DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

U.T. CHANDIGARH

Surjit Singh s/o late Bhagwant Singh r/o K. No.57, Punjab Judges and Officer’s Enclave, Sector 77, Mohali, Punjab.

                                      ---Complainant.

Versus

1.                 ICICI Lombard Healthcare, ICICI Lombard General Insurance Company Limited, TGV Mansions, 5^th and 6^th Floor, Khairatabad, above ICICI Bank, Hyderabad-500004.

2.                 ICICI Lombard HealthCare, Branch Office, SCO 24-25, Sector 8, Madhya Marg, Chandigarh.

---Opposite Parties.

BEFORE:  SMT. MADHU MUTNEJA, PRESIDING MEMBER

                   SHRI JASWINDER SINGH SIDHU, MEMBER

Argued by:  Sh. Rakesh K. Kaundal, Counsel for the complainant

                        Sh. Sandeep Suri, Counsel for OP No.1

                        OP No.2 already exparte.

PER JASWINDER SINGH SIDHU, MEMBER

1.                           In brief, the case of the complainant is that on the representations made by the representatives of the opposite parties, his father obtained a medi-claim insurance policy by paying premium of Rs.8,328.21 for the period 22.3.2007 to 21.3.2011.  Subsequently policy dated 22.7.2007 was issued as per which a total sum of Rs.2,29,324/- was insured for major medical illness and procedure and personal accident.  During the course of the policy period, father of the complainant suffered from heart ailment for which he was admitted in the hospital but he expired.  Thereafter, the complainant’s mother filed claim with the opposite party in response to which she was requested to provide the AML documents i.e. PAN Card, Voter I Card, driving licence etc. of the insured. The complainant’s mother submitted the required documents but still the claim was not considered on the ground that true information with regard to age of the insured at the time of filling the proposal form was not provided.  Thereafter an email dated 30.6.2011 was sent to the opposite parties requesting to correct the date of birth and settle the claim.  In the meantime the mother of the complainant also expired.  However, the claim was not settled despite service of legal notice.  Hence this complaint. 

2.                           In its written statement opposite party No.1 pleaded that the claim was rightly repudiated on the ground of providing incomplete and incorrect information.  It has been averred that the date of birth of the deceased insured, as mentioned in the proposal form, was 7.6.1958 whereas, as per the documents submitted at the time of lodging claim, the date of birth was 7.6.1935.  It has been pleaded that the policy was obtained by providing misleading information because had the correct date of birth been provided, the policy could not have been granted to the insured.  Pleading that there is no deficiency in service on its part, prayer for dismissal of the complaint has been made.

3.                           Notice sent for the service of opposite party No.2 was received back with the report of refusal.  Since refusal is good service and none appeared on its behalf on the date fixed, therefore, opposite party No.2 was proceeded against exparte. 

4.                           We have heard the learned counsel for the contesting parties and have gone through the documents on record.

5.                           It is settled law that while soliciting any insurance policy, proposer of the policy is required to fill up all the personal details or any other detail as required in the proposal document correctly.  In the present case the insured had subscribed a personal loan from ICICI Bank Ltd. and in order to secure this loan amount, as well as his health, he had purchased the said Safe Secure Mind Policy from the opposite parties by paying a premium of Rs.8,328/-.  The tenure of the policy was concurrent with the tenure of the loan period beginning 22.3.2007 upto 21.3.2011. The opposite parties while processing the claim of the complainant demanded the documents as were necessary for such a process and it was from the scrutiny of these documents that it came to their knowledge that the date of birth of the insured, mentioned in the proposal form, did not match with the date of birth, mentioned in the documents supplied after the filing of the claim. 

6.                           The opposite parties through their communication dated 22.6.2011 repudiated the claim of the complainant, clearly mentioning the fact that the date of birth, mentioned in the identity card, submitted by the complainant mentions the date of birth as 7.6.1935 whereas the date of birth, mentioned in the proposal form No.0670982 dated 10.3.2007, is quoted as 7.6.1958.  Therefore, according to the opposite parties, the act of mentioning wrong date of birth by the proposer is a breach of good faith.  Hence in these circumstances, the opposite parties have claimed that they are well within their right to deny the claim of the complainant. 

7.                           From the perusal of the documents of the opposite parties, the stand taken by them with regard to the mentioning of wrong date of birth, which otherwise also is not disputed by the complainant, is conclusively proved and there is no scope to believe the allegations of deficiency in service alleged by the complainant against them. 

8.                           In the light of these observations, we are of the view that the complainant has failed to make out a case of deficiency in service against the opposite parties.  Hence, the present complaint deserves to be dismissed and the same is hereby dismissed, leaving the parties to bear their own costs.

9.                           Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

24.7.2013.

 (MADHU MUTNEJA)

PRESIDING MEMBER

(JASWINDER SINGH SIDHU)

MEMBER