The Consumer ~~~ ing the of the for making aon 56 bscriber telephonic reminder to the sul telephone bills. This scheme was directed to be iesued from February 21, 1992 onwards of Telephone Number ; ¢ of telephone number without informing the subscribe, n service. In District Telecom Engineer, Amravati y Laxmi; the respondent made & complaint that her telephone number way arbitrarily changed without any justification and without any notice to her, ow, to which she suffered some inconvenience and loss being a leading lawyer. Thus, there was a deficiency in service. The District Forum passed the order directing the appellant to restore the previous telephone number and to pay 75,000 a damages. The orders were upheld in appeals. (vi) Functioning of | the Department In Union of India v Dr. (Mrs.) Satya Bhama Thakur? the National Commission found that the meter showed readings of calls after the telephone — a and remained disconnected. The Commission held that a vem ing of the telephone calls and their check was undependable and ess adequate system to protect the interests of the subscribers against the inflated bills. The Commission observed: The ioni perc bare department is far from satisfactory, the sctvices cea sul arn deficient. The subscriber is made to ai ea . a aie nt frustration in pursuing the matters with (v) Chang Any arbitrary chang amounts to deficiency i services rendered ? oo i = emit paeae on the ‘deficiency’ as envisaged. — by fire.’ Whenever, fails to indemnify the insured 9 tlemen lia GRrENe GES fie is a default or negligence '° of the n will constitute a ‘deficiency’ in the VY eyerreieDefinitions 57 rane an thus thee i deficiency in relation to service. When theres delay Liency in service.' Similarly A under the insurance policy, it amounts to in a reason la Parise jon-settlement of claim under insurance policy awarded for mental agony oa Se Forthery Oona ‘ony for delay in settlement of claim since the pplainant is put to avoidable strain and tension. Where the complainant having settled the insurance claim in full and final Jement after giving consent letter and also accepting the amount after cuting the discharge voucher without any protest or remarks is estopped from ng any further claim. Thus, once the claim is paid and received in full and al settlement, there is no deficiency in service and no relief can be granted the provisions of the Consumer Protection Act.‘ The repudiation of the insurance claim by the Insurance Company on the und that the driver was not holding a valid driving licence at the time of the ould not be termed as deficiency in service or negligence on the part of Insurance’ Company within the meaning of section 2(1)(g) of the Consumer ction Act’ If a person driving a vehicle at the time of the accident was a licence to drive a light motor vehicle but the licence did not have authorisation for driving a transport vehicle as required by section 3 of tor Vehicles Act, 1988, the driver cannot be said to be holding a valid ving licence for driving a transport vehicle and the Insurance Company would ustified in repudiating the claim and, therefore, there would be no deficiency service. General Insurance A contract of general insurance is expressly for the purpose of indemnifying insured fully against a loss which may arise upon the happening of some ent. In essence, the contact means that the assured in case of loss against which ¢ policy has been secured shall be fully indemnified. The amount mentioned in policy does not signify that the Insurance Company guarantees payment of ¢ said amount regardless of the actual loss suffered by the insured. A contract f insurance entitles the assured for the reimbursement of the actual loss that is roved to have been suffered by him.’ Now once that is so, it logically follows ‘ed and compensated for the loss expeditiously. Kumar Insurance Co. (1992) 1 CPR 224 (Gu. CDRC). Bharat €. Patel v United India Insir ect 1993) Il CPR 138 (Guj. CDRC). N. Laxmanbhai Savsani v National Insurance Kumar Iasurance Co. Lid. (1996) I CPR 2 (NCDRC). peed Nagra v United India Insurance Co 18 ed 1 CPR 4 (NCDRC). See also New India Assurance Co. Lid. v Achhar Kumar Gare (V0. Ty 'cpy 49 (SC); National ‘olymat fational Insurance C te ears re Lid. (2006) IV CPI 17 (SC); New India Assurance Co. Lid v Kusum Distributors (2007) .CPI31(NCDREY a cop 3g 358 (NCDRC). See also Nationalot, 1986 58 The Consumer Protection Act, I Delay in such a con! Ss y other fields w efeat the very n many other fields wou! |d de’ iy ontext as in . en ‘insurance. The Haryana State Commisst Insurance Co. Lid.,' observe condi 2d's claim must be sett} ition of the insurance contract 1s that the insured’s cin i led age r oa on ~ reds on, either by way of the acceptance utmos ion, y cat =r be the merit of the insurance claim, itis repudiation of the same. Whatever et Oe une a i en to the insurers to sit smugly © n , certainly not open ("ely for years over the heads of the helpless of Dames inn principle is clear and established, it is not difficult iq a tise plausible time frame, Whatever may have eget Situation eater, it appears that with the present technological advances, wl a are now freely available to the large insurance corporations, it would not be difficult for them to either settle or repudiate an insured’s claim within a reasonable period of three months. This is not to say that there may be minor claims which may be decided even earlier. The Commission thus held that the reasonable time frame within which the jationalised Insurance Companies must either settle or repudiate the insured onsumers’ claim would normally be a period of three months. Any delay beyond would per se attract the odium of ‘deficiency in service,’ unless the same is ogently explained by the insurers and the burden thereof must necessarily rest n them. jurveyor's Report In New India Assurance Co Ltd v Pradeep Kumar", the Supreme Court held the approved Surveyor’s report may be the basis or foundation for settlement aim by the insurer in respect of the loss suffered by the insured but such is neither binding upon the insurer or upon the insured. If the surveyor’s is tainted with some mala fides, the same can 5 aes Seed not be overlooked. If the pe y the insurer has to give valid reasons for not py iyana CDRC). See also Poly " Mat Ir INCPI 42 (NCDRC); United India Inswrarcg ee oa, 1 (NCDRC), Insurance Co, Lid. v premiul serio” | pre-mal the inst on Life fund bi provid bond ¥ poeczevecrsDefinitions 99 registration certificate and Re R id Route Pe in Din Dayal v No : ‘ e Co Lid the : permit for the truck e f he registration certificate and i " snsequell in TR hed ee Were issued after about five days of the ye! — e 10 be delayed f 5 tes Act, the egintniiatam for 5 days. According to Motor ae vehicle on ag alice ‘Sint Wee is mandatory requirement of law to rive ‘Vg wntlarly, it is mandatory to have the route , per, there was delay in lodging t mandatory to have the route permit he FIR for one re a e al Cy Or O1 ‘ason or the other, Und ese jumstances, the National Commission repudiated Sele i) Life Insuranc Life insurance 's'@ contract in which'the insurer, in consideration of a certalil Bpremium, agrees to pay a specified amount of mone: eriod or on pre-mature death of the insured, Th prematurely, his family need not depend on others; or if he survives th jie insurance amount will be useful to him in his old a a Life Insurance, observed! that - 'A Life Insurance policy is a callable sinking- und bond, issued upon the life of the policy holder! It will be paid promptly if jpovidence sees it fit to call away the policy holder. In case there is no call the pond will be paid through the accumulation of its sinking fund provision, or yeserves at the time of maturity." In Life Insurance Corporation of India v Sunjeev Mahendralal Shah’ the complainant was the husband of the deceased who was insured under the LIC policies. The LIC repudiated the claim under the said policies on the ground that the cased intentionally and fraudulently conceded and suppressed material facts in ‘the proposal form filled by her. The State Commission after a detailed and reasoned ‘analysis of the evidence on the record came to the conclusion that the proved facts are uggestive of the straight forward conduct of the insured and her husband both before after the malignancy was detected and also of the fact thatneither the insured, nor husband nor all the doctors and experts had any reason to suspect that the lump ich was found on the neck of the insured had malignancy. The LIC failed to prove the insured had suppressed any material information which might venti her obtain the policy. T hus, the National Commission dismissed the appeal an held: Itis not that assured is required to disclose casual ailments not requiring any treatment or consultation with a medical is required to be disclosed with referenc mit issued after theft the claim of the petitioner. y on the expiry of a cer ain ntage is, if the insured dies period, his book ad | doctor. The sickness, ailment which ¢ to serious disorders in health. 2013) 1 CPJ 10 (NCDRC). Lud. (2012) 1 CPI 559 (NCDRC). 11 Insurance Co.Ltd. ( alendra Kumar Mishra v Oriental “irri (2010) VCP) 321 (NCDRC). d India Insurance Co.Ltd. v Co, Ltd. (2013) 1 CPJ 12 (NCDRC). v Life cos Corporation v Krishan Insurance (2006) 139 (NCDRC); ‘Life Insurance Corporation oe aes! INCOR Ae ai Ehud) CPI 36 (NCDRC), 2014) IV PCI 658 (NCDRC). Corporation of Indiaw decident Benefit ‘accidental’, covers any unlooked expected of designed, or any exy n any unlooked for mishap or occurrence, The 5 unexpected is whether the ordinary reasonable man would not hy what e F currence. The stand point Is that of the victim, so that even willy expected the occ c sta a Ms Brder may be accidental as far as the victim is concerned. Insurance Corporation of India? the insured kidnapped and later on murdered. The National Commission found that ~ (i) the insured was not a party or privy (0 the event of murder; (ii) the immediate cay of injury was not the result of the deliberate or wilful act of the insured; and (jij the event was an unlooked for mishap or an untoward event which was no lexpected or designed by the insured nor the insured had expected the occurrence, The Commission, therefore, held that the death of insured was accidental and he as entitled to additional sum equal to the sum assured as per the terms and ponditions of the policy. i) Mediclaim Insurance © Endowment Policy with The word ‘accident’, or its adjective mishap or an untoward ev personal injury resulting from ent which is not In Ganga Ram Rai v Life The insurance companies should satisfy the requirement of reasonableness fairness while dealing with the customers.’ They must not take any irrelevant extraneous consideration while arriving to a decision. Arbitrariness should in their actions or decisions.‘ Sige by the Insurance Company to renew to mediclaim insurance . insured on the ground of his past conduct, since he had gone it for payment of his claim is not tenable. Such an act cannot be attributed ord as to disentitle the insured to get his policy renewed. It was, thus, the order of the Insuranc: 4 -e Company refusi insured was unfair and ebiiary sing to renew the aim Policy - Suppression of Facts © of New India Assurance Co. , ie . Lid. it M. Bhambani a mediclaim Policy effective from May 1 000 he yearDefinitions 61 jas further renewed for one year upto May 11, 1991. The respondent was in the hospital twice, once in July, 1990 and again in August, 1990 with lem and angio-plasty, respectively for which, a total expenditure of Was incurred. His claim was not settled by the appellant on the ground Mespondent was guilty of not describing material facts and fraudulently the facts that he was suffering from diabetes and hypertension prior fining of mediclaim policy National Commission observed that the respondent obtained the policy #2, 1989 and claim relates to the period of July/August 1990. By no ould this be stated that he required medical attention in immediate AS occurrence of ailment after 15-16 months of the policy having been May 12, 1989 could not qualify as immediate. The Commission held @ppellant had jon as per the proposal form and, therefore, dismissed the appeal. ailed to satisfy that the respondent gave any incorrect Vijay Kumar Jain v National Insurance Co. Lid.,' the petitioner got TMT March 19, 1992 which was found positive. He got the Mediclaim Policy 24, 1992 and again went for TMT test on April 25, 1992 which was ive. Thus, he got the Mediclaim Policy after he came to know on March that TMT test was positive. He did not disclose this fact of severe heart Fin the proposal form. Thus, he was not entitled to any claim under this tine Insurance tract of marine insurance may by its express terms, or by usage of extended so as to protect the assured losses on inland or any land risk ay be incidental to any sea voyage. In modern times, the scope of insurance has been extended to cover a wide variety of risks which are of idental to or connected directly or remotely, with a sea voyage. Marine s is a contract of indemnity against all losses occurring to the subject f the policy from certain perils during the adventure.’ While interpreting ance policy, the Court should view the intention of the parties as well as rds used in the policy.‘ If the intention of the parties sub-serves the ion used therein then the expression used in that context should be given and extended meaning. ) IV CPI 8 (SC). Marine Insurance Act, 1963, section 4(1). ) LR 7 QB 299. See also Oriental Insurance Co Lid v Ozma Shipping Company (2009) ‘CPI 1 (SC); New India Assurance Co Lid v Priya Blue Industries Pvt Led (2011) I CPI 15 ‘Ltd. v Great Eastern Shipping Co. Lid. (2007) Il CPJ 3 (SC). See v Oriental Insurance Co Lid (2014) IV CP} 9 (SC); New India (2014) II CPJ.370 (NCDRC). Salin Act, 1986 onsumer Protectio’ 62 The Con In Peacock Plyw v Oriental Insurance Co Lid.’ the Iriental Ih e é sk Plywood (P) Ltd. , : Court, while interpreting the expression ‘per’ | insured against’ has held thug: 1, Id i ance Act is subject to the terms of — rors | Marine Insuran {ditional premium and insures a high risk, no restr insurer takes ter iven, A term of the policy must be given its effec, vi Bering 8 contract of insurance, the reason for entering there into and Fie sought to be covered must be considered on its own terms. (») Vehicle Insurance an Under section 146 of the Motor Vehicles Act, 1988 there a a 2 gation the owner of a vehicle to take out an insurance policy as provided under XI of the Act. If any vehicle is driven without obtaining such an insurance poligy it is punishable under section 196 of the Act. The pol y may be comprehensive or only covering third parties or liability may be limited. © Driving without Valid Licence In National Insurance Co. Ltd. v Kusum Rai and Others,’ the owner of a tax, allowed the driver having a licence for driving L.M.V. to drive commercial vehicle and the said taxi met with an accident causing death of a girl child, It was held that the Insurance Company cannot get rid of its third-party liability as the question of violation of terms and conditions of insurance contract arises only between the owner of the vehicle and the Insurance Company. However, the Insurance Company can recover the amount from the owner of vehicle. In National Insurance Co. Ltd. v clearly laid down that the liabili Swaran Singh and Others, the ‘Supreme ity of the Insurance Company vis-a-vis the Case, on evidence led before the Tri s the fact of the driver possessing lice Ee other type of vehicle, was the : ‘on facts, itis found that the accident . se, Definitions oe of some other unforeseen of interveni ‘ similar other causes having no ny an fore like mechanical failures and type of licence, the insurer will not be a ent driver not possessing requisite technical breach of conditions concerni to avoid its ity merely for When a driver of a vehicle d ng driving licence, "i chicle does not have a valid ti a transport ‘ Cel ehicle, bg! te ee ae Not liable to anh ie toes eae to c ie ean ad cnt The issue of valid driving licence should be raised at jhe earliest stage and it cannot be rai ‘ ae ational Commission. ised in the revision petition before the Registration of Vehicle on sale There can bea transfer of title by payment of consideration and delivery of e vehicle. But that, by itself, would not absolve the party in whose name the ehicle stands in RTO records, from the liabi ity of a third person. So long as his ame continues in RTO records, he will remain liable to the third person.? Vehicle without Registration, Route Permit & Fitness Certificate In a catena of judgments made by the Supreme Court' and the National ‘omission’, it has been held that the claims are not payable if there is no valid -gistration certificate, fitness certificate or route permit for a vehicle on the date of the accident. It is quite evident that there is a violation of the statutory provisions of law contained in the Motor Vehicles Act which cannot be permitted d the insurer cannot be held liable.* Theft of Vehicle ~ Delay in Lodging FIR As per the policy conditions, in case of theft or cr ct h uubject to claim under the policy, the insured has to give immediate notice to the police and cooperate with the insurer in securing the conviction of the offender, Ina case,’ there was a delay of more than one and a half month in lodging an FIR d informing the insurer after the theft of the trucks. It was held that there inordinate delay in informing the police and the insurer, and consequently, it wk yt ORE»r Protection Act, 1986 The Consume 64 The and conditions of the policy. Therefore, the claim of f the terms ) ST vot able and tenable in law insured is not maintain: (vi Acceptance of Insurance claim The mere execution 0! m preferring cl f the discharge voucher would not always deprive aim with respect to the deficiency in servigg out of the amount paid in default of the rendered.' Despite execution of the discharge voucher, the consumer may be jy, position to satisfy the Forum or the Commission under the Consumer Pj Act that such discharge voucher or receipt had been obtained from him under ty circumstances which can be termed as fraudulent or exercise of undue influeng,| or by misrepresentation or the like. If in a given case the consumer Satisfies thy authority under the Act that the discharge voucher was obtained by fraud, undye influence or the like, coercive bargaining compelled by circumstances, the authority before whom the complaint is made would be justified in ir appropriate relief.* The mere execution of the discharge voucher and acceptanc, of the insurance claim would not allow stoppel against insured from making further claim from the insurer but only under the circumst. i ; lances noted herein above.’ In the case of United India Insurance Co. v Ajmer Singh ee, {jmer Singh Cotton & General Mills,‘ the Supreme Court held that - 'the Consumer Disputes Redressal Forums and Commi i seen as constituted under the Act shall also have the power to ib it i o . fasten ae pee Companies notwithstanding the execution of _ Mae pers claim cannot be termed to be fastening the liability Insuran, ompanies over and above the liabiliti ie ieeicance cxvisaned in GatPAT the liabilities payable under the ding the deficiency of service see, of insurance. The claim preferred policy, being covered by the provisic, deemed to be based upon the Provisions of section 14 of the Act.’ consumer fron f ; consequential benefits arising