This is a case under Section 35 of the Consumer Protection Act, 2019. 

       Brief facts of the complainant’s case described by the complainant are as under.

The Complainant deposited money in one policy of Life Insurance Corporation of India (L.I.C.) Policy No. - 456189314 dated 23/11/2009 under Market Plus– I, table no. - 191. The Xerox Copy of the said Policy is annexed as Annexure- 1.The said policy matured on 23/11/2019. On 27/11/2019 the Complainant came to the office L.I.C. Branch - I, Jalpaiguri and as per requirement L.I.C. Branch-I submitted all documents including NEFT Form, Policy Deed, and Photocopy of the Bank Account Pass Book, Pan Card, Adhar Card and other documents. On 29/11/2019 the office of the Opposite Parties informed the     Complainant over the phone to contact the O.Ps at their branch office at Santi Para.
When the Complainant visited the concerned branch, it was
stated to the Complainant that the final payment on maturity is not possible because the policy was converted to pension policy and the O.P.s forced the complainant to opt in to the pension scheme by applying through a separate form. That since the Complainant did not agree to opt in pension scheme; the office of the O.P.s returned all the documents submitted by the Complainant. That the Complainant by a letter dated 05/12/2019 ( Annexure - 2) requested the O.P. No.- 1 to pay the Complainant full maturity amount at a time as the
Complainant does not need any pension from his said insurance policy and the O.P.No.—1received the said letter on 05/12/2019. That since the O.P. No. - 1 did not give any reply to the said letter dated 05/12/2019, the Complainant again by a letter dated 19/12/2019( Annexure - 3) gave a reminder and again requested the O.P. No.-1 to pay the full maturity amount of the said policy to the Complainant. The O.P. No.- 1 received the said letter on 19/12/2019. This time also the O.P. No.- 1 did not give any reply of the said letter dated 19/12/2019.Finding no alternative the Complainant by another letter dated 13/01/2020(Annexure - 4) gave the second reminder and again requested O.P. No.- 1 to pay the Complainant the full maturity amount at a time. That the office of the Opposite Parties by two letters dated 06.01.2020 (Annexure - 5) and 15.01.2020(Annexure - 6) informed the Complainant that the above mentioned policy matured on 23.11.2019 and " Since the maturity value exceeds Rs. 1, 00,000/- (one Lakh) ,as per policy condition only pension will be payable upon maturity. The Complainant received those two letters on 18.01.2020 and 24.01.2020 respectively. That after receiving the said two letters, the Complainant by a letter dated27/01/2020(Annexure-7) informed the O.P. No.- 1 that though the insurance policy of the Complainant matured on 23’ November, 2019, but no confirmation was received from O.P. No.- 1 regarding maturity claim of the above policy, in spite of several communications with the branch office of O.P. No.- 1 before maturity date. On 27.11.2019 the Complainant submitted NEFT Form and certificate of Deeds (Original/true copy) as per requirement of the office of O.P. No.- 1 for processing the final payment, But on 29/11/2019 the office of the O.P. No.- 1 informed the Complainant over the phone to contact the branch . When the The Complainant visited the concerned branch and was told that the policy had been converted to pension policy and the Complainant was forced to opt in to the pension scheme through applying through a separate form. When the Complainant did not agree the documents were returned to the Complainant. In the said letter the Complainant stated also that the approach of the O.P.s in different times either verbally or in writing was contradictory and as such the Complainant was misguided by the O.P. The Complainant in the said letter again requested the O.P. No.- 1 to pay him the full maturity value as he was a senior citizen and needs cash for medical treatment of the Complainant   and his family. Besides the Complainant being a retired person gets a monthly pension from WBSEDCL. That after receiving the letter of the Complainant dated 27/01/2020, the O.P.No.-2 by a letter dated 12/02/2020 ( Annexure - 8), informed the Complainant that as per policy condition and as the maturity claim is more than 1 lakh, the proceeds cannot be paid in lump sum. As per rule after the date of maturity the pension option needs to be compulsorily accepted if the maturity amount is more than 1 lakh. That finding no other alternative the Complainant by a letter dated 24.02.2020 (Annexure - 9) requested the Grievance Redressal Officer, Insurance Ombudsman to do the needful so that the full maturity value of the Policy vide No. - 456189314dated 23/11/2009 can be disbursed in favour of the Complainant at the earliest. That in the meantime owing to the outbreak of corona virus disease total lockdown throughout the country started and the Complainant could not do anything for a long period. Ultimately Insurance Ombudsman after hearing both sides at Kolkata, by a letter dated 10/03/21 (Annexure - 10) informed the Complainant that they were unable to provide any relief to the Complainant and thereby disposed of the Complainant. That the O.P.s deliberately with a malafide intention has been depriving the Complainant of the maturity of the policy mentioned above vide Policy No.-456189314 dated 23/11/2009 which matured on 23/11/2019.That the O.P.s, instead of paying the due amount to the Complainant, has been forcing him to opt for the pension scheme. That the O.P.s falsely stated that after the date of maturity, the pension option needs to be compulsorily accepted if the maturity amount is more than 1 lakh. Before the depositing amount for the said policy vide Policy No.- 456189314 dated 23/11/2009,neither O.P.s nor their agent stated such a thing to the O.P. That nowhere in the policy it was written that the policyholder is compelled to accept pension options after maturity of the policy. That prior to the maturity nothing of this sort was stated or informed to the Complainant by the O.P.s. or by their agents Even immediately after the date of maturity i.e.on 27/11/2019 when the Complainant  submitted all the papers and documents as per requirement of the O.P.s , neither O.P.s nor their agents disclosed such facts to the Complainant. That even after the 23/11/2019 i.e. the date of maturity, the Complainant was asked by the O.P.s to submit documents for taking the payment of maturity amount. That had it been compulsory to accept pension option; the O.P.s would not have asked the Complainant to opt in pension scheme applying through a separate form. Application through a separate forms means that the maturity amount does not automatically is transferred in pension scheme rather it depends upon the application or confirmation of the policy holder.

Relief claimed by the complainant

Direct the O.P,s to make payment of the maturity amount of the Policy vide Policy No.- 456189314 dated 23/11/2009 along with interest @ 24% per annum calculated from the date of maturity till the date of payment.

Direct the O.P.s to pay compensation of Rs. 500000/-(Five lakh) for suffering and expenses sustained by the Complainant owing to omission and negligence of the O.P.s in making payment of the maturity amount of the policy vide Policy No.- 456189314 dated 23/11/2009.

Direct the O.P. to pay compensation of Rs. 500000/-(Five lakh) for prolonged mental agony and injury caused owing to the negligence and omission on the part of the O.P. Cost of the suit;

 The opposite parties contest the matter, files related documents and also participated in the hearing of argument. The OPs stated as under.
            That the allegations made in the para1 to 30 of the complaint petition are all false and denied. The O.Ps submits that I Policy no.456189314, Date of Commencement: 23.11.2009, Table-Term: 191-10 Year1 Prem. Rs 22, 0001=, Premium paid for 10 Yrs. Date of Vesting: 23.11, 2019.This plan of insurance, Market plus-I (T-191) does not technically mature, it vests. So, the said policy was vested on 23.11,2019 and the question of maturity does not arise at all.  It is denied that the Complainant came to the office of the O.P on 27.11.19 .The O.Ps submit that as per their official record  Annuity Option for the said policy was extracted on 06.02,2019,ie. Nine(9)
months earlier of the date of vesting and required forms along with Covering letter ( example-Annexure I of the List of Documents) were sent to the complainant on 25.02.2021 So, why the complainant contacted our office perfectly after the date of vesting was not clear. it was clearly mentioned in the said letter that " No lump sum payment will be allowed on or after the date of vesting except when the fund value of units (purchase price) is below I lakh". The statements made in the para 4of the petition are true. It is agreed that the complainant was called to explain the policy conditions..The statements made in the para 6 of the petition are all false and denied. As per conditions the policy was automatically converted to pension / annuity. So, the question of using fierce does not arise at all. That, the statements made in the para7 to 10 of the petition are all false and denied. It is denied that, no reply was given. Against the query of the complainant, he was informed again the 21 conditions of the policy and our inability to make any lump sum payment. That, as regards the statement made in the para - 11 of the petition the O.Ps submit that it 9 already noted in point no 2) & 3) above that the said policy never matures, it vests and the said policy vested on 23.11 2019. Complainant was informed well in advance regarding the details and it automatically / compulsorily converted 1o pension, Complainant was asked to exercise one of the various pension options only. There was no question of forcing our esteemed customer by any means. It is clearly noted that no lump sum payment will be allowed on or after the date of vesting (In this case-23.11, 2019), knowing this fully well, the complainant contacted our office through his letter dated.05. 12.2019, 19.12.2019 and 13.01 2020 asked several times for lump sum payment, All his aforesaid communications were answered by the office of the O.P and every time they expressed their inability to make lump sum payment, ceiling the policy conditions. That as regards the statements made in the para-13) & 14) of the petition the O.Ps submit that The Complaint Case no Kol-L-029-1920-1286 was lodged with the Insurance Ombudsman, Kolkata on 27.02.2020, hearing commenced on 19.01.2021 and given on 12.02.2021. Complaint was the same and Sri P.K.Rath, Insurance Om dismissed the complaint without providing any relief to the policy holder .(Annexure -ll of the List of Documents) Insurance Ombudsman is a forum, acting under the Finance Ministry of Govt. OF India , which is constituted solely to redress the dispute pertaining to insurance. Filling and outcome of the said Complaint/Appeal before the Ombudsman that the complaint bears no merit. That the statements made in the para 18) of the petition are false and denied by the O.Ps. In the face of the Policy Bond of the said plan ( Market Plus-l, Table-191 ) under the head  Benefits payable and events on the happening of which they are payable  it is clearly written that  Benefits payable on vesting: an amount equal to the policy holder's fund value at the vesting date, after allowing for an option to commute a maximum of one-third of the policy holder's fund value, shall be compulsorily utilized to provide a pension based on the then prevailing immediate annuity rate..." (Annexure-III of the List of Documents) 1l) that the statements made in the Para 20) of the petition are denied by the O.P. Complainant was asked to submit the documents, but nowhere was it communicated that it was for mature  payment.
Points for consideration

1. Whether the complainant is a consumer?
2. Whether the case is maintainable under the C.P. Act 2019?
3. Whether there is any deficiency in service in the part of the O.P. as alleged by the complainant?
4. Is the complainant is entitled to get any award and relief as prayed for?

All the points are taken up together for consideration and decision.

Policy conditions of the policy purchased by the complainant are described in the policy booklet is as under. 

1. LIC’s Market Plus – I is a Unit Linked Life Insurance product which is different from the traditional insurance products and is subject to the risk factors.
2. The premium paid in Unit Linked Life Insurance policies are subject to investment risks associated with capital markets and the NAVs of the units may go up or down based on the performance of fund and factors influencing the capital market and the insured is responsible for his/her decisions.
3. Life Insurance Corporation of India is only the name of the Insurance Company and LIC’s Market Plus - I is only the name of the unit linked life insurance contract and does not in any way indicate the quality of the contract, its future prospects or returns.
4. Please know the associated risks and the applicable charges, from your Insurance agent or the Intermediary or policy document of the insurer.
5. The various funds offered under this contract are the names of the funds and do not in any way indicate the quality of these plans, their future prospects and returns.
6. On surviving to the date of vesting, the Policyholder’s Fund Value will compulsorily be utilised to provide an annuity based on the then prevailing immediate annuity rates under the relevant annuity option.  An option will also be there to commute up to one-third of the Policyholder’s Fund Value at the time of vesting of the annuity, which shall be paid as a lump sum. In case commutation is opted for, the amount of annuity/pension available will be reduced proportionately.
7. Market plus 1 (Table No 191) is a unit-linked pension scheme (ULIP). The policyholder can choose the plan with or without risk cover. This investment plan is divided into four types of investment Funds namely Bond, Secured, Balanced, and Growth Fund. This is a unit linked deferred pension plan. You can take the plan with or without life cover. You can also choose the level of cover within the limits, which will depend on whether the policy is a Single premium or Regular premium contract and on the level of premium you agree to pay. Four types of investment Funds are offered. Premiums paid after allocation charge will purchase units of the Fund type chosen. The Unit Fund is subject to various charges and value of units may increase or decrease, depending on the Net Asset Value (NAV).

According to the consumer protection act 2023 Deficiency of service means any fault, imperfection shortcoming or inadequacy in the quality, nature, and manner of performance which is required to be maintained by or under any law for time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service.

And

The meaning of unfair trade practice is “unfair trade practice" means a trade practice which, for the purpose of promoting the sale, use or supply of any goods or for the provision of any service, adopts any unfair method or unfair or deceptive practice including any of the following practices”

The Recommendation or Award of the Insurance Ombudsman is both subject to acceptance by the complainant in full and final settlement of the complaint. If such acceptance is not agreeable, the complainant may exercise the right to take recourse to the normal process of law against the insurance company.

From the upper mention fact it is clear that according to the policy condition complainant have no rights apply for maturity value in this policy. He can only apply for Net Asset Value (NAV) or get the yearly pension.  It is from the record that the after compilation of the premium payment the complainant applied for the maturity value form the opposite party in written.           

            On Dated 15/09/2023 the opposite parties submits the Present Position and Payment Detail of the alleged policy. This document was signed by the Manager (Legal) LIC, Jalpaiguri Div. Office which reflects the same.

1) Pol.No: 456189314 on the life of the complainant vested on 23.11.2019 and accordingly yearly Annuity / Pension falls due wef. 23.11.2020. 

2) We have credited yearly annuity @Rs.15, 606/- for dues- 11/2020, 11/2021 & 11/2022 to his following Bank A/C: Bank: Central Bank of India Branch: Belakoba A/C no: 2102940842 this annuity payment will continue throughout the lifespan of the complainant.

3) There is no Paid Up Value accrued against this annuity policy.  An amount of Rs.2, 85,306/-(kept as NCO- Notional Cash Option) will be paid to the recorded nominee on demise of the complainant/ the life assure/ the annuitant. If the life assured intends to surrender the policy at this moment an amount of Rs.2.06, 395/-(approx) will be paid.

In replay of the upper mentioned version of the opposite party the complainant files a bank statement which reflects that till date complainant received four instalment of pension of Rs. 15606/- each (15606*4=62424/-) in the following dates 24/03/2022 and 23/11/2022.  

From the case record it transpires that Policy number-  456189314 on the life of the complainant vested on 23.11.2019 and accordingly yearly Annuity / Pension falls due wef. 23.11.2020 and the first payment made on 24/03/2022 and thereafter on 23/11/2022. No explanation was given by the opposite party that why not they credited the pension amount to the account of the policy holder/complainant within payable time?

The date of filing of this case is 23/04/2021. From this fact it can also be determine that the opposite party credited the pension amount to the account of the complainant after filing the case before this commission, only to show there good gesture. Opposite party never mention the payments date before this commission as and when the dispute/matter is sub-judies before this commission. For this act of the opposite party the complainant suffering from mental pain and agony and financial loss.

We have gone through the records and other related documents of the case and have come to conclusion that the complainant is eligible for receiving the Net Asset Value (NAV) if he surrender the policy.  The O.P. is partly guilty for deficiency in services and unfair trade practices as they have not credited the pension amount to the account of the policy holder/complainant within payable time. Complainant is partly succeeded to prove his case.

Therefore, the complainant is entitled to the relief as specified bellow.

All points are disposed of. In the result the case/ application succeeds in part.

Hence, it is

ORDERED

We allow the consumer case in part by issuing the following directions

1. Opposite Party is directed to pay the Rs. 10,000/- (Rupees Ten Thousand Five Hundred Only) along with 7% simple interest per annum from 23.11.2020 till the date of payment to the     complainant for  deficiency in services and unfair trade practices adopted by them.
2. Complainant is eligible for receiving the Net Asset Value (NAV) if he surrender the policy.
3. Opposite Party is directed to deposit Rs. 10,000/- (Rupees Ten Thousand Five Hundred Only) to the consumer legal aid account of this commission.

The order should be comply within 30 (Thirty) days from the date of this order failing which the complainant/O.P will be at liberty to put the order in execution according to provision of law.

Let a copy of this judgment be given to the parties free of cost.

Let plain copy of this order be given to the parties free of cost.