Haryana

Ambala

CC/454/2022

DEEPAK SHARMA. - Complainant(s)

Versus

GO DIGIT GENERAL INSURANCE LTD. - Opp.Party(s)

Deepak sharma

01 Dec 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	454 of 2022
Date of Institution	:	06.12.2022
Date of decision	:	01.12.2023

Deepak Sharma S/o Late Shri Vinod Kumar Sharma, R/o Flat No. 111, Green Tower 1, Omaxe Greens Apartments, Opposite Chaman Vatika School, Chandigarh-Ambala Highway, Tehsil-Derabassi, District-SAS Nagar, Pin-140501. Contact No.8571871510/8930186677, Email Id-dsharma860@gmail.com

.……. Complainant

Versus

Go Digit General Insurance Limited Atlantis, 95, 4 Cross Road Koramangala Industrial Layout, 5th Block, Bengaluru-560095 Email Id-hello@godigit.com

….…. Opposite Party.

 Before:         Smt. Neena Sandhu, President.

            Shri Vinod Kumar Sharma, Member.           

 

Present:        Complainant in person.

                      Shri R.K.Vig, Advocate, counsel for the OP.             

Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘OP’) praying for issuance of following directions to it:-

1. To reimburse the repair cost of Rs.4880/- paid by the complainant, which he was forced to pay after the claim rejection.
2. To cancel the policy and pay back the insurance premium of Rs.4522/- so that the complainant can buy the policy from any other trustworthy insurance company for the vehicle.
3. To pay compensation for mental agony and harassment caused by the OP as may be deemed fit in view of the facts and circumstances of the case.

 

 

2.             Brief facts of this case are that the complainant's vehicle bearing registration number 22BH2230B (TVS NTORQ-Two wheeler) which was insured with the OP met with an accident on 06 Nov 22 on Ambala-Chandigarh Highway near Baldev Nagar (Haryana) during the currency of the said policy. The complainant was riding with the pillion rider and there was a pothole on the road and the complainant was not in a position to either divert or change the lane so eventually, the vehicle passed over the pothole and the alloy wheel (rear) got damaged (bent and cracked) after a thud noise from the rear side of the vehicle. The complainant reported the incident at the toll free number-1800-258-5956, of the OP and claim no 202200433343 was registered successfully on the same date. Thereafter, the OP appointed the surveyor for the assessment and approval of the said claim. After the assessment, the OP rejected the claim of replacing the damaged alloy wheel (rear) and the complainant was told that this damage is caused due to external means and hence cannot be covered under claim. The complainant was not convinced with the said version as the purpose of buying the insurance is to protect the vehicle from any eventualities which may occur in future while driving either by the owner or other mistakes which may be external factors too. The complainant then approached to the customer care of the OP and narrated the matter of claim rejection. The customer care representative connected the complainant to Mr Hartej Singh (Senior Manager, Claims and Network Operations-Go Digit Insurance) and the same version of claim rejection was conveyed again to the complainant. Finally, the complainant got the vehicle repaired at TVS at his own cost (Invoice attached as Annexure C2). Meanwhile, the complainant has received another mail(Annexure B2) from the surveyor of the OP on 22 Nov 22 citing the terms and conditions vide section 1 (damage due to external means) under which the OP has rejected the claim. The complainant sent e mail(Annexure D) to the surveyor of the OP on 24 Nov 22 and expressed the dissent over the stand taken by the OP and asked the OP to share the details of Section I wherein the complainant has expressed his recorded agreement, while purchasing the policy. The complainant has bought the two wheeler insurance policy (No D063245727-Annexure C-1) on 27 Apr 22 through online mode from the OP. While purchasing the policy the complainant has not come across any exclusion in the policy. Moreover, in the terms and conditions of the OP wherein Section "T is mentioned (Annexure B2 of OP) there was no further elaboration of section 'I' in the online policy offered to the complainant. The process through which the complainant has to go through for the issuance of this policy online is attached as Annexure H (10 pages). Had the elaboration of section "I been displayed online, the complainant would have opted out of buying the policy as no consumer will be interested to buy such policy which disagree to honour the claim of the damages caused to the vehicle by external means. The mis-selling of the policy by the OP has caused harassment to the complainant. Hence, the present complaint.
3.           Upon notice, OP appeared and filed written version wherein it raised preliminary objections to the effect that the complaint is not maintainable; the present complaint filed by the complainant is false, frivolous and vague in nature; no cause of action either arose in favour of the complainant or against the OP; the complainant has not approached this Commission with clean hands;  the complainant has opted policy from Girnar Broker and was bound by terms and conditions of the said policy etc. On merits, it has been stated that the complainant informed to the OP on 06.11.2022 regarding the damage of vehicle which took place on 06.11.2022. It is a matter of record that the Insurance Company consequent upon the information, appointed surveyor who lost no time and prepared the report on the basis of physical verification. Accordingly the loss assessed of the vehicle in question came to Rs.4547.65. The surveyor observed that the loss claimed is not due to any accidental external means as against the cause of loss confirmed by the complainant.  The insured had claimed rear alloy rim crack/bend under loss which got affected as his vehicle ran from pothole/patch on road. The loss was due to manufacturing defect in the alloy wheel as generally it cannot be happened while even driving by anyone on the road. The Insurance Company is only held liable if the loss occurred due to accidental external means. The complainant cannot escape his responsibility from the terms and conditions. Section-1 of the policy reads as under:-

“…..Loss of or damage to the vehicle & Section-1: The Company shall not be liable to make any payment in respect of, both of which reads as under:

SECTION-1: LOSS OR DAMAGE TO THE VEHICLE INSURED:-

 

By fire explosion self-ignition or lightning

 

By burglary house breaking or theft

 

By riot and strike

 

By earthquake (fire and shock damage)

 

Hailstorm, frost

 

By flood, typhoon, hurricane, storm, tempest, inundation, cyclone.

 

By accidental external means

 

By malicious act

 

By terrorist activity

 

Whilst in transit by road rail inland waterway lift elevator or air

 

By landslide rockslide.

 

THE COMPANY SHALL NOT LIABLE TO MAKE ANY PAYMENT IN RESPECT OF:-

 

1. Consequential loss, depreciation, wears & tears, mechanical or electrical breakdown, failure or breakages…”

 

4.           The OP rejected the claim of the complainant on solid, legal grounds vide letter dated 14.01.2023. It being a case of violation of terms and conditions by the complainant, the insurance company cannot be faulted for rejecting the claim. Rest of the averments of the complainant were denied by OP and prayed for dismissal of the present complaint with heavy costs.
5.           Complainant tendered his affidavit as Annexure CA/1 alongwith documents as Annexure CA, CB1, CB1, CB2, CC1, CC2, CD, CE, CF, CG, CH, CI, CJ & CK closed the evidence of the complainant.  On the other hand, learned counsel for OP tendered affidavit of Aniruddha Kale, Senior Manager, Authorized Signatory of OP Company- Go Digit General Insurance Limited, 1^st to 6^th Floor, Ananta One (AR one), Pride Hotel Lane Narveer Tanaji Wadi, City Survey No.1579, Bhamburda, Shivajinagar, Pune, Maharashtra 411005 as Annexure OP-1/A alongwith documents as Annexure OP-1/1 to OP-1/13 and closed the evidence on behalf of the OP.
6.            We have heard the complainant and learned counsel for the OP and have also carefully gone through the case file.
7.           Complainant submitted that by repudiating the genuine claim filed by him on the bald ground that the loss claimed in respect of the accidental vehicle is not due to any accidental external means, the OP is deficient in providing service.
8.           On the contrary, the learned counsel for the OP while reiterating the objections taken in the written version submitted that the claim of complainant was rightly repudiated because the surveyor observed and has come to a conclusion that the loss claimed is not due to any accidental external means/impact as against the cause of loss confirmed by the complainant.
9.           The moot question which falls for consideration is, as to whether, the claim filed by the complainant was rightly repudiated by the OP or not. It may be stated here that we have gone through the letter dated 08.11.2022, Annexure CB-1 and repudiation letter dated 14.01.2023, Annexure OP-1/10 and found that the claim of the complainant was repudiated on the ground that the surveyor has observed and has come to a conclusion that the loss claimed is not due to any accidental external means as against the cause of loss. Relevant portion of Annexure CB-1 is reproduced hereunder:-

 

“….Sub: Claim No. 202200433343 Under Policy No. D063245727; Accident Claim of your vehicle NEW TVS NTORQ

 

Dear DEEPAK SHARMA Greetings from Digit! Trust this letter of ours finds you well and safe.

 

We are writing with reference to your vehicle claim reported to us on 06-Nov-2022 for damages that occurred on 06- Nov-2022 and surveyed on 07-Nov-2022 at ABC AUTO.

 

The surveyor has observed and has come to a conclusion that the loss claimed is not due to any accidental external means as against the cause of loss confirmed by you,

 

We thus seek your help in understanding the cause of loss in detail which would help us in taking your claim forward. Till then, we are constrained to reserve our rights on admissibility of the said claim.

 

You can reach out to us on WhatsApp at 7026061234 or through our 24x7 Toll-Free Number 1800-258-5956 or you can also write to us at Hello godigit.com for any assistance that you might require.

 

Hoping for an opportunity to serve you.

 

Yours sincerely.

 

Charanpreet Singh charanpreet.singh@godigit.com….”

 

10.           The plea of the complainant is that  the alloy wheel of the vehicle in question was damaged due to impact or accident, as such, he is entitled to get the claim amount. Whereas, the stand of the OP is that the loss claimed by the complainant against damaged alloy wheel was not due to any accidental external means/impact as opined by the surveyor. However, the OP has failed to place on record the report of the surveyor, who opined that the loss claimed is not due to any accidental external means/impact as against the cause of loss intimated by the complainant. Whereas, the complainant has proved his case that the loss claimed by him qua damaged alloy wheel of the vehicle in question was due to impact/accident; by way of placing on record the original certificate dated 17.03.2023, Annexure CJ, wherein, the Authorized Representative of ISOfine TVS, Ambala City, Haryana, from whom he had  purchased the said vehicle has clearly stated that the alloy wheel which was replaced was found damaged due to impact/accident and having no manufacturing defect. Relevant part of the said certificate is reproduced hereunder:-

“……TVS

 

ISOfine TVS

Plot 338/288, Ambala City, Model Town,

Haryana 134 003

+91 9138972171/9138972172

isofineprivatelimited@gmail.com

 

TO WHOM IT MAY CONCERN

 

This is to inform you that the vehicle, Engine no: CK3AN2308413 Chassis No: MD626BK36N2A08430 was purchased on 27th April'22 from our showroom and this was OK/Tested from TVS company side. After that also it was tested on 22 for PDI before the delivery and found fully ok.

 

The vehicle meets with an accident and got repaired & delivered on 23 Nov 22 by us. Alloy wheel which was replaced was found damaged due to impact/accident and having no manufacturing defect. The new alloy wheel was fitted and embarked with part number which are tested from TVS and rechecked by us (invoice copy attached). Vehicle Reg No: 22BH2230B

 

The vehicle was delivered and running successfully on the road for the past 6+ months. It was serviced twice in this period and never had any issue. So there is no point of manufacturing defect after going through all levels of inspections.

Regards

Sanjay Bhattacharya. 17/3/23. …….”

11.           The said certificate dated 17.03.2023, Annexure CJ was not challenged by the OP, as such, we have no reason to ignore the said certificate and not to believe the contention of the complainant that the alloy wheel of the vehicle in question got damaged due to impact/accident as it banged into pothole on the road with force. The complainant is therefore as per terms and conditions of the policy is entitled to get refund of the amount of Rs.4,880/-, spent for the replacement of the damaged alloy wheel, as is evident from the invoice dated 23.11.2022, Annexure CC-2.   Complainant is also entitled to get compensation for the mental agony and physical harassment suffered by him. 
12.           However this Commission is not inclined to accept the prayer of the complainant qua refund of the premium amount, as he has already utilized the policy in question, under which he has been awarded refund of the amount paid by him against the present dispute. The complainant is at liberty to discontinue the policy in question, after its expiry.
13.           In view of the aforesaid discussion, we hereby partly allow the present complaint and direct the OP, in the following manner:-  
    1. To reimburse the amount of Rs.4880/- paid by the complainant for replacement of damaged alloy wheel alongwith interest @6% p.a. from the date of repudiation of claim i.e. 14.01.2023, Annexure OP-1/10, till its realization
    2. To pay Rs.3,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.

     The OP is further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OP shall pay interest @ 8% per annum on the awarded amount, from the date of default, till realization. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

    Announced:- 01.12.2023

 

(Vinod Kumar Sharma)		(Neena Sandhu)
Member		President