Haryana

Karnal

CC/255/2022

Dinesh Kumar - Complainant(s)

Versus

ICICI Lombard General Insurance Company Limited - Opp.Party(s)

Mange Ram Sangwan

01 Aug 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 255 of 2022

                                                        Date of instt.28.04.2022

                                                        Date of Decision:01.08.2024

 

Dinesh Kumar son of Shri Rajinder Kumar, resident of Karsindhu Tehsil Saffidon, District Jind Haryana.

 

                                               …….Complainant.

                                              Versus

 

1. ICICI Lombard General Insurance Co. Ltd. through its Senior Manager Registered office at ICICI Lombard House, 414, Veer Savarkar Marg, near Sidhi Vinayak Tample, Prabhadevi, Mumbai-400025.
2. ICICI Lombard General Insurance Co. Ltd. through its Senior Manager Branch Office at Karnal, SCO no.3 Second floor Sector-8, HUDA Market Karnal.

 

                                                                    …..Opposite Parties.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.     

      Shri Vineet Kaushik…….Member

      Ms. Sarvjeet Kaur .…..Member

 

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

                    Shri Naveen Khetarpal, counsel for the OPs.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant is registered owner of car Skoda Laura bearing registration no.HR51 AP 2138, which was insured by the OPs, vide policy no.3001/190325490/00/B00 commenced from 08.01.2020 to 07.01.2021 and the insured declared value of the vehicle is Rs.7,00,000/-. The said vehicle met with an accident on 22.11.2020, near Madhuban Karnal. In the said accident complainant got received injuries and the vehicle was totally damaged. Intimation in this regard was given to the OPs. A DDR no.014 dated 23.11.2020 had also been lodged. The complainant lodged the claim with the OPs and submitted all the required documents. The surveyor was appointed by the OPs, who had inspected the vehicle. The loss of the vehicle was assessed as Rs.14,37,620/- by Sidak Automobiles Private Limited/Authorized Service Centre Karnal, where the vehicle was parked by the complainant. The complainant had submitted all the concerned documents with the OPs but OPs did not settle the claim. Thereafter, complainant visited the office of OPs so many times and requested to settle the claim but OPs did not pay any heed to the request of complainant and lastly close the claim of complainant on the false and frivolous ground. Then complainant sent a legal notice dated 05.01.2022 to the OPs but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version, raising preliminary objections with regard to maintainability; premature and concealment of true and material facts. On merits, it is pleaded that present complaint is not maintainable being premature. Till date complainant has not submitted any documents to the office of OPs regarding loss of his car. Complainant after lodging the claim, not cooperated with the OPs. Complainant neither allowed for spot survey and final survey of car. Till date complainant did not disclose, where car is parked after alleged accident.  Complainant does not provide single documents to OPs despite repeated requests for processing of the claim. OPs also failed to appoint surveyor and investigator in order to verify the facts of the case, genuineness of accident and loss assessment etc. due to non-cooperation of complainant, OPs closed the claim of the complainant vide letter dated 02.06.2021. As there is gross violation of terms and conditions of the policy by not provide the documents. It is specifically denied by the OPs that the car of complainant got damaged on 22.11.2020 near Madhuban Karnal. A false DDR was got recorded on the basis of false and concocted version on the advice of some experts in order to grab false compensation amount. 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 and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of RC Ex.C1, copy of driving licence Ex.C2, copy of insurance policy Ex.C3, copy of DDR Ex.C4, copy of claim form Ex.C5, copy of estimate of repair Ex.C6, copy of legal notice Ex.C7 and Ex.C8, postal acknowledgement Ex.C9 and Ex.C10 and closed the evidence on 14.03.2023 by suffering separate statement.

5.             In additional evidence, learned counsel for the complainant has tendered surveyor report Ex.C11 dated 24.09.2023 and closed the additional evidence on 18.04.2024 by suffering separate stamen.

6.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Sonu Rathi, Legal Manager Ex.RW1/A, copy of claim closure letter Ex.R1, copy of insurance policy Ex.R2, copy of terms and conditions of the policy Ex.R3 and closed the evidence on 10.08.2023 by suffering separate statement.

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

8.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that complainant got his vehicle insured with the OPs. On 22.11.2020, the said vehicle met with an accident and was totally damaged. Intimation was given to the OPs. A DDR no.014 dated 23.11.2020 was lodged. The complainant lodged the claim with the OPs and submitted all the required documents for settlement of the claim but OPs did not settle the claim despite repeated request of complainant and close the claim of complainant on the false and frivolous ground and lastly prayed for allowing the complaint.

9.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that the present complaint is pre-mature as the complainant had not cooperated with the OPs. Complainant has not allowed for spot survey and final survey of the vehicle. Complainant does not provide single documents to OPs despite repeated requests for processing of the claim. Due to non-cooperation of complainant, OP closed the claim of the complainant vide letter dated 02.06.2021 and lastly prayed for dismissal of the complaint.

10.           We have duly considered the rival contentions of the parties.

11.           Admittedly, complainant got insured the vehicle in question with the OPs. The vehicle in question met with an accident during the subsistence of the insurance policy. It is also admitted that the Insured Declared Value (IDV) of the vehicle in question is Rs.7,00,000/-.

12.           OPs have alleged that after lodging the claim, complainant has not submitted the documents with regard to loss of his car. Complainant has neither allowed for spot survey nor disclosed the place where the car was parked after alleged accident. On the other hand, complainant has alleged that after the accident, he submitted the claim from alongwith relevant documents to the OPs and surveyor of the OPs has also inspected the vehicle in question. The onus to prove his case was relied upon the complainant. To prove his case, complainant has placed on file copy of RC Ex.C1, copy of driving licence Ex.C2, copy of insurance policy Ex.C3, copy of DDR Ex.C4, copy of claim form Ex.C5, copy of estimate of repair Ex.C6, copy of legal notice Ex.C7 and Ex.C8, postal acknowledgement Ex.C9 and Ex.C10 and surveyor report Ex.C11.  A careful perusal of the said documents reveals that the complainant has submitted the claim form with the estimate of repairs to the OPs. When complainant submitted the claim form with the estimate of repairs to the OPs, why he would have not allowed the surveyor to inspect the spot and why he would have not informed the OPs about the place where the car was parked. Therefore, it appears that the OPs have made a concocted a story for the reasons best known to them.  Moreover, when the complainant has placed the said documents on record then why he would have not given it to the OPs, when his personal interest involved for getting a claim amount.

13.           If for the sake of gravity, if it is presumed that complainant has violated the terms and conditions of the insurance policy for not submitting the documents, in that eventuality, the claim of the complainant cannot be repudiated in toto.  In this regard, we relied upon the case laws cited in Revision Petition no.1870 of 2015(NC) decided on 14.08.2018 titled as New India Assurance Co. Ltd. Versus Thirath Singh Brar and authority of our own Hon’ble State Commission in First Appeal no.717 of 2016 decided on 6.4.2017 titled as United India Insurance Company Limited and others Versus Anshul Bansal.  In both judgments it was held that in case of any breach of warranty/condition of the policy the insurer is liable to pay 75% of admissible claim on non-standard basis.

14.           Further,  Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-

“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy”.

15.           Keeping in view the law laid down in the above judgments and facts of the case, the act of the OPs amounts to deficiency in service while repudiating the claim of the complainant in toto. Hence, complainant is entitled to get 75% only of the admissible claim on non-standard basis.

16.           The complainant has alleged that his vehicle has become damaged totally and claimed the Insured Declared Value (IDV) of the vehicle. To prove his version, complainant has placed on file survey report Ex.C11 dated 24.09.2023, prepared by Er. Virender Kumar, Surveyor and Loss Assessor. As per the said report net assessment loss is Rs.14,15,477/-, which is beyond the IDV of the vehicle.  As per insurance policy Ex.C3/Ex.R2, the IDV of the vehicle is Rs.7,00,000/-. Hence the complainant is entitled for Rs.5,25,000/-i.e. 75% of the insured amount alongwith interest, compensation for mental pain, agony and harassment and litigation expenses etc.

17.           In view of the above discussion, we partly allow the present complaint and direct the OP to pay Rs.5,25,000/- (Rs. five lakhs twenty five thousand only) i.e. 75% of the insured amount alongwith interest @ 9% per annum from the date of filing the complaint i.e. 28.04.2022 till its realization to the complainant. We further direct the OP to pay Rs.25,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.11,000/- for the litigation expenses. This order shall be complied with within 45 days from the receipt of copy of this order. Complainant is also directed to complete all the formalities with regard to transfer/cancel of the RC of the vehicle in question. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance..

Announced

Dated:01.08.2024                                                                    

                                                                President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

(Vineet Kaushik)                (Sarvjeet Kaur)    

                     Member                           Member