The Complainant has filed this case alleging deficiency-in-service by the O.Ps, where O.P No.1 is the Post Master, Ishan Nagar Sub-Post Office, Balasore, O.P No.2 is the Superintendent of Post Office, Balasore, O.P No.3 is the Deputy Divisional Manager (PLI), Office of the Chief Post Master General, Odisha Circle, Bhubaneswar and O.P No.4 is the Director of Postal Services Head Quarter (PLI), Odisha Circle, Bhubaneswar.
2. The case of the Complainant in brief is that the Complainant being the nominee and wife of Late Ratikanta Das, who had postal life insurance policy bearing No.OR-331222CS with the O.Ps for sum assured of Rs.2,00,000/- (Rupees Two lacs) only on dtd.13.05.2010 with a monthly premium of Rs.1,750/- (Rupees One thousand seven hundred fifty) only. The date of maturity of the said policy is April-2020 and the same policy also covers death claim benefits. After scrutinisation of all the required documents/ information in this regard and accordingly, the insurance policy certificate was issued in the name of the insured Ratikanta Das by the O.Ps. The regular monthly premium in the said policy is being paid on each due date by the insured since 2012. But, the insured Ratikanta Das died due to Tropical Chronic Pancreatitis, Diabetes Mellitus and Jaundice on dtd.13.09.2012 and thereafter, the claim was submitted before the O.Ps by the Complainant (nominee) to get the insurance benefit on dtd.17.12.2012. The Complainant approached several times to the O.Ps for settlement of the claim. But, after 18 months, the O.P No.3 rejected the said claim illegally by a written letter dtd.04.06.2014 causing mental agony and financial sufferings. Such type of activity by the O.Ps amounts to deficiency of service. The cause of action arose on 04.06.2014. The Complainant has prayed for settlement of the death claim of policy No.OR-331222CS along with compensation and litigation cost.
3. Written version filed by the O.Ps through their Advocate denying on the point of maintainability. The O.Ps have further submitted that Late Sri Ratikanta Das, husband of the Complainant had taken postal life insurance (PLI) policy No.OR-331222-CS on 13.05.2010 for sum assured of Rs.2,00,000/- (Rupees Two lacs) only with monthly premium of Rs.1,750/- (Rupees One thousand seven hundred fifty) only. He had paid premium from May-2010 to August-2012 and expired on 13.09.2012 i.e. within 3 years from taking the policy. At the time of submitting the proposal for the said policy, the insurant late Ratikanta Das had nominated his wife Arati Das (the Complainant) as nominee to receive the benefits of the said policy in case of death of the insurant and the insurant had furnished health declaration in the proposal form 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 without providing the information regarding cause of death of the late insurant. 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, which otherwise would not have allowed the proponent to be eligible for PLI and it should be examined whether the insurant was suffering from any disease prior to taking of a policy. Accordingly, the District Education Officer, Baripada who was the Controlling Authority of the late insurant was requested to furnish the particulars of leave applied on medical ground by the deceased insurant for the period from 13.05.2007 to 12.05.2010 specifying the name of disease and also endorsing a copy thereof to the claimant for information and requested to submit the medical certificate of cause of death from the doctor last attended to the deceased in order to settle the death claim. Since no response was received, a reminder letter was issued on 03.05.2013 and thereafter, the claimant sent copy of order No.541, dtd.17.01.2013 of Head Mistress, Govt. Girls’ High School, Kujidihi, Mayurbhanj furnishing the leave particulars of the deceased and copy of discharge certificate issued by the treating doctor and copy of cause of death issued by the Supdt., SCB Medical College and Hospital, Cuttack. All the prior enquiries and cause of death was verified from the Authorities concerned. As per treatment certificate of Dr. M.K Mohapatra, Professor and Head, Surgical Gastroenterology, SCB Medical College, Cuttack dtd.28.02.2014, the patient (late insurant) was suffering from “Tropical Chronic Pancreatitis and was operated upon in 1996”. This clearly proves that the late insurant was suffering from Chronic Pancreatitis at the time of taking the policy on 13.05.2010 and he has suppressed the material information about state of his health and given wrong declaration in the proposal form. As per Rule-39 of POLI Fund Rules-2011 suppression of factual information by the person admitted to the benefits of PLI will lead to forfeiture of all payments. Accordingly, the competent authority has duly considered and rejected the case as per the rule. So, there is no deficiency in service by the O.Ps and thus, the Complainant/ nominee is not entitled to any amount as claimed in the complaint. Hence, the case is devoid of merit, is liable to be dismissed with cost.
4. In view of the above averments of both the Parties, the points for determination of this case are as follows:-
(i) Whether this Consumer case is maintainable as per Law ?
(ii) Whether there is any deficiency of service on the part of the O.Ps ?
(iii) To what relief the Complainant is entitled for ?
5. In order to substantiate their claim, both the Parties have filed certain documents as per list. Perused the documents filed. It is admitted fact that Late Ratikanta Das, husband of the Complainant was the policy holder and he died on 13.09.2012 by suffering from disease. It has been argued on behalf of the Complainant that after death of her husband Ratikanta Das-the insured, she had applied for settlement of death claim, but after lingering the matter for 18 months, the O.Ps rejected the claim causing mental agony and financial sufferings, for which the Complainant has filed this case praying for settlement of the death claim of along with compensation and litigation cost. On the other hand, it has been argued on behalf of the O.Ps that before completion of 3 years of the policy, when the insured died, a thorough investigation was made by the O.Ps and it came to their notice that he was suffering from Tropical Chronic Pancreatitis and was operated on 1996, for which it was suppression of material information. The Rule-53 of POLI Rules-2011 empowers the authority to investigate the matter 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 the 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 sub-standard life or to cause loss to fund and whether the cause of death had any relation to the disease and this case is for death claim before completion of 3 years from the date of commencement of the policy. According to the O.Ps, the claimant sent copy of order No.541, dtd.17.01.2013 of Head Mistress, Govt. Girls’ High School, Kujidihi, Mayurbhanj furnishing the leave particulars of the deceased and copy of discharge certificate issued by the treating doctor and copy of cause of death issued by the Superintendent of SCB Medical College and Hospital, Cuttack. Though the cause of death issued by the authority of SCB Medical College and Hospital, Cuttack is available in the case record, but no other particulars as mentioned above are available in the case record as not produced by the Parties for clear assessment of the case. The claim was rejected basing on the medical report as per letter dtd.04.06.2014 of the Dy. Divisional Manager (PLI), O/o the Chief P.M.G, Odisha Circle, Bhubaneswar, which was available in the case record. The letter of the doctor addressed to the Dy. Divisional Manager (PLI), O/o the Chief Postmaster General, Odisha Circle, Bhubaneswar dtd.28.02.2014 discloses that “with ref. to above said subject I am to inform you that Sri Late Ratikanta Das, a case of Tropical Chronic Pancreatitis + Diabetes mellitus + jaundice (unknown cause) with poor general condition admitted to this hospital on 3.9.2012, expired on 13.9.2012. He was also admitted to this department on 25.7.2012 & discharged on 4.8.2012 as a follow up case of Tropical Chronic Pancreatitis (undergone lateral pancreatico jejunostomy operation) with jaundice recorded in history during the admission. As per bed head ticket and history he was suffering from Tropical Chronic Pancreatitis and was operated upon in 1996”. But, such bed head ticket and history of the patient is not available in the case record. Moreover, the policy was started on 13.05.2010. In the proposal form of the policy vide column-16(c), it has been mentioned as “During the last three years, have you ever consulted a Medical Practitioner for any ailment regarding treatment for a week or more been admitted to any Hospital or Nursing Home for general check up, observation, treatment or operation ? If yes, please give full details- No”. The doctor’s letter is not the conclusive evidence as it is not supported with material document. Furthermore, column-16(c) of the proposal form of the policy has no link with the suppression of material information. It is admitted fact that he has died on 13.09.2012 suffering from the disease as mentioned earlier, but it does not amount to suppression of material information as sufficient material document is not available in the case record for such conclusion.
6. So, now on careful consideration of all the materials available in the case record and after hearing both the sides, this Forum come to the conclusion that rejection of the death claim on the alleged ground is not sufficient and the Complainant is entitled to get death claim benefit from the O.Ps along with compensation and litigation cost and in our opinion, the O.Ps should jointly or severally liable for payment of the death claim for sum assured of Rs.2.00 lacs (Rupees Two lacs) only along with other benefits and compensation of Rs.10,000/- (Rupees Ten thousand) only and litigation cost of Rs.2,000/- (Rupees Two thousand) only to the Complainant within 60 days of receipt of this order, failing which it will carry interest @ 9% per annum on the total amount including the death claim amount along with compensation and litigation cost from the date of order till realization. Hence, ordered:-
O R D E R
The Consumer case is allowed on contest against O.Ps with cost. The O.Ps are jointly or severally directed to pay the death claim benefit of Rs.2.00 lacs (Rupees Two lacs) only along with other benefits and compensation of Rs.10,000/- (Rupees Ten thousand) only and litigation cost of Rs.2,000/- (Rupees Two thousand) only to the Complainant within 60 days of receipt of this order, failing which it will carry interest @ 9% per annum on the total amount including the death claim amount along with compensation and litigation cost from the date of order till realization. The Complainant is also at liberty to realize the same from the O.Ps as per Law, in case of failure by the O.Ps to comply the Order.
Pronounced in the open Forum on this day i.e. the 2nd day of April, 2018 given under my Signature & Seal of the Forum.
