Haryana

Karnal

CC/334/2022

Rajinder Singh - Complainant(s)

Versus

Iffco Tokio General Insurance Company Limited - Opp.Party(s)

Mange Ram Sangwan

02 Sep 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 334 of 2022

                                                        Date of instt.13.06.2022

                                                        Date of Decision: 02.09.2024

 

Rajinder Singh son of Shri Randhir Singh, resident of house no.736 sector 6 U.E. Karnal.

                                                                        …….Complainant.                                             Versus

 

1. Iffco Tokio General Insurance Co. Ltd. through its Senior Manager, Registered office at Iffco Sadan, C-1 District Center, Saket, New Delhi 110017.

 

2. Iffco Tokio General Insurance Co. Ltd. through its senior Manager Branch Office at SCO no.19-20 Ground floor Part-I, Sector 12 Urban Estate Karnal.

 

                                                                 …..Opposite Parties.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.

              Ms. Neeru Agarwal……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 the registered owner of car Volkswagen, bearing registration no.HR-10Y 4857, which was insured by the OPs, vide policy no.MA 960402, commenced from 29.10.2019 to 28.10.2020. On 04.08.2020, the said vehicle met with an accident, when complainant was going to Panipat and reached near Namastey Chowk, then the forgoing tractor with trolley suddenly applied breaks due to which frontal portion of the car striked on the back side of the trolley, the car of the complainant was totally damaged due to the accident. A DDR no.12 on 05.08.2020 was got registered by the Local Police at Karnal. The intimation was given to the OPs. The vehicle of the complainant was shifted to authorized service center Karnal by Bagga Crane Service Karnal and the vehicle was got  examined by PSB Automobiles Pvt. Ltd., the authorized service center, Karnal. The estimate of loss to the damaged vehicle was assessed to Rs.21,65,677/-. The complainant lodged the claim with the OPs and submitted all the required documents for settlement of the claim. Thereafter, unwanted documents were called and vague and unsustainable objections were levied on the claim of the complainant and in this way the matter was lingered on one pretext or the other and the claim of the complainant had not been settled, the OPs were adamant either to repudiate the claim or to postpone the matter without any sufficient cause, rather complainant was/is ready to cooperate with OPs and ready to furnish any type of information, which is required to settle the claim. It is further averred that OPs have issued a letter dated 27.03.2021 with the vague allegation that it was found that “there is variation in your submission regarding cause of loss mentioned by you in the claim form and in DDR registered with police” but true facts is that there is no variation as alleged in claim form submitted by complainant and it seems that OPs abovesaid have bad intention to repudiate the claim of complainant, inspite of the fact that the complainant has cleared all the query and have submitted all the concerned documents with OPs. When the claim of the complainant had not been settled till 28.04.2022, then the complainant had sent a legal notice 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; cause of action and concealment of true and material facts. On merits, it is pleaded that the present complaint is premature. The complainant till date, not completed the claim formalities for settlement of the claim, as required under the terms and conditions of the insurance policy. After getting the intimation regarding claim of complainant, OP company immediately appointed an IRDA approved independent surveyor Mr. Virender Singh, As per submission in claim form, DDR and survey of the physical damage to the vehicle it was found that there is variation in complainant submission regarding cause of loss mentioned by him in the claim from and in DDR registered with police. It was also observed that several key aspect of the physical damage were not correlating with the loss particulars provided by insured. In the light of the above, the vehicle was again inspected in the presence of complainant on 11.03.2021 by IRDA licensed surveyor Mr. Mohit Sharma for ascertaining compliance of policy terms and conditions at the time of accident. Based on his survey of the vehicle and loss particulars related to accent provided by complainant, following technical discrepancies related to claim have been observed:-

.       As per the declaration of the complainant a tractor trolley came in front of his vehicle from service land and the complainant’s vehicle hit at rear of tractor trolley but as per police report the tractor trolley was moved in front of insured vehicle which suddenly applied brake and the complainant’s vehicle hit at rear of it. So, there is difference in both the statement.

.       As per loss particulars provided, complainant’s vehicle hit at rear of tractor trolley then there will be straight impact on the front side of vehicle but during physical inspection it was observed that the oil dip stick which is on front side as well as at a higher height as compared to the high pressure pump, intake manifold were found to be intact whereas high pressure pump, intake manifold found to be damaged which is not possible as the parts which are on front side and at higher height are the first parts which will come in contact with the rear side of the tractor trolley.

.       The pipe which are on front side of the high pressure pump found to be intact whereas these pipes will get damaged first and then the damages will move on the high pressure pump on inside.

.       Fuel lines which are placed at higher height as compared to common rail and intake manifold are found to be intact whereas the fuel lines will get damaged first and then damages will move on to common rail and intake manifold.

.       While checking the initial survey photo it was observed that a piece of intake manifold, fuse box cover with fuse and relays were not present. A piece of intake manifold cannot move out of the insured’s vehicle from its place until and unless the same has been removed by someone. The fuses and relays has been removed from the fuse box by someone as from the initial survey photos and during physical inspection it was observed that the same were not broken inside the fuse box indicating tampering with the damaged vehicle.

.       The physical damages present on the cowl top of the vehicle were localized at the center portion whereas the cowl top of the vehicle is placed just underneath the front windshield and on the rear/underneath the front hood, so if the cowl of the insured’s vehicle have to get damaged then the front hood will have to be uprooted or displaced from its position by the impact of the tractor trolley so that the same reaches on the front windshield area after getting crumpled but the front hood has not reached the cowl top area and as the rear side of the tractor trolley is straight, the damages on the cowl top cannot be localized.

.       During physical inspection, it was observed that the switch which is used to switch on/off the air bag of co-driver side was at on position whereas the same has not deployed the accident which is not possible because if the switch is on then both the air bags of front side will deploy.

.       That seat belt of driver was well as co-driver side have not locked at its position and both the seat belt were free which is not possible as in the process of air bag deployment, first the seat belts will get locked and then the air bags will deploy, so from this it is evident that the air bags have not deployed in this accent and driver side air bag has been intentionally fitted in the vehicle.

It is further pleaded that for clarification of these discrepancies, OPs sent letter dated 27.03.2021 to complainant give reply, so that his claim may be process as per terms and conditions of the policy but complainant neither replied the letter nor has given clarification regarding discrepancies. OPs again sent reminder letter dated 07.04.2021 in this regard but again complainant did not reply. Left with no option, OPs closed the claim of the complainant due to non-compliance of documents as No Claim vide letter dated 29.06.2021. Further, it is submitted that there is gross violation of terms and conditions of the policy on the part of the complainant. The present claim is based upon mis-description and suppression of material information from the OPs, violation of principle of utmost good faith ‘Uberrima Fides,’ misrepresentation, hiding of facts, connivance and attempt to play fraud with the OPs and make profit out of the claim and it does not fall under the purview of the policy and the insured has given wrong declaration and wrong undertaking in the claim form. The OP received no rebuttal or any clarification of letter dated 27.03.2021 from the complainant so far except the present concocted, manipulated and misrepresented complaint having no iota of truth. In summary the claim is untenable due to many irregularities and inconsistencies that do not match with the cause of loss and are beyond the consideration as per policy terms and conditions. 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 insurance policy Ex.C2, copy of DDR Ex.C3, copy of Crane Service receipt Ex.C4, photographs of accidental vehicle Ex.C5 and Ex.C6, copy of Motor Claim Form Ex.C7, copy of letter to the Claim Manager Ex.C8, copy of letter dated 27.03.2021 Ex.C9, copy of legal notice Ex.C10, postal receipts Ex.C11, repair estimate Ex.C12 and closed the evidence on 10.1.2023 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Gurvinder Kaur, General Manager Ex.RW1/A, copy of claim form Ex.C1, copy of DDR Ex.C2, copies of letters dated 27.03.2021, 07.04.2021 and 29.06.2021 Ex.C3 to Ex.C5, copy of insurance policy Ex.C6, copy of terms and conditions of the policy Ex.C7 and closed the evidence on 08.07.2024 by suffering separate statement.

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

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that complainant got insured his vehicle with the OPs.  On 04.08.2020, the vehicle met with an accident and badly damaged. The matter was reported to local police and police lodged the DDR no.12 dated 05.08.2020. The loss intimation was also sent to the OPs. Complainant lodged the claim with the OPs and submitted all the required documents for settlement of claim. Complainant requested the OPs several times for settlement of the claim but OPs did not pay any heed to the request of complainant and closed the claim of complainant on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that on receipt of information, regarding damaged to the vehicle, OPs appointed an IRDA approved independent surveyor Mr. Virender Singh. As per submission in claim form, DDR and survey of the physical damage to the vehicle it was found that there was variation regarding cause of loss. The several key aspect of the physical damages were not correlating with the loss particulars provided by insured. So, the vehicle was again inspected in the presence of complainant on 11.03.2021 by IRDA licensed surveyor Mr. Mohit Sharma. Based on his survey of the vehicle and loss particulars, various technical discrepancies related to claim have been observed. Further, complainant did not reply the letter and reminder sent by OPs to him. Thus, the claim of the complainant was rightly repudiated by the OPs and lastly prayed for dismissal of the complaint.

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

10.           Admittedly, complainant got insured his vehicle with the OPs. It is also admitted that the vehicle in question met with an accident during the subsistence of the insurance policy. It is also admitted that the insured declared value of the vehicle in question was Rs.14,27,000/-.

11.           The claim of the complainant has been closed by the OPs, vide letter Ex.C9/Ex.R3 dated 27.03.2021 on the grounds there are various discrepancies related to the claim have been observed and the physical damages were not correlating with the loss particulars.

12.             The claim of the complainant has been repudiated by the OPs on the abovesaid grounds. The complainant has alleged that his vehicle has been badly damaged in the accident and had become damaged totally. The onus to prove this fact was relied upon the complainant but the complainant has miserably failed to prove the same by leading any cogent and convincing evidence. The claim of the complainant is only based upon the rough estimate Ex.C13 and photographs of the vehicle Ex.C5 and Ex.C6. From the said estimate and photographs, it cannot be ascertained that the vehicle in question has been damaged totally. Complainant neither placed on file any survey report nor any invoice, to prove that vehicle of complainant has been damaged totally. On the other hand, OPs have also not placed on file survey report, vide which loss has been assessed by the surveyor of the OPs. Thus, without any documentary evidence, it cannot be ascertained that to what extent the vehicle of the complainant has been damaged. There is nothing on file that the vehicle of the complainant has been damaged totally and not repairable.

13.           For clarification of the discrepancies, OPs sent letter Ex.R3 dated 27.03.2021 and reminder Ex.R4 dated 07.04.2021 but complainant neither replied the said letter nor had given clarification regarding discrepancies. Hence, the OPs have rightly closed the claim of complainant.

14.           Thus, as a sequel to abovesaid discussion, the present complaint is devoid of merits and same deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:02.09.2024                                                                    

                                                                President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.      

 

(Neeru Agarwal)    (Sarvjeet Kaur)    

                                Member                Member