Present (1) Nisha Nath Ojha,
District & Sessions Judge (Retd.) President
(2) Smt. Karishma Mandal,
Member
(3) Anil Kumar Singh
Member
Date of Order : 22.11.2018
Nisha Nath Ojha
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the opposite parties to pay Rs. 1,00,000/- as the 1st and 2nd premium of policy.
- To direct the opposite parties to pay interest of the amount deposited before the opposite parties Rs. 50,000/-.
- To direct the opposite parties to pay Rs. 1,50,000/- as compensation for physical, mental and financial loss.
- The facts of this case lies in a narrow compass which is as follows:-
The complainant has asserted that she has purchased a policy of ICICI prudential life insurance under the policy head of “life time super” in the year 2006. After fulfilling requisite criteria including medical test examination the opposite parties accepted Rs. 50,000/- as first premium and thereafter opposite party have sent the policy bond to the complainant. As per agreed terms the locking period of the policy was of three years. The complainant had also paid the amount of Rs. 50,000/- by way of second premium on 22.11.2007 through cheque which was encahsed by opposite parties. The complainant could not pay the third premium in November 2008 due to some financial crisis but after few months the complainant approached the branch manager of opposite parties for depositing the third premium so as to policy may continue and as per assurance of branch manager she deposited Rs. 50,000/- on 18.11.2009 by way of third premium through cheque no. 349699.
The further case of the complainant is that the aforesaid cheque bearing no. 349699 deposited by the complainant was encashed and the same was transferred in the account of opposite parties but after receiving the amount of third premium, the policy was not revived but despite assurance of the branch manager and repeated request of the complainant for receiving the insurance policy she was informed that only after health checkup by Trans Media Diagnosis Center situated near Panitanki, A.N. College, Patna the policy will be revived after accepting the aforesaid amount. Thereafter the complainant was examined by the doctor of opposite parties and after that the branch manager directed the complainant to make payment of Rs. 50,000/- as the fourth premium of the policy and on the aforesaid direction of branch manager she again deposited the amount of fourth premium of the policy on 07.12.2009 through cheque bearing no. 349700 which was accepted and encashed by the opposite parties on 11.12.2009.
The grievance of the complainant is that after depositing the third and fourth premium after medical checkup when the complainant met branch manager then she got information that her policy could not be revived on medical ground. After repeated request and even hot discussion the branch manager after some time handed over a letter dated 30.11.2009 to the complainant issued by ICICI prudential life insurance from which it transpires that due to medical report etc. the policy could not be revived. This letter has been annexed as annexure – 2. Thereafter the complainant on 29.12.2009 made an application to the branch manager requesting him to revive the policy with various request contained in annexure – 3. The complainant’s letter dated 29.12.2009 was replied by the opposite parties vide letter dated 02.01.2010 stating therein that amount of Rs. 1,00,000/- by way of third and fourth premium of the policy were withdrawn by the company due to system and server down and a letter was sent to the complainant dated 04.01.2010 contained in annexure – 4 series stating therein that due to history of Excertional Dysponea since last 15 years the company is unable to revive the policy.
The grievance of the complainant is that her policy was accepted after a detail health checkup by medical expert Dr. Birendra Prasad Sinha heart specialist, Balaji Heart Center, Boring Road, Patna and thereafter her two premium of Rs. 50,000/- of each was accepted and even after accepting the third premium she was forced to undergo medical examination she has further asserted that even after accepting the third and fourth premium her policy was not revived and opposite parties have returned the amount of Rs. 1,00,000/- through two cheque which was not withdrawn since the opposite parties without any reason stopped the payment of the cheque. Later on after some time the opposite parties again issued fresh cheque of Rs. 50,000/- which was encashed by the complainant. The complainant thereafter filed a case in the Court of learned C.J.M., Patna vide Complaint Case no. 3000 (c) 2010 in which the learned Magistrate has found prima facie case U/s 406, 120 (B) of IPC against which the opposite parties have filed Criminal Misc. no. 3533 of 2012 before the Hon’ble High Court, Patna.
On behalf of opposite party no. 1 to 4 written statement has been filed stating therein that the present complaint filed by the complainant is barred by limitation because the cause of action arose on 30.11.2009 the complainant would have filed this complaint till 29.11.2011. In Para – 4 of written statement the following facts have been asserted, “that for revival of policy, complainant was requested to furnish a duly filled health declaration form and on 22.11.2009 a fresh medical examination was conducted and based on the information provided during the medical examination and observation made by the medical examiner, it was found that the complainant was suffering from EXCEPTION DYSPNOEA since 15 years and the complainant underwent hysterectomy in June 2009(when the policy was lapsed).”
The complainant has filed a rejoinder stating therein that cause of action arose in the month of August 2013 when the opposite parties denied to revive the aforesaid policy and it was the last cause of action.
Heard, the learned counsel for the parties. We have carefully perused the complaint petition, written statement as well as rejoinder etc. filed by respective parties.
It goes without saying that initial proposal of admitting the insurance policy was accepted by the opposite parties after making verification of the relevant documents and after considering the confidential report of the agent as per regulation framed by IRDA. The policy bond has been issued after perusing the relevant documents as well as report of Dr. Birendra Prasad Sinha but after 4 years the complainant was also forced to undergo medical examination and even after accepting the third and fourth premium the policy was not revived to the utter surprise of the complainant.
We are of the opinion that opposite parties are bond as per the principle of estoppels. Once the complainant had been admitted to the insurance policy after proper verification, medical checkup then the opposite parties had committed blunder in not reviving the insurance policy even after accepting third and fourth premium on the ground of second medical report the copy of which was never furnished to the complainant.
In our opinion the opposite parties have not followed the procedure as prescribed under Section 50 of Insurance Act and as such the action of the opposite parties are totally contrary to the provision of Insurance Act.
Hence, we find and hold that in not reviving the policy after accepting third and fourth premium the opposite parties have committed deficiency on service for which all opposite parties are liable.
Hence, opposite parties are directed to pay Rs. 1,00,000/- ( Rs. One Lacs only) to the complainant within the period of two month from the date of receipt of this order or certified copy of this order failing which opposite parties will pay 10% interest on the above mentioned amount of Rs. 1,00,000/- ( Rs. One Lacs only) till its final payment.
Opposite parties are further directed to pay Rs. 2,00,000/- ( Rs. Two Lacs only) to the complainant by way of compensation and litigation cost within the period of two month.
Accordingly, this complaint stands allowed to the extent referred above.
Member Member(F) President
