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 an amount of Rs.25,853/- to the complainant and Rs.50,000/- as compensation for mental agony with cost of litigation to the complainant for the deficiency of service on the part of OPs.
The case of the complainant in brief:
The complainant was working as an excise officer. At that time he had taken the Jeevan Saral policy bearing No.796809976 issued from 2nd OP. The complainant paid Rs.510/- per month(Rs.1531/-quarterly) for the policy. The policy commenced on 22/12/2011 and the policy is also matured on 22/12/2021 and the maturity amount is Rs.43,630/-. But the complainant remitted an amount of Rs.61200/-. The complainant submits that he paid an amount of Rs.61200/- and who obtained the loyalty addition Rs.24,000/-. So total amount he is entitled for Rs.85,200/-. But the policy amount + loyalty addition (ie, Rs.43,630+15,707) by NEFT transfer to his account Rs.59,337/-. Thereafter the complainant send a letter to 1st OP regarding the maturity amount. The reply send by 3rd OP to complainant on 25/11/2011 stated that this Jeevan saral policy No.796809976 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.1,25,000/- and the maturity sum assured as the term 10 years ie, Rs.43,630/- which is correctly printed in the policy bond. Then the complainant filed a complaint before Insurance Ombudsman dtd.29/11/2021. Then the office of the insurance Ombudsman send a reply to the complainant to the complaint No.KOC-L-029-2122-0366 to furnish some documents regarding the insurance policy No.796809976. But no remedy 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 quarterly premium payable was Rs.1531/-. In the policy the maturity amount is Rs.43460/-, death sum assured is Rs.1,25,000/- which is very clearly shown in policy bond issued to the complainant. In the policy the maturity amount (Rs.43,630+ loyalty addition Rs.15,707/-) Rs.59,337/- 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.85,200/-( the premium amount paid Rs.61200/- +Rs.24,000/- as 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.
- Whether there is any deficiency of service on the part of the opposite parties?
- Whether the complainant is entitled for any relief?
- Relief and cost.
The evidence consists of the oral testimony of PW1 and Exts. A1 to A14(series) were marked. On OP’s side DW1 was examined and Exts.B1 & B2 marked.
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 A14(series) were marked on his part to substantiate his case. According to the complainant, he is the policy holder of Jeevan saral policy bearing No.796809976 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. In the evidence also the complainant deposed that “Ext.A1 പ്രകാരം maturity amount 43,630/- രൂപയാണ് കാണിച്ചിട്ടുള്ളത്? അതെ. 43,630/- രൂപയും loyalty amount Rs.15,707/- രൂപയും കൂടി മൊത്തം Rs.59,330/- രൂപ LIC നിങ്ങൾക്ക് തന്നിട്ടുണ്ട്?ഉണ്ട്. നിങ്ങൾ പറയുന്നത് 61200/- രൂപയും ആയതിന്ർറെ പലിശ 24000/- രൂപയും കൂടി വേണമെന്ന് പറഞ്ഞാണ് കേസ്സ് കൊടുത്തത്? അതെ. 61200/- രൂപയും ആയതിന്ർറെ പലിശ 24000/- രൂപയും കൂടി തരണമെന്ന് policy യിൽ വ്യവസ്ഥയുണ്ടോ? വ്യവസ്ഥ ഉണ്ടോ എന്ന് എനിക്കറിയില്ല Ombudsman ൽ കൊടുത്ത പരാതി dismiss ആയോ? ആയി എന്നു പറഞ്ഞ് എനിക്ക് letter വന്നു. Policy യിൽ പറഞ്ഞതുക maturity ആയ സമയത്ത് തന്നെ കിട്ടിയില്ലേ? കിട്ടി .എനിക്ക് Dec.29, 2021 ന്കിട്ടി. Moreover on OP’s side DW1 was examined and Exts.B1&B2 marked. In the evidence of DW1 who stated that “ policy പ്രകാരം policy ഉടമ 61200/- രൂപ company യ്ക്ക് അടച്ചിട്ടുണ്ട്? അതെ. പിന്നെ എന്തു കൊണ്ടാണ് policy ഉടമ യ്ക്ക് തുക കുറച്ചു കൊടുക്കാൻ കാരണം? policy condition പ്രകാരംആണ് പണം കൊടുക്കുക. അടച്ച തുക കൊടുക്കുക എന്നല്ല പറയുന്നത്. High risk policy ആണ്. premium ത്തിന്ർറെ 250 മടങ്ങ് risk coverage ആണ് ഉള്ളത്. As per the Ext.B2 policy which clearly shows that the maturity amount as Rs. 43,630/-, death sum assured is Rs.1,25,000/- which is very clearly shown in the policy bond issued to the complainant. Moreover the complainant admitted that he had received Rs.59,337/-(Rs.43,630+ loyalty addition Rs.15,707/-) is full and final satisfaction and executed discharge voucher also.
The OP’s side also produced the Hon’ble Supreme Court of India citation in 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-Policy
A2-claims/ maturity benefit dtd.19/8/21
A3- Complaint to Ombudsman
A4- Complaint to insurance Ombudsman
A5-Reply to Ext.A4
A6- Complaint to Ombudsman 14/12/21
A7-Reply from Ernakulam with annexure
A8- Reply to LIC Thalassery branch
A9-LIC policy receipt
A10-post card
A11- Reply to Ombudsman dtd.11/4/2022
A12&A13-spark salary slip
A14(series)-LIC policy receipts
B1-Proposal form
B2- Policy
PW1-Soman.K- complainant
DW1-Sajeevan.K.K- OP
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
eva
/Forwarded by Order/
ASSISTANT REGISTRAR
