Date of Filing: 30/10/2014 Date of Final Order: 24.07.2015
The brief facts of the case as can be gathered from the record is that deceased Kamal Ch. Roy was an employee at Gitaldah 2 No. Gram Panchayet Karjalaya as a post of ‘Karmee’ and during his life time the deceased husband of the Complainant obtained one “Janata Personal Accident Insurance Policy” (here in after JPA Policy) bearing No.(S) 512310/47/01/02206 from the O.P. No.1, New India Assurance Company Ltd. Siliguri through the O.P. No.2, Golden Trust Financial Services, Cooch Behar Branch for the period from 31/03/2002 to 30/03/2017 covering the risk for a sum assured of Rs.5,00,000/- and the present complainant is the recorded nominee of the said policy. A policy certificate was issued by the O.P. No.1 and the said policy had risk covered : Personal Accident Death/Loss of Limbs/ Permanent total disablement for an overall capital sum insured of Rs.5,00,000/-.
The main allegation of the Complainant is that the husband of the Complainant, deceased Kamal Ch. Roy 25/02/2013 at 10 p.m. while returning from Vetaguri on way at Kalirpat then he met with an accident self by his own motor cycle bearing registration No. WB-64-C/3377 and sustained grievous bodily injuries. Immediately the deceased was taken to the Dinhata Hospital and there after M.J.N Hospital, Cooch Behar and after examination, the Dr. of the M.J.N. Hospital referred to hire centre. Accordingly, the Complainant and his family members rushed to start at Siliguri and the patient was brought to Anandaloke Hospital and Neurosciences Centre, Sevoke Road, Siliguri but all efforts were in vain and in the long run the Kamal Ch. Roy died on 27/03/2013 at M.J.N Hospital, Cooch Behar and the post-mortem was duly done by the authority of M.J.N. Hospital, Cooch Behar bearing P.M. Report No. 146/2013 dated 27/03/2013.
After that the Complainant informed the incident of accident and death of her husband before the Dinhata P.S, and subsequently one G.R Case No.313/2013, has been started in respect of the said accident.
On 24/12/2013 the Complainant, wife of the deceased Kamal Ch. Roy, as a nominee filed claim application in the prescribed proforma along with all relevant papers before the O.P. No. 1, New India Assurance Company Ltd. for settling the said claim i.e. Accident Death benefit of Rs.5,00,000/-. But after submitting the required documents the O.Ps did not settle the said claim. The complainant made several contact to the O.P.No.1 & 2 on several occasions for settling the aforesaid claim but no any response has been received on the part of the O.Ps till now. From that, it is clear that the O.Ps with ill motive did not give the previously mentioned claim amount to the complainant. In that event the Complainant suffering from mental agony, pain, unnecessary harassment and irreparable loss due to negligence and deficiency in service on the part of the O.Ps. As a result, the Complainant is in great financial problem.
Hence, the Complainant filed the instant Case No. DF-71/2014 with enclosed relevant documents together with I.P.Os. of Rs.400/- before this Forum for redress of the dispute and prayed for direction to the O.Ps to pay (1) Rs.5,00,000/- as claim amount of the said policy, (2) Rs.50,000/- as compensation for mental agony, pain and unnecessary harassment, (3) Rs.50,000/- for deficiency in service and (4) Rs.10,000/- towards litigation cost, besides other relief(s) as the Forum deem fit, as per law & equity.
The O.P. No.1, New India Assurance Company Ltd., Siliguri has contested the case by filing their written version denying all material allegation of the Complaint contending inter-alia that the complainant has no cause of action to bring this case and the case is not tenable in law. The main allegation of the O.P. No.1 is that the Golden Trust Financial Services has its own filed personnel for its business in view to increase its business offer an incentive to its employees and investors the benefit of insurance coverage under two heads Mediclaim and Janata Personal Accident Insurance Policy launched by the New India Assurance Company Ltd. The main contention of the O.P. No.1 is that in the year 1998 two Memo of understanding (MOU) were executed between the Golden Trust Financial Services and New India Assurance Company Ltd. on 29-07-1998 for medical and the other dated 30-12-1998 for personal accident. The New India Assurance Company Ltd. issued two such group policies in favour of Golden Trust Financial Services. The insurance coverage as per the MOU was to cover (i) The investor, (ii) Their family members, (iii) Field workers and (iv) Their friends. As per MOU the premium was collected and remitted to the insurance company the Golden Trust Financial Services periodically and a computerized certificate in the name of O.P. No.1 i.e. the New India Assurance Company Ltd. was issued to each such person by the Golden Trust Financial Services. The New India Assurance Company Ltd. being guided by the parent body GIC issued letter to the insured Golden Trust Financial Services for canceling the MOU. The Golden Trust Financial Services moved to Hon’ble High Court and the Hon’ble High Court stayed the cancellation of MOU and restricted Golden Trust Financial Services from collecting premium from categories of friends.
This O.P. further contended that the insurance company took a policy decision to limit the sum assured under Janata Personal Accident Insurance Policy of Rs.1,00,000/- and the period of insurance to five years only for Group Janata Personal Accident Insurance Policy. The Insurance Company as per cancellation clause being condition No.5 cancelled the long term Janata Personal Accident Insurance Policies vide letter dated 01-08-2002. It is the onus of the O.P. No. 2 i.e. the Golden Trust Financial Services to prove that the certificate holder is the field worker of Golden Trust Financial Services. The Insurance Company is not satisfied with the service rendered by the O.P. No. 2, Golden Trust Financial Services. The Golden Trust Financial Services has played a fraud with the Insurance Company in the matter of non-disclosure the fact of field worker/investor. The Golden Trust Financial Services suppressed the relevant fact before the Insurance Company that the husband of the Complainant was an employee of Gitaldah 2 No. Gram Panchayat Karjalaya for the post of “Karmee” at the material point of time and being a Govt. employee he cannot be an employee/field worker of Golden Trust Financial Services. The husband of the Complainant obtained the policy from the Golden Trust Financial Services as a common person who has no nexus with the Golden Trust Financial Services which violated the terms and condition of the insurance policy. This O.P. also averred that the claim cannot be settled and the same was treated as closed due to non-submission of appropriate documents as to the status of the deceased Policy Holder for which no deficiency in service arises. Moreover, this O.P. ready to settle the claim within one month after receiving the said document as to the status of the deceased. Putting all this, the O.P. prayed for dismissal of the case with cost.
The O.P No. 2 in its turn also by filing written version contested the case and admitted the fact of obtaining Janata Personal Accident Insurance Policy by the deceased husband of the Complainant. This O.P. contended that the deceased husband of the Complainant was the field worker of the Golden Trust Financial Services and accordingly a Janata Personal Accident Insurance Policy was issued for a sum assured of Rs.5,00,000/- for the period from 31.03.2002 to 30.03.2017. As per MOU the Golden Trust Financial Services has only liability to collect the premium from the proposer and remit the same to the O.P. No.1 by a consolidated cheque with a list of field workers. Apart from this, it has no liability.
The further contention of this O.P. No.2 is that the Golden Trust Financial Services acted as per terms and condition of the policy and have no deficiency in service also they are not liable in any way for repudiation of the genuine claim of the complainant. It is fact that the husband of the Complainant died on 27.03.2013 due to a road accident on 25.02.2013. After sad demise of the husband, the present Complainant preferred a claim to the New India Assurance Company Ltd. However, the O.P did not settle the claim due to want of proper document. This O.P also averred that the Complainant might have submitted the requisite claim documents directly to the O.P. No. 1 as this O.P. did not receive any claim application but in the record all are enclosed. This O.P. further contended that the said JPA Policy No. 512301/47/01/02206 was never been disputed by the New India Assurance Company Ltd. at any time and after the death of the insured the O.P. No. 1 has no right to raise question as to the status of the deceased insured. In this connection this O.P referred a judgments of Hon’ble Calcutta High Court being No. W.P. 13359 (W) of 2008.
The O.P. No.2 concluded its version praying for proper justice as in the absence of her husband the Complainant is leading a hardship life as the settlement of the claim is beyond the scope and authority of this O.Ps. The Forum may pass order as deem feet and proper.
In the light of the contention of the complainant, the following points necessarily came up for consideration.
POINTS FOR CONSIDERATION
- Is the Complainant Consumer as per Section 2(1)(d)(ii) of the C.P. Act, 1986?
- Has this Forum jurisdiction to entertain the instant complaint?
- Have the O.Ps any deficiency in service by not settling the claim of the Complainant and are they liable in any way?
- Whether the Complainant is entitled to get relief/reliefs as prayed for?
DECISION WITH REASONS
We have gone through the record very carefully, perused the entire documents in the record along with Evidences also heard the argument advanced by the Agents of both the parties at a length. Considered the decision cited by the parties.
Point No.1.
The deceased husband of the Complainant during his lifetime obtained a Janata Personal Accident policy of The O.P. No.1, New India Assurance Company Ltd. through the O.P. No.2, Golden Trust Financial Services against depositing of certain amount. The present Complainant being the nominee of the deceased Policy Holder is also the Consumer of the O.Ps.
Point No.2.
The office of the O.P. No.2 is situated within the Jurisdiction of this Forum and the Complaint value of this case is Rs. 6,10,000/- i.e. far less than the prescribed limit. Thus, we have no hesitation to hold that this Forum has every jurisdiction to try this case.
Point No.3 & 4.
Both points are taken up together for convenience of discussion. On a careful consideration of the documents made available in the record it is seen that the deceased husband of the Complainant was covered the risk of accidental death in connection of the Janata Personal Accident Policy issued by the New India Insurance Company (O.P. No.1) through the Golden Trust Financial Service (O.P. No.2) and premium has been paid accordingly by the policy holder and admittedly the insured died within the valid policy period and the present Complainant is the nominee of the DLA. It appears from the Policy issued by the O.P. Insurance Company that the GTFS was the insured and the life of the deceased husband of the Complainant covered under the Policy and the fact is that the assured sum is of Rs.5,00,000/-. It also reveals that the DLA met an accident on 25.02.2013 and succumbed on 27.03.2013. The O.P. Insurance Company does not deny the fact of death but raised question that as per FIR the case was not an accident but murder. However, on perusal the P.M. Report undoubtedly it was the case of accident. Thus, the contention of the O.P. Insurance company is not sustainable in this context.
The Ld Agent for the Complainant cited the following Ruling:-
1. The New India assurance Company Limited Vs. Smt. Sayar Devi Baid (SCDRC W.B.) decided on 21.10.2014 .
2. New India Assurance Company Ltd. vs. Manish Abhay Bedmutha and Another
3. And one decision of District Forum In a case, Smt. Sayar Devi Vs. The New India assurance Company Limited (DCDRF Howrah) decided on 28.01.2014.
The Ld. Agent for the O.P. No. 1 filed the following Rulings:-
- (2013) CJ 1005 (S.C.)
- W.P.No. 1740 (W) of (H.C. Cal)
- S.C. Case No. FA/776/2012 (SCDRC, WB,Kol)
- S.C. Case No. FA/311/2012 (SCDRC,W.B.Kol) and other three decision of district Forum.
It is the case of the Complainant that the Insurance Company did not settle the genuine claim of the Complainant. The Insurance Company has taken pleas that Complainant is not the Field Worker, Investor; Family Member of the GTFS, Complainant is not the Insured Person as such not Consumer of this O.P. Besides, the GTFS vehemently argued that the record reveals that the Complainant files the claim to the Insurance Company and as per MOU it has no liability to settle the claim. It is pertinent point to mention that the GTFS did not submit the status report/identity card of the certificate holder. Both the Complainant and GTFS failed to adduce any cogent documents to substantiate their contention.
The Complainant stated in the complaint petition that her husband was an employee of Cooch Behar Zila Parishad, which is also clear from the record. Accordingly, there is no scope for such a Govt. employee to engage himself in a private job as a Field Worker under the GTFS even on temporary basis. Besides, as per terms and condition of the JPA policy one service man cannot be a field worker/employee of GTFS. In this juncture, reliance has been placed upon the decision of Hon’ble State Commission, W.B. in S.C case No. FA/311/2012 where it is observed that a govt. servant cannot be enlisted by the GTFS as a Fieldworker, which is an absurdity and the liability solely rests upon the GTFS in the matter for their conduct and manner. In four corners, it is established that the deceased policy holder was the friend of the GTFS not the Field Worker as stated by the O.P. No. 2. Complainant also failed to establish that the DLA was the field Worker under GTFS. Thus, it is very much clear that by suppressing the material fact, the GTFS took the Policy from the O.P. Insurance Company for which it has sole responsible but as per MOU it has no power to settle any claim.
On the other hand, when GTFS restricted to collect premium from the categories of Friend as per standing order of Hon’ble High Court passed in Writ Petition No. 1144/1999 dated 06.07.1999 then there is a clear violation of High Court order as well as MOU by the GTFS. IT is also held in S.C case No. FA/776/2012 that it was the bounded duty and obligation of the GTFS to check the particular categorization.
The Ld. Agent of the Complainant has filed rulings considering the same; it appears that in one case the DLA was the Agent of LICI not the permanent staff or a Govt. employee but in the instant case admittedly and evidently, the deceased Policy Holder was a govt. employee of Zila Parisad for which that decision is not applicable in the present case.
In the present case, the policy was purchased by GTFS in their name covering risk of Late Kamal Ch. Roy but it was by suppressing the material fact and there is no allegation of the Complainant in this respect.
So, in the circumstances, we are convinced to hold that we have nothing to do but to say that the present Complainant is not entitled to get any benefit because the policy was purchased by GTFS in their name covering risk of Late Kamal Ch. Roy but it was by suppressing the material fact for which the present case cannot be entertained in view of the fact that the DLA falls under the restricted category.
In the light of the foregoing discussion, we are constrained to hold that the Complainant badly failed to prove her case against the Insurance Company and thus we are unable to give her any relief. Accordingly, the claim of the Complainant cannot stand and fails.
ORDER
Hence, it is ordered that,
the present Case No. DF-71/2014 be and the same is dismissed on contest against the Opposite Parties. No order as to costs.
A plain copy of this order be made available and be supplied to the parties by hand/Registered post, free of cost with A/D.
Dictated and corrected by me.
Member President
District Consumer Disputes District Consumer Disputes
Redressal Forum, Cooch Behar Redressal Forum, Cooch Behar
Member Member
District Consumer Disputes District Consumer Disputes
Redressal Forum, Cooch Behar Redressal Forum, Cooch Behar
