Delhi

North

CC/25/2020

AMITA KUSHWAHA - Complainant(s)

Versus

ICICI LOMBARD GENERAL INSURANCE COMPANY LTD. - Opp.Party(s)

VIKAS KUMAR SHUKLA

01 Aug 2023

ORDER

District Consumer Disputes Redressal Commission-I (North District)

[Govt. of NCT of Delhi]

Ground Floor, Court Annexe -2 Building, Tis Hazari Court Complex, Delhi- 110054

CC NO.25/2020

In the matter of

Amita Kushwaha

W/o Late Virendra Kumar,

B-1/20, FF-3,

Ankur Vihar, Ghaziabad-201102                                                                               …                         Complainant

 

Versus

Director and Management Staff,

ICICI Lombard General Insurance Co. Ltd.

PA claims,

Claim No. BAF000480820

ICICI Bank Tower,

Plot No.12,

Financial District,

Nanakramgud, Gachibowli,

Hyderabad, Telangana-500032                                                                                  ...                        Opposite Party No.1

 

Branch Manager,

ICICI Bank, Kashmere Gate Branch,

Delhi                                                                                                                           …                        Opposite Party No.2

ORDER

01/08/2023
 

Ms.Harpreet Kaur Charya, Member

The present complaint has been filed by Smt. Anita Kushwaha, wife of late Shri. Virendra Kumar, against ICICI Lombard General Insurance Company Limited as OP-1, and Branch manager, ICICI Bank, Kashmiri gate as OP-2.

1. Facts necessary for the disposal of the present complaint are that, the deceased husband of the complainant was maintaining an account number 083101518507 with OP-2, for which a Coral Debit Card bearing number 5594690831000442was issued to the husband of the complainant.
2.  It has been stated by the complainant that one of the benefits was a personal accident Insurance cover of Rs.10,00,000/-. An amount of Rs.499/- was being deducted every month on account of premium towards the said policy. On 05/08/2018, the husband of the complainant passed away in an accident, leaving behind the complainant and a minor daughter.
3. A claim was filed with OP-1. It has been further stated by the complainant that she was informed as there was delay in intimation to OP-1, an amount of Rs.5,00,000/- shall be deducted from the sum insured of Rs. 10,00,000/-. Despite several requests, the claim of the complainant was not settled and thereafter, legal notice was issued to OPs demanding Rs.5,00,000/-. However, the same was neither replied nor complied with.
4. Hence, the present complaint with the prayer for directions to OPs to pay a claim/damage for a sum of Rs.5,00,000/- on account of mental pain and agony suffered by the complainant and Rs.50,000/- towards the litigation charges. The Complainant has also stated “It is further prayed that this Hon’ble court may kindly be pleased to direct the concerned doctors who treated the complainant and issue handicapped certificate to the complainant, so that the complainant shall meet the ends of justice.”(sic).
5. The complainant has annexed the copy of the legal notice dated 24/12/2019, copy of email dated 12/02/2020, copy of the Aadhar card of the complainant, copy of the coral card bearing number 5594690831000442, copy of statement of bank account, and copy of the catalogue of the coral card of ICICI Bank Unified Debit Card along with the complaint.
6.  Notice of the present complaint was served upon OP-1 and OP-2. Neither anyone appeared on behalf of OP-2, nor was any reply filed on their behalf, despite service. Hence, they were proceeded Ex-parte vide order dated 25/07/2022.
7. Written Statement was filed on behalf of OP-1, where they have taken several preliminary objections such as: the present complaint was misconceived, false, and frivolous, and same was liable to be dismissed; the complainant has suppressed the material facts.
8. It was admitted that the complainant's husband had the insurance cover of  Rs.10,00,000/-, which was subject to terms and conditions. It was submitted that the husband of the complainant met with an accident on 03/08/2018 and died on 05/08/2018. It has been further submitted by OP-1 that they were intimated on 07/12/2018, which is approximately after 125 days.
9. As per the terms and conditions of the policy, personal accident other than air accident, in case of delay of intimation of claim of more than 75 days and less than 105 days, the pay-out would be 75% of the payable sum insured. For delay of more than 105 days, the pay-out would be reduced to 50% of the payable sum insured. It was further submitted that the complainant had intimated claim after 105 days of the incident, therefore she was entitled for Rs.5,00,000/- only and the said amount has already been transferred in her account through NEFT transfer.
10. Rest of the contents of the complaint have been denied. Though, OP-1 in their Written Statement have stated that they have annexed the copy of the terms and conditions, NEFT transfer details and copy of the claim form as Annexure A1, A2 and A3,however, the same have not been filed along with the Written Statement.
11.  Rejoinder to the Written Statement of the OP-1 was filed on behalf of the complainant, where the contents of the complaint have been reiterated and those of the Written Statement have been denied. It has been submitted that the sum of Rs.10,00,000/- was payable subject to the terms and conditions, however there were no such conditions in the manual. 
12. Evidence by way of affidavit was filed by the parties. Complainant has reiterated the contents of the complaint and has got exhibited the evidence affidavit as Ex.CW1/1; copy of the Legal notice dated 24/12/2009 as Ex.CW1/A; Email dated 12/2/2020 as Ex.CW1/B; Copy of Aadhar card of complainant as Ex.CW1/C; copy of Coral credit card bearing no. 559469083000442 as Ex.CW-1/D; copy of Statement of Bank account as Ex.CW1/E; copy of Catalogue of Coral Card of ICICI Bank Unifare Debit Card as Ex.CW1/F and Ex.CW1/F1. The complainant has also deposed that no similar complaint has been filed by the Complainant in any other court of law.
13. OP-1 has got examined, Sh. Rohan Mishra, Manager Legal on their behalf. He has reaffirmed the contents of the Written Statement.
14. We have heard arguments on behalf Ld. Counsel for the complainant and Ld. Counsel for OP-1. We have also perused the material placed on record and written arguments filed by the parties. The factum of insurance cover of Rs.10,00,000/- is not in dispute. However, the complainant is aggrieved by the deduction of 50% of the insurance cover i.e. Rs.5,00,000/- from the total insured amount of Rs.10,00,000/-.
15.   As far as the relief “for direction to the concerned doctors who treated the complainant and issue handicapped certificate to the complainant” is concerned, this commission does not have powers to grant such relief and is not related to the facts of the complaint in hand.  It seems to be an error on part of the counsel due to the practice of cut, copy and paste.
16. OP-1, in their Written Statement has justified the deduction of 50% of claim on the ground of terms and conditions. The onus was on OP-1 to prove that the deduction of Rs.5,00,000/- was as per terms and conditions. However, no policy terms and conditions have been brought on record. OP-1 has not even placed on record the NEFT details and claim form. In the absence of policy terms and conditions, the OP-1 has failed to prove that their act was not arbitrary. Thus, the benefit of the same is to be given to the complainant. Therefore, we hold OP-1 by rejecting the claim of the Complainant has indulged in deficiency in services. As the claim was to be settled by OP-1 only, we find no deficiency in service on the part of OP-2.
17. Hence, we direct OP-1 to pay Rs.5,00,000/- which was arbitrarily deducted by them on account of policy terms and conditions. We further award a compensation of Rs.25,000/- on account of mental agony and harassment inclusive of litigation expenses.
18. The order be complied within 30 days from the receipt of this order, in case of non compliance, OP-1 shall be liable to pay an interest @9% on Rs.5,25,000/- from the date of order till realisation.
19. Office is directed to supply the copy of this order to the parties as per rules.  Order be also uploaded on the website.  Thereafter, file be consigned to the record room.

 

 

           (Harpreet Kaur Charya)                                                                                 (Ashwani Kumar Mehta)

                       Member                                                                                                               Member

 

(Divya Jyoti Jaipuriar)

President