Punjab

Faridkot

CC/16/372

Amritpal Singh - Complainant(s)

Versus

Bajaj Allianz General Insurance co. - Opp.Party(s)

Ashok Kumar Monga

28 Aug 2017

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :      372

Date of Institution:  22.12.2016

Date of Decision :   28.08.2017

 

Amritpal Singh s/o Inspector Singh r/o V. Jeeta Singh Wala, Tehsil Baghapurana, District Moga.

...........Complainant

Versus

1. Bajaj Allianz General Insurance Company Ltd, Regd.& Head Office: G E Plaza, Airport Road, Yerwada, Pune-411006 through its Chairman/MD.
2. Bajaj Allianz General Insurance Company Ltd, Claims Department, SCO 14, 4^th Floor, Urban Estate, Sector 5, Panchkula through Motor Claims Manager.
3. Bajaj Allianz General Insurance Company Ltd, Branch Office, Ferozepur Road, Faridkot through its Branch Manager.

................Ops

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh. Ajit Aggarwal, President,

               Sh P Singla, Member.

 

Present: Sh Ashok Monga, Ld Counsel for complainant,

              Sh S K Jain, Ld Counsel for OPs.

 

ORDER

(Ajit Aggarwal, President)

                               Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs seeking directions to OPs to make payment of Rs.6,61,413/-with interest and for further directing OPs to pay Rs.1,00,000/- as compensation for harassment, inconvenience, mental agony and Rs.10,000/-as litigation expenses.

2                                        Briefly stated, the case of the complainant is that complainant owns a car and he got insured his car with Ops vide Private Car Package Policy No.OG-16-1217-1801-00001779 valid from 30.04.2015 to 29.04.2016 against all kinds of risks and paid premium of Rs.24,007/-to OPs. It is submitted that during the validity of insurance period on 17.05.2015, said car of complainant met with an accident near village Bhagta Bhai Ka, District Bathinda while trying to save cattle that came across suddenly. His car hit with road side tree and as a result, its window opened and complainant fell outside the car. Thereafter, his car struck against an electric pole causing damage to occupants namely Jagseer Singh and brother of complainant Rajwinder Singh. Rajwinder Singh died on spot as he received severe injuries. People who gathered on the spot, they took them to  Civil Hospital Bhagta Bhai Ka and then post mortem of his brother was conducted on 18.05.2015. DDR No.10 to this effect was got recorded in Police Station Dialpura, District Bathinda and due intimation regarding it was also given to OPs, who appointed G S Sohal as Surveyor. Said Surveyor inspected the damaged vehicle and gave report that damaged vehicle is a total loss and is non-repairable. Thereafter, two representatives of Ops visited complainant and also inspected the vehicle and made thorough investigation and as per their advice, complainant handed over them all the documents like claim form, copy of DDR etc as demanded by them and they assured complainant that his claim would be processed shortly, but despite completing all formalities and submission of all requisite documents as demanded by them, Ops have not paid the claim amount to complainant and illegally and unlawfully repudiated the claim of complainant vide letter dated 3.11.2015. complainant made several requests to them to make payment of his genuine insurance claim, but all in vain. This act and conduct of OPs amounts to deficiency in service and trade mal practice on their part and it has caused unnecessary harassment, mental pain and agony to complainant for which he has prayed for directions to Ops to pay Rs.1,00,000/-as compensation and Rs.10,000/- for cost of litigation besides the main relief. Hence, the present complaint.

3                                           The counsel for complainant was heard with regard to admission of the complaint and vide order dated 10.01.2017, complaint was admitted and notice was ordered to be issued to the opposite party.

4                                            On receipt of the notice, the opposite party filed written statement taking preliminary objections that there is no deficiency in service on the part of OPs and present complaint involves complicated questions of law and facts requiring voluminous evidence that is not possible in summary procedure. Complainant already filed the present complaint before Permanent Lok Adalat, Moga, where same was dismissed and now it is not maintainable in present form. Moreover, complainant did not intimate the OPs regarding accident and gave intimation to them after a long period of 18 days which is a violation of terms and conditions of the policy. Complainant has concealed the material facts from this Forum. On receipt of information regarding accident on 6.06.2015, they appointed Sh Gagandeep Singh as Investigation, who gave report on 30.09.2015 and thereafter, case was got reinvestigated from Capital Risk Management Company and ICS Assured Service Pvt Ltd and last of JD Health Care Services Mohali, who reported that vehicle was driven by Rajvinder Singh deceased and not by complainant and they stated in their report that as per insured, car dash hit a tree, he fell outside and his brother and relatives were trapped inside the car. Insured have not sustained any major injury and has produced fabricated medical document pertaining to his alleged injuries. It is reported that damage to vehicle is mainly on the front side bumper and its impact does not majorly affect the back portion of car. It is inferred that deceased Rajvinder Singh was sitting on driver’s seat and he was driving the vehicle. He was about 17 years old and was not having effective and valid driving license at that time. Ops averred that on receipt of investigation report, vide letters dt 26.09.2015 and 15.10.2015, they asked complainant to provide them driving license of deceased Rajwinder Singh alongwith original verification and explanation, but complainant failed to do so and therefore, vide letter dt 3.11.2015, claim of complainant was repudiated. However, on merits, Ops have denied all the allegations being concocted ones and false and asserted that DDR lodged by complainant is false to avail undue benefit of insurance policy. It is further averred that on receipt of information regarding accident, they appointed surveyor and on after investigation report of Gagandeep Singh and further of Capital Risk Management Company and ICS Assured Service Pvt Ltd and last of JD Health Care Services Mohali, who reported that vehicle was driven by Rajvinder Singh deceased and not by complainant. Complainant made a false story by giving misrepresentation regarding alleged accident. It is further averred that loss of complainant is assessed as per instructions of IRDA and they are not liable to pay more than this. All the other allegations levelled by complainant are denied being wrong and incorrect and reiterated that there is no deficiency in service or unfair trade practice on the part of opposite parties. The allegations with regard to relief sought too were refuted with a prayer that complaint deserves to be dismissed with costs.

5                                               Parties were given proper opportunities to prove their respective case. The complainant tendered in evidence his affidavit Ex.C-1, and documents Ex C-2 to C-5 and then, closed his evidence.

6                                            In order to rebut the evidence of the complainant, the OPs tendered in evidence, affidavit of Sh Navjeet Singh Asstt Manager as Ex OP-1 and documents Ex OP-2 to OP-9 and then, closed the evidence.

7                                                We have heard the ld counsel for complainant as well as OPs and have also very carefully gone through the documents placed on record by respective parties.

8                                          Ld counsel for complainant vehementally argued that complainant owns a car and he got insured his car with Ops vide insurance policy valid from 30.04.2015 to 29.04.2016 against all kinds of risks and also paid premium of Rs.24,007/-to OPs. During the validity of insurance period, said car of complainant met with an accident on 17.05.2015, near village Bhagta Bhai Ka, District Bathinda while trying to save cattle that came across suddenly. His car hit with road side tree and as a result, its window opened and complainant fell outside the car. Thereafter, his car struck against an electric pole causing damage to occupants namely Jagseer Singh and brother of complainant Rajwinder Singh. Rajwinder Singh died on spot as he received severe injuries. People who gathered on the spot, they took them to  Civil Hospital Bhagta Bhai Ka and then post mortem of his brother was conducted on 18.05.2015. DDR No.10 to this effect was got recorded in Police Station Dialpura, District Bathinda and due intimation regarding it was also given to OPs, who appointed G S Sohal as Surveyor. Said Surveyor inspected the damaged vehicle and gave report that damaged vehicle is a total loss and is non-repairable. Thereafter, two representatives of Ops visited complainant and also inspected the vehicle and made thorough investigation and as per their advice, complainant handed over them all the documents like claim form, copy of DDR etc as demanded by them and they assured complainant that his claim would be processed shortly, but despite completing all formalities and submission of all requisite documents as demanded by them, Ops have not paid the claim amount to complainant. OPs illegally and unlawfully repudiated the claim of complainant vide letter dated 3.11.2015. Complainant made several requests to make payment of his genuine insurance claim, but all in vain. All this amounts to deficiency in service. Complainant has prayed for accepting the present complaint.

9                                           To controvert the allegations of complainant, ld counsel for Ops argued before the Forum that there is no deficiency in service on the part of OPs and present complaint involves complicated questions of law and facts requiring voluminous evidence that is not possible in summary procedure. Complainant already filed the present complaint before Permanent Lok Adalat, Moga, where same was dismissed and now it is not maintainable in present form. Moreover, complainant did not intimate the OPs regarding accident and gave intimation to them after a long period of 18 days which is a violation of terms and conditions of the policy. Complainant has concealed the material facts from this Forum. On receipt of information regarding accident on 6.06.2015, they appointed Sh Gagandeep Singh as Investigation, who gave report on 30.09.2015 and thereafter, case was got reinvestigated from Capital Risk Management Company and ICS Assured Service Pvt Ltd and last of JD Health Care Services Mohali, who reported that vehicle was driven by Rajvinder Singh deceased and not by complainant and they stated in their report that as per insured, car dash hit a tree, he fell outside and his brother and relatives were trapped inside the car. Insured have not sustained any major injury and has produced fabricated medical document pertaining to his alleged injuries. It is reported that damage to vehicle is mainly on the front side bumper and its impact does not majorly affect the back portion of car. It is inferred that deceased Rajvinder Singh was sitting on driver’s seat and he was driving the vehicle. He was about 17 years old and was not having effective and valid driving license at that time. Ops averred that on receipt of investigation report, vide letters dt 26.09.2015 and 15.10.2015, they asked complainant to provide them driving license of deceased Rajwinder Singh alongwith original verification and explanation, but complainant failed to do so and therefore, vide letter dt 3.11.2015, claim of complainant was repudiated. Ops have denied all the allegations being concocted ones and asserted that DDR lodged by complainant is false just to avail undue benefit of insurance policy. It is further averred that on receipt of information regarding accident, they appointed surveyor and on after investigation report of Gagandeep Singh and further of Capital Risk Management Company and ICS Assured Service Pvt Ltd and last of JD Health Care Services Mohali, who reported that vehicle was driven by Rajvinder Singh deceased and not by complainant. Complainant made a false story by giving misrepresentation regarding alleged accident. It is further averred that loss of complainant is assessed as per instructions of IRDA and they are not liable to pay more than this. All the other allegations levelled by complainant are denied being wrong and incorrect and reiterated that there is no deficiency in service or unfair trade practice on the part of opposite parties and prayed for dismissal of complaint.

10                                   From the careful perusal of record and evidence produced by parties, it is observed that case of the complainant is that his insured car met with an accident during the validity of insurance period. His car hit with road side tree, its window opened and complainant got expelled from the car and then, his car struck against an electric pole causing damage to occupants namely Jagseer Singh and Rajwinder Singh. Due to severe injuries Rajwinder Singh brother of complainant died on spot. People took them to  Civil Hospital Bhagta Bhai Ka and then post mortem of his brother was conducted on 18.05.2015. DDR No.10 dated 18.05.2015 to this effect was got recorded in Police Station Dialpura, District Bathinda and due intimation regarding it was also given to OPs. OPs appointed Surveyor, who after inspecting  the damaged vehicle reported that damaged vehicle is a total loss and is non-repairable. Two other representatives of Ops also inspected the vehicle thoroughly and demanded some requisite documents, which complainant supplied to them. But despite completion of formalities and submission of all demanded documents, Ops have not cleared the genuine claim of complainant and vide letter dt 3.11.2015, illegally repudiated his claim for no reason.  It amounts to deficiency in service. In reply, Ops asserted mainly on the point that vehicle in question was being driven by Rajwinder Singh deceased brother of complainant, who was only 17 years old and was not having effective and valid driving licence at the time of occurrence of said accident. All the other allegations are denied being wrong and concocted ones with prayer to dismiss the complaint.

11                                                    To prove his case, complainant has relied upon document Ex C-2 /copy of insurance policy, that proves that car of complainant was insured with Ops and accident occurred during the subsistence of insurance period, Ex C-3 copy of DDR dt 18.05.2015 also states the grievance of complainant. Ex C-4 copy of letter dt

4.12.2015 issued by Sandhu Automobiles, Ludhiana to complainant asking him to deposit the parking charging for placing his damaged vehicle at their place. Ex C-5 copy of repudiation letter dt 3.11.2015.  Through his affidavit Ex C-1, he has reiterated his pleadings with request to redress his grievance.

12                                            It is admitted case of the parties that vehicle of complainant was insured with OPs, which met with an accident during the insurance period and complainant duly gave intimation regarding accident to OPs, who appointed Surveyor and Investigator to investigate the calm of complainant. the only plea of Ops is that in their investigation, it is found that at the time of accident, the vehicle was not driven by Amritpal Singh/complainant, rather it was being driven by Rajwinder Singh deceased brother of complainant who  had no effective and valid driving license at the time of occurrence of said accident, which is clear violation of terms and conditions of the policy. As such, he cannot claim any relief under the policy. So, claim is rightly repudiated.

13                            Ld Counsel for complainant argued that it is wrong that at the time of accident, the vehicle was not driven by Amritpal Singh and it was driven by Rajwinder Singh. At the time of accident the vehicle was driven by Amritpal Singh and Rajwinder Singh deceased was sitting at the back seat of the car. When the car collided with tree, the window of driver side of car opened and Amritpal Singh fell out of the car and car further  hit  an  electric  pole  and  due  to  this  impact,

Rajwinder Singh jumped from back seat to front seat and his head directly hit the dash board of car and he suffered severe injuries  and he died on the spot. The complainant also suffered injuries and fractures in his arm. At the time of accident, Rajwinder Singh was sitting on the back seat of the car and was not driving the vehicle. Complainant immediately got recorded rapat regarding accident with Local Police where he narrated all the incident and stated that he was driving the vehicle at the time of accident and Rajwinder Singh was sitting in the back seat. Copy of DDR is Ex C-3, which proves the version of complainant. there is no need to manipulate the story regarding name of driver. Even DDR was recorded immediately and at that time, the complainant was in great shock due to sudden death of his brother and no one can imagine to set up this type of story in that condition. Moreover, during the investigation of claim the Investigator of OPs recorded the statement of complainant and also visited Police Station to check the police record and on spot of accident, they recorded the statement of persons who were present on spot at the time of accident. they also supported the version of complainant that at the time of accident, the complainant was driving the vehicle and due to opening of front window of driver side, he fell out of car and Rajwinder Singh jumped from back seat to front by impact of accident and hit with dash board of car and died on the spot. Entire story regarding the change of driver is made up by Ops only to deceive the complainant and to avoid their liability to pay compensation to complainant. Investigator and Surveyors are employees of Ops, who are appointed and paid by OPs and it is general tendency that a person gives report in favour of party who hires him like in this case; the investigator gave report in favour of Ops on the basis of imagination and presumptions without any cogent evidence. He further argued that if for the sake of arguments, it is presumed that at the time of accident, vehicle was not driven by Amritpal Singh and it was driven by Rajwinder Singh, then in that case also, the OPs cannot repudiate the claim of complainant as there is no allegation that accident occurred due to unskilled and negligent driving of the driven in question. He has placed reliance on citation 2004 (2) RCR 114 Supreme Court of India in case titled as National Insurance Co. Ltd Vs Swaran Singh and Ors wherein Hon’ble Apex Court held that Motor Vehicle Act 1988 Section 149 (2) (a) (ii) and proviso to Sub Sections (4) and (5) – Disqualification of driver – Validity of driving license – Insurer is entitled to raise all defences available u/s 149 (2) of the Act – However, mere absence, fake or invalid at the relevant time are not the defences available to insurer against the insured or third parties – To avoid its liability towards the insured also the insurer has to prove the insured to be guilty of negligence and failure to exercise reasonable care in compliance of conditions of Policy – Burden is on the insurer to establish breach of Policy by leading cogent evidence- Mere non production of license or evidence by the insured cannot be considered as discharge of burden of insurer.

14                                    He further argued that it is general tendency of Insurance Companies to show green gestures to customers at the time of selling the policies and make lame excuses to reject the claim of customers at the time of payment of claim on the basis of false terms and conditions. He placed reliance on citation 2001 (1) CPR 93 (Supreme Court) 242 titled as M/s Modern Insulators Ltd Vs The Oriental Insurance Company Ltd, wherein Hon’ble Apex Court held that clauses which are not explained to complainant are not binding upon the insured and are required to be ignored. Furthermore, it is generally seen that Insurance Companies are only interested in earning the premiums and find ways and means to decline the claims. He  further placed reliance on citation 2008(3)RCR (Civil) Page 111 titled as New India Assurance Company Ltd Vs Smt Usha Yadav & Others, wherein our Hon’ble Punjab & Haryana High Court held that it seems that Insurance Companies are only interested in earning premiums and find ways and means to decline the claims. The conditions, which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any Policy.

15                                 From the above discussion, we are of considered opinion that OPs have failed to prove that at the time of accident the vehicle in question was not driven by Amritpal Singh and it was driven by Rajwinder Singh deceased. The claim of complainant is repudiated by OPs on false grounds, which amounts to deficiency in service and trade mal practice on the part of OPs. Therefore, complaint in hand is hereby allowed. OPs are directed to pay Rs.6,61,413/- i.e insured value of the vehicle alongwith interest at the rate of 9% per anum from 3.11.2015, when they repudiated the claim of complainant till final realization. They are further directed to pay Rs.5,000/-to complainant as compensation for harassment and mental agony suffered by him besides Rs.3000/- as litigation expenses. Compliance of this order be made within one month of the receipt of the copy of the order, failing which complainant shall be entitled to proceed under Section 25 and 27 of Consumer Protection Act. Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Announced in Open Forum

Dated : 28.08.2017

                                                Member                   President

                                              (P Singla)              (Ajit Aggarwal)