1 Sh. Karwinder Singh complainant has filed the present complaint under the Consumer Protection Act (herein-after called as ‘the Act’) against The Manager, Reliance General Insurance Company Limited etc. (Opposite Parties) on the allegations of deficiency in service with further prayer to direct Opposite Parties-Reliance General Insurance to release the insurance amount of Rs.12 lacs alongwith damages to the tune of Rs.50,000/- for harassment and mental agony, etc. and Rs.33,000/- as litigation expenses.
2 The case of the complainant in brief is that the complainant is owner of car make Force One BS 4 Class bearing registration certificate No.PB-46L-0007 which the complainant purchased for Rs.13 lacs approximately; that the complainant got the said car insured with Opposite Parties-Reliance General Insurance under policy No.2003532311003792 for the period 26.9.2013 to 25.9.2014 and paid the premium for the same; that on 16.9.2014 Ranjit Singh cousin brother of the complainant, took the car to pay obeisance to Gurdwara Baba Budha Sahib Ji Jhabal, Tehsil &
District Tarn Taran and went inside Gurdwara Sahib and when he returned back, said car was stolen by some body; that Ranjit Singh tried his best to trace the car, but with no affect and on the same day i.e. 16.9.2014 Ranjit Singh filed an application in P.S.Jhabal and on the said application, the police made an enquiry and then investigated the theft in FIR No.83 dated 24.5.2014 under section 379/411 IPC, P.S.Jhabal as the present case was of the same nature; that Ranjit Singh also approached the office of Opposite Parties-Reliance General Insurance and narrated the whole occurrence of theft orally, but officials of the Opposite Parties-Reliance General Insurance told the complainant to bring Non Traceable Report and then they will start the process of claim; that Opposite Party No.1 company also issued letter dated 18.5.2015 demanding some documents from the complainant and the complainant contacted the officials of Opposite Party No.1 company and requested that Non Traceable Report is to be received from the competent authority and requested for more time; that on 7.8.2015, the complainant received Non Traceable Report from police of P.S.Jhabal and then went to office of Opposite Parties-Reliance General Insurance and delivered Non Traceable Report, but Opposite Parties-Reliance General Insurance refused to receive the same on the ground that claim of the complainant has already been closed; that the complainant again filed representation on 24.8.2015 to Opposite Parties-Reliance General Insurance with request to release the genuine claim of the complainant, but with no affect; that the conduct of the Opposite Parties-Reliance General Insurance caused harassment and mental agony to the complainant who has already suffered huge loss and it amounts to deficiency in service on the part of the Opposite Parties-Reliance General Insurance. Hence the complaint was filed.
3 After formal admission of the complaint, notice was sent to Opposite Parties. Opposite Parties No.1 and 2-Insurance Company appeared through counsel and filed written reply contesting the complaint on the preliminary objections that the complaint under section 12 and 13 of Consumer Protection Act, 1986 is not maintainable; that the complaint is not maintainable under section 11 of Consumer Protection Act, 1986 as this Forum has got no jurisdiction to try the present complaint and the complainant has no locus standi to file the present complaint and the complaint is also bad for mis-joinder and non-joinder of necessary and proper parties; that there is violation of terms of the policy as late intimation was given to the insurance company as the vehicle was stolen on 16.9.2014 whereas the claim was intimated on 25.9.2014 i.e. after 9 days and as such, there was no deficiency on the part of the Opposite Parties-Reliance General Insurance; that after intimation of the claim, it was registered under claim reference No.2141126229 and then the complainant was asked to submit the necessary documents, but he failed to submit those documents for settlement and as such, the claim could not be settled due to fault of the complainant himself; that the complainant has not submitted second key of the vehicle; that the complainant has not approached the Forum with clean hands and has suppressed the material facts as the documents were asked from the complainant which he intentionally did not provide and then reminders dated 18.3.2015, 17.4.2015 and 18.5.2015 were issued requiring the complainant to submit the documents, but with no affect and as such, the claim of the complainant was closed in the record of Opposite Parties-Reliance General Insurance and that the complainant has filed the complaint on the wrong facts and has suppressed the material facts in order to mislead the Forum and as the complainant has violated the terms and conditions of the policy and as such, has lost his right to be compensated for the alleged theft of the car. On merits, it was admitted that the policy in question for the period 26.9.2013 to 25.9.2014 was issued by Opposite Parties-Reliance General Insurance, but the policy was not valid at the time of alleged occurrence. All other allegations were denied for want of knowledge and also for being wrong and incorrect on the same lines as were taken in the preliminary objections and prayer was made for dismissal of the complaint with costs.
4 Sufficient opportunities were granted to the parties to lead evidence in order to prove their respective case. The learned counsel for complainant produced affidavit of complainant Ex. C-1, affidavit of Ranjit Singh Ex.C2 alongwith copies of documents Ex.C3 to Ex.C12 and closed the evidence and thereafter Ld. Counsel for Opposite Parties-Reliance General Insurance tendered in to evidence affidavit of Surya Deep Singh Thakur Ex.OPs/1 and closed the evidence.
5 We have heard the ld.counsel for the parties and also gone through the evidence and documents produced by parties.
6. Ld.counsel for the complainant contended that the complainant is owner of the car having approximate value of Rs.13 lacs which he insured with Opposite Parties-Reliance General Insurance for the period 26.9.2013 to 25.9.2014. He contended that on the date of theft i.e. 16.9.2014, the cousin of the complainant namely Ranjit Singh was driving the car and went to Gurudwara Baba Budha Sahib and parked the car and went inside, but when he returned back, the car was not found at the parked place and could not be traced inspite of efforts and due to this reason, Ranjit Singh filed an application with the police on the same day i.e. 16.9.2014 and police started investigation of the same as per endorsement made on the application and investigated the matter in previously registered case No.83 dated 24.5.2014 under section 379/ 411 IPC, P.S.Jhabal. He contended that the police prepared the Non Traceable Report Ex.C3 and the same was obtained by the complainant under Rights to Information Act and took the same to Opposite Parties-Reliance General Insurance, but the officials of Opposite Parties-Reliance General Insurance refused to receive the same on the ground that the claim case of the complainant has already been closed due to non submission of documents. He contended that Non Traceable Report was to be provided by the police and as such, he produced the Non Traceable Report to the officials of the Opposite Parties-Reliance General Insurance whenever it was delivered to the complainant and as such, there was no fault on the part of the complainant. He also contended that all required and necessary documents were submitted to the Opposite Parties-Reliance General Insurance, but Opposite Parties-Reliance General Insurance intentionally did not settle the claim of the complainant on flimsy grounds and it amounts to deficiency in service on the part of the Opposite Parties-Reliance General Insurance and it also caused harassment and mental agony to the complainant and as such, the complaint is required to be allowed and Opposite Parties-Reliance General Insurance is required to be directed to pay Rs.12 lacs i.e. insurance claim of the vehicle alongwith compensation and litigation expenses as mentioned in the complaint.
7. Ld.counsel for Opposite Parties-Reliance General Insurance contended that theft of the car in question took place on 16.9.2014, but the complainant intimated the theft to the Opposite Parties-Reliance General Insurance on 25.9.2014 i.e. with a delay of 9 days and the Opposite Parties-Reliance General Insurance could not conduct proper investigation due to the fault on the part of the complainant by reporting the theft with delay. He also contended that the complainant has wrongly claimed the insurance amount of Rs.12 lacs whereas the Insured Declared Value of the car was Rs.9,59,310/- and as such, the complainant has not come to the Forum with clean hands and has suppressed the material facts as he did not provide the documents required from the complainant by letters sent to the complainant by Opposite Parties-Reliance General Insurance and as such, the complaint is required to be dismissed with special costs.
8. The ownership of the car in question by the complainant is admitted fact in this case. It is also admitted fact in this case that the complainant got the car in question insured with Opposite Parties-Reliance General Insurance for the relevant period 26.9.2013 to 25.9.2014. It is also admitted fact that the complainant filed claim with Opposite Parties-Reliance General Insurance for the theft of the car in question. The contention of the Opposite Parties-Reliance General Insurance is that the complainant was asked to provide the documents vide different letters as placed on the file by Opposite Parties-Reliance General Insurance dated 18.5.2013, 17.4.2015 and lastly on 18.3.2015 which is also proved by the complainant as Ex.C6, but the complainant did not submit these documents and due to this reason, the claim was closed as intimation of theft was also given with delay of 9 days. Opposite Parties-Reliance General Insurance sought 7 documents from the complainant as mentioned in letter dated 18.5.2015 Ex.C6. Ist is copy of vehicle purchase invoice. This document is not required unless the claim is settled and payment is to be made. 2nd document is acknowledgement copy of letter to NCRB intimating them about theft. The theft is to be intimated to NCRB by police and not by the complainant. As such, this enquiry should be made by Opposite Parties-Reliance General Insurance from the police. 3rd document is acknowledgement copy of letter to Manufacturer intimating them about theft. The learned counsel for the OP has not provided any law or rule which requires that owner should inform the manufacturer about the theft of the vehicle. 4th is Non Traceable Report issued under section 173 CRPC. This report is to be prepared by the police after the completion of the investigation and it is the contention of the complainant that this report was delivered to him by police on 7.8.2015 and he took the same to Opposite Parties-Reliance General Insurance, but they refused to receive the same on the ground that claim case has already been closed. Said Non Traceable Report under section 173 CRPC is proved by the complainant as Ex.C3 and the forwarding letter sent by the police alongwith Non Traceable Report is proved by the complainant as Ex.C4. Application given by Ranjit Singh to police regarding theft of vehicle is proved as Ex.C5 and the police endorsement regarding the action taken by the police is also mentioned on the same which is dated 16.9.2014 and it clearly shows that Ranjit Singh intimated the theft of the car to the police on the same day when theft took place i.e. on 16.9.2014. In this eventuality the late intimation to the Opposite Parties-Reliance General Insurance is not of much significance as investigation is to be conducted by the police and intimation to the police was given at the earliest i.e. on the day of theft itself. Moreover, the officials or investigator of the Opposite Parties-Reliance General Insurance can go through the investigation conducted by the police. As such, this clause is also complied with by the complainant. 5th document is one cancelled blank cheque of the insured. Again this document is required after the settlement of the claim when payment is to be made by the insurer. 6th document is service history of vehicle which is not to be provided by the complainant, but by the service station. Moreover, this document is not necessary for the settlement of the claim and last documents is second original key of vehicle which is also not necessary for the settlement of the claim particularly when key of the vehicle has already been delivered to the Opposite Parties-Reliance General Insurance as is mentioned in letter Ex.C6 itself. As such, the query made by Opposite Parties-Reliance General Insurance vide different letters mentioned by it are not necessary for the settlement of the insurance claim of the complainant and it shows that the officials of the Opposite Parties-Reliance General Insurance were making the queries only for the purpose of delaying the settlement of the claim and it must have caused harassment and mental agony to the complainant.
9. Second and main point taken by Opposite Parties-Reliance General Insurance in closing or repudiating the claim of the complainant is delay of 9 days in intimating the Opposite Parties-Reliance General Insurance regarding theft of car in question. Otherwise, the complainant has alleged that Ranjit Singh intimated orally about the theft of car in question to Opposite Parties-Reliance General Insurance on the same day, but he was directed to bring Non Traceable Report. Otherwise also, it is admitted fact that intimation about theft was given to the Opposite Parties-Reliance General Insurance on 25.9.2014 with minor delay of 9 days. This delay in the opinion of the Forum is not such a delay which could compel the insurance company to close or repudiate the claim of the complainant. Otherwise also, a circular dated 20.9.2011 was issued by IRDA, referred to all the insurance companies, which reads as under:-
“Circular
To: All Life Insurers and non-life insurers
Re: Delay in claim intimation/ documents submission with respect to
i) All life insurance contracts and
ii) All Non-life individual and group insurance contracts.
The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.
The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances. The insurers’ decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such intimation clause does not work in isolation, and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.
Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.
The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers’ stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.
J. Harinarayan
Chairman”:
A bare reading of circular shows that if the claim is otherwise payable then it should not be repudiated or rejected simply on the ground of delay and delay is only to be considered when claim is otherwise not made out and is liable to be rejected even if the matter has been reported in time. In case titled as National Insurance Company Limited Vs. Kulwant Singh 2014(IV) CPJ page 62 (NC) the Hon’ble National Commission observed that the insurance company should not have repudiated the claim merely on account of delay in giving the information to insurance company particularly when there was absolute no delay in lodging the FIR with the police. In the case in hand also, the theft took place on 16.9.2014 and intimation to the police was also given on the same day i.e. 16.9.2014 and as such, there was no delay at all for giving the intimation to the police. Moreover, in similar case titled as Reliance General Insurance Company Limited- Petitioner Vs. Sri Avvn Ganesh-Respondent 2012(1) CPJ page 176 in case under Consumer Protection Act, 1986 the intimation of death was given to the insurer with delay and claim was repudiated on the ground that death of insured was intimated after 4 months as against stipulated period of one month.
The complainant filed complaint on the allegation of deficiency in service by insurance company, but the same was dismissed, but appeal filed by the complainant was allowed by Hon’ble State Commission. On revision, the Hon’ble National Commission, New Delhi observed that all the conditions for acceptance of insurance claim except point of reporting loss within one month of its occurrence had been substantially fulfilled and delayed intimation of death of insured due to injuries he suffered on account of accident could not be held to be destructive to insurance claim because the facts and circumstances of death were clearly established on the basis of medical on records as well as deposition of doctor who attended the insured and it was observed that like in case of theft of moveable insured property, delay in intimation was not prejudicial to the insurer because in such cases, Insurance company was not prevented, because of delay, from carrying out any investigation into the facts and circumstances as to whether the accident and consequent loss fell within the substantive condition of insurance policy and no infirmity was found in the order and revision petition was dismissed. In the case in hand also, the theft of vehicle in question was reported to the police on the same day by the person from whose possession the car in question was stolen and as such, the complainant has substantially fulfilled the condition of the policy as intimation to police was immediate and even to the insurance company was only with a delay of 9 days as claimed by the Opposite Parties-Reliance General Insurance which is not material in the case in hand for closing or repudiating the claim case of the complainant and as such, the complainant is entitled to claim the insurance amount of the vehicle in question.
10. The complainant has claimed Rs.12 lacs as insurance claim, but no evidence is led on the file as to how the complainant is claiming Rs.12 lacs. The insurance policy is not proved by the complainant on the file, but it is brought on the file by Opposite Parties-Reliance General Insurance and it shows that the complainant declared the Value of the car in question as Rs.9,59,310/-. In this eventuality, the complainant is not entitled to claim more than Rs.9,59,310/-. As the theft took place during the operation of the insurance policy, therefore, the complainant is entitled to claim only the Insured Declared Value from the Opposite Parties-Reliance General Insurance which is mentioned in the policy itself. The complainant is also entitled to compensation on account of harassment and mental agony and in the opinion of the Forum, the balance of justice would struck if the complainant is awarded Rs.10,000/- on account of compensation for harassment and mental agony.
11. In light of the above discussion, the complaint succeeds as discussed above and is allowed with costs in favour of complainant and against Opposite Parties-Reliance General Insurance. The complainant is held entitled to recover Rs.9,59,310/- (Rupees nine lac fifty nine thousands, three hundred and ten only) as insurance claim for the car in question, subject to fulfilling the necessary requirement for the transfer of the car in question in the name of Opposite Parties-Reliance General Insurance and filing the subrogation letter and other necessary compliance. The complainant is also entitled to Rs.10,000/- as compensation on account of harassment and mental agony. The complainant is also awarded Rs.2,000/- as costs of litigation from the Opposite Parties-Reliance General Insurance. Opposite Parties-Reliance General Insurance is directed to pay the awarded amount to the complainant within one month from the date of receipt of copy of the order. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.
Pronounced in Open Forum
Dated 21.03.2017.
