DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BARNALA, CAMP COURT AT AMRITSAR, PUNJAB.

 

Complaint Case No : RBT/CC/2018/19

Date of Institution : 08.01.2018/29.11.2021

Date of Decision : 22.06.2022

Sukhwinder Singh Chohan age 60 years resident of VPO Majitha, Tehsil and District Amritsar.    …Complainant

Versus

1. The Deputy Divisional Manager (PLI), Office of the Chief Post Master General, Punjab Circle, Chandigarh. 

2. Senior Superintendent Post Office, General Post Office, Amritsar.

…Opposite Parties

Complaint U/S 11 and 12 of The Consumer Protection Act, 1986

Present: Sh. Anil Sharma Adv counsel for complainant.

Sh. Vishal Bhardwaj Adv counsel for the opposite parties.

Quorum.-

1. Sh. Ashish Kumar Grover : President

2. Smt. Urmila Kumari : Member

(ORDER BY ASHISH KUMAR GROVER PRESIDENT):

    The present complaint has been received by transfer from District Consumer Commission, Amritsar in compliance of the order dated 26.11.2021 of the Hon'ble State Consumer Disputes Redressal Commission, Punjab, Chandigarh. The complainant filed the present complaint under Sections 11 and 12 of the Consumer Protection Act against The Deputy Divisional Manager, Chandigarh and another. (in short the opposite parties). 

2. The facts leading to the present complaint as stated by the complainant are that the wife of the complainant namely Palwinder Kaur was working as Postal Assistant in Post Office Majitha, District Amritsar. In the month of February 2015 at the age of 53 years she had availed Postal Life Insurance and paid premium up to March 2016 for sum of Rs. 1,00,000/- vide policy No. PB-174224. Before getting the said policy she had given full details about her health. After that medical examination of the wife of complainant was got conducted by Dr. Sawinder Singh CMO who has completed all formalities. The policy was issued by the opposite parties on 25.2.2015 in which complainant is nominee in the said policy. The wife of the complainant has expired on 23.3.2016. The complainant being nominee file the present complaint. In the month of January February 2016 the wife of the complainant fallen ill due to jaundice and she was under OPD of Dr. Amitabh Mohan who advised for conducting some medical tests. In Bio Chemistry Report Alpha Feto Protein were found at the ratio of 634.71. On 15.3.2016 tests were conducted in the same lab. The doctor advised the wife of complainant to take complete bed rest as it was diagnosed from the test dated 18.2.2016 that she was suffering from Liver Cancer and doctor referred her for OPD at Escorts Hospital, Amritsar. 

3. It is further alleged that on 23.3.2016 wife of complainant died. Thereafter, complainant being nominee filed application for settling insurance claim in respect of PLI to the opposite parties. The complainant astonished to know that his claim application was rejected by the opposite parties on the pretext on putting some excuses. The opposite parties instead of settling death claim of wife of complainant inquiry was conducted by ASP Amritsar. In his finding he stated that as per medical legal report of Forties Escorts Hospital on 1.2.2016 and 15.3.2016 diagno lab New Delhi that Alpha Feto Protein (AFP) Cancer 701.42 was available since long which spread whole body very quickly as per report. He also stated that the doctor of the department and field officer of the Department could not judge or examine the wife of the complainant correctly. The deceased was old and obtained the bad policy and cancer disease mentioned above was cause of death. The nominee has failed to produce any record prior to 14.2.2015 and after of any hospital in such serious disease. The complainant has failed to produce medical bills. He further stated that Sameer Nagpal Field Officer process a bad policy. He failed to fill up some columns completely. The claim is not fit for payment and may be rejected and this report was made on 5.1.2017. The opposite party No. 2 rejected the claim of the complainant on the same grounds on 5.6.2017. After that opposite party No. 1 also rejected the claim of the complainant on 5.6.2017. The wife of the complainant was not suffering from any disease or cancer prior getting this PLI so question does not arise to submit medical reports and medical bills. As per American Cancer research Society it is often hard to find liver cancer early because signs and symptoms often do not appear until it is in the later stage. Small liver tumors are hard to detect on a physical examination because most of liver cancer is covered by the right rib cage. The wife of the complainant was fit and find at the time of obtaining PLI. The complainant is claiming only for PLI not for medical reimbursement of his wife as PLI is related to life of the deceased and not for medical reimbursement of deceased. The act of opposite parties is deficiency in service and unfair trade practice. Hence, the present complaint is filed seeking the following reliefs.-

1) The opposite parties may be directed to settle the claim of PLI obtained by wife of complainant in which complainant is nominee alongwith interest at the rate of 18% per annum from the day when the claim was submitted by the complainant with the opposite parties till actual realization.   

2) To pay Rs. 50,000/- as compensation for mental agony and harassment and Rs. 11,000/- as litigation expenses.

3) Any other relief to which the complainant is found entitled. 

4. Upon notice of this complaint, the opposite parties filed written statement taking preliminary objections that the complainant has not come to this Commission with clean hands. Complainant has no cause of action and locus standi to file the present complaint. Further, Late Palwinder Kaur wife of complainant was working as Postal Assistant at Majitha SO who availed policy No. PB-174224-P on 14.2.2015 for assured value of Rs. 1,00,000/-. At the time of taking policy she intentionally concealed the facts about her health at the time of taking policy and declared herself physically fit in the proposal form. But as per office record of leaves/medical leaves availed by Palwinder Kaur she was suffering from various liver diseases and other health related and she died on 23.3.2016 due to liver cancer and other diseases. As a matter of fact this was early death case before completion of 3 years from the date of acceptance of policy so thorough investigation was required before sanctioning the claim and concerned Inquiry Officer rejected the claim case on the grounds of office leave records availed by late insured and medical certificates given by her so claim was rejected on the genuine grounds.

5. On merits, the policy was purchased through departmental agent Sameer Nagpal who filled the proposal form and policy was issued on 23.2.2015. The said Palwinder Kaur concealed the facts about her health. Dr. Sawinder Singh CMO, P&T Dispensary, Amritsar declared her fit on the basis of declaration made in column No. 30. The wife of the complainant was admitted in Life Line Hospital on 8.7.2013 for her treatment and undergone surgery. She was suffering from various liver diseases and so many other health problems which were life threatening but she concealed all the facts. The policy was obtained when the liver disease was at critical stage. The Inquiry Officer is not a doctor but he proposed to reject the policy on the basis of medical certificates and opinion of qualified doctors. The wife of the complainant violated the terms and conditions of the policy. The claim was rightly rejected by the opposite parties so there is no deficiency in service on the part of the opposite parties. Lastly, the opposite parties prayed for the dismissal of the present complaint with costs.   

6. To prove his case the complainant tendered in evidence his affidavit Ex.CW-1/A alongwith documents Ex.C-1 to Ex.C-19 and closed the evidence. 

7. To rebut the case of the complainant the opposite parties tendered in evidence affidavit of Makhan Singh Senior Superintendent of Posts Ex.OP-1 and closed the evidence. 

8. We have heard the learned counsel for the parties and gone through the record on the file. Written arguments also filed by both the parties. 

9. The complainant alleged in the complaint that the wife of the complainant namely Palwinder Kaur was working as Postal Assistant in Post Office Majitha, District Amritsar and she had availed Postal Life Insurance and paid premium up to March 2016 for sum of Rs. 1,00,000/- vide policy No. PB-174224. The complainant further alleged in the complaint that before getting the said policy she had given full details about her health and medical examination of his wife was got conducted by Dr. Sawinder Singh CMO. The wife of the complainant has expired on 23.3.2016. The complainant applied for claim amount being nominee but was rejected by the opposite parties on the pretext on putting some excuses. The opposite parties instead of settling the death claim of wife of complainant inquiry was conducted by ASP Amritsar.  The wife of the complainant fallen ill due to jaundice and she was under OPD of Dr. Amitabh Mohan who advised for conducting some medical tests. In Bio Chemistry Report Alpha Feto Protein were found at the ratio of 634.71. The doctor advised the wife of complainant for bed rest as she was suffering from Liver Cancer and doctor referred her for OPD at Escorts Hospital, Amritsar. The opposite parties rejected the claim of the complainant on the ground that at the time of taking the insurance policy the wife of the complainant concealed her disease. The complainant alleged in the complaint that the wife of the complainant was not suffering from any disease or cancer prior to getting this Postal Life Insurance so question does not arise to submit medical reports and medical bills. The complainant is claiming only for PLI not for medical reimbursement of his wife as PLI is related to life of the deceased and not for medical reimbursement of deceased.

10. On the other hand, the opposite parties filed written version and admitted the insurance policy. The opposite parties alleged in the written version that at the time of taking the policy the deceased Palwinder Kaur intentionally concealed the facts about her health and declared herself physically fit in the proposal form. But as per office record of leaves/medical leaves availed by Palwinder Kaur she was suffering from various liver diseases and other health related issues and she died on 23.3.2016 due to liver cancer and other diseases. As a matter of fact this was early death case before completion of 3 years from the date of acceptance of policy so thorough investigation was required before sanctioning the claim and concerned Inquiry Officer rejected the claim case on the grounds of office leave records availed by Palwinder Kaur. The opposite parties further alleged that the wife of the complainant violated the terms and conditions of the policy so the claim was rightly rejected by the opposite parties. 

11. On the perusal of the pleadings and evidence produced by both the parties it established that wife of the complainant had taken the insurance of Rs. 1,00,000/- and this fact is also admitted by the opposite parties. The learned counsel for the complainant argued that the wife of the complainant has not concealed any disease from the opposite parties and the doctor of the opposite parties Dr. Sawinder Singh Chief Medical Officer also examined the wife of complainant before issuing the policy and he certified that she was healthy and fit for taking the said insurance policy. The learned counsel for the opposite parties argued that as per the documents before department i.e. leaves/medical leaves the wife of the complainant suffered from liver and other diseases and she concealed the said facts from the department before taking the insurance policy. But on the perusal of the file and evidence produced by the opposite parties it revealed that the opposite parties have not produced any leave application as stated in the written version. Moreover, the death of the wife of the complainant was caused due to liver cancer and the opposite parties failed to prove that she suffered from the liver cancer before taking the insurance policy in question. Furthermore, the doctor of the opposite parties was also examined Palwinder Kaur and he certified that she was fit and healthy for taking the insurance policy. Therefore, from the above said discussion it is proved on the file that claim of the complainant was rejected by the opposite parties on unreasonable grounds. 

12. In view of the above discussion present complaint is partly allowed and opposite parties are directed to pay Rs. 1,00,000/- to the complainant alongwith interest at the rate of 7% per annum from the date of filing of present complaint till actual realization, as complainant is nominee of deceased Palwinder Kaur which established from the proposal form exhibited by the complainant. The opposite parties are also directed to pay Rs. 10,000/- to the complainant as compensation for  mental tension and harassment and Rs. 5,500/- as litigation expenses. Compliance of the order be made within the period of 45 days from the date of the receipt of the copy of this order. Both the parties are jointly and severally liable to comply with the above mentioned order. Copy of the order will be supplied to the parties by the District Consumer Commission, Amritsar as per rules. File be sent back to the District Consumer Disputes Redressal Commission, Amritsar.  

ANNOUNCED IN THE OPEN COMMISSION:

        22nd Day of June 2022

 

 

            (Ashish Kumar Grover)

            President

              

(Urmila Kumari)

Member