M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                         

                             PLOT NO.76, ARERA HILLS, BHOPAL

 

                                      FIRST APPEAL NO. 12 OF 2020

(Arising out of order dated 26.09.2019 passed in C.C. No.557/2017 by District Commission, Indore-2)

 

ICICI LOMBARD GENERAL INSURANCE

COMPANY LIMITED, ICICI LOMBARD HOUSE,

414, VEER SAWARKAR MARG,

PRABHADEVI, MUMBAI THROUGH MANAGER LEGAL.                              … APPELLANT.

 

         Versus

 

1. ANITA TIWARI

    W/O LATE ARVIND TIWARI,

    R/O KALYAN SAMPATTI COLONY,

    KALI BILLOD, INDORE (M.P.)

 

2. INDIA BULLS,

    FIRST FLOOR, 2-A&B

    CORPORATE HOUSE,

    R.N.T. MARG, INDORE (M.P.)                                                                ...   RESPONDENTS.  

                    

BEFORE :

            HON’BLE SHRI A. K. TIWARI                : PRESIDING MEMBER

            HON’BLE DR. SRIKANT PANDEY        :          MEMBER

                     

COUNSEL FOR PARTIES :

                Shri Alankar Soni, learned counsel for the appellant.

           Shri Sunil Nema & Shri Vivek Anand Nema, learned counsel for the respondent no.1

           None for the respondent no.2.

 

O R D E R

(Passed On 23.08.2023)

                                The following order of the Commission was delivered by A. K. Tiwari, Presiding Member:

                   Challenging the order dated 26.09.2019 passed by the District Consumer Disputes Redressal Commission, Indore-2 (for short ‘District Commission’) in C.C.No.557/2017 whereby the District Commission has allowed the complaint filed by the complainant/respondent no.1 (hereinafter

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referred to as ‘complainant’), the opposite party no.2/appellant-ICICI Lombard General Insurance Company (hereinafter referred to as ‘insurance company’) has filed the instant appeal.

2.                Facts of the case as narrated by the complainant are that the complainant’s late husband Arvind Tiwari (hereinafter referred to as ‘deceased-insured’) during his life time on 30.06.2014 took housing loan from the opposite party no.1-India Bulls (hereinafter referred to as ‘financer’). The said loan was insured with the insurance company by two policies for 5 years term of covering the risk for a sum of Rs.3,15,000/- and Rs.3,85,000/- respectively and the financer had paid premium to the insurance company. The deceased-insured was in good health at the time of taking loan and insurance policies. Later when he fell ill he consulted the doctors at Sagar and Betma but when he could not get any relief, he consulted Dr. Suman Agrawal at Mhow, and was diagnosed some kidney ailment.  Dr. Suman Agrawal referred to him Bombay Hospital, Indore. Thereafter he underwent kidney transplant at Choithram Hospital, Indore and unfortunately died on 15.05.2017. The complainant approached the insurance company and submitted her claim.  It is alleged that thereafter on 11.01.2017 two persons from the insurance company came and advise her to give in writing to the effect that the deceased-insured was suffering from pre-existing disease in order to get claim amount at the earliest. They also

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managed Dr. Suman Agrawal to write hypertension on the prescription and took Rs.25,000/- from her for settling the claim at the earliest, of which she lodged a police complaint against them on 23.06.2017. It is further alleged that despite genuine claim the insurance company rejected her claim on the ground of pre-existing disease.    The complainant therefore alleging deficiency in service on part of the opposite parties, approached the District Commission seeking relief.

3.                The opposite party no.1-financer resisted the complaint stating that the complainant had obtained housing loan from it thus liability of repayment of loan amount is of the complainant. The claim of the complainant was repudiated by the insurance company. The financer has no authority to interfere with the work of the insurance comp

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