Date of filing: 26.08.2021
Date of disposal: 20.02.2023
DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION
THIRUVALLUR
BEFORE TMT. Dr.S.M. LATHA MAHESWARI, M.A.,M.L, Ph.D (Law) .…. PRESIDENT
THIRU.P.MURUGAN,M.Com.,ICWA (Inter), B.L., ....MEMBER-II
CC. No.39/2021
THIS MONDAY, THE 20th DAY OF FEBRUARY 2023
Mrs.Renuga, W/o.Natarajan,
No.13/11, Munuswami Pallai Street,
West Banu Nagar, Ambattur,
Chennai – 600 053. ……Complainant.
//Vs//
Department of Posts, Postal Life Insurance,
Rep. by its Post Master/Manager,
Ambattur Head Office,
Ambattur, Chennai 600 053. ..........Opposite party
Counsel for the complainant : Mr.B.Ramaratnam, Advocate.
Counsel for the opposite parties : Mr.S.Sugadev,Advocate.
This complaint is coming before us on various dates and finally on 03.02.2023 in the presence of Mr.B.Ramaratnam Advocate, counsel for the complainant and Mr.S.Sugadev Advocate, counsel for the opposite party and upon perusing the documents and evidences of both sides, this Commission delivered the following:
ORDER
PRONOUNCED BY TMT. Dr.S.M. LATHA MAHESWARI, PRESIDENT.
This complaint has been filed by the complainant u/s 35 of the Consumer Protection Act, 2019 alleging deficiency in service in repudiating the Postal Life Insurance policy claim along with a prayer to direct the opposite party to pay a sum of Rs.10,00,000/- being the sum assured in the policy Nos.0000002843432 dated 06.04.2019 & policy No.0000003375133 dated 03.10.2019 with 18% interest per annum and to pay a sum of Rs.1,50,000/- towards compensation for unfair trade practice and to pay a sum of Rs.2,00,000/- towards compensation for deficiency in service and to pay a sum of Rs.1,50,000/- towards compensation for the mental agony and to pay a sum of Rs.30,000/- towards cost of the complaint to the complainant.
Summary of the facts culminating into complaint:-
Being aggreived by repudiation of Postal Life Insurance claim the present complaint has been preferred. The complainant’s son attracted with the schemes of Postal Life Insurance Policy filled up a printed form of the opposite party for PLI on 14.03.2019 for an assured sum of Rs.5,00,000/-. The amount collected towards premium was Rs.2975/-and the maturity was for 40 years and the life insured person‘s mother has been referred as nominee. Medical examination has been conducted by the nominated Medical Examiner Dr.R.Venkatesan Assistant Resident Medical Officer, Institute of Child Health and Hospital for Children, Egmore Chennai 600 008 who certified the fitness of complainant’s son. The life insured filled up another printed proposal form of opposite party for life insurance on 05.09.2019 for assured a sum of Rs.5,00,000/- and his mother was made as nominee for that policy also. When the complainant’s son died on 08.01.2021, claim was made by the mother of the deceased/complainant but the same was repudiated by the opposite party on the grounds of “suppression of material facts“. Thus aggrieved the present complaint was filed for the following reliefs as mentioned below;
To direct the opposite party to pay a sum of Rs.10,00,000/- being sum assured in the policy Nos.0000002843432 dated 06.04.2019 & policy No.0000003375133 dated 03.10.2019 with 18% interest per annum;
To pay a sum of Rs.1,50,000/- towards compensation for unfair trade practice;
To pay a sum of Rs.2,00,000/- towards compensation for deficiency in service;
To pay a sum of Rs.1,50,000/- towards compensation for the mental agony;
To pay a sum of Rs.30,000/- towards cost of the complaint to the complainant.
Defence of the opposite party:-
The opposite party by filing version admitted that the complainant’s son approached them for insurance and after filling up their proposal form paid an advance deposit of Rs.2795/- on 15.03.2019 and that the proposal was accepted under the policy as “SANTOSH ENDOWMENT ASSURANCE” vide policy No.0000002843432. Similarly on 04.09.2019 for the second time he approached the opposite party and obtained a policy after submitting a proposal form as “SANTOSH ENDOWMENT ASSURANCE” vide policy No.0000003375133. In column 11 b (vi) of the Postal Life Insurance Proposal Form it has been questioned about proponent’s health condition with regard to the kidney disease, prostate, hydrocele and urinary system wherein the complainant’s son stated ‘NO‘ as reply. Further in the column 11 d of the postal Life Insurance Proposal Form when it has been questioned whether the proposar availed any kind of leave on medical grounds or hospitalized during the last three years for which the complainant’s son has marked “Not Applicable”. Thus based on the proposal form and on a Medical Examiner conducting general checkup the complainant’s son policies were issued. The complainant’s son died on 08.01.2021 and the claim was submitted on 27.01.2021. Upon death claim verification by the Assistant Superintendent of Post Offices, Ambattur Sub Division who stated that in the Death Summary issued by SIMS Hospital, Vadapalani, it was found that the complainant’s son cause of death was “POST RENAL TRANSPLANT/ACUTE CELLULAR REJECTION/ RESPIRATORY TRACK INFECTION/SEPSIS“. It was found that he was diagnosed with SYSTEMIC HYPERTENSION, CHRONIC KIDNEY DISEASE STAGE 5 ON MHD and admitted at SIMS Hospital, Vadapalani on 05.09.2016 underwent renal transplant on 06.09.2016 and got discharged on 13.09.2016. Thus relying upon the declaration clause and Rule 39 of the Postal Life Insurance with regard to furnishing wrong information by a person or suppression of actual information the claim was rejected. Thus the opposite party sought for the dismissal of the complaint.
On the side of complainant proof affidavit was filed and documents Ex.A1 to Ex.A17 were marked. On the side of opposite party proof affidavit was filed and documents Ex.B1 to Ex.B5 were marked.
Point for consideration:-
Whether the repudiation of the Postal Life Insurance claim by the opposite party with regard to the Postal Life Insurance Policy Nos.0000002843432 dated 06.04.2019 & 0000003375133 dated 03.10.2019 amounted to deficiency in service and whether the same has been successfully proved by the complainant by admissible evidence?
If so to what reliefs the complainant is entitled?
Point:1
On the side of complainant the following documents were filed in proof of complaint allegations;
Aadhar Card of complainant was marked as Ex.A1;
Proposal from of complainant’s son dated 05.06.2019 was marked as Ex.A2;
Receipt of Rs.2975 from the complainant’s son dated 14.03.2019 was marked as Ex.A3;
Copy of policy No.0000002843432 dated 19.03.2019 was marked as Ex.A4;
Proposal form of complainant’s son dated 15.04.2019 was marked as Ex.A5;
Copy of Postal Life Insurance Policy No.0000003375133 dated 20.09.2019 was marked as Ex.A6;
Death Certificate of complainant’s son dated 08.01.2021 was marked as Ex.A7;
Rejection of claim by the opposite party regarding Policy No.0000002843432 dated 12.04.2021 was marked as Ex.A8;
Rejection of claim by the opposite party regarding Policy No.0000003375133 dated 12.04.2021 was marked as Ex.A9;
Letter issued by the complainant to the opposite party dated 28.04.2021 was marked as Ex.A10;
Premium payment of two policies details given by the opposite party to the complainant dated 28.04.2021 was marked as Ex.A11;
Legal heir certificate was marked as Ex.A12;
Legal notice issued by the complainant to the opposite party dated 31.07.2021 was marked as Ex.A13;
Acknowledgement card for proof of delivery was marked as Ex.A14;
Letter of opposite party to the complainant dated 09.08.2021 was marked as Ex.A15;
Photo of the complainant’s son was marked as Ex.A16;
A sheet of paper containing the hand writing of the deceased son of the complainant was marked as Ex.A17;
On the side of opposite party the following documents were filed in proof of their contentions;
Discharge Summary of the complainant’s son issued by the SIMS Hospital dated 13.09.2016 was marked as Ex.B1;
Death certificate issued by the SIMS Hospital dated 08.01.2021 was marked as Ex.B2;
Claim application submitted by the complainant dated 27.01.2021 was marked as Ex.B3;
Enquiry report of Assistant Superintendent of Post Offices, Ambattur. Dated 22.03.2021 was marked as Ex.B4;
Claim rejection order by the competent Authority dated 12.04.2021 was marked as Ex.B5;
The learned counsel appearing for the complainant vehemently argued that the complainant’s son has not suppressed any material facts and that the policies were issued only after accepting the proposal and based on the medical opinion given by the Doctor who was suggested by the insurance company. It is his contention that when they have accepted the proposal they cannot now deny the claim. It is also argued that the proposal form was not filled up by the complainant’s son but by the Postal Life Insurance Agent and hence the complainant’s son cannot be held liable for the suppression of material facts. Further he also argued that when the Doctors had examined the insured thoroughly, he ought to have seen and examined the suture marks that happened due to the kidney transplant and filed the report. In toto he argued that the complainant as nominee is entitled to the claim amount as the complainant’s son had not suppressed any material facts and sought for the complaint to be allowed.
On the other hand the learned counsel appearing for the insurance company argued that the complainant had failed to prove that the proposal form was filled up by the agent and even if it is filled up by the agent, it was done only on the information provided by the complainant. Further he stated that the complainant being an young aged person the Doctor would not have had any doubt with regard to the kidney transplant. Thus by relying upon the declaration clause provided in the policy documents sought for the complaint to be dismissed on the ground that no deficiency in service committed by them in repudiating the claim.
On appreciation of the entire pleadings and materials, we could found that under the caption Proponent’s Health Information the complainant’s son has marked “NO” for kidney disease, prostate, hydrocele and urinary system. Further in the column “11 d“ of the postal Life Insurance Proposal Form it had been questioned whether the proposar availed any kind of leave on medial grounds or hospitalization during the last three years for which the complainant’s son has marked “Not Applicable. However, it is even admitted by the complainant herself that on 05.11.2016 just before three years the complainant’s son had renal transplant in SIMS Hospital on 06.09.2016 and got discharged on 13.09.2016. When such severe medical condition had been underwent by the complainant’s son he ought to have revealed the same in the proposal form. It is to be noted that in the insurance contract the insured is the proposer and it is expected that he proposes only true information i.e. with utmost good faith or uberrimae fidei as known in legal parlance which will be acted upon by the insurance company to decide whether the proposal has to be accepted or to be rejected. In such circumstances the non discloser of the information about the kidney transplant by the complainant’s son is a clear violation of the terms and conditions as found in the policy. Further vide Ex.B1 it is found that the complainant’s son has underwent procedure vide live donor renal transplantation and it is also seen that the complainant’s son is a known case of chronic kidney disease stage 5 on MHD. Vide Ex.B2, the cause of death has been clearly mentioned as POST RENAL TRANSPLANT/ACUTE CELLULAR REJECTION/ RESPIRATORY TRACK INFECTION/SEPSIS. Hence it cannot be said that the kidney transplant has no impact or no way related to the cause of death of the complainant’s son. It is an established legal principle that when the terms and conditions of insurance contract is violated as found in the present case the same amounted to suppression of material fact making the insurance contract also initio.
The complainant submitted additional documents to show a mark on the left hand of the late son of the complainant and papers containing the hand writing of the deceased to prove that the doctor who examined the complainant’s son failed to take note of the mark and that the proposal form was not filled up by the complainant’s son respectively. When it is clearly established that there is suppression of material facts with regard to the health condition by the complainant’s son in the proposal form the said documents are of no use and not to be considered.
Hence this commission concludes that there is no deficiency in service on the part of the opposite party in repudiating the claim of the complainant. Thus we answer the point accordingly against the complainant and in favour of the opposite party.
Point No.2:-
As we have held above that the complainant had failed to prove any deficiency in service on the part of the opposite party, he is not entitled to any reliefs as claimed in the complaint from the opposite party. Thus we answer the point accordingly.
In the result, the complaint is dismissed. No order as to cost.
Dictated by the President to the steno-typist, transcribed and computerized by him, corrected by the President and pronounced by us in the open Commission on this the 20th day of February 2023.
Sd/- Sd/-
MEMBER-II PRESIDENT
List of document filed by the complainant:-
Ex.A1 .............. Aadhar card of the complainant. Xerox
Ex.A2 14.03.2019 Proposal form of complainant’s son. Xerox
Ex.A3 14.03.2019 Receiptof Rs.2975/-from the son of complainant. Xerox
Ex.A4 06.04.2019 Copy of PLI Policy No.0000002843432. Xerox
Ex.A5 05.09.2019 Proposal form of complainant’s son. Xerox
Ex.A6 03.10.2019 Copy of PLI Policy No.0000003375133. Xerox
Ex.A7 08.01.2021 Death Certificate. Xerox
Ex.A8 12.04.2021 Rejection of claim letter for the policy No. 0000002843432. Xerox
Ex.A9 12.04.2021 Rejection of claim letter for the policy No. 0000003375133. Xerox
Ex.A10 28.04.2021 Letter of complainant to the opposite party. Xerox
Ex.11 28.04.2021 Payment of premium details for PLI Policies given by the oppostie party to the complainant. Xerox
Ex.A12 05.07.2021 Legal Heir Certificate. Xerox
Ex.A13 31.07.2021 Legal notice issued by the complainant to the opposite party. Xerox
Ex.A14 ............ Acknowledgment card. Xerox
Ex.A15 09.08.2021 Letter of opposite party to the complainant. Xerox
Ex.A16 ............ Picture of the complainant’s son. Xerox
Ex.A17 ........... A sheet of paper containing the hand writing of the late son of the complainant. Xerox
List of document filed the opposite party:-
Ex.B1 13.09.2016 Discharge Summary. Xerox
Ex.B2 08.01.2021 Death Certificate. Xerox
Ex.B3 27.01.2021 Claim Application. Xerox
Ex.B4 22.03.2021 Enquiry Report. Xerox
Ex.B5 12.04.2021 Claim Rejection Order. Xerox
Sd/- Sd/-
MEMBER-II PRESIDENT
