BANGALORE URBAN DISTRICT, NO.8, SAHAKARA BHAVAN, CUNNINGHAM ROAD, BANGALORE – 560 052           

C.C.No.1159/2011

DATED THIS THE 18^th NOVEMBER 2013

PRESENT

SRI.J.N.HAVANUR, PRESIDENT

SRI.H.M.SHIVALINGAPPA, MEMBER

Complainant: -   

                                                Dr.M.Shivalingam

                                                # 5/26, BDA flat, 1^st A Cross,

                                                Cambridge Layout,

                                                Halasuru, Bangalore-08

V/s

Opposite parties:-                                     

1.     Mr.Grukiran R Kudtekar/ Mr.Raju /Mr.Ravikumar Relationship Manager, ICICI Prulife Ltd, Residency Road, Bangalore-28

2.     The Manager, Customer Service,

ICICI Prulife Towers,

1089, Appasaheb Marathe Marg,

Prabhadevi, Mumbai-25

ORDER

SRI.J.N.HAVANUR, PRESIDENT

        This is a complaint filed by the complainant against the OPs no.1 and 2, praying to pass an order, directing the OPs to honour and send the single life pinnacle super insurance policy certificate immediately or to refund Rs.90,000=00 with interest @ 30% from 28-3-2012 till date and to pay Rs.20,000=00 towards stress and strain and cost of litigation.

2. The brief facts of the complaint can be stated as under.

On 25-3-2012, he received a phone call on his mobile no.9886636765 from Mr.Raj, Manager, ICICI Prulife, Residency Road, Bangalore requesting him to invest in insurance cum saving scheme and he had shown interest in investing. On 26-3-2012, Mr.Ravikumar deputed by Mr.Raj met the complainant at his office explained the various scheme for investment. After hearing, the complainant finally told him that, he want to invest in an insurance scheme where there should not be any medical examination in the scheme as he is not in a position to undergo any kind of medical examination. Mr.Ravikumar responded with a policy called single life pinnacle super, which is a non medical, limited upto Rs.10.lakhs. Further he offered the complainant 10% discount on the premium, as he was an old customer of ICICI. In this policy, the complainant has to pay Rs.1.00 lakh yearly for five years, and he mentioned that after completion of 5 years, the complainant allowed to close the policy whenever he want and can take back the matured amount or continue till he attains 75 years of age. The life coverage of this scheme is seven times of the premium i.e. Rs.7.00 lakhs. He got attracted by this policy and asked him to leave an application form and told him to collect the same on 27^th March alongwith other relevant documents and cheque for Rs.90,000=00 (after 10% discount). On 27^th March, the complainant handed over the duly filled application form no.44678796 alongwith other relevant documents and authorization letter to debit Rs.90,000=00 from his ICICI credit card. After going through the application, Mr.Ravikumar refused to accept the application form and gave the complainant another application form no.45936079, and took only his signature, later he filled the application as per his needs and left the place with the information that the policy certificate will be sent from Mumbai within 15 days. On 27-3-2012, he contacted Mr.Raju over phone told him that, he is yet to receive the policy certificate as already one month was over, and immediately, he said that he will receive the policy very shortly as it is already processed. After few days, again he tried to contact Mr.Raju and Mr.Ravikumar; however both of them were deliberately avoiding his phone calls. On 8-5-2012 the complainant sent an email to the grievances customer care service of ICICI, and they in turn sent the reply on 22-5-2012 that the action has been initiated and they would contact him within six days. Since he was not contacted by anyone from grievances cell, again the complainant sent an email to the grievances cell on 18-5-2012. On 26-5-2012 the complainant received an email from grievances cell, asking him to complete certain formalities and to undergo medical fitness which is must, till date no one has approached the complainant for the same. The complainant is a handicapped person and has undergone major surgery of abdomen in 2008 and he is 62 years of age, and he is a medical doctor, he knew very well that he is medically unfit for any insurance policy. So with that reason only the complainant asked for non medical insurance policy and they also responded to his request and offered single life pinnacle super as a non medical policy. The complainant was keen to take the insurance policy before 31-3-2012 to avail the tax benefit on the maturity amount as per the government order. He cannot invest in any policy as the maturity amount would attract income tax after 1-4-2012. The ICICI Prulife agents totally misguided and have hidden the facts so as to invest him in their insurance policy. If they had told the complainant that the insurance is a medical fitness policy then he would not have taken the policy at all. Now they deliberately prevented the complainant in investing in other companies and avail the income tax benefit on maturity amount as per the government order.  So the complainant has come up with the present complaint.    

3. After service of notice, the OPs no.1 and 2 have appeared through their counsel and filed version contending interalia as under:

The present complaint is not maintainable and it is liable to be dismissed for non joinder of necessary parties. The complaint filed by the complainant is a gross misuse of process of law and it is liable to be dismissed on this ground alone. The complainant does not fall under section 2 (e) of the CP Act and this forum has no jurisdiction to entertain the complaint, and there is no deficiency of service or negligence on the part of this OP and the policy has not been issued to the complainant due to refusal by the complainant to undergo medical test, so the present complaint is liable to be dismissed.  The present complaint is not maintainable and the complainant is guilty of suggesto vari supresso falsi. The complainant has approached this forum with unclean hands suppressing the utmost material facts from this forum. In the present case, the OP has refunded a sum of Rs.90,000=00 because the complainant refused to undergo medical test which is the basic requirement of the policy in question. Due to refusal by the complainant to undergo the medical test, the policy was never issued to the complainant. M/s.ICICI Prudential Life Insurance Co. Ltd is an Indian Insurance Company registered under Section 3 of the Insurance Act. The OP received a dully filled and signed proposal form and based on the information given by the complainant in the proposal form, the policy in question was to be issued. The complainant was requested to undergo medical fitness test and the medicals were triggered on 28-3-2012. However the complainant refused to undergo the test. The complainant vide its letter dated 22-5-2012 approached the OP stating that he opted for a non medical policy and is still awaiting the policy. The OP duly replied the same stating that the complainant has to undergo medical fitness test. Due to failure on the part of the complainant to undergo the medical fitness test, the OP refunded the entire premium amount of Rs.90,000=00. The contents of para A  and B of the complaint are wrong and contents of para C are admitted to the extent that the complainant sent a dully filled proposal form alongwith relevant documents and authorization letter to debit Rs.90,000=00 from the credit card of the complainant. It is denied that Mr.Ravi Kumar refused to accept the application form and gave another application form to the complainant. The policy terms and conditions were dully explained to the complainant by the OP and after being satisfied with the terms and conditions the complainant filled and signed the proposal form. The contents of para no.4 of the complaint are wrong and denied. The reliefs claimed by the complainant are wrong and denied, so it is prayed to dismiss the complaint with exemplary cost.

4. So from the averments of the complaint of the complainant and objection of the OPs, the following points arise for our consideration.

1.                           Whether the complainant proves that, the OPs are negligent and there is deficiency of service on the part of the OPs, in denying the policy and subjecting himself for medical examination?

2.                           If point no.1 is answered in the affirmative, what relief, the complainant is entitled to?

3.                           What order?

5. Our findings on the above points are;

          Point no.1:  In the Negative

Point no.2:  In view of the negative findings on the

point no.1, the complainant is not entitled 

to any relief as prayed in the complaint

          Point no.3:  For the following order

REASONS

          6. So as to prove the case, the complainant has filed his affidavit by way of evidence and also filed additional affidavit and produced 11 documents which are marked as annexure-1 to 11 and two documents and also six more documents.  On the other hand, one Sudha Sharma who being the Chief Manager working in the OP has filed her affidavit by way of evidence. We have heard the arguments of both parties and we have gone through the oral and documentary evidence of both sides in between lines.

7. One Dr.M.Shivalingam, who being the complainant has stated in his affidavit that, on 25-3-2012, he received a phone call on his mobile from Mr.Raj, Manager, ICICI Prulife, Residency Road, Bangalore requesting him to invest in insurance cum saving scheme and he had shown interest in making investment. On 26-3-2012, Mr.Ravikumar deputed by Mr.Raj met at his office explained the various scheme for investment. After hearing, he finally told him that, he want to invest in an insurance scheme where there should not be any medical examination in the scheme as he is not in a position to undergo any kind of medical examination. Mr.Ravikumar responded with a policy called single life pinnacle super, which is a non medical, limited upto Rs.10.lakhs, and further he offered him 10% discount on the premium, since he was an old customer of ICICI. In this policy, he has to pay Rs.1.00 lakh yearly for five years, and he also mentioned that after completion of 5 years, he is allowed to close the policy whenever he want and can take back the matured amount or continue till he attain 75 years of age. The life coverage of this scheme is seven times of the premium i.e. Rs.7.00 lakhs. He got attracted by this policy and asked him to leave an application form and told him to collect the same on 27^th March alongwith other relevant documents and cheque for Rs.90,000=00 (after 10% discount). On 27^th March, he handed over the duly filled application form no.44678796 alongwith other relevant documents and authorization letter to debit Rs.90,000=00 from his ICICI credit card. After going through the application, Mr.Ravikumar refused to accept the application form and gave another application form no.45936079, and took only his signature, later he filled the application since per his needs and left the place with the information that the policy certificate will be sent from Mumbai within 15 days. On 27-4-2012, he contacted Mr.Raju over phone told him that, he yet to receive the policy certificate as already one month was over, and immediately, he told that he will receive the policy very shortly as it is already processed. After few days, again he tried to contact Mr.Raju and Mr.Ravikumar; however both of them were deliberately avoiding his phone calls. On 8-5-2012 he sent an email to the grievances customer care service of ICICI, and they in turn sent the reply on 22-5-2012 that the action has been initiated and they would contact him within six days. Again he sent an email to the grievances cell. On 26-5-2012 he received an email from grievances cell, asking him to complete certain formalities and to undergo medical fitness which is must. Till date no one has approached for the same. He is a handicapped person and has undergone major surgery of abdomen in the year 2008 and he is 62 years of age, and he is a medical doctor, he knew very well that he is medically unfit for any insurance policy. So with that reason he asked for non medical insurance policy and they also responded and offered single life pinnacle super as a non medical policy. He was to take the insurance policy before 31-3-2012 to avail the tax benefit on the maturity amount as per the government order. Henceforth he cannot invest in any policy as the maturity amount would attract income tax after 1-4-2012. The ICICI Prulife agents totally misguided and have hidden the facts so as to invest him. If they had told him that the insurance is a medical fitness policy then he would not have taken the policy at all. Now by denying the policy and subjecting him for medical examination amounts to unfair trade practice, deficiency of service and cheating, also in their replies it is nowhere agreed that the policy is non medical. Now they deliberately prevented him in investing in other companies and avail the income tax benefit on maturity amount.  On 25-6-2012 at 1.00 p.m he me Mr.Lakshmi Narayana the chief executive for ICICI Prudential Insurance Co. Ltd  and filed a complaint and he told that he would take action immediately, he will contract him later but till date he never contracted him. On 26-6-2012 he received a SMS text from Mr.Raj stating that, he is extremely sorry please excuse him.  Hence the present complaint is filed, so the complaint be allowed and pass an order as prayed for.

8. The complainant has filed an additional affidavit stating that, the OP said in para no.9 that the premium of Rs.90,000=00 has been refunded because the complainant has refused to undergo medical test and strongly denied the same. The representatives of the OP have clearly told him in the beginning that the policy is a non medical. According to them, if the policy is under medical then why the medical test was not fixed in the beginning itself. After fitness only they have to proceed further, when he refused to under go medical test they should have refunded the premium amount within a month. Why the amount was retained for six months. The ICICI Prudential life insurance Co. Ltd has credited the premium amount of Rs.90,000=00 to his credit card account, the same was not informed him neither over phone nor by any communication, he came to know only, when he received his monthly statement dated 27-9-2012 and the said fact was brought to the notice of this forum on 9-10-2012, so he prayed to pass an order as prayed in the complaint. 

9. Let us a have look at the relevant documents of the complainant. Annexure-1 is the copy of letter of Relationship Manager of ICICI Prulife Pvt. Ltd, Bangalore addressed to the complainant stating that, if he is investing Rs.1.00 lakh, he will be getting a premium discount of Rs.10,000=00 for entire 5 years premium (Every year) and it is written with ink as non medical policy. Annexure-2 and 3 are the copies of proposal forum filed up and signed by the complainant dated 27-3-2012 for elite life pinnacle super policy, but in the application form filled up by the complainant, it is nowhere stated that, the policy to be taken by the complainant was non medical policy particularly. Annexure-4 is the copy of acknowledgement slip issued by the ICICI Prudential Life Insurance Co. Ltd in the name of complainant for having received Rs.90,000=00 towards policy of pinnacle super through his credit card. Annexure-5 is the copy of email letter of complainant stating that, he had taken a non medical single life policy, now already 40 days are over he is yet to receive the policy. Annexure-6 is the copy of email of ICICI Prudential Life Insurance Co. Ltd addressed to the complainant stating that, they have initiated action on the email letter of complainant and will respond with a resolution within six business days. Annexure-7 is the copy of email letter of complainant addressed to the Customer service stating that, if deny the policy that amounts to deficiency of service, unfair trade practice and cheating and he is awaiting for the policy certificate within 15 days otherwise he proceed legally. Annexure-8 is the copy of email letter issued by ICICI Prudential Life Insurance Co. Ltd addressed to the complainant stating that, without medical completion they are unable to issue the policy. Annexure-9 is the copy of email letter of IDBI Federal addressed to the complainant dated 10-1-2011 stating that thanks for choosing IDBI Federal as life insurance partner and opted for IDIB Federal Incomesurance Endowment and money back plan and requested him to pay Rs.32,624=00 as premium for next four years, yearly upto Jan.2004, until 4-1-2015. In case, he is not satisfied with the said policy he can cancel it within the free look period of 15 days from the date of receipt of this document and the premium paid by him will be refunded subject to a deduction of proportionate risk premium. Annexure-10 is the copy of paper cutting dated 31-5-2012 given in the news paper, under the heading of ICICI Pru life penalized for violations. Annexure-11 is the copy of credit card statement of complainant issued by ICICI bank and that statement shows that the complainant paid Rs.90,000=00 towards the policy of OP through his credit card. The complainant has submitted one application dated 9-10-2012 stating that, ICICI Prudential Life Insurance Co. Ltd has credited the premium of Rs.90,000=00 to his account, and the same was not conveyed to him either over phone or by mail, he came to know this fact when he received the credit card statement dated 18-8-2012.

10. The material evidence placed by the complainant as mentioned goes to show that, the complainant has opted for elite life pinnacle supper policy which is a non medical and paid premium of Rs.90,000=00 by taking deduction of Rs.10,000=00 and signed and filled up the form and sent the same alongwith relevant documents to the OP and inspite of making correspondences, the OP did not send the policy as per the case of complainant. But, it is worthy to be noted from the documents of complainant that, whatever the policy chosen by the complainant by name elite life pinnacle super policy being a non medical has not been accepted by the OP and the OP has insisted the complainant to subject himself for medical test and take that policy and to that the complainant has objected and prevailed upon the OP to send the said policy only otherwise it will be unfair trade practice and deficiency of service. The proposal forms produced by complainant do not disclose clearly that the policy taken by the complainant was a non medical whereas in annexure-1 being a letter of the OP produced by complainant, it is stated that, if the complainant is investing of Rs.1.00 lakh he will be getting a premium discount of Rs.10,000=00 for entire five years premium and wording every year and non medical policy in the letter were written with ink separately. Since annexure-1 produced by the complainant is not supported by annexure-2 and 3 being proposal form filled up and given by the complainant, no much reliance can be placed on annexure-1.

11. Let us have a cursory glance at the material evidence of the OP. One Sudha Sharma has stated in her affidavit that, the complainant has approached this forum with unclean hands. In the present case, the OP has refunded a sum of Rs.90,000=00, because the complainant refused to undergo medical test which is the basic requirement of the policy in question. Due to the refusal by the complainant to undergo the medical test the policy was never issued to the complainant. The complainant is not a consumer as no policy was issued to him. The complaint is devoid of material particulars and has been filed merely to harass and gain undue advantage and unjustified money from the OP. So the complaint be dismissed with cost.

12. Taking the oral and documentary evidence of complainant and compare the same with the evidence of OP, it is made manifest that, the OP has not accepted the proposal of the complainant to issue elite life pinnacle super chosen by the complainant as the complainant has refused to undergo medical test. When the complainant did not agree for medical test as suggested by the OP, the premium of Rs.90,000=00 has been paid to the complainant by crediting the amount to his credit card account. In fact, the OPs have acted strictly in accordance with the terms and conditions of the policy to be issued in the name of complainant and there is no negligence or deficiency of service as such on the part of the OPs. On the other hand, the complainant started dictating the terms to issue particular policy chosen by him without any medical test that to after receiving the premium of Rs.90,000=00 from the OPs. So under the circumstances, we are of the view that, the material evidence of the OPs placed before the forum is more believable trustworthy and acted upon than the oral and material evidence of the complainant and as such, we are of the considered opinion that, the complainant who comes to the forum seeking relief has failed to prove this point with clear cogent and consistent material evidence that, the OPs are negligent and there is deficiency of service on the part of the OPs in denying the policy and subjecting himself for medical examination, and accordingly, we answer this point in a negative.

13. In view of our negative finding on the point no.1, the complainant is not entitled to any relief as prayed in the complaint. So, we answer this point in a negative. In the result, for the foregoing reasons, we proceed to pass the following order.

ORDER

          The complaint of the complainant is hereby dismissed. No cost.

          Supply free copy of this order to both parties.  

          (Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open forum on this, the 18^th day of November 2013).

MEMBER                                 PRESIDENT