BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL COMMISSION, JALANDHAR.
Complaint No.146 of 2021
Date of Instt. 05.04.2021
Date of Decision: 31.05.2023
Sh. Parmod Kumar S/o Sh. Shadi Lal R/o Mohalla Sant Nagar, Nurmahal, Distt. Jalandhar 144039.
..........Complainant
Versus
1. Go Digit General Insurance Company Limited, with its Branch Office at BSF Chowk, Jalandhar through its Branch Manager.
2. Go Digit General Insurance Company Limited, Atlantis, 95, 4th B Gross Road, Kara Mangala Industrial Layout, 5th Block, Bengaluru, Karnataka-560095 through its Managing Director/Authorized Official.
3. General Insurance Services, Jalandhar Business Centre, Shop No.3, New Rajinder Nagar, Jalandhar City-144001 through its Prop/Partner.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Dr. Harveen Bhardwaj (President)
Smt. Jyotsna (Member)
Sh. Jaswant Singh Dhillon (Member)
Present: Sh. A. K. Arora, Adv. Counsel for the Complainant.
Sh. Raman Sharma, Adv. Counsel for OPs No.1 and 2.
OP No.3 Withdrawn.
Order
Dr. Harveen Bhardwaj (President)
1. The instant complaint has been filed by the complainant, wherein it is alleged that the complainant is the owner of Car Toyota Innova bearing Registration certificate, P808- CT-0047. The complainant got his Car bearing Registration certificate PB08-CT-0047 insured from the OP No.1 through OP No.3 for a sum of Rs.965000/- for the period 15.09.2018 to 14.09 2019 vide policy of insurance bearing no.D001230880. OP No.2 is the head office of OP No.1. Vide the said policy of insurance, the OP No.1 has undertaken to reimburse and indemnify the complainant for the loss/damage caused to the vehicle during the operational period of policy of insurance. On 17.07.2019 at about 11.45 PM, the car of the complainant met with an accident and was badly damaged in the said accident and was a total loss. At the time of accident the son of the complainant namely Chetan Sekhri was driving the car in question Intimation qua the accident to the car was given to OP No.1 immediately and the car was sent to ANR Motors Pvt. Ltd. the authorized repairer and dealer of Toyota Car. As per estimate prepared by M/s ANR Motors Pvt. Ltd. the total damage caused to car was to the tune of Rs.13,37,543 00, which is more than the insured value of the car. The OPs No.1 and 2 wrote letters dated 31.07.2019 and 14.08.2019 asking for certain queries detailed in these letters. These queries were duly replied and as desired by the opposite party affidavits were submitted with OP No.1. Necessary documents called vide letters dated 31 07 2019 and 14.08.2019 were also submitted with OP No.1. The OP No.1 also appointed surveyor to assess the loss, who inspected the vehicle at the workshop of M/s ANR Motors. The car of the complainant is a total loss and still lying in the damaged state with the complainant. Till today the OP has not settled the claim and has not made payment of Rs.965000.00 to the complainant, being the insured value of Car to the complainant. On the insisting by OP, the matter was also reported to police qua the said accident GD No.33 dated 29.07 2020 in respect of said accident was got recorded with Police Station Goraya, Distt. Jalandhar. The OPs No.1 and 2 are wrongly and illegally withholding the genuine and bonafide claim of the complainant and has not paid the claim amount to the complainant qua the damage/loss caused to the vehicle of complainant in the aforesaid accident. The OPs No.1 and 2 are indulging in unfair trade practices and the services provided by the OP are deficient and defective in nature and as such, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to make the payment of Rs.9,65,000/- being the insured value of the vehicle alongwith interest @ 12% per annum from the date of loss i.e. 17.07.2019 till the date of payment. Further, OPs be directed to pay a compensation of Rs.1,00,000/- for causing mental tension and harassment to the complainant and Rs.22,000/- as litigation expenses.
2. Notice of the complaint was given to the OPs and accordingly, OPs No.1 and 2 appeared through its counsel and filed written reply and contested the complaint by taking preliminary objections that at the outset all the allegations and assertions made by the complainant in the complaint are hereby denied in toto and the allegations which are not denied specifically may not be taken as admitted, the complainant may be put to strict proof of his pleadings. It is further averred that the complainant has concealed the material facts from this Commission and as such not entitled for any discretionary relief. It is further averred that the insurance is a contract based on utmost good faith. It is the duty of the insured to disclose all the relevant facts and to provide all the documents demanded by the insurance company required for finalization of the claim. It is further averred that there is no deficiency in services on the part of the insurance company. It is the complainant who is at fault and failed to fulfill his part of obligation. It is further averred that the complainant has availed ‘Digit Private Car Package Policy’ vide Policy No.D001230880 for his car, a Toyota Innova bearing registration No. PB08CT0047 Having coverage of Insurance from 15 Sep 2018 to 14 Sep 2019 from the present opponent and the copy of policy schedule and its terms and conditions are on record. It is further averred that as per narration furnished by the complainant the insured vehicle on 17th July 2019 was hit from behind by an unknown lorry due to which it lost control and dashed behind a stationary lorry due to which the Insured vehicle sustained massive external damages. However, the said narration is denied and disputed. It is further averred that the intimation regarding the loss was given to the Company on 22th July 2019 and they have immediately registered the claim under claim bearing registration No.201900035328 for own damage claim, and simultaneously appointed IRDAI certified surveyor to ascertain the facts and collect necessary documents. It is further averred that the intimation about the said loss was received on 22nd July 2019 which is 5 days after the alleged accident and no FIR has been registered in the present case, which is in gross violation of condition 1 of the policy terms and condition which states ‘Notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the Company shall require.’ It is further averred that after intimation of the claim, a physical inspection/document verification was carried out by an authorized surveyor of the OP. Accordingly, a detailed report of the inspection dated 14th Aug 2019 was presented which disclosed many facts that were material for the Opposite Party to decide whether the said claim was admissible or not. Also, letter dated 27th July 2019 requesting submission of necessary documents was made by the surveyor requesting the insured to submit the required documents. It is further averred that after observing the photographs of the accident vehicle and the survey report the opposite insurance company suspects that, the complainant is misrepresenting facts with respect to the loss, also even after going through such a severe accident the alleged driver's wife declined to prepare a MLC. To unearth the truth a private investigator was appointed but the insured failed to cooperate with us and till date we have not received the insured statement and provide necessary documents for further processing of the claim. It is further averred that the OP, owing to the observations made from the available documents and to not be inadvertently prejudiced against the Complainant, hence via letter dated 31 July 2019 requested complainant to provide for necessary documents and provide clarification on the queries raised. On receipt of documents and facts gathered by the surveyors/investigator further queries were raised vide letter dated 14th Aug 2019 the complainant was given 7 days' time to support his claim with any document or reason for further consideration. It is further averred that the complainant failed to provide any satisfactory justification to the above-mentioned notice seeking reason for further processing of the claim, due to non-cooperation from the claimant side and failure to respond to the queries raised the claim was repudiated vide letter dated 2th August 2019. It is further averred that the insurance is a contract of Indemnity and it is the basis of this principle that the insured shall not make profits out of insurance contract and disclose all material and true facts. In the instant case, there is a misrepresentation of facts to get the claim from the Insurance company with a pre-determined and planned mode of concocted accident as such there is a willful breach of the principle of indemnity which forms the basis of contract. The compensation claimed by the Complainant is unreasonable and lacks conviction. In addition to this, despite the sincere efforts on part of the Opposite insurance company, the claim could not be cleared due to non-cooperation on part of the Complainant. The Complaint is not maintainable as the Complainant has violated the conditions of the policy and hence is estopped by his own act and conduct. It is further averred that the complainant has not approached this Court with clean hands and only with an intention to avail Insurance Claim, has manipulated the facts. It is further submitted that, this case involves intricate question of facts, which requires detailed trial, chief and cross examination of relevant witnesses as such it is not possible to decide the exact fact in issue in the summary procedure followed by this Court. Therefore, the Complainant may be directed to approach the competent Civil Court. It is further averred that there is no cause of action to file this complaint before this Court and the complaint is not entitled for any relief as prayed for. On merits, the factum with regard to ownership of the car bearing No.PB-08-CT-0047 as per RC in the name of the complainant is admitted and it is also admitted that the said car was insured with the answering OPs for the period 15.09.2018 to 14.09.2019 in the name of Parmod Kumar. It is further admitted that the Surveyor and Loss Assessor was appointed to assess the loss, but the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits, the same may be dismissed.
3. The complainant against OP No.3 was withdrawn by the counsel for the complainant vide his separate statement dated 31.01.2022.
4. Rejoinder to the written statement filed by the complainant, whereby reasserted the entire facts as narrated in the complaint and denied the allegations raised in the written statement.
5. In order to prove their respective versions, both the parties have produced on the file their respective evidence.
6. We have heard the learned counsel for the respective parties and have also gone through the case file as well as written arguments submitted by counsel for the complainant very minutely.
7. The complainant has proved vide Ex.C-1, the RC that he is the owner of the vehicle bearing No.PB08-CT-0047. It is also proved that the complainant got insured the vehicle from the OP vide Ex.C-2. The complainant has alleged that on 17.07.2019, the car of the complainant met with an accident and was badly damaged in the said accident and it was a total loss. It has been alleged that at the time of the accident, the son of the complainant namely Chetan Sekhri was driving the car in question. The driving license of the Chetan Sekhri has been proved as Ex.C-5, which was valid from 22.11.2013 to 21.11.2023. The intimation qua the accident to the OP No.1 was given, vide Ex.C-3. The complainant lodged the claim as it was a total loss. The inquiries were put by the OPs vide different letters Ex.C-6 & Ex.C-7, which was duly replied by the complainant and even the documents alongwith affidavit and cancelled cheque were submitted to the OPs, as per their demand, which have been proved as Ex.C-8 to Ex.C-10. The surveyor was appointed by the OP to assess the loss, who, inspected the vehicle at the workshop of M/s ANR Motors to whom the vehicle was sent for the repair. The photographs of the damaged vehicle were also given by the complainant to the OP, even the same have been proved in the Court as Ex.C-11 and Ex.C-12. The estimate was prepared by the ANR Motors which has been proved as Ex.C-4, but the OP has not settled the claim till date.
8. The contention of the OP is that the submission raised by the complainant that the car was hit behind by an unknown lorry due to which the vehicle sustained massive external damages, has wrongly been narrated by the complainant. The intimation was sent to the OPs regarding the accident and loss after five days of the alleged accident. No FIR has been registered in the present case, which is in violation of the terms and conditions of the insurance policy. The appointment of the surveyor has been admitted by the OP. When the photographs were inspected by the surveyor, then he gave the report that the complainant is misrepresenting facts with respect to the loss. The MLC was never allowed by the wife of the complainant. In such a severe accident, the complainant did not receive even a simple injury. This cannot be presumed after going through the photographs of the accident and damaged car. Request has been made that the complainant has filed false claim and the complaint is not maintainable.
9. The ownership of the vehicle and the vehicle being insured with the OP are admitted and has not been denied by the OPs. It has also not been denied by the OPs that the complainant has lodged the claim for the total loss. Ex.C-3 is the intimation in general. It has been mentioned ‘to whom it may concern’. It has been alleged that on 17.07.2019, suddenly an animal came infront of the truck, then truck driver had taken turn to save the animal and hit right side rear portion of his car, which hit another truck and the car became unbalanced and hit into the Footpath. Since, there was no third party loss, therefore no police report was there. Ex.C-6 and Ex.C-7 are the letters seeking documents from the complainant which have allegedly been supplied by the complainant. The complainant had given the affidavit also that at the time of accident, the vehicle was being driven by Chetan Sekhri and he has given the same version in the affidavit, which he had given in Ex.C-3. He again gave an affidavit Ex.C-9 that there was no third party loss and due to certain inadvertent circumstances, he could not inform the police party about the occurrence. He has mentioned in this affidavit that at the time of driving the vehicle, his son was alone in the vehicle. He has proved on record the photographs of the damaged vehicle. The DDR was registered on 29.07.2020 regarding the accident occurred on 17.07.2019. In this DDR, he has also given the same version, which has been given by the complainant in the affidavit as well as in the intimation. M/s ANR Motors gave the estimate vide Ex.C-4 amounting to Rs.13,37,543.11.
10. The OPs are relying upon the report of the Investigation Annexure-5. The findings of the Investigator in Annexure-5 show that as per the investigator, the complainant and his son never co-operated to join the investigation nor they were ready to give the statement about the accident nor they spared time nor they wanted to talk about the accident. He had come to the conclusion that no MLC of Chetan Sekri was provided as the wife of the Chetan Sekhri refused to get the medical done in DMC. Chetan Sekhri was alone in the Car as per the allegations of the complainant, she cannot be present there. The OPs have relied upon Annexure-6, which shows that Monika requested to the Competent Authority not to conduct the medical legal examination of the patient as they don’t want to get it done. The OPs have produced on record this document, but this document nowhere bears the date when this application was given to the DMC, the date mentioned in the bottom is 27.08.2016. Annexure-11 is the prescription slip of Chetan Sekhri, who came to the hospital on 18.07.2019 and on this, Monika Sekhri has written that they don’t want admission. The accident allegedly took place on 17.07.2019 and the prescription is of 18.07.2019 at 02:30 AM. In this prescription, there is no suggestion of the doctor for the admission of the patient Chetan Sekhri. Once there was no suggestion or requirement for the admission, then if Monika Sekhri has given the statement, it does not matter. The repudiation letter has been proved by the OP Annexure-9. In this letter, they have relied upon two letters of 31 July, 2019 and 14 August, 2019 and it was intimated that since the complainant has failed to respond to the fulfillment of the requirement for further processing the claim, therefore the claim was repudiated due to non-cooperation. Perusal of the letters dated 31 July, 2019 Annexure-7 and 14 August, 2019 Annexure-8 shows that some documents were sought for by the OP from the complainant for processing the claim further. The complainant has proved on record the cancelled cheque and other documents to show that the documents were supplied to the OP. The same has been alleged by the complainant that all the documents were supplied by the complainant to the OP. The report of the Surveyor Annexure-3 shows that he gave the observation that the damages sustained are accidental in nature and recommended that this do coincide with the cause of the loss. He has given observation that the complainant never approached despite the reminders to the surveyor’s to provide driving license and other information. The documents and the record of the hospital is already with the OPs. The apprehension of the OPs is that no such accident took place, but as per the report of the surveyor, the damage sustained was accidental in nature and there was a loss due to this accident. Non-examination i.e. MLC or non-admission in the hospital does not debar the complainant from filing the complaint as luckily he did not receive any injury though from the photographs, it is clear that the vehicle was badly damaged, but the complainant can be said to be fortunate enough to come out of the car safely and did not receive injury. Merely on the ground that since the car was damaged and he did not receive injury, the claim should not be given is wrong and illegal. There is no evidence on the record that the damage has been caused intentionally to the vehicle. No other reason of such damage has been alleged by the OP rather their own surveyor has opined about the accident to be natural. Since, he did not receive any injury, therefore his admission in the hospital was not necessary.
11. With regard to another ground for repudiating the insurance claim that the information was given late by the complainant to the OP is again of no value. As per the submission of the complainant and affidavit of the complainant, the complainant informed the OP No.1 and car was sent to ANR Motors Pvt. Ltd, the authorized repairer and dealer of Toyota Car. The estimate was prepared by M/s ANR Motors, to the tune of Rs.13,37,543/-. No intentional loss to the vehicle has been proved by the OP. Therefore, on the ground of late intimation, the claim cannot be repudiated unless anything wrong for claiming false claim comes on record. Thus, the repudiation is wrong and illegal.
12. In view of the above detailed discussion, the complaint of the complainant is partly allowed. The complainant is directed to produce the documents required by the OPs, if any, within 10 days. The estimate prepared by M/s ANR Motors Pvt. Ltd. for the total damage caused to the car was to the tune of Rs.13,37,543/-, but the insured value is Rs.9,65,000/-. So, the complainant is entitled for the insured value i.e. Rs.9,65,000/- and the OPs No.1 and 2 are directed to make the payment of Rs.9,65,000/- being the insured value of the vehicle alongwith interest @ 6% per annum from the date of loss i.e. 17.07.2019 till realization. Further, OPs No.1 and 2 are directed to pay a compensation to the complainant for mental agony and harassment caused to the complainant, to the tune of Rs.15,000/- and litigation expenses of Rs.5000/-. The entire compliance be made within 45 days from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
13. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jaswant Singh Dhillon Jyotsna Dr. Harveen Bhardwaj
31.05.2023 Member Member President
