Before the District Consumer Dispute Redressal Commission, Central District, ISBT Building, 5th Floor, Kashmere Gate, Delhi.

Complaint Case  No. 106/2017

                                                Versus

OP     National Insurance Company Ltd.

          2F/25, Third Floor, Jhandewala Extn.

          Above HDFC Bank & Near Metro Station

          New Delhi-110005                                                    ...Opposite Party

Quorum: Shri Inder Jeet Singh, President

              Shri Vyas Muni Rai, Member

              Ms. Shahina, Member (Female)

Inder Jeet Singh, President

ORDER-

1. (Introduction): It is a case of allegations of deficiency in services as complainant claims that he got insured his car, which was stolen, FIR was got registered besides informing the insurer/ OP, however his claim was repudiated despite all compliance but for no reasons, it was in order to deny his valid claim. Whereas, on the other side the case of OP is that there was no deficiency of any services, the complainant had concealed material facts as well as there was neither any FIR for theft of key of the said car and the claim was rightly repudiated for want of complying the terms and conditions of the policy.

2.1 (Matrix of Complainant’s Case):  The complainant is a senior citizen and he is a retired Officer, he took insurance policy in respect of his car bearing registration no. DL-4CAD-5974, model-2019 vide policy no. 360400/31/15/6100012983 for period from 10.02.2016 to 09.02.2017 (Annex. A/ Exh. CW1/1) against premium of Rs. 3,618/- by declaring IDV Rs. 1,00,000/- from the OP. It was 28.04.2016, the car was parked outside the house of complainant, there were  also valuables in the car, it was stolen and complainant called the police by dialing no. 100 after trying to locate in the vicinity and he also informed the insurer/ OP about the theft took place on the same very day. He also wrote complaint dated 28.04.2016 (Annex. B/ Mark-A) and an FIR was registered (Annex-C/ Mark-B).

2.2 Thence,  the OP asked the complainant to comply certain requirement of providing them documents and key of the said car.  In compliance, the complainant supplied copy of intimation of untraced report dated 19.05.2016 after obtaining it from e-PS MV Theft ( Annex.-D/ Exh. CW1/2) copy of order dated 28.05.2016 of ACMM-01 South West District ( Annex.-E/ Exh. CW1/3),  copy of particulars of vehicle obtained on 30.05.2016 from RTO, Raja Garden (Annex.-F/ Exh. CW1/4), Copy of statement of neighbours about stolen of the vehicle (Annex.-G/ Mark-C), copy of registration certificate of the car (Annex.-H/ Exh. CW1/5), copy of affidavit dated 15.12.2016 about misplace/ lost of one key of the car (Annex.-I/ Exh. CW1/6), apart from producing the other original key of the stolen car to the insurer.

2.3 The OP by its letter dated 12.01.2017 ( Annex.-J/ Exh. CW1/7) took flimsy ground by asking the complainant, inter alia, as to why his claim should not be repudiated and by another letter no. 52298 dated 20.01.2017 (Annex.-K/ Exh. CW1/8) informed the complainant that his claim is closed as the response given was not satisfactory. Whereas, the claim of complainant was covered within the validity of insurance policy from 10.02.2016 to 09.02.2017 and the episode of theft took place on 28.04.2016, it was an arbitrary conduct of the OP while repudiating the valid claim of complainant and there is deficiency of the services by OP. The complainant wrote a letter dated 20.01.2017 to the OP (Annex.-L/ Mark-D) requesting them to relook into the matter and also lodged claim letter (Annex.-P/ Exh. CW1/10) but of no result and consequently the complainant got served legal notice dated 09.02.2017 (Annex.-M with postal receipt/ Exh. CW1/9).  However, his request and claim was not considered, that is why the complaint was filed.

3. (Case of OP): In brief, in reply the OP contested the complaint vehemently by emphasizing repeatedly that the complainant could not give reasonable explanation about the other key, if the other key of the vehicle was lost or there was theft of such key, then as per the terms and policy, the complainant should have got registered a NCR. Moreover, the complainant was specifically asked to provide one unused ignition key of the stolen vehicle but that was not complied by him within 7 days of the letter dated 12.01.2017 and there is misrepresentation and concealment of theft of the vehicle and also its use by fraudulent means. The claim was rightly repudiated since response of the complainant vide letter dated 20.01.2017 to the pre-repudiation letter was not satisfied. Moreover, there is delay of about 28 days in informing the OP about theft of the vehicle, it is also in violation of the condition of the policy and it has been held in catena of judgment that delay in informing the insurer about theft or loss of insured vehicle will constitute fundamental breach of term of policy (reliance is placed on National Insurance Company vs Charanjeet Singh FA no. 1439/2007 in para 8 of the preliminary objection of reply. On merits, similar facts are reiterated by supplementing that a fraud is being played by the complainant and repudiation of the claim was not an arbitrary act. The complaint is liable to be dismissed.

4. ( Replication of complainant): The replication denies the allegations of reply of OP by reaffirming the complaint by supplementing that the complainant had informed the theft of car promptly to the insurer as well as to the police on the same day and that is why FIR was registered. The replication is replica of the complaint.

5. (Evidence of Parties): The complainant, Shri Narender Sharma led his evidence by filing his affidavit along with original documents, the exhibited documents referred above are either originals or office copy of legal notice. It is on the lines of complaint. Similarly, Shri Ragunath Pawar, Administrative Officer (legal) of OP, author of the reply led his exclusive evidence for OP, it is also on the lines of reply.

6. (Submissions/arguments of Parties): Both the parties filed their written submissions and during oral submissions Shri Ravikant Singh, Advocate also made  oral submissions in the presence of complainant, during oral submission complainant has relied upon Om Prakash vs Reliance Gen. Ins. And others Civil Appeal No. 15611/2017 (dod-04.10.2017), that a genuine claim shall not be repudiated on technical ground of delay and rejection of claim on purely technical ground in a mechanical manner will result in loss of confidence in policy holder in the insurance industry. In the present case, the complainant had informed both the police as well as the insurer on the same very day. Further, reliance is placed on Future General India Ins. Co. Ltd. vs Anshita Chaudhary, IV (2016) CPJ 138 (NC), wherein it was held that when there is no acts of complainant is involved in the theft of vehicle, repudiation of the claim was held to be deficiency in service. On the other side, Shri P.S. Tomar, Advocate for OP requests to consider the written arguments being complete arguments on behalf of OP. The written arguments of OP are compilation of extract from reply and evidence, both of them have already been referred above, it does not require reiteration.

7.1 (Findings): We have considered the contentions of both the sides, in the light of rival pleadings, evidence and contentions. However, there are many undisputed facts that the complainant got insured his car from OP bearing registration no. DL-4CAD-5974 against premium for period 10.02.2016 to 09.02.2017, it was against IDV Rs. 1,00,000/- and premium amount of Rs. 3,618/-. The lodging of FIR is also not disputed. The furnishing of documents by the complainant is also not disputed.

7.2 However, the OP has raised some objections inclusive of misrepresentation of concealment of the facts and the same are being analysed and considered. The complainant was asked by the OP to provide record and key of the car, the complainant furnished documents and one available key apart from an affidavit (Exh. CW1/6) that one of keys of his car was misplaced by him at his home and not traceable and he has also explained in his other letter (Mark-D) that he used to drive the car occasionally because of family constraints, therefore the stand of OP that NCR in respect of stolen of the key is not acceptable. The complainant has also mentioned in his complaint specifically (para 2) that he had informed the OP/insurer about theft of the car on same very day and the OP in its reply on merits stated that it is matter of record. In fact, the averments of para 2 of the complaint remains undisputed, therefore, the OP cannot derive any benefit by alleging that it was not informed by complainant. In addition, in case it is to be construed that complainant had informed orally to the insurer, even then the opposite plea is also an oral version but OP had replied that the plea mentioned by the complainant is matter of record.

          It is matter of settled law and also of common parlance that when there are allegations of playing of fraud or misrepresentation, the party who is alleging so is required to elucidate specifically and also establish the same, however, the OP has alleged it in a general way in its reply without specifying those fraud or misrepresentation and for want of proof of such allegation in evidence, the said plea of OP remains a hollow plea.

7.3 The complainant had written to OP to relook into the matter and without taking into record the documents furnished and the circumstances explained that even the police could not trace the vehicle, repudiation of claim of the complainant amounts to deficiency of service as despite having a valid claim in respect of insured vehicle within the currency of the policy.

7.4 Therefore, by weighing the totality of circumstances and the documentary record proved by the complainant, it makes him entitle for claim amount of Rs. 1,00,000/- as his insurance policy cover was up to Rs. 1,00,000/-, to that extent his complaint is allowed.

          Since he was prosecuting his claim diligently but it was not considered by the OP which caused him inconvenience and trauma of harassment, therefore a compensation of Rs. 10,000/- in favour of complainant and against the OP will be both ends of justice.

          The complainant had requested for interest which was also claimed in the legal notice (Exh. CW1/9) at the rate of 24 % pa but there is no evidence for proving rate of interest, consequently interest at the rate of 6% pa from the filing of the complaint on 18.04.2017  till realization of the amount will justify to both the sides.

          The complainant also held entitled for costs, it is quantified as Rs. 5,000/-  in his favour.

7.5  Accordingly, complaint is allowed in his favour and against the OP for  a claim of Rs. 1,10,000/- (i.e. Rs. 1,00,000/-+ Rs. 10,000/- ) along with simple rate of interest of 6% from 18.04.2017 being date of filing of the complaint till realization of the amount from the complainant. Cost of Rs. 5,000/- is also awarded in favour of complainant and against the OP. The OP shall make the entire payment within 30 days from the date of order.

8. Copy of this order be sent to the parties as per rules.

Announced on this 17th of  December 2022.