ICICI LOMBARD G.I.C. LTD. Vs. NEEMA SAINI
Icici Lombard G.I.C. Ltd.
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(1.) two Appeals, First Appeal No. 509 / 2016 and First Appeal No. 516 / 2020, have been filed by ICICI Lombard General Insurance Company Ltd. (hereinafter referred to as the Appellant Insurance Company) and ICICI Bank Limited (hereinafter referred to as the Appellant ICICI Bank) respectively against the Order dated 26.06.2020 passed by the State Consumer Disputes Redressal Commission Delhi (hereinafter to be referred to as "State Commission"), whereby the Complaint filed by Ms. Neema Saini (hereinafter referred to as the Complainant) was allowed and the Appellant Insurance Company and the Appellant ICICI Bank were directed to allow the claim preferred by the Complainant within two months from the date of receiving of the certified copy of the Impugned Order. They were also directed to pay Rs. 25,000/- towards costs for causing harassment to the Complainant.
Brief facts of the case as narrated in the Complaint are that the Complainant's husband Sh. Dharamvir Saini obtained a Home Loan No. LBDEL00002032769 for Rs. 75,00,000/- from the Appellant ICICI Bank.It was alleged that after insisting by the Appellant ICICI Bank, her husband obtained Insurance Cover for Rs. 75,00,000/- from the Appellant Insurance Company to safeguard the Housing Loan and it was told that in the event of his unfortunate death, his legal heirs would not be required to pay any loan and the entire loan would be paid off from the amount received from the Appellant Insurance Company.The Appellant ICICI Bank charged a sum of Rs. 3,43,980/- towards premium of the said Insurance Policy which was adjusted in the Home Loan and it was required to be paid by Shri Dharamvir Saini alongwith EMI of Home Loan.It was alleged that Insurance Policy was collected by the Appellant ICICI Bank and was not issued to the Complainant on the ground that he may cancel it in which event the loan would remain unrecovered.After two years from obtaining the Policy, i.e., on 20.10.2015 Shri Dharamvir Saini had fallen sick and was admitted in Max Healthcare Super Specialty Hospital.He could not survive and expired on 25.10.2015 due to septic shock with MODS.The Hospital issued the death summary.The Appellant ICICI Bank asked the Complainant to sign some documents for lodging claim with the Appellant Insurance Company.The Complainant received letter dated 23.11.2015 from the Appellant Insurance Company for submission of relevant documents, which were duly submitted.Despite repeated visits to the Appellant Insurance Company and the Appellant ICICI Bank, claim was not processed.Ultimately, the Appellant Insurance Company vide letter dated 07.03.2016 repudiated the claim on the ground that the claim do not fall within the purview of terms and conditions of the Insurance Policy.Alleging deficiency of service and Unfair Trade Practice on the part of the Appellant Insurance Company and the Appellant ICICI Bank for not providing Insurance Policy and repudiating the genuine claim, the Complainant has filed a Consumer Complaint before the State Commission seeking following directions to the Opposite Parties:-
a) To pay Rs. 75,00,000/- to the Complainant alongwith interest 18% per annum from the date of death of Sh. Dharamvir Saini, i.e., 25.10.2015 to till realization;
b) To pay Rs. 20 lakh as compensation against mental agony pain suffered by the Complainant;
c) To award litigation cost of Rs. 1,00,000/- to the Complainant.
(2.) The Appellant Insurance Company contested the Complaint by filing its Written Statement and denied the contents of the Complaint suffering from factual inconsistency and submitted that the Insured suppressed the material information regarding pre-existing disease due to which they were not liable to approve the claim of the Complainant.The Appellant ICICI Bank also contested the Complaint and raised preliminary objections that the Complainant is not a Consumer; Complaint is barred by limitation; no cause of action has been disclosed against them, therefore, they should be discharged from the array of Parties and complicated questions of facts and law are involved in the present Complaint, therefore, the same cannot be adjudicated by the Consumer Commission.
(3.) After hearing learned Counsels for the Complainant and the Appellant Insurance Company through video conferencing and perusal of material on record, the State Commission rejected the plea regarding the Complainant not a consumer in the absence of any cogent or tangible evidence proving that the Complainant is not a consumer.The State Commission held that the Complaint is filed within time as the cause of action in the matter arose on 25.10.2015, the date on which the Insured passed away and the Complaint had been filed in the year 2016.Relying upon the Judgment of 'Hon'ble Supreme Court in "J. J. Merchant versus Shrinath Chaturvedi, 2002 6 SCC 635], the State Commission rejected the plea of Appellants that the complicated question of facts and law cannot be adjudicated by the Consumer Commission.The State Commission allowed the Complaint in afore-noted terms by observing as under:-
"19. The fact that the onus to prove that insured was suffering from pre-existing disease is on the Insurance Company is fortified by the orders of the Hon'ble NCDRC in the matter of LIC of India versus Priya Sharma and ors, 2012 4 CPJ 646 (NC). Secondly, if the policy was issued by the insurance company without proper verification, they cannot be liable to repudiate the claim at the later stage, as per the view held by the Hon'ble NCDRC in the matter of Oriental Insurance Co. Ltd. versus Dipender Kaur, 2016 1 CPJ 603 (NC). It is trite law that the word existing means disease which exists at the time of taking the policy. Policy in the given case was obtained in 2013 but ailment visited the deceased in 2015.
20. Secondly an averment has been made by the Complainant that the policy obtained by the deceased was never served. This fact has not effectively denied. No evidence has been led by the OP-1 disputing this fact, which means the averments of the complainant to this effect are to be accepted.
21. The Hon'ble Apex Court in the matter of Modern Insulator Ltd. Versus Oriental Insurance Co. Ltd., 2000 2 SCC 734 is pleased to hold that insurance claim has to be allowed in the event terms and conditions of the policy were not furnished to him.";
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