Punjab

Ludhiana

CC/20/66

Gurdeep Bassi - Complainant(s)

Versus

ICICI Lombard Gen.Insurance Co.Ltd - Opp.Party(s)

Ravinder Modgill Adv.

13 Sep 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:66 dated 17.02.2020.                                                 Date of decision: 13.09.2023.

 

Gurdeep Bassi aged about 53 years son of Shri Charan Dass, Resident of House No.9254/1, St. No.11, Chanderlok Colony, Rahon Road, Ludhiana. Mobile No.98155-89751.                                                                                                                                                                                ..…Complainant

                                                Versus

1. M/s. ICICI Lombard General Insurance Co. Ltd., T.F. 1-5, 3^rd Floor, 88, Kunal Tower, The Mall Road, Ludhiana-141001, through its Manager/Authorized signatory.
2. M/s. ICICI Lombard General Insurance Co. Ltd., Registered office at ICICI Lombard House, 414, P. Balu Marg, Off Veer Sawarkar Marg, Near Siddhivinayak Temple, Prabhadevi, Mumbai-400025, through its Managing Director.
3. M/s. Capital First Limited, SCO-24, 2^nd Floor, Ludhiana Trade Tower, Feroze Gandhi Market, udhiana-141001 and 2^nd Address One India Bulls Center, Tower 2A and 2B, 10^th Floor Senapati Bapat Marg, Lower Parel (West), Mumbai-400013.                                                                                                                                                    …..Opposite parties 

Complaint Under section 12 of the Consumer Protection Act, 1986.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Rajan Modgill, Advocate.

For OP1 and OP2          :         Sh. G.S. Kalyan, Advocate.

For OP3                         :         Sh. Rahul Rajput, Advocate.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Briefly stated, the facts of the case are that the complainant got insured his TVS Sports motor cycle bearing registration PB-91-C-4455 from opposite party No.1 and 2 vide policy No.3005/TV-13481043/00/000 dated 26.10.2018 having validity from 26.10.2018 to 25.10.2019. The said motor cycle was hypothecated with opposite party No.3 for which the complainant had regularly paid 23 installments. The complainant claimed that his motor cycle was snatched by three unknown persons at Ferozepur Road, Near Friends Regency, Ludhiana including his driving license, registration certificate, Rs.2300/- and he got registered an FIR No.191 dated 02.07.2019, U/s.379-B/34 IPC with police station Division No.8, Ludhiana. The complainant further stated that he approached opposite party No.1 and its officials vide letter dated 06.09.2019 demanded the following documents:-

          a) GD Entry/100 no. call recording/PCR copy

          b) All keys

          c) Court certified untraced report

          d) Original RC

According to the complainant, he provided one key of the motor cycle along with copy of FIR and told the officials of opposite party No.1 that one key was taken by the thieves at the time snatching the motor cycle along with other documents. The complainant received letter dated 31.10.2019 from the opposite parties vide which they rejected the claim by mentioning that the vehicle was stolen on 06.06.2019 and FIR was lodged on 02.07.2019 and there is delay of 26 days, which is violation of terms and conditions of the policy and also mentioned that the claim was intimated to the insurer on 04.07.2019 after 28 days. Moreover, opposite party No.3 is demanding remaining installments from the complainant. Even opposite party No.3 has sent a legal notice dated 03.12.2020 to the complainant.  The complainant claimed to have suffered harassment, mental agony and torture due to deficiency in service on the part of the opposite parties for which he is entitled to compensation of Rs.5,00,000/-. In the end, the complainant prayed for issuing direction to opposite party No.1 and 2 to pay the amount of motor cycle and to stay the proceedings of repudiation of claim along with compensation of Rs.5,00,000/-.

2.                Upon notice, the opposite parties No.1 and 2 appeared and filed their joint written statement and by taking preliminary objections, assailed the complaint on the ground of maintainability of the complaint; lack of cause of action; concealment of facts etc. The opposite parties stated that on receipt of the claim intimation, regarding snatching of vehicle in question, they deputed Investigator Rajiv Kumar Nischal of Ferozepur City, who investigated the claim and submitted his report dated 13.07.2019.  The opposite parties sent letter dated 15.07.2019 to the complainant with request to provide PCR detail and to explain the reason of delay in notice to the police and insurance company, which is reproduced as under:-

“The date of loss as informed by you is 06.06.2019 and the notice/intimation to the policy is dated 02.07.2019 and insurance company on 04.07.2019.

Condition No.1 of the Motor Insurance Policy wording as follows:-

Notice shall be given in writing to the police immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. Every letter claim writ summons and/or process or copy thereof shall be forwarded to the company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution Inquest of Fatal Inquiry in respect of any occurrence which may give rise to a claim under this policy. In case of theft or criminal act which may be the subject of a claim under this policy the insured shall give immediate notice to the company in securing the conviction of the offender.

There has been a delay of 26 days in given notice to the police and to insurance company for 28 days, whereas, the aforementioned condition speaks of immediate notice to the police as well as insurance company.

Also if you have called police control room no.100 to report theft incident of said vehicle then please provide PCR details for the same. In above view, you are requested to acquaint us with the reason for the delay in notice to the Police and insurance company.

Please be noted that the company has to decide a claim within a given time frame, therefore, an early response to this letter, preferably within a 7 days from the date of receipt of this letter, would be appreciated. In absence of any response from your side, we would be constrained to close the claim for non-compliance of condition 1 of the policy wordings.”

The opposite parties further stated that they gone through the claim file very minutely and after applying their mind, repudiated the claim vide letter dated 31.10.2019, operative part of which is reproduced as under:-

"After scrutinizing the documents submitted and further surveying the facts of the claim, we regret we are unable to honor the claim for due to the below mentioned reasons: The above mentioned vehicle was stolen on June 06, 2019 and FIR for the same has been lodged on July 02, 2019. The FIR for the stolen vehicle is lodged after 26 days of the theft of the vehicle. This is in violation of the terms and conditions of Insurance Policy. The FIR should have been immediately lodged after the theft. The Motor Insurance Policy issued to you clearly states- In case of theft or criminal act which may be the subject of claim under the policy, the insured shall give immediate notice to the Police and cooperate with the company in securing the conviction of the offender.

In addition, the claim was intimated to the Insurer on Jul 04, 2019 i.e. after 28 days. This is in violation of policy terms & conditions. As per Policy terms - Notice shall be given in writing to the company immediately upon the occurrence of any accident loss or damage or theft in the event of any claim and hereafter the insured shall give all such information and assistance as the company shall require.

In the circumstance, you are therefore, informed that the above captioned claim as made by you hereby stands as "Rejected"

The opposite parties further stated that they have rightly repudiated the claim of the complainant.

                   On merits, opposite parties No.1 and 2 reiterated the crux of averments made in the preliminary objections and facts of the case. Opposite parties No.1 and 2 have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.      

3.                In its separate written statement, opposite party No.3 stated that it is a limited Company duly registered under Indian Companies Act. Opposite party No.3 took preliminary objections by assailing the complaint on the ground of maintainability, suppression of facts; lack of cause of action etc. Opposite party No.3 stated that the complainant availed two wheeler insurance policy from opposite party No.1 and 2 and it being corporate agent of opposite party No.1 and 2 had assisted the complainant in obtaining insurance policy by assisting in completion of the required formalities and forwarding the duly filled documents to opposite party No.1 and 2. The contract of the insurance is between the complainant and opposite party No.1 and 2 and they also received premium and issued the policy documents to the complainant. As such, the acceptance or rejection of the claim in favour of the complainant is solely done by opposite party No.1 and 2.

                   On merits, opposite party No.3 reiterated the crux of averments made in the preliminary objections and facts of the case. Opposite party No.3 have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.   

 

 

4.                In support of his claim, the complainant tendered his affidavit Ex. CA in which he reiterated the allegations and the claim of compensation as stated in the complaint. The complainant also tendered documents Ex. C1 is the copy of FIR No.191 dated 02.07.2019, Ex. C2 is the copy of invoice No.2058 dated 25.10.2018 of Alliance Automobiles, Ex. C3 is the copy of inspection notice dated 04.11.2019 issued by opposite party No.3, Ex. C4 is the copy of policy schedule w.e.f. 26.10.2018 to 25.10.2019, Ex. C5 is the copy of letter of insurance company, Ex. C6 is the copy of reminder-2 dated 06.09.2019, Ex. C7 is the copy of letter dated 31.10.2019, Ex. C8 to Ex. C10 is the copy of loan agreement, Ex. C11 is the copy of recall notice dated 03.12.2019, Ex. C12 is the copy of letter dated 06.07.2019, Ex. C13 is the copy of letter dated 15.07.2019 and closed the evidence.

5.                On the other hand, counsel for opposite parties No.1 and 2 tendered affidavit Ex. RA of Sh. Aditya Pandey, Legal Manager of opposite party No.1 and 2 along with documents Ex. R1 is the copy of repudiation QC checklist dated 18.10.2019, Ex. R2 is the copy of letter dated 15.07.2019, Ex. R3 is the copy of postal receipt, Ex. R4 is the copy of investigation report dated 13.07.2019, Ex. R5 is the copy of policy documents and closed the evidence.

                   The counsel for opposite party No.3 suffered statement that written reply filed by opposite party No.3 be considered as evidence of opposite party No.3 and closed the evidence.

6.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents and written replies along with affidavit and documents produced on record by the parties.

7.                One TVS Sports motorcycle bearing registration No.PB-91-C-4455 owned by the complainant was taken away from the lawful possession of the complainant near Hotel Friends Regency, Civil Lines, Ludhiana regarding which an FIR No.191 dated 02.07.2019 Ex. C1 was registered against unknown person by Police Station Division No.8, Ludhiana. The motor cycle in question  was insured with opposite parties No.1 and 2 and the theft had taken place during the subsistence of the policy Ex. C4, so the complainant preferred a claim for the reimbursement of the loss due to theft of the motor cycle. The claim was duly registered, entertained and processed and in pursuance thereof Sh. Rajiv Kumar Nischal was deputed for investigation who submitted the investigation report on 13.07.2019 Ex. R4, the operative part of the same reads as under:-

1) On 06-06-2019 insured Gurdeep Bassi son of Charan Dass after finishing his programme at Hotel Nagpal was returning to his home on his TVS Sports Motorcycle bearing RC No. PB-91-C-4455 and when he reached a little ahead of hotel Friends Regency, Near Bharat Nagar, Ludhiana at 2.00/2.30 AM, then one auto came from backside and has stopped the motorcycle of insured and three unknown persons came out from said auto and had snatched the said motorcycle from insured and fled from the spot.

2) Insured reported the theft to P.S. Division No.8, Ludhiana and FIR No.0191 was registered with P.S. Division No. 8, Ludhiana on 02-07-2019, U/S 379-B, 34 of IPC with delay of 26 days on the statement of insured.

3) Name of 1.0. is Shish Pal, SI and his contact number is 98767-00437.

4) RTI filed with SSP Ludhiana.

5) The original RC/Policy lost with said vehicle.

6) Insured has handed one new key and one key was lost with the snatching of said vehicle.

7) Insured has intimated the theft to insurer with delay of 28 days and the same not justified by him.

8) Photographs of loss spot enclosed with.

9) HPA with Capital First Bank Ltd. not mentioned in invoice.

10) Insured has not produced loan account statement from Capital First Ltd.

11) Theft by snatching seems genuine but there is inordinate delay in intimation to IL and registration of FIR, Leaving the final decision with the underwriter, Hence Report.”

8.                The said report was examined by the officials of opposite parties No.1 and 2 and vide letter dated 15.07.2019 Ex. C13 = Ex. R2, called upon the complainant to provide the PCR details and to explain the reason of delay in notice to the police and insurance company within 7 days from the date of receipt of letter and otherwise, in the absence of any response, they would be constrained to close the claim for non-compliance of condition No.1 of the policy. Condition No.1 of the policy is reproduced as under:-

Condition No.1:

Notice shall be given in writing to the police immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. Every letter claim writ summons and/or process or copy thereof shall be forwarded to the company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution Inquest of Fatal Inquiry in respect of any occurrence which may give rise to a claim under this policy. In case of theft or criminal act which may be the subject of a claim under this policy the insured shall give immediate notice to the company in securing the conviction of the offender.”

Opposite party No.1 and 2 vide their letter dated 31.10.2019 Ex. C7 repudiated the claim. The operative part of the letter Ex. C7 is reproduced as under:-

"After scrutinizing the documents submitted and further surveying the facts of the claim, we regret we are unable to honor the claim for due to the below mentioned reasons: The above mentioned vehicle was stolen on June 06, 2019 and FIR for the same has been lodged on July 02, 2019. The FIR for the stolen vehicle is lodged after 26 days of the theft of the vehicle. This is in violation of the terms and conditions of Insurance Policy. The FIR should have been immediately lodged after the theft. The Motor Insurance Policy issued to you clearly states- In case of theft or criminal act which may be the subject of claim under the policy, the insured shall give immediate notice to the Police and cooperate with the company in securing the conviction of the offender.

In addition, the claim was intimated to the Insurer on Jul 04, 2019 i.e. after 28 days. This is in violation of policy terms & conditions. As per Policy terms - Notice shall be given in writing to the company immediately upon the occurrence of any accident loss or damage or theft in the event of any claim and hereafter the insured shall give all such information and assistance as the company shall require.

In the circumstance, you are therefore, informed that the above captioned claim as made by you hereby stands as "Rejected"

 

9.                In this regard, reference can be made to Gurshinder Singh Vs Shriram General Insurance Co. Ltd. and another  in Civil Appeal No.653 of 2020 decided on 24.01.2020, it has been held by the Hon’ble Supreme Court of India that when an insured has lodged an FIR immediately after the theft of a vehicle occurred and when the police after investigation have lodged a final report after the vehicle was not traced and when the surveyors/investigators appointed by the insurance company have found the claim of the theft to be genuine, then mere delay in intimating the insurance company about the occurrence of the theft cannot be a ground to deny the claim of the insured.   Recently the Hon’ble Supreme Court of India in Ashok Kumar Vs New India Assurance Co. Ltd. (2023 Live Law (SC) 583) has also endorse the same view. Reference can be made to 2022(2) Apex Court Judgment 281 (SC) in case title Gurmel Singh Vs Branch Manager National Insurance Company Ltd. whereby it has been held by the Hon’ble Supreme Court of India that the insurance company has become too technical while settling the claim and has acted arbitrarily. 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.

10.              Moreover, the investigator in its report Ex. R4 found the theft of the vehicle by snatching to be genuine. Perusal of the Policy Schedule cum Certificate of Insurance (Two Wheeler Policy) Ex. C4 = Ex. R5 shows that the ID value of the motorcycle is Rs.43,473/-. In the given set of facts and circumstances, it would be just and appropriate if the opposite party No.1 and 2 are directed to settle and reimburse the claim strictly in accordance with terms and conditions of the insurance policy along with composite costs of Rs.10,000/-.

11.              As a sequel of above discussion, the complaint is partly allowed with direction to the opposite party No.1 and 2 opposite party No.1 and 2 are directed to settle and reimburse the claim strictly in accordance with terms and conditions of the insurance policy within 30 days from the date of receipt of copy of order, failing which opposite party No.1 and 2 shall pay interest @8% per annum on the settled amount to the complainant from the date of order till actual payment. Opposite party No.1 and 2 shall further pay a composite cost of Rs.10,000/- (Rupees Ten Thousand only) to the complainant within 30 days from the date of receipt of copy of order. However, the complaint as against opposite party No.3 is hereby dismissed. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

12.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

(Monika Bhagat)                                (Sanjeev Batra)

Member                                                President         

 

Announced in Open Commission.

Dated:13.09.2023.

Gobind Ram.