| Final Order / Judgement | CONSUMER DISPUTES REDRESSAL COMMISSION – X GOVERNMENT OF N.C.T. OF DELHI Udyog Sadan, C – 22 & 23, Institutional Area (Behind Qutub Hotel) New Delhi – 110016 Case No.150/2021 MAHAVIR SINGH, S/O. LATE SHRI RAM KUMAR, THROUGH RESIDENT OF 3/316, DAKSHINPURI EXTENSION NEW DELHI-110062.…..COMPLAINANT Vs. THE SENIOR DIVISIONAL MANAGER LIFE INSURANCE CORPORATION OF INDIA BRANCH NO. 12G, 9 VARDHMAN TRADE TOWER -
NEW DELHI-110019..…..RESPONDENT Date of Institution-12.07.2021 Date of Order- 05.04.2024 O R D E R MONIKA SRIVASTAVA– President - The complainant has filed the present complaint seeking Rs.1,94,223/- as per the terms of the policy, Rs.1,00,000/- towards mental harassment with interest @18% and Rs.55,000/- towards litigation cost.
- Complainant states that he had taken a policy Jeevan Saral with profits in March 2009 under which he had to contribute an amount of Rs.1,021/- for 132 months and on maturity on 28.03.2020 an amount of Rs.2,50,101/- was to be returned to the complainant. It is stated that the complainant contributed regularly for a period of 132 months i.e. Rs.1,34,772/- till the maturity of the policy.
- Complainant approached the OP for the maturity amount wherein it was informed that only an amount of Rs.55,878/- was due to the complainant. Complainant accepted the amount of Rs.55,878/- as he was in urgent need of the funds for medical purpose and accepted the amount “under protest”. It is further stated by the complainant that till date OP has neither given any calculation sheet nor offered any reason for non-payment of the maturity amount of Rs.2,50,101/-.
- The complainant has placed reliance on the judgments passed by Hon’ble Madras High Court in Subramaniam Vs. LIC wherein direction was given to the LIC to pay the amount with interest.
- In their reply, OP has stated that as per the terms and conditions of the policy taken by the complainant a sum of Rs.2,50,000/- was payable when the policy holder expired during the continuance of the policy and in case the policy holder certified the policy terms by signing the contract where maturity sum of Rs.39,490/- was payable. Copy of the policy and status report are annexed as annexure A and B.
- It is further stated that maturity sum of Rs.34,490/- along with the loyalty bonus of Rs.16,388/- totaling to Rs.55,878/- stands paid to the policy holder which is received by the complainant. It is stated that the policy holder has been paid as per the terms and conditions of the Jeevan Saral Policy and that there is no contravention or deficiency on the part of the OP and since there is no deficiency. This Commission does not have the jurisdiction to entertain the complaint.
- It is further stated that the policy was introduced on 16.02.2004 and was duly approved by IRDA. It is stated that this Policy is a unique plan and the sum assured is equal to 250 times of the premium amount and the premium amount is decided at the start of the policy irrespective of the age of the proponent unlike other insurance plans where higher premium is charged for higher age.
- It is stated that as per the plan feature, at least 10 years premiums had to be paid to get a loyalty addition for complete duration for which premium has been paid and therefore, the maturity fixation/ death benefit is not a static amount but increases every year. It is further stated that the primary charges of the policy is to provide protection /risk cover in the event of death of the insured which amount unless case is singularly higher than the amount paid by way of premium.
- It is further stated that the complainant filed the proposal form on 14.03.2009 for a monthly premium of Rs.1,021/- and as per the plan the death sum assured coverage shall be 250 time of the monthly premium amount chosen by the complainant and therefore, the policy holder having agreed to the terms was well aware of all the benefits of the plan. He was aware that the loyalty addition benefit is available only if the policy runs for more than 10 years and the policy holder had opted for ten years after taking a conscious decision.
- It is stated that in endowment insurance policy, it cannot be said that the entire premium paid by insured is applied only towards the payment of the maturity benefit. Part of the premium is applied towards mortality charges, some portion is applied towards administration charges and the remaining part is utilized for investment charges.
- It is stated that the death sum assured was clearly printed on the policy document which was never disputed by the policy holder during the policy term. It is further stated that the complainant has received the coverage of insurance under the policy and the OP has provided death cover and the benefits and therefore, discharged its obligations under the policy. It is stated that in case of involved occurrence of death of the policy holder during the term of the policy, OP would have paid all the benefits payable for death cover. It is reiterated that there is no deficiency on the part of OP.
- In his rejoinder, complainant has stated that the OP has not annexed the complete proposal form in order to avoid its liability and that the complainant is an illiterate person who just signed on the form on the asking of the agent of the OP. It is stated that had he been explained the clear terms and conditions, the complainant may not have opted for the policy. It is stated that even the terms of the policy itself speak “Sum Assured with Profit.” It is stated that the policy approved by IRDA cannot be against the interest of the policy holder and that maturity value calculation table is not applicable to the complainant as it was not explained to him at the time of taking of the policy.
- It is stated that OP has indulged in unfair trade practice and received the unintended monetary advantage on the cost of divesting complainant of the use of his legitimate money during that period when the amount was with the OP.
- Both the complainant as well as OP have filed their respective evidence affidavits as well as written argument. Complainant has placed on record judgment passed by the Hon’ble High Court of Karnataka in WP No.4766 of 2016. As per that judgment which pertains to the same policy it is stated by the Hon’ble High Court
a contract of insurance is a solemn agreement between the insurer and the insured, where the terms and conditions are set in stone. As noticed by the respondent no. 1, the petitioner had assured the respondent no. 2 that on the maturity of the policy in question, the respondent no. 2 would be paid a sum of Rs.98,160/-. The respondent no. 2, on that assurance, had paid premium for 10 years and on the maturity of the policy, the petitioner instant of paying a sum of Rs.98,160/- had released a sum of Rs.55,082/- claiming it to be the maturity value. ……….. Therefore, the petitioner cannot turn around and claim that what was mentioned in the policy was a typographical mistake. - In this case it is also seen that the sum assured is seen as Rs.2,50,000/- and that the complainant has paid a sum of Rs.1,34,772/-in 132 instalments regularly and has received a sum of Rs.34,490/- along with the loyalty bonus of Rs.16,388/- totaling to Rs.55,878/-. Relying upon the judgments passed by the Hon’ble High courts of Madras and Karnataka this Commission is of the view that the complainant is entitled to Rs.1,94,122/- (Rs.2,50,000 i.e. Sum Assured– Rs.55,878 paid to the complainant) is liable to be paid by the complainant by the OP along with interest @ 5% p.a. from the date of maturity till realization within three months from the date of pronouncement of the order failing which the said amount would be payable @7% p.a. Additionally, the OP is also liable to pay Rs. 15,000/- as compensation for causing harassment to the complainant.
Copy of the order be provided to the parties as per rules. File be consigned to the record room. Order be uploaded on the website. | |
