State Consumer Disputes Redressal Commission
Smt. Sandhya Roy vs The Manager, The New India Assurance Co. ... on 8 September, 2017
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION WEST BENGAL 11A, Mirza Ghalib Street, Kolkata - 700087 First Appeal No. A/432/2016 (Arisen out of Order Dated 24/07/2015 in Case No. Complaint Case No. CC/71/2014 of District Cooch Behar) 1. Smt. Sandhya Roy W/o Lt. Kamal Chandra Roy, Vill. & P.O. - Borodanga, P.S. Kotowali, Dist. Cooch Behar. ...........Appellant(s) Versus 1. The Manager, The New India Assurance Co. Ltd. Siliguri Division, Malhotra Tower, Pradhan Nagar, Hill-Cart Road, Siliguri, Dist.Darjeeling, Pin- 734 403. 2. The Br. Golden Trust Financial Services Cooch Behar Br., Terangi More(near Girls Hostel), Bangchatra Road, P.S. Kotowali, P.O. & Dist. Cooch Behar, Pin-736 101. ...........Respondent(s) BEFORE: HON'BLE MR. SHYAMAL GUPTA PRESIDING MEMBER HON'BLE MR. UTPAL KUMAR BHATTACHARYA MEMBER For the Appellant: Ms. Suman Sehanabis, Advocate For the Respondent: Mr. Sandip Ghosh., Advocate Dated : 08 Sep 2017 Final Order / Judgement Sri Utpal Kumar Bhattacharya, Member
With the instant complaint under section 15 of the C P Act, 1986, the Appellant/Complainant challenged the judgment and order dated 24/07/2015 passed by the Ld. District Forum in Complaint Case No. DF-71/2014 dismissing the complaint on contest against the opposite parties without cost.
The facts of the case, in a nutshell, are that the deceased Kamal Chandra Roy, an ex employee in Gitaldaha 2 G P in the post of "Karmee" and husband of the Appellant /complainant took one Group Janata Personal Insurance Policy under Policy No.(S) 512310/47/01/02206 from the New India Assurance Company Limited, the Respondent/OP No. 1, in the year 2002 through Respondent/OP No.2, that is, Golden Trust Finance Services, Cooch Behar Branch, Cooch Behar. The said policy of an assured sum of Rs 5,00,000/-was valid for a period from 31/03/2002 to 30/03/2017.
The said deceased, on 25/02/2013 while returning from Vataguri by the Motor bike met with an accident at about 10 PM. The deceased had undergone treatment in different phases at different hospital including MJN Hospital at Coochbehar and Anandaloke hospital and Neurosciences Centre, Sevoke Road, Siliguri but all efforts proved futile when the patient ultimately died on 27/03/2013 at MJN Hospital, Cooch Behar. P.M. was duly done at the MJN Hospital, Cooch Behar. The report in respect of the said P.M. was submitted under P.M. Report No. 146/2013 dated 27/03/2013 and on the basis of a report of the said accidental death, the Dinhata P.S. had initiated a G.R. Case No. 313/2013.
The Appellant/Complainant, thereafter, submitted a claim of accidental death benefit to the tune of Rs.5,00,000/-before the Respondent/OP No. 1 with all relevant papers but, did not get any response from the Respondent/OP No.1 till date. The Appellant/Complainant made several correspondences to Respondents/OPs in her effort to get an expeditious settlement of her claims. All her efforts being gone in vain, the aggrieved appellant/complainant filed the Complaint Case before the Ld. District Forum. The impugned judgment and order arose out of the said complaint.
Heard Ld. Advocates appearing on behalf of Appellant/Complainant and Respondent/OP No. 1.
Ld. Advocate appearing on behalf of the Appellant/Complainant submitted that the Golden Trust Financial Services, being the Principal Insured and Respondent/OP No.2 was supposed to cover the investors, the family members, field workers and their friends as per MOU entered into by it with the Respondent/OP No.1 The Respondent/OP No.2, as submitted, used to collect premium from the persons insured and remit the same to the Respondent/OP No.1. They also used to issue one computerized certificate to each of the insured.
The Ld. Advocate went on to submit that the Respondent/OP No.1's subsequent effort in terms of the guidance of its parent bodies for cancellation of the MOU with the Respondent/OP No. 2, was challenged by the Respondent/OP No.2 in Hon'ble High Court, Calcutta. Hon'ble High Court, Calcutta stayed the cancellation of MOU and at the same time restricted the Respondent/OP no. 2 from collecting the premium from "friends" categories.
As submitted, the Respondent/OP No. 1 claimed that the deceased was not entitled to any insurance benefit because of his non-eligibility to be considered as field worker under Respondent/OP No. 2 in view of the fact that the deceased was a "Karmee" under Gitaldaha 2 GP when the facts remained that the "Karmees" were casual workers with no definite pay scale and they received salary in muster Rolls.
The Ld. Advocate went on to submit that the sequence of events led us to believe that the Appellant/Complainant was entitled to the insurance benefit but, the point of issue was who was going to extend the same-- the Respondent/OP No. 1 or the Respondent/OP no 2.
With the above submission, the Ld. Advocate for the Appellant/Complainant prayed for the Appeal to be allowed setting aside the impugned judgment and order.
The Ld. Advocate appearing on behalf of the Respondent/OP No 1 submitted that the deceased was an employee as "Karmee" under Gitaldaha 2 GP and was receiving a salary out of the State Government's exchequer in regular pay scale. The deceased, therefore, was never a field worker as was claimed by the Appellant/Complainant and was accordingly, not entitled to get any compensation under the scheme.
None appeared on behalf of Respondent/OP No. 2.
Perused the papers on record. It appears that the groups of people to be covered under the Group Janata Personal accident policy are well illustrated in the policy. Field workers' group, which the deceased was claimed to have belonged to at the material point of time, was one of the said groups to be covered under the policy. Needless to mention that there should be no contention to the uncontroverted facts that the period of incident was well under the coverage of the policy.
The sole and cardinal point to be decided in this context is the fact of the deceased's belonging to the field worker category as has been claimed in the complaint.
It further appeared from the record that the deceased policy holder was a G P Karmee and the said contention was disputed nowhere in the proceedings. The Ld. Advocate appearing on behalf of the Appellant/Complainant disputed only on the point that the G P Karmee did not belong to regular employee under the Government. As submitted, they were casual employees and were receiving salary on the Muster Roll.
We have perused the record which reveals that the deceased, as Karmee of the Gitaldaha 2 G P. used to receive regular salary at a definite pay scale. This means the deceased was a regular employee receiving salary from the State exchequer and at the same time, engaged himself with the job of the field worker without obtaining previous sanction of the Government, a step which he is barred from taking according to the Service Rules.
The husband of the Appellant/Complainant, since deceased, therefore associated himself with Respondent/OP 1 and Respondent/OP 2 through the instant policy misrepresenting his employment status and thereby violated the terms of contract of his employment and the same of the insurance policy as well rendering the subject insurance policy voidable in the eye of law.
Such being the circumstances, we are of the considered view that the ld. District Forum had passed the impugned judgment and order on proper appreciation of the case and, therefore, the impugned judgment and order did not deserve any intervention from this end.
Hence, ordered that the Appeal stands dismissed. The impugned judgment and order stands affirmed. No order as to costs. [HON'BLE MR. SHYAMAL GUPTA] PRESIDING MEMBER [HON'BLE MR. UTPAL KUMAR BHATTACHARYA] MEMBER