Punjab

Ludhiana

CC/23/341

Vikram - Complainant(s)

Versus

National Insurance Co. - Opp.Party(s)

Sanjeev Kumar

02 Dec 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                             Consumer Complaint No:  341 dated 17.08.2023.                                       Date of decision: 02.12.2024. 

 

Vikram @ Bikram son of Sh. Bahadur Chand, r/o. H. No.166, Mohalla Bania Phillaur, District Jalandhar, c/o. Welfare Homeopathic Dispensary, Singh Sabha Gurudwara Market, Deep Nagar, Civil Line, Ludhiana. 141008. M. No.87290-22874.                                                                                                                                                                                            ..…Complainant

                                                Versus

1. National Insurance Co. Ltd., Head Office 3, Middletown Street, Kolkata-700071, through its Manager/Authorized Person.
2. National Insurance Co. Ltd., Phagwara Branch, G.T. Road, Phagwara, District Kapurthala, through Branch Manager-144401.
3. National Insurance Co. Ltd., Divisional Office-I, Ludhiana, Near Link Road, Atam Park, Atam Nagar, Ludhiana, through its Branch Manasger.141002                                                                                                                                                            …..Opposite parties 

Complaint Under the Consumer Protect Act, 1986 as amended upto date.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Sanjeev Kumar, Advocate.

For OPs                          :         Sh. Mandeep Sharma, Advocate.

 

 

 

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                In brief, the facts of the case are that the complainant got insured his vehicle No.PB-08-CC-2201 from the OPs vide insurance pollicyNo.401801312210000251 having validity from 29.05.2022 to 28.05.2023, which he again renewed. Sh. Bahadur Chand, father of the complainant is a doctor and is practicing at Welfare Homeopathic Dispensary, Singh Sabha Gurudwara Market, Deep Nagar, Civil Line, Ludhiana from 05.00 PM to 09.00 PM for which he regularly travels from Phillaur to Ludhiana. The complainant stated that on 03.12.2022, his father was coming from Ludhiana to Phillaur and the vehicle of the complainant met with an accident at Ladowal in which nobody was injured. The complainant visited the office of OP2 and OP3 for intimation of accident, upon which the employee/surveyor visited the spot and submitted the report. Thereafter, the complainant submitted claim of Rs.1,04,000/- along with original bills with OP3 but OP3 refused to accept the claim on flimsy ground. The complainant approached OP2 and OP3 many times but to no effect. According to the complainant, his father applied renewal of his driving license. The decision of the OPs regarding refusal of his claim is illegal and arbitrary. The complainant many times requested the OPs  to reimburse the amount of Rs.1,04,000/- but the OPs repudiated his claim. The complainant sent legal notice dated 01.06.2023 posted on 03.06.2023 upon the OPs but no response was given by the OPs. Hence this complaint, whereby the complainant has prayed for issuing directions to the OPs to pay the claim of Rs.1,04,000/- along with compensation of Rs.50,000/-.

2.                Upon notice, the OPs appeared and filed joint written statement and assailed the complaint by taking preliminary objections on the grounds of maintainability; the complainant has no locus standi to file the complaint; the complainant has not come with clean hands; suppression of material facts; the complainant being not a Consumer etc. The OPs stated that after receipt of intimation regarding the claim, they appointed Er. Vishal, Surveyor and Loss Assessor who demanded the documents of the vehicle and driving license of the driver. After visiting the spot and after going through and verification of the documents supplied by the complainant, the surveyor submitted his detailed report dated 05.12.2022. Thereafter, the insured was advised to get the insured vehicle for repair in the workshop. The OPs further stated that thereafter, they appointed Sawinder Singh, Surveyor and Loss Assessor who assessed the loss of the damaged vehicle and also verified the RC and driving license of driver supplied by the complainant. On verification of RC from the concerned office, the same was found genuine but the driving license of Bahadur Chand son of Ram Lubhaya bearing No.PB-3720080000428 issued on 22.09.2008 and valid till 23.09.2022 for LMV/MCWG only issued by S.D.M., Phillour whereas the accident occurred on 03.12.2022 which shows that on the date of accident the driving was not holding a valid and effective driving license. The OPs further stated that they wrote letter dated 20.03.2023 to the complainant that the driving license of Bahadur Chand driver of the damaged car was not valid on the date of accident as the same was expired on 23.09.2022 much before two months earlier and asked him to clarify the same within 10 days. The complainant sent reply dated 27.03.2023 stating that the driving of the car had applied for renewal of driving license on 03.12.2022. The OPs further stated that their competent authority after applying the mind to the claim of the complainant, observed that the driver of the insured vehicle was not holding valid and effective driving license to drive the vehicle on 03.12.2022, which is violation of terms and conditions of the policy and the provisions of the Motor Vehicle Act. According to the OPs, the claim of the complainant was rightly repudiated and duly informed to him vide letter dated 28.03.2023.

                   On merits, the OPs reiterated the crux of averments made in column brief facts of the case. The OPs have denied that there is any deficiency of service and have also prayed for dismissal of the complaint.

3.                In evidence, the complainant tendered his affidavit as Ex. CA and reiterated the averments of the complaint. The complainant also placed on record documents Ex. C1 to Ex C16 and closed the evidence.

4.                On the other hand, the counsel for the OPs tendered affidavit Ex. RA of Sh. Mohit Chawla, Deputy Manager of the OPs office at Ludhiana along with documents Ex. R1 to Ex. R8 and closed the evidence.

5.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents as well as written statement, affidavit and documents produced on record by both parties.

6.                Undisputably, a vehicle make Ford Figo car bearing registration No.PB-08-CC-2201 (R.C. Ex. C1) owned by the complainant was insured with the OPs vide Policy Schedule-Motor-Private Car-Package Ex. C2 = Ex. R1, which was valid from 29.05.2022 to 28.05.2023 having IDV of Rs.1,83,291/-. On 03.12.2022, the said vehicle met with an accident at G.T. Road, Near Hardy’s World, Ludhiana when it was being plied by father of the complainant Sh. Bahadur Chand. Prompt intimation to the OPs was given and the OPs appointed Er. Vishal, Insurance Surveyor & Loss Assessors to visit the spot, who submitted his Motor Survey Report-Spot dated 05.12.2022 Ex. R2. Vide his report Ex. R2, the surveyor observed the damages of the vehicle after inspection and advised the insured to remove the vehicle from the spot to some workshop and to keep the same unrepaired until the final survey is carried out. Further vide his report Ex. R2, the surveyor found the driving license of the driver Sh. Bahadur Chand, expired on 23.09.2022. Thereafter, the OPs appointed Sh. Sawinder Singh, Surveyor and Loss Assessor who submitted his Non Cashless Motor (Final) Survey Report dated 11.03.2023 Ex R6. In this report also, the surveyor made observation that as per spot surveyor the license expired on 23.09.2022 and the loss took place on 03.12.2022. Under the column Reinspection, the surveyor made the following remarks:-

                   “REINSPECTION

The vehicle was inspected after repairs also. On thorough checking the vehicle was found fully repaired and road worthy. On inspection all the recommended parts were found replaced and all the recommended labour jobs were found to have been undertaken and completed in all respects.

Some photographs of the repaired vehicle along with salvage were arranged, which are also enclosed along with.

The rates allowed are as per dealers/market price list whichever is less.

The recommended losses are in accordance with the cause and nature of loss.

The undersigned has only assessed the loss on the basis of information provided in the claim form and physical inspection of the vehicle.”

However, the surveyor in his report Ex. R6 assessed the net loss to be Rs.43,000/- to be made to the insured. The OPs vide letter dated 20.03.2023 Ex. R3 informed the complainant regarding having no valid driving license by the driver at the time of accident and gave an opportunity to the complainant to seek his comments within 10 days from the receipt of letter before Repudiation of his claim as No Claim. Further the OPs vide letter dated 28.03.2023 Ex. R4 intimated the complainant regarding receipt of his letter dated 27.03.2023 and driving license of Mr. Bahadur Chand having validity from 21.12.2022 to 20.12.2027. However the OPs closed the claim as No Claim on the ground that the driving license was not valid on the date of accident i.e. 03.12.2022. Consequently, the OPs vide letter dated 28.03.2023 Ex. C11 repudiated the claim as No Claim. The operative part of repudiation letter Ex. C11 is reproduced as under:-

“With ref. to your intimation of loss dated 07/12/2022 of your Ford Figo Car bearing registration No.PB-08-CC-2201 on 03.12.2022, under the policy mentioned above. Surveyor Vishal was deputed by the BO, Phagwara for SPOT survey. Mr. Sawinder Singh Surveyor was deputed for Final Survey by the company to access the loss, and have received the surveyor report on 14.03.2022.

While going through the intimation, claim form and Survey reports it has been observed that the Driver of the alleged car at the time of accident was Mr. Bahadur Chand s/o. Sh. Ram Lubhaya, holding DL No.PB-3720080000428, issuing authority DTO, Ludhiana, expires on 23/09/2022, and is NOT VALID on the Date of Accident i.e. 03/12/2022. It was one of the prime conditions of the insurance policy that the insured vehicle shall be driven by a person having a valid driving licence and in case it was not driven by a person having a valid licence, it would amount to breach of terms and conditions of the insurance policy and the insurer will not be liable to pay the claim.

Hence we have given you an opportunity to seek your comments on the above issue, and received your letter dated 27/03/2023. As per DL submitted by your good self of Mr. Bahadur Chand, the validity of DL is from 21/12/2022 to 20/12/2027 i.e. not valid on the date of accident i.e. 03.12.2022, hence we close the claim as NO CLAIM.”

 

Thus, the main reason for repudiation is that driver was not having legal and valid driving licence at the time of accident.

7.                It can be established from the record that father of the complainant namely Sh. Bahadur Chand was having driving licence No.PB-3720080000428 having validity from 24.09.2017 to 23.09.2022 with capacity of LMV, MCWG as per Application Reference Slip Ex. C3 = Ex. R7. However, the accident took place on 03.12.2022 and the said driving licence was expired much before the occurrence. The said Application Reference Slip Ex. C3 = Ex. R7 further shows that renewal of driving licence was applied on 03.12.2022 itself. The driving licence was renewed from 21.12.2022 to 20.12.2027 as shown in copy of driving licence Ex. C4. In this regard,  Section 15 of the Motor Vehicle Act provides as under:-

“15. Renewal of driving licences. - (1) Any licensing authority may, on application made to it, renew a driving licence issued under the provisions of this Act with effect from the date of its expiry:

Provided that in any case where the application for the renewal of a licence is made [either one year prior to date of its expiry or within one year] after the date of its expiry, the driving licence shall be renewed with effect from the date of its renewal.”

In view of the Section 15 of the Motor Vehicle Act as stated above, the driver was qualified to hold a driving licence and he was fulfilling one of the twin conditions of the policy. However, the driver was negligent in applying the renewal before the expiry of validity period. As such, the insurance companies are required to be more liberal in their approach without being too technical while settling the genuine claims.  In this regard, reference can be made to 2022(2) Apex Court Judgment 281 (SC) in case title Gurmel Singh Vs Branch Manager National Insurance Company Ltd. whereby it has been held by the Hon’ble Supreme Court of India that the insurance company has become too technical while settling the claim and has acted arbitrarily. The appellant has been asked to furnish the documents which were beyond the control of the appellant to procure and furnish. Once, there was a valid insurance on payment of huge sum by way of premium and the Truck was stolen, the insurance company ought not to have become too technical and ought not to have refused to settle the claim on non­submission of the duplicate certified copy of certificate of registration, which the appellant could not produce due to the circumstances beyond his control. In many cases, it is found that the insurance companies are refusing the claim on flimsy grounds and/or technical grounds. While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control.

8.                Recently, the Hon’ble Supreme Court of India in Civil Appeal No.4758 of 2023 title as Ashok Kumar Vs New India Assurance Co. Ltd. decided on July 31, 2023 while relying the judgments in National Insurance Company Limited Vs Nitin Khandelwal (2008) 11 SCC 259 and Amalendu Sahoo Vs Oriental Insurance Company Limited (2010) 4 SCC (536) has held that even if there was breach of any clause in the insurance policy, the claim could not have been repudiated in toto and the claim should have been settled on non-standard basis. The Hon’ble Supreme Court made the following observations in Para No.15, 18 and 19 of the said Civil Appeal No.4758 of 2023:-

18) In Amalendu Sahoo (supra), this Court noticed the guidelines issued by the New India Assurance Co. Ltd. in settling claims on non-standard basis. The guidelines read as under:-

Sl. No.	Description	Percentage of settlement
(i)	Under declaration of licensed carrying capacity.	Deduct 3 years' difference in premium from the amount of claim or deduct 25% of claim amount, whichever is higher.
(ii)	Overloading of vehicles beyond licensed carrying capacity.	Pay claims not exceeding 75% of admissible claim.
(iii)	Any other breach of warranty/condition of policy including limitation as to use.	Pay up to 75% of admissible claim."

The above guidelines were followed by this Court in Amalendu Sahoo (supra) as is clear from para 14 of the said judgment. The District Forum and the State Commission have rightly applied Amalendu Sahoo (supra) to the facts of the present case and awarded 75% on non-standard basis.

19) Nitin Khandelwal (supra) and Amalendu Sahoo (supra) lay down the correct formula that where there is some contributory factor, a proportionate deduction from the assured amount would be all that the Insurance Company can aspire to deduct.

We are inclined to accept the plea of the appellant that in the case at hand, on the facts governing the scenario, Clause (iii) of the table set out in para 14 of Amalendu Sahoo (supra) is attracted and the District Forum and the State Commission were justified in awarding the entire 75% of the admissible claim.”

Ex. R6 is the final survey report in which the liability of the OPs has been assessed as Rs.43,000/-. However, it was the duty of the OPs to assess the loss. The complainant has not controverted the facts mentioned in the written statement, so far as the surveyor report Ex. R6 is concerned as the complainant has neither filed any objections to controvert the averments made in the written statement. So by applying the ratio of the above cited cases, it would be just and appropriate if the claim of the complainant is allowed to the extent of 75% of the amount of Rs.43,000/- as assessed by the surveyor in survey report Ex. R6 on non-standard basis.

9.                As a sequel of above discussion, the complaint is partly allowed with direction to the OPs to reimburse the insurance claim of the complainant to the extent of 75% of the of Rs.43,000/- as assessed by the surveyor in survey report Ex. R6 on non-standard basis, within 30 days from the date of receipt of copy of order, failing which the complainant shall be held entitled to interest @8% per annum from the date of order till date of its actual payment. However, there shall be no order as to costs. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

11.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

 

(Monika Bhagat)                              (Sanjeev Batra)               Member                                         President  

 

Announced in Open Commission.

Dated:02.12.2024.

Gobind Ram.