Haryana

Ambala

CC/159/2010

KULWINDER KAUR - Complainant(s)

Versus

NIA CO. - Opp.Party(s)

B.S GARG

31 Dec 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

           Complaint Case No.       : 159 of 2010

Date of Institution         : 05.05.2010

            Date of Decision            : 31.12.2015

Kulwinder Kaur w/o Harpinder  Singh R/o village Sain Majra Tehsil Naraingarh, District Ambala.                                                                                                                                                                                                                                  ……Complainant.

Versus

National Insurance Co. Ltd.  through its Branch Manager, Naraingarh Tehsil Naraingarh, District Ambala.

                                                                                                ……Opposite Party.

Complaint Under Section 12 of the Consumer Protection Act

CORAM:        SH. A.K. SARDANA, PRESIDENT.

                        SH. PUSHPENDER KUMAR, MEMBER.                       

Present:           Sh.B.S. Garg, Adv.  counsel for complainant.

                        Sh. R.K. Vig, Adv. counsel for OP.

ORDER.

                        The present complaint under section 12 of  the Consumer Protection Act, 1986 (hereinafter in short called as the ‘Act’)  has been filed by the complainant alleging therein that  she got insured her Alto LX Car bearing Regn. No.HR04B-8165 with the OP vide policy No.420201/3108/6100002062 valid from 13.10.2008 to 12.10.2009. On 05.09.2009, the vehicle met with an accident and the factum of accident was brought to the notice of OP. The vehicle was got inspected by the Surveyor of OP as well as took photographs of the damaged car and thereafter, the OP asked the complainant to get his vehicle repaired.  As such, the complainant got his vehicle repaired from Modern Automobiles, Ambala City and spent a sum of Rs.22,420/- and the bills were submitted to the OP company on 09.10.2009 for settling the claim.   Thereafter, the OP company asked the complainant to bring No Claim Bonus Certificate from the previous company i.e. ICICI Lombard. Accordingly,  the ICICI Lombard Company vide letter dated 08.03.2010 issued No Claim Certificate  which was also submitted by the complainant to the OP company.  It has been further alleged that  the complainant requested Op company number of times to pay the compensation amount as per the insurance policy but they did not pay the genuine claim of the complainant.   So, the complainant wrote a letter dated 19.03.2010 to the OP company  to know the status of her  claim whereby Op company informed the complainant that your declaration regarding No claim Bonus is incorrect and thus  your claim has been repudiated. It has been further alleged that despite repeated requests of complainant, the OP No.1 did not release the claim and thus it is deficiency on the part of the OP.  Hence, the present complaint has been filed by complainant seeking reliefs as mentioned in prayer para of the complaint.  

 2.                    Upon notice, OP appeared and filed written statement raising preliminary objections qua non-maintainability of complaint,  no deficiency in service etc. on the part of Op. It has been contended by the OP that No Claim Bonus is admissible to the party if in the preceding full year of Insurance, neither any claim was made nor was pending. In this regard, the insured is required to give a declaration which runs as under:-

“I declare that the rate of NCB claimed by me is correct and that no claim has arisen in the expiring policy period. I further undertake that if this declaration is found to be  incorrect, all benefits under the policy in respect of section-I of the policy will stand forfeited”

                        In light of above declaration, the insured was entitled to get only 20% NCB if he/she fulfilled the condition which clearly says “No claim made or pending during the preceding full year  of Insurance.” It has been further submitted that   the policy issued in favour of complainant clearly indicates that concession of NCB of 20% i.e. Rs.1092/- was given to her since, the complainant intimated  the OP that she had not availed  the benefit of NCB earlier in the previous insurance which was insured with ICICI Lombard General  Insurance.  But  later on, complainant herself informed the Op vide application dated 04.01.2010 that in the policy with ICICI Lombard company,  her son had already taken claim which categorically shows that the declaration made for NCB  was found  false.  On merits, it has been submitted that  complainant claimed an amount of Rs.22420/- whereas the surveyor of OP assessed  the loss only to a sum of Rs.19011/- which was too subject to terms & conditions of the policy including NCB. Thus the OP company  has requested for dismissal of the complaint with costs being devoid of merits.

3.                     In evidence, complainant tendered  her affidavit  as Annexure CX-1/A alongwith documents as Annexure C-1  to Annexure C-7 and closed her evidence whereas on the other hand, counsel for OP has tendered in evidence affidavits of Sh. Suresh Sharma and  Sh. Vikas Kohli-Surveyor as Annexures RA & RB   alongwith documents as Annexures R-1 to R-31    and closed the evidence on behalf of OP.  

4.                     We have heard the learned counsels of both the parties & have gone through the records of case carefully.  Counsel for the complainant has argued that  the vehicle in question met with an accident  on 05.09.2009 and  at that time the vehicle was insured with OP company but despite submitting all the required documents and completing formalities, the OP has wrongly repudiated their claim on  19.03.2010.   

                        On the other hand, counsel for the OP has argued  that  the complainant has suppressed the material facts qua NCB while taking policy and submitted false declaration. Hence, her claim was rightly repudiated by them.  In support of their case, the OP has placed reliance on case law rendered by Hon’ble National Consumer Disputes Redressal Commission, New Delhi in case titled  Tata AIG General Insurance Company Ltd.  & Anr. Vs. Gulzari Singh II (2010) CPJ Pg. 272wherein it has been held that Consumer Protection Act, 1986, Section 2(1)(g)-Insurance-Suppression of material facts-Declaration regarding “No Claim Bonus” wrongly made by insured-insurance being contract of  uberrima fides, there must be complete good faith on part of insured-Attempt not to disclose details of claim obtained from previous Insurance Company clearly visible in documents produced on record- Contention, agent filled wrong information, not acceptable-Complainant not illiterate person having put his signature,. Role of agent brought only as after-thought-State Commission erred in awarding loss assessed by Surveyor –Order not sustainable-Set aside in revision.”

 5.                    At the very outset, it is not disputed by the OP company that the vehicle met with an accident on 05.09.2009 and at that time it was insured with them. However, the OP company  has repudiated  the claim of complainant only on the ground that she has suppressed the facts regarding No Claim Bonus  by giving false declaration  while taking policy from the OP.  The counsel for OP has drawn our attention   towards letter dated 04.01.2010 written by complainant to OP insurance company (Annexure R-3) wherein  complainant has herself admitted that she has come to know from his son that he has already received the claim in the previous policy  regarding the vehicle in question.  Further  the counsel for OP has  placed on record document G.R. 27  i.e. Instructions qua No Claim Bonus which depicts that where the insured is unable to produce such evidence of NCB entitlement from the previous insurer, the claimed NCB may be permitted after obtaining from the insured a declaration as per the following wording:-

                        “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 benefits under the policy in respect of Section I of the Policy will stand forfeited.”

                        In view of the  observations  made above,  it is clear from the document Annexure R-3  that the complainant has suppressed  the material facts  while taking benefit of  ‘No Claim Bonus’  from the OP insurance Company at the time of issuance of Policy and submitted false declaration resulting into forfeiting  of all benefits under the policy and thus we hold that complainant is not entitled for any claim from OP  company.  Further, the facts of case law Tata AIG General Insurance Company Ltd. & Anr. (supra) put-forth by the Op-company is fully applicable to the present case. As such, we have no option except to dismiss the present complaint.  Accordingly, the complaint is dismissed with no order as to costs. Copies of this order be sent to the parties free of costs. File be consigned to the record room.

 

Announced:31.12.2015                                                                       Sd/-

                                                                                                (A.K. SARDANA)

                                 PRESIDENT                

 

                                                                                                                 Sd/-

                      (PUSHPENDER KUMAR)

                                                                                                            MEMBER