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High Court of Fiji |
IN THE HIGH COURT OF FIJI AT LAUTOKA CIVIL JURISDICTION Civil Action No. HBC 211 of 1988 | ||
BETWEEN DOMINION AUTOPARTS AND ACESSORIES LIMITED 1st Plaintiff | ||
AND RAHMAT ALI 2nd Plaintiff AND THE NEW INDIA ASSURANCE COMPANY LIMITED | ||
| | Defendant |
| | |
| | |
| | |
JUDGEMENT
BACKGROUND
TRIAL
THE ALLEGED MATERIAL NON-DISCLOSURE
8. | (a) | Has the property been insured in the past or at the present time? If so, give full particulars. | Yes. National Insurance Co. Ltd. |
| (b) | Have you ever sustained loss by fire? Give full particulars. | No |
| (c) | Has any Office, Insurance Co, or underwriters – (1) Cancelled ........... Any insurance or repudiated claim under any one or more policies of insurance either for you or any one of your partner/s & Co-owner/s | No |
THE BASIS CLAUSE
I/We hereby declare that the statement made by me/us in this Proposal Form are true to the best of my/our knowledge and belief and I/We hereby agree that this declaration shall form the basis of the contract between Me/Us and THE NEW INDIA ASSURANCE COMPANY LIMITED..
................
.........................I/We further declare that I/We have read and understood particulars entered herein and I/We have signed this after verifying the same to be true and complete.......
(my emphasis)
THE DEFENDANT’S CASE
THE PLAINTIFFS’ CASE
THE LAW
Utmost Good Faith & Duty To Give Full Disclosure
The duty of disclosure ........ arises out of the fact that a contract of insurance is a contract uberrimae fidei.
Duty Begins From Proposal
Insurance is a contract based upon speculation. The special facts, upon which the contingent chance is to be computed, lie most commonly in the knowledge of the insured only; the underwriter trusts to his representation and proceeds upon the confidence that he does not keep back any circumstance in his knowledge, to mislead the underwriter into a belief that the circumstance does not exist, and to induce him to estimate the risk as if it did not exist. Good faith forbids either party by concealing what he privately knows, to draw the other into a bargain from his ignorance of that fact, and his believing the contrary.
Contracts of Insurance are generally matters of speculation, where the person desiring to be insured has the means of knowledge as to the risk, and the insurer has not the means or not the same means.
And earlier at 792:
There are some contracts in which our courts of law and equity require what is called “uberrimae fidei” to be shown by the person obtaining them....Of these, ordinary contracts of marine, fire and life insurance are examples, and in each of them, the person desiring to be insured must, in setting forth the risk to be insured against, not conceal any material fact affecting the risk known to him.
Breach of Duty Entitles Insurer to Avoid Policy
It is an elementary principle of insurance law that if the utmost good faith is not observed by either party the contract may be avoided by the other party. ...........The short question therefore, upon the answer to which the right of the respondent company to repudiate liability depends, is whether the fact of the cancellations was a material fact.
Onus
Tests for Materiality
....... which would affect the mind of a prudent insurer in deciding whether or not to provide cover (Mayne Nickless Ltd v. Pegler [1974] 1 NSWLR 228).
“the manner in which a person seeking insurance generally finds out what the intended insurer regards as material is by reference to the questions which the intended insurer requires him to answer”.
Held: l. The truth of the answers to the questions in the proposals for the motor vehicles having been made a condition precedent to the respondent company's liability the company was entitled to disclaim liability by reason of the untrue answers made by the appellant.
2. On the basis that the Marine Certificates evidenced unconditional contracts of insurance governed by common law principles the appellant was under a duty to make disclosure of every material fact.
3. Materiality is a question of fact and in the circumstances of the case the non-disclosure of the earlier cancellations was clearly material. (Per Marsack J.A.: to determine materiality in such a case the test may be applied whether or no a prudent underwriter would take the fact into consideration in estimating the premium or underwriting the policy.) (Per Gould V.P.: the cancellations were not so remote in time that they would have ceased to influence a reasonable insurer.)
4. The respondent company was therefore entitled to avoid the contracts.
Warranties of existing facts to be representation
16. A statement made in or in connection with a contract of insurance, being a statement made by or attributable to the insured, with respect to the existence of a state of affairs does not have effect as a warranty but has effect as though it were a statement made to the insurer by the insured during the negotiations for the contract but before it was entered into.
THE EVIDENCE
Defendant’s Evidence
Mr Rahmat Ali f/n Dildar Ali
P.O Box 472
BA Without Prejudice
Dear Sir
Re: | Alleged fire loss to Bulk Store on 2 October 1986 covered under our Policy No. 622/21/1487 |
We regret to note from your telephonic report of this date that your Bulk Store covered under the above policy was damaged.
In this connexion we draw your kind attention to important notice affixed to the above policy that if premium in full is not paid within 30 days from the date of the cover, the policy will be automatically deemed to have been cancelled and no further notice will be required.
We note from your records that you have not paid the full premium within 30 days from the date of cover viz 13 December 1985. Hence we formally reject your proposed claim on the above condition.
However, without prejudice to our above repudiation, we enclose herewith one claim form which we request you to return duly filled in and signed by you. We also ------M/s Toplis & Harding, Independent Adjusters without prejudice to our above stand to assess the loss.
Kindly note that this letter if written without any admission of liability and without prejudice to our rejection of your proposed claim on the above noted grounds and other grounds which are unknown at present and might come to our attention later.
Yours faithfully
C. Chandar Sekaran Manager, Western Region Encl. CC/sr | Cc: M/S Toplis & Harding – Please assess the loss without prejudice. Policy copy attached. Cc: M/s Ambika Prasad Investigation This is a connected claim. Cc: Mr. H.G Ganatra Chief Manager for Fiji This is for your kind information |
Dated: 25th November, 1986
Our Ref: D614/86
Your Ref
The Manager Western,
The New India Assurance Co Ltd.,
P.O. Box 257,
LAUTOKA.
Dear Sir,
Re: | Fire Claim – Dominion Auto Parts and Accessories Limited – Ba – Policy No’s: 622/21/1447 and 622/31/7865/86. |
We refer to the above insured’s claim and the details requested, supplied to us by your office following our advice that we were in possession of comprehensive historical data concerning this insured and although the Assessment and the Adjustment of this claim was delegated to Messrs. Toplis & Harding – Nadi, we considered that it was our responsibility to assist the Insurance Industry within Fiji especially in respect of dubious claims, however we make the request that the information that follows be confidential between us and that it not be disclosed to Toplis & Harding and further, not actioned, until after Toplis & Harding’s final report has been received.
With our knowledge of this gentleman and his companies we sent a member of our staff to Suva to confirm or otherwise our knowledge of his claim History together with whether insurance on application had ever been declined by Fiji Insurance or National Insurance.
We now list the results of this survey.
FIJI INSURANCE CO LTD
Dominion Auto Parts & Accessories Limited | | ||
Policy 01 | Stock Insurance | Paid $1409.32 5/83 | Cyclone Oscar |
Policy 02 | Building | Paid $ 558.85 3/83 | Cyclone Oscar |
Policy 01 | Stock Insurance | Paid $2830.00 5/85 | Cyclone Nigel |
Policy 02 | Building | Paid $ 282.46 5/86 | Cyclone Nigel |
Policy 01 | Stock | Claim $18239.26 - | Cyclone Gavin |
(Rejected and currently being subjected to Judicial Processes). | |||
Rahimat Ali | | | |
Policy 01 | Building | Paid $ 700.00 5/85 | Cyclone Oscar |
Policy 02 | Travel P.A. Accident | Paid $ 2278.00 9/83 | |
Policy 03 | Travel P.A. Accident | Paid $3661.00 8/86 | |
June/July 1985 Fiji Insurance long before a decision was made to close operations in Fiji, due to this clients Claim History refused
to re-instate or renew this clients policies therefore they totally went off risk. |
NATIONAL INSURANCE CO OF FIJI LTD
Dominion Auto Parts & Accessories Ltd | |
July 19th, 1985, Nationals Suva Office received a completed proposal form for Insurance from Dominion Auto Parts & Accessories Ltd., of
Ba from their Lautoka Office – declined to go on risk 08/10/85 following investigations and associated anticipated claims and
problems. |
On receipt of the above confirmation of our thinking we then perused your completed proposals for Fire Insurance by Dominion Auto Parts and Accessories Ltd and from which you raised policies 622/21/1447 – 15/11/85 to 15/11/86 and 622/31/7865/86 – 17/03/86 to 17/03/87 when blatant is the only word, misrepresentation of material facts were there, that automatically would void these policies, the proposal being the Basis of the Contract.
On the Proposal for House owners and Householders Policy 622/21/1447, Section 8 (a) and (b) both answers – NO – Deliberate misrepresentation – of course there had been claims, whilst two entirely unconnected Insurance Companies had declined to reinstate, renew or accept the risk. Proposal for Fire Insurance & Endorsements Policy No: 622/31/7865/86. Section 8 (a), (b) and (c) again are raised blatant misrepresentation of material facts voiding the Policy as for reason stated concerning Policy 622/21/1447.
Our material as now submitted was shown to Mr G. P. Shankar & Co., Barristers & Solicitors, Ba who unhesitatingly agreed with us by stating both claims 622/31/7865/86 Stock $50,000, 622/21/1447 Building $16,000 Total $66,000 must be rejected – cause, misrepresentation of material facts.
We may add that your form of Proposal covering Fire Policy 8 (b) gave cause for much concern – Fire Policies today not only cover fire but have many special risks endorsements – your question here Quote – “Have you ever sustained loss by FIRE? Give full particulars” – Unquote requires immediate correction in order to obtain full claim particulars from the proposer for Insurance. Your Proposal covering House owners & Householders Insurance, Section 8 (a) is certainly an improvement where it states Quote – “Ever been a claimant under a Fire or Special Risks Insurance Contract,” – Unquote but we consider that an open statement such as “Ever been a claimant under any Insurance Contract – If so give particulars” allows no room by a proposer for Insurance to give answers other than honest, as it relates to their Claim History – a must when evaluation of a risk arises.
Yours faithfully,
JIM ASH & ASSOCIATES
Jim Ash. J.P.
JA/rl
P.C. Mr Ganatra, manager for Fiji, The New India Assurance Co Ltd., Suva.
Mr G.P. Shankar, Barrister & Solicitors, Ba.
Plaintiffs’ Evidence
We refer to your unsigned letter Ref: 5/10 dated 25 March 1987 and wish to advise that the claims are receiving the attention of our investigators/assessors and your client is already in the know of the full facts.
Yours faithfully
(V K Bhasin)
Manager, Western
(my emphasis)
Q. | Look at 2nd page of Proposal. Clause 8. Notice the reference to NICL. You said they never cancelled or refused to renew. That answer is misleading.
8(c) is a lie. |
A. | I did not answer any question as a lie. |
Q. | I will be calling a Claims Officer who works with the defendant. He will show 8(c) is a lie. His name is Avinesh Rai. |
A. | If he can prove that – fine! He must prove that they rejected because of previous non-renewal by previous insurer. |
Q. | You said you moved to New Zealand. When did you migrate to New Zealand? |
A. | 1987. |
Q. | You filed this claim in 1988? Since then, you have not pushed your lawyers to expedite the claim. |
A. | I keep contacting lawyer Sahu Khan. He keeps on saying GP Shankar wants to make settlement. The years just went. Just talking settlement.
Last year, I told Sahu Khan I don’t want settlement. I wanted trial. He applied for hearing. GP Shankar passed away. Sahu Khan
has since lost his business. |
Q. | I put to you that defendant did make you aware that your claim declined due to material non-disclosure of your prior policy with NIFL
which they did not renew. |
A. | Not true. |
ANALYSIS
HAVE THE PLAINTIFFS PROVEN THEIR LOSS?
Q. | You said you suffered $50,000 and $16,000 worth of damages? |
A. | Yes |
Q. | Any Accounts with you to verify loss? |
A. | Not at the moment. |
Q. | You agree damages could be more than $50,000? |
A. | I had all materials in written record. Its 30 years. Floods and Hurricanes have happened affecting shop. House blown away. It’s
a long time. Documents destroyed. |
Q. | Any records with Accountants? |
A. | No. |
Q. | I put to you that damage sustained in loss ins less than $50,000. |
A. | I am pretty sure stock was there as claimed. |
Q. | Put to you did not suffer any damage from fire. |
A. | I did suffer. |
Q. | You agree you also made a claim to New India for $150,000? |
A. | I do not recall |
Q. | I put to you also made claim to defendant for $150,000 |
A. | Not true |
[19] It would be seen therefore that in a claim under an insurance policy the claimant is indemnified for the loss incurred by him. What he has to establish before Court is the loss incurred to the satisfaction of the Court. The furthest that can be said in terms of damages is that the loss has to be considered as unliquidated damages as the loss has to be ascertained. There is no necessity to go into the ramifications of seeing whether they are special or general damages as in the law of torts or in certain contracts. Insurance is a special contract where indemnity is the basis of granting a claim made by the insured.
[20] ..................................
[21] In a claim based on an insurance policy what is required to be considered is whether the claim made by the Insured comes within the terms of the policy, whether the conditions necessary to lodge a claim have been satisfied, whether the Insured is liable if the claim made by the Insurer is not met and if so to what extent is the insured liable for the loss incurred by the Insured. If it is concluded that the Insurer is liable and thereby has caused a breach of the contract, how should the Insured establish his claim regarding the loss he has suffered when claiming damages. In processing a claim under a policy it is usual for the Insurer to get a valuation done through their Loss Adjustors of the loss suffered by the Insured. So the basic questions that would arise in an action on a insurance policy would be whether the Insurer is liable regarding the claim and secondly to what quantum of damages is he liable.
ORDERS
(i) Claim dismissed.
(ii) Parties to bear their own costs.
......................................
Anare Tuilevuka
JUDGE
Lautoka
26 October 2018
[1] Genesis Housing Association Limited v Liberty Syndicate Management Limited [2012] EWHC 3105 (TCC).
[2] The headnotes summarise the facts as follows:
In September 1965, and March 1966, the appellant signed proposals to the respondent company for comprehensive insurance over two motor vehicles. In each he answered in the negative the question whether he had ever had an insurance cancelled. He had in fact had a motor vehicle policy and a marine open policy cancelled by the United Insurance Co. Ltd. in October, 1964, and August, 1964, respectively and his answer to the question abovementioned was to his knowledge false. The policies issued pursuant to the proposals contained a proviso that the truth of the answers in the proposal should be a condition precedent to any liability of the respondent company to make any payment under the policy.
In June, 1966, the appellant insured with the respondent company merchandise (to be loaded onto the two motor vehicles abovementioned) against road risks and in relation thereto the respondent company issued documents called Marine Certificates. The fact of the earlier cancellations by the United Insurance Co. Ltd. was not disclosed to the respondent company.
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