Salma Begum Vs. the Chief Manager, State Bank of India and Another

(The appeal coming before us for hearing finally on 21.09.2011, upon hearing the arguments of both sides and perused the documents, written submissions as well as the order of the District Forum, this Commission made the following order :-)

A.K. ANNAMALAI, PRESIDING JUDICIAL MEMBER

1. The unsuccessful complainant is the appellant.

2. Complainant filed a complaint against the opposite parties claiming for the direction to pay the benefits of the insurance cover attached to the housing loan availed by her husband from the opposite parties and declaring the loan amount obtained by her husband is duly discharged and to return the original documents and Rs.50,000/- as compensation and for costs.

3. Complainants husband K.Abdullah availed housing loan by way of transferring the existing housing loan from LIC Housing Finance from 1^st opposite party and availed further loan for his housing construction on 2.8.03. Further sum of Rs.1,00,000/- was given for the same. The complainants husband joined in the Group Housing Insurance cover to housing loan borrowers by paying Rs.38,310/- as premium for the entire period. The insurance was provided by the 2^nd opposite party through 1^st opposite party. The complainants husband died on 16.8.05 due to Jaundice after his admission in the hospital on 4.8.05. When the complainant made the claim for the insurance on 9.12.05 by producing all the necessary document after a long gap the 1^st opposite party sent the communication stating that the complainants claim was rejected. Hence after giving a legal notice on 28.12.06 demanding the benefits complainant has come forward with the consumer complaint.

4. The opposite parties denied the allegations of the complainant and contended in their written statement that the complainants husband was given an insurance cover for Rs.4,47,000/- under Master Policy SBI Home Loan Insurance Scheme and the risk was commenced from 14.7.05 and as the death of the complainants husband was on 16.8.05 within the period of 32 days from the date of risk cover as per the terms and conditions in the Master Policy in the event of death of the member at any time after 45 days 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 persons authorized by the insured for the sum assured the cover will be paid and since the complainants husband died within the lean period of 45 days and the cause of death is hemorrhage which is not the accidental death the claim was repudiated and there was no deficiency of service.

5. The District Forum by accepting the contentions of the opposite parties after an enquiry dismissed the complaint as she is not entitled for the relief as prayed for.

6. Hence the complainant come forward with this appeal and in the grounds of appeal among other things it is contended that the complainants husband has not suppressed any material facts relating to the health and the terms and conditions of the insurance certificate was not informed to the insurer and thereby the opposite parties cannot repudiate the claim.

7. While considering both sides arguments, averments and contentions and upon perusal of the District Forum order it is the admitted case of both sides that the complainants husband availed the housing loan from 1^st opposite party by transferring his earlier loan from LIC Housing Finance and obtained enhanced loan amount and died on 16.8.05. From the documents for both sides it is also not in dispute that the complainants husband has paid a sum of Rs.38,310/- for the cover of housing insurance scheme offered by the 2^nd opposite party through 1^st opposite party to cover the entire loan amount in case of death of the complainants husband as per terms and conditions of the insurance in which risk cover commences from 14.7.05 as per Exhibit A3 and B2 insurance certificate. But on the complainants side Exhibit A3 was filed only of the front page of the certificate and as per the details Exhibit B2 the certificate having both side details and on the reverse page of Exhibit B2 summary of terms and conditions of the scheme are mentioned and in the condition No.5 relating to the benefits it is stated in the event of the death of the insured housing loan borrower due to any cause the sum assured would become payable to the group administrator. The sum assured will be equalent to the outstanding loan amount including interest as per original EMI schedule and no claim however (except death due to accident) will be admissible within the 45 days from the date of admission of the borrower under the scheme for other exclusions to refer to group administrator. According to the condition if the death occurs within the first 45 days from the date of admission no claim will be admissible. In our case the risk commenced from 16.7.05 and the complainants husband borrower died on 16.8.05 within 32 days from the date of admission of the scheme and thereby he was not entitled for any benefit and as the death was also not due to accident, but due to hemmerage or Jaundice as admitted by both sides under the head death due to accident was also the insured was not covered and thereby the complainant in no way benefited to claim the amount on behalf of her husband under the insurance cover. The document Exhibit B1 Master Policy also discloses that it covers nearly 986 members from the year 1^st September 2002. On payment of single premium by paying initial premium of Rs.88,19,836/- by covering a sum of Rs.27,19,57,242/- and in the conditions it is mentioned in the event of death of member at any time after 45 days (except for accidental death) from the date of commencement of the risk subject to the policy being in full force and not later on completing of 70 years to pay the grantees or any person so authorized. Hence it is clear that in no way the complainant is entitled to get the benefits and the contention that the execution clause was not intimated by the opposite party cannot be accepted as the complainant failed to produce the original document Exhibit A3. Whereas the opposite parties produced the same as Exhibit B2 containing details on both side pages and in the reverse of the certificate the exclusion clause are clearly mentioned. Hence in this regard the ruling relied upon by the complainant reported in 2000 NCJ (SC) page 219 in which it is stated as follows : “Consumer Protection Act, 1986 - Section 14 Deficiency in service - Insurance - All risk Insurance policy - Allegation of violation of policy of insurance - Duties of all the parties to disclose all facts known to them - Non communication of exclusion clause to the insured - Insurer can not take the advantage of the exclusion clause to the insured - Insurer cannot take the advantage of the exclusion clause - Order of National Commission, set aside - Direction of State Commission to indemnify the loss, restored.”

and in II (2007) CPJ page 320 in which it is stated as follows :- “Contract - Interpretation of terms statute should be in consonance with its aims and objects - Any other interpretation not permissible - Interpretation should not be grammatical or literal - Same should always be logical and liberal - True intention of statue or contract is guiding principle.”

cannot be accepted as beneficial to the complainant. Hence we are of the view for the reasons and discussions made in the foregoing paragraphs that the order of the District Forum to be confirmed and to dismiss the appeal as no merits.

8. In the result, the appeal is dismissed, by confirming the order of the District Forum, Tirunelveli in C.C.No.66/2007 dated 19.04.2010. No order as to costs in this appeal.