1.      The present Revision Petition has been filed by the Petitioner under Section ­­­58(1)(b) of the Consumer Protection Act, 2019 (the “Act”) against impugned order dated 22.04.2022, passed by the State Consumer Disputes Redressal Commission, Maharashtra, Circuit Bench at Nagpur (‘State Commission’) in FA No. 18/428 wherein the Appeal of the Complainant (Respondent herein) was partly allowed and set aside the Order dated 12.07.2018, passed by the District Consumer Disputes Redressal Forum, Nagpur (“District Forum”) in CC No. RBT/CC/13/659 wherein the complaint was dismissed by the District Forum.

2.      As per office report, there is 22 days delay in filing the Revision Petition. For the reasons stated in the Application of Condonation of delay, the delay is condoned.

3.      For ease of reference, the parties are referred to as stated in the original Complaint filed before the District Forum. Shri Kailash Kanugo is referred to as the Complainant and Life Insurance Corporation of India is referred to as the Opposite Party (OP for short).

4.      Brief facts of the case, as per the Complainant, are that in year 1993 the Petitioner/OP had launched a scheme in the name and style Asha-Deep Policy-I wherein the plan of insurance had introduced to cover risk of four major aliment namely (i) Cancer (ii) Paralytic stroke (iii) Renal Failure of the both kidneys (iv) Coronary artery disease (in which bypass surgery needs to be done). The pamphlets in Marathi were published mentioning there in that the policy was for the period from 07/09/1993 to 30/11/1993.

5.      On-going through the pamphlet, Respondent/Complainant Kailash Kanugo obtained the policy at Nagpur on 28.11.1993 through the LIC Agent and paid all half yearly premiums of Rs.3690/- each to the Appellant till November, 1997. In May, 1998 he experienced Chest pain with respiratory disorders and consulted Dr. VS Agrawal, a consultant & physician of CIIMS Hospital, Bajaj Nagar, Nagpur. He was examined and issued certificate dated 22.05.1998 stating therein that Complainant is suffering from Moderate Aortic Regurgitation with E 66 ERT Angina and needs early investigation like Coronary Angiography and Navr (Open Heart Surgery). As per of the medical advice, he was required to under-go Open Heart Surgery. Therefore, he applied to the Petitioner/OP i.e. LIC for benefits under the insurance policy. But, the Petitioner/OP repudiated his claim by replying to his notice dated 15.12.1998. Being aggrieved he filed Consumer Complaint No.08/1999 before the District Forum.

6.      The District Forum, vide order dated 31.07.2001, directed the Petitioner to pay Rs.65,000/- which is the 50% of the sum assured along with 12% p.a. interest applicable from the date when the Complainant has applied for the above benefit.  The litigation cost of Rs.2,000/- was also awarded.

7.      Being aggrieved by the order dated 31.07.2011, the Petitioner/ OP preferred an Appeal and the State Commission, vide order dated 03.10.2011 dismissed the said Appeal.

8.      Being dissatisfied, the Petitioner/OP preferred Revision Petition No. 827 of 2012 before the National Commission and during the pendency of the case, he paid Rs.91,000/- to the Complainant/ Respondent on 23.04.2013. Later on, the said Revision Petition came to be disposed of on 05.08.2013 with the following observation:

“Claim of the Respondent has been settled.  Revision Petition stands allowed and disposed of in above terms.

The Respondent, if not satisfied with the amount paid, is put at liberty to re-agitate the issue before the District Forum and file a fresh complaint for the remaining within two months. We have advised the respondent not to do so as the costs of litigation would be much more than the amount claimed.

In case, the complaint is filed within two months, the District Forum is directed to treat the same within limitation.”

9.      In the second round of litigation, the Complainant again filed a Consumer Complaint No. RBT/CC/13/659 for claiming the remaining sum assured of the policy in question on maturity i.e. Rs.1,17,000/- (Interest amount @ 12% p.a. since 23.05.1998 to 23.05.2013) and Rs.1,56,000/- (10% of policy amount since 23.05.1999 to 2011) totaling to Rs.2,73,000/- and also the amount of ‘Vested Bonus’ on the whole assured sum of Rs.1,30,000/- along with interest thereon.

10.    The Petitioner/OP in its Reply filed before the District Forum given the final calculation of Maturity Claim as under:

(a) Balance 50% of sum assured (130000/-)         = Rs.   65,000/-

(b) Bonus @ Rs.1123/- per thousand S.A. on

  Rs.130000/- for 20 years term of policy               = Rs.1,45,990/-

(c) Final Additional bonus @ Rs.40/- per thousand SA

                                                                                    = Rs.     5,200/-

                                                                                  -------------------

                                                  Total                                   = Rs.2,16,190/-

                                                                                  ----------------------

Less: Unpaid premiums from half yearly due on 28.05.1998 to 28.05.2010 (date preceding the heart Operation)@ Rs.3690/- for 26 premiums is Rs.95,140. Further the Interest on the above is Rs.85,995.45.

The total liable to be deducted is                       (-) Rs.1,81,935.45

                                                                     -------------------------------

                               Net Amount Payable            = Rs.    34,254.55

  Less: Amount paid to the Complainant on      (-)Rs.    69,745/-

                                                                     --------------------------------

Balance, Excess Amount Recoverable             = (-) Rs.35490.45

From the Complainant                             ---------------------------------

11.    The Petitioner/OP sought refund of the excess Rs.35,940.45 from the Complainant and dismissal of the complaint.

12.    The District Forum, vide order dated 12.07.2018, dismissed the complaint No. RBT/CC/13/659 as the Petitioner/OP has already paid the excess amount to the Complainant.

13.    Being dissatisfied, the Complainant filed the FA No. 18 of 428 and the State Commission, vide the impugned order dated 22.04.2012 partly allowed the Appeal and passed the following order:

i. Appeal is partly allowed.

ii. The Order passed by the learned Additional District Consumer Commission Nagpur is hereby set aside.

iii. Respondent is hereby directed to pay Rs.50,000/- towards cost of this proceedings to appellant.

iv. Respondent is hereby directed to pay Rs.65,000/- which is half of the policy amount along with 9% p.a. interest from the date of filing of the complaint before the Additional District Consumer Commission till its realization within a period of two month failing which interest will be @ 12% p.a. till its realization.

v. Respondent is hereby directed to pay the bonus as assured in the terms and conditions of the policy.

vi. The above order shall be complied with within two months from the receipt of this order.

14.    Hence, the present Revision Petition.

15.    In his arguments, the learned Counsel for OP reiterated the facts of the case and the Reply filed before the District Forum. He asserted that the Respondent has already received Rs.69,745/- on 28.11.2013 as per the policy active till 1998 i.e. as proportional sum assured up to the date of premium paid by him up to half year due 28.11.1997 i.e. Rs.29,250 and add vested bonus up to valuation dated 31.03.1998 i.e. Rs.40,495/-, total Rs.69,745/-. This was over and above what was due i.e. Rs.34,254.55. He sought setting aside the impugned order and urged to refund the excess amount. He has relied upon Oriental Insurance Company V. Sony Cherian, (1999) 6 SCC 451.

16.    The learned Counsel for the Complainant argued in favour of the impugned order passed by the State Commission. He admitted that Rs.91,000/- and Rs.69,745/- were received and, however, sought the amount due from OP i.e Rs.4,24,190/-. (Rs.1,17,000/- Interest amount @ 12% p.a. from 23.05.1998 to 23.05.2013 + Rs.1,56,000/- 10% policy amount since 23.05.1999 to 2011 + Rs.1,51,190/- Bonus amount of policy). He sought dismissal of Revision Petition with costs.

17.    I have examined the pleadings and associated documents placed on record and rendered thoughtful consideration to the arguments advanced by the learned Counsels for both the parties.

18.    The central issue in this case is to determine the entitlement of the Complainant with respect to the policy in question.

19.    Admittedly, the Complainant had already received Rs.91,000 i.e. half of the policy amount and other dues on 23.04.2013. Additionally, Rs.69,745 was received on 28.11.2013. The Complainant contended that he is entitled to a total of Rs.4,24,190, including interest, policy amount and bonus. Conversely, OP argued that the Complainant owes unpaid premiums amounting to Rs.95,140, along with interest. Despite requests, he refused to pay. Petitioner/OP asserted that the net amount payable to him is Rs.34,254.55, and seeks a refund of the excess amount.

20.      After considering the pleadings, associated documents and the arguments advanced by learned Counsels for both parties, it is evident from the calculations and payment details provided by the Petitioner that the Complainant had not paid the premiums due from 28.05.1998 to 28.05.2010, amounting to Rs.95,140. Additionally, interest on this amount is calculated at Rs.85,995.45. The Complainant neither contested these amounts nor provided any evidence to suggest that the premiums were paid. Therefore, based on the lack of evidence of premium payments, the Complainant is not entitled to be paid any further amount with respect to the policy in question.

21.    In view of the discussions above, I am in the considered view that the Order of the learned State Commission 22.04.2022 deserves to be interfered with and is, therefore, set aside. And the order dated 12.07.2018 passed by the learned District Forum is upheld. The RP No.1385 of 2022 is, therefore allowed.

22.    There shall be no order as to costs. The amount, if any, deposited by the Petitioner/OP may be refunded as per law.

23.    All other pending Applications, if any, stand disposed of.