S.C. CASE NO-FA/09/93



DATE OF FILING : 27.2.09 DATE OF FINAL ORDER: 5.8.09



APPELLANTS/COMPLAINANTS :



1. New India Assurance Company Ltd.

Represented by its Divisional Manager.

Having its Divisional office at Malhotra Towers,

Hill Cart Road,P.O- Prodhan Nagar, P.S.-Siliguri.

Dist- Darjeeling.



2. The Branch Manager,

The New India Assurance Co. Ltd.

Siliguri Branch ,Hill Cart Road ,

Malhotra Towers, P.O- Pradhan Nagar,

P.S. Siliguri, Dist- Darjeeling.

…………….Appellant.



RESPONDENTS/O.P.S : :



1. Smt Jharna Neogi.

W/o . Late Ratan Neogi,

Resident of :-

Beltala, Arobinda Nagar,

Municipal Ward No.1,

P.O-Alipurduar Court,

P.S-Alipurduar, Dist-Jalpaiguri.



2. The Golden Trust Financial Services.

Represented by its Branch Manager,

Having its Branch Office at College Halt,

P.O- Alipurduar Court,

P.S- Alipurduar, Dist- Jalpaiguri,

Pin 736 122. … Respondents





BEFORE : HON’BLE JUSTICE :

HON’BLE MEMBER : Shri A.K. Ray.

HON’BLE MEMBER : Smt. Silpi Majumder.



FOR THE PETITIONER : Shri P. Banerjee. Advocate.

FOR THE RESPONDENT : Shri S.K. Das. Advocate.

Shri B. Mondal . Advocate.



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Sri. A.K. Ray. Hon’ble Member







The Complainant, Appellant no.1 before us in her complaint before the Dist Forum, circuit bench, Alipurduar, Jalpaiguri stated that her husband Ratan Neogi, since deceased, obtained a Janata Personal Accident Insurance Policy from the OP/ Appellant, New India Insurance Company Ltd. through Respondent no. 2, Golden Trust Financial Services. The policy was valid from 23.2.02 to 22.2.07. The husband of the Complainant met with an accident while proceeding towards Alipurduar Court by a rickshaw. A motorcycle dashed the rickshaw from behind. The victim sustained serious injuries on his person and was hospitalized at Alipurduar S.B. Hospital where he succumbed to his injuries on 8.7.05.The Complainant / Respondent no-1 thereafter filed her petition before the Appellant Insurance Company requesting them to settle the insurance amount; but it was not paid heed to by the Insurance Company. After one year from the date of receiving intimation of death, OP-2 advised Complainant to submit final police report / charge sheet. Complainant submitted charge sheet through OP-3 for settling the claim. Failure to settle the claim amount was negligence in service & accordingly, the Complainant moved the Forum below for redressal of her grievances.



2. The Forum below by its order dated 10.09.08 passed in case no 22 of 2007 allowed the complainant on contest with cost of Rs. 2,000/- against the OP 1 & 2 who were also directed to pay the claim amount of Rs. 5 lakh to the Complainant against accidental death together with interest @ 6% p.a from the date of lodging of the claim on 5.10.05 till realization & also to pay compensation of to Rs. 10,000/- for her mental agony & harassment within 2 months from the date of the order & in default a panel interest @ 10 % p.a was also levied upon the unpaid amount till realization.



3. Being aggrieved by the aforesaid order the Appellants have preferred the instant appeal mainly on the grounds that the aforesaid order of the Forum below was passed mechanically without applying any judicial mind. If an insurance claim cannot be considered by the Insurance Company for non-submission of appropriate documents then the same cannot be said to be deficiency in service. In the instant case it was incumbent upon the claimant as well as the GTFS to establish the status of the claimant by way of documentary evidence to establish that they did not belong to the category of “friend” which category was barred by the Hon’le High court at Calcutta. The Forum below failed to appreciate the fact and circumstance of the case & misconstrued the evidence. The right & liabilities of the party were absolutely circumscribed by the terms & conditions of the contract. It was a case of group insurance but the Forum failed to appreciate the concept of the group insurance which principally covers homogeneous group & not heterogeneous group. GTFS acted illegally beyond the scope of the contract by issuing certificate which could be extended to the homogeneous group only. Neither the GTFS nor the claimant provided documentary proof regarding the status of the certificate holder. The condition precedent for settlement of the claim was establishment of status by way of documentary evidence, such condition precedent not being fulfilled the question of settlement of the claim did not arise & as such there was no cause of action in the matter.



4. Smt Jharna Neogi Respondent no.1 in her written objection filed before us on 11.5.09 contended inter alia that her deceased husband in his lifetime was a policyholder of Janata Personal Accident Policy of the present Appellant, the New India Insurance Company Ltd. The said Ratan Neogi during his lifetime deposited the premium through the authorized agent (GTFS – Respondent-2) of the Appellant Insurance Company. After the accidental death of the said policyholder being the legal beneficiary as well as the nominee of the said policy, the Respondent no.-1 claimed the insured money as per condition of the policy in question to the insurer & its agent. After lapse of 31 months Respondent no. 1 further requested the Appellant by a registered letter to make payment of the insured amount. But it yielded no results. Non-payment of the insured amount by the Appellant was deficiency in service. The Respondent No-2 (GTFS) colleted premium /fee for insurance & transmitted the same to the New India Insurance Company Ltd & acted as the agent of the said Insurance Company which after getting proper premium issued the policy in question in favour of deceased Ratan Neogi. The relation between the Appellant & the Respondent no-2 was principal & agent. It is a settled principle of law that the principal is always liable for the act of his agent. If there is any misunderstanding between the principal & his agent the real beneficiary of the policy consumer should not be affected. In the present case the Respondent no-1 being the real beneficiary of the insurance policy was a consumer and there was no reason or justification to deprive her from the legitimate right or to be affected by any such misunderstanding between the Insurance Company & its agent. As per the principle of vicarious liability, the principal will be responsible for all acts & omissions of the agent to a third party.





5. The Forum below in its impugned order also observed that the Complainant should not suffer if the OP-3 (GTFS) was non co-operative & fails to remit relevant documents & certification. OP Insurance Company remained silent over the matter of settling the claim inspite of receiving several reminders. The reason for not settling the claim was also not intimated to the Complainant who was being harassed by such acts of the Insurance Company. It was deficiency in service. It could be presumed that the Insurance Company was satisfied about the category & status of the insured otherwise they had the opportunity to refuse issuing the policy in question.



6. We have heard the parties to this case and have perused the impugned order along with the written submissions of the parties to this case. The Respondent no-1 being the real beneficiary of the Insurance policy was a consumer & there was no reason or justification to deprive her from her legitimate right or to be affected by any quarrel in between the Insurance Company & its agent (GTFS). The Ld. Advocate for the GTFS filed copies of a letter dated 22.2.02 addressed to the Branch Manager, Siliguri Branch of New India Insurance Company Ltd. It appears that a cheque for Rs. 96,989/- towards premium of Group GPA investors field workers & their family members of Golden Trust Financial Service was enclosed. This was also accepted by the said Insurance Company. It also appears from the list for lot no. 0202, risk commenced from 23.02.02, that the deceased Ratan Neogi was covered against the sum assured Rs. 5 lakh. The Insurance Company requested the GTFS in their letter-dated 21.7.06 for furnishing the final police report/ charge sheet & a certificate clarifying the status of the insured Ratan Neogi. GTFS in turn furnished the same ,vide their letter dated 6.9.06. The letter-dated 22.2.02 from the Golden Trust Financial Services also disclosed the status of the GPA also (Group holders) being investors, field workers, & their family members. There was therefore, no reason for the Appellant Insurance Company to withhold the claim amount in respect of the deceased policyholder. The said Ratan Neogi therefore did not belong to the friend’s category.



7. In the light of what has been discussed above we are of the opinion that the impugned order of the Forum below does not suffer from any infirmity. The appeal therefore fails to succeed. The appeal is thus dismissed on contest without cost. The impugned order of the Forum below is affirmed. Appellants are directed to comply with the aforesaid order of the Dist Forum within 45 days from the date of communication of this order.





Member Member