DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Sangita Dhingra Sehgal (President), Pinki, Member (Judicial) and J.P. Agrawal, Member (General)
In the matter of the Oriental
Insurance Co. Ltd. – Appellant
versus
M/s Orient Resins Ltd. – Respondent
First Appeal No.348 of 2015
Decided on 20.11.2023
Consumer Protection Act, 1986 – Section 15 [Consumer Protection Act, 2019 – Section 41] – Services – Insurance – Repudiation of Claim – Unjustified – ”Theft of vehicle” – The appellant Insurance Company is liable to indemnify the owner of the vehicle when the insurer has obtained comprehensive policy for the loss caused to the insurer. The respondent submitted that even assuming that there was a breach of condition of the insurance policy, the appellant Insurance Company ought to have settled the claim on non-standard basis. The Insurance Company cannot repudiate the claim in toto in case of loss of vehicle due to theft – The respondent submitted that even assuming that there was a breach of condition of the insurance policy, the appellant Insurance Company ought to have settled the claim on non-standard basis. However, in the present case, the appellant even failed to appoint surveyor for the claim of the Respondent – The Appellant contended that the District Commission erred in holding deficiency on the part of the Appellant. The final report of the concerned police officers also stated that there was no road in existence, therefore the Appellant rightly repudiated the claim, as there was no such accident. However, on perusal of the record, it is clear from the District Commission’s records that the Respondent had provided photographs, including milestones of Phaphund, showing the existence of the disputed road. Furthermore, the existence of the said road is also evident from Google Maps – Thus, it is clear from the insurance policy that the IDV value of the vehicle in question was Rs.2,00,000/-. Therefore, there was an error on the part of the District Commission by awarding a total loss of Rs.3,11,000/-. Appeal disposed off, impugned order modified. [Paras 6 to 18].
Result: Appeal dismissed.
JUDGMENT
Sangita Dhingra Sehgal, President—The facts of the case as per the District Commission record are:—
“The complaint pertains to repudiation of claim by OP on theft of vehicle. The complainant’s vehicle Tata Sumo, bearing No.HR-26G 8735 was insured with OP vide policy No.2002/1863. The vehicle was stolen by two unidentified persons who drugged the driver in the intervening night of 7-8 April, 2002, near Kanpur.
The driver on recovering his senses, returned to Delhi and narrated the incident to complainant’s Director and thereafter FIR was lodged on 14.4.2002 in Achhalada Police Station which is duly annexed with complainant. Claim was filed and untraceable report was made on 13.4.2002.
On 25.2.2003, the Magistrate gave a finding that the road between Achhalanda to Phahphund does not exist and thereafter claim was repudiated. Complainant has also annexed photographs revealing Achhalanda Police Station, elementary school building, Achhalaanda Distt. and Phuphand Milestone. A revised report was made by concerned magistrate on 14.3.2005 that FIR by police is liable to be accepted.”
2. The District Commission after taking into consideration the material available on record passed the order dated 09.04.2015, whereby it held as under:—
“We have considered the entire records. Perusal or file reveals that interim Order was passed on 23.12.11 wherein it was stated that delay has been appropriately explained and OP has no evidence to discredi: the statement of complainant. OP was directed to reprocess the claim afresh. The Forum had observed in Order dated 17.5.12, that OP has again relied on old report of surveyor in which there is ambiguity regarding the existence of road itself instead of sending another surveyor/ investigator to file fresh report OP’s letter dated 15.2.2003, discloses that theft has not taken place at the reported spot and claim was therefore repudiated. None-the-less, complainant has placel photographic evidence including milestone of phuphnd showing the existence of disputed road.
Further the delay in lodging FIR and claim has been appropriately explained, as the driver was drugged and on coming back to conciseness, he returned to Delhi and narrated the incident to owners who thereafter filed the claim. We, therefore, find OP guilty of deficiency in services and direct OP to pay Rs.3, 11,000/- 9% interest from date of claim till realization. We also award Rs.50,000/- as compensation for harassment, mental agony physical inconvenience inclusive of litigation expenses.
The order shall be complied with within 30 days of the receipt of the copy of the order; otherwise action can be taken under Section 25/27 of the Consumer Protection Act.”
3. Aggrieved by the aforesaid judgment of the District Commission, the Appellant/Opposite Party has preferred the present appeal contending that the District Commission erred in ignoring the terms and conditions of the insurance policy as the claim of the respondent was repudiated as per the terms and conditions of the policy in question. The counsel for the Appellant further submitted that the District Commission also ignored the fact that the total sum insured for the vehicle in question was Rs.2,00,000/- but the District Commission awarded claim for a sum of Rs.3,11,000/-. He further submitted that the District Commission erred in holding deficiency on the part of the Appellant as the final report of the concerned police officer also stated that there was no such Achhchalda phaphund road exited, therefore, the Appellant rightly repudiated the claim as there was no such accident. Pressing the aforesaid contentions, the Appellant prayed to set aside the impugned judgment.
4. The Respondents, on the other hand, denied all the allegations of the Appellant and submitted that there is no error in the impugned judgment as the entire material available on record was properly scrutinized before passing the said order.
5. We have perused the material available on record and
Theft – The Insurance Company cannot repudiate the claim in toto in case of loss of vehicle due to theft.
Exclusion Clause – Complainant/Respondent is at no fault and the contention of the Appellant that the Complainant/Respondent left the money unattended which falls under the Exclusion Clause hold no w....
(1) Non-Standard Settlement – In cases of theft where there is a contributory factor or breach of warranty (like limitation as to use) that is not fundamental to the loss, the claim should be settled....
1. Delay in filing FIR and insurance claim to be condoned if reasonable explanation given, especially in case of theft of vehicle.2. Mere delay cannot be a reason for not providing claim as per Apex....
Inordinate Delay – The appellant/insurance company has committed deficiency in service in not deciding the claim of the respondent No.1/ complainant for an inordinate delay even after having sufficie....
(1) Definition of Fundamental Breach – An insurance company can only deny a claim in its entirety if there is a “fundamental breach” of policy conditions. A delay in reporting is generally considered....
(1) Insurance Policy between Insurer and insured has to be strictly construed to determine extent of liability of Insurer.(2) Insured cannot claim anything more than what is covered by Insurance Poli....
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