Tamil Nadu

South Chennai

CC/75/2018

G Subramanian - Complainant(s)

Versus

LIC, Rep by Branch Manager & Another - Opp.Party(s)

Party in Person

23 Aug 2022

ORDER

Date of Complaint Filed : 21.02.2018

Date of Reservation      : 22.07.2022

Date of Order               : 23.08.2022

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

CHENNAI (SOUTH), CHENNAI-3.

 

PRESENT:    TMT. B. JIJAA, M.L.,                                                 : PRESIDENT

                        THIRU. T.R. SIVAKUMHAR, B.A., B.L.,                :  MEMBER  I 

                        THIRU. S. NANDAGOPALAN., B.Sc., MBA.,         : MEMBER II

 

CONSUMER COMPLAINT No. 75/2018

TUESDAY, THE 23^rd DAY OF AUGUST 2022

1.G.Subramanian

2.R.Muthulakshimi

 

Both are residing at,

No.1331/2, Sree Jeya Adukkam,

20^th Main Road, Anna Nagar West,

Chennai – 600 040.                                                                                                                                                              ... Complainant       

 

..Vs..

 

1.The Branch Manager,

   LIC of India,

   City Branch No.28,

   Koyambedu,

   Chennai – 600 107.

 

2.The Regional Manager (CRM) ZM,

   Divisional Office I,

   7^th Floor,

   LIC Building,

   153, Anna Salai,

   Chennai – 600 002.                                                                                                                                                    ...  Opposite Parties

 

******

Counsel for the Complainant          : Party in person

Counsel for the Opposite Parties     : M/s. K. Kumaran

 

        On perusal of records and after having heard the oral arguments of the Complainant and the Counsel for the Opposite Parties, we delivered the following:

ORDER

Pronounced by the President Tmt. B. Jijaa, M.L.,

1.      The Complainant has filed this complaint as against the Opposite Party under section 12 of the Consumer Protection Act, 1986 and prays to pay the policy matured benefits and to pay a sum of Rs.2,00,000/- as compensation for damage and to pay interest on the award amount from the date of repudiation of the claim till date of payment along with cost.

2.     The averments of Complaint in brief are as follows:-

        The Complainants had obtained Jeevan Aadhar Policies 12759804 and 713125080 from the Opposite Parties. The said copies of the policies are produced as Document No.1 and 2. As per the policy condition is a clause,

As per the policy issued by the Opposite Parties there existed a specific clause as below:-

Event on the happening of which sum assured is payable

On the stipulated dated of maturity if the life assured is then alive or at his death if earlier

  and on the basis these Complainants chose these policies. These complainants had obtained the policies for the benefit of their mentally Retarded son, Opposite Parties when once proposals accepted and issued policies it is a concluded contract. These Opposite Parties had no right to delete any clause in the policies. They have to act according to the policy conditions. While the facts are being so these Opposite Parties struck off a clause in policies. These Complainants policies were matured on 28.02.2015. They have sent letter to 1^st Opposite Parties for settlement of policies maturity benefit. The Opposite Parties instead of providing the maturity benefit repudiated the claim as if policy condition, the benefit was not available to these Complainants. These Complainants sent another claim letter dated 17.02.2016. The Opposite Parties repudiated the claim of the Complainant on 23.03.2016. Then these complainant had sent letters to Opposite Party, and RTI petitions to the Opposite Parties. The 2^nd Opposite Party sent reply dated 05.12.2016 and 03.12.2016. At last these Complainants lodged a claim with Ombudsman dated 18.12.2017. The Ombudsman also sent a reply dated 26.12.2017 stating that the repudiation is correct and to approach appropriate Legal Forum. The Repudiation of the claim is illegal, unjustice and against the principles of Natural Justice. The non-settlement and wrong repudiation of the claim would clearly indicate their deficiency of service on the part of Opposite Parties and they are not only liable to settle the claim with accrued benefits and interest but also liable to pay damage to the tune of Rs.2,00,000/- apart from the cost. Even inspite of repeated demands and requests the claim was unsettled till date. Hence the complaint.

3. Written Version filed by the Opposite Parties in brief is as follows:-

 At the outset, the above complaint is liable to be dismissed as it is barred by limitation. Even according to the complainant, the alleged correction in the policy took place in the year 2006, though the said correction has been made by the Opposite Parties with the concurrence and consent of the complainant. Hence if at all the complainants have any grievance against the said correction in the policies issued to them, the Complainants ought to have filed the complaint within two years from thereof i.e., on or before 27-2-2008. But the present complaint has been filed only in the year 2018 and the same is hopelessly barred by limitation. The above complaint is also liable to be dismissed for the reason that a single complaint has been filed by two persons having two different set of cause of action. In this regard it is further submitted that, admittedly the complainants 1 & 2 have taken two policies separately. i.e., the first complainant has taken a policy bearing No.712759804 and the second complainant has taken another policy bearing No.713125080. As such both are two different independent contracts taken by two persons and if at all they have any grievance against the opposite parties pertaining to the policy taken by them, it will give only a separate and independent cause of action to each of the complainant, hence the complainants are precluded from filing a single complaint for two separate insurance contracts entered into by them independently, separately with the opposite parties. The Complainants obtained Jeevan Adhar policies 712759804 and 713125080 with date of commencement 28.02.2000 for a term of 15 years. The nominee under the policies is S.Mohan, son of the Complainants. The Complainants sent letter to the opposite party for settlement of maturity claim by mentioning a clause "Event on the happening of which Sum Assured is payable-On the stipulated date of maturity if the Life Assured is then alive or at his death if earlier". The opposite parties replied that the said clause mentioned by the complainant is not applicable for the said Jeevan Adhar policy. The opposite parties have clearly explained to the Complainants and with the knowledge of the policy holder have put an endorsement in the policy bond after striking the above clause. Thereafter the complainants continued to pay the premium till 2015 for more than 9 years, for the benefit of the dependent Son. As the complainants have accepted the said condition and continued to pay the premiums thereafter, the complainants are precluded from raising the issue now. The opposite parties have duly replied on 13.01.2016 to the Complainant's letter dated 21.12.2015 that no benefit can be paid to the disabled dependent under the policy till the proposer survives. Hence prayed to dismiss the complaint.

4.  The Complainant submitted his Proof Affidavit and Written Arguments. On the side of the Complainant, documents Ex.A-1 to Ex.A-23  were marked. The Opposite Parties submitted his Proof Affidavit and Written Arguments. On the side of the Opposite Parties, documents Ex.B-1 to Ex.B-2  were marked.

 

Points for Consideration

1. Whether the Complaint is barred by limitation?

2. Whether there is unfair trade practice and deficiency in service on the part of the Opposite Parties?

3. Whether the Complainant is entitled for reliefs claimed?

4. To what other reliefs the Complainant is entitled to?

Point No. 1:

The contention of the Opposite Parties is that the alleged correction of the Jeevan Aadhar Policies bearing Nos.712759804 and 713125080 taken by the Complainant from the Opposite Parties had taken place in the year 2006 with the consent of the Complainants and if any grievance in the said correction of the policies issued to the them, the Complainants ought to have filed the complaint within 2 years i.e., on or before 27.02.2008, but the complaint is filed only in the year 2018 and hence the complaint is hopelessly barred by limitation. The maturity date for the policies availed by the Complainants is on 28.02.2015. Moreover the Opposite Parties has repudiated the claim of the Complainants on 13.01.2016 and 23.03.2016. And on subsequent dates the Opposite Parties had replied to the communications of the Complainants. The complaint was filed on 21.02.2018 from the date of repudiation the complaint is well within the period of limitation. Accordingly Point No.1 is answered.

Point No.2

Upon perusal of Ex.A-1 it is found that the Complainants had taken Jeevan Aadhar Policies bearing Nos.712759804 and 713125080 from the Opposite Parties. The premium amount was to be paid for a period of 15 years commencing from 2000 to 2015 for their mentally retarded son, S.Mohan. The Jeevan Aadhar Policy is specifically designed for maintenance  of the handicapped dependants and provided for payment of Notional sum assured partly in lump sum and partly in the form of annuity to the handicapped dependant payable on the death of the Life Assured. The Complainants were prompt in payment of premium amounts. As the policy stipulated that “Event on the happening of which Sum Assured is payable – on the stipulated date of maturity if the Life Assured is then alive or at his death if earlier”, after the maturity period as per Ex.A-3, the Complainants had sent a letter dated 21.12.2015 to the Opposite party for settlement of maturity claim. However the Opposite Parties had referred the claim of the Complainants vide their letter dated 13.01.2016, Ex.A-4 stating as follows”

“As per the policy conditions, the policy does not have maturity claim. Representations were received for allowing annuity payments for the disabled dependent before death of parents / Life Assured after certain age. But CBDT / Govt. of India have refused to do so. Hence it is clarified that no benefit can be paid to dependent till the proposer / LA survives”.

Further to the representation dated 17.02.2016 Ex.A-5, the Opposite Parties through their letter dated 23.03.2016, Ex.A-6 had denied the claim of the Complainant stating that no maturity benefits becomes payable under the Policy as per the terms and conditions of plan and that the request of the Complainants could not be accedbed as the very purpose of the Policy is to provide for the handicapped dependant.

As per Exs.A-1 and A-2 the policy condition is stipulated as follows:

Event on the happening of which sum assured is payable

On the stipulated dated of maturity if the life assured is then alive or at his death if earlier

 

The above policy condition has been struck off, which according to the Complainant has been struck down by the Opposite Parties in the year 2006 on the assurance that the Complainants right would not be affected. However as the claim of the Complainants were repudiated, various letters and RTI Petitions were sent by the Complainants to the Opposite Parties as found in Exhibits of the Complainant.  There is no dispute that at the time of availing the policy the above condition that “Event on the happening of which Sum Assured is payable – on the stipulated date of maturity if the Life Assured is then alive or at his death if earlier”, was very much available and it has been struck off by the Opposite Parties in the year 2006, which was not disputed by the Opposite Parties. The Complainants had availed the policies on satisfaction of its terms and conditions and suddenly after payment of premium for 6 years striking off a clause by the Opposite parties is arbitrary and unfair trade practice.

The contention of the Opposite Parties that a single complaint has been filed by 2 persons having 2 different set of cause of action i.e., the 1^st Complainant has taken a policy bearing No.712759804 and the 2^nd Complainant has taken another policy bearing No.713125080, both are two different independent contracts taken by two persons hence the complainants are precluded from filing a single complaint for two separate insurance contracts entered into by them independently, will not hold good for the reason that the Complainants are husband and wife having taken Insurance Policies for their child against the same Opposite Parties, which will not preclude the Complainants from maintaining this complaint.

On careful perusal of records and considering the oral submissions on both sides, this Commission is of the view that the act of the Opposite Parties by striking off an important clause of the Policies Ex.A-1, Ex.A-2  in the year 2006, which was availed by the Complainant on 28.02.2000 on believing and agreeing with the terms and condition contained therein at the time of availing the policies and the allegation of the Opposite Parties that the correction of policy in the year 2006 was made with the concurrence and consent of the Complainant will not be sustained without any written consent of the Complainant for the alleged manipulation of the Policy documents and taking into consideration of the entire premium amounts paid by the Complainants, this Commission is of the considered view that the Opposite Parties had acted in a arbitrary manner and hence held liable for unfair trade practice and deficiency of service. Accordingly Point No.2 is answered.

Point Nos 3 and 4:

As discussed and decided in Point No.2, the Opposite Parties having committed unfair trade practice and deficiency of service are held liable for a sum of Rs.1,50,000/- in respect of Policy No.712759804 to the 1^st Complainant and a sum of Rs.1,50,000/- in respect of Policy No.713125080 to the 2^nd Complainant and a sum of Rs.50,000/-  towards compensation for deficiency in service to the Complainant along with cost of Rs.3000/-. Accordingly, Point Nos. 3 and 4 are answered.

In the result the complaint is allowed in part. The 1^st and 2^nd Opposite parties are jointly and severally directed to pay the policy matured benefits of Rs.1,50,000/- (Rupees One Lakh and Fifty Thousand Only) in respect of Policy No.712759804 to the 1^st Complainant and Rs.1,50,000/- (Rupees One Lakh and Fifty Thousand Only) in respect of  the Policy No.713125080 to the 2^nd Complainant and a sum of Rs.50,000/- (Rupees Fifty Thousand Only) towards compensation for deficiency in service to the Complainant along with cost of Rs.3000/-(Rupees Three Thousand Only) within 8 weeks from the date of receipt of this order, failing which the Complainant is entitled to recover the same along with interest @ 9% per annum from the date of this order to till the date of realisation.

In the result the complaint is allowed.

Dictated to Steno-Typist, transcribed and typed by her, corrected and pronounced by us in the Open Commission, on 23^rd of August 2022.

 

 

 

S. NANDAGOPALAN               T.R. SIVAKUMHAR                    B.JIJAA

         MEMBER II                       MEMBER I                        PRESIDENT

 

List of documents filed on the side of the Complainant:-

 

Ex.A1	28.02.2000	Copy of Jeevan Aadhar policy life assured G.Subramanian
Ex.A2	28.02.2000	Copy of Jeevan Aadhar policy life assured R.Muthulakshmi
Ex.A3	21.12.2015	Copy of Letter of complainants to adversaries
Ex.A4	13.01.2016	Copy of Reply by 1st Adversary
Ex.A5	17.02.2016	Copy of Letter of Complainants to Adversaries
Ex.A6	23.03.2016	Copy of Letter of Adversaries to Complainants
Ex.A7	28.04.2016	Copy of Letter of complainants to 2nd Adversary
Ex.A8	09.05.2016	Copy of RTI application of Complainants to Adversaries
Ex.A9	07.06.2016	Copy of Reply of 2nd Adversary
Ex.A10	15.06.2016	Copy of RTI application
Ex.A11	12.07.2016	Reply of 2nd Adversary
Ex.A12	15.07.2016	Copy of RTI application
Ex.A13	16.08.2016	Copy of Reply of 2nd Adversary
Ex.A14	15.07.2016	Copy of RTI application
Ex.A15	13.08.2016	Copy of Reply of 2nd adversary
Ex.A16	19.09.2016	Copy of Letter of Complainants to 2nd Adversary
Ex.A17	17.10.2016	Copy of Letter of 2nd Adversary to Complainants
Ex.A18	05.11.2016	Copy of Letter of Complainants to 2nd Adversary
Ex.A19	05.12.2016	Copy of Reply of 2nd Adversary
Ex.A20	04.11.2016	Copy of Letter of Complainants to 2nd Adversary
Ex.A21	03.12.2016	Copy of Reply of 2nd Adversary
Ex.A22	18.12.2017	Copy of Petition sent to Ombudsman
Ex.A23	26.12.2017	Copy of Letter from ombudsman to Complainant

 

List of documents filed on the side of the Opposite Parties:-

 

Ex.B1	13.01.2016	Copy of reply letter sent to the Complainant
Ex.B2	24.01.2008	Copy of circular issued by LIC, CRM Department, Central Office, Mumbai.

 

 

 

 

S. NANDAGOPALAN               T.R. SIVAKUMHAR                    B.JIJAA

         MEMBER II                       MEMBER I                              PRESIDENT