State Consumer Disputes Redressal CommissionThe New India Assurance Company Ltd vs Maya Banerjee on 8 March, 2013State Consumer Disputes Redressal Commission
  
 
 







 



 

State Consumer Disputes Redressal Commission

 

 West Bengal 

 

BHABANI BHAVAN
(GROUND FLOOR)

 

31,   BELVEDERE ROAD,
ALIPORE

 

KOLKATA  700 027

 

  

 

SC.CASE NO. : FA/377/12 

 

  

 

(Arisen out of Order
Dated 24.05.2012 in Case No. CC/98/2011 of District Consumer Disputes Redressal
Forum Howrah )  

 

  

 

  

 

  

 

DATE OF FILING : 06.07.12  DATE
OF FINAL ORDER: 08.03.13 

   

 

APPELLANTS : 1. The New India Assurance Company Ltd.

 


Howrah Branch, Unit No. 512200, 

 


Madhusudan Apartment, P-18, Dobson 

 


Lane, 2nd Floor, P.S. Golabari, 

 

 Dist-Howrah.

 

  

 

2.     
The Divisional Manager, 

 

The New India
Assurance Company Ltd.

 

Howrah
Branch, Madhusudan Apartment, P-18, Dobson Lane,

 

2nd
Floor, Howrah-1. 

 

  

 

  

 

RESPONDENTS : : 1.
Maya Banerjee,

 


9/C, Manasatala Lane,

 


P.O. Mahesh, P.S. Serampore,

 

 Dist- Hooghly,

 

  

 

2.       
The Golden Trust Financial Services,

 

16, R.N.
Mukherjee Road, 

 

Kolkata- 700
001. 

 

  

 

BEFORE : MEMBER : MR. S. COARI  

 

 MEMBER :
MR. D.BHATTACHARYA 

 

FOR THE APPELLANTS: Mr. Pralay Kar, Ld. Advocate.  

 

FOR THE RESPONDENTS .: Mr. Bibhas
Mondal, Ld. Advocate . 

 


Mr. Abhik Dutt, Ld.
Advocate . 

 



 

  



 

  

 

: O R D E R :MR. D.BHATTACHARYA, Ld. Member 

 

   

 

   

 

Being aggrieved by and dissatisfied with the final order
dated 24.05.2012 in Case No. 98/2011 as passed by the Ld. District Forum,
Howrah, the O.P. Nos. 1 & 2 thereof have preferred this appeal.It is the case of the Complainant/Respondent
No.1 in her petition of complaint is that her son, Tapan Banerjee secured a
Group Janata Personal Accident Insurance Policy from the O.P. No.1 through the
Proforma O.P. No.3 (GTFS) and she was made a nominee in the said policy, being
policy no. 4751220001799 /E. No. 4730861, covering a period from 23.06.2000 to
22.06.2015, of an amount of Rs.1,00,000/-. The role of the GTFS is merely a
facilitator having no authority to settle and/or to decide any claim, who has
rendered its service to the Complainant satisfactorily and the Complainant has
no grievance against it. Said son of the Complainant along with others proceeded
from Bandel, Hooghly towards Medinipur on 08.03.2009 along NH6 by a Tata Indica
Car bearing No. WB-16T9860 which suddenly dashed a lorry from behind near Jiandabazar
within Panskura P.S., for which 04 persons including the son of the Complainant
died on the spot and 02 others were severely injured, which was reported by one
Ashok Mallick being the husband of one of the deceased persons, namely, Susmita
Mallick to the O.C., Panskura P.S., Medinipur (East) on 08.03.2009 upon which Panskura
P.S. Case No. 57/09, u/s 279/338/304A/427,IPC, was registered. The fact of such
unfortunate incident was intimated to the O.P. Nos. 1 and 2 on 20.04.2009 by
the Complainant and the O.P. No.2 vide letter dated 09.06.2009 requested the
Complainant to fill up a claim form annexed therewith and to return the same
along with certain documents, which was submitted on 15.07.2009. As there was
no response from the end of the O.P. Nos. 1 and 2, the Complainant made several
representations dated 17.08.2009 and 14.02.2011 requesting to settle her claim.
Thereafter, the O.P. No.2 vide letter dated 15.02.2011 requested the
Complainant to submit a copy of the appointment letter or ID Card of Fieldworker
of her deceased son, which was replied on 29.03.2011, but the Complainant did
not get any response. It is also contended that the letter dated 15.02.2011 by
the O.P. Insurance Company was made mechanically and with pre-conceived notion without considering the
claim in accordance with the law. Accordingly, the O.P. Nos. 1 and 2 are
negligent and deficient in their service. So, the Complaint case.On the other hand, the case of the
O.P. Nos. 1 &2/Appellants in their W.V. is that the O.P. No.3 (GTFS) is a
partnership firm and the main activities of such firm is to mobile fund on the
behalf of the Unit Trust of India, State Bank of India Mutual Funds, etc., and
has its own field personnel for its business and to increase its business it
had decided to cover its employees and/or fieldworkers under insurance coverage, rather to offer an
incentive to its investors the benefit of insurance coverage under two heads,
Mediclaim and Janata Personal Accident Policy
of New India Assurance Co. Ltd. Accordingly, in the year 1998, two
memorandum of understanding (MOU) were
executed between the GTFS and the O.P. Insurance Company, one on 29.07.1998 for
mediclaim policies and another on 30.12.1998 for personal accident. In these
Group Policies, the Insurer was the New India Assurance Co. Ltd. and the
insured was the GTFS and the beneficiry was the employee/ fieldworker/investor
of the GTFS. Under the Group Janata
Personal Accident Policy, the sum insured varied from Rs.50,000/- to Rs.10,00,000/-
and the periods of coverage were 1,3,5,7,9,10,12,14 and 15 years. Under the
said MOU, the investors and their family members, field workers and their
family members and their friends were given and/or extended insurance coverage
by the New India Assurance Co. Ltd. Under Clause (2) of the MOU, the GTFS would
collect the premium and remit the same to the Insurance Company periodically
and the New India Assurance Co. Ltd.shall issue a computerized certificate in the name of each such person.
Against the cancellation of the MOU by a letter dated 07.05.1999, the GTFS
moved a writ petition being W.P. No. 1144 of 1999 in which after hearing the
submission made by the respective party, the Honble High Court inter alia
directed the GTFS to collect premium from its field workers, investors and
their family members but not from friend category. In the instant case, the certificate as to the
status of fieldworker of the deceased son of the Complainant issued by GTFS was
not accepted as the same is a manufactured document and issued long after his death
and as such it is an afterthought. As neither the Complainant nor the GTFS
could provide any such document in support of the status of the deceased son as
again called for by letter dated
15.02.2011, the claim could not be settled. Accordingly, they have prayed for
dismissal of the complaint.It is to be considered if the
impugned order suffers from any anomaly or incongruity so as to reverse the
same in this appeal, or not.Decision with reasons.Ld. Advocate for the Appellants has submitted
that the document in respect of the deceased son of the Complainant as Fieldworker
is absolutely an afterthought document and that admittedly the GTFS does not
keep any records regarding the same. Further, he made out that no original
documents as called for from the Complainant by the Insurance Company by the
letter dated 09.06.2009 have been supplied. He has also referred both to the certificate
of the GTFS dated 11.07.2009 and the letter dated 24.03.2011 of the Complainant
to the GTFS, where she had made out that she failed to understand of
non-issuance of the Fieldworker Certificate earlier and as to why the legitimate claimant will suffer both
financially as well as mentally due to such reason and for the arrangement between the GTFS and the
Insurance Company. He made out that the GTFS cannot shrug off its
responsibility and liability in the matter and that the policy concerned is not
an individual policy but Group Policy, namely, Group Janata Policy and the insurance
certificates were issued on good faith. He has referred to a judgment of the
Honble Calcutta High Court in this respect in MAT 1054 of 2012 with CAN 6127
of 2012, in the case of New India Assurance Co. Ltd. & Ors. Vs. Pawan Kumar
Joshi & Anr.Ld. Advocate for the Respondent No.1
has submitted that the requirement of identity proof of the insured person
should have been called for at the initial stage and not at the time of
contingency on the happening of an accident of the insured person and it was
the bounden duty of the Insurance Company to clear it at the threshold. It is a
contractual obligation of the Insurance Company which it can not avoid. The dispute,
if any, is between the insurance company and the GTFS. Accidental death of the
insured person is undisputed.Ld. Advocate for the Respondent No. 2has submitted that the settlement of the claim should have been done by the
Insurance Company on the basis of the policy conditions. The MOU was undertaken
for the benefit of un-employed or semi-unemployed persons. The schedules sent
by it have been accepted by the Insurance Company and the onus lies upon the
Insurance Company to settle the claim normally. He has referred to certain
decisions of the Honble Calcutta High Court in this regard, namely, in W.P.
No. 17808 (W) of 2004 and W.P. No. 13359(W) of 2008 along with M.A.T. 918 of 2010
with C.A.N. 6418 of 2010 in which the purported finding is that as the
insurance company, namely, New India Assurance Co. Ltd. had given the
certificate after being satisfied with the proposal and declarations submitted
to the company, such query in the letter issued to the GTFS is uncalled for
and that once certificate has been issued by the said Insurance Company as per
the proposal and declarations submitted to the company, it can not be
reopened.It was the first and foremost duty of
the said Insurance Company to go through all the documents before issuing
and/or distributing the individual policy certificates in the name of the
insured persons under the Group Insurance Policy. This is a fanciful effort of
the Insurance Company to dislodge the claim of the insured person or its
nominee only after a contingency happened and a claim has been preferred. It
has been rightly held by the Ld. District Forum that the conduct of the O.P.s 1
and 2 in demanding the appointment letter or I.D. Card of the deceased insured
after lapse of two years vide their letter dated 15.02.2011 is not proper and
befitting. It is found that the concerned policy was issued on 23.06.2000,
while the first letter calling for the documents has been issued by the
Insurance Company on 09.06.2009, say about 09 year hence. It cannot be demanded
on its whims just to unsettle the claim of a hapless person. It cannot be
supported after lapse of so many years. It does only demean the stature and
conduct of the institution of the said insurance company. The decision referred
by the Ld. Advocate for the Appellant is not in rem. There is found to be no
kind of any inconsistency in the finding and order of the Ld. District Forum
and the same is upheld.Hence, 

 

 Ordered 

 

  

 

that the appeal be and the same is dismissed
on contest against the Respondents but without cost. The impugned order is
hereby affirmed.MR. D.BHATTACHARYA   MR. S. COARI 

 

 MEMBER   MEMBER