1. This is a petition filed by one Smti. Junu Keot (hereinafter referred to as the petitioner) against the Union of India and two others (hereinafter referred to as the opposite parties) U/S 12 of the consumer Protection Act, 2019 praying for recovery of money, compensation and other reliefs.
2. Fact and circumstances for filing of the aforesaid petition as narrated by the petitioner are as follows:-
The husband of the complainant, namely, deceased Arun Kumar Keot during his lifetime opened a policy of Rural Postal Life Insurance on last 13/03/2013 vide policy number R-A-WLA-423621 for sum assured Rs.1,00,000/- (Rupees one Lakh)only which was accepted by the Department of Posts, Postal Life Insurance, Nagaon Division and the present petitioner was made nominee for the said policy. Further case of the complainant is that the policyholder- Arun Kumar Keot paid 13 premium for the said policy and thereafter, he fall ill suddenly on last 04-02-2014 and though he was treated by the Doctors of Mercy Hospital, Mullapatty No.2, Nagaon but unfortunately, on last 05-12-2014 he expired in that Hospital due to cardiac and Respiratory failure. It is further submitted by the petitioner that after death of her husband, she intimated the matter to the opposite parties and placed her claim before opposite party No.3 along with all relevant documents to get the insurance benefit but the opposite parties rejected her claim on flimsy ground. She further stated that the Rural Postal Life Insurance by Advertisement apprised people about the policy and the policy-holder - deceased Arun Kumar Keot being satisfied with the terms and condition of the policy had opened the policy and paid 13 premium but the opposite parties did not pay her the insurance benefit without any sufficient ground which amount to deficiency of service on their part. Hence, this claim petition is before this Commission praying for the relief.
3. The opposite party No.1 to 3 filed their written version denying all the allegation of the petitioner leveled against them. By their written version, the opposite parties pleaded inter- alia that there is no cause of action for the complainant to file the petition and that the petition is unsustainable in law and liable to be dismissed. The opposite parties further stated that since the claim being an early claim, the same was investigated by ASP(Divn.), Nagaon Division and ASP(Divn.), Nagaon Division contacted 2 neighbors of the deceased policy holder, namely, one Sri Jagya Bezbaruah and another Sri Maghi Kalita and obtained their written statements. It is further stated on behalf of the opposite parties that from the statement of Sri Jagya Bezbaruah, it was found that the deceased policy holder was suffering from serious illness since few years before his death and he was under treatment in the Hospitals of Chennai and Guwahati and from the statement of Sri Maghi Kalita, it was found that the deceased policy holder was suffering from serious disease(Hernia) since long and he got treatment for three months in the Hospital of Chennai and moreover the mother, brother and sister who were contacted by the ASP(Divn.), Nagaon Division during investigation, confessed that the deceased policy holder was suffering from serious illness since long. The opposite parties in the written version further submitted that the ASP(Divn) also visited the “MERCY HOSPITAL” Nagaon and as per confidential report it was found that the immediate cause of death of the deceased Policy Holder was “Cardiac & Respiratory Failure” and the antecedent cause was “Cirrhosis of Liver, HT/R, Ascitis, Hepatic Encephalopath, Hepato Renal Syndrome”. The opposite parties again submitted that the rejection of the claim in the instant case was as per the rule 53 of Post Office Life Insurance-2011 Act and thus, the petitioner is not entitled to get any relief in this case. Under the above premises, the opposite parties pray for dismissal of the claim petition.
4. Upon pleading of parties the following points are found for discussion and decision in the case.
- Whether the opposite parties illegally denied to extend the benefit to the complainant for the insured policy No. R-A-WLA-423621 dated 13-03-2013 for sum assured Rs.1,00,000/- (Rupees One Lakh)only as nominee for the deceased policy holder Arun Kumar Keot without any justified cause and whether such act on the part of opposite parties amount to deficiency in service?
- Whether the claimant is entitled to any relief as prayed for?
5. During hearing the petitioner side adduced evidence of three witnesses and exhibited several documents in support of the petition while the opposite parties adduced evidence of one D.W. and also exhibited several documents.
6. Written argument filed by both the contesting parties and perused the same.
7. Decision and reasons thereof:-
8. For the sake of brevity both the Point (i) & (ii) are taken jointly for discussion and decision:-
The claim of the complainant is that her husband- deceased Arun Kumar Keot, during his life time opened a Postal Life Insurance policy with the opposite party No.3 and on his death, the complainant being his wife and nominee, filed her claim for insurance benefit of the policy of her husband but the opposite parties without having any justified cause hold that her husband suppressed the material facts regarding his health condition at the time of opening the policy and thereby, refused to provide her with the insurance benefit of her husband. In support of her claim, she as P.W.1 adduced evidence to the effect that her husband, namely, deceased Arun Kumar Keot, during his lifetime, opened a policy of Rural Postal Life Insurance on last 13/03/2013 vide policy number R-A-WLA-423621 for sum assured Rs.1,00,000/- (Rupees one Lakh)only which was accepted by the Department of Posts, Postal Life Insurance, Nagaon Division and the present petitioner was made nominee for the said policy. Further evidence of this witness is that policy holder Arun Kumar Keot paid 13 premium for the said policy and thereafter, he fall ill suddenly on last 04-02-2014 and though he was treated by the Doctors of Mercy Hospital, Mullapatty No.2, Nagaon but unfortunately, he expired on last 05-12-2014 in that Hospital due to cardiac and Respiratory failure. It is further deposed by the P.W.1 that after death of her husband, she intimated the matter to the opposite parties and placed her claim before opposite party No.3 along with all relevant documents to get the insurance benefit but the opposite parties rejected her claim on flimsy ground. She further stated in her evidence that the Rural Postal Life Insurance by Advertisement apprised the people about the policy and the policy-holder, namely, deceased Arun Kumar Keot being satisfied with the terms and condition of the policy had opened the policy and paid 13 premium but the opposite parties did not pay her the insurance benefit without having any sufficient ground which amount to deficiency of service on their part. The P.W1 exhibited the death certificate of Arun Kumar Keot as Ext.1, the medical certificate of death issued by Mercy Hospital as Ext.2 and the Policy Document as Ext.3. P.W.2-Ranjan Bezbaruah deposed in his evidence that the deceased policy holder- Arun Kumar Keot had served as the secretary of Rupahi Block Gatanga Panchayat and was a neighbor of this witness. He further deposed that on last 04-12-2014, the said Arun Kumar Keot fall ill suddenly and though he was admitted in Mercy Hospital immediately but he expired on last 05-12-2014 in that Hospital. He also deposed that he knew that the deceased policy holder had no illness till before death. The P.W.3 –Dipu Bora also stated the same version in his evidence as P.W.2
The opposite parties while filing their written version submitted that the claim being an early claim, it was investigated and during investigation, it was found that the deceased was suffering from serious illness since long before his death and as such, the claim petition was rejected as per rule 53 of the Post Office Life Insurance-2011 Act. In support of the written version, the opposite parties examined one Rubul Goswami, Asst. Superintendent of Post Offices, Nagaon Division as D.W.1. In his evidence, this witness deposed to the effect that the petitioner Smt. Junu Keot filed this instant case claiming insurance benefit of her late husband- Arun Kumar Keot for policy number R-A-WLA-423621 dated 13-03-2013 and the claim being an early claim within three years, the same was investigated by ASP(Divn.), Nagaon Division who contacted 2 neighbors of the deceased policy holder, namely, one Sri Jagya Bezbaruah and another Sri Maghi Kalita and also obtained their written statements. He again deposed that from the statement of Sri Jagya Bezbaruah, it was found that the deceased policy holder was suffering from serious illness since few years before his death and he was under treatment in the Hospitals of Chennai and Guwahati and from the statement of Sri Maghi Kalita, it was found that the deceased policy holder was suffering from serious disease(Hernia) since long and he got treatment for three months in the Hospital of Chennai. Further evidence of D.W.1 is that as per the death certificate issued by the “MERCY HOSPITAL” Nagaon, it was found that the deceased policy holder was suffering from serious liver disease since long before obtaining the policy. The D.W.1 further stated in his evidence that as the deceased policyholder had suppressed the material facts regarding his disease while obtaining the policy, hence, the rejection of the claim in the instant case was as per the rule 53 of Post Office Life Insurance-2011 Act and thus, the petitioner is not entitled to any relief in this case. This witness also exhibited the statement of Sri Jagya Bezbaruah as Ext.A and the statement of Sri Maghi Kalita as Ext.B.
Thus, from the submission and evidence of the parties, it is seen that the facts of opening of the policy by the husband of the petitioner during his life time and he paid 13 premium for the said policy are not disputed. According to the opposite parties, they rejected the claim of the petitioner as the deceased policyholder suppressed the material facts regarding his health condition at the time of obtaining the policy and after investigation, it was found that the deceased policy holder was suffering from serious illness long before his death and hence, the claim for insurance benefit was rejected as per rule 53 of the Post Office Life Insurance-2011 Act. The D.W.1 exhibited the written statements of Sri Jagya Bezbaruah as Ext. A and the statement of Sri Maghi Kalita as Ext. B. However, these two persons had not adduce their evidence before this commission and thus, the petitioner side was deprived of cross examining these two persons and hence, the statement of persons exhibited as Ext. A and Ext. B can not be admitted in evidence to establish the fact that the deceased policy holder was suffering from serious illness long before his death.
Hon’ble Apex Court in Life Insurance Corporation of India-Vs-Komalavalli Kamba & Ors. Reported in (1984) AIR, 1014, 1984 SCR (3) 350 has held that “the general rule is that the contract of Insurance will be completed only when the party to whom an offer has been made accepts unconditionally and communicates the acceptance to the person making the offer. The duty of the insurer is to verify the correctness of the information supplied by the person whose life is assured regarding his health condition.” In the instant case, the opposite parties failed to adduce any convincing evidence in support of their written version that they verified regarding the information supplied by the policy holder regarding his health condition and that he was suffering from serious illness long before his death and at the time of obtaining the policy while from the cross examination of P.W.1, P.W.2 and P.W.3 reveals nothing that at the deceased policy holder- Arun Kumar Keot was suffering from serious illness long before his death and the policy bearing Number R-A-WLA-423621 dated 13-03-2013 was obtained by suppressing the fact of illness of the deceased policy holder . In view of above observation we are of the opinion that the petitioner has successfully established that there was a deficiency of service on the part of the opposite parties.
In result both the points for discussion and decision are answered in affirmative and go in favour of the complainant.
O R D E R
9. In view of the above discussion, it is found that the petitioner has succeeded to prove that there was a deficiency of service on the part of opposite parties.
Accordingly, the prayer made by the petitioner U/S 12 of the Consumer protection is allowed on contest. Issue direction to the opposite parties to pay the complainant the insurance benefit for the insured policy No. R-A-WLA-423621 dated 13-03-2013 of deceased Arun Chandra Keot as per terms and condition of the policy with interest @ 12 per annum from today till realization.
Furnish copies of this judgment and award to both the parties.
Given under the hand and seal of this Commission, we signed and delivered this Judgment on this 26th Day of December 2023.
