Delhi

South Delhi

CC/109/2019

SH. NARESH KUMAR - Complainant(s)

Versus

SHRIRAM GENERAL INSURANCE COMPANY LIMITED - Opp.Party(s)

29 Dec 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi- 110016

 

Case No.109/2019

Naresh Kumar

S/o Sh. Gian Chand Sharma

R/o House No. E-72, Chattarpur Extn,

New Delhi-110074

….Complainant

Versus

SHRIRAM GIC LTD

A-32, Second Floor, Lajapat Nagar-II

New Delhi-110024

 

Branch Address:

SCF 26, Sec 14

1^st Floor Gurgaon-122002

 

Head Office:

E-8, EPIP Sitapura Industrial Area,

Jaipur, Rajasthan-302022

       ….Opposite Party

    

 Date of Institution    :  18.04.2019     

 Date of Order            :  29.12.2022    

Coram:

Ms. Monika A Srivastava, President

Ms. Kiran Kaushal, Member

Sh. U.K. Tyagi, Member

 

ORDER

 

Member: Sh. U.K. Tyagi

 

1.      Complainant has made a complaint requesting to pass an award directing Shri Ram General Insurance Company Ltd. (hereinafter referred to as OP) to release the claim amount of Rs.71,889/- with interest; (ii) to compensate the Complainant in the sum of Rs.1,00,000/- towards mental torture, pain and agony; (iii) to pay Rs.30,000/- as litigation charges etc.

2.      Brief facts of the case are as under:

The Complainant took insurance policy for his car (Taxi) from the OP vide insurance policy no.102015/31/19/0003840 for the period 16.07.2018 to midnight 15.07.2019. After completing the codal formalities i.e to provide the necessary documents, paid the premium amount of Rs.16,683/-, the agent of the company neither sought signature  on proposal form nor provided the copy of terms & conditions. The said vehicle met with an accident on 18.12.2018. The  Complainant  immediately informed the OP. Consequently the  surveyor did the spot survey. As per direction, the vehicle was sent to M/s Prem Motors, Mahipalpur. The repairing was to be done on approval of claim as the  complainant did not have sufficient amount.  M/s Prem Motors informed the Complainant that they have got approval for repair. They started repairing and prepared the bill of Rs.71,889/- on 18.12.2018.

 

3.      Since the Complainant was not having the requisite amount, hence, due to urgent need of payment the Complainant sold the vehicle on 23.03.2019 and accordingly, the payment was made to the repairer company.

 

4.      The Complainant then submitted the claim alongwith said bill. He made several calls for release of the claim amount. Ultimately, he submitted a written letter date 07.02.2019. Copy of the same is enclosed as Annexure-4. Thereafter the complainant visited the office of the OP and he was told that claim had been rejected due to No claim Bonus (NCB). He expressed his innocente about NCB. It was advised that he may deposit the amount of NCB i.e Rs.2,072/- the same  was done through NEFT. It was revealed that OP sent a letter dated 17.09.2018 indicating the violation of the policy in question as “ you had taken a claim under previous policy”. The complainant had been registered for NCB but it was never issued. Moreover, the Proposal Form was filled in by the agent of OP. the Copy of said proposal form & terms & conditions were never supplied to him. Hence, there is deficiency in service and concealment of material facts at the end of OP. Hence, the complaint.

5.      OP, on the other hand, filed reply interalia raising some preliminary objections. On the receipt of intimation about said accident, the OP appointed an independent investigator and got the particulars of the previous insurance policy verified from the Religare General Insurance Co. Ltd and found that the Complainant  had taken claim under previous  year’s policy whereas he declared in the Proposal  Form of the policy with the OP that he had not received any claim from the previous year’s policy. As such, the Complainants had violated the Section 149(2)(a)(iii) (b) of the Motor Vehicle Act, 1988 by not disclosing this fact. This fact of the complainant amounts to breach of the basic principle of Insurance i.e “utmost good faith” i.e Condition no. 8 of the Motor Insurance Policy. Since there is violation of the Policy’s terms & conditions, the claim in question is not payable. The reason for repudiation of claim was intimated to the Complainant vide A.D letter dated 28.12.2018.

 

6.      The Complainant is guilty of suppression of material facts from this Ld. Forum. The Complainant got 35% NCB from the OP on the premise that he did not got OD claim from the previous insurer i.e Religare General Insurance Company.  The OP, on the knowledge of said fact, sent letter dated 17.09.2018 to refund NCB within 7 days. However, the complainant, with the malafide intention, transferred NCB amount of Rs.2,072/- by NEFT on 16.02.2019 i.e after the receipt of repudiation letter  and before filing claim before Delhi Govt. Mediation and Reconciliation Centre and this Forum. The adjudication of this kind of complicated facts which requires  elaborate evidence, cannot be  tried in summary proceedings.

 

 7.     OP filed written submission and evidence in affidavit. Written statement is on record so is rejoinder. Oral arguments were heard and concluded. Complainant appeared in person and not filed written arguments since he was in person, the same were not insisted upon.

 

8.      This Commission has gone into material placed on record and due consideration was given to the arguments. From the perusal of facts, it is transpired that the complainant was having the valid insurance cover under the commercial vehicle package policy with the OP, at the time of accident of subject vehicle. Due claim for the repair of the said vehicle, was not released by the OP on the premise that the Complainant had not disclosed the material fact in the Proposal Form of the current insurance policy with the OP. The Complainant got NCB claim of 35% from the OP and did not disclose the  fact that he  was in receipt of OD claim from the previous policy. The receipt of NCB claim on wrong facts made him disentitled of the claim under reference. The OP company has contended as discussed about  the non-disclosure of the facts leads to violation of principle of “Uberima  Fide”. The Hon’ble Supreme Court in catena of judgement held that the insurance cover is a contract and non-disclosure of material fact disentitles the insured of the due claim.

9.      The complainant maintained that the copy of Proposal Form and terms & conditions were not supplied to him and moreover, the said proposal form was filed in by the agent of the insurer. Further, he stated that he transferred the NCB amount to the OP vide  NEFT on 16.02.2019. the above contention of the complainant was examined by this Commission with the help of  documents available. Firstly, the Complainant was intimated by OP vide its letter dated 17.09.018 with the request to deposit the NCB  amount within 07 days. The said letter bore the A.D postal receipt confirming that he was told about the receipt of NCB on wrong facts. It goes to establish that there was no force in his argument that he was not given copies of proposal form, terms & conditions.

10.    On verification of facts from the previous policy with Religare Health Insurance co. Ltd., the complainant was told on 17.09.2018 well before the accident of subject vehicle on 18.12.2018. In a way, the complainant was given chance to deposit the NCB claim so as viable him to entitle any claim in case of any eventuality. The  complainant also maintained that  he was not in  receipt of letter dated  17.09.2018 but the said letter is having the A.D receipt on the face of it which establishes that letter was  sent and same had not been received back by the company. As mentioned  above, the complainant did transfer the NCB claim of  Rs.2,072/- on 16.02.2019 via NEFT. Since it was much later of the accident claim and before the filing the complaint in this Commission and Mediation and Conciliation Centre. The Complainant had referred the case of New India Assurance Co. Ltd Vs Pradeep Kumar, New India Assurance Co. Ltd Vs  Sturdy Polymers Ltd. (2011) III CPJ 338 (NCDRC) etc but the facts of these cases are different from the facts of the instant case. Hence not applicable here.

11.    The OP   mentioned the  citation CPJ 2006 SC265, of Hon’ble Supreme Court in New India Assurance Co.Ltd Vs Harshad bhai, Amrutbhai Modhiva & another- “ Consumer Court cannot go beyond Policy term & condition. The insurance policy has to be construed of having reference only to  stipulations contained in it and no artificial far-fetched meaning could be given”

12.    In nutshell, after having considered the material placed  on record,  and discussion as mentioned above, this Commission is of considered view that the OP has successfully proved its case and no  merit is found in the case of complainant. Thus, complaint fails.

          No order as to cost.

File be consigned to the record room and order be uploaded on the website.