Punjab

Ludhiana

CC/21/45

Nitin Bajaj - Complainant(s)

Versus

M/s Tata AIG General Insurance Co.Ltd - Opp.Party(s)

Kamal Jatika

05 Apr 2024

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:  45 dated 28.01.2021.                                                         Date of decision: 05.04.2024. 

 

Nitin Bajaj son of Vinay Bajaj, R/o. House No.15530, Street No.11, Parbhat Nagar, Dholewal, Millerganj, Ludhiana-141003.                                                                                                                               ..…Complainant

                                                Versus

1. M/s. Tata AIG General Insurance Co. Ltd., Lodhi Tower, Second Floor, Mall Road, Ludhiana through its Manager/Authorized Representative.
2. M/s. Tata AIG General Insurance Co. Ltd., Peninsula Business Park, Tower-A, 15^th Floor, G.K. Marg, Lower Parel, Mumbai through its Manager/Authorized Representative.

…..Opposite parties. 

Complaint Under Section 35 of the Consumer Protection Act, 2019.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant             :         Sh. Rajesh Kumar, Advocate.

For OPs                          :         Sh. Rajeev Abhi, Advocate.

 

ORDER

PER SANJEEV BATRA, PRESIDENT

 

1.                Shorn of unnecessary details, the facts of the case are that the complainant previously obtained Auto Secure-Two Wheeler Package Policy  No.0182497063/000000/00 and has presently policy No.0182497063/000001/00 from the OPs for insuring his Splendor Plus motor cycle No.PB-10GF-9297. The OPs assured the complainant that in case of theft/serious nature of said motorcycle, they shall provide claim or new motorcycle on claim of the complainant. The complainant stated that his motorcycle was stolen on 03.03.2019 regarding which a DDR No.28 dated 10.03.2019 was lodged at P.S. Sarabha Nagar, Ludhiana. The complainant also informed the OPs and lodged claim in this regard but OP1 did not considered his genuine requests and refused to release any amount under the policy. The act and conduct of deficiency in service and unfair trade practice on the part of the OPs has caused mental tension and agony to the complainant. The complainant sent a legal notice dated 28.10.2020 through Sh. Rajesh Kumar, Advocate but to no avail. Hence this complaint whereby the complainant has prayed for issuing directions to the OPs to pay claim of Rs.70,000/- of theft of insured motor cycle and to pay compensation of Rs.1,00,000/- besides legal expenses of Rs.10,000/-.

2.                Upon notice, the OPs appeared and filed joint written statement and assailed the complaint by taking preliminary objections on the ground of maintainability; concealment and suppression of material facts; lack of cause of action; lack of jurisdiction; the complainant being estopped by his own act and conduct from filing the present complaint etc. The OPs stated that immediately on receipt of claim on 08.03.2019 regarding the alleged theft of motorcycle which took place on 03.03.2019, it was duly registered, entertained and processed. The complainant had obtained insurance policy No.0182497063/000001/00 valid from 08.06.2018 to 07.06.2019 with IDV value of Rs.40,413/-. It is further submitted that the insurance policy is a contract itself and the parties are bound by the terms and conditions of the insurance policy and nothing can be added or subtracted out of the said insurance policy.  It is one of the conditions No.1 in the policy that the claim must be lodged immediately, which is reproduced as under:-

“Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require. Every letter, claim, writ, summons and/or process or copy thereof shall be forwarded to the company immediately on the receipt by the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution/inquest or fatal enquiry in respect of any occurrence which may give rise to a claim under this policy. In case of theft or criminal act which may be a subject matter of a claim under this policy the insured shall give immediate notice to the police and corporate with the company in securing the conviction of the offenders.”

It is also one of the condition No.8 in the policy that “The due observance and fulfillment of the terms, conditions and endorsements of this policy in so far as they relate to anything to be done or complied with by the insured shall and the truth of the statements and answer in the said proposal shall be conditions precedent to any liability of the company to make any payment under this policy." The OPs further stated that the complainant  lodged the claim on 08.03.2019 after the gap of 5 days and reported the matter to the police vide GD No.028 on 10.03.2019 after the gap of 7 days which was clubbed with some other FIR No.013 dated 08.02.2019. Thus there is violation of condition No.1 read in conjunction with condition No.8 of the insurance policy as the complainant was bound to lodge the claim immediately. No regular FIR has been lodged with regards to this incident. After the receipt of the claim on 08.03.2019 an independent investigator, M/s Probe Services, # 137/01, Kaccha Killa, Sadhaura, District Yamuna Nagar was appointed as investigator to investigate the alleged theft claim of motor cycle No.PB-10-GF- 9297. After the appointment the said investigator vide its letter dated 28.03.2019 had called upon the complainant to submit the documents detailed in the said letter. The said investigator had made thorough investigation, recorded the statements, took the documents and thereafter prepared his report dated 01.05.2019 under his signature and submitted the same with the opposite parties along with the annexures and enclosures attached with the report clearly stating under the head Findings of the Investigator that

"3.There is 7 days delay in police report & 5 days delay in intimation to the company.

4. No call made at 100 number. However, intimation to the police was given on time and the same was found documented in police record. Photographs of the record captured by undersigned and attached.

5. Incident recorded to the police vide GD No.028 dated 10.03.2019 and clubbed the matter with FIR No.013 dated 08.02.2019."

 

After the receipt of report of M/s Probe Services dated 01.05.2019, after scrutinizing the documents placed in the claim file and after applying the mind by the officials of the opposite party the complainant was called upon vide letter dated 14.05.2019 to submit the following documents and information which are material and required for further processing of the claim:

• 100 number call details against the theft of the vehicle as GD entry register dated 10.03.2019 and the loss was occurred dated 03.03.2019.
• Final untraced report of the vehicle under section 173 Cr.P.C.

 

The said letter was followed by the reminder dated 22.05.2019 whereby the complainant was again called upon to submit the aforesaid two documents being required for further processing of the claim and it was made clear in the said reminder letter that "Since the claim file cannot be kept open immediately, your earlier submission of the above documents within 10 days shall be highly appreciated, for further processing the claim. Inability to do so shall most reluctantly force us to close the case at our end without any further correspondence.

Your co-operation will facilitate a speedy settlement.-"

The OPs further stated that the complainant has failed to submit the requisite documents which were material and were required for processing of the claim and as such the claim file in terms of the letter dated 22.05.2019 was closed as no claim on account of non-submission of the aforesaid documents. According to the OPs, the claim file has rightly been closed as no claim on account of non-submission of the document which were material for processing of the claim.

                   On merits, the OPs reiterated the crux of averments made in the preliminary objections and facts of the case. The OPs have denied that there is any deficiency of service and has also prayed for dismissal of the complaint.

3.                In evidence, the complainant tendered his affidavit as Ex. CA and reiterated his averments of the complaint. The complainant also placed on Ex. C1 copy of his Aadhar Card, Ex. C2 is the copy of insurance policy w.e.f. 08.06.2018 to 07.06.2019, Ex. C3 is the copy of tax invoice, Ex. C4 is the copy of DDR No.28 dated 10.03.2019, Ex. C5 is the copy of FIR No.13 dated 08.02.2019, Ex. C6 is the copy of legal notice dated 27.10.2020, Ex. C7 and Ex. C8 are the postal receipts, Mark-A is the copy of  job card, Mark-B is the copy of statement of the complainant, Mark-C is the copy of letter dated 03.03.2019 of complainant written to the police and closed the evidence.

4.                 On the other hand, the learned counsel for the OPs tendered affidavit Ex. RA of Sh. Amit Chawla, Chief Manager of the OPs as well as affidavit Ex. RB of Sh. Gurjeet Singh of M/s. Probe Services, Yamuna Nagar along with document Ex. R1 is the copy of insurance policy w.e.f. 08.06.2018 to 07.06.2019, Ex. R2 is the copy of terms and conditions of the policy, Ex. R3 is the copy of letter dated 22.05.2019, Ex. R4 is the copy of report of investigator dated 01.05.2019, Ex. R5 is the copy of letter dated 28.03.2019 of the investigator to the complainant, Ex. R6 is the copy of postal receipt, Ex. R7 is the copy of FIR No.13 dated 08.02.2019, Ex. R8 is the copy of statement of Satmeet Singh, Ex. R9 is the copy of statement of the complainant, Ex. R10 is the copy of letter in Hindi language dated 03.03.2019 of the complainant written to police, Ex. R11 is the copy of letter in Punjabi language dated 03.03.2019 written by the complainant to the police, Ex. R12 is the copy of Aadhar Card of the complainant, Ex. R13 is the copy of PAN Card of the complainant, Ex. R14 is the copy of Driving Licence of the complainant, Ex. R15 is the copy of claim form,  Ex. R16 to R21 are the copies of photographs, Ex. R22 is the copy of letter written to RTA, Ludhiana, Ex. R23 is the copy of postal receipt, Ex. R24 is the copy of status of RC, Ex. R25 is the copy of letter dated 25.03.2019 written to Transport Authority, Ludhiana for verification of RC, Ex. R26 is the copy of statement of the complainant, Ex. R27 is the copy of tax invoice dated 30.04.2017, Ex. R28 is the copy of job card, Ex. R29 is the copy of detail of loss, Ex. R30 is the copy of letter dated 14.05.2019 and closed the evidence.

5.                We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents and written statements along with affidavits and documents produced on record by the both parties.

6.                From the facts and circumstances of the case in hand, the only point of issue arises that whether the opposite parties were justified in repudiating the claim due to non-submission of documents to the surveyor/OPs?

7.                It is established on record that the motor cycle Splendor bearing No.PB-10GF-9297 insured vide insurance policy Ex. C2 = Ex. R1 was stolen on 03.03.2019 in the area of near MBD Mall, Ferozepur Road, Ludhiana. A DDR Ex. C4 to this effect was also lodged and subsequently, an FIR Ex. C5 = Ex. R7 was got registered by the police of Police Station  Sarabha Nagar, Ludhiana. On receipt of intimation, the opposite parties also deputed surveyor M/s. Probe Services, Kacha Kila, Sadhaura, District Yamunanagar to investigate the theft claim of motorcycle who vide its letter dated 28.03.2019 Ex. R5 asked the complainant to submit documents, the operative part of said letter is reproduced as under:-

“With reference to captioned claim & meeting dated 15.03.19 held with your goodself on behalf of TATA AIG General Insurance Co. In this regards undersigned had several discussions with you regarding pending documents but nothing heard till date. Hence request you to please submit the following highlighted details/documents/information to precede further in the claim as per policy T&C:

1. Original insurance policy
2. Previous policy details
3. Original RC
4. D.D. report/100 NO/PCR receiving
5. Final report U/s.173 Cr.P.C.
6. Court untraced report

Hence once again request you to please provide the above requisite details/documents/information within 7 days from the receipt of this letter. Also additional documents may be asked for proper adjudication & processing of claim.”

 

Thereafter, the said investigator submitted its report dated 01.05.2019 Ex. R4 with the OPs with the following findings and observation:-

11. Findings of the Investigator

1. Vehicle was registered from Ludhiana RTO vide Registration No.PB10-10GF-9297. 2. Insured purchase the vehicle by cash. 3. There is 7 days delay in Police report & 5 days delay in intimation to company. 4. No call made at 100 no. However intimation to Police was given on time and same was found documented in police record, photographs of record captured by undersigned and attached. 5. Incident recorded to police vide GD No.028 dated 10.03.2019 and clubbed the matter with FIR No.013 dated 08.02.2019. 6. ASI- Mool Raj-8427500970 is concerned Investigation Officer. 7. Reported last parked location is on another side of Mall and no vehicle was found during visit i.e. Vehicle was parked by insured on footpath on other side of road. 8. Both original keys submitted by insured.

12. Observation of the investigator

1. Claim found genuine. 2. Spot seems genuine, as on week end/Sunday it is reported that there is huge rush in the Mall that’s why people also parked their vehicle on another side of road. Further no one on spot confirm about such incident. 3. Intimation to Police was given on time and same was found in Police Record too. 4. Both original keys submitted by the insured.

It is not the categorical case of the opposite parties that there is a violation of any terms and conditions of the policy which could lead to denial/repudiation of the claim.

8.                On the other, the counsel for the opposite parties has raised contention that despite repeated requests and requisitions of the investigator, the essential documents in order to assess the loss were not submitted and accordingly, the claim was rightly repudiated by them vide repudiation letter dated 22.05.2019 Ex. R3.

9.                In view of the aforesaid admitted position regarding theft of motorcycle bearing No.PB-10GF-9297 of the complainant, the lodging of DDR by the police and visit of the investigator all show that the theft of the vehicle was occurred and the claim was found genuine by the investigator. It is not the case of the opposite parties that there is violation of any terms and conditions contained in the policy which could lead to denial/repudiation of the claim. It is also evident that no clause of the policy has been invoked in order to repudiate the claim of the complainant. In the given set of circumstances, it was the duty of the opposite parties to assess the loss even when the documents were submitted to them. The delay on the part of the complainant in submitting the documents cannot be made a sole ground to repudiate the claim of the complainant. The insurance companies are required to be more liberal in their approach without being too technical. In the given set of circumstances, it would be just and proper if the complainant is directed to submit all the necessary documents mentioned in letter Ex. R30 with the opposite parties within 15 days from the date of receipt of copy of order and after the receipt of the documents from the complainant, the opposite parties shall consider and reimburse the claim strictly as per terms and conditions of the policy within a period of 30 days from the date of receipt of documents from the complainant.

10.              As a result of above discussion, the complaint is partly allowed with direction to the complainant to submit all the necessary documents mentioned in letter Ex. R30 with the opposite parties within 15 days from the date of receipt of copy of order and after the receipt of the documents from the complainant, the opposite parties shall consider and reimburse the claim strictly as per terms and conditions of the policy within a period of 30 days from the date of receipt of documents from the complainant. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.

11.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

 

(Monika Bhagat)                              (Sanjeev Batra)               Member                                         President  

Announced in Open Commission.

Dated:05.04.2024.

Gobind Ram.