State Consumer Disputes Redressal Commission
The New India Assurance Company vs Sugiya Devi on 17 January, 2014
State Consumer Disputes Redressal Commission State Consumer Disputes Redressal Commission West Bengal 11A, MIRZA GHALIB STREET, KOLKATA 700 087 S.C. CASE NO FA/648/12 (Arisen out of Order Dated 08/08/12 in Case No. CC/123/2009 of District Burdwan) DATE OF FILING :21.09.12 DATE OF ORDER:
17.01.2014 APPELLANTS : 1. The New India Assurance Company, Howrah Branch Unit No. 512200, Madhusudan Apartment, P-18, Dobson Lane, 2nd Floor, Howrah-
711101 and its branch unit
2. The New India Assurance Company, Asansol Branch, Asansol East, Ghati Bhaban, 173, G.T. Road.
RESPONDENTS : 1.
Sugiya Devi, Wife of late Goutam Keyat of Bahula Colony, Jambad, P.O. Bahula, P.S. Andal, District- Burdwan.
.. Respondent/Complainant
2. Golden Trust Financial Services, 16, R.N. Mukherjee Road, Kolkata- 700 001, Service thorough Divisional Manager
3. Golden Trust Financial Society, Assansol Branch Office, Asansol G.T. Road, Ushagram, Asansol, Durgamandir .. Proforma Respondents/ OPs BEFORE HONBLE MEMBER : Sri Debasis Bhattacharya.
HONBLE MEMBER : Sri Jagannath Bag.
FOR THE APPELLANTS : Mr. Pralay Kar, Ld. Advocate FOR THE RESPONDENTS : Mr. Apurba Ghosh, Ld. Advocate Mr. Abhik Dutt, Ld. Advocate Sri Debasis Bhattacharya , Member Being aggrieved by and dissatisfied with the judgment , dated 08.08.2012 passed by the Ld. District Forum, Burdwan in Case No. 123/2009, the OP Nos. 1 & 2 thereof have preferred this appeal.
By the impugned judgment, the complaint has been allowed on contest , and the Insurance Company has been directed to pay the sum assured of Rs. 3,00,000/- along with interest @ 8% p.a. from the date of filing the complaint till actual payment of the entire amount and also to pay a sum of Rs. 5,000/- towards compensation and Rs. 2,000/- for litigation cost.
The case of the Complainant is that her deceased husband , Goutam Keyat during his lifetime was working as an Agent of the Proforma OP in its Asansol Branch and got himself insured by the OP No.2 for the period from 15.06.2000 to 14.06.2015 of a sum of Rs. 3,00,000/- , and the Complainant was made nominee thereof, being policy No. 4751220001799 / E.No.47-30852. He met with an accident while returning to his house in a trekkar on 17.04.2005 at about 00.30 hours, on Bahula Paraskole Road and died on the spot. As the death was accidental in nature, the concerned Andal P.S. registered the FIR u/s 279/304A , IPC . The Complainant appeared before Proforma OP No.2 for settlement of her claim, who provided her a claim form and she sent all connected papers to the OP as per the demand and direction of the proforma OP. As the claim was not settled , she sent a letter to the OP No.1 on 14.02.2009 to settle up her claim , but with no effect. So, the case.
On the other hand , the case of the OP Insurance Company is mainly that the Complainant has not submitted any proper claim along with required papers and documents and also regarding employment of the insured. Further, surprisingly enough, the principal insured , GTFS did not submit any statutory documents/evidence of the insureds working as an Agent of the GTFS . Lastly, it prayed rejection of the complaint.
Further, the case of the Proforma OPs is that they worked as facilitator to extend the cover of Janata Personal Accident Policy under Group Insurance Scheme to their Fieldworkers and their family members and upon collecting the requisite premium would remit the same to the OP No.1 who having been satisfied would accept the same and used to issue certificate of policy , and the husband of the Complainant was one of such Fieldworkers of the Proforma OP No. 1, who was favoured with such coverage. The Proforma OP No.1 vide their letter dated 10.05.2005 , 31.12.2005, 13.01.2007, 05.02.2008 and 07.02.2009 forwarded the claim papers/ documents to the OP No.1 as were submitted to them by the Complainant. The OP No.1 vide their letter dated 20.12.2005 asked the Proforma OP No.1 regarding status of the deceased insured person, and by their letter dated 31.12.2005, the proforma OP No. 1 confirmed that the deceased insured person was their Fieldworker. Accordingly, it prayed dismissal of the case against them, or deletion .
It is to be seen and considered if the impugned judgment suffers from any kind of anomaly so as to negate the same.
Decision with Reasons Ld. Advocate for the Appellants has submitted that there is an apparent difference in the cause titles of the petition of complaint and the judgment, and there has been non-application of mind as such in formulating the judgment by the Ld. District Forum . Though the Complainant admitted in her petition of complaint that her husband was working as an Agent of GTFS , no document has been filed either by the Complainant or the GTFS in substantiation ; even though the gentle lady could not produce any document , it has been incumbent upon the GTFS to produce the same. At the time of settlement of claim , necessary document is required. Further, the P. M. report is not complete and the cause of death could not be ascertained. If the benefit is to be extended, the term accidental is to be proved , which is not done, and the same is not the version of the Insurance Company, but of the I.O. of the police case.
Ld. Advocate for the Respondent No. 1 has submitted that the claim of the Complainant is a bonafide one. She has filed all the documents to the corporate agent or franchisee of the insurance company, namely, GTFS . There is no case of the insurance company before the Ld. District Forum that the death did not take place out of an accident, or it was not an accidental death. So, it is barred by estoppel in this matter. It was a clear case of death for rash and negligent driving on the part of the offending vehicles driver, and not a case of taking of liquor, for which chemical report would be of no value and necessity , and in fact the police has submitted a charge sheet u/s 279/304A/427 , IPC . So, there has been gross negligence of service on the part of the Insurance Company. The insurance company also neither admitted the case nor repudiated the same.
Ld. Advocate for the Respondent Nos 2 and 3 has submitted that the claim form was sent to the insurance company with certain relevant documents . Accident is a fact , what is proved absolutely. The Fieldworker is the main grade, according to seniority . It was incumbent upon the Insurance Company to call for the I.Card at the initiation , otherwise it could have been void ab initio . By way of consent and conduct, the insurance was granted . After all , the Insurance Company merrily swallowed the premiums, and such proposition is uncalled for and unwarranted . He has relied upon the decision of the Honble Calcutta High Court in W.P. No. 17808 (W) /2004 and W.P No. 13359 (W) /2008 along with M.A.T. No. 918 /2010 /C.A.N. No. 6418 /2010 .
It has been stated by the Complainant in the petition of complaint that her husband was an Agent of the GTFS , while it is the categorical position of the GTFS that he was one of their Fieldworkers. The Complainant lady is found to be an illiterate one. The work of her husband in GTFS was admitted by both such sides, but as said by the Ld. Advocate for the GTFS / Respondent Nos. 2 & 3 that actually the work done by him is that of a Fieldworker and there is no such position of Agent. In view of the policy granted by the Insurance Company in favour of her husband , in absence of any contrary evidence, he is deemed to be a Fieldworker of the GTFS . As regards the accidental death, no objection has been put specifically in this regard in the W.V. But, the particulars of the case and the investigation of the police very much make out that the instant death of the husband of the Complainant is an accidental death. The insurance company did neither accepted the claim nor repudiated the same, which tentamounts to some extent a deficiency in service. There is found to be hardly any flaw in the impugned judgment, except for the wrongness /typographical mistake of the cause title, which does not hit the merit of the case. In view of the facts and circumstances of the case, the Ld. District Forum has rightly allowed the case in favour of the Complainant as against the Insurance Company. There is nothing to disturb the same.
In the result , the appeals fails.
Hence, Ordered The appeal be and the same is dismissed on contest but without any order as to costs. The impugned judgment is hereby affirmed.
Let a copy of this judgment along with the LCR be forwarded to the Ld. District Forum forthwith.
Sri Jagannath Bag. Sri Debasis Bhattacharya.
(Member) (Member)