IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
MURSHIDABAD AT BERHAMPORE.
CASE No. CC/173/2014.
Date of Filing: 08.12.2014. Date of Final Order: 21.04.2017.
Complainant: Anwara Bibi, W/O Late Sk. Mahashin Ali @ Mahashin Sk. Vill& P.O. Jhunka,
Beldanga, Dist. Murshidabad.
-Vs-
Opposite Party:1. The Divisional Manager, The New India Assurance Company Ltd,
Howrah Divisional Office 512200, Madhusudan Apartment2nd Flor,P-18, Dobson Lane , Howrah, 700001.
2. Manager, The new India Assurance Company Ltd, 37A, R. N. Tagore Road,
P.O. Berhampore, Dist. Murshidabad. Pin-742101.
3. Manager Golden Trust Financial Services, 16 R.N. Mukherjee Road,Kolkata-700001.
Present: Sri Anupam Bhattacharyya ………………….President.
Smt. Pranati Ali ……….……………….……………. Member
FINAL ORDER
Sri Anupam Bhattacharyya, Presiding Member.
The instant complaint case has been filed by the complainant u/s 12 of C. P. Act, 1986 praying for assured policy amount of Rs.2 lakhs for accidental death of her husband and compensation of Rs.1,00,000/- and Rs.25,000/- towards litigation cost.
The complainant’s case, in brief, is that the complainant’s husband was a field worker of GTFS, OP No.3 since 2000 who died on spot on 5.11.2009 at 1.15 p.m. by a road accident being run over by truck no. WGQ 1445 on NH-34 at Babulbona and his life was covered by Janata Personal Accidental Insurance Policy of Rs.2 lakhs whose policy No. is 4751220001799/E No.47-30816 issued by OP No.1 /New India Assurance Co. The policy was purchased by OP No.3 and issued on 15.5.2000 and life risk was covered up to 14.5.2015. The OP No.1 issued claim form on 14.5.2010 in favour of the complainant being satisfied with the application and the complainant submitted the duly filled in claim form along with documents on 14.6.10 and 22.7.10 through OP-3-GTFS. After a long delay the OP No.1 repudiated the claim by letter dt. 15.02.11 quoting same claim No but different policy No. . The attention of OP no.1&2 were drawn to that mistake but no result. On 14.11.14 the OP No.2 lastly refused verbally to entertain the claim of the complainant. Hence, the instant complaint case.
The written version filed by OP No.1&2 New India Assurance Co, in brief, is that the Hon’ble High Court, Calcutta, passed an order dated 06.07.1999 inter alia restricting G.T.F.S from collecting any premium from category of friends from the date of such order and as per such order neither the complainant nor the G.T.F.S provided any documentary proof regarding the status of the deceased policy Holder. The complainant never submitted the said document to the OP. The OP has denied the death of the complainant’s husband by Truck accident. The complainant submitted the claim in the year 2014 which is barred by Limitation u/s 24A, C. P. Act being the claim filed after three years after repudiation on 15.02.11. The deceased husband of the complainant being not field worker of OP No.3 the complaint is liable to be dismissed. Hence, the instant written version.
The written version filed by OP No.3, in brief, is that Mahasin Sk, husband of the complainant, was a field worker of OP No.3 having insurance coverage of Janata Personal Accident Insurance Policy by OP No.1 for sum assured of Rs.2 Lakh for the period from 15.5.2000 to 14.5.2015 under Group Insurance Scheme who died on road accident leaving his wife as nominee of that policy where a MOU was executed by and between OP no.3 on 30.12.1998 and under the said MOU the OP No.3 was only obliged to collect premium and remit the same to OP No.1. The OP No.1 will be solely and directly responsible for the claim in case of death of the insured subject to terms of the policy. The OP No. 3 shall not have any liability to the settlement of claim. The OP No.3 has no negligence or deficiency in service on their part and prays that their names be kindly expunged/struck down from the petition of complaint. Hence, the instant written version filed by OP No.3.
Considering the pleadings of both sides the following points have been arrayed for the disposal of the case.
Points for decision.
- Whether the complaint is maintainable in its present form and in law?
- Whether the case is barred by Principle of waiver, acquiescence and estoppels.
- Whether the complaint is bad for defect of parties?
- When the case is barred by Law of Limitation?
- Whether the complainant is entitled to get relief as prayed for?
- To what other relief/reliefs the complainant may get?
Decision with Reasons.
Point Nos. 1 to 6.
All the points are taken up together for the sake of convenience.
The instant complaint is praying for Rs.2 lakh as assured sum of the policy and for compensation of Rs. 1 lakh and cost of Rs.25000/-.
The complainant’s main case is that husband of the complainant was a field worker of OP No.3 and he had Janata Personal Accident Insurance Policy by OP No.1 and died by road accident but the OP No.1 has illegally repudiated the claim by letter dt. 15.02.2011 with the plea that the status of the deceased as field worker which is vital document as per order dt. 6.7.99 of the Hon”ble High Court, Calcutta being not provided with OP No.1.
On the other hand the OP No.1’s main case is that they have rightly repudiated the claim as the vital requirement, status of the deceased policy holder in the Op No.3 being not proved.
Where, the OP No.3 in its letter dt. 12.6.10 as well as in the reply in point No.4 to the questionnaire of Op No.1 has stated that the deceased continued to be a field worker till his death.
To prove the case the complainant has adduced evidence on affidavit and also deposed on dock when she was cross-examined by OP No.1 and the same was adapted by OP No.3 and also adduced relevant document in support of her case.
In this case the OP No.1 has filed questionnaire and OP No.3 has filed reply against those questionnaire.
Admittedly, the policy of the deceased policy holder was issued on 15.5.2000.
The dispute is that as per order dt. 06.07.99 of Hon’ble High Court, Calcutta, OP No.3 is restricted to extend any coverage to the category of friends.
This policy was issued by the OP No.1 after about one year of passing such order.
It is true that in this case no document has been filed categorically from either side of the complainant and OP No. 3 as to the status of the deceased policy holder whether he was friend or field worker of OP No.3.
The complainant has deposed in her cross-examination by OP No.1 that her husband died in a motor accident. She lodged FIR with the P.S. over the incident. Police submitted charge sheet. Whether her deceased husband Mohisin Sheikh was a field worker of OP No.3 or not is not known to her.
She has deposed in her cross-examination that she has no document relating to identity proof, agency license, registration number, appointment as field worker of her deceased husband in the company of OP No.3.
She has also deposed that she does not know whether her husband was friend of OP No.3.
The Ld. Lawyer for the OP No.1 has strongly advanced argument that the Op No.1 repudiated the claim by letter dt. 15.2.11 where the complaint was filed on 8.12.14 beyond the period of limitation for two years without any prayer for condonation of delay as well as without any explanation showing sufficient cause of such delay in the complaint petition and for that the complaint is hopelessly barred by Limitation.
He has also advanced argument that admittedly friends category of OP No.3 are not entitled to get any coverage to the policy as per order dt. 06.07.1999 of Hon’ble High Court, Cal.
In this regard he has advanced argument strongly that the impugned policy was issued through OP No.3 and not direct to the complainant by OP No.1.
He has further argued that in his case the complainant herself has deposed on dock and during her cross-examination she has deposed categorically that she has no document as to appointment of her husband as a field worker.
It is true that in this case neither the complainant nor the OP No.3 has filed any appointment letter or any document showing that the deceased policy holder was a field worker of the OP No.3.
But the complainant has filed a letter dated 12.10.16 written by the OP No.3 to OP No.1 regarding the spirit of interim order dated 06.07.1999 of the Hon’ble High Court, Calcutta that since then we had all along been very careful in not collecting premium as also recommending extension of the Janata Personal Accident Insurance coverage to the category friends and also stated drawing the attention to note that in the instant case, the Insured Person was one of our Field Workers and there had no dispute about the eligibility of insurance coverage whatsoever.
Also the ld. Lawyer for the complainant has advanced argument relying upon the decision of Hon’ble State Commission, W.B. in Sr. Div. Manger, New India Assurance Co. Ltd. V/s Sushila Das & others that when the Insurance Co. issued the certificate being satisfied with the status of the insured, it cannot challenge the status of the insured at the stage of settlement of claim.
In the aforesaid decision the observation of the Hon’ble Commission is as under:-
“ As per MOU it was settled that it was the only duty of the GTFS to collect premium from the abovementioned categories and to deposit the same with the Insurance Company and the Insurance Company after accepting premium it was under obligation to issue the certificate and to decide and settle the claim. In the instant case, it was not the case of the Insurance Company that the Insured did not pay the premium, so there is no doubt that the Insurance Company received the premium amount through the GTFS in respect of this policy and admittedly issued the policy certificate in favour of the deceased insured. As and when the Insurance Company issued the policy certificate being satisfied with the status of the insured, it cannot challenge the status of the insured at this stage when claim has been filed before the Company after the death of the insured. Such action in my opinion is tantamount to deficiency in service as it is intentionally harassing the widow of the insured who is also the legal heir and nominee. In my opinion the complainant has proved her case that her husband died due to accident and knowing very well that he belonged to the category of Field Workers the Insurance Company has harassed the complainant intentionally, which is an example of deficiency in service on their part. After taking premium from the insured, harassment at the time of settlement of the genuine claim cannot be accepted in the eye of Law.”
Regarding condonation of delay on the point of barred by limitation at the stage of passing final order after completion of hearing argument of both sides, the complainant has filed a petition for condonation of delay on the ground that the claim was repudiated against wrong policy number , and then the complainant personally requested the OP to look into the matter and finally denied on 14.11.14 where the OP assured the complainant verbally that they would look into the matter and the complainant being illiterate rustic widow has prayed for condonation of this unintentional delay.
The instant condonation of delay petition is a separate petition and not a petition for amendment of the complainant petition for adding a separate paragraph for condonation of delay.
On the other hand the OP has filed written objection against this petition along with a separate letter dt 7.2.17 written by OP No.1 to his Ld. Lawyer Mr. A. K. Bhattacharyya of this case that the policy number mentioned in the certificate in the year 1999-2000 manually and the same was rightly numbered as per CWISS system and rightly mentioned in the repudiation letter dt. 15.02.2011.
Even if the above contention is correct one but no such letter was given to the complainant where it is clear that the policy number mentioned in the repudiation letter dt. 15.02.2011 differs from the policy number mentioned in the original Policy Certificate.
The complainant’s case is that verbally given assurance ultimately refused on 14.11.14 and thereafter within period of limitation the complainant filed the complaint and for that in this case there is no prayer for condonation of delay.
The verbal assurance as well as verbal request of the complainant is not rebutted by adducing any cogent evidence by the OP and also there is no such letter clarifying the initial manual policy number and subsequent number created by CWISS system.
Considering the above facts and circumstances, we are of the view that the instant case is not barred by limitation.
Also, considering the above discussions and relying upon the aforesaid decision of the Hon’ble State Commission, W.B., we find that all the points are disposed of in favour of the complainant in part and as such the complainant is entitled to get policy amount of Rupees Two Lakh as the policy was issued being satisfied with the status of the policy holder after passing the restricted order by Hon’ble High Court and Rupees Five Thousand towards compensation for harassment and litigation cost and there being no claim against OP No. 3 , the case be dismissed against OP No.3 .
Hence,
Ordered
that the Consumer Complaint No. 173/2014 be and the same is hereby allowed on contest in part against the OP Nos.1&2 and dismissed against the OP No. 3 without any order as to cost.
The complainant is entitled to get Rupees Two Lakh as Policy amount and Five Thousand towards compensation for harassment and litigation cost.
OP Nos.1 & 2 are hereby directed to pay jointly and/or severally the Policy amount of Rs.200000/-(Rupees two lakh only) along with Rs.5000/- as compensation to the complainant within 60 days from the date of receipt of this order, failing which the OP Nos.1 &2 have to pay cost of Rs.50/- per day’s delay and the amount so accumulated shall be deposited in the Consumer Legal Aid Account.
Let a plain copy of this order be made available and be supplied free of cost, to each of the parties on contest in person, Ld. Advocate/Agent on record, by hand under proper acknowledgment / be sent forthwith under ordinary post to the concerned parties as per rules, for information and necessary action.
Member President
