16(1)/17 OF THE INSURANCE OMBUDSMAN RULE

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

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

OMBUDSMAN – SHRI G S SHRIVASTAVA

Mr Sudama Prasad Patel………...…………………………………..….. Complainant

V/S

HDFC Standard Life Insurance Co. Ltd. …………………….……….……Respondent

COMPLAINT NO: BHP-L-019-2021-0079 ORDER NO: IO/BHP/A/LI/ 0043 /2020-2021

1. Name & Address of the

Complainant

Mr Sudama Prasad Patel

Behind Mahima Kirana Rafi Ahmad Kidwa

Ward Dubey Colony, Katni

Madhya Pradesh 483 501

2. Policy No:

Type of Policy

Duration of policy/Policy period

21796506

HDFC Life Pension Guaranteed Plan

29.08.2019

3. Name of the insured

Name of the policyholder



4. Name of the insurer HDFC Standard Life Insurance Co.Ltd.

5. Date of Repudiation/ Rejection 01.10.2019

6. Reason for Repudiation/ Rejection Policy did not allow to withdraw the entire

fund from a pension policy

7. Date of receipt of the Complaint 08.07.2020

8. Nature of complaint Non Cancellation of policy

9. Amount of Claim --

10. Date of Partial Settlement --

11. Amount of relief sought Rs.1,92,803/-

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

13. Date of hearing/place 19.08.2020 at Bhopal

14. Representation at the hearing

For the Complainant Over mobile No.78985 56201 Mr Sudama

Prasad Patel

For the insurer Mr Gurpreet Singh through Goto Meet App

15. Complaint how disposed Dismissed

16. Date of Award/Order 20.08.2020

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Mr Sudama Prasad Patel (Complainant) has filed a complaint against HDFC Standard Life

Insurance Co. Ltd. (Respondent) alleging non cancellation of policy under freelook period.

Brief facts of the Case –

a) Contention of the complainant - The complainant has stated that he purchased above

policy from respondent company. Policy dated 29.08.2019 was received by him on 09.09.2019

and as per clause for cancellation in the freelook period within 15 days of receiving the policy,

he sent the policy bond for cancellation to local office of respondent at Katni vide Madhur

courier tracking No.1211356284 on 09.09.2019. But the same was returned noted as DAK

LENE SE INKAR. So he sent the bond to respondent office at Mumbai on 17.09.2019 via

speed post which was received by them on 21.09.2019. But till date he has not received

surrender amount nor received back the policy bond. He approached their Customer Service

Center also but has not got any response so far.

b) Contention of the respondent - The respondent in their SCN have stated that the

complainant has approached the company for cancellation of captioned policy under freelook

period. However, said policy cannot be cancelled under free look period since the free look

period is not applicable in the said policy as the same has been issued from the vesting amount

of complainants previous policy No.13107315, which was a Unit Linked Pension Plan

purchased by complainant on 25.08.2009 with yearly premium of Rs.20,000/- for ten years.

Post attaining maturity of the policy 13107315, policy bearing No.21796506 was issued post

instructions of the complainant, from the vesting amount of the complainants previous policy –

13107315 to which complainant had consented. As per policy No.13107315 entire vesting

amount could not be withdrawn. Only a maximum of 1/3rd

of the fund could be withdrawn tax

free in lumpsum and the remaining 2/3rd

amount is mandatorily to be used for issuance of a

new annuity plan in the name of the policyholder, which is the case herein. On 29.08.2019

complainant had approached us to withdraw the vesting amount as per policy terms. As per

complainants request Rs.1,96,723/- was used to issue a new annuity plan i.e. 21796506 (2/3rd

amount) and the remaining amount of Rs.98,136/- was transferred to complainant on

30.08.2019 and the same was informed to complainant vide our letter dated 01.10.2019. As per

terms of new annuity policy i.e. 21796506, a monthly amount of Rs.940.08 is being paid to the

complainant since November, 2019.

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

while respondent have filed SCN with enclosures.

I have heard the complainant over his mobile number and the representative of the respondent

company through Goto Meet App at length and perused papers filed on behalf of the

complainant as well as the Insurance Company.

Observation and Conclusion - In this case, complainant had sent request for cancellation and

refund of premium amount of policy No.21796506 under free look period which was not

considered by the respondent. As per respondent, policy No.13107315 (Unit Linked Pension

Plan) was previously purchased by the complainant on 25.08.2009 and on 29.08.2019

complainant had approached respondent for withdrawal of vesting amount as per policy terms

and conditions. As per request of complainant, amount of Rs.1,96,273/- was used to issue a

new annuity plan with policy No.21796506(2/3rd

amount) and remaining amount of Rs.98,136/-

(1/3rd

amount) was transferred to the complainant on 30.08.2019. The representative of the

respondent has argued that as per mandatory annuitisation clause of the vesting pension policy,

complainant can only change options within HDFC Life Pension Guaranteed Plan or switch to

HDFC Life New Immediate Annuity Plan during the free look period, hence impugned policy

cannot be allowed to be cancelled in free look period since the issuance of same is mandatory

as per terms of the pension plan previously purchased by the complainant. He further argued

that on the request of complainant amount of Rs.1,96,273/- (2/3rd

amount) was used to issue

impugned new annuity plan and remaining amount Rs.98,136/- (1/3rd

amount) was paid to the

complainant. Respondent has filed photocopy of application for transfer of funds for issuance

of new policy in which it is clearly mentioned by the complainant to transfer Rs.1,96,273/-

from policy No.13107315 to the application No.3100055105276. As per terms and conditions

of the policy No.13107315 “entire vesting amount cannot be withdrawn and only a maximum

of 1/3rd

of the fund could be withdrawn tax free in lumpsum and remaining 2/3rd

amount is

mandatorily to be used for issuance of a new annuity plan in the name of the policyholder”. In

page No.9 of policy No.21796506 under free look in period clause it is mentioned “15 days

from the date of receipt of the original policy document. If you have purchased your policy

through distant marketing this period will be 30 days. If the vesting pension policy has a

mandatory annuitisation clause, you can only change options only within HDFC Life Pension

Guaranteed Plan or switch to HDFC New Immediate Annuity Plan during the freelook period”.

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In this case, respondent with due consent from complainant has acted as per terms and

conditions of the policy and free look cancellation cannot be made. In the result complaint is

liable to be dismissed.

Let copies of Award be given to both the parties.

Dated : Aug 20, 2020 (G.S.Shrivastava)

Place : Bhopal Insurance Ombudsman

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


OMBUDSMAN – G S SHRIVASTAVA

Mr Rakesh Garg …………………………………………….. Complainant

V/s

LIC of India ……………………….………….……………………..Respondent

COMPLAINT NO: BHP-L-029-2021-0045 ORDER NO: IO/BHP/A/LI/ 0047 /2020-2021


Complainant

Mr Rakesh Garg

B-175, Alkapuri, Ma Ambe Chowk, Ratlam

Madhya Pradesh 457 001

2. Policy No:

Type of Policy


203454743

LICs Health Protection Plus – Table No.902

15.12.2010



Shri/Smt Rakesh Garg

Shri/Smt Rakesh Garg

4. Name of the insurer LIC of India

5. Date of Repudiation/ Rejection 02.05.2020

6. Reason for Repudiation/ Rejection Policy cannot be surrendered as per policy

terms and conditions

AWARD

The complaint filed by Mr Sudama Prasad Patel stands dismissed herewith.

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Mr Rakesh Garg (Complainant) has filed a complaint against LIC of India (Respondent)

alleging non payment of policy.

Brief facts of the Case –

a) Contention of the complainant - The complainant has stated that in the first week of

March 2020 he had submitted all documents to Branch Office, Sheopurkalan but till date the

respondent company has not made payment of his policy. Instead they are asking for some

medical papers, etc. and the same has not been mentioned in any of the policy terms and

conditions. He had even visited the office on 22nd

April, 2020 and lodged complaint but the

matter has not been solved yet.

b) Contention of respondent - The respondent in their SCN have stated that the above

policy under Plan No.902-16 which is a Unit Linked Health Insurance Plan was issued on

15.12.2010 with a premium paying term of 16 years. Policyholder applied for surrender of

policy which is not allowable as per terms and conditions of plan. Branch Office has intimated

policyholder telephonically and through email dated 02.05.2020 and 14.05.2020 that as per

policy terms and conditions, policy cannot be surrendered. However, insured can avail

Domiciliary Treatment benefits subject to the limits mentioned in the policy. Health Insurance


8. Nature of complaint Non payment of claimed amount


10. Date of Partial Settlement --

11. Amount of relief sought Full value of units on basis of NAV as on 1st

March 2020 + Rs.2 lac compensation as

mental agony

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

13. Date of hearing/place 26.08.2020 at Bhopal


For the Complainant Mr Rakesh Garg over Goto Meet App

For the insurer Mr Rajendra Xaxa , Manager HI over Goto

Meet App



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Department, Gwalior too through their letter dated 02.07.2020 has informed policyholder about

benefits available under policy particularly Domiciliary Treatment Benefit Page No.5 point (d).

The above mentioned plan is a Unit linked Health Insurance plan wherein policy cannot be

surrendered nor eligible for partial surrender which is clearly stated in Point No.9 Surrender &

point No.10 partial withdrawal.

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 over Goto Meet App at length and perused papers filed on behalf

of the complainant as well as the Insurance Company.

Observation and Conclusion - Policy No.203454743 LIC‟s Health Protection Plus Plan under

Table No.902 was taken by the complainant on 15.12.2010 which as per SCN is an Unit Linked

Plan. As per respondent policyholder / complainant had applied for surrender of policy which is

not allowable under Clause 16 of the policy conditions. Respondent has filed photocopy of

application for surrender filed by the complainant and LICs Health Protection Plus conditions

and privileges. In Clause 16(ii) & (iii) of LICs Health Protection Plus conditions and privileges

under Head other Benefits it is provided that surrender and partial withdrawal is not allowed

under the said policy. The representative of the respondent has also informed that on

02.07.2020 complainant was informed of the same. Hence as per above condition surrender is

not allowed and complaint is liable to be dismissed.

Let copies of Award be given to both the parties.

Dated : Aug 26, 2020 (G.S.Shrivastava)

Place : Bhopal Insurance Ombudsman

AWARD

The complaint filed by Mr Rakesh Garg stands dismissed herewith.

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PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, CHANDIGARH

(UNDER INSURANCE OMBUDSMAN RULES, 2017)

INSURANCE OMBUDSMAN-Dr. D.K. VERMA

Case of Mr. Abhishek Chaudhary Vs SBI Life Insurance Co. Ltd.

CASE NO-CHD-L-041-1920-1498


Complainant

Mr. Abhishek Chaudhary

House No.- 2, Mahila Ashram Campus, Karnal,

Haryana-132001

Mobile No.- 7404104514

2. Policy No: DOC

Type of Policy


1G441585910 / 05-08-2019

SBI Life- e shield Policy



Mr. Abhishek Chaudhary

4. Name of the insurer SBI Life Insurance Co. Ltd.

5. Date of Repudiation NA

6. Reason for repudiation NA

7. Date of receipt of the Complaint 09-01-2020

8. Nature of complaint Correction in difference of premium

9. Amount of Claim Premium may be revised from 1443 to 1393 p.m

10. Date of Partial Settlement NA

11. Amount of relief sought Premium may be revised from 1443 to 1393 p.m

12. Complaint registered under

Rule no: Insurance

Ombudsman Rules, 2017

13 1 (d)

13. Date of hearing/place 03.07.2020/ Chandigarh


For the Complainant Self through VC

For the insurer Ms. Shagun

15. Complaint how disposed Award


17. Brief Facts of the case:

On 09-01-2020, Mr. Abhishek Chaudhary had filed a complaint about difference in premium

against SBI Life Insurance Co. Ltd. in respect of policy bearing no. 1G441585910. The company

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has received complaints vide letter and email dated 18-09-2019, 31-10-2019 and 14-11-2019 i.e.

within 2 months and also to this forum on 09.01.2020 i.e. within 6 months.

18. Complainant’s argument

Mr. Abhishek Chaudhary the complainant attended Video/ tale conferencing on 03.07.2020,

reiterated the contents of complaint and submitted that he had applied online insurance policy for

Rs. 1 crore and accordingly completed all the requirements with agreed premium of Rs. 1393 per

month on 11.07.2019. The SBI Life Insurance Company had asked him to deposit 03 months

installments in advance i.e amounting Rs. 4179.and it was also mentioned in proposal form

no.1GP2070837 dated 11.07.202019. Later on he was surprised to note from policy no.

1G441585910 issued against above said proposal, the premium amount was mentioned as Rs. 1443

p.m. After observing discrepancy he raised the issue with insurer on 18.09.2019. The complainant

alleged that the company has intentionally delayed the process of completion & issuance of policy

and unnecessary waited up to his birthday i.e 22.07.2019 resulting into one year increase in age and

also proportionate increased in monthly premium to 1443. The premium amount for 03 months was

also transferred to SBI life on 11.07.2019 but the policy was issued on 05.08.2019.He added that the

said policy was taken consciously to get the benefit of lower age before upcoming birthday i.e on

22.07.2019. He also submitted that no written communication was received from insurance company

regarding pending requirements. Had the insurance company informed him pending requirements in

between he would had completed before 22.07.2019, The complainant has requested for

rescheduling/ correction of the policy with date of commencement as 11.07.2019 with monthly

premium amounting Rs.1393. He further added that this mistake is due to none pro active action of

insurance company.

19. Insurers’ argument

In Video/ tale conferencing on 03.07.2020 & also in SCN the insurance company submitted that the

complainant has filed this present complaint alleging increase in the premium amount under the

policy and hence demanding the revision of premium amount mentioned in the proposal. The date of

birth of the complainant is 22-07-1994 and in the instant case, the complainant has initiated

submission of e-shield policy through online platform on 11-07-2019, when the age of the

complainant was 24 years. However, he completed the submission of the proposal form vide

electronic signature through OTP authentication on 22-07-2019 i.e. as on the date of his birthday.

Subsequently, policy was issued with date of commencement on 05-08-2019. Thus, as on the date of

the completion of e signing and commencement of the policy, the age of the complainant was 25

years. Hence the premium amount was calculated considering the complete age of the complainant

i.e. 25 years as on the date of issuance of the policy. The increase in the premium amount is due to

the change in the age of the complainant. The premium paying mode opted by the complainant was

monthly and accordingly Rs. 4,179/- was received along with proposal form towards initial premium

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plus two monthly premiums. The company also received complaints vide letter and email dated 18-

09-2019, 31-10-2019 and 14-11-2019.

20. The following documents were placed for perusal a) Complaint to the company. b) Reply of the insurer

c) Proposal Form. d) Policy Schedule

21. Result of Personal hearing with both parties (Observations & Conclusion

On perusal of various documents available in the file and considering the submission of complainant and representative of the insurance company, it has been observed that the complainant has taken on line policy from insurer on 11.07.2019 by fulfilling all requirements and transferred required amount from his a/c on same day i.e. with 03 months advance premium, this is also evident in copy of online proposal issued on 11.07.2019 showing monthly premium Rs. 1339/ - The complainant had consciously taken the policy on 11.07.2019 when he was 24 years and also before his date of birthday i.e. 22.07.2019 to take the benefit of lower age & comparatively with less monthly premium. The insurance company had also admitted in SCN that policy was applied online on 11.07.2019 and also received 03 advance premiums when the age of complainant was 24 years and requirement of electronic signature through OTP was authenticated on 22.07.19 and after that policy was issued with date of commencement as 05.08.2019, in this whole process policy holder had completed 25 years of age resulting into difference in monthly premium. It was also observed that insurance company had received premium amount on 11.07.2019 thereafter not made correspondence regarding pending medical requirement from complainant till 25.07.2019, it indicates that insurance company has called requirements in piecemeal manner which is violation of IRDA [Protection of Policyholders Interest] Regulation 2017.The policy was issued on 05.08.2019 without informing/ communicating the complainant about changes in premium amount & age. It

was also evident that the insurer had not taken proper care & urgency of the complainant while issuing the policy. This is clear deficiency in service & lack of pro customer centric approach not shown to customer.

ORDER

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

insurance company during the course of personal hearing, the insurance company is

directed to change the date of commencement of policy no1G441585910 as 11.07.2019

and change the premium accordingly considering age at entry 24 years.

Hence, the complaint is treated as closed.

Dated at Chandigarh on 10.08.2020

Dr. D. K. Verma

INSURANCE OMBUDSMAN

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Case of Mr. Prem Pal Singh Vs ICICI Prudential Life Ins. Co. Ltd.

CASE NO-CHD-L-021-1920-1697


Complainant

Mr. Prem Pal Singh

C/o Jullunder Motor Agency (D) Ltd., 458-1/16,

Opposite New Court, Sohna Road, Gurugram,

Haryana- 122001

Mobile No.- 9312091788

2. Policy No: DOC

Type of Policy


09806026 / 30-08-2008 Prm. 15000 YLY

ICICI Pru Life Stag RP TERM -15YRS



Mrs. Swadesh

Mrs. Swadesh

4. Name of the insurer ICICI Prudential Life Ins. Co. Ltd.




8. Nature of complaint Rejection of critical illness rider benefit claim

9. Amount of Claim Rs.50000

10. Date of Partial Settlement Rs. 309642/- basic sum assured paid

11. Amount of relief sought Rs.50000


Rule no: Insurance


13 1 (d)



For the Complainant Self- Through VC

For the insurer Ms. Nitu Singh



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On 10-02-2020, Mr. Prem Pal Singh had filed a complaint about rejection of critical illness rider

benefit against ICICI Prudential Life Ins. Co. Ltd. in respect of policy bearing no. 09806026.


Mr. Prem Pal Singh, the complainant attended Video/ tale conferencing on 15.07.2020,

reiterated the contents of complaint and submitted that insurance company had paid him basic

death claim of his late wife Mrs. Swadesh. The critical rider benefit was also taken by his wife

under the policy but the insurer rejected the claim citing policy conditions. He submitted that when

the critical illness rider was taken the representative / official of the insurance company told them

that on diagnosis of illness, critical illness benefit would be given immediately to the life assured for

meeting treatment expenses without any condition. His wife unfortunately died on 12.05.2019 after

the cancer diagnosed on 08.05.2019.He further submitted that policy conditions were wrongly

explained to them at time of taking critical rider benefit and requested for direct the company to

consider his claim.



critical illness rider was denied by the company as per policy clause i.e CR illness rider shall be

payable on the life assured surviving 28 days from the date of diagnosis. Basic death claim under the

policy had processed and amounting Rs. 309,642.10/- had been transferred to claimants a/c on

06.08.2019. The complainant had also approached for reconsideration for the critical rider claim in

09 August 2019 and demanding for refund of the critical illness rider amount. It has been identified

that the Life Assured was diagnosed with “ Acute Leukemia” on 03 May 2019 and the Life Assured

expired on 12 May 2019” within 10 days from the diagnosis and CR claim was denied as per policy

clause.

20. The following documents were placed for perusal.

a) Complaint to the company. b) Reply of the insurer

c) Proposal Form. d) Policy Schedule

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21. Result of Personal hearing with both parties (Observations & Conclusion

On perusal of various documents available in the file and considering the submission of complainant

and representative of the insurance company, it has been observed that the complaint about

misrepresentation of policy conditions about critical illness rider benefit taken along with basic sum

assured in policy 2008 was made about 08 years from the policy issuance date. The complainant

had received policy bond well in time he ought to had read conditions annexed therein. The Life

Assured was diagnosed with “ Acute Leukemia” on 03 May 2019 and expired on 12 May 2019”

within 10 days from the diagnosis however as per Rider Benefit Clause b [2] policy the Critical

illness benefit is payable on the life assured surviving 28 days from such illness. It is also fact that

insurance company has already paid Rs. 309,642.10 for basic sum assured amounting Rs. 100000/- as

per terms & conditions of the policy. The complainant could not produce any documentary evidence

to support his allegation for wrong representation of policy facts/conditions by insurance company.

Since the insurance company has paid basic claim as per policy conditions and denial critical illness

rider benefit under the policy conditions seems to be correct.

ORDER

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

by insurance company during the course of personal hearing, the complaint in respect

of policy no. 09806026 is dismissed.



Dr. D. K. Verma

INSURANCE OMBUDSMAN

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Case of Mr. Jai Prakash Tripathi Vs ICICI Prudential Life Ins. Co. Ltd.

CASE NO-CHD-L-021-1920-1906


Complainant

Mr. Jai Prakash Tripathi

Gulmoher Trend, Flat No.- 75, C-2 Tower, Dhakoli,

Zirakpur, Punjab- 140603

Mobile No.- 9910409348

2. Policy No: DOC

Type of Policy


31533439, 26883482 / 31-12-2018, 27-09-2018

Pru Savings Suraksha Plan



Ms. Malti Tripathi, Mr. Jai Prakash Tripathi

Ms. Malti Tripathi, Mr. Jai Prakash Tripathi

4. Name of the insurer ICICI Prudential Life Ins. Co. Ltd.




8. Nature of complaint Agent not full filled commitments

9. Amount of Claim Rs. 150000 + GST

10. Date of Partial Settlement NA

11. Amount of relief sought Rs. 150000 + GST


Rule no: Insurance


13 1 (d)



For the Complainant Self- Through VC

For the insurer Ms. Nitu Singh



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On 17-03-2020, Mr. Jai Prakash Tripathi had filed a complaint about commitments not full filled

by agent against ICICI Prudential Life Ins. Co. Ltd. in respect of policy bearing no. 31533439 &

26883482.


Mr. Jai Prakash Tripathi, the complainant attended Video/ tale conferencing on 15.07.2020,

reiterated the contents of complaint and submitted that the representative of insurance company

had sold him 2 policies in the name of waiving one premium amounting Rs. 1, 20,000 against his

old policy in the year 2018 between 09/18 to 12/2018, believing on his false assurance he took one

policy in his own name & another policy in his wife‟s name for premium amounting Rs. 62705 &

94051 respectively. He further added that the representative of the insurer had also assured him of

high returns and promised to get handsome amount. He further added that representative has never

fulfilled his initial promise given to him at the time of taking policies therefore he decided to closed

the policies and requested for refund of the deposited amount with interest. The complainant

submitted that first complaint for refund of the premium under policies was sent to company on 19.02.2020.



policyholder having signed the application forms must have read and understood the terms and

conditions of the policy. The policyholder failed to pay renewal premiums under the said policies and

the premiums under both the policies were due since second year onwards. On February 19, 2020

policyholder approached the company after one year and two months from the first policy issuance

date, with concern that policies were sold with incorrect policy features with false promise and

demanding refund of premium paid in the said policies. The company has declined his demand for

policy cancellation and refund of premium paid in the said policies. The company further submitted

that the compliannat is an existing policy holder and taken policies prior to the issuance of disputed

policies and is well verse with the insurance products & its functioning.

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20. Result of Personal hearing with both parties (Observations & Conclusion):

On perusal of various documents available in the file and considering the submission of complainant

and representative of the insurance company, it has been observed that the complaint about

commitments not full filled by agent against policies were made by the complainant to the insurance

company on 19-02-2020, for the policies taken in 09/ 2018 & 12/2018. The complainant had

purchased one more policy in 12/2018 after receiving previous policy taken in 09/2018. The

complainant has also admitted that he has received the policy bonds along with photocopy of the

proposal forms well in time. The complainant being an educated person ought to have read the

policy bonds and the terms and conditions annexed along with the bond. He should have lodged the

complaint within a reasonable period for cancellation of policies once observed some foul play but

he remained silent over a period of more than 01 years the commencement of first policy to make

the complaint in this forum. The complainant has not submitted any documentary proof in support

of assurance/promise given by representatives to justify his allegations. It is also observed that if he

was not satisfied by earlier policy there is no reason for going for another policy. Moreover, the

complainants is old /existing customer of the insurance company ought to have made confirmation

from company before taking the policies. Since the complainant has purchased policies one after

another in the years 2018 and also existing customer of insurance company, he cannot take a plea

after more than 01 years that the policies have been sold to him by false promises.


Dr. D. K. Verma

INSURANCE OMBUDSMAN

ORDER


insurance company during the course of personal hearing, the complaint in respect of policy

nos. 31533439 & 26883482 is dismissed.


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Case of Mrs. Vaishali Gupta Vs SBI Life Insurance Co. Ltd.

CASE NO-CHD-L-041-1920-1482


Complainant

Mrs. Vaishali Gupta

181/14, Jacobpura, Gurugram, Haryana- 122001

Mobile No.- 9810064841

2. Policy No: DOC

Type of Policy


35055432008 / 08-03-2014

Shubh Nivesh Policy



Mrs. Vaishali Gupta

Mrs. Vaishali Gupta

4. Name of the insurer SBI Life Insurance Co. Ltd.




8. Nature of complaint Seeking refund of premium

9. Amount of Claim Rs. 99750/-

10. Date of Partial Settlement

11. Amount of relief sought Rs. 99750/- & interest


Rule no: Insurance


13 1 (d)

13. Date of hearing/place 03.07.2020 & 24.08.2020/ Chandigarh, Go to meeting

app


For the Complainant Self - VC

For the insurer Ms. Shagun




On 23-12-2019, Mrs. Vaishali Gupta had filed a complaint about inability to deposit renewal

premium of Rs.99750 due to bad financial condition against SBI Life Insurance Co. Ltd. in respect

of policy bearing no. 35055432008.

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The complainant, Mrs. Vaishali Gupta attended the hearing through Go to meeting app/ /VC/

audio/video on 24.08.2020 , reiterated the contents of basic complaint and submitted that in 2014 she

has taken a policy and accordingly paid premium but after paying initial premium she could not pay

further premiums due to some financial problems resulting into policy in lapsed condition. She further

submitted that on 20.06.2019 requested for refund of premium with interest under the above said policy.

She further submitted that revival is not possible under the policy and requested the form to direct the

company for refund of deposited amount.

19. ) Insurers’ argument:

The insurer‟s representative attended the hearing through Go to meeting app/ /VC/ audio/video on

24.08.2020 & also in SCN submitted that the first complaint under the policy was received by the

company only in June 2019, after a period of more than 5 years from the date of commencement of

the policy. The company further submitted that the complainant is seeking refund of premium under

policy bearing no. 35055432008 along with interest. The company has admittedly received only the

initial premium under the policy while the policy was issued for a premium paying term of 15 years.

The company did not receive a request for free-look cancellation of the policy within the free-look

cancellation period. The policy has gone into lapse status due to non-payment of renewal premiums

since the due date 08-03-2015 and onwards. The revival period under the policy ended on 08-03-

2017 and the policy has not been revived by the complainant .The stated policy has not acquired any

paid-up value under the policy and hence, noting is payable and there is no provision for refund of

premiums under the policy. The company further submitted that premium is the consideration for

insurance and the complainant has availed the insurance cover for the period for which premium was

paid by her.

20) Result of personal hearing with both parties (Observations & Conclusion)

On going through the various documents available in the file and also hearing both, the complainant

and the representative of the Insurance Company, it is observed that the complainant has taken the

above said policy in March, 2014 herself by paying required premium under the policy. It indicates

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that the complainant was well aware about the insurance product features but unable to deposit

renewal premiums due to bad financial position. The complainant had received the policy bond well

in time under the said policy and had ample opportunity to go through the policy terms & conditions.

The reason stating bad financial position was raised for the first time on 20.06.2019 i.e. after a gap of

more than 05 years from the issuance of said policy. It is also observed that policy was taken

deliberately according to her need and that covered for risk during premium paid period. Hence there

is no deficiency in service on the part of insurer.

ORDER


both the parties during the course of hearing, the compliant under policy no.

35055432008. is dismissed.

Hence, the complaint is treated as closed


D.K.VERMA

INSURANCE OMBUDSMAN

-19-

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. RAM CHANDRA VARYANI V/S LIFE INSURANCE CORPORATION OF INDIA

COMPLAINT REF: NO: NOI-L-029-1920-0686

AWARD NO:


Complainant

Sh. Ram Chandra Variyani

2. Policy No:

Type of Policy


263051074, 265970438, 263051188

------------Life Plan-------------

25/18, 25/25, 25/16



Sh.Ram Chandra------ Sh. Rajesh

kumar

- Sh.Ram Chandra------ Sh. Rajesh

kumar

4. Name of the insurer Life Insurance Corporation of India


6. Reason for repudiation

NA

7. Date of receipt of the Complaint 20.11. 2019

8. Nature of complaint Renewal premium amount due on 3/

2017 deposited by cash but cheque

dishonor action taken by branch office

9. Amount of Claim Rs.4262/- Plus Rs.29827/- Plus

Rs.32301/-Total Rs. 66390/-

10. Date of Partial Settlement NIL

11. Amount of relief sought Rs.66390/-


IOB rules

13.1.d

13. Date of hearing/place On 31.8.2020


a) For the Complainant Self

b) For the insurer Sh. Ram Singh, Manager

15 Complaint how disposed Award

16 Date of Award/Order 31.08. 2020

-20-

17) Brief Facts of case ;- :- This complaint is filed by Sh. Ram Chandra Variyani against LIC of

India relating to cheque dishonor action taken by branch office on Renewal Premium amount which

was deposited by cash under policy numbers 263051074, 265970438, 263051188 for renewal

premium due on 28.1.2017.

18) Cause of Complaint:-

Complainants argument --The complainant stated that he had made payment of renewal premium

for due 28.1.2017 under policy numbers 263051074, 265970438, 263051188 by CASH on

31.3.2017. The complainant did not receive letter of cheque dishonor action on the premium deposit

on 31.1.2017 by cheque of UNION BANK and neither cheque nor bank memo was enclosed with the

letter. The complainant stated he has no account with Union Bank of India. The complainant had

written to the insurer letter dated 1.1.2018 and on14.4.2018 for adjustment of premium deposited on

31.3.2017 by cash. He further stated that he has also deposited renewal premium due under all the 3

policy which is kept in deposit as unadjusted. But, till date he has not received any reply from insurer

regarding adjustment of premium and updation of First unpaid Premium.

Insurers’ argument:- The insurer stated that they have received complaint letter from complainant

in respect of policy numbers 263051074, 265970438, 263051188 regarding updation of First unpaid

premium which was deposited in cash on 31.3.017. The insurer further stated that in the Branch

office Bharthana financial irregularity has come in their notice. The investigation is in the process at

Divisional office Level. The departmental action is being taken for disposal of complaint which will

be informed as the complaint is disposed.

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:-On line hearing in the case was held on 31.8.2020.Both parties

appeared for on line hearing. At the outset, the complainant was told that under policy number

263051188 he has no locus standii as he is neither the proposer nor the life assured. The complainant

told that this policy belongs to his real brother who was also there with him during hearing. The life

assured under the policy 263051188, Sri Rajesh Kumar Variyani was asked to submit the authority

letter in favour of Sri Ram Chandra Variyani to present his case. This authority letter was received

through e-mail on the same date.

The complainant submitted that he had made payment of renewal premium for due 28.1.2017under

policy numbers 263051074,265970438, 263051188 by CASH on 31.3.2017. But the complainant

received letter of cheque dishonor action on the premium deposited on 31.3.2017 by cheque. The

complainant confirmed that he has no bank account with Union Bank. The further renewal premiums

deposited are also being kept in deposit as unadjusted. The insurer submitted that as per record, the

renewal premium due on 28.1.2017 was deposited by cheque of Union bank and it was dishonored

due to reason insufficient fund. The insurer further stated that in the year 2017 in the Branch office

Bharthana financial irregularity has come in their notice. The investigation is in the process at

Divisional office Level.

-21-

I find that the complainant has no account in Union Bank. The dishonoured cheque was of Union

Bank and neither cheque leaf nor bank memo was attached with the letter to confirm the account

holder name and address. The insurer failed to produce the bank cash memo and cheque leaf. The

dishonor action was taken on 23.12.017 i.e. after 9 months of receipt of premium. The premium

history records submitted by the insurer show that the complainant has deposited further due renewal

premium by Cash under all the 3 policies which are kept in deposit unadjusted. Due to non

adjustment of premium, all policies are lying in Reduced Paid Up Condition as a result. In case of

any mis happening, the complainant and his brother will not get full insurance cover under the

policies.

In view of above, the insurer is directed to adjust all the premiums and update the First Unpaid

Premium under all the 3 policies within 15 days under intimation to us.

AWARD

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

by both the parties during the course of hearing, the insurer is directed to update First

Unpaid Premium of policy numbers 263051074, 265970438, 263051188 under

intimation to us.

The complaint is treated as closed accordingly.

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 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.

Place: Noida. C.S. PRASAD

Dated: 31.08.2020 INSURANCE OMBUDSMAN

(WESTERN U.P. & UTTARAKHAND)

-22-

PROCEEDINGS BEFORE



OMBUDSMAN – SHRI C. S. PRASAD

CASE OF MUNENDRA SHROTRIYA V/S BIRLA SUN LIFE INSU. CO LTD.

OMPLAINT REF: NO: NOI-L-009-1920-0742

S.n

o.

Name & Address of the Complainant Mr. Munendra Shrotriya

43/1 Nikhil Udhyan Shastripur

Sikandra Agra UP- 282007

2. Policy No:

Type of Policy


A47151940 & M3722006

LIFE

15/15 Years



Mr. Munendra Shrotriya

Mr. Munendra Shrotriya

4. Name of the insurer Birla Sun Life insurance.

5. Date of Rejection No reply

6. Reason for rejection Policies terminated


8. Nature of complaint Request of cancellation rejected

9. Amount of Claim

10. Date of Partial Settlement Nil

11. Amount of relief sought


IOB rules

Yes

13. Date of hearing/place 17-08-2020/ NOIDA


a. For the Complainant Mr. Munendra Shrotriya

b. For the insurer Ms. Aakriti Manocha


16 Date of Award/Order 31-08-2020

17 . Brief Facts of the case :

The complainant Mr. Munendra Shrotriya purchased the above mentioned two policies from Birla

Sun Life insurance company. First policy was purchased in the year 2010, and after five years, he

got his policy surrendered but insurer paid only Rs10844/-, against deposit of above 72 thousand,

-23-

The other policy was purchased in 2012 and paid two premium but insurer refused to pay any amount

against this policy. The complainant wants a proper surrender amount for these policy payments.

18. Cause of the complaint:

A. Complainant’s argument :

The complainant stated that he had purchased his first policy on 4-10-2010 and paid premium for 4

and ½ years totally Rs 72856/- . Due to his financial problems, he got his policy surrendered, but he

got only RS 10844/- which is very less. He should be given a proper return of the amount paid. For

the other policy which he had purchased in 2012 and paid premium for two years, the insurer refused

to return any amount against the policy as it was terminated without any surrender value. He has

stated that he was not told while selling the policy that for surrender of policy minimum three years is

to be paid, He also mentioned that he did not get any reminder for payment of premium by the

insurer.

B. Insurer’s argument :

The insurer has stated that Assured was paying premium and paid annual premium of Rs 10884 for

three years , a total amount of RS 38,308.97/-. The surrender value of Rs. 10,884/- is as per policy

rules. The other policy was purchased in year 2012 and paid only two premiums, and the policy was

terminated without acquiring the surrender value. The complainant had received the termination letter

in 2016 but he approached the insurer in the year 2019. The insurance company stated that they had

covered the risk of the life cover of the insured till the policies were inforce. The assured could get

his policies revived in two years but he did not try for revival.

19. Reason for Registration of Complaint: Scope of Insurance Ombudsman Rule 2017.

20. Following documents were placed for perusal:

1. Complaint letter.

2. Copy of proposal forms and IDs

3. SCN

21. Observation and conclusion :

Both the parties appeared for online hearing and reiterated their submissions. The complaint is for

two policies. For the policy number 0058433534, the premium paid for two years. The complainant

paid total premium of Rs. 29,100/-. He was not in position to pay the further premium due to his

-24-

financial problem. He has argued that it is nowhere mentioned in the policy that for surrender value,

three years premiums are to be paid. In the second case under policy number 004444551, where the

policy is already surrendered, he said that he had paid more than seventy two thousand but he got the

surrender value of Rs. 10884/- only. He has submitted a certificate showing the amount paid by him

against this policy. The insurer has reiterated that as per their record they have received the premium

till year 2013 only, and surrender value was calculated as per rules on the payment received by them,

and they have paid the correct amount.

After going through the documents on record, it is observed that in the first case the copy of the

policy was produced and in the clause of surrender value, it was clearly mentioned that surrender

value would be arrived only after payment of three years premium. In the second case, the receipt

produced by the complainant has no signatures and has no evidentiary value in this complaint. The

complainant has submitted bank statement which shows that the premium deducted for this policy

was uptil the year 2013; no further payment confirmation was available. The insurer has paid the

surrender value to the complainant after taking the total premium amount collected against the policy.

I do not find any merit in the case. The complaint is dismissed.

AWARD

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

the parties during the course of hearing, the insurer’s decision not to cancel the policies as per

policy rules is justified. I do not find any merit in the case. The complaint is dismissed.

The complaint is treated as closed accordingly




-25-

PROCEEDINGS BEFORE



OMBUDSMAN – SH. C.S.PRASAD

CASE OF Ms. VIDHU BAJPAI V/S ICICI PRUDENTIAL LIFE INSURANCE COMPANY LTD.

COMPLAINT REF: NO: NOI-L-021-2021-0005

AWARD NO:


Complainant

Ms. Vidhu Bajpai,

Assistant Commissioner,

Novodya Vidyalaya Samiti

B-15, Institutional Area,

Sector-62, NOIDA (U.P.)-201309

2. Policy No:

Type of Policy


13231476

PENSION PLAN , DOC-13.01.2010

VESTING DATE : 13.01.2020

10/10 YEARS



Ms. Vidhu Bajpai

Ms. Vidhu Bajpai

4. Name of the insurer ICICI Pridential Life Insurance Co.

Ltd.

5. Date of Repudiation 26.02.2020

6. Reason for repudiation

Entitlement of annuity after vesting

date on 13.01.2020.


8. Nature of complaint Withdrawal of policy investment.

9. Amount of Claim Rs.3,13.252/-


11. Amount of relief sought Rs.3,13,252/-


IOB rules

YES

13. Date of hearing/place 24.08.2020/NOIDA


a) For the Complainant Ms. Vidhu Bajpai

b) For the insurer Ms. Nitu Singh

15 Complaint how disposed AWARD

16 Date of Award/Order 31.08.2020

-26-

17)Brief Facts of case ;- This is a complaint filed by Ms. Vidhu Bajpai against the decision of

ICICI Prudential Life Insurance Company Ltd., relating to withdrawal of policy proceeds against

Insurance policy No. 13231476.

18)Cause of Complaint:- Refusal of policy proceeds by company after vesting date in case of

annuity plan.

Complainants argument :- The complainant alleged that she was sold the above policy on

13.10.2010 with yearly premium of Rs.50,000/- . She was assured that she could withdraw the

policy investments along with the other benefits at any time after completion of 3 years of the policy.

She approached the office of ICICI, Bhopal who has informed her that a minimum of 3 installments

are to be paid; otherwise her whole investments will be lapsed. The company`s official misguided

her. The company rejected her request for withdrawal of policy proceeds after the date of vesting.

The complainant has approached Insurance Ombudsman for redressal of her grievance.

Insurers’ argument:- Insurer denied the allegations and contended that the above policy was

issued on the basis of duly signed proposal forms and related documents submitted by the

complainant. The complainant is an educated person and all the features of the said policies were

explained to the complainant by our sales representative. The policy bonds were also delivered on the

address of the policy holder registered within the record of the company and the same has not been

disputed by the complainant. The complainant has deposited 3 yearly premium and approached the

company on 25.2.2020, after the date of vesting. The insurance company had also initiated annuity

calling on 28.10.2019 prior to policy non-annuitized date and also post policy attaining non

annuitized status on 24.2.2020 and 27.02.2020 but policyholder did not reply. The policy proceeds

cannot be withdrawn after date of vesting date as per terms and condition of the policy. The

allegations made by the complainant in his complaint are denied being false and incorrect.

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


a) Complaint Letter

b) Repudiation Letter

c) Policy Document

d) SCN

-27-

21) Observations and Conclusion :- Both the parties appeared for on-line hearing on 24.08.2020

and reiterated their submissions. The complainant Ms. Vidhu Bajpai stated that she had applied

on 25.01.2020 for withdrawal of policy proceeds. However, the insurance company informed her

that she could not withdraw the policy amount after the policy maturity date which in this case is

13.1.2020 and is eligible for annuity only after date of vesting 13.01.2020. The insurance

company submitted the copies of the e-mails sent to the complainant prior to 13.1.2020 on

15.7.2019, 6.8.2019, 15.08.2019, 15.10.2019, 21.11.2019, 15.12.2019 and 17.12.2019. the

complainant admitted that she could not reply to the above e-mails due to her pre occupation.

It is observed that the main reason of complaint was non payment of maturity due to policy being

a pension plan. Regulation does not allow complete withdrawal of maturity of pension plan. The

company tried to inform the complainant via various mails which she could not attend. However,

during the course of hearing, the insurer was asked to find a way out as the complainant is in

need of her money. Evaluating the case again empathetically, the insurer have informed via mail

dated 25.8.2020 that they have agreed to settle this case by offering full refund of maturity

payout amounting to Rs.3,13,296.41.as a special case.

AWARD

Taking into account the facts and circumstances of the case and the submissions

made by both the parties during the course of hearing, the insurance company is

directed to settle the maturity proceed to the complainant against policy No.

13231476.

The complaint is treated as closed accordingly.

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 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.




-28-

PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, STATES OF A.P., TELANGANA & YANAM

(Under Rule 16(1)/17 of The Insurance Ombudsman Rules, 2017)

OMBUDSMAN - Shri I. SURESH BABU

Complaint Ref. No. HYD-L-010-1920-0966

Award No. IO/HYD/A/LI/0031/2020-21

1. Name & address of the complainant Mr.Chinnam Naidu

NIPHM,

Rajendranagar,

Hyderabad,

Telangana- 500030.

2. Policy No./Collection No.

Type of Policy

Policy term/Premium paying period

0090887011

Canara HSBC life secure plan

40Years/40Years

3. Name of the Policy holder Mr.Chinnam Naidu

4. Name of the insurer Canara HSBC Life Insurance Company

Ltd

5. Date of Rejection by Insurer NA

6. Reason for Rejection NA

7. Date of receipt of the Complaint 04/03/2020

8. Nature of complaint Previous policy details not included

9. Amount of Claim NA


11. Amount of Relief sought NA


Rule No 13.1. ( e) of Insurance Ombudsman

Rules

13. Date of hearing/place 22/06/2020/Hyderabad


a) For the complainant Self

b) For the insurer Mr. K.R.Manjunath, Centre Manager.

15. Complaint how disposed Allowed

16. Date of Order/Award 06/08/2020

-29-

17) Brief Facts of the Case:

Mr. M.Chinnam Naidu complained that the insurer had not included his previous policy

details in his policy. .

The complaint falls within the scope of the Insurance Ombudsman Rules, 2017 and so it was

registered.

18) Cause of Complaint: Previous policy details not included.

a) Complainants argument:

Mr.Chinnam Naidu took an insurance policy from Canara Bank HSBC Life Insurance on

31/03/2019. After receiving the policy bond he observed that his previous policy details were not

included in his policy. He wrote a letter to the insurance company giving details of the insurance

policies which he was having in various other insurance companies and requested the insurer to

include the details of all the policies in his present policy records. As he did‟nt receive proper

response from the insurance company, he decided to approach the Forum for justice.

19) Reason for Registration of Complaint:-

An insurance policy bearing number 0090887011 was issued to Mr.M.Chinnam Naidu on

31/03/2019. The policy was issued on the basis of online proposal form submitted by the

complainant. Later, the Company received a letter dated 22/01/2020 from the complainant, stating

that, he had availed insurance policies from some other insurance companies before applying for the

Policy and requested the insurer to include the policies taken by him from other insurance companies.

He also enquired whether he was entitled for the life cover provided by the Company under the

subject policy, after including all the policies taken by him from other insurance companies. As

requested by the complainant, the company included all the policies taken by the complainant from

other insurance companies. His eligibility for life cover was also evaluated and it was observed that,

the Complainant was eligible for the life cover provided by the Company under the subject policy

despite his other insurance policies and the same was also communicated to the Complainant by the

Company.

-30-


A )Policy schedule

b) Complaint letter to the insurer.

c) Reply by insurer.

d) P Form by complainant.

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

Pursuant to the notices issued by this office the representative of the insurer attended the

hearing held at Hyderabad on 22/06/2020 and the complainant attended the hearing through on line

video call.

On close consideration of submissions made and documents produced it was observed that the

complainant Mr.Chinnam Naidu, an Ex serviceman from Indian Army, took an insurance policy from

Canara HSBC Oriental bank of commerce Life Insurance company limited on 31/03/2019. Before

taking the policy he had taken some other policies from various other companies. After receiving the

policy bond from Canara HSBC Life Insurance company, he observed that the policies taken by him

from other insurance companies were not included in the new policy taken by him from Canara

HSBC life Insurance. He wrote a letter dated 22/01/2020 to the company requesting for including the

policies taken by him from other insurance companies also. He also requested the insurer to confirm

whether he was eligible for life cover in the policy issued by the company after taking into

consideration, all the policies taken by him from other insurance companies. He received a reply

from the insurer acknowledging his letter. The insurer also confirmed the receipt of the required

documents sent by him to update the additional policies. The insurer further, stated that his request

was under process. As the complainant did‟nt receive any further information from the insurer, he

reminded the insurer vide mail dated 28/02/2020. He received a reply dated 03/03/2020 from the

insurer, informing him that his request was still under process. As the matter was being dragged on,

the complainant approached the Forum on 04/03/2020 for justice.

During the course of hearing the representative of the insurer informed that the company had

taken note of the complainant‟s concern and included all the policies which he was having with other

companies. The insurer also informed that the company had also evaluated his eligibility for life

cover and it was observed that he was eligible for life cover provided by the company even after

-31-

taking into consideration his other policies. The insurer further informed that the same was

communicated to the complainant. Anyhow, the complainant stated that, though he received a

confirmation letter from the insurer, he requested that, the company may send confirmation on it‟s

letter head giving the details of all his existing policies and also mention in the letter that, he was

eligible for life cover in the new policy even after taking into consideration all his previous policies.

In view of the above, the insurer is directed to send a letter addressed to the complainant

giving the details of all his existing policies with other companies and also confirm his eligibility for

life cover in the new policy after taking into consideration all his existing policies with other

companies.

AWARD

Taking into account the facts & circumstances of the case and submission made by both the parties,

the insurer is directed to send a letter to the complainant on the Company‟s letter head giving the

details of all his existing policies with other companies and also confirm his eligibility for life cover

in the new policy after taking into consideration all his existing policies with other companies.

In result the complaint is Allowed.

Dated at Hyderabad on the 6th

day of August 2020

( I SURESH BABU )

INSURANCE OMBUDSMAN

FOR THE STATES OF A.P. TELANGANA AND CITY OF YANAM

-32-

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF RAJASTHAN

UNDER THE INSURANCE OMBUDSMAN RULES, 2017

OMBUDSMAN – MS. SANDHYA BALIGA

CASE OF SH BHUPENDRA DHAKAR V/S ICICI PRU. LIFE INS.CO.LTD.

COMPLAINT REF: NO JPR-L-021-2021-0049

AWARD NO: IO/JPR/L/A/2021/0/0/0

00


Complainant

Sh Bhupendra Dhakar, Udaipur.

2. Policy No:

Type of Policy

DOC /Prem. Paying Term

Premium/ S.A.

04710072

Life Time Super

08.03.2007 / 36 years

Rs.20,000 / 5 Lakh



Sh. Bhupendra Dhakar

Sh. Bhupendra Dhakar

4. Name of the insurer ICICI PRU. Life

5. Date of Repudiation 12. 06. 2020

6. Reason for repudiation Non-payment of premium.


8. Nature of complaint Forclosed the Policy.

9. Amount of Claim N.A

10. Date of Partial Settlement NA-

11. Amount of relief sought Reinstatement of policy.


Rule no: of IOB rules

13(i)

13. Date of hearing/place 24.08.2020/ Video conferencing through

GoTo Meeting app


For the Complainant Sh. Bhupendra Dhakar

For the insurer Sh. Varun Sharma



-33-

17). Sh.Bhupendra Dhakar (herein after referred to as the complainant) had filed a complaint against

the decision of ICICI Pru.Life Insurance Co. Ltd. (herein after referred to as respondent Insurance

Company) alleging foreclosed under Policy no.04710072.

18) Cause of Complaint:

Complainant‟s argument: The complainant submitted that he had unit linked insurance policy No.

04710072 of the Respondent Company with commencement date 08.03.2007 having premium of

Rs.20,000/- policy term of 36 years with premium paying term 36 years. The complainant further

submitted that he had paid three years regular premium and after that he had partial withdrawal of

Rs.50,000/ and maintained Rs. 28000/ fund value in the policy. Suddenly due to market crash in

sensex on 15.03.2020 fund value of policy came down to Rs. 20836/.The Insurance Company

foreclosed the policy and send the cheque without any prior information through SMS or phone or

e.mail. The complainant further submitted that when he came to know that subject policy was sold to

him on false promise to maintain minimum amount of Rs. 21000/ in the policy. He visited the office

of the Insurance Company during lockdown period to enquire the policy details but the respondent

company representative asked him to deposit Rs. 2,20,000/. He requested to the Insurance Company

on 25. 04.2020 to reinstate the policy but the Insurance Company denied to reinstate the policy. The

complainant represented to GRO vide letter dated 28. 04.2020, but did not get any relief from the

Insurance Company. Being aggrieved , the complainant approached this forum for redressal of his

complaint.

Insurer‟s argument:- The Insurance Company in their SCN dated 07.08.2020 stated that the subject

policy no. 04710072 was issued on 08.03.2007 with an annual premium of Rs.20,000/, policy term

and premium paying term of 36 years. The Company had received three years premiums via cheque

payment. The complainant approached the Company on 25.08.2010 with the partial surrender

request and accordingly an amount of Rs. 50,000/ was processed via cheque to the complainant‟s

registered communication address. The Company submitted that renewal premium in the said policy

was due since 08.03.2010. Renewal premium reminders were sent through SMS‟s to his registered

contact number and via letter. As per policy terms and conditions, “if premiums have been paid for

three full policy years and after three policy years have elapsed and the fund value across all funds

under the policy falls bellow 110% of one full year‟s premium, the policy shall be terminated by

paying the fund value after applying surrender charges.” For the said policy, the fund value fell

bellow 100% of the one full year‟s premium and accordingly the subject policy was foreclosed on

18.03.2020 in lines with policy terms and conditions. Accordingly the Company had processed the

refund of forclosure amount of Rs.20,826.82/ vide cheque which was dispatched to his registered

communication address on 19.03.2020 and cheque encashed by the complainant.The company

received first complaint on 25.04.2020 i.e. after one month seven days from the policy foreclosed

date. Further after reviewing the case it was informed to the complainant that , the policy was

foreclosed with the policy terms and conditions as per policy clause 9. “Foreclosure of the policy”

and clause 2.2 “Surrender” and his request for revival cannot be accepted and the decision through

-34-

email dated 28.04.2020. In view of this, the respondent company rejected the said request of

reinstating the policy.

19) Reason for Registration of Complaint: Forclosed the Policy.


a) Complaint letter

b) Copy of Certificate of Insurance

c) Form VI A duly signed by the complainant.

d) SCN and a form VIIA duly signed by the Insurance Company

21) Result of hearing with both parties(Observations and Conclusions):-Both the parties

appeared in the personal hearing through goto meeting video conferencing on 24.08.2020. The

complainant submitted that the subject policy no. 04710072 was issued on 08.03.2007 having

premium of Rs.20,000/- payable yearly. The complainant submitted that he had paid three years

regular premium and after that he had done partial withdrawal of Rs.50,000/ on 25.08.2010 and

maintained Rs. 28000/ fund value in the policy. The Complainant reiterated that his policy was

inforce for 13 years and suddenly, the Insurance Company foreclosed the policy on 18.03.2020 and

sent the cheque without any prior information through SMS or phone or e.mail. The complainant

further submitted that he requested the Insurance Company on 25. 04.2020 to reinstate the policy but

he did not get the relief. The Insurance Company submitted that the said policy is an ULIP plan

which provides benefits of the investment in market. The Investment is done post deduction of

premium allocation charges, however mortality charges and policy administration charge also levied

under the said policy by deduction of units on monthly basis. The Insurance Company further

submitted that the renewal premium in the said policy was due since 08.03.2010 onwards and

renewal premium reminders were sent through SMS to his registered contact number and via letter.

Insurance Company sent fund value statement on December 2018. The Insurance Company stated

that the policyholder was associated with us in the capacity of an advisor from 21.02.2007 to

29.05.2008 and policy was also opted by the policyholder under his own advisor code. As per policy

terms and conditions, “if premiums have been paid for three full policy years and after three policy

years have elapsed and the fund value across all funds under the policy falls bellow 110% of one full

year‟s premium, the policy shall be terminated by paying the fund value after applying surrender

charges.” For the said policy, the fund value fell bellow 100% of the one full year‟s premium and

accordingly the subject policy was foreclosed on 18.03.2020 in lines with policy terms and

conditions.

Accordingly the Company had processed the refund of forclosure amount of Rs.20,826.82/ vide

cheque which was dispatched to his registered communication address on 19.03.2020. The company

received first complaint on 25.04.2020 i.e. after one month seven days from the policy foreclosed

date. Further after reviewing the case it was informed to the complainant that the policy was

foreclosed with the policy terms and conditions as per policy clause 9. “Foreclosure of the policy”

-35-

and clause 2.2 “Surrender” and his request for revival cannot be accepted and the decision conveyed

through email dated 28.04.2020. Hence complaint was denied to accept the policy foreclosure

reversal and reinstatement.

On perusal of the documents exhibited and oral submissions made during the course of GoTo

meeting video conferencing , I find that the complainant had paid three years regular premium and

after that he had done partial withdrawal of Rs.50,000/ and after that the renewal premium in the

said policy was due since 08.03.2010 onwards and renewal premium reminders were sent through

SMS‟s to his registered contact number and via letter. The Insurance Company representative during

the hearing showed SMS of fund value dated 31.12.2017 and 31.12. 2018 sent to policyholder. The

policyholder was associated with the Insurance Company in the capacity of an advisor from

21.02.2007 to 29.05.2008 and policy was also opted by the policyholder under his own advisor code.

As per policy clause 9. “Foreclosure of the policy” and clause 2.2 “Surrender” policy terms and

conditions, “if premiums have been paid for three full policy years and after three policy years have

elapsed and the fund value across all funds under the policy falls bellow 110% of one full year‟s

premium, the policy shall be forclosed by paying the fund value after applying surrender charges.”

For the said policy, the fund value fell bellow 100% of the one full year‟s premium and accordingly

the subject policy was foreclosed on 18.03.2020 in line with policy terms and conditions. During the

hearing the Insurance Company also showed the email dated 17.03.2020, sent to the insured . The

insured confirmed that it was his email ID but denied having received it. The policy was foreclosed

as per the policy conditions.

In view of above, I see no reason to interfere with the decision of the Insurance Company.

Accordingly the complaint filed by the complainant is hereby dismissed.

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(5) of Insurance Ombudsman Rules 2017,A copy of the Order shall be sent

to the complainant and the Insurer named in the complaint.

Place: Jaipur SANDHYA BALIGA

Dated :25.08.2020 INSURANCE OMBUDSMAN

ORDER

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

parties during the course of hearing, the complaint is hereby dismissed.

-36-




CASE OF SANTOSH GUPTA V/S LIC OF INDIA

COMPLAINT REF: NO JPR-L-029-2021-0031

AWARD NO: IO/JPR/G/A/1920/000


Complainant

Smt. Santosh Gupta

19E/124, CHB, Jodhpur (Raj.) -342008

2. Policy No:

Type of Policy

DOC

Term of policy / NCO

102571054

Life ( New Jeevan Suraksha)

28.01.2003

17 Years / 199050



Smt. Santosh Gupta

Smt. Santosh Gupta

4. Name of the insurer LIC of India ( DO Jodhpur)

5. Date of Repudiation N/A

6. Reason for repudiation N/A


8. Nature of complaint Less pension being paid

9. Amount of Claim Rs. 1928/- per month

10. Date of Partial Settlement Rs. 1745/- per month

11. Amount of relief sought Rs. 183/- per month ( 1928-1745)



13 (1) (i)

13. Date of hearing/place 18.08.2020 / Video Conferencing

through GoToMeeting app


For the Complainant Smt. Santosh Gupta

For the insurer Sh. A. K. Dani



-37-

17) Brief Facts of the Case:- Smt. Santosh Gupta (herein after referred as complainant) had filed

a complaint against LIC of India (herein after referred to as respondent Insurance Company)

alleging less payment of annuity under policy no. 102571054.


Complainant’s argument: The complainant submitted that he had the subject policy under pension

plan on her life from the LIC of India with DOC 28.01.2003 for 17 years. The date of vesting was

28.01.2020. The complainant had requested the Insurance Company vide mail dated 23.07.2019 to

provide available options for payment of pension / annuity.

As per option letter received through mail dated 28.01.2020, she opted option “H” for monthly

pension without commutation. As per option selected, she was supposed to receive monthly pension

of Rs. 1928/- p.m. from 28.02.2020., but payment of pension being made to her by the Insurance

Company is Rs. 1475/- p.m. On repeated enquiry, the Insurance Company replied that the option

letter was sent 9 months in advance and in the meanwhile annuity rates were revised. Annuity at the

time of vesting was Rs. 1745/-. The complainant submitted that no intimation regarding change in

annuity rates was given to her and no fresh option letter was provided to her. She submitted that her

opted pension of Rs. 1928/- must be restored or fresh option form to be provided to her. The

Complainant had further represented his contention to the GRO of the Insurance Company but did

not get relief. Being aggrieved complainant approached this forum for redressal of his grievance.

Insurer’s argument:- The respondent Insurance Company in its SCN dated 22.07.2020, submitted

that as per option form (provided to annuitant on 23.07.2019 on e-mail) dated 10.08.2019, submitted

by annuitant, which was received by the office on 14.08.2019, option with monthly pension without

commutation was opted. The opted option was posted in the system on 14.08.2019 and ratification

was done on 29.01.2020. First installment of annuity was released on 28.02.2020 of Rs. 1745/-. The

policy vested on 28.01.2020 and ratification was done on 29.01.2020. At the time of ratification of

policy, only applicable annuity was showing after selection of option and mode of annuity, but what

amount had been printed in option form provided to the annuitant was not showing. Due to this

Branch could not figure out the differences. Annuity rates were revised after withdrawal of plan of

189 and as per circular CO/CRM/1173/23 dated 10.10.2019; revised rates were applicable on

policies, vesting on or after 28.08.2019.

-38-

19) Reason for Registration of Complaint:


a) Complaint letter

b) Policy copy


d) SCN and form VIIA duly signed by the Insurance Company

21) Result of hearing with both parties (Observations and Conclusion) :- The matter was heard

through video conferencing (GoToMeeting app) on 18.08.2020. The complainant reiterated her

contentions as in complaint. She submitted that no intimation regarding change in annuity rates was

given to her and no fresh option letter was provided to her. She submitted that she had opted pension

of Rs. 1928/- under “option” H. Nowhere in the option letter was mentioned that Rs. 1928/- was

notional amount of annuity and it may be changed at the time of vesting. As such pension of Rs.

1928/- must be restored or fresh option form to be provided to her. The Insurance Company

submitted that the policy vested on 28.01.2020 and as per policy conditions annuity was payable “as

applicable to the version of the new jeevan akshaya plan current at the time of vesting. The option for

annuity type is to be exercised at least 6 months before the date of vesting.” As on the date of vesting

payable annuity under the selected option was Rs. 1745/-, which was correctly paid.

On perusal of the documents exhibited and oral submissions, I find that as per policy conditions

annuity rate as applicable on the vesting date was payable, but the Insurance Company did not inform

the insured that amount shown in the option letter under different options was on the date of option

only. Actual annuity rate as applicable on the vesting date would be payable. It was deficiency in

service on the part of Insurance Company.

Accordingly an Award is passed with a direction to the Insurance Company to provide fresh

option form of different annuity payable to the annuitant as on the date of vesting and pay the

annuity according to selected option minus any annuity already paid.

-39-

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

provisions of Insurance Ombudsman Rules 2017.

According to Rule 17(5) of Insurance Ombudsman Rules 2017, a copy of the award shall be sent to

the complainant and the insurer named in the complaint.

b. 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: 19.08.2020. (INSURANCE OMBUDSMAN)

AWARD

Taking into account the facts and circumstances of the case and the

submissions made by both the parties during the course of hearing, the

Insurance Company is directed to provide fresh option form of different

annuity payable to the annuitant as on the date of vesting and pay the annuity

according to selected option minus annuity already paid.

-40-




CASE OF RANG LAL SHARMA V/S LIC OF INDIA

COMPLAINT REF: NO JPR- L-029-2021-0066

AWARD NO: IO/JPR/A/LI/ /2020-2021


Complainant

Rang Lal Sharma

88, Prithvi Raj Nagar, Ajmer Road

Madanganj Kishangarh, Ajmer

2. Policy No:

Type of Policy

DOC

Mty SA / Death SA

186694743

Life (Jeevan Saral)

05.07.2010

Rs. 194652 / Rs. 900000/-



Rang Lal Sharma

Rang Lal Sharma

4. Name of the insurer LIC of India (Ajmer Division)

5. Date of Repudiation N/A

6. Reason for repudiation N/A


8. Nature of complaint Less Maturity claim paid

9. Amount of Claim Rs. 277379.50

10. Date of Partial Settlement Rs. 277379.50 on 05.07.2020

11. Amount of relief sought Rs. 163621/-



13 (1) (i)

13. Date of hearing/place 27.08.2020 / Video Conferencing through

GoToMeeting app


For the Complainant Sh. Rang Lal Sharma

For the insurer Sh. V. K. Jain



-41-

17) Brief Facts of the Case:- :- Sh. Rang Lal Sharma ( herein after referred as complainant) had

filed a complaint against LIC of India (herein after referred to as respondent Insurance Company)

alleging less payment of Maturity Claim under policy no. 186694743.


Complainant’s argument: The complainant submitted that he had taken the subject Jeevan Saral

policy on 05.07.2010 from the respondent Insurance Company for 10 years term. On maturity he

received Rs. 277379.50 as maturity claim against total premium deposited by him Rs. 441000/-. Thus

he received Rs. 163621/- less to the total premium deposited by him, which is not justified. He

submitted that maturity claim should not be less than the total amount paid by him as premium. The

complainant approached the GRO of Insurance Company but did not get relief. Being aggrieved the

he approached this forum for redressal of his complaint.

Insurer’s argument:- The respondent Insurance Company in its SCN dated 18.08.2020 submitted

that the subject Jeevan Saral policy was issued for 10 years. Age of the insured was 57 years at that

time. Death SA and Maturity SA was Rs. 9.00000/- and Rs. 194652/- respectively, which was

mentioned on the policy bond. Loyalty addition was also payable as per policy conditions under the

policy. The subject policy matured on 05.07.2020. Maturity SA Rs. 194652/- was paid along with the

loyalty addition Rs. 82727/- correctly to the life assured. On receiving the representation, maturity

claim payment was again checked and found correct as per policy conditions.

19) Reason for Registration of Complaint: Less Maturity Claim paid.


a) Complaint letter

b) Policy copy


d) SCN and form VIIA duly signed by the Insurance Company

21) Result of hearing with both parties (Observations and Conclusion):- The matter was heard

through video conferencing (GoToMeeting app) on 27.08.2020. The complainant reiterated his

contentions as in complaint. He submitted that on maturity he received Rs. 277379.50 as maturity

claim against total premium deposited by him Rs. 441000/-. Thus he received Rs. 194652/- less

towards the Maturity Benefit. He submitted that it was explained to him by the agent of the Insurance

Company at the time of taking policy that a sum equal to Maturity Sum Assured in addition to the

Maturity Sum Assured along with the loyalty addition would be paid as maturity claim. He argued

that the same fact was mentioned on the policy bond too.

The Insurance Company reiterated that Death SA and Maturity SA under the policy was Rs. 900000/-

and Rs. 194652/- respectively, which was mentioned on the policy bond. Loyalty addition was also

payable as per policy conditions under the policy. The subject policy matured on 05.07.2020.

Maturity SA Rs. 194652/- was paid along with the loyalty addition Rs. 82727/- correctly to the life

assured. No additional amount equal to the Maturity Sum Assured was payable under the policy. As

per policy conditions, amount equal to Maturity Sum Assured was payable along with loyalty

addition and the same was paid.

On perusal of the documents exhibited and oral submissions made during the hearing, I find that

maturity claim was settled as per policy conditions. The policy condition, in specifies the Maturity

Benefit as “In the event of the Life Assured surviving the date of maturity a sum equal of Maturity

-42-

Sum Assured in force after partial surrenders, if any, along with the correspondence loyalty addition,

if any, shall be payable”.

The Insurance Company settled as per the policy conditions.

In view of above, I see no reason to interfere with the decision of the Insurance Company.

“Accordingly, the complaint is hereby dismissed.”

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

the Insurance Ombudsman Rules, 2017:

a. According to Rule 17(5) of Insurance Ombudsman Rules, 2017, a copy of the award shall be sent

to the complainant and the insurer named in the complaint.


Dated: 27.08.2020 (INSURANCE OMBUDSMAN)

AWARD

Taking into consideration the facts and circumstances of the case and

submissions made by both the parties, the complaint is hereby dismissed.

-43-

PROCEEDINGS OF THE INSURANCE OMBUDSMAN, DELHI

(Under Rule No: 13 (1) (a) of the Insurance Ombudsman Rules, 2017)

Ombudsman: Shri Sudhir Krishna

Case of Pradeep Goel Versus SBI Life Insurance Co. Ltd.

Complaint Ref. No.: DEL-L-041-2021-0061

Case No.: LI/SBI/054/20


Complainant

Shri Pradeep Goel

B-118, Puru Apartment, Plot No.22, Sector-13, Rohini,

Delhi-110085

2. Policy No.

Type of Policy

Policy Term/Premium Paying

Term

06000515910 and 06000515802

Life-Endowment / Regular

16 years / 16 years

3. Name of the Insured

Name of the Policy Holder

Pradeep Goel

Pradeep Goel

4. Name of Insurer SBI Life Insurance Co. Ltd.

5. Date of Rejection 11.07.2019

6. Reason for Grievance Delay in maturity payment / Deficiency in service


8. Nature of Complaint Delay in maturity payment / Deficiency in service

9. Amount of Claim Rs 11,199/- + Interest

10. Date of Partial Settlement 13.04.2019

11. Amount of Partial Settlement -

12. Amount of relief sought Rs 11,199/- + Interest

13. Complaint registered under Rule

no:

Insurance Ombudsman Rules,

2017

(a) delay in settlement of claims, beyond the time

specified in the regulations, framed under the Insurance

Regulatory and Development Authority of India Act,

1999

14. Date of hearing 06.08.2020

Place of hearing Delhi, Online Video Conferencing via Cisco WebEx


a) For the Complainant Shri Pradeep Goel, the Complainant

b) For the Insurer Smt. Anjali Chahar, Associate V-P


17. Brief Facts of the Case:

Shri. Pradeep Goel (hereinafter referred to as the Complainant) has filed this complaint against the

decision of SBI Life Insurance Co. Ltd. (hereinafter referred to as the Insurer or the Respondent

Insurance Company) alleging delay in settlement of claim of policy No. 06000515910 and

06000515802.

18. Cause of Complaint:

-44-

a. Complainant's Argument: The aforesaid policies were purchased by the Complainant from

SBI Life Insurance Co. Ltd. in the month of March 2003. He paid regular premiums till

maturity, which was due on 13.03.2019. The Complainant never received any advance

intimation of maturity payment for both policies. He himself approached the Insurer and

deposited all relevant documents related to maturity on 01.03.2019. After repeated follow up

with the Insurer the maturity cheque was handed over to him after one month on 14.04.2019.

Only then he could know that the Insurer had sent communication at wrong address. Due to

delay in receipt of payment, he couldn‟t make investment in time and had to pay income tax

worth Rs.11,199/- while filing the ITR for the AY 2019-20. He approached the Insurer to

make good the incurred loss of I.Tax due to delay in maturity claim payment. The Insurer

denied his request on 11.07.2019. The Complainant represented to the Insurer on 19.08.2019,

but denied by the Insurer, he approached this forum for relief.




b. Insurer's Argument: The dispute over payment of Individual income tax is outside the

purview of Insurance Ombudsman Rules. Individual income tax is a liability of individual and

Company is not liable to make good for any loss caused due to payment of individual income

tax, hence it is not tenable. The address mentioned in proposal form and policy is B-118, Puru

Apartment, Plot No. 22, Sector-13, Rohini, New Delhi-110085. On his request his address

was changed to 66, Krishi Apartment, Plot No-4, Sector-13, Rohini, New Delhi-110085.

Accordingly, the Insurer has sent the maturity payout intimation to his new registered address

on 03.09.2018 and thus denied the allegation of maturity cheques sent on wrong address. The

maturity cheque bearing no. 353845 and 353840 dated 13.03.2019 of Rs. 33,989/- each were

sent by speed post no. EM787723613IN and EM787729103IN on dated 20.03.2020, and the

same was realized on 17.04.2019 with this reason his request could not be considered.

19. Reason for registration of Complaint: Delay in settlement of claim

-45-

20. The following documents were placed for perusal:

a) Copy of policy.

b) Correspondence between the Complainant and the Insurance Company.

c) Self Contained Note from the Insurer.

21. Result of hearing with the parties (Observations and Conclusion):

Case called. Parties are present and recall their arguments as noted in Para 18 above.

I have perused the evidence and arguments submitted by the parties.

The Complainant has stated that the Insurer had sent the maturity sum on some wrong address and

after much effort, he could receive the same in person, but in the process, a time of one month was

lost, which led to financial losses to him in respect of income tax etc., which the Insurer should

compensate him for.

The Complainant had declared his address as „118, Puru Apartments,…….‟ In the policy proposal

form and states that he continues to stay there. However, the Insurer had changed his address in 2017

as ‟66, Krishi Apartment, …..‟ and the cheque for maturity sum was sent at that address, but could

not be delivered as the addressee (the Complainant) was not found residing there. The Complainant

denies having ever asked for change of address. The Insurer could not produce any proof to the effect

that the address was changed at the behest of the Complainant. Therefore, I conclude that the Insurer

was at fault in effecting change of address of the Complainant in the policy document. Accordingly,

the Insurer was responsible for the delay in reaching the maturity sum to the Complainant.

As per the clause 14(2)(iv) of the Insurance Regulatory and Development Authority of India

(Protection of Policyholders‟ Interests) Regulations, 2017, “In respect of Maturity, Survival Benefit

claims and Annuities, the Life Insurer shall initiate the claim process by sending intimation

sufficiently in advance or send post-dated cheque or give direct credit to the bank




-46-

account of claimant through any electronic mode approved by RBI, so as to pay the claim on or

before the due date. In case of any delay on the part of the Insurer in settling the claim on due date,

the life insurer shall pay interest at a rate, which is 2% above bank rate from the due date of payment

or date of receipt of last necessary document from the insured/claimant, whichever is later.”

Therefore the Insurer needs to pay interest to the Complainant in terms of the IRDAI regulations

quoted above, for the delay in providing the maturity sums. However, the request of Complainant for

compensation for the financial losses in respect of income tax etc. is not in the domain of this forum

and hence I declare the same as non-entertainable.

Award

The complaint is partially allowed by way of a direction to the Insurer to pay interest to the

Complainant in terms of the IRDAI regulations quoted above, for the delay in providing the

maturity sums. However, the request of Complainant for compensation for the financial losses in

respect of income tax etc. is not in the domain of this forum and hence I reject the same as non-

entertainable.

(Sudhir Krishna)

Insurance Ombudsman

6th

August 2020

-47-


(Under Rule 13 & 16 of the Insurance Ombudsman Rules, 2017)


Case of Sujith Babu AK versus PNB MetLife Insurance Co. Ltd.


Case No.: LI/PNB/059/20


Complainant

Shri Sujith Babu AK

G-1/414, First Floor, Uttam Nagar, New Delhi-110059

2. Policy No.

Type of Policy


Term

1200900782730

Life- ULIP / Regular

15 year / 15 year



Sujith Babu AK

Sujith Babu AK

4. Name of Insurer PNB MetLife Insurance Co. Ltd.


6. Reason for Grievance Deficiency in service


8. Nature of Complaint Deficiency in service

9. Amount of Claim Rs. 1,00,000/- + Interest

10. Date of Partial Settlement ---

11. Amount of Partial Settlement ---

12. Amount of relief sought Rs. 1,00,000/- + Interest

13. Complaint registered under Rule

no:

Insurance Ombudsman Rules,

2017

(f) policy servicing related grievances against insurers

and their agents and intermediaries.

14. Date of hearing 12.08.2020

Place of hearing Online Video Conferencing via Cisco WebEx


a) For the Complainant Shri Sujith Babu AK, the Complainant

b) For the Insurer Shri Shri Arijit Basu, Sr. Manager, Legal & Nodal

Officer

16. Date of Award/Order Recommendation/12.08.2020


Shri Sujith Babu AK (hereinafter referred to as the Complainant) has filed this complaint against the

decision of PNB MetLife Insurance Co. Ltd. (hereinafter referred to as the Insurer or the Respondent

Insurance Company) alleging closure of policy without intimation, inadequate payment of surrender

value and deficiency in service under policy number 1200900782730.

-48-


a. Complainant's Argument: The Complainant had purchased the aforesaid policy in January 2009

with annual premium of Rs. 50,000/- and had paid three premiums under the policy. The Company

adjusted full first year premium towards allocation charges and Rs. 3000 to 3500 as policy expenses

per month. For this reason he stopped paying premium and opted to wait for 10th

years for surrender,

when the loyalty addition of Rs. 25,000 became vested in policy in January 2019. Before he could

initiate surrender action, the Company foreclosed the policy and issued a cheque for Rs. 49,804.67

against the fund value, which had come down to one annual premium. Not satisfied with full one year

premium adjustment against allocation charge, poor fund performance and non-intimation of

foreclosure action, he approached the Insurer on 17.08.2019. The Insurer replied on 21.08.2019 and

rejected his request for refund of premium on 18.11.2019. Not satisfied with the reply of the Insurer

the Complainant again represented on 07.12.2019, the Insurer rejected his request on 18.12.2019.

Now he approached this forum for relief.




b. Insurer's Argument: The Insurer have contended vide their Self Contained Note that the ULIP

policy was issued on 30.01.2009 on the basis of duly filled proposal form and dispatched to the

Complainant on 03.02.2009. The Complainant never raised any objection either in PIVC or in free

look period available to him. The Complainant had paid only three premiums out of which first

year full premium amount had gone to premium allocation charges (as per policy clause 6.1). The

Complainant failed to pay premium of 2012 year onward. The Company sent renewal premium

notice dated 04.01.2012 but premium was not received. The Company also sent the Pre auto

foreclosure notice after 4 years on 03.03.2018 (copy of both could not be enclosed due to system

error, a mail dated 10.08.2020 in this regard is enclosed) The Complainant lodged a complaint on

28.08.2019 through IRDA and stated that his policy was foreclosed without intimation given to

him and further mentioned he had paid three premiums in the subject policy, However, the

-49-

Company has paid him only 49000/-. The Insurer after evaluation and assessment replied to the

Complainant on 11.09.2019 stating that the policy has gone to auto foreclosure due to non-receipt

of premium and refunded the balance fund value as per the terms of the policy, for which reason

his request could not be considered.

19. Reason for registration of Complaint: Deficiency in service.


a) Copy of policy.

b) Correspondence between the Complainant and the Insurance Company.

c) Self Contained Note from the Insurer.



I have examined the arguments and the evidence submitted by the parties. Clause 4.6(b) of the

policy enables the policyholder, who has paid the due regular premium for at least three

consecutive Policy years from the Policy Date, to seek reinstatement of the Policy within two

years from the date of first unpaid premium. At the end of the allowed period for reinstatement,

if the Policy is not reinstated, the Policy shall be terminated by paying the Surrender Value.

The Complainant had paid the first three premiums and had stopped thereafter. He did not seek

either continuation or discontinuation of the Policy. Therefore, the policy was deemed to have

been terminated at the end of the two years from the date of first unpaid premium. The Insurer

should have terminated the policy and paid the surrender value accordingly, rather than

continuing the policy and deducting the mortality charges.

The Insurer accepts this position and offers to revisit the claim of the Complainant accordingly.

The Insurer also accepts the liability to pay to the Complainant the interest on the delayed

payment as per the provisions of Clause 14 of the the IRDA (Protection of Policyholders’

Interests) Regulations, 2017.

The Complainant accepts this offer. Thus an agreement of conciliation could be arrived at

between the parties during the hearing today, which I consider as fair and reasonable.

-50-




Award

The complaint is disposed off in terms of the agreement of conciliation arrived at between the

parties during the hearing today. Accordingly, the Insurer shall revisit the claim of the

Complainant by treating the policy as deemed to have been terminated at the end of the two

years from the date of first unpaid premium and computing the surrender value accordingly.

The Insurer shall pay the surrender value so computed, less the amount of Rs. 49,000 already

paid, to the Complainant. The Insurer shall also pay to the Complainant the interest on the

delayed payment as per the provisions of Clause 14 of the the IRDA (Protection of

Policyholders’ Interests) Regulations, 2017. The Insurer shall release the above payments

and also provide the detailed calculation of the surrender value and interest payment to the

Complainant within the next 30 days.

(Sudhir Krishna)

Insurance Ombudsman, Delhi

12th

August 2020

-51-


(Under Rule No: 13/16 of the Insurance Ombudsman Rules, 2017)


Case of Binod Kumar Srivastava & Anupam Srivastava Versus SBI Life Insurance Co. Ltd.




Complainant

Shri Binod Kumar Srivastava & Smt. Anupam Srivastava

B-5, Tower-B, Type V, East Kidwai Nagar, New Delhi-

110023

2. Policy No.

Type of Policy


Term

Master Policy No. 70000011107

Life: Master policy / Term plan against loan / Regular

15 year / 05 year


Name of the Insured


Binod Kumar Srivastava, (Form No. 7003596710)

Anupam Srivastava, (Form No. 7003596709)

Master Policy (SBI Bank)

4. Name of Insurer SBI Life Insurance Co. Ltd.


6. Reason for Grievance Dispute in surrender value payment


8. Nature of Complaint Deficit in surrender value payment

9. Amount of Claim Rs. 43,032/-

10

.

Date of Partial Settlement ---

11

.

Amount of Partial Settlement ---

12

.

Amount of relief sought Rs. 43,032/-

13

.

Complaint registered under Rule

No.: Insurance Ombudsman Rules,

2017

13 (b) any partial or total repudiation of claims by the life

insurer

14

.

Date of hearing 25.08.2020

Place of hearing Delhi. Online Video Conferencing via Cisco WebEx

15

.

Representation at the hearing

For the Complainant Shri Binod Kumar Srivastava &

Smt. Anupam Srivastava, the Complainants

For the Insurer Smt. Anjali Chahar, Associate Vice President (CRM)

16

.

Date of Award/Order Recommendation under Rule 16/ 25.08.2020

-52-


Shri Binod Kumar Srivastava & Smt. Anupam Srivastava (hereinafter referred to as the

Complainants) have filed this complaint against the decision of SBI Life Insurance Co. Ltd.

(hereinafter referred to as the Insurer or the Respondent Insurance Company) alleging less surrender

value payment and deficiency in service by late acknowledgment of request under master policy

number 70000011107 / Form No. 7003596710 & 7003596709, respectively.


a. Complainant's Argument: The Complainants had taken a home loan from SBI bank, loan

account no. 24805577287, and along with the same, the aforesaid master life insurance policy

from SBI Life Insurance under RiNn Raksha plan against home loan security, as applicant and

co-applicant, respectively. They had foreclosed the home loan account on 15.04.2019 and same

day submitted surrender request to SBI life office without taking acknowledgment. As per the

Bank Statement submitted by him, premiums of Rs.23,794 and Rs.21,187 under form no.

7003596710 and 7003596709 were deducted on 17.04.2019 and 15.04.2019, respectively (Total

of both premium is Rs. 44,981). The Complainants on 23.04.2019 got the surrender value of Rs.

36967 and Rs. 32918 only against both policies. They approached the Insurer on 22.05.2019,

11.07.2019, 15.07.2019 and 13.09.2019 for refund of deducted premium after the closure of loan

account and submission of surrender request in time but the Insurer rejected their request. They

represented again on 28.02.2020 but did not get any reply. Now, they have approached this

forum for relief.

Case of Binod Kumar Srivastava & Anupam Srivastava Versus SBI Life Insurance Co. Ltd.



b. Insurer's Argument: The Insurer have contended vide their Self Contained Note that the said

master policy no. 70000011107 was given to the Complainant against the loan account no.

34805577287 on 17.04.2015 and 14.04.2015 as an applicant and co-applicant in loan. They offer

group insurance policy for the housing loan borrowers of State Bank of India on certain

eligibility criteria on the basis of duly paid requisite premium under the group policy. The

Insurer had paid surrender value on 23.04.2019 on the surrender request received by them on

22.04.2019. Now they agreed to refund both premiums, calculate surrender value after excluding

the said premium and adjusting the surrender value with the already paid amount. The payment

mark “E” below is under process and amount arrived at is as under:

Under form No. : - 7003596710 7003596709

A 5th

year premium amount paid by Claimant 23,794

21,187

-53-

B Surrender amount including above premium 36,967

32,918

C Surrender amount before paid premium -29574 -26334

D Difference in surrender amount (recoverable) (B – C) 7393

6584

E Balance amount refunded to customer (A - D) 16401

14603

23. Reason for registration of Complaint: less surrender value payment and deficiency in service.


d) Copy of policy.

e) Correspondence between the Complainant and the Insurance Company.

f) Self Contained Note from the Insurer.



At this stage, the Insurer offers to admit the complaint as a goodwill gesture and refund the premium

amounts that are in dispute after recovering the surrender value difference as per rules, for both the

policies. The Complainants accept this offer. Thus an agreement of conciliation could be arrived at

between the parties during the hearing today, which I consider as fair and reasonable.

Award

The complaint is allowed in terms of the agreement of conciliation arrived at between the parties

during the hearing today. Accordingly, the Insurer shall refund the premium amounts that are in

dispute after recovering the surrender value difference as per rules, for both the policies (Form No.

7003596710 & 7003596709).

Parties should implement this agreement within 30 days.

(Sudhir Krishna)


25th

August 2020

-54-


(Under Rule 13/16 of the Insurance Ombudsman Rules, 2017)


Case of Dhan Singh Lamkoti versus Life Insurance Corporation of India

Complaint Ref. No.:DEL-L-029-2021-0103

Case No.:LI/LIC/72/20


Shri Dhan Singh Lamkoti (hereinafter referred to as the Complainant) has filed this complaint against the

decision of Life Insurance Corporation of India (hereinafter referred to as the Insurer or the Respondent

Insurance Company) alleging receipt of less maturity amount under group policy no. 321843.


1. Name & Address of the Complainant Shri Dhan Singh Lamkoti

10-6, Maya Kunj, Maya Puri, Delhi - 110064

2. Policy No:

Type of Policy

Duration of entry

DOC

321843

Life- Group Insurance

08.01.1982


Name of the Master Policy holder

Dhan Singh Lamkoti

National Training Academy, ESIC

4. Name of the Insurer Life Insurance Corporation of India

5. Date of repudiation N.A

6. Reason for repudiation N.A

7. Date of receipt of the complaint 04.06.2020

8. Nature of complaint Less maturity amount received under GSLI policy

9. Amount of claim Rs. 20000/-

10. Date of partial settlement N.A.

11. Amount of partial settlement N.A.

12. Amount of relief sought Rs. 20000/-

13. Complaint registered under Rule No. of

the Insurance Ombudsman Rules, 2017

Rule 13(1)(f) -policy servicing related grievances

against insurers and their agents and intermediaries

14. Date of hearing/place 21.08.2020 /Online via Cisco WebEx


a) For the Complainant Shri Dhan Singh Lamkoti, the Complainant

b) For the insurer Smt. Kala Sivaramakrishnan, Manager (CRM)

16. Complaint how disposed/

Date of Award/Order

Recommendation under Rule 16/

21.08.2020

-55-

a) Complainant's Argument: The Complainant vide letter dated 04.03.2020 submitted that he worked

with Employee State Insurance Corporation and his organization had purchased a Group Policy for its

employees. He retired on 30.06.2019 and was paid less maturity claim to the tune of Rs 20000/- less

than an employee who had retired before him, despite the fact that same amount being deducted from

their salary. He has now approached this forum for release of Rs 20000/-.

b) Insurer's Argument: The Insurance Companyvide its SCN dated 10.08.2020 submitted that they have

recalculated the claim paid and found deficiency of Rs. 23256/- in the maturity claim paid to the

Complainant. However, they have now rectified the deficiency and have paid Rs. 23256/- to the master

policyholder i.e. Employees State Insurance Corporation National Training Academy, on 07.08.2020 for

onward transfer to the insured.

19. Reason for registration of Complaint:Less maturity amount received under GSLI policy.

Case of Dhan Singh Lamkoti versus Life Insurance Corporation of India

Complaint Ref. No.:DEL-L-029-2021-0103

Case No.:LI/LIC/72/20


a) Complaint Copy

b) SCN and Letter dated 10.08.2020 from the Insurer

c) Claim paid document to Shri Ramesh Chander, the other employee

21. Result of hearing of the parties (Observations and Conclusion):


The Insurerreconfirms their statement, vide their letter dated 10.08.2020,that they have recalculated the

claim paid and found deficiency of Rs. 23,256 in the maturity claim paid to the Complainant.

Accordingly, they have now rectified the deficiency and have paid Rs. 23,256 to the master

policyholder i.e. Employees State Insurance Corporation National Training Academy, on 07.08.2020

-56-

for onward transfer to the insured. The Complainant expresses satisfaction with this additional

payment. Thus an agreement of conciliation could be arrived at between the parties after registration of

the case in this forum but before the hearing scheduled for today. I find this agreement fair and

reasonable. Insurer also states that they have paid this amount to the Group Policyholder, that is the

ESIC, on 10.08.2020 for onward payment to the Complainant.

In addition, the Insurer is liable to pay interest on the delayed payment of this balance amount in terms

of the Clause 14(2) (iv & vi) of the IRDAI (PPHI) Regulations 2017. Insurer agrees to pay this amount

also.

Award

The complaint is disposed off in terms of the agreement of conciliation arrived at between the

parties as noted above. Accordingly, the Insurer has agreed to pay the deficient amount of Rs.

23,256 to the Group Policyholder and released the same on 10.08.2020 for onward payment to

the Complainant.

In addition, the Insurer shall also pay the interest to the Complainant on the delayed payment of

this balance amount in terms of the Clause 14(2)(iv & vi) of the IRDAI (PPHI) Regulations

2017.

The Insurer should also provide computation details of the payments being made towards

deficient calculation of maturity sum and the interest amounts, to the Complainant.

This award/recommendation should be implemented within 30 days.

(Sudhir Krishna)


21stAugust, 2020

-57-

PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW


Mr. Subhash Chandra Yadav…………………………………………………Complainant

V/S

Max life Ins. Co. Ltd.…………………….…...……………..………………...Respondent

COMPLAINT NO: LCK-L-032-1920-0036 ORDER NO. IO/LCK/A/LI/0090/2020-21

1. Name & Address of the Complainant Mr. Subhash Chandra Yadav

Harhariya Prayag

Prayagraj

2. Policy No:

Type of Policy

Duration of policy/DOC

837803717

Life Partner Plus Limited Pay Endowment

13.09.2011



Mr. Subhash Chandra Yadav

Mr. Subhash Chandra Yadav

4. Name of the insurer Max Life Ins. Co. Ltd.

5. Date of Repudiation/Rejection -

6. Reason for repudiation/Rejection -


8. Nature of complaint Surrender value not paid

9. Amount of Claim ---


11. Amount of relief sought ---

12. Complaint registered under Rule Rule No.13(1)(b) of Ins. Ombudsman Rule

2017

13. Date of hearing/place On 04.08.2020, 12.00 PM at Lucknow


For the Complainant Mr. Subhash Chandra Yadav

For the insurer Ms Aanchal Yadav



17. Mr. Subhash Chandra Yadav (Complainant) has filed a complaint against Max Life Ins. Co. Ltd.

(Respondent) alleging that surrender value is not paid to him.

MS

-58-


Brief Facts Of the Case: -

18. Mr. Subhash Chandra Yadav has filed a complaint on 25/04/2019 before this Forum alleging that

the above policy was sold to him by Max Life Insurance Co. Ltd. through Axis Bank Ltd. Allahabad.

The complainant has stated that he had paid two installments of premium of Rs.50,000/ in 2011 and

2012 under the policy. After that he could not deposited premium due to his poor financial condition.

The complainant has applied for surrender payment of his policy due to financial need for his sister`s

marriage. The complainant visited branch office of RIC to get back his amount with interest but no

favorable reply was given to him. When he has called on toll-free number of the RIC, reply was that

your advisor will call you but nothing heard from RIC/advisor. Being aggrieved, the complainant

approached this forum for the redressal of his grievance

Written reply/SCN:-

19. In their SCN/written reply, the RIC has stated that the policy was issued on the basis of duly

signed proposal form and relevant documents submitted by the complainant. The policy bond was

duly delivered to him. The complainant did not raise any complaint during free look period. The

complainant has paid only two premiums and after that due to non- payment of due premiums policy

got lapsed. As per the terms of the policy, the complainant is not eligible for surrender value. The

complainant has no where alleged miss-selling or deficiency in service, and requesting refund on

ground of financial constraints.

20. The complainant has filed a complaint letter, correspondence with respondent while respondent

not filed SCN stating relevant terms and conditions of the policy.

21. Complainant could not be connected on his registered mobile no. 9651482248 but I had a talk

with his wife on registered mobile no. 9651482248. I also heard the respondent representative on

mobile no. 9999369696 from mobile no. 9889223333 and perused the record.

-59-


Findings:-

22. According to complaint, complainant has paid 2 premiums but could not deposit the 3rd

premium

due to financial difficulty. As per terms and conditions of the policy bond policy can acquire paid up

value only if minimum 3 premiums are paid by the insure. Non- payment of premium due to financial

constraints could not entitle the complainant for refund of 2 premiums paid by him. Policy is in

lapsed state. Complaint lacks merits and liable to be dismissed.

Order:-

23. Complaint is dismissed.

24. Let the copies of this award be given to both the parties.

Date: 04.08.2020 Justice Anil Kumar Srivastava

Place: Lucknow (Insurance Ombudsman)

-60-



Mr. Vipin Kumar Gupta………………………....………………. Complainant

VS

Life Insurance Corporation of India…………………………………………...Respondent

COMPLAINT NO: LCK-L-029-1920-0579 Order No. IO/LCK/A/LI/0108/2020-21

1. Name & Address of the Complainant Mr. Vipin Kumar Gupta

2/180 ; Vishwas Khand

Gomti Nagar

Lucknow 226010 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

215290065

Bima Gold Plan

28.01.2006

N/A

20 years

3. Name of the insured /


Mr. Vipin Kumar Gupta

Mr. Vipin Kumar Gupta


5. Date of Repudiation/Rejection N/A

6. Reason for repudiation/Rejection N/A


8. Nature of complaint S.B due on 28.01.2018 not paid

9. Amount of Claim 30,000/-


11. Amount of relief sought 30,000/- with interest

12. Complaint registered under Rule Rule No.13(1)(a)of Insurance Ombudsman

Rule 2017

13. Date of hearing/place 14.08.2020 at 15.00 p.m.


a) For the Complainant Mr. Vipin Kumar Gupta

b) For the insurer Mr. Heera Singh



17. Mr. Vipin Kumar Gupta (Complainant) has filed a complaint against Life Insurance Corporation

of India. (Respondent) alleging that Survival Benefit due on 2018 has not been paid.

-61-

YKS


Brief Facts of the Case:-

18. As per the complaint, complainant had taken one policy no. 215290065 under Bima Gold plan for

20 years on 28.01.2006 from LIC of India. As per policy condition, he has to get survival benefit

payment on 28.01.2018. Complainant has not received survival benefit due on 2018. Hence he

approached the L.I.C. Branch where they have informed that the said survival benefit of Rs. 30,000/-

was credited through NEFT ON 28.01.2018 Via UTR no.CM767785406 in State Bank of India. But

complainant has not received this amount. Complainant has further stated that his a/c no. is

10294102207 in State Bank of India and he has also submitted his Bank Statement from 01.01.2018

TO 30.04.2018. Being aggrieved, the complainant approached this forum for the redressal of his

grievance.

Written reply/SCN:-

19. In SCN/reply dated 24.02.2020; RIC has informed that the policy no. 215290065 was issued on

the life of Mr. Vipin Kumar Gupta under Bima Gold Plan 174-20 on 28.01.2006.Two S.B payments

were made on 01/2010 and 01/2014. Third Survival Benefit was due on 28.01.2018. LIC has made

the payment of Rs. 30,000/- through NEFT on 26.02.2018.

20. The complainants have filed a complaint letter along with other relevant papers while respondent

has filed SCN with enclosures. Annexure VIA is not signed by complainant.

21. I have heard the complainant on her mobile no. 9415188002 from mobile no. 9889223333. I have

also heard the respondent representative through videoconferencing and perused the record.

-62-

Findings:-

22. The complainant was insured with the respondents. His survival benefits were due in January,

2018 amounting to Rs. 30,000/-. According to complainant the amount was not credited to his

account no. 10294102207 of State Bank of India, Ayodhya, Naya Ghat Road, Ayodhya.


23. According to respondents the payment of Rs. 30,000/- was made in the bank account no.

10294102207 of State Bank of India, Ayodhya, Naya Ghat Road, Ayodhya on 26.02.2018. As per the

bank statement this amount was credited in the aforesaid account and was debited on 27.02.2018

through internet banking. It is apparent that the respondents have complied and fulfilled their part of

the contract by making deposit in the complainant account. Now how the amount was debited? It is

not the responsibility of the respondents. Complainant would be at liberty to seek appropriate

information from the concerned bank. So far as respondents are concerned since they have paid the

amount. Hence no cause of action arose against them. Accordingly complaint lacks merits and liable

to be dismissed.

Order:-





-63-



Mr. Raj Singh………………………………....……....………………. Complainant

VS



1. Name & Address of the Complainant Mr. Raj Singh

S/O Sri Asharfi Lal Singh

Vill.- Mauhariya

Post- Naripara

Teh.-Bara

PRAYAGRAJ- 212107 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

375474083

Children Money Back Plan

-

N/A

25 years with 17 years premium paying term



Mr. Raj Singh

Mr. Asharfi Lal





8. Nature of complaint S.B due on 28.03.2019 not paid

9. Amount of Claim 10000/-


11. Amount of relief sought 10000/- with interest


Rule 2017

13. Date of hearing/place 14.08.2020 at 12.00 Noon


a) For the Complainant Mr. Raj Singh

b) For the insurer Mr. Uma Shanker Dubey



-64-

17. Mr. Raj Singh (Complainant) has filed a complaint against Life Insurance Corporation of India.

(Respondent) alleging that Survival Benefit due on 2019 has not been made.

YKS


Brief Facts of the Case:- 18. As per the complaint, complainant had taken one policy no. 375474083

under Children Money Back plan for 25 years from LIC of India. As per policy condition, he has to

get survival benefit payment on 28.03.2019. Complainant has not received survival benefit due on

2019. Hence he approached the L.I.C. Branch where they have informed that the said survival

benefits of Rs. 10,000/-was paid through NEFT ON 28.03.2019.But complainant has not received

this amount. Being aggrieved, the complainant approached this forum for the redressal of his

grievance.

Written reply/SCN:-

19. In SCN/reply dated 17.04.2020; RIC has informed that the policy no. 375447083 was issued on

the life of Raj Singh under Children Money Back Plan 113-25-17. First Survival Benefits was due on

28.03.2019. Claimant has submitted NEFT mandate form on 04.02.2019 and LIC has made the

payment of Rs. 10,000/- through NEFT on 28.03.2019 under a/c no. 28628100001033, Bank of

Baroda Naudiauparhar Branch (UP).


has filed SCN enclosures. Annexure VI A NOT ENCLOSED.

21. I have heard the complainant on his mobile no. 7460038808 from mobile no. 9889223333. I have


-65-

Findings:-

22. The complainant is the policy holder of the policy in question. Survival Benefits accrued to him

on 28.03.2019. As per complainant survival benefit of Rs. 10,000/- was not credited in his bank

account no. 20628100001033 in the Bank of India, Branch Naudiauparhar, U.P. According to the

respondents complainant himself has given the NEFT mandate wherein account number was

mentioned as 28628100001033 with IFSC code BARB0NAUDIA. Account was credited in the same

account.


23. Since complainant is challenging the fact that amount is not credited in his account it would be

appropriate that the complainant should submit his clear copy of his passbook to the respondents

Branch concerned. Thereafter respondents shall confirm as to whether the amount is credited in the

bank account or not. Respondents would also verify the details of account no. 28628100001033. If it

is found that the amount is not paid in the complainant account then respondents should make

payment of survival benefit to the complainant after taking the indemnity bond from the complainant.

If amount is paid wrongly to some other person then respondents would be at liberty to recover the

amount from the concerned person. Accordingly complaint is allowed.

Order:-

24. Complaint is allowed. Complainant should submit his clear copy of his passbook to the

respondents Branch concerned. Thereafter respondents shall confirm as to whether the amount is

credited in the bank account or not. Respondents would also verify the details of account no.

28628100001033. If it is found that the amount is not paid in the complainant account then

respondents should make payment of survival benefit to the complainant after taking the indemnity

bond from the complainant. If amount is paid wrongly to some other person then respondents would

be at liberty to recover the amount from the concerned person. Accordingly complaint is allowed.




-66-

PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP


Mrs. Madhu Dixit ………………………………………………………………..Complainant

V/S

Life Insurance Corp. of India …….……....……………….…………………Respondent


1. Name & Address of the Complainant Mrs. Madhu Dixit

W/O Sri Ram Dutt Dixit

H.NO-653 ; Madhu Niwas

Shiv Colony, Behjam Road,

Lakhimpur Kheri-262701

U.P.

2. Policy No:

Type of Policy


211787415

Money Back

28.04.1997



Mrs. Madhu Dixit

Mrs. Madhu Dixit

4. Name of the insurer Life Insurance Corp. of India




8. Nature of complaint Interest on survival benefit not paid

9. Amount of Claim


11. Amount of relief sought COMPOUND INTEREST@11% with

penal interest

12. Complaint registered under Rule Rule No. 13(1)(b) of Ins. Ombudsman Rule

2017

13. Date of hearing/place On 18.082020 , 14.30 pm at Lucknow


For the Complainant Mrs. Madhu Dixit

For the insurer Mr. Sunil Arora



-67-

17. Mrs. Madhu Dixit (Complainant) has filed a complaint against Life Insurance Corp. of India

(Respondent) alleging that interest on survival benefit not paid by RIC.

YKS


Brief Facts Of the Case:-

18. Mrs. Madhu Dixit has lodged his complaint on 14.10.2019 stating that she had a policy with LIC.

The complainant has stated that survival benefit was due under the policy on 28.04.2002 and

28.04.2007. As per the provisions of policy, there is an option to avail survival benefit after due date

with increase of 11% compound interest. She invested her two survival benefits, under the

provisions. Her policy got matured in 2017. The RIC has agreed to pay Maturity with one survival

benefit which is not acceptable to her. After two years she lodged her complaint on Ministry/Govt.

of India portal, then two payment Rs.15,000 each were received by her. She approached RIC to know

the reason of late payment but was not satisfied. The complainant lodged her complaint to receive

11% compound interest with penal interest. The complainant approached this forum for the redressal

of her grievance.

Written reply/SCN:-

19. In their SCN/reply dated 18.08.2020; RIC has informed that the aforesaid policy was issued

under Jeevan Sneha plan. As per special feature of the plan, life assured may defer to take survival

benefit on the due date of Survival benefit as and when needed. In the policy survival benefit due on

04/2002 was reinvested (for 15 years) which was paid accordingly-

Survival benefit amount 15,000/- (paid on 06.09.2019)

Interest 56,769/-

Less Income Tax @20% (-) 11,360/-

Loyalty addition (-) 7500/-

NET PAID 37,909/-

-68-

Earlier branch has paid Survival benefit due on 04/2007 considering this is not reinvested. survival

benefit amount was paid with panel interest with the following details-

Survival benefit amount 15,000/- (paid on 06.09.2019)

Interest 12,375/-

Less Income Tax @20% 2480/-

NET PAID 9895/-

Hence total interest (Investment for survival benefit due on 04/2002 and penal interest for survival

benefit due on 04/2007) was paid with following details-


37,909/-

+ 9895/-

-----------------

47,804/- (Paid on 17.12.2019)

------------------

On further scrutiny of papers submitted by policy holder at the time of survival benefit due (04/2007,

branch has paid the difference amount by considering survival benefit due on 04/2007) as

reinvestment with following details –

Total reinvestment interest 27,591/- (For 10 years)

Earlier paid as penal interest (-) 12,375/- (on 17.12.2019)

Total payable 15,216/-

Less Income Tax @10% (-) 1520/-

-----------------

13,696/-

-69-

---------------------

Hence survival benefit due on 04/2002 and 04/2007 are paid as reinvestment and no further amount

is due for payment. RIC has further stated that earlier policyholder has not submitted Pan Card, hence

Income Tax was deducted @ 20%.

20. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent

while respondent has filed SCN with enclosures.


also heard the respondent representative and perused the record.

Findings:-

22. Admittedly complainant was insured with the respondents under a plan “Jeevan Sneha.” Sum

assured was Rs. 75,000/-. Date of commencement was 28.04.1997. Survival benefits were due in the

year 2000 to 2007 and 2012. There was a clause in the policy bond that the policy


holder can defer to take survival benefits on the due date of survival benefits and would be entitled

for 11% interest on it. Following calculation is submitted by the respondents to show the mode of

payment:-

In this policy SB, due 04/2002 was reinvested (for 15 years) which was paid accordingly:-

SB amount - 15000 (paid on 6-9-19)

(a) Interest - 56769

Income Tax deducted @ 20% (-) 11360

(-) 7500 (Loyalty addition was not payable when SB amount was

37909 reinvested (paid on 06/9/19)

-70-

Earlier branch has paid survival benefit due 04/2007 considering this is not reinvestment. SB amount

was paid with penal interest whose details are as follow:-

SB amount - 15000 (Paid on 6.9.19)

Penal Interest- 12375

Income tax deducted @20% (-) 2480

9895

Hence total interest (reinvestment for SB due 04/2002 & penal interest for SB due 04/2007) was paid

whose details are as follows:-

37909 (a)

+ 9895 (b)

47804 Paid on 17.12.19

On further of scrutiny of papers submitted by policyholder at the time of SB due (04/2007, branch has

paid today the difference amount by considering SB due (04/2007) as reinvestment whose details are

as follow:-


Total reinvestment interest- 27591 (For 10 years)

Earlier paid as penal interest (-) 12375 (on 17.12.2019)

Total Amount payable 15216

Income Tax @ 10% - 1520

13696

-71-

23. On maturity of the policy remaining sum assured was Rs. 30,000/- vested bonus Rs. 1,05,000/-,

loyalty bonus Rs. 7500/-. Total 1,42,500/-. Unclaimed interest 18,606/-, deduction of 20% Income

tax on interest amount Rs. 3721/-.

24. Above aforesaid calculation shows that interest amount paid on 06.09.2019 that is 37,909/-

(Survival Benefit 2002) and amount of Rs. 9895/- (Survival Benefit 2007) were due on 28.04.2017

but paid on 06.09.2019. Accordingly complainant is entitled for penal interest on amount of Rs.

47804/- from 28.042017 till date of payment that is 17.12.2019. Accordingly complaint is liable to be

partially allowed.

25. Complainant further submits that she has not received the form XVI.

Order:-

26. Complaint is partially allowed. Respondents are directed to pay penal interest on Rs. 47,804/-

with effect from 28.04.2017 to 17.12.2019 at the rate of 6.65 percent per annum within 30 days.

Respondents are further directed to sent the form XVI to complainant by speed post within 30 days.




-72-



Mr. Jawahar Lal Verma………………………………....……....………………. Complainant

VS

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


1. Name & Address of the Complainant Mr.Jawahar Lal Verma

Vill. – Mahgaon

Post- Raja Talab

Dist. Varanasi - 211311

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

22708178210

Annuity Plus Plan

30.10.2018

---

-



Mr. Jawahar Lal Verma

Mr. Jawahar Lal Verma

4. Name of the insurer SBI Life Insurance Co. Ltd

5. Date of Repudiation/Rejection 14.11.2019

6. Reason for repudiation/Rejection Annuity plan cannot be surrendered


8. Nature of complaint Surrender of policy

9. Amount of Claim 1500000/-

10. Date of Partial Settlement 1381005/- + Annuity 95196/-

11. Amount of relief sought Balance amount with interest

12. Complaint registered under Rule Rule No.13(1)(d)of Insurance Ombudsman

Rule 2017

13. Date of hearing/place 25.08.2020 at 12.45 P.M.


a) For the Complainant Mr. Jawahar Lal Verma

b) For the insurer Md. Tariq Khan



17. Mr.Jawahar Lal Verma (Complainant) has filed a complaint against SBI Life Insurance Co. Ltd

(Respondent) alleging mis-selling of policy.

-73-

YKS



18. As per the complaint, complainant has abank account in State Bank Of India Branch Kachnar

RjaTalab Varanasi. Complainant had Rs. 1,50,00,00/- in his saving account and he wanted to fix this

amount for the marriage of his granddaughter. Hence he requested to the Branch Manager who has

taken his signature on some blank forms and assured him that the money is in fixed deposit and he

can withdraw this amount any time. After some time, complainant has received a policy bond. Hence

he enquired from Branch where it was told to him that his money is invested in SBI Life Insurance

and his money is totally safe and can be withdrawn at any time. Complainant was getting annuity of

Rs. 7933/- per month. Complainant has further stated that now he wants to surrender the policy due

to his health problem. Hence he visited the branch where he was told that this policy was issued

under Annuity Plan and cannot be surrendered and have informed him that this money can only be

refunded after his death. Further complainant vide his letter dated 16.03.2020 informed that he has

received an amount of Rs. 1,38,10,05/- through NEFT ON 25.02.2020 and he has also received

Rs.95196/-(12 installments of Rs.7933/- each) as annuity. In this way, complainant has received

Total Rs.1,47,62,01/.Complainant has not received any interest on his amount. Hence he has

requested for balance amount and interest on Total deposited amount of Rs. 1,50,00,00/-. Being

aggrieved, the complainant approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 23.03.2020, RIC has stated that the Company has decided to cancel the policy

and refund the premium as a special case and customer service gesture. Accordingly, a letter dated

15.01.2020 sent to policyholder for submission of required papers. Complainant has deposited Rs.

1,50,00,00/. An amount of Rs. 1,38,10,05/- has been credited on 25.02.2020 after making the

deductions of the annuities of Rs. 1,18,995/-(15 installments of Rs.7933/- each).

20. The complainants have filed a complaint letter, Annexure VI A along with other relevant papers

while respondent has filed SCN with enclosures.




Findings:-

22. Complainant has specifically alleged that an amount of Rs. 15 Lakhs was outstanding in his

saving bank account in the State Bank of India, Kachnar Raja Talab, District Varanasi. He intended

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to deposit the amount in the fixed deposit but respondents have fraudulently issued a policy in the life

annuity plan. He never intended to take a insurance policy. He has further alleged that the amount

was deposited by him for the marriage of his grand-daughter. He continuously contacted the

concerned bank but of no use.

23. As per the respondents contention policy was issued on the basis of proposal form. Further

respondents have cancelled the policy and refunded the premium amount after deducting the annuity

amount already paid.

24. It is a case where fraud has been played upon the complainant. He wanted to deposit the amount

in FDR but the concerned agent of the insurance company in collusion with the bank officers cheated

the complainant. They obtained his signature on the blank form. Further respondents have cancelled

the policy and refunded the premium amount but the amount of Rs. 15 lakhs remained with the

respondents from 30.10.2018 to 25.02.2020. At the most we can deducted an amount of Rs.

1,18,995/- which was paid to the complainant as annuity but so far as remaining amount of Rs.

13,81,005/- is concerned complainant is entitled for payment for interest over the amount. An offer

was given to the respondent representative to pay the interest on this amount which he did not

accepted. In such circumstances when the policy itself was fraudulently issued complainant would be

entitled for the penal interest at the rate of 6.65 percent per annum with effect from 30.10.2018 to

25.02.2020. Accordingly complaint is liable to be allowed.


Order:-

25. Complaint is allowed. Respondents are directed to pay the interest at the rate of 6.65 percent from

30.102018 to 25.02.2020 on an amount of Rs. 13,81,005/- within 30 days.




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Mr. Ashok Kumar Shukla ………………………………....………………. Complainant

VS



1. Name & Address of the Complainant Mr. Ashok Kumar Shukla

MIG-16; Awas Vikas Colony

Abu Nagar Road

Fatehpur- 212601 (U.P.)

2. Policy No:

Type of Policy

DOC

DOD

Duration of policy

313676455 ; 313676463 & 313676451

Money Plus Plan

06.07.2009

N/A

15 years Under Single premium mode



Mr. Ashok Kumar Shukla

Mr. Ashok Kumar Shukla





8. Nature of complaint Policies surrendered without his consent

9. Amount of Claim 25000/ + 25000/ + 30000/ Total 80000/-

10. Date of Partial Settlement -

11. Amount of relief sought Refund of premiums with interest

12. Complaint registered under Rule Rule No.13(1)(f)of Insurance Ombudsman

Rule 2017

13. Date of hearing/place 05.08.2020 at 12.00 Noon.


a) For the Complainant Mr. Ashok Kumar Shukla

b) For the insurer Ms. Savita Singh



17. Mr. Ashok Kumar Shukla (Complainant) has filed a complaint against Life Insurance

Corporation of India. (Respondent) alleging that his policies were surrendered without his consent.

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YKS



18. As per the complaint, complainant had taken aforesaid three policies no. 313676455 ; 313676463

& 313676451 under Market Plus ULIP plan with single premium mode and invested Rs.80000/- for

15 years term on 06.07.2009 from LIC of India. Claimant has got all policies bonds which are in his

possession. Further claimant has stated that he went to Fatehpur Branch on 14.01.2019 to know his

policies status. Than he came to know that all his policies have already been surrendered in 2012

without his consent. He has all original policy bonds with him. LIC has cheated several LIC

customers of that particular Fatehpur branch by transferring the customer‟s premium money into their

personal account instead of LIC account. Claimant has lodged written complaint to Branch Manager,

but no action has been taken by him. Being aggrieved, the complainant approached this forum for the

redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 2.07.2020, RIC has stated that aforesaid policies no. 313676455, 313676463

& 313676451 were issued on the life of Mr. Ashok Kumar Shukla. Fraudulently Theses policies were

surrendered by agent. Departmental enquiry was conducted against Agent Mr. Sushil Kumar (Code

no. 03565244) and his agency has been terminated by the competent authority. Respondent has

further stated that LIC is ready to refund the amount but Complainant has not given NEFT and other

details, hence payment could not be made.


has filed SCN with enclosures.


also heard the respondent representative on her mobile no. 9936345161 from mobile no. 9889223333

and perused the record.

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Findings:-

22. Admittedly complaint insured had taken 3 policies total amounting to Rs. 80,000/- under „Money

plus Plan 1.” Date of Commencement was 06.07.2009. Policy term was 15 year. It


appears that the respondents agent namely Sushil Kumar in collusion with the respondents employees

fraudulently surrendered the policies on 24.09.2012 and 16.10.2012. Even the surrender value was

paid for the 3 policies which is an under:-

Policy No. S.V. Amount

313676451 34001.00

313676455 28095.00

313676463 28249.00

23. Neither the complainant had surrendered the policies nor he received any surrender value.

Fraudulently surrender value was paid to some other person under the name of the complainant.

When on 14.01.2019 complainant visited the branch officer at Fatehpur then he came to know about

the fraudulent surrender of his policies. Original policy bond are still in his possession. Then

complainant moved the complaint to respondents but no action was taken by the respondents. Then

complainant moved the complaint to this forum.

24. It is a clear case of miss-utilization of public money which amounts to embezzlement. It is

surprising that in the SCN not a single word is stated about the action if any, taken against the

concerned officers/officials of LIC. It is a case where strict penal as well as administrative

departmental action should be taken against the officers/officials who were involved in this

fraudulent action and embezzlement of public money. It appears that concerned officers of LIC have

not even initiated any proceedings in this matter. It is highly recommended that the Competent

Authority should initiate the proceeding in the light of the observations made above.

25. Complainant submits that he did not want to surrender his policy rather he wants to continue with

the policy and shall receive the payment on its maturity. Since complainant had never applied for

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surrender of the policy and original policy bonds are still in his possession he is entitled to continue

with the policy and to receive the payment on maturity. It is also recommended that respondent

should initiate the proceedings for recovery of the amount which was paid fraudulently. Accordingly

complaint is liable to be allowed.


Order:-

26. Complaint is allowed. Respondents are directed to reinforce the policies of complainant insured.

Complainant insured would be entitled to receive the maturity payment on maturity of the policies.

27. Compliance be made within 30 days.

28. Let a copy of this order be sent to the Zonal Manager LIC, Kanpur and Senior Divisional

Manager LIC, Allahabad for information and necessary action as mentioned in the body of this order.

It is expected that the action taken report would be sent to this office by the Concerned Authority

within 2 months.


Date: 05.08. 2020 Justice Anil Kumar Srivastava


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Mr. Deenu………………....……..............................................………………. Complainant

VS



1. Name & Address of the Complainant Mr. Deenu

S/O Sri Ram Behari Chauhan

Gaya Ghat

Balia -277209 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

530572801

Money Back Plan

28.03.1991

N/A

25 Years



Mr. Deenu

Mr. Deenu





8. Nature of complaint Policy Not Transferred

9. Amount of Claim 30000/- + Bonus

10. Date of Partial Settlement -

11. Amount of relief sought Maturity payment with interest


Rule 2017

13. Date of hearing/place 18.08.2020 at 12.45 P.M.


a) For the Complainant Mr. Deenu

b) For the insurer Mr. Ramesh Chandra Yadav



17. Mr. Munna Lal (Complainant) has filed a complaint against Life Insurance Corporation of India.

(Respondent) alleging that his policy was not transferred hence maturity payment has not been made.

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YKS



18. As per the complaint, complainant had taken one policy no. 530572801 under T-T 93-25 for

Rs.30,000/- on 28.03.1991 from LIC Branch Marauda (53F) under Muzaffarpur Division.

Complainant has requested to transfer his policy from Marauda branch (53F) to Ballia branch (286)

under Varanasi Division. But servicing branch of the policy is not clear as on date. Hence he could

not deposit his premium since 2001.Complainant has also stated that he has received two Survival

benefits due on 1996 & 2001 from Marauda branch. Now the policy got mature on 28.03.2016 and he

is not getting his maturity claim. Complainant has further stated that after vigorous fallow-up, he

came to know that policy master is not being merged at Ballia branch. Hence he has lodged a

complaint with Manager (CRM) Varanasi, but no reply has been given by him. Being aggrieved, the

complainant approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 17.08.2020, RIC has stated that policy no.530572801 was issued on the life

of Mr. Dinu on 28.03.1991 by their 53F Branch (Mharajganj, Bihar). Later on the request of

policyholder, policy was transferred from 53F Branch to 286 Branch (Ballia under Varanasi

Division) on 03.07.2001.But due to some error and omission policy master was not merged at Branch

Ballia (BO 286) under Varanasi Division. RIC has further stated that as policy was in transfer out

status at Branch 53F (Maharajganj), any transaction like maturity payment could not be made.

Thereafter corrective action has been taken by Ballia Branch with the help of SDC Pune on

11.08.2020.Accordingly maturity payment of Rs. 22,590/-(Paid-up value Rs.930/- and Bonus

Rs.21,660/-) has been made through NEFT on 13.08.2020 and same has been confirmed to claimant

on his mobile number.

20. The complainant has filed a complaint letter, Annexure VIA along with other relevant papers and

respondent has filed SCN.

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21. Complainant could not be connected on his registered phone no. 9565927958. I have heard the

respondent representative on his mobile no. 8004335758 from mobile no. 9889223333 and perused

the record.


Findings:-

22. Policy in question was issued from LIC Maharajganj Branch which was subsequently transferred

to Branch Ballia but due to some error policy master was not merged with branch office Ballia.

Policy got matured on 28.03.2016. As per the SCN payment of paid- up value along with bonus total

Rs. 22,590/- is made on 13.08.2020 in the bank account of the complainant with UTR No.

AXISP00139121163 dated 14.08.2020. It appears that the complainant was also entitled for the penal

interest which is not paid. Accordingly complaint is liable to be allowed.

Order:-

23. Complaint is allowed. Respondent are directed to pay the penal interest at the rate of 6.65 percent

per annum on Rs. 22,590/- from due date 28.03.2016 till the date of actual payment.




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Mr. Harpreet Singh……….…..……....……………………………………. Complainant

V/S

IDBI Federal Life Ins. Co. Ltd.…….…………………………………………Respondent

COMPLAINT NO: LCK-L-022-1920-0651 Order No. IO/LCK/A/LI/ 0120/2020-21

1. Name & Address of the Complainant Mr. Harpreet Singh

Bajpai Colony

Lakhimpur Kheri

2. Policy No:

Type of Policy

Duration of policy/DOC/Revival

4001120455

Saving Insurance Plan

31.10.2017

3. Name of the life insured


Mr. Harpreet Singh

Mr. Harpreet Singh

4. Name of the insurer IDBI Federal Life Ins. Co. Ltd.




8. Nature of complaint -

9. Amount of Claim Balance of surrender payment.



12. Complaint registered under Rule Rule No. 13(1)(f) of Ins. Ombudsman Rule

2017

13. Date of hearing/place On 19.08.2020 at 10.15 am at Lucknow


a) For the Complainant Mr. Harpreet Singh

b) For the insurer Dhanashree Joshi



17. Mr. Harpreet Singh (Complainant) has filed a complaint against IDBI Federal Life Ins. Co.

(Respondent) alleging non-payment of correct surrender value.

MS


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Brief Facts of the Case: -

18. Mr. Harpreet Singh has filed a complaint on 14.02.2020 before this Forum alleging that the

insurance company IDBI Federal Life Insurance Co. Ltd. has not paid correct surrender value of his

policy on surrender. The complainant has stated that he has purchased the above policy and paid

three annual premiums under the policy. A total amount of Rs. 80562/= was paid by him but he

received only Rs. 41,400/- when he surrendered his policy. The complainant has contacted the RIC

for payment of balance amount but company refused stating that surrender value was paid as per

rules. Being aggrieved, the complainant approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/written reply, the RIC has stated that the policy was issued to the complainant after

he duly signed and verified the proposal form and benefit illustration. The company has received the

premium from the insured towards the said policy for the years 2017, 2018 and 2019. The

complainant submitted an application for surrender of policy in November 2019. Applicable

surrender value of Rs.41,400/= was credited to the complainant bank account as per clause 6 of the

terms and conditions of the policy document and the same was duly communicated to the

complainant. The complainant was unhappy with the surrender value and approached the company

with his complaint in November 2019. The complainant lodged his complaint after more than 3 years

from the receipt of policy document, hence free-look cancellation is not possible. It is strictly denied

that the complainant is eligible to receive any money under the policy as the contract has terminated

upon surrender of the policy.

20. The complainant has filed a complaint letter, Ann. VIA and correspondence with respondent

while respondent filed SCN with enclosures.




Findings:-

22. Admittedly complainant was insured with the respondents. He paid 3 annual premiums of total

amounting to Rs. 77,094/-. He made a request for surrender of the policy after paying the 3rd

premium. Accordingly his request was processed in accordance with clause 6 of the policy bond

which reads as under:-

” 6. Surrender value

The policies with premium paying term of less than 10 years, will acquire a Guaranteed Surrender

value, if all premiums have been paid for at least two consecutive years.

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The policies with premium paying term of 10 years or more, will acquire a Guaranteed Surrender

value, if all premiums have been paid for at least three consecutive years. On surrender, the higher

of the Guaranteed Surrender value and the Special Surrender Value will be paid.

6.1 Guaranteed Surrender value

Guaranteed Surrender value has two components. The first component is a percentage of total

premiums paid as below, according to the policy term and the second component is a percentage of

accrued guaranteed additions and vested bonuses. The percentage factors are provided in the table

below. On the payment of the surrender benefit, the policy will terminate and no more benefits will be

payable.

6.2 Special Surrender value

The company, at its discretion, may also pay a special surrender value which may be higher than the

guaranteed surrender value. The special surrender values are not guaranteed and may be changed at

any time, subject to the prior approval of the IRDAI.”

23. Calculation was made which is mentioned in para 5.6 of the SCN which is as under:-


Mr. Harpreet Singh Male

Policy No. 4001120455

Mode of premium Yearly

Policy status Inforce

Age at entry 35

Policy Term (PT) 10

Premium payment term (PPT) 5

Maturity Sum Assured (MSA) (Rs.)

(Policy schedule given on Page No. 5 of Policy Document)

1,15,000/-

Premium Amount (Rs.) 25,698.00

No. of premiums paid 3

Total amount of Premium paid (Rs.) 77,094.00

Policy Year of surrender 3

No. of full years policy is inforce 2

Outstanding Term 8

Guaranteed Additions Accrued (Rs.)

(Per clause 3 on Page no. 8 of Policy Document

17,250/-

Reversionary Bonuses Accrued (Rs.)

(Per clause 4 on Page no. 8 of Policy Document)

0

Guaranteed Surrender Factor 1

(Per clause 6.1 on page no. 9 of policy document)

30%

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Guaranteed Surrender Factor 1

(Per clause 6.1 on page no. 9 of policy document)

16%

Guaranteed Surrender Factor (GSV) (Rs.)

(As per clause 6, Guaranteed Surrender value under terms

and conditions of Policy Document i.e. 30% of total

premiums paid + 16%

Of Guaranteed Additions)

25,888.2

Special Surrender Factor 1 48%

Special Surrender Value (SSV) (Rs.)

(Per clause 6.2 on page no. 9 of the policy document)

41,400

Surrender Value payable (Rs.) (higher of GSV and SSV as

per clause 6 on page no. 9 of the policy document)

41,400


24. Main grievance of the complainant is that he received an amount equal to 50% of the total

deposited premium amount. This contention could not find support from the record. Clause 6 as

referred above of the policy bond specifically deals with the surrender and terms and conditions of

the policy bond.

25. Accordingly I am of the view that surrender value was paid in accordance with the terms and

conditions of the policy bond. I do not find any ground for interference. Accordingly complaint is

liable to be dismissed.

Order:-





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Mr. Gopal Singhaniya……………………………………………………………….Complainant

V/S

Max life Ins. Co. Ltd.…………………...…...……………..……………………...Respondent


1. Name & Address of the Complainant Mr. Gopal Singhania

Ram Bagh

Kanpur

2. Policy No:

Type of Policy


371394776

Life Partner Plus Endowment

26.09.2008



Mr. Yatin Singhania

Mr. Gopal Singhania

4. Name of the insurer Max Life Ins. Co. Ltd.



7. Date of receipt of the Complaint 14/10/2019

8. Nature of complaint Cheating


10. Date of Partial Settlement Surrender Value paid


12. Complaint registered under Rule Rule No. 13(1)(c) of Ins. Ombudsman

Rule 2017

13. Date of hearing/place On 04.08.2020, 14.00 at Lucknow


a) For the Complainant Mr. Gopal Singhaniya

b) For the insurer Ms. Aanchal Yadav



17. Mr. Gopal Singhania (Complainant) has filed a complaint against Max Life Ins. Co. Ltd.

(Respondent) alleging cheating.

MS

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18. Mr. Gopal Singhania has filed a complaint on 14/10/2019 before this Forum alleging that the

above policy was sold to him by Max Life Insurance Co. Ltd. The complainant has stated that he

talked with Ms. Monika Guptaji on 31.07.2019 on phone and enquired about surrender value of his

policy. She replied that system showing Rs.20,000/= as surrender value and there will be more loss

on surrender. On 07.08.2019 he further enquired about surrender value then Ms. Gupta replied that

she will talk to him when she reaches office, but she never replied him. On enquiry regarding his

complaint and surrender formalities he was advised that policy is good and beneficial and he can

avail bonus facility on this policy. The complainant was in Agra, he visited Agra branch to receive

payment of bonus where he was informed that premium of policy was due and so bonus cannot be

paid. The complainant surrendered his policy on the advice of his advocate friend and now he wants

his premiums amount to be refunded by them with interest till date. He had approached the RIC for

refund of his amount deposited, but nothing heard from RIC. Being aggrieved, the complainant

approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/written reply, the RIC has stated that the complainant has himself admitted to have

paid 11 annual premiums only. He has lodged his complaint to receive his full premium amount paid

by him minus surrender value paid to him. The policy was issued on the basis of duly signed

proposal form, policy bond issued to him duly received by him. The complainant was given 15 days

period to raise concerns in relation to features and terms and conditions of the policy, he did not raise

any concern regarding features and the terms and conditions of the said policy. The complainant was

fully satisfied and agreed with the conditions. Insurance company has run the risk of the life insured.

The complainant requested for surrender of the policy, accordingly request was processed and

surrender value as per the terms of the policy was paid. The complainant is not entitled to claim any

refund.

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20. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent

while respondent filed SCN stating relevant terms and conditions of the policy.



also heard the respondent representative on her mobile no. 9999369696 from mobile no. 9889223333

and perused the record.

Findings:-

22. At the very outset respondent representative submits that respondents are ready and prepared to

refund the amount deposited by the complainant after deducting the amount already paid to

complainant on surrender of the policy. Complainant will not be entitled for any interest.

Complainant also agreed for the same. Accordingly complaint is liable to be allowed.

Order:-

23. Complaint is allowed. Respondent are directed to pay the difference of amount paid by the

complainant minus amount already paid to the complainant. Complainant will not be entitled for

payment of any interest. Compliance to be made within 30 days.


Date: 04.08. 2020 Justice Anil Kumar Srivastava


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LT. COL. Jai Prakash Narayan Singh……….………..……....………………. Complainant

V/S

SBI Life Ins. Co. Ltd…………………………..…..………….....………………..Respondent


17. Lt. Col. Jai Prakash Narayn (Complainant) has filed a complaint against SBI Life Ins. Co. Ltd.

(Respondent) alleging that RIC has not done correction in maturity date.

MS

1.

Name & Address of the Complainant Lt. Col. Jai Prakash Narayan Singh

Kushhal Nagar

Varanasi

2. Policy No:

Type of Policy


Policy No.1K450127404

SBI Life Smart Wealth Builder

11.02.2019



Mr. Anand Prakash

Mr. Anand Prakash

4. Name of the insurer SBI Life Ins. Co. Ltd.

5. Date of Repudiation/Rejection 22.03.2019

6. Reason for repudiation/Rejection


8. Nature of complaint Correction in maturity date

9. Amount of Claim Rs.1,00,000/= Annual premium



12. Complaint registered under Rule RuleNo.13(1)(f) of Ins.Ombudsman Rule 2017

13. Date of hearing/place On 11.08.2020, 14.00 at Lucknow


a) For the Complainant LT. COL .Jai Prakash Narayan Singh

b) For the insurer Mohd. Tariq Khan



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18. Lt. Col. Jai Prakash Narayan has filed a complaint on 09.07.2019 before this Forum alleging that

the correction in date of maturity was not done by SBI Life Insurance Co. Ltd. The complainant has

stated that he purchased a policy on the life of his son Mr. Anand Prakash. Premium of the policy

was paid on 11.01.2019 and all formalities were completed, but the policy was issued with maturity

date 11.02.2029 instead of 11.01.2029. He has further stated that he had approached the RIC for

correction in maturity date but his request was rejected by RIC. 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 policy was issued as per proposal form and on receipt

of requirements raised. The complaint pertains to Pol. No. 1K450127404 on the life of Mr. Anand

Prakash, but the complaint was filed by Mr. Jai Prakash Narayan Singh. The complainant has alleged

delay in issuing of the policy and demanding advance maturity date. Payment of some amount does

not automatically result in the granting of insurance cover. On receipt of proposal requirements were

raised vide letter dated 16.01.2019 followed by reminder dated 22.01.2019, 29.1.2019 and

05.02.2019. On receipt of last requirement on 08.02.2019 the policy was issued on 11.02.2019 for a

term of 10 years with premium payment term 5 years, the term of 10 years would be completed only

on 11.02.2029. Original policy document was dispatched on 14.02.2019 through speed post, the

complainant has the option to return the policy under free look cancellation. The company has

received complaints dated 18.03.2019 and 30.04.2019 which were duly replied. Maturity date cannot

be changed.

20. The complainant has filed a complaint letter, Ann. VIA and correspondence with respondent

while respondent has filed SCN to consider this case as closed/resolved in favour of RIC.



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Findings:-

22. According to the complainant he deposited the premium amount with the respondents on

11.01.2019. The concerned agent of the respondents asked certain queries which were provided by

the complainant. When he received the policy it was revealed that the policy would mature on

11.02.2029 instead on 11.01.2029. Main grievance of the complainant is that there is deficiency in

service of the respondents. Policy should mature on 11.01.2029.

23. Certain quarries were raised by the respondents on 16.01.2019 which are as under:-

“(i) Financial Q

(ii) Evidence of source of premium funding

(iii) Cancelled cheque /Copy of Bank Statement

(iv) Photo Identity proof of Premium Payor

(v) Residence Proof of Premium Payor

(vi) NACH mandate

(vii) Annexure to Electronic Application.”

24. Reminders were issued subsequently. The requirements were received on 05.02.2019. On

08.02.2019 requirements like Financial Q, Evidence of source of premium funding was received.

Thereafter the policy bond was issued.

25. Complainant himself has signed the declaration in the proposal which is as under:-

“At the end of the proposal, the complainant signed a declaration stating: I understand that the

contract will be governed by the provisions of the Indian Insurance Act 1938, and other applicable

Statutes and prevailing laws in India and that the risk cover will not commence until a written

acceptance of this proposal is issued by the Company and that the risk cover and other benefits

under the policy shall be subject to the terms and conditions contained in the contract of

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assurance. I also agree that the amount held in proposal/ policy deposit shall not earn any

interest.”

26. It is necessary that the underwriting requirements should be completed before acceptance of the

proposal. Accordingly on receipt of the requirements the policy bond was issued.


27. It is further relevant that date of payment of premium every year is also 11th

of February.

Accordingly the date of maturity is also 11.02.2029.

28. Policy bond was delivered to the complainant on 18.02.2019 but option of free-look was not

exercised within 15 days. Complainant himself was a Senior Officer in Defence Forces. He was well

aware of the terms and conditions of the policy bond. Complainant submits that he has raised the

objection orally during free-look period but it could not be substantiated by the material available on

record. Non exercise of option within free-look period debars the complainant from exercising the

option of alteration of due date of maturity.

29. Accordingly I am of the view that complaint lacks merits and is liable to be dismissed.

Order:-





16(1)/17 OF THE INSURANCE OMBUDSMAN RULE

Documents

Transcript of 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE