Haryana

Karnal

CC/11/2022

Narender Kumar - Complainant(s)

Versus

SBI General Insurance Company Limited - Opp.Party(s)

M.R. Sangwan

15 Feb 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                      Complaint No. 11 of 2022

                                                      Date of instt.10.01.2022

                                                      Date of Decision:15.02.2024

 

Narender Kumar son of Shri Dharampal, resident of H.No.409, VPO Lallupura, Tehsil Gharaunda, District Karnal.

                                               …….Complainant.

                                              Versus

 

1. SBI General Insurance Company Limited, through its Branch Manager, SCO 3988-389 Ist Floor, Karan Commercial Complex, Old Mughal Canal Road, Karnal, 132001.
2. SBI General Insurance Company Limited, registered and corporate office through its Senior Manager Natraj 101, 201 and 301, Junction of Wester Express Highway and Andheri Kurla Road, Andheri (East) Mumbai 400069.

 

…..Opposite Parties.

       

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

 

Before   Shri Jaswant Singh……President.

              Shri Vineet Kaushik…….Member

              Dr. Suman Singh……Member

          

Argued by:  Shri Pardeep Nehra, counsel for complainant.

                    Shri A.K.Vohra, counsel for 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 is registered owner of Maruti Vitara Breza Car bearing No.HR91A-2189 which was got insured by OPs vide policy no.P01100321316609, commencing from 10.03.2021 to 09.03.2022, for IDV of Rs.6,50,000/- after receiving the insurance amount of Rs.16,350/-. On 19.03.2021, when the complainant was going to Karnal from his village and in the way, the said vehicle was met with an accident as the wild animal came suddenly in front of the car. Intimation with regard to the accident was given to OPs and a surveyor was appointed. The complainant has submitted all the requisite documents with the OPs. Despite repeated requests, the claim of the complainant was not settled and finally on 26.04.2021, the claim of the complainant was repudiated on false and frivolous grounds. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence this complaint.

2.             On notice, OPs appeared and filed its written version, raising preliminary objections with regard to abuse of process of law, maintainability; cause of action and concealment of true and material facts, etc. On merits, it is pleaded that the complainant has misrepresented the material facts related to the insured vehicle at the time of pre-inspection and the material facts of the loss only to gain advantage under the insurance policy. On scrutiny of survey report and claim documents, the OPs observed the following anomalies:-

i)      Pre inspection conducted at the same location, where claim was reported at garage/S JL motors, Karnal.

ii)     Sticker of Ganesh Ji on hood present in final survey whereas same was missing at the time of pre-inspection.

iii)    Red ribbon was not present on hood hinges and lower grills in pre-inspection whereas it is found in vehicle produced for final survey.

iv)    Spanner marks were found on the hood hinges in the vehicle produced for final survey.

v)     Resonator tube/pipe found open condition in vehicle produced for pre-inspection.

vi)    White pencil marks on left head lamp housing was missing in pre-inspection whereas it is found in vehicle produced for final survey.

vii)   The cross member is also found new one duly painted alongwith head lamps and front bumber when the vehicle produced for pre-inspection.  

3.             The complainant has not got lodged FIR/DDR in the concerned police station regarding accident in question occurred due to wild animal came suddenly in front of the car. This had led to the violation of declaration in proposal form submitted for issuance of policy. Thus, the claim of the complainant was repudiated vide letter dated 26.04.2021. 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.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of repudiation letter Ex.C2, copy of RC Ex.C3, copy of driving licence Ex.C4, copy of Aadhar Card Ex.C5, copy of claim form Ex.C6 and copy of previous year policy Ex.C7 and closed the evidence on 29.08.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OPs have tendered into evidence affidavit of Jitender Dhabhai Ex.RW1/A, affidavit of Shubham Arora, Investigator Ex.RW2/A and copy of claim form Ex.OP1, copy of policy Ex.OP2, copy of Investigator report Ex.OP3 and copy of repudiation letter Ex.OP4 and closed the evidence on 24.07.2023 by suffering separate statement.

7.             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.

8.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that complainant is registered owner of vehicle bearing No.HR91A-2189. During subsistence of insurance policy, the said car was met with an accident. Intimation in this regard has been given to OPs and a surveyor was appointed and the complainant has submitted all the requisite documents with the OPs. Despite repeated requests, the claim of the complainant was not settled and finally on 26.04.2021, the claim of the complainant was repudiated without any reason and rhyme and lastly prayed for dismissal of complaint.

9.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that complainant has misrepresented the material facts related to the insured vehicle at the time of pre-inspection and the material facts of the loss only to gain advantage under the insurance policy. On scrutiny of survey report and claim documents, the OPs observed several anomalies.  The complainant has not got lodged FIR/DDR in the concerned police station regarding accident in question, thus, the complainant has violated the terms and conditions of the policy. The claim of the complainant has been rightly repudiated and lastly prayed for dismissal of complaint.

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

11.           Admittedly, the vehicle in question met with an accident during the subsistence of the insurance policy. It is also admitted that the IDV of the car in question is Rs.6,50,000/-.

12.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.C2/OP4, the relevant portion of the said letter is reproduced as under:-

“On scrutiny of the survey report and claim documents submitted by you, we observed following anomalies:-

i)      Pre inspection conducted at the same location, where claim was reported at garage/S JL motors, Karnal.

ii)     Sticker of Ganesh Ji on hood present in final survey whereas same was missing at the time of pre-inspection.

iii)    Red ribbon was not present on hood hinges and lower grills in pre-inspection whereas it is found in vehicle produced for final survey.

iv)    Spanner marks were found on the hood hinges in the vehicle produced for final survey.

v)     Resonator tube/pipe found open condition in vehicle produced for pre-inspection.

vi)    White pencil marks on left head lamp housing was missing in pre-inspection whereas it is found in vehicle produced for final survey.

vii)   The cross member is also found new one duly painted alongwith head lamps and front bumber when the vehicle produced for pre-inspection. 

 

From the above points, it is noted that the vehicle produced at the time of pre-inspection was fitted with newly painted hood, new headlamps, newly painted cross member, front bumper and grill and later on intimated a claim on the policy issued and produced the vehicle with parts fitted off vehicle for the surveyor to assess the loss on reported claim.

You have mispresented the material facts related to the insured vehicle at the time of pre-inspection and the material facts of the loss only to gain advantage under the insurance policy. This has led to the violation of declaration in proposal form submitted for issuance of policy. The same is reproduced below for ready reference.

Part III declaration by proposer:

I/We hereby declare that the statements made by me/us in this proposal form are true to the best of my/our knowledge and belief and I/We hereby agree that this declaration shall form the basis of the contract between me/us and the SBI General Insurance Co. Ltd.

I/We also declare that any additions or alteratioins carried out after the submission of this proposal form would be conveyed to SBI General Insurance Co. Ltd immediately.

Hence, we deny the liability for the claim reported to us under policy NO.22173391.

 

 

13.           The claim of the complainant has been repudiated by the OP on the above mentioned ground. The complainant has alleged that his vehicle has met with an accident and total damaged. The complainant has claimed IDV of the vehicle in question i.e. Rs.6,50,000/-.

14.           The onus to prove its version was relied upon the complainant but complainant has miserably failed to prove his version by leading any cogent and convincing evidence. The complainant in order to prove his case has only placed on file photographs of car attached with Ex.C1 i.e. policy documents. On perusal of the photographs, it cannot be ascertained that the vehicle in question was damaged as alleged by the complainant. Furthermore, the complainant has not placed on file any surveyor report and damage report of the vehicle, from which it can be ascertained that the vehicle in question has ever been damaged. Neither the complainant nor OPs have placed on file surveyor report to ascertain the damage or loss of the vehicle in question. Furthermore, the OPs only placed on file only motor investigation report Ex.R3. In the said report, no loss has been assessed. Except this there is no document on the file to prove the factum of accident or loss caused to the vehicle in question.

15.           No doubt, in Investigation Report Ex.R3, the OPs have come to the conclusion that the accident is genuine one but OP has withheld the surveyor report for the reason best known to them.  The OPs have repudiated the claim of the complainant on various anomalies during the final survey which is not a genuine ground to repudiate the claim of the complainant in toto. If the complainant has violated the terms and conditions of the policy, the OPs should have decide the claim of the complainant on non-standard basis. Without any surveyor report or loss assessment report, this Commission cannot ascertain to which extent the damage has been caused to the vehicle.  

16.           Thus, in view of the above, the present complaint is devoid of any merits and same deserves to be dismissed and same is hereby dismissed. Parties concerned be communicated of the order accordingly and file be consigned to the record room.

 

Announced

Dated: 15.02.2024                                             

                                                          President,

                                             District Consumer Disputes

                                             Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Suman Singh)

                          Member                     Member