Smt.Suman, complainant through the present complaint filed under Section 12 of the Consumer Protection Act, 1986 (for short, ‘the Act’) has prayed for issuance of necessary order to the opposite parties to pay her Rs.4,60,390/- as claim along with interest @ 16% P.A. from the date of rejection of claim i.e. December 2014 till realization along with compensation of Rs.35,000/-.

2.       The case of the complainant in brief is that she got her vehicle No.PB/06/E/9985 insured from the opposite party vide policy No.36160231130100000432. The insured vehicle met with an accident Doda-Batote Road, Batote, J & K on 6.10.2013. F.I.R.No.105/2013 was also lodged at Police station Batote, J & K. She also informed to the opposite party about this accident immediately and Surveyor and Loss Assessor of opposite party came at the spot and performed his duty. She has further pleaded that she then sent the vehicle for repairs to the workshop and after repair she contacted the opposite party and made application to get her claim. She performed all the ncessary formalities and handed over the Estimate, Original Bills etc. to the insurance company to get the claim, but the opposite party linger on her claim and was negligent in the discharge of its duties towards her and finally closed her claim in the month of December 2014. She has spent total amount of Rs.4,60,390/- on the repair of vehicle. She is entitled for the recovery of Rs.4,60,390/- as claim. She has suffered a lot due to the negligence of the opposite party.  Hence this complaint.

3.          On notice, the opposite parties appeared and filed their joint written reply through their counsel by taking the preliminary objections that the complaint is not maintainable. The complainant is not entitled to any claim as asked for, because the vehicle was used in violations of the terms and conditions of the policy of insurance. The vehicle PB-06-E-9985 which was damaged is a good carriage vehicle and has been insured as such. As per police report and investigation report there were 5 passengers traveling in the said vehicle. The vehicle which is registered and insured as goods vehicle cannot be used for carrying passengers. On merits, it was submitted that the claim has been repudiated as per terms and conditions of the policy of insurance and there is no illegality in the same. The claim if at all becomes payable by the opposite parties, it is as per loss assessed by the surveyor/loss assessor. It was further submitted that the complainant is not entitled to any claim because of violation of terms and conditions of policy of insurance. Lastly, the complaint has been prayed to be dismissed with costs.

4.       Complainant tendered into evidence her affidavit Ex C1, along with the other documents exhibited as Ex.C2 to Ex C6 and closed the evidence.

5.      Sh.Shiv Lal, Sr.Branch Manager of opposite parties tendered into evidence his own affidavit Ex.OP1/1, alongwith other documents exhibited as Ex.OP1/2 & Ex.OP-1/3 and closed the evidence.

6.       We have carefully gone through the pleadings of both the parties; arguments advanced by their respective counsels and have also appreciated the evidence produced on record with the valuable assistance of the learned counsels for the purpose of adjudication of the present complaint.

7.       We find that the OP insurers have closed the impugned accident claim of the insured Goods Vehicle for the one and the prime reason that at the time of accident there were 5 nos. of Passengers traveling in the truck and that violated the ‘terms & conditions’ of the related insurance Policy. The said objection raised by the OP vide letter dated 2.12.2014 Ex.C3 has yet not been replied/explained by the complainant and such the claim has not been decided finally. The OP has further contended that the claim is premature as the complainant has not replied to the specific objection and if at all it becomes payable by them it is as per the loss assessed by their surveyor only.   But, we find that no surveyor report as alleged by the OP has been filed/placed on record. Moreover as per the case of the complainant his claim has been closed by the OP by raising some objections.  

8.       In the light of the all above, we are of the considered opinion that the present complaint shall be best disposed of by directing the complainant to re-submit his accident claim afresh by removing the earlier objections within 15 days of the receipt of the copy of these orders, to the OP insurers, who in turn shall decide the same (in accordance with the Policy terms and the IRDA extant guidelines on the subject matter) within 15 days of the receipt of the complete support documents etc. The OP insurers shall assist the complainant in the submission of the requisite claim documents to expedite its fair adjudication.

9.       Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

   (Naveen Puri)

                                                                                   President   

Announced:                                                               (Jagdeep Kaur)

July 28, 2015                                                              Member

*MK*