Chennai consumer court directs insurance firm, bank to pay up Rs 51 lakh to customer's widow
The consumer commission -- headed by president D Gopinath and members V Ramamurthy and Kavitha Kannan -- said the complaint against Niva Bupa health insurance and Karur Vysya bank were allowed and both opposite parties were held jointly and held for deficiency in service.
Seoul Court
CHENNAI: The Chennai North District Consumer Disputes Redressal Commission directed Niva Bupa health insurance company and Karur Vysya bank to pay Rs 51,00,000 and additional nine per cent interest on it to a widow and her son, who filed a complaint citing deficiency in services.
The complainants Santosh Sudhersan Sharma and her son Sandeepan Sudhersan Sharma are from Ambattur.
Sandeepan's father Sudhershan Pohloram Sharma took a housing loan of Rs 50,47,000 from Karur Vysya Bank in 2021. The loan was to be repaid in 239 monthly instalments of Rs 41,974 per month.
At the insistence of the bank, Sudhershan bought a policy (critical illness cover accidental cover) from Niva Bupa health insurance by paying a premium of Rs 2,99,956 at the time of availing the loan. The insurance was bought through the bank who is an intermediary; no one from the insurance company contacted Sudhershan to explain policy terms.
Sudhershan died on January 25, 2022, in Gorakhpur due to acute coronary syndrome (ACS) with severe LV Dysfunction and cardiogenic shock with AKI; he also had uncontrolled diabetes.
The complainants submit that he only had diabetes and hypertension, which was disclosed to the bank right from the start; he neither had medicines nor had been hospitalised for any cause or reason connected to liver and heart functions.
Sandeepan submitted that after his father's demise they thought the insurance policy would cover the housing loan, but the bank claimed the EMI amount from Santosh who was the co-borrower.
Santosh approached the insurance company in May 2022 seeking a claim but they denied her claim citing the cause of death did not fall under critical illness benefits.
The complainants submit that Sudhersan died due to myocardial infarction, and it is one of the critical illnesses covered under the scheme, but the insurance company deliberately denied their claim.
The consumer commission -- headed by president D Gopinath and members V Ramamurthy and Kavitha Kannan -- said the complaint against Niva Bupa health insurance and Karur Vysya bank were allowed and both opposite parties were held jointly and held for deficiency in service.
The health insurance company has been directed to pay the complainant the base sum insured of Rs 50,00,000 with nine per cent interest per annum from the date of death of the insured till the date of payment to the complainants.
They have been directed to pay the complainants jointly or severally an additional Rs 1,00,000 towards compensation for deficiency in service, mental agony, pain and sufferings and Rs 5,000 towards litigation cost within two months from the date of receipt of this order, failing which the complainants are entitled to get the above amount of Rs 1,05,000 with nine per cent interest per annum from the date of this order till the date of realisation.
