DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II U.T. CHANDIGARH Complaint Case No.:96 of 2009 Date of Inst:20.01.2009 Date of Decision:.20.05.2010 Ashima Jain wife of Sh.Lalit Jain, r/o H.No.1087/2, Sector 39-B, Chandigarh. ---Complainant V E R S U S National Insurance Co. Ltd., Divisional Office, SCO No.133-135, Sector 17-D, Chandigarh through its Divisional Manager. ---Opposite Party QUORUM SHRI LAKSHMAN SHARMA PRESIDENT SMT.MADHU MUTNEJA MEMBER PRESENT: Sh.Munish Goel, Adv. for complainant Sh.N.S.Jagdeva, Adv. for OPs. --- PER MADHU MUTNEJA, MEMBER Smt.Ashima Jain has filed this complaint under section 12 of the Consumer Protection Act, 1986 praying therein that OP be directed to :- i) Release the claim of Rs.3,59,303.46 towards the repairs of the car along with interest. ii) Regularize the insurance policy of the vehicle in question. iii) Pay a sum of Rs.50,000/- as compensation for mental agony and harassment. iv) Pay a sum of Rs.11000/- as costs of litigation. 2. In brief, the case of the complainant is that she got her Indigo Car insured under cashless insurance policy with OP by paying premium of Rs.11,510/-. This policy was valid from 12.06.2008 to 11.06.2009. The vehicle met with an accident on 05.08.2008 and was extensively damaged. As per the agreement between the OP and Tata Motors, the vehicle was taken to Hind Motors for repairs. A rough estimate (dated 06.08.2008) for Rs.3,59,303.46P was prepared. After repairs, M/s Hind Motors raised a bill of Rs.3,12,738/- towards repairs of the car. The complainant was asked to pay Rs.72,740/- and the remaining amount i.e. Rs.2,36,998/- was to be paid by OP under the cashless policy. The complainant made payment of Rs.72,740/- and the vehicle was released to her. She was advised to use the car and report problems, if any. According to the complainant, the surveyor deputed by the Company had got certain papers signed from her. She took back the vehicle to M/s Hind Motors for rectification of some mechanical defects which had not been rectified during repairs. Now instead of releasing the vehicle, M/s Hind Motors insisted on payment of Rs.2,36,998/- since the OP had not released the payment to them. The complainant made repeated requests to OP for releasing the claim of Rs.3,59,303.46 but to no effect. The complainant was issued a letter dated 03.11.2008 (Annexure C-7) wherein she was asked as to why her claim should not be repudiated under the terms and conditions of the insurance policy. The complainant replied vide her reply dated 15.11.2008 (Annexure C-8). According to the complainant, the claim has been illegally repudiated by the OP on the ground that the complainant had taken the claim from previous company i.e. Oriental Insurance Co. vide claim No.1860/2008 and she had not disclosed this fact while obtaining the insurance policy from the OP. According to the complainant, the repudiation of the genuine claim amounts to deficiency in service on the part of OP. In these circumstances, the present complaint was filed seeking the reliefs mentioned above. 3. In the reply filed by the OP, it has been pleaded that the complainant at the time of obtaining the insurance policy had made a wrong declaration in the proposal form that she was entitled to No Claim Bonus (for short NCB) @ 20%. It has been pleaded that when the NCB was confirmed, it came to light that the complainant had taken a claim from the previous company i.e. Oriental Insurance Co. vide claim No.1860/08 and she had concealed this fact while taking the policy in question. According to OP, as per the terms and conditions of the insurance policy and GR-27 of Motor Tariff Rules, the complainant was duty bound to disclose all these facts while obtaining the insurance policy and therefore, the claim of the complainant was rightly repudiated vide letter dated 11.12.2008. It has been further pleaded that surveyor namely Sh.Subhash Madan vide his report dated 14.10.2008 assessed the loss to the vehicle to the tune of Rs.2,55,989 and the value of the salvage to the tune of Rs.5989/-. It has been denied that the repair of the car was started after obtaining the approval of OP. All other averments made in the complaint have been denied by OP. According to OP, the claim of the complainant was rightly repudiated vide letter dated 11.12.2008. In these circumstances, according to OP, there is no deficiency in service on its part and the complaint deserves dismissal. 4. We have heard the learned counsel for the parties and have gone through the entire record including documents, annexures, affidavits etc. 5. The claim of the complainant was repudiated vide letter dated 11.12.2008 on the ground that the complainant did not disclose the fact that she had taken the compensation regarding the said car from the previous insurance company during the subsistence of the previous policy. On the contrary, the complainant made a false declaration while filling the proposal form to the effect that she had not obtained any compensation regarding car in question during the subsistence of the previous policy. The relevant part of the declaration made by the complainant in the proposal form (Annexure OP-2) reads as under: “I/We declare that the rate of NCB claimed by me/us is correct and that no claim as arisen in the expiring policy period. (copy of the policy enclosed). I/We further undertake that if this declaration is found to be incorrect, all the benefits under the policy in respect of section I of the policy shall stand forfeited”. Thus the complainant has concealed the material facts from the insurance company and has made herself liable for denial of all the benefits under policy in question. This view stands forfeited by the ratio of the case passed in the Appeal No.157 of 2009 titled as National Insurance Co. Ltd. and Anr. Vs. M/s Ganpati Bricks Traders decided on 07.08.2009 in which our own Hon'ble State Commission has held as under: “13. In view of the foregoing, we have no hesitation in coming to the conclusion that the complainant had at the first instance, made a wrong declaration to the Insurer i.e. OP No.1 with regard to claiming N.C.B. This action of the complainant clearly debars him from receiving any benefits under the policy as per its terms and conditions. Furthermore, the complainant has miserably failed to prove that he made any payment towards the N.C.B amount to OP No.1 for the benefit, which he received from it at the time of proposing for the policy. Thus, we find no deficiency in service on the part of OP No.1 in the nonpayment of the accident claims filed by the complainant. We also hold the view that people who knowingly try to cheat the system deserve no sympathy. We also cannot subscribe to the view held by the learned District Forum that the complaint qua OP No.2 is dismissed because it is on record that OP No.2 had received Rs.2,063/- from the complainant allegedly towards collection of N.C.B. Thus, OP No.2 was liable to account to the complainant regarding this payment. In view of the above discussion, we find that the impugned order cannot be legally justified”. 6. Hence, the claim of the complainant has been rightly repudiated keeping in view the terms and conditions of the insurance policy. Thus, the complainant has failed to make out any case of deficiency in service against OP. 7. In view of the above findings, the complaint is hereby dismissed with no order as to costs. Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room. Announced 20.05.2010 Sd/- (LAKSHMAN SHARMA) PRESIDENT cm sd/- (MADHU MUTNEJA) MEMBER
| | MRS. MADHU MUTNEJA, MEMBER | HONABLE MR. LAKSHMAN SHARMA, PRESIDENT | , | | 
