Haryana

Karnal

CC/384/2020

Raj Kumar Sharma - Complainant(s)

Versus

ICICI Prudential Life Insurance Company Limited - Opp.Party(s)

Surinder Kumar Sharma

30 Oct 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 384 of 2020

                                                        Date of instt.24.09.2020

                                                        Date of Decision:30.10.2023

 

Raj Kumar Sharma, Advocate, Chamber no.409, presently Chamber no.236, Lawyers Chamber Building, District Courts, Karnal, resident of house no.625, Sector-2, Urban Estate Kurukshetra.

 

                                                                       …….Complainant.

                                              Versus

 

1.     ICICI Prudential Life Insurance Co. Ltd. Tower no.1089, Appa Sahab Maratha Marg, Prabhadevi, Mumbai through its M.D.-cum-C.O.

2.     ICICI Prudential Life Insurance Company Limited, Branch Office, SCF no.135/136, 2^nd floor, near Bangla Sweets, Sector-13, Urban Estate, Karnal through its Branch Manager.

 

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.

              Shri Vineet Kaushik……Member

              Dr. Suman Singh…….Member

                   

Argued by: Shri Surinder Sharma, counsel for complainant

                   Shri Anshul Chaudhary, counsel for the OPs.

               

                    (Vineet kaushik, Member)

 

ORDER:                    

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant has purchased a policy no.01182881 known as Smart Kid Life in the name of his son Kamal Kant and the said policy was commenced w.e.f.25.11.2004 to 2019 and continued for a term of 15 years and total sum insured of the policy was Rs.2,00,000/-. The said policy was issued alongwith the benefit of ADBR (Accidental Benefit Rider)s of 15 years of Rs.2,00,000/- and IBR (income benefit rider) of 15 years of Rs.2,00,000/-. The said policy was matured on 25.11.2019. The total premium of the policy was Rs.17440/- yearly and the complainant paid Rs.8720/- half yearly premium and the complainant paid regular premium till the maturity of the policy.

That the fixed terms benefit payable by the OPs as were as follows:

25.11.2012               20% of the sum insured

25.11.2014               25% of the sum insured

25.11.2017               25% of the sum insured

25.11.2019               30% of the sum insured

 

 The complainant was to be paid guaranteed additions of Rs.35/- per thousands of the basic sum assured per annum for the first four years compounding annually. The guaranteed additions and vested bonus was to be payable by the respondents on the maturity date on the basis of two option which is explained below:

Option 1                Guaranteed                    Option II               Guaranteed

                             Educational           Age of the             Educational

Age of the child     benefit                  child                      benefit

 

18 years                40,000/-               21 years                50,000/-

20 years                50,000/-               22 years                40,000/-

23 years                50,000/-               23 years                40,000/-

25 years                60,000/-               24 years                40,000/-

                                                          25 years                40,000/-

In addition to the above benefit, the OPs were also under legal obligation to pay the following benefit at the time of maturity of the policy.

                                        Senario I                   Senario II

Accumulated

Guranteed Additions           29,505/-                   29,505/-

 

Estimated accumulated      1,52,868/-                79,804/-

Annual Bonus

 

On the date of maturity, the complainant was entitled to receive the guaranteed educational benefits and also above mentioned other benefits but the OPs have not paid the said benefit with malafide intention and has grabbed the huge amount of the complainant. On 30.08.2020, complainant approached the OPs and requested them to pay the benefits of policy. The said policy was matured on 25.11.2019 but did not pay the same and lingered the matter on one pretext or the other. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that the policy in question is a Smart Kid Plan, which is a special plan for securing the educational expenses of children wherein a child is the nominee and usually the parents or grandparents are the  life assureds’ who pay the premium and who’s lives are secured. This plan ensures that even after the death of the parents, the policy continues and the benefits are paid to the nominee(child) or the appointee. The policy documents clearly mentioned that in case policyholder is not satisfied with the features or the terms and conditions of the policy, he can withdraw/return the policy within 15 days i.e. under the “Freelook period”. It is further pleaded that complainant has already received the Fixed Term Benefits and the Maturity Benefit as payable under the policy, directly to his bank account but complainant has concealed the said facts from this Commission. It is further pleaded that it is the duty of the policyholder to read and understand the contents of the proposal and the policy documents and approached the OPs in case of any discrepancy whatsoever on the maturity benefit or other feature of the product. In the present case, complainant even after receiving the policy documents and after reading it, failed to approach the OPs within freelook period, with any concerns pertaining to maturity amount or guaranteed additions. It is further pleaded that the sum assured under the said policy is payable only on death of the life assured during the term of the policy. In the instant case, the policy has matured at the end of its term, and God’s grace, the policy holder is still alive, therefore, no sum assured stands payable as per the policy terms and conditions. It is clear and evident from the clause 1.1 of the policy terms and conditions that the sum assured of Rs.2,00,000/- would have been payable only on the death of life assured, provided that the policy is in force and has not matured. Thus the same does not apply to the present case and hence sum assured is not payable to the complainant. It is further pleaded that since the complainant has chosen Option I of the policy, the fixed term benefit has become payable accordingly. The amount mentioned under option I, in key feature document as Guaranteed Educational Benefit is already paid. It is further pleaded that the Guaranteed Addition which was offered as mentioned in the policy certificate was Rs.35/- per thousand of the Sum Assured per annum for the first 4 years, compounding annually. The sum assured under the policy is Rs.2,00,000/-, in other words it is nothing but 100 thousand (200x1000=2,00,000), therefore 35 multiplied by 200 sums up to Rs.7000/-. Thus, Rs.7000/- multiplied by 4 years equal to Rs.28,000/- which when compounded for 4 years equal to Rs.29,504/-, which the complainant is eligible for receiving as guaranteed additions under the policy. The detail table is reproduced as under:-

Policy Year                         Guaranteed Accrued Additions

1^st year                             7000/-

2^nd year                             7245/-

3^rd year                             7498/-

4^th year                             7761/-

Total                                 Rs.29504/-.

The said payment towards guaranteed accrued additions has already been paid to him alongwith fixed term benefit payable in 2019 when the policy attained maturity. It is further pleaded that as Vested Bonuses or Accumulated annual Bonuses, the company has made a payment of Rs.93,657/-. The said bonus is between the estimated bonus mentioned under two scenarios that may occur, in the key feature document. In the feature document itself that the rates of guaranteed bonuses are not guaranteed and the same depends upon various factors including the experience of the company in investment return and the rates provided therein are only for illustration. It is further pleaded that on the maturity of the policy, the fixed term benefit due in 2019, the guaranteed accrued additions and the Bonus was paid together as Rs.1,23,162/-. Therefore, OPs have made the payout of all the amounts payable under the policy terms and condition and as clearly mentioned in the policy certificate. It is further pleaded that complainant did not suffer from any financial loss as in total he has received an amount which is more that the premium paid by him during the terms of the disputed policy. The sum of all the payments made under the policy the detail of which is reproduced as under:-

Year of payment         payment type                amount

2012                                 fixed term benefit          Rs.40,000/-

2014                                 fixed term benefit           Rs.50,000/-

2017                                 fixed term benefit           Rs.50,000/-

2019                                 maturity                         Rs.1,23,162.21/-

Total benefit received by the complainant                 Rs.2,63,162/-

 

The complainant has paid a total premium of Rs.2,56,187/- and has also enjoyed the life cover under the policy, in case of the unfortunate event of death of life assured during the policy term and therefore company had incurred expenses towards the life cover provided to him. Therefore, it is clear that the present complaint has been filed merely to harass the OPs. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of Key Feature Document Ex.C2 and closed the evidence on 22.07.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Swathy Nair Ex.OP1/A, copy of proposal form alongwith terms and conditions of the insurance policy Ex.OP1 and closed the evidence on 24.05.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that the complainant has purchased a Smart Kid Life policy in the name of his son and the said policy was commenced from 25.11.2004 to 2019, for the sum insured of Rs.2,00,000/-. The said policy was issued alongwith the benefit of Accidental Benefit Rider of 15 years of Rs.2,00,000/- and income benefit rider of 15 years of Rs.2,00,000/-. Complainant also paid guaranteed additions of Rs.35/- per thousands of the basic sum assured per annum for the first four years compounding annually. The guaranteed additions and vested bonus was to be payable by the respondents on the maturity date on the basis of two options On the date of maturity, the complainant was entitled to receive the guaranteed educational benefits alongwith other benefits but OPs have not paid all the benefits as epr the terms of the policy and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that the complainant has filed for claiming the Guaranteed Additions and Guaranteed Educational Benefits under the policy, as per complainant’s own erroneous/inaccurate interpretation of the Terms and Conditions of the policy and its understanding. Complainant has already received the fixed term benefits and the maturity benefit as payable under the policy directly to his bank account. The sum assured under the said policy is payable only on Death of the Life Assured during the terms of the policy. The policy document clearly mentions that in case policyholder is not satisfied with the features or the terms and conditions of the policy he can withdraw/return the policy within 15 days i.e. under the “freelook period”. The company has duly paid the Accumulated bonus of Rs.93,657/-, which falls in between the estimated values provided in the table with lower and higher rates and now nothing due is pending towards the complainant and lastly prayed for dismissal of complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the complainant has purchased a Smart Kid Life policy for his son from the OPs for a sum of Rs.2,00,000/-. It is also admitted that the complainant has received an amount of Rs.2,63,162/-.

11.           Now, the question arises for consideration before Commission is that whether the OPS have paid all the complete benefits as per policy or not?

12.           The OPs have alleged that the complainant has chose the option 1 in key feature documents Guaranteed Educational benefit which is as under:-  

Option 1

Age of child	Guaranteed educational benefits
18	Rs.40,000/-
20	Rs.50,000/-
23	Rs.50,000/-
25	Rs.60,000/-

 

13.           As per OPs, the following amounts have been paid to the complainant by the OPs:-

Year of payment	Payment type	Amount
2012	Fixed Term benefit	Rs.40,000/-
2014	Fixed Term benefit	Rs.50,000/-
2017	Fixed Term benefit	Rs.50,000/-
2019	Maturity	Rs.123,162.21/-
Total benefit received by the complainant.		Rs.2,63,162/-

       

14.           On the other hand, as per the complainant the OPs were liable to pay Rs.2,00,000/- as sum assured, Rs.29,505/- as accumulated guaranteed additions and Rs.1,52,868/- as estimated accumulated annual bonus i.e. Rs.3,82,373/- and out of them, the OPs has paid Rs.2,63,162/- and an amount of Rs.1,19,211/- is still due towards the OPs. In order to prove his case, the complainant has placed on record insurance policy Ex.C1, wherein the benefits have been clearly depicted, which are reproduced as under:-

Age of child	Guaranteed educational benefits
18	Rs.40,000/-
20	Rs.50,000/-
23	Rs.50,000/-
25	Rs.60,000/-

 

WHAT YOU RECEIVED AT MATURITY OF THE POLICY
Accumulated guaranteed additions	Rs.29,505/-
Estimated accumulated annual bonus	Rs.152,868/-

15.           As per the key features document Ex.C2, the complainant is entitled for Rs.2,00,000/- as sum assured, Rs.29,506/- as accumulated guaranteed additions and Rs.1,52,868/- as estimated accumulated annual bonus i.e. Rs.3,82,374/-. In its written version, the OPs have admitted that in the feature document it is clearly mentioned that the rates of guaranteed bonus are not guaranteed and the same depends upon various factors including the experience of the company in investment return and the rates provided therein are only for illustration and thus, the company has made payment of Rs.93,657/-. If the version of the OPs is believed then the company has made payment of Rs.93,657/- as estimated accumulated annual bonus instead of Rs.1,52,868/-. In that case also, the complainant was entitled for Rs.2,00,000/- as sum assured and Rs.29,506/- as guaranteed additions and Rs.93657/- as estimated accumulated annual bonus instead of Rs.1,52,868/- i.e. Rs.3,23,073/- but the OPs had paid an amount of Rs.2,63,162/- to the complainant at the time of maturity instead of Rs.3,23,073/-. Thus, the complainant is entitled for remaining amount i.e. Rs.59,911/- (Rs.3,23,073-2,63,162) alongwith interest, litigation expenses and compensation on account of harassment. 

16.           Keeping in view the above discussion, we are of the considered view that act of the OPs while not paying the entire benefits of the policy to the complainant, amounts to deficiency in service and unfair trade practice.

17.           Thus, as a sequel to abovesaid discussion, we partly allow the present complaint and direct the OPs to pay Rs.59,911/- (Fifty five thousand nine hundred and eleven only) to the complainant alongwith interest @ 9% per annum from the date of filing of the present complaint i.e.24.09.2020 till its realization. We further direct the OPs to pay Rs.10,000/- to the complainant on account of mental agony and harassment and Rs.5500/- towards the litigation expenses.  This order shall be complied with within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:30.10.2023

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

                (Vineet Kaushik)        (Dr. Suman Singh)    

                      Member                    Member