IMPORTANT POINT
There is difference between accidental death and death due to accident.

This revision petition has been filed by the petitioner, SBI Life Insurance Co. Ltd. against the order dated 22.11.2012 of the Punjab State Consumer Disputes Redressal Commission, (in short ‘the State Commission’) passed in First Appeal No.1914 of 2011, First Appeal No.1913 of 2011 and First Appeal No.1891 of 2011, wherein the appeal filed by the petitioner was dismissed and the order dated 24.10.2011 of the District Consumer Disputes Redressal Forum, Bathinda, (in short ‘the District Forum’) was upheld.

2. The facts of the case are that husband of respondent No.1 Sh. Gurlal Singh took a home loan of Rs.10,00,000/- from the respondent No.2, State Bank of Patiala. He also took the group insurance policy vide Membership No.933092658 dated 7.12.2010 by paying premium of Rs.51,735/- for two years. This group insurance policy was taken by the respondent No.2 State Bank of Patiala from the petitioner SBI Life Insurance Co. Ltd. The loanee, Sh. Gurlal Singh, died on 02.01.2011 and a claim was preferred by the respondent No.1, which was rejected by the petitioner SBI Life Insurance Co. Ltd. on account of the fact that under Clause-3 of the Terms and Conditions of the policy, the Company would not be liable to pay any claim amount except for a claim arising out of death due to accident. The Consumer Complaint was filed by respondent No.1 before the District Forum which ordered as follows:-

“In view of what has been discussed above, this complaint is accepted with Rs.25,000/- as cost and compensation against both the opposite parties. The opposite party No.2 is directed to pay Rs.3,59,158/- to the complainant. The amount of cost and compensation i.e. Rs.25,000/- would be paid by both the opposite parties jointly and severally.

The compliance of this order be made within 45 days from the date of receipt of copy of this order. In case of non-compliance of the order within the stipulated period, an amount of Rs.3,59,158/- would carry interest @ 9% P.A. from the date of institution of this complaint i.e. 10-05-2011 till realization.”

3. Against this order of the District Forum, the three separate appeals were filed by the petitioner, respondent No.1 and respondent No.2. State Commission dismissed all the three appeals vide its order dated 22.11.2012. The present revision petition has been filed by SBI Life Insurance Co. Ltd., the petitioner against order dated 22.11.2012 of the State Commission.

4. We have heard learned counsel for the petitioner as well as learned counsel for the respondent No.1. On behalf of respondent No.2, Ms. Suman Gupta, Branch Manager was present and she was also heard. The learned counsel for the petitioner basically argued that the Terms and Conditions of the policy are binding on all the parties. It is nobody’s case that the policy documents were not signed by the deceased. Therefore, it is imperative that the Terms and Conditions of the policy are applicable in the present case as well because the policy is a contract between the parties based on trust. The Clause-3 of the Terms and Conditions of the policy reads as follows:-

“3. 45 days Exclusion During the first 45 days from the date of commencement of cover for an Insured Member, the Company shall not be liable to pay any claim amount except for a claim arising out of death due to accident.”

5. From the above Clause of the Terms and Conditions of the policy, it is quite evident that the Insurance Company is not bound to make any payment for death claim where the death has occurred within 45 days of the commencement of the policy in case of natural death. The death of the husband of the complainant occurred due to “Acute M.I.” and ‘Cardio-pulmonary arrest’ and cannot be treated as death due to accident. The fora below have erred in appreciating the phrase “the death due to accident”. The fora below have treated death due to “Acute M.I.” as the accidental death and had allowed the claim as per Clause -3 of the Terms and Conditions of the policy referred to a