Delhi

East Delhi

CC/72/2014

SMT. RADHA - Complainant(s)

Versus

SHRI RAM GEN. INS - Opp.Party(s)

28 Sep 2017

ORDER

           DISTRICT CONSUMER DISPUTE REDRESSAL FORUM, EAST, Govt of NCT of Delhi

              CONVENIENT SHOPPING CENTRE, 1^st FLOOR, SAINI ENCLAVE, DELHI 110092  

 

                                                                                                   Consumer complaint no           72/2014

                                                                                                   Date of Institution               20/01/2014

                                                                                                   Order reserved on               03/10/2017        

                                                                                                   Date of Order                       06/10/2017                                                                                     

 

In matter of

Mrs Radha Sahi, adult   

W/o  Sh Rajeev Sahi    

R/o- JE-36, Gupta Colony  

Khirki Extension, New Delhi- 110017…………………………....…………….Complainant

                                                                    Vs

Shri Ram General Insurance Co. Ltd. 

506-507,5^th Floor,

Pragti Deep Building,

Laxmi Nagar District Centre, Delhi 110092……….…..……..……………..Opponent

 

Complainant  Advocate          Harendra  Kumar

Opponent Advocate                Naveen Kumar Chauhan 

 

Quorum   Sh Sukhdev  Singh       President

                   Dr P N Tiwari                Member

 

Order by Dr P N Tiwari  Member  

 

Brief Facts of the case                                                                                                

 

Complainant is a registered owner of a commercial tourist taxi of Mahindra and Mahindra Xylo D2 diesel had purchased for a sum of Rs 6,99675/- and same was registered with state registration office as Tourist Taxi which was duly financed from L &T Finance ltd. which was having All India Tourist Permit with carrying capacity of six persons. The said taxi was insured with OP / Shriram General Insurance Co. Ltd. vide ‘Package’ Policy no. 101046/31/12/ 008195 from 31/10/2011 to 30/10/2012 (Ex CW1/1 to Ex CW1/5).  

The said taxi met an accident on 13/12/2012 in the early morning at 4 AM after being collided with another vehicle from front side. The complainant informed customer care help line no. of Mahindra & Mahindra, the manufacturer of the taxi, who provided road side help and took the damaged vehicle to the nearest workshop of Koncept Automobiles Pvt. ltd. at Okhla, New Delhi.   On the intimation to OP, surveyor was appointed who informed the complainant for verification of said accidental vehicle as per surveyor’s letter dated 31/10/2012 (Ex CW1/6) and all the required documents were handed over to him. It was stated that complainant received a letter  from  the  workshop  that  the cost  of damage were  approx  a  sum  of  Rs  6,50,000/- (Ex CW1/7) and surveyor had sent a letter to deposit as sum of Rs 2.5 Lakh at workshop so that the repair work could be started (Ex CW1/7A). Later complainant was asked to deposit a sum of Rs 90,000/- which was deposited with workshop (ExCW1/12).  

It had been stated that despite of depositing the asked amount, OP did not clear the sanctioned amount as per policy sum assured despite of repeated follow up with OP, so filed this complaint claiming insured amount a sum of Rs 5,97,117/- with 18 % interest p.a. and compensation to business loss to the sum of Rs 11 lakhs as damages.

On receiving notice, OP submitted written statement and denied all the allegations put in the complaint. It was admitted that the said commercial vehicle as tourist taxi of the complainant was insured and had registration no. DL 1YC 6510, had valid insurance from 31/10/2011 to 30/10/2012 under the Package Policy (Ex Anne. A) under terms and conditions as annexed. It was stated that the said taxi met with an accident on 13/05/2012 after intimation was received from the complainant on 23/05/2012 with the delay of 10 days and police was informed on 07/06/2012 after the delay of 25 days without any specific reason given by the complainant which itself amounts violation of the terms and conditions of the policy.

 

It was an important and mandatory condition that OP had to be intimated immediately for any accident within 48 hours, but here complainant neither informed the police about the accident, its mode and its cause and had no witness or list of any injured persons, so information was given very late intentionally without any specific reason to OP (Ex Anne. B). OP had appointed its independent surveyor from Jaipur immediately who asked complainant for certain clarification (Ex. Anne. C).

It had been stated that surveyor asked certain documents for claim purpose and verification of the incidence on 14/06/2012 (Ex Anne. D), but complainant did not comply the asked requirement.  Number of letters were sent to complainant to submit documents, but did not receive any intimation or any required documents from complainant as driver’s batch no., cause of accident, mode of accident, place of accident and reason why police was not intimated immediately (Ex Anne. D). when no documents were received by the surveyor, damages were estimated to the tune of 3,27,000/- under the terms and conditions of the said policy as per the final report of surveyor on dated 08/11/2012(Ex Anne. G).  

 

It had been stated that complainant was repeatedly intimated to submit the required claim documents, but OP did not get any documents so based on the final surveyor report, OP assessed the loss on the basis of 75% of net liability (IDV) to be paid to the complainant as full and final claim after claim process was complete.

 

Complainant submitted her rejoinder, but did not submit evidences on affidavit.

OP filed their evidences on affidavit through Yogesh Kumar, Legal Officer with OP, reaffirmed on oath that all the facts and evidences were true and on record. It was stated that there was no deficiency or unfair trade practice adopted by OP and claim settlement was based on 75% basis on the terms and condition of the policy subject to the fulfillment of claim documents were to be submitted by the complainant.

 

Arguments were heard from OP counsel and also submitted written arguments and citations in their favour, but complainant did not put her appearance in person or through her counsel despite of serving notices. So file was perused and order was reserved.  

 

We have gone through all the facts and evidences of OP and observed that claim was not rejected, but OP had closed due to non compliance of submission of claim documents with OP still OP had decided to pay the claim based on 75% IDV of policy subject to the submission of required claim documents by complainant under the terms and conditions.

 

We have also observed that this complaint has no merit as complainant has neither complied the terms of the policy as intimating OP for timely getting claim nor informed the police about the said accident which was mandatory for taking genuine claim from OP when her policy was in force. Giving intimation much beyond the required time without any sufficient cause, clearly violate the policy conditions. Also, complainant has not submitted her evidences on affidavit to prove her claim as genuine.  

Under the Commercial Vehicle Package Policy Section I (vi) which means “accident by external means” and as per Condition 1 of the Policy, insured has to intimate the insurer/OP in writing immediately about the loss/damages, but here in this case, complainant neither intimated police nor OP about the damage/accident. This clearly establishes deficiency on the part of complainant.

Besides this case pertains to commercial business and complainant had nowhere stated that she was carrying on her tourist taxi business for her livelihood, so commercial business relief has no jurisdiction in this Forum and as such there was no merit seen in this case.

Thus we are of the opinion that this complaint is devoid of any merit and deserves to be dismissed without any order to cost, but as OP has offered to pay the claim on the basis of 75% of insured declared value (IDV) under policy terms and conditions; though OP has produced certain citations in favor of rejection of claim under the policy conditions as -

 

1-Sriram General Insurance Co. Ltd. vs Sharwan Kumar Gupta, RCA 61183/16 (ADJ, THC, Delhi) decided on 04/08/2017.

2- New India Assurance Co. Ltd. vs Trilochan Jani, IV(2012)CPJ 441 (NC) in FA 321/2005 decided on 09/12/2009.

3- Prahald Sharma vs ICICI Lumbard Gen. Insu. Co. & others, II (2012) CPJ 498 (NC) in   

    CC-215/2010, decided on 24/04/2012.

4-Vikram Greentek India Ltd. vs New India Assurance Co. ltd., (2009) 5 SCC 599 decided on 01 April 2009.

5-Sikksa Papers Ltd. vs National Insurance Co. Ltd.,(2009) 7 SCC 777, decided on 29 May, 2009.

 

It was held in all above cases that complainant had violated the terms and conditions of the policy and rejection of claim by OP was justified.   

 

So, taking reference of these citations where law has been laid down that violation of terms cannot be overlooked, but in this case, as OP has assessed claim on 75% of IDV, so in the interest of justice, we direct the complainant to comply all the required claim formalities with OP in 30 days from the receiving of this order, so that claim process may be completed and thereafter, complainant shall be entitled to receive the assessed value/IDV under the terms and conditions of the policy. There shall be no other order to cost or award.  

 

The copy of this order be sent to the parties as per the Regulation 18(6) of The Consumer Protection Regulation (in short CPR) and file be consigned to the Record Room under Regulation 20 (1) of CPR.

 

 (Dr) P N Tiwari – Member                                                                            Sukhdev Singh - President