Madhya Pradesh

StateCommission

A/23/1308

SANTOSH SHARMA - Complainant(s)

Versus

HDFC ERGO GENERAL INSURANCE COMPANY LIMITED - Opp.Party(s)

YASH VIDYARTHI

04 Jul 2024

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                         

PLOT NO.76, ARERA HILLS, BHOPAL

 

FIRST APPEAL NO. 1308 OF 2023

(Arising out of order dated 11.09.2023 passed in C.C.No.242/2020 by District Commission, Ratlam)

 

SANTOSH SHARMA,

S/O SHRI SUNIL SHARMA,

R/O 28, ARIHANT COLONY, PAHADIYA ROAD,

JAORA DISTRICT-RATLAM (M.P.)                                                                    … APPELLANT.

 

                  Versus

 

1. HDFC ERGO GENERAL INSURANCE CO. LTD.

    THROUGH CHAIRMAN,

    FIRST FLOOR, 165-166, BACHBAY RECLAMATION,

    IT PARK MARG, CHURCH GATE, MUMBAI-400 020

 

2. HDFC ERGO GENERAL INSURANCE CO. LTD.

    THROUGH MANAGING DIRECTOR,

    STELLER IT PARK TOWER-15^TH FLOOR,

    C-25, SECTOR-62, NOIDA (UP) -201 301

 

3. HDFC ERGO GENERAL INSURANCE CO. LTD.

    THROUGH MANAGER,

    6^TH FLOOR, LEELA BUSINESS PARK,

    ANDHERI KURLA ROAD, ANDHERI (E), MUMBAI-400 059

 

4. HDFC ERGO GENERAL INSURANCE CO. LTD.

    THROUGH BRANCH MANAGER,

    D.M.TOWER, FLAT NO. 205-206, 2^ND FLOOR,

    NEW PALASIYA ROAD, INDORE (M.P.)- 452 001                                …. RESPONDENTS.  

 

BEFORE :

            HON’BLE SHRI A. K. TIWARI                : ACTING PRESIDENT

            HON’BLE DR. SRIKANT PANDEY        :          MEMBER

                       

COUNSEL FOR PARTIES :

                Shri Yash Vidyarthi, learned counsel for the appellant.

            Shri Amit Tiwari, learned counsel for the respondents.

O R D E R

(Passed On 04.07.2024)

         The following order of the Commission was delivered by A. K. Tiwari, Acting President:

           This appeal by the complainant/appellant arises out of the order dated 11.09.2023 passed by the District Consumer Disputes

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Redressal Commission, Ratlam (for short ‘District Commission) in C.C.No.242/2020 whereby the complaint filed by him has been partly allowed.

2.                The brief facts of the case as per the complainant/appellant (hereinafter referred to as ‘complainant’) are that complainant’s car Honda BR-V bearing registration no. MP-43 CA-5394 was insured with the opposite parties/respondents-insurance company (hereinafter referred to as ‘insurance company’) for the period w.e.f. 15.08.2020 to 14.08.201 for IDV of Rs.8,69,219. It is submitted that during insurance cover on 30.08.2020 the subject vehicle stuck with something and stopped moving as there was water logging on the road due to heavy rainfall. Due to water logging the complainant could not see the ditch and therefore the accident was caused. The insurance company was informed and a claim for a sum of Rs.4,92,464/- was filed with the insurance company. The surveyor appointed by the insurance company assessed the loss to the tune of Rs.19,600/- The insurance company vide letter dated 14.09.2020 repudiaed the claim on the ground that damage was purely mechanical damage and not due to any external impact and the same is not covered under the terms of the policy.  The complainant therefore alleging deficiency in service against the insurance company approached the District Commission seeking relief.

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3.                The opposite party no.1 to 3-insurance company were proceeded ex-parte. The opposite party no.4-insurance company in its reply before the District Commission admitting the insurance of the subject vehicle has submitted that there was no external damage to the vehicle and since the mechanical damage is not payable under the terms and conditions of the policy, therefore the claim has rightly been denied by the insurance company. There has been no deficiency in service on part of the insurance company.  It is thus prayed that the complaint be dismissed.

4.                The District Commission vide impugned order partly allowing the complaint directed the insurance company to pay the amount as assessed by the surveryor with interest @ 6% p.a. from the date of filing of complaint till payment. Compensation of Rs.5,000/- with costs of Rs.2,000/- is also also awarded. Hence, this appeal by the complainant for enhancement of compensation.

5.                Heard learned counsel for the parties. Perused the record.

6.                Learned counsel for the complainant/appellant argued that the District Commission erred in not allowing the complaint in total inspite of holding that there was deficiency in service on part of the opposite parties-insurance company. He argued that the District Commission failed to consider the fact that the survey report is silent about the reason for not

 

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considering the entire claimed amount.  He therefore prayed for allowing the appeal and for grant of relief as claimed in the complaint.

7.                Learned counsel for the opposite parties/respondents-insurance company argued that since the subject vehicle was damaged due to mechanical damage and and not due to external impact, the insurance company has rightly repudiated the claim as per terms and conditions of the policy. He argued that even though the complainant is entitled to get the amount as assessed by the surveyor and he is not entitled to get any further claim. There has been no deficiency in service on part of the insurance company. He prayed for dismissal of appeal. 

8.                Having heard learned counsel for the parties and on going through the record we find that it is an admitted position that the subject vehicle was insured with the opposite parties insurance company and during insurance cover it got damaged. The claim filed with the insurance company was repudiated by the insurance company on the ground that there was mechanical damage and damages not due to external impact and therefore the claim is not payable as per terms and conditions of the policy. It is well settled that when there was no definite opinion about mechanical failure in the spot survey report, the insurance company cannot deny to pay the claim on technical grounds.

 

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9.                D-4/5 is survey report dated 04.09.2020 of Surveyor Deepak Soni who assessed the loss to the tune of Rs.19,600/-. Spot surveyors and final surveyors though appointed by the insurance company under statutory provisions and they are independent authorities. It is well settled that the insurance claim can only be settled on the basis of survey report unless it was challenged by cogent evidence.  Here in the instant matter, the complainant has not challenged the survey report, therefore without any reason and basis, the surveyor’s report cannot be discarded. 

10.              Hon’ble National Commission in Iffco Tokio General Insurance Co. Ltd. Vs Beena Raghav III (2015) CPJ 75 (NC) and United India Insurance Co. Ltd. Vs East Indian Produce Limited & Anr, I (2015) CPJ 409 (NC) has held that ‘In terms of Section 64UM(2) of the Insurance Act, 1938 the surveyor was an independent professional engaged by the insurance company to assess the loss suffered by the complainant with respect to his vehicle.  The report prepared by the Surveyor is of a significant and evidentiary value cannot be ignored and dismissed as such by saying that the assessed loss cannot be considered trustworthy, without giving valid reasons.’

11.              In view of the settled position of law, the surveryor’s report cannot be brushed aside unless it is proved otherwise.  Thus in view of the above discussion we are of a considered view that the complainant is

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entitled to get the amount as assessed by the Surveyor. Thus, we find that the District Commission has rightly allowed the complaint and directed the insurance company to pay the amount as assessed by the surveyor. Thus, we find that the complainant is not entitled to get any further relief.  We do not find any illegality or perversity in the impugned order so as to interfere with the impugned order.

12.              In the result, the appeal fails and is hereby dismissed with no order as to costs.                  

                     (A. K. Tiwari)              (Dr. Srikant Pandey)  

                  Acting President                      Member