Haryana

Karnal

CC/526/2021

Vikash Kumar - Complainant(s)

Versus

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

Balwan Singh

15 Apr 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 526 of 2021

                                                        Date of instt.27.09.2021

                                                        Date of Decision:15.04.2024

 

Vikash Kumar age about 33, son of Shri Jai Narain, resident of house no.584, Sector 4, Housing Board Complex, Karnal. Mobile no.7988189773.

 

                                                                        …….Complainant.

                                              Versus

 

Bajaj Allianz General Insurance Company Ltd. SCO 156-159, 2^nd floor, Sector 9-C, Chandigarh, through its Divisional Manager.

 

                                                                        …..Opposite Party.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.      

      Sh. Vineet Kaushik…….Member

      Dr.  Suman Singh…..Member

 

 Argued by: Shri Balwan Singh, counsel for the complainant.

                    Shri Atul Mittal, counsel for the OP.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that complainant got insured his vehicle i.e. Skoda Octavia Elegance 1.9 TDI bearing Registration no.HR-70C-5109 with the OP for a sum insured of Rs.3,81,039/- under a package policy no.0G-20-9906-1801-00013786 for the period of insurance 29.04.2019 to 28.04.2020 by paying a premium of Rs.29,938/-. On 15.03.2021 at about 6.45 p.m. Mr. Virender Kumar (brother of complainant) was passing through Flyover, Namastey Chowk, Karnal on the above car bearing registration no.HR-70C-5109. The ahead going canter suddenly applied brakes but the car of complainant could not be stopped immediately and dashed into the back portion of canter, due to which substantial damages were caused to the car. The driver of the car has also blunt injury. There is no mistake of anybody in this act. It was taken place just by chance. After the accident the damaged car was towed by a recovery van of Bagga Crane Service, Meerut Chowk, Karnal and sent to the Sidhak Automobiles, G.T. Road, Karnal. A DDR no.12 dated 16.03.2021 was registered by P.P. Sector-4, Karnal.  A claim was lodged on 17.03.2020 by the complainant with the OP before survey of the vehicle. Surveyor inspected the damaged vehicle and verified all the claim documents, arranged snaps of the accidental vehicle and discussed the loss with the repairer and complainant and instructed that the vehicle need not to be repaired because of the fact that vehicle is total loss and is beyond repair. All requisite claim documents were handed over to the surveyor, since the vehicle being beyond repair, the surveyor declared the vehicle total loss but the survey report prepared on the instructions of the OP for meager amount of Rs.1,49,341/- inspite of the fact that surveyor had observed that vehicle is total loss and valuation report of IRDAI approved surveyor Mr. Radhey Shyam Garg is placed on file.

 2.            It is further alleged that inspite of the fact that all the documents and queries were provided to the entire satisfaction of the OP, but OP by taking exception to its letter dated 03.06.2020 and 28.08.2020 repudiated the claim on 09.09.2020, on the ground that explanation submitted by the complainant vide letter dated 02.09.2020 has not been found satisfactory without any documentary evidences. After repudiation of the claim, complaint was lodged with office of Insurance Ombudsman on 06.01.2021, the hearing were conducted and the award was passed on 30.03.2021 in favour of complainant as admissible claim amount subject to terms and conditions of the policy, accordingly the insurance company which had already got prepared the survey loss assessment to Rs.1,49,341/- and the same was released to the complainant in satisfaction of the awarded passed by Insurance Ombudsman. This amount is short paid by Rs.1,89,698/-. Since IDV of the insured car is Rs.3,81,039/- (3,81,039- excess clause Rs.2000-wreck value Rs.40,000-amout of award Rs.1,49,341= 1,89,698/-). A period of more than two months has elapsed and claim for compensation for Rs.1,89,698/- is being lodged with this Commission. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence complainant filed the present complaint.

3.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi; jurisdiction and concealment of true and material facts. On merits, it is pleaded that the claim of the complainant was thoroughly processed by the OP by way of appointment of Shri Raman Chatwal, Surveyor and Loss Assessor, who thoroughly investigated the claim of the complainant and submitted the detailed report dated 28.08.2020 and who assessed the loss to the tune of Rs.1,49,341/-, which was subject to the approval and terms and condition of the insurance policy. Vide his report surveyor found that Damages to the vehicle are not correlate with cause of loss, misrepresentation of facts, moreover, the damages to under hood parts/mechanical parts, i.e. tappet cover, timing cover, air cleaner, air meter/air mass sensor, intake manifold, turbo battery, adaptor/oil filter etc. were found to be the result of direct hit on it and mark of same was clearly visible and previous claim of windshield claim was taken by insured but not replaced till date, further more the maker of windshield glass is available in market for not more than Rs.5000/- but the claim was taken of Rs.24000/- by insured. It is further pleaded that the IDV of vehicle was 3 lakh in 2016 while current IDV is higher than that. In this regard many letters dated 03.06.2020, 28.08.2020 and 02.09.2020 was written to the complainant wherein that Damages to the vehicle are not correlate with cause of loss and not accidental nature. The complainant has failed to provide satisfactory explanation to the quarries raised in the aforesaid letters.  Since the complainant failed to reply the said letters and the claim of the complainant was repudiated, vide letter dated 09.09.2020. It is further pleaded that the abovesaid complaint was earlier filed before Ombudsman court and the award of Rs.1,49,341/- was passed by that court. In compliance of the order passed by Insurance Ombudsman, OP has already paid the payment of awarded amount of Rs.1,49,000/- on 29.04.2021. It is further alleged the surveyor of the OP has also assessed the loss of the OP to the tune of Rs.1,49,341/-. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complainant.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of certificate of insurance policy Ex.C1, copy of claim form Ex.C2, copy of GDR no.12 dated 16.03.2020 Ex.C3, copy of statement of complainant Ex.C4, copy of driving licence of Virender Kumar alongwith RC Ex.C5, copy of bill dated 15.03.2020 Ex.C6, copy of survey report Ex.C7, copy of repudiation letter dated 09.09.2020 Ex.C8, copy of independent survey report from Radhe Shyam Garg Ex.C9, copy of complaint with Insurance Ombudsman Chandigarh Ex.C10, copy of mail from DFC Ministry of Finance of mohit Dahiya case against IFFCO Tokio General Insurance dated 09.08.2017 Ex.C11and closed the evidence on 12.08.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Ruhee Rana, working as Executive legal Ex.OW1/A, copy of order of Insurance Ombudsman Ex.O1, copy of payment process sheet Ex.O2, copy of calculation sheet Ex.O3, copy of letter dated 27.05.2020 Ex.O4, copy of letter dated 03.06.2020 Ex.O5, copy of letter dated 28.08.2020 Ex.O6, copy of letter dated 09.09.2020 Ex.O7, copy of insurance policy Ex.O8, copy of claim summary sheet Ex.O9, copy of investigation report Ex.O10, copy of final survey report Ex.O11, copy of statement of Vikas Ex.O12, photographs of car Ex.C13 and Ex.C14, copy of RTI letter dated 19.06.2020 Ex.O15, copy of application of empanelment sent by Virender Kumar Ex.O16 and closed the evidence on 13.07.2023 by suffering separate statement.

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

8.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that the complainant got insured his vehicle with the OP, for the sum insured of Rs.3,81,039/-. On 15.03.2021, the vehicle of the complainant met with an accident and badly damaged. The intimation in this regard was sent to OP. Upon which, OP has appointed a surveyor, who assessed the loss to the tune of Rs.1, 49,341/-, whereas IDV of the vehicle was to the tune of Rs.3,81,039/-. The claim of the complainant has been repudiated by the OP on the false and flimsy grounds. On repudiation, the complainant approached the  Insurance Ombudsman but Ombudsman has also passed the award only to the tune of Rs.1,49,341/- instead of Rs.3,81,039/- and lastly prayed for allowing the complaint.

9.             Per-contra, learned counsel for OP, while reiterating the contents of the written version has vehemently argued that the after thoroughly investigation, the surveyor has assessed the loss to the tune of Rs.1,49,341/-. The complainant has removed the vehicle in question from the site without any intimation, thus, the complainant has violated the terms and conditions of the insurance policy. An amount of Rs.1,49,341/- has already been paid to the complainant and there is no deficiency in service on the part of OP and lastly prayed for dismissal of complaint.

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

11.           Admittedly, the vehicle in question met with an accident during the subsistence of the policy. It is also admitted that IDV of the vehicle was Rs.3,81,039/-. It is also admitted that the OP has already paid an amount of Rs.1,49,341/- as assessed by the surveyor of the OP.

12.           The claim of the complainant has been repudiated by the OP vide repudiation letter Ex.C8/Ex.OP7 dated 09.09.2020 on the following ground, which is reproduced as under:-

“This is with reference to the above reported claim, letters sent to you on 03.06.2020 and 28.08.2020, your replied received on 02.09.2020, thorough social media, we have again reviewed subject claim and would like to inform your that the explanation submitted by your goodself is not found to be satisfactory without any documentary evidence.

In view of the above your claim stands repudiated.”

13.           The claim of the complainant has been repudiated by the OP on the above mentioned grounds Admittedly, the complainant has removed the vehicle in question from the spot without any intimation to the OP, thus the OP has deprived from their right to ascertain the actual cause of accident, thus, there is violation of terms and conditions of the insurance policy.

14.           The surveyor of the OP has assessed the loss to the tune of Rs.1,49,341/- vide surveyor report Ex.O11 dated 21.03.2020. The matter was also got investigated by the OP through its investigator who submitted his report Ex.O10 dated 14.06.2020. In his report, the investigator has mentioned that “it seems that insured vehicle not having accident damage and same was broken by insured/driver intentionally.”

15.           The claim amount assessed by the surveyor of the OP has not been released in favour of complainant, thus, the complainant had approached the Ombudsman. On hearing the parties, the Ombudsman has passed an award with the observation that admissible claim amount subject to terms and condition of policy is hereby awarded to be paid by the insurer to the insured towards full and final settlement of the claim. In compliance to the award passed by Ombudsman, on 29.04.2021, the OP has paid an amount of Rs.1,49,341/- to the complainant.

16.           The complainant claimed the remaining value of IDV of vehicle on the basis of surveyor report Ex.C9 dated 24.06.2021, prepared by Radhe Shyam Garg, Surveyor, loss assessor and Valuer. The said report has got prepared by the complainant after passing the award by the Ombudsman and after making the payment by the OP to the complainant. In the report Ex.C9, no findings have been given by the surveyor with regard to total damage of the vehicle and as to why the complainant is entitled for entire IDV of the vehicle in question. The said report has been prepared only on the basis of assumption and presumption. Furthermore, it appears that the said report has been prepared by the surveyor in collusion with the complainant just to extract money from the OP. Hence, the said report is not admissible in the eyes of law. 

17.           Hence, in view of the above, the present complaint is devoid of any merit and deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced
Dated: 15.04.2024 

  President,       

District Consumer Disputes

Redressal Commission, Karnal.

 

                  (Vineet Kaushik)              (Dr. Suman Singh)                                          

                            Member                          Member