MR. PRABODHA KUMAR DASH, PRESIDENT:-
This C.C.Case No. 5/2021 taken up today for order. We perused the materials available on record. We gone through complaint petition along with PLI Bond, calculation sheet & written version of Ops with calculation sheer, rules & regulation of IRDA, Postal (PLI) Pass book, the only dispute arose regarding auto-paid up maturity inclusive of bonus or without any bonus.
Brief Fact:-
Complainant being an employee eligible for Postal Life Insurance in short (PLI) known as “ Yugal Surakshya” purchased from Kendrapara Head Post Office on dt. 21.07.2001 vide Policy No. OR-YS-79122-CSfor sum assured Rs. 1,00,000/-(One Lakh) at the age of 39 as joint Policy with his wife maturity dt. 22.07.2020 & monthly premium amount of Rs. 473/- for 19 years. The insured paid premium for four years six months i.e, 54 months amounting to Rs. 25,542/-. Unfortunately the insured failed to deposit subsequent premium as per policy terms. The said policy on maturity the insurer after verifying relevant document paid only Rs. 23,684/- on dt. 04.08.2020 to the insured as full and final settlement Complainant raised the grievances several times sent advocate notice that the insurer kept the money for 19 years and did not pay appropriate bonus as per the policy. The Ops could not settled the dispute on remark that, the policy amount on maturity date did not prescribe any bonus. Being aggrieved by inaction of Ops complainant appeared before this Commission with prayer for appropriate bonus with mental agony and litigation cost with interest.
The Ld. Counsel for Complainant submitted that, the insured is a consumer under the insurer. The Ops committed deficiency in service as the mandate under C.P.Act. Further the Ops did not paid appropriate bonus as provided under the Policy condition. Complainant further filed the pass book insured by Op while the said bond was issued where in and where under on Point No.7 it was given as under.
A Policy holder may at any time after payment of premium for not less than 3 years, apply to have his policy paid up for reduced sum assured free from payment of further premium thereon. Bonus is paid on paid up policies also on the reduced sum assured for which the policy is paid up which was in 2001 at the time of insurance contract.
A paid up value is the value of your sum assured after you stop paying your premium. The sum assured decided at the start of policy is reduced if you do not pay all the premiums. The reduced sum assured is known as paid up value.
The Ld. Counsel for Ops take us to the Postal Rules 2011, Rules 51(1) wherein and where under “paid up policies will not attract bonus with effect from the date of discontinuance of premia, proportionate of bonus shall however be paid on paid up value after completion of 5 years i.e, if a policy remain in force at least for 5 years”. Ld. Counsel submitted their rules are applicable for Complainant case which was entered into 2001.
The Ld. Counsel for Ops further submitted the formula for paid up maturity value;-
= No of installment already given X sum assured
Terms of policy years X 12 (as 12 months in one year)
= 54 months premium X Sum assured(1,00,000/-)
19X2
= Rs. 23,684/-.
Paid up maturity value on decreased sum assured not disputed, but only dispute relating to bonus on auto paid-up Policy for which the Complainant given calculation formula as below:-
Reduced accured bonus also known as proportionate bonus admissible to insured under the paid-up policy.
For sum assured Rs. 1000/- the declared bonus accrues at rate of Rs.52/-.
For the sum assured Rs. 23,684/- the declared bonus accrues per annum is
Rs.52 X Rs. 23,684 = Rs.1232 (One year bonus) .
1000
The Policy remain for 19 years, hence the accumulated bonus for 19 years is Rs. 1232 X 19 = Rs. 23, 408/-.
It is stated Ld. Counsel for Complainant that the Ops only paid paid-up maturity value without bonus. Therefore insured entitled to paid up value + accumulated bonus i.e, Rs. 23,684/- + Rs. 23,408/- = Rs. 47,092/-.
Ld. Counsel for Op insurer opposed the contention of Complainant so also the calculation in respect of bonus. The formula for bonus as above not exist as per rules 2011. The insured not eligible for any bonus because he had not paid premium for 5 years which was mandatory under the rule 2011. The rule 2011 applicable retrospectively for a policy entered into in 2001. This Commission while removing ambiguity relating to bonus followed Honbl’e Apex Court in United India Insurance Co. Ltd. Vs Pushpalaya Printers (2004) 3 SCC694, where it was held, where the words of a documents are ambiguous they shall be construed against the party which prepared the documents.
It was held in General Assurance Society Ltd. Vs Chandmull Jain AIR 1966 SC1644 where in case of ambiguity in a contract of insurance, the ambiguity should be resolved in favour of the claimant & against the insurance Company. We found that the contention raised by insurer are devoid of merit & unacceptable to this Commission. Ops are failed to referred any decided cases in their favour applicable to facts & laws, the same so also on part of complainant.
After exercise of Commission’s jurisdiction we found the Complainant is entitled to both maturity value & bonus. The Complainant already received the maturity value. Hence he is entitled to bonus amount as calculated above Rs. 23,408/- as additional entitlement under the policy.
O R D E R
It is directed that, the Ops (Postal Authority) shall pay bonus amount Rs. 23,408/- as calculated above within one month to the Complainant, failing which the Ops shall liable to pay interest @6% per annually will be paid till its realization. This Complainant’s complaint is here by allowed. No order as to cost.
Issue extract of the order to the parties for compliance.
Pronounced in the open Court, this the 24th day of August,2022.
I, agree.
Sd/- Sd/-
MEMBER PRESIDENT
