Consumer Complaint No.: 34/2005

 

Present (1) Sri S. K. Ghosh - Presiding Member

(2) Samiksha Bhattacharya - Lady Member

 

Counsel(s) (1) Sri Achintoya Das - Advocate for the complainant

(2) Sri Goutam Das - Advocate for the OP No.1 NIC

(3) Sri Uttaran Banerjee - Advocate for the OP Nos. 2 & 3

Golden Trust Financial Services

 

This is to consider an application U/s 12 of the C.P. Act, 1986 filed by the complainant praying for payment of Rs.2,00,000/- to the complainant as per terms and conditions of the policy with interest @9% p.a. from 05.03.2004 till realization and also for cost.

 

Facts of the case, in brief, is that the son of the complainant viz. Taibar Rahaman has purchased a Jananta Personal Accident Policy for Rs.2,00,000/- from Opposite Parties vide Policy No.100300/47/01/9600022/02/96/30204 for the period from 23.09.2002 to 22.09.2009 covering risk of accidental death / loss of limbs/permanent total disablement. The complainant was the nominee of the said policy. An accident was occurred on 17.10.2003 at Gurgaon within the state of Haryana and the complainant’s son viz. Taibar Rahaman died thereon the same day.

 

In this regard an FIR was lodged at P.S. Tauru. The complainant has filed an application on 05.03.2004 to the OP No.3, the agent of OP No.1 for payment of Rs.2,00,000/- which has been referred to OP No.2 along with all documents as a legal heir and nominee of deceased Taibar Rahaman. The OPs did not pay any heed to the complainant. The complainant also contacted with OP No.3 and assurance was given by the OP No.3 to the complainant but in vain. The complainant further stated that there is a gross negligence and deficiency in service on the part of OPs due to non-payment of Rs.2,00,000/- only to the complainant as per policy condition. Hence the application.

 

The OP NIC contested this case by filing written version stating inter alia that the concerned policy is a group policy and it is controlled by the Master Policy. At the time of filing the petition for compensation under the head of the policy before the GTFS the complainant has sent a Xerox copy of the claim form, Xerox copy of the FIR, Post Mortem Report and Xerox copy of the investigation report. These documents are not acceptable according to the condition of policy and law. GTFS sent a letter to the complainant that all photocopies sent by the complainant are quiet eligible and thumb impression in the claim form is not attested by any gazetted officer. GTFS also requested to submit the original copy of the death certificate, true copy of the FIR, final police report post mortem report etc. It is also requested to furnish the attested photocopy of the voter identity card, ration card of the deceased as well as the voter identity card and ration card of the complainant herself. The complainant, though, received a letter on 17.06.2004 but the OPs received no response from the end of the complainant. OP NIC also stated that the complainant intentionally did not comply with the condition properly. There is no deficiency in service on the part of OP NIC, so the said application will liable to be rejected.

 

OP Nos. 2 and 3 also contested this case by filing written version stating inter alia that as per terms of the provision of the Memorandum of Understanding (MoU) entered between the OP No. 1 and OP No. 2 the settlement of the claim exclusively lies with the OP No.1 and OP No.2 & 3 have nothing to do in regard to the settlement of the claim other than role of the facilitating services to the petitioner in the matter of settlement of the claim provided all relevant papers are available and this stand has been further accentuated with the words letter dt. 17.07.2001 given by the OP No.1 to the GTFS where it is clearly stated that OP No.2 will only procure premium and deposit the same to the OP No.1 only. OP Nos. 2 and 3 have had no liability to pay or rejected the claim at any point of time. Lastly OP Nos. 2 and 3 prayed that their names may kindly be expunged /deleted from the petition filed by the complainant as OP Nos.2 and 3 GTFS have no role at all to pay with regard to the settlement of the complainant’s claim.

 

From the aforesaid contentions made by the both parties following point arose for consideration :-

 

1. Whether the consumer-complainant is entitled to get any relief as prayed for or not?

DECISION WITH REASONS:

Point No. 1 :

The complainant files the relevant documents at the time of hearing, which are kept with the record.

We heard contentions of both parties and perused all material documents produced before us with reference to relevant provisions of law.

We have considered the submission of both sides with reference to the materials on record. At the time of hearing the Ld. Counsel for OP Ins. Co. argued that the complainant is not entitled to get any relief /benefit / claim as prayed for due to violation of the conditions prescribed by the OP NIC Ltd.

 

The Ld. Forum holds that the OP Ins. Co. may repudiate the claim on previous occasion on the basis of violation of the said condition. But the OP Ins. Co. could not repudiate the said claim. Moreover, instead of repudiation of the said claim the OPs demanded several papers on several occasions for further queries. From the said activities of the OPs it is clear that the OPs are highly interested to enquiry the matter in respect of providing claim amount ignoring the violation of the aforesaid conditions. It is to be noted that till now the OP Ins. Co. does not repudiate the said claim. The Ld. Forum perused the petition dated 22.02.2007, 03.05.2007 filed by the OP NIC stating that the OP NIC started talking with GMSC and informed to the Division-III considering the matter with great care. The Ld. Forum perused the letter dt. GTFS/Claim/MKT/JPA 28842 dt. June 12, 2004 where the complainant was requested to arrange submission of original copy of death certificate, certified true copy of FIR, final police report, post mortem report, voter identity card, ration card etc. The Ld. Forum also perused the letter vide Memo No: GTFS/CLAIMS/SKB/JPA/21954 dt. September 21, 2005 where the OP GTFS instructed the claimant to submit all papers to GMSC.

 

The Ld. Forum further perused the letter dated 25^th October, 2005 issued by the OP NIC Ltd. in favour of the complainant where the OP NIC acknowledge with thanks receipt of complainant’s claim along with supporting documents /letters in respect of aforesaid claim and the complainant was further requested to submit all the original/duly attested copies before the authority concerned OP NIC to enable the process of the file.

 

The OP NIC further stated that Ins. Co. shall revert on the merit of the documents of the claim filed and thereafter OP NIC stated further that “awaiting your early reply for our further attention and assuring you of our best services at all times”. At that time the OP NIC did not raise any question regarding conditions mentioned above. At this stage, it should be the duty of the OP NIC to provide best and proper service to the complainant as per letter dated 25^th October, 2005 otherwise it will cause deficiency in service and gross negligence on the part of OP NIC. The OP Ins. Co. gave several opportunities to the complainant for settlement of the disputes ignoring the conditions mentioned above. So, at this stage the plea regarding violation of conditions taken by the Ld. Counsel for OP Ins. Co. is baseless. It is the view of the Ld. Forum that the argument against regarding violation conditions presented by the Ld. Counsel for OP NIC are not applicable in the instant case due to the following reasons :-

• As per Policy Condition, it is the duty of the ‘insured’ under this policy to give written notice to the company with full particulars of the claims within the prescribed period of time. It is not the duty of the insured person/nominee under this policy. As per policy deed the Golden Multi Services club of GTFS is to be treated as ‘insured’, Md. Taibar Rahaman (since deceased) is to be treated as ‘insured person’ and Tamijan Bewa (mother) is to be treated as ‘nominee’.

• Condition No. (2) provides some duties and functions to be performed by any medical or other agent of the company in respect of alleged injury or disablement or in the event of death of the person of the insured on behalf of the company. But the said duty has not been performed properly for and on behalf of the company.

 

At first Ld. Counsel for complainant submitted attested copy of FIR and postmortem report before the Ld. Forum. But the Ld. Counsel for the OP NIC argued that the attested copy is not admissible in evidence. It is necessary to submit original copy of FIR and Postmortem Report. If it is not so the “certified to be true copy” should be presented before the Ld. Forum. Ld. Counsel for OP NIC also argued at the time of hearing that if the complainant submits the original / certified to be true copy of the aforementioned document before the Ld. Forum, there will be no objection from the end of OPs in respect of settlement of complainant’s claim. Thereafter the Ld. Counsel for complainant submits the “certified to be true copy” of Postmortem Report and FIR before the Ld. Forum as per demanded by the OP NIC. Section 63 of the Evidence Act, ‘provides secondary evidence which means and includes the copies made from the original by mechanical process which in themselves ensure the accuracy of the copy; and copies compared with such copies’. So, the Ld. Forum holds and concludes that the “certified to be true copy” is admissible in evidence.

Ld. Forum perused the “certified to be true copy” of Post Mortem Report vide No.SK/PMR-4/18-10-03 in respect of deceased Taibar Rahaman. The dead body was examined on 18.10.2003. In the said report, Medical Officer opined that injuries were in antimortem in nature and sufficient to cause death in natural course of life. The Ld. Forum also perused the “certified to be true copy” of FIR No.195 dt. 17.10.2003 of PS Tauru, District Gurgaon, Haryana U/s 279/304A of Indian Penal Code vide Sl No.235528 in respect of road accident of Taibar Rahaman (since deceased) occurred on 17.10.2003. So, it is evident on the basis of said FIR and Post Mortem Report that Taibar Rahaman died on 17.10.2003 by way of road accident.

 

The Ld. Forum also perused the policy deed i.e. Group Janata Personal Accident Insurance Policy deed vide Policy No.100300/47/01/9600022/02/96/30204 for the covering period from 23.09.2002 to 22.09.2009 where Md. Taibar Rahaman is an insured person / proposer and Tamijan Bewa (mother) is a nominee of the said policy. The said policy indicates the sum insured of Rs.2,00,000/-. It is also evident that Taibar Rahamn proposer of the said policy died by way of road accident during the policy covering period i.e. 23.09.2002 to 22.09.2009. It is also fact that the complainant viz. Tamijan Bewa (mother of deceased Taibar Rahaman) is a nominee of the said policy. It is also fact that the OP Nos. 2 and 3 have no liabilities to pay or reject the claim at any point of time as well as they have no role at all to pay any amount with regard to the settlement of the complainant’s claim.

From the above analysis in details the Ld. Forum comes into conclusion that as a nominee the complainant is entitled to get relief as prayed for against only OP NIC.

Point No.1 is decided accordingly on the basis of aforesaid findings. Hence.

 

O R D E R E D

 

 

That the Consumer Complaint No. 34/2005 is allowed on contest with cost of Rs.500/- assessed by the Ld. Forum.

That as a nominee the complainant is entitled to get relief against the OP NIC.

 

That the OP NIC is hereby directed to pay Rs.2,00,000/- (i.e. sum insured) to the complainant within 30 days from the date or order.

 

That the OP NIC is also hereby directed to pay cost of Rs.500/- to the complainant within 30 days from the date of order.

 

That the OP NIC is hereby further directed to pay Rs.2,00,000/- towards sum insured and Rs.500/- towards cost i.e. total amount of Rs.2,00,000/ - + 500/- = 2,00,500/- to the complainant within 30 days from the date of order. If not paid within the prescribed period of time the said amount shall bear interest @8% p.a. till full payment.

 

That the OP Nos. 2 and 3 GTFS have no role at all to pay amount with regard to the settlement of the complainant’s claim.

 

That the case could not be disposed of within the specified period of time as the Ld. Counsels for both parties took adjournments several times for different reasonable grounds.

 

Both parties are directed to collect their copies within 7 (seven) days positively from the date of passing final order.

Let a copy of this order be supplied to the parties free of cost.

 

I agree,

By order of the Forum

 

(Samiksha Bhattacharya) Lady Member District Consumer Disputes Redressal Forum Dakshin Dinajpur at Balurghat Date: 31.10.2008		(S.K.Ghosh) Presiding Member District Consumer Disputes Redressal Forum Dakshin Dinajpur at Balurghat Date: 31.10.2008