C.F. CASE No. : CC/09/46
COMPLAINANT : Rinku Dey
W/o Late Sankar Dey,
Vill. Old Mayapur Bazar,
P.O. + P.S. Nabadwip,
Dist. Nadia
OPPOSITE PARTIES/OPs : 1) Divisional Manager,
National Insurance Co. Ltd.
Div. III, Middleton St.
Kolkata – 700 071.
: 2) Branch Manger,
National Insurance Co. Ltd.,
M.M. Ghosh St., Krishnagar
P.O. Krishnagar, Dist. Nadia
: 3) Manager,
Golden Trust Financial Service,
Poramatala (Nadia Plaza)
Nabadwip, Nadia.
PRESENT : KANAILAL CHAKRABORTY PRESIDENT : SMT SHIBANI BHATTACHARYA MEMBER
DATE OF DELIVERY
OF JUDGMENT : 26th February, 2010
: J U D G M E N T :
In brief, the case of the complainant is that her husband Late Sankar Dey purchased one Janata Personal Accident Insurance Policy from the OP No. 1 on 23.09.02 with an insured amount of Rs. 50,000/- and the policy was valid up to 22.09.07. It is her further case that she is the nominee of that policy. That Sankar Dey went at Haridwar where he expired in an accident on 08.12.02. Thereafter the complainant submitted her claim application on 29.01.03 along with relevant documents. On 01.08.03 the OP No. 3, GTFS intimated her to submit the original Death Certificate, PM report, FIR and Final Report of Police. In compliance with that direction she deposited all those documents also. The Co. men visited her house and enquired about the incident also, but till today the OP No. 1, Insurance Co. has not settled her claim. On 06.08.07 the OP No. 1 intimated her that he received all the documents submitted by her and also asked her to submit voter card, ration card, FIR, PM Report, Bank Pass Book Nominee and Local Municipal Identity Certificate. The complainant submitted all those documents in due time. On 09.02.09 the OP Insurance Co. sent a letter to this complainant intimating that as the PM report was illegible, so it was not possible for him to entertain the claim application. This activity of the Insurance Co. is a gross deficiency of service on its part. So having no other alternative she has filed this case praying for the reliefs as stated in the petition of complaint.
OP National Insurance Co. Ltd. has filed a written version in this case, inter alia, stating that the case is not maintainable in its present form and nature. It is his submission that this OP issued a JPA insurance policy in favour of Sankar Dey from its Kolkata office subject to terms, conditions and limitation to that policy. After receiving the claim form from the petitioner in respect of death of Sankar Dey this OP wrote a letter to the petitioner to file original and clear documents like PM report, FIR and charge sheet, but she did not act as per that. So it was not possible for this OP to settle her claim due to noncompliance of her duty. Hence, she has no cause of action to file this case and the same is liable to be dismissed.
The OP No. 3, GTFS has filed a separate written version in this case, inter alia, stating that the OP No. 1, National Insurance Co. Ltd. issued one JPA insurance policy in favour of Sankar Dey for the period from 23.09.02 to 22.09.07 for the sum assured of Rs. 50,000/- and the petitioner, Rinku Dey is the wife and the nominee of deceased Sankar Dey. The policy was purchased through GTFS, Nabadwip Branch. It is his further submission that as per MOU executed between the National Insurance Co. Ltd. and this OP No. 3, GTFS the claim of accidental benefit is to be settled and considered by the OP Insurance Co. only and this OP has no liability to settle that claim. He also submits that as per letter of the OP No. 1 the complainant submitted all the documents before him, but the OP No. 1 issued a further letter dtd. 09.02.09 stating that due to non-receipt of legible PM report, FIR and police report he closed the claim application. In such a situation this OP has no liability regarding the payment of money to the complainant. It is the OP No. 1 who is to consider and settle the claim of the complainant. So the complainant has no cause of action to make him a party in this case. Hence, the case may be dismissed against him.
POINTS FOR DECISION
Point No.1: Has the complainant any cause of action to file this case?
Point No.2: Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
Both the points are taken up together for discussion as they are interrelated and for the sake of convenience.
On a careful perusal of the petition of complaint along with the annexed documents and written versions filed by the OPs and also after hearing the arguments advanced by the ld. lawyers for the parties it is available on record that the OP No. 1, National Insurance Co. Ltd. issued a JPA insurance policy in favour of one Sankar Dey on 23.09.02 with an insured amount of Rs. 50,000/- and the said policy was valid up to 22.09.07. It is also available that on 08.12.02 that Sankar Dey fell in an accident at Haridwar, who ultimately expired. The present petitioner being the nominee and wife of Sankar Dey filed a claim application before the OP Insurance Co. claiming insurance amount which is not denied by the OP Insurance Co. also. It is the case of the complainant that she filed all the relevant documents along with the claim application and thereafter, the OP Insurance Co. sent a letter to her on 09.02.09, inter alia, asking to file some documents such as death certificate, FIR, PM, and other documents. That letter is marked as 'Annexure – 5’ in this case from which it is available that as the complainant failed to submit death certificate, FIR and PM Report, so the claim was not entertained by the OP Insurance Co. due to noncompliance with the terms and conditions of contract. From a document filed by OP No. 3, GTFS it is available that on 22.11.05 GTFS intimated the complainant that GTFS forwarded and sent the claim application of the complainant, Rinku Dey enclosing with the documents, viz., 1) Original claim form, 2) Original policy certificate, 3) Original death certificate, 4) photocopy of panchayatnama duly certified by the police, 5) Photocopy of Post Mortem report duly certified by the police and 6) Original money receipt of Khankhal Burning Ghat and all the documents were received by the OP No. 1 on 25.11.05. On behalf of the OP No. 1 seal was affixed on the copy of the documents after receiving it from the OP No. 3, GTFS. In spite of that the OP No. 1, Insurance Co. did not settle the claim of the complainant. Rather on 09.02.09 he again sent a letter to this petitioner directing her to submit death certificate, FIR and PM Report and it is also intimated to her that due to non-submission of these mandatory documents her claim was not entertained by the OPs. On a careful perusal of this letter along with the letter issued by the GTFS to the complainant dtd. 22.11.05, we find that all the relevant documents, i.e., death certificate, FIR, Police report and PM report were duly submitted by the complainant to the OP, Insurance Co. through GTFS and the OP Insurance Co. duly received those documents on 25.11.05. In spite of receipt of those documents he did not settle the claim of the complainant, rather on flimsy ground the claim was practically repudiated by him.
Undoubtedly, it is a great deficiency in service on the part of the OP Insurance Co. Even the complainant has filed the copy of the death certificate and PM report before this Forum also.
Therefore, considering all these and in view of our above discussions we have no hesitation to hold that the policy holder, Sankar Dey expired in an accident at Haridwar and the petitioner being the nominee and wife of late Sankar Dey duly submitted claim application before the OP Insurance Co. in due time. But the OP Insurance Co. did not settle her claim, rather with baseless allegation repudiated her claim. So our considered view is that the complainant has become able to prove her case and she is entitled to get the reliefs as prayed for. We pass no order against the OP No. 3 as per MOU between the OP No. 3 and the Insurance Co. the liability to settle the claim of the complainant rests upon the OP Insurance Co. In result the case succeeds.
Hence,
Ordered,
That the case, CC/09/46 be and the same is decreed on contest against the OPs. The complainant is entitled to get Rs. 50,000/- + Rs. 5,000/- as compensation for mental harassment caused to her along with Rs. 2,000/- as cost of the case. The OP No. 1 & 2 are jointly or severally directed to pay the decretal dues of Rs. 57,000/- to this complainant within a period of one month since the date of passing of this judgment, in default, the decretal amount will carry interest @ 9% per annum since this date till the date of realization of the full amount.
Let a copy of this judgment be delivered to the parties free of cost.
