Before the District Consumer Dispute Redressal Commission [Central District] - VIII, 5th Floor Maharana Pratap ISBT Building, Kashmere Gate, Delhi
Complaint Case No. 268/19.12.2018
Mr. Ashok Kumar Rai s/o Late R.R. Rai
A-138, Yojana Vihar, Delhi-110092 …Complainant
Versus
Branch Manager LIC of India,
Branch Office-12A, Karol Bagh
New Delhi-110005 ...Opposite Party
Senior Citizen Case
Date of filing: 19.12.2018
Coram: Date of Order: 01.01.2024
Shri Inder Jeet Singh, President
Ms. Shahina, Member -Female
ORDER
Inder Jeet Singh , President
1.1. (Introduction to case of parties) – The complainant has grievances of deficiency of services against OP/LIC of India that he had purchased Wealth Plus policy no. 115449724 on 08.05.2010 from OP having maturity date of 08.05.2018 (hereinafter referred the policy) and he deposited Rs. 3 lakhs by way of three annual premiums of Rs. 1 lakh each. But, he was not paid the amount as per NAV applicable at the end of the term of policy. The refund was lesser of Rs. 3,350/- and that is why the complaint was filed for refund of Rs. 3,350/- along with current rate of interest, besides compensation of Rs. 50,000/- in lieu of harassment and damages and cost of Rs. 30,000/-.
1.2. The OP opposed the complaint that neither there was any deficiency of services nor any claim is made out since the amount was paid as per NAV prevailing at the material time and the entire amount was to complainant, there is no cause of action. The complainant is not entitled for any relief.
2.1. (Case of complainant) –As per amended complaint, the facts are the complainant purchased the policy and paid the entire premium regularly. On maturity of policy on 08.05.2018, the complainant was paid amount of Rs. 2,28,725/- by miscalculating the amount on maturity date, amount was payable as per highest NAV, being the terms and conditions of the policy. The complainant refers maturity benefit clause no. 9 it reads as “9. Maturity benefit- At the end of policy term and the policy is in full force, payment of fund value will be made based on the highest NAV over the first 7 years of the policy or the NAV as applicable at the end of the policy terms whichever is higher”. However, at the time of redeem of policy, the OP failed to pay the amount as per NAV applicable, he also wrote letter dated 14.05.2018 to Branch Manager and then correspondence/letters of 31.05.2018 and 10.08.2018 to the Chairman of OP, which was responded on 14.06.2018. However, his amount was not released and then legal notice was sent. The policy has matured in the 8th year and NAV was 16.2047 w.e.f. 07.01.2018 to 08.05.2018, which is on the website of the LIC, however, the amount was not paid.. That is why the complaint.
2.2. The complaint is accompanied with LIC Wealth Plus Scheme of OP, NAV history from time to time (for showing that the highest NAV was 16.2047 during April/May 2018 but NAV 15.9708 on 08.05.2018, OP had release the amount on the basis of NAV 15.9708), correspondence, reply and legal notice.
3. (Case of OP)-The OP opposed the complaint, also referring and reproducing the same clause no.9, that the complainant was paid the amount as per NAV 15.9708, the NAV as on 8.5.2018 is admitted fact in the complaint. The paid amount of Rs.2,28,725/- was calculated on the basis of NAV of 15.9708 x Rs.14,321.465 (maturity amount), which as per agreed terms of policy. Thus, nothing was left due to be payable. The complaint is without cause of action. There is no deficiency of services.
3.2. However, the complainant suppressed the complete NAV statement of year 2017 but OP files it with reply. The reply is also accompanying with NAV of year 2017 and NAV 8.5.2017 is underlined to make emphasis.
4. (Replication of complainant) – The complainant filed replication and he denies all allegations as well as that OP is misleading with NAV of 2017 or of 8.5.2017 since in this case the highest NAV of 8th year is to be seen. The complainant also computes the highest NAV of 16.2047 on 2.5.2019 to be considered at maturity of policy for payment, which comes to Rs.2,32,075/- but he was paid Rs.2,28,725/, which is lesser of Rs.3,350/-. He reaffirms the complaint as correct.
5. (Evidence) – The complainant led his evidence by detailed affidavit coupled with documents filed with the complaint. But on the other-side, OP led evidence by filing affidavit of Ms Deepa Sinha, Manager (Legal), which is replica of the written statement.
6. (Final hearing)- Both the sides were given opportunity for arguments, they filed written arguments. They were also given opportunity to make oral submissions, Ms. Rita Jain, Advocate for OP made the oral submissions but no oral submissions on behalf of OP. However, the rival contentions appearing from record will also be considered.
7.1 (Findings)- The rival contentions are considered, keeping in view the evidence of parties, this case is based on policy contract and documentary record, inclusive of NAV.
7.2. It is apparent that rates of NAV are not disputed by the parties but controversy in respect of invoking of rate NAV on maturity of policy of complainant. It needs to see the interpretation clause no.9, which is "at the end of policy term and the policy is in full force, payment of fund value will be made based on the highest NAV over the first 7 years of the policy or the NAV as applicable at the end of the policy terms whichever is higher” The OP is interpreting that by taking two end points - firstly the highest NAV of 7 years is to be opted and other end is date of maturity of 8.5.2018. and the OP has invoked NAV of 08.05.2018 (15.9708). But according to complainant, the highest NAV (16.2047 from 27.04.2018 to 02.05.2018) in the 8th year is to be invoked. Now what is the appropriate NAV?
The clause 9 does not mandate any particular date but it talks of policy terms, the policy was for 8 years and the clause 9 provides the first component is of highest NAV in the first 7 years of policy or NAV at the end of policy terms. The highest NAV of first 7 years NAV has been stipulated because the policy holder has kept the policy valid and alive, the policy holder is held entitled for highest NAV. Second limb of clause 9 is mentions about end of policy term, it does not stipulate last date of policy but end of policy term. It means entire last term/year is to be seen and then highest NAV is to be invoked. There cannot be interpretation that the insurance contract provides tenure of 7 year for highest NAV but for the 8th year it will be of lower side amongst many NAV. The OP is choosing a specific date of 08.05.2018 for NAV, which is not acceptable since as per clause 9 the last tenure of policy is to be considered in toto. Therefore, the complainant has rightly calculated the amount as per NAV 16.2047 (as on 02.05.2018) being in last tenure of policy, which is higher than NAV 15.9708 (as on 08.05.2018). The complainant has proved his claim of Rs. 3350/- in his favour and against the OP. Thus, non-payment of eligible amount on maturity amounts of deficiency of services.
7.3. It would not be out of context to mention that LIC of India should illustrate the calculations and invoking of NAV, while policy scheme is understood so that the aspirants of policy and policy holder may understand the terms and conditions vis a vis it would also curtail the litigations.
7.4. The complainant claims interest at the current market rate, however, there is no such data proved or available in the file, therefore, interest at the rate of 6% pa from the date of complaint till realization of the amount will meet both ends.
7.5. The complainant claims compensation of Rs.50,000/- on account of harassment, however, by considering age of complainant, the documentary record as well as denial of valid claim by OP; compensation of Rs. 15,000/- is determined in favour of complainant and against OP. The complainant also claims litigation charges of Rs.30,000/-, however, considering the complainant was constraint to issue legal notice and then he filed the complaint, cost of Rs. 9,000/- is determined in his favour against the OP.
8. Accordingly, the complaint is allowed in favour of the complainant and against the OP, while directing the OP to return amount of Rs.3,350/- with interest at the rate of 6%pa to the complainant, apart from compensation of Rs. 15,000/- and cost of Rs. 9,000/-, within 45 days of this order. In case amount is not paid within 45 days from the date of this order, then OP will be liable to pay interest at the rate of 8%pa on amount of Rs.3,350/- from the date of complaint till realization thereof. The amount may be deposited in the Registry of this Commission by demand draft in favour of complainant.
9. Announced on this 1st January, 2024 [पौष 11, साका 1945]. Copy of this Order be sent/provided forthwith to the parties free of cost as per rules, besides to upload on the website of this Commission.
[Shahina] [Inder Jeet Singh]
Member(Female) President
