SMT.MOLYKUTTY MATHEW : MEMBER

        This is a complaint filed by the complainant U/S 35 of the Consumer Protection Act 2019  for an order directing  the OPs to pay the entire premium  amount already paid to OP as Rs.96080/- with interest  to the complainant for the deficiency of service  and unfair trade practice on  the  part of OPs.

The case of the complainant in brief:

    The  complainant was  a retired Gazetted officer.  The complainant is the policy holder of  Jeevan Saral policy bearing No.798166321 issued  by the OPs.  The complainant paid Rs.9608/- per year for 10 years.  The policy commenced on 28/11/2012 and the policy  is also matured on 28/11/2022 and the maturity amount is Rs.31768/-. But the complainant  remitted an amount of Rs.96080/-.  The complainant submits that he paid an amount of Rs.96080/-  and at the time of taking the policy the agent of OPs stated that who obtained total amount of Rs.2 lakhs.  But the policy amount + loyalty addition (ie, Rs.31,768+11,436) by NEFT transfer to his account Rs.43,204/-.  Thereafter the complainant send a letter to 1^st OP regarding the maturity amount.  The reply send by 1^st OP to complainant on 11/10/2022 stated that this Jeevan saral policy No.798166321  the maturity sum  assured Rs.31768/- and the loyalty addition Rs.11,436/- and the  total maturity claim paid Rs.43204/-..  This Jeevan saral policy No798166321  belongs to the category of  high risk plans, wherein the insurance coverage offered is substantially higher, especially at higher ages.  The death sum assured under this plan is 250 times the monthly premium selected by the  customer.  The death sum assured and the accident benefit sum assured is Rs.2,00,000/- and the  maturity sum assured as the  term 10 years  ie, Rs.31768/- which is correctly printed in the policy bond.  Then the complainant filed a complaint before  Insurance Ombudsman.  Then the office of the insurance Ombudsman send a reply to the complainant Ref: No.KOC-L-029-2223-0398 to the  complaint is dismissed. No relief obtained from the  complainant before the ombudsman. The act of the  OP’s the complainant caused much mental agony and financial loss.  So there is deficiency of service and unfair trade practice on the part of OP’s.  Hence the complaint.

       After receiving notice  all OP’s appeared before the commission  and filed their written version.  They  contended  that the yearly premium payable was Rs.9608/-.  In the policy the maturity amount is Rs.31768/-, death sum assured is Rs.2,00,000/- which is very clearly  shown  in policy bond issued to the  complainant.  In the policy the maturity amount (Rs.31768+ loyalty addition Rs.11,436)ie, Rs.43,204/- by NEFT transfer to the complainant’s account and the  complainant executed a receipt in full satisfaction of the amount due under the policy.  The allegation of the complainant is that he is entitled  for Rs.96080/and the loyalty interest is not correct and there is no such clause in the policy.  The OPs had paid the full amount payable to the  complainant immediately after maturity and there is no  delay and no deficiency  of service.  All the queries and  letters are properly replied.  The complainant is bound  by the terms of the policy which is the contract between the parties.  The maturity sum assured is calculated  depending upon the age of the life assured and the terms of the policy.  The death sum  assured is  250 times of the monthly premium selected by the customer. Hence there is no  deficiency in service and unfair trade practice on the part of OP’s.  So the complaint is liable to be dismissed.

      On the basis  of the rival contentions by the pleadings the  following  issues  were framed for consideration.

1. Whether there is  any deficiency of service   on the part of the opposite parties?
2. Whether the complainant is entitled for any relief?
3. Relief and cost.

     The evidence consists of the oral testimony of PW1 and Exts. A1 to A7 were marked.  On OP’s side Exts.B1 to  B3 were marked.  OPs filed the argument note also.

Issue No.1: 

                The  Complainant  adduced evidence before the commission by submitting  his chief affidavit in lieu of  his chief examination to the tune of the pleadings in the complaint and denying the  contentions in the version.  He was cross examined as PW1 by the OPs.  The documents  Exts.A1 to A7 were marked on his  part to substantiate his case. According to the complainant,  he is the policy holder of Jeevan saral policy bearing  No.798166321 issued to the complainant clearly shows  the  maturity sum assured.  As per the policy the guaranteed maturity sum assured as Rs.31768/-.  As per Ext.A1 dtd.18/10/2022 shows that the  amount of Rs.43,204/- was credited to his bank account with Central Bank of India.  Moreover at the time of evidence the complainant deposed that “policy  പ്രകാരം    maturity amount Rs.31768/- ആണ്? അതെ. അത്കൂടാതെ loyalty addition ആണ് policy  പ്രകാരം    അർഹതപ്പെട്ടത്? അതെ. So the amount of Rs.43204/- was credited to his account and shows in Ext.A1 document also.   The complainant’s complaint is that the agent cheated him saying that  Rs.2 lakhs will be paid on maturity.  The agent is neither made a party to this case and nor examined as a witness and the allegation is not proved.   As per the Ext.B2 policy which clearly shows that the maturity amount is Rs. 31,768/-. The two entries of Rs.2,00,000/- shown in the policy is the death benefit sum assured and  accident benefit sum assured which is  payable in case of  death, or accident of the insured  during the terms of the policy.  Moreover the complainant admitted that he had received Rs.43,204/-(Rs.31,768+ loyalty addition Rs.11,436/-)  is full and final satisfaction and executed discharge voucher also.

       The OP’s side also produced the citation of   Hon’ble Supreme Court of India 2023(1)KLJ 721” insured cannot claim anything more than what is covered by the insurance policy”.  So it is clear that the complainant cannot claim additional amount what is covered by the  insurance policy.    So there is no deficiency of service  and unfair trade practice on the part of   opposite parties .  Hence the issue No.1 found in favour of the OPs and  answered accordingly.

Issue Nos.2&3:

        As discussed above due to the aforesaid deficiency of service  and unfair trade practice on the part of   opposite parties not proved by the complainant.  So the complainant is miserably failed to prove his case. Thus issue No.2&3 are also  found  against the complainant.

    Hence the complaint is  dismissed on the ground that the complainant is not proved the deficiency of service and unfair trade practice against the opposite parties. So the compensation and cost not allowed. 

          In the result the complaint stands dismissed.  No order as to compensation and cost.

Exts:

A1 to A3- letter issued by OP to complainant

A4- Ombudsman letter dtd.7/2/23

A5-letter issued by OP to complainant dtd.12/4/23

A6- Mathrubhoomi daily

A7-statement regarding several other policies

B1-Proposal form

B2- Policy

B3- Agent’s manual

PW1-Purushu.K.P-Complainant 

Sd/                                                                 Sd/                                                     Sd/

PRESIDENT                                             MEMBER                                         MEMBER

Ravi Susha                                       Molykutty Mathew                                    Sajeesh K.P

eva           

                                                                        /Forwarded by Order/

                                                                   ASSISTANT REGISTRAR