DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  9^th  day of  August, 2023 

Present      :   Sri. Vinay Menon V., President

                   :   Smt. Vidya A., Member

                  :   Sri. Krishnankutty N.K., Member                               Date of Filing:  23/03/2021     

                                                                                  CC/55/2021

1. Aswathy A.,

      W/o. Late U. Sunilkumar,

      Kareth Valappil, Nandiyamkode,

       Koottanadu Post, Palakkad – 679 533    

2. Swathvik (Minor),

       S/o. Late U. Sunilkumar,

       Kareth Valappil, Nandiyamkode,

       Koottanadu Post, Palakkad – 679 533

       Rep. by mother, Aswathy A.

3. A. Parukutty, 

      M/o. Late U. Sunilkumar,

      Kareth Valappil, Nandiyamkode,

       Koottanadu Post, Palakkad – 679 533                               -          Complainants

      (By Adv.M/s.A.V.Ravi,  K.P. Vijayakrishnan & Venugopal G.P.)

                                                                                                            Vs

1. M/s. HDFC Bank Ltd.,

Mele Pattambi Post,

Pattambi, Palakkad

Rep. by Manager

2. M/s. HDFC Ergo GIC Ltd.,

2^nd Floor, Kanakath Tower,

West Fort Road, Palat Junction,

Palakkad – 678 001

Rep. by its Manager                                                        -           Opposite parties  

      (OP1 by Adv. M/s. K. A. Kailas & Lavanya S

        OP2 by Adv. M/s. Saji Issac K. J & Ullas Sudakaran)

O R D E R

By  Sri. Vinay Menon V., President  

1. Undisputed pleadings are that one Sunilkumar was a beneficiary of a policy issued by the second OP which was an add-on facility availed while taking auto loan from the first OP. Accidental death was covered under this policy. Said beneficiary died of cardiac arrest on 15/4/2020 during the coverage period. Complainants, who are the legal heirs of the deceased plead that cardiac arrest being an accident, are entitled to the accidental death benefit assured under the policy.
2. Except for the contention of the complainants that death by cardiac arrest is an accidental death and hence the complainants are entitled to the benefit under the policy, all other pleadings are admitted.
3. Considering the nature of the complaint pleadings by OP1 are not discussed.
4.  The following issues were framed for consideration:

1. Whether heart attack comes under the definition of accident referred to in the policy and is it covered by the policy?
2. Whether the complainant has submitted claim form and supporting document required to process the claim before OP2 ?
3. Whether there is any deficiency in service / unfair trade practice on the part of OP in repudiating the claim ?
4. Whether the complainants are  entitled to any reliefs sought for ?
5. Any other reliefs?

5.         (i)         1^st Complainant  filed proof affidavit and marked Exts. A1 to A4.   Marking of       document were objected as they are photocopies. Since this Commission not          bound by the principles of Indian Evidence Act and in the absence of any         allegation that the  said documents were fabricated this objection is overruled.

(ii)        OPs  filed proof affidavits. OP1 marked  Exts. B1 to B3. OP2  marked Ext.B4.

Issue No. 1

6.         Seminal question that requires answering is whether cardiac arrest is covered under the definition of ‘accident’ as contemplated under Ext.B4 policy agreement. Complainants’ case is that as beneficiary died due to sudden heart attack, said death has to be considered as an accident and benefit arising out of the insurance coverage be paid to the legal heirs.

7.         Ext.B4 is the policy document. The policy certificate shows that upon an accidental death the legal heirs would get Rs.5 lakhs. Page 4 of Ext.B4 contains the Terms and Conditions.  Terms and conditions contain policy wordings with regard to the sum payable under the head “Accidental Death”. Terms “Accident” or “Accidental” are defined as herein below:

            ‘4. “Accident or Accidental” means a sudden, unforeseen and involuntary event caused by external, visible and violent means’.

            Thus we can see that words ‘accident or accidental’, as contemplated under Ext.B4, is an event arising out of an external visible and violent means. The sudden cardiac arrest,   in the facts and circumstances of the case, is not caused by any external, visible and violent means. 

8.         Thus we are unable to approve the contention of the complainants that death of the life assured was an accidental death.

Issue Nos. 2 &3

 9.        In view of the findings in Issue No.1 we are not resorting to discussing Issue No.2. We hold that there is no deficiency in service on the part of opposite parties.

            Issue Nos. 4 & 5

10.       Naturally the complainants are not entitled to any of the reliefs sought for.

11.       Considering the facts and circumstances of the case, parties are directed to suffer their respective costs.

12.       The complaint stands dismissed.

                  Pronounced in open court on this the  9^th  day of August,  2023.    

                                                                                                                                  Sd/-

                                                                                                            Vinay Menon V

                                                                President

                         Sd/-    

                                                                   Vidya A.

                                                                   Member

                          Sd/-

              Krishnankutty N.K.

                                                                                                                     Member

APPENDIX

Exhibits marked on the side of the complainant :

Ext.A1 –  Copy of lawyer’s notice dated 14/10/2020

Ext.A2 –  Copy of policy certificate

Ext.A3 –  Copy of death certificate

Ext.A4 –  Copy of certificate issued from Modern Hospital

 Exhibits marked on the side of the opposite party:

Ext.B1 –  Copy of agreement for auto loan

Ext.B2 –   Copy of statement of account

Ext.B3 –   Copy of communication

Ext.B4 -  Copy of policy document

Court Exhibit:  Nil

Third party documents:  Nil

Witness examined on the side of the complainant:  Nil

Witness examined on the side of the opposite party: Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.