Delhi

East Delhi

CC/916/2013

RENU GOEL - Complainant(s)

Versus

TATA AIG - Opp.Party(s)

24 Jul 2017

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 -      916/2013

                                                                                                   Date of Institution               17/10/2013

                                                                                                   Order reserved on               24/07/2017        

                                                                                                   Date of Order                       25/07/2017                                                                                     

 

In matter of

Mrs.  Renu  Goel, adult   

w/o Sh Ashok Goel   

R/o- A-153, Block A,

Preet Vihar, Delhi-110092……………………………………...…………….Complainant

                                                                    Vs

1-Tata AIG General Insurance Co. Ltd. 

1^st Floor, Lotus Tower,

New Friends Colony, New Delhi

Through Regional Manager

 

2-Tata AIG General Insurance Co. Ltd.

B-12, 1^st Floor, Sector 16,

Noida, UP 201301

Through Claim Manager ……………..………………………….…………..Respondents

 

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 a self employed dealing in readymade garments in Delhi, had Hyundai I 10 ERA car having registration no. DL 2 CAM-4347 took private car package policy insurance from OP1 vide policy no. 0151767800 effective from 27/05/2012 to 26/05/2013 and paid premium of Rs 7749/-annexed here as copy of driving licence, premium paid receipt and policy copy as per Ex CW1/1, 2, and 3. The IDV was Rs 3,37,000/- under the policy.

The complainant stated that she had disclosed orally all the facts about her previous policy at the time of filing policy proposal form and signed declaration also marked as Ex CW1/4 A, Ex CW1/4B and Ex CW1/4C.  

It had been stated that the said car met with an accident on 19/10/2012 and maximum damages occurred in the car which was towed by crane to the authorized service station, MGF Hyundai Automobiles Ltd. workshop, on the same day. Workshop gave estimate which was intimated to OP1, but OP1 rejected the claim stating as claim false and bogus as all incorrect facts were given in the claim intimation. The car was repaired and cost Rs. 1,67,309/-was paid by the complainant marked as bills Ex CW1/5A B, C, D, E, F, G and H.

Due to deficient service of OP1, legal notice was served on dated 15/04/2013 vide Ex CW1/6 for reimbursing the claim amount. When she did not get any reply, filed this complaint claiming damage charges Rs 1,67,309/- with compensation for harassment and mental agony Rs 1 lakh and appropriate cost of litigation. 

OP submitted written statement and denied all the allegations put by complainant. It was stated that IRDA licensed independent surveyor was appointed to assess the loss which was to the tune of Rs 60,816/- vide annexure R1 which was subject to the fulfillment of policy terms and conditions.  

During their process of claim, OP verified that complainant had taken one claim from her previous insurer as M/s Bharti AXA General Insurance Co. Ltd. It was stated that complainant had intentionally filled wrong entries pertaining to NCB 20% benefits. It was confirmed by Bharti AXA Insurance vide their email dated 19/10/2012. As complainant had not disclosed about claiming NCB 20% in her policy proposal form, her present claim was not admissible, hence claim and policy was rejected which was contrary to the declaration signed by the complainant.

OP reproduced policy declaration contents as-

“I/We desire to insure with Tata AIG General Insurance Co. Ltd. in respect of the vehicle described in the proposal form and confirm that statements contained in this application are my /our true and accurate representation. I/We undertake that if any of the statements are found to be false or incorrect, benefits under this policy stand forfeited.”  

The above said declaration read in concurrence with condition no. 8 of the policy which states as-

“the due observance and fulfillment of the terms, conditions and endorsements of this policy in so far as they relate to anything to be done or complied with by the insured and truth of statements and answers in the said policy proposal form shall be conditions precedent to any liability of the company to make any payment under this policy.”

 

OP replied to all the clarifications sought by the complainant and annexed here as Annexure R3, 4 and 5. It was stated by OP that as per GR 27 (general regulation 27 of India Motor Tariff) in declaring wrong NCB, all the benefits under the Motor Insurance Policy stands forfeited.  Here in this, the complainant had concealed factum that she had lodged a claim with the previous insurer Bharti AXA General Insurance in short BAGI, made a wrong declaration of NCB therefore all the benefits of “Section I Own Damage” under the present policy stand forfeited.

 

OP had also taken reference of judgment under TATA AIG General Insurance Co. Ltd. & others vs Gulzari Singh in II(2010)CPJ 271 NC where it was laid down that -

             “That insurance being contract of uberrima fides, there must be complete good faith on part of insured. Non disclosure of correct details of NCB benefits not acceptable. Complainant not being illiterate person having put his signature, so role of agent is not necessary.”

OP stated that liability if any was strictly restricted to the assessment as carried out by their surveyor in consonance with the terms and conditions of the policy.

 

The complainant submitted her rejoinder and stated that contents in the complaints were correct and OP had submitted their facts wrongly. It was stated that surveyor did come but gave incorrect figures to the workshop.  So complainant took her car to some other workshop for getting repaired under low cost.  Complainant annexed a bill of service charges marked as Ex CW1/8 and estimate of parts marked as CW1/9 A, B, C and D as unpaid.

Complainant submitted her evidences on affidavit and affirmed on oath that all the contents and facts were correct as per her complaint and further stated that she had told all the facts about her previous policy to the agent of the OP while he was filling policy proposal form and her claim was wrongly repudiated by OP despite of being surveyed by OP.  

OP also submitted their evidences on affidavit through Mr Mohd Azhar Wasi, Claims Head with OP who stated on oath that the claim was repudiated on the basis of non disclosure of material fact of 20% NCB benefit which complainant had availed from earlier insurer (Bharti Axa General Insurance Co.) and did not disclose in policy proposal form. This clearly amounts to non disclosure of material facts and based on the conditions of GR 27, her policy benefits were denied. It was also stated that OP may consider the surveyor report for Rs 60,816/- as damages to the said car for claim purpose in accordance to the policy terms and conditions.

 

Complainant submitted written arguments with reference of citation as United India insurance Co. Ltd. vs ET. TRAV AIDS Pvt Ltd & others in RP 3263/2007, NC which was dismissed in limine on 16/06/2016 and the order passed by the Forum was upheld. The facts were similar to the present case where complainant had not disclosed the benefits of NCB in policy proposal form from earlier insurer which was obtained by the complainant. The refusal of NCB was based on the GR 27 of India Motor Tariff and benefits were denied by OP, but complainant stated that the copy of GR was never given by OP. It was held that OP was bound to write the NCB after obtaining the details from earlier insurer co. within 21 days of issuing the policy and not mentioning the NCB itself amounts to the breach of tariff. Hence, complainant cannot be deprived of his claim under the current policy. The complainant also submitted another citation of State Commission Chandigarh UT in United India Insurance Co Ltd vs Ms Ruchi Madan in FA 350/2013 where similar legal issues were laid down. Hence, complainant prayed for consideration of her claim.  

 

OP also submitted their written submission and stated that their repudiation was justified based on the non disclosure of material facts while submitting policy proposal form by the complainant and she was not illiterate who could not understand the clauses of policy documents and also she had signed declaration form, which proves intentional hiding of material facts regarding NCB benefits taken from prior insurer (BAGI).

 

OP also submitted GR copy and citation from NCDRC as “TATA AIG General Insurance Co. Ltd vs Gulzari Singh in RP1255/2009 where it was held that complainant had not properly disclosed about the NCB benefit taken from other insurer, hence it amounts to non disclosure of material facts and OP was justified in repudiating the claims and other benefits in the policy.  So there was no deficiency in their service of OP and complaint may be dismissed.  

 

Arguments were heard from both the party counsels and order was reserved.

 

We have gone through all the facts and evidences on record and observed that under this vehicle insurance policy, there was nondisclosure of NCB benefit obtained by the complainant from Bharti AXA General Insurance Co. (in short BAGI) while filling the policy proposal form and also complainant had not mentioned any word about the previous policy in her complaint. The NCB benefit from BAGI was investigated and when claim was lodged, it was repudiated under the policy terms and conditions. Though car accident damages were investigated by their surveyor and damage estimate was given to sum of Rs 60,816/-.

 

Complainant had not mentioned about the cause of accident as where it happened and how it happened and also no FIR was lodged as her car was insured. Complainant knew that taking claim for damages from OP, the onus to prove damages rest upon complainant and here she has failed to prove so. Therefore, this complaint has no merit to say that repudiation was not justified by OP, but OP has stated that as per surveyor assessment damage report, OP may sanction the amount Rs. 60,816/-.  

 

Hence, we come to the conclusion that -

• OP shall reimburse surveyor’s estimated amount for damages a sum of Rs. 60, 816/-to the complainant within 45 days from receiving of this order.
• If OP fails to comply the order in stipulated time, said amount shall carry interest of 9% till realized.

 

• There shall be no other order to cost.  

The copy of this order be sent to the parties as per Act and file be consigned to the Record Room.

 

(Dr) P N Tiwari - Member                                                                      Mrs Harpreet Kaur- Member  

                                

                                       

                                                 Mr Sukhdev Singh - President