JUDGEMENT

          ComplainantSmtRumaBiswas widow wife of Late Samir Biswasby filing this complaint has alleged that her husband Samir Biswas obtained an insurance coverage under a policy under name and style “Janata Personal Accident” policy being No.4751170000001/475110030054 issued by op no.1 on 23.12.2000 and accordingly op no.1 issued a policy certificate being facilitated by the pro forma op no.2 and the said policy was issued in the name of pro-forma op no.2 as principal insured by giving coverage to the husband of the complainant in the event of any accidental death etc. and coverage period is from 23.12.2000 to 22.12.2015 for an overall capital sum insured of Rs.2 lakhs and the present complainant as wife of Late Samir Biswas was the nominee in the said policy.

          It is the case of the complainant that during valid period of the said policy on 12.01.2009 at about 10:45 hours Samir Biswas, the husband of the complainant met with a road accident being dashed by a lorry while insured was proceeding by his motor cycle bearing No. WB-16D-4921 at AdiSaptagramNatun Pole, by a truck vide No.WB-41C-9328 and due to rash and negligent driving of the said driver of the truck the accident took place and as a result of which the insured received serious injuries and died at spot and over the said accident a written complaint was lodged by the son of the complainant to the local Mogra Police Station and to that effect police case has been started and proceeding is under investigation.

          Thereafter Mogra Police Station registered a case and sent the dead body for post mortem to District Hospital, Hooghly to examine the actual cause of death.  Thereafter post mortem examination was done over the dead body of Samir Biswas.  After such unfortunate incident the complainant being the wife and nominee of the deceased Samir Biswas duly intimated and informed the ops about the said accident and death of her husband and after getting such intimation op no.1 advised the complainant to submit her claim in the prescribed manner together with necessary documents like Policy Certificate, Death Certificate, FIR, Postmortem Report, charge sheet etc. as required by the op no.1 and same were duly filled in vide claim No. JPA 511700/47/09/619000006 on 30.01.2009 and along with all relevant papers and thereafter GTFS Proforma op performed their part of duties by way of forwarding all necessary relevant documents etc. with request to take necessary action to settle the claim of the complainant at an early date.

          Thereafter op no.1 did not dispose of the same within a short period and subsequently issued one letter on 07.07.2009 asking for the certificate with regards to the status of the husband of the complainant and in reply of the same, the op no.2 has issued one certificate dated 21.07.2009 and 24.07.2009 in favour of the op no.1.  But since then the op no.1 did not settle the claim.  But after expiry of one year from the date of submission of claim along with relevant documents op no.1 deliberately and intentionally with an ulterior motive did not settle the claim in favour of the complainant.  Though complainant got the coverage under the Janata Personal Accident Policy, thereafter complainant on several occasions met with op no.1 to know the fate of her claim but failed to get any positive response.  Though the op no.1 is liable to pay the said claim amount with interest and for negligent and deficient manner of service this complaint was filed for relief.  It is further submitted that previously this complaint was filed before the D.C.D.R.F., Barasat North 24 Parganas but by an order dated 16.09.2011 for want of jurisdiction the case was not decided and after that the present complaint was filed after getting the order from the D.C.D.R.F. on 16.09.2011 in C.C. No.32 of 2011.

          On the contrary proforma op no.2 GTFS by filing written statement submitted that everything was done as per agreement in between the op nos. 1 & 2 and said deceased Samir Biswas was field workers and as per agreement he was insured as he was field workers and he has supported the entire contention of the complainant and practically submitted that it is the liability of the op no.1 to compensate.

Whereas op no.1by filing this written statement submitted that practically complainant has failed to prove the bona fide field worker status of the deceased under the op no.2 because as per Hon’ble High Court’s order it is mandatory to prove the status of the deceased in case of releasing any insured claim against Janata Personal Accident policy and practically complainant and op no.2 failed to give any detail of the appointment of the deceased as field worker under op no.2, his code number and other materials and no appointment letter was also not submitted or no identity card of the field worker was also filed and practically after receiving the claim application the op appointed one investigator named Moloy Nag who held the investigation against the claim of the complainant and it was found that op no.2 or complainant both failed to produce any document to prove that he was a field worker.

Further the statement of the complainant before the investigator was that her husband was not a field worker of the op no.2.  So, it is apparent that the deficiency of the part of the complainant and reluctantancy to produce such certificate by op no.2 is proved it.  So, as per agreement in between the op nos. 1 & 2 when the complainant’s husband was not field worker of op no.2 for the claim could not be processed and in the circumstances op no.1 has prayed for dismissal of this case.

Decision with reasons

On proper assessment of the complaint and the written version and also considering the written version of the op no.2 it is clear that op no.2 nowhere has mentioned the code number, appointment letter or the status of Samir Biswas and fact remains on 21.07.2009 GTFS issued one certificate that Samir Biswas insured present deceased was one of their field worker.  But interesting factor is that op no.2 failed to produce any appointment letter from their end, no identity card or no code number of Samir Biswas as field worker and at the time of argument GTFS was asked to produce those papers but they did not submit it and fact remains in most of the cases GTFS procured insurance certificate by submitting some false documents and in the present case it is proved that GTFS issued of one certificate dated 21.07.2009 without stating the code number, date of appointment and commission payment slip of field worker, salary slip etc. and considering that fact it is clear that Samir Biswas was not the field worker of the op no.2.

But on the contrary after considering the entire material it is proved GTFS run a very illegal business on the strength of agreement in between the op nos. 1 & 2 but fact remains in the year 1999 in the month of May Hon’ble High Court passed an order that GTFS shall not have to collect any premium from any person (friends or friends family).  But they were permitted to collect premium from the field worker etc. but subject to production of their appointment letter, identity card etc. and following that order of the Hon’ble High Court we have gathered that in the year 2000 i.e. 23.12.2000 GTFS has no legal authority to purchase any Janata Personal Accident Policy in the name of 3^rd person who is not related with the op no.2.

After proper evaluation of the material we are confirmed that GTFS issued a false and fabricated certificate and submitted it before this Forum along with its written version because in the said certificate the code number, so called field worker Samir Biswas is not mentioned including date of appointment and no salary certificate, is submitted for which we are not relying upon such certificate a issued by the op no.2 which is false and fabricated certificate and only to save their skin it is submitted in their present case but in many other cases we have gathered that no such certificate was issued.

Fact remains that as per Central Government Policy Janata Personal Accident policy was introduced and its highest insured amount was Rs.1 lac and under any circumstances any facilitator had no capacity to purchase any such Janata Persona Accident policy above insured amount of Rs. 1 lac but in this case it is Rs.2 lakhs.  So, considering that fact it is clear that op no.2 runs a vexatious business on the strength of the agreement in between the op nos. 1 & 2 and for which several litigations are pending and at the same time GTFS have been restricted to collect any premium or to open any policy afterMay 1999.  But in this case it is found that this policy was opened on 23.12.2000 which is completely against the order of the Hon’ble High Court.  It is also proved that Samir Biswas was not the field worker of GTFS which has been admitted by the wife of Samir Biswas, that is the complainant before investigating authority of the op no.1 and for which it is proved that op no.2 submitted some false version and certificate and it has no basisfor recognition and so the act of the op no.2 is found no doubt unfair and practically op no.2 acted illegally and at the same time op has beenrunning an unfair trade practice by deceiving 3^rd parties by accepting their premium even after existence of injunction already passed by the Hon’ble High Court in a suit filed by the op no.2 against op no.1 GTFS.

Considering all the above fact and the present state of affairs we find that as per Central Government Policy Janata Personal Accident Policy was introduced and as per that provision no doubt the sum insured in all respect was Rs. 1 lac.  But considering the present situation and also the pendency of several cases in between the op nos. 1 & 2 before the Hon’ble High Court and Civil Court also we find that at least a sum of Rs.1 lac may be released at this stage, though sum insured was Rs.2 lakhs but balance amount of Rs. 1 lac shall be considered by the Insurance Company and the GTFS after disposal of the pending Civil suits and writ petition pending before the Hon’ble High Court  because that is the dispute in between the op nos. 1 & 2 regarding over act of the op no.2.

Another factor is that when in this case complainant’s husband is not a field worker of op no.2 then invariably the liabilities are upon the op no.2 to compensate such insured or his or her nominiees if the conduct of the GTFS is found by the Civil Court, by Hon’ble High Court as illegal.

In this regard we have also considered some legal aspects and it is fact that insurance company is in turmoil for some overact of the GTFS and that matter should be considered in this case.

Fact remains after thorough consideration of the entire materials we have gathered that there was no fault on the part of the op no.1 for not releasing the claim amount as there are several legal complications and particularly in this case GTFS had no legal authority to purchase any insurance policy in the name of 3^rd person (friends or friends family) after May 1999.  But in this case op no.2 purchased it violating the order of the Hon’ble High Court.

So, at this stage considering the whole aspect as per Central Government Insurance Policy Janata Personal Accident policy op no.1 may be directed to release Rs.1 lac at this stage but without any interest on the ground we are directing the op no.1 to release to protect the interest of the widow lady and this order is being passed considering the social aspect when Consumer Protection Act 1986 is a social legislation and invariably some legal complications are here and there what we cannot overcome but considering the entire aspect and also social and moral cause op no.1 is directed to release Rs.1 lac to the complainant as compensation and about balance Rs.1 lac the matter shall be decided by the op nos. 1 & 2 after completion of the civil suits and also the writ petition pending before Hon’ble High Court.

Accordingly the complaint succeeds in part.

Hence, it is

ORDERED

That the complaint be and the same is allowed accordingly on contest against the op nos. 1 & 2 and op no.2 shall have to pay cost of Rs.10,000/- to the complainant on the ground op no.2 is the creator of all trouble and as he did not produce any appointment letter, code number, salary slip, identity card of Samir Biswas to prove that he was field worker of the op no.2.

Op no.1 is hereby directed to release and pay a sum of Rs.1,00,000/- as claimed amount out of sum insured Rs.2,00,000/-.  Regarding balance amount of Rs.1,00,000/- shall be decided by the op nos. 1 & 2 after completion of the civil suits and the writ petition pending before the Hon’ble High Court.

Op no.2 shall have to pay some compensation of Rs.10,000/- to the complainant because op no.2 deceived the insured Samir Biswas in so many ways and moreover op no.2 had no legal right to purchase any Janata Personal Accident Policy in the name of 3^rd party after May 1999 as per order of the Hon’ble High Court.

The order against op no.2 is passed considering the unfair trade practice as adopted by op no.2 and also for submitting false certificate regarding status of Late Samir Biswas the insured.  Further op no.2 shall have to pay a sum of Rs.10,000/- as punitive damages to this Forum for adopting unfair trade practice and also for violating the orderof the Hon’ble High Court passed in May 1999 which is within the knowledge of the op nos. 1 & 2.

Op nos. 1 & 2 are hereby directed to comply the order within one month from the date of this order failing which for each day’s delay each op shall have to pay penalty interest @ Rs.200/- per day till full satisfaction of the decree and till full implementation of this decree and if op nos. 1 & 2 are found reluctant to comply the order of this Forum as per spirit of this order in that case penal proceeding shall be started against them and in that case Rs.10,000/- shall be imposed as per provision of section 27 of C.P. Act 1986.