This first appeal has been filed against the impugned order dated 22.09.2015, passed by the Tamil Nadu State Consumer Disputes Redressal Commission (hereinafter referred to as ‘the State Commission’) in consumer complaint No. 33/2010, vide which, the said complaint was dismissed.

2.       The facts of the case are that the deceased husband of the complainant Venkataraman availed loan from the opposite party (OP) HDFC Bank of ₹37,75,000/- for purchasing a residential house, for which he had taken an insurance policy  from OP-2 HDFC Ergo General Insurance Co. Ltd. and the Insurance Policy was meant to indemnify the complainant for the loan amount in the case of critical illness, accidental death and damage to the insured premises due to natural calamities like lightning, flood, cyclone etc.  The OP-1 Bank also sanctioned a sum of ₹1,54,268/- as amount of premium to be paid under the Policy and hence, the total loan amount was ₹39,29,268/-.  The insurance policy was valid for a 5-year period from 21.08.2009 to 20.08.2014.  The husband of the complainant died on 03.09.2009 due to heart-attack, following which, the complainant made claim application with OP-2 on 23.09.2009.  In the meantime, the OP-1 presented cheques for 4 EMIs for payment.  The OP-2 repudiated the claim of the complainant on the basis of exclusion clause, stating that if any illness arose within 90 days from the commencement of period of insurance, the Insurance Company shall not be liable to make any payment under the said Policy.  The complainant filed the consumer complaint in question, seeking direction to OP-2 to make payment of the assured sum of ₹39,29,268/- and to pay the said amount to the OP-1 Bank, excluding the amount of first EMI, i.e., ₹57,565/- which should be paid to the complainant.  The compensation of ₹1 lakh for mental agony was also demanded.

3.       The complaint was resisted by OP-1 & 3 by filing a written statement before the State Commission, in which they stated that the cheques presented by them for the EMIs were returned with the remarks, ‘funds insufficient’.  The OP-1 & 3 were legally entitled to recover the loan amount from the legal heirs of the deceased.  They had, therefore, not indulged in any deficiency in service towards the complainant.  The OP-2 Insurance Company also filed a written statement before the State Commission, saying that under the terms and conditions of the Policy, the claim arising out of major illness is not covered, unless such illness occurs after expiry of a period of 90 days of the commencement of the insurance policy.  The OP-2 stated that the entire policy including the terms and conditions had been supplied vide letter dated 26.08.2009 to the complainant, and hence, there was a binding contract between the parties.  The complainant had deliberately not filed the terms and conditions of the policy before the State Commission.

4.       The State Commission, after taking into account the contentions of the parties, dismissed the consumer complaint, saying that the repudiation of the claim by the OP-2 was in accordance with the terms and conditions of the policy.  Being aggrieved against this order, the complainant is before this Commission by way of the present revision petition. 

5.       It was contended by the Ld. Counsel for the appellant at the time of arguments that the appellant or her deceased husband, were never made aware of the exclusion clause in the Policy.  The Ld.  Counsel has drawn attention to order dated 27.06.2012 issued by the Insurance Regulatory and Development Authority (IRDA) vide reference No. IRDA/LIFE/ORD/MISC/146/06/2012 stating that as per this order, the claim could not be denied by the Insurance Company, even if the death occurred within 90 days of taking the said policy.

6.       I have examined the entire material on record and given a thoughtful consideration to the arguments advanced by the parties before me.  

7.       It is a well-settled proposition of law that the parties to the contract of insurance are governed by the terms and conditions of the insurance policy issued at the time of such contract.  A perusal of the record of the State Commission reveals that a copy of the insurance policy in question filed before the State Commission carries an exclusion clause which shows as follows:-

“Insured event : For the purposes of this Section and the determination of the Company’s liability under it, the Insured Event in relation to the insured, shall mean any illness, medical event or surgical procedure as specifically defined below whose signs or symptoms first commence more than 90 days after the commencement of period of Insurance and shall only include:-

a)       First Diagnosis of the below-mentioned illness more specifically described below:-

1.       Cancer,

2.       Kidney Failure (End Stage Renal Failure);

3.       Multiple Sclerosis; or ”

8.         A letter dated 26.08.2009 sent by the OP-2 addressed to the deceased husband of the complainant has also been placed on record, which shows that complete details with regard to “Home Suraksha Plus” Policy issued by the OP-2 were enclosed with the said letter.  It is very clear, therefore, that the insured was made aware of the terms and conditions governing the said policy.  The State Commission has rightly reached the conclusion that the repudiation of claim by OP-2 was justified, in view of the exclusion clause in the said policy as the life assured died due to heart attack within 90 days of obtaining the said policy.  I, therefore, do not find any illegality, irregularity or jurisdictional error in the impugned order passed by the State Commission.  It is held, therefore, that there is no merit in this appeal and the same is ordered to be dismissed and the order passed by the State Commission is upheld with no order as to costs.