Order by:
Sh.Amrinder Singh Sidhu, President
1. This Consumer Complaint has been received by transfer vide order dated 26.11.2021 of Hon’ble President, State Consumer Disputes Redressal Commission, Punjab at Chandigarh under section 48 of CPA Act, vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 from District Consumer Commission, Ludhiana to District Consumer Commission, Moga to decide the same in Camp Court at Ludhiana and said order was ordered to be affected from 14th March, 2022.
2. The complainant has filed the instant complaint under section 12 of the Consumer Protection Act, 1986 (now section 35 of Consumer Protection Act, 2019) on the allegations that he got his car bearing RC No.PB-10-FK-7072, Engine No. D4FCFM409515, Chassis No.MALBM51RLFM160796 insured with Opposite Parties for IDV of Rs.6,50,000/- vide policy cover note No.2006043116P108649870 valid for the period 28.09.2016 to 27.09.2017 against the paid up premium of Rs.14,000/-. Unfortunately, said vehicle met with an accident on 05.07.2017 and in this accident, the vehicle was totally damaged. Thereafter, the complainant lodged the claim with the Opposite Parties for the reimbursement of his claim. On this, the Opposite Parties appointed their surveyor, but lateron, the claim of the complainant was repudiated by the Opposite Parties on the false and frivolous grounds and as such, there is deficiency in service on the part of the Opposite Parties. Vide instant complaint, the complainant has sought the following reliefs.
a) The Opposite Parties may be directed to make the payment of Rs.6,50,000/- as insured value of the vehicle alongwith interest @ 12% per annum from the date of accident till its actual realization and also to pay of Rs.1,00,000 on account of compensation due to mental tension and harassment caused by the complainant besides costs of litigation amounting to rs.22,000/- and also to pay any other relief to which this District Consumer Commission may deem fit.
3. Opposite Parties appeared through counsel and contested the complaint by filing the written version taking preliminary objections therein inter alia that the complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this District Consumer Commission. Admittedly, the complainant lodged the claim with the Opposite Parties and immediately on receipt of the claim, it was duly registered, entertained and processed. As a matter of fact, this is a case of wrong declaration of NCB and the claim of the complainant was repudiated as per GR-27 of India Motor Tariff and on the ground that he had suppressed the material facts with regard to having received claims on 04.09.2017 under the policy No. 404004/31/15/6100002605 of the vehicle in question from previous insurance company i.e. National Insurance Company Limited, and thus amounts to misrepresentations and breach of terms and conditions of the policy. As such, the officials of the Opposite Parties fully applied their mind to the facts of the case regarding the concealment of the facts of NCB and violation of the terms and conditions of the policy. On merits, the Opposite Parties took up almost same and similar pleas as taken up by them in the preliminary objections and the complaint may be dismissed with costs.
4. In order to prove his case, the complainants tendered into evidence his affidavit Ex.C-A alongwith copies of documents Ex.C1 to Ex.C28, Ex.C21A, affidavit Ex.CB alongwith documents Ex.C21 and Ex.C29 and closed the evidence on behalf of the complainant.
5. On the other hand, to rebut the evidence of the complainant, Opposite Parties also tendered into evidence the affidavit Ex.RA alongwith copies of documents Ex.R1 to Ex.R5 and closed the evidence.
6. We have heard the ld.counsel for the parties and also gone through the documents placed on record.
7. During the course of arguments, ld.counsel for the Complainant has mainly reiterated the facts as narrated in the complaint and contended that the complainant got his car bearing RC No.PB-10-FK-7072, Engine No. D4FCFM409515, Chassis No.MALBM51RLFM160796 insured with Opposite Parties for IDV of Rs.6,50,000/- vide policy cover note No.2006043116P108649870 valid for the period 28.09.2016 to 27.09.2017 against the paid up premium of Rs.14,000/-. Copy of policy document is placed on record Ex.C11. Further contended that said vehicle met with an accident on 05.07.2017 and in this accident, the vehicle was totally damaged. Thereafter, the complainant lodged the claim with the Opposite Parties for the reimbursement of his claim. On this, the Opposite Parties appointed their surveyor, but lateron, the claim of the complainant was repudiated by the Opposite Parties on the false and frivolous grounds and as such, there is deficiency in service on the part of the Opposite Parties.
8. On the other hand, ld.counsel for the Opposite Party has repelled the aforesaid contention of the ld.counsel for the complainant on the ground that immediately on receipt of the claim, it was duly registered, entertained and processed. As a matter of fact, this is a case of wrong declaration of NCB and the claim of the complainant was repudiated as per GR-27 of India Motor Tariff and on the ground that he had suppressed the material facts with regard to having received claims on 04.09.2017 under the policy No. 404004/31/15/6100002605 of the vehicle in question from previous insurance company i.e. National Insurance Company Limited, and thus amounts to misrepresentations and breach of terms and conditions of the policy. As such, the officials of the Opposite Parties fully applied their mind to the facts of the case regarding the concealment of the facts of NCB and violation of the terms and conditions of the policy.
9. The main plea raised by the Opposite Party for the repudiation of the claim of the complainant is that it is a case of wrong declaration of NCB and the claim of the complainant was repudiated as per GR-27 of India Motor Tariff and on the ground that he had suppressed the material facts with regard to having received claims on 04.09.2017 under the policy No. 404004/31/15/6100002605 of the vehicle in question from previous insurance company i.e. National Insurance Company Limited, and thus amounts to misrepresentations and breach of terms and conditions of the policy. But however, it is certain that the complainant has breached the terms and conditions of the insurance policy and even then the Insurance Company ought to have settled the claim of the complainant on “non standard basis” even if some of the conditions of the insurance policy are not adhered 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 70% 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”.
10. In such a situation the repudiation made by Opposite Parties regarding genuine claim of the complainant appears to have been made without application of mind. It is usual with the insurance company to show all types of green pesters to the customer at the time of selling insurance policies, and when it comes to payment of the insurance claim, they invent all sort of excuses to deny the claim. 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., III (2008) CPJ 63 (SC) is fully attracted, wherein 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. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-
“It seems that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All 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. The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.
11. Undisputedly, the vehicle in question was insured with the Opposite Parties for Insured Declared Value of Rs,6,50,000/- as per copy of policy placed on record as Ex.C11 and this fact has not been denied by the Opposite Parties. Hence, having regard to the position of the law, as has been laid down, by the Hon'ble Apex Court in the various decisions referred to here-in-above and also the view expressed by the Hon'ble National Commission, we are of the considered view that in the present case the complainant, if not entitled for the entire amount of IDV, the Insurance Company definitely ought to have settled the complainant's claim on 'non-standard basis”, which in the facts and circumstances taking the assistance of the view expressed by the Hon'ble Apex Court and also by the Hon'ble National Commission, we allow 70% of the assessed amount on 'non-standard' basis” of the Insured Declared Value.
12. In view of the aforesaid facts and circumstances of the case, we allow the complaint of the Complainant partly and direct the Opposite Party-Insurance Company to make the payment of Rs.4,55,000/- (Rupees four lakh fifty five thousands only) i.e. 70% of the Insured Declared Value of Rs.6,50,000/- to the Complainant alongwith interest @ 8% per annum from the date of filing the present complaint i.e. 25.10.2017 till its actual realization. Opposite Party-Insurance Company is also directed to pay the lump sum compensation to the complainant to the tune of Rs.10,000/- (ten thousands only) on account of harassment, mental tension and litigation expenses. The compliance of this order be made by Opposite Party-Insurance Company within 45 days from the date of receipt of this order, failing which the complainant shall be at liberty to get the order enforced through the indulgence of this District Commission. Copies of the order be furnished to the parties free of cost by District Consumer Commission, Ludhiana and thereafter, the file be consigned to record room after compliance.
13. Reason for delay in deciding the complaint.
This Consumer Complaint was originally filed at District Consumer Disputes Redressal Forum (Now Commission) at Ludhiana and it keep pending over there until Hon’ble State Consumer Disputes Redressal Commission, Punjab vide letter No.04/22/2021/4 C.P.A/38 dated 17.1.2022 has transferred the instant Consumer Complaint alongwith Other Complaints to District Consumer Commission, Moga with directions to work on this file onward from 14th March, 2022 and accordingly District Consumer Commission, Moga has decided the present complaint today i.e.23.05.2022 at Camp Court, Ludhiana, as early as possible as it could decide the same
Announced in Open Commission at Camp Court, Ludhiana.
Dated: 23.05.2022.
