The titled Complainant Sh. Karan Mahajan aggrieved at the unjust arbitrary repudiation (Ex.C14) of his Car-Accident Repairs Claim on the pretext of his being ineligible to have availed of the No-Claim-Bonus (NBC) discount at the time of purchase of the related car-policy; has filed the present complaint against the titled opposite parties seeking release of the total amount of his Car Repairs-Claim for Rs.36,400/- (Ex.C3) besides Rs.50,000/- as compensation and Rs.30,000/-as litigation expenses.
2. The complainant has been the registered owner of TATA Make Tiago Car Model 2018 R.C. # PB-06-AQ-8960 and had got it insured from the OP1 insurers through the OP2 Agent vide the related Zero Depreciation Cashless Car Insurance Policy # 401502311810003467 (Ex.C1) at a purchase premium @ Rs.11,663/- and at an Insured Depreciated Value (IDV) @ Rs.4 Lac valid from 18.03.2019 to 17.03.2020. Somehow, the said Car met with a Road-side Accident on 15.03.2020 (Sunday) and thus the OP1 insurers were duly intimated on 16.03.2020 (Monday) and Vishwajit Bhargwa Surveyor was deputed for assessment of loss/damage etc and under his advice the damaged Car was shifted to Sandhu Motors, Pathankot (Authorized TATA Dealers) for repairs. As the OP1 insurers delayed the payment of repairs Bills Rs.36,400/- to the work-shop it refused delivery of the repaired car so the complainant paid the Bills himself (Ex.C2) and lodged the related claim with the insurers and also served the Legal Notice (Ex.C4 to Ex.C6) on 04.06.2020. Further, letters (Ex.C7 to Ex.C13 & Ex.C15) + document Ex.C16 and postal receipts Ex.C17 and Ex.C18 were exchanged and finally the OP1 insurers repudiated the repairs-claim on the pretext that the complainant had availed of NCB (No Claim Bonus) to which he was not eligible/entitled as he had availed of an insurance-claim from his past/previous insurers.
3. The complainant did pleaded that in terms of the G.R. Rule # 27 of the IRDA General Rules, the present new/fresh insurers are liable/bound to confirm the NCB eligibility from the past/previous insurers within the stipulated period of 21 days but the OP1 insurers have confirmed the same on 17.03.2020 i.e. after the expiry of the related insurance and at the time of resolve/settlement of the repairs claim. But, the OP insurers had rejected the said plea, ignored the served upon legal notice and stood firm at their unjust repudiation and thus prompted the present complaint duly accompanied by the self attested affidavit (Ex.CW-1) along with the above exhibits seeking the aforesaid relief(s). Rejoinder as well as Written Arguments are duly filed by the complainant.
4. The titled opposite party No.1 insurers, in response to the commission’s summons/notice appeared through their counsel and filed the written statement/reply stating therein preliminary as well as other (on merits) objections whereas the OP2 Agent preferred to stay absent and was ordered to suffer ex-pa-rte proceedings.
5. The OP No.1 insurers plead that the complaint is not maintainable as the complainant has neither 'cause of action' nor 'locus-standee' to file the present complaint. And, there has been 'No deficiency in Service' on their part. In fact, upon receipt of the accident-claim from the complainant an investigation was conducted and it was revealed that the complainant had availed-of the NCB (No Claim Bonus) Discount to which he was not eligible as he had filed and had also availed-of an insurance-claim from his past/previous insurers and had not disclosed the same rather had suppressed the material fact during purchase of the insurance policy, in question. Thus the claim has been rightly repudiated and the present complaint has been prayed to be dismissed with costs, in the interest of justice. The OP1 insurers have filed the listed documents (along with the duly Sworn Affidavit Ex.OPW1/A by their Sr. Div. Manager Sh.Sunil Tuli) in evidence as: Ex.OP1/1– Copy of Requisition Letter 19.06.2020 to the complainant; Ex.OP1/2–Copy of OP Reminder Letter 12.06.2020 to the complainant; Ex.OP1/3–Copy of Pre-Repudiation Letter 04.06.2020 to the complainant; Ex.OP1/4–Copy of NCB related Letter by the previous insurers; Ex.OP1/5–Copy of the applicable Package Policy Wording;
6. We have duly heard the learned counsels for both the sides, on points of law, and have also thoroughly examined the records with requisite care and caution on the points of fact, as placed before us. We are also inclined to examine the inference it’s ‘scope n spread’ on account of some documents ignored to be produced/not-produced during the course of the present proceedings.
7. We observe that the OP insurers' prime objection/pleading favoring its claim repudiation has been that the complainant has availed of the No Claim Bonus Discount to which he has not been eligible since he had availed of an insurance claim from his previous insurers but had not disclosed the same while purchasing the present policy from the OP1 insurers. In response, the complainant has referred to the GR 27 of the IRDA General Rules that directs the insurers to verify the previous policy particulars pertaining to NCB issues/matter from the previous insurers within 27 days of the issuance of the new/fresh policy. However, here the OP1 insurers have verified the issue at the time of settlement of the claim and that has been apparently the one negligent omission on their part and harsh to the interests of the complainant at the stage of settlement of claim(s). Usually, the insured do not check the details of the insurance premium being charged by the insurance agents who do all these calculations etc and the insurers need to cross check the same in line with the IRDA guidelines and recover arrears, if any, well in time and not at the time of resolve/settlement of the claim(s) etc. The insured shall not suffer/pay towards the negligence n dereliction of duty at the insurers' end.
8. We thus discard the OP insurers' above pleadings/arguments, being in total contravention of the laws of natural justice. We are of the considered opinion at the face of the evidenced-facts as available on the records that there’s have been an unfair display of its superior/dominant position by the OP1 Insurers in settling the accident-claim that they have been legally bound to honor of course up to the IDV level, only; and as such the impugned ‘repudiation’ on the OP1 insurer's part of the insurance-claim, in question, had been unwarranted, arbitrary and unfair; neither in accordance with the provisions of the statutory law nor in conformity with the sanctity of natural justice, equity and good conscience. Further, it has violated with impunity the preferred statutory consumer rights of the young banker complainant causing him much physical harassment, mental agony and financial loss in his routine peaceful life. Lastly, we hold the insurers guilty of statutory misconduct amounting to ‘unfair trade practices/deficiency in service’ and thus liable to an adverse award under the provisions of the governing statute.
9. In the light of the all above, we order the OP1 insurers to pay the impugned claim @ its full amount of Rs.36,400/- with interest @ 6% PA from the date of complaint till realization besides Rs.10,000/- in lump sum as cost cum compensation within 45 days of receipt of the certified copy of orders otherwise the aggregated award amount shall attract an additional interest @ 3% PA from the date of the orders till realization, in full.
10. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
11. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Naveen Puri)
President.
ANNOUNCED: (B.S.Matharu)
DEC. 07, 2022. Member.
YP.
