SENIOR DIVISIONAL MANAGER, NEW INDIA ASSURANCE COMPANY LIMITED Vs. UMA KAR W/O AKSHAY KAR AND ORS

JUDGEMENT

(1.) THE present appeal has arisen out of the judgment passed by the Ld. District Forum, Paschim Medinipur, on 17.10.2008, in its case no -52/2008, wherein the Ld. Forum below allowing the complaint on contest against the OP -2 and dismissed against the OP -1 has directed the OP - 2 to pay Rs.3,00,000/ - to the Complainant together with Rs.37,125/ - being the interest @9% p.a. for the period from 01.10.2007 to the date of the judgment within 30 days from the date of communication of the judgment, failing which interest would apply @12% with quaterly rests on the whole amount i.e. Rs.3,37,125/ - payable to the Complainant on the date date of the judgment for the delayed period. The OP -2 was also directed to pay a sum of Rs.2000/ - to the Complainant as litigation cost.

(2.) THE brief facts of the case of the Complainant before the Forum below were that her husband, since deceased obtained a Janata Personal Accident Policy during his life time on 15.12.2000 covering a period from 15.12.2000 to 14.12.2015 and the sum assured was of Rs.3,00,000/ -. The insured -husband of the Complainant died due to train accident on 15.02.2007 and the said incident was informed to the OP -1 and as per their advice the Complainant being the sole nominee of the said policy submitted the claim form along with all relevant documents to the OP -2. But till date of filing the complaint before the Forum below the OPs did not settle the claim and hence she filed the complaint against the OPs praying for direction against the OPs to pay her the assured sum along with interest, cost and compensation.

(3.) BEING aggrieved by the above -mentioned judgment the Insurance Company -Appellant has preferred the present appeal contending that the Appellant did not receive any claim from the Complainant and so they are not liable to pay the claim. It has been stated by the Appellant that as per MOU by and between the Insurance Company and the GTFS, the GTFS were under the obligation to extend the policy to the investors, their family members, field workers and their friends. The premium was collected and remitted to the Appellant by the GTFS periodically and a computerized certificate in the name of New India Assurance was issued to each policyholders. The Ld. Counsel for the Appellant has submitted that nowhere it has been stated by the GTFS that under which category the insured belonged. It has been further stated by the Appellant that after the issuance of such group policy, the same was reviewed by the GIC at the instance of the GIC and the understanding between the Insurance Company and the G.T.F.S was cancelled. Such cancellation was challenged before the Hon'ble High Court by the G.T.F.S and by an order dated 06.07.1999 the Hon'ble High Court has stayed the cancellation of MOU and directed the G.T.F.S not to collect premium from the "Friend" category. It was the incumbent upon the claimant as well as the GTFS to establish the status of the claimant by way of documentary evidence to establish that the insured does not fall under the category of 'Friends' as the Hon'ble High Court has barred this category. According to the Appellant the judgment of the Forum below is liable to be quashed and he has prayed for allowing the present appeal. Being dissatisfied with the above -mentioned judgment passed by the Ld. Forum the OP no -3 -Insurance Company has preferred the present appeal before this Commission contending that the Appellant did not receive any claims of the Complainant and so they are not liable to pay the claim. It has been stated by the Appellant that as per MOU by and between the Insurance Company and the GTFS, the GTFS were under the obligation to extend the policy to the investors, their family members, field workers and their friends. The premium was collected and remitted to the Appellant by the GTFS periodically and a computerized certificate in the name of New India Assurance was issued to each policyholders. The Ld. Counsel for the Appellant has submitted that nowhere it has been stated by the GTFS that under which category the insured belonged. It has further stated by the Appellant that after the issuance of such group policy, the same was reviewed by the GIC at the instance of the GIC and the understanding between the Insurance Company and the G.T.F.S was cancelled. Such cancellation was challenged before the Hon'ble High Court by the G.T.F.S and by an order dated 06.07.1999 the Hon'ble High Court has stayed the cancellation of MOU and directed the G.T.F.S not to collect premium from the "Friend" category. The Ld. Counsel for the Appellant has mentioned in the memorandum of appeal that the law is settled that impossibility to render service does not tantamount to deficiency in service. If the Appellant due to non -submission of appropriate documents cannot consider an insurance claim, the same cannot be termed as deficiency in service. It was the incumbent upon the claimant as well as the GTFS to establish the status of the claimant by way of documentary evidence to establish that the insured does not fall under the category of 'Friends' as the Hon'ble High Court has barred this category. According to the Appellant the judgment of the Forum below is liable to be quashed and he has prayed for allowing the present appeal.