Judgment:
J. Bag, ld. Member.
The present appeal is directed against the Order dated 03.12.12 of the Ld. District Consumer Disputes Redressal Forum, Kolkata, Unit “II in Case No. CDF/Unit “II / CC No. 169 of 2011 , whereby, the complaint case was allowed on contest in part with cost against OP Nos. 1 and 2 and dismissed on contest against OP No.3.
The complaint case, in brief, was as follows:
The insured Biswajit Dey, being the husband of the Complainant , had obtained a Group Janata Personnel Accident Insurance Policy from the OP Insurance Company for a sum insured of Rs. 50,000/-(Fifty thousand) only . The said policy holder was a Filed Worker of the Golden Trust Financial Services, being OP No. 3 who issued the insurance certificate No. 4751170000001/4751170030027 for the period from 01.12.200 to 31.11.2015.The Complainant is the wife of the deceased policy holder and also recorded as Nominee of the insured. On 18.12.2008 at about 9AM the insured died by drowning when he fell down from a boat into the river at Sundarban. The Police case being No. Kultali P.S. U/D Case No. 48/08 was started and a report was submitted on 07.10.2009 . The accident was intimated to the OPs and claim form along with necessary papers were submitted on 22. 01. 2009 to the OP No 3 i.e.,GTFS who sent all those documents with a forwarding letter on 23.01.2009 to the Insurance Company. Copy of the Police investigation report was forwarded on 27. 07. 2010. Inspite of repeated request, the OP Insurance Company did not settle the claim which caused mental pain, agony and harassment . A complaint case on the ground of deficiency in service on the part of the OP Insurance Company was filed.
The complaint was contested by the OP Insurance Company. It was contended , inter alia, that as per MoU dated 30.12.1998 between the Insurance Company and the GTFS , the investors and their family members, filed workers and their family members and friends would be covered by the insurance policy . The said MoU was cancelled by a letter dated 07.05.1999 against which OP No. 3 moved a writ application, WP No 1144(W) of 1999, before the Honble High Court. An interim order was passed on 06.07.99 restraining the GTFS from collecting any premium from the category of friends from the date of that order. It was also contended that the deceased was not a Field Worker of OP No. 3 for which the status report was called for from the GTFS who submitted a computerized certificate confirming the deceased as one of their Field Workers, but the same was not an authenticated document . The OP Insurance Company repudiated the claim of the Complainant rightly and there was no deficiency in service on their part.
Ld. Forum below having considered all the documents and facts decided the complaint in favour of the Complainant and directed the OP Nos. 1 and 2 to pay an award of Rs. 50,000/- to the Complainant apart from Rs.10,000/- as compensation and Rs. 2,000/- as costs.
Being aggrieved by and dissatisfied with the Order of the Ld. Forum below the Appellants have come up before this Commission with a prayer for direction to set aside the impugned order for certain reasons.
We have gone through the Memorandum of Appeal together with the impugned order , the petition of complaint, the written version of the OP filed before the Ld. Forum below and other documents including the copy of the certificate issued by the Insurance Company in the name of Biswajit Dey and a copy of the investigation report submitted to the Divisional Manager , New India Assurance Company Ltd., 4 No. Mango Lane , Kolkata by Jayanta Deb,Investigator and Claim Recovery Agent. BNAs have been filed by Respondent No. 1 and 2 . Ld. Advocates appearing for the Appellants and the Respondent No.1 and 2 have been heard.
Ld. Advocate appearing for the Appellants submitted that the Complainant failed to produce necessary documents before the Insurance Company in connection with the settlement of her claim. The identification of the deceased insured as a Field Worker of GTFS was never produced. It was obligatory on the part of the Respondent No.2 i.e., GTFS to issue identity card in favour of their Field Workers, which was never done. No photo identity card in support of the status of the deceased insured was ever made available to the Insurance Company. In the absence of necessary documents showing that the deceased insured was a Field Worker, the claim of the Complainant was repudiated and there was no deficiency on the part of the Insurance Company.
Ld. Advocate appearing for the Complainant / Respondent No.1 submitted that the Insurance Company issued a policy in favour of the deceased insured on payment of premium and after verification of all information as required at the time of issue of the insurance certificate. The order of the Honble Justice Soumitra Pal in WP No. 13359 (W) of 2008 (Manoranjan Mukherjee “vs- the New India Assurance Company Ltd and Ors ) was referred to whereby it was held that once certificate has been issued by the Respondent Nos 1 and 2 œas per proposal and declaration submitted to the company it can not be reopened, which means that after issuance of the insurance certificate, queries regarding the status of the deceased insured is uncalled for? . The insurance contract as entered into by the Insurance Company and the insured is binding in nature for both the parties. It was, therefore, incumbent upon the Insurance Company to release the insured amount in the reported contingency which is covered by the policy. There was no employer-employee relationship between the Field Workers and Golden Trust Financial Services and as such no identity cards were issued to the Field Workers. The order of the Ld. Forum below has been rightly passed and deserves to be carried out by the Insurance Company.
Ld. Advocate appearing for Respondent No.3 submitted that after the order of the Honble High Court in 1999, the MOU could have been modified asking for identity cards. But, no such instruction was issued by the Insurance Company and in fact there was no necessity of issuing any identity card by the GTFS. Only at the time of filing claim, such plea is taken by the Insurance Company without issuing any general instruction to be carried out by GTFS. Necessary documents being provided to the insurance company, the claim of the Complainant should have been allowed. There is deficiency in service on the part of the insurer.
Decision with Reasons
Admittedly, the deceased was issued with an insurance certificate upon receipt of premium with requisite declaration and submission of the proposal which contained all necessary information. Once the insurance company accepted the premium, they can not go back on their assurance to entertain the claim as may arise subsequently as per terms of the policy. No specific ground of violation of the policy terms has been pointed out by the Insurance Company. The risk covered by the insurance company and the premium received by them for covering risks being found in order, as held by the Honble High Court in Writ Petition No. 13359 (W) of 2008 and as referred to, any further requirement for identify proof of the insured is but a ploy to deny the benefit of insurance policy .
Ld. Forum below appears to have examined all relevant points in detail and there appears to be no material irregularity or legal infirmity.
We are of the considered view that there is no reason to interfere with the impugned order. The appeal does not succeed.
Hence,
Ordered
That the appeal be and the same is dismissed on contest . The impugned order stands confirmed. There shall be no order as to costs.