D.O.F:08/07/2021
D.O.O:27/01/2023
IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KASARAGOD
CC.No.120/2021
Dated this, the 27th day of January 2023
PRESENT:
SRI.KRISHNAN.K :PRESIDENT
SRI.RADHAKRISHNAN NAIR.M : MEMBER
SMT.BEENA.K.G : MEMBER
Mr. Badruddeen Abdul Rahiman, aged 49 yrs
S/o Late. Abdul Rahiman,
R/at: Goliyady House, Moosodi,
Post Uppala, Uppala Village, : Complainant
Manjeshwar Taluk,
Kasaragod
(Advs. Sadananda Kamath.K & Rahul Das.K)
And
The Manager,
L.I.C. of India,
Kasaragod Branch, : Opposite Party
Jeevan Jyothi, P.B.No.12
M.G. Road, Kasaragod
(Adv. A.Radhakrishnan)
ORDER
SRI.RADHAKRISHNAN NAIR.M : MEMBER
The complaint is filed for compensation on the basis of service deficiency and unfair trade practice on the part of the opposite party.
The facts of the case in brief is that complainant has obtained two Bima Gold insurance policies of the opposite party, viz. Policy 795597302 dated 03.03.2008 and Policy No.795590565 dated 15.05.2008, which were term policies for a period of 12 years. At the time of offering proposals the authorised agent and development officer of the opposite party assured the complaint that on maturity he would get back the sum assured with bonus and other incentives. The sum assured under Policy No.795590565 was 5,00,000/- and the premium amount to be paid Rs.8,212/- quarterly and the sum assured under the Policy No. 795597302 was 25,00,000/- and the premium to be paid was Rs.50,908/- quarterly. The policy No.795590565 was matured on 03.03.2020 and the other policy matured on 15.05.2020. The complainant received an amount of 4,38,176/- under the Policy No. 795590565 and he has no complaint against opposite party in that case. But as far as policy No.795597302 is concerned complaint has received only Rs.21,09,925/- only on maturity, which is much less than the total amount of premium Rs.24,43,482/- paid by him over 12 years. When the complainant approached the opposite party through e-mail dated 02/07/2020 seeking clarification, the opposite party sent an undated reply and at that time for the first time it was revealed that opposite party has charged a ‘health extra’ at the rate of Rs.15.75/- per thousand Rupees. But neither the authorised agent nor the development officer of the opposite party had disclosed under what circumstance they have charged the health extra from the complainant. The opposite party has not conveyed these things to the complainant at the time of availing of the policies.
If the opposite party had disclosed the same at that time, he would not have subscribed this policy. On the other hand when the authorised agent and development officer of the opposite party approached the complainant with proposal of the policy they had promised that he would get the amount paid him as premium and bonus and incentive etc. But when the above said policy matured the complainant received only a lesser amount.
The act of the opposite party amounts to unfair trade practice and deficiency of service which caused huge monitory lose and great mental agony to the complainant and the opposite party is liable to compensate or that. The complainant estimate his monitory loss at Rs.5,00,000/- and an amount of Rs.1,00,000/ towards compensation for deficiency of service and mental agony. Hence this complainant is filed for a direction to the opposite party to pay a sum of 5,00,000/- towards monitory loss and Rs.1,00,000/- towards compensation along with litigation cost.
The notice send to the opposite party was duly served and the opposite party entered in appearance through their counsel, who filed written version.
As per the version of the opposite party the complaint is false, frivolous, vexatious and not maintainable in law. The opposite party admits that the complainant has obtained two Bima Gold insurance policies as mentioned in the complaint. But it is not correct to state that both the policies were term policies for a period of 12 years. Also the contentions in the complaint that at the time of offering the proposals for insurance policy the authorised agent and development officer assured the complainant that on maturity he would get the sum assured with bonus and other incentives etc. are false and hence denied. The opposite party submitted that under the plan Bima Gold policy free insurance cover is available for half of the original term and half of the original sum assured of the policy after premium term is over, auto cover is also available under this plan. If at least 2 full years premium has been paid and any subsequent premium has not fully paid, full death cover shall continue for a period of 2 years from the date of first unpaid premium. Even after payment, survival benefit risk cover is available for full sum assured. The opposite party submits that the insured has remitted 12 years full premium with Rs.15.75/- health extra per thousand. Sum assured as the mortality is high for the concern based on the special reports submitted by him under policy No.795597302. The complainant has received maturity claim of Rs.4,38,176/- under policy No. 795590565. Plan and term 179-12, survival benefit paid after the completion of 4 years to 02/2012- Rs.75,000/- and after completion of 8 years 02/2016- Rs.75000/-, maturity claim Rs.2.88.176/- settled 03.03.2020. free insurance cover is available under this policy, even after premium payment is over.
As regards to the policy No.795597302, survival benefit paid after completion of 4 years 15.05.2012- Rs.3,75,000/- and after completion of 8 years 15.05.2016- Rs.3,75,000/- maturity claim settled - Rs 14,40,925/- on 26.06.2020, hence he has received an amount of 21,90,925/- and not Rs.21,09,925/- as mentioned in the complaint. The total premium paid under the policy is Rs. 24,43,488/-. In the policy documents it is clearly mentioned that the maturity benefit under the policy will be total amount of premiums (excluding extra / optional rider premiums, if any) plus loyalty addition, if any, less the amount of survival benefits paid earlier. This policy has been charged Rs.15.75/- health extra per thousand sum assured and Rs.1/- double accident benefit per thousand sum assured. Hence the opposite party has settled maturity claim after deducting the premium paid as per the extras charged. Further on perusal of the policy bond it is clearly mentioned, “the instalment premium stated in the policy is inclusive of an extra premium”. Hence the contentions that the complainant was not aware of the health extra charge cannot be accepted. The opposite party had acted only as per the terms and conditions of the policy.
Further there was option of cooling of cancellation wherein the policy holder has the choice/ option of cancelling the policy and getting refund of premium if he is not satisfied in the terms and conditions of the policy within 15 days from the receipt of the policy bond, which he could have done if he has not satisfied with the terms and conditions of the policy. There is no service deficiency or unfair trade practice of the opposite party and the complaint is liable to be dismissed.
The complainant did not adduce any oral evidence. Certain documents produced by complainant are marked as Ext.A1 to A4. Ext.A1 is copy of LIC new Bima Gold policy No. 795597302 dated 15.5.2008 issued by the opposite party, Ext. A2 is copy of the reply letter send by the opposite party, Ext.A3 is copy of lawyers notice dated 04.12.2020 issued by the complainant. Ext A4 is reply notice dated 15.12.2020 issued by opposite party.
From the side of opposite party Mr. Sajeevan.K.K, legal and housing property finance manager filed proof affidavit in lieu of chief examination.
Based on the pleadings and documents of the rival parties the following issued are framed in this case.
- Whether there is any unfair trade practice or service deficiency on the part of the opposite party?
- If so what is the relief?
For convenience, both these issues are discussed together. The specific case of the complainant is that as far as policy No. 795597302 is concerned complaint has received only Rs.21,09,925/- on maturity, which is much less than the total amount of premium Rs.24,43,482/- paid by him over 12 years. When the complainant approached the opposite party through e-mail dated 02/07/2020 seeking clarification, the opposite party sent an undated reply and at that time for the first time it was revealed that opposite party has charged a ‘health extra’ at the rate of Rs.15.75/- per thousand Rupees. But neither the authorised agent nor the development officer of the opposite party had disclosed under what circumstance they have charged the health extra from the complainant. The opposite party has not conveyed these things to the complainant at the time of availing of the policies.
If the opposite party had disclosed the same at that time, he would not have subscribed this policy. On the other hand when the authorised agent and development officer of the opposite party approached the complainant with proposal of the policy they had promised that he would get the amount paid by him as premium and bonus and incentive etc. But when the above said policy matured the complainant received only a lesser amount.
The act of the opposite party amounts to unfair trade practice and deficiency of service which caused huge monitory lose and great mental agony to the complainant and the opposite party is liable to compensate or that.
The opposite party argue that as regards to the policy No.795597302, survival benefit paid after completion of 4 years 15.05.2012 Rs.3,75,000/- and after completion of 8 years 15.05.2016- Rs.3,75,000/- maturity claim settled is Rs 14,40,925/- on 26.06.2020, hence he has received an amount of 21,90,925/- and not Rs.21,09,925/- as mentioned in the complaint. The total premium paid under the policy is Rs.24,43,488/-. In the policy documents it is clearly mentioned that the maturity benefit under the policy will be total amount of premiums (excluding extra / optional rider premiums, if any) plus loyalty addition, if any, less the amount of survival benefits paid earlier. This policy has been charged Rs.15.75/- health extra per thousand sum assured and Rs.1/- double accident benefit per thousand sum assured. Hence the opposite party has settled maturity claim after deducting the premium paid as per the extras charged. Further on perusal of the policy bond it is clearly mentioned, “the instalment premium stated in the policy is inclusive of an extra premium”. Hence the contentions that the complainant was not aware of the health extra charge cannot be accepted. The opposite party had acted only as per the terms and conditions of the policy. Further there was option of cooling of cancellation, wherein the policy holder has the choice/ option of cancelling the policy and getting refund of premium, if he is not satisfied in the terms and conditions of the policy within 15 days from the receipt of the policy bond, which he could have done if he has not satisfied with the terms and conditions of the policy.
Here the complainant raised dispute regarding the amount taken towards health extra. The argument is that such a thing was not told to him by the agent or development officer at the time of proposal. But it is clear that the total premium amount Rs.50,906/-, is inclusive of amount towards health extra, which was being remitted by the complainant from the very beginning. So it cannot be said that the complainant had any further amount of loss in that account towards health extra.
The opposite party produced a ruling 2010(7) Supreme (SC)83 , wherein it is held that in a contract of insurance, the rights and obligations are governed by the terms of the contract, which have to be strictly construed-No exception can be made on the ground of equity.
The major purpose of life insurance is protection of the life, and to meet survivor needs. Some policies include a savings feature, but the possible savings feature is a secondary consideration. Life insurance is a contract through which a person transfers to an insurance company the life risk of a person in whose life he or she has an insurable interest. Insurable interest means gains from survival of a person or probability of suffering financial loss on the demise of the person. When buying life insurance policy, the primary concern is providing adequate protection and that risk is performed by the insurance company.
Therefore when a life insurance policy of a long term of 12 years has been matured, it is needless to say that the insured had the protection coverage over these long years. In that circumstance, there is no illegality in deductions in the maturity amount, as per the contract of the insurance policy.
The complainant has not pleaded or proved that the calculation of the insurance amount sanctioned by the opposite party is not as per the contract of the insurance policy. He has no such a case. But he argue that when the authorised agent and development officer of the opposite party approached the complainant with proposal of the policy they had promised that he would get the amount paid him as premium and bonus and incentive etc. But he did not prove that aspect by leading reliable evidence. The opposite party submit that the opposite party had acted only as per the terms and conditions of the policy. So there is no merit in the argument of the complainant that he did not get the entire premium amount paid, but only a lesser amount, on maturity of the policy. In this case it is clear the opposite party disbursed the maturity benefit after calculation on the basis of the contract of the insurance policy.
Considering the facts and circumstances of the case this commission is of the view that the complainant failed to prove any service deficiency or unfair trade practice on the part of the opposite party.
In the result, the complaint is dismissed without cost.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Exhibits
A1: Copy of LIC new Bima Gold policy
A2: Copy of the reply letter send by the opposite party
A3: Copy of lawyers notice
A4: Reply notice
Witness Cross-examined
DW1: Sajeevan.K.K
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Forwarded by Order
Assistant Registrar
Ps/
