D. Bhattacharya, Ld. Member
1. Being aggrieved by and dissatisfied with the final order dated 24.05.2012 in Case No. 98/2011 as passed by the Ld. District Forum, Howrah, the O.P. Nos. 1 and 2 thereof have preferred this appeal.
2. It is the case of the Complainant/Respondent No.1 in her petition of complaint is that her son, Tapan Banerjee secured a Group Janata Personal Accident Insurance Policy from the O.P. No.1 through the Proforma O.P. No.3 (GTFS) and she was made a nominee in the said policy, being policy no. 4751220001799 /E. No. 4730861, covering a period from 23.06.2000 to 22.06.2015, of an amount of Rs.1,00,000/-. The role of the GTFS is merely a facilitator having no authority to settle and/or to decide any claim, who has rendered its service to the Complainant satisfactorily and the Complainant has no grievance against it. Said son of the Complainant along with others proceeded from Bandel, Hooghly towards Medinipur on 08.03.2009 along NH6 by a Tata Indica Car bearing No. WB-16T9860 which suddenly dashed a lorry from behind near Jiandabazar within Panskura P.S., for which 04 persons including the son of the Complainant died on the spot and 02 others were severely injured, which was reported by one Ashok Mallick being the husband of one of the deceased persons, namely, Susmita Mallick to the O.C., Panskura P.S., Medinipur (East) on 08.03.2009 upon which Panskura P.S. Case No. 57/09, u/s 279/338/304A/427,IPC, was registered. The fact of such unfortunate incident was intimated to the O.P. Nos. 1 and 2 on 20.04.2009 by the Complainant and the O.P. No.2 vide letter dated 09.06.2009 requested the Complainant to fill up a claim form annexed therewith and to return the same along with certain documents, which was submitted on 15.07.2009. As there was no response from the end of the O.P. Nos. 1 and 2, the Complainant made several representations dated 17.08.2009 and 14.02.2011 requesting to settle her claim. Thereafter, the O.P. No.2 vide letter dated 15.02.2011 requested the Complainant to submit a copy of the appointment letter or ID Card of Fieldworker of her deceased son, which was replied on 29.03.2011, but the Complainant did not get any response. It is also contended that the letter dated 15.02.2011 by the O.P. Insurance Company was made mechanically and with pre-conceived notion without considering the claim in accordance with the law. Accordingly, the O.P. Nos. 1 and 2 are negligent and deficient in their service. So, the Complaint case.
3. On the other hand, the case of the O.P. Nos. 1 and2/Appellants in their W.V. is that the O.P. No.3 (GTFS) is a partnership firm and the main activities of such firm is to mobile fund on the behalf of the Unit Trust of India, State Bank of India Mutual Funds, etc., and has its own field personnel for its business and to increase its business it had decided to cover its employees and/or fieldworkers under insurance coverage, rather to offer an incentive to its investors the benefit of insurance coverage under two heads, Mediclaim and Janata Personal Accident Policy of New India Assurance Co. Ltd. Accordingly, in the year 1998, two memorandum of understanding (MOU) were executed between the GTFS and the O.P. Insurance Company, one on 29.07.1998 for mediclaim policies and another on 30.12.1998 for personal accident. In these Group Policies, the Insurer was the New India Assurance Co. Ltd. and the insured was the GTFS and the beneficiry was the employee/ fieldworker/investor of the GTFS. Under the Group Janata Personal Accident Policy, the sum insured varied from Rs.50,000/- to Rs.10,00,000/- and the periods of coverage were 1,3,5,7,9,10,12,14 and 15 years. Under the said MOU, the investors and their family members, field workers and their family members and their friends were given and/or extended insurance coverage by the New India Assurance Co. Ltd. Under Clause (2) of the MOU, the GTFS would collect the premium and remit the same to the Insurance Company periodically and the New India Assurance Co. Ltd. shall issue a computerized certificate in the name of each such person. Against the cancellation of the MOU by a letter dated 07.05.1999, the GTFS moved a writ petition being W.P. No. 1144 of 1999 in which after hearing the submission made by the respective party, the Honble High Court inter alia directed the GTFS to collect premium from its field workers, investors and their family members but not from âfriend category. In the instant case, the certificate as to the status of fieldworker of the deceased son of the Complainant issued by GTFS was not accepted as the same is a manufactured document and issued long after his death and as such it is an afterthought. As neither the Complainant nor the GTFS could provide any such document in support of the status of the deceased son as again called for by letter dated 15.02.2011, the claim could not be settled. Accordingly, they have prayed for dismissal of the complaint.
4. It is to be considered if the impugned order suffers from any anomaly or incongruity so as to reverse the same in this appeal, or not.
Decision with reasons.
5. Ld. Advocate for the Appellants has submitted that the document in respect of the deceased son of the Complainant as Fieldworker is absolutely an afterthought document and that admittedly the GTFS does not keep any records regarding the same. Further, he made out that no original documents as called for from the Complainant by the Insurance Company by the letter dated 09.06.2009 have been supplied. He has also referred both to the certificate of the GTFS dated 11.07.2009 and the letter dated 24.03.2011 of the Complainant to the GTFS, where she had made out that she failed to understand of non-issuance of the Fieldworker Certificate earlier and as to why the legitimate claimant will suffer both financially as well as mentally due to such reason and for the arrangement between the GTFS and the Insurance Company. He made out that the GTFS cannot shrug off its responsibility and liability in the matter and that the policy concerned is not an individual policy but Group Policy, namely, Group Janata Policy and the insurance certificates were issued on good faith. He has referred to a judgment of the Honble Calcutta High Court in this respect in MAT 1054 of 2012 with CAN 6127 of 2012, in the case of New India Assurance Co. Ltd. and Ors. Vs. Pawan Kumar Joshi and Anr.
6. Ld. Advocate for the Respondent No.1 has submitted that the requirement of identity proof of the insured person should have been called for at the initial stage and not at the time of contingency on the happening of an accident of the insured person and it was the bounden duty of the Insurance Company to clear it at the threshold. It is a contractual obligation of the Insurance Company which it can not avoid. The dispute, if any, is between the insurance company and the GTFS. Accidental death of the insured person is undisputed.
7. Ld. Advocate for the Respondent No. 2 has submitted that the settlement of the claim should have been done by the Insurance Company on the basis of the policy conditions. The MOU was undertaken for the benefit of un-employed or semi-unemployed persons. The schedules sent by it have been accepted by the Insurance Company and the onus lies upon the Insurance Company to settle the claim normally. He has referred to certain decisions of the Honble Calcutta High Court in this regard, namely, in W.P. No. 17808 (W) of 2004 and W.P. No. 13359(W) of 2008 along with M.A.T. 918 of 2010 with C.A.N. 6418 of 2010 in which the purported finding is that as the insurance company, namely, New India Assurance Co. Ltd. had given the certificate after being satisfied with the âproposal and declarations submitted to the companyâ, such query in the letter issued to the GTFS is uncalled for and that once certificate has been issued by the said Insurance Company âas per the proposal and declarations submitted to the companyâ, it can not be reopened.
8. It was the first and foremost duty of the said Insurance Company to go through all the documents before issuing and/or distributing the individual policy certificates in the name of the insured persons under the Group Insurance Policy. This is a fanciful effort of the Insurance Company to dislodge the claim of the insured person or its nominee only after a contingency happened and a claim has been preferred. It has been rightly held by the Ld. District Forum that the conduct of the O.P.s 1 and 2 in demanding the appointment letter or I.D. Card of the deceased insured after lapse of two years vide their letter dated 15.02.2011 is not proper and befitting. It is found that the concerned policy was issued on 23.06.2000, while the first letter calling for the documents has been issued by the Insurance Company on 09.06.2009, say about 09 year hence. It cannot be demanded on its whims just to unsettle the claim of a hapless person. It cannot be supported after lapse of so many years. It does only demean the stature and conduct of the institution of the said insurance company. The decision referred by the Ld. Advocate for the Appellant is not in rem. There is found to be no kind of any inconsistency in the finding and order of the Ld. District Forum and the same is upheld.
9. Hence,
Ordered
that the appeal be and the same is dismissed on contest against the Respondents but without cost. The impugned order is hereby affirmed.