Chandigarh

StateCommission

A/97/2019

ICICI Prudential Life Insurance Company Limited - Complainant(s)

Versus

Atul Narang - Opp.Party(s)

Gaurav Bhardwaj, Karandeep Singh Cheema & Parmeet S Bhangu Adv.

29 May 2019

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

 

Appeal No.	:	97 of 2019
Date of Institution	:	17.05.2019
Date of Decision	:	29.05.2019

 

1.  ICICI Prudential Life Insurance Company Limited, Grievance Redressal Committee, Claims Cell, Ground Floor, Unit No.1-A & 2-A, Raheja Tipco Plaza, Rani Sati Marg, Malad (East), Mumbai – 400 097, through its Authorized Signatory.

2.  ICICI Prudential Life Insurance Company Limited, Regd. Office at ICICI Prulife Tower, 1089, Appasahib Marathe Marg, Prabha Devi, Mumbai – 400 025, through its Authorized Signatory.

3.  ICICI Prudential Life Insurance Company Limited, SCO No.134-135-136, Madhya Marg, Sector 8, Chandigarh – 160 017 through its Authorized Representative.

…..Appellants/Opposite Parties.

Versus

 

Atul Narang S/o Sh. Avinash Narang, resident of House No.2403, Sector 22-C, Chandigarh – 160 022.

...Respondent/Complainant.

 

Appeal under Section 15 of the Consumer Protection Act, 1986  against  order  dated  25.03.2019 passed by District   Consumer Disputes Redressal Forum-I, U.T. Chandigarh  in Consumer Complaint No.213 of 2018.

 

BEFORE: JUSTICE JASBIR SINGH (RETD.), PRESIDENT.

                MRS. PADMA PANDEY, MEMBER.

                MR. RAJESH K. ARYA, MEMBER.

 

Argued by:

 

Sh. Gaurav Bhardwaj, Advocate for the appellants/opposite parties.

 

PER  RAJESH  K.  ARYA, MEMBER

                In this appeal, the appellants/opposite parties have impugned order dated 25.03.2019 passed by District Consumer Disputes Redressal Forum-I, U.T., Chandigarh (in short ‘the Forum’) vide which, the complaint filed by the respondent/complainant was partly allowed by directing the appellants/opposite parties to make payment of Rs.2,91,288/- to the respondent/complainant being 75% of the claim amount of Rs.3,88,384/-. However, compensation for mental harassment/ stress and litigation expenses was declined by the Forum. Order was directed to be complied within 30 days from the date of receipt of its certified copy, failing which, the amount awarded was to attract interest @9% p.a. from the date of passing of the said order till realization.

2.             At the time of admission hearing on 21.05.2019, Counsel for the appellants/Opposite Parties argued that the medical claim of the respondent/complainant was rightly repudiated by the appellants/opposite parties as material information qua transient ischemic attack suffered 10 years back and also being in the habit of smoking and consumption of liquor for the last 13 years, was concealed and not disclosed by the respondent/complainant at the time of filling up the proposal form. It was next argued that the claim raised by the respondent/complainant for Acute Ischemic Stroke and Brain Stroke is directly related to transient ischemic attack suffered 10 years back. It was further argued that the Forum erred in not properly appreciating the documentary evidence produced by the appellants/opposite parties.  It was prayed that the impugned order be set aside and the complaint of the respondent/complainant be dismissed.

3.             After hearing the Counsel for the appellants/opposite parties, the impugned order and the documents on record, we are of considered opinion, it is not a fit case for admission and the appeal is liable to be out rightly dismissed.

4.             Qua the plea that the respondent/complainant is an occasional drinker etc., the Forum has rightly observed in its order that in the proposal form, the appellant/opposite parties had jotted down the answers of the respondent/complainant pertaining to consumption of tobacco, alcohol and narcotics, in the negative. The appellants/opposite parties miserably failed to bring on record any cogent and convincing evidence to prove the aforesaid allegation of occasional consumption of tobacco, alcohol or narcotics by the respondent/ complainant, which resulted in brain stroke as well as Transient Ischemic Attack 10 years back. There is no nexus between the two. Furthermore, it was also not established from the medical record produced before the Forum. As rightly held by the Forum, there was only a passing reference in the record of medical history of the respondent/complainant, his being habitual smoker and drinker for the past 13 years, which could not be said to be the cause of the disease. The Forum further rightly held in Para 7 of its order as under:-

“7.     There were terms and conditions which were referred in the reply but the fact remains that two premiums were charged and the OPs are making use of only those passing references of which history was narrated at the time of admission in the PGI.  Who had given such history to the attending doctor has not been explained?  What was the quantum of drinks taken daily or the quantity of cigarette smoking per day, so as to term the complainant as alcoholic or a chain smoker?  These facts have not been specified at all.  For example, if the complainant had given the reply that he once or twice had smoked a cigarette in his life till 35 years age or say had taken occasional drinks on special occasions that would not have formed the genesis to say that he has suffered the given diseases.  It is also not the case had such answers been given of occasionally taking drinks or smoking then the policy was not to be issued by the OPs…….” 

 

5.             The Forum in its order has cited PNB Metlife India Insurance Co. Ltd. Vs. Sunita Goyal, 2016 (3) CPR 672 (NC), wherein, under similar facts and circumstances, the Hon’ble National Consumer Disputes Redressal Commission, New Delhi directed the insurer to pay 75% of the insured amount to the complainants, without any interest on the said amount.

6.             Keeping in view the ratio of aforesaid judgment of Hon’ble National Commission, New Delhi, the Forum, in our considered opinion, rightly directed the appellants/opposite parties to pay payment of Rs.2,91,288/- to the respondent/complainant being 75% of the claim amount of Rs.3,88,384/-.

7.             No other point was argued by the Counsel for the appellants/opposite parties.

8.             For the reasons recorded above, the appeal being devoid of merit, must fail, and the same is dismissed in limine with no order as to costs. The impugned order dated 25.03.2019 passed by District Forum – I, U.T., Chandigarh is upheld.

9.             Certified copies of this order, be sent to the parties, free of charge.

10.           The file be consigned to Record Room, after completion

Pronounced.

29.05.2019.

[JUSTICE JASBIR SINGH (RETD.)]

PRESIDENT

 

 

(PADMA PANDEY)

        MEMBER

 

 

(RAJESH  K. ARYA)

MEMBER

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