Adv. For the Complainant: - Self
Adv. For O.Ps :- Sri P.K.Biswal
Date of filing of the Case :-13.07.2021
Date of Order :- 17.03.2023
JUDGMENT
Fact of the case in nutshell-
(1) The complainant had purchased a Glamour (EF) Motor Cycle bearing Registration No. OD-03.M-1520 on payment of Rs 68410/- from Aasiward motors Kantabanji and the said vehicle was insured with National Insurance company Ltd. who is Op in this case vide insurance certificate No.390102311-86203319047 which was valid from 30.03.2019 to 29.03.2020.
On 11.11.2019 the son of the complainant had been to village Bangomunda to visit “ DHANU YATRA” in the said Motor Cycle , at about 11 P.M. in that might he found his Motorcycle was missed from the place of parking . He search about it but failed to trace the same. Thereafter on 12/11/2019 he went to Bangomunda P.S. to lodge the F.I.R. regarding the theft of the motorcycle, but due to the absent of the IIC Bangomunda P.S. the F.I.R was lodged on dt 14.11.2019 when the IIC was present and the IIC
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Bangomunda P.S. registered the F.I.R vide P.S case No. 116/2019 U/C 379 of IPC. After the investigation he submitted his final report stating fact true but no clue.
The complainant on the very day of the theft of Motorcycle had duly made claim to the National Insurance company through their local authorised agent Aasiward Motors. The complainant being failed with the information to the agent, enquired about his insurance claim to the Branch Manager National Insurance Bolangir , Branch over phone. The B.M stated that the said agent had not deposited Rs.30,00,000/- of Insurance premium to the company so the company could not settle the claim. After several correspondence with the Op it was in vain, ultimately on dt.26/03/2021 the complainant received a letter of repudiation regarding settlement of claim. Hence this case.
(2) To substantiate his case the complainant relied on the following documents.
(1) Insurance certificate of National Insurance Company Ltd. through (Hero Insurance Booking
India Private Ltd.)(Xerox Copy)
(2) Aadhar Card (Xerox Copy)
(3) Voter ID Card (Xerox Copy)
(4) D.L. ( Xerox Copy)
(5) Vehicle Registration Certificate from R.T.O. Bolangir (Xerox Copy)
(6) Invoice of Aasiward Motors, Kantabanji (Xerox Copy)
(7) F.I.R Copy dt. 14/11/2019 of P.S Bangomunda (Xerox Copy)
(8) Letter dated 10/02/2021 , 18/03/2021 ( Xerox Copy)
(9) The Repudiation letter dt.26/03/2021 (Xerox Copy)
(3) Having gone through the complainant its accompanied documents and on hearing the complaint primafacie it seemed to be a genuine case hence admitted, issue notice to the OP was served and in response the OP appeared through his council and filed his written version.
(4) The rival contention the Op denied totally and submitted in Para 4 of his written version after getting intimation on 06.10.2020 from the complainant this OP has supplied him the claim form and at the same time advise him to submit the requirements along with the claim application for speedy settlement of his claim but the petitioner remains silent till 25.03.2021 and did not complied the formalities and requirements of the OD claim as advised by this Op , as such the OP is bound to repudiate the claim of the petitioner It is false to say that Aasiward Motors , Kantabanji is the agent of the Op. This OP is tied with the Hero Company Ltd. and Hero company Ltd. appoints Aasiward Motors as his agent for National Insurance Company. The petitioner has suppress the material facts and lodged
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F.I.R in three days delay and intimated this OP after 11 months from the date of occurrence violating policy contract.
More over the case is filed beyond the Limitation period as per consumer protection Act 2019 . As such there is no deficiency in service by this OP and the complainant made by the petitioner be dismissed.
(5) Heard the complainant and perused the material on record with submission and vehement denials of the learned advocate for the OP with arguments.
(6) Going through the materials on record carefully scrutinized the evidence and perusal of the facts and evidence this commission found and observes that.
F.I.R of Bangomunda P.S. states about the theft of the vehicle in question on dt. 11/11/2019 but the F.I.R received on dt. 14/11/2019 and the final report disclosed that fact true but No clue presume to be not traced by the Investigating officer. The vehicle was a registered vehicle registered with R.T.O Bolangir and also a valid D.L up to 25/06/2039 . The cause of action arouse under Bangomunda P.S. as per the evidence.
The complainant orally submitted that he intimated to the agent regarding theft where he paid the insurance premium and contact with the B.M National Insurance Company Ltd. Bolangir Branch over phone , which found also in the form of affidavit. After this incident Covid-19 spread its root and all are busy to save owns life which cause delay in communication.
Taking the above circumstances we have to look over the Instruction of IRDA.
“ Insurance for effecting various post claim activities like investigation loss assessment, provisioning claim settlement etc. However this condition should not prevent settlement of genuine claim particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances”.
In the instant case the B.M in his letter dt.18/03/2021 knowing that the M/S Aasiward Motors was underground stated “please provide us the valid documentary evidence of claim intimation as accepted by the dealer M/S Aasiward Motors , Kantabanji within 5 days receipt of this letter “ was Just to defect the complainant to repudiate the contract only”.
Insurance company should not be too technical while settling the claim and asks for documents that the insured is not in a position to produce due to circumstances beyond his control. In this case all the incident, transaction and communication is in between the Covid-19 wave as such the complainant is exempted from contractual Liability.
(7) It is pertinent to mention here that No. investigative report filed by the OP regarding theft which shows the attitude of suppression of material fact by the OP without appointing investigator how the
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final report of the P.S received by the OP is a question mark .Regarding the answer towards Broker the Op clearly stated he tied up with Hero Insurance Broking India Pvt . Ltd. as such we see who is a Broker and who is an agent.
Broker represents consumer Broker search for policies from different insurance companies. The work of a Broker is vast. where as The agent of an Insurance company sells policies from the insurance company they represents. Work of an agent is limited to a company only. But both done the same work. The Op admitted that there is a tie up with Hero Insurance Broking India Pvt. Ltd. as such the premium paid by the complainant with the Broker and received the policy certificate was genuine.
The certificate of insurance reflects that it was valid from 30/03/2019 to 29/03/2020 which was issued by the Hero Insurance Broking India Pvt . Ltd. tie up with National Insurance Company Ltd. after receiving the premium through the Broke the Op denied that we did not know the Aasiward Motors when the payment of claim arouse. The Insurance company cannot free from the vicarious liability when there is a tie up or Joint venture with others any wrong done by his broker what may be the cause the principal( here the Op i.e. national Insurance Company )is liable for the wrong done.
More over even if the FIR is lodged before the P.S still the Insurers duty to appoint a surveyor or investigator even if the final report of P.S for non tracing the theft article. The Investigator appointed by the Insurance company. have found the claim of theft to be genuine then mere delay in intimating the insurance company about the occurrence of the theft cannot be a ground to deny the claim of the insured . In this case the insurance company neither appointed any investigator nor submits any investigator report.
Regarding this the Hon’ble Apex court in judgment of case of Dharmendra Goel V. Oriental Insurance Co Ltd. III (2008) CPJ 63 (SC) held as under. “ Insurance company being in a dominant position often acts in an un reasonable manner and after having accepted the value of a particular insured goods disowns that very figure on one pretext or other when they are called upon to pay compensation this take it or leave it attitude is clearly unwarranted not only as being bad in law but ethically indefensible . It is generally seem that the insurance companies are only interested in earnings the premium and find ways and means to decline claims.
More over in Gurushinder Singh V. Sri Ram General Insurance Company Ltd. 2020 (II) SCC. 612 – clearly clarify the delay in lodging of FIR as well as the information to the insurer where it is held that delay in lodging FIR or to the insurance company is not a sole ground to repudiate the contract ( claim) where the policy is valid one and within the coverage period.
The case is failed within the time prescribed because of its continuation of the wrong. Taking the above facts and circumstances the materials and evidence on the record this commission came to conclusion that the OP intentionally delay the claim and repudiate the same amounts to deficiency in service , as such this commission given the thoughtful consideration in favour of the complainant. Hence order.
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ORDER
The OP ( National Insurance Company Ltd) is directed to pay a sum of Rs.68,400/- @12 % interest P.A from the date of filing of this case and Rs.20,000/- towards the mental agony and Rs.5,000/- as litigation expenses within one month from the date of order, failing which the OP is directed to pay the entire amount @ 12 % interest P.A from the date of filing till realization.
No award as to cost.
PRONOUNCED IN THE OPEN COMMISSION TODAY i.e DATED 17TH DAY OFMARCH’2023.
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(J.MISHRA) (R.K.TRIPATHY)
MEMBER. PRESIDENT(I/C)
