Tripura

StateCommission

A/42/2016

Smt. Sima Rani Kar - Complainant(s)

Versus

Kotak Mahindra Old Mutual Insurance ltd. - Opp.Party(s)

Mr. P.K Dhar, Mr. A. Debsarkar, Mr. R.G Chakraborty, Miss. S.Das

13 Jan 2017

ORDER

State Consumer Disputes Redressal Commission, Tripura.

 

Case No.A.42.2016

 

1. Smt. Sima Rani Kar,

W/o Shri Swapan Kar,

Resident of Gopal Nagar, Kunjaban,

P.O. & P.S. Kalyanpur,

District - Khowai, Tripura.

… … … … Appellant/Complainant

 

 

1. Kotak Mahindra Old Mutual Life Insurance Ltd.,

Kotak Infinity, Building No.21, Infinity Park,

Off Western Express High Way,

General A.K. Vaidya Marg, Malad (E),

Mumbai – 400097, Maharashtra.

 

2. The In-charge, Head Retail,

Mahindra & Mahindra Financial Services Ltd.

Sadhna House, 2^nd Floor,

Behind Mahindra Towers 570, P.B. Marg,

Worli, Mumbai 400018, Maharashtra.

 

3. The In-charge,

Mahindra & Mahindra Financial Services Ltd.

Agartala Branch, C.R. Road,

Agartala, P.S. East Agartala,

District - West Tripura.

… … … … Respondents/Opposite Parties

4. Sri Rajesh Kar,

S/o Sri Swapan Kar,

Resident of Gopalnagar, Kunjaban,

P.O. & P.S. Kalyanpur,

District - Khowai, Tripura.

… … … … Proforma Respondent/Opposite Party

 

Present

 

Mr. Justice U.B. Saha,

President,

State Commission, Tripura.

 

Mrs. Sobhana Datta,

Member,

State Commission, Tripura.

 

Mr. Narayan Sharma,

Member,

State Commission, Tripura.

 

For the Appellant: Mr. Ranagopal Chakraborty, Adv.

For the Respondent no.1: Mr. Pranabashis Majumder, Adv.

For the Respondent nos.2, 3 & 4: Absent.

Date of Hearing & Delivery of Judgment: 13.01.2017.

J U D G M E N T [O R A L]

 

 

U.B. Saha,J,

This instant appeal filed by the appellant-complainant, Smt. Sima Rani Kar (hereinafter referred to as complainant), W/o Shri Swapan Kar of Gopal Nagar, Kalyanpur, Khowai District under section 15 of the Consumers Protection Act, 1986 is directed against the Judgment dated 11.08.2016 passed by the Ld. District Consumer Disputes Redressal Forum, West Tripura, Agartala (hereinafter referred to as District Forum), in Case No.CC-39/2015 whereby and whereunder the complaint petition was dismissed by the Ld. District Forum.

2. Heard Mr. Ranagopal Chakraborty, Ld. Counsel appearing for the complainant. Also heard Mr. Pranabashis Majumder, Ld. Counsel appearing for the respondent-opposite party no.1 (hereinafter referred to as opposite party).
3. The facts relevant for disposal of the present appeal lie in a narrow compass are as follows:-

The complainant has filed an application under section 12 of the Consumers Protraction Act, 1986 alleging that one of her son Shani Kar purchased one vehicle from the opposite party, Mahindra & Mahindra Financial Company, the respondent herein, taking loan in the name of her deceased son Shani Kar. Shri Rajesh Kar another son of the complainant was the guarantor of such loan. The vehicle was purchased through Mahindra & Mahindra Financial Services Ltd. Insurance Policy was issued by Kotak Mahindra Old Mutual Life Insurance Ltd. Coverage was for an amount of Rs.3,40,000/-. Premium for the said insurance was Rs.3,333/-. On 24.05.2011, her son Shani Kar committed suicide for which a police case was registered and a criminal case was started U/S 306 of the IPC against some persons and those accused persons have been already been acquitted from the charge levelled against them. On the death of her deceased son Shani Kar, his survivors and complainant claimed death benefit under the Insurance Policy, but the claim was not entitled by the opposite party no.1, Kotak Mahindra Old Mutual Life Insurance Ltd. on the ground that as per terms and conditions, the complainant is not entitled for any death benefit as her son committed suicide within one year after the commencement of the policy. As the opposite party did not settle the matter, it caused harassment to the complainant. The claim was outdated. On getting information as to the death of her deceased son Shani Kar, the opposite party, Mahindra & Mahindra Financial Services Ltd. issued letter on 11.11.2013 addressing the guarantor Shri Rajesh Kar referring the said loan agreement etc. and asked him to pay the outstanding loan amount of Rs.1,03,765/-, but the claim on the death of the Late Shani Kar was not settled by the opposite party. The insurance coverage was for Rs.3,40,000/-. Claimed petition was filed for compensation for an amount of Rs.5 lacs.

4. The opposite party no.1, Kotak Mahindra Old Mutual Life Insurance Ltd. by way of filing written statement has denied the claim of the complainant. In its written statement, the opposite party no.1 specifically stated that any claim arising as a result of a member under this policy committing suicide within one year of commencement of his/her cover, will be disallowed as per Clause-10 of the Certificate of Insurance and as per Clause-7 of Policy of Contract of the Insurance and thus, the complainant is not entitled any relief as sought for.
5. The Ld. District Forum after hearing the parties and considering the documents submitted before it as well as the evidence on record dismissed the complaint petition on the ground that the death of the deceased son of the complainant was not the result of poisoning as per forensic report and in the postmortem report also, nothing mentioned regarding the cause of death, but the complainant herself admitted that it was a case of suicide. As per Clause-10 of the Certificate of Insurance, any claim arising as a result of a member under this policy committing suicide within one year of the commencement will be disallowed and in the instant case, the death of commission of suicide of deceased Shani Kar was 24.05.2011 and the date of commencement of insurance coverage policy is 04.08.2010. Thus, the deceased Shani Kar committed suicide within one year from the date of commencement of the insurance coverage policy for which the District Forum dismissed the complaint petition. Hence the appeal.
6. Mr. Chakraborty, Ld. Counsel appearing for the complainant i.e. appellant herein, while urging for allowing the appeal has contended that the Ld. District Forum ought to have decided that the suicide committed by deceased Shani Kar was not a suicide simpliciter, but the suicide as a result of provocation. Therefore, the suicide of deceased Shani Kar would not come within the purview of the Clause-10 of the Certificate of Insurance. He further submits that an amount of Rs.1,03,765/- demanded by the Mahindra & Mahindra Financial Services Ltd. i.e. opposite party nos.2 & 3. According to him, such demand itself is a harassment.
7. On the other hand, Mr. Majumder, Ld. Counsel appearing for the respondent no.1, Kotak Mahindra Old Mutual Life Insurance Ltd. while supporting the judgment of the Ld. District Forum submits that the Ld. District Forum did not commit any error while deciding the complaint case of the complainant as neither the District Forum nor any Court can go beyond the terms and conditions mentioned in the Certificate of Insurance and the Insurance Policy itself. He has referred one judgment of the Apex Court in Export Credit Guarantee Corporation of India Ltd. Vs Garg Sons International 2013 (1) SCALE 410, wherein it has been held by the Apex Court that “while construing the terms of the contract of insurance, the Court must give paramount importance to the terms used in the said contract, and it is not open for the Court to add, delete or substitute any words. It is also well settled, that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the policy, its terms have to be strictly construed in order to determine the extent of the liability of the insurer. Therefore, the endeavour of the Court should always be to interpret the words used in the contract in the manner that will best express the intention of the Party.”

He has also referred to the Clause-10 of the Certificate of Insurance, which is as follows:

“10. Claims:

Any claim, arising as a result of a member under this policy committing suicide within one year of the commencement of his/her cover, will be disallowed. Further where any member commits suicide within a year of any increase in his/her cover; the portion of cover equal to such increase will be disallowed.”

He also referred to the Clause-7 of the Policy of Contract, which is as follows:

“7. Death due to natural causes, suicides etc.

No claim arising from the death of a member due to any cause other than an Accident shall be payable where such death occurs within 3 months from the date of his/her commencement of cover as herein stated. A member will be said to have died due to an accident where the member dies as a result (solely, directly and independently of all other causes of death) of sustaining any bodily injury, directly and solely from an accident, which has been caused by outward, violent and visible means. For the company to consider the claim arising out of a member’s death within 3 months from the date of his/her commencement of cover, the Policyholder must produce proof to the complete satisfaction of the Company that the member’s death is on account of an accident, and submit requisite supporting documents as herein stated. The Company shall decide whether a claim is due to an “Accident” as aforesaid based, inter alia, on the information/documents/material at its disposal and the decision of the Company in this regard shall be final and conclusive. The Company may, in such cases (where a claim arises from death of a member due to a non accidental causes within 3 months from the date of his/her commencement of cover), at its discretion, pay an amount equivalent to the actual EMIs paid by the member upto the date of his/her death, subject to a maximum of 3 EMIs.  

Further, any claim arising as a result of a member under this policy committing suicide (whether being sane or insane at such time) within one year of commencement of his/her cover will be disallowed.

Where a member commits suicide within a year of any increase in his/her cover, the claim payable will be restricted to the lower of:

• the member’s cover (under this policy) as on the date of death and
• the member’s cover (under this policy) one year prior to the date of death.”

8. We have gone through the evidence as well as the impugned judgment passed by the Ld. District Forum. Though the complainant contended that a criminal case was registered regarding the suicide of her deceased son but fact remains that the allegation of another son of the complainant, namely, Rajesh Kar who was the informer in the Police case could not be proved before the Criminal Court and the accused therein were acquitted. More so, the Ld. District Forum in its judgment though stated that in the post-mortem report, there is nothing regarding cause of death, but facts remain that in the chemical examination report, it has been clearly mentioned that there was presence of Organocholoro group of pesticide. Therefore, according to us, this is a clear case of suicide. We are of the further opinion that the money which was demanded by the respondent nos.2 & 3 is not related to the Life Insurance Policy purchased by the deceased son of the complainant, rather the amount of Rs.1,03,765/- was demanded by the respondent nos.2 & 3 as loan amount. As the same was not the subject matter before the Ld. District Forum, the District Forum rightly refrain itself from deciding the said issue. We are of the further opinion that Ld. District Forum rightly opined, “There is no scope to give any relaxation by this Consumer Court to give any relief beyond the contract or agreement”.
9. In view of the decision of the Supreme Court as stated (supra) and the Clause-10 of the Certificate of Insurance and Clause-7 of Policy of Contract, the opposite party no.1, Kotak Mahindra Old Mutual Life Insurance Ltd. rightly repudiated the claim of the complainant i.e. appellant herein. As there is no infirmity in the impugned judgment of the Ld. District Forum, it is not necessary on our part to interfere with the impugned judgment.

Accordingly, the present appeal filed by the appellant is dismissed being devoid of merit. No order as to costs.

Send down the records to the Ld. District Forum, West Tripura, Agartala.

    

 

MEMBER State Commission Tripura MEMBER State Commission Tripura PRESIDENT State Commission Tripura