ORDER

1.       This revision petition has been filed under section 21(b) of The Consumer Protection Act, 1986 in challenge to the impugned Order dated 13.02.2018 passed by the State Commission in First Appeal No. 58 of 2014 arising out of the Order dated 13.12.2013 passed by the District Commission in Complaint No. 88 of 2013.

2.       It appears that feeling aggrieved by the repudiation of the insurance claim after the death of her husband the complainant brought a consumer complaint in the District Commission which was allowed. The Order passed by the District Commission is quite brief and in order to bring forth the factual matrix as well as rival contentions raised by the both sides and the analysis and reasonings adopted by the fora below to arrive at the conclusion which it did, the relevant extracts are being reproduced below:

Brief fact of the case is that Complainant's husband, Dhirendra Singh since deceased applied for a home loan to O.P. 1 on 02.11.2010 and O.P. 1 sanctioned the loan amount of Rs. 6,74,000/- vide sanction letter dt. 14.01.2011 out of such Rs.6,74,000/-, O.P. 1 deducted Rs.34,000/- towards the insurance premium as SBI Life covering HBL vide disbursement schedule (a part of letter of arrangement) For availing such loan, Dhiredra Singh, since deceased, also paid the required processing fee and other incidental charges. Finally on 11.08.2011 The loan was sanctioned. And complainant paid Rs.5575/- on 03.08.2011 being the difference amount of SBI Life premium. Initially, a cheque of Rs.6.40,000/- was issued by O.P. 1 In favour of the seller / vender of the flat in question and Rs.34000/- was kept by O.P. 1 as premium of SBI Life premium covering the life of the lonee, Dhirendra Singh, since deceased. As security, O.P. 1 took the sale deed being no.05137 for the year 2011 registered with A.D.S.R. Howrah. The EMI for the said loan was Rs.6700/- per month, which was started on and from10.09.2011. But unfortunately on 10.09.2011, Dhirndra Singh died due to acute cardiac arrest. And his wife and children became the legal heirs. This sudden untimely death made his wife Manju Singh, complainant herein, completely helpless. And after coming out of this mental trauma, she wrote a letter to O.P. 1 on 14.06.2012 to inform O.P. 1 about this death with a request to exempt her from the burden of this loan. As per O.P. 1 instruction and advice, complainant submitted claim form along with all documents. But al on a sudden O.P. 2 repudiated the claim, vide annexure letter dt. 02.01.2013, on the ground that complainant's husband died within 30days of the initiation of the Insurance policy. And as per their exclusion clause, claim would have been allowed if complainant's husband would have died after 45 days of the initiation of the policy. It is also alleged that O.P. 1 never supplied any policy document and only at the time of submitting the claim form, complainant came to know the policy no, which is 70000000310. And also she came to know, the policy condition that no claim is payable within 30 days if death occurs due to some natural reason. The claim is only payable in the event of accidental death of life assured if accrued within a period of 45 days but all these condition were never under the knowledge of the life assured as well as his wife, herein the complainant. After receiving the repudiation letter, complainant became perplexed. According to her version all deaths are noting but accidents. Moreover here in this case, complainant's husband died even at the age of 44 years, which is noting but an accident by which complainant and her children are the only sufferers. In this situation, O.Ps this kind of attitude and stand can only be treated as deficiency in service. Not only that O.P. also adopted unfair means as once they are not allowing the death claim and on the other hand they are sending the demand notice dt.04.04.2013 asking for the repayment of loan amount with all threatening words. Finding no other alternative complainant filed this instant petition with the aforesaid prayers.

Notice were served upon the O.Ps. O.P.1 never appeared or filed W/V. But O.Ps. 2 & 3 appeared and filed W/V. Accordingly the case was heard exparte against
O.P. 1

Decision with reason.

On scrutiny of the record, we find that O.P. 3 sent demand notice on 04.04.2013 asking for the total repayment of loan amount being Rs.6.74.000 with threatening words like publishing of photographs etc. And immediately after receiving the copy of this instant petition, as O.P. 3 was impleaded after the amendment was allowed, O.P. 3 sent another letter dt. 26.04.2013 stating therein that photo threat notice dt. 04.04.2013 was sent in advertently and the inconvenience caused due to this incidence, is sincerely regretted. From this it clearly shows that without thinking twice, O.P. 3 sent such a notice dt. 04.04.2013 to the complainant.  How far it can affect complainant and her minor children's emotion was never given any consideration. It is the contention of O.P. 2 that complainant's husband only on 04.08.2011 submitted proposal form for availing himself of the insurance coverage by way of depositing Rs.7915/- vide cheque bearing no.698038 dt. 04.08.2011 and the amount was received by them on 11.08.2011. So, Insurance coverage was granted on and from 11.08.2011 for a sum assured of Rs.6,79,575/- And as the complainant husband died on 10.09.2011 which is within 30 days of policy commencement, claim is not payable as per policy condition no. 11.3 But as per their policy condition, the death is required to occur due to an accident which should not be a natural one. O.Ps.’ this argument makes is surprised. The death of a person, at the age of 44 years, when he was having two minor School going children, has been considered by O.Ps. as a natural death! we all know now a days, average life time of human being is 65- 70 years. We have also carefully gone through para 31,32, 33, 34, 35, 38, 39 of the W/v filed by O.P. 2 and noted their contents. It is a specific plea of O.P. 2 that as proposal form was submitted by the complainant's husband, the terms and condition was also under his knowledge and he suppressed all material facts-such as he was having diabetes. And suppression of fact by complainant husband does not help complainant to get the claim amount. But no proposal form filled by the complainant's husband has been annexed by O.P 2. O.P 2 has annexed policy document and claim form with their BNA O.Ps. 2 & 3 have accepted premium only on 11.08.2013 for an amount of Rs.7,915/- but denied the acceptance of Rs.34000/- as premium. It is not accepted by us as it is very clear from O.Ps. own annexure named 'Disbursement’ ‘schedule’ from that it is clear that O.Ps; retained Rs.34,000/-as insurance premium and although they sanctioned Rs.6,74,000/- as loan, a cheque of Rs.6,40,000/- only was issued in favour of the vender / seller of the flat in question. From the policy document, Page 3 it is evident that date of commencement of master policy being no.70000000310 is 07.06.2011. And suddenly on 10.09.11, complainant's husband died out of cardiac arrest which is nothing but an accident. O.Ps. are interpreting the provision/clauses of the policy as per their advantage. It is nothing but their arbitrariness. They have retained Rs.34000/-as premium although they sanctioned Rs.6,74,000/- vide sanction letter dt. 14.01.2011. And it is also admitted by O.Ps. 2 & 3 that another amount of Rs.7,915/- was received by O.Ps. on 11.08.2011 as further premium towards the same policy. Even after that O.Ps. refused to pay the claim amount which is noting but gross negligence on the part of the O.Ps. They have indulged in to all emotional harassment which should not be allowed to be perpetuated. Consumer Protection Act, 1986, being a beneficial legislation, will always protect the interest of a consumer.

Housing is a basis need for any human being and O.Ps. have harassed the complainant and her minor children immensely when they are passing through very tough financial condition after the sudden demise of Dhirndra Sinha. Accordingly, we find O.Ps. to be deficient in providing service towards the complainant.   

3.         In view of the aforesaid findings the following award was granted:

O  R  D  E  R  E  D

That case is allowed on contest with cost against O.P. 2 & 3 and exparte against
O.P. 1 with cost.

That O.Ps are directed to adjust the outstanding loan amount lying in the loan A/C. being no. 31602521040 with the sum assured of Life Insurance membership policy issued in the name of Dhirendra Singh. Since deceased and there by cancel the demand notice dt. 04/04/2013 with immediate effect.

That O.Ps. are directed to handover original sale deed no. 05137 to the complainant within 15 days from the date of this order.

That O.Ps. are jointly and severally directed to pay an amount of Rs.10,000/- as compensation and Rs.2000/- as litigation cost within one month form this order i.d. this amount of Rs.12000/- shall carry an interest @10% p.a. till actual realization.

4.       It appears that feeling aggrieved by the Order of the District Commission, the appeal was filed in the State Commission but the State Commission did not find any merits in the appeal and while dismissing the same passed the following order:

Complainant's case, in short, is that, at the time of purchasing a flat with the financial assistance rendered by the OP No. 1, her husband took a life insurance policy from the OP No. 2. Initially the OP No. 1 issued a cheque worth Rs. 6,40,000/- on 11-06-2011 in favour of the vendor of the flat and a sum of Rs. 34,000/- was taken from Complainant's husband as premium of the Insurance policy. Complainant's husband died on 10-09-2011 due to acute cardiac arrest. The insurance claim lodged in this respect being repudiated by the OP Insurance Company, the instant complaint was filed.

By filing a WV, the OP No. 2 stated that the claim was repudiated as per policy terms and conditions. This OP claimed that it received the claim amount of Rs. 7,195/- vide a cheque dated 04-08-2011 only on 11-08-2011. Based on the membership form, the insurance coverage was granted w.e.f. 11-08-2011. As per Clause 22 of the policy, during the waiting period of 45 days, death benefit was payable only on account of accidental death of the Life Assured (LA). Since the LA died within 30 days of inception of the policy and such death was not accidental in nature, the instant claim was not payable.

            xxxx xxxx xxxx xxxx

According to policy terms and conditions, during the initial waiting period of 45 days, only accidental death was eligible for indemnification, otherwise not. In this case, the LA died of heart attack. The burning issue, therefore is, whether such death falls under the category of accidental death or not.

Be it mentioned here that the policy wordings contained in the policy schedule does not define the term 'accidental'. Therefore, we deem it fit and proper to go by the literal meaning of the word. According to Cambridge dictionary, the term 'accidental' means happening by chance. Oxford Living dictionary defines 'accidental' as happening by chance, unintentionally or unexpectedly.

Going by the above literal meaning, accidental death not necessarily mean death caused due to external injury; any death that occurs suddenly/unexpectedly can be treated as accidental death. No document is placed on record by the Appellant to show that the LA was suffering from any kind of previous ailment. At the time of death, the LA was only 44 years old and at this age, if one suffers heart attack, that sounds indeed unusual. Notwithstanding the death certificate attributes the cause of death to Cardiac arrest with Type-II diabetes, unlike Type-I diabetes in which symptoms usually start in childhood, in case of Type-II diabetes, the person may not have symptoms before diagnosis.

Accordingly, we find no justification whatsoever behind repudiation of the instant claim of the Respondent No. 1 by the Appellant citing exclusion period as stipulated under clause 22 of the policy in question. Thus, we are of opinion that the Ld. District Forum rightly allowed the complaint.

5.       Learned counsel appearing for the petitioner insurance co. has once again tried to take us through the entire factual aspects of the case and has tried to persuade us to appreciate them afresh. He has submitted that the deceased died due to heart attack within 45 days of issuance of the policy and only in the accidental cases could the relief of insurance coverage be given within such short period of death. Further submission is that premium was not received by the petitioner in time and therefore petitioner is not to blame for that omission which is said to have been committed by the respondent no. 2-bank. Submission is that in matters like this the petitioner cannot be held liable for committing any deficiency. Learned counsel has also tried to point out that the deceased insured had some previous ailments also but they were not disclosed by the deceased which also disentitles the insured from getting the advantage of insurance coverage.

6.       Learned counsel for the respondent no. 1 / complainant has submitted that the claim of the complainant was refused by the petitioner on the sole ground that the deceased had died as a result of heart attack within 45 days from the date of issuance of the policy in question which was not an accidental death. No allegation of suppression of pre-existing disease was shown or reflected in the repudiation letter. Contention is that at this later stage, the petitioner insurance co. is estopped from raising such allegations or arguments which were not even included in the repudiation letter and were not its part. Submission is that the respondent no. 2 (State Bank of India) who is the sister concern of the petitioner insurance co. had already deducted the premium amount of Rs. 34,000/- for 5 years collectively from the sanctioned loan amount of Rs.6,74,000/- being the compulsory coverage through an insurance policy namely ‘SBI Rinn Raksha Policy’ being  a  pre-existing condition for disbursement of the loan and had issued a cheque dated 11.06.2011 for Rs. 6,40,000/- for the cost of flat. It has been contended that now the petitioner insurance co. is alleging without merit that after deducting the premium amount of Rs.7,915/- for the month of June 2011 on 11.06.2011, the respondent no. 2-bank issued the purported cheque in favour of the petitioner insurance co. only on 04.08.2011. The actual fact is that respondent no.2 is holder of Insurance Master Policy of its sister concern (the petitioner insurance co.) which itself collected the application and recovered the entire premium amount for the insurance policy for five years from the loan amount before its disbursal. Now therefore it cannot be pleaded on behalf of the petitioner insurance co. that the claim of the complainant had been rightly repudiated on the ground that the premium amount  of Rs.7,915/- for the month of June 2011 could not be remitted in favour of the petitioner insurance co. in time and it was belatedly remitted on 11.08.2011 only. For all practical purposes it was the internal procedural administrative functioning and internal mutual understanding between the petitioner insurance co. and the respondent no.2 bank as to when the cheque of requisite premium amount was to be issued in favour of the petitioner insurance co. because the whole premium amount of
Rs. 34,000/- against the subject insurance policy had already been deducted at the time of disbursement of the loan amount. The respondent no. 2 bank had further accepted an amount of Rs. 5,575/- on 03.08.2011 being the difference of premium amount of the subject insurance policy which itself proves that the proposal for subject insurance policy had been accepted by the petitioner insurance co. much earlier i.e. at the time of receipt of premium amount of Rs.34,000/- on 11.06.2011. Thus the argument raised by the learned counsel regarding repudiation of the insurance claim on the ground that the insured deceased had died of heart attack within a short period of 30 days from the date of issuance of insurance policy does not hold any water.   

          It has been argued that if the premium amount had gone out from the pocket of the deceased insured as early as in the month of June 2011 and if the loan was granted by the respondent no. 2-bank itself on the unwritten condition that the deceased shall have to take the insurance policy  and the respondents no.2 and no. 3–Bank being the sibling concerns of the petitioner insurance co. (SBI General Insurance Co.) itself,  the complainant or the insured should not be made to suffer because of some internal negligence on the part of the bank who was also deducting the EMIs and had also accepted the insurance premium. Submission is that in this view of the matter the embargo of 45 days should not be allowed to operate as the whole issue of death of the deceased insured being accidental or natural would pale into insignificance and irrelevance. The death of the deceased should be deemed to have occurred much after the premium had already been paid to the State Bank of India which had the onus to deposit the same with its sister concern insurance branch / company as required.

      Emphasis was also laid by the learned counsel that all factual aspects have already been gone into by the fora below and there is no jurisdictional error in the impugned Orders. Contention is that unless some jurisdictional error or illegality is shown, no interference can be made by this Commission in concurrent findings returned by the fora below.

7.       It may be observed that it is apparently clear that the petitioner and the respondents no.2 and no. 3 bank are not unconnected concerns. There is no reason to doubt on the statement made by the learned counsel for the respondent no.1 / complainant that when the loan was granted the deceased / insured was persuaded or forced to take the insurance policy from the petitioner insurance co. or otherwise the loan would not be granted. This is a kind of common course of business pervading the finance world. This is a routine practice being adopted by the financial institutions whereby they run two shows simultaneously and make both of them mutually complementary. If the collective premium was given and received in the month of June, 2011, then the whole argument of 45 days embargo will be misleading because in that case whether the deceased died accidentally or met with unnatural death will become an irrelevant question. With regard to the suppression of previous ailments by the deceased insured also it may be seen that the repudiation letter does not give any reflection of the same. We have gone through the orders given by both the fora below and find that all the factual aspects have already been gone into, analysed and discussed.

8.       Learned counsel for the petitioner has not been able to point out any such jurisdictional error which may be said to have been committed by the fora below  nor any such illegality could be shown which may go to vitiate the findings given by both the fora below.

9.       The Orders of the two fora are a matter of record. No useful purpose will be served by reproducing them here all over again. Suffice is to say that the Bench finds that the Orders passed by the two fora below to be well-appraised and well-reasoned. The Bench also does not notice any material irregularity as may go to vitiate the findings and also does not find any reason to make fresh de novo re-appreciation of the evidence in revision. The Bench therefore finds no good ground for interference in the impugned Order in the exercise of the revisional jurisdiction of this Commission. The Bench has also not been able to come across any streak of perversity in the findings nor has it been able to discern any legal principle having been overlooked or wrongly ruled. Certainly the fora below cannot be castigated either to have overstepped or transgressed their jurisdiction or to have omitted to exercise the same rightfully. The facts and circumstances appear to have been weighed and vetted well and to our satisfaction.

10.     Hon’ble Supreme Court too in its decision given in case of Rajiv Shukla vs. Gold Rush Sales and Services Ltd. and Anr., (2022) 9 SCC 31 has observed that in exercise of power in its revisional jurisdiction, the National Commission is not required to interfere with the concurrent findings given by the fora below on appreciation of evidence. Relevant extracts of the observations made by Hon’ble Apex Court may be quoted herein below:

At this stage, it is required to be noted that on appreciation of evidence on record the District Forum as well as the State Commission concurrently found that the car delivered was used car. Such findings of facts recorded by the District Forum and the State Commission were not required to be interfered by the National Commission in exercise of the revisional jurisdiction. It is required to be noted that while passing the impugned judgment and order the National Commission was exercising the revisional jurisdiction vested under Section 21 of the Consumer Protection Act, 1986. As per Section 21(b) the National Commission shall have jurisdiction to call for the records and pass appropriate orders in any consumer dispute which is pending before or has been decided by any State Commission where it appears to the National Commission that such State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise a jurisdiction so vested, or has acted in the exercise of its jurisdiction illegally or with material irregularity. Thus, the powers of the National Commission are very limited. Only in a case where it is found that the State Commission has exercised its jurisdiction not vested in it by law, or has failed to exercise the jurisdiction so vested illegally or with material irregularity, the National Commission would be justified in exercising the revisional jurisdiction. In exercising of revisional jurisdiction the National Commission has no jurisdiction to interfere with the concurrent findings recorded by the District Forum and the State Commission which are on appreciation of evidence on record. Therefore, while passing the impugned judgment and order the National Commission has acted beyond the scope and ambit of the revisional jurisdiction conferred under Section 21(b) of the Consumer Protection Act.

11.     Similar views were expressed by the Apex Court in the earlier case of Rubi (Chandra) Dutta vs. United India Insurance Company (2011) 11 SCC 269.

12.     The bench has considered both the Orders passed by the fora below and the relevant record available in the light of the rival contentions raised at the bar but feels constrained to observe that there is hardly any good reason which may persuade the Bench to take a different view in the matter other than what has already been taken or adopted by the two fora below.

13.    The present petition being bereft of merits stands dismissed as such.

14.    The Registry is requested to send a copy each of this Order to the parties in the petition and to their respective learned counsels for the parties as well as to the two fora below within three days. The stenographer is requested to upload this Order on the website of this Commission within three days.