DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
DATED THIS THE 4TH DAY OF MARCH, 2024.
PRESENT : SRI. VINAY MENON .V, PRESIDENT.
: SMT. VIDYA .A, MEMBER.
: SRI. KRISHNANKUTTY N.K, MEMBER.
Date Of Filing: 24.11.2022.
CC/234/2022
1. Preethy Ignatius, Aged 52 years, - Complainant
Wife of (late) Raju George,
Residing at Arrisseril House,
Pookkad, Anjumoorthy Post,
Alathur Taluk, Palakkad-678 682.
(By M/s.U.Muhammed Musthafa)
VS
1. The Post Master, -Opposite Party
Alathur-MBR Post Office,
Alathur Taluk, Pin-678 541.
2. Chief Post Master General,
Kerala Circle,
Thiruvananthapuram,
Pin-695 033.
ORDER
BY SRI. SMT. VIDYA .A, MEMBER.
1. Pleadings of the complainant in brief
The complainant’s husband was a policy holder of Postal Life Insurance issued by the 2nd opposite party with No.KL 71594CS for sum assured Rs.2 lakhs. The policy holder died on 01.05.2021 and the complainant is the nominee of the life insurance policy.
The insured had paid the premium amount without fail upto June, 2019. After that, he was affected with cancer and became mentally depressed and failed to remit the premium amount. His wife, the complainant, was totally unaware of these facts when he recovered from illness, he contacted the opposite parties and they informed him that policy will be revived if he pays the arrears with interest. He agreed to that and signed the document and paid the balance amount. He made payments of premium till his death.
After his death, the complainant as his nominee filed a claim before the opposite parties for the insured amount. But the opposite parties rejected the claim stating that the insured did not disclose the details of his ailment in the revival form. The opposite parties did not ask any medical certificate or details from the policy holder; but they only asked him pay the arrears with interest.
There was no suppression of material facts and the insured would have submitted the medical records if the same has been demanded by the opposite parties.
The opposite parties are bound to give the policy amount to the complainant. The acts of the opposite parties rejecting the genuine claim of the complainant amounts to deficiency in service on their part.
So, she filed this complaint for directing the opposite parties
1) To pay 2 lakhs, being the sum assured together with bonus from 01.05.2021 till payment together with 12% interest per annum.
2) To pay Rs.2 lakhs as compensation for the mental agony and other inconveniences suffered by the complainant.
3) To pay Rs.10,000/- as cost of litigation.
2. After admitting the complaint, notices were issued to the opposite parties. The opposite parties entered appearance and filed version.
3. The opposite parties in their version admitted that the complainant’s husband was a policy holder of Postal Life Insurance Policy for a sum of Rs.2 lakhs. He took the policy on 12.03.2008 with a monthly premium of Rs.1,190/- in which the insured has nominated his wife, the complainant, as the sole nominee. The various provisions of Postal Life Insurance Scheme provided by the opposite parties are regulated by the Post Office Life Insurance Rules. The insured had remitted the premium regularly till June, 2019. Later, the policy became inactive as the premium was not remitted. On 08.10.2020, the complainant/insured approached Vadakkanchery MBR Post Office for reviving the policy. As per Rules, the policy can be revived by paying all the arrears of premium with interest therein at the Rules prescribed by the Director General of Posts calculated from the due date of the first unpaid premium, provided the life of the insured is insurable at the time of revival and there has been no adverse change in the health & habits of the insured or in his personal/family history or occupation.
In this connection, the insured gave a declaration about his health condition as good and policy was revived on 30.10.2020. Consequent to revival, he remitted premium till 2021. After the death of the insured on 01.05.2021, the complainant (his nominee) submitted a claim form before the opposite parties on 22.05.2021. As per PLI Rules, for claims where death occurred before the completion of three years from the date of acceptance/revival of policy whichever is later, investigations need to be done to confirm whether there was any suppression of material facts. Inquiries revealed that the insured was undergoing chemotherapy and radiotherapy and under treatment for SEPSIS during September, 2020. He was also suffering from Type 2 Diabetes mellitus and chronic liver disease. This was against the declaration given at the time of revival of policy that he was in good health. As per PLI Rules, wrong information furnished by a person or suppression of factual information by a person admitted to the benefits of the PLI policy will become void and lead to forfeiture of all payments made in the policy if any claim is made in respect of the policy before the completion of three years from the date of acceptance/revival of policy whichever is later. The claim was rejected by the opposite parties as this a clear case of suppression of facts. There is no deficiency in service on the part of the opposite parties and the complaint has to be dismissed with their cost.
4. From the pleadings of both parties, the following points arise for consideration;
1) Whether the complainant’s husband revived the lapsed PLI policy without disclosing his ill health?
2) Whether there is any deficiency in service on the part of the opposite parties in denying the insurance claim?
3) Whether the complainant is entitle to the reliefs claimed?
4) Reliefs as to cost and compensation.
5. Evidence of complainant comprised of proof affidavit and Exts.A1 & A2. The opposite parties filed proof affidavit and Exts.B1 to B10 marked from their side. Evidence closed and both parties filed notes of argument.
6. Point No.1
The complainant’s case is that the complainant’s husband was a policy holder of PLI policy dated 12.03.2008 issued by the opposite parties for a sum assured of Rs.2 lakhs. The insured paid the premium without any default till 2019. After that, he was affected with cancer and failed to remit the premium in time. On recovery, he approached the opposite parties for the revival of the policy. As per their advice, the assured signed the form of revival of policy and paid the entire arrears with interest. He died on 01.05.2021 and the complainant as his nominee preferred a claim before the opposite parties. The opposite parties repudiated the claim on the ground that there is suppression of material facts regarding the health condition of Assured at the time of revival of policy in 2020.
7. The opposite parties contented that the insured had violated the terms and condition of the PLI policy which resulted in the policy becoming void and payments towards it forfeited. Inorder to prove their case, the opposite parties produced ten documents which are marked as Exts.B1 to B10.
8. From the pleadings and evidence, it is clear that the policy in the name of the complainant’s husband was issued on 12.03.2008 with a monthly premium of Rs.1,190/-. The insured paid the amount upto June, 2019. Thereafter, there was failure on his part to remit the premium for 16 Months. The policy was revived on payment of arrears with interest on 30.10.2020. The insured died on 01.05.2021. The death of the insured occurred before the completion of three years from the date of revival of policy.
9. Ext.B1 is the Rule 58(1) of PLI Rules, 2011. The opposite parties have produced only that portion of the document which deals with revival of policies. They have not produced the entire document containing this relevant rules.
As per 58(1), “such revival shall be subject to payment, within a date to be specified by the competent authority, all arrears of premium with interest thereon at the rates prescribed by the Director General of posts and calculated from the date the first unpaid premium in respect of such policy had become due and certificate from an authorised medical attendant in the prescribed Performa certifying that the life assured is insurable having regard to the insurants health and habit and of evidence to show that there has been no adverse change in his/her personal or family history or his/her occupation”.
10. Ext.B5, “Postal Life Insurance Policy.” Terms of contract in Paragraph 8 “revival of discontinued policies” also states that “the policy holder may apply for revival of his policy to the Chief Post Master General concerned before the policy has matured subject to payment of all the arrears of premium with interest thereon and further subject to production of a certificate from an Authorised Medical Examiner certifying that the life assured is insurable having regard to the insurant’s health and habits and of evidence to show that there has been no change in his/her personal or family history or his/her occupation as also a certificate from his employer, if employed, certifying that the policy holder had not taken any leave on medical grounds during the last one year or during the entire period of service or from the date of first unpaid premium had become due, whichever is the least. The policy shall not be treated as revived unless the concerned Chief Post Master General has satisfied himself and has permitted such revival in writing.
11. Ext.B2 is the “Application for revival of Postal/Rural Life Insurance Policy” which contain a declaration that “I hereby declare that I continue to be in good health since the date, the first unpaid premium had become due in respect of the above mentioned policy till date.” The insured has put his signature on this document. It also contains the certificate from Dr.Jayant, Civil Surgeon stating that “I have examined Shri Raju George on 13.10.2020 and found him in continuous good health. It contains the statement of his wife and another person as witness which states that there has been no adverse change in personal or family history or occupation of insurant. It contains the signature of postmaster, Vadakkencherry approving the revival form.
12. The opposite parties contention is that inquiries made in connection with the processing of claim revealed that the insured was undergoing chemotherapy and radio therapy due to treatment for SEPSIS (Septic Shock, Fungal Pneumonia, Carcinoma Oesophagus, Chronic Liver Disease) during September, 2020. Ext.B4 discharge summary from Aster Medicity, Cochin affirms the contention of the opposite parties to be correct. Discharge summary history part clearly mentions that Mr. Raju George is a akk/0 Carcinoma Oesophagus completed chemotherapy and radiotherapy in September, 2020. Further, it discloses Chronic Liver Disease and Type 2 diabetes mellitus.
13. So, in the declaration form, there is a suppression of material fact relating to the health condition of the complainant’s husband (insured) and the insured has revived the lapsed PLI policy without disclosing his ill health.
Hence, point No.1 is found against the complainant.
14. Point No.2
As per condition 10 of terms and condition, Ext.B5, Postal Life Insurance Policy, “The policy shall be void and the payment made by the insurant shall be forfeited, if the statement contained in the proposal and declaration made therein are found to be untrue.” “Rule 39 of the Postal Life Insurance Rules, 2011, also states that wrong information furnished by a person or suppression of factual information by a person admitted to the benefits of post office life insurance fund/Rural POLI fund will, at the discretion of the Approving Authority, render voidable the contract concluded with the person and laid to forfeiture of all payments made in respect of that policy, if the insurance policy becomes claim before completion of three years from the date of acceptance of policy or revival of policy whichever is later”.
So the opposite parties were correct in repudiating the claim of the complainant as there was suppression of material fact. There is no deficiency in service on the part of the opposite parties, as they have repudiated the claim as per the terms and condition of the policy.
15. Point No.3 & 4
As there is no deficiency in service on the part of the opposite parties, the complainant is not entitled to get the reliefs prayed for.
As already stated supra, the complainant had wilfully suppressed material facts from the opposite party. Further, she had filed this complaint as against the opposite party knowing fully well that the opposite parties where well within their rights in repudiating her claim. Her conduct tantamount to filing a vexatious complaint against the opposite party. Such a conduct cannot be permitted to go scotfree. We therefore, impose a cost of Rs.5,000/- on the complainant payable to the 1st opposite party within 45 days from the receipt of a copy of this order.
With the above direction, the complaint is dismissed.
Pronounced in open court on this the 4th day of March, 2024.
Sd/-
VINAY MENON .V, PRESIDENT.
Sd/-
VIDYA.A., MEMBER.
APPENDIX
Documents marked from the side of the complainant:
Ext.A1: Postal Life Insurance Policy No.KL-71594-CS dated. 12.03.2008 fir sum assured Rs.2,00,000 issued by the 2nd opposite party in favour of Raju George.
Ext.A2: Claim rejection intimation dated 06.12.2021 issued by the 1st opposite party to the complainant.
Exhibits marked on the side of the opposite party :
Ext.B1: Rule 58(1) of Post Office Life Insurance Rules, 2011.
Ext.B2: Revival application submitted by the insurant dated 08.10.2020.
Ext.B3: PLI Directorate Memo No.25-04/SOP/2020-LI dated 18.08.2020.
Ext.B4: The medical reports/discharge summary of the insurant issued by Aster Medicity, Kochi.
Ext.B5: Policy Bond held by the insurant.
Ext.B6: Rule 39 of Postal Life Insurance Rules, 2011.
Ext.B7: Letter dated 06.12.2021 issued by OP-1 to the complainant.
Ext.B8: Order issued by Deputy Divisional Manager (PLI) disposing the appeal of the complainant.
Ext.B9: Order of the Hon’ble Supreme Court in Civil Appeal No.2776 of 2002, Satwant Kaur Sandhu v. New India Assurance Company Ltd.
Ext.B10: Order of Hon’ble National Consumer Dispute Redressal Commission, New Delhi dismissing Revision Petition No.273/2013.
Witness examined on the side of the complainant: Nil
Witness examined on the side of the opposite party: Nil
Court witness: Nil
Cost : Nil
NB: Parties are directed to take back all extra set of documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure)Regulations, 2020 failing which they will be weeded out.
