This is a case U/S 12 of the C. P. Act, 1986 with the prayer directing the O.P. No.1 and 2 to pay the assured sum of Rs.5,00,000/- connected with two JPA policies being No. 100300/47/2K/9601062/2K/96/00486 and being No. 100300/47/01/9600022/01/96/30189 with 10% interest p.a. from the date of filing of the claim petition, Rs.25,000/- for                                          

unnecessary harassment, mental pain and agony, Rs.5,000/- as litigation cost and other reliefs.

The complaint’s case in brief is that the O.P. Nos. 1 and 2 are the business concern dealing with insurance business and the O.P. No.3 is the corporate agent as well as marketing concern of O.P. No.1. The complainant’s husband Barun Dhar (since deceased) was the holder of two Group Janata Personal Accident Insurance Policy certificates being No-100300/47/2K/9601062/2K/96/00486 in which assured sum was/is Rs.2,00,000/- covering the risk for the period from 15.07.2001 to  14.07.2016   and being No. 100300/47/01/9600022/01/96/30189 in which assured sum was/is Rs.3,00,000/- covering the risk for the period from 08.09.2002 to 07.09.2017 and the complainant was/is the nominee of the two policies mentioned above. The said two policies were purchased by the complainant’s husband since deceased, Barun Dhar from O.P. No.1 through O.P. No.3 who was the corporate agent as well as the marketing concern of O.P. No.1.  Barun Dhar died on 08.10.2012 due to motor vehicle accident in front of K. C. Mitra Petrol Pump under Raiganj P.S. and over such incident Raiganj P.S. case U/S 279/304(A) IPC was started  and on completion of investigation the Police Authority submitted Charge Sheet against the driver of the offending vehicle No. WB-59A/1162. The complainant as a nominee of the above mentioned JPA policies placed her claim before the O.P. No.1 for payment of sum assured of the two policies mentioned above through O.P. No.3 by submitting required documents but the O.P. No.1 did not adhere the claim of the complainant. Finding no other alternative the complainant was forced to come before this Forum for  relief as mentioned.

The O.P. No. 1 has contested this case appearing on the date of hearing and by filing written version stating inter alia that the case is not maintainable, the petitioner has no cause of action against the O.P. Nos. 1 and 2, the petitioner’s claim is false, fictitious and the same has been made for wrongful gain, the second policy of which sum assured is Rs.3,00,000/- is not effective for the existence of the first policy and this O.Ps. have no liability to pay any amount.

The O.P. No.3 has also contested this case appearing on the date of hearing and by filing written version stating inter alia that according to the Memorandum of understanding amongst the O.P. Nos. 1 and 3, the O.P. No. 1 empowers GTFS to extend insurance coverage to its member, Mr. Barun Dhar (since deceased) under the said JPA policy, the O.P. No.3 has no role to play, so far as claim settlement and accordingly there is no deficiency in service on the part of O.P. No.3.

The O.P. No. 2 did not contest this case appearing in this case. Accordingly this case was heard exparte against O.P. No. 2.

DECISIONS WITH REASONS

It is admitted that the O.P. Nos. 1 and 2 are a business concern dealing with insurance business and the O.P. No.3 is the corporate agent as well as marketing concern of the O.P. No.1. and also the O.P. No. 1 issued two JPA policy certificates in the name of Late Barun Dhar.

So we are of the opinion that O.P. No. 3 has no liability to settle the claim of the complainant.

The complainant has brought a specific case that after the death of Mr. Barun Dhar, she being the nominee in said policies, placed her claim of total Rs.5,00,000/- as sum assured in said two JPA policies, with all required documents before the O.P. No. 1 through O.P. No.3, and she made several correspondences with O.Ps. The O.P. No.3 has admitted that withholding and without settling the claim of the nominee for an indefinite period caused deficiency in service by the O.P. No.1. After the laps of unreasonable period, the O.P. No.1 by a letter dated 22.07.2013 intimated the complainant that the policy holder Mr. Barun Haldar i.e. husband of the complainant suppressed the first policy being No. 100300/47/2K/9601062/2K/96/00486 valid upto 14.07.2016 in the proposal Form, to get the second JPA policy being No.100300/47/01/9600022/01/96/30189 illegally for which the contract of the insurance policy become null and void and for this illegal acts, the alleged second insurance policy becomes non-effective as per Insurance Act. According to the terms and conditions of the insurance policy the insurance company shall be liable only to make payment as per  first policy as mentioned. So there was/is no deficiency in service on the part of the O.Ps.

On scrutiny of the record it appears that the  O.P. Nos. 1  did not  adduce any evidence to establish its specific case. It has only made  formal denial in the W.V. filed in this case. We carefully go through the insurance policy condition printed on the overleaf of the above mentioned policy certificates nowhere it has been mentioned that suppression of material fact or false statement in the proposal Form the policy become non-effective and null and void. As such the O.Ps. have no leg to stand to establish their case and it clearly shows the negligence and deficiency in service on the part of the O.P. Nos. 1 & 2 in settling the claim of the complainant.

Considering the evidence on record and in view of the discussions held in foregoing lines we are of the opinion that the complainant is entitled to get an award for Rs.2,00,000/- (Rupees Two Lakh) as sum assured in the policy certificate being No. 100300/47/2K/960102/2K/96/00468 valid up to 14.07.2016,  Rs.3,00,000/- (Rupees Three Lakh) only as sum assured in the policy certificate being No. 100300/47/01/ 9600022/01/96/30189 valid up to 07.09.2017, Rs.10,000/- (Rupees Ten Thousand) only as compensation for unnecessary harassment and mental pain and Rs.2,000/- (Rupees Two Thousand) only as litigation cost against the O.P. Nos. 1 and 2 only and  the O.P. Nos. 1 and 2 are individually or jointly liable to pay such amount.

Accordingly the complaint case succeeds in part.

Fees paid is correct.

Hence, it is

ORDERED

that the complaint case No.CC-73/2013 is allowed in part on contest against the O.P. No. 1 and exparte against O.P. No. 2 but  the same is dismissed against the O.P. No.3 on contest.

 the complainant do get an award directing the O.P. Nos. 1 and 2 to pay Rs.5,00,000/- (Rupees Five Lakh) only as total sum assured of the insurance policies in question, Rs.10,000/- (Rupees Ten Thousand) only as compensation for harassment and mental pain and Rs.2,000/- (Rupees Two Thousand) only as litigation cost within one month from the date of this order failing which the awarded total amount of Rs.5,12,000/- (Rupees Five Lakh Twelve Thousand) only will carry interest @ 6% p.a. from the date of filing of this complaint till the date full realization and the complainant will be at liberty to put this award in execution in accordance with law against the O.P. Nos. 1 and 2 jointly or individually.

Let true copy of this order be supplied to the parties each free of cost.