Brief fact of this case is that, the complainant is the Registered owner of A Truck bearing Regd. No.OD09A-3537 and insured the aforesaid vehicle under OP’s office at Barbil for the IDV of Rs.15,00,000/- for the period covering from dt. 13.12.2018 to dt.12.12.2019 and paid premium of Rs.53,588/- having policy No.345506/31/2019/3166. The copy of R.C.Book and Insurance Policy are annexed as Annexure 1&2.That during subsistence of policy the vehicle met with an accident on 15.06,.2019 under Kanjipani policy Station. The complainant on dt.19.06.2019 reported the fact at Kanjipani PS and the Police enquired the case with a Station Diary Entry No.11 dt.19.06.2019.The copy of SDE No.11/19 is annexed as Annexure-3.Thereafter the complainant had intimated the OP’s office regarding accidental damage of the vehicle and the OP had deputed his surveyor for assessment of the extent of damage. After survey was over the complainant had taken the damaged vehicle to Santosh Engineering Works,Serenda,Barbil for repair and spent a sum of Rs.5,86,600/- and also spent a huge amount to shift the damaged vehicle from Kanjipani Ghat to Barbil. After collecting the bills from Santosh Engineering Works, the complainant has submitted all the original bills in the OP’s office and claimed a sum of Rs.6,50,000/- towards own damage claim. The Photocopies are annexed as Annexure-4. The OP remained silent and has not taken any steps to sanction the own damage claim for a long time. And in fact on 31.12.2020 the OP has issued one letter to the complainant alleging therein that the vehicle in question was not operating under a valid goods permit on the date of accident. Copy of letter is annexed as Annexure-5. Lastly on 08.01.2021 the OP in his letter has repudiated the claim of the complainant with the reason that the said vehicle had no valid permit during the time of accident. The copy of the repudiation letter is annexed as Annexure-6. Repudiation of Motor claim of the complainant was totally arbitrary and non-application of mind of the OP. Though Law permits that in case of violation of policy conditions, the OD claim can be settled as a non-standard basis. But in this case the OP without giving any opportunity has repudiated the claim illegally for which the complainant became harassed mentally and financially in the past one year and seven months. It is clear deficiency in service from the side of theOP. Finding no other way the complainant compelled to file this case to realise his legitimate dues of Rs.6,50,000/- along with Rs.50,000/- towards mental agony and other cost with any other reliefs.
The complainant relies upon the following documents:
- Copy of R.C.Book and Insurance policy. Annex.1&2..
- Copy of SDE No.11/19. 1no.(Annex.3).
- Copy of bills. (Annex.4)
- Copy of letter of OP. 1no.(Annex.5)
- Copy of repudiation letter of OP. 1no.(Anne.6).
- Under the above complain the case was admitted and notice issued to Ops. The Op appeared and filed their written version in detail. In their written version the Ops stated that the case is not maintainable in the eye of law and on the facts and record. The present case is not a consumer dispute as per the provision of C.P.Act. There was no any deficiency in rendering service by the OP Insurance company. Since the claim of the complainant was repudiated vide letter Dt.08.01.2021 after due application of mind and after taking all relevant factors in to consideration, the question of deficiency in service on the part of OP does not arise and is not maintainable and liable to be dismissed.
Coming into para wise averments the content of para 1&2 of the complaint petition is admitted. Facts stated in para 3is not within the knowledge of OP. That averment made in para 4 of the petition is admitted by the OP. The content of para 5&6 are denied by the OP. The insured had spent Rs.5,86,600/- towards repairing charges whereas the surveyor and loss assessor has submitted his report and has assessed loss of Rs.1,95,000/-.So the extend of repairing charges has submitted by the complainant has inconsistent with the damage without any equitable and legal basis. That the content of para 7 &8of the petition are partly admitted. It is not admitted by the OP that after getting through the claim intimation and bills of the complainant has remained silent.(After verifying all relevant vehicular documents it comes to the knowledge of OP that the permit of the damage vehicle was not valid at the time accident which is gross violation of policy terms and conditions as well as statutory provision of M.V.Act. Accordinglythe OP has repudiated the claim.)Thatthe facts stated in content of para No.9,10 &11are denied. (There is no deficiency of service on the part of Ops. The claim of the petitioner is baseless without any legal and equitable basis. The OP is not liable to pay any claim of the petitioner, hence the case deserves to be dismissed with cost of litigation.) As such, the OP prayed the learned Commission to exempt the OP Insurance Company from payment of compensation to the complainant in the interest of justice.
The OP relies upon the following documents:
- Surveyor report.
- Repudiation letter with R.C.
- Policy certificate.
On the above pleadings the following issues are framed to decide the case.
- Whether the case is maintainable?
- Whether any cause of action arises on this case?
- Whether Ops have made any deficiency of service?
- Whether the complainant is entitled to get any relief sought for?
FINDINGS
All the above issues of the case are decided jointly. The claim is only repudiated due to valid route permit. In this case the Learned Adv. of the complainant has filed a circular issued by General Insurance Corporation of India in where there is a condition -Any other breach of warranty including limitation as to us. But in Note, it is clearly written as such” Any breach of warranties/ conditions which do not involve and saving in premium or any additional exposure to the insurance such claim be considered as standard claim e.g ”Route permit” pay 75% of admissible claim.
The aforesaid circular has been relied upon by the Supreme Court in its decision reported in-
ACJ 2010 SC-1250= Motor Insurance-Private vehicle-damage to vehicle- Comprehensive policy-Breach of Repudiation of claim-Owner gave his vehicle insured for private purpose for being used on hire against terms of policy thoughno payment for hire charges was proved and vehicle met with accident-Claim of owner was repudiated by Insurance company on the ground of violation of terms of policy-Owner filed complaint under Consumer Protection Act and all the foras upheld repudiation-Whether Insurance Company can repudiate the claim in toto –Held no claim has to be settled on non-standard basis-Insurance Company directed to pay Rs.2,50,000/- though compensation claimed is Rs.5,00,000/-.
Furthermore in para 13 of the judgement the Hon’ble Apex Court has given a table of description and in Sl.No.(III) has mentioned (III) Any other breach of warranty/condition of policy including limitation to use pay up to 75% of admissible claim.
In the instant case as per the report of the surveyor of the Insurance Company the admissible claim of Rs.1,95,000-/- and basing upon the decision of the Supreme Court 75% of the said admissible claim would be Rs.1,46,250/-.
Since Insurance Policy in question is admitted, OP is liable to pay the own damage claim of the complainant up to the extent Rs.1,46,250/-. Accordingly the complainant prays to allow his complaint petition.
The complainant Advocate also cited a decision of ACJ 2010 SC-1250 in where the Company cannot repudiated the claim in toto. The claim has to be settled on Non-standard basis Insurance Company directed to pay Rs.2,50,000/- though compensation claimed is Rs.5,00,000/-.
The surveyor of the Ops Mr.Pramod Ku.Sahoo has submitted his final survey report and access the loss of damage vehicle of Rs.1,95,000/-.The written argument filed by the complainant Advocate states that, the admissible claim is Rs.1,95,000/- as per Survey report basing upon the decision of the Supreme Court 75% of the said admissible claim would be Rs.1,46,250/-.
This Commission comes to conclusion that the complainant is liable to get the admissible claim of the surveyor with other compensation.
ORDER
The complaint petition is allowed on contest. The OP Insurance Company is directed to pay Rs.1,46,250/- to complainant. The OP Insurance Company is further directed to pay Rs.50,000/- towards mental agony and Rs.20,000/- for cost of litigation within 45 days on receipt of this order. If OP Insurance Company failed to comply the order within stipulated period the total amount of Rs.1,46,250/-+50,000/-+20,000/-= Rs.2,16,250.00 shall carry 12% interest per annum from the date of order till realisation.
