West Bengal

Jalpaiguri

CC/99/2022

SMT. NIM LAKHI SHERPA - Complainant(s)

Versus

CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED - Opp.Party(s)

Dipika Roy

15 Mar 2024

ORDER

District Consumer Disputes Redressal Forum,
JALPAIGURI
 
Complaint Case No. CC/99/2022
( Date of Filing : 08 Dec 2022 )
 
1. SMT. NIM LAKHI SHERPA
W/O Nima Sherpa, Kopibari Syari Deorali East, Dist. East Sikkim, Sikkim- 737102
East Sikkim
Sikkim
...........Complainant(s)
Versus
1. CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED
Dare House, No. 2, NSC Bose Road, Chennai-600001.
Tamilnadu
2. THE BRANCH MANAGER/LEGAL MANAGER, Chola Mandalam M.S. General Insurance Company Limited
2nd Floor, Sona Wheels Building, 3rd Mile, Sevoke Road, Siliguri, Ward No. 42 of S.M.C, PO Salugara, PS Bhaktinagar, Dist Jalpaiguri, Pin 734008.
Jalpaiguri
West Bengal
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. APURBA KUMAR GHOSH PRESIDENT
 HON'BLE MRS. Arundhaty Ray MEMBER
 HON'BLE MR. DEBANGSHU BHATTACHARJEE MEMBER
 
PRESENT:Dipika Roy, Advocate for the Complainant 1
 
Dated : 15 Mar 2024
Final Order / Judgement

The case of the complainant (According to the complainant petition, evidence on affidavit along with Written notes of argument) is that she is the registered owner of a goods vehicle bearing registration No.SK-01-D3798 and the aforesaid vehicle was duly insured with the Respondents. The aforesaid vehicle which was driven by the driver, namely Dil Kumar Shilal (Kami), Son of Nar Bahadur Shilal (Kami) having valid licence along with a handy boy, Suresh Rai loaded with the consignment of iron rods and cement coming towards Gyalshing from Legshep side, Sikkim skidded off the road approximately 300 feet at Khopa, 6th Mile, Sikkim. Over the said incident, a specific case was registered by the Gayzing Police Station vide Gayzing P.S. Case No.20/2022, dated 29-04-2022, under Section 279/337/338 of I.P.C. against the driver, said Dil Kumar Shilal. The concerned police personnel visited the accident spot and held an inquiry. Thereafter on 02-05-2022, the complainant lodged online insurance claim and the Respondents registered the insurance claim vide Insurance Claim No.3379364896, dated- 02-05- 2022 and one Panel Surveyor was engaged by the Respondents who visited the place of accident spot and took photographs of the damaged vehicle. The online insurance claim form was filled up by her constituted Attorney in haste, tension and urgency but due to inadvertence and mistake wrote the name of the driver as Adip Shilal Kami, Son of Kumar Shilal Kami in place of the actual and original driver, Dil Kumar Shilal (Kami) on the said insurance claim form but the fact remains, that the said vehicle was driven by said Dil Kumar Shilal (Kami) at the time of accident and said Adip Shilal Kami is in no way connected with the said vehicle and the said vehicle was not driven by said Adip Shilal Kami at the time of accident.

The further case of the complainant is that after lodging the said insurance claim, the complainant received one letter vide reference No.3379364896/KOL/Closure, dated 24-05-2022 from the Respondents giving intimation to produce the damaged vehicle with all relevant documents before the Respondents so as to proceed further with the insurance claim. In reply to the said letter, dated- 24-05-2022, the complainant through her Ld. Lawyer sent a legal notice, dated- 06-07- 2022 informing therein that the said vehicle has been hanging 300 feet below the road at the danger zone and to recover the said vehicle by any recovery van/vehicle may cause risk and danger to the lives and property and moreover it may incur a huge amount and to recover and for transportation of the said damaged vehicle would be beyond the financial capacity of the complainant but the Respondents showed reluctance to produce the said damaged vehicle before them else insurance claim shall not be proceeded further and finding no other alternative way, the complainant recovered and transported the said damaged vehicle at her own expense of Rs.1,35,000/- (One Lakh Thirty Five Thousand) and produced the same before them. After producing the damage vehicle before them and submitting all the relevant papers and documents to the Respondents, the complainant was under belief and expectation of getting the insurance claim against the valid insurance policy from the Respondents.

It is the further case of the complainant that on several occasions, the constituted Attorney of the complainant visited the office of the Respondents so as to know about the claim status and requested them for settlement of the insurance claim at the earliest but the Respondents went on delaying the matter on various pretexts. Inspite of receiving the said reply notice, dated- 06-07-2022, despite producing the damaged vehicle before them, after incurring expenses of Rs.1,35,000/- (Rupees One Lakh Thirty Five Thousand) only for recovery and transportation of the said vehicle and submitting all the relevant documents for settlement of insurance claim, the Respondents paid no heed to settle the insurance claim and lastly repudiated her insurance claim on the ground of "driver implant and overloading".

 

CASE OF THE OPPOSITE PARTIES

The case of the opposite parties is that the present complaint is not maintainable either in law or on facts as the claims are not lawful, proper and bonafide. This Forum has no jurisdiction to entertain and determine the instant complaint. There is no cause of action and the complainant has impeached the opposite parties with an ulterior motive only to harass and to derive unlawful pecuniary gain basing upon falsehood and figment of imagination beyond comprehension. The instant complaint is frivolous, vexatious and harassive. The facts do not reveal prima-facie grounds for any such relief/s. The instant complaint petition has been made in gross abuse of the process of law equity and/or good conscience.

It is further case of the opposite parties that it is an admitted fact that the said vehicle in question was duly insured with the opposite parties but the same is always to certain terms, conditions, exclusions and definitions contained therein. It is also admitted that a claim was intimated by the complainant under the said policy for a loss that occurred and the same was registered. The opposite parties deputed an IRDA licensed independent surveyor, "North East Agencies" for assessing the loss and extent of liability of the insurer towards the damage of the vehicle.

It is further case of the opposite party that in the claim form it was clearly stated by the complainant herself that at the relevant time of the accident, the vehicle in question was being driven by the driver, "Adip Silal Kami" and he had declared himself as the driver and he had also submitted the driving license along with the form. During the survey, the surveyor came to know that in fact, at the time of the accident, 'Dil Kumar Shilal' was the actual driver.

Further case of the opposite parties is that from the seizure-list collected by the said surveyor from the concerned police station, it is apparent that the police seized the driving-license of Adip Silal Kami, Son of Kumar Silal Kami, @ Dil Kumar Shilal, Son of Nar Bahadur Shilal and since father's name of both the drivers is different and hence, it is crystal clear that the complainant with malafide intention, the reason best known to her implanted the driver for processing of the claim by the insurance company.

Further case of the opposite parties is that it was also observed by the surveyor that as per the load-challan, the vehicle in question was loaded with 7.5 ton of cement and 5.11 ton of iron rod i.e., the total weight of consignment was 12.61 ton or 12,610 kg whereas the carrying capacity of the said vehicle is 9,755 kg. Hence, at the time of accident, the vehicle was overloaded by 2,855 kg which is the violation of the statute as well as the policy terms & conditions. The said surveyor after completing their survey/investigation, submitted the Investigation Report with the

 

Conclusion & findings:

Repudiation

Repudiation Ground: Driver Implant and Overloading.

 

EVIDENCE OF THE COMPLAINANT

The complainant adduced evidence as PW1 by way of examination- in-chief and corroborated entire complaint petition and following documents were admitted in evidence:-

  1. Original copy of registration certificate of the vehicle bearing registration No. SK-01-D3798 in the name of the complainant;
  2. ii) Original copy of the Driving License in the name of the driver said Dil Kumar Shilal (Kami);

iii) Original copy of certified copy of the formal F.I.R dated-29-04- 2022.

iv) Original copy of certified copy of the enquiry report dated-29-04- 2022 of the Gayzing Police in respect of the said accident of the aforesaid vehicle.

v) Original of the letter dated- 24-05-2022 sent by the Respondents to the Complainant

vi)  Original office copy of the legal notice, dated-06-07-2022 replying to the letter dated-24-05-2022

vii) Original copy of the bill/money receipt against recovery and transportation of the damaged vehicle

viii) Original copy of Insurance policy

ix) Original copy of Power of Attorney

x) Copy of circular No.RT11028/11/2017 MVL and Gazette Notification Regd. No.D.L.-33004/99, dated-18-07-2018 respectively issued by the Government of India, Ministry of Road Transport & Highways (Transport Division)

PW1 in her evidence corroborated the entire complaint petition and from the registration certificate, it is proved that she is the owner of the said vehicle in question; on the strength of the driving licence, formal F.I.R. and Inquiry Report of the concerned police station, it is an established fact and undoubtedly proved that said Dil Kumar Shilal was the driver of the vehicle in question who was driving the said vehicle at the relevant point of time of accident; from the letter, dated- 24-05-2022 sent by the opposite parties to the complainant, it is an established fact that through the said letter, the opposite parties informed the complainant to produce the damaged vehicle in question with all relevant documents so as to indentify exact vehicle with actual VIN Plate (Vehicle Identification Number Plate) and embossed chassis number; from the Gazette Notification, dated 18-07-2018 it is an established fact that the carrying capacity of the vehicle in question is 11.5 tons and more so from the F.I.R. As well as the enquiry report of the concerned police, the Sections incorporated is of rash and negligent driving of the driver, Dil Kumar Shilal not of alleged overloading. The complainant has established and proved that the complainant is entitled to get the insurance claim from the opposite parties and there is deficiency in service on the part of the opposite parties.

 

EVIDENCE OF THE RESPONDENT BANK:-

I) Evidence on affidavit and documents admitted in evidence:-

The opposite parties have adduced evidence as DW1 by way of evidence on affidavit corroborating the entire written version and certain documents were admitted in evidence.

II) Admission of the fact:-

The opposite parties have admitted in para no.14(i) of the written version and in para no.3 of the examination-in-chief, that the said vehicle in question was duly insured with the opposite parties. It is also admitted in para no.14(ii) of the written version and in Para no.4 of the examination-in-chief that a claim was intimated by the complainant under the said policy for a loss that occurred and the same was registered. It is also admitted in para no.14(iv) of the written version, in para no.6 of the examination-in-chief and in para no.2 of the answer/reply to the questionnaires that during the survey, the surveyor came to know that in fact at the time of accident one "Dil Kumar Shilal" was the actual driver.

III) Contradiction:-

The opposite parties have stated in para no.14(iv), page no.2 of the written version, in para no.6, page no.2 of the examination-in-chief and in para no.2 of the answer/reply to the questionnaires that during the survey, the surveyor came to know that in fact at the time of accident one "Dil Kumar Shilal" was the actual driver but in para no.14(iv), page no.3 of the written version, in para no.7 of page no.2 of the examination-in-chief and in para no.2 of the answer/reply to the questionnaires, the opposite parties have stated that it appears that the police seized the driving licence of Adip Silal Kami, Son of Kumar Shilal Kami @ Dil Kumar Shilal, Son of Nar Bhadur Shilal and since their father's name of both the drivers are different, it is crystal clear that the complainant has implanted the driver for processing the insurance claim.

POINTS ON FACTS:-

I) Driver implant

i) That in connection with the accident of the vehicle in question, concerned police station started aforesaid criminal case against the driver, said Dil Kumar Shilal, Son of Nar Bahadur Shilal on the basis of the written complaint of one Arbith Chettri and the concerned police also made enquiry in respect of the said accident and as per the enquiry report said Dil Kumar Shilal was driving the vehicle in question at the time of accident.

ii) That it is reiterated that the opposite parties themselves admitted that during the survey, the surveyor engaged by the opposite parties came to know that in fact at the time of accident one "Dil Kumar Shilal" was the actual driver.

iii) That it is not the case of the opposite parties that in the said F.I.R. there was/is no mention of the name of the driver or the F.I.R. was modified or the complainant in collusion with the police incorporated that the vehicle was driven by Dil Kumar Shilal at the time of accident.

II) Overloading

i) That the concerned police have started the specific case vide Gayzing P.S. Case No.20/2022, dated-29-04-2022 under Section 279/337/338 of I.P.C. against the driver, Dil Kumar Shilal on the strength of a written complaint of one Arbith Chettri but neither Section/s under 113 of the Motor Vehicles Act against the alleged overloading incorporated by the concerned police in the aforesaid case nor any case started and/or registered by the concerned police station against the alleged overloading. As per the F.I.R. and the enquiry report of the concerned police, the accident was caused due to rash and negligent driving of the driver, Dil Kumar Shilal and not due to alleged overloading.

ii) That as per the inquiry report, dated 29-04-2022, the concerned police has not reported on inquiry that the said accident of the vehicle in question was caused due to overloading as alleged by the opposite parties.

iii) That as per the Gazette Notification, dated 18-07-2018 that the carrying capacity of those vehicles having single axle with four tyres is 11.5 tons and not 9.7 tons as stated by the opposite parties.

 

POINTS ON LAW:-

i) It is a settled position of law that the insurance company, in order to avoid liability must not only establish the defence claimed in the proceeding concerned but also establish breach on the part of the owner/insured of the vehicle for which burden of proof would rest with the insurance company. In the instant case, the opposite party/company has not produced any evidence on record to prove that the accident occurred on account of the overloading. For the insurer to avoid its liability, the breach of the policy must be so fundamental in nature that it brings the contract to an end. In the instant case, it is undisputed that the accident was in fact caused on account of the rash and negligent driving of the vehicle by its driver, Dil Kumar Shilal and against whom a criminal case was registered for the offence referred aforesaid under the provision of I.P.C.

PRAYER

In the above facts and circumstances and considering that such callousness, intentional high-handedness and harsh attitude, actions and conducts of the opposite parties towards the complainant have resulted the complainant to remain in extreme mental pain and agony, sufferings and harassment and also considering that in such circumstances it tantamount to serious departure from consumer kindness and as a consequence of the same, considering that the complainant till this day is confronted with acute mental pain and agony and financial loss and suffering at every material times. Also considering that the opposite parties have never sub-served the consumer able interest from any corners of the facts and circumstances as portrayed hereinabove and also considering that the opposite parties have most unlawfully committed serious unfair trade practice, gross negligence and complete deficiency in service- towards the complainant.

That the Complainant claimed a sum of Rs.12,00,000/- (Rupees Twelve Lakhs) only towards the value of the said vehicle and Rs.1,35,000/- (Rupees One Lakh Thirty Five Thousand) only as expenses incurred for recovery and transportation of the said damaged vehicle, a sum of Rs.1,00,000/- (One Lakh) only for travelling expenses of the Complainant, her men and Panel Surveyor and a sum of Rs.3,00,000/- (Three Lakhs) only as compensation for mental pain and agony, harassment, business loss and legal expenses etc. suffered by the Complainant due to negligence and deficiency in service on the part of the opposite party.

 

The opposite party submitted as follows:

1. The said O. Ps. have appeared in this case and filed its Written Version supported by an affidavit on 22-02-2023 and also filed their Evidence - in - Chief on 24-03-2023 and thereafter filed their Questionnaires on 22-05-2023 and Para-wise Reply on 06-07-2023 against the Questionnaires on behalf of the complainant.

2. The instant complaint is not at all maintainable either in law and / or on facts against the said O. Ps. and hence, the same deserves to be dismissed in limine as against the said O. Р.

3. The complainant has filed this complaint with an ulterior motive only to harass and to derive unlawful pecuniary gain from the said O.P. basing upon falsehood and figment of imagination beyond comprehension.

 

4. The complainant has not approached this Ld. Commission with clean hands because she has suppressed various material facts in the present complaint.

5. The said vehicle bearing Regn. No. SK-01-D-3798 (Goods Carrying Vehicle) in question was duly insured with the answering O.Ps. vide Policy No. 3379/03016126/000/00 for the period from 25/09/2021 to 24/09/2022 but the same is always subject to certain terms, conditions, exclusions and definitions contained therein.

6. Thereafter a claim was intimated by the complainant to the O.Ps. on 02/05/2022 under the said policy for a loss that occurred on 29/04/2022 and the same was registered as Claim No. 3379364896.

7. Thereafter after receiving the said intimation from the insured / complainant, the said insurance company / O.Ps. deputed an IRDA licensed independent surveyor, "North East Agencies" for assessing the loss and extent of liability of the insurer towards the damage of the vehicle.

8. Subsequently, in the Claim Form, it was clearly stated by the complainant herself that at the relevant time of the accident, the vehicle in question was being driven by the driver, "Adip Silal Kami" and he had declared himself as the driver and he had also submitted the driving license of the said driver along with the claim form.

 

It is pertinent to mention here that during the survey, the surveyor came to know that in fact, at the time of accident, one "Dil Kumar Shilal" was the actual driver.

9. Further from the Seizure List collected by the said surveyor from the concerned Police Station, it is apparent that the police seized the driving - license of Adip Silal Kami, S/O Kumar Shilal Kami @Dil Kumar Shilal, S/O Nar Bahadur Shilal and since father's name of both the drivers is different and hence, it is crystal clear that the complainant / insured with malafide intention and for the reason best known to him implanted the driver for processing of the claim by the insurance company.

10. Further during survey, it was also observed by the surveyor that as per the load challan, the vehicle in question was loaded with 7.5 ton of cement and 5.11 ton of iron rod i.e., the total weight of consignment was 12.61 ton or 12,610 kg whereas the carrying capacity of the said vehicle is 9,755 kg.

 

Hence, at the time of accident, the vehicle was overloaded by 2,855 kg. which is the violation of the statute as well as the policy terms & conditions.

11. The said surveyor after completing their survey / investigation, submitted the Investigation Report with the conclusion & findings:

Conclusion

: Repudiation

Repudiation Ground : Driver Implant and Over Loading.

12. From the aforesaid facts, it is crystal clear that the complainant just to derive an unlawful pecuniary gain from the O.Ps. knowing very well about the terms & conditions of the policy as well as the statute, had tried to mislead / play a fraudulent role which clearly amounts to misrepresentation of material fact.

13. The said O.Ps./Ins. Co. on the basis of the Surveyor's Final Report and also other documents, has recently repudiated the claim on 03/03/2023 since it is a clear case of the "driver implant and overloading".

14. It is apprised to mention here that in the Claim Form, it is clearly stated that:

"I/We do hereby declare that the above particulars are true and correct in each and every aspect. I agree to provide any further information / documents / assistance that may be required for processing my / our claim. In case any information furnished by me / representative is found incorrect, we agree to accept the decision of the company on admissibility of the claim."

 

15. That the policy conditions are mandatory and neither the complainant nor the O.P./ Insurance Company can go beyond, bye-pass and ignore the scope and benefit thereof because all the & C are framed and guided by the IRDA and the insurance co. are not empowered to do any sort of alteration &/or addition therein.

16. That the question of negligence in service comes only if there is no breach of contract and/or violation of any such policy terms and conditions.

17. That in the light of above facts and circumstances as per the policy terms and conditions and as well, as per the settled principle of law, the present complaint case is not maintainable in law and the same is liable to be dismissed in limine instantly.

18. That the complainant is not entitled to any relief /s from the said O. Ps. as claimed in the instant complaint petition.

19. That unless the order is made as prayed for herein, the said O. Ps. will suffer an irreparable loss, injury and prejudice.

Points for consideration- Complainant is a consumer of the opposite party and this commission has territorial and pecuniary jurisdiction to entertain the case.

 

Decision with reason -                                   

Both the parties files evidence on affidavit, Written notes of argument and also participate in the hearing of argument.

               It appears from the record that the Insurance Company had appointed an agency (North east Agencies)

 to investigate the matter and the said agency had recommended repudiation of the claim. Investigating agency

investigates the alleged matter on behalf of the OPs and submits their report to the OPs. The complainant had duly

answered the query of surveyor. The surveyor not even asses the loss of the vehicle. The insurance company denied the

 claim merely on the grounds 1. Driver Implanted 2. Overloading. But, from the case record it is found that the

 submission of the complainant was not disproved by the insurance company by any cogent evidence.  The insurance company

 took hyper technical view to repudiate the claim. It is not established by the O.P that the agency appointed by the

 insurance company is an authorized or approved survey/ investigating agency. So, we cannot totally depend on the survey

 report submitted by the opposite party. From the survey report following facts are came out.

“As directed by SHO/GPS self-visited the accident spot located at Khopa

6th mile and conducted enquiry. During my enquiry, I found that truck

 bearing registration No. SK01D3798, driven by alleged driver Dil

Kumar Shilal, 23 Yrs, S/O- Nar Bahadur Shilal, R/O- Chalamthang, Sang,

 East Sikkim along with a handy boy Suresh Rai, 22yrs, R/O- Khani

Khola Majitar East Sikkim had skidded off the road approx. 300ft at

Khopa 6th mile. The said truck was loaded with the consignment of iron

rod and cement which was coming towards Gyalshing from the Legship

 side. The injured people were being rescued by the locals and taken to

Gyalshing Dist. Hospital for medical attention.”

 

“Insured's driver and helper were severely injured in this

 accident. Dil Kumar Shilal (insured's driver) R/O- Chalamthang,

 Sang, East Sikkim. Suresh Rai (helper) R/O- Khani Khola Majitar

East Sikkim”

“Insured's driver and helper were severely injured in this

 accident. After the accident, they were taken to the District

Hospital of Gyalshing for treatment and from there they were

referred to Gangtok for better treatment. During the course of

investigation, we visited the concerned hospital and there we

 found their names in the emergency register.”

 

“The said vehicle Tata Ultra 1518 bearing registration number is SK-01-

D-3798 registered on the name of Nima Lakhi Sherpa.”

 

“During the course of investigation, at first, we visited the spot

and there the local JALPAIGURI peoples verbally informed us that

 at the time of accident, IV was loaded with iron rods and cements,

and driver & helper got serious injuries and the accident occurred 4-5 months ago. After that, we moved to the Gyalshing

PS and met with

the IO and collected FIR copies from there. In the FIR copy, we

found that at the time of accident Dil Kumar Shilal, S/O- Nar

Bahadur Shilal was present as the driver of IV and Suresh Rai was

the helper. Then, we visited the Gyalshing Dist. Hospital and

collected the emergency register and in the register, we found the

 above-mentioned names.”

               In Life Insurance Corporation Of ... vs Pramila Basak on 20 May, 2021 the hon’ble National Consumer

 Disputes Redressal Commission  New Delhi in Revision Petition No. 414 Of 2020 (Against the Order dated 17/12/2019 in

Appeal No. 232/2018 of the State Commission West Bengal) observed as follows…

“The insurance contract being a contract of utmost good faith is a

 two-way door. The standards of conduct as expected under the utmost

good faith obligation should be met by either party to such contract.”

We have perused the material available on record and heard the counsel for the complainant. It is pertinent to note that the Insurance Company has not repudiated the claim on the ground that it was not genuine. The O.P never mentions that which of the policy condition was violated by the complainant.

In IFFCO Tokio General Insurance Co. Ltd. v. Geeta Devi, 2023 SCC OnLine SC 1398, Decided on: 30-10-2023 The honarable Supreme Court held that an insurance company cannot claim that it is not liable to pay compensation in a motor vehicle accident claim just because the vehicle owner did not verify the genuineness of the driving license of the driver employed.

Looking to the judgment of Hon'ble National Commission passed in Mohd. Unis vs. United India Insurance Company Limited (Supra) & Baljeet v. United India Insurance Company Limited (Supra), it appears that the breach was not a fundamental breach and hence the respondent (O.P.) (Insurance Company) was required to pay compensation at least on non-standard basis to the appellant (complainant).

A Two Bench of the Supreme Court comprising of Justice J.K. Maheshwari, and K.V. Viswanathan passed a Judgment dated 31.07.2023 in a recent case of Ashok Kumar Vs New India Assurance Co. Ltd., Civil Appeal No. 4578 of 2023 and observed that in respect of repudiation of insurance claim, in certain cases, even though the insured is proved to be careless to some extent, 75% of the claim amount is admissible on a non-standard basis.

In the case of Gurmel Singh vs Branch Manager National InsuranceCo.Ltd.2022 The honourable Supreme Court observed that while settling the claims, the insurance company should not be too technical and ask for the documents, which the  insured is not in a position to produce due to circumstances beyond his control. Generally, where a breach of insurance policy condition or warranty are not the cause of loss or do not contribute to the extent of loss incurred by the insured, such claim is treated as a ‘standard claim’. However, there are certain claims that cannot be settled in a standard form i.e. where all terms, conditions and warranties of the policy are not fully complied by the insured, such claims may be treated as ‘non standard claims’.

In Amalendu Sahoo (supra), this Court noticed the guidelines issued by the New India Assurance Co. Ltd. in settling claims on non-standard basis. The guidelines read as under:-

  1. 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
  2. Overloading of Vehicles beyond licensed carrying capacity. Pay Claims not exceeding 75% of admissible Claim.
  3. Any other breach of warranty/condition of policy including limitation as to use. Pay up to 75% of admissible Claim.

Nitin Khandelwal (supra) and Amalendu Sahoo (supra) lay down the correct formula that where there is some contributory factor, a proportionate deduction from the assured amount would be all that the Insurance Company can aspire to deduct. We are inclined to accept the plea of the complainant in the case at hand, on the facts governing the scenario, Clause (iii) of the table set out in Amalendu Sahoo (supra) is attracted and we are in a view that it will be justified in awarding the entire 75% of the IDV is admissible claim.

               In Gurmel Singh vs Branch Manager, National ... on (CIVIL APPEAL NO. 4071 OF 2022)20 May, 2022 the

 hon’ble Supreme Court of India has observed as follows… “In many cases, it is found that the

insurance companies are refusing the claim on flimsy grounds and/or

 technical grounds. While settling the claims, the insurance company

should not be too technical and ask for the documents, which the

insured is not in a position to produce due to circumstances beyond his

control”

 Considering the contentions made in the complaint and also the evidence in support of such contentions as sworn by the parties and also the copy of documents filed we find that the Complainant has proved her case in part. We find that the Complainant has successfully proved her case in part. 

In the instant case, the copy of the insurance policy was filed by the O.P. In the insurance policy, the Insured Declared Value (I.D.V.) of the vehicle is mentioned as Rs.12,00000 /-(Twelve lack only). We are in view that the complainant should get award of compensation on non-standard basis i.e. 75% of the I.D.V. of the vehicle. The I.D.V. of the vehicle is Rs.1200000/-(Twelve lack only)  and its 75% comes out to Rs. 900000/-(Nine lack only).

Hence, It is

                                                    O R D E R E D

 

That the case C.C./99/2022 be and the same is allowed on contest against the O.P No-1&2 with cost of Rs. 5,000/- Payable to the complainant.

O.P No-1&2 are liable to pay Rs. 900000/- (Nine lack only) or 75% of the I.D.V. of the vehicle to the Complainant within 30 days from this date.

O.P has to pay Rs. 10.000/- to the consumer legal aid account of this commission.

Failing which the Complainant is at liberty to execute the decree according to law.

Let plain copy of this order be given to the parties free of cost.

 

 
 
[HON'BLE MR. APURBA KUMAR GHOSH]
PRESIDENT
 
 
[HON'BLE MRS. Arundhaty Ray]
MEMBER
 
 
[HON'BLE MR. DEBANGSHU BHATTACHARJEE]
MEMBER
 

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