STATE CONSUMER DISPUTES REDRESSAL COMMISSION, MAHARASHTRA, MUMBAI Appeal No.A/15/301 (Arisen out of order dated 08/12/2014 passed in Complaint No.218/2013 by District Commission, Nashik)

HDFC ERGO General Insurance Co. Ltd., Deolali Branch Office, Through Branch Manager, Deolali Camp, Tal. District Nashik. ....... Appellant(s)

Versus

1. Smt.Rupali Yogesh Barhe, Having address at:

Manegaon, Taluka Sinnar, District Nashik.

2. HDFC Bank Ltd., Through Branch Manager, Having address at:

Opp.Nandan Sweet, Rushi Nagar, College Road, ………Respondent(s)

Nashik.

BEFORE Justice S.P.Tavade – President Mukesh V. Sharma – Member Poonam V. Maharshi - Member For the Appellant(s) : Advocate Harshada Rane.

For the Respondent(s): Advocate K.G. Shelke for Respondent No.1.

ORDER

(04/06/2024)

Per Hon’ble Ms.Poonam V. Maharshi – Member:

(1) Being aggrieved and dissatisfied by the judgment and order dated

08/12/2014 passed in Complaint No.218 of 2013 by the District Consumer Disputes Redressal Commission, Nashik, the original opponent no.2 has preferred this appeal. Parties to this appeal shall be referred and called as per their status in original complaint.

(2) The facts giving rise to the present appeal can be summarized as under:

The complainant’s husband was an Account holder of opponent no.1 HDFC Bank Ltd. The opponent no.1 had issued Platinum Debit Card to the complainant’s husband along with Insurance cover through Opponent no.2 HDFC Ergo General Insurance Co. Ltd. wherein the Complainant’s husband was insured for personal accident with the base cover of Rs.5,00,000/-. It is submitted that accelerated cover upto Rs.5,00,000/- more (total upto Rs.10,00,000/-) for every Re.one spent on purchase through Platinum Debit Card, sum increases by five times the spent amount (subject to minimum spent of Rs.20,000/-) in the last twelve months as per the latest bank statement of the customer. The date of commencement of policy was 25/08/2012. The insured met with an accident during the policy period and claim under personal accident was lodged with the Company. The claim of the complainant was filed through opponent no.1 before opponent no.2. The claim of the complainant was repudiated by opponent no.2 on 12/03/2013. Hence, the complainant filed the complaint for deficiency in service and unfair trade practice with the prayer seeking sum assured of Rs.10,00,000/- with interest, compensation and costs.

(3) Notice of the complaint was issued to opponents. The opponent no.2 appeared and filed written version and resisted the complaint. The opponent no.2 has admitted that the Complainant’s husband was insured for sum of Rs.10,00,000/-. It is contended that the complainant through opponent no.1 filled the claim form along with all the documents submitted to them. The said claim was repudiated on 12/03/2013 by opponent no.2 on the ground that late Mr.Yogesh Barne died due to accident on 28/10/2012. In his bank statement no POS was swiped during three months before the date of loss and as per the policy wording, “Non ATM swipe (transaction) is Mandatory i.e. on or before 3 months from the date of loss of claims eligibility”. Since losses claimed are not covered under the policy wordings, we treat the claim as ‘No Claim’ and close in our records.”

(4) It is contended that they have rightly rejected the claim of the complainant. Hence, it is prayed for dismissal of the complaint with costs.

(5) The Complainant and opponent no.2 led evidence. On going through the evidence on record and after hearing both the parties the District Commission allowed the complaint directing the opponent no.2 to pay a sum of Rs.10,00,000/- with interest @10% per annum from 12/03/2013 along with Rs.5,000/- as compensation for mental agony and Rs.3,000/- towards costs. Being aggrieved the opponent no.2 has preferred this appeal.

(6) Appeal was admitted. Notices were issued to the respondents. Advocate for respondent no1/complainant appeared. Though served, respondent no.2 was absent. Hence, we heard advocat