Delhi

North East

CC/29/2020

Sh. Ritik Sharma - Complainant(s)

Versus

M/s SBI General Insurance Co. ltd. - Opp.Party(s)

11 Aug 2023

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 29/2020

 

 

In the matter of:

 

 

	Sh. Ritik Sharma S/o Sh. Anil Sharma R/o H.No. C-1/119, Yamuna Vihar, Seelampur, Delhi-110053	Complainant
	Versus
	M/s SBI General Insurance Company Ltd. Through its General Manager, Claims Department,   Corporate & Registered Office at:- “Natraj” 301, Junction of Western Express Highway & Andheri Kurla Road, Andheri (East), Mumbai-400069   Branch Office at:- 3rd and 4th Floor, Lotus IT Park, Road No. 16, Plot No. B-18,19, Wagla Industrial Estate, Thane(W), Thane-4000604	Opposite Party

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                           DATE OF ORDER:

16.03.2020 18.05.2023 11.08.2023

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

Ms. Adarsh Nain, Member

 

 

ORDER

 Ms. Adarsh Nain, Member

The Complainant has filed the present complaint under Section 35 of the Consumer protection Act, 2019.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that Complainant purchased a second hand vehicle under the mark Volkswagen Jetta bearing registration no. DL 10CC-0325 in year 2018. In the month of December 2018, SBI general insurance agent approached Complainant and Complainant agreed for the insurance policy. Thereafter, Opposite Party issued SBI General Insurance Policy bearing no. 000000001239715 w.e.f. 28.12.18 to 27.12.19 and the Complainant stated to have paid premium of Rs. 39,773/- to Opposite Party. The Complainant further stated that on 15.06.19 the vehicle in question got stolen and Complainant immediately reported theft to Opposite Party having e-FIR no. 020856 dated 15.06.19 and the Complainant also informed the Opposite Party about the theft of said vehicle on their helpline telephone numbers. The Complainant stated that the concerned police station issued the untraced report as the said vehicle was not traced out. The Complainant stated that Opposite Party through theft claim acknowledgment letter dated 19.06.19 directed Complainant to file his claim along with required documents with their investigation agency namely M/s Third eye Investigator and thereafter Complainant filed its claim along with entire documents including the FIR and Untrace Report. The Complainant stated that the investigation agency sent a letter dated 27.09.19 to Complainant to file some additional documents and thereafter Opposite Party requested Complainant to settle the claim for amount of Rs. 4,50,000/- or get second hand car of same value and further requested to file consent letter for the payment of the claim but Complainant refused the same. The Complainant sent various reminders to Opposite Party though emails on several dates but Opposite Party always raised absurd requirement of documents and Opposite Party did not release the claim. The Complainant stated that Opposite Party without any notice closed the claim disbursal. The Complainant stated that he received letter dated 26.12.19 from Opposite Party informing about discrepancies through observation and findings. The Complainant sent legal notice to Opposite Party dated 22.01.20 and 21.02.20 and received reply of legal notice dated 10.02.20. Hence, this shows deficiency on the part of Opposite Party. The Complainant has prayed for Rs. 8,70,000/- i.e. the value of the vehicle in question along with interest    @ 24 % w.e.f. 15.06.19. He further prayed for Rs. 1,00,000/- for mental harassment and Rs. 25,000/- as litigation cost.

Case of the Opposite Party

2. The Opposite Party contested the case and filed written statement.  While admitting the policy issued in the name of the complainant insuring the vehicle in question and same was stolen, it has been contended that the company’s liability was subject to terms and conditions under the policy. It has been alleged by the Opposite Party that during investigation of the claim of the complainant, the investigator made observations that the complainant purchased the said vehicle from previous owner through his brother-in-law Rahul Chaudhary and transferred the sale amount to the sister of Rahul Chaudhary. As per investigator’s report, Mr. Rahul chaudhary involved in many other old vehicle theft cases. It is alleged that the complainant has misrepresented the facts and lodged a fraudulent claim with the Opposite Party. The complainant had allegedly transferred the sale consideration of the vehicle in question i.e. Rs.5,30,000/- to the bank account of one Jyoti Talan and Insurance premium was also paid from the same account which amounted to violation of Anti-money laundering Policy & guidelines of the Opposite Party. Under the said guidelines it has been provided that Insurance premium paid by the person other than the insured should be looked into to establish insurable interest. Opposite Party contends that the above conduct of the complainant shows that the prima facie intention of the complainant was to purchase the insurance policy for fraudulent claim only. It is also alleged that family members and closed group of Mr. Rahul Chaudhary have lodged similar fraudulent claims in short span of time which is indicative of large nexus operating to defraud insurance companies. In view of above facts, it is prayed that the present complaint deserves to be dismissed and there has been no deficiency on their part.

 

 

Rejoinder to the written statement of Opposite Party

3. The Complainant filed rejoinder to the written statement of Opposite Party wherein the Complainant has denied the pleas raised by the Opposite Party and has reiterated the assertion made in the complaint.

Evidence of the Complainant

4. The Complainant in support of his complaint filed his affidavit wherein he has supported the averments made in the complaint.

Evidence of the Opposite Party

5. In order to prove its case, Opposite Party has filed affidavit of Sh. Jitendra Dhabhai, Legal Manager of Opposite Party, wherein the averments made in the written statement of Opposite Party have been supported. Opposite Party has also filed an affidavit of Sh. Balauadra Khatua, Proprietor of Third Eye Investigator.  

 Arguments & Conclusion

6. We have heard the Ld. Counsels for the Complainant and Opposite Party. We have also perused the file and the written arguments filed by the parties.  The case of the Complainant is that his vehicle which was duly insured by the Opposite party for the insured value of Rs. 8,70,000/-. It is alleged that the said vehicle was stolen and the Complainant immediately informed the police and lodged an e-FIR bearing no. 020856 dated 15.06.19 and the Complainant also informed the Opposite Party about the theft of said vehicle on their helpline telephone numbers. It is also the case of the complainant that the vehicle could not be traced out by police and Untrace Report had been filed by the police. The Complainant filed its claim along with entire documents including the FIR and Untrace Report. The Complainant sent various reminders to Opposite Party though emails on several dates but Opposite Party always raised absurd requirement of documents and Opposite Party did not release the claim. The Complainant stated that Opposite Party without any notice closed the claim disbursal. The Complainant alleges that in spite of providing all the documents and information related to the incident, the Opposite Party has not paid his claim, hence, committed deficiency of service.
7. The case of the Opposite Party is that while admitting that the Complainant had insured the vehicle in question with the Opposite Party for the insured value of Rs. 8,70,000/-, the Opposite Party  contended that during investigation of the claim of the Complainant, the investigator found certain discrepancies such as the Complainant purchased the said vehicle from previous owner through his brother-in-law Rahul Chaudhary who is involved in many other old vehicle theft cases. It is alleged that the Complainant failed to explain those discrepancies and also to provide requisite documents. It is alleged that the Complainant has misrepresented the facts and lodged a fraudulent claim with the Opposite Party. It is also alleged that the Anti-money laundering Policy of Opposite Party has been violated as the premium has been paid by a person other than the insured; hence, no insurable interest has been established. Opposite Party alleges that the above conduct of the Complainant shows that the prima facie intention of the Complainant was to purchase the insurance policy for fraudulent claim only. It is also alleged that family members and closed group of Mr. Rahul Chaudhary have lodged similar fraudulent claims in short span of time which is indicative of large nexus operating to defraud insurance companies. It is also the case of the Opposite Party that the investigator had lodged a Police complaint against the Complainant on 17.02.20 complaint with Commissioner of Police and the inquiry is pending. In view of above facts, it is prayed that the present complaint deserves to be dismissed and there has been no deficiency on their part.
8. Admitted facts of the case are that the vehicle in question was insured with the Opposite Party and theft took place during the subsistence of valid policy. It is also admitted by the Opposite Party that the claim of the insured/Complainant was still pending and has not been closed.
9. The contention of the Opposite Party is that the Complainant purchased the said vehicle from previous owner through his brother-in-law Rahul Chaudhary who is involved in many other old vehicle theft cases. It is alleged that the Complainant failed to explain those discrepancies and also to provide requisite documents. It is alleged that the Complainant has misrepresented the facts and lodged a fraudulent claim with the Opposite Party and the investigator had lodged a Police complaint against the Complainant on 17.02.20 with Commissioner of Police and the inquiry is pending. It is to be noted that even after three years of lodging the complaint; police has not registered any FIR and proceeded ahead. Hence, the Opposite Party cannot be allowed to refuse a valid claim on mere assumptions.
10. The another contention of the Opposite Party is that the Anti-money laundering Policy of Opposite Party has been violated as the premium has been paid by a person other than the insured; hence, no insurable interest has been established. In this regards, the perusal of the Anti-money laundering Policy reveals that under the head, KYC at the time of request for services, it is the responsibility of the Insurance Company to exercise due caution in such cases. Since the Opposite Party company had accepted the premium and issued the policy, the Opposite Party cannot be allowed to raise ground of insurable interest at the later stage and refuse the claim.  
11. On perusal of the material on record including the pleadings of the parties, we are of the view that when an insured has lodged an FIR without delay after the theft of the vehicle occurred and when the police after investigation have issued a final report as untraced report, then, insurance company cannot refuse to pay the claim on flimsy grounds.
12. In view of above, we are of the considered opinion that as the Opposite Party has failed to prove any of their contentions and also failed to prove that the Complainant/claimant has committed breach of terms and conditions of the aforesaid policy, Opposite Party has been deficient in services by not paying Complainant’s valid claim under the effective Policy in force at the time of incident.
13. Thus, we hold that Opposite Party insurance company is guilty of deficiency of services, and direct the Opposite Party to pay Rs. 8,70,000/- (Rs. Eight Lakhs, Seventy Thousand only), the insured amount under the policy along with 6% interest from the date of filing the complaint till its recovery. The Opposite Party is further directed to pay Rs. 25,000/- towards compensation and litigation cost along with 6 % interest from the date of this order till its recovery.
14. Order announced on 11.08.2023.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room.

( Anil Kumar Bamba)        Member

(Adarsh Nain)   Member

(Surinder Kumar Sharma) President