SRI. SAJEESH.K.P    : MEMBER

    The complainant has  filed this complaint  under Sec.35 of the Consumer Protection Act 2019,  seeking direction against the  OPs to pay  Rs.1,25,000/-  with 12% interest and also pay compensation for the mental agony.

Complaint in brief :-

   According to the complainant,  complainant took an insurance policy  on 2011 March  on the persuasion of 1^st OP who is the agent of 2^nd  OP.  According to the policy the sum assured was 1,25,000/- and the  period of policy was for 10 years.  The premium was Rs.6005/- per year and  all these are cross checked with a staff of  2^nd OP and complainant paid Rs.12010, ie premium of 2 years since the policy required to be closed before the complainant attained age of 60.  But  the complainant received the receipt of Rs.6005/- and on enquiry OP told that it will be adjusted to the last premium.  Due to the pandemic year 2020, OP told that policy will end up only  on March 2021 and demanded the premium amount of the year 2020 and the complainant paid the said amount on 5/6/2020 along with penalty of Rs.113/-.  Since complainant couldn’t pay the premium amount of 2020 due to the pandemic  issues.  The 2^nd OP intimated complainant that his policy will mature on 28/3/2021 and the complainant will get Rs.55,270/-.  At  the time  when the complainant joined the policy, the sum assured shown as 1,25,000/- but 2^nd OP told that they can give only Rs.55270/-.  The complainant  paid the premium for 10 years but the OPs practiced unfair trade practice by not giving the sum assured hence this complaint.

    After filing the complaint, commission  sent notice  to both OPs and both OPs entered  appearance before the commission and filed their version accordingly.

Version of   1^st OP in brief:

    The 1^st OP denies the entire averments except those specifically admitted.  The 1^st  OP admits that complainant took the policy through 1^st OP.  The 1^st OP contended that out of 2 policies explained  complainant  choose the cost duration policy and also  1^st OP contended that he  well explained the terms and conditions of policy that Rs.1,25,000/- will credited in the event of accident or death otherwise the maturity amount shown in the policy will be  credited.  The amount of Rs.113/- collected  only us the penalty of non payment of premium on time.  As per the terms of policy, the amount will be  credited by 2^nd OP and 1^st OP has no liability and hence the complaint against 1^st OP will not lie and  liable to be dismissed.

Version of   2^nd  OP in brief:

   The  2^nd OP denies the entire averments except those specifically admitted.  There is no dispute with regard to the policy and its maturity date issued to complainant.  The policy is  Jeevan Saral  policy which is a high risk covering  plan providing a death sum assured.  The maturity sum assured is arrived as per the chart and depends on the premium selected by policy holders age at the time of entry.  The policy issued to complainant shows that the death benefit sum assured.  Accident benefit sum assured of  Rs.1,25,000/- is only with regard to the event of accident or death.  Since the complainant survived the policy he is entitled for the  agreed sum assured and bonus.  The 2^nd OP sent the policy to the complainant by registered post and he received the same in 2011 itself.  The complainant is entitled to return the policy if there is any mistake found as per the clause stated in the policy but complainant accepted the offer and raised complaint after 10 years.  The total amount payable to the complainant as per the policy along with  loyalty addition was Rs. 55,270/-.  The maturity intimation showing  on 13/11/2020, the information required for the payment and 2^nd OP is ready  and willing to pay the Rs.55,270/- at any time upon furnishing  require documents mentioned in the letter dtd.13/11/2020.  There is no deficiency of service practiced by 2^nd OP and the complaint is liable to be dismissed.

       Due to the rival contentions raised by the OPs to the litigation, the commission decided to cast the issues  accordingly.

1. Whether there is any deficiency in service and unfair trade practice from the side of  OPs?
2. Whether there is any  compensation  &  cost to the complainant?

       In order to answer the issues, the commission called evidence from both parties. The  complainant produced documents which is marked as Exts.A1 to &A10.    Ext.A1 is the LIC bond issued by 2^nd OP dtd 5/4/2011, Exts.A2 &A3 are the receipts issued by 2^nd OP dtd.7/3/2019, 5/6/2020, Ext.A4 is the inland letter dtd.10/3/2020, Ext.A5 is the notice sent by complainant to 2^nd OP, Ext.A6 is the reply sent by 2^nd OP to complainant.  Ext.A7 is the  lawyer notice, Ext.A8&A9 are the Acknowledgment card of  OPs  1&2, Ext.A10 is the  reply notice send by 2^nd OP to complainant. The complainant adduced evidence  through proof  affidavit and examined as PW1. 1^st OP adduced evidence through  proof affidavit and examined as DW1. No document from the side of 1^st OP.     2^nd OP produced documents which is marked as Exts.B1 to B3.  Ext.B1 is the proposal form.  Ext.B2 is the policy with  terms and conditions and Ext.B3 is the letter issued by  complainant to 2^nd OP.  The 2^nd OP adduced evidence through proof affidavit and examined as DW2.  2^nd OP filed argument note.

       Let us have a clear glance into the  evidences produced by both  parties to answer the issues . As there is no dispute with regard to the policy, or its premium, no detailed discussion  is necessary. The dispute arise on the sum assured after the maturity.  According to complainant, the sum assured is Rs.1,25,000/- and he paid the premium amount until the maturity date.  But as per  the version of both OPs the sum assured on the maturity  date, if  policy holder survives  the  maturity date of the policy then the sum assured  is Rs.40640/- along with loyalty addition, here in this case loyalty addition shown as Rs.14630/-.  On perusing Exts.A1& B2 which is one and the same.  The sum assured on  maturity date is seen  as  Rs.40640/- and Rs.1,25,000/- is in the event of death or accident.  Moreover Exts.A1(B2) is  with the complainant and he  can peruse the policy to understand the  details regarding the sum assured.  As the complainant deposed that he is ignorant of  terms and conditions of policy cannot be  taken into consideration.  Furtherly, complainant admitted during the cross examination that 2^nd OP intimated  the complainant to present before 2^nd OP along with relevant documents to obtain  the maturity sum assured.  The complainant is demanding Rs.1,25,000/- as sum assured on maturity date which is  against the terms and conditions of Ext.A1.  In National Insurance Co.Ltd vs.  Chief Electoral officer and others(2023 (1)KLJ 721) .  The Hon’ble Supreme Court specifically stated that insured cannot claim anything more than what is covered by the insurance policy.  In the present case there is no  delay from  2^nd OP to provide their service  as the complainant also admits  in the deposition that he received intimation on time.  On 2011, the  complainant received the policy and he never raised any complaint but paid the premium until the maturity date. There is no serious dispute raise against  1^st OP to discuss as he is the agent of 2^nd OP.  During the pendency of the case, 2^nd OP deposited Rs.55,270/- before this commission and complainant received the same.  On perusing the documentary as well as oral evidence of both parties, this commission is in the view that there is no delay or deficiency in service or unfair trade practice from the part of 2^nd OP but the complainant himself deliberately lagged to obtain  the service of 2^nd OP.  Hence the commission came into the conclusion that there is no efficiency in service or unfair trade practice  from the part of OPs and the case is liable to be dismissed.

        The complainant is not entitled to get any  cost  or compensation as prayed because there is no deficiency in service or unfair trade practice from the part of OPs is proved.

        In the result the complaint is dismissed not cost

Exts:

A1- LIC- bond issued by 2^nd OP dtd 5/4/2011

A2 &A3- receipts issued by 2^nd OP dtd.7/3/2019, 5/6/2020,

A4- inland letter dtd.10/3/2020,

A5- notice sent by complainant to 2^nd OP,

A6 - reply sent by 2^nd OP to complainant. 

A7-  lawyer notice,

A8&A9- Acknowledgment card of  OPs  1&2,

A10- reply notice send by 2^nd OP to complainant.

B1-proposal form.

B2- policy with  terms and conditions

B3- letter issued by  complainant to 2^nd OP

PW1-Sebastian.M.D- Complainant

DW1-Thomas.K.J-1^st OP

DW2-Sajeevan.K.K-2^nd OP

Sd/                                                             Sd/                                                   Sd/

PRESIDENT                                             MEMBER                                               MEMBER

Ravi Susha                                       Molykutty Mathew                                    Sajeesh K.P

eva           

                                                                        /Forwarded by Order/

                                                                   ASSISTANT REGISTRAR