Punjab

Moga

CC/16/104

Baljit Singh - Complainant(s)

Versus

National Insurance Co. Ltd - Opp.Party(s)

Sh Sumit Mittal

31 Aug 2016

ORDER

THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MOGA.

 

 

                                                                                      CC No. 104 of 2016

                                                                                      Instituted on: 02.06.2016

                                                                                      Decided on: 31.08.2016

 

Baljit Singh, aged about 28 years son of S. Joginder Singh, resident of Parkash Karyana Store, Ajit Nagar, Moga.

                                                                          ……… Complainant

 

Versus

National Insurance Co. Ltd., G.T. Road, Moga, through its Divisional Manager

 

                                                                           ……….. Opposite Party

 

 

Complaint U/s 12 of the Consumer Protection Act, 1986.

 

 

Quorum:    Sh. Ajit Aggarwal,  President,

                   Smt. Vinod Bala, Member,

                   Smt. Bhupinder Kaur, Member.

 

Present:       Sh. Sumit Mittal, Advocate Cl. for complainant.

                   Sh. Ajay Gulati, Advocate Cl. for opposite party.

 

 

ORDER :

(Per Ajit Aggarwal,  President)

 

 

1.                Complainant has filed the instant complaint under Section 12 and 14 of the Consumer Protection Act, 1986 ( hereinafter referred to as the "Act") against National Insurance Company Limited, G.T. Road, Moga, through its Divisional Manager (hereinafter referred to as the opposite party) directing them to pay a sum of Rs.2,38,469/- in regard to vehicle Indigo Car ECS LS TDI bearing registration PB-29-U-9978 vide policy no.55270031146160123617. Further opposite party may be directed to pay sum of Rs.50,000/- on account of compensation, damages, mental tension and deficient services to the complainant or any other relief which this Forum may deem fit and proper be also granted.

2.                Briefly stated the facts of the case are that the complainant is the owner of Car Make Indigo ECS LS TDI bearing registration no.PB-29-U-9978, which was insured with opposite party vide policy no.55270031146160123617 valid for the period from 15.10.2014 to 14.10.2015. The said car of the complainant met with an accident at Haryana on 14.05.2015. The complainant informed the opposite party about the accident and requested them to get survey  the said vehicle, but the insurance company did not bother to survey the said vehicle. There was no human injury in the said accident, so police has not lodged any FIR. As per the directions, the complainant has got repaired the said car from Garyson Motors Pvt. Ltd. Moga and spent an amount of Rs.2,38,469/- vide bill dated 18.08.2015. The complainant deposited all the necessary documents and papers with the opposite party as required by them. At the time of deposition of papers and documents opposite party assured the complainant that the claim will be passed and the amount spent by him regarding the repair of the car will be paid to him within 30 days. But no claim had been passed so far and no amount was given to complainant by the opposite party. The complainant visited so many times in the branch of opposite party and made a grievance before them, but all in vain. Thereafter, opposite party sent a letter dated 18.04.2016 to complainant vide which the claim of the complainant was repudiated. The opposite party was asked many times to admit the rightful claim of the complainant, but they refused to do so. The service rendered by opposite is deficient one. Hence this complaint.

3.                Upon notice, opposite party appeared through their counsel and filed written reply taking certain preliminary objections that this Forum has got no jurisdiction to try and entertain the present complaint. The vehicle in question was admittedly used for "Commercial Purposes". The vehicle in question was used in business of sale/purchase of cars in daily routine and it was plied upto 32750 Kms within 8 months from the date of its purchase, which means it was being used on a very high mileage 137 Kms per day without any break and the said vehicle was attached with M/s Khalsa Tours and Travels at Moga i.e. a taxi stand and the same was being used for commercial use and not for personal use of the complainant, which amount to violation of registration certificate as well as terms and conditions of the Insurance Policy of the vehicle; that the complaint being not maintainable, false, self contradictory, frivolous, vague and vexatious is liable to be dismissed with compensatory costs; that the complainant has not come with clean hands. He has not disclosed the true facts. The alleged claim appears to be very doubtful; that no deficient services have been rendered to the complainant as alleged in the complaint. The claim of the complainant was duly entertained, surveyed and investigated. The independent surveyors were appointed to investigate and survey the extent and genuineness of alleged loss and the surveyors did not recommend alleged claim as payable and the independent surveyor after making enquiry and investigations, opined that "In our opinion while taking into consideration the findings of the investigation it has come to light that the above claim appears to be arranged in order to grab undue compensation from the insures.". Hence on the basis of report of surveyor, the opposite party has repudiated the alleged claim; that the complainant is estopped to file the present complaint by his own act and conduct. The complainant did not give any opportunity to the insurance company to verify/inspect the alleged loss immediately after the alleged accident and no spot survey was got conducted by the complainant, which is mandatory as per terms and conditions of Insurance Policy in question to find out the legitimacy of alleged claim. As per allegations of the surveyor the vehicle in question was hit by an Innova Car from front side and by a truck from rear side on dated 14.05.2015, but the complainant neither gave an immediate information to the answering insurance company nor gave any opportunity to conduct spot survey, nor gave any particulars of drivers/owners of alleged offending vehicles i.e. said Innova Car and Truck, nor gave any information to police or lodged any FIR/DDR/complaint etc. regarding alleged accident and nor gave any particulars/information about towing of his vehicle from the spot of alleged accident to the place of dealer/repairer. All such circumstances and conduct of complainant make the alleged claim highly suspicious. It is mentioned that admittedly the complainant doing business of sale/purchase of cards and it can be presumed that the complainant must be aware about all the terms, conditions, formalities and requirements to prove any claim as genuine under any Insurance Policy. Further submitted that at the time of alleged accident the vehicle of the complainant was having only temporary number i.e. PB. 10/EM (Temp) 9486. The vehicle was purchased on 22.10.2014 and the registration certificate of the vehicle has been got issued on dated 13.07.2015 i.e. much after the date of accident i.e. 14.05.2015, which is also a grouse violation of terms and conditions of Insurance Policy. On merits, the all other allegations made in the complaint have been denied and a prayer for dismissal of the complaint with heavy costs has been made.

4.                In order to prove the case, complainant Baljit Singh tendered in evidence his duly sworn affidavit Ex. C-1 and copies of documents Ex.C-2 to Ex.C-6 and closed the evidence. 

5.                In rebuttal, the opposite party tendered in their evidence duly sworn affidavit of Sh. Kamaljit Singh, Divisional Manager, National Insurance Company Ltd. Ex. Ex.OP-1 and copies of documents Ex.OP-2 to Ex.OP-22 and closed the evidence.

6.                We have heard the learned counsel for the parties and have very carefully gone through record placed on file.

7.                Learned counsel for complainant argued that complainant was the owner of Indigo Car ECS LS TDI bearing registration no.PB-29U9978, which was insured with opposite parties from 15.10.2014 to 14.10.2015, copy of the RC of the vehicle is Ex.C-5 and copy of the certificate of insurance is Ex. C-3. During the insurance period, the said vehicle met with an accident at Haryana on 14.05.2015. The complainant informed regarding it to opposite parties and requested them to get the survey of the vehicle, but they did not bother to survey the said vehicle. As there is no human injury in the alleged accident, the police had not lodged any FIR. On the directions of the opposite parties, the complainant got repaired his vehicle from Garyson Motors Pvt. Ltd. Moga and spent Rs.2,38,469/- vide bill dated 18.08.2015. The complainant has deposited all the necessary documents alongwith claim form to opposite parties for processing of his claim and the opposite parties assured the complainant that his claim will be passed in a short period, but no claim so far as has been passed by the opposite parties. He visited the office of opposite parties many times, but all in vain. The opposite parties sent a letter dated 18.04.2016, vide which they intimated that the claim of the complainant is repudiated; copy of the letter is Ex.C4. The service rendered by the opposite parties is deficient one. The complainant is entitled for the claim of loss occurred to his vehicle. The complainant requested the opposite parties to admit his claim, but they refused to do so. The complainant prayed that opposite parties may be directed to pay the insurance claim to him alongwith compensation and litigation expenses.

8.                To controvert the arguments of complainant, learned counsel for opposite parties argued that this Forum has no jurisdiction to try and entertain the present complaint, as the vehicle in question was used for commercial purpose. The vehicle in question was used in the business of sale/purchase of cars in daily routine and it was plied upto 32750 kms in 8 months from the date of its purchase and it was being used on a very high mileage. Further this vehicle was attached with M/s Khalsa Tours and Travels Taxi Stand and the same was being used for commercial purpose and not for personal use. It is violation of registration certificate and terms and conditions of insurance policy. There is no deficiency in service on the part of opposite parties. The claim of the complainant was duly entertained, surveyed and investigated. The independent surveyors were appointed to investigate and survey the extent and genuineness of alleged loss and they did not recommend the alleged claim as payable and opined that the above claim appears to be arranged in order to grab undue compensation from the opposite parties. Hence on the basis of the report of the surveyors, the insurance company has repudiated the alleged claim of the complainant. The complainant had not given any opportunity to opposite parties to verify the alleged loss immediately, after the accident and no spot survey was got conducted, which is mandatory as per terms and conditions of the policy. The complainant did not give any information to police for the alleged accident and did not lodge any FIR/DDR regarding the said accident. All such act and conduct of complainant make the alleged claim highly suspicious. The vehicle in question was purchased on 22.10.2014 and the registration certificate of the vehicle had been got issued on 13.07.2015 i.e. more than 7/8 months after the purchase of vehicle, which is also violation of terms and conditions of the policy. It is wrong that the vehicle of the complainant met with an accident as alleged by the complainant. The claim of the complainant was investigated by two independent surveyors, copies of these survey reports are Ex.OP-20 and OP-22. The complainant is not entitled for any claim, rather his claim has been found highly doubtful and the complainant violated the terms and conditions of the policy. The surveyors did not recommend to pay the alleged claim to the complainant. So, the opposite parties repudiated the claim vide letter dated 23.05.2016, copy of the same is Ex.OP-10. As the vehicle in question is used for commercial purpose, so they rightly repudiated the claim of the complainant. The complainant is not entitled for any relief and the present complaint may be dismissed with costs.

9.                We have thoroughly gone through the file, evidence and arguments lead by both the parties. The case of the complainant is that he is the owner of car, which was duly insured with opposite parties and during the insurance period, his car met with an accident. He gave information regarding it to opposite parties and also submitted all the required documents with them for processing of his claim. But opposite parties did not pay his genuine claim to complainant and repudiated the same on false grounds. In reply, opposite parties submitted that the claim of the complainant was duly surveyed, investigated and processed and during the investigation, it come to notice that the vehicle of the complainant was used for commercial purpose and not for personal use, which is violation of terms and conditions of the policy. So they rightly repudiated his claim. In support of their allegation, they produced copy of Job Card as OP-11 to OP-14 issued by Garyson Motors Pvt. Ltd. regarding the service record of the vehicle in question. Whereas, the vehicle in question is shown in the heading 'Account' as "New Khalsa Tour & Travels" i.e. some Taxi Stand. They further submitted that the vehicle in question runs about 32750 Kms only in 8 months which is too excessive and it was being used for commercial purpose and the complainant himself admitted that he dealing in the business of sale purchase of cars for which he travels in routine, which is commercial in nature.

10.              Learned counsel for complainant argued that the vehicle in question never used for commercial use and it is personal vehicle of the complainant. Learned counsel for complainant further argued that the vehicle was never attached with Khalsa Tour and Travels, he produced the copy of letter issued by Garyson Motors Pvt. Ltd. Ex.C-6, which is sent by them to opposite party clarifying that the vehicle in question is owned by the complainant and he purchased this car for private purpose only. Registration Certificate of the car also done under private section by Transport Department and in their record mistakenly complainant name was attached with New Khalsa Tour & Travel Company. Moreover, no said Tours and Travels company is existing in Moga. So, the account written in the Job Sheet New Khalsa Tour and Travels is the mistake of Garyson Motors regarding which they issued certificate. He further argued that the plying of vehicle in excess does not mean that the vehicle in question is used for commercial purpose. The complainant has to travel more for his business purposes to earn his livelihood, which does not mean that the vehicle is used for commercial purposes. The opposite parties wrongly repudiated his claim on this ground. At this stage, learned counsel for complainant submitted that by typical mistake in complaint in para no.2 date of accident is written as 14.05.2015, whereas actual accident was taken place on 12.08.2015. The complainant submitted the claim form and other documents to opposite parties stating the correct dated of accident i.e. 12.08.2015, but while typing the complaint inadvertently, it is written as 14.05.2015 and date of accident in complaint may read as 12.08.2015 and necessary permission to this effect may be granted. We has thoroughly gone through the file and it came to our notice from the estimate of repair submitted by Garyson Motors Ex.C-2 the date of accident is mentioned as 12.08.2015. Further in the intimation letter to opposite parties regarding accident and claim form date of accident written by complainant is 12.08.2015. Further in the survey report conducted by the opposite parties OP-20 and investigation report Ex.OP-22 the date of accident is mentioned as 12.08.2015. The letters sent by opposite parties to the complainant regarding his claim Ex. OP-8 to OP-10 date of accident is mentioned as 12.08.2015. From the perusal of above documents, we are of the opinion that the correct date of accident is 12.08.2015 and it is only typographical mistake, the date of accident is mentioned in complaint as 14.05.2015 and the same is required to be corrected. The request of learned counsel for complainant is allowed the date of accident is to be read as 12.08.2015. The other allegation of the opposite parties is that whereas the vehicle in question was purchased on 22.10.2014 and Registration Certificate has been prepared on 13.07.2015, which is violation of terms and conditions of the policy. It is admitted that the alleged accident occurred on 12.08.2015 and RC was prepared on 13.07.2015, which is prior to accident. So, there is no violation of terms and conditions of the policy. Opposite parties submitted that on intimation from the complainant they duly appointed surveyors to assess the loss to the vehicle and and genuineness of the claim, who submitted their reports Ex.OP-20 and OP-22 respectively. In their investigation report the investigators gave Opinion that "In our opinion while taking into consideration the findings of the investigation it has come to light that the above claim appears to be arranged in order to grab undue compensation from the insurers. The underwriters my please take into consideration the above Analysis for the settlement of the claim and did not recommend the claim. So, on the basis of survey and investigation they correctly repudiated the claim. From the perusal of survey report Ex.OP-20 it come to notice that as per the observation of the surveyor, the damages as allowed found fresh and tally with the history of accident as mentioned in the Claim Form & Explained to them by the insured. Loss appears to be accidently in nature and vide this report surveyor allowed the Net Assessed Loss to the tune of Rs.2,10,000/-. But subsequently the opposite parties appointed investigator to investigate the case, who gave his report making certain objections for payment of claim. Learned counsel for complainant argued that there was no need to re-investigate the matter. The opposite parties appointed the second investigator arbitrarily without the consent of the complainant only to make the false and flimsy grounds to deny the genuine claim of the complainant. He put reliance on the citation National Insurance Company Vs Ajay Kumar 2008 (2) CLT 402 whereas our Hon'ble National Consumer Disputes Redressal Commission, New Delhi held that Insurance claim. Repudiation- Surveyor report- Investigator - appointment of - Held that the insurance Act permits appointment of Surveryors and they are licenced by the Insurance Regulatory Development Authority. Appointment of an 'Investigator' is neither backed by any statute nor are they licenced by any Regulatory Authority. Keeping in view the principles of natural justice and equity report of Investigator considered in detail. It does not in any way reduce the importance of the observations made by the Surveryor and the conclusion drawn by him. There is no legal jurisdictional error in orders passed by the For a below allowing the claim. When the surveyor duly survey and assess the loss and allow the claim of the complainant. The opposite parties cannot deny the claim on the ground of investigator report.

11.              From the above discussion, we are of the considered opinion that opposite parties wrongly, illegally repudiated the claim of the complainant on false grounds which amounts to deficiency in service and trade mal practice on their part. Hence the complaint in hand is allowed and opposite parties are directed to pay the claim for the loss to the car of the complainant to the tune of Rs. 2,10,000/- as assessed by the surveyor vide his survey report Ex.OP20 alongwith interest @ 9% p.a. from 23.05.2016, when they finally repudiated the claim of the complainant till final realization. Further opposite parties are directed to pay Rs. 5000/-(Five thousand only) as compensation for harassment and mental agony suffered by him besides litigation expenses of Rs.3000/-(Three thousand only). Compliance of this order be made within one month of receipt of the copy of the order, failing which complainant shall be entitled to proceed under Section 25 and 27 of the Consumer Protection Act. Copy of the order be supplied to parties free of cost as per rules. File be consigned to record room.

Announced in Open Forum.

Dated: 31.08.2016.

 

 

                              (Bhupinder Kaur)         (Vinod Bala)         (Ajit Aggarwal)

                                        Member                        Member                President