State Consumer Disputes Redressal Commission
Icici Prudential Life Insurance Co. ... vs Sh. Kartikey Sharma. & Ors. on 2 May, 2022
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA
First Appeal No. : 03/2019
Date of Presentation: 20.11.2018
Order Reserved on : 02.04.2022
Date of Order : 02.05.2022
......
ICICI Prudential Life Insurance Company Ltd. 1A & 2A, Raheja
Tipco Plaza, Rani Sati Marg, Malad (East), Mumbai-400097,
through its Area Manager.
...... Appellant/Opposite party.
Versus
1. Sh.Kartikey Sharma S/o late Sh. Navneet Kumar Sharma,
R/o Village Benska, Post Office Sarol, Tehsil and District
Chamba, H.P.
2. Sh.Chaitanya S/o late Sh. Navneet Kumar Sharma, R/o
Village Benska, Post Office Sarol, Tehsil and District
Chamba, H.P.
3. Smt. Santosh Sharma W/o late Sh. Navneet Kumar
Sharma, R/o Village Benska, Post Office Sarol, Tehsil and
District Chamba, H.P.
......Respondents/complainants
Coram
Hon'ble Justice Inder Singh Mehta,President
Hon'ble Ms. Sunita Sharma, Member
Hon'ble Mr. R.K. Verma, Member
Whether approved for reporting?1Yes.
For the Appellant : Mr.Sanjay Bhardwaj, Advocate.
For the Respondent : Mr.Divya Raj Singh, Advocate.
Justice Inder Singh Mehta
ORDER
Instant appeal is arising from order dated 29.09.2018, passed by learned District Forum, Chamba, in 1 Whether reporters of the local papers may be allowed to see the order? ICICI Prudential Life Insurance Co. Ltd. Vs. Kartikey Sharma & Ors.
(F.A.No.03/2019) Consumer Complaint No.27/2018, title Kartikey Sharma & Ors Versus the ICICI Prudential Life Insurance Company Limited. Brief facts of Case:
2. Brief facts stated are that Sh. Navneet Kumar Sharma took insurance policy No. policy No.17925607 on 19.07.2013 for a sum of Rs.10,00,050/- from opposite party ICICI Prudential Life Insurance company. Navneet Kumar Sharma life assured died on 16.01.2015 after a gap of one year and six months. In the instant appeal, the complainants No.1 and 2 are the sons and complainant No.3 is the wife, of life assured Navneet Kumar Sharma. The legal notice issued is dated 20.03.2018. Hence, the present complaint for direction to the opposite party to pay the insured amount on account of death of life assured Sh.Navneet Kumar Sharma.
3. The opposite party resisted the claim of the complainant by taking preliminary objections of maintainability, cause of action, suppression of material facts and limitation. The opposite party further pleaded that the life assured had withhold and suppressed material information, qua his previous medical history. It is further pleaded that the life assured had given false answers in the Proposal Form regarding his health status and since the life assured concealed material facts qua previous ailment at the time of obtaining insurance policy, therefore, the claim is not 2 ICICI Prudential Life Insurance Co. Ltd. Vs. Kartikey Sharma & Ors.
(F.A.No.03/2019) payable to the complainants as per the terms and conditions of the insurance policy. The opposite party in para No.33 has pleaded that the insurance company has already paid the surrender value of Rs. 2,16,684/- on 22.08.2015 by direct credit ICICI Bank Account No.199201501873 through NRFT.
4. The Learned District Forum allowed the consumer complaint directing the opposite party to pay sum of Rs.10,00,050/- to the complainants alongwith interest @ 9% per annum from the date of complaint till payment. Besides this, compensation of Rs.15,000/- and litigation costs of Rs.5,000/- have also been awarded to the complainants.
5. We have heard learned counsel for the parties and we have also perused the entire record carefully.
6. Learned counsel of the appellant has submitted that the impugned order suffers from illegality. He further submitted that District Forum below has not considered the point of limitation and the complaint should have been filed within the period of two years from the date of cause of action, whereas, the claim has been repudiated on 24.06.2015 and the complaint was filed on 01.06.2018 after the gap of about three years. Learned counsel for the appellant relied upon (2009) 5 SCC 121, titled State Bank of India Versus B. S. Agriculture Industries, para-11 and para-12 and Latest HLJ 3 ICICI Prudential Life Insurance Co. Ltd. Vs. Kartikey Sharma & Ors.
(F.A.No.03/2019) 2018 (HP) 570 titled ICICI Lombard General Insurance Co. Ltd. Vs. Smt. Shan Dei, para-9.
7 Learned counsel for the appellant further submitted that District Forum below went wrong on the plea of territorial jurisdiction and same has been ignored and he relied upon 2014 Latest HLJ (H.P) 1538, titled Des Raj Thakur Vs. M/s Tata AIG Insurance Co. Ltd., para-8&9. 8 Learned counsel for the appellant further submitted that there was suppression of material facts by the deceased/insured in the proposal form while obtaining the insurance policy. Therefore, appeal of the appellant be allowed.
9. On the other hand, learned counsel of the respondent has submitted that there is no infirmity in the order passed by the District Commission and appeal of the appellant be dismissed.
FINDINGS 10 The basis of the claim of the complainants is based upon insurance policy No.17925607 purchased by Sh. Navneet Kumar Sharma, 19.07.2013 for a sum of Rs.10,00,050/- which is not in dispute.
11. The opposite party has denied the claim of the complainants on the ground that the insured has withheld the material facts while obtaining the policy. 4 ICICI Prudential Life Insurance Co. Ltd. Vs. Kartikey Sharma & Ors.
(F.A.No.03/2019) Para No.10 of the reply reads as under:-
" That at the time of proposing the disputed policy, the life assured did not disclose, withheld and fraudulently suppressed the fact that merely 10 months prior to obtaining the disputed policy the life assured had undergone a test on September 30,2012 which revealed Liver Parenchyma disease with Splenomegaly. Further the Life Assured had undergone upper gastrointestinal endoscopy on October 01,2012 which revealed Portal hypertension with severe portal hypertensive gastropathy and had also undergone endoscopic variceal ligation. It is also noted that Life assured had consulted a doctor on October 12,2012 for treatment of Alcoholic Liver disease with Cirrhosis with Portal Hypertension and was on treatment for the same".
12. The complainant has chosen not to file rejoinder to the reply filed by the opposite party to admit or deny the contents thereof. Therefore, the contents of the reply remain unrebutted.
13. The factum of non-disclosing of the deceased having been suffering from previous ailment prior to the taking of the insurance policy is a material fact leading towards the cause of death of deceased Navneet Kumar Sharma. The factum of ailment of life assured Navneet Kumar Sharma is pleaded by the opposite party in its reply.
14. The opposite party has also placed on record Annexure OP4 which are (i) Outdoor patient prescription slip dated 12.10.2012 of insured Navneet Kumar Sharma of Davanand Medical College and Hospital Ludhiana(ii) 5 ICICI Prudential Life Insurance Co. Ltd. Vs. Kartikey Sharma & Ors.
(F.A.No.03/2019) Endoscopy Report of insured dated 25.12.2012,(iii) Radio diagnosis report Ultrasound upper abdomen of insured dated 24.09.2013, (iv) Medical bills/cashmemo of the insured dated 05.10.2012, 30.09,2012 and (v) Medical reimbursement bills submitted by the insured to his Department.
15. In these circumstances, we are of the opinion that the deceased Navneet Kumar Sharma has suppressed the material facts regarding his state of health while taking the insurance policy and committed breach of the terms and conditions of the insurance policy in view of the judgment of Hon'ble Supreme Court in Reliance Life General Insurance Comnpany Limited Versus Rekhaben Nareshbhai Rathod (2019) 6 Supreme Court 175.
16. The complaint filed is on 29.08.2018 and repudiation of the claim is dated 24.06.2015. The claim is beyond the period of three years and barred under law of Limitation. Reliance is placed on (2009) 5 SCC 121, titled State Bank of India Versus B. S. Agriculture Industries.
17. Therefore, the appeal of the appellant succeeds and impugned order dated 29.09.2018 of District Forum Chamba, is set aside.
18. Certified copy of this order be sent to District Forum below and file of State Commission be consigned to record room after due completion. Certified copy of order be 6 ICICI Prudential Life Insurance Co. Ltd. Vs. Kartikey Sharma & Ors.
(F.A.No.03/2019) sent to parties strictly as per rules. Pending application(s) if any also disposed of.
Justice Inder Singh Mehta President Sunita Sharma Member 02.05.2022 DKM R.K. Verma Member 7