SAI HARISHA Vs. NATIONAL INSURANCE CO LTD

JUDGEMENT

(1.) ONE Sri M.S. Harish of Basaveswaranagar, Bangalore, has filed his complaint against the Divisional Manager, National Insurance Company Limited, Divisional Office -3, Bangalore -560001, praying for a direction to the O.P. to pay Rs. 5,75,000.00, and for mental agony and tension, and loss and damage sustained to him due to non -settlement of the claim by the O.P., and compensation of any other amount may be decided Rs. 5,00,000.00 with current interest and costs.

(2.) THE stand of the O.Ps. as per their versions is that the complainant taking an insurance policy covering Computerized Wheel Aligner, Computerized Wheel Balancer, Computerized Engine Analyzer, is admitted. According to them, Model of Computerized Wheel Aligner is of 1990. The sum assured shown in the policy and in claim in respect of the Equipment shall be payable in terms of conditions of the policy of the Insurance Company issued, and if any amount is payable in the event of any damage to the insured equipment, shall be strictly in terms and conditions set -forth in the policy. Only on the fulfilment on the same, insured is entitled to get the amount for the damages caused to the insured equipments and in such conditions, the O.P. shall reimburse the amount insured, after fully satisfying about the nature and cause of loss. Even the loss is not due to any conditions in the policy, it is not payable. They have also estimated the claim made by the complainant regarding the damage of Computerized Wheel Aligner on 17.4.1998, the estimated loss was Rs. 5,75,000.00. Soon after the receipt of the information on 20.4.1998, O.P. has appointed preliminary Surveyor Mr. V.L. Ganapathi Subramanya and also the final survey has been done by Mr. Arunkumar. The estimated loss was at Rs. 2,32,156.00 as per the Surveyor. The second Surveyor Mr. Arun Kumar though appointed to carry out final survey did not inform the O.P. company about the steps he has taken, but submitted his report assessing the loss at Rs. 2,32,156.00 on total loss basis towards the replacement by the replacement by the equipment s capacity. It does not suggest that the Surveyor has carried out the investigation as suggested by the company BRO. The Surveyor has based his assessment with service report issued by the authorized repairers without discussion. He has taken the document submitted by the complainant at face value. When the Surveyor has enquired about these things and also questioned why the Surveyor has conducted investigation of the claim. He has no instructions from BRO to carry out such investigation. In such situation, O.P. appointed Pryman Detective Agency to investigate the claim of the complainant thoroughly and to submit the detailed report. It has concluded that the claim of the complainant is fraudulent claim. The complainant himself is licensed Surveyor has done survey for the O.P. company and he was also in Divisional Office -3, in which the present equipment of the complainant is insured. This is a old equipment and insured is unable to give from whom it is purchased, but said the value of the equipment is Rs. 4,50,000.00 and he has paid the same in cash. No supporting documents are forthcoming. There is no other documents to show the ownership of the insured equipment involved in this case is of complainant. He was running two different units under the name Right Computerised Auto Industry, and Prithvi Motors. Earlier, the said equipment was insured with M/s. Oriental Insurance Company Limited, and complainant had made claim in 1996 and got a sum of Rs. 1,75,000.00 from the said company on the same equipment. Mr. Arunkumar, Surveyor in this case has also conducted survey in this case. The complainant after getting the claim of Rs. 1,75,000.00 from M/s. Oriental Insurance Company Ltd., and got a policy from M/s. United India Insurance Co. Ltd., fire policy -A, for a period from 1.7.1996 to 30.6.1997 and subsequently took the policy involved in this case from the O.P. Since Computer Wheel Aligner was very old and out -dated machine, the complainant has no business and in fact no single vehicle which has come for wheel alignment has come back for the second time to the complainant indicating that the machine was problematic and outdated.

(3.) THE claim of the complainant for the said Computerized Wheel Aligner broke down on 17.4.1998 and he got the service engineer from Bombay after intimation, on deputation, to attend the repairs is unusual. The report produced by complainant alleged to be issued by Premji s Sales Corporation, Bombay, dated 20.4.1998 is a fabricated document created to make an unlawful claim. It is not issued by the said Premji s Sales Corporation. As per their letter dated 15.4.1999, check report dated 20.4.1998 alleged to be issued by them was not issued by that Firm, nor they have deputed any of their employees to the complainant s firm for effecting any repairs. It shows fraudulent attitude of the complainant. The complainant has obtained the policy from M/s. United Insurance Company Limited from 1.7.1996 to 30.6.1997 giving estimated value of equipment at Rs. 2,61,000.00, and even before expiry of such policy, he has taken policy involved in this case, enhancing value at Rs. 8,00,000.00 which is to be covered in the present policy. There is no basis for the complainant in changing the Insurance Companies year to year, after obtaining the claim, and above change of companies estimated value of the equipments is periodically enhanced. He had made a claim on 20.12.1997 from United India Insurance Company Ltd. regarding theft of Engine Analyzer from the United India Insurance Company Ltd. So it is the habit of the complainant of changing the Insurance Company every year and making a claim with every company on false grounds. The detailed investigation report of M/s. Pryman Detective Agency clearly indicates that the complainant is trying to make false claim and take advantage under the policy. According to that Computerized Wheel Aligner is Model of 19905000 copies, purchased by him for a very low sum from a person in Kerala, who was using after bringing it from foreign country. KSFC has valued this equipment for Rs. 50,000.00 having regard to the age of the equipment. No company is manufacturing the Computer Wheel Aligner and such Model is no longer in existence, thereafter three other new Models have been released. The complainant is trying to make a unlawful gain from a non -existing claim and has produced fabricated documents by fraudulent means with intention of gaining unlawfully on the policy, which was issued in utmost good faith, which is essence of insurance contract. The property valued for Rs. 50,000.00 for security purpose by the KSFC, is valued Rs. 6,00,000.00 by the complainant and has taken the policy from the O.P. He has not offered any salvage value to the final Surveyor. He has chosen to obtain the policy for a equipment for which he has no legal ownership. The place of business is changed from place to place by the complainant without proper intimation to O.P. The claim form is falsely filled -up that there was no previous claim, knowing fully well, having made claim on the said equipment from United India Insurance Co. Ltd. He has also given false information even though fully known, that this a very old model of 1990 and second hand machine purchased by him. In the proposal form, it is mentioned as new machine which actually is obsolete, known to him. He has never used UPS with the above equipment in spite of recommendation to use it, but has given false statement that the machine is maintained in accordance with manufacturer s instructions. He has wantonly given misrepresentation in the proposal form and violated general conditions 1 and 3 of the policy. The machine was not under use and there were no regular customers, one customer coming to him never comes back. The break down alleged in the complaint is only a ploy to claim total loss from the O.P. which does not arise because the machinery was not at all working and there were no income from it. Causing loss or non -working of the machinery is only due to the obsoleteness, and not due to short circuit. The complainant has brought lot of pressure on the Officers of O.P. company to settle the claim which reflects that it is not genuine and honest. As per the policy condition, submission of the bill for the replacement of the property is a pre -condition for the settlement of a claim, there is no such repairs are effected to the complaint s equipments and no such repair bills are produced till now. Lot of dust was accumulated and Wheel Alignment pit was filled with water, which shows that the machine was non user. No work was turned out from the said machine. Only for making claim, false allegations were made by the complainant. The complainant concealed the material facts with intention to deceive and try to misrepresent the facts in order to make false claim. And it is not maintainable. O.P. has taken all steps to enquire into the matter and in fact preliminary Surveyor and final surveyor were appointed and Detective Agencies were engaged to find out the reasons for the loss and on their report. It is noticed that complainant is trying to make fraudulent claim and enrich himself unlawfully and has gone to the extent of fabricating documents, to some how get the claim settled. The investigation report clearly discloses the action taken by O.P. company. Steps taken to finalize the claim by O.P. disclose its eagerness to settle it, but having regard to the report of the detective agency, the claim itself is fraudulent claim and such claim settlement does not arise. The correspondence between the parties reflect that there is no deficiency in service by O.P., which shows necessary steps are taken in the matter. Non -entertaining of fraudulent claim and non -payment of the amount is not a deficiency in service. The complainant being a Insurance Surveyor, and trying to make a false claim by fraudulent attempts, and the sequence of things shows how he has manipulated to make a false claim and the complainant is misconceived and is not maintainable, and liable to be dismissed with exemplary cost. The O.P. denied other allegations in the complaint and put for strict proof of the same by the complainant.