KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION

VAZHUTHACAUD, THIRUVANANTHAPURAM

APPEAL No.88/2019

JUDGEMENT DATED: 22.11.2022

(Against the Order in C.C.No.138/2018 of CDRC, Kottayam)

PRESENT:

APPELLANT:

(by Party in person)

Vs.

RESPONDENT:

(by Adv. Anitha Aji)

JUDGEMENT

SRI. RANJIT R.: MEMBER

          The complainant has filed this appeal dissatisfied by the relief granted by the Consumer Disputes Redressal Forum, Kottayam (in short District Forum) in C.C.No.138/2018 dated 13.12.2018.  The District Forum by its order directed the opposite parties to pay the maturity sum assured of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) within one month from the date of maturity (12.02.2019).  If fails, the opposite party is also liable to pay an interest of 10% to the said amount from the date of maturity onwards i.e. 12.02.2019.  The opposite parties were also directed to pay Rs.3,000/-(Rupees Three Thousand) to the complainant with 10% interest as costs.

          2.       The parties are referred to herein in accordance with their status in the complaint.

          3.       The short facts of the case of the complainant is that the complainant had availed a Jeevan Saral Policy on 06.04.2004 from the opposite party, Insurance Company.  As per the policy the Maturity sum assured was stated as Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) at the time of expiry of the policy and that she is entitled to get loyalty addition also.  However, on 08.01.2018, the opposite party had sent a notice to the complainant stating that the Maturity sum assured is only Rs.47,000/-(Rupees Forty Seven Thousand) and that Rs.62,000/-(Rupees Sixty Two Thousand) stated in the policy is only the ‘Death benefit sum assured’.  According to the complainant the said notice was issued after fourteen years of inception of the policy, is against law.  It is contended that as per the policy she is eligible to get an amount of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) as maturity sum for the said policy and also the loyalty addition.  Therefore the opposite party committed deficiency in service and hence complainant had filed the complaint claiming maturity sum assured of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) with compensation, costs etc.

          4.       The opposite party entered appearance and filed version.  It is contended that the amount of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) which is stated in Exhibit P1 policy is Death benefit sum assured and not the maturity sum assured.  On the date of maturity, the policy holder is entitled to the Maturity sum assured along with the loyalty addition.  The maturity sum assured and the Death benefit sum assured are entirely different.  An inadvertent mistake happened as they omitted to incorporate the maturity sum assured in the policy and the said error was identified later and this was intimated to the complainant on 08.01.2018.  Maturity sum assured has been calculated by the opposite party based on mortality expenses.  According to the opposite party the complainant is eligible to get ‘Maturity sum assured’ of Rs.47,000/-(Rupees Forty Seven Thousand) along with the loyalty addition of Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) on the date of maturity i.e. on 12.03.2019.  Thus the complainant is eligible to get a total amount of Rs.67,680/-(Rupees Sixty Seven Thousand Six Hundred and Eighty).  The opposite party has not committed any deficiency in service and therefore prays for dismissal of the complaint.

5.       The evidence consists of the testimony of the complainant as PW1 and Exhibits A1 and A2 marked on her side.  The opposite party did not adduce any evidence.

          6.       The District Forum on the basis of the evidence let in by the parties and after hearing both parties, found that the complainant is entitled to get an amount of Rs.62,250/-(Rupees Sixty Two Thousand Two Hundred and Fifty) as ‘Maturity sum assured’ as per Exhibit A1 policy and not Rs.47,000/-(Rupees Forty Seven Thousand) as stated by the opposite party.  The District Forum on such finding allowed the complaint and directed the opposite party to pay the maturity sum assured of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) along with costs of Rs.3,000/-(Rupees Three Thousand) with 10% interest from the date of order.  Dissatisfied with this order, the complainant has come up in appeal.

          7.       The complainant contends that the Forum only allowed the maturity sum assured for Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) to be paid by the opposite party even though as per Exhibit A1 policy the opposite party is liable to pay loyalty additions also.  The opposite party in their version has admitted the fact that they are liable to pay loyalty additions also.  According to the opposite party the complainant is eligible to get Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) the loyalty addition also on the date of maturity.  Thus according to the complainant the total amount payable by the opposite party would comes to Rs.83,180/-(Rupees Eighty Three Thousand One Hundred and Eighty).  The opposite party is also liable to pay compensation and costs.  However, the District Forum without considering the above facts allowed only the maturity sum assured of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) and costs of Rs.3,000/-(Rupees Three Thousand).  Hence complainant prayed that the order of the District Forum is to be modified so as to direct the opposite party to pay ‘Maturity sum assured’ of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) along with the loyalty addition of Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) and compensation and costs. 

          8.       According to the learned counsel for the opposite party the amount of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) stated in Exhibit A1 policy is the Death sum assured only and not the Maturity sum assured.  They would contend that while preparing the policy certificate they inadvertently omitted to incorporate the Maturity sum assured in the policy schedule.   The actual Maturity sum assured of the policy for fifteen years, is only Rs.47,000/(Rupees Forty Seven Thousand), since the basic monthly premium is only Rs.250/-(Rupees Two Fifty).  Subsequently, the error was identified by them and had intimated the complainant through Exhibit A2 letter dated 08.01.2018 stating that the maturity sum assured is only Rs.47,000/-(Rupees Forty Seven Thousand).  The policy holder on maturity is not entitled to get the Death benefit sum assured, but only the ‘Maturity sum assured’.  The complainant is also eligible for loyalty addition which comes to Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty).  Thus the total amount payable to the complainant is only Rs.67,680/-(Rs.47,000+Rs,20,680).  Payment of higher amounts higher than what is envisaged in the policy conditions will drain the public fund, which is not in conformity with the rules and regulations issued by the LIC.  The learned counsel therefore prays for dismissal of the appeal.

          9.       We have considered the contentions made by the respective parties at length and also perused the records.  The complainant had availed a Jeevan Saral LIC policy as per Exhibit A1.  In the second column ‘Maturity sum assured’, Death benefit sum assured, Accident benefit sum assured and Term Rider sum assured respectively are all recorded as Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred).  This can only be the Maturity sum assured.  Further, the maturity benefit is defined as “in the event of life assured surviving the date of maturity sum equal to maturity sum assured in force after partial surrender if any, along with loyalty additions shall be paid.”  Hence complainant is entitled to get the Maturity sum assured.  Exhibit A2 is the notice issued by the opposite party to the complainant.  In the said notice the opposite party had admitted that as a result of inadvertent typographical error the Maturity sum assured has been shown as NIL and that the actual Maturity sum assured is only Rs.47,000/-(Rupees Forty Seven Thousand).  However we note that Exhibit A2 was issued to the complainant only on 08.01.2018, which is about fourteen years after the inception of Exhibit A1 policy (12.03.2004).  They could have issued notice to the complainant if actually there was any inadvertent mistake, within a reasonable time.  Sending notice after fourteen years, that too on the maturity year stating therein that there was inadvertent mistake crept in the policy records in noting the Maturity sum assured and Death benefit sum assured is not at all justifiable by any means.  This is a clear case of wanton deficiency in service and laches on the part of the opposite party.  As already found, the amount mentioned as Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) can only be the Maturity sum assured and not Death benefit sum assured, as alleged by the opposite party, since the first line appearing in the second column in Exhibit A1 is Maturity sum assured.  The District Forum, for the above reasons had correctly held that the Maturity sum assured is Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred).  The opposite party has not challenged the finding of the District Forum that the Maturity sum assured is Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred).  This order of the District Forum the Maturity sum assured is Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) has thus become final and binding as against the opposite party.  Therefore, we find that the ‘Maturity sum assured’ can only be Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) and not Rs.47,000/-(Rupees Forty Seven Thousand) as alleged by the opposite party.  Moreover, even according to the opposite party the complainant is also eligible for loyalty additions which according to them comes to Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) as on 12.03.2019 the date of maturity.  Thus the total amount payable to the complainant comes to Rs.83,180/-(Rupees Eighty Three Thousand One Hundred and Eighty).  However, we find that the District Forum went wrong in not awarding the loyalty addition amount of Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) also along with maturity amount of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) to the complainant.

          Hence we are of the opinion that the order of the District Forum to that extend is to be modified to include the loyalty addition amount of Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) along with the maturity sum assured of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) to be paid by the opposite party to the complainant.  The amount of Rs.3,000/-(Rupees Three Thousand) awarded as costs is just and reasonable and is upheld.

          In the result the order of the District Forum is modified as follows:

1. The opposite party is directed to pay the Maturity sum assured of Rs.62,500/-(Rupees Sixty Two Thousand Five Hundred) along with the loyalty addition of Rs.20,680/-(Rupees Twenty Thousand Six Hundred and Eighty) totaling an amount of Rs.83,180/-(Rupees Eighty Three Thousand One Hundred and Eighty) with interest @10% from the date of maturity (12.02.2019).
2. The opposite party is directed to pay costs of Rs.3,000/-(Rupees Three Thousand) to the complainant within one month from the date of receipt of a copy of this order, failing which the said amount will carry interest @10% per annum.

Parties to suffer their respective costs.

SL