By Sri. Mohamed Ismayil.C.V, Member
The Complainant alleged deficiency in service against the opposite parties in the following manner:-
1. The complainant had insured his vehicle (Maruthi Car No. KL-55-J-2996) with the first opposite party in the year 2019 through the agent of the second opposite party. Later the complainant again renewed policy in 2020 vide policy No. 39010231206100009330 for the period of 12/08/2020 to 11/08/2021. Prior to the year 2019, the complainant had availed insurance coverage policy continuously from of M/s New India Insurance Company. On 13/11/2020, the insured vehicle was hit by vehicle No. KL-43-A-4922 in the rear, as a result the insured vehicle moved forward and hit another car in its front side. Even though no case was registered by police a certificate was issued by the police with regard to the incident of accident. The damaged vehicle was taken to Popular Vehicles and Services Limited, Kottakkal for repairment and matter was informed to the opposite parties. Subsequently a surveyor of opposite party contacted the complainant and inspected the vehicle. Both opposite parties informed that the payment should be made directly by the first opposite party and balance amount should be remitted by the complainant. The service centre completed repair work on 07/12/2020, but the first opposite party did not pay any amount to take back the vehicle. After two weeks, the complainant directly paid Rs.40,598/-(Rupees Fourty thousand five hundred and ninety eight only) to the service centre and taken back the vehicle for his urgent use. The complainant contacted the opposite parties for reimbursement under insurance coverage. The second opposite party has collected Rs. 430/- from the complainant in connection with processing of insurance policy. But the opposite party did not pay the amount claimed by the complainant. On 11/05/2021, the complainant has sent application along with original bills to the first opposite party. On 02/06/2021, the complainant also sent document related to previous policy covered by M/s New India Insurance Company. But the opposite parties did not take any step to make payment under the policy coverage so far. So the complainant alleged that the opposite parties committed gross deficiency in service by not settling the claim within six months and even did not reply to the claim application of the complainant. So the complainant approached the Commission to redress his grievances. The complainant prayed for a direction to the opposite party to pay Rs. 40,598/- to the complainant towards the repair charges of the vehicle with 12% interest from 07/12/2020 onwards. The complainant also claimed Rs. 1,00,000/- (Rupees One lakh only) from the opposite parties as compensation for the sufferings of mental agony and hardship resulted due to the deficiency in service committed by the opposite party.
2. The complaint is admitted and notices are issued to the opposite parties. The opposite parties appeared and filed version separately.
3. In the version, the first opposite party has denied all allegations and contended that the complaint is not maintainable. The opposite party admitted that the vehicle of the complainant was insured as stated in the complaint. The opposite party also admitted that the insured vehicle was involved in an accident as alleged and a claim was also raised by the complainant. It is stated that the vehicle was insured with M/s New India Insurance Company earlier and subsequently the complainant approached the opposite parties and availed insurance policy of the first opposite party. The policy period started from 08/08/2019 to 07/08/2020. Later the policy was renewed on 12/08/2020 till the period of 11/08/2021. At the time of first issuance policy by the opposite party, the complainant had declared no claim and thus availed no claim bonus @ 25% in the present policy. After receiving the claim petition of the complainant, the first opposite party conducted an investigation and found that there was a claim under the previous policy with New India Insurance Company which was admitted orally by the complainant. It is alleged by the opposite party that even after availing earlier claim, the complainant also availed 20% no claim bonus under the policy issued by the opposite party for the period of 08/08/2019 to 07/08/2020 and later availed 25% no claim bonus for the policy issued during the period of 12/08/2020 to 11/08/2021. According to the opposite party, the complainant had erroneously claimed the amount and already availed the no claim bonus for two times by way of misrepresentation. It is stated by the opposite party that the opposite party has repudiated the claim of the complainant, because the insurance contract became null and void due to misrepresentation. The opposite party stated that an intimation dated 23/06/2021 was issued to the complainant describing the reasons for repudiation of claim. According to the opposite party, the complainant was not entitled for any amount or compensation as claimed in the complaint. There was no deficiency in service from the side of opposite party and hence prayed for dismissal of complaint.
4. The second opposite party also denied all allegation raised in the complaint and contended that the complaint is not maintainable. It is also contended that the second opposite party is not a necessary party in the proceedings. Moreover the complainant is not entitled for any relief as prayed in the complaint. The second opposite party admitted that the complainant had availed insurance policy through the second opposite party and renewed in the year 2020. It is submitted by the second opposite party that in the insurance portal, the engine number, chassis number are that of the complainant’s car , but in the vehicle description column it was shown as bike. The second opposite party requested the first opposite party to rectify the mistake and same is informed to the complainant also. It is further admitted by the second opposite party that the first opposite party had committed mistake in describing the details of vehicle in the online portal due to carelessness. It is admitted that the second opposite party was acted as an agent of the first opposite party. It is stated that the complainant had availed no claim bonus for which he was allegedly not eligible. It is submitted by the second opposite party that the complainant had remitted Rs. 423/- as the NCB amount on the basis of the instruction of the first opposite party, but the first opposite party did not pay the claim amount to the complainant . It is also stated by the second opposite party that the first opposite party should have entered the details of earlier claims in the insurance portal. The second opposite party prayed for dismissal of the complaint.
5. The complainant and opposite parties are filed affidavits in lieu of evidence and the complainant also produced documents. The Commission marked the documents produced by the complainant as Ext.A1 to Ext.A7 documents. Ext. A1 document is the copy of certificate –cum –policy schedule of vehicle No.KL-55-J-2996 issued by the first opposite party to the complainant showing the insurance coverage between 12/08/2020 to 11/08/2021. Ext. A2 document is the copy of Registration Certificate of vehicle number KL-55-J-2996 in favour of the complainant. Ext. A3 document is the copy of General Dairy abstract dated 14/11/2020 issued by the Tirur Police Station. Ext. A4 document is the copy of Job Card Retail – Tax Invoice dated 07/12/2020 issued by the Popular vehicles and services showing the cost of repair work of vehicle owned by the complainant. Ext. A5 document is the copy of receipt No. 10484 dated 24/12/2020 for Rs. 430/- issued by the second opposite party to the complainant. Ext. A6 document is the copy of letter dated 11/05/2021 sent by the complainant to the first opposite party. Ext. A7 document is the copy of letter dated 02/06/2021 and reminder dated 15/06/2021 through email by the complainant to the first opposite party. The opposite parties are not produced documents.
6. Heard both parties in detail. Perused documents and affidavits. The Commission considered the following points for its consideration:-
- Whether the opposite parties are committed deficiency in service towards the complainant.
- Relief and cost of the proceedings.
7. Point No.1 and 2:-
The complainant has averred that he is the owner of the vehicle No.KL-55-J-2996 and produced copy of Certificate of Registration before the Commission and same is marked as Ext. A2 document. It is also stated that the above said vehicle was insured with the first opposite party and the second opposite party was acted as an agent of the first opposite party. The complainant produced copy of Certificate –Cum Policy Schedule and the same is marked as Ext. A1 document. Ext. A1 document shows that the vehicle was insured during the period between 12/08/2020 to 11/08/2021. The complainant pleaded that on 13/11/2022 the insured vehicle was hit by a Car in the rear area resulting the movement of vehicle forward to hit another vehicle in its front. As result of the accident the vehicle of the complainant was damaged. The complainant produced copy of General Diary abstract issued by the Tirur Police Station and same is marked as Ext. A3 document. The complainant has taken the vehicle for repair work to the service centre and on 07/12/2020 repair work was completed. The complainant argued that he is entitled for reimbursement of the expenses incurred for the repair work under the insurance coverage of the first opposite party. Though, the complainant made repeated request to get reimbursed the expenses incurred for repair work, the opposite parties were turned down. The complainant produced copy of Job Card Retail -Tax invoice dated 07/12/2021 issued from service centre and it is marked as Ext. A4 document. Ext.A4 document clearly shows that the complainant had spent Rs. 40,598/- for repair work of the insured vehicle. The complainant produced copy of letter dated 11/05/2021 sent to the first opposite party requesting to release the claim amount and it is marked as Ext. A6 document. The complainant again sent a email dated 02/06/2021 to the first opposite party and a reminder dated 15/06/2021 to reimburse the claim amount and copy of email is produced before the Commission and same is marked as Ext. A7 document.
8. The opposite parties have admitted the issuance of policy by the first opposite party through the agency of second opposite party. It is also admitted by the opposite parties that the accident occurred during the period of insurance coverage. But the first opposite party contended that the complainant was not entitled for the reimbursement of claim under Ext. A1 document. It is stated by the first opposite party that the claim of the complainant was repudiated due to misrepresentation done by the complainant. In the evidence of first opposite party, it can be seen that the complainant had availed insurance policy in the year 2019 onwards. Subsequently the policy coverage was renewed on 12/08/2020 to 11/08/2021. It is contended that prior to 2019, the complainant had availed insurance policy coverage from M/s New India Insurance Company. After changing the insurer, the complainant had availed 20% no claim bonus during the policy period of 08/08/2019 to 07/08/2020 from the first opposite party. Later, during the period of policy coverage between 12/08/2020 to 11/08/2021, the complainant had also availed 25% no claim bonus from the first opposite party. It is averred that the first opposite party conducted an investigation and found that the complainant had made a claim under previous policy with New India Insurance Company which was admitted by the complainant orally. It is alleged that the above said claim was suppressed by the complainant and availed no claim bonus from the first opposite party. So it is contended that the complainant has no right to claim reimbursement under the present policy. In the version and affidavit it is claimed that second opposite party was not a necessary party in the proceedings. It is revealed by the second opposite party that in the description column of portal of first opposite party , the engine number and chassis number of the insured vehicle are correctly shown, but the vehicle was shown as bike instead of car. According to the second opposite party the above said mistake was a negligent act of the first opposite party. It is also revealed that the details of earlier claim, if any, should have entered in the portal by the first opposite party.
9. In the evaluation of evidence, it can be seen that the complainant has specifically stated that he had previously insured his vehicle with M/s New India Insurance Company and in the year 2019, he allied with the first opposite party due to the promise of good service given by the agent, who worked under second opposite party. Moreover the complainant has categorically stated in the affidavit that he did not claim any sum as insurance coverage as alleged in the versions of the opposite parties. In addition, it is also stated by the complainant that the opposite parties checked all details prior to the issuance of Ext. A1 policy. At the same time the opposite parties failed to adduce any kind of documentary evidence to show that the complainant had claimed any quantum of amount from the previous insurer i.e, M/s New India Insurance Company. The Commission is holding the view that if any claim had made by the complainant from previous insurer, definitely the opposite parties could have produce documents on that aspect. But the opposite parties failed to produce any document with regard to alleged previous claim. So in this situation, the Commission finds that the first opposite party committed deficiency in service towards the complainant by withholding the claim made under Ext. A1 document.
10. Ext. A6 and Ext. A7 documents produced by the complainant shows that the complainant had made consistent effort to get refunded the expenses incurred under Ext. A4 document. But no action was taken by the first opposite party. From the evidence of the complainant, it can be noted that the second opposite party had collected Rs. 430/- (Rupees Four hundred and thirty only) from the complainant in connection with policy claim. This fact also admitted by the second opposite party, who acted as agent of the first opposite party. It is categorically stated by the complainant that a surveyor was contacted and inspected the damage of the vehicle. But the first opposite party did not take any step to release the amount claimed by the complainant. It can be also find that the first opposite party even did not care to disclose the reason for withheld the claim application. The first opposite party did not produce any kind of document to show a communication made between the first opposite party and the complainant in connection with claim application. The contention of the first opposite party that the complainant had orally admitted previous claim has no evidentiary value before the Commission. The Commission finds that the first opposite party committed unreasonable delay in disposing the claim application of the complainant. So it can be find that there was no legal ground for the repudiation of claim. On the basis of above discussed facts and circumstances the Commission finds that the first opposite party has committed deficiency in service towards the complainant. There is no specific allegation against the second opposite party in the complaint. It is found by the Commission that the second opposite party acted as an agent of the first opposite party. But the act of repudiation was done by the first opposite party and there was no contribution from the side of the second opposite party in the procedure of repudiation. The first opposite party is solely responsible for the act of deficiency in service. Hence the complaint is allowed in the following manner:-
- The first opposite party is directed to refund Rs. 40,598/- (Rupees Fourty thousand five hundred and ninety eight only) to the complainant as per Ext. A4 document with 12% interest from 07/12/2021 till the date of this order.
- The first opposite party is directed to pay Rs. 25,000/- (Rupees Twenty five thousand only) to the complainant as compensation for the sufferings of mental agony and hardship due to the act of deficiency in service committed by the first opposite party.
- The first opposite party is also directed to pay Rs. 10,000/- (Rupees Ten thousand only to the complainant as the cost of the proceedings.
The first opposite party shall comply this order within 30 days from the date of receipt of copy of this order otherwise the entire amount shall carry 12% interest per annum, from the date of order till its realisation.
Dated this 13th day of June, 2023.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
APPENDIX
Witness examined on the side of the complainant : Nil
Documents marked on the side of the complainant : Ext.A1to A6
Ext. A1 : Document is the copy of certificate –cum –policy schedule of vehicle
No.KL-55-J-2996 issued by the first opposite party to the complainant
showing the insurance coverage between 12/08/2020 to 11/08/2021.
Ext. A2 : Document is the copy of Registration certificate of vehicle number KL-55-J-
2996 in favour of the complainant.
Ext. A3 : Document is the copy of General Dairy Abstract dated 14/11/2020 issued
by the Tirur Police Station.
Ext. A4 : Document is the copy of Job Card Retail – Tax invoice dated 07/12/2020
issued by the Popular vehicles and service showing the cost of repair work
of vehicle owned by the complainant .
Ext. A5 : Document is the copy of receipt No. 10484 dated 24/12/2020 for Rs. 430/-
issued by the second opposite party to the complainant.
Ext. A6 : Document is the copy of letter dated 11/05/2021 sent by the complainant
to the first opposite party.
Ext. A7 : Document is the copy of letter and reminder dated 02/06/2021 and
15/06/2021 through email by the complainant to the first opposite party
Witness examined on the side of the opposite party : Nil
Documents marked on the side of the opposite party : Nil
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
