Delhi

North

CC/113/2022

NEERAJ SHARMA - Complainant(s)

Versus

ORIENTAL INSURANCE COMPANY LIMITED - Opp.Party(s)

20 Feb 2024

ORDER

District Consumer Disputes Redressal Commission-I (North District)

[Govt. of NCT of Delhi]

Ground Floor, Court Annexe -2 Building, Tis Hazari Court Complex, Delhi- 110054

Consumer Complaint No.113/2022

In the matter of

(As per amended complaint)

Sh.Neeraj Sharma         

S/o Sh. V.P.Sharma

R/o 14, Second floor, Shiv Puri

Patparganj, Road, Delhi-110051                                               …Complainant

      

Versus

The Oriental Insurance Co.Ltd.

Through its Manager

7678, Singh Sabha Road

Near Amba Cinema

New Delhi-110007                                                                 ...Opposite Party

ORDER
20/02/2024

Ms.Harpreet Kaur Charya, Member

The present complaint has been filed by Sh. Neeraj Sharma, the complainant against Oriental Insurance Company Ltd, the insurer as OP with the allegations of deficiency in services and unfair trade practice.

1. Facts necessary for the disposal of the present complaint are that the complainant is the registered owner of Duster car bearing Registration No.DL-1CS-8890, Chassis no. MEEHSRAW5E5062799, engine no.E071279 and  got the same insured vide policy No.271500/31/2021/4649 for the period from 04/03/2021 to 03/03/2022 with the IDV of Rs.4,75,200/-.
2. On 02/06/2021, the insured vehicle was gutted in fire at the main gate no.2 of Supreme Enclave, Mayur Vihar, Phase-1, Delhi-110091. The complainant after completing all the formalities lodged a claim with OP. It has been alleged by the complainant that he is entitled to the insured amount as the insured vehicle was completely damaged due to fire.
3. The complainant has further stated that as he was in dire need of money so, vide letter dated 15/08/2021, he agreed to accept Rs.4,55,000/-, however , same was not paid by OP. As, the said amount was not paid despite reminder dated 13/09/2021, the complainant was constrained to withdraw his offer.
4. Complainant has been alleged that OP has failed to follow the guidelines issued by IRDA for the settlement of the claims.  Legal notice dated 28/10/2021 was served upon OP, calling them to pay Rs.4, 75,200/- (IDV) alongwith interest @18% per annum, Rs.5,00,000/- on account of mental tension and harassment, which was neither reply nor complied with by OP despite service.
5. On 28/04/2022, the OP issued a letter no.SVCNR02/31/2022/00030515, stating ,the competent authority had approved the claim for Rs.4,44,200/- subject to cancellation of the registration certificate.  The said approval was unacceptable to the complainant. Feeling aggrieved by the non settlement of the claim, the complainant has prayed for the directions to OP to pay a sum of Rs.4,75,200/- alongwith interest @ 18% per annum: Rs.5,00,000/- as damages on account of deficiency of services and Rs.25,000/- as litigation expenses. 
6. The complainant has annexed the copy of the insurance policy, fire report dated 02/06/2021; copy of email dated 03/06/2021; legal notice dated 28/10/2021 alongwith postal receipts and delivery report and letter dated 28/04/2022 issued by OP with the amended complaint.
7. Notice of the present complaint was issued to OP.
8. Written Statement was filed on behalf of OP.  They have taken several preliminary objections such as: there is no deficiency in the services as the surveyor was duly appointed for investigation; the complainant had failed to comply with the policy term and conditions; there was 9 days delay in lodging of complaint with the police authority which creates suspicion; there is no consumer-service provider relationship after the claim of the complainant was repudiated; the dispute cannot be decided in summary proceedings under the Consumer Protection Act, 2019 as it required investigation; the services of the OP had been availed by the complainant for commercial purposes and the complete set of documents had not been supplied by the complainant.
9. OP has denied that the complainant is the registered owner of the vehicle bearing No.DL-1CS-8890;the said vehicle gutted in fire on 02/06/2021; the complainant has completed all the required formalities and the complainant is entitled for  full value of Rs.4,75,200/-. It has further been denied that the complainant vide letter dated 15/08/2021 had agreed to accept an amount of Rs.4,55,000/-.  Receipt of legal notice has also been denied.  
10. It has been submitted by OP that upon receipt of the claim Sh. Amarjeet Singh Duggal was appointed as a surveyor and the 2^nd surveyor ,Sh. M.S. Uppal was also appointed for second opinion and based on the recommendations of the surveyor letter dated 28/04/2022 was issued to the complainant.  They have annexed survey report of Sh.Amarjeet Singh Duggal dated  07/07/2021 as Annexure-A.  
11. Rejoinder to the written statement of OP was filed by the complainant reiterating the contents of the complaint and denying those of the written statement.
12. Evidence by way of affidavit was filed by both the parties. The complainant has got himself examined. He has repeated the contents of the amended complaint and has got exhibited the insurance policy as CW1/1; fire report dated 02/06/2021 as CW1/2; copy of email dated 03/06/202 as CW1/3; legal notice dated 28/10/2021 alongwith postal receipts and delivery report as CW1/4 and letter dated 28/04/2022 issued by OP as CW1/5.
13. Sh. Vikas, Manager, Oriental Insurance Co. Ltd. Division office has been examined on behalf of OP. He has also repeated the submission made in the written statement. He has got exhibited the survey report dated 07/07/2021 as Ex-DW1/1 (colly).
14. We have heard the arguments for the Ld. Counsel for the parties. The complainant is aggrieved by the non settlement of his claim by OP. The factum of existence of policy cover, loss of insured vehicle due to fire is not in dispute. The complainant has placed on record the letter dated 28/04/2022(Ex.CW1/5) stating:

We are settling the Total Loss(NOS) Claim under claim no. 270011/31/2022/00030515 and Policy no.271500/31/2021/4649 for Vehicle number DL 01 CS8890. The competent authority has approved the abovementioned claim for Rs. 4,44,200/- subject to cancel the registration certificate.

15.  First and foremost deciding upon the objections raised by the OP that complainant is not a consumer. As the policy was issued by OP, there exists a relationship of consumer- service provider relationship between the complainants.  Hence this plea of OP does not hold ground.  As far as the objections pertaining to the commercial use is concerned, it seems to be a mere bald assertion as OP has placed noting on record in support of their defence.
16. OP in its Written Statement has stated that 2 surveyors were appointed to assess the claim of the complainant. We are unable to understand as to why the 2^nd surveyor was appointed and even if it was appointed then what stopped the OP from filing the report of the 2^nd surveyor, Sh. M.S. Uppal. Therefore, an adverse inference is to be drawn against OP.
17. Further, Hon’ble Supreme Court in the matter of “Sri Venkateswara Syndicate Versus Oriental Insurance Company Ltd. & Anr.” II(2010) CPJ 1(SC) has also observed that:
    22.  The assessment of loss, claim settlement and relevance of survey report depends on various factors. Whenever a loss is reported by the insured, a loss adjuster, popularly known as Loss Surveyor, is deputed who assess the loss and issues report known as Surveyor report which forms the basis for consideration or otherwise of the claim. Surveyors are appointed under the statutory provisions and they are the link between the insurer and the insured when the question of settlement of loss or damage arises. The report of the Surveyor could become the basis for settlement of a claim by the insurer in respect of the loss suffered by the insured. There is no disputing the fact that the Surveyor/Surveyors are appointed by the insurance company under the provisions of Insurance Act and their reports are to be given due importance and one should have sufficient grounds not to agree with the assessment made by them. We also add, that, under this Section the insurance company cannot go on appointing Surveyors one after another so as to get a tailor-made report to the satisfaction of the concerned officer of the insurance company, if for any reason, the report of the Surveyors is not acceptable, the insurer has to give valid reason for not accepting the report. Scheme of Section 64-UM particularly, of Sub-sections (2), (3) and (4) would show that the insurer cannot appoint a second surveyor just as a matter of course. If for any valid reason the report of the Surveyor is not acceptable to the insurer may be for the reason if there are inherent defects, if it is found to be arbitrary, excessive, exaggerated, etc., it must specify cogent reasons, without which it is not free to appoint second Surveyor or Surveyors till it gets a report which would satisfy its interest. Alternatively, it can be stated that there must be sufficient ground to disagree with the findings of Surveyor/Surveyors. There is no prohibition in the Insurance Act for appointment of second Surveyor by the Insurance Company, but while doing so, the insurance company has to give satisfactory reasons for not accepting the report of the first Surveyor and the need to appoint second Surveyor.

 

 “31. The assessment of loss, claim settlement and relevance of survey report depends on various factors. Whenever a loss is reported by the insured, a loss adjuster, popularly known as loss surveyor, is deputed who assess the loss and issues report known as surveyor report which forms the basis for consideration or otherwise of the claim. Surveyors are appointed under the statutory provisions and they are the link between the insurer and the insured when the question of settlement of loss or damage arises. The report of the surveyor could become the basis for settlement of a claim by the insurer in respect of the loss suffered by the insured.

 

18. We have carefully perused the report of Sh. Amarjeet Singh Duggal,(1^st surveyor) dated 07/07/2021  (Ex.DW1/1). The net liability on net of salvage basis (without RC) is stated to be Rs.4,49,200/-, this figure is arrived at after deduction of Rs.15,000/- on account of wreck value of the damaged vehicle (without RC) and the said value is valid only for 40 days implies till  01/09/2021.  The letter dated 28/04/2022 (Ex.CW1/5) issued by OP, stating that the competent authority has approved the claim for Rs.4,44,200/- subject to cancellation of the Registration Certificate, has been issued almost after 09 months from the date of 1^st Surveyor Report, by then the salvage value  must have reduced. This letter further does not disclosed as to how the amount of Rs.4,44,200/- has been arrived at by OP.  The reduction of the sanctioned amount by Rs.30,000/- without any cogent reason is also arbitrary.   
19. Further, the claim allowed by the surveyor was without RC and OP has without any plausible reason further reduced it by Rs.5,000/- rather the claim should have been settled at IDV of Rs.4,75,200/-. At the same time, the complainant has also not disputed the surveyor report. There is considerable delay on part of OP to settle the claim and considering the salvage value to be Zero, we deem that OP should pay Rs.4,64,200/- (Rs.4,49,200/- as assessed by the surveyor + Rs.15,000/- as wreck value without RC).
20. Thus, based on the reasons mentioned above, the act/omission on the part of OP in delayed settlement of the claim as well as arbitrary reduction amounts to deficiency in services and unfair trade practice.
21. Therefore, in the facts and circumstances of the present complaint and in the interest of justice, we direct OP to :-

1. Pay Rs.4,64,200/- on account of the settlement of the claim;
2. Pay interest @7% p.a. from the date of loss i.e. 02/06/2021 till realization;
3. Pay compensation of Rs.25,000/- on account of mental harassment and agony and;
4. Pay Rs.15,000/- as litigation expenses.

 

The order be complied within 30 days from the date of receipt of order. In case of non-compliance, the OP shall be liable to pay interest @9% per annum on (a)+(c)+(d) from the date of order till realisation.

Office is directed to supply the copy of this order to the parties as per rules. Order be also uploaded on the website.  Thereafter, file be consigned to the record room.

 

 

(Harpreet Kaur Charya) Member	(Ashwani Kumar Mehta)                          Member   (Divya Jyoti Jaipuriar)           President