Insurance claims for loan-protection policies should not be repudiated on narrow technical grounds if the insured suffers permanent total disability and loss of earning capacity, as this defeats the primary object of safeguarding the loan liability.

ORDER

BY HON'BLE MRS. SUNITA CHANNABASAPPA BAGEWADI, LADY MEMBER:

This appeal is hled by the Appellants/Opposite parties No.1 & 2 being aggrieved by the Order dated 16.09.2022 passed by the Dakshina Kannada District Consumer Disputes Redressal Commission, Mangalore in CC.No.239/2019 and prays to set-aside the order passed by the District Commission by allowing appeal, in the interest of justice and equity.

2. The brief facts of the case are as under;
The complainants have constructed their residential house by obtaining Housing loan of Rs. 15,00,000/- from Opposite Party No.3 and the loan installment amount is Rs.13,440/- per month. On 14.11.2017 the Opposite Party No.3 bank have arranged for UNIHOME CARE INSURANCE POLICY, Policy No.0729012317P111646700 valid from 15.11.2017 to 14.11.2027 for the premium amount of Rs.7,097/- was debited from the loan account of the complainants and covered risk for the loan amount of the complainant of Rs.15,00,000/- i.e. Rs. 10,00,000/- in the name of complainant No.1 and Rs.5,00,000/- in the narne of complainant No.2. On 16.11.2017 at about 12.30 p.m, complainant No.1 had an accidental fall from height about 10 feet at his new residence and sustained spinal injuries to his lower back with inability to move bilateral lower limb as a result of which he had decreased sensation over bilateral lower limb and pain over the left shoulder. Immediately, he was shifted to a nearby local hospital and as per the advice of the local doctor, he was shifted to A.J. Institute of Medical Sciences, Kuntikaaa, Mangalore. In the said hospital he was admitted as In-patient on 16.11.2017 and given treatment for his injuries as an In-patient till 01.12.2017. The complainant No. 1 suffering from disability to the tune of 75% consisting of post traumatic paralysis after the accidental fall and his condition is not improved even today. Hence, the complainants have filed claim before the insurance company i.e., Opposite Parties No.1 & 2. The Opposite Party No.1 sought for production of certain documents and after submission of documents, the Opposite Party No.1 has refused the claim of the complainants. Hence, the complaint.

3. After service of notice of the District Commission, the Opposite Parties No.1 to 3 appeared through their counsels and filed written version. The Opposite Parties 1 & 2 admitted certain allegations of the complainants and denied all other allegations. The Opposite Party No.1 admitted the issuance of the UNIHOME CARE Policy for the period commencing from 15.11.2017 to 14.11.2027 and have availed housing loan from Opposite Party No.3 and contended that after receipt of the claim from the complainants, the same was repudiated on the basis of exclusion condition of Section-II of the policy and further contended that as per the terms of the policy, only the risk of the death of the insured's borrower is covered and not the case of risk of injuries resulting permanent disability and prays to dismiss the complaint. The Opposite Party No.3 also admitted the home loan obtained by the complainants from Opposite Party No.3 and denied all other allegations made by the complainants. The Opposite Party No.3 denied that the loan obtained by the complainants is covered fully in the terms of the policy issued by the Opposite Parties No.1 & 2. Further denied that insurance policy is arranged by Opposite Party No.3 to secure the complainant's loan and prays for dismissal of the complaint.

4. After trial, District Commission allowed the complaint in part.