Haryana

Karnal

CC/424/2020

Sarvesh Kaushik - Complainant(s)

Versus

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

Mange Ram Sangwan

20 Apr 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 424 of 2020

                                                        Date of instt.14.10.2020

                                                        Date of Decision:20.04.2023

 

Sarvesh Kaushik son of Shri Dinesh Kaushik, resident of house no.66C, New Ramesh Nagar, Karnal.

                                               …….Complainant.

                                              Versus

 

1.     Iffco Tokio General Insurance Company Ltd. through its Branch Manager, SCO 19-20 ground floor Part-1, Sector-12, near Mini Secretariat, Hafed office Sector 12, Urban Estate, Karnal.

 

2.     Iffco Tokio, General Insurance Co. Ltd. through its Senior manager Iffco Sadan C1, District Centre Saket New Delhi 110017.

                                                                 …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary….Member

          

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

                    Shri Rohit Gupta, counsel for the opposite parties.

 

                    (Jaswant Singh, president)

ORDER:   

                

                  The complainant has filed the present complaint under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant got insured his car Skoda Superb bearing registration no.26AE8465, Model 2010 with the OPs, vide policy no.1-QVOD OFTO, P-400 M8313757, valid from 11.06.2019 to 10.06.2020 and the Insured Declared Value (IDV) of the vehicle is Rs.9,16,080/-. The said policy was transferred by the OPs in the name of complainant on 03.09.2019 after receiving the transfer fee. The vehicle of complainant got damaged due to road side accident, which occurred on 18.12.2019, on Ghogri pur Munak, Road Karnal. The complainant immediately has made a call on 100 number and the police reached at the spot immediately. The complainant had also got minor injuries in this accident. Complainant had informed the OPs about the accident and vehicle was parked in the workshop of authorized service centre on the advice of the OPs. A surveyor was appointed by the OPs for the inspection of the vehicle in question in the workshop. The complainant had filled the claim form and submitted all  the concerned documents but till today OPs have neither settled nor approved the claim of the damaged vehicle till today although as per estimate/job card of damaged vehicle, the loss to the damaged vehicle has been shown for about Rs. twenty nine lacs and accordingly the survey report, the complainant was entitled to be compensated on the basis of total loss basis. The OPs had not settled the claim of the complainant till 22.06.2022 and the complainant had received a letter dated 22.06.2020 from Karnal Associates, investigation and defective agency Karnal, in which it has been written that the OPs have appointed Karnal Associates as Investigating Agency to investigate the matter and said Karnal Associates demanded call details of mobile number, previous policy, car purchase, record/receipt and statement of seller and Mr. Naveen, which are irrelevant document, which shows that the OPs have bad intention to linger on the claim on one pretext or the other, because the abovesaid vehicle has already been transferred the Registering Authority Karnal in August, 2019 in the name of complainant and on the basis of change of ownership, the OP had already changed the name of owner and had transferred the insurance in the name of complainant, after charging transfer fee in the month of September, 2019 and all the concerned documents have been submitted by the complainant to OP no.1, but the claim of the complainant has not settled. Then complainant sent a legal notice dated 14.07.2020 to the OPs but it also did not yield any result. Complainant received letters dated 21.07.2020, reminderI 21.05.2020, reminderII21.07.2020 with vague allegation and demanded unwanted/unnecessary documents with intent to reject the claim of the complainant and in this letter it has been mentioned that “in the event of not receiving your response we shall be constrained to close the claim as “No Claim”. Complainant had made a phone call to the OP no.1 and on enquiry it was found that the claim of the complainant has been rejected by the OP on the false and frivolous grounds. 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; jurisdiction and concealment of true and material facts. On merits, it is pleaded that OPs vide private car package policy no.M8313757 insured vehicle Dkoda Superb 2.0 TDI bearing registration no.HR-26AE-8465 for the period from 11.06.2019 to 10.06.2020 and the said policy transferred, vide endorsement dated 30.08.2019 in the name of the complainant. Thereafter, complainant had intimated a claim on 18.12.2019 with the OPs on account of alleged loss/damages of insured vehicle on 18.12.2019 and the same had been registered. The claim of the complainant has been duly processed by OPs by way of appointment of an IRDA approved independent Surveyor and Loss Assessor Er. J.K. Sharma for conducting the survey and assessment of loss of vehicle, who had conducted the survey, assessed the loss and submitted Motor Final Survey Report. The claim of the complainant stands closed as since the complainant has failed to respond and submit any reply/response to the queries as mentioned in the letters dated 21.05.2020, 21.07.2020, 21.08.2020 and 09.11.2020. The OP has neither repudiated nor denied the claim of the complainant and will decide the admissibility of the claim on receiving the response/reply to the queries as mentioned in the said letters from the complainant as required.  It is further pleaded that the insured stated in the claim form that the accident occurred on 18.12.2019 at about 5.45 p.m. when his car collided with behind of a Dumper going ahead, when it applied brakes suddenly. The insured have stated that he was traveling at 90-100 km. per hour speed at the time of accident. The extent of damages under the bonnet is quite severe and many parts are crushed with impact, however there is hardly any correlating frontal impact damage to radiator and the radiator upper member. Further the front windshield of car is largely intact which otherwise would be crushed in such severe collision and the interior of the car including dashboard components are largely free of damages after accident (other than opening of the airbag). Further, in such severe collision there would be telescoping damages to the dashboard components which is absent in this case. Further the complainant has also not explained as to how the vehicle got damaged from the rear side. From such technical examination, it is found that the extent of damages does not co-relate with the cause of accident, thereby raising apprehension about the cause of loss and other loss particulars provided by insured. The complainant was requested to clarify on the above technical observations noted from loss particulars provided by him, but instead of sending reply to the OPs the insured opt to prefer the present complaint to bye pass the mandatory claim formalities. It is further pleaded that the complaint of the complainant is premature as the claim is not repudiated rather the same is pending due to want of requisite documents/clarification from the complainant and in the absence of necessary documents the maintainability of claim cannot be decided. It is further pleaded that on receipt of intimation of loss, the said claim of the complainant has been duly processed by OPs by way of appointment of an IRDA approved independent surveyor and loss assessor Er. J.K. Sharma for conducting the survey and assessment of loss and further M/s Karnal and Associates was appointed to carry out the necessary investigation who submitted their report dated 29.07.2020 to the OPs whereby the claim was recommended for closure on account of non-cooperation behaviour of the complainant due to non-submission of the requirement documents. There is no deficiency in service 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 the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of premium receipt Ex.C2, copy of crane bill dated 18.12.2019 Ex.C3, copy of estimate of loss/damages Ex.C4, copy of letter dated 05.03.2020 Ex.C5, copy of letter dated 22.06.2020 Ex.C6, copy of legal notice dated 14.07.2020 Ex.C7, postal receipt and acknowledgment Ex.C8, AD Ex.C9, copies of letters dated 21.07.2020 and 21.08.2020 Ex.C10 and Ex.C11, copy of RC of vehicle Ex.C12, copy of driving licence of complainant Ex.C13 and closed the evidence on 09.06.2021 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Devendra Kumar, General Manager Ex.OP1/A, copies of letters dated 21.05.2020, 21.07.2020, 21.08.2020 and 09.11.2020 Ex.OP1 to Ex.OP4, copy of claim form Ex.OP5, photographs of damaged vehicle Ex.OP6, copy of insurance policy Ex.OP7, copy of investigation report Ex.OP8 and closed the evidence on 12.07.2022 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 the complainant, while reiterating the contents of complaint, has vehemently argued that complainant got insured his vehicle with the OPs. The policy of the vehicle in question was transferred by the OPs in the name of complainant on 03.09.2019 after receiving the transfer fee. On 18.12.2019, the vehicle of complainant met with an accident and badly damaged. The complainant informed the police in this regard immediately. The intimation was also sent to the OPs about the accident and vehicle was parked in the workshop of authorized service centre on the advice of the OPs. A surveyor was appointed by the OPs for the inspection of the vehicle in question in the workshop. The complainant had filled the claim form and submitted all the concerned documents but till today OPs have neither settled nor approved the claim of the complainant 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 the OP has neither repudiated nor denied the claim of the complainant and will decide the admissibility of the claim on receiving the response/reply to the queries as mentioned in the letters 21.05.2020, 21.07.2020, 21.08.2020 and 09.11.2020 from the complainant and prayed for dismissal of the complaint.

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

10.           Admittedly, the vehicle in question has met with an accident during the subsistence of the insurance policy. It is also admitted that insurance policy was transferred in the name of the complainant prior to the accident.

11.           The claim of the complainant has been closed by the OPs on the ground of non-submission of the documents. OPs has sought following documents:

1.     Call detail.

2.     Previous policy.

3.     Car purchase record/receipt

4.     Statement of seller and Mr. Naveen

 

 

Upon receipt of intimation, the claim of the complainant has been duly processed by the OPs by way of appointing the Surveyor and Loss Assessor Er. J.K. Sharma, who had conducted the survey, assessed the loss and submitted final survey report to the OPs. The matter was also got investigated by the OPs through M/s Karnal Associates, who had sought the documents mentioned above.

12.           Investigator of the OPs has sought the call detail of mobile number 89291-10009, previous policy, car purchase record/receipt and statement of seller and Mr. Naveen. Prior to the accident, not only registration certificate but also insurance policy also had been transferred in the name of the complainant. Thus, question for demanding the said documents does not rise out. So, to settle the claim of the complainant, there was no need of such above mentioned documents. Furthermore, OPs have not placed on record the survey report of Shri Er. J.K. Sharma Surveyor, same has been concealed by them just to harass the complainant and delay the claim.

13.           The claim of the complainant has not been settled by the demanding of irrelevant documents, which shows that OPs have lingered on the claim just to escape from their liability. The claim of the complainant neither repudiated nor closed by the OPs. Moreover, OPs have concealed its survey report.

14.  

                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 ratio of the law laid down in aforesaid judgments, facts and circumstances of the present complaint, we are of the considered view that act of the OPs not to settle the claim amounts to deficiency in service and unfair trade practice.

16.           Thus, in view of the above discussion, we dispose off the present complaint and direct the OPs to settle the claim of the complainant within one month on receipt of order without demanding the documents discussed above. We further direct the OPs to pay Rs.50,000/- on account of mental agony and harassment and Rs.5500/- towards litigation expenses to the complainant. However, the OPs are at liberty to recover the said amount from investigator who had demanded the irrelevant documents and indulged the parties’ in unwanted litigations. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:20.04.2023                                                                      

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

(Vineet Kaushik)             (Dr. Rekha Chaudhary)

           Member                         Member