insurance Policy NO. 0405002617P115322349, under which sum insured Rs.11 lakh was mentioned at serial No.2 of Uni Home Care Policy schedule. For the above policy an amount of Rs.4410/- was paid by the policy holder as per policy No. 0405002617P115322349 dated 22.01.2018 to 21.01.2028. The complainants were legal heirs of Mr. Gajender Sharma – the policy holder and had made the payment of premium to the insurance policy and in such a manner the complainants were the consumer with the opposite party and since the said Gajender Sharma had expired on 10.12.2020 after leaving behind the complainants as legal heirs and they had rights to sue and file the present complaint before this Hon’ble Commission. The deceased Gajender Sharma on 10.12.2020 expired suddenly when he was driving the vehicle during course of work, while driving the vehicle on 10.12.2020 at about 08-09 am intimation received by mobile NO. 9582570084 on mobile No. 9015199982 with regard the sudden pain in stomach
and head and had taken medicines. After coming to the notice with regard sudden illness of Gajender Sharma his yonger brother namely Shiv Kumar, brother in law Vinod and his wife Laxmi alongwith relative namely Pawan reached at about 02:30 PM and met at toll tax situated after crossing Murana. They brought Gajender Sharma to Govt. Hospital, Dholpur, Rajasthan, where he was check up in emergency and declared dead and crimination was conducted at Samshan ghat, Saran, Faridabad on 11.12.2020. Thereafter the complainants received some notice for the payment of loan advance by Gajender Sharma and thereafter performing the last rights the complainants made several representation to the bank and the insurance company alongwith required/demanded documents but all in vain. The complainant No.1 was house wife and the complainant No.2 & 3 were school going children having no independent source of income to repay the above said loan amount and since the loan amount was insured as per policy issued by the opposite party, so the opposite party was liable to satisfy the insured amount to the bank concerned and to pay the extra amount to the complainants as in his lifetime the said Gajender Sharma paid some amount in EMI as per schedule.The aforesaid act of opposite parties amounts to deficiency of service and hence the complaint. The complainant has prayed for directions to the opposite party to:
a) pay a sum of Rs.11 lakh as per policy either to bank or to the complainants with interest @ 24% p.a..
b) pay Rs.5,00,000/- as compensation for causing mental agony and harassment .
c) Pay Rs.35,000/- as litigation charges.
2. Opposite party put in appearance through counsel and filed written statement wherein Opposite party refuted claim of the complainant and submitted that the complainant availed the loan facility form Canara Bank for a sum of Rs.15,00,000/- and in this regard the bank issued the Uni Home Care Insurance
Policy No. 0405002617P115322349 in respect to the insured sum of Rs.11,00,000/- towards the claim under Personal accident and Rs.11,00,000/- under Fire relates to the property No. DB 1335, Gali No.2, Near ND Public School, NIT Faridabad by paying the premium of Rs.4410/- to the insurance company and the same was valid form 22.01.2018 to 21.01.2018 wherein as per the terms and conditions of the insurance company clearly mentioned that the insured was entitled for any claim in respect to the insured Borrower sustained injuries boldly, injury resulting solely directly from accident caused by external violent and visible means as per the terms and conditions of the insurance company. As per the present complaint wherein mentioned that the deceased Gajender Sharma barrower/insured suddenly expired on 10.12.2020 when he was driving his vehicle and sudden pain in stomach and head and further died due to heart failure and thereafter the complainant being the legal heirs claiming the claim from the opposite party as per insurance policy issued by the insurance company under Uni-Home Care Policy Schedule but at the same time the said policy was covered with the injuries caused due to the personal accident and the insured was expired due to heart failure which did not cover under the provisions and as per the terms and conditions of the insurance company and therefore the insurance company had no ay liability arising out of this claim and rightly closed the claim of the complainant vide letter dated 05.09.2022 wherein clearly mentioned that the perils not covered, hence no liability of the insurance company. Opposite party denied rest of the allegations leveled in the complaint and prayed for dismissal of the complaint.
3. The parties led evidence in support of their respective versions.
4. We have heard learned counsel for the parties and have gone through the record on the file.
5. In this case the complaint was filed by the complainant against
opposite party–United India Insurance Company Ltd. with the prayer to: a) pay a sum of Rs.11 lakh as per policy either to bank or to the complainants with interest @ 24% p.a.. b) pay Rs.5,00,000/- as compensation for causing mental agony and harassment . c) Pay Rs.35,000/- as litigation charges.
To establish his case the complainant has led in his evidence, Ex.CW-1/A – affidavit of Laxmi , Ex.C-1 to 4 – Adhar cards, Ex.C-5 & 6 – identity card of school, Ex.C-7 – Citizen Resource Information Department, Ex.C-8 – death certificate,, Ex.C-9 – insurance policy,, Ex.C-10 to 12 – emails, Ex.C-13 to 15- GR, Ex.C-16 – not readable, Ex.C-17 & 18 - receipt of shamshan ghat, Ex.C-19 – RC.
On the other hand counsel for the opposite party strongly agitated and opposed. As per the evidence of the opposite party Ex.RW1/A – affidavit of Shri Dinesh Kumar, Administrative Officer, M/s. United India Insurance Co. Ltd., Branch Office at SCO-106, Sector-16, Faridabad,, Ex.O/1 – investigation report, Ex.O/2 – No claim letter dated 05.09.2022, Ex. O/3 – insurance policy.
6. It is evident from Ex.O/3 that the complainant availed the loan facility form Canara Bank for a sum of Rs.15,00,000/- and in this regard the bank issued the Uni Home Care Insurance Policy No. 0405002617P115322349 in respect to the insured sum of Rs.11,00,000/- towards the claim under Personal accident and Rs.11,00,000/- under Fire relates to the property No. DB 1335, Gali No.2, Near ND Public School, NIT Faridabad by paying the premium of Rs.4410/- to the insurance company and the same was valid form 22.01.2018 to 21.01.2018 .The deceased Gajender Sharma barrower/insured suddenly expired on 10.12.2020 when he was driving his vehicle and sudden pain in stomach and head and further died due to heart failure and thereafter the complainant being the legal heirs claiming the claim from the opposite party as per insurance policy issued by the
insurance company under Uni-Home Care Policy Schedule but at the same time the said policy was covered with the injuries caused due to the personal accident and the insured was expired due to heart failure which did not cover under the provisions and as per the terms and conditions of the insurance company and therefore the insurance company had no any liability arising out of this claim and rightly closed the claim of the complainant vide letter dated 05.09.2022 wherein clearly mentioned that the perils not covered.
7. In rebuttal of the complainant’s evidence, opposite party has filed an affidavit of Shri Dinesh Kumar, Administrative Officer, M/s. United India Insurance Co. Ltd., Branch Office at SCO-106, Sector-16, Faridabad vide Ex.RW1/A. Section -II Personal accident of the policy is as under:
“Subject to the terms, exclusions, definitions and conditions contained herein or otherwise expressed here on the Company will pay the insured as herein after mentioned.
If at any time during the currency of this policy the insured’s borrower shall sustain bodily injury resulting solely and directly from accident caused by external violent and visible means, then the company shall pay to the insured of the borrower’s legal personal representative(s) as the case may be, the sum herein after set forth, that is to say: If such injury shall within Twelve (12) calendar months of its occurrence be the sole and direct cause of the death of the insured’s borrower, the Capital sum insured stated in the schedule hereto.”
Opposite party has also submitted the investigation report dated 30.04.2021 vide Ex.O/1and policy Unihome Care Insurance policy vide Ex.O/3 .
8. After going through the investigation report, affidavit of Shri Dinesh
Kumar, Administrative Officer, M/s. United India Insurance Co. Ltd., as well as the terms and conditions of the policy, the claim of the complainant does not fall under the coverage of the policy of the insurance. Hence the complaint is dismissed. Copy of this order be given to the parties concerned free of costs and file be consigned to record room.
Announced on: 16.02.2024. (Amit Arora)
President
District Consumer Disputes
Redressal Commission, Faridabad.
(Mukesh Sharma)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
(Indira Bhadana)
Member
District Consumer Disputes
Redressal Commission, Faridabad.
