DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
PASCHIM MEDINIPUR.
Complaint case No. 66/2009 Date of disposal: 13/11//2009
BEFORE : THE HON’BLE PRESIDENT : Mr. P. K. Sarkar.
MEMBER : Mr. S. Pal.
MEMBER : Smt. J. Sarkar. For the Complainant/Petitioner/Plaintiff: Mr. B. K. Pratihar.
For the Defendant/O.P.S. : Mr. M.K. Chowdhury & Mr. S. Bhattacharya.
(1) Smt. Shila Das, D/o-Late Anil Kumar Das of Kaushallya (near D.H.M.S. College), Town & P.O.-Kharagpur, Dist Paschim Medinipur………….Complainant.
Vs.
1) M/S-Golden Trust Financial Service, at 16-R. N. Mukherjee Road, Kolkata-700001.
2) M/S-Golden Trust Financial Service, branch office at Bat tala Chak, Town & P.O.-Midnapore, P.S.-Kotwali, Dist. Paschim Medinipur.
3) The New India Assurance Co. Ltd., at Kolkata Divisional office, Unit-51700, 4, Mangoe Lane, 2nd Floor, Kolkata-700001…………………………..Ops. The facts of the case, in brief, is as follows :-
The deceased husband of the complainant late Anil Kumar Das took a Janata Personal Accident Insurance Policy from the New India Assurance Co. Ltd., through their corporate agent M/S-GTFS for an assured sum of Rs.100,000/- (one lakh only) and during the validity of such policy insured Anil Kumar Das died in a rail accident occurred near the Jakpur Railway Station within the Kharagpur Police Station on 05/09/2006. The complainant being the nominee of the insurance policy, submitted her claim for the assured sum of Rs.100,000/- under the insurance policy for the accidental death of her husband, the insured, to the Op. no.3, but the Op. no.3 failed to settle the claim of the complainant in spite of her repeated demands for the same. As such, the complainant filed this complaint against the Ops with prayer for issuance direction upon the Ops to pay the assured sum of Rs.100,000/- under the JPA Insurance policy issued by them in favour of her deceased husband and to pay consumption for their deficiency in service as well as the litigation cost.
The Op New India Insurance Co. Ltd., contested the case by filing their W/O contending interalia, that they could not settle the claim of the complainant as neither the
Contd………….P/2
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complainant nor the GTFS, their corporate agent, submitted documentary evidence regarding the status of the insured as asked for by them.; and that the status of the insured must be ascertained to settle the claim of the complainant as the corporate agent, the GTFS, was directed not to collect subscriptions from the category of friends by the Hon’ble High Court vide its order dated 06/07/1999 in writ petition no.1144 of 1999 filed by them. The Op, New India Assurance Co. Ltd. further contended that in pursuant to the policy decisions of their parent body , the GIC, they cancelled all the long term J.P.A. Policy more then 5 yrs. and for more than Rs.1,00,000/- by their circular dated 01/08/2000, by invoking clause no. 5 of the terms and conditions of such policies; and that although the Hon’ble High Court stayed the operation of said circular dated 01/08/2002 in W.P. no. 2343 of 2002 filed by the G.T.F.S., subsequently the Hon’ble High Court disposed of the writ petition, vacating all interim orders passed earlier vide its order dated 16/03/06 and as such the J.P.A. policy in question for a period of 15 yrs. became nonest. Accordingly, the Op-Insurance Co. submitted that there was no deficiency in service on their part as alleged, for not setting the claim of the complainant for the accidental death of her husband and as such the complaint filed against them is liable to be dismissed.
The Op. nos.1&2, the G.T.F.S. also filed their W/O contending interalia, that the complainant’s husband Anil Kumar Das since deceased, being their filed worker, obtained JPA Insurance policy of the New India Assurance Co. Ltd. through them on payment of requisite premium for an assured sum of Rs.100,000/- for the period from 15/01/2001 to 14/01/2016 as per MOU executed by them with the Insurance Co. on 30/12/1998; and that, besides collection of premiums from the proposers of the specified categories they had no other liability in the matter of the JPA policies issued by the New India Assurance Co. Ltd. as per terms and conditions mentioned therein; and that they have duly forwarded the claim of the complainant for the accidental death of her husband, the insured, but the insurance company failed to settle the claim of the complainant in spite of several requests and representations made by her which amounted to gross deficiency in service on the part of the Insurance Co. The Op. nos. 1&2 pointed out that there was little justification of the Insurance Co. to ask for submission of the identity card of the insured person after issuance of Insurance policy in question, to settle the claim of the complainant under the policy.
The points for decisions are :
1) Whether the complainant is a consumer within the meaning of the section 2 (i) (d) (ii) of the C.P. Act, 1986 ?
2) Whether the Ops. are deficient in service within the meaning of section 2 (1)(g) read with section 2(1)(0) of the C. P. Act, 1986 ?
Contd………….P/3
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1) Whether the complainant is entitled to get the reliefs as sought for ?
Decisions with reasons :
Point No. 1.
It is not disputed that the Op-New India Assurance Co. Ltd. issued JPA, Insurance policy no.4751170000001 in favour of G.T.F.S. covering the life of one Anil Kumar Das for an assured sum of Rs.100,000/- for the period from 15/01/2001 to 14/01/2016 and prior to that a MOU was signed on 30/12/1998 by and between the Op-New India Assurance Co. Ltd. and the Op. no.1, GTFS for issuance of such JPA policy covering the latter’s field workers and their family members as well as their invertors and their family members. It is also not disputed that the beneficiary Anil Kumar Das died on 05/08/06 in a rail accident and the complainant being the nominee of the JPA Insurance policy of her husband Anil Kumar Das, submitted her claim for the assured sum before the Insurance company but Insurance Co. failed to settle the claim in spite of repeated requests by her. So, the complainant filed this case against the Insurance Company alleging deficiency in service on their part for the non-settlement of her claim under the policy of her husband. So there is no doubt that the complainant was a consumer within the meaning of the section 2 (1) (d) (ii) of the C.P. Act, 1986 read with the section 2(1)(g) and 2(1)(o) of the Act.
Point Nos. 2.& 3.
Under the MOU dated 30/12/1998 (Exhibit A/1) executed by and between the Insurance Co. and the GTFS, the Op. no.3, the Insurance Co. agreed to allow GTFS to collect subscriptions for the JPA Insurance policy from their field workers and their family members, investors and their family members and their friends. The Op-Insurance Co. asserted in their w/o that by their letter dated 07/05/1999 they informed the GTFS that the MOU signed on 30/12/98 stood cancelled in view of change of their policy regarding issuance of JPA policy which however, was challenged by the GTFS before Hon’ble High Court by filing the W.P. no. 1144/99 and the Hon’ble High Court was pleased to pass an interim order on 06/07/1999 restraining the GTFS from collecting subscriptions from the category of friends from the date of such order.. The GTFS Op. no.1 asserted in their w/o that they collected the premium for the JPA policy from their field worker Anil Kumar Das since deceased and on receipt of such premium along with the proposal through them, the Op Insurance Co. issued the JPA policy in
favour of the said Anil Kumar Das for an assured sum of Rs.100,000/- for the period from 15/01/2001 to 14/01/2016. According to the Op-Insurance Co., the claim of the complainant, the nominee of the beneficiary/insured since deceased, could not be settled as neither the GTFS nor
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the complainant submitted documents regarding the status of insured as asked by them. It may be noted that, though the insurance co. revoked the MOU executed by them with the GTFS earlier by their letter dt.07/05/99, admittedly the Hon’ble High Court stayed the operation of the letter but restrained the GTFS form collecting the subscriptions from the category of friends only. According to the submission of the Op.no.1- GTFS, the deceased husband of the complainant was their field worker. So in view of the change of their policy and order of the Hon’ble High Court dt.06/07/1999 restraining the GTFS from collecting subscriptions from the category of friends, the insurance co. must have issued the JPA policy in question after verifying the antecedents of the beneficiary/insured. As such, there was little justification for the insurance co. to ask the GTFS or the Complainant to submit the documentary evidence regarding the status of the insured to settle the claim of the complainant, without procuring any evidence to the effect that the insured was not the field worker of the GTFS as contended by them. So it must be held that the Op-Insurance co. was deficient in service for not settling the claim of the complainant and as such they are not only liable to pay the assured sum of Rs. 100,000/- with interest but also liable to pay adequate compensation for their deficiency in service for not settling the claim of the complainant within the reasonable time of submission of such claim.
Hence,
Ordered,
that the complaint be allowed on contest. The Op. New India Assurance Co. Ltd is directed to pay the assured sum of Rs.100,000/- (Rupees one lakh only) to the complainant, the nominee of the JPA policy no.4751170000001, with interest thereon at the rate of 9% p.a. from the date of filing the claim till payment. The Op. New India Assurance Co. Ltd is further directed to pay Rs.5,000/- to the complainant towards compensation for their deficiency in service and litigation cost incurred by the complainant. The payment as per above order should be made within one month from the date of communication of this order failing which the amount due shall carry interest at the rate of 12% p.a. from the date of filing the claim till payment.
Let the copies of this order be supplied to the contesting parties free of cost.
Dic. & Corrected by me
I agree I agree
President Member Member President
District Forum
Paschim Medinipur.