​A.K.Mehta President

1        The complainant Jasbir Kaur filed the present complaint under Section 11, 12, 13 and 14 of the Consumer Protection Act (herein after called as 'the Act') against Post Master Post Office Village Jauneke Tehsil and District Tarn Taran etc. (Opposite Parties) on the allegations of deficiency in service with further prayer to direct the opposite parties to pay insurance amount of Rs. 3,00,000/- alongwith interest and to pay Rs. 20,000/- as compensation for harassment etc. and Rs. 11,000/- as litigation expenses.

2        The case of the complainant in brief is that son of the complainant namely Hira Singh took 6 policies of insurance Gram Santosh (Endowment Assurance) under Rural Postal life insurance bearing Nos. R/PB/EA-256964, R/PB/EA-256967, R/PB/EA-256968, R/PB/EA-256969, R/PB/EA-256970, R/PB/EA-256971 from the Opposite Parties for Rs. 50,000/- each on 22.2.2012 with monthly installment of Rs. 86/-; that Hira Singh appointed complainant Jasbir Kaur who is real mother of Hira Singh as his nominee and paid 9 monthly installments in the above said policies; that Hira Singh died on 15.11.2012 and after his death, complainant approached the Opposite Parties-Department for release of insurance amount of the policies and also filed claim form to the Opposite Parties-Department on 8.8.2013 alongwith death certificate of Hira Singh and other documents; that complainant approached the Opposite Parties many times but claim was not paid and then complainant sent a legal notice to Opposite Party on 6.4.2015 and Opposite Party No. 3 replied the notice vide letter dated 8.4.2015 and took objections that complainant has not completed the claim form properly and after receiving the reply, complainant again submitted the claim form with the Opposite Parties but again claim was not sanctioned by the Opposite Parties in favour of complainant and when complainant requested the Opposite Parties to admit her claim then her request was declined by Opposite Parties. Hence complaint was filed.

3        After formal admission of the complaint, notice was issued to the Opposite Parties and Opposite Parties appeared through counsel and filed written version contesting the complaint on the Preliminary Objections that complainant has not come to the Forum with clean hands and have suppressed material facts; that complainant is estopped by her act and conduct from filing the complaint and no cause of action has arisen in favour of complainant and against the Opposite Parties and complaint is not legally maintainable in the present form as Hira Singh suppressed the material facts from the knowledge of Department and has not got himself medically examined before depositing the premium of aforesaid insurance policies and provisions of ROPLI, rule 2011 Section 53 relates to cases of early death i.e. before completion of 3 years, from the date of acceptance of the policy will be investigated thoroughly to inquire if the insurant has suppressed material information at the time of submitting proposal which would not have allowed the proponent to be eligible for PLI/ RPLI and it should be examined whether insurant was suffering from any disease prior to taking of policy and whether there is any deliberate attempt on the part of marketing staff to assure sub-standard life and to cause loss to fund and whether the cause of death had any relation to the disease and Post Master General after satisfying himself may sanction the death claim; that first premium against which new proposal was deposited on 23.2.2012 whereas the subsequent premium from March 2012 to October 2012 was deposited on 18.10.2012 and thereafter premium for the month of November 2012 was deposited on 7.11.2012 which is in-contravention with POLI Rules 56(3) &
(i) as late insurant deposited the subsequent premium after a long delay of 8 months allowing the said policies to become void; that while processing the case, it was found that complainant for claiming the amount of policy with other benefits and interest against said policies in the name of Late Hira Singh is not maintainable in view of provision contained in rule 56(3), 56(3)(i); that late Hira Singh paid one installment of Rs. 86/- as monthly premium plus Rs. 4/- service tax on 23.2.2012 for each policy and thereafter insurant had not paid premium up to the month of September 2012 and as such, the policies became void and as per POIL Rules, the premium shall be paid in advance on the first day of each month though grace period is allowed up to last working day of the month for which premium is due and in the instant case the insurant failed to pay the premium on due date allowing policies to be lapsed in his life time but the insurant paid the premium of lapsed polices without getting it revived from the competent authorities and without medical examination as required under Rules and as per rule 56(3) (i) if any payment purporting to be premium payment is made during the period of 6 months as mentioned above and if they did not cover all arrears together with interest thereon required to prevent the policy becoming void then such policy payment shall be held in suspense and shall not be considered as payment by way of premium to cover the risk of life assured and as such claim was not maintainable in view of these rules. On merits, the issuance of policies in the name of deceased Hira Singh were not denied. It was also not denied that Jasbir Kaur complainant mother of Hira Singh was nominee in the policies and she approached the Opposite Party-office for release of insurance amount of the policies but on verification of documents submitted by Jasbir Kaur, it was found that application was incomplete and she was asked vide letter No. RPLI/DC/14-15 dated 11.8.2014 to reconcile the forms and sent the same to the office and thereafter, complainant again resubmitted the claim form complete in all respect during the month of June 2015 i.e. after two months of reply to legal notice and same was sent for verification to the concerned officer vide office letter No. PLI/DCC/2014 dated 2.6.2015 as earlier death claim cases required thorough investigation as per sub rule 53 of POLI Rules, 2011 which provides that in case of early death i.e. before completion of 3 years from the date of acceptance of the policy will be investigated thoroughly to inquire if the insurant while submitting the proposal has suppressed material information which otherwise would not have allowed the proponent to be eligible for PLI/RPLI and it was to be examined whether insurant has suffering from any disease prior to taking of policy and to investigate whether the cause of death had any relation to the disease and Post Master (General) is to sanction the death claim if claim is genuine. The complaint was also contested on the same lines as were taken in the preliminary objections. All other allegations mentioned in the complaint were denied being incorrect  and prayer was made for dismissal of the complaint with costs.

4        Sufficient opportunities were granted to the parties to lead evidence in order to prove their respective case. The complainant tendered in to evidence her affidavit Ex. C-1 alongwith documents Ex. C-2 to C-11 and closed the evidence and thereafter, Ld. Counsel for the Opposite Parties tendered in to evidence affidavit of Jeth Mal Jingar Ex. O.Ps/1 alongwith documents Ex. O.Ps/2 to  O.Ps/7 and closed the evidence.

5        We have heard the Ld. Counsel for parties and also gone through the evidence and documents produced by the parties.

6        We have heard the Ld. Counsel for complainant and also gone through the file minutely.

7        Ld. counsel for the complainant contended that complainant obtained 7 insurance policies from Opposite Parties-Department and appointed complainant, who is mother of the insurant, as nominee. He contended that insurant Hira Singh died after paying 9 premiums and complainant filed claim with the Opposite Parties-Department but inspite of numerous visits and requests, Opposite Parties did not pay the claim amount and complainant then served a legal notice Ex. C-9 on the Opposite Parties-Department and Opposite Parties-Department gave reply Ex. C-11 and took objection that claim form was incomplete and thereafter complainant completed the claim form and resubmitted the same. He contended that Opposite Parties-Department now filed written version and took different plea that the terms and conditions of the insurance policies have not been complied which is totally different plea which the Opposite Parties-Department could not take in the written version. He contended that Opposite Parties-Department also took the plea that policies have become void whereas no such plea was taken while giving reply to the legal notice served by the complainant and as such contrary pleas should not be taken in to account and complaint is required to be allowed and Opposite Parties are required to be directed to pay the claim of insurance policies to the complainant with compensation and litigation expenses.

8        The ld. counsel for Opposite Parties contended that complaint has not been filed properly, as proper parties have not been arrayed in the complaint. He contended that Opposite Parties-Department falls under Central Govt. and the complaint is required to be filed against Union of India and not against the officials individually. He also contended that even Article 300 of the Constitution of  India provides that Union of India should be the main party in case complaint is filed against Central Govt. Department and its officials. He further contended that Hira Singh took life insurance policies under Rural Postal life insurance on 23.2.2012 for Rs. 50,000/- each and paid only one premium on 23.2.2012 and then did not pay the premium thereafter, for more than 6 months and policies lapsed. He contended that Hira Singh paid total  due premium on 18.10.2012 and then paid premium on 7.11.2012 for the month of November 2012 and thereafter Hira Singh died on 15.11.2012. He contended that if premium is not paid for more than 6 months continuously then policies become void policies and medical certificate is to be given by policy holder if insurance policies are to be reinstated. He contended that in order to reinstate the polices, the insurant is required to submit medical certificate  of good health which the insurant Hira Singh failed to deposit with the Opposite Parties-Department and as such policy was not reinstated and the amount of premium remained in suspense account and as such, Opposite Parties-Department have rightly not paid the claimed amount as the same was not maintainable and as such complainant has filed a wrong complaint in the Forum which is liable to be dismissed with special costs.

9        After going through the facts of the pleadings and evidence and documents led on the file by the parties, this Forum does not find force in the contentions of the complainant rather found force in the contention of Ld. counsel for Opposite Parties. It is admitted fact that deceased Hira Singh took 6 life insurance policies of Gram Santosh (Endowment Assurance) under rural Postal Life Insurance. It is also admitted fact that deceased Hira Singh took policies on 23.2.2012 and paid one installment in the month of Feb. 2012 on 23.2.2012 and thereafter did not pay any installment till 18.10.2012 which means insurance installments for the policies were not paid for more than 6 months and in this eventuality, the policies lapsed as is provided in Rule 56(3) of Postal Life Insurance Rules 2011. Rule 56(3) Postal Life Insurance Rule 2011 provides that:-

56(3)           In the event of Policy-holder of a void policy desiring  re-instatement of his/her policy within a period not later than six months from the date of first unpaid premium had become due in respect of such policy, he may deposit all the arears of premium/ premia till the date of payment along with interest thereon at the rates as prescribed by the Director General of Posts in the Post Office specified for the purpose of payment of premia in respect of such policy and then re-instatement of the policy shall be automatic without any further act on the part of the insurant or the Department, subject to continued insurability of the life at the time of payment of arrears and for that the insured person shall submit declaration of good health and medial certificate to this effect from Authorised/ Registered Medical Practitioner;

1. Provided that if any payment purporting to be premium payments are made during the period of six months mentioned above and if they do to cover all the arrears together with interest thereon required to prevent the policy from becoming void, such payment shall be held in suspense and shall not be considered as payment by way of premium to cover the risk of the life assured. No claim whatsoever shall lie on the Department in the event of death of the life assured during such period when premium/ premia are held in suspense and the policy is not re-instated. Such premia as are held in suspense shall be refunded to the policy holder.

The bare reading of Rule 56(3) shows that if the premium of the policy remains unpaid for the last more than six months then it can be reinstated by paying the due premium without interest and the re-instatement of policy shall be automatic with any further act on the part of the insured or the Department but subject to continued insurability of the life at the time of payment of arrears and that the insured person shall submit declaration of good health and medical certificate to this effect from authorized/ registered medical practitioner and rule 56(3)(i)  provides that if the declaration of good health and medical certificate is not filed then payment shall be held in suspense and shall not be considered as payment by way of premium to cover the risk of life assured and no claim whatsoever shall lie on the Department in the event of death of life assured during such period when premium are held in suspense and policy is not reinstated though in such event, the premium which are held in suspense shall be refunded to the policy holder. It is clear that deceased Hira Singh did not pay the premium for more than 6 months and the policies lapsed due to this reason. It is correct that Hira Singh (deceased) paid premium after 8 months in October 2012 but this payment of arrears of premium was subject to good health of insurant and medical certificate to this effect from authorized/ registered medical practitioner and admittedly in the case in hand Hira Singh (deceased) did not submit declaration of good health nor medical certificate to this effect from authorized/ registered medical practitioner and in this eventuality, the payment was held in suspense and was not considered as payment by way of premium to cover the risk of life assured and as such no claim lie on the Department in the event of death of life assured during such period when the premium was held in suspense and also policy was not reinstated and as such in view of Rule 56 (3) Postal Life Insurance Rule 2011, the claim of the complainant was not maintainable otherwise also, in case of insurance contract, the parties are bound by the terms and conditions of the policy and rules framed thereunder. As such, Opposite Parties-Department has rightly refused the claim amount to the complainant.

10      In the light of above discussion, complaint fails and same is hereby dismissed. However, keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.