ORDER

SMT.SHARAVATHI S.M.  MEMBER

1.     This is the complaint filed by the complainant against the Opposite Parties (herein referred to as OPs) under section 35 of the Consumer Protection Act 2019 for the deficiency in service in repudiating the insurance claim of the wife of deceased Raju S.H.  who died due to SNAKE BITE  and for payment of Rs.15,00,000/- as compensation towards accidental death claim, sum of Rs.1,00,000/- as damages and for compensation and for such other reliefs, as the Hon’ble District Commission deems fit.

2.     The brief facts of the complaint are that: One H.S.Raju is the husband of the complainant Smt. M.H Hemalatha. He had obtained an two insurance policies with OP’S i.e. one insurance for a sum of Rs.10,00,000/- towards personal accidental death, and fire accident covering for the period from 30/03/2010 to 29/03/2020 bearing policy No.071603/46/09/90/00000542, and another  policy for a sum of Rs.5,00,000/- covering for the period of 24/08/2011 to 23/08/2021 bearing No.071603/46/11/90/00000289 under “UNIHOME CARE INSURANCE POLICY” while availing home loan from Bharath Credit co-operative Society Ltd Bangalore by paying requisite one time premium to cover the above period. The wife of the deceased Raju i.e. Hemalatha was a nominee to the said insurance.

3.     It is stated that her husband S.H.Raju met with accidental death due to snake bite on 14/09/2019. The accident was registered in the concerned jurisdictional police station. The  same was intimated to the OP’s and accident death claim was submitted. By issuing a letter, OP did  not consider  the claim of the complainant on the ground that on the date of death of  Raju the borrower, all dues towards Bharath Credit Cooperative Society Ltd was cleared. Due to the same she is extremely facing difficulties in life and that too the inaction of the OP in not settling the claim made her life miserable. She is having two children by name Prajwal and Shreyas who are depending on her and she has to take care of her. OP by writing a letter dated 13.08.2020 informed that since the loan has been cleared by Raju by himself.

4.     There is no liability fastened to the insurance company and they are not liable to pay the claim of the complainant. Then only she came to know that all the dues to the bank loan was cleared and further the insured ought to have informed her regarding the same and the cancellation of the policy which OP did not do it.  In view of the same, the insurance cover in respect of her husband continued till his death and hence they are entitle for the insured amount under the two policies. The rejection of the claim by OP is unfair, unethical, illegal. OP is bound by the rules and regulations and they are liable to pay the damages. Further OP -2 have partly settled the amount by paying 75% in respect of the death of her husband under another policy number 0723822615P1106920066, wherein the assured amount in respect of the said policy was Rs.12,00,000/-. This itself makes clear that inspite of the complainant eligible for the insured amount in respect of other two policies, only to cheat the complainant, and to make wrongful gain to the company, OPs repudiated the claim of the complainant by adopting false business practice, which is oppose to public policy. Hence there is deficiency in service, unfair trade practice on the part of OP, and prayed this commission to allow the complaint.  

5.     Upon the service of the notice, OP’s appeared before the commission through their advocate and filed version contending that the complaint filed is on false, frivolous vexatious grounds liable to be dismissed with cost. OP has admitted that the complainants husband obtained policy while availing housing loan from Bharath Credit Cooperative Society Bangalore in respect of the loan borrowed.  In order to secure the loans the two insurance policies were issued. The first insurance policy bearing no 071603/46/09/90/00000542 is for the sum of Rs.10,00,000/- and another policy bearing No.071603/46/11/90/00000289 being the personal accident policy insured is for a sum of Rs.5,00,000/-. The two policies are valid from 30/03/2010 to 29/03 2020 and another policy 24/08/2011 to 23/08/2021respectively.

6.     It is contended that, the claim could not be considered as the loan borrowed by deceased S.H.Raju during his lifetime was repaid by him on 24/12/2018 itself, during his lifetime and the insurance policy issued towards personal accident cannot be claimed by her. The said policies were for the purpose of indemnifying the bank loan with respect to the immovable property provided as security for the loan borrowed by deceased under the said policy. OP would have been liable to pay the said amount only in the event of the property being destroyed due to any events as stated in the policies and hence, the complainant is not entitle to seek any claim. There is no deficiency in service and unfair trade practice on their part. Hence prayed the commission to dismiss the complaint.

7.     In order to prove the case, both parties filed their affidavit evidence and produced documents. Arguments heard. The following points arise for our consideration:-

1. Whether the complainant has proved deficiency in service on the part of the opposite parties?

2. Whether the complainant is entitled to the relief prayed for in the complaint?

8.     Our answers to the above points are:-

POINT NO 1 –IN THE AFFIRMATIVE.

POINT NO-2- PARTLY IN THE   AFFIRMATIVE

for the Following:

REASONS

POINT NO 1:

9.     On perusing the complaint, the version, documents, evidence filed by the respective parties, it becomes clear that, the husband of the complainant obtained three insurance policies from OP. There is no dispute regarding issuing of the insurance polices as per Ex-P6, P7 and P8 in favour of the deceased S.H.Raju. The said policy is under “UNIHOME CARE INSURANCE POLICY” wherein the name of insured is mentioned as S.H.Raju and the same has been assigned to the name of Bharath Credit Cooperative Society Bangalore. The first insurance policy bearing No.0723822615P106920066 is for Rs.24,00,000/- of which sum insured towards fire accident is Rs.12,00,000/- and towards personal accident is Rs.12,00,000/- covering for the period 03.09.2015 to 02.09.2030 i.e. Ex P6. The second insurance policy bearing No.071603/46/11/90/00000289 Ex.P7 covering for a period from 24.08.2011 to 23.08.2021 the insured amount was for Rs.5,00,000/- towards fire insurance and Rs.5,00,000/- towards person accident and the name of the assign is Bharath Co-operative Society Ltd. Ex P8 is the another insurance policy for the period from 30.03.2010 to 29.03.2020 for a sum of Rs.10,00,000/- towards fire accident and for Rs.10,00,000/- towards personal accident. Again the assignee is Bharth Credit Cooperative Society Ltd., OP has collected premium of Rs.8,227/- towards first policy Rs.2,212/- towards 2^nd policy and Rs.4,422/- towards the third policy. 

10.   It is not in dispute that the said Raju died on 14.09.2019 due to Snake Bite in Ittapatna, near Arakalagoodu Talukd of Hassan District when he had been to attend the funeral ceremony of his relative. Ex P11 is the copy of the charge sheet,  and Ex P12 is the Port mortem report and Ex P13 is the letter written by the complainant to the insurance company informing the reason for delay in communicating the death of her husband.  Ex P9 is the certificate issued by the Bank stating that, the entire loan amount has been repaid on 24.12.2018 by Mr.Raju himself and that they have returned the original insurance policies i.e. for Rs.10,00,000/- and Rs.5,00,000/- bearing Policy No.071603/46/09/90/00000542 and No.071603/46/11/90/00000289 to the complainant,  consequent upon the death of Mr.Raju due to Snake Bike.

11.   Ex P10 is the personal accident insurance claimant statement recorded by the insurance company. Ex P14 is the copy of the repudiation letter wherein OP has repudiated the claim of the complainant on the ground that the “UNIHOME CARE INSURANCE POLICY” was taken by Bharath Credit Co-operative Society Ltd., from which the deceased had taken loan and as on the date of death all the dues were paid to the financier and no loan was outstanding. On the closure of the loan, the insured ought to have informed the insurer regarding the same and cancellation of the policy.  Nevertheless, the insured did not furnish the said information to the insurer.  Since the loan has been paid off, the insurer does no bear any liability and hence the claim was rejected.

12.   As per the above repudiation letter, OP has repudiated the claim of the complainant on the ground that the loan has been cleared by the deceased himself during his life time and hence there is no liability on the part of the insurance company to pay the any amount under the above policies as the policies were issued in order to cover the loan liability. 

13.   It is to be noted here that the complainant has stated in the complaint that the insurance claim in respect of policy No.0723822615P106920066 for Rs.12,00,000/- personal accidental death has been paid to the extent 75% by the OP, whereas purposefully intentionally, illegally, refusing to pay the amount as claimed in respect of the other two policies bearing Policy No.071603/46/09/90/00000542 and No. 071603/46/11/90/00000289 covering for sum assured Rs.15,00,000/- together.

14.   As per Ex.P9 No Objection Certificate issued by Bharath Credit cooperative society ltd Bangalore, the amount of the loan with interest has been cleared by the deceased Raju himself on 24.12.2018.  Due to this only, OP is claiming that there is no liability on its part as the insurance was obtained by deceased Raju through the Bharath Credit Cooperative Society only to cover the liability of loan obtained from the said society.

15.   On perusing Ex. P6, P7 and P8 which are the insurance policies the said policies were obtained by deceased Raju by paying the premium by himself and the said policies were assigned to Bharath Credit Cooperative Society.  It is to be noted that in case of demise of the borrower the amount payable under the policies is to be paid towards the outstanding dues of the loan and than the remaining to be paid to the legal representatives of the deceased.  In this case, as per Ex.P9 the loan has been cleared by the deceased himself.

16.   Nowhere, in Ex.P6 P7 and P8 it has been mentioned and also in the exclusion clause that in case the loan amount is cleared before the insurance cover period, the amount mentioned in the insurance policy is not payable to the deceased or to his assignees or his nominees or his legal representatives.

17.   As already mentioned above in the policy No. 071603/46/09/90/00000542 and No. 071603/46/11/90/00000289 issued for Rs.10,00,000/- and Rs.5,00,000/- it is clearly mentioned that it covers personal accident which also includes accidental death.  In this case, it is not in dispute that Raju the husband of the complainant died due to snake bite which is amplified by the medical and police documents produced which has not been denied/refuted by the OP. Its only contention is that since the loan amount has been cleared, it has no liability to pay any amount under the above policies as immediately after the loan is cleared the policy extinguishes. 

18.   Accordingly to us, it is not so, as it covers for the full period of insurance as there is no tag or condition product appended to the terms and conditions while issuing the policy that the insurance cover lost till the clearance of the loan amount to the creditor only, it is not coextensive with the then clearance about as it is even for beyond the clear of the loan.  Hence repudiation of the claim of OP amounts to unfair trade practice, illegal, unethical besides deficient in service. Hence we answer POINT NO 1 IN THE AFFIRMATIVE.

POINT NO 2:-

19.   As pointed above the deceased S.H. Raju was issued two UNIHOME CARE INSURANCE POLICIES. One   for the period from 30/03/2010 to 29/03/2020 for Rs.10,00,000/- and another policy for the period from 24/08/2011 to 23/08/2021 for a sum Rs.5,00,000/-. The husband  of the complainant Mr. Raju died on 14.09.2019 which is within the period covered under the above insurance policies. In view of the accidental death of deceased Raju under the above two policies, OP is bound to pay Rs.10,00,000/- and Rs.5,00,000/- respectively along with interest at 12% per annum from the date of death of Raju i.e. from14.09.2019 till payment of the entire amount.

20.   Repudiation of the genuine claim in this case, put the complainant and her two sons into untold hardship and misery in their life as they lost the earning member in the family which virtually put them on streets.  The insurance company has made it a policy and rule as “repudiation of the claim as a rule and honouring the claim is an exception” which is to be deprecated with all possible terms.  They would be very happy while receiving the premiums towards the policy, whereas when the claim is made by the policy holders, insurance company will make all nonsensical, imaginary, ill-founded, minute mistakes on the part of the claimants as a reason to deny the insurance claim. 

21.   Hence we are of the opinion that if hefty compensation of Rs.5,00,000/- as damages if imposed on the Ops, they may not in future venture to such a silly reason to repudiate the insurance claim.  Further, the act of OP made the complainant to engage advocate to file this complaint by spending time, money and energy which has to be compensated by imposing cost of Rs.15,000/- as litigation expenses.  In view of this we answer POINT NO 2 PARTLY IN THE AFFIRMATIVE and pass the following:

ORDER

1. The complaint is partly allowed with cost.
2. OP No.1 and 2 are jointly and severally hereby directed to pay a sum of Rs.15,00,000/-  to the complainant along with interest at 12% per annum from the date of death of S.H.Raju i.e. on 14/09/2019 till payment of the entire amount.
3. Further OP’S are further directed to pay Rs.5,00,000/- towards damages and Rs.15,000/- towards costs of the litigation expenses to the complainant.
4. OP’s are hereby directed to comply the above order within 30 days from the date of receipt of this order and submit the compliance report to this commission within 15 days thereafter.
5. Send copy of this order to both parties free of cost.

Note: You are hereby directed to take back the extra copies of the Complaints/version, documents and records filed by you within one month from the date of receipt of this order.

(Dictated to the Stenographer over the computer, typed by him, corrected and then pronounced by us in the Open Commission on this day the 10^th day of MARCH 2022)

MEMBER                   MEMBER                  PRESIDENT

ANNEXURES

1. Witness examined on behalf of the Complainant/s by way of affidavit:

Copies of Documents produced on behalf of Complainant/s:

Ex P1: Copy of the Genealogical tree affidavit  

Ex P2: Copy of the  death certificate of complainant’s husband.

Ex P3: Copy of Adhaar card of complainant and her husband

Ex P4: Copy of the facing sheet of SB account.

Ex P5: Copy of the insurance certificate.

Ex P6: Copy of the receipts.

Ex P7: Copy of No Objection Certificate.

Ex p8: Copy of insurance claim application

Ex P9: Copy of the FIR

Ex P10: PM report.

Ex P11: Copy of letter written by complainant to OP.

Ex P12: Copy of the repudiation letter.

2. Witness examined on behalf of the Opposite party/s by way of affidavit:

RW-1: Sri Pannaga, Deputy Manager of OP.

Copies of Documents produced on behalf of Opposite Party/s

 - Nil -

MEMBER                   MEMBER                  PRESIDENT

RAK*