Date of filing: 31.12.2011.

Date of disposal: 04.12.2012.

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM - II:

VIJAYAWADA, KRISHNA DISTRICT

Present: Sri A. M. L. Narasimha Rao, B.Sc., B. L., President

Smt N. Tripura Sundari, B. Com., B. L., Member

Tuesday, the 4th day of December, 2012

C.C.No.28 of 2012

Between:

Thirupachur Comarica Geetha, W/o T.C. Bhaskar, Door No.1-3-19/22A, Sri Ramaswamy Street, Near Ramamandir, Vidyadharapuram, Vijayawada – 520 012.

….. Complainant

And

1. The Manager, ICICI Lombard General Insurane Co., Ltd., Door No.6-3-352/1, 3rd Floor, Usman Plaza, Road No.1, Banjara Hills, Hyderabad – 34.

2. The M.D and C.E.O, ICICI Lombard General Insurane Co., Ltd., Zenith House, Keshavarao Khadge Marg, 2nd Floor, Mahalakshmi, Mumbai – 400 001.

3. Branch Manager, ICICI Home Finance Co., Ltd., 1st Floor, Shilpa Arcade, 59-14-8, Ring Road, Gayatri Nagar, Vijayawada – 8.

. … Opposite Parties.

This complaint coming on before the Forum for final hearing on 22.11.2012, in the presence of Sri A. Sainath Babu, advocate for complainant, Sri T. Veerabhadra Rao, advocate for opposite parties and upon perusing the material available on record, this Forum delivers the following:

O R D E R

(Delivered by Hon’ble Member Smt N.Tripura Sundari)

This complaint is filed under Section 12 of Consumer Protection Act, 1986.

1. The averments of the complaint are in brief:

The husband of the complainant worked as deputy chief controller in South central railways and who availed housing loan of Rs.6,00,000/- from the 3rd opposite party in the month of September, 2003 under loan application No.7771097053. At the time of sanctioning housing loan the 3rd opposite party insured the life of the principal borrower i.e., the husband of the complainant with the 1st opposite party.

The complainant stood as co-obligent to the said loan. The said housing loan is to be paid at Rs.7,006/- per month for 10 years and at Rs.3,106/- per month for 3 years. The husband of complainant used to pay the EMIS regularly. While so, unfortunately the complainant’s husband died on 5.10.2006 in a train accident. Due to that incident the complainant became depressed and she was forced to take medical care for a long period. After some recovery of her mental shock the complainant informed the accident to the 1st opposite party in writing and they acknowledged the same and made process. Subsequently the opposite parties changed their version and sent a letter dated 14.7.2010 to the complainant stating that the claim was repudiated on the ground that there is no intimation within thirty days of the death of her husband. Even after negotiations the opposite parties did not consider the request of the complainant. She approached the insurance ombudsman, wherein the claim of the complainant was dismissed. In the meanwhile the 3rd opposite party threatened the complainant for repayment of the loan amount. Infact when the principal borrower dies during the subsistence of the insurance policy, the insurance company shall pay the amount to the nominee or to the loan account. Accordingly the opposite parties 1 and 2 are liable to pay the insurance amount to the complainant or to the 3rd opposite party, but they failed to do so. The 3rd opposite party collected huge amounts from the complainant after the death of her husband. As such all the opposite parties are committed deficiency in service towards the complainant. Hence she filed a complaint against the opposite parties praying the Forum to pay Rs.6,00,000/- with interest at 24% p.a., from 5.10.2006 to till realization and award compensation and costs.

2. The opposite party No.1filed the version and the 2nd opposite party adopted the same and the 3rd opposite party is called absent.

3. The version of the opposite parties 1 and 2 is in brief:

The opposite parties denied all the allegations of the complaint and submitted that as per ‘3 general exclusions applicable to the policy” the company shall not be liable for any loss or damages under the policy part II of the schedule – 3.6 which reads: “arising out of or as a result of any act of self-destruction or self inflicted injury, attempted suicide or suicide. The suicidal death of the insured clinchingly establishes through the crime records of policy including the inquest report in Column No.VII, IX, XV, it was reported clearly that the insured person committed suicide and the post mortem report clearly states opinion as to cause of death due to “traumatic separation of head”. The claim settlement is applicable to Section 11, 2.2.2 of the policy (1) upon the happening of any injury giving rise or likely to give rise to a claim under this policy, the injury as described above shall be intimated to the company within seven days from the date of its occurrence (II) the insured deliver to the company, within 30 days of the date of occurrence of the insured event, a detailed statement in writing as per the claim form and any other material particulars relevant to the making of such claim. The complainant did not comply with Section 11, 2.2.2 of the policy and informed the death of the deceased to the opposite parties belatedly and more over she herself committed the violation of “3. General exclusions applicable to the policy. Therefore the company shall not be liable for any loss or damage under the policy and hence the opposite parties repudiated the claim. On repudiation of the claim by the opposite parties, the complainant approached the Hon’ble Ombudsman, Hyderabad under rule 16 of the redressal of public grievances rule, 1998 and the same was registered as complaint No.1. 4. (Hyderabad) G – 11 57.2010 – 11. On hearing both the parties the insurance ombudsman dismissed the complaint on 20.7.2011 stating that the complainant’s claim merits no consideration. In the result the complaint is dismissed without any relief. The insured person’s death does not fall under Section 11, 2.2.2. “personal accident/insures event” and that as per the crime records insured did not sustain any accidental physical bodily harm solely and directly caused by external, violent, visible and evident causes the death and the death of the insured person was due to traumatic separation of head which could not be the case of accidental hit by running train and the insured allowed himself run over by the train in other words, he committed suicide. Therefore the complainant is not entitled to the benefits under the policy. There is no deficiency on the part of the opposite parties towards the complainant. Hence prayed to dismiss the complaint with costs.

4. On behalf of the complainant she gave her affidavit and got marked Exs.A1 to A26 and on behalf of the opposite parties Sri J. Sravan Kumar, Manager in legal of the 1st opposite party filed his affidavit and got marked Exs.B1 to B3.

5. Heard and perused.

6. Now the points that arise for consideration in this complaint are:

I) Whether there is any deficiency in service on the part of the opposite parties in not accepting the claim of the complainant or not?

II) If so is the complainant entitled for any relief?

III) To what relief the complainant is entitled?

Points 1 and 2:

7. On perusing the material on hand it is an admitted fact that the complainant’s husband availed housing loan of Rs.6,00,000/- from the 3rd opposite party. The complainant says that at the time of sanctioning the loan the 3rd opposite party insured the life of the principal borrower i.e., the husband of the complainant with the 1st opposite party, the complainant stood as co-obligent to the said loan. The complainant’s husband used to pay the said loan regularly, while so the husband of the complainant died on 5.10.2006 in a train accident, Exs.A5 to A9 relating to the death of the complainant’s husband. Due to the death of her husband the complainant became depressed and was forced to take medical care for a long time, Ex.A10 to Ex.A12 the certificates given by the doctors show the same. After some recovery from her mental shock, the complainant informed the accident to the 1st opposite party in writing under Ex.A1 and they acknowledged the same. They sent a letter under Ex.A2 dated 14.7.2010 to the complainant stating that the claim was repudiated on the ground that there was no intimation within thirty days about the death of her husband. The complainant approached the Ombudsman of the insurance by writing a letter dated 10.3.2011 under Ex.A3 and the said Ombudsman wrote a letter to furnish the details of the complaint and the complainant furnished all the details in her complaint to the Ombudsman. On hearing the parties the ombudsman dismissed the complaint on 20.7.2011 under Ex.A4. The 3rd opposite party collected huge amount from the complainant under Ex.A13 to A26 after death of her husband. The 1st opposite party shall pay the insurance amount to the complainant as the nominee or to the 3rd opposite party who sanctioned housing loan.

8. The opposite parties 1 and 2 says that as per “3 general exclusions applicable to the policy the company shall not be liable for any loss or damage under the policy part II of the schedule Ex.B3 clause 3.6 reads as arising out of or as a result of any act of self destruction or self inflicted injury attempted suicide or suicide. The death of the insured establishes through the crime record Ex.A5 to A9 of police, in inquest report it was clearly reported in column no.VII, IX, XV that the insured person committed suicide and the opinion in postmortem states that the cause of the death due to “traumatic separation of head”. The claim settlement is applicable to Section II, 2.2.2 of the policy (1) upon the happening of any injury giving rise or likely to give rise to a claim under this policy, the injury as described above shall be intimated to the company within seven days from the date of its occurrence (II) the insured deliver to the company, within 30 days of the date of occurrence of the insured event, a detailed statement in writing as per the claim form and any other material particulars relevant to the making of such claim. The complainant did not comply with Section 11, 2.2.2 of the policy and informed the death of the deceased to the opposite parties belatedly and more over she herself committed the violation of “3. General exclusions applicable to the policy. Therefore the company shall not be liable for any loss or damage under the policy and hence the opposite parties repudiated the claim. On repudiation of the claim by the opposite parties, the complainant approached the Hon’ble Ombudsman, Hyderabad under rule 16 of the redressal of public grievances rule, 1998. On hearing both the parties the insurance ombudsman dismissed the complaint on 20.7.2011 under Ex.B2 stating that the complainant’s claim merits no consideration. The complaint be dismissed without any relief. The insured person’s death does not fall under Section 11, 2.2. “personal accident/insures event” and that as per the crime records insured did not sustain any accidental physical bodily harm solely and directly caused by external, violent, visible and evident causes the death and the death of the insured person was due to traumatic separation of head which could not be the case of accidental hit by running train and the insured allowed himself run over by the train and committed suicide. Therefore the complainant is not entitled to the benefits under the policy. Ex.B1 is account statement of the home loan given by the 3rd opposite party.

9. The complainant referred citations (1) 1992 (1) CPR Page.227, National Consumer Disputes Redressal Commission, New Delhi in between Smt Masulaben V Parmar & Another – Appellants VS LIC of India & Anr, respondents. In this case the complainant had taken a life insurance policy from LIC of India under Jeevan Mitra plan. The said policy commenced from January 16, 1986. The assured died on December 4, 1986 within nine months and twenty days after taking the policy. The widow of the assured lodged a claim under the policy. The LIC of India repudiated the claim on the ground that the deceased had not disclosed the material/correct information regarding his health against question Nos.18, 20 and 24 in the proposal from and that the answers given were false as they were having indisputable proof that for about two years before the proposal, the assured had suffered from chest pain and cough for which he had consulted medical men and had taken treatment. The Hon’ble National Commission gave a finding that the assured was not aware of any disease pertaining to heart at the time he signed the proposal form. His answers to various questions in the proposal form were honest and correct and the repudiation of the claim by the corporation is not supported by any legal and valid grounds.

(2) 2005 (1) CPR 80, Gujarat State Consumer Disputes Redressal Commission, Ahmedabad in New India Assurance Company Limited, Vs Padmaben Himatlal Shah and Another. In this case that Mr. Himatlal K. Shah, complainant’s husband had taken membership in the 10 years welfare endowment certificate under social welfare scheme of the original opponent no.1, the Peerless General Finance and Investment Company Limited, under which the risk of life on account of accident was covered by the opponent.2, Insurance Company. The insured paid the subscriptions from 13.8.1991 for a period of 10 years and died in the earthquake on or around 26.1.2001. The complainant claimed for the risk of accident. The 2nd opponent rejected the claim by its repudiation letter on 7.5.2011 on the ground that “no claim due to the age of the deceased certificate holder being over 65 years could be said to be covered under the policy condition. The Hon’ble Forum gave finding that no terms and conditions were communicated to the insured by the condition, which is canvassed in this appeal. No evidence has been adduced to show that the insured came to be communicated with the terms and conditions of the policy. In the above two complaints the facts and circumstances are different to the facts and circumstances of the present case and do not support the complainant’s case.

10. The opposite parties referred citations (1) 1993 (3) 34 CPR, State Consumer Disputes Redressal Commission, Panjab, Chandigarh, Shiv Yagya Paul Duggal Vs National Insurance Company Limited. In this case the complainant’s son Shiv Kumar Duggal aged 32 years had insured himself with the opposite party under personal accident insurance scheme on 24.5.1990 for an amount of Rs.2,00,000/- along with cumulative bonus of Rs.10,000/- and it was valid up to 23.5.1991. The insured while working on a kerosene stove at his residence on 14.12.1990 received burn injuries as his clothes accidentally caught fire and he was admitted in hospital and died on 23.12.1990. The insurance claim was filed and the opposite party repudiated the claim stating that the deceased had committed suicide. On hearing the parties and perusing the document the Hon’ble Commission gave a finding that the insured had not used the kerosene stove to warm-up his lunch on 14.12.1990. Instead he had poured kerosene oil on his cloths in a bid to burn himself and commit suicide. If the insurance company has on its own showing came to a bonafide conclusion that the claim of the complainant was not tenable and consequently repudiated it.

(2) 1997 (3) CPR 353, State Consumer Disputes Redressal Commission, Rajastan; Jaipur; Oriental Insurance Company VS Mangler Devi and Another. In this case the deceased insured Begduram Sharma was a workman in J.K. Cement works under a group insurance policy of work men against accident risk with the complainant. On 12th and 13th of September, 1984 at 10 PM some trouble was taking place between the workmen and management relating to certain demands of the workmen. During this agitation, the police fired a gun shot which hit the said insured and died. The widow of the deceased filed a complaint against the J.K. Cement and the complainant on 27.1.1993. The insurance company pleaded that the complaint was filed beyond limitation period of three years and therefore the same was not maintainable. The Hon’ble Forum gave a finding that refer to Article 44 of the Limitation Act, 1963, which provides for a limitation of three years for insurance claim and the limitation starts from the date of the death of the deceased or where the claim of the policy is denied. The death of insured took plea on 13.9.1984 and the complaint filed on 27.1.1993. The complaint is stale complaint and was dismissed.

3. The opposite parties relief on scale of compensation is to be decided as per Railway Accident and untoward incidents (compensation) Rules 1990 that no compensation shall be payable by the railway administration if, the passenger dies or suffers injury due to suicide or attempted suicide by him.

4. The opposite party submits extracts From the Journal of the Punjab Academy of Forensic Medicine & Toxicology containing deferent pages. The case study in that extracts deals with death of male adult lying by the side of railway track. The head was separated from the trunk. It was not shown be a case of homicide.

11. On hearing the both parties we, the Forum perused Ex.A5 to A9 the crime record of the insured and noticed in Ex.A6 i.e., the inquest report columns VII, IX and XV that the insured committed suicide. Ex.A7 i.e., postmortem report given by the Associate Professor department of Forensic Medicine Government of Andhra Pradesh, Sidhartha Medical College, Vijayawada gave its opinion that the cause of death was due to traumatic separation of head, we also perused Part II of the policy schedule general exclusions applicable to the policy and 2.2.2 claim settlement applicable to Section II and noticed “arising out of or as a result of any act of self destruction or self inflicted injury, intimation shall be given within a period of thirty days. The complainant violated the terms and conditions of the policy. More over the crime records clearly show that the insured deceased committed suicide.

12. The complaint filed by the complainant was also barred by limitation. The complainant’s husband died on 5.10.2006 and the claim was submitted on 19.3.2010 after lapse of four years. On taking into consideration the submission of opposite parties, we hold that there is no deficiency in service on the part of the opposite parties towards the complainant and the complainant is not entitled for any relief from the opposite parties. Accordingly these points are answered.

Point No.3:

13. In the result, the complaint is dismissed without costs.

Dictated to Steno N. Hazarathaiah, transcribed by him corrected by me and pronounced by us in the open Forum, this the 4th day of December, 2012.

PRESIDENT                                                                                                            MEMBER

Appendix of evidence

Witnesses examined

For the complainant: -None-                                                                                           For the opposite parties: -None8

Documents marked

On behalf of the complainant:

Ex.A1 19.03.2010 Photocopy of letter issued by complainant to OP.3

Ex.A2 14.07.2010 Copy of letter issued by OP.1 to complainant

Ex.A3 10.03.2011 Photocopy of letter issued by complainant to OP.1

Ex.A4 Photocopy of award copy of insurance ombudsman.

Ex.A5 Photocopy of FIR.

Ex.A6 Photocopy of inquest report.

Ex.A7 06.10.2006 Photocopy of post mortem report.

Ex.A8 copy of paper cutting.

Ex.A9 Original copy death certificate.

Ex.A10 07.11.2007 Original copy of medical certificate.

Ex.A11 15.09.2009 Original copy of medical certificate.

Ex.A12 Original copy of medical certificate.

Ex.A13 30.08.2010 Notarized copy of payment receipt.

Ex.A14 24.12.2010 Notarized copy of payment receipt.

Ex.A15 28.03.2011 Notarized copy of payment receipt.

Ex.A16 06.04.2011 Notarized copy of payment receipt.

Ex.A17 10.05.2011 Notarized copy of payment receipt.

Ex.A18 09.06.2011 Notarized copy of payment receipt.

Ex.A19 08.07.2011 Notarized copy of payment receipt.

Ex.A20 09.08.2011 Notarized copy of payment receipt.

Ex.A21 09.09.2011 Notarized copy of payment receipt.

Ex.A22 10.11.2011 Notarized copy of payment receipt.

Ex.A23 25.11.2011 Notarized copy of payment receipt.

Ex.A24 27.11.2011 Notarized copy of payment receipt.

Ex.A25 27.11.2011 Notarized copy of payment receipt.

Ex.A26 12.01.2012 Notarized copy of payment receipt.

On behalf of the opposite parties:

Ex.B1 13.09.2012 copy of statement of account.

Ex.B2 Award copy of insurance ombudsman.

Ex.B3 Part II of the schedule.

PRESIDENT