DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi-110016.

Case No. 437 /2011

Sh. Jagjit Singh,

S/o Sh. Kartar Singh,

R/o B-111, Ground Floor,

Mansarover Garden, New Delhi                                   ……Complainant

Versus

HDFC ERGO General Insurance Co. Ltd.

C-302, IIIrd Floor, Ansal Plaza,

Hudco Place, Andrews Ganj,

New Delhi-110049                                                        ……Opposite Party

                                                          Date of Institution          : 18.11.2011                       Date of Order        :  14.03.2017

Coram:

Sh. N.K. Goel, President

Ms. Naina Bakshi, Member

O R D E R

          Briefly stated, the case of the Complainant is that the Complainant had got his Scorpio Car bearing No.DL-4C-NB-3254 insured from the OP vide a Private Car Package Comprehensive Insurance Policy No.2311200072722300000 for a total sum insured of Rs.6,00,000/- which  was effective for the period 16.02.2011 to 15.02.2012 against a total premium of Rs.21,000/- as per their own calculation. However, the said vehicle was stolen from the parking area of Community Center Market, Naraina on 18.02.11. The matter was reported to the police vide FIR No.25 dated 18.02.11  at PS Naraina. The matter was also brought to the notice of the OP at about 9.22 a.m. on the very next day i.e. 19.02.11 after tracing the policy documents immediately on its customer care No.18002700700 from his mobile no.9810571571 and the customer care officer of the OP after taking down the car details, policy details, name and telephone no. of the Complainant and assured him that some responsible officer of the OP company will get back to him for further formalities. However, when nobody from the side of OP contacted him he ultimately after waiting for about 3-4 days called from his mobile No.9810571571 on 25.02.11 at about 1.20 a.m. on the aforesaid customer care of OP but, however, customer care official of OP assured him that some responsible officer from the OP shall contact him to inform about the procedure to be adopted for submitting the insurance claim but to no response. Thereafter, he repeatedly called on the aforesaid customer care No. of the OP on 10.03.11, 20.03.11, 11.04.11 & 13.04.11 but to no result. On 14.04.11 when he again called the customer care of OP, then he was directed to contract their agency M/s Suraksh Enterprises having its office at 944/3, Gulati Chamber, First Floor, Karol Bagh, New Delhi for completion of the formalities for processing his claim. All the formalities were completed by the Complainant on 15.04.11 and he also submitted the claim form. However, in the meantime, when the police officials could not trace out the Complainant’s vehicle, the police issued an untrace report dated 30.03.11 which was also submitted to the aforesaid agency of OP. However, after waiting for almost for 5 months from the date of loss and intimation thereof to the OP, the OP vide its letter dated 06.07.11 closed the  Complainant’s case as NO CLAIM on false, frivolous and flimsy ground alleging that there was  delay on the part of the Complainant in informing the OP. 

Pleading deficiency in service on the part of the OP the Complainant has filed the present complaint. The prayer of the Complainant is that the OP be directed to pay the insured amount of Rs.6,00,000/- alongwith interest @ 15% p.a. from the date of loss i.e. 18.02.11 till realization, Rs.2,00,000/- as compensation for rendering deficient services and also the cost of the present proceedings.

OP in the written statement has inter-alia stated that the Complainant had purchased the policy bearing No.2311200072722300000 for the period 16.02.11 to 15.02.12 and had duly paid the premium of Rs.21,000/-. At the time of inception of the policy with the OP, the Complainant had provided the previous policy for his vehicle  of Shriram General Insurance Company bearing Policy No.102115/21/19/00115 and the above previous policy was verified from Shriram General Insurance Company and as per their report, this policy did not exist and as such the Complainant had provided incorrect, false and fabricated policy to the OP which amounts to misrepresentation and fraud. As per the rules of the insurance policy, if the insured person gives any false and fraudulent statement and conceals or suppresses any material information or makes any statement which he knows to be incorrect or makes any misrepresentation, the policy shall be void and all rights to recover thereunder in respect of any accident shall be forfeited. The relevant portion of the policy reads as under:-

“I/we the above named do hereby to the best of my/our knowledge and belief warrant the truth of the foregoing statement in every respect and I/we agree if I/we have made or in any further declaration the company may require in respect of the said accident shall make any false or fraudulent or suppression of any suppression, concealment, the policy shall be void and all rights to recover thereunder in respect of the past or future accidents shall be forfeited.”

It is further stated that the OP had appointed surveyor to assess and verify the genuineness of the claim of the Complainant. The surveyors are independent and impartial bodies duly licensed by IRDA which carry out the investigation and inspection and give a detailed report thereof. As per the report of the Surveyor “the previous policy provided by the Complainant was fake and there was also a delay of 55 days in intimation to the Insurer. It is misrepresentation/concealment of facts and violation of policy condition No.1 on the part of the insured”. It is stated that the Complainant informed the OP about the theft for the first time on 13.04.11 i.e. 55 days after the theft. By doing this, the Complainant not only violated the terms and conditions of the policy but also denied the opportunity to the insurance company to investigate the case. Denying any deficiency in service on its part, OP has prayed for dismissal of the complaint.

          Complainant has filed a rejoinder to the written statement of OP. It is inter-alia stated as under:-

          “It is denied for want of knowledge that upon inspection from Sriram General Insurance Co Ltd, the previous policy provided by the Complainant was found to be fake. That however, for the sake of arguments, even if this alleged convention of the opposite party is believed to be correct, then it is the Complainant who has been the victim of the alleged fraud and forgery as he has been cheated upon of his hard earned money which he had paid as premium for the said insurance cover. That whereas, the opposite party has failed to specify as to how the opposite party has been prejudiced by the alleged previous fake insurance cover. The opposite party has also failed to specify as to why this verification was not got done earlier at the time of issuing a fresh insurance policy to the Complainant in respect of the vehicle in question.  That therefore the alleged contention of the opposite party regarding the previous cover note being false is only a ploy to avoid the legitimate insurance claim of the Complainant. It is pertinent to note that the Complainant had not raised his present claim under the alleged fake insurance cover and therefore the opposite party has failed to specify as to how it has been prejudiced by the alleged fraud having been played upon earlier upon the Complainant while being issued the alleged fake insurance cover. That from the perusal of the present insurance policy, it is also pertinent note that the Complainant has not sought any discount on account of no claim (NCB) and thus he had paid the complete premium as demand by the opposite party. That the opposite party has therefore failed to specify as to what benefit would the Complainant may have achieved by forging the previous cover note. That it is pertinent note that even the surveyor of the opposite party in his report has not opinioned that the Complainant was not in possession of the car as on the date of mishap and therefore the opposite party has failed to specify as to what purpose of the Complainant would have been served by forging a previous cover note as alleged. It is denied that the Complainant by any of his voluntary acts has breached the sine qua non of the insurance contract as alleged.”

          Complainant has filed his own affidavit in evidence. On the other hand, affidavits of Sh. Pankaj Kumar, Legal Manager of OP and Sh. Sunil Malhotra, Investigator have been filed in evidence on behalf of the OP.

          Written arguments have been filed on behalf of the parties.

          We have heard the arguments on behalf of the parties and have also perused the material placed before us.

Suppression of material facts from the Insurance Company while taking an insurance policy, may it be a vehicle insurance policy or personal insurance policy or life insurance policy, amounts to playing fraud and misrepresentation on the Insurance Company.

In the present case, the case of the complainant is not that he had given particular of a fake insurance policy in respect of the vehicle in question stated to have been taken from Shriram General Insurance Company bearing Policy No.102115/21/19/00115 while taking the policy in question from the OP.  On the other hand, his case is that no prejudice has been caused to the OP with the suppression of this fact from the OP Co. while taking the policy in question or while dealing with the claim in question of the complainant.  We do not agree with him. Prejudice must be deemed to have been caused to the OP with the suppression of this fact by the complainant. If the earlier policy allegedly taken by the complainant from Shriram General Insurance Company was fake one and this fact had been made known to the OP, the OP would have perhaps not issued the policy in question to the complainant at all or would have charged an enhanced premium amount from him. The complainant had a malafide intention while submitting the particulars of a fake policy to the OP while obtaining the policy in question from the latter. The condition stipulated in condition No.1 of the policy in question is not in dispute. We have reproduced the relevant portion of the policy hereinabove.  Therefore, the claim of the complainant is hit by the said terms and conditions of the policy in question.

           According to the Complainant, he had given intimation to the OP regarding theft of the vehicle on 19.02.11 at about 9.20 a.m. after the lodging of the FIR (copy of the FIR Ex. CW-1/3). The said intimation was not a written intimation. There is also no material on the record to prove that after giving information to the OP on 19.02.11 the complainant had followed the matter with the OP and made repeated calls on 10.03.11, 20.03.11, 11.04.11 and 13.04.11. The OP has denied the receipt of any such information from the complainant.   The copy of the untrace report has been filed as Ex. CW-1/6 which shows that the FIR had been sent untraced on 30.03.11. Without going into the aspect whether the police had sent the untrace report in a hurry without investigating the matter properly, we are of  the considered opinion that sending a written intimation by the complainant to the OP after the untrace report sent on 30.03.11 could not amount  to immediate intimation sent to the OP with regard to theft of the vehicle in question. Therefore, we hold that the delay of about 55 days in sending intimation by the complainant to the OP was fatal to him. In case the intimation had been sent to the OP in time the OP could have got the case investigated in its own manner and perhaps could have been able to trace out the vehicle by using its own sources/recourses. Insurance contract has to be construed like any other contract on basis of its terms and conditions and outside aid for construction of insurance policy is impermissible.  Delay in intimation amounts to breach of the condition of the insurance policy and in such a case repudiation of the claim is totally justified (see Jaswer Singh Vs. Reliance General Insurance Co. Ltd. II (2013) CPJ (NC) 21B and New India Assurance Co. Ltd. Vs. Pankaj Kapoor II (2013) CPJ 406 (NC). Therefore, we hold that the complainant has failed to prove any deficiency in service on the part of the OP while repudiating the claim in question of the Complainant.  Therefore, we dismiss the complaint with no order as to cost.

Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations.  Thereafter file be consigned to record room.

Announced on 14.03.17.