State Consumer Disputes Redressal Commission
Dabbir Malati W/O Late Rama Rao vs 1. Icici Bank, Rep. By Its Branch ... on 2 August, 2013
BEFORE THE CIRCUIT BENCH A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT VISAKHAPATNAM F.A.No. 969 OF 2012 AGAINST C.C.NO.36 OF 2012 DISTRICT CONSUMER FORUM SRIKAKULAM Between Dabbir Malati W/o late Rama Rao aged about 50 years, Occ: Household Duties R/o Panchireddy Street, Patrunivalasa Village and Post, Srikakulam District Appellants/complainant A N D 1. ICICI Bank, rep. by its Branch In-Charge Srikakulam, Srikakulam District-001 2. ICICI Bank Limited, rep. by its Manager Anakapalli, Visakhpatnam District-001 3. ICICI Bank Limited, Rep. by its Home Loans Department D.No.47-14-18, Isnar Satyasri Complex Main Road, Dwarakanagar, Visakhapatnam-001 4. ICICI bank Limited rep. by its Customer Service Manager ICICI Bank Home Loans PA Policy, Mumbai-001 Respondents/opposite parties Counsel for the Appellant M/s A.Ramarao Counsel for the Respondent M/s S.Nagesh Reddy (R1toR4) QUORUM: SRI R.LAKSHMINARSIMHA RAO, HONBLE MEMBER
& SRI S.BHUJANGA RAO, HONBLE MEMBER FRIDAY THE SECOND DAY OF AUGUST TWO THOUSAND THIRTEEN Oral Order ( As per R.Lakshminarsimha Rao, Member) ***
1. The unsuccessful complainant is the appellant. The appellant filed complaint claiming the sum assured under insurance policy towards set off of the outstanding loan amount and for payment of balance amount of `50,983 with interest thereon as also damages to the extent of `1,00,000/- and costs .
2. The appellants husband namely Dabbira Rama Rao availed home loan to an extent of `3,00,000/- under loan account bearing number LBSK 0000992386 from the respondent-bank and he used to pay the monthly installments regularly from 11.01.2005 and he died on 8.03.2010. After the death of the appellants husband, the respondent-bank issued demand notice to the appellant for an amount of `2,49,017/-.
3. The appellant submitted that as per the terms of personal insurance cover issued in favour of her husband, she is entitled to set off the outstanding loan amount with the sum assured under the insurance policy and as there was no response for her request, she got issued notice dated 20.12.2011 which did not draw any response from the respondent-bank either in settlement of her claim or set-off of the loan amount with the sum assured under the insurance policy.
4. The respondent-company resisted the claim on the premise that the terms and conditions of the loan agreement do not provide for personal accident benefit to the borrower making him entitled to set off of the loan amount, in case of his death, for the outstanding loan amount. It is contended that the insurance benefit is not payable in case of natural death of the insured and that there is no deficiency in service on the part of the respondent-bank.
5. The appellant filed her affidavit and the documents, Exs,A1 to A9. On behalf of the respondents, the Collection Manager of respondent no.2 filed his affidavit and the documents Ex.B1 and B2.
6. The District Forum dismissed the complaint on the premise of non-applicability of terms of the personal accident cover in case of death of the insured due to heart attack which is natural death. The District Forum held that there was no deficiency in service on the part of the respondent-bank in not setting off of the loan amount for the insurance benefit.
7. Aggrieved by the order of the District Forum dismissing her compliant, the complainant has filed appeal contending that death of her husband occurred as a result of heart attack which is not natural death and it is an accident whereby she is entitled to the insurance benefit for the set off of the loan amount.
8. The point for consideration is whether the appellant is entitled to the insurance benefit in terms of personal accident cover?
9. The facts which do not require discussion in view of their admitted position is availing of home loan of `3 lakh by the appellants husband under loan account number LBSK 0000992386 from 11.01.2005 till his death on 8.03.2011 which occurred as a result of heart attack. The appellants husband being a home loan account holder was provided with personal accident insurance coverage free of any charges. The scope of cover is restricted to death of the insured within a period of 12months from the date he met an accident which is caused by external, violent and visible means. The sum assured under the insurance policy is 100% of principal outstanding amount.
10. The exclusions mentioned in the insurance policy are mentioned hereunder:
Amount relating to medical expenses.
Payment of compensation in respect of death of Insured Person (a) from intentional self-injury, suicide or attempted suicide; (b) whilst under the influence of intoxicating liquor or drugs; (c) whilst engaging in aviation or ballooning, or whilst mounting into, or dismounting from or traveling in any balloon or aircraft other than as a passenger (fare-paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. Standard type of aircraft means any aircraft duly licensed to carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is privately owned or chartered or operated by a regular airline or whether such an aircraft has a single engine or multiengine; (d) directly or indirectly caused by venereal disease or insanity; (e) airing or resulting from the Insured committing any breach of the law with criminal intent.
11. After the death of her husband, the appellant got issued notice dated 20.10.210 to the respondent-bank that in terms of the loan agreement, she is entitled to the death benefit of her husband. Paragraph 3 of the notice reads as follows:
I am to further inform your authorities that during the life time of my late husband Ramarao used to ay the monthly instalment @ Rs.3331/- regularly to your bank without fail but unfortunately, all of a sudden my husband Ramarao was expired on 08.03.2010 due to severe heart attack and after the death of my husband Ramarao, your authorities got issued a notice to me to show me a First Class heir of my husband and demanded me to pay the remaining balance amount immediately.
12. The appellant has stated that personal insurance is available to whoever avails home loan and her husband having availed housing loan and died on account of heart attack, she is entitled to the death benefit. She has stated that the respondent-bank had not paid the death benefit to her even after she submitted the claim form along with relevant documents. The appellant has stated :
After receipt of said demand notice from the opposite parties the complainant verified the terms and conditions of the loan agreement in which discloses that whoever taken Home Loan and get personal insurance absolutely free in case of death of Home Loan person, the opposite party bank had agreed to pay the death benefits to the deceased legal heirs.
The above death benefit also equals to the capital sum insured i.e., Rs.3,00,000/- as staed in para/I of the schedule form ICICI and the above insured sum will be paid to the complainant within period of twelve months from the date of death of the insured person. But the opposite parties have not paid the insurance amount to the complainant, even though the complainant submitted a claim documents as specified in claim procedure within stipulated period.
The complainant further submits that it is due to unforeseen death of her husband, her financial resource of income is badly spoiled. Hence the opposite parties have bounden duty to set off the death benefits of the deceased into the balance Home loan installment amount.
But the opposite parties have issued several demand notices for payment of home loan account instead to settling the death benefits of the deceased husband of the complainant which is contrary to law and against the principles of natural justice.
13. Thus, the appellant proceeded to claim death benefit on account of death of her husband due to heart attack. Death due to heart attack except in certain circumstances cannot be considered as accident. The nomenclature of the insurance policy indicates the scope of the insurance policy is limited to the claim arising as a result of accident.
The Honble National Commission in R.P.No.3375 of 2009 between SBI Life Insurance Co., Ltd., and Mrs Y.Dayamani decided on 25.10.2010 held that death on account of heat attack is not an accident. It was held:
While the District Forum has held that it would not fall in the category of an accidental death, the State Commission has held otherwise as myocardial infarction developed all of a sudden for which the life assured had to be rushed to the railway hospital where he died while undergoing treatment. The State Commission further held that in the absence of any prior treatment for heart ailment, such a sudden heart attack can very well be said as an accidental death. No doubt a sudden stroke i.e. heart attack may occur all of a sudden, without any prior apprehension or any symptom and perhaps cannot be foreseen or anticipated. However, given the medical history of the life assured that he was suffering from Diabetes Mellitus for over a period of five years, as reported by the doctor from the railway hospital which cannot be disbelieved, the case of death resulting out of Acute Myocardial Infarction (heart attack), in this case cannot but be held to be a natural death. It is by now well established and acknowledged that diabetic individual more than non-diabetic persons are prone to heart attacks/strokes and such pre-disposition in case of the life assured could not be totally ignored. The State Commission, in our view has taken a completely erroneous view to declare it as a case of an accidental death. The nearest, Acute Myocardial Infarction (heart attack) can be said to be an accidental death would be if such an attack takes place as a result of some external and sudden incident such as trauma or shock induced by external factors/forces but it cannot certainly be said that a death due to heart attack in the normal course would fall in the category of an accidental death.
14. The appellants husband as per the version of the appellant died due to heart attack. In the light of aforementioned decision, the death claim in terms of the insurance policy cannot be held to be entitled for settlement. This Commission does not find any infirmity in the findings recorded by the District Forum. The appeal, as such is liable to be dismissed.
15. In the result, the appeal is dismissed confirming the order of the District Forum. There shall be no separate order as to costs.
MEMBER MEMBER Dt.02.08.2013 కె.ఎం.కె*