West Bengal

Paschim Midnapore

CC/78/2015

Smt. Bakul Dolai - Complainant(s)

Versus

New India Assurance Co.Ltd - Opp.Party(s)

10 Mar 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President

and

 Kapot Chattopadhyay, Member.

   

Complaint Case No.78/2015

                                                       

Smt. Bakul Dolai……………….….……Complainant.

Versus

 

1)The Golden Multi Services

(Golden Trust Financial Services);

2) New India Assurance Co. Ltd........…..Opp. Parties.

 

              For the Complainant :       Mr. Asim Kumar Dutta, Advocate.

              For the O.P.               : 1)   Mr. Swapan Bhattacherjee, Advocate,

2)Mr. Mrinal Kanti Chowdhury, Advocate.

                                                                                           

Decided on: -10/03/2016

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in brief, is that Jagannath Dolai, since deceased, the son of the complainant during his life time obtained a Janata Personal Accident Insurance Policy, issued by Opposite party no.2-New India Assurance Co. Ltd. through Opposite party no.1-Golden Trust Financial Services being policy no.4751220001799/E no. 4730897 covering the period from 23/07/2000 to 22/07/2015 for an amount of Rs. 1,00,000/-.  The complainant is the nominee of the said policy.  Unfortunately, Jagannath Dolai, the son of the complainant, met with a road traffic accident and he sustained severe injuries and in course of his treatment, he succumbed to his such injuries. Burdwan Police Station started a criminal case bearing number 614 of 2011 dated 26/08/2011 regarding such death of Jagannath Dolai in road traffic accident. After investigation, charge sheet was submitted.  Thereafter, the complainant, being the

                                                                                                                                                               Contd………………..P/2

 

                                                                                              ( 2 )

nominee, filed an application with all relevant documents in the office of opposite party nos. 1 & 2 regarding the claim of that policy.  After receiving all documents about the accidental death of Jagannath Dolai, Opposite party no.2 sent a letter with claim form on 13/11/2014 to the complainant and the complainant again sent all relevant papers.  After receiving those papers, Opposite party no.2 by sending a letter dated 23/02/2015 informed the complainant that the settlement of claim is under process. Again thereafter, the complainant sent all relevant papers by registered post on 18/03/2015.  The opposite party no.2 received the same but without result. Even after receiving all such papers, opposite party no.2 is  trying to avoid in various ways for settlement of the claim which tantamounts to deficiency in service as well as repudiation of the claim. Hence the complaint, praying for directing the Opposite parties to pay the sum assured of Rs.1,00,000/- with interest  @ 12% from the date of application along with litigation cost of Rs.25,000/- to the complainant.

                 Both the Opposite parties have contested this case by filling separate written objections.

                 By filing the written objection, the Opposite party no.1-G.T.F.S. has supported the case of the complainant.  It is stated by the Opposite party no.1 in their written objection that Jagannath Dolai, since deceased, was a field worker of Golden Trust Financial Services and he obtained a Janata Personal Accident Insurance coverage of New India Assurance Co. Ltd. under the group insurance scheme through facilitation of G.T.F.S..  The said policy in the name of Jagannath Dolai was issued by opposite party no.2 after receiving due premium by way of consideration money.  The complainant is the mother and the nominee of the deceased insured under that policy.  It is stated that the complainant informed the accidental death of his son and lodged claim before the Opposite party no.2 along with all relevant documents.  In spite of that the claim has not yet been settled.  It is stated that the aforesaid Group Janata Personal Insurance Policy in question was never disputed by the opposite party no.2 at any point of time.  As the amount of settlement of claim is beyond the scope of authority of Golden Trust Financial Services, the matter is left to the discretion of this Forum.  There is no negligence or deficiency in service on the part of the opposite party no.1.  Opposite party no.1 is not responsible in any manner whatsoever for non settlement or repudiation of the claim by opposite party no.2.

            In their written objection, opposite party no.2 have claimed dismissal of the complaint on the ground that in spite of repeated demands though their letters dated 13/11/2014 and 23/02/2015, neither the complainant nor the G.T.F.S. did not give any

                                                                                                                                                               Contd………………..P/3

 

                                                                                                  ( 3 )

information as regards alleged deceased Jagannath Dolai and they failed to produce any evidence to show that the deceased was the investor or agent or field worker of opposite party no.1. In absence of such documents, the opposite party-Insurance Company could not settle the claim.  It is stated further that Jagannath Dolai was not connected with G.T.F.S. in any manner and he was a Goldsmith by profession.  In view of non production of the status of the insured as investor or agent/field worker of G.T.F.S. or their family members either from the side of G.T.F.S or from the side of the complainant, no benefit of policy under Janata Personal Accident will be available to the complainant and the Opposite party no.2 therefore claimed dismissal of the complaint.  

Point for decision

                      Is the complainant entitled to get the reliefs, as sought for ?    

                   

Decision with reasons

   In this case, the complainant has adduced no evidence but she has filed some documents in support of her case.  Opposite party no.1 also adduced no evidence.  On behalf of Opposite party no.2, one witness namely one Malay Nag, the empanelled investigator of Opposite party no.2, has been examined as OPW-1 and during his evidence, three documents have been marked as Exhibit A,B & C respectively.

 From the respective cases of the parties as well as from the documents filed by them, it appears to us that admittedly Jagannath Dolai, since deceased, the son of the complainant, obtained a Janata Personal Accident Insurance Policy being no. 4751220001799/E for a sum of Rs.1,00,000/- issued by Opposite party no.2 through opposite party no.1-G.T.F.S. and the same was valid from 23/07/2000 to 22/07/2015.  Admittedly, during such period of insurance, said Jagannath Dolai died in a motor accident on 25/08/2011 which also finds support from the copy of death certificate issued by Registrar of Birth and Death, Burdwan Municipality.  It is also not denied and disputed that after the death of insured person, the complainant being the mother and nominee of that policy submitted claim form along with necessary papers before the opposite party no.2.  Admittedly, opposite party no.2, who issued the policy in question in favour of the deceased, has not yet settled the claim of the complainant.  From the lengthy written objection of the Opposite party no.2, we find that the main objection regarding settlement of claim is that the deceased-insured was neither an agent nor an investor nor a field worker or family members of the Opposite party no.1 but he was a Goldsmith by occupation for which the opposite party no.2 asked the complainant to establish the status of the deceased-insured as an agent, investor/field worker or family member of opposite party no.1.  According to opposite party no.2 for such failure to establish the status of the deceased-insured, they are unable to settle the claim of the

                                                                                                                                                                    Contd………………..P/4

 

                                                                                                 ( 4 )

insurance policy.  In such support of their case, the opposite party no.2 examined their empanelled investigator Sri Malay Nag O.P.W.-1 and during his evidence, he proved three documents which were marked as exhibit A, B & C respectively.  Exhibit-A is the  investigation report submitted by OPW-1 Malay Nag before the opposite party no.2 and in the said report, O.P.W.-1 has stated that the complainant and the uncle of the deceased and other local people have confirmed that the said deceased Jagannath Dolai was a Goldsmith by occupation and he was not involved in any other job profile and he was also not involved with G.T.F.S. as a field worker/agent.  In support of such statement, O.P.W.-2 relied much on Exhibit B & C which were allegedly issued by one Panchanan Dolai and the mother of the complainant.  During his cross-examination by the complainant, it was denied that no such document was issued by Panchanan Dolai and the complainant and that the OPW-1 prepared those documents (Exhibit A, B & C) at the instance of the opposite party no.2.  In view of such denial, no reliance can be placed upon those documents and the evidence of O.P.W.-1 to hold that the deceased Jagannath Dolai was a Goldsmith by occupation and that he was not a field worker/agent/investor of the opposite party no.1.

    Now the question arises for consideration is that whether in the present facts and circumstances of the case, as aforesaid, the opposite party no.2 was justified in withholding the claim of the complainant in respect of the Insurance policy issued in favour of  Jagannath Dolai. Admittedly the O.P. No.2 issued the policy certificate in favour of Jagannath Dolai after receiving premium through O.P. No.1. So when a certificate of insurance is issued by the 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 the insured person, the complainant, being the mother and nominee of the said policy, intimated the opposite party no.2 regarding the unfortunate death of her son and she also submitted her claim for settlement of the policy.  It is well settled that when a certificate has been issued as per the proposal and declaration to the insurance 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 the opposite party no.2 for non settlement of the claim of the policy in question and the complainant is, therefore, entitled to the reliefs as prayed for.

                                             Hence, it is,

                                                  Ordered,

               that the complaint case no.78 /2015  is allowed on contest with cost against opposite party no.2 and dismissed on contest against opposite party no.1 without cost.  Opposite party no.2 is directed to pay the complainant the policy amount of

                                                                                                                                                          Contd………………..P/5

 

 

                                                                                                      ( 5 )

 

Rs.1,00,000/- with interest @ 8% p.a. thereon from the date of filing of the complaint and to pay a sum of Rs.5000/- as litigation cost to the complainant.  All such payment shall be made within a month from this date of order.

Let plain copy of this order be given to the parties free of cost.

 

                 Dictated & Corrected by me

                                Sd/-                                           Sd/-                                         Sd/-

                           President                                    Member                                  President

                                                                                                                          District Forum

                                                                                                                      Paschim Medinipur