DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
Dated this the 10th day of September 2021
Present : Sri.Vinay Menon.V President
: Smt.Vidya.A, Member Date of Filing: 06/9/2010
CC/112/2010
Bhagyalakshmi,
W/o.Haridas,
Kottamangalam House,
Kottayi Post,
Palakkad – 678572
(By Adv.K.Dhananjayan) - Complainant
Vs
1. M/s.ICICI Lombard General
Insurance Company Ltd.,
Regd.Office at ICICI Bank Towers,
Bandra-Kurla Complex
Mumbai – 400 051
(By Adv.Jayachandran.G)
2. The Managing Director/Authorised Signatory
ICICI Lombard General Insurance Co. Ltd.
Interface Building, No.11, 401/402,
4th Floor, New Link Road, Malad, Mumbai – 400 064
(By Adv.Jayachandran.G)
3. The Manager
ICICI Bank Ltd.,
Udaya Towers, Near Rappadi,
Palakkad - Opposite parties
(By Adv. M.Ramesh)
O R D E R
By Sri.Vinay Menon. V, President
1.A complaint seeking accident death benefit arising out of the accidental death of
the complainant’s son.
2.In gist, case of the complainant is that her late son Mr.K.H.Kishore, life assured under the ICICI Lombard Personal Accident Policy, issued by the first opposite party died in a road traffic accident on 23/12/2008. At the time of his death there was a valid and subsisting policy bearing No.4005/0007774/1773 for Accidental Death Claim of Rs.10 lakhs and an Accidental Death Benefit of Rs.25,000/- under policy bearing No.4005/0007774/1774. Upon his death on 23/12/2008 when a claim was raised by the complainant, the claim was repudiated for no reason at all. Initially the complainant had stated that the premium was being deducted from the SB account maintained in the 3rd opposite party bank by the deceased Kishore. Subsequently it has come to notice that it was not from the SB account but from the credit card account bearing No.4477468605881007 of the deceased that the premium was deducted.
3. Opposite parties 1 and 2 entered appearance and raised defence that Mr.K.H.Kishore was not a beneficiary and there were no relevant document to substantiate such claim. There was no automatic renewal of the policy and the averment of the complainant that they received communication regarding renewal was not correct. There was no reduction of premium and there is no liability to compensate to pay Rs.10 lakhs. There is no deficiency in service or unfair trade practice.
4. Opposite party 3 denied that the premium was deducted from the account maintained in OP3 bank.
5. From the reading of the pleadings in the complaint as well as in the written version filed by the parties the following issues arise for consideration.
- Whether there was a valid and subsisting policy issued by opposite party 1 as on 23/12/2008, the date of death of K.H.Kishore. ?
- Is there deficiency of service on the part of OP1 ?
- Compensation and Cost ?
6. From the part of complainant Ext.A1 to A10 were marked. Ext.B1 to B3 were marked on the part of opposite parties. PW1 is the complainant and DW1 is the Manager of 3rd opposite party.
Issue No.1 :
7. The entire dispute in this lis revolves around the question of the existence of a valid and subsisting policy as on 23/12/2008.
8. Complainant’s case is that her son died in a road traffic accident on 23/12/2008. As on the date of death, nominee of the deceased was entitled to receive Rs.10 lakhs as Accident Death Claim and an amount of Rs.25,000/- as Accident Death Benefit. Both the claims were repudiated. Ext.A1 is a series of two documents titled “The schedule” with regard to Confirmation of Availability of Insurance. The first schedule is part of the policy No. 4005/0007774/1774 in the name of Kishore K.H. with regard to the Accident Death Benefit of Rs.25,000/-.
9. The second schedule is the confirmation of availability of insurance bearing Policy No.4005/0007774/1773 for Rs.10 lakhs in the name of the deceased K.H.Kishore. Date of commencement of both the policies were 13/4/2007 for a period of one year till 12/4/2008. Complainant is named as nominee in both the documents.
10. Ext.A2 is a communication dated 17/4/2007 with regard to policy bearing No.4005/0007774/1773. Subject matter of the letter is “Accident Death
Cover for ICICI Bank Customers”. This communication, addressed to late Mr.Kishore.K.H., states in its second paragraph as follows:
“Enclosed you will find your ICICI Lombard personal accident policy NO.4005/0007774/1773 for Rs.10 lakhs of Accident Death Cover and a confirmation of availability of insurance for Rs.25,000/- of Accidental Death Cover which is an one time cover from ICICI bank.” (Line 1 paragraph 2)
11. Ext.A3 is another communication dated 3/4/2008 issued to the deceased Kishore.K.H. This communication is with regard to renewal of accident death cover policy No.4005/0007774/1773 for Rs.10 lakhs, the Accident Death Cover for yet another one year.
12. Ext.A7 is the credit card statement pertaining to credit card used by the deceased Kishore. Ext.A7 contains various entries with regard to EMI principal and interest paid to ICICI Lombard general insurance charged on the credit card bearing NO.4477468605881007.
13. Authenticity of Ext.A1, 2,3 & 7 and veracity of its contends are not disputed by the opposite parties. Nothing is brought out in evidence to disprove the said documents or its contents or discredit its worth. Hence these documents can be relied upon to reach a conclusive observation vis-à-vis the conflicting pleas.
14. A conjoint reading of Ext.A1 ,2,3, and 7 would go to evidence the following facts.
- The deceased Kishore had a valid and subsisting Accidental Death Cover issued by the first opposite party as on 23/12/2008, date of the fatal accident.
- The complainant herein is the beneficiary.
- The Accidental Benefit Covers of Rs.25,000/- was only for 1 year and that was not renewed to cover 13/4/2008 to 12/4/2009. Hence the complainant is not entitled to benefit thereof.
15. The aforesaid being the facts as evidenced by the pleadings and documents marked in evidence by the complainant, we are of the opinion that the first issue is to be answered in favour of the complainant with regard to Accidental Death Claim. We do so.
Issue No.2
16. Even though the opposite parties have vehemently denied the existence of such a policy, they do not have a case that the aforesaid documents are a product of fraud or concoction / forgery. Moreover they have not adduced any evidence to counter the cogent evidence adduced by the complainant.
17. The opposite parties after having received the premium for the Accident Benefit Cover has upon the occurrence of death turned around to deny any claim. In the face of the cogent documentary evidence submitted by the complainant to substantiate their claim one can rightly come to the conclusion that the conduct of the first opposite party is an attempt at unjust enrichment by defrauding the complaint. Conduct of the OP1 and 2 are illegal, perverse, deprecable and tantamount to deficiency in service. Hence the second issue is found against the OP1 and 2.
Issue No.3
18. The opposite party 1 has denied a rightful claim of the complainant, that too, one which was so apparent on the face of records. There was no haze whatsoever that prevented the opposite parties from honoring the claim of the complainant. Conduct of the opposite parties are vexatious, malicious and ill-motived. Hence we are of the opinion that the complainant is entitled to interest @10% from 23/12/2008, the date on which the Accidental Death Claim arose till the date of payment. The complainant is also entitled to a compensation of Rs.1 lakh and a cost of Rs.50,000/-
19. In the result we hold as follows:
- The Opposite parties 1 & 2 are liable to pay the complainant the Accidental Death Claim for Rs.10 lakhs under the policy bearing No.4005/0007774/1773
- The complainant is entitled to receive interest @10% from 23/12/2008, the date on which the Accidental Death Claim arose till date of payment.
- The complainant is entitled to a compensation of Rs.1 lakhs in view of the deficiency in service on the part of opposite parties 1 & 2.
- The complainant is entitled to a cost of Rs.50,000/-
- No liability is cast on opposite party No.3
Period of compliance is 30 days from the date receipt of this order.
Pronounced in the open court on this the 10th day of September 2021.
Sd/-
Vinay Menon V
President
Sd/-
Vidya.A
Member
APPENDIX
Exhibits marked on the side of the complainant
Ext.A1 – Original Policy ICICI Lombard bearing No.4005/0007774/1774
Ext.A2 – Compute fulfillment letter dt.17/4/2007 issued by Sanjay Dutta on behalf of ICICI
Lombard
Ext.A3 – Computer fulfillment letter dt.3/4/2008 for renewal of accidental death cum
policy
Ext.A4 – Summary of account of late Sri.Kishore.K.H. issued from ICICI Bank, Palakkad
Ext.A5 – Slip and acknowledgement issued by the representative of OP1&2
Ext.A6 – Legal heirship certificate issued to the complainant. (attested copy)
Ext.A7 – Transaction details of credit card for the period from 14/5/2007 to 14/4/2010
Ext.A8 – Attested copy of the FIR in Crime No.1122/08 of Palakkad Traffic Police Station
Ext.A9 – Attested copy of the postmortem certificate bearing No.734/2008 issued by
Dr.P.B.Gujaral.
Ext.A10 – Appointment and conditions of employment details issued to deceased
Kishore.K.H. by Reliance Securities Mumbai
Exhibits marked on the side of the opposite party
Ext.B1 – Statement of account dated 23/5/2011 from 31/3/2007 to 31/3/2010
Ext.B2 – Copy of Insurance policy bearing No. 4034/FNP/02194277valid from 17/5/2007 to
16/5/2008.
Ext.B3 – Copy of letter sent to Kishore by ICICI Lombard dated 25/4/2008 regarding
rejection of premium amount
Witness examined on the side of the complainant
PW1- Bhaghyalakshmi, complainant
Witness examined on the side of the opposite party
DW1- Raghavan, Chief Manager ICICI Bank Ltd.
Cost : Rs.50,000/- allowed as cost.
NB : Parties are directed to take back all extra set of documents submitted in the
proceedings in accordance with Consumer Protection (Consumer Commission
procedure) Regulations, 2020.
