Delhi

North East

RBT/CC/210/2022

KARTIK SHARMA - Complainant(s)

Versus

TATA AIG GENERAL INS.CO.LTD. - Opp.Party(s)

16 Feb 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: NORTH-EAST

GOVT. OF NCT OF DELHI

D.C. OFFICE COMPLEX, BUNKAR VIHAR, NAND NAGRI, DELHI-93

 

RBT/Complaint Case No. 210/22

 

In the matter of:

 

	Sh. Kartik Sharma S/o Sh. Parbodh Kumar Sharma R/o I-3/102, Sector-16, Rohini Delhi-110085	Complainant
	Versus
	M/s Tata AIG General Insurance Co. Ltd. Through its Director/Branch Head 301-308, Third Floor, Aggarwal Prestige Mall, Plot No.2, Road No.44, Near M2K Cinema, Rani Bagh, Pitampura, Delhi-110034	Opposite Party

 

 

DATE OF INSTITUTION:        JUDGMENT RESERVED ON:                           DATE OF ORDER:

17.07.18 27.01.23 16.02.23

 

CORAM:

Surinder Kumar Sharma, President

Anil Kumar Bamba, Member

ORDER

      Surinder Kumar Sharma, President

The Complainant has filed the present complaint under Section 12 of the Consumer protection Act, 1986.

Case of the Complainant

1. The case of the Complainant as revealed from the record is that he purchased a motor insurance from Opposite Party bearing policy no. 0156915351 valid from 05.08.17 to 04.08.18. He submitted that on 25.10.17 his vehicle bearing no. DL8CAN9295 Hyundai I-10 Grand met with an accident causing heavy damage to vehicle and he also sustained injuries. He also reported this matter to Police Station, KNK Marg, Delhi, vide DD no. 31-B and NCR no. 187/17. The Complainant was taken to Dr. BSA hospital having MLC no. 15057/17. He further submitted that he had applied for insurance claim having claim no. 0820540479A but his claim was refused by Opposite Party vide letter dated 01.11.17 stating that “As per MLC driver of the vehicle i.e. Complainant was under influence of alcohol and his relative refused for Blood sample”. The Complainant have also requested for repairing of accidental vehicle but Opposite Party have not sent any person to estimate the loss of his vehicle. The Complainant submitted that he made several visits and phone calls to officials of Opposite Party but Opposite Party did not release his claim. The Complainant also submitted that on 15.03.18 he had sent a legal notice to Opposite Party vide speed post having receipt dated 21.03.18 and the same has been delivered to Opposite Party on 22.03.18. The Complainant stated that Opposite Party had repudiated his claim on false grounds. Hence, this shows deficiency on the part Opposite Party. Complainant has prayed to get his car repaired and hand it over to him and  Rs. 5,00,000/- for  repairing charges if the Opposite Party does not get the car repaired. He has further prayed to direct the Opposite Party to pay a sum of Rs. 500/- per day from 26.10.17 till repairing or making payment of repairing charges of the damaged vehicle on account of daily taxi expenses and Rs. 2,00,000/- towards mental harassment, Rs. 11,000/- as litigation expenses.

Case of the Opposite Party

2. The Opposite Party contested the case and filed written statement. It is stated by the Opposite Party that the complaint is barred under section 26 of CPA, 1986 and the same is not maintainable and deserves to be dismissed. It is further submitted by Opposite Party that on receiving the intimation of claim under the policy, they immediately appointed surveyor to inspect the insured vehicle and assess the loss under the said policy, who duly inspected the insured vehicle at Hans Hyundai, Rohini, Delhi.  On inspection certain doubts were created and accordingly, they appointed M/s Shiva Investigation Consultants to investigate the claim thoroughly and submit its report.
3. After scrutiny of the claim documents, MLC, and investigation report of said Consultants, it revealed that at the time of accident on 25.10.17, the Complainant himself was driving the said insured vehicle and he sustained injuries in the said accident and thereafter he was taken to Dr. Baba Sahib Ambedkar Hospital, Sector -6, Rohini, Delhi-110085 for treatment where his MLC No. 15057/17 was prepared. As per MLC, doctors observed smell of alcohol in the breath of the Complainant and accordingly, recommended for BAC (Blood Alcohol Concentration) Test and blood sample of the Complainant. However, relative of Complainant refused in writing for the said test and blood sampling with the plea that they want to take the Complainant to a private hospital for further treatment. It is apparent that relatives refused for the same with their ill and malafide intention to hide the fact that at the time of accident the Complainant was drunk and under influence of liquor/alcohol/intoxicant.
4. It is further submitted that the Complainant was drunk, also duly confirmed by eye witness who called the PCR after the accident and other witnesses. That since, at the time of accident, the Complainant was drunk, as per terms of policy, the Complainant was not entitled to the claim amount and accordingly, the same was repudiated vide letter dated 15.01.18 when no satisfactory reply received by the Opposite Party to their letter dated 01.12.17.
5. That at the time of accident, the Complainant was driving the subject vehicle under influence of alcohol in gross violation of section 1 (2) (c) of the policy terms and conditions and also the condition No.8 of the Motor policy which are as under below:-
6. Section 1 (2) of the policy :- The Company shall not be liable to make any payment in respect of :

(c) “ Any accident loss or damage suffered whilst the insured or any person driving the vehicle with the knowledge and consent of the insured is under the influence of intoxicating liquor or drugs.” paid Rs. 14,313/- and not Rs. 15,000/-. It is alleged that the Complainant did not suffer any harassment or loss on account of any action of Opposite Party No.1. It is stated that the complaint be dismissed.

Condition No.8 of Motor Policy:- “ the due observance and fulfilment of the terms, conditions and endorsements of this policy in so far as they relate to anything to be done or complied with by the insured shall be conditions precedent to any liability of the company to make any payment under the policy.

7. Opposite Party submitted that the Complainant is not entitled to the claim amount as he was drunk and under influence of the alcohol at the time of accident and prayed for dismissal of the complaint.

Rejoinder to the written statement of Opposite Party

8. The Complainant filed rejoinder to the written statement of Opposite Party wherein the Complainant has denied the pleas raised by the Opposite Party and has reiterated the assertion made in the complaint. It is stated that mere presence of the smell of alcohol in the breath cannot be a ground to reject the claim.

Evidence of the Complainant

9. The Complainant in support of his complaint filed his affidavit wherein he has supported the averments made in the complaint. The Complainant has also filed affidavit of Shri Varun Sharma, who has stated that after the accident while he was passing through the spot he saw that the car of the Complainant has met with an accident while saving the dog. He has stated that he did not feel that the Complainant was intoxicated or drunk.

Evidence of the Opposite Party

10. In order to prove its case Opposite Party has filed affidavit of Sanjay Bhagat, Authorized Representative of the Opposite Party, having office at Plot No. C-001, Unit No. 810-816, 8^th floor, World Trade Tower, Sector -16, Noida-201301, wherein the averments made in the written statement of Opposite Party have been supported.

Arguments & Conclusion

11. We have heard the Complainant and Ld. Counsel for the Opposite Party. We have also perused the file and the written arguments filed by parties. The case of the Complainant is that at the time of the accident he was driving the car and he was not drunk. It is his case that the Opposite Party has wrongly rejected his claim. On the other hand, the case of the Opposite Party is that at the time of accident Complainant was driving the car under the influence of liquor.  It is the case of Opposite Party that as the Complainant was driving the car under the influence of liquor and as such there was violations of the terms and conditions of the insurance policy and on this account the claim was rejected.
12. It is an admitted case that the Complainant was driving the car at the time of accident. It is also an admitted case that after the accident the Complainant was taken to Dr. Baba Sahib Ambedkar Hospital, Sector-6, Rohini, Delhi-110085 where he was examined vide MLC No. 15057/17. Complainant has filed copy of this MLC. The perusal of the MLC shows that the Complainant had smell of alcohol in his breath. The MLC further shows that the relative of the Complainant refused for BAC test. The said statement has been signed by the relative of the Complainant. The emergency registration card of the said hospital also shows that it is stated and signed by the relative of the Complainant that he wanted to take the Complainant to some private hospital. The Complainant has not disclose as who was his said relative who has signed the MLC for refusing the BAC test. Had the Complainant not refused for BAC test he would have disclosed the name of his relative and he would have also filed his affidavit stating therein that BAC test was not refused. If the Complainant was not drunk he would have opted for BAC test coupled with the fact that the MLC itself shows that the Complainant has consumed alcohol, falsifies the stand of the Complainant. Therefore, under these circumstances, we are of the opinion that the complaint is without any merit and the same is dismissed.
13. Order announced on 16.02.23.

Copy of this order be given to the parties free of cost.

File be consigned to Record Room. 

(Anil Kumar Bamba)           Member

(Surinder Kumar Sharma) President