Haryana

Karnal

CC/109/2018

Jagbir Singh - Complainant(s)

Versus

HDFC ERGO General Insurance Company Limited - Opp.Party(s)

Mange Ram Sangwan

16 Jul 2019

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

 

                                                           Complaint No.109 of 2018

                                                        Date of instt. 07.05.2018

                                                        Date of decision: 16.07.2019

 

Jagbir Singh son of Shri Ishwar Singh resident of village Begum Pur PO Gudha Tehsil Gharaunda District Karnal.

                                                                        …….Complainant       

                                        Versus

 

1. HDFC Egro General Insurance Company Ltd. through its Manager, SCO 237, 2^nd floor Sector-12 Karnal.

2.  HDFC Egro General Insurance Company Ltd. through its Managing Director 1^st floor 165-166 Back Bay reclamation, H.T. Parekh Marg Church Gate Mumbai 400020.

                                                                     …..Opposite Parties.

 

           Complaint u/s 12 of the Consumer Protection Act.            

 

Before   Sh. Jaswant Singh……President.       

      Sh.Vineet Kaushik ………..Member

              Dr. Rekha Chaudhary……Member

 

 Present   Shri Mange Ram Advocate for complainant.

                Shri Sanjeev Vohra Advocate for opposite parties.

               

                (Jaswant Singh President)

ORDER:                    

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986 on the averments that complainant is registered owner of the vehicle HR-05 AE 3445 Muriti Swift car make 2011 which was insured with OPs, vide cover note no.2311201729180200000 w.e.f.30.03.2017 to 29.03.2018. The said vehicle met with an accident on 23.11.2017 at about 2 p.m. when the complainant was going crossing sector 6 over bridge Karnal and front side radiator engine etc. was got damaged in the said accident. The DDR in this concern was got registered by the Local police on dated 23.11.2017 vide DDR no.10. The vehicle was parked in the workshop of modern Auto Karnal with the help of Bagga Crane and claim for the damaged vehicle was got lodged by the OPs, vide claim no.C230017191466. Vehicle was inspected on 28.11.2017 but the OPs have issued a letter of repudiation of claim on 21.02.2018 illegally, unlawfully arbitrarily on the vague ground “during survey it has been observed that the damages claimed in the alleged accident are unrelated to the cause of accident as reported in the claim form, the damages do not commensurate with the cause of loss as mentioned in the claim form, these damages are multiple and accumulated in the nature. Hence, it is violation of motor vehicle policy package condition no.1 and also tantamount to misrepresentation of material facts” these remarks are vague only with intent to repudiate the claim filed by complainant and hence the OPs are liable for deficiency in service on their part. The OPs have not settled the claim of the complainant rather finally the OPs has sent a repudiation of claim letter dated 21.02.2018. The repudiation of claim on the basis of alleged report is not sustainable and deserves to be set aside which is arbitrary illegal and proves deficiency in service on the part of the OPs. As per terms and conditions the OPs are liable to compensate the complainant on total loss basis for IDV value of the vehicle of Rs.4,40,000/- as per policy but the OPs have rejected the claim of the complainant on the false ground. In this way there was deficiency in service on the part of the OPs. Hence complainant filed the present complaint.

2.             Notice of the complaint was given to the OPs, who appeared and filed written version raising preliminary objections with regard to jurisdiction; complicated questions of law and facts are involved, which cannot be decided in summary jurisdiction and concealment of true and material facts. On merits, it is pleaded that date of loss was 23.11.2017 and same was reported on 27.11.2017. Surveyor was deputed to assess the loss, during survey it has been observed that the damages claimed in the alleged accident are un-related to the cause of accident as reported in the claim form. The damages do not commensurate with the cause of loss as mentioned by insured in the claim form, damages were multiple and accumulated in nature. Hence it is violation of policy terms and conditions and claim of the complainant was rightly made no claim and duly conveyed the same to complainant through letter dated 11.01.2018.

3.             It is further pleaded that the complainant has taken Private Car Comprehensive Policy bearing no.2311201729180200000, valid from 30.03.2017 to 29.03.2018 from the OP. However, it is submitted that the aforesaid insurance policy was issued to the complainant by the OPs, subject to the provision of IMT and Policy conditions, which was never disputed by the insured. Therefore, it is submitted that in case if any liability would arise against the OP, then it would be subject to the terms and conditions of the insurance policy. It is further pleaded that complainant intimated about loss to the OP on 27.11.2017 whereas the insured vehicle met with an accident on 23.11.2017 i.e. after delay of 3 days. As per the policy terms and conditions, condition no.1, the intimation about the incident is to be given “immediately”. But in the present case the complainant intimated the OPs after the delay of 3 days. Even after the delay intimation the OPs processed the claim of the complainant and OPs duly appointed an IRDAI approved and licensed surveyor, namely B.B. Chawla, in order to assess the loss and damages sustained by the insured vehicle. During survey it has been observed by the surveyor that the damages do not match with the cause of loss, further it was mentioned that the damages do not commensurate with the cause of action. It is further pleaded that OPs also simultaneously appointed a Forensic & Reconstruction expert in order to verify the genuineness of the facts of the alleged accident, who also after going through the facts and circumstances as presented by complainant and the evidence as provided also made the similar observation akin to the report of surveyor. The observation made by the expert was that the damages as claimed would have not occurred in the single event of accident. Further, it was opined that damages as observed on the vehicle are not in accordance with the insured’s mentioned scenario. The mis-representing the false facts of the accident/loss/damage, the complainant himself had played the fraud upon the OPs. Keeping in view the above facts the claim of the complainant was repudiated as per the policy terms and conditions. There is no deficiency in service on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Complainant tendered into evidence his affidavit Ex.C1 and documents Ex.C2 to Ex.C8 and closed the evidence on 19.12.2018.

5.             On the other hand, OPs tendered into evidence affidavit of Shweta Pokhriyal Ex.RW1/A and documents Ex.R1 to Ex.R4 and closed the evidence on 14.06.2019.

6.             We have heard the learned counsel of both the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             The case of the complainant is that the vehicle of the complainant bearing registration no. HR-05 AE 3445 Muriti Swift car was insured with OPs, vide cover note no.2311201729180200000 w.e.f.30.03.2017 to 29.03.2018. The said vehicle met with an accident on 23.11.2017 at about 2 p.m. when the complainant was going crossing sector 6 overbridge Karnal and front side radiator engine etc. was got damaged in the said accident. The DDR in this regard was got registered by the Local police on 23.11.2017 vide DDR no.10. The vehicle was parked in the workshop of modern Auto Karnal with the help of Bagga Crane and claim for the damaged vehicle was got lodged by the OPs, vide claim no.C230017191466. Vehicle was inspected on 28.11.2017 but the OPs have repudiated the claim of the complainant on the ground that “during survey it has been observed that the damages claimed in the alleged accident are unrelated to the cause of accident as reported in the claim form, the damages do not commensurate with the cause of loss as mentioned in the claim form, these damages are multiple and accumulated in the nature. Hence, it is violation of motor vehicle policy package condition no.1 and also tantamount to misrepresentation of material facts.” The repudiation of claim on the basis of alleged report is not sustainable.

8.             On the other hand, the case of the OPs is that complainant has taken Private Car Comprehensive Policy from the OP. The policy in question was issued to the complainant subject to the provision of IMT and Policy conditions, which was never disputed by the insured. Therefore, it is submitted that in case if any liability would arise against the OPs, then it would be subject to the terms and conditions of the insurance policy. The complainant intimated about loss to the OP on 27.11.2017 whereas the insured vehicle met with an accident on 23.11.2017 i.e. after delay of 3 days. As per the policy terms and conditions, condition no.1, the intimation about the incident is to be given “immediately”. But in the present case the complainant intimated the OPs after the delay of 3 days. Even after the delay intimation the OPs processed the claim of the complainant and OPs duly appointed an IRDAI approved and licensed surveyor, namely B.B. Chawla, in order to assess the loss and damages sustained by the insured vehicle. During survey it has been observed by the surveyor that the damages do not match with the cause of loss. The OPs also simultaneously appointed a Forensic & Reconstruction expert in order to verify the genuineness of the facts of the alleged accident, who also after going through the facts and circumstances as presented by complainant and the evidence as provided also made the similar observation akin to the report of surveyor. The observation made by the expert was that the damages as claimed would have not occurred in the single event of accident. Further, it was opined that damages as observed on the vehicle are not in accordance with the insured’s mentioned scenario. The mis-representing the false facts of the accident/loss/damage, the complainant himself had played the fraud upon the OPs. Hence, the claim of the complainant was repudiated as per the policy terms and conditions.

9.             Admittedly, the vehicle in question was met with an accident during the subsistence of the policy. DDR no.10 dated 23.11.2017 on the day of accident was got lodged by the complainant. Intimation regarding loss of vehicle was given to the OPs, vehicle was inspected by the surveyor of OP. The complainant lodged his claim with OPs but same was repudiated by the OPs. The claim of the complainant was repudiated by the OPs on the ground that damages do not commensurate with the cause of loss, damages were multiple and accumulated in nature. 

10.           As per Motor Accident Reconstruction Report Ex.R3, image no.04 in the report, Engine hood bent, Radiator support damaged, Front Bumper reinforcement damaged and LHS headlight damaged. As per image no.5, windshield damaged. As per image no.09, coolant hose bent and damaged. As per image no.10, Cowl panel observed dislodged from it’s position, Air filter assembly damaged. So, as per Motor Accident Reconstruction Report Ex.R3, most of the parts of the vehicle in question were found damaged. Such types of damaged accrued as per said accident scenario.

11.           It is pertinent to mention here that the surveyor has been appointed by the OPs, who assessed the loss to the vehicle in question to the tune of Rs.202912/- but according to the complainant he is entitled for total IDV i.e. Rs.4,40,000/- of the vehicle in question because in the accident the vehicle was totally damaged. In this regard we can rely upon the authority 2(2008) CPJ paged 182 (NC), United India Insurance Co. Vs. Maya, wherein it has been held that a surveyor report should not be dismissed summarily as the surveyor is independent and qualified person under the relevant provision of Insurance Act, 1938. In view of this authority as well as the facts and circumstances of the case, we are of the considered view that the OPs are liable to pay the loss assessed by the surveyor i.e. Rs.2,02,912/-.

12.           Thus, as a sequel to abovesaid discussion, we partly allow the present complaint and direct the OPs to pay Rs.2,02,912/- to the complainant with interest @ 9% per annum from the date of repudiation till its realization. We further direct the OPs to pay Rs.20,000/- to the complainant on account of mental agony and harassment suffered by him and for the litigation expenses. This order shall be complied within 30 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:16.07.2019                                                                     

                                                                  President,

                                                           District Consumer Disputes

                                                           Redressal Forum, Karnal.

       

                (Vineet Kaushik)        (Dr. Rekha Chaudhary)

                    Member                         Member