Delhi

East Delhi

CC/209/2018

PARAS GUPTA - Complainant(s)

Versus

UNITED INDIA INS. - Opp.Party(s)

19 Dec 2022

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION (EAST)

GOVT. OF NCT OF DELHI

CONVENIENT SHOPPING CENTRE, FIRST FLOOR,

SAINI ENCLAVE, DELHI – 110 092

 

C.C. No. 209/2018

 

	Shri Paras Gupta S/o Shri Subhash Chand Gupta R/o House No. P-79, Gali No.4 Bihari Colony, Shahadara, Delhi-110032.	….Complainant
Versus
	United India Insurance Co. Ltd. Delhi Regional Office-2, Core IV, 1st Floor Scope Minar Complex, Laxmi Nagar, District Centre, Delhi-110092.	……OP

 

Date of Institution: 09.07.2018

Order Reserved on: 06.12.2022

Order passed on: 19.12.2022

                  

QUORUM

Sh. S.S. Malhotra (President)

Ms. Ritu Garodia (Member)

Sh. Ravi Kumar (Member)

 

Order by Ms. Ritu Garodia (Member)  

The complaint pertains to deficiency in service on part of OP insurance company w.r.t repudiation of claim on grounds of delay in intimation w.r.t. his stolen vehicle to OP Company.

The facts of the complaint in nutshell are that a Santro Car bearing registration No. DL7 CP 2227, owned by complainant and insured with OP for Rs.3,50,000/- was stolen in the intervening night of 29.9.2017- 30.9.2017. The complainant states that he had parked the aforesaid vehicle in front of A-1, 229, Madangir, Virat Road, New Delhi, in the night of 29.9.2017 but found it missing in the morning of 30.9.2017. After searching for the car in the locality, complainant made a call on 100 to make a complaint. As there was no response, FIR bearing no. 030799 dated 30.9.2017 was registered online with Police Station Sunlight Colony, New Delhi.

Thereafter, the complainant made a call on the Phone no. 011-25439290 mentioned on the insurance certificate. As no one picked the phone, he visited the showroom from where he had purchased the said vehicle to meet the insurance agent, Alok Singhania. He was informed that the said agent was out of town and his phone was not reachable. He visited showroom again after one week to meet his agent who was not available. He, then, telephonically contacted the said agent who advised him to file his claim at Scope Minar office of OP. The complainant lodged the claim at Scope Minar office on 16.10.2017. Thereafter, a surveyor was appointed by OP. He visited the residence of the complainant who handed over the two keys of the stolen vehicle. An untraced order dated 20.11.2017 w.r.t. the stolen vehicle was passed by the Court of Ld. ACMM-1, Saket Court, Delhi.

The complainant followed up with the insurance company for settlement of claim. He received a letter dated 12.12.2017 whereby he was required to explain the delay in intimation of theft to OP. A breach of policy condition no 1 was also mentioned. The complainant alleges that no policy condition was handed over to him. The complainant replied to this letter explaining the reasons for delay. OP however rejected the claim vide letter dated 29.12.2017. The complainant filed a complaint before Grievance Redrassal Officer of OP and Insurance Obmudsman.

The complainant has suffered a lot due to non-approval of claim and prays that OP pay the claim amount of Rs. 3,50,000/- with interest @ 18 p.a., compensation amounting to Rs.1,25,000/- and litigation cost amounting to Rs. 25,000/-.

OP in its reply states that intimation of theft was given after a lapse of 16 days which is a breach a policy condition no.1. OP admits sending letter dated 12.12.2017 and 29.12.2017. It is further stated that the date of theft is mentioned in FIR as 13.9.2017 whereas the same is mentioned in the complaint lodged in Insurance Obmudsman as 13.10.2017.

It is imputed that the signature and address of the complainant in the complaint letter and proposal form does not match. It is further alleged that the chassis number mentioned in proposal form is 787453 while as per email dated 26.4.2017 at 5:12 pm addressed to OP Officer, the chassis number mentioned in inspection report by Adroit Technical Services is 787452. This allegedly amounts to suppression of material facts. It is further alleged that there is endorsement in the present policy for Rs. 25,000/-. OP prays for dismissal of complaint with cost.

Complainant in his rejoinder to the reply filed by OP has denied the breach of policy condition no.1. He has relied on last two line of the policy condition that are as follows:- “In case of theft or criminal act which may be the subject of a claim under this policy the insured shall give immediate notice to the police and co operate with the company in securing the conviction of the offender”.

 Complainant has also relied on judgment of Supreme Court in Om Prakash V/s Reliance General Insurance. He states that the signature mismatch is not the reason mentioned in the letter sent by OP. It is submitted that the inspection report by Adroit Technical Services has not been prepared by the complaint not countersigned by him. It is alleged that the said person is from the company and there may be a clerically mistake w.r.t. the chassis number.

The complainant has filed his evidence by way of affidavit and exhibited the following documents:-

1. Copy of policy cover note/certificate of insurance is exhibited as Ex.CW-1/1.
2. Copy of FIR is exhibited as Ex. CW-1/2.
3. The untraced order dated 20.11.2017 is exhibited as Ex. CW-1/3.
4. Copy of letter dated 12.12.2017 is exhibited as Ex. CW-1/4.
5. Copy of reply is exhibited as Ex.CW-1/5.
6. Copy of letter dated 29.12.2017 is exhibited as Ex.CW-1/6.
7. Copy of the complaint in Insurance Ombudsman is exhibited as Ex.CW-1/7.

OP has filed its evidence by way of affidavit and exhibited the following documents:-

1. Copy of complaint to the Ld. Ombudsman is marked as Exhibit R1/1.
2. Copy of the claim form is marked as Exhibit R1/2.
3. Copy of the FIR is marked as Exhibit R1/3.
4. Copy of the proposal form is marked as exhibit R1/4.
5. Copy of the inspection report of the Adroit Technical Service is marked as exhibit R1/5.
6. Copy of the service hub claim note DRO II, Delhi is marked Exhibit R1/6.
7. Copy of the condition no.1 of policy document is marked Exhibit as R1/7.
8. Copy of the letter dated 29.12.2017 is marked Exhibit R1/8.
9. Copy of letter dated 12.12.2017 is marked as Exhibit R1/9.

The Commission has given thorough consideration to arguments advanced by both the parties and material placed on record. It is undisputed that the complainant is the owner of a Santro car bearing registration no. DL7CP2227. OP had insured the car vide policy no. 2216003117P101804644 from 26.04.2017 to 25.04.2018 with  IDV of Rs. 3,50,000/-. It is undisputed that the vehicle was stolen in the intervening night of 29.9.2017 and 30.9.2017. The complainant made a call at phone no. 100. The complainant lodge FIR online on 30.09.2017 with e-Police Station, Sunlight Colony. The untraced order dated 20.11.2017 passed by ACMM is undisputed. Admittedly the complainant informed the insurance company on 16.10.2017. A surveyor was appointed who took the keys of the stolen vehicle from OP. The complainant claim was repudiated on grounds of delay in intimation. OP’s letter dated 12.12.2017 asked the complainant to explain the delay of about of 16 days in intimation of theft resulting in breach of the policy condition no.1. The said condition is as follows:-

     “Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. Every letter claim writ summons and/or process or copy thereof shall be forwarded to the company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution inquest or fatal injury in respect of any occurrence which may give rise to a claim under this policy. In case of theft or criminal act which may be the subject of a claim under this policy the insured shall give immediate notice to the police and co operate with the company in securing the conviction of the offender.”

The complainant in his reply to the said letter explained that he immediately informed the police by calling 100 number. An online FIR was registered. He, then, tried to call the phone number given on policy certificate but there was no response. Thereafter, he called his agent Mr. Alok Singhania on whose advice he filed the claim in the Scope Minar Office of OP on 16.10.2017.

OP vide letter 29.12.2017 repudiated the claim on ground of delay intimation. OP did not consider or gave any heed to the explanation given by the complainant in his letter. It appears that letter dated 12.12.2017 asking the complainant to provide an explanation was a mere formality.

Perusal of policy condition reveals that in case of theft, the insured should give immediate notice to the police and co-operate with the company in securing the conviction of the offender. There appears to be no breach of this policy condition as FIR was registered on 30.09.2017 i.e. the same day of discovery of theft. Even Apex Court in Om Prakash vs Reliance General Insurance and anr 2017.  has observed “That It is common knowledge that a person who lost his vehicle may not straightaway go to the insurance company to claim compensation. At first, he will make efforts to trace the vehicle................. Rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. If the reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay”.

In the present matter, the complainant in his letter to OP and complaint filed in the Commission has stated that he informed the police immediately. He called number given on policy certificate. Receiving no response, he tried to contact the agent. He was able to connect with the agent only after a week, who advised him to file a claim is Scope Minar Office. OP has not disputed this sequence of event. It has neither denied the phone number provided in the insurance certificate nor the calls made to insurance agent on his phone number. OP has also not denied that the claim was filed in Scope Minar Office on the advice of insurance agent. Complainant has satisfactorily explained the delay and same has not been rebutted by OP. OP has stated that there is endorsement on the proposal from. Perusal of the said form shows “Excess Rs.25,000/- ………….26.1.2017 subject to correction of ............ dated 27.4.2017” Provisional Inspection Report dated 26.4.2017 is filed. The policy is issued on 28.4.2017 with IDV for Rs.3,50,000/- with no endorsement.

The OP has raised an objection as to the wrong chassis number mentioned in the inspection report by Adroit Technical Services Pvt. Ltd. This report has been filed by OP along with the contention that the said report was sent to OP. Inspection Report Titled Provisional Case States Sheet dated 26.4.2017 States “It is only a provisional case inspection report. Actual inspection report will be provided later”. It is not clear as the who has prepared the inspection report and on whose instruction the report was prepared. The complainant was neither instrumental in getting this report prepared nor signed it. The mistake in chassis number was made by independent agency and cannot be held against the complainant. Even the actual inspection report has not been placed on record by OP. Nevertheless, the policy certificate issued by OP shows chassis number as 787453 and same is reflected in untraced report by Ld. ACMM. Similarly the mistake regarding the date of theft in the complaint file before the Ombudsman appears to be typographical in nature and does not affect the claim filed before the insurance company.

OP has also objected to difference in signature an proposal form and claim form. However, OP has not disputed the identity of the complainant nor has taken this objection in repudiation letter. OP has also not filed any opinion of handwriting expect to dispute the veracity of signatures.

It appears that insurance company will take any technical obligation to reject the genuine claim of the insured. Thus we hold OP guilty of deficiency in service in repudiating the claim of the complainant. We direct OP to pay the claimed amount i.e. the IDV of Rs.3,50,000/- with interest @ 9% p.a, Rs.35,000/- as compensation for mental agony and stress and Rs.10,000/- towards litigation expenses.

Copy of the Order be supplied/sent to the Parties free of cost as per rules.

File be consigned to Record Room.

Announced on 19.12.2022.