Delhi

East Delhi

CC/293/2019

KHERUNNISHA - Complainant(s)

Versus

BAJAJ ALLIANZ G.I.C. - Opp.Party(s)

07 Mar 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. No.293/2019

 

	Smt. Kherunnisha W/o Late Sh. Suhel Ahmad R/o A-23, Joshi Colony, IP Extension, Delhi-110092	….Complainant
Versus
	The Bajaj Allianz General Insurance Company Ltd. Branch Office At:- Block No. 4, 7th Floor, DLF Tower, 15 Shivaji Marg, New Delhi-110015	……OP

 

 

Date of Institution: 12.09.2019

Judgment Reserved on: 21.02.2023

Judgment Passed on: 07.03.2023

 

                  

QUORUM:

Sh. S.S. Malhotra (President)

Ms. Rashmi Bansal (Member)

Sh. Ravi Kumar (Member) On Leave

 

Order By: Rashmi Bansal (Member)

 

 

 

JUDGMENT

 

The present complaint has been filed by the complainant against the repudiation of the claim of the complainant by OP on the ground that the information about the death of the insured was not communicated to the OP within period of 30 days.

1. It is the case of the complainant that the deceased husband of the complainant purchased a vehicle policy which was insured for an amount of Rs. 4,02,412/- with OP vide policy number 09-19-1104-1803-00000469 valid from 18.04.2018 to 17.04.2019. The said insured had died on 24.04.2018 and on 17.03.2019 the said vehicle was stolen. An FIR was lodged with the police and thereafter OP was also informed on the same day. A surveyor was appointed who has submitted his report that vehicle has been stolen, however, OP has repudiated the claim on 02.05.2019 stating that since the policy has not been transferred within the period of three months from the date of death of the insured, as per terms and conditions no. 12 of the policy, hence the policy has lapsed, way before the date of the theft on 17.03.2019.
2. Complainant submits that though the policy has to be transferred in the name of the complainant within three months but the same was not possible because she was observing iddat for 04 months and 10 days, during which she was not allowed to go outside the home and the three-month period of transferring the policy in her name was expired during her iddat period. The entire family consists of minors and the senior citizens, all are illiterate and are not aware about the terms and conditions of the policy. The whole family was undergoing depression, and moreover, being illiterate and having no information about the terms and conditions of the policy, the same could not be transferred in the name of the complainant or the legal heirs of the complainant’s husband. When the claim was filed with the OP, the same was repudiated. The complainant has also filed application with grievance cell of the OP but she received no information from them.
3. Complainant submits that only online policy was given to her husband, which was only one page policy named as ‘Certificate cum Policy Schedule’ and at the bottom of it something was written which was not readable from the naked eye. Complainant came to know later on that it is written there that ‘this is one page policy document (without enclosing the terms and conditions of the policy) issued by the company, pursuant to the authorization of insured to display the terms and conditions of the policy on its website (www.bajajallianz.com) that enables access by the insured.’ The complainant submits that the claim was rejected on a technical ground which itself is a deficiency of services on the part of OP. The complainant being the legal heir entitled to claim compensation from the insurer even when there is no direct written agreement between the complainant and the insurer and the OP cannot escape just on technical grounds.  The complainant prays for the policy amount of the said vehicle amounting to Rs. 4,02,412/- with interest along with the cost of 5,000/- towards cost of the complainant. Reliance is placed by the complainant on certain judgements in support of her plea that on the technical grounds, the claim cannot be repudiated, viz. Madras Port Trust vs Hymanshu international, National insurance co. ltd vs Sanjeev Deswal, Ramesh Yadav vs The New India Insurance co. and IRDA circular dated 20.09.2011.
4. Upon notice, OP appeared and contested the claim by filing its written statement and submitted that complainant is neither the insurance policy holder nor the registration certificate is in the favour of the complainant. It is further stated that the husband of the complainant was the registered owner of the vehicle and after his death on 24.04.2018, neither the insurance policy nor the registration certificate was got transferred in the name of the legal heirs, and therefore, OP is justified in repudiating the claim of the complainant. OP submits that in the event of the death of the sole insured, a policy does not immediately lapse but remains valid for period of three months from the date of death of the insured or until the expiry of the policy whichever is earlier. During the said period, the legal heirs of the insured, to whom the custody devolves and who use the vehicle, have to apply to get this policy transferred in the name of legal heirs or obtain a new insurance policy for the vehicle.  The condition 12 of the terms and conditions of the policy has to be complied with for claiming any payment under the policy. It is a well settled position of law that the parties to the insurance contract are bound by the terms and conditions of the policy. In support of its case, OP has relied upon United India insurance Co Ltd versus Hari Chand Rai Chandra Lal (2004) 8 SCC 644; Suraj Mal Ram Niwas oil Mills Private Limited versus United India insurance Co Ltd and another, (2010) 10 SCC 567; Oriental Insurance Co Ltd versus Sony Cherian (1999) 6 SCC 451 to the effect the terms of the policy have to be strictly construed to determine the extent of liability of the insurer. The insured cannot claim anything more than what is covered by the insurance policy.
5. Both sides adduced their respective evidence by way of affidavit. We have heard Ld. Counsels for complainant and the OP and perused the record.
6. Complainant has filed the one-page policy cum certificate schedule in her evidence. OP has filed complete policy of many pages in its evidence. The other documents filed by both the parties are not relevant for determining the issue in case.
7. Admittedly, the above stated policy was in force at the time of death of the husband of the complainant on 24.04.2018. The facts with respect to the theft of vehicle, appointment of surveyor, FIR by complainant are not in dispute. Also, it is not disputed that complainant is the wife of policyholder and therefore the insurable interest would deemed to be in favour of the complainant. There is also no letter by OP to the effect that policy has ever been cancelled, which implies that policy was in force at the time of theft of vehicle. The only dispute is with respect to the transfer of the names of the legal heirs in the policy, which as per terms and condition no. 12 of the said policy have to be done within a period of three months.
8. This is shown by the complainant that since the insured was dead and there was no other mode for the complainant to know the terms and conditions of the policy. Moreover, this is also established that the period of three months passed in observing iddat and rest of the legal heirs were either minor or senior citizens who are illiterate. OP has not disputed one page policy cum certificate schedule was issued & has failed to establish that a complete policy has been handed over to the deceased.
9. In the case of National Insurance Company Ltd. V/s Nitin Khandelwal, IV (2008) CPJ 1 (SC), Apex Court has observed as under:-

“12. In the case in hand, the vehicle has been snatched or stolen. In the case of theft of vehicle breach of condition is not germane. The appellantInsurance Company is liable to indemnify the owner of the vehicle when the insurer has obtained comprehensive policy for the loss caused to the insurer. The respondent submitted that even assuming that there was a breach of condition of the insurance policy, the appellant Insurance Company ought to have settled the claim on non standard basis. The Insurance Company cannot repudiate the claim in toto in case of loss of vehicle due to theft”.

10. National Commission in New India Assurances Ltd. Vs Narayan Prasad II (2006) CPJ 144 NC has given guidelines for settling the claim on non standard basis.

Non- standard claims following types of claims shall be considered as non-standard and shall be settled as indicated below after recording the reasons:

Sr. No.		Percentage of Settlement
	Under declaration of licensed carrying capacity.	Deduct 3 years’ difference in premium from the amount of claim or deduct 25% of claim amount, whichever is higher.
	Overloading of vehicles beyond licensed carrying capacity.	Pay claims not exceeding 75% of admissible claim.
	Any other breach of warranty/condition of policy including limitation as to use.	Pay up to 75% of admissible claim.

 

11. Considering the undisputed facts with respect to theft of the vehicle, the insurance of vehicle at the time of theft, the intimation of theft to the insurance company and registration of FIR, the supply of the one page policy to the husband of the complainant without any terms and conditions, no ground is made to reject the claim in toto by OP in case of stolen vehicle as per law laid down by Hon’ble National Commission. The complainant and the other LRs of the policy holder are not expected to know the terms and conditions of the policy which was issued to the insured. Moreover, ‘Certificate cum Policy Schedule’ issued to the insured shows that only one page policy document (without enclosing the terms and conditions of the policy) was issued by the OP, and authorised the insured to display the terms and conditions of the policy on its website (www.bajajallianz.com) that enables access to the insured only, which in case of dead person is not possible at all and the complainants were having no authorisation to know the same. This is beyond comprehension that  a policy holder’s family would  be aware of the terms and conditions of the policy when the policy itself authorises the insured only, to get the knowledge of terms and conditions on website. Even if it is presumed that family members of the insured had to be aware about the T&C of the policy, then also it would only be construed as breach of terms and conditions and the claim is to be settled on non standard basis, as per National Commission Order(Supra) to fall under category III – ‘Any other breach of warranty/condition of policy including limitation as to use’ and to be paid up to 75% of admissible claim. Therefore, there is deficiency on the part of OP in rejection of the claim of complainant in totality and the ground for repudiation of the claim of the complainant in toto is not tenable.
12. Hence, the Commission directs OP to pay the claim to complainant on non-standard basis at of the sum insured i.e. 75% of 4,02,412/- = 3,01,809/- . In these circumstances, the Commission is neither granting interest nor any compensation to the complainant. However, if the OP would not pay the awarded amount within one month of the receipt of the order, the OP would pay interest @9% per annum from the date of order till actual payment.
13. Copy of the order be supplied/sent to both the parties free of cost as per rules, and file be consigned to Record room after uploading the order on web site.
14. Announced on 07.03.2023.