( Passed on dated 29^th  October, 2015 )

Per Shri Atul D. Alsi – Hon’ble President.

              The complainant is owner of Volkswagen Polo car having R.T.O. registration No. MH-35/P-2382.  The complainant insured her car with opposite party vide policy No. 181301/31/2013/5093, valid from dated 13.10.2012 to 12.10.2013.       

2.            On dated 29.04.2013, the car was met with an accident near Palewada on Mundipar-Kohamara road.  The said car was driven by Rohan Rane who was holding effective, valid & legal driving license at the time of accident.  The driver of car had immediately intimated the fact of accident to Police Station, Goregaon, Tah. Goregaon, Distt. Gondia.  The complainant also intimated accident to opposite party immediately.  That, as no person had sustained any injury; the police authority had not registered any offence but drawn panchnama at accident spot on same day.

3.            The complainant thereafter took the car MH-35/P-2382 to authorized dealer of Volkswagen namely Sadiq Motors Pvt. Ltd. that, the concern authorized dealer had issued estimate of worth Rs.4,78,208/- which was submitted to opposite party by complainant along with claim form.  The complainant had subsequently carried out repairing of car and actually incurred total Rs.3,56,377/- towards repairing.  The opposite party had also appointed surveyor and the report of survey with opposite party.

4.            The complainant vide her letter dated 23.04.2014 had submitted her explanation along with request to consider her claim.  In the meanwhile vide letter dated 31.03.2014 the opposite party had repudiated the claim of complainant on technical ground. 

5.            The opposite party had repudiate claim of complainant only on ground that the complainant had claimed 20% NCB discount on policy issued by opposite party when there was OD claim in previous expiring policy issued by Bajaj Allianz General Insurance Company.  The opposite party had repudiated claim of complainant by alleging that the complainant had made false declaration regarding previous claim while obtaining policy from opposite party.  The complainant vide letter dated 23.04.2014 & 28.05.2014 had duly submit explanation to opposite party that at the time of submission of proposal form & declaration, the concern agent had obtained her signature without making any inquiry regarding claim arisen in expiring policy.

6.            That, as per settled principal of law and Guidelines issued by General Insurance Corporation of India, the opposite party can deduct the amount of ‘no due claim’ with interest from the claim amount and liable to pay outstanding amount to complainant.  The above act of opposite party regarding repudiation of whole claim of complainant amounts to deficiency in service and unfair trade practice towards complainant.

7.            The complainant praying to direct the opposite party to pay repairing expenses Rs.3,56,377/- with 12% interest from the date of accident i.e. dated 29/04/2013 till date of actual payment to the complainant.  She also prayed to direct the opposite party to pay compensation of Rs.20,000/- towards mental harassment and Rs.15,000/- towards litigation charges.

8.            After receiving the notice issued by the Forum, the O. P. appeared through their counsel and filed their written statement before the forum. 

9.            In their reply, the O. P. admitted that, the complainant is owner of the vehicle Volksvagon Polo Car having No. MH-35/P-2382.  It is also admitted by the opposite party that the above car was insured with opposite party vide policy No. 181301/31/2013/5093 valid for the period from 13.10.2012 to 12.10.2013. 

10.                   In special pleading the opposite party submitted that as per proposal form and declaration submitted by the complainant to O. B. for insurance of above vehicle it is observed that the complainant had claimed 20% N.C.B. discount being no claim on previous policy of the said vehicle of Bajaj Alianz General Insurance Company, Pune having policy No. OG-12-2101-1801-00003848 for the period 18.10.2011 to 17.10.2012.  According this O. B. had allowed 20% N.C.B. (No Claim Bonus).

11.                   It is also submitted by the opposite party that as per proposal form and declaration submitted by the complainant at the time of insurance “we declare that the rate of NCB claimed by me/us is correct and that no claim has arisen in the expiring policy period.  I/We further undertake that if this declaration is found incorrect all benefits under the policy in respect of Section 1 of the policy will stand forfeited”. 

12.                   However the complainant was given one more opportunity to substantiate his claim within 2 weeks from the date of receipt of the letter.  Hence the petition is liable to be dismissed with costs.

13.                   The complainant has suppressed the material facts from the opposite party while taking the policy as mentioned above hence the complainant is not entitled for any relief as claimed by the complainant.  Hence complaint of complainant be dismissed with costs.              

14.                   The complainant has filed copy of repudiation letter at page no. 12, Copy of letter of O. P. at page no. 13, Copy of complainant’s letter dated 23/04/2014 at page no. 14, Postal receipt & acknowledgement at page no. 16, Copy of reminder letter dated 28/05/2014 at page no. 17, Postal receipt & acknowledgement at page no. 18, Letter of insurance company dated 13/06/2014 at page no. 19,  Copy of certificate of registration at page no. 20, Copy of insurance policy at page no. 21, Copy of driving license at page no. 22,  Copy of spot panchnama at page no. 23, Copy of tax invoice at page no. 25, Copy of payment receipt at page no. 30 to 32 on record.

15.                   The learned counsel for complainant Mr. S. B. Rajankar argued that, the cost incurred for repairing Rs.3,56,377/-. The O.P. has sought explanation vide letter No. dated 30/12/2013 but due to personal difficulty it could not be supported for meantime the claim was repudiated.  At the time of renewal of policy the counsel agent has obtained signature without making any enquiry.  The mistake was occurred due to oversight and not with illegal intention.  The amount of no claim bonus may be deducted from claim along with interest.  Therefore, the complaint be allowed.

16.                   The learned counsel for O.P. Adv. Hotchandani argued that due to false declaration the claim as per clause 1 of policy can not be entertained.  However, the complainant was given opportunity to substantiate claim without 2 weeks but she failed to do so.

              Therefore, the O.P. vide letter dated 31/03/2014 intimated the complainant that the claim is repudiated.  Hence, petition is liable to be dismissed with cost.

17.                   As per petition and arguments and documents filed on record following points came for consideration:-

REASONING & FINDINGS

18.                    The complainant’s vehicle No. MH-35/P-2382 met with accident on 29/04/2013 near Palewada on Mundipar-Kohamara road, Dist. Gondia, is proved as per spot panchanama of police station Goregaon, Dist. Gondia and the vehicle was damaged and repaired with Volkswagen authorized dealer.

19.                   The complainant is literate person and having knowledge that on what paper she is signing.  There is clear cut breach of terms of Insurance policy.  There is suppression of material fact that the complainant has claimed 20% Non Claim Bonus on claim of previous policy as per confirmation letter dated 09/10/2013 and reminder dated 12/10/2013 and e-mail at 10/10/2013, but as per Judgment cited by Counsel for complainant  on UNITED INDIA INSURANCE CO.LTD. –VS.- BUPINDER SINGH 2013 II CPJ 335 N.C. “Claim repudiated on ground of wrongly availing “No claim Bonus @ 25% on renewal of policy- breach of policy condition-In case of theft of vehicle, breach of condition is not germane and insurance company is liable to indemnify the respondent-The Insurance company is directed to settle the claim on basis “Non Standard” basis and pay 75% of amount-complainant will pay 9% interest on “No Claim Bonus”.

20.                   Hence, as per Judgment the complaint is partly allowed and the Insurance company shall settle the claim on non-standard basis and pay 75% of amount on Rs.2,41,350/- as per survey report of O.P. to the complainant by deducing the amount of no claim bonus @ 9% p.a. from the date of policy till the date of Judgment.  The complainant is not entitled to receive any interest, cost and compensation. 

              Hence, the following order is passed.

-: ORDER :-

1.            The complaint is partly allowed.

2.            The O. P. is directed to settle the claim of complainant on non-standard basis and pay 75% of amount on Rs.2,41,350/- as per survey report by deducting the amount of no claim bonus @ 9% p.a. from the date of policy till the date of Judgment.

3.            No order as to costs and compensation.

4.            The O. P. is directed to settle the claim of complainant within 30 days from the date of receipt of this order.