Hon’ble Sri Rituraj Dey, (Member)

The present case has been filed by the complainant praying for Rs. 1,14,200/- along with interest @ 10% p.a., Rs. 25,000/- for mental harassment and pain and Rs. 10,000/- as a litigation cost to be paid by the O.P. to the complainant.

The complainant’s case, in a nutshell, is that the complainant purchased a vehicle receiving a loan from Tata Motors Finance Limited to maintain his livelihood by way of self employment. The said vehicle was insured to ICICI Lombard General Insurance Company Ltd. The said vehicle did not meet any accident/incident within the said policy coverage period. Accordingly, no claim was done by the complainant at the last insurance policy. The complainant did not renew the said insurance policy. The complainant availed of a new insurance policy from the O.P./ National Insurance Company Ltd. with the validity period from 13/06/2013 to 12/06/2014. The aforesaid vehicle of the complainant became damaged and the driver of the vehicle was assaulted by some miscreants on 26/6/2013 when it was coming from Purulia to Asansol. An FIR was done by the complainant on 26/06/2013. The complainant submitted motor claim form along with necessary documents. A surveyor deputed by the O.P. inspected the damaged vehicle. The Branch Manager of the O.P. informed the complainant that the complainant was not entitled to get NCB as the complainant received claim from his previous insurance company. According to the O.P. due to such misrepresentation in the proposal form by the complainant, the claim of the complainant from present insurance policy may be repudiated. The complainant was asked to give reply for such action at the time of submission of the proposal form to the O.P./insurance company. According to the complainant, the complainant did not avail of any claim from ICICI Lombard General Insurance Company and he made a correct information in the proposal form submitted to the O.P. The complainant paid Rs. 1,08,850/- towards repairing charges of the vehicle and paid Rs. 5,400/- for cost of the SF Sonic Battery. The O.P. has denied to make settlement regarding the said insurance claim. Hence the case has been filed by the complainant.

The O.P. has appeared in the present case by filing written version supported by affidavit wherein the O.P. has stated that the complainant was not entitled to get the ‘No Claim Bonus’ as at the time of filing up the proposal form, the complainant furnished wrong information. According to the O.P., the complainant is duty bound to obtain certificate from the previous insurer regarding ‘No Claim’ and to submit the same before this O.P.

According to the O.P., if any policy is not renewed in time, then it can be renewed on inspection of vehicle in submission of fresh proposal. O.P. has stated that the complainant has suppressed the material facts in his complaint. The complainant delivered his vehicle to R.H.Automobiles but the complainant could not take delivery of the vehicle due to financial trouble and the O.P. has not been in position to settle the claim without submission of cash memo and bills. The complainant requested the O.P. to settle the claim by paying the claim amount directly to the R.H. Automobiles. At the time of processing of claim settlement, the O.P. came to know that the complainant was not entitled for NCB at the time of availing of insurance of O.P. According to the O.P., the O.P. is still ready to pay if the complainant can provide a proof from ICICI that there was ‘no claim’ by the complainant so that the complainant is entitled to get NCB.

The O.P. repudiated the claim of the complainant on 19/11/2014 as per renewal notice of ICICI Lombard General Insurance Company Ltd and motor vehicle guideline dated 09/08/2012. The O.P. asked for suitable reply from the complainant for such action at the time of submission of proposal form to the O.P.

Points for consideration

1)Is there any deficiency in service on the part of the O.P.?

2)Whether the complainant is entitled to get any compensation or relief?

Decision with reason

Points No. 1 &2

            Having perused the facts as well as the documents filed by both parties and considered the arguments made by the parties, it appears that the complainant availed of an insurance policy (vide annexure no. 4 “Goods carrying commercial vehicle policy & package”) in respect of his vehicle bearing no. WB 55-9803, with the validity period from 13/6/2013 to 12/6/2014 from O.P./National Insurance Company Ltd. The complainant claimed the benefit derivable from insurance policy of the O.P. after the occurrence happened on 26/6/13 for which the vehicle of the complainant was damaged. The complainant lodged an FIR on 26/6/2013 and informed the O.P. about the said accident. The O.P. sent a letter to the complainant on 19/11/2014 where the O.P. informed the complainant that the complainant was not entitled to get ‘No Claim Bonus’ which he received at the time of filing proposal form of the insurance policy offered by the O.P. because of misrepresentation of facts by giving wrong declaration of ‘No Claim’ in complainant’s proposal. The O.P. also mentioned in his letter that due to such misrepresentation of facts while insuring a policy the subsequent claim might be repudiated by the insurance company. In this letter the O.P. required a reply from the complainant regarding the said matter. In reply the complainant informed the O.P. on 2/12/2014 that ‘No Claim’ was lodged by the complainant from his previous insurer, ICICI Lombard General Insurance Company at the insurance coverage period that was 23/4/2012 to 22/4/2013.

            From the arguments made by both the parties and the documents filed by the parties, it appears to us that question has arisen only on ‘No Claim Bonus’. The complainant has been demanding that he had not availed of any claim from his previous insurer ICICI Lombard General Insurance Co. Ltd and the O.P. has been making a demand that the complainant had received a claim from his previous insurance company which was ICICI Lombard General Insurance Company.

            From the proposal form of the O.P. on record, we find that in question no. 18, i.e. ‘Are you entitled to ‘No Claim Bonus’, the complainant/insured person mentioned tick mark on ‘Yes’. But at the below of the said question it is written that ‘if yes, please submit proof thereof’. After submission of proposal form the O.P./Insurance Company issued said policy (No 150503/31/13/6300004573 issued on 13/06/13) receiving premium of Rs. 19,224/-. It is a fact that any insurance company issues policy certificate having scrutinized the proposal form submitted by the applicant who wish to be an insured person. In this case the same thing happened. Accordingly, we find here two things viz. either the complainant had submitted the proof in respect of question No. 18 of proposal form and its answer or the O.P. having violated his/its own rules/norms as mentioned in question no. 18 in the proposal form, issued policy certificate to the complainant. If any of it happened in this case, then we find deficiency in service on the part of the O.P. because if O.P had had the proof certificate, then O.P. had no right to repudiate/stop the claim of the complainant and if the O.P. had not received any proof from the complainant then a question arises why and how the O.P. issued the policy certificate without making any investigation and queries to ‘No Claim Bonus’.

We think that it is not justified and perfect procedure regarding consideration of claim of the O.P. when the complainant having paid a healthy amount as premium made a claim against his insurance policy after happening of genuine occurrence/accident.

We have gone through the ‘Motor Renewal Premium Notice’ filed by both the parties. From the sentence written at the last portion of the notice that “the renewal premium indicated above is based upon information on claims with respect to your current policy as on date of this notice. Please note that if you have reported any claim subsequently, your No Claim Bonus stands withdrawn and will require payment of higher premium”, it appears that this notice is a general notice. From this notice without mentioning of issuing date we cannot decide whether the complainant availed of any claim from his previous insurance company or not.

            The complainant sent an e-mail to his previous ICICI Lombard General Insurance Co. Ltd for having a certificate of ‘No Claim’ on 4/5/2015 but no reply comes from ICICI Lombard General Insurance Co. Ltd. Having done this job, the complainant has shown his honest intention and transparent attitude regarding the present dispute on ‘No Claim Bonus’.

            The O.P. also sent an e-mail to ICICI Lombard General Insurance Company on 18/5/2015 but no reply comes from the ICICI. The question arises why not O.P. sent such e-mail to ICICI Lombard General Insurance Company before issuing the present insurance policy. If the O.P. would have done this job at the time of receiving proposal form and offering insurance policy, then no dispute would have been created in subsequent time. Here, we find a gross negligence on behalf of the O.P./Insurance Company.

            The complainant had paid a definite premium to get the insurance policy and its facility. From the facts and documents, it is clear to us that an occurrence/accident happened during the validity period of the said insurance policy. So, the complainant is entitled to get Rs. 1,14,200/- along with interest @ 10 % p.a. from 26/6/2013 till payment of the said amount along with compensation of Rs. 20,000/- for harassment and mental pain and litigation cost of Rs. 8,000/- from O.P.

The above two points are, thus disposed of with the above observation and findings. Hence, it is,

ORDERED

            that the instant case be and the same is allowed against the O.P. on contest.

            The O.P. is directed to pay Rs. 1,14,200/- along with interest @ 10% p.a. chargeable from 26/6/2013 till payment of the said amount and Rs. 20,000/- for harassment and mental pain as well as Rs. 8,000/- as litigation cost within 30 days from the date of issuance of this order, failing which the O.P. will be liable to pay a fine of Rs. 200/- per day chargeable from the date of issuance of this order till compliance of the order in toto.

            The complainant is at liberty to put the order in execution after expiry of 30 days from the date of issuance of this order as per rule.

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