Sri Partha Kumar Basu, Hon’ble Member
The instant case is filed by the complainant against the OP1 Insurance Company and their OP2 Service provider regarding a dispute on a vehicle insurance claim for one 2 - wheeler.
In gist the case of the complainant is that on 27.07.2019 at around 7- 8 p.m. his 2- wheeler Motor Bike bearing registration no. WB 96A 7885 met with an accident dashed by a pick-up van coming from the opposite side and hitting an electric post. The complainant got himself injured and was treated by local physician. It is the case of the complainant that as per the advice of the insurance agent, the damaged vehicle was brought to the automobile repairer OP-2 on 05.08.2019 which is the network Service provider of the Insurance Company. The complainant exhibited copy of the receipt dated 05.08.2019 issued by the repairer against the vehicle deposited for inspection. It is further submitted by the complainant that inspite of several follow ups with the OP-1 & OP-2 Insurance Company and their repairer, there was no respite about the insurance claims. In the complaint petition the complainant mentioned about receipt of an e-mail from the OP-1 Insurer on 26.06.2020 with query about the claim intimation having given with 15 days delay on 28.01.2020 against the date of loss being on 13.01.2020 as mentioned in the claim form. The complainant received one more email from the OP1 Insurer on 11.10.2020 asking about the date of loss mentioned as 27.07.2019 against the date as 13.01.2020 in the claim form. The complainant exhibited documents in support of ownership of the vehicle, valid insurance policy, tax token, driving license, receipt dated 05.08.2019 for the 2- wheeler from the OP-2 repairer, e-mail copy dated 25.06.2020, 26.06.2020, 27.06.2020 and 11.10.2020 from the insurer. But no job card copy is found on record as claimed in the complaint petition. The complainant prayed for a claim for Rs.22,500/- on account of repair of the damaged vehicle along with Rs.70,000/- as compensation and a litigation cost of Rs.8,000/- totaling to Rs. 1,00,500/-.
The OP opposes the move of the complainant and contested the insured’s own damage claim that was reported to the insurer on 28.01.2020 by mentioning the date of loss in the claim form as 11.01.2020. The OP-1 Insurance Company contested that the complainant misguided the insurers by providing incorrect information about the date of loss in the claim form. The OP-1 insurer also denied that the complainant having contacted the Insurance Company through their call centre as there is no evidence to that effect provided by complainant. It is contested by OP1 that the complainant failed to submit any declaration or provide any bonafide document in support of the actual date of loss even after repeated requests. The OP-1 Insurer further argues that when internal surveyor was appointed by Insurer asking the complainant to provide the OEM Job Card and Gate Entry Card for further scrutiny about date of incident in terms of IRDAI guide-lines, but the complainant ignored the same. The Insurer opposes the move of complainant that Surveyor found the damage caused at the vehicle is due to old age and rusting. As such the Insurer was not in a position to process the claim as per extent guidelines. The OP-1 Insurer claims that the complainant has not approached the Commission with clean hands but with intentions and consequently there is no deficiency in service as alleged by the complainant neither there was any unfair trade practice by the OPs.
The complaint case was heard in full on 27.07.2024 when both sides filed BNAs and advanced their arguments. Records and exhibits were perused. The case has been running ex-parte against the OP-2 which is the service provider appointed by OP-1 Insurance Company for estimation of the vehicle under damage claim. OP1 Insurance company contested the case by filing W/V. Thereafter 29.08.2024 was fixed for delivery of Judgment. The case file was received 02.09.2024 for preparing this Judgement / Final order and was rescheduled for delivery of Judgment on 06.09.2024.
It appears that the complainant is a vehicle Insurance policy holder of the OP-1 Company for the period from 18.06.2019 to 17.06.2020 against payment of a premium for own damage, 3rd party and PA cover for an annual premium of Rs.1,740/-. Hence, the complainant is a consumer under the scopes and meaning of the Consumer as defined under the Consumer Protection Act, 2019.
All the points of contesting parties are taken up together for the sake of brevity and to avoid repetitions.
The main points of dispute is centering around the date & time of lodging vehicle insurance claim at the material point and delay thereof, if any. There is no quarrel between the contesting parties on the documentation and other factual part of the dispute. The rebuttal of the OP Insurance company is about the contradiction on the time of accident. It appears that the complainant approached the OP-2 network automobile repairer namely Sri Krishna Automobiles, Jogibottala, Baruipur. From the Insurance policy it is clear that the OP2 is not only the network repairer of OP1 Insurer but also their Insurance Agent. The OP1 Insurance company exhibited the same Insurance policy in part – but by hiding the name and signature portion of the OP2 Agent. Therefore it is amply clear that the accident intimation was in the knowledge of the Insurer or their Agents & hence the denial of OP1 is not sustainable..
In the Annexure-B the time and date of accident of the vehicle is mentioned as 18.01.2020 at 7:00 p.m. which is signed by the insured but the exhibited claim form is found undated. It is quite apparent here that although there was a delay in intimating and filing the claim intimation as pointed out by the OP-1 but from Annexure E exhibited by OP1, it appears that the receipt of the vehicle at the workshop of the OP- 2 was with a promised date of delivery as on 05.08.2019. This exhibit was not contradicted by the OP-1 Insurer. Hence mere date of claim or delay thereof can not be of sole consideration to deny the insurance claim. Also the delay in filing claim is not much of a violation and not beyond IRDAI rules on limitation period and quite justified as per factum of the case.
Further as per annexure-D, the estimate dated 14.01.2020 for Rs.27,513/- depicts that all the parts and description of items to be replaced for repairs points out that the claim is more or less about damages of Headlight, assembly, Visor, Meter assembly, Fork, Fender, Number plate, Muffler etc. which can take place in case of accidental damages and not due to rusting or old age only. Therefore the Insurer has not succeeded to substantiate their point herein.
The claim of Job card and gate pass from the complainant is also not sustainable as these documents are the records of the Insurer OP1 or their Agent OP2. Hence there is no cogent reason to deny claims on these grounds.
In view of such stipulation it can be said that in the instant case the responsibility was casted upon the Insurance company to give insurance coverage and to compensate the sufferer. But in the case in hand there was no effect and under compelling circumstances the Complainant had to approach before the Court of Law. Therefore we are of the view that there was deficiency in service on the part of the OP1.
From the facts and circumstances and materials on record, more particularly, relying upon the evidence on record, it is palpably clear that the OP1 could not keep their promise and as such, they are deficient in rendering services towards a consumer.
In view of the above we are inclined to hold that the complainant is entitled to get the insurance claims in respect of the damages along with appropriate compensation for the mental agony and harassment suffered by them on account of the failure of the OPs to deliver service. We hold that there is deficiency in service on the part of the Opposite parties. In resultant, the Complaint case succeeds.
Fees paid is correct.
ORDER
The OP1 Insurance company is directed to pay the insurance claim of Rs 22,500/- Rs. TwentyTwo Thousand Five Hundred only) along with a simple interest @ 9% per annum from the completion of 60 days after the promised delivery date of vehicle on 05.08.2019 i.e. from 05.10.2019 till the payment of the entire decreetal amount as compensation.
The OP1 Insurance company is directed to pay a litigation cost of Rs. 10,000/- (Rs. Ten Thousand only).
In default, the total payable amount shall carry a simple interest @ 12% per annum. for the entire period till completion of payment.
With the aforementioned order the complaint case is thus disposed of accordingly.
Let a plain copy of this Order be provided to both the parties free of cost as per CPR.
