Haryana

Ambala

CC/364/2021

Gulab Singh - Complainant(s)

Versus

Reliance General Insurance Co Ltd - Opp.Party(s)

21 Mar 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	364 of 2021
Date of Institution	:	01.12.2021
Date of decision	:	21.03.2024

Gulab Singh S/o Shri Hawa Singh R/o # 10, Housing Board Colony, Baldev Nagar, Ambala City.

          ……. Complainant.

Versus

Reliance General Insurance Company Ltd., 6^th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express City, Goregaon (E), MUMBAI.

….…. Opposite Party

Before:       Smt. Neena Sandhu, President.

                    Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Dev Batra, Advocate, counsel for the complainant. 

                      Shri Mohinder Bindal, Advocate, counsel for the OP.

Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘OP’) praying for issuance of following directions to it:-

1. To pay to the claim amount of Rs.4,39,529/-, incurred towards expenditure qua repair of the insured vehicle, alongwith interest.
2. To pay Rs.25,000/- as compensation for harassment and mental agony.
3. To pay Rs.25,000/- on account of litigation expenses.

Or

Grant any other relief which this Hon’ble Commission may deems fit.

 

2.             Brief facts of the case are that for the purpose of self-employment & for earning livelihood, the complainant purchased a vehicle i.e. Truck Ashoka Leyland bearing registration no HR337-E-1550 in the month of Feb 2021. Being a poor person, having no personal source of finance, the complainant had no other option rather to purchase the said truck for livelihood, through bank finance. "Yes Bank" had financed the said truck on monthly installments of Rs.39,529/-. However the only condition put forwarded by the "Yes Bank" was to get the vehicle insured from there tie up insurance in vehicle finance case i.e. with Reliance General Insurance Company ltd. Hence as forced by the bank, the said Truck Leyland bearing registration no HR337-E-1550 was insured vide the policy number 200422123340001706 w.e.f 03.02.2021 to 02.02.2022 under Reliance Commercial Vehicles Package Policy with assessed total IDV of Rs.20,42,500/-. After purchasing the said truck, the complainant completed all legal issues i.e, registration, route permit at RTA Ambala etc. On 22.05.2021 while going from Ambala to Chandigarh for loading some goods, the said truck fell down in the sewerage made adjoining the national highway, near Mc Donald KFC Zirakpur. The complainant was told about the incident by the driver Mahipal through mobile no 9518286539. Immediately complainant after coming to know regarding the said incident, informed the Bank Manager, who advised the complainant to make the call to insurance company on its toll free number and to inform about the incident of damage suffered on national highway near MC Donald KFC Zirakpur. Hence all particulars of the said incident were detailed to the insurance company on its toll free number. On 22.05.2021 itself, spot survey was conducted by the surveyor hopefully Mandeep from Mohalli, of the insurance company. It was only, on advice of the official of insurance company that the vehicle was lifted through Jaggi Crane Service, Zirakpur to AS Motors, Haryana Motor Market, Ambala City, where the vehicle was dismantled for loss assessment and repairs by several mechanics. Mahipal who was driving the vehicle at the time of accident was having a valid & effective driving. By grace of God nobody was injured & no FIR was registered in this regard. However the Truck in question was badly damaged, even front mirror, one tyre, battery was also busted besides total damage of excel, radiator, intercooler etc. On 22.05.2021 itself the intimation was given to the OP and on there advice the vehicle was lifted from site of accident through crane & was taken to workshop at Ambala City. Surveyor namely Amir Khan of the O.P insurance company reached at workshop on 24.05.2021 and took the estimate from the workshop. Thereafter he advised the workshop in charge & other mechanics involved in repairs, to get the vehicle repairs done at the cost of the OP. Even one investigator of OP named Mr Arora had also visited the complainant and also visited the workshop and  mechanics attending the damaged vehicle. He was narrated the true & factual happening of the incident, while it was being driven by Driver Mahipal. The said investigator of the OP had obtained all papers i.e. estimate, bills, photographs, RC, Policy, RP of vehicle, DL of Mahipal etc & also signatures of the complainant on some papers & had also assured soon release of payment. Finally the vehicle was repaired & invoice of various workshops/Mechanics were obtained for approx Rs. 3,00,000/-, which was paid by the complainant on the advice of the O.P to their another surveyor namely Amir Khan, that after payment entire payment would transferred through NEFT to the account of the complainant. Copies of RC, Insurance policy, Original bills, receipts, one blank signed cheque, PAN Card, Driving License of Mahipal, etc. were obtained by the officials of the O.P from the complainant on the pretext that soon the entire payment amounting i.e. Rs.3,00,000/- which included damage repair, spare parts, dismantling & reaffixing the parts, cabin etc, battery, tyre, front mirror charges etc. would be credited to the account of the complainant. The complainant was surprised to receive a repudiation letter dated 09.07.2021 from the OP, on the ground that driver-Shankar who was driving the vehicle at the time of accident was not holding a valid licence.  Thereafter, when after making number of requests to the OP to release the claim amount, the OP failed to pay the same, he served legal notice dated 11.08.2021, upon the OP but to no avail.  Hence, the present complaint.
3.           Upon notice, OP appeared and filed written version and raised preliminary objections to the effect that this complaint is not maintainable; the complainant has not approached this Commission with clean hands and has suppressed the material facts; the present complaint is ex-facie misconceived, vexatious, untenable and devoid of any merit; the present complaint has been filed without any cause of action etc. On merits, it has been stated that a claim was reported by the complainant with regard to accidental loss to his insured vehicle. As per intimation given by the complainant, the alleged accident took place on 22.05.2021 when it was being driven by his driver-Shanker alongwith other details about the accident, insurance policy, registration certificate etc.
4.           On intimation, the reported claim of the complainant was duly entertained and one IRDA approved surveyor was immediately deputed to assess the loss. Said surveyor immediately contacted the complainant and inspected the vehicle in question and discussed the matter with him as well as with the mechanic at the workshop where the complainant had parked his said truck himself for repair, and surveyed the vehicle in detail. After scrutinizing and elaborating the whole facts and position of the vehicle in question and after getting the detailed information and papers from the complainant, the surveyor submitted his detailed report wherein he assessed the payable loss to the tune of Rs.95,236/- on repair basis subject to terms and conditions of the insurance policy and approval by the competent authority. On getting contradictory version from the insured about the person on wheel at the relevant time on his being failed to provide the driving license of the driver Shanker as disclosed at the time of intimation of loss, this matter was entrusted to investigator Mr. Shubham Arora to investigate in detail and to give his fact finding report in this regard. The said investigator met the complainant, his alleged driver and other related persons and also visited the place of accident etc. After his detailed investigation, the investigator found that at the time of accident the alleged person Mr. Mahipal who was later introduced by the complainant as driver was infact not driving the said truck in question and was rather not present there in the truck at the time of alleged accident and was thus proved to be introduced later on by the insured since his actual person Mr. Shanker who was driving the said truck at the time of said accident was not having any driving license. Thus it was the sole reason as to why the insured concealed true facts about the actual driver and substituted his other driver Mr. Mahipal, who was not in the truck even, in place of his driver Shanker who was actually driving the said truck at that time in violation of the terms and condition of the insurance policy and in contravention of the Motor Vehicle Act. After scrutinizing and elaborating the whole facts, situation, records and the evidence, the OP was compelled to repudiate the reported claim of the complainant as per the terms of the policy on the ground of false information, misrepresentation and for playing fraud. Under the insurance contract utmost good faith must be observed by the contracting parties and good faith forbids the insured from concealment, non-disclosure of the facts which the party knows and from making any false statement. The insured has a duty to disclose each and every information and material fact correctly. Since the complainant has intentionally and deliberately concealed and suppressed the true facts about the actual driver and other occupant in the said vehicle at the relevant time to get claim compensation deceitfully from the OP hence the claim was held not maintainable and payable. The complainant was duly informed about the fate of his claim vide letter dated 09.07.2021. Rest of the averments of the complainant were denied by the OP and prayed for dismissal of the present complaint with costs.
5.           Learned counsel for the complainant tendered affidavit of the complainant as Annexure C/A alongwith documents as Annexure C-1 to C-41 and closed the evidence on behalf of the complainant.  On the other hand, learned counsel for the OP tendered evidence by way of affidavit of Suryadeep Thakur, Authorized Signatory of OP-Company-Reliance General Insurance Company Ltd., Regional Office, Chandigarh and Ameer Khan, Surveyor and Loss Assessor, Chandigarh as Annexure OP-A and OP-B respectively alongwith documents Annexure OP-1 to OP-3 and  closed the evidence on behalf of OP.
6.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
7.           Learned counsel for the complainant submitted that by not paying the claim amount to the complainant, which fell due under the policy in question, as accident of the vehicle took place during subsistence of the said policy, the OP is deficient in providing service,. 
8.           On the contrary, the learned counsel for the OP submitted that since the driver-Shankar driving the vehicle in question at the time of accident was not having any licence, and later on, the complainant produced licence of one Mahipal instead of Shankar, as such, the claim of the complainant was rightly rejected by the OP.    
9.           The moot question which falls for consideration is, as to whether, the complainant is entitled to any relief in this case or not. It may be stated here that from perusal of contents of claim repudiation letter dated 09.07.2021, Annexure OP-1 reveals it was repudiated on the ground that though the driver details provided by the insured was of one  Mr.Mahipal, however, upon investigation it was found that it was Mr.Shankar  who was driving the vehicle of accident and was not having a valid licence, which fact amounts to misrepresentation of facts. 
10.           It may be stated here that not even a single evidence in the shape of any intimation letter/statement of insured or Mr.Mahipal or Mr.Shankar aforesaid has been placed on record by the OP to prove that it was ever informed to the OP that alleged Mr.Shankar was driving the vehicle in question at the time of accident. On the other hand, it is the definite case of the complainant that Mr.Mahipal, was having valid licence, Annexure C-4. Once, a specific plea was taken by the   complainant to this effect, the onus then shifted upon the OP to prove that it was Mr.Shankar who was driving the vehicle in question at the time of accident and not Mr.Mahipal. Under these circumstances, bald assertions of the OP in this regard, being devoid of merits, stand rejected. Thus, it is held that the claim of the complainant was wrongly rejected by the OP. The Hon’ble Supreme Court of India in Om Prakash vs Reliance General Insuarance, CIVIL APPEAL NO.15611  of 2017, decided  on 4 October, 2017, has clearly held that the decision of the insurer to reject the claim has to be based on valid grounds and that rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry.  
11.            It is significant to mention here that though the complainant has sought amount of Rs.4,39,529/- yet, the Surveyor in his report, Annexure OP-3, which is a detailed one, has assessed the liability of the OP to the tune of Rs.95,236/- on repair basis. The complainant has not challenged this report, Annexure OP-3 by placing on record any contrary evidence.  Under these circumstances, the complainant is held entitled to an amount of Rs.95,236/-. By not making payment of this amount of Rs.95,236/- the OP is deficient in rendering service. 
12.           In view of the aforesaid discussion, we hereby partly allow the present complaint and direct the OP, in the following manner:-
    1. To reimburse/pay the claim amount of Rs.95,236/- alongwith interest @6% p.a. from 09.07.2021 onwards.
    2. To pay Rs.5,000/- as compensation for the mental agony and physical harassment suffered by the complainant.
    3. To pay Rs.3,000/- as litigation expenses. 

                    The OP is further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OP shall pay interest @ 8% per annum on the awarded amount, from the date of default, till realization. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

 Announced:- 21.03.2024

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President