The present complaint has been filed by the complainant, M/s.K.S.Selection Pvt. Ltd. through its Director Sh.Rajender Chawla, against Oriental Insurance Company Ltd, the insurer as OP with the allegations of deficiency in services and unfair trade practice.

1. Facts necessary as per the complaint are that the complainant, a Private Ltd. Company registered under the Registrar of Companies at New Delhi owner of  White Pearl Crystal Shine Colour Fortuner Car 2WD, 2.8:6AT   bearing Registration No.DL10CH9498, got the same insured with OP vide policy No.272600/31/2021/15 for the period from 19/04/2020 to 18/04/2021 with the IDV of Rs20,03,436/- by paying a premium of Rs67,327/-.

2. It has been stated that the vehicle was insured in continuation of previous policy No. 272600/31/2020/154 issued by OP. The vehicle was insured without any default since the date of purchase i.e from 19/04/2017. The complainant had also opted for an add- on- cover for Return To Invoice (RTI) by paying Rs.12,099/-and only cover note of the said policy was issued and terms were orally explained by the sales agent.    

3. The complainant company had availed bank loan by hypothecating the insured vehicle for Rs.29,00,000/- and continued to pay EMI without any default.  OP has also charged for Add-on cover for consumable for Rs.2,204/-, key replacement for Rs.400/-, NIL depreciation policy for Rs.24,121/- apart from RTI.

4. On 24/09/2020, the insured vehicle was stolen from the backside of Central Hospital, Tilak Nagar, Delhi between 23.00 hrs. to 4.00 hrs.FIR No.024187/2020 was registered on the same day. The complainant was asked by OP to submit the regular service record to show that the insured vehicle was in good condition and well maintained

5. OP alongwith other authorities was also informed. Untraced report was accepted by Ld.ACMM-01, West District, Tis Hazari Court, Delhi on 05/11/2020.  

6. On 31/03/2021, the complainant received a letter stating that the claim of Rs.20,01,436/- had been approved as on normal indemnity policy.  It has been alleged by the complainant that OP knowingly and deliberately deducted the amount payable for the claim under the “Add-on” despite the fact the vehicle was insured on RTI with No depreciation.  Despite several communications the claim of the complainant was not settled as per add-on policy for return to invoice.

7. Hence, the present complaint with prayer for directions to OP to disburse the claim of Rs.35,71,373/- alongwith interest @18% p.a. from 24/09/2020 (date of theft till disbursal of the claim amount to the satisfaction of the complainant; provides an alternative vehicle of the same category till disbursal of the claim; compensation of Rs.10,00,000/- for mental pain, harassment and agony and cost of litigation. 

8. The Complainant company has filed Board of Resolution dated 30.06.2021; copy of certificate of incorporation; copy of performa invoice dated 24.03.2017; copy of registration documents by the transport department, Govt. Of NCT of Delhi; copy of Insurance policy with computation of schedule of payment dated 31.03.2020; copy of FIR dated 24.09.2020; copy of affidavit on e-stamp of Rs.10/- alongwith self declaration dated 30.09.2020; copy of letter to the registering authority, District Transport office, Raja Garden, New Delhi-110027 dated 28.09.2020; copy of bank loan statement as on 30.09.2020; copies of email correspondence with OP and the IRDAI; copy of order dated 05.11.2020 passed by court of Ms.Neha, Ld. ACMM-01, West District, Tis Hazari, Delhi; copy of email dated 07.09.2021 regarding information of stolen car; copy of communication dated 25.09.2020;copy of email dated 24.09.2020; copy of FIR No.024187 dated 24.09.2020 regarding stolen car; Copy of self declaration dated 30.09.2020; copy of insurance policy No.272600/31/2021/15 

9. Notice of the present complaint was served upon OP; thereafter written statement was filed on their behalf.   

10. They have taken preliminary objections such as: no cause of action had arisen in favour of the complainant;  the claim was settled as per normal indemnity GR-8 of IMT and condition No.3 of Package policy for private car and the complainant was not entitled to Return To Invoice Cover on 3rd renewal; claim was passed on total loss for Rs.20,01,436/- ; complainant did not submit the reply to the letter of OP despite several mails hence, the claim was closed for non-compliance and there is not deficiency of service on part of OP.

11. It has been denied that the complainant had opted for additional cover for RTI by paying gross premium of Rs.12,099/-. It has also been denied that only cover note was handed over to the complainant and policy was never delivered.  All the contents of the complaint have been denied with the prayer for the dismissal of the complaint with cost.

12. OP has annexed conditions pertaining to return to invoice-add on cover, letter dated 13/03/2021, 16/12/2021 and 31/03/2021 requesting the complainant to comply with the formalities with the written statement. 

13. Rejoinder with the written statement was filed by the complainant stating that the complainant had got its vehicle insured from the OP since the purchase of said vehicle and subsequently by paying yearly premium on time.  It has been denied that the claim had been approved as per normal indemnity by the competent authority.  As OP had been collecting additional premium specifically for RTI, thus, they are bound to disburse the claim as per add-on-policy.  It has also been denied that the complainant had not supplied the documents as required for the settlement of the claim.  Rest of the contents of the complaint have been reiterated and those of the written statement have been denied.

14. Evidence by way of affidavit has been filed on behalf of the complainant Company. Sh. Rajender Chawla, Director of the Complainant Company has been examined on its behalf.  He has repeated the contents of the complaint and got exhibited the board resolution and certification of incorporation as Exh.C-1& Exh.C-2 respectively.  The copy of Performa Invoice and invoice dated 19/04/2017 as Exh.C-3 and Exh.C-4 respectively; copy of registration certificate issued by Government of NCTD as Exh.C-5; copy of insurance cover note  with computation of schedule of payment dated 31/03/2020 as Exh.C-6; Bank loan statement as on 30/09/2020 as Exh.C-7.

15. Copy of letter to the Registering Authority dated 28/09/2020 and after sale service record of the said vehicle with email dated 26/09/2020 as Exh.C-8;  copies of emails dated 24/09/2020 and 25/09/2020 as Exh.C-9 and Exh.C-10; copy of email dated 07/09/2021 as Exh.C-11; affidavit on e-stamp alongwith self declaration dated 30/09/2020 is Exh.C-12; untraced report date 05/11/2020 as Exh.C-13; copy of letter dated 31/03/2021 as Exh.C-14  and copy of email correspondence with the OP and the IRDAI as Exh,C-15 (colly).  

16. OP has got examined Ms. Seema Gupta, Deputy Manager on their behalf.   The contents of the written statement have been reiterated and she has got exhibited the copy of head office circular as Ex.R1W1/1 and Ex.R1W1/2; copy of letter dated 13/09/2021, 16/12/2021 and 31/03/2021 are Ex.R1W1/3 to Ex.R1W1/5 respectively.

17. We have heard the arguments on behalf of Ld. Counsel for the complainant and Ld. Counsel for the OP. We have also gone through the written submission filed by the parties. It is seen that the OP has approved the claim of complainant as per standard policy cover and has asked the complainant company to comply the formalities. On the other hand the complainant company is aggrieved by non settlement of its claim by OP to Return To Invoice cover despite charging premium for add-on-cover for RTI of Rs.12,021/- excluding GST. 

18. As per Ex.CW1/6, Motor insurance Certificate cum Policy schedule bearing policy no.272600/31/2021/15, the complainant had paid Rs.67,327/- as premium for IDV of Rs.20,03,436/-.  This document is digitally signed by authorised signatory Sh. Ajit Kumar , General Manager for and on behalf of the Oriental Insurance Co. Ltd. Schedule of premium which forms part the policy schedule bears:-

Add:  Add on cover for return to invoice :Rs.12,021/-

19. In para 5 of the written statement OP has specifically denied that complainant also opted for additional add-on-cover for RTI and paid a gross premium of Rs.12,099/. This is contrary to the policy schedule issued by OP.

20. OP on the other hand denied the assertions of the complainant by placing on record Ex.RW1/1 and Ex.RW1/2 circular no.H.O/MOT/UW/2014-15.CR-6916 dated 01/07/2014 stating the salient features of the New add on cover return to invoice for Motor policies. It deals with the applicability of the cover upto age of 2 years of vehicle at the time of insurance of vehicle.   It is to be noted that this circular is to all BOS/DOS/ROS, I-AD, VIGILANCE DEPTT, IT DEPTT, OSTC, ALL Deptts of H.O & CMD SECRETARIAT, CLAIMS SERVICE CENTRES/TP HUB.

21. This circular meant for internal circulation. It is also not the case of OP that these circulars were supplied to the complainant. The premium has been accepted including for Add-on-Return-To-Invoice and thereafter policy has been issued on 31/3/2020. There is a gap 9 months from issuance of policy and filing of the claim. No corrigendum was also issued subsequent to issuance of policy cover, it is only at the time of claim, OP has denied claim of ‘RTI’ by complainant. Once, OP has accepted extra premium and issued policy for Add on Cover, principle of estoppel will apply against OP. They are estopped from claiming that the insured was not entitled for ‘RTI’ cover on 3rd renewal.

22. Non –settlement of Claim of the complainant as per issued policy thus amounts to deficiency in services and unfair trade practice.

23. Therefore, in the facts and circumstances of the present complaint, we direct OP to pay:

(a) The claim of the complainant Company as per Return to Invoice cover along with  interest @7% p.a. from the date of filing of present complaint (09/08/2021) till realization.

(b) Compensation of Rs.25,000/-  inclusive of  litigation expenses. 

The order be complied with in 30 days from the date of receipt of order.   Office is directed to supply the copy of this order to the parties as per rules. Order be also uploaded on the website.  Thereafter, file be consigned to the record room.