SMT. RAVI SUSHA: PRESIDENT
Complainant has filed this compliant U/s Consumer Protection act 2019 for getting an order against opposite party No.1 to refund Rs.60,445- with 12% interest together with compensation of Rs.10,00,000/- from OPs 1 and 2 and cost of the proceedings alleging deficiency in service on the part of opposite parties.
Complainant, who is the registered owner of Maruti Belano car bearing Reg. No. KL-59-Q 6382 got his vehicle comprehensively insured from the OP No.1 for a period from 23/08/2020 to 22/08/2021. The different parts of the car was damaged on 14/07/2021 and on 28/07/2021 by hitting. It was brought to OP No.2 on 04/08/2021 and entrusted for repair work. The incident was informed to OP No.1 and claimed for getting insurance benefit. Complainant pleaded that OP2 started the repair work after getting instruction from OP 1. Complainant has submitted entire documents as directed by OP No.1 through letters dated 25/08/2021. But OP No.1 had repudiated the claim application of the complainant raising untenable contentions. Complainant contended that since OPNo.1 denied his claim applied, he had to pay the repair charges Rs.60,445/- to OP No.2 and take back the vehicle on 03/09/2021. Hence this complaint.
After getting notices OPs 1 and 2 filed separate written version. OP No.1 contended that it is submitted that mere pleadings cannot take place or proof unless and until proved by any cogent, convincing and conclusive evidence. The complainant has not given any cogent reason for the delay of reporting the accident to this OP. As an insurer this OP has not meted out any kind of negligence, unfair trade practice or deficiency of service. It is submitted that the complainant has not suffered any kind of pain or mental agony. The complainant is not entitled for any kind of compensation. Hence, prayed for the dismissal of complaint.
OP No.2 has stated that the complainant is the registered owner of Maruti Belan car bearing Reg. No. KL-59-Q 6382. The complainant is strict proof regarding the fact that the care was damaged on 14/07/2021, all these facts are not known to this OP and hence they are denied by this OP. It is admitted that the car was brought to this OP on 04/08/2021 for repairing the damages stated in the complaint. At the time of arrival the damages appeared to be very old and the OP had expressed his opinion t that effect to the complainant. The 1st OP has approved only for front bumper and rear portion damages, consequently this OP informed to the complainant that for rectifying the said repairs this OP would need at least one month and it is agreed by the complainant as well. As per the opinion of the complainant this OP had repaired the damaged portion of the care very promptly and satisfaction of the complainant. This OP had forwarded all the necessary documents to the OP No.1 as per the directions of the complainant. It is admitted that the complainant had remitted an amount of Rs.60,455/- to this OP towards the repairs and service carried out, since the 1st OP denied to approve the front fog lamps and covers, LF fenders, LH rear door LH QTR panel, LH and RH running board and these are done by paid service and the exact amount for the placement of the spare parts, labour charges and the service charge for the repairs undertaken by the OP No.2. After completion of the service complainant has been delivered the care to the complainant on 03/09/2021 to the full satisfaction of the complainant. There was never any undue delay for conducting the repairs or delivering the vehicle on the part of this OP. Hence it is liable to be dismissed with the cost of the OP No.2.
Complainant has filed his proof affidavit and documents. He has been examined as Pw1 and marked the documents as Ext.A1 to A8. Pw1 was subjected to cross-examination by OPNo.1. Neither of the OPs adduced oral or documentary evidence. After that the learned counsel of complainant has submitted oral argument.
Here there is no dispute that the vehicle in question was insured with OP No.1 and the incident happened within the policy period. It is also an admitted fact that the complainant had paid Rs.60,445/- to OP No.2 towards the repairs and service carried out by OP No.2. Further the insurance claim of complainant was repudiated by OP No.1 company on the ground that “it is to inform that surveyor approved for rear bumper, Dicky repairs and front bumper in additional excess subjected to policy terms and conditions, cause of loss & date of loss mentioned in the claim form. Damages for front fog lamps & covers, LH Fender, LH Rear door, LH QTR Panel, LH & RH Running board are not consistent and does not tally with the cause of loss and date of loss mentioned in the claim form.”
From Ext.A3 it is revealed that complainant has submitted claim application within the period and OP No.1 has appointed a surveyor, and assessed the quantum of loss happened to the vehicle. Further the complainant does not have case that the repair work done by OP No.2 was not satisfactory. OP No.2 contended that he had repaired the vehicle without any undue delay and had been delivered to the complainant on 03/09/2021 after receiving Rs.60,445/- to the will full satisfaction of the complainant. OP2 further contended that complainant had remitted the repair charges to him, as OP No.1 denied the claim application. According to OP 2 there was no deficiency in service on his part.
OP No.1 Insurance company admitted that the policy of the vehicle was bumper to bumper policy. The reason for denial of OP No.1 was due to delay in submitting the vehicle for repair work and thus violated the policy terms and conditions. From the contention of OP No.1, it can be seen that OP No.1 also admitted that the insured vehicle got damaged. During cross-examination of Pw1 by OP No.1, the witness explained the delay in entrusting the vehicle was due to covid pandemic and he was a under quarantine.
Here the question to be decided is whether the rejection of claim application of the complainant is justifiable or not?
The circular of Insurance Regulartory and development Authority dated 20/09/2011 No.IRDA/HLTH/MISC/CIR/206/9/2011 states that claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for affecting various post claim activities like investigation, loss assessment, provisioning claim settlement etc. However this condition should not prevent settlement of genuine claims particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances.
Here OP has no case that the complainant has not submitted necessary documents before them. Further there is unavoidable circumstances (Covid 19 Pandemic) happened for presenting the vehicle for repair work as well as to give intimation to Insurance company.
During cross-examination of Pw1, the learned counsel of OP asked only to about delay to give vehicle for repair work and to give intimation.
From the above said decision it is very clear that the Insurance company cannot repudiate the bonafied claims on technical grounds like delay in intimation and submission of some required documents.
Moreover, OP admits that company has appointed a surveyor, who inspected the vehicle and assessed the loss happened to the vehicle. This document is a vital documents in this case, to ascertain what amount was assessed by the Insurance surveyor and what was his opinion. The said important document has not been submitted by OP No.1 before us.
Further nobody was examined from the side of OPs to establish their contentions. Without examining the representative of OP1, mere contentions in the version cannot be accepted.
Thus the repudiation of complainants claim on the ground of delay in intimation is not significant in genuine claim of the complainant.
Under these circumstances, it was a deficiency in service on the part of OP No.1 for repudiating complainant’s claim on flimsy ground. It would not be fair to reject even the genuine claims of the insured. There may be a condition in the policy regard delay in intimation but does not mean that the insurer can repudiation the genuine claim of the insured after receiving huge amount as premium, which is otherwise proved to be genuine. Pw1 deposed that delay was caused due to covid 19 Pandemic and also due to his quarantine period. It is correct that during that period there was restriction due to Covid pandemic. Hence without any contra evidence, we also believe the submission of the complainant. Hence there was no intentional delay happened from the side of complainant. Considering the facts and circumstances of this case, we are of the view that complainant is entitled to get relief from OP No.1. There is no evidence that there was intentional and inordinate delay in delivery of the vehicle to complainant, after repair work by OP No.2. Considering the pandemic situation existed during that period. Moreover there is no complaint regarding the repair work done by OP No.2. Hence, there is no deficiency in service on the part of OP No.2.
In the result complaint is allowed in part. Opposite party No.1 is directed to pay Rs.60,455/- to the complainant together with Rs. 15,000/- towards compensation and Rs.5,000/- towards cost of the proceedings. Opposite party No.1 shall comply the order within one month after receipt of the certified copy of this order. Failing which the Rs.60445+15000 carries interest @ 9% per annum from the date o order till realization. Complainant can execute the order as per provision in Consumer Protection Act 2019.
Exts
A1- Application send by complainant to OP No.1 dated 18/08/2021
A2- Reminder letter issued by OP 1
A3- Claim declined notice (repudiation letter)
A4 (series) -Cash receipt 3 in numbers
A5 (series) - Tax invoice 2 in numbers
A6 (series) – Photos (13 in Nos.)
A7- Copy of RC Book (subject to proof)
A8- copy of insurance certificate (Subject to proof)
Pw1- Complainant
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Assistant Registrar
