By Sri. A.S. Subhagan, Member:-

            This is a complaint filed under section 35 of the Consumer Protection Act 2019.

            2.  Facts of the case in brief:-  The Complainant had taken a postal life insurance policy No.RKLEA758644 dated 24.03.2015 in the name of his wife, and the Complainant was made as nominee in that policy.  The half yearly premium payable in respect of the policy was Rs.7,530/- which was regularly paid by the Complainant.  On 01.07.2017, owing to chest pain, his wife was admitted in Leo Metro Hospital and angioplasty was done on that day itself, and for better treatment for bypass surgery, as per the direction of Dr. Cheriyan of WIMS Hospital, Meppady, she was admitted in SAI Hospital, Bengaluru on 11.10.2017.  As per the instruction from SAI Hospital, the Complainant’s wife was used to take treatment from WIMS Hospital on monthly basis, but she suicided on 21.01.2018.  For getting the claim of insurance on the policy, the Complainant submitted claim application together with all the required documents, in Head Post Office, Kalpetta.  In spite of repeated enquiry, as the Complainant did not get any information, the Complainant submitted an application before the Adalath conducted by the District Collector, Wayanad on 20.10.2019.  In the adalath conducted on 03.11.2019, the Assistant Superintendent of Post Office, Kalpetta had offered to settle the matter.  On 27.11.2020, a letter was received from Senior Superintendent of Post Offices, Kozhikode division stating that his claim application had been forwarded to the Approving Authority.  But on 21.12.2020, the Complainant got a letter from the Manager, Postal Life Insurance, Department of Posts, Kalpetta Head Office, repudiating the claim and hence this complaint with prayers

1. To direct the Opposite Party to pay the claim amount of Rs.3,00,000/- and 15% interest on it
2. To direct the Opposite Party to pay Rs.50,000/- as compensation towards physical and mental inconvenience and hardships and
3. To direct the Opposite Party to pay Rs.5,000/- towards cost of this complaint.

3.  The Opposite Party appeared and filed version, the contents of which in brief are as follows:-  It is submitted that Smt. Bindu . P. M, (the late insurant) had joined in RPLI policy on 24.03.2015 (policy No. R-KL-EA-758644. Sum assured of the policy was Rs.3,00,000/- and premium was Rs.7,305/-,(half yearly premium). Smt. Bindu P.M nominated her husband Sri. M. Raveendran, Ramalayam, Theneri, Kakkavayal Post as nominee for this insurance policy. The insurant Late Bindu. P.M, committed suicide on 21.01.2018. Her husband Sri. Raveendran M, is the claimant in this policy. Claim received on 31.10.2018 at Kalpetta HPO. As this is a premature death case, after conducting necessary enquiries through ASP, Kalpetta Sub Division, the claim was forwarded to approving authority (Postmaster General) on 18.06.2019.  Since this is a claim arising out of death of the insured before completing three years from acceptance of policy, a detailed enquiry had to be conducted on the claim. This was conducted through Assistant Superintendent of Post Offices, Kalpetta Sub Division. As revealed during the enquiry, the late insurant was first admitted to DM Wayanad Institute of Medical Sciences, Meppadi on 01.07.2017 as she suffered chest pain. She underwent Angioplasty and was referred to Sri. Sathya Sai Institute of Higher Medical Sciences, Bangalore, for further treatment, where she was treated on 11.10.2017. After that, she was under medication in consultation with DM Wayanad Institute of Medical Sciences, Meppadi till her death. The insurant Late Bindu. P. M, committed suicide on 21.01.2018.  It is submitted that the claimant filed a complaint in Adalath convened by District collector, Wayanad. On behalf of the Opposite Party, Assistant Superintendent of Post Offices, Kalpetta Sub Division attended the Parathi Parihara Adalath which was held at the chamber of the District Collector, Wayanad on 03.11.2020. The details of the case were explained during the Adalath and the District Collector directed to settle the claim soon.  It is respectfully submitted that as per Rule 53 of Post Office Life Insurance Rules 2011, cases of early death before completion of three years from the date of acceptance of policy will be investigated thoroughly to enquire if the insurant while submitting the proposal had suppressed material information. A copy of the said rule is produced and marked as Annexure Bl. As per the discharge summary from DM WIMS the late insurant had a past history of 5 years treatment for Diabetes Mellitus and hypertension. The discharge summary was issued in 2017. A copy of the discharge summary dated 10.07.2017 is produced and marked as Annexure B2. As such the insurant was under treatment for diabetes and hypertension since 2012. The insurant while submitting the proposal form on 24.03.2015 for the policy had submitted that she was not suffered from Diabetes and Hypertension. The insured has mentioned “No” against the relevant column 30(b) (viii) and (ix) of the proposal form. Moreover, the insured had declared in the proposal form as “I hereby declare that the foregoing statements and answers have been given by me after fully understanding the questions and the same are true and complete in all respects and that I have not withheld any information and I do hereby agree and declare that these statements and this declaration shall be the basis of the contact of assurance between me and the Department of Posts and that if any untrue averment be contained therein, the said contract shall be absolutely null and void and all moneys which shall have been paid in respect thereof shall stand forfeited to the Department.” A copy of the proposal form submitted by the insured is produced herewith and marked as Annexure B3. By not disclosing the fact regarding treatment for DM and hypertension even at the time of submitting the proposal, the insured had suppressed the fact and as such the competent authority, Postmaster General, Northern Region, Calicut, had rejected the death claim of the above policy as this is a case of bad life insured due to suppression of facts. Information regarding the rejection of the claim had been informed to the claimant, the complainant herein, on 21.12.2020.  It is submitted that the decision of the Postmaster General, Northern Region, Calicut had been scrutinized by the Chief Postmaster General, Kerala Circle Trivandrum and agreed with the decision taken by the PMG. It is therefore respectfully submitted that the Approving Authority has considered all aspects of the case in detail and rejected the claim as the case involved suppression of facts as the Late insurant had past history of treatment for Diabetes Mellitus and hypertension. The decision had been taken as per the exact statutory rules on the subject. Hence, the complaint is liable to be dismissed.

4.  Complainant filed chief affidavit and Exts.A1 to A8 were marked from his side and he was examined as PW1.  Opposite Party also filed chief affidavit, Exts.B1 to B7 were marked from their side and the Assistant Superintendent of Posts, Kalpetta was examined as OPW1.

5.  On going through the complaint, version, documents marked, oral evidences adduced by the Parties, the arguments in hearing and the facts and circumstances of the case, Commission raised the following points for consideration:-

1. Whether there has been any deficiency in service/unfair trade practice from the part of Opposite Party?
2. If so, Relief and Cost…?

            6.  Point No.1:-  The Postal Life Insurance Policy is admitted by the Opposite Party.  The allegation of the Complainant is that in spite of a valid policy, the Opposite Party repudiated his claim as nominee, on the suicide of his wife, though he had the eligibility to get the amount of claim, which is deficiency in service.  On the other hand, the contentions of the Opposite Party are that (1) As this claim was related to a premature death case (ie death before three years of acceptance of policy) after conducting enquiry through Assistant Superintendent of Posts, Kalpetta Sub-Division, the claim application was forwarded to Approving Authority.  (2) As per the discharge summary issued from DM WIMS in 2017 the insured had a past history of five years treatment for diabetics and hypertension.  (3)  The insured had suppressed this facts of pre-existing disease from the proposal form on 24.03.2015.  (4)  hence the claim application of the Complainant was rejected.

            7.  To substantiate the contention of the Opposite Party, they have produced Ext.B2 discharge summary dated 10.07.2017.  But in oral evidence the Complainant has stated that “26.03.2015  BWv C³jqd³kn tNÀ¶Xv policy bn tNcp¶ kab¯v AkpJ§sfm¶pw CÃmbncp¶p.  06.01.2023 \v kaÀ¸n¨ chief affidavit  WIMS Hospital hcp¯nb ]nghn\v Fsâ claim At]£ \ncnkn¨ncn¡pIbmsW¶v ]dbm³ ImcWw discharge summary bn hypertension and diabetes Ds­¶v ]dªXn\memWv.  Repudiation letter e`n¨Xns\ XpSÀ¶v discharge summary bn h¶ ]nghns\Ipdn¨v At\zjn¨ncp¶p.  tcmKnbpsS IqsS \n¶hÀ ]dªXnsâ ASnØm\¯n Bbncnbv¡mw A¯c¯n report sNbvXsX¶mWv ]dªXv”.  In re-examination, the Complainant has stated that “Fsâ `mcy  policy FSp¡p¶Xn\v ap³]v medical FSp¯ncp¶p.  BbXv Ext.A1 Bbn mark sNbvXn«p­v.  B kab¯v diabetics and hypertension ]cntim[n¨t¸mÄ tcmKw CÃmbncp¶p”.  Here, the Opposite Party contents that the insured had diabetics and hypertension at the time of giving proposal for policy which was suppressed and hence she had pre-existing disease.  While the deposition of the Complainant in cross examination and re-examination is that she had no previous disease such as diabetes and hypertension.  He also stated that the recording as to these diseases might have been noted from the tongues of the bystanders in the hospital.  Therefore, so as to prove the fact that the insured had pre-existing diseases such as diabetes and hypertension, the examination of the treated doctor who prepared the discharge summary was inevitable but the Opposite Party has failed to examine the treated doctor as witness to prove the veracity of their contention that the insured had diabetes and hypertension at the time of or before taking the policy.  The policy holder was a woman who had suicided.  The policy premiums were paid regularly.  The policy was taken on 24.03.2015.  The suicide was occurred on 21.01.2018.  That is, the Complainant had paid insurance premiums in respect of the policy for about three years.  Even then the claim on the policy was repudiated by the Opposite Party without and undoubtedly proving the veracity of the recording in the discharge summary with substantiating evidence through examining the treated doctor who prepared the discharge summary.  Moreover, in cross-examination of OPW1 by the Complainant, OPW1 has stated that  “Cu policy bn join sN¿m³ Postal Department recognize sNbvX Medical Practitioner sS report lmPcmt¡­XmWv. Proposal form  sâ `mKamWv.  A§ns\ Cu tIkn am\´hmSnbnse recognized doctor BWv  report kaÀ¸n¨n«pffXv”.  From this deposition of OPW1, it is clear that the insured was issued this policy considering the report of their own recognized doctor after satisfying the health and disease aspects of the Complainant.  Considering the overall evidences available before us, we are of the view that the claim of the Complainant is seen repudiated by the Opposite Party not in good faith but in bad faith on untenable grounds which is deficiency in service.  So, there has been deficiency in service from the part of the Opposite Party for which they are liable to the Complainant.  Therefore, Point No.1 is proved against the Opposite Party.

            8.  Point No.2:-  Since Point No.1 is proved against the Opposite Party the Complainant has the right to get the policy claim amount, compensation and cost of this complaint.

            In the result, the complaint is allowed and the Opposite Party is directed to

1. Pay Rs.3,00,000/- (Rupees Three Lakh Only) being the policy claim amount together with interest @ 8% per annum from the date of repudiation of the claim ie, from 21.12.2020
2. Pay Rs.50,000/- (Rupees Fifty Thousand Only) towards compensation for mental agony and physical loss and injury and
3. Pay Rs.5,000/- (Rupees Five Thousand Only) towards cost of this complaint.

The above amounts shall be paid to the Complainant within one month from the date of receipt of this Order, failing which the amounts will carry interest @ 9% per annum from the date of this Order.

Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 25^th day of August 2023.

Date of Filing:-15.01.2021.

PRESIDENT   :Sd/-

MEMBER       :Sd/-                   

MEMBER       :Sd/-

APPENDIX.

Witness for the Complainant:-

PW1.              M. Ravindran.                                 Conductor, KSRTC.

Witness for the Opposite Party:-

OPW1.          Ragesh Ravi.                                                Assistant Superintendent of Posts,

Kalpetta.

Exhibits for the Complainant:

A1.                  Rural Postal Life Insurance policy.

A2.                  Death Certificate.                                                   Dt:05.05.2018.

A3.                  Copy of Post-mortem Certificate.                     Dt:29.01.2018.

A4.                  Copy of First Information Report.                     Dt:21.01.2018.

A5.                  Copy of Final Report.                                           

A6.                  Copy of Judgment of Sub-Divisional Magistrate Court,

Mananthavady.                                                      Dt:12.11.2020.

A7.                  Copy of Letter.                                                        Dt:27.11.2020.

A8.                  Copy of Claim Repudiation Letter.                    Dt:21.12.2020.

Exhibits for the Opposite Party:-

B1.                  Copy of Post Office Life Insurance Rules 2011 (payment of policies)

B2.                  Copy of Discharge Summary.

B3.                  Copy of Medical Examiner’s Report.   

B4.                  Copy of Post Office Life Insurance Rules 2011 (1 page).

B5.                  Copy of Rural Postal Life Insurance policy.

B6.                  Copy of Judgment in the Hon’ble Supreme Court of India Civil

Appeal No.2776 of 2002. Dt:10.07.2009.

B7.                  Copy of Judgment in T. Manjulatha & Anr Vs Birla Sun Life

Insurance Co Ltd of National Consumer Disputes Redressal Commission, New Delhi. Dt: 19.02.2020.

PRESIDENT   :Sd/-

MEMBER       :Sd/-

MEMBER       :Sd/-

/True Copy/

                                                                                     Sd/-

                                                                                             ASSISTANT REGISTRAR

                                                                                                 CDRC, WAYANAD.

Kv/-