State Consumer Disputes Redressal Commission
Navneet Kumar vs Hdfc Ergo General Insurance Pvt. Ltd. on 25 October, 2023
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
U.T. CHANDIGARH
[ADDITIONAL BENCH]
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Ap p ea l N o : A/88/2023
Da t e o f I ns ti tu ti o n : 10/ 05/ 20 23
Da t e of D ec is i on : 25/ 10/ 20 23
Dr. Navneet Kumar son of Sh. Darshan Kumar, Resident
of House No. 612/2, Omaxe Cassia, New Chandigarh,
Punjab.
.... Appellant
V E R S U S
1. HDFC Ergo General Insurance Co. Limited,
through its Senior Vice President Accident &
Health Claims, 6t h Floor, Leela Business Park,
Andheri Kurla Road, Andheri (East), Mumbai -
400059.
2. HDFC Ergo General Insurance Co. Limited,
through its Director, SCO 124-125, Sector 8-C,
Madhya Marg, Chandigarh - 160008.
...... Respondents
BEFORE: MRS. PADMA PANDEY PRESIDING MEMBER
PREETINDER SINGH MEMBER PRESENT : Mrs. Aruna Sachdeva, Advocate for the Appellant.
Sh. Nitesh Singhi, Advocate for the Respondents. PER PREETINDER SINGH, MEMBER This appeal is directed against the order dated 26.10.2022, rendered by the District Consumer Disputes Redressal Commission-I, U.T. Chandigarh (for
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brevity hereinafter to be referred as "the Ld. Lower Commission"), vide which, it dismissed the Consumer Complaint bearing no.CC/377/2019, in the following terms:-
"7] In view of the aforesaid discussion and the reasons recorded hereinbefore, we do not find any deficiency in service or unfair trade practice on the part of the OPs. Accordingly, the consumer complaint, being meritless, is hereby dismissed, leaving the parties to bear their own costs."
2. For the convenience, the parties are being referred to, in the instant Appeal, as position held in Consumer Complaint before the Ld. Lower Commission.
3. Before the Ld. Lower Commission, it was the case of the Complainant that he took a Housing Loan from HDFC Bank Chandigarh and was given an insurance cover under Home Suraksha Plus Policy on payment of a premium of Rs.1,92,913/-. The Complainant was also paying Rs.1500/- monthly towards premium for the same. The complainant was given Policy Certificate and cover starting from 13.10.2017 to 12.10.2022 for the purposes of tax exemption under Section 80-D of the Income Tax Act. As per Policy, the Complainant was covered for major medical illness and procedures, accident and loss of job. Under head loss of job,
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condition that voluntary unemployment or voluntary retirement shall be excluded. As per coverage details under head loss of job sum insured was 3 EMIs of Housing Loan i.e., Rs.37,000/-. The complainant was a specialist doctor in Anesthesia and his MBBS and MD Degrees were from G.M.C.H. Sector 32, Chandigarh. As per complainant, he was working in E.S.I.C. Hospital, Village Katha, Baddi, District Solan as a Senior Resident since 21.08.2014. The services of the complainant were terminated from E.S.I.C. Hospital, Baddi on the ground that he had his total two spells of Senior Resident (Anesthesia) for 3 years were over. The complainant remained without service for more than two months and thereafter, he joined Max Hospital, Mohali. The complainant wrote to the OPs about termination of his services and loss of job. He had filed his claim under loss of job clause, which was repudiated because his job was contractual. The OP No.1 has cited that loss of job due to reasons other than retrenchment as a result of mergers and acquisition was not covered. Eventually, the complainant served a legal notice through his counsel upon the OPs, but to no avail. Hence, the aforesaid Consumer Complaint was filed before the Ld. Lower
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Commission, alleging deficiency in service and unfair trade practice on the part of the OPs.
4. Upon notice, the OPs resisted the consumer complaint, inter alia, pleading that the complainant was employed on a contractual basis. As per the memorandum (Annexure R-6), the complainant was engaged for the post of Senior Resident (Anesthesia) on contractual basis for one year extendable upto 3 years under residency scheme in the E.S.I.C. Model Hospital, Baddi. It was pleased that as per the terms & conditions of the policy, the OPs shall not be liable for any claim arising due to unemployment from contractual job. The claim of the complainant was rightly repudiated as per the settled terms & conditions of the Policy, after going all the documents of the policy holder/complainant as well as the documents of the policy in question. On these lines, the cause was sought to be defended and a prayer for dismissal of the Complaint was made.
5. On appraisal of the pleadings and the evidence adduced on record, Ld. Lower Commission dismissed the consumer Complaint of the Complainant/ Appellant, as noticed in the opening para of this order.
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6. Aggrieved against the aforesaid order passed by the Ld. Lower Commission, the instant Appeal has been filed by the Appellant/Complainant.
7. We have heard the Learned Counsel for the parties at length and have gone through the evidence and record of the case, with utmost care and circumspection.
8. The core question that falls for consideration before us is as to whether the Ld. Lower Commission has rightly passed the impugned order by appreciating the entire material placed before it.
9. After giving our thoughtful consideration, to the contentions raised and material on record, we are of the considered opinion, that the instant Appeal deserves to be dismissed for the reasons to be recorded hereinafter.
10. It is the case of the Appellant/ complainant that the Ld. Lower Commission while passing the impugned order has failed to appreciate the documentary evidence available on record, which resulted into perverse finding. Ld. Counsel for the
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Appellant argued that the Ld. Lower Commission failed to take into consideration the policy document (Annexure C-1/Annexure R-1) that complainant was covered for major medical illness and procedures, accident and loss of job. However per material available on record, we are not convinced by the argument advanced. Record transpires, that the complainant was working as a Senior Resident (Anaesthesia) and after he had rendered total two spells of Senior Resident (Anaesthesia) for three years, his services were terminated on 10.01.2019 by the ESIC Hospital, Badi. The Ld. Lower Commission has duly gone through the policy schedule and policy terms & conditions attached thereto before recording a categorical finding that the job of the complainant was contractual in nature and same was excluded under the policy. Even the relevant provisions relating to exclusion clause ( Exclusions applicable to Section 5 ) were also examined thoroughly by Ld. Lower Commission which clearly showed that the OPs shall not be liable to make any payment in respect of any claim relating to unemployment from a job which is casual, temporary, seasonal or contractual in nature. Since the job of the complainant was contractual in nature and was thus, excluded under the policy as discussed
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hereinabove, the Ld. Lower Commission has correctly held that the claim of the complainant was rightly repudiated as per settled terms and conditions of the policy and OPs were not deficient in providing service or found to be involved in unfair trade practice. Hence, we are of the considered view that no case is therefore made for any interference in the findings recorded qua this issue by the Ld. Lower Commission.
11. No other point was urged, by the Ld. Counsel for the parties.
12. It is demonstrable from a reading of the impugned Order of the Ld. Lower Commission that it is certainly not an order passed without reasons or without applying the judicious mind. The facts and circumstances of the case have been gone into, weighed and considered, and due analysis of the same has been made. It also does not appear to be an order passed without taking into account the available evidence.
13. In the wake of the position, as sketched out above, we are dissuaded to interfere with the impugned order rendered by the Ld. Lower Commission.
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The appeal being bereft of merit is accordingly dismissed and the order of the Ld. Lower Commission is upheld.
14. The pending application(s), if any, stand disposed off in terms of the aforesaid order.
15. Certified copies of this order be sent to the parties free of charge.
16. The file be consigned to Record Room, after completion.
Pronounced 25 t h Oct., 2023 Sd/-
(PADMA PANDEY) PRESIDING MEMBER Sd/-
(PREETINDER SINGH) MEMBER "Dutt"