ORDERS:

Nidhi Verma, Member

1        The complainant has filed the present complaint by invoking the provisions of Consumer Protection Act under Section 12 and 13 against the opposite parties on the allegations that the complainant Gurpreet Singh is filing the present complaint through Tarlochan Singh as he is working at Muscat, (Oman) and as such is not available for pursuing the present complaint and Tarlochan Singh has been appointed Special Power of Attorney Holder of complainant Gurpreet Singh through special power of attorney dated 18.4.2019. Tarlochan Singh is real brother of Gurpreet Singh complainant and is fully conversant with the facts of the present case. Gurpreet Singh purchased one Motorcycle bearing registration No. PB46-Z-1450 from Karan Motors Goindwal Sahib, Tarn Taran on 12.4.2017 and the same was insured by Gurpreet Singh through opposite party vide insurance policy having No. 3005/36304790/30547/000 which was valid from 14.4.2017 to 13.4.2019 by paying Rs. 3,509/- as gross premium to the opposite party at Goindwal Sahib Tarn Taran. The value / purchased price of the motorcycle mentioned above was Rs. 45,242/- at the time of insuring it with the opposite party. Unfortunately, the abovementioned motorcycle belonging to Gurpreet Singh was stolen on 20.12.2017 from village Sarhali Kalan, Tarn Taran and after knowing of the theft of the motorcycle Gurpreet Singh immediately approached to police station Sarhali Tarn Taran and moved a complaint to the police and the police immediately registered the complaint with No. 12-Dasti Police Station Sarhali dated 20.12.2017 and the occurrence of theft of the motorcycle was clubbed by the police in the FIR No. 141 dated 1.12.2017 already registered at P.S. Sarhali under the Section 379 IPC being an offence of similar nature as that of the FIR and it was a routine practice in such like cases by the Punjab Police. Gurpreet Singh also immediately lodged the claim of the insurance with the opposite party and also supplied the required documents to the opposite party which consisted of the copy of FIR, copy of complaint, copy of insurance policy and copy of Police DDR. The opposite party assured Gurpreet Singh that the claim of the value of the vehicle will be released to him in a fortnight. The opposite party had been corresponding with Gurpreet Singh on various occasions during the proceedings of claim case and Gurpreet Singh had been complying with the requisites of the opposite party as and when made by them. Gurpreet Singh was very much embarrassed, humiliated and harassed when he received letter dated 15.11.2018 qua which the opposite party closed the claim case of Gurpreet Singh’s Motorcycle by giving false reasons for the same.  After receiving the above mentioned letter from the opposite party, the complainant sent a legal notice dated 24.1.2019 to the opposite party, whereby he cleared the facts of the case on the basis of which opposite party had closed his claim case and also gave 30 days time to review its decision on the basis of actual facts but of no avail. The complainant has prayed that the opposite party No. 1 may be directed to release the insurance claim of Rs. 45,242/- to Gurpreet Singh i.e. value/ purchased price of the motorcycle as per the insurance policy and prayed Rs. 50,000/- as compensation and Rs. 20,000/- as litigation expenses. Alongwith the complaint, the complainant has placed on record affidavit of Tarlochan Singh Ex. C-1, Special Power of attorney deed dated 18.4.2019 Ex. C-2, Self attested copy of Registration Certificate Ex. C-3, self attested copy of insurance policy Ex. C-4, Self attested copy of complaint to SHO dated 20.12.2017 Ex. C-5, self attested copy of FIR Ex. C-6, self attested copy of letter dated 15.11.2018 Ex. C-7, Self attested copy of letter dated 19.6.2018 Ex. C-8, self attested copy of letter dated 24.8.2018 Ex. C-9, Self attested copy of letter dated 18.4.2018 Ex. C-10, Self attested copy of letter Ex. C-11, Self attested copy of letter dated 18.4.2018 Ex. C-10, Self attested copy of letter Ex. C-11, Self attested copy of legal notice dated 22.1.2019 Ex. C-12, Postal receipt dated 24.1.2019 Ex. C-13 to Ex. C-15, self attested copy of receipt of bill dated 12.4.2017 Ex. C-16, Self attested copy of DDR dated 20.12.2017 Ex. C17, Self attested copy of Adhar Card Ex. C-18, Self attested copy of passport of Gurpreet Singh Ex. C-19.

2        Notice of this complaint was sent to the opposite party and opposite party appeared through counsel and filed written version inter-alia pleadings that the present complaint is not legally maintainable. The complainant has not come to the commission with clean hands and has suppressed the material facts from the knowledge of this commission. The present complaint bas bad for misjoinder and non joinder of necessary parties. The present complaint is baseless and abuse of process of law just to harass the opposite party. The opposite parties seek protection under Section 45 & Section 64 V.B. of the Insurance Act and reserves its right to file any other additional facts or submissions as may be warranted in future.  There is no negligence on the part of the replying opposite parties. The complainant has distorted the facts to suit his version. The true and real facts of the present case are that the present claim of the complainant has been lodged with regard to the theft of the two wheeler bearing No. PB46-Z-1450, after receiving the said claim, the said claim was registered vide No. MOT0751112 against the policy and the surveyor was appointed for its report and in this regard one letter dated 18.4.2018 was issued to the complainant which is Ex. OP1, thereafter, one reminder letter dated 22.5.2018 was also issued to the complainant, which is Ex. OP2, through which certain documents were demanded, despite of receiving the letters, no proper reply was given, finding no other way, one another reminder dated 19.6.2018 was given, which is Ex. OP3 in which also certain documents were demanded. After receiving the documents, the said documents were processed and it was found that complainant has breached the terms and conditions of the policy as the date of loss as informed by complainant was 1.12.2017 and the intimation to the police was given on 20.12.2017 and the said claim was lodged with the insurance company on 16.4.2018 which is in violation of the terms and conditions of the policy. The said claim was repudiated on this ground, as the claim was lodged in violation of terms and conditions of the policy. The said reputation letter is Ex. OP4. Thereafter, again one another letter dated 15.11.2018 was also served upon the complainant, which is Ex. OP5 from the above said facts, it is clear that complainant has violated the terms and conditions of the policy and as such, claim of complainant stands as no claim. The intimation was also given to complainant vide above said letters, but the said facts have been concealed by the complainant while filing the present complaint. The execution of alleged attorney is not as per law, as such, Tarlochan Singh is not competent to file the present complaint. The policy issued to the complainant was subject to certain terms and conditions.  The copy of the said policy is Ex. OP-6 and its terms and conditions are Ex. OP6/A. The intimation regarding the theft was given to the opposite party on 16.4.2018 as stated above which is against the terms and conditions of the policy. After receiving the claim, the replying opposite party has made regular correspondence with the complainant to pursue the claim and in this regard many letters were issued to the complainant but no proper reply has been given by the complainant. The opposite parties have denied the other contents of the complaint and prayed for dismissal of the complaint. Alongwith the written version, the opposite parties have placed on record letter dated 18.4.2018 Ex. OP-1,Reminder letter dated 22.5.2018 Ex. OP-2, One another reminder dated 19.6.2018 Ex. OP-3, Repudiation letter Ex. OP-4, letter dated 15.11.2018 Ex. OP-5, Policy is Ex. OP-6

3        We have heard the Ld. counsel for the parties and have carefully gone through the record placed on the file.

4        In the present complaint, the complainant purchased one Motorcycle bearing registration No. PB46-Z- 1450 from Karan Motors Goindwal Sahib Tarn Taran on 12.04.2017 and the same was insured by Gurmeet Singh through OP, policy No. 3005/36304790/30547/000 which was valid from 14.04.2017 to 13.04.2019 by paying Rs. 3509/- as gross premium. On dated 20.12.2017 above mentioned motorcycle was stolen from village Sarhali Kalan ,Tarn Taran . The complainant immediately approached the police station Sarhali Tarn Taran and the police registered the complaint with No. 12 dasti dated 20.12.2017 and occurrence of the theft of the motorcycle was clubbed by the police in the FIR No. 141 dated 01.12.2017.

5        The complainant lodged the claim of the insurance with the OP and also supplied the required documents to the OP which consisted of the copy of FIR, copy of complaint , copy of Insurance policy and also copy of the police DDR. On dated 15.11.2018 the complainant received the letter (Ex. C 7) from OP stating that the OP closed the claim case of Gurmeet Singh’s motorcycle :- “as vehicle was stolen on 1^st December, 2017 and FIR for the same has been lodged on 20^th December, 2017 . The FIR was lodged after 19 days of the theft which is violation of terms and conditions of insurance policy. Further the complainant intimated claim to insurance after 136days of date of loss.”

6        The complainant sent a legal notice to the OP dated  24.01.19 (Ex.C-12) whereby he cleared the facts of the case on the basis of which OP had closed his claim case but till date no reply of the above legal notice was ever given by the OP.

7        Opposite Party stated in their written version that after receiving the said claim , the said claim was registered vide No. MOT0751112 against the policy and the surveyor was appointed for it’s report and in this regard letters were issued to the complainant through which certain documents were demanded :-

After receiving the documents the said documents were processed and it was found that the complainant have breached the terms and conditions of the policy:- “as the vehicle was stolen on 1^st December, 2017 and FIR for the same has been lodged on 20^th December, 2017 . The FIR was lodged after 19 days of the theft which is violation of terms and conditions of insurance policy. Further the complainant intimated claim to insurance after 136days of date of loss.” The said claim was repudiated on this ground, as the claim was lodged in violation of terms and conditions of the policy.

8        We have heard the Ld. Counsel and have gone through the documents placed on record. The only defence of the OP is that there is a delay of 19 days in giving notice to the police and to insurance company for 136 days. Whereas, the aforementioned condition speaks of immediate notice to police as well as insurance company. As it is clear that the complainant has violated the terms and conditions of the policy and as such , claim stands as no claim. But it is common knowledge that a person who lost his vehicle may not straightaway go to the insurance company to claim compensation. At first, he will make an efforts to trace the vehicle. It is true that the owner has to intimate the insurer immediately after the theft of the vehicle. However, this condition should not bar settlement of genuine claims particularly when the delay in intimation or submission of documents is due to unavoidable circumstances. The decision of the insurer to reject the claim has to be based on valid grounds. If the reason for delay in making a claim is satisfactory explained such a claim cannot be rejected on the ground of delay. In the present complaint, the complainant after receiving the repudiation letter (Ex.C-7) on dated 15^th Nov 2018 , the complainant sent a legal notice to the OP dated 24.01.2019 (Ex. C12) where he cleared the facts of the case on the basis of which OP had closed his claim case. The complainant stated in their legal notice that :-

“The reason for deny of the claim that the said vehicle had been stolen on 01.12.2017 and the FIR was lodged after 19 days of theft i.e. on 20.12.2017. It is pertinent to mention here that the FIR No. 141 dated 01.12.2017 has been got lodged by Harmanjit Singh S/o Ranjit Singh R/o village Pringri ,PS Harike , District Tarn Taran and not got registered by the complainant but the official of P.S. Sarhali was investigating the theft of motorcycle of the complainant in FIR No. 141 dated 01.12.2017 as the mode of theft in both the cases is same.” To prove this point, the complainant placed on record as an evidence the copy of complaint of theft to SHO dated 20.12.2017 as ( Ex. C 5) ,the complaint with No. 12 dasti police station Sarhali dated 20.12.2017 mentioned clearly. Further, the complainant placed on record FIR as (Ex. C 6) dated 01 .12. 2017 , clearly mentioned in the complaint that the occurrence of theft of the motorcycle was clubbed by the police in the FIR No. 141 dated 01.12.2017 already registered at P.S Sarhali under the section 379IPC being an offence of similar nature as that of the FIR and it was a routine practice in such like cases by the Punjab police. Further the complainant placed on record the DDR on dated 20.12.2017 (Ex. C-17) clearly stated that No. 12 Dasti clubbed with FIR No. 141 dated 1.12.2017.

However, even after receiving the legal notice OP has not reconsidered the claim case, as there is no delay on the part of the complainant for lodging the complaint before police regarding theft of Motorcycle bearing registration No PB46-Z-1450 . As Motorcycle was stolen on 20.12.2017 and complainant had moved the complaint bearing No 12 dasti dated 20.12.2017 ,on the same day DDR has been lodged . The occurrence of this DDR also co relate with the incident in the FIR 141 dated 01.12.2017 , which was clubbed by the Punjab police as an offence of similar nature as that of the FIR  (Ex. C-17).

Hence, it reveals in Ex.C-5, Ex.C-6, Ex. C-12 and Ex C17 that the complainant has lodged the complaint for the stolen Motorcycle to the police on the same date i.e. 20.12.2017 and after he or police could not traced it in his searching and then he lodged a complaint before the insurance company. The complainant have to give intimation to the insurer about the theft of the vehicle on the same day but it is common knowledge that a person who lost his vehicle may not straightaway go to the insurance company to claim compensation but at first he make the efforts to trace the vehicle. The complainant has placed reliance in Civil appeal No. 653 of 2020 titled Gurshinder Singh Vs Shri Ram General Insurance co. Ltd. And Anr. Of Supreme Court of India and relevant Para No. 16 of the citation is as:-

It is further to be noted that in the event after the registration of an FIR the police successfully recovering the vehicle and returning the same to the insured there would be no occasion  to lodge a claim for compensation on account of the policy . It is only when the police are not in a position to trace and recover the vehicle and the final report is lodged by the police after the vehicle is not traced, the insured would be in a position to lodged his claim for compensation.  As observed by the bench of two learned judges in the case of Om Prakash (supra), after the vehicle is stolen a person who lost his vehicle would immediately lodged the FIR and immediate conduct that would be expected of such a person would be to assist the police in search of the vehicle.  The registration of the FIR regarding the theft of the vehicle and the final report of the police after the vehicle is not traced would substantiate the claim of the claimant that the vehicle is stolen. Not only that but the surveyors appointed by the insurance company are also required to enquire whether the claim of the claimant regarding the theft is genuine or not.  If the surveyor appointed by the insurance company upon inquiry finds that the claim of the theft is genuine then coupled with the immediate registration of the FIR in our view would be conclusive proof of the vehicle being stolen.

In ibid citation, it has rightly held that mere delay in intimating the insurance company about the theft of the vehicle should not be a sheltered to repudiate the insurance claim which has been otherwise proved to be genuine.

9        We therefore answer the reference accordingly:-

          In the present case, the theft had occurred on 20.12.2017 and the complainant approached the police station Sarhali Tarn Taran and moved a complaint to the police and the police immediately registered the complainant with No 12 Dasti police station Sarhali dated 20.12.2017 and the occurrence of the theft of the motorcycle was clubbed by the police in the FIR No. 141dated 01.12.2017 already registered at P.S Sarhali under section 370IPC being an offence of similar nature as that of the FIR. After receiving the repudiation letter from OP on dated 15^th November, 2018 , where FIR lodged and theft date misunderstood by the OP , the complainant sent the legal notice to clarify his point as mentioned above but after that clarification the OP had not reconsider the claim case of the complainant. Information by complainant was given to opposite party:-

          Date of theft                                      20.12.2017

          D.D.R./Approached Police                20.12.2017 (Ex. C-5, C-17)

          FIR clubbed as of same  occurrence  :1.12.2017 (Ex. C-6)

          information misunderstood by OP    :-

          Date of Theft                                     :1.12.2017

          Date of FIR                                       :20.12.2017 (Ex. C-7)   

          This all shows that the opposite party has taken the contradictory stand in repudiation the claim of the complainant.

10      Otherwise also, it is admitted fact that intimation about theft was given to the Opposite Party with minor delay. This delay in the opinion of the Commission is not such a delay which could compel the insurance company to close or repudiate the claim of the complainant. Otherwise also, a circular dated 20.9.2011 was issued by IRDA, referred to all the insurance companies, which reads as under:-

“Circular

To:    All Life Insurers and non-life insurers

Re:    Delay in claim intimation/ documents submission with respect to

i)       All life insurance contracts and

ii)      All Non-life individual and group insurance contracts.

          The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.

          The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances. The insurers’ decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such intimation clause does not work in isolation, and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result  in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.

Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have  otherwise been rejected even if reported in time.

The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers’ stand to condone delay on  merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.

                                                          J. Harinarayan

                                                            Chairman”:

A bare reading of circular shows that if the claim is otherwise payable then it should not be repudiated or rejected simply on the ground of delay and delay is only to be considered when claim is otherwise not made out and is liable to be rejected even if the matter has been reported in time. In case titled as National Insurance Company Limited Vs. Kulwant Singh 2014(IV) CPJ page 62 (NC) the Hon’ble National Commission  observed that the insurance company should not have repudiated the claim merely on account of delay in giving the information to insurance company particularly when there was absolute no delay in lodging the FIR with the police. Moreover, in similar case titled as Reliance General Insurance Company Limited- Petitioner Vs. Sri Avvn Ganesh-Respondent 2012(1) CPJ page 176  in case under Consumer Protection Act, 1986 the intimation of death was given to the insurer with delay and claim was repudiated on the ground that death of insured was intimated after 4 months as against stipulated period of one month. The complainant filed complaint on the allegation of deficiency in service by insurance company, but the same was dismissed, but appeal filed by the complainant was allowed by Hon’ble State Commission. On revision, the Hon’ble National Commission, New Delhi observed that all the conditions for acceptance of insurance claim except point of reporting loss within one month of its occurrence had been substantially  fulfilled and delayed intimation of death of insured due to injuries he suffered on account of accident could not be held to be destructive to insurance claim because the facts and circumstances of death were clearly established on the basis of medical on records as well as  deposition of doctor who attended the insured and it was observed that like in case of theft of moveable insured property, delay in intimation was not prejudicial to the insurer because in such cases, Insurance company was not prevented, because of delay, from carrying out any investigation into the facts and circumstances as to whether the accident and consequent loss fell within the substantive condition of insurance policy and no infirmity  was found in the order and revision petition was dismissed. In the case in hand also, the theft of vehicle in question was reported to the police immediately after the theft. By repudiating the genuine claim of the complainant, it amounts to deficiency in service and unfair trade practice. 

11      In light of the above discussion, the complaint succeeds and the same is hereby allowed with costs in favour of the complainant. The opposite party is directed to pay the insurance claim of Rs. 45,242/- to the complainant. The complainant has been harassed by the opposite party unnecessarily for a long time. The complainant is also entitled to Rs. 15,000/- as compensation on account of harassment and mental agony and Rs 11,000/- as litigation expenses. Opposite Party is directed to comply with the order within one month from the date of receipt of copy of the order, failing which the complainant is entitled to interest @ 9% per annum, on the awarded amount, from the date of complaint till its realisation.  This complaint could not be decided within prescribed period due to heavy pendency of cases in this commission and COVID-19. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.

Announced in Open Commission.

02.03. 2023