Smt. Syeda Shahnur Ali, Member(L)

The case of the complainant is that one Madan Pramanik, since deceased, purchased a policy under Group Janata Personal Accident Insurance Policy (hereinafter referred to as GJPAIP) vide policy no. 4751170000001/4751170030045 which was issued in the name of Golden Trust Financial Services (hereinafter referred to as GTFS) and which covered the period from 15.12.2000 to 14.12.2015 and the same was issued by New India Assurance Co. Ltd. (hereinafter referred to as NIA) the insured. The said Madan Pramanik, met with an accident and died on 22.12.2012 at Beraberia on Tamluk Panskura pitch road at about 2.20 PM under Panskura P.S. The incident was reported to the Panskura P.S. on 31.12.2012 u/s 279/304(A) of IPC. The Investigating Officer of the said case submitted Final Report on 18.8.2013 u/s 279/304(A) of IPC. The policy holder received a policy deed after paying policy premium wherein Madhusudan Pramanik is made the nominee.

The Advocate on behalf of the complainant herein sent a notice to the OPs on 13.11.2014 but they are not prepared to settle the claim. The complainant states that he went to the Office of the OPs personally and requested to settle the claim, but all efforts were in vain. Hence the complainant filed this instant case.

The OP2 and 3 entered their appearance and contested the case by filing W/V and WNA, but the case is being heard exparte against the OP no1, The Senior Divisional Manager, New India Assurance Co. Ltd.

We have gone through the record and documents filed by the parties.

The OP3 in his W/V stated that OP2, a Partnership Firm, is a mobiliser of fund on behalf of UTI, SBI Mutual Fund etc. In the year 1998 MOU was entered between NIA and GTFS for mediclaim and personal accident insurance. The insurer was NIA and the insured was GTFS. As per MOU, premium was collected by GTFS and remitted to the insurance co. and computerized certificate was issued in respect of each person who was insured. As per decision taken by GICI, the insured co. issued a letter dtd. 07.05.1999 addressed to GTFS cancelling and challenging the said order of cancellation of MOU, GTFS moved a Writ Petition before the Hon’ble Calcutta High Court and the Hon’ble High Court passed an interim restraining the GTFS from collecting the premium from the date of such order. In the circumstances, vide letter dtd. 01.08.2000, the long term GJPAIP for more than Rs. one lakh and above 5 years were cancelled. Vide letter dtd. 01.08.2002, the NIA cancelled the long term GJPAIP for more than Rs. one lakh and above 5 years. In the said letter it was further decided that henceforth no long term certificate for more than 5 years and for more than Rs.5 lakhs will be issued under the said above policy.

The NIA sent a letter dtd. 19.11.2014 addressing the ld. Advocate on behalf of the complainant wherein insurance co. stated that that have sent a letter to GTFS, but neither the GTFS nor claimant provided any documentary evidence that can establish that the deceased was an investor/field worker of GTFS and in absence of any such evidence, the insurance co. was not in a position to process with the claim. The OP2 in his W/V states that under the said MOU, the OP2 was obliged to collect premium from the proposer and remit the same to the NIA. They also stated that the NIA embodied certain terms and conditions wherein it has been specifically mentioned that GTFS shall have no liability with regard to settlement of claim, if any under the said policy and the NIA will be solely/directly responsible for any death, injury or disability of the insured person subject to terms and conditions of the policy concerned. The OP2 states from the records dtd. 17.06.2013 that complete claim form in original was submitted to NIA. The OP2 also stated in letter dtd. 07.12.2013 that everything was made clear and categorically mentioned that further enquiry as field worker after being satisfied with the proposal and the declaration submitted by GTFS for further clarification was totally uncalled for. They further said GJPAIP policy no. 4751170000001/4751170030045 were never disputed by NIA. Therefore, the insurance co. has no moral right for compliance of requirement of submission of Identity Card after death of insured is an uncomfortable and distress situation.

On going through the records/documents submitted by the parties, we feel that Madhusudan Pramanik was a nominee of deceased Madan Pramanik who had purchased a GJPAIP policy from GTFS which was insured by NIA ltd. The ld. Advocate of NIA stated that the said MOU between GTFS and NIA was severed in the year 2002.

If that had been the case, then how NIA had issued the certificate to GTFS in the year 2000 when the same has already been cancelled. That being so, we are of the opinion that the complainant is entitled to claim as nominee and receive the benefit of GJPAIP of Rs.100000/- to which he is legally entitled to. The NIA in order to defraud the valid customer tried to indulge in unfair trade practice and repudiating the valid claim.

Hence, it is,

Ordered

that the complaint case being no. CC-10/2015 be and the same is allowed on contest against the OP3 and exparte against the OP1 and the same is dismissed against the OP2. The OP1 and 3 are jointly and severally liable to pay the insured amount of Rs.100000/- alongwith compensation of Rs.10000/- to the complainant within 45 days from the date of this order. They are also liable to pay jointly and severally Rs.5000/- as litigation cost to the complainant within 45 days, failing which the complainant will be at liberty to execute the order as per law, in which case the OP1 and 3 will pay Rs.100 per diem to the complainant till realization in toto.