State Consumer Disputes Redressal Commission
1.Icici Prudential Life Insurance Co. ... vs 1.Noorjahan Begum, on 30 January, 2024
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BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION : HYDERABAD.
FA.NO.393 OF 2019
AGAINST ORDERS IN CC.NO.146 OF 2013, DISTRICT
CONSUMER COMMISSION, WARANGAL
Between:
1.ICICI Prudential Life Insurance Co.Ltd., Having registered office at:
10th Floor, Building No.2, R-Tech Park, Nirlon Compound, Next to Hub Mall, Goregaon (East), Mumbai - 400 063.
Also at:
ICICI Prudential Life Insurance Co.Ltd., Door No.9/1-9/16, New # 9-1-3 to 9-1-7, 2nd Floor, Warangal Central, JPN Road, Warangal District - 506002.
....Appellant/Opposite Party No.3 And
1. Noorjahan Begum, W/o.Late Syed Masood, R/o.H.No.5-2-304, Bokkalagadda, Idga, Hanamkonda Mandal, Warangal District.
.....Respondent/Complainant
2. ICICI Bank, Rep. by its Branch Manager, Door No.3-4-5, Nehru Park Road (Old), New Door No.2-7-132, Main Road, Jangaon (P&M), Warangal District - 506167.
.....Respondent/Opp.Party No.2 (R2 is not a necessary party) Counsel for the Appellant/Opp.Party 3 : M/s. P. Yasasvi Counsel for the Respondent/Complainant: M/s K. Karunakar QUORAM:
HON'BLE SMT.MEENA RAMANATHAN...IN-CHARGE PRESIDENT & HON'BLE SRI K.RANGA RAO, MEMBER-JUDICIAL TUESDAY, THE THIRTIETH DAY OF JANUARY TWO THOUSAND TWENTY FOUR ******* 2 Order : (Per Smt.Meena Ramanathan, Hon'ble I/c President)
1. This is an appeal filed U/s.15 of Consumer Protection Act,1986 against the order dated 22.12.2016 of the District Consumer Commission, Warangal made in CC.No.146/2013. The Appellant is the Opposite Party No.3, Respondent No.1 is the Complainant and Respondent No.2 is the Opposite Party No.2 in CC.No.146/2013.
2. For the sake of convenience, the parties are described as arrayed in the complaint.
3. Briefly stated, the facts are that the Complainant is a resident of Hanamkonda of Warangal District and wife of the deceased life assured.
(i) The Opposite Party No.1 is the Grievance Redressal Committee of ICICI Prudential Life Insurance Company Ltd., i.e., Opposite Party No.3.
(ii)The Opposite Party No.2 is the ICICI Bank and
(iii)The Opposite Party No.3 is the Life Insurance Servicing Branch.
4. The Complainant's husband was an employee of the police department and was an account holder in Opposite Party No.2- Bank bearing A/c.No.070301501067. He has been receiving and withdrawing his salary from the said account. Upon repeated requests from the Opposite Parties, he availed a policy named "ICICI PRU LIFE LINK WEALTH SP" for a sum assured of Rs.5,00,000/-. He also issued a cheque for Rs.1,00,000/- towards first instalment of premium and this was encashed by the Opposite Parties on 01.10.2010. The proposal was accepted and LIC policy bearing No.15007354 under non-medical scheme for single payment commenced on 26.01.2011. Although the amount was paid vide cheque bearing No.004325 dated 23.09.2010, the Opposite Parties issued the policy bond only in the month of Januaray,2011. While the policy was in force, the deceased life assured passed away on 28.01.2011 due to heart attack. The Complainant as the nominee, approached the Opposite Parties for 3 claiming the death benefits, the claim was repudiated on the grounds of suppression of material facts. For this malicious act of negligence and deficiency, the present complaint is filed seeking the reliefs as sought supra.
5. The Opposite Party No.1 has not filed vakalat despite several adjournments before the District Commission, hence, the right for filing vakalat by Opposite Party No.1 was forfeited.
6. The Opposite Party No.2 has denied the contentions raised by the Complainant submitting that the policy was issued by Opposite Party No.3 and this Opposite Party is in no way concerned with the affairs of Opposite Party No.2. They submit that the Complainant has unnecessarily made them a party to the complaint and seek dismissal of the complaint against them with exemplary costs.
7. The Opposite Party No.3 filed their written version and contended that the Life Assured concealed the material fact regarding his health at the time of taking the policy and thereby rendered the contract of insurance void ab initio and inoperative. This Opposite Party submits that under Section 45 of the Insurance Act, a life insurance policy may be called in question on the ground of concealment of material fact within 2 years of commencement of policy. The Life Assured had concealed the fact that he was hospitalized with chest pain on 13.11.2010 in the proposal form thus rendering the subject policy void. In view of the facts and circumstances, they pray dismissal of the complaint with exemplary costs.
8. Before the District Forum, the Complainant filed evidence affidavit and Ex.A1 to A10 are marked on her behalf. The Opposite Parties filed evidence affidavit and Ex.B1 to B17 are marked on their behalf.
9. The District Forum after hearing and considering the material on record, allowed the complaint directing the Opposite 4 Party No.3 to deposit Rs.5,00,000/- towards sum assured amount before the Forum along with interest @ 7.5% p.a. from the date of filing of the complaint i.e., 02.08.2013 till the date of realization and to pay Rs.5,000/- towards legal expenses and costs within one month. The claim against Opposite Party No.1 and 2 is dismissed.
10. Aggrieved by the said order of the District Forum, the Appellant/Opposite Party No.3 filed the appeal contending that the Commission below had failed to consider the following:
That the Complainant had wilfully concealed the fact that the policy No.14629158 was never issued by the Company on the life of deceased life assured and the Company had duly refunded the premium under the said application which was encashed by the Complainant without any demur or protest.
The District Forum erroneously assumed that cheque No.4325 was for policy No.14629158, but actually it was issued for policy No.15007354. For the second application i.e., policy No.15007354, the deceased life assured had given cheque No.4324 dated 17.01.2011.
The proposal form No.LL40584414 for the subject policy No.15007354 was signed on 17.01.2011, hence by no stretch of imagination it can be said that the subject policy No.15007354 started before 17.01.2011. In spite of the specific question asked in the Insurance Application Form, the proposer failed to disclose his past medical history and details of his hospitalization in November,2010 in the proposal form No.LL40584414 for subject policy No.15007354 which was signed on 17.01.2011.
It is submitted that the policy No.15007354 was applied by the Complainant on 17.01.2011 and the policy was issued on 08.02.2011, but the District Forum had wrongly taken a view that the Company delayed the issuance of the said policy.
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11. The point that arises for consideration is whether the impugned order as passed by the District Forum suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with, in any manner? To what relief?
12. It is evident from the docket proceedings of this Commission dated 08.01.2024 as follows:
"No representation for the Appellant. It was made clear on 06.11.2023 itself that if the Appellant fails to advance his arguments, his arguments will be treated as heard. Counsel for Respondents present. Heard the arguments. The arguments of the Appellant are treated as heard. Judgment reserved."
13. We have carefully perused the records, the impugned order and heard the submissions.
14. The deceased life assured i.e., Mr.Syed Masood submitted two proposals to the Opposite Party No.2 Company and only one proposal was accepted by the Insurance Company. The policy certificate was issued vide Ex.A2 and the following details are recorded on this policy schedule:
Address: POLICE QUATOR NO.19 Category: Non-Medical WARANGAL ROAD JANGAON WARANGAL JANAGAON Andhra Pradesh 506167 Date of Birth: 05/02/1955 Age (years): 55 Policy No. 15007354 Policy Term: 10 years Risk Commencement Date: 26/01/2011 Maturity Date: 26/01/2021 Sum Assured (Rs.): 5,00,000/- Premium (Rs.): 1,00,000/-
15. The Life Assured died on 28.01.2011. Since the claim was raised early i.e., (26.01.2011-date of commencement and 28.01.2011-date of death) the Respondent/Complainant claims 6 that the premium amount was paid vide cheque bearing No. 004325 dated 23.09.2010 vide Ex.A1, but the policy was issued only on 26.01.2011. Although the Respondent No.2/Opposite Party No.2 disputed this early payment of premium, the fact that the policy was commencing on 26.01.2011 is not in dispute and the claim was raised early. Since it was an early claim, the Respondent No.2/Opposite Party No.2 addressed a letter dated 15.04.2011 seeking certain documents for claim assessment vide Ex.A5:
(i) A copy of Medico-Legal Cause of death Certificate
(ii) A copy of Employer Certificate
(iii) Treating Doctor's certificate issued by last treating doctor
(iv) A copy of the Current and Previous Medical Records for last 5 years.
16. The Respondent/Complainant failed to provide the above necessary documents. A close examination of the proposal form vide Ex.A6 reveals that the relevant questions regarding the life assured health condition were answered as follows:
Q.No. Question Answer 23(c) Have you ever consulted any doctor or are you
currently undergoing/have undergone any tests, investigations, awaiting results of any tests or investigations or have you ever been advised to No undergo any tests, investigations or surgery or been hospitalized for general check-up, observation treatment or surgery?
23 (f) Did you have any ailment/injury/accident requiring No treatment/medication for more than a week?
23 (h) Have you ever suffered or are suffering from any of the following:
(xi) Chest pain, palpitation, rheumatic fever, heart murmur, heart attack, shortness of breath or any No other heart related disorder.
(xv) Have you undergone/have been recommended to undergo any of the following - angioplasty, bypass surgery, brain surgery, heart valve surgery, aorta surgery or organ transplant.7
17. Since the policy was issued with risk commencement on 26.01.2011 and the Life Assured expired on 28.01.2011, an Investigator was appointed who submitted his report vide Ex.B3 along with the medical records of the treatment undergone by the Life Assured. As per the medical records, the Life Assured was admitted in NIMS on 13.11.2010 with chest pain and was treated at NIMS from 13.11.2010 to 22.11.2010. This was never revealed by the Life Assured in his proposal form. The Commission below only observed that in the admission record vide Ex.B6 under history of illness it was recorded as follows:
"Chest pain since 3 hours
- Typical
- Associated with sweating
- Vomiting"
This interpretation cannot be endorsed in view of a catena of judgments as passed by the Hon'ble National Commission and the Hon'ble Supreme Court.
(1) ICICI Prudential Life Insurance Company Ltd., Vs. Bimal Kanta Kharab, I (2013) CPJ 155 (NC).
(2) Mrs.Rubi (Chandra) Dutta Vs. M/s.United India Insurance Co.Ltd., II (2011) CPJ 19 (SC) = IV (2011) SLT 303=2011 (3) Scale 654.
18. The Life Assured was admitted on 13.11.2010 in emergency and he has signed the original medical record-Ex.B5. The signature on this record tallies with the signature on the policy certificate-Ex.B2. In the medical records submitted vide Ex.B5, the medical advisor for the Arogya Bhadratha Scheme has recorded that the Life Assured requires PTCA+IDES+Integralin and the estimate for the said procedure is Rs.1,47,000/-. This was never considered by the Commission below. The medical records are not in dispute and were never carefully studied by the Commission below. PTCA procedure is an invasive procedure to open blocked or stenosed coronary arteries. This was suppressed by the Life Assured which amounts to suppression of material facts.
819. We place reliance on the following judgments of the Hon'ble Supreme Court of India:
(1) Reliance Life Insurance Company Ltd., & another Vs. Rakhaben Nareshbhai Rathod, II (2019) CPJ 53 (SC) = IV (2019) SLT 235 = Appeal (civil) 4261 of 2019, on 24.04.2019. (2) Mithoolal Nayak Vs. Life Insurance Corporation of India, 1962 (SLT SOFT) 241 = Civil Appeal No.224 of 1959, on 15.01.1962, reported in (1962) O Supreme (SC) 5; (1962) Supp 2 SCR 571; (1962) AIR (SC) 814.
The decision of the Hon'ble Apex Court is relevant in this case regarding suppression of material facts.
20. After having gone through the whole material on record, it is necessary to preface our analysis with reference to two basic facts. The first pertains to the nature of disclosure made by the Insured in the proposal form. The second relates to the ground of repudiation.
21. In this case, the Life Assured did not disclose his medical history although he signed his proposal form in English. Even if he was not aware of the language, he could have taken help from others to understand the same, which was not done by him. The conduct of the Life Assured shows that the concealment was deliberate. The second aspect is that the repudiation was within a period of two years after commencement of insurance cover and this assumes significance because of the provision of law under Section 45 of Insurance Act, 1938.
22. For the reasons stated herein above, this complaint is not fit to be allowed. In view of the provisions of Section 45 (4) second provision of the Insurance Act, 1938, the premium collected on the policy by the Insurance Company till date of repudiation shall be paid to the nominee or the legal representatives of the Life Assured within a period of 90 days from the date of such repudiation, but the Appellant/Opposite Party No.3 failed to follow the provisions.
923. Hence, the premium amount was due as on date i.e., (90 days from repudiation) along with interest. Ex.A6 is the letter of repudiation dated 30.07.2011. Interest will be calculated for 90 days from the date of repudiation. In view of the aforesaid discussions, the impugned order is liable to be modified and the Appellant/Opposite Party No.3 is directed to pay the premium amount along with interest.
24. In the result, the appeal is disposed of by modifying the impugned order and the following order is passed in its place:
The Appellant/Opposite Party No.3 is directed to pay the premium amount of Rs.1,00,000/- along with interest @ 7% p.a. from 29.10.2011 till its payment. Time for compliance is six weeks.
Sd/- Sd/-
I/C PRESIDENT MEMBER-J
Dt: 30.01.2024
UC*