Punjab

Faridkot

CC/22/119

Gurlal Singh - Complainant(s)

Versus

Bajaj Allianz General Insurance - Opp.Party(s)

Ashu Mittal

14 Mar 2023

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, FARIDKOT

 

C.C.  No. :             119 of 2022

Date of Institution:   01.08.2022

Date of Decision :    14.03.2023

 

Gurlal Singh son of Kashmir Singh r/o Village Dhira Patra, District Ferozepur now resident of villainge Pipli Tehsil and District Faridkot.

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

Versus

Bajaj Allianz General Insurance Company, Branch Office, SCO 30-31, 2^nd Floor, Guru Ram Dass Divine Tower, Puda Complex, Opposite Tehsil Complex, Jallandhar.                                               ..............OP

 

Complaint under Section 35 of the

Consumer Protection Act, 2019.

 

Quorum: Smt Param Pal Kaur, Member,

               Sh Vishav Kant Garg, Member.

 

Present: Sh Ashu Mittal, Ld Counsel for complainant,

              Sh Satish Kumar Jain, Ld Counsel for OP.

 

ORDER

( Param Pal Kaur, Member)

                    Complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against OP seeking directions to OPs to make payment of Rs.20,00,000/-with interest and for further directing OPs to pay Rs.2,00,000/- as compensation for harassment, inconvenience, mental agony and Rs.22,000/-as litigation expenses.

2                Briefly stated, the case of the complainant is that complainant owns a car and he got insured his car with OP vide Private Car Package Policy No.OG-22-1201-1801-00000794 valid from 15.07.2021 to

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14.07.2022 against all kinds of risks and paid premium of Rs.40,574/-to OP. It is submitted that during the validity of insurance period on 11.01.2022 which was a foggy day, said car of complainant met with an accident. Vehicle was on the way to Chandigarh, when a stray cattle suddenly came on the road and to save the said cattle, complainant applied brake in emergency, meanwhile, a truck coming from backside hit the vehicle of complainant, due to which vehicle got off the road after breaking milestone and hit the electricity tower. Police of Police Station Kulgari visited the accident site and also got recorded DDR to this effect on same day. Information regarding this was also given to OP, who sent Surveyor Mr Om Parkash Yadav. Said surveyor conducted spot survey and thereafter, OP deputed Er. Sunil Chawla for conducting final survey as vehicle was parked at G S Auto World for repair and estimate of Rs. 50 lacs approx was made. After processing of claim, vehicle of complainant is under ambit of total loss. OP stated that vehicle is in category of total loss and tried to make negotiations verbally for taking less amount as IDV of vehicle is Rs.20 lacs. OP stated that claim is being processed and thereafter in connivance with final surveyor, OP lingered on the matter for not paying the genuine claim of complainant. After that OP deputed Investigator who submitted his report on the basis of information collected from spot and nearby places. After completion of investigation, complainant approached OP with requests to process his claim, but OP kept lingering on the matter on lame excuses. Complainant also made complaint regarding his grievance to

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Ombudsman and IRDA vide token no.03-22-013159, on which OP stated that they are settling the claim, but thereafter, complainant received letters dated 25.04.2022 and 02.06.2022 from OP vide which they repudiated the claim of complainant on the ground that cause of reported loss narrated by complainant on claim form does not correlate and loss is not concurrent with physical damages seen on accidental vehicle. OP also blamed complainant for misrepresentation of facts. On receipt of these letters, complainant approached OP and obtained Spot Survey Report wherein it was mentioned that damages were fresh with respect to cause, magnitude and nature of accident and several front and rear portion parts were found broken or deformed. Complainant made several requests to OP to pass his genuine claim, but all in vain. This act and conduct of OP 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.2,00,000/-as compensation and Rs.22,000/- for cost of litigation besides the main relief. Hence, the present complaint.

3                      Ld counsel for complainant was heard with regard to admission of the complaint and vide order dated 03.08.2022, 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 all the allegations levelled by complainant are wrong and incorrect and there is no

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deficiency in service on their part. it is averred that complainant has not disclosed all the necessary facts and it is liable to be dismissed on this ground. It is asserted that vehicle of complainant is make BMW, model 525 D, manufactured in year 2011 and it met with an accident on 11.01.2022. It is further averred that accident took place on 11.01.2022, but complainant got registered his claim with answering OP on 14.01.2022 after delay of three days. On receipt of intimation regarding said accident, OP appointed Investigator, who investigated the claim, got recorded the statement of Insured/driver and then, submitted his report on 29.01.2022. OP averred that as per complainant, he purchased the vehicle in question for Rs.19,60,000/-and paid entire amount in cash, but nothing is placed on record to prove this fact. Moreover, as per Income Tax Act, cash transaction is limited upto Rs.2 lacs  per day. OP also appointed domain expert to carry out accident reconstruction and to provide his domain opinion. Domain Experts are a team of renowned Doctors, Automobile engineers and Forensic Experts that explore every minute detail of accident and give their findings after detailed scrutiny, study and research. Domain Expert gave Motor Accident Reconstruction Report dated 31.03.2022 wherein opined that narration of events given by complainant, does not correlate with the damages caused to vehicle. Answering OP also appointed independent IRDAI approved Surveyor, who gave report dated 01.07.2022 wherein submitted that damages to the insured vehicle are fabricated and con concurrent with the cause of loss mentioned by insured. As per report, complainant is guilty of

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concealment and misrepresentation and therefore, answering OP has rightly repudiated the claim of complainant. 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-10 and then, closed his evidence.

6                       In order to rebut the evidence of the complainant, the OPs tendered in evidence documents Ex OP-1 to OP-4 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                       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 while saving a stray cattle. DDR No.22 dated 11.01.2022 to this effect was got recorded in Police Station, Kulgari and due intimation regarding it was also given to OP. OPs appointed Surveyor, who after inspecting  the damaged vehicle reported that damaged vehicle is a total loss and is

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non-repairable. sAfter processing of claim, vehicle of complainant was found under ambit of total loss. OP tried to make negotiations verbally for taking less amount as IDV of vehicle is Rs.20 lacs, but thereafter, complainant received letters dated 25.04.2022 and 02.06.2022 regarding repudiation of claim on the ground that cause of reported loss narrated by complainant on claim form does not correlate and loss is not concurrent with physical damages seen on accidental vehicle. OP blamed complainant that damages were fresh and several front and rear portion parts were found broken or deformed. Grievance of the complainant is that despite completion of formalities and several requests, Op has wrongly and illegally repudiated the claim of his vehicle, which amounts to deficiency in service.

9                   To prove his case, complainant has relied upon document Ex C-2 /copy of insurance policy, that proves the fact that car of complainant was insured with OP for sum of Rs.20 lacs and there is also no doubt that accident occurred during the subsistence of insurance period, Ex C-4 copy of DDR dt 11.01.2022 also states the grievance of complainant. Ex C-9 copy of letter dt 25.04.2022 vide which OP illegally and unlawfully repudiated the genuine insurance claim of complainant on false grounds.Through his affidavit Ex C-1, he has reiterated his pleadings with request to redress his grievance.

10                   It is admitted case of the parties that vehicle of complainant was insured with OP, which met with an accident during

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the insurance period. It is also admitted that complainant duly gave intimation regarding accident to OP, who appointed Surveyor and Investigator to investigate the claim of complainant. The only plea of OP is that in their investigation, it is found that narration of events given by complainant, does not correlate with the damages caused to vehicle which is clear violation of terms and conditions of the policy and admitted that they have rightly repudiated the claim.

11                          It is observed that entire story regarding the repudiation of claim on false grounds is made up by OP 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 narration of events given by complainant, does not match or correlates with the damages caused to the vehicle, then in that case also, the OPs cannot repudiate the claim of complainant as there is no allegation that accident did not happen. OP cannot deny the Survey Report wherein it is clearly  mentioned regarding damage of major part of the vehicle. There is nothing on behalf of OP to contradict the report given by Police regarding accident dated 11.01.2022 that occurred due to heavy fog. There is no allegation

 

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of OP that accident occurred due to unskilled and negligent driving of the driven in question.

12                                    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 to 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.

13                                 From the above discussion, we are of considered opinion that OP have failed to prove that vehicle of the complainant is not entirely damaged. The claim of complainant is repudiated by OPs on

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flimsy grounds, which amounts to deficiency in service and trade mal practice on the part of OP. Hence, complaint in hand is hereby allowed. OP is therefore, directed to pay entire amount of Rs.20 lacs i.e insured value of the vehicle to the complainant within 45 days of transfer of ownership in the name of OP by complainant, failing which it shall carry interest at the rate of 4% per anum from the date of order till final realization. Opposite party is 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. Complainant is also directed to transfer the ownership of vehicle in question in the name of Opposite Party within one month of receipt of this order. Compliance of this order be made by respective parties within stipulated period as mentioned above. Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Announced in Commission

Dated : 14.03.2023

(Vishav Kant Garg)                  (Param Pal Kaur)    Member                                           Member