IN THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, MURSHIDABAD AT BERHAMPORE.
CASE No. CC/126/2019
Date of Filing: Date of Admission: Date of Disposal:
30.08.19 05.09.19 29.06.22
Complainant: Rustam Sk
S/o Saisuddin Sk
Vill- Khuntipara, P.O.- Beniagram,
P.S.- Farakka, Dist- Murshidabad
Pin- 742212
-Vs-
Opposite Party: Manager & Deputy Vice-President
Of TATA AIG General Insurance
Company Ltd., Constantia Bldg,
2nd Floor, 11 Dr, UN Brahmachari Street,
Kolkata-700017
Agent/Advocate for the Complainant : Md Saddam Hossain
Agent/Advocate for the Opposite Party No.1 : P. Banerjee
Present: Sri Ajay Kumar Das………………………….......President.
Sri. Subir Sinha Ray……………………………….Member.
Smt. Aloka Bandyopadhyay……………………..Member.
FINAL ORDER
Smt. Aloka Bandyopadhyay, ember.
This is a complaint under section 12 of the CP Act, 1986.
One Rustam Sk (here in after referred to as the Complainant) filed the case against Manager & Deputy Vice President, TATA AIG General Insurance Co. Ltd. (here in after referred to as the OP) praying for compensation alleging deficiency in service.
The brief fact of the case is that the complainant purchased a Motor Cycle being registration No. WB/94/C/5002, Engine No. MD634RE48G2 DI6555, Type-TVS Apache RTR 160 CC, BS III, Colour Dark FR Blue, which was insured by the O.P. being Policy No. 0187615306. The said Motor Cycle has been missing along with some documents which were kept in the tool box of said Motor Cycle on 16.01.2019 at about 7.30 P.M. when the complainant went to inside the Indian Islamic School. After that he began to search here and there for the said Motor Cycle but could not find out the same. Then he immediately informed the matter to the I/C Farakka P.S. on next date i.e., on 17.01.2019 being G.D. No. 970 dated 17.01.2019 and later on F.I.R has been lodged as Farakka P.S. Case No. 38/19 dated 24.01.2019, u/s 379 IPC. But they failed to recover the said Motor Cycle and subsequently the Farakka P.S. has submitted FRT being No. 130/19.
The complainant also informed the matter to the O.P. but the O.P. repudiate his claim by sending a notice on 28.05.2019 stating that due to delayed intimation policy condition has been violated. Finding no other alternative the complainant filed the instant case for appropriate relief.
Defence Case
After due service of the notice the O.P. appeared and filed the Written Version contending inter alia that the case is not maintainable as the complainant has not intimated the matter to the O.P. within the time specified in the policy. As such the case is not maintainable and the same is liable to be dismissed with cost.
On the basis of the complaint and the written versions the following points are framed for proper adjudication of the case :
Points for decision
1. Is the Complainant a consumer under the provision of the CP Act, 1986?
2. Is the Complainant entitled to get any relief, as prayed for?
Decision with Reasons:
Point no.1 & 2
All the points are taken up together for the sake of convenience and brevity of discussion. Undoubtedly complainant is the owner of the Motor Cycle being registration No. WB/94/C/5002, Engine No. MD634RE48G2 DI6555, Type-TVS Apache RTR 160 CC, BS III, Colour Dark FR Blue, which was insured by the O.P. being Policy No. 0187615306 and the same has been missing from outside the Indian Islamic School and the complainant intimidated the matter to the I/C Farakka P.S. on the next date on 17.01.2019 being G.D. No. 970 dated 17.01.2019. The complainant also informed the matter to the O.P. but the O.P. rejected his claim for violation of the policy conditions.
The O.P. in the written version stated that claim of the insured was denied vide Letter dated 1st April, 2019 giving detailed reasons for the denial. The Ld. Advocate for the O.P. drew our attention to the that the condition No. 1 of the policy which stated as under
1. Notice shall be given in writing to the Company immediately upon the occurrence of any accidental or 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 or fatal injury in respect of any occurrence which may give rise to a claim under this policy. In case of theft or other criminal act which may be the subject of a claim under this Policy the insured shall give immediate notice to the police and co-operate with the Company in securing the conviction of the offender.
The Ld. Advocate for the O.P. stated that the complainant lodged FIR after lapse of 8 days so the repudiation is justified.
The Ld. Advocate for the complainant filed the petition starting that O.P. has returned the vehicle but it is not possible as the O.P. is an Insurance Company and it does not deal with the vehicle, its business only limited with insurance. So, the petition filed by the Ld. Advocate for the complainant is not believable. The reason for filing such type of petition is not clear to us. Hence, the said petition is rejected.
It is pertinent to mention that in a Circular No. IRDA/HLTH/MISC/CIR/216/09/2011 dated September 20, 2011 issued by Insurance Regulatory Development Authority (IRDA), the relevant portion of the same reads as under:
“The insurers’ decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation 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.”
From the guidelines of the IRDA, it is clear that genuine claims are not to be repudiated on the basis of delay in intimation to the insurance company. In the instant case the specific condition in case of theft that police must be immediately informed, has been complied with and therefore the veracity of the incident cannot be questioned. Thus, the claim seems to be applicable to this case.
The Hon’ble Supreme Court in the matter of OM Prakash vs. Reliance General Insurance & Anr. AIR 2017 Supreme Court 4836 while confronted with the similar issue observed as under:-
“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 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 for settlement of genuine claims particularly when the delay in intimation of submission of documents is due to unavoidable circumstances. The decision of the insurer to reject the claim has to be based on valid grounds. Rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. If the reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay. It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the Investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims & which have been otherwise proved to be genuine. It needs no emphasis that the Consumer Protection Act aims at providing better protection of the interest of consumers. It is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten while considering the claims made under the Act.”
It is clear from the case record that the complainant has informed the matter to the I/C Farakka P.S. on the very next date of the theft of the vehicle i.e., on 17.01.2019 being G.D. No. 970 dated 17.01.2019 and on 24.01.2019 the I/C Farakka P.S has registered the complaint as FIR being Farakka P.S. Case No. 38/2019 u/s 379 IPC and the complainant informed the matter to the Insurance Companyon 24.01.2019 i.e., after 8 days from the date of alleged theft. On 28th May, 2019 the Insurance Company rejected the claim for delaying in intimation.
Considering the facts and circumstances of the case and the documents filed before us and legal positions stated above we are of the view that the repudiation of the claim of the complainant on the technical ground is not justified. So, the complainant is entitled to get relief and the O.P. should pay the claim amount as per rule.
Reasons for delay
The Case was filed on 30.18.19 and admitted on 05.09.19. This Commission tried its level best to dispose of the case as expeditiously as possible in terms of the provision under section 13(3A) of the CP Act, 1986. Delay in disposal of the case has also been explained in the day to day orders.
In the result, the Consumer case is allowed.
Fees paid are correct. Hence, it is
Ordered
that the instant case being no. 126 of 2019 be and the same is allowed on contest against the OP but without costs.
The OP is directed to pay the insured amount as per rule.
O.P. is further directed to comply the order within 2 (two) months from the date of this order.
Let plain copy of this order be supplied free of cost, to each of the parties / Ld. Advocate/Agent on record, by hand /by post under proper acknowledgment as per rules, for information and necessary action.
The Final Order will also be available in the following Website:
confonet.nic.in
