This is an application u/s.12 of the C.P. Act, 1986.
Complainant by filing this complaint has submitted that the husband of the complainant Late Brij Nandan Singh being deceived by the OP1 purchased a personal insurance policy in his name for some insured of Rs.1 lakh vide insurance certificate no.0129147/980000214613, Policy No.4751220001607/E No,47-30326 on 08-07-1999 and in the said policy complainant’s name is inserted as nominee and the said policy expiry date was on 07-07-2013 but in the meantime due to ill fate insured, the husband of the complainant died due to road accident on 18-09-2010 and for which complainant has widow and nominee of the said insured, submitted prescribed claim form of the OPs duly filled in along with all relevant papers on 10-12-2010 for getting her lawful claim but on 06-06-2014 complainant was intimated by the OP1 vide their letter no.512200/J.P.A/SP/2011 dated 06-06-2011 to submit the prescribed papers and documents in original what complainant submitted forthwith.
Thereafter, complainant and her younger son visited the office of the OP on several occasions in connection with the said claim as and when the respective authorities of the OP1 asked to comply the formalities and each and every occasion complainant satisfied all the requirements and for getting her bona fide claim on urgent basis. But all the efforts of the complainant went futile for dragging the matter by the OP1 and ultimately a letter dated 02-04-2012 was submitted on 09-04-2012 to the OP1 for pursuing the legitimate claim of the complainant but they kept mum without taking any necessary steps for the intention best known to them. Subsequently, complainant on 22-02-2013 submitted a letter seeking for redressal of her grievances but no fruitful result ws achieved.
Apart from this it is stated that she is a lay man and is not conscious with the terms and conditions of the policy and if there is any irregularities on the part of the OPs for that reason the complainant cannot be deceived and in fact, OP has violated the rules and regulations, guidelines of the IRDA in connection with the said insurance policy for settlement of the claim. Thereafter, complainant took all initiatives, sent demand notice through their Ld. Lawyer but no relief was granted against the complainant and in the circumstances, complainant for violation and for negligent and deficient manner of service this complaint was filed for redressal.
On the other hand, OP4 Golden Trust Financial Services by filing written statement submitted that Brij Nandan Singh obtained Janata Personal Accident Insurance Coverage from the OP1 under a group insurance scheme through the facilitation of Golden Trust Financial Services being policy no.4751220001607/E.No.47-30326 was issued by the OP1 and insured since 08-07-1999 to 07-07-2014 for sum insured of Rs.1 lakh. It is further submitted that as per MOU in between the OP4 and the OP1 a consolidated cheque with a list of insured persons was paid and except this there had been no other liability to be borne by Golden Trust Financial Services in this regard. Fact remains with a view to sustain this insurance policy OP always stand by the side of the insured persons and in the present case also OP1 acted bona fide within the boundary of their authority and there is no negligence and deficiency on the part of the OP4 and they are not responsible for any such payment or claim as made by the complainant. OP4 has submitted that they supplied all the materials for settlement of the claim but that has not been decided by the OP1.
On the other OP1 New India Assurance Company Ltd. by filing written statement submitted that GTFS moved a writ application before the Hon’ble High Court at Calcutta being W.P. No.1144 of 1999 and in the said writ application the Hon’ble Court passed an interim order on 06-07-1999, inter alia, restricting the said GTFS from collecting any premium from the category of friends from the date of the said order and GTFS was further directed not collect any premium from the category of friends as mentioned in the said policy from that day(i.e. 06-07-1999).
In accordance with the policy decision of OP took a policy decision to limit the sum assured under JPA scheme up to 1 lakh only and the period of insurance to 5 years for group JPA policies and as per their decision OP vide letter 01-08-2011 covering more than Rs.1 lakh and the period of insurance covering more than 5 years and challenging the said letter of cancellation GTFS moved before Hon’ble High Court vide W.P. No.2343 of 2002 and an interim order was passed by the Hon’ble High Court staying the operation of the said letter dated 01-08-2002 to which the answering OP1 was a party.
As because Hon’ble High Court passed such order against GTFS not to collect premium from friends and thereafter, the insurance company specifically requested GTFS to disclose the status of the certificate holder in detail, along with documentary evidence but the said GTFS failed and neglected to divulge such information and materials document in respect of the present insured (since deceased).
It is mandatory provision of the law and rules and regulations of the policy that settlement of the claim shall be established by the status by way of documentary evidence and in absence of production of such documentary evidence by the said GTFS, the question of settlement of a claim does not arise. So, there is no cause of action of the complainant in the instant case. Further it is submitted that it is the onus of the said GTFS to prove by way of evidence that the certificate holder is its field worker and a field worker is employed to procure business from the market and earns remuneration from the said GTFS. The field workers are supposed to possess identity and further supposed to be enlisted with the said GTFS. The identity of field worker cn be established by enumerable documentary evidence, but the GTFS along with the claim forwarded a certificate to the complainant and moreover after passing of the order by the Hon’ble High Court in Writ Petition 1144 of 1999 on 06-07-1999 OP GTFS has no authority to collect premium from any friends etc and in this case as because complainant and GTFS has failed to prove the status of the insured (since deceased) as field worker of the OP4 the settlement could not be properly disposed of but always complainant and oP4 were directed to produce the entire document in respect of the status of the insured (deceased) as field worker of the OP4 but OP4 did not filed it for which the claim could not be properly settled so, there is no negligence and deficiency on the part of the OP Insurance
Company and for which the complaint should be dismissed.
Decision with Reasons
On proper consideration of the complaint and the written version and also assessing the material on record including the argument as advanced by the Ld. Lawyers of both the parties it is found that it is an undisputed fact that there was an insurance policy being No.4751220001607/E No.47-30326 issued in the name of Golden Trust Financial Services and proposal and declaration as submitted to the New India Assurance Company Ltd. by the Golden Trust Financial Services for Group Janata Personal Accident Insurance Policy of the Company and the insured name was Brij Nandan Singh C/o. Geekay Sales (India), 80/81, Bentinck Street, 1st floor, Calcutta – 1 and risk covered for accidental death/loss of limbs/permanent total disablement for a capital sum of Rs.1 lakh and name of the nominee is noted Sakuntala Devi Singh C/o. Geekay Sales (India), 80/81, Bentinck Street, 1st floor, Calcutta – 1.
No doubt claim was submitted by the complainant through GTFS on the death of her husband Brij Nandan Singh who died due to a road accident on 18-09-2010. Truth is that said policy was valid up to 07-07-2014. But the policy was issued on 08-07-1999 but as per Hon’ble Calcutta High Court’s order passed in WP No.1144 of 1999 on 06-07-1999 GTFS is debarred and restricted from collecting any sort of premium from category of friend from the date of the said order and in that order it is specifically mentioned “the petitioner is further directed not to collect any premium from the category of friends as mentioned in the said policy from today until the matter is heard by the Court” and considering that order it is clear that after 06-07-1999 GTFS OP4 had no legal authority to collect the premium for the category of friends from 06-07-1999.
So, it is the duty on the part of the complainant and the GTFS to prove that Brij Nandan Singh, the deceased the insured as per the policy was field worker of the GTFS Company but no doubt OP4 has failed to produce any such document that Brij Nandan Singh since deceased was appointed as field worker of the GTFS and he used to earn commission for such work and as field worker his name was insured in the Group Janata Personal Accident Policy. Fact remains OP4 has not disclosed in his written statement what was the status of Brij Nandan Singh but fact remains in the written version nowhere OP has stated that he was field worker of GTFS but shrewdly avoided to disclose the status of deceased and truth is that OP4 has filed written statement but has not filed any document in support of the status of the deceased Brij Nandan Singh that deceased Brij Nandan Singh was field worker of the OP4.
Fact remains OP Insurance Company always asked the complainant and OP4 to produce all the documents in support of proving the status of the said Brij Nandan Singh as field worker of the OP4 and as because that document was not submitted by the OP4 for which the matter was not actually disposed of by the OP1. If we consider the order of the Hon’ble High Court as already mentioned and including the version of the OP4 it is clear that OP4 even being restrained by the order of the Hon’ble High Court managed to procure such insurance policy in respect of Brij Nandan Singh who was not an employee or field worker or any officer of the OP4.
Fact remains OP4 has tried to convince that in one case Hon’ble High Court after considering the everything directed the present OP1 to settle the claim of one such person namely Bimal Chanda but that order cannot be taken into account as applicable in all the cases because in that case fact was otherwise but in the present case fact remains that after passing restrain order against the OP4 on 06-07-1999 to take any premium for purchasing any policy of friends category present OP4 unscrupulously managed to procure the said policy covering the risk of Brij Nandan Singh who was not a field worker or officer of GTFS but fact remains JPA Insurance Policy was issued in the name of the Company i.e. GTFS and only the employees or their field workers are covered by the said policy but not any outsider but OP4 unscrupulously managed to procure this policy on 08-07-1999 when OP4 had no legal authority to get such insurance policy. So, admittedly, as per order of the Hon’ble High Court on 06-07-1999 the present policy is ipso facto void and for which the present OP rightly refused to settle the claim of the complainant and it is also fact that the Golden Trust Financial Services OP4 must have to prove that Brij Nandan Singh was employee or field worker of GTFS on the date of purchasing the JPA Insurance Policy on 08-07-1999 if it is not proved in that case invariably insurance company is not liable to pay any compensation to the wife of the deceased Brij Nandan Singh in view of the fact that there was specific order of the Hon’ble High Court passed in W.P. No.1144 of 1999 on 06-07-1999. So, considering that order of the Hon’ble High Court we are convinced that the OP4 managed to procure the present policy suppressing the entire fact knowing fully well that Brij Nandan Singh was not employee or field worker of the OP4 then it is the duty of the OP4 to find out the status of the Brij Nandan Singh as on 08-07-1999 and if OP4 fails to produce such documentary evidence and materials before the insurance company about the status of the Brij Nandan Singh as employee or field worker in that case this policy is void ab initio as per order of the Hon’ble High Court and in the above circumstances, it is not possible to dispose of this case but to direct the OP insurance company to settle the claim when the vital document in support of status of Brij Nandan Singh would be filed by the complainant or the OP4. Accordingly we are disposing of the complaint with a directin to the complainant and OP4 to produce all necessary documents in support of the status of the Brij Nandan Singh as employee of OP4 or as field worker of OP4 prior to and since 08-07-1999 and till the death of Brij Nandan Singh and on receipt of the same the Insurance Company shall have to dispose of the matter as per law.
Hence,
Ordered
That the case be and the same is allowed in part on contest against the all the OPs but cost shall be paid by the OP4 because for his laches complainant is being harassed. So, OP4 shall have to pay a sum of Rs.5,000/- as cost to the complainant.
OPs1 to 3 are directed to dispose of the settlement of the claim in respect of the present disputed policy on receipt of all necessary documents to be produced by the complainant and the OP4. So, complainant and OP4 are directed to produce all the official documents of OP4 to prove that Brij Nandan Singh was an employee of GTFS (OP4) or field worker of OP4 on and from 08-07-1999 or prior to that and till his death. If complainant and OP4 failed to produce all those documents in that case OP Insurance Company has no liability to dispose of the same but to close it as per law.
If OP4 fails to prove the status of Brij Nandan Singh as employee or field worker with proper document in that case OP4 shall have to pay a sum of Rs.50,000/- as compensation to the complainant and that entire matter shall be disposed of by the OP4 on their part within two months from the date of this order failing which penal action shall be started against the OP4 and further penalty shall be imposed as per law.
