DIST. CONSUMER  DISPUTES  REDRESAL  COMMISSION

NORTH 24 Pgs., BARASAT.

C.C. No. 283/2017

Date of Filing                        Date of Admission                Date of Disposal

29.5.2017                                         12.06.2017                        22.09.2023

P R E S E N T                       :- Smt. Sukla Sengupta………………President.

:- Smt. Monisha Shaw.……………… Member.

                                                :- Sri.  Abhijit Basu…………………. Member.

                   JUDGMENT/FINAL ORDER

The Complainant has filed this case U/s 12 of the Consumer Protection Act, 1986. It is stated by the Complainant that his  elder brother deceased Pravat Kumar Mondal booked one insurance policy from the New India Assurance Co. Ltd., which is covered under Policy No. (s)4751220001799/E No. 47-30952 issued in the name of Golden Trust Financial Services from 01/09/2000 to 31/08/2015 (midnight) risk covered: accidental death/loss of limbs/permanent total disablement for an overall capital sum assured of Rs. 5,00,000/- which was still active as on 31/08/2015 (midnight). The xerox copy of the policy is annexed as annexure ‘A’.

It is further stated by the Complainant that on 30/08/2012 the insured person died due to rail accident and one U.D case was registered by Naihati GRPS vide Case No. 63/2012 dated 30/01/2012. On 31/08/2012 post-mortem was done. The post-mortem report no. 1504 dated 31/08/2012 is annexed as annexure ‘B’. After demised of the insured the Complainant got the original Policy Certificate and claimed the insured amount after depositing all the relevant documents in the office of New India Assurance Co. Ltd. through Naihati Branch which is marked as annexure ‘C’.

After verifying the matter the O.P insurance company sent a letter addressing the nominee Reba Mondal being the mother of the deceased insured stating inter-alia that “in respect of alleged murder of her son Pravat Kumar Mondal on 30/08/2012 due to rail accident covered under the above mentioned policy.” They redirect the original intimation letter along with photocopy of the policy certificate of the insured to the authority. Then the Complainant became confused and made contact with Naihati Branch but Naihati branch advised her to wait for few days. Then, on 19/08/2014 the mother i.e. the mother of  the  Complainant being the nominee of the policy in question received the letter from the O.P insurance company wherein the insurance company demanded some documents regarding the death of the deceased insured Pravat Mondal then she again submitted the documents which was previously submitted along with the claim the copy of the notice annexed as annexure ‘E’. Thereafter the O.P insurance company sent a letter to the Complainant on 10/12/2014 claiming that on investigation it is transpired that the deceased Pravat Kumar Mondal was not at all a field worker of M/s. GTFS nor he was associated with any kind of job with GTFS, he was only engaged with government service. Thereafter on 29/12/2014 the Complainant collected the certificate by GTFS from the O.P no. 4 who certified that deceased Pravat Kumar Mondal was a field worker of the GTFS and vide letter dated 17/03/2015 the claim was repudiated by the O.P insurance company,

hence the case is filed by the Complainant with prayer to give direction to the O.Ps to settle the claim immediately by issuing the claim amount of Rs. 5,00,000/- in favour of the nominees/complainant along with the banking interest as may deemed fit and proper and also prayed for giving direction to the Opposite Parties to pay compensation of a sum of Rs. 3,00,000/- for harassment, mental pain and agony along with litigation cost of Rs. 10,000/-. The O.P No. 1 to 4 have contested the claim application by filing Written Version denying all the material allegations leveled against them.

The O.P No. 1 to 3 stated in their Written Version that the petition of complaint is harassive, motivated and filed by the Complainant with malafide intention.

It is also the O.Ps case that the Complainants are not the consumer under the C.P. Act, so the petition of complaint is liable to be rejected. It is also stated by the Opposite Parties Nos. 1 to 3 that this Forum has got not territorial jurisdiction to try this case.

It is the O.Ps case that the present petition of complaint has filed by the Complainant by suppressing material fact for some wrongful gain. The O.P. No. 4 GTFS alleged to be a partnership firm and is a mobilise of funds on behalf of UTI, SBI Mutual Funds etc. It has its own field for its business. To increase its business the O.P No. 4 decided to offer an incentive to its employees and investors, the benefit of insurance coverage under two heads mediclaim and Janata Personal Accident Claim with the New India Assurance Co. Ltd. 

 The O.P No. 1 to 3 further stated that in the year 1998 two memo of understandings were executed between the Golden Trust and the New India dated 29/07/1998 for mediclaim and the other dated 30/12/1998 for personal accident. Two such group insurance policies were used in favour of the Golden Trust by New India Assurance. The insurer was the New India Assurance Co. Ltd. and the insured was the Golden Trust Financial Services under the accident policy the sum assured varied from Rs. 50,000/- to Rs. 10,00,000/-. The insurance coverage as per the MOU was to cover (i) investors, (ii) to their family members, (iii) field workers, (iv) their family members, (v) their friends.

The premium was collected  and remitted to the insurance company by the Golden Trust periodically and a computerized certificate on the new India was issued to each such person by the O.P. No.4 M/s. GTFS which has also contested the case by filing a written statement denying  all the allegation leveled against it.

It is stated by the O.P. no.4 that a memorandum of understanding (in short MOU) executed by and between  the O.P. no.4 the New India Assurance company Ltd and the O.P. no.4 Golden trust financial services, the O.p. No.2 agreed to allow the O.P. no.4 to explaine:”Group Janata Personel Accident Insurance Coverage” to the field workers including their family members and their friends under Group Insurance Scheme. Subsequently the Hon’ble High Court Calcutta by an order omitted the category of “Friends” amongst the aforesaid category and the O.p. No.4 was allowed the extend such insurance cover to the category of Field workers and investors under the said Group Insurance scheme.

The O.p. No.4 further stated in its written version that the O.p. No.4 was only obliged to collect premium from the insured persons/person concern and remit the same to the O.p. 2 by a consolidated cheque with a list of insured persons barring that no other liabilities there to be borne by the O.P no.4.

It is further stated that the O.p. no.4 has no liabilities with regards to the settlement of claim under the policy and the O.P no.4 only responsible for that matter the photocopy of MOU is Annexed herewith as Annexure A the elder brothers of the complainant was one of such Field workers of the said O.P. 4 who was favored such extension of coverage under the policy by the O.P no. 1 to 3.

It is also stated by the O.P no.4 that vide letter date 02/07/2014 and 05/01/2015 for the O.P. no.4 forwarded the intimation letter and claim paper of the complainant (Annexure B).  The O.p. No.4 has acted bonafied and strictly in terms of the guidelines in respect of the said policy. there is / was no latches was deficiency of service on the part of the O.P. no.4 the entire matter would be settle and consider by O.P. no.1 and 3 so the complainant would have no grievance against the O.P, no.4 and thus the instant petition of complainant has filed by the complainant against the O.P no.4 is liable to be dismissed.

          As per O.Ps case the Complainant has no cause of action to file this case thus the case is liable to be rejected in limini.

In view of the above stated pleadings the points for considerations are as follows:-

1. Is the case maintainable in its present form and law?
2. Has the Complainant any cause of action to file this case?
3. Is the Complainant a Consumer within the ambit of C.P. Act, 1986?
4. Is there any deficiency in service on the part of the opposite parties?
5. Is the complainant entitled to get relief as prayed for?

Decision with Reasons

All the points are taken up together for convenience of discussion and to avoid unnecessary repetition.

On  perusal of materials on record it appears that  this Forum has territorial as well as pecuniary jurisdiction to try this case, moreover from the materials on record it also appears that the complainant has sufficient cause of action to filed this  case within the period of limitation. Thus it is held that the case is well maintainable in the eye of law.

 From the evidence as well, as materials on records it appears that deceased Pravat kumar mondal  was booked one Insurance policy from the O.P.  Insurance company which covered under policy no.(s)4751220001799/E. No. 47-30952 issued in the name of Golden Trust Financials services for the period on and from 1.9.200 to 31.8.2015(Midnight) Risk Covered, Accidental Death/Lose off limbs /permanent total disablement for an overall Capital sum insured of Rs. 5 Lakhs which was still active as on dated 31.8.2015(Midnight)(Annexure A)

From the evidence on record it is revealed that the insured was died on 30.8.2012 in a rail accident  and one U/D  case was registered by the Naihati GRPS vide case no. 63/2012 dated 30.8.2012. post mortem was held on 31.8.2012 vide post mortem report no. 1504 dated 31.8.2012 and the Naihati Municipality issued the death certificate of Pravat Mondal (Annexure B) there after the family members of the  deceased claim the insured amount by filing the claim application along with relevant document before the O.P. Insurance  company at the Naihati Branch(Annexure C).

It is also admitted facts that inspite of received of the said claim letter the o.p. no 1 and 2 verified the matter in the house of the complainant and sent a letter to the nominee that the mother of the deceased on 2.7.2014 mentioning the death of the deceased as a   murder and  redirect the policy certificate of the insured.

Subsequently the O.p. no.1 & 2 informed the mother of the deceased through annexure A that as per investigation report dated 20.9.14 made  by their licensed investigator it transferred that the insured Pravat kr.. Mondal since deceased  was not at all a field worker of M/s. GTFS. And nor he was associated with any kind of job with M/s. GTFS. ,only he was engaged with Government service so he cannot entitled this privilege but from annexure G as issued by the authorized signatory of GTFS it is proved that the deceased Pravat Kumar Mondal as field worker the insured person was attached to GTFS. and covered under insurance certificate number 0192508/200000298538 valid from 1.9.2000 to 31.8.2015 issued by the New India Assurance company limited, Howrah divisional office/512200,Madhusudan apartment ,P-18,Dovson lane second floor,Howrah-711001 .This certificate (annexure G ) was issued on 29.12.14

Hence evidence on record it is established that the deceased Pravat Kumar Mondal being a field worker of GTFS covered under   the insurance policy in question being certificate no. 0192508/200000298538 and policy no. 4751224751220001799/E.No. 47-30952 issued in the name of GTFS  valid from 1.9.2000 to 31.8.2015 sum insured of Rs. 5 Lacs. and he died in  rail accident on 30.8.2012 but the O.P. no.1 & 2 even after getting the claim application filing by the complainant and the nominee Smt. Reba Mondal the mother of the deceased repudiated the same on the ground that the deceased was not connected with GTFS by any means so the complainant is not entitled to get the relief as prayed for.

But in the above made discussions it has already been held by this Forum that from annexure ‘G’ as issued by the authorized signatory of GTFS dated 29/12/2014 it is proved that deceased Pravat Kumar Mondal was one of the field workers of GTFS and was covered under insurance certificate no. 0192508/200000298538 being policy no. 4751220001799/E. No. 47-30952 issued in the name of GTFS valid from 01/09/2000 to 31/08/2015 (midnight). Risk covered: accidental death/loss of limbs/permanent total disablement for an overall capital sum assured of Rs. 5,00,000/-. But the Opposite Parties no. 1 to 3 intentionally ignored the claim of the Complainant and repudiated the same which should be considered as the harassment, negligence and deficiency in service on the part of the Opposite Party No. 1 to 3. The Opposite Party No. 1 to 3 are thus liable to pay compensation to the Complainant for their misdeed.

Under such circumstances, it is held by this Forum that the Complainant could be able to prove his case beyond all reasonable doubt and is entitled to get the relief as prayed for.

All the points are thus considered and decided favorably to the Complainant.

The case is properly stamped.

Hence,

Ordered,

That the case be and the same is decreed on contest against the Opposite Parties with cost of Rs. 5,000/- only.

The Complainant do get the decree as prayed for.

The Opposite Party no. 1, 2 and 3 are directed to settle the claim immediately in favour of the Complainant and paid a sum of Rs. 5,00,000/- to the Complainant along with interest @6% p.a. on the amount mentioned above from the date of filing of this case till realization within 45 days from this date of order.

The Opposite Party no. 1, 2 and 3 are further directed to pay  compensation of Rs. 50,000/- to the Complainant for harassment, mental pain and agony along with litigation cost of Rs. 5,000/- to the Complainant either jointly or severally within 45 days from this date of order in default the Complainant will be at liberty to execute the decree as per law in a separate proceeding.

Let a plain copy of this order be given to the parties free of cost as per CPR, 2005.

Dictated and Corrected by me

President

Member                                            Member                                  President