Before the District Consumer Disputes Redressal Forum, Room No. 208 2nd Floor, District Administrative Complex, Tarn Taran
Consumer Complaint No : 81 of 2017
Date of Institution : 09.10.2017
Date of Decision : 03.07.2019
Surjit Singh son of Karnail Singh Sandhu resident of VPO, Sarhali Kalan, Tehsil and District Tarn Taran.
...Complainant
Versus
The Manager National Insurance Company Motor Claim Hub 4th Floor, Grand Walk Mall, Ferozepur Road, Ludhiana 141012.
…Opposite Party.
Complaint Under Section 11 and 12 of the Consumer Protection Act, 1986.
Quorum: Sh. Charanjit Singh, President
Smt. Jaswinder Kaur, Member
For Complainant Sh. Randeep Sood Advocate
For Opposite Party Sh. Sandeep Khanna Advocate
ORDERS:
Charanjit Singh, President;
1 The complainant Surjit Singh has filed the present complaint under Section 11 and 12 of the Consumer Protection Act (herein after called as 'the Act') against The Manager National Insurance Company Motor Claim Hub 4th Floor, Grand Walk Mall, Ferozepur Road, Ludhiana 141012 (Opposite Party) on the allegations of deficiency in service and negligence in service on the part of opposite party with prayer to reimburse the Insurance Claim amount of Rs. 3,25,075/- out of which Rs. 2,59,860/- has been paid by the opposite party and also prayed Rs.1,00,000/- as compensation and Rs. 10,000/- as litigation expenses.
2 The case of the complainant in brief is that Surjit Singh obtained a comprehensive Insurance Policy from the Opposite party in respect of his motor vehicle RENUALT DUSTER RXL CAR bearing No.PB-46-P-1942 and the policy bears No.40130031166200000488. The above said vehicle of the complainant met with an accident on 31.8.2016 and sustained loss and on the same day, the Vehicle was towed to be parked with the dealer and informed the office of opposite party, regarding the accident having been occurred. The dealership was to be changed by the company and Benchmark Motors Pvt. Ltd. or the previous dealer did not inform/ intimate the opposite party regarding the loss of the vehicle regarding which the dealer has also given in writing to the complainant. Thus, the intimation being late is not on the part of the complainant but due to change of dealership. Therefore, the complainant cannot be held responsible for the act and conduct on the part of the dealer. The opposite party has also got consent letter signed from the complainant regarding the payment of Rs.3,25,075/- vide consent letter dated 18.02.2017. The said consent letter was prepared by the office of opposite party and thereafter, the same was got singed from the complainant but now the opposite party has again sent a letter dated 28.7.2017 to the complainant for consenting to receive Rs. 2,60,060/- which is wrong, illegal and against the law. The letter is arbitrary and the opposite party has no right or interest to reduce the amount of claim which the complainant has already consented vide consent letter dated 18.02.2017. The complainant is entitled to the amount of Rs. 3,25,075/- alongwith interest of 11 months as the opposite party has unnecessarily delayed the claim of the complainant without any reason. The complainant served a legal notice to the opposite party through his counsel and the opposite party did not even give reply to said notice and simply deposited a sum of Rs. 2,59,860/- in the account of the complainant which is also wrong, illegal and against the law. The opposite party has got no right to deposit less amount in the account of the complainant. From the above said facts, it is crystal clear that the opposite party is guilty of fault, imperfection, short coming and inadequacy in the quality, nature and manner of performance of service on the part of the opposite party. Feeling dissatisfied by the act and conduct of the opposite party, the complainant perforce has filed this complaint against the opposite party.
3 After formal admission of the complaint, notice was issued to Opposite Party and opposite party appeared through counsel and filed written version contesting the complaint on the preliminary objections that the complainant has violated the basic terms and conditions of the insurance policy in question and hence the present complaint is not maintainable. As per condition No.1 of the current insurance policy, the intimation regarding the occurrence/accident of the vehicle in question is required to be given immediately to the insurance Co. The date of loss was 31.08.2016. However, the complainant failed to intimate the loss immediately to the insurance co. rather the same was intimated on 14.09.2016 after a long unjustified delay of 14 days. Resultantly, the claim was settled by the competent authority of the opposite party on Non-Standard Basis for Rs.2,60,060/- on net of Salvage Basis with R.C. and the same was intimated to the complainant vide letter dated 28.07.2017. The complainant is estopped from filing the present complaint. The opposite party has already credited the sanctioned amount of Rs. 2,59,860/- into the Bank account of the complainant on 15.09.2017 and the complainant had received the said amount without any protest. Hence, the claim in question stands fully satisfied. Moreover, the complainant never raised any objection with the competent authority of the opposite party, even after receiving the above said sanctioned amount, which clearly proves that the said amount was received by him with his full consent. As such, the present complaint is clearly an afterthought which has been filed just to harass the opposite party. The complainant has got no cause of action to file the present complaint. The complainant had received the sanctioned claim amount without any protest and the claim in question stood fully satisfied. The complainant never raised any objection with the competent authority of the opposite party, even after receiving the above-said sanctioned amount, which clearly proved that the said amount was received by him with his full consent. Hence, the complainant is not entitled to get the relief claimed for. The complainant has not approached this Forum with clean hands and has tried to conceal the material facts. The version of the complainant is nothing but an afterthought and a concocted story altogether put forth to get a false claim which in itself is not a genuine one. The parties to the complaint are strictly governed by the terms and conditions of the policy in question. As the claim already stands fully satisfied, therefore, no consumer dispute survives, hence, the complainant has no right to file the present complaint. The opposite party has already credited the sanctioned amount of Rs.2,59,860/- into the bank account of the complainant on 15.09.2017 and the complainant had received the said amount, therefore, there is no deficiency or delay on the part of opposite party. Hence the relief towards interest and damages, etc. is not payable, in this regard it is submitted that basically neither there is any provision under the Consumer Protection Act nor there is any agreed clause on the contract of insurance to pay such relief. On merits, the opposite party has reiterated the stand as taken in the preliminary objections and denied the other contents of the complaint and prayed for dismissal of the complaint.
4 To prove his case, Ld. counsel for the complainant tendered in evidence affidavit of Surjit Singh complainant Ex. C-1, affidavit of Satnam Singh son of Thakar Singh resident of Makboolpura Chownk, Amritsar Ex. C-2, affidavit of Jatinder Singh son of Jasbir Singh resident of Chatiwnind, Amritsar Ex. C-3 alongwith documents i.e. Legal notice dated 11.8.2017 Ex. C-4, Postal Receipt Ex. C-5, Policy Ex. C-6, Self attested copy of account statement Ex. C-7, Self attested copy of Rapat Roz Namcha Ex. C-8, Self attested copy of consent letter Ex. C-9, Self attested copy of letter dated 28.7.2017 Ex. C-10, Self attested cop of letter addressed to National Insurance Company Ex. C-11 and closed the evidence. The opposite party tendered in evidence affidavit of Dheeraj Seth D.M. Ex. OP/1, Attested copy of affidavit of Surjit Singh Ex. OP/2, attested copy of E-mail Ex. OP/3, Attested copy of intimation Ex. OP/4, Attested copy of claim note Ex. OP/5, Attested copy of intimation Ex. OP/6, Attested copy of e-mail Ex. OP/7, Attested copy of recommendation Ex. OP/8, Attested copy of recommendation Ex. OP/9, Attested copy of voucher Ex. OP/10, Attested copy of registered letter dated 28.7.2017 Ex. OP/11, attested copy8 of consent letter Ex. OP/12, attested copy of statement of account Ex. OP/13 and closed the evidence.
5 We have heard the Ld. Counsel for the complainant and opposite party and have gone through the evidence and documents placed on the file by the parties.
6 In the present case, accident of the vehicle in question is not disputed, Insurance of the vehicle in question is also not disputed. The opposite party has given the claim to the complainant of Rs. 2,59,860/- on non-standard basis. The dispute in the present case is only for an amount of Rs. 65,215/- because the opposite party has made the payment of Rs. 2,59,860/- on non standard basis, however, the complainant is claiming the amount of Rs. 3,25,075/-. The case of the opposite party is that the complainant has violated the basic terms and conditions of the insurance policy in question. As per condition No. 1 of the insurance policy, the intimation regarding the occurrence/ accident of the vehicle in question is required to be given immediately to the insurance company. The date of loss was 31.8.2016, however, the complainant filed to intimate the loss immediately to the Insurance, company rather the same was intimated on 14.9.2016 after a long unjustified delay of 14 days. Resultantly, the claim was settled by the competent authority of the opposite party on ‘Non Standard Basis’ for Rs. 2,60,060/- on net salvage basis and the same was intimated to the complainant vide letter dated 28.7.2017. On the other hands, the case of the complainant is that the vehicle of the complainant met with an accident on 31.8.2016 and the complainant made a Rapat no. 7 dated 1.9.2016 Under Section 427 dated 1.9.2016 at Police vide Ex. C-8. The vehicle in question as towed to be parked with the dealer and informed the office of the opposite party regarding the accident having been occurred. The complainant has placed on record affidavit of Satnam Singh son of Thakar Singh resident of village Makboolpura Chownk, Amritsar as Ex. C-2 who is working as Insurance Adviser at the Renault Showroom which was being run in the name and style of Padam Cars Pvt. Ltd at Jandiala Guru Tehsil and District Amritsar who declared in his affidavit that on 31.8.2016 the vehicle of the complainant bearing Renault Duster RXL Car Bearing No. PB-46-P-1942 was towed to be parked at their dealership as the same met with an accident. He further declared in his affidavit Ex. C-2 that the complainant informed him and other staff members including Jatinder Singh Finance Manager regarding the accident and insurance claim. Satnam Singh further declared in his affidavit that, he has informed the insurance company. He further declared in his affidavit that old and new dealer informed the insurance company in writing. He further declared in his affidavit that the complainant is entitled to all benefits and insurance company should reimburse the insurance claim amount of Rs. 3,25,075/- The intimation being late is not on the part of the complainant but due to change of dealership. The complainant cannot be held responsible for the act and conduct on the part of the dealership. The complainant has also placed on record affidavit of Jatinder Singh so of Jasbir Singh resident of Chatiwind Chowk, Amritsar District Amritsar Ex. C-3 and declared that he worked as Finance Manager with the dealer at the time of accident of the vehicle of the complainant i.e. on 31.8.2016. He further declared that on the same day, the vehicle Renault Duster RXL Car bearing No. PB-46 –P-1942 was towed to be parked at their dealership and dealer informed the employee of the National Insurance Company. The complainant has also placed on record one consent letter Ex. C-9 regarding the payment of Rs. 3,25,075/- as full and final settlement on net of Salvage basis with R/C excluding the value of damaged vehicle. On the other hands, the opposite party has given Rs. 2,60,060/- to the complainant on non-standard basis which is contrary to each other. The opposite party has placed on record one letter Ex. OP/6 i.e. intimation letter addressed to the Divisional Manager 26-D court Road Amritsar by the complainant Surjit Singh and same is dated 2.9.2016. It shows that the complainant has given the intimation to the opposite party on 2.9.2016 i.e. just two days after and the said document has been placed on record by the opposite party itself, which shows that the complainant has given the intimation to the opposite party within time from the accident. It is not disputed that the complainant has suffered loss to the tune of Rs. 3,25,075/- in the accident. The opposite party has made the payment to the complainant to the tune of Rs. 2,60,060/- on non standard basis only on the ground that the complainant has given the intimation late to the opposite party but as per Ex. OP/6 the complainant has given the intimation to the opposite party on 2.9.2016 and accident took place on 31.8.2016. The complainant has also given intimation regarding the accident to the police on 1.9.2016 and to support his version, the complainant has placed on record Rapat Ex. C-8. Otherwise also, it is admitted fact that intimation about theft was given to the Opposite Party with minor delay. This delay in the opinion of the Forum is not such a delay which could compel the insurance company to close or repudiate the claim of the complainant. Otherwise also, a circular dated 20.9.2011 was issued by IRDA, referred to all the insurance companies, which reads as under:-
“Circular
To: All Life Insurers and non-life insurers
Re: Delay in claim intimation/ documents submission with respect to
i) All life insurance contracts and
ii) All Non-life individual and group insurance contracts.
The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.
The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting 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. The insurers’ decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such intimation clause does not work in isolation, and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.
Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.
The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers’ stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.
J. Harinarayan
Chairman”:
A bare reading of circular shows that if the claim is otherwise payable then it should not be repudiated or rejected simply on the ground of delay and delay is only to be considered when claim is otherwise not made out and is liable to be rejected even if the matter has been reported in time. In case titled as National Insurance Company Limited Vs. Kulwant Singh 2014(IV) CPJ page 62 (NC) the Hon’ble National Commission observed that the insurance company should not have repudiated the claim merely on account of delay in giving the information to insurance company particularly when there was absolute no delay in lodging the FIR with the police. In the case in hand also, the theft took place on 16.9.2014 and intimation to the police was also given on the same day i.e. 16.9.2014 and as such, there was no delay at all for giving the intimation to the police. Moreover, in similar case titled as Reliance General Insurance Company Limited- Petitioner Vs. Sri Avvn Ganesh-Respondent 2012(1) CPJ page 176 in case under Consumer Protection Act, 1986 the intimation of death was given to the insurer with delay and claim was repudiated on the ground that death of insured was intimated after 4 months as against stipulated period of one month. The complainant filed complaint on the allegation of deficiency in service by insurance company, but the same was dismissed, but appeal filed by the complainant was allowed by Hon’ble State Commission. On revision, the Hon’ble National Commission, New Delhi observed that all the conditions for acceptance of insurance claim except point of reporting loss within one month of its occurrence had been substantially fulfilled and delayed intimation of death of insured due to injuries he suffered on account of accident could not be held to be destructive to insurance claim because the facts and circumstances of death were clearly established on the basis of medical on records as well as deposition of doctor who attended the insured and it was observed that like in case of theft of moveable insured property, delay in intimation was not prejudicial to the insurer because in such cases, Insurance company was not prevented, because of delay, from carrying out any investigation into the facts and circumstances as to whether the accident and consequent loss fell within the substantive condition of insurance policy and no infirmity was found in the order and revision petition was dismissed. In the case in hand also, the theft of vehicle in question was reported to the police on the very next day by the complainant and as such, the complainant has substantially fulfilled the condition of the policy as intimation to police was immediate and as per version of the opposite party intimation even to the insurance company was only with a delay of 14 days as claimed by the Opposite Party which is not material in the case in hand for closing or repudiating the claim case of the complainant and as such, the complainant is entitled to claim the insurance amount of the vehicle in question.
7 In light of the above discussion, the complaint succeeds as discussed above and is allowed with costs in favour of complainant and against Opposite Party. The complainant is held entitled to recover Rs.65,215/- (Sixty Five Thousand two hundred and fifteen only) i.e. remaining insurance claim amount for the vehicle in question, subject to fulfilling the necessary requirement for the transfer of the vehicle in question in the name of Opposite Party and filing the subrogation letter and other necessary compliance. The complainant is also entitled to Rs.4,000/- (Rs. Four Thousand only) as compensation on account of harassment and mental agony. The complainant is also awarded Rs.3,500/- (Rs. Three thousand and five hundred only) as costs of litigation from the Opposite Party. Opposite Party is directed to pay the awarded amount to the complainant within one month from the date of receipt of copy of the order. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.
Pronounced in Open Forum
3.7.2019
