BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, JALANDHAR.

Complaint No.40 of 2019

      Date of Instt. 11.02.2019

      Date of Decision: 06.09.2022

Harbhajan Kaur wife of Mela Singh, Resident of Village Saidpur Jhiri, Tehsil Shahkot, District Jalandhar.

..........Complainant

Versus

United India Insurance Company Ltd., Opposite Bus Stand Nakodar, District Jalandhar through its Manager.

….….. Opposite Party

Complaint Under the Consumer Protection Act.

Before:        Dr. Harveen Bhardwaj             (President)

                   Smt. Jyotsna                            (Member)

                   Sh. Jaswant Singh Dhillon       (Member)                                

Present:       Sh. S. S. Turna, Adv. Counsel for the Complainant.

                   Sh. A. K. Arora, Adv. Counsel for OP.

Order

Dr. HarveenBhardwaj (President)

1.                The instant complaint has been filed by the complainant, wherein it is alleged that the complainant is owner of Swift Dezire Diesel car manufactured by Maruti Udyog Ltd. bearing registration No.PB08-DK-2800 and same was used by complainant and his family and said car is insured with the OP. The OP is an insurance company who insured the vehicle with the assurance to pay the losses as per the terms and conditions of the insurance policy. The complainant got his car bearing No.PB08-DK-2800 with the OP for the value of Rs.4,90,000/- and paid the insurance money Rs.14,024/- in cash and OP issued the insurance policy covering the loss by way of any damages or loss on account of theft accident fire etc. vide policy no.2005033117P104573236 which started from 24.06.2017 valid upto midnight 23.06.2018. The car in question which was insured with the OP faced an accident on 23.03.2018 at about 08:00 AM in the area Naushara Pattan with the motorcycle bearing No.PB07-BK-2664 and car was damaged and meter was reported to OP immediately and surveyor of the OP Sh. Pargat Singh visited on 26.03.2018 at workshop of Lovely Autos, Nakodar Chowk Jalandhar who verified the accident and ultimately car was repaired with the consent of the OP and after that complainant paid a Rs.58,060/- on 31.03.2018 to Lovely Auto, Jalandhar in cash and claimed the amount from the OP which was wrongly repudiated by the OP with mark “closing of claim by insurance” by mentioning a handwriting objection, your previous insurer confirm there is no NCB claim has been reported which is totally wrong. At the time of accident all the history of the vehicle and previous insurance was narrated to the authorized person who insured/issued the policy bearing No.2005033117P104573236. The OP without any reason repudiated the claim of the complainant without any reason, whereas as per the terms and conditions of the insurance policy, OP liable to pay the cost of the repair Rs.58,060/-, but in the present complaint OP failed to pay the compensation and wrongly repudiated the claim of the complainant. The complainant approached OP company for claim the compensation of the repair of car as per the terms and conditions of the insurance policy for which OP is legally liable to pay the same. Complainant filed all the documents with the OP which was necessary for the disposal of the claim, however OP without following any procedure wrongly repudiated the claim of the complainant and after the repudiation of the claim complainant served a legal notice to the OP, but all in vain and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OP be directed to pass an award of Rs.58,060/- alongwith interest @ 12% per annum alongwith Rs.1,00,000/- as a compensation for causing mental tension and harassment to the complainant.

2.                Notice of the complaint was given to the OP, who filed its written reply and contested the complaint by taking preliminary objections that there is no deficiency in service, unfair trade practice on the part of the answering OP and that being so, the present complaint filed by the complainant is liable to be dismissed. It is further averred that on the receipt of information qua the loss caused to the vehicle i.e. Car bearing Registration No.PB08-DK-2800 in the alleged accident, alleged to have occurred on 28.03.2018 at 08:30 AM on the Mukerian to Gurdaspur Road, S. Pargat Singh, B. E. Mechanical Surveyors and Loss Assessors was appointed as Surveyor to assess the loss, who has submitted his survey report dated 27.04.2018 with the OP assessing loss to the tune of Rs.27457.15. It is further averred that the complainant has taken the present policy of insurance in respect of the vehicle in question for the period 24.06.2017 to 23.06.2018 for the first time from the OP. At the time of taking the said policy of insurance from the OP, the complainant/insured made a verbal declaration before the OP that she has not taken any claim on the previous policy of insurance, which was taken from Royal Sundram Insurance Company Believing on the representation of the complainant/insured, No Claim Bonus to the tune of 20% was given to the complainant. On the receipt of the claim from the complainant by the OP, position regarding having no claim on the previous policy of insurance taken by the complainant from Royal Sundram Insurance Company Limited was enquired vide e-mail dated 26.03.2018. Since the complainant/insured has mis-represented the OP regarding taking of no claim under the previous policy of insurance at the time of taking of insurance policy from the OP and as such the file of the complainant was closed by the OP on the ground of breach of condition of policy of insurance qua mis-representation to the OP as per at the time of taking of policy of insurance and giving of wrong NCB declaration, since the claim was not payable and was repudiated as per India Motor Tariff GR-27. The complainant through his counsel served Legal Notice dated 02.01.2019 upon the OP. The said notice was replied vide letter dated 10.01.2019. On merits, the factum with regard to purchasing of the car by the complainant from the OP is admitted and it is also admitted that the complainant has paid the insurance money to the OP, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.

3.                Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.

4.                In order to prove their respective versions, both the parties have produced on the file their respective evidence.

5.                We have heard the learned counsel for the respective parties and have also gone through the case file very minutely.

6.                The complainant has proved on record that he is owner of car Swift Dezire Diesel. Ex.C-1 is the RC, which proves the ownership of the complainant of the car. The complainant has got his car insured from the OP and the OP issued him the insurance cover, which has been proved by the complainant as Ex.C-2. The policy commenced on 24.06.2017 and the same was valid upto 23.06.2018. The complainant has alleged that on 23.03.2018, an accident took place at about 08:00 AM in the area of Naushara Pattan with the motorcycle bearing No.PB-07-BK-2664 and the car was damaged. The matter was reported to the OP. The complainant has also proved on record the job card dated 31.03.2018 Ex.C-5 and the net bill amount for the damage was assessed as Rs.58,060/- and the complainant paid the amount to the Lovely Autos, Jalandhar in cash. Thereafter, the complainant filed claim before the OP, which was repudiated, vide Ex.C-6 on the ground that ‘your previous insurer confirm there is no NCB, claim has been reported’ and on the basis of this, the claim was closed by the insurer. The complainant has proved on record the legal notice Ex.C-3 and reply to the notice Ex.C-4 by the OP.

7.                In the reply to the legal notice, it has been alleged that the previous insurer has confirmed that a claim was made by the complainant, therefore, the claim was repudiated. It is admitted that the Surveyor was appointed, who has given his report Ex.OP-1 and he has also recommended that damage to the vehicle do coincide with the stated cause of loss and are accidental in nature. The surveyor has assessed the loss for Rs.54127.09. The OP has also proved on record the email of the previous insurer from whom the OP has confirmed about the previous claim and as per the reply, it was mentioned that ‘NIL NCB due to old claim’. The OPs have repudiated the claim as per Indian Motor Tariff GR 27. It has been alleged by the OPs that the complainant has concealed the material fact of claim and he was granted discount of NCB, whereas he had already filed a claim before the previous insurer and therefore, he is not entitled to any relief.

8.                As per Indian Motor Tariff GR 27 an insured becomes entitled to NCB only at the renewal of a policy after the expiry of the full duration of 12 months and 20% of the discount will be given on own damage premium where no claim made or pending during the proceeding full year of insurance. As per the submissions of the OP, the discount of 20% was given to the complainant as he made verbal declaration that he did not make any claim before the previous insurer, whereas as per the confirmation, the claim was made by the complainant before the previous insured. It has been held by the Hon'ble National Commission in a Revision Petition No.3761 of 2013, titled as “New India Assurance Co. Ltd. Vs. Shinder Pal Singh”, that “As per the GR 27 of Indian Motor Tariff, the company did not take steps to verify the correctness of declaration regarding “No Claim Bonus” from the previous insurance company. The question which needs answer is whether the petitioner OP was right in repudiating the claim on the plea of concealment and misrepresentation of facts irrespective of the fact that petitioner insurance company has failed to seek verification of declaration given by the insured in support of his plea for No Claim Bonus, within 21 days of the issue of insurance cover as envisaged in GR 27 of Indian Motor Tariff.?”.

                    It has further been held by the Hon'ble National Commission that ‘in such circumstances, the repudiation of the insurance claim by the insurance company was not justified and the equity demands that insurance company should have allowed the insurance claim on pro rata basis i.e. by reducing the entitlement under the claim by 20%’.

9.                In the present case also, as per the allegations of the OP, the complainant has given oral declaration that he has not filed any claim, but the insurance company did not verify it at that time nor took the undertaking and declaration of the complainant in writing. Therefore, as per the law laid down by the Hon'ble National Commission, the repudiation of the whole claim of the complainant by the OPs is wrong, illegal and is liable to be set-aside. Accordingly, as per the law laid down by the Hon'ble National Commission, the insurance claim of the complainant is allowed on pro rata basis i.e. by reducing the entitlement under the claim by 20% of the total assessed amount by the Surveyor and the complaint of the complainant is partly accepted. Further, the OP is directed to pay a compensation of Rs.15,000/- for causing mental tension and harassment to the complainant and Rs.10,000/- as litigation expenses. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.

10.              Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.

Dated          Jaswant Singh Dhillon    Jyotsna               Dr. Harveen Bhardwaj     

06.09.2022         Member                          Member           President