DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
MUCHIPARA, BURDWAN.
Consumer Complaint No 118 of 2015
Date of filing 13.5.2015 Date of disposal: 18.01.2016
Complainant: Rekha Laha, W/o. Sukamal Laha, resident of Tirupati Engineering, Old Monteswar Road (Memari), PO & PS: Memari, District: Burdwan, PIN – 713 146.
-V E R S U S-
Opposite Party: 1. Life Insurance Corporation of India, represented by Marketing Manager, L.I.C. of India, having its office at Divisional Office, Asansol, Jeevan Prakash, West End, G.T. Road, Asansol – 713 304, District: Burdwan.
2. Memari Branch, L.I.C. of India, represented by Branch Manager, Memari Branch, L.I.C.I., having its office at L.I.C.I., Memari Branch Office (L.I.C.I.), G. T. Road, PO. & PS: Memari, District: Burdwan, PIN – 713 146.
3. Branch Manager, Memari Branch, L.I.C.I., having its office at L.I.C.I., Memari Branch Office (L.I.C.I.), G. T. Road, PO. & PS: Memari, District: Burdwan, PIN – 713 146.
Present: Hon’ble President: Sri Asoke Kumar Mandal.
Hon’ble Member: Smt. Silpi Majumder.
Hon’ble Member: Sri Pankaj Kumar Sinha.
Appeared for the Complainant: Ld. Advocate, Sanyuk Banerjee.
Appeared for the Opposite Party (s): Ld. Advocate, Saurabh Dey.
J U D G E M E N T
This complaint is filed by the complainant u/S. 12 of the C.P. Act, 1986 alleging deficiency in service as well as unfair trade practice against the Ops as the Ops did not pay double benefit of the sum assured in respect of the three policies obtained from the Ops.
The brief fact of the case of the complainant is that her son during his lifetime purchased three LICI policies from the OP-1. Her son died due to premature unnatural death on 26.4.2013 and the matter was informed to the OP-3 on 30.5.2013. Upon receipt of such information claim forms were issued by the Ops and the same were duly submitted with the Ops along with relevant papers and documents on 26.6.2013. In the claim form prayer was made by the complainant for making payment of Rs. 2,64,040=00 in respect of the ‘A’ schedule policy, Rs. 38,950=00 in respect of the ‘B’ schedule policy and Rs. 1,00,000=00 in respect of ‘C’ schedule policy through cheque in her name as she was declared as nominee in the three policies. Therefore, being the sole legal heir and successor of the deceased she claimed the amount from the Ops. The rhythm of calculation in respect of ‘A’ schedule policy has been described as Rs. 1,84,000=00 as sum assured plus Rs. 80,040=00 as vested bonus, totaling Rs. 2,64,040=00. Similarly the rhythm of calculation of the ‘B’ schedule policy is Rs. 25,000=00 as sum assured plus Rs. 13,950=00 as vested bonus and the total amount is for Rs. 38,950=00. The manner of calculation in respect of ‘C’ schedule policy had been surprisingly Rs. 1, 00,000=00 only. Although in respect of ‘C’ schedule policy the sum assured was of Rs. 2, 40,000=00 and the commencement of the said policy fixed on 17.01.2009. In respect of the ‘C’ schedule policy neither the total sum assured had been paid in full nor the single premium of Rs. 39,564=00 paid back by the Ops to the complainant nor any vested bonus is paid to settle the claim in respect of the ‘C’ schedule policy. In respect of the ‘A’ & ‘B’ schedule policies the Ops did not pay the amount of premiums as paid by her son during its force. At the time of handing over the cheque the Op-2 told the complainant for making signature on some papers because without signature the said cheque could not be handed over to the complainant and as she was very much perplexed due to sudden and premature death of her son she put signature for taking payment of the benefit arising out of the death of her beloved son. After receipt of the payment the complainant enquired the matter through her husband about the actual manner of payment of the claim arising out of the death of the policy holder and she came to know that due to death of an insured prior to maturity of the insurance policy the manner of calculation of the benefit will be the total sum assured plus vested bonus plus amount of the deposited premium up to the date of death of the policy holder. In respect of ‘A’ schedule policy the date of commencement is 27.01.2004, the Ops at the time of settlement of the claim did not pay the complainant the amount of premiums as paid by her son to the tune of Rs. 1,12,510=00 (premium amount of Rs. 11,251 X10). Similarly, ‘B’ schedule policy was commenced on 24.01.2002 and the Ops did not pay the amount of premium paid by her son to the tune of Rs. 16,588=00 (premium amount of Rs. 319X4X13). Regarding ‘C’ schedule policy is concerned the date of commencement is 17.01.2009 and in respect of this policy also the Ops did not pay the premium amount of Rs. 39,564=00 (single premium plus Rs. 1,40,000=00) (as the amount of sum assured was of Rs. 2,40,000=00 and the Ops calculated the same wrongfully as Rs. 1,00,000=00, therefore, the actual amount which has not been paid by the Ops to the tune of Rs. 1,40,000 (Rs. 2,40,000 – 1,00,000 = Rs.1,40,000=00). So in respect of the C schedule policy the total amount which has not been paid by the Ops is Rs. 39,564=00 plus Rs. 1,40,000=00 is Rs. 1,79,564=00 plus vested bonus. Thus in the aforesaid manner under A, B & C schedule policies the Ops did not pay the complainant an amount of Rs. 1,12,510=00 plus Rs. 16,588=00 plus Rs. 1,79,564=00 plus Rs. 3,08,662=00. In addition to the same the complainant is also entitled to get interest @9% p.a. on Rs. 3, 08,662=00 as may be accrued on 24.11.2014, which is the date of issuance of the cheque. In this manner the Ops have acted unfair trade practice as well as deficiency in service for which the complainant had to face harassment, mental agony and suffering for a quite considerable period and for this reason she is entitled to get adequate compensation from the Ops. As due to deficiency in service this case has been filed before the court of law she is also entitled to get litigation cost. Having no alternative the complainant has filed this complaint before this ld. Forum praying for direction upon the Ops for making payment of Rs. 4, 18,662=00 towards the policy amount along with interest and vested bonus, Rs. 1,00,000=00 as compensation due to unnecessary harassment and mental agony and litigation cost of Rs. 10,000=00.
The petition of complaint have been contested by the Ops by filing written version contending that Suryadeep Laha, S/o. Sukamal Laha and Rekha Laha, since deceased, purchased three polices form the Op-2 during his lifetime. After the death of the life assured, being the nominee in respect of those polices, the present complainant intimated the death of her son to the Ops and submitted relevant documents and papers along with claim forms. After scrutiny of those documents the Ops paid a sum of Rs. 2, 64,040=00, Rs. 38,950=00 and Rs. 1, 00,000=00 against those policies respectively. A sum for Rs. 2, 64,040=00 was paid to the complainant under the policy no. 465313504 (A schedule policy) (sum assured of Rs. 1,84,000=00 plus vested bonus of Rs. 80,040=00), a sum of Rs. 38,950=00 was paid to the complainant under the policy no. 464548571 (schedule B) (sum assure of Rs 25,000=00 plus vested bonus of Rs. 13,950=00), in respect of the rest policy no. 468232202 the Ops have paid a sum of Rs. 1,00,000=00 (one-third of basic sum assured of Rs. 2,40,000=00 i.e. Rs. 80,000=00 plus a guaranteed addition of Rs 20,000=00 ) to the complainant and the said payments were made as per the terms and conditions of the policy stated on the front of page of the policy bonds. In this policy contract there is no provision for refund of premium which was tendered by the life assured during the policy period rather due to premature death of the life assured the Ops settled the death claim by paying a large amount of Rs. 1,00,000=00 i.e. one-third of basic sum assured of Rs. 2,40,000=00 along with guaranteed addition of Rs. 20,000=00 against contribution of single premium for Rs. 39,564=00 only and the said payment was made by the Ops as per the terms and the conditions of the policy. Similarly the Ops have settled the refund in respect of other two claims under two policies and rightly paid the said amount as per the terms. As the Ops have settled the claim of the complainant rightly hence the complainant is not entitled to get additional amount of Rs. 3,08,662=00 together with interest @9% p.a. as prayed for and as there was no deficiency in service on behalf of the Ops she is also not entitled to get any amount towards compensation and litigation cost. The Ops have further stated that no accidental coverage was taken by the life assured which is quite clear from the proposal form submitted by the proposer life assured at the time of taking the policies. Moreover no additional premium was taken by the Ops for coverage of accidental benefit during the period of payment of policies. So the complainant is not entitled to get double benefit for accidental death of the insured in respect of the three policies. Hence the claim of the complainant as well as the complaint petition is untenable, misconceived and vexatious one and her claim cannot be regarded as bonafide. Accordingly payer has been made by the Ops for dismissal of the complaint with cost.
The complainant has filed evidence on affidavit along with several papers and documents and the Ops have submitted written notes of argument along with several papers and documents in support of their contentions by way of ‘firisti’.
We have carefully perused the record and related papers and documents as available and heard argument at length advanced by the ld. Counsel for the parties. It is seen by us that the son of the complainant, since deceased, obtained three LICI policies from the Ops during his lifetime, due premium was paid by him prior to his premature death, the no. of the ‘A’ schedule policy is 465313504 having sum assured of Rs. 1,84,000=00, the date of commencement of the said policy is 27.01.2004, date of maturity on 27.01.2020 and yearly premium was of Rs. 11,251=00, in respect of the ‘B’ schedule policy being no. 464548571 having sum assure of Rs. 25,000=00, date of commencement on 24.01.2002, date of maturity 24.01.2021 and its quarterly premium was of Rs. 319=00, the policy no. of ‘C’ schedule is 468232202 having sum assured of Rs. 2,40,0000=00, date of commencement 17.01.2009, maturity date 17.1.2019 and single premium of Rs. 39,564=00, the life assured died due to unnatural death on 26.4.2013, the incident was informed by the mother of the life assured to the Ops on 30.5.2013, upon receipt of such information claim forms were issued by the Ops, claim was lodged by the mother of the life assured along with relevant papers and documents on 26.6.2013, in those policies the mother of the life assured being the complainant was declared as nominee. The allegation of the complainant is that though the Ops have paid the policy sum assured along with vested bonus in respect of all the policies but did not pay the double benefit which she is entitled to get in respect of those polices due to accidental death of her son as per the policy terms and the conditions. Alleging such deficiency in service this complaint has been initiated by the complainant.
The rebuttal case of the Ops is that they have paid entire amount along with vested bonus to the nominee in respect of those policies as per the terms and the conditions of the policy and therefore the complainant is not at all entitled to get any farthing from the Ops in respect of those policies. It is further submitted by the Ops as no extra premium was paid by the life assured in respect of those polices during his lifetime the question for making payment of double benefit does not arise at all. Further case of the Ops is that as there is no provision in the policy terms and the condition for refund of premium amount the Ops are not in a position to pay the complainant as prayed for. For this reason the Ops have prayed for dismissal of the complaint with cost being vexatious and frivolous.
As the complainant has mentioned the three policies in three separate schedules it is better to discuss as per the schedule mentioned in the complaint. We are to mention first the schedule ‘A’ policy being no. 465313504 having sum assured of Rs. 1, 84,000=00. From the tabulation sheets it is evident that in respect of this policy vested bonus amount was paid by the Ops to the tune of Rs. 72,312=00 and interim bonus for Rs. 7,728=00 and thus the total payable amount is for Rs. 2, 64,040=00 and the said amount has duly been paid to the complainant before filing of this complaint. Though the complainant has claimed that she is entitled to get double benefit in respect of this policy but upon careful perusal of the policy terms and conditions of this policy we are unable to find out any provision for coming to the conclusion that the complainant is entitled to get double benefit in respect of this policy. During hearing the ld. Counsel for the complainant has relied on 10. (2) of the policy condition as annexed by the Ops along with his written notes of argument by way of ‘firisti’ and therefrom it is evident that in the policy paper it has been clearly mentioned that the said condition and privilege i.e. 10. (2) is not applicable. Therefore the complainant cannot get the double benefit in respect of this policy as sought for.
In respect of schedule ‘B’ policy being no. 464548571 having sum assured of Rs. 25,000=00 the bonus amount of Rs. 12,900=00 and interim bonus of Rs. 1,050=00 totaling Rs. 38,950=00 have duly been paid by the Ops to the complainant. During hearing ld. Counsel for the complainant has submitted that in respect of this policy she has no claim because the Ops have paid in to to as per the policy condition. Now we are to discuss the schedule ‘C’ policy being no. 468232202 having sum assured of Rs. 2, 40,000=00. In respect of this policy the Ops have paid one-third of the basic sum assured of Rs. 2, 40,000=00 i.e. Rs. 80,000=00 and guaranteed addition @100/- per thousand maturity sum assured of Rs. 40,000=00 per year into 5 totaling of Rs. 20,000=00 and the Ops have duly paid to the complainant Rs. 1, 00,000=00 in respect of this policy. During hearing ld. Counsel for the complainant has submitted that in respect of this policy she is entitled to get double benefit of the policy sum assured and as the Ops did not pay the same hence the action of the Ops can easily be termed as deficiency in service. But the ld. Counsel for the complainant has failed to show us any document from where we can get the knowledge for coming to the conclusion that the complainant is entitled to get double benefit in respect of this policy.
Upon considering all the papers and documents we are of the view the Ops have duly and rightly paid the entire amount to the complainant which she is entitled to get from the Ops in respect of these policies. Therefore, the action and activities of the Ops cannot be regarded as deficient as well as unfair. The complainant has miserably failed to prove her allegations adducing cogent document i.e. by filing any document from where it will be evident that she is entitled to get refund of the premium amount. We have carefully perused all the terms and conditions of these three policies but nowhere it is mentioned that either the life assured or the nominee is entitled to get refund of the premium amount as paid. As the complainant has failed to substantiate her claim by producing papers and documents, hence the complaint fails.
Going by the foregoing discussion hence, it is
O r d e r e d
that the complaint is dismissed on contest without any cost.
Let plain copies of this final order/judgment be supplied to the parties free of cost as per provisions of Consumer Protection Regulations, 2005.
(Asoke Kumar Mandal)
Dictated and corrected by me. President
DCDRF, Burdwan
(Silpi Majumder)
Member
DCDRF, Burdwan
(Pankaj Kumar Sinha) (Silpi Majumder)
Member Member
DCDRF, Burdwan DCDRF, Burdwan
