IMPORTANT POINT
Insurance claim held rightly repudiated for suppression of pre-existing disease.

ORDER

Two Appeals, First Appeal No. 509 / 2016 and First Appeal No. 516 / 2020, have been filed by ICICI Lombard General Insurance Company Ltd. (hereinafter referred to as the Appellant Insurance Company) and ICICI Bank Limited (hereinafter referred to as the Appellant ICICI Bank) respectively against the Order dated 26.06.2020 passed by the State Consumer Disputes Redressal Commission Delhi (hereinafter to be referred to as “State Commission”), whereby the Complaint filed by Ms. Neema Saini (hereinafter referred to as the Complainant) was allowed and the Appellant Insurance Company and the Appellant ICICI Bank were directed to allow the claim preferred by the Complainant within two months from the date of receiving of the certified copy of the Impugned Order. They were also directed to pay Rs.25,000/- towards costs for causing harassment to the Complainant.

Brief facts of the case as narrated in the Complaint are that the Complainant’s husband Sh. Dharamvir Saini obtained a Home Loan No. LBDEL00002032769 for Rs.75,00,000/- from the Appellant ICICI Bank. It was alleged that after insisting by the Appellant ICICI Bank, her husband obtained Insurance Cover for Rs.75,00,000/- from the Appellant Insurance Company to safeguard the Housing Loan and it was told that in the event of his unfortunate death, his legal heirs would not be required to pay any loan and the entire loan would be paid off from the amount received from the Appellant Insurance Company. The Appellant ICICI Bank charged a sum of Rs.3,43,980/- towards premium of the said Insurance Policy which was adjusted in the Home Loan and it was required to be paid by Shri Dharamvir Saini alongwith EMI of Home Loan. It was alleged that Insurance Policy was collected by the Appellant ICICI Bank and was not issued to the Complainant on the ground that he may cancel it in which event the loan would remain unrecovered. After two years from obtaining the Policy, i.e., on 20.10.2015 Shri Dharamvir Saini had fallen sick and was admitted in Max Healthcare Super Specialty Hospital. He could not survive and expired on 25.10.2015 due to septic shock with MODS. The Hospital issued the death summary. The Appellant ICICI Bank asked the Complainant to sign some documents for lodging claim with the Appellant Insurance Company. The Complainant received letter dated 23.11.2015 from the Appellant Insurance Company for submission of relevant documents, which were duly submitted. Despite repeated visits to the Appellant Insurance Company and the Appellant ICICI Bank, claim was not processed. Ultimately, the Appellant Insurance Company vide letter dated 07.03.2016 repudiated the claim on the ground that the claim do not fall within the purview of terms and conditions of the Insurance Policy. Alleging deficiency of service and Unfair Trade Practice on the part of the Appellant Insurance Company and the Appellant ICICI Bank for not providing Insurance Policy and repudiating the genuine claim, the Complainant has filed a Consumer Complaint before the State Commission seeking following directions to the Opposite Parties:-

a) To pay Rs.75,00,000/- to the Complainant alongwith interest 18% per annum from the date of death of Sh. Dharamvir Saini, i.e., 25.10.2015 to till realization;

b) To pay Rs.20 lakh as compensation against mental agony pain suffered by the Complainant;

c) To award litigation cost of Rs.1,00,000/- to the Complainant.

2. The Appellant Insurance Company contested the Complaint by filing its Written Statement and denied the contents of the Complaint suffering from factual inconsistency and submitted that the Insured suppressed the material information regarding pre-existing disease due to which they were not liable to approve the claim of the Complainant. The Appellant ICICI Bank also contested the Complaint and raised preliminary objections that the Complainant is not a Consumer; Complaint is barred by limitation; no cause of action has been disclosed against them, therefore, they