D.O.F:06/04/2015
D.O.O:04/09/2020
IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD
CC.No.88/2015
Dated this, the 04th day of September 2020
PRESENT:
SRI.KRISHNAN.K :PRESIDENT
SRI.RADHAKRISHNAN NAIR.M : MEMBER
SMT.BEENA.K.G : MEMBER
Mohammedkunhi.C.I
S/o Late. C. Ibrahim,
Ameer Manzil, : Complainant
Post – R.D. Nagar
Kasaragod – 671125
(Adv: Shrikanta Shetty)
And
LIC of India,
Jeevan Jyothi, P.B.No: 12
Jalsoor Road, Kasaragod : Opposite Party
Rep: by its Sr/Branch Manager.
(Adv: P.V Jayarajan)
ORDER
SRI.RADHAKRISHNAN NAIR.M : MEMBER
The complaint is filed under section 12 of the Consumer Protection Act
The facts of the case in brief is as follows:-
That the complainant took an LIC Jeevan Saral (With profit) policy from Opposite Party on 25/03/2005 paying basic monthly premium of Rs. 14412/- for a term of 10 year which is matured on 28/03/2015. At the time of proposal it was assured by the Opposite Party that in case of death, addition and in case of maturity benefits , the sum assured plus loyalty additions (interim bonus) payable in lump sum together. The complainant promptly paid all his yearly premium under the policy and on maturity requested the Opposite Party to disburse the maturity benefit. The Opposite Party allowed only a total amount of Rs. 1,15,864/- which was not withdrawn and protested as it is not agreeable. At the initial stage the opposite party canvassed the complainant and made to believe by printed policy that he will get maturity sum assured amount of Rs. 144120/- . The printed policy of Jeevan Saral (with profit) given to the complainant would show that Rs. 144120/- as assured amount. The Opposite Party never disclosed that the amount available under plan 165-10 to the complainant is Rs. 2,12,904/-. The Opposite Parties have committed unfair trade practice causing loss to him. Therefore the complaint is filed seeking order to the Opposite Parties to pay the complainant a maturity sum assured Rs.2,66,130/- or the disclosed amount payable as per data say, Rs. 1,44,120/- plus the minimum loyalty addition Rs. 36,030/- and thus a total of Rs.180150/- together with compensation of Rs. 50,000/- and costs.
The Opposite Party entered appearance and filed their version. As per the version the complaint is false frivolous vexatious and not sustainable at law. The Opposite Party admitted the issuance of the policy and the fact that it was matured on 28/03/2015.
As per calculation total maturity sum assured is Rs.88,896/-. But it is wrongly printed in the original policy bond as Rs.1,44,120/- due to program error, which was
subsequently corrected as Rs. 88,896/-. Amount specified as maturity benefit Rs.1,44,120/- actually was the total premium to be paid for the full term (10 year). Based on the policy condition and the circular for this plan maturity amount payable is only Rs. 115564/-. There is no question of any unfair trade practice or any deficiency of service as alleged. The complainant is to be dismissed.
Complainant filed proof affidavit in lieu of chief examination and the documents Ext A1 to A4 are marked. Ext A1 is the policy certificate, Ext A2 is the copy of registered notice sent to Opposite Party, Ext A3 is the postal receipt, Ext A4 is the copy of the table of Jeevan Saral ATM plan (T No-165).
The Pw1 was cross examined. from the side of the Opposite Party its two managers L&HPF dept. were examined as Dw1 and Dw2 and documents Ext B1 to Ext B2 marked. Ext B1 is the copy of the proposal form submitted by the complainant. Ext B2 is the copy of the central office circular No: CO/ACT/1984/4 dated 12/02/2004.
Based on the rival contention the following issues are raised in this case for consideration.
1. Whether there is any service deficiency or unfair trade practice on the part of the Opposite Party?
2. If so what is the relief?
For convenience, both these issues are considered together.
Complaint is regarding the maturity amount payable to the complainant under an insurance policy namely Jeevan Saral issued by the Opposite Parties. Clear case of the complainant is that the above insurance policy attained maturity on 28/03/2015 and the Opposite Party is not ready to pay the entire maturity benefit sum assured. As per the promise made by the opposite Party the complainant is entitled for Rs. 2,12,904/- as the maturity sum assured. But the Opposite Party allowed only Rs. 115864/-. Which is not acceptable. The Opposite Party contented that based on the policy condition and the circular for this plan the maturity sum assured payable is only Rs. 1,15,564/-. The policy bond document dated 23/04/2005. Ext A1 issued to the complainant by the Opposite Party would show that the maturity sum assured is Rs.144120/-. The Opposite Party content that the maturity sum assured as per calculation according to the policy schedule is Rs.88.896/-. But it is wrongly printed in the original policy bond as Rs.144120.- due to a program error; which was subsequently corrected as Rs. 88,896/-. The figure of Rs. 1,44,120/- is the total premium to be paid for full term of 10 years at the rate of Rs.1,44,12/- per year . This contention of the Opposite Party cannot be accepted. Here believing the contents of the policy bond the complainant paid the entire premium amount of Rs. 1,44,120/-for the period of 10 years without any failure.
At no point of time the Opposite Party intimated the error occurred in the above policy bond document. The complainant was never informed till the payment of last premium that the amount shown in the Ext A1 document is not the exact amount of the maturity sum assured. Now the Opposite Party content that the amount shown in the policy bond is not correct and that amount was happened to be entered in the document due to some program error. In the circumstance, this commission is of the view that the stand of the Opposite Party cannot be accepted. In the light of the decision reported in 2019 (A) KLT 204, the policy is one issued by the insurer either erroneously or on account of a bonafied mistake. If that be, the insurer is not entitled to avoid the liability as they cannot take advantage of their own erroneous conduct or mistake. Therefore the Opposite Party is liable to pay the insurance benefit to the complainant based on the policy bond document Dt.23/04/2005. (The Ext A1). So the complainant is entitled for the benefit calculated based on the Ext A1 documents in which the maturity sum assured is Rs.144120/-. As per the document Ext B2 the circular No. Act/1934/4 Jeevan Saral Policy holders are entitled for loyalty additions which will be calculated on the basis of monthly premium.
As per the version of the Opposite Party the Loyalty Addition declared as per valuation at 31/03/2014 is Rs. 300/- for term 10 years and therefore annual premium benefit as on 28/03/2015 is Rs. 1,44,120 + ( 300 X 144120/1000) = 1,87,356/-. Therefore the complainant is entitled for the sum of Rs.1,87,356/- as the insurance benefit. Since the Opposite Party was not ready to pay the amount in time, there is a deficiency of service on their part due to which the complainant suffered mental agony and hardships. The Opposite Party is liable to compensate for that.
In the result the complaint is allowed and the Opposite Party is directed to pay the complainant a sum of Rs.187356/- (Rupees One lakh Eighty seven thousand three hundred and fifty six only) as insurance benefit with interest at the rate of 8% per annum from (06/04/2015) the date of complaint to the date of payment. The Opposite Party is also directed to pay Rs. 10,000/- (Rupees Ten thousand only) as compensation and Rs.5000/- (Rupees Five thousand only) as litigation cost to the complainant.
The time for compliance is 30 days from receipt of copy of this judgement.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Exhibits
A1- Policy Certificate
A2- Registered notice sent to opposite party
A3- Postal receipt.
A4- copy of the table of Jeevan Saral ATM plan
B1- Policy Certificate
Witness Examined
Pw1- Mohammed Kunhi C.I
Dw1- Augastiyan goras
Dw2- C. Padmanabhan
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Forwarded by Order
Senior Superintendent
Ps/
