Tamil Nadu

North Chennai

CC/03/2018

Mrs.V.Shakila w/o.late.M.Venkatesan, M/s.Lavanya, Mr.V.Premkumar - Complainant(s)

Versus

The Chief Post Master general (PLI) tamil nadu circle the post master Park Town HPO - Opp.Party(s)

M/s.K.R.Neelambar

26 Jun 2019

ORDER

 

                                                            Complaint presented on:  26.12.2017

                                                               Order pronounced on:  26.06.2019

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT:  TMT.K.LAKSHMIKANTHAM, B.Sc., B.L., DTL.,DCL, DL & AL -  PRESIDENT

 

TMT.P.V.JEYANTHI B.A., MEMBER - I

 

WEDNESDAY  THE 26^th  DAY OF JUNE 2019

 

C.C.NO.03/2018

 

1.Mrs.V.Shakila,

W/o.Late M.Venkatesan,

No.40/29, Ramanathan Street,

Ayanavaram, Chennai – 600 023.

 

2.Ms.V.Lavanya,

D/o.Late M.Venkatesan,

No.40/29, Ramanathan Street,

Ayanavaram, Chennai – 600 023.

 

3.Mr.V.Premkumar,

S/o.Late M.Venkatesan,

No.40/29, Ramanathan Street,

Ayanavaram, Chennai – 600 023.

 

                                                                                        …..Complainants

 ..Vs..

1.The Chief Post Master General, (PLI),

Tamil Nadu Circle,

Mount Road, Chennai – 600 002.

 

2.The Post Master,

Park Town HPO,

Chennai – 600 003.

 

.....Opposite Parties

Counsel for Complainants                    : M/s.K.R.Neelambar

 

Counsel for    opposite parties                  : M/s.Pushpavathi

 

O R D E R

 

BY PRESIDENT TMT.K.LAKSHMIKANTHAM, B.Sc., B.L., DTL.,DCL, DL & AL

          This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The complainants humbly submit that Mr.M.Venkatesan husband of the 1^st complainant, father of the 2^nd and 3^rd complainant was working as Head Constable, HC – 13331, F-2, Egmore Traffic Police Station, Chennai has taken the subject Postal Life Insurance Policy No.TN- 529520-CC on 11.02.2012 namely SANTHOSH (ENDOWMENT ASSURANCE) policy. The sum assured is for Rs.2,00,000/-. There is no default in payment of premium. The complainants further submit that the said Mr.M.Venkatesan died on 26.05.2014 due to ill health, leaving the complainants herein as his legal heirs to inherit his estate.  The 1^st complainant had approached the 1^st opposite party on 01.12.2014 and had submitted all the relevant papers along with original policy bond to the 1^st opposite party and they had acknowledged the same. The complainants were waiting for the claim amount from the opposite parties. The complainants humbly submit that to their shock and surprise the Death Claim was rejected by the 1^st opposite party vide their letter dated CPC/PLI/Misc/dlgs dated at Chennai – 600 003, dated 01.08.2016 saying that the Insurant was known diabetic for 14 years and he had suppressed the facts of his disease by clearly marking “NO” in Sl.No.17(a)(b) of the Proposal Form which as per Rule 39 of the Rural Postal Life Insurance Schemes is Voidable.  The complainant further submit as per rule 39 the reason shown here is a voidable one and it can be re considered by the 1^st opposite party and the Death Claim can be given to the complainants. The complainants further state that since the reason is a voidable one, the act of repudiating the genuine Insurance Claim of the complainants by the opposite parties  1 & 2 in a negligent manner amounts to deficiency in service. It has caused severe mental agony to the complainants,  for which the opposite parties 1 & 2 are severally and jointly liable to compensate the same under the Consumer Protection Act. Hence the complaint.

2. WRITTEN VERSION OF THE   OPPOSITE PARTIES IN BRIEF:

          The opposite party submits that the  1^st complainant herself had declared that Shri.Venkatesan  died on 26.05.2014 due to ill health. Moreover, the death of the insurant occurred within three years from the date of acceptance, hence as per rule such case has to be investigated thoroughly. The investigation report revealed that the late insurant had suppressed the material fact in the proposal form. The opposite party submits that as a result of complete enquiry it was found that the late insurant was diabetic for 14 years, Hypertension for 6 years, Diabetic Kidney Disease (stageV). Chronic Kidney disease (StageV), Diabetic Foot, Peripheral Neuropathy, CAHD and expired on 26^th May 2014 due to massive myocardial infarction. Moreover the insurant had availed Medical leave for 77  days before taking up the policy. He had suppressed the facts of this disease by clearly marking “NO” in SL.17 (a)(b) of the proposal form. The policy therefore treated as null and void and hence the death claim is rejected by the Postmaster General, Chennai City Region, Chennai – 600 002. The same was intimated to the complainant vide lr no: CPC/PLI/Misc dlgs dated 01.08.2016. The opposite party submits that in the proposal form it was clearly declared by the proponent that contents in the proposal form were thoroughly read/explained. The insurance agent could not fill details without the knowledge of the insurant. Here he had suppressed the facts of his disease by clearly marking “NO” in SL.17 (a) (b) of the proposal form. Hence the death claim had been disposed by rule and complete investigation. The opposite party states that when the claim was submitted, the complainant was enquired in detail for further action. It was established that the insurant had submitted the proposal form suppressing the material fact with incorrect declaration and hence the case was disposed by the Postmaster General. Therefore there is no deficiency in service as adversed by the complainant.                 

3. The complainants and the   opposite parties had come forward with their respective proof affidavit and documents. Ex.A1 to Ex.A8 were marked on the side of the complainants and the opposite parties documents Ex.B1 to Ex.B8 were marked. 

          4. The written argument of the complainants and the opposite parties were filed and the oral argument of both were heard.   

5. POINTS FOR CONSIDERATION:

          1. Whether there is deficiency in service on the part of the opposite parties?

          2. Whether the complainant is entitled to any relief? If so to what extent?

6. POINT NO :1 

One Mr. Venkatesan  husband of  the 1^st complainant, father of the  2^nd & 3^rd complainant who was working as an  HC-13331, F-2, Egmore Police station, Chennai  had taken Postal Life Insurance policy No.TN-529520-CC on 11.02.2012 namely SANTHOSH (ENDOWMENT ASSURANCE) policy in Ex.A1. The sum assured was Rs.2,00,000/-. Mr. Venkatesan died on 26.05.2014 due to ill-health. He was admitted in Trust Hospital and the  discharge summary from Trust Hospital is Ex.A2.  The death certificate and the legal heir certificate  copies are Ex.A3 & Ex.A4. Late Venkatesan nominated his wife the 1^st complainant as nominee in the policy papers. On 01.12.2014 the 1^st complainant approached the opposite parties and submitted the relevant papers for the claim. The claim acknowledgement by the 1^st opposite party is under Ex.A5. Subsequently the claim was rejected by the 1^st opposite party as per clause 17, which explains that non- disclosure of the proposer’s personal history of the previous ailments  which  resulted in rejection and  cannot be sustained.

         07. Under  Ex.A6 in DC 3396/DEO-16/TN-529520-CC dated 10.12.2014, 1^st opposite party addressed  a letter to the Commissioner of Police with a copy to the 1^st complainant, requiring particulars of medical leave taken by the deceased from 11.02.2009 to 10.02.2012 with photocopies of medical certificate. Again cause of death certificate issued by the hospital and Medical/treatment summary from the hospital was sought by the 1^st opposite party.  Ex.A7 & Ex.A8 are the letters confirming rejection of claim with reasons.

         08. Rule 53 from the extract of the policy is in Ex.B1. The proposal form is Ex.B2. It is pointed out by the  opposite parties that the deceased suppressed the facts of the disease which he suffered  by  clearly marking ‘No’ in SL.17 (a) (b) of the proposal form. Rule 39 of the policy reads as:

‘Wrong information  furnished by a person or suppression of factual information by a person admitted to the benefits of the Post Office Life Insurance Fund/Rural Post Office Life Insurance Fund will,  at the discretion of the Postmaster General, render voidable the contract concluded with that person and lead to forfeiture of all payments made by him’

which is produced in Ex.B3. As per  rule 39, since the  suppression of factual information by  the insured  person  ended in treating the  voidable at the instance of the opposite parties and was rejected by them. The complainants in their complaint stated that the insurance agent wrongly filled up the proposal form without the knowledge of the insurant. It actually means that the insured had the disease  earlier but the agent has filled up as ‘No’ in column No.17. The Insured/ deceased  was  an educated person and  a head constable  signed in English after  giving a declaration at the end of the proposal form  as read/explained and hence the reason stated by the 1^st complainant, for wrongly filling up the proposal form  by the agent cannot be accepted by this forum.

        09. As per policy 2011 in rule -53, (B1) “cases of early death i.e before the completion of  3 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, whether there was any deliberate attempt on the part of marketing staff to insure substandard life or to cause loss to fund and whether the cause of death had any relation to the disease. The Postmaster General after satisfying himself may sanction death claim.”

            10. As per investigation, it is found out that the insurant was diabetic for 14 years, Hypertension for 6 years, Diabetic Kidney  disease  (stage V ) Diabetic Foot, Peripheral Neuropathy, CAHD and expired on 26^th May 2014 due to massive myocardial infarction. Moreover the insurant had availed Medical leave for 77  days before taking up the policy. Particulars of Medical Leave taken by the insurant/deceased from11.02.2009 to 10.02.2012 was  requested by the opposite parties from the Commissioner of Police a copy to the 1^st complainant is Ex.A6. Ex.B7 & Ex.B8 are the documents to prove that the deceased insured person suffered from illness.  Therefore it confirms that based on his illness he had taken medical leave  and suppressed the fact in the proposal form.

            11. The following citations have been submitted on the side of the complainant 

DIRECTOR, POSTAL LIFE INSURANCE

VS

DR. B.B. GOYAL

IN

                                                   (II (1998) CPJ 54)

This case is an appeal before Union Territory Consumer Disputes Redressal Commission, Chandigarh. The complainant applied for convertible whole life policy and the maturity age being 60 years and the opposite party treated maturity age as 58 years where the District Forum directed the opposite parties to fix the maturity age as 60 years and hence appeal preferred and this case is not applicable to the present case since the facts do vary.

  POST MASTER GENERAL

VS

BHATERI AND OTHERS.

IN

II(1992) CPJ 834

This  Case is an Appeal from District forum to Haryana  State consumer Disputes Redressal Commission, Chandigarh, wherein the whole case revolved around the proposal form of the deceased regarding the alleged  mis statements and suppressions. The proposal form which was the foundation of the alleged concealment and non-disclosure had not been produced before the Forum, no separate application had also been filed to place an additional evidence hence the appeal was dismissed. Therefore this case do not relate to the present case, since the supportive  document is filed here, in the present case.

MADHYA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BHOPAL

SMT. ZUBAIDA QURESHI

VS

POST-MASTER GENERAL , M.P.CIRCLE AND OTHERS

IN

       (III (2003) CPJ 93)

          12. The appeal is against the order of District Forum, Bhopal.The claim was repudiated in the District Forum on the basis of suppression of material fact. Among the three proposals, two proposals in the name of the Medical officer is written, which bears the signature of the proposer, but not of the Medical officer, the other one bears not only  the name of the  Medical Officer, but initials and signature of the proposer. The statement made in the proposal for insurance or any report of the Medical Officer leading to the issue of policy was inaccurate or false, unless it is pleaded and proved that such statement was on a material matter to disclose and that it was fraudulently made, the burden which lies on the Insurer and the Insurer had not placed any material on record and the appeal was allowed. This case does vary in situations and circumstances of the present case.

          13. The contract of insurance is found upon utmost good faith i.e. Ubberimae   fide. If one party fails to observe good faith, the contract may be avoided by the other as put forth by the opposite parties. The opposite parties would contend that the fact of existing disease was fraudulently suppressed in the proposal form  and also the 1^st complainant herself had declared that her husband died due to ill health. Since it happened within three years from the date of acceptance of the policy, as per rule it was investigated and then the insurant’s suppression of material fact came to light. If there had been proper disclosure, opposite parties  would not have allowed the proponent to be eligible for Postal Life Insurance is the point put forth by opposite parties and is to be accepted. After investigation it was found that the late insurant was diabetic for 14 years render voidable the contract concluded with that person and lead to forfeiture of all payments made by him and it was informed to the 1^st complainant  through the letter  Ex.B5. Discharge summary and certificate from the Trust Hospital is in Ex.B6. From Ex.B7 & Ex.B8 it is inferred that the deceased had availed medical leave from 11.02.2009 to 09.04.2010 and also from 14.04.2010 to 10.02.2012. The policy was first taken on 11.02.2012. Hence earlier to taking policy, admittedly, he had availed medical leave.  From this also it is confirmed that the husband of the 1^st complainant suffered from illness and that has not been disclosed in the proposal form. Discharge Summary given by the Doctor in Ex.B6 series also confirms that the deceased person had many diseases it infers that it might be pre-disposing factors of or myocardial infarction also. As per Ex.A2 dated 17.05.2014 the Discharge Summary, the deceased Insurer was a Diabetic patient   since 14 years and hypothetic  for 6 years. The proposal form  in Ex.B2 is dated 11.02.2012. Hence it is also proved at the proposal form that the deceased insurer had the said diseases but not disclosed in the proposal Form. To confirm the same, the 1^st complainant had not denied the fact and she defends that the proposal form was filled up by the agent mistakenly and these points have already been discussed in earlier paragraphs. After going through all factors, we come to the conclusion that the opposite parties had rightly rejected the claim and there is no deficiency in service on the part of opposite parties and the complaint fails in its part.

14. POINT NO:2

 As per the discussions held by us in point No.1, the complainant is not entitled to any relief as prayed for and the complaint is liable to be dismissed.  

In the result this complaint is dismissed. No costs.         

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 26^th   day of June 2019.

 

MEMBER – I                                                                PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANTS:

Ex.A1 dated 11.02.2012         Xerox copy of Postal Life Insurance Policy bearing No.TN-529520-CC Santhosh (Endowment Assurance) policy

Ex.A2 dated 07.05.2014         Xerox copy of Discharge Summary

Ex.A3 dated 26.05.2014         Xerox copy of Death Certificate of Mr.M.Venkatesan

Ex.A4 dated 25.05.2014         Xerox copy Legal hership Certificate of Mr.M.Venkatesan

Ex.A5 dated 01.12.2014         Letter from the 1^st opposite party to the 1^st complainant

Ex.A6 dated 10.12.2014         Letter from the 1^st opposite party to the Commissioner of Police marking copy to the 1^st complainant

Ex.A7 dated 10.12.2014         Letter from the 1^st opposite party the 1^st complainant

Ex.A8 dated 01.08.2016         Rejection letter from the 2^nd opposite party

 

LIST OF DOCUMENTS FILED BY THE   OPPOSITE PARTIES:

 

Ex.B1 dated NIL                     Extract of POLI 2011 – Rule 53

 

Ex.B2 dated 11.02.2012                   Copy of Proposal Form

 

Ex.B3 dated NIL                     Extract of POLI rules 2011 – Rule 39

 

Ex.B4 dated 26.07.2015         Letter No: PLI/DC/CCN/2015/CCR of the Postmaster General, Chennai City Region, Chennai 600 002

 

Ex.B5 dated 01.08.2016         Letter No:COC/PLI/Misc  dlgs of the Postmaster, Parktown HPO, Chennai – 600 003.

 

Ex.B6 dated 17.05.2014         Discharge Summary of Trust Hospital, Chennai – 600 023

 

Ex.B7 dated 23.12.2014         Report from Inspector of Police Crime, G5-Secretariate Colony, Police Station, Chennai -10

 

Ex.B8 dated 23.12.2014         Report from Inspector of Police Traffic, F2 Egmore Police Station, Egmore, Chennai – 08.

 

 

 

MEMBER – I                                                               PRESIDENT