JUDGEMENT

          In precise complainant’s case is that complainant purchased one Group Janata Personal Accident Insurance Policy through op no.3 with risk covered accidental death/loss of limits/permanent total disability for an overall capital sum of Rs.5,00,000/- payment for one time of Rs.20,000/- only and in the said policy Shrimati Sipra Mondal was the nominee.

          As per terms and conditions of the said policy it was valid for 15 years started from 15.11.2000 to 14.11.2015 and op no.1 issued the said policy certificate to that effect.

-         2 -        

On 30.10.2010 suddenly complainant slipped his legs on the pond and suffered serious injury and he was admitted to S.S.K.M. Hospital and after long treatment complainant recovered but lost his strength and ability to walk by his both limbs and released on 13.01.2013 from the hospital.

          That on 28.05.2003 the Superintendent of M.R. Bangur Hospital issued a certificate declaring the complainant a permanent handicapped person of 100% orthopeadecially and thus he has become a declared disabled person and he cannot move without any escort.

          In the above circumstances, complainant made an application to the op no.2 requesting to supply a claim form so that he may submit his claim in respect of the policy of op no.1 which was duly received by the op no.2 and accordingly a claim form was given and filled up thereafter the complainant handed over all the necessary documents in support of his claim to the op no.2 through op no.3 and on 12.03.2004 the Manager of the op no.2 sent a letter to the Sr. Divisional Manager of op no.1 for taking necessary action and final settlement of the claim of the complainant along with all materials.  But in spite of receiving of the same by the op no.1, op no.1 did nothing and did not dispose of the matter though repeated assurance was given by the op nos. 2 &3 about statement of the claim but complainant waited for long time till 21.10.2009 and finding no other alternative, the complainant sent a letter to the Sr. Divisional Manager of op no.1 through his Ld. Advocate Sri Prakash Ch. Mondal but ultimately op no.1 did not take necessary action to settle his claim though the letter was forwarded by op no.2.

          Thereafter the op no.1 sent a letter on 28.10.2009 stating that over the long term JPA Policy a cancellation case is subjudiced before the Hon’ble Calcutta High Court as they have cancelled the long term policy beyond five years and sum assured more than Rs.1,00,000/- and until the case is disposed of, they cannot take any steps for settlement of claim.  In the above circumstances, complainant has prayed for redressal.

          On the other hand op GTFS by filing written statement submitted that Milan Kr. Mondal was a field worker of Golden Trust Financial Services and said Janata Personal Accident Insurance Policy bearing No.4751170000001/4751170030009 was issued by the New India Assurance Co. Ltd. in favour of GTFS covering the risk of the life of field worker Milan Kr. Mondal for ther period from 15.11.2000

-         3 -

to 14.11.2015 for a sum isured of Rs.5,00,000/- only and Sipra Mondal is the wife and the nominee of the deceased member and op no.2 has stated that op no.1 being satisfied insurance policy was issued so the present question of cancellation of the said policy by any means does not arise and fact remains on the death of Milan Kr. Mondal his wife as nominee has filed a complaint and her claim was forwarded to the Insurance Co. along with all papers but that was not disposed by the op no.1 for which op no.2 can be expunged from the case because op no.2 did not issue any insurance policy.  On the contrary insurance company by filing written version submitted that as per JPA Policy the sum assured varies from Rs.50,000/- to Rs.10,00,000/- and the periods of coverage were 1 to 15 years and GTFS used to collect the premium and used to remit it and fact remains that New India Assurance Co. issued a letter on 07.05.1999 addressed to the Insured Golden Trust Financial Services for cancellation of the MOU and on receipt of that cancellation letter GTFS moved a Writ Application before the Hon’ble Supreme Court and Hon’ble High Court passed an interim order on 06.07.1999 that GTFS is debarred from collecting any premium from the category of friends from the date of such order.  Fact remains the complainant’s husband was not any employee or filed worker of the said op no.2 but it was discriminately issued to the general public at large and it was also alleged that New India Assurance Co. declared that the limit of the assured amount of the JPA Policy shall be only Rs.1,00,000/- but that was not followed and it was issued and as per order dated 01.03.2002 the long term JPA Policy for more than Rs.1 lakh and more than five years were cancelled and the same was served to GTFS and for which the complainant cannot get any relief in respect of that.  Moreover, it is suggested that the other litigation in between the op nos. 1 & 2 are still pending and so at this stage the present case cannot be anyway decided by this Forum.

          In the circumstances, op has prayed for dismissal of the case.

                                                 Decision with reasons

          On proper consideration of the entire argument as advanced by the Ld. Lawyers of both the parties and also considering the fact as it is evident from the argument as advanced by the Ld. Lawyers of both parties, it is proved that long term JPA policy was more than Rs.1 lakh and more than five years as per order dated 01.03.2002 but policies were valid for only sum assured of Rs.1 lakh for the

-         4 -

period of five years and practically in this regard there is no denial on the part of the GTFS because JPA has not denied that fact because there was MoU but in the present case it is found that the present complainant Milan Kr. Mondal a JPA Policy holder was admitted to SSKM Hospital on 30.10.2002 and he was released on 13.01.2003 from hospital and Bangur Hospital Authority issued disabled certificate on 28.05.2003.

          Complainant has claimed assured amount of Rs.5 lakh as per said policy through GTFS op no.3.  But fact remains rather it is undisputed fact that all the policies as per MoU which was issued, were changed and restricted to Rs.1 lakh and for five years.  It is fact in this case, there are so many allegations and as per policy claim it is found for permanent total disablement for an overall capital sum insured is Rs.5 lakh and it is also fact that GTFS collected premium on the basis of MoU from many general public though they are not employees or their family member and in this case it is proved that complainant was not an employee of op no.2 or his family members.  The general public who purchased it by paying of premium invariably relied upon the terms of MoU disclosed by the op no.2 and fact remains insurance policy was in the name of the op no.2 not in the name of the complainant.  Whatever it may be fact remains that op no.1 has expressed JPA Policy was for five years insured amount being was Rs.50,000/- to Rs.1,00,000/- but anyhow as per MoU this was issued by the op no.2 on behalf of the op no.1.  But that was in violation of the terms of the MoU what is found.   Fact remains in the present case though in our view we find that the policy was valid for five years and sum assured was Rs.1 lakh and that is the valid policy, terms and conditions as per MoU.  Fact remains the policy was issued for 15.11.2000 to 14.11.2015.  But it would be for five years and even if it is found that validity of the insurance was from 15.11.2000 to 14.11.2005 in that case also it is found that the accident took place within that time.  Further considering the total episode and the report of the medical certificate for handicapped person it is found that he sustained partial disability permanently calculated 100%, but it was issued on 08.05.2003 and fact remains he sustained such sort of injury and he was treated at hospital at SSKM Hospital which is also fact but question is what would be the amount of insurance claim he is entitled to get.  Considering the entire fact and evidences, we find that all the JPA policy was for sum assured of Rs.1 lakh only and only for five years

-         5 -

but violating the rules GTFS op no.2 issued for five years policy and collected premium and thereafter sum assured was shown Rs.5 lakhs.  But this matter is under challenge at Hon’ble High Court and Civil Court.  But considering the ops version that JPA was issued for five years term and maximum limit of insurance and sum assured was Rs.1 lakh.  We find that on the basis of the present demand of the op insurance company, op insurance company shall have to release Rs.1,00,000/- at once when the permanent disability of the complainant is well proved.  But question of giving of Rs. 5,00,000/- would arise when the entire dispute shall be decided by the Hon’ble High Court and in Civil Suit and also in Writ application.  On the ground particularly present company GTFS is declared by the Hon’ble High Court to accept any premium from any insured person.  So, it is clear that dispute is very complicated dispute in between the op nos. 1 & 2 and when Civil Suit is pending we shall have no other alternative but to direct the op insurance company to allow it.  In the light of the above findings we are convinced to hold that at this stage complainant is entitled to get Rs.1,00,000/- as sum assured for his permanent partial 100% disability from the op no.1.  On the ground all the papers and materials were sent by the GTFS but fact remains the act of the GTFS is very illegal because they have committed some mischief for which ops are unable to realize such amount from GTFS because it is a public exchequer wherefrom the compensation shall be paid by the insurance company.  So this complaint succeeds in part at this stage.

          Hence, it is

                                                   ORDERED

          That the complaint be and the same is allowed on contest with a cost of Rs.2,000/- against op no.1 and same is also allowed against op no.2 but without cost.

          Op no.1 is hereby directed to pay a sum of Rs.1,00,000/- against particular bank account of the complainant by issuing account payee cheque in favour of the complainant within two months from the date of this order and in the mean time complainant shall have to submit his bank account  number by supplying attested Xerox copy of his bank pass book to the op no.1 by registered post with A/D by SPEED Post along with the copy of the judgement and on receipt of the same op no.1 Insurance Co. shall have to issue such cheque without any further delay and

-         6 -

harassment.  In this case no further compensation is awarded in view of the fact.  Op no.1 has right to wait till decision of the Civil proceeding which is pending so until their matter is disposed, we are of the opinion that no further compensation can be awarded to the complainant when there is no negligence, deficiency on the part of the op no.1, when Civil Suit regarding this matter is pending and another matter is that policy was issued in the name of the op no.2 not the party.  So release of insurance amount till disposal of the said two writ petitions of High Court shall be limited to the extent of Rs.1,00,000/- and for five years in respect of all JPA Policies and for that reason this case is disposed of finally giving such relief to the complainant at this stage.