This is an application u/s 12 of Consumer Protection Act 1986 filed on behalf of Smt Anita Nag the complainant wherein it is contended inter alia to the effect that her husband Pratap Shankar Nag (since deceased) was the holder of an insurance policy being No.4751230100472/4751230130233 under Janata Personal Accident Insurance Policy. The said insurance policy with sun assured of Rs.5,00,000/- was valid for the period of 23.08.2001 to 22.08.2016. On 02.02.2006 at evening while Pratap Shankar Nag was returning home by his scooter he sustained injuries on his person caused by a track on a road near Nangdala Railway Gate wherefrom he was taken to Anandalok Hospital on the same evening and on 03.02.2006 he succumbed to injuries at Anandalok Hospital and Neuro Science Centre at Siliguri. A un-natural death case being Case No.20/2006 dated 03.02.2006 was started at Bhaktinagar P.S. and subsequently over this accident Birpara P.S. Case No. 89/2006 was also started against the said offending vehicle. On 07.04.2006 the complainant reported the matter in writing to the ops through op no.1 to whom the Xerox copies of death certificates, post mortem report, FIR and insurance policy were handover. On 29.04.2006 the complainant filed the claim form along with all relevant documents with a request to settle her claim and lastly on 22.02.2012 she went to the office of the op no.1 for settlement her claim, but in vain. Hence, this case.
The op no.1 contested this case by filing written version and by filing the relevant document of Memorandum of Understanding(MoU) and relevant order dated 31.01.1996 addressed to op no.1 by op no.2 and also filed the Xerox copy of the insurance policy in question. It is specifically contended inter alia in the said written version to the effect that the op no.1 acted as agent under op no.2 on the basis of letter dated 31.01.1996 (Vide Ext No.B) and accordingly the complainant is not entitled to get any relief against op no.1 and thus the op no.1 prays for dismissal of the case.
The op no.2 also contested this case by filing written version who denied all material allegations as alleged against him by the complainant. It is specific case of the op no.2 that the concerned insurance were allotted to the insurance policy holder who must be filed worker but as the deceased Pratap Shankar Nag the holder of the insurance policy was not filed worker, the complainant is not entitled to get any relief as sought for. Thus the op no.2 claimed for dismissal of the case.
Under the above averments both parties went on trial with the following points:
- Is the complainant entitled to get relief as legal heir of her deceased husband Pratap Shankar Nag on the basis of the insurance policy in question?
- To what other relief/reliefs is the complainant entitled to get?
Decision with reasons
Point Nos. 1 & 2 –
Both these points are taken up for consideration for the sake of convenience as they are interlinked and interrelated.
After having gone through the respective cases of both parties and after having considered the materials on record we got ingredients to the effect that Pratap Shankar Nag was insurance policy holder (Vide Ext-C). Admittedly the said insurance policy was valid for the period of 23.08.2001 to 22.08.2016 within which the said policy holder sustained injuries with the road accident on 02.02.2006 and the said injured fellow succumbed to injuries on 03.02.2006 leaving this complainant as his only legal heir wife. After having considered the ingredients as available in the Xerox copies of insurance and other documents (Vide Ext-A, B & C). We got materials that the op no.1 being agent under op no.2 acted as per terms and conditions mentioned in Ext-B, the relevant documents issued by op no.2 in favour of op no.1 and as op no.1 acted as agent of op no.2, the complainant is not entitled to get any relief against op no.1.
It is specific case of op no.2 that as the insurance policy holder Pratap Shankar Nag the husband of complainant Smt Anita Nag was not a field worker as per Ext-A (MoU), the complainant is not entitled to get any relief against op no.2. But after scanning the relevant documents in this respect we got no material and/or the op no.2 could not adduce any relevant document in proving his claim that deceased Pratap Shankar Nag was not a filed worker under Group Insurance Scheme. But when the insurance policy was valid up to 22.08.2016 within which the policy holder sustained injuries on his person and subsequently succumbed to injuries on 03.02.2006 and when this policy runs from 23.08.2001, it is to be presumed that the ops have considered his status as filed worker. This being the position we are inclined to hold that the complainant being legal heir of deceased Pratap Shankar Nag is entitled to get relief as sought for.
Thus the case succeeds.
Hence, it is
O R D E R E D
That the Consumer Case No.61/2012 u/s 12 of Consumer Protection Act,1986 be and the same is allowed on contest against op no.2 with cost of Rs.2,000/-(Rupees two thousand) and dismissed on contest against op no.1 Golden Trust Financial Services Ltd without cost.
The op no.2 New India Assurance Company is hereby directed to pay the entire sum assured of Rs.5,00,000/-(Rupees five lakhs) in favour of complainant within one month from this date.
The op no.2 is also directed to pay a sum of Rs.50,000/-(Rupees fifty thousand) for compensation for deficiency in service and another sum of Rs.50,000/-(Rupees fifty thousand) as compensation for mental agony and harassment.
The op no.2 is hereby directed to liquidate the entire decretal amount within one month from this date failing which the complainant will be at liberty to recover the said amount along with interest @10% p.a. to be calculated on and from the date of filing of this case till recovery of the entire dues by filing a separate proceeding against the op no.2 as per provision of law.
