JUDGEMENT
This is a petition U/S 12 of the Consumer protection Act, 1986( as amended ) for the deficiency in services and non – payment of insurance claim.
Brief fact of the case is that the complaint Smt. Jayshree Patwary had duly insured her Bus No AS-25-A-9032 with the opposite party vide policy No. 321200/1/87/31/2000-843 valid from 28.09.99 to 27.09.2000 and the said vehicle met with a road traffic accident on 08.06.2000 near Krishnai under Dudhnai P.S. causing heavy damages. A claim was lodged by the complainant to the insurer immediately and the insurance company has deputed its surveyor to assess the loss and accordingly the surveyor inspected the damaged vehicle, took photographs and assessed the loss and submitted his report to the insurance company alongwith all the relevant documents etc. for processing the claim file for payment. But the Insurance Company repudiated the claim vide its letter No. nil dated 26/2/03. The complaint visit the office of the opposite party on several occasions personally and through her agents for settlement of the claim of the claim but the insurance company did not pay any heed to it. Hence the complainant has preferred this complaint.
O.P has contested the case by filing W.S and started that the complaint is not maintainable, there is no cause of action, the claim was repudiated with due diligence, the liability of the company is subject to terms of policy issued and limitations as to use of the vehicle in terms of the policy issued and further subject to the provisions of M.V. Act, 1988, that the amount of compensation is fantastic and without any legal basis and prays for dismissals of the complaint petition.
Upon the pleading the following issues were framed:-
1. Whether or not there is any cause of actions.
2. Whether or not the vehicle No. AS-25-9032 was insured by the O.P. vide policy No. 843 valid from 28-09-99 to 27-09-2000 after due verified and collected premium for accidental damaged vehicle. In addition to other risk by comprehensive Insurance policy.
3. Whether or not the policy was sold by the O.P. after due verification of the vehicle before selling of the vehicle.
4. Whether or not the vehicle met with a road traffic accident 08-06-2000 under Dudhnai PS and cause damages as claim or any other damages.
5. Whether or not there is delay on the part of O.P. insurer on various counts in setting genuine claim for which policy is issued and premium collected deficiency in services.
6. Relief proceed. The case shall proceed without survey report as O.P. insurer has failed to submit it.
Decision and Reasons thereof
Issue No.1:- Insurance Premium is respected of the Vehicle No. AS-25-A-9032 was duly accepted by the O.P/Insurance Company and the vehicle was duly insured after physical as well as documentary verification of the same and relevant policy NO. 320200/1/87/31/2000/843 valid from 28.9.99 to 27.9.2000 was issued, accident of the vehicle cause damages, repudiation of the claim was not denied by O.P and matter of record and there is certainly cause of action and hence this issue goes in flavor of the complaint.
Issue No. 2,3&4:- All these issues are taken together for decision as well as all are interrelated with each other. Contents of issues No.2 are matter of record and not denied by O.P. contents of issue No.3 are proved by affidavit and Exhibits and are matter of record. Contents of issue No.4 is proved by means of affidavit and oral evident of complainant and further the opposite Party Insurance has not denied the receipt of documents which are relevant in regards to the accident. During cross examination also the O.P has not put any question / suggestion to CW-1 Jayshee Patwari towards denial of the accidents and damages thereby. But O.P has simply put a suggestion that delay in settlement of the claim was due to late submission of documents to the insurance company, which was also replied by the by the CW-1 in negative and it has thus proved that the insurance company has received all the relevant papers / documents in time from the complainant as well as the surveyor. In their W/S also the OP/insurance company has not specifically denied the accident and damage to the vehicle thereby an inspection of the vehicle after the acci9dent by it appointed surveyor was also not denied. During trial the OP/insurance was given time on occasions to produce the Surveyor report but it has not produce the same to prove the fact otherwise. Hence all the above issues goes in favour of the complainant.
Issue No. 5:- This issue relates to deficiency in rendering services. The claim arose on 8.6.2000, when the vehicle met with an accident near Krishnai under Dudhnai P.S. and repudiated the claim on 26.03.2003 stating that the O.P has not received reply in respect of the clarification sought by them from the complainant – insured of vehicle No. AS-25-A-9032 and hence the claim was made as ‘No claim’. During trial the OP/insurance has neither produce any document to prove what type of clarification was sought by them from the insured complainant nor they have put any questions in this regards to the witness during cross examination, Moreover such plea was not taken in their W/S also and hence the OP/insurance is barred from taking the same as ground for repudiation of the motor claim. Generally a Insurance claim should be settle within a span of 3(three) months time the Insurance Co sized of the matter and here is the present case the O.P./ insurance has instead of settling the claim int5imated the complainant insured about making the claim as ‘No Claim’ after a gap of more than 33 months and dragged her form door to desk for setting her genuine insurance claim. Such long delay in intimating about repudiation of a insurance claim itself is deficiency in services. Hence there is certainly deficiency in rendering services by the O.P./Insurance and this issue also goes in favour of the complainant.
During hearing the complainant has exhibited certain documents and this forum has perused the documents fields.
The complainant has field evidence on affidavit and she was duly cross examined by the O.P./Insurance has neither filed any document nor examined any defence witnesses. Even the O.P/Insurance has filed to produce the surveyor’s report, thought direction was given to this forum on several occasions for a look for the assessment made by their deputed surveyor towards damage of the accident vehicle. But the O.P./Insurance has filed to produce the surveyor’s report despite direction by this forum time and again. Complainant on her complaint petition claimed the sum of Rs. 2,50,000/- towards damages to the vehicle and this was the actual amount spent by her for repairing the accident vehicle and from the policy document it appears that the vehicle was insured for the sum of 4,00,000/- only. But in her evidence the complainant-insured stated that her surveyor assessed the loss to the sum of Rs. 1,60,000/- only. The O.P./Insurance was given ample opportunity to produce the surveyor’s report to verify the settlement made by him but it failed to do so. In absence of the surveyor’s report this forum has nothing to do but to assess the loss by its own and it accordingly decided to assess the sum of Rs. 1,60,000/- towards damages to the vehicle leaving behind the amount claimed by the complainant but the amount assessed by the surveyor is taken into consideration.
Award
In the result of complaint petition it allowed awarding the sum of Rs. 1,60,000/- towards damages to the vehicle with 6% interest after 3 months of the accident i.e. 8.9.2000 till payment (this 3 months time is excluded as being time allowed for processing the claim by the insurance company as allowed in different cases decided by hon’ble National Forum. A sum of Rs. 20,000/- is awarded towards deficiency in rendering services and the sum of Rs. 50,000/- is awarded towards cost of the proceeding. The whole awarded sum will be paid by O.P./insurance company M/S Oriental Insurance Company within 30 days failing which the entire amount will further carry 12% penal interest till realization.
