Chandigarh

DF-I

CC/530/2023

BAL KRISHAN DHIR - Complainant(s)

Versus

M/S NATIONAL INSURANCE CO. LTD - Opp.Party(s)

DEEPAK AGGARWAL

04 Dec 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-I,

U.T. CHANDIGARH

                          

Consumer Complaint No.	:	CC/530/2023
Date of Institution	:	07.11.2023
Date of Decision	:	04/12/2024

 

1.    Bal Krishan Dhir, aged 59 years son of late Sh.Som Parkash Dhir, Partner of M/s Dhir E-Logistic LLP, SCF 274, Motor Market, Mani Majra, Chandigarh-160101.

2.    Dhir E-Logistic LLP, through its Partner having its registered office at SCF 275, Motor Market, Mani Majra, Chandigarh-160101.

...Complainants

Versus

M/s National Insurance Co. Ltd., Gurgaon Division-II, 1^st Floor, SCO-35, Sector 14, Old Delhi Road, Gurugram-122001 through its Managing Director/Manager.

...Opposite Party

 

CORAM :	SHRI PAWANJIT SINGH	PRESIDENT
	MRS. SURJEET KAUR	MEMBER
	SHRI SURESH KUMAR SARDANA	MEMBER

 

                                                                               

ARGUED BY	:	Sh.Deepak Aggarwal, Advocate for complainants
	:	Sh.Arjun Kundra, Advocate for OP

Per Pawanjit Singh, President

1.        The present consumer complaint has been filed by complainants against the opposite party (hereinafter referred to as the OP).  The brief facts of the case are as under :-     
   1. It transpires from the averments as projected in the consumer complaint that the complainant No.2 is the registered owner of the truck bearing registration No.HR-68-B-1623 (hereinafter referred to as the ‘subject vehicle’) and the complainant No.1 is the partner of the complainant No.2 and the same was got insured with OP vide policy (Annexure C-1) which was valid from 11.03.2022 to 10.03.2023 for IDV of Rs.16,27,887/-. On the evening of 30.08.2022 at around 4:00 P.M., the subject vehicle being driven by Sh.Kuldeep Sharma met with an accident near Bhopatpur Toll Plaza, on Banaras-Kanpur, National Highway with the already stationary accidental truck bearing registration No.RJ-19-GD-1494 which had also met with an accident on the same day with another vehicle as a result of which the driver of the subject vehicle suffered multiple injuries and in the said accident another unknown person had also died. The police recorded the General Diary Details/GD No.008 (Annexure C-2). On receiving the information regarding the accident, the complainants informed the OP about the accident on the same day i.e. 30.08.2022 and upon this OP got conducted the spot survey from the surveyor/loss assessor namely Sh.Pushpraj Khushwaha who reported the damaged caused to the subject vehicle vide report dated 25.09.2022 (Annexure C-6). On asking of the OP/surveyor, the complainants have submitted all the requisite documents to the OP and completed all required the formalities. The complainants had also paid a sum of ₹2300/- to the surveyor as spot survey fee vide receipt (Annexure C-7). On the directions of the surveyor, the complainants got the subject vehicle repaired from the authorized dealer by incurring a sum of ₹8,63,550/- against receipt/bills (Annexure C-9 Colly.). However, till date, the OP has not done anything for the settlement of the claim, rather instead of settling the claim, the OP sent an email dated 23.01.2023 (Annexure C-8) requiring the complainant to submit certain documents.  Thereafter, the OP had also sent another e-mail for certain clarification despite of the fact that the complainants have already submitted the documents and had given clarifications to the OP.  As the OP has not settled the claim of the complainants within the stipulated period and thereby violated the regulation No.9 of the IRDA  and it, amounts to deficiency in service and unfair trade practice on the part of OP. OP was  requested several times to admit the claim, but, with no result.  Hence, the present consumer complaint.
   2. OP resisted the consumer complaint and filed its written version, inter alia, taking preliminary objections of maintainability, jurisdiction, locus standi, cause of action, non-joinder @ mis-joinder of parties and concealment of facts.  However, it is admitted that the complainant No.2-Company is the registered owner of the subject vehicle and the same was insured vide subject policy with the OP at the time of its accident. It is further alleged that the complaint is premature as the OP has not repudiated the claim of the complainants and the same has not been settled as the complainants have not submitted the requisite documents/clarification for processing the claim. On merits, the facts as stated in the preliminary objections have been re-iterated. The cause of action set up by the complainant is denied.  The consumer complaint is sought to be contested.
   3. In rejoinder, complainant reiterated the claim put forth in the consumer complaint and prayer has been made that the consumer complaint be allowed as prayed for.
2.        In order to prove their respective claims the parties have tendered/proved their evidence by way of respective affidavits and supporting documents.
3.        We have heard the learned counsel for the parties and also gone through the file carefully, including the written arguments.
   1. At the very outset, it may be observed that when it is an admitted case of the parties that the complainant  No.2 is the registered owner of the subject vehicle and the same was insured with the OPs vide subject policy, which was valid 11.03.2022 to 10.03.2023 for IDV of Rs.16,27,887/-, as is also evident from the copy of policy (Annexure C-1) and the subject vehicle being driven by Sh.Kuldeep Sharma was badly damaged in the accident which took place on the intervening night of 06/07.08.2023 and he had suffered multiple injuries as is also evident from the hospital record (Annexure C-4)  and the matter was also reported to the police as is also evident from the general diary (Annexure C-2) and on receiving the intimation from the complainants, the OPs deputed the surveyor/loss assessor who submitted his report (Annexure C-6) and the claim of the complainants has not been settled by the OP till date and the complainant has also got repaired the subject vehicle, as is evident from the copies of the receipt/Bills (Annexure R-9), the case is reduced to a narrow compass as it is to be determined if the OP is unjustified in not settling the claim for want of submissions of the requisite documents/clarification and the complainants are entitled to the claim as prayed for, as is the case of the complainants or if the OP is justified in not setting the claim for want of submissions of the documents/clarification on the part of the complainants and the complaint of the complainants, being false and frivolous, is not maintainable and is liable to be dismissed,  as is the defence of the OP.
   2. In the backdrop of the foregoing admitted and disputed facts on record, one thing is clear that the entire case of the parties is revolving around the terms and conditions of the subject policy (Annexure C-1), Motor Spot/Final Report dated 25.09.2022 (Annexure C-6) and the same are required to be scanned carefully.
   3. Perusal of the Motor Spot/Final Report dated 25.09.2022 (Annexure C-6) submitted by the Surveyor/Loss Assessor deputed by the OP namely Sh.Pushp Raj Kushwaha clearly indicates that the aforesaid surveyor visited the spot, verified the  particulars of the subject vehicle and the driver and also the damage caused to the subject vehicle in the accident and the aforesaid Surveyor/Loss Assessor had found the correct D.L. details of the driver Sh.Kuldip Sharma with all the documents including the RC, permit etc of the subject vehicle in order and also endorsed the loss to the subject vehicle in the said accident and found fresh damage to the subject vehicle. Thus, one thing is clear on record that once the Surveyor/Loss Assessor has verified all the documents relating to the subject vehicle and found the accident to be genuine one with documents of the subject vehicle in order and also that the complainants have submitted the copy of the RC, DL, Permit to the Surveyor/Loss Assessor and clarified all the facts to the OP on receiving the email, to our mind by not settling the claim of the complainants as per the IRDA guidelines, the aforesaid act of the OP amounts to deficiency in service and unfair trade practice especially when it stands proved on record that the complainants have spent an amount of ₹8,63,550/- by paying the same to the authorized dealer of the subject vehicle, has also been proved from the receipt/bills (Annexure C-9 Colly.).
   4. Here, the case of the complainants is supported by the judgment reported in I (2016) CPJ 1 (NC) titled as  Gupta Polyester Pvt. Ltd. Vs. National Insurance Company Limited & Others wherein it has been held as under:-.

“20. Secondly, we address ourselves as to whether the first Respondent Insurance Company adhered to the IRDA (Protection of Policyholders’ Interests) Regulations, 2002?

21. Regulation 9 of the IRDA (Protection of Policyholders’ Interests) Regulations, 2002 reads as under:

“9. Claim procedure in respect of a general insurance policy.

……………………

(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.”

 

5. In view of the aforesaid discussion, it is safe to hold that the complainants have successfully proved the cause of action set up in the consumer complaint and the present consumer complaint deserves to succeed.
6. Now coming to the quantum of relief, since the complainants have proved on record Annexure C-9 Colly. i.e. receipt including bills which clearly indicates that the complainants have incurred a sum of ₹8,63,550/- on the repair of the subject vehicle, it is safe to hold that OP/insurer is liable to pay the said amount to the complainants after deduction of the excess clause as well as depreciation on the rubber parts as per India Motor Tariff alongwith interest and compensation etc. for the harassment caused.

4.        In the light of the aforesaid discussion, the present consumer complaint succeeds, the same is hereby partly allowed and OP is directed as under :-
   1. to pay ₹8,63,550/- less the excess clause (i.e. compulsory deductions as well as depreciation of rubber parts etc. as per the policy terms) to the complainants alongwith interest @ 9% per annum (simple) from 24.12.2022 i.e. after three months of the submission of the final Motor Spot/Final Report dated 25.09.2022 onwards.
   2. to pay ₹30,000/- to the complainants as compensation for causing mental agony and harassment;
   3. to pay ₹10,000/-to the complainants as costs of litigation.
5.        This order be complied with by the OP within a period of 45 days from the date of receipt of certified copy thereof, failing which the amount(s) mentioned at Sr.No.(i) & (ii) above shall carry penal interest @ 12% per annum (simple) from the date of expiry of said period of 45 days, instead of 9% [mentioned at Sr.No.(i)], till realisation, over and above payment of ligation expenses.
6.        Pending miscellaneous application(s), if any, also stands disposed off.
7.        Certified copies of this order be sent to the parties free of charge. The file be consigned.

04/12/2024			Sd/- [Pawanjit Singh] President
			Sd/-
			[Surjeet Kaur] Member
			Sd/-
			[Suresh Kumar Sardana] Member