Punjab

Ludhiana

CC/21/26

Natish Kathpal - Complainant(s)

Versus

ICICI Bank Ltd - Opp.Party(s)

sunil Sharma

08 Sep 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No: 26 dated 15.01.2021.                                                Date of decision: 08.09.2022.

Nitish Kathpal S/o. Late Sh. Vinod Kumar, R/o. H. No.722-C, Model Town Extension, Block-C, Ludhiana.

                                                                                      ..…Complainant 

1. ICICI Bank Lombard Insurance Company, Ludhiana, TF 1-5, 3^rd Floor, 88 Kunal Tower, The Mall Road, Ludhiana through its Manager.
2. ICICI Lombard General Insurance, IL Health Care, PA Claims, ICICI Bank Tower, Plot No.12, Financial District, Nanakramguda, Gachibowli, Hyderabad, Telangana-500032.
3. Indiabulls Housing Finance Ltd., SCO 16-17, Fortune Chambers, 1^st Floor, Feroze Gandhi Market, Ludhiana, through its Manager.                                                                                             …..Opposite parties 

Complaint under Section 35 of the Consumer Protection Act,      2019.

QUORUM:

SH. K.K. KAREER, PRESIDENT

SH. JASWINDER SINGH, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Sunil Sharma, Advocate.

For OP1                         :         Exparte.

For OP2                         :         Sh. G.S. Kalyan, Advocate.

For OP3                         :         Sh. Anand Sabherwal, Advocate.

 

ORDER

PER K.K. KAREER, PRESIDENT

 

1.                In brief, the case of the complainant is that in  the year 2018, the father of the complainant availed a loan of about Rs.75,00,000/- from OP3 against his property. At the time of taking the loan , OP3 got the father of the complainant insured from OP1 on payment of premium of Rs.91,916/-.The father of the complainant was assured that in case of his death, the loan would be secured and no payment has to be made by the family members of the father of the complainant.

2.                It is further alleged that the father of the complainant paid the installments of the loan to OP2 from 2018 to September 2019. Thereafter, on 22.11.2019, father of the complainant died. After his death, the employees of OP3 started demanding installments from the complainant and the mother of the complainant even paid Rs.1,98,600/- to OP3. The complainant lodged the claim with OP1 as per the policy terms and conditions. The complainant received a letter dated 09.03.2020 from OP2 to which reply was duly sent along with the documents but the claim was not reimbursed by OP1 and OP2. This amounts to deficiency of service on the part of the OPs. In the end, it has been requested that the OPs be directed to sanction the insurance claim in respect of the policy availed by the father of the complainant and further the OPs be made to pay Rs.50,000/- as compensation for harassment and Rs.33,000/- towards litigation expenses.

3.                Upon notice, OP1 appeared through counsel Sh. Alok Mohindra, Advocate but no written statement was filed on behalf of OP1 and exparte proceedings were initiated against OP1 on 28.10.2021.

4.                The complaint has been resisted by OP2 and OP3. In the written statement filed on behalf of the OP2 it has been, inter alia, pleaded that the complaint is not maintainable. According to OP2, on receipt of the claim intimation, the OP processed the claim and requested the complainant to supply the documents vide letters dated 05.02.2020 and 09.03.2020 which included claim form, death certificate, copy of FIR/MLC, copy of post mortem report, panchnama etc. The complainant, however, failed to submit the documents. Thereafter, the claim was rejected in view of the policy terms and conditions vide letter dated 12.06.2020 on the ground that as per the death summary of Dayanand Medical College and Hospital dated 22.11.2019, the insured Vinod Kumar died due to medical illness i.e. Cardio Pulmonary Arrest, CAD LV Dysfunction Post Liver Transplant CAD ACS. There was no evidence of any accidental injury suffered by the deceased and as such, the claim falls outside the purview of the policy terms and conditions. Thus, there has been no deficiency of service on the part of OP2. The other allegations made in the complaint have been denied as wrong and a prayer for dismissal of the complaint has also been made.

4.                In a separate written statement filed on behalf of OP3, it has been pleaded that the complaint is not maintainable as against OP3. According to OP3 it has been pleaded that no loan has been availed by the complainant or his father from the OP and, therefore, OP3 is incapable to provide any information or documents. Moreover, no loan document has been placed on record by the complainant which might show that the loan facility was availed from OP3. Besides, the complainant has also filed a civil suit in the court of Sh. Rajiv Kumar Gupta, Civil Judge (Junior Division), Ludhiana and in that case, it has been claimed that the loan was obtained from India Bulls Commercial Credit Pvt. Ltd. Thus, OP3 has been unnecessarily dragged into litigation in the present complaint. OP3 has also prayed for dismissal of the complaint.  

5.                In evidence, the complainant submitted his affidavit Ex. CA along with documents Ex. C1 to Ex. C9 and closed the evidence.

6.                On the other hand, the counsel for OP3 tendered affidavit Ex. RB of Sh. Sanjeev Kumar, Regional Legal Manager of OP3 along with document Ex.OP3/R1 and closed the evidence. OP2 did not formally tender any evidence. However, affidavit Ex. RA of Sh. Nishant Gera, Manager Legal of OP2 is on record.

7.                We have heard arguments advanced by the counsel for the parties and gone through the record.

8.                During the course of arguments, the counsel for the complainant has argued that the Ops have wrongly repudiated the death claim in respect of the policy of the father of the complainant. While in the policy documents, it was clearly provided that in the event of death of the life insured, OP2 would be liable to pay the outstanding loan amount of Rs.75,00,000/-. The counsel for the complainant has further pointed out that the claim along with the requisite documents have already been submitted with the OPs and, therefore, there is no dispute with regard to the fact that the policy holder Vinod Kumar died during the currency of the policy on 22.11.2019. The counsel for the complainant has further argued that the OPs be directed to reimburse the claim as per the terms of the policy.

9.                Per contra, the counsel for OP2 has argued that the claim has been rightly rejected as the insurance policy was admittedly a group accident policy which was availed by the father of the complainant and as per the policy terms and conditions, the claim would have been payable if Vinod Kumar had died resulting from an accident. The counsel for OP2 has further contended that the father of the complainant died a natural death and not from accident and, therefore, the natural death is not covered under the policy. In this regard, the counsel or OP2 has referred to the policy document Ex. C4 where under the column of benefit and extension table, it is clearly mentioned that only death and permanent disability resulting from the accident is covered under the policy. The counsel for OP2 further contended that the claim has been rightly repudiated.

10.              We have considered the above contentions raised by the counsel for the parties and have also gone through the record.

11.              In this case, the availment of the policy by the father of the complainant deceased Vinod Kumar is not disputed. The claim has been repudiated on the ground that natural death was not covered under the policy. In this regard, a reference can be made to the policy cover note Ex. C4 wherein it is clearly mentioned that the policy covered only the death resulting from accident or permanent total disablement resulting from accident. In the policy terms and conditions attached with the letter Ex. C5, the accident is defined as a sudden, unforeseen and involuntary event caused by external and visible and violent means. In the terms and conditions also, under the column of benefit covers, it is mentioned against the clause 2.1 that the policy covers death resulting from accident. Clause 2.2 states that the policy covers permanent total disablement resulting from the accident and clause 2.3 further states permanent partial disablement resulting from accident and clause 2.4 says that the policy covers temporary total disablement again resulting from the accident. Even otherwise, the very title of the policy is group personal accident policy which clearly means that the policy covers the death only if it has taken place due to accident. It has not been even disputed by the complainant that the death of Vinod Kumar did not take place by way of accident. In the reply Ex. C9 placed on record by the complainant, it is clearly mentioned that there was no serious trauma or injury and, therefore, no medico legal or FIR was done. It is further mentioned in Ex. C9 that Vinod Kumar was admitted in hospital on 22.11.2019 and hospital declared him dead on the same day. Post mortem report of Vinod Kumar was not done. The viscera report was also not obtained. This clearly shows that the death was not by way of accident. On the other hand, it has been clearly pleaded by OP2 that in the death summary of Dayanand Medical College and Hospital dated 22.11.2019, it was found to have been mentioned that Vinod Kumar had died due to medical illness such as Cardio Pulmonary Arrest, CAD LV Dysfunction Post Liver Transplant CAD ACS. Thus, it is evident that since Vinod Kumar died natural death due to illness and his death had not taken place by way of some accident, the same was not covered under the policy. Therefore, the repudiation of the claim cannot be said to be illegal or arbitrary.

12.              As a result of above discussion, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

13.              Due to rush of work and spread of COVID-19, the case could not be decided within statutory period.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:08.09.2022.

Gobind Ram.

Nitish Kathpal Vs ICICI Bank Limited                                     CC/21/26

Present:       Sh. Sunil Sharma, Advocate for the complainant.

                   OP1 exparte.

                   Sh. G.S. Kalyan Advocate for the OP2.

                   Sh. Anand Sabherwal, Advocate for OP3.

 

                   Arguments heard. Vide separate detailed order of today, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

 

                             (Jaswinder Singh)                            (K.K. Kareer)

                    Member                                           President

 

Announced in Open Commission.

Dated:08.09.2022.

Gobind Ram.