Delhi

East Delhi

CC/351/2017

ANIL KR. SHARMA - Complainant(s)

Versus

OIC LTD. - Opp.Party(s)

22 Feb 2019

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

 

C.C. NO. 351/17

 

SHRI ANIL KUMAR SHARMA

S/o Lt. Shri K.L. SHARMA

R/O B-51, GALI NO. 5, UNCHEPAR

MANDAWALI, DELHI-110092                                                                                                                    ….Complainant

 

Vs.

 

THE ORIENTAL INSURANCE COMPANY Ltd.

THROUGH ITS MANAGER

9, IInd FLOOR, RAJ BLOCK, NAVEEN SHAHDARA

DELHI-110032                                                                                        …Opposite party

 

 

Date of Institution: 28.08.2018

Judgement Reserved on: 22.02.2019

Judgement Passed on: 25.03.2019

 

CORUM:

Sh. Sukhdev Singh (President)

Dr. P.N. Tiwari (Member)

Ms. Harpreet Kaur Charya (Member)

 

Order By: Sh. Sukhdev Singh (President)

 

JUDGEMENT

The present complaint has been filed by Shri Anil Kumar Sharma, the complainant against the Oriental Insurance Company Limited, OP with the, allegation of deficiency in service and unfair trade practice.

Briefly stated the facts of the present complaint are that the complainant got his Santro car bearing number DL 3CAP 7403 insured from OP for a period from 23/1/2016 to 22/01/2017 vide policy bearing number 271702/31/2016/20671.The theft of the said insured vehicle took place on 15/16.08.2016 for which FIR dated 17/08/2016 was registered with P.S. Madhu Vihar.

It has been stated that the complainant had informed the agent of OP on the same day i.e. 17.08.2016, who asked the complainant to fill the motor insurance claim intimation form alongwith untraced report. The complainant has further stated that he was informed by the agent of OP that the claim intimation form has been misplaced and requested to submit a new claim form. Surveyor was appointed who demanded bribe for which written complaint dated 14.12.2016 was made to OP. The complainant was shocked to receive letter dated 16.05.2017 from OP seeking clarification which was duly replied by the complainant. Again, the complainant received letter dated 22.06.2017 seeking clarification which was also replied vide letter dated 29.06.2017. The claim of the complainant was not settled for which legal notice dated 03.08.2017 was served upon OP which was neither replied nor complied with. The complainant has alleged that the OP did not settle the claim despite timely intimation, non settlement of the claim even after the report prepared by the second surveyor and seeking repeated clarifications amounted to deficiency in services. Hence, the present complaint with prayer for directions to OP to pay claim of Rs. 83000/-, compensation of Rs. 1,00,000/- on account of harassment and cost of litigation.

Copy of registration certificate, insurance policy, FIR bearing number 024012 under section 379 IPC, claim intimation form, untraced report, complaint of surveyor dated 14.12.2016, letter dated 16.05.2017 and its reply dated 28.05.2017, cash receipt, discharged voucher, copy of crossed cheque with pass book, repudiation letter dated 22.6.2017 with reply and legal notice have been annexed with the complaint.

Summons were served upon OP thereafter written statement was filed, wherein it was stated that the complainant had informed the Police on 17.08.2016 and the claim was lodged with the OP only on 23.11.2016 i.e. after the delay of 98 days from the date of incident which was 15.08.2016, thereby resulting in breach of policy terms and conditions; there was suppression of material facts by the complainant; the complaint involved complicated question of facts and law which could not be adjudicated in summary proceedings under Consumer Protection Act. It was submitted that OP was prompt in redressing the grievance of the complainant, and as per policy terms and conditions, claim for theft of vehicle was not payable if theft was not reported to the company within 48 hours of its occurrence. As the complainant was communicated with each and every stage of the claim no deficiency in services could be attributed to OP. it was also submitted that the legal notice was replied vide reply dated 20.09.2017 sent on 29.09.2017, the fact which has been concealed by the complainant. Rest of the contents of the complaint have also been denied.

Copy of the insurance policy, reply dated 20.09.2017 to the legal notice sent by the complainant, investigation report, dated 24.01.2017 have been annexed with the reply.

Rejoinder to the written statement was filed by the complainant where the contents of the complaint have been reiterated and those of the written statement filed by OP have been denied.

Evidence by way of affidavit was filed by both the parties, where the complainant has got examined himself and has deposed on oath the contents of the complaint. He has also got exhibited the copy of documents of insurance and ownership as Ex. CW1/1 (colly); copy of FIR as Ex. CW1/2, copy of claim intimation form as Ex. CW1/3; copy of untraced report and second claim intimation form as Ex. CW1/4 and Ex. CW1/5 respectively; copy of complaint dated 14.12.2016 as Ex. CW1/6, copy of letter dated 16.05.2017, 29.05.2017, 22.06.2017 and 29.06.2017 as Ex.CW1/7 to Ex. CW1/10; copy of legal notice alongwith AD Card as Ex. CW1/11  (colly) and Ex. CW1/12 respectively.

Shri Rajeev Chopra (senior divisional manager) was examined on behalf of OP who has also reaffirmed the submissions made by them in their written statement and has relied on copy of policy certificate alongwith terms and conditions as Ex. OP/A (colly); copy of investigation report as Ex. OP/B (colly); copy of reply to the legal notice as Ex. OP/C (colly).

We have heard Ld Counsel for Complainant and Ld. Counsel for OP. It has been argued on behalf of Oriental Insurance Company Ltd. that the claim was repudiated on the ground of inordinate delay of 98 days in informing the insurance company. Ld. Counsel for Oriental Insurance Co. Ltd. have placed reliance on the judgement of Hon’ble Supreme Court in Oriental Insurance Co. Ltd. V/s Parvesh Chander Chadha [(2018) 9 SCC 798], where it has been laid down that as per terms of insurance policy, insured was duty bound to inform insurer about the loss immediately after the incident. Repudiation of claim on ground of delay was held to be proper.

On the other hand Ld. Counsel for the Complainant has argued that they had intimated to the agent of the insurance company on the very day i.e. 17.08.2016. He has further argued that the insurance company appointed the surveyor, who investigated the claim and assessed the same for a sum of Rs. 73,700/-. He has relied upon a judgement of Hon’ble Supreme Court in Om Prakash V/s Reliance General Insurance and Anr. Civil Appeal No. 15611 of 2017, which was decided on 4th October, 2017.

To appreciate the arguments of the Ld. Counsel of parties. Firstly, a look has to be made to the judgement relied upon by Ld. Counsel for the Parties, if a look is made to the judgement of Hon’ble Supreme Court in Oriental Insurance Co. Ltd.(Supra) , the reliance has been placed by Ld. Counsel for the OP, it is noticed that the said case was decided on 17.10.2010 about 9 years back, on the other hand the judgement of Hon’ble Supreme Court in Om Prakash (Supra) on which counsel for complainant have placed reliance was decided on 4th October, 2017, which is the latest law on the land. Thus, the judgement of Hon’ble Supreme Court in Oriental Insurance Co. Ltd. (Supra) relied by Ld. Counsel for OP does not hold the law of the land. Thus, the case of the complainant have to be decided on the basis of the law laid down by the Hon’ble Supreme Court in Om Prakash (Supra), where the Hon’ble Supreme Court have made observations in respect of rejection of claims by the insurance companies and the complaints made by complainants under the Consumer Protection Act and their disposal thereof. The relevant portion of the judgement is extracted here under:

It is common knowledge that a person who lost his vehicle may not straightaway to the insurance company to claim compensation. At first, he will make efforts to trace the vehicle. It is true that the owner has to intimate the insurer immediately after the theft of the vehicle. However, this condition should not bar settlement of genuine claims particularly when the delay in intimation or submission of documents is due to unavoidable circumstances.

The decision of the insurer to reject the claim has to be based on valid grounds. Rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. If a reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the grounds of delay.

It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine. It needs no emphasis that the Consumer Protection Act aims at providing better protection of the interest of consumers. It is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten while considering the claims make under the Act.

In the light of these observations, it has to be seen as to whether rejection of claim by the insurance company on the ground of delay was justified or not.

It is the case of the Oriental Insurance Co. Ltd. that there was a delay of 98 days, whereas the complainant have stated that he has informed to the agent of the insurance company on the very day itself. Admittedly, the complainant have not informed to the insurance company immediately after his vehicle was stolen. However, from the observations of the Hon’ble Supreme Court, which have been made in the case of Om Prakash (Supra), the insurance company have not to reject the claim of the policy holder merely on the technical grounds, if the claim is genuine one. Further, the Consumer Protection Act have to be given liberal interpretation to advance justice. In the present case complainant has stated that he has informed to the agent of the insurance company and on filing the claim with insurance company, it has appointed surveyor who have recommended an amount of Rs. 73,700/- as a claim settlement. He has further pointed that the claim was a genuine one. When the surveyor M/s Reliable Investigation have found the claim to be genuine one and have recommended for settlement for an amount of Rs. 73,700/-, the rejection of the claim by the insurance company merely on the ground of delay, which is a technical ground should not have weighed with the insurance company. Thus, rejection of the claim merely on the technical ground amounts to deficiency in services of the insurance company. Procedural law should not come in the way of substantive justice. Thus, the complainant was entitled for an amount of Rs. 73,700/-, which was recommended by the surveyor.

In view of the above, we order that the Oriental Insurance Co. Ltd. shall pay an amount of Rs 73,700/- to the complainant within a period of 45 days. In order to balance the interest of both the parties, we do not want to award any compensation to the complainant except the cost of litigation for amount of Rs. 10,000/-.

If the awarded amount of Rs. 73,700/- is not paid within the stipulated period, it will carry an interest @9% per annum from the date of order.

Copy of the order be supplied to the parties as per rules.

File be consigned to Record Room.

 

 

    (HARPREET KAUR CHARYA)                                               (SUKHDEV SINGH)

       Member                                                                      President