The central legal point established in the judgment is that the insurer's obligation to settle an insurance claim cannot be questioned after the expiry of two years from the policy's inception, and the liability for settlement of the claim lies with the insurer as per the MoU.

JUDGMENT :

Mr. Debasis Bhattacharya, Presiding Membe-Both the appeals arise out of the same impugned order dated 21-01-2014 in Case No. 370/2012, passed by the Ld. District Forum, Kolkata, Unit-II, whereby the complaint case has been allowed on contest. Being aggrieved by and dissatisfied with the same, the Opposite Parties thereof has separately preferred this appeal.

2. Facts of the complaint case, in brief, are that husband of the Complainant took an insurance policy under the name and style, ‘Group Janata Personal Accident’ Policy (hereinafter referred to as the JPA Policy) from the OP No. 1 through the OP No. 2 on 23-12-2000 for an insured sum of Rs. 2,00,000/-. Following the accidental death of the insured on 12-01-2009, the Complainant lodged death claim with the OP No. 1 through the OP No. 2 along with all the requisite particulars as per the direction of the OP No. 2 on 30-01-2009. However, till date the OP No. 1 has not settled her claim. Out of desperation and financial impediment, the Complainant filed the instant case.

3. It is the case of the OP No. 1 that after receiving the claim, they appointed one Investigator, Mr. Moloy Nag to investigate the matter and from his report, the OP No. 1 came to know that the deceased insured was not at all a Field worker of the OP No. 2 and his report is supported by a statement made by the claimant admitting that her husband was never a fieldworker of the OP No. 2. Therefore, they are not at all guilty of deficiency in service, as alleged.

4. The case of the OP No. 2, on the other hand, is that vide its certificate dated 21-07-2009, they made it pretty clear that the deceased insured was a ‘fieldworker’ of their company. In terms of the MoU executed between the OP No. 1 and OP No. 2, all liabilities of settling a claim vests with the OP No. 1. After receiving the completed proposal form from the incumbent, the insurance company is totally free either to accept the same or reject it. But, acceptance of the same upon reciprocal consideration, it becomes a binding contract between the parties. It is evident from the face of the certificate itself that the said insurance company has issued the certificate on the basis of ‘proposals and declarations submitted to the company’ by the insured person, since deceased, which necessarily implies that the said Insurance Company had issued the certificate after being completely satisfied with the declarations as made in the relevant proposal form by the deceased insured person. The OP No. 2 has never assumed the role of an insurer and it will be unjustified and illegal to burden them with the contractual liability of the insurance claim. It will also be contrary to the law and against the law of the land if the OP No. 2 is allowed to perform like a licensed insurer, allowing it to settle the insurance claim.

5. It is to be considered in this appeal as to whether there is any illegality in the impugned order, or not.

Decision with reasons

Ld. Advocate for the Insurance Company has submitted that, unfortunately, while the GTFS has all through and all along been held liable in the four corner of the impugned order, for some obscure reasons in the ordering portion charity has been doled out to the Complainant at the expenses of the insurance company by making it liable to shoulder the burden of paying insurance benefit without any rhyme or reason. Further, the Complainant herself has confessed before the Investigator of the insurance company that her deceased husband was never associated with the GTFS in any manner. Therefore, the impugned order should be set aside.

Ld. Advocate for the GTFS has stated that it is almost like beating around the bush to hold them liable for the present imbroglio. Insofar as the GTFS has no such accountability to settle an insurance claim, an MRI of the impugned order should be made to see if it at all it is logical to unnecessarily drag them in the matter. The certificate was issued by the insurance company itself on bein