PER SHRI. S.M. RATNAKAR – HON’BLE  PRESIDENT

1)        The Complainant has claimed an amount of Rs.1,80,000/- with interest @ 24% p.a. from the date of accident till realization of the entire amount and Rs.1,00,000/- towards compensation for mental agony, harassment + Rs.50,000/- towards the incidental expenses incurred by the Complainant.      

 2)        It is submitted that the complainant is carrying his business under the name and style as M/s. Progressive Transport Co. having office at 19/2, Karivali Village, Tal. Bhiwandi, Dist. Thane, for his livelihood.  He is the proprietor of the said business.  He is having Motor Tanker bearing No.MH-04-DK 9504.  The Complainant has insured the said vehicle with the Opposite Party under Policy No.250700/31/09/ 6300000530, for the period 02/06/2010 to 01/06/2011. The Complainant has submitted that the said vehicle met with accident on 07/08/2010 at Borikua, Udaipur and got damaged.  The Complainant informed about the said accident to the Opposite Party within the stipulated period.  According to the Complainant, the Opposite Party advised the Complainant that he should first get repaired the damaged motor vehicle and thereafter put up proposal for settlement of claim.   The Complainant accordingly repaired the damaged motor vehicle and submitted claim form alongwith all requisite documents.  It is submitted that the Opposite Party repudiated the legitimate claim of the Complainant on ridiculous ground and therefore, the Complainant has filed this complaint for grant of the said claim.

 3)        According to the Complainant, the damaged motor tanker was surveyed by the Surveyor of the Opposite Party and he had submitted the survey report dtd.24/03/2011.  According to the Complainant he has also lodged the FIR regarding the said accident.  The Complainant alongwith the claim lodged by him filed repairing charges bill of B.K. Auto works, Javed Sheikh, Harkesh Enterprises and intimation letter regarding the accident to his motor vehicle.  It is submitted that the Opposite Party however, repudiated the claim on the ground that the Complainant has claimed for exorbitant amount more than the actual expenses incurred for repairing of the damage motor tanker.  It is alleged that out of the total amount of Rs.1,80,000/- the Surveyor has admitted that Rs.1,00,000/- has been paid by the Complainant to the owner of garage.  The Surveyor has also admitted some bills of purchasing materials for repairing.  The Complainant has therefore, submitted that the Opposite Party ought to have granted at least the admitted amount and was required to pay to the Complainant.  It is submitted that the attitude of the Opposite Party show that the Opposite Party was not interested in settling the legitimate and genuine claim of the Complainant and thereby caused grave loss and hardship to the Complainant.  The Opposite Party is thus, guilty of deficiency of service and as such the Complainant is entitled for the claim made in the complaint as referred in para 1 of this order.

 4)        The Opposite Party contested the claim by filing written statement. The Opposite Party denied the case made out by the Complainant.  It is contended that the Complainant has filed false, frivolous and fictitious claim with intention to make profit out of the insurance policy based on forged and bogus documents.  The Complainant has thus, violated the fundamental principle of indemnity by implication wherein insurance cannot be used to make profit.  It is contended that the repudiation of the claim is based on the investigation report which is based on cogent reasoning.  It is contended that subsequent to the alleged accident as per the Complainant’s own admission minor repairs were done to the vehicle and thereafter the vehicle proceeded further to deliver the goods at Surat. It is contended that the vehicle of the Complainant met with an alleged accident on 07/08/2010 at Borikua, Udaipur however, thereafter after the vehicle plied from Udaipur to Surat and then reached at Mumbai.  It is contended that the distance Udaipur to Mumbai is quite far and for any heavily damaged vehicle to travel more alongwith goods loaded if taken into consideration it clearly suggest that the vehicle was not damaged heavily and therefore, claim made is and inflated one, fabricated by the Complainant only with the intention to make profit out of insurance cover available. It is denied that the Opposite Party gave any suggestion to the Complainant to repair the insured vehicle first and thereafter claim the reimbursement. The Opposite Party has challenged the authenticity of the documents relied by the Complainant.  The Opposite Party has thus, denied the averment made in the complaint and submitted that the complaint is liable to be dismissed with cost.

 5)        The Complainant has adduced his evidence by way of affidavit.  The Opposite Party filed affidavit of evidence of Shri. B.S. Gautam, Sr. Divisional Manager, and affidavit of Shirish Raautraya – the Investigator. Both the parties filed their written arguments.  We heard the N.B. Sarpate, Ld.Advocate for the Complainant and Smt. Harshada Rane for the Opposite Party.    

 6)        The Advocate for the Complainant Shri. Sarpate relied documents filed with the complaint and submitted that the vehicle of the Complainant met with an accident on 07/08/2010 on its way from Panipath to Surat near Borikua between Barpal and Tidi is amply proved on the basis of copy of FIR and copy of Spot Survey Report.  The Complainant thereafter got repaired his vehicle is also proved by the documents such as, bills issued by the various garages.  He thus, submitted that as per the terms and conditions of the policy the Opposite Party is liable to pay the claim made in the complaint.  He submitted that the Opposite Party by letter dtd.30/03/2011 wrongly repudiated the claim on the ground that the Complainant has submitted forged, bogus bills, cash memos to take benefit of insurance policy. It is submitted that the Complainant has also placed on record Indemnity Bond-cum-Declaration of Harkesh Vishwakarma who has specifically stated that on 08/11/2010 he had issued a bill cum receipt No.225 of Rs.1,80,000/- to the Complainant and he received full payment.  He also confirmed that he had not issue blank bill copies to him.  Shri. Sarpate Advocate thus, submitted that the Opposite Party has wrongly repudiated the claim on the basis of the report of Investigator and therefore, the Opposite Party is guilty of unfair trade practice and is liable to pay the claim as made in the complaint. 

 7)        The Advocate for the Opposite Party – Smt. Harshada Rane on the other hand submitted that the Complainant has submitted the forged bills.  The Complainant is not coming with clean hands.  She submitted that according to the Complainant he got repaired his accidental vehicle from Harkesh Enterprises and paid Rs.1,80,000/-.  The Complainant for that purpose relied the bill dtd.08/11/2010 bearing No.225 filed at page 26 Annexed with the complaint. She made submission that the bill which is relied is totally forged as the signature on the said bill for Harkesh Enterprises and the signature on indemnity bond-cum-declaration are totally different.  The signature on the said bill is in English. However, on the aforesaid bond the signature is in Devnagari lipi. She also submitted that even in the ICICI Bank Account of the Complainant the payment made to Harkesh Enterprises is shown as 28/09/2010 Rs.30,000/-, on 08/10/2010 Rs.10,000/-and 28/12/2010 Rs.28,000/-. She made submission that even if the payment is considered made to Harkesh Enterprises it does not tally with the payment shown in the receipt dtd.08/11/2010.  She further submitted that in the present case the Insurance Company appointed the Investigator to investigate the claim made by the Complainant.  The Investigator of “Thee Escorts” in his affidavit has stated that he verified the said bills through handwriting experts and the report of the handwriting experts is also on the record.  She made submission that as per the findings of the Investigators, the Complainant has submitted the forged bills.  The Complainant has also fabricated the documents.  The Complainant did not at any point of time informed the Investigator about the vehicle towed, however submitted the bill of it.  She submitted that as the Complainant is having near about 15 vehicles from the ICICI Bank account and the payment made to Harkesh Enterprises as referred above cannot be considered made only for the insured accidental vehicle by the Complainant.  She further submitted that the investigator has filed his affidavit as to how he noticed the fraud played by the Complainant.  She therefore, submitted that the repudiation made by the Opposite Party because of the fraudulent act on the part of the Complainant is justified.  The Ld.Advocate Smt. Harshada Rane, thus, submitted that the complaint is liable to be dismissed. 

 8)        We have gone though the documents placed on record by both the parties.  From the report of the spot surveyor the vehicle no.MH-04-DK 9504, met with an accident on 07/08/2010 at Borikua and was damaged as mentioned in the report of P.C. Paliwal, can be accepted.  However, the claim made by the Complainant on the basis of the bills placed on the record cannot be held proved as the bill of Harkesh Enterprises is totally false and unreliable.  The said bill bears the signature in English for Harkesh Enterprises.  The Complainant by producing the Indemnity Bond-cum-Declaration of Harkesh Vishwakarma tired to bring on record that the bill of Rs.1,80,000/- issued by Harkesh Enterprises is genuine does not bear his signature in English. The handwriting expert has also opined that the said bill relied by the Complainant is false and bogus.  Besides that the Investigator Shirish Raautraya in his affidavit specifically stated that he had perused the bills and receipts submitted by the Complainant with regard to this claim and the bill from Harkesh Enterprises is written by the Complainant himself and not by the workshop owner.  He also in his affidavit stated that he had confirmed that Mr. Harkesh orally stated that the Insured had taken away the blank copies of the bills and companies letter head to prepare estimation and bills.  He further stated that the carbon copies of the bills in the bill book of Harkesh Enterprises were found blank and Harkesh had informed him that he had charged Rs.1,00,000/- from the Insured. The investigator has therefore, opined that the Insured has manipulated the repair bills and has inflated the bills.  The said fact also can be collaborated by going through the bill placed on record by the Complainant dtd.08/11/2010 in which no vehicle number is mentioned what and exact repairs had been carried out is also not mentioned.  The Investigator has also opined that the towing bill of the Complainant’s own company also can be considered as fake and bogus as the Complainant did not at any point of time informed the Investigator that the vehicle was brought to Mumbai by towing on the other hand it was revealed to him that the vehicle was driven to the Mumbai destination by making delivery of some consignment at Surat.  The said fact is also collaborated by the Complainant’s own letter filed at page 5 annexed with the complaint and addressed to the Opposite Party.  It is also pertinent to note that in the ICICI Bank Account of the Complainant placed on record the payment made to Harkesh Enterprises is not to the tune of Rs.1,80,000/-.  Considering all these facts we hold that the claim made by the Complainant is not supported by genuine and reliable documents.  The report of the Investigator “Thee Escorts” as well as the Handwriting expert report placed on record with the affidavit of the Investigator, if taken into consideration we find that the repudiation made by the Opposite Party on the ground that the Complainant has submitted forged/bogus bills/cash memos to take benefit of the insurance policy which is in violation of the principle of indemnity is justified.  In the result we hold that the complaint is liable to be dismissed with cost of Rs.3,000/-.  Hence, the following order is passed –

                                                                                            O R D E R

i.                    Complaint No.255/2011 is dismissed with cost of Rs.3,000/-(Rs.Three Thousand Only). The Complainant to pay Rs.3,000/- towards cost to Opposite Party. 

ii.                 Complainant is directed to comply the aforesaid order within one month from the date of service of this order.  

iii.               Certified copies of this order be furnished to the parties.