IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT AURANGABAD
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Complaint case No :- 307/2014 Date of filing :- 27/06/2014
Date of disposal – 20/01/2015
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Mr.K.N.Tungar, President
Mrs.Sandhya Barlinge, Member Mr. Kiran R.Thole, Member
____________________________________________________________________________________________ Prabhakar Apparao Tupe,
R/o Rashmi Nagar, Mayur Park,
Jalgaon road, Aurangabad. Complainant.
V/s
The Divisional Manager,
The New India Assurance Company Lt,.
(Non-Suit claim Hub)
Jivan Suman, LIC Building, Plot No. 3,
N-5, Cidco, Aurangabad Respondent
Adv.U.A.Khekale for the complainant .
Adv.N.G.Mali for respondent.
Judgment
(per – Mrs.Sandhya Barlinge, Member)
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Complainant had purchased a Swift Desire car manufactured by Maruti Udyog limited; bearing registration number MH020-BY-3541.Complainant had insured the said car with ICICI LOMBARD COMPANY LTD. for the period from 9/9/11 to 8/9/12. At the time of renewal of the said insurance policy, one Mr. M.B.Damodare ,development officer of respondent company met him and insisted to renew his insurance policy . Relying upon his words, complainant had renewed his car insurance policy with respondents insurance company . Complainant had deposited Rs. 11,686/- on 19/11/12 as premium. Complainant had handed over previous insurance policy and RC book to respondent. On 25/9/13 complainant’s car met with an accident while he was driving the car. On 26/9/13 he informed respondent company about the accident. Respondent had sent Mr. K.B.Parmar Surveyor for assessment. The surveyor had visited car care service on 1/10/13 and after having detail scrutiny, he had submitted his report on 19/10/13 along with assessment of estimate of loss. Complainant had filed claim proposal along with all necessary documents. Since then complainant had taken continuous follow up for payment of claim amount but respondent company did not settle the claim. Meanwhile, Complainant had paid Rs. 25000+6000+125016 for the repair and servicing of the car and took the delivery from car service station. On 31/1/14 respondent had informed the complainant that its liability against the claim is nil.
‘ According to the allegations of respondent, at the time of taking the policy ,insured did not disclose the previous policy ,which amounts to concealment of material fact. Complainant has committed breach of GR 27 of India motor tariff. Therefore, so that he is not eligible for no claim bonus.’ In fact, at the time of issuing policy, not a single question relating to previous policy was asked in the proposal form.
It was the duty of the respondent to verify the history of previous claim from IIB . Respondent company has not given any discount under the head of no claim bonus to the complainant and falsely repudiated the claim. Therefore complainant has requested to grant his insurance claim with interest along with compensation.
After being served, respondent appeared and filed its written statement. Respondent did not dispute preliminary facts of the case but opposed rest of the content. Respondent has stated that it was confirmed from IIB (INSURANCE INFORMATION BEURO) that complainant had enjoyed 2 claims from the previous insurer ICICI Lombard. In the proposal form, Complainant had left those column blank where the questions were asked regarding previous insurer and NCB particulars. It was resulted in violation of GR-27(f) of IMT. It is stated that it relied on the information of declaration given in the proposal form by the complainant. To that effect, NCB was allowed @ 20% and to that the claimant did not pay extent premium. Complainant has concealed previous claim information and enjoyed the benefit of NCB@20%. Thus ,there was a clear violation of insurance contract terms and conditions . The claim was rightly repudiated by the answering respondent and therefore requested to dismiss the complaint with cost.
We have heard the counsels of both sides and perused the material on record.
After hearing the counsels and having gone through the facts of the case, we hold that the main dispute in the present case is, whether complainant had actually concealed the material facts which can influence the insurance contract.
The relevant portion of the repudiation letter dated 31st January is as follows :-
‘ At the time of taking policy, insured has not disclosed claim on previous policy. This is concealment of material fact. On that basis of your declaration at the time of proposal, our underwriting office has allowed you discount for the same.’
It is seen from the proposal form filed by complainant that the information columns related to previous insurer were left blank. We have noticed that the declaration by the proposer is signed by someone else who is other than complainant.
In the above background, we hold that there is substance in the submission of the complainant that he had no intention to conceal the fact . However, the fact remains that he had history of previous insurance. Respondent insurance company has repudiated the claim for violation of G 27(F). In that connection, it would be appropriate to reproduce G27 (F) which is directly relevant to the present context:-
(f) ….Where the insured is unable to produce such evidence of NCB entitlement from the previous insurer, the claimed NCB may be permitted after obtaining from the insured a declaration as per the following wording :-
“I /we declare that the rate of NCB claimed by me/us is correct and that no claim as arisen in the expiring policy period (copy of the policy enclosed). I/we further undertake that if this declaration is found to be incorrect, all benefits under the policy in respect of Section I of the policy will stand forfeited.”
Notwithstanding the above declaration, the insurer allowing the NCB will be obliged to write to the policy issuing office of the previous insurer by recorded delivery calling for confirmation of the entitlement and rate of NCB for the particular insured and the previous insurer shall be obliged to provide the information sought within 30 days of the receipt letter of inquiry failing which the matter will be treated as breach of tariff on the part of the previous insurer. Failure of the insurer granting the NCB to write to the previous insurer within 21 days after granting the cover will also constitute a breach of the tariff.”
It is relevant to mention here that the last part of G27(F) clearly indicates that it is not sole responsibility of the claimant but the insurer is also equally duty bound to furnish the information within specified time. From the perusal of record, it is clear that at the time of issuing the policy respondent was neither produced nor gathered any such information. Respondent contented that complainant had enjoyed NCB @20% by not disclosing previous claim information. In support of this , respondent has not produced any documentary evidence. Complainant has specifically stated in the complaint that he had not sought any discount under the head of ‘NO CLAIM BONUS’.
The affidavit of Mr. Milind Damodare , ADMIN OFFICER ( Marketing) filed by respondent proved prime documentary evidence in the present case. It clearly shows that respondents were well aware of the fact that complainant has history of previous insurance policy. In the said affidavit, Mr. Damodare has stated that on 19/11/12 along with RC BOOK and proposal form, he had obtained a copy of earlier insurance by ICICI Lombard. It appears that respondent knew the fact from the beginning but it did not enquire about earlier insurance by ICICI Lombard to the complainant for the reasons best known to it. Therefore, we cannot deny complainant’s submission that he was under impression that he had furnished necessary information before getting insurance policy.
Thus, on careful consideration of submissions as well as documents, we are of the considered opinion that insurance company cannot escape from its liability of payment of compensation. As per the survey report dated 12/11/13, Surveyor MR. K. G. Parmar has assessed the loss at Rs. 1, 08,000/- . The respondent has not denied surveyor’s report in its written statement. Therefore, We hereby direct respondent insurance company to pay the insurance amount as per the below order.
In view of abovementioned facts, we are passing following order.
ORDER
- Respondent is directed to pay insurance amount Rs. 1,08,000/- to the petitioner through bank DD within 30 days from the date of receipt of the copy of this order.
- No order as to costs.
(Mrs.Sandhya Barlinge) ( Shri Kiran R Thole ) ( Shri K.N.Tungar )
Member Member President
