Shri B. Mukhopadhyay, President.   

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

            Complainant by filing this complaint submitted that Samar Biswas during his life time insured himself with one “Janata Personal Accident Insurance Policy” under the OP1 through the OP2 who acted as facilitator and agent of OP1 at the time of inception of the said policy vide Police No.4751220001799/E.No.-47-30924 for a sum of Rs.50,000/- making the complainant nominee of the said policy and which was purchased on 15-08-2000 on payment of premium of Rs.197/- vide Receipt No.184704 dated 18-07-2000 having validity period from 15-08-2000 to 14-08-2015 and during continuation of the said policy Samar Biswas lost his life following a road accident on 25-03-2006 while he was dashed by an unknown lorry on the way to Panduah from Mogra through G.T. Road with motor cycle vide Regd. No.WB-16/P-8757 and in respect of that accident Mogra P.S. Case No.76 of 2006 dated 22-06-2006 was started and Accidental Death Case was ended in Final Report dated 31-08-2006 .

            Subsequently, complainant intimated the fact of death of his son to the OP1 and accordingly he was given a Janata Personal Accident Insurance Policy Claim Form vide claim No.51220047066190000033 asking the complainant to submit the claim form along with relevant documents and OP2 also informed the fact to the OP1 and submitted the claim form along with relevant documents to the OP1 on proper receipt on 01-02-2008 and thereby completed all the formalities on his part for obtaining his legitimate claim amount towards death claim for his deceased son.  But, ultimately, his claim is not settled by the OP.  The matter was reported to Insurance Ombudsman who also dismissed the complaint vide their order dated 25-08-2010 giving the complainant liberty to file fresh compliant before appropriate Forum and in the circumstances complainant has prayed for relief.

            On the contrary, OP1 by filing written statement submitted that as per terms of the Personal Accident Policy and as per MOU in between the OP1 and 2 Insurance coverage risk of investor’s family members, field workers and their family members were are valid.  But present deceased was not within the category of the same and for which the complainant is not entitled to get any relief and particularly on the ground that the MOU          had been cancelled against and against that OP2 moved the writ petition having No.1144 of 1999 and Hon’ble High court passed an interim order on 06-07-1999, inter alia, restricting the OP2 from collecting any premium from the category of friends from the date of the said order.  An Hon’ble High Court also passed an order of stay of cancellation of MOU and simultaneously injuncted the OP2 from collecting premium from category of friends and, in fact, in the present case complainant has failed to prove the status of the deceased as investors, field workers or their family members and moreover, the present insurance policy was for the period from 22-06-2006 to 31-08-2006.  Then it is clear that present complainant is not entitled to get any relief on the basis of the said order of the Hon’ble High Court because on investigation it was found that complainant’s son was not field worker and or investor or family members of them and for which the claim was not allowed by the Insurance Company when OP2 failed to produce such status of the deceased as insured.

            On the contrary, the OP2 by filing written statement submitted with the proposal of the insured was accepted on the basis of receipt of premium and the accidental risk of Samar Biswas since deceased was duly accepted by the insurance company with issuance of the policy certificate on acceptance of the requisite premium.  Therefore, it is obligatory on the part of the OP1 to release claim amount in favour of the petitioner on the happening of death which is covered under the said insurance policy.  But it is admitted that writ petition no.1144 of 1999 and 2343 of 2002 are pending before the Hon’ble High Court but without any stay order.  OP2 has further submitted that in the normal course they sent the materials as submitted by the complainant but in the written statements it is submitted that once certificate of insurance is issued on acceptance of proposal and declaration submitted by the company, further queries are uncalled for and as per the proposal and terms it cannot be reopened and so the OP1 is bound to settle the claim of the complainant and further submitted that the OP2 is not liable for any compensation.

Decision with Reasons

On proper consideration of the entire material facts and also considering the defence of the OP including the OP2 and after relying upon order of the Hon’ble High Court passed in writ petition No.1144 of 1999 it is found that with effect from 06-07-1999 OP Golden Trust Financial Service has no authority to collect any premium from any friend’s categories and to purchase any insurance policy.

            Fact remains in this case status of the deceased Samar Biswas has not been proved by the OP Golden Trust Authority rather it is proved that he was a businessman and died due to road accident on 25-03-2006 but in this case main question is whether Samar Biswas was within the category of investor and their family members and or field workers and their family members and in this regard we have gone through the written version of the Golden Trust but Golden Trust has not admitted in their written version that they  collected such premium in the year 2006 from said deceased as friend category even after existence of the standing injunction order against the Golden Trust not to collect any premium from any friends category but in this case it is proved that Golden Trust Financial Services suppressing the status of the deceased purchased insurance policy from the OP and now, the Golden Trust has not produced any paper to show that Samar Biswas the deceased was investor or their family members or the field workers or their family members then it is clear that Golden Trust Financial Services (GTFS) violating the order of the Hon’ble High Court suppressing the status of Samar Biswas purchased the said insurance policy in the name of the OP2 covering the risk of Samar Biswas and it is to be mentioned that policy was issued in the name of the OP2  covering the risk of Samar Kumar Biswas for the period of 15-08-2000 to 14-08-2015 and in the particular case policy was issued in the name of the OP2 covering the risk of the life of Samar Kumar Biswas then it is the duty of the GTFS to prove that he purchased policy covering the risk of Samar Kumar Biswas as his investor or their family members and or their field workers and their family members but it is proved that OP2 has not stated in their written version or evidence that Samar Biswas belonged to said category and when that is that fact then it is clear that under any circumstances on the death of Samar Biswas no insurance claim shall be entertained by the OP1 insurance company on the ground that the OP2 purchased that insurance policy in their name i.e. OP2’s name declaring that Samar Biswas was their investors or field workers or their family members but now they have denying that matter and OP2 has tried to say that he was not investor or field workers or family members but their plea is that when the said insurance policy was purchased then invariably the complainant is entitled to get such benefit and the matter cannot be reopened by the insurance company.

            Taking into all the matters into consideration we are confirmed the insurance policy was purchased by the OP2 in their name covering the risk or life of Samar Kumar Biswas following the injunction order of the Hon’ble High Court passed in writ petition No.1144 of 1999 dated 06-07-1999 and fact remains Samar Kumar Biswas never belongs to said category but suppressing that fact OP2 purchased the present policy in OP2’s name covering the accidental death, life risk of Samar Kumar Biswas but anyhow the OP2 has failed to prove that Samar Kumar Biswas belonged to such categories i.e. investors, field workers and their family members and for which no doubt as per following order of the Hon’ble High Court, OP2 purchased the policy in their name covering the risk of a person Samar Kumar Biswas who belonged to friend’s category and for which the entire terms and condition of the policy is void in view that of the fact that there is injunction order of the Hon’ble High Court passed on 06-07-1999 in Case No.1144 of 1999 though this policy was purchased by OP2 and for which invariably the OP1 Insurance Company is not in a position to give any compensation to the complainant.  When the status of the deceased as field worker and or investor and or their family members has not been proved by OP2 and in the written version OP2 has not asserted and claimed that Samar Kumar Biswas belonged to said categories bu it is palpably proved that he was not anyway related to the GTFS and in the light of the above observation and considering the order of the Hon’ble High Court and also the terms and condition of the policy we find that if OP2 cannot prove the status of the Samar Kumar Biswas as investor, field workers and their family members, on the death of Samar Kumar Biswas no sum assured can be realized by the OP on the death of Samar Biswas as life risk coverage to pay to his nominee and further it is proved that OP2 by dis-obeying Hon’ble High Court’s injunction order and adopting unfair trade practice stating false status of deceased purchased the same so said policy is not valid policy in the eye of law and, as such, OP2 shall pay compensation to the complainant. 

Hence,

Ordered

That the complaint be and the same is dismissed on contest without any cost against the OP1 but same is allowed against OP2 with cost of Rs.5,000/-

(Rupees Five thousand only).

OP2 is directed to pay compensation of Rs.50,000/- (Rupees Fifty thousand only) to the complainant within two months from the date of this order for adopting unfair trade practice and also violating Hon’ble High Court’s injunction order in purchasing insurance policy and if it is not paid by the OP2 within that period in that case OP2 shall pay punitive damages of Rs.10,000/- per month till full satisfaction of the decree and even penal action may be taken against OP2 as per provision of Section 27 of the C.P. Act.