National Consumer Disputes Redressal
Icici Prudential Life Insurance ... vs Smt. Bimal Kanta Kharab on 5 December, 2012
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 2466 OF 2012 with I.A. No.01 of 2012 (Application for Stay) (From the order dated 27.4.2012 First Appeal No.708/2010 of the State Commission, Haryana, Panchkula) ICICI Prudential Life Insurance Company Ltd. ICICI Pru Life Tower, 1089, Appa Saheb Maratha Marg, Prabha Devi, Mumbai 400 025 Also at: Branch Office: Ashok Plaza, Delhi Road Rohtak, Haryana Petitioner Vs. Smt. Bimal Kanta Kharab W/o Sh. Dayal Singh Kharab R/o H. No.411/22, Dev Colony, Near Telephone Exchange, Rohtak, Haryana ...Respondent BEFORE: HONBLE MR. JUSTICE V.B. GUPTA, PRESIDING MEMBER For the Petitioner : Mr. Sanjay K. Chadha, Advocate with Mr. Avanish Kumar, Advocate Pronounced on: 5th December, 2012 ORDER
PER MR. JUSTICE V.B. GUPTA, PRESIDING MEMBER Being aggrieved by order dated 27.4.2012, passed by State Consumer Disputes Redressal Commission, Haryana (for short State Commission) petitioner/opposite party has filed the present revision petition.
2. Brief facts are that respondents/complainants husband Sh. Daya Singh Kharab had taken policy no. 04133929 from the petitioner/O.P. for a sum of Rs.1,85,348/- while availing housing loan from ICICI Bank for 5 years. The premium of Rs.10,348/- was paid vide cheque bearing no.075325 dated 13.12.2006 drawn on ICICI Bank at Rohtak. Respondent was declared as nominee. Husband of the respondent has expired on 30.01.2007. After his death, respondent applied for disbursement of the claim amount with the petitioner, but it repudiated her claim, vide letter dated 13.10.2007, alleging therein that The death benefit shall not apply in the event of death of a member due to a cause other than accident within a period of 45 days from the date of commencement of life cover and the respondent had paid premium of Rs.9,219/- only which was credited in the home loan account of deceased, vide cheque dated 17.5.2007. The alleged condition was never conveyed to the respondents husband nor any consent in this regard was ever accorded by the deceased. The act of petitioner is illegal and amounts to deficiency in service. Hence, respondent filed a complaint praying to direct the petitioner to pay the sum assured alongwith bonus and interest and other benefits under the policy and a sum of Rs.2,00,000/- as compensation on account of mental agony, harassment and litigation expenses.
3. Petitioner in its written statement took preliminary objection stating that as per clause 3(i) (b) of the condition of the policy;
the death Benefit shall not apply in the event of death of a member due to cause other than accident within a period of 45 days from the date of commencement of the life cover and in whose respect the Company had not required further evidence of health at the time of commencement of Life Cover. However, the company shall return the premium paid after deducting the expenses towards the issuance of the life cover.
4. On merits, it is stated that the life assured had submitted proposal dated December 26, 2006 on his life under the ICICI Home Assured plan and policy bearing no.04133929 was issued on the life of the Life Assured on January 02, 2007. Death of the life Assured occurred on January 30, 2007 due to illness i.e. within 28 days from the Policy Issuance. Therefore, no Death benefit shall apply in the event of the death, due to the cause other than accident, within 45 days from the commencement of life cover. The benefits under the policy are already paid to the Master Proposer at the time of the claim. Hence, no other amount is payable under the said case. The complaint be dismissed with costs.
5. District Forum, vide order dated 23.3.2010, allowed the complaint and passed the following directions;
Accordingly, we hereby allow the complaint with direction to the opposite parties to pay the sum assured of Rs.1,85,348/- (Rupees one lac eight five thousand three hundred forty eight only) alongwith bonus & other benefits under the policy alongwith interest @ 9% p.a. from the date of filing the present complaint till its realization and Rs.2,000/- (Rupees two thousand only) as litigation expenses to the complainant maximum within one month from the date of filing the present complaint failing which the amount of award shall carry interest @ 12% p.a. from dated 23.4.2010 onwards till its realization to the complainant.
6. Being aggrieved, petitioner filed an appeal before the State Commission which dismissed the same.
7. Hence, the present revision.
8. It is contended by learned counsel that as per clause 3(i)(b) of the terms and conditions of the policy in question, as policy holder has died within the period of 45 days from the date of commencement of life cover due to cause other than accident thus, no death benefit is payable. In the present case, policy was issued on 2.1.2007 to the life assured with 30.12.2006 as risk commencement date. The life assured had died on 30.1.2007 which was within 45 days of the date of commencement of policy. So, his claim was rightly rejected. Both the fora below have committed error on this issue.
9. District Forum in its order has held;
After going through the file and hearing the parties we are of the considered view that no doubt as per policy document Ex.R5 the death Benefit shall not apply in the event of death of a member due to cause other than accident within a period of 45 days from the date of commencement of the life cover but in the present case premium was credited into the account of opposite party on 13.12.2006 and the date of death of life assured is 30.01.2007 i.e. after 47 days from the date of depositing the amount of premium in the account of opposite party. Moreover, it is not proved on file that the alleged terms & conditions have been issued to the complainant. In this regard as per 2009(3)CLT 184 titled ICICI Lombard General Insurance Company Ltd. Vs. Gurmeet and another, Honble Punjab State Commission, Chandigarh has held that:
Exclusionary clause-No evidence to prove if the document was either signed by the complainant-insured or if it was an enclosure of the Insurance policy or if it was duly communicated to the respondent no.1-The Insurance Company cannot avail the benefits of these terms and conditions contained in the document, as per 2008(1)137CCC titled Yellamma Vs. Bhy Sukhadev Singh, Honble Karnataka High Court has held that:
Liability commences from the date of issuance of cheque and not from the date of its encashment-Insurer liable to pay compensation when accident occurs within 15 days from the date of issuance of cover note, as per 2005(2)CLT 231 titled Express Resorts and Hotels Ltd. Vs. Oriental Insurance Co. Ltd. and others, Honble National Commission has held that: Insurance contract-Cover note-Insurance policy-Held that till the time the policy is issued, the cover note itself covers the peril and as per 2008(1)CLT 70 titled Rita Devi Vs. NIC& Ors., Honble National Commission New Delhi has held that: Insurance policy-Interpretation of-When two reasonable interpretations of the terms of the policy are possible, the interpretation which favours the insured is to be accepted and not the interpretation which favours the insurer.
10. The State Commission while dismissing the appeal in its impugned order has observed;
From the record it is established that the premium was credited in the account of opposite party on 13.12.2006 and the date of death of the life assured is 30.1.2007 i.e. after 47 days from the date of depositing the amount of premium to the account of the opposite party. Thus, the Clause 3(i)
(b) stated above by the opposite parties, is not attracted to complainants claim. Opposite parties committed error in repudiating complainants claim, hence, no case for interference in the impugned order while issuing direction to the opposite parties to pay the insurable benefits to the complainant, is made out.
In view of the above, we do not find any merit it in this appeal, it is dismissed.
11. Clause 3(i)(b) of the Policy on which much stress has been laid down by learned counsel for the petitioner states;
3. Benefits subject to the Life Cover being in force
(i) Benefit on death of the Member
(a) x x x x x x x x x x x x
(b) Death after the full disbursement of the Loan The Company shall pay the reduced Life Cover as on the date of death.
The Death benefit shall not apply in the event of death of a Member due to a cause other than accident within a period of 45 days from the date of commencement of the Life Cover and in whose respect, the Company had not required further evidence of health at the time of commencement of Life Cover. However, the Company shall return the Premium paid after deducting the expenses towards the issuance of the Life Cover. For the purpose of the above clause, the accident must be caused by violent, external and visible means.
12. Thus, short question which arise for consideration is, as to whether life assured has died within the period of 45 days after issuing of the policy or not.
13. As per averments made in paras no. 1 & 2 of the complaint, it has been stated that deceased Daya Singh, husband of respondent had taken a policy while availing housing loan. A sum of Rs.10,334/- was paid, vide cheque no.075325 dated 13.12.2006. The husband of respondent expired on 30.1.2007.
14. In the written statement, petitioner in response to the above averments has stated;
That the contents of Para no.1 & 2 are formal and matter of record and hence do not call for any reply.
15. Thus, there is no denial on behalf of the petitioner to the averments made by the respondent in her complaint. Hence, the averments made in paras no.1&2 of the complaint, stand admitted.
16. As per record, the cheque for the insurance premium was issued by the deceased on 13.12.2006, while he died on 30.1.2007.
Thus, the death has occurred only after 47 days from the date of deposit of the amount of premium with the petitioner. Under these circumstances, the life cover had already commenced from 13.12.2006 and not from 2.1.2007, when the policy was issued.
17. In view of the concurrent findings of facts given by fora below, no jurisdiction or legal error has been shown to call for interference in the exercise of power under section 21 (b) of the Consumer Protection Act, 1986. Both the fora have given cogent reasons in their order which do not call for any interference nor do they suffer from any infirmity or revisional exercise of jurisdiction.
18. Honble Supreme Court in Mrs. Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd. 2011 (3) Scale 654 has observed ;
Also, it is to be noted that the revisional powers of the National Commission are derived from Section 21 (b) of the Act, under which the said power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order, and only then, may the same be set aside. In our considered opinion there was no jurisdictional error or miscarriage of justice, which could have warranted the National Commission to have taken a different view than what was taken by the two Forums.
The decision of the National Commission rests not on the basis of some legal principle that was ignored by the Courts below, but on a different (and in our opinion, an erroneous) interpretation of the same set of facts. This is not the manner in which revisional powers should be invoked. In this view of the matter, we are of the considered opinion that the jurisdiction conferred on the National Commission under Section 21 (b) of the Act has been transgressed. It was not a case where such a view could have been taken by setting aside the concurrent findings of two fora.
19. Since, two Fora below have given detailed and reasoned orders, which does not call for any interference nor they suffer from any infirmity or erroneous exercise of jurisdiction, the present petition is hereby dismissed with costs of Rs.10,000/- (Rupees Ten Thousand only).
20. Petitioner is directed to deposit the cost by way of demand draft in the name of Consumer Legal Aid Account of this Commission, within eight weeks, failing which, petitioner shall be liable to pay interest @ 9% p.a. till realization.
21. Pending application also stands disposed of.
22. List for compliance on 8.2.2013.
..J (V.B. GUPTA) PRESIDING MEMBER Sg.