OMBUDSMAN NEERJA SHAH

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF KARNATAKA (UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN –NEERJA SHAH

In the Matter of Mr BADAL KUMAR MAITI V/s LIFE INSURANCE CORPORATION OF INDIA

Complaint No: BNG-L-029-1920-0606 Award No: IO/BNG/A/LI/0454/2019-2020

1. Name & Address of the

Complainant

Mr. Badal Kumar Maiti

A/7,MF-43, Panchadeep Colony,

PO Saraswathipura, Nandini Layout

Bengaluru - 560096

Mob # 8618652733

Email : [email protected]

2. Policy No:

Type of Policy:

Name of the Policy:

Commencement of Policy/ Policy

Period/PPT

414766805

Life- Annuity

Jeevan Suraksha

28.01.2000/19/ 19 Years

3. Name of the Insured

Name of the Policyholder

Mr. Badal Kumar Maiti

4. Name of the Respondent Insurer LIC Of India –Kolkata Division-1

5. Date of Repudiation/ Rejection 06.06.2019

6. Reason for repudiation/ Rejection Notional Cash Option Rectification

7. Date of receipt of Annexure VI-A 03.02.2020

8. Nature of complaint Annuity Not being paid

9. Amount of claim Rs.2,89,456/- (NCO) – Quarterly Annuity of Rs

7,620/-

10. Date of Partial Settlement -

11. Amount of relief sought ₹.2,89,456/- (NCO) – Quarterly Annuity of

₹.7,620/-

12. Complaint registered under Rule

No

13(1) (b) of Insurance Ombudsman Rules, 2017

13. Date of hearing/place 18.03.2020 – Bengaluru

14. Representation at the hearing

a) For the Complainant Self

b) For the Respondent

Insurer

Mr. Muralidhar Joshi, AO(Claims)

15. Complaint how disposed Allowed

16. Date of Award/Order 20.03.2020

17. Brief Facts of the Case:

The complaint arose due to the non payment of annuity to Complainant by Respondent Insurer

(hereinafter referred as RI). Grievance Redressal Officer (G.R.O.) of the RI did not resolve the

issue. Hence Complainant approached this Forum for redressal of grievance.

18. Cause of Complaint: -

a. Complainant’s argument:

The Complainant stated that he purchased the said policy in the year 2000 for a period of 19 years.

He submitted the annuity option to the RI on 12.12.2018. He did not receive the annuity on due

date i.e., 28.01.2019. After several visits to branch and correspondence with the RI, he received

―Intimation for payment of Annuity‖ letter on 06.04.2019. The Notional Cash Option (NCO)

mentioned in the letter was ₹.2,89,456/- with Quarterly Annuity payment of ₹.7,620/-. However the

annuity payment was not initiated by the RI. He escalated the complaint to the grievance cell of the

RI. He received a letter on 26.06.2019 stating that his NCO amount was corrected as ₹.2,42,500/-

with Quarterly Annuity payment of ₹.6,384/- and ― WITH LIFE COVER‖ option as opted by him.

The Complainant further submitted that the RI neither explained the reason for changes in the

promised annuity nor started the payment of annuity. This created lot of confusion regarding his

annuity amount and the correspondence with RI regarding the same were of no help to him.

Aggrieved with the resolution provided by the RI, he approached this Forum for redressal of his

grievance.

b. Respondent Insurer’s argument:

The RI vide their SCN dated 11.03.2020 admitted to the issuance of the aforesaid ―Intimation for

payment of Annuity‖ letter on 06.04.2019 which stated that the (NCO) amount as ₹.2,89,456/- with

Quarterly Annuity payment of ₹.7,620/-. However, they stated that the letter sent to him was

erroneous as it did not take consideration of the ―With Life cover‖ option opted by the Complainant.

Second letter after rectification was sent to him on 26.06.2019, showing NCO as ₹.2,42,500/-,

Quarterly Annuity payment of ₹.6,384/- and ―With Life Cover‖ option.

In view of the above facts, the non consideration of higher annuity payment request of the

Complainant was in order.

19. Reason for Registration of complaint: -

The complaint falls within the scope of Insurance Ombudsman Rules, 2017.

20. The following documents were placed for perusal: -

1. Complaint along with enclosures,

2. Respondent Insurer‘s SCN along with enclosures and

3. Consent of the Complainant in Annexure VIA & and Respondent Insurer in VII A.

21. Result of personal hearing with both the parties (Observations & Conclusions):

The issue before the Forum is, whether the rejection of quarterly annuity payment of ₹.7,620/-

request by RI is appropriate. During the personal hearing, both the parties reiterated their earlier

submissions. In addition to what was stated earlier RI submitted that they have initiated the

payment of quarterly annuity payment of Rs.6,384/- from 16.08.2019.

The Forum notes that the

a. Complainant availed the said pension policy in the year 2000 for a period of 19 Years and payment of annuity was to begin from 28.02.2019.

b. Complainant submitted the Annuity option form on 12.12.2018 well before the vesting date. c. RI failed to initiate the annuity payment from the due date i.e., on 28.02.2019. d. RI issued ―Intimation for payment of Annuity‖ letter as late as 06.04.2019 to the

Complainant wherein they informed that they have determined Notional Cash Option (NCO) as Rs.2,89,456/- with quarterly annuity payment of Rs.7,620/-. Subsequently after more than two months on 26.06.2019 they issued a rectification letter mentioning lower NCO as Rs.2,42,500/- with quarterly annuity payment of Rs.6,384/- and ―With Life Cover‖ option.

e. RI initiated the annuity payments from 16.08.2019 with quarterly annuity payment of Rs.6,384/-.

Having entered into the contract of insurance, the Complainant and the RI are bound by the terms

and conditions of the policy schedule and payments can be made as per existing terms and

conditions only. In this case RI failed to stand by the terms of the contract by not initiating the

annuity payments on the promised date. RI issued a letter on 06.04.2019 to the Complainant that

he would be receiving quarterly annuity payment of ₹.7,620/- with NCO of ₹.2,89,456/- under

option ‗F‘ based on Complainant‘s request. They should honour the same and give this annuity

amount with effect from the 28.02.2019- the date of payment of annuity mentioned in the policy

bond. RI is also liable to pay interest on the delayed payment of annuity. No cognizance needs to

be taken of the rectification letter dated 26.06.2019 which is to the determinant of the complainant.

AWARD

Taking into account, the facts & circumstances of the case, and the submissions made by

both the parties during the course of Personal hearing, the Respondent Insurer is directed to

pay difference of annuity i.e.,₹.1,236/- (Payable ₹.7,620/- less Paid ₹.6,384/-) to

Complainant with interest for delayed payment of annuities till date at 6.25% + 2% Penal

interest as laid down under Regulation 14 of IRDAI (Protection of Policy Holders Interest)

Regulations, 2017.

Henceforth annuities are to be paid quarterly @ Rs.7,620/- with NCO as Rs.2,89,456/- with

‗F‘ option.

The complaint is Allowed.

22. Compliance of the Award:

The attention of the Complainant and the Insurer is hereby invited to the following provisions of

Insurance Ombudsman Rules, 2017:

a. The Complainant shall submit all requirements/Documents required for settlement of award

within 15 days of receipt of the award to the Respondent Insurer.

b. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply with

the award within thirty days of the receipt of the award and intimate compliance of the same to the

Ombudsman.

Dated at Bengaluru on 20th March, 2020

(NEERJA SHAH)

INSURANCE OMBUDSMAN

FOR THE STATE OF KARNATAKA

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF KARNATAKA

(UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)


In the Matter of MR. V.S.HARINATH V/s HDFC STANDARD LIFE INSURANCE COMPANY LTD.

Complaint No: BNG--L—019--1920--0632

Award No: IO/BNG/A/LI/0457/2019-2020


Complainant

Mr. V.S. Harinath

27/1, 2nd Cross, 3rd Main, Mico Layout

BTM 2nd Stage

BANGALORE -560076,

Mob: 9845119652

Mail. Id. : [email protected]

2. Policy No:

Type of Policy:

Name of the Policy:

Commencement of Policy/

Policy Period/PPT

Mode/Premium Amount

15215781

Life

HDFC Life Sampoorn Samridhi Plan

08.06.2012

7 Years/ 7 Years

Yearly/ Rs. 48502/-

3. Name of the Insured

Name of the Policyholder

Mr. V.S. Harinath

4. Name of the Respondent Insurer HDFC Standard Life Insurance Company

Limited

5. Date of Repudiation/ Rejection Non settlement of Maturity claim

6. Reason for repudiation/

Rejection

Maturity claim requirements not submitted by the

Complainant

7. Date of receipt of Annexure VI-

A

10.02.2020

8. Nature of complaint Maturity claim amount to be settled by the RI is

not acceptable to the Complainant

9. Amount of claim Rs. 7,00,000/-

10. Date of Partial Settlement N A

11. Amount of relief sought Rs.7,00,000/-

12. Complaint registered under Rule

No

13(1)(a)&(d)of Insurance Ombudsman Rules,

2017

13. Date of hearing/place 18.03.2020 - Bengaluru



b) For the Respondent Insurer Mr. Amith – Manager

15. Complaint how disposed Disallowed



The complaint arose from the alleged short settlement of maturity claim by the Respondent Insurer

(RI) on the policy held by the Complainant. Though he represented his issues of the said policy,

the RI maintained their earlier stand. Aggrieved, he has approached this forum.

18. Cause of Complaint: -


The Complainant vide letter dated 30.01.2020 stated that during June,2012, he availed the policy

based on the false promises made by the brokers (India Infoline Insurance Brokers Limited) of RI,

who informed him that if he availed the said policy, the maturity benefit would be around Rs. 7

lakhs. He has paid all the premiums amounting to Rs.3,39,514/- and on maturity of the said policy

on 08.06.2019 the RI intimated him that the maturity claim payable would be Rs.3,75,004/-. Unable

to understand the short payment, he sent mails to the RI seeking balance of payment which was

rejected by the RI. Hence, he has approached this Forum seeking directions to the RI for

considering payment of balance of maturity amount.


The RI stated their SCN dated. 10.03.2020, & 11/03/2020, that they have issued the said policy

based on the correct requirements received from the Complainant and despatched the policy bond

along with ‗Free Look Cancellation‘ clause to the Complainant and he has received the same.

The policy availed by the Complainant had both the maturity and death benefit along with accident

benefit coverage for a basic sum assured of Rs.2,30,064/-. On maturity of the policy, the RI

intimated the complainant about the maturity of the said policy and the proceeds that would be paid

as maturity claim i.e. Sum Assured of Rs.2,30,064/- + Reversionary Bonus Rs. 8052/- + Maturity

bonus Rs.52,914/- = Rs. 3,75,004/-). But the Complainant has refused to submit the requirements

as sought by the RI to settle the maturity claim.

The Complainant did not raise the issue of ‗Mis-Sale‘ of the said policy at any point of time and

continued to pay the premiums till the date of maturity. As the policy is issued as per the

requirements of the Complainant, the allegations made by him is denied as baseless and false and

untenable. Hence, the RI prayed the Forum for passing an appropriate order.

19. Reason for Registration of complaint: -

The complaint falls within the scope of Insurance Ombudsman Rules, 2017 under Sec 13(1)(a)&(d)

and hence, it was registered.

20. The following documents were placed for perusal: -



3. Consent of the Complainant in Annexure VIA &and Respondent Insurer in VII A.


The issue to be decided by the Forum is whether the sale of said policy is a ‗Mis-sale‘ and whether

the consideration of maturity claim payment is in order.

During the personal hearing on 18.03.2020, the Complainant informed the forum that the sales

representatives of RI assured the complainant that if he availed the said policy, he would receive

Rs.7 lakhs, on maturity date and hence sought the directions of the Forum to the RI for approval of

balance of amount as maturity claim in addition to what was intimated to him.

The RI maintained their stand as per their SCN

The forum after careful examination of records has observed that that the Complainant availed

‗HDFC Life Sampoorn Samridhi Insurance Plan‘ on 08.06.2012 for a basic sum assured of

₹.2,30,064/- by paying an annual premium of 48,502/- for a period of 7 years and has paid all the

premium up to the date of maturity and the policy is in ‗Full-Force‘. Upon the maturity of the said

policy, on 08/06/2019 the life assured is eligible for ‗Enhanced Cash Benefit‘ in which case the

amount payable on maturity date would be ‗Basic Sum Assured +Accrued Bonus if any, OR

‗Enhanced Cover Benefit‘ in which case the life assured would be eligible for ‗Basic Sum Assured

+ Accrued Bonus. In addition to this amount, an additional sum assured will be payable on death of

the life assured up to age 99 years.

As per the terms and conditions of the policy, the RI sent the maturity intimation on 08/08/2018 i.e.

to the Complainant requesting him to exercise his option to receive the maturity claim, but the

Complainant did not exercise any option.

The Forum notes that as the policy is issued for a basic sum assured is Rs.2,30,064/- and the

maturity benefit is ‗Basic Sum Assured + Accrued Bonus, the Complainant is eligible for the

maturity benefit on basic sum assured of Rs. 2,30,064/- together with accrued bonuses as per

policy terms and conditions. Hence, the Complainant request to direct the RI to settle the maturity

benefit for a total amount of ₹. 7 Lakhs is ‘Disallowed’.

AWARD

Taking into account, the facts & circumstances of the case, and the submissions made

by both the parties during the course of Personal hearing, the complaint is

‗DISALLOWED.

22. The attention of the Complainant and the Insurer is hereby invited to the following provisions of Insurance Ombudsman Rules, 2017:

1. The Complainant shall submit all requirements/Documents required for settlement of award within 15 days of receipt of the award to the Respondent Insurer.

2. According to Rule 17(6) of the Insurance Ombudsman Rules, 2017, the insurer shall comply with the award within thirty days of the receipt of the award and intimate compliance of the same to the Ombudsman.

Dated at Bengaluru on 20th March, 2020.

(NEERJA SHAH)

INSURANCE OMBUDSMAN


PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF KARNATAKA

(UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)


In the Matter of MR. MOHAN JOSEPH NADAKATTIN V/s LIFE INSURANCE CORPORATION OF INDIA

Complaint No: BNG—L--029--1920– 0626

Award No: IO/BNG/A/LI/0463/2019—2020

1. Name & Address of the Complainant

Mr. Mohan Joseph Nadakattin # 4, Deenabandhu Colony Behind Gokavi Khspital Karwar Road, Hubli – 580029 (M):9449833416 E-Mail: [email protected]

2. Policy No: Type of Policy: Name of the Policy: Commencement of Policy/ Policy Period/PPT Mode/Premium Amount

639535749 Life LIC‘s Jeevan Saral Policy with Profits (Plan No 165) 15/12/2008 11 Years Monthly S.S.S./₹.1021

3. Name of the Insured Name of the Policyholder

Mr. Mohan Joseph Nadakattin

4. Name of the Respondent Insurer LIC Of India – Dharwad DO

5. Date of Repudiation/ Rejection 31/12/2019

6. Reason for repudiation/ Rejection Policy bond is issued correctly to the complaint

7. Date of receipt of Annexure VI-A 10/02/2020

8. Nature of complaint Discrepancy with the policy document

9. Amount of claim Rs.2,50,000/- + Interest

10. Date of Partial Settlement N A

11. Amount of relief sought Rs.2,50,000/- + Interest

12. Complaint registered under Rule No

13(1)(b) of Insurance Ombudsman Rules, 2017

13. Date of hearing/place 18/03/2020 - Bengaluru



b) For the Respondent Insurer

None

15. Complaint how disposed Disallowed

16. Date of Award/Order 23/03/2020


The complaint arose due to non-settlement of correct maturity claim amount on the policy held by the Complainant as printed in the policy document. In spite of his representations to Grievance Redressal Officer (G.R.O), his request was denied. Aggrieved, he has approached this forum. 18. Cause of Complaint: -


The Complainant vide his letter dated 27/10/2020 stated that he availed the said policy on

15/12/2008 for a period of 11 years for sum assured of Rs.2,50,000/- by paying a monthly premium

of Rs.1021/- In all, he has paid the total premium of Rs.1,34,772/- for a sum assured of

Rs.2,50,000/-. When he received the maturity intimation from the RI for a lesser amount compared

to what the premium he has paid, he was shocked. When he enquired with the officials of the RI,

they maintained their stand that the calculation of maturity amount is as per policy terms and

conditions. He is perplexed as to how the maturity value can be less than the premiums paid.

Even assuming the stand of the RI that there are 2 different sum assured, the same was not

incorporated in the proposal at the time of availing the policy. Even though he escalated this issue

to the G.R.O. no information/clarification has been forth coming from the RI. Though the contract of

insurance is a contract of ‗Ut most good faith‘, the RI has failed to follow this principle at the time of

sale of the said policy. Had the RI disclosed the true facts about the said policy, the Complainant

would not have availed the said policy. Further the RI has not printed the ‗caution‘ in bold letter.

Had the RI printed the ‗caution‘ the Complainant would have availed the facility of ‗Free Look

Cancellation‘. Having paid all the premiums under the said policy, no purpose is being served by

receiving a meagre amount as ‗Maturity Claim‘. The Complainant also submitted a list of points in

support of his argument. This being a clear case of misleading the Complainant and the novice

public at large, the Complainant has approached this Forum seeking full sum assured together with

applicable bonus as ‗Maturity Claim‘.


The RI vide their SCN dated 15/02/2020 stated they have issued the said policy with all the details of the policy being correctly incorporated in the policy document. It is pertinent here mention that the maturity sum assured under the said policy is ₹.76,720/- whereas the death sum assured is Rs.2,50,000/- and accidental benefit sum assured is Rs.2,50,000/-. The basic feature of this policy

is that in the event of life assured surviving the maturity date, a sum, equal to the Maturity Sum Assured in force after partial surrenders if any along with corresponding loyalty addition is payable. Upon the maturity of the policy, the RI sent the maturity intimation to the Complainant urging him to submit the necessary requirements to enable them to settle the maturity claim under the said policy. But the Complainant has been unrelenting and not submitting the same. The RI also averred that the amount payable under the policy would be as per the terms and conditions of the policy. 19. Reason for Registration of complaint: -

The complaint falls within the scope of Insurance Ombudsman Rules, 2017 under Sec 13(1)(b) and hence, it was registered. 20. The following documents were placed for perusal: -



3. Consent of the Complainant in Annexure VIA &and Respondent Insurer in VII A.


The issue to be decided by the Forum is whether the policy document is issued correctly. During the personal hearing on 18/03/2020 the Complainant informed the Forum, that he availed the policy for a sum assured of Rs.2,50,000/-. When he received the maturity claim intimation for a meagre amount of Rs.76,720/- he was shocked as to how he could get an amount less than the premiums paid. Hence he sought the Forums directions to RI to settle the maturity claim for full sum assured of Rs.2,50,000/- together with accrued benefits.

The RI did not attend the hearing. The Forum after careful examination of records has observed that the Complainant availed LIC‘s –Jeevan Saral Policy with Profits (Plan – 165) for a period of 11 years by paying monthly premium of ₹.1021/-. The risk cover under this plan is 250 times the monthly premium. For the premium of ₹.1021/-, the death sum assured is ₹.2,50,000/- and the same is payable on death of the life assured during the term of the policy. Upon maturity of the policy, maturity sum assured together with loyalty addition is payable. As the risk cover is 250 times the monthly premium, majority of premium paid by the life assured has gone towards risk cover, naturally the balance amount available in the actuarial reserves of the RI is less and the same is paid to the life assured as ‗Maturity Claim‘.

Ongoing through the policy document, it is observed that all the values like maturity sum assured, death sum assured, event on which the policy money‘s are payable are printed correctly in the policy document. The Forum notes that though the ‗Sum Assured‘ is written as Rs.2,50,000/- it is to be interpreted as ‗Death Sum Assured‘ as the premium paid by the Complainant is commensurate with the death sum assured opted by the Complainant. Having paid the premium of Rs.1021/- P.M. the maturity sum assured works out to Rs.76,720 and not Rs.2,50,000/- as soughtby the Complainant. As the schedule of the policy contains correct values and terms and conditions, the forum concludes that the policy issued by the RI is in order. The Forum notes that the Complainant should have exercised ‗Free Look Cancellation‘ but did not do so and instead continued to pay the premium up to the date of maturity. Therefore the request of the Complainant to direct the RI to treat Rs.2,50,000/- as ‗Maturity Sum Assured‘ is ‗Rejected‘.

The Complainant is directed to submit all the documents to the RI to enable them to settle the maturity claim. Upon receipt of all the documents, the RI is directed to settle the ‗Maturity Claim‘ as per policy terms and conditions without interest.

AWARD

Taking into account, the facts & circumstances of the case, and the submissions made by both the parties during the course of Personal hearing, the complaint is ‘Disallowed’.

Dated at Bengaluru on 23rd Day of March 2020.

(NEERJA SHAH)

INSURANCE OMBUDSMAN


PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF M.P. & C.G.

(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)

Mr Pawan Bisariya ……………………………………………………. Complainant

V/s

SBI Life Insurance Co Ltd ……………….………….……………………..Respondent

COMPLAINT NO: BHP-L-041-1920-0523 ORDER NO: IO/BHP/A/LI/ 0300 /2019-2020

1. Name & Address of the Complainant Mr Pawan Bisariya

Sector 2A, House No.139, Jail Ki Bagiya Ka

Picha 100 Feet Road, District Gwalior, Madhya

Pradesh

2. Policy No:

Type of Policy

Duration of policy/Policy period

1M006137110

SBI Life – Flexi Smart Plus

26.02.2015

3. Name of the insured

Name of the policyholder

Mr Pawan Bisariya

Mr Pawan Bisariya

4. Name of the insurer SBI Life Insurance Co Ltd

5. Date of Repudiation/ Rejection --

6. Reason for Repudiation/ Rejection --

7. Date of receipt of the Complaint 05.02.2020

8. Nature of complaint Less maturity amount intimation received

9. Amount of Claim --

10. Date of Partial Settlement --

11. Amount of relief sought Rs.3.50 lacs

12. Complaint registered under Rule Rule No. 13(1)(d) Ins. Ombudsman Rule 2017

13. Date of hearing/place 19.03.2020 at Bhopal

Mr Pawan Bisariya (Complainant) has filed a complaint against SBI Life Insurance Co. Ltd.

(Respondent) alleging receipt of less maturity amount intimation.

Brief facts of the Case - The complainant has stated that he had been depositing

Rs.50,000/- as premium every year for the past five years under above policy and on

maturity is being offered Rs.2.43 lakhs as against Rs.3.50 lakhs which was assured by the

Branch Manager at the time of taking the policy. Further at that time this plan was stated as

the Best Plan and he is unhappy with the sale of policy made with misleading and wrongful

assurance. The complainant has now approached this forum for redressal of his grievance.

The respondent in their SCN have stated that above policy was issued on 26.02.2015

to the complainant on the basis of the proposal form, dispatched with option of free look

period to the registered address of the complainant through Speed Post vide AWB

No.EA118446547IN on 28.02.2015. Policy matured on 26.02.2020 and the complainant will

be paid maturity value as per terms and conditions of the policy. Respondent has received all

the premiums under the policy. The complainant did not raise any objection regarding the

terms and conditions of the policy and continued to pay all the premiums under the policy by

which it is clear that he has accepted the terms and conditions of the policy. The primary

objective of the insurance policy is risk cover and returns under the policy, if any, are

incidental. The Company did not promise return of Rs.3,50,000/- as alleged by the

complainant. Further in the benefit illustration it is clearly mentioned that some benefits are

guaranteed and some benefits are variable with returns based on the future performance of

the company. The complainant enjoyed an insurance cover for a period of almost 5 years.

Further he is well educated i.e. Post Graduate and working as RES in Panchayat, M P

Government and had every source to find out the nature of the product he was purchasing

and it was his duty to ascertain the terms and conditions of the policy. He is now complaining

about the policy after expiry of free look period and after policy term. Maturity date is

26.02.2020. Maturity intimation letter dated 01.08.2019 mentioning Rs.2,56,176.91 as

maturity amount is the account value as on 01.08.2019 and actual maturity value will be

based on policy account value as on the date of maturity. On receipt of required documents,

company will pay the maturity amount to the complainant on maturity of the policy and exact

maturity value will be known after the maturity date only. In SCN received on 19.03.2020

respondent has stated that the policy matured on 26.02.2020 and on receipt of required

documents from the complainant, the company has made payment of Rs.2,64,081/- in

complainant‘s account on 27.02.2020. As per clause 11.1 of policy premium allocation


For the Complainant Mr Pawan Bisariya & Mrs Rekha Bisariya, wife

of complainant

For the insurer Mr Pankaj Vashistha, CRM Head

15. Complaint how disposed Dismissed


charges amounting to Rs.5,056.20 was deducted from the initial premium and further amount

of Rs.3,721.25, Rs.3737.50, Rs.3,835/- and Rs.3,540/- were deducted towards the 2nd, 3rd,

4th and 5th years renewal premium also. Total of Rs.12,170.23 was recovered as mortality

charges for the entire term of the policy. In SCN respondent has tabulated the policy account

value as at the end of every year i.e. from 2014-15 to 2019-20 (upto 26.02.2020). As per

SCN total payable amount is Rs.2,64,081/-.

The complainant has filed complaint letter, Annex. VI A and correspondence with respondent,

while respondent have filed SCN with enclosures.

I have heard both the parties at length and perused papers filed on behalf of the

complainant as well as the Insurance Company.

The complainant had taken SBI Life Flexi Smart Plus policy from the respondent on

26.02.2015 with annual premium payment of Rs.50,000/-. It is a participating non linked

variable insurance plan. The plan had a basic risk cover sum assured of Rs.5 lacs. The

premium paying term of the policy was 5 years and the date of maturity of the policy was

26.02.2020. As per terms and conditions of policy, policy account value is payable in lumpsum

on maturity along with terminal bonus, if any, as maturity benefit. As per SCN, original policy

document was dispatched to the complainant on 28.02.2015 and the complainant did not raise

any issue during the freelook period and had not availed option of freelook period. As per

SCN, it has been clarified by the respondent that the policy account value at the beginning of

the financial year 2019-20 was Rs.2,45,761.82 and after deducting amount of Rs.2,257.09

towards premium admin charges and mortality charges closing balance works out to

Rs.2,43,504.73. Total addition to this policy account was Rs.22,543.33 (Rs.2,221.01 as

interest amount as per guaranteed floor rate, Rs.13,881.31 as vested bonus and Rs.6,441.01

as terminal bonus) and from this an amount of Rs.1,967.06 has been deducted towards FMC

charges. Hence the total payable amount on maturity comes to Rs.2,64,081/-. The maturity

payment calculated above is thus as per the terms and conditions of the policy. In the plan

benefit illustration, the maturity benefit has been illustrated as Rs.2,34,135/- by considering

gross yield at the rate of 4% and a maturity value of Rs.2,64,092/- by considering the gross

yield at the rate of 8%. The benefit illustration is dated 23.02.2015 and is signed by the

complainant as well. It also carries a note that the illustrations does not in any way create any

right and or obligations and the actual experience on the contract may be different from what

is illustrated. The non guaranteed low and high rate mentioned above relates to assumed

investment return at different rates and may vary depending upon market conditions. The

actual maturity amount paid (Rs.2,64,081/-) is almost nearest to the higher one (Rs,2,64,092/-

) as illustrated in the illustration. It is nowhere mentioned in the policy benefit illustration, policy

schedule, policy conditions that on maturity an amount of Rs.3,50,000/- will be paid as

maturity value as alleged by the complainant. Hence the maturity amount calculated and paid

by the respondent is in consonance with the terms and conditions of the policy. In the result,

complaint is liable to be dismissed.

The complaint filed by Mr Pawan Bisariya stands dismissed herewith.

Let copies of the order be given to both the parties.

Dated : Mar 19, 2020 (G.S.Shrivastava)

Place : Bhopal Insurance Ombudsman

PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, INSURANCE OMBUDSMAN OFFICE,GUWAHATI

(UNDER RULE NO: 13(2)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – K. B. SAHA

CASE OF SUSHIL CH ROY V/S LIC of INDIA

COMPLAINT REF: NO: 1) GUW-L-029-1920-0325


Complainant

Mr. Sushil Ch Roy

S/O Narendra Nath Roy.

Vill, Ujanpetta Part-II P.O Ujanpetta

Dist Dhubri,Assam-783332 (M) 9957335336

2. Policy No:

Policy Type/Duration/Period

497295529

DETAILS ARE IN THE TABLE

3. Name of the Insured/LA

Name of the proposer

Sushil Ch Roy

Self

4. Name of the insurer LIC of INDIA (Bongaigaon Division)

5. Date of Repudiation Not Applicable

6. Reason for repudiation Not Applicable

7. Date of receipt of the Complaint 21-02-2020

8. Nature of complaint Dispute with regard to Paid up SA payment

9. Amount of Claim Not known

10. Date of Partial Settlement Not applicable

11. Amount of relief sought Not Known

12. Complaint registered under

Insurance Ombudsman Rules’ 2017

13 (2)

13. Date of hearing/place 11.03.2020 At O/O Insurance Ombudsman

Guwahati


For the Complainant Absent

For the insurer Mr. Maheswar Kumar .AO

15 Complaint how disposed BY CONDUCTING HEARING

16 Date of Award/Order 11.03.2020

17) Brief Facts of the Case:

Life Insurance Corporation of India

Pol No L.A. PLAN DOC Premium (yly)

Term /PPT &

FUP

1ST

Comp /Representation to

GRO of Ins. Co

497295529 Sushil Ch Roy

Endowment type 23/09/2013 4,531/- 06/06 yrs June/16

22.01.2020

The complainant has alleged the following:-

i) That he had purchased the above mentioned endowment policy in the year 2013 from LIC of

India Gossaigoan Branch for six years term to cover his life.

ii) He paid all arrear quarterly premiums up to June 2016 on 09.06.2016; presuming that policy

was kept in paid up condition. Thereafter he could not continue to run the policy due to his

financial condition.

iii) On maturity on 09/2019, when he asked insurer for paid up maturity value payment, he was

told that the policy has not acquired any paid up value due to non payment last one quarterly

instalment of premium and thus nothing is payable.

Being dissatisfied with the insurer‘s decision, the complainant has now approached this

Forum for redressal of his grievance.

18) Cause of Complaint: Non payment of paid up value Sum assured...

Complainant’s argument: In point No. 17 it is mentioned categorically.

Insurers’ argument: As per SCN received from the insurer

1. Insurer in their self contained note mentioned that complaint lodged by the complainant is not

acceptable to them as said policy was lapsed with FUP 06/2016 which continued only for 2

years 9 months and did not acquire any paid up value. Hence, nothing is payable.

2. The insurer further mentioned that during his visit to Branch office and also divisional office,

he was explained the reason for which no payment can be made under such circumstances.

19) Reason for Registration of Complaint:- Scope of Insurance Ombudsman rule 2017.

(Non receipt of paid up value amount.)

20) The following documents were placed for perusal.

i) Complaint letter ii) P – form iii) SCN

21) Result of hearing with both parties (Observations & Conclusion) :

Both the parties were called for hearing on 11.03.2020. The complainant Mr. Sushil Chandra Roy

was absent under intimation to this forum and the Insurer was represented by Mr. Maheswar

Kumar.

Decision

We have taken in to consideration the facts and circumstances of the case from the

documentary as well as verbal submission made by the representative of the Insurance

Company. During the course on hearing the representative of insurer submitted premium history

of the said policy to this forum along with letter dated 05.02.2020 addressed to the complainant.

We have also gone through the records.

As per the terms and condition of the policy, to acquire paid up value a policy must have

received premium for at least for three full years, In the instant case three full years premium

had not been paid .Thus Insurer has done as per the rules.

From the premium history it is appearing that an amount of Rs 29513/ was paid on 09.06.2016

toward premium due from 12/2014 to 03/2016. It indicates the intention of L/A was to keep the

policy in paid up condition after reviving the policy on payment of seven installment premiums.

The complainant was under misconception that full three years premium were paid, but the

Insurer did not include the premium due on 23rd June although the revival was effected on the

same month. .The technical inability of the Insurer to accept a premium due during a later date

in the same month was obviously, not properly clarified to the Insured person. Neither was there

any follow up done for further premium. The complainant was intrigued in to believing that the

policy had acquired paid up value. The intention of the policy holder to keep the policy in paid up

condition was clear. Otherwise, he would not revive the policy by paying more than Rs 29,000/

knowing fully well that the entire money will be lost. This shows glaring deficiency in service and

lack of transparency on the part of the Insurance Company. Although technically insurer can

deny the claim, in the interest of upholding fairness and ensuring an equitable treatment to the

hapless complainant, the Insurer is directed to settle the paid up value with accrued bonuses, if

any and recover one quarterly premium that was required to be paid for acquiring paid up value.

No interest for delayed payment is to paid /recovered from either side.

Thus, the complaint is treated as disposed of.

The attention of the Complainant and the Insurer is hereby invited to the following provisions of the

Insurance Ombudsman Rules, 2017.

As per Rule 17(6) of the said rules the Insurer shall comply with the Award within 30 days

of the receipt of the award and shall intimate the compliance to the Ombudsman.

Dated at Guwahati, the 11th day of March 2020.

K.B.Saha

Insurance Ombudsman

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA

(UNDER RULE NO: 16(1)/17of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – Shri Suresh Chandra Panda

CASE OF (Mrs Reeta Jain Vs. LIC of India Bhubaneswar DO)

COMPLAINT REF: NO: BHU-H-029-1920-0302

AWARD NO:BHU-A/LI/241/2019-2020


Mrs. Reeta Jain, B-143, Cosmopolis Dumuduma, Bhubaneswar

2. Policy No: Type of Policy Duration of policy/Policy period

587217224 Life 28.10.2008

3. Name of the insured Name of the policyholder

Mrs. Reeta Jain - do-

4. Name of the insurer LIC of India Bhubaneswar DO

5. Date of Repudiation NA

6. Reason for repudiation NA

7. Date of admission of the Complaint

18.10.2019

8. Nature of complaint Less payment of Maturity benefit

9. Amount of Claim 264000/-

10. Date of Partial Settlement NA

11. Amount of relief sought 264000/-

12. Complaint registered under Rule no: of Insurance Ombudsman Rules

13(1)(b)

13. Date of hearing/place 09.03.2020/ Bhubaneswar


For the Complainant Reeta Jain

For the insurer Sunita Panda

15 Complaint how disposed Under Insurance Ombudsman Rule 17.


17) Brief Facts of the Case:- The above mentioned policy was purchased by the complainant under

Jeevan Saral Plan on 28.10.2008 from the present insurer. The Sum Assured and quarterly

premium of the policy were Rs.500000/- and 6000/- respectively. The complainant had paid total

Rs.240000/- (Rs.6000 X 4X10) during the 10 years term of the policy. When the policy was sold to

her, she was categorically assured that she would get maturity amount of Rs.500000/- + Bonus at

the time of maturity. But after maturity she was informed by the insurer that she would get only

Rs.236376/- as maturity benefit in the subject policy which is even less than what she paid as

premium. Now she wants that she should be paid full sum assured of the policy as mentioned in

the policy bond which is a legally binding document of the insurer.

The insurer on the other hand submitted SCN stating that Jeevan Saral plan is a combination of

conventional plan with flexibility of ULIP features. In this plan, death sum assured is 250 times of

monthly premium which is decided at the inception irrespective of age at entry and policy term.

Hence, it is a high risk plan with the unique feature where death SA is independent of age at entry

and policy term. In view of the high risk covered, maturity sum assured is not exactly the return of

premiums paid, but determined on the basis of age

at entry and policy term. Moreover, LIC policies are not savings/investment products only, but

cover insurance aspects which is unparalleled with any other aspect. Moreover, no one should get

undue benefit in a contract out of mistake. Hence, the complaint should be dismissed.

18) Cause of Complaint:

a) Complainant‘s argument:- The complainant stated that she had purchased the above

mentioned policy under Jeevan Saral Plan on 28.10.2008 from the present insurer. The Sum

Assured and quarterly premium of the policy were Rs.500000/- and 6000/- respectively. The

complainant had paid total Rs.240000/- (Rs.6000 X 4X10) during the 10 years term of the policy.

When the policy was sold to her, she was categorically assured that she would get maturity

amount of Rs.500000/- + Bonus at the time of maturity. But after maturity she was informed by the

insurer that she would get only Rs.236376/- as maturity benefit in the subject policy which is even

less than what she paid as premium. Now she wants that she should be paid full sum assured of

the policy as mentioned in the policy bond which is a legally binding document of the insurer.

b) Insurers‘ argument:- The insurer on the other hand pleaded that Jeevan Saral plan is a

combination of conventional plan with flexibility of ULIP features. In this plan, death sum assured is

250 times of monthly premium which is decided at the inception irrespective of age at entry and

policy term. Hence, it is a high risk plan with the unique feature where death SA is independent of

age at entry and policy term. In view of the high risk covered, maturity sum assured is not exactly

the return of premiums paid, but determined on the basis of age at entry and policy term.

Moreover, LIC policies are not savings/investment products only, but cover insurance aspects

which is unparalleled with any other aspect. Moreover, no one should get undue benefit in a

contract out of mistake. Hence, the complaint should be dismissed.

19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017. This is a complaint against less payment of maturity claim by the Insurer. 20) The following documents were placed for perusal.

a) Photo copies of policy documents. b)Photo copy of representation to Insurer and its reply.

21)Result of hearing with both parties(Observations & Conclusion):- After going through the

arguments and submissions of both the parties it was observed that the subject policy was issued

under Jeevan Saral plan in which both maturity sum assured and death sum assured are different.

But in the instant case, there was no mention about the death sum assured, in the policy bond.

However, in the policy bond, maturity sum assured was mentioned as Rs.500000/-. The

complainant was also assured by the concerned Agent and Development Officer that she would

get 500000/- plus loyality addition at the time of maturity. Policy bond is the document that is

issued by the insurer to the insured which reflects all the conditions and privileges available in the

contract. So when the maturity claim amount is mentioned as Rs.500000/- in the policy bond, then

it should not be disputed by either of the parties in the contract, after contract period is over. After

the contract period insurer does not have the liberty to deny the benefits on the plea that ―maturity

amount was mentioned wrongly‖. Had it been known to the policyholder earlier she would have

cancelled the policy or stopped paying further premium. Hence, this forum is of the opinion that the

insurer has to pay Rs.500000/- as maturity benefits in the said policy.

22) The attention of the Complainant and the Insurer is hereby invited to the following

provisions of Insurance Ombudsman Rules, 2017:

a. According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall

comply with the Award within 30 days of the receipt of the award and shall

intimate the compliance to the Ombudsman.

b. As per rule 17(7) the complainant shall be entitled to such interest at a rate per

annum as specified in the regulations framed under the Insurance Regulatory and

Development Authority of India Act 1999, from the date the claim ought to have

been settled under the regulations, till the date of payment of the amount

awarded by the Ombudsman

c. As per rule 17 (8) of the said rule, the award of the Insurance Ombudsman shall

be binding on the Insurers.

Dated at Bhubaneswar on 9th March. 2020 (SURESH CHANDRA PANDA) INSURANCE OMBUDSMAN

FOR THE STATE OF ODISHA

AWARD

Taking into account the facts & circumstances of the case and the submissions made by both the

parties during the course of hearing, it is awarded that the insurer has to pay Rs.500000/- as

maturity amount in respect of the subject policy.

Hence, the complaint is treated as allowed accordingly.

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF ODISHA

(UNDER RULE NO: 16(1)/17of THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – Shri Suresh Chandra Panda

CASE OF (Mrs Rishabh Jain Vs. LIC of India Bhubaneswar DO)

COMPLAINT REF: NO: BHU-H-029-1920-0301

AWARD NO: BHU-A/LI/240/2019-2020


Mr. Rishabh Jain, B-143, Cosmopolis Dumuduma, Bhubaneswar


587215437 Life 28.10.2008


Mr. Rishabh Jain - do-

4. Name of the insurer LIC of India Bhubaneswar DO

5. Date of Repudiation NA

6. Reason for repudiation NA

7. Date of admission of the Complaint

18.10.2019

8. Nature of complaint Less payment of Maturity benefit

9. Amount of Claim 500000/-


11. Amount of relief sought 500000/-

12. Complaint registered under Rule no: of Insurance Ombudsman Rules

13(1)(b)

13. Date of hearing/place 09.03.2020/ Bhubaneswar


For the Complainant Rishabh Jain

For the insurer Sunita Panda

15 Complaint how disposed Under Insurance Ombudsman Rule 17.


17) Brief Facts of the Case:- The above mentioned policy was purchased by the complainant under

Jeevan Saral Plan on 28.10.2008 from the present insurer. The Sum Assured and quarterly

premium of the policy were Rs.500000/- and 6000/- respectively. The complainant had paid total

Rs.240000/- (Rs.6000 X 4X10) during the 10 years term of the policy. When the policy was sold to

him, he was categorically assured that he would get maturity amount of Rs.500000/- + Bonus at

the time of maturity. But after maturity he was informed by the insurer that he would get only

Rs.227584/- as maturity benefit in the subject policy which is even less than what he paid as

premium. Now he wants that he should be paid full sum assured of the policy as mentioned in the

policy bond which is a legally binding document of the insurer.

The insurer on the other hand submitted SCN stating that Jeevan Saral plan is a combination of

conventional plan with flexibility of ULIP features. In this plan, death sum assured is 250 times of

monthly premium which is decided at the inception irrespective of age at entry and policy term.

Hence, it is a high risk plan with the unique feature where death SA is independent of age at entry

and policy term. In view of the high risk covered, maturity sum assured is not exactly the return of

premiums paid, but determined on the basis of age at entry and policy term. However, LIC policies

are not savings/investment products only, but cover insurance aspects which is unparalleled with

any other aspect. Moreover, no one should get undue benefit in a contract out of mistake. Hence,

the complaint should be dismissed.

18) Cause of Complaint:

a) Complainant‘s argument:- The complainant stated that he had purchased the above mentioned

policy under Jeevan Saral Plan on 28.10.2008 from the present insurer. The Sum Assured and

quarterly premium of the policy were Rs.500000/- and 6000/- respectively. The complainant had

paid total Rs.240000/- (Rs.6000 X 4X10) during the 10 years term of the policy. When the policy

was sold to him, he was categorically assured that he would get maturity amount of Rs.500000/- +

Bonus at the time of maturity. In the policy bond the maturity sum assured was also mentioned as

Rs.500000/-. But after maturity he was informed by the insurer that he would get only Rs.227584/-

as maturity benefit in the subject policy which is even less than what he paid as premium. Now he

wants that he should be paid full sum assured of the policy as mentioned in the policy bond which

is a legally binding document of the insurer.

b) Insurers‘ argument:- The insurer on the other hand pleaded that Jeevan Saral plan is a

combination of conventional plan with flexibility of ULIP features. In this plan, death sum assured is

250 times of monthly premium which is decided at the inception irrespective of age at entry and

policy term. Hence, it is a high risk plan with the unique feature where death SA is independent of

age at entry and policy term. In view of the high risk covered, maturity sum assured is not exactly

the return of premiums paid, but determined on the basis of age at entry and policy term. However,

LIC policies are not savings/investment products only, but it covers insurance aspects which is

unparalleled with any other aspect. Moreover, no one should get undue benefit in a contract out of

mistake. Hence, the complaint should be dismissed.

19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017.

This is a complaint against non-payment of claim by the Insurer.


a) Photo copies of policy documents.

b)Photo copy of representation to Insurer and its reply.

21) Result of hearing with both parties(Observations & Conclusion):- After going through the

arguments and submissions of both the parties it was observed that the subject policy was issued

under Jeevan Saral plan in which both maturity sum assured and death sum assured are different.

But in the instant case, there was no mention about the death sum assured, in the policy bond.

However, in the policy bond, maturity sum assured was mentioned as Rs.500000/-. The

complainant was also assured by the concerned Agent and Development Officer that he would get

500000/- plus loyality addition at the time of maturity. Policy bond is the document that is issued by

the insurer to the insured which reflects all the conditions and privileges available in the

contract. So when the maturity claim amount is mentioned as Rs.500000/- in the policy bond, then

it should not be disputed by either of the parties in the contract, after contract period is over. After

the contract period insurer does not have the liberty to deny the benefits on the plea that ―maturity

amount was mentioned wrongly‖. Had it been known to the policyholder earlier he would have

cancelled the policy or stopped paying further premium. Hence, this forum is of the opinion that the

insurer has to pay Rs.500000/- as maturity benefits in the said policy.

22) The attention of the Complainant and the Insurer is hereby invited to the following


a. According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall

comply with the Award within 30 days of the receipt of the award and shall

intimate the compliance to the Ombudsman.

b. As per rule 17(7) the complainant shall be entitled to such interest at a rate per

annum as specified in the regulations framed under the Insurance Regulatory and

Development Authority of India Act 1999, from the date the claim ought to have

been settled under the regulations, till the date of payment of the amount

awarded by the Ombudsman

c. As per rule 17 (8) of the said rule, the award of the Insurance Ombudsman shall

be binding on the Insurers.

Dated at Bhubaneswar 09th March. 2020.

(SURESH CHANDRA PANDA) INSURANCE OMBUDSMAN

FOR THE STATE OF ODISHA

AWARD

Taking into account the facts & circumstances of the case and the submissions made by both the

parties during the course of hearing, it is awarded that the insurer has to pay Rs.500000/- as

maturity amount in respect of the subject policy.

Hence, the complaint is treated as allowed accordingly.

PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS


OMBUDSMAN: MR. P.K. RATH

CASE OF ARNAB DAS V/s. LIC OF INDIA

COMPLAINT REF: NO: KOL-L-029-1819-0821

AWARD NO: IO/KOL/A/LI/0687/2019-2020

1. Name & Address of the Complainant Mr. Arnab Das

21/6/2, SMP Sarani,

P.O. Barrackpore

Kolkata-700 120

West Bengal

Mob : 8981257037/9830180731

2. Policy No:


424826451

Details are in the table



Mr. Arnab Das

Self

4. Name of the insurer LIC of India




8. Nature of complaint Non-receipt of Survival Benefit

9. Amount of Claim Rs.30000/-


11. Amount of relief sought Rs.30000/- + Intt as per P-Form


Insurance Ombudsman Rules‘ 2017

13 (1) (c)

13. Date of hearing/place 17.03.2020 AT KOLKATA


For the Complainant ABSENT

For the insurer Mr. Gautam Bishnu, AO (CRM)



17) Brief facts of the case :

Pol No L.A. / Annuitant

Plan DOC Premium/ Mode

Term /PPT

1ST

Comp/ to Ins. Co

424826451 Arnab Das

Bima Gold 23.03.2006 11185/- Yly 12/12 07.07.2018

The complainant alleged the following against the insurer:

i) That he is having a Bima Gold policy with commencement date as 23.03.2006.

ii) That as per policy conditions he was eligible for receiving an amount of Rs.30000/- as

Survival Benefit due on 06.03.2014. However, he is yet to get the said SB amount.

iii) That on approaching the insurer office, he was provided with the details of payment made

by them with pay date as 06.03.2014, though on checking his bank account he did not find

any such credit in the respective account.

iv) That he informed the Chief Manager, Krishnanagar Branch and the Divisional Manager,

CRM, KSDO, about non-receipt of the SB amount. But neither got the amount nor received

any response.

18) Cause of Complaint: Survival Benefit not paid by insurer

a) Complainant’s argument: In point No. 17 it is mentioned categorically. b) Insurers’ argument: SCN not received at the time of preparation of case brief.

19) Reason for Registration of Complaint:- Scope of the Insurance Ombudsman Rules 2017


i) Complaint letter ii) P – form iii) Correspondences with insurer

21) Result of hearing with both parties (Observations & Conclusion):

Complainant’s submission :

i) Complainant remained absent on the date of hearing without any prior intimation.

Insurer’s submission :

i) Complainant purchased the policy from Krishnagar Branch-I in 2006 and after getting two

Survival Benefits, he transferred the policy to Barrackpore Branch.

ii) Only after getting the maturity proceeds from Barrackpore Branch, he raised the issue of

non-receiving the Survival Benefit which was due in March, 2014.

iii) On investigating the matter, it was found that SV for Rs.30000/- due in 2014 was paid to the

policyholder vide Cheque dated 23.03.2014 which was encashed on 24.03.2014.

AWARD

Taking into account the facts & circumstances of the case and the submissions made by

representative of the insurer during the course of hearing and also after going through the

relevant documents on record, it is observed that the insurer paid the Survival Benefit

amount of Rs.30000/- vide Cheque No.0604752, dated 23.03.2014 in favour of the

complainant/policyholder. As per letter issued by AXIS Bank dated 12.02.2020, the said

instrument of Rs.30000/- was given credit to the Savings Account No.910010041892490 on

24.03.2014 maintained in the name of the complainant.

Since the disputed Survival Benefit amount in respect of Policy No. 424826451 had been

paid by the insurer as evidenced from the documents submitted, the complaint is dismissed

without providing any relief to the complainant.

Dated at Kolkata, the 18th day of March, 2020

P K RATH

INSURANCE OMBUDSMAN

FOR THE STATE OF WEST BENGAL, SIKKIM and A&N ISLANDS

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN

STATES OF WEST BENGAL, SIKKIM AND UT OF ANDAMAN & NICOBAR ISLANDS

(UNDER RULE NO: 16(1)/17 of INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – MR. P. K. RATH

CASE OF CHITRA PODDER Vs. LIC OF INDIA

COMPLAINT REF: NO: KOL-L-029-1819-1068 AWARD NO: IO/KOL/A/LI/0695/2019-2020

1. Name & Address of the Complainant Mrs. Chitra Podder

Netaji Subhas Road

Bura Shibtala

P.O. Nabadwip

PIN-741 302

West Bengal,

Mob. No. 8653228939

2. Policy No:

Type of Policy


Pol. No : 427259766/427259774

Details are given in the Table below.

----do------------------------------------



Mrs. Chitra Podder

----do--------------------


5. Date of Repudiation N.A.

6. Reason for repudiation N.A.

7. Date of receipt of the Complaint 12.03.2019 - at the office of Ombudsman

8. Nature of complaint Less maturity payment


10. Date of Partial Settlement N.A.

11. Amount of relief sought Rs.199916/- as per Annex. VI A


Insurance Ombudsman Rules,2017

13 (1) ( c )



For the Complainant Mrs. Chitra Podder

For the insurer Mr. Gautam Bishnu, AO(CRM)

15. Complaint how disposed BY CONDUCTING HEARING


17) Brief facts of the case:--

The complainant alleged the following against the Insurer -

i) That she purchased 2 Jeevan Saral policies from LICI in 2009 as per a printed chart

provided by the Agent at the time of selling the products.

ii) That she deposited Rs.141560/- each against the said policies during the policy term of 10

years. However, on maturity LIC paid her back Rs.41602/- against each policy, which

means Rs.99958/- less out of the total premium paid in respect of each policy.

iii) That since LICI is a govt. organization; she is unable to understand the reason of getting

such less maturity payment. She tried to bring the matter to the notice of the concerned

authority vide his letter dated 19.01.2019, but yet to get any response from them.

iv) Being aggrieved, she approached the Hon‘ble Ombudsman for redressal of her complaint.

Details of the policy issued -

Policy No.

LA/Proposer Plan Name DOC PT/ PPT

Premium

Complaint to Co.

427259766 Chitra Podder

Jeevan Saral

26.03.2009 10/10 Rs.14156

yly 19.01.2019/ 01.02.2019

427259774 Chitra Podder

Jeevan Saral

26.03.2009 10/10 Rs.14156

yly 19.01.2019/ 01.02.2019

18) Cause of Complaint: Settlement of less maturity value

a) Complainant’s argument : Already briefed under point 17

b) Insurer’s argument:

SCN received from the insurer on 29.07.2019 with the following submissions :

i) Complainant purchased 2 Jeevan Saral policies on 26.03.2009 under Plan Term 165-10.

ii) On maturity, LIC calculated the Maturity Sum Assured as Rs.30590/- + Rs.11012 as interim

bonus totaling Rs.41602 against each policy. The final payment was made after deduction

of outstanding loan with interest thereon in respect of both the policies.

iii) Under Jeevan Saral policy, SA payable on death is 250 times of basic monthly premium.

But in case of maturity it depends on age at entry and term of the policy. In the instant

case, age at entry of the LA was 60 years and the term chosen 10 years. The MSA for

entry age 60 is Rs.3059/- against Rs.100/- paid as monthly premium, therefore, for

Rs.1000/- monthly premium the MSA is (3059/- x 1000/-) / 100 = Rs.30590/-. In addition,

Rs.11102/- was added with the MSA for both the policies. Hence, the maturity value paid

to the policyholder was as per terms and conditions of the policies.

19) Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules, 2017

20) The following documents were placed for perusal -

a) Complaint letter b) P form c) Correspondences with the Insurer d) SCN

21) Result of hearing with both parties (Observation & Conclusion) :


i) Purchased two Jeevan Saral policies from LIC in 2009 and paid premium for 10 years with

total amount of Rs.141560/- against each policy.

ii) At the time of selling the products she was told of getting back Rs.5.00 lakh on maturity.

However, she got Rs.83,000/- only for two policies against total payment of Rs.283120/-.

iii) Trusted on the verbal assurances of the people who were instrumental in selling the

products.


i) Life assured purchased the policy at an advanced age; 60 years at the time of

commencement of the policy. The product is not beneficial for the policyholders who are at

upper age bracket.

ii) Complainant was paid the maturity value along interim bonus as per policy conditions.

AWARD



relevant documents on record, it is observed that the insurer has paid Rs. Rs.41602 /-(

Rs.30590/- & Rs.11012/- as Maturity Sum Assured and interim bonus respectively) each

against the policies purchased by the complainant. The exact amount of Maturity Sum

Assured the insurer has to pay to the policyholder on maturity is clearly mentioned in the

policy document. So, the maturity payment made by the insurer in respect of both the

policies was as per terms and conditions of the policy.

Base on the above, the complaint is dismissed without providing any relief to the

complainant.


P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATES OF WEST BENGAL,

SIKKIM AND UT OF ANDAMAN & NICOBAR ISLANDS

PROCEEDINGS BEFORE



OMBUDSMAN – P. K. RATH

CASE : PRADIP KUMAR GHOSH V/S LIFE INS. CORPN. OF INDIA.

COMPLAINT REF: NO: 1) KOL-L-029-1819-1065

AWARD NO: 1) IO/KOL/A/LI/0685/2019-2020

1. Name & Address of the Complainant PRADIP KUMAR GHOSH

Nabapally West, P.O. Dhalua, Garia,Kolkata – 700152. W.B.

2. Policy No:


499820629




PRADIP KR. GHOSH

SELF

4. Name of the insurer LIFE INS. CORPN. OF INDIA




8. Nature of complaint Any partial Or total repudiation of claims – 13 (1) (b)

9. Amount of Claim Rs.1,39,459/-


11. Amount of relief sought Rs. 1,39,459/-



13 (1) (b)

13. Date of hearing/place 16.03.2020, AT KOLKATA


For the Complainant PRADIP KUMAR GHOSH

For the insurer SUDIP KUMAR NANDI




Pol No L.A. PLAN DOC Premium (yly)

Term /PPT

1ST

Comp to Ins Co

499820629 Pradip Kumar Ghosh Jeevan Saral 28.01.2009 1021/- 10/10 04.02.2019


1. The complainant is the life assured under the policy and submitted that maturity value

under the policy less settled by the insurance company.

2. He raised the objection that in the policy bond the Maturity Sum Assured is for Rs.

250000/- but the insurance company paid him Rs. 1,10,541/-

3. He took the matter to the Branch Manager of the Servicing Branch and they have clarified

as it is a printing mistake.

4. Being aggrieved, the complainant has now approached this forum for redress of his

grievance.

18) Cause of Complaint: Any partial or total repudiation of claim - 13 (1) (b).


Insurers’ argument: :

No SCN has yet been submitted by the insurance company but in reply to the complainant‘s

letter vide their letter dt. 13.02.2019 that correct amount of Maturity Claim for Rs. 110541/- has

been paid as per Circular CO/ACT/1934/4 dt. 12.02.2004 and also clarified that actual Maturity

S/A will be Rs. 81280/- and not Rs. 250000/- which is actually Death S/A under the policy. The

Maturity Value is payable is :

Maturity S.A. : Rs. 81280/- +

Loyalty Additions : Rs. 29261/-

Total Mat. Value : Rs. 110541/- So no more maturity value is

payable, as per terms and conditions of the policy.


: Any partial Or total repudiation of claims – 13 (1) (b)


i) Complaint letter ii) P – form

iii) Proposal papers


The complainant repeated the allegations as made in his complaint letter and submitted that he is

a layman and knows nothing about the ins and out of the insurance policy and only believe that

what is written in the policy bond he will get the same benefit. He also submitted that on getting

the policy bond it was noticed that on maturity he will get the Maturity Sum Assured for

Rs.2,50,000/- and accordingly being convinced he accepted the policy but on maturity of the said

policy he got the maturity value for Rs. 110541/- only. Immediately he took up the matter to the

Branch Manager of the concerned servicing branch and from where it was told that the maturity

value paid correctly to him and also said that the Maturity Sum Assured wrongly printed as Rs.

2,50,000/- in stead of Rs. 81,280/- in the Policy Bond. He is totally disappointed with the decision

of the Branch Authority and demanded for balance amount of Maturity Value, as printed on the

policy bond.

The representative of the Insurance Company submitted that as per Terms and Conditions of the

policy the Maturity Value under the policy paid correctly to the life assured and nothing more is

actually payable to the life assured and also the life assured also was not at all deprived as per

IRDAI guideline and Terms and Conditions of Jeevan Saral Class of Assurance of policy including

the captioned policy also. The insurance representative also clarified that due to misalignment of

computer printing in the Policy Bond wrongly shows Maturity Sum Assured as 2,50,000/- instead of

81,280/- and Death Sum Assured as 81,280/- instead of 2,50,000/- for which we are extremely

sorry. The representative also submitted that they have identified the mistakes much earlier in

some policies and rectified most of them but some how this policy could not be corrected due to

non availability of the particular policy bond from the concerned policyholder.

A W A R D

Taking into account the facts & circumstances of the case, the submissions made by both

the parties during the course of hearing and after perusal of documents on record, this

Office is of opinion that the concerned Policy No. 499820629 on the life of Pradip Kumar

Ghosh issued with Date of Commencement 28.01.2009, Table – 165 & Term of the policy 10

yrs. Accordingly Policy Bond was printed with Maturity Sum Assured Rs. 2,50,000/- and

Death Sum Assured Rs. 81,280/-, as evident from the Policy Bond, but during the Term of

the policy it is not evident that any initiative was taken from the insurance company to

rectify the mistake, if any, took place in the policy bond and not even any letter

communicated to the Life Assured under the policy in this regard. As such, since the Policy

Bond is the basis of contract between Insurer and Insured, the Insurer is directed to give

effect of Maturity Sum Assured which is printed in the Policy Bond i.e. Rs. 2,50,000/- and

accordingly settle the Maturity Benefit under the policy, under intimation to this office.

This case should not be treated as a precedent in any further dispute between an insured

and an insurer.

Hence, the complaint is treated as disposed of.

The attention of the Complainant and the Insurer is hereby invited to the following


As per Rule 17(6) of the Insurance Ombudsman Rules 2017, the Insurer shall comply with the

Award within 30 days of the receipt of the award and shall intimate the compliance of the same

to the Ombudsman.

Sd/

Dated at KOLKATA on 23rd day of March, 2020 P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATE OF WEST BENGAL,

SIKKIM and A&N ISLANDS

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN STATES OF WEST BENGAL, SIKKIM AND UT OF ANDAMAN & NICOBAR ISLANDS

(UNDER RULE NO: 16(1)/17 of INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – MR. P. K. RATH

CASE OF MANIK LAL GHOSH Vs. LIC OF INDIA

COMPLAINT REF: NO: KOL-L-029-1819-0987

AWARD NO: IO/KOL/A/LI/0694/2019-2020


Complainant

Mr. Manik Lal Ghosh

E-8/202, Peerless Nagar

Sodepur

P.O. Panihati

PIN-700 114

West Bengal,

Mob. No.

2. Policy No:

Type of Policy


Pol. No : 428287022

Details are given in the Table below.

----do------------------------------------



Mr. Manik Lal Ghosh

----do--------------------


5. Date of Repudiation N.A.

6. Reason for repudiation N.A.

7. Date of receipt of the Complaint 19.01.2019 - at the office of Ombudsman

8. Nature of complaint Less maturity payment

9. Amount of Claim Full maturity value as calculated by

complainant

10. Date of Partial Settlement N.A.

11. Amount of relief sought Rs. 31791/-(86056 – 54265) as per Annex.

VI A


Insurance Ombudsman

Rules,2017

13 (1) ( c )



For the Complainant Mr. Manik Lal Ghosh

For the insurer Mr. Gautam Bishnu, AO(CRM)

15. Complaint how disposed BY CONDUCTING HEARING


17) Brief facts of the case:--

The complainant alleged the following against the Insurer -

i. That he had a Wealth Plus policy in LIC of India since March 2010, the policy terms of which expired on 31.03.2018. After expiry, insurer paid Rs.54265/- as NAV against total Unit held in his credit as 3509.626 with Rs.15.4619 per unit.

ii. That he deposited Rs.75000/- in total towards premium payment from 2010 to 2012, but received Rs.54265/- only as the maturity value.

iii. That he lodged complaint to the Divisional Office of the insurer against less maturity

payment, but received an unsatisfactory reply from their end.

iv. That he alleged suppression of mode of calculation of allotting units by LICI against

each premium received by them. He also alleged that though as per premium receipt

LIC would intimate the policyholder about allotment of units separately, but he was

never provided with the same, particularly against his premium payment in 2011 & 2012

respectively. On a constant follow up with the Branch concerned, they issued him a

status report wherein allotment of 2123.993 units is mentioned in respect of his deposit

of Rs.25000/- in 2010.

v. Being dissatisfied with the reply of the insurance company, he approached the Hon‘ble

Ombudsman for resolving the complaints.

Details of the policy issued -

Policy No.

LA/Proposer Plan Name DOC PT/ PPT

Premium

Complaint to Co.

428287022 Manik Lal Ghosh

Wealth Plus 31.03.2010 08/03 25000/-yly

30.07.2018

18) Cause of Complaint: Less maturity payment

a) Complainant’s argument : Already briefed under point 17

b) Insurer’s argument:

SCN not received at the time of preparation of case brief. However, vide their communication

dated 08.08.2018, LICI, KSDO, informed the complainant that payment of Rs.54265/- was

calculated as per NAV over the first 7 years of the policy or at the end of the policy term,

whichever is higher and the calculation is correct as per terms and conditions of the policy.

19) Reason for Registration of Complaint: - Scope of the Insurance Ombudsman Rules, 2017

20) The following documents were placed for perusal -

a) Complaint letter b) P form c) Correspondences with the Insurer

21) Result of hearing with both parties (Observation & Conclusion) :


i) Paid Rs.25000/- each for 3 years under a Wealth Plus policy. However, received

Rs.54265/- only on maturity after 8 years from the date of purchasing the policy.

ii) As per policy document, insurer has to issue Unit Statement as and when a transaction

takes place. However, except for the first premium deposited, LICI did not intimate him

about the no. of Units allocated and NAV thereon in respect of his subsequent deposits.


i) There was no less payment of maturity value under the policy as alleged by the

complainant; the amount paid was in accordance with policy conditions. The details of

units allocation under the policy has been given with the Self-Contained Note submitted to

Ombudsman Office.

ii) The allocation charges/administrative charges etc. deducted every month by redeeming the

allocated units as per provisions might not have taken into consideration by the

complainant.

AWARD



relevant documents on record, it is observed that complainant did not get any Unit

allocation statement from the insurer after depositing his 2nd and 3rd installment of

premium, in spite of a provision for the same in the policy document.

As regards, complainant’s other allegation about receipt of less maturity value, the insurer

has submitted this Office details of the Unit particulars in respect of the said policy for the

full policy term. From the document, it is found that as on 31.03.2018 there was a credit of

3509.626 Units in favour of policy no. 428287022 with corresponding NAV of total Units as

Rs.54265.48. Hence, as per the document submitted, the maturity value of Rs.54265/- paid

to the complainant was as per terms and conditions of the policy. The insurer is, however,

directed to provide a copy of the said Unit calculation sheet, as submitted to this Office, to

the complainant for perusal.

The complaint is, therefore, dismissed without providing any relief to the complainant.


P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATES OF WEST BENGAL,

SIKKIM AND UT OF ANDAMAN & NICOBAR ISLANDS.

PROCEEDINGS BEFORE




CASE : TAPAN KUMAR MAJI V/S LIFE INS. CORPN. OF INDIA.


AWARD NO: 1) IO/KOL/A/LI/0658/2019-2020


Complainant

TAPAN KUMAR MAJI

Vill. Sitalpur, P.O. Bahula, P.S. Andal,Burdwan – 713322. W.B.

2. Policy No:


577437976 & 577437978




TAPAN KUMAR MAJI

SELF

4. Name of the insurer LIFE INS. CORPN. OF INDIA




8. Nature of complaint Delay in Settlement of claims – 13 (1) (a)

9. Amount of Claim


11. Amount of relief sought


Insurance Ombudsman Rules‘

2017

13 (1) (a)

13. Date of hearing/place 16.03.2020, AT KOLKATA


For the Complainant MILON KUMAR MAJI

For the insurer SUMITA BARMAN PYNE




Pol No L.A. PLAN DOC Premium (s.p.)

Term /PPT

1ST

Comp to Ins Co

467471663 Tapan Kumar Maji Profit Plus (188) 16.01.2008 20000/- 10/01 14.02.2018


1. The complainant alleged that he paid the premium for Rs. 20,000/- as single premium under the above noted policy but on maturity he received the maturity discharge voucher for Rs.5317.29 only. Which shocked him and accordingly took the matter to the insurance company on 14.02.2018 and 21.08.2018 but till date neither he received any maturity value under the policy nor any reply from the insurance company.

Being aggrieved, the complainant has now approached this forum for redress of his

grievance.

18) Cause of Complaint: Any partial or total repudiation of claim - 13 (1) (a).


Insurers’ argument: :

As per SCN received from the insurance company they have clarified that the amount payable

under the policy is Rs.5317.29, as per terms and conditions of the policy. They have also

stated that the policy basically is ULIP policy and the break up of payment they have given as :

No. Of Units held at the time of Maturity is : 249.792

NAV as on the date of Maturity for Growth Fund is : Rs. 21.2869.

So Maturity Value is payable Rs. 249.792 X 21.2869 = Rs. 5317.29.

As such no more value is payable under the policy. But did not mention as to whether Maturity

Value has been paid or not.


: Dispute over premium paid or payable in terms of insurance policy – 13 (1) (c)& (d)


i) Complaint letter ii) P – form iii) SCN.


On behalf of the complainant, Mr. Milon Kumar Maji, son of the Complainant, represented the

complainant and submitted that his father paid Rs. 20000/- as single premium under the policy and

the maturity discharge voucher received for Rs. 5317.29 which probably not correct and wants to

get the correct maturity value under the policy.

The representative of the insurance company clarified that the policy in dispute is a ULIP policy in

nature and took the policy on very high age of 54 years and also took the Risk Coverage of Rs. 1

lakh with Accident Benefit coverage. As a result a considerable amount had been deducted in the

1st. Year of policy, as per Terms of the policy, from the amount deposited as Single Premium and

balance amount converted into Units held in deposit under Growth Fund. Thereafter all necessary

charges e.g. Mortality Charges, Accident Benefit Premiu, Policy Administration Charges, Service

Tax etc. regularly deducted, as per terms of the policy, realised every month by cancelling

proportionate no. of units from the policyholder‘s balance fund and as a result at the end maturity

date the total no. of units finally decreased to 249.792 and accordingly the maturity value payable

as on the date of maturity is @ NAV of Rs. 21.2869 which comes to Rs. 5317.29. Accordingly D/V

for Rs. 5317.29 sent correctly to Life Assured.

AWARD

Taking into account the facts & circumstances of the case, the submissions made by

both the parties during the course of hearing and after perusal of documents on record

this office is of opinion that as per Terms & Conditions of the policy the Maturity Value

Payable under the policy is for Rs. 5317.29 and the Servicing Branch correctly sent D/V

for Rs. 5317.29. So the Insurer is directed to Pay an amount of Rs. 5317.29 towards

Maturity Value to the Life Assured under the policy, on getting the necessary D/V and

required papers , at the earliest, with an intimation to this office.

Hence, the complaint is treated as disposed of.




Award within 30 days of the receipt of the award and shall intimate the compliance of the same

to the Ombudsman.

Sd/

Dated at KOLKATA on 18th day of March, 2020. P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of DURGES CHAUDHURI V/S LIC of INDIA


AWARD NO: 1) IO/KOL/A/LI/ 0668 /2019-2020

1. Name & Address of the Complainant Mr. DURGES CHAUDHURI

C/O- ASHALATA CHAUDHURI

FLAT NO.- C1/14, DIPABALI COPERATIVE,

KOLKATA GREENS, SURVEY PARK, KOLKATA-

700075

MOBILE NO. - 9432342927

2. Policy No:


464904483




DURGES CHAUDHURY & ASHALATA

CHAUDHURY

SELF

4. Name of the insurer LIC OF INDIA



7. Date of receipt of the Complaint 26/12/2018

8. Nature of complaint Delay in Settlement of Maturity Claim – 13-1-(a)

9. Amount of Claim Rs. 71676/


11. Amount of relief sought NOT SPECIFIED



13 (1) (a)

13. Date of hearing/place 13/03/2020, AT KOLKATA


For the Complainant DURGES CHAUDHURY

For the insurer KAMALESH GOSWAMI(A.O,CLAIMS)


16 Date of Award/Order 19/03/2020


Pol No L.A. PLAN DOC Premium (Yly)

Term /PPT

1ST Comp to Ins Co

464904483 Mr. Durges Chaudhuri &

Ashalata Chaudhuri

Conventional Table-89

15/07/2003 Rs.4425/ 15/15

04/10/2018


a) That, the above policy matured on 15/07/2018 but LIC did not settled the maturity claim

only due to a remark on the policy bond - “the policy is assigned to Canara Bank”.

b) That as per complainant, he had already repaid the full loan amount along with interest to

Canara Bank and Canara Bank also issued him a certificate about total loan

reimbursement.

c) That the certificate as issued by Canara Bank was shown to LIC, Burdwan Branch but LIC

denied to settle Maturity claim on the basis of that certificate although on the basis of same

certificate, LIC Sarsuna Branch settled a maturity claim of a policy of the complainant.

d) That as per advice of LIC, the complainant had sent the bond to Canara Bank, Bolpur

Branch for rectification of wrongly marked statement “assigned to Canara Bank” on

10/10/2018 but till date, no action taken by the Bank.

Being aggrieved, the complainant has now approached this forum for redressal of his

grievance.

18) Cause of Complaint: Due to non-settlement of Maturity payment of the above policy.


Insurers’ argument: As per SCN, the Insurer argued the following—

a) That the settlement of maturity claim is pending due to the fact that the policy was assigned on 20/10/2010 in favor of Canara Bank, Bolpur Branch and the assignee although submitted the original policy bond and DV for settlement of claim but some discrepancies were observed therein like- a) signature of the claimant was left blank, b) self attested proof of identity of Branch Manager was not submitted & c) no forwarding letter submitted by Bank.

b) That the reason behind non-settlement of claim was informed to Canara Bank by e mail dated 21/02/2019 and another blank DV along with NEFT mandate was sent vide speed post for necessary action but till date, no fresh compliance received from Bank.

c) That the policy was neither reassigned in favor of the complainant nor any letter sent by Canara Bank to LIC requesting for reassignment in favor of complainant. Moreover, no repayment certificate, issued by Canara Bank sent to LICI till date.

d) That LIC already informed to Mr. and Mrs. Chaudhury vide speed post dated 09/10/2018 that the policy money would be settled to Canara Bank, Bolpur Branch in view of absolute assignment in favor of Canara Bank.


: Dispute over nonpayment of Maturity Claim under rule – 13 (1) (a).


i) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form, iv) Copy of policy bond & v) SCN


Complainant’s submission: The complainant repeated all the points as mentioned in his

complaint letter dated 26/12/2018 and demanded immediate settlement of his maturity claim as it is

pending for more than 1.5 years.

Insurer’s Submission: The representative of the Insurer also repeated all the points as mentioned

in their SCN dated 04/04/2019. He reiterated that due to some discrepancies observed in D.V like-

signature of the claimant, self- attested proof of identity of Branch Manager & absence of

forwarding letter of the Bank, maturity claim could not be settled. In the question of follow-up with

the Bank to get the requirements, the representative replied that the last follow-up was made with

the Bank on 21/02/2019.

AWARD

Taking into account the facts & circumstances of the case and after going through the

documents on record and the submissions made by both the parties during the course

of hearing, it is observed that the settlement of maturity claim is pending only due to

non-compliance of some requirement on the part of the Canara Bank, Bolpur Branch for

which adequate follow-up not done by the Insurer.

Considering all the above, the Insurer is advised to get the requirements from the Bank

within 15 days and settle the claim immediately as the responsibility of collecting

requirement lies with the Insurer, under intimation to this office.

Hence, the complaint is disposed of.



As per Rule 17(6) of the Insurance Ombudsman Rules 2017, the Insurer shall comply

with the Award within 30 days of receipt of the award and shall intimate the compliance

of the same to the Ombudsman.

Dated at KOLKATA, the 19th day of March 2020.

S/d

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of JAYDEB BHAR V/S LIC of INDIA



1. Name & Address of the Complainant JAYDEB BHAR YOGIPARA, 1ST LANE, P.O- CHANDANNAGAR,

HOOGHLY, WEST BENGAL-712136 MOBILE NO. – 9038624980

2. Policy No: Policy Type/Duration/Period

496241612 DETAILS ARE IN THE TABLE

3. Name of the Insured/LA Name of the proposer

JAYDEB BHAR SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable

7. Date of receipt of the Complaint 20/12/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i)

9. Amount of Claim Rs. 39504/ 10. Date of Partial Settlement Not applicable

11. Amount of relief sought Rs. 20496/ 12. Complaint registered under

Insurance Ombudsman Rules‘ 2017 13 (1) (i)

13. Date of hearing/place 13/03/2020, AT KOLKATA 14. Representation at the hearing

For the Complainant JOYDEB BHAR

For the insurer GOUTAM NANDAN(A.O,CRM)




Pol No L.A. PLAN DOC Premium Hly

Term /PPT

1ST

Comp to Ins Co

496241612 Mr. JAYDEB BHAR ULIP Table-801 30/03/2010

Rs.10000/ 08/03 30/08//2018

The complainant’s Arguments—

a) That the complainant deposited total premium Rs.60000/ and after 8 years he got

Rs.39504/ as Maturity Payment which is less by Rs.20496/ than the invested amount.

b) That he wanted to know the reason behind getting so poor return from the Insurer and for

that he wrote letter to LIC, Howrah Division on 31/05/2018 and subsequently on 30/08/2018

but till date no response received from the Insurer in this regard.

c) That, being aggrieved, he now appealed to this office for the necessary explanation for

getting so poor maturity return and demanded the difference of invested amount ie

Rs.20496/ as additional payment.

18) Cause of Complaint: Due to substantial less payment of Maturity claim.


Insurers’ argument: As per SCN dated 07/01/2019, the Insurer argued the following—

a) That the Wealth Plus policy is a unit linked policy which is different from traditional policy in

the sense that the maturity return is subject to market risk and the investment risk to be borne

by the policy holder.

b) That the Policy Holder‘s Fund Value is subject to deduction of different charges as mentioned

in policy bond like fund management charge, policy administration charge, premium allocation

charge, mortality charge and other charges.

c) That the rate of different charges to be deducted are given in the ―Conditions and Privileges‖

of policy bond.

d) That the maturity payment calculation has been done on the basis of highest NAV recorded

either in first 7 policy years or on the date of maturity whichever is higher and in this case, the

highest NAV was on the date of maturity which is Rs.15.4619(in first 7 years, highest NAV

was Rs.14.5278)

e) That the maturity payment calculated by multiplying the ―net number of unit as on date of

maturity‖ with highest NAV ie 2554.895(net no. of unit) X 15.4619 = Rs.39504.00 paid as

Maturity Payment.

f) That the policy holder was 63 years at the time of taking the policies‘ & enjoyed the life cover

for Rs.1 lakh for 8 years and in case of any unfortunate incident, his nominee would have

received policy sum assured + policy holder‘s fund value. Moreover, mortality charge goes up

in an accelerated way with increased age. As the complainant was 63 years of age, a steep

mortality charges deducted in this case.

g) That the policy holder will enjoy risk cover for another 2 years for Rs.1 lakh beyond the date of

maturity.

h) That the maturity calculation made as per the terms and conditions of the policy and there

was no discrepancies in the calculation.


: Dispute over less payment of Maturity Claim, under rule – 13 (1) (i).


i) Complaint letter, ii) P– form, iii) Copy of policy bond and iv) Copy of complaint lodged to

Insurer and v) SCN


a) Complainant’s Submission: The complainant repeated all the points as mentioned in his

complainant letter dated 17/12/2018. He added that he is a retired Teacher, aged 63 years

and appealed for the difference of invested amount ie Rs.20496/ as additional payment.

b) Insurer’s submission: The Representative of the Insurer also repeated all the points as

mentioned in their SCN dated 07/01/2019. He reiterated that high mortality premium in this

case has resulted so poor maturity return.

AWARD


documents on record and the submissions made by both the parties during the course of

hearing, it is observed after necessary verification that the maturity calculation made by the

Insurer is absolutely justified.

Considering all the above, the Insurer is advised to issue a detailed Fund Value Statement

to the complainant immediately, showing all the details of unit accumulations and the

deductions made therein towards different charges item wise to justify the maturity

payment calculation and the complaint is dismissed without giving any relief to the

complainant.

Hence, the complaint is treated as closed.

Dated at KOLKATA, the 19th day of March2020.

S/d

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of TAPATI BHATTACHARYYA V/S LIC of INDIA



1. Name & Address of the Complainant TAPATI BHATTACHARYYA

W/O- LATE SWAPAN BHATTACHARYYA

TEJGANJ GARH, P.O- NITANGANJ,

BARDHAMAN(E),

BURDWAN, WEST BENGAL-713102

MOBILE NO. - 9564840104

2. Policy No:


469804823




LATE SWAPAN BHATTACHARYYA

SELF





8. Nature of complaint Delay in Settlement of Maturity Claim – 13-1-(a)

9. Amount of Claim SUM ASSURED Rs.100000/ + VESTED BONUS


11. Amount of relief sought SUM ASSURED + BONUS



13 (1) (a)



For the Complainant PRABIR BHATTACHARYA(BROTHER)

For the insurer KAMALESH GOSWAMI(A.O CLAIMS)





Term /PPT

1ST

Comp to Ins Co

469804823 LATE SWAPAN BHATTACHARYYA

Conventional Table-48

19/03/2012 Rs.19201/ 10/05

29/05/2018


a) That, her Husband Swapan Kumar Bhattacharyya expired on 20/01/2017 after suffering

from cancer.

b) That she, being the wife of the deceased and Nominee of the above policy submitted Death

claim in the year2017along with all requisite papers like claim form B and B1.

c) That the Insurer called for treatment particulars of last 3 years prior to date of death of the

deceased in connection with his old ailments but she is not a in a position to comply the

same as all these papers are not traceable now.

d) That she is now passing the days with acute financial crunch and as such appealed to

Insurer for immediate settlement of the claim but the Insurer denied to settle the same

without the previous treatment particulars.


grievance.

18) Cause of Complaint: Due to non-settlement of Death Claim of the above policy.


Insurers’ argument: SCN not yet submitted. However, Burdwan Division vide their letter dated

20/12/2017 called for treatment particulars of Respiratory distress and Coronary ailments for the

last 3 years prior to date of death as the Insured was suffering from these ailments since 09/2016

and 2015 respectively as is evident from B1 form. The Insurer again requested to the claimant vide

letter dated 29/05/2018 and 06/07/2018 to deposit the previous treatment papers to enable them to

settle the case early and also informed to the complainant to let them know atleast the name/s of

the Nursing Home or Hospitals where the deceased was treated earlier to enable them to collect

the required treatment particulars. But the same was not complied by the claimant till date.


: Dispute over nonpayment of death Claim under rule – 13 (1) (a).


i) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form, iv) Copy of policy bond &

v) Reply of the Insurer.


Complainant’s Submission: The complainant repeated all the points as mentioned in her

complaint letter dated 26/11/2018. He reiterated that patient died of lung cancer and questioned

how lung cancer is related to PTC. He informed that all previous treatment papers were destroyed

at the time of death and appealed for immediate settlement of the claim.


in their letter dated 20/12/2017. He also informed that the policy in question was revived on

26/12/2016 and the life assured expired on 20/01/2017. As such, it is an early claim and from the

Medical attendant‘s certificate of SSKM Hospital, it is observed that DLA was suffering from SOB,

cough with scanty expectoration right side chest pain since Sept. 2016 and he was treated with

P.T.C.A in the year 2015. So, the previous treatment particulars are very important for settlement

of claim in this case and that was the reason behind the forfeiture of the revival of the policy. He

also mentioned that the Insurance Company is ready to settle the paid-up value of the policy

Rs.96000/ as it appears before revival date.

AWARD



hearing, it is observed that the Deceased Life Assured (DLA) was suffering from respiratory

distress from 09/2016 and coronary ailments from 2015 for which he was treated with

P.T.C.A as is evident in medical attendant’s certificate of S.S.K.M Hospital in claim form B &

B1.

Considering all the above, the Insurer is advised to settle the claim on the basis of Paid-up

value to be calculated on the date of revival + Bonus accrued if any as on that date to the

complainant, under intimation to this office.

Hence, the complainant is disposed of.




Award within 30 days of the receipt of the award and shall intimate the compliance of the same to

the Ombudsman.

Dated at KOLKATA, the 23rd day of March 2020.

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of PRAGATI AGARWAL V/S LIC of INDIA



1. Name & Address of the Complainant Ms. PRAGATI AGARWAL

24/25, B. D. LANE, HOWRAH

WEST BENGAL- 711106

MOBILE NO. -9038639855

2. Policy No:


578347227




PRAGATI AGARWAL

SELF


5. Date of Repudiation --

6. Reason for repudiation ---


8. Nature of complaint LESS PAYMENT OF MATURITY CLAIM -13(1)(i)

9. Amount of Claim Rs.94895/


11. Amount of relief sought Additional payment Rs.37105/ + Interest



13 (1)(i)



For the Complainant Pragati Agarwal

For the insurer A N Hati,Mgr(CRM) & Sathi Nag, A.O(CRM)




Pol No L.A. PLAN DOC Premium (Mly)

Term /PPT

1ST Comp to Ins Co

578347227 Pragati Agarwal Bima Account Table-805

07/03/2011 Rs.1100/ 07/07

03/05/2018

The complainant has argued the following:-

a) That she deposited total premium Rs.92400/ and got the maturity payment Rs.94895/ after

7 years ie just the investment amount.

b) That she wrote several times to the Insurer dated 03/05/2018, 17/05/2018 and 03/06/2018

seeking explanation for such a very poor return but till date not a single response received

from the Insurer.

c) That, the Sum Assured of the policy is Rs.132000/, so the maturity payment should be at

least Rs.132000/, if not more.

d) That, the rise of Index both Nifty and Sensex during the period 07/03/2011 to 07/03/2018 is

1.8 times greater.

e) The complainant demanded a total statement in this regard justifying her maturity payment

and also demanded an explanation from LIC, why she was not informed about her unit

balances time to time.

f) She also demanded a bifurcation of Total Management Expenses Rs.8240/, charged from

her account.


grievance.

18) Cause of Complaint: Due to less payment of Maturity Claim.


Insurers’ argument: As per SCN dated 07/03/2020, the Insurer Argued the following:

a) That the policy was issued under Bima Account 1 plan under table 805 with a term and

premium paying term of 07/07 years.

b) That as per terms of the policy, various charges like expense charge and mortality charge

are recovered from the premium amount and the balance is credited to policy holder‘s

account.

c) That on the policy holder surviving the date of maturity, an amount equal to the balance in

policy holder‘s account is payable as maturity value.

d) That in the instant case, the maturity claim has been settled Rs.94886.95 and the basis of

calculation is as under---

Premium balance is calculated after deduction of Expense Charge from monthly

premium every month @ 27.5% of first year premium, 7.5% of 2nd and 3rd year’s

premium and 5% on subsequent premium. Net premium balance credited to policy

holder‘s account on the date of maturity is Rs.79637.80/. Total accumulated Interested

credited to policy holder‘s account at maturity Rs.15995.31/. Total Mortality charge

deducted Rs.746.16/ and net amount Rs.94886.95/ paid to policy holder as maturity.


under rule – 13 (1) (i).


i) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form, v) Copy of policy bond & vi) SCN


Complainant’s Submissions:

The complainant repeated all the points as mentioned in her complaint letter dated 30/07/2018.

She added that LIC paid maturity payment initially Rs.79900/ and after 3 days, a second payment

of Rs.15000/ made. She complained that the necessary statement justifying the calculation of

maturity payment with all the details of deductions and interest accrued therein is yet to be

received from the Insurer. She questioned why LIC did not send the policy holder‘s Fund statement

time to time.

Insurer’s Submissions:

The Representative of the Insurer also repeated all the points as mentioned in their SCN. He

added that rate of interest given on policy holder‘s fund is 6% per annum. In the question of

sending a total statement of policy holder‘s fund balance with all details of deductions and interest

accumulation to the complainant, he replied that it would be sent very shortly. He demanded their

maturity calculation absolutely correct and appealed for dismissal of the complaint.

AWARD



hearing, it is observed that the maturity calculation made by the Insurer is absolutely

justified.

Considering all the above, the complaint is dismissed without giving any relief to the

complainant and the Insurer is advised to issue a total Policy Holder’s Account Statement

to the complainant at the earliest, with all the details of premium balance accumulations

and interest accrued time to time and the deductions made therein towards mortality

charge to justify the maturity payment amount.



S/d P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of SHEKHAR ROY V/S LIC of INDIA




Complainant

SHEKHAR ROY

Flat No. – A402, KOYLA VIHAR VASUNDHARA,

V. I. P ROAD, KOLKATA, WEST BENGAL-700052

MOBILE NO. - 9433344095

2. Policy No:


579098330




SHEKHAR ROY

SELF





8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i)



11. Amount of relief sought NOTHING SPECIFIED.



13 (1) (i)



For the Complainant Mr. Shekhar Roy

For the insurer Mr. Ashesh Ghosh





Term /PPT

1ST Comp to Ins Co

579098330 Mr. SHEKHAR ROY ULIP Table-801

08/05/2010 Rs.20000/ 08/03

20/08/2018

The complainant’s Arguments--

a) That he deposited total premium Rs.60000/ and got a maturity return Rs37145/ after 8

years.

b) That, how maturity returns comes to negative when NAV value increased by 50% after 8

years.

c) That, the Complainant demanded a total statement showing the total unit accumulated in

the credit of his policy and the various deductions made therein towards different charges

itemwise and total number of unit deducted.

d) That the complainant also demanded to justify the huge deductions, about 60% of the total

accumulated unit towards different service charges.

e) That the complainant getting no satisfactory reply from Insurer, approached this forum for

redressal of his grievance and for a payment of atleast his investment amount.



Insurers’ argument: As per SCN dated 03/03/2020, the Insurer Argued the following:

a) That the Wealth Plus policy is a unit linked policy which means that the maturity return

is subject to market risk.

b) That the Policy Holder‘s Fund Value is subject to deduction of different charges as

mentioned in policy bond like fund management charge, policy administration charge,

premium allocation charge, mortality charge and other charges.

c) That the rate of different charges to be deducted are given in the ―Conditions and

Privileges‖ of policy bond.


either in first 7 policy years or on the date of maturity whichever is higher and in this case,

the highest NAV was on the date of maturity which is Rs.15.9708/(in first 7 year, highest

NAV was Rs.14.7181/)


maturity‖ with highest NAV ie 2325.7810(net no. of unit) X 15.9708 = Rs.37145.38/.

f) That the policy was accepted with class-II extra premium and the mortality premium

was Rs.40.65 per 1000 sum assured including the extra premium Rs.13.55. So, for

sum assured Rs.1 lakh, annual mortality charges are = 40.65* 100 =Rs.4065. The

policy holder was 60 years of age at the time of taking the policy, enjoyed the life cover for

Rs.1 lakh for 8 years. Moreover, mortality charge goes up in an accelerated way with

increased age and as such a steep mortality charge deducted in this case. Total unit

allotted after imposition of allocation charge in the instant policy is 5810.127 and total unit

deducted towards other different charges is 3484.346. So, net number of unit on the date of

maturity is 2325.7810

g) That the policy holder will enjoy risk cover for another 2 years for Rs.1 lakh after the date of

maturity ie upto 08/05/2020.


: Dispute over less payment of Maturity Claim under rule – 13 (1) (i).


i) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form, iv) Reply of the Insurer, v) Copy of policy bond & vi) SCN


Complainant’s Submissions: The complainant repeated all the points as mentioned in his

complaint letter dated 20/11/2018. He questioned ―why the mortality charge is so high‖. In the

question of Fund Value Statement, he replied that he had received the same with all the details

from the Insurer 2 days back.

Insurer’s Submissions: The Representative of the Insurer also repeated all the points as

mentioned in their SCN. He explained the reason behind so high mortality charge imposed in the

instant case and said that mortality charge in-general increases in an accelerated way with

increased age but this policy was accepted with imposition of class-II extra. So, annual mortality

charge deducted @ Rs.4065/. He demanded their maturity calculation absolutely justified and as

per terms and conditions of the policy and appealed for dismissal of the complaint.

AWARD



hearing, it is observed that the maturity payment calculations made by the Insurer is

absolutely justified & it is as per the terms and conditions of the policy.

Considering all the above, the complaint is dismissed without giving any relief to the

complainant.





Award within 30 days of the receipt of the award and shall intimate the compliance of the same to

the Ombudsman.


S/d

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of SUBRATA SANA V/S LIC of INDIA




Complainant

SUBRATA SANA

S/O- LATE SARBESWAR SANA, VILL- THUBA,

P.O- TAKI, P.S- HASNABAD, NORTH 24

PARGANAS,

WEST BENGAL-743429

MOBILE NO. – 9732767481

2. Policy No:


427908168 & 427908170




SUBRATA SANA

SELF






9. Amount of Claim Rs. 49254/ FOR EACH POLICY





13 (1) (i)



For the Complainant Mr. Subrata Sana

For the insurer Mr. Goutam Bishnu, AO (CRM)




Pol No L.A. PLAN DOC Premium single

Term /PPT

1ST Comp to Ins Co

427908168 & 427908170

Mr. Subrata Sana ,,

ULIP Table-801

31/03/2010 ,,

Rs.50000/ ,,

08/01

15/05/2018


a) That he deposited single premium Rs.50000/ in each policy and after 8 years he got

maturity return Rs.49254/ in each policy which is less than the invested amount by Rs.746/

b) That he wanted to know the reason behind getting so poor return from the Insurer as at the

time of taking these two policies, his agent assured him a maturity return of 1.90 lakhs for

each policy with supporting Leaflet, enclosed.

c) That he wrote letter to Sr.Dm, KSDO on 15/05/2018 for the explanation behind such poor

return but till date no response received from the Insurer in this regard.

Being aggrieved, he now appealed to this office for the necessary explanation behind getting

so poor maturity return.




a) That the Wealth Plus policy is a unit linked policy and as the Investment is subject to Market

Risk, past performance may not indicate future performance.

b) That, LIC of India did not publish and circulate any document containing the projection of

return under such Unit-Linked policy. So the document, if any, circulated by the Development

Officer, does not form any part of responsibility of the Corporation.

c) That the Fund Value calculation has been done on the basis of highest NAV recorded either

in first 7 policy years or on the date of maturity whichever is higher and in this case, the

highest NAV was on the date of maturity which is Rs.15.4619(in first seven policy years,

highest NAV was Rs.14.5278). So, the Fund Value is equal to

multiplying the ―net number of unit as on date of maturity‖ with highest NAV ie 3185.50(net

no. of unit) X 15.4619(highest NAV) = Rs.49254.00 paid as Maturity value.

d) That the Sum Assured is payable only on death during the policy term or on death within an

extended period of 2 years after Maturity. So, the complainant will enjoy the risk cover for

Rs.130000/ (Rs.65000/ in each policy) till 31/03/2020.

e) That there is no question of cheating the Policy Holder by the Corporation as the maturity

calculation made by them is correct. So they appeal for dismissal of the complaint.




i) Complaint letter, ii) P– form, iii) Copy of policy bond and iv) Copy of complaint lodged to

Insurer and v) SCN


Complainant Submissions: The Complainant repeated all the points as mentioned in his

complaint letter dated 19/07/2018. He however added that he had applied for a single policy of

Rs.1 lakh but he got 2 policies for Rs.50000/ each instead of one policy of Rs.1 lakh. In the

question of Fund Statement, he replied that no fund value statement received by him from the

Insurer yet.

Insurer’s Submission: The Representative of the Insurer also repeated all the points as

mentioned in their SCN. He mentioned that the complainant was 59 years of age at the time of

taking the policy and as such a high mortality charge deducted in this case due to the fact that

mortality charge goes up in an accelerated way with increased age. He also mentioned about other

charges like Premium allocation charge, Fund management charge and Policy administration

charge. He reiterated about the correctness of their Fund Value calculation and appealed for

dismissal of the complaint.

AWARD



of hearing, it is observed after necessary verification that the maturity calculation made

by the Insurer is absolutely justified.

Considering all the above, the Insurer is advised to issue a Fund Value Statement to the

complainant immediately showing all the details of unit accumulations and the



complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of MADHAB CHANDRA MAITY V/S LIC of INDIA



1. Name & Address of the Complainant MADHAB CHANDRA MAITY

At-MAHABISHRA, P.O- KAITHORE, P.S- EGRA

EAST MIDNAPORE, WEST BENGAL-721429

MOBILE NO. - 9732493248

2. Policy No:


499017699




MADHAB CHANDRA MAITY

SELF











13 (1) (i)



For the Complainant MADHAB CHANDRA MAITY

For the insurer ASHIS KUMAR MAITY (A.O, CLAIMS)





Term /PPT

1ST Comp to Ins Co

499017699 Madhab Ch. Maity ULIP Table-801

05/05/2010 Rs.20000/ 08/03

20/08/2018

The complainant’s Allegations--

a) That he deposited total premium Rs.60000/ and got a maturity return Rs 45729/ after 8

years.

b) That, how maturity returns comes to negative value when LIC Officials of Egra Branch

assured him at the time of taking the policy about lucreative maturity return equal to

Rs.60000/ + Highest NAV + loyalty addition.

c) That he getting no satisfactory reply from Insurer, approached this forum for redressal of his

grievances.



Insurers’ argument: As per SCN dated 05/07/2018, the Insurer Argued the following---

a) That the Policy Holder‘s Fund Value is subject to deduction of different charges as mentioned

in policy bond like fund management charge, policy administration charge, premium allocation

charge, mortality charge and other charges.

b) That the rate of different charges to be deducted are given in the ―Conditions and Privileges‖

of policy bond.

c) That the maturity payment calculation has been made on the basis of highest NAV recorded

either in first 7 policy years or on the date of maturity whichever is higher and in this case, the

highest NAV was on the date of maturity which is Rs.15.8205/

d) That the maturity payment calculated by multiplying the ―net number of unit as on date of

maturity‖ with highest NAV ie 2890.504(net no. of unit) X 15.8205 = Rs.45729.21 and

accordingly maturity payment made Rs.45729/.

e) That the policy holder was 62 years of age at the time of taking the policy, enjoyed the life

cover for Rs.1 lakh for 8 years. Moreover, mortality charge goes up in an accelerated way

with increased age and as such a steep mortality charges deducted in this case.

f) That the policy holder will enjoy an extended risk cover for Rs. 1 lakh for another 2 years

after the date of maturity.

g) That, all Insurance Policies are purchased through Agent of LICI and in this case also the

Policy Holder had purchased this policy from our Agent. There is no such assurance given on

the part of LICI regarding maturity value as the maturity value totally depends on NAV.

h) That, every terms and conditions of the policy was clearly written in the policy bond and it is

the duty of the policy holder to go through the policy conditions after receipt of policy bond

and take decision whether to continue or Cool-off the policy.




i) Complaint letter, ii) P– form, iii) Copy of policy bond & iv) SCN


Complainant’s Submission: The complainant repeated all the points as mentioned in his

complaint letter dated 02/07/2018 and demanded additional payment.


in their SCN and demanded absolute correctness and as per terms and conditions in their maturity

payment calculation.

AWARD



hearing, it is observed that the maturity calculation made by the Insurer is correct as per

policy conditions.

Considering all the above, the Insurer is advised to issue a detailed Fund Value Statement

to the complainant immediately, showing all the details of unit accumulations and the



complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATES OF WEST BENGAL, SIKKIM and A&N ISLANDS

PROCEEDINGS BEFORE




CASE of ASIT KUMAR DAS V/S LIC of INDIA



1. Name & Address of the Complainant ASIT KUMAR DAS

C/O- LATE SANAT KUMAR DAS

VILL + P.O- MAHESHPUR, P.S- EGRA,

EAST MIDNAPORE, WEST BENGAL- 721452

MOBILE NO. – 8972262582

2. Policy No:


499009137




ASIT KUMAR DAS

SELF




7. Date of receipt of the Complaint 20/06//2018




11. Amount of relief sought NOT SPECIFIED.



13 (1) (i)



For the Complainant Mr. Asit Kumar Das

For the insurer Mr. Ashis Kumar Maity




Pol No L.A. PLAN DOC Premium YLY

Term /PPT

1ST Comp to Ins Co

499009137 ASIT KUMAR DAS

ULIP Table-801

27/03/2010

Rs.25000/

08/03

-----


a) That he deposited total premium Rs.75000/ and after 8 years he got a maturity return

Rs.89877/ which is much less than the return as assured at the time of taking the policy.

b) That he wanted to know the reason behind getting so poor maturity return as at the time of

taking this policy, he was assured that maturity payment would be made on the basis of

highest NAV recorded.

c) That at the time of taking this policy, Sensex was about 14000 and in March 2018, Sensex

was near about 34000. So, there is tremendous growth of Sensex within the Policy Tenure,

still, why return is so poor. He expressed his doubt about payment of Maturity Value made

not on the basis of Highest NAV.

He now appealed to this office for the necessary explanation behind getting his so poor

maturity return.


Insurer’s Arguments: As per SCN, the Insurer Argued the following--

a) That the Wealth Plus policy is a unit linked policy which is different from traditional policy in

the sense that the maturity return is subject to market risk.

b) That the Policy Holder‘s Fund Value is subject to deduction of different charges as

mentioned in policy bond like fund management charge, policy administration charge,

premium allocation charge, mortality charge and other charges.

c) That the rate of different charges to be deducted are given in the points 2,4,5,6,7 and 9 of

―Conditions and Privileges‖ of policy bond.


either in first 7 policy years or on the date of maturity whichever is higher and, in this case,

the highest NAV was on the date of maturity which is Rs.15.4380


maturity‖ with highest NAV ie 5821.806 (net no. of unit) X 15.4380 = Rs.89877.00 and

Maturity Payment made also Rs.89877/. So, maturity claim paid is correct.

f) That the policy holder will enjoy an extended risk cover for another 2 years for Rs.125000/

after the date of maturity ie till 27/03/2020.

g) That they can‘t comment on Sensex.




i) Complaint letter, ii) P– form, iii) Copy of policy bond and iv) SCN


Complainant’s Submission: The Complainant repeated all the points as mentioned in his

complaint letter dated 20/06/2018. He however added that he was assured by his agent to get a

return of Rs.125000/ at the time of maturity. He also mentioned that he had not received any Fund

Value Statement from the Insurer till date.

Insurer’s Submission: The Representative of the Insurer also repeated all the points as

mentioned in their SCN. He reiterated about the correctness of their maturity calculation and

appealed for dismissal of the complaint.

AWARD






complainant immediately, showing all the details of unit accumulations and the



complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE




CASE of BHUT NATH MONDAL V/S LIC of INDIA



1. Name & Address of the Complainant BHUT NATH MONDAL

VILL- MATHGOBINDAPUR, P.O- CHANAK,

PURBA BARDHAMAN, BURDWAN,

WEST BENGAL- 713131, MOBILE NO. –

9153915360

2. Policy No:


468829958 & 468830102




BHUT NATH MONDAL

SELF






9. Amount of Claim Rs. 55820/ & Rs.71865/





13 (1) (i)



For the Complainant Mr. Bhut Nath Mondal

For the insurer Mr. Kamalesh Goswami, A.O(Claims)




Pol No L.A. PLAN DOC Premium

Term /PPT

1ST

Comp to Ins Co

468830102 468829958

Mr. BHUT NATH MONDAL

ULIP Table-801

31/03/2010 both

Rs.25000(Yly) Rs.10000(Hly)

08/03

------


a) That the complainant deposited total premium Rs.75000/ in case of first policy and

Rs. 60000/ in case of 2nd policy in anticipation of Maturity return of 3.35 lakh and

2.35 lakh as per leaflet distributed by LIC Gushkara Branch but in reality he got

Rs.71865/ and Rs.55820/ which are far far less than the leaflet fighure.

b) That he is a blind supporter of LIC and in earlier occasion also, he faced a substantial loss

in case of Market Plus policy.

c) The Complainant appealed to this office to look into the matter so that the loss suffered by

him is make good.




a) That the Wealth Plus policy is a unit linked policy. Since it is a unit linked plan,

maturity return is subject to market risk.

b) That the rate of different charges to be deducted are given in the ―Conditions and

Privileges‖ of policy bond.

c) That the maturity payment calculation has been done on the basis of highest NAV recorded

either in first 7 policy years or on the date of maturity whichever is higher and in this case,

the highest NAV was on the date of maturity which is Rs.15.4619(in first 7 year, highest

NAV was Rs.14.5278)

d) That the maturity payment calculated by multiplying the ―net number of unit as on date of

maturity‖ with highest NAV ie 4647.886(net no. of unit) X 15.4619 = Rs.71865.00 paid for

first policy and similarly maturity payment for 2nd policy net number of unit 3610.157 x

highest NAV Rs.15.4619 = Rs.55820/ paid for second policy.

e) That the policy holder will enjoy an extended risk cover of 2 years after the date of maturity

for Rs.2.25 lakh.

f) The Insurer also informed that the delayed submission of maturity D.V, NEFT Mandate and

KYC by the complainant was the reason behind delayed payment of Maturity Claim.




Complaint letter, ii) P form, iii) Reply of the Insurer, iv) Copy of policy bond and v) SCN.


Complainant’s Submissions: The complainant repeated all the points as mentioned in his

complaint letter dated 08/06/2018 and demanded additional payment as mentioned in the leaflet.

He informed that he had not been served any fund value statement by LIC.

Insurer’s Submissions: The representative of the Insurer also repeated all the points as

mentioned in their SCN. He states that the maturity payment made by LIC in both the policies are

absolutely correct and as per terms and conditions of the policy.

AWARD






complainant immediately, with all the details of unit accumulations and the deductions

made therein towards different charges item wise to justify the maturity payment

calculation and the complaint is dismissed without giving any relief to the complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATE OF WEST BENGAL, SIKKIM and A&N ISLANDS

PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW


Mr. Umesh Kumar Singh……………………………....………………. Complainant

VS

Life Insurance Corporation of India…………………………………………...Respondent

COMPLAINT NO: LCK-L-029-1920-0095 Order No. IO/LCK/A/LI/0492/2019-20

1. Name & Address of the Complainant Mr. Umesh Kumar Singh

10 / 10 ; BHS

Shiv Nagar Colony

Allapur ; Near Loha Park

Prayagraj - 211006 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

211289553 & 211286259

Money Back Plan

…………

N/A

………..

3. Name of the insured /


Umesh Kumar Singh & Mamta Singh

Umesh Kumar Singh & Mamta Singh

4. Name of the insurer Life Insurance Corporation of India

5. Date of Repudiation/Rejection N/A

6. Reason for repudiation/Rejection N/A


8. Nature of complaint S.B due on 2011 & 2012 not received

9. Amount of Claim 6250/ + 7000/ = Total 13250


11. Amount of relief sought S.B. DUE ON 2011 & 2012 NOT PAID

12. Complaint registered under Rule Rule No.13(1)(a)of Insurance Ombudsman

Rule 2017

13. Date of hearing/place 13.03.2020 at 10.15 A.M.


For the Complainant Mr. Umesh Kumar Singh

For the insurer Mr. Heera Singh



17. Mr. Umesh Kumar Singh (Complainant) has filed a complaint against Life Insurance

Corporation of India, alleging that Survival Benefit due on 2011 & 2012 were not paid

YKS

COMPLAINT NO: LCK-L-029-1920-0095 Order No. IO/LCK/A/LI/ 0492/2019-20

Brief Facts of the Case:- 18. As per the complaint, complainant had taken two policies, one policy no. 211289553 on his

own life and the other policy no. 211286259 on the name of his wife Smt. Mamta Gupta under

Money Back plan from LIC of India. Both the policies have matured and he has got the maturity

value under both the policies. But he has not received last installment of S.B. due in 2011 & 2012

as he was transferred from Sultanpur. Hence he approached the L.I.C. Branch but has not

received any response from them. Being aggrieved, the complainant approached this forum for the

redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply 07.03.2020, RIC has stated that-

A).Under policy no. 211289553, S.B. of Rs. 6250/- due on 03/2011 was paid vide cheque

no.1056186 dated 25.03.2011.But the cheque was enchased, hence a fresh cheque no. 388096

dated 27.02.2012 was issued which was enchased on 16.03.2012. The cheque was encashed

through Union Bank of India Sultanpur. A letter has been written to bank for providing the details of

account.

B).Under policy no. 211289259, S.B of Rs. 7000/- along with interest of Rs. 3533/- (Total Rs.

10533) due on 03/2011 was paid on 05.03.2020 and credited in A/C no.31544966076 of S.B.I.

Allalpur branch Allahabad.

20. RIC has stated S.B of Rs. 30000/- due on June-2018 was paid on 07.07.2018 through NEFT

by the company. They further stated that this amount has been credited to A/C no.

09840100001792 of Bank of Baroda Bhadohi on 09.07.2018. This account pertains to Mamta

Gupta. Hence requested to close the complaint.

21. The complainants have filed a complaint letter, Annexure VI A along with other relevant papers

while respondent has NOT filed SCN with enclosures.

22. I have heard the complainant as well as respondent representative and perused the record.

COMPLAINT NO: LCK-L-029-1920-0095 Order No. IO/LCK/A/LI/0492 /2019-20

Findings:-

23. Complaint relates to non-payment of 2 survival benefits. One survival benefit due in March, 2011 in

the name of Smt. Mamta Singh was made on 05.03.2020 wherein survival benefit of Rs. 7000/- and

Rs. 3533/- as penal interest was paid. Rate of interest is not mentioned in the SCN. If the payment

was not made on due date insured is entitled for penal interest at the rate of 8.25 percent per annum.

Accordingly interest at the rate of 8.25 percent per annum on Rs. 7000/- on due date is to be made.

24. In policy no. 211289553 insured Umesh Kumar Singh his survival benefit of Rs. 6250/- was

due in March, 2011 as per the contention in SCN payment was made through cheque no. 388096

dated 27.02.2012 which was in cashed on 16.03.2012. Complainant submits that he did not

receive the payment. He submitted the photostat copy of passbook wherein no amount is credited

on 16.03.2012. Accordingly complainant would be entitled for survival benefit of Rs. 6250/- from its

due date with penal interest subject to submission of indemnity bond.

Order:-

25. In policy no. 211286259 complaint is allowed respondent are directed to make payment of

interest at the rate of 8.25 percent per annum on Rs. 7000/- survival benefit from it due date till the

date of actual payment. Amount already paid would be adjusted.

26. In policy no. 211289553 respondent are further directed to make payment of Rs. 6250/-

survival benefit with penal interest at the rate of 8.25 percent per annum from its due date till the

date of actual payment subject of furnishing of indemnity bond by the insured. Compliance be

made within 30 days.

27. Let the copy of this award be given to both the parties.

Date: 13.03.2020 (Justice Anil Kumar Srivastava)

Place: Lucknow Insurance Ombudsman



Mrs. Sandhya Ojha………………………....…………….…....………………. Complainant

VS



1. Name & Address of the Complainant Mrs. Sandhya Ojha

B-24/14-A-1

Shalimarganj

Varanasi-221001 (U.P)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

281996562

Jevan Sneha Plan

28.03.1997

N/A

20 years



Mrs. Sandhya Ojha

Mrs. Sandhya Ojha





8. Nature of complaint S.B. DUE ON 2002 NOT RECEIVED

9. Amount of Claim 5000/- + 18% Interest


11. Amount of relief sought S.B. DUE ON 2002 NOT PAID


Rule 2017




For the insurer Mr. Vinod Kumar Singh



17. Mrs. Sandhya Ojha (Complainant) has filed a complaint against Life Insurance Corporation of

India. (Respondent) alleging that Survival Benefit due on 2002 has not been paid.

YKS


Brief Facts of the Case:- 18. As per the complaint, complainant had taken one policy no. 281996562 for Rs. 25,000/- under

Jeevan Sneha (Money Back) plan for 20 years on 28.03.1997 from LIC of India. As per policy

condition, she had to get survival benefit payment on 2002, 2007 and 2012 otherwise this amount

will be refunded at the maturity with 11% interest. Complainant has further stated that she had got

the maturity amount with survival benefit payment due on 2007 & 2012 with interest but she had

not received survival benefit due on 2002. Being aggrieved, the complainant approached this

forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 16.08.2019, RIC has stated that survival benefits due on 2002 of Rs.

5,000/-was paid on 28.03.2002 and this amount is also not appearing in Stale Cheque account.

RIC has further stated that case is almost 18 years old, so it is very difficult to trace the

encashment details as old record is being destructed after 10 years.

20. The complainants have filed a complaint letter Annexure VI A, along with other relevant papers

while respondent has filed SCN with enclosures.

21. Despite notice complainant is not present. I have heard the respondent representative and

perused the record.

Findings:-

22. Complainant submits that her survival benefits of Rs. 5,000/- which was due in March 2002

was not paid to her. Along with SCN scanned copy of policy bond is attached wherein it is

endorsed that payment of Rs. 5,000/- as survival benefits was made in 28.02.2002 which was

enchased by cheque on 28.03.2002. Since it is an old record the relevant registers have been

destroyed.

23. It is relevant that the complainant has not made any complaint regarding non-payment of

survival benefits due in March, 2002 till making of the complaint before this forum or before 2017. If

the same was not paid to the complainant she should have made the complaint at the


earliest possible opportunity which was not done. Accordingly presumption is drawn against the

complainant. Accordingly complaint is liable to be dismissed.

Order:-

24. Complaint is dismissed.

25. Let the copy of award be given to both the parties.





Mrs. Nirmala Devi………………………....…………………...………………. Complainant

VS



1. Name & Address of the Complainant Mrs. Nirmala Devi

W/O Sri Kailash Ram Kushwaha

415 ;Balaji Colony Extension

Bhagwanpur; Lanka

Varanasi- 221005 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

282295832

Jevan Sneha Plan

10.06.1999

N/A

20 years



Mrs. Nirmala Devi

Mrs. Nirmala Devi





8. Nature of complaint S.B. DUE ON 2004 & 2009 NOT RECEIVED

9. Amount of Claim 40000/- + 11% Interest


11. Amount of relief sought S.B. DUE ON 2004 & 2009 NOT PAID


Rule 2017







17. Mrs. Nirmala Devi (Complainant) has filed a complaint against Life Insurance Corporation of

India. (Respondent) alleging that Survival Benefit due in the year 2004 & 2009 have not been paid.

YKS


Brief Facts of the Case:- 18. As per the complaint, complainant had taken one policy no. 282295832 for Rs. 1,00,000/-

under Jeevan Sneha (Money Back) plan for 20 years on 1.06.1999 from LIC of India. As per policy

condition, she had to get survival benefit payment on 2004, 2009 and 2013 otherwise this amount

will be refunded at the maturity with 11% interest. Complainant has further stated that she got the

maturity amount with survival benefit payment due on 2015 with interest but she had not received

survival benefit due in the year 2004 & 2009. Being aggrieved, the complainant approached this

forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 25.10.2019, RIC has stated that survival benefit due on 2004 of Rs.

20,000/- alongwith 11% interest total Rs. 95,962 was paid on 16.08.2019 and survival benefit due

on 2009 of Rs. 20,000/- along with 11% interest total Rs. 56,788/- was paid on 16.08.2019. RIC

has further stated that maturity intimation of Rs. 1,90,000/-wherein Loyalty addition of Rs. 10,000/-

was included, has been sent to policy holder on 18.04.2019. But in this case policy holder has

deferred the survival benefit payments hence loyalty addition is not payable.




perused the record.

Findings:-

22. This complaint relates to payment of survival benefit due in 2004 and 2009. Respondent

submits that payment with interest has been made to the complainant which is duly acknowledged

by the complainant through e-mail message dated 16.03.2020. However it is informed that form 16

is not sent by the respondent. Tax deducted is also not available in form 26 AS.


23. Accordingly complaint is liable to be disposed off with a direction to the respondent to send the

form 16 to the complainant.

Order:-

24. Complaint is disposed off with a direction to the respondent to send the form 16 to the

complainant in accordance with law.






Mr. Dashrath Ram Yadav………………………....……....………………. Complainant

VS



1. Name & Address of the Complainant Mr. Dashrath Ram Yadav

Sarveshwari Nagar Colony ;

Vill.- Tilmapur

Post-Ashapurj

Varanasi- 221007 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

282677648

Money Back Plan

28.09.2000

N/A

15 years



Mr. Dashrath Ram Yadav

Mr. Dashrath Ram Yadav





8. Nature of complaint S.B. DUE ON 2004 NOT RECEIVED AND

OTHER S.Bs HAS ALSO RECEIVED VERY

LATE

9. Amount of Claim 15000/- + Interest


11. Amount of relief sought S.B. DUE ON 2004 NOT PAID


Rule 2017



For the Complainant Mr. Dashrath Ram Yadav




17. Mr. Dashrath Ram Yadav (Complainant) has filed a complaint against Life Insurance

Corporation of India. (Respondent) alleging that Survival Benefit due on 2004 has not been made.

YKS


Brief Facts of the Case:- 18. As per the complaint, complainant had taken one policy no. 282677648 for Rs. 50000/- under

Jeevan Surabhi (Money Back) plan for 15 years on 28.09.2000 from LIC of India. As per policy

condition, he had to get S.B. payment on 2004, 2008 and 2012 and balance amount on maturity on

28.09.2015. Complainant has further stated that he had got the maturity amount of Rs. 28550/-

only. He had not received S.B payment due on 2004,2008 & 2012. When he enquired from LIC he

came to know that that S.B due on 2004 was paid on 14.08.2004, S.B due on 2008 was paid on

17.09.2008 and S.B. due on 2012 was paid on 23.08.2012.After verification, complainant has

observed that these payments have not been received by him. Hence again he lodged a complaint.

Thereafter he received the S.B due on 2008 on 16.10.2015 and S.B. due on 2012 on 31.10.2015

through NEFT without interest but he had not received S.B due on 2004. Being aggrieved, the

complainant approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. Dated 13.03.2020, RIC has stated that S.B. due on 09/2004 of Rs. 15000/-was paid on

28.09.2004 vide cheque no 312543 and it was also endorsed on Original policy bond. This amount

is also not appearing in Stale account. RIC has further stated that case is almost 16 years old, so it

is very difficult to trace the encashment details as old record is destroyed after 10years.RIC has

also stated that SB due on 09/2008 and 09/2012 was paid by cheque and both cheques were not

encashed ,hence payments were made on 16.10.2015 through NEFT.




Findings:-

22. Complainant has taken a policy under the table 106-15. It was a 15 years ―Jeevan Surabhi

policy‖ wherein first survival benefit was due on 4th year from commencement. Date of


commencement was 30.09.2000. Sum assured was Rs. 50,000/-. An amount of Rs. 15,000/- was

paid to the complainant on 28.09.2004 by cheque no. 312543. Although complainant is denying

the receipt of the amount but the same cannot be accepted. Endorsement of the payment was

made on the original policy bond. Further since 2004 till 2015 complainant did not raise any

complaint regarding non- receipt of survival benefit. Had it been so, complainant would have raised

his grievance. Accordingly it is held that survival benefit of September, 2004 was paid to the

complainant.

23. So far as maturity amount is concerned same was paid to the complainant. Survival benefit‘s of

September 2008 and September 2012 were made on 16.10.2015 and 31.10.2015 but no interest

was paid by the respondent. When the amount was not paid on its due date complainant would be

entitled for the payment of penal interest. Accordingly complaint is liable to be allowed.

Order:-

24. Complaint is partially allowed. Respondent are directed to pay penal interest at the rate of 8.25

percent per annum from due date till the date of actual payment on the survival benefit due on

September, 2008 and September 2012. Compliance be made within 30 days.




PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP


Mr. Umesh Sharma………………………………………….……………………….Complainant

V/S

Life Insurance Corp. of India …….…..…....…………………...…………………Respondent


1. Name & Address of the Complainant Mr. Umesh Sharma

Khurram Nagar

Lucknow

2. Policy No:

Type of Policy

Duration of policy/DOC

219078586

-

-



Mr. Umesh Sharma

Mr. Umesh Sharma

4. Name of the insurer Life Insurance Corp. of India

5. Date of Repudiation/Rejection -

6. Reason for repudiation/Rejection -


8. Nature of complaint SB payment

9. Amount of Claim

10. Date of Partial Settlement


12. Complaint registered under Rule Rule No. 13(1)(b) of Ins. Ombudsman

Rule 2017

13. Date of hearing/place On 06.03.2020 , 10.30 am at Lucknow


For the Complainant Mr. Umesh Sharma

For the insurer Mr. Rishi Misra



17. Mr. Umesh Sharma (Complainant) has filed a complaint against Life Insurance Corp.

of India (Respondent) alleging that survival benefit was not credited in his bank account.

MS


Brief Facts of the Case:-

18. Mr. Umesh Sharma has lodged his complaint on 18.06.2019 stating that he had a

policy with LIC. His survival benefit was due under the policy on 28.01.2019. As per SMS

from LIC he changed his NEFT Details in his policy in December 2018 and survival benefit

due on 20.01.2019 was credited to his old inactive bank account with IDBI. He was feeling

cheated and lodged his complaint on LIC portal and reply was received that payment

voucher was made before his fresh mandate updation. LIC is in communication with IDBI

for reversal of the said amount. He has waited for two months but payment was not

received. Being aggrieved, the complainant approached this forum for the redressal of his

grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that LIC makes SB payment vouchers (NEFT),

45 days in advance. It get credited to the account on due date which was registered at the

time of making payment voucher. In this case the payment voucher was made on

15.12.2018 and was credited on due date 28.01.2019 to IDBI account which was active at

that time. The policy holder account was changed on 31.12.2018 at some other outstation

branch. The complainant did not inform branch office that he has got his account changed

at some other branch. Once SB payment voucher is prepared then there is no system that

automatically updates the account. On complaint branch office acted and wrote to bank for

reversal. However, RIC replied that account was active on date and amount is credited in

customer`s account on 28.01.2019. All future payments will be credited to changed new

account number.

20. The complainant has filed a complaint letter, annexure VI A, correspondence with

respondent while respondent has filed SCN with enclosures.

21. I have heard the complainant as well as respondent representative and perused the

record.

Findings:-

22. Admittedly an amount of Rs. 20,000/- of survival benefit was due in favour of the

complainant which was paid in already registered account no. 015104000227711 of IDBI

bank. The contention of the complainant is that he filled in a NEFT update form which was

duly done by the LIC on 31.12.2018. Intimation of the same was also sent to the

complainant but even


then the amount of survival benefit is transferred in IDBI bank which was dormant at that

time. Respondent representative submits that the survival benefits to be paid to insured

was processed on 15.12.2018 much prior to the change of NEFT details by the

complainant. Thereafter although the complainant has updated the NEFT details but they

could not be changed by the LIC so far as particular survival benefit is concerned. Hence

the payment was made to the IDBI bank.

23. Complainant bank account of IDBI bank was operated. Payment of survival benefit

was made in that account. If it was a dormant account complainant should have informed

the LIC about it. On the request of complainant LIC tried for reversal of survival benefit

amount from IDBI bank but was informed that the amount has been credited in the

account holder‘s account. Since the account in IDBI was operated there was no question

of reversal of amount. Accordingly I do not find any merit in the complainant which is liable

to be dismissed.

Order:-


25. Let copy of this award be given to both the parties.





Mr. Haridwar Pandey…… ………………..……....………………. Complainant

V/S

Life Insurance Corp. of India…………………....…....…………………………Respondent


1. Name & Address of the Complainant Mr. Haridwar Pandey

Basdila Sardar Nagar

Gorakhpur

2. Policy No:

Type of Policy


291164376

-

28.12.1998



Mr. Haridwar Pandey

Mr. Haridwar Pandey





8. Nature of complaint Less Maturity Amount paid

9. Amount of Claim



12. Complaint registered under Rule Rule No. 13(1)(b) of Ins. Ombudsman Rule

2017




For the insurer Mr. Dheeraj Kumar Saxena



17. Mr. Haridwar Pandey (Complainant) has filed a complaint against Life Insurance Corp. of

India (Respondent) alleging that less maturity amount was paid.

MS



18. Mr. Haridwar Pandey has lodged his complaint on 30.10.2019 stating that less maturity amount

was paid by the company Life Ins. Corp. of India. The complainant has stated that as per LIC letter

dated 05.05.2009 PDB benefit was granted on his policy and further premiums under the policy

was waived. Endorsement on his policy bond was also done by the LIC. But on maturity of the

policy he has not received full benefit due to unpaid premiums. The complainant is not able to be

present at RIC`s office, he approached many time LIC via his representative but no action was

taken. Being aggrieved he approached this forum for redressal of his grievance.

Written reply/SCN:-

19. In their SCN/written reply, the RIC has stated that disability benefit was approved on

05.05.2009 and disability benefit was paid from 11/2003 to 11/2013. Full sum assured with bonus

was payable on maturity. Due to non payment of premium (disability was not endorsed on system)

Rs. 37334/- was paid. On policy holder request balance maturity amount with bonus was paid to

the complainant.

20. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent



perused the record.

Findings:-

22. Complainant was insured under the plan Table 14-20. Date of commencement was

28.12.1998. Date of maturity was 28.12.2018. On maturity an amount of Rs.34,334/- only was

paid. Complainant made a complaint. Subsequently respondent calculated the amount which

was due as 1,01,600/- Accordingly there was a difference of Rs. 64266/-. Interest of late payment

was calculated as Rs. 5715/-. Payment of Rs. 64266/- was made on 15.02.2020


while the interest was paid on 04.03.2020. Accordingly since payments have been made

complaint becomes infructuous and liable to be dismissed.

Order:-







Mr. Vijay Kumar Verma ………………..…………………....………………. Complainant

V/S

L.I.C.OF INDIA …………………………………………………………………….....Respondent

COMPLAINT NO: LCK-L-029-1920-0397 Order No. IO/LCK/R/LI/ 0516 /2019-20

1. Name & Address of the Complainant Mr. Vijay Kumar Verma

C 33/265 – 16 C;

Chhittupur

Varanasi- 221005

2. Policy No:

Type of Policy

DOC

Duration

280913945

Money Back Plan

25.02.1994

15Years with premium paying term 12 Years



Mr. Vijay Kumar Verma

Mr. Vijay Kumar Verma

4. Name of the insurer L.I.C.OF INDIA

5. Date of Repudiation/Rejection --



8. Nature of complaint Payment not made to policyholder under

Assigned Policy

9. Amount of Claim Maturity along with interest


11. Amount of relief sought Maturity amount along with interest

12. Complaint registered under Rule Rule No.13(1)(e)of Insurance Ombudsman

Rule 2017

13. Date of hearing/place 17.03.2020 at 10.15A.M.


For the Complainant Mr. Vijay Kumar Verma


15. Complaint how disposed Recommendation


17. Mr. Vijay Kumar Verma (Complainant) has filed a complaint against L.I.C.OF INDIA.

(Respondent) alleging that maturity amount has not paid under Assigned Policy.

YKS

COMPLAINT NO: LCK-L-029-1920-0397 Order No. IO/LCK/R/LI/0516 /2019-20

Brief Facts of the Case: -

18. As per complaint, the complainant had taken policy no.280913945 for Rs. 10000/- under

―Jeevan Surabhi‖ plan on 25.02.1994. Policy matured on 25.02.2009.Policy was assigned with

Syndicate Bank Varanasi. Bank has given NOC on 09.09.2015 that there are no outstanding dues

as on date. But LIC has not made the maturity payment. Being aggrieved, the complainant

approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 10.12.2019, RIC has stated that Policy no. 280913945 was issued under T-

T 106-15 with Sum assured 10000/- on 25.02.1994. Maturity was due on 25.02.2009. Policy was

assigned in favour of Syndicate Bank Varanasi, hence claim amount of Rs.7780/-was paid through

cheque no.39326 dated 31.03.2009 to Syndicate Bank Varanasi. This cheque was not encashed

by Bank and amount is lying under Stale account.RIC has further stated that the case is 10 years

old and no record is available in the branch and System is not generating payment voucher.

20. The complainant has filed a complaint letter and correspondence with respondent while

respondent has filed SCN.


Findings:-

22. Admittedly a loan was taken by the complainant from Syndicate bank Branch, Hathua Market,

Varanasi. Policy was in question was assigned in favour of the bank. Loan amount was fully repaid

and loan account was closed.

23. Whole controversy arose when the maturity amount was not paid to the complainant. As per

the respondent cheque no. 39326 dated 31.03.2009 for Rs. 7780/- was issued in favour of the

Syndicate bank which was not enchased by the bank. Subsequently cheque was in stale but

details of encashment are not available with the LIC. Undoubtedly complainant is entitled for

COMPLAINT NO: LCK-L-029-1920-0397 Order No. IO/LCK/R/LI/0516 /2019-20

the amount if the cheque was not enchased by the Syndicate Bank. Accordingly complaint is

disposed off with certain direction.

Order:-

24. Complaint is disposed off. Respondent should obtain a certificate from the Syndicate Bank,

Hathua Market, Branch Varanasi on the point as to whether the cheque was enchased by the bank

or not. If the cheque is not enchased by the bank then respondent shall make the payment to the

complainant with penal interest at the rate of 8.25 percent per annum from it due date till the date

till the date of actual payment. If bank certifies that payment has been received by the bank then

details of payment should be communicated by the respondents to the complainant. Compliance

be made within 45 days.






Mr. Surendra Jeet Singh ……………………………..……....………………. Complainant

V/S

L.I.C.OF INDIA ……………………………………………………………………...Respondent


1. Name & Address of the Complainant Mr. Surendra jeet Singh

S/O Sri Amarjeet Singh

Moh-Raipur Raja

Dist. Baharaich- 271801

2. Policy No:

Type of Policy

DOC

Duration

213808671 & 212375151

Money Back Plan

28.12.2002 & 28.12.1999

12Years & 20 Years



Mr. Surendra jeet Singh & Preeti Ahluwalia

Mr. Surendra jeet Singh & Preeti Ahluwalia

4. Name of the insurer L.I.C.OF INDIA

5. Date of Repudiation/Rejection --



8. Nature of complaint Payment not made to policyholder under

Assigned Policy

9. Amount of Claim Maturity & S.B. amount along with interest


11. Amount of relief sought Maturity & S.B. amount along with interest

12. Complaint registered under Rule Rule No.13(1)(e)of Insurance Ombudsman

Rule 2017




For the insurer Mr. Heera Singh



17. Mr. Mr. Surendra jeet Singh & Preeti Ahluwalia (Complainant) have filed a complaint against

L.I.C.OF INDIA. (Respondent) alleging maturity and S.B. amount has not paid under Assigned

Policy.

YKS



18. As per complaint, the complainants have stated that policy no.213808671 & 212375151 were

issued on the life of Mr. Surendra jeet Singh & Preeti Ahluwalia by L.I.C. of India. Complainant has

stated that---

A) Policy no.212375151 was issued under Money Back Plan and S.B. was due on

28.12.2004,28.12.2009 & 28.12.2014.Policy was Assigned with State Bank of India on 19.08.009

and Re-assigned on 24.08.2015. Bank has given NOC on 04.02.2015 that there is no outstanding

as on date against the policy no. 212375151.But no S.B. has been paid by LIC.

B) Policy no. 213808671 was issued on 28.12.2002 for 12 years. Policy got matured on

28.12.2014. Policy was assigned with State Bank of India on 19.08.009. Bank has given NOC on

04.02.2015 that there is no outstanding as on date (But this policy number is not mentioned).But

LIC has not made the maturity payment.

Original policy bonds of both the policies are with the complainant, but payments are not being

made to them. Being aggrieved, the complainant approached this forum for the redressal of his

grievance.

Written reply/SCN:-

19. In SCN/reply dated 18.01.2020, RIC has stated that-

A). Policy no. 213808671 was issued under T-T 154-20 with Sum assured 68000/- on 28.12.2002.

S.B. under above policy was due on 12/2206 & 12/2010 and was paid on 28.12.2006 & 10.12.2010

through cheque no. 05228756 & 96986. Cheques were encashed on 13.02.2007 & 19.01.2011

respectively. Maturity was due on 28.12.2014. Policy is assigned in favour of Oriental Bank of

Commerce Kanpur, hence claim could not be settled.

B). Policy no. 212375152 was issued under T-T 75-20 with sum assured 200000/- on 28.12.1999.

S.B. was due on 2004, 2009 & 2014. S.B due on 12/2004 was paid vide cheque no.613076 on

28.12.2004 which was encashed on 28.02.2005. But S.B due on 12/2009 & 12/2014 could not be

made as policy is assigned. Further RIC has informed that payment can only be made after getting

Original policy bonds and discharge forms which are still not received in office.


20. The complainant has filed a complaint letter annexure VI A, and correspondence with

respondent while respondent has filed SCN.


perused the record.

Findings:-

22. The complaint relates to following 2 LIC policies in which contention is that even after maturity

period LIC is not making the payment.

23. In the SCN dated 18.01.2020 it is mentioned that the policy no. 213808671 was matured on

28.12.2014. This policy was assigned to Oriental Bank of Commerce, Kanpur. Now complainant

has submitted that the Oriental Bank of Commerce, Kanpur has given a no objection certificate

dated 04.02.2015. No objection certificate relates to 6 policies wherein the policy no. 213808671 is

not mentioned. In any case LIC was required to made the payment on maturity either to the

complainant or the Oriental insurance bank as the case of be but the same was not made. It is

against the law.

24. Policy no. 212375151 matured on 28.12.2019. This policy finds place in the no objection

certificate of Oriental Bank of Commerce dated 04.02.2015. On the date of maturity Oriental Bank

of Commerce was not having outstanding dues on this policy then LIC should have made the

payment which was not done. Accordingly complaint is liable to be allowed.

Order:-

25. Complaint is allowed. Respondent are directed to make the payment of policy no. 213808671

and 212375151, in accordance with the terms and conditions of the policy bond as per the title of

the policy holder. LIC should also pay the penal interest at the rate of 8.25 percent per annum from

28.12.2014 till the actual date of payment in policy no. 213808671 and in policy no. 212375151

from 28.12.2019 till the actual date of payment.

COMPLAINT NO: LCK-L-029-1819-0282 Order No. IO/LCK/A/LI/ 0468 /2019-20

26. Let copy of award be given to both the parties.

Date: 05.03.2020 Justice Anil Kumar Srivastava

Place: Lucknow (Insurance Ombudsman)



Mrs. Soni…………..…… …………………..……....…………….……………. Complainant

V/S

L.I.C. of India……..…...……………..………..…………………..…..………...Respondent


1. Name & Address of the Complainant Mrs. Soni

Telibagh

Lucknow

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

MR no.156

Dated 31.05.2006



-

-

4. Name of the insurer L.I.C. of India




8. Nature of complaint Payment of maturity

9. Amount of Claim Rs. 25000/=


11. Amount of relief sought Rs.25000/=

12. Complaint registered under Rule Rule No.13(1)(d)of Insurance Ombudsman Rule

2017




For the insurer Rishi Misra



17. Mrs. Soni (Complainant) has filed a complaint against LIC of India (Respondent) alleging that

maturity amount was not paid.

MS



18. Ms. Soni has lodged her complaint on 20.05.2019. The complainant has stated that she has

deposited Rs.25000/= for policy and receipt was issued by LIC. Maturity of policy was after 10

years i.e. on 31.05.2016. After maturity the complainant has not received her policy maturity

amount. The complainant approached insurance company but no response was received. Being

aggrieved, the complainant approached this forum for the redressal of her grievance.

Written reply/SCN:-

19. In their SCN/reply the RIC has stated that Rs.25000/- was deposited at branch office Mohan

Lal Ganj vide M.R. No.156 dated 31.05.2006. The RIC has mentioned that due to under age plan

No.172 was not given to Ms. Soni. As per terms and conditions of policy minimum age at entry was

18 years. The said amount was adjusted towards policy no.216315060 favoring Sri Suresh Kumar

Dubey (Father of complainant) Ms. Soni is the nominee under the said policy. The said policy

stands surrendered by the policy holder Sri Suresh Kumar Dubey in 2011.

20. The complainants have filed a complaint letter along with other relevant papers Ann. VI A while

respondent has filed SCN with enclosures.


perused the record.

Findings:-

22. Amount of Rs. 25,000/- is deposited by the complainant on 31.05.2006 vide miscellaneous

receipt No.156. A policy under plan 172 was to be provided but it was found that the complainant

Miss Soni was minor at that time hence the policy could not be issued in her favour under the

aforesaid plan. Consequently the policy was issued in favour of her father namely Suresh Kumar

Dubey for the amount of Rs. 25,000/- as above. Policy was surrendered in 2011 and payment was

made.


23. It appears that there is some confusion to the complainant regarding her insurance policy. No

policy bond was issued in her favour hence there is no question for making payment in her favor.

Accordingly complaint lacks merit and liable to be dismissed.

Order:-







Dr. Ram Ashray Sahu…………. ………………..……....………………. Complainant

V/S



1. Name & Address of the Complainant Dr. Ram Asray Sahu

Haleem College Road,

Kanpur

2. Policy No:

Type of Policy


233694767

Wealth Plus

08.05.2010



Mr. Ram Asray Sahu

Mr. Ram Asray Sahu





8. Nature of complaint Maturity Amount less paid

9. Amount of Claim




2017



For the Complainant Dr. Ram Ashray Sahu

For the insurer Alka Srivastava



17. Dr. Ram Asray Sahu (Complainant) has filed a complaint against Life Insurance Corp. of India

(Respondent) alleging less amount paid on maturity.

MS



18. Dr. Ram Asray Sahu has lodged his complaint on 20.09.2019 stating that less amount was

paid by the company Life Ins. Corp. of India on maturity of his policy. The complainant has stated

that he deposited Rs.1,00,000/= as single premium for 8 years but on maturity of the said policy

he received only Rs.76,997/= as maturity amount of the policy. He further stated that at proposal

stage agent assured him to get highest NAV for policy period and gave him pamphlet to assure

payment of Rs.3,45,639/=. The complainant is senior citizen and cheated by

promoter/adviser/Branch Manager/Dev. Officer of RIC by giving false allurement. This is ―Criminal

breach of Trust‖, done by LIC of India. Policy bond was also not returned by LICI for extended risk

cover of two years after proper endorsement. The complainant was not satisfied. Being aggrieved

he has approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the complainant has purchased policy no.

233694767 under plan 801 (Wealth Plus) for term 8 years with single premium paying term. He

lodged his complaint regarding maturity payment of wealth Plus policy. As per terms and

conditions of the policy risk premium was chargeable every month, and at the time of proposal the

age of the complainant was higher side. There is two years extended life cover under this policy

after completion of policy term. On maturity, the bid value as on date of maturity will be based on

the highest NAV over the first 7 years of the policy or the NAV as applicable at the end of the policy

term whichever is higher. After deduction as per rules maturity amount was paid to the policy

holder. Highest NAV on maturity date 08.05.2018 was 15.9708. The RIC has paid fund value of

units held in policy holders account as Rs.76,997/-.





Findings:-

22. Complainant had taken the policy under ―Wealth plus plan (unit linked)‖ on 08.05.2010.

Complainant has paid single premium of Rs. 1,00,000/- On maturity as per the NAV Rs. 7,69,97/-

was paid.

23. On the date of maturity the unit value was 15.9708. Respondent‘s representative submits that

although the value of unit was increased but the allocation charges, mortality charges and other

charges were deducted and the maturity sum of Rs. 76,997/- was paid. The maturity claim was

calculated correctly as per the terms and conditions of the policy bond. I do not find any ground to

interfere. Accordingly complaint lacks merit and is liable to be dismissed.

Order:-


25. Let copy of award be given to both the parties.





Mr. Ram Awadh Yadav……………………………….………………………….Complainant

V/S

Life Insurance Corp. of India…………………....………………........…………Respondent


1.

Name & Address of the Complainant Mr. Ram Awadh Yadav

Vill. Chakhani Bhoj Chhapra

Kushinagar (Gorakhpur)

2. Policy No:

Type of Policy


295768482

Jeevan Saral

28.08.2009



Mr. Ram Awadh Yadav

Mr. Ram Awadh Yadav





8. Nature of complaint Less Maturity Amount

9. Amount of Claim




2017



For the Complainant Mr. Ram Awadh Yadav




17. Mr. Ram Awadh Yadav (Complainant) has filed a complaint against Life Insurance Corp. of

India (Respondent) alleging that less amount was paid on maturity.

MS



18. Mr. Ram Awadh Yadav has lodged his complaint on 17.09.2019 stating that less maturity

amount was shown by the company Life Ins. Corp. of India on discharge voucher for maturity of his

policy. The complainant has deposited Rs.12130/= half yearly regular for 10 years amounting total

Rs.2,42,600/= but LIC intend to pay Rs. 1,54,100 only which was less by Rs.88500/= than to his

deposited amount. The complainant has stated that he was entitled for his deposit amount with

bonus. The complainant has approached RIC but no response was received from them. Being

aggrieved he has approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the policy under reference is still pending for

payment for want of policy bond and discharge form duly signed by the policy holder. Under the

policy death sum assured was Rs.5 lacs. Basically purpose of this plan is to cover death risk. The

policy was taken at the age of 57 years so maturity sum assured is Rs.1,08,140/= plus loyalty

addition Rs.45960/= total payable Rs.1,54,100.00 as per terms and conditions of the policy.




Findings:-

22. Complainant has taken the LIC Jeevan Saral (with profit) policy on 28.08.2009. Instalments

premium for main plan was Rs. 11880/- while instalments accident benefit premium was Rs. 250/-

total instalments premium was Rs. 12130/-. Premium was to be paid on half yearly mode. Date of

maturity was 28.08.2019. Policy was taken by the insured at the age of 57 years.

23. Controversy arose when the life assured was offered Rs. 1,54,100/- only. Contention of the

complainant is that it is a case of mis-selling.


24. Per Contra respondent representative submitted that in the policy bond maturity sum assured

is not mentioned. It is further submitted that the calculation of the maturity sum was made in

accordance with the table no. 165 under which the plan the policy was issued.

25. No doubt policy was issued under the approval of IRDA. As per the circular no. ACTL/1934/4 of

the LIC the plan in question was issued under the table no. 165 wherein the basic core factor is

that it provides to the policy holder highly covered with a smooth return, Liquidity and lots of

flexibility. It is also provided in the plan in conventional products premium rates are given per

1000/- sum assured for different entry ages and terms. Under this product death cover will be

same irrespective of at entry and term but the sum payable at maturity will differ for different entry

ages and terms. This policy also provides for loyalty additions. Loyalty additions will be declared

after the policy has been in full form for at least 10 years. On Maturity the life insured will get the

maturity sum assured plus loyalty addition if any.

26. Only point to be looked into as to whether the complainant can take advantage of non-

mentioning of maturity sum assured in the policy bond? Column redressing to maturity sum

assured is lying vacant. When nothing is printed in this column how it can would be presumed that

the maturity sum assured will be premiums deposited alongwith 8.5 percent bonus. The policy

bond was generated through computer and the entries are made on a printed form. It is settled

legal position that a party cannot take the advantage of a printing or typographical error in the

agreement. A presumption cannot be raised in favor of the complainant. It is more important that

the basic features of table no. 165 are in public domain. In that situation it cannot be accepted that

any mis-selling was done with the complainant.

27. Accordingly I am of the view that the payment of Rs. 1,54,100/- was offered by the respondent

LIC to the complainant in accordance with the terms and conditions of the policy bond which is

justifiable. It doesn‘t require any interference. Accordingly complaint is liable to be dismissed.


Order:-







Mr. Rishikesh Pandey.…… ………………..……...............………………. Complainant

V/S

Life Insurance Corp. of India…………………....…....…………….……………Respondent


1. Name & Address of the Complainant Mr. Rishikesh Pandey

Vill. Khopapaar, Post Deideeha

Distt. Gorakhpur

2. Policy No:

Type of Policy


294883908

Jeevan Saral

23.03.2009



Mr. Rishikesh Pandey

Mr. Rishikesh Pandey






9. Amount of Claim




2017



For the Complainant Mr. Rishikesh Pandey




17. Mr. Rishikesh Pandey (Complainant) has filed a complaint against Life Insurance Corp. of

India (Respondent) alleging that less amount was paid on maturity.

MS



18. Mr. Rishikesh Pandey has lodged his complaint on 02.08.2019 stating that less maturity

amount was paid by the Life Ins. Corp. of India on maturity of his policy. He has deposited

Rs.3032 /= half yearly premium regularly for 10 years. The LIC of India has paid total Rs.40589/=

maturity amount of his policy against deposited amount of Rs.60640. The complainant has stated

that agent of RIC has allured him that on maturity he will get Rs. 106452/= and gave him pamphlet

of the plan. The complainant has approached RIC but no response was received from them. Being

aggrieved he has approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that maturity sum assured under the said policy was

Rs.29845/= and on maturity sum assured with loyalty addition of Rs. 10744/= total Rs. 40589/=

was paid to the policy holder. The plan is basically for death cover benefit on minimum premium

higher death cover benefit. Payment of maturity was done as per terms and conditions of the

policy.




Findings:-


premium for main plan was Rs. 2969.50/- while instalment accident benefit premium was Rs.

62.50/-.Total instalments premium was Rs. 3032.00/-. Premium was to be paid in half yearly mode.

Date of maturity was 23.03.2019. Policy was taken by the insured at the age of 56 years.


23. Controversy arose when the life assured was offered Rs. 40,589/- only. Contention of the

complainant is that it is a case of mis-selling. When the policy was sold he was told that the

maturity value would be Rs. 1,06,452/-.


is not mentioned. It is further submitted that the calculation of the maturity sum was made in

accordance with the table no. 165 under which the plan the policy was issued.











mentioning of maturity sum assured in the policy bond? Column redressing to maturity sum


it was Rs. 1,06,452/-. The policy bond was generated through computer and the entries are made

on a printed form. It is settled legal position that a party cannot take the advantage of a printing or

typographical error in the agreement. A presumption cannot be raised in favor of the complainant.

It is more important that the basic features of table no. 165 are in public domain. In that situation it

cannot be accepted that any mis-selling was done with the complainant.

27. Accordingly I am of the view that the payment of Rs. 40,589/- was offered by the respondent

LIC to the complainant in accordance with the terms and conditions of the policy


bond which is justifiable. It doesn‘t require any interference. Accordingly complaint is liable to be

dismissed.

Order:-







Mr. Suraj Gupta.…… ………………..………………...………………. Complainant

V/S

Life Insurance Corp. of India…………………....…....………….…………Respondent


1.

Name & Address of the Complainant Mr. Suraj Gupta

Vill. & post Lakhima

Distt. Maharajganj

2. Policy No:

Type of Policy


295208256

Jeevan Saral

24.02.2009



Mr. Suraj Gupta

Mr. Suraj Gupta






9. Amount of Claim




2017







17. Mr. Suraj Gupta (Complainant) has filed a complaint against Life Insurance Corp. of India

(Respondent) alleging that less amount was paid on maturity.

MS



18. Mr. Suraj Gupta has lodged his complaint on 28.05.2019 stating that less maturity amount was

paid by the company Life Ins. Corp. of India on maturity of his policy. The complainant has stated

in his complaint that he has deposited regularly Rs.4704/= for 10 years. The LIC of India has paid

total Rs.58105/= as maturity amount of his policy, this is not acceptable so he approached

RIC/GRO for redressal but their message received that complaint resolved but no letter received

for redressal of his grievance. The complainant has stated that he is entitled for sum assured

Rs.100000/= with bonus as mentioned on policy bond.. The complainant has approached RIC but

no response was received from them. Being aggrieved he has approached this forum for the

redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the policy holder submitted documents for maturity

payment on 27.01.2020 and paid Rs. 58105.00 + Rs. 1571 as interest to the complainant through

NEFT. The maturity sum assured of the policy was Rs.44696.00. The plan is basically for death

cover benefit on minimum premium higher death cover benefit. Payment of maturity was done as

per terms and conditions of the policy.




perused the record.

Findings:-

22. Insured Shri Suraj Gupta took a policy ―LIC Jeevan Saral‖ with a sum assured Rs. 1.00 lakh.

Date of commencement was 24.02.2009. Annual premium was Rs. 4704/-. Term was 10 years. On

maturity insured got an amount of Rs. 58,105/- as maturity.


23. Main grievance of the complainant is that he paid an amount of Rs. 47,040/- in 10 years while

he received only Rs. 58,105/-. He was put to loss. This fact was not communicated to her by the

concerned agent.

24. This policy was under ―LIC Jeevan Saral‖ with profit. In the policy bond itself maturity sum

assured mention as Rs. 44,696/-. Policy bond is a document which is binding upon the parties. It is

also mentioned in the bond 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 the

corresponding loyalty addition, if any, shall be payable‖.

25. Undisputedly policy bond was sent to the insured. Policy bond was presented by the insured at

the time of maturity. Life of the insured was covered under the plan till the date of maturity. In such

circumstances when bond itself provides the maturity sum assured the insured cannot challenge

the same. Insured is estopped from challenging the same.

26. On the basis of discussion made above, I do not find any merit in the complaint which is liable

to be dismissed.

Order:-


28. Let the copy of this award be given to both the parties.





Mr. Ashok Kumar Garg…… ………………………….……....………………. Complainant

V/S

L.I.C. of India……..…...……………..………..………………..…..…..………...Respondent


1. Name & Address of the Complainant Mr. Ashok Kumar Garg

Allen Ganj

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

233680926

Jeevan Saral

28.10.2009

10 years



Mr. Ahok Kumar Garg

Mr. Ahok Kumar Garg





8. Nature of complaint Maturity amount less



11. Amount of relief sought Maturity figure in Policy Bond


2017



For the Complainant Mr. Ashok Kumar Garg

For the insurer Sri Brajesh Kumar Katiyar



17. Mr. Ahok Kumar Garg (Complainant) has filed a complaint against LIC of India (Respondent)

alleging that less maturity amount was paid.

MS



18. Mr. Ashok Kumar Garg has lodged his complaint on 30.12.2019. Alleging that he is senior

citizen. He had taken a policy no.233680926 under T-T 165-10 for Rs. 375000/- on 28.10.2009.

Under this policy, he has paid premium of Rs.18015/- per annum for 10 years. Accordingly he had

deposited the premiums in time. Maturity amount of his policy as informed by RIC was only

Rs.45885/= + addition Rs.16519/=. Claimant has further stated that the maturity sum assured

should be Rs. 375000/- so he signed discharge voucher with remark ―Under Protest & without

Prejudice to my right‖. The complainant received payment of Rs.62404/= as maturity sum. He

approached RIC/GRO but was not satisfied with reply. He personally met with the LIC CRM

Kanpur and was not satisfied. The complainant has been cheated by the officials of LIC as on

launching the ―Jeevan Saral with Profit‖ benefits were explained by LIC not about losses during

that time. Being aggrieved, the complainant approached this forum for the redressal of her

grievance.

Written reply/SCN:-

19. In their RCN/reply the RIC has stated that policy no.233680926 was issued on the life of Mr.

Ashok Kumar Garg on 28.10.2009 under T-T 165-10. The annual premium is Rs.18015/- . Death

sum assured and Double accident benefit under the policy is 375000/- but the maturity amount is

Rs.45885+ Rs.16519(loyalty), total Rs. 62404/= only. Maturity amount is not printed on the policy

bond by mistake.




Findings:-



total instalments premium was Rs. 18015/-. Premium was to be paid on yearly mode. Date of



23. Controversy arose when the life assured was given Rs. 62404/- only. Contention of the

complainant is that it is a case of mis-selling. When the policy was sold it was sold with the sum

assured and the maturity value would be Rs. 3.75 lakh and maturity bonus would also to be

payable. It is further submitted that even in the policy bond sum assured is mentioned as Rs 3.75

lakh. It is further submitted that in the policy bond maturity sum assured was mentioned as Rs 3.75

lakh.

24. Complainant very vehemently argued that he was cheated by the LIC. False promises were

made even by Senior Officials of LIC. Hoardings were spotted with false promises. Sum assured

should be given on maturity. There is no justification for making payment of an amount which is

even less to the deposited amount.


is not mentioned. Due to some typographical mis-match amount of Rs. 3.75 lakh which was death

benefit sum assured is being misunderstood as maturity sum assured. It is further submitted that

the calculation of the maturity sum was made in accordance with the table no. 165 under which the

plan the policy was issued.

26. Complainant has also filed certain papers today. These papers are new items article or

speeches regarding ―Jeevan Saral‖Policy:-

I. Will LIC be made to pay for the horrible mis-selling for Jeevan Saral?

II. Mr. Dr. Kirti Somaiya‘s letter to IRDAI Chairman

III. Branch office surprised with negative returns.

IV. Letter of National Federation of Insurance Field workers of India of LIC.

V. RTI information denied by LIC.

VI. Where are the Consumers Protection Regulations

VII. Why Senior Citizen should never buy life insurance

VIII. Get money life‘s top stories and E-mail


27. No decision of any authority is filed. Mere newspaper cutting or article have no bearing on merit

of the case. These are the opinion of different persons which does not have any binding effect

legally. Hence, I do not find any substance in all these newspaper cuttings or articles.

28. A copy of award dated 11.08.2017 is also filed. It is neither a certified nor attested copy.

Further name of Insurance Ombudsman place of sitting is also not mentioned. Further it is a

judgement of coordinate forum which did not have any binding effect upon this forum.











mentioning of maturity sum assured in the policy bond? We can read the bond and find that 2

sums are mentioned in the policy bond which is Rs 3.75 lakh each meant for death benefit sum

assured under main plan and accident benefit sum assured. Column relating to maturity sum


it was Rs 3.75 lakh? The policy bond was generated through computer and the entries are

made on a printed form. Little mis-match that is printing of an amount of Rs 3.75 lakh on a higher

side with a few millimeters difference cannot extend a benefit or right to the complainant. It is

settled legal position that a party cannot take the advantage of a printing or





31. Accordingly I am of the view that the payment of Rs. 62404/- was paid by the respondent LIC

to the complainant in accordance with the terms and conditions of the policy bond which is


Order:-







Mrs. Alpna Rani Garg…………………………………………………………Complainant

V/S

L.I.C. of India……..…...……………..………..………………..…..………...Respondent


1. Name & Address of the Complainant Mrs. Alpna Rani Garg

Allen Ganj

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

233678583

Jeevan Saral

26.09.2009

10 years



Mrs. Alpna Rani Garg






8. Nature of complaint Less Maturity



11. Amount of relief sought maturity figure in Policy Bond


2017



For the Complainant Mrs. Alpna Rani Garg




17. Mrs. Alpna Rani Garg (Complainant) has filed a complaint against LIC of India (Respondent)


MS



18. Mrs. Alpna Rani Garg has lodged her complaint on 22.11.2019. She had taken a policy

no233678583 under T-T 165-10 for Rs. 375000/- on 26.09.2009. Under this policy, she has paid

premium of Rs.18015/- per annum for 10 years total Rs.180150. Accordingly she had deposited

the premiums in time. Maturity amount of his policy as informed by RIC was only Rs45885/= +

addition Rs.16519/=. Claimant has further stated that the maturity sum assured should be Rs.

375000/- so she signed discharge voucher with remark ―Under Protest & without Prejudice to my

right‖. The complainant received cheque of Rs.62404/= as maturity sum. She approached

RIC/GRO but not satisfied with reply. She personally met with the LIC CRM Kanpur and not

satisfied. The complainant has been cheated by the official of LIC. Being aggrieved, the

complainant approached this forum for the redressal of her grievance.

Written reply/SCN:-

19. In their RCN/reply the RIC has stated that policy no.233678583 was issued on the life of Mrs.

Alpna Rani Garg on 26.09.2009 under T-T 165-10. The annual premium is Rs. 18015/- Death sum

assured and Double accident benefit under the policy is 375000/- but the maturity amount is Rs.

45885+Rs. 16519(loyalty) only. Maturity amount is not printed on the policy bond by mistake.




Findings:-






23. Controversy arose when the life assured was offered Rs. 62404/- only. Contention of the





lakh.












IX. Will LIC be made to pay for the horrible mis-selling for Jeevan Saral?

X. Mr. Dr. Kirti Somaiya‘s letter to IRDAI Chairman

XI. Branch office surprised with negative returns.

XII. Letter of National Federation of Insurance Field workers of India of LIC.

XIII. RTI information denied by LIC.

XIV. Where are the Consumers Protection Regulations

XV. Why Senior Citizen should never buy life insurance

XVI. Get money life‘s top stories and E-mail







judgment of coordinate forum which did not have any binding effect upon this forum.













assured under main plan and accident benefit sum assured. Column redressing to maturity sum


it was Rs 3.75 lakh? The policy bond was generated through computer and the entries are made

on a printed form. Little mis-match that is printing of an amount of Rs 3.75 lakh on a higher side

with a few millimeters difference cannot extend a benefit or right to the complainant. It is settled

legal position that a party cannot take the advantage of a printing or








Order:-







Mr. Anil Kumar Garg ……..…………………………………....………………. Complainant

V/S

L.I.C. of India……..…...…………………………….………..………..…..……...Respondent


1. Name & Address of the Complainant Mr. Anil Kumar Garg,

Vishnupuri

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

234788629

Jeevan Saral

28.01.2009

10 years

3. Name of the insured Mr. Anil Kumar Garg

Name of the policyholder Mr. Anil Kumar Garg










2017



For the Complainant Mr. Anil Kumar Garg




17. Mr. Anil Kumar Garg (Complainant) has filed a complaint against LIC of India (Respondent)

alleging payment less maturity amount.

MS



18. Mr. Anil Kumar Garg has lodged his complaint on 08.11.2019. The complainant has stated that

he had taken a policy no.234788629 under T-T 165-10 for Rs. 250000/- on 28.01.2009 and as per

terms and conditions of the policy contract a sum of Rs.250000/- was assured on policy maturity.

Claimant has further stated that his policy got matured and LIC has sent discharge voucher of Rs.

77940/= as maturity value and Rs.28058/- as loyalty addition. The complainant has paid all

premiums as demanded in due date without break. The maturity sum assured should be Rs.

250000/- so he met with the LIC officials and lodged his complaint but no response was received.

He also complained on IRDA portal. As per contract between LIC and Policyholder, it is against

Rules of Law. Being aggrieved, the complainant approached this forum for the redressal of her

grievance.

Written reply/SCN:-

19. As per their SCN/reply the RIC has stated that policy No.234788629 was issued on the life of

Mr. Anil Kumar Garg with death sum assured Rs.250000/- premium Rs.12010/- annual. Due to

typographical mistake death sum assured and DAB was printed but maturity sum assured was not

appeared on policy bond. As per circular dated 12.02.2004 ―death cover will be same irrespective

of age at entry and term but the sum payable at maturity will differ for different entry age and

terms‖. Under the said policy Rs.77940/= +28058 is payable.

20. The complainants have filed a complaint letter along with other relevant papers Ann. VI A



Findings:-


premium for main plan was Rs. 11780.00/- while instalments accident benefit premium was Rs.

250/- total instalments premium was Rs. 12010/-. Premium was to be paid on yearly mode. Date of



23. Controversy arose when the life assured was offered Rs. 1,05,998/- only. Contention of the

complainant is that it is a case of mis-selling. When the policy was sold it was told with the sum




lakh.





















on a printed form. Little mis-match that is printing of an amount of Rs 2.50 lakh on


a higher side with a few millimeters difference cannot extend a benefit or right to the complainant.

It is settled legal position that a party cannot take the advantage of a printing or typographical error

in the agreement. A presumption cannot be raised in favor of the complainant. It is more important

that the basic features of table no. 165 are in public domain. In that situation it cannot be accepted

that any mis-selling was done with the complainant.

27. Accordingly I am of the view that the payment of Rs. 105998/- was offered by the respondent

LIC to the complainant in accordance with the terms and conditions of the policy bond which is


Order:-







Mr. Shree Krishna Verma…………………………….…..……..……………. Complainant

V/S

L.I.C. of India……..…...……………..………………………..………..………...Respondent


1. Name & Address of the Complainant Mr. Shree Krishna Verma

Rajeev Nagar

Jhansi

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

234824102

Jeevan Saral

21.08.2009

10 years



Mr. Shree Krishna Verma

Mr. Shree Krishna Verma








11. Amount of relief sought --


2017



For the Complainant Mr. Shree Krishna Verma

For the insurer Sri. Brajesh Kumar Katiyar



17. Mr. Shree Krishna Verma (Complainant) has filed a complaint against LIC of India

(Respondent) alleging payment less maturity amount.

YKS



18. The complainant has stated that he had taken a policy no.234824102 under T-T 165-10 for

Rs. 250000/- on 21.08.2009. Under this policy, he had to pay premium of Rs.12010/- per annum

for ten years. Accordingly he had deposited the premiums in time. Maturity amount of his policy as

informed by RIC is only Rs.59690/= + addition Rs.21488/=. Claimant has further stated that the

maturity sum assured should be Rs. 250000/- so he met with the LIC officials and they said it is

right. But as per contract between LIC and Policyholder, it is against Rules of Law. Being


Written reply/SCN:-

19. In SCN/reply dated 16.09.2019 , RIC has stated that policy no.234824102 was issued on the

life of Mr. Shree Krishna Verma on 21.08.2009 under T-T 165-10. The annual premium is Rs.

12010/- Death sum assured and Double accident benefit under the policy is 250000/- but the

maturity amount is 59690+21488 only. Maturity amount is not printed on the policy bond by

mistake.




Findings:-

22. Complainant has taken the LIC Jeevan Saral (with profit) policy on 21.08.2009. Total

instalments premium was Rs. 12010/-. Premium was to be paid on yearly mode. Date of maturity

was 21.08.2019. Policy was taken by the insured at the age of 56 years.

23. Controversy arose when the life assured received Rs. 81178/-(Maturity sum assured of Rs.

59690/- along with Loyalty addition of Rs. 21488/-). Contention of the complainant is that it is a

case of mis-selling. When the policy was sold it was told with the sum assured and the maturity

value would be Rs. 2.50 lakh and maturity bonus would also to be payable. It is further


submitted that even in the policy bond sum assured is mentioned as Rs 2.50 lakh. It is further

submitted that the policy bond maturity sum assured has mentioned as Rs 2.50 lakh.















26. The only point to be looked into as to whether the complainant takes advantage of non-

mentioning of maturity sum assured in the policy bond. We can read the bond and find that 2 sums

are mentioned in the policy bond which is Rs 2.50 lakh each meant for death benefit sum assured

under main plan and accident benefit sum assured. Column redressing to maturity sum assured is

lying vacant. When nothing is printed in this column how it can would be presumed that it was Rs

2.50 lakh. The policy bond was generated through computer and the entries are made on a printed

form. Little mis-match that is printing of an amount of Rs 2.50 lakh on a higher side with a few

millimeters difference cannot extend a benefit or right to the complainant. It is settled legal position

that a party cannot take the advantage of a printing or typographical error in the agreement. A

presumption cannot be raised in favor of the complainant. It is more important that the basic

features of table no. 165 are in public domain.


In that situation it cannot be accepted that any mis-selling was done with the complainant.




Order:-







Mr. Ashok Kumar Garg…… …………………..………...………………. Complainant

V/S

L.I.C. of India……..…...……………..………………….………..…..………...Respondent


1. Name & Address of the Complainant Mr. Ashok Kumar Garg

Allen Ganj

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

233650276

Jeevan Saral

28.02.2008

11 years



Mr. Ahok Kumar Garg

Mr. Ahok Kumar Garg





8. Nature of complaint Maturity amount less





2017



For the Complainant Mr. Ashok Kumar Garg




17. Mr. Ashok Kumar Garg (Complainant) has filed a complaint against LIC of India (Respondent)


MS



18. Mr. Ashok Kumar Garg has lodged his complaint on 08.08.2019. Alleging that he is senior

citizen. He had taken a policy no.233650276 under T-T 165-11 for Rs. 625000/- on 28.02.2008.

Under this policy, he has paid premium of Rs.30025/- per annum (total Rs.330275/-) for 11 years.

Accordingly he had deposited the premiums in time. Maturity amount of his policy as informed by

RIC was only Rs.98725/= + addition Rs.46894/=. Claimant has further stated that the maturity sum

assured should be Rs. 6,25,000/- so he signed discharge voucher with remark ―Under Protest &

without Prejudice to my right‖. The complainant received cheque of Rs.145619/= as maturity sum.

He approached RIC/GRO but was not satisfied with reply. He personally met with the LIC CRM

Kanpur and was not satisfied. The complainant has been cheated by the officials of LIC as on

launching the ―Jeevan Saral with Profit‖ benefits were explained by LIC not about losses during

that time. Being aggrieved, the complainant approached this forum for the redressal of her

grievance.

Written reply/SCN:-

19. In their RCN/reply the RIC has stated that policy no.233650276 was issued on the life of Mr.

Ashok Kumar Garg on 28.02.2008 under T-T 165-11. The annual premium is Rs. 30025/- . Death

sum assured and Double accident benefit under the policy is 625000/- but the maturity amount is

Rs. 98725+Rs. 46894(loyalty) only. Maturity amount is not printed on the policy bond by mistake.




Findings:-






23. Controversy arose when the life assured received Rs. 145619/- only. Contention of the





lakh.












XVII. Will LIC be made to pay for the horrible mis-selling for Jeevan Saral?

XVIII. Mr. Dr. Kirti Somaiya‘s letter to IRDAI Chairman

XIX. Branch office surprised with negative returns.

XX. Letter of National Federation of Insurance Field workers of India of LIC.

XXI. RTI information denied by LIC.

XXII. Where are the Consumers Protection Regulations

XXIII. Why Senior Citizen should never buy life insurance

XXIV. Get money life‘s top stories and E-mail


27. No decision of any authority is filed. Mere newspaper cutting or article has no bearing on merit





judgment of coordinate forum which did not have any binding effect upon this forum.













assured under main plan and accident benefit sum assured. Column relating to maturity sum










31. Accordingly I am of the view that the payment of Rs. 145619/- was given by the respondent LIC



Order:-







Mrs. Alpna Rani Garg…… …………………………...……....………………. Complainant

V/S

L.I.C. of India……..…...……………..…………………….………..…..………...Respondent


1. Name & Address of the Complainant Mrs. Alpna Rani Garg

Allen Ganj

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

233650343

Jeevan Saral

28.02.2008

11 years












11. Amount of relief sought maturity figure in Policy Bond


2017



For the Complainant Mrs. Alpna Rani Garg

For the insurer Sri. Brajesh Kumar Katiyar



17. Mrs. Alpna Rani Garg (Complainant) has filed a complaint against LIC of India (Respondent)


MS



18. Mrs. Alpna Rani Garg has lodged her complaint on 06.08.2019. She had taken a policy

no.233650343 under T-T 165-11 for Rs. 625000/- on 28.02.2008. Under this policy, she has paid

premium of Rs.30025/- per annum for 11 years. Accordingly she had deposited the premiums in

time. Maturity amount of his policy as informed by RIC was only Rs.98725/= + addition loyalty

Rs.46894/=. Claimant has further stated that the maturity sum assured should be Rs. 625000/- so

she signed discharge voucher with remark ―Under Protest & Without Prejudice to my right‖. The

complainant received cheque of Rs.145619/= as maturity sum. She approached RIC/GRO but was

not satisfied with reply. She personally met with the LIC CRM Kanpur and was not satisfied. The

complainant has been cheated by the officials of LIC. Being aggrieved, the complainant

approached this forum for the redressal of her grievance.

Written reply/SCN:-

19. In their RCN/reply the RIC has stated that policy no.233650343 was issued on the life of Mrs.

Alpna Rani Garg on 28.02.2008 under T-T 165-11. The annual premium is Rs. 30025/- Death sum

assured and Double accident benefit under the policy is 625000/- but the maturity amount is Rs.

98725+ Rs. 46894(loyalty) only. Maturity amount is not printed on the policy bond by mistake.




Findings:-






23. Controversy arose when the life assured was given Rs. 145619/- only. Contention of the





lakh.












XXV. Will LIC be made to pay for the horrible mis-selling for Jeevan Saral?

XXVI. Mr. Dr. Kirti Somaiya‘s letter to IRDAI Chairman

XXVII. Branch office surprised with negative returns.

XXVIII. Letter of National Federation of Insurance Field workers of India of LIC.

XXIX. RTI information denied by LIC.

XXX. Where are the Consumers Protection Regulations

XXXI. Why Senior Citizen should never buy life insurance

XXXII. Get money life‘s top stories and E-mail







judgement of coordinate forum which did not have any binding effect upon this forum.























31. Accordingly I am of the view that the payment of Rs. 145619/- was given by the respondent LIC



Order:-







Mr. Rajendra Kumar Pandey ……..…………………..……....………………. Complainant

V/S

L.I.C. of India……..…...……………..………..………..…………………..………...Respondent


1. Name & Address of the Complainant Mr. Rajendra Kumar Pandey

Shivpuri

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

234668741

Jeevan Saral

28.02.2009

10 years



Mr. Rajendra Kumar Pandey

Mr. Rajendra Kumar Pandey






9. Amount of Claim Rs.250000=




2017



For the Complainant Mr. Rajendra Kumar Pandey




17. Mr. Rajendra Kumar Pandey (Complainant) has filed a complaint against LIC of India

(Respondent) alleging payment of less maturity amount.

MS



18. Mr. Rajendra Kumar Pandey has lodged his complaint on 23.07.2019. The complainant has

stated that he had taken a policy no234668741 under T-T 165-10 for Rs.250000/- on 28.02.2009

and as per terms and conditions of the policy contract a sum of Rs.250000/- was assured on policy

maturity. Claimant has further stated that his policy got matured and LIC has sent Rs. 81178/ as

maturity value The complainant has paid all premiums as demanded in due date without break. He

has deposited total Rs.12100 but received only 81178/=. The maturity sum assured should be Rs.

250000/- so he approached RIC but they not replied. Being aggrieved, the complainant

approached this forum for the redressal of her grievance.

Written reply/SCN:-


Mr. Rajendra Kumar Pandey with death sum assured Rs.250000/- premium Rs.6065/-half yearly.

Due to typographical mistake death sum assured and DAB was printed but maturity sum assured

was not appeared on policy bond. As per circular dated 12.02.2004 ―death cover will be same

irrespective of age at entry and term but the sum payable at maturity will differ for different entry

age and terms‖. Under the said policy Rs.59690/= maturity amount +21488/= loyalty addition total

Rs.81178/- is payable which was paid to policy holder.

20. The complainants have filed a complaint letter along with other relevant papers Ann VI A/

while respondent have filed SCN with enclosures.


Findings:-



total instalments premium was Rs. 6065/-. Premium was to be paid on half yearly mode. Date of



23. Controversy arose when the life assured received Rs. 81178/-(Maturity sum assured of

Rs.59690/- along with Loyalty addition of Rs. 21488/-). Contention of the complainant is that it is a

case of mis-selling. When the policy was sold it was told with the sum assured and the maturity

value would be Rs. 2.50 lakh and maturity bonus would also to be payable. It is further submitted

that even in the policy bond sum assured is mentioned as Rs 2.50 lakh. It is further submitted that

the policy bond maturity sum assured has mentioned as Rs 2.50 lakh.















26. Only point to be looked into as to whether the complainant takes advantage of non- mentioning

of maturity sum assured in the policy bond. We can read the bond and find that 2 sums are

mentioned in the policy bond which is Rs 2.50 lakh each meant for death benefit sum assured

under main plan and accident benefit sum assured. Column redressing to maturity sum assured is

lying vacant. When nothing is printed in this column how it can would be presumed that it was Rs

2.50 lakh. The policy bond was generated through computer and the entries are made on a printed

form. Little mis-match that is printing of an amount of Rs 2.50 lakh on


a higher side with a few millimeters difference cannot extend a benefit or right to the complainant.

It is settled legal position that a party cannot take the advantage of a printing or typographical error







Order:-







Mr. Ram Lal Chaurasiya……..…………………..……....………..……………. Complainant

V/S

L.I.C. of India……..…...……………..………..………………….…..…..………...Respondent


1. Name & Address of the Complainant Mr. Ram Lal Chaurasiya

Kidwai Nagar

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

234650883

Jeevan Saral

20.12.2008

10 years



Mr. Ram Lal Chaurasiya

Mr. Ram Lal Chaurasiya






9. Amount of Claim Rs.6 2500/=




2017



For the Complainant Mr. Ram Lal Chaurasiya




17. Mr. Ram Lal Chaurasiya (Complainant) has filed a complaint against LIC of India (Respondent)

alleging payment of less maturity amount.

MS



18. Mr. Ram Lal Chaurasiya has lodged his complaint on 18.07.2019. The complainant has stated

that he had taken a policy no234650883 under T-T 165-10 for Rs.62500/- on 28.12.2008 and as

per terms and conditions of the policy contract a sum of Rs.62500/- was assured on policy


maturity value The complainant has paid all premiums as demanded in due date without break.

The maturity sum assured should be Rs. 62500/- so he approached RIC but they replied that

maturity amount paid as per rules. He complained on IRDA portal also. As per complainant he has

received Rs.34140 less amount. Being aggrieved, the complainant approached this forum for the

redressal of her grievance.

Written reply/SCN:-


Mr. Ram Lal Chaurasiya with death sum assured Rs.62500/- premium Rs.1516/- per month. Due

to typographical mistake death sum assured and DAB was printed but maturity sum assured was

not appeared on policy bond. As per circular dated 12.02.2004 ―death cover will be same


age and terms‖. Under the said policy Rs.21815/= +6545/= is payable which was paid to policy

holder.

20. The complainants have filed a complaint letter along with other relevant papers while



Findings:-


premium for main plan was Rs. 264.80/- while instalments accident benefit premium was Rs. 5.20/-

total instalments premium was Rs. 270/-. Premium was to be paid on monthly mode. Date of



3. Controversy arose when the life assured received Rs. 28360/-(Maturity sum assured of Rs.

21815/- along with Loyalty addition of Rs. 6545/-). Contention of the complainant is that it is a case

of mis-selling. When the policy was sold it was told with the sum assured and the maturity value

would be Rs. 62500/- and maturity bonus would also to be payable. It is further submitted that

even in the policy bond sum assured is mentioned as Rs 62500/-. It is further submitted that the

policy bond maturity sum assured has mentioned as Rs 62500/-.


is not mentioned. Due to some typographical mis-match amount of Rs. 62500/- which was death













26. Only point to be looked into as to whether the complainant takes advantage of non- mentioning

of maturity sum assured in the policy bond. We can read the bond and find that 2 sums are

mentioned in the policy bond which is Rs 62500/- each meant for death benefit sum assured under

main plan and accident benefit sum assured. Column redressing to maturity sum assured is lying

vacant. When nothing is printed in this column how it can would be presumed that it was Rs

62500/-. The policy bond was generated through computer and the entries are made on a printed

form. Little mis-match that is printing of an amount of Rs 62500/- on a


higher side with a few millimeters difference cannot extend a benefit or right to the complainant. It

is settled legal position that a party cannot take the advantage of a printing or typographical error in

the agreement. A presumption cannot be raised in favor of the complainant. It is more important






Order:-







Mr. Shravan Kumar Srivastava……..…………………..…….………………. Complainant

V/S

L.I.C. of India……..…...…………………..………..…………………....………...Respondent


1. Name & Address of the Complainant Mr. Shravan Kumar Srivastava

Naubasta

Kanpur

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

234315400

Jeevan Saral

06.01.2009

10 years



Mr. Shravan Kumar Srivastava

Mr. Shravan Kumar Srivastava






9. Amount of Claim Rs.200000=




2017



For the Complainant Mr. Umesh Kumar Srivastava from Mr. Shravan

Kumar Srivastava




17. Mr. Shravan Kumar Srivastava (Complainant) has filed a complaint against LIC of India

(Respondent) alleging payment of less maturity amount.

MS



18. Mr. Shravan Kumar Srivastava has lodged his complaint on 27.06.2019. The complainant has

stated that he had taken a policy no. 234315400 under T-T 165-10 for Rs.200000/- on 06.01.2009

and as per terms and conditions of the policy contract a sum of Rs.200000/- was assured on policy


maturity value The complainant has paid all premiums as demanded in due date without break. He

has deposited total Rs.96000 but received only 81525/=. The maturity sum assured should be Rs.

200000/- so he approached RIC but they not replied. He complained on IRDA portal also. Being


Written reply/SCN:-


Mr. Shravan Kumar Srivastava with death sum assured Rs.200000/- premium Rs.800/- per month.

Due to typographical mistake death sum assured and DAB was printed but maturity sum assured

was not appeared on policy bond. As per circular dated 12.02.2004 ―death cover will be same


age and terms‖. Under the said policy Rs.62352/= maturity amount +22447/= loyalty addition is

payable which was paid to policy holder.

20. The complainants have filed a complaint letter along with other relevant papers while



Findings:-


premium was Rs. 800/-. Premium was to be paid on monthly mode. Date of maturity was

06.01.2019.


23. Controversy arose when the life assured received Rs. 81532. Contention of the complainant is

that it is a case of mis-selling. When the policy was sold it was told with the sum assured and the

maturity value would be Rs. 2.00 lakh and maturity bonus would also to be payable. It is further

submitted that even in the policy bond sum assured is mentioned as Rs 2.00 lakh. It is further

submitted that the policy bond maturity sum assured has mentioned as Rs 2.00 lakh.














maturity sum assured plus loyalty addition if any. The only point to be looked into as to whether the

complainant takes advantage of non- mentioning of maturity sum assured in the policy bond. We

can read the bond and find that 2 sums are mentioned in the policy bond which is Rs 2.00 lakh

each meant for death benefit sum assured under main plan and accident benefit sum assured.

Column redressing to maturity sum assured is lying vacant. When nothing is printed in this column

how it can would be presumed that it was Rs 2.00 lakh. The policy bond was generated through

computer and the entries are made on a printed form. Little mis-match that is printing of an amount

of Rs 2.00 lakh on a higher side with a few millimeters difference cannot extend a benefit or right to

the complainant. It is settled legal position that a party cannot take the advantage of a printing or

typographical error








Order:-







Mr. Shyam Sunder Saraf…… ………………..……....………………. Complainant

V/S



1.

Name & Address of the Complainant Mr. Shyam Sunder Saraf

Krishna Niwas, Betiyan Hata

Gorakhpur

2. Policy No:

Type of Policy


291339630

Kishore Jeevan Bima

28.04.1999



Master Krishna Saraf

-





8. Nature of complaint Intt. On Maturity Amount

9. Amount of Claim




2017







17. Shyam Sunder Saraf (Complainant) has filed a complaint against Life Insurance Corp. of India

(Respondent) alleging that Less Interest was paid on maturity amount.

MS



18. Mr. Shyam Sunder Saraf has lodged his complaint on 28.03.2019 stating that less interest on

maturity amount was paid by the Life Ins. Corp. of India. Basically complaint was lodged for

maturity payment but maturity amount was paid to the policy holder with interest then

complainant insisted for payment of interest as per his calculation vide letter dated 16.01.2020.

The complainant has stated that maturity cheque of the above referred policy was issued on

31.05.2018 for Rs. 397200/= after one month from maturity date. Cheque was returned by his

banker demanding on line transfer. The complainant retuned the cheque to LIC for on line

transfer. He received payment on 15.01.2020. LIC paid interest only Rs.24,357/= instead of

Rs.72,316/=. Now the complainant is demanding balance Rs. 47,959/= of interest. He

approached divisional office, Gorakhpur with copy to our office.

Written reply/SCN:-

19. In their SCN/reply , the RIC has stated that due to American citizenship of the policy holder

and due to no bank account in India maturity payment was delayed and sent through NEFT on

15.01.2020 Maturity amount Rs.397200/= plus late interest Rs.24,357/= total Rs.4,21,557 paid.




perused the record.

Findings:-

22. At the very outset complainant sought a direction for payment of sum assured with interest.

Respondent submits that already sum assured along with interest total Rs. 4,21,557/- has been

paid. Complainant also admits the amount but he has claimed interest at the rate of 10 percent per

annum while the LIC had paid interest at the rate of 6.12 percent per annum which is prevalent.

Accordingly there is no ground for payment of interest at the rate of 10 percent.


Since payment has already been made complaint becomes infructuous and is liable to be

dismissed.

Order:-





PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P. AND UTTARAKHAND

UNDER INSURANCE OMBUDSMAN RULES 2017

OMBUDSMAN – SH. C.S.PRASAD

CASE OF SH. DHARAMVIR V/S PNB MET LIFE INSURANCE COMPANY LIMITED

COMPLAINT REF: NO: NOI-L-033-1920-0245

AWARD NO:


Sh. Dharamvir Village Gulawali Greater Noida, Uttar Pradesh PIN 201306


21835143 and 22507163 Life Plan Life plan


Sh.Dharamvir Sh. Dharamvir Sh.Dharamvir Sh. Dharamvir

4. Name of the insurer PNB Met Life Insurance Company Limited

5. Date of Repudiation 20.4.2018

6. Reason for repudiation

NA


8. Nature of complaint Less Surrender Value Paid


10. Date of Partial Settlement NIL

11. Amount of relief sought Rs.

12. Complaint registered under IOB rules

Rs.54321/-

13. Date of hearing/place On 13.3.2020 at Noida



For the insurer Sh. Nirmal Gulhane, Chief Manager, Legal

15 Complaint how disposed Award


17)Brief Facts of case ;- This complaint is filed by Sh. Dharamvir against the decision of PNB MET Life Insurance Company Limited relating to less payment of surrender value under policy numbers 21835143 and 22507163 issued on his life.

18)Cause of Complaint:- Mis-selling of the policies.

a)Complainants argument:- The complainant submitted that he had applied for surrender of policy bearing no. 21835143 to the insurer. On the date of surrender of policy the complainant was told that he will get surrender value of Rs.1,33,000/- after deduction of Rs. 30,000/- . The complainant received an amount of Rs.78679/- only in his account as surrender value which was less by Rs.54321/- from the surrender value which was told to him. Hence the complainant requested for payment of balance amount to him.

Insurers’ argument:- The insurer in their SCN dated 5.2.2019 submitted that the insurer received request for surrender of policy number 21835143 from the complainant on 19.3.2019 and accordingly it was processed. The surrender value at the time of request was Rs.108679/-. An amount of Rs.30,000/- was deducted for issuance of new policy no. 22507163. The balance surrender amount of Rs.78679/- was credited to bank account of the complainant vide UTR No. CITIN 8841448384.The surrender amount under policy number 21835143 is correctly paid as per terms and conditions of the policy.

19) Reason for Registration of Complaint: Scope of the Insurance Ombudsman Rules 2017.

20) The following documents were placed for perusal. a) Complaint Letter

b) Repudiation Letter

c) Policy Document

d) SCN

21)Observations and Conclusion:- The personal hearing in the case was fixed on 13.3.2020 .

The complainant did not attend the hearing and none represented him. However, the insurer

attended the hearing.The insurer submitted that the surrender value at the time of request was

Rs.108679/-. An amount of Rs.30,000/- was deducted for issuance of new policy no. 22507163.

The balance surrender amount of Rs.78679/- was credited to bank account of the complainant vide

UTR No. CITIN 8841448384.The surrender value calculation sheet submitted by the insurer has

been examined and it is seen that the surrender amount under policy number 21835143 is

correctly paid as per terms and conditions of the policy.

In view of above, I see no reason to interfere with the decision of insurance company.

Place: Noida. C.S. PRASAD

Dated: 19.03.2020 INSURANCE OMBUDSMAN

(WESTERN U.P. & UTTARAKHAND)

AWARD

Taking into account the facts and circumstances of the case and the submissions made by

both the parties during the course of hearing, I find no reason to interfere with decision of

insurance company.

The complaint is disposed off accordingly.

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WESTERN U.P AND UTTARAKHAND

UNDER THE INSURANCE OMBUDSMAN RULES, 2017 OMBUDSMAN – Sh. C.S.PRASAD

CASE OF MR. RAM BHAGAT AGARWAL V/S SBI LIFE INS. CO. LTD. COMPLAINT REF: NO: NOI-L-041-1920-0585

AWARD NO:


Mr. Ram Bhagat Agarwal 540/1, North Civil Lines, Saket Road, Muzaffarnagar, Uttar Pradesh-251001

2. Policy No: Type of Policy Duration of policy/Policy Premium payment period

14000679901 SBI Life Money Back Plan 15/15 years


Mr. Ram Bhagat Agarwal Mr. Ram Bhagat Agarwal

4. Name of the insurer SBI Life Insurance Co ltd

5. Date of Repudiation 26.9.2019

6. Reason for repudiation

Less Maturity Value Paid


8. Nature of complaint Less Maturity Value Paid

9. Amount of Claim ----


11. Amount of relief sought ----

12. Complaint registered under Rule no: of IOB rules

Rule No. 13(b) of Insurance Ombudsman Rules, 2017

13. Date of hearing/place 11.3.2020 at Noida


a) For the Complainant Sh. Ram Bhagat Aggarwal

b) For the insurer Ms. Anjali, AVP, SBI Life

15 Complaint how disposed Award


17) Brief Facts of the Case: This is a complaint filed by Mr. Ram Bhagat Aggarwal against the decision of SBI Life Insurance Company Limited relating to non receipt of correct maturity amount alongwith vested/interim/terminal bonus under insurance policy no- 14000679901 with date of commencement 15.9.2004 and term of 15 years with annual premium of Rs. 4920/- with basic sum assured of Rs.50,000/-.

18) Cause of Complaint: Less maturity value paid

(a) Complainants argument: The complainant stated that he had purchased one policy on 15.9.2004 with 15 years term and had paid the regular installment of Rs 4920/- per year from 15.9.2004 to 15.9.2019 i.e. for 15 years and had thus deposited Rs. 73,800/-. Rs. 35000/- was refunded in four instalments as survival benefit. Thus the balance amount of Rs. 38,800/- was lying with Insurer from total premiums paid but on maturity Insurer paid only Rs. 38,124/- inclusive of bonus. This was less than the amount paid by him during the last 15 years. The Insurer claiming that Rs. 13845/- was paid as vested/interim/terminal bonuses also. He received less amount than the premiums paid in the said policy. Thereafter, he preferred a complaint to this office on 04.11.2019 for resolution of his grievance.

(b) Insurers’ argument: The insurer denied the allegation made by the complainant vide their SCN dated 20.1.2020 stating that policy holder had applied for above plan on 15.9.2004 and had

paid renewal premiums upto 15.9.2019 and maturity claim was also paid alongwith four survival benefits. The four survival benefits( 10%, 15%, 20%, 25%) for total amounting to Rs. 35000/- were paid during 3rd, 6th , 9th AND 12TH policy YEAR . The balance amount of Rs. 22,500/-(45% of survival benefit) was paid alongwith bonus amount of Rs. 10775 plus Rs. 4849/- as vested and interim bonus. The policy was issued on the basis of a duly filled signed proposal form. The original policy document was dispatched to the policyholder in 2004. The insured never challenged the terms and conditions of the policy. The complainant had paid the renewal premium till maturity and having paid the renewal premium, the allegations made are baseless and vexatious. The Complainant had also availed the insurance cover for the period for which premiums were paid by him. The Policy has been matured and the maturity value of Rs. 38124/- was paid as per terms and conditions of the Policy. The Company has duly paid the amount payable under the policy and nothing further is payable. The insured had enjoyed insurance cover for basic sum assured of Rs.50,000/- and accidental death and rider for same sum assured for a period of 15 years. The insured had been paid for the benefits of Rs. 73,124/- (35000 plus Rs. 38,124/-). It is submitted that all payments have been made as per terms and conditions of the policy.

19) Reason for Registration of Complaint: Scope of the IOB rules, 2017

20) The following documents were placed for perusal. a) Complaint b) Copy of complaint to the Insurance Company c) Reply of the Insurance Company d) SCN Dated 20.1.2020

21) Observations & Conclusion: Both the Complainant and Insurer were present and reiterated their submissions. The insured stated that he has received the maturity amount less than the premiums paid amount. He had paid total premiums to the tune of Rs. 73800/- whereas after maturity , he received only Rs. 73,124/- inclusive of maturity bonus. The Insurer clarified his doubts about the mortality and concept of Insurance. The Insured after receiving the policy bond in the year 2004 never raised the issue of high premiums to Insurer. I find that as per policy terms and conditions, the maturity benefits were paid correctly to the insured.

AWARD

Taking into account the facts and circumstances of the case and the submissions made by Insurer during the course of hearing, I see no reason to interfere with the decision of the Insurance Company. The Complaint is thus disposed off.

Place: Noida. (C.S. PRASAD) Dated:13.3.2020 INSURANCE OMBUDSMAN

(WESTERN U.P. & UTTARAKHAND)

OMBUDSMAN NEERJA SHAH

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