1. The complainant has filed this Complaint against the Opponent (herein after referred in short as OP) u/s 12 (2) of Consumer Protection Act, 1986 alleging deficiency in service against OP.
2 The complainant has filed this complaint for payment of sum assured amount and order for compensation for mental agony & cost and such other relief.
The brief fact of the case is that the complainant is Govt.employee he insured his life with OP under the LIC Jeevan Saral (with profit) under policy No 631631234 by paying premium amount of rupees 255/- pm commencing from 28/4/2006, the sum assured in the [policy appears to be 62,500/- on maturity. The maturity date was 28/04/2016. Prior to the policy attaining maturity date the OP wrote a letter to the complainant dtd 28/4/2016 asking him to submit bank details for sending maturity benefit amount through NEFT wherein Gross amount of Rs;26,909/- was shown as estimated under the policy. Instead the promise assured sum assured Rs;62,500/-
The complainants further submits that after receiving the letter from OP stunned to go through the letter and therefore the complainant approached the concerned branch office and wrote a letter to the OP on 16/5/2016 to Hubli Branch and request to respond with the reason. In response OP wrote letter dtd.19/5/2016 stating that maturity sum is Rs;21105/- +Loyalty benefit Rs;5,803/-.
3. Further complainant submits that in the policy bond it clearly mentioned that the sum assured is Rs 62,500/-. At the time of issuance of Policy but OP has appeased with various benefit of LIC Jeevan Saral without any justifications now unlawfully falling back from the promise. Because of the deficiency of OP complainant has suffered loss and harassment. Hence op made deficiency in service and unfair trade practice. The complainant further prayed to order the Op to pay the balance amount of Rs;35,591/- alongwith other reliefs.
4. The predecessor on seat registered the Complaint and notice were ordered as such OP appeared through his advocate and filed their Vakalat and Written Version.
Brief facts of the Written Version of OPs:
5. That the OP had denied the contents of the Complaint and further stated that the policy issued by the OP and number of the policy is admitted, maturity date and name of the policy holder and the name of the policy also had been admitted by the OP and submits that the mode of payment by SSS and submits that the sum assured Rs 62,500/- is only payable on death of the insured and further submits that the complainant had misconstrued himself claiming it as a maturity sum assured payable to him it is clearly written in the policy bond terms and conditions which envisages. Benefits payable event on which they are payable on maturity benefits and death benefits, On maturity benefits insurer is benefitted for Rs 26,909/- and death benefit sum assured is Rs 62,500/-.
6. Further Op alleged that the Saral Jeevan account plan is a term insurance policy and where in Rs255/- monthly premium, worth Risk cover has been covered . There is provision to pay the maturity sum amount plus loyalty additions declared by the corporation by time to time. In the present case the complainant demanding death benefits amount is unjust, unlawful and not admissible, hence Op sent intimation for maturity benefit payment of Rs 26,909/-the same amount has been credited to the account of the complainant. Further as per the Annexure F printing the policy bond due to programme error maturity sum assured in the first column has been left blank and this error was not noticed while signing the policy bond. This is a bonafide error on the part of the Op. It is submitted that as per the maturity sum assured chart, age is of 50years entry for Rs;100/- and monthly premium Rs.8,442/- after 10 years duration . And current year loyalty addition declared was Rs;750/- per Rs;1,000/- sum assured was Rsp;21,105/- + loyalty addition Rs;5,803/- Total maturity value is as Rs;26,909/-. Hence Complainant is wrong notion that he is entitle for Rs;62,500/- and submit that this policy has been awarded by golden peacock award for its uniqueness and customer friendly. In view of various contentions OP prays to dismiss the complaint with cost.
7. In the background of the above said pleadings, the Complainant filed his affidavit and produced Ex.C-1 to Ex.C-4. The documents are as follows.
1.Ex.C-1. LIC Policy Bond
2. Ex.C-2 Discharge voucher for maturity claim
3.Ex.C-3&4 Photocopy Correspondent Letters
8. On the other hand, Op filed Affidavit of one Sri. Hanumappa, The Manager, Legl and HP, LIC of India, Dharwad division. Filed Chief Affidavit and produced 6 un marked documents are as follows;
- Certified copy of proposal
- Certified copy of Agent confidential Report
- Certified copy of letters 2 in No.eevan Saral Plan of 17 pages
- LIC’s Jeevan Saral Plan of 17 pages
- Certified copy of Policy Bond.
- Amount Transferred Receipt
9. On perusal of the above documents and arguments heard on both the sides, we conceived that the dispute is regarding the maturity amount complainant claims that sum assured amount should be as shown in the policy bond. The OP had denied the averments made in the Complaint. This being the pleadings, the points arises before us for adjudication are as follows:
1. | Whether the Complainant proves that the OP made any deficiency in service? |
2. 3. | Whether the Complainant is entitled for relief? What Order? |
Our Answer to the above Points are:-
Point No.1 – Affirmative,
Point No.2 – Partly Affirmative,
Point No.3 - As per the final order.
10. On consideration of pleading, objection, evidence, documents and arguments of the parties, we answer the above points as under:
R E A S O N S
11. POINT NO.1 and 2: Since the pint No.1 and 2 are identical to avoid the repetition of the fact we consider both the points together for discussion.
12. The complainant had insured his life with OP under Jeevan Saral (with profit) Policy the premium of Rs.255/- p.m. commencing from 28/4/2006 ,the OP issued a policy bond in the name of the complainant with a column of sum assured which shows as Rs;62500/- and date of maturity 28/4/2016 The OP had admitted these facts and contended that the sum assured Rs;62,500/- is only payable on death .
13. The controversial point here is that the OP had denied to pay the sum assured, the OP stated that the complainant had misconstrued himself and claiming the benefit as maturity sum assured. But the terms and conditions of the policy bond states that maturity benefit on the life assured , surveying the maturity date of the contract the amount equal to the balance in the policyholder account shall be payable, Death benefit in the event of death of the life assured during the terms when the cover is in full force the sum assured along with the balance in the policy holder’s account shall be payable.
14. After the maturity of the policy the OP informed the complainant that the maturity amount of the complainant is Rs;26,909/- on receipt of the same the complainant wrote a letter on 16/5/2016 and OP replied the letter of the complainant stating that the maturity sum is Rs;21,105/- +Loyalty benefit Rs;5,803/- Further the complainant submits that Op had not at all disclosed either prior to the contract or at the time of contract or at least before payment was never made known about the nonpayment of sum assured of Rs;62,500/-, the advocate for Op had argued the matter and submitted that the complainant demanding the death benefit of the amount is unjust and unlawful and stated that the OP had not made any deficiency in service.
15. On perusal of the documents on record the policy issued in the name of the complainant clearly stated that premium is Rs;255/- and in the column of sum assured had been filled as a Rs;62,500/- Where in the sum assured had not been mentioned as the sum assured in case of death of policy holder. Extent to above discussion the OP filed document i.e., No.1& 6, in these documents also the OP had mentioned that Sum Assured is Rs;62,500/- But document does not whispers about the clauses shown in the document No1&6. Rs;62,500/- is to be paid only in case of the death of the insurer. Hence it is crystal clear that the assured sum for the respective policy on the date of maturity is Rs;62,500/-.
III (2015)CPJ 71(HP)
HIMACHAL PRADESH STATE CONSUMER DISPUTES
REDRESSAL COMMISSION,SHIMLA
Hon’ble Mr.Justice Surjit Singh,President;
Mre.Prem Chauhan and Mr.Vijay Pal
Khachi,members.
LIFE INSURANCE CORPORATION OF INDIA – Appellant
Vs
PRADEEP KUMAR & anr.-Respondents- Respondents
First Appeal No.306 of 2014-Decided on 21.11.2014
Consumer Protection Act,1986-Sections 2(1)(g),14(1)(d),15- Insurance(Life)-Maturity amount less than assured- Misrepresentation – Deficiency in service- District Forum allowed complaint – Hence appeal – From policy document it is made clear that in addition to sum assured, insured will get bonus on maturity- Complainant is entitled to sum assured and bonus which comes to Rs.5125-Impugned order modified –Amount payable to complainant reduced.
16. As such we relied upon the citation cited above, in this citation the Dist.Forum allowed the complaint and Op appealed before the State Commission the Appellant Forum upheld the order passed by the Dist.Forum reducing the bonus already paid by the appellant. While going through the citation, the case in our hand is same which resembles to this case. It is clear that OP is liable to pay the sum assured as shown in a Bond.
17. Further Advocate for the complainant filed Memo along with writ petition No.112919/2015, against the same policy in the Hon’ble High court of Karnataka (Dharwad Bench) which had been dismissed. In W.P Honble High court directed the OP to pay entire assured amount shown in the policy bond. As such the complainant is liable for claim spartly. Hence we answer Point No.1 in affirmative and Point No.2 in partly affirmative.
18. POINT No.3: For the reasons and discussion made above and finding on the above points, we proceed to pass following:
ORDER
- This Complaint is partially allowed.
- Op is directed to pay Rs;35,591/-(Rupees Seventy two thousand only) towards sum assured of the policy.
- Op is directed to pay Rs;1000/- (Rupees One thousand only) towards the cost of this litigation and Rs;2,000/- (Rupees Two thousand only) towards mental agony and harassment.
- The op is directed comply this order within a period of 30 days from the date of this order, failing which the Op is liable to pay interest at 09% p.a., till realization.
- Send a copy of this Order to both parties free of cost.
(Dictated to the Stenographer, transcribed by her, corrected and then pronounced by me in the Open Court 22nd day of Nov., 2016)
