The present complaint pertains to repudiation (Ex.C7) of a comprehensively insured accidented Motor Car by the insurers quoting I) violation of condition no. 1 that warrants ‘an immediate notice by the insured to the insurer, in writing, of occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the insurance company shall require’ and II) violation of provisions of the Motor Vehicle Act and also of the Driver Clause under Insurance Policy Schedule as the owner/ insured driving the car at the time of accident was alleged to be as NOT Having/ Holding a valid driving-license. The titled complainant declines and contests both the above assertions/ allegations raised by the titled opposite party insurers.
2. We observe that a few following facts along with their evidentiary documents, reproduced in a simple cum understandable brevity, along with the above two issues of contention between the insured and the insurer shall suffice the purpose of our judicious adjudication. These are:
i) The complainant Palwinder Singh has been the registered owner of Motor Car (Ex.C1) with RC # PB06AV0148 and got the same comprehensively insured from the OP insurers vide Insurance policy # 991091923740001785 (Ex.C2) valid with effect from 16.05.2019 to 15.05.2020.
ii) The insured Car had somehow got immensely-damaged in a road-side accident at Batala on the night of 24.01.2020. The Nissan Motor Car Vendors’ recovered/ towed the accidented Car to its Workshop at Amritsar on 25.01.2020 and filed its Repair Estimates (Ex.C3) for Rs.638,771/-.
iii) The Photographs (as clicked by the Car Vendor) of the Accidented Car (Ex.C6) were flashed to the insurer by the insured on 25.01.2020.
iv) The related report/ intimation (Ex.C4 & Ex.C5) vide DDR and CS etc was initiated on 25.01.2020.
v) The insurance claim (Ex.OP3) stood filed by the complainant along with (Ex.OP5) Repairs Estimates Rs.638,771/- coupled with the Investigation Report of the OP appointed Surveyor (Ex.OP4) Repair Estimates Rs.492,772/- stand filed with their respective supporting documents.
vi) The insured complainant Palwinder Singh has also filed his Driving License (Ex.C8) valid up to 15.05.2020 along with its Verification (Ex.C9) by the issuing authority; coupled with Govt. of India Notification (Ex.C10) extending validity of all the Transport Documents (expiring on or before 30.09.2020) up to 30.09.2020; And, also the Driving License (Ex.C11), in question, duly renewed up to 15.05.2030.
We observe that adjudication of the two basic issues, in contest, prompting repudiation, shall autobiographically resolve the complaint besides the other points of contravention.
3. We have duly heard the learned counsels for both the sides, on the points of law, and have also thoroughly examined the records with requisite care and caution on the points of fact, as placed before us. We find that the OP insurers disallowed the impugned Car Accident Insurance Claim vides repudiation letter Ex.C7/ Ex.OP1 dated 27.02.2020 for of the prime reason (as addressed therein) that there has been violation of Condition no. 1 that warrants ‘an immediate notice by the insured to the insurer, in writing, of occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the insurance company shall require’. We observe that the road-side accident occurred on the night of 24.01.2020 and the photographs of the accidented car as received from the Nissan Vendor Workshop on 25.01.2020 were duly forwarded on the same day to the OP insurers who have not rebutted its receipt throughout the proceedings and that legally amounts to an implied admission. So presently the OP insurers cannot be permitted to plead violation of condition 1. Moreover, we find the contents of condition 1, somewhat ambiguous. An immediate Accident intimation to insurers may not always attract first priority. There may be more urgent priorities as: injured accident-victims warranting medical assistance, some requiring hospitalization, reporting to police authority, following/ tracing the run-away vehicle so as to name a few. In our considered opinion, Rule of ‘Contra Proferentem’ shall be applicable, here. ‘Ambiguous Terms In Insurance Contracts To Be Interpreted In Favor Of Insured as held by the Hon'ble Supreme Court’. Further, the OP Insurers have admitted in its written reply that ‘insurance claim’ was received on 29.01.2020 i.e., sans any inordinate delay etc. We hold the OP insurers’ repudiation of the claim as arbitrary and unfair on the pretext of violation of condition no. 1, by the insured complainant.
4. We further observe that the OP insurers have put forth that the insured complainant Sh. Palwinder Singh does not have a driving license and that he misrepresented that one Pargat Singh was driving the car at the time of accident and he failed to present himself before the Insurer’s Surveyor. Moreover, the OP has also alleged that the complainant Palwinder Singh did not file his Driving License in spite of their requests/ reminders. Somehow, we do not find much force in this contention of the OP Insurers. The claim was filed on 29.01.2020; Driving License of the complainant was requisitioned vide letter dated 14.02.2020 and repudiation followed in quick succession on 27.02.2020. The complainant has placed on records his genuine and valid Driving License duly verified by (Exhibits Ex.C8 to Ex.C11) the issuing authority. We find that the OP insurers, in its hurry to repudiate the claim, in question, lost patience n prudence to defer the impugned ‘repudiation’ and allow sufficient time to the complainant to file the requisitioned papers. In the process, we observe the OP have infringed the complainant’s consumer rights, for sure.
5. Lastly, we find that the OP insurers have indeed violated the complainant’s statutory rights causing him physical-harassment; mental agony and financial loss vide their hurried and an unfair repudiation of his genuine insurance claim and thus we hold them liable to suitably compensate the insured complainant. Now, reverting to the quantum of reasonable compensation we observe that the ‘proposition’ stands for minimizing the actual losses incurred to the ‘aggrieved’ to a good extent but does not ‘favor’ undue ‘enrichments’ to him, at the cost of ‘tormentor’ so as to cause a sort of turn-table reversal of roles. The Nissan Vendor Workshop have assessed the accident losses and repairs @ Rs.638,771/- whereas the OP’s Surveyor has estimated Rs.492,772/- for the same. Further, the claimed amount of Rs.50,000/- by the insured as parking charges are not evidenced by any demand or bill etc., Similarly, the claim of Transport Charges of Rs.250,000/- and Litigation Charges of Rs.50,000/- are seemingly unreasonable and we decline these amounts. Under the circumstances and to the best of moderation in line with the listed facts and available evidence (on record) we are of the considered opinion that a settlement and payment as per Serveyor Report coupled with interest @ 6% PA from the date of filing of complaint till actual payment along with a lump sum payment of Rs.10,000/- in lieu of compensation cum litigation charges etc to the insured complainant by the OP insurers shall squarely meet the ends of justice. Thus, the OP insurers are directed to settle and pay and execute compliance to above orders within 45 days of receipt of certified copy of these orders.
6. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
7. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Naveen Puri)
President.
ANNOUNCED: (R.S.Sukhija)
MAY 06, 2022. Member.
YP.
