Delhi

East Delhi

CC/808/2015

AJAY KUMAT - Complainant(s)

Versus

SHRI RAM GENERAL INS - Opp.Party(s)

29 Oct 2015

ORDER

            DISTRICT CONSUMER DISPUTE REDRESSAL FORUM, EAST, Govt of NCT of Delhi

              CONVENIENT SHOPPING CENTRE, 1^st FLOOR, SAINI ENCLAVE, DELHI 110092  

 

                                                                                                   Consumer Complaint no.        808/2015

                                                                                                   Date of Institution                29/10/2015

                                                                                                   Order reserved on                24/07/2019        

                                                                                                   Date of Order                        26/07/2019                                                                                    

 

In matter of

Mr. Ajay Kumar  

S/o  Sh Ram Singh

R/o  C /1274, Gali no. 11    

Sangam Vihar, New Delhi 110080…….……………....…………….Complainant

                             

                                      Vs

The Manager

Shri Ram Gen. Insurance Co. Ltd. 

506 – 507, 5^th Floor, Pragati Deep Building

Laxmi Nagar District Centre, Delhi 110092……..........…………Opponent

 

Complainant  Advocate                Mr BP Shukla & Asso.       

Opponent  Advocate                     Mr N K Chauhan    

 

Quorum                                          Sh Sukhdev  Singh        President

                                                         Dr P N Tiwari                 Member

                                                         Mrs Harpreet Kaur       Member                                                                                             

 

Order by Dr P N Tiwari  Member  

Brief Facts of the case                                                                                                

Complainant, owner of commercial vehicle Innova Toyota car vide registration numbers DL-1VB-6220 got insured from present OP vide policy no. 10003/31/14/414317 having tenure from 10/10/2013 to 09/10/2014 with IDV Rs 6,40,750/-and had commercial permit (Ex CW1/3 &4) for earning his livelihood from this vehicle. The said car was hired for outstation tour from 08/07/2014 to 10/07/2014 with driver, complainant himself and other members. The said car met with an accident on 08/07/2014 after hitting standing Canter. The driver Sanjay with other passengers were injured, but no FIR was registered. After treatment (Ex CW1/5 & 6), complainant’s relative intimated OP about damage of car in an accident. OP after lodging claim nominated surveyor to assess damages.

The surveyor after assessment of damages demanded certain documents from complainant which were supplied. It was stated that Galaxy Toyota work shop took damaged car for repair and gave an estimate for repair amount which was approximate 10 lacs, but even after intimating OP about damage, but OP did not pay repairing charges to workshop as per estimate. In turn workshop started parking charges Rs 200/- per day and workshop did not start repair of the car. Seeing deficiency of OP, claimed the cost of the car Rs 9,74,046/-with Rs 73,000/-as parking charges from 20/09/2014 till removal and Rs 30,000/- per month as loss of earning till 20/09/2015 totaling Rs 3,60,000/-and Rs 50,000/-for harassment and mental agony.

 

OP denied all the allegations of deficiency and submitted that complainant neither got repaired his vehicle even on repeated reminding for repair nor submitted required documents for claim to the surveyor as per reminding letters dated 31/10/2014, 08/11/2014, 18/11/2014 and 28/11/2014 (Ex OPW1/E). It was submitted that commercial car policy was issued by present OP on the facts disclosed in policy proposal form vide policy no. 10003/31/14/414317 with all terms and condition with IDV, but on scrutiny it was found that complainant had earlier vehicle policy from Reliance General Insurance vide policy no. 1304522340000036 which was effective from 10/10/2012 to 09/10/2013 and was cancelled (Ex OPW1/G). This fact was not disclosed by the complainant before present OP at the time of taking policy so this amounts concealment of material fact which was done intentionally OP (Ex OPW1/A).

 

It was stated that complainant and OP were always bound by the terms and conditions in reference to United India Insurance Co. vs M/s Harchand Rai Chandan Lal, JT 2004 (8) SC 8 and  in LIC vs G M Channabasamma, 1991 (1) SCC 357 where law was laid down by the Hon. Supreme Court that contract between Insurer and Insured was based on good faith and if concealment of material fact was found it amounts to cancellation of policy based on misrepresentation of material facts under policy terms and conditions. Hence, claim was repudiated as complainant intentionally hidden concealment of material fact about previous policy of Reliance General Co., hence, this complaint be dismissed.    

Complainant filed rejoinder to the written statement and denied all the replies submitted by OP. Complainant stated that despite of repeated follow up to OP office, genuine accidental claim was not paid despite OP’s surveyor report. Complainant stressed that all his facts and evidences were correct and on record. So, OP was deficient in their services. Hence, due to presence of deficiency in their services, relief claimed in the complaint may be awarded.

Complainant filed his evidences by way of his own affidavit and affirmed on oath that all the facts of his complaints were true and correct. He stressed his evidence as ownership of vehicle (Ex CW1/1) and copy of Insurance cover note based by OP (Ex CW1/4) and all medical records (Ex CW1/5) with photograph of total damaged vehicle/car (Ex CW1/7). He also relied upon estimate charges for repair given by the workshop of manufacturer of car (Ex CW1/11) along with daily parking charges from the workshop (Ex CW1/12). Complainant also filed copy of MACT case vide exhibit no. CW1/15 to 19. Hence, all his evidences prove deficiency in the service of OP, so his claim be processed as per policy terms and conditions.

 

OP submitted evidences on affidavit through Mr Rama Raman, Legal Officer with OP and relied on the policy documents issued by them vide policy no 10003/31/14/4131 having tenure from 10/10/2013 to 09/10/2014 with all the terms and conditions which were on record (Ex OPW1/A). It was stated that claim was rightly rejected on concealment of previous policy taken from Reliance Insurance Co. vide policy no. 1304522340000036 for the period from 10/10/2012 to 09/10/2013 (Ex OPW1/G) which was cancelled and complainant did not disclose about this policy at the time of taking policy from present OP which amounts willful concealment of facts.  So, his claim was repudiated on policy terms and conditions and was justified.

Arguments were heard from the counsel of complainant as OP counsel did not put his appearance. So after perusal of materials and evidences of both the party’s on record, order was reserved.

After going through all the facts and evidences on record, it was observed that the rejection of accidental claim was based on the concealment of material facts in reference to Reliance Insurance Co. vehicle policy by complainant and complainant preferred present OP to take vehicle policy which was from 10/10/2013 to 09/10/2014 and it was also evident that accident took place during current year policy (2013 to 2014). More so, OP was intimated in time by the complainant’s relative when complainant was under treatment. OP on receiving intimation, claim was registered and surveyor was nominated to assess the damages. The surveyor also gave estimate of damages of the vehicle, but as per OP’s reminder letters to complainant, claim documents were not submitted by the complainant though complainant stated n his complaint that all the required claim documents were submitted, but there was no evidence for that.

Also repudiation of accidental claim by OP does not hold any weight as OP had nothing to do with previous Reliance policy as in vehicle insurance, only current year policy is considered for claim or NCB. OP rejection was based on non disclosure or concealment of fact of previous year policy.

So, there are merits in this complaint as- 

                                                                       i- Effective policy was in force,

                                                                       ii-Accident took place during current year policy

                                                                       iii- OP was intimated immediately about damages/loss

                                                                       iv-Surveyor was nominated and estimate was given

                                                                       v- Police proceedings were present (MACT case),

but as per OP, complainant did not submit the required documents, so considering above facts, we come to the conclusion that repudiation was not justified by OP.

We direct complainant to submit all the required claim papers with OP within 45 days from receiving copy of this order and OP shall proceed for accidental claim settlement under policy terms and conditions in 30 days after completion of formalities by complainant. There shall be no order to cost.

 

The first free copy of this order be sent to the parties as per the Section 18 (6) of the Consumer Protection Regulations (in short the CPR) and file be consigned to Record Room under Section 20 (1) of the CPR.

(Dr) P N Tiwari  Member                                                                 Mrs  Harpreet Kaur  Member                                             

                                                  Sukhdev Singh  President