Delhi

East Delhi

CC/1149/2014

KUSUM JAIN - Complainant(s)

Versus

ICICI PRUDATIAL LIFE INS - Opp.Party(s)

23 Oct 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. NO. 1149/14

 

Ms. Kusum Jain

W/o Shri Jai Kumar Jain

R/o A-51, 2^nd Floor

Anand Vihar, Delhi – 110 092                                                  ….Complainant

 

Vs.     

 

ICICI Prudential Life Ins. Co. Ltd.

Plot No. 5, 2^nd Floor,

Karkardooma Community Centre

O.D. Parmesh Complex

Karkardooma, Delhi – 110 092                                                     ….Opponent

 

Date of Institution: 18.12.2014

Judgement Reserved on: 23.10.2018

Judgement Passed on: 30.10.2018

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By: Harpreet Kaur Charya (Member)

 

JUDGEMENT

            This complaint has been filed by Ms. Kusum Jain, against ICICI Prudential Life Insurance Company Limited (OP) under Section 12, of the Consumer Protection Act, 1986 with allegations of unfair trade practice and deficiency in service. 

2.         The facts in brief are that on 10.11.2009 after doing necessary health check up, as required by OP, the complainant was issued a Health Saver Insurance policy bearing no. 12686106, which was valid till 2029.  The complainant started paying monthly premium of Rs. 1,500/- regularly i.e. Rs. 18,000/- per year. 

            In March, 2013, respondent foreclosed the policy of the complainant and was informed that to continue with the same policy, she had to increase the premium from Rs. 18,000/- to Rs. 38,000/-.  Having no other option, the complainant agreed for the same and started paying monthly premium of Rs. 3,166/-.

            Again on 29.04.2014, the complainant received a letter from OP stating that the said policy again foreclosed and to revive the same, the complainant had to pay a revised annual premium of Rs. 38,000/-.  As the complainant was in the process of paying the premium of Rs. 38,000/- as yearly premium, she visited the office of OP, but did not get any satisfactory reply.

            Legal notice dated 16.09.2014 and detailed letter dated 06.11.2014 were sent by the complainant, but nothing happened. 

            It was stated that the policy stood suspended from 29.03.2014 and the premium was paid up to date till 29.03.2014.  OP assured the complainant that they will restore the policy after medical tests for their record.  The medical tests were done, but the policy remained un-restored.

            It had been further stated that the cancellation of policy by OP had left her uninsured against any medical expenses which might have arise in future.

            It was stated that by not restoring the policy of the complainant, there was deficiency in service on the part of OP.  Hence, the complainant has prayed for directions to OP to restore and continue policy no. 12686106 on the basis of original premium of Rs. 18,000/- per year; to pay Rs. 5,00,000/- as compensation on account of mental agony, pain and suffering and      Rs. 15,000/- towards cost of litigation.

            The complainant has annexed copy of policy no. 12686106, letter dated 16.11.2014 to the Insurance Ombudsman, letter dated 06.11.2014, email dated 21.10.2014, legal notice dated 16.09.2014 alongwith postal receipt and email dated 15.10.2014 alongwith complaint.     

 3.        In reply filed on behalf of ICICI Prudential Life Insurance Company Limited, they have taken various pleas such as the complaint was time barred as the cause of action arose in 2012 and the complaint has been filed in 2015; as per letter dated 31.10.2014 option of Freelook period was not exercised; OP company was willing to refund his entire premium amount alongwith interest @ 6% p.a. which the complainant had not accepted and the policy was foreclosed as per Clause 26 of the policy terms and conditions as mentioned below:

26. Foreclosure of the Policy:

If premiums have been paid for three full policy years and after three policy years have elapsed since inception, notice will  be given to the policyholder well before the total Fund Value reaches 110% of one full year’s premium.  Thereafter if the Fund Value reaches or falls below 110% of one full years’ premium the Policy will be foreclosed.  The foreclosure Fund Value (Fund Value as on the foreclosure date based on that day’s NAV) can be claimed within the next five years as Health Savings benefit subject to a maximum limit of 50% of the foreclosed Fund Value.

            It was stated that the foreclosure was done as the policy was not sustainable due to the reason that the fund value of the policy had fallen below 110% of one full year premium, the policy was first foreclosed on 24.04.2012 and the premium was revised to Rs. 3,167/- on 10.11.2012 as per the request of the complainant to sustain the 110% benchmark.  As a goodwill gesture, OP vide its reply dated 31.10.2014 had offered to return the total premium amount paid by the complainant alongwith 6% interest per annum  and OP was still willing to refund as offered on their reply dated 31.10.2014. 

            It was also stated that the complainant had paid lump sum premium of 7 months in August 2014, but the same was reversed due to the reason that the credit card transaction was declined. 

            It was further stated that the policy taken by the complainant was a ULIP policy which was directly related to market fluctuation.  Due to higher age of the complainant and market fluctuation, the fund value was insufficient to keep the policy active.  Thus, they had provided the services as and when required.  Hence, no deficiency in services could be attributed to them.  Other facts have also been denied. 

            OP has annexed copy of proposal form as Annexure-1, terms and conditions of the policy as Annexure-2, copy of reply dated 31.10.2014 as Annexure-3 and reply of legal notice dated 31.10.2014 as Annexure-4 alongwith written statement.

4.         Rejoinder to the WS of OP was filed by the complainant where the contents of the WS have been denied and reaffirmed the averments of her complaint. 

5.         In support of its case, the complainant has examined herself.  She has deposed on affidavit.  She has narrated the facts which have been stated in the complaint.

            OP did not file any evidence.

6.         We have heard Ld. Counsel for the parties and have perused the material placed on record.  The dispute pertains to the cancellation of policy issued by OP.  The OP has stated that as per Clause 26, in case fund value reaches or falls below 110% of one full year’s premium, the policy will be foreclosed. 

            If a look is made to the policy certificate which mentions the cover cessation date as 10.11.2029, thus it is clear that the complainant was to enjoy the cover from 2009 to 2029, but the OP cancelled his policy taking plea of Clause 26.  In support of their contention, OP has placed nothing on record such as NAV calculation and fund value calculation to show that the fund value has reached less than 110%.  The complainant has been rendered hapless all of a sudden by cancellation of the policy despite the fact that the cover was still 2029.

            Hence, we direct OP to refund the total amount of premium paid by the complainant which they have stated in their written statement to be    Rs. 1,30,008/-  alongwith 9% interest per annum from the date of issuance of policy i.e. 10.11.2009 till realization.  We also award compensation of      Rs. 20,000/- for mental agony and harassment due to the reason discussed above and the cancellation of policy has left the complainant uninsured against the medical expenses.  This compensation includes litigation expenses also.  This order be complied within a period of 30 days from the date of receipt of order. 

            Copy of the order be supplied to the parties as per rules.

            File be consigned to Record Room.

 

(DR. P.N. TIWARI)                                              (HARPREET KAUR CHARYA)

       Member                                                                             Member    

 

            (SUKHDEV SINGH)

        President