Complainant:       1)   Sri. Irappa S/o Sannasatyappa Abbigeri

                                        Since dead rep. by his LRs.    

                                   1(A)  Smt. Kashavva W/o Irappa Abbigeri

                                           Age:60, Occ:Housewife.

                                           R/o Hatalgeri Tq: & Dist:Gadag.

                                   1(B) Kavita S/o Irappa Abbigeri

                                           Age:36 Yrs, Occ:Agri.

                                       R/o Hatalgeri Tq:& Dist:Gadag.

                                   1(C)  Ravichandra S/o Irappa Abbigeri

                                          Age:34 Yrs, Occ:Agri.

                                       R/o Hatalgeri Tq:& Dist:Gadag.

                                   1(D) Ravikiran S/o Irappa Abbigeri

                                          Age:32 Yrs, Occ:Pvt. Job.

                                       R/o Hatalgeri Tq:& Dist:Gadag.

                                                (Rep. by Sri. M.B.Sajjanar, Advocate)   

V/s

JUDGEMENT

JUDGEMENT DELIVERED BY SMT. YASHODA. B. PATIL, WOMAN MEMBER

          The complainant has filed the complaint U/Sec. 35 of C.P Act, 2019, to direct the OP to pay the assured amount of Rs.1,25,000/- with interest @ 18% p.a. from 28.03.2021 till realization, Rs.50,000/- towards mental agony and Rs.10,000/- towards cost of the litigation.  

          2. The brief facts of complaint are as under:

          The complainant has obtained from OP (LIC’s JEEVAN SARAL) policy on 28.03.2011 and policy commenced from 28.03.2011 to 28.03.2021.  The said policy No.638483348, and the total number of installments are 10 each amounting to Rs.6,005/- and  the total amount of Rs.60,050/- is paid to the OP.     After maturity of the policy the sum assured amount payable is Rs.1,25,000/-. The said policy got matured on 28.03.2021 and the sum assured towards policy is Rs.1,25,000/- and accordingly it is duty of the OP to refund the maturity amount. The OP did not refund the said sum assured amount. But, on 12.11.2020 OP informed the complainant that he is entitled for an amount of Rs.32,259/- which has been wrongly calculated by the OP. The OPs have intentionally harassed the complainant by not paying the assured sum amount. Ops have not settled the assured amount. Hence, the complainant was constrained to issue a legal notice to OP on 23.07.2021.  OP has not replied. Therefore, Ops have committed the deficiency of service.  Hence, filed this complaint.

          3.      After admitting the complaint, notice was issued to the OP, who appeared through their counsel and filed the written version.

          4.     The brief facts of written version of OP are as under:

          The OP denied the contents of the complaint and admits the policy being issued.  It is submitted that, the said life insurance policy necessarily provides for coverage against the risk of untimely death and premium amount to be charged is decided based on proponent at the start of policy. The basic principle of deciding insurance premium is – ‘Higher the age at entry, higher the amount of premium charged. This is because with the rising age of a person, the risk of causing death also increases.  Also higher the element of risk cover, higher is expected mortality charges/cost of risk cover’.    It is submitted that, as per said IRDAI Circular, the Mortality Tables to be used for deciding premium must be one prescribed by Institute of Actuaries of India (‘IAI’).  Accordingly, the Mortality Table applied by OP LIC in Jeevan Saral Plan is also the one which was prescribed by IAI only. As such there is no violation of any settled principles of insurance by the OP. The OP contends that, under the normal life insurance, the premium is determined by Mortality rating which is age dependent, on age higher premium is charged for higher age and maturity or death cover benefit is fixed. Also higher is the risk cover, higher is the expected cost of risk cover.  Under the Term Life Insurance Policy, the policy holder pays the premium for the entire term of policy and at the end of the term, if the policy holder survives, nothing is payable as the entire premium amount is applied towards mortality charges. So, under Jeevan Saral Plan in the event of death the policy holder during the term of the policy the death benefit is huge i.e. 250 times of monthly premium amount, plus loyalty additions for 10 completed years or more and also the refund of premium excluding first year premium and all other extra premiums. Further, if the policy holder survives the terms of policy, he will get the maturity sum assured and also the loyalty additions for the completed term of 10 years and more. The Jeevan Saral policy is directly linked to the risk coverage i.e. death sum assured and not at all linked in any manner with the maturity sum assured. Therefore, for the person with higher age at entry, the major part of the premium is applied towards mortality charges and consequently less amount remains for investment purpose. It is submitted that, the plan is launched vide circular No.1934 dtd:12.02.2004 the maturity sum assured value payable per Rs.100/- monthly premium is calculated in advance for each age at entry and Term of Policy.  Therefore, under the plan it is well defined at the inception itself and it is clearly printed in the schedule of the policy bond which the complainant was well aware of all the benefits and the terms and conditions under the policy at the time of filing the proposal form and also well aware that the main purpose of the plan is to provide death risk coverage and high returns are available under death benefit and also aware about benefits available upon maturity of policy which were fixed at the inception only.  Hence, he is estopped from contending otherwise.  The complainant was intimated well in advance on 12.11.2020 about his policy maturing on 28.03.2021 with maturity intimation No.M/032021/001406 which has been acknowledged by the complainant and he was requested to submit to necessary requirement to release the maturity benefit due on 28.03.2021 on time. But, the complainant has not done so.  Therefore, the OP denies that they have committed any deficiency of service. Hence, OP prays for dismissal of the complaint.

          5.  To prove the case, the complainant has filed affidavit and examined as PW-1 and got the documents marked as  Ex.C-1 to Ex.C-6. Later the complainant expired and his LRs, complainant No.1(a) to 1(d) are brought on record. OP has not filed the affidavit evidence.

          6. Heard the arguments on both sides.

          7. The points for consideration are as under:

                   1. Whether the LRs of complainant proves

    the deficiency of service committed by the 

    Opponent?

                   2. Whether the LRs of complainant are entitled

    for the reliefs  as sought for?

                   3. What order?

          8.  Our findings on the above points are as under:

               Point No 1. Negative.

               Point No 2. Negative.

             Point No 3. See final order.

REASONS

9 .Point No.1 and 2: The point No.1 and 2 are taken together to avoid the repetition of facts.

10. On careful perusal of all the documents and materials placed before the commission, PW -1 has reiterated the contents of the complaint.  PW-1 has stated that, the complainant has obtained from OP (LIC’s JEEVAN SARAL) policy on 28.03.2011 and policy commenced from 28.03.2011 to 28.03.2021.  The said policy No.638483348, and the total number of installments are 10, each installment is of Rs.6,005/- and  the total amount of Rs.60,050/- is paid to the OP.         After maturity of the policy the sum assured amount payable is Rs.1,25,000/-. The said policy got matured on 28.03.2021 and the sum assured towards policy is Rs.1,25,000/- and accordingly it is the duty of the OP to refund the maturity amount. The OP did not refund the said sum assured amount. But, on 12.11.2020 OP informed the complainant that he is entitled for an amount of Rs.32,259/-  which has been wrongly calculated by the OP. The OP has intentionally harassed the complainant by not paying the assured sum amount. OP has not settled the assured amount. Hence, the complainant was constrained to issue a legal notice to OP on 23.07.2021.  OP has intimated the complainant that he is entitled for sum Rs.32,259/-. Therefore, Op has committed the deficiency of service.

          11. Per contra, in written version, OP has  stated that, under Jeevan Saral Plan in the event of death the policy holder during the term of the policy the death benefit is huge i.e. 250 times of monthly premium amount, plus loyalty additions for 10 completed years or more and also the refund of premium excluding first year premium and all other extra premiums. Further, if the policy holder survives the terms of policy, he will get the maturity sum assured and also the loyalty additions for the completed term of 10 years and more. The Jeevan Saral policy is directly linked to the risk coverage i.e. death sum assured and not at all linked in any manner with the maturity sum assured. Therefore, for the person with higher age at entry, the major part of the premium is applied towards mortality charges and consequently less amount remains for investment purpose. It is submitted that, the plan is launched vide circular No.1934 dtd:12.02.2004 the maturity sum assured value payable per Rs.100/- monthly premium is calculated in advance for each age at entry and Term of Policy.  Therefore, under the plan it is well defined at the inception itself and it is clearly printed in the schedule of the policy bond which the complainant was well aware of all the benefits and the terms and conditions under the policy at the time of filing the proposal form and also well aware that the main purpose of the plan is to provide death risk coverage and high returns are available under death benefit and also aware about benefits available upon maturity of policy which were fixed at the inception only.  Hence, he is estopped from contending otherwise.  The complainant was intimated on 12.11.2020 about his policy maturing on 28.03.2021 with maturity intimation No.M/032021/001406 which has been acknowledged by the complainant and he was requested to submit the necessary requirements to release the maturity benefit due on 28.03.2021 on time. But, the complainant has not done so.  Therefore, the OP denies that they have committed any deficiency of service.

          12. Ex.C-1 to Ex.C-6, the policy bond, intimation letter,  notice, and other documents are not disputed by the OP. The main grievance of the complainant is that he paid all installment premium amount and is entitled for the assured amount of Rs.1,25,000/-. But, Op stated that, the complainant is entitled for matured amount of Rs.32,259/- only. Op contended that, policy was issued under plan-Term 165/10 for death SA 125000. Policy is inforce and the life assured is alive as on the date of maturity, then MC will be paid i.e. maturity sum assured plus loyalty addition only. So, the complainant is eligible for the maturity SA  Rs.23,720/- plus loyalty addition Rs.8,539/- total eligibility amount Rs.32,259/- is payable.  Op is ready to discharge its contractual liability for Rs.32,259/-. Such being the case, when this aspect is intimated to the complainant, who did not agree and got issued, a legal notice to Op and filed this complaint.
Ex.C-1 policy is not disputed by the parties.  Wherein, the detailed conditions are mentioned and terms are binding on both the parties.   Sum assured of Rs.1,25,000/- is entitled only in case of death of complainant before maturity date. So, complainant is not entitled for the assured amount of Rs.1,25,000/- as per terms and condition of the Ex.C-1 policy.

          In written version, Op has relied on the following judgments of Apex Court and Karnataka State Commission, Bengaluru.

…In FA Nos.922 to 932/2016 decided on 10.02.2022 between LIC of India V/s Mr. Vishwanath Hegade and Others, General Insurance Society Ltd., V/s Chandmull Jain (1966) 3 SCR 500, in Oriental Insurance Co., Ltd. V/s Sony Cherian, II (199) ACC 196 (SC), United Insurance Co. Ltd., V/s Harchand Rai Chandan Lal, (2004) 8 SCC 644 and Vikram Greentech (I) Ltd. V/s New India Assurance Co. Ltd., (2009) 5 SCC 599. 

          On careful perusal of above judgments Hon’ble Apex Court has held that, …. In interpreting documents relating to a contract of Insurance, the duty of the Court is to interpreting the words in which the contract is expressed by the parties, because it is not for the court to make new contract, however reasonable, if the parties have not made it themselves. So, facts, circumstances and ratio of the above decisions is aptly applicable to the case on hand.    

13.     For the above, even though Ops is ready to pay Rs.32,259/- as per contractual liability, complainant has approached this Commission. So, the complainant has failed to prove that, Op has committed the deficiency of service. Therefore, the LRs of complainant are not entitled for the relief as sought.  However, the LRS of complainant are at liberty to file fresh claim for Rs.32,259/- within two months to OPs, then the Ops shall settle the eligible claim. Accordingly, we answer Point No.1 & 2 in the negative. 

          14.    Point No.3:- In the result, we proceed to pass the following: 

ORDER

          The complaint filed U/Sec.35 of the Consumer Protection Act, 2019 is dismissed.No order as to costs.

          The LRs of complainant are at liberty to file fresh claim for Rs.32,259/- within two months to OPs, then the Ops shall settle the eligible claim.

Office is directed to send the copies of this order to the parties free of cost.

           (Dictated to the Stenographer, directly on computer, corrected and then pronounced by us in the Open Commission on this 24^th Day of
November-2022)

,            

 (Shri Raju N. Metri)     (Shri. D.Y. Basapur)   (Smt.Yashoda Bhaskar. Patil)

        MEMBER                 PRESIDENT              WOMAN MEMBER

-: ANNEXURE :-

EVIDENCE ON BEHALF OF COMPLAINANT/S:

PW-1: Sri. Irappa S/o Sannasatyappa Abbigeri

DOCUMENTS ON BEHALF OF COMPLAINANT/S

Ex.C-1 : Original LIC bond.

Ex.C-2 : Intimation letter  

Ex.C-3: Legal notice.

Ex.C-4 : Regd Postal slip.  

Ex.C-5: Postal acknowledgment

Ex.C-6: Copy of Voter ID Card.

EVIDENCE ON BEHALF OF OPs:

              NIL

DOCUMENTS ON BEHALF OF OPs

              NIL

(Shri Raju N. Metri)    (Shri. D.Y. Basapur)   (Smt.Yashoda Bhaskar. Patil)

        MEMBER                 PRESIDENT              WOMAN MEMBER