Madhya Pradesh

StateCommission

A/15/1030

MAGMA HDI GEN. INSU. - Complainant(s)

Versus

PRAKASH SHIVHARE - Opp.Party(s)

SH. RAVINDRA TIWARI

18 Sep 2024

ORDER

M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BHOPAL

PLOT NO.76, ARERA HILLS, BHOPAL

 

FIRST APPEAL NO. 1030 OF 2015

(Arising out of order dated 10.08.2015 passed in C.C.No.377/2014 by the District Commission, Gwalior)

 

MAGMA HDI GENERAL INSURANCE CO.LTD.

THROUGH LEGAL OFFICER,

OPPOSITE STATE BANK OF INDIA,

SAPNA-SANGEETA ROAD, INDORE (M.P.)                                                     …          APPELLANT.

 

            Versus                

PRAKASH SHIVHARE,

S/O SHRI VIDYARAM SHIVHARE,

R/O SECTOR-4, KOTESHWAR ROAD,

VINAY NAGAR, GWALIOR                                                                              …         RESPONDENT.

 

BEFORE:

                  HON’BLE SHRI A. K. TIWARI                  :       ACTING PRESIDENT

                 HON’BLE DR. SRIKANT PANDEY          :       MEMBER     

 

COUNSEL FOR PARTIES :

      Shri Ravindra Tiwari, learned counsel for the appellant.

      Shri S. M. Qazi, learned counsel for the respondent.

 

 

O R D E R

                                       (Passed On 18.09.2024)

                   The following order of the Commission was delivered by A. K. Tiwari, Acting President:    

                        This appeal by the opposite party/appellant-insurance company is directed against the order dated 10.08.2015 passed by the District Consumer Disputes Redressal Commission, Gwalior (for short ‘District Commission’) in C.C.No.377/2014, whereby the complaint filed by the complainant/respondent has been allowed.

 

 

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2.                In short facts of the case are that the complainant’s car bearing registration no. MP-07 CC-7709 was insured with the opposite party-insurance company for a period w.e.f. 20.11.2012 to 19.11.2013 for IDV Rs.4,30,000/-. It is submitted that earlier the car was insured with Sri Ram General Insurance Co. Ltd. On 23.06.2013, the insured vehicle on its way from Morena to Gwalior met with an accident and damaged totally of which intimation was given to the insurance company.  The claim was also filed with the insurance company but the insurance company vide letter dated 05.09.2013 repudiated the claim on the ground that the complainant had availed no claim bonus while obtaining the insurance policy suppressing the material fact that earlier he had obtained a claim with the earlier insurance company. It is submitted that the insurance company insured the subject vehicle after fully satisfying all the facts and had given benefit of no claim bonus. The complainant therefore alleging deficiency in service against the insurance company filed a complaint with the District Commission seeking IDV of subject vehicle Rs.4,30,000/- with interest @ 10% p.a., compensation of Rs.20,000/- and costs of Rs.5,000/-. 

3.                The opposite party/appellant-insurance company admitting the fact of insurance of the subject vehicle has submitted that it is wrong to say that in the said accident the subject vehicle was not damaged to the extent so that it can be ascertained that there is total loss. On intimation

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being received, the insurance company appointed Surveyor Rajeev Juneja who assessed the loss to the tune of Rs.2,18,314/-. Since the complainant had suppressed the material fact at the time of obtaining policy that earlier

he had obtained claim from the earlier insurance company to which the subject vehicle was insured and also took benefit of no claim bonus, which amounts to violation of policy conditions. The insurance is based on utmost good faith. Since there was violation of policy condition, the insurance company has rightly repudiated the claim. There has been no deficiency in service on part of the insurance company. It is thus prayed that the complaint be dismissed.

4.                The District Commission partly allowing the complaint directed the insurance company to pay the amount of Rs.2,18,314/- as assessed by the Surveyor to the complainant within a period of 30 days. Interest @ 8% p.a. from the date of repudiation of claim i.e. 05.09.2013 till payment is also awarded along with costs of Rs.1,500/-. Hence this appeal by the opposite party-insurance company.

5.                Heard learned counsel for the parties. Perused the record.

6.                Learned counsel for the opposite party/appellant-insurance company argued that earlier the subject vehicle was insured with Future Generali Insurance Co. Ltd and the complainant had obtained the claim from that company. The complainant was well aware of the fact that if he

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could have get the policy renewed from the said insurance company he will not get benefit of 50% no claim bonus. The complainant therefore with ill intention took insurance policy from the opposite party insurance company and availed benefit of 50% no claim bonus suppressing the material fact that earlier he had obtained claim from the earlier insurance company. Since there was violation of policy condition, the insurance company has rightly repudiated the claim but this fact was not considered by the District Commission and erroneously allowed the complaint by the impugned order.

7.                Learned counsel for the complainant/respondent argued that it is true that earlier the complainant’s vehicle was insured with Sri Ram General Insurance Company Limited but the complainant did not get any claim from the previous insurer. The insurance company has repudiated the genuine claim of the complainant on false grounds. In such circumstances, the District Commission after considering the evidentiary material available on record has rightly allowed the complaint directing the insurance company to pay the amount as assessed by the Surveyor. He therefore prayed for dismissal of appeal. 

8.                To substantiate the allegations made in complaint, the complainant has filed his affidavit along with document C-1 i.e. the repudiation letter dated 05.09.2013. On behalf of insurance company an

 

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affidavit of Govind Pandey, Assistant Manager with documents R-1 to R-5 has been filed. An affidavit of Rajeev Juneja, Surveyor and Loss Assessor has also been filed.

9.                Having heard learned counsel for the parties and on careful perusal of record, we find that it is an admitted fact that the complainant’s subject vehicle bearing registration no. MP-07 CC-7709 was insured with the opposite party-insurance company for the period w.e.f. 20.11.2012 to 19.11.2013 for IDV Rs.4,30,000/- (R-1) met with an accident on 23.06.2013 of which intimation was given to the insurance company. However, the claim filed with the insurance company was repudiated by the insurance company vide letter dated 05.09.2013 (C-1) on the ground that “The policy was issued allowing a No Claim Discount of 50%. However, your previous insurer Shri Ram General Insurance Co. Ltd. has confirmed that you are not eligible for any No Claim Discount, since you have made claim under the policy. Therefore vide your wrongful declaration you have violated the principle of good faith and also paid inadequate consideration towards policy.”

10.              The dispute between the parties is with regard to no claim bonus. The complainant on his affidavit has submitted that he never received any claim from the previous insurance company i.e. Shri Ram

 

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General Insurance Company Limited. On the other hand the pleading of the insurance company is that the complainant had obtained claim from the previous insurer Future Generali India Insurance Company Limited which is evident from R-4 and since the complainant had obtained insurance policy suppressing this material fact which amounts to violation of policy condition, the complainant is not entitled to get any claim. 

11.              R-1 is policy with conditions. R-2 is survey report dated 27.08.2013 of Rajeev Juneja wherein he has assessed the loss to the tune of Rs.2,18,314/-. R-3 is repudiation letter dated 05.09.2013 and R-4 is copy of email received from the Future Generali India Insurance Company Limited. R-5 is proposal form dated 19.11.2012 of the complainant submitted by the insurance company.

12.              On bare perusal of repudiation letter dated 05.09.2013 (C-1=R-3) we find that the insurance company has stated that the policy was issued allowing no claim discount of 50% however on going through the policy document (R-1) we find that the insurance company had given no claim bonus to the extent of 20% i.e. of Rs.1,920.98/-. Also in the repudiation letter it is mentioned that your previous insurer M/S Shri Ram General Insurance Company Ltd. has confirmed that you are not eligible for no claim discount since you have made claim under the policy whereas

 

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by relying the document R-4 the insurance company has submitted that the complainant had obtained claim from Future Generali India Insurance Company Limited. Learned counsel for the insurance company tried to convince us that there was typographical error, if that was so, it can be corrected and the corrected repudiation letter could have been sent to the complainant as also may filed before the District Commission.

13.              It is also pertinent to mention here that in the complaint as also in the affidavit the complainant has put his thumb impression whereas the proposal form R-5 is signed by the complainant stating that he had obtained claim from Future Generali Insurance Company showing policy number. How it is possible that an illiterate person who put his thumb impression on complaint and affidavit can sign the proposal form in good handwriting. Thus creates doubt.

14.              In view of the above discussion, we find that the District Commission has rightly concluded that the insurance company failed to prove that the complainant had obtained no claim bonus after suppressing the fact that he had obtained claim from the previous insurer. In our considered view the District Commission after considering the facts and circumstances and documentary evidence available on record has rightly directed the insurance company to pay Rs.2,18,314/- as assessed by

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surveyor with interest and costs. We do not find any illegality or infirmity in the impugned order passed by the District Commission. Accordingly, the impugned order is hereby affirmed.

15.              In the result, this appeal being devoid of any merit is hereby dismissed.  No order as to costs.

 

(A. K. Tiwari)                 (Dr. Srikant Pandey)    

                            Acting President                              Member