Insurance Claim Rejected Amid Allegations of Fabricated Theft.


25 November 2024 Civil Revision >> Civil & Consumer Law   |   Insurance Claim/Money Rejected >> Insurance  

In Krishna Kumar Kushwaha v/s Managing Director, United India Insurance Company Ltd. & Anotherthe National Consumer Disputes Redressal Commission (NCDRC) has upheld the concurrent orders of the Uttar Pradesh State Consumer Disputes Redressal Commission, Lucknow, and the District Consumer Disputes Redressal Commission, Kanpur Nagar, dismissing a consumer complaint seeking insurance claim for a stolen and subsequently damaged car. The NCDRC, in its order on Revision Petition No. 455 of 2021, found no grounds to interfere with the well-reasoned decisions of the lower fora, which concluded that the complainant had failed to establish the factum of the vehicle's theft and that the insurance claim was potentially based on a fabricated story.

The case originated from a complaint filed by an individual who claimed to have purchased a car on January 24, 2012, and insured it until January 23, 2013. The complainant alleged that the car was stolen on March 10, 2012, and subsequently recovered in a damaged state, with repair costs estimated at Rs. 4,77,975. The complainant accused the insurer, United Insurance Company Limited (OP-1), of deficiency in service for allegedly demanding an undocumented deposit and ultimately rejecting the claim. Society Motors (OP-2), the repair service provider, was also named as an opposite party.


 

 

However, the insurance company (OP-1) contested the claim, asserting that the alleged theft and accident were fabricated to conceal a separate criminal act of rape allegedly committed in the same car on April 2, 2012. OP-1 highlighted the delayed filing of the theft report by the complainant's father on April 29, 2012, long after the alleged rape incident, suggesting an attempt to cover up the complainant's criminal activity. Based on this perceived fabrication, OP-1 had rejected the insurance claim on January 23, 2013.

Society Motors (OP-2) also denied the theft and accident allegations, stating that there was no deficiency in their service and that any legitimate claim was the sole responsibility of the insurer.

The District Forum, after considering the evidence and arguments, dismissed the complaint. The Forum noted the insurance company's evidence suggesting the car was recovered from the complainant's possession on April 2, 2012, indicating that the theft and accident claims were fictitious. The District Forum also cited a precedent emphasizing that insurance claims could be rejected for delayed intimation and submission of documents, noting that the repair estimate was provided to the insurance company significantly after the alleged accident.

The complainant's appeal to the State Commission was also dismissed. The State Commission's order highlighted the District Commission's findings regarding the delayed intimation and the circumstances surrounding the car's recovery in connection with a pending criminal case against the complainant for the alleged rape of a minor girl. The State Commission concluded that the appeal was devoid of merit and dismissed it at the admission stage.

Subsequently, the complainant filed a Revision Petition before the NCDRC, reiterating the claim of vehicle theft and alleging that the insurance company's rejection was frivolous.
The NCDRC, after examining the records and hearing the arguments, upheld the concurrent findings of the lower fora. The Commission emphasized the limited scope of its revisional jurisdiction under the Consumer Protection Act, stating that it can only interfere if the State Commission has exercised a jurisdiction not vested in it by law, failed to exercise a vested jurisdiction, or acted illegally or with material irregularity.

The NCDRC noted that the District Forum had rendered a detailed and well-reasoned order based on the evidence presented, and the State Commission had duly considered the pleadings and arguments before affirming the District Forum's decision. The NCDRC found no significant grounds or reasons presented by the petitioner that warranted interference with these concurrent findings of fact, particularly the failure to establish the vehicle's theft.

The NCDRC cited the Hon'ble Supreme Court's decisions in "Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd." and "Sunil Kumar Maity vs. SBI & Anr." to reinforce the limited nature of revisional jurisdiction and the impropriety of interfering with concurrent findings of fact based on the appreciation of evidence by the lower consumer fora. The NCDRC also referred to the Supreme Court's judgment in "Rajiv Shukla Vs. Gold Rush Sales and Services Ltd.," which further clarified the limited scope of revisional powers.

Based on these legal precedents and its own assessment of the case, the NCDRC concluded that the State Commission's order did not suffer from any illegality or impropriety. Consequently, the Revision Petition was dismissed, and the concurrent orders of the State and District Commissions were upheld. The NCDRC also directed that there would be no order as to costs.

This case underscores the importance of substantiating insurance claims with credible evidence and the reluctance of higher consumer fora to interfere with concurrent findings of fact by lower courts, especially when those findings suggest a potential fabrication of events.


CONSUMER PROTECTION ACT, 2019