Complaint No: 130 of 2019.
Date of Institution: 03.04.2019.
Date of order: 04.01.2024.
Joginder Singh Son of Sh. Bua Singh, resident of Village Saidowal Kalan, Tehsil and District Gurdaspur.
….........Complainant.
VERSUS
1. Shri Ram General Insurance Company Limited, 2nd Floor Thakur Market, opposite Kalika Hospital, Dhangu Road, Pathankot (Punjab).
2. Shri Ram General Insurance Company Limited, E-8, EDIP Sitapur Industrial Area, Jaipur, Rajasthan – 302022.
….Opposite parties.
Complaint u/s 12 of the Consumer Protection Act.
Present: For the Complainant: Sh.Rahul Vashisht, Advocate.
For the Opposite Parties: Sh.Sandeep Ohri, Advocate.
Quorum: Sh.Lalit Mohan Dogra, President, Sh.Bhagwan Singh Matharu, Member.
ORDER
Lalit Mohan Dogra, President.
Joginder Singh, Complainant (here-in-after referred to as complainant) has filed this complaint under section 12 of the Consumer Protection Act (here-in-after referred to as 'Act') against Shri Ram Gen. Ins. Co. Ltd. Etc. (here-in-after referred to as 'opposite parties).
2. Briefly stated, the case of the complainant is that the complainant is linked with the transport company KST Delhi. The complainant was the Owner of truck model Tata Motors-LPT 3118/56 BS 3 TC Cabin bearing registration No.HR-38-T-1848. It is pleaded that the truck of the complainant was fully insured by the opposite parties vide Policy No. 105011/31/17/017540 and the same was issued on 27.01.2017 by the opposite party No. 1 which was valid up to 30.01.2018. The cover note number issued by the opposite parties with regard to the above insurance policy is P901566. It is further pleaded that complainant had paid final premium of Rs.38,643/- against the above noted insurance policy to the opposite parties. It is further pleaded that in the month of January 2018, the diver of complainant namely Unkar Singh was driving the truck of the complainant and he was coming towards Delhi from Durgapur for unloading the consignment of wires at Delhi and when he reached at Topchanchi Jharkhand, the truck of complainant met with an accident with another truck. It is further pleaded that the truck of the complainant was badly damaged in the accident and immediately the driver of complainant namely Unkar Singh telephonically called the office of the opposite parties and complaint with regard to the same was lodged with P.S. Topchanchi by the driver of the complainant. It is further pleaded that thereafter, on the call of driver of the complainant, a surveyor from the office of the opposite parties reached at the spot of accident and physically verified the damage of the truck. He also clicked the photographs of the damaged truck and the spot of the accident. It is further pleaded that after this, the truck was taken to Delhi and the same was repaired at "Gurdev Body Builders" Delhi. It is further pleaded that the surveyor from the office of the opposite parties also visited the workshop of Gurdev Body Builders and there he also analyzed the estimate on the repair of the truck and the total estimate for the repair of truck was analyzed Rs.5,50,000/- approximately from the Gurdev Body Builders and the surveyor of opposite parties. It is further pleaded that thereafter, the final bill was issued by Gurdev Body Builders amounting Rs.5,55,580/- which was paid by the complainant. It is further pleaded that the complainant has also handed over the verification of the driving license of his driver from RTO Office to the Branch Office of the opposite party No. 1. The complainant also provided all the necessary documents demanded by the opposite parties as required for the insurance claim. It is further pleaded that the claim of the complainant was also pending before the office of the opposite parties vide claim No.10000/31/18/C/070788, but till today claim no claim has been released towards the complainant. It is further pleaded that on the contrary, the complainant is unnecessarily being harassed by the opposite parties even after fulfillment of all the necessary requirements required for passing of the accident claim. It is further pleaded that opposite parties intentionally did not release the accidental claim amount of the complainant even after several requests made by the complainant. It is further pleaded that the complainant had got issued the legal notice dated 09.01.2019 besides visiting number of times office of the opposite parties for getting insurance claim and settlement of his genuine claim, but to no avail. It is further pleaded that rejection of the request of the complainant is arbitrary, whimsical, and untenable in the eyes of law and clear harassment to the complainant. It is further pleaded that due to this illegal act and conduct of the opposite parties the complainant has suffered great loss and also suffered mental agony, Physical harassment and inconvenience. It is further pleaded that there is a clear cut deficiency in service on the part of the opposite parties.
On this backdrop of facts, the complainant has alleged deficiency and unfair trade practice on the part of the opposite parties and prayed that necessary directions may kindly be issued to the opposite parties to settle the insurance claim of the complainant and the opposite parties may also be directed to pay Rs.50,000/- as damages and compensation for causing mental and physical agony to the complainant and any other relief which this Hon'ble Commission may deem fit may also be passed in favour of the complainant and against the opposite parties, in the interest of justice.
3. Upon notice, the opposite parties appeared through counsel and contested the complaint and filing their written reply by taking the preliminary objections that the complainant has no cause of action to file the present complaint and there is no deficiency in services on the part of the answering opposite parties and it is the complainant who is at fault and failed to fulfilled his part of obligations. It is pleaded that the vehicle bearing registration No. HR-38-T-1848 was insured with the answering opposite parties and the policy was issued and the period of insurance is from 31.01.2017 to 30.01.2018. It is further pleaded that intimation regarding the loss has been intimated to the insurance company and the claim form has been duly filled by the complainant. It is further pleaded that the surveyor has been appointed and it has been found that the opportunity has not been given to the surveyor and insurance company to inspect the vehicle immediately following the accident. It is further pleaded that vehicle had already dis-mantled prior to the survey and as per section 1 of the policy terms and conditions the opportunity to inspect the vehicle should be given to company immediately and the complainant failed to give such opportunity which is violation of the policy conditions. It is further pleaded that the relevant policy provisions are reproduced as under:-
Section 1 Loss or damage to the vehicle insured: The insured may authorize the repair of the vehicle necessitated by damage for which the company may be liable under the policy provided that....
c) The insured shall give the company every assistance to see that such repair is necessary and the charges are reasonable. Further the documents i.e. load challan of wire loaded at the time of accident and DL verification etc. are also not provided. So, the claim has been made as no claim vide letter dated 24.03.2018. It is further pleaded that the vehicle has been duly surveyed by the surveyor Pardeep Kumar Khandelwal, Surveyor and Loss assessor and he submitted his survey report and as per his survey report the liability of the insurance company is only of Rs.2,04,025/-. But, as already stated the claim has been repudiated and as such there is no liability of the insurance company. It is further pleaded that even otherwise if this Ld. Commission comes to the conclusion that there is any liability of the insurance company then in that case the liability is only as per survey report who submitted his detailed report after going through each and every detail of the vehicle and loss and he is duly qualified person to access the loss and as already stated the liability as per his report is Rs.2,04,025/- only.
On merits, the opposite parties have reiterated their stand as taken in legal objections and denied all the averments of the complaint and there is no deficiency in service on the part of the opposite parties. In the end, the opposite parties prayed for dismissal of complaint with costs.
4. Learned counsel for the complainant has tendered into evidence affidavit of Joginder Singh, (Complainant) as Ex.CW-1/A alongwith other documents as Ex.C-1 to Ex.C-5.
5. Learned counsel for the opposite parties has tendered into evidence affidavit of Sh. Aman Sharma, (Authorized Signatory, Shri Ram Gen. Ins. Co. Ltd, Jaipur) as Ex.OP-1,2/A alongwith other documents as Ex.OP-1,2/1 to Ex.OP-1,2/6.
6. Rejoinder filed by the complainant.
7. Written arguments not filed by both the parties.
8. Counsel for the complainant has argued that the truck of the complainant was insured with the opposite parties and the said truck met with an accident and intimation was given to the opposite parties regarding accident and the surveyor deputed by the opposite parties assessed the loss to the tune of Rs.5,50,000/-. However, opposite parties have repudiated the claim without any justified reason which amounts to deficiency in service on the part of the opposite parties. Counsel for the complainant has relied upon judgment of Hon'ble Supreme Court of India reported in 2022 Live Law (SC) 506 wherein it was held by the Hon'ble Supreme Court of India as under:-
"Insurance - Insurance companies refusing claim on flimsy grounds and/or technical grounds - While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control. (Para 4.1)".
9. On the other hand counsel for the opposite parties has argued that after receiving intimation surveyor was appointed. However, it was found by the surveyor that the vehicle had already dismantled prior to the survey which is violation of Section '1' of the policy. It is further argued that the complainant had failed to provide documents i.e. load challan and driving licence verification and as such claim was rightly repudiated by the opposite parties.
10. We have heard the Ld. counsels for the parties and gone through the record.
11. It is admitted fact that the truck bearing registration No.HR-38-T-1848 owned by the complainant was insured with the opposite parties insurance company vide policy of insurance valid from 27.01.2017 to 30.01.2018. It is further admitted fact that said truck met with an accident and on receiving intimation opposite parties had deputed Pardeep Kumar Khandelwal surveyor to assess the loss. It is further admitted fact that opposite parties have repudiated the claim vide letter dated 24.03.2018. The disputed issue for adjudication is whether the repudiation of claim on account of violation of terms and conditions and non submissions of documents is justified or not.
12. To prove his case complainant has placed on file his affidavit Ex.CW-1/A, copy of policy of insurance Ex.C1, copy of intimation to the police Ex.C2, copies of estimate and bills regarding repair Ex.C3, copy of legal notice Ex.C4 and postal receipt Ex.C5 whereas counsel for the opposite parties has placed on record unnamed affidavit Ex.OP-1,2/1/A, copy of claim form Ex.OP-1,2/1, copy of repudiation letter Ex.OP-1,2/2, copy of policy of insurance Ex.OP-1,2/3, terms and conditions in original Ex.OP-1,2/4, copy of survey report Ex.OP-1,2/5 and copy of claim intimation slip Ex.OP-1,2/6.
13. Perusal of claim form Ex.OP-1,2/1 shows that the vehicle met with an accident on 05.01.2018 and intimation regarding loss was given to the opposite parties as per report of surveyor is 06.01.2018 meaning thereby that opposite parties were given intimation within time and the report of surveyor shows that survey was allotted to the surveyor on 19.01.2018 and as such we are of the view that complainant is not expected to wait for such a long period for the surveyor to come and inspect the vehicle when the intimation was already given timely to the opposite parties. As such we are of view that no prejudice has been caused to the opposite parties if the vehicle was dismantled prior to the inspection of the vehicle as the delay was caused by the opposite parties in appointing surveyor.
14. As far as the violation of Section '1' of the policy terms and conditions is concerned. It has not come on record that the said policy wording Ex.OP-1,2/4 was ever supplied to the insured alongwith the policy of insurance. As such since no such terms and conditions accompanied the policy document. As such insurance company cannot compel and bind the complainant with such terms and conditions.
15. We have relied upon judgment of Hon'ble State Consumer Disputes Redressal Commission, Punjab Chandigarh in first appeal No.1095 of 2022 dacided on 1.12.2023 titled as Care Health Insurance vs Guriqbal Singh
As per which it has been held that when it is proved on record that said terms and conditions were never supplied to the complainant the insurance company cannot deny payment of claim to the insured on such ground and exclusion clause.
16. The second issue is regarding non supply of load challan and driving licence verification. We are of the view that since the complainant has placed on record copy of driving licence of the driver which is also scanned by the surveyor of the opposite parties and as such the opposite parties cannot deny the settlement of claim on any such ground of non supply of documents. We are of the view that insurance company is denying the claim settlement on frivolous grounds and by demanding unnecessary documents like load challan.
17. We have further relied upon the judgment of Hon'ble Supreme Court of India reported in 2022 Live Law (SC) 506 wherein it was held by the Hon'ble Supreme Court of India as under:-
"Insurance - Insurance companies refusing claim on flimsy grounds and/or technical grounds - While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control. (Para 4.1)".
18. Perusal of surveyor report Ex.OP-1,2/5 shows that surveyor has assessed the loss to the vehicle to the tune of Rs.2,04,025/- and there is no ground or justification to ignore the said report of the surveyor regarding essessment arrived at.
19. As such by relying upon the report of surveyor Ex.OP-1,2/5, we partly allowed the present complaint and opposite parties are directed to pay Rs.2,04,025/- to the complainant alongwith interest @ 9% P.A. from the date of filing of the present complaint till realization. Complainant is also held entitled to receive Rs.10,000/- as compensation on account of mental tension and harassment and Rs.5,000/- as cost of litigation. Entire exercise shall be completed within 30 days from the date of receipt of copy of this order.
20. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
21. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Lalit Mohan Dogra)
President
Announced: (B.S.Matharu)
Jan.04, 2024 Member
*YP*
