BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.202/2014

DATED ON THIS THE 3^rd February 2017

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

    2) Smt. M.V.Bharathi                    

                                   B.Sc., LLB., -  MEMBER

                     3) Sri. Devakumar.M.C.                  

                                                          B.E., LLB.,    - MEMBER

Sri DEVAKUMAR.M.C,

Member

1.     The complainant has filed the complaint under section 12 of the C.P.Act, 1986, against the opposite party, alleging deficiency in service and unfair trade practice and seeking a direction to settle the insurance claim amount of Rs.4,34,318/- with interest at 12% p.a. from the date of claim, till the date of payment and Rs.2,50,000/- towards damages and mental agony with cost and other reliefs.
2.     The complainant’s car was insured with opposite party and the same valid from 23.12.2012 to 22.12.2013.  The car met with an accident on 11.08.2013.  The insurance claim has been repudiated on the ground that the accident occurred after the lapse of insurance policy.  The opposite party issued a cheque for a sum of Rs.524.28 on 09.10.2013 as refund of excess premium amount. Hence, the aggrieved complainant filed the complaint, seeking reliefs.
3.     The opposite party admits issue of policy, valid from 23.12.2012 to 22.12.2013, on receipt of premium amount with a rebate of 20% NCB.  Since there was claim made during the previous policy period, the complainant was not entitled for 20% NCB benefit. As such, there was a shortfall of premium of Rs.13,693/-, the complainant has been informed to deposit the same to provide the policy coverage upto 22.12.2013. But, the complainant failed to pay the same.  Accordingly, the policy period has been reduced upto 22.07.2013 only.  Since, the accident occurred on 11.08.2013, i.e. after the lapse of policy period, the insurance claim has been repudiated and there is no deficiency in service and unfair trade practice by it and not liable to pay any damages, hence prays for dismissal of the complaint.
4.     To establish the facts, the complainant lead his evidence by filing affidavit with documents.  The opposite party filed its affidavit only.  Complainant filed written arguments and counsel addressed oral arguments.  Opposite party not filed the written arguments and not addressed oral arguments.  Perusing the material on record, matter posted for orders.
5.      The points arose for our consideration are:-

1. Whether the complainant establishes the deficiency in service and unfair trade practice by opposite party, in not settling the insurance policy claims and thereby he is entitled for the reliefs sought?
2.  What order?

6.    Our findings on the aforesaid points are as follows:

Point No.1 :- Partly in the affirmative.

Point No.2 :- As per final order for the following

:: R E A S O N S ::

7.    Point No.1:- The complainant insured his car with opposite party and the policy has been renewed from 23.12.2012 to 22.12.2013, on payment of premium amount of Rs.57,448/.  The IDV of the vehicle was Rs.30,90,586.40.  The car met with an accident on 11.08.2013 and the same has been informed to opposite party.
8.    The opposite party surveyor inspected the vehicle, subsequently, the opposite party, vide its letter dated 23.09.2013, informed the complainant that, the policy period was 23.12.2012 to 22.07.2013 only, since the date of accident does not fall within the policy period, there was no valid contract between them, as such, the insurance claim has been repudiated.  On enquiry, the opposite party informed that, the complainant had paid a lesser amount of Rs.13,700/- towards the premium amount and the same has been communicated to him and requested to make good the shortfall.  Despite of the same, the complainant fail to pay the shortfall amount, to provide policy coverage as per the policy schedule.  Therefore, the opposite party adjusted the premium amount between 23.12.2012 to 22.07.2013 only and the excess amount of Rs.524.28 has been refunded to the complainant through cheque on 09.10.2013.
9.    The opposite party contended that, a discount of 20%.  No claim Bonus (NCB) has been provided, presuming that, there was no claim during the previous policy period i.e. 23.12.2011 to 22.12.2012 and renewed policy for the period 23.12.2012 to 22.12.2013 has been issued on receipt of premium amount of Rs.57,448/-.
10. Since, the complainant made the claim on 08.01.2013, for the loss suffered on 25.11.2012, (i.e. during the previous policy period).  So an NCB of 20% given on renewal of the policy in the subsequent year was not valid.  Because of the claim made, the complainant was not entitled for the benefit of 20% NCB, thereby there was shortfall of premium amount of Rs.13,693/- to provide policy coverage for the stipulated period.  Since, the complainant failed to make good the shortfall of premium amount of Rs.13,693/-, the policy coverage period has been adjusted to the amount paid.  Accordingly, the policy has been amended to the period between 23.12.2012 to 22.07.2013 only.  However, the complainant contended that, there was no intimation from the opposite party, with regard to the said facts.
11. So the opposite party repudiated the claims, on the ground of lapse of the policy coverage on the date of occurrence of the accident (i.e. on 11.08.2013).
12. However, the complainant got his car repaired from the authorised service centre and paid Rs.4,00,000/- on 29.11.2013 as against the invoice for a sum of Rs.4,34,318/-.  Even though the opposite party surveyor assessed the loss at Rs.6,70,492/-.
13. In view of the above observations, we opine that, insurance being a bilateral agreement, the opposite party has unilaterally modified the policy coverage period, which is not acceptable.  Therefore,  the opposite party is liable to pay the insurance claims made by the complainant with interest, by deducting the shortfall of premium amount, due from the complainant and providing the policy coverage as per the policy issued (i.e. from 23.12.2012 to 22.12.2013).  Further, the opposite party is liable to pay damages for the mental agony and deficiency in service and cost of proceedings to the complainant.  Accordingly, point No.1 is answered partly in the affirmative.
14. Point No.2:- With the above observations, we proceed to pass the following

:: O R D E R ::

1. The complaint is allowed in part.
2. The opposite party shall pay Rs.3,86,307/- (Rs.4,00,000/- - 13,693/-) along with interest at 18% p.a. from the date of filing the complaint till the date of payment, to the complainant within 60 days of this order.  Failing which, the opposite party shall pay Rs.100/- per day, until payment made.
3.  The opposite party shall pay Rs.10,000/- compensation towards deficiency in service and mental agony and Rs.5,000/- towards cost of the proceedings to the complainant, within 60 days of this order.  In default to pay interest at 12% p.a. on the said total sum of Rs.15,000/-, until compliance is made.
4. In case of default to comply this order, the opposite party shall undergo imprisonment and also liable for fine under section 27 of the C.P.Act, 1986.
5. Give the copies of this order to the parties, as per Rules.

 (Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 3^rd February 2017)

                          (H.M.SHIVAKUMARA SWAMY) 

                                      PRESIDENT     

(M.V.BHARATHI)                           (DEVAKUMAR.M.C.)

      MEMBER                                         MEMBER