ORDER

23.07.2024

Sh. Sanjay Kumar, President

1. The factual matrix of the present case is that complainant is the registered owner of Honda Accord UP16 W 1102 insured with Liberty Videocon General Insurance Company Ltd. vide cover note no.20000112158 dated 24.05.2014 valid from 24.05.2014 to 23.05.2015 for an IDV of Rs.12,50,000/- and premium of Rs.32,688/- was taken cash for the same from the complainant.
2. It is stated that the OP got this vehicle physically inspected prior to issuance of this insurance cover note. This procedure is called Pre-Inspection of the vehicle It is stated that the insurance policy was not sent to the complainant before the vehicle met with an accident and the complainant was having only the cover note issued by the OP. The policy was brought to the notice of the complainant by the OP after this accident. It is stated that the vehicle met with an accident on 20.09.2014 at Delhi and it burnt completely. It is further stated that Mr. Pardeep S/o Sh. Ramesh was driving the vehicle at the time of accident and Mr. Arvind Kumar friend of the complainant was also sitting in the car. Mr. Arvind Kumar also burnt/injured in this accident and was also hospitalized. The Police and Fire department was informed.
3. It is stated that the claim of the vehicle was lodged with the OP in time without any delay and the claim no. is 200102201114110026401. It is stated that the survey in  this case was done by the surveyor Mr. Ravi Kant with surveyor’s license no. SLA-73082 deputed by the OP and the complainant submitted all the documents such as claim form, DL, RC, copy of Pan card and photo of the complainant, address proof, cancel cheque for payment of the claim and all the other documents as demanded from time to time. All the other requirements of the OP were also completed. All the documents including RC, DL, fire report, Police report, medical documents etc. were verified by the surveyor and were found in order. The surveyor verbally told the complainant that the case is of constructive total loss and claim will be paid as per IDV of the vehicle after deducting the compulsory excess clause of Rs.2,000/-. In this way the complainant was expecting Rs.12,48,000/- (12,50,000 IDV – 2,000 Excess Clause) as a payment for the claim. All the documents were found in order by the insurance company and the surveyor and no objection of any kind was raised by them.
4. It is stated that suddenly after all this, the complainant was informed that the IDV as per insurance policy has been taken as Rs.10,25,000/- instead of the IDV of Rs.12,50,000/- as taken in the cover note and also premium of Rs.27,665/- had been taken in record instead of Rs.32,688/-. It is further stated that no refund of the premium was given to complainant even till date. It is further stated that the complainant was asked to submit acceptance voucher as per the IDV mentioned in the insurance policy and the same was refused by the complainant. It is stated that complainant also pointed out that as the amount of Rs.32,688/- was still in the possession of the OP, so the OP is liable to pay the total loss claim as per the IDV mentioned in the cover note of Rs.12,50,000/-.
5. It is stated that the complainant contacted the surveyor but the surveyor told the complainant that he always prepares reports under pressure from the OP as his bread and butter depends only on the OP and he will not be able to do anything against the wishes of the OP and asked the complainant to contact the OP for any information. The surveyor also refused to give a copy of survey report submitted by him to the OP which has been not  only against the legal right of the complainant but also against the duty and responsibility of the licensed surveyor as set by the IRDAI. It is further stated that the complainant received a letter dated 27.03.2015 for closure of claim on the observation that the complainant was not interested in pursuing the claim though the complainant was behind the OP for payment of the claim but only refused to accept the claim on amount dictated by the OP.
6. It is stated that complainant contacted the OP and also sent email dated 26.08.2015 and also personally visited and submitted a letter dated 27.08.2015 to Mr. Sunny Singh (Claims Service Manager of company at Delhi) and requested him for copy of survey report, investigation report, pre-inspection report and claim form and other documents related to this claim but the same were not given to the complainant till date and was again asked the complainant to accept the claim on total loss for the IDV as per policy and also told to the complainant that the documents will be given him only after submission of the above acceptance. But the complainant again refused to accept the claim to any amount less than the net amount of Rs.12,48,000/-. It is stated that the working of the surveyor deputed by the OP was against the rules and the guidelines set by the IRDAI and his working is not independent as expected  from a licensed surveyor and the surveyor has only harassed the complainant as per the instruction of the OP.
7. It is stated that the insurance in this case was done by the OP after proper inspection of the vehicle of the complainant and cover note was issued for IDV of Rs.12,50,000/-, so nothing was hidden from the OP and the OP has the full liberty to refuse the insurance of this vehicle at the time of inspection of the vehicle. The complainant paid the premium for insurance as demanded by the OP as per the IDV as mentioned in cover note. It is further stated that by pressurizing the complainant by the surveyor and officer Mr. Sunny Singh of the OP and working against the guidelines of IRDAI, they along with the OP has not only harassed the complainant but they are also liable for civil and criminal offences. The OP is required to settle the claim within 30 days as per the IRDAI and by not doing it, the OP has done the act of deficiency of services. It is further stated that no communication for any relevant requirement was received from the OP till date which was not fulfilled.
8. It is stated that the complainant has communicated a number of times to the OP and also visited the office of OP for the claim. The complainant had made a number of phone calls to all the above persons of the OP. It is further stated that the OP delayed  the payment of the above said claim and also not taken the possession of accidental total loss vehicle and due to this delay, the complainant is also paying charges for the parking of the burnt vehicle. It is stated that OP sent letter of repudiation of the claim to complainant dated 27.03.2015 on irrelevant ground. It is further stated that this act of not making the payment of legal, bonafide and legitimate claim of the complainant is a crystal clear case of negligence and deficiency of services and harassment of the complainant from the side of the OP including surveyor. It is stated that complainant got served a legal notice to the respondent dated 28.05.2016 through speed post vide receipt no. ED008433020IN dated 30.05.2016 through the counsel and the said notice was duly served upon the OP but the respondent neither replied nor complied with the notice. The legal notice was also sent to the surveyor Mr. Ravi Kant through speed post vide receipt no. ED025826812IN dated 03.06.2016 and the said notice was duly served upon the surveyor but he also neither replied nor complied with the notice.  It is stated that complainant has been harassed physically and mentally as he has visited several times with the OP and their surveyor whereby wasting his valuable time and money and the OP caused the mental pain and agony to the complainant.
9. The complainant is seeking direction against OP to pay Rs.12,48,000/- (Rs. Twelve Lacs Forty Eight Thousand Only) along with interest @ 24% per annum from the date of accident till the date of payment to the complainant, to pay Rs.5,00,000/- (Five Lacs only) as compensation on account of mental torture, harassment, physical pain and agony, to pay Rs.500/- per day as parking charges of the aforesaid accidental vehicle from the date of accident till the date of payment, to pay cost of litigation and any other order which deems fit and proper.
10. OP filed WS. It is stated that the repudiation letter is in accordance with the terms and conditions of the contract and on the basis of documents therefore, there is no deficiency of service on the part of OP. It is stated that the claim of complainant was duly processed by OP in accordance with the terms and conditions of the policy and it was found not admissible. It is further stated that the complainant in the proposal form proposed to the insured his interest in vehicle bearing registration no. UP 16W 1102 for period from 24.05.2014 to 23.05.2015 and also made declaration.
11. It is stated that when the proposal was put up to concerned sales officer the under writer denied to grant proposed higher IDV of Rs.12,50,000/- as vehicle proposed for insurance was 2008 model. It is stated that sales manager thereafter contacted the complainant and explained the same. It is stated that than original proposal form was collected from complainant and necessary changes with regard to IDV was made thereon and than returned to the complainant with his consent. It is stated that complainant thereby agreed to insure his vehicle with IDV as Rs.10,25,000/-. It is stated that on 13.06.2014 a private car package policy issued to complainant for period 24.05.2014 to 23.05.2015 for vehicle no. UP 16W 1102.
12. It is stated that original insurance policy was dispatched to complainant firstly on 16.06.2014 through Bluedart courier services and again on 26.06.2014 through post and duly received by the complainant. It is stated that though complainant is claiming that he received policy only after claim subject matter of this complaint but complainant at first call intimation intimated the policy no. and the call details are mentioned by the OP. It is further stated that on 20.09.2014 OP received an information from complainant to the fact that on 20.09.2014 while the vehicle was being driven on public roads, it caught fire and thus completely damaged.
13. It is stated that immediately on receiving the claim intimation the OP deputed Mr. Ravi Kant, an independent IRDA Accredited and licensed surveyor to inspect damaged vehicle and ascertain exact cause of loss and extent of damage if any. It is stated that said surveyor had made thorough inspection of damaged vehicle, discussed the matter with complainant, investigator and claims officers of the OP from time to time and finally bases available documents and records submitted the report dated 20.10.2014. It is stated that on the basis of facts mentioned in investigation report the claim treated as not admissible and no claim.
14. It is stated that OP had simultaneously deputed M/s Dynamic Investigations, an independent investigation agency, to ascertain facts pertaining to matte. It is stated that investigation report submitted by M/s Dynamic Investigations. It is stated that the information also sought from previous insurer M/s HDFC Ergo General Insurance Co. Ltd. vide email dated 13.10.2014. It is further stated that it was informed that previously the insured was Mr. Manoj Rana for a value of Rs.6,70,000/- and also informed that there was settlement of total loss and on 14.03.2014 Rs.3,46,000/- was paid out of total Rs.6,28,000/- and remaining amount of Rs.2,82,000/- was paid by complainant to their insured as value of salvage. It is stated that it established that complainant had purchased the vehicle as scrap for total value of Rs.2,82,000/- from its previous owner Mr. Manoj Rana. It is stated that OP also sought clarification from complainant in this regard vide letter dated 19.12.2014. It is stated that complainant replied on 30.12.2014.
15. It is stated that complainant also given another letter dated 29.01.2015. It is stated that the insurance being contract of utmost good faith, it is duty of proposal to give all information within his knowledge to the insurer which has material bearing on judgment of prudent underwriter on assessment of the risk. It is stated that in the proposal form, specific questions are being asked with regard to previous insurance details and claim history wherein complainant chosen to keep the same blank thereby representing no such facts was within his knowledge. It is stated that as per record it is clearly shows that at the time of presenting proposal itself, complainant was very well aware of insurance details of vehicle and its claim history but concealded the material information from OP and obtained policy without disclosing material information.
16. It is stated that complainant had not provided any details of financial transctions as alleged between him and Azad Motors with regard to sale and purchase of the vehicle. It is stated that complainant deliberately suppressed and concealded the material facts with regard to previous insurance details and claim history, therefore, OP vide letter dated 27.03.2015 closed the claim of the complainant. It is stated that as per available documents and information the complainant being in vehicle scrap business had purchased the scrap vehicle for nominal cost of Rs.2,82,000/- and got it locally repaired with sub standard parts and than got it insured for Rs.10,25,000/- with ulterior motive to gain wrongfully and caused wrongful loss to OP. It is stated that as the policy was obtained by misrepresentation/concealment of material facts, therefore, OP is not bound to discharge its obligation under such contract.
17. It is stated that complainant is in business of vehicle scrap and thus is thoroughly aware of working of insurance companies. It is stated that the cover note was obtained on 24.05.2014 and for the very first time allegation of  non receipt of policy was made in notice dated 28.05.2016 i.e after policy got expired and period of two years. It is stated that claim intimation call clearly shows complainant had told policy no. which substantiates fact that complainant was having policy documents with him, therefore, all allegations are baseless. It is stated that as per email dated 26.08.2015 and letter dated 27.08.2015 of complainant shows that complainant never asked for policy copy or raised any grievance that he never received policy copy. It is stated that the complainant never submitted relevant documents like PAN Card and cancelled cheque leaf to process direct transfer of excess premium and now complainant seems to take advantage of his own negligence.
18. OP denied all para wise allegations and relied on reply on contents of reply on merits. It is stated that present complaint is liable to be dismissed.  
19. Complainant filed rejoinder to the WS of OP and denied all the allegations made therein and reiterated contents of complaint.
20. Complainant filed evidence by way of his affidavit and reiterated contents of complaint. Complainant relied on copy of RC Ex.CW1, copy of cover note Ex.CW2, copy of police report Ex.CW3, copy of fire report Ex.CW4, copy of medical paper of Arvind Kumar Ex.CW5, copy of insurance policy Ex.CW6, copy of letter of closure of claim Ex.CW7, copy of email dated 26.08.2015 Ex.CW8, letter submitted in office of OP  on 27.08.2015 Ex.CW9, copy of legal notice with postal receipt Ex.CW10 and delivery proof of legal notice Ex.CW11.
21. OP filed evidence by way of affidavit of Jitendra Jain National Litigation Manager with OP company and reiterated contents of WS. OP relied on copy of proposal form Annexure OP-1, copy of proposal form with changes in IDV Annexure OP-2, certified copy of original policy Annexure OP-3, call recording of claim intimation burned on CD Annexure OP-4, copy of survey report Annexure OP-5, copy of complete investigation report with statement of complainant Annexure OP-6, copy of email dated 13.10.2014 from M/s HDC ERGO General Insurance Co. Ltd. Annexure OP-7, copy of letter dated 19.11.2014 Annexure OP-8, copy of reply of complainant dated 30.12.2014 Annexure OP-9 and copy of reply of complainant dated 20.01.2015 Annexure OP-10.
22. Complainant as well as OP filed written arguments.
23. We have heard Sh. Raman Kumar counsel for complainant and Sh. Raghav Gupta proxy for Sh. R.K Gupta counsel for OP. We have also gone through the record.
24. It is admitted case of the parties that complainant is the registered owner of  Honda Accord Car UP 16W 1102 and insured with OP insurance company for period 24.05.2014 to 23.05.2015 and a premium of Rs.32,668/- paid by complainant. The OP has disputed the IDV value as claimed by complainant of Rs.12,50,000/-. It is admitted case of the parties that the vehicle met with an fire accident and burnt on 20.09.2014. The complainant has lodged a claim and OP insurance company appointed Mr. Ravi Kant Surveyor who investigate and assess the damage and claim. It is admitted case of the parties that OP insurance company repudiated the claim vide letter dated 27.03.2015.
25. The OP claimed that at the time of taking the insurance complainant filed up a motor vehicle insurance proposal and cover note form no.20000112158 dated 24.05.2014 wherein disclose the facts which were not true and correct. According to OP in the proposal form the IDV of Rs.12,50,000/- proposed was higher as vehicle was 2008 model and complainant was agreed for IDV as Rs.10,25,000/-. According to OP the original insurance policy was dispatched to complainant on 16.06.2014 which was  duly received. The OP corroborated this fact on the basis of conversation with the complainant. The telephonic conversation is of the day on which complainant informed the incident of  fire in the vehicle. This conversation clearly establish that complainant had given complete insurance number to the representative of OP. It clearly establish that the complainant had received the copy of policy which was having IDV value of Rs.10,25,000/-.
26. It is admitted case of the parties that OP insurance company appointed Sh. Ravi Kant Surveyor, who conducted the survey and inspection of damaged vehicle and submitted the report dated 20.10.2014. We have gone through the survey report. As per investigation report the complainant had purchased the insured vehicle from used car dealer namely M/s Azad Motors, Sector 3, Rohini, New Delhi at Rs.8,50,000/- but after investigation it was found that complainant purchased the vehicle as a value of salvage for Rs.2,82,000/- on 14.03.2014 from previous insurer M/s HDFC Ergo General Insurance Co. Ltd. having claim details C230013106589 and policy no.231120-0298520101000 and IDV Rs.6,70,000/-. As per report statement of complainant was also recorded to this effect. The OP insurance company sought the information from M/s HDFC Ergo General Insurance Co. to confirm these facts. It has come to the knowledge of the insurance company that previously the insured was having policy no. 231120029852010000 in the name of Manoj Rana for IDV Rs.6,70,000/-. It was further informed that insurer settled the total loss claim of the vehicle on 14.03.2014 for total amount of Rs.6,28,000/- out of which Rs.3,46,000/- was paid to the insured and remaining amount Rs.2,82,000/- was paid by complainant as a salvage to the insured. The OP established that the vehicle was purchased by complainant as scrap.
27. The OP further establish that after investigation report and other facts which were not disclosed by complainant when see the light of the day than several letters were written to complainant to seek further information and clarification on these vital facts. The OP insurance co. filed on record letters dated 19.12.2014, 30.12.2014 and 29.01.2015. On the  other hand complainant failed to file any documentary proof that at any point of time he had replied these letters and clarify all the true and correct facts to the OP insurance company. The complainant alleged that surveyor Mr. Ravi Kant prepares the report under pressure from OP insurance company. The complainant failed to file any documents where he had  made a complaint against the surveyor or challenge the final investigation report of the surveyor.
28. It is established on record that complainant has suppressed and concealded the true and correct facts. The complainant neither filed documentary proof of purchase of vehicle from Azad Motors in April 2014 for Rs.8,50,000/- before the surveyor or OP insurance company or before this court. The complainant also failed to clarify the vital fact that the vehicle was a salvage purchased by him from HDFC Ergo for Rs.2,82,000/-. The complainant also failed to file documents of transfer of ownership of M/s Azad Motors. In these special circumstances where complainant suppressed the true and material facts the OP insurance company fairly, legally and as per terms and conditions specially the declaration given by complainant justify the closing the claim vide letter dated 27.03.2015. It is pertinent to mention here that Hon’ble Supreme Court in the case of LIC Vs. Asha (2001) 2 SCC 160, Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. SC (2002) 2776, P.C Chacko & Anr. Vs. Chairman, LIC Ltd. AIR 2008 SC 424 and LIC of India Vs. Smt. G.M Chanmaparsmma AIR 1991 SC 392 held that the contract of insurance is “UBERRIMNA FIDES” and every fact of material must be disclosed otherwise there is good ground for recession of the contract. In this present case complainant violated this principle and suppressed the non material and true facts. In these circumstances complainant failed to establish any deficiency of service on the part of OP Insurance Co.
29. On the basis of above observations and discussions present complaint is dismissed. No order as to cost. File be consigned to record room.
30. Copy of the order be given to the parties free of cost as per order dated 04.04.2022 of Hon’ble State Commission after receiving an application from the parties in the registry. The orders be uploaded on www.confonet.nic.in.

Announced in open Commission on  23.07.2024.

     SANJAY KUMAR                 NIPUR CHANDNA                       RAJESH

       PRESIDENT                             MEMBER                                MEMBER