Orissa

Kalahandi

CC/135/2015

Patitapabana Behera - Complainant(s)

Versus

The Divisional Manager, United insurance Co.Ltd - Opp.Party(s)

11 Feb 2016

ORDER

            

The present disputes arises out of the complaint petition filed by the above named complainant  alleging deficiency in service  against the afore said O.Ps for repudiation  of insurance claim on technical  ground  to the  accident vehicle. The brief facts of the case is briefly  summarised  hereunder.                                                

 

1.         That  the complainant  had  insured his vehicle  i.e. Mahindra Bolero XL 2WD bearing   registration No. OR-08-G-8600 from the  O.P. NO.2   with  package policy which covers   vehicle  damages   in case of accident  vide policy  No. 260582 / 31 / 12 / 01 / 00001642 which was valid from 6.3. 2013 to    5/3/2014.   On Dt. 20.2.2014 while   the above vehicle  was travelling from  Bhawanipatna to Dhanpur met with an accident near the village Sagada at about  12.30 A.M. police reached  at the place and F.I.R was registered  for the same. That in total 10 Nos of  MACT cases  i.e. 9 of occupants  and 1  of driver had  been filed  before the MACT  Kalahandi, Bhawanipatna on account of death and injury of passengers and death of driver. The  insurance company  after verifying  all the required documents  including   final report  of police filed before the  SDJM and  in C.T. case  No. 23 /  14  in the  court of  MACT, Kalahandi  held that there is no  violation of terms and conditions  of the  insurance policy and accordingly    enter  into compromise on   his own free  will in  State Lok Adalat held on 14^th  Dec.  2014 and paid the  awarded amount to the claimants of the victims.   After such  payment to all the victims  on the ground of non violation  of any terms of insurance policy, O.Ps had  repudiated claim of the complainant vide its reference No.260582 /  2015:0019  dt.29.5.2015  on whimsical   ground contending  that  11   Nos. of passengers were  travelling  in the  aforesaid vehicle at the time  of accident  which violates the  terms and condition of the policy. Hence this case filed  before the  forum for  necessary  redressal. The  complainant prays  the forum to direct the O.Ps to  settle  complainant’s vehicle damaged  claim by paying the  amount finally  assessed  by the surveyor with  interest @ Rs 9% per annum from the date of   accident  till  realization  and further  direct the O.Ps to pay  cost,  compensation and such other  relief as the court deems fit and proper for the best interest of justice.

2.         On being  noticed the O.Ps. filed    written version jointly through  their learned counsel   and submitted that  the present complaint case is not maintainable  in the eyes of law and therefore  the same is liable to be rejected. The O.Ps are  further submitted that  the contents of  para- 1  &  para- 3 of the petition are true hence admitted.  The para-2  of the petition  is not fully correct.  In reply to para-4  that 3^rd. parties  claim were settled as the same are  statutory liabilities  of the insurance company. In reply to para-5  of the petition  the competent  authority of the O.Ps   repudiated  the claim as 11(eleven)  persons excluding  the driver were travelling  in  the vehicle of the complainant  exceeding  the seating  capacity as per RC at the time of  the accident. In reply to para – 6  of the petition  the Ops have taken premium to cover own  damage liability but as  per contract of insurance  it is limited to limitation of use of the vehicle and as the complainant violates the terms of contract  his own damage claim has been  rightly  repudiated by the competent authority.  The O.Ps. prayed the forum to dismiss the complaint petition against the O.Ps. for the  best  interest of  justice.

 

The O.Ps had appeared and filed their written version.  Arguments from the  learned counsel for  the  complainant  and O.Ps  heard.  Perused the record, documents, written argument,  citations   filed by the parties. 

The  parties  are   vehemently advanced their  arguments touching the points both on the facts  as well as on  law.

          FINDINGS.

3.         On the basis of the pleadings of the parties, the sole question of determination is  Whether  the complainant is entitled  to insurance claim made by him ?

            On careful perusal of  all the  papers we  observed  that  there is no  dispute that the  complainant  had   purchased a   Mahindra Bolero XL  2 WD  bearing Registration  No. OR-08-G-8600  and got it insured with the O.Ps   which  met   with an accident    on Dt. 20.02.2014  near  the village Sagada  at about 12.30 A.M.   The policy  No.  260582 / 31 / 12 / 01 / 00001642 was valid from 6.3. 2013 to    5/3/2014 which is a comprehensive policy.

On  perusal of the written version  filed  by the  O.Ps  it is revealed that  the  O.Ps  repudiated the   insurance claim  as  11(eleven) persons  excluding  the driver  were  travelling  in the vehicle   exceeding the seating  capacity  as per  R.C.  at the  time  of the accident.   The  O.Ps  also  further  contended  that   settlement of own damage  claim  is based on contract  of insurance and thus a contratual  liability    and not statutory liability  of the insurance company as such the claim of the  complainant has been rightly repudiated. The  O.Ps also argued that they have settled   the third party claims  before the MACT, since the same is statutary liability  and no way  connected  with  own damage claim

  The vehicle was insured and  insurance  coverage is valid  at the material time of accident  has not been disputed  by the  O.Ps and also  the fact that in the  road accident  the  vehicle was damaged which  resulted  in loss  to the complainant.  The vehicle was  registered   to carry 9 + 1 person, It is to be seen  if those  ten  person  when  travelling  in the vehicle  are assumed   not  to have  increased  any  risk  from the  point of view  of the   O.Ps  on occurring of the said  accident, how could those   added  single  person  be said to   have  contributed  to the occurrence  of the said accident.  The  vehicle was comprehensively  insured  by the   O.Ps  and when  it  met with an accident  resulted  in the  loss to the complainant, the O.Ps   are liable to make good  of the loss suffered by the complainant.   There is absolutely  no evidence  that those added  one  more person beyond statutory limit   have  contributed to the  accident.  So  at  present there is  no  impediment  on the part of the O.Ps  to pay the insurance amount  as arrived by the Surveyor in his final  Survey report.

That total 10 Nos. of  MACT case have been filed before the  Hon’ble  MACT, Kalahandi where the  O.Ps by accepting their legal position and after verification  of all the relevant  documents  including  final  police report, had come forward to settle the claim with their own  free will in State Level Lok Adalat held on 14^th. December, 2014.  The O.Ps had not disputed  or raised any objection before the MACT on the ground  of violation of policy conditions.  Where  such payment on the ground  of non violation of any term,  the O.Ps   admitted the  third party claims of victims  of accident in the same  cause of action the O.Ps repudiate the own damage  claim of the  complainant on the ground of violation of policy condition.

It is reported in SCC (1979) 4   page- 178  where in the Hon’ble  Supreme Court observed  “Resort to the plea of limitation by public authority to defeat just  claim of citizen depreciated- Though  permissible under law, such technical pleas should only be taken when claim is not well founded”.

Further the learned counsel for the  complainant  filed citation  reported in   AC J- 1996 page No.1178   where in   the Hon’ble   Supreme   Court   observed  “ It is plain  from the terms of the insurance  policy  that the insured vehicle as entitled  to carry  6 (six) workmen ,  excluding  the  driver.  If those  6 workmen when travelling   in the vehicle are assumed  not have increased any risk from the point  of view of the insurance company on occurring of an accident, how could those added persons  be said  to have  contributed  to the causing  of it is poser, keeping apart the load  it was carrying.    Here, it is   nobody’s  case that  the driver  of the said  vehicle was  responsible  for the accident.   In fact, it was not  disputed  that the oncoming  vehicle  had  collided head-on against the  insured vehicle, which resulted  in the damage .  Merely by  lifting a person or two or even  three, by the driver  or the cleaner  of the vehicle, without the knowledge of the owner , cannot   be said to  be such  fundamental breach that the owner should,  in all events, be  denied  the indemnification.    The  misuse  of the vehicle was  somewhat  irregular though, but not   so fundamental  in nature so as to put  an end to the contract, unless some  factors  existed which,  by  themselves,  had gone   to  contribute     to the causing  of the accident.  In the instant case, however we find no such contributory factor”.

It  is held and reported in   T.A.C.  2009 (2)  page  No.  146  where in  the Hon’ble  Madhya  Pradesh  High Court  observed   Insurance  policy- Overloading- Liability of  insurer – Plea of  insurer  that 15 persons  were carried in  jeep in contravention of  its  carrying  capacity- Due to negligence  of driver,  vehicle  fell in to ditch- No evidence on  record that  number of passengers in fact had contributed  to accident- Fundamental breach of policy not  established- Insurer not exempted  from  liability.

It  is held and reported in   T.A.C.  2007 (4) page No. 545  where in  the Hon’ble  Madras   High Court  observed  “Merely by  lifting a person or two, it cannot be said to be such a fundamental breach that the owner should, in all events, be denied  indemnification.  The breach of the condition of the policy was  some what  irregular, though, but not so fundamental in nature,  so as to put an end to the  contract, unless some   factors existed, which, by  themselves  had gone  to contribute to the  causing  of the accident. “

It  is held and reported in   T.A.C.  2009 (3) page No. 468  where in  the Hon’ble  Gauhati    High Court  observed  “Permit violation – Overloading of vehicle-  Liability of Insurance company- Permit stated sitting  capacity of vehicle being 52 – Maximum passengers to be  carried in bus not specified in permit- Policy not  containing any clause relating to over  loading of passengers- No evidence that accident  took  place due to over loading  of  passengers- Plea of  Insurance Company not sustainable.”

 

Further  in the present case the original  estimate   assessed  by the Surveyor the   damage to the tune of Rs. 6,61,156/-. The   Surveyor  assessed the loss   to the tune of Rs. 4,12,816/-  if the complainant  opt for repair. The  Surveyor assessed  the loss  on  total  loss basis  or  Net of Salvage loss basis to the tune of Rs. 3,49,000.00 in his  final surveyor report.

Further we perused the case law  in the instant case. It is held and reported in  CPC- 1991, page -540 the  Hon’ble  Hariyana State  Commission held that when ever there is any delay or dilatoriness in finalizing  the insurance claim, the same would be tentamount to a  deficiency  in service and thus comes squarely within the  purview of Consumer Forum.  Once it is held that default or negligence in the  settlement of an insurance claim is a deficiency  in service then an arbitrary  or mischievous  rejection  of an insurance claim  would patently  be a default  within its larger  meaning. On principle , it would   seem  some what manifest that the mere repudiation of the insurance claim cannot itself operate  as a  jurisdiction bar for redressel forums under the Act.  This is further  made it clear  held and reported  in CPR-1991(2), page No.18  the Hon’ble National Commission  clearly defines  the mere unilateral  rejection of an insured parties  claimed by the insurer does not  per  se  operate as jurisdictional bar to seek redressal before  the forums under the Act. It is on the strength of the  above decisions  the present  case is admitted by this forum.

It is held and reported in C.P.R. 2001 (1) page  No. 191  where in the  Hon’ble  National Commission, New delhi  obeserved   “Repudiation  of claim  on the ground of  overloading of the vehicle- No evidence of overloading as a cause of accident- Is deficiency  in service.

 

The learned counsel for the  O.Ps. filed  non reported copies of    judgement   relating to  this case in connection  Revision petition  No. 2636 of 2010  pronounced on Dt.13^th. July, 2011  of  Hon’ble  National  Commission,  New Delhi  National Insurance Vrs. Ms. Usha Devi.    In this case  the Insurance Company  repudiated  the claim on the ground  of over load  capacity of passengers  where in   the ratio  of   over load was 100% ie. Capacity  13  passengers but the vehicle was  carrying 26  persons.    So the above Citation filed by the O.P   is not squarely  applicable to  the  present case and  the  facts  of the case   is  not identical to this present case.

The  pleading of complainant and O.Ps are silent whether the insured vehicle was repaired by the  complainant  or surrender before the O.Ps  for settlement on total loss basis.  The final survery report  produced before this forum  by the O.Ps  reveals that the complainant  accepted the  “Net of Salvage “ loss mode of claim  settlement without  surrender of R.C. book. The final surveyor  calculated the loss on  “Net of  Salvage” loss basis without  surrender of R.C. Book to the tune of Rs. 3,49,000.00. The prayer of the complainant is also to  settle  the claim  as per the assessment  of the  final surveyor. 

In the above facts, circumstances  & on perusal of the record, the complaint petition,   documents, and referring on above Citations there  exists a strong “prima-facie” case in favor of the complainant.

On the strength of the aforesaid rulings of the Apex court  this forum  allow this case  in  part.     Hence to  meet the ends of justice, the following order is passed.

                                                ORDER.

In the result  with these observations, findings, discussions the complaint petition is allowed  in part   on contest against the O.Ps.

The O.Ps  are  ordered  to pay Rs.3,49,000.00     to the complainant as per the final  Surveyor  report   as discussed above. The O.Ps   are  further directed  to pay  Rs.2,000/- towards cost of litigation.The OPs    are  ordered to make compliance the aforesaid Order within  30 days from the  date of  receipt  of the  order  failing which  an interest  @ Rs.9 %  would  accrue on the above  amount . from  the date of  final survey report   submitted   i.e. on  Dt.15.12.2014  till  realization.

Dictated and corrected by me.                                   Pronounced on this  11^h.   Day of  February,   2016.

 

Member.                                                             Member.                                                      President

 

Documents relied upon:-

By the Complainant:-

 

1. Xerox copies of the  Letter DT. 29.5.2015  issued by  O.P. addressed the complainant.
2. Insurance policy  bond.
3. Xerox copies of F.I.R.
4. Xerox copies of final  police  report.
5.  

By the O.Ps:-

 

1. Xerox copies of the  Surveyor report.
2. Xerox copies of the R.C.

President

 

11.2.2016

Order pronounced  in the open forum  in  presence of the parties and filed  separately  in the file.

 

The complaint petition is allowed  in part   on contest against the O.Ps.

The O.Ps  are  ordered  to pay Rs.3,49,000.00     to the complainant as per the final  Survey report. The O.Ps   are  further directed  to pay  Rs.2,000/- towards cost of litigation.

The OPs    are  ordered to make compliance the aforesaid Order within  30 days from the  date of  receipt  of the  order  failing which  an interest  @ Rs.9 %  would  accrue on the above  amount . from  the date of  final survey report   submitted   i.e. on  Dt.15.12.2014  till  realization.