West Bengal

Birbhum

CC-57-2014

Kamini Mohan Sarkar, - Complainant(s)

Versus

1) The Divisional Manager, - Opp.Party(s)

Prosenjit Das

12 Feb 2015

ORDER

The complainant’s case, in brief, is that Kamini Mohan Sarkar purchased “Jeenvan Saral” policy of LICI (the O.Ps) through an agent on 20/04/2004 with quarterly premium of Rs.3063 and deposited all the premiums regularly during 10years, i.e. from April 2004 to April 2014 amounting Rs. 1,22,520 . After maturity of the policy the complainant is directed by a letter from O.P No. 2 to receive Rs. 77,597 only as maturity sum which is far less than the principal amount of Rs. 1,22,520 and after reading the policy paper the complainant came to know that the O.P No.2 had not mentioned the maturity sum assured in the policy paper and the complainant overlooked that at the time of receiving the policy bond. But at the time of opening the policy the complainant was assured by the agent of the LICI that he will get all the deposited money with stipulated interest and bonus and the complainant had no knowledge about his policy. After that the complainant and O.P No.2 made correspondence to each other through letter several times. But all the effort of the complainant was in vain as the O.P No.2 did not send any cheque against his claim. On repeated demands the O.Ps also deliberately avoid to justify and specify the calculation of the payment of Rs. 77,597/-. Due to such activities of the O.Ps the complainant has been suffering with heavy loss and mental agony, hence this case. The complainant has prayed for reliefs as per complaint.

The O.Ps contested the case by filing written version and has admitted about the existence and maturity of the policy. The O.Ps have also stated that in the instant case the amount of death sum assured was only stated in the policy bond. But as per terms and condition of the “Jeevan Saral” policy under table 165 of manual provision, the person who have purchased this policy based on quarterly premium of Rs. 3063 and having age 56 years at the time of entry is entitled to get Rs. 59690 as maturity sum and a loyalty of Rs. 17,907/- if that person is survived at the date of maturity. They also mentioned that the O.P Corporation has correctly intimated the maturity amount to the complainant well in advance before the date of maturity. The O.Ps have again mentioned that their Suri Br. Office had rightly responded to every letter of the complainant in time and ready to pay the maturity value of Rs. 77,597 as per terms

​and conditions of the policy after completing all the formalities and there is no deficiency in service from their parts. As such the O.Ps have prayed for dismissal of the case with cost.

Both complainant and O.Ps did not adduce any oral evidence. Ld. Lawyer of both sides have filed written arguments and some relevant documents and made oral arguments also.

On appreciation of pleadings of both sides and verifying the documents on record following points are necessary for discussion to determine the case.

  POINTS FOR DETERMIATION

1. Is the complainant’s claim liable to be refused as per condition of the policy?
2. Whether there is any deficiency in service on the part of the O.Ps?
3. Is the complainant entitled to get relief or reliefs as prayed for?

DECISION WITH REASONS

Point No.s i), ii) & iii)

            All the points are interrelated to one another and taken up together for convenience of discussion and brevity.

            As a matter of fact, there is no dispute as regards the creation of the policy (Jeevan Saral policy) bearing No. 465354825 through an agent of LICI, Suri Branch on 20/04/2004 in the name of the complainant Kamini Mohan Sarkar at the age of 56 years against quarterly premium of Rs. 3063 with date of maturity 20/04/2014 and the complainant had deposited all the premiums in time total amounting to Rs. 1,22,520/-. We have heard Ld. Lawyers at length touching the nature of the policy.

            The complainant claims that the O.P has not mentioned the maturity sum assured in the policy bond and as per the declaration of the agent he is entitled to get entire deposited amount of Rs. 1,22,520 along with interest and bonus whereas the O.Ps claim that as per the terms and condition of the policy the complainant is entitled to get Rs. 77,59 in total.

            We have carefully gone through the terms and conditions provided in the manual provision under which Jeevan Saral policy was planned. Apparently the manual provision of the policy in question speaks that as per table and term 165-10(mentioned in the policy bond also) a person who has purchased this policy at the age of 56 years against monthly premium of Rs. 100/- for the terms 10 years, if survives at the date of maturity he will get Rs. 5,969 as maturity sum assured. In the instant case the complainant has purchased this policy at the age of 56 years against quarterly premium for the main plan of Rs. 3000 i.e. against monthly premium of Rs. 1,000/- (100x10) for the terms 10 years. So, he will entitle to get Rs. 59,690 (5969x10) as maturity sum assured. Again the chart for loyalty addition shows that a person will get Rs. 300/- as loyalty addition against maturity sum assured of Rs. 1,000. So, the complainant is entitled to get Rs. 17,907 (300x59.690) as loyalty over his maturity sum of Rs. 59,690. Therefore the complainant is entitled to get Rs. 77,597 (59,690+17,907) in total as maturity value and in case of death before the date of maturity the amount of death benefits sum assured as per the said policy is Rs. 2,50,000. Moreover the O.Ps have explained at the time of argument that Jeevan Saral policy was​ designed for high risk coverage at death before the date of maturity at a lower rate premium. That is why the death sum assured is much higher than the maturity sum assured. In view of the above, our conclusion is that as per terms and conditions of the said policy the complainant is entitled to get Rs. 77,597/- in total as maturity sum assured along with loyalty addition. It is true that the O.Ps did not mention the maturity sum assured in the policy bond. It is nothing but merely omission. For that reasons the terms and conditions of the policy have not been hampered in any way and the complainant has not been prejudiced in manner for such omission. For such omission it cannot be concluded that there is deficiency in service on the part of the O.Ps.

            Again the complainant has stated that he had no knowledge about the policy bond and he overlooked the matter of omission regarding the maturity sum assured in the policy bond. It is unbelievable that a literate person had no knowledge about the terms and conditions of the policy. Besides that there is a provision at the end of the policy paper where the policy holder is requested to examine the policy papers and return it or approach to grievance Redressal Officer or Ombudsman if there is any mistake or complaint. So, the complainant had the opportunity to clear his queries but the complainant did not do the same when the policy was in running mode. Therefore, such type of pleading of the complainant is not acceptable.  Here we find that the complainant is entitled to Rs. 77,597 in toto and the O.Ps were/are ready to pay the sum after observing all the formalities. The O.Ps have not violated the terms and conditions of the policy. So, we are of the view that there is no deficiency in service on the part of the O.Ps. Therefore the instant case is liable to be dismissed. Accordingly points No. i), ii) & iii) are disposed of. In the result the instant case fails.

Proper fees have been paid.

Hence,

O R D E R E D

                                                              that C.F case No. 57/2014 be and the same is dismissed on contest against the O.Ps without cost.

Copy of this order be supplied to the parties free of cost.