West Bengal

Paschim Midnapore

CC/75/2015

Anjali Jana - Complainant(s)

Versus

Sr. Divisional Manager, The New India Assurance Co.Ltd. - Opp.Party(s)

10 May 2016

ORDER

 

 

 

 

                                                       DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President

and

Mrs. Debi Sengupta, Member

   

Complaint Case No.75/2015

                                                       

                                                              Smt. Anjali Jana…………..……………...……Complainant.

Versus

 

                 1)Divisional Manager, The New India Assurance Co. Ltd.,

                2)Manager, Golden Trust Financial Service, 16 R.N. Mukherjee Road,

                3)Manager, Golden Trust Financial Service,  Battala Chak                         

………………….…Opp. Parties.

              For the Complainant: Mr.  Subal Chakraborty, Advocate.

              For the O.P.               : Mr. Mrinal Kanti Chowdhury, Advocate.

                                                  :  Mr. Swapan Bhattacharjee, Advocate.

 

Decided on: - 10/05/2016

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in brief, is that Manik Lal Jana, since deceased, the husband of the complainant, obtained a Group Janata Personal Accident Insurance Policy, issued by opposite party no.1 through the opposite party no.2-Golden Trust financial Service.  The number of that policy is 475122000-1799/E no.47-30685 and the said policy was valid up to 2^nd February 2015.  The complainant is the nominee of that policy.  Unfortunately, Manik Lal Jana, the husband of the complainant, died on 02/05/2012  in a motor accident.  Regarding such accident, Daspur P.S. started Daspur P.S. case no.76/12 dated 06/05/2012 and after investigation, charge sheet was submitted in that case.  After the death of her husband, the complainant informed the said  matter to the opposite parties and made a claim of Rs.5,00,000/- as compensation as per assurance of the  policy issued by the O.Ps.  Complainant also submitted  all necessary documents  to the O.Ps. Thereafter the complainant went to the

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

 

 

( 2 )

office of the opposite party no.1 on several times but the opposite party no.1 did not pay the amount under that policy.  On 25/08/2014, the complainant sent a lawyer’s notice to the opposite party no.1 by registered post but till today the opposite party no.1 did not pay any accidental benefit under that policy.  Hence this complaint alleging deficiency in service and praying for directing the opposite party no.1 to pay Rs.5,00,000/- with interest to the complainant and for other reliefs.

                  The opposite party Nos. 1 & 2 have also contest this case by filling separate written objection. O.P. No.3  also contested this case by adopting the written objection filed by opposite party no.2.

                  Denying and disputing the case of the complainant it is the specific case of the opposite party no.1 that  in spite of repeated demands by the  opposite party no.1 neither  the complainant  nor the  GTFS did give any information as regard the alleged deceased Manik Lal Jana and no documentary evidence has been furnished by them to prove that the insured was the investor, agent/field worker of GTFS, although they were under obligation to produce such documents as required by the opposite party-Insurance Company. In absence of the aforesaid documents the O.P.-Insurance Company could not settled the claim of the complainant.   It is stated that the deceased Manik Lal Jana was not connected with GTFS in any manner and he was a Marbel Mistry by occupation.  For such non-production of document regarding the status of the aforesaid  insured as investor or agent/field worker of GTFS or their family members either from the side of  GTFS or from the side of the complainant, no benefit of policy under  Group Janata Personal Accident Insurance Policy will be available to the complainant and the opposite party no.1 therefore claims dismissal of the compliant with cost.

                 By filing the written objection, the opposite party nos.2&3 have supported the case of the complainant.  It is stated by the opposite party nos.2&3 in the written objection that Manik Lal Jana, since deceased, was a field worker of Golden Trust Financial Services and he obtained a Group Janata Personal Accident Insurance coverage of New India Assurance Company Ltd. under the Group Insurance Scheme through facilitation of GTFS. The said policy  in the name of  Manik Lal Jana was issued by the opposite party no.1 after receiving due premium by way of consideration money.  The complainant is the widow of said Manik Lal Jana and the nominee of that policy.  It is stated that the complainant informed the incident of death of her husband and lodged claim before the opposite party no.1 along with all relevant documents.  In spite of that, the claim has not yet been settled.  It is stated that the aforesaid  Janata Group Personal Policy in question was never disputed by the opposite party no.1 at any point of time.  As the amount of settlement of claim is beyond the scope of the authority of opposite party nos.2

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

 

 

( 3 )

& 3, the matter is left to the discretion of this Forum.  There is no negligence or deficiency of service on the part of the opposite party nos.2 & 3 and they are not responsible in any way whatsoever for non-settlement or repudiation of the claim by opposite party no.1.          

 

Point for decision

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

                   

Decision with reasons

At the very outset, it is stated here that in this case neither the complainant nor the opposite parties adduced any sort of evidence but they have relied upon some documents, was filed by them.

From the respective cases of the parties as well as from the documents filed by them, it appears  that admittedly Manik Lal Jana, since deceased, the husband of the complainant, obtained the Group Janata Personal Accident Insurance Policy for a sum of Rs.5,00,000/-, issued by the opposite party no.1 through opposite party no.2 and the same was valid up to 22/02/2015. Admittedly, during such period of insurance, Manik Lal Jana died in a motor accident on 02/05/2012.  It is not denied and disputed that after the death of insured person, the complainant being the wife and nominee of that policy submitted claim form along with necessary papers before the opposite party no.1.  Admittedly, the opposite party no.1, 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.1, 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 member of the Opposite party no.2 but he was a Marvel Mistry by occupation for which the Opposite party no.1 asked the complainant to establish the status of the deceased-insured as an agent, investor/field worker or family member of Opposite party no.2.  According to opposite party no.1, for such failure to establish the status of the deceased-insured, they are unable to settle the claim of the insurance policy.  In support of their said case, the Opposite party no.1 has relied on a letter, addressed to the Investigator Maloy Nath, allegedly written by the complainant Anjali Jana.  In the said letter, Anjali Jana allegedly declared that her deceased husband was engaged in Marvel Stone worker and he was not involved with GTFS as an agent or field worker.  At the time of hearing of argument, Ld. Lawyer of the complainant submitted that no such letter was given by Anjali Jana to the Investigator of the opposite party no.1.  In view of such denial and since the said letter has not been admitted in evidence, so no reliance can be placed upon that letter to hold that the deceased Manik Lal Jana was a Marvel Mistry by

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

 

 

 

( 4 )

occupation and that he was not a field worker/agent/investor of the opposite party no.2.

             Now the question arises for consideration is that whether in the present facts and circumstances of the case, as aforesaid, the opposite party no.1 was justified in withholding the claim of the complainant in respect of the insurance policy, issued in favour of Manik Lal Jana.  Admittedly the O.P. No.1 issued the policy certificate in favour of Manik Lal Jana after receiving premium through O.P. No.2. 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 wife and nominee of the said policy, intimated the opposite party no.1 regarding the unfortunate death of her husband 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.1 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.75 /2015  is allowed on contest with cost against opposite party no.1 and dismissed on contest against opposite party no.2 & 3 without cost.  Opposite party no.1 is directed to pay the complainant the policy amount of Rs.5,00,000/- with interest @ 8% p.a. thereon from the date of filing of the complaint and to pay a sum of Rs.2,000/- as litigation cost.  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