State Consumer Disputes Redressal Commission
Renu Gupta vs National Insurance Co. Ltd. on 22 August, 2022
C/1690/2017 MRS. RENU GUPTA VS NATIONAL INSURANCE CO. LTD. D.O.D.: 22.08.2022
IN THE DELHI STATE CONSUMER DISPUTES
REDRESSAL COMMISSION
Date of Institution: 04.10.2017
Date of hearing: 12.07.2022
Date of Decision: 22.08.2022
COMPLAINT CASE NO.- 1690/2017
IN THE MATTER OF:
MRS. RENU GUPTA
W/o MR. SANDEEP KUMAR,
R/o A-112,
PRASHANT VIHAR,
DELHI-110085
(Through: Mr. Hemant Gupta & Associates)
...Complainant
VERSUS
NATIONAL INSURANCE CO. LTD.
17-18, INDRAPRASTHA BHAWAN,
SUBZI MANDI, AZADPUR,
DELHI - 110033
ALSO AT:
2E/25, 3RD FLOOR,
JHANDEWALAN EXTENSION,
NEW DELHI - 110055
(Through: Mr. S.K. Pandey, Advocate)
... Opposite Party
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C/1690/2017 MRS. RENU GUPTA VS NATIONAL INSURANCE CO. LTD. D.O.D.: 22.08.2022
CORAM:
HON'BLE JUSTICE SANGITA DHINGRA SEHGAL
(PRESIDENT)
HON'BLE MS. PINKI, MEMBER (JUDICIAL)
Present: None for the parties.
PER: HON'BLE JUSTICE SANGITA DHINGRA SEHGAL,
PRESIDENT
JUDGMENT
1. The present complaint has been filed by the Complainant before this Commission alleging deficiency of service on the part of Opposite Party and has prayed the following reliefs:
a) To direct the Opposite Party to pay sum of Rs.21,47,500/- towards the IDV value of the insurance policy in issue in favour of the Complainant;
b) To direct the Opposite Party to pay a compensation amount of Rs.5,00,000/- to the Complainant for the deficiency in services on its part by illegally rejecting the claim of the Complainant;
c) To direct the Opposite Party to pay an interest @24% per annum on IDV amount of Rs.21,47,500/- from the date of the crime / snatching / loot i.e. 01.04.2015 till actual realization;
d) To award a sum of Rs2,50,000/- towards the cost of litigation;
e) to pass any other/further order(s) which this Hon'ble Commission may deem fit and proper keeping in mind the facts and circumstance of the case, in the interest of justice.
2. Brief facts necessary for the adjudication of the present complaint are that the Complainant purchased a TATA 3118 Truck bearing no. HR-69B-8364 and insured the said vehicle with the Opposite Party i.e. National Insurance Co. Ltd. vide Insurance Policy No. ALLOWED PAGE 2 OF 10 C/1690/2017 MRS. RENU GUPTA VS NATIONAL INSURANCE CO. LTD. D.O.D.: 22.08.2022 360801/31/14/6300004756 for the period starting from 06.02.2015 till 05.02.2016. The Complainant assign Mr. Pramod Kumar for the purpose of plying goods from one place to another. On 02.04.2015, the vehicle in question was robbed while it was passing through ITO Flyover, New Delhi. The Complainant informed the Police about the said robbery and registered an FIR on the same day i.e. on 02.04.2015. Thereafter, the Complainant informed the Opposite Party about the incident on 10.04.2015 and for the purpose of assessment, the insurance company appointed Mr. Arvind Kumar Mishra for investigating the said incident of robbery/snatching of the said vehicle.
3. After examination, the investigator sent its Driving Licence verification report on 22.07.2016 wherein, under the opinion clause, the investigator stated that: "On going through the DL particulars issued by DTO Muzaffarpur and comparing with the copy of DL; it formed the opinion that DL No. 1339/01 of driver Sri Pramod Kumar is true and genuine. License was not valid on the date of accident."
4. Thereafter, in pursuance to such investigation report, a Pre-
Repudiation letter dated 26.08.2016 was sent by the Opposite Party which was received by the Complainant on 19.06.2017 wherein, the Opposite Party asked for the valid effective driving license of the Driver. The Complainant tried numerous times to contact the Opposite Party and requested them to release the claim but Opposite Party did not pay any heed towards the said requests of Complainant. Therefore, alleging deficiency in service and unfair trade practice on the part of the Opposite Party, Complainant approached this Commission.
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5. The Opposite Party have contested the present case and has raised preliminary objection as to the maintainability of the complaint case. The counsel of the Opposite Party contended that there is a delay in intimating the Opposite Party which is in violation of the terms and conditions of the insurance policy. The counsel for the Opposite Party further contended that the Complainant violated the condition mentioned in the policy namely "Limitation as to Use- Driver Clause". Pressing the aforesaid contentions, the counsel appearing on behalf of the Opposite Party prayed that present complaint be dismissed.
6. The Complainant has filed the Rejoinder rebutting the written statement filed by the Opposite Party. Thereafter, both the parties have filed their evidences by way of Affidavit in order to prove their averments on record.
7. We have perused the material available on record and heard the counsel for both the parties.
8. The question for consideration before us is whether the complaint should be dismissed on the ground that there was a delay in intimation to the Opposite Party about the said incident. The counsel for the Opposite Party submitted that the insurance company must be intimated without any delay, but in the present case the incident of robbery was occurred on 02.04.2015 and the Complainant intimated the insurance company on 10.04.2015 i.e. nine days after the said incident.
9. To resolve this issue, we deem it appropriate to refer to the case titled as Om Prakash Vs. Reliance General Insurance and Anr. reported in 2018 (1) CPR 907 (SC), wherein, the Hon'ble Supreme Court has held as under:
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"11. 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. It is true that the owner has to intimate the insurer immediately after the theft of the vehicle. However, this condition should not bar settlement of genuine claims particularly when the delay in intimation or submission of documents is due to unavoidable circumstances. The decision of the insurer to reject the claim has to be based on valid grounds. 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. It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the Investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine. It needs no emphasis that the Consumer Protection Act aims at providing better protection of the interest of consumers. It is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten while considering the claims made under the Act."
10. We further deem it appropriate to refer to Civil Appeal No. 653/2020 titled as Gurshinder Singh Vs. Sriram General Insurance Co. Ltd. & Anr. in decided on 24.01.2020, wherein, the Hon'ble Supreme Court considered the same issue and decides it on merits, which to the extent is relevant reads as under:
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"15. We find, that the second part of Condition No. 1 deals with the 'theft or criminal act other than the accident'. It provides, that in case of theft or criminal act which may be the subject of a claim under the policy, the insured shall give immediate notice to the police and co-operate with the company in securing the conviction of the offender. The object behind giving immediate notice to the police appears to be that if the police is immediately informed about the theft or any criminal act, the police machinery can be set in motion and steps for recovery of the vehicle could be expedited. In a case of theft, the insurance company or a surveyor would have a limited role. It is the police, who acting on the FIR of the insured, will be required to take immediate steps for tracing and recovering the vehicle. Per contra, the surveyor of the insurance company, at the most, could ascertain the factum regarding the theft of the vehicle.
16. It is further to be noted that, in the event, after the registration of an FIR, the police successfully recovering the vehicle and returning the same to the insured, there would be no occasion to lodge a claim for compensation on account of the policy. It is only when the police are not in a position to trace and recover the vehicle and the final report is lodged by the police after the vehicle is not traced, the insured would be in a position to lodge his claim for compensation. As observed by the bench of two learned Judges in the case of Om Prakash (supra), after the vehicle is stolen, a person, who lost his vehicle, would immediately lodge an FIR and the immediate conduct that would be expected of such a person would be to assist the police in search of the vehicle. The registration of the FIR regarding the theft of the vehicle and the final report of the police after the vehicle is not traced would substantiate the claim of the claimant that the vehicle is stolen. Not only that, but the surveyors appointed by the insurance company are also required to enquire whether the claim of the claimant regarding the theft is genuine or not. If the surveyor appointed by the insurance company, upon inquiry, finds that the claim of theft is genuine then coupled with the immediate registration of the FIR, in our view, would be conclusive proof of the vehicle being stolen.
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18. We concur with the view taken in the case of Om Prakash (supra), that in such a situation if the claimant is denied the claim merely on the ground that there is some delay in intimating the insurance company about the occurrence of the theft, it would be taking a hyper technical view. We find, that this Court in Om Prakash (supra) has rightly held that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the investigator.
19. We find, that this Court in Om Prakash (supra) has rightly held that the Consumer Protection Act aims at protecting the interest of the consumers and it being a beneficial legislation deserves pragmatic construction. We find, that in Om Prakash (supra) this Court has rightly held that mere delay in intimating the insurance company about the theft of the vehicle should not be a shelter to repudiate the insurance claim which has been otherwise proved to be genuine.
20. We, therefore, hold that when an insured has lodged the FIR immediately after the theft of a vehicle occurred and when the police after investigation have lodged a final report after the vehicle was not traced and when the surveyors/investigators appointed by the insurance company have found the claim of the theft to be genuine, then mere delay in intimating the insurance company about the occurrence of the theft cannot be a ground to deny the claim of the insured."
11. From the aforesaid settled law, it is clear that the delay in intimation to the Opposite Party (insurance company) does not justify the repudiation of the claim by the Opposite Party. Returning to the facts of the present case, it is noted that the Complainant had duly informed the Police about the incident of robbery on the same day i.e. on 02.04.2015 and the F.I.R report of the concerned official is also on record which clears the said fact.
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Consequently, the objection raised on behalf of the Opposite Party is answered in negative.
12. The last question of consideration before us is whether the Opposite Party is liable for the Deficiency in services for not settling the claim of the Complainant till date. To resolve this issue, we have perused the Driving Licence verification report and Pre-Repudiation letter, we find that the said claim has not been settled by the Opposite Party on the ground that the valid license was not available at the time of incident which in itself is a violation of the condition as per the said policy.
13. For proper appreciation of the matter, the relevant condition of the Insurance Policy, is reproduced below for the ready reference:
"Limitation as to Use-Driver Clause:
As per Motor Tariff a person driving holds an effective driving Licence at the time of accident and is not disqualified from holding or obtaining such a licence and that such a person satisfies the requirements of Rule 3 of the Central Motor Rule".
14. A bare perusal of the aforesaid condition shows that at the time of accident, the driver should be holding effective driving licence. However, no such situation/clause is mentioned in the policy wherein, the loss had occurred without any involvement of the driver
15. Further, we are of the view that the present case is totally differ from an accident case in which the vehicle met with the accident due to the rash or negligence of the driver and the driver has no valid effective license at the time of accident. As in the instant case, the vehicle in question was robbed by two persons and the ALLOWED PAGE 8 OF 10 C/1690/2017 MRS. RENU GUPTA VS NATIONAL INSURANCE CO. LTD. D.O.D.: 22.08.2022 FIR was also registered against them on 02.04.2015. Therefore, as far as the facts of present case is concerned, there is no connection or nexus between the said robbery and having a valid license at the time of incident.
16. Therefore, we can safely proceed on this basis that there was no involvement of the driver when the said vehicle was stolen/robbed on 02.04.2015 which caused loss to the Complainant and there was no fault, omission or negligence on the part of driver in the present case. Therefore, in our considered opinion, we are of the view that the Opposite Party is deficient in service by not settling the claim of the Complainant till date.
17. Keeping in view the facts of the present case as discussed above, we direct the Opposite Party to pay an amount of Rs. 21,47,500/- (Insured Declared Value as per the Insurance Policy) along with interest as per the following arrangement:
A. An interest @ 6% calculated from 04.10.2017 (date of institution of the present case) till 22.08.2022 (being the date of the present judgment);
B. The rate of interest payable as per the aforesaid clause (A) is subject to the condition that the Opposite Party pays the entire amount on or before 22.10.2022; C. In case the Opposite Party fails to refund the amount as per the aforesaid clause (A) on or before on or before 22.10.2022, the entire amount is to be paid with an interest @ 9% p.a. calculated from 04.10.2017 till the actual realization of the amount.
18. In addition to the aforesaid and taking into consideration the facts of the present case, the Opposite Party is directed to pay a sum of ALLOWED PAGE 9 OF 10 C/1690/2017 MRS. RENU GUPTA VS NATIONAL INSURANCE CO. LTD. D.O.D.: 22.08.2022 A. Rs. 1,00,000/- as compensation for mental agony and harassment caused to the Complainant; and B. The litigation cost to the extent of Rs. 50,000/-.
19. Applications pending, if any, stand disposed of in terms of the aforesaid judgment.
20. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
21. File be consigned to record room along with a copy of this Judgment.
(JUSTICE SANGITA DHINGRA SEHGAL) PRESIDENT (PINKI) MEMBER (JUDICIAL) Pronounced On:
22.08.2022
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