Heard the learned counsel for both the parties.
2. This appeal is filed U/S-15 of erstwhile Consumer Protection Act,1986(herein-after called the Act). Parties to this appeal shall be referred to with reference to their respective status before the learned District Forum.
3. The case of the complainant, in nutshell is that he has wife namely Parvati who had availed housing loan from SBI,Bhawanipatna for a sum assured of Rs.1,50,000/-. Against sanction of loan she was covered with SBI Life insurance policy with equal amount of loan availed of. loan It is alleged inter-alia that after insured on 29.09.2004 the life insured died on 29.10.2004 due to heart failure Subsequently, the husband of the deceased being the nominee of the policy holder claimed death benefit from the Opp.Parties. It is further averred that the insurance company repudiated the claim as per clause-6,Schedule-II of the Policy. Challenging same the complaint was filed showing deficiency in service on the part of the OP.
4. The OP No.1 & 2 filed written version stating that the deceased Parvati had incurred a housing loan from the SBI Group under SBI Life Super Suraksha plan meant for the Housing loan borrowers . It is also averred that she was insured with equivalent amount vide Master Policy No.83001000203 issued by OP with condition that in case of insured borrower dies within 45 days of the commencement of risk otherwise than due to an accident, no claim is admissible. Therefore, the risk is not covered in this case. So, there is no deficiency in service on the part of OP No.1 & 2 in repudiating claim.
5. OP No.3 filed the written version stating that with the consent of life assured the premium amount was debited to the loan account of the Parbati and it was remitted to the SBI Life Account. It is averred that they have nothing to do in this case.
6. After hearing both the parties, learned
District Forum passed the following order:-
Xxxxx xxxxxxxx xxxxxx
“Hence, on the aforesaid findings we allow the case of the complainant and direct the Oppositre Party No.1 & 2 to pay a sum of Rs.1,50,000/-(Rupees one lakhs fifty thousand) to the Opposite Party No.3 for adjustment of housing loan of late Parvati Hota against policy No.83001000203 under intimation to the complainant within 30 days from the date of receipt of the order. The Opp.Party No.1 & 2 are also directed to pay a sum of Rs.1,000/-(Rupees one thousand) towards cost of the litigation to the complainant within the above period. The case is disposed of accordingly.”
7. Mr.R.C.Mohanty,learned counsel for the appellant submitted that the impugned order is illegal and improper as they have not interpreted the policy condition at clause -6 of the policy. He has also submitted that learned District Forum ought to have considered the policy conditions because Parvati has not died due to accident but due to heart failure. He urged that she died out of heart attack which is not covered by policy condition because it is stated that it would not cover the risk if death occurs within 45 days from the date of commencement of policy due to any disease other than accident. Learned District Forum ought to have considered such fact and law while passing the impugned order. Therefore, he submitted to set-aside the impugned order by allowing the appeal.
8. Learned counsel for the respondent no.2 submitted that there is no any order passed against them but the benefit according to the OP No.1 & 2 would be available to them to adjust the loan amount.
9. Considered the submission of respective counsels, perused the DFR and impugned order.
10. It is well settled in law that the complainant has to prove the deficiency in service on the part of the OP. It is admitted fact that the complainant’s wife was a policy holder for Rs.1,50,000/- by incurring same from OP No.3. It is not in dispute that the Parvati, the deceased policy holder has also purchased the insurance policy of equal amount of loan from OP No.2 under sponsorship of OP No.3. It is also not in dispute that one premium has already paid by Parvati by debiting to the loan amount . It is also not in dispute that on 29.09.2004 the insurance policy commenced but the policy holder died on 29.10.2004 due to heart failure. It is submitted by the learned counsel for the appellant that the undoubtedly death was occurred but the SBI master policy in clause No. 6 of the SBI Life Insurance policy is as such:-
“In the event of the death of the Member at any time, after 45 days(except for Accidental Death), from the Date of Commencement of Risk,subject to the Policy being in full force, but not later than the Member completing the age of 70 years, to pay the Grantees or any person so authorized by the Grantees the Sum Assured.
The Grantees shall, on receipt of the Sum Assured, liquidate the loan amount due from the Member, as per the original EMI Schedule, and remit the surplus amount, if any, to the Nominee.
On payment of the benefits as above, the liability of the Company to the Grantee/Beneficiary/Member, as the case may be, would stand extinguished. Upon payment of the benefits, the membership of the Member in the Scheme would stand terminated. “
11. With regard to the policy condition, it appears in this case that death occurred due to heart failure. No doubt the question arises whether the death occurred due to cardiac failure and same can be treated as accident. The word “accident” has not been defined in the policy. In the instant case the cardiac failure happened after fall on the ground as per materials produced by both the parties. It is not the case that she suffers from cardiac failure due to long suffering or any pre-existing disease. Therefore, in the above facts and circumstances of the case, cardiac failure is proved to be an accident. Thus, the Parvati, policy holder is covered under such clause-6 became she died out of accident within 45 days of commencement of policy. Therefore, this Commission is of the view that there is no error in judgment passed by the learned District Forum. As such we are not inclined to interfere with the impugned order which is hereby confirmed and the appeal stands dismissed. No cost.
Free copy of the order be supplied to the respective parties or they may download same from the confonet or webtsite of this Commission to treat same as copy of order received from this Commission.
DFR be sent back forthwith.
