Order by:
Sh.Mohinder Singh Brar, Member
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 on the allegations that on the allurement of the agent of Opposite Parties that they have best policies for older persons and showed green pastures to the complainant regarding the investment of the money by the complainant in LIC schemes, the complainant had purchased the policy namely LIC’s Jeevan Saral (With Profits) bearing no.133106961 on 15.04.2020 from Opposite Parties here from Moga and deposited Rs.24,020/- per year as premium without any break and hence total 11 installments of the premiums of Rs.24,020/- have been paid by the complainant total amounting to Rs.2,64,220/-. Said policy has become due on 15.04.2021 and the complainant completed all the formalities and submitted the original policy to the Opposite Parties here at Moga office for getting the maturity value of the policy. The complainant stunned to receive an amount of Rs.1,69,000/- against the policy in question as maturity value against the total deposit of Rs.2,64,220/-. The complainant shocked and unbelieved that against the paid up premium of Rs.2,64,220/- the Opposite Parties have released the amount of Rs.1,69,000/- only which is against the terms of the policy as well as against the IRDAI rules and against the law. In this way, the Opposite Parties has paid less amount of Rs.95,220/- which is recoverable alongwith interest @ 12 % per annum as well as its benefits/bonus against the said policy. After the receipt of the said maturity amount, the complainant made so many visits to the office of Opposite Parties and enquired the reason for less payment against the said policy, but the officials of the Opposite Parties did not listen the request of the complainant. Further alleges that at the time of issuing the policy in question alongwith this cover note, the Opposite Parties never issued any terms and conditions of the policy documents. As such, the alleged terms and conditions, particularly the exclusion clause of the policy in question is not binding upon the insured. Hence, the repudiation of the claim of the complainant has been made by the Opposite Parties on the false and frivolous grounds. There is deficiency in service on the party of the Opposite Parties for not making the maturity amount alongwith its benefits and bonus etc. on the deposited amount on its maturity. Hence this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite Parties may be directed to pay an amount of Rs.95,220/- which is recoverable alongwith interest @ 12 % p.a. as well as its benefits/bonus against the said policy.
b) To pay an amount of Rs.2,00,000/- as compensation on account of mental tension, agony and harassment caused by the complainant.
c) To pay an amount of Rs.20,000/- as litigation expenses.
d) And any other relief which the Commission deem fit and proper be granted to the complainant in the interest of justice and equity.
2. Opposite Parties appeared through counsel and contested the complaint by filing written reply taking preliminary objections therein inter alia that the present complaint is not maintainable and is liable to be dismissed due to non-joinder of necessary parties. The agent against whom serious allegations have been made by the complainant is a necessary party and has a definite right of audience before this Commission adjudicate the complaint for its decision. The complainant has no cause of action to file the present complaint. Further alleges that the plan opted by the complainant was launched vide Circular No.1934 dated 12.02.2004 and in the Annexure-II of the said circular the Maturity value payable per Rs.100 monthly premium is provided in advance for each age and term of the policy. As such, it is submitted that the Maturity Value payable under the plan is well defined at the inception of the policy itself and in this case also maturity sum assured has been paid strictly as defined and disclosed at the purchase of the policy by the complainant. There is no deficiency in rendering service on the part of the Opposite Parties. As per policy record Sh.Mohal Lal Goyal has purchased the policy no.133106961 under table term 165 (Jeevan Saral) on 15.04.2010 for Death benefit sum assured of Rs.5 Lacs, Maturity Sum Assured of Rs.1,15,220/- by paying premium of Rs.24,020/- through annual mode. The complainant is demanding higher maturity value/refund of premiums under the present complaint. However to decide thereon, it is inevitable to understand the policy/product features and the objective it serves. Under the normal Life Insurance, the premium is determined by morality rating which is age dependent, that it to say, high premium is charged for higher age and maturity or death cover benefit is fixed. Also higher is the risk cover, higher is the expected cost of risk cover. Unlike regular insurance plans wherein higher premium is charged for proponent higher in age, under this plan the premium amount is decided irrespective of the age of proponent, at the start of the policy and the death sum assured is calculated equal to the 250 times of monthly premium amount. As such the proponents higher in age will also get same insurance cover in the same premium amount as that of the proponents lower in age, but the maturity value of the policy would differ according to the age at the entry of the insured. Thus, higher the age at entry of insured, lower will be the maturity amount and vice-versa. In this case please refer to 1st page of policy document where death benefit sum assured is mentioned as Rs.5,00,000/-, maturity sum assured is mentioned as Rs.1,15,220/-. Further, loyalty addition amounting to Rs.54,730/- has been paid for the complete duration of the policy. Therefore, maturity amount of Rs.1,69,950/- i.e. (1,15,220 + 54730) has been paid correctly to the complainant. The present complaint is not maintainable and is liable to be dismissed with special costs as the same has been filed intentionally on false and frivolous facts. On merits, all other facts mentioned in the complaint are denied and a prayer for dismissal of the complaint is made.
3. Complainant has filed replication to the written reply of the Opposite Parties in which he has mainly reiterated the same facts as narrated in the complaint. He further submitted that complainant has ever cause of action as the rules of LIC are not applicable. Moreover, the Internal Circular No.1934 of 12.02.2004 is not binding upon the legal rights of the complainant nor any such circular was ever intimated to the complainant or annexed with the cover note at the time of supplying the same by the agent of Life Insurance Corporation of India to the complainant. The annexure 02 is altogether different one whereas in the cover note, it is mentioned that Jeewan Sara with Profits (Medical, whereas the annexure attached with the present reply is LIC Jeewan Saral Plan No.165. Both are altogether different one. Now, the Opposite Parties are intentionally and knowingly referring this circular which is not part of the policy. This clearly shows that now the Opposite Parties are misleading this District Commission on flimsy grounds. It is unbelievable that a person with his knowledge ever accept the plan mentioned by the Opposite Parties that against the total paid up premium of Rs.2,40,220/- he will accept only Rs.1,15,220/-. Further stated that the annexure with this statement circular dated 16.02.2004 was never supplied and delivered at the time of selling the policy to the complainant. Moreover, no other terms and conditions have ever been supplied or conveyed to the complainant except the cover note. Not only this, in the cover note, some conditions are printed which are not readable at all. Further stated that the Opposite Parties admitted the rules of IRDA, but the payment has not been made as per the IRDA rules. All other objections raised by the Opposite Parties in the written reply are denied.
4. In order to prove his case, complainant tendered in evidence his affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C9.
5. To rebut the evidence of complainant, Opposite Party No.2 tendered in evidence affidavit of Sh.R.S.Sambyal, Manger, Life Insurance Corporation of India Ex.OP1 & 2/A alongwith copies of documents Ex.OP1 & 2/B to Ex.OP1 & 2/E.
6. Ld. counsel for the complainant has filed written arguments, in which, complainant has mainly reiterated the same facts as narrated in the complaint. He further stated that the complainant had purchased the policy namely LIC’s Jeevan Saral (With Profits) bearing no.133106961 on 15.04.2020 from Opposite Parties here from Moga and deposited Rs.24,020/- per year as premium without any break and hence total 11 installments of the premiums of Rs.24,020/- have been paid by the complainant total amounting to Rs.2,64,220/-. But the complainant stunned to receive an amount of Rs.1,69,000/- against the policy in question as maturity value against the total deposit of Rs.2,64,220/-. The complainant shocked and unbelieved that against the paid up premium of Rs.2,64,220/- the Opposite Parties have released the amount of Rs.1,69,000/- only which is against the terms of the policy as well as against the IRDAI rules and against the law.
7. Ld. counsel for the Opposite Parties has repelled the aforesaid contentions of ld. counsel for the complainant on the ground that the plan opted by the complainant was launched vide Circular No.1934 dated 12.02.2004 and in the Annexure-II of the said circular the Maturity value payable per Rs.100 monthly premium is provided in advance, for each age and term of the policy. As such, it is submitted that the Maturity Value payable under the plan is well defined at the inception of the policy itself and in this case also maturity sum assured has been paid strictly as defined and disclosed at the purchase of the policy by the complainant. As per policy record Sh.Mohal Lal Goyal has purchased the policy no.133106961 under table term 165 (Jeevan Saral) on 15.04.2010 for Death benefit sum assured of Rs.5 Lacs, Maturity Sum Assured of Rs.1,15,220/- by paying premium of Rs.24,020/- through annual mode. The complainant is demanding higher maturity value/refund of premiums under the present complaint. However to decide thereon, it is inevitable to understand the policy/product features and the objective it serves. Under the normal Life Insurance, the premium is determined by morality rating which is age dependent, that it to say, high premium is charged for higher age and maturity or death cover benefit is fixed. Also higher is the risk cover, higher is the expected cost of risk cover. Unlike regular insurance plans wherein higher premium is charged for proponent higher in age, under this plan the premium amount is decided irrespective of the age of proponent, at the start of the policy and the death sum assured is calculated equal to the 250 times of monthly premium amount. As such the proponents higher in age will also get same insurance cover in the same premium amount as that of the proponents lower in age, but the maturity value of the policy would differ according to the age at the entry of the insured. Thus, higher the age at entry of insured, lower will be the maturity amount and vice-versa. In this case please refer to 1st page of policy document where death benefit sum assured is mentioned as Rs.5,00,000/-, maturity sum assured is mentioned as Rs.1,15,220/-. Further, loyalty addition amounting to Rs.54,730/- has been paid for the complete duration of the policy. Therefore, maturity amount of Rs.1,69,950/- i.e. (1,15,220 + 54730) has been paid correctly to the complainant.
8. We have perused the rival contentions of ld. counsel for both the parties and have gone through the record. The allegation of the complainant is that he had purchased the policy namely LIC’s Jeevan Saral (With Profits) bearing no.133106961 on 15.04.2020 from Opposite Parties here from Moga and deposited Rs.24,020/- per year as premium without any break and hence total 11 installments of the premiums of Rs.24,020/- have been paid by the complainant total amounting to Rs.2,64,220/-. But against the paid up premium of Rs.2,64,220/- the Opposite Parties have released the amount of Rs.1,69,000/- only. The perusal of policy document Ex.C6 placed on record by complainant show that he purchased the policy Jeevan Saral (With Profits) (Table no.165) under which the Maturity Sum Assured is Rs.1,15,220/-, Death benefit Sum Assured under main plan is Rs.5,00,000/- and Accident benefit Sum Assured is Rs.5,00,000/- and date of Last premium Payment is mentioned as 15.04.2021. In the case of the complainant, he has not claimed the death benefit and accident benefit. He has claimed the Maturity sum assured, which is as per the policy document Ex.C6 is Rs.1,15,220/-, which was already paid by the Opposite Parties to the complainant alongwith loyalty addition amounting to Rs.54,730/- in total Rs.1,69,950/- which is not denied by the complainant. Moreover, it is the Life Insurance policy not investment plan in which the complainant expects to get extra amount. Hence, the complainant failed to prove any deficiency in service or unfair trade practice on the part of the opposite parties.
9. In view of the above discussions, there is no merit in the complaint and the same stands dismissed. Keeping in view the aforesaid facts and circumstances, the parties are left to bear their own costs. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.
Announced in Open Commission.
