Chandigarh

DF-II

CC/87/2021

Mrs. Kanwalpreet Kaur - Complainant(s)

Versus

ICICI Prudential Life Insurance Co. Ltd. - Opp.Party(s)

Amandeep Singh adv

01 Sep 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	87/2021
Date of Institution	:	02.02.2021
Date of Decision	:	01.09.2023

 

                     

        

 

Mrs. Kanwalpreet Kaur W/o. Late Sh. Amandeep Singh Sra R/o. Flat No. 9 Tower A, 5th Floor, Sandwoods Opulencia, Sector 110, Banur- Landran Road, SAS Nagar Mohali, Punjab - 140307.

…..Complainant

Versus

 

1. ICICI Prudential Life Insurance Company Ltd. Having its Branch office at:- SCO 1-3, Above KFC, Sector 8-C, Madhya Marg,Chandigarh.

    Having its Registered Office at:- 1089, Appasaheb Marathe Marg, Prabhadevi, Mumbai-400025

 

2. IIFL House Finance Limited (Formerly Known As: India Infoline Housing Finance Ltd)

Having its Branch Office At:- SCO No 2907/08, 2nd Floor, Adjacent to Karnataka Bank, Sector-22/C, Chandigarh 160022

Having its Corporate Office At:-

Plot No. 98 Phase-VI, Udyog Vihar Gurgaon, Haryana-122015

….Opposite Parties

BEFORE:
	SHRI AMRINDER SINGH SIDHU,	PRESIDENT
	SHRI B.M.SHARMA	MEMBER
PRESENT:-
	Mr.Amandeep Singh, Counsel for complainant Mr.Gaurav Bhardwaj, Counsel for OP No.1 Mr.Sameer Mahajan, Adv. Proxy for Sh.Mohit Sareen, Counsel for OP No.2.

ORDER BY AMRINDER SINGH SIDHU, M.A.(Eng.),LLM,PRESIDENT

1.     The brief facts of the present complainant are that the complainant has filed the present complaint u/s 35 of the Consumer Protection Act, 2019 alleging gross deficiency in service on the part of the OPs pleading that OP No.1 in sheer disregard to the policy reports and inquest proceedings concluding that the husband of the Complainant (LA) died due to an accident, maliciously repudiated the Claim under the ICICI Prudential Group Loan Secure Policy No.23443596 arising due to the unfortunate demise of her husband.  The complainant pleaded that the Home Loan rendered by OP No.2 was completely secured through ICICI Prudential Group Loan Secure Policy No. 23443596, being a Master Policy issued by OP No.1 to OP No.2 and OP No.2 is liable to recover the loan amount from OP No.1. The complainant alleged that OP No.1 illegally rejected the claim of Rs.95,87,032/-  under the ICICI Prudential Group Loan Secure Policy No.23443596. The LA (husband of the complainant since deceased), availed a Housing Loan from OP No.2. vide Agreement No.844903 for purchasing a residential Property bearing No.Flat No. 40, Tower A, 20 Floor, Sandwoods Opulencia, Sector 110, SAS Nagar, Mohali. The Complainant was a co-applicant in the said home loan.  At the time of sanction of the Home Loan, OP No.2 pressed upon the LA to take an insurance policy from OP No.1 with the purpose of insuring the loan amount in the event of his death. The LA became the member of the "ICICI Pru Group Loan Secure Policy bearing no. 23443596" issued by OP No.1 to OP No.2. It is a Master Policy availed by OP No.2 from OP No.1 and only OP No.2 can introduce members to the same. The LA was allotted Member id No. 24833281 and the Policy Schedule dated 11.08.2018  was also issued  by OP No.1. The  total amount of Rs.1,66,951/- was paid to OP No.1 towards the Insurance Premium which was also financed by OP No.2. The LA being a Member in the Master Policy bearing No. 23443596 was eligible for a total Sum Assured of Rs.48,37,050/- in case of death or terminal illness and additional Accidental Death Benefit of Rs. 48,37,050/- in the first policy month. The complainant was nominee under the said policy. The insurance cover under the policy was valid from 09.08.2018 till 09.08.2033. On 06.06.2019, the LA unfortunately died due to accidental injury sustained by him in a sudden and accidental Fire from his licensed pistol near RKM water tank, Landara, Sahibzada, Ajit Nagar, Mohali, Punjab. The inquest proceedings under Section 174 of the Code of Criminal Procedure, 1973 were conducted. On the very same day, the post mortem was conducted at Civil Hospital Mohali and the Post Mortem Report was prepared under PMR No. PMR/MA/DHM/01/2019. Vide investigation report dated 29.08.2019 (Annexure C-6), the Investigating Officer Sub Inspector Prakash Masih concluded that the cause of the death of the LA was due to a sudden and accidental bullet fire from his licensed pistol which has hit him in his head and the said report was accepted by the Station Head Officer, Sohana on 30.08.2019 vide Reference No. 3706/5A/PS Sohana (Annexure C-7). Further vide report bearing No. 3888/SA/DSP dated 17.09.2019 (Annexure C-9) the concerned Deputy Superintendent of Police, SAS Nagar, Mohali accepted the Investigation Report. The said investigation report was verified and agreed upon by the Dy District Attorney, who certified the same vide Report No. 92 DDA (Legal) dated 25.09.2019(Annexure C-9). Thereafter vide Report No. 56 V.R.K dated 27.09.2019 (Annexure C-10), the concerned Senior Superintendent of Police Dist. S.AS Nagar submitted the death report of the husband of the Complainant to the Sub-Division Magistrate, Illaqua Mohali concluding that the husband of the Complainant died due to sudden and accidental fire from his pistol.  The SDM SAS Nagar, Mohali vide order dated 14.02.2020 (Annexure C-13) accepted the police inquest/investigation report filed under Section 174 of Cr.P.C.  The complainant submitted the claim with requisite documents with OP No.1 but the same was repudiated vide letter dated 04.06.2020 on the ground that the LA had died due to suicide. The complainant submitted the representation /complaint with the Grievance Cell of OP No.1 with a request to review the decision in the light of the totality of the facts established in the inquest proceedings under Section 174 Cr.P.c. and the order dated 14.02.2020 passed by the SDM, SAS Nagar (Mohali). However, the said request was also rejected by the Insurance Company. Alleging that the aforesaid acts of omission and commission on the part of the OPs amount to deficiency in service and unfair trade practice, the complainant has filed the instant complaint with a prayer to direct the Opposite Party No. 1 to discharge their obligation under the ICICI Prudential Group Loan Secure Policy No.23443596 by paying the sum insured amounting to Rs.95,87,032/- (Rupees Ninety Five Lacs Eighty Seven Thousand and Thirty Two Only), along with interest at the rate of 18% per annum since 01.03.2020 till the release of the payment as the Complainant has submitted all the necessary documents for the processing of the Insurance claim or alternatively direct the Opposite Party No 1 to release to the Opposite Party No. 2 an amount equivalent to the total balance outstanding principal loan amount from the abovementioned total claim amount towards the settlement of the Housing Loan Account No.844903 and Opposite Party No. 2 be directed to accept and adjust the said amount towards the full and final settlement of the Housing Loan Account No. 844903 and forthwith issue an acknowledgment/loan settlement letter to the Complainant and the balance claim amount be paid to the Complainant; further direct the Opposite Party No. 2 not to harass the Complainant through their officials, recovery agents or employees, through repeated phone calls and notices till the pendency of the present Complaint, along with compensation and litigation expenses.

 

2.     After service of notice, OP No.1 appeared before this Commission and while admitting the factual matrix of the case has stated that on receipt of the claim intimation form on 27.09.2019 wherein it was mentioned that the DLA had died on 06.06.2019 while sitting in his car.  Since the death of the DLA was within one year from the issuance of the policy, the same was investigated through an independent Investigator under clause 14(2) of the Insurance Regulatory and Development Authority of India (Protection of Policyholder's Interest) Regulations-2017 in order to verify the authenticity of the claim. During the investigation, it was confirmed that the Life Assured in fact committed Suicide. Based on the said findings, it was concluded that the Life Assured had committed suicide within one year. The Investigation undertaken by the Company has produced enough and more evidences to establish that the Life Assured had committed suicide and the death was  covered by the complainant and the father of the LA along with the authorities.  It has further been stated that the policy terms and conditions is in line with Clause 6 (d) of IRDA (Non-Linked Insurance Products) Regulations, 2013, wherein it is clearly listed that the Company shall accept the claim and pay only 80% of the total premium received in case of death of the life assured due to suicide within 1 year from the policy issuance. Hence, OP No. 1 Company had paid 80% of the premium amount as the member had committed suicide on the same date of the policy issuance. The said mandate is mentioned in Chapter III, Regulation 6(d) of the IRDAI Non Linked Regulations, 2013 as reproduced below:

    “In case of death due to suicide, within 12 months from the date of inception of the policy, the nominee of the policyholder shall be entitled to at least 80% of the premiums paid or from the date of revival of the policy, the nominee of the policyholder shall be entitled to a minimum of the surrender value / policy account value, as available on the date of death”.

         The remaining allegations have been denied, being false. Pleading that there is no deficiency in service on its part, a prayer for dismissal of the complaint has been made by the insurance company.

3.     After service of notice, OP No.2 appeared before this Commission and stated that the complainant, the complainant alongwith her husband, since deceased, Taj Tiles and one Taj Marbles made an application for availing the facility of the loan and also furnished their personal details and they were was made aware of the terms and conditions of the said loan and after carefully understanding the terms and conditions, signed the said declaration with his own free will and consent. The borrowers were sanctioned financial facility aggregating to Rs.54,12,434/- vide Prospect Number 844903 dated 31.07.2018 which was to be repaid in 240 monthly installments of Rs.48,004/- at floating rate of interest of 13.95% on monthly reducing basis with monthly rest. The borrowers for securing the loan amount, also mortgaged their property bearing Flat Number 40, Tower-A, 20th Floor, Sector 110, Sandwoods Opulencia, Mohali. It has further stated that they have no role to play as they have just forwarded the request of purchase of group insurance policy and the said group insurance policy was provided to the late Shri Aamandeep Singh Sra by OP No.1. The Insurance premium of Rs.1,66,952/- was paid by OP No.2 to Op No.1 at the instance of the deceased borrower and therefore, they have no role to play in either providing the Insurance Policy or to assess the Insurance claim of the deceased. It is the sole prerogative of OP No.1 to provide the Group Insurance Policy of the deceased and to assess the claim of the deceased, if any. The remaining allegations have been denied, being false. Pleading that there is no deficiency in service on its part, a prayer for dismissal of the complaint has been made by OP No.2.
4.     The complainant filed separate replications to the written replies of OPs No.1 & 2 controverting their stand and reiterated the contents of the complaint.
5.     The parties filed their respective affidavits and documents in support of their case.
6.     We have heard the Counsel for the contesting parties and have gone through the documents on record including written submissions.
7.     The main issue involved in the present complaint is that whether the OP No.1-Insurance Company repudiated the claim of the complainant wrongly and arbitrarily or not?
8.     In order to find out answer to the above mentioned issue, it is important to take into consideration the following facts and circumstances of the present complaint.
9.     Annexure C-21 is the letter dated 04.06.2020 wrote by the Insurance Company-OP No.1 to the complainant, which reads as under:-

“Dear Ms. Kaur,

We are sorry to hear about the demise of Mr. Amandeep Singh Sra. Please accept our condolences.

Mr. Amandeep Singh Sra (herewith referred as life assured) had taken housing loan from India Infoline Housing Finance Ltd for LAN no: 844903 against which a Group loan secure SP policy no. 24833281 was issued for base sum assured of Rs. 48,37,050/- and accidental death benefit rider of Rs. 48,37,050-on August 9, 2018.

We refer to the death claim intimation dated September 27, 2019 submitted to the Company informing demise of the life assured on June 6, 2019.

We wish to state that based on the documents received during claim intimation Lo. statement of Mr. Mewa Singh in daily diary report dated June 6, 2019, and newspaper article published in Tribune, it can be gathered that the death of the life assured was due to suicide.

We wish to draw you reference to Clause( If a Member, whether sane or insane, commits suicide within 12 months from the date of commencement of cover, higher of 80% of total premiums paid including underwriting extra premiums, if any bill the date of death or the surrender value available as on date of death, in respect of such a Member will be payable of the policy T&C stating that in case of a death due to suicide during the first policy year. 80% of premiums is payable towards the policy.

In this regard, please note that a sum of Rs.1,13,187.20 as claim amount is payable under the subject policy, and the same will be paid to India Infoline Housing Finance Ltd. Against outstanding loan amount.

For further assistance, please speak to Seema Pawar at 022-42058057 between 10 am to 6 pm or call us on 1860 266 7766, our 24*7 Claim Care helpline.”.

 

10.     On the basis of documents received during claim intimation i.e. statement of Mr.Mewa Singh in daily diary report dated 06.06.2019 and the newspaper article dated 07.06.2019 published in Tribune, the OP No.1 has held that the death of the LA was caused due to suicide.
11.     It is observed that on 06.06.2019, the husband of the complainant i.e. LA unfortunately died due to the injury sustained by him in the bullet fire from is licensed pistol near RKM Water tank, Landara, Sahibzada, Ajit Nagar, Mohali, Punjab. The inquest proceedings under Section 174 of the Code of Criminal Procedure, 1973 were conducted. On the very same day post mortem was conducted at Civil Hospital Mohali and the Post Mortem Report was prepared under PMR No. PMR/MA/DHM/01/2019. In investigation report dated 29.08.2019 (Annexure C-6), the Investigating Officer Sub Inspector Prakash Masih concluded that the cause of the death of the LA was due to a sudden and accidental bullet fire from his licensed pistol which had hit him in his head and the said report was accepted by the Station Head Officer, Sohana on 30.08.2019 vide Reference No. 3706/5A/PS Sohana (Annexure C-7). Further vide report bearing No. 3888/SA/DSP dated 17.09.2019 (Annexure C-9) the concerned Deputy Superintendent of Police, SAS Nagar, Mohali accepted the Investigation Report. The said investigation report was verified and agreed upon by the Dy. District Attorney, who certified the same vide Report No. 92 DDA (Legal) dated 25.09.2019 (Annexure C-9). Thereafter vide Report No. 56 V.R.K dated 27.09.2019 (Annexure C-10), the concerned Senior Superintendent of Police Dist. S.AS Nagar submitted the death report of the husband of the Complainant to the Sub-Division Magistrate, Illaqua Mohali concluding that the husband of the Complainant died due to sudden and accidental fire from his pistol.  The SDM SAS Nagar, Mohali vide order dated 14.02.2020 (Annexure C-13) accepted the police inquest/investigation report filed under Section 174 of Cr.P.C. 
12.     Keeping in view the facts and circumstances of the present case and documentary evidence on record, it is clear that the death of the LA i.e. Sh.Amandeep Singh Sra, husband of the complainant caused due to accidental bullet fire injury suffered by him from his licensed pistol near RKM Water tank, Landara, Sahibzada, Ajit Nagar, Mohali, Punjab on 06.06.2019 and the OP No.1 on mere statement of the father of the deceased  and article of newspaper published in the Tribune on 07.06.2019 (Annexure R-7) presumed that the death of the LA was caused due to suicide.

          However, the complainant has claimed both the benefits i.e. ‘sum assured’ as well as ‘benefit of accidental death’ i.e. Rs.47,93,516/- each in para No.4(vi) of her complaint, but it is held that the complainant is not entitled to both benefits  but only one i.e. benefit of accidental death because the husband of the complainant died accidentally on account of fire arm injury suffered by him accidentally from the bullet of his licensed pistol. Hence, OP No.1 is liable to pay Rs.47,93,516/-  along with interest from the date of repudiation of the claim by OP No.1.

13.     That it is usual with the insurance company to show all types of green pasters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted,  wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation.  This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.  It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

    “It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.  The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

14.     In view of the above discussion, we have no hesitation to held that OP No.1-Insurance Company has wrongly and arbitrarily repudiated the claim of the complainant.
15.     Hence, the present complaint deserves to be partly allowed and the same is accordingly partly allowed. OP No.1 is directed to release an amount of Rs.46,80,329/-  (Rs.47,93,516/- minus Rs.1,13,187/- already paid by OP No.1 to OP No.2 i.e. 80% of the total premium amount) along with interest @ 9% p.a. from the date of repudiation of the claim i.e. 04.06.2020 till the date of actual refund/release to OP No.2 towards the balance outstanding principal loan amount account No.844903. OP No.2 is also directed to accept and adjust the above said amount towards settlement of the Housing Loan Account No.844903 and issue an acknowledgement/loan settlement to the complainant after receiving the balance loan amount, if any (in case the loan amount is excessive than the awarded amount) or pay the balance amount to the complainant, if any (in case the loan amount is lesser than awarded amount).
16.     This order be complied with by the OPs jointly and severally, within 60 days from the date of receipt of its certified copy.
17.     The pending application(s) if any, stands disposed of accordingly.
18.     Certified copy of this order be sent to the parties, as per rules. After compliance file be consigned to record room.

Announced 01.09.2023
	Sd/- (AMRINDER SINGH SIDHU) PRESIDENT
	Sd/- (B.M.SHARMA) MEMBER