DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
Dated this the 27th day of March, 2023
Present : Sri. Vinay Menon V., President
: Smt. Vidya A., Member
: Sri. Krishnankutty N.K., Member Date of Filing: 15/07/2019
CC/196/2019
Revathy N.,
W/o.R.Balan,
“Thrishul”,
Udayanagar,
Pudussery, Palakkad - Complainant
(By Adv. Manoj Ambat)
Vs
- SBI Life Insurance Co. Ltd.,
N.S.Tower,
Ground Floor, Near Stadium Bus stand,
Coimbatore Road,
Palakkad – 678 013
Rep.by Branch Manager
- Radakrishnan V.N.,
Insurance Agent,
Chulikal House, Vadakkumpuram,
Peringottukurissi P.O.,
Palakkad – 678 573 - Opposite parties
(O.P.1 by Adv. P.Prasad &
O.P.2 set exparte )
O R D E R
By Sri. Vinay Menon V., President
- Bereft of unnecessary details, the complainant pleads that she availed a policy floated by the 1st O.P. at the insistence of the 2nd O.P. She was to make tri-monthly deposits of Rs. 25,000/- for 5 years, at the end of which, as per the 2nd O.P., the complainant would receive returns of 105%. Therefore the complainant is entitled to receive over Rs. 10,00,000/-. The opposite party paid her Rs.5,14,000/- alone. She is entitled to receive Rs.5,16,000/- more. This complaint is filed seeking the aforesaid Rs.5,16,000/- along with other incidental reliefs.
- Opposite party No.1 filed version contending that the complaint is barred by limitation and that the maturity value was paid as per the terms and conditions of the policy which was duly approved by the IRDA. They stated that they had paid all amounts due to the complainant in accordance with the various clauses of the terms and conditions after deduction of charges, as applicable.
- O.P.2 was ex-parte.
- Pleadings and counter pleadings give rise to the following Issues:
- Whether the complaint is barred by limitation?
- Whether OP2 is a necessary party to adjudicate the dispute?
- Whether any amount is due to the complainant from the OP as policy benefit as per the terms and conditions of the policy?
- Whether there is any deficiency in service or unfair trade practice on the part of
the 1st O.P.?
V. Whether the complainant is entitled to any reliefs sought for?
VI. Any other Reliefs?
5. (i) Complainant filed proof affidavit. As the documents already stood marked on
the part of the opposite party, documents filed by the complainant were not marked. (O.P.s documents were marked before that of the complainant’s, as the complainant had failed to filed proof affidavit and their evidence stood closed. The complainant subsequently got the evidence re-opened)
(ii) Opposite party filed proof affidavit and marked Exts.B1 to B7.
Marking of Ext.B5 was objected to on the ground that it is a photocopy and an extract from an unknown source. Ext.B5 is a notification which forms part of the Gazette of India Extra Ordinary Part III. The notification is seen issued by the IRDA.
In view of the fact that this Commission is not bound by the Indian Evidence Act and in the absence of a contention that Ext.B5 is concocted, the objection that Ext. B5 is a photocopy is rejected. Further Ext.B5 being content in the Gazette of India, the objection that it was availed from an unknown source is also rejected.
Issue No.I
6. The question of limitation was taken up for preliminary hearing and an order thereon was passed on 29/9/2022 holding that the complaint is not barred by limitation.
Issue No.II
7. It is an accepted proposition of law that an insurance agent is, in fact, an agent of the insured and not the agent of the insurance company. Hence, we are of the opinion that this complaint will not lie as against the second opposite party.
Issue No. III
8. Per complainant, the OP2 had assured that the complainant would be entitled to receive 105% of the premium paid by her. She had paid Rs. 5,00,000/- as premium. The complainant is entitled to receive over Rs. 10,00,000/-. Complainant’s case is that even though she had already received Rs.5,14,000/-, she is entitled to receive a further amount of Rs.5,16,000/- as well. This complaint is filed seeking the balance amount.
9. The opposite party No.1 filed version admitting that the complainant would become entitled to a sum equivalent to 105% of the premium deposited as sum assured. The said sum assured would become due only upon the event of death of the life assured and not otherwise. The opposite parties rely on the relevant terms and conditions in Exts.B2 policy document.
9. Ext.B2 is the certificate of SBI Life – Flexi Smart Plus Gold Cover along with policy document. The said policy document contains the terms and conditions pertaining to the insurance transactions.
1. In the definition clause, item 61 defines the term “Sum Assured”. The definition is “the guaranteed amount payable under the Policy, upon the happening of insured events”.
2. Page 5 of Ext.B2 contains “Benefits of policy”. The death benefit for Gold Option is given as “highest of the policy account value or applicable to sum assured is payable or 105% of total premium paid till the time of death”. In the event of maturity benefit, policy account value will be paid in lumpsum. Terminal bonus, if any, will also be paid.
3. Admittedly this is a Gold Option Policy. Page 16 of Ext. B2, dealing with “Policy Benefits”, “Death Benefit” is stated in clause 4.3. Herein the case of “105% interest is seen dealt-with in Sub-clause 4.3.1.1.
` “4.3. Death Benefit
In case of death of the life assured, the death benefit will be subject to the following:
4.3.1 For Gold Option:
4.3.1.1 In case of the death intimation is received while the policy is in-force, we will
pay the highest of the following:
4.3.1.1.1 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
4.3.1.1.2 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
4.3.1.1.3 105% of the total basic premiums paid till the date of intimation of death”
10. From a reading of the aforesaid clauses it can be seen that 105% of the total basic premium becomes payable only as death benefit. And not otherwise.
11. Hence, we find that the complainant’s contention that the complainant is entitled to 105% of the premium paid is made only on a misunderstanding of the terms and conditions of the policy. Over and above the grievance that she was not paid 105% of premium paid, the complainant does not dispute the correctness of the amount already paid to her. She has no case that the calculation statement of the opposite party 1 with regard to amount paid is wrong.
12. We, therefore, hold that the opposite party No.1 had paid the amounts due to the complainant in accordance with the terms and conditions of Ext.B2 policy schedule.
Issue No. IV
13. Apropos the finding in issue No.III there are no deficiency in service or unfair trade practice on the part of the first opposite party. This complaint is only liable to be dismissed. We do so.
Issue No. V & VI
14. In the facts and circumstances of the case, the parties are directed to bear their respective costs.
Pronounced in open court on this the 27th day of March, 2023.
Sd/-
Vinay Menon V
President
Sd/-
Vidya.A
Member
Sd/- Krishnankutty N.K.
Member
APPENDIX
Exhibits marked on the side of the complainant : Nil
Exhibits marked on the side of the opposite party:
Ext.B1 – Copy of common proposal form’
Ext.B2 - Copy of policy certificate and policy document
Ext.B3 – Copy of an indecipherable document
Ext.B4 – Copy of IRDA Regulations 2013 bearing F.No.IRDA/Reg./13/71/2013
Ext.B5 - Copy of IRDA Regulations 2013 bearing F.No.IRDA/Reg./15/73/2013
Ext.B6 – Copy of transaction cum unit statements dated 24/4/2019
Ext.B7 series – a) Copy of communication dated 27/6/19
b) Copy of communication dated 8/6/19
c) Copy of communication dated 22/7/19
d) Copy of communication dated 8/6/19 with seal of the office of Finance
Minister
e) Copy of communication dated 9/4/19
f) Copy of communication dated 29/7/19
g) Copy of communication dated 18/7/19
Court Exhibit: Nil
Third party documents: Nil
Witness examined on the side of the complainant: Nil
Witness examined on the side of the opposite party: Nil
Court Witness: Nil
NB : Parties are directed to take back all extra set of documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.
