Order by:

Smt.Priti Malhotra, President

1.       The complainant  has filed the instant complaint under section 35 of  the Consumer Protection Act, 2019 on the allegations that the complainant is the owner of vehicle no.PB76A4890. He got insured his vehicle from Opposite Party for the period from 23.11.2021 to 22.11.2022, vide policy no.233904/31/2022/1963. The said vehicle of the complainant met with an accident on 19.05.2022 and Opposite Party was duly informed about the accident through mobile. The complainant has taken the said vehicle to Meet Automobiles Pvt. Ltd. where the said vehicle was got repaired and complainant has to pay Rs.7295.95 to the said workshop. Due intimation was given to Opposite Party and all the formalities were completed by the complainant, but despite that Opposite Party rejected the claim of the complainant on the ground that the said vehicle was driven by son of complainant. The complainant approached the Opposite Party several times and requested them to pay the amount in question, but to no effect. Due to the aforesaid illegal and unwarranted acts of the Opposite Parties, the complainant has suffered huge mental tension and agony. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs.

a)       Opposite Party may be directed to pay a sum of Rs.7292.95/- on account of repair charges of vehicle no.PB76A4890 which was insured with Opposite Party alongwith interest @ 12% p.a. from the date of claim till its realization.

b)      To pay Rs.50,000/- as compensation for causing mental tension, harassment and agony to the complainant.

c)       And any other relief to which this Hon’ble Consumer Commission, Moga may deem fit be granted in the interest of justice and equity.       

2.       Upon notice Opposite Party appeared through counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the present complaint does not raise any Consumer Dispute as defined under section 2 (8) of the Consumer Protection Act, 2019 as there has been no deficiency in service or negligence on the part of Opposite Party as they have raised the requirement for the claim process as per the pre determined and agreed terms and conditions of the policy and presently evaluating the claim; the present complaint is premature and thus liable to be dismissed, as then the complaint was filed, the claim submitted by the complainant was under evaluation, so alleging that the claim has been repudiated at the time of filing complaint is baseless and false. The claim has been repudiated on 26.08.2022. Further averred that complainant obtained motor insurance policy no.233904/31/2022/1963 which was valid for the period 23.11.2021 to 22.11.2022 for his vehicle no.PB-76A4890. On 19.05.2022, intimation was received from the complainant that his vehicle met with an accident while he was driving the same. The claim intimation letter and claim intimation form dated 19.05.2022 was presented to the company. It has been specifically mentioned by the complainant that he himself was driving the vehicle. On receiving the claim, the Opposite Party company appointed K.S. Bawa and Company surveyor and loss assessor to check the veracity of the claim and documents submitted. During investigation, it was found that the licence of the complainant was expired on 06.02.2022 and the same is intimated to the complainant that his claim is not valid as he was not holding valid driving licence. It was suggested to him that either he should provide the company proof of valid driving licence or his claim will not be accepted. Along with the same it was also requested to him to provide copy of FIR to support accident etc. But seemingly when the complainant found that his claim is not going to get passed due to the expiration of his driving licence, he filed the present complaint by twisting facts and alleging different story which is completely false and misleading. There is no negligence on the part of the answering Opposite Party. Further averred that it is a law that courts including the consumer commissions empowered under the Consumer Protection Act, 2019 cannot grant relief beyond the agreed terms and conditions of contract entered between the parties; the present complaint is not maintainable as the claim of the complainant is illegal and contrary to the established principle of uberrima fide which is rocky foundation of contract of insurance; the present complaint is not maintainable as it has been filed with ulterior motive and malafide intention to cause harassment and prejudice to the Opposite Party; the complainant has sought a relief from this Commission which he is not entitled to get under the terms and conditions of the subject policy and as such no deficiency in service on the part of the Opposite Party demonstrated by the complainant; the policy terms and conditions for all products of the Opposite Party is approved by the Insurance Regulatory and Development Authority and any benefit under the policies become payable strictly in accordance of the policy terms and conditions. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.

3.       In order to prove  his  case, the complainant has tendered into evidence  his affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C7.

4.       On the other hand, to rebut the evidence of the complainant,  Opposite Party tendered into evidence affidavit of Sh.Sukhwinder Singh, Senior Divisional Manager, The Oriental Insurance Co. Ltd. Ex.OP1 alongwith copies of documents Ex.OP2 to Ex.OP12.

5.       We have heard the ld.counsel for the parties and gone through the documents placed on record.

6.       The complainant is the owner of vehicle bearing no.PB-76A-4890 and he got his vehicle insured from Opposite Party for the period 23.11.2021 to 22.11.2022 and during the policy coverage his vehicle met with an accident are not disputed facts. The only grievance of the complainant is that despite completing all the formalities, Opposite Party failed to pay any amount with regard to his claim.

7.       On the other hand, ld. Counsel for the Opposite Party contended that on receiving the claim, the Opposite Party appointed K.S. Bawa Company surveyor and loss assessor to check the veracity of the claim. During investigation, it was found that the licence of the complainant expired on 06.02.2022 and the same is intimated to the complainant that his claim is not valid, as he was not holding valid driving licence and he was suggested to provide the proof of valid driving licence along with copy of FIR., but the complainant failed to submit the same and has filed the present complaint.

8.       The main plea taken by the Opposite Party is that at the time of accident complainant was not holding a valid driving license, as the vehicle of the complainant met with an accident on 19.05.2022 and driving license of the complainant had already been expired on 06.02.2022. So, the Opposite Party failed to settle the claim of the complainant. This fact is proved on record vide Ex.OP9. Though the complainant has averred that at the time of accident, the vehicle in question was driven by his son, who was having valid driving license, but there is no document on record revealing that the vehicle in question was being driven by the son of the complainant.

From the above, it is proved that at the time of accident complainant’s driving license was expired and in this way, the complainant has violated the term and condition of the policy in question. At the same time we are of the concerted view that the factum that the license found to be expired at the time of accident and was renewed later on (which is proved on record vide Ex.C4) reveals that the complainant was skilled to drive the vehicle in question and has committed the violation of the provision of Motor Vehicles Act, 1988 qua renewal of driving license before its expiry, for which, the provision of penalty to be imposed is there in the said Motor Vehicles Act, 1988. Thus, in our concerted view the violation in question not appears to be a material violation of the term of the policy in question. However, even if the driving license of the complainant timely not got renewed, it does not mean that he was not a skilled driver or he fails to possess the driving skill. In our view, in the circumstances of the given case, the Insurance Company ought to have settled the claim of the complainant on “non standard basis” even if any of the condition of the insurance policy is not adhered to by the insured. In this regard, we are supported with judgment  in  case titled National Insurance Company Limited versus Kamal Singhal IV (2010)CPJ297 (NC) wherein the Hon'ble National Consumer Disputes Redressal Commission, New Delhi relying upon various decisions of the National Consumer Disputes Redressal Commission in the matter of (1) National Insurance Company Ltd. v. J. P. Leasing & Finance Pvt. Ltd. (RP No. 643/2005), (2) Punjab Chemical Agency v. National Insurance Company Ltd. (RP No. 2097/2009), (3) New India Assurance Co. Ltd. v. Bahrati Rajiv Bankar, (RP) No. 3294/2009) and (4) National Insurance Company Ltd. v. Jeetmal, (RP No.3366/2009) and also judgment of the Hon'ble Apex Court in the matter of Insurance Company Versus Nitin Khandewal IV (2008) CPJ 1(SC), held the  breach of condition of the policy was not germane and also held further that : “ the appellant Insurance Company is liable to indemnify the owner of the vehicle when the insurer has obtained comprehensive policy to the loss caused to the insurer”. The Hon'ble Supreme Court has further held that; “even assuming that there was a breach of policy, the appellant Insurance Company ought to have settled the claim on “non-standard basis.” Hon'ble Apex Court in back drop of these features, in these cases, allowed 75% of the claim of the claimant on the “non-standard basis”. This view was again reiterated by the Hon'ble Apex Court in the matter of Amalendu Sahoo versus Oriental Insurance Company Limited. II(2010) CPJ 9(SC)=II (2010)SLT 672.  Hon'ble National Commission in the case National Insurance Company Limited versus Kamal Singhal referred to above relying upon the law laid down by the Hon'ble Supreme Court has held that;

“there being a long line of decisions on this score, we have no option but to uphold the finding of Fora below with modification that the claim be settled on 'non-standard' basis”, in terms of the guidelines issued by the Insurance Company. In case petitioner company fails to carry out the direction contained therein, the amount payable on 'non-standard' basis, shall carry interest @ 6% p.a from the date of expiry of six weeks till the date of actual payment”.

9.       Enlightened by the judgements referred above and from the discussion above, we partly allow the complaint of the Complainant and direct the Opposite Party to make the payment of Rs.5,469/- (Rupees Five Thousand Four Hundred Sixty Nine only) i.e. 75% of the bill amount of Rs.7,292/- to the Complainant.  Opposite Party is further directed to pay compository costs of Rs.3,000/- (Rupees Three Thousand only) as compensation and litigation expenses to the complainant. The compliance of this order be made by  the Opposite Party  within 30 days from the date of receipt of this order, failing which, they are further burdened with Rs.5,000/- (Rupees Five Thousand only) to be paid to the complainant for non compliance of the order. Copies of the order be furnished to the parties free of cost. File be consigned to record room after compliance.

Announced in Open Commission