KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
VAZHUTHACAUD, THIRUVANANTHAPURAM
APPEAL No. 844/2016
JUDGMENTDATED: 14.03.2023
(Against the Order in C.C. 63/2016 of CDRF, Pathanamthitta)
PRESENT:
HON’BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT
SRI. RADHAKRISHNAN K.R. : MEMBER
APPELLANTS:
- The Branch Manager, Life Insurance Corporation of India, Branch office, Punthala Tourist Complex, Adoor- 691523.
- Marketing Manager, LIC of India, Divisional Office, Jeevan Prakash, P.B. No. 609, Nagampadam, Kottayam- 686001.
(By Adv. Anitha Aji)
Vs.
RESPONDENT:
G. Devadas, Janatha Medicals, Adoor P.O, Pathanamthitta, Pin. 691523.
(By Adv. Sreevaraham N.G. Mahesh)
JUDGMENT
SRI. RADHAKRISHNAN K.R.: MEMBER
This is an appeal filed under section 15 of the Consumer Protection Act 1986 by the opposite parties in C.C. No. 63/2016 on the file of the Consumer Disputes Redressal Commission (District Commission for short), Pathanamthitta. As per the order dated 03.05.2016 the District Commission allowed the complaint as under:
- The opposite parties are directed to pay an amount of Rs. 2,50,000/- as the maturity value of LIC’s Jeevan Saral policy bearing policy No. 393135819 to the complainant with 10% interest from the date of the order onwards.
- The opposite parties are directed to pay a compensation of Rs. 10,000/- to the complainant with 10% interest from the date of order onwards.
- A cost of Rs. 3,000/- is also allowed to the complainant from the opposite parties with 10% interest from the date of order onwards.
2. The case of the complainant is briefly as follows:-
The complainant had taken a Life Insurance Policy called “Jeevan Saral” from the opposite party on 20.01.2006 for a term of 10 years which was due for maturity on 20-01-2016. The complainant paid the entire premium payable under the policy amounting to Rs. 1,22,480/-. The opposite party made him to believe that the policy has a sum assured Rs. 2,50,000/- payable on maturity. However, the opposite party sent a letter dated 29.09.2015 stating that the amount payable under the policy was only Rs. 1,03,130/-, even though he had paid Rs. 1,22,480/- as premium. As there was no positive response to his grievance he filed this complaint claiming Rs. 2,50,000/- with a compensation of Rs. 50,000/-.
3. The opposite parties entered appearance and filed their version admitting that they had issued policy named “Jeevan Saral Plan” (plan 165). They admitted the premium amount, date of commencement, term and date of maturity of the policy. According to them the amount of Rs. 2,50,000/- was only for death benefit. The maturity amount payable was only Rs. 1,03,130/-. He is also eligible for a loyalty bonus of Rs. 33,517/-. Thus, the total amount payable under the policy on maturity was Rs. 1,36,647/-. It was due to an inadvertent error that the column for maturity value was left blank. The opposite party was liable to pay as per the terms and conditions of the policy only and hence they prayed for dismissal of the complaint.
4. Evidence in the case consisted of oral evidence of the complainant as PW1 and Exbts. A1 to A4 documents marked on his side. DW1 was examined on the side of the opposite parties and Exbt. B1 to B4 were marked on their side. On the basis of the evidence adduced the District Commission passed the impugned order. Aggrieved by the said order the opposite parties have filed this appeal.
5. Heard both sides.
6. The learned counsel for the appellants submitted that it was a clerical error in not mentioning the maturity amount in the relevant column of the policy. Respondent/complainant should not take advantage of a bonafide error on the part of the appellant. Rs. 2,50,000/- shown in the policy is the death benefit sum assured under the main plan. The appellants had communicated about the error to the respondent vide their letter dated 29.09.2015 (Exbt. B1). The actual maturity sum assured is Rs 1,03,130/-. This is evident from the Maturity benefit chart (Ext B2 series) also. The learned counsel also submitted that the Insurance Ombudsman, Kochi dismissed the complaint of the respondent vide its order dated 29-02-2016 (Exbt. B3). According to her, the District Commission should have considered paragraph 5 of the order of the Insurance Ombudsman. If the appellants have to pay the amount ordered by the District Commission it will be an unnecessary loss of public money. The learned counsel argued that the amount admitted is as per the policy condition and that there is no deficiency on the part of the opposite parties and hence prayed to allow the appeal and set aside the order of the District Commission.
7. The learned counsel for the respondent / complainant submitted that it was his bonafide belief that the policy was taken for a maturity sum assured of Rs. 2,50,000/-. There was no communication from the appellant regarding any error in the policy till the maturity of the policy. He has paid a premium of Rs 1,22,480/- which is more than the maturity value of Rs 1,03,130/- offered by the appellant. He is entitled to get the maturity amount of Rs. 2,50,000/- shown in the policy (Exbt. A1).Hence he prayed for dismissal of the appeal and confirmation of the order of the District commission.
8. We have considered the submissions on both sides and carefully perused the records. This is a case in which the dispute is regarding the amount payable on maturity under the policy. The column for maturity sum assured under the policy (Ext A1) was left blank. The official who signed the policy erred in not noticing such an important omission in the policy. Once the policy is issued, it is a concluded contract. If at all there was a bonafide error in the policy document, it should have been rectified within a reasonable time with the concurrence of the policyholder. The appellants miserably failed in this regard. The appellants did not issue any communication at all to the respondent till they sent Ext B1 Letter at the fag end of the policy period. They did not take any effort to rectify their mistake during the entire period of the policy. The appellants have not produced any evidence to prove the sum assured under the policy as claimed by them. As deposed by PW1, the receipt of Exbt.B1 communication by him was after maturity of the policy. The figure of Rs. 1,03,130/- offered by the appellant as maturity value is not seen anywhere in the policy document (Ext A1). The maturity benefit chart (Ext B2 series) is only for the internal circulation of the appellant, which is not made known to the respondent/complainant. Hence it cannot be accepted as evidence to prove the maturity value.
9. The appellants submitted that the District Commission should have considered the order dated 29.02.2016 of the Insurance Ombudsman(Exbt. B3) dismissing his complaint and that the respondent should not have approached the District Commission after the dismissal of the complaint by the Insurance Ombudsman.The learned counsel further submitted that the observations in the award were not considered by the District Commission. In this connection the following rules of the Insurance Ombudsman Rules are relevant here:
“16(2): If the recommendation of the Ombudsman is acceptable to the complainant, he shall send a communication in writing within 15 days of receipt of the recommendation, stating clearly that he accepts the settlement as full and final”
17(8): “The award of the Insurance Ombudsman shall be binding on the insurers…”
Thus the award of the Insurance Ombudsman is binding on the insurer whereas it is not so in the case of the complainant. The order of the Insurance Ombudsman is not binding on the complainant unless he agrees to the award passed by the ombudsman. There is no case that the respondent accepted the award in writing as per Rule 16(2). He has the option to reject the award and seek other legal remedies. Thus Ombudsman’s award does not prejudice in any way, the complainant’s right to seek legal remedy against the action of the insurers complained against, as per normal process of law. Moreover as per section 3 of the Consumer Protection Act, 1986 (corresponding section 100 of Consumer Protection Act, 2019), the reliefs available to the Consumer are in addition to and not in derogation of any other law for the time being in force. The complainant has exercised this right and we do not find any illegality in filing the complaint before the District Commission despite a dismissal order by the Insurance Ombudsman. Being a separate and independent proceeding, it was for the District Commission to decide whether to consider or accept any of the observations in the award.
10. On the basis of the foregoing discussion we do not find any error in the finding of the District Commission that the appellants / opposite parties could not prove their contention about the maturity sum assured and that there is deficiency in service on the part of the appellants/opposite parties. Hence we confirm the order passed by the District Commission.
In the result, the appeal is dismissed and the order dated 31.10.2016 of the District Commission, Pathanamthitta is confirmed. There shall be no order as to costs.
The statutory deposit of Rs. 25,000/- remitted by the appellants shall be released to the respondent /complainant on filing proper application before this Commission. The appellants are directed to pay to the complainant the balance amount as per the order of the District Commission within one month failing which the respondent / complainant can initiate appropriate proceedings for executing the order.
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JUSTICE K. SURENDRA MOHAN : PRESIDENT
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RADHAKRISHNAN K.R.: MEMBER
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