The brief facts of the present case are that the complainant is registered owner of a TATA Safari Car bearing registration No.HR-33C- 3580. The said vehicle of the complainant was fully insured against all the claims i.e loss, damage, theft etc. with the respondents No.1 & 2 through their agent i.e. the respondent No.3. The respondents No.1 & 2 insured the said vehicle through the respondent no.3 for the value of Rs.4,50,000/- and received the premium amount of Rs.22,533/- from the complainant and issued Policy No. M0205650 w.e.f. 21.03.2018 to 20.3.2019 for the said vehicle. The said Insurance policy /Cover note is valid with effect from 21.3.2018 to 20.3.2019. Unfortunately on 12.4.2018 the said insured vehicle of the complainant met with an accident as a wild cow came on road suddenly in front of said vehicle and due to this accident /incident, this said vehicle was damaged badly and is not in a condition to run on road. In this regard, a DDR No.21 dated 24.04.2018 was registered in police post Sector 6-7, HUDA, Panipat. The complainant intimated the respondents regarding the said accident and as per the assurance of respondents, the  complainant got estimate of repair of the said vehicle from Shiva Motors which was for spent Rs.10,42,535/- Thereafter the complainant deposited the required documents with the respondents No. 1 & 2 and requested them to make the above said claim amount to the complainant and also replied the letters issued by the respondents No.1 & 2, but the respondents No.1 & 2 did not make the claim amount to the complainant and repudiated the claim by issuing letter dated 29.04.2019. The complainant made request to the respondents several times to issue the claim of the complainant, but the respondents have been prolonging the matter under one pretext or the other. Thereafter the complainant got served a legal notice upon the respondents but the respondents neither replied the notice nor made the said payment to the complainant. So the complainant has come to this Commission with the prayer to direct the respondents to make the payment of Rs.4,50,000/- as insured value of said vehicle alongwith interest upto date and to make compensation of Rs.50,000/- on account of mental pain and agony alongwith litigation expenses.

2.                 Upon notice, respondents No.1 and 2 appeared and filed their joint written statement but none appeared on behalf of respondent No.3, hence respondent No.3 was also proceeded ex parte vide order dated 15.02.2022.

3.                In reply/written statement, respondents No. 1 and 2 submitted that the complainant intimated a loss arising from an accident dated 12.04.2018 with a delay of 15 days on 27.04.2018. Upon this intimation Mr. Sanjeev Chhabra independent and IRDA approved Surveyor was immediately appointed as Surveyor to assess the loss suffered by the complainant on 28.04.2018. It is further submitted that the Surveyor visited the complainant, did a spot survey and submitted his report highlighting that the damage of the Insured vehicle number HR33C3580 does not match with the cause of loss. The cause of loss as mentioned in the claim form by the complainant was that the insured vehicle was being driven near Sector 6, Panipat. At the site of accident, a wild animal suddenly came in front of Insured Vehicle (IV) resulting to save hit with that animal when the insured quickly steered the vehicle towards left side but lost control on the steering at once so it hit/dashed its front to the rear of a tralla going ahead of insured car causing the damage. The Karnal Associates, Investigating and Detective Agency were also appointed as Investigators to investigate into the matter. Letters dated 28.07.2018 and 07.08.2018 were sent to the complainant asking for the vehicular details of the tralla which struck the insured vehicle but there was no response to the same. The Investigator submitted their report with the findings that:

• The TATA Safari has been intentionally damaged, to convert it into a total loss as the damage of the Car does not match with the cause of loss. Also, the insured did not reveal the vehicular details of the said tralla. Thus, the insured has tried to manipulate the case and misrepresent to the Insurance Company.
• The damage of Engine and Bonnet of Car does not compare with the place of accident as there is no proof of oil spots at the place of accident and it appears that Car has been intentionally damaged, to convert it into total loss.
• The tie member of insured vehicle found damaged with multiple hits which is not at all possible when a vehicle will hit to the rear of a truck. The tie member will definitely be damaged but will not be damaged in a manner as found signs of multiple hits. The insured has reported in claim form that the insured vehicle hit to the rear of a tralla. The undersigned inspected the vehicle and found that the front bumper along with tie member and radiator/condenser etc found damaged as well as engine head area along-with front bonnet found badly crushed and pushed to windshield. If any vehicle will hit to the rear of a truck then that vehicle will stopped to the rear of that ahead going vehicle, but in the insured vehicle it is found that the front bonnet along with engine head and fenders area found badly damaged/crushed which is not at all possible in this case.

                   So, after inspecting the vehicle, the surveyor’s opinion was that the damages found in the insured vehicle do not coincide with the cause of loss. Hence, in accordance with the Survey report and the Investigator's Report the claim was closed as No claim as the complainant had tried to manipulate the case and mis-represented the facts to the Insurance Company. Letters dated 08.03.2019 and 18.02.2019 were sent asking for clarifications but were not replied and finally a NO CLAIM letter dated 29.04.2019 was sent to the complainant. Hence, the repudiation of the claim of the complainant has been done according to the Surveyor's recommendations. The answering respondents denied all the other allegations of the complainant and took preliminary objections regarding maintainability, jurisdiction, locus standi and suppression of true and material facts.

4.                In order to prove the allegations of the complaint, the complainant has filed his sworn affidavit Ex.CW1/A and closed the evidence after tendering the following documents;

5.                On the other side, respondents No.1 and 2 in evidence have tendered affidavit of Sameer Gupta, Authroized Signatory as Ex.RW1/A and closed the evidence after tendering the following documents;

6.                We have heard the arguments advanced by learned counsel for the parties and gone through the material on record thoroughly and carefully.

7.                The vehicle of the complainant bearing registration No. HR-33C-3580 was insured with the respondents No.1 and 2 vide insurance policy Ex.C1 for IDV of Rs.4,50,000/- w.e.f. 21.03.2018 to 20.03.2019. The vehicle met with an accident on 12.04.2018 when suddenly wild cow came in front of the said vehicle and the vehicle was damaged and DDR to the effect Ex.C3 bearing DDR No.21 dated 24.04.2018 was got recorded in police post Sector 6-7, HUDA, Panipat by complainant. Shiv Motors gave estimate Ex.C6 for repair of the said vehicle as Rs.10,42,535/-. The complainant lodged claim with the respondents which was repudiated on 29.04.2019 vide letter Ex.A8 on the ground that damages in the vehicle do not co-relate with the cause of loss and further there was delay of 15 days in giving intimation to the insurance company.

8.                The insurance company on receipt of intimation deputed Sanjeev Chhabra, surveyor and loss assessor who submitted his final survey report Ex.R1 and assessed the loss as Rs.3,28,000/- on net of salvage basis. The insurance company has also deputed Karnal Associates Investigating and detective agency to conduct the investigation and this agency submitted investigation report Ex.A5 on 29.09.2018 with the findings that TATA Safari car No. HR-33C- 3580 was registered in the name of complainant Parvinder who was having a valid driving license, insurance policy was valid upto 20.03.2019. The damage of engine and bonnet of car does not compare with the place of accident as there was no proof of oil spots at the place of accident and it appears that the car has been intentionally got damaged to convert it into total loss. The insured has not intimated the RC Number of Tralla with which the accident occurred. With these findings, further concluded that damage of car  does not match with the cause of loss.

9.                On the basis of this investigation report A5 and observation made therein, the insurance company has repudiated the claim of the complainant. The complainant has specifically alleged that on 12.04.2018 the insured vehicle met with an accident as a wild cow came on the road suddenly in front of the said vehicle and due to this accident, the said vehicle was damaged badly and not in a condition to run on the road. In this regard, a DDR No.31 dated 24.04.2018 (Ex.C3) recorded in police post. The complainant got repaired estimate from Shiv Motors as Ex.C6 and thereafter lodged claim with the insurance company as per motor claim form Ex.A2. This very facts have been supported by the complainant in his affidavit Ex.CW1/A.

 10.             The insurance company has claimed that there was delay in giving intimation of 15 days to the insurance company by the complainant. When the insurance company has got investigated the case from the Investigating Agency vide report Ex.A5, the insurance company has further got conducted survey of the vehicle from surveyor and loss assessor as per report Ex.A1 dated 10.05.2019, then this delay in giving intimation to the insurance company is not fatal as the assessment and investigation of the accident has sufficiently been got done by the insurance company. It is nowhere alleged in the written statement what prejudice has been caused to the insurance company by giving this delay intimation to the insurance company and no such statement on this point has been made by Sameer Gupta, Authorized Signatory in his affidavit Ex.RW1/A. Therefore, the denial of claim on the basis of delay in intimation to the insurance company is not justified.

11.              The complainant in his affidavit Ex.CW1/A has alleged that the damage to the vehicle was caused due to accident took place on 12.04.2018 when a wild cow suddenly came in front of the vehicle. The complainant has narrated the manner of accident in DDR Ex.C3 as well as in claim form A2. In claim form he has also stated that the vehicle was hit back to a Tralla going ahead on the road. Mere non-disclosing of registration number of Tralla is also no ground to reject the claim. The surveyor and loss assessor in his report Ex.A1 has given findings that loss net payable was found Rs.3,28,000/- on net of salvage basis. The investigator in his report Ex.A5 has given findings that damage of car does not match with the cause of loss and further gave findings that vehicle was intentionally got damaged to convert into total loss. There is no evidence to this effect disclosed in the investigation report and merely mentioning of this fact in the investigation report, is not sufficient unless or until it is supported by some cogent and convincing evidence. The complainant has simply gave version of accident in which manner it has taken place. The factum of damage to be assessed by the surveyor and loss assessor. If the complainant has manipulated the accident, then he could have narrated the manipulated version in DDR in accordance with nature of damage caused to the vehicle. Once it is proved that accident of vehicle has taken place, then it is for the insurance company to indemnify the damage when duly covered under the insurance policy.

12.              The complainant has also produced on record copy of letter Ex.C4 whereby he has given reply of queries of letter Ex.A7 dated 18.02.2019. Therefore, it cannot be said that the complainant has not replied the letter of investigator and insurance company. The complainant has claimed insured value of the vehicle as Rs.4,50,000/-. The surveyor and loss assessor vide report Ex.A1 has assessed the net liability of insurance company as Rs.3,28,000/- on net salvage basis and complainant has failed to rebut this report and in such circumstances, this report being of expert in the field is to be believed by this Commission. Hence, the complainant is entitled to loss claim of the vehicle as Rs.3,28,000/- assessed by the loss assessor vide survey report Ex.A1 and present complaint is liable to be accepted partly.

13.              For the reasons recorded above, we partly allow the present complaint and direct the opposite parties/respondents No.1 and 2 as under;

1. To pay Rs.3,28,000/- (Rupees Three Lakhs Twenty Eight Thousand Only) as compensation to the complainant on account of loss of damage of his vehicle alongwith interest @ 9% per annum from the institution of this complaint till realization.

1. To pay Rs.15,000/- (Rupees Fifteen Thousand Only) as compensation to the complainant for causing physical harassment and mental agony besides Rs.5,500/- (Rupees Five thousand five hundred only)  as litigation expenses.

14.              The above ordered amount shall be paid by the respondents/opposite parties No.1 and 2 within 45 days from the date of receipt of the copy of this order.

15.              This complaint qua respondent/opposite party No.3 stands dismissed as he being agent, for his act the insurance company is liable.

16.              Miscellaneous application(s), if pending, be disposed off in view of this order.

17.               This order be communicated to the parties free of costs and file be consigned to the record-room.