State Consumer Disputes Redressal Commission
The New India Assurance Co. Ltd.And Anr. vs Smt. Kakali Dakshi And Anr. on 22 September, 2011
State Consumer Disputes Redressal Commission State Consumer Disputes Redressal Commission West Bengal BHABANI BHAVAN (GROUND FLOOR) 31, BELVEDERE ROAD, ALIPORE KOLKATA 700 027 S.C. CASE NO. FA/383/2010 DATE OF FILING: 12/07/2010 DATE OF FINAL ORDER: 22/09/2011 APPELLANTs 1. The New India Assurance Co. Ltd. Calcutta Division, Unit No. 511700, 4 Mangoe Lane, 2nd Floor Kolkata 700 001. 2. The Divisional Manager, The New India Assurance Co. Ltd. 48, K. N. C Road, P.O & P. S Barasat, Dist.- North 24 Parganas. RESPONDENTs 1. Smt. Kakali Dakshi, Vill : - Ganguria, P.O Simhat, P.S Haringhata, Dist. North 24 Pgs. 2. Golden Trust Financial Services, S. B Mansion, 16 R. N. Mukherjee Road, Kolkata 700 001. ..Proforma Respondents BEFORE : HONBLE JUSTICE MR. PRABIR KUMAR SAMANTA, PRESIDENT MEMBER : MRS. S. MAJUMDER MEMBER : FOR THE APPELLANTs : 1. Mr. N. R. Mukherjee & Ms. K. Mukhopadhyay, Advocates. FOR THE RESPONDENTs : 2. Mr. A. K. Dutt, Advocate : O R D E R :
HONBLE JUSTICE MR. PRABIR KUMAR SAMANTA, PRESIDENT The Opposite Party No.1,The New India Assurance Company Ltd. and the Opposite Party No.2, its Divisional Manager have filed this appeal against the judgment of the Forum below thereby directing them to pay to the complainant respondent, the nominee of the deceased insured, the sum assured i.e Rs. 5,00,000/- (Five lacs) along with interest @ 12% per annum on the same w.e.f 15-10-2005 till realization and a sum of Rs.1,000/- (One thousand) as the cost of litigation.
The aforesaid O.P Nos.1 & 2 entered into a memorandum of understanding with the Opposite Party No.3 namely Golden Trust Financial Services thereby allowing the said O.P No.3 to extend the benefit of Group Janata Personal Accident Insurance Policy to its members. As per the said memorandum of understanding the Insurance coverage for accidental death would be extended to the investors as would be forwarded to the Insurer by the said O.P No.3 as their field workers. For such purposes, premium collections made from such categories of persons were remitted in its entirety to the insurer. The New Indian Assurance Co. Ltd., the insurer in its turn had issued certificates of insurance serving the purpose of documentary evidence for the relevant insurance coverage for such persons giving details of their names, addresses, period of insurance, sum assured, names of the nominees, relationship with the nominee while the master policy (Group Janata Personal Accident Police) was issued by the Insurer, The New India Assurance Co. Ltd., in favour of the O.P No.3, Golden Trust Financial Services.
In fact the contract of insurance as per the aforesaid memorandum of understanding was by and between the O.P Nos. 1 & 2 in one hand and O.P No.3 on the other hand. In terms of such memorandum of understanding the O.P Nos. 1 is the Insurer and the O.P No.3 is the insured with the persons covered under such Group Insurance Policy as benefactors. All such benefactors were issued certificates of insurance serving the purpose of documentary evidence for the relevant insurance coverage giving details of the names of the insured person, address, period of insurance, name of the nominee, relationship with the nominee etc. The said certificate, accordingly stands as an evidence of the insurance coverage of the benefactor in terms of the insurance contract entered into by and between the O.P No. 1 & 2 and the O.P No.3.
In these state of affairs, the complainant respondents husband Bimal Kumar Dakshi obtained a Group Janata Personal Accident Insurance Policy from New India Assurance Co. Ltd. through the O.P No.3 as a benefactor to the said policy covering the risk of Rs. 5,00,000/- (Rs. Five lacs) in the event of his accidental death. Evidently, the Master Insurance Policy was issued in the name of the O.P No.3. The husband of the complainant was issued a certificate of insurance evidencing his insurance coverage on the basis of such Insurance Policy as being the field worker of O.P No.3 as recommended by it. The said benefactor Mr. Bimal Kumar Dakshi suffered an accidental death during the period under insurance coverage. Accordingly, the Claim Form along with relevant documents was forwarded by the O.P No.3 to the Insurer O.Ps within the stipulated time. In spite of receipt of the same the O.Ps Insurer did not settle the claim of the complainant in the absence of documentary evidence establishing the status of the said benefactor of insurance as field worker of O.P No.3.
The complaint case thus filed by the wife of the said deceased has been allowed on contest with cost as above by holding that the Opposite Party Insurer has most illegally repudiated the claim of the complainant on the grounds which are not covered by any exclusion Clause of the policy itself.
In this appeal it has been seriously urged on behalf of the appellant insurer that the insurance coverage was extended to the benefactors of the insurance policy on the basis of the status of the benefactor as field worker of the O.P No.3 and the absence of any documentary evidence to establish such status of the said benefactor non-settlement of the claim on such ground did not give rise to any deficiency of service.
Evidently, the insurers liability is borne out of the insurance contract entered into by and between the appellant Insurer and the O.P No.3. The policy of insurance was issued in favour of the O.P No.3 covering the insurance coverage for the sum assured in respect of the persons nominated by the O.P No.3 as its field workers. The certificate was thus issued in the name of the field workers as recommended by the O.P No.3. It is also evident that there was no insurance contract by and between the Insurer appellant and the benefactor of the Insurance Coverage namely the field worker of the O.P No.3. Furthermore, the insurance contract that was entered into by and between the appellant Insurer and the O.P No.3, did not prescribe any particular criteria for being described as a field worker by the O.P No.3 for being covered under such Janata Personal Accident Insurance Policy. There is no denial to the fact that the complainants husband was issued with the certificate of insurance coverage for a sum of Rs. 5,00,000/- (Five lacs) in the event of his accidental death. Such certificate was issued to the complainants husband through the O.P No.3 who had forwarded his name as its field worker for such insurance coverage. In the complaint case, the said O.P No.3 has also not deviated from its stand that the complainants husband was its field worker at the time of taking his insurance coverage under the aforesaid Janata Personal Accident Insurance Policy. In the absence of any privity contract by and between the appellant insurer and the complainants husband and more particularly in the absence of any criteria being prescribed in the aforesaid memorandum of understanding stipulating the status of a field worker of the O.P No.3, more so, when the appellant insurer had accepted the status of the complainant as field worker of the O.P No.3 on the basis of the recommendation made therefore by the said O.P No.3 and premium from him for such insurance coverage, there is no scope to raise question as to the status of the said deceased as the field worker of the O.P No.3 for settling the claim. In view of overwhelming presence of documentary evidence showing insurance coverage of the complainants husband issued under the aforesaid Janata Personal Accident Policy by the appellant insurer for a sum of Rs.5,00,000/- (Five lacs) and the documents showing the accidental death of the complainants husband during the period under insurance coverage and further his status as field worker having been affirmed by the O.P No.3, the non-settlement of the claim by the insurer on the plea as above, was clear deficiency of service by the appellant insurer.
Therefore, there is hardly any scope to interfere with the impugned judgment and order of the Forum below. The appeal is accordingly dismissed.
(S. Majumder) (Justice P.K. Samanta) MEMBER(L) PRESIDENT