State Consumer Disputes Redressal Commission
The New India Assurance Co. Ltd. vs Arati Shaw on 14 August, 2015
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION WEST BENGAL 11A, Mirza Ghalib Street, Kolkata - 700087 First Appeal No. FA/830/2013 (Arisen out of Order Dated 20/06/2013 in Case No. Complaint Case No. CC/158/2012 of District Paschim Midnapore) 1. The New India Assurance Co. Ltd. CDU - 511 700, 4, Mangoe Lane, 2nd Floor, Kolkata - 700 001. ...........Appellant(s) Versus 1. Arati Shaw W/o Late Kartick Shaw, Vill. Kelegada, P.O. - Gochati, P.S. Daspur, Dist. Paschim Medinipore. 2. Golden Trust Financial Services 16, R.N. Mukherjee Road, Kolkata - 700 001. 3. The Branch Manager, Golden Trust Financial Services Ghatal Branch, P.O. & P.S. - Ghatal, Dist. Paschim Medinipore. ...........Respondent(s) BEFORE: HON'BLE MR. DEBASIS BHATTACHARYA PRESIDING MEMBER HON'BLE MR. JAGANNATH BAG MEMBER For the Appellant: Mr. Pralay Kar, Advocate For the Respondent: Mr. Shouvik Chatterjee., Advocate Mr. Abhik Kr. Dutt., Advocate ORDER 14.08.2015 DEBASIS BHATTACHARYA, PRESIDING MEMBER
Being aggrieved by and dissatisfied with the order dated 20.06.13 passed by the Ld. District Forum, Paschim Medinipore in CC No. 158/12, the OP No.2 thereof has preferred this appeal.
By the impugned order, the District Forum has allowed the complaint case and directed the OP Insurance Company to make payment of the entire amount of policy of Insurance of Rs. 2,00,000/- to the Complainant within 45 days , in default the amount shall carry interest @ 9% p.a. from the date of filing of the case till payment of the entire amount.
The case of the Complainant is that her husband, Kartik Shaw, the insured, having policy No. 01152338/00010003657D, of the OP/Insurance Company, met with a road accident on 27.07.11, by one ambassador car near Tajpur School under P.S. Daspur, Paschim Medinipore for which Daspur P.S. Case No. 85/2011 dated 01.08.2011 u/S 279/304, IPC and also UD Case No. 118/2011 were started. He suffered severe injuries all over his person and died at Ghatal S.D. Hospital on 27.07.11. Accordingly, the Complainant being the nominee of the policy submitted a claim form with the OP /GTFS on 28.09.2011 along with relevant documents. But, on 15.12.11, a letter has been received from the OP /Insurance Company asking GTFS to submit evidence regarding status. Though, the Complainant filed a petition on 18.05.11 to the OP Insurance Company through the OP / GTFS , for earlier settlement of the claim, no payment has still been made. Accordingly, the instant case claiming compensation of Rs. 2,00,000/- with interest.
On the other hand, the case of the OP / Insurance Company is mainly that neither the GTFS nor the Complainant has provided documentary proof regarding the status of the certificate holder, which is the condition precedent for settlement of the claim to establish the status of the insured /deceased by way of documentary evidence, which has not been fulfilled. Further , from the investigation of the company's investigator, Malay Nag, it has been established that the insured was a businessman and not an investor/ filedworker or their family members . So, the prayer for dismissal of the case.
It is to be considered in this appeal whether the impugned order suffers from any kind of anomaly as to fact and law calling for an intervention in this appeal.
Decision with Reasons Ld. Advocate for the Appellant has submitted that the principal insured is the GTFS, and the Complainant is only a mere beneficiary. The prerequisite for settlement of a claim is to produce documentary proof as to the status of the deceased , who was the original beneficiary. But, the necessary document in that regard has neither been filed by the Complainant or the GTFS. It is not a life insurance policy but a general insurance as per MOU between the insurance policy and the GTFS and not an individual policy, as the premium was paid in consolidation. It is also his case that the deceased was misguided and fraud has been practiced by the GTFS. By onetime payment of a meagre amount of premium , the group policy was obtained by the GTFS. As per report of the investigator, the deceased was a businessman, and there is no other evidence contrary to it. In this matter, there has been absolute non -cooperation of the GTFS also.
Ld. Advocate for the Respondent No.1 has submitted that the policy has been issued in the name of the deceased husband of the Complainant for a total sum insured of Rs. 2,00,000/- , which can not be challenged in this fashion by the insurance company. There is no valid proof that he was a businessman. His association with the GTFS is beyond controversy.
Ld. Advocate for the Respondent No. 2 & 3 has submitted by referring four decisions of this Commission, namely, FA Nos. 97/2014, 598/2013, 668/2013 , 924/2013 and also referring W.P No. 17808/(W)/2004 , of the Hon'ble Calcutta High Court, that the claim of the Complainant is a valid one, her husband being a valid and bonafide fieldworker of the GTFS.
There is no proof of any kind that the victim was a businessman. His association with the GTFS was beyond controversy, which is certified by issuance of the policy by the Insurance Company, and such point can not be raised under the Insurance Act at this belated stage. There is no anomaly whatsoever in the impugned order. Accordingly, the same is being upheld.
Hence, Ordered That the appeal is dismissed on contest against the Respondents but without cost. The impugned order is hereby affirmed.
[HON'BLE MR. DEBASIS BHATTACHARYA] PRESIDING MEMBER [HON'BLE MR. JAGANNATH BAG] MEMBER