Haryana

Karnal

CC/709/2019

Jagdish Kumar Sharma - Complainant(s)

Versus

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

M.K. Sangwan

27 May 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                       Complaint No. 709 of 2019

                                                        Date of instt.16.10.2019

                                                        Date of Decision:27.05.2022

 

Jagdish Kumar Sharma son of Shri Lok Ram Sharma, resident of House no.1691, Sector 6 Urban Estate Karnal.

                                               …….Complainant.

                                              Versus

 

1.     HDFC Ergo General Insurance Company Ltd. through its Manager SCO 237 2^nd floor sector 12 Karnal.

 

2.     HDFC Ergo General Insurance Company Ltd. through its Managing Director 1^st floor 165-166 Back Bay Reclamation, H.T. Parekh Marg Church Gate Mumbai 40020.

                                                                      …..Opposite Parties.

 

Complaint under Section 12 of the Consumer Protection Act, 1986 as amended under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri M.R.Sangwan, counsel for the complainant.

                    Shri Sanjeev Vohra, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                 The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant got insured his vehicle Swift Dzire bearing registration no.HR-05-AP-9272 with the OPs, vide cover note no.C231110030340030000 effective from 25.04.2018 to 24.04.2019 in which the Insured Declared Value (IDV) of the vehicle has been shown as Rs.423349/-. The vehicle of the complainant met with an accident on 09.04.2019, when the son of complainant was going to Panipat from Karnal and when he reached village Kambo Pura at about 7.30 p.m., suddenly a stone came in front of the car and when car was turned other side, then suddenly it struck with the trolla, due o which vehicle was damaged. The son of complainant got injuries in the said accident. Thereafter, the vehicle was parked in authorized service centre and surveyor was appointed by the OPs, who examined the vehicle and submitted his report. The DDR no.008 dated 14.04.2019 was got registered regarding the said accident. The Surveyor B.B. Chawla had submitted his report dated 31.05.2019 with the remarks that “during survey it was found that the damages to the parts fitted in engine compartment were not accidental in nature, so the claim of the complainant was rejected, vide letter dated 01.07.2018 on the basis of false and manipulated report of the surveyor, although the complainant is entitled to get his claim on the basis of damaged caused to the vehicle in the accident. OPs have rejected the claim of the complainant illegally, unlawfully and without considered the actual and factual position of the vehicle because the vehicle of the complainant got damaged in the accident. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence, complainant filed the present complaint seeking direction to the OPs to pay the IDV value of the vehicle alongwith interest @ 12% per annum and also to pay compensation for harassment of Rs.40,000/- and Rs.10,0000/- as  litigation costs.

3.             On notice, OPs appeared and filed its written version maintainability; jurisdiction and concealment of true and material facts. On merits, it is pleaded that the claim of the complainant was repudiated on the ground of misrepresentation of facts, as it was appraised from the report of surveyor that the damages as claimed through the alleged accident are unrelated to the cause of accident as reported in the claim form. It is further pleaded that on receipt of intimation regarding the abovesaid accident, OPs appointed an IRDA approved surveyor, in order to assess the loss qua the vehicle in question. Thereafter, the surveyor after minute inspection filed his survey report with the observations that damages of the insured vehicle do not correlate with the cause of accident mentioned in the claim form. Based upon the report submitted by independent surveyor, OPs rightly repudiated he claim of the complainant, vide letter dated 22.07.2019 duly served upon the complainant as actual damage does not commensurate with the loss detailed notified to the company. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied by the OPs and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.C1, copy of R.C. Ex.C2, copy of insurance cover note Ex.C3, copy of DDR Ex.C4, copy of surveyor report Ex.C5, copy of reminder letter dated 10.07.2019 Ex.C6, copy of repudiation letter dated 01.07.2019 Ex.C7, copy of repudiation letter dated 22.07.2019 Ex.C8, copy of medical certificate Ex.C9 and closed the evidence on 18.02.2020 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Shweta Pokhriyal Legal Manager Ex.RW1/A, copy of repudiation letter dated 22.07.2019 Ex.R1, copy of surveyor report Ex.R2, copy of photographs of accidental vehicle Ex.R3, copy of insurance policy Ex.R4, copy of claim form Ex.R5 and closed the evidence on 08.10.2021 by suffering separate statement.

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

7.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that complainant got insured his vehicle in question with the OPs. On 09.04.2019 the vehicle of the complainant met with an accident and was totally damaged. Complainant intimated the OPs regarding the said accident and DDR was also recorded in this regard. He further argued that the on receipt of intimation, the surveyor of the OPs inspected the vehicle and submitted his report with the OPs with the remarks that the damages to the parts fitted in engine compartment were not accidental in nature and repudiated the claim of the complainant on the false and frivolous grounds. Hence, prayed for allowing the complaint.

8.             Per contra, learned counsel for OPs, while reiterating the contents of written version, has vehemently argued that the claim on receipt of intimation regarding the abovesaid accident, OPs appointed an IRDA approved surveyor, in order to assess the loss qua the vehicle in question. Thereafter, the surveyor afte inspection filed his survey report with the observations that damages of the insured vehicle do not correlate with the cause of accident mentioned in the claim form. Based upon the report submitted by independent surveyor, OP rightly repudiated the claim of the complainant, vide letter dated 22.07.2019. Hence, prayed for dismissal of the complaint.

9.             Admittedly, the vehicle in question met with the accident during the subsistence of the insurance policy.

10.           The claim of the complainant has been repudiated by the OPs, vide letter Ex.C8/Ex.R1 on the ground reproduced as under:-

“During survey it has been observed that the damages of all the parts 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 mention by you in the claim form. These damages are multiple and accumulated in nature. Hence, it is a violation of the Motor Package Policy Condition no.1 and also tantamount to misrepresentation of material facts”

We would like to draw your attention to the condition no.1 of the insurance policy which states that 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 inured shall give all such information and assistance as the company shall require”.

 

In the light of the above, we would not be able to honour our liability for the abovesaid loss and are repudiating the above claim as ‘No Claim’ in our records.

11.           The first plea taken by the OPs is that complainant had not sent the intimation to the OPs regarding the said accident within time and OPs had been deprived of the legitimate right to investigate the matter properly. It is admitted that the accident took place on 09.04.2019 and DDR Ex.C4 in this regard lodged on 14.4.2019. Hence, plea taken by the OPs is having force.

12.           The next plea taken by the OPs is that the damages of the insured vehicle do not correlate with the cause of accident. The onus to prove its case was lied upon the OPs. In support of its version OPs have placed on record photographs Ex.R3. On perusal of the said photographs it appears that the accident is manipulated one. Hence, the surveyor of the OPs has rightly come to the conclusion that the accident in question is unrelated to the cause of accident.

13.           The complainant has taken a plea that he has taken the treatment after the accident from Kumar Clinic, vide treatment record Ex.C9. On perusal of the said treatment record it also appears that the same has been got prepared just to fill up the lacunae. Hence, we are of the considered view that OPs have rightly repudiated the claim of the complainant. Thus, we found no deficiency in service on the part of the OPs while repudiating the claim of the complainant.

13.           Thus, as a sequel to abovesaid discussion, we found no merits in the present complaint and the same is hereby dismissed. No order as costs. The parties concerned be communicated the order accordingly, and the file be consigned to the record room, after due compliance.

Announced

Dated: 27.05.2022    

                                                               

                                                              President,

                                                 District Consumer Disputes

                                                 Redressal Commission, Karnal.

 

 

                 (Vineet Kaushik)       (Dr. Rekha Chaudhary)

                      Member                       Member