NCDRC

NCDRC

FA/1414/2018

REGIONAL CLAIMS MANAGER, HDFC ERGO GENERAL INSURANCE CO. LTD. - Complainant(s)

Versus

SAS MACHINE TOOLS PVT. LTD. - Opp.Party(s)

M/S. SUMAN BAGGA & ASSOCIATES

20 Sep 2024

ORDER

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
 
FIRST APPEAL NO. 1414 OF 2018
(Against the Order dated 12/04/2018 in Complaint No. 38/2014 of the State Commission Telangana)
1. REGIONAL CLAIMS MANAGER, HDFC ERGO GENERAL INSURANCE CO. LTD.
HDFC ERGO GENERAL INSURANCE CO LTD.5 FLOOR TOWER 1, STELLAR IT PARK, C-25, SECTOR 62,
NOIDA 201301
...........Appellant(s)
Versus 
1. SAS MACHINE TOOLS PVT. LTD.
THROUGH MANAGING DIRECTOR, M.S. RAVI KUMAR, PLOT NO 119, H NO 11-3-267/119, MADHURANAGAR
SECUNDERABAD
...........Respondent(s)

BEFORE: 
 HON'BLE MR. SUBHASH CHANDRA,PRESIDING MEMBER
 HON'BLE DR. SADHNA SHANKER,MEMBER

FOR THE APPELLANT :
MS. SUMAN BAGGA, ADVOCATE
FOR THE RESPONDENT :
MR. DEEPAK K. SINGH, ADVOCATE WITH
MR. GOLI RAMAKRISHNA, ADVOCATE

Dated : 20 September 2024
ORDER

 

DR. SADHNA SHANKER, MEMBER

1.       This appeal has been filed under section 19 of the Consumer Protection Act, 1986 (hereinafter referred to as the ‘Act’) in challenge to the Order dated 12.04.2018 of the State Commission in complaint no. 38 of 2014 whereby the complaint was allowed.

2.       We have heard the learned counsel for the appellant (hereinafter referred to as the ‘insurance company’) and the learned counsel for the respondent (hereinafter referred to as the ‘complainant company’) and perused the record including inter alia the impugned Order dated 12.04.2018 and the memorandum of appeal.

3.       This Commission vide its order dated 13.11.2018 had dismissed the said appeal as barred by limitation. The insurance company filed civil appeal No. 2626-2627 of 2019 before Hon’ble Supreme Court. The Hon’ble Supreme Court, vide its Order dated 08.03.2019 condoned the delay of 68 days in filing the appeal before this Commission, subject to payment of Rs.25,000/- to the complainant and restored the appeal before this Commission for disposal on merits.

4.       The facts in brief are that the complainant company had taken Zero Depreciation Policy for its Volva Car S-60 D3, AP10BA1122 from the Insurance Company for the period from 21.04.2013 to 20.04.2014. During the subsistence of the insurance policy, on 26.10.2013, when Mr. M. S. Ravi Kumar was coming from Hyderabad after attending some official work and reached Pedda Vangara Village, Torrur, the front right wheel of the vehicle fell into a ditch covered with water due to heavy rainfall and broke down and that immediately a message was splashed on the car system, “service required to the engine”.   It is alleged that on contacting the service centre of the vehicle’s company, it lifted the car on 28.10.2013 in a flatbed body truck and on inspection the service centre assessed the damage with a tentative estimate of Rs. 12,61,437/- towards cost of the engine subject to escalation on other additions like Spares, Tax etc. Again, on 30.07.2014 it gave enhanced estimate of the engine cost at Rs. 19,13,532/-, which may likely to increase in future. The complainant submitted a claim with the insurance company. The insurance company repudiated the claim vide letter dated 27.11.2013 on the ground that the vehicle had dashed against a stone, resulting in damage and there was no sign of any external impact neither to the engine nor to the vehicle, which could cause breakage of engine parts and that the parts inside the engine were not covered by the policy.

5.       Being aggrieved, the complainant filed a complaint before the State Commission seeking compensation of Rs. 19,13,532/- and enhanced compensation, if any, in future with interest @24% p.a. from the date of estimation till realization, alongwith Rs. 5 lakh towards deficiency in service and unfair trade practice and Rs. 5 lakh towards hardship, mental agony etc.

6.       The State Commission, vide its order dated 12.04.2018 allowed the complaint and directed the insurance company to pay to the complainant a sum of Rs. 19,13,532/- towards policy coverage of the vehicle damage with interest @9% p.a. from the date of the claim i.e. 26.10.2013 till realization and compensation of Rs. 1,00,000/- with costs of Rs. 5,000/-.

7.       Being aggrieved by the order dated 12.04.2018, the complainant has filed the instant appeal before this Commission.

8.       The main question before us is as to whether the rejection of the survey report by the State Commission was correct or not.

9.       Before this Commission, learned counsel for the insurance company has vehemently argued that the surveyor after inspecting the vehicle had assessed the loss to the tune of Rs. 1,30,524/-. The surveyor had observed that the damage is only to the oil sump and no physical damage was observed to the engine and there was no sign of any external impact that would have damage the engine parts. It was further submitted that the vehicle was stopped only after the message displayed on the system that “service required to the engine”. It was submitted that this is made clear that the complainant drove the vehicle for considerable distance before it actually stopped, which resulted in damage to the internal parts of the engine. It was submitted that the claim had rightly been repudiated by the insurance company relying upon clause no. 4 of the insurance policy as the insured did not take all reasonable steps to safeguard the vehicle from loss or damage by driving it even after it fell into the ditch. It was argued that no reason was given by the State Commission to discard the report of the surveyor and it allowed the damages at the sum of Rs. 19,35,532/-, being the cost of repairs submitted by the service center.

10.     Learned counsel for the complainant reiterated that the State Commission has passed a reasoned order after considering all the facts and evidence.

11.     In the instant case, the final report of the surveyor dated 15.11.2013 states as under:-

“As per the information provided in the claim form and made enquiries with the available sources that on 26th Aug 2013 at about 10.00 AM, near Torrur, the insured vehicle RH front wheel fell on the pot hole and under body portion got damaged. Thus the insured vehicle sustained with the damages and the cause of accident corroborates with the damages to the insured vehicle under body portion oil sump only.

      REMARKS

During our inspection noticed that the damage to the oil sump, there is no sign of any external impact neither to the engine nor to the vehicle which can cause breakage of engine parts made of solid metal and housed inside well protected body of the engine. The damage to the parts inside the engine such as Cam Shaft/connecting rod/pistons is not payable because these are aggravated in nature, resulted due to driving the vehicle in same condition (engine seizure caused due to lack of lubricant inside the engine). Thus, claim for the damages to failure of engine internal components and parts are not found covered under the policy, which is damaged due to consequential loss, depreciation, wear and tear, mechanical or electrical breakdown are not covered under the terms and conditions of the policy.”

12.     It is clear from the reading of the above that the surveyor had accepted the cause of accident being the right front wheel falling into pot hole. He has then gone on to state that as per his inspection, he did not see any external damage and that the damages to the engine and the parts inside thereof occurred because the vehicle was driven in the same condition. It is seen that no evidence has been led to prove that once the accident had happened, the vehicle was driven thereafter. The insurance company has stated that it was only after the car was driven for sometime, the message referred to above flashed on the screen. It has been stated by the complainant as follows:

“the front right wheel of the vehicle fell into the ditch which was covered with water due to heavy rainfall. It is submitted that car broke down and a message was splashed on the car system that “service required to the engine”. It is submitted that immediately the complainant contacted the service centre of the vehicle Company”

 

      As per the version of the complainant, the message flashed immediately after the right wheel of the car went into the ditch.

13.     The entire case of the insurance company is that the damages didi not occur due to the accident but due to subsequent driving of the car after the accident. However, they have not been able to bring anything on record to substantiate or prove the same. The surveyor too has not said anything by way of evidence that the car was driven after the accident, due to which the damages occurred.  It is simply a bald statement without any basis. Once the fact of accident to the car is accepted by the surveyor, he cannot arbitrarily decide which damages to give when there is an estimate by an authorized service provider before him, unless he brings material to rebut the same.

14.     In view of the above, we are of the view that the insurance company has not been able to prove that the claim was hit by clause 4 of the insurance policy. It is seen that till the time, the surveyor gave his report, the estimate of repair provided by the authorized service station was Rs.12,61,437/-. This estimate is dated 25.12.2013 soon after the accident. The service centre revised its estimate on 30.07.2014 to an amount of Rs.19,13,532/- but no reason or ground for the upward revision of the estimate of repair has been given by the complainant. Hence, we are of the view that the original estimate of repair, which was also considered by the surveyor would be the correct quantum of damages to be given to the complainant keeping in view that the insurance policy is a zero depreciation policy.

15.     The Hon’ble Supreme Court in the case of DLF Homes Panchkula Pvt. Ltd. vs. D.S. Dhanda, in CA Nos. 4910-4941 of 2019 decided on 10.05.2019 has held that multiple compensations for singular deficiency is not justifiable. Therefore, the award of compensation of Rs.1,00,000/- for mental agony and harassment granted by the State Commission is found to be not tenable.

16.     In the result, the appeal is disposed of and the Order of the State Commission is modified to the extent that the insurance company shall pay a sum of Rs. 12,61,437/- along with interest at the rate of 6% per annum from the date of claim i.e. 26.10.2013 till realization. The insurance company is also directed to pay Rs. 5,000/- as litigation cost. The direction to pay compensation of Rs.1,00,000/- is set aside. The insurance company is directed to comply with this Order within a period of eight weeks, failing which, interest at the rate of 9% per annum shall be accrued. All pending I.A.s stand disposed of.

 
......................................
SUBHASH CHANDRA
PRESIDING MEMBER
 
 
.............................................
DR. SADHNA SHANKER
MEMBER

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