D.O.F:02/02/2022
D.O.O:12/03/2024
IN THE CONSUMER DISPUTES REDRESSAL COMMISSION KASARAGOD
CC.24/2022
Dated this, the 12th day of March 2024
PRESENT:
SRI.KRISHNAN.K : PRESIDENT
SMT. BEENA. K.G : MEMBER
S Thomas Gonsalves, aged 80 years
Muttikkal House, Edayilakkad,
Valiyaparamba (PO) – 671312,
Hosdurg Taluk, Kasaragod. : Complainant
(Adv: M.T.P Abdul Kareem)
And
1. The Executive Director
ICICI Prudential Life Insurance Co. Ltd;
1089, Appasaheb Marathe building,
Prabhadevi, Mumbai 400025.
2. Mr, Dilip Kumar.P, : Opposite Parties
Manager
ICICI Prudential Life Insurance Co, Ltd;
Payyanur Branch
3rd Floor, Behind New Bus stand
Payyannur (P.O) – 670307
Kannur District.
(Adv: Saji Isac K.J)
ORDER
SRI. KRISHNAN.K : PRESIDENT
The case of the complainant is that he is a Senior citizen Opposite Party No:2 is the Manager of Opposite Parties Payyannur branch. On 05/05/2011 Opposite Party No:1 approached the complainant and explained about the insurance policy scheme. The Opposite Party No:2 Persuaded the complainant to join the scheme for 10 years and assured that Rs. 3,50,000/- will be the coverage on maturity and subscriber will get Rs. 12,00,000/-investing Rs. 50,000/- per year for 5 year. The complainant to withdraw Rs. 20,000/- assured after 6 year from the completion of 5 year without affecting return of maturity and Rs.2,50,000/- investing on share market. A total of Rs. 15,50,000/- and it will benefit the complainant by way of old age passion. The complainant has withdrawn partial amount of Rs. 1,37,000/- complainant claims insurance maturity amount of Rs. 12,00,000/- and Rs. 3,50,000/-. The complainant sent legal notice dated 17/09/2021 and received to reply dated 21/10/2021. The complainant claim insurance maturity amount 12,00,000/- and Rs.3,50,000/- and financial loss of Rs. 25,000/- and litigation cost. The Opposite party violated the procedure rules. Amount given on maturity is derived after deducting Rs. 1,37,000/-. On 30/06/2021 complainant received a letter with check of Rs. 67,925/- as maturity amount from the policy.
The Opposite party appeared and filed written version saying that complaint is barred by limitations. Policy was issued on 27/06/2011 complainant filed on 28/01/2022 ie, after 10 year of policy lawyer notice sent on 17/09/2021. No explanation for condoning the delay. The complainant did not avail the free look in period. If any deficiency in service or did not approach company for cancellation of policy and thereby agreed to terms of policy. He paid all renewal premiums. He approached opposite Party for the 1st time on 17/09/2021. Insure is a binding contract between both parties. There is no deficiency in service or any unfair trade practice while closing the subject policy. There is no cause of action for putting the claim. Partial withdrawal is an advantage of customer during the time of the policy. Policy matured on 27/06/2021. An amount of Rs. 67,925.68/- was paid in charge as per policy term. There is no further amount payable. The complainant has complete information at partial withdrawal will reduce the maturity amount payable. The entire amount paid as premium is not used to purchase the units in the ULIP policy. The insures deduct charge for allotting units. Remaining premium is invested as per policy holders choice. Partial withdrawal are paid on various occasions. Correct and proper reply is sent to lawyer notice. Complainant is not entitled to any reliefs claimed in the case and hence to dismiss the complaint.
The complainant filed chief affidavit and cross examined as Pw1 Ext A1 to A6 documents marked. Ext A1 is policy of insurance, Ext A2 is lawyer notice, Ext A3 is reply notice, Ext A4 is hand written notice, Ext A5 unit statement, Ext A6 is copy of documents of policy. The Opposite party filed Ext B1 to B5 documents Ext B1 is proposal form, Ext B2 Electronic benefits illustration, Ext B3 partial withdrawal request, Ext B4 letter and unit statement. Ext B5 copy of legal notice.
On the basis of rival claims following points arised for consideration in the case.
- Whether complainant is barred by limitation
- Whether there is deficiency in service negligence in the matter of refusal to pay the insurance benefits covered by the policy.
- Whether there is any compensation is payable? If so for what reliefs?
All the points are discussed together for conveniences:-
The case is for insurance benefits rejected by the Opposite party. The complainant claims insurance policy maturity value namely Rs.12,00,000/- and Rs.3,50,000/-. He claims financial loss of Rs. 2,50,000/-. The policy benefits are rejected for the reason that complainant has made partial withdrawal unit available was withdrawn by the complainant and hence fund value will be reduced corresponding to the limits withdrawn.
The Pw1 cross examined by Opposite party. Pw1 deposed that he is not aware that opposite Party issued unit linked policy. The pw1 admitted that with 6 years, he has withdrawn amount is part including Rs.1,37,000/- and Rs. 67,925/- policy coverage is upto life time. He denied the suggestion that to received entire amount covered by the policy and did not suffer any loss. Regarding the limitation, absolutely no cross examination. The complaint is filed though in 2021, he has paid the list premium up to an in closure of 2021 and policy matures only on 27/06/2021. Complaint filed in 2022 within the time and thus not barred by limitation.
Ext A3 repudiation letter shows sum proposed is Rs. 2,50,000/- as premium. Premium Rs. 50,000/- yearly period from 23/06/2021. The complainant regularly paid monthly instalment as well as interest due. On 27/06/2021 policy was matured and maturity amount is Rs. 67,925.68/- for which cheque is duly encashed. The maximum amount due shall be 20% of the fund value as on the date of partial withdrawal. Insurance being the contact governed by terms and conditions. Thus complainant is not liable to pay the amount claimed. This is the stand taken by the opposite party company. In a unit linked insurance policy, the money paid as a premium goes into a pool called the unit linked fund. The insurance company manages this fund. It is invested in a range of equity and debt instruments to offer the dual benefits of a life cover and the potential to get maximum benefits.
Partial withdrawals are allowed after the completion of five policy year insured can make an unlimited number of partial withdrawals as long as the total amount of partial withdrawals in a year does not exceed 20% the fund value in a policy year. The partial withdrawals are free of cost.
The company has no case that policy not completed five years or the value of withdrawals in a year is more than 20% of the fund value.
There is thus fault, short coming, in nature and manner of performance of service which is required to be performed by the insurance company.
Policy is issued on 27/06/2011. Premium is paid for five year. Premium per year is Rs. 5000/-. So total amount paid is Rs. 2,50,000/- as on 27/06/2016. All withdrawals are after premium cessation date 27/06/2016.
If claim of insurance is accepted after five years of joining having paid Rs. 2,50,000/- and waiting for another five year insured will be paid Rs. 1,37,000/- plus Rs. 67,925/- in total Rs. 2,64,925/- even less than maturity value of Rs. 2,50,000/-.
Every year, either 9% or 10% of total premium paid will be added to policy benefits depending on policy term, so addition will be Rs. 5000/- for 5 year. A guaranteed lumpsum benefits at maturity at the end of the policy term, irrespective of market interest rates.
The complainant claims Rs. 12, 50,000/- plus insurance maturity value namely Rs. 3, 50,000/- for which no calculation statement or justification. The complainant is entitled to final insurance benefits as per policy terms and condition guaranteed conditions.
The opposite Party is directed to work out and re fix total insurance benefits payable as per policy terms and pay Rs. 3,50,000/- being maturity value and guaranteed addition to complainant. Thus there is deficiency in service from the part of opposite party is repudiating to claim. The Opposite party is liable to pay compensation for that we fixes Rs. 25,000/- as compensation and Rs. 5000/- as cost of litigation.
In the result complaint is allowed in part opposite parties are directed to work out and re-fix total insurance benefits payable as per policy and pay as per policy and pay Rs. 3,50,000/- being maturity value and plus guaranteed additions to complainant. The opposite party is also directed to pay Rs. 25,000/- (Rupees Twenty Five thousand only) as compensation for deficiency in service and Rs. 5000/- as cost of litigation with 30 days of the receipt of the order.
Sd/- Sd/-
MEMBER PRESIDENT
Exhibits
A1- Policy of insurance
A2- Lawyer notice
A3- Reply notice
A4- Hand written notice
A5- Unit statement
A6- copy of documents of Policy
B1- Proposal form
B2- Electronic benefits illustration
B3- Partial withdrawal request
B4- Letter and unit statement
B5- Copy of legal notice.
Witness Examined
Pw1- S Thomas Gonsalves
Sd/- Sd/-
MEMBER PRESIDENT
Forwarded by Order
Ps/ Assistant Registrar
