BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.351/2019

DATED ON THIS THE 30^th January, 2020

      Present:   1) Sri. C.V.Maragoor

B.Com., L.L.M., - PRESIDENT   

                     2) Sri. Devakumar.M.C.           

                                        B.E., LLB., PGDCLP   - MEMBER

Sri C.V.MARAGOOR,

President

1.       This complaint has filed by Smt.Manjula W/o late Manchaiah and her two sons to direct the opposite party United India Insurance Company Limited, Mysuru to pay a sum of Rs.10,00,000/- being the insured amount under the Unihome Care Insurance Policy with interest at the rate of 18% p.a. from 01.03.2019 till the date of payment, cost of the complaint and damages for mental agony.
2.       The husband of complainant No.1 and father of complainant Nos.2 and 3 had applied for loan of Rs.10,00,000/- from Syndicate Bank, Vijayanagar Branch, Mysuru wherein he was employee for the construction of house in the month of July, 2015.  The bank has sanctioned loan with a condition of repayment of the same in monthly installments by deducting in his salary.  The employer of the deceased bank has purchased insurance policy from the opposite party known as Unihome Care Insurance Policy for the period from 24.07.2015 to 23.07.2032 for Rs.10,00,000/-. The life of deceased Manchaiah was insured for the said amount in case of any mishap to him or to the insured property the entire loan amount was to be repaid by the opposite party to the bank and his heirs. 
3.        It is further case of complainants that the deceased Manchaiah has paid monthly installments from July, 2015 till January, 2019 and he was passed away on 01.02.2019 due to heart attack.  The complainants have submitted application to the opposite party through the Syndicate Bank on 27.02.2019 for settlement of the insured amount but the opposite party has repudiated the claim since the death of deceased not accidental.  Hence, this complaint.
4.        The opposite party after the service of notice filed written version admitting that the Syndicate Bank has taken insurance policy from it for housing loan for the benefit of deceased.  The opposite party admitted that on 01.02.2019 late Manchaiah was died due to cardiac arrest. The opposite party further admitted that the complainants have submitted claim application through its bankers on the death of Manchaiah.  But this opposite party has repudiated the claim since the death of deceased is natural and not due to any kind of accident caused by external, violent and visible means.  However, the opposite party asked to dismiss the complaint.
5.        The complainant No.1 filed her affidavit in lieu of evidence and marked Exhibits P.1 to 7 documents.  On behalf of opposite party K.N.Dinesh, Divisional Manager filed his affidavit evidence and got marked Exhibits R.1 to R.6 documents. 
6.        We have heard the oral arguments advanced by the learned counsel for the complainant and opposite party in addition to written brief submitted by the complainant and opposite party  and the points that would arise for determination are as under:-  

1. Whether the complainants prove that the repudiation of claim by the opposite party is not justifiable and amounts to deficiency in service?
2.  Are complainants entitled to the reliefs sought for?

7.         Our findings on the aforesaid points are as follows:

Point No.1:- In the affirmative;

Point No.2:- Partly in the affirmative as per final order for the following

:: R E A S O N S ::

8.           Point Nos.1 and 2- The learned counsel for the complainants have submitted that the death of Manchaiah is natural and it also falls within the ambit of accidental death.  The opposite party has repudiated the claim on mis-conceived term used in the policy.  As against this the learned counsel for the opposite party has urged that late Manchaiah death is natural but not in accident.  The opposite party has issued policy to cover personal accident, but not personal life of the deceased.
9.          The opposite party has admitted the case of complainants that it has issued Unihome Care Insurance Policy in favour of Syndicate Bank for the benefit of late Manchaiah housing loan of Rs.10,00,000/- for the period from 24.07.2015 to 23.07.2032.  The complainants and opposite party have produced similar documents like insurance policy, death summary issued by Jayadeva Institute of Cardio Vascular Sciences and Research, Mysuru death certificate of deceased, legal heirship certificate issued by Deputy Tahasildar, Kasaba Hobli, Mysuru, claim application and repudiation letter.  The only point to be determined is as to whether natural death comes within the ambit of accidental death.  Exhibit P.1 policy Section 2 says with regard to exclusions.  It says that the company shall not liable under the policy for payment of compensation in respect of death, injury or disbursement of the insured from intentional self injury, suicide or attempted suicide, while under the influence of intoxication liquor or drug etc., 
10.       Section 2 says that – “personal accident subject to the terms, exclusions, definitions and conditions contained herein or endorsed or otherwise expressed hereon the company will pay the insured as herein after mentioned.  If at any time during the currency of this policy the insured’s borrower shall sustain bodily injury resulting society and directly from accident caused by external violent and visible means, then the company shall pay to the insured or the borrower’s legal personal representative(s) as the case may be, the sum herein after set forth, that is to say; if such injury shall within twelve (12) calendar months of the occurrence be the sole and direct cause of the death of the insured’s borrower, the capital sum insured stated in the schedule hereto” .  The opposite party has not disputed the death of deceased on 01.02.2019 due to heart attack at Jayadeva Hospital, Mysuru.  The death of late Manchaiah not falls within the exclusion clause of section two mentioned in Exhibit P.1.  Therefore, narrow meaning cannot be given to the natural death is not an accidental death.  The death of deceased falls within the ambit of accident as such, the opposite party repudiation of claim is not justifiable. 
11.        The complainant has produced the statement of account of the housing loan and as on 01.09.2019 loan outstanding balance was Rs.5,95,093/-.  Therefore, the opposite party shall liable to pay a sum assured of Rs.10,00,000/- to the complainants.  The complainants have not asked any specific amount as damages for mental agony.  The opposite party has repudiated the claim by interpreting the contents of exhibit P.1. policy as such, the complainants are not entitled for damages.  However, they are entitled for litigation cost of Rs.10,000/-. Accordingly, we proceed to pass the following;         

:: ORDER ::

1. The complaint filed by Smt. Manjula and two others is partly allowed directing the opposite party to pay a sum of Rs.10,00,000/- to the complainants with interest at the rate of 10% p.a. from 09.04.2019 till payment.
2. It is further ordered that the opposite party shall pay Rs.10,000/- towards litigation costs to the complainant within 30 days from the date of order. Otherwise, it carries interest at the rate of 10% p.a. from the date of filing complaint till payment.
3. Furnish the copy of order to the complainant and opposite party at free of cost.

(Dictated to the Stenographer transcribed, typed by her, corrected by us and then pronounced in open Forum on this the 30^th January, 2020)