DATE OF FILING : 12.02.2014.
DATE OF S/R : 10.04.2014.
DATE OF FINAL ORDER : 20.01.2016.
Smt. Durga Nath,
widow of late Swapan Kumar Nath
of Tematha, Jogipara, P.O. & P.S. Chandernagore,
District Hooghly,
PIN 712136. ………………………………………………………… COMPLAINANT.
1. The New India Assurance Co. Ltd.,
represented by its Divisional Manager,
Howrah Divisional Office, Madhusudan Apartment ( 2nd floor ),
P 18, Dobson Lane,
Howrah 71 101.
2. The Manager,
Golden Trust Financial Services,
16, R.N. Mukherjee Road, P.S. Hare Street,
Kolkata 700001. …………………………………………OPPOSITE PARTIES.
P R E S E N T
Hon’ble President : Shri B. D. Nanda, M.A. ( double ), L.L.M., WBHJS.
Hon’ble Member : Smt. Jhumki Saha.
Hon’ble Member : Shri A.K. Pathak.
F I N A L O R D E R
- This is an application U/S 12 of the C.P. Act, 1986 filed by the petitioner, Smt. Durga Nath, praying for a direction upon the o.p. nos. 1 & 2 to pay her Rs. 2 lakhs towards her insurance claim against policy no. 4751220001799/E no. 47-30958 with interest @ 18% w.e.f. 26.04.2010 and to pay compensation of Rs. 1 lakh and Rs. 10,000/- as litigation costs.
- The case of the petitioner is that her husband Swapan Kumar Nath had Janata Personal Accident Insurance Policy under o.p. nos. 1, New India Assurance Company Ltd., & o.p. no. 2, Golden Trust Financial Services Ltd., acted as facilitator and agent of o.p. no. 1. The policy was purchased by her husband from the agent of o.p. no. 1 namely o.p. no. 2 on payment of premium of Rs. 530/- by receipt no. 19475 dated 18.8.2000 issued by o.p. no. 2 and the tenure of the policy was valid from 08.09.2000 to 07.09.2010. During continuance of the policy her husband, Swapan Nath, lost his life following a road accident on 08.11.2009 at Bhadeswar on G.T. Road. Death of the petitioner was investigated by Bhadesawar P.S. in the P.S. Case no. 173 of 2009 dated 09.11.2009 and final report submitted on 20.01.2010. The petitioner intimated the death of her husband to o.p. no. 1 through one claim intimation letter dated 11.12.2009 and accordingly on 10.03.2010 she was given a Janata Personal Accident Insurance Policy Claim Form along with letter dated 10.03.2010 being her claim form no. 512200/47/09/61/90000083 asking her to submit the same along with documents. She submitted the claim form to the o.p. no. 2 with proper receipt on 26.04.2010 and thus completed formalities. She met the o.p. nos. 1 & 2 personally for a number of times. O.p. no. 2 informed her that the matter was sent to o.p. no. 1. On 13.10.2010 the petitioner went to the office of o.p. no. 2 where the officers told her that the policy was issued by New India Assurance Company Ltd. and they acted as an agent and regarding settlement of claim they have nothing to do. Then the petitioner sent legal notice to the o.p. nos. 1 & 2 and filed this case stating that due to negligence on the part of the o.ps. she could not get her claim settled.
- The o.p. no. 2, Golden Trust Financial Service Ltd., contested the claim by filing a written version wherein they denied any allegations made against them by the petitioner and submitted that they are simply the agent of the o.p. no. 1 and received premium deposited before them on behalf of o.p. no. 1 and received a spot discount of Rs. 78.45 p. out of the premium amount of Rs. 459/- as they had an agreement with the New India Assurance Company Ltd. and the life assured was a customer of the o.p. no. 1 and they had no deficiency in service on their part as they duly processed the application form of the petitioner and sent the same to the o.p. 1 who is the insurer and who is to make the claim of the petitioner settled.
- The o.p. no. 1 contested the case by filing a written version denying the allegations made against them and submitted that in the year 1998 two memos of understanding were executed between Golden Trust Financial Services and New India Assurance Company Ltd. on 29.7.1998 for medi claim and on 30.12.1998 for personal accident. Two such group insurance policies were issued in favour of o.p. no. 2 by o.p. no. 1. The insurer was New India Assurance Company Ltd. and the insured Golden Trust Financial Services under the accident policy. The sum insured varied from Rs. 50,000/- to 10 lakhs and the coverage period was 1 to 15 years. The premium was collected and remitted to the insurance company by the o.p. no. 2 periodically and computerized certificate in the name of the New India Assurance Company Ltd. used to be issued to the customers by the o.p. no. 2, G.T.F.S. The General Insurance Corporation of India regulates the insurance business in India under General Insurance Business Nationalization Act, 1972. The General Insurance Corporation of India took a policy and issued a circular to deny the groups and restrict the group and accordingly insurance company issued letter dated 07.05.1999 addressed to the G.T.F.S. cancelling the MOU. Challenging the said cancellation, the G.T.F.S. moved the Hon’ble High Court, Calcutta, in Writ Petition no. W.P. No. 1144 of 1999 wherein the Hon’ble High Court passed an interim order dated 06.07.1999 restricting the GTFS collecting the premium from category of ‘friends’ from such date and also Hon’ble High Court stayed the cancellation of MOU. The insurance company took a policy decision to limit sum assured under Janata Personal Accident Policy to Rs. 1 lakhs and the period was only for five years. Under such changed circumstances, the policy verified and to restrict the sum insured of Rs. 1 lakh and the period of insurance to five years. It was neither illegal nor arbitrary.
- In the circumstances the insurance company cancelled the Janata Accident Policy of more than 1 lakh coverage and the covering period beyond five years. The petitioner did not file appropriate document to the insurance company for establishing the status of the certificate holder and so she should be asked to submit appropriate Form and the Forum to pass appropriate order which the Forum feels fit and proper.
- Upon pleadings of parties the following points arose for determination :
- Is the case maintainable in its present form ?
- Whether the petitioner has any cause of action to file the case ?
- Whether there is any deficiency in service on the part of the O.Ps.?
- Whether the complainant is entitled to get any relief as prayed for ?
DECISION WITH REASONS :
- All the issues are taken up together for the sake of convenience and brevity for discussion and to skip of reiteration. In support of her case the petitioner, Smt. Durga Nath, filed affidavit as well as policy certificate of New India Assurance Company Ltd., Howrah Branch, intimating the death of her husband in an accident which took place at Bhadreswar in the G.T. Road on 09.11.2009 and on filing the claim form before the company through the agent Golden Trust Financial Services.
- In her petition before the Forum the petitioner prayed directing the o.ps. to pay her Rs. 2 lakhs being the insured sum of the Janata Personal Accident Policy and Rs. 1 lakh as compensation and Rs. 10,000/- as litigation costs.
- The o.p. no. 1 being the New India Assurance Company Ltd. submitted before the Forum that they had executed two memos of understanding with the Golden Trust Financial Services namely o.p. no. 2 here to act as agent for the medi claim scheme and for personal accident scheme in the year 1998 and most specifically on 29.7.1998 for medi claim and on 30.f12.1998 for personal accident and the said two group insurance policies were to be issued by the o.p. no. 2 on behalf of o.p. no. 1 who authorized the o.p. no. 2 t issue the policy certificates on behalf of o.p. no. 1. The o.p. no. 1 further submitted that the sum assured as per the memos of understanding was between Rs. 50,000/- to Rs. 10 lakhs and the coverage period was from one year to 15 years. They further submitted that in the year 1999 the General Insurance Corporation of India who is to regulate the insurance business issued circular on a policy decision imposing restriction and the o.p. no. 1 in pursuance of the same issued letter dated 07.05.1999 addressed to G.T.F.S. cancelling the MOU. Challenging the said letter, Writ Petition No. WP 1144 of 1999 was filed before the Hon’ble High Court Calcutta which stayed the cancellation of the MOU also restrained the o.p. no. 2 G.T.F.S. from collecting premium from the parties. Ld. counsel for the o.p. no. 1 submitted that in spite of restrain order from Hon’ble Court the o.p. no. 2 collected premium from the parties which was illegal and the o.p. no. 1 cannot held liable for payment of such amount to the insured as the very policy made by the G.T.F.S. was illegal and there was no liability in the form of photographs on the part of the o.p. no. 1. This Forum also kept in mind the submission of the ld. counsels for the petitioner as well as for the o.p. no. 2 and kept in kind the cases of the parties as came out from their petition as well as written version and also from the documents filed by them. No document has been produced before this Forum regarding the fate of the Writ Petition No. 1144 of 1999 except interim order stated in the petition as well as written version. It is palpably clear before this Forum that several Writ Petitions filed on this matter in between 1999 to 2004 and order passed by the Hon’ble Court as in the case of W. P. NO. 17808 ( W ) of 2004 wherein the High Court Calcutta allowed the writ petition of the petitioner against the respondent insurance company with cost and directing the company to take immediate steps for settlement of insurance claim in connection with the policy therein for the Janata Personal Accident Insurance Policy made on 15.10.1999 as also same type of policy was made by the husband of the petitioner on 18.8.2000 in this case. .
- In the instant case this petitioner’s husband Swapan Kumar Nath made a Janata Personal Accident Insurance Policy under theG.T.F.S. which signed MOU with the New India Assurance Company and the insured Swapan Kumar Nath died in an accident on 08.11.2009 at Bhadreswar P.S. area on the G.T. Road and the matter was intimated to the Branch Manager, New India Assurance Company Ltd., through the o.p. no. 2, within the schedule time.TheG.T.F.S. submitted the claim form along with documents before the insurance company but the insurance company took no positive step. There is no allegation in the fact that the claim of the insurance policy in favour of the victim was a disputed one rather as a matter of fact the insurance policy certificate was issued in the name of the victim, Swapan Kumar Nath, husband of the petitioner and thus keeping in mind all the facts of the case along with documents and submission of counsels, thisForum is satisfied that the victims was undisputedly covered under the policy as also decided by the Hon’ble Court in the Writ Petition no. 17808 of 2004. In this case the o.p. no. 1, insurance company, took no step and submitted certain vague facts from which no conclusion could be drawn but it is true that the husband of the petitioner made himself insured and thus this petitioner is entitled to the sum insured as the husband of the petitioner died in an accident and there is no denial of such facts. It is true that the liability of the agent is the liability of the insurer and thus the insurer should take immediate step for settlement of the insurance claim by making payment as prayed for by the petitioner. If there is any latches on the part of the agent and the agent being solely liable for collection of premium then the o.p. no. 1 would have the liberty to get the insured sum recovered from the o.p. no. 2 through proper legal steps.
In view of above discussion and findings this Forum finds that the petitioner is entitled to the reliefs as prayed for.
In the result, the claim case succeeds.
Court fee paid is correct.
Hence,
O R D E R E D
That the C. C. Case No. 69 of 2014 ( HDF 69 of 2014 ) be and the same is allowed on contest with costs against the O.Ps.
The petitioner is entitled to get the insured sum of Rs. 2 lakhs from the o.p. no. 1, insurance company who is to pay the said amount to the petitioner within one month from the date of this order and also the petitioner is to get interest @ 9% per annum on the above sum of Rs. 2 lakhs from 26.4.2010 and entitled to compensation for a sum of Rs. 20,000/- for the mental agony and harassment and Rs. 10,000/- as litigation costs.
The o.p. no. 1 is directed to pay the above sum to the petitioner within 30 days from the date of this order failing the whole sum would carry interest @ 9% p.a. till realization from the date of expiry of the period of appeal and also the petitioner would be at liberty to put the order in execution.
Supply the copies of the order to the parties, free of costs.
DICTATED & CORRECTED
BY ME.
( B. D. Nanda )
President, C.D.R.F., Howrah.
