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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.
COMPLAINT NO: LCK-L-006-1920-0176 Order No. IO/LCK/A/LI/ 0431/2019-20
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
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Chandra Datta..……....………………………………………………………. Complainant
V/S
L.I.C. of India……..…...……………..……………………..………..…..………...Respondent
COMPLAINT NO: LCK-L-029-1819-0493 Order No. IO/LCK/A/LI/0377/2019-20
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
3. Name of the insured
Name of the policyholder
Mr. Chandra Datta
Mr. Chandra Datta
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4. Name of the insurer L.I.C. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
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.
14. Representation at the hearing
c) For the Complainant Mr. Chandra Datta
d) For the insurer Shri P. K Dixit
15. Complaint how disposed Dismissed
16. Date of Award/Order 18.02.2020
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.
21. I have heard the complainant as well as respondent representative and perused the record.
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
COMPLAINT NO: LCK-L-029-1819-0493 Order No. IO/LCK/A/LI/ /2019-20
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
COMPLAINT NO: LCK-L-029-1819-0493 Order No. IO/LCK/A/LI/0377/2019-20
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:-
28. Complaint is dismissed.
29. Let the copy of award be given to both the parties.
Date: 18.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Lal Sahab Yadav………………..……....………………………….………. Complainant
V/S
Bajaj Alianz Life Insurance Co. Ltd……....................…………………………Respondent
COMPLAINT NO: LCK-L-006-1819-0001 Order No. IO/LCK/A/LI/ 0387/2019-20
1. Name & Address of the Complainant Mr. Lal Sahab Yadav,
Chota Baghara,
Allahabad
2. Policy No:
Type of Policy
Duration of policy/DOC
0078806501
-
Matured
3. Name of the insured
Name of the policyholder
Mr.Lal Sahab Yadav
Mr. Lal Sahab Yadav
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4. Name of the insurer Bajaj Alianz Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 03.04.2018
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
14. Representation at the hearing
a) For the Complainant Absent
b) For the insurer Mr. Amit Khanna
15. Complaint how disposed Dismissed
16. Date of Award/Order 20.02.2020
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
COMPLAINT NO: LCK-L-006-1819-0001 Order No. IO/LCK/A/LI/ /2019-20
Brief Facts of the Case:-
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
COMPLAINT NO: LCK-L-006-1819-0001 Order No. IO/LCK/A/LI/ 0387/2019-20
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:-
24. Complaint is dismissed.
25. Let the copy of award be given to both the parties.
Date: 20.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, STATE OF UP
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Dr. Dingur Mal Mishra…………. ………………..……....………………. Complainant
V/S
Life Insurance Corp. of India…………………....…....…………………………Respondent
COMPLAINT NO: LCK-L-029-1819-0457 Order No. IO/LCK/A/LI/ 0354/2019-20
1. Name & Address of the Complainant Dr. Dingur Mal Mishra
Civil Lines
Sultanpur
2. Policy No:
Type of Policy
Duration of policy/DOC
236794052
Wealth Plus
08.05.2010
3. Name of the insured
Name of the policyholder
Dr. Dingur Mal Mishra
Dr. Dingur Mal Mishra
4. Name of the insurer Life Insurance Corp. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 06.11.2018
8. Nature of complaint Maturity Amount less paid
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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 14.02.2020 , 10.30 am at Lucknow
14. Representation at the hearing
a) For the Complainant Absent
b) For the insurer Mr. Heera Singh
15. Complaint how disposed Dismissed
16. Date of Award/Order 14.02.2020
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
COMPLAINT NO: LCK-L-029-1819-0457 Order No. IO/LCK/A/LI/ /2019-20
Brief Facts of the Case:-
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.
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. 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.
COMPLAINT NO: LCK-L-029-1819-0457 Order No. IO/LCK/A/LI/ /2019-20
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:-
24. Complaint is dismissed.
25. Let the copies of award be given to both the parties.
Date: 14.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mrs. Urmila Tripathi..……...............................................………………. Complainant
V/S
L.I.C. of India……..…...……………..………………….…..………..…..………...Respondent
COMPLAINT NO: LCK-L-029-1819-0494 Order No. IO/LCK/A/LI/ 0384/2019-20
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
3. Name of the insured
Name of the policyholder
Mrs. Urmila Tripathi
Mrs. Urmila Tripathi
4. Name of the insurer L.I.C. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 03.12.2018
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.
14. Representation at the hearing
e) For the Complainant Shri Chandra Datta
f) For the insurer Shri P K Dixit
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15. Complaint how disposed Dismissed
16. Date of Award/Order 18.02.2020
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.
COMPLAINT NO: LCK-L-029-1819-0494 Order No. IO/LCK/A/LI/ /2019-20
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.
21. I have heard the complainant as well as respondent representative and perused the record.
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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
COMPLAINT NO: LCK-L-029-1819-0494 Order No. IO/LCK/A/LI/ /2019-20
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.
25. No doubt policy was issued under the approval of IRDA. As per the circular no.
ACTL/1934/4 of the LIC the plan in question was issued under the table no. 165 wherein the
basic core factor is that it provides to the policy holder highly covered with a smooth return,
Liquidity and lots of flexibility. It is also provided in the plan in conventional products premium
rates are given per 1000/- sum assured for different entry ages and terms. Under this product
death cover will be same irrespective of at entry and term but the sum payable at maturity will
differ for different entry ages and terms. This policy also provides for loyalty additions. Loyalty
additions will be declared after the policy has been in full form for at least 10 years. On Maturity
the life insured will get the maturity sum assured plus loyalty addition if any. 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
COMPLAINT NO: LCK-L-029-1819-0494 Order No. IO/LCK/A/LI/0384/2019-20
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.
26. Accordingly I am of the view that the payment of Rs. 185200/- was offered by the
respondent LIC to the complainant in accordance with the terms and conditions of the policy
bond which is justifiable. It doesn‟t require any interference. Accordingly complaint is liable to
be dismissed.
Order:-
27. Complaint is dismissed.
28. Let the copy of award be given to both the parties.
Date: 18.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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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. Anoop Kumar Sinha…………. ………………..……....………………. Complainant
V/S
Life Insurance Corp. of India…………………....…....…………………………Respondent
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
Duration of policy/DOC
214735077
Jeevan Nidhi
11.12.2004
3. Name of the insured
Name of the policyholder
Mr. Anoop Kumar Sinha
Mr. Anoop Kumar Sinha
4. Name of the insurer Life Insurance Corp. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 01.01.2019
8. Nature of complaint Maturity not settled
9. Amount of Claim Pension Plan
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 14.02.2020 , 10.30 am at Lucknow
14. Representation at the hearing
a) For the Complainant Mr. Anoop Kumar Sinha
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e19
b) For the insurer Mr. Rishi Mishra
15. Complaint how disposed Dismissed as settle
16. Date of Award/Order 14.02.2020
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.
COMPLAINT NO: LCK-L-029-1819-0528 Order No. IO/LCK/A/LI/ /2019-20
Brief Facts of the Case:-
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.
20. The complainant has filed a complaint letter, annexure VI A, correspondence with
respondent while respondent has filed SCN with enclosures.
21. I have heard the complainant as well as respondent representative and perused the record.
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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.
25. Let the copy of award be given to both the parties.
Date: 14.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
Pag
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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. Radhey Shyam Agarwal…… ………………..……....………………. Complainant
V/S
Life Insurance Corp. of India…………………....…....…………………………Respondent
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
Duration of policy/DOC
216844235
Jeevan Saral
05.11.2008
3. Name of the insured
Name of the policyholder
Mr. Radhey Shyam Agarwal
Mr. Radhey Shyam Agarwal
4. Name of the insurer Life Insurance Corp. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 21.01.2019
8. Nature of complaint Maturity Amount less paid
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 14.02.2020 , 10.30 am at Lucknow
14. Representation at the hearing
a) For the Complainant Mr. Radhey Shyam Agarwal
b) For the insurer Mr. Rishi Mishra
15. Complaint how disposed Dismissed
16. Date of Award/Order 14.02.2020
17. Mr. Radhey Shyam Agarwal (Complainant) has filed a complaint against Life Insurance
Corp. of India (Respondent) alleging less amount paid on maturity.
Pag
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MS
COMPLAINT NO:LCK-L-029-1819-0566 Order No. IO/LCK/A/LI/ /2019-20
Brief Facts of the Case:-
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.
20. The complainant has filed a complaint letter, annexure VI A, correspondence with
respondent while respondent has filed SCN with enclosures.
21. I have heard the complainant as well as respondent representative and perused the record.
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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:-
24. Complaint is dismissed.
25. Let the copy of award be given to both the parties.
Date: 14.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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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. Om Prakash Kapoor…… ………………..……...........………………. Complainant
V/S
Life Insurance Corp. of India…………………....…....…………………………Respondent
COMPLAINT NO: LCK-L-029-1819-0617 Order No. IO/LCK/A/LI/ 0383/2019-20
1. Name & Address of the Complainant Mr. Om Prakash Kapoor
Pheel Khana
Kanpur
2. Policy No:
Type of Policy
Duration of policy/DOC
234713489
Jeevan Saral
28.12.2008
3. Name of the insured
Name of the policyholder
Mr. Om Prakash Kapoor
Mr. Om Prakash Kapoor
4. Name of the insurer Life Insurance Corp. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 22.02.2019
8. Nature of complaint Maturity Amount less paid
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 18.02.2020 , 10.30 am at Lucknow
14. Representation at the hearing
a) For the Complainant Mr Vikas Kapoor
b) For the insurer Sri Pramod Kumar Dixit
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15. Complaint how disposed Dismissed
16. Date of Award/Order 18.02.2020
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.
COMPLAINT NO: LCK-L-029-1819-0617 Order No. IO/LCK/A/LI/ /2019-20
Brief Facts of the Case:-
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.
20. The complainant has filed a complaint letter, annexure VI A, correspondence with
respondent while respondent has filed SCN with enclosures.
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21. I have heard the complainant as well as respondent representative and perused the record.
Findings:-
22. Complainant has taken the LIC Jeevan Saral (with profit) policy on 28.12.2008. Instalment
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
COMPLAINT NO: LCK-L-029-1819-0617 Order No. IO/LCK/A/LI/ /2019-20
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/-.
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. 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
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.
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
Pag
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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 takes 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 3 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
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
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. 49739/- was offered by the
respondent LIC to the complainant in accordance with the terms and conditions of the policy
bond which is justifiable. It doesn‟t require any interference. Accordingly complaint is liable to
be dismissed.
Order:-
28. Complaint is dismissed.
29. Let the copy of award be given to both the parties.
Date: 18.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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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. Sunder Lal…………. ………………..……………….…....………………. Complainant
V/S
Life Insurance Corp. of India …….…..…....……………………………..…………Respondent
COMPLAINT NO: LCK-L-029-1819-0618 Order No. IO/LCK/A/LI/ 0378/2019-20
1. Name & Address of the Complainant Mr. Sunder Lal
Rawatpur
Kanpur
2. Policy No:
Type of Policy
Duration of policy/DOC
234258911
Jeevan Saral
26.12.2008
3. Name of the insured
Name of the policyholder
Mr. Sunder Lal
Mr. Sunder Lal
4. Name of the insurer Life Insurance Corp. of India
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 20.02.2019
8. Nature of complaint Amount less paid on maturity
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 18.02.2020 , 10.30 am at Lucknow
14. Representation at the hearing
a) For the Complainant Mr. Sunder Lal
b) For the insurer Shri P.K Dixit
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15. Complaint how disposed Dismissed
16. Date of Award/Order 18.02.2020
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
COMPLAINT NO: LCK-L-029-1819-0618 Order No. IO/LCK/A/LI/ /2019-20
Brief Facts of the Case:-
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.
20. The complainant has filed a complaint letter, annexure VI A, correspondence with respondent
while respondent has filed SCN with enclosures.
21. I have heard the complainant as well as respondent representative and perused the record.
Findings:-
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22. Complainant has taken the LIC Jeevan Saral (with profit) policy on 26.12.2008. Instalment
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.
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. 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
COMPLAINT NO: LCK-L-029-1819-0618 Order No. IO/LCK/A/LI/ 0378/2019-20
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
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.
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.
Pag
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26. The only point to be looked into is as to whether the complainant takes 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 3.75 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 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
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
COMPLAINT NO: LCK-L-029-1819-0618 Order No. IO/LCK/A/LI/ 0378 /2019-20
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. 121320/- was offered by the
respondent LIC to the complainant in accordance with the terms and conditions of the policy
bond which is justifiable. It doesn‟t require any interference. Accordingly complaint is liable to
be dismissed.
Order:-
28. Complaint is dismissed.
29. Let the copy of award be given to both the parties.
Date: 18.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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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. Anil Kapur…………. ……………………………..…..……....………………. Complainant
V/S
Star Union Dai-ichi- Life Insurance Co. Ltd…..…....…………………………Respondent
COMPLAINT NO: LCK-L-045-1819-0260 Order No. IO/LCK/A/LI/0344/2019-20
1. Name & Address of the Complainant Mr. Anil Kapur
Hazratganj
Lucknow
2. Policy No:
Type of Policy
Duration of policy/DOC
00645131
Dhan Suraksha (Unit Linked)
24.05.2013
3. Name of the insured
Name of the policyholder
Mr. Anil Kapur
Mr. Anil Kapur
4. Name of the insurer Star Union Dai-ichi- Life Insurance Co. Ltd.
5. Date of Repudiation/Rejection -
6. Reason for repudiation/Rejection -
7. Date of receipt of the Complaint 31.07.2018
8. Nature of complaint Amount less paid
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 11.02.2020 , 10.30 am at Lucknow
14. Representation at the hearing
a) For the Complainant Mr. Anil Kapur
b) For the insurer Anis Aslam Kazi
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15. Complaint how disposed Dismissed
16. Date of Award/Order 11.02.2020
17. Mr. Anil Kapur (Complainant) has filed a complaint against SBI Life Insurance Co. Ltd.
(Respondent) alleging less amount paid on maturity.
MS
COMPLAINT NO: LCK-L-045-1819-0260 Order No. IO/LCK/A/LI/ 0344/2019-20
Brief Facts of the Case:-
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
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20. The complainant has filed a complaint letter, annexure VI A, correspondence with
respondent while respondent has filed SCN with enclosures.
21. I have heard the complainant as well as respondent representative and perused the record.
Findings:-
22. 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
COMPLAINT NO: LCK-L-045-1819-0260 Order No. IO/LCK/A/LI/ 0344/2019-20
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:-
23. Complaint is dismissed.
24. Let copy of award be given to both the parties.
Date: 11.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
Pag
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PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Ram Prakash ………………………………....……....………………. Complainant
VS
Life Insurance Corporation of India…………………………………………...Respondent
COMPLAINT NO: LCK-L-029-1819-0341 Order No. IO/LCK/A/LI/0317/2019-20
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 /
Name of the policyholder
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
7. Date of receipt of the Complaint 03.10.2018
8. Nature of complaint Maturity not received
9. Amount of Claim Maturity Value 65000/-
10. Date of Partial Settlement -
11. Amount of relief sought Maturity Value
12. Complaint registered under Rule Rule No.13(1)(f)of Insurance Ombudsman
Rule 2017
13. Date of hearing/place 04.02.2020 at 10.15 A.M.
Pag
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14. Representation at the hearing
a) For the Complainant Mr. Ram Prakash
b) For the insurer Mr. Rishi Misra
15. Complaint how disposed Closed
16. Date of Award/Order 04.02.2020
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
COMPLAINT NO: LCK-L-029-1819-0341 Order No. IO/LCK/A/LI/ 0317 /2019-20
Brief Facts of the Case:-
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
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20. The complainants have filed a complaint letter, Annexure VI A along with other relevant
papers while respondent has filed SCN with enclosures.
21. I have heard the complainant as well as respondent representative and perused the record.
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.
COMPLAINT NO: LCK-L-029-1819-0341 Order No. IO/LCK/A/LI/ 0317/2019-20
Order:-
23. Complaint is closed.
24. Let copy of award be given to both the parties.
Date: 04.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Shiv Singh ………………………………....……....………………………. Complainant
VS
Life Insurance Corporation of India…………………………………………...Respondent
COMPLAINT NO: LCK-L-029-1920-0181 Order No. IO/LCK/A/LI/ 0422/2019-20
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
3. Name of the insured /
Name of the policyholder
Mr. Shiv Singh
Mr. Shiv Singh
4. Name of the insurer Life Insurance Corporation of India
5. Date of Repudiation/Rejection N/A
6. Reason for repudiation/Rejection N/A
7. Date of receipt of the Complaint 03.07.2018
8. Nature of complaint Maturity not received
9. Amount of Claim Maturity Value 410208/-with interest
10. Date of Partial Settlement -
Pag
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11. Amount of relief sought Maturity Value
12. Complaint registered under Rule Rule No.13(1)(f)of Insurance Ombudsman
Rule 2017
13. Date of hearing/place 27.02.2020 at 10.15 A.M.
14. Representation at the hearing
a) For the Complainant Mr. Shiv Singh
b) For the insurer Ramakanti
15. Complaint how disposed Allowed
16. Date of Award/Order 27.02.2020
YKS
COMPLAINT NO: LCK-L-029-1920-0181 Order No. IO/LCK/A/LI/ /2019-20
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.
Brief Facts of the Case:-
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.
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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.
21. I have heard the complainant as well as respondent representative and perused the record.
COMPLAINT NO: LCK-L-029-1920-0181 Order No. IO/LCK/A/LI/ 0422/2019-20
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.
4 235268853 Surrendered on 07.11.2013 for Rs
48166/- Lying in stale
191-20-01 3354.871 27.08.2010 27.08.2020 Growth
0/50000
Single Prem.
5 234613738 Surrendered on 13.07.2012 for Rs
64182/-
191-20-01 4744.392 29.09.2008 29.09.2028 Growth
0/50000
Single Prem.
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6 235268855 Surrendered on 26.10.2013 for Rs
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:-
COMPLAINT NO: LCK-L-029-1920-0181 Order No. IO/LCK/A/LI/ 0422/2019-20
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
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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
COMPLAINT NO: LCK-L-029-1920-0181 Order No. IO/LCK/A/LI/0422/2019-20
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.
COMPLAINT NO: LCK-L-029-1920-0181 Order No. IO/LCK/A/LI/ 0422/2019-20
32. Let the copy of award be given to both the parties.
Date: 27.02.2020 Justice Anil Kumar Srivastava
Place: Lucknow (Insurance Ombudsman)
Pag
e44
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Suresh Kumar Gupta………………....…….....................………………. Complainant
VS
Life Insurance Corporation of India…………………………..…………………...Respondent
COMPLAINT NO: LCK-L-029-1819-0591 Order No. IO/LCK/A/LI/ 0386/2019-20
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
3. Name of the insured /
Name of the policyholder
Mr. Suresh Kumar Gupta
Mr. Suresh Kumar Gupta
4. Name of the insurer Life Insurance Corporation of India
5. Date of Repudiation/Rejection N/A
6. Reason for repudiation/Rejection N/A
7. Date of receipt of the Complaint 04.02.2019
8. Nature of complaint Less Maturity payment
9. Amount of Claim 55000/-
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
13. Date of hearing/place 20.02.2020 at 10.15 A.M.
Pag
e45
14. Representation at the hearing
a) For the Complainant Mr. Suresh Kumar Gupta
b) For the insurer Mr. Rishi Misra
15. Complaint how disposed Dismissed
16. Date of Award/Order 20.02.2020
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.
COMPLAINT NO: LCK-L-029-1819-0591 Order No. IO/LCK/A/LI/ 0386/2019-20
Brief Facts of the Case:-
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 10 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.
COMPLAINT NO: LCK-L-029-1819-0591 Order No. IO/LCK/A/LI/ 0386/2019-20
20. The complainant has filed a complaint letter along with other relevant papers. But
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 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:-
23. Complaint is dismissed.
24. Let the copy of award be given to both the parties.
Date: 20.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
Pag
e47
PROCEEDINGS BEFORE - THE INSURANCE OMBUDSMAN, LUCKNOW
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
Mr. Suresh Kumar Gupta………………....…….....................………………. Complainant
VS
Life Insurance Corporation of India…………………………..…………………...Respondent
COMPLAINT NO: LCK-L-029-1819-0591 Order No. IO/LCK/A/LI/ 0386/2019-20
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
3. Name of the insured /
Name of the policyholder
Mr. Suresh Kumar Gupta
Mr. Suresh Kumar Gupta
4. Name of the insurer Life Insurance Corporation of India
5. Date of Repudiation/Rejection N/A
6. Reason for repudiation/Rejection N/A
7. Date of receipt of the Complaint 04.02.2019
8. Nature of complaint Less Maturity payment
9. Amount of Claim 55000/-
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
13. Date of hearing/place 20.02.2020 at 10.15 A.M.
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e48
14. Representation at the hearing
a) For the Complainant Mr. Suresh Kumar Gupta
b) For the insurer Mr. Rishi Misra
15. Complaint how disposed Dismissed
16. Date of Award/Order 20.02.2020
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.
COMPLAINT NO: LCK-L-029-1819-0591 Order No. IO/LCK/A/LI/ 0386/2019-20
Brief Facts of the Case:-
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-
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e49
S.B due after 05 years Rs. 10000/-
S.B due after 10 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.
COMPLAINT NO: LCK-L-029-1819-0591 Order No. IO/LCK/A/LI/ 0386 /2019-20
20. The complainant has filed a complaint letter along with other relevant papers. But
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 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:-
23. Complaint is dismissed.
24. Let the copy of award be given to both the parties.
Date: 20.02.2020 (Justice Anil Kumar Srivastava)
Place: Lucknow Insurance Ombudsman
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
14. Representation at the hearing
a) For the Complainant Self
b) For the Respondent
Insurer
Mr K P Ravi Kumar, AO(CRM)
15. Complaint how disposed Allowed
16. Date of Award/Order 07.02.2020
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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF
KARNATAKA
(UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN –NEERJA SHAH
In the Matter of MR. 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
1. Name & Address of the
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:
Commencement of Policy/ Policy
Period/PPT
Mode/Premium Amount
630492512
Life
LIC- Endowment Policy with Profits
28/09/1994
25 Years
Quarterly / ₹. 508/-
3. Name of the Insured
Name of the Policyholder
Mr. R.B. Mirajkar
4. Name of the Respondent Insurer LIC Of India – Dharwad Do
5. Date of Repudiation/ Rejection 08.03.2017
6. Reason for repudiation/ Rejection NIL
7. Date of receipt of Annexure VI-
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
12. Complaint registered under Rule
No
13(1)(c) & (a) of Insurance Ombudsman Rules,
2017
13. Date of hearing/place 08/01/2020 &
29/01/2020 - Bengaluru
14. Representation at the hearing
a) For the Complainant None
b) For the Respondent
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.
18. Cause of Complaint: -
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.
20. The following documents were placed for perusal: -
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
FOR THE STATE OF KARNATAKA
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF
KARNATAKA
(UNDER RULE NO: 16/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN –NEERJA SHAH
In the Matter of MR. 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
1. Name & Address of the
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:
Commencement of Policy/ 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/-
3. Name of the Insured
Name of the Policyholder
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
7. Date of receipt of Annexure VI-
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
12. Complaint registered under Rule
No
13(1)(a) of Insurance Ombudsman Rules, 2017
13. Date of hearing/place 05/02/2020 - Bengaluru
14. Representation at the hearing
a) For the Complainant Self
b) For the Respondent
Insurer
Mrs. Ushashree – Manager Claims
15. Complaint how disposed Allowed
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.
18. Cause of Complaint: -
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.
20. The following documents were placed for perusal: -
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
FOR THE STATE OF KARNATAKA
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
1. Name & Address of the
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.
(UNDER RULE NO: 16(1)/17 OF THE INSURANCE OMBUDSMAN RULE 2017)
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
1. Name & Address of the
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
3. Name of the insured
Name of the policyholder
Dr Mukti Mishra
Dr Mukti Mishra
4. Name of the insurer LIC of India
5. Date of Repudiation/ Rejection ---
6. Reason for Repudiation/ Rejection ---
7. Date of receipt of the Complaint 13.11.2019
8. Nature of complaint Less payment of maturity amount
9. Amount of Claim --
10. Date of Partial Settlement --
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
14. Representation at the hearing
For the Complainant Mr Vishesh Tiwari, Son-in-law
For the insurer Mr Dayal P Bhidwalkar, Manager CRM
15. Complaint how disposed Dismissed
16. Date of Award/Order 14.02.2020
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
1. Name & Address of the
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
Duration of policy/Policy period
371969887
LIC’s Jeevan Anand (with profits)(with
accident benefit)
29.05.2009
3. Name of the insured
Name of the policyholder
Mr Kishor Singh
Mr Kishor Singh
4. Name of the insurer LIC of India
5. Date of Repudiation/ Rejection --
6. Reason for Repudiation/ Rejection --
7. Date of receipt of the Complaint 20.12.2019
8. Nature of complaint Non-payment of premium amount deposited
in policy
9. Amount of Claim
10. Date of Partial Settlement
11. Amount of relief sought --
12. Complaint registered under Rule Rule No. 13(1)(d) Ins. Ombudsman Rule 2017
13. Date of hearing/place 25.02.2020 at Bhopal
14. Representation at the hearing
For the Complainant Mr Kishor Singh Chauhan & Mr Jay Singh
Chauhan, Son
For the insurer Mr Hrishikesh Barori, Admn Officer
15. Complaint how disposed Dismissed
16. Date of Award/Order 25.02.2020
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.
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.
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.
Dated : Feb 25, 2020 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
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
1. Name & Address of the
Complainant
Mr Pramod Singh
Retd DGM, BSNL, C-11, Chetakpuri
Gwalior, Madhya Pradesh
2. Policy No:
Type of Policy
Duration of policy/Policy period
01678916
Kotak Retirement Income Plan without cover
12.08.2009
3. Name of the insured
Name of the policyholder
Mr Pramod Singh
Mr Pramod Singh
4. Name of the insurer Kotak Mahindra Old Mutual Life Insurance
Company Limited
5. Date of Repudiation/ Rejection 18.09.2019
6. Reason for Repudiation/ Rejection Full maturity value not payable, maturity
payout already refunded on 14.08.2019
7. Date of receipt of the Complaint 09.12.2019
8. Nature of complaint Non payment of full amount on maturity
9. Amount of Claim --
10. Date of Partial Settlement --
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
12. Complaint registered under Rule Rule No. 13(1)(d) Ins. Ombudsman Rule 2017
13. Date of hearing/place 25.02.2020 at Bhopal
14. Representation at the hearing
For the Complainant Mr Pramod Singh
For the insurer Ms Shweta Joshi, Manager
15. Complaint how disposed Dismissed
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
16. Date of Award/Order 25.02.2020
of free look period is not possible and hence claim was repudiated.
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.
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.
Dated : Feb 25, 2020 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
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
1. Name & Address of the
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
Duration of policy/Policy period
11942751 (New policy No.40541131)
ICICI Pru Life Stage Pension
29.05.2009
3. Name of the insured
Name of the policyholder
Mr M Z Iqbal Khan
Mr M Z Iqbal Khan
4. Name of the insurer ICICI Prudential Life Insurance Co. Limited
5. Date of Repudiation/ Rejection --
6. Reason for Repudiation/ Rejection --
7. Date of receipt of the Complaint 09.12.2019
8. Nature of complaint Non-payment of maturity amount
9. Amount of Claim --
10. Date of Partial Settlement --
11. Amount of relief sought Rs.8,04,328.25 + 18% interest from date of
maturity (27.05.2019) + compensation
Rs.1,00,000/-
12. Complaint registered under Rule Rule No. 13(1)(d) Ins. Ombudsman Rule 2017
13. Date of hearing/place 26.02.2020 at Bhopal
14. Representation at the hearing
For the Complainant Mr M Z Iqbal Khan
For the insurer Mr Mahesh Baniya, Sr Manager II
15. Complaint how disposed Partially allowed
16. Date of Award/Order 26.02.2020
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.
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.
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.
Let copies of the order be given to both the parties.
Dated : Feb 26, 2020 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Ms Prema Rajiv Gaur …………………………………………….. Complainant
V/s
Max Life Insurance Co. Ltd ……….………….……………………..Respondent
COMPLAINT NO: BHP-L-032-1920-0409 ORDER NO: IO/BHP/A/LI/ 0289 /2019-2020
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
1. Name & Address of the
Complainant
Ms Prema Rajiv Gaur
421, Vishnupuri NX AB Road, Indore,
Madhya Pradesh
2. Policy No:
Type of Policy
Duration of policy/Policy period
876482308
Max Life Guranteed Monthly Income Plan
22.10.2012
3. Name of the insured
Name of the policyholder
Ms Prema Rajiv Gaur
Ms Prema Rajiv Gaur
4. Name of the insurer Max Life Insurance Co.Ltd
5. Date of Repudiation/ Rejection --
6. Reason for Repudiation/ Rejection --
7. Date of receipt of the Complaint 23.09.2019
8. Nature of complaint Non payment of full maturity amount
9. Amount of Claim
10. Date of Partial Settlement
11. Amount of relief sought Surrender value as applicable
12. Complaint registered under Rule Rule No. 13(1)(d) Ins. Ombudsman Rule 2017
13. Date of hearing/place 27.02.2020 at Bhopal
14. Representation at the hearing
For the Complainant Mrs Prema Rajiv Gaur & Mr Rajiv Gaur,
Complainant and her husband
For the insurer Ms Pallavi Tiwari, DM Operations
15. Complaint how disposed Dismissed
16. Date of Award/Order 27.02.2020
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.
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.
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.
Let copies of the order be given to both the parties.
Dated : Feb 27, 2020 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
Mr G D Golandaj …………………………………………….. Complainant
V/s
LIC of India ……………………….………….……………………..Respondent
COMPLAINT NO: BHP-L-029-1920-0473 ORDER NO: IO/BHP/A/LI/ 0292 /2019-2020
1. Name & Address of the
Complainant
Mr G D Golandaj
MPEB Clony, Behind Tagore School
Gadarwara, Narsingpur, Chhindwara
2. Policy No:
Type of Policy
Duration of policy/Policy period
371890203
Jeevan Tarang (With profits)
05.03.2008
3. Name of the insured
Name of the policyholder
Mr G D Golandaj
Mr G D Dolandaj
4. Name of the insurer LIC of India
5. Date of Repudiation/ Rejection --
6. Reason for Repudiation/ Rejection --
7. Date of receipt of the Complaint 30.12.2019
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.
The complainant has filed complaint letter, Annex. VI A and correspondence with respondent,
while respondent have filed SCN with enclosures.
9. Amount of Claim --
10. Date of Partial Settlement --
11. Amount of relief sought 5.5% of sum assured payable as survival
benefit every year
12. Complaint registered under Rule Rule No. 13(1)(d) Ins. Ombudsman Rule 2017
13. Date of hearing/place 28.02.2020 at Bhopal
14. Representation at the hearing
For the Complainant Absent
For the insurer Mr Hrishikesh Barori, Admn Officer
15. Complaint how disposed Dismissed
16. Date of Award/Order 28.02.2020
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.
Let copies of the order be given to both the parties.
Dated : Feb 28, 2020 (G.S.Shrivastava)
Place : Bhopal Insurance Ombudsman
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF ODISHA
(UNDER RULE NO: 16(1)/17of
THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Shri Suresh Chandra Panda
CASE OF (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
Duration of policy/Policy period
583702690
Life
28.03.2009
3. Name of the insured
Name of the policyholder
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
9. Amount of Claim 125000/-
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
14. Representation at the hearing
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.
20) The following documents were placed for perusal.
a) Photo copies of policy documents.
b)Photo copy of representation to Insurer and its reply.
21)Result of hearing with both parties(Observations & Conclusion):- After going through the arguments and
submissions 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
Insurance Ombudsman Rules, 2017:
a. According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with the
Award within 30 days of the receipt of the award and shall intimate the compliance to the
Ombudsman.
b. As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as specified
in the regulations framed under the Insurance Regulatory and Development Authority of India Act
1999, from the date the claim ought to have been settled under the regulations, till the date of
payment of the amount awarded by the Ombudsman
c. As per rule 17 (8) of the said rule, the award of the Insurance Ombudsman shall be binding on the
Insurers.
Dated at Bhubaneswar on 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
THE INSURANCE OMBUDSMAN, STATE OF ODISHA
(UNDER RULE NO: 16(1)/17 of
THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Sri Suresh Chandra Panda
CASE OF Mr. Rajanikanta Samantray Vs. LIC of India Bhubaneswar)
COMPLAINT REF: NO: BHU-L-029-1920-0219
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
Duration of policy/Policy period
588550378
Life
28.02.2009
3. Name of the insured
Name of the policyholder
Mr. Rajanikanta Samantray
----do-----
4. Name of the insurer LIC of India, DO, Bhubaneswar
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint 20.08.2019
8. Nature of complaint Less payment of Maturity claim
9. Amount of Claim Rs.122480/-
10. Date of Partial Settlement NA
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
14. Representation at the hearing
For the Complainant Rajanikanta Samantaray
For the insurer Daitary Naik
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 25.02.2020
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.
18) Cause of Complaint:
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.
b) Insurers’ argument:- The insurer on the other hand pleaded 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.
19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017.
This is a complaint against less payment of maturity claim by Insurer.
20) The following documents were placed for perusal.
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.
22) The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
a. According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with the
Award within 30 days of the receipt of the award and shall intimate the compliance to the
Ombudsman.
b. As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as specified in the
regulations framed under the Insurance Regulatory and Development Authority of India Act 1999, from the
date the claim ought to have been settled under the regulations, till the date of payment of the amount awarded
by the Ombudsman.
c. As per 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
(SURESH CHANDRA PANDA)
INSURANCE OMBUDSMAN
FOR THE STATE OF ODISHA
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, it is awarded that the insurer has to
refund all the premium received by it against the subject policy with interest by
deducting the amount already paid as maturity benefit.
Hence, the complaint is treated as allowed accordingly.
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, STATE OF ODISHA
(UNDER RULE NO: 16(1)/17 of
THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – Sri Suresh Chandra Panda
CASE OF Mr. Nityananda DashVs. LIC of India Bhubaneswar)
COMPLAINT REF: NO: BHU-L-029-1920-0193
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
Duration of policy/Policy period
582712032
Life
28.03.2009
3. Name of the insured
Name of the policyholder
Mr. Nityananda Dash
----do-----
4. Name of the insurer LIC of India, DO, Bhubaneswar
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of admission of the Complaint 20.08.2019
8. Nature of complaint Less payment of Maturity claim
9. Amount of Claim Rs.210000/-
10. Date of Partial Settlement NA
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
14. Representation at the hearing
For the Complainant Nityananda Dash
For the insurer Daitary Naik
15 Complaint how disposed Under Insurance Ombudsman Rule 17.
16 Date of Award/Order 25.02.2020
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
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.
18) Cause of Complaint:
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.
b) Insurers’ argument:- The insurer on the other hand pleaded 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
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.
19) Reason for Registration of Complaint: - scope of the Insurance Ombudsman Rules 2017.
This is a complaint against less settlement of maturity claim by Insurer.
20) The following documents were placed for perusal.
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.
22) The attention of the Complainant and the Insurer is hereby invited to the following provisions of
Insurance Ombudsman Rules, 2017:
a. According to Rule 17(6) of the Insurance Ombudsman Rule 2017, the Insurer shall comply with the
Award within 30 days of the receipt of the award and shall intimate the compliance to the
Ombudsman.
b. As per rule 17(7) the complainant shall be entitled to such interest at a rate per annum as specified in the
regulations framed under the Insurance Regulatory and Development Authority of India Act 1999, from the
date the claim ought to have been settled under the regulations, till the date of payment of the amount awarded
by the Ombudsman.
c. As per 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.
(SURESH CHANDRA PANDA)
INSURANCE OMBUDSMAN
FOR THE STATE OF ODISHA
AWARD
Taking into account the facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, it is awarded that the insurer has to refund
all the premium received by it against the subject policy with interest by deducting the
amount already paid as maturity benefit.
Hence, the complaint is treated as allowed accordingly.
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
1. Name & Address of the
Complainant
Shri R K Mehta
Deputy Zonal Manager, Punjab National
Bank, Zonal Office, Sector 17 B,
Chandigarh
2. Policy No:
Type of Policy
Duration of policy/Policy period
1049172
HDFC life classic assure plus plan
3. Name of the insured
Name of the policyholder
Shri R K Mehta
4. Name of the insurer HDFC Standard Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 04.07.2019
8. Nature of complaint Less maturity value
9. Amount of Claim NA
10. Date of Partial Settlement NA
11. Amount of relief sought Rs 67766/-
12. Complaint registered under
Rule no:
13.1(b)
13. Representation at the hearing
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
16) Brief Facts of the Case:
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/-.
17) Cause of Complaint:
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
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the
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
Duration of policy/Policy period
750276388, 750276362 / 25-06-2009,
Smart Assure Plan [ Unit linked plan]
3. Name of the insured
Name of the policyholder
Mr. Sukhdev Singh Gill & Mrs. Daljit Kaur
Mr. Sukhdev Singh Gill & Mrs. Daljit Kaur
4. Name of the insurer Max Life Insurance Co. Ltd.
5. Date of Repudiation NA
6. Reason for repudiation NA
7. Date of receipt of the Complaint 04-12-2019
8. Nature of complaint Less Maturity Paid
9. Amount of Claim Less Maturity Paid
10. Date of Partial Settlement NA
11. Amount of relief sought NA
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 1 (d)
13. Date of hearing/place 17-02-2020 / Chandigarh
14. Representation at the hearing
For the Complainant Sh. Satinder Bir Singh Gill [Son]
For the insurer Sh. Sanjeev
15. Complaint how disposed Dismissed
16. Date of Award/Order 17.02.2020
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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 17.02.2020
Dr. D. K. Verma
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE
THE INSURANCE OMBUDSMAN, CHANDIGARH
(UNDER INSURANCE OMBUDSMAN RULES, 2017)
INSURANCE OMBUDSMAN-Dr. D.K. VERMA
Case of Mr. Subhash Chandra Vs Max Life Insurance Co. Ltd.
CASE NO-CHD-L-032-1920-1311
1. Name & Address of the
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
Duration of policy/Policy period
412926933 / 31-01-2005
Life maker unit linked investment plan
3. Name of the insured
Name of the policyholder
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
7. Date of receipt of the Complaint 26-11-2019
8. Nature of complaint Maturity amt. due 2015 not received till date
9. Amount of Claim Maturity amount with interest
10. Date of Partial Settlement NA
11. Amount of relief sought NA
12. Complaint registered under
Rule no: Insurance
Ombudsman Rules, 2017
13 1 (d)
13. Date of hearing/place 17-02-2020 / Chandigarh
14. Representation at the hearing
For the Complainant Self
For the insurer Sh. Sanjeev
15. Complaint how disposed Award
16. Date of Award/Order 17.02.2020
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.
Hence, the complaint is treated as closed.
Dated at Chandigarh on 17.02.2020
Dr. D. K. Verma
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
1. Name & Address of the
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:-
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.
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.
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.
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 WEST BENGAL, SIKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
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
1. Name & Address of the
Complainant
Mrs Prity Dey Ghosh
W/o Bappa Ghosh, Panishalahat, Dhowabushua,
PO : Panishalahat, PS : Raiganj,
North Dinajpur, PIN : 733134
2. Policy No:
Policy Type/Duration/Period
01076694
DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
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
7. Date of receipt of the Complaint 17-01-2019
8. Nature of complaint Dispute with regard to partial or total
repudiation of claim.
9. Amount of Claim Could not be ascertained
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs 5,00,000/-
12. Complaint registered under
Insurance Ombudsman Rules’ 2017
13 (1) ( B )
13. Date of hearing/place On 07-02-2020 at SILIGURI
14. Representation at the hearing
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
17) Brief Facts of the Case:
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
The complainant has alleged the following:-
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)
20) The following documents were placed for perusal.
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
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – MR.P.K.RATH
CASE OF MR. TAPAN DAS
V/S
LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0437
AWARD NO: 1) IO/KOL/A/LI/ 0521 /2019-2020
1. Name & Address of the
Complainant
Mr. Tapan Das 24B, Pitamber Ghatak Lane,
Kolkata, West Bengal,
PIN : 700 027.
Mob No.9830248408
2. Policy No:
Policy Type/Duration/Period
495089763
DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
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
7. Date of receipt of the Complaint 01-10-2018
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
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs 14,000/- with interest
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( c )
13. Date of hearing/place 06-02-2020 AT KOLKATA
14. Representation at the hearing
For the Complainant Mr.Tapan Das
For the insurer Ms. Mohua Bhattacharya, Manager (CRM),
LICI, KMDO-I
15 Complaint how disposed BY CONDUCTING HEARING
16 Date of Award/Order 10-02-2020
17) Brief Facts of the Case:
The complainant has alleged the following:-
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.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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)
20) The following documents were placed for perusal.
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.
Hence, the complaint is treated as disposed of.
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
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – MR.P.K.RATH
CASE OF MR. ARABINDA GHOSH
V/S
LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0473
AWARD NO: 1) IO/KOL/A/LI/ 0517 /2019-2020
1. Name & Address of the
Complainant
Mr. Arabinda Ghosh 8, Satish Mukherjee Road,
PO-Kalighat,
Kolkata, West Bengal,
PIN : 700 026.
Mob No.9432276202
2. Policy No:
Policy Type/Duration/Period
578920914
DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
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
7. Date of receipt of the Complaint 14-11-2018
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
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Not quantified
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( e )
13. Date of hearing/place 06-02-2020 AT KOLKATA
14. Representation at the hearing
For the Complainant Unrepresented
For the insurer Ms.Dipu Bala Sarkar, Manager (CRM) &
Mr.Ashesh Ghosh, A.O., LICI, KMDO-II
15 Complaint how disposed BY CONDUCTING HEARING
16 Date of Award/Order 10-02-2020
17) Brief Facts of the Case:
The complainant has alleged the following:-
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.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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.
19) Reason for Registration of Complaint:- Scope of the Insurance Ombudsman Rules 2017 :
Less payment of maturity amount – 13 (1) (e)
20) The following documents were placed for perusal.
iii) Complaint letter ii) P – form
iii) Proposal papers iv) SCN of the Insurance Company.
21) Result of hearing with both parties (Observations & Conclusion):
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:
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, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of SONA GHOSH V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0492
AWARD NO: 1) IO/KOL/A/LI/ 0581 /2019-2020
1. Name & Address of the
Complainant
Mr. SONA GHOSH
AF- 228, RABINDRA PALLI,
SHANKER APARTMENT, 3RD FLOOR,
KRISHNAPUR, KOLKATA, WEST BENGAL-700101
MOBILE NO. - 7003629459
2. Policy No:
Policy Type/Duration/Period
059630472 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
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/
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs. 74879/ + Fixed deposit Interest rate
12. Complaint registered under
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
17) Brief Facts of the Case:
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
The complainant has alleged the following:-
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.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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.
19) Reason for Registration of Complaint:- Scope of the Insurance Ombudsman Rules 2017 :
Dispute over nonpayment of Maturity Claim under rule – 13 (1) (a).
20) The following documents were placed for perusal.
iv) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form, v) Copy of policy bond.
21) Result of hearing with both parties (Observations & Conclusion):
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.
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:
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.
Dated at KOLKATA, the 19th day of February 2020.
S/d
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, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of PRADIP KUMAR BANERJEE V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0518
AWARD NO: 1) IO/KOL/A/LI/ 0594 /2019-2020
1. Name & Address of the
Complainant
PRADIP KUMAR BANERJEE
A/27, RAJNARAYAN PARK, KOLKATA,
WEST BENGAL- 700154
2. Policy No:
Policy Type/Duration/Period
577874753 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
Mr. PRADIP KUMAR BANERJEE
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 11/09/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs. 19626/
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs.19626/
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( i)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant Mr. Pradip Kumar Banerjee For the insurer Mrs. Mohua Bhattacharya, Mgr CRM
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
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
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to substantial less payment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurers’ argument: SCN not yet received. So, the view of LIC could not be furnished.
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).
20) The following documents were placed for perusal.
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):
Complainant’s Submission:
The complainant repeated all the points as mentioned in his complaint letter dated 11/09/2018. He
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.
Insurer’s Submission:
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
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 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.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL,
SIKKIM and A & N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of SUNIL MAJHI V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0519
AWARD NO: 1) IO/KOL/A/LI/0592 /2019-2020
1. Name & Address of the
Complainant
Mr. SUNIL MAJHI
VILL + P.O – BHURKUNDABAD, PURULIA,
WEST BENGAL -0
MOBILE NO. -7047109772
2. Policy No:
Policy Type/Duration/Period
462371270 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
MR. SUNIL MAJHI
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 06/09/2018 8. Nature of complaint Non Payment of Maturity Claim – 13(1)(a) 9. Amount of Claim Not Specific
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Amount of Maturity Claim + Penal Interest
12. Complaint registered under
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. Sunil Majhi For the insurer Mr. Alak Kumar Das
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
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
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to nonpayment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurers’ argument: SCN not yet received. So, Insurer’s view could no be furnished.
19) Reason for Registration of Complaint:- Scope of the Insurance Ombudsman Rules 2017 :
Dispute over delayed settlement of Maturity Claim under rule – 13 (1) (a).
20) The following documents were placed for perusal.
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.
21) Result of hearing with both parties (Observations & Conclusion):
Complainant’s Submission:
The complainant repeated all the points as mentioned in his complaint letter dated 06/09/2018. He
appealed to the forum for immediate settlement of his maturity claim as it is already late by almost
6 years.
Insurer’s Submission:
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
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 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
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.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL,
SIKKIM and A & N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of Prantosh Kumar Ghosh V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0522
AWARD NO: 1) IO/KOL/A/LI/ 0585 /2019-2020
1. Name & Address of the
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:
Policy Type/Duration/Period
434677463 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
Mr. PRANTOSH KUMAR 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 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 -
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Seeking details of Maturity Payment Particulars.
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( f)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant ABSENT For the insurer Mr. GOUTAM NANDAN,A.O, CRM
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
Pol No L.A. PLAN DOC Premium
Term /PPT
1ST Comp to Ins Co
434677463 Mr. Prantosh Kumar Ghosh.
Conventional --- --- ---
29/01/2018
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to not getting of Maturity Statement along with reinvestment figure.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurers’ argument: SCN not yet received. So, the view of LIC could not be furnished.
19) Reason for Registration of Complaint:- Scope of the Insurance Ombudsman Rules 2017 :
Dispute over servicing related matter under rule – 13 (1) (f).
20) The following documents were placed for perusal.
vii) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form,
20) Result of hearing with both parties (Observations & Conclusion):
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.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL,
SIKKIM and A&N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of ANJAN BARUA V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0523
AWARD NO: 1) IO/KOL/A/LI/ 0593 /2019-2020
1. Name & Address of the
Complainant
ANJAN BARUA
178, KANUNGO PARK, KOLKATA- 700084
WEST BENGAL
MOBILE NO. - 9831690384
2. Policy No:
Policy Type/Duration/Period
578408516 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
ANWESHA BARUA
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 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
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) (i )
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
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
17) Brief Facts of the Case:
Pol No L.A. PLAN DOC Premium (Single)
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Dispute over less payment of Maturity Claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurer’s Argument: SCN not yet received. So, the view of the Insurer could not be furnished
herewith.
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).
20) The following documents were placed for perusal.
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.
21) Result of hearing with both parties (Observations & Conclusion):
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
Taking into account the facts & circumstances of the case and after going through the
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.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL, SIKKIM AND A&N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of MANOHAR MALL V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0524
AWARD NO: 1) IO/KOL/A/LI/ 0595 /2019-2020
1. Name & Address of the
Complainant
Mr. MANOHAR MALL
13, TARA CHAND DUTTA STREET, KOLKATA -700073
MOBILE NO. -
2. Policy No:
Policy Type/Duration/Period
496266307 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
MR. MANOHAR MALL
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 26/07/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs. 60000/
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs.60000/ + Addition for 8 years
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( i)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant Mr. Sandeep Mall (Son) For the insurer Mr. Goutam Nandan, A.O, CRM
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
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.
18) Cause of Complaint: Due to substantial less payment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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).
20) The following documents were placed for perusal.
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
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 after necessary verification that the maturity payment calculation
made by the Insurer is absolutely justified & as per the terms and condition of the policy.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at Kolkata, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL,
SIKKIM and A&N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of ASHOKA KUMAR JAIN V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0525
AWARD NO: 1) IO/KOL/A/LI/ 0591 /2019-2020
1. Name & Address of the
Complainant
ASHOKA KUMAR JAIN
35/Y, NEETAI SUBHAS ROAD, RISHRA,
HOOGHLY, WEST BENGAL-712248
MOBILE NO. - 9681400083
2. Policy No:
Policy Type/Duration/Period
496241529 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
Mr. ASHOKA KUMAR JAIN
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 25/06/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs. 104319/
10. Date of Partial Settlement Not applicable
11. Amount of relief sought As per rise of BSE sensex during policy period.
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( i)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant Mr. Ashoka Kumar Jain For the insurer Mr. Goutam Nandan
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
Pol No L.A. PLAN DOC Premium (Single)
Term /PPT
1ST Comp to Ins Co
496241529 Mr. Ashoka Kumar Jain
ULIP 30/03/2010 Rs.100000/ 08/01
02/05/2018
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to substantial less payment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurers’ argument: SCN not yet received. So, the view of LIC not known.
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).
20) The following documents were placed for perusal.
viii) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form, v) Copy of policy bond.
20) Result of hearing with both parties (Observations & Conclusion):
Complainant’s Submission:
The complainant repeated all the points as mentioned in his complaint letter dated 25/06/2018. He
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
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 maturity payment calculations made by the Insurer is justified
& it is as per the terms and conditions of the policy.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL,
SIKKIM and A&N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of GORACHAND GIRI V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0526
AWARD NO: 1) IO/KOL/A/LI/ 0588 /2019-2020
1. Name & Address of the
Complainant
Mr. GORACHAND GIRI
S/O – LATE KALIPADA GIRI
VILL + P.O – ELAHIPUR, HOOGHLY
WEST BENGAL- 712707
MOBILE NO. - 9932859394
2. Policy No:
Policy Type/Duration/Period
439486534 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
Mr. GORACHAND GIRI
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 14/06/2018 8. Nature of complaint Dispute on less Payment of Maturity Claim under
rule – 13-(1)-(i) 9. Amount of Claim Rs.15907/
10. Date of Partial Settlement ---
11. Amount of relief sought Not Specified
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) (i )
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant ABSENT For the insurer Mr. GOUTAM NANDAN, A.O, CRM
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
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.
18) Cause of Complaint: Dispute over less payment of Maturity Claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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/.
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).
20) The following documents were placed for perusal.
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
Taking into account the facts & circumstances of the case and after going through the
documents on record and the submissions made by the representative of the Insurer during
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.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
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, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of SUBRATA MUKHERJEE V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0528
AWARD NO: 1) IO/KOL/A/LI/ 0586 /2019-2020
1. Name & Address of the
Complainant
Mr. SUBRATA MUKHERJEE
GARBATI (RAJ RAJESWARI TALA),
P.O- BURASHIB TALA, HOOGHLY,
WEST BENGAL -712105
MOBILE NO. - 9748611992
2. Policy No:
Policy Type/Duration/Period
496047793 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
Mr. SUBRATA MUKHERJEE
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 Less Settlement of Maturity Claim – 13-(1)-(i) 9. Amount of Claim Rs.53188/
10. Date of Partial Settlement ---
11. Amount of relief sought Not Specified
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) (i )
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant COMPLAINANT WAS ABSENT. For the insurer MR. GOUTAM NANDAN
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
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
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to less payment of Maturity claim of the policy.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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
the sense that the maturity return is subject to market risk and the investment risk to be borne
by the policy holder.
j) 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.
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
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.15.4846/.
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.
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).
20) The following documents were placed for perusal.
x) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P form, v) Copy of policy
bond(part) and vi) SCN
21) Result of hearing with both parties (Observations & Conclusion):
Complainant’s Submission: The complainant was absent in Hearing.
Insurer’s Submission:
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
Taking into account the facts & circumstances of the case and after going through the
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 & it is as per the terms and conditions
of the policy.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATE OF WEST BENGAL,
SIKKIM AND UT OF A & N ISLAND
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of AJAY KUMAR CHATTOPADHYAY V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0530
AWARD NO: 1) IO/KOL/A/LI/ 0582 /2019-2020
1. Name & Address of the
Complainant
AJAY KUMAR CHATTOPADHYAY
5, CHOUDHURY PARA LANE, FLAT NUMBER-103,
P.O- SANTRAGACHI, HOWRAH
WEST BENGAL- 711104
2. Policy No:
Policy Type/Duration/Period
497712420 & 497711458 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
Mr. AJAY KUMAR CHATTOPADHYAY & MRS. JHARNA
CHATTERJEE
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 31/05/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Received Rs.37273/ + Rs.43492/
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs.189235/ (As per P form)
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) (i)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant Mr. AJAY KUMAR CHATTOPADHYAY For the insurer Mr. GOUTAM NANDAN
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
Pol No L.A. PLAN DOC Premium (Single)
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
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to substantial less payment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurer’s argument: SCN not yet received. So, the view of LIC could not be furnished.
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).
20) The following documents were placed for perusal.
xi) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P– form, v) Copy of policy bond.
20) Result of hearing with both parties (Observations & Conclusion):
Complainant’s Submission:
The complainant repeated all the points as mentioned in his complaint letter dated 30/05/2018. He
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.
Insurer’s Submission:
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
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 maturity payment calculations made by the Insurer is justified
& it is as per the terms and conditions of the policy.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
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, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH CASE of ARUN KUMAR GANGULY V/S LIC of INDIA COMPLAINT REF: NO: 1) KOL-L-029-1819-0533
AWARD NO: 1) IO/KOL/A/LI/ 0583 /2019-2020
1. Name & Address of the
Complainant
Mr ARUN KUMAR GANGULY
161/16, G. T. ROAD, BAIDYABATI, HOOGHLY
WEST BENGAL - 712222
MOBILE NO. -8697821741
2. Policy No:
Policy Type/Duration/Period
495686348 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
MR. ARUN KUMAR GANGULY
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 26/09/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs.1346/
10. Date of Partial Settlement Not applicable
11. Amount of relief sought Rs.1346/ + Interest
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) (f)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant Mr. ARUN KUMAR GANGULY For the insurer Smt. MOHUA BHATTACHARYA, Mgr. CRM
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
Pol No L.A. PLAN DOC Premium
PLAN & TERM
1ST Comp to Ins Co
495686348 Mr. Arun Kumar Ganguly
171 28/03/2013 ------------ 171-5
23/05/2018
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to less payment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurers’ argument: SCN not yet received. So, Insurer’s view can’t be furnished.
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).
20) The following documents were placed for perusal.
i) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form,
21) Result of hearing with both parties (Observations & Conclusion):
Complainant’s Submission:
The complainant repeated all the points as mentioned in his complaint letter dated 26/09/2018. He
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.
Insurer’s Submission:
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
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 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
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of KALIDAS MONDAL V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0542
AWARD NO: 1) IO/KOL/A/LI/ 0590 /2019-2020
1. Name & Address of the
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:
Policy Type/Duration/Period
428283636 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
MR. KALIDAS MONDAL
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 10/05/2018 8. Nature of complaint Less Payment of Maturity Claim – 13(1)(i) 9. Amount of Claim Rs. 65000/(SUM ASSURED)
10. Date of Partial Settlement Not applicable
11. Amount of relief sought FULL S.A + ROYALTY
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) ( i)
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
For the Complainant Mr. Kalidas Mondal For the insurer Mr. Goutam Bishnu, A.O CRM
15 Complaint how disposed BY CONDUCTING HEARING 16 Date of Award/Order 19/02/2020
17) Brief Facts of the Case:
Pol No L.A. PLAN DOC Premium (Single)
Term /PPT
1ST Comp to Ins Co
428283636 Mr. Kalidas Mondal ULIP 15/03/2010 Rs.50000/ 08/01
11/04/2018
The complainant has alleged the following:-
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Due to substantial less payment of Maturity claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
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.
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).
20) The following documents were placed for perusal.
xii) Complaint letter, ii) Complaint letter lodged to Insurer, iii) P–form, v) Copy of policy bond,
and vi) Reply of the Insurer.
20) Result of hearing with both parties (Observations & Conclusion):
Complainant’s Submission:
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.
Insurer’s Submission:
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
the sense that the maturity return is subject to market risk and the investment risk to be borne
by the policy holder.
y) 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.
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
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.15.4236/ (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
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 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.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATES OF WEST BENGAL,
SIKKIM and A&N ISLANDS
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN, STATE OF WEST BENGAL, SIKKIM, A&N ISLANDS
(UNDER RULE NO: 16(1)/17 of THE INSURANCE OMBUDSMAN RULES, 2017)
OMBUDSMAN – P. K. RATH
CASE of ALO DAS V/S LIC of INDIA
COMPLAINT REF: NO: 1) KOL-L-029-1819-0550
AWARD NO: 1) IO/KOL/A/LI/ 0587 /2019-2020
1. Name & Address of the
Complainant
SMT ALO DAS
89, PIRPUKUR ROAD, BANSDRONI, KOLKATA
WEST BENGAL -700070
MOBILE NO. -
2. Policy No:
Policy Type/Duration/Period
577846594 DETAILS ARE IN THE TABLE
3. Name of the Insured/LA
Name of the proposer
ALO DAS
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 04/06/2018 8. Nature of complaint Dispute on less Payment of Maturity Claim under
rule – 13-(1)-(i) 9. Amount of Claim Rs50340/
10. Date of Partial Settlement ---
11. Amount of relief sought Not Specified
12. Complaint registered under
Insurance Ombudsman Rules’ 2017 13 (1) (i )
13. Date of hearing/place 18/02/2020, AT KOLKATA 14. Representation at the hearing
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
17) Brief Facts of the Case:
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.
Being aggrieved, the complainant has now approached this forum for redressal of his grievance.
18) Cause of Complaint: Dispute over less payment of Maturity Claim.
Complainant’s argument: In point No. 17 it is mentioned categorically.
Insurer’s Argument: SCN not yet received. So the view of the Insurer could not put up.
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).
20) The following documents were placed for perusal.
xiii) Complaint letter, ii) P form, iii) Copy of policy bond(part).
20) Result of hearing with both parties (Observations & Conclusion):
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
the sense that the maturity return is subject to market risk and the investment risk to be borne
by the policy holder.
gg) 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.
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
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 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
Taking into account the facts & circumstances of the case and after going through the
documents on record and the submissions made by the representative of the Insurer during
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.
Considering all the above, the complaint is dismissed without giving any relief to the
complainant.
Hence, the complaint is treated as closed.
Dated at KOLKATA, the 19th day of February 2020.
S/d
P. K. RATH
INSURANCE OMBUDSMAN
FOR THE STATE OF WEST BENGAL,
SIKKIM AND A & N ISLANDS
.
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