Consumer Complaint No. 226 of 2015
Date of filing: 19.11.2015 Date of disposal: 20.12.2016
Complainant: Mrs. China Gope, W/o. Late Nirmal Gope, resident of Village: Alkusha, Post Office: Samdi, Police Station: Salanpur, District: Burdwan.
-V E R S U S-
Opposite Party: 1. Senior Divisional Manager, National Insurance Co. Ltd., Division – III, 8, India Exchange Place, Kolkata – 01.
2. The Manager, Golden Trust Financial Services, 16, R. N. Mukherjee Road (1st Floor), Kolkata – 700 001.
3. The Manager, National Insurance Co. Ltd., on the 1st Floor, Hindustan Sweets, Bhagat Singh More, Asansol – 713 304.
4. The Manager, National Insurance Co. ltd., Beside Kolkata Bazar Shopping Mall, Asnasol – 713 304.
Present: Hon’ble President: Sri Asoke Kumar Mandal.
Hon’ble Member: Smt. Silpi Majumder.
Hon’ble Member: Sri Pankaj Kumar Sinha.
Appeared for the Complainant: Ld. Advocate, Debmalya Chatterjee.
Appeared for the Opposite Party Nos. 1, 3&4: Ld. Advocate, Ahi Bhushan De.
Appeared for the Opposite Party No. 2: Ld. Advocate, Bibhas Mondal & Mrs. Monalisha Banerjee.
J U D G E M E N T
This complaint is filed by the Complainant u/S. 12 of the Consumer Protection Act, 1986 alleging deficiency in service, as well as, unfair trade practice against the OP-1, 3 and 4-National Insurance Company as the Insurance Company did not settle her legitimate insurance claim till filing of this complaint.
The brief fact of the case of the Complainant is that on 15.10.2001 her husband, since deceased obtained Janata Personal Accident policy from the Insurance Company and the Company issued policy certificate in the name her husband wherein the Complainant was declared as nominee. The policy was valid for 15 years i.e. from 15.10.2001 to 14.10.2016 and sum assured of Rs. 5, 00,000=00. The said policy was obtained by the insured through the GTFS-OP-2. The insured was a permanent employee of ECL at Mohan Colliery, who died unfortunately on 23.01.2008 at about 11.00 A.M. while he was on duty. He met an accident due to roll back of dumper and fell down into water of Mohanpur OCP while reversing for dumping and expired on the spot. The incident was informed to Salanpur Police Station, who started one U.D. case being no-03/2008 dated 23.01.2008 and subsequently the dead body was sent to the Sub-Divisional Hospital, Asansol for Post Mortem. Post Mortem was done. It was opined that death was due to asphyxia as a result of drawing anti-mortem in nature. Subsequently FRT was issued from the additional Superintendent of Police, Asansol on 29.04.2008 regarding the incident stating that no foul play could be detected behind the death of the deceased as reported. Thereafter the Complainant-the widow of the insured being a nominee made contract with the Insurance Company, Asansol and informed the incident. The concerned official of the Company asked the Complainant to furnish some documents and the Complainant on 21.06.2008 submitted those documents before the office of the Insurance Company, Asansol. Claim was lodged being no-472008960000241. The Complainant again went to the office of the Insurance Company, Asansol and wanted to know about the status of her claim. She was informed by the officials that some time is needed for processing of the claim and in this manner the OP started to delay the matter continuously. Being aggrieved with the behavior of the officials of the Insurance Company the Complainant contacted with the Senior Divisional Manager of the Company in Kolkata where the said Manager asked her to furnish some documents on 15.05.2010 regarding her JPA claim. The Complainant immediately furnished all the documents but surprisingly the Senior Divisional Manager again asked for some documents on 07.01.2014 and the Complainant accordingly submitted all the documents, but astonishingly the Senior Divisional Manager again directed the Complainant to submit some more documents on 31.03.2014 and the Complainant complied with the said direction in toto. Thereafter the Complainant went to the office of the Insurance Company in Kolkata on 13.06.2014 and met with the Senior Divisional Manager and on that date also the said Manager asked for some documents and on that date the Complainant prayed for providing her at least two months for furnishing all those documents for satisfaction of the Manager. At that point of time the Complainant decided to send all the documents through courier service and send the documents to the Kolkata office of the Insurance Company through DTDC courier on 11.07.2014 which was duly received by the Kolkata Office of the Company and the track report has been filed by the Complainant. Thereafter the Complainant went to the Kolkata Office of the Company on several occasions and on every occasion the Senior Divisional Manager took time on the ground of investigation of the claim and in such manner prolonged delay has been occurred. On 07.08.2015 the Complainant again went to the said office and wanted to know about the status of her claim from the Senior Divisional Manager. Then she was told by the Manager that if she leaves her claim for Rs. 5, 00,000=00, then the claim will be settled at Rs. 2, 00,000=00 immediately. But the Complainant had refused to accept such offer and for this reason the Insurance Company did not take any step to settle her legitimate claim till filing of this complaint. Being dissatisfied with such action of the Insurance Company this complaint is initiated by the her before this ld. Forum praying for direction upon the Insurance Company to pay sum assured of Rs. 5, 00,000=00 along with interest @18% p.a., Rs. 4, 00,000=00 as compensation due to physical and mental strain, agony and harassment and litigation cost of Rs. 50,000=00 to her.
The petition of complaint have been contested by the OP-1, 3 and 4 by filing conjoint written version contending that the husband of the complainant, since deceased took a Group Janata Personal Accident Policy from the OP-1 for the period from 15.10.2001 to 14.10.2016 for the sum assured of Rs. 5, 00,000=00 and the Complainant was declared as nominee in the said policy. The OPs came to learn from a letter dated 06.03.2008 issued by the Complainant that the insured died on 23.01.2008 due to a fatal accident at Mohanpur Colliery at ECL while driving a dumper. The OP-1 received the claim docket through the GTFS-OP-2 and after scrutinizing the papers submitted by the Complainant, the OP-1 requested the Complainant to arrange and send some relevant documents and papers i.e. Final Police Report/Charge Sheet, Legible copy of the Post-mortem Report, copy of FIR & Ford Banyan, Employer Certificate, document showing the cause of death of the insured, salary Certificate of the employee etc vide letters dated 15.05.2010, 07.01.2014 and 31.03.2014 within 15 days from the date of receipt of those letters, but the Complainant did not submit the said relevant documents and papers within the stipulated time. The Complainant prayed for two months time for producing those documents vide her letter dated 13.06.2014. But these OPs did not receive those necessary documents and papers within due time and as such the claim is pending for non-submission of the documents by the Complainant. Be it mentioned that inspite of those letters to the Complainant dated 15.05.2010, 07.01.2014 and 31.03.2014 regarding compliance, but till date the Ops did not receive the relevant documents and papers and as such the OP-1 is not in a position to proceed with the Claim File and thus the claim is pending for settlement. Therefore under such circumstances the Complainant is not entitled to get any relief as prayed for in the petition of complaint. The OPs have strongly denied the allegations as stated by the Complainant in the complaint. According to these OPs as there is no negligence and deficiency in service on their behalf, the complaint is liable to be dismissed with cost.
The OP-2 has contested the complaint by filing written version stating that this OP had acted bonafide and within its bounds of authority, so question does not arise for deficiency in service. The Complainant has no grievance against this OP and for this reason she is not entitled to get any relief from it. It is submitted by the OP-2 that with a view to assist the insured it always extended co-operation. The documents as submitted by the insured to it for settlement of claim, upon receipt of those documents this OP immediately forwarded the same to the OP-1 for appropriate decision of the Insurance Company. It is apparent from the record that this OP vide its letter dated 25.06.2008, 17.02.2010 and 02.01.2010 forwarded the claim papers/documents to the OP-1 for settlement of the claim of the Complainant. The OP-2 had discharged its duties and liabilities in terms of the guideline of the policy concerned as well as the terms and the conditions of the MOU, executed by and between it and the Insurance Company. It is contended by the OP-2 that acceptance of proposal for the policy, issuance of Insurance certificate and settlement of any claim arising out thereof, are under exclusive domain of the OP-1. The OP-1 is the sole, ultimate and absolute authority to take decision; this OP has no authority to that effect. As no allegation has been made out by the Complainant within the four corners of the complaint, hence prayer is made by the OP-2 for dismissal of the complaint.
The Complainant has adduced evidence on affidavit along with several documents in support of her contention. The OP-1, 3 and 4 have filed written notes of argument with a copy to the Complainant along with several documents by way of ‘firisty’ in support of their contention.
We have carefully perused the record; documents and papers filed by the contesting parties, WNA filed by the OP-1, 3 and 4 and heard argument at length advanced by the Ld. Counsel for the parties. It is seen by us that there are some admitted facts in the case in hand i.e. the husband of the Complainant, since deceased, purchased a Group Janata Personal Accident policy from the OP-1 through the OP-2, the policy was for the period from 15.10.2001 to 14.10.2016, sum assured is of Rs. 5,00,000=00, one time premium was paid to the OP-2 which was duly remitted to the OP-1, the OP-1 issued the policy document in favour of the husband of the Complainant, the Complainant was declared as nominee in the said policy, the principal insured died on 23.01.2008 due to fatal accident at Mohanpur Colliery at ECL while driving a dumper, postmortem done, FIR lodged with the local Police Station, after investigation Final Police Report submitted, the incident was duly intimated to the OP-1 through the OP-2, claim form issued by the OP-1 which was received by the Complainant through the OP-2, claim form was submitted by the Complainant along with relevant papers and documents which was received by the OP-1 through the OP-2, as per the MOU the OP-2 has no authority to issue any policy in favour of the intending insured and to settle any claim, if arises, the OP-2 is used to act as an mediator by and between the insured and the Insurance Company, though the OP-2 used to receive the premium amount but the same is duly remitted to the Insurance Company for issuance of the policy document in favour of the insured, in case of any claim the liability of the OP-2 is to send the claim form and relevant documents to the Insurance Company, after scrutinizing the papers submitted by the Complainant the OP-1 requested to the Complainant to arrange and send it some related documents and papers, i.e. Final Police Report/Charge Sheet, Legible Copy of the Post Mortem Report, First information Report & Ford Bayan, Employer Certificate regarding the cause of death of the insured, salary Certificate of the employee by issuing letters dated 15.05.2010, 07.01.2014 and 31.03.2014 within 15 days from the date of receipt of those letters, on 13.06.2014 by issuing a letter to the OP-1 the Complainant had prayed for at least two months time for submitting the relevant papers as sought for by the OP-1 for settlement of the claim. The allegation of the Complainant is that the OP-1 did not bother to settle her legitimate insurance claim and kept it pending till date arbitrarily and illegally. As her grievance had not been settled by the OP-1, hence this complaint is initiated praying for the sum assured along with other reliefs. The contention of the OP-2 is that it has duly discharged its duties and liabilities and it is not empowered to settle any claim by making payment, hence there is no deficiency in its behalf. The contention of the OP-1, 3 and 4 is that as till filing of this complaint the required documents has not been received by the Insurance Company and for which the Complainant took two months time, the claim could not be settled. It is also contended by the Insurance Company that upon receipt of those documents they will decide the claim.
During hearing the Ld. Counsel for the Complainant has argued that as per the letter dated 31.03.2014 she had send the required documents and papers to the OP-1 though DTDC Courier & Cargo on 11.07.2014 and inspite of receipt of the documents the Insurance Company did not bother to settle her claim. In this respect the ld. Counsel for the Insurance Company has submitted that as per the terms and the conditions of the policy as well as the MOU the documents relating to any claim should be sent to the Insurance Company through the GTFS, who is acting as its agent, not directly in any manner. It is further submitted by the said ld. Counsel that whether the Insurance Company has received the content through the Courier or not there is no prove in this respect and if case of receipt the same whether entire documents was sent by the claimant or not, there is also no evidence. Moreover as to why the Complainant did not send the same through the GTFS, no explanation is given by the Complainant in this regard. We find much substance in the argument as advanced by the Ld. Counsel for the OP-1, 3 and 4. In our opinion the Complainant is under obligation to abide by the terms and the conditions of the policy. So it was the duty of the Complainant to submit those documents to the GTFS, not before the Insurance Company directly. We have noticed that the Complainant sought for at least two months time for sending the required documents to the OP-1 and it is true that until and unless the required documents is received by the Insurance Company, it is not possible for the Insurance Company to settle the claim.
It is noticed by us that as per the policy terms and the conditions the Complainant being a nominee in respect of the policy is entitled to get the sum assured as the insured died due to accident. But simultaneously it is obligation of the Complainant to discharge her liability as per the policy terms and conditions. As the Complainant has failed to discharge her liability, hence we cannot say that the action or activity of the Insurance Company suffer from any deficiency in service. As before discharging her duty, this complaint is initiated, hence that Complainant is not entitled to get any amount towards cost and compensation as prayed for. As no compensation has been imposed either on the shoulder of the GTFS or the Insurance Company, we are not inclined to discuss on the interim order passed by the Hon’ble Supreme Court as relied on by the ld. Counsel for the OP-2.
Going by the foregoing discussion hence, it is
O r d e r e d
that the complaint is dismissed on contest without any cost against the OP-2-GTFS. The complaint is allowed against the OP-1, 3 and 4 on contest without any cost. The Complainant is directed to submit the required documents in view of the letter dated 31.03.2014 to the OP-1 through the OP-2 within 30 days from the date of passing of this judgment and from the date of receipt of those documents within 15 days the OP-1, 3 and 4 either jointly or severally pay the sum assured of Rs. 5,00,000=00 to the Complainant, in default the abovementioned amount shall carry interest @10% p.a. for the default period.
Let plain copies of this order be supplied to the parties free of cost as per provisions of Consumer Protection Regulations, 2005.
(Asoke Kumar Mandal)
Dictated and corrected by me. President
DCDRF, Burdwan
(Silpi Majumder)
Member
DCDRF, Burdwan
(Pankaj Kumar Sinha) (Silpi Majumder)
Member Member
DCDRF, Burdwan DCDRF, Burdwan
