PBEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, ERNAKULAM.
Dated this the 30th day of June 2012
Filed on : 19-11-2010
Present :
Shri. A Rajesh, President.
Shri. Paul Gomez, Member.
Smt. C.K. Lekhamma, Member
C.C. No. 640/2010
Between
Indira, : Complainant
W/o. Padmadas, (By Adv. Bosco Paul P,
Puthenpurayil house, Aluva, Ernakulam)
Thrikkunnapuzha,
Arattupuzha North P.O.,
Allappuzha.
And
The Manager, : Opposite party
HDFC, Ergo, (By Adv. A.R. George,
General Insurance Co. Ltd., Anthikkatt house, P.O.
Capital Centre, 2nd Floor, Vennala, Cochin-28)
2E, M.G. Road,
Opp. Secretariat, Trivandrum.
O R D E R
A Rajesh, President.
The case of the complainant is as follows:
The complainant is the mother of late Tharadas P. Late Tharadas was the holder of policy No. 40305406 of the opposite party. The policy commences from 27/03/2010, which is for a period of 60 months from commencement. The policy was alive at the time of the death of the son of the complainant. The son of the complainant expired on 16/06/2010 due to Diabetic Ketoacidosis Cardio Respiratory Arrest. The complainant is the beneficiary of the policy. As per the policy, at the event of the death of the policy holder the opposite party is legally liable to pay the insured amount fully without any demur or disbursed it to the beneficiary. After the death of the son, the complainant repeatedly requested the opposite party for the release of policy amount in favour of the complainant. But the opposite party has not acceded to the demands made by the complainant. Complainant is entitled to get insurance claim of Rs. 5 lakhs together with costs of the proceedings. Hence this complaint.
2. The version of the opposite party is as follows:
The opposite party issued a “Sarv Suraksha Plus Policy” to the insured/deceased Taradas P., valid for a period of 60 months commencing from 27-03-2010. He died on 16-06-2010 on account of “diabetic Ketoacidosis Cardio Respiratory arrest” As per Section 5 of the policy, coverage is applicable only when the death of insured is an accidental death. The complainant has no case that the death of the insured was an accidental one. There is no deficiency in service on the part of the opposite party.
3. This Forum allowed the complaint vide order dated 28-02-2011. The opposite party preferred appeal before the Hon’ble Kerala State Consumer Disputes Redressal Commission against the said order and vide order dated 31-08-2011, the Hon’ble State Commission remitted the complaint with a direction to pay Rs. 8,000/- towards costs of the proceedings to the complainant. The opposite party duly complied with the order. The complainant was examined as PW1 and Exts. A1 to A8 were marked. Neither oral nor documentary evidence was adduced by the opposite party. Heard the counsel for the parties.
4. The points that arose for consideration
i. Whether the complainant is entitled to get the insurance claim
from the opposite party?
ii. Whether the opposite party is liable to pay costs of the
proceedings to the complainant.?
5. Point No. i. Admittedly the complainant’s son Tharadas the deceased had availed Ext. A1 insurance policy for the period from 27-03-2010 to 26-03-2015. It is not in dispute that during the coverage of the policy the said Tharadas breathed his last on 16-06-2010. As per Ext. A4 medical certificate the reason for death is diabetic Cardio Respiratory Arrest.
Section 5 of Ext. A1 policy reads as follows:
“In the event of Accidental Death or Permanent Total Disability of the Insured Person during the Policy Period, the Company will make payment under this policy as detailed below.
The company will pay the balance outstanding loan amount in the manner agreed in the name of the insured Person in the books of the Finance/Bank/Mortgage Company, subject to the maximum Sum insured specified in the Schedule Claim will be directly paid to the Finance/Bank/Mortgage Company to the extent of Outstanding Loan amount.
The outstanding Loan amount would not include any arrears of the borrower due to any reasons whatsoever. The claim to be settled only in respect of the death of the first named borrower and not in respect of the others, which may happen in case loan is taken jointly.”
6. In the instant case the deceased died due to reasons which is not covered as per Ext. A1 policy. It is well settled law that parties to an insurance contract is bound by the terms and conditions in the policy. The Hon’ble Supreme Court in United India Insurance Co. Ltd. Vs. Harchand Rai Chandal Lal IV 2004 CPJ 15 (SC) has held that, “the terms of the contract have to be strictly read and natural meaning be given to it. No out side aid should be sought unless the meaning is ambiguous”. In the instant case there is no ambiguity in the terms and conditions of Ext. A1 policy.
7. Though our sympathies are with the complainant, the sustained law is at a no go to accept her contentions, we are left with no option but to agree with the same. Let alone contradict it.
8. In the result, we are only to uphold the decision of the
Hon’ble Supreme Court and not to allow this complaint. Ordered accordingly.
Pronounced in the open Forum on this the 30th day of June 2012.
Sd/- A Rajesh, President.
Sd/- Paul Gomez, Member
Sd/- C.K. Lekhamma, Member.
Forwarded/By Order,
Senior Superintendent.
Appendix
Complainant’s exhibits :
Ext. A1 : Copy of policy schedule
A2 : Copy of legal notice dt. 20-9-2010
A3 : A.D. card
A4 : Medical certificate
A5 : Copy of death certificate
A6 : Postal receipt
A7 : Repayment receipt dt. 19-7-2010
A8 : Copy of registration
Opposite party’s Exhibits : Nil
Depositions:
PW1 : Indira Padmadas
