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MAHARASTRA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
D.N. Admane, Presiding Judicial Member and K.B. Gawali, Member
NATIONAL INSURANCE COMPANY LTD. - Appellant
Versus
ANIL RAMGOPAL LAHOTI - Respondent
First Appeal No. 413 of 2011 in Complaint Case No. 891 of 2009
Decided on : 19-03-2012
Mr. S.P. Chapalgaonkar, Advocate, for the Appellant; Mr. S.T. Agrawal, Advocate, for the Respondent
The lack of direct evidence to support an allegation of fraud and the importance of considering supporting documentation and case law in determining the nature of an incident and the validity of an insurance claim.
Headnote:
Insurance Claim - Vehicle Insurance - Condition No. 4, Condition No. 8 - [Condition No. 4, Condition No. 8] - The court discussed the insurance policy conditions related to safeguarding the vehicle and making true statements. The court highlighted the appellant's allegation of fraud based on the investigator's report and witness statements, emphasizing the lack of direct evidence to support the insurance company's claim of fraud. The court also referenced letters from the police supporting the respondent's contention that the fire was accidental, and cited relevant case law to support its observation.
Fact of the Case:
The respondent's vehicle was insured with the appellant Insurance Company. After the vehicle caught fire and was totally burnt, the Insurance Company rejected the claim, alleging that the fire was a deliberate act by the respondent to claim compensation fraudulently.
Finding of the Court:
The court found that the fire was accidental, supported by police letters, and observed that the insurance company committed deficiency in service by repudiating the claim.
Issues: Dispute over the nature of the fire incident, validity of the insurance claim, and alleged fraudulent act by the respondent.
Ratio Decidendi: The court emphasized the lack of direct evidence to support the insurance company's claim of fraud and highlighted the supporting letters from the police, ultimately concluding that the fire was accidental and the insurance company committed deficiency in service.
Final Decision: The appeal was dismissed, and no order as to cost was made.
ORDER
K.B. Gawali, Member (Oral)- This appeal is filed by the appellant/original opponent against the judgment and order dated 5.7.2011 passed by District Forum, Aurangabad in complainant case No. 891/2009.
2. The facts leading to the present appeal are as under:
That, present respondent/org. complainant was the owner of the vehicle bearing registration No. MH-20 AG 333 and same was insured with the appellant Insurance Company under package policy No. 270600/31/06/6100000382 for the period 7.5.2006 to 6.5.2007. That, this vehicle met with an accident on 2.5.2007 near Pachod while going to Georai from Aurangabad. The said vehicle caught fire and it was totally burnt. The intimation of the said accident was given to the police authority by the driver on the same day. Accordingly, police authority registered offence, spot Panchanama was also drawn. It was contended that the intimation of the accident was given to the Insurance Company and accordingly company issued claim form. The said claim form along with necessary documents submitted to the Insurance Company claimed insured sum towards loss caused to the vehicle. It was further contended that appellant Insurance Company appointed Surveyor to assess the loss. However Surveyor's report was not supplied to him and in spite of submitting all documents the company rejected the claim through their letter dated 30.3.2009 on the false and flimsy ground. He therefore approached to the District Forum seeking directions to appellant Insurance Company to pay him the insured sum along with interest @ 12% p.a. from the date of repudiation till realisation. It was also requested to direct the appellant to pay him Rs. 35,000 as mental agony and Rs. 25,000 for physical harassment and Rs. 40,000 for financial loss.
3. Appellant Insurance Company i.e. original opponent appeared before the Forum and contested the claim. It was submitted that although the said car caught fire and burnt on 2.5.2007, it was not an accidental fire. It was specifically contended by the appellant company that incident of fire was found suspicious and therefore investigator Shri. V.R. Navathe, a retired Superintendent of Police, C.B.I. was appointed to investigate the matter and it was revealed from his report that the said car was set on fire by the respondent himself so as to claim compensation fraudulently. Therefore this action of respondent was in violation of terms and conditions of the policy and therefore claim was repudiated vide its letter dated 30.3.2009. It was further submitted that since claim was rightly repudiated for breach of terms and conditions of the policy there was no deficiency in service on the part of appellant. Therefore complaint be dismissed.
4. District Forum after going through the papers and hearing the parties allowed the complaint and by way of its impugned judgment and order the appellant Insurance Company was directed to pay to the respondent compensation of Rs. 9 lakh along with interest @ 9% from the date of repudiation of the claim i.e. 30.3.2009 till realisation of the payment of entire amount within a period of 30 days from the date of knowledge of the said order. It was also directed to the Insurance Company to pay Rs. 1,000 as mental agony and Rs. 1,000 as cost of the complaint.
5. Being aggrieved and dissatisfied with the said judgment and order present appeal is filed by Insurance Company in this Commission.
6. The appeal was registered. Respondent was served with the notice. The matter was fixed for admission hearing on 2.3.2012. Advocate Mr. S.P. Chapalgaonkar present for appellant whereas Advocate Mr. S.T. Agrawal was present for respondent. We heard both Counsel at length finally at the stage of admission with their consents and appeal was reserved for order to be delivered on 2.3.2012. However, since the order was not ready on the said date it was further extended to 19.3.2012. Learned Counsel for the appellant submitted that District Forum has failed to consider the fact tha
