Reportable

Before,

State Consumer Disputes Redressal Commission, Bihar, Patna

Appeal  No. 319 of 2019

The Branch Manager, Life Insurance Corporation of India, M.G.Road, Khagaria.

                                                                                                           ............... Appellant

                                      Versus

Upendra Sah,  S/o- Bhola Sah, Resident of Village- Murgiachak, Ward No. 9,  P.S. & District – Khagaria.

                                                                                                   ........... Respondent

Counsel for the Appellant- Mr. Raj Dular Sah, Advocate

Counsel for the Respondent - Mrs. Deepika Sharma, Advocate

Before:

Miss Gita Verma (Judicial Member)

Mr. Subodh Kumar Srivastava (Judicial Member)

                               Mr. Raj Kumar Pandey ( Member )

Dated: 22.09.2022

Order

As per: Mr. Subodh Kumar Srivastava, (Judicial Member)

1. Appellant/opposite party has preferred this appeal against judgment/order dated 13.08.2019 passed by learned District Consumer Disputes Redressal Forum Khagaria (hereinafter mentioned as ‘Forum’), whereby and whereunder learned Forum has allowed the complaint petition of the respondent/complainant and directed the appellant to pay Rs.63,709/- within two months from the date of order, failing which 6% interest p.a. will be charged. Appellant has also been directed to make payment of Rs. 5,000/- for mental harassment and litigation cost to the complainant.
2. In short, the complaint case before the District Forum was that complainant purchased an insurance policy of ‘Jeevan Saral’ from Khagaria branch on 15.10.2008 for sum assured Rs. 1,00,000/- vide policy no. 524544648 for a term of ten years for which premium of Rs. 1,200/- and with accidental benefit 1225/- quarterly. Complainant’s further case is that opposite party has paid less maturity amount to him. Opposite party was requested to pay remaining sum assured, but O.P. avoided. Then complainant sent a legal notice through his advocate thereafter, the opposite party sent reply of legal notice to the complainant  stating therein that policy was high risk plan, so, the maturity amount i.e. sum assured (Rs. 36,291/-) has been paid to the complainant. Hence, the complaint petition was filed.
3. Opposite party had appeared before the District Forum and filed written statement stating therein that there was no deficiency of service on the part of the opposite party. Maturity amount paid to the complaint was correct as per calculation of term and conditions of the policy. Complainant is claiming the maturity amount of Rs.1,00,000/- as printed in the policy bond, which was by typographical error, printed wrongly.
4. Learned counsel for the appellant argued that learned District Forum did not consider the technicality of the terms and conditions of the policy and simply believing on the printed amount on the policy bond allowed the complaint. Learned Forum did not appreciate the material facts available on record and passed illegal, improper, unjust order which is not sustainable in the eye of law. Admittedly, the complainant has obtained the policy and paid premium to avail two different claim related benefits: (a) risk cover for death during term of policy i.e. death sum assured, and (b) if he survives throughout the term maturity benefit i.e. the maturity sum assured at the end of term policy. It is clearly printed on the policy document, so, contract is perfectly valid and binding on the parties. Since, complainant survived the policy period he was paid maturity amount. He has availed the benefit of life cover for death sum assured under the policy since inception of the policy.
5. Whereas, learned counsel for the respondent argued that learned District Forum rightly passed the impugned order. Appellant has failed to prove that there has been any typographical error in the said policy bond In fact, the table 165 was not part of the policy bond and was not supplied along with the policy document. Hence, the respondent may not be bound by this table, rather the respondent and appellant both are bound by the written contract as mentioned in the policy document.
6. We have gone through the material available on record and also taken into consideration the submissions made on behalf of both parties. So called typographical error is the main issue between the parties. Complainant had taken a policy plan 165 ‘Jeevan Saral’. There is mention of Rs. 1,00,000/- against sum assured and Rs. 1225/- quarterly premium for ten years and death sum assured as Rs. 1,00,000/-. When policy matured complainant was paid Rs. 36,291/- minus loan amount, which is the matter of contention.
7. Both parties admit the contract as mentioned in the policy document. We find that complainant has received ‘Policy Bond’ of Jeevan Saral (With Profits) commencing from 22.11.2008, date of maturity 22.11.2018. In this policy bond in lower portion terms are mentioned as:

Maturity benefit – In the event of the Life Assured Surviving the date of maturity a Sum equal to maturity Sum Assured in force after partial surrenders, if any, along with the corresponding loyalty addition, if any, shall be payable.

         Benefit on death—A sum equal to the Death Benefit Sum Assured along with all premiums paid (excluding premium paid for the first policy year, any extra premium and premiums in respect of Accident Benefit and Term Rider Benefit) shall be payable provided the policy is in full force on the date of death, loyalty addition, if any, shall also be payable, if the proposer and/or Life Assured had surrendered the policy partially, as per terms of the policy, the benefit shall be reduced in proportion of the reduction in premium for the main plan.

In such circumstance complainant cannot say that he was not aware of the term and conditions as mentioned in the Policy Bond. There is clear term of contract that “in the event of the Life Assured surviving the date of maturity ‘a Sum equal to maturity Sum Assured in force’ after partial surrenders, if any,along with corresponding loyalty addition, if any, shall be payable.

8.         Hon’ble Supreme Court has observed in the case Oriental Insurance Co. Ltd. Vs. Sony Cherian II (1999) CPJ 13 (SC), as follows:        

                 “The insurance policy between the insurer and the insured represents a contract between the parties. Since the insurer undertakes to compensate the loss suffered by the insured on account of risks covered by the insurance policy, the terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy. That being so, the insured has also to act strictly in accordance with the statutory limitations or terms of the policy expressly set out therein.”

9. Karnataka State Consumer Commission, Banglore in similar nature case Appeal No. 19/ 2017 - The Chief Manager, Life Insurance Corporation of India Vs. Manoharaj Bhasme, passed on 01.03 2019 has held that:
10.  
10.    Appellant has brought on record the “Brochure” containing terms & conditions of the Policy- LIC’s Jeevan Saral**Plan No.-165 ( With Loyalty Addition ), which clause (H) deals with Maturity Claim,  runs as under:

1. In Force Policy- Provided all the premiums during policy have been paid and life assured is alive as on date of maturity, then maturity claim will be Maturity sum assured (not death sum assured) + loyalty addition declared in said valuation year.

No maturity claim for Term assurance rider is payable.

In case of maturity claims, if premiums have not been paid during the last policy year, but the policy was in force for full sum assured on the policy anniversary prior to the maturity date, the claim is paid for full sum assured on the maturity date along with loyalty addition subject to the deduction of the unpaid instalments of premium with interest, if any, for the last year of the policy.

11.      When we examine the Policy Bond delivered to the complainant we  find  that this fact and information about terms of maturity claim have been mentioned in the “Bond i.e. Policy Certificate”. Appellant has made payment as per rules framed for this Policy Plan-165. Both parties are bound by the contact. In such circumstance, complainant cannot demand more than what is covered by the Insurance Rules, as decided by the Hon’ble Apex Court in Oriental Insurance Co.Ltd. Vs. Sony Cherian (Supra).
12.     Respondent has cited an order passed by Hon’ble National Commission, in Revision petition No. 2655/2019 Chief/SR/Branch Manager, L.I.C. of India Vs. Dr.Abhoy Banarjee. This order has been passed in the the matter of similar nature. Hon’ble N.C.D.R.C. has upheld the decision of West Bengal State Commission and dismissed the revision. We respectfully differ with the finding of the Hon’ble National Commission, as in our considered view, total benefit meant to cover death claim cannot be extended in the case of maturity claim when life assured is alive, which is clearly incorporated in the “Policy Bond” of Jeevan Saral- Plan 165- Rules (contract), which was never disputed and so, binding upon the parties. If we allow the extension of sum assured for death claim even in case of sum assured on maturity, when life assured is alive, it will be against public interest at large as well as misuse of public money.
13.        On the basis of foregoing discussion, this Commission arrives at the conclusion that impugned order passed by the District Forum is not sustainable in the eye of law, therefore is set aside. Appeal is allowed.

           Amount in deposit shall be refunded to the appellant.

                                                                                               Miss Gita Verma

                                                                                          (Judicial Member)

                                                                                       Subodh Kumar Srivastava

                                                                                            (Judicial Member)

                                                                                             Raj Kumar Pandey

                                                                                                    (Member)

Md. Fariduzzama