Lali Devi Saini vs Post Master General

V.K.Jain, J.

Late Sh. Shankar Lal Saini, husband of the complainant/petitioner, obtained a Postal Life Insurance Policy from the respondent on 13.02.2013. He

having died on 09.12.2013, a claim was submitted by the petitioner/complainant for payment of the policy benefit to her, she being his nominee. The

claim was repudiated vide letter dated 14.10.2015 which to the extent it is relevant, reads as under:

“… We regret to inform you that your claim under the captioned Policy Number has been denied. The said claim is not payable due to the reason

mentioned below.

· POLICY HOLDER SUFFERING FROM LIVER DISEASE

If you have any queries concerning the decision please notify at your nearest Post Office. …â€​

Being aggrieved from the rejection of the claim, the complainant/petitioner approached the concerned District Forum by way of a consumer complaint.

The complaint was resisted by the respondent primarily on the ground on which the claim had been repudiated.

The District Forum having decided in favour of the complainant, the respondents approached the concerned State Commission by way of an appeal.

Vide impugned order dated 23.11.2017, the State Commission allowed the appeal and consequently, dismissed the complaint holding that the deceased

insured was suffering from Alcoholic Liver Disease, prior to obtaining the insurance policy.

The only question involved in this petition is as to whether the deceased was suffering from Alcoholic Liver Disease at the time the policy was

taken by him or not. It is not in dispute that while obtaining the insurance policy, the deceased had denied suffering from any kind of liver disease. A

perusal of the certificate dated 23.07.2011, issued by Dr. D.N. Sharma, Medical Officer, Government Hospital, Dausa (Rajasthan) would show that

the said doctor certified that the insured Shankar Lal had been relieved of his ailment namely Alcoholic Liver Disease and was fit to join duty from

23.07.2011. It is therefore, evident that the deceased insured had suffered from Alcoholic Liver Disease some time prior to obtaining the insurance

policy.

Therefore, he was under an obligation to disclose the past history of having suffered from Alcoholic Liver Disease, while obtaining the insurance

policy. He having denied that he had ever suffered from a liver disease, concealed a material information with respect to the state of his health, which

influenced the decision of the insurer on the decision as to whether to grant the insurance or not. Had the deceased disclosed, at the time of taking the

policy, that he had in the past, suffered from liver disease, either the policy would not have been granted, or the insurer would have subjected the

deceased to further investigations.

The learned counsel for the petitioner submits that no investigation was carried out by Dr. D.N. Sharma before issuing the aforesaid certificate.

That however, would be of no consequence since the previous history of Alcoholic Liver Disease was recorded by the doctor on the basis of the

information supplied by none other than the insured himself. Had he not been suffering from Alcoholic Liver Disease, the insured would not have

stated so to Dr. D.N. Sharma and consequently, he would not have noted the same in the certificate dated 23.07.2011.

I therefore, hold that since the deceased concealed a material fact with respect to the state of his health while taking the insurance policy, the

repudiation of the claim was justified. The order passed by the State Commission therefore, does not call for any interference by this Commission in

exercise of its revisional jurisdiction. The revision petition is therefore, dismissed with no order as to costs, alongwith accompanying application seeking

condonation of delay of eight days in filing the revision petition.