Order by:

Smt.Aparana Kundi, Member

1.           The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 on the allegations that the complainant get insured his Motorcycle i.e. Royal Enfield (Unit of Eicher Ltd.) bearing registration no.PB-05-AK- 6078 from opposite parties no. 1 to 3, vide Insurance policy no.3409/00114974/000/00 for the period from 07.10.2021 (wrongly mentioned in complaint as 17.10.2021) to 06.10.2022. Unfortunately on 09.10.2021 the above mentioned insured vehicle of complainant had met with an accident and due to such accident the insured vehicle of complainant got damaged and complainant informed the opposite parties about such incident and also submit his claim to Opposite Parties. Thereafter, Opposite Parties appointed the surveyor and investigator to verify about the loss caused to the insured vehicle and he also visited at the spot and verify about such loss. Thereafter, the complainant had got his vehicle repaired from opposite party no.4 i.e. M/s Royal Hut and they also informed complainant as well as Opposite Parties that the total loss-cum-damage caused to the said insured vehicle is Rs.14,798.84/- including costs of repair of said vehicle and he also informed that above said payment is due against him, but Opposite Parties no.1 to 3 did not pay any amount to said agency i.e. opposite party no.4 and then in order to release his vehicle from said agency complainant has to pay whole of the said bill under protest. Thereafter, the complainant received a letter on 27.11.2021 from the office of Opposite Parties no.1 to 3, vide which the claim of the complainant is rejected with the excuse that ‘During investigation break in fraud as damage parts changed by dealer in break in pics. Hence claim not admissible.’ The complainant has not committed any fraud with the opposite parties no.1 to 3 as alleged by them. Due to the act and conduct of the Opposite Parties no.1 to 3, complainant suffered mental tension and harassment. Hence this Complaint. Vide this complaint, the complainant has sought the following reliefs”-

a)       Opposite Parties no.1 to 3 may be directed pay the claim amount of Rs.14,798.84/- with interest @ 24% per annum to the complainant from the date of accident i.e. 09.10.2021 till the realization of the amount.

b)      To pay an amount of R.1,00,000/- as compensation on account of damage and harassment caused to the complainant.

c)       To pay an amount of Rs.50,000/- on account of mental agony  alongwith Rs.5500/- as costs of the complaint.

d)      And any other relief which this Commission may deem fit and proper be granted to the complainant in the interest of justice and equity.

2.       Opposite Parties no.1 to 3 appeared through  counsel  and contested the complaint by filing  the written version taking preliminary objections therein inter alia that the intricate questions of law and facts are involved in the present complaint which require voluminous documents and evidence for determination which is not possible in the summary procedure under Consumer Protection Act and appropriate remedy, if any, lies only in the Civil Court. The complainant has concealed material facts and documents from this Commission as well as from the Opposite Parties. Therefore, the complainant is not entitled to any relief. Further alleged that on perusal of documents and after investigation, it was found that it was a case of close proximity, as the insurance was taken from 07.10.2021 to 06.10.2022 and accident was alleged to be on 09.10.2021. During investigation it was found that it was break in fraud as damage parts changed by dealer in break in pics, hence the claim was not admissible and decided as such vide letter dated 27.11.2021. The complainant was called upon to give clarifications but no such clarifications were given. The red lines in logo in fuel tank were not there in survey reports and golden lines on tool box were not in break in photos. In view of this non disclosure of vital/material information the contract of insurance became void and no claim is payable. The complaint is not maintainable in the present form. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.

3.       Opposite party no.4 filed written reply taking certain preliminary objections therein inter alia that the present complaint is not maintainable as the same is false, frivolous and vexatious to the knowledge of the complainant. The answering opposite party has no business or concern with the Insurances of the vehicle and only deals in selling, repairing and servicing of Motor Vehicle make Royal Enfield. The complaint is regarding the rejection of the insurance claim which is filed by the complainant with opposite parties no.1 to 3. The answering Opposite Party has been falsely arrayed as party to the present complaint. Further alleged that complainant came with one bike model Royal Enfield Bullet 350 having registration NO.PB-05AK-6078 on 11.10.2021 in the showroom of answering Opposite Party. Entry regarding the same was entered in the register. The complainant wanted to get the same repaired and showed his insurance papers. The officials of the answering Opposite Party after seeing the insurance papers got filed the Motor Claim insurance Form from the claimant and intimated the claim to the insurance company and an estimate of Rs.15681.91/- was prepared. The officials of the answering Opposite Party also took all the necessary papers from the complainant and forwarded the same to the insurance company. After waiting for few days, when no reply was received from the insurance company. The complainant requested the officials of the answering Opposite Party to repair the bike. After the necessary repair and service a bill of Rs.14,798.84/- was prepared which the complainant paid. Further alleged that Opposite Party has no business to check the details of the accident or the reasons for the repair of the bike. The details of the accident are filed in the Claim form as mentioned by the claimant. On the request of the person insured, the claims were forwarded to the insurance companies and during that time if any person requests that the repair be done with or without approval of the insurance company, the same is done. Like wise, in the present case, the complainant requested to got repair the bike and job card was prepared on 01.11.2021 and invoice was prepared on 12.11.2021. All the parts which are changed were new and original and the same find mention in invoice dated 12.11.2021 along with the description of the part changed, Code, HSN No, price and taxes. Seemingly, the insurance company in order to avoid paying its liability is leveling false allegations on the answering Opposite Party without any substance or evidence to prove the same. The answering Opposite Party reserves its right to launch appropriate criminal as well as civil proceedings against the insurance company for leveling false and baseless allegations against the answering Opposite Party. On Merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.

5.       In order to prove his case, complainant tendered in evidence his affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C7.

6.       To rebut the evidence of complainant, Opposite Parties No.1 to 3 tendered in evidence copies of documents Ex.OP1 to 3/1 to Ex.OP1 to 3/3 and affidavit of Sh.Rajeev Kumar Nischal, Owner, Capital Risk Management Company Ex.OP1 to 3/4. Whereas, opposite party no.4 tendered in evidence affidavit of Sh.Tarik Narang, Proprietor Ex.OP4/1 alongwith copies of documents Ex.OP4/2 to Ex.OP4/7.

7.       We have heard the counsel for the parties and also gone through the documents placed on record.

8.       Ld. Counsel for the complainant contended that complainant got insured his Motorcycle i.e. Royal Enfield bearing registration no.PB-05-AK-6078 from opposite parties no. 1 to 3, vide Insurance policy no.3409/00114974/000/00 for the period from 07.10.2021 to 06.10.2022. On 09.10.2021 the said insured vehicle of complainant met with an accident and due to such accident the insured vehicle of complainant got damaged and complainant informed the opposite parties about the incident. Thereafter, Opposite Parties appointed the surveyor and investigator to verify about the loss caused to the insured vehicle and he also visited at the spot and verify about loss. Thereafter, the complainant got his vehicle repaired from opposite party no.4 i.e. M/s Royal Hut and they also informed complainant as well as Opposite Parties that the total loss-cum-damage caused to the said insured vehicle is Rs.14,798.84/- including costs of repair of said vehicle, but Opposite Parties no.1 to 3 did not pay any amount to said agency i.e. opposite party no.4 and then in order to release his vehicle, complainant has to pay whole of the said bill under protest. Opposite Parties no.1 to 3 rejected the claim of the complainant vide letter dated 27.11.2021. On the other hand, defence of the Opposite Parties no.1 to 3 is that after investigation it was found that it was a case of close proximity as the insurance was taken from 07.10.2021 to 06.10.2022 and the accident was alleged to be on 09.10.2021 and during investigation it was found that it was break in fraud as damage parts were changed by dealer with old ones, hence the claim was not admissible and rejected vide letter dated 27.11.2021. Whereas, ld. Counsel for opposite party no.4 contended that opposite party no.4 has no business or concern with the insurance of the vehicle and only deals in selling, repairing and servicing of Motor Cycles make Royal Enfield. The complainant requested to get his bike repaired and accordingly job card was prepared on 01.11.2021 and invoice was prepared on 12.11.2021. All the defective parts were changed with original and new ones and the same were mentioned in invoice.

9.       We have considered the rival contentions of ld. Counsel for the parties and have gone through the record. As per the report of the surveyor Ex.OP1 to 3/3 clues of accident of the vehicle is found, complainant suffering from injuries admitted, spot inspection is also done. However, in the Final Conclusion, Surveyor submitted that suspected change of date of loss by insured in view of the close proximity of policy, medical treatment seems managed and break in photographs do not matched and seems managed. But the pleas taken by the surveyor are not supported with any cogent and convincing documentary evidence on record and it’s only presumptions. If the policy is admitted, the clues of accident are found, complainant’s injuries are admitted, then there is no reason for Opposite Parties to repudiate the claim of the complainant. In view of the above, we are of the view of that the repudiation of the claim of complainant by Opposite Parties seems to be unjustified.

10.     From the above facts and circumstances, we partly allow the complaint of the complainant and direct the Opposite Parties No.1 to 3-Insurance Company to pay the claim amount of Rs.14,798/-(Rupees Fourteen Thousand Seven Hundred Ninety Eight only) to the complainant alongwith interest @ 8% p.a. from the date of filing of the complaint i.e. 10.01.2022 till its actual realization. Complaint against Opposite Party No.4 stands dismissed. Keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. The compliance of this order be made by the Opposite Parties No.1 to 3-Insurance Company within 45 days from the date of receipt of the copy of this order, failing which, the Opposite Party is burdened with additional cost of Rs.2,000/- (Rupees Two Thousand only) to be paid to the complainant for non compliance of the order.  Copy of the order be supplied to the parties, free of costs. File be consigned to record room after compliance.

Announced in Open Commission