Tamil Nadu

North Chennai

CC/21/2022

Dr.Saai Prasanna,Wife of Late L.Kishore Kumar - Complainant(s)

Versus

ICICI Prudential Life Insurance Company Limited - Opp.Party(s)

L.N.Pragasam

12 Apr 2023

ORDER

                                                                                                                 Complaint presented on :20.09.2021                                                                             

                                                                                                                     Date of disposal            :12.04.2023

                                                                                  

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

CHENNAI (NORTH)

@ 2^ND Floor, T.N.P.S.C. Road, V.O.C. Nagar, Park Town, Chennai – 600 003.

 

                PRESENT : THIRU. G. VINOBHA, M.A., B.L.,                          :PRESIDENT

                                      TMT. KAVITHA KANNAN, M.E.,                         : MEMBER-I

                              THIRU.V.RAMAMURTHY,B.A.,B.L.,PGDLA.,   :MEMBER-II

 

C.C. No.21/2022

 

DATED WEDNESDAY THE 12^th DAY OF APRIL 2023

Dr.Saai Prasanna,

Wife of Late L.Kishore Kumar,

No.136/4, Ajantha Flats,

16^th Main Road,

Anna Nagar west, Chennai-600 040.                                                                

                                                                                                …..Complainant

 

 ..Vs..

1. ICICI Prudential Life Insurance Company Limited,

Represented by its Chief Manager of Claims,

No.1089, Appasaheb Marathe Marg,

Prabha Devi, Mumbai-400 025.

 

2. ICICI Prudential Life Insurance company Limited,

Represented by its Managing Director,

LKS Towers, Second avenue,

Main Road, Anna Nagar,

Chennai-600 040.                                                          …..Opposite Parties

 

 

Counsel for Complainant                          : M/s.L.N.Pragasam and 2 others

Counsel for 1^st & 2^nd opposite party            :Exparte.

 

 

 

 

 

ORDER

BY PRESENT:THIRU.G.VINOBHA,M.A.,B.L.,:PRESIDENT

This complaint has been filed by the complainant against the opposite parties under section 35 of the Consumer Protection Act, 2019 prays to direct the opposite parties to remit the sum assured (Accidental Death Claim) of Rs.20000000/- with accrued interest thereon at the rate of 24% per annum payable under the policy No.33506971 to the complainant and to pay a sum of Rs.2500000/- to the complainant as compensation for mental agony and hardship suffered by the complainant due to deficiency in service and unfair trade practice of the opposite parties.

1.THE COMPLAINT IN BRIEF:

The Complainant states that during her husband's life time, the Opposite of complainant's husband had taken a life insurance police with the Opposite Parties herein. The name of the policy is ICICI PRU IPROTECT SMART The Policy number is 33506971. The sum assured is Accidental benefit c Rs.2,00,00,000/- (Rupees Two Crores only). The terms of Accidental death cover is 39 years. The terms of the policy is for 44 years from the inception ie, on and from 12.02.2019 to 12.02.2063. The Complainant's husband had paid the monthly premium regularly and promptly from February 12, 2019 onwards. The Complainant states that due to spread of covid 19 and consequential lockdown declared by the Government, her husband met with huge loss in his business and he could not get back his money from his own customers. On frustration, the complainant's husband committed suicide on 10.11.2020 and succumbed in its attempt. The complainant approached the Opposite Parties and submitted her claim petition along with the Original Policy Bond to them on 12.12.2020 and thereby claimed the accidental death benefit (accidental death cover) of Rs.2,00,00,000/- (Rupees Two Crores Only) from the Opposite Parties. The Opposite Parties, by their communication dated 04.01.2021 had informed that "As per the policy terms only the policy premium is payable in case of death due to suicide in the first year of the policy re-instatement done on October 02, 2020. The Opposite Parties further informed that "We have processed the eligible claim payout amount of Rs.79,330/- to the bank account number provided by the complainant herein". Thus the Opposite Parties repudiated the complainant's claim arbitrarily and unilaterally. The Complainant states that on 30.01.2021, she sent an e-mail to the Opposite Parties and thereby request them re-consider their decision an settle the policy amount in its entirety. The Complainant also sent a letter on 03.02.2021. The above said letter issued by the Complainant was 16.02.2021 but they have not chosen to reply.  They have also failed to settle the policy amount as demanded by the complainant vide her letter dated 30.01.2021 and 03.02.2021. The Complainant states that again and again the Opposite Parties are attempting to settle the complainant's husband's policy for a sum of Rs.79,330/- namely 80% of the premium paid by the Complainant's deceased husband. This has been confirmed by Letter dated 17.03.2021 and 29.03.2021 respectively by the Opposite Parties to the Complainant. The Complainant states that the policy has been taken on 12.02.2019 and the one year period expires on 11.02.2020 and that therefore the complainant's husband has paid the premium from 12.02.2019 to 11.02.2020 without any default. The Complainant's husband died on 10.11.2020 which is beyond the period of one year and that therefore repudiation by the Opposite Party is illegal, unlawful, arbitrary and unfair trade practice. The Complainant states that as per the policy conditions of the Opposite Party, "If the Life Assured, whether sane or insane, commits suicide within 12 from the date of inception of this policy, we will refund 80% of the premium paid provided the policy is in force. In the case of a revived Policy, if the Life Assured, whether sane or insane, commits suicide within 12 months of the date of revival of the Policy, higher of 80% of the premiums paid till date of death or surrender value will be payable by us. The Policy will terminate on making such a payment and all rights, benefits and interest under the Policy will stand extinguished. The Complainant states that this condition is not applicable to the complainant's case as the Opposite Parties never issued any notice intimating about the lapse of policy. And now the Opposite Parties are attempting to use it as a defence to repudiate the complainant's claim. It is bounden duty of the Opposite Parties to issue notice to the policy holder about the due date of premium but the same has not been followed by the Opposite Parties. Moreover the period taken into consideration by the Opposite Parties for lapse of policy and reinstatement of the same falls within the pandemic period, for which the Hon'ble Supreme Court of India has granted moratorium and that therefore the stand taken by the Opposite Parties is unfair trade practice, which ultimately resulted in deficiency in their service and hence the complaint.  

2. POINTS FOR CONSIDERATION:

1. Whether there is any deficiency in service or unfair trade practice on the part opposite parties as alleged in the complaint?

2. Whether the complainant is entitled for the reliefs prayed in the

    complaint.  If, so to what extent?

The complainant had filed proof affidavit, written arguments and documents Ex.A1 to A8 are marked on their side.  The opposite party 1 and 2 were set exparte.

3. POINT NO :1:-

          The fact that the complainant’s husband during his life time had taken a life insurance policy with the opposite party namely ICICI PRU IPROTECT SMART The Policy number is 33506971 and the sum assured Rs.20000000/- in respect of accidental death benefit and the coverage period is 44 years and the policy commenced from 12.02.2019  and ended with 12.02.2063 and the monthly premium payable is Rs.4722/- and further the complainant’s husband died on 10.11.2020 by committing suicide is not in dispute between the parties but according to the complainant her husband paid monthly premium from 10.02.2019 to 11.02.2020 without any default and her husband’s death was beyond the period of one year from the date of commencement of the policy but when a claim was raised by the complainant by letter dated 04.01.2021 which is marked as Ex.A4 the opposite party repudiated the claim by stating that as per the policy terms only the policy premium is payable in case of death due to suicide in the first year of the policy re-instatement done on 02.10.2020 and hence paid an amount of Rs.79330/- alone to her Andhra Bank account and repudiated the total claim which according to the complainant is illegal and unlawful and amounts to unfair trade practice and the complainant contended that the unilateral decision of the opposite party to settle the premium amount paid by the deceased husband alone is arbitrary and amounted to deficiency in service and further contended that the opposite party has not sent any notice to the policy holder about the lapse of the policy and re-instatement of the policy and further since the one year period from re-instatement false within the pandemic period as per the moratorium given by the Honble Supreme Court the repudiation is illegal and therefore claim deficiency in service on the part of opposite parties.

          4. The opposite parties remained exparte.  The policy premium receipt and policy in favour of complainant’s husband were marked as Ex.A1 and A2 and the death certificate is marked as Ex.A3 wherein the date of death is shown as 10.11.2020 whereas the commencement of the policy as per Ex.A2 is from 12.02.2019 based on this the complainant contended that the death of her husband occurred one year after the commencement of the policy and therefore contended the terms and conditions as found in Ex.A2 in Clause 11 will not apply to the facts of this case and further contended that there is no documentary evidence on the side of opposite party to prove that the policy lapsed and no prior notice was given to the complainant’s husband and there is no intimation regarding re-instatement of the policy and therefore the complainant contended that the policy condition is illegal and not valid as found in Clause No.11 of Ex.A2 if the life assured commits suicide within 12 months from the date of policy 80% of premium will be refunded if the policy is in force and further in case of revived policy if life assured commit suicide within 12 months of the date of revival of the policy higher of 80% of premium paid till this death will be payable by the opposite party on perusal of Ex.A8 it is found that the opposite party has sent a letter to the complainant by giving the details of premium paid by her husband from the date of commencement of policy and it is found that no premium was paid for August and September 2020 and hence the policy lapsed and subsequently revived on 02.10.2020 and therefore as per the above said terms and conditions the one year period will commence from 02.10.2020 and since the complainant’s husband died on 10.11.2020 which is within one year period from the date of revival of policy the claim of the complainant was rightly repudiated by the opposite party under Ex.A4 which cannot be said to be illegal or arbitrary or unfair trade practice.  The complainant failed to prove that her husband was paying monthly premium without any default till his death.  It is the duty of the insured to pay premium in time for which he cannot be blame the opposite party by alleging that no notice about due date of premium was given by the opposite party.  There is no force in the contention of the complainant that the lapse of the policy and re-instatement false within the pandemic period which false within the moratorium period granted by the Supreme Court.  The non-payment of premium during the respective months as stated above by the complainant’s husband as found in Ex.A8 has lead to lapse of policy which was again revive from 02.10.2020 and therefore the repudiation of the whole claim by the opposite party is found to be valid in law and as per the terms and conditions of the policy and hence it is found that there is no deficiency in service or unfair trade practice on the part of the opposite parties. Point No.1 is answered accordingly.

5. POINT NO :2 :-

          Based on findings given in Point No.1 the complainant is not entitled for the sum assured Rs.20000000/-with interest in respect of the Policy No.33506971 as claimed in the complaint and further the complainant is not entitled for compensation claimed in the complaint.  Point No.2 is answered accordingly.

    In the result, the complaint is dismissed. No costs.

Dictated by the President to the Steno-Typist taken down, transcribed and computerized by him, corrected by the President and pronounced by us in the open Commission on this the 12^th day of  April 2023.

 

MEMBER – I                MEMBER – II                                 PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1	01.02.2019	Policy premium receipt.
Ex.A2	12.02.2019	Policy no.33506971
Ex.A3	10.11.2020	Death certificate of the complainant’s husband.
Ex.A4	04.01.2021	Repudiation letter of the opposite parties.
Ex.A5	30.01.2021	Email sent by the complainant to the opposite parties.
Ex.A6	03.02.2021	Letter sent by the complainant to the opposite parties.
Ex.A7	17.03.2021	Communication sent by the opposite parties to receive the premium amount as calculate by them.
Ex.A8	29.03.2021	Communication sent by the opposite parties acknowledging the payment of premium by the complainant’s deceased husband.

 

MEMBER – I                MEMBER – II                                 PRESIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C.C.No.21/2022, Dated:12.04.2023 Order Pronounced,     In the result, the complaint is dismissed. No costs.   Member-I       Member-II        President

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C.C.No.62/2021, Dated:16.03.2023

Order Pronounced,

    In the result, the complaint is partly allowed. The  opposite parties 1 and 2 are directed to pay a sum of Rs.40000/- (Rupees Forty Thousand only) to the complainant towards deficiency in service in delay in delivering the vehicle to the complainant and also pay Rs.10000/- towards hardship and mental agony suffered by the complainant and also pay Rs.5000/- towards cost of the complaint. The above amount shall be paid to the Complainant within two months from the date of receipt of the copy of this order, failing which the above said amount shall carry 9% interest from the date of order till the date of payment.