BEFORE THE DISTRICT CONSUMER DISPUTES REDFESSAL FORUM, SANGLI
CONSUMER COMPLAINT NO. 31/13
Smt. Prabhavati Sudhakar Kambale ……. COMPLAINANT
Versus
1. ICICI Bank Ltd.
etc.2 ……. RESPONDENT
ORDER BELOW EXH. 1
(Delivered by Hon’ble Mr. A.V. Deshpande, President)
1. Heard Adv. Sh. Madhale for the complainant on the point of admission.
2. The facts in nutshell are that the deceased husband of the complainant No.1 and the father of the complainant No.2 & 3 had obtained a housing loan on 20/9/06 and in terms of the loan agreement, the deceased had obtained an insurance policy from the Resp.No.2, on his life. The policy period was from 20/9/06 to 19/9/11. The husband of the complainant No.1 died on 17/4/12 and as per medical certificate issued by one Dr. Naim Shaikh, a consulting Cardiologist and Physician, the cause of death was “resistant pulmonary Kochs.” This is commonly known as “tuberculosis.” Dr.Naim has in his certificate certified that the deceased had no past history of hyper tension EHTN/ I.H.D./CRF/Cancer/COPD/CVA. The complainant appears to have submitted a claim for the death of the deceased and the same was repudiated on the ground that the cause of death is not covered by the list of diseases mentioned in the policy documents. The perusal of the policy would reveal (1) the list of major medical illnesses and (2) procedures which are covered by the said insurance policy. They are - cancer, end stage renal failure, multiple sclerosis and (3) undergoing following surgical procedures – Major organ transplant, heart valve replacement or coronary artery bypass graft. The death of deceased was also not due to any stroke, paralysis or myocardial infarction, which are covered in clause C under the head of occurrences of the medical events due to which the death occurs. The disease of tuberculosis or resistant pulmonary Kochs, as certified by Dr. Naim Shaikh does not fall into any of these categories or diseases covered by the said insurance policy. As has been pointed out above, the said policy period was from 20/9/06 to 19/9/11 and the death of the deceased took place on 17/4/2010, on which day, the said policy was not subsisting. Although the deceased appears to have taken an extension for the repayment of the said housing loan, there is nothing on record to show that the said policy covered the extended period. The learned counsel for the complainant, Mr. Madhale has tried to contend that in the repudiation letter, the insurance company has not mentioned that, on the date of death, the said insurance policy was not subsisting and therefore, it cannot be held that on the date of death of deceased, the said policy was not existing and therefore, the life of the deceased was not covered. In the absence of any documents in that behalf, the said submission cannot be accepted.
3. It has been contended that the Forum has no power to dismiss the complaint at the admission stage and that the admission of the complaint is a rule. The Hon’ble Apex Court; in the case of Dr. V.N. Shrikhande Vs. Mrs. Anita Sera Fernandes reported in AIR 2011, Supreme Court, page 212, has held that the conjoint reading of sections 12, 18, 22 and 24, makes it clear that the consumer fora are not bound to admit each and every complaint and u/s 12(3), the District Forum is empowered to decide the issue of admissibility of the complaint. The District Forum can either allow the complaint to be proceeded with, which implies that the complaint is admitted or reject the same. The Apex Court has held that the similar power is vest with the State Commission u/s 18 and also u/s 22 of the said Act. It is held by The Apex Court that if the concerned Forum is prima-facie satisfied that the complainant is consumer as defined in Section 2(d) and there is a “defect” as defined in Section 2(f) in relation to any goods or there is “deficiency in service” as defined in Section 2(g) r/w Section 2(4) and the complaint has been filed within the prescribed period of limitation, then it can direct that the complaint may be proceeded with. On the other hand, the Apex Court says, further, if the concerned Forum is satisfied that the complaint does not disclose a grievance which can be redressed under the Act, it can reject the complaint at the threshold after recording the reasons for doing so.
4. Therefore, the power is vest in this Forum to dismiss the complaint at the threshold, if prima-facie the complaint does not disclose any grievance. As discussed in detail above, it appears prima-facie that as on the day of the death of the life assured, the concerned insurance policy was not in existence at all. There is no evidence to show that the said policy was continued after it elapsed on 19/9/11. Therefore, the insurance company could not have granted the claim of the complainant and it has, therefore, lawfully repudiated the said claim. As such, we do not find any deficiency in service as alleged by the complainant in the complaint. Therefore, the complaint does not disclose any cause of action and hence, it cannot be admitted and hence, it stands dismissed in limini.
SANGLI
Dated : 11/07/2013
( Varsha Shinde ) ( A.V. Deshpande )
Member President
