DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

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

(Behind Qutub Hotel), New Delhi-110016

Case No. 299/2017

Dr. Satinderpal Aggarwal       

R/o 3-B/46,

Jawahar Nagar,

Sri Ganga Nagar, Haryana-335001                                ….Complainant

Versus

1.       Iffco Tokyo General Insurance Company Ltd.                                    Through its Managing Director

Registered Office at:

Iffco Sadan, C-1, District Centre,

Saket, New Delhi-110017

          Also at:

          Iffco Tower 4^th and 5^th Floor,

          Plot No.3, Sector-29,

          Gurugram Haryana-122001

2.       Branch Head

          Iffco Tokyo General Insurance Co. Ltd.

          Plot No. B & C

          Sector-28-A, Madhya Marg,

          Chandigarh                                                          ….Opposite Party

                                                Date of Institution                    :  25.08.17                                                                     

                                                                   Date of Order        :  05.03.20

Coram:

Ms. Rekha Rani, President

Ms. Kiran Kaushal, Member

Ms. Kiran Kaushal, Member

ORDER

1. Brief fact as stated by the complainant are that the complainant got his vehicle insured from Iffco Tokyo General Insurance Company Ltd. hereinafter  referred to as OP and paid premium of Rs.13401.48. The said policy was valid from 24.12.16 to 23.12.17. 
   1. It is averred that within the insurance period i.e. 20.02.2017 the complainant’s vehicle met with an accident and was damaged. The complainant approached the authorized dealer of Honda Company for getting the car repaired.  It is stated that the insurance policy in question was cashless however the authorized dealer apprised the complainant that they do not deal with cashless policy and the cost of repairing of the vehicle will be Rs.42,301/-.  The complainant informed OP regarding the same and was told that after submitting the documents from dealer with respect to the damaged car the amount in question shall be reimbursed to the complainant. The complainant thereafter made several request to OP to reimburse the aforesaid amount of Rs.42,301/- paid to the dealer by the complainant. However, after various request OP repudiated the claim of the complainant stating-

“No claim bonus was claimed and availed by you while insuring the vehicle in question with us as per the terms and conditions of the policy. It is submitted that earlier the complainant have never availed any claim with respect to the aforesaid vehicle from the respondents.”

1. Dissatisfied and aggrieved on account of the repudiation  the complainant approached this Forum to direct OP to pay the insurance claim of Rs.48301/- alongwith 18% interest, Rs.1,55,000/- with interest @ 18% as compensation for mental torture & harassment and litigation cost.

2. OP resisted the complaint inter-alia stating that on receipt of the intimation regarding the accident of the complainant’s vehicle OP appointed an Independent Surveyor for verifying the facts and  assessment of the loss to the insured vehicle.
   1. According to the Surveyor the total amount assessed against the damaged caused was Rs.31,700/-.  It is submitted that on receipt of report and on perusal of other documents pertaining to the claim it was observed by the OP that-

“No claim bonus was claimed and availed by the complainant while insuring the subject vehicle with the opposite party. As per the terms and conditions of the policy:

Notwithstanding anything to the contrary contained in the policy, it is hereby agreed, understood and warranted that No Claim Bonus (NCB) allowed under the Policy is subject to the fact that own damage claim experience of your insured vehicle or your earlier vehicle (in case of transfer of No Claim Bonus from the earlier vehicle) in previous year policy (s) was Nil. Accordingly you give the consent and accept that the “No Claim Bonus” (NCB) allowed under this current Policy for Insured Vehicle is based on the above Nil Claim history. However, if we find that the basis of availing the “No Claim Bonus” under the current policy is incorrect; then we will imposed suitable damages at the time of claim under Own Damage Section of the policy, which may at our discretion include forfeiture of all benefits under the Own Damage Section of the Policy. In case you find that  No Claim Bonus under the present policy is not correct, then you may please deposit amount for No Claim Bonus (NCB) to us within 10 day (s) from the date of insurance policy for the continuation of the benefits under the Own Damage Section of the Policy.”

1.  OP further submits that it was confirmed from the website of Insurance Information Bureau Portal of India that an OD claim amounting to Rs.21,511/- had already been availed via Universal Sonpo General Insurance Company Ltd. for accidental loss dated 14.11.15. Hence, the NCB slab should have been 20% instead of 35% availed by the insured in the current policy. It is in these circumstances it was concluded by OP that there was gross misrepresentation and withholding of the material facts on the part of the complainant, therefore opted to forfeit the benefit under the policy. It is submitted that based on the facts above the complaint made by the complainant is untenable as the claim has been rightly treated as no claim by OP. Hence, it is prayed that the complaint be dismissed with cost.

3. Complainant opted not to file rejoinder.  Evidence by way of affidavit of the complainant and Sh. Saurabh Singh, Vice- President of OP have been filed.  
4. Written submissions are filed on behalf of the parties.
5. Oral submissions made on behalf of the parties are heard. Material placed on record is perused carefully.
6. The only question to be decided in the present complaint is whether the claim of the complainant was repudiated rightly or not. The claim of the complainant was repudiated by the OP stating-

‘No claim bonus was claimed and availed by you while insuring the above said vehicle with us’.

          Attention is hereby drawn towards undertaking made by you in the claim form as under:

I/We hereby understand, agree and submit that No Claim Bonus (NCB) allowed to me/us under the  Policy for which the claim is being preferred/lodged is subject to the fact that the own damage claim experience for the  insured  vehicle or my/our earlier insured vehicle ( in case of transfer of No Claim Bonus from earlier insured vehicle) in previous year policy (s) was Nil. Accordingly I/We once again submit/ undertake that the “No Claim Bonus” (NCB) allowed under the current policy for the Insured Vehicle for which the Claim is preferred is based on the above Nil Claim history. Further I/We undertake and submit that in case the basis of availing the No Claim Bonus (NCB) under the current policy is incorrect, then the company may at its discretion impose suitable damages on the preferred claim which may include forfeiture of all benefits of all benefits on own damage section of the policy.”

7. Undertaking made by the complainant is very clear on the fact that the current year policy for the insured vehicle is based on the Nil Claim History. OP has appended a No Claim Bonus Data Report at page 11 with its evidence wherein it is clearly mentioned that the registration number of the vehicle PB59A5477. The total OD claim paid is Rs.21,511/-.   The contract between the insured and the insurer is based on Uberrima fides utmost good faith. The complainant chose to withhold the material facts while entering into the contract with the OP.  Hence, this Forum is of the opinion that OP had rightly rejected the claim as per terms and conditions mentioned in the insurance policy.  Having made an undertaking the complainant now cannot hide behind the fact     that the complainant has not availed any claim with respect to the aforesaid vehicle from OP.
8. Thus in view of the discussion above, we find that the complaint is meritless and has no substance we are withholding ourselves from imposing cost for filing such complaint. Case is accordingly dismissed. File be consigned to record room.  

10. 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.