Tamil Nadu

South Chennai

CC/271/2019

Mrs. M. Shanthi - Complainant(s)

Versus

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

R. Baskaradoss

03 Jan 2023

ORDER

                                                      Date of Complaint Filed : 14.10.2019

                                                      Date of Reservation      : 21.12.2022

                                                     Date of Order               : 03.01.2023

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

CHENNAI (SOUTH), CHENNAI-3.

 

PRESENT:         TMT. B. JIJAA, M.L.,                                              : PRESIDENT

                            THIRU. T.R. SIVAKUMHAR, B.A., B.L.,              :  MEMBER  I 

                           THIRU. S. NANDAGOPALAN., B.Sc., MBA.,       : MEMBER II

 

CONSUMER COMPLAINT No. 271/2019

TUESDAY, THE 3^rd DAY OF JANUARY 2023

Mrs. M. Shanthi, (F/56),

W/o R. Baskaradoss,

Lastly resided at:-

464/10, TNHB Quarters,

7^th Main Road, Anna Nagar,

Chennai – 600 040. 

 

Now residing at:-

Block No.VI, Floor o.5, Door No.4 “Pace Prana”

Anna Nagar West Extension,

Chennai – 600 040.                                                                                                                                ... Complainant                

..Vs..

The Manager (Claims),

HDFC ERGO General Insurance Company Limited

RR Tower II, 2^nd Floor,

No.94/95 TVK Industrial Estate,

Guindy, Chennai – 600 032.                                                                                                               ...  Opposite Party

******

Counsel for the Complainant        : M/s. R. Baskaradoss

Counsel for the Opposite Party     : M/s. M.B. Gopalan Associates

On perusal of records and after having heard the oral arguments of the Counsel for the Complainant and the Counsel for the Opposite Party, we delivered the following:

ORDER

Pronounced by the President Tmt. B. Jijaa, M.L.,

1.      The Complainant has filed this complaint as against the Opposite Party under section 12 of the Consumer Protection Act, 1986 and prays to direct the Opposite Party to pay the claim amount of Rs.7,086/- + conveyance amount of Rs.1800/- totalling Rs.8,886/- in view of deficiency of service of payment of claim amount to the Complainant and to pay a compensation of Rs.1,00,000/- towards mental agony suffered by the Complainant along with cost of Rs.50,000/-.

2.     The averments of Complaint in brief are as follows:-

The Complainant submitted that she is the owner of the Two-Wheeler - Honda Activa-3G bearing Engine No.JC44E2392745, Chasis No.ME4JC44LC8281678 and Registration No.TN 02 AV 8223. She is having a valid Driving Licence bearing DL No.TN02 20010019160 dated 30.11.2001 to drive Motor Cycle with Gear and LMV and it is valid up to 17.05.2023. She obtained a Long Term Two wheeler Package Policy on 07.04.2017 for a period of three years ending on 06.04.2020 from the Opposite Party bearing Policy No.2312 1001 8843 4500 000. She met with an accident through a third party's four wheeler near Anna Nagar Roundana and caused personal minor injury and major damage to her vehicle. For which incident, She made a police complaint through the Tamil Nadu Police Website Portal and obtained proper Acknowledgement vide Ref.No.HAM19082103. The Complainant has made a claim to the Opposite Party on 01.09.2019 itself vide Claim No.C230019241340. The Surveyor deputed who contacted the Complainant was informed about the Vehicle where it was given to carry out repair. The Surveyor assessed the Vehicle in the Garage and asked the Mechanic to give the estimate to carry out the repair. Accordingly, the mechanic opened the shield of the bike and found that Fork, Chassis, Mud Guard, Head light shield, side stand were severely damaged and the Surveyor took the photographs. The Surveyor informed the complainant not to carry out any repair work until the approval is given by his office. Accordingly, the Complainant informed her Mechanic not to carry-out any repair to her vehicle. The Complainant working as a Teacher in Corporation School has engaged call taxi for her every trips to her daily work. The Complainant was shocked about the intimation of Opposite Party's about the closure of claim No. C230019241340 dated 06.09.2019 for the alleged reason that the vehicle in question was already repaired on the Complainant's instruction/advices and the Surveyor was unable to inspect the vehicle and assess the damages and in view of the above mentioned fact and deprived of assessing the actual damage/loss caused to the Complainant's vehicle, as without waiting for the inspection through the Surveyor for necessary assessment and on the Complainant's own instruction carried out the repairing work on the said vehicle, resulted in gross violation of policy terms and conditions. The reply is totally false and baseless and the Complainant has never made any repair to her vehicle from the date of accident to till the receipt of reply from the opposite party. The Complainant informed the Surveyor well in advance. The Complainant never repaired her vehicle before the Surveyor's inspection, which took place on 03.09.2019. Moreover, the Surveyor has rudely behaved with the Complainant and has given a false report to the Opposite Party, for the reason best known to him. The Complainant has actually informed her Mechanic to carry out the repair works on 10.09.2019, that too after receipt of rejection of claim letter from the opposite party and the work was started only on 10.09.2019, at the cost of the Complainant and completed the repair work and took delivery of her vehicle from the garage only on 19.09.2019 Evening. She had suffered a lot for 19 days (01.09.2019 to 19.09.2019) from the date of accident/making her claim complaint/handing over of her vehicle to the garage till it was repaired. The Complainant was forced by the Surveyor that not to carry-out any repair work till he informed. Accordingly, She didn't repair her vehicle. Only after receipt of the refusal letter, the Complainant herself did the repair work. Till then, she used to take her trips to her work through call taxies/Auto, for which she spent about Rs.200 per day for 19 days. The conveyance charges met out by the Complainant is Rs. 1800/-. Only after the receipt of refusal letter from the opposite Party, she started to spent out for repair of her vehicle and the bills produced by her show that she repaired her vehicle on the following dates and incurred a sum of Rs.7,086/-. Hence the complaint.

3. Written Version filed by the Opposite Party in brief is as follows:-

The Complainant had insured her vehicle TN 02 AV 8223 under Long Term Two Wheeler Package Policy No, 2312100188434500000 for the period 07.04.2017 to 06.04.2020. The coverage under the Policy is subject to terms and conditions stipulated. The Opposite Party received intimation of claim for damage to the said vehicle in accident on 01.09.2019. The Opposite Party had appointed a Inhouse Surveyor Mr. Selvaraj K to assess the damage due to the accident. The Complainant must await survey before repairs so that the actual damage due to accident could be verified. Since the liability of the Opposite Party is only for repairs due to accidental damage and not for any other repairs it is the right of the Opposite Party to get the damage duly verified by the Surveyor. Repairs before survey denies the opportunity to verify the accidental damage. On 03.09.2019 when the Surveyor went for inspection of the vehicle, he found that the repairs were already going on and he could not determine the actual accidental damage pertaining to the accident. The Opposite Party would point out that Surveyors are appointed under Sec. 64 UM of the Insurance Act to conduct Survey on receipt of a claim by an insurance company to identify the loss/damage due to insured risk and decide upon admissibility of any claim including the quantum of loss. The Complainant has deprived the Opposite Party of their right to verify the nature and extent of damage to the Insured vehicle in accident on 01.09.2019 by subjecting the vehicle to repairs before Surveyor's inspection. The conduct of the Complainant was a fundamental breach and also prevented assessment of the actual accidental damage. In view of the same and the inability to identify the actual accidental damage the Opposite Party repudiated the claim vide letter dated 06.09.2019 for valid reasons. Certain repair bills are filed by the Complainant before this Hon'ble Forum the fact remains that the vehicle was subject to repairs prior to date when the Surveyor undertook inspection of vehicle. The Complainant is trying to mislead this Hon'ble Forum as if repairs were carried out after repudiation while in reality the repairs had been going on before Survey and repudiation. The conduct of the Complainant is mala fide and it appears that the intimation of claim itself was an afterthought to misuse the insurance for routine running repairs. The Opposite Party has thus acted bonafide and vehemently denies that it has committed deficiency in service. The complaint is not maintainable and liable to be dismissed. The further allegation that Surveyor forced delay in repairs or that Complainant thereby incurred Rs.1,800/- as conveyance are denied. Such expenses are consequential losses not covered by the Policy. It was denied that the Complainant incurred Rs.7,086/- towards accidental damage to the vehicle. The Opposite Party is not liable for the same. Hence prayed to dismiss the complaint.      

4. The Complainant submitted her Proof Affidavit and Written Arguments. On the side of the Complainant, documents were marked as  Ex.A-1 to Ex.A-13. The Opposite Party submitted its Written Version and Proof Affidavit. On the side of Opposite Party documents were marked as Ex.B-1 to Ex.B-2.

Points for Consideration

1. Whether there is deficiency in service on the part of the Opposite Party?

2. Whether the Complainant is entitled for reliefs claimed?

3. To what other reliefs the Complainant is entitled to?

Point No.1:

        On 01.09.2019 the Complainant had met with an accident causing minor injury to herself and damages to the vehicle, for which she has made complaint through the Tamil Nadu Police Website Portal. The Complainant had also submitted her claim to the Opposite Party on the same day vide claim No.C230019241340 as seen from Ex.A-5 and Ex.A-6. However, as per Ex.A-7, the Opposite Party had repudiated the claim of the Complainant on the ground that, it was own damage claim, and that the surveyor was unable to inspect the vehicle and assess the damages as the vehicles was already repaired.  

        The Opposite Party agreed that they had received intimation of claim for damage to the vehicle in accident on 01.09.2019. Further contended that on 03.09.2019 when the surveyor went for inspection he found that the repairs were already going on and that he could not determine the actual damage caused due to the accident. Hence the Opposite Party had repudiated the clause of the Complainant.

        Though the Survey Report indicates that the date of survey was on 02.09.2019, there is no physical verification of the vehicle done by the Surveyor. He had contacted the Complainant and based on photos shared by the Complainant the surveyor had concluded to deny the claim of the Complainant. It is pertinent to note that in the Written Version the date of inspection of the surveyor is mentioned as 03.09.2019. The repudiation of the claim that the vehicle was already repaired by the Complainant cannot be accepted as the invoices, bills for the purchase of spare parts of the vehicle and the Labour Bills are dated between 10.09.2019 to 19.09.2019 as seen from Ex.A-8 which is subsequent to the rejection of the claim. The Surveyor without due inspection of the vehicle had come to a wrong conclusion to reject the claim of the Complainant.

        When the Complainant is holding a valid and subsisting insurance policy and having submitted the claim on the same date of accident to the Opposite Party in time along with necessary documents the rejection of claim by Opposite Party that the repairs were already carried out by the Complainant before the surveyor could assess the damage, when such repairs are carried out subsequent to the rejection of claim as seen from Ex.A-8, amounts to deficiency in service on the part of the Opposite Party and the Complainant is entitled to get the claim amount. Accordingly, Point No.1 is answered.

Point Nos.2 and 3:

As discussed and decided Point No.1 against the Opposite Party, the Opposite Party is liable to pay a sum of Rs.7,086/- and to pay a sum of Rs.20,000/- towards deficiency of service and mental agony suffered by the Complainant along with litigation cost of Rs.5,000/-. Accordingly Point Nos. 2 and 3 are answered. 

In the result, the complaint is allowed in part. The Opposite Party is  directed to pay the claim amount of Rs.7,086/- (Rupees Seven Thousand and Eighty six Only) and to pay a sum of Rs.20,000/- (Rupees Twenty Thousand Only) towards deficiency of service and mental agony suffered by the Complainant along with litigation cost of Rs.5,000/- (Rupees Five Thousand Only) to the Complainant, within 8 weeks from the date of receipt of this order failing which the amount of Rs.7,086/- shall carry interest @9% p.a from the date of receipt of this order till the date of realization.

          In the result this complaint is allowed.        

Dictated to Steno-Typist, transcribed and typed by her, corrected and pronounced by us in the Open Commission, on 3^rd of January 2023.

 

 

S. NANDAGOPALAN               T.R. SIVAKUMHAR                 B.JIJAA

         MEMBER II                       MEMBER I                        PRESIDENT

 

List of documents filed on the side of the Complainant:-

 

Ex.A1	04.12.2012	Copy of Registration Certificate of the vehicle of the Complainant
Ex.A2	30.11.2001	Copy of Driving Licence of the Complainant
Ex.A3	31.03.2017	Copy of Policy Certificate issued by the Opposite Party to the Complainant
Ex.A4	01.09.2019	Copy of Police complaint lodged with regard to the Complainant caused with an accident
Ex.A5	01.09.2019	Online claim made by the Complainant to the Opposite Party
Ex.A6	01.09.2019	Copy of claim application of the Complainant sent to the Opposite Party
Ex.A7	06.09.2019	Rejection of claim sent by the Opposite Party to the Complainant
Ex.A8	10.09.2019 to 19.09.2019	Invoices/Bills fo the purchase of spares to the vehicle of the Complainant and Labour Bill settled by the Complainant
Ex.A9	23.09.2019	Legal Notice of the Complainant sent to the Opposite Party
Ex.A10	25.09.2019	Proof of Delivery of Registered post sent to the Opposite Party
Ex.A11	03.10.2019	Empty reply received from the Opposite Party’s official cover by the Complainant
Ex.A12	04.10.2019	Further Legal Notice sent by the Complainant to the Opposite Party
Ex.A13	05.10.2019	Proof of Delivery of Registered post sent to the Opposite Party

 

List of documents filed on the side of the Opposite Party:-

 

Ex.B1		Insurance Policy with terms and conditions
Ex.B2		Survey Report

 

 

 

S. NANDAGOPALAN               T.R. SIVAKUMHAR                    B.JIJAA

         MEMBER II                       MEMBER I                         PRESIDENT