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Case Summary: First Appeal No.711 of 2013

Factual and Procedural Background

This appeal was filed by Oriental Insurance Company Limited (two offices named) as appellants/opposite parties against the order dated 30.04.2013 of the District Consumer Disputes Redressal Forum, Moga. The complaint was instituted under Section 12 of the Consumer Protection Act, 1986 by Rajbir Kaur and Satwinder Kaur (respondents/complainants). The complaint alleged that Kultaran Singh (deceased husband of complainant No.1 and son of complainant No.2) was the registered owner of a vehicle (Reg. No. PB-29D(T)4-5377) insured for the period 17.11.2011 to 16.11.2012 for Rs.8,72,000/- (insured declared value) after payment of a premium. On 13.01.2012 the vehicle met with an accident causing total loss and the death of Kultaran Singh. A surveyor was appointed and declared the vehicle a total loss. The complainants, as legal heirs, lodged a claim and sought full claim payment (minus Rs.1,000 excess), compensation for mental agony, and litigation costs.

The District Forum allowed the complaint by its order dated 30.04.2013 and directed the opposite parties to pay the insured value of the vehicle (Rs.8,71,000/-), with interest at 9% per annum from 13.04.2012, within one month, and burdened the opposite parties with Rs.10,000/- as litigation expenses. The appellants challenged that order by way of this first appeal (institution date 01.07.2013; decision date 27.02.2015).

Legal Issues Presented

  1. Whether the District Forum erred in allowing the complaint without adjudicating the question whether the insurer could repudiate the claim on the ground that the vehicle was not regularly registered on the date of the accident (alleged violation of policy terms / Motor Vehicles Act)?
  2. Whether the insurer's failure to process and settle the claim within the time frame prescribed by the I.R.D.A. regulations (one month ordinarily; extendable to six months where a surveyor is appointed) amounted to deficiency in service?
  3. What relief, if any, should be granted where an insurer failed to process/settle a claim within the regulatory time frame, but had not formally repudiated the claim on the ground of non-registration?

Arguments of the Parties

Complainants' (Respondents') Allegations and Contentions

  • The vehicle was insured for Rs.8,72,000/- for the period stated and the accident on 13.01.2012 caused total loss and the death of Kultaran Singh. DDR No.14 dated 16.01.2012 was registered in Police Station Dayalpura.
  • A surveyor appointed by the insurer declared the vehicle a total loss and the complainants, as legal heirs, were entitled to Rs.8,71,000/- (after deducting Rs.1,000 excess).
  • The complainants made repeated requests for settlement; the insurer made offers to pay 75% of the claim which the complainants rejected because the vehicle was a total loss.
  • The complainants were allegedly told that if they submitted a blank prepaid receipt the amount would be released; they submitted the blank receipt but payment was still not released.
  • They sought the insured amount (Rs.8,72,000/-) with 12% interest from the date of filing of the claim, Rs.1,00,000/- as compensation for mental agony, and Rs.20,000/- as litigation costs.

Opposite Parties' / Appellants' (Insurer's) Arguments

  • Admitted the insurance and that a surveyor was appointed; averred that the complainants had agreed to accept 75% of the insured amount and had given an affidavit to that effect.
  • Contended that the vehicle had only temporary registration for 17.11.2011 to 16.12.2011 and the regular registration was issued on 28.02.2012; thus, on 13.01.2012 (date of accident) the vehicle was not regularly registered, constituting violation of terms and conditions of the policy and rules under the Motor Vehicles Act.
  • Argued that because of the alleged violation of policy terms the complainants were not entitled to any insurance benefit; they claimed the complainants had no locus standi and the complaint was not maintainable.
  • Pleaded that there was no deficiency in service and asked for dismissal of the complaint with special costs because the complaint was false and frivolous.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The Commission noted the factual matrix and the pleadings. It observed that:

  • It was not the case (pleaded or taken by the insurer) that the claim had been formally repudiated by the insurer on the ground of non-registration of the vehicle on the date of the accident. Instead, the parties admitted that the complainants had given consent to accept 75% of the claim (and had given an affidavit to that effect), which indicated that the insurer had not intended to repudiate the claim outright.
  • The Commission applied I.R.D.A. regulations/instructions concerning claim settlement: ordinarily claims are to be settled within one month of submission, and where a surveyor is appointed, the period may extend up to six months. Because a surveyor had been appointed in this matter, the insurer was required to process and settle the claim within six months.
  • The insurer failed to process and settle the claim within the time-frame permitted by I.R.D.A. Regulations. The Commission held that such failure amounted to deficiency in service by the insurer.
  • The Commission concluded that the District Forum erred in allowing the complaint without first issuing a direction to the insurer to process and settle the claim within a specified time frame. The correct procedure, the Commission held, would have been for the District Forum to direct processing/settlement within a fixed period and, if the insurer then repudiated the claim, to evaluate the grounds of repudiation.

Based on the above analysis the Commission considered appropriate relief for the deficiency in service (delay in processing/settling the claim).

Holding and Implications

APPEAL ALLOWED; ORDER OF THE DISTRICT FORUM SET ASIDE.

Direct consequences and orders made by the Commission:

  • The opposite parties (insurers) were directed to pay compensation of Rs.40,000/- to the complainants for deficiency in service (for failure to process and settle the claim within the regulatory time frame).
  • The opposite parties were directed to process and settle the complainants' claim within one month of receipt of the copy of this order.
  • If, after processing, the complainants feel prejudiced by the decision taken by the opposite parties (for example, if the claim is repudiated), they retain the right to file a fresh complaint.
  • Regarding amounts deposited in the appeal: the appellants had deposited Rs.25,000/- at the time of filing the appeal and a further sum of Rs.9,80,381/- on 24.07.2013 pursuant to Commission directions. The registry shall remit Rs.40,000/- (the compensation awarded) to the complainants by crossed cheque/demand draft. The remaining amount, together with interest accrued on the two deposited sums (Rs.25,000/- and Rs.9,80,381/-), shall be remitted by the registry to the appellants by crossed cheque/demand draft after expiry of 45 days from sending the certified copy of the order to them.

The opinion does not discuss broader legal precedent or purport to lay down new law; the decision addresses the parties' rights and obligations in this particular matter and the procedural remedy available where an insurer fails to process/settle a claim within the I.R.D.A. prescribed time frame.

Additional Notes

- The appeal decision was delivered on 27.02.2015. The bench comprised Hon'ble Mr. Justice Gurdev Singh (President), Shri Baldev Singh Sekhon (Member) and Mrs. Surinder Pal Kaur (Member). Counsel appearing were Shri Vinod Chaudhary for the appellants and Shri K.S. Sidhu for the respondents.

If any section above appears brief, that reflects the absence of further detail in the provided opinion; no facts, arguments or precedents have been added beyond what appears in the source text.

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    Oriental Insurance Co. Ltd. & Anr. v. Rajbir Kaur

    STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB DAKSHIN MARG,

    SECTOR 37-A, CHANDIGARH.

    First Appeal No.711 of 2013

    Date of institution : 01.07.2013

    Date of decision : 27.02.2015

    1. Oriental Insurance Company Limited, Divisional Office, Amolak Bhawan, G.T. Road, Moga.

    2. Oriental Insurance Company Limited, Regional Office, SCO No.109-111, Surindera Building, Sector 17-D, Chandigarh, through its Manager Ram Avtar.

    …….Appellants/Opposite Parties

    Versus

    1. Rajbir Kaur W/o Sh. Kultaran Singh S/o Buta Singh;

    2. Satwinder Kaur W/o Buta Singh; Both R/o Village Longodeva, Tehsil Zira, District Ferozepur. …Respondents/Complainants

    First Appeal against the order dated 30.04.2013 of the District Consumer Disputes Redressal Forum, Moga.

    Quorum:-

    Hon'ble Mr. Justice Gurdev Singh,

    President.

    Shri Baldev Singh Sekhon, Member.

    Mrs. Surinder Pal Kaur, Member.

    Present:-

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    For the appellants : Shri Vinod Chaudhary, Advocate. For the respondents : Shri K.S. Sidhu, Advocate.

    JUSTICE GURDEV SINGH, PRESIDENT :

    This appeal has been preferred by the appellants/opposite parties against the order dated 30.04.2013 passed by District Consumer Disputes Redressal Forum, Moga (in short, "District Forum"), vide which the complaint filed by the respondents/complainants, under Section 12 of the Consumer Protection Act, 1986, was allowed and the opposite parties were directed to pay the insured value of the vehicle (Rs.8,71,000/-), along with interest at the rate of 9% per annum from 13.04.2012, within one month of the receipt of the copy of the order and they were also burdened with Rs.10,000/-, as litigation expenses.

    2. The complainants averred, in their complaint, that Kultaran Singh, husband of complainant No.1 and son of complainant No.2, was the registered owner of the vehicle, bearing registration No.PB-29D(T)4- 5377, which was got insured with the opposite parties for the period 17.11.2011 to 16.11.2012, for Rs.8,72,000/-, after the payment of Rs.25,679/-, as the premium. On 13.01.2012, said Kultaran Singh, along with Gurpreet Singh and others, was going from village Jalal to village Ramuwala on this vehicle which was being driven by Gurpreet Singh, when it suddenly developed a defect, became uncontrollable and struck in the tree by the roadside. Kultaran Singh died at the spot on account of the injuries sustained by him. Regarding the accident, DDR No.14 dated 16.01.2012 was registered in Police Station Dayalpura. In the accident, the vehicle was totally damaged. They immediately informed the opposite parties about the accident and lodged a claim with them; being the legal heirs of Kultaran Singh. The opposite parties appointed the surveyor for assessing the loss to the vehicle and the same was declared by him, as total loss. The vehicle was brand new and, as such, for the total loss they were entitled to the sum of Rs.8,71,000/-, after deducting Rs.1,000/- from the IDV on account of the excess clause. They made a number of requests to the opposite parties to settle their claim, but they failed to do so. Even the service of the legal notice dated 22.12.2012 did not yield any result. The opposite parties had been making an offer to make the payment on the basis of 75% of the claim amount, which was not acceptable to them; as the vehicle was total loss. The surveyor and officials of the opposite parties had been assuring them that in case they submit blank prepaid receipt, the amount would be released in their favour. They did submit the blank prepaid receipt as full and final settlement of the claim, but still the opposite parties are lingering on the matter, without any cogent reason. As a result of these illegal and unwarranted acts of the opposite parties, they suffered mental tension and agony; for which, they are entitled to a compensation of Rs.1,00,000/-. They prayed for the issuance of following directions to the opposite parties:-

    i) to pay the insurance claim of Rs.8,72,000/-, along with interest at the rate of 12% per annum from the date of filing of the claim till the realization of that amount;

    ii) to pay Rs.1,00,000/-, as compensation for causing mental tension and harassment; and

    iii) to pay Rs.20,000/-, as costs of litigation.

    2

    3. The complaint was contested by the opposite parties, who filed joint written reply before the District Forum. In the written reply, they admitted that the vehicle was got insured with them by Kultaran Singh, for the period mentioned in the complaint and that intimation of the accident was given to them, upon which Rajesh Wadhawan, Surveyor was appointed for assessing the loss to the vehicle. They also admitted that the complainants had agreed to accept the 75% of the amount, for which the vehicle had been insured and had given an affidavit to that effect. While denying the other allegations made in the complaint, they pleaded that Kultaran Singh had purchased the vehicle and had obtained temporary RC for the period 17.11.2011 to 16.12.2011. The regular registration was issued on 28.02.2012 and, as such, the vehicle was not registered on the day, the accident took place (13.01.2012). Thus, there was violation of the terms and conditions of the policy. After the complainants gave their consent for acceptance of 75% of the loss, the file along with their consent was sent to the higher authorities for further action; as that claim was within the financial authority of the Head Office, New Delhi. However, the complainants are not entitled to any such insurance, having violated the terms and conditions of the insurance policy and rules and regulations of the Motor Vehicles Act. They have no locus standi to file this complaint and the same is not maintainable. There was no deficiency in service on their part. The complainants have concealed the material and patent facts from the District Forum and have not come to it with clean hands. They prayed for the dismissal of the complaint with special costs; being false and frivolous.

    4. Both the sides produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf, allowed the complaint, vide aforesaid order.

    5. We have heard the learned counsel for the parties and have carefully gone through the records of the case.

    6. It has been submitted by the learned counsel for the opposite parties that the District Forum committed an illegality, while allowing the complaint without going into the aspect of the case that there was violation of the terms and conditions of the policy, as the vehicle was being plied by Kultaran Singh, insured, without getting the same registered from the Registering Authority. That was fundamental breach of the terms and conditions and is a valid ground for repudiation of the claim made by the complainants. He prayed that the appeal be allowed, the order passed by the District Forum be set aside and the complaint filed by the complainants be dismissed.

    7. It was never the case pleaded by the opposite parties that they repudiated the claim of the complainants, on the ground that the vehicle was being driven in a public place, without getting the same registered and, as such, violated the terms and conditions of the policy and the provisions of the Motor Vehicles Act. It is the admitted case of the parties that the consent of the complainants was obtained for the payment of 75% of the claim. Thus, the opposite parties never intended to repudiate their claim and the same has still not been settled by them.

    8. As per the regulations/instructions issued by the I.R.D.A., the claims, made under the insurance policies, are ordinarily to be settled within one month of the submission of the claim and where surveyor is appointed, that period is extendable to six months. Thus, the opposite parties were required to process and settle the claim of the complainants within six months, as they had appointed a surveyor for assessing the loss to the vehicle. They failed to do so; which amounts to deficiency in service on their part. The question, whether the claim could have been repudiated on the ground of non-registration of the vehicle on the day of the accident, was to be decided after the submission of the claim, by the opposite parties; one way or the other. The District Forum should have issued a direction to the opposite parties to process and settle the claim of the complainants, within the period to be fixed by it. In case, the claim was repudiated by the opposite parties, then the ground, on which the same was repudiated, was to be evaluated by the District Forum. It erred while deciding the complaint, without giving such a direction.

    9. Accordingly, the appeal is allowed and the order passed by the District Forum is set aside. For the deficiency in service, in not processing and settling the claim within the time frame laid down by the

    3

    I.R.D.A., the opposite parties are directed to pay a compensation of Rs.40,000/- to the complainants. The opposite parties are directed to process and settle the claim of the complainants within one month of the receipt of the copy of the order. In case, the complainants will feel prejudiced by the decision taken by the opposite parties, they shall have a right to file fresh complaint.

    10. The appellants had deposited a sum of Rs.25,000/- at the time of filing of the appeal. They had deposited another sum of Rs.9,80,381/- on 24.07.2013, as per the directions of this Commission. Out of these amounts, a sum of Rs.40,000/-(awarded as compensation in favour of the complainants vide this order) shall be remitted by the registry to the complainants by way of a crossed cheque/demand draft and the remaining entire amount, along with interest which has accrued on both the above amounts of Rs.25,000/- and Rs.9,80,381/- shall be remitted by the registry to the appellants by way of a crossed cheque/demand draft after the expiry of 45 days of the sending of certified copy of the order to them.

    11. The appeal could not be decided within the statutory period due to heavy pendency of court cases.

    (JUSTICE GURDEV SINGH)

    PRESIDENT

    (BALDEV SINGH SEKHON)

    MEMBER

    (MRS. SURINDER PAL KAUR)

    February 27, 2015 MEMBER (Gurmeet S)

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    Oriental Insurance Co. Ltd. & Anr. v. Rajbir Kaur
    (Feb 27, 2015)