SMT. RAVI SUSHA: PRESIDENT
Complainant has filed this complaint under Consumer Protection Act 2019, seeking to get an order directing opposite parties to pay Rs.29,992/- as the balance amount of policy benefit along with Rs.55000/- towards compensation for mental agony and Rs.15,000/- towards cost of the proceedings.
Brief facts of the complaint are that the complainant has insured his vehicle Inova crista having Registration No. KL11BC 5493 with OP. This vehicle met with an accident and the authorized dealer of the vehicle VPK Motors, Amana Tayota has given an estimate of Rs.1,08,559 for the repair work of the vehicle. Complainant has submitted claim form and connected records to the1st OP. Further stated that after the repair work he has received the vehicle after paying Rs.78,567/- to the workshop. But though the vehicle has bumper to bumper policy, the insurance company has given only Rs. 46,575/- as claim amount. Hence filed this complaint for getting the balance amount of Rs.29,992/- with compensation and cost of the proceedings.
OPs entered appearance through counsel and filed written version. It is contended that the claim of the complainant was surveyed by independent licensed surveyor and loss assessor. The surveyor assessed the loss of the complainant at Rs.69,169/-. The allegation in the complaint that the complainant is entitled to an amount of Rs.78,567/- after deduction of the amount of Rs.2000/- is false and hence denied. The complainant is only entitled to the amount as payable by the OPs according to the terms, conditions and exclusions of the policy. The OPs are entitled to deduct the exclusions in the policy from the amount of Rs.69,169/- assessed by the surveyor. The complainant had only availed zero depreciation cover as an add on cover where by depreciation applicable under section 1 of the policy terms and conditions alone would stand deleted. The zero depreciation cover excludes tyres and hence depreciation of 50% is applicable to tyres. The complainant had not availed add on cove for consumables and hence the expenses incurred towards consumable items is not covered under the policy. The complainant is entitled only to the expenses incurred for the damages caused to the vehicle in the accident. The OP is not liable to compensate the complainant for the repairs carried out by the complainant to the vehicle for the damages not caused in the accident. The complainant is entitled only to the cost of damages to one alloy wheel and the replacement made by the complainant for two alloy wheels is not in accordance with the damages which could have been caused in the accident. The complainant is the second owner of the vehicle and had purchased the vehicle in July 2020. The OPs had paid an amount of Rs.46,575/- towards full and final settlement of the claim. The complainant had accepted the said amount in full and final satisfaction of the claim without any protest. There has been no deficiency in service or unfair trade practice on the part of the OPs. The complainant is not entitled to any of the reliefs claimed in the complaint and prayed for the dismissal of the complaint.
At the evidence stage complainant has submitted his chief affidavit and 4 documents. He has been examined as Pw1 and the documents marked as Ext.A1 to A4. He was examined as Pw1 and was cross-examined for the OPs. From the side of OPs the policy document was produced and marked as Ext.B1. After that complainant has argued the matter and the learned counsel of OP field written argument note. There is no dispute that the vehicle has met with an accident it has valid insurance at the time of the accident.
The contentions of OP are that the surveyor assessed the loss of the complainant at Rs.69,169/-. Further submitted that the report of the surveyor could become the basis for settlement of a claim by the insurer in respect of the loss suffered by the insured. There is no disputing the fact that the surveyor/surveyors are appointed by the insurance company under the provision of the Insurance Act and their reports are to be given due importance and one should have sufficient grounds not to agree with the assessment made by them. The complainant is only entitled to the amount as payable by the OPs according to the terms, conditions and exclusions of the policy. The OPs are entitled to deduct the exclusions in the policy from the amount of Rs.69,169/- assessed by the surveyor.
Ext.B1 shows that the complainant had only availed zero depreciation cover as an add-on cover whereby depreciation applicable under section of the policy terms and conditions alone would stand deleted. The zero depreciation cover excludes tyres and hence depreciation of 50% is applicable to tyres. The complainant had not availed add on cover for consumables, hence the expenses incurred towards consumable items is not covered under the policy.
It is also contended that the complainant is entitled only to the expenses incurred for the damages caused to the vehicle in question in the accident. The OP is not liable to compensate the complainant for the repairs carried out by the complainant to the vehicle for the damages not caused in the accident. The complainant is entitled only to the cost of damages to one alloy wheel and the replacement made by the complainant for two alloy wheel is not in accordance with the damages caused in the accident.
The OPs had paid an amount of Rs.46,575/- towards full and final settlement of the claim. The OPs had accepted the said amount in full and final satisfaction of the claim without any protest.
It is evident that during cross-examination complainant has agreed that he had full knowledge of the policy terms and condition at the time of taking the policy and also admitted that the surveyor has assessed an amount Rs.69,169/- as damage caused to the vehicle in the accident. Further admitted that the vehicle has zero depreciation coverage and not eligible to get claim amount with respect consumable items. It is also admitted that Rs.46,575/- was received as full and final settlement.
Complainant claimed the balance amount from the repair bill amount.
OP has submitted citations of Hon’ble Supreme court in which the Hon’ble court held that it is settled law that terms of the policy shall govern the contract between the parties, they have to abide by the definition given there in and all those expressions appearing in the policy should be interpreted with reference to the terms of policy and not with reference to the definition given in other laws. It is a matter of contract and in terms of the contract the relation of the parties shall abide and it is presumed that when the parties have entered into a contract of insurance with their eyes wide open, they cannot rely on definition given in other enactment and also “the terms of an insurance policy have to be strictly construed to determine the extent of liability of and insurer and the court while construing the terms of policy is not expected to venture into extra liberalism that may result in re-writing the contract or substituting the terms which were not intended by the parties”.
Here complainant failed to substantiate his claim through material evidence. He has not taken any steps to discard the assessment made by the surveyor. It is evident that he has admitted the full and final settlement of the claim with Insurance company without any objection.
Hence considering the decisions of Hon’ble apex court and from the facts and circumstance of this case, complainant is entitled to get the policy claim amount as per the terms and condition of the policy which was received by him without any objection. Complainant failed to substantiate deficiency of service on the part of opposite parties.
In the result, complaint fails and hence it is dismissed. No order as to cost.
Exts
A1-Repair estimate
A2-Repair bill
A1-Claim summery report
A1-Policy certificate
Pw1- Complainant
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Assistant Registrar
