-IN THE COURT OF THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR
C.C NO-47/2021
Present-Sri Dipak Kumar Mahapatra, President, Smt. Arati Das, Member (W).
Bimaleswar Prasad Panda, Aged about 57 Years
Represented through his
Wife- Sanjukta Panda Aged about 54 Years
Present Address; C/o Sanjib Kumar Mishra,
Qr. No. PWD UD 20, Commissioner Colony,
PS- Dhanupali, City/ Dist- Sambalpur,
State-Orissa, Pin– 768001. ..........Complainant
Versus
- Chairman
ICICI Bank Ltd
ICICI Bank Tower, Bandra Kurla Complex,
Mumbai- 400081.
2. Chairman
ICICI Lombard GIC Ltd
ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple,
Prabhadevi, Mumbai400025. ......... Opposite Parties
Counsels
For the Complainant:-Sri P.P. Panigrahi, Advocate.
For the O.P-1:-Sri A.K. Sahu, Advocate & Associates,
For the O.P-2:-Sri B.K Purohit, Advocate & Associates.
DATE OF HEARING :23.11.2021, DATE OF ORDER : 13.12.2021
SRI DIPAK KUMAR MAHAPATRA,PRESIDENT:-Brief facts of the case is that the Complainant Bimaleswar Prasad Panda has availed two policies from the Insurer. He met with a road traffic accident on dtd. 08.03.2020 at Sambalpur city entailing considerable treatment expenditure and other expenses about Rs. 30 lakhs. He is became permanently disable totally and can never be restored to his pre loss condition. The accident caused him economical death and hecould not get back to his job. He was the sole bread winner of the family now became absolutely dependent on the family his survival, nursing, care and compassion. In this circumstance the wife Sunjukta Panda represents him for his cause of insurance claim and loan settlement before the Honourable Consumer Commission. In one of the two policies in Free Personal Accident Insurance Cover provided by the OP-1 to the Complainant for 25 lakhs. Although the loan amount is of Rs. 30.65 lakhs but the sanction letter limits the sum assured to Rs. 25 lakhs for Personal Accident Insurance Cover which is mentioned in the sanction letter dt. 22.01.2018. The validity of this insurance is till the subsistence of the loan tenure of 10 years. The loan outstanding as on the date of accident 08.03.2020 was Rs. 26.27 Iakhs.That the other one is paid policy "Group Personal Accident Policy", with payment of Rs. 65,000/- towards premium. The validity is from dt.28.06.2018 to dtd. 27.06.2023 of this insurance policy i.e. for a period of 5 years with sum insured for 31,39,850/- vide policy no. 4005/M/69397073//00/000 and policy certificate no. 4005/M/ICICIHL/150734786/00/000. In this policy document the name of insured Bimaleswer has been incorrectly typed as Bikaleswer subsequently corrected to Bimaleswar on 17.09.2018. The spouse Sanjukta Panda is the nominee under the policy. According to the insurance benefit under this policy, the assured amount is payable on either of the two conditions i.e. (1) on death resulting from accident and (2) permanent total disability resulting from accident. The policy document also shows that OP-1 is the Agent of OP-2 with agent code (ID) (AQ):2470377. For the purpose of this document, the insurance company considers ICICI Bank Ltd. as the policy holder and it's Home Loan Customer as the insured. Only two sheet Group Personal Accident insurance document supplied to the insured in which all the above information is available. The OP-1 has granted home loan in the name of her husband for Rs. 30.65 lakhs repayable with 120 equitable EMI @Rs.38,496/- from 05.03.2018 to 05.02.2028. Originally the loan requirement was for Rs. 30 lakhs. The O.P-1 wanted to cover the husband Bimaleswar Prasad Panda under Group Personal Accident insurance policy with its sister concern O.P-2 with a total premium of Rs.65,000/-, the loan amount was for Rs. 30.65 lakhs. The home loan was taken for his flat at Sipra Sun City at Ghaziabad, Uttar Pradesh. The accident took place when he was on a visit to his native city Sambalpur, Odisha. The Complainant wife wrote a letter to the Branch Manager, ICICI Bank Ltd Plot No. -7, LSCOkhla Phase-2, New Delhi- 110020 vide letter dt. 15.07.2020 bringing the above stated facts fact to the knowledge of the Bank for the necessary action for indemnification from insurance company for the outstanding loan amount since the date of loss i.e accident from the insurance company for which the bank is the policy holder and the borrower insurance company is the insured. She fervently urged upon the Bank to initiate necessary process
forrealization of insurance amount and they may be exoneratedfrom the loan liability
of her husband. Even though more than one year has been elapsed the O.Pshas paid no heed for indemnification under insurance policy. The OPs are under obligation under the contract of insurance and promise made under loan sanction letter to indemnify the borrower for the total loan outstanding and under paid group personal accident policy and further make a payment to the Complainant borrower for the promised assured amount of Rs. 25 lakhs towards free personal accident cover by the Bank with interest. That apart the Bank has arbitrarily realized 4 EMIs between April-July 2020 even after accident amounting to Rs. 1, 53,984/-. The bank is liable to refund this amount with interest.
As per the O.P-1, on January 2018, the Complainant along with his wife, were availed from the O.P-1 Bank for a sanctioned loan of Rs. 30,65,000.00 (Rupees Thirty Lakhs Sixty-Five Thousand only) vide loan account no. LBGHZ00004271828 accordingly issued an offer/sanction letter to the complainant on 27.01.2018 enumerating terms and conditions of the loan. That, as per the terms of the sanction letter, the complainant was required to repay his existing auto loan account no. LAGHZ00034699024 and personal loan account no. SPGHZ00036577359 in full form the disbursement of the top up loan. After accepting the terms and conditions of the loan the Complainant executed loan facility agreement. Out of the sanctioned loan amount of Rs. 30,65,000/-, an amount of Rs. 1,91,160/- was disbursed to the personal loan account no. SPGHZ00036577359 towards closure of the personalloan, an amount of Rs. 4,04,596/- was disbursed to the auto loan account no. LAGHZ00034699024 towards closure of the auto loan, an amount of Rs. 24,04,244/- was disbursed to the Complainant on 25.01.2018 in his ICICI Bank SB a/c no. 071801003725 and Rs. 65,000/- was disbursed to ICICI Lombard GIC Limited towards one-time insurance premium. That, as per the terms of the sanction, the disbursed loan amount of Rs. 30,65,000/- was required to be repaid in 120 monthly installments of Rs. 38,496/- each. The Complainant repaid the installments regularly from 05.01.2018 till 05.07.2020 and started default in the loan thereafter. He added that the Complainant is not eligible for the Free Personal Accident Insurance Cover as per the terms of the sanction letter as the Free Accident Insurance Cover is only applicable to those Borrowers where the sanctioned loan amount is upto Rs. 25 lacs. Complainant availed loan amount of Rs. 30,65,000/- as such, the Complainant is not eligible for the free accident Insurance cover.The O.P-1 Bank has never received any letter intimation issued by the Complainant
intimating the incident as alleged. It is a matter of fact that the insurance claim has to be raised with the insurer not with the financier. However, as intimated by Opposite Party No. 2 a claim is raised claim with the Opp. Party No. 2 vide claim no. BAF044849109, wherein, the Opp. Party No.2 also has intimated the Complainant to produce certain documents for processing the claim vide its letter dated 20.10.2021. As such, the answering Opp. Party No.1 denied to have arbitrarily realized the installment amounts.
In the above noted case, the Opposite Party Nos.2, submitted that as per the Annexure-2 of the complaint petition, a Group Personal Accident Policy was issued by the ICICH-Lombard General Insurance Co. Ltd, but there is no other Policy under reference, so that a claim under Two Insurance Policies would arise. The averments in the Para-1 are denied by the O.P-2. The representative capacity of Smt. Sanjukta Panda for filing the case and to proceed with the claim is subject to the provisions of law and it at all the circumstances exist, this case would be maintainable at the instance of Smt. Sanjukta Panda, otherwise not. The O.P-2 stated that he has no knowledge as to what the Complainant speaks of "one of the Two Policies of Free Personal Insurance Cover provided by the financier/O.P.No.1 ICICI Bank Ltd. to the borrower/complainant for Rs.25 lakhs". But, as per the Annexure-1 the facility amount sanctioned to Bimaleswar Prasad Panda and Mrs. Sanjukta Panda, Ghaziabad was Rs.30 lakhs under the terms and conditions mentioned in the Annexure-1 of the complaint petition. It is admitted that one Group Personal Accident Policy Certificate bearing No.4005/M/ICICIHL/150734786/00/000 was issued by the O.P.No.2 Insurance Company for the insured Bikaleswar Prasad Panda and the sum insured was Rs.31,39,850/- for the period from 28.06.2018 to 27.06.2023 subject to receipt of complete premium, terms and conditions mentioned in the Policy . Since this Certificate was issued under the ICICI-Lombard Group Personal Accident Policy No.4005/M/69397073/00/000, dated 29.06.2018, it is governed by and is subject to the terms, conditions and exclusions contained in the Policy itself or otherwise expressed in the said Policy but not exceeding the sum insured as specified in Part-1 of that Policy Schedule. This Certificate of Insurance along with the Policy of Insurance covers the death resulting from accident and permanent total disablement resulting from accident of the insured. Subsequent to the issuance of the Policy, an endorsement was made by the O.P.No.2/Insurance Company to change the name from Bikaleswar Prasad Panda to Bimaleswar Prasad Panda with all other conditions remaining the same. Further he added
that the Annexure-2 is not the total Policy of Insurance, but the reverse page of the Annexure-2 is also an independent document and was issued subsequently to ratify the name of the insured. It is false to say that two sheets of Group Personal Accident Insurance documents were supplied to the insured. Hence, the averments are answered accordingly. The O.P-2 has denied that Bimaleswar Prasad Panda has been permanently totally disabled; and that he will depend on the family for his survival; and that this O.P. is under the obligation under the contract of insurance and promise made under Loan Sanction Letter to indemnify the borrower for the total loan outstanding and under Paid Group Personal Accident Policy; and that the complainant is entitled for Rs.25 Lakhs towards free personal accident cover along with interest.In this case no such information has been given to the O.P.No.2 at any point of time and no claim whatsoever has been made. Under those circumstances, the discharge of any obligation under any terms of contract does not arise at all. The O.P.No.2 Insurance Company is not a sister concern of the O.P.No.1 ICICI Bank Ltd. but they are two separate legal entities, and the O.P.No.2 Insurance Company is not liable to pay any compensation towards mental agony, harassment, inconvenience as there was never any negligence or deficiency in rendering services or adoption of any unfair trade practices by the Opposite Party No.2. The O.P.No.2 Insurance Company is also not liable for any cost.
POINTS OF DETERMINATION:-
- Whether the Complainant is comes under the purview of Consumer Protection Act-2019?
- Whether the O.Ps has committed any Deficiency in Service to the Complainant?
From the above discussion and materials available on records we inferred that the Complainant comes under the purview of Consumers as she is the wife of the deceased Bimaleswar Panda who had availed Insurance Policy on payment of premium amount as consideration for availing services. It is seen from the sanction letter that the Bank has made a declaration that“on final disburdenment of the loan, we provide a Free Personal Accident Insurance cover to the first applicant of the loan subject to the loan amount up to Rs. 25 lacs”. The amount is to the extent of Principal amount and as per the applicable conditions. It means that the Bank is agreed to provide a Free Personal Accident Insurance cover up an amount which is restricted to Rs.25 Lakhs and not more than that amount. As the Complainant has availed a loan of Rs.30,65,000/- from the O.P-1, the claim must be
settled at Rs. 25 Lakhs which is to be exonerated from the loan amount and the rest of the loan amount of Rs. 5,65,000/-will have to be paid by the Complainant as per the terms and conditions. In addition to that, a Group Personal Accident Policy was issued by the ICICI-Lombard General Insurance Co. Ltd for an amount of Rs. 31,39,850/- for the period from 28.06.2018 to 27.06.2023. The premium paid was for Rs. 65,000/-. Though the O.P-2 claims that the PA cover is not within his knowledge but it has been reflected in the sanction letter issued by the O.P-1 in favour of the Complainant. Again the question arose on the capacity of filing the Consumer Complaint by Sanjukta Panda, it is stated that as per section 2(7) of C.P act-2019 the Complainant has the right to file a consumer complainant on representative capacity on behalf her husband where there is an authorization by the original consumer or being the wife/legal heir of the Consumer. The O.P-2 has evasively denied the fact of permanently totally disablement of the policy holder Bimaleswar Prasad Panda and that he depends on the family for his survival. It is evident that Bimaleswar Prasad Panda was being treated at VSSIMSAR, Burla and AMRI, Bhubaneswar after getting severely injured by Road Traffic Accident.The complainant sent letter to the O.P.s for exonerating him from the liability of loan on the basis of terms and conditions mentioned in the insurance policy, but the OPs did not respondent her letter. In case "New India Assurance Company Limited Vs Smt. Usha Yadav & Ors.", 2008(3) RCR (Civil)-111(P&H), Hon'ble Punjab & Haryana High Court held as under:-"It seems that the Insurance Companies are only interested in earning the premiums, which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance Companies make the effected people to fight for getting their genuine claims. The insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus, pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy." Again answering the claim of the complainant that the O.P-1 is the sister concern of the O.P-2 this Commission observed that ICICI Lombard General Insurance has ceased to be a subsidiary of ICICI Bank from September-2021. Further it is observed that, the Bank has arbitrarily realized 4 EMIs between April-July 2020 even after accident amounting to Rs. 1, 53,984/-. Hence the non settlelement of claim in spite of receiving policy premium amounts to deficiency in service as well as Unfair Trade Practice as per C.P Act-2019. Hence we order as under:-
ORDER
The Complaint petition is allowed. The O.P-1 is directed to indemnify the PA cover amount of Rs.25 Lakhs to the Complainant with interest @ 9% per annum from the date of accident till its realization. The O.P-1 is further directed to return the 4 EMIs amounting to Rs. 1,53,984/- and Rs.23,200/- & 1,20,737/- taken arbitrarily to the Complainant with interest @ 9% p.a from dtd.05.07.2020 till its realization.The O.P-2 is directed to realize the assured amount under the Group Personal Accident Policy as assured to indemnify for the insured Complainant and adjust the same towards the outstanding loan (exonerated from the loan liability) and free the property from all liabilities. Further the O.Ps are jointly and severally directed to pay Rs.3,00,000/-as the compensation for inconvenience, harassment, mental agony and pain caused to the Complainant along with Rs.1,00,000/-(Rupees One Lakh)towards cost of litigation. All the above orders are to be carried out within 30 (Thirty) days of receiving of this order, failing which, the complainant is at liberty to proceed in due process of law.
Order pronounced in the open court today i.e, on 13th day of December-2021 under my hand and seal of this Commission.
Office is directed to supply copies of the Order to the parties free of costs receiving acknowledgement of the delivery thereof.
I agree,
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MEMBER(W) PRESIDENT
Dictated and Corrected
by me.
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PRESIDENT
policy premium amounts to deficiency in service as well as Unfair Trade Practice as per C.P Act-2019. Hence we order as under:-
ORDER
The Complaint petition is allowed. The O.P-1 is directed to indemnify the PA cover amount of Rs.25 Lakhs to the Complainant with interest @ 9% per annum from the date of accident till its realization. The O.P-1 is further directed to return the 4 EMIs amounting to Rs. 1,53,984/- and Rs.23,200/- & 1,20,737/- taken arbitrarily to the Complainant with interest @ 9% p.a from dtd.05.07.2020 till its realization. The O.P-2 is directed to pay the assured amount to the O.P. No.1 under the Group Personal Accident Policy as assured to indemnify for the insured Complainant and adjust the same towards the outstanding loan (exonerated from the loan liability) and free the property from all liabilities. Further the O.Ps are jointly and severally directed to pay Rs.3,00,000/-as the compensation for inconvenience, harassment, mental agony and pain caused to the Complainant along with Rs.1,00,000/-(Rupees One Lakh)towards cost of litigation. All the above orders are to be carried out within 30 (Thirty) days of receiving of this order, failing which, the complainant is at liberty to proceed in due process of law.
Order pronounced in the open court today i.e, on 13th day of December-2021 under my hand and seal of this Commission.
Office is directed to supply copies of the Order to the parties free of costs receiving acknowledgement of the delivery thereof.
I agree,
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MEMBER(W) PRESIDENT
Dictated and Corrected
by me.
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PRESIDENT
