I.C.I.C.I Prudential

Mary Joseph,

W/o. Late Joseph,

Aged 54 years,

House No.73/2,

Near Kodava Samaja,

Market Road,

Kushalnagar.



OPPOSITE PARTY:



The Area Manage,

I.C.I.C.I Prudential Life Insurance

Company Limited,

Unit No.301,

Mysore Trade Centre,

Opp:KSRTC Bus Stand,

Mysore.


O R D E R






The case of the complainant is as follows;



1. That the husband of the complainant Sri. Joseph had availed a loan from ICICI Prudential, Kushalnagar branch in March 2006 for construction of his residential house at Kushalnagar. At that time at the instance of the opposite party, he also availed a home assurance policy bearing No.02618704 from ICICI Lombard at Kushalnagar on 27-1-2006 for a sum of Rs.2,41,231/- with a annual premium of Rs.10,750/- for a period of four years.



2. That the husband of the complainant died on 12-1-2007 at his house. The complainant had approached the opposite party for the insurance claim. The opposite party repudiated the claim stating that the policy holder was under treatment for cordial in June 2004, which was not disclosed by him at the time of obtaining the policy. The same was intimated through its letter dated 27-3-2007 which was received by the complainant on first week of April 2007.



3. That by repudiating the claim of the complainant, the opposite party committed deficiency in service and thereby causing great financial loss and also mental agony and hence the complainant approached this Forum praying for a direction to the opposite party to honour the claim of the complainant along with other reliefs.



4. Upon admitting the complaint notice was ordered to be sent to the opposite party and on receipt of the notice opposite party appeared through their advocate and has filed the version and affidavit evidence in lieu of examination in chief and has taken the following contentions;



1. That the ICICI Prudential Life Insurance Company Ltd., is a Life Insurance Company registered under section 3 of the Insurance Act 1938, having its registered office at Mumbai.



2. That as a life insurer opposite party offers insurance coverage to individuals through individual assurance and to group of individuals through group life insurance schemes. In the group schemes, on acceptance of the risk under the proposal, a master policy is issued to the proposer, the group administrator covering all the eligible members of the group and the proposer group administrator becomes the policy holder of the master policy. The ICICI prudential company has a group scheme known as “Home Assure” plan of insurance for borrowers of housing loans of different financial institutions and are granted insurance coverage for an amount equal to the outstanding loan as on the date of the death of the borrower.



3. That the contract of insurance is a contract of utmost goodfaith, the life assured is bound to disclose all the material facts relating to his health and to reply truthfully, honestly and correctly to all questions in the proposal form and any suppression of those details rendered the contract of insurance illegal, invalid, void ob-ini and unenforceable.



4. That the policy no.02618704 had run for a very short period of 9 ½ months, before death claim dated 24-2-2007 was lodged by the complainant intimating the opposite party about the sad demise of the life assured, cause of death of life assured being natural death/ heart attack.



5. That it is the duty of the insured to disclose all material information at the time of proposing for the policy and as per the provisions of section 45 of the Insurance Act, 1938, the insurer can call a policy in question on the ground of non-disclosure and / or false statements in the proposal form. Since the life assured admittedly failed to disclose the fact that he was diagnosed to be suffering from Ischemic cardimyopathy and two vessel coronary artery disease with left ventricular dysfunction in June 2004 as also the fact that he used to consume alcohol and cigarette, the claim was rightly repudiated by the opposite party.



6. That the complainant in her complaint has no where denied that fact that the life assured had concealed the materials information pertaining to his health status prior to the proposal stage neither has she denied the fact of his health status at the time of proposing for the policy and the life assured obtained the policy by concealment of material facts.



7. That Mr. Joseph K.M., the life assured submitted the proposal form for insurance on his life on March 27,2006 as per the details given below;



Application No.


H100043624

Proposal signed date


March 27,2006

Proposal received by respondent


March 28,2006

Age at entry


56 years

Profession/occupation of the life assured


Salaried

Plan name


Home assure

Details of First Premium deposit paid


Cheque No.824363 dated March 24,2006 drawn on ICICI Bank Ltd for Rs.10750 (Rupees ten thousand seven hundred and fifty only)

Base sum assured


Rs.241231/-

Premium installment


Rs.9,755/-



8. That it is clearly mentioned in the proposal form that the insurance is a contract of utmost good faith requiring of the life to be assured not only to disclose all material facts but also not to suppress any material facts in response to the questions in the personal declaration form.



9. That as per the declaration and authorization in the proposal form duly submitted by the life assured he has to declare that the answers given to questions to the proposal form and the information given to the medical examiner of the company as to the state of health and habits are true and complete in every respect and not withheld any material information or suppress any fact and any changes in the state of health of the life assured or as to his occupation subsequent to the signing the proposal and before the acceptance of risk by the company.



10. That the life assured had not disclosed any adversities regarding his health in the proposal form and the same is evidenced by the fact that he had replied in negative to question Nos:E(d) to E (m) in the proposal form.



11. That believing the information given by the life assured in the proposal form to be true and correct as per the under writing norms of the company the said proposal was accepted by the opposite party at ordinary rates of premium under the non-medical category without subjecting the life assured to an medical examination and the policy being No.02618704 was issued on March 31,2006.



12. That in accordance to clause 6(2) of the Insurance Regulatory and Development Authority (Protection of Policy holders interests) Regulations 2002, every policy document sent by it is accompanied by a forward letter which clearly mentions that in case policy holder is not satisfied with the terms and conditions of the policy he can withdraw / return the policy within 15 days i.e. under the ‘Free Look Period’ provision. But the life assured retained the policy document and did not return the same to the opposite party for cancellation of the policy during the free look period thereby implying that he had agreed to all the policy terms and conditions mentioned therein.



13. That the life assured deliberately misled the opposite party by concealing material information and furnishing false replies while filling up the proposal form. It is submitted that the life assured had not disclosed the full, complete and correct facts regarding his health and medical history. The proposal for insurance signed by the life assured on 27-3-2006 which was received by the O.P on 28-3-2006 the relevant questions in the proposal form were answered as follows;-



Q.No.


Question


Answer

E(e)


Have you ever consulted/ been hospitalized for general check-up observation, treatment or surgery?


No

E(f)


Did you have any ailment/ injury requiring treatment/ medication for more than a week?


No

E(g)


Have you ever availed leave on medical grounds in the last two years?


No

E(h)


Have you ever suffered or are suffering from any of the following:

(i) Ailments/ symptoms relating to the Heart, Digestive system, Kidney, Brain or Nervous system, Mental/ Psychiatric ailment.


No



14. The opposite party had sent two reminders to the complainant on 27th February 2007 and 14th March 2007 requesting to submit the documents of previous medical records, certificate from usual/ family doctors etc. in order to process the claim. But the complainant did not submitted the documents required to assess the claim and during the claims processing, the following records were obtained.



Sl.No


Name of the Document


Particulars from the document

1


Discharge summary from Vikram Hospital & Heart Centre, Mysore dated July 01, 2004 duly signed by Dr.Arun Srinivas, MD. DM Cardiologist.


Name:Mr.K.M. Joseph.

Date of Admission:24-6-04

Diagnosis: Ischemic Cardiomyopathy. Two Vessel coronary artery disease with LV dysfunction.

History:

a) History of breathlessness since 15 days present even at rest associated with cough, PND and decreased urine output.

b) Known case of CAD-two vessel disease with LV dysfunction.

c) Ex-smoker and alcoholic quit 4 months back.

2D Echo

a) Ischaemic Heart Disease.

b) Akinetic septum, Inferoposterior wall. Hypokinetic anterior wall.

c) Severe left ventricular dysfunction. EF-23%

d) Severe Mitral Regurgitation.



Course in the Hospital:

a) Patient was admitted in CCU on 24-6-2004 with the above complaints. He was treated with IV inotropes, diuretics, Lanoxin, nebulisation.

b) 2D Echo done showed Ischaemic Heart Disease. Akinetic Septum, Inferoposterior wall.

c) Patient was haemodynamically stable and shifted to ward.



15. That Ischemic Cardiomyopathy is a heart and muscle related disease coronary artery disease (CAD) is also called coronary heart disease, CAD can weakers the heart muscle and lead to heart failure and is most common type of heart disease. Left ventricular dysfunction usually leads to heart failure.



16. These information about the health status of the life assured was material for the O.P to evaluate the proposal made by him and also incumbent upon the life assured to declare true and correct facts about his own medical state at the time of proposing, the OP would have declined the proposed and would not have issued the policy.



17. That life assured was suffering from ischemic Cardiomyopathy and two vessel coronary artery disease with left ventricular dysfunction prior to the issuance of the policy and it is evident that non-disclosure is directly related to the cause of death. It is the obligation of the life assured to make full disclosure of material facts which may be relevant for the insurer to take in to account while deciding whether the proposal should be accepted.



18. That the claim is paid by any insurance company out of the common funds belonging to all policy holders of the company and insurance Company has to check the genuineness of a claim before honouring it and cannot do injustice to genuine policy holders by allowing false claims. The claim of the complainant was repudiated bonafide and due to suppression of material facts at the time of seeking the proposal for insurance and hence the complainant is not entitled for any compensation or relief from the opposite party and prays for the dismissal of the complaint.



5. Heard the advocate for both side and perused the documents and the written arguments filed by the O.P. The points arisen for consideration are;





1. Whether the O.P has committed deficiency in service by not honouring the claim of the complainant?



2. To what order?





R E A S O N S



6. It is the case of the complainant that he never suppressed any facts at the time of sending the proposal for obtaining insurance, as it was not within his knowledge and illness suffered and there is no nexus between the illness suffered and the cause of death.



7. It is submitted by complainant’s advocate that the complainant’s husband died of natural death and not with any disease, therefore, the opposite party has illegally repudiated the claim of the complainant being the wife of the insured.



8. It is also argued that the opposite party has not placed any medical records to show that during 2004 the complainant’s husband took treatment for ischemic cardio myopathy, though the burden was on the opposite party to establish that the complainant’s husband knew the disease with which he was suffering at the time of sending the proposal.



9. As against the above submission the advocate for O.P has submitted written arguments and also orally argued the matter.



10. It is the case of the opposite party that the complainant has suppressed the facts regarding the health of her husband wherein the policy was obtained by concealing the fact and the documents produced by them are sufficient to prove that the complainant has failed to establish his right.



11. It is further submitted that the life assured is reported to have died on January 10th, 2007 within 9 ½ months from issuance of the subject policy and the opposite party though had sent two reminders to the complainant requesting her to submit the relevant documents such as copies of previous medical records, certificate from family doctors, in order to process the claim, but the complainant chose not to submit the documents require to assess the claim.



12. It is also submitted that from the documents on record is clearly evident that the life assured was diagnosed of ischemic cardiomyopathy and two vessel coronary artery disease with left ventricular dysfunction in 2004 which is prior to submission of proposal for insurance on Mary 27, 2006 and had the complainant’s husband had disclosed medical history properly the company would not have issued the policy and therefore, the complainants husband has committed breach of contract and on this ground the contract has become void and no right is accrued and therefore the complainant being the wife of Sri. K.M. Joseph is not entitled for any relief prayed for in her complaint.



13. The following citations would suggest that burden is on the insurer to establish that there is nexus between the disease and the cause of death and the burden is heavily on the insurer to establish that the insured had the knowledge of the disease and knowingly the insured has failed to disclose the same at the time of sending the proposal.



“Life Insured died- claim repudiated on the ground of suppression of fact of illness- but there was no nexus between ailment and death” – Dvl.Manager, LIC of India Vs Jeetho Devi 1997(1) CPJ 310.



“Claim was repudiated on the ground that the insured who died on heat attack suppressed the fact of his suffering from diabetes- the insurance company has failed to prove the nexus between heart attack and diabetes. Repudiation of claim amounts to deficiency in service” – Shantha Ben Ratilal Patel Vs LIC of India 1996(2) CPJ 92.



“Insurance claim repudiated for concealment of fact of insured suffering from cancer. There was no evidence that the insured had the knowledge . Repudiation held was bad.” LIC of India Vs Sanjeev Mahendra Paul Sha 1998(1) CPJ 45-National Commission.



“Claim repudiated for suppression of material fact no nexus of cause of death and ailment was proved. Repudiation was held to be arbitrarily” Dvl.Manager, LIC of India Vs T.Venkateshwaralu 1998(1) CPJ 568 AP.



“The burden to prove of ailment lies on the company. No document was produced in support of contention that the deceased did not disclose that he was suffering from heart ailment. Insurance company failed to discharge his duty and held liable for deficient in service and liable to payment with interest” LIC of India Vs Smt.Asha Singh 2002(1) CPJ 403 UP, LIC of India Vs Charanjit Kour 2001(1) CPJ 53, LIC of India Vs Surjan Singh Saini 2001(1) CPJ 278.



14. Keeping the above citation in mind and the materials placed before the Forum it can be said that the O.P has failed to establish that the insured had deliberately and knowingly suppressed the fact of the disease which he was suffering at the time of sending the proposal for obtaining home assurance policy.



15. The advocate for the complainant has relied on the following citations to convince the Forum that the burden of proving the suppression of material facts by the insured is heavily on the insurer, if that burden is not discharged by the insurer, repudiation becomes illegal.

1. III (2005) CPJ 683

2. I (2005) CPJ 78

3. II (2005) CPJ 662

4. II (2005) CPJ 124

5. II (2005) CPJ 9 (NC)

6. II (2005) CPJ 114



16. Since the O.P had repudiated the genuine claim made by the complainant it can be said that they have committed deficiency in service and therefore we answer point no.1 positively.



17. Having given the findings and the reasons thereto we proceed to pass the following order.



O R D E R



The complaint is allowed and the O.P is hereby directed to consider the claim of the complainant positively taking in to consideration of the amount paid towards the house loan and the balance amount due from the complainant’s husband towards house loan as per the claim proposal sent by complainant. For complainant being put to hardship and mental agony the O.P is directed to pay a compensation of Rs.1,000/- and further directed to pay Rs.1,000/- towards the cost of this proceedings to the complainant.



The above order shall be complied within sixty days from the date of receipt of this order by the opposite parties.



Communicate the order to the parties.

Comments

  • adv.sumitadv.sumit Senior Member
    edited October 2009
    Raghavarapu Rama Devi,

    W/o. late Venkata Subba Rao,

    R/o. Near Ayyappaswamy Temple,

    Nehru Nagar,

    Guntur. … Complainant



    AND



    ICICI Prudential Life Insurance,

    Rep. by its Branch Manager,

    15th line, Main Road, Arundelpet,

    Guntur. … Opposite party









    O R D E R




    This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant praying relief for sum assured to the tune of Rs.1,00,000/- and also for compensation and costs from the opposite party.

    The case of the complainant is that

    Her deceased husband by name Raghavarapu Venkata Subba Rao during his life time obtained policy bearing No.01520206 for a sum of Rs.1,00,000/- which commenced from 24-03-05 on payment of premium of Rs.20,000/-. This is the life time policy issued by the opposite party fixing yearly premium of Rs.20,000/-. Her husband died due to heart attack on 14-02-07. The complainant being the wife her name was noted as nominee of deceased.


    After death of her husband, she addressed a letter dt.18-04-07 vide Ex.A6 to the opposite party for settling the claim under policy vide Ex.A2. She has also submitted death certificate of her husband vide Ex.A5. But the opposite party did not give any reply nor settled the claim. The complainant requested the opposite party on number of occasions for early settlement of claim. But they failed to do so, as such it amounts to deficiency of service. Hence, the complaint.

    The opposite party filed its version taking preliminary objections about the maintainability of complaint and also denied the allegations made in the complaint. According to the version, this complaint is filed in order to harass and gain undue advantage for unjustified amount on the lapse of policy as on the date of death of life assured. With regard to the facts of the case, it is submitted that the deceased was 52 years of age at the time of submitting his proposal for insurance, doing cool drink business and running STD shop. The proposal was submitted on 15-03-05 on his life under ICICI Life Time plan of insurance for sum of Rs.1,00,000/-. He had also opted for supplementary benefit namely Accident & Disability of a sum of Rs.1,00,000/-. The life assured had chosen yearly frequency for paying the premium of Rs.20,000/-. He had nominated his wife, the complainant herein under section 39 of the Insurance Act.


    As per the age of life assured, the sum assured opted and the underwriting norms of the company, the life assured was required to undergo physical medical test and the same was completed by life assured on 23-03-05. Believing the information given by the life assured in the proposal form and believing the medical examination to be true and correct in all aspects, the proposal was accepted at standard (ordinary) rates of premium for basic cover and also for supplementary benefit of Rs.1,00,000/- and the policy was issued on 29-03-05 vide Ex.B1 and B2. As per the terms of policy, the premium of Rs.20,000/- is payable on 24th March every year.

    The life assured is reported to have died on 14-02-07. After the death of life assured, the complainant lodged a claim with the opposite party on 18-04-07 vide Ex.B1 (Ex.A6).

    It is further submitted that the premium payable on 24th March of every year to be paid either on due date or within the grace period but the same was not paid. Thus as per the terms and conditions of the policy the grace period would expire on 24th April of the relevant year, in present case i.e., 24-04-06. Therefore, no benefits become payable on death of life assured if the policy was in a lapsed condition. Since premiums under the policy were not even paid for three consecutive years, the policy lapsed without acquiring any paid-up value. The opposite party crave leave to draw the attention of the Forum on clause 4.1 (i) (payment of premium). The opposite party informed the complainant vide its letter dt.28-04-07 vide Ex.B5 that the above said policy was in lapsed condition on 14-02-07 being the date of death of life assured.


    Further the premiums due on 24-03-06 and all subsequent premiums had remained unpaid. Therefore, as the policy is in lapsed condition on the date of death of life assured no benefits are payable there under. For the above said reasons, the policy benefits are not settled on the complainant. The complaint is devoid of merits. Hence, it is prayed to dismiss the complaint.

    Both parties have filed their affidavits. Ex.A1 to A6 are marked on behalf of complainant. Ex.B1 to B5 are marked on behalf of opposite party.

    Now the points for determination are that

    1. Whether there is any deficiency of service on the part of opposite party in not settling the claim?

    2. Whether the complainant is entitled for the sum assured under the policy vide Ex.A2?

    3. To what relief?

    POINT No.1

    The facts are no way in dispute. The opposite party admits about having insurance policy under ICICI Life Time plan of insurance for a sum of Rs.1,00,000/- to the deceased Venkata Subba Rao who had nominated his wife, the complainant herein as beneficiary there under. According to the opposite party, after completion of formalities they have accepted proposal and issued policy on 29-03-05. As per the terms and conditions of the policy premium of Rs.20,000/- is payable on or before 24th March every year within the grace period provided. According to opposite party except the initial premium amount at the time of issuing policy subsequently yearly premiums for the years 2006 and 2007 are not paid. Therefore, by the date of death of deceased on 14-02-07, policy was said to be in lapsed condition, as such no benefits will arrive out of the same and the complainant is not entitled for any amount as claimed.

    In the aforesaid circumstances, the opposite party claims that absolutely there is no deficiency of service on their part. In this regard, they rely upon policy documents, which provides various terms and conditions of the policy vide Ex.B4, clause 4.1(i), which reads as follows:

    “Payment premiums:

    Premium are payable on the due dates and at the rate mentioned in the policy certificate. However, a grace period of not more than 30 days, where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace, the policy shall lapse and no benefit shall be payable. If a premium is not paid during the days of grace after three full years’ premium have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in clause 4.4. hereof”

    The above provisions makes it clear that premium amount is not paid within the grace period of 30 days, the policy shall lapse and no benefits shall be payable. It also makes it clear that after making three full years premium and subsequent premiums are not paid within grace period, the benefits payable under the policy shall be as indicated in clause 4.4 thereon. But this situation does not arise in this case as deceased did not pay the premium of the year 2006 and 2007. Of course, he died one month before the premium is due in the year 2007.


    But ultimately two years premium remains unpaid. As such, the policy lapsed and no benefits would accrue there under. The revival of policy as provided under general conditions does arise if the life assured is alive and on undertaking to pay premiums subject to other conditions provided there under. Thus we observe that absolutely there is no deficiency of service on the part of opposite party in repudiating the claim of complainant. They are justified in doing so as per the terms and conditions of the policy. The point is answered accordingly.

    POINT 2 & 3

    In view of the findings given in preceding point, the complainant is not entitled for any benefits under the policy. The complaint is devoid of merits. Hence, the complaint is dismissed. Each party shall bear their own costs.

    In the result, the complaint is dismissed. Each party shall bear their own costs.
  • adv.sumitadv.sumit Senior Member
    edited October 2009
    Raghavarapu Rama Devi,

    W/o. late Venkata Subba Rao,

    R/o. Near Ayyappaswamy Temple,

    Nehru Nagar,

    Guntur. … Complainant



    AND



    ICICI Prudential Life Insurance,

    Rep. by its Branch Manager,

    15th line, Main Road, Arundelpet,

    Guntur. … Opposite party







    O R D E R





    This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant praying relief for sum assured to the tune of Rs.1,00,000/- and also for compensation and costs from the opposite party.

    The case of the complainant is that

    Her deceased husband by name Raghavarapu Venkata Subba Rao during his life time obtained policy bearing No.01520206 for a sum of Rs.1,00,000/- which commenced from 24-03-05 on payment of premium of Rs.20,000/-. This is the life time policy issued by the opposite party fixing yearly premium of Rs.20,000/-. Her husband died due to heart attack on 14-02-07. The complainant being the wife her name was noted as nominee of deceased. After death of her husband, she addressed a letter dt.18-04-07 vide Ex.A6 to the opposite party for settling the claim under policy vide Ex.A2. She has also submitted death certificate of her husband vide Ex.A5. But the opposite party did not give any reply nor settled the claim. The complainant requested the opposite party on number of occasions for early settlement of claim. But they failed to do so, as such it amounts to deficiency of service. Hence, the complaint.

    The opposite party filed its version taking preliminary objections about the maintainability of complaint and also denied the allegations made in the complaint. According to the version, this complaint is filed in order to harass and gain undue advantage for unjustified amount on the lapse of policy as on the date of death of life assured. With regard to the facts of the case, it is submitted that the deceased was 52 years of age at the time of submitting his proposal for insurance, doing cool drink business and running STD shop. The proposal was submitted on 15-03-05 on his life under ICICI Life Time plan of insurance for sum of Rs.1,00,000/-.


    He had also opted for supplementary benefit namely Accident & Disability of a sum of Rs.1,00,000/-. The life assured had chosen yearly frequency for paying the premium of Rs.20,000/-. He had nominated his wife, the complainant herein under section 39 of the Insurance Act. As per the age of life assured, the sum assured opted and the underwriting norms of the company, the life assured was required to undergo physical medical test and the same was completed by life assured on 23-03-05.


    Believing the information given by the life assured in the proposal form and believing the medical examination to be true and correct in all aspects, the proposal was accepted at standard (ordinary) rates of premium for basic cover and also for supplementary benefit of Rs.1,00,000/- and the policy was issued on 29-03-05 vide Ex.B1 and B2. As per the terms of policy, the premium of Rs.20,000/- is payable on 24th March every year.

    The life assured is reported to have died on 14-02-07. After the death of life assured, the complainant lodged a claim with the opposite party on 18-04-07 vide Ex.B1 (Ex.A6).

    It is further submitted that the premium payable on 24th March of every year to be paid either on due date or within the grace period but the same was not paid. Thus as per the terms and conditions of the policy the grace period would expire on 24th April of the relevant year, in present case i.e., 24-04-06. Therefore, no benefits become payable on death of life assured if the policy was in a lapsed condition. Since premiums under the policy were not even paid for three consecutive years, the policy lapsed without acquiring any paid-up value. The opposite party crave leave to draw the attention of the Forum on clause 4.1 (i) (payment of premium). The opposite party informed the complainant vide its letter dt.28-04-07 vide Ex.B5 that the above said policy was in lapsed condition on 14-02-07 being the date of death of life assured.


    Further the premiums due on 24-03-06 and all subsequent premiums had remained unpaid. Therefore, as the policy is in lapsed condition on the date of death of life assured no benefits are payable there under. For the above said reasons, the policy benefits are not settled on the complainant. The complaint is devoid of merits. Hence, it is prayed to dismiss the complaint.

    Both parties have filed their affidavits. Ex.A1 to A6 are marked on behalf of complainant. Ex.B1 to B5 are marked on behalf of opposite party.

    Now the points for determination are that

    1. Whether there is any deficiency of service on the part of opposite party in not settling the claim?

    2. Whether the complainant is entitled for the sum assured under the policy vide Ex.A2?

    3. To what relief?

    POINT No.1

    The facts are no way in dispute. The opposite party admits about having insurance policy under ICICI Life Time plan of insurance for a sum of Rs.1,00,000/- to the deceased Venkata Subba Rao who had nominated his wife, the complainant herein as beneficiary there under. According to the opposite party, after completion of formalities they have accepted proposal and issued policy on 29-03-05.


    As per the terms and conditions of the policy premium of Rs.20,000/- is payable on or before 24th March every year within the grace period provided. According to opposite party except the initial premium amount at the time of issuing policy subsequently yearly premiums for the years 2006 and 2007 are not paid. Therefore, by the date of death of deceased on 14-02-07, policy was said to be in lapsed condition, as such no benefits will arrive out of the same and the complainant is not entitled for any amount as claimed.

    In the aforesaid circumstances, the opposite party claims that absolutely there is no deficiency of service on their part. In this regard, they rely upon policy documents, which provides various terms and conditions of the policy vide Ex.B4, clause 4.1(i), which reads as follows:

    “Payment premiums:

    Premium are payable on the due dates and at the rate mentioned in the policy certificate. However, a grace period of not more than 30 days, where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace, the policy shall lapse and no benefit shall be payable. If a premium is not paid during the days of grace after three full years’ premium have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in clause 4.4. hereof”

    The above provisions makes it clear that premium amount is not paid within the grace period of 30 days, the policy shall lapse and no benefits shall be payable. It also makes it clear that after making three full years premium and subsequent premiums are not paid within grace period, the benefits payable under the policy shall be as indicated in clause 4.4 thereon. But this situation does not arise in this case as deceased did not pay the premium of the year 2006 and 2007. Of course, he died one month before the premium is due in the year 2007. But ultimately two years premium remains unpaid.



    As such, the policy lapsed and no benefits would accrue there under. The revival of policy as provided under general conditions does arise if the life assured is alive and on undertaking to pay premiums subject to other conditions provided there under. Thus we observe that absolutely there is no deficiency of service on the part of opposite party in repudiating the claim of complainant. They are justified in doing so as per the terms and conditions of the policy. The point is answered accordingly.

    POINT 2 & 3

    In view of the findings given in preceding point, the complainant is not entitled for any benefits under the policy. The complaint is devoid of merits. Hence, the complaint is dismissed. Each party shall bear their own costs.

    In the result, the complaint is dismissed. Each party shall bear their own costs.
  • adv.sumitadv.sumit Senior Member
    edited October 2009
    Raghavarapu Rama Devi,

    W/o. late Venkata Subba Rao,

    R/o. Near Ayyappaswamy Temple,

    Nehru Nagar,

    Guntur. … Complainant



    AND



    ICICI Prudential Life Insurance,

    Rep. by its Branch Manager,

    15th line, Main Road, Arundelpet,

    Guntur. … Opposite party









    O R D E R



    This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant praying relief for sum assured to the tune of Rs.1,00,000/- and also for compensation and costs from the opposite party.

    The case of the complainant is that

    Her deceased husband by name Raghavarapu Venkata Subba Rao during his life time obtained policy bearing No.01520206 for a sum of Rs.1,00,000/- which commenced from 24-03-05 on payment of premium of Rs.20,000/-. This is the life time policy issued by the opposite party fixing yearly premium of Rs.20,000/-. Her husband died due to heart attack on 14-02-07. The complainant being the wife her name was noted as nominee of deceased.


    After death of her husband, she addressed a letter dt.18-04-07 vide Ex.A6 to the opposite party for settling the claim under policy vide Ex.A2. She has also submitted death certificate of her husband vide Ex.A5. But the opposite party did not give any reply nor settled the claim. The complainant requested the opposite party on number of occasions for early settlement of claim. But they failed to do so, as such it amounts to deficiency of service. Hence, the complaint.

    The opposite party filed its version taking preliminary objections about the maintainability of complaint and also denied the allegations made in the complaint. According to the version, this complaint is filed in order to harass and gain undue advantage for unjustified amount on the lapse of policy as on the date of death of life assured. With regard to the facts of the case, it is submitted that the deceased was 52 years of age at the time of submitting his proposal for insurance, doing cool drink business and running STD shop.


    The proposal was submitted on 15-03-05 on his life under ICICI Life Time plan of insurance for sum of Rs.1,00,000/-. He had also opted for supplementary benefit namely Accident & Disability of a sum of Rs.1,00,000/-. The life assured had chosen yearly frequency for paying the premium of Rs.20,000/-. He had nominated his wife, the complainant herein under section 39 of the Insurance Act.


    As per the age of life assured, the sum assured opted and the underwriting norms of the company, the life assured was required to undergo physical medical test and the same was completed by life assured on 23-03-05. Believing the information given by the life assured in the proposal form and believing the medical examination to be true and correct in all aspects, the proposal was accepted at standard (ordinary) rates of premium for basic cover and also for supplementary benefit of Rs.1,00,000/- and the policy was issued on 29-03-05 vide Ex.B1 and B2. As per the terms of policy, the premium of Rs.20,000/- is payable on 24th March every year.

    The life assured is reported to have died on 14-02-07. After the death of life assured, the complainant lodged a claim with the opposite party on 18-04-07 vide Ex.B1 (Ex.A6).

    It is further submitted that the premium payable on 24th March of every year to be paid either on due date or within the grace period but the same was not paid. Thus as per the terms and conditions of the policy the grace period would expire on 24th April of the relevant year, in present case i.e., 24-04-06. Therefore, no benefits become payable on death of life assured if the policy was in a lapsed condition.


    Since premiums under the policy were not even paid for three consecutive years, the policy lapsed without acquiring any paid-up value. The opposite party crave leave to draw the attention of the Forum on clause 4.1 (i) (payment of premium). The opposite party informed the complainant vide its letter dt.28-04-07 vide Ex.B5 that the above said policy was in lapsed condition on 14-02-07 being the date of death of life assured.


    Further the premiums due on 24-03-06 and all subsequent premiums had remained unpaid. Therefore, as the policy is in lapsed condition on the date of death of life assured no benefits are payable there under. For the above said reasons, the policy benefits are not settled on the complainant. The complaint is devoid of merits. Hence, it is prayed to dismiss the complaint.

    Both parties have filed their affidavits. Ex.A1 to A6 are marked on behalf of complainant. Ex.B1 to B5 are marked on behalf of opposite party.

    Now the points for determination are that

    1. Whether there is any deficiency of service on the part of opposite party in not settling the claim?

    2. Whether the complainant is entitled for the sum assured under the policy vide Ex.A2?

    3. To what relief?

    POINT No.1

    The facts are no way in dispute. The opposite party admits about having insurance policy under ICICI Life Time plan of insurance for a sum of Rs.1,00,000/- to the deceased Venkata Subba Rao who had nominated his wife, the complainant herein as beneficiary there under. According to the opposite party, after completion of formalities they have accepted proposal and issued policy on 29-03-05. As per the terms and conditions of the policy premium of Rs.20,000/- is payable on or before 24th March every year within the grace period provided.


    According to opposite party except the initial premium amount at the time of issuing policy subsequently yearly premiums for the years 2006 and 2007 are not paid. Therefore, by the date of death of deceased on 14-02-07, policy was said to be in lapsed condition, as such no benefits will arrive out of the same and the complainant is not entitled for any amount as claimed.

    In the aforesaid circumstances, the opposite party claims that absolutely there is no deficiency of service on their part. In this regard, they rely upon policy documents, which provides various terms and conditions of the policy vide Ex.B4, clause 4.1(i), which reads as follows:

    “Payment premiums:

    Premium are payable on the due dates and at the rate mentioned in the policy certificate. However, a grace period of not more than 30 days, where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace, the policy shall lapse and no benefit shall be payable. If a premium is not paid during the days of grace after three full years’ premium have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in clause 4.4. hereof”

    The above provisions makes it clear that premium amount is not paid within the grace period of 30 days, the policy shall lapse and no benefits shall be payable. It also makes it clear that after making three full years premium and subsequent premiums are not paid within grace period, the benefits payable under the policy shall be as indicated in clause 4.4 thereon. But this situation does not arise in this case as deceased did not pay the premium of the year 2006 and 2007. Of course, he died one month before the premium is due in the year 2007.


    But ultimately two years premium remains unpaid. As such, the policy lapsed and no benefits would accrue there under. The revival of policy as provided under general conditions does arise if the life assured is alive and on undertaking to pay premiums subject to other conditions provided there under. Thus we observe that absolutely there is no deficiency of service on the part of opposite party in repudiating the claim of complainant. They are justified in doing so as per the terms and conditions of the policy. The point is answered accordingly.
  • adv.sumitadv.sumit Senior Member
    edited October 2009
    N. Priyadarsanan
    ...........Appellant(s)

    Vs.

    Manager

    ICICI Home Finance Co. Limited
    ...........Respondent(s)







    ORDER





    The case of complainant is as follows. The complainant has availed a house loan from the respondent Bank having number LAN HTHR 000350053 by depositing the title deed of property. The loan was closed on 7.1.05 and the respondents given a letter with regard to this on 12.1.05. But till this time the respondents had not returned the title deed of the complainant’s property. The complainant approached the respondents at several times and now they stated that the title deed is misplaced. The complainant lost several chances to sell his property for a high rate due to the lack of title deed. The complainant sent a lawyer notice dated 16.5.05. But no remedy so far. Hence the complaint.


    2. The counter of first respondent is as follows: The company admits that the complainant had availed a housing loan by depositing the title deed and the complainant closed the loan and all the original prior deeds including land tax receipt etc. were immediately returned to the complainant. But the company admits that the company had not returned the original title deed relating to the mortgaged property.


    In this instant case, unlike other cases of availing loan by mortgaging immovable property the complainant had not actually produced the titled deed of the property to the company’s Branch Office at Thrissur in advance for processing the sanctioning of the loan. The procedure adopted by the company in this case is slightly different from other procedures normally adopted by the company in sanctioning the loan on immovable property in respect of which all the documents made available to the company in advance.


    In this case the title deed pertaining to the purchase of the property will be normally received from the Sub Registrar Office after 15-25 days. Of course, the first respondent herein had received the original title deed from the Sub Registrar Office and as usual the same was forwarded to the Storage Centre at Bombay to be kept along with the prior deeds of the property already dispatched immediately after registration. On closure of the loan the first respondent had received back the prior deeds from the storage centre and the same was immediately handed over to the complainant. At that time the title deed of the property was not available in the cover.


    The first respondent intimated the fact of non-receipt of the title deed to the storage centre and they are making all efforts to find out the misplaced title deed. The company will make all endeavour to obtain certified copy from the Sub Registry Office and is prepared to execute indemnity bonds in favour of the complainant and also issue requisite certificate stating the aforesaid facts to the complainant. There is no deficiency in service or willful latches on the part of the respondents. Hence dismiss.

    3. The 2nd respondent filed a statement adopting the counter of first respondent.

    4. The points for consideration are:
    (1) Is there any deficiency in service?
    (2) If so, reliefs and costs.

    5. The evidence consists of Exts. P1 to P3 and the testimonies of PW1 and RW1.


    6. Points-1 & 2: The complainant’s case is that he had availed a housing loan from the respondent company by mortgaging immovable property owned by the complainant by duly depositing the title deeds pertaining to the property in the first respondent branch at Thrissur. Subsequently the loan was closed by the complainant. But the company had not returned the original title deed relating to the mortgaged property. So the complaint is filed.

    7. The respondents in their counter clearly admitted that the complainant had deposited the title deed of the property in first respondent’s company and they forwarded it to the Storage Centre at Bombay to be kept. But on closure of loan they couldn’t hand over the title deed to the complainant, as they haven’t received it from their Storage Centre. Further they admitted that they are making all efforts to find out the misplaced title deed.

    8.Ext. R2 is a letter from respondents to petitioner shows that the case of complainant is admitted by them. In that letter they stated that the original sale deed is not available in the file maintained by them and they are in the process of retrieving the same. The Manager who is examined as RW1 deposed that they are unable to trace out the title deed. So the entire case of complainant is admitted by the respondents. The first prayer sought is the return of title deed.


    Since there is clear admission on the part of respondents regarding the non-availability of the document this prayer cannot be allowed. Definitely the complainant is entitled for reasonable compensation. He is examined before the Forum as PW1 and he stated that he was not able to sell the house in time. He also stated that he was not in a position to left the place. But the circumstances did not explain by him. During cross-examination he also stated that he has not entered into any agreement to sell the property. In the absence of such evidence the compensation cannot be extended to the extent claimed.

    9. In the result, complaint is allowed and the respondents are directed to pay Rs.1500/- (Rupees one thousand and five hundred only) towards the expenses for taking certified copy of the lost title deed from the Sub Registrar Office and publication in the leading newspaper. The respondents are further directed to pay Rs.10,000/- (Rupees ten thousand only) as compensation with cost Rs.1000/- (Rupees one thousand only) to the complainant within two months.
  • adv.sumitadv.sumit Senior Member
    edited October 2009
    Raghavarapu Rama Devi,

    W/o. late Venkata Subba Rao,

    R/o. Near Ayyappaswamy Temple,

    Nehru Nagar,

    Guntur. … Complainant



    AND



    ICICI Prudential Life Insurance,

    Rep. by its Branch Manager,

    15th line, Main Road, Arundelpet,

    Guntur. … Opposite party








    O R D E R



    This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant praying relief for sum assured to the tune of Rs.1,00,000/- and also for compensation and costs from the opposite party.

    The case of the complainant is that

    Her deceased husband by name Raghavarapu Venkata Subba Rao during his life time obtained policy bearing No.01520206 for a sum of Rs.1,00,000/- which commenced from 24-03-05 on payment of premium of Rs.20,000/-. This is the life time policy issued by the opposite party fixing yearly premium of Rs.20,000/-. Her husband died due to heart attack on 14-02-07. The complainant being the wife her name was noted as nominee of deceased.


    After death of her husband, she addressed a letter dt.18-04-07 vide Ex.A6 to the opposite party for settling the claim under policy vide Ex.A2. She has also submitted death certificate of her husband vide Ex.A5. But the opposite party did not give any reply nor settled the claim. The complainant requested the opposite party on number of occasions for early settlement of claim. But they failed to do so, as such it amounts to deficiency of service. Hence, the complaint.

    The opposite party filed its version taking preliminary objections about the maintainability of complaint and also denied the allegations made in the complaint. According to the version, this complaint is filed in order to harass and gain undue advantage for unjustified amount on the lapse of policy as on the date of death of life assured. With regard to the facts of the case, it is submitted that the deceased was 52 years of age at the time of submitting his proposal for insurance, doing cool drink business and running STD shop.


    The proposal was submitted on 15-03-05 on his life under ICICI Life Time plan of insurance for sum of Rs.1,00,000/-. He had also opted for supplementary benefit namely Accident & Disability of a sum of Rs.1,00,000/-. The life assured had chosen yearly frequency for paying the premium of Rs.20,000/-. He had nominated his wife, the complainant herein under section 39 of the Insurance Act. As per the age of life assured, the sum assured opted and the underwriting norms of the company, the life assured was required to undergo physical medical test and the same was completed by life assured on 23-03-05.


    Believing the information given by the life assured in the proposal form and believing the medical examination to be true and correct in all aspects, the proposal was accepted at standard (ordinary) rates of premium for basic cover and also for supplementary benefit of Rs.1,00,000/- and the policy was issued on 29-03-05 vide Ex.B1 and B2. As per the terms of policy, the premium of Rs.20,000/- is payable on 24th March every year.

    The life assured is reported to have died on 14-02-07. After the death of life assured, the complainant lodged a claim with the opposite party on 18-04-07 vide Ex.B1 (Ex.A6).

    It is further submitted that the premium payable on 24th March of every year to be paid either on due date or within the grace period but the same was not paid. Thus as per the terms and conditions of the policy the grace period would expire on 24th April of the relevant year, in present case i.e., 24-04-06. Therefore, no benefits become payable on death of life assured if the policy was in a lapsed condition. Since premiums under the policy were not even paid for three consecutive years, the policy lapsed without acquiring any paid-up value.


    The opposite party crave leave to draw the attention of the Forum on clause 4.1 (i) (payment of premium). The opposite party informed the complainant vide its letter dt.28-04-07 vide Ex.B5 that the above said policy was in lapsed condition on 14-02-07 being the date of death of life assured. Further the premiums due on 24-03-06 and all subsequent premiums had remained unpaid. Therefore, as the policy is in lapsed condition on the date of death of life assured no benefits are payable there under. For the above said reasons, the policy benefits are not settled on the complainant. The complaint is devoid of merits. Hence, it is prayed to dismiss the complaint.

    Both parties have filed their affidavits. Ex.A1 to A6 are marked on behalf of complainant. Ex.B1 to B5 are marked on behalf of opposite party.

    Now the points for determination are that

    1. Whether there is any deficiency of service on the part of opposite party in not settling the claim?

    2. Whether the complainant is entitled for the sum assured under the policy vide Ex.A2?

    3. To what relief?

    POINT No.1

    The facts are no way in dispute. The opposite party admits about having insurance policy under ICICI Life Time plan of insurance for a sum of Rs.1,00,000/- to the deceased Venkata Subba Rao who had nominated his wife, the complainant herein as beneficiary there under. According to the opposite party, after completion of formalities they have accepted proposal and issued policy on 29-03-05. As per the terms and conditions of the policy premium of Rs.20,000/- is payable on or before 24th March every year within the grace period provided.


    According to opposite party except the initial premium amount at the time of issuing policy subsequently yearly premiums for the years 2006 and 2007 are not paid. Therefore, by the date of death of deceased on 14-02-07, policy was said to be in lapsed condition, as such no benefits will arrive out of the same and the complainant is not entitled for any amount as claimed.

    In the aforesaid circumstances, the opposite party claims that absolutely there is no deficiency of service on their part. In this regard, they rely upon policy documents, which provides various terms and conditions of the policy vide Ex.B4, clause 4.1(i), which reads as follows:

    “Payment premiums:

    Premium are payable on the due dates and at the rate mentioned in the policy certificate. However, a grace period of not more than 30 days, where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace, the policy shall lapse and no benefit shall be payable. If a premium is not paid during the days of grace after three full years’ premium have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in clause 4.4. hereof”

    The above provisions makes it clear that premium amount is not paid within the grace period of 30 days, the policy shall lapse and no benefits shall be payable. It also makes it clear that after making three full years premium and subsequent premiums are not paid within grace period, the benefits payable under the policy shall be as indicated in clause 4.4 thereon. But this situation does not arise in this case as deceased did not pay the premium of the year 2006 and 2007. Of course, he died one month before the premium is due in the year 2007.


    But ultimately two years premium remains unpaid. As such, the policy lapsed and no benefits would accrue there under. The revival of policy as provided under general conditions does arise if the life assured is alive and on undertaking to pay premiums subject to other conditions provided there under. Thus we observe that absolutely there is no deficiency of service on the part of opposite party in repudiating the claim of complainant. They are justified in doing so as per the terms and conditions of the policy. The point is answered accordingly.
  • adv.sumitadv.sumit Senior Member
    edited October 2009
    Raghavarapu Rama Devi,

    W/o. late Venkata Subba Rao,

    R/o. Near Ayyappaswamy Temple,

    Nehru Nagar,

    Guntur. … Complainant



    AND



    ICICI Prudential Life Insurance,

    Rep. by its Branch Manager,

    15th line, Main Road, Arundelpet,

    Guntur. … Opposite party








    O R D E R





    Her deceased husband by name Raghavarapu Venkata Subba Rao during his life time obtained policy bearing No.01520206 for a sum of Rs.1,00,000/- which commenced from 24-03-05 on payment of premium of Rs.20,000/-. This is the life time policy issued by the opposite party fixing yearly premium of Rs.20,000/-.


    Her husband died due to heart attack on 14-02-07. The complainant being the wife her name was noted as nominee of deceased. After death of her husband, she addressed a letter dt.18-04-07 vide Ex.A6 to the opposite party for settling the claim under policy vide Ex.A2. She has also submitted death certificate of her husband vide Ex.A5. But the opposite party did not give any reply nor settled the claim. The complainant requested the opposite party on number of occasions for early settlement of claim. But they failed to do so, as such it amounts to deficiency of service. Hence, the complaint.

    The opposite party filed its version taking preliminary objections about the maintainability of complaint and also denied the allegations made in the complaint. According to the version, this complaint is filed in order to harass and gain undue advantage for unjustified amount on the lapse of policy as on the date of death of life assured.


    With regard to the facts of the case, it is submitted that the deceased was 52 years of age at the time of submitting his proposal for insurance, doing cool drink business and running STD shop. The proposal was submitted on 15-03-05 on his life under ICICI Life Time plan of insurance for sum of Rs.1,00,000/-. He had also opted for supplementary benefit namely Accident & Disability of a sum of Rs.1,00,000/-. The life assured had chosen yearly frequency for paying the premium of Rs.20,000/-. He had nominated his wife, the complainant herein under section 39 of the Insurance Act.


    As per the age of life assured, the sum assured opted and the underwriting norms of the company, the life assured was required to undergo physical medical test and the same was completed by life assured on 23-03-05. Believing the information given by the life assured in the proposal form and believing the medical examination to be true and correct in all aspects, the proposal was accepted at standard (ordinary) rates of premium for basic cover and also for supplementary benefit of Rs.1,00,000/- and the policy was issued on 29-03-05 vide Ex.B1 and B2. As per the terms of policy, the premium of Rs.20,000/- is payable on 24th March every year.

    The life assured is reported to have died on 14-02-07. After the death of life assured, the complainant lodged a claim with the opposite party on 18-04-07 vide Ex.B1 (Ex.A6).

    It is further submitted that the premium payable on 24th March of every year to be paid either on due date or within the grace period but the same was not paid. Thus as per the terms and conditions of the policy the grace period would expire on 24th April of the relevant year, in present case i.e., 24-04-06. Therefore, no benefits become payable on death of life assured if the policy was in a lapsed condition. Since premiums under the policy were not even paid for three consecutive years, the policy lapsed without acquiring any paid-up value.


    The opposite party crave leave to draw the attention of the Forum on clause 4.1 (i) (payment of premium). The opposite party informed the complainant vide its letter dt.28-04-07 vide Ex.B5 that the above said policy was in lapsed condition on 14-02-07 being the date of death of life assured. Further the premiums due on 24-03-06 and all subsequent premiums had remained unpaid. Therefore, as the policy is in lapsed condition on the date of death of life assured no benefits are payable there under. For the above said reasons, the policy benefits are not settled on the complainant. The complaint is devoid of merits. Hence, it is prayed to dismiss the complaint.

    Both parties have filed their affidavits. Ex.A1 to A6 are marked on behalf of complainant. Ex.B1 to B5 are marked on behalf of opposite party.

    Now the points for determination are that

    1. Whether there is any deficiency of service on the part of opposite party in not settling the claim?

    2. Whether the complainant is entitled for the sum assured under the policy vide Ex.A2?

    3. To what relief?

    POINT No.1

    The facts are no way in dispute. The opposite party admits about having insurance policy under ICICI Life Time plan of insurance for a sum of Rs.1,00,000/- to the deceased Venkata Subba Rao who had nominated his wife, the complainant herein as beneficiary there under. According to the opposite party, after completion of formalities they have accepted proposal and issued policy on 29-03-05.


    As per the terms and conditions of the policy premium of Rs.20,000/- is payable on or before 24th March every year within the grace period provided. According to opposite party except the initial premium amount at the time of issuing policy subsequently yearly premiums for the years 2006 and 2007 are not paid. Therefore, by the date of death of deceased on 14-02-07, policy was said to be in lapsed condition, as such no benefits will arrive out of the same and the complainant is not entitled for any amount as claimed.

    In the aforesaid circumstances, the opposite party claims that absolutely there is no deficiency of service on their part. In this regard, they rely upon policy documents, which provides various terms and conditions of the policy vide Ex.B4, clause 4.1(i), which reads as follows:

    “Payment premiums:

    Premium are payable on the due dates and at the rate mentioned in the policy certificate. However, a grace period of not more than 30 days, where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace, the policy shall lapse and no benefit shall be payable. If a premium is not paid during the days of grace after three full years’ premium have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in clause 4.4. hereof”

    The above provisions makes it clear that premium amount is not paid within the grace period of 30 days, the policy shall lapse and no benefits shall be payable. It also makes it clear that after making three full years premium and subsequent premiums are not paid within grace period, the benefits payable under the policy shall be as indicated in clause 4.4 thereon. But this situation does not arise in this case as deceased did not pay the premium of the year 2006 and 2007. Of course, he died one month before the premium is due in the year 2007.


    But ultimately two years premium remains unpaid. As such, the policy lapsed and no benefits would accrue there under. The revival of policy as provided under general conditions does arise if the life assured is alive and on undertaking to pay premiums subject to other conditions provided there under. Thus we observe that absolutely there is no deficiency of service on the part of opposite party in repudiating the claim of complainant. They are justified in doing so as per the terms and conditions of the policy. The point is answered accordingly.
  • adv.sumitadv.sumit Senior Member
    edited October 2009
    N. Priyadarsanan
    ...........Appellant(s)

    Vs.

    Manager

    ICICI Home Finance Co. Limited
    ...........Respondent(s)





    ORDER





    The case of complainant is as follows. The complainant has availed a house loan from the respondent Bank having number LAN HTHR 000350053 by depositing the title deed of property. The loan was closed on 7.1.05 and the respondents given a letter with regard to this on 12.1.05. But till this time the respondents had not returned the title deed of the complainant’s property. The complainant approached the respondents at several times and now they stated that the title deed is misplaced. The complainant lost several chances to sell his property for a high rate due to the lack of title deed. The complainant sent a lawyer notice dated 16.5.05. But no remedy so far. Hence the complaint.


    2. The counter of first respondent is as follows: The company admits that the complainant had availed a housing loan by depositing the title deed and the complainant closed the loan and all the original prior deeds including land tax receipt etc. were immediately returned to the complainant. But the company admits that the company had not returned the original title deed relating to the mortgaged property.


    In this instant case, unlike other cases of availing loan by mortgaging immovable property the complainant had not actually produced the titled deed of the property to the company’s Branch Office at Thrissur in advance for processing the sanctioning of the loan. The procedure adopted by the company in this case is slightly different from other procedures normally adopted by the company in sanctioning the loan on immovable property in respect of which all the documents made available to the company in advance.


    In this case the title deed pertaining to the purchase of the property will be normally received from the Sub Registrar Office after 15-25 days. Of course, the first respondent herein had received the original title deed from the Sub Registrar Office and as usual the same was forwarded to the Storage Centre at Bombay to be kept along with the prior deeds of the property already dispatched immediately after registration. On closure of the loan the first respondent had received back the prior deeds from the storage centre and the same was immediately handed over to the complainant.


    At that time the title deed of the property was not available in the cover. The first respondent intimated the fact of non-receipt of the title deed to the storage centre and they are making all efforts to find out the misplaced title deed. The company will make all endeavour to obtain certified copy from the Sub Registry Office and is prepared to execute indemnity bonds in favour of the complainant and also issue requisite certificate stating the aforesaid facts to the complainant. There is no deficiency in service or willful latches on the part of the respondents. Hence dismiss.

    3. The 2nd respondent filed a statement adopting the counter of first respondent.

    4. The points for consideration are:
    (1) Is there any deficiency in service?
    (2) If so, reliefs and costs.

    5. The evidence consists of Exts. P1 to P3 and the testimonies of PW1 and RW1.


    6. Points-1 & 2: The complainant’s case is that he had availed a housing loan from the respondent company by mortgaging immovable property owned by the complainant by duly depositing the title deeds pertaining to the property in the first respondent branch at Thrissur. Subsequently the loan was closed by the complainant. But the company had not returned the original title deed relating to the mortgaged property. So the complaint is filed.

    7. The respondents in their counter clearly admitted that the complainant had deposited the title deed of the property in first respondent’s company and they forwarded it to the Storage Centre at Bombay to be kept. But on closure of loan they couldn’t hand over the title deed to the complainant, as they haven’t received it from their Storage Centre. Further they admitted that they are making all efforts to find out the misplaced title deed.

    8.Ext. R2 is a letter from respondents to petitioner shows that the case of complainant is admitted by them. In that letter they stated that the original sale deed is not available in the file maintained by them and they are in the process of retrieving the same. The Manager who is examined as RW1 deposed that they are unable to trace out the title deed. So the entire case of complainant is admitted by the respondents.


    The first prayer sought is the return of title deed. Since there is clear admission on the part of respondents regarding the non-availability of the document this prayer cannot be allowed. Definitely the complainant is entitled for reasonable compensation. He is examined before the Forum as PW1 and he stated that he was not able to sell the house in time. He also stated that he was not in a position to left the place. But the circumstances did not explain by him. During cross-examination he also stated that he has not entered into any agreement to sell the property. In the absence of such evidence the compensation cannot be extended to the extent claimed.

    9. In the result, complaint is allowed and the respondents are directed to pay Rs.1500/- (Rupees one thousand and five hundred only) towards the expenses for taking certified copy of the lost title deed from the Sub Registrar Office and publication in the leading newspaper. The respondents are further directed to pay Rs.10,000/- (Rupees ten thousand only) as compensation with cost Rs.1000/- (Rupees one thousand only) to the complainant within two months.
  • adv.singhadv.singh Senior Member
    edited January 2010
    Appeal no. FA-9/803



    (Appeal against the order dated 25.09.2009 passed by District Forum-(New Delhi ) in complaint case no.694/2009)

    M/s ICICI Prudential Life

    Insurance Company Limited

    1089 Appa Saheb Marthe Marg

    Prabhadevi, Mumbai-400025.
    Also at

    B-39, Ground and First Floor,

    Connaught Place,

    New Delhi.

    …..Appellant/OP
    VS

    Shri Manjeet Singh Bal,

    Saidulajaib Opp.

    D Block, Saket Main,

    M B Road, New Delhi-110030.

    ……Respondents/complainant.

    CORAM
    Justice Barkat Ali Zaidi, President.

    M.L. Sahni, Member

    1. Whether reporters of local newspaper be allowed to see the

    judgment?

    2. To be referred to the reporter or not?

    M.L. SAHNI, MEMBER

    1. This appeal has been filed by M/s ICICI Prudential Life Insurance Company Limited against the order of the District Consumer Disputes Redressal Forum, New Delhi, K.G. Marg, whereby the appellants have been ordered to pay Rs. 2 lacs to the complainant Shri Manjeet Singh Bal (hereinafter referred to as Respondent) and also to pay Rs. 50,000/- to him as compensation for mental agony and harassment with Rs. 10,000/- as cost of litigation within 30 days of the order dated 25.09.2009.

    2. The appeal was listed for admission today when the respondent also appeared with his counsel.

    3. After hearing the parties it was observed that the disputes between them can amicably be settled through the process of mediation. With their mutual consent, matter was referred to the Mediator, Ms. Shalini Upadhaya, who after due persuasions resolved the dispute between them on the following terms :-

    It is agreed between the parties (1) that appellant will pay a sum of Rs. 1,50,000/- to the respondent by D.D. within one month from today i.e. 9.12.2009.



    (2) that this payment would be in full and final settlement against policy no. 02641565 which is in the name of the respondent. After this payment, the respondent would have no claim what so ever with regard to the policy in question and the policy would be closed thereafter.

    (3) that the appellant as well as respondent shall appear before the Commission to make appropriate statements in view of the present settlement and respondent shall withdraw the execution filed by him before the District Consumer Forum.



    (4) that the respondent shall have no objection in case the amount deposited by the appellant while filing the present appeal in statutory compliance, is refunded to the appellant and the appellant shall be at the liberty to get it refunded after completing the formalities.



    4. Parties appeared and affirmed that they have agreed to the terms stated above and shall abide by the same.

    5. Since the parties have come to terms and settled the dispute amicably, there is nothing left to be adjudicated by this Commission. The appeal stands disposed off accordingly in the terms agreed between the parties as noted above. File be consigned to record room.
  • edited March 2010
    Dear Sirs

    I, Rajesh Sadanandan, have purchased policy no. 00163142 (smart kid) from ICICI Prudential dated 12-07-2002 in my son's name and paid the premium till April 2006. The premium was paid thru electronic clearing from my A/C in ICICI bank savings A/C. The bank has stopped debiting my A/C in April 2006 while I was staitioned in UAE due to the reasons best known to them.

    Now i am back in India and wanted to close this policy and take my money paid back. Unfortunately the company said i can get back 15 to 20% of the paid value and informed me i have signed the form in which this condition is mentioned. When i enquired more about this condition, they told me that this is one of the conditon printed on the back side of the leaflet in very small font size. I feel cheated hearing this kind of language from ICICI Prudential and want the justice to be done.

    I request your goodself to please help me out of this situation.

    Thanks and best regards

    Rajesh S
    9716975053 begin_of_the_skype_highlighting              9716975053      end_of_the_skype_highlighting
  • edited January 2014
    POlicy # 17438470

    I recently got a call from your representative asking for registration of ECS for premium payment. I was little surprised as to what premium payment was the person talking about.
    On clarification, I was told that my policy is a five year premium policy i.e. I have to pay the premium every year.

    This was completely shocking. I had signed up for the policy as a one-time premium payment of Rs. 10 Lakhs which was paid in Feb 2013 year.

    Moreover, when signing up for the policy I was never told about the charges. The fund value has gone nowhere in past 11 months but declined badly while everything in the market has moved up.
    Even though I reallocated my funds to a more safer zone (debts, fixed income) nothing seems to be moving at all.

    The amount that I entrusted with you is not a small amount and I am also surprised that none of your executive has ever cared in the past 10 months to even call me or see how my investment is doing and finally I am called for ECS registration ???

    I am afraid to say that I need my money back.
    This is completely not acceptable from bank like yours.

    I have been harassed like anything by your lifeline support people. They have been claiming that they will send emails but never got one. It has been such a night mare dealing with ICICI. I have recommended at least 500 people in my firm here that they should never deal with ICICI and move to another professional bank.
  • edited June 2014
    I am raising this complaint on behave of my father, he started a health policy (premium amount 25,000 and minimum number of premium payments:5 ) on 2009, based on the information provided by local policy agent. It was said by the agent that, the partial surrender and complete surrender are applicable for this policy. Complete surrender after five years will give the premium holder, full amount with 9% interest.
    We got the policy agreements only after the initial premium payment, and it is saying partial surrender and complete surrender are NOT applicable for this policy.
    My father is from a very rural village in Wayanad, Kerala, and is not able to understand the terms and conditions written over there in the agreement. So, now after completion of five years, when my father asked for full surrender, the agent saying company changed its policy, and he is no more part of the company, so don't ask.
    When I go through the document, I felt like we were cheated by the Agent.

    But, when we made an inquiry in our local area, we came to know that, It is not a single agent who made this, lot of village people (traditional farmers, who are not able to clearly go through the agreements written in English), are cheated like this by different agents of this same company. So, it was clearly a marketing strategy of the company in short [Which I don't believe a professional one]. And the surprising thing is, the agents are improved financially well in these five years and are no more part of the company now.

    So, It is a clear case of conspiracy between the agent (may be a short term contract), and lot of village people are cheated. There are even people who deposited money (which they saved by working on farms, competing with hard day sun) in these policies (by hearing about the good benefit/profit margins) for needs like, daughter's marriage, building a house etc.. Now they cannot approach anyone against these cheating case because of below factors:

    1. They got one of the biggest company in India to complaint against (because there is no paper contract between that person and agent)
    2. Policy agreements will not support in the complaints (they knew about the cheating in agreements, only now)
    3. Psychological part- People will laugh by saying "you lost, as you looked for over profits". [But I believe even Ambani will deposit money, if he feel it is the area where he can get more profit, its only human nature.]

    While raising this complaint, I am sure that, any of the paper documents will not support us, but there will be 100 such examples in my village as victims (and I am sure witness's words will be considered as proof). Also I believe, the size of opposite side, doesn't matter while fighting for justice.

    If I have raised this, in a wrong place, please anyone direct me to the right process/place to raise this complaint. Many thanks.
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