DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: BHADRAK : (ODISHA).

Dated the 12^th day of December 2022.

C. C. No. 57 of 2020.

Present 1. ShriShiba Prasad Mohanty, President,

                                                                                                                                                        2.  Smt. Madhusmita Swain, Member.

Madhumati Dash, W/o:- Late Muktikanta Dash,

Vill/Po:-Ambaroli, Via:- Charampa, P.S:- Bhadrak (R),

Dist- Bhadrak.

                                                             ……………. Complainant.

                                   (Versus)

1. The Post Master General, Odisha Circle (P.M.G.Office)

At/Po:- Bhubaneswar, Dist:- Khurda.

2. The Superintendent of Post Offices,

Bhadrak Division, At/Po/Dist:-Bhadrak.

     3)  The C.P.C. Manager (P.L.I.),

          Bhadrak Head Office, Bhadrak,

          At/Po/Dist:-Bhadrak.       

                                                        …………Opposite parties.

Counsel For Complainant                 : Sri S. Nayak, Advocate & Others.

Counsel For the OPs No.1,2 & 3       :   Sri Durga Prasad Raymohapatra(SGC)

Date of hearing                                 :   29.11.2022.

Date of order                                     :   12.12.2022.

SHIBA PRASAD MOHANTY, PRESIDENT.

          In the matter of an application filed by the complainant alleging deficiency of service against the Opposite Parties under Consumer Protection Act, 2019.

Brief facts of the case is that :-  the complainant’s husband Muktikanta Dash was serving as a Branch Post Master having his permanent address of village Ambaroli, Via- Charampa, Dist. Bhadrak which is under the division of O.P. No. 2 & under the circle of O.P. No. 1.  The O.P. No. 3 is the sole in charge of Postal Life Insurance policies & happens to be the C.P.C. Manager (P.L.I.) of Bhadrak Head Post Office, Bhadrak.  Husband of the complainant while in service opted to purchase postal insurance policies for which he purchased 8 Nos. of policies & the premium were being paid regularly after deduction from his monthly salary.During the continuance of the said 8 nos. of postal life insurance policies, husband of the complainant namely Muktikanta Dash all on a suddenly fell ill and was treated at D.H.H., Bhadrak vide Regd. No. 27320, dt.28.11.2013 due to acute Myocardial infarction and hepatocellular failure.  Thereafter as his condition became serious he was referred to S.C.B., Medical College Hospital, Cuttack where he expired on the same day.  Thereafter being the nominee & wife of the deceased policy holder Muktikanta Dash, the present Complainant lodged claim before O.P. No. 3 to get the amount accrued under the policies of her deceased husband.  Thereafter as per desire of O.P. No. 2 & 3, complainant submitted all the relevant documents before O.P. No. 3 in the office of O.P. No. 2.Complainant was given the amount accrued under 5 nos. of policies of her deceased husband.  But with respect to the following polices the amount has not yet been given to the complainant.  Those are as below:-

            The decision of the O.Ps regarding rejection of the claim of the complainant is illegal, arbitrary and is not in accordance of the norms of the policy.  The original 3 nos. of policies are with O.P. No. 3. The plea taken by the O.Ps for repudiating the claim of the complainant is not supported by any record or material evidence.  The husband of the complainant was well & good in health till his death.  Moreover myocardial infarction & hepatocellular failure may appear suddenly due to various reasons & may disappear of proper treatment is given in time.  There are casual illness & while entering into the policy such disease was not there in the husband’s of the complainant.  In the worst sake, if the complainant’s husband has not disclosed about temporary suffering of this type of sickness, it shall not amount to violation of policy conditions.  The insured has neither concerned nor suppressed about his sufferings of such illness prior to entering into such policy.  By repudiating the general life insurance claim the O.Ps have caused deficiency of service.  The complainant being the nominee of the deceased policy holder is entitled to get the benefits accrued under the above mentioned three nos. of policies amounting to Rs. 5,00,000/- (Rupees five lakhs) only.  Vide letter dt. 22.06.2017, O.P. No. 3 intimated the complainant regarding repudiation of the claim under the three nos. of P.L.I. policies & in that letter it has been written that “if you have any queries concerning the decision, please notify at your nearest post office.  Since long the complainant has been running to the office of O.P. No. 2 & 3 to know about her claim & to appraise her regarding the details of suppression of health condition by her deceased husband at the time of taking the policy but it yielded no result.  Complainant being a widow is running from pillar to post to get the death claim of her deceased husband, but it went in vain.  At last on 22.07.2019, complainant sent a legal notice to O.P. No. 1 & 2 through her advocate requesting them to intimate regarding the delay in settlement of her claim.  Though the said notices have been duly received by them, no reply has yet been received from them by the complainant or his advocate which also amounts to deficiency in service to the nominee & wife of a valued customer.  By running to the office of O.P. No. 1 & 2 by correspondence the complainant being a widow has spent about Rs. 5,000/-.  The O.Ps have not yet settled the claim of the complainant which accrued under the P.L.I. policies of her deceased husband for which the complainant is mental agony which is assumed to a tune of Rs. 50,000/-& the cause of action of filing this case arose on 23.07.2018 when the O.P. No. 1 & 2 received the notice & did not reply.  This being a claim for Rs. 5,55,000/-, fixed Court fees in shape of postal order of Rs. 200/- is filed herewith.  The complainant prays to the Commission for direction as below:-

1. To pay an amount of Rs. 5,00,000/- to the complainant along with interest which are accrued under the above mentioned 3 nos. of P.L.I. policies of her deceased husband.
2. To pay an amount of Rs. 5,000/- which has been spent by the complainant in running to the office of O.P. No.1 & 2 several times & by correspondence.
3. To pay an amount of Rs. 50,000/- to the complainant for her mental agony, and
4. Any other relief to which the learned Commission deem fit & proper be given to the complainant.

 O.Ps resisted the claim and contested the case   that, Late Muktikanta Dash, At/Po:-Ambroli, Via:- Charampa, Dist:- Bhadrak while working as Branch Postmaster, Ambroli Branch Post Office procured 9 (nine) Postal Life Insurance Policies from Department of Posts, particulars of which are given below, Premia for all the policies were recovered from his monthly establishment pay bill of Bhadrak Head Post Office.

In the aforesaid policies, Smt. Madhumati Dash is the nominee/ claimant who is the wife of the insurant & now working as Branch Postmaster, Ambroli Branch Post Office being engaged on compassionate ground after demise of the insurant. 

While working as such, the insurant Muktikant Dash experienced chest pain/ illness in the night of 27/28.11.2013 & was admitted at Dist. HQ. Hospital, Bhadrak for treatment vide Regd. No. 27320, dt. 28.11.2013. Subsequently he was referred to SCB MCH, Cuttack & expired on the way to Cuttack on 28.11.2013.The nominee Smt. Madhumati Dash preferred claim separately policy wise & her claim in respect of policies mentioned have been settled.  The PLI Policy No. OR.-366985-P dt. 16.10.2012 for sum assured value of Rs. 1,50,000/- was issued to the insurant against the proposal dt.16.10.2012 .The PLI Policy No. OR-375901-P dt. 28.12.2012 for sum assured value of Rs.1,50,000/-was issued to the insurant against the proposal dt.28.12.2012 & the PLI Policy No. OR-394497-P dt.18.11.2013 for sum assured value of Rs. 2,00,000/- was issued to the insurant against the proposal on dt.18.11.2013 .

Complainant submitted claim applications in respect of PLI Policies No. like OR-366985-P, OR-375901-P & OR-394497 along with policy bond, death certificate, and report of doctor on 17.02.2014.

            The insured expired on 28.11.2013, policies mentioned from Sl. No. 7 to Sl. No. 9 of the above table which were issued within three years of commencement of policy & such early death claims are required to be settled as per Rule 53 of Post Office Life Insurance Rules, 2011.  As per rule, the Postmaster General (O.P. No.1) after satisfying himself may sanction such early death claims.The said claims were verified by Asst. Supdt. Posts (I/c), Bhadrak Central Sub-Division, O.P. No. 2 i.e. Supdt. of Post Offices, Bhadrak Division forwarded the claim with report to O.P. No.1 for consideration.Considering the adverse inquiry report furnished by O.P. No.2, three cases were rejected by O.P. No.1 accepting the non-recommendation of O.P. No.2, with certain observation that  the  Insured  procured policy No. OR-366985-P sum assured value 1.5 lakh on 16.10.2012 & expired after 1 year 1 month & 12 days.  He had not mentioned particulars of previous 6 PLI policies of sum assured value of Rs. 6.4 lakh in proposal form resulting suppression of fact.  Insured procured policy No. OR-375901-P sum assured value 1.5 lakh on 28.12.2012 & expired after 11 months.  He had not mentioned particulars of previous 7 PLI policies of sum assured value of Rs. 7.9 lakh in proposal form resulting suppression of fact.  Insured procured policy No. OR-394497-P sum assured value 2 lakh on 18.11.2013 & expired after 10 days.  He had not mentioned particulars of previous 8 PLI policies of sum assured value of Rs. 9.4 lakh in proposal form resulting suppression of fact.  He had given details of 4 policies for sum assured value of Rs. 5.6 lakh only.  Three policies were taken by insurant within 13 months of death.  The insurant had 9 policies for sum assured value of Rs. 11.40 lakh with total monthly premium of Rs. 5601/- while his gross salary for the month of Oct/2013 (previous month of death) was Rs. 9872/-.  Total monthly premium is abnormally high & disproportionate to his total income from salary.  The insurant did not disclose all previous PLI policies held by him in column-14 of related proposal form resulting suppression of facts for which the limit of accepting power vested with different authorities could not be assessed.  For this reason, last policy i.e. policy No. OR-394497-P was accepted by the authority (O.P. No.3) lower than the competent authority (O.P. No.2).  Out of two collateral statements collected during inquiry, one Shri Mahendra Upadhyay in his collateral statement dt. 29.09.2015 stated that the policy holder had a history of health problem having experienced chest pain in the past.  This fact disputes the claim that policy holder was in good health till he was admitted to D.H.Q. Hospital for treatment on 27/28.11.2013 .As per medical certificate dt. 28.11.2013 issued by ADMO (PH), DHQ. Hospital, Bhadrak which is submitted by the claimant along with other claim papers, the policy holder expired due to “Acute Myocardial Infarction & Hepatocellular failure” which according to medical meaning is heart attack due to lever failure.It is found from the medical dictionary as answered by Google that excessive alcohol consumption is one of the reasons for lever failure.   On oral questioning on 22.02.2017by Shri B.B. Mohanty, the then Supdt. of Post Offices, Bhadrak Division in presence of Shri G.C. Behera, the then Asst. Supdt. of Post Offices (I/c), Bhadrak Central Sub-Division, the complainant Smt. Madhumati Dash admitted that the policy holder was consuming alcohol at times.  On inquiry, it was inferred that the policy holder was actually not in good health..Proposal for Policy No. OR-394497-P for sum assured value of Rs. 2 lakh  was collected just before 10 days of death policy holder.  On checking Column -21  it was found that medical certificate was obtained in support of good health from a far off place like Orasahi PHC, Chandbali which is more than 50 kms away from workplace of policy holder, medical examination, as per rule, should be done nearer to the place of duty or residence of the proponent.    Further in this case medical examination was done by a Medical Officer of a PHC while there was requirement of the medical examination to be done by a Civil Surgeon or CMO as per Rule 24 of PO LI Rules, 2011 keeping in view the sum assured value of the policy.  Based on the confidential report dt. 25.05.2017 of O.P. No. 2, the three claims of Smt. Madhumati Dash were rejected by O.P. No. 1 due to suppression of health condition at the time of taking PLI policies and the complainant was informed accordingly vide CPC, Bhadrak Head Post Office (O.P. No.3) Letter No. dt.21.06.2017 & 22.06.2017.

                 Therefore, the insurant was not in good health at the time procuring PLI policies & the policies are termed as bad policies.  In view of the stated in brief history of the case & submissions made above the O.Ps. strongly pleaded that the insurant has suppressed the particulars of previous PLI policies  basing on the provision of Rule 53 of PO IF Rules, 2011 supported by confidential enquiry report of O.P. No. 2, the OP prays before this Commission to reject the prayer of the complainant since it is devoid of merit.

After hearing rival contention of the parties to this case and perusal of material evidence on the record it is observed that the following issues need to be answered to arrive at the conclusion.

Issue No.1.

          Whether the deceased having the knowledge that he was about to die, procured the said policies for illegal enrichment of his dependents?

Issue No. 2 .

          Whether the deceased has suppressed facts which amounts to breach of policy conditions and resultantly ended in claim repudiation?

Issue No. 3.

          Whether there are irregularities present in the said policies ? If so, then the responsibility be fastened to whom ?

Issue No. 4.

          Whether the O.P. in deficient in providing service ?

Issue No. 5.

          What relief the complainant is entitled to ?

          So far as answering the Issue No. 1 & 2 nobody in the world can say when he is going to die.  At best, from the circumstances it may be presumed that the death is proximate in cases where major organs of the body has failed to function.  The onus to prove that the deceased was having pre-existing total ailments is on O.P.  In the instant case, there is absolutely no medical evidence or papers of earlier treatment to say that the deceased had knowledge about any of his heart or liver disease.  There is not a single scrap of paper or proof to say that the deceased was having any pre-existing disease earlier in any hospital.  From the averments of both these parties, it is evident that till the date the deceased felt pain in his chest he was an able man and discharging his duties regularly.  The deceased has admittedly taken as many as 9 PLI policies starting from 2003.  So, it cannot be said that knowing the death to be proximate, the deceased has taken these case 3 policies in 2012/2013 to unjustly enrich his dependents.  Further, myocardial infraction is not a disease, rather its a condition or representation of the disease.

In National Insurance Co. Ltd. Vrs. BipulKudill (2005) CPJ 12 NC, the Hon’ble National Commission held as follows :-

“It is settled that Insurance Company cannot avoid consequences of insurance contract by simply showing in accuracy or falsity of the statement made by a policy holder.  Burden is cast on the insurer to show that statement on a fact had been suppressed which was material for the policy holder to disclose.  It is further to prove by the insurer that statement was fraudulently made by the policy holder with the knowledge of falsity of that statement or that the suppression was of material fact which had not been disclosed.

 In absence of any medical evidence, it cannot be said that the deceased was having any pre-existing ailment of heart or liver which he has suppressed at the time of taking of the PLIs.  So issues No. 1 & 2 are answered in favour of the complainant.

          So far as Issue No. 3 is concerned, the learned counsel of O.P. has raised objections that the deceased had not given details of previous PLI policies as per Column-14 of the respective proposal forms of those said 3 policies.  Ex-facie, it can be seen from the hand writing that the proposal form has been filled up by other person than the deceased.  However, at the relevant column No.14, it has been said ‘Yes’ in Proposal No.-OR-375901-P & OR-366985-P and 4 Nos. of previous PLI policies amounting to 5.6 Lakhs have been reflected at Column-14 of Proposal No.-OR-394497-P.  Similarly, as per the postal rules (Annexure-R/9) for insurance in excess of Rs. 10 lakhs CDMO is to give the Medically fit Certificate be the said Medical Officer be posted to the place of duty of the proponent.The deceased in the personal history column has stated specifically he had never suffered hearts or liver disease interalia others and on the foot of the declaration of proposal form, he states agreeing to pay Rs. 50/- for medical examination if his proposal is not accepted.  It was well within the ambit of the O.P. to either to reject the proposal or re-examine the insurant medically if any kind of doubt was there.

The O.P. avers further that the total amount of monthly premium i.e. Rs.5,186/- is high and disproportionate to the total is came from salary i.e. Rs.9,872/-.  In absence of any evidence that the deceased was not having any other source of income and in absence of any communication from O.P. to the deceased in this regard, so the benefit of deciphering should go in favour of complainant that he might have paid Rs. 5,186/- as total premiums when his salary is Rs. 9,872/- .

Further, the collateral statement of one Mahendra Upadhya, collected during enquiry by one B.B. Mohanty Superintendent of Post Offices, Bhadrak are not relevant in this case.  In no stretch of imagination the contents of those unverified statements can be termed as evidence.  Even though the said Mahendra Upadhya has opined that the deceased was a strong and stout person.There is no admission by the complainant anywhere in the record that the deceased was an alcoholic.

The OP has deliberately allowed certain discrepancies to remain in the case PLIs and now after death of the insurant trying to take advantage of those discrepancies which it has allowed to remain. The O.P. have never communicated in any form to the deceased about these discrepancies present in the PLIs nor did it took any step to reject the proposal or later on start the policy at the time of issuance or thereafter. So, the O.P. is estopped from raking up these issues after death of the insurant.  The O.P. cannot repudiate death benefit claim basing on conjectures and surmises without any substance in the evidence.

So issue no.3 is answered in favour of the complainant and the responsibility has been fastened to the OP.

          So far as Issue No. 4 is concerned, the O.P. when declines the claim request under Policy No. OR-394497-P just said “Not sanctioned, rejected”. The O.P. did not even reply to the pleader notice of the complainant.  The O.P. answers in its written version at Para-10 that it was felt not necessary to examine it again.  So, rejecting claim without assigning reason, not replying to pleader notice and not communicating to the widow complainant speaks volumes about their mindset.  So, without a shade of doubt it can be said that the O.P, was deficient in providing service.  So, issue NO.4 is answered in favour of the complainant.

          The O.P. has absorbed the complainant on compassionate ground on rehabilitation scheme in the same post office in the same post without reasonable time.  So, it cannot be said that the complainant has suffered much harassment & mental agony in the hands of the O.P.  The O.P. has also paid death benefit against 5 of PLIs.  But she is entitled to get the death benefits of 3 case PLIs along with accrued interest along with litigation cost without anything towards mental agony and harassment.

ORDER

                     In the result, the complaint be and the same is allowed against the O.Ps for above circumstance without cost and compensation. O.Ps are directed to pay the death benefits of 3 case PLIs amounting to Rs.5, 00,000/- (Rupees Five Lakhs) Only along with accrued interest @ 5% P.A along with litigation cost of Rs.10, 000/- (Rupees Ten Thousand)Only within 30 days of receipt of the Order, failing which additional 5% interest P.A shall be charged on the awarded amount from the date of order till the date of payment. 

                     This order is pronounced in the open Court on this day of 12^th December, 2022 under my hand and seal of the Commission.