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Thread: ICICI Prudential Life Insurance

  1. #1
    Sidhant's Avatar
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    Default ICICI Prudential Life Insurance

    State Consumer Disputes Redressal Commission

    West Bengal

    BHABANI BHAVAN (GROUND FLOOR)

    31, BELVEDERE ROAD, ALIPORE

    KOLKATA – 700 027





    S.C. CASE NO.: FA/2009/167 DATE: 22.07.2009



    DATE OF FILING: -05.05.2009



    APPELLANTS : 1. ICICI Prudential Life Insurance

    Company Limited, ICICI Prulife Towers,

    1089, Appasaheb Maratha Marg, Prabhadevi,

    Mumbai-400 025.



    2. Vice-President-Claims, ICICI Prudential Life

    Insurance Company Limited,

    ICICI Prulife Towers, 1089,

    Appasaheb Maratha Marg, Prabhadevi,

    Mumbai-400 025.



    3. Regional Manager, ICICI Prudential Life

    Insurance Company Limited, Burdwan Road

    (Opp. Howrah Pump), P.O.- Siliguri, P.S.- Siliguri,

    Dist-Darjeeling, West Bengal.



    4. Area Manager, ICICI Prudential Life

    Insurance Company Limited, 2nd Floor,

    EBM Water Works Compound, Plot no-113,

    P.S.-English Bazar, Dist-Malda, Pin-732101.



    5. Smt. Jyoti Singh North Baluchar,

    P.S.- Englishbazar, Dist-Malda, West Bengal.





    RESPONDENT : Smt. Alka Agarwala, W/o Late Bimal Agarwala,

    Jublee Road, North Baluchar, P.S.- English Bazar,

    Dist-Malda, West Bengal.





    BEFORE: HON’BLE JUSTICE : Sri. Aloke Chakrabarti, PRESIDENT.

    MEMBER : Smt. Silpi Majumder



    FOR THE APPELLANTS : Ms. Rita Bhattacharyya, Advocate.

    FOR THE RESPONDENT : Ms. Rita Dey, Advocate.





    -ORDER-



    S. Majumder, Member.



    This appeal has been directed against the judgment passed by the District Forum, Malda, on 06.04.2009, in its case no-34/2008, wherein the Ld. Forum below has allowed the complaint on contest against the OPs no- 1-4 without any cost and dismissed the complaint against the OP-5. The OP nos- 1-4 were directed jointly and severally to pay the insured amount of Rs.2,50,000/- to the Complainant within 30 days from the date of passing the judgment, failing which the Complainant would be at liberty to get the awarded amount through execution.



    The brief facts of the case of the Complainant before the Forum below were that her husband since deceased took a Life Insurance Policy from the insurer ICICI, Malda Branch for an amount of Rs.2,50,000/-and proposal form was filed on 12.10.2006. The insured deposited the first premium, but unfortunately her husband died on 26.06.2007. Being legal nominee of the said policy the Complainant lodged the death claim with the insurer along with all the relevant documents. But the OP informed her that the Complainant had the past habit of consuming tobacco, alchohol etc. and the OP repudiated the claim due to suppression of material fact at the time of taking out the policy. Thereafter the Complainant issued several representations upon the OP to consider her claim, but to no effect and finding no other alternative the Complainant filed the complaint before the Forum below praying for direction upon the OP to pay her the assured amount of Rs.2,50,000/- together with interest and Rs.1,50,000/- towards damages and other consequential reliefs.



    Being aggrieved by the above-mentioned judgment the OPs-Appellant have preferred this appeal contending the the Forum below has failed to appreciate documentary evidence on record from where it is evident that the insured suppressed the actual facts and state of his health in the proposal form at the time of taking out the policy and based on the material records available, the Appellants have bonafide repudiated the claim of the Complainant in accordance of settled law. The Ld. Advocated for the Appellant has stated that it was within the knowledge of the insured that he had been suffering from fatal disease like cancer and the insured had various symptoms of cancer i.e. difficulty in opening the mouth, swelling of maxillary region etc. and he was well aware of these symptoms before filing the proposal form. The Ld. Forum below has failed to appreciate that the insured used to consume pan masala since 7 years and alchohol since 5 years prior to the date of proposal. The Respondent has not uttered a single word about the specific and factual averment made by the Appellant in the repudiation letter and she never denied the symptoms of the life assured which were pre-existing from the date of filing the proposal for the policy. The Ld. District Forum has failed to appreciate that the principle of utmost good faith applies on both the parties equally. The Appellants have mentioned in the memo of appeal that the cause of death of the life assured had a direct nexus with the symptoms and habits of the life assured, which were deliberately not disclosed in the proposal for insurance. According to the Appellants the judgment passed by the Ld. Forum is erroneous, illegal and liable to be set aside.



    During hearing Exhibit-D clearly and evidentially has established that the life assured was suffering from cancer symptoms for more than two years and hence he was well aware about his health condition, but he intentionally had suppressed the said material fact in the proposal form at the time of procuring the insurance policy. We have perused the Exhibit-D which is a medical report dated 20.11.2006 issued by the Jaslok Hospital, Mumbai from where it is evident that the life assured complained of difficulty in opening the mouth since two years, swelling of left maxillary regions since two months associated with bleeding from swelling. Final diagonosis of the said Hospital after biopsy was ‘Sqaumous Cell Carcinoma Left Buccal Mucosa’ and it was planned for administering of two cycles of chemotheraphy. This report does not reflect that the life assured was suffering from carcinoma before 12.10.2006, when the life assured filed the proposal form. The Ld. Advocate for the Appellant has argued that the symptoms of cancer was within the knowledge of the assured on 12.10.2006, but he did not disclose the same. In this respect we are of the vew that symptom cannot be tantamount to disease and nowhere the Appellants have proved by adducing documentary evidence that the assured was suffering from cancer before taking out the policy. We are unable to say that based on symptom the repudiation was right and legal. The Appellants have stated that the Complainant’s husband used to take alcohol since five years and pan parag for seven years. We do not know whether any tobacco content is in pan parag or not and in this respect the Appellants did not make any case and in case of alcohol, there is no evidence that due to consumption of alcohol the life assured was attacked by carcinoma. Therefore the Appellants have failed to connect consumption of alcohol with carcinoma. Moreover, in our opinion due to taking alcohol the assured might have been attacked by carcinoma in his abdomen, but he was attack by it in his mouth. We have no reason to believe the averments as stated by the Appellants. The Forum below has rightly observed that in absence of any evidence either documentary or oral to show that prior to filling up the proposal form the insured was with the exclusive knlwledge that he had been suffering from fatal disease like cancer. It is clear that he obtained the policy on 12.10.2006 and cancer has been detected on 17.11.2006 while he was under treatment at Jaslok Hospital and hence we are at one with the Court below that it is not true that at the time of taking out the policy the life assured was suffering from cancer and its symptoms were within the knowledge of the assured, moreover only symptoms cannot save the case of the OPs. In our opinion the Forum has rightly passed the judgment with reasons in which we are no inclined to interfere and it does not suffer from any infirmity and material irregularity.



    Hence it is ordered that the appeal be dismissed on contest without any cost and the judgment passed by the Ld. Forum below is hereby affirmed. The office is directed to send down the copy of this judgment to the Forum below and issue the same upon the parties free of cost forthwith.



    (S.Majumder) (Justice. A. Chakrabarti)

    MEMBER PRESIDENT

  2. #2
    adv.sumit is offline Senior Member
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    Default ICICI Prudential Life Insurance

    Raghavarapu Rama Devi,

    W/o. late Venkata Subba Rao,

    R/o. Near Ayyappaswamy Temple,

    Nehru Nagar,

    Guntur. … Complainant



    AND



    ICICI Prudential Life Insurance,

    Rep. by its Branch Manager,

    15th line, Main Road, Arundelpet,

    Guntur. … Opposite party








    O R D E R




    This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant praying relief for sum assured to the tune of Rs.1,00,000/- and also for compensation and costs from the opposite party.

    The case of the complainant is that

    Her deceased husband by name Raghavarapu Venkata Subba Rao during his life time obtained policy bearing No.01520206 for a sum of Rs.1,00,000/- which commenced from 24-03-05 on payment of premium of Rs.20,000/-. This is the life time policy issued by the opposite party fixing yearly premium of Rs.20,000/-. Her husband died due to heart attack on 14-02-07. The complainant being the wife her name was noted as nominee of deceased. After death of her husband, she addressed a letter dt.18-04-07 vide Ex.A6 to the opposite party for settling the claim under policy vide Ex.A2. She has also submitted death certificate of her husband vide Ex.A5. But the opposite party did not give any reply nor settled the claim. The complainant requested the opposite party on number of occasions for early settlement of claim. But they failed to do so, as such it amounts to deficiency of service. Hence, the complaint.

    The opposite party filed its version taking preliminary objections about the maintainability of complaint and also denied the allegations made in the complaint. According to the version, this complaint is filed in order to harass and gain undue advantage for unjustified amount on the lapse of policy as on the date of death of life assured. With regard to the facts of the case, it is submitted that the deceased was 52 years of age at the time of submitting his proposal for insurance, doing cool drink business and running STD shop. The proposal was submitted on 15-03-05 on his life under ICICI Life Time plan of insurance for sum of Rs.1,00,000/-. He had also opted for supplementary benefit namely Accident & Disability of a sum of Rs.1,00,000/-. The life assured had chosen yearly frequency for paying the premium of Rs.20,000/-.


    He had nominated his wife, the complainant herein under section 39 of the Insurance Act. As per the age of life assured, the sum assured opted and the underwriting norms of the company, the life assured was required to undergo physical medical test and the same was completed by life assured on 23-03-05. Believing the information given by the life assured in the proposal form and believing the medical examination to be true and correct in all aspects, the proposal was accepted at standard (ordinary) rates of premium for basic cover and also for supplementary benefit of Rs.1,00,000/- and the policy was issued on 29-03-05 vide Ex.B1 and B2. As per the terms of policy, the premium of Rs.20,000/- is payable on 24th March every year.

    The life assured is reported to have died on 14-02-07. After the death of life assured, the complainant lodged a claim with the opposite party on 18-04-07 vide Ex.B1 (Ex.A6).

    It is further submitted that the premium payable on 24th March of every year to be paid either on due date or within the grace period but the same was not paid. Thus as per the terms and conditions of the policy the grace period would expire on 24th April of the relevant year, in present case i.e., 24-04-06. Therefore, no benefits become payable on death of life assured if the policy was in a lapsed condition. Since premiums under the policy were not even paid for three consecutive years, the policy lapsed without acquiring any paid-up value. The opposite party crave leave to draw the attention of the Forum on clause 4.1 (i) (payment of premium).


    The opposite party informed the complainant vide its letter dt.28-04-07 vide Ex.B5 that the above said policy was in lapsed condition on 14-02-07 being the date of death of life assured. Further the premiums due on 24-03-06 and all subsequent premiums had remained unpaid. Therefore, as the policy is in lapsed condition on the date of death of life assured no benefits are payable there under. For the above said reasons, the policy benefits are not settled on the complainant. The complaint is devoid of merits. Hence, it is prayed to dismiss the complaint.

    Both parties have filed their affidavits. Ex.A1 to A6 are marked on behalf of complainant. Ex.B1 to B5 are marked on behalf of opposite party.

    Now the points for determination are that

    1. Whether there is any deficiency of service on the part of opposite party in not settling the claim?

    2. Whether the complainant is entitled for the sum assured under the policy vide Ex.A2?

    3. To what relief?

    POINT No.1

    The facts are no way in dispute. The opposite party admits about having insurance policy under ICICI Life Time plan of insurance for a sum of Rs.1,00,000/- to the deceased Venkata Subba Rao who had nominated his wife, the complainant herein as beneficiary there under. According to the opposite party, after completion of formalities they have accepted proposal and issued policy on 29-03-05. As per the terms and conditions of the policy premium of Rs.20,000/- is payable on or before 24th March every year within the grace period provided. According to opposite party except the initial premium amount at the time of issuing policy subsequently yearly premiums for the years 2006 and 2007 are not paid. Therefore, by the date of death of deceased on 14-02-07, policy was said to be in lapsed condition, as such no benefits will arrive out of the same and the complainant is not entitled for any amount as claimed.

    In the aforesaid circumstances, the opposite party claims that absolutely there is no deficiency of service on their part. In this regard, they rely upon policy documents, which provides various terms and conditions of the policy vide Ex.B4, clause 4.1(i), which reads as follows:

    “Payment premiums:

    Premium are payable on the due dates and at the rate mentioned in the policy certificate. However, a grace period of not more than 30 days, where the mode of payment of premium is other than monthly, and not more than 15 days in the case of monthly mode is allowed. If a premium is not paid during the days of grace, the policy shall lapse and no benefit shall be payable. If a premium is not paid during the days of grace after three full years’ premium have been paid and the policy has been in force for the full sum assured for those three policy years, the benefits payable under the policy shall be as indicated in clause 4.4. hereof”

    The above provisions makes it clear that premium amount is not paid within the grace period of 30 days, the policy shall lapse and no benefits shall be payable. It also makes it clear that after making three full years premium and subsequent premiums are not paid within grace period, the benefits payable under the policy shall be as indicated in clause 4.4 thereon. But this situation does not arise in this case as deceased did not pay the premium of the year 2006 and 2007. Of course, he died one month before the premium is due in the year 2007. But ultimately two years premium remains unpaid.


    As such, the policy lapsed and no benefits would accrue there under. The revival of policy as provided under general conditions does arise if the life assured is alive and on undertaking to pay premiums subject to other conditions provided there under. Thus we observe that absolutely there is no deficiency of service on the part of opposite party in repudiating the claim of complainant. They are justified in doing so as per the terms and conditions of the policy. The point is answered accordingly.

    POINT 2 & 3

    In view of the findings given in preceding point, the complainant is not entitled for any benefits under the policy. The complaint is devoid of merits. Hence, the complaint is dismissed. Each party shall bear their own costs.

    In the result, the complaint is dismissed. Each party shall bear their own costs.

  3. #3
    Unregistered Guest

    Default fraud by ICICI PRU LIFE

    sir,
    i have taken policy from ICICI before two years, at that time the agent has said that this is a single premium policy so we gave a cheque of rupees 250000 towards the name of ICICI PRU LIFE, after some time when i went the icici offfice they said this is a monthly policy so u have to pay this much amount for every month otherwise your policy will be lapsed and your money willl not be returned . so sir please do needful in this regards, and help me to get back my money.
    from - indrajeetsinh zala
    mob - 09723996747
    e mail - inder_zala@yahoo.co.in

  4. #4
    Unregistered Guest

    Default Cheating My ICICI Prudential Life Insurance

    Sir,

    I taken the policy no: 05131984 dated March 2007 with premium of Rs. 35,000.00 per year. On completion of 3 years i opted to surrender my Policy and filed the documents required for the refund of my Fund value on 26th April, 2010. I got the message on my mobile no: 9417388699 from ICICI Prudential that My Fund value is Rs. 1,66,315.00 and at the time of Surrender of the documents on 20th april, 2010, i was assured that your maturity fund value will be processed and remitted to you with in 7 working days. After lapse of one month i again inquired from Mr. Navin aggarwal, manager (Priority Clients), Jalandhar, who informed me that still your case has not been processed due to mis match of signatures which i was never intimated by ICICI prudential. Then on 3rd of June a sum of Rs. 1,55,413.80 were credited in my PNB account nio: 1549000105132438 without any intimation to me.. So there is a loss of Rs. 10901.20 without any fault on my part and ICICI prudential has cheated me.

    Again I Contacted Mr. Navin aggarwal, manager (Priority Clients), Jalandhar, who gave no satisfactory reply. So now i approach to make up my loass from the ICICI Prudential.
    Thanking You,

    Dr. Hans Raj Gupta,
    33 Vasant Vihar, Jalandhar City, Punjab, 9417388699 e-mail: vestpharma@hotmail.com

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