Haryana

Kaithal

381/19

Jeet Kaur - Complainant(s)

Versus

Oriental insurance co. - Opp.Party(s)

Sh.Gurdev Singh

08 Sep 2023

ORDER

                    

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAITHAL.

                                                     Complaint Case No.381/2019.

                                                     Date of institution: 25.11.2019.

                                                     Date of decision:08.09.2023.

Jeet Kaur wife of Raj Pal, resident of Village Hemu Majra, Tehsil Guhla, Distt. Kaithal.

                                                                        …Complainant.

                        Versus

Oriental Insurance Company Ltd., Hafed Road Cheeka, through its Branch Manager. 

….OP.

        Complaint under Section 12 of the Consumer Protection Act

CORAM:     SMT. NEELAM KASHYAP, PRESIDENT.

                SMT. SUMAN RANA, MEMBER.

                SH. SUNIL MOHAN TRIKHA, MEMBER.

       

Present:     Sh. Gurdev Singh, Advocate, for the complainant.   

                Sh. M.R.Miglani, Advocate for the OP.

               

ORDER

NEELAM KASHYAP, PRESIDENT

        Jeet Kaur-Complainant has filed this complaint under Section 12 of Consumer Protection Act, 1986 (hereinafter referred to as ‘the Act’) against the OP.

2.             In nutshell, the facts of present case are that the complainant got insured his car I-20 bearing No.HR09E-0962 with the OP vide policy No.261390/31/2019/2542 valid for the period w.e.f. 20.10.2018 to 19.10.2019 for the insured amount of Rs.4,80,000/-.  In the month of October, 2018, the said car met with an accident and the vehicle of complainant was totally damaged.  Information regarding accident was given to the OP, who appointed the surveyor.  The complainant lodged the claim with the OP and submitted all the necessary documents but the OP repudiated the claim of complainant vide letter dt. 06.03.2019.  The said repudiation of claim is stated to be wrong and illegal.   So, it is a clear cut case of deficiency in service on the part of OP and prayed for acceptance of complaint.     

3.            Upon notice, the OP appeared before this Commission and contested the complaint by filing their written version raising preliminary objections with regard to locus-standi; maintainability; cause of action; jurisdiction; that the complainant has concealed the true and material facts from this Commission.  The true facts are that at the time of purchasing the insurance policy, the complainant has got taken benefit of 25% as “No Claim Bonus” by concealing the facts that she had not taken any claim on previous policy.  When the answering OP processed the claim of complainant, the answering OP got verified from the New India Assurance Co., then previous insurer of complainant informed the answering OP in writing that she had taken claim on her previous policy.  So, the complainant herself has violated the terms and conditions of insurance policy and as-well-as G.R.No.27 (B).  There is no deficiency in service on the part of OP.  On merits, the objections raised in the preliminary objections are rebutted and so, prayed for dismissal of complaint.

4.             To prove his case, the complainant tendered into evidence affidavit Ex.CW1/A alongwith documents Annexure-C1 to Annexure-C14 and thereafter, closed the evidence.

5.             On the other hand, the OP tendered into evidence affidavits Ex.RW1/A, E.RW2/A alongwith documents Annexure-R1 to Annexure-R5 and thereafter, closed the evidence.

6.             We have heard the learned Counsel for both the parties and perused the record carefully.

7.             Ld. counsel for the complainant has contended that the complainant got insured his car I-20 bearing No.HR09E-0962 with the OP vide policy No.261390/31/2019/2542 valid for the period w.e.f. 20.10.2018 to 19.10.2019 for the insured amount of Rs.4,80,000/-.  In the month of October, 2018, the said car met with an accident and the vehicle of complainant was totally damaged.  Information regarding accident was given to the OP, who appointed the surveyor.  It is further argued that the complainant lodged the claim with the OP and submitted all the necessary documents but the OP repudiated the claim of complainant vide letter dt. 06.03.2019.  The said repudiation of claim is stated to be wrong and illegal.   So, it is a clear cut case of deficiency in service on the part of OP.  Ld. counsel for the complainant has placed reliance upon the case law titled as ICICI Lombard General Insurance Company Ltd. Vs. Verma Hospital decided by Hon’ble Punjab State Commission bearing first appeal No.46 of 2018, date of decision: 12.04.2018 and NIC Vs. Manjit Sharma decided by Hon’ble Punjab State Commission, bearing first appeal No.994 of 2005, date of decision: 11.03.2021.

8.             On the other hand, ld. counsel for the OP has argued that at the time of purchasing the insurance policy, the complainant has got taken benefit of 25% as “No Claim Bonus” by concealing the facts that she had not taken any claim on previous policy.  When the OP processed the claim of complainant, the OP got verified from the New India Assurance Co., then previous insurer of complainant informed the answering OP in writing that she had taken claim on her previous policy.  He has further argued that no specific date of accident has been mentioned by the complainant in the complaint.  He has further argued that no FIR was lodged by the complainant.  Ld. counsel for the OP has placed reliance upon the case law titled as Kaustubh Gajanan Dixit Vs. OIC, 2018(2) CLT 496 decided by Hon’ble National Commission.       

9.             We have considered the rival contentions of both the parties.  It is not disputed that the vehicle in question was insured by the complainant vide policy No.261390/31/2019/2542 valid for the period w.e.f. 20.10.2018 to 19.10.2019 for the insured amount of Rs.4,80,000/-as is clear from the copy of Private Car Package Policy (Annexure-C1).  It is also not disputed that during the subsistence of the policy, the said vehicle met with an accident.  The first objection of the OP is that the complainant has not mentioned the specific date of accident in the complaint and no FIR was lodged by the complainant regarding the accident in question.  To rebut the said contention of OP, ld. counsel for the complainant has contended that on 06.08.2019 the complainant had moved an application before C.M.Window, Kaithal as per Annexure-C8 and the OP admitted the accident.  He has further contended that the complainant also moved an application on 06.08.2019 before S.P.Kaithal for lodging the DDR as per Annexure-C9 but they did not take any action.  The another objection of OP is that the complainant has got taken benefit of 25% as “No Claim Bonus” by concealing the facts that she had not taken any claim on previous policy which was insured with the New India Assurance Company.  No doubt, the complainant has violated the terms and conditions of insurance policy but there would have been no justification for the OP for denying the claim of complainant in its entirely only for such violation of terms and condition.  In this regard, reliance can be made to authority titled as Amalendu Sahoo Vs. OIC Ltd., 2010(2) CPJ 9, wherein it has been held by Hon’ble Supreme Court that even in cases where there is any breach of warranty/conditions of policy, an amount upto 75% of the admissible claim can be agreed to.  Similarly, in case titled as United India Insurance Co. Ltd. Vs. Gian Singh reported in II(2006) CPJ page 83 (NC), wherein, it has been held by Hon’ble National Commission that in case of violation of condition of policy as to nature of use of the vehicle, the claim ought to be settled on non-standard basis.

10.            The above authorities are fully applicable to the facts of instant case, whereas, the case law relied upon by the ld. counsel for the OP is not distinguishable but the same is not applicable to the present case.  Hence, we are of the considered view that the claim in respect of vehicle in question should have been settled by the OP on the basis of the guidelines of non-standard settlement. Therefore, the OP has wrongly repudiated the claim of complainant in toto.  In the present case, the surveyor Mr. Ravi Gupta has assessed the loss of the damaged vehicle for Rs.65,720/-.  The surveyor is an independent person and the report of surveyor, Annexure-R1 is placed on the file.  So, this report of surveyor is taken into consideration for deciding the compensation amount in the complaint.  In this regard, we rely upon a judgment 2(2008) CPJ page 182 (NC), United India Insurance Co. Vs. Maya, wherein it has been held that a surveyor report should not be dismissed summarily as the surveyor is independent and qualified person under the relevant provisions of Insurance Act, 1938.

11.            Thus, in view of above discussion, we allow the complaint partly and direct the OP to settle the claim of complainant on non-standard basis i.e. 75% of Rs.65,720/- (as assessed by the surveyor) which becomes Rs.49,290/- within 45 days from today.  The OP is further directed to pay Rs.5,000/- as compensation on account of physical harassment and mental agony as-well-as Rs.5,000/- as litigation charges to the complainant.  However, it is made clear that if the OP is failed to pay the awarded amount of Rs.49,290/- to the complainant within stipulated period, then they shall be liable to pay interest @ 7% p.a. from the date of this order till its realization. 

12.            In default of compliance of this order, proceedings against respondent-OP shall be initiated under Section 72 of Consumer Protection Act, 2019 as non-compliance of court order shall be punishable with imprisonment for a term which shall not be less than one month, but which may extend to three years, or with fine, which shall not be less than twenty five thousand rupees, but which may extend to one lakh rupees, or with both.  A copy of this order be sent to both the parties free of cost.  File be consigned to the record room after due compliance.     

Announced in open court:

Dt.:08.09.2023.

                                                                (Neelam Kashyap)

                                                                President.

 

(Sunil Mohan Trikha),           (Suman Rana),          

Member.                            Member.

 

Typed by: Sanjay Kumar, S.G.