1.       This Revision Petition has been filed under section 21 of the Consumer Protection Act, 1986 by the Petitioner against the order dated 29.01.2013 passed by the State Consumer Disputes Redressal Commission, Rajasthan at Jaipur (herein referred to as the “State Commission”) in First Appeal No.488 of 2012, arising from the order dated 30.01.2012, passed by the District Consumer Redressal Forum, Bhilwara (herein referred to as the “District Forum”) in Complaint Case No.192 of 2011.  

2.       Case of the Complainant is that her husband was sanctioned loan for a tractor by Opposite Party No.1/Bank with loan account no. 80078895. Insurance Policy was taken from Opposite Party No.2 covering sudden or accident event against loan of tractor vide Sar Surkasha Super Policy No. 40463033. As per the Policy, in case of sudden death of the insured the outstanding loan amount and other liabilities was to be paid to Opposite Party No.1 so as to close the account of the Complainant, noting of HPA removed and issue no objection certificate. Her husband Pyar Chand Bairwa suddenly died on 18/04/2011 at Hinduja Hospital Khandwa (M.P). The husband of Complainant had deposited first installment on 04/01/2011 by cash. The next installment due on 04/07/2011 could not be paid due to his sudden death. As per the terms of the Policy, the balance outstanding amount was to be paid by Opposite Party No.2 to Opposite Party No.1. Though intimation of sudden death was given to Opposite Party No.2 and the available documents were supplied, there was no response from Opposite Party No.2, despite repeated reminders. Opposite Party No.1 started harassing the Complainant for making repayment of loan and threatening to forfeit the tractor. Aggrieved by deficiency in service and unfair trade practice of the Opposite Parties, Complaint was filed with the District Forum with the following prayer:-

"1.The Opposite Party No 2 insurance company is directed to pay within one month the outstanding amount of loan with penalty and other charges out of insured amount of Rs.6.00 lakhs to the opposite party no. 1 and balance amount out of six lakhs to Smt. Shanti Devi within one month with interest.

2. The opposite parties be directed to pay Rs. 1.00 lakh as compensation for mental and physical tension with 18% interest due to their illegal acts.

3. The   costs of the complaint be also directed to be paid.

4. Any other relief which this Hon’ble Forum deems fit and proper be also awarded.”

3.       Reply was filed by Opposite Party No.1 stating that they had given a loan of Rs.2,00,730/- to Pyar Chand Bairwa for the purchase of tractor on 14/07/2010 which was to be repaid in half yearly installments of Rs.43,135/-. A sum of Rs.1,95,656.43/- was due on 30.09.2011 as per the account statement. They stated that they had every right to recover the unpaid loan amount. They prayed that the Complaint be dismissed against them.

4.       Opposite Party No.2 in their reply admitted to having issued Sar Surkasha Super Policy to Pyar Chand Bairwa, according to which in case of an accidental death, payment of the outstanding loan on the insured vehicle or Rs.6,00,000/- whichever is less was to be made, subject to compliance of terms and conditions of the Policy during the period of insurance from 14/07/2010 to 13/07/2013. The insured shall immediately and in any event within 14 days intimate them. The Complainant, however has not given any information/ made any claim in respect of death of the insured in the accident. Settling of the claim, therefore, did not arise. Moreover death of the insured took place due to illness and not due to accident. In the discharge slip issued by the Hospital, the decease is shown as “severe headache”. There was no mention of any accident. The Complainant had not given intimation about the death of the insured within the time mentioned in the Policy nor thereafter any claim had been lodged.

5.       The District Forum after considering the argument of both Parties passed the following order:-

“1.The Opposite Party No 2 insurance company is directed to pay within one month the outstanding amount of loan with penalty and other charges out of insured amount of Rs.6.00 lakhs to the opposite party no. 1 and balance amount out of six lakhs to Smt. Shanti Devi within one month with interest.

2. The complainants are directed that if they have not presented the claim form duly filled in, they should present the claim form duly filled in according to rules to the opposite party no. 2 within one month for which the insurance company will render all the help.

3. The opposite party no. 1 is directed to intimate the balance outstanding amount of loan in the account of Pyar Chand to the opposite party no. 2 within one month positively. On receipt of the outstanding loan amount from Opposite Party no.2, the opposite party no. 1 within one month thereof will remove the entry of hypothecation from the Registration Certificate of tractor and issue NOC to the complainants.

4. The opposite parties shall pay interest @9% per annum on the amount of insured amount from the date of complaint ie. 05.09.2011.

5. The complainants are also entitled to get Rs. 2000.00 (Two Thousands only) as cost of the complaint.

         The Opposite Insurance Co. is directed to abide by the award and deposit the balance by way of cheque in the name of complainant with this forum within a month

        That on non payment of the amounts within one month the opposite insurance company will have to pay interest @ 12% per annum.”

6.       Aggrieved by the order of District Forum, Opposite Party No.2 filed an Appeal with the State Commission. The State Commission after pursuing the record and hearing the arguments of both the Counsel for Parties upheld the order of the District Forum and directed the Opposite Party to pay Rs.10,000/- towards mental harassment and Rs.5000/- towards cost to the Complainant.

7.       Against the concurrent finding of both the Fora, Petitioner/Opposite Party No.2 filed Revision Petition in this Commission. Heard the Learned Counsel for the Petitioner/Opposite Party No.2 and Respondent No.6/Opposite Party No.1. As none appeared on behalf of Respondent No.1 to 5/Complainants No.1 to 5 despite last opportunity being given to them, they were proceeded ex parte.

8.       Brief facts of the case are that the husband of Respondent No.1/Complainant No.1 was sanctioned loan for purchase of tractor by Opposite Party No.1/Bank. Sarv Suraksha Super Policy was issued by the Petitioner/Opposite Party No.2 covering the loan for any sudden or accident event. It is admitted fact that Respondent/Complainant’s husband Pyar Chand Bairwa died on 18/04/2011 at Hinduja Hospital Khandwa (M.P). Before his death he had deposited/paid the 1^st installment of loan. The case of the Complainant is that Opposite Party No.1 started harassing her for payment of balance of outstanding loan amount which had not been taken care of by the Petitioner/Opposite Party No.2/insurer. Opposite Party No.2 admitted that they had issued the Sarv Suraksha Super Policy to Pyar Chand Bairwa for payment of outstanding loan on insured vehicle or Rs.6 lakh whichever is less in case of accidental death of insured. It is also incumbent on the part of the claimant to inform them immediately or within 14 days. Petitioner/Opposite Party No.2 in the reply stated that they did not receive the information on time and that the death of insured took place due to illness and not due to any accident.

9.       The District Forum took the view the insured died within the Insurance period. The Petitioner/Opposite Party No.2 nowhere stated as to when intimation of death was given nor when the claim was presented. As mentioned in the discharge ticket the insured died in the Hospital. They considered this as sudden and accident death and allowed the Complaint. The District Forum directed to Complainant as follows:-

“2. The complainants are directed that if they have not presented the claim form duly filled in, they should present the claim form duly filled in according to rules to the opposite party no. 2 within one month for which the insurance company will render all the help.”

10.     The State Commission also held that the deceased died due to accident. It was proved by the discharge slip of the Hospital. It further went on to state that he died in an accident and the repudiation of the claim of the Complainants was wrong. Upholding the order of the District Forum they granted a further sum of Rs.10,000/- towards mental harassment and imposed a cost of Rs.5000/-.

11.     The Respondent no.6/Opposite Party No.1 purchased Sarv Suraksha Super Policy from Petitioner/Opposite Party No.2 for covering outstanding loan amount of the tractor purchased by the husband of the Complainant or Rs.6 lakh whichever was less for the period 14/07/2010 to 13/07/2013 as credit shield for outstanding loan amount to be paid on the death of the borrower Pyar Chand Bairwa. Among the duties and obligation, after occurrence of an insured event, the insured shall immediately and in any event give written notice within 14 days and submit claim from within 28 days. Credit Shield Policy is taken in the event of accidental death or permanent total disability of the insured. Company shall pay the outstanding loan amount in the name of insured person in the books of the finance/Bank company. Accident or accidental means a sudden, unintended and fortuitous external and visible event. The insured shall take all reasonable steps to minimize the consequential steps of bodily injury and in the event of death of the insured, written notice should be accompanied by  copy of Post Mortem report. The insured was admitted in the Hospital in 18/04/2011 for severe headache at 5.30 p.m. and not for any accidental injury. No bodily injury to the insured was reported and the Complainant failed to prove the death occur due to accident.

12.     Both the fora below erred in holding the death of the patient, after being admitted in Hospital after severe headache was sudden death and therefore covered under the Policy. The Complainant was admitted at 5:30 p.m. with past history of headache for the last 3 hour and he died at 11 p.m. There can be umpteen reasons for headache which has not been diagnosed and certainly, it was not due to bodily injury and any accident.

13.     Petitioner/Opposite Party No.2 has many types of medical Insurance Policies but the present case is covered for credit shield of outstanding loan amount, where terms and conditions prescribed for informing within 14 days and filing claim within 28 days. Post Mortem report was to be filed and death must be due to accident or accident meaning sudden, unintended and fortuitous external and visible event. Bodily injury means physically body harm or injury but does not include any mental sickness, disease or illness.

14.     The present Petition/Complaint does not cover all the above ingredients necessary for allowing the claim of the Respondents/Complainant. Insurance Policy is a contract between the insurer and the insured. The insured cannot get any claim/ benefits beyond the scope of the Policy. The contract has to be strictly construed and is binding on both parties.

15.     In view of the above, orders of both the Fora are set aside. The Revision Petition is allowed and the Complaint is dismissed. No order as to costs.