: J U D G M E N T :
This is a case under Section 12 of the Consumer Protection Act filed by the complainant, Gita Chakraborty against the Divisional Manager, New India Assurance Co. Ltd., Howrah Divisional Office and the manager, Golden Trust Financial Services, Krishnagar. The facts of the case to put in a nutshell, are as below:-
The husband of the complainant, Bijan Krishna Chakraborty purchased a Personal Accident Insurance Policy from the New India Assurance Co. Ltd., OP No. 1 through Golden Trust Financial Services, OP No. 2 vide policy No. 47512200016077/E No. 4730354 and the amount covered by the policy was Rs. 2,00,000/-. The complainant is the nominee of the said policy. The insurance policy was valid from 23.07.1999 to 22.07.2014. After demise of the husband (on 06.03.12), the complainant claimed her policy amount with all the requisite documents to the OP No. 1 through OP No. 2, Golden Trust Financial Services but no claim was settled by the OP No. 1. The complainant requested several times to disburse the claim amount but in vain. Finally a lawyer’s letter was sent to the OPs but they denied their duties to settle the claim. Finding no other alternative the complainant files this case praying for the claim amount of Rs. 2,00,000/- with interest, compensation of Rs. 80,000/- and cost of the suit.
Written versions were filed by the OP No. 1 & OP No. 2 separately on 8th May, 2014. Written objection of both parties may be summarized as follows:-
Golden Trust Financial Services (GTFS) is not liable to pay the amount as it acted as agent of New India Assurance Co. Ltd. Hence, OP No. 1 may be held liable for any pecuniary responsibilities. The Group Janata Personal Accident insurance policy No. 47512200016077/E No. 4730354 was never disputed. The judgement of Hon'ble Justice, Sri Pranab Kumar Chattopadhyay, reported in 2005 (3) CHN 154 was referred in the pleadings by the Golden Trust Financial Services.
OP No. 1, Insurance Company also stated that as per the High Court order in reference Golden Trust Financial Services is totally prohibited from collecting premium from friend category. Hence it is important to establish the identity of certificate holder. If the certificate holder actually belongs to category friend then the Insurance Company is not liable to extend the coverage of such person. The law is well settled that impossibility to tender service does not tantamount to deficiency in service. It was incumbent upon the claimant as well as Golden Trust Financial Services to establish the status of the claimant by way of documentary evidence that they do not fall under the category ‘friends’.
It has been also pleaded that the complaint is barred by principles, estopples, waiver and acquiescence. The jurisdiction of the Forum has also been challenged. The complainant is duty bound to prove his case by way of documentary evidence. The Insurance Company has no liability to pay the insurance amount. Hence, the prayer of the complainant is dismissed with cost.
POINTS FOR DECISION
Point No. 1. Whether the complainant is to be treated as a consumer or not as per provision of Consumer Protection Act, 1986.
Point No. 2. Whether there is any gross negligence or deficiency in service on the part of OPs or not.
Point No. 3. Whether the complainant is entitled to get any relief as prayed for or not.
REASOND DECISIONS
For the purpose of brevity and convenience all the points are taken up together for discussion.
Perused the pleadings of the parties along with the affidavit on record and other relevant documents filed by the parties. It is fact and admitted position that the life of Bijan Krishna Chakraborty since deceased was covered under the insurance policy being No. 4751220001607 /E No. -47-30354 issued in the name of GTFS, wherein the overall capital sum insured was Rs. 2,00,000/-. It is also fact and admitted position that Gita Chakraborty (relationship wife) was figured as a nominee in the said policy which is clearly revealed from the policy certificate issued by the Insurance Company dated 23rd July, 1999. To that effect Mr Chakraborty since deceased paid the premium to the OP / Insurance Company through the OP / Golden Trust Financial Services. So in view of the status of the OPs and complainant / nominee, the complainant is to be treated as consumer as per Consumer Protection Act, 1986. It is admitted position that Bijan Krishna Chakraborty died on 06.03.2012 at Disun Hospital and Heart Institute, Kolkata – 700107 which is clearly revealed from death certificate issued by the KMC Health Department, Kolkata 700013.
It is also crystal clear that Mr Chakraborty died on 06.03.12 which was within the policy covering period i.e., 23.07.1999 to 22.07.2014.
We have perused first information report bearing No. 125/11 dtd. 18.03.12. The FIR has been lodged in Kaliganj P.S. U/S 279 /304 A, wherein the original complaint was treated as FIR. Thereafter, we have perused the P.M. report from these two documents it is clear that an accident was occurred and Bijan Krishna Chakraborty died on 06.03.12 due to road accident.
It is fact that Mr. Chakraborty paid the necessary premium and obtained the policy. It is very much common factor that when the Insurance Company received the said premium on good faith and on the basis of honesty of applicant then it should be the duty of Insurance Company to settle the claim without raising any irrelevant & baseless cause.
Regarding the pleas of ‘friend category’ taken by OP / Insurance Company is actually the inner matter between the OP / Insurance Company and Golden Trust Financial Services only and the complainant / nominee cannot suffer from the said cold war between the OPs as the complainant / nominee has no fault on her part.
In this context the Hon'ble Apex Court in the case of Bimal Krishna Bose vs. United India Insurance Company Ltd. and Ors. Reported in III (2001) CPJ 10 (SC) had observed the following:-
- That the Insurance Companies are ‘state’ within the meaning of Article-12 of the Constitution of India and they are expected to act fairly & reasonably.
- That the Insurance Companies are required to satisfy the requirement of reasonableness & fairness which dealing with consumer / customer
They must not take any irrelevant & extraneous consideration while arriving at a decision. Arbitrariness should not appear in their actions or decisions.
In the light of the above observation we hold that the OP / Insurance Company has failed to follow up the above dictum of the Hone'ble Supreme Court adopting unfair & unreasonable means as after repeated request from the end of complainant. OP / Insurance Company has failed to settle the claim till date. When the case was genuine one, it should be the duty of OP / Insurance Company to disburse the amount in favour of the complainant without any further harassment. There is a fault & deficiency in service on the part of the Insurance Company. So the complainant is entitled to get relief as against OP / Insurance Company .
In this regard OP / Golden Trust Financial Services has no role regarding payment of claim amount as they can act only as an agent of OP / Insurance Company. There is no gross negligence or deficiency in service on the part of OP / Golden Trust Financial Services. All the points mentioned above are thus decided as per above observations. The case succeeds.
Hence,
Ordered,
That, the case CC/2014/26 be and the same is allowed on contest against the OP / Insurance Company with cost of Rs. 1000/- and dismissed against OP / Golden Trust Financial Services without cost. That the OP / Insurance Company is hereby directed to pay the insured amount of Rs. 2,00,000/- plus Rs. 1000/- i.e., total of Rs. 2,01,000/- to the nominee / complainant within 30 days from the date of order i.d., an interest @ 10% p.a. shall be charged upon the awarded amount till full realization.
Let a copy of this judgment be delivered to the parties free of cost.
