Punjab

Moga

CC/16/155

Sudarshan Lal - Complainant(s)

Versus

United India Insurance Co. Ltd. - Opp.Party(s)

Sh. Arun Tayal

28 Dec 2016

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 155 of 2016

                                                                                      Instituted on: 10.10.2016

                                                                                      Decided on: 28.12.2016

 

 

Sudarshan Lal s/o Sham Lal  r/o # 3159 GF, Sector 44-D, Chandigarh.

 

                                                                                ……… Complainant

 

Versus

United India Insurance Company Limited, having its divisional office at Shop no. 6-7, Shaheed Bhagat Singh Market, G. T. Road, Moga, Tehsil and District Moga, through its Divisional Manager.

 

                                                                           ……….. Opposite Party

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President

                   Smt. Vinod Bala, Member

                   Smt. Bhupinder Kaur, Member

 

Present:       Sh. Arun Tayal, Advocate Cl. for complainant.

                   Sh. Pawan Kumar Sharma, Advocate Cl. for opposite party.

 

ORDER :

(Per Ajit Aggarwal,  President)

 

1.                Complainant has filed the instant complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the "Act") against United India Insurance Company Limited, having its divisional office at Shop no. 6-7, Shaheed Bhagat Singh Market, G. T. Road, Moga, Tehsil and District Moga, through its Divisional Manager (hereinafter referred to as the opposite party) directing them to pay a sum of Rs.1,61,182/- on account of insurance claim alongwith interest thereon @ 12 % per annum w.e.f. 28.11.2015, till the date of realization. Further opposite party may be directed to pay Rs.50,000/- on account of mental agony and harassment and Rs.11,000/- as litigation expenses to the complainant and to pass such other orders in favour of the complainant as deemed fit and proper in the facts and circumstances of the case.

2.                Briefly stated the facts of the case are that complainant is the registered owner of car bearing registration no. CH-01-AL-0359, which was insured with opposite party for the period from 16.01.2015 to 15.01.2016. Earlier the car of the complainant was insured with ICICI Lombard GIC Ltd for the period 16.01.2014 to 15.01.2015. In the first week of January, 2016, the complainant alongwith his brother namely Dr. Satish Kaura visited the office of opposite party to insure the abovesaid car. After arrival in the office of opposite party, the dealing official of the opposite party asked the complainant that whether he received any claim from the previous insurer or not. The complainant replied that he did not remember. Thereafter, the dealing official of the opposite party replied that the opposite party would itself confirm the same from the previous insurer and after due confirmation they will issue the policy to the complainant. On 13.01.2015, the complainant alongwith his brother again visited the office of opposite party and purchased the policy of opposite party. He paid the premium amount and got insured his car for the period 16.01.2015 to 15.01.2016 vide policy no.2012003114P108602239 under Nil Depreciation Scheme and for this scheme, the complainant also paid extra premium to the opposite party. During the policy period, the car of the complainant met with an accident. The complainant immediately filed an insurance claim with opposite party, thereafter, opposite party appointed a surveyor, who inspected the car and after inspection of the surveyor, the complainant repaired his car and received the delivery of his car from the repairer on 28.11.2015 and before delivery of the car, the complainant paid a bill of Rs.1,61,182/- to the repairer. On the very next day, the complainant visited the office of opposite party and submitted all the required documents alongwith original bill issued by the repairer in the office of opposite party. The dealing official of the opposite party told the complainant that the claim amount will be directly transferred in the bank account of the complainant within 15 days. After passing of 15 days, the complainant again visited the office of opposite party and inquired about the insurance claim. The dealing official of the opposite party told the complainant that after receiving the report from the surveyor, they will pay the claim amount. In the month of January, 2016, the complainant received a letter from the opposite party regarding repudiation of the claim. After receiving the said letter, the complainant immediately approached in the office of opposite party and told them that he did not suppress anything and before issuing the policy in question, he already told to the dealing official of the opposite party that he did not remember whether any claim from the previous insurer was received or not as he did not drive this car personally and thereafter after due verification from the previous insurer, the official of the opposite party issued the policy in question. But opposite party did not listen anything. The opposite party replied to the complainant that at the time of issuing the policy, the complainant signed the declaration that he did not get any claim from the previous insurer. The complainant replied that he did not do so. The complainant visited the office of opposite party several times, but to no effect. Due to the acts of opposite parties, the complainant has suffered a great financial loss, irreparable loss and injury at the hands of the opposite party. Hence this complaint.

3.                Upon notice, opposite party appeared through counsel and filed written reply taking certain preliminary objections that the complaint is not maintainable; that the complainant is estopped by his own act and conduct; that the complainant has not complied with the terms and conditions of the insurance policy; that there is no deficiency in service on the part of opposite party; that the complainant has not come to the Forum with clean hands. He has concealed, suppressed and mis-sated the material facts from this Forum. The true facts are that Sh. Sudarshan Lal got insured a vehicle bearing registration no.CH-01-AL-0359 from opposite party. The said vehicle was insured under policy no.201200/31/14/P/108602239 for the period of 16.01.2015 to 15.01.2016 with (no claim bonus) subject to policy's terms and conditions. The insured Sudarshan Lal has stated in the proposal form that he is entitled to 'no claim bonus' meaning thereby he had not lodged any claim with the previous insurer. However, on verification with the previous insurer i.e. ICICI Lombard GIC Ltd. Insurance company Ltd. vide email dated 29.12.2015 it came to light that the complainant had filed claim which stands paid vide their policy no. 3001/69052871/02/000 valid from 16.01.2014 to 15.01.2015. Thus by misrepresenting the material facts the complainant have obtained the benefit of NCB (No claim bonus) breaching the terms and conditions of the insurance policy. Hence all the benefits under section 1 of the policy stand forfeited. Therefore, the claim of the complainant has been repudiated on this ground. Therefore, there is no deficiency in service on the part of opposite party and the claim was repudiated after thorough investigation. Further submitted that the opposite party appointed the surveyor and loss assessor Sh. R.P. Singh who assessed the loss to the extent of Rs.1,58,511/- subject to the terms and conditions of insurance policy and declaration submitted by the insured. On merits, it is admitted to the extent that vehicle bearing registration no.CH-01-AL-0359 got insured vide policy no.201200/31/14/P/108602239 for the period of 16.01.2015 to 15.01.2016. Further admitted that after receiving the information, the opposite party appointed the surveyor to assess the loss and surveyor assessed the loss to the extent of Rs.1,58,511/- subject to the terms and conditions of the insurance policy and declaration submitted by the insured. The claim was repudiated on the ground of mis-representing the facts regarding NCB (no claim bonus). All other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with special costs has been made.

4.                To prove the case, complainant tendered in evidence his duly sworn affidavit Ex. C-1 and other affidavit of Dr. Satish Kaura Ex.C-2 alongwith copies of documents Ex. C-2 to Ex.C-6 and closed the evidence. 

5.                On the other hand, opposite party tendered in evidence duly sworn affidavit of Sh. Baldev Singh, Divisional Manager, United India Insurance Co. Ltd. Ex.OP-1/1 and copies of documents Ex.OP-1/2 to Ex.OP-1/7 and closed the evidence.

6.                We have heard the ld. Counsel for the parties and have very carefully gone through record placed on file.

7.                The case of the complainant is that he is owner of car bearing registration no.CH-01-AL-0359, which was insured with opposite party for the period 16.01.2015 to 15.01.2016. Earlier the said vehicle was insured with ICICI Lombard General Ins. Co. for the period 16.01.2014 to 15.01.2015. During the period of insurance policy, the car of the complainant met with an accident. The complainant immediately informed regarding the accident to opposite party, who appointed a surveyor to asses the loss to the vehicle, who inspected the car and after inspection of surveyor on the instructions of opposite party, the complainant repaired his car and paid Rs.1,61,182/- to the repairer on account of repair charges. He duly submitted all the required documents alongwith original bills to opposite parties for payment of his claim, copy of insurance policy is Ex.C-5 and copy of bill dated 28.11.2015 is Ex.C-4, but opposite party wrongly and illegally repudiated the claim of the complainant vide letter dated 05.01.2016, copy of same is Ex.C-3 on the ground that by misrepresenting the material facts, he had obtained the benefit of NCB breaching the terms and conditions of the insurance policy. Hence all the benefits under section I of policy stands forfeited. But the complainant did not suppress anything. Before the issuing of the policy in question, he already told to the official of the opposite party that he did not remember whether any claim was received or not. They wrongly repudiated the claim of the complainant on false grounds. Due to the acts of opposite party, the complainant had suffered great mental tension, harassment and agony. All the acts of the opposite party amounts to deficiency in service and trade mal practice on their part.

8.                On the other hand, ld. counsel for opposite party admitted that car of the complainant was insured with them for the period 16.01.2015 to 15.01.2016 under No Claim Bonus subject to policy's terms and conditions. They admitted that during the policy period, the car of the complainant met with an accident and complainant intimated regarding the same to opposite party and they appointed surveyor and loss assessor to assess the loss to the car, who assessed the loss to the extent of Rs.1,58,511/-, subject to terms and conditions of the policy, copy of surveyor report is Ex.OP-1/7. Ld. counsel for opposite party argued that earlier the vehicle in question was insured with ICICI Lombard General Insurance Co. Ltd. At the time of purchase of insurance policy from opposite party, the complainant concealed, suppressed and misstated material fact from opposite party. The complainant got insured his vehicle under no claim bonus scheme. He stated in the proposal form that he is entitled to no claim bonus, as he had not lodged any claim with previous insurer. But during processing to his claim on verification from the previous insurer, it came to light that the complainant had filed claim under previous policy, which stand paid to him, copy of e-mail dated 29.12.2015 of ICICI Lombard General Insurance Co. is Ex.OP-1/2. Thus by misrepresenting the material fact, the complainant had obtained the benefit of no claim bonus breaching the terms and conditions of the insurance policy. Hence all the benefits under section I of the policy stand forfeited. The claim of the complainant had been rightly repudiated on this ground after thorough investigation as per terms and conditions of the policy. There is no deficiency in service on the part of opposite party. Hence the present complaint may be dismissed with costs.

9.                Now, it is admitted case of the parties that the vehicle of the complainant was insured with opposite party, which met with and accident and complainant lodged the claim for the loss of his vehicle with opposite party, but opposite party rejected the claim of the complainant only on the ground that at the time of purchase of insurance policy, by suppressing the material facts the complainant had taken the benefit of NCB by stating that he had not lodged any claim with previous insurer. But during the investigation, it come to the notice that he had already received the claim from the previous insurer, which amounts to breach of terms and conditions of the policy. Ld. counsel for complainant argued that if the complainant did not disclose regarding the lodging of claim with previous insurer, then in that case, the opposite party can verify this fact from the previous insurer within time. But the opposite party kept mum, through entire insurance period. When the complainant lodged his claim, the opposite party repudiated the claim on the ground that complainant had taken the benefit of No Claim Bonus, so they cannot deny the payment of claim amount to the complainant. Moreover more or less they are entitled to recover the amount of NCB from the complainant, but not to reject the claim of the complainant straightway. He put reliance on 2016 (2) CPC 459, titled as National Insurance Company Ltd. Vs Jagir Kaur, whereas Hon'ble National Commission, New Delhi held that Accident of Vehicle. Surveyor appointed - Loss assed. False statement at time of obtaining of insurance policy alleged. Repudiation of Claim. Deficiency in service. District Forum dismissed complaint. State Commission allowed appeal. Hence Revision. Proposal form shows that respondent/complainant claimed claim bonus while renewing policy and also while charging premium no claim bonus of 20% was allowed. Survey report which is on record assessed loss on net salvage basis for Rs.2,09,000/-. District Forum's order also records that respondent/complainant urged that as per survey report respondent/complainant entitled to amount of Rs.2,09,000/- and amount to be awarded to her. Therefore, Petitioner/Insurance Company directed to pay to respondent/complainant 75% of amount assessed by surveyor i.e. Rs.2,09,000/- that comes to Rs.156,750/- with 9% interest from date of filing of complaint with salvage being given to petitioner/insurance company. Hence, revision partly allowed. Further in case tiled as National Insurance Co. Ltd. Vs Harpreet Singh- 2016 (1) CPR 910, whereas our Hon'ble National Commission, New Delhi held that for reimbursement of damage to Truck caused due to accident. Repudiation of claim on ground that respondent complainant obtained No Claim Bonus by concealment of misrepresentation of fact. Where insured is unable to produce evidence regarding his No Claim Bonus entitlement, he may be permitted to give a declaration in support of his No Claim Bonus. In instant case, admittedly no communication was sent by the petitioner to the previous insurer within 21 days after granting the insurance cover to the insured. This obviously amounts to breach of tariff on the part of the petitioner insurance company and disentitle the insurance company to take shelter of the plea of misrepresentation of facts on the part of petitioner. Complainant on the basis of false declaration given to petitioner paid 25% less premium. Equity demands that bonus payable to complainant in respect of his insurance claim should be decreased by 25%. Directions issued to petitioner insurance company to pay to respondent complainant 75% of claimed amount with 9% interest. Revision petition partly allowed. So, as per the law settled by Hon'ble National Commission, New Delhi, the opposite party cannot reject the claim of the complainant straightway. They are liable to pay the claim even if, it is presumed that the complainant has breach any term and condition of the policy, in that case, he is entitled for the claim on non standard basis. All these acts of opposite party amounts to deficiency in service and trade mal practice on the part of opposite party.

10.              In view of the above discussion and in light of the case laws discussed above, the present complaint in hand is hereby partly allowed and opposite party is directed to pay the amount of Rs.1,18,884/- i.e. 75% of Rs.1,58,511/- as assessed by the surveyor vide survey report dated 14.12.2015 Ex.OP-1/6 and OP-1/7 alongwith interest @ 9% per annum from 05.01.2016 when opposite party repudiate the claim of the complainant till final realization. Further opposite party is directed to pay Rs.3000/-(three thousand only) as litigation costs to the complainant. Compliance of the order be made within one month from the receipt of copy of this order till final realization, failing which, the complainant shall be entitled to initiate proceedings under section 25 & 27 of the Consumer Protection Act. Copy of the order be supplied to the parties free of costs. File be consigned to record room.

Announced in Open Forum.

Dated: 28.12.2016.

 

                               (Bhupinder Kaur)                 (Vinod Bala)         (Ajit Aggarwal)

                                             Member                          Member                President