A. K. BHATTACHARYYA, PRESIDENT
The instant case arose over non-settlement of complainant’s claim by the OPs. It is stated by the complainant in her petition of complaint that her husband Manoj Kumar Maity, since deceased, took a JPA Policy bearing no. 4751170000001/4751170030054 which was valid for the period from 23-12-2000 to 22-12-2015. It is further stated by the complainant that her husband died of electrocution on 13-05-2010 and OC, Ghatal PS started a case in respect of such accidental death being Ghatal UD case no. 69/10 dt. 13-05-2010. Complainant also stated that OP no. 2 sent all requisite papers in respect of such death to OP no. 1 under cover of their letter dt. 27-07-2011 and also followed up the matter from pillar to post quite vigorously, but all her efforts went in vain as after dragging their feet for a long time, the OP no. 1 ultimately repudiated her legitimate claim terming it as ‘NO CLAIM’ vide letter dt.11-10-2012 on account of non-submission of paper pertaining to the status of the beneficiary of the insurance policy i.e. her deceased husband by OP no. 2, hence the instant case.
In support of her claim, complainant submitted photocopy of policy certificate, police complaint lodged by WBSEDCL, PM Report, Death Certificate of the insured, correspondences exchanged among the parties including the Repudiation letter dt.11-10-2012 of OP no. 1 etc.
OP no. 1 contested the case truly by entering appearance, submitting written version, WNA and taking a positive part in the entire proceedings. By their written version the OP no. 1 denied inter alia all the material allegations of the complainant and also stated that OP no. 2, their collection agent, issued several policies without proper verification of the status of the person; that the OP no. 2 did not disclose the actual status of the deceased insured despite their specific direction to that effect. Therefore, they had no other alternative but to repudiate the claim as ‘NO CLAIM’ and accordingly prayed for dismissal of the instant case against them.
OP no. 2 also contested the case by filing written version and taking a positive part in the entire proceeding. By their written version, OP no. 2 also denied all material allegations of the instant complaint case with further contention that there was no irregularity in the matter of issuance of policy in favour of Manoj Kumar Maity, since deceased, one of their field workers for an insured sum of Rs. 1 lakh; that in terms of the MoU executed between the OP nos. 1 & 2, the latter was only responsible for collecting premiums from the proposers and remit the same to the former i.e. OP insurer; that nowhere in the said MoUit is stated that the Fieldworker of OP no. 2 cannot be employed elsewhere; that in terms of the said MoU the obligation of settlement of claims lies with the OP insurer i.e. OP no. 1 therefore, the OP no. 2 cannot be held responsible for settlement of complainant’s claim; that OP no. 2 forwarded all the requisite documents to the OP no. 1 to facilitate settlement of complainant’s claim besides following up the matter through repeated letters. By so many words, they denied any deficiency in rendering proper service to the complainant.
Points for consideration
- Whether there is any deficiency in service on the part of the OPs?
- Whether the complainant is entitled to get any relief as prayed for?
Decisions with reasons
Point nos. 1 & 2:
Both the points are taken up jointly for the brevity of discussion.
We have carefully gone through the materials on record including the written version, WNA being submitted by the parties and also heard the submission of ld. counsels of both sides.
There is no dispute that the JPA policy in question was issued in favour of Manoj Kumar Maity, since deceased by OP no. 1 and the complainant was the sole nominee of the said policy. Admittedly the accident took place during the validity period of the insurance policy in question. There is also no dispute as regards accidental death of the policy holder in question. OP no. 2 has admitted Manoj Kumar Maity, since deceased, as their bona fide Field Worker.
Ld. lawyer for the OP no. 1 squarely blamed the OP no. 2 for the total mess up with the contention that despite their specific demand, the OP no. 2 did not furnish requisite particulars about Manoj Kumar Maity, since deceased viz Appointment letter, Monthly Performance Report as Field Worker etc. those were essential to process the insurance claim of the complainant. Hence, they were left with no other alternative but to repudiate the claim of the complainant.
It hardly needs any emphasis that being the issuer of the policy in question; OP no. 1 was as much responsible to check the eligibility of Manoj Kumar Maity prior to issuance of the certificate in so far as JPA policy is meant for a niche group of people. It is totally ridiculous to see that OP no. 1 didn’t mind accepting premium amount from its agent without bothering to check whether such proposer at all fits into the bill. However, after nearly 10 long years when it gave rise to a claim, they suddenly woken up to their responsibility and felt it inevitable to check the eligibility criteria of the deceased insured to process the claim and citing non-receipt of requisite documents as regards status of the beneficiary from their agent, ultimately disallowed the claim being unmindful of the fact that had they refused accepting premiums without proper documents in respect of the proposers and rejected the proposal of Manoj Kumar Maity, since deceased, instantly in the event hewas indeed misfit to come under the ambit of JPA policy, Manoj Kumar Maity could have opted for some other insurance policy. In our considered view, it was totally illogical/unethical on the part of OP no. 1 to call in question an insurance policy after almost 10 years. In any case, an insured cannot be made a scapegoatover thebilateral dispute between an insurer and its agent. More so, being the principal, OP no. 1 cannot abdicate its responsibility for the wrongdoing, if any done, of its authorized agent.
Ld. lawyer for the OP no. 1 drawing our attention to the letter of WBSEDCL dt. 13-05-2010 addressed to the OC, Ghatal P.S. contended that Manoj Kumar Maity, since deceased, was a Sr. Technical Support Head under Birsingha Gr. Elec. Supply. According to the said ld. Advocate, projectingManoj Kumar Maity, since deceased, as a Field Worker was nothing but an utter distortion of fact by OP no. 2. In this regard, it is contended by the ld. lawyer for OP no. 2 that Manoj Kumar Maity was indeed their Field Worker. It is also contended by the ld. lawyer that the MoU executed between the OPs does not put any embargo on a Field Worker from taking employment elsewhere. Interestingly, neither the OP no. 1 furnished any copy of the MoU to negate such contention nor placed any substantial evidence to show that the job of a Field Worker is a full time job. Therefore, the objection of OP no. 1 in this regard is not tenable.
In our opinion OP no. 1 acted quite irrationally in dealing with the matter resulting which the complainant had to endure severe mental pain/stress/agony. It clearly points out gross deficiency on the part of OP no. 1 and so the liability of settling insurance claim entirely lies with OP no. 1. Therefore, we hold OP no. 1 liable to pay Rs. 1,00,000/- as insurance benefit to the complainant together with Rs. 6,000/- as compensation and litigation cost for a sum of Rs. 1,000/-.
Both these points are, thus, disposed of in favour of the complainant.
Hence, it is
ORDERED
that the instant C.Case No. 47/2012 be and the same is allowed on contest against OP and dismissed against OP no. 2. OP no. 1 is directed to pay Rs. 1 lakh to the complainant being accidental insurance benefit together with compensation Rs. 6,000/- and litigation cost Rs. 1,000/- within 45 days from the date of communication of this order i.d. the complainant is at liberty to execute the order in accordance with law in which case the OP no. 1 shall be liable to pay interest @ 10% p.a. over the total awarded amount from this day till full and final settlement.
S.S. Ali A.K. Bhattacharyya
Member President
