DISTRICT CONSUMER DISPUTES REDRESSAL FORUM;BHADRAK
…………………
C.D.Case No.42 of 2014
Sri Atul Mandal, aged 50 years
S/o: Late Rakhal Mandal,
Vill/PO: Kaithakhola,Via: Naikanidihi,
Dist:Bhadrak
…………………..Complainant
(Vrs.)
1. The Chief Post Master General,
Odisha Circle,
Bhubaneswar-751001
2. The Superintendent of Post Offices,
Bhadrak Division,
Bhadrak-756100
3. The Post Master,
Post Office Kaithkhola,
At/PO: Kaithkhola
PS:Bansada,Dist:Bhadrak
……………………..Opp.Parties
Order No.17 dt.16.11.2015:
This case has been filed by the Complainant on 02.05.2014 alleging deficiency in service against the O.Ps in repudiating the insurance claim.
The case of the Complainant is that his son Late Sanjay Mandal had insured himself under the Scheme of Santosh(Endowment Assurance) Policy in Rural Postal Life Insurance vide Policy No.R.O.R-EA-563599 for a sum assured of Rs.20,000/- wherein the Complainant was nominee. Premium amount of Rs.114/- was deposited before O.P.No.3 on 25.08.2012 and also money receipt was issued by O.P.No.3. Accordingly, a Policy bond was issued by O.P.No.2. Unfortunately, during subsistence of the said policy, Sanjay Mandal breathed his last due to pulmonary infection, which leads to asphyxia due to obstruction of respiratory passage due to aspirated blood during blood vomiting. Being the nominee of the policy holder, Complainant registered claim before the O.Ps towards policy benefit along with bonus. However, the O.P.No.3 without inquiry and verification of documents, illegally rejected the claim in writing on 07.02.2014 citing the reason that “insurant died suffering Heart Attack on 10.09.2012. The insurant made a policy on 25.08.2012 just before 17th day of his death while he was suffering from the disease mentioned above. He has suppressed the material information about his state of health and given wrong declaration in the proposal Form. Thus, the policy contract has become void under Rule 39 of Post Office Life Insurance Rules,2011 on ground of suppression of material information as to his state of health and so the claim is rejected”. After receipt of repudiation letter from O.P.No.1, the Complainant issued a legal notice on 18.03.2014 to the O.P.No.1 through his Advocate claiming the policy benefit. Despite receipt of notice, the O.P.No.3 instead of taking any tangible step to settle the claim sent a rejoinder to his Advocate reiterating the aforesaid reason for rejection. The Complainant further states that from the postmortem report and other connected documents, it is clear that the insured had not died due to heart attack but for pulmonary infection. So, the insured had not suppressed any material information about his state of his health. So the repudiation of claim of the Complainant is quite illegal an amounts to deficiency in service. Hence, the Complainant prayed for a direction to O.Ps to pay the sum assured of Rs.20,000/- along with bonus and interest accrued thereon, to pay compensation of Rs.25,000/- towards harassment and humiliation and Rs.5,000/- towards litigation expenses to him.
O.Ps in their written version stated that Late Sanjay Mandal, son of the Complainant had taken Rural Postal Life Insurance Policy No.R-OR-EA-563599 on 25.08.2012 for an assured sum of Rs.20,000/- with monthly premium of Rs.113/- and expired on 10.09.2012 i.e. after 17 days from taking the policy. At the time of submitting the proposal for the said policy, the insurant late Sanjay Mandal had nominated his father Sri Atul Mandal as nominee to receive the benefits of the said policy in case of death of the former and against para-31 onwards of the Proposal Form, the insurant had furnished health declaration that he was not suffering from any diseases as mentioned therein. Accordingly the Policy Bond and Premium Receipt Book were issued in favour of the insurant. After death of the insurant, the Complainant claimed the amount in respect of the policy. On scrutiny it was found that the insurant expired within three years from the commencement of the policy i.e. only after 17 days. As per Rule-53 of POLI Rules,2011 cases of early death i.e. before completion of three years from the date of acceptance of a policy will be investigated thoroughly to enquire if the insurant while submitting the proposal had suppressed material information. On verification of the documents it is revealed that the insurant was suffering from Pulmonary Infection of lungs, which he had suppressed at the time of taking the policy. But the claimant who states that the insurant died of heart attack is not correct and corroborated by post mortem report. As such, the insurant late Sanjay Mandal was suffering from fatal diseases. Since it is found that the late insurant had suppressed the factual information at the time of taking policy, the policy stood void and void policy does not have the right for any claim arising thereof. Accordingly, the claimant was informed on 07.02.2014. The competent authority has duly considered and rejected the case as per the rule. Hence, the case being devoid of merit is liable to be dismissed.
Having heard the Ld.Counsel for Complainant and the Ld.G.P. appearing for O.Ps and on perusal of record, it is found that the Complainant who is the father-nominee of the insured late Sanjay Mandal has filed this case claiming sum assured amounting to Rs.20,000/- from the O.Ps along with bonus and interest accrued thereon against Rural Postal Life Insurance Policy No.R.O.R-EA-563599. Admittedly, the policy in question was commenced on 25.08.2012 on payment of monthly premium of Rs.113/- by the insured and subsequently after 17 days from taking the policy; the insured Sanjay Mandal expired on 10.09.2012. So invoking Rule 39 of Post Office Life Insurance Rules,2011, the O.Ps repudiated the claim of the Complainant on the ground of suppression of material information as to his state of health. Thus, it needs to be considered whether there has been any deficiency in service on such repudiation?
It has been stated by the O.Ps in their repudiation letter No.D-1149/R-OR-EA-563599 dt.07.02.2014 that “the insurant died suffering Heart attack on 10.09.2012. The insurant made a policy on 25.08.2012 just before 17th day of his death, while he was suffering from the diseases mentioned above. He has suppressed the material information about his state of health and given wrong declaration in the proposal Form. Thus, the policy contract has become void under Rule 39 of Post Office Life Insurance Rules,2011 on ground of suppression of material information as to his state of health and so the claim is rejected”. It is revealed from the aforesaid repudiation letter that the insurant who died on heart attack had suppressed the material information about his state of health and given wrong declaration in the proposal Form. It is undoubtedly true that Rule-39 of POLI Fund Rules,2011 envisages suppression of factual information by the person admitted to the benefits of PLI will lead to forfeiture of all payments. Rule-53 of POLI Rules,2011 provides that cases of early death i.e. before completion of three years from the date of acceptance of a policy will be investigated thoroughly to enquire if the insurant while submitting the proposal had suppressed material information which otherwise 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 a policy. Admittedly, the insurant died on 10.09.2012 and the policy was commenced on 25.08.2012. So the death of the insured occurred within 17 days of commencement of policy. It has been stated by the O.Ps in their written version that on verification of the documents, it was revealed that the insurant was suffering from Pulmonary Infection of lungs which he had suppressed at the time of taking the policy. In their repudiation letter dt.07.02.2014, the O.Ps have stated that the insurant died sufferings from Heart attack on 10.09.2012. On perusal of post mortem report filed by the Complainant goes to show that the cause of death was due to Asphyxia due to obstruction of respiratory passage due to Aspirated blood during blood vomiting. The blood vomiting may be due to pulmonary infection. Therefore, burden lies on the O.Ps to prove that the insurant was suffering from pre-existing disease i.e. heart disease or Pulmonary Infection of lungs and he was undergoing treatment for the same prior to filing in the proposal Form and he deliberately suppressed this fact. Admittedly, except the bald statement made by the O.Ps in their written version, they have not produced any credible documentary evidence or previous treatment particulars of the insured and expert medical opinion in support of their case. In absence of any documentary evidence or previous treatment particulars of the insured and expert medical opinion from the side of O.Ps and on perusal of post mortem report, we are constrained to hold that the insurant had not suppressed any material information about his state of health in the proposal Form. So repudiation of genuine claim of the Complainant on flimsy ground without proper application of mind amounts to deficiency in service on the part of O.Ps. Accordingly, it is ordered:
O R D E R
In the result, the complainant is allowed on contest against the O.Ps. The O.Ps 1 to 3 are directed to pay the sum assured amounting to Rs.20,000/- along with bonus etc. from the date of repudiation of the claim i.e. 07.02.2014 with interest @ 9% per annum besides litigation cost of Rs.500/- to the Complainant within a period of 30 days of receipt of this order.
