Order No.16

Shri A.K. Chanda, Member.   

This is an application u/s.12 of the C.P. Act, 1986.

            The complainant’s case, in short, is that her husband since deceased had obtained a Group Janata Personal Insurance Policy No.475117000000/47511 and also was covered under the Policy No.01159043/000100208050-0286307 issued in the year 2001 for the period from 31-03-2001 to 30-03-2016.  The risk covered for an overall capital sum insured of Rs.1 lakh only.  The said policy was issued in the name of OP2 as principal insured by giving coverage to the husband of the complainant in the event of any accident/loss of limbs and total permanent disablement during the period of the said Insurance Policy.  This policy is a Group Janata Personal Accident Insurance Policy and the OP2 had only facilitated such insurance coverage to the husband of the deceased being the member of the said club acting merely as a service provider.

            It is the case of the complainant that her husband died on 17-03-2008 with a road accident (dashed by a lorry).  After the death of her husband she applied on 26-03-2008 before the OP1 duly filled in claim form along with document and original policy certificate for settlement of the claim.  But the claim of the complainant was not honoured and being aggrieved and dissatisfied, the complainant approached this Ld. Forum for redressal of her grievances.

            The OP1 did not appear and contested the case.  Hence, the case is heard in ex parte form against OP1.

            The OP2/GTFS appeared and submitted its written version wherein stated that the Insurance Company i.e. the OP1 is solely responsible in case of claim of the insured person subject to terms, conditions warranty and exclusion of the policy concerned.  But they have no liability with regard to settlement of the claim.  The OP2 has only remitted the premium to the OP1.  In the instant case the OP2 have acted bona fide and strictly in terms of the guidelines in respect of the policy.  There have been no laches or lapses and deficiency in service on their part for non-settlement or repudiation of the complainant by the OP1.  Hence, the complainant is not entitled to any relief from the OP2.

 The compliant case being No.332 of 2011 was initially filed on 02-02-2010 before DCDRF, North 24 Pgs., Barasat by order dated 25-1-2011 and the complaint/petition was returned to the complainant with liberty to file the same before the Appropriate Forum and accordingly the instant complaint case has been filed by the complainant on 27-02-2012 before this Forum having territorial jurisdiction.

Points for Determination

1)    Whether the complainant is a consumer under the OPs?

2)    Whether the P.O.C. is maintainable?

3)    Is there any deficiency in service on the part of the OPs?

4)    Whether the complainant is entitled to get relief as prayed for?

Decision with Reasons

All the points are taken up together for the sake of convenience and brevity.

            Undisputedly, the complainant’s husband obtained a group JPA Insurance Policy from the New India Assurance Company Ltd; being No.4751170000001/ 4751170030162 with a period of coverage from 31-03-2001 to 30-03-2016.  Though the policy was issued in the name of OP2 GTFS Ltd. it is the deceased who covered under the said policy against accidental death, loss of limb, permanent total disablement for over all capital sum assured of rs.1 lakh.  The complainant was made the nominee of the insured.  During the subsistence of the policy, the insured Late Sanatan Khanra was died due to an accident.

            It appears from the record that the deceased husband of the complainant was sent to Arambag S.D. Hospital for holding post mortem report and the complainant duly intimated the OPs about the said incident and also submitted her claim in the prescribed manner together with necessary documents viz. original policy certificate, death certificate, FIR, post mortem report charge sheet, final police report as claimed by the OPs for settlement of her claim vide JPA Claim No.511700/47/08/61/90000027 on 26-03-2008 along with original policy certificate.  It is also stated that the OP2 duly performed their part to settle the claim of the complainant.  But due to unknown reasons the OP1 has not settled the claim.

            Admittedly, the  GTFS Ltd., the proforma OP2 acts as an agent for various companies including the OP1 being the only facilitator of the JPA Policy coverage among the members of the club and on behalf of the Insurance Company.  Here, the policy was issued in the name of the GTFS Ltd. and insured was the husband of the complainant.  It is quite clear that any claim liability under the above insurance policy would be solely against OP1 and no responsibility can be fastened to the GTFS Ltd. though the premium was collected by them from the insured but it was remitted to the Insurance Company and, as such, the Insurance Company is directly held responsible and liable to pay the accidental claim benefit to the insured.

            We have perused the documents filed by the complainant such as death certificate post mortem report copy of the insurance policy, copy of the FIR police report in final form and the correspondences with the OPs.  It is not in dispute that the death of the complainant’s husband caused due to an accident and the same has been fortified by the death certificate and the P.M. Report.  The original policy is lying with the OP1.  The OPs never disputed the genuineness of the policy, where the name of Dipali Khanra has been figured as nominee.  Naturally the stand taken by the Insurance Company was not justifiable without any cogent reason for which they are not settling the claim of the complainant.

            In this circumstances, of the case we held that there is deficiency of service on the part of the OP New India assurance co. Ltd. who has not settled the bona fide claim of the complainant for which the complainant suffers from harassment, mental agony and financial constraint.  The case, therefore, succeeds.  The OP1 Insurance Company should pay the sum assured of Rs.1 lakh to the complainant.  the OP1 should also pay a sum of Rs.2,000/- towards cost of litigation.  Considering all the materials on record we are of the opinion that the complainant being the nominee of the deceased husband, is entitled to get the sum assured.  In view of the facts and circumstances of the case we are not inclined to award any compensation.

Hence,

Ordered

That the case be and the same is allowed ex parte against OP1 with litigation cost of Rs.2,000/-(Rupees Two thousand only) but dismissed on contest against OP2 GTFS.

            The OP1, the New India Assurance Company Ltd. is directed to pay the sum of Rs.1 lakh to the complainant, the wife of the deceased husband within a period 30(thirty) days from the date of the order failing which it would carry interest @9% p.a. (at the rate of nine per cent per annum) till realization.

            There shall be an order of litigation cost of Rs.2,000/-(Rupees Two thousand only) to be paid by the op1 to the complainant.

            In case of default, the complainant is at liberty to put the decree in execution.

            Let copies be supplied to the parties as per rules.