By Sri. MOHANDASAN.K, PRESIDENT
1.The complaint in short is as follows: -
The complainant is the policy holder of the opposite party. The complainant subscribed Jeevan Saral policy of the opposite party on 24/08/2006. The monthly premium amount was Rs.408/- and duration of the policy was 15 years. The complainant state that he remitted Rs. 72,624/- during the policy period and the policy attained maturity on 24/08/2021. The opposite party issued policy benefit of Rs.49,902/-. The complainant submitted that the policy was for Rs. 1,00,000/- and so he is entitled the balance amount of Rs.55,000/-. The complainant alleges deficiency in service on the part of the opposite party and prayed for the direction against opposite party to pay Rs. 55,000/- to the complainant.
2. On admission of the complaint notice was issued to the opposite party and the opposite party entered appearance and filed version denying the averments and allegation in the complaint.
3. The opposite party admitted that the complainant herein had availed Jeevan Saral Policy No.793583528 issued by the opposite party branch, Nilambur on 24/08/2006. The monthly premium under the policy was Rs. 408/-. As per the policy, the death benefit sum assured under the main plan was Rs.1,00,000/- and accident benefit sum assured was Rs. 1,00,000/- and the maturity sum assured as per the policy bond was Rs. 34,620/-. The opposite party was submitted that the maturity sum assured plus loyalty additions were paid to the complainant as per the policy bond.
4. The opposite party submitted that the LIC’s Jeevan Saral belongs to the category of high-risk plans, where in the insurance coverage offered is substantially higher, especially higher ages. The death benefit offered under the plan is much higher than the other comparable conventional plans. The opposite party submitted that the policy in dispute provides total coverage including accident benefit for Rs. 2,00,000/- up to the age of life assured 65 years , only by remitting a total premium of Rs. 73,440/-. Death benefit is very high compared to the total premium received. In a case of unfortunate demise of the policy holder due to accident , LIC has to pay Rs. 2,00,000/- plus return of premium excluding first year and all extra premiums plus loyalty additions, if any. The maturity value is calculated based on age and duration of the policy. The opposite party submitted that if the age when the policy is purchased is on the higher side, the maturity value is lower. It is submitted that in case of maturity, the amount payable is the maturity sum assured along with loyalty addition, if declared. In this complaint the maturity sum assured is calculated on the basis of age of the life assured, term of policy along with loyalty addition. The policy has taken at the age of 55years for a term 15 years, i.e. as per the chart 8655 x monthly premium /100 (i.e., 8655x400=34620/-). The maturity sum assured according to the age at entry 55 years and term 15 years is Rs. 34,620/-, which are correctly written in the policy bond, issued by LIC. The opposite party also submitted that Life insurance is an alienated contract on the principles of UTMOST GOOD FAITH and performance of the contract is as per the conditions and privileges embodied in the policy document, which is evidence of the contract. The features of the policy are laid down in the LIC’s Jeevan Saral conditions and privileges, which is part of the policy document and is given to the insured including the complainant.
5. Hence the submission of the opposite party is that the maturity amounts eligible
to the complainant as per the disputed policy bond which is Rs.34,620/- along with loyalty amount for 11 years, i.e., Rs.16,098/-, the total amount is Rs.50,718/-. The opposite party after deducting the premium due i.e., Rs. 816/-, the net balance payable amount was Rs.49,902/- and the same was transferred to the bank account of the complainant on 24/08/2021 through NEFT. Since the policy matured amount as per the bond is correctly paid to the insured, the allegation of deficiency of service or unfair trade practice against the opposite party is not maintainable and the complainant is not entitled any amount towards policy claim amount or compensation or cost.
6. The complainant and opposite party filed affidavit and documents. The documents on the side of complainant marked as Ext. A1 and A2. Ext. A1 is policy schedule of LIC’s Jeevan Saral (with profits) with policy No.793583528 dated 24/08/2006. Ext.A2 is copy of pass book issued by opposite party to the complainant. The documents on the side of opposite party marked as Ext. B1 and B2. Ext. B1 is policy schedule of LIC’s Jeevan Saral (with profits) with policy No.793583528 dated 24/08/2006 (Ext. A1), Ext. B2 is Policy Schedule correction letter dated 24/09/2020.
7. Perused affidavit and documents and heard both sides. The following points arise for consideration.
- Whether there is deficiency in service on the part of the opposite party?
- Relief and cost?
8.Point No.1:-
The issue to be answered in this complaint is that whether the complaint is
entitled for the insured sum of Rs. 1,00,000/- or not . The complainant and opposite party admitted that issuance of the Ext. A1 insurance policy. As per Ext. A1 the maturity sum assured is Rs. 34,620/-. Ext. A1 also reveals death benefit some assured under the main plan is Rs.1,00,000/-and also accident benefit sum assured is Rs. 100,000/-.The perusal of Ext.A1 document itself, it is clear that maturity some assured as per the policy is Rs. 34,620/-. There is no any sort of averments that the maturity sum assured was Rs. 1,00,000/- as claimed by the complainant. The opposite party has explained in the affidavit that the policy provides a total coverage including accident benefits for Rs. 2,00,000/- up to the age of life assured 65 years, only by remitting a total premium of Rs. 73,440/-. It is also submitted by the opposite party in a case of unfortunate demise of the policy holder due to accident the opposite party has to pay Rs. 2,00,000/- plus return of premium excluding first year and all extra premiums plus loyalty additions if any. It is submitted that maturity amount eligible to the complainant as per the policy bond is Rs. 34,620/- along with loyalty amount for 11 years,i.e.,Rs.16,098/- and the total amount is Rs. 50,718/-. The opposite party submitted that out of the above sum of Rs. 50,718/-, the opposite party assessed net payable amount after deduction premium due amount of Rs.816/- as Rs.49,902/-. Both parties admitted that the opposite party has transferred the amount to the account of the complainant and the complainant has no dispute of the same. Hence from the perusal of the documents and the affidavits we cannot find that as per the policy bond the complainant is entitled to Rs. 1,00,000/- as matured premium amount as per the scheme and what is entitled as per the policy bond has been transferred by the opposite party to the account of the complainant duly. Hence it is not proper to hold that there is any sort of deficiency in service on the part of the opposite party and the Commission find first point accordingly and so the consideration of second point does not arise.
9. In the light of above facts and circumstances, the complaint stands dismissed.
Dated this 26th day of September, 2022.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
APPENDIX
Witness examined on the side of the complainant : Nil
Documents marked on the side of the complainant : Ext.A1& A2
Ext.A1 : Policy schedule of LIC’s Jeevan Saral (with profits) with policy No.793583528
dated 24/08/2006.
Ext.A2 : Copy of pass book issued by opposite party to the complainant.
Witness examined on the side of the opposite party : Nil
Documents marked on the side of the opposite party : Ext. B1 & B2
Ext.B1 : Policy schedule of LIC’s Jeevan Saral (with profits) with policy No.793583528
dated 24/08/2006 (Ext. A1).
Ext.B2 : Policy Schedule correction letter dated 24/09/2020.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
