Haryana

Karnal

CC/4/2021

Surender Kumar - Complainant(s)

Versus

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

Sandeep Kadyan

16 Aug 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                          Complaint No. 4 of 2021

                                                          Date of instt.04.01.2021

                                                          Date of Decision 16.08.2023

 

Surender Kumar son of Shri Bhim Singh, resident of House no.131, Nand Vihar, behind Choudhary Hospital, Jattal Road, Panipat.

 

                                                 …….Complainant.

                                              Versus

 

1. Royal Sundram General Insurance Co.Ltd. situated at Karnal through its Branch Manager.

 

2. Royal Sundaram General Insurance Co. Ltd. Corporae Claims Departments, Vishranthi Melaram Towers, no.2/319, Rajiv Gandhi Salai Karapakkam, Chennai-600097, through its authorized person.

 

                                                                      …..Opposite Parties.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary…..Member

 

 Argued by: Shri Sandeep Kadiyan, counsel for complainant.

                    Shri A.K. Vohra, counsel for the OPs .

                   

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant had purchased a second hand vehicle Honda Accord, bearing registration no.HR-51AP-6491. The said vehicle was insured by the OP no.1, vide policy no.VPC1108394000100, valid from 09.04.2019 to 08.04.2020. On 31.12.2019, the real son of the complainant namely Partik Kumar was going to Shimla from Panipat, when the said Partik Kumar reached at Madhuban, Karnal at about 10.40 a.m., in the meantime unknown one person came front of the said vehicle and the said Partik Kumar saved the life of the said unknown person and hit back side of a truck, which was parked on the road. One canter came back side of the said car and hit the car of the complainant, due to this accident the car of the complainant was damaged from both sides. Thereafter, said Partik Kumar gave a telephonic call to the complainant and told about this fact to the complainant, then complainant gave information to OP no.1. As per direction of the OP no.1, complainant parked his damaged car in Honda Agency, Panipat. The said agency gave repair estimate of the damaged car to the complainant and the complainant submitted the said repair estimate and other relevant documents to OPs and then OPs gave assurance to the complainant that they will pass his genuine claim. Thereafter, complainant has lodged a DDR no.21 dated 03.01.2020 regarding the abovesaid accident. After some day the complainant contacted with OP no.1 and demanded his genuine claim from OPs but the OPs did not pay the same and lingered the matter on one pretext or the other and lastly declined the genuine claim of the complainant, vide letter dated 02.12.2020 on the ground that damages of the vehicle are not relevant to cause of accident narrated in the claim form. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability and concealment of true and material facts. On merits, it is pleaded that the claim of the complainant was rightly repudiated by the OPs on the ground that the damaged claimed by the complainant for the insured vehicle is not relevant to the cause of accident narrated in the claim form and hence not covered in the policy as per the terms and conditions. The policy of motor insurance is for covering accidental damage or loss of the insured vehicle by theft and not for any intentional damages caused to the insured vehicle. It is further pleaded that complainant had taken a Private Car Package Policy in respect of his Honda Accord 2.4MT bearing registration no.HR-51-AP-6491 for the period of insurance from 09.04.2019 to 08.04.2020, vide policy no.VPC1108394000100 subject to the terms and conditions. The complainant lodged a claim in respect of the above subject insured vehicle for alleged accidental damages on 31.12.2019. On receipt of the claim intimation, the OPs immediately appointed licensed surveyor Mr. Sachin Kataria to inspect the vehicle and assess the loss and damage. Without prejudice as to the admissibility, the surveyor has assessed the loss subject to the terms and conditions of the policy. On the basis of the survey report, an investigation report was required to throw light on the actual incident of the cause of accident, hence an investigation was initiated by M/s Karnal Associate, the Investigator submitted the report concluding the facts of the incident was manipulated and the insured vehicle was voluntarily damaged to extract more money by misusing the policy. The complainant had crookedly misguided the entire incident of the accident and intended to exploit public money, which is involved in the insurance sector. Finding during the investigation are crucial in assimilating the actual cause of accident and the wrongful intention of the complainant, some of the frivolous aspects of the insured are as follows:

1. The statements of the insured (owner) and he inured son (Driver) convey a contradiction of the Registration Number of the stationed Truck in which the car got collided, earlier the registration number provided by them was HR-45A-6943 which belongs to an Auto Rickshaw and later they communicated that the registration no.HR-45A-6939.
2. It is further created room for contradiction when the statement was recorded from the owner of the Truck, where he stated that the Truck was parked two acres ahead to Pacca Pull (Bridge), in reality the spot mentioned by the insured and the spot mentioned by the Truck Owner are 1.5 kms away, which amounts to misrepresentation of facts.
3. Moreover, the insured in claim form mentioned that Bike came in front of the Car, but in the statements the insured and his son mentioned that a person came from the right side of the road in front of the car.
4. Due to all these facts and contradictions, the investigation engaged a specialist Mr. R.K. Koshal, Retd. Deputy Director FSL has conducted inspection of the said car, in his report he opined clearly that the damages of the car are found to be intentionally damaged which did not quantify the incident narrated in the claim form.
5. The market value of the car is about 3.5 lakhs and the insured and insured son in their statement said that the car was purchased for Rs.8,62,000/- one year ago. It is to be noted that the insured intentionally declared the IDV for Rs.11,00,000/- which creates an apprehension that the entire incident of the accident is clearly a pre-planned claim for misusing the policy and the public money involved.

It was observed by the OPs after consultation with the survey report and investigation report that the damages to the insured vehicle are not tallying with the cause of accident mentioned in the claim form and the damages seems intentional damaged which amounts to consequential loss. As per policy section 1, the company shall not be liable to make any payment in respect of consequential loss, depreciation, wear and tear, mechanical or electrical break down, failures or breakages. In view of the above conclusion, the OPs rightly repudiated the claim of the complainant, vide letter dated 02.12.2020. There is no deficiency in service and unfair trade practice on the part of the OPs. 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 complaint Ex.C1, copy of DD no.21 dated 03.01.2020 Ex.C2, copy of insurance policy Ex.C3, copy of  Bagga crane service bill dated 31.12.2019 Ex.C4, copy of RC Ex.C5, copy of driving licence Ex.C6 and Ex.C7, copy of aadhar card Ex.C8, copy of cheque/DD/credit card receipt C9, copy of bill/tax invoice of Lally Motors dated 01.07.2020 Ex.C10, copy of estimate of Lally Motors Ex.C11 and closed the evidence on 22.02.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Purshotam Singhal Ex.RW1/A, affidavit of Balbir Singh Virk Ex.RW2/A, affidavit of Sachin Kataria Ex.RW3/A, affidavit of Dr. Rajesh Kumar Kaushal Ex.RW4/A, copy of report of Karnal Associates Ex.R1, copy of survey report of Sachin Kataria Ex.R2, copy of report of R.K. Kaushal Ex.R3, copy of repudiation letter Ex.R4, copy of insurance policy Ex.R5, copy of claim form Ex.R6 and closed the evidence on 07.06.2023 by suffering separate statement.

 6.            We have heard the learned counsel for 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 complainant  purchased a Honda Accord car and got insured the same with the OPs. On 31.12.2019, the said vehicle met with an accident and was badly damaged. The intimation in this regard was sent to OPs. Complainant got lodged a DDR with regard to accident. Complainant had shifted his damaged car in Honda Agency, Panipat. The said agency prepared the estimate of Rs.12,87,326/- of the damaged car and same was handed over to the surveyor of the OPs. The car in question became totally damaged. Complainant approached the OPs and requested to pass his genuine claim but OPs did not pay the same and lastly declined the claim of the complainant, vide letter dated 02.12.2020 on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that damages to the insured vehicle were not matched with nature and cause of accident. In the previous policy the IDV was Rs.6,21,000/- but in the current policy the IDV is Rs.11,00,000/- and market value of the vehicle is not more than Rs.3,50,000/-. As per survey report and investigation report, complainant is not entitled for any claim and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, complainant had purchased a second hand vehicle in question in previous year from the date of alleged accident.  

11.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.R4 dated 02.12.2020 on the ground, which is reproduced as under:-

“With reference to the above mentioned claim, we observed from the claim paper that the damages to the vehicle are not relevant to the cause of accident narrated in the claim form.

Hence, we regret to inform out inability to entertain the claim”.

 

12.           On receipt of intimation of claim intimation, OPs appointed surveyor Mr. Sachin Kataria. Said surveyor has submitted his report Ex.R2 on 25.09.2020. As per survey report, damages to insured vehicle are not tally with cause of accident mentioned with the claim form. Damages seems intentionally in nature and higher IDV taken in the current policy Rs.11,00,000/- whereas previous year policy IDV was Rs.6,21,000/-. The vehicle in question was met with an accident on 31.12.2019 and said report has been prepared on 25.09.2020 with the gap of near about nine months from the date of accident. But surveyor in his report has not mentioned the cause for not tallying the damages with cause of accident in his report.

13.           Shri Purshotam Singla authorized signatory and legal officer of the OPs has tendered his affidavit Ex.RW1/A and mentioned in para no.6 of his affidavit that on the basis of survey report an investigation report was required to throw light of the actual incident of the cause of accident, hence the OPs appointed an investigator named Karnal Associates, to investigate genuinity of the claim.

 14.          OPs assigned the investigation to Shri Balbir Singh Virk, authorized representative of Karnal Associates, who after conducting the investigation submitted detailed report Ex.R1 on 27.08.2020 after the gap of near about eight months from the date of accident.  The matter was also got investigated by Dr.R.K. Kaushal Ballistis Expert on the request of Balbir Singh Investigator and he submitted his report on 04.08.2020 to him. On perusal of the investigation report Ex.R1, it reveals that investigator has started his work on 05.02.2020 and submitted his report on 27.08.2020. But as per the version of the OPs, on receipt of survey report Ex.R2 dated 25.09.2020, the matter was got investigated by the Karnal Associates but as per report of Karnal Associates, the investigation was started on 05.02.2020 and report was submitted on 27.08.2020 i.e. prior to submission of the survey report Ex.R2 dated 25.09.2020. Hence, the plea taken by the OPs with regard to hand over the investigation to Karnal Associates, on receipt survey report became doubtful.

15.           In the previous policy, the OPs alleged that the IDV of the vehicle was Rs.6,21,000/- and market value is Rs.3,50,000/- but to prove its version, neither the OPs have placed on file copy of previous insurance policy nor proof of market value of the vehicle in question as alleged by the OPs. Moreover, statement of the complainant (insured) and his son Partik were recorded by the investigator of the OPs and they categorically stated that they have purchased the car one year ago from Delhi for Rs.8,62,000/-. During the course of arguments, learned counsel for the complainant submits that after purchasing the said car, complainant spent huge amount on the car, so that it appears to be new one. When the complainant had purchased the car for Rs.8,62,000/- and spent huge amount on its. Then how did OPs assess the market value as Rs.3,50,000/-. Hence, it appears that the plea taken by the OPs is only on the basis of presumption and assumption.

16.           As per insurance policy Ex.C3/Ex.R5, the IDV of the vehicle in question is Rs.11,00,000/-. The Honda Agency, Panipat prepared the estimate of Rs.12,87,326/- of the damaged car, which is more than the IDV value and falls under  the category of total loss. Hence complainant is entitled for the IDV Value. OPs have alleged that the complainant intentionally and deliberately got insured his vehicle with the higher IDV just to take the claim on higher side. Generally, the vehicle got insured by the insurance company on the inspection of vehicle and considering the previous policy. It is not possible that the OPs had insured the vehicle without inspection of the vehicle and as well as considering the previous policy. Moreover, it was the OPs, who had insured the vehicle in higher IDV and for that complainant cannot be blamed wrong act, if any, committed by the agent/official/officer of the OPs. Furthermore, vehicle in question was insured on 09.04.2019 and the said accident took place on 31.12.2019 for the gap of more than eight months, survey report Ex.R2 received on 25.09.2020 and the claim of the complainant was repudiated on 02.12.2020, there is unexplained delay to decide the claim of the complainant. Hence the plea taken by the OPs has no force.

17.           On 31.12.2019, complainant moved an application Ex.C1 before the SHO, Police Station, Madhuban and on the basis of said application DDR Ex.C2 was recorded in the said Police Station. Matter was investigated by Head Constable Krishan Kumar, on enquiry, he came to the conclusion that accident took place on 31.12.2019 and driver of the vehicle also received injuries in the said accident. The facts with regard to injuries proved from the medical record of Partik mentioned in investigation report Ex.R1 by the Karnal Associates.

18.           If for the sake of gravity, if it is presumed that complainant has violated the terms and conditions of the insurance policy, in that eventuality, the claim of the complainant cannot be repudiated in toto.  In this regard, we can relied upon the case laws cited in Revision Petition no.1870 of 2015(NC) decided on 14.08.2018 titled as New India Assurance Co. Ltd. Versus Thirath Singh Brar and authority of our own Hon’ble State Commission in First Appeal no.717 of 2016 decided on 6.4.2017 titled as United India Insurance Company Limited and others Versus Anshul Bansal.  In both judgments it was held that in case of any breach of warranty/condition of the policy the insurer is liable to pay 75% of admissible claim on non-standard basis.

19.           Further,  Hon’ble Punjab and Haryana High Court in case titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, has held as under:-

“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy”.

20.           Keeping in view the ratio of the law laid down in the abovesaid judgments and the facts and circumstances of the present complaint, we are of the considered view that the act of the OPs amounts to deficiency in service and unfair trade practice while repudiating the claim of the complainant in toto. Hence, complainant is entitled to get 75% only of the admissible claim on non-standard basis.

21.           As per insurance policy Ex.C3/Ex.R5, the IDV of the vehicle in question is Rs.11,00,000/-. Hence the complainant is entitled for Rs.8,25,000/- i.e. 75% of the insured amount alongwith interest, compensation and litigation expenses etc.

22.           In view of the above discussion, we partly allow the present complaint and direct the OPs to pay Rs.8,25,000/- (Rs. eight lakhs twenty five thousand only) to the complainant alongwith interest @ 9% per annum from the date of repudiation of the claim till its realization. We further direct the OPs to pay Rs.25,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.11,000/- for the litigation expenses. This order shall be complied within 45 days from the receipt of copy of this order. The complainant is also directed to handover the salvage to the OPs and also completed  all the formalities with regard to cancellation of the RC of the vehicle in question. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:16.08.2023     

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

                     Member                        Member