West Bengal

Jalpaiguri

CC/16/2020

Sri Uttam Kumar Goel, - Complainant(s)

Versus

The National Insurance Company Limited. - Opp.Party(s)

Self.

07 Oct 2021

ORDER

        This is a consumer complaint case filed by the complainant Sri Uttam Kumar Goel against the opposite parties/National Insurance Company claiming   Rs. 1,68,750 and compensation and litigation cost. 

The complainant’s case in brief is as follows: The complainant being the registered owner of vehicle no. WB-72P-0222 Hyundai Eon, got his vehicle duly insured with the opposite party insurance company during the year 2017 vide insurance policy number 156010311710000123 through authorised agent Mr. Shibu Sutradhar. Subsequently, during subsistence of the valid insurance policy with the OP, the complainant’s vehicle met with an accident on 12.10.2017. The complainant informed the local Metelli Police authority vide GD entry number 994 dated 27.10.2017. The complainant placed before the OP all his necessary related papers and documents in support of his legitimate claims. The authorised staff/assessor of the opposite party Mrs. Sarkar of Siliguri based satellite HUB office had called the complainant at the Siliguri office, and after thorough verification of the complainant’s policy related documents, had made less of twenty-five percent amount from the assessed amount of Rs. 2,25,000 and an amount to the tune of Rs. 1,68,750 was allowed. Thereafter, she had taken one signed consent letter from the complainant after assuring the complainant to disburse him his legitimate claim amount. 

Thereafter the legitimate claim of the complainant to the tune of Rs. 1,68,750 was most arbitrarily and unlawfully repudiated by the opposite party insurance company vide letter dated 08.08.2018. In spite of several letters of the complainant the OP insurance company failed to settle the claim of complainant amounting to Rs. 1,68,750. Hence the complainant filed this case,

 

 

praying for direction to the opposite parties to pay Rs. 1,68,750 to the complainant along with interest and also Rs. 50,000 as compensation and Rs. 10,000 as litigation cost. 

The OP no. 1 and 2 insurance company contested the case by filing their written version denying the allegations of the complainant. The OP insurance company contended that the vehicle of the Complainant was previously insured with Tata AIG General Insurance Company and the complainant made a claim before Tata AIG for minor damage of his vehicle. The complainant admitted that his claim was disbursed by Tata AIG but this fact was not disclosed when the present insurance with the OP no. 1 was made. The OP also contended that it was very much questionable that the said vehicle met with an accident on 12.10.2017, but the information was given to the PS on 27.10.2017 after fifteen days’ delay, and because of the delay the fact of the accident was reasonably suspicious. The complainant also did not file any police report about the accident. The OP further contended that the complainant did not mention the date on which he attended the authorised staff/assessor Mrs. Sarkar. The OP stated that the said authorised staff/assessor was not aware of the actual fact at that time and the fault of the complainant about the suppression of the previous damage claim, though her act showed the positive gesture to disburse the claim of the OP no. 1. The OP also contended that the complainant in his proposal form stated that he was eligible for twenty percent NCB but it was found that complainant lodged an own damage claim before his previous insurer and therefore the complainant violated the condition of the insurance policy and therefore forfeited his right to the claim. Hence the OP contended that the claim was rightly repudiated and prayed for dismissal of the case. 

                                       

        The main issues raised by the opposite parties in this case are that the diary of the accident was lodged in the PS fifteen days after the alleged accident and therefore the accident itself was suspicious. Then there was suppression of fact regarding the earlier claim lodged and received by complainant from the erstwhile insurance company, though the complainant at the time of proposal of the present insurance policy fraudulently availed twenty percent NCB in breach of the condition of the policy, and thereby forfeiting his right to any claim. The OP further raised the issue that the complainant did not mention the date on which the authorised staff/assessor of the OP admitted the claim amount as alleged by the complainant. 

Considering the pleadings of the parties, the documents filed and the arguments of both sides carefully, it is found that the OP in the written version in para 13 made evasive denial regarding the alleged admission of the claim amount by authorised staff/assessor Mrs. Sarkar. It is clearly stated by the OP in para 13 that the authorised staff/assessor was not aware of the actual fact at the time and the fault of the complainant about the suppression of the previous damage claim that was not disclosed. The OP also admitted that the act of authorised staff/assessor showed the positive gesture to disburse the claim of the OP no. 1. But the complainant agreed to accept the settled amount because he wanted to grab the money by any means and ill-motive. Thus, the allegations of the complainant that the claim was finalised by the said authorised staff of the OP is proved by admission of the OP. Now the OP cannot dispute the accident as suspicious because of the fifteen days’ delay in informing the PS since after considering all the fact and circumstances of the case, the authorised staff admitted the complainant’s claim with 

  twenty-five percent deduction. The contention of the OP regarding suspicious nature of the accident is only speculative because the OP did not place any internal report of investigation to prove the suspicions regarding the accident or claim amount. It is proved by admission that the claim was settled by authorised staff of the OP by twenty-five percent deduction of the original claim. 

In the decision reported in (2010) 4 SCC536 (Amalendu Sahoo v/s Oriental Insurance Company Limited) the Honourable Supreme Court decided that if certain conditions of the MV Act and consequently of the policy are violated, the claim can be settled on non-standard basis and in case of any breach of warranty/condition of policy, payment up to seventy-five percent of admissible claim can be allowed. 

In our case, there was a breach of policy regarding non-disclosure of the earlier claim and availing twenty percent NCB by the complainant without disclosing the receipt of the earlier claim during the proposal of the present policy. But such violation of policy cannot be termed as a fundamental breach of the policy as per the aforesaid decision of the Honourable Supreme Court. Therefore, the complainant was entitled to seventy-five percent of the admissible claim and presumably the authorised staff/assessor rightly allowed seventy-five percent of the complainant’s claim with twenty-five percent deduction on non-standard basis. 

Therefore, considering all the fact and circumstances of the case, it is found that the complainant is entitled to get Rs. 1,68,750 as claimed by the complainant, and the repudiation of such claim by the OP was not lawful. Therefore, the issues are all decided in favour of the complainant and against the opposite parties. 

                                                   

In the result the case succeeds.

Hence, it is,

ordered 

 that the case is allowed on contest against the opposite parties. 

The opposite parties are directed to pay the complainant Rs. 1,68,750 with six percent interest thereon, from the date of filing of this case till realization of the same. 

The complainant is also entitled to Rs. 5000 as litigation cost from the OP. The opposite parties are also directed to pay Rs. 10,000 to the Consumer Legal Aid Account, DCDRC Jalpaiguri as compensation.

The opposite parties are directed to pay all the aforesaid decretal amounts within three months from this date, failing which the same shall be realized according to law.

A copy of the judgment be given to the parties free of cost.