Delhi

North East

CC/110/2022

Ankit Gupta - Complainant(s)

Versus

Edelweiss General Insurance Co. - Opp.Party(s)

04 Oct 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

Complaint Case No. 110/22

 

 

In the matter of:

 

	Sh. Ankit Gupta S/o Sh. Satish Kumar, R/o H.No. 405, Pocket Q, Dilshad Garden, Delhi	Complainant
	Versus
	Edelweiss General Insurance Co. Ltd. Through its Commercial Manager/Director   Corporate Office at:- 5th Floor, Tower 3, Kohinoor City Mall, Kirol Road Kurla West Mumbai,   Branch Office:- 503, 5th Floor, Mercantile House, 15, K G Marg, Delhi -110001	Opposite Party

 

DATE OF INSTITUTION: JUDGMENT RESERVED ON:  DATE OF ORDER:

09.05.22 11.08.23 04.10.23

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

Adarsh Nain, Member

ORDER

Anil Kumar Bamba, Member

The Complainant has filed the present complaint under Section 35 of the Consumer protection Act, 2019.

Case of the Complainant

1. The facts of the caseas revealed from the record are that the Complainantis the owner of vehicle bearing no. DL 08 CAN 09868,engine no. G4LAGM983454 chassis no. MALBM51BLGM233241 after expiry of previous insurance policy, Complainant purchased insurance policy from Opposite Party bearing no. 820069348 w.e.f. 05.05.21 to 04.05.22.The Complainant stated that on 15.04.22, the said vehicle met with an accident and vehicle was completely damaged. Thereafter Complainant completed all formalities and filed claim with Opposite Party bearing claim no. 600000000063018.The Complainant stated that as per the assurance of Opposite Party, Complainant waited several days and approached Opposite Party and official of Opposite Party told Complainant that claim is under process. The Complainant stated that Opposite Party emailed to Complainant and officials of Opposite Party refused to give damage and claim to Complainant stating “ Loss assessed of right side damage subject to the terms and condition of policy, other damages are not related with the cause of accident and not fresh hence disallowed”. The Complainant requested Opposite Party several times to clear the said claim but Opposite Party did not release the claim of Complainant. The Complainant stated that even after submitting the claim, Opposite Party failedto clear the claim of Complainant. The Complainant stated that despite serving legal notice Opposite Party failed to comply the norms nor replied to the legal notice. The Complainant made several request to Opposite Party and also sentlegal notice to Opposite Party for releasing the claim of Complainant but Opposite Party did not pay any heed to the request of Complainant. Hence this shows deficiency on the part of Opposite Party. The Complainant has prayed for the insurance claim with interest @ 24 % p.a. and Rs. 35,000/- for litigation cost. He has also prayed for Rs. 2,00,000/- towards mental harassment and Rs. 68,950/- to fix the accidental car as well as repair the windshield of the car.

Case of the Opposite Party

2. Opposite Party contested the case and filed written statement within the stipulated period. It is stated that the Complainant is the owner of the vehicle make HYUNDAI I 20, bearing Registration No. DL 08 CAN 09868, engine no. G4LAGM983454 chassis no. MALBM51BLGM233241 applied for Edelweiss Private Car Package Policy and submitted that application Form.
3. That on receipt of the application, required documents and believing the information filled by the Complainant as to be true, the policy bearing no. 820069348 was issued to the insured on 05.05.21 and the policy documents with welcome letter were sent to the insured i.e. Complainant and the same were delivered online to the insured with immediate effects. The said policy was valid from 05.05.21 to 04.05.22.
4. It is submitted that during the policy period the Complainant filed a Motor Accident Claim vide claim no. Dated 15.04.22 in the company’s call centre and submitted a claim of Rs. 68,950/- stating that I came back from Haridwar with my family on 15.04.22. , nearby Meerut road around 11 to 12 PM a big truck hits our car from backside and car was thrown ad truck dragging our car approx 8-10 feet.” A copy of the claim form intimation dated 15.04.22 submitted by the Complainant at the call centre of the Opposite Party and claim form dated NIL submitted by the Complainant. It is submitted that pursuant to receipt of the claim from the Complainant the Opposite Party appointed an independent IRDAI licensed Loss Assessor and Surveyor Mr. Harish Juneja to inspect the insured vehicle and assess the claim.
5. That the said Loss Assessor and Surveyor thoroughly investigated the claim after inspecting the vehicle carefully and arranging the necessary photographs submitted the survey report dated 01.07.22 to the Opposite Party wherein the said surveyor had assessed the total payable claim as Rs. 20,334/-. It is further submitted that the Opposite Party has also received the final invoice dated 01.07.22 from the Garage i.e. Jamuna Fashions Pvt. Ltd. 12/68, Sahibabad Industrial Area, Ghaziabad, Uttar Pradesh for a sum of Rs. 21,739/-. It is submitted that based on the said invoice as well as the survey report the Opposite Party has processed the claim and paid an amount of Rs. 20,334/- which was deposited in the account of the garage on 05.07.22 via UTR No. IN10N22070502YOR.
6. It is submitted that upon receipt of the above stated report dated 01.07.22 from the said loss assessor and surveyor as well as the invoice dated 01.07.22 received from the garage, the Opposite Party vide their reply dated 02.08.22 to the legal notice received on 22.07.22 sent by the Complainant has informed that the company has made the payment of Rs. 20,334/- in respect of the claim to the garage on 05.07.22.
7. It is submitted that since the company has already made the payment to the Complainant as per the invoice received from the garage and surveyor report the company has fully discharged its liability against the said claim, hence the present complaint is liable to be dismissed with heavy cost.

Evidence of the Complainant

8. The Complainant in support of his complaint filed his affidavit wherein he has supported the averments made in the complaint.

Arguments and Conclusion

9. We have heard the Complainant and we have also perused the file. The case of the Complainant is that he is having valid insurance policy for his vehicle w.e.f 05.05.21 to 04.05.22 and on 15.04.22 the said vehicle met with an accident and vehicle was completely damaged. It is further stated by the Complainant that he had completed all formalities and filed claim with Opposite Party. The Complainant persuade his claim with the Opposite Party and Opposite Party refused to pass his claim on the ground that “ Loss assessed of right side damage subject to the terms and condition of policy, other damages are not related with the cause of accident and not fresh hence disallowed”. After receiving this mail from the Opposite Party the Complainant requested the Opposite Party several times to clear the said claim but Opposite Party did not release the claim of the Complainant.  Hence this shows deficiency in service on behalf of Opposite Party. The Complainant did not file any policy document or copy of the claim paper submitted to the Opposite Party or copy of the repudiation letters as alleged by the Complainant.
10.  The case of the Opposite Party is that it is admitted that Complainant was having valid policy at the time of accident and during the policy period Complainant filed Motor Accident Claim of Rs. 68,950/- after receiving the claim from the Complainant Opposite Party appointed an independent IRDAI licensed Loss Assessor and Surveyor to inspect the insured vehicle and assess the claim.
11. The said Loss Assessor and Surveyor thoroughly investigated the claim after inspecting the vehicle carefully and arranging the necessary documents submitted the survey report to the Opposite Party wherein the said surveyor had assessed the total payable claim as Rs. 20,334/-. It is further submitted by the Opposite Party they had also received the final invoice from the Garage which had repaired the vehicle for a sum of Rs. 21,739/-. It is submitted that based on the said invoice as well as the survey report the Opposite Party has processed the claim and paid an amount of Rs. 20,334/- to the garage. It is submitted by the Opposite Party that since the Opposite Party had also made the payment to the Complainant as per invoice received from the garage and surveyor report they had fully discharged their liability against the said claim. Hence there is no deficiency in service on behalf of Opposite Party.
12. In view of the above facts, it is clear that Complainant did not approach this Commission with clean hands. He has not disclosed that the Opposite Party appointed independent licensed Loss Assessor and Surveyor, and also his claim was investigated and on the basis of surveyor report Opposite Party paid the amount assessed by the said surveyor to the garage i.e. Neev Autoworks, A Unit of Jamuna Fashions Pvt. Ltd.
13. In view of the above discussion, the complaint is dismissed.     
14. Order announced on 04.10.23.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room.

 

(Anil Kumar Bamba)           (Member)

(Adarsh Nain)    (Member)

(Surinder Kumar Sharma) (President)