Order8.

Date-14/09/2015.

This is an application u/s.12 of the C.P. Act, 1986.

          Complainant by filing this complaint has submitted that complainant’s husband (since deceased) purchased one Janata Personal Accidental Insurance Policy being No.0179503 through Golden Trust Financial Services and that policy was valid from 15-12-2011 to 14-12-2015 being policy No.4751170000001/4751170045.

          Truth is that her husband due to Gas Cylinder burst sustained injury in the Motor repairing garage of Karan Singh on 22-11-2011 and that garage is situated on Bombay Road, opposite of Refill Pump area.  On his death complainant collected the claim form and filled up the same duly and submitted it through GTFS on 17-03-2012 along with required documents and GTFS deposited the same to the New India Assurance Company on 19-03-2012 and on 07-07-2012 officers of New India Assurance Company came to the house of the complainant, investigated the matter and also reported her to submit written letter stating the entire incident for early disposal of the said claim and also collected some papers by handing over an acknowledgement letter.  Thereafter, on 17-07-2012 New India Assurance Company asked the complainant to submit some other documents that was also submitted but OP Insurance Company did not take any step and also did not release the said benefit of the insurance policy though insured amount was Rs.1 lakh and for not receiving the claim complainant has been suffering much financial stringency and when OP’s attitude was found negative complainant filed this complaint for redressal.

          On the other hand, OP1 by filing written statement submitted that entire claim is not tenable when in view of the fact OP2 failed to prove the genuinity of the claim as agent (deceased) and no such document has been filed by the OP2 to prove that deceased Ranajit Halder was the field worker of the OP2, and as per Hon’ble High Court order the genuinity of the claim must be proved.

          After receiving the claim application OP appointed one investigator named Moloy Nag, who hold indepth investigation into the claim of the complainant, filed claim report stating that the insured was not at all a field worker of the OP2 and was engaged as motor mechanic in the said garage and on the basis of the said report of the investigator OP did not allow the same as because and OP2 has failed to prove that he was an agent for which there was no illegality, deficiency or negligency on the part of the OP for which the complaint should be dismissed.

          On the other hand, OP2 by filing written statement submitted that they complied all the requirements of OP1 and as per judgment of Hon’ble Justice Soumitra Pal when the Certificate of Insurance has been issued by the OP1 being satisfied with the proposal and declaration submitted to the company.  So, further queries are uncalled for and one certificate has been issued as per proposal and declaration submitted by the company it cannot be reopened and said judgment was passed in connection with WP 13359(W) of 2008 and in the above circumstances, the complaint is not maintainable against the OP2.

Decision with Reasons

Having heard the Ld. Counsel appeared for the OP Insurance Company and also the complainant herself and scrutinizing the documents as produced by the complainant we are satisfied that the husband of the complainant is undisputedly covered under the policy and complainant has full filled all the documents for settlement of the claim and payment of the insured money in terms of the insurance policy certificate.

          Truth is that OP insurance company refused to settle the claim of the complainant without any valid reason.  On the contrary OP Insurance Company tried to convince that GTFS has failed to produce any document to prove that Ranajit Halder was an agent or field worker of the OP2 but considering the conduct of the OP we find that OP2 is the insured of the JPA Policy under the OP1.  If GTFS fails to produce any documents for that reason insurance policy cannot be cancelled because  regarding validity of the insurance policy, there is no denial on the part of the OP.  So, considering the deprecated stand taken by the OP New India Assurance Ltd. when policy is valid and Ranajit Halder since deceased is no doubt an insured of the policy, then invariably in that case there is no other alternative on the part of the OP insurance company to refuse the claim of the complainant by any illegal stand as taken.

          Most interesting factor is that in so many cases insurance company has failed to pay insured amount even as per order of the Hon’ble High Court, Hon’ble State Commission and Hon’ble National Commission and in most of the cases the defence is same but the Hon’ble High Court or the Hon’ble State Commission or the Hon’ble National Commission decided that when the policy was issued by the OP Insurance Company and policy is not void for any reasons or terms and conditions and when the insured is covered by that policy in that case there is no question to determine the status of the insured under the OP2.  In the light of the above observation and materials we are of opinion that complainant being a poor widow of a poor deceased insured is being harassed by the OP even after existence of so many judgment passed by the Hon’ble High Court, Hon’ble State Commission and Hon’ble National Commission against this Company regarding such type of JPA policy.

          We have also considered this present position of the lady and invariably it ws the duty of the OP to release that amount within one month from the date of submission of that claim but that has not been done and complainant had been harassed and truth is tht complainant husband died on 22-11-2011, complainant submitted all documents with claim form on 05-12-2011, thereafter, up to 17-07-2012 complainant complied all the requirements of the OP Insurance company but OP insurance company did not send any reply or did not inform when she shall have to get it.

          Such an attitude on the part of the OP insurance company is uncalled for and arbitrary in nature.  Fact remains OP Insurance Company is compelled to release that Rs.1 lakh, the sum insured when death was accidental in nature and complainant was entitled to get it within 05-01-2012 but that was not done.  So, since 05-01-2012 complainant is also entitled to get some interest over the said amount till its full payment.

          At the same time we have gathered that this complainant hails from Mandir Bajar area of 24 Pgs(S) and this widow lady is compelled to file this complaint and attending the Forum daily for defending the case.  So, invariably the complainant is entitled to get some amount as litigation cost further for being harassed by the OP such widow lady of rural village is entitled to some compensation and truth is that insurance company ought to have release the same long back in the month of January, 2012 but it is September, 2015 but amount has not been released but OP insurance company is defending the case so that the complainant may not get insured amount but judgement passed in WP-13359(W) of 2008 already confirmed that release of insured amount is mandatory when queries about status of insured is uncalled for.

          In the light of the above observations and findings we are convinced to hold that complainant is entitled to get a decree as prayed for against the OP1 and practically GTFS is not service provider but they are not insured and OP2 is made party in view of the fact that policy was purchased by the complainant’s husband through GTFS as its employee or agent etc. and for the fault of the OP2 complainant cannot be anyway deceived by the OP1 insurance company.    

In the result, the case succeeds.

Hence,

Ordered

That the case be and the same is allowed on contest against the OP1 with a cost of Rs.5,000/- and same is allowed on contest against the OP2 but without any cost.

          OP1 is hereby directed to pay the sum insured of Rs.1 lakh and also shall have to pay interest  at the rate ofRs.8 percent p.a. over the said amount with effect from 05-01-2012 and till its full payment and it must be paid within one month from the date of this order.

          Further for causing mental pain and sufferings and also for harassment this widow lady by different means by the OP1, OP1 shall have to pay penal damages+ to the extent of Rs.10,000/- to the complainant within one month from the date of this order.

          Accordingly OP1 is hereby directed to comply the order invariably within one month from the date of this order failing which for disobeyance and non-compliance of the Forum’s order OP1 shall have to pay penal interest  at the rate ofRs.100/- per day till full satisfaction of the decree and if it is collected it shall be deposited to this Forum.

Even if it is found that OPs are reluctant to comply the order in that case penal proceeding u/s.25 read with Section 27 of the C.P. Act, shall be imposed for which further penalty and fine shall be imposed.

Order No. 9                            Dated: 20.12.2022

Record is put up today on prayer of the OP-1.

Ld. Advocate for the OP-1 is present and he files Vakalatnama.  A petition annexing a copy of order dated 11.11.2022 passed by the Hon’ble NCDRC in RP/37/2018 and one D.D bearing no.169290 dt. 19.12.2022 for Rs.1,87,715/- issued in favour of ‘’Consumer Legal Aid Account Unit-II’’ is filed by the OP-1 with the prayer for permission to comply order dated 11.11.2022 passed in RP/37/2018 and the same is registered as MA/807/2022.  Perused the MA. Heard considered.  It appears from the order dt. 11.01.2022 passed in RP aforesaid that the petitioner/Op-1 herein is directed to deposit the insured amount along with interest before this Commission within a period of six weeks along with intimation of deposit to the Respondent-1/Complainant herein and the District Forum shall make payment to the complainant without taking any security and the matter has been fixed on 07.02.2023.

In view of the above, prayer of the Op-1 is allowed. Let the D.D be accepted and same be deposited to the concerned Bank A/C of this Commission by keeping note it that the deposit is a refundable one and on prayer of the complainant, the same amount be disbursed to the complainant without taking any security on furnishing authentic photo I card and receipt. MA being no.807/2022 is thus disposed of. Inform the complainant accordingly.