Haryana

Ambala

CC/311/2014

JAI PAL - Complainant(s)

Versus

RELIANCE GENERAL INSURANCE - Opp.Party(s)

RAJBIR SAINI

12 Sep 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AMBALA

                                                          Complaint case no.        : 311 of 2014

                                                          Date of Institution         : 10.11.2014.

                                                           Date of decision             : 12.09.2017

Jai Pal son of Sadhu Ram r/o H.No.5, Luxmi Vihar, Model Town, Jandli Ambala City.

……. Complainant.

                                      Versus

1.Reliance General Insurance Company Limited 16, Okhla Industrial Estate, New Delhi-110020, through its Manager.

2.Gurunanak Insurance Service, 17 Old Civil Hospital Road, Ambala City through its proprietor–Rohit Chabra

 ….…. Opposite parties.

BEFORE:   SH. D.N. ARORA, PRESIDENT

                   SH. PUSHPENDER KUMAR, MEMBER         

                   MS. ANAMIKA GUPTA, MEMBER                 

Present:       Sh.Rajbir Singh, counsel for complainant.

                   Sh.M.Bindal, counsel for OP No.1.                                                                     

                   OP No.2 exparte.

ORDER:

                   Brief facts of the present complaint are that the complainant is registered owner of car bearing registration No.01AA-0368 and he got the vehicle in question insured with OP No.1 vide policy No.2004542311004604. On 16.04.2012 the vehicle of the complainant met with an accident with a scooter and got badly damaged. He intimated about the accident to branch of OP which deputed a surveyor. The surveyor visited the spot and as per its directions the complainant got the vehicle in question repaired from Metro Motors, Ambala by spending a sum of Rs.50,000/-. After that the complainant submitted all the bills and other relevant documents to the office of OP and requested to settle the claim but his claim was repudiated vide letter 01.07.2014 on the ground that at the time of accident the driver was under the influence of intoxicating liquor or drugs.  The finding of the OP is based on the statement of driver of the scooter but the police in report under Section 173 Cr.P.C. had never disclosed that the driver was in drunken condition at the time of the car.  The act and conduct of the OPs clearly amounts to deficiency in service on their part. In evidence the complainant has tendered his affidavit Annexure CX and also tendered documents Annexure C1 to Annexure C8.                

2.                On notice, OP No.1 appeared and filed reply to the complaint. In the reply many preliminary objections such as cause of action, maintainability, territorial jurisdiction and suppression of material facts from this Forum have been taken. It has been submitted that the matter was reported vide claim No.2141077265 on 11.06.2014, which was duly entertained in due course but after scrutinizing and elaborating the whole facts, records and evidence, the competent authority legally repudiated the claim as per terms and conditions of the policy because the claim to the insurance company was lodged after 9 days of alleged loss and even at the time of accident the driver of the car was under the influence of liquor, therefore, the repudiation letter dated 01.07.2014 is justified and has been made keeping in view the terms and conditions of the policy. The manner of accident and statement of the injured clearly proved the position and senses of the driver at the time of accident. There is no deficiency in service on the part OP No.1. Other allegations made in the complaint have been controverted and prayer for dismissal of the complaint has been made. In evidence the OP No.1 has tendered affidavit Annexure RX and documents Annexure R1 to Annexure R3.  OP No.2 did not turn up before this Forum, therefore, he was proceeded against exparte vide order dated 03.06.2015.

3.                          Learned counsel for the complainant has argued that as per FIR Annexure R2 as well as the Final Report Form Annexure C4 wherein it has been mentioned Raghvinder Singh sustained injuries in an accident and he had got lodged an FIR wherein it has been mentioned that the driver of the car was in drunken condition but the police during investigation and in final report Annexure C4 has not shown that the driver of the car was in drunken condition. It has been further argued that the driver of the scooter bearing registration No.HR03P/6169 in his statement has also not disclosed to the police that the driver of the car was under the intoxication, so insurance company wrongly and illegally repudiated the genuine claim of the complainant on the ground that the driver Vikram Singh s/o Jai Pal Singh (complainant) was under the influence of liquor or drugs and thus violated the condition No.1 of the terms and conditions of the policy which says that Any accidental loss or damage suffered whilst the insured or any person driving the vehicle with the knowledge  and consent of the insured is under the influence of liquor or drugs.  

4.                          On the other hand learned counsel for the OP No.1 has argued that there is delay of 9 days in intimating the accident to the insurance company, therefore, it cannot be held liable to indentify the loss. It has been further argued  though the complainant has mentioned in his complaint that he had spent Rs.50,000/- on repairing of the vehicle but he has not produced any evidence to support his plea. The insurance company had rightly repudiated the claim of the complainant on the ground mentioned in the repudiation letter Annexure C3, therefore there was no need to depute any surveyor to assess the loss. Hence, the complainant is not entitled for any relief.

5.                After hearing both the counsels and going through the material available on the case file, it is established that in the final report Annexure C4 and in the statement of driver of the scooter namely Ranjit Singh recorded under Section 161 Cr.P.C. by the police there is not mentioned that the driver of the car was under the influence of liquor or drug and the repudiation on this ground is not justified and sustainable in the eyes of law.  The case laws titled as United India Insurance Company Limited Vs. Sparkle Hospitals Pvt. Limited 2005 (2) CLT 642 (Chattishgarh State Commission) and  New India Assurance Co.Limited Vs. Maria Claude Borthwish and another  2005 (2) CLT  621 (Tamil Nadu State Commission)  relied upon by learned counsel for the OP No.1/insurance company are not applicable to the case in hand and the same are hereby distinguished. 

6.                Undisputedly, the accident in question had taken place on 02.06.2014 and the complainant had intimated the insurance company only on 11.06.2014 after a delay of 9 days but it does not mean that the delay in intimating the insurance company by the complainant was intentional. Perusal of the case file reveals that the police had registered an FIR No.112 dated 05.06.2014 under Sections 279/336/337/427 IPC against the driver of the car by showing the same as offending vehicle and this FIR was registered after the date of accident i.e. on 02.06.2014 and before the intimation given by the complainant to the insurance company on 11.06.2014. It is a matter of common knowledge that no one would straight away go to the insurance company for intimating about the damage of vehicle when any member of the insured is booked by the police in a criminal case by showing the insured vehicle as an offending vehicle. In the present case, there is every possibility that the complainant might have busy in proceedings of that case/investigations to be taken place by the police in an FIR lodged against his son, therefore, this Forum can easily turned town the plea of the insurance company that the delay in intimating to the insurance company was fatal. Moreover, the decision of insurance company to reject a claim of the complainant was not based on sound logic and valid grounds and the rejection of claims on purely procedural grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. The claim of the complainant is a genuine claim and it should not have been rejected on this ground. On this point reference can be taken from case law  titled as Shriram General Insurance Company Limited versus Rajesh Kumar, 2014(2) CLT 390, wherein reference of the circular dated September 20^th, 2011 issued by Insurance Regulatory and Development Authority (IRDA) has been given.  It has been specifically mentioned by IRDA that there may be a condition in the policy regarding delay in intimation but that does not mean that the insurer can take the shelter under that condition and repudiate the claim of the claim, which is otherwise proved to be genuine.  The operative part of the circular reads as under:-

“The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.

 

                    The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances.”

 

Hence, the delay in intimation to the insurance company on the part of the complainant is not fatal to the case of the complainant.

7.                Perusal of Annexure C9 and Annexure C10 reveals that the complainant had paid Rs.43400/- to the Metro Motors as repairing charges of the vehicle and he also spent Rs.2,000/- to G.M.Crane service for towing the vehicle to the service centre. It is strange that the vehicle of the insured got damaged in an accident but despite that the insurance company has not bothered to even depute some surveyor to assess the loss. The insurance company is not suppose to get only premium but it also liable to act fairly without taking the benefits of the weaknesses of the assured and it is also liable to indemnify all the responsibilities for which the premium has been received.  In the present case it is clear that the OP No.1/ insurance company has not acted fairly, therefore, it cannot shirk from its liability under indemnification qua the loss for which it had received premium. Hence, it would be appropriate if we direct the OP No.1/insurance company to pay the complainant to the tune of Rs.45400/- (Rs.26400/- + Rs.17000/- and Rs.2000/- as mentioned in Annexure C6, Annexure C9 and Annexure C10) alongwith interest @ 9 % per annum from the date of filing the compliant till its realization after deducting 10 % as salvage and deprecation. It is ordered accordingly. The present complaint is partly allowed against OP No.1-insurance company with costs which is assessed as Rs.3,000/-.  Complaint against OP No. 2 stands dismissed. Order be complied within one month from the date of receiving of the copy of this order. Copies of the order be sent to the parties concerned, free of costs, as per rules. File after due compliance be consigned to record room.

Announced on: 12.09.2017                      

                                                                                              Sd/-

                                                                                  (D.N. ARORA)

                                                                                       President

 

                            Sd/-

     (PUSHPENDER KUMAR)

                                                                                       Member

 

                              Sd/-

         (ANAMIKA GUPTA)

                                                                                       Member