16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017) Mr ...

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PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP

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

Mr. Gopal Chandra Sharma……. ………………..……....………………. Complainant

V/S

Bajaj Allianz Life Insurance Co Ltd..…..…....……………………………Respondent

COMPLAINT NO: LCK-L-006-1920-0176 Order No. IO/LCK/A/LI/0431/2019-20

1. Name & Address of the Complainant Mr. Gopal Chandra Sharma

Gomti Nagar

Lucknow

2. Policy No:

Type of Policy

Duration of policy/DOC

0027574660, 0034549794

New Unit Gain EasyPension Plus,Capital

Unit Gain

28.09.2006, 28.12.2006

3. Name of the insured

Name of the policyholder

Mr. Gopal Chandra Sharma

Mrs. Asha Sharma

4. Name of the insurer Bajaj Allianz Life Insurance Co. Ltd.

5. Date of Repudiation/Rejection -

6. Reason for repudiation/Rejection -

7. Date of receipt of the Complaint -

8. Nature of complaint Payment of Mty and interest thereon

9. Amount of Claim

10. Date of Partial Settlement

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 28.02.2020 , 10.30 am at Lucknow

14. Representation at the hearing

a) For the Complainant Mr. Gopal Chandra Sharma

b) For the insurer Mr. Amit Khanna

15. Complaint how disposed Dismissed

16. Date of Award/Order 28.02.2020

17. Mr. Gopal Chandra Sharma (Complainant) has filed a complaint against Bajaj Allianz Life

Insurance Co. Ltd. (Respondent) alleging maturity payment not paid and interest on it.

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MS

COMPLAINT NO: LCK-L-006-1920-0176 Order No. IO/LCK/A/LI/ 0431/2019-20

Brief Facts of the Case:-

18. Mr. Gopal Chandra Sharma has lodged his complaint stating that he had two policies with

Bajaj Alianz Life Insurance Co. Ltd. He has deposited total one premium only under the policies.

He visited RIC`s office to know about his policies. They gave him account statement and

assured him more benefits even if he did not deposit premiums. As he was not in a position to

deposit renewal premiums, he waited till maturity. On maturity, company has not replied his

letters. Nothing was heard from them. The complainant initially lodged his complaint for

maturity payment but when amount was received by him, he claimed for interest of his deposit

money under the policies. 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 in their mail to the complainant with c.c. to us that

they have cancelled the policies since inception and amount was paid to the complainant

through cheque on 06.08.2010 for Rs. 10667/= and rest amount through NEFT on 22.01.2019

and 28.01.2019. Detailed SCN was not received.

20. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent

while respondent has not filed SCN with enclosures.

21. I have heard the complainant as well as respondent representative and perused the record.

Findings:-

22. Admittedly the complainant had taken 2 policies with an annual premium of Rs. 30,000/- and

Rs. 51,000 with commencement date 28.09.2016 respectively. One premium was paid thereafter

due to personal reasons complainant did not continue with the policy. He approached the

respondent and other officers in the government of India. Complainant received the refund of his

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amount in the month of January, 2019 but without any interest. Accordingly he has prayed for

interest on the deposited amount.


23. As per the respondent following were made:-

Policy No.

Voucher No. Bank Name

Payment

Mode

Cheque

No.

Amount

Cheque

Date

Payment

Date

0027574660 1260123 UTI Bank Ltd Cheque 233365 10667 6/8/2010 6/8/2010

Policy No.

Payment Type Bank Name

Account No.

UTR Amoun

t

Payment

Date

Payment

Mode

0027574660 CI UCO Bank 16540100002846 SIN00101Q4949371 19333 22/01/2019 NEFT

Policy No.

Payment Type Bank Name

Account No.

UTR Amount

Payment

Date

Payment

Mode

0034549794 CI UCO Bank 16540100002846 SIN00101Q4967948 51000 28/01/2019 NEFT

24. Now it is to be looked into as to whether the complainant entitled for any interest on the

amount refunded by the respondent.

25. Admittedly only one premium was paid by the complainant thereafter he discontinued the

policy. The payment was made treating the policies cancelled since inception. Policies were not

revivable. In such circumstances since policies itself got cancelled since inception although

amount remained with the respondent but the complainant cannot claim any interest on the

premium amount. Refund of premium amount itself is a good gesture from the respondent. In

such circumstances complaint is liable to be dismissed.

Order:-

26. Complaint is dismissed.

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COMPLAINT NO: LCK-L-006-1920-0176 Order No. IO/LCK/A/LI/ 0431 /2019-20

27. Let the copy of award be given to both the parties.

Date: 28.02.2020 Justice Anil Kumar Srivastava

Place: Lucknow (Insurance Ombudsman)

PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW


Mr. Chandra Datta..……....………………………………………………………. Complainant

V/S

L.I.C. of India……..…...……………..……………………..………..…..………...Respondent


1. Name & Address of the Complainant Mr. Chandra Datta

M-22 , Indra Nagar

Kanpur -208026

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

235122830

Jeevan Saral

26.04.2010

--

10 years



Mr. Chandra Datta

Mr. Chandra Datta

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4. Name of the insurer L.I.C. of India



7. Date of receipt of the Complaint 12.10.2018

8. Nature of complaint Mis-selling

9. Amount of Claim 625000/-

10. Date of Partial Settlement --

11. Amount of relief sought To Correct the maturity figure in Policy Bond

12. Complaint registered under Rule Rule No.13(1)(d)of Insurance Ombudsman Rule

2017

13. Date of hearing/place 18.02.2020 at 10.15 A.M.


c) For the Complainant Mr. Chandra Datta

d) For the insurer Shri P. K Dixit



17. Mr. Chandra Datta (Complainant) has filed a complaint against LIC of India (Respondent)

alleging that maturity amount is not correctly printed in policy bond.

COMPLAINT NO: LCK-L-029-1819-0493 Order No. IO/LCK/A/LI/ /2019-20

Brief Facts of the Case: -

18. The complainant has stated that he had taken a policy no.235122830 under T-T 165-10 for

Rs. 625000/- on 13.05.2010. Under this policy, he had to pay premium of Rs.30025/- per Anum

for ten years. Accordingly he had deposited the premiums in time. On 18.08.2018, he obtained

a Loan Quotation wherein Maturity sum assured was mentioned Rs.136500/-. Claimant has

further stated that the maturity sum assured should be Rs. 625000/- in place of 136500/- , so

he met with the LIC officials and they said it is right. But as per contract between LIC and

Policyholder, it is against Rules of Law. Being aggrieved, the complainant approached this

forum for the redressal of her grievance.

Written reply/SCN:-

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19. In SCN/reply dated 17.01.2019 , RIC has stated that policy no.235122830 was issued on

the life of Mr. Chandra Datta on 26.04.2010 under T-T 165-10. The annual premium is Rs.

30025/-. Death sum assured and Double accident benefit under the policy is 625000/- but the

maturity amount is 149225/-only. Maturity amount is not printed on the policy bond by mistake.

20. The complainants have filed a complaint letter along with other relevant papers but

Annexure VI A , is not enclosed, respondent has filed SCN with enclosures.


Findings:-

22. Complainant has taken the LIC Jeevan Saral (with profit) policy on 26.04.2010. Instalment

premium for main plan was Rs. 29400/-. Instalment of accident benefit premium was Rs. 625/-

total installments premium was Rs. 30025/-. Premium was to be paid on yearly mode. Date of

maturity is 26.04.2020. Policy was taken by the insured at the age of 56 years. Controversy

arose the life assured obtained a loan quotation for this policy wherein maturity sum assured

was mentioned as 1,36,500.

23. Contention of the complainant is that it is a case of mis-selling. When the policy was sold it

was told that the maturity value would be Rs. 6.25 lakhs and maturity bonus would also to


payable. It is further submitted that in even in the policy bond sum assured is mentioned as Rs

6.25 Lakhs. It is further submits that the policy bond maturity sum assured has mentioned as

Rs 6.25 Lakhs.

24. Per Contra respondent representative submits that in the policy bond maturity sum assured

is not mentioned. Due to some typographical mis-match amount of Rs. 6.25 Lakhs which was

death benefit sum assured is being misunderstood as maturity sum assured. It is further

submitted that the calculation of the maturity sum was made in accordance with the table no.

165 under which the plan the policy was issued.

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25. No doubt policy was issued under the approval of IRDA. As per the circular no.

ACTL/1934/4 of the LIC the plan in question was issued under the table no. 165 wherein the

basic core factor is that it provides to the policy holder high risk covered with a smooth return,

Liquidity and lots of flexibility. It is also provided in the plan in conventional products premium

rates are given per 1000/- sum assured for different entry ages and terms. Under this product

death cover will be same irrespective of at entry and term but the sum payable at maturity will

differ for different entry ages and terms. This policy also provides for loyalty additions. Loyalty

additions will be declared after the policy has been in full form for at least 10 years. On Maturity

the life insured will get the maturity sum assured plus loyalty addition if any.

26. The only point to be looked into is as to whether the complainant take an advantage of

non- mentioning of maturity sum assured in the policy bond. We can read the bond and find

that 2 sums are mentioned in the policy bond which is Rs 6.25 Lakhs each. They are meant for

death benefit sum assured under main plan and accident benefit sum assured. Column relating

to maturity sum assured is lying vacant. When nothing is printed in this column how it would be

presumed that it was Rs 6.25 Lakhs? Policy bond was generated through computer and the

entries are made on a printed form. Little mis-match that is printing of an amount of Rs 6.25

Lakhs on a higher side with a few millimeters difference cannot extend a benefit or right to the

complainant. It is settled legal position that a party cannot take the advantage of a printing or

typographical error in the agreement. A presumption cannot be raised in favor of the


complainant. It is more important that the basic features of table no. 165 are in public domain.

In that situation it cannot be accepted that any mis-selling was done with the complainant who

himself is a retired employee.

27. Accordingly I am of the view that the payment of Rs. 149225/- was offered by the

respondent LIC to the complainant in accordance with the terms and conditions of the policy

bond which is justifiable. It doesn‟t require any interference. Accordingly complaint is liable to

be dismissed.

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Order:-



Date: 18.02.2020 (Justice Anil Kumar Srivastava)

Place: Lucknow Insurance Ombudsman



Mr. Lal Sahab Yadav………………..……....………………………….………. Complainant

V/S

Bajaj Alianz Life Insurance Co. Ltd……....................…………………………Respondent


1. Name & Address of the Complainant Mr. Lal Sahab Yadav,

Chota Baghara,

Allahabad

2. Policy No:

Type of Policy


0078806501

-

Matured



Mr.Lal Sahab Yadav

Mr. Lal Sahab Yadav

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4. Name of the insurer Bajaj Alianz Life Insurance Co. Ltd.




8. Nature of complaint Maturity amount less paid

9. Amount of Claim Rs.25,000/=

10. Date of Partial Settlement Rs.16915/=

11. Amount of relief sought Balance amount with interest

12. Complaint registered under Rule Rule No. 13(1)(b) of Ins. Ombudsman

Rule 2017

13. Date of hearing/place On 20.02.2020 at 10.30 am at

Lucknow


a) For the Complainant Absent

b) For the insurer Mr. Amit Khanna



17. Mr. Lal Sahab Yadav (Complainant) has filed a complaint against Bajaj Alianz Life

Insurance Co. Ltd. (Respondent) alleging that less maturity amount was paid to him.

YKS



18. Mr. Lal Sahab Yadav has lodged his complaint on 03.04.2018 stating that he has

received less amount of maturity. The complainant has stated that he had deposited

Rs.25000/= as single premium for 10 years as per terms of policy but on maturity he

received less amount. He has received only Rs.16915/= against Rs. 25,000/=

deposited by him for 10 years. He approached RIC but was not satisfied. Being

aggrieved he has approached this forum for the redressal of his grievance.

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Written reply/SCN:-

19. In their SCN/reply the RIC has stated that total amount payable under the policy

has been paid to the complainant and no amounts are due or payable in any manner.

It is submitted that being an advocate himself, the complainant was able to assess the

terms and conditions of the said policy, which was unit linked, the details of charges in

respect of the said policy have been clearly provided therein. Single premium amount

was fully invested in the Equity Index Fund II as per the proposal form, the same was

allocated accordingly and on maturity the fund value, as on the date of maturity, was

paid to the complainant.

20. The complainant has filed a complaint letter, annexure VI A, correspondence with

respondent while respondent has filed SCN with enclosures.

21. Despite notice complainant is not present. I have heard the respondent

representative and perused the record.

Findings:-

22. Complainant has taken a policy “Bajaj Alliance New Unit Gain Plus-SP” dated

18.12.2007 where in one single premium of Rs. 25,000/- was paid. Sum Assured was

Rs. 1,25,000/-. On maturity complainant received only Rs. 16915/- on 05.01.2018.

23. Respondent submits that it was a „Unit Link Policy‟ wherein the maturity value was

to be calculated in accordance with the NAV. The fund value was paid as was existing

on the date of maturity. The single premium amount was equity index fund-II.

Payment was made in


accordance with the terms and conditions of the policy bond. I do not find any merit in

the complaint which is liable to be dismissed.

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Order:-







Dr. Dingur Mal Mishra…………. ………………..……....………………. Complainant

V/S

Life Insurance Corp. of India…………………....…....…………………………Respondent


1. Name & Address of the Complainant Dr. Dingur Mal Mishra

Civil Lines

Sultanpur

2. Policy No:

Type of Policy


236794052

Wealth Plus

08.05.2010



Dr. Dingur Mal Mishra

Dr. Dingur Mal Mishra

4. Name of the insurer Life Insurance Corp. of India




8. Nature of complaint Maturity Amount less paid

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9. Amount of Claim




2017



a) For the Complainant Absent

b) For the insurer Mr. Heera Singh



17. Dr. Dingur Mal Mishra (Complainant) has filed a complaint against Life Insurance Corp. of

India (Respondent) alleging that less amount was paid on maturity.

MS



18. Dr. Dingur Mal Mishra has lodged his complaint on 06.11.2018 stating that less amount was

paid by the Life Ins. Corp. of India on maturity of his policy. The complainant has stated that he

deposited Rs.75000/= as single premium for 8 years but on maturity of the said policy he

received only Rs.75969 /= as maturity amount of the policy. He further stated that at proposal

stage agent assured him to get highest NAV for policy period. The complainant has written

many letters for receiving less payment but he received no response from RIC. The complainant

was not satisfied. Being aggrieved he has approached this forum for the redressal of his

grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the company has received complaint on

06.12.2018 regarding maturity payment of „wealth Plus policy‟. AS per terms and conditions of

the policy, risk premium was chargeable every month, and at the time of proposal the age of

the complainant was 60 years. There is two years extended life cover under this policy after

completion of policy term. After deduction as per rules maturity amount was paid to the policy

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holder. Proposal form was not printed due to technical problem. Maturity claim amount fund

value chart deduction wise enclosed by the RIC.


while respondent has filed SCN with enclosures.

21. Despite notice complainant is not present. I have heard the respondent representative and

perused the record.

Findings:-

22. Policy was taken under the plain TT 801-08(01) Wealth Plus. An amount of Rs. 75,000/-

was deposited under the policy but on maturity after 8 years insured received Rs. 75969/-only.

Main concern of the complainant is that he got less amount then what he was told by the

agent.


23. It was the policy under „Wealth Plus Plan‟ where the maturity value was paid in accordance

with the terms and conditions of the policy bond. Highest NAV during the last 7 years or on the

date of maturity was to be paid which was paid at the rate of 15.9708 as on the date of

maturity. Charges under the head of administration and mortality were deducted by the

insurer. Hence the maturity amount was paid in accordance with the terms and conditions of

the policy bond. Complaint lacks merit and liable to be dismissed.

Order:-


25. Let the copies of award be given to both the parties.



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Mrs. Urmila Tripathi..……...............................................………………. Complainant

V/S

L.I.C. of India……..…...……………..………………….…..………..…..………...Respondent


1. Name & Address of the Complainant Mrs. Urmila Tripathi

M-22 , Indra Nagar

Kanpur -208026

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

235123064

Jeevan Saral

27.04.2010

--

10 years



Mrs. Urmila Tripathi

Mrs. Urmila Tripathi

4. Name of the insurer L.I.C. of India




8. Nature of complaint Mis-selling



11. Amount of relief sought To Correct the maturity figure in Policy Bond

12. Complaint registered under Rule Rule No.13(1)(d)of Insurance Ombudsman Rule

2017



e) For the Complainant Shri Chandra Datta

f) For the insurer Shri P K Dixit

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17. Mrs. Urmila Tripathi Complainant) has filed a complaint against LIC of India (Respondent)

alleging that maturity amount is not correctly printed in policy bond.


Brief Facts of the Case: -

18. The complainant has stated that she had taken a policy no.235123064 under T-T 165-10 for

Rs. 625000/- on 13.05.2010. Under this policy, she had to pay premium of Rs.30025/- per

annum for ten years. Accordingly she had deposited the premiums in time. On 18.08.2018, she

obtained a Loan Quotation wherein Maturity sum assured was mentioned as Rs.1,65,650/-.

The complainant has further stated that the maturity sum assured should be Rs. 6,25,000/- in

place of 1,65,650/-, so she met with the LIC officials and they said it is right. But as per

contract between LIC and Policyholder, it is against Rules of Law. Being aggrieved, the

complainant approached this forum for the redressal of her grievance.

Written reply/SCN:-

19. In SCN/reply dated 17.01.2019 , RIC has stated that policy no.235123064 was issued on

the life of Mrs. Urmila Tripathi on 27.04.2010 under T-T 165-10. The annual premium is Rs.

30025/-. Death sum assured and Double accident benefit under the policy is 625000/- but the

maturity amount is 1,85,200/-only. Maturity amount is not printed on the policy bond by

mistake.

20. The complainants have filed a complaint letter along with other relevant papers but

Annexure VI A, is not enclosed, respondent has filed SCN with enclosures.


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Findings:-

22. Complainant has taken the LIC Jeevan Saral (with profit) policy on 27.04.2010. Installments

premium for main plan was Rs. 29,400/- while instalments accident benefit premium was Rs.

625/- total installments premium was Rs. 30025/-. Premium was to be paid on yearly mode.

Date of maturity was 27.04.2020. Policy was taken by the insured at the age of 53 years.

23. Controversy arose when the life assured obtained a loan quotation from LIC Branch wherein

Maturity Sum Assured was mentioned as 1,65,650/-. Contention of the complainant is that it is


a case of mis-selling. When the policy was sold it was told with the sum assured and the

maturity value would be Rs. 6.25 lakhs and maturity bonus would also to be payable. It is

further submitted that even in the policy bond sum assured is mentioned as Rs 6.25 Lakhs. It is

further submitted that the policy bond maturity sum assured has mentioned as Rs 6.25 Lakhs.

24. Per Contra respondent representative submitted that in the policy bond maturity sum

assured is not mentioned. Due to some typographical mis-match amount of Rs. 6.25 Lakhs

which was death benefit sum assured is being misunderstood as maturity sum assured. It is

further submitted that the calculation of the maturity sum was made in accordance with the

table no. 165 under which the plan the policy was issued.



basic core factor is that it provides to the policy holder highly covered with a smooth return,






the life insured will get the maturity sum assured plus loyalty addition if any. The only point to

be looked into as to whether the complainant takes advantage of non- mentioning of maturity

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sum assured in the policy bond. We can read the bond and find that 2 sums are mentioned in

the policy bond which is Rs 6.25 Lakhs each meant for death benefit sum assured under main

plan and accident benefit sum assured. Column redressing to maturity sum assured is lying

vacant. When nothing is printed in this column how it can would be presumed that it was Rs

6.25 Lakhs. The policy bond was generated through computer and the entries are made on a

printed form. Little mis-match that is printing of an amount of Rs 6.25 Lakhs on a higher side

with a few millimeters difference cannot extend a benefit or right to the complainant. It is

settled legal position that a party cannot take the advantage of a printing or typographical error

in the agreement. A presumption cannot be raised in favor of the complainant. It is more


important that the basic features of table no. 165 are in public domain. In that situation it

cannot be accepted that any mis-selling was done with the complainant who himself is a retired

employee.




be dismissed.

Order:-





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Mr. Anoop Kumar Sinha…………. ………………..……....………………. Complainant

V/S


COMPLAINT NO:LCK-L-029-1819-0528 Order No. IO/LCK/A/LI/0362/2019-20

1. Name & Address of the Complainant Mr. Anoop Kumar Sinha

Faizabad Road

Lucknow

2. Policy No:

Type of Policy


214735077

Jeevan Nidhi

11.12.2004



Mr. Anoop Kumar Sinha

Mr. Anoop Kumar Sinha





8. Nature of complaint Maturity not settled

9. Amount of Claim Pension Plan




2017



a) For the Complainant Mr. Anoop Kumar Sinha

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b) For the insurer Mr. Rishi Mishra

15. Complaint how disposed Dismissed as settle


17. Mr. Anoop Kumar Sinha (Complainant) has filed a complaint against Life Insurance Corp. of

India (Respondent) alleging that maturity claim of the policy was not settled by the LIC.



18. Mr. Anoop Kumar Sinha has lodged his complaint on 01.01.2019 stating that maturity claim

of his policy was not settled by the Corporation. The complainant has stated that on maturity

of the policy he has submitted all requirement as consent letter for pension and for payment of

1/3rd commutation amount but the claim was not settled. The complainant visited branch office

where it was confirmed by concerned officer that there was some mismatch in policy master

but no written response was received from RIC. The complainant was not satisfied. Being

aggrieved he has approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the respondent has stated that due to technical mistake of policy master

commutation amount and annuity was not paid but now commutation value with penal interest

has been paid to the complainant and Zonal Office has started to make annuity payment as per

option requested by the annuitant.




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Findings:-

22. Undisputedly the insured had taken „LIC Jeevan Nidhi Plan‟ which got matured on

11.12.2017 but neither the pension nor commutation amount was paid to the insured. It is

admitted by the LIC that due to incorrect policy master payment could not be made. Payment

of Rs. 59991/- has been made on 18.09.2019 which includes penal interest at the rate of 8.25

percent amounting to Rs. 4759/-. Now pension is regularly being paid. Complainant submits

that he wants that the amount be paid to him one time in lump sum. It is submitted by the

respondent representative that onetime payment cannot made after maturity except on medical

grounds.

COMPLAINT NO: LCK-L-029-1819-0528 Order No. IO/LCK/A/LI/0362 /2019-20

23. Having considered the submission I am of the view that the LIC had already made the

payment of commutation value along with penal interest. Now the pension is being paid

regularly. As per terms and conditions of policy bond, policy cannot be surrendered after

maturity except on exceptional grounds of illness. No such ground is taken by the complainant.

Hence, now policy cannot be surrendered. Complaint is to be disposed off accordingly.

Order:-

24. Complaint is disposed off.




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Mr. Radhey Shyam Agarwal…… ………………..……....………………. Complainant

V/S


COMPLAINT NO:LCK-L-029-1819-0566 Order No. IO/LCK/A/LI/0364 /2019-20

1. Name & Address of the Complainant Mr. Radhey Shyam Agarwal

Rajajipuram

Lucknow

2. Policy No:

Type of Policy


216844235

Jeevan Saral

05.11.2008



Mr. Radhey Shyam Agarwal

Mr. Radhey Shyam Agarwal






9. Amount of Claim




2017



a) For the Complainant Mr. Radhey Shyam Agarwal

b) For the insurer Mr. Rishi Mishra



17. Mr. Radhey Shyam Agarwal (Complainant) has filed a complaint against Life Insurance

Corp. of India (Respondent) alleging less amount paid on maturity.

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MS

COMPLAINT NO:LCK-L-029-1819-0566 Order No. IO/LCK/A/LI/ /2019-20


18. Mr. Radhey Shyam Agarwal has lodged his complaint on 21.01.2019 stating that less

amount was paid by the company Life Ins. Corp. of India on maturity of his policy. The

complainant has stated that he deposited Rs.1,20,000/= during policy term for 10 years but on

maturity of the said policy he received only Rs.64,281 /= as maturity amount of the policy. He

further stated that at proposal stage agent assured him to get his deposit with loyality addition

after completion of policy term. The complainant has written letter for less payment but he

received no response from RIC/GRO. The complainant was not satisfied. Being aggrieved he

has approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the above said policy was issued to policy

holder with DOC 05.11.2008, Death sum assured Rs.2,50,000/=, Maturity sum assured Rs.

47,440/=, monthly premium was Rs.1000/= for ten years term. The same was mentioned on

policy bond. On maturity of the policy as per terms and conditions maturity sum assured with

loyalty addition was paid to the policy holder.




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Findings:-

22. Undisputedly the insured has taken the plan „Jeevan Saral (with profits) wherein he

deposited an amount of Rs. 1000/- per month for 10 years but on maturity he got Rs. 64281/-

only. Main grievance of the complainant is that he had received the amount which is less than

the amount deposited by him.

COMPLAINT NO:LCK-L-029-1819-0566 Order No. IO/LCK/A/LI/0364 /2019-20

23. Policy in question was a term policy wherein the policy bond itself maturity sum assured as

mentioned as Rs. 47440/- only. On the basis of the terms and conditions of the policy bond

calculation was made wherein loyalty bonus of Rs. 16841/- was paid. Accordingly the payment

was made in according to the terms and conditions of the policy bond. Complaint is devoid of

any merit and is liable to be dismissed.

Order:-





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Mr. Om Prakash Kapoor…… ………………..……...........………………. Complainant

V/S



1. Name & Address of the Complainant Mr. Om Prakash Kapoor

Pheel Khana

Kanpur

2. Policy No:

Type of Policy


234713489

Jeevan Saral

28.12.2008



Mr. Om Prakash Kapoor

Mr. Om Prakash Kapoor






9. Amount of Claim




2017



a) For the Complainant Mr Vikas Kapoor

b) For the insurer Sri Pramod Kumar Dixit

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17. Mr. Om Prakash Kapoor (Complainant) has filed a complaint against Life Insurance Corp. of

India (Respondent) alleging that less amount was paid on maturity.



18. Mr. Om Prakash Kapoor has lodged his complaint on 22.02.2019 stating that less amount

was paid by the Life Ins. Corp. of India on maturity of his policy. The complainant has stated

that when he purchased the said policy it was mentioned in policy documents and also as

explained by his advisor, the policy term was 10 years, sum assured at maturity 3 lakhs, and

loyalty bonus was Rs.50 per thousand but he got only Rs.36,708/= at maturity . At the time of

purchasing this policy, if maturity amount would have been mentioned on policy bond, the

complainant would have never bought this policy or he would have opted for cooling off

cancellation. The complainant has approached RIC through e-mail but no response was

received from them. Being aggrieved he has approached this forum for the redressal of his

grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the policy no.234713489 was issued with doc

28.12.2008, death sum assured Rs.3,00,000/=, Yearly premium Rs.14,412/, Plan term 165-10.

Under the policy maturity sum assured was Rs.36708/= but on bond death sum assured and

double accidental benefit was mentioned. Maturity sum assured was not mentioned on the

policy bond due to mistake.



Pag

e26


Findings:-


premium for main plan was Rs. 14112/-. Instalment of accident benefit premium was Rs. 300/-

total installments premium was Rs. 14412/-. Premium was to be paid on yearly mode. Date of

maturity was 28.12.2018. Policy was taken by the insured at the age of 60 years. Controversy


arose when policy became matured. An intimation was sent to the insured that will get Rs.

36708/- as maturity sum and Rs. 13031/- as royalty addition total Rs. 49739/-.


was told that the maturity value would be Rs. 3 lakhs and maturity bonus would also be

payable. It is further submitted that in even in the policy bond sum assured is mentioned as Rs

3 Lakhs. It is further submitted that the policy bond maturity sum assured is mentioned as Rs 3

Lakhs.

24. Per Contra respondent representative submitts that in the policy bond maturity sum assured

is not mentioned. Due to some typographical mis-match amount of Rs. 3 Lakhs which was










Pag

e27




26. The only point to be looked into is as to whether the complainant takes an advantage of


that 2 sums are mentioned in the policy bond which is Rs 3 Lakhs each. They are meant for



COMPLAINT NO: LCK-L-029-1819-0617 Order No. IO/LCK/A/LI/0383 /2019-20

presumed that it was Rs 3 Lakhs? Policy bond was generated through computer and the entries

are made on a printed form. Little mis-match that is printing of an amount of Rs 3 Lakhs on a

higher side with a few millimeters difference cannot extend a benefit or right to the









be dismissed.

Order:-





Pag

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Mr. Sunder Lal…………. ………………..……………….…....………………. Complainant

V/S

Life Insurance Corp. of India …….…..…....……………………………..…………Respondent


1. Name & Address of the Complainant Mr. Sunder Lal

Rawatpur

Kanpur

2. Policy No:

Type of Policy


234258911

Jeevan Saral

26.12.2008



Mr. Sunder Lal

Mr. Sunder Lal





8. Nature of complaint Amount less paid on maturity

9. Amount of Claim




2017



a) For the Complainant Mr. Sunder Lal

b) For the insurer Shri P.K Dixit

Pag

e29



17. Mr. Sunder Lal (Complainant) has filed a complaint against Life Insurance Corp. of India

(Respondent) alleging that less amount was paid on maturity.

MS



18. Mr. Sunder Lal has lodged his complaint on 20.02.2019 stating that less amount was paid

by the Life Ins. Corp. of India on maturity of his policy. The complainant has stated that he

deposited Rs.1,83,720/= as Rs. 1531/= per month (ecs mode) premiums for 10 years but on

maturity of the said policy he received only Rs.1,21,320 /= against his initial amount deposited

by him. He further stated that he was expecting to get his money with reasonable interest in

ten years long time but he got lesser amount. He approached RIC/GRO but was not satisfied.

Being aggrieved he has approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply , the RIC has stated that under the said policy death sum assured is

Rs.3,75,000/= and maturity sum assured Rs. 89,535/= but due to printing mistake maturity

sum assured was not mentioned on policy bond.


while respondent has filed SCN with enclosures.


Findings:-

Pag

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premium for main plan was Rs. 1499.75/-. Instalment accident benefit premium was Rs.

31.25/- total installments premium was Rs. 1531/-. Premium was to be paid on monthly mode.

Date of maturity was 26.12.2018. Policy was taken by the insured at the age of 56 years.

Controversy arose when policy became matured and an amount of Rs. 121320/- was sent to his

bank account as maturity amount.


was told that the maturity value would be Rs. 3.75 lakhs and maturity bonus would also to be

payable. It is further submitted that even in the policy bond sum assured is mentioned as Rs


3.75 Lakhs. It is further submitted that in the policy bond maturity sum assured is mentioned as

Rs 3.75 Lakhs.

24. Per Contra respondent representative submits that in the policy bond maturity sum assured

is not mentioned. Due to some typographical mis-match amount of Rs. 3.75 Lakhs which was













Pag

e31

26. The only point to be looked into is as to whether the complainant takes an advantage of


that 2 sums are mentioned in the policy bond which is Rs 3.75 Lakhs each. They are meant for



presumed that it was Rs 3.75 Lakhs? Policy bond was generated through computer and the

entries are made on a printed form. Little mis-match that is printing of an amount of Rs 3.75

Lakhs on a higher side with a few millimeters difference cannot extend a benefit or right to the










be dismissed.

Order:-





Pag

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Mr. Anil Kapur…………. ……………………………..…..……....………………. Complainant

V/S

Star Union Dai-ichi- Life Insurance Co. Ltd…..…....…………………………Respondent


1. Name & Address of the Complainant Mr. Anil Kapur

Hazratganj

Lucknow

2. Policy No:

Type of Policy


00645131

Dhan Suraksha (Unit Linked)

24.05.2013



Mr. Anil Kapur

Mr. Anil Kapur

4. Name of the insurer Star Union Dai-ichi- Life Insurance Co. Ltd.




8. Nature of complaint Amount less paid

9. Amount of Claim -

10. Date of Partial Settlement -

11. Amount of relief sought -


2017



a) For the Complainant Mr. Anil Kapur

b) For the insurer Anis Aslam Kazi

Pag

e33



17. Mr. Anil Kapur (Complainant) has filed a complaint against SBI Life Insurance Co. Ltd.

(Respondent) alleging less amount paid on maturity.

MS



18. Mr. Anil Kapur has lodged his complaint on 31.07.2018 stating that less amount was paid by

the company Star Union Dai-ichi- Life Ins. Co. Ltd. on maturity of his policy. The complainant

has stated that he deposited Rs.25000/= as annual premium for 5 years but on maturity of the

said policy he received only Rs.1,16,805.25 /= against Rs. 125000/= deposited by him. He

further stated that at proposal stage agent assured him to get at least double of his deposit.

The complainant has made many efforts to get his maturity and when he received his maturity

amount he was surprised and he approached RIC but was not satisfied. Being aggrieved he has

approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In their SCN/reply, the RIC has stated that the complainant had submitted the proposal

form for purchasing SUD Life Dhan Suraksha Premium 3 with the company and policy was

issued. The complainant is very well educated to understand the policy documents which

contain various details. The complainant has duly paid all the premiums and now making false

allegations after completion of the policy term. The said plan is unit linked insurance plan

wherein the risk in investment portfolio is borne by policy holder. Investment in the unit is

subject to market and others risks and maturity benefits are equivalent to the fund value as on

the date of maturity. The company hereby submits that upon payment of the maturity benefits

on 29.05.2018 the company has duly discharged its liability under the policy.

Pag

e34




Findings:-

22. The insurance cover of the complainant is connected with the loan taken by him from Bank

of India. There is no dispute that the policy was taken by the insured and policy bond was sent


to him. Total premium paid in 5 years was 1.25 lakhs while the payment of Rs. 116805.25 was

made on maturity. It was a Unit Linked Policy wherein the value was assessed on the basis of

units. Complainant main concern is about the harassment made by the bank as well as

insurance company. It is admitted that the payment was made in the insured account on

31.05.2018. So far as harassment by bank is concerned, insured would be at liberty to

approach the proper forum. Payment is made in accordance with the terms and conditions with

the policy bond. Deductions were made under different heads of charges as per the terms and

conditions of the policy bond. Accordingly I do not find any merit in the complaint which is

liable to be dismissed.

Order:-


24. Let copy of award be given to both the parties.



Pag

e35



Mr. Ram Prakash ………………………………....……....………………. Complainant

VS

Life Insurance Corporation of India…………………………………………...Respondent


1. Name & Address of the Complainant Mr. Ram Prakash

538K / 1557 ,

Triveni Nagar- II,

Sitapur Road

Lucknow- 226020 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

219125727

Wealth Plus Plan

31.03.2010

N/A

08 years

3. Name of the insured /


Mr. Ram Prakash

Mr. Ram Prakash

4. Name of the insurer Life Insurance Corporation of India

5. Date of Repudiation/Rejection N/A

6. Reason for repudiation/Rejection N/A


8. Nature of complaint Maturity not received

9. Amount of Claim Maturity Value 65000/-


11. Amount of relief sought Maturity Value

12. Complaint registered under Rule Rule No.13(1)(f)of Insurance Ombudsman

Rule 2017


Pag

e36


a) For the Complainant Mr. Ram Prakash

b) For the insurer Mr. Rishi Misra

15. Complaint how disposed Closed


17. Mr. Ram Prakash (Complainant) has filed a complaint against Life Insurance Corporation of

India. (Respondent) alleging that Maturity value of his policy is not being made.

YKS



18. As per the complaint, complainant had taken one policy no. 219125727 under „Wealth Plus

Plan‟ for Rs. 65000/- with single premium of Rs.50000/- for 08 years term on 31.03.2010 from

LIC of India. Policy matured on 31.03.2018, hence he has deposited Original Policy bond with

other relevant papers with LIC on 12.03.2018 at Trans Gomti Branch Lucknow. After vigorous

follow-up, complainant came to know that the aforesaid policy has already been surrendered by

the employees of LIC at his own in 2014 without original policy bond and consent letter of the

policy holder and part amount was used for new business from the proceeds. Being aggrieved,

the complainant approached this forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 03.02.2020, RIC has informed that grievance has been resolved and

Branch has paid following amount to policy holder through NEFT on 01.02.2020.

Maturity claim amount as on 31.03.2018 Rs. 65050/-

(Considering Units 4207.102, NAV Rs. 15.4619)

Interest Thereon Rs. 7058/-

TOTAL Rs. 72108/-

They further informed that the delay has occurred due to Technical reason.

Pag

e37

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. Undisputedly complainant had taken the policy under „Wealth Plus Plan‟ on 31.03.2010.

Duration was 8 years. It is alleged that the policy was surrendered in 2014 due to the fault of

the respondent. However respondent has paid an amount of Rs.72108/- to the complainant on

01.02.2020. It includes interest amount of Rs. 7058/-. Since payment has already been made

complaint become infructuous and is liable to be closed.


Order:-

23. Complaint is closed.

24. Let copy of award be given to both the parties.



Pag

e38



Mr. Shiv Singh ………………………………....……....………………………. Complainant

VS

Life Insurance Corporation of India…………………………………………...Respondent


1. Name & Address of the Complainant Mr. Shiv Singh

S/O Sri Duniya Singh

69; Gayatri Nagar

Sanigavon Road

Kanpur- 208021 (U.P.)

2. Policy No:

Type of Policy

DOC

DOD

Duration of policy

234613739;234613773;234613741;

235268853;234613738;235268855

235268851;234613740 & 234613787

Wealth Plus Plan & Last one Jeevan Saral

29.09.2008;30.09.2008;29.09.2008

27.08.2010;29.09.2008;27.08.2010

27.08.2010;29.09.2008 & 29.09.2008

N/A

10-20 years & last one 16 years



Mr. Shiv Singh

Mr. Shiv Singh





8. Nature of complaint Maturity not received

9. Amount of Claim Maturity Value 410208/-with interest


Pag

e39

11. Amount of relief sought Maturity Value

12. Complaint registered under Rule Rule No.13(1)(f)of Insurance Ombudsman

Rule 2017



a) For the Complainant Mr. Shiv Singh

b) For the insurer Ramakanti

15. Complaint how disposed Allowed


YKS


17. Mr. Shiv Singh (Complainant) has filed a complaint against Life Insurance Corporation of

India. (Respondent) alleging that his policies were surrendered and amount adjusted in some

other policies.


18. As per the complaint, complainant had taken aforesaid nine policies (Except Last One)

under ULIP plan with single premium of Rs.50000/- each for 10 & 20 years term on aforesaid

dates from LIC of India. Last policy no.234613787 was issued under Jeevan Saral for 16 years

on 29.09.2008. Claimant has got all policies bonds and is in his possession. Further claimant has

come to know from Local Newspapers that LIC has cheated to several LIC customers of that

particular branch no. CBO-8by transferring the customer‟s premium money into their personal

account instead of LIC account. Claimant has lodged written complaint against LIC Agent Mr.

Gajendra Singh. After vigorous follow-up, complainant came to know that the aforesaid policy

has already been surrendered by the employees/agent of LIC at his own without original policy

bond and consent letter of the policy holder and amount was used for new business from the

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

grievance.

Pag

e40

Written reply/SCN:-

19. In SCN/reply dated 25.02.2020, RIC has stated that aforesaid policies were issued on the

life of Mr. Shiv Singh. Departmental enquiry is being conducted against Agent and reply of Legal

Notice has already been given through our panel Advocate Sri Rajesh Pandey. Respondent has

further stated that since Complainant has not given NEFT and other details, hence payment

could not be made.

20. The complainants have filed a complaint letter along with other relevant papers while

respondent has filed SCN with enclosures. Annexure VI A not enclosed.



Findings:-

22. It is a case which relates to the fraud, having been played by one Mr. Gajendra Singh,

agent of the respondent LIC.

23. The following chart is submitted by the respondent LIC:-

S No Policy No. Status T-T No. of

units

DOC Mty Date Fund

Type

SA/Inst Prem

1

234613739 Surrendered on 28.12.2011 for Rs

57358/-

191-20-

01

4755.095

29.09.2008

29.09.2028

Growth

0/50000

Single Prem.

2 234613773 Surrendered on 01.02.2012 for Rs

62586/-

191-10-

01

4752.124

30.09.2008

30.09.2018

Growth

0/50000

Single Prem.

3

234613741 Surrendered on 02.01.2012 for Rs

56825/-

191-20-01 4755.095 29.09.2008 29.09.2028 Growth

0/50000

Single Prem.


48166/- Lying in stale

191-20-01 3354.871 27.08.2010 27.08.2020 Growth

0/50000

Single Prem.


64182/-

191-20-01 4744.392 29.09.2008 29.09.2028 Growth

0/50000

Single Prem.

Pag

e41


48195/- Lying in Stale as per Branch

Record

191-10-01 3354.871 27.08.2010 27.08.2020 Growth

0/50000

Single Prem.

7 235268851 FP Cheque Dishonored 191-10-01 0 27.08.2010 27.08.2020 Growth

0/50000

Single Prem.

8 234613740 Surrendered on 18.01.2012 For Rs

59571/-

191-20-01 4753.432 29.09.2008 29.09.2028 Growth

0/50000

Single Prem.

9 234613789 Policy is issued in the name of Madhu

Lata nominee is Shiv Singh Husband,

This is in Lapsed Condition Premium is

unpaid since 09/2009 cannot be revived

165-16-16 28.09.2008 28.09.2024 212500 Death

SA/10208 Yly

24. It is clear from the chart in the SCN that the complainant insured had taken policies from

serial 1 to 9 to the respondent LIC. We can classify the policies in the following manner. Policy

mentioned at serial no. 1 to 6 and 8 were undisputedly taken by the insured. These policies

were under” wealth Plus Plan.” The policies had never been surrendered by the complainant.

Letter dated 09.01.2019 written by the insurance company to the insured reads as under:-


सेवा मे:-

श्री शिव शस िंह

69 गयात्री नगर सननगावओिं रोड, कानऩरु- 208021

महोदय

ववषय:- आऩकी ऩॉशऱसीस के भगूतान के सिंदभभ मे

सऺम अधधकारी से स्वीकृती शमऱने के ऩियत आऩको सधूित ककया जाता है कक आऩकी ननम्नशऱखित ऩॉशऱसीस

के अिंतगभत आऩकी शिकायत के सिंदभभ मे आऩको भगुतान ककया जाना है

क्र स० ऩाशऱसी स० राशि

1 234613738 64182.00

2 234613739 57358.00

3 234661374 59571.00

Pag

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4 234613741 55000+1825(stale)

=56825.00

5 234613773 53206.00

6 235268853 48166.00 (stale)

7 235268855 48195.00 (stale)

8 235268851 िेक अनाद्रथ

( अत: देय नहीिं है)

आऩ से अनरुोध है की NEFT द्वारा भगूतान प्राप्त करने हेत ुआऩ ननम्नशऱखित आवश्यकता प्रऩत्र ऩरू्भ कर

िािा मे प्रश्ततु करे जजसस ेकी भगुतान की प्रकक्रया की जा सके

25. It is admitted by the insurance company that a vigilance enquiry is pending against the

agent regarding fraud having been committed by him. Surrender amount of the policies was not

paid to the complainant rather was transferred to the account of some other person. It is also

admitted in the letter dated 09.01.2019 and SCN that the surrender value as on the date of the

alleged surrender is to be paid by the insurance company. At this stage it would be relevant to

mention that the complainant insured had never applied for surrender in 2012 rather it was a

matter of enquiry as to who had applied for surrender and in whose account was paid if the


payment was made by the LIC but the record shows that the complainant applied for the

surrender of policies on 15.06.2017. Hence, complainant would be entitled for the surrender

value as on 15.06.2017.

26. It is further relevant that one policy no. 235268851 is not in existence as the cheque of

premium got dishonored. Complainant submits that he had paid the amount in cash to his

agent name Gajendra Singh but he received the receipt from LIC wherein it is mentioned that

payment was made through cheque which got dishonored. It is a matter of enquiry as to who

had issued the cheque which was dishonored and if it is established that complainant had made

the payment in cash and someone else had issued cheque in that case complainant would be

entitled for the surrender value as prevalent on 15.06.2017 alongwith penal interest @ 8.25

percent per annum.

Pag

e43

27. Another policy was 234613789 is “Jeevan Saral” in the name of complainant‟s wife Madhu

Lata. It is submitted that complainant had paid all the premium to the agent but only first

receipt and receipt of premium dated 28.09.2016 are on record. This receipt is also not issued

by the LIC. It is also on matter of enquiry. Result of enquiry would decide the fate of this policy.

28. Having considered the submission and discussion made above I am of the view that

complaint is liable to be partially allowed.

Order:-

29. Complaint is partially allowed. Respondents are directed to make the payment of policy no.

1 to 6 and 8 as surrender value as on 15.06.2017 with penal interest @ 8.25 percent per

annum w.e.f 15.06.2017 till the date of actual payment.

30. Fate of policy no 235268851 and 234613789 shall be subject to decision of vigilance enquiry

as observed in the body of order.

31. This order shall not affect the vigilance enquiry. LIC would be at liberty to get the legal

formalities completed from the complainant.



Date: 27.02.2020 Justice Anil Kumar Srivastava

Place: Lucknow (Insurance Ombudsman)

Pag

e44



Mr. Suresh Kumar Gupta………………....…….....................………………. Complainant

VS

Life Insurance Corporation of India…………………………..…………………...Respondent


1. Name & Address of the Complainant Mr. Suresh Kumar Gupta

715 , Azad Mohal

Sadar Bazar

Lucknow -226002 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

212121310

Jeevan Sanchay Plan

………….

N/A

20years



Mr. Suresh Kumar Gupta






8. Nature of complaint Less Maturity payment


10. Date of Partial Settlement 93000/-

11. Amount of relief sought S.B. payment Rs 20000/-+ Loyalty Addition

35000/- (TOTAL 55000/-)

12. Complaint registered under Rule Rule No.13(1)(a)of Insurance Ombudsman

Rule 2017


Pag

e45


a) For the Complainant Mr. Suresh Kumar Gupta




17. Mr. Suresh Kumar Gupta (Complainant) has filed a complaint against Life Insurance

Corporation of India. (Respondent) alleging that he has received less maturity amount of his

policy.



18. As per the complaint, complainant had taken one policy no. 212121310 for Rs. 50000/-

under “Jeevan Sanchay Plan” from LIC of India for 20 years. As per policy condition, he had to

get 20% survival benefit payment after 05, 10 and 15 years and balance 40% on maturity.

Complainant had received three survival benefit of 10000/- each. Thereafter on maturity he

received a mail from LIC intimating that a Bonus of Rs. 70000/- is due for payment. Hence he

had submitted all claim papers with LIC. Claimant has received Rs 93000/- only (70000/-

against Bonus and Rs. 23000/-against balance maturity amount) through NEFT. Hence he has

received less maturity amount of Rs 53000/-. Being aggrieved, the complainant approached this

forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 17.02.2020, RIC has stated that claimant has taken a policy under

Jeevan Sanchay Plan for 20 years. Survival benefit were payable at the interval of every five

years(i.e 5 years, 10 years and 15 years from DOC )as 20% of sum assured .On life assured

surviving at the date of maturity 40%of the sum assured along with accrued Guaranteed

Additions and Loyalty Addition would be payable. Under this plan guaranteed addition was

Pag

e46

Rs.70 per thousand at the end of each policy anniversary. Hence fallowing payments have been

made-

S.B due after 05 years Rs. 10000/-


S.B. due after 15 years Rs. 10000/-

Maturity claim paid 20000/- (40% of S.A.)

70000/- (Guaranteed addition @70/- per thousand)

3000/- (Loyalty addition)

-------------------

93000/-

------------------------

Hence correct amount has been paid to claimant.


20. The complainant has filed a complaint letter along with other relevant papers. But

respondent has not filed SCN with enclosures.


Findings:-

22. Admittedly complainant had a policy under 125(Jeevan Sanchay) with term of 20 years and a

sum assured Rs. 50,000/-. He received 3 instalments of survival benefit Rs. 10,000/- each. On

maturity he got the balance sum assured i.e. Rs. 20,000/-, Rs. 70,000/- as bonus, Rs. 3000/- as

loyalty addition. It appears that due to some mis-conception complainant is claiming Rs. 35,000/-

as loyalty addition. Payment has been made in accordance with the terms and conditions of the

policy bond. Accordingly complaint lacks merit and is liable to be dismissed.

Order:-





Pag

e47



Mr. Suresh Kumar Gupta………………....…….....................………………. Complainant

VS

Life Insurance Corporation of India…………………………..…………………...Respondent


1. Name & Address of the Complainant Mr. Suresh Kumar Gupta

715 , Azad Mohal

Sadar Bazar

Lucknow -226002 (U.P.)

2. Policy No:

Type of Policy

DOC /DOR

DOD

Duration of policy

212121310

Jeevan Sanchay Plan

………….

N/A

20years









8. Nature of complaint Less Maturity payment


10. Date of Partial Settlement 93000/-

11. Amount of relief sought S.B. payment Rs 20000/-+ Loyalty Addition

35000/- (TOTAL 55000/-)

12. Complaint registered under Rule Rule No.13(1)(a)of Insurance Ombudsman

Rule 2017


Pag

e48


a) For the Complainant Mr. Suresh Kumar Gupta




17. Mr. Suresh Kumar Gupta (Complainant) has filed a complaint against Life Insurance

Corporation of India. (Respondent) alleging that he has received less maturity amount of his

policy.



18. As per the complaint, complainant had taken one policy no. 212121310 for Rs. 50000/-

under “Jeevan Sanchay Plan” from LIC of India for 20 years. As per policy condition, he had to

get 20% survival benefit payment after 05, 10 and 15 years and balance 40% on maturity.

Complainant had received three survival benefit of 10000/- each. Thereafter on maturity he

received a mail from LIC intimating that a Bonus of Rs. 70000/- is due for payment. Hence he

had submitted all claim papers with LIC. Claimant has received Rs 93000/- only (70000/-

against Bonus and Rs. 23000/-against balance maturity amount) through NEFT. Hence he has

received less maturity amount of Rs 53000/-. Being aggrieved, the complainant approached this

forum for the redressal of his grievance.

Written reply/SCN:-

19. In SCN/reply dated 17.02.2020, RIC has stated that claimant has taken a policy under

Jeevan Sanchay Plan for 20 years. Survival benefit were payable at the interval of every five

years(i.e 5 years, 10 years and 15 years from DOC )as 20% of sum assured .On life assured

surviving at the date of maturity 40%of the sum assured along with accrued Guaranteed

Additions and Loyalty Addition would be payable. Under this plan guaranteed addition was

Rs.70 per thousand at the end of each policy anniversary. Hence fallowing payments have been

made-

Pag

e49



S.B. due after 15 years Rs. 10000/-

Maturity claim paid 20000/- (40% of S.A.)

70000/- (Guaranteed addition @70/- per thousand)

3000/- (Loyalty addition)

-------------------

93000/-

------------------------

Hence correct amount has been paid to claimant.


20. The complainant has filed a complaint letter along with other relevant papers. But

respondent has not filed SCN with enclosures.


Findings:-

22. Admittedly complainant had a policy under 125(Jeevan Sanchay) with term of 20 years and a

sum assured Rs. 50,000/-. He received 3 instalments of survival benefit Rs. 10,000/- each. On

maturity he got the balance sum assured i.e. Rs. 20,000/-, Rs. 70,000/- as bonus, Rs. 3000/- as

loyalty addition. It appears that due to some mis-conception complainant is claiming Rs. 35,000/-

as loyalty addition. Payment has been made in accordance with the terms and conditions of the

policy bond. Accordingly complaint lacks merit and is liable to be dismissed.

Order:-





PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF

KARNATAKA

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

OMBUDSMAN –NEERJA SHAH

In the Matter of Mrs. GANAPI SHANKAR BHANDARI V/s LIFE INSURANCE

CORPORATION OF INDIA

Complaint No: BNG-L-029-1920-0447

Award No: IO/BNG/A/LI/0405/2019-2020

1. Name & Address of the

Complainant

Mrs. Ganapi Shankar Bhandari

#532,11th Cross, 29th Main, HSR Sector 1

Bengaluru - 560102

Mob # 9480335566

Email : [email protected]

2. Policy No:

Type of Policy:

Name of the Policy:

Commencement of Policy/ Policy

Period/PPT

615547006

Life- Annuity

Market Plus

07.03.2018/10/ 10 Years/Annuity

3. Name of the Insured

Name of the Policyholder

Mrs.Ganapi Shankar Bhandari

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

5. Date of Repudiation/ Rejection 17.03.2018

6. Reason for repudiation/ Rejection Terms and Conditions of the policy

7. Date of receipt of Annexure VI-

A

22.11.2019

8. Nature of complaint Surrender value not paid

9. Amount of claim Full maturity value

10. Date of Partial Settlement 07.03.2018

11. Amount of relief sought Full maturity value

12. Complaint registered under Rule

No

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

13. Date of hearing/place 22.01.2020 – Bengaluru


a) For the Complainant Self

b) For the Respondent

Insurer

Mr K P Ravi Kumar, AO(CRM)



17. Brief Facts of the Case: The complaint arose due to the repudiation of maturity payment to Complainant by Respondent

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

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

18. Cause of Complaint: -

a. Complainant’s argument: The Complainant stated that he purchased the said policy in the year 2008 for a period of 10 years.

The Notional Cash Option (NCO) as on vesting date of the policy was ₹.1,37,680/-. She received an

amount of ₹.37,680/-. She requested RI to pay surrender value considering her present illness. She

had undergone medical tests as suggested by the RI and submitted them for further process. RI

communicated to her that her medical condition does not fall under the list of critical illness as per

the terms and conditions of the policy and denied the surrender payment.

Aggrieved with the resolution provided by the RI, she approached this Forum for redressal of her

grievance.

b. Respondent Insurer’s argument: The RI vide their SCN dated 03.12.2019 admitted to the issuance of the aforesaid policy with half

yearly mode premium of ₹.5,000/- for ten years. They stated that the amount paid to the customer is

not exactly 1/3rd amount of NCO. They reproduced the Benefit payable on vesting clause from the

policy schedule which states “An amount equal to the fund value of the units held in the policy

holders unit account at the vesting date, after allowing an option to commute a maximum of one

third of the fund value of units held in the policy holders account, shall be compulsorily utilized to

provide a pension based on the then prevailing immediate annuity rates and other terms and

conditions either from the corporation or from any other life insurance company”. Accordingly to

purchase an immediate annuity the minimum price of ₹.1,00,000/- was retained and remaining

amount of ₹.37, 680/- was paid to the Complainant.

The RI further submitted that the surrender of annuity policy is governed by their circular which is

summarised below

Surrender after vesting date shall be allowed only after completion of at least one policy

year from date of vesting and

Annuitant is receiving the annuity under option ‘F’ and

Annuitant is diagnosed from any one of the listed 21 critical illnesses.

Complainant’s present illness does not fall under the list of 21 critical illness hence her request was

repudiated. In view of the above facts, the non consideration of surrender request of the

Complainant was in order.

19. Reason for Registration of complaint: - The complaint falls within the scope of Insurance Ombudsman Rules, 2017.

20. The following documents were placed for perusal: -

a. Complaint along with enclosures,

b. Respondent Insurer’s SCN along with enclosures and

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

21. Result of personal hearing with both the parties (Observations & Conclusions): The issue before the Forum is, whether the rejection of surrender request by the RI is appropriate.

During the personal hearing, both the parties reiterated their earlier submissions.

The Forum notes that the

1. Complainant availed the said policy in the year 2008 for a period of 10 Years with annuity

option.

2. Complainant received less than the eligible 1/3 commutation amount.

3. RI retained an amount of ₹.7,754/- as downward adjustment to maintain minimum purchase

price of immediate annuity at ₹.1,00,000/- as per their internal circular.

4. Policy schedule received by the complainant clearly shows that the Complainant is eligible

for 1/3 commutation of Notional cash option available as on the date of vesting.

The Forum further notes that there is no such condition for retaining the portion of commutation

amount which is legally due to the life assured. It is also noted that there is no condition which

specifies that minimum amount of ₹. 1,00,000/- will be retained for issue of annuity policy in the

policy terms and conditions. Having entered into the contract of insurance, the Complainant and the

RI are bound by the terms and conditions of the policy schedule and payments can be made as per

existing terms and conditions only. Internal circular cannot effect the terms and conditions of the

policy unless endorsed in the schedule with mutual consent.

The IRDAI (Minimum Limits for Annuities and other Benefits) Regulations, 2015 dated 31.08.2015

inter alia lays down minimum limits to the annuities offered by the life insurers which are made

applicable to all the products offered by life insurers which are approved by the Authority after the

date of notification i.e., 31.08.2015. The Authority may issue separate instructions for withdrawing

the products which are not in compliance with these Regulations but are currently offered by the

Life Insurers and which are approved by the Authority prior to the date of notification of these

Regulations.

The Regulations further states that this would not invalidate the insurance policies issued prior to

these regulations (i.e., 31.08.2015). In other words, the minimum limit for the annuities and other

benefits offered by the life insurers even prior to 31.08.2015 would be as specified under the said

regulations dated 31.08.2015.

Further, the policies issued before 31.08.2015 would not be invalidated but the minimum limit of

annuity mentioned there in would be as specified in these regulations.

Regulation 3.a.i of the aforesaid Regulations lays down that “No life insurer shall pay or undertake

to pay an amount of benefit excluding any profit or bonus on any policy of insurance issued less

than Annuity of ₹. 1,000/- per month.”

In the case at hand RI is paying monthly annuity of ₹.507/- which is in violation of (Minimum

Limits for Annuities and other Benefits) Regulations, 2015 dated 31.08.2015. Hence the RI is liable

to refund the full NCO to the Complainant less commutation value and annuities already paid.

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

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

full NCO less commutation value and annuities already paid to the Complainant with interest

for delayed payment at 6.25% + 2% Penal interest as laid down under Regulation 14 of

IRDAI (Protection of Policy Holders Interest) Regulations, 2017.

The complaint is Allowed.

22. Compliance of the Award: The attention of the Complainant and the Insurer is hereby invited to the following provisions of

Insurance Ombudsman Rules, 2017:

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

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

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

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

Ombudsman.

Dated at Bengaluru on 07th February, 2020

(NEERJA SHAH) INSURANCE OMBUDSMAN

FOR THE STATE OF KARNATAKA


KARNATAKA



In the Matter of MR. MIRAJKAR. R.B. V/s LIFE INSURANCE CORPORATION OF

INDIA Complaint No: BNG--L--029--1920– 0462

Award No: IO/BNG/A/LI/ 0421/2019--2020


Complainant

Mr. R.B. Mirajkar

‘Vaishnavi Medicals’, Dharwad Plaza,

Tikare Road, Dharwad – 580001

(M):9902489316

2. Policy No:

Type of Policy:

Name of the Policy:


Period/PPT

Mode/Premium Amount

630492512

Life

LIC- Endowment Policy with Profits

28/09/1994

25 Years

Quarterly / ₹. 508/-



Mr. R.B. Mirajkar

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


6. Reason for repudiation/ Rejection NIL


A

02/12/2019

8. Nature of complaint Interest not paid on ‘Advance Premium’.

Delay in Settlement of Maturity Claim

9. Amount of claim 1. Interest to be paid on ‘Advance Payment

of Premium.

2. Payment of penal interest on delayed

settlement of claim

10. Date of Partial Settlement N A

11. Amount of relief sought Not Mentioned in Annexure VI A


No

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

2017

13. Date of hearing/place 08/01/2020 &

29/01/2020 - Bengaluru


a) For the Complainant None


Insurer

Mr. Shashidhar Turamari – Manager (C.R.M.)

15. Complaint how disposed Partly Allowed

16. Date of Award/Order 11/02/2020

17. Brief Facts of the Case: The complaint is the result of non-payment of interest on advance premium paid by the

Complainant and also non-settlement of maturity claim on the due date by the Respondent Insurer

(RI) on the policy held by the Complainant. In spite of his representations to GRO, his request was

denied. Aggrieved, he has approached this forum.


a. Complainant’s argument: The Complainant vide his letter dated 30/07/2019 stated that he availed the said policy in the year

1994 for a period of 25 years by paying quarterly premium of ₹. 508/-. On 20/06/2006, when he

sought the alteration in mode of premium from existing quarterly mode, to Yearly mode, the RI

effected the necessary change and advised the Complainant to pay the yearly premium of ₹.1970/-

from June 2006 and in June every year thereafter. Accordingly he has paid all the premium (due in

September) in June and the said policy matured in June 2019. The RI settled the maturity claim due

in June 2019 on 26/09/2019 i.e. with a delay of 3 months. Hence, he has sought the Forums

intervention directing RI to pay interest for the early premiums which he has paid till date and also

penal interest on the delayed settlement of claim.

b. Respondent Insurer’s argument: The RI vide their SCN dated 30/11/2019 stated that the said policy was issued by them on

28/09/1994 under the quarterly mode of premium of ₹.508/- . Subsequently during the month of

June 2006, the mode of payment of premium was altered from quarterly to yearly at ₹.1970/- P.A.

While effecting the alteration, the Complainant should have paid one quarterly instalment due June

2006 @ ₹.508/- so that the alteration could be effected from 28/09/2006 coinciding with the date of

commencement. As a result the Complainant continued to pay Yearly premium due in September,

in the month of June every year. After analysing the complaint received from the Complainant, the

RI concluded that the interest payable to the Complainant on the advance premium for 13 years and

interest payable by the Complainant on outstanding quarterly premium of ₹.508/- for 13 years

would be one and the same and there would be no loss to the Complainant and hence prayed the

Forum to pass an appropriate order in the said case.

19. Reason for Registration of complaint: - The complaint falls within the scope of Insurance Ombudsman Rules, 2017 under Sec 13(1)(c)&(a)

and hence, it was registered.


d. Complaint along with enclosures,

e. Respondent Insurer’s SCN along with enclosures and

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

21. Result of personal hearing with both the parties (Observations & Conclusions): The issue to be decided by the Forum is whether there is any delay on the part of the RI, in

settlement of the maturity claim and whether the premium is paid in advance by the Complainant.

The Complainant did not attend the hearing on 08/01/2020 and hence another opportunity was

given him to attend the hearing on 29/01/2020. However the Complainant failed to attend the 2nd

hearing also.

The RI attended the hearing on 08/01/2020 and informed the Forum that the policy with

commencement date 28/09/1994 was initially issued under quarterly mode of premium payment.

On 16/06/2006 the Complainant opted for alteration in mode of payment of premium from quarterly

mode to yearly mode. At the time of effecting the alteration, the due date of premium was

inadvertently changed to June every year in yearly mode with revised premium of ₹ 1970/- . The

RI also informed the Forum vide their mail dated 05/02/2020 that they had settled an amount of

₹1,35,591/- as maturity claim after deducting one outstanding quarterly premium of ₹ 509/- due in

June 2006.

On perusal of the records placed before the Forum it is observed that the Complainant availed the

said policy on 28/09/1994 for a period of 25 years by paying quarterly premium of ₹.508/- . The

Complainant opted for alteration of mode of payment of premium from existing quarterly mode to

yearly mode on 16/06/2006. The quarterly premium due June 2006 @ ₹.508/- remained unpaid.

The RI should have altered the policy in September 2006 instead of in June 2006 and the RI

continued to receive the premiums in June every year instead of September every year.

As per the grievance of the Complainant, the premium was paid in advance from 2006 onwards.

From the records it is observed that the Complainant has paid the premium due 28/06/2016 on

7/10/2016 and the premium due 28/06/2017 & 28/06/2018 on 24/08/2018 and thus making late

payments which do not entitle for any interest for those dues. Regarding the balance payment made

in advance, the RI is liable to pay interest.

The Forum notes from the schedule that the policy has matured on 28/09/2019. Alteration in mode

of payment of premium does not alter the date of maturity and hence the settlement of maturity

claim on 17/09/2019 i.e. before the date maturity, by the RI is in order. Hence, the Complainant

request to pay interest on delayed settlement of maturity claim is rejected.

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

the parties during the course of Personal hearing, the RI is directed to:-

1. Pay interest on ‘Advance Premium paid’ by taking the duration from date of payment

of premium to the actual due date of premium for each yearly instalment of premium

paid from June 2006 at 8.25% P.A.

2. Calculate and Collect the interest on outstanding instalment quarterly premium due

June 2006 (not paid at the time of mode alteration) from the date of alteration i.e.

16/06/2006 till the date of maturity.

Hence, the complaint is ‘Partly Allowed’.

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

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

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

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

Ombudsman.

Dated at Bengaluru on 11th Day of February 2020

(NEERJA SHAH)

INSURANCE OMBUDSMAN



KARNATAKA



In the Matter of MR. C. PURUSHOTHAMA V/s LIFE INSURANCE CORPORATION OF

INDIA Complaint No: BNG—L—029--1920– 0555

Award No: IO/BNG/A/LI/0426/2019--2020


Complainant

Mr. C. Purushothama

# 304/2, 21st Main Road

‘C’ Block, Vijayanagar 3rd Stage

Mysore – 570017

(M):9980528850

2. Policy No:

Type of Policy:

Name of the Policy:


Period/PPT

Mode/Premium Amount

Sum Assured

046750570

Life

LIC’s Endowment Policy with Profits (Plan 14-

25)

28/07/1983

25 Years

S.S.S./ ₹. 51.30

₹.15,000/-



Mr. C. Purushothama

4. Name of the Respondent Insurer LIC Of India – Bangalore Do - 2

5. Date of Repudiation/ Rejection NIL

6. Reason for repudiation/ Rejection NIL


A

27.06.2017

8. Nature of complaint Mis-sale

9. Amount of claim ₹15,000/- +Bonus + Interest

10. Date of Partial Settlement N A

11. Amount of relief sought ₹. 15,000/- + Bonus + Interest


No

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

13. Date of hearing/place 05/02/2020 - Bengaluru


a) For the Complainant Self


Insurer

Mrs. Ushashree – Manager Claims


16. Date of Award/Order 11/02/2020

17. Brief Facts of the Case: The complaint is the result of non-settlement of maturity claim by the Respondent Insurer (RI) on

the policy held by the Complainant. Even though he has submitted all the documents required to

settle the maturity claim a decade ago, the RI has not settled the maturity claim. Aggrieved, he has

approached this forum.


a. Complainant’s argument: The Complainant vide his letter dated 04/12/2019 stated that he availed the said policy and has paid

all the premiums up to date. Though the policy matured in 2008 and he has submitted all the

documents to the RI on 5/12/2008, the RI has not taken any steps to settle the maturity claim even

after 11 years. Even though he has been regularly following up the matter for 11 years, there is no

response from them. Hence he has approached this Forum for settlement of maturity claim together

with all the benefits and interest for the delayed settlement of the claim as applicable.

b. Respondent Insurer’s argument: SCN not received.

19. Reason for Registration of complaint: - The complaint falls within the scope of Insurance Ombudsman Rules, 2017 under Sec 13(1)(a) and

hence, it was registered.


g. Complaint along with enclosures,

h. Respondent Insurer’s SCN along with enclosures and

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

21. Result of personal hearing with both the parties (Observations & Conclusions): The issue to be decided by the Forum is whether there is delay in settlement of maturity claim under

the said policy.

During the personal hearing on 05/02/2020 the Complainant reiterated his stand as per his

complaints and produced the original salary slip of earlier years, and also details of remittances

made to various branch offices of the RI, as proof for having deducted the premium under his salary

and remitted the same to RI. He also displayed the acknowledgment for having submitted all the

documents on the RI on 05/12/2008 to the RI to enable them to settle the maturity claim. Hence he

prayed the Forum to pass appropriate order in his favour.

The Forum after careful scrutiny of records has observed that the Complainant availed the said

policy under Salary Savings Scheme where the premium is being deducted from the salary of the

Complainant and remitted the same to RI. From the original salary slips submitted by the

Complainant to this Forum it is clear that the Complainant has paid all the premiums under the said

policy and the policy is in full force. The Complainant also submitted the policy documents to the

RI on 05/12/2008 to enable the RI to settle the maturity claim on his policy.

The RI informed the Forum that they have traced the premium position and they would settle the

maturity claim at the earliest and prayed the Forum to pass an appropriate order.

From the records placed before the Forum, it is observed that the Complainant availed the said

policy and has been paying the premium under Salary Savings Scheme (S.S.S) mode of payment of

premium till the date of maturity. The said policy matured on 28/07/2008 and through the

Complainant submitted all the documents/requirements to the RI, on 05/12/2008 the RI has not

taken any steps to settle the maturity claim. The Forum further notes that there is an extreme delay

on the settlement of maturity claim on the said policy held by the Complainant. Non-settlement of

maturity claim for over a decade amounts to serious deficiency of service.

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

both the parties during the course of Personal hearing, the RI is directed to settle the maturity

claim (for Sum assured + accrued bonus) together with interest at 8.25% (6.25% bank rate

+2% extra) as per Rule 14(iv) of Policy Holders Protection Rules 2017 from the date of

submission of all requirements i.e. 05/12/2008 till the date of payment.

Hence, the complaint is Allowed.

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

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

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

Ombudsman.

Dated at Bengaluru on 11th February 2020

(NEERJA SHAH)

INSURANCE OMBUDSMAN


PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, INSURANCE OMBUDSMAN OFFICE,GUWAHATI

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

OMBUDSMAN – K. B. SAHA CASE OF CHANDRESWAR PRASAD GUPTA V/S LIC of INDIA

COMPLAINT REF: NO: 1) GUW-L-029-1920-0293


Complainant Mr Chandreswar Prasad Gupta C/O Jamuna Atta & Dal Mill

N.S. Road,(New Market) Dhubri

P.O. and Dist Dhubri-783301 Assam

2. Policy No:

Policy Type/Duration/Period

489828238

DETAILS ARE IN THE TABLE

3. Name of the Insured/LA

Name of the proposer Chandreswar Prasad Gupta.

Self

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

5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 03-02-2020 8. Nature of complaint Dispute with regard to payment of maturity

Amount. 9. Amount of Claim Not known

10. Date of Partial Settlement Not applicable

11. Amount of relief sought Not Known

12. Complaint registered under

Insurance Ombudsman Rules’ 2017 13 (2)

13. Date of hearing/place 24.02.2020 At O/O Insurance Ombudsman Guwahati

14. Representation at the hearing For the Complainant Absent For the insurer Mr. Maheswar Kumar .AO

15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 24.02.2020

17) Brief Facts of the Case:

Life Insurance Corporation of India Pol No L.A. PLAN DOC Premium

(yly) Term

/PPT

1ST Comp

/Representation

to GRO of Ins.

Co

489828238 Chandreswar

Prasad Gupta

LIC’s Jeevan

Saral Policy

20/01/2010 4,804/- 10/10 yrs 20.12.2019

The complainant has alleged the following:-

i) That he had purchased the above e mentioned Jeevan Saral policy in the year 2010 from LIC of India

(Dhubri Branch) to cover his life. ii) As per terms and Condition of the policy he paid all yearly premiums till the maturity @ Rs 4804/ per

instalment (Total Premium paid by him Rs. 48,040).

iii) That on maturity, the insurer paid him total maturity amount Rs.36, 279/. Being dissatisfied with the insurer’s short payment of maturity amount, and subsequent

unsatisfactory reply by the relevant higher authorities of the insurer, the complainant has now

approached this Forum for redressal of his grievance.

18) Cause of Complaint: Due to short payment of maturity amount.

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

Insurers’ argument: As per SCN received from the insurer:

a) The above Jeevan Saral policy on the life of Mr. Chandreswar Prasad Gupta which

pertains to Dhubri Branch got matured on 20.01.2020.

b) As per the Policy condition, the maturity SA plus Loyalty addition, if any, was payable to the

LA surviving on the date of maturity.

c) Accordingly, as per the terms and condition of the policy, maturity SA Rs 27916/ along with

Loyalty addition Rs 8375/ together amounting Rs 36279/ was payable to the LA subject to

deduction of X-Charge of Rs 11.98 which is correct and within the framework of Policy Schedule.

d) Thus the contention of the Policy holder claiming the amount of Rs. 85162/ was not acceptable

and not based on any laid down rules and policy conditions.

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

20) The following documents were placed for perusal.

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

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

Both the parties were called for hearing on 24.02.2020. The complainant Mr. Chandreswar Prasad

Gupta was absent and intimated the forum through mail expressing his inability to attend the

hearing due to illness of his wife. The Insurer was represented by Mr. Maheswar Kumar (AO).

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

as well as verbal submission made by the representative of the Insurance Company. During the

course of hearing the representative of insurer submitted

the detailed terms and condition under this plan. We have also gone through the records.

As per the terms and condition and features of this particular plan it is seen

that it is a pure term and endowment combination plan. So, unlike term plan, it has provision for

return of premium on death along with death Sum assured. Death benefits under this Plan is

much higher than any traditional endowment plan

Based on the above, the decision of insurer (although maturity Sum

Assured was not printed in the policy bond) was as per the terms and condition of the

policy. Absence of any amount at the designated place for maturity sum Assured ( in the

policy deed) has created a misconception in the mind of the complainant. This, however,

seems to be an unintended omission on the part of the insurer. The maturity Sum Assured

has been arrived at as per benefit structure of the product filed with IRDAI. This forum

does not find any reason to interfere in to the decision of the Insurer and accordingly, no

relief is provided to the complainant against his complaint lodged to this Forum under Policy

No. 489828238.

Hence, the complaint is treated as disposed of.

Dated at Guwahati, the 24th day of February 2020.

K.B.Saha

Insurance Ombudsman

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


Dr Mukti Mishra …………………………………………….. Complainant

V/s

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

COMPLAINT NO: BHP-L-029-1920-0406 ORDER NO: IO/BHP/A/LI/ 0274 /2019-2020


Complainant

Dr Mukti Mishra

T-4 Green Paradise, Vishal Nagar

Behind Hotel Chattisagarh, Teli banda, Ward

No.48, P.O. Raivgram, Raipur

2. Policy No:

Type of Policy

Duration of policy/Policy period

384382023

LIC’s Jeevan Saral (with profits)

28.10.2006



Dr Mukti Mishra

Dr Mukti Mishra

4. Name of the insurer LIC of India

5. Date of Repudiation/ Rejection ---

6. Reason for Repudiation/ Rejection ---


8. Nature of complaint Less payment of maturity amount

9. Amount of Claim --


11. Amount of relief sought Rs.3,01,400/-

Dr Mukti Mishra (Complainant) has filed a complaint against LIC of India (Respondent)

alleging less payment of maturity amount.

Brief facts of the Case - The complainant has stated that she had taken above policy whose

date of commencement was 28.10.2006. The installment premium per year was Rs.36,030/-

and she has paid the premium regularly for 12 years. Policy matured on 28.10.2018. As per

the conditions of the policy the amount will be paid along with sum assured with loyalty

addition. She has paid total Rs.4,32,360/- in 12 years. Respondent vide letter

No.M/102018/000458 had informed that the basic amount of Rs.1,47,450/- and loyalty

addition of Rs.70,039/- totaling Rs.2,17,489/- is payable on maturity which is almost half of

what she had paid i.e. Rs.4,32,360/-. She had written letters to respondent company but has

got no response from them so far. Moreover in the policy the maturity sum assured is left

blank and death benefit sum assured is written as Rs.7,50,000/-. She is a retired senior citizen

and has been paying premiums regularly from her pension. The complainant has approached

this forum for redressal of her grievance.

The respondent in their SCN have stated that the above policy was issued to the

complainant on 28.10.2006 under plan 165-12-12 with Sum assured of Rs.7,50,000/- and

premium of Rs.36,030/- payable yearly. This plan had age at entry 12 years to maximum 60

years. In this plan the risk cover was offered 250 times the monthly premium to be paid. So in

the said matter the monthly premium was Rs.3,000/- and thus the risk cover so offered was

3000x250 = Rs.7,50,000. This policy was completed under ordinary rates + accident benefit

for 12 years (the age at entry for said proposer was 58 years/ DOB 14.09.1948). Since in this

plan the risk cover was 250 times of monthly basic premium, so the mortality charges were

quite higher with the higher age at entry. So in this case the maturity sum assured was

declared at the inception of policy Rs.4915/- per /100 monthly premium (monthly premium is

Rs.3,000/-) so 4915x30 = 1,47,450 + bonus Rs.70,039 total + unclaimed interest Rs.6,143 =

Rs.2,23,632 becomes payable; A sum of Rs.614/- was deducted out of it as income tax on

interest. So net amount payable Rs.2,23,018/- was paid on 10.10.2019 vide NEFT to the life

assured. So in this case the age at entry for plan was higher and risk of Rs.7,50,000/- was

covered upto the age of 70 years.

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

13. Date of hearing/place 14.02.2020 at Bhopal


For the Complainant Mr Vishesh Tiwari, Son-in-law

For the insurer Mr Dayal P Bhidwalkar, Manager CRM



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

while respondent have filed SCN with enclosures.

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

as well as the Insurance Company.

The complainant has taken LIC’s Jeevan Saral (with profits) Table No.165-12 bearing

No.384382023 with Death Benefit and accidental benefit sum assured as Rs.7,50,000/- each

on payment of premium amount of Rs.36,030/- on yearly mode with date of commencement

as 28.10.2006 for a term of 12 years from the respondent company. Policy matured on

28.10.2018. The complainant has stated that on maturity an amount of Rs.2,23,018/- has been

paid which is very less. Maturity amount calculation has been shown in SCN which states that

as per maturity table for age at entry 58 years, Rs.4,915/- is payable for Rs.100/- premium per

month. In this case monthly premium is Rs.3,000/-. Maturity amount payable is Rs.1,47,450

(4915 x 3000/100). Loyalty addition was Rs.70,039/- plus Rs.6,143/- unclaimed interest. Thus

total amount payable on maturity is Rs.1,47,450/- + Rs.70,039 + Rs,6,143/- aggregating

Rs.2,23,632/-. As per SCN a sum of Rs.614/- was deducted from the payable amount as

income tax on interest and net amount payable comes to Rs.2,23,018/- which was paid on

10.10.2019 by NEFT. Respondent has filed Circular about the Jeevan Saral Plan (Actl.1934/4

dated 12.02.2004) which provides that in conventional products, premium rates are given per

thousand sum assured for different entry age and terms. In this plan insured has to first decide

the amount of premium he wants to pay per year. Once the premium is chosen, the sum

assured payable on death gets automatically determined whatever be the age and term. This is

called the sum assured under the policy. The sum payable at maturity will be different for

each age at entry and term of policy. The policy document shows that no amount has been

mentioned in front of maturity sum assured and death benefit and accidental sum assured is

mentioned as Rs.7,50,000/- each. The representative of the respondent has also filed chart

showing maturity sum assured per Rs.100/- monthly premium in which at the age of 58

maturity sum assured for a term of 12 years is shown as Rs.4,915/-. In this case, Rs.2,32,018/-

was found payable as maturity amount to the complainant which is proper as per policy terms

and conditions. The representative of the complainant has argued that maturity sum assured

calculated is not mentioned in the policy. The representative of respondent with reference to

above argument has argued that after receiving the policy bond complainant should have

enquired about the maturity sum assured but she remained silent for 12 years and enquired

nothing with respect to maturity sum assured. He further argued that as per chart and

procedure maturity sum assured paid is in accordance with the policy. Calculation of maturity

amount shown in SCN is in accordance with the terms and conditions of the policy which has

already been paid to the complainant. In the result, complaint is liable to be dismissed.

The complaint filed by Dr Mukti Mishra stands dismissed herewith.

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

Dated : Feb 14, 2020 (G.S.Shrivastava)

Place : Bhopal Insurance Ombudsman

Mr Kishor Singh Chauhan …………………………………………….. Complainant

V/s

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

COMPLAINT NO: BHP-L-029-1920-0465 ORDER NO: IO/BHP/A/LI/0284 /2019-2020

Mr Kishore Singh (Complainant) has filed a complaint against LIC of India (Respondent)

alleging non payment of premium amount paid towards the policy.

Brief facts of the Case - The complainant has stated that he had taken above policy from

respondent company and as he was working with WCL, he has been depositing premium

towards the policy through deductions from his salary. He had retired from service on


Complainant

Mr Kishor Singh Chauhan

C-G-F-09, Indus Satllite Greens Kailod Hala,

Near Panchwati AB Rord, Dewas Naka,

Indore, Madhya Pradesh

2. Policy No:

Type of Policy


371969887

LIC’s Jeevan Anand (with profits)(with

accident benefit)

29.05.2009



Mr Kishor Singh

Mr Kishor Singh


5. Date of Repudiation/ Rejection --

6. Reason for Repudiation/ Rejection --


8. Nature of complaint Non-payment of premium amount deposited

in policy

9. Amount of Claim


11. Amount of relief sought --




For the Complainant Mr Kishor Singh Chauhan & Mr Jay Singh

Chauhan, Son

For the insurer Mr Hrishikesh Barori, Admn Officer



01.07.2012 and till then regular deduction of premium of the said policy was being made

from his salary. Premium deduction was discontinued with effect from August 2012. He was

assured by the Agent that on maturity he will get back the premium deposited in the policy till

01.07.2012 along with interest after 12.07.2019.In Aug 2019 he contacted the respondent’s

Branch for payment and he was informed that no payment is due under the policy as there is a

shortfall of one months premium, for any payment to accrue under the policy. He has

therefore approached this forum for redressal of his grievance.

The respondent in their SCN have stated that the above policy was issued under Salary

Savings Scheme to the complainant on 12.08.2009 under plan 149-43-10. Policy matured on

12.08.2019. Under this policy respondent has received premium for only 2 years and 11

months and after that policy holder retired from his service and they have not received any

further due premium hence policy has been lapsed. As per policy condition No.4, if after

atleast three full year premiums have been paid in respect of this policy and any subsequent

premium be not duly paid, this policy shall not be wholly void, but the sum assured shall be

reduced to such a sum (paid up value) as shall bear the same ratio to the full sum assured as

the number of premiums actually paid shall bears to the total number originally stipulated for

in the policy. In this disputed policy, we have not received full three years premium (one

month premium short) hence policy has been lapsed without acquiring any paid up value and

therefore nothing is payable at maturity and same has been intimated to policyholder through

letter dated 06.12.2019.





Policy No.371969887 was issued under Salary Savings Scheme to the complainant on

12.08.2009 and premium paying term was 10 years. The maturity date under the policy was

12.08.2019. As per complainant, he retired from the services of the WCL on 01.07.2012. As

per respondent they have received premium for only 2 years and 11 months. In support of the

same, respondent has filed attested photocopy of policy ledger of above policy whereby the

last premium paid and adjusted is for the premium due on June 2012 and the first unpaid

premium is July 2012 which is also evident from the attested copy of the status report of the

said policy. The complainant has not submitted any evidence to show that the premium for

July 2012 was also remitted through salary or deposited in cash by him. As per condition No.4

of policy, if after atleast three full years premiums have been paid and any subsequent

premium be not duly paid, this policy shall not be wholly void, but the sum assured shall be

reduced to such a sum (paid up value) as shall bear the same ratio to the full sum assured as

the number of premiums actually paid shall bears to the total number originally stipulated for

in the policy. In the instant case, it is clear that full three years premiums have not been paid,

so it had not acquired any paid up value and hence nothing is payable on maturity of the

policy. Under the above circumstances, the respondent has not erred in denying any maturity

value to the complainant and the same been intimated also to him through B.O. letter dated

06.12.2019 and acted as per terms and conditions of the policy. In the result, complaint is

liable to be dismissed.

The complaint filed by Mr Kishor Singh Chauhan stands dismissed herewith.

Let copies of Award be given to both the parties.



Mr Pramod Singh …………………………………………….. Complainant

V/s

Kotak Mahindra Old Mutual Life Insurance Ltd ……….………….……Respondent

COMPLAINT NO: BHP-L-026-1920-0450 ORDER NO: IO/BHP/A/LI/0282/2019-2020


Complainant

Mr Pramod Singh

Retd DGM, BSNL, C-11, Chetakpuri

Gwalior, Madhya Pradesh

2. Policy No:

Type of Policy


01678916

Kotak Retirement Income Plan without cover

12.08.2009



Mr Pramod Singh

Mr Pramod Singh

4. Name of the insurer Kotak Mahindra Old Mutual Life Insurance

Company Limited


6. Reason for Repudiation/ Rejection Full maturity value not payable, maturity

payout already refunded on 14.08.2019


8. Nature of complaint Non payment of full amount on maturity



11. Amount of relief sought Return of balance 2/3rd amount lying with

Kotak Insurance i.e. about 3 lacs along with

interest from 11.08.2019




For the Complainant Mr Pramod Singh

For the insurer Ms Shweta Joshi, Manager


Mr Pramod Singh (Complainant) has filed a complaint against Kotak Mahindra Old Mutual

Life Insurance Co. Ltd (Respondent) alleging non payment of full amount on maturity.

Brief facts of the Case - The complainant has stated that the respondent company is not

paying full amount against the above policy. He has further stated that he had taken above

insurance plan on 10.08.2009 and paid all premiums since last 10 years. The maturity date

was 10.08.2019 but to get 100% payment he has submitted all documents and payout request

on 26.06.2019 i.e. prior to maturity date (10.08.2019). He has simply signed payout request

form and other entries were made by officer sitting on payment counter of the Branch who

informed that he will get 100% payment by 14.08.2019. But he was surprised when he

received only 1/3rd amount (Rs.1.94 lac) on the plea that 2/3rd balance amount will be

transferred in annuity option plan. He has also stated that he never opted for annuity option

nor has filled the desired form for annuity and his application number RTA 317633 for taking

insurance was not having any option for annuity. He had written to the Grievance Cell of

respondent company but has not got any response so far. Vide email dated 10.10.2019 and

letter dated 04.11.2019 he had asked copy of payout request form submitted by him on

26.06.2019 but the respondent has refused to provide the same. The complainant has therefore

prayed for 2/3rd amount lying with respondent along with interest from 11.08.2019.

The respondent in their SCN have stated that the above policy was issued on 12.08.2009

to the complainant on the basis of proposal form duly signed by him, dispatched on

12.08.2009 through First Flight via AWB No.B55140656 and thereafter welcome letter was

sent which clearly mentioned that there was a period of 15 days to the customer to return the

policy under Free look cancellation. However the customer did not avail this benefit and

raised his first complaint on 10.09.2019 after the maturity of policy which is beyond free look

period. Policy matured in 2019 and as per terms of the policy he had received one third of the

Guaranteed Maturity Benefit as lump sum and the balance amount was used to buy a Life

Annuity from the company or any other registered life insured. As per policy contract, policy

holder has to indicate in writing the manner in which he wishes to take the Normal Retirement

Benefit on or before 10.07.2019. On maturity, respondent had paid Rs.1,94,767.34 which is

1/3rd of the maturity amount as per terms and conditions of the policy. The same was also

intimated by the company vide letter dated 18.09.2019 and the rest amount should be used to

purchase an annuity plan in the name of the policy holder. Respondent had sent an intimation

letter dated 04.02.2019 to complainant to choose the annuity plan. There is no provision in the

policy for the payment of entire amount to the complainant at the time of maturity of the

policy. Cancellation of policy after expiry of full tem of policy, after maturity and after expiry


of free look period is not possible and hence claim was repudiated.





Policy No.01678916 under Kotak Retirement Income Plan without cover was issued in the

name of complainant on 12.08.2009 for a term of 10 years with premium paying mode as half

yearly. As per respondent as policy matured on 12.08.2019 they had paid Rs.1,94,767.34 i.e.

1/3rd of the maturity amount as per benefits payable under clause A of the terms and conditions

of the policy. Clause A of the policy states that when the life assured retires, upto 1/3rd of the

Normal Retirement Benefit may be taken as lumpsum and the balance must be used to buy a

life annuity from the company and the policy holder must indicate in writing the manner in

which he wishes to take the Normal Retirement Benefit on or before 10.07.2019. On

26.06.2019 complainant requested the respondent for the maturity value wherein in the payout

request form complainant has ticked the check box for maturity instead of check box for full

surrender, available in the form. A photocopy of the payout request form has been filed by the

complainant himself. Representative of respondent during hearing stated that they had made

payment of Normal Retirement Benefit on the basis of the above option selected by the

complainant. It is correct that the complainant had not applied for the surrender of the policy

and opted for Normal retirement Benefit. The contention of the complainant as mentioned in

his letter dated 25.09.2019 addressed to the Senior Grievance Officer of the respondent that he

had submitted payout request form on 26.06.2019 for full payment, is not correct. Under the

above circumstances, respondent has rightly acted and paid the Normal Retirement Benefit as

per terms and conditions of the policy, by which, apart from the lumpsum payment of 1/3rd of

the maturity amount, the complainant is entitled to receive the balance amount in the form of

annuity only. In the result, complaint is liable to be dismissed.

The complaint filed by Mr Pramod Singh stands dismissed herewith.

Let copies of Award be given to both the parties.



Mr M Z Iqbal Khan ………………………………………………... Complainant

V/s

ICICI Prudential Life Insurance Co. Ltd ……….………….……..…Respondent

COMPLAINT NO: BHP-L-021-1920-0449 ORDER NO: IO/BHP/A/LI/0288/2019-2020

Mr M Z Iqbal Khan (Complainant) has filed a complaint against ICICI Prudential Life

Insurance Co. Ltd (Respondent) alleging non payment of maturity amount.

Brief facts of the Case - The complainant has stated that he is an NRI and resides in USA.

He had taken a policy No.11942751 from respondent under Plan Pre Life Stage Pension

Policy and deposited amount of Rs.5 lacs in ten years. Maturity of policy was in May 2019

and he had to get an maturity amount as Rs.8,04,328.25. Copy of policy was not given to the

complainant inspite of repeated demand. Respondent had stated that policy was started on

29.05.2009 and dispatched to the policy holder on 01.06.2009. He had received premium paid

certificate on 10.04.2019 in which it was mentioned that next due date was 27.05.2019. On

28.05.2019 he had received an email of respondent in which it was mentioned that his

application for ICICI Pru Imm.Annuity Tied – 107 with application No.DUMMYIA37157 is

accepted and policy is issued. He had never given any application nor submitted any


Complainant

Mr M Z Iqbal Khan

C/o Mohammed Shanawas Khan

H No 121/B, Zawabit Line Opposite Sara Gas

Agency, Barkhedi, Bhopal, Madhya Pradesh

2. Policy No:

Type of Policy


11942751 (New policy No.40541131)

ICICI Pru Life Stage Pension

29.05.2009



Mr M Z Iqbal Khan

Mr M Z Iqbal Khan

4. Name of the insurer ICICI Prudential Life Insurance Co. Limited




8. Nature of complaint Non-payment of maturity amount



11. Amount of relief sought Rs.8,04,328.25 + 18% interest from date of

maturity (27.05.2019) + compensation

Rs.1,00,000/-




For the Complainant Mr M Z Iqbal Khan

For the insurer Mr Mahesh Baniya, Sr Manager II

15. Complaint how disposed Partially allowed


documents nor selected any option. Respondent had without permission of the complainant

had started pension from 27.05.2019. No notice before maturity of policy had been given to

the complainant by the respondent and at their own will they had converted it to pension. He

has therefore prayed this forum for maturity amount with 18% interest and Rs.1,00,000/- as

compensation.

The respondent in their SCN dated 03.01.2020 have stated that Policy No.1942751 was

issued on 29.05.2009 with an annual premium of Rs.50,000/- for term of 10 years and the

same was delivered to the registered address of the complainant. The company is in receipt of

total premium of Rs.5 lacs for 10 policy year. Post registration of the annuity option,

respondent has sent the same details vide letter dated 21.06.2016 dispatched to the registered

address of complainant. Prior to policy vesting stage additionally, respondent had proactively

sent annuity quotations details informing about the various annuity options to complainant on

29.03.2016, 15.11.2018, 03.12.2018, 26.12.2018, 15.01.2019 and Feb 2019 respectively via

email to registered email address [email protected]. However respondent had not received

any confirmation for the same till May 2019 when the policy got vested in lines of policy

terms and conditions. As per policy terms and conditions, on the basis of complainant request

received in March 2016, policy got vested on 27.05.2019 and post vesting of the said policy

pension payout certificate policy number 40541131 was issued on 28.05.2019 as Life annuity

without return of purchase price 100% of maturity value with monthly pension payout option.

In view of above respondent were unable to comply with complainants request for refund of

lumpsum maturity amount. They further stated that as a special case and on exception basis,

respondent can offer change in annuity payout option either to use 100% of maturity amount

to get pension or withdraw upto 33% of maturity amount as lumpsum and use the balance to

get pension. Respondent vide their SCN dated 11.02.2020 have stated that as complainant had

not accepted the above offer, as a special case and on compassionate ground they are offering

refund of maturity payout amounting to Rs.8,04,328.25 and in order to process the same

requested complainant to submit certain documents. The respondent in their letter dated

11.02.2020 has mentioned that the respondent has offered a refund of maturity amount to the

policy holder by cancelling the subject policy and communicated to the policyholder.





Policy No.11942751 under plan ICICI Pru Life Stage Pension Policy was issued to the

complainant on 29.05.2009 with an annual premium of Rs.50,000/- for term of 10 years. As

per SCN, policy got vested on 27.05.2019 and post vesting of the said policy, pension payout

certificate policy number 40541131 was issued on 28.05.2019 as Life annuity without return

of purchase price but with 100% of maturity value under monthly pension payout option. As

per complainant, on 28.05.2019 he got an email from respondent stating that his application

for ICICI Pru Imm.Annuity Tied 107 with application No.DUMMYIA37157 is accepted and

policy No.40541131 is issued while he had never applied for annuity nor submitted any

documents and no option was exercised. Complainant has prayed for return of full maturity

amount. In their SCN, respondent has mentioned that they evaluated the complaint,

considering as a special case and on compassionate grounds they are offering for refund of

maturity payout amount of Rs.8,04,328.25 to the complainant and requested complainant to

provide some documents so as to process payment of the same. Hence as per SCN,

respondent is agreed to make payment of Rs.8,04,328.25 as maturity payout to the

complainant. Complainant has prayed for interest over the payout. The representative of the

respondent has argued that the respondent has acted in accordance with the terms and

conditions of the policy and had prior to policy vesting stage sent annuity quotations details

informing about the various annuity options on March, 2016, 15.11.2018, 03.12.2018,

26.12.2018, 15.01.2019 and Feb 2019 via email to the registered email address and had not

received any confirmation for the same till May 2019 when the policy got vested in the lines

of policy terms and conditions. As complainant had not submitted required papers till date of

vesting, hence there appears no mistake on the part of the respondent. Under the

circumstances, complainant is not entitled for any interest. Complainant has also prayed for

compensation towards mental and physical torture. For consideration of mental and physical

torture, oral evidence is necessary to be taken. As this forum has no power to take oral

evidences, hence question of mental and physical compensation cannot be considered. In the

result, complaint is liable to be partially allowed to the extent of payment of maturity payout

as offered by the respondent and prayer of interest & compensation towards mental and

physical torture is liable to be dismissed.

The complaint filed by Mr M Z Iqbal Khan is partially allowed and respondent is directed to

pay maturity payout of Rs.8,04,328.25 to the complainant within 30 days after receipt of

required documents from the complainant. Rest of the prayer stands dismissed herewith.




Ms Prema Rajiv Gaur …………………………………………….. Complainant

V/s

Max Life Insurance Co. Ltd ……….………….……………………..Respondent


Ms Prema Rajiv Gaur (Complainant) has filed a complaint against Max Life Insurance Co.

Ltd. (Respondent) alleging non-payment of full maturity amount.

Brief facts of the Case - The complainant has stated that she had purchased the above policy

with complete assurance of Mr Himanshu Gupta, an employee of respondent company and

CRM of Axis Bank Ltd, Sapna Sangita (Branch Indore) that after paying 6 instalments for

consecutive 6 years the total deposited amount will be refunded by respondent in 7th year. She

has already deposited 6 instalments and since she is badly in need of funds requested the

respondent to arrange for refund of total deposited amount along with interest and other

benefits within 7 days. Respondent received her surrender request and later on rejected three

times. She had also written to IRDA from IGMS portal on 25.04.2019 which was also rejected

stating that in this plan she cannot surrender after policy term of 6 years and she has to take


Complainant

Ms Prema Rajiv Gaur

421, Vishnupuri NX AB Road, Indore,

Madhya Pradesh

2. Policy No:

Type of Policy


876482308

Max Life Guranteed Monthly Income Plan

22.10.2012



Ms Prema Rajiv Gaur

Ms Prema Rajiv Gaur

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




8. Nature of complaint Non payment of full maturity amount

9. Amount of Claim


11. Amount of relief sought Surrender value as applicable




For the Complainant Mrs Prema Rajiv Gaur & Mr Rajiv Gaur,

Complainant and her husband

For the insurer Ms Pallavi Tiwari, DM Operations



monthly payments. The complainant has now approached this forum for redressal of her

grievance.

The respondent in their SCN have stated that above policy was issued on the basis of

proposal form duly filled in and submitted by the complainant. The complainant has also

made a declaration that she has understood the meaning and scope of proposal form and has

purchased the present policy out of her own volition without being induced by anyone. The

complainant did not approach the company with regard to any cancellation, etc. during the

free look period which implied acceptance of terms of the policy and further completed the

premium paying term of the policy by paying six annual premiums which indicate acceptance

of the terms of policy. Post completion of premium paying term, she has also started to

receive benefits in the form of Monthly income. Complainant vide letter dated 07.12.2018

requested for surrender of policy and vide letter dated 14.12.2018 specifically requested

respondent to stop the surrender request and declared to seek all benefits under the policy.

Complainant again on 09.04.2019 approached for surrender of policy and refund of premium

which was replied by the respondent vide letter dated 23.04.2019 expressing inability to

surrender any policy post completion of premium paying term.





Complainant had taken policy No.876482308 on 22.10.2012 under Max Life Guaranteed Monthly

Income Plan for a term of 6 years in which 6 annual premiums were to be paid. As per

complainant, she was told that after payment term, she can either choose to opt monthly

income or can have lumpsum payout as surrender as well. She personally visited the

respondent’s office on 13.12.2018 and submitted all the documents for surrender which later on

were cancelled by her due to some unavoidable reasons and she again applied for surrender on

03.04.2019 which was denied by the respondent on 24.04.2019. Respondent during hearing

stated that the complainant had started to receive the benefits under the policy w.e.f. December

2018 in the form of monthly income as per terms and conditions of the policy. Respondent in

their SCN have admitted that the complainant had requested for surrender on 07.12.2018 but

later on the complainant had vide letter dated 14.12.2018 specifically requested the respondent

company to stop the surrender request dated 07.12.2018 and declared to seek all benefits under

the policy. Later on they started making monthly income payouts w.e.f. December 2018 and are

continuously paying to the complainant. The respondent further informed that the complainant

again approached them vide letter dated 09.04.2019 seeking surrender of the policy and refund

of premium amount and they have vide letter dated 23.04.2019 specifically informed the

complainant their inability to consider surrender request of the policy post completion of

premium paying term. In the illustration details of the policy which is a part of the policy

document, it is clearly illustrated that surrender benefit is not payable after completion of 6

years and only a guaranteed income payable of Rs.60,000/- annually shall become payable

under the policy. Respondent had vide letter dated 31.10.2012 had informed the complainant

that in case she was not satisfied with the terms and conditions of the policy she may opt to

cancel the policy within the period of 15 days from the receipt of the policy document.

However, the complainant did not make any communication in this regard to disconnect with

the terms of the policy and rather paid 6 annual premium under the policy which indicates

implied acceptance of the terms of the policy. As per above illustration, the decision of the

respondent to deny surrender payment after completion of premium paying term and after

commencement of payment of monthly income is in accordance with the terms and conditions

of the policy. During hearing, complainant requested the respondent to consider her case on

humanitarian grounds as she was in need of money which was denied by the representative of

the respondent stating that it is not possible to allow the request as monthly income payments

are being paid since December 2018. In the result, complaint is liable to be dismissed.

The complaint filed by Mrs Prema Rajiv Gaur stands dismissed herewith.




Mr G D Golandaj …………………………………………….. Complainant

V/s

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



Complainant

Mr G D Golandaj

MPEB Clony, Behind Tagore School

Gadarwara, Narsingpur, Chhindwara

2. Policy No:

Type of Policy


371890203

Jeevan Tarang (With profits)

05.03.2008



Mr G D Golandaj

Mr G D Dolandaj





8. Nature of complaint --

Mr G D Golandaj (Complainant) has filed a complaint against LIC of India (Respondent)

alleging non payment of 5.5% of sum assured every year.

Brief facts of the Case - The complainant has stated that he had taken above policy from

respondent company for a term of ten years and premium payment towards the policy has

been regularly deducted from his salary. But premiums for the month of March 2017, June

2017, Sept 2017 and Dec 2017 were not adjusted by the Branch and he has not been paid

5.5% of the sum assured every year. For this purpose he has visited the Branch Office and

also the Division Office and also written letters dated 26.06.2019, 22.07.2019 and 24.09.2019

but has not got any response so far. The complainant has now approached this forum for

redressal of his grievance.

The respondent in their SCN have stated that above policy was issued to the

complainant under Plan 178-47-10-10 on 05.03.2008. Policy matured on 05.03.2018.

Premium under the policy has been received for 9 years hence policy was in reduced paid up

condition and as per plan condition only maturity (reduced paid up value and bonus) amount

is payable on 05.03.2018 and no further survival benefits are payable. As per policy

conditions, if policy becomes paid up then on survival to the end of accumulation period,

reduced paid up sum assured + vested bonus will be paid to the life assured. No further

survival benefits are payable. However, during course of payment due to technical error,

Branch has paid only accumulated bonus that was Rs.41,000/- instead of Rs.1,31,000/-

(reduced paid up amount Rs.90,000/- and bonus Rs. 41,000/-). The system had not being

allowing to make the remaining amount of Rs.90,000/- hence copy of PAN Card and

discharge had been called for which were received on 05.02.2020 and payment of remaining

amount of Rs.90,000/- has been paid on 06.02.2020 which is full and final.





11. Amount of relief sought 5.5% of sum assured payable as survival

benefit every year




For the Complainant Absent

For the insurer Mr Hrishikesh Barori, Admn Officer



During hearing complainant remained absent. I have heard the representative of the respondent

company at length and perused papers filed on behalf of the complainant as well as the

Insurance Company.

Policy No.371890803 was issued to the complainant under Plan 178-47-10 with date of

commencement of 05.03.2008. Policy matured on 05.03.2018. Complainant has complained

of non receipt of survival benefits @ 5.5% of the sum assured every year w.e.f March 2019.

As per SCN, complainant has paid premium for 9 years only against premium paying term of

10 years and as on the date of maturity, policy was in reduced paid up condition. As per terms

and conditions of the policy, respondent has paid reduced paid up value and bonus amount

under the policy, as maturity amount. They have paid a total amount of Rs.1,31,000/-

(Rs.90,000/- + Rs.41,000/-). As far as survival benefit @ 5.5.% of the sum assured after the

end of accumulation period is concerned, it is payable, only if premiums for premium paying

term have been paid fully. In the instant case, respondent have received only 9 years premium

out of 10 years and hence policy was in reduced paid up condition and as per plan condition

only maturity amount is payable and no further survival benefits are payable. It is pertinent to

mention that complainant in his complaint has admitted that he has not paid quarterly

premium from March 2017 to December, 2017. During hearing, none appeared on behalf of

complainant to press the complaint. Hence, respondent has acted in accordance with the terms

and conditions of the policy and has not erred in denying the payment of survival benefit @

5.5.% of sum assured after accumulation period. In the result complaint is liable to be

dismissed.

The complaint filed by Mr G D Golandaj stands dismissed herewith.




PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, STATE OF ODISHA

(UNDER RULE NO: 16(1)/17of

THE INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – Shri Suresh Chandra Panda

CASE OF (Sri Bansidhar Sahoo Vs. LIC of India Bhubaneswar DO)

COMPLAINT REF: NO: BHU-L-029-1920-0225

AWARD NO: BHU-A/LI/207/2019-2020

1. Name & Address of the Complainant Mr. Bansidhar Sahoo, C/O- Sankarsan Sahoo

House no- EB- 492, Badagada BRIT Colony

Badagada, Bhubaneswar

2. Policy No:

Type of Policy


583702690

Life

28.03.2009



Mr. Bansidhar Sahoo

- do-

4. Name of the insurer Life Insurance Corporation of India, Cuttack

5. Date of Repudiation NA

6. Reason for repudiation NA

7. Date of admission of the Complaint 27.08.2019

8. Nature of complaint Less payment of Maturity claim


10. Date of Partial Settlement NA

11. Amount of relief sought 125000/-

12. Complaint registered under Rule no: of

Insurance Ombudsman Rules

13(1)(e)

13. Date of hearing/place 12.02.2020/ Bhubaneswar


For the Complainant Bansidhar Sahoo

For the insurer Daitary Nayak

15 Complaint how disposed Under Insurance Ombudsman Rule 17.

16 Date of Award/Order 12.02.2020

17) Brief Facts of the Case:-.The above said policy was purchased by the complainant on 28.03.2009 under

Jeevan Saral plan from the present insurer. The Sum Assured and mode of premium payment were 125000 &

monthly. The life assured had paid total Rs.61200/- (510 X 12 X 10) as premium during the 10 years term. But

the maturity benefit calculated to be paid to him was Rs.59337/- only. As the maturity amount of the subject

policy was much less than what he paid in terms of premium, he has approached this forum for redressal.

The insurer on the other hand submitted SCN stating that, as per the policy schedule maturity SA of the policy

was only Rs.43630/-. In addition to it the corporation also paid loyalty additions of Rs.15707/- in the said policy.

Hence, the total maturity value of the said policy was Rs.59337/- was paid to the policy holder. The said policy is

a combination of conventional plan with flexibility of ULIP features. In this plan death SA is 250 times of the

basic premium decided at the inception irrespective of age at entry and policy term. Hence, it is a high risk

policy. In view of the high risk covered, maturity sum assured is not exactly the return of premiums paid. Hence

the maturity benefit in this plan is less. So, the amount paid by the corporation is correct and justified.

18) Cause of Complaint:

a) Complainant’s argument:-The complainant stated that the above said policy was purchased by him on

28.03.2009 under Jeevan Saral plan from the present insurer. The Sum Assured and mode of premium payment

were 125000 & monthly. The life assured had paid total Rs.61200/- (510 X 12 X 10) as premium during the 10

years term. But the maturity benefit calculated to be paid to him was Rs.59337/- only for which he did not accept

the same.

b) Insurers’ argument:- The insurer on the other hand pleaded that, as per the policy schedule maturity SA of the policy

was only Rs.43630/-. In addition to it the corporation also paid loyalty additions of Rs.15707/- in the said policy. Hence, the

total maturity value of the said policy was Rs.59337/- was paid to the policy holder. The said policy is a combination of

conventional plan with flexibility of ULIP features. In this plan death SA is 250 times of the basic premium decided at the

inception irrespective of age at entry and policy term. Hence, it is a high risk policy. In view of the high risk covered, maturity

sum assured is not exactly the return of premiums paid. Hence the maturity benefit in this plan is less. So, the amount paid by

the corporation is correct and justified

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

This is a complaint against less payment of maturity claim by the Insurer.


a) Photo copies of policy documents.

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

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

submissions made by both the parties it was observed that the above said policy is a high risk policy in which 250

times of the basic monthly premium is payable on the death of the policy holder. As per the insurer, it is a plan

with unique feature where death SA is independent of age at entry and policy term. In view of the high risk

covered, maturity SA has no relation with the amount of premium paid by the policy holder. Further, it is clearly

mentioned in the policy bond that maturity SA is Rs.43630/- in the said policy which has been completely ignored

by the complainant. The policy bond is the basis of contract made between the insurer and the insured. It is the

duty of the policyholder to go through the policy documents and bring it to the notice of the insurer if there is

any discrepancy, within the free look period. But in this case policyholder complained at the time of maturity

which could not be entertained by the insurer. Hence, this forum is of the opinion that as the complaint is devoid

of any merit hence it is to be dismissed.

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


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

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

Ombudsman.

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

in the regulations framed under the Insurance Regulatory and Development Authority of India Act

1999, from the date the claim ought to have been settled under the regulations, till the date of

payment of the amount awarded by the Ombudsman

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

Insurers.

Dated at Bhubaneswar on 12th Feb. 2020

(SURESH CHANDRA PANDA)

INSURANCE OMBUDSMAN

FOR THE STATE OF ODISHA

AWARD

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

by both the parties during the course of hearing, the complaint is treated as dismissed.

Hence, the complaint is treated as allowed accordingly.

PROCEEDINGS BEFORE


(UNDER RULE NO: 16(1)/17 of


OMBUDSMAN – Sri Suresh Chandra Panda

CASE OF Mr. Rajanikanta Samantray Vs. LIC of India Bhubaneswar)


AWARD NO: IO/BHU/A/LI/229/2019-2020

1. Name & Address of the Complainant Mr. Rajanikanta Samantaray, At/Po- Kandhaatagada

(Raghu Divakar Sahi), Via- Chandpur, Dist- Nayagarh

2. Policy No:

Type of Policy


588550378

Life

28.02.2009



Mr. Rajanikanta Samantray

----do-----

4. Name of the insurer LIC of India, DO, Bhubaneswar





9. Amount of Claim Rs.122480/-


11. Amount of relief sought Rs.122480/-

12. Complaint registered under Rule no:

of Insurance Ombudsman Rules

13(1)(b)

13. Date of hearing/place 25.02.2019 / Bhubaneswar


For the Complainant Rajanikanta Samantaray

For the insurer Daitary Naik



17) Brief Facts of the Case:- The above said policy was purchased by the claimant on 28.02.2009 from the present insurer. The

quarterly premium of the policy was Rs.3062/- and premium paying term was 10 years. Thus the complainant paid total

Rs.122480/- (Rs.3062/- X4 X 10) towards the premium of the said policy. As per the policy schedule death SA and Maturity SA

were Rs.250000/ and Rs.65080/- respectively. The major grievance of the complainant was that he was advised by the

Development Officer of the concerned insurer that he would get a maturity benefit of Rs.250000/- plus bonus after completion

of 10 years. But the company paid Rs.88509/- only towards maturity claim which is much less than the amount that he had

already paid. Hence, being aggrieved, he approached this forum for redressal.

The insurer on the other hand submitted SCN stating that, as per the policy schedule maturity SA of the policy was only

Rs.30590/--. In addition to it the corporation would be paying loyality additions of Rs.23429/- for Jeevan Saral plan. Hence,

the total maturity value of the said policy was Rs.88509/-. The said policy is a combination of conventional plan with

flexibility of ULIP features. In this plan death SA is 250 times of the basic premium decided at the inception irrespective of

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

exactly the return of premiums paid. Hence the maturity benefit in this plan is less.


a) Complainant’s argument:- The complainant stated that the above said policy was purchased by the claimant on

28.02.2009 from the present insurer. The quarterly premium of the policy was Rs.3062/- and premium paying term was 10

years. Thus the complainant paid total Rs.122480/- (Rs.3062/- X4 X 10) towards the premium of the said policy. As per the

policy schedule death SA and Maturity SA were Rs.250000/ and Rs.65080/- respectively. The major grievance of the

complainant was that he was advised by the Development Officer of the concerned insurer that he would get a maturity

benefit of Rs.250000/- plus bonus after completion of 10 years. But the company paid Rs.88509/- only towards maturity claim

which is much less than the amount that he had already paid.


was only Rs.30590/--. In addition to it the corporation would be paying loyality additions of Rs.23429/- for Jeevan Saral plan.

Hence, the total maturity value of the said policy was Rs.88509/-. The said policy is a combination of conventional plan with





This is a complaint against less payment of maturity claim by Insurer.


a) Photo copies of proposal/policy document.

b) Photo copy of complaint letter and rejection letter by Insurer.

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

submissions made by both the parties it was observed that the claim relates to Jeevan Saral plan which was

issued to a person of higher age. Total premium that he paid was much higher than the amount he was paid by

way of maturity. In the premium receipt Sum Assured was mentioned as Rs.250000/-. Nowhere in the premium

receipt the term “Maturity claim” & “Death Claim” is pronounced. It means, the policyholder was kept in dark

regarding the benefits of the policy till the maturity of the policy and he went on paying the premium as an

innocent and loyal policyholder. Further, the argument of the complainant that, had he been informed earlier

correctly regarding the benefits in the said policy, he would have opted to close it by not paying renewal

premium, is justified. So, it is observed that there was some problem in the policy construct itself. Hence, this

forum is of the opinion that the insurer has to refund the total premium paid by the complainant with interest

from the date of maturity till the date of this award after deducting the amount already paid as maturity benefit

in the subject policy.





Ombudsman.

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

regulations framed under the Insurance Regulatory and Development Authority of India Act 1999, from the

date the claim ought to have been settled under the regulations, till the date of payment of the amount awarded

by the Ombudsman.

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

the Insurers.

Dated at Bhubaneswar on 25th Feb. 2020


INSURANCE OMBUDSMAN


AWARD

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

both the parties during the course of hearing, it is awarded that the insurer has to

refund all the premium received by it against the subject policy with interest by

deducting the amount already paid as maturity benefit.


PROCEEDINGS BEFORE


(UNDER RULE NO: 16(1)/17 of


OMBUDSMAN – Sri Suresh Chandra Panda

CASE OF Mr. Nityananda DashVs. LIC of India Bhubaneswar)


AWARD NO: IO/BHU/A/LI/228/2019-2020

1. Name & Address of the Complainant Mr. Nityananda Dash, MIG-1/170

Satyasai Enclave, Khandagiri, Bhubaneswar

2. Policy No:

Type of Policy


582712032

Life

28.03.2009



Mr. Nityananda Dash

----do-----

4. Name of the insurer LIC of India, DO, Bhubaneswar





9. Amount of Claim Rs.210000/-


11. Amount of relief sought Rs.210000/-

12. Complaint registered under Rule no:

of Insurance Ombudsman Rules

13(1)(b)

13. Date of hearing/place 25.02.2019 / Bhubaneswar


For the Complainant Nityananda Dash

For the insurer Daitary Naik



17) Brief Facts of the Case:- The above said policy was purchased by the claimant on 28.03.2009 from the present insurer. The

yearly premium of the policy was Rs.12010/- and premium paying term was 10 years. Thus the complainant paid total

Rs.120100/- (Rs.12010/-X 10) towards the premium of the said policy. As per the policy schedule death SA and Maturity SA

were Rs.250000/ and Rs.30590/- respectively. The major grievance of the complainant was that he was advised by the

Development Officer of the concerned insurer that he would get a maturity benefit of Rs.250000/- plus bonus after completion

of 10 years. But the company paid Rs.41602/- only towards maturity claim which is much less than the amount that he had

already paid. Hence, being aggrieved, he approached this forum for redressal.

The insurer on the other hand submitted SCN stating that, as per the policy schedule maturity SA of the policy was only

Rs.30590/--. In addition to it the corporation would be paying loyality additions of Rs.11012/- for Jeevan Saral plan. Hence,

the total maturity value of the said policy was Rs.41602/-. The said policy is a combination of conventional plan with





a) Complainant’s argument:- The complainant stated that the above said policy was purchased by him on 28.03.2009 from

the present insurer. This policy was issued by the insurer under Jeevan Saral plan. The yearly premium of the policy was

Rs.12010/- and premium paying term was 10 years. Thus the complainant paid total Rs.120100/- (Rs.12010/-X 10) towards

the premium of the said policy. As per the policy schedule death SA and Maturity SA were Rs.250000/ and Rs.30590/-

respectively. The major grievance of the complainant was that he was advised by the Development Officer of the concerned

insurer that he would get a maturity benefit of Rs.250000/- plus bonus after completion of 10 years. He was also given one

leaflet issued by the insurer, in which above mentioned amount was mentioned as maturity benefits. Further, the sum assured

mentioned in the premium receipt was Rs.250000/-. In the premium receipt no where it was mentioned that the maturity sum

assured is Rs.30590/-. Had it been known to him earlier he would not have paid the premium for continuing the policy. But

the company paid Rs.41602/- only towards maturity claim which is much less than the amount that he had already paid.


was only Rs.30590/--. In addition to it the corporation would be paying loyality additions of Rs.11012/- for Jeevan Saral plan.

Hence, the total maturity value of the said policy was Rs.41602/-. The said policy is a combination of conventional plan with





This is a complaint against less settlement of maturity claim by Insurer.


a) Photo copies of proposal/policy document.

b) Photo copy of complaint letter and rejection letter by Insurer.

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

submissions made by both the parties it was observed that the claim relates to Jeevan Saral plan which was

issued to a person of higher age. Total premium that he paid was much higher than the amount he was paid by

way of maturity. The premium of the subject policy was paid by the complainant through online. In the premium

receipt Sum Assured was mentioned as Rs.250000/-. Nowhere in the premium receipt the term “Maturity claim”

& “Death Claim” is pronounced. It means, the policyholder was kept in dark regarding the benefits of the policy

till the maturity of the policy and he went on paying the premium as an innocent and loyal policyholder. The

policyholder complained on the very next day after receipt of the maturity intimation. Even, after getting the

maturity intimation, when he enquired from the customer care of the insurer, he was advised that he would get

Rs.250000/- + loyality addition as maturity benefit in the said policy. Secondly, without submitting the policy

bond along with the discharge form the maturity proceeds was credited to his bank account. The information

about this bank account was collected from the other policies that he had with the same insurer. Further, the

argument of the complainant that, had he been informed earlier correctly regarding the benefits in the said

policy, he would have opted to close it by not paying renewal premium, is justified. So, it is observed that there

was some problem in the policy construct itself. Hence, this forum is of the opinion that the insurer has to refund

the total premium paid by the complainant with interest from the date of maturity up to the date of this award

after deducting the amount already paid as maturity benefit in the subject policy.





Ombudsman.

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

regulations framed under the Insurance Regulatory and Development Authority of India Act 1999, from the

date the claim ought to have been settled under the regulations, till the date of payment of the amount awarded

by the Ombudsman.

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

the Insurers.

Dated at Bhubaneswar on 25th Feb. 2020.


INSURANCE OMBUDSMAN


AWARD

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

both the parties during the course of hearing, it is awarded that the insurer has to refund

all the premium received by it against the subject policy with interest by deducting the

amount already paid as maturity benefit.


PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF CHANDIGARH

(UNDER INSURANCE OMBUDSMAN RULES, 2017)

OMBUDSMAN – Dr. D K Verma

Case of Shri R K Mehta V/S HDFC Standard Life Insurance Co. Ltd.

COMPLAINT REF: NO: CHD-L-019-1920-0540


Complainant

Shri R K Mehta

Deputy Zonal Manager, Punjab National

Bank, Zonal Office, Sector 17 B,

Chandigarh

2. Policy No:

Type of Policy


1049172

HDFC life classic assure plus plan



Shri R K Mehta

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




8. Nature of complaint Less maturity value

9. Amount of Claim NA


11. Amount of relief sought Rs 67766/-


Rule no:

13.1(b)


For the Complainant Self

For the insurer Shri Arpit Higgins, Manager(Legal &

Comp)

Shri Gurpreet Singh, Dy Manager(Legal)

14 Complaint how disposed Award

15 Date & Place of Hearing 05.02.2020/Chandigarh


On 04.07.2019 Shri R K Mehta, had filed a complaint in this office against HDFC Standard Life

Insurance Company. The complainant alleged that he has visited the company’s office several

times along with his wife but the company has not resolved his complaint neither they replied.

The complainant alleges that he has been informed that maturity value of payment of premium

of Rs 50000/- is Rs 14506/- approx. which means the staff of the company has committed some

fraud as in the same company after paying 50000/- premium in his policy he has received Rs

82272.75 as maturity value and Rs 59521.84 after paying premium of Rs 40000/-.


a) Complainant’s argument:

The complainant reiterated the contents of his complaint and informed that the policy number

10340937 on the life of Nirmal Mehta was surrendered by the company and they never asked

for its surrender however they paid Rs 22552.66 as surrender value and they had paid only

two premiums in that policy. But in the policy in question the company is paying only 14506

that too after payment of 5 premiums, one of which was paid along with penalty.

b) Insurers’ argument:

The representative of the Company informed that the policy bearing number 10496172 was

issued on 30.01.2006 for a premium of Rs. 10,000/= to be paid for 25 years. The first

complaint was received on 30.05.2017 wherein the policy holder complained that she

deposited cheque number 263557 for Rs 10000/- towards premium under the captioned policy

which was dishonored and to rectify the same the complainant deposited another cheque

bearing No. 253251 for Rs 10250 which was debited from her account on 30.03.2007. She

was informed vide response dated 08.06.2017 that the cheque no. 253251 was adjusted in

Policy No. 10340937 towards revival and since the medical formalities were not completed by

the complainant the revival was not completed and the amount was refunded to the

complainant vide cheque dated 321252 and was encashed by the complainant on 27.01.2009.

So, the company received only 4 premiums under the policy and not 5. The complainant was

also informed that the premium under the policy for due 2010 was not paid so the policy

status was changed to paid-up cancelled. Also if the unit fund of the policy falls below 15000

as per terms and conditions of the policy the company reserves the right to cancel the policy

and pay unit fund value to the policy holder. For this page-4 clause-5 point -6 may be referred.

The policy went into paid-up cancellation status on 16.12.2014 and the refund cheque of Rs

14906 was sent to the complainant which was received undelivered. The life assured Mrs

Nirmal Mehta is elder to Mr Mehta by 3 years so attracted higher mortality charges as

compared to Mrs Mehta. Moreover there was a rate up request which was accepted by Mrs

Mehta. The consent letter from the policy holder was also placed on record. Thus the two

policies, of Mr and Mrs Mehta cannot be compared for surrender values. The policy of Mr

Mehta never attained the paid-up cancellation status so, surrender amount of Rs 59521.84 was

paid but fund value of Mrs Mehta’s policy went below 15000 and attained paid-up

cancellation status.

18) The following documents were placed for perusal:-

a) Complaint to the Company

b) Reply of the Insurance Company

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

I have examined the various documents available in the file including the copy of the

complaint, Annexure-VI and the contents of the SCN filed by the Insurance Company. It is

evident from the documents and submission of both the parties that the policy bearing

number 10496172 on the life of Mrs Nirmal Mittal is a ULIP policy commenced on

30.01.2006. As per the complainant 5 premiums were paid under the policy whereas the

company confirmed to have received 4 and has informed that one premium of Rs 10250/-

which was received was although deposited with them but was later refunded to the

complainant vide cheque number 321252. The complainant however denied the same stating

that the cheque bearing this number was although received and encashed by them was

actually the maturity of policy bearing number 10340937 on the life of Nirmal Mehta. It was

also observed that there was discrepancy in the statements of both the complainant and the

company. The complainant did not disclose the fact that the life assured had actually

consented for rating up of the policy and the company informed that the premium of Rs

10250/- was refunded vide cheque number 321252 dated 27.01.2009 and later clarified that

it actually contained the premium as well as the surrender proceeds of the policy bearing

number 10340937 which could not be revived due to non receipt of medical formalities after

being denied by the complainant. The company was also asked to provide the forwarding /

letter accompanying the said cheque. The company has submitted that it being very old and

is not traceable. In view of the above facts it is justified that the company be directed to

cancel the policy and refund the four premiums it received without interest and without

deduction of any charges.

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

by both the parties during the course of hearing, the Insurance Company is

directed to cancel the policy bearing number 10496172 since inception and

refund the 4 premiums collected there-in without interest or deduction of any

charges.

Hence, the complaint is treated as closed.

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

of Insurance Ombudsman Rules, 2017:

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

comply with the award within 30 days of the receipt of the award and intimate compliance

of the same to the Ombudsman.

Dated at Chandigarh on 25th day of February, 2020.

Dr. D K Verma

INSURANCE OMBUDSMAN

PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, CHANDIGARH


INSURANCE OMBUDSMAN-Dr. D.K. VERMA

Case of Mr. Sukhdev Singh Gill & Mrs. Daljit Kaur Vs Max Life Insurance Co. Ltd.

CASE NO-CHD-L-032-1920-1319


Complainant

Mr. Sukhdev Singh Gill & Mrs. Daljit Kaur

House No.- 426, Sector- 71, S.A.S. Nagar (Mohali),

Punjab- 160071

Mobile No.- 9914200065

2. Policy No: DOC

Type of Policy


750276388, 750276362 / 25-06-2009,

Smart Assure Plan [ Unit linked plan]





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



7. Date of receipt of the Complaint 04-12-2019

8. Nature of complaint Less Maturity Paid

9. Amount of Claim Less Maturity Paid


11. Amount of relief sought NA


Rule no: Insurance

Ombudsman Rules, 2017

13 1 (d)

13. Date of hearing/place 17-02-2020 / Chandigarh


For the Complainant Sh. Satinder Bir Singh Gill [Son]

For the insurer Sh. Sanjeev



17. Brief Facts of the case:

On 04-12-2019, Mr. Sukhdev Singh Gill & Mrs. Daljit Kaur had filed a complaint about less

payment of maturity claim amount in respect of policy bearing nos. 750276388 & 750276362.

18. Complainant’s argument

Mr. Sh. Satinder Bir Singh Gill, Son of the complainant attended personal hearing and

reiterated the contents of complaint and submitted that his parents had paid approximately Rs.

4, 00,000 as premium under the both the policies for 10 years. Now, after the completion of ten

years, the insurer had paid his parents only Rs. 381910- which is even less than their deposited

amount. He further added that the representative of the insurer had assured his parents of high

returns and promised to get handsome amount after completion of ten years period. He submitted

that he had been cheated and missold the policy and requested for payment of difference amount

between deposited amount & maturity amount with interest

19. Insurers’ argument

In personal hearing & in SCN the insurance company submitted that the complainant under policy

no. 750276388 paid 10 annual premiums and the complainant’s policy stood matured in June 2019

and accordingly, in adherence to the policy terms & conditions a maturity payout of Rs. 1,

50,000.40 was paid to the complainant. The complainant’s spouse under policy no. 750276362 had

completed the premium paying term of the policy by payment of 10 annual premiums under the

policy. The said policy got matured in 2019 and in adherence to the policy terms and conditions, a

maturity value of Rs. 231,910.85/- was paid to the complainant’s spouse. The complainant

purchased the policies of his own choice after understanding the terms and conditions of the policy

and submitted duly signed proposal forms and signed illustrations with the respondent for the said 2

policies. The complainant has alleged that he paid the premium but when the policy got matured, he

received fewer amounts than the premium paid amount. The allegations leveled by the complainant

are totally baseless as the maturity value has been calculated strictly on the basis of the terms of the

policies and also detail of calculation of maturity amount was provided through mail and also given

hard copies of the same. The difference of Maturity amount payout is due to age difference , higher

age more risk cover amount is being deducted.

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 complaint

about mis-selling about the stated policies was made by the complainants to the insurance company

after more than 10 years from the date of commencement of the policies. Moreover, the

complainants are well educated person; they are supposed to know insurance products/ financial

instruments. Further, they had paid all the renewal premiums due under the policies and also

received maturity amount. Since the complainants have paid renewal premiums, they cannot take a

plea after more than 10 years that the policies have been mis-sold to them & the insurer has paid

less maturity amount.

AWARD

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 nos. 750276388 & 750276362 is dismissed.


Dated at Chandigarh on 17.02.2020

Dr. D. K. Verma

INSURANCE OMBUDSMAN

PROCEEDINGS BEFORE

THE INSURANCE OMBUDSMAN, CHANDIGARH


INSURANCE OMBUDSMAN-Dr. D.K. VERMA

Case of Mr. Subhash Chandra Vs Max Life Insurance Co. Ltd.

CASE NO-CHD-L-032-1920-1311


Complainant

Mr. Subhash Chandra

C/o K S Grewal, House No.- 105-SKS Nagar,

Phase-1, Pakhowal Road, Ludhiana, Punjab-141013

Mobile No.- 9463911105

2. Policy No: DOC

Type of Policy


412926933 / 31-01-2005

Life maker unit linked investment plan



Mr. Subhash Chandra

Mr. Subhash Chandra

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

5. Date of Repudiation Na

6. Reason for repudiation Na


8. Nature of complaint Maturity amt. due 2015 not received till date

9. Amount of Claim Maturity amount with interest


11. Amount of relief sought NA


Rule no: Insurance

Ombudsman Rules, 2017

13 1 (d)

13. Date of hearing/place 17-02-2020 / Chandigarh


For the Complainant Self

For the insurer Sh. Sanjeev

15. Complaint how disposed Award


17. Brief Facts of the case:

On 26-11-2019, Mr. Subhash Chandra had filed a complaint of Maturity amt. due in 2015 not

received till date against Max Life Insurance Co. Ltd. in respect of policy bearing no. 412926933.

18. Complainant’s argument

Mr. Subhash Chandra, the complainant attended personal hearing and reiterated the contents

of complaint and submitted that he took policy in 2005 and paid all the premiums under the

policy as per term & conditions but when policy got matured in 2015,the insurance company has

paid maturity proceed to some other person. The maturity amount has been encashed by . The

cheque has been fraudulently verified in cheque clearing house that Subhash Chandra & Subhash

Chandra Chanana is the one & same person. On 18.10.2016 someone impersonating him gave a

letter to insurance company under his signature to issue a fresh cheque to be collected at ADEL -6

branch office personally. On the basis of this letter insurer has issued fresh cheque without verifying

signatures, credential and documents or contacting the actual owner of the policy through mail,

telephone or registered post. He further submitted that this is negligence/ deficiency on the part of

insurer for which he has been suffering from last five years. He requested for refund of his money

with penal interest.

19. Insurers’ argument

In personal hearing & in SCN the insurance company submitted that the complainant herein was

required to pay 10 annual premiums and the said policy was due for maturity on 31-01-2015 subject

to the policy terms and conditions. The complainant’s policy got matured on 31-01-2015 and in

regard to the same a cheque bearing no. 092617 dated 05-10-2016 was duly dispatched to the

complainant on 06-10-2016. However, the said cheque couldn’t be delivered to the complainant due

to incomplete address and was returned back the respondent company. Te respondent company

received a letter from Mr. Subhash Chandra dated 18-10-2016 seeking the maturity amount under

policy bearing no. 412926933 and requesting the same to be sent to the Delhi branch office. The

respondent under the impression to have received request from the complainant, processed the said

request and inadvertently delivered the cheques to Mr. Subhash Chandra for an amount of Rs,

71,302.81/- dated 05-10-2016. The above said Mr. Subhash Chandra had clearly duped both the

complainant and the respondent company by means of misrepresentation and wrongfully en-cashed

the maturity cheque of the complainant. That it important to mention here that the respondent

company in order to rectify its mistake vide letter dated 07-02-2020 has sent a recovery notice

seeking to recover the said amount from Mr. Subhash Chandra. Also, to further assist the

complainant to recover the said maturity amount, the respondent company is also initiating criminal

proceedings against the above said Mr. Subhash Chandra by means of filing of criminal complaint

before the concerned policy authorities.

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 deposited all premiums due under the policy and policy got matured in 2015.

The insurance company has issued a cheque to another person with an impression to have

received a request letter from actual owner and the same was encashed by Subhash Chandra &

Subhash Chandra Chanana instead of Mr. Subhash Chandra. It is also observed that a fresh

cheque was issued without verifying signatures, credential, documents and contacting the actual

owner of the policy through mail, telephone or registered post. Since the complainant has been

running from pillar to post for last 4 -5 years for no fault of his due to procedure negligence/

casualness approach of insurer. Hence, the insurance company, cannot deny deficiency in

service on their part.

AWARD

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 pay maturity claim under the policy no. 412926933 with

penal interest from date of maturity to till final payment.


Dated at Chandigarh on 17.02.2020

Dr. D. K. Verma

INSURANCE OMBUDSMAN

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, INSURANCE OMBUDSMAN OFFICE,GUWAHATI


OMBUDSMAN – K. B. SAHA CASE OF CHANDRESWAR PRASAD GUPTA V/S LIC of INDIA

COMPLAINT REF: NO: 1) GUW-L-029-1920-0293


Complainant Mr Chandreswar Prasad Gupta C/O Jamuna Atta & Dal Mill

N.S. Road,(New Market) Dhubri

P.O. and Dist Dhubri-783301 Assam

2. Policy No:


489828238



Name of the proposer Chandreswar Prasad Gupta.

Self

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

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

7. Date of receipt of the Complaint 03-02-2020 8. Nature of complaint Dispute with regard to payment of maturity

Amount. 9. Amount of Claim Not known


11. Amount of relief sought Not Known


Insurance Ombudsman Rules’ 2017 13 (2)

13. Date of hearing/place 24.02.2020 At O/O Insurance Ombudsman Guwahati

14. Representation at the hearing For the Complainant Absent For the insurer Mr. Maheswar Kumar .AO

15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 24.02.2020


Life Insurance Corporation of India Pol No L.A. PLAN DOC Premium

(yly) Term

/PPT

1ST Comp

/Representation to

GRO of Ins. Co

489828238 Chandreswar

Prasad Gupta

LIC’s Jeevan

Saral Policy

20/01/2010 4,804/- 10/10 yrs 20.12.2019


iv) That he had purchased the above e mentioned Jeevan Saral policy in the year 2010 from LIC of India

(Dhubri Branch) to cover his life. v) As per terms and Condition of the policy he paid all yearly premiums till the maturity @ Rs 4804/ per

instalment (Total Premium paid by him Rs. 48,040).

vi) That on maturity, the insurer paid him total maturity amount Rs.36, 279/. Being dissatisfied with the insurer’s short payment of maturity amount, and subsequent

unsatisfactory reply by the relevant higher authorities of the insurer, the complainant has now

approached this Forum for redressal of his grievance.

18) Cause of Complaint: Due to short payment of maturity amount.


Insurers’ argument: As per SCN received from the insurer:

a) The above Jeevan Saral policy on the life of Mr. Chandreswar Prasad Gupta which

pertains to Dhubri Branch got matured on 20.01.2020.

b) As per the Policy condition, the maturity SA plus Loyalty addition, if any, was payable to the

LA surviving on the date of maturity.

c) Accordingly, as per the terms and condition of the policy, maturity SA Rs 27916/ along with

Loyalty addition Rs 8375/ together amounting Rs 36279/ was payable to the LA subject to

deduction of X-Charge of Rs 11.98 which is correct and within the framework of Policy Schedule.

d) Thus the contention of the Policy holder claiming the amount of Rs. 85162/ was not acceptable

and not based on any laid down rules and policy conditions.

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


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

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

Both the parties were called for hearing on 24.02.2020. The complainant Mr. Chandreswar Prasad

Gupta was absent and intimated the forum through mail expressing his inability to attend the

hearing due to illness of his wife. The Insurer was represented by Mr. Maheswar Kumar (AO).

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

as well as verbal submission made by the representative of the Insurance Company. During the

course of hearing the representative of insurer submitted

the detailed terms and condition under this plan. We have also gone through the records.

As per the terms and condition and features of this particular plan it is seen

that it is a pure term and endowment combination plan. So, unlike term plan, it has provision for

return of premium on death along with death Sum assured. Death benefits under this Plan is

much higher than any traditional endowment plan

Based on the above, the decision of insurer (although maturity Sum

Assured was not printed in the policy bond) was as per the terms and condition of the

policy. Absence of any amount at the designated place for maturity sum Assured ( in the

policy deed) has created a misconception in the mind of the complainant. This, however,

seems to be an unintended omission on the part of the insurer. The maturity Sum Assured

has been arrived at as per benefit structure of the product filed with IRDAI. This forum

does not find any reason to interfere in to the decision of the Insurer and accordingly, no

relief is provided to the complainant against his complaint lodged to this Forum under Policy

No. 489828238.


Dated at Guwahati, the 24th day of February 2020.

K.B.Saha

Insurance Ombudsman

PROCEEDINGS BEFORE

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


OMBUDSMAN : Shri P.K. RATH

CASE OF PRITI DEY GHOSH V/S STAR UNION DAI-ICHI LIFE INSUARNCE

CO.

COMPLAINT REF: NO: 1) KOL-L-045-1920-0032

AWARD NO: 1) IO/KOL/A/LI/ 0560 /2019-2020


Complainant

Mrs Prity Dey Ghosh

W/o Bappa Ghosh, Panishalahat, Dhowabushua,

PO : Panishalahat, PS : Raiganj,

North Dinajpur, PIN : 733134

2. Policy No:


01076694



Name of the proposer

Mrs Priti Dey Ghosh

Self

4. Name of the insurer Star Union Dai-Ichi Life Insurance Co.

5. Date of Repudiation Not Applicable

6. Reason for repudiation Not Applicable


8. Nature of complaint Dispute with regard to partial or total

repudiation of claim.

9. Amount of Claim Could not be ascertained


11. Amount of relief sought Rs 5,00,000/-


Insurance Ombudsman Rules’ 2017

13 (1) ( B )

13. Date of hearing/place On 07-02-2020 at SILIGURI


For the Complainant Mrs Prity Dey Ghosh & Mr Bappa Ghosh (Husband)

For the insurer ABSENT

15 Complaint how disposed BY CONDUCTING HEARING

16 Date of Award/Order 13-02-2020


Pol No L.A. PLAN DOC Premium

(yly)

Term

/PPT

1ST Comp to

Ins Co

01076694 Priti Dey Ghosh Non-linked Non-

participating HI

25-03-2017 Rs 9120 10/10 yrs 30-10-2018


i) That her husband is a consumer of Union Bank of India, Raiganj Branch and he is having

cash/credit account with that bank branch. Hat in March’ 2017 when she and her husband had

visited the branch for their personal work, they were persuaded by the branch manager and one

representative of Star Union Dai-ichi Life Insurance Company Limited to purchase the

aforementioned health insurance policy with the assurance that it was the best available policy

and that there would not be any inconvenience for getting the claim (if required). ii) That she had mentioned at the time of purchasing the policy that 12 years ago when she

had conceived for the first time, serious gynaecological problems resulting in the baby

getting aborted and she had to undergo Kidney Dialysis.

iii) That due to this disclosure before paper works she had to appear before a medical

practitioner as appointed by the insurance company and only then the policy was issued

to her. That she had disclosed everything before the insurance company’s medical

practitioner also. That after some days she was called at the bank and the official obtained

her signatures on the policy agreement papers which were filled up by the representative

of the insurance company and then after some time she received the new policy

certificate bearing number 01076694 for Health Insurance having sum of Rs 5,00,000/-

iv) That thereafter after completion of Kidney Dialysis she was completely cured and

subsequently on baby girl was born to her whose at the time of policy purchase was 8

years.

v) That in the year 2018 she was diagnosed with breast cancer and underwent treatment for

the same at Tata Memorial Hospital (TMC), Mumbai. There she first underwent

Chemotherapy and then surgery and then again chemotherapy. Thereafter the doctor has

advised her to undergo 17 cycles of chemotherapy upto 22-06-2019.

vi) That during the course of treatment she has expended more than Rs 5 lakhs but when she

submitted her claim to the insurer Star Union dai-ichi along with all documents, the

insurer has repudiated the claim vide their letter dated 29-10-2018 because of her

previous treatments of Dialysis.

vii) That she had disclosed her previous treatment history at the time of policy purchase and

the insurer has issued the policy only after being fully satisfied and after conduct of

medical examinations. That she has also written to the Claims Review Committee of the

insurance company on 12-12-2018 but no satisfactory response has been provided.

As such, aggrieved by the repudiation of claim, the complainant has now approached this forum

for redressal of his grievance.

18) Cause of Complaint: Due to misselling of policy.

Complainants argument : In point No. 17 it is mentioned categorically.

Insurers’ argument: As per SCN received from the insurer –

i) Policy has been issued only after receipt of duly filled up application form and relevant

declaration regarding full understanding of policy terms and conditions along with valid

documents submitted by the complainant cum policyholder. The policy bond has been

already received by the complainant.

ii) The complainant has submitted the Critical illness Claim Form on 11-06-2018 and a pr the

contents of the same the complainant had symptoms of “Tumor in Right Breast” since 20-

03-2018. As the relevant treatment documents were not accompanying the claim form the

same were called for vide letter dated 12-06-2018 wherein Indoor case papers, Consultation

papers and Medical reports, etc. were asked to be submitted.

iii) As per treatment documents received the complainant was admitted at Sunrise Nursing

Home Pvt. Ltd. Siliguri on 22-09-2018 and relevant treatment papers mention that the

complainant had H/o Hypertension since age 34 and H/o Dialysis in post partum period

at age 23 years. These material facts were not disclosed by the complainant in the proposal

form.

iv) The treatment papers of Tata Memorial Hospital also mentions clearly under the head –

Clinical Information – that the complainant had H/o hypertension diagnosed at 34 yrs,

discontinued Rx, now on Amlong 5mg*2. As per information available in public domain

Amlong 5 mg tablet is used to treat high blood pressure and other heart complications.

v) Hence it is clearly understood from the treatment documents that the complainant was

suffering from Hypertension prior to issuance of the policy and had intentionally suppressed

the material information to take insurance coverage from the company. Further the treatment

papers of TMC also states – “F/h/o – father-Brain ca – 60 y”. It shows that the complainant

had family history of Cancer which was suppressed by the complainant.

vi) The complainant had also concealed facts regarding abortion of her child and her breast

operation in the proposal form and answered the relevant questions in the negative.

vii) Based on the above findings it was concluded that the complainant had intentionally

suppressed / mis-represented multiple information in the proposal form and as such the

claim was repudiated and in accordance to Section 45 of the Insurance Act, the policy was

cancelled and the premium amount of Rs 18,108/- was transferred to the complainant’s bank

account.

viii) The complainant has stated in the proposal form that she is a XII pass and it is a hard truth

to believe that she was not aware of the contents of the Proposal Form and had signed it

blindly without verification.

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

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


i) Complaint letter ii) P – form iii) Proposal papers iv) SCN

v) Case summary issued by Sunrise Nursing Home Pvt. Ltd., Siliguri

vi) Case letter dated 01/10/2018 issued by Tata Memorial Hospital, Mumbai.

viii) Communication dated 29-01-2020 of the insurer containing copy of the DCDRF Notice in

respect of Consumer Case No. CC – 64/2019.

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

The complainant was present in the hearing along with her husband. The insurer was not

represented as they had sent a prior communication dated 29-01-2020 wherein they had

submitted that they be excused from being present at the hearing as the complainant had already

filed a case against the Company before District Consumer Disputes Redressal Forum (DCDRF),

Uttar Dinajpur, Raiganj and the same was already listed for hearing at that Forum on 06-02-

2020. The insurer had also sent a copy of the notice received by their Company from DCDRF,

Raiganj. The competent authority had granted their request.

During the course of hearing the complainant and her husband repeated the allegations as

mentioned in the written. They submitted that they have already filed a complaint before the

DCDRF, Raiganj.

AWARD

Taking into account the fact that the complainant has already filed a complaint with District

Consumer Dispute Redressal Forum, Uttar Dinajpur, Raiganj vide Consumer Case Number

CC – 64/2019, the complaint in this instant case is not maintainable before the Insurance

Ombudsman as per Section 14 (5) of Insurance Ombudsman Rules’ 2017.

Hence, the complaint is treated as dismissed without any relief to the complainant.

Dated at KOLKATA on 13th day of February’ 2020.

P.K. RATH

INSURANCE OMBUDSMAN

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

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKIM, A&N ISLANDS


OMBUDSMAN – MR.P.K.RATH

CASE OF MR. TAPAN DAS

V/S

LIC of INDIA




Complainant

Mr. Tapan Das 24B, Pitamber Ghatak Lane,

Kolkata, West Bengal,

PIN : 700 027.

Mob No.9830248408

2. Policy No:


495089763




Mr. Tapan Das

------------------Do----------------------------

4. Name of the insurer LIC of INDIA (KMDO-I)

5. Date of Repudiation Not applicable

6. Reason for repudiation Not applicable


8. Nature of complaint Less payment of maturity claim

9. Amount of Claim Top up payment amount of Rs.14,000/- not

incorporated in maturity value


11. Amount of relief sought Rs 14,000/- with interest


Insurance Ombudsman Rules’ 2017 13 (1) ( c )

13. Date of hearing/place 06-02-2020 AT KOLKATA


For the Complainant Mr.Tapan Das

For the insurer Ms. Mohua Bhattacharya, Manager (CRM),

LICI, KMDO-I





ix) That the Complainant purchased one Bima Account Policy for Sum Assured with annual

premium of Rs.14,000/- on his own life from LIC of India on 31-01-2013 for a term of 05 years

and he deposited the specified premium every year along with the top up of Rs.14,000/- for each

year.

x) That he deposited a total sum of Rs.1,40,000/- as premium including top up payment but he

received Rs.1,32,869/- as maturity proceed after 5 years.

xi) That while depositing his annual due premium of 01-2015 on 02-02-2015, he paid a total of

Rs.28,000/- (Rs.14,000/- each as premium and top up) and the said premium was adjusted on 03-

02-2015 but the top amount was not accounted for by allocating units as per applicable NAV.

xii) That to recover the amount of Rs.14,000/- deposited as top up on 02-02-2015 which was not

taken into account in maturity amount, he approached different quarters of the insurer repeatedly

on 31-03-2018, 31-05-2018 & 06-06-2018 without any positive outcome.

Being dissatisfied with the insurer’s indifference to refund the unaccounted for top up amount of

Rs.14,000/- along with interest thereof, he approached this form for redressal of his grievance on

01-10-2018.

Details of the policy issued:

Policy No. 495089763

Name of Life Assured Mr. Tapan Das

Plan/Term/PPT Bima Account 805 / 05 / 05

DOC of Policy 31-01-2013

Sum Assured Rs. 1,40,000/-

Premium / Mode Rs.14,000/- (Yearly)

Top up paid Rs.14,000/- for 5 years along with

premium

Total premium paid including top up Rs.1,40,000/-

Total maturity amount paid Rs.1,32,869/-

18) Cause of Complaint: Less payment of maturity amount due to top-up premium of

Rs.14,000/- paid on 02-02-2015 remained unaccounted for.


Insurers’ argument: Submission of Insurance Company is not available with us as SCN not

received till date.

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

u/s 13 (1) (c)


ii) Complaint letter ii) P – form

iii) Proposal papers iv) SCN submitted during the course of hearing

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

Both the parties attended the hearing at the Office of the Insurance Ombudsman, Kolkata on 06-02-

2020.

The Complainant told that he deposited the yearly premium of Rs.14,000/- throughout the term of 5

years alongwith top of Rs.14,000/- in each occasion. But he had not received the credit of

Rs.14,000/- which he deposited as top up on 02-02-2015 in maturity proceed of his policy.

The representative of the Insurance Company submitted their SCN during the course of hearing and

she confirmed that the Complainant did deposit the normal premium along with a top up premium

for Rs.14,000/- each on 02-02-2015 at their City Branch Office 15 vide Transaction No.130811 &

130813 respectively. But due to some technical fault the transaction no. 130813 was rejected by

their system on 03-02-2015. As a result the top up amount of Rs.14000/- was neither reverted back

to the specified deposit A/c. nor converted into units against the Policy. They sorted out the issue

with the help of their technical hub and refunded Rs.14,002/- on 05-02-2020 through NEFT to the

Bank A/c. of the Complainant.

AWARD

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

the parties during the course of hearing, it is observed that the Complainant deposited

Rs.14,000/- as additional top premium on 02-02-2015 against his policy in a Branch Office of

the insurer which was duly credited to the account of the insurer. But due to some technical

reasons the amount was not properly accounted for by their internal system and the

Complainant did not get the credit of the top up deposit while receiving the maturity proceed

of his policy. The Insurance Company confirmed during the course of hearing that the refund

of Rs.14,002/- was made by them on 05-02-2020 to the Complainant through NEFT. However,

the fact remains that the Insurance Company received the money from the Complainant on

02-02-2015 and they held this unadjusted money for a period of 5 long years without any

justified reason before finally refunding it on 05-02-2020.

As such the Insurance Company is instructed to pay interest @2% above existing Bank rate

on the amount of Rs.14,000/- for a period of 5 years.


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

provisions of Insurance Ombudsman Rules, 2017:

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

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

the Ombudsman.

Sd/-

Dated at KOLKATA on 10th day of February 2020. P.K.Rath

INSURANCE OMBUDSMAN

FOR THE STATE OF WEST BENGAL,

SIKKIM and A&N ISLANDS

PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKIM, A&N ISLANDS


OMBUDSMAN – MR.P.K.RATH

CASE OF MR. ARABINDA GHOSH

V/S

LIC of INDIA




Complainant

Mr. Arabinda Ghosh 8, Satish Mukherjee Road,

PO-Kalighat,

Kolkata, West Bengal,

PIN : 700 026.

Mob No.9432276202

2. Policy No:


578920914




Mr. Arabinda Ghosh

------------------Do----------------------------

4. Name of the insurer LIC of INDIA (KMDO-II)

5. Date of Repudiation Not applicable

6. Reason for repudiation Not applicable


8. Nature of complaint Less payment of maturity amount

9. Amount of Claim Maturity value as mentioned in leaflet given by

the Agent at the time of signing the agreement


11. Amount of relief sought Not quantified


Insurance Ombudsman Rules’ 2017 13 (1) ( e )

13. Date of hearing/place 06-02-2020 AT KOLKATA


For the Complainant Unrepresented

For the insurer Ms.Dipu Bala Sarkar, Manager (CRM) &

Mr.Ashesh Ghosh, A.O., LICI, KMDO-II





xiii) That the Complainant purchased one Jeevan Varsha Policy for Sum Assured of Rs.1 lakh on

his own life from LIC of India on 28-03-2009 for a term of 09 years with quarterly premium of

Rs.4,597/- and he was allegedly mis-led by the Agent with a leaflet illustrating 3 times return of

investment on maturity of the policy.

xiv) That he paid his entire premium in due time for the policy.

xv) That he received two Survival Benefits of Rs.15,000/- & Rs.25,000/- on 28-03-2012 & 28-

03-2015 respectively and a maturity amount of Rs.1,29,500/- on 28-03-2018.

xvi) That he paid a total premium of Rs.1,65,492/- and received a total of Rs.1,69,500/-including

Survival Benefit amounts. So, his total benefit on investment remains Rs.4,008/- after 9 years

which does not match with the benefits illustrated in leaflets given by the Agent at the time of

taking the policy.

Being dissatisfied with the quantum of the maturity proceeds settled by the Insurance Company

which is much less than the amount illustrated by the Agent at the time of purchasing the policy,

the Complainant approached this forum for redressal of his grievance.

Details of the policy issued:

Policy No. 578920914

Name of Life Assured Mr. Arabinda Ghosh

Plan/Term/PPT Jeevan Varsha 196 / 09 / 09

DOC of Policy 28-03-2009

Sum Assured Rs. 1,00,000/-

Premium / Mode Rs.4,597/- (Quartery)

Age at entry 65 yrs

18) Cause of Complaint: Delay in effecting the change of mode of payment from Yearly to

Monthly ECS charging interest on premium thereby.


Insurers’ argument: The submission of the Insurance Company as per the SCN received on

26-12-2018 is as follows:

(i) That the maturity value paid to the Complainant exactly as per terms and conditions of the

policy.

(ii) That the Insurance Company never published or circulated any such leaflet allegedly used

by the Agent to misled Complainant in purchasing the policy.

(iii) That the net gain of only Rs,4,008/- in 9 years as presented by the Complainant did not take

into account the risk cover part of Insurance policy.

(iv) That the policy was taken at the age of 65 years of age and hence the premium was

exceptionally high as risk undertaken by the insurer is also extremely high.


Less payment of maturity amount – 13 (1) (e)


iii) Complaint letter ii) P – form

iii) Proposal papers iv) SCN of the Insurance Company.


The Complainant did not attend the hearing at the Office of the Insurance Ombudsman, Kolkata on

06-02-2020. He informed while contacted over phone that he is quite aged and physically not in a

position to move from home. There is nobody to represent the hearing on his behalf.

The representatives of the Insurance Company reiterated that they have correctly settled the

maturity value of the policy under complaint on due date of maturity. The Complainant received

two installments of Survival benefits 15% & 25% of Sum Assured at the end of 3 years and 6 years

from Date of Commencement (DOC) of policy respectively. On maturity at the end of 9 years from

DOC of the policy he was paid remaining 60% of Sum Assured along with guaranteed addition

@Rs.65 per thousand Sum Assured and Loyalty addition as per terms and condition of the policy.

AWARD

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

the parties during the course of hearing, it is observed that

1) The Complainant received two Survival Benefits @ 15% of Sum Assured & @ 25% of

Sum Assured at end of 3 years & 6 years from DOC respectively as per terms and

conditions of the policy.

2) The Insurance Company settled the maturity in due time which comprised of the

remaining 60% of SA along with Guaranteed Addition (GA) @Rs.65/- per thousand

Sum Assured for 9 years + Loyalty Addition of Rs.11,000/-

3) Maturity proceed:Rs.1,29,500 >> SA (remaining 60%) = 60,000

GA = 65x100x9 = 58,500

Loyalty Addition = 11,000

1,29,500

As such it is noted that the maturity amount settled by the insurer is correct as per terms and

conditions mentioned in the policy document.

Hence, the complaint is treated as disposed of without providing any relief to the

Complainant.

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

provisions of Insurance Ombudsman Rules, 2017:



the Ombudsman.

Sd/-

Dated at KOLKATA on 10th day of February 2020. P.K.Rath

INSURANCE OMBUDSMAN



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


OMBUDSMAN – P. K. RATH

CASE of SONA GHOSH V/S LIC of INDIA




Complainant

Mr. SONA GHOSH

AF- 228, RABINDRA PALLI,

SHANKER APARTMENT, 3RD FLOOR,

KRISHNAPUR, KOLKATA, WEST BENGAL-700101

MOBILE NO. - 7003629459

2. Policy No:


059630472 DETAILS ARE IN THE TABLE



Mr. SONA GHOSH

SELF

4. Name of the insurer LIC OF INDIA

5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 11/07/2018 8. Nature of complaint Delay in Settlement of Maturity Claim – 13-1-(a) 9. Amount of Claim Rs. 74879/


11. Amount of relief sought Rs. 74879/ + Fixed deposit Interest rate


Insurance Ombudsman Rules’ 2017 13 (1) ( a )

13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing

For the Complainant Mr. SONA GHOSH For the insurer Mr. GOUTAM BISHNU

15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020


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

Term /PPT

1ST Comp to Ins Co

59630472 Mr. Sona Ghosh Conventional 28/03/1986 Rs. 475/ 25/25

31/10/2017


a) That, the above policy (policy number – 059630472) matured in the year 2011 but the

Assignee of the policy, the State Bank Of India, Manicktala Civic Centre Branch yet to get

the Maturity Value.

b) That, the LIC of India, Lake Town Branch after repeated request for many years has

informed that they have settled the case a long time back vide cheque number 803641 dated

18/01/2012 for Rs.74879/ favouring SBI (most probably) and the same cheque stands

encashed on 17/03/2012 but they are not in a position to mention confirmly the name of the

Bank and Branch although they mention that it would be most probably SBI Lake Town

Branch.

c) That, the LIC, Lake Town Branch also informs that their Banker, Axis Bank, Lake Town

Branch has expressed their inability to confirm the name of the Bank and Branch where the

said cheque gets credited as the case is more than 5 years old.

d) That, the SBI, Manicktala Civic Centre Branch has informed LIC vide letter dated

19/08/2017 that they have thoroughly checked their record but their record does not reveal

any receiving of such cheque and requested LIC to provide the details encashment of the

cheque including the name of the Bank and Branch which encashed the cheque.

e) That, the LIC is silent about confirming the name of the bank and branch which encashed

the cheque.

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

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


Insurers’ argument: SCN not yet received. However, LIC, Lake Town Branch vide their letter

dated 31/10/2017 informed SBI Manicktala Civic Centre Branch about their difficulty to provide

the name of the encashing Bank and Branch and requested them to take up the matter with SBI

Lake Town Branch.


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


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


Complainant’s Submission:

The complainant repeated all the points as mentioned in his complaint letter dated 06/07/2018. He

added that out of 3 policies assigned in favor of SBI Manicktala Civic Centre Branch, he got

maturity payment for 2 policies from SBI excepting the policy 59630472 for which SBI, Manicktala

Branch complained of nonreceipt of maturity payment from LIC. The complainant questioned why

LIC sent the maturity payment to SBI, Lake Town Branch instead of SBI, Manicktala Civic Centre

Branch. He alleged that due to negligency on the part of the Insurer, he ultimately suffered and as

such he demanded interest from the Insurer.

Insurer’s Submission:

The representative of the Insurer informed that the maturity claim of the policy in question was

settled on 29/03/2011 for Rs.74879/ vide instrument number 0528138 favoring SBI. But the said

Instrument got staled two times and fresh cheque finally issued on 18/01/2012 vide instrument

number 803641 and the same instrument was encashed on 17/03/2012 as confirmed by Axis Bank,

Lake Town Branch vide their letter dated 13/02/2020. The Insurer also confirmed that the

beneficiary of maturity payment amount was SBI, Lake Town Branch as was evident from the scan

copy of the Instrument, sent by Axis Bank. So, there was no lapsation on the part of the Insurer and

the Insurance company discharged all its obligation without any deviation. The Insurer also assured

to the complainant about sending of full details of payment and subsequent encashment particulars

within 2 days and as such demanded dismissal of the complaint.

AWARD

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

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

hearing, it is observed that the Insurer has duly settled the Maturity payment long time

back to SBI, Lake Town Branch as is evident from the scan copy of the instrument,

furnished by Axis Bank, Lake Town Branch.

Considering all the above, the Insurer is advised to direct SBI, Lake Town Branch to remit

the amount Rs.74879/ to their SBI, Manicktala Civic Centre Branch, the assignee of the

captioned policy, giving all details about the beneficiary and particulars of encashment of

the instrument, with a copy to the complainant, under intimation to this office.


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




the Ombudsman.

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

S/d

P. K. RATH

INSURANCE OMBUDSMAN






CASE of PRADIP KUMAR BANERJEE V/S LIC of INDIA




Complainant

PRADIP KUMAR BANERJEE

A/27, RAJNARAYAN PARK, KOLKATA,

WEST BENGAL- 700154

2. Policy No:





Mr. PRADIP KUMAR BANERJEE

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 11/09/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs. 19626/


11. Amount of relief sought Rs.19626/


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


For the Complainant Mr. Pradip Kumar Banerjee For the insurer Mrs. Mohua Bhattacharya, Mgr CRM



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

Term /PPT

1ST Comp to Ins Co

577874753 Mr. Pradip kumar banerjee

ULIP (801)

18/03/2010 Rs.50000/ 08/01

30/07/2018


a) That, LIC, City Branch no. -2 settled Maturity claim of the above Ulip policy substantially

less, only Rs.46985/ after 8 years against a single premium of Rs.50000/

b) That, as per policy bond, Maturity Amount should be Rs.65000/ but LIC settled maturity

amount only Rs.46985/

c) That the complainant referred a policy (policy no.-578280568) of his close relative who got

the Maturity Claim Rs.66611/ for the exactly same policy. According to complainant, he also

should get minimum Rs.66611/ like his close relative.

d) That, the complainant requested to Mgr CRM KMDO-1, on 30/07/2018 for payment of

balance amount Rs.19626/ but yet to get any response from LIC.


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


Insurers’ argument: SCN not yet received. So, the view of LIC could not be furnished.


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


v) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P form, v) Copy of policy bond

and vi) calculation detail of the Insurer.

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



categorically mentioned about receiving of Rs.66611/ as maturity claim by his close relative for the

exactly same policy for the same period and questioned why he was paid so much less compared to

his relative. He added that the minimum payment should not be less than Sum Assured of the policy

ie Rs.65000/ as printed in the bond.


The representatives of the Insurer at the outset informed about issuing one letter to the complainant

on 14/02/2020 wherein detail calculation of Maturity claim along with deductions made monthwise

in terms of unit towards different charges like premium allocation charge, mortality charge, policy

administration charge and fund management charge etc. have been shown clearly and they

confirmed their Maturity calculation on the basis of net number of units in the policy holder’s fund

as on date of maturity ie 3056.680 multiplied by the highest NAV Value on that date ie Rs.15.3712/

is absolutely O.K. In this connection they clarified that highest NAV in first 7 year was Rs.14.4448/

and the NAV on the date of maturity was Rs.15.3712/.

The representative also clarified about less deduction of mortality charge for younger person and

that is the reason behind getting higher return by younger people. They explained the Term “Sum

Assured” as printed in the bond and said that it is payable only in case of Death and not in Maturity

case.

AWARD



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

Insurer is absolutely justified.

Considering all the above, the complaint is dismissed without giving any relief to the

complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATES OF WEST BENGAL,

SIKKIM and A & N ISLANDS




CASE of SUNIL MAJHI V/S LIC of INDIA


AWARD NO: 1) IO/KOL/A/LI/0592 /2019-2020


Complainant

Mr. SUNIL MAJHI

VILL + P.O – BHURKUNDABAD, PURULIA,

WEST BENGAL -0

MOBILE NO. -7047109772

2. Policy No:





MR. SUNIL MAJHI

SELF


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

7. Date of receipt of the Complaint 06/09/2018 8. Nature of complaint Non Payment of Maturity Claim – 13(1)(a) 9. Amount of Claim Not Specific


11. Amount of relief sought Amount of Maturity Claim + Penal Interest


Insurance Ombudsman Rules’ 2017 13 (1) (a)


For the Complainant Mr. Sunil Majhi For the insurer Mr. Alak Kumar Das



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

PLAN & TERM

1ST Comp to Ins Co

462371270 Mr. SUNIL MAJHI 75-20 28/03/1994 Rs.267/ 75-20

16/06/2015


e) That, the above policy matured on 28/03/2014 and the complainant deposited the Maturity

DV, original policy bond and the Neft at Chirkunda Branch on 28/04/2014 but till date,

Maturity Payment not settled in spite of repeated request made to Chirkunda Branch.

f) That, the Chirkunda Branch did not provide any reply to the complainant in spite of his

lodgment complaint to Chirkunda Branch on 06/06/2015.

g) That the Status of the above policy showing gaps of 83 monthly premium although according

to the complainant, all these premium have been remitted to Chirkunda Branch by the P.A

code-679(Basantimata Colliery).

h) That the complainant has submitted his 21 salary pay slips to Chirkunda Branch on

16/06/2015 but Chirkunda Branch did not take any action to resolve the matter.


18) Cause of Complaint: Due to nonpayment of Maturity claim.


Insurers’ argument: SCN not yet received. So, Insurer’s view could no be furnished.


Dispute over delayed settlement of Maturity Claim under rule – 13 (1) (a).


vi) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form, v) Copy of status of the

policy, and vi) Copies of salary pay slips.




appealed to the forum for immediate settlement of his maturity claim as it is already late by almost

6 years.


The representative of the Insurer informed that the policy in question was introduced in Kulti

Branch and subsequently after 1.5 years, transferred to Chirkunda Branch. Total number of gaps

detected 83 after adjustment of some deposits. The representative expressed that LIC, Chirkunda

Branch, did not receive the 83 gap premium from Basantimata Coaliary and that was the reason

behind nonpayment of Maturity claim. In the question of issuing gap intimation to the complainant,

he expressed ‘yes’ although no documentary evidence could be provided in support of his claim. In

the question of “How 3 S/B payment settled” where 83 gaps detected, he replied that first 2 S/B

payment was settled in full but the 3rd S/B which was about to be settled after deduction of one

premium but subsequently not paid by cancellation of cheque.

AWARD



hearing, it is observed that the Insurance Company failed to take timely action against 83

gaps as is evident from the fact that full S/B payment made by the Insurer for the due on

03/1999 & 03/2004 without any deduction of gap premium. Moreover, though the Insurer

mentioned about issuing of gap intimation time to time to the complainant, but they failed

to produce any documentary proof in support of their claim. On sample checking, we also

find that the premium for the due 03/2000 deducted from the salary of the complainant

although in Insurer’s record, it is showing ‘gap’.

Considering all the above, the Insurer is directed to settle the maturity claim to the

complainant without deducting any gap premium, under intimation to this forum.

Hence, the complaint is disposed of.

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




the Ombudsman.


S/d

P. K. RATH

INSURANCE OMBUDSMAN


SIKKIM and A & N ISLANDS




CASE of Prantosh Kumar Ghosh V/S LIC of INDIA




Complainant

PRANTOSH KUMAR GHOSH

23, 23/1/3, DAKSHIN BAXARAH LANE

P.O- D.S. LANE, HOWRAH

WEST BENGAL - 711109

MOBILE NO. - 9433610031

2. Policy No:





Mr. PRANTOSH KUMAR GHOSH

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 14/08/2018 8. Nature of complaint Servicing related complaint, non compliance of

Maturity payment details after deduction of

reinvestment amount. 9. Amount of Claim -


11. Amount of relief sought Seeking details of Maturity Payment Particulars.


Insurance Ombudsman Rules’ 2017 13 (1) ( f)


For the Complainant ABSENT For the insurer Mr. GOUTAM NANDAN,A.O, CRM




Term /PPT

1ST Comp to Ins Co

434677463 Mr. Prantosh Kumar Ghosh.

Conventional --- --- ---

29/01/2018


i) That his above Jeevan Anand policy matured on 28/11/2017. As per the advice of Howrah

District Branch and agent, he reinvested some money from maturity amount in two new

policy on the life of his wife and daughter but the detailed maturity payment statement

including reinvestment amount has not been provided to him by the office in spite of his

request to Howrah District Branch vide letter dated 29/01/2018 for the said statement.

j) That his agent also did not cooperate him in getting the said statement from office.


18) Cause of Complaint: Due to not getting of Maturity Statement along with reinvestment figure.


Insurers’ argument: SCN not yet received. So, the view of LIC could not be furnished.


Dispute over servicing related matter under rule – 13 (1) (f).


vii) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form,


Complainant’s Submission: The complainant was absent in the Hearing.

Insurer’s Submission: The representative of the Insurer informed that they had issued one letter to

the complainant dated 17/02/2020 giving details of Maturity payment made under the above policy

and the deduction made thereof towards introduction of 2 new policies and the balance amount paid

to the complainant. The representative of the Insurer appealed to Hon’ble Ombudsman for closure

of the complainant as the necessary statement as sought for by the complainant has already been

sent.

AWARD

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

representative of the Insurer during the course of hearing, it is observed that the

complainant’s demand for a detailed statement of Maturity Claim paid along with the

deductions made thereof, has already been met by the Insurer.

As such, the complaint is treated as closed.


S/d

P. K. RATH

INSURANCE OMBUDSMAN






CASE of ANJAN BARUA V/S LIC of INDIA




Complainant

ANJAN BARUA

178, KANUNGO PARK, KOLKATA- 700084

WEST BENGAL

MOBILE NO. - 9831690384

2. Policy No:





ANWESHA BARUA

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 17/07/2018 8. Nature of complaint Dispute on less Payment of Maturity Claim under

rule – 13(1)(i) 9. Amount of Claim Rs.21981/

10. Date of Partial Settlement ---

11. Amount of relief sought Not Specified


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


For the Complainant Absent For the insurer Mrs. Mohua Bhattacharya, Mgr CRM &

Mrs. Sathi Nag, A.O, CRM 15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020



Term /PPT

1ST Comp to Ins Co

578408516 ANWESHA BARUA

ULIP(Wealth plus)

31/03/2010 Rs. 1 lakh.

08/01

17/07/2018

The Complainant Arguments:-

f) That a less payment has been made in Maturity settlement of the captioned policy. The

complainant has paid Single premium Rs.100000/ and in return she got Rs.132638/ as

Maturity Payment after 8 years.

g) That, as per complainant, LIC has settled Maturity payment on the basis of NAV value

Rs.13.2638/ but as per LIC site, NAV value of Wealth Plus as on 31/03/2018 is Rs.15.1619/.

So, his Maturity Payment should have been Rs.154619/ (taking NAV Rs.15.1619/) but LIC

settled Rs.132638/. So, his daughter has been paid less by Rs.21981/.

h) That he appealed to Manager CRM, KMDO-1 on 08/06/2018 for the detail explanation of

the Maturity Calculation but no reply received yet.


18) Cause of Complaint: Dispute over less payment of Maturity Claim.


Insurer’s Argument: SCN not yet received. So, the view of the Insurer could not be furnished

herewith.


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


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

Insurer and v) The calculation sheet of the Insurer.


Complainant’s Submission: The complainant was absent on the date of hearing.

Insurer’s Submission: The representatives of the Insurer at the outset informed about issuing of

their letter to the complainant dated 18/02/2020 wherein detail calculation of Maturity claim along

with total deductions made therein monthwise in terms of unit towards different charges have been

shown clearly. They also confirmed their Maturity calculation on the basis of net number of units in

the policy holder’s fund as on date of maturity ie 3056.680 multiplied by the highest NAV Value on

that date ie Rs.15.4619/ is absolutely O.K. In this connection they clarified that highest NAV in first

7 year was Rs.14.2278/ and the NAV on the date of maturity was Rs.15.4619/

AWARD


documents on record and the submissions made by the representative of the Insurer during

the course of hearing, it is observed after necessary verification that the maturity payment

calculation made by the Insurer is absolutely justified and it is as per the terms and conditions

of the policy.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATES OF WEST BENGAL, SIKKIM AND A&N ISLANDS




CASE of MANOHAR MALL V/S LIC of INDIA




Complainant

Mr. MANOHAR MALL

13, TARA CHAND DUTTA STREET, KOLKATA -700073

MOBILE NO. -

2. Policy No:





MR. MANOHAR MALL

SELF




11. Amount of relief sought Rs.60000/ + Addition for 8 years




For the Complainant Mr. Sandeep Mall (Son) For the insurer Mr. Goutam Nandan, A.O, CRM



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

Term /PPT

1ST Comp to Ins Co

496266307 Mr. Manohar Mall ULIP 08/05/2010 Rs.5000/ 08/03

22/05/2018

The complainant has alleged the following: -

k) That, LIC, Howrah City Branch-2 settled Maturity claim of the above Ulip policy

substantially less, only Rs.55958/ after 8 years against total invested premium amount

Rs.60000/.

l) That, the Maturity amount is less than the invested amount by Rs.4042/

m) That as per terms & conditions of the policy, LIC is bound to pay of the on the basis of

highest NAV achieved on any day in first 7 years or will pay the total investment made in

case of nonperformance.

Being aggrieved with the reply of LIC served on 01/06/2018, the complainant has now

approached this forum for redressal of his grievance.



Insurers’ argument: SCN not yet received. However, Howrah City Branch-2 in their reply dated

01/06/2018 against the complaint, explained in detail how maturity calculation finalised.

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

2017: Dispute over less payment of Maturity Claim under rule – 13 (1) (i).


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

and vi) Reply of the Insurer including calculation details.

21) Result of hearing with both parties (Observations & Conclusion): Complainant’s Submission: The representative of the Insurer repeated all the points as mentioned in the complaint letter dated 26/07/2018. He questioned how LIC settled maturity claim which is less than the invested amount, made 8 years earlier. He appealed to this forum to look into the matter. Insurer’s Submission: The representative of the Insurer strongly refuted the complainant’s point that in case of nonperformance of the fund, total invested amount to be refunded. He explained that as per terms and conditions of the policy, highest NAV recorded in the first 7 policy years or the NAV at the date of maturity whichever is higher to be considered for maturity calculation in case of inforce policy and in this case highest NAV in first 7 year was Rs.14.7181/ and at the date of maturity, it was Rs.15.9708/ and accordingly maturity calculation made as under- Net number of unit in policy holder’s fund as on 08/05/2018 is 3503.761 and highest NAV rate @ Rs.15.9708/ and multiplication of this two will give the actual maturity amount which is = (

3503.761 X Rs.15.9708/) Rs. 55957.87/. He also mentioned how net number of unit is calculated after deduction of different charges like fund allocation charge, mortality charge, policy administration charge and fund management charge etc for 8 years.

AWARD



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

made by the Insurer is absolutely justified & as per the terms and condition of the policy.


complainant.


Dated at Kolkata, the 19th day of February 2020.

S/d

P. K. RATH

INSURANCE OMBUDSMAN






CASE of ASHOKA KUMAR JAIN V/S LIC of INDIA




Complainant

ASHOKA KUMAR JAIN

35/Y, NEETAI SUBHAS ROAD, RISHRA,

HOOGHLY, WEST BENGAL-712248

MOBILE NO. - 9681400083

2. Policy No:





Mr. ASHOKA KUMAR JAIN

SELF




11. Amount of relief sought As per rise of BSE sensex during policy period.




For the Complainant Mr. Ashoka Kumar Jain For the insurer Mr. Goutam Nandan




Term /PPT

1ST Comp to Ins Co

496241529 Mr. Ashoka Kumar Jain

ULIP 30/03/2010 Rs.100000/ 08/01

02/05/2018


n) That, LIC, Serampur Branch settled Maturity claim of the above Ulip policy substantially

less, only Rs.104319/ after 8 years against a single premium of 1 lakh.

o) That, the return from BSE sensex is more than 100% for the same corresponding period

although LIC paid only 0.5% return uncompounded in last 8 years.

p) That, he appealed to LIC to reconcider the return amount considering market return for

similar period.

q) That, the complainant requested to LIC on 02/05/2018 but yet to get any response from LIC.




Insurers’ argument: SCN not yet received. So, the view of LIC not known.




viii) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form, v) Copy of policy bond.




added that he was assured by the agent to have a very handsome return at the time of maturity as

Highest NAV is granted in this policy but actual return is beyond his imagination. He appealed to

the forum for an additional return.

Insurer’s Submission: The representative of the Insurer argued the following:

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

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

by the policy holder.

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

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

charge, mortality charge and other charges.

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

of policy bond.

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

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

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

Rs.14.5136)

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

maturity” with highest NAV ie 6746.815(net no. of unit)X15.4619= Rs.104319/.

f) That the policy holder aged 59 years at the time of taking the policy enjoyed the life cover for

Rs.1.25 lakh for 8 years and in case of any unfortunate incident, his nominee would have

received policy sum assured + policy holder’s fund value.

g) That the policy holder will enjoy risk cover for another 2 years for Rs.1.25 lakh after the date

of maturity.

h) The representative of the Insurer also demanded their maturity calculation as absolutely O.K

and as such appealed for dismissal of the complaint.

AWARD



hearing, it is observed that the maturity payment calculations made by the Insurer is justified

& it is as per the terms and conditions of the policy.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN






CASE of GORACHAND GIRI V/S LIC of INDIA




Complainant

Mr. GORACHAND GIRI

S/O – LATE KALIPADA GIRI

VILL + P.O – ELAHIPUR, HOOGHLY

WEST BENGAL- 712707

MOBILE NO. - 9932859394

2. Policy No:





Mr. GORACHAND GIRI

SELF



rule – 13-(1)-(i) 9. Amount of Claim Rs.15907/






For the Complainant ABSENT For the insurer Mr. GOUTAM NANDAN, A.O, CRM



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

Term /PPT

1ST Comp to Ins Co

439486534 Mr. Gorachand Giri Conventional, Jeevan Saral

21/06/2008 Rs.1225/ 10/10

09/06/2018

The complainant Submissions:-

i) The complainant alleged that he had paid total premium Rs.49000/ under the above policy

throughout the term of 10 years and in return he got Maturity Payment only Rs.15907/.

j) He wondered how Maturity Payment could be so meagre amount when Sum Assured of the

policy is one lakh. Moreover the policy is with profit policy, so Maturity amount should be

atleast more than one lakh.

k) He expressed, he had been deprived by LIC.

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

grievance.



Insurer’s Argument: SCN not yet received. However, CRM Deptt. of Eastern Zonal Office of

LIC in reply against the complaint dated 09/06/2018 informed that Maturity Payment had been

settled correctly, taking into account Maturity Sum Assured Rs.12236/ and loyalty addition Rs.

3671/.




ix) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P form, v) Copy of policy

bond(part).

21) Result of hearing with both parties (Observations & Conclusion): Complainant’s Submissions: The complainant was absent in the Hearing. Insurer’s Submissions: The representative of the Insurer submitted the followings: That the “Jeevan Saral” policy is basically a high life risk cover policy with low maturity return, specially at higher age. As the complainant was 60 years of age at the time of introduction of the policy, maturity sum assured in this policy is only Rs.12236/ although basic death sum assured is Rs.1 lakh. Both are given in policy bond. As per policy conditions, final maturity payment is equal to Maturity Sum Assured + Loyalty Addition = Rs.12236/ + Rs.3671/ (rate of L.A for 10 years duration is Rs.300 per 1000 Sum Assured) = Rs.15907/ and payment also made Rs.15907/. So, payment made absolutely as per rules without any discrepancies and as such, the Insurer appealed for dismissal of the complaint. AWARD



the course of hearing, it is observed that the maturity payment calculation made by the

Insurer is absolutely justified & it is as per the terms and conditions of the policy.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN


SIKKIM AND A&N ISLANDS




CASE of SUBRATA MUKHERJEE V/S LIC of INDIA




Complainant

Mr. SUBRATA MUKHERJEE

GARBATI (RAJ RAJESWARI TALA),

P.O- BURASHIB TALA, HOOGHLY,

WEST BENGAL -712105

MOBILE NO. - 9748611992

2. Policy No:





Mr. SUBRATA MUKHERJEE

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 11/07/2018 8. Nature of complaint Less Settlement of Maturity Claim – 13-(1)-(i) 9. Amount of Claim Rs.53188/






For the Complainant COMPLAINANT WAS ABSENT. For the insurer MR. GOUTAM NANDAN



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

Term /PPT

1ST Comp to Ins Co

496047793 Mr. Subrata Mukherjee

Ulip 26/02/2010 Rs. 20000/

08/03

18/04/2018


l) That a substantial less payment has been made in Maturity settlement of the captioned

policy. The complainant has paid total premium Rs.60000/ and in return he has got Rs.

53188/ as Maturity Payment which is less by Rs.6812/ from that of total premium invested in

this policy.

m) That, at the time of introduction of the policy, LIC assured to pay Maturity Value on the

basis of highest NAV throughout the term of the policy but their assurance and the actual

payment differs in such a big manner that the policy holder has to suffer a great loss.

n) According to complainant, it is a clear case of cheating by LIC.

o) That he requested LIC, Chinsurah Branch Manager for providing a clear statement showing

the details of calculation how maturity payment arrived at but his request was not complied

by LIC till date.


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


Insurer’s Argument: As per SCN dated 28/11/2018, the Insurer argued the following:

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



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



k) That the rate of different charges to be deducted are given in “Conditions and Privileges” of

policy bond.

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


highest NAV is on the date of maturity which is Rs.15.4846/.

m) That the maturity payment amount calculated by multiplying the “net number of unit as on

date of maturity” with highest NAV ie 3434.879X15.4846= Rs.53188/

n) That the policy holder aged 59 years at the time of taking the policy enjoyed the life cover for

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

policy sum assured + policy holder’s fund value.

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

maturity.

p) That, they confirmed their maturity calculation absolutely O.K and as such demanded

dismissal of the complaint.


Dispute over Less Payment of Maturity Claim under rule – 13 (1) (i).


x) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P form, v) Copy of policy

bond(part) and vi) SCN


Complainant’s Submission: The complainant was absent in Hearing.


The representative of the Insurer repeated all the points as mentioned in their SCN. They

appealed to the forum to dismiss the complaint as they have no flaws in the maturity payment

calculation.

AWARD



the course of hearing, it is observed, after necessary verification that the maturity payment

calculation made by the Insurer is absolutely justified & it is as per the terms and conditions

of the policy.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN


SIKKIM AND UT OF A & N ISLAND




CASE of AJAY KUMAR CHATTOPADHYAY V/S LIC of INDIA




Complainant

AJAY KUMAR CHATTOPADHYAY

5, CHOUDHURY PARA LANE, FLAT NUMBER-103,

P.O- SANTRAGACHI, HOWRAH

WEST BENGAL- 711104

2. Policy No:


497712420 & 497711458 DETAILS ARE IN THE TABLE



Mr. AJAY KUMAR CHATTOPADHYAY & MRS. JHARNA

CHATTERJEE

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 31/05/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Received Rs.37273/ + Rs.43492/


11. Amount of relief sought Rs.189235/ (As per P form)


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


For the Complainant Mr. AJAY KUMAR CHATTOPADHYAY For the insurer Mr. GOUTAM NANDAN




Term /PPT

1ST Comp to Ins Co

497712420 497711458

Ajay Kr. Chattopad Jharna Chatterjee

ULIP ‘’

24/03/2010 15/03/2010

Rs.40000/ Rs.40000/

08/01 08/01

10/05/2018


r) That, LIC, Howrah City Branch-1 settled Maturity claim of the above Ulip policies

substantially less, only Rs.37273/ & Rs.43492/ after 8 years against single premium of

Rs40000/.

s) That, the agent at the time of introduction of the policies assured an expected return of

Rs.190000/ in 8 years but LIC returned only Rs.765/ as gain in 8 years, taking into account

both policies.

t) That as per terms and conditions of the policy, maturity payment will be made on the basis

of highest NAV recorded either in first 7 policy years or on the date of maturity whichever is

higher.

u) That, he appealed to LIC, Howrah City Branch-1 to reconcile the actual maturity payment

made in the light of the conditions stated in point (c), but no reply yet received from LIC.




Insurer’s argument: SCN not yet received. So, the view of LIC could not be furnished.




xi) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form, v) Copy of policy bond.




added that he was not informed anything by LIC about the fund growth in the last eight years and

questioned “why LIC did not inform about negative growth”. Had he been informed time to time,

he could have withdrawn the money and transfer it to Bank where he could have enjoyed senior

citizen interest rate. He appealed to this office for considering additional payment to make good his

financial loss.


The representative of the Insurer argued the following:

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

policy in the sense that the maturity return is subject to market risk and the investment

risk to be borne by the policy holder as per terms and conditions of the policy.

r) That the Policy Holder’s Fund Value is subject to deduction of different charges time to

time as mentioned in policy bond like fund management charge, policy administration

charge, premium allocation charge, mortality charge and other charges.

s) That the rate of different charges to be deducted are given in the “Conditions and

Privileges” of policy bond.

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

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

in this case, the NAV on the date of maturity is the highest which is Rs.15.3283/ in case of

policy number 497712420. The net number of available units on the date of maturity

after all deductions in this policy was 2431.633. So, maturity value calculated to

2431.633x15.3283 = Rs.37273/. In the same way maturity value calculated for policy

number 497711458 to Rs.43492/ taking highest NAV Rs.15.4236 on the date of maturity

and net number of units 2819.838

u) That the policy holders aged 60 years & 55 years at the time of taking the policy enjoyed

the life cover for Rs.50000/ for 8 years and in case of any unfortunate incident, his or her

nominee would have received an amount which is equal to policy sum assured + policy

holder’s fund value.

v) That both the policy holders will enjoy risk cover for another 2 years for Rs.50000/ even

after the date of maturity.

w) The representative of the Insurer also demanded their maturity calculation as absolutely

O.K and as such appealed for dismissal of the complaint.

AWARD



hearing, it is observed that the maturity payment calculations made by the Insurer is justified

& it is as per the terms and conditions of the policy.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN



PROCEEDINGS BEFORE

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


OMBUDSMAN – P. K. RATH CASE of ARUN KUMAR GANGULY V/S LIC of INDIA COMPLAINT REF: NO: 1) KOL-L-029-1819-0533



Complainant

Mr ARUN KUMAR GANGULY

161/16, G. T. ROAD, BAIDYABATI, HOOGHLY

WEST BENGAL - 712222

MOBILE NO. -8697821741

2. Policy No:





MR. ARUN KUMAR GANGULY

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 26/09/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs.1346/


11. Amount of relief sought Rs.1346/ + Interest


Insurance Ombudsman Rules’ 2017 13 (1) (f)


For the Complainant Mr. ARUN KUMAR GANGULY For the insurer Smt. MOHUA BHATTACHARYA, Mgr. CRM




PLAN & TERM

1ST Comp to Ins Co

495686348 Mr. Arun Kumar Ganguly

171 28/03/2013 ------------ 171-5

23/05/2018


a) That, in the Maturity Intimation dated 01/12/2017, maturity payment to be made shown

Rs.134628/ but LIC finally paid Rs.133282/ without giving any explanation.

b) That, he also came to know from his Banker about the deduction of Rs.1346/ from his

Maturity Benefit.

c) That, he wrote a letter to the Zonal Manager of LIC, Eastern Zone on 25/05/2018 to know

the reason behind deduction of Rs.1346/ but no response received from LIC.


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


Insurers’ argument: SCN not yet received. So, Insurer’s view can’t be furnished.




i) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form,




however informed about receiving one letter very recently from Insurer wherein deduction of I.T @

1% of Maturity Value has been shown as the reason behind less payment of Maturity Claim by

Rs.1346/. The complainant questioned “why I.T deducted without any intimation to the policy

holder”. He informed that his total income does not attract Income Tax as per I.T laws and had he

been informed by the Insurer about deduction of I.T, he could have deposited 15(H) form to avoid

I.T deduction but the Insurer deprived him the opportunity to deposit 15(H) from.


The representative of the Insurer mentioned about issuing the letter dated 11/02/2020, addressed to

the complainant and said that deduction of I.T @ 1% of total Maturity Payment was the reason

behind less payment of maturity claim by Rs.1346/. In the question of sending intimation to the

complainant about I.T deduction prior to deduction of tax, the Insurer replied ‘NO’. The Insurer

appealed for dismissal of the complainant as no less payment actually made.

AWARD



hearing, it is observed that the Insurance Company although deducted Income Tax from

Maturity Payment as per rules but without any prior intimation to the complainant that

lead to misunderstanding of less payment. Since no discrepancies observed in maturity

payment calculation, the complaint of ‘less payment’ is dismissed with the advice to the

Insurer to issue prior intimation of tax deduction to the policy holder in each and every

case in all future payment and also to issue form(16) to the complainant if not already

done.

Hence, the complaint is treated as closed without any further reference.

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

S/d

P. K. RATH

INSURANCE OMBUDSMAN

FOR THE STATES OF WESTBENGAL, SIKKIM and A&N ISLANDS




CASE of KALIDAS MONDAL V/S LIC of INDIA




Complainant

Mr. KALIDAS MONDAL

3, INDRANI HOUSING SOCIETY, RASHMONI ROAD,

RAILWAY GATE NO.-8, P.O- SODEPUR, KOLKATA

WEST BENGAL, MOBILE NO. -9477258488

2. Policy No:





MR. KALIDAS MONDAL

SELF


5. Date of Repudiation Not Applicable 6. Reason for repudiation Not Applicable 7. Date of receipt of the Complaint 10/05/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs. 65000/(SUM ASSURED)


11. Amount of relief sought FULL S.A + ROYALTY




For the Complainant Mr. Kalidas Mondal For the insurer Mr. Goutam Bishnu, A.O CRM




Term /PPT

1ST Comp to Ins Co

428283636 Mr. Kalidas Mondal ULIP 15/03/2010 Rs.50000/ 08/01

11/04/2018


v) That, LIC, Sodepur Branch settled Maturity claim of the above Ulip policy substantially

less, only Rs.39735/ after 8 years against invested premium amount Rs.50000/.

w) That, the Maturity amount is less than the invested amount by Rs.11265/.

x) That the BSE sensex at the time of introduction of the policy was 17164 and at the time of

maturity was 33685which is almost double but still the maturity return why so poor?

y) That he did not receive any reply neither from Sr.DM nor Chief Manager of Sodepur Branch

for a long time.




Insurers’ argument: SCN not yet received. However, Manager CRM, KSDO in their reply

dated 14/08/2018 against the complaint, explained in detail how maturity calculation finalised.




xii) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form, v) Copy of policy bond,

and vi) Reply of the Insurer.



The complainant repeated all the points as mentioned in his complaint letter dated 10/05/2018.

He also added that his agent never told him about life risk coverage under this policy. When the

representative of the Insurer informed him about the extended risk cover for another 2 years even

after the date of maturity, the complainant expressed his unwillingness to enjoy risk cover for

another 2 years, instead he demanded higher maturity return.


The representative of the Insurer argued the following points:

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



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



z) That the rate of different charges to be deducted are given in the “Conditions and Privileges”

of policy bond.

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


highest NAV is on the date of maturity which is Rs.15.4236/ (in first 7 year, highest NAV was

Rs.14.35/)

bb) That the maturity payment calculated by multiplying the “net number of unit as on date of

maturity” with highest NAV ie 2576.2467(net no. of unit) X 15.4236= Rs.39734.99/.

cc) That the policy holder aged 63 years at the time of taking of the policy enjoyed the life risk

cover for Rs.65000/ for 8 years and in case of any unfortunate incident, his nominee would

have received an amount which is equal to policy sum assured + policy holder’s fund value.

dd) That the policy holder will enjoy risk cover for another 2 years for Rs.65000/ after the date of

maturity.

ee) The representative of the Insurer also demanded that their maturity calculation was absolutely

O.K and as such appealed for dismissal of the complaint.

AWARD



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

made by the Insurer is absolutely justified & it is as per the terms and conditions of the policy.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN






CASE of ALO DAS V/S LIC of INDIA




Complainant

SMT ALO DAS

89, PIRPUKUR ROAD, BANSDRONI, KOLKATA

WEST BENGAL -700070

MOBILE NO. -

2. Policy No:





ALO DAS

SELF



rule – 13-(1)-(i) 9. Amount of Claim Rs50340/






For the Complainant ABSENT For the insurer MOHUA BHATTACHARYA, MGR CRM

SATHI NAG, A.O CRM 15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020


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

Term /PPT

1ST Comp to Ins Co

577846594 ALO DAS ULIP 31/03/2010 Rs.20000 08/03

31/05/2018

The Complainant Submissions:-

p) That a substantial less payment has been made in Maturity settlement of the captioned

policy. The complainant has paid total premium Rs.60000/ and in return she has got Rs.

50304/ as Maturity Payment which is less by Rs.9696/ from that of total premium invested in

this policy.

q) That, at the time of introduction of the policy, LIC assured to pay Maturity Value on the

basis of highest NAV recorded but LIC’s assurance and the actual payment differs so widely

that the policy holder had to suffer a great loss.

r) That the complainant is an old retired lady and wants to know the reason behind such less

payment.




Insurer’s Argument: SCN not yet received. So the view of the Insurer could not put up.




xiii) Complaint letter, ii) P form, iii) Copy of policy bond(part).


Complainant’s Submissions: The complainant was absent in the Hearing without giving any

intimation to the Insurance Ombudsman Office.

Insurer’s Submission: The representative of the Insurer argued the following points:

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



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



hh) That the rate of different charges to be deducted are given in the “Conditions and Privileges”

of policy bond.

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


highest NAV is on the date of maturity which is Rs.15.4619/(in first 7 policy year, highest

NAV was Rs.14.5278/)

jj) That the maturity payment calculated by multiplying the “net number of unit as on date of

maturity” with highest NAV ie 3253.388(net no. of unit) X 15.4619= Rs.50303.55/.

kk) That the policy holder aged 60 years at the time of taking the policy, enjoyed the life risk cover

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

received an amount which is equal to policy sum assured + policy holder’s fund value.

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

maturity.

mm) That a letter already sent to the complainant on 11/02/2020 informing her the reason for less

payment duly supported by fund summary.

nn) The representative of the Insurer demanded their maturity calculation as absolutely O.K and

appealed for dismissal of the complaint.

AWARD



the course of hearing, it is observed that the maturity payment calculation made by the

Insurer is absolutely justified & it is as per the terms and conditions of the policy. Moreover, a

letter informing the reason for less payment, duly supported by fund summary already sent to

the complainant on 11/02/2020.


complainant.



S/d

P. K. RATH

INSURANCE OMBUDSMAN


SIKKIM AND A & N ISLANDS

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