Date of filing:11.03.2014 Date of disposal:25.08.2014
Complainant: Nurjahan Begum, D/o.Late Sk. Idu, residing at Uchalan, P.S.-Madhabdihi,
District-Burdwan, Pin-713427.
-VERSUS-
Opposite Party: 1. The Divisional Manager, New India Assurance Co. Ltd., having its office at
Howrah Division Office, Madhusudan Apartment, 2nd floor, P-18, Dobson
Lane, Howrah-71101.
2. The Officer-in-charge, Golden Trust financial Services, 16, R.N.Mukherjee
Road, Kolkata-700 001.
3. The Branch Manager, Golden Trust Financial Services, Burdwan Branch,
267, G.T.Road, Burdwan.
Present : Hon’ble President: Sri Udayan Mukhopadhyay
Hon’ble Member : Smt. Silpi Majumder
Hon’ble Member : Sri Durga Sankar Das
Appeared for the Complainant: Ld. Advocate Tamal De
Appeared for the Opposite Party No.1: Ld. Advocate ahibhushan De.
Appeared for the Opposite Party No.2 & 3: Ld. Advocate Bibhas Mondal & Mrs. M.Banerjee.
JUDGEMENT
This is an application U/s 12 of the C.P. Act, 1986.
The complainant’s short case is that she happened to be the daughter of Late Sk.Idu, was a field worker of the GTFS and while in his life time he proposed to the O.P. No.3 for an accidental insurance policy and the O.P. No.1 issued a Janata Accident Insurance Policy bearing No.4751220001799/E-No.47-30888 dated 15.7.2000 in the name of the risk covered of the Sk.Idu for accidental death/loss of limbs/permanent total disablement for an overall capital sum insured of Rs.1,00,000/- from 15.7.2000 to 14.7.2015 and the daughter of the deceased is the nominee of the said policy.
That the father of the complainant was died in a motor vehicle accident dated on 16.10.2012 and FIR was lodged in this respect in the Madhabdihi Police Station being No.91/12 U/s 279/304 AIPC. The complainant intimated to the O.P. No.1 on 7.11.2012 about the death of her father and thereafter a claim form was issued directing to submit the necessary documents bearing claim No.512200/47/12/23/90000058.
The complainant submitted the claim form with all the required documents in original to the O.P. No.1 on 20.3.2013 but the O.P.s has not initiated to disburse the claim amount till this date and as such the complainant sent a notice through her Ld. Advocate requesting to disburse the claim amount within 15 days from the date of receipt of the notice. But there was no fruitful result. Finding no other alternative the complainant filed this case before this Ld. Forum for relief.
The O.P. No.1 contested the case by filing written version, denying inter-alia all the material allegations as leveled against him. The O.P. No.1further stated that GTFS being the O.P. No.2 & 3 made an agreement with the O.P. No.1 on 30.12.98, stating that they will issue Janata Personal Accident Policy for their investors and their family members, field workers and their family members and friends under group insurance scheme, closely connected with said GTFS and the said memorandum of undertaking was signed with the O.P. Be it mentioned that the said GTFS violated such MOU and issued certificate to the public in general. It is also stated that one person should be given not more than one policy and the sum assured shall be restricted to maximum of Rs.1,00,000/-. GTFS had appointed some field workers. But GTFS was unable to produce documentary evidence of field workers and investors.
The O.P. No.1 submits that the policy holder and/or complainant Nurjahan Begum, as nominee is duty bound to fulfill the requirements of insurance policy before settlement of his/her claim i.e. proof of agency license, investment certificate issued by GTFS, identity card of field worker but the complainant failed to produce the necessary documents and as such in absence of the said Identity Card this O.P. was unable to process the claim. The O.P. insurance company has not received the vital document of status proof whether he was a field worker or agent of GTFS, being the O.P. No.2 & 3.
Be it mentioned here as per Hon’ble High court ‘ order dated 6.7.99 the O.P. No.2 & 3 GTFS was restricted to collect any premium from friends category and as such this O.P. No.1 is required to obtain identity cared either of field worker, agent or investor from the competent authority of O.P. No.2 & 3, GTFS. The O.P. No.2 & 3 did not produce any supporting document/documents in support of the Field Worker/Agent of Sk.Idu since deceased. Even after passing the order by the Hon’ble High Court, Calcutta the O.P. No.2 & 3, GTFS suo-moto collected premiums from the insured, Sk.Idu, for the reasons best known to them.
The O.P. No.1 further submits that there has not been any deficiency in service or negligence or unfair trade practice on the part of the O.P. No.1 and this O.P. rightly repudiated the claim of the complainant and hence prayed for dismissal of the case.
The O.P. No.2 & 3also contested the case by filing written version, denying the entire material allegations as leveled against them. The O.P.s also stated that a Memorandum of Understanding was executed by and between the O.P. No.1, The New India Assurance Company and O.P. No.2, GTFS. Under the said MOU the O.P. No.2 & 3 was only obliged to collect premium from the insured person/persons concerned and remit the same to the O.P. No.1 by a consolidate the sue with a list of insured persons. Apart from that there had been no other liability to be borne by the O.P. No.2 & 3. Accordingly the O.P. No.2 went to facilitating extension of the cover of Janata Personal Accident Policy under Group Insurance Scheme to their field workers and their family members and upon collecting the requisite premium therefore would remit the same to the O.P. No.1, who having been satisfied would accept the same and used to issue certificate of policy.
The O.P.s also stated that the father of the complainant Sk.Idu, since deceased, was one of such field workers of the O.P. No.2, who was favoured with such extension of coverage under the Group Janata Personal Accident Policy by the O.P. No.1. However, with a view to assist those insured persons, the O.P. No.2 & 3 always extend their co-operation of those insured person/persons and they immediately forwards the claim papers to the O.P. No.1 for appropriate decision by the O.P. No.1 and it will appear from the record that O.P. No.2 forwarded the letter of the complainant on 26.11.2012 and 18.1.2013 to the O.P. No.1.
It is stated that O.P. No.2 & 3 have got no authority to decide over the claim of the complainant and therefore, for repudiation of non-settlement of the claim of the complainant by the O.P. No.1. These O.P. have duly discharged their duties and obligations in respect of the subject policy strictly in terms of the guidelines to which it was obliged and there has been no negligence or deficiency in service on the part of the O.P. No.2 & 3.
The O.P. No.2 & 3 further stated that in the instant case they acted bonafide and strictly in terms of the guidelines of the said policy and there has been no laches and/or lapses and /or deficiency of service on the part of the O.P. No.2 & 3 for non-settlement of the claim of the complainant. Thus, these O.P.s prayed for dismissal of the case.
Point for consideration in this case is;
- Whether there is any deficiency in service or unfair trade practice acted by the O.P.s by non-settling the claim of the complainant?
DECISION WITH REASON
At the outset it must be stated that initially the complaint was filed showing her as a “wife of Sk.Idu”. Thereafter filed amendment application and by that amendment it was corrected as “daughter”.
The next point is whether the deceased insured was a field worker or not? GTFS already has given certificate to that effect (O.P. No.3) that Sk. Idu was one of their field workers. This certificate was also sent to O.P. No.1 & 2 at the time of claim application and they accepted the collected premium and issued policy. Apart from that the said certificate was drafted on the official ‘letter head’ of O.P. No.3 along with seal and signature by the authorize person. So, how we departure from that contents, particularly when, on the other hand there is no believable document filed by the O.P. No.1. It is true that O.P. No.1 procured some statements bearing the signature of the complainant but the said statement was not written by the complainant nor filed with affidavit. So, it is very difficult to keep reliance whether the actual contents were narrated to little learning complainant, who is coming from rustic family. The Ld. Advocate of the complainant also stated that the statement of the complainant is not the volunteer’s statement of the complainant and complainant was not aware of the same. Thus, we hold on the basis of the certificate of GTFS that complainant was one of the field workers. It is true that O.P. No.1 already filed some judgment of our Hon’ble State Commission passed in SC Case No. FA/193/2013, SC Case No. FA/552/2013, SC Case NO.FA/98/2013 and our judgment in Consumer Case No.134/2013, we are respectfully in agreement with the same view of the Hon’ble State Commission because if the insured was engaged in service private or government, then he will not get any amount. But in the instant case the GTFS already sent certificate in its letter head with official seal and signature that insured is one of the field workers. Thus, the fact of the case in hand is highly unmatched with the reported decisions of the Hon’ble State Commission. It may be mentioned once again that some scrap of paper bearing the signature of the complainant, who is one of the member of weaker section of our society, cannot suffice to say that the believable documentary evidence of GTFS will go bye.
Accordingly we find that repudiations is not at all justifies. Apart from that it was the duty of the O.P. No.1 to submit documentary evidence from the employer where the Sk.Idu was employed during his life time. But O.P. No.1 failed to do so by engaging his investigator. But in SC Case No. FA/193/2013 investigator of Insurance company collected documentary evidence, that deceased was an employee of Kolkata Port Trust bearing identity card No.22615 having monthly salary Rs.26,981/-. In the case in hand nothing submitted by the Insurance Company which directed us to departure from the certificate issued by the GTFS in their letter head. We have already expressed that the nature of document submitted by the Insurance Company which is not admissible in evidence. Thus, the reported judgment will not helpful to the Insurance Company since the fact and circumstances is not identical.
Again in the reported judgment reported in SC Case No. FA/552/2013 we find deceased was working as a Secretary of Gram Panchayat under the Directorate of Panchayat and Rural Development, Government of West Bengal, so his status strictly debar him from performing the job of field worker. So this circumstances also is unmatched to the instant case.
Again SC Case No. FA/98/2013 clearly speaks that deceased was a head teacher of the Kapasdanga Primary School , which does not entitle to perform any other job. Thus this facts and circumstances is not identical to this instant case because insurance company miserably failed to prove the engagement of deceased any other else by any convincing documents evidence which is admissible in law.
In this above backdrop we hold that Sk.Idu was a field worker of GTFS and after his accidental death which is derived from post mortem report followed by FIR lodged by Madhabdihi Police Station being No.91/2012 U/s 279, 304A IPC, the complainant being a daughter is entitled to get compensation, particularly when the accidental death took place within the period of coverage which run on and from 15.7.2000 to 14.7.2015 and deceased died on 16.10.2012, which is also within the coverage. Thus we failed to understand why the petty amount of Rs.1,00,000/- was not given to the complainant in terms of the policy, particularly when there is no admissible document even filed in affidavit to satisfy the Forum that complainant herself filed affidavit and disclosing the fact that her father was a hawker and who used to sale bed sheet, mosquito net and mats door to door and he was not a staff of GTFS. Although O.P. No.1 tried to convince this Forum taking advantage of little learning complainant, who is a member of weaker section of our society, only collecting his signature in Bengali language, got some papers which was although included some local witnesses but no affidavit of any of the witnesses are forthcoming before this Forum regarding the genuinity of the documents, particularly when the Ld. Advocate of the complainant clearly submits that the com plaint is in dark regarding the same save and except the signature which is appearing there. So all this circumstances, clearly suggest that this complaint should be allowed. Hence is
ORDERED
that the D.F. Case 35/2014 is allowed on contest against the O.P.s. The O.P. No.1 is directed to pay Rs.1,00,000/- together with interest accrued thereon if any till date of disbursement to the complainant within 45 days from this date of order and also directed to pay compensation of Rs.10,000/-(Ten thousand) and litigation cost of Rs.1000/- within 45 days from this date of order, in default 9% interest will carry of the entire amount till its realization. The complainant is at liberty to execute the order if not satisfied in toto by the O.P. No.1 in this regard. The O.P. No.2 & 3 is directed to see that the entire order should be complied with by the O.P. No.1 and the poor complainant be get the entire money as directed. Let the plain copy of this order be given to all the parties free of cost.
(Udayan Mukhopadhyay)
Dictated and corrected by me. President
D.C.D.R.F., Burdwan
(Udayan Mukhopadhyay)
President
D.C.D.R.F., Burdwan
(Silpi Majumder) (Durga Sankar Das)
Member Member
D.C.D.R.F., Burdwan D.C.D.R.F., Burdwan
