Kerala

StateCommission

A/14/134

DIVISIONAL OFFICER, DEPARTMENT OF POSTS - Complainant(s)

Versus

B. GAYATHRI - Opp.Party(s)

SANDEEP. R P

22 Dec 2014

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL

COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM

 

APPEAL NO.134/14

JUDGMENT DATED 22/12/2014

 (Appeal filed against the order in CC No.25/2012 on the file of CDRF, Wayanad dated, 29/11/2013)

 

PRESENT:

SMT. A. RADHA                             :         MEMBER

SHRI. K. CHANDRADAS NADAR :        JUDICIAL MEMBER

SMT. SANTHAMMA THOMAS    :        MEMBER

 

APPELLANT:

 

Department of Posts, Government of India

Represented by its Divisional Officer,

Office of the Chief Postmaster General,

Kerala Circle, Thiruvanmanthapuram-695 033.

 

(By Authorised Representative - Sri. Sandeep.R.P.)                   

 

                   Vs

 

RESPONDENT:

 

B. Gayathri, W/o. Late Raveendran,

# 545 HIG-B HUDCO, 1^st Stage,

Lakshmi Nagar, Hebbal, Mysore-570 017.

 

(Amicuscurea – Adv: C.S. Rajmohan)

 

                                      

JUDGMENT

 

SMT. A. RADHA  :  MEMBER

 

          Appellant is the opposite party in C.C.No.25/12 on the file of CDRF, Wayanad wherein the Forum Below partly allowed the complaint and directed the opposite party to pay  Rs.1 Lakh  with  8%

 

interest and Rs.5,000/- as compensation and also Rs.3000/- as cost of the proceedings.

          2.  The brief facts of the case are that the husband of the complainant availed a Postal Life Insurance Endowment Assurance Policy for a sum of Rs.1 Lakh on 31/03/2009 and paid the premium amount of Rs.1,515/-.  The insured died due to Cardiac arrest on 01/08/2010.  The claim form was submitted on 16/09/2010 which was rejected by the opposite party on vague reasons.  It was on the assumption that the insured was suffering type-II diabetic mellitus which will result high blood sugar and increase heart attacks, strokes etc. and repudiated the claim made by the complainant.  It is the definite case of the complainant that her husband had never treated for diabetics.  The repudiation of the claim amounts to deficiency of service on the part of the opposite parties.  The complaint is filed for the insured amount with 12% interest and for Rs.25,000/- as damages and Rs.5,000/- as cost.

          3.  The opposite party admitted the issuance of policy for      Rs.1 Lakh on 31/03/2009.  The claim was repudiated on the ground of suppression of facts pertaining to his health.  It is specifically stipulated in the rule that the claim of the insured or legal heir is sustainable only after completion of 3 years.  The insured died on 01/08/2010 ie. 16 months after the commencement of the policy.  Since the insured died within 3 years from the date of acceptance of policy, an enquiry was conducted under rule 53 of Post Office Life Insurance Rules 2011.  As per the death summary the insured was admitted in the hospital on 30/07/2010 and the report revealed that one among the various factors diagnosed for the cause for cardiac arrest was type-II diabetic mellitus.  The history of the patient shows that it was a known case of type-II diabetic mellitus, since 2 years on regular treatment.  In the proposal form again serial No.16(b) the list of diseases given includes diabetic wherein the insured had recorded that he was in sound health and had not suffered from any diseases.  As per the terms and conditions of the contract the policy is void and the payments made by the insured shall be forfeited, if the statement contained in proposal and declaration made therein are found to be untrue.  The insured has suppressed a material fact which tantamounts to breach of contract and the claim was forfeited as the contract became null and void.  The insurance contract is based on the principle of utmost good faith.  The rule 39 of Post Office Life Insurance Rules insist that wrong information furnished by a person, or suppression of factual information by a person admitted to the benefits of Postal Life Insurance Fund will, at the discretion of the Postmaster General, render the contract void leading to forfeit all payments made by the person.  Hence the repudiation of claim by opposite party is in accordance with the rules. 

          4.  The complainant filed proof affidavit and examined as PW1 and documents were marked  as Exbts.A1 to A3.  On the part of opposite parties OPW1 and OPW2 were examined and documents were marked as Exbts.B1 to B10.

5.  It is submitted on behalf of the appellant that the insured died of cardiac arrest and he was having the history of diabetics which was suppressed in the proposal form.  It is also argued that as per the terms and conditions of the policy the policy is void and the payment shall be forfeited by the appellant in case of making false declaration regarding his health.  The claim of the insured or the legal heir is sustainable only on completion of minimum 3 years from the date of acceptance of the policy.  The insured died within 16 months after the commencement of the policy.  The claim filed by the wife of the insured was repudiated on the ground that there is suppression of material fact regarding the health of the insured in the proposal form.  The insured was under the treatment for type-II diabetics mellitus which is revealed in the history of the death summary of the insured.  The suppression of material facts is a breach of contract and the claim is forfeited as per rules.  The violation of the terms and conditions made the claim null and void.  Parties to the contract are bound by the terms and conditions and in the instant case the policy has not completed 3 years, the suppression of material facts in revealing state of health of insured entitles the appellant to forfeit the insured amount as well as the claim raised by the respondent.  The false declaration enables the appellant to forfeit the insurance claim.  The death summary shows that the reason for cardiac arrest was type-II diabetic mellitus and the appellants produced Exbt.B2 to prove their contention.  The insured had certified and declared that he is in good health in the proposal form (Exbt.B3) which is a clear suppression of material fact in view of the death summary of the insured.  It is prayed that the order of the District Forum is to set-aside on the various aspects putforth by appellant which was not considered.  He also pointed out that the deposition of OPW2, Dr. Abdul Hameed, that the history of the illness was explained by the wife of the deceased who also gave the history of diabetic mellitus for the last 2 years on irregular treatment.  The insured was having   type-II mellitus since 2 years of regular treatment and this fact was suppressed while filing the proposal form.  As per law the appellant is not liable to pay any amount to the insured for suppression of material fact regarding the health and the complaint is only to be dismissed. 

6.  It is submitted by the counsel for the respondent that the complainant’s husband was having a policy for Rs.1 Lakh and he died of cardiac arrest within 16 months.  The appellant conducted an enquiry and from the death summary it is contended that the insured suppressed the history of diabetics since 2 years.  The complainant paid the premium of Rs.1,515/- and was in good health.  It is submitted that the complainant was hospitalized and the cause of death shown by the Doctors that the insured was suffering from   type-II diabetic mellitus which will result in high blood pressure increase, heart attack, strokes and kidney failure etc.  It is argued that the complainant is not a diabetic patient and was keeping good health.  The insured had never treated for diabetics in any hospital.  The counsel also pointed out that no document or evidence produced by the appellant that the complainant’s husband was having any disease prior to his death.  He was in good health as stated in the proposal form.  It is argued that Exbt.B2 was issued by the hospital authorities where the insured was admitted for the first time.  Though the appellant’s claim that the insurer had conducted investigation, no investigation report is seen filed before the Forum Below.  It is also not clear from evidence of OPW1 that who had conducted the investigation regarding the health condition of the insured other than noting in the death summary.  It is also confirmed by OPW1 that he had not imparted any treatment to the insured for type-II diabetic mellitus prior to the hospitalization on 30/07/2010.  The claim was repudiated merely based on the death summary issued by the hospital where the insured was hospitalized for the first time for treatment.  It is also argued that the insured died of cardiac arrest and not of type-II diabetic.  It is only one among the reasons for cardiac arrest hence it could not be taken as a ground for repudiation of the claim made by the complainant and the order of Forum is to be allowed in toto.

          7.  Having heard both the parties and on going though the documents we find that it is an undisputed fact that the complainant’s husband joined the Post Office Life Insurance Policy and paid the premium on 30/03/2009.  It is also an undisputed fact that the husband of the complainant died due to cardiac arrest on 30/07/2010 ie. within 16 months on inception of the policy.  The ground taken by the appellants to repudiate the claim is the suppression of material facts regarding the state of health of the insured.  As per the death summary produced as Exbt.B2 one among the reasons for cardiac arrest is type-II diabetic mellitus.  The argument putforth by the respondent is that the insured has never treated for diabetics in any hospital or he was not taking any medicine.  The false declaration made by the insured entitles the appellants to forfeit the insurance amount and also entitle to repudiate the claim as per the rules.  At this juncture we would like to point out that the appellant examined the doctor who issued the death summary and in the deposition it reveals that the wife of the deceased informed him that the deceased was having diabetics for 2 years and was taking medicines irregularly.  This point was not made clear by the appellant in evidence.  Though investigation is made regarding the death of the insured no investigation report is filed by the appellant before the Lower Forum.  We would also like to point out that the appellant failed to produce any documentary evidence or hospital records regarding the treatment taken by the insured prior to the death.  In the absence of any documentary evidence on the part of the appellants regarding the state of health of the insured prior to death we are constrained to overlook the history in the death summary.  Hence we are of the view that the respondent/complainant is entitled for the insurance policy.

          In the result, appeal is dismissed and we uphold the order passed by the Forum Below and the order is to comply within one month on receipt of the copy of the order. Failure to comply the order will entitle the respondent to claim interest @ 12% to the claim amount till realization.

The office is directed to send a copy of this order to the Forum below along with LCR.

 

 

 

A. RADHA           :        MEMBER

 

K. CHANDRADAS NADAR  :   JUDICIAL MEMBER

 

 

SANTHAMMA THOMAS     :        MEMBER

 

 

 

Sa.

 

 

 

 

 

 

 

 

 

KERALA STATE CONSUMER

                                                                  DISPUTES REDRESSAL

                                                           COMMISSION

THIRUVANANTHAPURAM

 

 

 

 

 

 

 

 

 

APPEAL NO.134/14

JUDGMENT DATED 22/12/2014

 

 

 

 

 

 

 

 

sa