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2023 Supreme(Online)(Del) 18189
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Not mentioned, Not mentioned
HDFC Bank v. Syed Ayzul Hasan
Revision Petition No. 1436 of 2016
Insurers must provide terms and conditions to be binding; failure to do so negates exclusions in insurance claims.
Headnote:The Revision Petition filed under S.21(b) of the Consumer Protection Act, 1986 concerns a dispute regarding the denial of insurance benefits following the accidental death of Hasan Raza. The District Forum allowed the complaint in part, awarding death benefits and medical expenses based on the terms of the insurance policy. However, the State Commission dismissed the appeal by the opposing party, confirming the earlier findings. The primary issue was centered on whether terms and conditions were communicated to the insured, with the court affirming that lack of proof on the insurer's part negated their defense. Ultimately, the revision petition was dismissed, upholding the lower courts' findings as there was no observed error in their judgment.
| Table of Content |
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| 1. petition filed under consumer protection act to challenge lower forum's decision on an insurance claim. (Para 1 , 2) |
| 2. claim premise based on alleged insurance coverage from debit card usage. (Para 3 , 4 , 6) |
| 3. discussion on factual complications involving insurance policy and claim legitimacy. (Para 5 , 7 , 8) |
| 4. court's observations on communication of terms related to the insurance policy. (Para 9 , 11 , 12) |
| 5. burden of proof lies on the insurer to show terms were communicated. (Para 13 , 14 , 15) |
| 6. judicial limits on revising findings from lower courts without jurisdictional errors. (Para 16 , 17 , 18) |
| 7. final dismissal of the revision petition reaffirming previous judgments. (Para 19) |
1. This Revision Petition has been filed under S.21(b) of the Consumer Protection Act, 1986 by the Petitioner against the order dated 18.3.2016 passed by State Consumer Disputes Redressal Commission, Uttar Pradesh, Lucknow (hereinafter referred to as the "State Commission") in First Appeal No. 199 of 2016.
2. Along with the Revision Petition, the Petitioner filed IA / 7435/2016 an application for Condo nation of Delay of 48 days in filing the Revision Petition. However, as per report of the registry, there is a delay of 50 days. For the reason stated in the application and in the interest of justice IA / 7435/2016 is allowed and delay condoned.
3. Case of the Complainant that his son Hasan Raza (deceased) opened Saving Bank Account No. 2851930001488 with the Opposite Party / Bank. The Bank issued one Easy Shop Gold Debit Card No. 4214 2405 0095 6897 on which he was given comprehensive insurance cover of Rs.5,00,000. On 24.1.2011, the son of the Complainant was grievously injured in a car accident and he was admitted in Jaswant Rai Speciality Hospital, Meerut. He died on 30.1.2011 and an amount Rs.71,920 spent on his treatment. He was also covered for Accidental Hospitalization for Rs.1,00,000 per annum, along with cash for Hospitalization @ Rs.1000 per day. Hasan Raza (deceased) had nominated his father (Complainant) to recover and receive the accidental death insurance claim. The Complainant sent demand letter along with photocopies of bills of treatment Rs.71,920 besides Rs.5,00,000 towards insurance and hospitalization cover to the Opposite Party. Despite repeated requests and reminders, the Opposite Party failed to make payment of claimed amount. The Complainant filed Consumer Complaint No. 490 of 2011 with District Forums with the following prayer :
"It is therefore prayed that Honourable District Forums will be pleased to direct the opposite parties severally and jointly to pay the Complainant (1) a sum of Rs.5,00,000 (Rupees five lacs) towards comprehensive accidental death Insurance beside (2) a sum of Rs.71,920 (Rupees seventy one thousand nine hundred twenty) as accidental hospitalization cover (re - imbursement - cover) and to award a sum of Rs.1,00,000 (Rs.One lac) as damages to the Complainant against O.Ps for deficiency of service, mental harassment and agony of the Complainant along with 12 percent interest per annum from the date of preference of claim, i.e. 25/28.3.2011 besides cost of case amounting to Rs.10,000 (Rupees ten thousand) and to award other reliefs which the Honourable Forums might deem fit in favour of Complainant and against O.Ps 1&2."
4. The Opposite Party contested the Complaint before the District Forum. The Bank admitted that Hasan Raza (deceased) opened Saving Account No. 2851930001488 with their Branch at Western Court Road, Meerut. It was also admitted that Easy Shop Gold Debit Card No. 4214 24050095 6897 was issued to the deceased under which comprehensive accidental death insurance cover of Rs.5,00,000 and accidental hospitalization cover of Rs.1,00,000. The terms & conditions for use of the card were communicated to customers as per guidelines of Reserve Bank of India and also uploaded on the official websites of the Bank. It was necessary to use the debit card for shopping once withi
