SRI SHYAMAL KUMAR GHOSH, PRESIDING MEMBER

1. The instant appeal has been preferred by the appellant/complainant challenging the order impugned dated 22/10/2019 passed by the ld. Trial Commission, Kolkata Unit – 1 (North) in connection with the CC case no – 02/2019 wherein the ld Trial Commission concerned dismissed the same on contest without cost against the opposite party. Being aggrieved and dissatisfied with such order the appellant/complainant preferred the instant appeal before this Commission praying for setting aside the order impugned dated 22/10/2019.
2. The brief fact of the case is that the complainant purchased three policies on different dates viz. LIC Jeevan Saral with profit through their agents and the opposite party issued the following policy certificates which are mentioned below :-

1. Policy no – 418649770, date of commencement 28/03/2005, sum assured Rs.1,00,000/-, yearly premium amounting to Rs. 4,804/- for 13 years and maturity sum assured amounting to Rs. 1,00,000/-, date of maturity 28/03/2018.
2. Policy no – 419956086, date of commencement 28/04/2007, sum assured Rs.5,00,000/- , yearly premium amount 24,020/- for 11 years, maturiyu sum assured Rs. 5,00,000/-, date of maturity 28/04/2018.
3. Policy no – 418653201, date of commencement 23/09/2005, sum assured Rs.1,00,000/-, yearly premium payable amounting to Rs.4,804/- for the period 11 years, maturity sum assured amounting to Rs. 1,00,000/- and the date of maturity 23/09/2018.

3.      The complainant paid all premiums which were accepted and acknowledged by the opposite party/insurance company.
4. But the complainant was utterly surprised when he received a letter in respect of claim/maturity benefit dated 13/12/2017, 04/01/2018 and 02/06/2018 from the end of op/insurance company. By the said letters, the op/insurance company informed that the op agreed to pay the gross amount of Rs.33,622/-, Rs.1,14,521/- and Rs.33,622/- respectively in respect of maturity benefit.
5.  After receiving such letter the complainant also came to learn that due to some typographical error or mistake in the assured sum, the correct assured sum would be Rs.24,016/- and the terms and conditions as mentioned in the said policy remained unaltered. On the basis of the said fact the complainant lodged a complaint to op whereby he raised objection regarding payment of maturity benefit and the complainant accordingly did not accept the said maturity amount and demanded the sum assured as mentioned in the policy certificate. But the complainant did not receive any positive response from the end of op/insurance company. Having no other alternative the complainant knocked at the door of the ld Trial Commission for getting proper relief as prayed for.
6.  The op/insurance company contested this case by filing written version stating inter alia that the complainant took 3 policies which are described as follows.

1. Policy no – 418653201, maturity SA Rs.24,016, death SA Rs.1,00,000/-, accident benefit SA Rs.1,00,000/-, date of commencement 30/09/2005, date of maturity 23/09/2018 and yearly premium payable Rs.4804/-
2. Policy no – 418649770, maturity SA xxxxx (remained blank), death benefit SA Rs.1,00,000/-, accident benefit SA Rs.1,00,000/-, date of commencement 28/03/2005, date of maturity 28/03/2018 and yearly premium payable Rs.4804/-.
3. Policy no – 419956086, maturity SA xxxx (remained blank), death benefit SA Rs.5,00,000/-, accident benefit SA Rs.5,00,000/- date of commencement 28/04/2007, date of maturity 28/04/2018 and yearly premium payable Rs.24,020/-.

7. By filing written version the op/insurance company stated that regarding policy no – 418653201, the figure of SA amounting to Rs.24,016/- was absolutely correct. Regarding the policy no – 418649770 and policy no – 419956086, the figures of SA remained blank which were shown in the policy certificates as XXX.
8.  In respect of policy no – 418649770, the op/insurance company issued a letter dated 04/11/2015 wherein the insurance company stated that as per the plan conditions, the correct maturity sum assured is Rs.24,016/- and the other terms and conditions remained unaltered.
9. From the above descriptions it is clear that only in respect of the policy no – 419956086 inadvertently due to typographical error or mistake the place kept blank and nothing was written or mentioned. Under such circumstances, by filing written version the op/insurance company clearly stated that it cannot be presumed that maturity SA of the said policy became Rs.5,00,000/-.
10. By filing written version the op/insurance company urged that the death benefit sum is always 250 times of the monthly premium. The death benefit sum assured as chosen by the complainant in respect of policies no – 418653201 and 41864970 became Rs.1,00,000/- ie 250 times of the monthly premium which means Rs.250x400=Rs.1,00,000/-. The yearly premium as such would be Rs.400x12=Rs.4800/-. But in respect of the policy no – 419956086 the death benefit sum assured as opted by the complainant is Rs.5,00,000/- ie 250 times of the monthly premium which means Rs.250x2000=Rs.5,00,000/-. The yearly premium as such would be Rs.2000x12=RS.24,000/-.
11. By filing written version as per terms and conditions the op/insurance company rightly transmitted the discharge vouchers for the maturity SA amounting to Rs.33,622/- in respect of policies no – 418653201 and 418649770 respectively and Rs.1,14,521/- in respect of policy no – 419956086 including loyalties.
12. By filing written version the op/insurance company also contended that the complainant was well aware of the fact but unnecessarily he tried to misrepresent the actual happening of the event. There is no gross negligence or fault or deficiencies in service on the part of the op/insurance company and accordingly the op/insurance company prayed for dismissal of the petition of complaint.
13. In course of hearing ld. counsel appearing for the appellant/complainant drew our attention to the observations of the ld. DCDRC and pointed out that the ld. DCDRC, below completely ignored and overlooked the materials on record while passing the impugned order mentioned above. Ld. Counsel also submitted that the complainant is entitled to get maturity sum assured amounting to Rs.1,00,000/- each for the two policies and is also entitled to get maturity sum assured amounting to Rs.5,00,000/- for another policy plus benefit of loyalty. But the respondent/opposite party did not take any proper steps for releasing the aforesaid maturity SA plus benefit of loyalty in respect of 3 policies as mentioned in the policy certificates. The op/insurance company has failed to provide actual benefit to the complainant till date. The appellant further argued that the respondent wants to arbitrarily discharge the appellant’s maturity claim in respect of LIC’s JEEVAN SARAL with profit policies without considering the terms and conditions of the said policies. Accordingly the ld counsel appearing for the appellant/complainant prayed for setting aside the order impugned passed by ld Trial commission.
14. In course of hearing ld counsel appearing for the respondent/op/insurance company argued that the policy holder used to pay the premium for entire term of policy and at the end of term, if the policy holder survives, nothing is payable to the policy holder as the entire premium amount is applied towards mortality charges. Unlike to this, under JEEVAN SARAL PLAN, in the event of death of the policy holder during the term of the policy, the death benefit is very higher ie including 250 times of monthly premium amount plus loyalty additions for the completed years and also the refund of premium. Further if the policy holder survives the term of the policy, he will get the maturity value and also the loyalty additions for the completed term. The ld counsel further submitted that the complainant enjoyed the benefit of insurance coverage for the sum assured amounting to Rs.(1,00,000 + 1,00,000 + 5,00,000) = Rs.7,00,000/- throughout the term of policy along with other features of plan and therefore the LIC is entitled to collect or retain the premium amount for death cover provided corresponding to age of the policy holder. In case of unfortunate occurrence of death of the policy holder during the term of policy, the LIC would have to pay all the benefits payable for death cover, ie Sum Assured, Loyalty additions and refund of premium as stated herein above. Thus the claims demanded by the complainant are palpably wrong, illegal and against the terms and conditions of the aforementioned policy. Accordingly the ld counsel prayed for dismissal of the appeal with exemplary costs.
15. We have heard the ld advocates for both sides at length and in full.
16. We have considered their submissions.
17. We have also perused the materials available on record meticulously. 
18. Before entering into the merits of the aforesaid case, we try to evaluate the features of the aforesaid policies viz. LIC’S JEEVAN SARAL WITH PROFITS (TABLE NO-165). It is actually an endowment policy with a lot of flexibilities that is usually available only with unit linked insurance plans. Hence it is categorized under Special Plans. This plan offers Double Death Benefit of sum assured + return of premium. In this plan, the premium amount is decided by the policy holder and he/she is entitled to get 250 times the monthly premium as Sum Assured. If the Life Insured survives the entire term, then he/she would receive only maturity sum assured + loyalty additions. Again the maturity Sum Assured obviously depends upon different age of entry as well as the policy terms and conditions which is clearly specified at the beginning of the policy. Now, if the life insured dies within the policy period/tenure then his/her nominee would receive the Sum Assured + return of premiums excluding extra/rider premium and first year premium + loyalty addition, if any. Thus the death benefit would be the same irrespective of age of entry and policy term since it depends only on chosen premium amount but the maturity benefit would differ according to varied age of entry and policy term.     
19. It is admitted that no death or accident was occurred during the period in question and is also admitted fact that the complainant/appellant has been survived since opening of the policy to till date.
20. In pursuant to the policy conditions it is clear to us that the complainant/appellant is not entitled to get the death or accidental benefit from the respondent/LICI. But as per policy conditions the complainant/appellant is entitled to get maturity sum assured + loyalty additions as the complainant/appellant (life insured) survives the entire term of the aforesaid policy.
21. It is admitted that the death benefit sum is always 250 times of the monthly premium. Actually this policy provides maximum death benefit on the event of death of the life assured during the tenure of the policy. It is fact that the death benefit sum assured amounting to Rs. 1,00,000/- has been chosen by the appellant/complainant in respect of two policies being nos-418653201 and 418649770 wherefrom it also appears to us that the said death benefit sum assured is equivalent to 250 times of the monthly premium paid ie Rs.250 x 400. Accordingly the yearly premium in respect of two policies would come to Rs. 400 x 12 = Rs.4800/-. It also fact that the death benefit sum assured amounting to Rs.5,00,000/- has also been chosen by the appellant/complainant in respect of another policy being no – 419956086 wherefrom it appears to us the said death benefit sum assured is equivalent to 250 times of the monthly premium paid ie Rs.250 x 2000. Accordingly the yearly premium in respect of aforesaid policy would come to Rs. 2000 x 12 = Rs.24,000/-. In this respect upon careful perusal of the policy certificates we find that the yearly premium amount of Rs.4804/- has been fixed for payment in respect of policy being nos. 418649770 and 418653201 and in policy no – 419956086 the yearly premium amount of Rs.24,020/- has been fixed for payment at the behest of the complainant/appellant in order to get the benefits from the LICI.
22. Whether the amount calculated by the LICI payable to the appellant/complainant is correct or not that should be decided on the basis of mathematical calculation in pursuant to the terms and conditions of the aforesaid policies. We have meticulously perused the chart showing the maturity sum assured per Rs. 100/- monthly premium and also notification Reference no. Actuarial/Valuation/2230/4 dated 23^rd August, 2017 wherefrom it appears to us that in case of first two policies mentioned above, the loyalty addition would come to Rs.400 x 24.016 = Rs.9606/-. So the maturity value would be Rs.24,016/- + 9606/- = Rs.33,622/-. In case of third policy the loyalty addition would be come to Rs.450 x 78.98 = Rs.35541/- and finally the maturity amount comes to Rs.(2000x3949/100)= Rs.78980 + 35541 = Rs.1,14,521/-. At this stage we are very much satisfied as the arguments advanced by the ld counsel appearing for the respondent/LICI are corroborating the documents submitted by the parties. Accordingly there is hesitation to hold that there is no such wrong or error in calculation the amount payable to the appellant/complainant in order to meet the actual demand of the complainant/appellant.    
23. At this stage we are constrained to hold that the arguments advanced by the ld counsel appearing for the appellant/complainant have no leg to stand upon but we differ from the view taken by the ld Trial commission regarding typographical mistake or error committed in the policy certificates. Upon careful perusal of the policy certificates being nos. 418649770 and 419956086 it is revealed that there is no such figure clearly mentioned as maturity Sum Assured. Whereas regarding policy certificate being no 418653201, it is found that the amounting to Rs.24,016/- has been clearly recorded/mentioned as the maturity Sum Assured. So from the above observations we can take the firm view that there was enough scope to mention the correct figure of maturity sum assured but instead of mentioning the same the place was kept blank and the said two certificates were issued by the LICI causing serious complications so that the complainant/appellant was not in a position to understand the correct proposition of law. Be it mentioned here that the Consumer Protection Act has been enacted exclusively for the benefit of the consumers and accordingly the better protection should be given to the consumers from hazardous goods and services. Regarding this point we hold and firmly hold that there is fault or negligence on the part of LICI. Resultantly we are constrained to allow the instant appeal in part and set aside the order impugned dated 22/10/2019.
24. Hence,

O R D E R E D

The respondent/LICI is directed to pay Rs.33,622/- + Rs.33,622/- + Rs.1,14,521 = Rs 1,81,765/- one lakh eighty one thousand seven hundred sixty five only to the complainant/appellant within 60 days from the date of this order after observing all formalities. In this respect the complainant/appellant is hereby also directed to co-operate with the respondent/LICI.

The respondent/LICI is further directed to pay compensation amounting to Rs.50,000/- Fifty thousand only and litigation cost amounting to Rs.20,000/- twenty thousand only to the complainant/appellant within the stipulated period of time. In default the whole awarded amount ie Rs.1,81,765 + 50,000/- + 20,000/- = Rs.2,51,765/- (Two Lakh Fifty One Thousand and Seven Hundred Sixty Five) only shall carry interest @ 10% pa till full payment.

In case of non-compliance of the aforesaid order, the complainant/appellant is at liberty to put the order in execution before the ld Trial Commission.

Note accordingly.

Let a copy of this order be transmitted to the ld Trial Commission for compliance and for necessary action.