Haryana

Ambala

CC/151/2022

Ashok Kaushik - Complainant(s)

Versus

IFFICO Tokio General Insurance Co Ltd - Opp.Party(s)

Sanjeev Vashisht

21 Feb 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case No.	:	151 of 2022
Date of Institution	:	18.05.2022
Date of decision	:	21.02.2024

Ashok Kaushik Aged 31 Yrs. son of Shri Surinder Pal Kaushik, resident of village Baknaur, Tehsil and Distt. Ambala

          ……. Complainant

Versus

1. IFFICO TOKIO General Insurance Co. Ltd. through its Authorized Signatory, Ist Floor, Minerva Cinema, Rai Market, AMBALA CANTT, AMBALA (HARYANA)- 133001.
2. Maruti Insurance Broking Pvt. Ltd. through its Authorized Signatory, 1 Nelson Mandela Road, Vasant Kunj, New Delhi-110070.

 

….…. Opposite parties

Before:       Smt. Neena Sandhu, President.

                     Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Sanjeev Vashisht, Advocate, counsel for the complainant.

                    Shri Mohinder Bindal, Advocate, counsel for OP No.1

                    Shri Abhishek Bansal, Advocate, counsel for OP No.2.                 

Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

a) To pay the balance claim amount of Rs.22,339/- to the complainant;

 b) To pay Rs.50,000/- as compensation to the complainant on account of harassment and mental agony

c) To pay Rs.10000/- as cost of litigation to the complainant

d) Grant any other relief, which this Hon’ble Commission may  deems fit.

2.             Brief facts of the case are that the complainant is the registered owner of Car bearing registration No. HR-01AT-0197, Make MARUTI SUZUKI INDIA LTD., Model & Varient- THE NEW CIAZ ALPHA PETROL /MARUTI CIAZ SMART HYBRID ALFA, which was insured with OP No.1 from Bumper to Bumper vide insurance policy No.12827172 valid upto 20.01.2023. The said policy was sourced and serviced by OP No.2. During the insurance period, the aforesaid vehicle of the complainant met with an accident on 05.02.2022 at about 5.00 P.M with a bus at Aggarsain Chowk, Ambala City and was badly damaged from right side including front and rear bumper. Information regarding the accident alongwith vehicle was sent to the Nexa Service Station, Authorized Service Station of Maruti Suzuki vehicle. Surveyor -Shri Raman Chatwal deputed by the OPs also inspected the vehicle and pass the claim for the rear-light only and not for the panel front fender R, Bumper front, Bumper rear.  The complainant furnished all the desired documents to the OP No.1 and it was assured that claim will be settled. The vehicle of the complainant was got repaired from Nexa Service Station, Authorized Service Station of Maruti Suzuki, Ambala- Chandigarh Expressway, Ambala and a bill for a sum of Rs.50,154/- was issued out of which, the OPs paid only Rs. 27,815/- to the complainant and the remaining amount of Rs.22,339/-  was not paid. Earlier to this, the vehicle of the complainant was insured with OP No.1 during the period 2021-22 and during the said period the complainant had not taken any claim. The vehicle of the complainant remained parked with Nexa Service Station, Authorized Service Station of Maruti Suzuki, Ambala-Chandigarh Expy, Ambala from 5.2.2022 to 24.2.2022 and during that period the complainant, who is an Advocate by profession, had to spend Rs.500/- per day for visiting at District Courts, Ambala City. The complainant also served legal notice dated 4.3.2022, which was duly received on 7.3.2022 by the OPs but to no avail. Hence, the present complaint.
3.           Upon notice, OP No.1 appeared and filed written version wherein it raised preliminary objections to the effect that this complaint is not maintainable; the complainant has not approached this Commission with clean hands as he has suppressed the material facts so as to get the claim amount; the complaint is liable to be dismissed on this preliminary ground of non-disclosure and concealment of material facts; the present complaint has been filed without any cause of action etc. On merits, it has been stated that a claim was reported by the complainant with regard to accidental loss to his insured vehicle. As per claim form submitted by the complainant, the alleged loss occurred in an accident that took place on 05.02.2022 at Aggarsain chowk, Ambala City when a bus hit into the right side of his car and another vehicle hit in the rear side of his car and it got damaged. On getting intimation, the reported claim of the complainant was duly entertained and one IRDA approved surveyor M/s Raman Auto Surveyors & Loss Assessors was immediately deputed to assess the loss. The said surveyor visited the workshop M/s Eakansh Wheels, Ambala where the damaged car in question was parked for repair and inspected the vehicle in question. The said surveyor met the complainant and the mechanic etc. of the said workshop and inspected it, in detail and took the photographs of the damaged parts. On reconstructing all the events according to the version of the complainant and comparing the same with the existing loss, it was proved that the loss to right hand side rear door and right hand side quarter panel does not coincide with the narrated cause and it was also found that the front bumper and rear bumper were repaired with screws and thus were disallowed as per the insurance norms and byelaws. Loss to these parts were not associated and coincide with the nature and cause and were not related to said accident as narrated and proved. It was duly informed to the complainant that these parts and repair thereof, will not be allowed, being not associated with the alleged occurrence but the complainant got them repaired with replacement of both the bumpers including the front grills and other accessories of the front bumper. The complainant tried to involve and correlate all these damages with the alleged incident dated 05.02.2022 which cannot be allowed as per law. By going through all the facts and by giving due consideration to the claim of the complainant and merits of this case, the surveyor submitted his report dated 25.02.2022 whereby he assessed the payable loss to the tune of Rs. 27,794/- due to said incident subject to approval of claim by the competent authority. After scrutinizing and elaborating the whole facts, situation, records and the evidence, OP No.1 allowed the claim in toto and released the payment to the said workshop against invoice no.33/BI/21001011 dated 23.02.2022 under cashless policy without deducting any amount under depreciation head being a nil depreciation policy. Rest of the averments of the complainant were denied by the OP No.1 and prayed for dismissal of the present complaint with costs.
4.           Upon notice, the OP No.2 appeared and filed written version wherein it raised preliminary objections to the effect that this complaint is not maintainable; the complainant is not a consumer; OP No. 2 is an insurance broking entity licensed with the Insurance Regulatory and Development Authority of India ("IRDAI") and mainly acts as a facilitator of motor insurance products offered by various Insurance Companies (including Iffco Tokio General Insurance Co. Ltd.); the role of OP No.2, being a facilitator, is to apprise the customers about the features and benefits of motor insurance products; after the facilitation by OP No. 2, customers buy insurance as per their own will and volition and pay insurance premium which goes to the concerned Insurance Company only;. Policy issuance/cancellation, appointment of Surveyors for claim investigation and assessment, acceptance or repudiation of claims is the sole prerogative of the concerned Insurance Company only and OP No.2 has no role in that etc. On merits, which admittedly the factual matrix of the case that the vehicle in question was insured by "Iffco Tokio General Insurance Co. Ltd." Surveyors are appointed solely by insurance companies to inspect the accident and assess the accidental damage of the vehicle under insurance cover. Claim has to be passed by the insurance company and it has been unnecessarily dragged into the instant litigation.  Rest of the averments of the complainant were denied by the OP No.2 and prayed for dismissal of the present complaint with costs.
5.           Learned counsel for the complainant tendered affidavit of complainant as Annexure CW1/A alongwith documents as Annexure C-1 to C-6 and closed the evidence on behalf of complainant. Learned counsel for OP No.1 tendered affidavit of Hardeep Singh, Deputy General Manager and Authorized Signatory, IFFCO Tokio General Insurance Co. Ltd., Regional Office, Chandigarh and affidavit of Raman Chhatwal, Prop. Raman Auto Surveyors & Loss Assessors, having its Office at # 135, Ajit Nagar, Ambala Cantt as Annexure OP-X and OP-Y respectively alongwith  documents-Annexure OP-1 to OP-21 and closed the evidence on behalf of OP No.1. Learned counsel for OP No.2 gave statement on 04.07.2023 that written version filed on behalf of OP No.2 be treated as its evidence also and closed the evidence on behalf of OP No.2.
6.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
7.           Learned counsel for the complainant submitted that by not making payment of the entire amount spent by him towards repair of the inured vehicle in question and withholding the amount of Rs.22,339/-  without any justification,  the  OPs are deficient in providing service, negligent and adopted unfair trade practice. 
8.           On the contrary, the learned counsel for the OP No.1 submitted that since the claim of the complainant was settled strictly as per terms and conditions of the policy in question, and was based on the opinion of the surveyor appointed by it, as such, now the complainant cannot claim anything more, out of the amount settled by the surveyor and already paid to the complainant.   
9.           Learned counsel for OP No.2 while reiterating the submissions made in its reply stated that OP No.2 being facilitator, has no role whatsoever with the terms and conditions of the policy in question or the claim amount paid under the same by OP No.1 to the complainant.
10.           The moot question which falls for consideration is, as to whether, the complainant is entitled to the amount of Rs.22,339/-, over and above the amount of Rs.27,815/- as assessed by the Surveyor vide report dated 25.02.2022, Annexure OP-1 or not? It may be stated here that not even a single document has been placed on record by the complainant to rebut the opinion given by the Surveyor in the report dated 25.02.2022,  Annexure OP-1 to the effect that the some damages to the vehicle in question which were got repaired under the current policy and also some parts which were replaced i.e. front and rear bumper found repaired with screws and RHS rear door and RHS QRI panel doesn’t coincide with the accident (supported by the relevant photographs, Annexure OP-7 to OP-21), were already pre-existing. The report, Annexure OP-1 is a detailed report, which has not been challenged by the complainant, by placing on record any evidence, to prove that it is not correct. In fact surveyor's report is the main document on which the insurance claim is settled.  The complainant has not pointed out any discrepancy or lacunae in the report of the surveyor.  Hence without any reasons, the surveyor's report, Annexure OP-1 cannot be disregarded.  The Hon'ble Supreme Court in the case of Sri Venkateswara Syndicate vs. Oriental Insurance Company Limited &Anr., (2009) 8 SCC 507, has observed the following:-

"31. The assessment of loss, claim settlement and relevance of survey report depends on various factors. Whenever a loss is reported by insured, a loss adjuster, popularly known as loss surveyor, is deputed who assesses the loss and issues report known as surveyor report which forms the basis for consideration or otherwise of the claim. Surveyors are appointed under the statutory provisions and they are the link between the insurer and the insured when the question of settlement of loss or damage arises. The report of the surveyor could become the basis for settlement of a claim by the insurer in respect of the loss suffered by the insured.

 

11.           It is therefore, held that the insurance company has already paid the amount as assessed by the surveyor and nothing remains due to the complainant. Be that as it may, the complaint filed by the complainant is devoid of merits, consequently, we dismiss the same. The parties are left to bear their own costs. Certified copies of the order be sent to the parties concerned as per rules.  File be annexed and consigned to the record room.

  Announced:- 21.02.2024

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President