BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMRITSAR.
Consumer Complaint No. 633 of 2018
Date of Institution: 24.8.2018
Date of Decision:28.9.2021
Smt. Kamlesh Kumari wife of Sh. Om Parkash Aggarwal, aged 70 years resident of House No. 350 UV, Behind Jai Maa Medical Store, Opposite Flyover, Sama Kalan, Pathankot, Punjab 145025
Complainant
Versus
- Life Insurance Company of India , Division Office at Ranjit Avenue, Amritsar through its Principal Officer
- Life Insurance Corporation of India, having its branch office at 2nd Floor, R.S. Tower, Hall Bazar, Amritsar
Opposite Parties
Complaint under section 12 & 13 of the Consumer Protection Act, 1986 ( now u/s 35 of the Consumer Protection Act, 2019
Result : Complaint Allowed
Cases referred:-
- LIC of India Vs. Consumer Welfare Association and Others 2019(2) CLT 602 of the Hon’ble National Commission, New Delhi
- Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC)
- New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111
- Sri Animesh Ganguli Vs. Life Insurance Corporation of India & Ors. in First Appeal No. A/239/2016 decided on 21.3.2016 of the Hon’ble State Commission, West Bengal, H.P. State Forest Company Vs. M/s. United India Insurance Co.Ltd. in Civil Appeal No. 6347 of 2000 of the Hon’ble Supreme Court of India, Virupaxappa J.Yaragatti Vs. Sr. Branch Manager LIC of India in Revision Petition No. 3833 of 2011 and LIC of India Vs. Anil Kumar Jain in Revision Petition No. 2802 of 2011 ,Kishore Prasad Vs. LIC in Revision Petition No. 414 of 2013 of the Hon’ble National Commission, New Delhi, The Divisional Manager LIC Vs. Arjun in Appeal No. 17/2017, The Chief Manager Vs. Sr. Manohar J Bghasme in Appeal No. 19/2017 of the Hon’ble Karnataka State Commission, Bangalore.
- Hon’ble Supreme Court in case Amitabha Dasgupta Vs. United Bank of India and others AIR 2021 SC (Civil) 1457
Counsel for the parties :
For the Complainant : Sh.Anil Bhatia,Advocate
For the Opposite Parties : Sh. R.K.Mahajan,Advocate
CORAM
Mr. Jagdishwar Kumar Chopra, President
Mr.Jatinder Singh Pannu, Member
ORDER:-
Mr. Jagdishwar Kumar Chopra, President :-Order of this commission will dispose of the present complaint filed by the complainant u/s 12 & 13 of the Consumer Protection Act, 1986 (now covered u/s 35 of the Consumer Protection Act, 2019).
Brief facts and pleadings
1. Brief facts of the case are that the complainant purchased LIC’s Jiwan Saral (with profits) policy from the opposite parties bearing No. 471670120 on 25.7.2006 for a period of 12 years with the premium of Rs. 1225/- quarterly i.e. Rs. 4900/- yearly, as such the complainant has paid the total premium of Rs. 58,800/- for a period of 12 years. The sum assured of the said policy was Rs. 1,00,000/-. At the time of purchasing the policy, the complainant was resident of Amritsar and the address was given as 33/1, Ram Bagh Bazar, Gali Pehalwana, Amritsar and during the pendency of the policy, the address of the complainant got changed and intimation to this effect was duly given to the opposite parties and new address of the complainant was updated in the policy. Document pertaining to change of address is Ex.C-2. During these 12 years, the complainant used to pay the premium amount on time and never delayed the same and has paid the total amount of Rs. 58,800/- for the period of 12 years. Document pertaining to payment of premium is Ex.C-3. On 4.7.2018 on the policy being getting matured, the complainant approached the opposite parties to get the matured amount . But the complainant was surprised when she came to know that she will only receive Rs. 19709/- being the matured amount of the policy. The same was told by the concerned officers of the opposite parties and they make written acknowledgement to this effect. The abovesaid information regarding the matured amount being Rs. 19709/- only was a great harassment to the complainant as such the complainant again approached the opposite parties and requested them to pay the full maturity amount of Rs. 1,00,000/- but the opposite parties flatly refused to release the amount as stated in the policy cover note itself. On repeated requests , the opposite parties finally agreed to enhance the maturity amount but enhanced the maturity amount only to the tune of Rs. 27036/-. The complainant has paid a premium of Rs. 58800/- for a period of 12 years with the sum assured of Rs. 1,00,000/- and no person would have purchase the policy with a maturity sum assured of Rs. 27000/- with the total premium of Rs. 60000/-. The complainant number of times visited the opposite parties and requested them to release the maturity sum assured of Rs. 1,00,000- but the opposite parties flatly refused to accede to the genuine requests of the complainant. The aforesaid acts of the opposite party in not paying the maturity amount of sum assured of Rs. 1,00,000/- to the complainant on frivolous grounds is an act of deficiency in service, malpractice, unfair trade practice and has caused lot of mental agony, harassment, inconvenience besides financial loss to the complainant for which the opposite party is liable to pay compensation to the complainant. Vide instant complaint, complainant has sought for the following reliefs:-
(a) Opposite party be directed to release the maturity amount of Rs. 1,00,000/- alongwith interest @ 18% p.a.;
(b) Compensation to the tune of Rs. 50,000/- may also be awarded to the complainant.
(c) Opposite party be also directed to pay Rs. 25000/- as litigation expenses to the complainant.
(d) Any other relief to which the complainant is entitled be also awarded to the complainant.
Hence, this complaint.
2. Upon notice, opposite parties appeared and filed written version taking certain preliminary objections therein inter alia that the present complaint is not maintainable ; that the complainant has got no locus standi to file the present complaint against the replying opposite parties ; that complainant has got no cause of action to file the present complaint against the replying opposite parties ; that the complainant has not come to this Forum with clean hands and he has suppressed the material facts from the notice of this Forum, as such the complainant is not entitled to any relief. The real facts are that complainant Smt.Kamlesh Kumari purchased a LIC’s Jeewan Saral Policy No. 471670120 with Death sum assured of Rs. 1,00,000/- and the said policy was having quarterly premium of Rs. 1225/-. The policy is fully paid and date of commencement of policy was 25.7.2016 and the same was to be matured in the month of July 2018. The premium of Rs. 1225/- was paid regularly in the said policy. The said policy was got matured on 25.7.2018 and thereafter an agent of the complainant approached the opposite party to know about the maturity amount and he was told exact maturity amount of Rs. 27,033/- but he was never told the amount of Rs. 19,709/- as alleged in the complaint. It is pertinent to mention over here that as per the terms and conditions of the policy in question the policy holder is entitled to the amount of Rs. 1,00,000/- in case of any eventuality which falls within the ambit of accidental benefit and death benefit under the policy in question. However, the maturity value has been calculated as per the table and term applicable to each policy. In the present case, applicable table and terms is mentioned in the policy bond and the sum assured in the policy bonds to the tune of Rs. 27033/- after calculation based on the table and terms as mentioned in the policy bond. However, inadvertently due to typographical mistake, the same amount of Rs. 1,00,000/- has been mentioned against maturity sum assured as mentioned against death benefit sum assured and accidental benefits sum assured in the policy. It is worth to mention here that the said typographical mistake bonafidely occurred in so many policies of sake nature and accordingly, when the said mistake came to the knowledge of the opposite party, the opposite party issued circular in this regard and informed accordingly. Moreover, when the specific procedure/table term has been mentioned in the policy bond for the calculation of benefits payable under the policy , then definitely the amount payable on maturity has to be calculated accordingly. Moreover, mere mentioning of wrong amount of maturity value in the policy, due to typographical mistake would not entitle the policy holder to grab the same from the opposite party. Moreover the maturity amount is booked by the system prior to 3 months of maturity so there is no question of enhancing the amount to the tune of Rs. 27,033/- and moreover the plan purchased by the complainant is Table No. 165 which is high risk plan and risk premium at age of 58 years is quite high and as such the said amount of Rs. 27033/- was the exact maturity mount and the same is payable to the complainant . It is pertinent to mention here that complainant on completion of maturity never approached the opposite parties. On merits, the opposite parties have taken the similar pleas as were taken in the preliminary objections, as such there is no need to reproduce the same. While submitting that there is no deficiency in service and while denying and controverting other allegations, dismissal of complaint was prayed.
Points for Determination
3. From the pleadings the following are the points to be determined by this Commission:-
- Whether there is deficiency in service the part of the opposite party in not paying the maturity sum assured of Rs. 1,00,000/- ?
- If point No.1 is proved , whether the complainant is entitled for compensation on account of harassment and mental agony and also entitled for litigation expenses , if so , to what amount ?
Evidence of the complainant and Arguments
4. Alongwith the complaint, complainant has filed her affidavit , copy of policy cover note Ex.C-1 , Copy of document pertaining to updated address of the complainant Ex.C-2, copy of payment of premium Ex.C-3, copy of policy cover Ex.C-4, copy of acknowledgement Ex.C-5 and closed her evidence.
5. To rebut the evidence of the complainant, opposite party alongwith written version has filed affidavit of S. Virsa Singh, Manager (Legal) Ex.OP1/A, copy of status report of policy with calculations Ex.OP1, maturity table Ex.OP2, letter dated 23.8.2017 Ex.OP3, terms and conditions of policy Ex.OP4, letter dated 21.9.2007 Ex.OP5, letter dated 21.12.2013 Ex.OP6 and letter dated 27.7.2015 Ex.OP7. closed the evidence on behalf of the opposite party.
6. We have heard the Ld.counsel for both the parties and have carefully gone through the record on the file . We have also gone through the written synopsis submitted by the Ld.counsel for both the parties.
Findings
7. From the appreciation of the facts and circumstances of the case it stands proved on record that the complainant has obtained Life Insurance policy bearing No. 471670120 commencing for the period from 25.7.2006 for a period of 12 years and in this regard complainant has placed on record copy of cover note Ex.C-1/Ex.C-4. It also stands proved on record that the sum assured of the said policy as per cover note Ex.C-1/Ex. C-4 is Rs. 1,00,000/-. It was the case of the complainant that when the policy was matured , she approached the opposite parties to comply with the formalities in order to get the maturity amount, she came to know that she will only receive Rs. 19709/- and when she requested the opposite parties to pay the maturity amount of Rs. 1,00,000/-, the opposite parties enhanced the amount from Rs. 19709/- to Rs. 27,036/- . However, complainant again approached the opposite parties that as she has paid a premium of Rs. 58,800/- for a period of 12 years , how she can receive Rs. 27,036/-, whereas the sum assured as per policy cover note is Rs. 1,00,000/-. But the opposite parties did not pay any heed to the requests of the complainant. Ld.counsel for the complainant contended that the act of the opposite parties in not paying the maturity amount of Rs. 1,00,000/- amounts to deficiency in service which caused lot of mental tension, agony and harassment to the complainant as the complainant is a senior citizen.
8. On the other hand it was not disputed by the opposite party that complainant had taken one policy bearing No. 471670120 with the date of commencement as 25.7.2006 and date of maturity was 25.7.2018 . The only plea of the opposite parties is that the sum assured in the policy comes to the tune of Rs. 27,033/- after calculation based on the table and terms as mentioned in the policy bond due to some typographical mistake amount of Rs. 1,00,000/- has been mentioned against maturity sum assured as mentioned against death benefit sum assured and accidental benefits sum assured in the policy and this type of typographical mistake occurred in so many policies of same nature and in this regard circular was issued and informed accordingly. But we are not agreed with the pleas taken by the opposite party that the sum assured of Rs. 1,00,000/- was wrongly mentioned against the column of sum assured as it was a typographical error .In this regard Ld.counsel for the opposite party has vehemently argued that if there is some typographical mistake in policy document or in some other documents, then the persons who are parties cannot take benefits or advantage of such mistake. Reliance in this connection has been placed Sri Animesh Ganguli Vs. Life Insurance Corporation of India & Ors. in First Appeal No. A/239/2016 decided on 21.3.2016 of the Hon’ble State Commission, West Bengal wherein it has been held that “From above, it becomes quite clear that the dispute centers around a simple typographical mistake. There was no malafide intention on the part of the respondent/OP while settling the claim of Rs. 2,04,940/-. The position of law in this regard is well settled- Insurance claim has to be settled as per intrinsic nature and conditions of the policy. Insurance company, therefore, cannot be compelled to pay the price of an unintentional and inadvertent mistake.” Further reliance has been placed upon H.P. State Forest Company Vs. M/s. United India Insurance Co.Ltd. in Civil Appeal No. 6347 of 2000 of the Hon’ble Supreme Court of India, Virupaxappa J.Yaragatti Vs. Sr. Branch Manager LIC of India in Revision Petition No. 3833 of 2011 and LIC of India Vs. Anil Kumar Jain in Revision Petition No. 2802 of 2011 ,Kishore Prasad Vs. LIC in Revision Petition No. 414 of 2013 of the Hon’ble National Commission, New Delhi, The Divisional Manager LIC Vs. Arjun in Appeal No. 17/2017, The Chief Manager Vs. Sr. Manohar J Bghasme in Appeal No. 19/2017 of the Hon’ble Karnataka State Commission, Bangalore.
9. Ld.counsel for the opposite party also argued and drawn our attention towards LIC’s Jeevan Saral Plan No. 165 vide which as per table the amount was calculated as Rs. 27,033/- to be payable to the complainant. On the other hand Ld.counsel for the complainant argued that the opposite party has admitted the payment of premium to the tune of Rs. 4900/- yearly and the policy was commenced from 25.7.2006 with date of maturity 25.7.2018. In all the amount is to be calculated for 12 years comes to Rs. 58,800/- which has been paid as premium and how it is justified that after the span of 12 years the complainant is entitled to only Rs. 27,033/-. Further more it has been contended by the Ld.counsel for the complainant that the opposite party has raised the objection of mistake at the time when the policy was going to mature which itself proves that the opposite party has been finding the way of not paying the sum assured of Rs. 1,00,000/-. Not only this the opposite party cannot back out of their promises which were rather made in writing as proved in the cover note Ex.C-1/Ex.C-4 on record. Reliance in this connection has been placed upon LIC of India Vs. Consumer Welfare Association and Others 2019(2) CLT 602 of the Hon’ble National Commission, New Delhi in which it has been held as under:-
“Insurance Policy-Typographical mistake in the policy-plea of the OP was that amounts mentioned against the death claim and the maturity value have been interchanged in the policy document and the policy has been issued in accordance with table 165 of the LIC-Held-That even if the mistake is justified on the basis of table 165 of the LIC, it is seen that this table was not part of the policy and was not supplied alongwith the policy document-Therefore, the complainant may not be bound by this table, rather , the complainant and the Insurance company both are bound by the written contract of the policy as mentioned in the policy documents-Appeal dismissed.”
10. Moreover it is usual with the insurance companies to show green pastures to the consumers when they are to sell their policies. But however when it comes to the payment for claim, they invent all sort of excuses to deny the claim. Reliance in this connection can be had on the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., III (2008) CPJ 63 (SC) is fully attracted, wherein it was held that, Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-
“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.
The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.
11. The abovesaid law squarely covers the case of the complainant for all corners. Cover note Ex.C-1/Ex.C-4 fully proves that the opposite party has itself mentioned the amount of Rs. 1,00,000/- under the column Sum Assured and the opposite party is liable to pay the sum assured as mentioned on the cover note Ex.C-1 i.e. to the tune of Rs. 1,00,000/-.
12. Hence, point No.(i) and (ii) are decided in favour of the complainant. Consequently the complaint is allowed and the complainant is entitled to the following reliefs:-
- Opposite parties are directed to make payment of the claim amount of Rs. 1,00,000/- alongwith interest @ 9% p.a. from the date of its maturity till realization of the amount.
- So far as compensation , since the complainant was compelled to knock the door of this Commission and the opposite party did not bother to redress the grievance of the complainant and certainly this litigation could have been avoided . Though admittedly compensation term has not been explained in the Consumer Protection Act, however since this Act is based on principle of equity, good concise and natural justice and the Commission is empowered to provide compensation after assessing the facts of each case. In the present case the conduct of the opposite party is so callous and in human which compelled the complainant to knock the door of this Commission, hence, the opposite parties are liable to pay exemplary compensation to meet the ends of justice. This Commission relied upon the latest law on this point of compensation i.e. the Hon’ble Supreme Court in case Amitabha Dasgupta Vs. United Bank of India and others AIR 2021 SC (Civil) 1457 wherein it has been held that “ Deficiency in service- Duty of care should be exercised by bank irrespective of application of laws of bailment to contents of locker- Bank inadvertently broke customer’s locker, without giving prior notice, inspite of clearing pending dues by him- Bank acted in blatant disregard to responsibilities owned to customer as service provider- Case of gross deficiency in service- Imposition of costs of Rs. 5,00,000/- on bank, would be appropriate compensation to customer.” As the complainant has suffered a lot of mental as well as physical agony due to the act of gross deficiency of service of the opposite parties as she has to wander here and there and then to approach this Commission, as such the opposite parties are guilty of gross deficiency in service hence liable to pay compensation to the tune of Rs. 35000/- , out of which Rs. 5000/- be deposited in the Consumer Legal Aid Account of this Commission and Rs. 30000/- be paid to the complainant. Opposite parties are also directed to pay litigation expenses to the tune of Rs. 5000/- to the complainant .
Compliance of this order be made within 30 days from the date of receipt of copy of this order ; failing which complainant shall be entitled to get the order executed through the indulgence of this Commission . Copies of the orders be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission.
Announced in Open Commission (Jagdishwar Kumar Chopra) President
Dated: 28.9.2021
(Jatinder Singh Pannu)
Member
