West Bengal

Paschim Midnapore

CC/36/2014

Smt. Shibani Bose. - Complainant(s)

Versus

The Manager, The New India Assurance Co. Ltd. - Opp.Party(s)

23 Sep 2015

ORDER

                                                              DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 

Bibekananda Pramanik, President

and

Mrs. Debi Sengupta, Member.

   

Complaint Case No.36/2014

                                                       

                 Smt. Shibani Bose………………………………………….…Complainant.

Versus

1)The Manager of the New India Assurance Co. Ltd.,

2)The Regional Manager of Golden Trust Financial Services,

3)The Branch Manager of Golden Trust Financial Services….…..Opp. Parties.

 

              For the Complainant    : Tirthankar Bhakat, Advocate.

              For the O.Ps.                 : Mr. Mrinal Chowdhury, Advocate.

                                                    : Mr. Swapan Bhattacherjee, Advocate.

 

Decided on: - 23/09/2015

 

                          Bibekananda Pramanik, President :- Facts of the case, in brief, is that Samit Kr. Bose, since deceased, the husband of the complainant was the holder of Janata Personal Accident Insurance Policy, issued by the opposite party no.1 in the year 2000 vide serial no.0166510/200000356891, Policy no.4751220001799/E no.47-30970, validity period from 15/09/2000 – 14/09/2015 and the capital sum insured was Rs.2,00,000/- (Two lac).  The complainant was the nominee of the said policy.  During his life time, the husband of the complainant duly tendered one time premium of Rs.767/- on 6.8 2K before the concerned authority.  On 13/08/2013, the husband of the complainant died in a road traffic accident.  A police case being no. KGP (T) P.S. Case no.253/13 was initiated against the driver of the offending vehicle.  Said incident was duly communicated to the opposite party-Insurance Company. The complainant duly approached on several times before the opposite party-New India Assurance Company Ltd. to issue a claim form in her favour so that she may be able to

                                                                                                                                                                     Contd………………..P/2

                                                                                                                 ( 2 )

lodge her claim but all her efforts become futile.  The opposite party-Insurance Company did not supply claim form in spite of repeated reminder.  The complainant also approached before opposite party nos. 2 & 3 for settlement of her claim but they remained silent in this regard.  Hence, the complaint, praying for directing the opposite party-Insurance Policy to pay the entire insured sum of Rs.2,00,000/- (Two lac) and for other reliefs.

            Opposite party no.1-New India Insurance Company has contested this case by filing a written objection.  Denying and disputing the case of the complainant, it is the specific case of the opposite party no.1 that in spite of repeated demands through letters dated 15/12/2011 from the side of the New India Assurance co. Ltd. to the complainant as well as GTFS, no documentary evidence has been furnished to prove that the insured person was investor of agent/field worker or their family members although they are under obligation to produce documents as required by the opposite party.  It is stated that after investigation, the opposite party came to know that the deceased was a railway employee in the post of RPF Head Constable and he was not involved with any other job profile or with GTFS as a field worker/agent. In the F.I.R., lodged by the son of the deceased  it has been stated that the deceased was a railway employee and it was not the case of the complainant that the deceased took leave of the railway authority concerned to work as a field worker of GTFS.  In view of failure to establish the status of the proposer/insured Samit Kumar Bose as investor/field worker or staff of the GTFS in connection with JPA Insurance Policy, the opposite party-Insurance Company is unable to settle the claim.  It is also stated that in view of the above facts and circumstances of the case and the settled law, the aforesaid policy in question was void and invalid and the complainant is not entitled to get any benefit from the policy, as mentioned in the petition of complaint.  Opposite party-Insurance Company, therefore, claims dismissal of the complaint case.

            Opposite party nos.2 & 3 in their written statement has stated that Sumit Kumar Bose, since deceased the husband of the complainant, was a field worker of Golden Trust Financial Services and he obtained a Janata Personal Accident Insurance coverage of the opposite party no.1-the New India Assurance Company Ltd. under a group insurance scheme through the facilitation of the Golden Trust Financial Services.  The said insurance policy was issued by the opposite party no.1 after receipt of due premium by way of consideration money covering the field worker Samit Kumar Bose. Smt. Shibani Bose, the complainant is the widow and nominee of the said deceased under the policy.  By virtue of a MOU, executed on 30/12/1998, by and between opposite party no.1 and the opposite party nos.2 & 3 a Group Janata Personal Accident Policy was extended by opposite party no.1 to cover to their field workers and their family members, their investors and their friends.  Under the said MOU,

                                                                                                                                                                   Contd………………..P/3

                                                                                                                    ( 3 )

opposite party no.2 was only obliged to collect premium from the proposer and to remit the same to the opposite party no.1.  That apart, their had been no other liability to be borne by the opposite party nos.2 & 3.  Opposite party nos.2 & 3 duly forwarded the claim papers of the complainant to the opposite party no.1 for appropriate decision and there is no negligence or deficiency in service on their part.  In their statement, opposite party nos.1 & 2 have cited two decisions of the Hon’ble Court reported in 2005 (3) CHN 154 passed by Hon’ble Justice Pranab Kumar Chattopadhya and another judgement of Hon’ble Justice Soumitra Pal passed in W.P. no. 13359(W) of 2008 wherein their Lordship has been pleased to hold that once certificate has been issued as per proposal and declaration submitted to the company, it cannot be reopened challenging the status of the insured person.  It is further stated by the opposite party nos.1 & 2 in their written statement by withholding the settlement and payment of claim to the complainant for a long time without reasonable cause amount to deficiency in service on the part of the opposite party no.1.

                                                                                                      Point for decision

                                                                             Is the complainant entitled to get the relief, as prayed for?

Decision with reasons

To prove her case, the complainant has examined herself as PW-1 by tendering her examination-in-chief and during her further evidence on oath, three documents were marked as Exhibits 1, 2 & 3 respectively.  Opposite parties adduced no evidence. 

From the respective cases on the parties and the documents, filed by them, it appears to us that admittedly Samit Kumar Bose, since deceased, obtained a Janata Personal Accident Insurance Policy from the opposite party no.1 through opposite party nos.2 & 3.  Validity period of the said policy was from 15/09/2002 to  14/09/2014 and the capital sum insured is Rs.2,00,000/- (Two lack).  It is not denied and disputed that the said insured Samit Kumar Bose died in a road traffic accident on 13/08/2013.  It is admitted by opposite party nos.2&3 that after the death of the insured person, the complainant informed the said incident of death of her husband  vide letters dated 19/09/2013 and 04/01/2013 praying for issuance of claim form and those letters were duly sent by opposite party nos.2 & 3 to the opposite party no.1-New India Assurance Company Ltd. to did not settle her claim.  Admittedly, the opposite party no.1, who issued the policy certificate in favour of the deceased, has not yet settled the claim of the complainant, who is admittedly the nominee of that policy.  From the lengthy written objection of the opposite party no.1, we find that the main objection of such inaction regarding settlement of the claim is that the deceased insured person was neither an agent nor investor nor a field worker nor a family member of opposite party no.2 and in spite of repeated demands by opposite  party no.1, neither the complainant nor the opposite party no.2

Contd………………..P/4

( 4 )

submitted any documentary evidence regarding the status of the deceased insured person and for such failure to establish the  status of the deceased proposer/ insurer, the Janata  Personal Accident Insurance Policy is to be held as obtained in other wise manner and therefore  same will be treated as void and invalid policy.  Further according to opposite party no.1 the husband of the opposite party was a railway employee in the post of RPF Head Constable, which has been admitted by the complainant during her cross examination.

            Now the question left for consideration is that whether in the given facts and circumstances of the present case, as aforesaid, the opposite party no.1 was justified in  withdrawing the claim of the complainant in respect of Insurance Policy issued in favour of her deceased husband by the opposite party no.1.  Undisputedly, the opposite party no.1 issued that policy in favour of the husband of the complainant.  When a certificate of Insurance is issued by the Insurance Company, it is to be presumed that such certificate was issued pursuant to the proposal and declaration made by the insured person.  It is not denied and disputed that after the death of insured person, the complainant intimated the opposite party no.1 through opposite party nos.2 & 3 regarding the unfortunate death of her husband and she prayed for issuance of claim form.  It is none but opposite party no.1 has admitted that they did not issue claim form for failure of the complainant and opposite party nos.2 & 3 to produce documents regarding the status of the insured person.  It is well settled that when a certificate has been issued as per proposal and declaration to the Insurance Company, it cannot be reopened by raising an objection regarding the status and eligibility of the deceased insured person.  We are, therefore, of the view that there is deficiency in service on the part of opposite party no.1 by not issuing the claim form in respect of that policy and therefore the complainant is entitled to the reliefs, as prayed for.

                                                                                Hence, it is

                                                                                                  Ordered,

                                                                                                                  that the complaint case no. 36/2014 is allowed on contest with cost against opposite party no.1 and dismissed without cost against opposite party nos. 2 & 3.

Opposite party no.1 is directed to issue claim form to the complainant and to settle her claim in respect of that Insurance Policy as per law within a period of 2 (Two) months from the date of this order and to pay Rs.5,000/- as compensation and Rs.5,000/- as litigation cost to the complainant within that period of  2 (Two) months.

   Dictated & Corrected by me

             

                President                                         Member                             President

                                                                                                               District Forum

                                                                                                           Paschim Medinipur