Haryana

Jind

023/14

Suresh Kumar - Complainant(s)

Versus

Amit Insurance Services - Opp.Party(s)

Sh Maya Ram Devli

13 May 2016

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JIND.
                            Complaint No. 23 of 2014
                            Date of institution:-13.3.2014
                            Date of decision:-13.5.2016
Suresh Kumar aged 39 years s/o Sh. Sukhdev Sharma r/o village & P.O. Muwana, Tehsil Safidon, District Jind.
                                       ..Complainant.
Versus
Amit Insurance Services #8 near BDO office Safidon through its Proprietor/Manager.
Reliance General Insurance Company Ltd. through its Manager first floor plot No.2, Tower-F, DLF building, ITG park, Chandigarh.

                                          …Opposite parties.
Complaint under section 12 of
                Consumer Protection Act, 1986.

Before:     Sh. Dina Nath Arora, President.
            Smt. Bimla Sheokand, Member.
            Sh. Mahinder Kumar Khurana, Member.  

Present:-    Sh. M.R. Devli, Adv. for  complainant. 
        Sh. J.B. Goyal, Adv. for opposite party No.2. 
            Opposite party No.1 already ex-parte.  
Order:-
         Brief facts of the complaint are that complainant had got insured his Bajaj Platina motor cycle bearing registration No. HR-33C-6850 with opposite party No.2 through opposite party No.1 vide cover note No.C2004532312003218 valid w.e.f. 15.2.2013 to 14.2.2014. It is alleged that the complainant met with an accident on 
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22.5.2013 of the above said motor-cycle when he was going from his village to Jind. In the mean time all of  a sudden a Neel Cow from one side and one motor-cycle from other side came in front of his motor-cycle and he applied breaks to save the cow and the another motor-cycle and resultantly his motor-cycle fell down on the fields and suffered injuries  and fractures on his  body. After the accident he was shifted to Dr. Manoj Orthopaedic & Maternity Hospital, Jind where he was medically examined and he remained admitted in the above said hospital w.e.f. 22.5.2013 to 28.5.2013, 13.6.2013 to 19.6.2013, 8.7.2013, 6.9.2013 to 12.9.2013, 2.10.2013 to 8.10.2013 and thereafter continuously taking the treatment even till now. The complainant informed the opposite party No.1 immediately regarding the accident. A DDR No.34 dated 22.5.2013 was lodged in P.S. Safidon on his statement. The complainant lodged a claim amount and submitted all the necessary documents to the opposite parties. The opposite party No.2 has wrongly repudiated the lawful claim of the complainant on false ground of delay.  Deficiency in service on the part of the opposite parties is alleged. It is prayed  that the complaint be accepted and opposite parties be directed to pay the claim amount of Rs.1,00,000/- along with interest @ 18% p.a. to the complainant. 
2.    Opposite party No.1 was proceeded against ex-parte vide order of this Forum dated 16.7.2015.
3.  Upon notice, the opposite party No.2 has appeared and filed the written statement by taking some preliminary objections such as  complainant has no cause of action and locus-standi to file the present 
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complaint ; the complaint is not maintainable in the present Forum and complainant has not come before this Forum with clean hands and concealed true and material facts. On merits, it is contended that after intimation to the answering opposite party, perfect investigators were deputed for investigation of CPA claim for alleged injuries suffered by complainant in the alleged accident. The surveyor submitted his report vide letter dated 26.12.2013. The accident of the complainant had taken place on 22.5.2013 and complainant informed the opposite parties on 12.12.2013  regarding accident after a delay of 204 days and complainant has violated the terms and conditions of the insurance policy. All the other allegations have been denied by the answering  opposite party. Dismissal of complaint with special compensatory cost is prayed for.
4.    In evidence, the complainant has  produced his own affidavit Ex. C-1,  letter dated 27.12.2013 Ex. C-2, copy of letter Ex. C-3, postal receipt Ex. C-4,  application dated 23.5.2013 Ex. C-5, copy of cover note Ex. C-6, copies of receipt Ex. C-7 to Ex. C-9, copy of ration card Ex. C-10, copy of rapat Ex. C-11, copy of MLR Ex. C-12, copies of invoice Ex. C-13 to Ex. C-26 and photograph Ex. C-27 and closed the evidence. On the other hand, the opposite party No.2 has produced the affidavit of Sh. Amit Chawla Deputy Manager Ex. OP-1, copy of letter dated 27.12.2013 Ex. OP-2, copy of claim form Ex. OP-3, copy of investigation report dated 26.12.2013 Ex. OP-4, copy of policy schedule Ex. OP-5 and copy of instruction Ex. OP-6 and closed the evidence.  
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5.    We have heard the Ld. Counsel for both the parties and have gone through the pleadings as well as perused the record placed on file. Ld. Counsel for the complainant reiterated the averments made in the complaint and prayed for its acceptance whereas the counsel for the opposite party No.2 reiterated the averments made in the reply and prayed for its dismissal. 
6.    The accident of the complainant took place on 22.5.2013 motor-cycle of the complainant was insured with the opposite party vide policy No.C2004532312003218 valid w.e.f. 15.2.2013 to 14.2.2014. The counsel for  OP No.2 argued that the accident of the complainant took place on 22.5.2013 and intimation was given to the opposite parties on 12.12.2013 after a delay of 204 days which is violation of terms and conditions of the insurance policy. Hence the claim of the complainant has rightly been repudiated and there is no deficiency in service on the part of the opposite parties. Ld. Counsel of opposite party No.1 has  referred the case law titled as Royal Sundram Alliance Insurance Co. Ltd. Vs. Kanwal Jeet Singh Gil, 2015 (3) CLT page 90 (N.C) and another case law titled as H.D.F.C. Ergo General Insurance Co. Ltd. Vs. Bhagchand Saini, 1 (2015) CPJ page 206 (N.C) have weight as delay  to intimate the opposite parties regarding the accident would be violation of condition of the policy. The Hon’ble National Commission in case titled as Om Parkash Vs. National Insurance Company Ltd. 2012 (III) CPJ page 59 has observed that delay in intimation-claim repudiated-alleged deficiency in service-District Forum allowed complaint-State Commission 
            Suresh Kumar Vs. Amit Insurance Services etc.
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allowed appeal-Hence revision-terms and conditions of insurance policy are required to be strictly construed and no exception can be made on the ground of equity-Even delay of few days in  not intimating insurance company is fatal-insured loses its right to be indemnified when he himself is not vigilant about his rights and his obligations in regarding to compliance of terms and conditions of policy-impugned order upheld.
7.    The forth most question arises before us whether the complainant informed the Insurance company through their agent on 23.5.2013 regarding the accident or not ?.In the present case, it is confirmed from the DDR dated 27.5.2013 Ex. C-11  that the accident of the complainant took place on 22.5.2013. The complainant relied upon the document Ex. C-5 alleging that he informed the agent-opposite party No.1 on 23.5.2013  regarding the accident. We have perused the document Ex. C-5 this application is original one not a photo copy or carbon copy apart this there is  no receiving of the opposite party No.1 on the application. Hence the plea is not supported by the credible evidence. In these circumstances, we have no option to believe the version of the opposite party No.2 that the complainant had informed the company on 12.12.2013. We have also gone through the document Ex. OP-3 (claim form)  on which the complainant has appended his signature on 29.12.2013. It reveals that the intimation was given to the  opposite parties after a delay of 204 days. Ld. Counsel of opposite party referred the case law titled as Royal Sundram Alliance Insurance Co. Ltd. Vs. Kanwal Jeet Singh Gil, 2015 (3) CLT page 
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90 (N.C) and another case law titled as H.D.F.C. Ergo General Insurance Co. Ltd. Vs. Bhagchand Saini, 1 (2015) CPJ page 206 (N.C) have weight as delay in reporting to the insurer about the theft would be violation of condition of the policy as it deprives insurer of a valuable right to investigate as to commission of theft and to help in tracing the vehicle. Moreover, in the policy, it has been specifically mentioned that claim for theft of the vehicle not payable if theft not reported to the company within 48 hours of its occurrence. The Hon’ble National Commission in case titled as Om Parkash Vs. National Insurance Company Ltd. 2012 (III) CPJ page 59 has observed that insurance-theft of vehicle-delay in intimation-claim repudiated-alleged deficiency in service-District Forum allowed complaint-State Commission allowed appeal-Hence revision-terms and conditions of insurance policy are required to be strictly construed and no exception can be made on the ground of equity-Even delay of few days in  not intimating insurance company about incident of theft is fatal-insured loses its right to be indemnified when he himself is not vigilant about his rights and his obligations in regarding to compliance of terms and conditions of policy-impugned order upheld.
8.    Further in the case titled as New India Assurance Company Ltd. Vs. Trilochan Jane First Appeal No.321 of 2005 decided on 9.12.2009 has observed in the case of theft “where no bodily injury has been caused to the insured, it is incumbent upon the respondent to inform the police about the theft immediately, say within 24 hours, otherwise valuable time would be lost in tracing the vehicle. 
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Similarly, the insurer should also be informed within a day or two so that the insurer can verify as to whether any theft had taken place and also to take immediate steps to get the vehicle traced. The insurer can coordinate and cooperate with the police to trace the car. Delay in reporting to the insurer about the theft of the car for 9 days, would be a violation of condition of the policy as it deprives the insurers of a valuable right to investigate as to the commission of the theft and to trace/help in tracing the vehicle. 
9.    Further in case titled as Royal Sundaram Alliance Insurance Co. Ltd. Vs. Kanwal Jeet Singh Gil (NC) has observed that insurance claim-theft of car insured intimated the insurer regarding theft of his car after 39 days of the accident-held-insured has violated the mandatory terms and  conditions of the insurance policy-revision petition allowed. 
10.    In the present case, it is admitted fact that vehicle of the complainant was insured with the opposite party and accident was took place on 22.5.2013 and the DDR was registered on 27.5.2013 i.e. after delay of 5. Beside this the complainant has informed the opposite parties regarding the accident after delay of 204 days which is violation of terms and conditions of the insurance company. Moreover, as per terms and conditions of the insurance company on what condition company is liable to pay the claim which is reproduced as under:-

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    Nature of Injury                Scale of compensation
Death                    100%

Loss of two limbs or sight of
Two eyes or one limb and sight    100%
of one eye
Loss of one limb or Sight of one 
Eye    
                          50%
Permanent total disablement from
Injuries other than named above      100%

The above said conditions of the insurance company apply for releasing the claim only when the claimant is provide the disability certificate from the office of  concerned Civil Surgeon. In the present case,  the complainant is failed to provide the disability certificate to the insurance company and in this eventuality the opposite parties unable to decide the claim of the complainant. 
11.    In view of the above discussion, We are of the considered view that complainant has intimated the opposite parties after a gap of  204 days which is in violation of terms and conditions of the policy. Ld. Counsel for the opposite party referred the terms and conditions mentioned in the Insurance Policy. Hence, in the light of the law laid down by the Hon’ble National Commission in the judgments mentioned (supra) and factual position of this case, we are of the  considered view that there is violation of terms and conditions of 
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policy and opposite party has rightly repudiated the claim  of the complainant. The authorities (supra) tendered by the opposite parties are  fully applicable in the present case. Apart this the complainant is also failed to provide the disability certificate to the opposite parties for settlement of claim. As such, there is no deficiency in service on the part of the opposite parties and  the present complaint is  hereby dismissed. Parties will bear their own expenses. Copies of order be supplied to the parties under the rule. File be consigned to the record-room after due compliance.
Announced on: 13.5.2016
                                              President,
       Member       Member                 District Consumer Disputes                                          Redressal Forum, Jind

 

 

 

 

 

 

       Suresh Kumar Vs. Amit Insurance Services etc.
                    
                
Present:-    Sh. M.R. Devli, Adv. for  complainant. 
        Sh. J.B. Goyal, Adv. for opposite party No.2. 
            Opposite party No.1 already ex-parte.  

                Remaining arguments heard.  To come up on  13.5.2016 for orders.
                                        President,
        Member             Member                               DCDRF/Jind
                                        12.5.2016

Present:-    Sh. M.R. Devli, Adv. for  complainant. 
        Sh. J.B. Goyal, Adv. for opposite party No.2. 
            Opposite party No.1 already ex-parte. 
 
        Order announced. Vide our separate order of the even date, the complaint is dismissed. File be consigned to the record room after due compliance. 
                                                                                                    President,
        Member             Member                               DCDRF/Jind
                                        13.5.2016