The present case has been filed by the complainant praying for an order directing the O.P. to pay Rs. 2,68,280.85 as repairing charge, Rs. 8,000/- as cost for preparation of estimate, Rs. 7,500/- as towing charge, an interest @ of 10% p.a. on the said amount, Rs. 50,000/- as compensation for harassment as well as mental pain and litigation cost.
The complainant’s case, in a nutshell, is that the complainant made an insurance policy from the O.P., National Insurance Company Ltd with the validity period from 07/12/13 to 06/12/14 for his vehicle namely Maruti Omini Van registered as an Ambulance. According to the complainant the said vehicle was purchased by the complainant to maintain livelihood by way of self employment. The Superintendent of Deben Mahato (Sadar) Hospital, requested the complainant to provide an Ambulance under “Nischay Yan Prakalpa” of the Government. In accordance with the complainant the said vehicle/ambulance met an accident on 30/5/2014 at about 7 p.m. when it was coming from Balarampur. The driver of the vehicle and one person were injured and the vehicle was damaged. The complainant lodged an FIR to Arsha Police Station being Case No.47/14 dated 31/5/2014 and immediately after the accident intimated the O.P. about the said accident over phone. The complainant could not attend the office of the O.P. physically to give details and to receive claim form due to deep engagement in medical treatment for their injury. The complainant visited the O.P. to give detail about the said accident and to collect the claim form on 04/06/2014. The complainant made an expense of Rs 7,500/- towards towing charges as the said vehicle was taken to Arsha P.S. from the place of occurrence and it was carried to workshop of Maruti from Arsha P.S. As per advice of the O.P. the complainant received an estimate of Rs. 2,68,283.85 for repairing the damaged vehicle, paying Rs. 8,000/- to Maruti Workshop for estimate charge. The complainant submitted the Motor Claim Form to the O.P. on 07/07/2014 along with estimate and related documents such as R.C.Book, Tax token, FIR but the O.P. issued a repudiation letter of said claim mentioning the ground of repudiation of said Motor Claim Form therein. The complainant became surprised as the O.P. repudiated the claim of the complainant on the ground of non-submission of RC Book, Tax Token and FIR; delay in intimation to the insurance company about the accident and the question of using vehicle as an ambulance. According to the complainant, the complainant noticed after receiving the First Policy certificate that the said vehicle was insured under the category of Private Insurance Policy and for the very reason he made aware the O.P. about the fact but the O.P. assured the complainant that no problem would arise in respect of the policy category. Having believed the O.P./Insurance Company the complainant renewed the said policy on payment of Rs. 3,936/-. In accordance with the complainant the premium which he offered to the O.P. higher than normal rate in respect of private vehicle. According to the complainant in spite of paying insurance premium amount and submitting the documents required for getting insurance claim regarding the said motor vehicle, the O.P./Insurance Company repudiated the insurance claim of the complainant. Hence the case has been filed by the complainant.
The O.P. appeared in this case by filing W/V as well as examination-in-chief supported by affidavit wherein the O.P. has stated that the O.P. has rightly repudiated the claim as the alleged vehicle duly registered as ambulance for commercial purpose where as the complainant has taken a private car policy. According to the O.P. the complainant submitted a motor proposal form for private vehicle insurance and the insurance was done and issued as per Section 2 of the Motor Regulations. Premium was also computed for private vehicle use as per guideline of Section 2 Regulations. The O.P. has stated in written version that after receiving the letter of intimation of the said accident on 04/06/2014 the O.P. sent a reply to the complainant on the same day stating reasons therein that the claim of the complainant is deemed as no claim. In accordance with the O.P., the complainant has mentioned in the claim form that the vehicle was used as commercial purpose at the time of the said accident. The O.P. has stated that the complainant has violated the terms and conditions of the Insurance Company. The O.P. has also stated that the Divisional Manager of Asansol Division to whom the entire file regarding the Insurance Claim was sent, returned the file making note by repudiation the claim with reasons. The O.P. informed the matter to the complainant on 04/09/2014 stating the reasons of repudiation of Insurance Claim and asked the complainant to give reply if any, within 7 days from the date of receipt of the letter but the complainant did not give any reply/response to O.P. within the time. The O.P. has stated that R.C.Book, Tax Token and FIR were not submitted by the complainant when the pre-repudiation letter dated 4/6/2014 was sent to the complainant by the O.P. The O.P. denied the allegation made by the complainant against the O.P./Insurance Company. According to the O.P, the Branch manager of the Insurance Company never give any false assurance to the complainant.
None of the parties has adduced any oral evidence, but they have relied upon the arguments mentioned in their respective pleadings which are supported by affidavit and the documents submitted by them before this Forum.
Points for consideration
- Is there any deficiency in service on the part of the O.P.?
- Whether the complainant is entitled to get any compensation or relief?
We have gone through the pleadings of the parties, the documents including examination-in-chief and written argument submitted by them.
Decision with reason
Point Nos. 1 & 2
Having perused the facts as well as the documents filed by both the parties and heard the arguments made by the complainant and O.P., it appears that the complainant took a private car policy and package from the O.P./National Insurance Co. Ltd in respect of his vehicle no. JH-09-R/6117 which has been registered with model no. OMNI E MPI STD BS 4 and body type of Ambulance. It also appears to us that the said vehicle which was insured to the O.P. met on accident on 30/5/2014 at about 7 p.m. and the said accident was informed to the O.P./Insurance Company and an FIR was made in time. The complainant paid a premium to get insurance facility and claimed the insurance benefit against his vehicle as the said vehicle met the accident within the valid period of the said insurance.
The O.P. has repudiated the insurance claim of the complainant on the ground of using the vehicle for commercial purpose.
It is true that the O.P. issued the Private Car Insurance Policy to the complainant after receiving the scheduled premium and proposal form including relevant documents submitted by the complainant. The question arises why the O.P. issued the said insurance as Private Car Insurance whereas in registration certificate it has been mentioned that the body type of the said vehicle is Ambulance.
From the documents on record it appears to us that said ambulance was involved at Deben Mahato (Sadar) Hospital, Purulia in Nischay Yan Prakalpa. It is not clear from the documents whether the said ambulance worked under the said department free of charge/cost.
From the Insurance Certificate it has been cleared that the said vehicle was insured as Private Car and in the “Limitation as to use” it has been mentioned in the said certificate that “the policy covers use of the vehicle for any purpose other than a) Hire or Reward….”. Accordingly, the said vehicle registered as an ambulance cannot be used as commercial purpose.
We have carefully gone through the “Motor Claim Form” submitted by the complainant to the O.P. in respect of the policy no. 150503/31/13/6100014357 and the vehicle no. JH-09-R/6117. We find that the complainant has mentioned at the column C in serial no. 2 the word ‘commercial’. It means that the said vehicle was used for commercial purpose at the time of the said accident. It proves that the complainant/ the owner of insured vehicle made private car insurance policy but violated the terms and conditions as well as rules and regulations of the said insurance policy.
From the entire documents filed by both the parties, we find that the O.P. communicated with the complainant after receiving the intimation letter and Motor Claim Form sent by the complainant to the O.P., clarifying the reason of repudiation of said insurance claim. Here we find no deficiency in service on the part of the O.P.
As the complainant used the vehicle as commercial purpose violating the terms and conditions of the insurance policy regarding Private Car Policy and Package, so, the complainant is not entitled to get any award as sought for.
That being so, the instant case is liable to be dismissed.
Both the points are, thus, disposed of.
Hence, it is,
ORDERED
That the case being no. CC-32/2014 be and the same is dismissed on contest against the O.P. without any cost.
Let a copy of this judgement be supplied to the parties free of charge.
