Chandigarh

DF-II

CC/337/2015

Dr. Ritesh Gupta - Complainant(s)

Versus

Tata AIG General Insurance Co.Ltd. - Opp.Party(s)

Rakesh Bajaj,Adv

22 Jul 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

============

Consumer Complaint  No	:	337 of 2015
Date  of  Institution	:	29.06.2015
Date   of   Decision	:	22.07.2016

 

 

 

 

 

Dr.Ritesh Gupta son of Sh.Ramesh Gupta, resident of H.No.705, Sector 4, Panchkula.

 

            …....Complainant

Versus

 

1]  Tata AIG General Insurance Co. Ltd., SCO No.232-234, IInd Floor, Sector 34-A, Chandigarh through its Branch Manager.

 

2]  Tata AIG General Insurance Co. Ltd., Regd. Office 15^th Floor, Tower-A, Peninsula Business Park, Ganpatrao Kadam Marg, Off. Senapati Bapat Marg, Lower Parel, Mumbai 400 013, through its authorised representative.    

 …...Opposite Parties

 

BEFORE:  SH. RAJAN DEWAN           PRESIDENT

MRS.PRITI MALHOTRA        MEMBER

           

 

Argued By: Sh.Rakesh Bajaj, Counsel for the complainant

Sh.Rajesh K Sharma, Counsel for Opposite Parties

 

 

PER PRITI MALHOTRA, MEMBER

 

                                As per the case, the complainant got an insurance policy No.015195920402 from Opposite Party Company, for car Verna Fluidic bearing Regd. No.HR-03M-7293, effective from 13.6.2014 to 12.6.2015 having Zero depreciation.  It is averred that the complainant, an Eye Specialist Doctor, was going to Mullana on 16.1.2015 in morning in his above said car and on the way, his car was hit on the back bumper by the speedy motorcycle from rear side.  Then the car was got repaired from Charisma Goldwheels (P) Ltd., Chandigarh, but out of the total repair cost of Rs.24,911/-, the OPs had paid Rs.15,083/- and the complainant had to pay the balance amount of Rs.9830/- though the policy was cashless.  The complainant took the matter with the Opposite Parties, but nothing effective was done.  As such, the complainant sent legal notice to the Opposite Parties, but to no avail.  Hence, this complaint has been filed alleging the above act of the OPs as gross deficiency in service and unfair trade practice.

 

2]       The OPs have filed joint reply and admitted the insurance of the vehicle, lodging of the claim, repair of the vehicle and payments done as alleged.  It is stated that the claim of the complainant has been processed with respect to the damage which were found fresh and in consonance with the cause of loss as mentioned in the claim form. It is also stated that the claim of the complainant was processed on the basis of survey report and as per the terms of the policy and there is no further amount due and payable to the complainant (Ann.R-5).  It is pleaded that pre-existing damage was noted on rear bumper, hence was disallowed for replacement. It is also pleaded that the damage on rear bumper were same as appearing in the photograph arranged at the time of previous claim of the same vehicle vide Claim NO.620831510, dated 17.9.2014 (Ann.R-3 & R-4). It is also pleaded that admissible amount was paid directly to the Garage under the cashless arrangement and the complainant had to pay for the repairs that were not covered under the term of the policy. Pleading no deficiency in service and denying rest of the allegations, it is prayed that the complaint be dismissed.

 

3]       Rejoinder has been filed by the complainant thereby reiterating the contents of the complaint and controverting that of the reply.

 

4]       Parties led evidence in support of their contentions.

 

5]       We have heard the ld.Counsel for the parties and have also perused the record.

 

6]       The present complaint filed against the OPs is admitted to the extent that the complainant got an insurance policy No.015195920402 from OP Company, for car Verna Fluidic bearing Regd. No.HR-03M-7293, effective from 13.6.2014 to 12.6.2015 having Zero depreciation.  It is not disputed that the said insured vehicle during the currency of the insurance policy, got damaged on 16.1.2015 when the car of the complainant was hit on the back bumper by the speedy motorcycle from the rear side, as alleged by the complainant.  This is also a matter of record that the said vehicle was got repaired by Charisma Goldwheels (P) Ltd., Chandigarh and due claim was lodged with the OPs for reimbursement and in response, the OPs paid only Rs.15,083/- against the claim amount of Rs.24,911/-.

 

7]       The moot question involved in the present complaint is the less settlement of the claim by the OPs.

 

8]       It is the main grouse of the complainant that the insurance policy procured for the vehicle in question from the OPs was 0% Depreciation Reimbursement cashless policy and thus, was entitled for the full claim amount.  It is claimed on behalf of the complainant that despite having 0% depreciation cashless policy, he has to pay Rs.9830/- to the repairer from his own pocket in order to get the delivery of the vehicle, which otherwise was the responsibility of the Opposite Parties to pay.

9]       Contrary to the allegations of the complainant, the OPs No.1 & 2 claimed that the complainant vide present complaint has concealed some material facts and projected a wrong story before the Forum. While admitting the institution of claim under the given policy, the Opposite Parties submitted that they deputed an IRDA Licensed Surveyor to inspect the vehicle in order to assess the loss under the terms & conditions of the policy.  It is submitted that the Loss Assessor, after thorough verification submitted its report with the OPs, wherein the claim of the complainant was approved for front bumper and left tail light for replacement and left quarter panel & rear door for repairs, the damages which were found to be fresh and in consonance with the cause of loss.  It is submitted that the Surveyor noticed that there was a pre-existing damage on rear bumper, for which a previous claim vide Claim No.620831510, dated 17.9.2014 was lodged by the complainant with the OPs.  It is claimed by the OPs that the complainant tried to club the old damages, which already existed on the alleged date of accident, which provides a base to reject the whole claim of the complainant being it based on concealment of facts.  Further claimed that the OPs rightly paid an amount of Rs.15,083/- against the claim of Rs.24,911/-, for the damages which were found fresh and in consonance with the loss, as mentioned in the claim form. 

 

10]      To establish their stand about the previous claim, lodged by the complainant regarding the rear bumper, the OPs have placed on record the Photostat copy of photographs allegedly arranged at the time of previous claim as Ann.R-3 and photographs of the present claim are attached as Ann.R-4.  OPs claimed that the damages on the rear bumper are similar in both the documents. On the contrary, the complainant vide his rejoinder, claimed that the stand of the OPs is totally wrong and baseless, as he has not filed any claim earlier for the repair of the rear bumper, as alleged by the OPs, rather it was a claim for the damage of wind sheet and also placed on record the copy of the invoice/cash memo dated 18.9.2014.

 

11]      From the above submissions and documents referred, it is clear that the previous claim lodged by the complainant was not for the reimbursement of the charges spent on the repair of the rear bumper; rather it was a claim for the wind sheet. Our opinion is further strengthened by the absence of the previous ‘claim form’ vide which the complainant lodged the earlier claim, which the OPs did not place on record for the reasons best known to them. The Opposite Parties failed to establish their stand, thus the OPs are liable to pay the amount, which they wrongly deducted. In this view of the matter, it is held that the OPs found deficient in rendering proper service.

 

12]      In view of the foregoing discussion, we are of the opinion that the deficiency in service on the part of the OPs is proved.  Therefore, the complaint stands allowed against the OPs and the OPs are jointly & severally directed as under:-

[a] To pay the remaining amount of claim i.e. 9830/- to the complainant;

[b] To pay an amount of Rs.5000/- as compensation to the complainant;

[c] To pay an amount of Rs.3000/- as litigation expenses. 

 

         This order shall be complied with by the OPs jointly & severally within a period of 45 days from the date of receipt of its certified copy, failing which the OPs shall be liable to pay the awarded amount, as at sub-para [a] & [b] above, along with interest @12% p.a. from the date of this order till realization, apart from paying the litigation expenses.

         The certified copy of this order be sent to the parties free of charge, after which the file be consigned.

Announced

22^nd July, 2016                                                                            Sd/-

(RAJAN DEWAN)

                                       PRESIDENT

 

 

Sd/-

(PRITI MALHOTRA)

MEMBER