Ld. Advocate(s)
For Complainant: Makbul Rahaman
For OP/OPs :Swapan Ghosh
Date of filing of the case :25.09.2019
Date of Disposal of the case :25.04.2024
Final Order / Judgment dtd.25.04.2024
The concise fact of the case of the complaint is that the complainant insured LIC policy for Rs.3,39,780/- with a maturity value of Rs.11,21,920/- and death benefit of sum assured of Rs.10,00,000/- and accidental benefit is Rs.10,00,000/-. The premium was Rs.48,540/-. The complainant started depositing the said premium. After depositing the first premium on 13.07.2011 the OP No.2 Branch Manager, LICI issued one certificate to the complainant on 27.10.2011. The complainant continued that policy for 7 years and deposited total premium of Rs.3,39,780/-. Suddenly, the complainant fell ill and lost his vision. On 03.10.2018 the complainant filed an application to the Branch Manager, LICI, Krishnagar with prayer for surrendering the policy before its maturity on 03.10.2018. The LICI refunded Rs.2,64,000/- without arising any reason although the complainant deposited Rs.3,39,000/-. Due to his sudden, illness the complainant was compelled to surrender the policy. The complainant thus suffered loss of Rs.75,000/- due to premature surrendering of the policy. Due to getting less amount the complainant sustained mental pain and harassment for which is entitled to get compensation. The cause of action arose on 27.10.2011 and thereafter, on 03.10.2018 when the complainant surrendered the policy. The complainant prayed for an award to get return of Rs.75,000/- from the OPs and Rs.1,00,000/- towards mental pain and agony and harassment .
The Opposite parties contested the case by filing W/V wherein they denied the major allegations . The OPs challenged the case as not maintainable. The complainant is not a consumer under the C.P Act. The positive defence case of the OPs is that the complainant surrendered the policy before its maturity and to that effect he violated the policy terms and conditions . After being satisfied he received Rs.2,64,000/- in full and final settlement of the policy . So, question of loss of Rs.75,000/- does not arise. The OPs claimed that the case of the complainant is liable to be dismissed.
The conflicting pleadings of the parties and the different point raised by the parties in course of argument led this Commission to ascertain the following points for proper adjudication of the case.
Points for Determination
Point No.1.
Whether the case is maintainable in law and its present form.
Point No.2.
Whether the case is barred by any provisions of law.
Point No.3.
Whether the complainant is entitled to get the relief prayed for.
Point No.4.
To what other relief if any the complainant is entitled to get.
Decision with Reasons
Point No.1&2.
Both the points are involved with maintainability of the case and as such these are taken up together for the sake of brevity and convenience of discussion.
The OPs challenged the case as not maintainable and barred by limitation. After perusing the pleadings of the parties and the evidence in the case record it is found that the complainant surrendered the insurance policy before maturity on 03.10.2018 and the present case is filed on 25.09.2019. So, the present case is filed within the statutory period of limitation , so there is no ground to hold that the case is barred by limitation . Both the parties reside within the territorial jurisdiction of this Commission. The amount of relief claim also falls within the pecuniary jurisdiction of this Commission, so the present case is not barred by any provisions of law.
Accordingly, point 1&2 are answered in favour of the complainant positively.
Point No.3&4.
Both the points are closely interlinked with each other and as such these are taken up together for proper adjudication of the case.
It is the admitted position that the complainant surrendered the policy before maturity due to loss his vision following cerebral attack . The OP insurance company refunded a sum of Rs.2,64,000/- instead of Rs.3,39,000/-, so the complainant alleged that a sum of Rs.75,000/- has been paid less to him by the OP company.
The complainant in order to substantiate the case adduced both oral evidence in the form of affidavit in chief and documentary evidence. The complainant proved the following documents:-
Annexure-1 is the LICI Jeevan Saral Policy.
Annexure-2 is the LICI premium receipt in the name of complainant Prabir Kumar Das.
Annexure-3 is the disability certificate of the complainant issued by Nadia District Hospital , Krishnagar.
Annexure-4 is the complaint lodge by the complainant to the CAB, Nadia dated 27.02.2019.
There is no denial of the fact that the complainant is a policy holder under the OPs and he submitted the said policy before its maturity under the constrained circumstances of his felling ill due to cerebral attack in which he lost his vision.
It is also admitted fact that the policy was in force at that time.
Ld. Defence Counsel argued that in case of premature surrender of a policy that is partial surrender the proportionate amount shall be deducted. He drew the attention of this Commission as regards clause 8 of the said policy . As per clause 8 “partial surrender. On completion of three or the more years from the date of commencement and payment of premium for at least three full years partial surrender shall be permitted. This will be effected by reducing the only premium under the policy and corresponding to the amount by which the annual premium is reduced shall become payable on a partial surrender.
Ld. Senior Defence Counsel further argued that , so there is no illegality or irregularity in the less payment to the complainant. The complainant is a highly educated person. He signed the policy bond after knowing the terms and conditions of the policy. So, he got the actual amount what he is entitled to, that is Rs.2,64,000/-. He also argued that before lock period penal amount was deducted.
The case record shows that the date of proposal of the policy is 24.10.2011 and date of commencement is 13.07.2011. The policy is guided by table 165 for 25 years . The date of maturity is 13.07.2036. The date of surrender is 03.10.2018. The complainant continued the policy for 7 years, so due to premature surrender the OPs did not pay the entire maturity value of the policy by deducting Rs.75,000/-.
It is fact that the complainant deposited the total premium of Rs.3,39,780/-. The OPs could not deny the said fact .
The OPs categorically stated in cross-examination against the question of the complainant that the complainant was paid surrender value vide voucher no. 422161 dated 25.10.2018 as per calculation table 165 so monthly premium without rebate was paid to him. So, it is crystal clear that there is no deficiency in service .
Ld. Senior Advocate for the OPs argued that the complainant is estopped from denying the terms and conditions of the policy as per the rule of estoppels.
Ld. Advocate for the complainant counter argued that there is no document that the reduced calculation was served to the complainant and as such he was kept in dark regarding the calculation made by the OPs.
The argument has reasonable force . There is nothing within four-corners of the case record that the OPs ever informed the complainant about the actual calculation of payment of the said sum of Rs.2,64,000/-.
Ld. Defence Counsel further argued that the complainant deliberately avoided to answer the cross-examination motivatedly.
The answer given by the complainant against the question put by the OPs in cross-examination disclose that the complainant answered all the questions in stereotype manner that he did not read out properly the question of OPs , so he could not understand the said questions .
The complainant could have approached this Commission to direct the OPs to file petition in printed form instead of hand written application of interrogatories but without doing so , taking that plea of not understanding it cannot save him against the specific allegation of the OPs that the complainant suppressed some facts by no answering the said question properly.
Ld. Advocate for the complainant referred to a decision reported in WP (C) complaint No. 14885 of 2018 and 25559 of 2019 of Hon’ble Kerala High Court wherein it was held that the LIC is bound by the facts and figures of the documents .
The said case law does not apply since in the reported case there was no premature surrender of the policy. That apart the settlement of the dispute in Lok Adalat was upheld by the Hon’ble High Court, Kerala. So, the said case law does not help the complainant.
Thus after assessing the entire evidence in the case record the Commission is of the view the OPs failed to inform the complainant about the method of calculation for payment of Rs.2,64,000/- instead of his actual claim of Rs.3,39,000/-. Had the complainant knew about the said calculation then he might have not filed this case. This has caused harassment for which he is entitled to get compensation.
In the result the complaint case succeeds on contest in part with cost.
Point no.3&4 are answered in affirmative in favour of the complainant.
Hence,
It is
Ordered
that the complaint case no.CC/296/2019 be and the same is allowed on contest with cost of Rs.5,000/- (Rupees five thousand) against OPs. The complainant do get an award for a sum of Rs.30,000/- (Rupees thirty thousand) towards harassment for mental pain and agony. The Ops are directed to pay Rs.35,000/- (Rupees thirty five thousand) to the complainant within 30 days from the date of passing the final order failing which the entire award money shall carry an interest @ 8% p.a till the date of its realisation.
All Interim Applications (I.A) stand disposed of accordingly.
D.A to note in the trial register.
The case is accordingly disposed of.
Let a copy of this final order be supplied to both the parties at free of costs.
Dictated & corrected by me
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PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,) ................ ..........................................
PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,)
I concur,
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MEMBER
(NIROD BARAN ROY CHOWDHURY)