Sri. P. Satheesh Chandran Nair (President):
The complainant filed this complaint against the opposite parties for getting a relief u/s.12 of the C.P. Act 1986.
2. The complainant availed an insurance policy vide Policy No.392883509 from the opposite party on 09.03.2004 for an amount of Rs. 1 lakh and the same was matured on 09.03.2014. The complainant paid the whole premium for the said policy and after its maturity claimed for the maturity amount but the opposite party was allowed only Rs.15,295/- in favour of the complainant. Aggrieved by the decision of the opposite parties, the complainant sent a notice to the opposite party claiming Rs.1 lakh along with ancillary benefit on 17.02.2016. The opposite parties sent a reply notice which denied the claim of the complainant. According to the complainant, as per the policy he is eligible for Rs. 1 lakh along with ancillary benefits. Hence this complaint, for the insurance amount of Rs. 1 lakh, ancillary benefit, compensation, cost etc. etc.
3. This Forum entertained the complaint and issued notice to the opposite parties for their appearance. Opposite party 1 and 2 appeared before the Forum and filed their version as follows: According to them, this complaint is not maintainable either in law or on facts. It is further contended that the complaint is false, frivolous, vexatious and gross misuse of process of law and there is no consumer disputes arised between the parties. It is admitted that the complainant he who availed a policy vide Policy No.392883509 under LIC’s Jeevan Saral Plan (T-165) for which death benefit sum assured is Rs. 1 lakh and also admitted that they received the whole premium from the complainant. It is stated that Rs. 1 lakh will get only as the death benefit sum assured, at the event of the death of the complainant if it happened during the policy period. It is further contended that the policy of the complainant is a Jeevan Saral Policy introduced to cover high death benefit at low premium irrespective of age. As the complainant avail the policy at the age of 60 years the maturity sum assured happened to be lower than the total premium paid by the applicant. As per the maturity benefit chart which forms part of the policy profile, the maturity sum assured for 10 years at the age 60 is Rs.3,059/-. In this case the basic monthly premium is Rs.400/-. Hence the maturity sum assured is Rs.3,059/- x 4 = Rs.12,236/-.
The following is the maturity sum assured under the policy.
Rs. 3059 X 4 = Rs. 12,236/- (A)
Loyalty Addition for term 10 years:-
Per Rs.1,000 maturity Sum Assured = Rs. 250/-
Loyalty Addition for Rs.12,236/- = Rs.250 X 12,236
1000
= Rs. 3,029/- (B)
The total amount payable on maturity is (A) + (B) = Rs.15,295/- ============
4. According to the opposite parties, LIC of India never withholds an amount of Rs. 1 lakh as stated by the complainant. The claim of the complainant is against the terms and conditions of the LIC’s Jeevan Saral Plan. As per the policy schedule the maturity benefit is stated as follows: “In the event of the Life Assured, surviving the date of maturity a sum equal to maturity sum assured in force after partial surrenders, if any, along with the corresponding loyalty addition, if any shall be payable”. It is further contended that the complainant is not entitled to get any of the relief claimed. The maturity sum assured in the policy can be calculated by several factors like mortality, expenses etc. at the time of maturity of the policy. Therefore, this opposite parties prayed to dismiss this complaint with cost to them.
5. This Forum peruse the complaint, version and the records before us and we framed the following issues:
- Whether the petition is maintainable before this Forum?
- Whether the opposite parties committed any deficiency in service against the complainant?
- Regarding the relief and costs?
6. In order to prove the case of the complainant, the complainant he who filed a proof affidavit in lieu of chief examination and marked Exts.A1 to A4. He is examined as PW1 in this case and at the time of cross-examination through him Ext.B1 to B3 are also marked. Ext.A1 is the true copy of policy certificate. Ext.A2 is the copy of legal notice dated 17.02.2016 sent by the complainant’s counsel to 2nd opposite party. Ext.A3 is the postal receipt. Ext.A4 is the reply notice sent by opposite party’s counsel to complainant’s counsel. Ext.B1 is the original of the proposal form. Ext.B2 is the Jeevan Saral Policy Certificate. Ext.B3 is the acknowledgment receipt. On the other side for opposite party 1 and 2 one Sreedevi S. Nair was examined as power of deligative of opposite party 1 and 2. She is examined as DW1 in this case and through him apart from Ext.B1 to B3, B4 and B5 are also marked. Ext.B4 is the maturity payment notice (computer print) dated 28.02.2014. Ext.B5 is the claim payment voucher. After the completion of the evidence of either parties both sides filed argument notes.
7. Point No.1:- The opposite parties in this case seriously contended that the complainant is not comes under C.P. Act and there is no consumer disputes between the complainant and opposite parties. When we appreciate the evidence adduced by both sides in this case, it is clear that the complainant in this case is the insured and the opposite parties are insurer. It is also admitted that the complainant remitted the whole premium for the above said policy. Hence it can be easily inferred that the complainant is a consumer of the opposite parties and the opposite parties are service providers of the complainant. Hence we can safely find that the complaint is maintainable before the Forum and the Forum has got jurisdiction to entertain this case. Therefore, Point No.1 found in favour of the complainant.
8. Point Nos.2 & 3:- For the sake of convenience, we would like to consider Point No.2 and 3 together. The complainant as PW1 deposed that he availed LIC Jeevan Saral (profits) policy on 09.03.2004 and the said policy had matured on 09.03.2014. It is further deposed that the maturity sum assured is Rs. 1 lakh and the monthly instalment premium of the policy is Rs.1,225/-. It is also admitted that PW1 has paid the whole premium amount to the above said policy by 17.12.2013. The opposite parties contention is that the maturity sum assured is not Rs. 1 lakh the amount mentioned in Ext.A1 connotes the death benefits sum assured under the plan. When we examine Ext.A1 or Ext.B2 (the original policy bond of the complainant), it is to be understood that in column 2 of the schedule Rs.1 lakh is mentioned and in the bottom of this writing there is a printing of Maturity sum assured (Rs), Death benefits sum assured under main Plan (Rs), Accident benefit sum assured (Rs) and Term rider sum assured (Rs) can be seen. Anyway, in the bottom of the above writing only Rs. 1 lakh is mentioned. It is evident to see that Ext.B2 document was actually produced by the complainant before the opposite parties for getting the insurance claim and it is also noted that on the basis of the surrender and on the basis of the claim application of the complainant PW1, the opposite parties sanctioned and credited Rs.15,295/- to complainant’s bank account as insurance claim. Aggrieved by the disbursement of the above said low amount PW1 approach this Forum for getting maturity claim of Rs. 1 lakh. It is true that the opposite parties contended and argued that the maturity sum assured and the death benefit sum assured are entirely different and the complainant’s policy is a Jeevan Saral policy, and such kind of policy the maturity sum will vary according to the entry age of the policy holder, period of the policy, factors like mortality, expenses etc. In this case, it is clear that the complainant PW1 claim is for a maturity benefit as per Ext.A1 or Ext.B2. The maturity benefit is clearly defined, “In the event of the Life Assured surviving the date of maturity a sum equal to Maturity Sum Assured in force after partial surrenders, if any, along with the corresponding loyalty addition, if any, shall be payable”. The learned counsel appearing for the opposite parties argued that the non-mentioning of the maturity sum assured in Ext.A1 and Ext.B2 happened due to a clerical mistake or a typing mistake. It is to see that if the submission note of the learned counsel of the opposite parties was a genuine one, what prevented the opposite parties to raise this contention at the time of filing version. When we examine the cross-examination of PW1, it shows that though the opposite party’s counsel put so many questions with regard to their contention nothing brought out to disbelieve the contention of the complainant in this case. Moreover, in re-examination he answered, “10 കൊല്ലത്തെ maturity period കഴിയുമ്പോള് എന്ത് തുക കിട്ടും എന്ന വ്യവസ്ഥയിൽ ആണ് നിങ്ങള് ഈ policy എടുത്തത്? (A) ഒരു ലക്ഷം രൂപാ കിട്ടും. എന്ന വ്യവസ്ഥയിൽ ആണ്. On the basis of the deposition of PW1 and the records produced by PW1 as Ext.A1 to A4, it can be inferred that a maturity amount of Rs. 1 lakh is clearly mentioned in Ext.A1 certificate. On the other side, when DW1 is examined in cross, “Ext.A1-se insurance policy എത്ര തുക ആയിരുന്നു. (A) Rs.1,00,000/- ആണ് Maturity period 10 വർഷം ആയിരുന്നു. ഈ കേസിലെ പരാതിക്കാരൻ premium മുഴുവനും അടച്ചിട്ടുണ്ട് (Q) Maturity period കഴിഞ്ഞു policy holder ജീവിച്ചിരിക്കുകയും ചെയ്താൽ Ext.A1 പ്രകാരം എത്ര രൂപാ കിട്ടും? (A) Ext.A1 പ്രകാരം Rs.1,00,000/-ഉം loyalty benefit-þ ഉം കിട്ടും”. When we peruse the above deposition of DW1, it is clear that as per the writing in Ext.A1 nobody can say that the maturity value would be less than the amount mentioned in Ext.A1. It is true that the opposite party argued that the mistake happened in the relevant column of maturity sum assured is an inadvertent omission of the opposite parties at the time of their computer programming. In cross-examination DW1 answered, “affidavit-ൽ Page No.5þ ൽ inadvertent omission എന്ന് പറഞ്ഞിട്ടുണ്ട് അത് എന്ന് മനസ്സിലായി (A) policy mature ആയതിനുശേഷം മനസ്സിലായി ഈ omission programmeþ ൽ സംഭവിച്ചതാണ് ആയതിന് പരാതിക്കാരൻ ഉത്തരവാദിയല്ല”. When we examine the explanation of DW1 with regard to the programme error or typographical mistake, the complainant is anyway not responsible at all. Moreover, it is to see that at the time of filing the version or at the time sending the repudiation letter the opposite parties have no case to the effect that the error happened due to a typographical error or a programme error. Therefore, the story of typographical error or programme error is only an afterthought of the opposite parties in this case. It is true that the opposite parties learned counsel produced a decision reported in Revision Petition No.2802 of 2011 of our National Consumer Disputes Redressal Commission, New Delhi the main dictum is, “In the light of aforesaid citations it becomes clear that typographical mistakes can be rectified as and when they are noticed and opposite party has not committed any error in asking complainant to make payment or premium to continue old term plan, particularly when complainant’s father, who was employee of petitioner must be aware that premium shown in term table 79-30 is not correct, and on refusal by the complainant, opposite party has not committed any error in revising term plan”. When we go through this decision, it is so clear that if a typographical mistake happened in the policy certificate the insurer can be rectified this defect and it has to be informed to the concerned. The complainant or opposite parties did not adduce any evidence before us with regard to the ancillary benefit claimed by the complainant. Hence, there is no need of considering the ancillary benefit of the complainant connected to the insurance policy. It is to see that another decision reported by our Hon’ble Supreme Court in Civil Appeal No.6347 of 2000 in H.P. State Forest Company Ltd. Vs. M/s. United India Insurance Co. Ltd. it is held that, “on the basis of typographical mistake which has been rectified in the records of the company before the occurrence, insured cannot get benefit of typographical mistake”. When we refer these two decisions, it is to be understood that the insurance company rectified the mistake within the policy period or before the occurrence (death). Here it is to see that the policy period was over on 09.12.2013 and the opposite parties prepared a chart for the payment of insurance amount of Rs.10,982.20 on 22.02.2014 under the policy and sent a notice to PW1 on 27.04.2016 with regard to maturity payment by Ext.B4. Ext.B5 is a claim payment voucher dated Nil shows that a cheque for an amount of Rs.15,295/- was issued to PW1 complainant as his maturity claim. It is to be noted that if any programme error or typographical mistake happened in Ext.A1 or B2 as argued by the opposite party’s learned counsel what prevented the opposite parties to intimate to this fact at that time. When we peruse Ext.A4 repudiation letter it can be seen that, “but we inadvertently omitted to incorporate the same in the policy document”. Here also the opposite parties did not mention the programme error or typographical mistake happened from their side. Moreover, it is also to be noted that through the above stated document the opposite parties have an inconsistent case with regard to the error committed in Ext.A1 certificate. Even if, the case of the opposite parties are failed we should like to appreciate the effort of DW1 the officer who represent for opposite parties was so vigilant in conducting the defence before us. Considering the above facts, the decision submitted by the learned counsel for the opposite parties are any way not applicable in this case. On the basis of the appreciation of the above evidence of this case it can be find that the complainant’s case is more probable than the case presented by the opposite parties before us. Therefore, we find that the complaint is allowable and Point No. 2 and 3 are also found in favour of the complainant.
9. In the result, we pass the following orders:
- The opposite parties are directed to pay a maturity sum assured value Rs. 1 lakh (Rupees One Lakh only) to the complainant with 10% interest from the date of this petition onwards. The maturity value can be calculated after deducting the payment already credited in favour of the complainant, i.e. Rs.15,295/-).
- The opposite parties are also directed to pay a compensation of Rs.10,000/- (Rupees Ten Thousand only) and a cost of Rs.3,000/- (Rupees Three Thousand only) to the complainant with 10% interest from the date of order onwards.
Dictated to the Confidential Assistant, transcribed and typed by her, corrected by me and pronounced in the Open Forum on this the 28th day of April, 2017.
(Sd/-)
P. Satheesh Chandran Nair,
(President)
Smt. Sheela Jacob (Member) : (Sd/-)
Appendix:
Witness examined on the side of the complainant:
PW1 : Surendranathan Nair
Exhibits marked on the side of the complainant:
A1 : True copy of policy certificate.
A2 : Copy of legal notice dated 17.02.2016 sent by the complainant’s counsel
to 2nd opposite party.
A3 : Postal receipt.
A4 : Reply notice sent by opposite party’s counsel to complainant’s counsel.
Witness examined on the side of the opposite parties:
PW1 : Sreedevi S. Nair.
Exhibits marked on the side of the opposite parties:
B1 : Original of the proposal form.
B2 : Jeevan Saral Policy Certificate.
B3 : Acknowledgment receipt.
B4 : Maturity payment notice (computer print) dated 28.02.2014.
B5 : Claim payment voucher
(By Order)
Copy to:- (1) Surendranathan Nair, Lakshmi Vilasom,
Arukalickal East, Nedumon.P.O.,
Pin – 691 566.
(2) Manager, Claims, Life Insurance Corporation of India,
Divisional Office, Jeevan Prakash, P.B.No.609, Nagampadom,
Kottayam – 686 061.
(3) Branch Manager, LIC of India, Adoor Punthala Tourist Complex,
Adoor.
(4) The Stock File.
