Date of filing -13.09.2022                                     Date of judgement -21.04.2023                                              

Facts of the case in nutshell is that the complainant has financed a vehicle bearing registration No. OD09N-6310 for earning his livelihood and the vehicle is duly insured by Ops vide policy No.-3003/166853486/02/000 valid from 13.03.2021 to 12.03.2022. On dated 30.04.2021 the said truck met with an accident at Khudaposi to save a cow in front of alleged vehicle. Due to heavy rain the driver suddenly stopped the vehicle and which turned down and damaged, During accident the vehicle was driven by one Dilip Kumar Munda, having valid driving license. Complainant immediately lodged F.I.R before Baria Police Station, Keonjhar who entered station dairy vide SDE No. 4/15/2021. From the said accident there is no loss of life but the truck was totally damaged. The matter was intimated to insurance company. Due to covid-19 the Ops company asked his officials to send the photographs of vehicle and then company advised to shift the vehicle to the nearest garage namely  Afteen truck Body work at Palaspalga. Insurance company hesitated to come and directed to open the vehicle and send photos. Complainant sent  estimated cost of repairing of Rs 8,38,600/-. The complainant was allotted a claim No. by Ops vide No. MOT10997317. Complainant repaired the said vehicle by arranging hand loans.

All documents are sent to Ops on Dated 18.05.2021 Ops Company took inquiry report from the driver but delayed to pay the claim amount. When the complainant pressed hard to Ops for settlements they avoided it and repudiated the claim on dated 30.08.2021 taking a vague plea that drivers details are not sent, without getting any help the complainant filed this case praying for repairing cost of Rs 9,65,502/- along with mental agony and cost of litigation.

On the above situation the case is admitted and notice issued to Ops. Ops appeared and filed their written version.

Complainant relied on the following documents to establish his case

1. Photo copy of R.C book, Pollution certificate, Permit      
2. Insurance copy
3. Copy of F.I.R
4. Copy of D.L
5. Way Bills.
6. Driver documents.

On the other hand the Ops insurance company submitted in their written version that the case is not maintainable but admitted the insurance policy is valid .They all submitted that the Ops insurance company deputed a surveyor, Er.Dharanidhar Das to find out the notional loss incurred by the complainant due to damage of vehicle in accident. Accordingly the surveyor submitted his report and assessed the liability of Rs 2,35,783/-

It is also submitted in written version that complainant did not support to collect driver’s statement and also not allowed the investigator to verify the driver and helper.

It is also submitted that insurance company appointed Corporate Risk Solution Private Ltd. to investigate the accident case and submit his report that insured failed to submit driver statement and on verification of physical condition of damaged vehicle it is likely chances of injury to driver but insured stated that there was no injury to driver.

Ops Insurance Company also appointed ICS Assure Service Pvt Ltd. for scientific analysis and scientific observation on different angle. On the report they said that Dilip Kumar Munda is not correlating to be sitted on driver seat at the time of accident as no injury is observed. As because driver can not escape un hurt in the said accident as major damage observed. So insurance company repudiated the claim on mis representation of facts regarding driver details at intimation/claim form and try to hide the material facts.

Ops relied on the following documents    

1. Report of surveyor
2. Report of corporate risk solution Pvt.Ltd.
3. Report of ICS assure survice Pvt.Ltd.
4. Repudiation letter

Going through the complainant petition, written version of Ops and submission made by parties the following issues are framed to decide the case.

1. Whether the case is maintainable?
2. Whether any cause of action arises on this case ?
3. Whether Ops have made any deficiency of service?
4. Whether the complainant is entitled to gate any relief sought for?  

FINDINGS

All issues are discussed jointly to find out the conclusion. In this case the complainant has categorically stated that the company requested to repair the damaged vehicle in the nearest garage of Arfeen Body Garage at Palaspanga and also estimated the expenditure, applied the claim form in proper manner. Three investigation report are prepared like surveyor /loss assessor report, Corporate Risk Solution Pvt. Ltd. report for damaged and ICS Assure Pvt.Ltd. report for scientific angles of accident. The surveyor assessed the loss of Rs 2,35,000/- and other two reports states that complainant did not support to take statement of driver and helper. Their report concluded in one point that due to such accident driver can not escape unhurt. So Ops company repudiated the claim on the ground of miss representation of fact in claim.

On analytical study of report it is cleared that the vehicle is fully damaged. Insurance policy is valid. The claim can not be repudiated by Ops only for a mere ground. Learned Advocate for complainant has relied on citation in the following grounds.

1. “Claim can be settled on Non standard  basis in case of minor breach of condition of insurance policy”  (ICICI Lombard VS Chandrakanta Ramanikal 2017 (2) CPR 614 (NC)
2. If there is any breach of warranty or condition of policy including limitations or to use . Complainant is entitled to get 75% of admissible claim on non standard basis. ( New India assurance company Ltd. Vs Smt. Malati Vika Vhone)

So Ops have made deficiency of service by repudiating the claim. Cause of action arrises on the date of accident caused and complainant applied for settlement of claims. So the case is maintainable. Ops insurance company is liable to pay the insurance claim on 75% of total amount 9,65,502/- on non standard basis. The complainant is entitled to get reliefs.

ORDER

The complaint Petition is allowed on contest.

1. The Ops company are directed to pay Rs.7,23,000/- as claim amount to complainant.
2. And Ops company  are further directed to pay Rs. 50,000/- for mental agony and cost of litigation.

And if The Ops company failed to comply this order within 15 days of receipt of this order it shall carry 9% interest P.A on total amount (7,23,000+50,000 = 7,73,000/-) from the date of application  till the realization of money. 

              The Order is pronounced in open Commission today i.e on 21^st April 2023.