SRI. K. ANIRUDHAN (MEMBER)<br /> <br /> The complainant Smt.Julie Susan George, is the wife of the deceased C.D. Raju has filed the complaint before this Forum alleging deficiency in service on the part of the opposite parties. The contentions of the complainant is as follows:- Sri. C.D. Raju the husband of the complainant who was a policy holder for a sum of Rs.2 lakhs under the postal Life Insurance Scheme, vide policy No. KL/44592B., died due to Cardiac arrest on 26.6.2004 at Pushpagiri Medical College Hospital, Thiruvalla. The complainant nominee has filed the claim form, along with all the required documents before the postal department on 13.9.2004. But the postal department has disallowed the claim and sanctioned only a sum of Rs.30,000/- instead of the full policy amount of Rs.2,00,000/- and repudiated the policy claim only on flimsy ground of pre-existing disease to the insured without having bonafides. Hence the complainant seeking relief alleging deficiency in service on the part of the opposite parties. <br /> 2. Notices were issued to the parties and they entered appearance. Opposite parties filed version and produced documents and marked as Exts. B1 to B7. On the side of the complainant they produced 6 documents and marked as Exts.A1 to A6. It is contended by the opposite parties that this Forum has no jurisdiction to entertain the complaint. It is further stated that the insurant or his beneficiary shall not be eligible for any benefits if there is suppression of facts pertaining to his health. The version further shows that during enquiry, it was noticed that the late insurant was under treatment for cerebral hemorrhage and the policy was obtained suppressing the bad health of the insurant and he had procured PLI policy after taking treatment of disease of brain for more than three months and that in the proposal form deceased had deliberately omitted to reveal the real status of the body. So the complainant is not entitled to get any relief, whatsoever, except the sanctioned amount of Rs.30,000/- vide letter No.L1/KL 44952/B/DA dt. 18.11.2004.<br /> 3. Considering the rival contentions of the opposite parties, this Forum has raised the issues :-<br /> (1) Whether this Forum has jurisdiction to entertain the complaint?<br /> (2) Whether there is deficiency in service on the part of the opposite parties? <br /> 4. Issue No1:- At the time of taking the policy, the deceased was working an Asst. Manager, S.B.I., Venmony branch in Alappuzha District and he had remitted the premium through the Pandanad Post Office of Alappuzha District. The cause of action arises at Venmony and at Pandanad post office, which is in Alappuzha District. So it is perfectly within the jurisdiction of this Forum and the complaint is maintainable. Issue No. I is found in favour of the complainant. <br /> 5. Issue No.2:- The deceased C.D. Raju had taken the policy for Postal Life Insurance on 4.10.2002 and it has been accepted by the postal department on 24.10.2002 vide intimation letter dt. 25.10.2002. Ext. A1 document clearly shows the above matter. Ext.A2 is the certificate dt. 22.7.04. It indicate that Sri. C.D. Raju was admitted in the Pushpagiri Medical College Hospital on 26.6.04 in a very critical condition and expired on 26.6.04 due to coronary artery heart disease systemic cardiogenic shock, cardirespiratory arrest, Asyhole and patient expired due to natural disease process. But the documents produced are silent with regard to the matter that the deceased was under treatment for any disease prior to 3 years from the date of the proposal of the policy. So contention that the policy holder was suffering from any form of disease and had suppressed material facts at the time of taking the policy, cannot be accepted for a valid ground for denying the benefit (Ext.A3 letter). Ext.A4 is the letter dt. 17.11.2004 denying the release of the total policy amount of Rs.2,00,000/- issued by the postal authorities. Ext.A5 is the letter of the Deputy Divisional Manager (PLI) of postal authority issued to the wife of the deceased. Ext.A6 is the Certificate dt. 23rd August, 1999, by the doctor stating that the deceased was under his treatment for intra cerebral Hemorrhage in coma from 10.6.99. On a reading of the above said documents produced by the complainant, the denial of the full insured amount of Rs.2,00,000/- (Rupees two lakhs only) amount to deficiency in service on the part of the opposite parties and issue No.2 is found in favour of the complainant. On a perusal of the Exts.B1 to B7 shows that the contentions raised by the opposite parties lacks bonafides and cannot be accepted as a valid grounds for denial of the full policy amount. The deceased had not suppressed any material facts regarding his disease at the time of taking the policy and the death was caused due to the cardiac arrest as evidenced by Ext.A2. Therefore the contentions of the opposite parties for repudiating the claim has no locus standi and the complainant is entitled to get the full insured amount; since the deceased C.D. Raju was a holder of valid policy bearing No.KL/44592 B for Rs.2,00,000/- at the time of death. On a careful reading of the complaint, affidavit and evidences produced on both sides and depositions and on a detailed hearing, we are of the view that the complaint is to be allowed.<br /> In the result we direct the opposite parties to pay the insured amount of Rs.2,00,000/- (Rupees two lakhs only) to the complainant with interest at the rate of 12% from 26.6.2004 onwards, and compensation of Rs.5000/- (Rupees five thousand only) for willful negligence on the part of the opposite parties and a cost of Rs.2000/- (Rupees two thousand only). We further direct the opposite parties to pay the above said amounts to the complainant within one month from the date of receipt of this order. Complaint allowed.<br /> Pronounced in open Forum on this the 30th day of April, 2008. <br /> <br /> Sd/- K. ANIRUDHAN :<br /> <br /> Sd/- JIMMY KORAH :<br /> <br /> Sd/- N. SHAJITHA BEEVI:<br /> <br /> APPENDIX:- <br /> <br /> Evidence of the complainant:-<br /> <br /> PW1 - Julie Susan George (Witness)<br /> <br /> Ext.A1 - Letter dated 25.10.02 (Photo copy)<br /> <br /> Ext.A2 - Photo copy of the certificate dated 22.7.04<br /> <br /> Ext.A3 - Photo copy of the letter dated 29.9.04<br /> <br /> Ext.A4 - Photo copy of the letter dated 17.11.2004<br /> <br /> Ext.A5 - Photo copy of the Regd. Letter dated 23.8.04<br /> <br /> Ext.A6 - Certificate dated 23.8.1999<br /> <br /> Evidence of the opposite parties:-<br /> <br /> RW1 - S. Sarath Chandran (Witness)<br /> <br /> Ext.B1 - Proposal for Postal Life Insurance (Photo copy)<br /> <br /> Ext.B2 - Photo copy of the policy<br /> <br /> Ext.B3 - Photo copy of the Receipt Book<br /> <br /> Ext.B4 - Letter dated 15.10.04 (Photo copy)<br /> <br /> Ext.B5 - Letter dated 14.10.04 (Photo copy)<br /> <br /> Ext.B6 - Letter dated 17.11.04 (Photo copy)<br /> <br /> Ext.B7 - Photo copy of the letter dated 24.5.06<br /> <br /> // True Copy //<br /> By Order<br /> <br /> <br /> Senior Superintendent<br /> To<br /> Complainant/Oppo. Parties/S.F.<br /> <br /> Typed by:-pr/-<br /> <br /> Compared by:-<br />