1.      The present revision petition has been filed against the order dated 9.10.2017 in appeal No.509/2016 filed by the petitioner and FA No. 656/2017 filed by the respondent of the State Commission whereby the State Commission had dismissed both the appeals against the order of the District Forum dated 10.02.2016 in complaint no.415 of 2013 whereby the complaint of the respondent was allowed.

2.      The brief admitted facts of the case are that the complainant was the owner of tractor No.HR 60-7516 which was duly insured with the petitioner for the period from 14.07.2011 to 13.07.2012.  While driving the said tractor on 13.5.2012, the complainant met with an accident which resulted into amputation of his right leg.  He submitted his claim with the petitioner but the petitioner had repudiated his claim vide letter dated 26.08.2012 on the ground that the driver, at the time of accident, was not holding the effective driving license.

3.      Aggrieved by the said act of the petitioner, the complainant filed the complaint before the District Forum.  In the reply by the petitioner, several issues had been raised.  Parties led their evidences before the District Forum.  The District Forum heard the learned counsels for the parties and after perusing the evidences on record reached to the following conclusion:

“12.         The complainant lodged claim for injuries sustained by him in the accident in question, on the ground that he had paid premium for personal accident of owner cum driver alongwith total premium of comprehensive insurance of the tractor.  As per copy of the policy Ex./OP1/B, the complainant had paid premium for personal accident cover also. For owner-driver the personal accident cover is upto Rs. Two lacs. The complainant has produced discharge summary Ex.C7, according to which he sustained injuries, the details of which have been given in the said summary.  His right leg had been amputated and as per copy of the disability certificate Ex.C6, he has suffered permanent disability to the extent of 85%. He has produced the copy of medical bills Ex.C8 to Ex.C14 and Ex.C16 to Ex.C19 for total amount of Rs.5,23,345.00. Under such circumstances, the complainant is entitled to get the entire sum insured of Rs.Two lacs under personal accident claim from the Opposite Parties. Therefore, repudiation of the claim of the complainant by the Opposite Parties amounted to deficiency in services.”

4.      The petitioner impugned this order before the State Commission on the ground that the complainant was not holding valid driving license to drive tractor.  This argument of the petitioner was rejected by the State Commission and the order of the District Forum was confirmed.

5.      While challenging the impugned order, it is argued by learned counsel that the petitioner is only confining its argument to the liability to pay 50% of the capital sum assured i.e. of Rs.2 lakh as per GR 36 of Indian Motor Tariff.  It is submitted that the insured amount towards personal injury was upto Rs.2 lakh and the petitioner has no objection to the payment of claim upto 50% of the CSI in terms of GR 36 as only one limb had been lost in the accident.

6.      It is apparent that no such plea was taken by the petitioner in their repudiation letter to the claim of the respondent.  No such plea had been taken by the petitioner in the reply to the complaint nor in appeal.  It is also apparent that in the insurance policy, there is no mention of GR 36.  There is no contention that the insured was served of such terms and conditions.

7.      In United India Insurance Co. Ltd. Vs. M.K.J Corporation AIR 1997 SC 408, the Hon’ble Supreme Court has held as under:

          The duty of good faith is of a continuing nature.  After the completion of the contract, no material altercation can be made in terms except by mutual consent.  The materiality of a fact is judged by the circumstances existing at the time when the contract is concluded. In the present case, the introduction of the Tariff Advisory Committee document materially affects the terms of the policy, resulting in the denial of the very indemnity of the claim.  And this was what the appellant sought to do, at the stage of clearing of the complaint.  The commission rightly rejected the appellants plea.  Notwithstanding, on behalf of the appellant it was insisted that the instructions on the Tariff Advisory Committee form part of the contract.  Admittedly, the appellant-insurer had not incorporated the above quoted clause as part of the policy undertaken with the insured.  Consequently, the insured is not bound by this exclusionary clause of liability since the appellant-insurer admittedly had undertaken liability for the riot or strike, damage due to riot or strike.

8.      In Bharat Watch Company Vs. National Insurance Co. ltd. (2019) 6 SC 212, Hon’ble Supreme Court has held as under:

…..The NCDRC missed the concurrent findings of both the District and State Forum that the terms of the exclusion were  not made known to the insured.  If those conditions were not made known to the insured, as is the concurrent finding, there was no occasion  for the NCDRC to render a decision on the effect of such an exclusion.”

9.      It has been held that unless the insured is apprised of all the terms and conditions, the insurance company cannot be allowed to take shelter behind it. 

10.     Hon’ble Supreme Court in the case of Galada Power and Telecommunication Ltd. Vs. United India Insurance Co. Ltd. 2016 (14) SCC 161 has clearly  held that insurance company cannot raise objections beyond the letter of repudiation. The Hon’ble Supreme Court has held as under:

“In this regard, Mr. Mukheree, learned senior counsel appearing for the Appellant has commended us to a decision of the High Court of Delhi in Krishna Wanti Vs. LIC wherein the High Court has taken note of the fact that if the letter of repudiation did not mention an aspect, the same could not be taken as a stand when the matter is decided. We approve the said view.”

11.     From the facts and circumstances of the case as discussed above, it is apparent that opposite parties have failed to justify the ground of repudiation of claim of the complainant.  Repudiation of claim, therefore, is bad in law and hence it amounts to deficiency in service.

12.    I find no illegality in the impugned order, the present revision petition has no merit and the same is dismissed.

13.    The complainant/respondent submits that he has not received the sum of Rs.7,500/- which the petitioner was directed to pay pursuant to order dated 01.06.2018 of this Commission.  Learned counsel for the petitioner submits that he has sent it by demand draft, however, in case the amount is not received by the complainant, he can file an execution before the District Forum for this sum as well.