Chandigarh

DF-II

CC/543/2015

Rohit Gupta - Complainant(s)

Versus

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

Sh. Jasbir Singh

28 Jan 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

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Consumer Complaint  No	:	543 of 2015
Date  of  Institution	:	28.09.2015
Date   of   Decision	:	28.01.2016

 

 

 

 

 

Rohit Gupta S/o Late Shri Dev Raj Gupta, R/o House No.902, Sector 40-A, Chandigarh.

 

             …..Complainant

Versus

 

The Oriental Insurance Company Limited, Service Centre (Chandigarh RO), SCO 109-111, Sector 17-D, Chandigarh.

 

….. Opposite Party

 

BEFORE:  SH.RAJAN DEWAN                 PRESIDENT

         MRS.PRITI MALHOTRA             MEMBER

 

 

For complainant(s)      :     Sh.J.S.Banger, Advocate.

 

For Opposite Party(s)   :     Sh.G.S.Ahluwalia, Advocate

 

 

PER PRITI MALHOTRA, MEMBER

 

 

          As per the case, the complainant got his vehicle i.e. Toyota Etios GD Car bearing Regd. No.CH-01-AP-3190, insured from the Opposite Party for the period from 11.7.2014 to 10.7.2015 vide Policy No.231203/31/2015/3074 by paying premium of Rs.12,893/- (Ann.C-1). 

         It is averred that the said car met with an accident on 24.12.2014 at light point of Sector 4, Panchkula, which was informed to the Opposite Party, whereupon Surveyor Mr.Navneet Singh was deputed to assess the loss.  It is also averred that the complainant spent Rs.23,605/- for the repair of his car (Ann.C-2 & C-3). That the complainant visited the office of Opposite Party to avail his claim, but nothing was done.  Unfortunately, again on 19.3.2015 the car of the complainant met with another accident at KARU on SUBATHU Road in Himachal Pardesh.  The complainant shifted his car on the same day for repair to Globe Automobiles Pvt. Ltd., Indl.Area, Mohali.  The Opposite Party was also informed, who deputed Mr.Balwinder Singh, Surveyor to assess the loss.  This time the complainant paid an amount of Rs.32,550/- for repair of his car (Ann.C-4 & C-5).  Thereafter, the complainant lodged the claim with the Opposite Party.  However, the Opposite Party vide letter dated 6.5.2015 (Ann.C-6) repudiated both his claims on the ground that the complainant has concealed the material facts regarding NCB at the time of taking insurance policy and got 35% rebate on the premium.  The complainant again represented the matter, but to no avail.  Hence, this complaint has been filed alleging deficiency in service on the part of the Opposite Party.    

 

2]       The Opposite Party has filed the reply and admitted the factual matrix of the case with regard to insurance of the vehicle in question, occurrence of loss to the insured vehicle on account of two accidents on different dates, receipt of information about the said accidents, deputation of Surveyors for assessment of loss and repudiation of the claims filed by the complainant. 

         It is stated that the complainant made a wrong declaration with regard to the previous claim, out of the previous policy, and obtained 35% NCB from the Opposite Party, which amounts to a clear cut violation of terms & conditions of the policy in question.  It is pleaded that the complainant intentionally concealed the fact about his taking claim from previous policy, which has been got verified from the previous insurance company i.e. IFFCO Tokyo vide e-mail Ann.R-5. It is also pleaded that the complainant made wrong declaration qua NCB in his proposal form (Ann.R-8), which rendered the insurance policy to be void, hence the claims of the complainant have rightly been repudiated. Rest of the allegations have been denied with a prayer to dismiss the complaint.

 

3]       Rejoinder has also been filed by the complainant thereby reiterating the assertions as made in the complaint and controverting that of the Opposite party as made in its written reply.

 

4]       Parties led evidence in support of their contentions.

 

5]       We have heard the ld.Counsel for the parties and have also perused the record.

 

6]       It is admitted by the Opposite Party that the complainant got insured of his vehicle i.e.Toyota Etios GD Car bearing Regd. No.CH-01-AP-3190, from it for the period from 11.7.2014 to 10.7.2015 vide Policy No.231203/31/2015/3074 by paying premium of Rs.12,893/- (Ann.C-1).  The factum of accident of the insured vehicle for the first time on 24.12.2014 is not disputed as well as lodging of claim, appointment of Surveyor and the assessment of loss amounting to Rs.18,220/- as per the Survey Report dated 14.1.2015 is evident vide Ann.R-3.  Similarly, the occurrence of second accident on 19.3.2015, lodging of claim, appointment of Surveyor and its assessment of loss amounting to Rs.30,446/-, is evident vide Ann.R-7. 

 

7]       The grouse of the complainant is that the Opposite Party vide letter dated 6.5.2015 (Ann.C-6) had allegedly repudiated both the claims of the complainant.  The only justification presented for the repudiation of the claims lodged by the complainant is well mentioned in the repudiation letter dated 6.5.2015, the contents of which are reproduced below, for the sake of convenience:-

“On going through the claim papers, it is noticed that you have availed 35% N.C.B. at the time of inception of the policy. On verification of the same, from iffco Tokio, they confirmed that they had paid a claim, hence you were not entitled for N.C.B. as availed/declared by you.

Since, you have misrepresented the company, and concealed material facts at the time of taking insurance policy, your insurance contract becomes void, and no claim is payable.  If you want to give any clarification then give within seven days, otherwise we will close your both files as repudiated.

                   Thanking you and assuring of best service always.”

 

8]       From above, it generates that the Opposite Party repudiated the claim in question as complainant wrongly availed benefit of 35% NCB by concealing material fact of previous claim obtained by him from the previous policy.

 

9]       In the written statement too, the Opposite Party claimed that the complainant made a wrong declaration with regard to the previous claim out of the previous policy and obtained 35% NCB from the Opposite Party, which amounts to a clear cut violation of terms & conditions of the policy in question.  Submitted further that the intentional concealment of the claim taken from the previous policy by the complainant was verified from the previous insurance company i.e. IFFCO Tokyo which vide e-mail dated 17.3.2015 (Ann.R-5).  Clarified that the complainant obtained claim from the insurance company on 16.1.2014.  The counsel for the Opposite Party further submitted that the complainant made wrong declaration qua NCB in his proposal form placed on record vide Ann.R-8.  Thus, they righty repudiated the claim of the complainant.

 

10]      The contention of the Opposite Party that the complainant availed 35% of NCB from the Opposite Party is devoid of any cogent evidence for the reason that the proposal form placed on record vide Ann.R-8 speaks about the NCB of 25% at Page No30-A whereas in their defence they pleaded that the complainant obtained 35% NCB.

 

11]      In addition to this, the complainant in his rejoinder denied his signatures on the said proposal form/declaration with further submission that he paid the premium amount as calculated by the agent of Opposite Party to whom the complainant disclosed the factum of claim taken in the earlier policy.  Out of the doubt created by the Opposite Party qua the mentioning of contradictory percentages of NCB obtained by the complainant, the adverse inference is being drawn against the Opposite Party for such wrong assertions.  Thus, it is believed that complainant had not signed any declaration as alleged by the Opposite Party.

 

12]      Certainly such adverse inference will not hamper the right of the Opposite Party to claim back the benefit of NCB availed by the complainant as is evident vide policy document (Ann.C-1 Page 12).  At the same time, it is right to state that the NCB obtained by the complainant at the time of issuance of the policy in question needs to be refunded to the Opposite Party as the complainant himself admitted in his complaint regarding taking of the claim in the previous insurance policy.

 

13]      The above discussion lead to the conclusion that the complainant is entitled for the claim amounts as assessed by the Surveyor of the Opposite Party as assessed under both the claims lodged by the complainant and the repudiation of same stand nullity.  We restrict to the claims assessed by the Surveyor for the reason that the complainant has not agitated the amounts assessed by the Surveyor and the Surveyor’s Report being a reliable document cannot be brushed aside. The outright repudiation of the genuine claims of the complainant amounts to deficiency in service on the part of the Opposite Party for which they are liable to compensate the complainant for causing harassment and thrusting litigation on the complainant.

 

14]     In view of the above observations, the deficiency in service on the part of the Opposite Party is proved. Therefore, the complaint stands allowed against Opposite Party.  The Opposite Party is directed as under:-

 

a]  To pay an amount of Rs.18,220/- and Rs.21,231/-, as assessed by the Surveyor vide Ann.R-3 & R-7 respectively, to the complainant, along with interest @9% p.a. from the date of repudiation till it is paid.

b]  To pay a composite amount of Rs.15,000/- to the complainant for causing harassment and thrusting litigation upon him.

 

         This order shall be complied with by the Opposite party within a period of 30 days from the date of receipt of its copy, failing which it shall be liable to pay interest @18% per annum, on the amount mentioned in sub-para [a] above from the date of repudiation till realization and also on the amount as mentioned in sub-para [b] above from the date of filing this complaint, till it is paid.

         The certified copy of this order be sent to the parties free of charge, after which the file be consigned.

Announced

28^th January, 2016                                                                                                                                                         Sd/-  

 (RAJAN DEWAN)

PRESIDENT

 

 

         

          Sd/-

 (PRITI MALHOTRA)

MEMBER

Om                                                                                                                        

 

 

DISTRICT FORUM – II

CONSUMER COMPLAINT NO.543 OF 2015

PRESENT:   None   Dated the 28th day of January, 2016

O R D E R                        Vide our detailed order of even date, recorded separately, the complaint has been allowed against Opposite  Party.                    After compliance, file be consigned to record room.

 

(Priti Malhotra)	(Rajan Dewan)
Member	President