DATE OF FILING : 25-01-2010.
DATE OF FINAL ORDER : 14-06-2010.
Smt. Lakshmi Mondal,
wife of Late Ashok Mondal,
Jyangra ( Mondalpara ), P.O. Jyangra,
P.S. Rajarhat, District – 24 Parganas ( North),
Kolkata – 700059. -------------------------------------------------Complainant.
Versus -
1. The General Manager
representing the M/S. New India Assurance Co. Ltd.
87, Mahatma Gandhi Road,
Fort Mumbai – 400001.
2. The Branch Manager,
The New India Assurance Co. Ltd.,
Howrah Divisional Office, Unit No. 512200,
at Madhusudan Apartment, 2nd floor, P.-18, Dobson Lane,
P.S. & District – Howrah – 711101.
3. The Manager / Authorized Officer
representing Golden Trust Financial Services,
having its office at 16 R.N. Mukherjee Road,
Kolkata – 700001.----------------------------------------- Opposite Parties.
P R E S E N T
1. Hon’ble President : Shri J. N. Ray.
2. Hon’ble Member : Smt. Samiksha Bhattacharya.
3. Hon’ble Member : Dr. Dilip Kr. Chakraborty.
C O U N S E L
1. Representative for the Complainant : Shri Pranay Naskar,
Authorised representative.
2. Representative for the O.P. no. 1 & 2 : Shri Pralay Kar,
Ld. Advocate.
3. Representative for the O.P. no. 3 : Mr. Bibhas Mondal,
Ld. Advocate.
F I N A L O R D E R
This is to consider an application U/S 12 of the C.P. Act, 1986 as amended till date regarding insurance claim on the ground of deficiency in service.
Facts of the case, in brief, is that Late Ashok Mondal, husband of the complainant, being field worker of the Golden Trust Financial Services, in short, G.T.F.S., o.p. no. 3, obtained one Janata Personal Accident Insurance Policy, in short, JPA Policy bearing no. 4751220001607 / E No. 47-30399 for the period from 23-08-1999 to 22-08-2014 for sum assured of Rs, 2,00,000/- from The New India Assurance Company Ltd., o.ps. no. 1 & 2 through the G.T.F.S.
While the policy was in force on 07-07-2007 he met with a road accident and died a premature death on 07-07-2007. The complainant Smt. Lakshmi Mondal, an uneducated village house wife, informed of the accident to the o.ps. in course of time. The o.p. issued her a letter vide No. 5/1/512200/JPA//SPG/2007 dated 31-07-2007 and acknowledging her and asked her to return the enclosed claim form duly completed and signed together with some papers / documents in original. However, the complainant submitted the same with the o.ps. after duly filled in. That in spite of her repeated representations and pursuance she did not get the claim as yet and the settlement of the claim is still pending with her. Hence the complaint.
O.p. no. 3, G.T.F.S. has been impleaded in this case and there is no allegation or claim against them. However, o.p. no. 3 filed written version supporting the claim of the complainant contending interalia that according to the MOU between the GTFS and the insurance company the JPA policies including the instant policy were issued. The deceased policy holder was their field worker who also obtained the policy and after accidental death of the said policy holder his wife / nominee submitted the claim which was duly forwarded to the insurance company.
It has also been contended by the o.p. no. 3, G.T.F.S., that the insurance company cancelled the MOU and the long term JPA policy and as such two writ petitions were filed before the Hon’ble High Court at Calcutta. Subsequently by an order of the Hon’ble High Court at Calcutta amongst the aforesaid categories , the category of friend was omitted and the o.p. no. 3 was allowed to extent such insurance to the category of field workers and investors as stated under the said group insurance scheme.
It is further stated that under the said MOU the o.p. no. 3 was also obliged to collect premium from the insured person /persons concerned and remit the same to the o.p. no. 1 by a consolidated cheque with a list of insured persons. Apart from that there had been no other liability to be borne by the o.p. no. 3. So the o.ps. no. 1 and 2 will be solely and directly responsible in case of claim contingent upon death, disability, injury, hospitalization of the insured person subject to terms, conditions warrantly any exclusion of the policy concerned. It is further stated that the husband of the complainant was one of such field worker of the o.p. no. 3 who was favoured with such extension of coverage under the Group Janata Personal Accident Policy by the o.p. no. 1. In support of the contention the o.p. no. 3 also produced a Xerox copy of said premium particulars along with list of insured persons including the insured Ashoke Mondal ( since deceased ) which was forwarded to the o.p. no. 1 the insurance company dated 23-08-1999 which duly marked exhibit letter A. So it is submitted that latches and / or lapses and /or deficiency in service on the part of o.p. no. 3 for non settlement of the claim of the complainant.
On the other hand it appears that the o.ps. no. 1 & 2 have accepted the premium through o.p. no. 3 and issued policy in favour of the deceased Ashoke Mondal covering the period from 23-08-1999 to 22-08-2014.
The New India Assurance Company , o.p. nos. 1 & 2 entered appearance in this case through their authorized lawyer who did not file any written version despite repeated directions and opportunities given to him. On the contrary the ld. Advocate for the insurance company filed his objection raising question of status of the insured person but that objection cannot be tenable when the o.p. no. 3 specifically stated in written version supported by an affidavit that the deceased was a field worker and the deceased was allowed to continue the policy till the death by accepting the premium. However, as insurance company o.ps. no. 1 & 2 did not participate at the hearing of the case but filed written version at the initial stage supported by an affidavit. But there is no cogent materials on record to show that the deceased was not a field worker of the o.p. no. 3. It is evident that the deceased Ashoke Mondal obtained policy from the o.ps. no. 1 & 2 through G.T.F.S. and policy was in force till his accidental death occurred on 07-07-2007.
In view of the pleadings of the parties following question arose for determination :
Have the o.ps. no. 1 & 2 committed deficiency in service by not settling the
insurance claim ?
Is the complainant entitled to get any order in terms of Section 14 of the C. P. Act, 1986 ?
DECISION WITH REASONS :
Both the points are taken up together for the sake of convenience of discussion and for brevity.
It appears from the record that the deceased Ashoke Mondal being field worker of GTFS, o.p. no.3, obtained the JPA policy in question on 23-08-1999 through the GTFS. On 07-07-2007 he was dashed by a train and died on spot. One U.D. Case was started by the G.R.P.F. as a matter of formalities and after investigation the final report was submitted on the basis of post mortem report.
It also appears from the record that the complainant submitted all relevant documents along with claim form claiming the assured amount. But the insurance company, o.ps. no. 1 & 2, did not settle the matter. On the contrary o.p. no. 2 claimed the status of the deceased policy holder as a field worker. But the o.p. no. 3 has stated that the deceased was a field worker under them and in support of their contention they also filed written version supported by an affidavit.
It further appears from the record that the complainant produced all the documents through the G.T.F.S. which also confirmed that the deceased policy holder was their field worker and but in spite of production of all those documents the insurance company did not consider the claim.
There is nothing to show on record that the contention of the o.ps. no. 1 & 2 is not tenable and in fact the JPA policy in question was in force at the time of accidental death of the deceased policy holder. So the insurance company shall have no claim to be escaped from their own liability in terms of the policy condition.
Now turning to the merit of the case the Forum is of the view that the complainant being nominee of the deceased policy holder is entitled to get the sum of Rs. 2,00,000/- in terms of the policy condition. She is also entitled to get reasonable compensation as the insurance company, o.ps. no. 1 & 2 caused harassment to the complainant by not settling the claim within a reasonable time.
Points under consideration are accordingly decided.
In result the application succeeds.
Hence,
O R D E R E D
That the consumer complaint case is allowed on contest against o.ps. no. 1 & 2 with cost assessed Rs. 1,000/- and dismissed against o.p. no. 3, G.T.F.S. without cost.
That the complainant shall get an award of compensation of Rs. 2,00,000/- on account of assured sum of the JPA Policy in question.
That the complainant shall also get an award of compensation of Rs. 5,000/- against o.ps. no. 1 & 2, insurance company, on account of causing harassment and mental agony.
That the o.ps. no. 1 & 2, insurance company, are jointly and severally liable to comply with this order and they are directed to pay the aforesaid amount of compensation and cost to the complainant within 30 days hereof in default the said amount shall bear further interest @ 12% per annum from the date of this order till the payment or recovery.
Supply the copy of the order to the parties, free of costs.
