Haryana

Karnal

CC/124/2021

Sandeep - Complainant(s)

Versus

Bajaj Allianz General Insurance Company Limited - Opp.Party(s)

03 Nov 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No.124 of 2021

                                                        Date of instt.26.02.2021

                                                        Date of Decision:03.11.2022

 

Sandeep aged about 40 years son of Shri Daya Nand, resident of house no.184, Gali no.1, Basant Vihar, Karnal. Aadhar card no.753959307695.

 

                                               …….Complainant.

                                              Versus

 

1.     Bajaj Allianz General Insurance Co. Ltd. Regd. office Bajaj Allianz House, Airport road, Yerwada, Pune 411006, Maharastra, through its M.D. Contact no.09120-6602666.

 

2.     Bajaj Allianz General Insurance Co. Ltd. Zonal office at SCO 156-159, 2^nd floor, Sector-9, Chandigarh, through its Manager.

 

3.     Bajaj Allianz General Insurance Co. Ltd. Corporate office at Block no.4, 7^th floor, DLF Tower, 15, Shivaji Marg, New Delhi-110015 through its Manager contact no.011-66278000.

 

                                                                   …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary….Member

 

 Argued by: Complainant in person.

                    Shri Atul Mittal, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant is the registered owner of a car make Audi, Model A-8, bearing registration no.DL-3C-BM-0204 and the same was got insured with the OPs, vide policy no.OG-20-1104-1801-00013630, valid from 23.09.2019 to 22.09.2020. The insured declared value (IDV) of the said vehicle was assessed by the OPs as Rs.48,00,000/- and received Rs.93,547/- as total/final premium amount including GST (18%). On 21.08.2020 at about 4.30 a.m. when complainant was returning to Karnal from village Darar, and when he reached ahead new Bus Stand at Karnal then suddenly one vagabond animal came in front of vehicle of the complainant and in order to save the life of the said animal, complainant applied sudden break, due to which the vehicle of the complainant struck into the pillar and the complainant also sustained injury on his chest. Due to the said impact, the vehicle was also badly damaged. Thereafter, complainant got himself treated from Life Care Hospital, Sector-7, Urban Estate, Karnal and taking pills of pain killer. Complainant got lodged a DDR no.24 dated 21.08.2020 in Police Station Sadar, Karnal. Thereafter, complainant contacted the Audi Service Centre and after that by arranging a crane took the damaged vehicle to Audi Service Center, G.T. Road, Karnal. Complainant sent the intimation regarding the said accident to OPs for inspecting the damaged vehicle and for surveyor report. OPs appointed Mr. Ajay Mahajan as surveyor to inspect the damaged vehicle and to prepare actual and factual position and loss of the vehicle. The said surveyor inspected the vehicle of the complainant and advised the complainant to get estimated cost of repair from service center by saying that the claim of the complainant is genuine and OPs will pass the claim of damage very soon. The concerned engineer of Audi Car Service Center prepared an estimate report of damaged car about Rs.56,65,033/- and the same has been sent by the complainant to the OPs. The service centre demanding 5% of estimated costs from the complainant whereas they have already received Rs.1,00,000/- from the complainant. A team of four members sent by the OPs to investigate the spot and damaged vehicle on 26.08.2020. On 03.09.2020, OPs made a telephonic call to the complainant by saying that said team has given their positive report in favour of the complainant and the claim of the complainant would be passed very soon. After that a forensic team was sent by the OPs to check the blood sample fell into the damaged vehicle with the complainant and the forensic team took the sample of blood of the complainant. The forensic team also submitted its report by saying that the blood matched with the complainant. Thereafter, complainant sent many letters to the OPs and requested to pass the claim but OPs neither passed the claim of complainant nor given any satisfactory reply for making delay in passing the claim of complainant. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi; territorial jurisdiction and concealment of true and material facts. On merits, it is pleaded that OPs appointed IRDA license surveyor Mr. Ajay Mahajan, Surveyor and Loss Assessor under section 64 UM of Indian Insurance Act 1938. Said surveyor duly verified and assessed the loss and submitted the detailed report dated 23.02.2021. The said surveyor assessed the loss to the tune of Rs.14,60,030/- subject to the terms and conditions of the policy of insurance. The said surveyor further commented in his report that the claim of the complainant is not payable due to misrepresentation and suppression of material fact on part of the complainant. It is further pleaded that the claim of the complainant was duly verified and investigated by the OPs by appointment of Forensic Investigator and Forensic Specialist M/s Zubair & Co. Surveyor and Loss Assessor, who visited the spot and submit his report on 03.09.2020 and found that the exterior, interior, underneath damages are not co relating with narration mentioned by complainant and location showed by the complainant does not support the crash events described according to the narration of the complainant. However, the geographical examination of the scene of accident, road gradient and terrain did not produce damages underneath the subject vehicle as CG (Centre of Gravity) of the subject vehicle is low, no rearward motion was noticed in the final resting position of the subject vehicle, a crash scene which does not fit with the laws of conservation of momentum and crash dynamics in collusion with a fixed object from ground. Moreover, considering all the points and demonstrative evidence, technical evidence, administrative evidence, circumstantial evidence, it is evident that the spot shown by the insured is staged managed or fabricated. The narration mentioned by complainant does not co relate with facts. It is further pleaded that many letters dated 29.10.2020, 12.11.2020, 14.01.2021, 11.02.2021 were written to the complainant wherein that the complainant deliberately removed the vehicle from the spot of accident without the knowledge of the OPs, thus by depriving an opportunity to ascertain the necessary facts related to the accident including without limitation, cause of loss, circumstances and quantum of loss, required to decide admissibility of claim and also provide vehicle purchase sale deed details and payments details with documentary proof and moreover as per physical inspection of the vehicle and survey report confirms that the cause of loss as narrated by the complainant goodself is not concurrent with nature of damages. It is further pleaded that as per the survey report and diagnostic report of manufacturer which were duly referred by the surveyor it has been transpired that:-

i)      Airbag deployed report projects that airbag got deployed on 20.05.2020 at 11.10 a.m. and meter reading is 28583Kms.

ii)     Meter reading at the time of survey is 28584kms and the meter is also showing date as 10.05.2020.

iii)    Keeping in view the IDV seems to be on the higher side that is 48 lacs and the market value of the care is around 14.50 lacs.

iv)    Electrical failure/headlights failure on 25.11.2019 with meter reading 28422 kms.

v)     Air conditioning/heating system failure on 27.11.2019 with meter reading 28422 kms.

vi)    Vehicle driven only 1 km over a period of 3 months and 11 days.

vii)   During the inspection under causing damaged were observed which is not possible in the frontal impact, exhaust pipe recorded to be detached at the time of accident, Hose pipe also found out to be unfitted condition and also under body cross member was not found.

viii)   During the interaction with workshop M/s Kanish motor Karnal that they had not removed any part from the vehicle after the alleged accident, keeping in view all the observation it is not possible to play car on the road since the car is not the road worthy condition.

In view of the abovesaid observations made by OPs, it clearly showed that complainant with malafide intentions to obtain profit from the insurance policy by making fraudulent claim of vehicle damaged which was not in roadworthy condition has file said complaint. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Complainant has tendered into evidence his affidavit Ex.CW1/A, copy of medical report Ex.C1, copy of Audi workshop letters I and II Ex.C2 and Ex.C3, copy of workshop estimate report Ex.C5, copy of replies of letters of OPs Ex.C6 and Ex.C7, copy of RC Ex.R8, copy of DDR Ex.C9, copy of legal notice Ex.C10, postal receipt Ex.C11, copy of letter dated 14.01.2021 Ex.C12, copy of driving licence Ex.C13, copy of last insurance claim and MSG Ex.C14, copies of emails to insurance companies and surveyor Ex.C15 and Ex.C16, copy of R.R. Automobiles crane bill Ex.C17, copy of insurance company letter dated 12.11.2020 Ex.C18 and closed the evidence on 20.01.2022 by suffering separate statement.

5.             On the other hand, learned counsel for OPs has tendered into evidence affidavit of Saurav Khullar, Assistant Manager of OPs company Ex.OW1/A, affidavit of M/s Zubair & Co. Surveyor and Loss Assessor Ex.OW2/A, affidavit of Mr. Ajay Mahajan, Surveyor and Loss Assessor Ex.OW3/A, affidavit of Ravi Kumar, Investigator Ex.OW4/A, copy of cash details Ex.OP1, copy of final survey report Ex.OP2, copy of letters dated 12.11.2020, 14.01.2021, 11.02.2021 and closed the evidence on 18.05.2022 by suffering separate statement.

6.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that the OPs had insured his Audi car model 2019 for the IDV of Rs.48,00,000/- for the period of 23.09.2019 to 22.09.2020. On 21.08.2020 said vehicle was met with an accident near New Bus Stand, Karnal and badly damaged. Complainant got lodged the DDR in this regard and also intimated to the OPs. The concerned engineer of the Audi service centre prepared the estimate report of damaged car of Rs.56,65,033/-. The investigator of the OPs had made visit at the spot and complainant had replied all the questions asked by the surveyor of the OPs. The vehicle of the complainant was not repairable due to total loss. Complainant requested many times to the OPs to pay IDV of the vehicle but OPs had repudiated the claim of the complainant on the false and frivolous ground and lastly prayed for allowing the complaint with interest, heavy compensation and litigation expenses etc.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version has vehemently argued that on receipt of the intimation, OPs company has immediately acted as per the guidelines of IRDA and registered the claim. OPs have appointed an independent IRDA licensed surveyor, Forensic Expert an investigator and taken opinion of Accident Reconstruction Engineer. The claim was not found admissible under the terms and conditions of the policy and same was rightly repudiated by the OPs and lastly prayed for dismissal of the complaint with cost.

9.             We have duly considered the rival contentions of the parties.

10.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.OP4 dated 14.01.2021 on the following grounds, which reproduced as under:-

1.     “That after verification of the claim and technical assessment of the vehicle it is observed that some part of vehicle was missing without which vehicle cannot be driven on road, further from details extracted through vehicle it observed that vehicle does not sustain any accident on 21.08.2020, and there is misrepresentation and suppression of material fact relating to factum of accident, narration of accident and alleged damages to the vehicle.

2.     That after technical assessment of the vehicle, it observed that vehicle was not sustained any accidental damages, further important part of the vehicle was missing which makes vehicle non-drivable, hence in that event vehicle cannot ply on the road.

3.     That after technical assessment of vehicle it is further observed that alleged damages to the vehicle are not concurrent with narration of loss mention in claim form.

Keeping in view of the above, the claim stands for repudiation only”.

 

11.           The claim of the complainant has been repudiated by the OPs on the ground that some part of the vehicle was missing without which vehicle cannot be driven on road, vehicle was not sustained any accident damage and the alleged damaged to the vehicle are not concurrent with the narration of loss.  

12.           The onus to prove its version lies upon the OPs. OPs have proved its version by leading cogent and convincing evidence.

 13.          To prove its version, OPs have tendered in evidence affidavit of Saurav Khullar, Assistant Manager Ex.OW1/A of Bajaj Allianz Insurance Company, who reiterating the contents of written version filed by the OPs.

 14.          OPs have also tendered affidavit of M/s Zubair & Co. Surveyor and Loss Assessor as Ex.OW2/A, who has duly processed the claim of the complainant and found that the exterior, interior, underneath damages are not co-relating with narration mentioned by complainant and location showed by complainant does not support the crash events. Considering all the points and demonstrative evidence, technical evidence, administrative evidence, circumstantial evidence, it is evident that the spot shown by the insured is staged managed or fabricated. The narration mentioned by complainant does not co relate with facts.

 15.          OPs have also tendered in evidence affidavit of Mr. Ajay Mahajan, Surveyor and Loss Assessor as Ex.OW3/A, who has also duly processed the claim of complainant and submitted his report dated 23.02.2021 and assessed the loss to the tune of Rs.14,60,030/- which was subject to the approval and terms and conditions of the policy of the insurance.  As per report Ex.OP2 the present market value of the car 14.50 lacs (approximately). He also opined that the cause of loss as narrated by the complainant in his claim is not concurrent with the nature of damage and these damages implanted only.

16.           OPs have also tendered in evidence affidavit of Ravi Kumar, investigator as Ex.OW4/A, who has categorically stated in his affidavit that during the course of investigation he has checked the Google time line of insured Mr. Sandeep and as per his time line time from 17.14 to 17.35 hours insured was available at Audi Workshop Karnal and accident was occurred at time about 4.30 hours and as per his time line no visit place was found and no Google time line was found for the time when accident was occurred.

 17.          After considering the above points and demonstrative evidence, technical evidence, administrative evidence, circumstantial evidence, OPs have come to the conclusion that the spot shown by the insured is staged managed or fabricated and does not  co relate with facts.

18.           As per the version of the complainant, he was returning to Karnal from village Darar and the accident took place at about 4.30 a.m. Complainant has failed to disclose his purpose for returning to Karnal in the very early morning. As per slip Ex.C1, complainant has taken treatment at about 11.48 a.m. whereas accident took place 4.30 a.m. if the complainant had received any injuries as alleged by him he would have gone to the hospital straightway without any delay. Complainant has gone to the hospital on delay of more than seven hours creating doubts and it appears that OPD slip has also been got prepared by the complainant just to prove the alleged said accident. Complainant got lodged DDR Ex.C9 at about 8.18 p.m. i.e. in the night hours whereas alleged accident took place in the early morning. This fact is also doubtful.

19.           The complainant has moved the vehicle in question from the spot without the spot inspection done by the surveyor of the OPs and thus complainant deprived the right of the OPs to ascertain the necessary facts with regard to the accident.

20.           To rebut the evidence produced by the OPs, complainant has only tendered his affidavit Ex.CW1/A, copy of medical report Ex.C1, copy of Audi workshop letters I and II Ex.C2 and Ex.C3, copy of workshop estimate report Ex.C5, copy of replies of letters of OPs Ex.C6 and Ex.C7, copy of RC Ex.R8, copy of DDR Ex.C9, copy of legal notice Ex.C10, postal receipt Ex.C11, copy of letter dated 14.01.2021 Ex.C12, copy of driving licence Ex.C13, copy of last insurance claim and MSG Ex.C14, copies of emails to insurance companies and surveyor Ex.C15 and Ex.C16, copy of R.R. Automobiles crane bill Ex.C17, copy of insurance company letter dated 12.11.2020 Ex.C18. Except these documents, no other evidence has been produced by the complainant. Complainant has failed to examine any eye and technical expert witnesses to rebut the versions of the OPs.

21            In view of the above, it has been proved on record that no accident took place as alleged by the complainant. Thus, complaint is devoid of any merits and deserves to be dismissed and same is hereby dismissed. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:03.11.2022.                                                                    

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

       

(Vineet Kaushik)        (Dr. Rekha Chaudhary)                     

      Member                                Member