: J U D G M E N T :
That the sister of the complainant viz Nandita Kundu since deceased obtained JPA policy bearing certificate No. – 100300/47/ 01/9600022 /01/96 /31164 from the OP No. 1 through GTFS for the period from 31/03/2002 to 30/03/2017 wherein the sum insured was of Rs. 3,00,000/-. Pralay Kundu was figured as a nominee who is a cousin brother of said insured person. Thereafter the said insured viz Nandita Kundu died on 24/02/2009 due to road accident. Thereafter the complainant submitted claim form along with all relevant documents in the office of OP Insurance Company through GTFS. The complainant several times requested the OP Insurance Company to settle the claim but the OP Insurance Company has failed to settle the said claim till date. The complainant has lodged a complaint on 30/12/2013 before the Assistant Director, Consumer Affairs Department, Nadia, but the OP Insurance Company did not turn up in the said office for settlement of the said claim. Hence, the complainant has knocked at the door of the Forum for getting his relief mentioned in his complaint.
The OP Insurance Company contested the case by filing written version stating, inter alia, that this OP issued the above policy in favour of Nandita Kundu and after her death the op received the claim form along with documents through GTFS vide letter dated 4/8/2010 and after scrutiny this OP further requested the complainant to submit income of the deceased policy holder / salary certificate / Form No. – 16. But till date no document regarding this matter was received by this OP. The complainant did not submit the said document. The OP insurance company again sent last reminder by letter dated 19/9/2013 to the complainant requesting him for clarification, but no reply was received from the end of complainant. So the complaint is liable to be rejected.
The op/ GTFS also contested the case by filling written version stating inter alia that this OP can never be jointly and / or severally liable to settle the claim of the complaint. The authority to settle the insurance claim is solely with the insurer i.e. OP No. – 1. The OP/ GTFS has prayed for expunging their names from the cause title as they have no role for settlement of the claim.
Now this Forum is to consider the followings:-
- Whether the complainant is to be treated as consumer or not as per
Consumer Protection Act 1986,
- Whether there is any gross negligence or deficiency in service on the
part of ops or not,
- Whether the complainant is entitled to get any relief as prayed for.
Reasoned Decisions
For the purpose of brevity and convenience all the points are taken up together for discussion. Perused the pleadings of the parties along with the affidavit on record and other relevant documents filed by the parties. It is fact and admitted position that the life of Nandita Kundu since deceased was covered under the insurance policy being no –100300/47/01/9600022/01/96/31164 issued in the name of GTFS , wherein the sum insured was Rs300000/- . It is also fact and admitted position that Prolay Kundu ( relationship brother ) was figured as a nominee in the said policy which is clearly revealed from the policy certificate issued by the insurance company dated 31/03/2002. To that effect NanditaKundu since deceased paid the premium to the op / insurance company through the op / GTFS. So in view of the status of the ops and complainant / nominee , the complainant is to treated as consumer as per C P Act , 1986.It is admitted position that NanditaKundu died on 24/02/2009which is clearly revealed from certificate of death. So It is also crystal clear that the insured vizNanditaKundu died on 24/02/2009 which was within the policy covering period ie31/03/2002 to 30/03/2017 .
Now we have perused the FIR being no – 17/09 dated 24/02/09. It is admitted position that NanditaKundu died due to road accident which is clearly revealed from the said FIR. Thereafter we have also perused the PM report. It is fact that a UD case bearing no – 05/2009 dated 24/02/2009 has been started. In the said PM report, the medical officer opined that the death of NanditaKundu is occurred due to haemorrhagic shock due to injury which is antemortem in nature. Though the Form no – 16 for the assessment year 2009- 2010 has been submitted in the case record , yet in this respect we hold that it is not so urgent required document for settlement of the said claim. Actually the insurance is a contract between the parties. When the insurer has failed to abide by the undertaking given by it in pursuance of a contract or otherwise there was deficiency in relation to service. It was held that the insurance company when it has failed to make payment to the nominee appointed under section – 39 of the Insurance Act , 1938 , it has committed default in the performance of the undertaking in pursuance of the contract of Insurance. So as per policy condition the complainant is entitled to get relief against the op / insurance company. After repeated requested from the end of complainant, op / insurance company has failed to settle the claim till date. When the case was genuine one, it should be the duty of op / insurance company to disburse the amount in favor of complainant without any further harassment. But in vain. There is fault and deficiency in service on the part of op / insurance company. The complainant is entitled to get relief as against the op / insurance company.
In this regard op / GTFS has no role regarding payment of claim amount as they can act only as an agent of op / insurance company. There is no gross negligence or deficiency in service on the part of op / GTFS. All the points mentioned above are thus decided as per above observations .The case succeeds.
Hence,
Ordered,
That the CC no – 2014/25 is allowed on contest against the op/insurance company with cost of Rs 1000/- and dismissed against op / GTFS without cost.
That the op / insurance company is hereby directed to pay the insured amount of Rs 300000/- + 1000/- ie total of Rs 301000/- to the nominee / complainant within 30 days from the date of order i.d. an interest @ 10 % pa shall be charged upon the awarded amount till full realization .
