Chandigarh

DF-II

CC/514/2014

Sushant Kumar - Complainant(s)

Versus

M/s ICICI Lombard Insurance Company - Opp.Party(s)

Complainant In Person

12 Aug 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	514/2014
Date of Institution	:	01.10.2014
Date of Decision	:	12/08/2015

 

                       

                  

 

 

Sushant Kumar son of Sh.Lakshmi Narayan, r/o H.No.3122, Mauli Jagran Colony, UT, Chandigarh.

                   ...  Complainant.

Versus

1.   M/s ICICI Lombard Insurance Co. through its General Manager, SCO No.24-25, Sector 8-C,Chandigarh

 

2.   M/s EM PEE Motors & Scooter Pvt. Ltd., through its Managing Director, SCO No.2907-08, Sector 22-C,Chandigarh.

…. Opposite Parties.

 

BEFORE:   SHRI RAJAN DEWAN, PRESIDENT

SHRI JASWINDER SINGH SIDHU, MEMBER

SMT.PRITI MALHOTRA, MEMBER

 

Argued by: None for the complainant

          Sh.Sandeep Suri, Advocate for OP No.1

          OP No.2 exparte.

 

PER RAJAN DEWAN, PRESIDENT

1.      In brief, the case of the complainant is that he got insured his motorcycle with OP No.1 vide Annexure C-3 for the period from 05.10.2013 to 04.10.2014 for IDV of Rs.77,460/-. Unfortunately, the vehicle in question met with an accident on 03.08.2014 and suffered damages. The complainant gave information regarding the accident to the OPs and the vehicle was taken to OP No.2 for its repairs. The surveyor of OP No.1 inspected the vehicle at the workshop of OP No.2 on 05.08.2014 and OP No.2 promised to replace all the damaged parts i.e. fuel tank, side panel and lights within 7 days.  The complainant supplied all the documents as demanded by the OPs. It has further averred that the motorcycle was lying in the showroom of OP No.2 for the last more than one and half months but OP No.2 did not repair the same on the ground that OP No.1 was not clearing cashless claim of the complainant. OP No.2 sent the estimate in respect of the vehicle to OP No.1 two times but it did not show any interest. Subsequently, the complainant sent repeated emails to OP No.1 and even served a legal notice upon the OPs but to no avail. Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of the opposite parties, the complainant has filed the instant complaint.
2.      OP No.1, in its written statement admitted the facts with regard to the issuance of the Insurance Policy and the accident of the vehicle in question on 03.08.2014.  It has been denied that the policy in question is a Cashless Insurance Policy. It has been pleaded that the estimate was prepared on 05.08.2014 and the invoice in respect of the repair was made by the repairer on 10.11.2014. Subsequent to the issuance of the invoice aforesaid, the amount as assessed by the surveyor to the tune of Rs.5266/- has been credited to the account of the complainant on 13.11.2014 and the claim was satisfied. The remaining averments were denied, being false.  Pleading that there is no deficiency in service on its part, a prayer for dismissal of the complaint has been made.
3.      Notice was sent for the service of Opposite Party No.2 through registered post on 12.11.2014.  However, neither the same was received back served/unserved till date.  As the period of more than 30 days had passed, therefore, it was presumed that it had been duly served.  None appeared on behalf of Opposite Party No.2 on the date fixed, hence it was proceeded against exparte vide order dated 19.12.2014.
4.      On 31.07.2015 none appeared on behalf of the complainant.  Therefore, we proceeded to dispose the complaint under Rule 4(8) of the Chandigarh Consumer Protection Rules, 1987 read with Section 13(2) of the Consumer Protection Act, 1986 (as amended upto date) even in his absence. We have heard the learned counsel for OP No.1 and have gone through the documents on record.
5.      The core question to be determined in this case is as to whether there is delay in settlement of the claim on the part of OP No.1 as per the guidelines of the IRDA.
6.      To appreciate this controversy, we consider it appropriate to refer to Clause 9 i.e. claim procedure in respect of a General Insurance Policy of the IRDA (Protection of Policyholders’ interests) Regulations, 2002, which is extracted hereunder:-

 

9. Claim procedure in respect of a general insurance policy

(1) An insured or the claimant shall give notice to the insurer of any loss arising under contract of insurance at the earliest or within such extended time as may be allowed by the insurer. On receipt of such a communication, a general insurer shall respond immediately and give clear indication to the insured on the procedures that he should follow. In cases where a surveyor has to be appointed for assessing a loss/ claim, it shall be so done within 72 hours of the receipt of intimation from the insured.

 

(2) Where the insured is unable to furnish all the particulars required by the surveyor or where the surveyor does not receive the full cooperation of the insured, the insurer or the surveyor as the case may be, shall inform in writing the insured about the delay that may result in the assessment of the claim. The surveyor shall be subjected to the code of conduct laid down by the Authority while assessing the loss, and shall communicate his findings to the insurer within 30 days of his appointment with a copy of the report being furnished to the insured, if he so desires. Where, in special circumstances of the case, either due to its special and complicated nature, the surveyor shall under intimation to the insured, seek an extension from the insurer for submission of his report. In no case shall a surveyor take more than six months from the date of his appointment to furnish his report.

 

(3) If an insurer, on the receipt of a survey report, finds that it is incomplete in any respect, he shall require the surveyor under intimation to the insured, to furnish an additional report on certain specific issues as may be required by the insurer. Such a request may be made by the insurer within 15 days of the receipt of the original survey report.

 

    Provided that the facility of calling for an additional report by the insurer shall not be resorted to more than once in the case of a claim.

 

(4) The surveyor on receipt of this communication shall furnish an additional report within three weeks of the date of receipt of communication from the insurer.

 

(5) On receipt of the survey report or the additional survey report, as the case may be, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be recorded in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of the survey report or the additional survey report, as the case may be.

 

(6) Upon acceptance of an offer of settlement as stated in sub-regulation (5) by the insured, the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by the insured. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by it.

7.      In the present case, the accident in question took place on 03.08.2014 and the surveyor was appointed by the Insurance Company on 05.08.2014 i.e. within three days as provided under the IRDA guidelines, aforesaid.   It is also admitted fact between the parties that the estimate in respect of the vehicle in question was prepared on 05.08.2014. It is also evident from the letter dated 27.08.2013 placed on record by the Insurance Company that the complainant was requested to give his consent for repairing of the fuel tank and replacing the fairings at the garage.  In the rejoinder to the written statement, the complainant himself stated that he received the letter aforesaid in which he was requested to give his consent to repair the fuel tank and replacing fairings at garage.  The complainant has further stated in the said letter that the word ‘garage’ is used for the local garage of the cities and the Insurance Company did not mention the word ‘Service Station’ where his bike was already kept for repair purposes and, as such, he refused to get the bike repaired from the some local garage.  In our considered view, if the complainant has any ambiguity regarding the word ‘garage’ then he could have got it clarified from the Insurance Company by writing a letter/e-mail etc. to this effect but he did not do so for the reasons best known to him.  It is also a factum on record that the invoice  in respect of the repairs carried out to the vehicle in question was prepared by OP No.2 on 10.11.2014 and the Surveyor has assessed the claim in respect of the vehicle in question to the tune of Rs.5266/- vide assessment sheet dated 11.11.2014, attached with the written statement.   Admittedly, the claim as assessed by the surveyor i.e. Rs.5266/- has been released through ECS to the A/c No.911010040803191 on 13.11.2014 under instruction CSM No.260361138 to the insured i.e. within two days from the date of assessment of the claim.  Keeping in view of the facts and circumstances of the case, we are of the considered view that there is no deficiency in service on the part of the Insurance Company in processing the claim of the complainant as per the guidelines of the IRDA, aforesaid.  The delay, if any, was on the part of the complainant who himself failed to give his consent in time for the repair of the fuel tank and replacing fairings of the bike at garage.  The complainant cannot be allowed to take benefit of his own wrongs.
8.      For the reasons recorded above, finding the complaint to be devoid of any merit and substance, the complaint is hereby dismissed with no order as to costs.
9.      Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

12/08/2015

Sd/-

(RAJAN DEWAN)

PRESIDENT

 

Sd/-

(JASWINDER SINGH SIDHU)

MEMBER

 

Sd/-

(PRITI MALHOTRA)

MEMBER