Haryana

Karnal

CC/375/2021

Lakhwinder Pal Singh - Complainant(s)

Versus

Royal Sundaram General Insurance Company Limited - Opp.Party(s)

Balwan Singh Dhaunchak

21 Mar 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No. 375 of 2021

                                                        Date of instt.04.08.2021

                                                        Date of Decision:21.03.2023

 

Lakhwinder Pal Singh son of Shri Buta Ram, aged about 33 years, resident of House no.1219, Ram Nagar, Karnal. Aadhar no.4793 0924 3728. Mobile no.7082503609.

 

                                               …….Complainant.

                                              Versus

 

Royal Sundaram General Insurance Company Ltd. Registered office 21 Patullos Road, Chennai-600002, Tamilnadu through its CMD.

 

                                                                   …..Opposite Party.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary….Member

       

 Argued by: Sh. Balwan Sigh Dhunchak, counsel for complainant.

                    Shri Ashok Vohra, counsel for the opposite party.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that initially insurance policy no.VPB0050789000100, valid from 20.10.2018 to 19.10.2019 was issued in favour of Surinder Pal Singh and lateron vide endorsement no.001 dated 19.11.2018 the policy was transferred in favour of Shri Lakhwinder Pal Singh against the vehicle i.e. Wolks Wagen Polo 1.5 Highline, Model 2014, bearing registration no.HR-20AF-7076. The premium paid for insurance was Rs.29712/- for a sum insured of Rs.5,44,336/-.  On 07.07.2019, while the complainant was going  from Karnal to Indri, suddenly a truck brushed off the vehicle from the rear side resulting into misbalancing of the vehicle due to which the front side of car hit into a tree on the road side. The insurance company was intimated about the loss, who deputed a surveyor for assessment of loss, surveyor was provided all the necessary documents and details and assessed the loss for Rs.4,47,052/-. Upon receipt of survey report the company sought information from the complainant as to correct cause of loss and after scrutiny of claim documents observed that the damages to the vehicle were not relevant to the cause of accident as narrated in the claim form and the claim was repudiated, vide letter dated 20.11.2019. On repudiation of claim by the insurance company, complaint was lodged with the office of the Insurance Ombudsman Chandigarh on 10.01.2020, which was decided on 11.09.2020 under observation that during the course of personal hearing the insurance company could not produce evidences that complete claim is fraudulent accordingly 75% of admissible claim was awarded in favour of complainant to be paid by OP. So, the amount of Rs.3,42,502/- has been paid by the OP but the amount so paid is short by Rs.1,00,834/- (sum insured Rs.5,44,336/- excess clause 1000/-, wreck value 1,00,000/-). Since the IDV of the vehicle is Rs.5,44,336/- accordingly the complaint is being lodged for Rs.1,00,834/- being the short paid amount towards IDV. Complainant requested the OP so many times to settle the claim but OP did not pay any heed to the request of complainant and lingered the matter on one pretext or the other. In this way there is deficiency in service on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version, raising preliminary objections with regard to maintainability; locus standi; cause of action and concealment of true and material facts. On merits, it is pleaded that the claim of the complainant was duly processed, considered on merits and it was repudiated, vide speaking letter dated 20.11.2019 on the ground that the damages to the vehicle are not relevant to the cause of accident narrated in the claim form and also there has been a manipulation of damages parts to the vehicle for which the OP is not liable for the same as per the policy terms and conditions. Feeling aggrieved, the complainant approached the Insurance Ombudsman at Chandigarh, where the complainant produced the audio which was recorded by him illegally during a discussion regarding the IDV of the car as discussed between the complainant and officer of the OP. The Insurance Ombudsman at Chandigarh listened to the audio provided by the complainant where they discussed about 4,00,000/- claim, so the Insurance Ombudsman by considering the said audio awarded 75% of admissible claim, vide order dated 11.09.2020. It is further pleaded that after the awarded by the office of Insurance Ombudsman at Chandigarh, the OP has paid a sum of Rs.3,42,502/- being full and final settlement and has intimated the same to the office of the Insurance Ombudsman at Chandigarh, vide its mail dated 17.02.2021. It is further pleaded that complainant is not entitled for the remaining amount of Rs.1,00,834/-. There is no deficiency in service on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of letter dated 20.11.2019 Ex.C2, copy of letter dated 02.01.2020 Ex.C3, copy of letter dated 07.01.2020 Ex.C4, copy of complaint to IRDAI dated 10.12.2019 Ex.C5, copy of complaint dated 10.01.2020 to Insurance Ombudsman Ex.C6, copy of sale proceeds of wreck of car and amount received Rs.1,00,000/- Ex.C7, copy of statement of account showing receipt of claim amount from OP Ex.C8, copy of Aadhar card of complainant Ex.C9, copy of RC of insured car Ex.C10 and closed the evidence on 20.07.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Purshottam Singhal Ex.OW1/A, copy of policy schedule Ex.O1, copy of letters dated 20.11.2019, 02.01.2020, 07.01.2020, 22.01.2020 Ex.O2 to Ex.O5, copy of award of Ombudsman Ex.O6, copy of proceeding before Ombudsman Ex.O7, copy of RC Ex.O8 and closed the evidence on 21.11.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that vehicle of the complainant was got insured with the OP. On 07.07.2019, the vehicle of the complainant met with an accident. The insurance company was intimated about the loss, who deputed a surveyor for assessment of loss, surveyor was provided all the necessary documents and details and assessed the loss for Rs.4,47,052/-. The claim of complainant was repudiated, vide letter dated 20.11.2019. On repudiation, complaint was lodged with the Insurance Ombudsman Chandigarh on 10.01.2020, which was decided on 11.09.2020. The Insurance Ombudsman awarded 75% of admissible claim in favour of complainant. An amount of Rs.3,42,502/- has been paid by the OP but the said amount is short by Rs.1,00,834/- and the complaint is being lodged for Rs.1,00,834/- being the short paid amount towards IDV and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that the claim of the complainant was repudiated, vide letter dated 20.11.2019. Feeling aggrieved of the repudiation letter, complainant approached the Insurance Ombudsman at Chandigarh, the Insurance Ombudsman considering the facts and circumstances of the case and evidence produced by the complainant, awarded 75% of admissible claim, vide order dated 11.09.2020. The OP has paid a sum of Rs.3,42,502/- being full and final settlement. Complainant is not entitled for the remaining amount of Rs.1,00,834/-.

9.             Complainant had already challenged the repudiation letter before the Insurance Ombudsman, Chandigarh. The Insurance Ombudsman passed an award, which as under:-

“Taking into account the facts and circumstances of the case and the submission made by both the parties during the course of personal hearing, 75% of admissible claim is hereby awarded to be paid by the insurer to the insured, towards full and final settlement of claim.

Hence, the complaint is treated as closed”.

10.           Aggrieved from the order of Insurance Ombudsman, complainant filed the present complaint.

11.           As per survey report, mechanical parts have been fabricated. Insured vehicle was having frontal and rear damages, whereas the hood and the member had pressed from the front side. While the external damages are to be left side bonnet portion the mechanical parts like injector, fuel rail, fuel pump alternator, manifold intake fitted on the right hand side are found to be damaged. Impact of loss on front portion could not have travelled so far as the inside of the engine compartment, which could damage the engine parts.

12.           The surveyor of the OP had assessed the loss of Rs.4,47,052/- in total. As per his report, many damages are not correlated with the version of the accident. On considering the survey report, the Insurance Ombudsman had rightly awarded 75% of the admissible claim and same has been accepted by the complainant. Hence, in view of the above, the present complaint is devoid of any merits and same deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:21.03.2023                                                                       

                                                        President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

       

                (Vineet Kaushik)        (Dr. Rekha Chaudhary)      

                      Member                        Member