KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL No. 732/2016
JUDGMENT DATED: 02.09.2022
(Against the Order in C.C. 265/15 of CDRF, Malappuram)
PRESENT:
HON’BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT
SRI.T.S.P. MOOSATH : JUDICIAL MEMBER
SRI.RANJIT. R : MEMBER
SMT. BEENA KUMARY. A : MEMBER
SRI. RADHAKRISHNAN K.R. : MEMBER
APPELLANT:
The Branch Manager, LIC of India, Ramanattukara, P.O. Ramanattukara represented by the Authorized Officer, Manager L & HPF LIC of India, Divisional Office, Thiruvananthapuram.
(By Adv. Anitha Aji)
Vs.
RESPONDENT:
B. Mohammed, Anees Nivas (H), House No. VPV: 150, Vazhakkad P.O., Malappuram-673 633.
(Party in person)
JUDGMENT
SRI. RADHAKRISHNAN K.R. : MEMBER
The appeal has been filed under Sec. 15 of the Consumer Protection Act, 1986 by the opposite party in C.C. No. 265/2015 of the Consumer Disputes Redressal Forum, Malappuram (District Forum/Commission for short) against the order dated 30.07.2016. The District Forum allowed the complaint and directed the opposite party to give an amount of Rs. 31,792/- being the balance amount towards his policy along with a compensation of Rs. 10,000/- for the mental agony and hardships suffered by him and a cost of Rs. 5,000/- within one month from the date of receipt of the copy of the order, failing which the complainant is held entitled to get 12% interest upon the above amount from the date of pronouncement of the order.
2. Brief details of the complaint are as follows: The complainant had taken a money-back policy ‘Jeevan Surabhi’ from the opposite party for a sum assured of Rs. 50,000/- for a period of 15 years from 28.08.2000. Quarterly premium was paid @ Rs. 1,704/- for 12 years as per terms of the policy and the total premium paid was Rs. 81,792/-. He received an amount of Rs. 50,000/- (Rs. 15,000/- after 4 years, Rs. 15,000/- after 8 years and Rs. 20,000/- after 12 years). He is entitled to get Rs. 28,550/- towards bonus after the policy period. Complainant alleges that though he has paid Rs. 81,792/-, the opposite party paid Rs. 50,000/- only and thus cheated him by not paying the balance amount of Rs 31,792/-. Hence, he filed the complaint claiming Rs. 31,792/- with compensation for mental agony and hardships suffered by him.
3. Opposite party entered appearance and filed version. The opposite party admitted having issued a money-back policy to the complainant with a sum assured of Rs. 50,000/- and collected quarterly premium of Rs. 1,704/- for 12 years. They contended that the premium collected included premium for covering the death of the life assured and in case of the death of the life assured full sum assured with vested bonus is paid. In this case only survival benefit and vested bonus are payable. Survival benefit of Rs. 50,000/- was already paid and the bonus was not paid as the life assured/complainant did not surrender the policy document in time. There is no deficiency on their part and hence they prayed for dismissal of the complaint.
4. Complainant filed chief affidavit and marked Exts. A1 to A5 on his side. Considering the evidence adduced the District Commission passed the impugned order. Aggrieved by the said order the opposite party has preferred this appeal.
5. Heard. The learned counsel for the appellant submitted that they have paid the amount as per the terms and conditions of the policy. The policy covered for death benefit of the respondent/complainant for a period of 15 years and the amount collected includes the premium for this coverage also. The survival benefit of Rs. 50,000/-, as stated on the face of the policy is already paid in three instalments on agreed dates. The survival bonus of Rs. 28,550/- was also paid after maturity of the policy. Timely intimation was given to the respondent/complainant for submitting policy bond and discharge voucher. But he did not submit the required documents in time. This is the reason for the delay in payment of the bonus amount for which respondent only is liable.
6. The learned counsel further submitted that an insurance policy is taken as a security or protection against unforeseen events such as death or accident. Total benefit under the policy given to the respondent is Rs. 78,550/- (Rs 50,000+Rs 28,550/-) plus value of risk cover for 15 years. This coverage is enjoyed by the respondent/complainant/life assured during the policy period. The sum assured is paid in case of death or accident benefit to his nominee or himself as the case may be, and if he survives, policy assured amount and bonus are paid. The appellant acted only as per terms and conditions of the policy which are binding on both parties. The order of the District Commission is against the contract of insurance. The learned counsel relied on the judgment of the Apex Court in United India Insurance Co Ltd Vs M/s Harchand Rai Chandan Lal {AIR (2004) SC 2094} in support of her arguments, in which case their lordships observed that “the policy is a contract between the parties and both parties are bound by the terms of contract”. The respondent did not suffer any mental agony or hardship. There is no deficiency on the part of the appellant and hence prayed for setting aside the order of District commission and allow the appeal.
7. The respondent/complainant in his written reply submitted that the appellant / opposite party was bound to pay the bonus amount, which is the share of the profit, over and above the total premium paid by him and it was his right. Thus he was eligible to get the full amount of Rs. 81,792/- paid by him and the bonus of Rs. 28,550/-. He has received Rs. 50,000/- plus bonus amount of Rs. 28,550/- only. He is yet to get Rs. 31,792/- from the appellant. The appellant is making frivolous arguments to avoid payment of his eligible amount. Denying payment of balance amount and delaying bonus payment amount to deficiency in service. Hence he prayed for dismissing the appeal and confirming the order of the District Commission.
8. We have considered the submissions and perused the records. The policy issued by the appellant is a money-back policy called ‘Jeevan Surabhi’. It provides a combination of protection against death throughout the term of the policy of 15 years along with periodic payment on survival at the specified durations during the term. If the life assured survives, he would receive 30% of the sum assured at the end of 4th and 8th years and the remaining 40% of the sum assured at the end of 12 years. The risk cover continues till the maturity of the policy when he would receive the bonus. These terms are printed on the face of the policy (Ext. A1) itself. It is stated that vested bonus only is payable on the date of maturity. The sum assured under the policy is Rs. 50,000/-. It is true that the appellant has collected Rs. 81,792/- as premium. But we have to consider the fact that the amount paid by the respondent includes the premium for covering his life, with accident benefit, for 15 years. As per policy conditions, the appellant was liable to pay the full sum assured with bonus, in case of the unforeseen event of the death of the life assured, till the end of 15 years. Whether the unforeseen event happened or not, the appellant covered the risk of life of the life assured/Complainant/Respondent, with accident benefits for the entire period, for which premium is payable. The observations of the Apex Court in M/s Export Credit Guarantee Corporation of India Ltd Vs M/s Garg Sons International, {2013(4)CPR 373(SC)}, which is reproduced below, are relevant here:
“9. The insured cannot claim anything more than what is covered by the insurance policy. The terms of the contract have to be construed strictly, without altering the nature of the contract as the same may affect the interests of the parties adversely” In view of what is stated above, we do not find any lapse on the part of the appellant in making the payments under the policy issued to the respondent.
9. The policy matured on 28.08.2015 and the respondent/complainant was eligible to get Rs. 28,550/- as survival bonus. This was paid only on 17.06.2016 and there is delay on the part of the appellant in payment of the bonus amount. But it is observed that this delay occurred as the respondent/complainant did not comply with certain requirements in time. He failed to surrender the policy document despite the communications dated 04.06.2015 (Ext. A3) and 29.06.2015 (Ext. A4) from the appellant. Hence we do not find any deficiency on the part of the appellant in this regard.
10. From the foregoing discussion, we find that there is valid ground for the contentions of the appellant. The District Commission erred in finding deficiency on the part of the appellant and hence the order under appeal is liable to be set aside.
In the result, the appeal is allowed. The order dated 30.07.2016 in C.C. No. 265/2015 on the file of the District Commission, Malappuram is set aside. There is no order as to costs.
The sum of Rs. 25,000/- deposited by the appellant on filing this appeal shall be refunded to them on filing proper application.
JUSTICE K. SURENDRA MOHAN : PRESIDENT
T.S.P. MOOSATH : JUDICIAL MEMBER
RANJIT. R : MEMBER
BEENA KUMARY. A : MEMBER
K.R. RADHAKRISHNAN : MEMBER
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