West Bengal

Paschim Midnapore

CC/78/2013

Smt. Mina Devi - Complainant(s)

Versus

Sr. Divisional Manager, National Insurance Co. Ltd - Opp.Party(s)

29 Aug 2014

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 Complaint case No.78/2013                                                         Date of disposal:29 /08/2014                               

 BEFORE : THE HON’BLE PRESIDENT :  Mr. Sujit Kumar Das.

                                                      MEMBER :  Mrs. Debi Sengupta.

                                                      MEMBER :  Mr. Kapot Chattopadhyay.

  

    For the Complainant/Petitioner/Plaintiff : Mr. B. K.Pratihar, Advocate.

    For the Defendant/O.P.S.                        : Mr. S, Bhattacharya, Advocate.                                   

          

    Smt. Mina Devi, W/o- Late Ram Kailash Yadav of Gopalnagar, Jhapetapur, P.O. Kharagpur, P.S. Kharagpur Town, Dist- Paschim Medinipur…………..Complainant

                                                           Vs.

1. Sr.  Divisional Manager, National Insurance Co. Ltd., Division-III, Ground Floor, 8, India Exchange Place, Kolkata  700 001.
2. Divisional Manager, National Insurance Co. Ltd., Medinipur Divisional Office, at Station Road, P.O. Medinipur, Dist.  Paschim Medinipur, Pin.  721101.
3. Manager, Golden Trust Financial Service, Medinipur, at Battalachak, P.O. Medinipur, Dist. Paschim Medinipur, Pin. 721101...……………Ops.

          The case of the complainant Smt. Mina Devi, in short, is that Janata Personal Accident Insurance Policy was purchased in the name of deceased Ram Kailash Yadav who died on 28/12/2010 and on that account the complainant moved before the Op National Insurance Company Ltd. for payment of sum assured.  But despite the repeated persuasion the Op did not make any payment.  Stating the case the complainant moved before us with the prayer for giving direction  to the Op for payment of sum assured to the amount of 5,00,000/- (Five lakhs) only and                  1,00,000/- (One lakh) only for damage. In this connection, certain documents by firisty namely Policy certificate, Death certificate etc. together with claim form duly furnished are filed.

                      The Op Insurance Company contested the case by filling written objection challenging that the case is not maintainable for want of cause of action and jurisdiction of this Forum.  In this connection, it is also submitted that the complainant is not a consumer to the present Op but one Golden Multi Services Club. It is admitted that upon receipt of necessary documents forwarded to the Op Insurance Company by the complainant whom the Op requested for original

Contd…………P/2

 

-(2)-

documents.  But it was not complied with.  Besides, the request of the complainant was conveyed                                                                                                           to the Op No.3 Golden Trust Financial Services.  But no response was made by them (Op No.3).  So it is not possible for the Op Insurance Company to fulfill the prayer of the complainant.  In order                                  

to support the plea a bunch of documents by firisty namely M.O.U., letter dated 12/08/2011, 3/10/2012 etc.  together with Janata Personal Accident Insurance proposal are submitted.              

           Upon the case of both parties the following issues are framed.

Issues:

1. Whether the case is maintainable in its present from?
2. Whether the complainant has any cause of action for presentation of this petition of complaint?
3. Whether the case is barred by jurisdiction?
4. Whether the complainant is entitled for getting relief from the Op Nos.1&2?
5. Whether the Op No.3 Golden Trust Financial Service is liable for payment of sum assured?
6. Whether the complainant is entitled for getting relief for?

 

Decision with reasons

Issue Nos.1 to 6:

              All the issues are taken up together for discussion as those are interlinked each other.

              Ld. Advocate for the complainant made his argument that the admitted case of the complainant that the policy certificate and death certificate as submitted in this case for seeking relief in terms of the prayer made in the petition of complaint and there is no dispute raised by the Ops.  Since the terms and conditions are already notified in the policy certificate, there is no bar for payment of the sum assured in favour of the complainant.  In this connection, it is submitted by the Ld. Advocate that the claim form duly furnished along with relevant documents was submitted before the Op Insurance Company, no payment has been made till date.  So the complainant has ultimately moved before this Forum.  In the light of the available documents and terms of the policy Ld. Forum, as submitted by the Ld. Advocate, should pass necessary direction in terms of the prayer made by the complainant together with compensation.

              Ld. Advocate for the Op Insurance Company made a challenge claiming that the policy though issued by Insurance Company but the Op No.3 Golden Multi Service Club has the liability towards the claim of the complainant as there exists a memo understanding constituted between Insurance Company and Op No.3 who are by virtue of the said agreement empowered to process and entertain the claim.  So the complainant is the direct consumer under Op No.3.

             While making argument it is pointed out by the Ld. Advocate that there was a proposal towards the nature of actual benefit relating to the policy which discloses that the claim shall be

                                                                                                                                  Contd………..P/3

 

                                                                                                         ( 3 )

entertainable to the maximum limit of 60 times of monthly income of the policy holder who closed the amount of monthly salary to the extent of 4,296/- (Four thousand two hundred ninety six) only.  If that be so, the complainant should get 60 times of his monthly income according to the terms and conditions of the policy.

            We have carefully considered the material evidence on record and it appears that the policy being its no.100300/47/01/9600022/03/96/30451 covering from 31/03/2004 to 30/03/2019 and the deceased policy holder Ram Kailash Yadav, husband of the complainant Smt. Mina Debi died on 18/12/201.  Thus the death of the policy holder was occurred within the stipulated period of aforesaid policy.

            Apart from the above, it appears that the aforesaid policy itself shows the Benefit Schedule within the scope of policy coverage to the effect that Death =100% of sum insured.  If that be so, there is no valid reason to discurred the schedule benefit duly prescribed in the certificate of the policy already issued to the policy holder against  the sum insured 5,00,000/- (Five lakhs) only.

              From the case of the Op and the Insurance Certificate itself, it is evident that the deceased policy holder is the direct consumer of the OP Insurance Company Ltd. and as such the OP shall be remaining liable and responsible to satisfy the claim of the complainant here in this case.

             Under the facts and circumstances and the discussion made here in above it is held and decided that the case is maintainable before this Forum and the allegation of deficiency in service against the Op Insurance Company is established.  Thus, all the issues are disposed of in favour of the complainant.

             As a result, the complainant should get payment of Insurance amount of 5,00,000/-(Five lakhs) only with 9% interest from the date of filing of this case on 25/06/2013 till payment.  The complainant should get 10,000/- (Ten thousand) only on account of damage and harassment.

                        Hence,

                           It is Ordered,    

                                                    that the case be and the same is allowed  on contest  without cost.

      The complainant Mina Debi do get the payment of Insurance amount of 5,00,000/- + 9% interest w.e.f  the date of filing of this case, 25/06/2013 till payment thereof.

      Complainant to further get 0,000/- (Ten thousand) only on account of damage and harassment to the complainant.

                                                                                                                                  Contd………..P/4

 

 

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The Op Insurance Company is hereby directed to make payment of the sum insured and cost of damage as above in favour of the complainant with interest @ 9% w.e.f 25^th June 2013 till its payment within 90 days failing which execution proceeding shall proceed at the instance of the complainant.

Dic. & Corrected by me

              

         President                                Member              Member                          President

                                                                                                                        District Forum

                                                                                                                    Paschim Medinipur.