Haryana

StateCommission

A/827/2015

MAX LIFE INSURANCE CO.LTD. - Complainant(s)

Versus

DHIRAJ CHANDRA MAHATO - Opp.Party(s)

RAJNEESH MALHOTRA

12 Jul 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA

 

 

                                      First Appeal No.           827 of 2015

                                                Date of Institution:       29.09.2015

                                                Date of Decision:         12.07.2016

 

1.      Max Life Insurance Company Limited and others, 11^th Floor, DLF Square, Jacaranda Marg, DLF, Phase II, Gurgaon-122002 through its Authorized Person.

 

2.      Mr. Analjit Singh, Chairman, Max Life Insurance Company Limited, 11^th Floor, DLF Square, Jacaranda Marg, DLF, Phase II, Gurgaon-122002.

 

3.      Mr. Gary Benett, Managing Director & CEO, Max Life Insurance Company Limited, 11^th Floor, DLF Square, Jacaranda Marg, DLF Phase II, Gurgaon -122002.

 

4.      Mr. Sabina Daniel, Customer Services Executive, Max Life Insurance Company Limited, Operation Centre, Plot No.90-A, Sector 18, Udyog Vihar, Gurgaon -122002.

…..Appellants-Opposite Parties

 

Versus

 

Dhiraj Chandra Mahato son of late Sh. Nakul Mahato, resident of F-088, Richmond Park, DLF City, Phase 4, Gurgaon -122009, Haryana.

…Respondent-Complainant

 

 

 

CORAM :            Hon’ble Mr. Justice Nawab Singh, President

                             Mr. B.M. Bedi, Judicial Member.

                             Mr. Diwan Singh Chauhan, Member.

                  

 

For the parties:  Mr. Rajneesh Malhotra, Advocate for the appellants

                             Mr. Dhiraj Chandra Mahato, respondent-complainant in person

 

O R D E R

 

NAWAB SINGH J, (ORAL)

 

          Max Life Insurance Company Limited and its functionaries-opposite parties (hereinafter referred to as ‘Insurance Company’) are in appeal against the order dated May 15^th, 2015 passed by the District Consumer Disputes Redressal Forum, Gurgaon (for short ‘District Forum’) whereby it directed the Insurance Company to pay Rs.60,400.59 alongwith interest at the rate of 9% per annum from the date of maturity of the insurance policy, that is, March 11^th, 2013 till its realization, Rs.10,000/- as compensation and Rs.5500/- litigation expenses to Dhiraj Chandra Mahato-complainant.

2.      Complainant purchased insurance policy – Life Invest Unit Linked Investment 3 Year Plan on March 01^st, 2008.  The maturity date of the policy was March 11^th, 2013.  Complainant paid Rs.1,50,000/- in all in first three years.  On maturity of the insurance policy, Insurance Company paid Rs.1,89,599.41 to the complainant.  The grievance of the complainant was that as per the schedule attached with the insurance policy, sum assured was mentioned Rs.2,50,000/- and he was entitled to that amount whereas Insurance Company paid Rs.1,89,599.41.  The District Forum after deducting Rs.1,89,599.41 out of Rs.2,50,000/- directed the Insurance Company to pay Rs.60,400.59 alongwith interest, compensation and litigation expenses. 

3.      Learned counsel for the Insurance Company has urged that the District Forum while calculating the amount have taken into consideration the schedule.  For ready reference, the schedule is reproduced as under:-

 

 

List of coverages	Maturity Date		Insured Event	Sum Assured (Rs.)	Annual Target Premium (Rs.)	Due Dates when premium payable ; Date when last installment of premium date	Modal Flat Extra Premium
Base Policy
Life Invest Unit Linked Investment 3 Pay Plan		11-March-13	Maturity or Death of Life Insured	250000	5000.00	11th of Mar  Every Year; 10-mar-2010	NA
The benefits are payable to: A)  If the life insured and the policyholder are same; to the life assured or his nominees or proving executors or administrators or other legal representative, who shall have taken out representation to his estate from a competent court. B)  If the life assured and the policyholder are different; to the policyholder or proving executors or administrators or other legal representatives who shall have taken out representation to his estate from a competent court.
Special Provisions

 

4.      It has been stated by learned counsel for the Insurance Company that District Forum has interpreted the schedule wrongly, that is, in the column Insured Event, it was mentioned Maturity or Death of Life Insured and in the next column, the sum assured was Rs.2,50,000/-, which in fact was that in the event of Maturity or Death, Clauses 2.1 & 2.4 of the policy were to be taken into consideration.   Clause 2.1: Death Benefit and Clause 2.4 : Maturity Benefit reads as under:-

“Death Benefit

          2.1    Either of (a) or (b) depending upon the option chosen at the stage of the proposal or subsequently.

          a)      Level Death Benefit i.e. Higher of :

          i.        The Fund Value prevailing on the date which immediately follows the date of intimation of death; or

          ii.       The Sum Assured

          b)      Increasing Death Benefit i.e. Sum Assured plus the Fund Value prevailing on the date which immediately follows the date of intimation of death.      

          Maturity Benefit

          2.4    If the Life Insured is living as on the Maturity Date, a benefit equal to the Fund Value prevailing on the Maturity Date will be paid if the settlement option as stated in clause 3 below has not been opted.”

5.      Upon reading of the aforesaid clauses, it is clear that in case of death of insured, sum assured of Rs.2,50,000/- is to be paid.  Since the life insured is living on the date of maturity, he was only entitled to the benefit equal to the fund value prevailing on the maturity date, which the Insurance Company has already paid, that is, Rs.1,89,599.41 to the complainant.

6.      In view of above, District Forum has failed to interpret the schedule and clauses referred to above and erred in allowing the complaint.  Hence, the impugned order under challenge cannot be allowed to sustain. 

7.      For the reasons recorded supra, this appeal is accepted, the impugned order is set aside and the complaint is dismissed. 

8.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification, in accordance with the rules, after the expiry of period of appeal/revision, if any.

 

 

Announced 12.07.2016

(Diwan Singh Chauhan Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

 

U.K