IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Monday the 30th day of November, 2015
Filed on 13..04..2015
Present
- Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt. Jasmine D (Member)
in
C.C.No.119/2015
between
Complainant:- Opposite Party:-
Smt. Sasiamma LIC of India
W/o Mohandas Branch Office No.2
Thaiparambil Sreevalsam Building
Kattoor P.O. Kidangamparambu
Kalavoor, Alappuzha Alappuzha – 688 013
(By Adv. S. Devalal)
O R D E R
SMT. JASMINE D. (MEMBER)
The brief facts of the allegations of the complainant are as follows:-
The complainant availed a policy from the opposite party. The sum assured is Rs. 62,500/-. The premium was paid quarterly and the premium amount is Rs.766/-. The complainant availed a loan of Rs.4,750/- from the said policy and the interest for the loan amount was paid regularly till 2014, when the policy got matured the complainant got a letter from the opposite party that the complainant is entitled to get an amount of Rs.18,394/- only after deducting the loan due amount of Rs.5,962/-. According to the complainant she is entitled to get an amount Rs.56,537/- from the opposite party after deducting the loan amount. The complainant sustained much mental agony and hence filed this complaint.
2. The version of the opposite party is as follows:-
The complainant happened to file the complaint under a mistaken belief that the maturity sum assured as per policy is Rs.62,500/- instead of Rs.19,485/-. In the instant case the amount stated in the policy is the death benefit calculated at the time of issuance of the policy on the basis of the rate of monthly premium applicable and the same is Rs.62,500/-. The death benefit is different from the maturity benefit. In the instant case, the tabular rate of maturity sum assured for Rs.100/- monthly premium in respect of age 52 years and policy term 10 years is Rs.7,794/-. Hence maturity sum assured under the policy works out to 7794/100x250 = 19,485/-. Total maturity benefit payable as per policy condition is the sum equal to maturity sum assured along with the corresponding loyalty addition, if any declared by the Corporation from time to time. Loyalty addition depends upon the experience of Corporation. Hence loyalty addition payable under the above policy comes to Rs.4,871.25 (19485/1000x250 = 4871.25). Loyalty addition declared as per relevant valuation as at 31.03.2014 per Rs.1000/- maturity is Rs.250/-. Hence Gross Maturity Benefit payable under the policy (i.e. Maturity Sum Assured + Loyalty addition) is Rs.24,256.25) (19485/- + 4871.25= 24,356.25). After deducting Rs.5178/- towards loan & interest, Net maturity benefit paid to the life assured is Rs.19,178/-. In the instant case, the complainant claimed an amount of Rs.56,537.75 after deducting the loan amount under a wrong notion that the maturity value of the policy is Rs.62,500/- which is the death benefit under the policy and not the maturity benefit under the policy. This may be because the maturity value which is not mentioned in the policy and the death benefit alone is stated therein and hence the complaint may be dismissed.
3. The complainant was examined as PW1 and produced documents marked as Exts.A1 series and A2. The opposite party was examined as RW1 and documents marked as Exts.B1 to B5.
4. Considering the allegations of the complainant and the contentions of the opposite party, this Forum has raised the following issues:-
1) Whether there is any deficiency in service and negligence on the part of the
opposite party?
2) Whether the complainant is entitled to get the reliefs sought for?
5. The case of the complainant is that the complainant availed a policy from the opposite party on 26.4.2005 for a tenure of 10 years. The premium was paid quarterly and the sum assured is Rs.62,500/-. The complainant availed a loan from the policy. According to the complainant on maturity she is entitled to get a sum of Rs.56,537.75 against the said insurance policy after deducting the loan due amount, but according to the opposite party, she is entitled to get Rs. Rs.18,394/- only. The complainant filed proof affidavit in support of the complaint and produce 2 documents which were marked as Ext.A1 series and A2. According to the complainant, the opposite party assured an amount of Rs.62,500/- on maturity of the policy and the same was mentioned in all the documents provided to her. The complainant produced Ext.A1 series (41 numbers) to support of her allegation. According to the opposite party, the complainant availed Jeevan Saral policy and same has three bifurcations as Maturity Sum Assured, Death Benefit Sum Assured and Accident Benefit Sum Assured. The complainant was under a wrong notion that the maturity value of the policy is Rs.62,500/- which is the death benefit under the policy and not the maturity value. Admittedly the complainant availed an insurance policy on 26.4.2005 for a period of 10 years. The mode of payment of premiums was quarterly and the opposite party issued receipt for the same and in every premium receipts the Sum Assured was mentioned as Rs.62,500/-, and not specifically mentioned whether it was as Maturity Sum Assured, Death Benefit Sum Assured or Accident Benefit Sum Assured. The complainant paid the premium for 10 years and throughout the period the opposite party never intimated the complainant that the Sum Assured shown in the receipt is the Death Benefit Sum Assured and not the Maturity Sum Assured. Therefore the complainant was under the strong belief and hope that the Sum Assured is Rs.62,500/- and on maturity, she will get that amount. The complainant invested her hard earned savings in the policy under the strong belief that on maturity she will get the Sum Assured Rs.62,500/- as mentioned in the premium receipts. The policy had run its entire tenure of 10 years and the complainant remitted all the premiums without default. According to the complainant only after the maturity of the policy the opposite party intimated the complainant that she is entitled to get Rs.18,394/- only and this is against natural justice. Further the policy certificate issued by the opposite party – Ext.B1, it was mentioned that the Maturity Sum Assured is Rs.62,500/- and also the Death Sum Assured is also Rs.62,500/-. According to the opposite party that due to some mistake the maturity sum assured was not mentioned in the policy certificate, the amount mentioned as Rs.62,500/- twice in the Death Benefit Sum Assured and the Accident Benefit Sum Assured. We have perused the entire documents placed before us. On Ext.A1 series it was mentioned on Sum Assured 62,500/- but not specifically stated whether it is Maturity Sum Assured, Death Benefit Sum Assured or Accident Benefit Sum Assured. According to the opposite party on Ext.B1 the Maturity Sum Assured was not printed. No documents produced would show that the opposite party has intimated the complainant that the Maturity Sum Assured is only Rs.19485/-. The opposite party produced Exts.B4 and B5 ie. the copy of the policy document given to other policy holders
of the same policy in which it was clearly stated Matured Sum Assured, Death Benefit Sum Assured and Accident Benefit Sum Assured. From these documents it is clear that the Matured Sum Assured was not printed in the policy document issued to the complainant. This shows the negligence and carelessness of the opposite party. Since the Maturity Sum Assured was not printed in the policy document issued to the complainant the opposite party has committed deficiency in service. The complainant is entitled to get the maturity value calculated as per Ext.B6(1). Since the opposite party has committed deficiency in service, the complainant is entitled to get compensation and cost from the opposite party. So the complaint is allowed accordingly.
In the result, the complaint is allowed partly. The opposite party shall pay the Maturity Sum Assured Rs. 24,356/- (Rupees twenty four thousand three hundred and fifty six only) with 12% interest per annum from the date of maturity till realization. The opposite party is further directed to pay an amount of Rs.10,000/- (Rupees ten thousand only) towards compensation and Rs.2000/- (Rupees two thousand only) towards costs of this proceedings to the complainant. The order shall be complied within one month from the date of receipt of this order.
Dictated to the Confidential Assistant transcribed by her corrected by me and pronounced in open Forum on this the 30th day of November, 2015.
Sd/- Smt. Jasmine D (Member)
Sd/- Smt. Elizabeth George (President)
Sd/- Sri. Antony Xavier (Member)
Appendix:-
Evidence of the complainant:-
PW1 - Sasiamma (Witness)
Ext. A1 series - Premium receipts
Ext.A2 - Letter from LIC to the complainant
Evidence of the opposite party:-
RW1 - Preetha J. Menon (Witness)
Ext.B1 - Copy of the policy schedule
Ext.B2 series - Copy of the Introduction of LIC’s Jeevan Saral Policy (6 pages)
Ext.B3 - Copy of the Maturity Sum Assured statement
Ext.B4 - Copy of the LIC’s Jeevan Saral policy schedule
Ext.B5 - Maturity Sum Assured calculation of Jeeven Saral policy
// True Copy // By Order
Senior Superintendent
To
Complainant/Opposite party/S.F.
Typed by:- pr/-
Compared by:-
