State Consumer Disputes Redressal Commission
Adm, Cpmg (Pli) & Ors vs Smt Kalpana Murlidhar Mohite on 20 October, 2010
Daily Order
BEFORE THE HON'BLE STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MAHARASHTRA, MUMBAI
First Appeal No. A/10/72
(Arisen out of order dated 17/12/2009 in Case No. 1260/08 of District Sangli)
1. ADM, CPMG (PLI) & ORS
GPO BUILDING MUMBAI 400001
Maharastra
....Appellant
Versus
1. SMT KALPANA MURLIDHAR MOHITE
1135, KHANBAUG , KANSE GALLI SANGLI
Maharastra
....Respondent
BEFORE :
Hon'ble Mr. P.N. Kashalkar
, PRESIDING MEMBER
Hon'ble Mrs. S.P.Lale , Member PRESENT:
S C PAL, Advocate for the Appellant 1 None for the Respondent *JUDGEMENT/ORDER Per Shri P.N.Kashalkar, Hon'ble Presiding Judicial Member:
This is an appeal filed by Postal Life Insurance against the judgement and award passed by District Consumer Disputes Redressal Forum, Sangli in consumer complaint no.1260/2008 dated 17/12/2009. Said complaint has been allowed by the District Consumer Disputes Redressal Forum and it directed the postal authorities to pay sum of Rs.30,000/- which is the sum assured as per postal life policy with interest @9% p.a. from 15/01/2008 till its realization. The Forum below also awarded Rs.5,000/- towards compensation and costs. Aggrieved by this order, the postal authorities has filed this appeal. The facts to the extent material may be stated as under:
Complainant's husband/Murlidhar Mohite had taken postal life insurance policy on 13/03/2006 for the sum assured of Rs.30,000/-. The policy was in force up to 13/03/2011. The complainant, who is widow of deceased was nominated by the insured in the policy during his lifetime. Complainant's husband was regularly paying premium. However, on 12/11/2007 the complainant's husband expired due to chronic pneumonia. The complainant brought this fact to the notice of postal authorities and lodged the claim with them to receive claim amount under the policy. However, on insufficient ground the claim under policy was repudiated by the postal authorities. As such, the widow of the deceased filed consumer complaint claming an amount of Rs.30,000/- with interest and also some cost and compensation.
Opp.party filed written statement and denied all the allegations made by the complainant. According to opp.party, husband of the complainant suppressed the material facts while filling the proposal form. So, there was breach of terms and conditions of the policy. While purchasing the policy the insured had not disclosed all the material facts and principal of utmost good faith has been violated by the husband of the complainant and therefore, postal authorities submitted that complaint should be dismissed and they pleaded that they had rightly rejected the claim on the ground that the complainant's husband had suppressed the fact that he was patient of DM and HTN. The affidavit of officer was also filed along with the written statement.
Upon hearing the rival Counsels and upon perusal of the affidavits and documents placed on record, the Forum below did not agree with the submission of postal authorities that the husband of the complainant had suppressed the material facts. The Forum below in fact found that postal department illegally rejected the claim without any basis. The Forum below also observed that there was no nexus between the ailment of deceased-Murlidhar Mohite for which he had taken treatment in hospital and cause of death of said M.Mohite. He had died with illness of chronic pneumonia whereas the deceased had taken treatment in the year 2003 in one hospital of Sangli for diabetes mellitus, hyper tension and ischemic heart disease. So observing, Forum below was pleased to allow the complaint and passed the award in favour of the widow. Aggrieved by the said award, the postal department has filed this appeal.
We heard submissions of Adv.Mr.S.C.Pal for appellant. None is present for respondent though on last occasion Adv.Mr.Satish Kumbhar proxy advocate for Adv.Mr.Vaze was present for respondent and with his consent today's date is given.
Upon hearing Adv.Pal, we are finding that there is no merit in the appeal. What is pertinent to note is the fact that while filling the proposal form, the proposer/deceased/ Murlidhar Mohite has simply mentioned that during the last three years he had not consulted a medical practitioner for any illness regarding treatment for one week or more or been admitted to any hospital for general check up, observation, treatment or operation. His answer in the negative under this column is very much relied upon by the Counsel for the postal authorities. According to deceased, he had taken treatment from Dr. Patange of District Sangli from 26/12/2003 to 30/12/2003. So, he had taken treatment only for five days in Niramay Chikitsa Upchar Kendra and question asked was whether for any ailment, he had taken treatment for one week or more or had been hospitalized in any hospital for general check up. No doubt, he was admitted in hospital for five days as it is clear from doctor's certificate but at that time he was simply suffering from diabetes mellitus, hyper tension and ischemic heart disease whereas death of M.Mohite is not on account of any ailment arising from concealed ailment of the deceased. The husband of the respondent had simply died after having chronic pneumonia. Chronic pneumonia is the one ailment which is not connected or related with hyper tension, ischemic hear disease or diabetes mellitus. We would have accepted the contention of Ld.Counsel for the appellant had there been death of respondent's husband by heart attack or any other related ailment of heart because deceased was suffering from diabetes mellitus and hyper tension. Moreover, in the instant case the husband of the complainant simply died because of chronic pneumonia and it cannot be said to be arising out of heart disease, hyper tension and diabetes mellitus. For these reasons, we hold that there is no material suppression of facts which respondent's husband should have disclosed and the death is not related to diabetes mellitus or heat decease and therefore, this claim must be paid by the appellant. Every concealment of facts does not givi right to insurance company to repudiate the claim. It is the only when material suppression of facts bordering the fraudulent suppression that can give right to the insurance company to reudiate the claim. In the instance case, the person had died simply due to chronic pneumonia and therefore, claim must be paid by the appellant herein `in terms of the order passed by the District Consumer Disputes Redressal Forum. We therefore find that there is no substance in the appeal filed by the appellant. Counsel for the appellant has given particulars of amounts deposited from time to time by postal authorities. It is taken on record and marked as Exhibit-9. As such, we pass the following order:-
:-ORDER-:
1. Appeal stands dismissed.
2. Since the appellant has deposited an amount of Rs.47,069/- with the State Commission while filing the appeal at the ad-interim stage, there is no necessity for the appellant to deposit anything more. This amount shall be directly paid to the respondent for satisfaction of award.
3. Parties are left to bear their own costs.
4. Copies of the order herein be furnished to the parties.
Pronounced Dated the 20 October 2010 [Hon'ble Mr. P.N. Kashalkar] PRESIDING MEMBER [Hon'ble Mrs. S.P.Lale] Member