Both these Revision Petitions have been preferred by the Petitioner/OP-2/ICICI Prudential Life Insurance Co. Ltd. against the Respondent/Complainant-Prem Kumar Aggarwal (RP No. 732 of 2020) and against Respondent/OP-1/ICICI Bank Ltd. (RP No. 735 of 2020).  These Revisions are challenging the common Order dated 7.1.2020 of the State Commission Delhi, passed in First Appeal No. 231 of 2016 filed by the ICICI Bank and First Appeal No. 367 of 2016 filed by ICICI Prudential Life Insurance Co. Ltd.  Both these Appeals were filed before the State Commission against the Order dated 14.12.2015 passed by the District Forum in Consumer Complaint No. 405 of 2015 filed by the Complainant-Prem Kumar Aggarwal against OP-1/ICICI Bank Ltd. and OP-2/ICICI Prudential Life Insurance Co. Ltd.

2.      Originally, the Consumer Complaint bearing no. 405 of 2015 was filed before the District Forum (East), Delhi by Sh. Prem Kumar Aggarwal/Complainant/Respondent against ICICI Bank Ltd./OP-1/Respondent and ICICI Prudential Life Insurance Co. Ltd./OP-2/Petitioner. The factual matrix before the District Forum was as under:

1. The case of the Complainant was that he had a Saving Bank Account bearing No. 003701017072 and loan account bearing No. LBNOD00002341496 with the OP 1-ICICI Bank. The Bank vide its letters Nos. 9885413 and 0076694 both dated 15.01.2015, offered a loan with and without Insurance for Rs.1,50,00,000/- and Rs.1,63,00,000/- respectively. The total premium for the Insurance was Rs.13,00,000/- which was being financed by OP-1 for payment to OP-2. The Premium was to be directly paid by OP-1 to OP-2. The Complainant opted for loan of Rs.1,63,00,000/- with Insurance, and the OP-1 got the Agreement dated 16.03.2015 signed from the Complainant and Co-applicant of the Complainant.
2.  Vide letter dated 18.03.2015, the OP-1 informed that it had disbursed a sum of Rs.1,52,60,000/- against a sanctioned loan of Rs.1,63,00,000/- on 17.3.2015. The OP-1 collected a pre EMI of Rs.21,513/- from the Complainant on 06.04.2015. The OP-1 then handed over a cheque of Rs.1,50,00,000/- to the seller of the house on 21.04.2015. On enquiring about the difference in  amount, the OP-1 informed that Rs.2,60,000/- had been paid to OP-2 towards Insurance Premium for two years. After 15 days of disbursement of loan of Rs,1,52,60,000, the OP-1 deducted Rs.2,16,762/- as EMI for loan amount of Rs,1,63,00,000/- from the Savings Account of the Complainant.
3. The OP-2 had never stated that the Insurance would be subject to any condition and no such condition was mentioned in the Offer Letter dated 15.01.2015.  The OP-2 refused to provide Insurance cover citing ‘TMT findings and past medical history” without any basis and no critical medical condition was ever mentioned by OP-2. Hence, the complaint was filed by the Complainant originally praying for refund of Rs.21,513/-; recalculating EMI on Rs,1,52,60,000/- instead of Rs,1,63,00,000/- from 05.06.2015 and refund of EMI charged on 05.05.15; charge pre-EMI on 05.05.15 for loan of Rs.1,52,60,000; direction for Insurance Company to provide the Insurance cover, refund Rs.1,30,000 premium for one year from the premium of Rs.2,60,000/- which was for two years along with other ancillary reliefs.  
4. The District Forum observed that the amount of sanctioned loan of Rs.1,63,00,000/- was for a tenure of 120 months and EMI of Rs.2,16,763/- and date of commencement was 05.04.2015.   The District Forum also noted that Annexure C-4 gives the total amount sanctioned, the disbursed amount of Rs.1,52,60,000/- and further mentioned about a pre EMI for the next month till further disbursal of Rs.1,29,075/.
5. The District Forum also observed that Rs.1,50,00,000/- was paid to the seller on 31.03.2015. It had been argued that till 31.03.2015, the amount was with the Bank and the date of commencement of EMI was 05.04.2015. The EMI could only be started from the date of disbursement and payment by the Bank. At best, EMI could only be charged by the Bank from 31.03.2015 to 05.04.2015 while they have calculated pre EMI from 17.03.2015 when this amount was not available to the Complainant. As such the charging of Rs.21,513/- was illegal, and the same deserved to be reverted by OP-1 into the Complainant’s Account.
6. The District Forum further observed that charging of EMI on Rs.1,63,00,000/- which was Rs.2,16,762/- was illegal as the disbursed amount was Rs.1,52,60,000/-. The   OP-1 had thus violated the principles of financial discipline.
7. The District Forum had also observed that the Insurance Policy was not issued by  OP-2 only on the ground of Health risk. The amount of Premium was received by OP-2 Company and refunded back to the Bank. The OP-2 had not filed any evidence to disentitle the Complainant for availing facility on Insurance on the health grounds. The only fact mentioned in OP’s affidavit was that kidney of the Complainant was removed in 2010.  In last five years, there was no evidence to show that the complainant was suffering from any other ailment. The ground taken by OP-2 that the Complainant’s health was at risk was therefore as arbitrary, as there was no proof on record that the Complainant was having ‘TMT findings and Past Medical History’. Hence, denial on the part of   OP-2 and reversal of the amount was held to be illegal.   
8. Consequently, the District Forum vide its order dated 14.12.2015 allowed the complaint and directed i) OP-2 to provide insurance cover to the loanee; ii) OP-1 to refund Rs.21,513/-; iii) and also to refund the excess amount charged on EMIs with interest along with other ancillary reliefs.

3.      First Appeal No. 231 of 2016 was filed against the aforesaid Order dated 14.12.2015 of the District Forum by ICICI Bank Ltd. against Prem Kumar Aggarwal and ICICI Prudential Life Insurance Co. Ltd. before the State Commission, Delhi.  Another First Appeal No. 367 of 2016 was filed against the aforesaid Order dated 14.12.2015 of the District Forum by ICICI Prudential Life Insurance Co. Ltd. against Prem Kumar Aggarwal and ICICI Bank Ltd. before the State Commission, Delhi.  Both these Appeals were decided by the State Commission vide common impugned Order  dated 07.01.2020 as follows:

1. As Rs.1,50,00,000/- were paid to seller on 21.04.2015 vide cheque dated 31.03.2015, the amount had remained with the Bank till 21.04.2015. Hence, the Bank could not charge pre EMI from 17.03.2015. Hence, charging of Rs.21,513 towards pre EMI was illegal.
2. Regarding the second dispute, the State commission observed that EMI of Rs.2,16,762/- was for loan of Rs.1,63,00,000/- but when the amount disbursed was Rs.1,52,60,000/-, the same EMI could not be charged. It should have been reduced proportionately.
3. Regarding the third issue, the State Commission gave an opportunity to the OP-2 to file the Proposal Form to show whether  the Complainant had concealed that his kidney was removed in 2010. The OP-2 failed to file the Proposal Form. Hence, an adverse inference was drawn against OP-2 to that effect. Hence, findings of the District Forum directing the OP-2 to provide Insurance Cover were upheld.  
4. The State Commission therefore disposed off both the Appeals and held that the Order of the District Forum directing OP-1 to credit Rs.21,513/- in the Complainant’s Account was justified, and directing  OP-1 to refund the excess amount charged on EMI by calculating interest of 10.15% was also justified. The OP-1 was directed to recalculate the EMI by taking the rate of interest as 9.85% p.a. on Rs.1,50,00,000/- instead of Rs. 1,63,00,000/-and charge the future EMI at that rate, and credit the excess amount already recovered. The OP-2 was directed to issue Insurance Policy to secure loan after receiving Premium as offered.

4.      Hence, these two revision petitions have been filed by the Petitioner/Insurance Company challenging the impugned Order dated 07.01.2020 passed by the State Commission, Delhi.

5.      It may be mentioned at the outset that both these Revision Petitions were filed on behalf of the Insurance Company ICICI Prudencial Life Insurance Company,  simultaneously on 27/07/2020 through Shri B.S Banthia, Ld. Counsel for the Petitioner.

6.      It is not clear why two separate Revisions against the same impuged Order were filed by the same Party, when even the entire contents are virtually identical. The only superficial difference that transpires is that the Respondent No.1 in RP/732/2020 has been shown as Respondent No.2 in the other Revision, while the Respondent No.1 i.e ICICI Bank Limited (in RP/732/2020) has been arraigned as the First Respondent in the other Revision Petition.

7.      Decisions of both the Ld. Fora below are also virtually concurrent, in essence, having gone in favour of the Complainant/Respondent No.1 in RP/732/2020.  During the course of hearing a limited point of controversy had emerged which was put on record on an earlier date (25/11/2022) as to whether the Petitioner/Insurance Company in the facts and circumstances of the present case could have been compelled to accept the Insurance proposal on behalf of the Complainant merely because the premium of the first two years installment was into its account even before the requisite medical examination of the proposal could be done.

8.      In this regard, Ld. Counsel for the Respondent/Complainant has relied upon the decision of this Commission in which the Revision filed on behalf of the Life Insurance Corporation of India against the Order of the State Commission in a somewhat similar situation was dismissed by this Commission with the following observations:-

“11. The Hon'ble Supreme Court has clearly held that the insurance contract is a contract of utmost faith and is two ways door and where the premium is paid it is for the Insurance Company to ensure that on receipt of such premium, the policies are issued in due time. In the present case, the premium was received on 31.07.2000 and the Insured died only on 21.10.2001 and for more than one year, the Insurance Company has failed to issue any policy to the insured. They had taken the plea that they had been writing letters to the insured for his medical examination which they had eventually failed to prove on record as they took the plea that the applications had been destroyed. Even the Hon'ble Supreme Court in D. Srinivas's case supra has also held that once the Insurance Company accepts the premium, the very acceptance of the premium shows that they have waived the condition precedent for medical examination. This very act that no insurance policy had been issued for such a long period despite the receipt of the premium itself shows deficiency in service on the part of the Insurance Company. Therefore, non-payment of insured sum, compounds the said deficiency. In light of this established principle of law, which the State Commission has correctly followed in the impugned order, I find no illegality or infirmity requiring any intervention in the impugned order. The Revision Petitions have no merits and are dismissed with no order as to costs.”   

Emphasis added

9.    In the present case, the Complainant/Respondent did undergo the medical examiniation as required by the Insurance Company.  His Insurance proposal was subsequently declined by the Company with such reasons which are reproduced as below:-

 “We have evaluated your Application and regret to inform you, that we are unable to provide you with insurance cover as your Medical Reports indicate the following medical conditions:

1. TMT Findings.
2. Past Medical History”

10.  A bare glance over the reasons for declining the proposal would prima facie indicate that there must have something wrong in the TMT Findings/Report pertaining to the proposal during the course of medical examination, and that there must have been some indication about the likelihood of his life expectancy being compromised on account of certain medical conditions which were however, not specified in the relevant letter dated 25/05/2015 issued by the Petitioner’s Insurance Company.

11.  This Court has thereafter perused the aforesaid documents pertaining to the Complainant’s Medical Examination which include his TMT Report as well as the Medical Examination Report pertaining to his examination conducted by “Dr. Chandra’s Path Lab” which was the Authorized Medical Officer/Establishment on behalf of the Insurance Company itself.

12.  The TMT Report which is part of the Annexure P-1 concludes, “Negative for Provocable Reversible Ischaemia” which would mean that during the TMT Exercise undergone by the Complainant, there was no danger of short supply of blood relating to any heart problem like Angina or feelings in the nature of a heart attack.  In the nutshell, the TMT Report squarely went in the favour of the Complainant.

13.  Regarding his “Medical History” as relied upon by the Insurance Company, which is on Page 80  of the Paper-Book in RP/732/2020, it is seen that the fact that one kidney of the Petitioner had been removed in 2010 after invasive surgery was noted in the report itself, and in the confidential comments, the Medical Examiner has categorically stated “No” in his opinion about the existence of the “Examinee’s”, “life style or character which might in infavourably  affect insurability or any points on which you suggest further information be obtained?”

14.  Consequently, even the Medical Examination Report including the Complainant’s Medical History found nothing adverse against him except for the effect that he had got removed one kidney 05 years ago prior to the Medical Examination and which was also disclosed in his own proposal form.  Till now nearly 13 years have passed since his kidney was removed, and the Respondent/Complainant claims of not having faced any kidney related problems ever since.  Medical jurisprudence also holds that persons with single kidney  are medically fit to live a regular life.

15.  Consequently, the refusal on part of the Petitioner/Insurance Company to provide Insurance coverage to the Complainant was clearly cryptic and insufficient especially in a situation when it had already accepted the premium in advance for the first two years of the Insurance coverage before calling the Complainant for medical examination, in which even otherwise nothing adverse emerged against him.

16.  The case is therefore squarely covered by the decision of the Supreme Court in “D Srinivas Vs. SBI Life Insurance Company Limited (Civil Appeal No.2216/2018)”, which was also relied upon by this Commission in “Life Insurance Corporation of India Vs. Savitri Devi” (Supra).

17.  It may be further noted that no appearance on behalf of the Petitioner’s side was made in either of the Revision Petitions when the matter finally came up for hearing today after the Petitioner’s side had been regularly appearing and taking steps right up to 25/11/2022, on which date the limited question which has been dealt with in this Order was identified and noted.

18.  For the aforesaid reasons, this Commission finds no tangible grounds to interfere with the concurrent decisions  of both the Fora below.  The Revisions are dismissed with consolidated costs of ₹20,000/- in favour of Respondent/Complainant Mr. Prem Kumar Aggarwal.