Kerala

Idukki

CC/111/2020

Anas manickal Ismail - Complainant(s)

Versus

Royal sundaram general Insurance - Opp.Party(s)

Adv: R Sajeev

18 May 2023

ORDER

DATE OF FILING : 07/09/2020

IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, IDUKKI

Dated this the 18^th day of May 2023

Present :

              SRI.C.SURESHKUMAR                                               PRESIDENT

              SMT.ASAMOL P.                                                          MEMBER

              SRI.AMPADY K.S.                                                        MEMBER

CC NO.111/2020

Between

Complainant                            :   Anas Manickal Ismail,

                                                    15/142E, Manickal House,

                                                     Kummankallu, Thodupuzha East,

                                                     Idukki – 685 585

                                                          (By Adv.R.Sajeev)

                                                           And

Opposite Party                   :  1 . The Head-MOD Claims,

                                                   Royal Sundaram General Insurance

                                                   Company Ltd., Corporate Office,  

                                                   Vishranti Melaram Towers,

                                                    Rajiv Gandhi Salai (OMR) Karpakkam,

                                                    Chennai – 600 097.

                                               2 . The Claims Co-Ordinator,

                                                     Royal Sundaram General Insurance Co.Ltd.,

                                                     Amirtha Towers, Near Maharajas Ground,

                                                     M.G.Road, Ernakulam, Cochin – 682 011.

                                                                    (Both by Adv.K.Pradeepkumar)                                                                                                                  

O R D E R

SMT.ASAMOL P., MEMBER

 

Facts of complaint are discussed hereunder:-

 

1 . Complainant had purchased an insurance policy No.VPN0143459000100 issued by opposite party Royal Sundaram General Insurance Co.Ltd., for his Maruti Baleno Car bearing Reg.No.Kl 38G 0614 for a period of one year from 14/12/2019 to 13/12/2020.  The claim number of the policy is PV00610462.

                                                                                                 (Cont.....2)

-2-

2 . The vehicle met with an accident on 15/01/2020 at Chadayamangalam and was informed to the Insurance Company and the loss occurred to the vehicle was assessed by the Insurance Surveyor at Popular Automobiles, Kottarakkara and permission was given to effect the repairs.  On completion of the repairs complainant had paid an amount of Rs.45698/- as cost of parts and labour.  When complainant enquired about the fate of the claim on 6^th February 2020, an e-mail was received from the insurance company stating that the petitioner had made a claim in the previous policy which fact was not mentioned while taking the current policy and hence the claim stands repudiated.  Complainant also received a letter from the corporate office, Chennai dated 11/02/2020, received after on week stating the same facts.

3 . Complainant had written several letters to the insurance company seeking clarifications as to the repudiation.  All the mails dated 06/02/2020 and also letters of various dates are attached with this petition.  The insurance company had never given the complaint a reply.  Complainant had also asked for a copy of the insurance survey report to know about the amount of loss assessed was also not attended to.

4 . While applying for a policy online, complainant had never thought that it will lead to unnecessary expenditures embodied in the new policy as “additional covers”.  There are a number of additional covers which the complainant haven’t heard of and are included in the policy.  On a scrutiny of the policy issued by the insurance company, it can be seen that they have collected the following premiums without his knowledge or intention.  They are the following under the heads “additional coverage for package policies”.

No.17 depreciation Waiver Clause – Rs.2804.00

No.18 Wind Shield Glass Clause       Rs.280.00

                                                                                                 (Cont.....3)

-3-

No.20 Full Invoice Price Invoice             Rs.1308.80

No.23 Engine Protector Clause                Rs.467.20

No.24 NCB Protector Clause                   Rs.1401.60

No.25 Key Replacement Cover               Rs.112.00

No.26 Tyre Cover Clause                         Rs.561.00

Total                                                          Rs.6934.60

The above add on covers are not usually taken for a vehicle of 2017 model and only ordinary basic package policies are issued by  General Insurance Companies.  Moreover the insurance company have not given the complainant any discount on the basic premium of Rs.8388/- which is allowed up to 70% by other General Insurers.  So for a policy which is available in the market for less than Rs.10,000/-. The complainant had paid Rs.20321/-.

As the complainant did not know the selection of risks, which was kept as default by the online system by the insurance company, was included in the policy as add on covers.  It is interesting to note that the opposite party has collected a premium of Rs.1401/60 as No Claim Bonus Protection Clause, when a claim itself is repudiated on a mistake of NCB declaration that amounts to only Rs.1687/60.  So  after collection of a premium to protect NCB, when a claim is occurred, the insured is denied the payment of claim, only for an inadvertent mistake occurred while taking the policy online.

On a later date when the petitioner called the insurance company to know the position of the claim, they have asked the complainant to remit the mistaken NCB amount of Rs.1687/60 as mentioned in their letter dated 11/02/2020 to set right the policy and under the impression that they will

                                                                                                 (Cont.....4)

-4-

honour the claim, the complainant had remitted on 13/05/2020 an amount of Rs.2008/- including GST.  Still they are adamant on the matter and have not considered his grievance.

In such circumstances of committing of mistake of a bona fide nature, it is the practice of General insurers to collect the shortage in premium by deducting from the claim amount and paying the balance amount, thus honouring the claim.  Here the complainant had remitted the shortage in premium and satisfied their demand.  The petitioner have attached here with all the copies of letters sent to the insurance company in this regard, which they have not cared to attend or reply. 

By not replying to the complainant’s grievance on repudiation and by not providing him a copy of the loss assessment Survey Report, and also repudiating the claim unreasonably, after collecting the shortage of premium, they have committed deficiency of service for which as a consumer the complainant is resorting for appropriate remedies. Hence he has prayed the following reliefs.

Upon notice served from this Commission, opposite parties have appeared through their counsel.  No written version is filed.  Therefore, this case was posted for complainant’s evidence.  Proof affidavit was filed.  Ext.P1 to P8 series were marked.  Complainant was examined as PW1.  Opposite parties have not adduced any evidence.  Heard the counsels for both sides, therefore it was taken for orders.  Now, the points which arise for consideration are :-

1 . Whether there is any deficiency in service on the part of opposite parties?

2 . What reliefs the complainant is entitled to?

                                                                                                 (Cont.....5)

-5-

Points are considered together

 

We have perused the proof affidavit and evidence on record.  Complainant alleges that claim amount with respect to his Baleno Vehicle was repudiated by opposite parties due to the reason that wrong NCB declaration.  The insurance policy was taken for a period of one year from 14/12/2019 to 13/12/2020.  The certificate of insurance and policy schedule was issued by opposite parties and it was marked as Ext.P6.  opposite parties have not challenged this Ext.P6 document also.  But, opposite parties have repudiated the claim of complainant during this policy period.  As per Ext.P2 ie, printout of g-mail communication on 06/02/2020, it is seen that opposite parties have repudiated the claim due to wrong NCB declaration and complainant has submitted that he didn’t declare for the NCB deduction and the system automatically deducted it, therefore he is not responsible for it.  Complainant has taken this policy from online.  Thereafter, on 11/02/2020, opposite parties  has issued a letter regarding the repudiation of claim and it was marked as Ext.P3.  as per Ext.P3 document, opposite parties have requested complainant to refund back the NCB amount availed in this current policy to set right the policy for the remaining policy period.  As per Ext.P7 ie, endorsement receipt dated 13/05/2020, opposite parties have collected Rs.2,008/- as additional premium from complainant.  Also, it is stated in this Ext.P7 document that the insured is eligible for 0% NCB with effect from 14/12/2019 and all other terms, conditions and warranties remain unaltered.  Complainant has remitted this amount of Rs.2008/- under the request of opposite parties for setting right the policy.  After collecting the shortage of premium through policy was set right, they didn’t pay the claim amount to complainant.  Under Ext.P7, it is clearly mentioned that the policy conditions, terms and warranties remain unaltered with effect from 14/12/2019.  Thereafter we are of the opinion that opposite parties are liable to settle the claim amount regarding this policy period from 14/12/2019 to 13/12/2020.

                                                                                                 (Cont.....6)

-6- 

Opposite parties have neither challenged these documents nor adduced any evidence against it.   Complainant has submitted through his proof affidavit that he had paid an amount of Rs.45,698/- as repairing charges , cost of parts and labour cost to popular automobiles, Kottarakkara.  The loss occurred to this vehicle was assessed by insurance surveyor and permission was given to effect the repairs.  This is not challenged by opposite parties.  No evidence adduced against these statements.  Thus, opposite parties have not confronted about the claim amount which demanded by complainant.

          Hence, unreasonable non settlement of the claim amount during this valid policy period is deficiency in service on the part of opposite parties.  We are of the considered view that complainant is entitled to get reliefs from opposite parties.  Accordingly, complaint is allowed in part as hereunder. 

1 . Opposite parties are directed to pay Rs.45,698/- along with 12% interest from 13/05/2020 ie, the policy set right date to complainant.

2 . Also, opposite parties are directed to pay Rs.15,000/- as compensation and Rs.10,000/- as litigation cost to complainant within 45 days from the date of receipt of this order.  The amounts, except litigation cost shall carry 12% interest per annum from the date of order till its realization.

Extra copies to be taken back by parties without delay.

 Pronounced by this Commission on this the  18^th  day of May, 2023.

                                                                                           Sd/-                                                                                            

                                                                                SMT.ASAMOL P., MEMBER

                                                                                            Sd/-           

                                                                        SRI.C.SURESHKUMAR, PRESIDENT                                                                                                

                                                                                                    Sd/-

                                                                                SRI.AMPADY K.S., MEMBER

 

                                                                                                 (Cont.....7)

-7-

 

APPENDIX

Depositions :

On the side of the Complainant :

PW1 - Anas Manickal Ismail

On the side of the Opposite Party :

Nil

Exhibits :

On the side of the Complainant :

Ext.P1  -   Letter from the travel market -Claim Register No.PV 00 610 462 Policy

                  No.VPN 0143459000100

Ext.P2  -   Gmail letter – PV 00610462 Claim Status dated 06/02/2020

Ext.P3  -  Letter from royal Sundaram General Insurance Co. To the complainant

                 dated 11/02/2020.

Ext.P4  -  Letter from complainant to M/s Royal Sundaram General Insurance Co.Ltd

                dated 23/03/

Ext.P5   -  Copy of Acknowledgement

Ext.P6   -  Certificate of Insurance & Policy schedule

Ext.P7   - Motor Insurance endorsement

Ext.P8 (series)- Cash Receipt Voucher  and Job Card Retail-

                          Tax Invoice dated 25/01/2020

On the side of the Opposite Party :

Nil

 

                                                                                           Forwarded by Order  

 

 

                                                                     ASSISTANT REGISTRAR