Orissa

Cuttak

CC/158/2011

Urmila Singh - Complainant(s)

Versus

Branch Manager,National Insurance Co Ltd - Opp.Party(s)

R K Pattanaik

23 Feb 2017

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

C.C No.158/2011

Urmila Singh,

Res. of Baldev Jew Colony,

At/PO/Dist:Keonjhar.                                                           … Complainant.

 

                Vrs.

 

1.        Branch Manager,

National Insurance Co.,

Keonjhar Branch Office,

Mining Sqauare,Keonjhar.

 

2.        Sr. Divisional Manager,

National Insurance Company Ltd.,

Division Office No.I,

Mata Matha,Cuttack-1.                                                            … Opp. Party.

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Sri Bichitra Nanda Tripathy,LL.B. Member.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:   14.07.2011.

Date of Order: 230.02.2017.

 

For the complainant:   Sri R.K.Pattnaik,Advocate & Associates.

For the O.Ps.                : Sri B.N.Udgata,Advocate & Associates.

 

Sri Bichitra Nanda Tripathy,Member.

                The complaint is against deficiency in service on the part of O.Ps.

1. The complainant’s case in brief is that the complainant had purchased a Tata LPT 1612 truck for earning her livelihood under self employment.  The said truck was purchased by the financial assistance of “Tata Motors Ltd.” and was also insured with O.P., Insurance Company for the period from 14.11.07 to 13.11.08.  The insured declared value of the vehicle was Rs.4,80,000/-(Annexure-1 & 2).  On 13.07.2008, the said vehicle faced an accident near Keonjhar and fell down into the river.  Necessary police case was lodged for the purpose and O.P.1 was intimated accordingly.  OP.1 deputed a surveyor to the spot who inspected the vehicle on 15.7.2008 and submitted his report dt.20.7.2008 (Annexure-3).  Subsequently the vehicle was sent to a garage namely “M/s. Bajrangi Automobiles” for repair and dismantling to the vehicle.  A 2^nd surveyor was again deputed by O.P.1, who inspected the vehicle and assessed the loss at Rs.1,42,000/- and submitted the report dt.9.4.2009(Annexure-4).  The repair estimate as submitted by M/s. Bajrangi Auto Works was Rs.7,45,120/-(Annexure-5).  The complainant requested O.P.1 to settle his claim on total loss basis vide letter dt.8.6.2009 whereas O.P.1 intimated the complainant vide letter dt.10.7.2009 that the claim cannot be settled on total loss basis. (Annexure-7).  The O.P. vide letter dt.14.12.2009 intimated the complainant to assess the loss on cash loss basis which was calculated at Rs.1,02,967/- and asked the complainant  to give her consent  otherwise the file will be closed treating the same as “No claim”.  On 15.2.2010 the complainant requested the O.P to reassess the claim or to pay her Rs.3,30,000/- by deducting Rs.1,50,000/- as salvage value(Annexure-9).  Bhubaneswar Regional office of the O.P Insurance Company intimated the borrower on 16.3.2010 that in case the complainant is not satisfied with the claim settlement made by their Keonjhar Branch (O.P.1) she may move to Hon’ble Insurance Ombudsman,Bhubaneswar(Annexure-10).  Finding no other way she has filed this case under this Hon’ble Forum.  She has prayed for payment of claim amount from the O.Ps on total loss basis amounting to Rs.7,45,120/-, compensation for mental agony Rs.1,00,000/-, cost of litigation Rs.3000/- and thus has claimed Rs.8,48,120/-.
2. The O.Ps vide their written version dt.18.11.2011 have intimated that the complainant had insured her vehicle with O.P.1 vide policy No.163006/31/07/6300002267 for the period from 14.11.2007 to 13.4.2008.  The insured declared value of the vehicle was Rs.4,80,000/- which is subject to terms and conditions of the policy and risk covered under the policy as envisaged therein.  The vehicle faced an accident on 13.7.2008.  The Insurance Company was intimated and a surveyor was deputed to conduct spot survey on 15.7.2008 and submitted his report on 20.7.2008.  The complainant was advised to take the vehicle to a garage for repair.  The complainant took the vehicle to M/s. Bajrangi Automobiles where the vehicle was dismantled.  Another final surveyor namely Er. S.C.Senapati was deputed to survey the damaged vehicle.  After conducting thorough survey, the surveyor submitted his final report on 9.4.2009 assessing the loss at Rs.1,42,000/-.  In reply to complainant’s letter dt.8.6.2009, the O.P intimated that when the aggregate cost of retrieval or repair of the vehicle subject to terms and conditions of the policy exceeds 75% of insured declared value, then only the claim can be settled on total loss basis.  Since the surveyor had assessed the loss at Rs.1,42,000/- which comes around 30% of IDV and is  also much less than 75% of IDV, the O.P requested the complainant to submit required original bills/money receipts cash memos etc. towards replacement of parts and labour charges along with other documents such as R.C.Book,fitness certificate,permit,driving license etc for settlement of the claim.  The complainant without complying the same wrote another letter addressing CMD to settle the claim on total loss basis against which the O.P reiterate the explanation made vide their letter dt.10.7.2009 & expressed their inability to settle the claim on total loss basis and on the other hand offered the complainant to accept a sum of Rs.1,02,967/- on cash loss basis without submission of any bills, cash memos and requested the complainant to give her consent within a fortnight in order to release the amount failing which the file will be closed as no claim.
3. We have gone through the case thoroughly, heard the learned counsel of both the sides at length, perused the documents as filed by the complainant as well as by the O.Ps minutely and have observed that the vehicle of the complainant faced an accident near Keonjhar on 13.7.2008.  Since the vehicle was insured with O.P.1, the complainant intimated the matter to O.P.1 and in turn O.P.1 deputed a spot surveyor for the purpose who made required survey on the spot on 15.7.2008 and submitted his report on 20.7.2008.  Then the vehicle was taken to the garage for repair and dismantling.  The 2^nd surveyor conducted survey of the damaged vehicle and submitted a detailed report where in the surveyor has reported that the quantum of damages sustained was virtually not that high, although estimate submitted or the claim lodged by the insured was of very much higher value amounting for Rs.7,45,120/- against the IDV that has been fixed against the captioned vehicle for Rs.4,80,000/-.

                The surveyor has also reported that during their discussion in this regard with the Insured’s Husband Mr. Singh, the surveyor clarified them in details that why the captioned claim could not be settled on “Constructive Total Loss”(CTL) basis considering the quantum of damages sustained and also the liability of the insurer that comes on the Net Repair basis of assessment.  The surveyor tried his level best to convince them about the fact that, the captioned claim not at all viable for CTL basis of settlement and also advised for dismantling of the vehicle for further inspection by the surveyor in Post-dismantling condition, which is quite essential in order to ascertain the exact “extent and quantum” of damages sustained including the internal items so also for proper assessment of the aforesaid loss.  However, finally they agreed and assured to expedite the matter and also to intimate the surveyor in due course after completion of the necessary dismantling works.

 

                Finally, after completion of necessary survey and Inspection against the captioned vehicle, the surveyor worked out the Assessment against the aforesaid loss sustained that based on the Estimate of repair submitted and most importantly considering the affected items that the undersigned could observed during thorough physical inspection against the captioned vehicle in both Pre & Post-dismantling conditions( items that produced before us in dismantling condition and also considering the all the related damaged items, although not asked as per the Estimate submitted), in order to ascertain the maximum liability of the Insurer in monetary quantum that comes on “Net Repairing Basis”.  However, considering the Net Loss assessment on “Repairing Basis” it is observed that, as per norms of the policy issued the captioned claim not at all coming under the scope of “Constructive Total Loss” CTL Basis of assessment being the Net Assessment comes around 30% of the IDV- much less than that of 75% which actually is the bench mark for admissibility of claim on Constructive Total Loss Basis.  Hence, the mode of Assessment got finalized. (As reported by surveyor Er. S.C.Senapati vide his report dt.09.04.2009-page-5,sl.no.3,para-3 & 4)

 

The complainant has not challenged the report of the surveyor, rather insisted to settle the claim on total loss basis.  Estimate given by the complainant to repair the damaged vehicle for Rs.7,48,120/- appears to be too much on higher side since IDV of the said vehicle was Rs.4,80,000/-.  Thus we conclude that the surveyor has clarified the situation/condition for which the vehicle claim was not settled on total loss basis.

Total loss thus assessed by the 2^nd surveyor i.e. Er. S.C.Senapati was calculated at Rs.1,42,000/-. Vide her letter dt.8.6.2009 the insurer requested to settle the claim as total loss basis which was not acceptable to O.P. insurance company.  The O.P. insurance company has briefed the reason for which the claim cannot be settled on total loss basis vide their letter dt.10.7.2009.  Since the complainant did not submit the original bills, money receipts and all other documents required for settlement of claim, the O.P.1 gave an offer to the complainant to settle the claim on cash loss basis for Rs.1,02,296/- vide their letter dt.14.12.2009 which was also not acceptable to the complainant.  The complainant lodged a complaint with CMD of O.P,Insurance Company for which Bhubaneswar Regional Office vide their letter dt.16.3.2010 have clarified the matter before the complainant that the final surveyor was a IRDA A-grade surveyor who after due inspection of the vehicle has assessed the loss on repair basis for Rs.1,42,000/-.  The said claim does not qualify for total loss settlement.  Only when the repair assessment exceeds 75% of IDV the claim can be settled on total loss basis.

ORDER

Basing on the facts and circumstances as stated above, we have observed that the O.Ps are not at fault.  Hence the case is dismissed.

Typed to dictation, corrected and pronounced by the Hon’ble Member in the Open Court on this the 23^rd  day of February,2017 under the seal and signature of this Forum.

 

   (Sri B.N.Tripathy )

                                                                                                        Member.

 

                                                                                                     (  Sri D.C.Barik )

                                                                                                              President.

 

 

                                                                                                     (Smt. Sarmistha Nath) 

                                                                                               Member(W).