Complainant Mrs. Arati Bose by filing this complaint submitted that her husband Joydev Bose purchased one Group Janata Accident Insurance Policy through G.T.F.S. (Golden Trust Financial Services) for capital sum insured of Rs.3 lakhs and valid of the said policy was from 23.06.2000 to 22.06.2015 and having Policy No. 4751220001799/E. No.-47-30861 and that policy was issued on 23.06.2000 and in that policy the complainant was noted as nominee of the insured Joydev Bose.
Subsequently Joydev Bose the insured died prematurely on 28.05.2010 due to serious road accident and accident took place near Balaji Steel Factory of Baidyabati Delhi Road when an unknown vehicle knocked down and became seriously injured when he suffered injuries and was admitted to Serampore Walse SD Hospital by the local people. Thereafter he was shifted to Medical College Kolkata where he died finally on 28.05.2010 at 03:50 P.M.
On his death his nominee the present complainant is entitled to get benefit of the aforesaid policy of her husband as beneficiary in respect of Rs.3 lakhs from op no.1 and for that reason, complainant submitted her claim towards the aforesaid benefit arising out of the said policy through op no.2 to the op no.1 furnishing all material documents, post mortem report and death certificate etc. But on the plea of pending of certain cases the Hon’ble High Court Calcutta in between the ops, op no.1 failed and neglegected to pay the amount against the policy, though complainant moved from pillar to post to get the relief. But subsequently one Goutam Naskar on behalf of the ops made enquiry about the details of the death and about the policy and submitted report stating that claim of the complainant is bona fide as nominee of the deceased. But even then no fruitful result was achieved by the complainant for which for relief and for negligent manner service of the ops this complaint is filed.
On the other hand, notices were duly served upon the op and op no.1 filed written statement and submitted that there was MoU in between the ops on the basis of the MoU dated 30.12.1998 and as per MoU the entire coverage covered the categories of 1) investors, 2) Family Members, 3) Field Workers, 4) Their Family Members and that is noted in the said MoU. But as because op no.2 G.T.F.S. did not follow this condition and issued many insurance policies outside that categories for which on the basis of the policy decision taken by General Insurance Corporation, the New India Assurance Co. Ltd., ultimately cancelled that MOU by issuing a letter by 07.03.1999 and by challenging the said order GTFS moved a writ petition being WP No. 1144 of 1999 before the Hon’ble High Court and Hon’ble Justice Pinaki Chandra Ghosh on 06.07.1999 directed GTFS to collect premium from its filed workers, investors and family members but not from friend category. But this policy was issued even after that and for which the present policy is vitiated due to such non-disclosure of material fact as it is fatal to validity of contract and for which the present policy has no validity in the eye of law and fact remains under the present case complainant was asked to produce the proof of agency licnense, investment certificate or the photo identity card of her deceased husband before insurance company to show his status (J.Bose) as investors and their the family member and or field workers and their family members, but that has not been filed and GTFS was also asked to produce such document and for which the complaint is false and fabricated which cannot be allowed for legal reasons and in the above circumstances, op has prayed for dismissal of the case.
Decision with reasons
On proper consideration of the materials on record and also hearing the Ld. Lawyer for the complainant, we have gathered that complainant’s plea is that her husband Joydev Bose purchased one Group Janata Personal Accident Insurance Policy from the op no.1 via op no.2 GTFS and complainant in support of that has produced the copy of the insurance policy where from it is found that insurance company issued that policy only name of GTFS covering the Group Janata Personal Accident Insurance of Joydev Bose and risk covered was for accidental death/loss of limbs or physically total disablement for over all capital insured Rs.3 lakhs and that policy was issued on 23.06.2000 and validity of that policy was from 23.06.2000 to 22.06.2015.
No doubt Joydev Bose died due to accident and fact remains that Joydev Bose sustained injury on 28.05.2010 on the road being knocked down by running unknown vehicle and he died on that date on 28.05.2010 at 03:50 P.M..
Complainant has relied upon the report of investigation insurance company Goutam Naskar and that report is filed wherefrom it is found that no doubt he submitted report but he has specifically mentioned in that report that GTFS was asked to prove the status of deceased against the present Janata Personal Accident Policy claim No. 51220047102310050 and GTFS was asked to show supporting documents in support of status of Joydev Bose as filed workers. But the GTFS failed to give any such document even then GTFS authority was asked to file it, but the GTFS authority did not respond and for which the op no.1 failed to decide this claim on the ground this policy was issued on 23.06.2000. But prior to that as per Hon’ble High Court’s order passed in WP No. 1144/1999 passed by Hon’ble Justice P.C. Ghosh on 06.07.1999 that GTFS were restrained from collecting any premium from any outsider or from any one from friend category but was permitted to collect premium from his filed workers, investors and their family members and fact remains that the said writ petition is still pending before the Hon’ble High Court. So considering that order it is clear that GTFS had no legal authority to collect premium from any outsider friend category or any other third persons except from its own field workers, investors and their family members and that order was passed by the Hon’ble Justice P.C. Ghosh on 06.07.1999. Then invariably GTFS had no legal authority to collect premium from any third person or from friend category. But even then GTFS collected premium from Joydev Bose who is outsider of the GTFS Co. and GTFS has failed to produce any document to prove that said Joydev Bose was investors or the family members of the investors or field workers or the family members of the field workers. Fact remains as per order of the Hon’ble High Court passed in writ petition No.1144/1999 dated 06.07.1999 GTFS has or had no legal authority to collect premium from outsiders and in this case GTFS or the complainant has failed to produce any document that Joydev Bose was investors or field workers, family members or field workers for their family members of GTFS. Then relying upon the order of the Hon’ble High Court passed in Write Petition No. 1144/1999 on 06.07.1999 we are convinced to hold that GTFS adopted unfair trade practice with the op no.1 and received and collected illegal premium from third party Joydev Bose who has no connection with GTFS and for which the present policy is against the order of the Hon’ble High Court passed on the W.P. No. 1144/1999 dated 06.07.1999. At the same time GTFS is a party no.2 and GTFS submitted claim form on behalf of the complainant. But truth is that along with that GTFS has not submitted any identity card of the deceased of Joydev Bose to show that he was investors or worker of GTFS or their family members of investors and workers of GTFS. Considering that we are convinced to hold that as per order of the Hon’ble High Court as mentioned above the present policy was prepared by the GTFS illegally violating the order of the Hon’ble High Court as mentioned above and practically that the present policy was issued on 23.06.2000 that is long after restrained order passed by Hon’ble High Court on 06.07.1999.
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 issued in the name of GTFS covering the risk in favour of investors, workers and their family members of the GTFS Co. But GTFS is a party in this case as op no.2. He submitted the claim of the complainant but did not file any such document to show that Joydev Bose falls under the category of investors and workers and their family members. It is also proved from the report of Goutam Naskar investors of the insurance company (upon whose report complainant relied) that the complainant failed to produce any such identity card of deceased Joydev Bose in respect of his status as worker or investors and or family members of workers and investors of GTFS and no doubt considering that fact the claim of the complainant was not processed by the op no.1 and that was justified and legal and in view of the order of Hon’ble High Court passed in above writ petition of 06.07.1999. In the result we are convinced to hold that complainant is not entitled to get any relief in this Forum because the policy was purchased by the GTFS in their name covering risk of Joydev Bose but it was purchased by suppressing all facts and against the standing order of the Hon’ble High Court passed in the above writ petition on 06.07.1999 and for which the present claim cannot be entertained in view of the fact that deceased was not investors, workers and or family members of investors or workers of GTFS.
In the result the complaint fails.
Hence, it is
ORDERED
That the complaint be and the same is dismissed on contest without cost against the op no.1 and same is also dismissed against op no.2 without any cost.
Order dated- 19/06/2017.
Record is put up for passing order in terms of orders dated 29.04.2016, 29.07.2016 and 25.11.2016 passed by the Hon’ble Supreme Court of India in I.A.No.1/2016 In Petition(s) for Special Leave to Appeal (c) No.(s) 7732/2016 with I.A. No.1-67 in S.L.P. (c) Nos.7889-7955/2016 for release the amount deposited by the JDr. as per order of the Hon’ble Supreme Court of India on 25.11.2016 in favour of the DHr. It appears from the record that JDr.- The New India Assurance Co. Ltd. deposited a sum of Rs.1,50,555/- (Rupees One Lakh Fifty Thousand Five Hundred and Fifty five) Only on 27.02.2015 in terms of the order dated 20.01.2015 of Hon’ble National Commission in Revision Petition No.16 of 2015 with I.A.No.30 of 2015 and again in terms of order dated 25.11.2016 of Hon’ble Supreme Court of India as aforesaid deposited a sum of Rs.2,02,335/- (Rupees Two Lakh Two Thousand Three Hundred and Thirty five) Only to this Forum on 03.02.2017.
Perused the copy of orders dated 29.04.2016, 29.07.2016 and 25.11.2016 passed by the Hon’ble Supreme Court of India as well as order dated 20.01.2015 of Hon’ble National Commission as aforesaid.
In the order dated 29.07.2016 of Hon’ble Supreme Court of India it is stated inter alia that ‘in view of the aforesaid, we modify our order dated 29th April, 2016 and permit the respondents to withdraw the amount deposited before the District Forum with accrued interest without furnishing any security’
And in the order dated 25.11.2016 of Hon’ble Supreme Court of India it is stated that ‘Having heard learned counsel for the petitioner, we intend to modify the order dated 29th April, 2016, by directing the petitioner to deposit further 50 percent amount before the concerned district consumer forum within six weeks hence and the said amount shall be withdrawn by the consumers/petitioners therein without furnishing any security. The similar arrangement shall be done for the previous deposit as the amount has already been deposited and directed to be withdrawn.
The affected persons need not appear to contest the matter before this Court, for the dispute is between the insurance company and the principal insured pertaining to determination of composite negligence. The stand of either side is that the principle of ‘composite negligence’ would not be attracted as the factual matrix of the case would show that either the insurer or the principal insured would be liable.’
In view of the above, office to release the deposited amount of Rs.1,50,555/- (Rupees one lakh fifty thousand five hundred and fifty five) alongwith interest accrued thereon and Rs.2,02,335/- (Rupees Two Lakh Two Thousand three hundred and thirty five) Only to the DHr.- Arati Bose with proper identification and receipt.
Sd/- Sd/-
Member President
