Delhi

East Delhi

CC/248/2014

MAMTA - Complainant(s)

Versus

ICICI LIFE INS. - Opp.Party(s)

12 Mar 2014

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, SAINI ENCLAVE: DELHI-92

 

CC. NO-248/14

In the matter of:

Smt. Mamta Sirohi,

W/o Late Lt. Col. Dr. Satender Singh Sirohi

S.I.-50, Shastri Nagar, Ghaziabad-201002

Uttar Pradesh           

          Complainant

Vs

ICICI Prudential Life Insurance Co. Ltd.,

Having it s Registered Office at

Videocon Tower, Block E-1,

Rani Jhansi Marg,

Jhandewalan Extension, Delhi

                                                                                                                    Opposite Party

                                                                                             DATE OF ADMISSION-12/03/2014

                                                                                        DATE OF ORDER         -29/10/2015

ORDER

SH. N.A.ZAIDI, PRESIDENT:

The complaint has been filed by the complainant Smt. Mamta Sirohi who is the wife of Late Lt. Col. Doctor Satender Singh Sirohi. The deceased husband of the complainant was employed as a Doctor with the Indian Army and visited at Mhow, Distt. Indore, (M.P.) at the time of his death, where he remained posted as Recruiting Medical officer during the period from 1997-1999. He visited Mhow and stayed at a guest house where on 09/02/2012 he died all of a sudden without any symptoms of illness. He was a healthy, hale and hearty person. But, because of unnatural death the matter was reported to local police and the authorities got conducted the Panchnama & Postmortem. At the time of his death, he was holding two life insurance policies issued by the respondent company bearing No.16162771 & 16165216 for Rs.10,00,000/- & Rs.7,35,000/- respectively, in which the complainant was named as Nominee.  The matter was reported to the insurance company and the claim with regard to the policies was filed on 11/04/2012. The respondent asked the complainant to file certain documents which were duly submitted.  The respondent company was taking unduly long period to settle the claim and on 08/05/2012 it was reported that the claim is being processed vide communication dated 31/08/2012.  The claim was repudiated on flimsy and untenable grounds with malafide intention to cause harassment to the complainant.  The letter was sent at wrong address having no concern whatsoever with the complainant.  Even the mobile number quoted was wrong. When she learnt about the rejection, she sent representation dated 15/10/2012.  Finally the respondent company offered to make nominal ex-gratia payment while maintaining the correctness of their earlier repudiation.  There was no concealment of the fact by the policy holder. The husband of the complainant was invalidated from his job in the Army during the year 2006 on medical grounds recording “S5 H1 A1 P2 E1”. Complainant was ignorant regarding the ground on which the husband was removed from the services.  She moved an application under the The Right to Information Act.  The deceased husband had no cardiac history although he suffered with constitutional/metabolic/ineffective disease operative procedures but he was well stabilized. He was unfit from his military services on account of physiological personality which is quite normal as the deceased husband stayed away from his family since long time. There was no misrepresentation or mis-concealment on the part of the deceased husband of the complainant. The insurance company goes for routine medical checkup before issuing Insurance-policy and the same must have been conducted in the instant matter. If it is not conducted the respondent company is liable for its own wrong. After the death of the husband of the complainant they cannot take the advantage of any such ground. The ex-gratia payment offered by the respondent was with dishonest gesture to cheat the innocent widow. The complainant has prayed for awarding the sum of Rs,17,35,000/-,  being the total sum insured under the policies with interest, Rs.2,00,000/- as compensation and cost, etc.

            The respondent filed their reply wherein the plea of concealment of fact by the deceased has been taken. The complainant has wrongly approached this forum knowing fully well that material facts have been suppressed. There is no deficiency in service and the complaint deserves to be dismissed u/s 26 of the Consumer Protection Act. The insurance is a contract between the insurer and the insured and both the parties are bound by the terms of the policy.  Dr. Satinder Singh Sirohi applied for four policies in the month of January 2011- January 2012 under the Policy Plan “ICICI Pru Pinnacle Super- LP”. In all these policies he filled up the armed forces questionnaire in which he stated that he retired recently when he was relieved from his duties in 2006. He signed the declaration wrongly. The complainant presented the Death Claim Intimation Form on 07/04/2012 stating that life insured had died on 09/02/2012 due to heart attack and requested to release the claim amount. The claim was investigated; life assured had died within 16 days from the issuance of last policy which was issued on 12/01/2012. The life assured was invalidated from the Indian Army in the year 2006 on the grounds of S5H1A1P2E1. This S5H1A1P2E1 is the code used by the Indian Army to categorize different medical conditions. This particular code pertains to Bipolar Affective Disorder which requires treatment with heavy Anti-psychiatric drugs.  This was concealed by the deceased. The other facts regarding the issuance of the policy, of making ex-gratia payment have also been pleaded and rest all the allegations in complaint have been denied.

            Complainant filed the Rejoinder wherein the complainant refuted all the allegations of the respondent and have pleaded that the deceased had taken four policies on 25/11/2011, 28/11/2011, 30/11/2011 and 12/01/2012 but surprisingly the date mentioned in all the four declaration letters is 28/11/2011 which creates prima facie suspicion on the averments of the respondent.  No concealment made on the part of Life Assured. They have also pleaded that no Armed Forces Questionnaire was given to the Life Assured to fill up and the said Questionnaire has been prepared by the respondent to cover up their wrongs. The deceased was leading absolutely happy normal life. The reply of respondent is based on false and fabricated documents.

Affidavit filed by both the parties during the course of proceedings. An Application for production of original proposal forms and questionnaire signed by the deceased was made by the complainant. Objections were filed by the respondent. Application was allowed, and two original proposal forms were filed on record.

            Both the parties have filed their written submission. The respondent has also filed an application objecting the filing on record of additional documents by the complainant with her written submission. This is an admitted fact that on the date of death Dr. Satindra Singh Sirohi was duly insured by the policies in question.  On that date his age as mentioned in the policy documents was 45 years. He died 09/02/2012 at Mhow, Indore, Madhya Pradesh.  An FIR was lodged & a Medico-Legal case was registered. He was examined at Military Hospital where he was declared dead and his postmortem was conducted. As per the Post-Mortem Report, the cause of death was Cardiac Arrest.  The question that arises for consideration is as to whether the deceased ever made any wrong declaration for the purpose of getting his life assured from the respondent. The complainant in Rejoinder has noted in Para-1 that her husband had taken four policies on 25/11/2011, 28/11/2011, 30/11/2011 and 12/01/2012 and in all the four declarations letters the date mentioned is 28/11/2011. We have carefully examined the proposal forms filed by the respondent, in one of the forms the date is 28/11/2011 & in other form it is 30/11/2011. The signature of the deceased on the two forms and the date are in different inks. The date is noted with a different pen & ink. The respondent has not filed on record the proposal forms with regard to policies issued on 25/11/2011 & 12/01/2012. Complainant has moved an application for summoning these documents.  The application was allowed and the respondent was asked to file on record original proposal forms. Withholding these two forms create serious doubt in the case of the respondent when there is a clear assertion of the complainant that the signature on these proposal forms are forged and have not been appended by the deceased Mr. Satyendra Singh Sirohi.  In such case, adverse influence has to be drawn against the respondent that those proposal forms were not signed by the deceased. Hand-writing and Fingerprint Expert Report which the complainant has filed on record along with arguments opined that the signatures on all these proposal forms were not that of Dr. Sirohi. The burden lies upon the respondent to prove this fact that the signatures on these forms were actually appended by the deceased. There is no affidavit filed from the side of the respondent of the official, Mr. Vishal Gupta, who is responsible for getting the deceased insured. He was the best person in this regard that the signature on all these proposal forms was put in his presence by the deceased. In these circumstances this cannot be accepted that the signatures on all these proposal forms were put by the deceased Dr. Satyendra Singh Sirohi. These forms were not filled by Dr. Sirohi, there is no explanation, why he was not allowed to fill these forms, when he could have very well filled them.

            The respondent has taken the plea that the complainant husband has wrongly stated this fact that he retired recently from the Armed Forces Service. In the application form No.44369080 there is no such mention, contrary to it the total years in service has been recorded as twenty therein with a blue pen when rest of the form has been filed in the black pen. In Armed and Pilot Questionnaire, it has been noted in Column No.23 where he was required to state the current postings it has been noted by the person who filled this form “retired just now”.  It is an admitted case of the complainant that her husband retired in 2006. Had this form been filled by the deceased there was no question as to why he will not mention the date of his retirement or date when he was relieved from the Armed Forces. In any case, it cannot be the reason which could invalidate the policy which was sold by the respondent to the complainant. This is a fact that he was a retired Colonel Doctor in the Army on the date when he purchased these policies. As such, the repudiation on this ground cannot be said to be legal and valid and it does not involve any violation of the condition of the policy.

            The second question which arises for our consideration is as to whether the deceased has concealed the factum of any disease from which he was suffering from on the date of purchasing the policies. In the Questionnaire there is “no” ailment of the illness in the proposal form. In Para 5 Psychiatric Ailments is noted to which reply is in negative. The respondent has taken the plea that he was relieved from the Armed Forces on the ground that Dr. Sirohi was suffering from S5H1A1P2E1 which pertains to Bipolar Affective Disorder, the complainant has vehemently denied this fact.  The respondent has not filed any document on record which could show that this code is for psychiatric ailment. In the absence of any such proof that this code is for psychiatric ailment this cannot be accepted that the reason of his discharge from the Armed Forces was Bipolar Affective Disorder. It has been argued by the Ld. Counsel for the complainant that on the date of the insurance the deceased had completed 45 years and it was obligatory on the part of the respondent to have him medically examined and should have conducted medical tests before issuance of the policy.  If they erred in their obligation to get him medically examined then they cannot take advantage of their own wrong. Further, it has been argued that the cause of death of the deceased was not connected with the Bipolar Affective Disorder. It is clear from the Autopsy (post-mortem) Report that cause of death is “Cardiac Arrest”. He died a sudden death due to heart failure. In these circumstances, the rejection of the claim is totally illegal when the death is not connected with Bipolar Affective Disorder.  Further, the plea of respondent falls flat from their own admission by allowing the deceased exgratia payment, If the claim was not payable then how the respondent could justify their offer to the complainant to accept the payment on the recommendation of the Grievance Redressal Committee. The above facts clearly establish that the rejection of the claim of the complainant is wholly illegal and it has been denied with the sole objective of not making the payment with ulterior motive and indulgence in unfair trade practice.

On the basis of the above discussion, we are of the view that the complainant is entitled for all the benefits under the policy in question along with the interest @ 9% from the date of filing of the petition till the amount is paid.

            We direct the respondent to pay to the complainant a total sum of Rs.17,35,000/-, the sum assured under the policy in question, together with interest @ 9% p.a. thereon from the date of filing this complaint till it is finally paid.

             The complainant, the widow of the deceased Doctor from Army, has been made to suffer on account of wrong full and unjustified rejection of her bona fide claim under the policies purchased by her deceased husband, causing her mental, physical and financial strain. Had the respondent company officers considered the claim of the complainant with positive set of mind the claim may not have been rejected.  They have rejected the claim with a malafide intention not to pay the claim. We allow to the complainant compensation of Rs.1,00,000/- on account of mental pain, agony and suffering which shall also include the cost of litigation. She will be entitled for interest @ 9% p.a. from the date of this order till it is finally paid if this amount of compensation is not paid within 45 days from this date of order.

The copy of the order be sent to the parties as per rules.

 

POONAM MALHOTRA                                                                                               N.A.ZAIDI

          MEMBER                                                                                                           PRESIDENT