Smt.Bhupinder Kaur, Member
1. The complainant has brought the instant complaint under section 12/14 of the Consumer Protection Act, 1986 on the allegations that the Complainant is owner of Honda City Car No.PB-29U-6307 and the Complainant is sole proprietor of the firm M/s.Hans Raj & Sons, Moga and he got fully insured his vehicle with Opposite Parties vide policy No. 2012003117-P101024492 valid for the period from 15.4.2017 to 14.4.2018 and as such, there is relationship of consumer and service provider between the parties, copies of the policy and Aadhar card are enclosed; that on 29.4.2017 when the vehicle in question was lying parked at Focal Point, Moga then some unknown vehicle hit it and fled away. When the Complainant and her husband came to know about the said accident, then he immediately informed this fact to Opposite Party No.1 and Opposite Party No.1 appointed a surveyor and got assessed the loss and thereafter as per the directions of Opposite Party No.1, the Complainant got repaired the vehicle in question from AKC Motors Private Limited, Authorised Service Centre of Honda Company and Complainant paid Rs.53,273/- as repair charges, copy of invoice dated 5.5.2017 is enclosed. The Complainant thereafter submitted the original tax invoice of Rs.53,273/- to Opposite Party No.1 and Opposite Party No.1 assured the Complainant that within few days, the claim amount will be paid. Thereafter, the Complainant and her husband visited the office of Opposite Party No.1 and made requests to release the claim amount, but the Branch Manager stated that at the time of purchase of the policy in question, the Complainant has availed No Claim Bonus of Rs.3121.60 and then the Opposite Parties asked the Complainant to deposit of Rs.6890/- (No Claim Bonus Rs.3121.60 paisa and penalty of Rs.3768.40 paisa) and then the claim of Rs.53,273/- will be released to the Complainant. As per the directions of Opposite Party No.1, the Complainant deposited Rs.6,890/- with Opposite Parties on 1.8.2017 vide cheque No. 08558 of Bank of Maharashtra, Branch Moga and then Opposite Party No.1 assured the Complainant that within few days, the claim amount will be paid. Thereafter, the Complainant and her husband visited many times to office of Opposite Party No.1 and made requests to release the amount of Rs.53,273/-, but the Opposite Party No.1 is lingering on the matter on one pretext to another, which clearly shows that there is clear cut deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) Opposite Parties be directed to make the payment of claim of Rs.53,273/- alongwith upto date interest @ 24% per annum from the date of lodging the claim.
b) Opposite Parties be also directed to pay Rs.40,000/- on account of compensation for damages alongwith costs of the present litigation.
c) Further it is prayed that any other relief which this Forum may deem fit and proper, be also granted.
Hence, this complaint.
2. Upon notice, Opposite Parties appeared and contested the complaint by filing written statement taking the preliminary objections inter alia that the Complainant has concealed the material facts from this Forum and has been telling lies before this Forum, so the complaint is liable to be dismissed. In fact, the claim of the Complainant has been rightly repudiated due to the breach of conditions of the policy and due to misrepresentation of the material facts. As the Complainant was required to narrate true and actual facts before purchasing the policy from the Opposite Parties, but the Complainant obtained the policy from the Opposite Parties by playing a fraud and by misrepresenting material facts to the Opposite Parties. Admittedly, the Complainant had earlier purchased policy from The New India Insurance Company Limited and after the Complainant purchased the policy from the Opposite Parties. However, the Complainant purchased the policy from the Opposite Parties by stating that she never lodged any claim with the earlier company, but the Complainant had availed the benefits of policy by lodging one claim with them but while purchasing policy from the Opposite Parties, the Complainant concealed the said material facts and obtained the benefit of No Claim Bonus from the Opposite Parties under said misrepresentation. The Opposite Parties issued policy to the Complainant bonafidely by believing the Complainant and even provided the benefits of NCB @ 20% i.e. for an amount of Rs.3121/- as fully reveals from the very perusal of the policy itself, copy of which is enclosed. However, when the Complainant lodged the claim with the Opposite Parties, only after making verification from the previous insurer the above mentioned facts came to knowledge of the Opposite Parties, as such the claim of the Complainant has rightly been repudiated vide letter dated 1.5.2017. On merits, the Opposite Parties almost took up the same and similar pleas as taken up by them in the preliminary objections. Remaining facts mentioned in the complaint are also denied and a prayer for dismissal of the complaint with cost was made.
3. In her bid to prove the case, complainant tendered into evidence affidavit Ex.C1 in support of the allegations made in the complaint and also produced copies of documents Ex.C2 and Ex.C6 and closed her evidence.
4. On the other hand, to rebut the evidence of the complainant, the Opposite Parties tendered into evidence the affidavit of Sh.R.N.Bansal, Divisional Manager Ex.OPs1 and copies of documents Ex.OPs2 and Ex.OPs3 and closed the evidence on behalf of the Opposite Parties.
5. We have carefully gone through the pleadings of the parties; arguments advanced by the ld.counsel for the parties and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for both the parties.
6. From the record i.e. pleadings of the parties and the evidence produced on record by the parties, it is the case of the Complainant that he is owner of Honda City Car No.PB-29U-6307 and he is sole proprietor of the firm M/s.Hans Raj & Sons, Moga and he got fully insured his vehicle with Opposite Parties vide policy No. 2012003117-P101024492 valid for the period from 15.4.2017 to 14.4.2018 and as such, there is relationship of consumer and service provider between the parties, copy of the policy accounts for Ex.C3 whereas the copy of the Aadhar card accounts for Ex.C2 on the record. It is the contention of the ld.counsel for the Complainant that on 29.4.2017 when the vehicle in question was lying parked at Focal Point, Moga then some unknown vehicle hit it and fled away. When the Complainant and her husband came to know about the said accident, then he immediately informed this fact to Opposite Party No.1 and Opposite Party No.1 appointed a surveyor and got assessed the loss and thereafter as per the directions of Opposite Party No.1, the Complainant got repaired the vehicle in question from AKC Motors Private Limited, Authorised Service Centre of Honda Company and Complainant paid Rs.53,273/- as repair charges, copy of invoice dated 5.5.2017 is enclosed as Ex.C4 (second leaf). The Complainant thereafter submitted the original tax invoice of Rs.53,273/- to Opposite Party No.1 and Opposite Party No.1 assured the Complainant that within few days, the claim amount will be paid. Thereafter, the Complainant and her husband visited the office of Opposite Party No.1 and made requests to release the claim amount, but the Branch Manager stated that at the time of purchase of the policy in question, the Complainant has availed No Claim Bonus of Rs.3121.60 and then the Opposite Parties asked the Complainant to deposit of Rs.6890/- (No Claim Bonus Rs.3121.60 paisa and penalty of Rs.3768.40 paisa) and then the claim of Rs.53,273/- will be released to the Complainant. As per the directions of Opposite Party No.1, the Complainant deposited Rs.6,890/- with Opposite Parties on 1.8.2017 vide cheque No. 08558 of Bank of Maharashtra, Branch Moga and then Opposite Party No.1 assured the Complainant that within few days, the claim amount will be paid. Thereafter, the Complainant and her husband visited many times to office of Opposite Party No.1 and made requests to release the amount of Rs.53,273/-, but the Opposite Party No.1 is lingering on the matter on one pretext to another and hence the Opposite Parties has allegedly been deficient in rendering services to the Complainant. It was prayed to accept the complaint and to award the relief as claimed. Ld. counsel for the Complainant has placed reliance upon the following judicial pronouncements to strengthen its point:-
(i) National Insurance Company Limited Vs. Harpreet Singh of Hon’ble National Commission, New Delhi (Revision Petition No. 3216 of 2012 (against the order dated 15.5.2012 in Appeal No. 64 of 2009 of the State Commission, Punjab) D/D 08.02.2016.
(ii) United India Insurance Company Vs. M/s.Jindal Poly Buttons Limited of Hon’ble National Commission, New Delhi (Revision Petition No. 2920 of 2015, decided on 20.02.2017.
7. On the other hand, ld.counsel for the Opposite Parties has repelled the aforesaid contention of the ld.counsel for the Complainant on the ground that there is no deficiency in service on the part of the Opposite Parties. It is further argued that in fact, the claim of the Complainant has been rightly repudiated due to the breach of conditions of the policy and due to misrepresentation of the material facts. As the Complainant was required to narrate true and actual acts before purchasing the policy from the Opposite Parties, but the Complainant obtained the policy from the Opposite Parties by playing a fraud and by misrepresenting material facts to the Opposite Parties. Admittedly, the Complainant had earlier purchased policy from The New India Insurance Company Limited and after the Complainant purchased the policy from the Opposite Parties. However, the Complainant purchased the policy from the Opposite Parties by stating that she never lodged any claim with the earlier company, but the Complainant had availed the benefits of policy by lodging one claim with them but while purchasing policy from the Opposite Parties, the Complainant concealed the said material facts and obtained the benefit of ‘No Claim Bonus’ from the Opposite Parties under said misrepresentation. It is the contention of the ld.counsel for the Opposite Parties that the Opposite Parties issued policy to the Complainant bonafidely by believing the Complainant and even provided the benefits of NCB @ 20% i.e. for an amount of Rs.3121/- as fully reveals from the very perusal of the policy itself. However, when the Complainant lodged the claim with the Opposite Parties, only after making verification from the previous insurer the above mentioned facts came to knowledge of the Opposite Parties, as such the claim of the Complainant has rightly been repudiated vide letter dated 1.5.2017, copy of the repudiation letter accounts for Ex.OPs2 on the record. Ld.counsel for the opposite parties submitted that there is no deficiency of service on the part of the Opposite Parties. Ld. counsel for Opposite Parties- Insurance Company have placed reliance upon the following judicial pronouncements to strengthen its point
(i) Tata AIG General Insurance Company Limited Vs. Gulzari Singh of Hon’ble National Commission, New Delhi (Revision Petition No. 1255 of 2009 from Order dated 16.12.2008 in Appeal No. 389 of 2007 of State Commission, Delhi, D/d 26.2.2010.
(ii) Shri Inder Pal Rana Vs. National Insurance Company Limited of Hon’ble National Commission, New Delhi (Revision Petition No. 4470 of 2014, D/d 2.1.2015)
8. From the entire above discussion, we have come to the conclusion that the only ground for repudiation of the claim of Complainant is that before purchasing the policy from the Opposite Parties, but the Complainant obtained the policy from the Opposite Parties by playing a fraud and by misrepresenting material facts to the Opposite Parties. It is not disputed that during the currency of the policy period, the accident took place. It is also not denial of the case that the Complainant had earlier purchased policy from The New India Insurance Company Limited and after the Complainant purchased the policy from the Opposite Parties. However, the Complainant purchased the policy from the Opposite Parties by stating that she never lodged any claim with the earlier company, but the Complainant had availed the benefits of policy by lodging one claim with them but while purchasing policy from the Opposite Parties, the Complainant concealed the said material facts and obtained the benefit of ‘No Claim Bonus’ from the Opposite Parties under said misrepresentation. The Opposite Parties issued policy to the Complainant bonafidely by believing the Complainant and even provided the benefits of NCB @ 20% i.e. for an amount of Rs.3121/- as fully reveals from the very perusal of the policy itself.. However, when the Complainant lodged the claim with the Opposite Parties, only after making verification from the previous insurer the above mentioned facts came to the knowledge of the Opposite Parties, as such the claim of the Complainant has rightly been repudiated vide letter dated 1.5.2017. The Complainant has in this regard, placed on record two citations i.e. (i)National Insurance Company Limited Vs. Harpreet Singh of Hon’ble National Commission, New Delhi (Revision Petition No. 3216 of 2012 (against the order dated 15.5.2012 in Appeal No. 64 of 2009 of the State Commission, Punjab) D/D 08.02.2016 and another
(ii) United India Insurance Company Vs. M/s.Jindal Poly Buttons Limited of Hon’ble National Commission, New Delhi (Revision Petition No. 2920 of 2015, decided on 20.02.2017 which are fully application to the facts of the present case. On this point, recently Hon’ble National Commission, in case Anjani Gupta Vs.Future Generally India Insurance Company in revision Petition No. 1051 of 2017 decided on 12th December, 2017 has held that if ‘No Claim Bonus’ is wrongfully taken by the insured, the claim would still be payable on a ‘non standard basis’. The relevant para 4(b) is reproduced as under:-
“In case of the insured taking the insurance policy of the vehicle from new insurance company and it is established that the insured by making wrongful declaration has taken benefit of No Claim Bonus and where the insured had failed to seek confirmation regarding correctness of the declaration submitted by he insured in support of plea for No Claim bonus within the stipulated period as provided in GR 27 of India Motor Tariff, the insurer would not be justified in repudiating the insurance claim. However, because the insured had taken benefit of No Claim Bonus by making false declaration his insurance claim would be reduced proportionately. It would therefore be seen that if No Claim Bonus is wrongfully taken by the insurer, the claim would still be payable on a non standard basis, if the insurer had the means to verify the correctness of the declaration made by the insured while claiming the No Claim bonus. In the present case also, the respondent had an opportunity to verify the correctness or otherwise of the declaration made by the petitioner/ Complainant by making necessary enquiry from the concerned insurer. That having not been done, the Complainant is entitled to reimbursement of the loss sustained by him, subject to course of proportionate deduction. Since the No Claim bonus was availed by the Complainant @ 25%, the amount payable to the Complainant/ petitioner has to be reduced in the same proportion.”
The supra judgements produced by the ld.counsel for the Complainant are of same and similar facts. But however, the citations produced by the Opposite Parties are not applicable to the facts of the present case. Hence, keeping in view the aforesaid rulings of Hon’ble National Commission, New Delhi, it will be in the interest of justice, if the claim of the Complainant be ordered to be passed on ‘Non Standard basis’ i.e. reducing the 20% out of the claimed amount.
9. Further more, this is a common practice of the Insurance Companies to repudiate the claim on flimsy grounds without any justification. In this regard, we are supported with the rulings: Life Insurance Corporation of India Vs. Ambika Prasad Pandey, AIR 1999 MP 13 and Life Insurance Corporation of India Vs. Narmada Agarwalla, AIR 1993 Ori 103. In the facts of this case, ratio of the decision of Hon’ble Apex Court in case of Dharmendra Goel Vs. Oriental Insurance Co. Ltd., 2008(3) CPJ 377 (SC) is fully attracted. It was held that
“Insurance Company being in a dominant position, often acts in an unreasonable manner and after having accepted the value of a particular insured goods, disowns that very figure on one pretext or the other, when they are called upon to pay compensation. This ‘take it or leave it’, attitude is clearly unwarranted not only as being bad in law, but ethically indefensible.”
On this point, Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others (2008) 151 PLR 313 has held to the following effect:-
“It seems that the Insurance Companies are only interested in earning the premiums, which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance Companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus, pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy
In fact, all these conditions, which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy .”
10. Keeping in view the aforesaid facts and circumstances of the case, the complaint filed by the Complainant is partly allowed and we direct the Opposite Parties to make the payment of claim amount on ‘Non Standard Basis’ i.e. to make the payment of Rs.53,273/- after deducting 20% of the awarded amount, to the Complainant. The compliance of this order be made by the Opposite Parties within 30 days from the date of receipt of copy of this order, failing which the awarded amount shall carry interest @ 6% per annum from the date of filing the complaint till its actual realization. Opposite Parties are also directed to pay Rs.1,500/- to the complainant on account of compensation besides Rs.1,000/-as litigation expenses. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced in Open Forum
