West Bengal

Paschim Midnapore

CC/12/2015

Pratima Chakraborty - Complainant(s)

Versus

Golden Trust Financial Services - Opp.Party(s)

27 Jul 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President

                                               and  Kapot Chattopadhyay, Member.                                              

                                                        

Pratima Chakraborty ……………….………Complainant

Versus

Golden Trust Financial Services ……..……..Opp. Party.

 

Complaint Case No.12/2015

For the Complainant : Mrs. Poulomi Kala (Bera), Advocate.

For the O.P.               : Mr. Swapan Bhattacharya & Mr.Mrinal Kanti Choudhury, Advocate.

 

Decided on: - 27/07/2015

                               

ORDER

          Bibekananda Pramanik, President - Facts of the case, in brief, is that the complainant is the wife of Santanu Chakraborty, since deceased. Said Santanu Chakraborty obtained the Janata Personal Accident Policy, issued by Opp. No.2, the New India Assurance Co. Ltd. through the Opp. No.1 Golden Trust Finance Services being policy No.(S)4751220001799/E No.47-30952 valid from 01/09/2000 to 31/08/2015  amounting to Rs.1,00,000/-.  During the period of such Insurance Policy,  said Santanu Chakraborty died in a motor vehicle accident on 05/01/2014  in the Nasik Civil Hospital at Nasik within the state of Maharastra.  Santanu Chakraborty died in course of employment as helper of Truck No.WB-29A/2938.  After demines of said Santanu Chakraborty, the complainant being the wife/nominee in the respect of the said policy in question, lodged a claim before the Opp.-Insurance Co. through Opp. No.1 and requested them for early payment of the assured policy amount. The complainant also submitted all required documents but the Opp. did not settle her claim. On 23/02/2011, 03/06/2011, 25/02/2013 and 15/12/2014 the complainant sent letters for early payment of the policy amount but of no effect.  It is stated that the Opp.Parties are liable for deficiency in service. Hence the complaint, praying for an order for payment of the insured amount of Rs.1,00,000/-, compensation of Rs.25,000/- for deficiency of service, cost and interest.

                                                                                                                                                                                       Contd…………..P/2

 

                                                                                                        -(2)-

All the three Opp. Parties have contested this case by filing two separate W/O, one by Opp. Party  No.1 Golden Trust Financial Services and other by   Opp. Party Nos.2 and 3 jointly.

In their joint written objection, Opp. Party Nos.2 and 3 have claimed dismissal of the complaint on the ground that the deceased was helper of the Truck by profession and he had no connection with Opp. Party No.1 G.T.F.S. as investor or agent or field worker and in view of failure to establish  the status of the proposer/insured  Santanu Chakraborty as investor or field worker or staff of GTFS in connection with JAP Insurance Policy, they are unable to settle  the claim and the complainant is not therefore entitled to get benefit from the said policy.

By filing a W/O Opp. Party No.1 G.T.F.S. has supported the case of the complainant. It is      stated by Opp. No.1 that Santanu Chakraborty, since deceased, was a field worker of Opp. Party No.1/GTFS, who obtained a Janata Personal Accident Insurance coverage from Opp. Party No. 2 and 3 under a group insurance scheme through facilitation of G.T.F.S. and the sum insured of was Rs.1,00,000/-.The complainant Pratima Chakraborty is the wife and nominee under the said policy. It is stated that the complainant informed the accidental death of her husband and lodged claim to Opp. Party No.2 through Opp. Party No.1 and submitted all requisites papers and she also sent various letters and representation but inspite that, her claim has not yet been settled by the Opp.-Party No.2.  Golden Trust Financial Services i.e. the answering Opp. Party No. 1 forwarded all such necessary papers and information regarding such claim to the Opp. Party No.2 and there is no negligence or deficiency in service on their part.                

  Point for decision                        

Is the complainant entitled to the reliefs, as prayed for?

 

Decision with reasons

                      At the very outset, it is to be mention here that neither the complainant not the Opp.-Parties  has adduced any sort of  oral or documentary evidence in support of the their respective cases but they have relied upon  some documents, so filed by them in this case. From the respective cases of the parties and the documents filed by them, it appears to us that admittedly Santanu Chakraborty  since deceased, the husband of the complainant Smt Pratima Chakraborty obtained  Janata Personal   Accident Policy issued by Opp. Party No.2 New India Assurance Co. Ltd. through Opp. Party No.1 GTFS for a sum of Rs.1,00,000/-  which was valid from 01/09/2000 to 31/08/2015 and during such period of insurance, said Santanu Chakraborty died in a motor vehicle accident on 05/01/2014  in the Nasik Civil Hospital, Maharastra. It is also not denied and disputed that after the death of insured person, his wife/nominee Smt. Pratima Chakraborty, the present complainant submitted claim form etc through Opp. Party No.1 before the Opp. Party No.2.  Admittedly, the Opp. Party No.2, who issued the policy certificate in favour of the deceased has not yet settled the

                                                                                                                                                                                       Contd…………..P/3

 

                                                                                                           -(3)-

claim of the complainant, the widow/nominee of the insured person. From the lengthy written objection of the Opp. Party No.2 we find that the main objection for such inaction regarding settlement of claim is that deceased-insured  person was a helper of the Truck of the Opp. Party No.1 and he was neither an agent, nor a investor, nor a  field worker or a family member  of the Opp. Party No.1 and inspite of repeated demands by the Opp. Party No.2 neither the complainant not the Opp. Party No.1 submitted any  documentary evidence regarding the status of the deceased insured person and for such failure to establish the status of the deceased proposer/insured, the JPA insurance policy is to be held  as obtained in otherwise  manner and therefore the same will be treated as void and invalid policy.

                Now the question left for consideration is that whether in the facts and circumstances of the case, as aforesaid, the Opp. Party No. 2 and 3 were justified in withholding the claim of the complainant in respect of the insurance policy issued in favoru of her husband. When a certificate of insurance is issued by insurance company it is to be presumed that such certificate was issued pursuant to the proposal and declaration submitted by the insured person. It is not denied and disputed that after the death of insured person, the complainant intimated the Opp. Party Nos. 2 and 3 through Opp. Party No.1 regarding unfortunate death of her husband and she also submitted her claim of the policy. It is none but Opp. Party No.1, with whom Opp. Party No.2 and 3 executed the MOU regarding such JPA, has claimed that they forwarded all such death information, necessary papers and claim of settlement of the policy to the Opp. Party Nos. 2 and 3. It is well settled that when a certificate has been issued as per the proposal and declaration to the company, it cannot be reopened by raising an objection regarding the status and eligibility of the deceased insured.  We are therefore of the view that there is deficiency in service on the part of Opp. Party Nos. 2 and 3 by non-settling the claim of the policy in question and therefore the complainant is entitled to the relief’s, as prayed for.

                                          Hence, it is,

                                                            Ordered,

                                                    that the case be and the same is allowed  on contest with cost against the Opp. Party No.2 and 3 and dismissed against the Opp. Party No.1 without cost. Opp. Party Nos. 2 and 3 are directed to settle the claim of the complainant as mentioned in the certificated of insurance within a period of two months from the date of this order and to pay an amount of Rs.25,000/- as compensation and litigation cost of Rs.10,000/- to the complainant.          

Dictated & Corrected by me

              Sd/-                                              Sd/-                                           Sd/-

         President                                        Member                                    President                                                           

                                                                                                             District Forum

                                                                                                          Paschim Medinipur