Date of Filing: 13-07-2015 Date of Final Order: 15-03-2016
The Complainant, Sri Anurag Das has filed the present case U/S 12 of the Consumer Protection Act, 1986 against the O.P, National Insurance Company Ltd., Cooch Behar Branch praying for issuing a direction upon the O.P to pay the claim amount to the complainant also to pay as compensation for harassment, godown rent and vehicle repair charge and cost amounting to Rs.15,73,620/- in total and other relief(s) as the Forum may deem feet and proper.
The gist of the complaint as culled out from the record is that the Complainant being owner of the vehicle bearing Registration No. WB-64-G/8190 (Mahindra Xylo) which was insured with the National Insurance Company Ltd., Cooch Behar Branch. The O.P issued a policy vide No.153901/31/13/6100008772 for the period from 01/01/2014 to 31/12/2014 and total sum insured was Rs.8,61,422/-.
During the validity of the said policy, unfortunately on 13/09/2014 when the Complainant was driving his vehicle, he met an accident due to mechanical failure of the vehicle at Shalbari (near Himghar) for which the vehicle of the Complainant almost damaged and the Complainant himself was severally injured. After the said accident the Complainant’s father, Sri Gopal Das informed the Dhupguri Police Station about the said accident and lodged F.I.R vide Dhupguri P.S Case No.420/14 dated 22/09/2014, corresponding G.R. Case No.4624/14. Sri Gopal Das, father of the Complainant also informed National Insurance Company Ltd., Cooch Behar Branch about the said accident. Thereafter releasing the vehicle from the Police custody it was sent to the Khokon Motors Works Pvt. Ltd. in damaged condition and it was lying in the said workshop with garage charge of Rs.200/- per day. After preliminary investigation by the surveyor of the O.P Company it was found that the vehicle was totally damaged. The assessment of repairing which was given by the said workshop was Rs.8,17,480/- and Khokon Motors Works Pvt. Ltd. issued five Money Receipts vide No. (1) 2996 dated 02/03/2015, Rs.3,00,000/-, (2) 3019 dated 07/03/2015, Rs.2,23,198/-, (3) 2339 dated 22/12/2014, Rs.50,000/-, (4) 1934 dated 14/11/2014, Rs.10,000/- and (5) 2338 dated 22/12/2014, Rs.50,000/- after receiving the money of Rs.6,33,198/- from the Complainant which were submitted to the O.P Company on 10/03/2015 according to the direction of the Branch Manager of Cooch Behar Branch of the O.P Company. The Complainant claimed his claim amount to the O.P Company with duly fulfilled claim form along with all relevant original/Xerox copy of documents but the O.P Insurance Company did not give any positive reply. Thereafter the Complainant send Notice dated 14/11/2014, 05/12/2014 and 06/12/2014 with A/D through his lawyer to the O.P Insurance Company to give his claim amount which was legally due to the Complainant. After receiving the said Notice from the Complainant, the O.P Insurance Company gives reply through issued a letter dated 08/12/2014 which was not clear and they have mentioned in the said Notice some baseless grounds also they have not made it clear as to why the claim amount will not be given to the Complainant. By not getting any positive result from the O.P, the Complainant sent Notice on several occasion to the O.P Insurance Company regarding to release his claim amount but all in vain. Lastly, on 06/06/2015 the Complainant went to the Branch Manager of O.P insurance company for getting his claim amount but the O.P did not pay any heed towards the Complainant. On 15/06/2015 the Complainant further sent Notice through his lawyer to the O.P but no fruitful result came out.
Thus the Complainant suffered great loss by such activities from the part of the O.P insurance company and finding no other alternative the Complainant has filed the present case before this Forum seeking redress.
The O.P., National Insurance Company has contested the case by filing written version denying all material allegation of the complaint contending inter-alia that the case is not maintainable and the complainant has no cause of action to bring this case. The main contention of the O.P insurance company is that on 31/12/2013 National Insurance Company Ltd., Cooch Behar Branch issued a Private Car Package insurance policy bearing No.153901/31/13/6100008772 for the period from 01/01/2014 to 31/12/2015 for the vehicle bearing No. WB-64-G/8190 (Mahindra Xylo) in the name of the Complainant Anurag Das. On 08/10/2014 after receiving completed claim form from the Complainant along with all bills, vouchers and copies of vehicular documents and completion of other formalities, the O.P insurance company started to process the claim and completed his process but could not make payment due to non-verification of Driving License of the Complainant though amount already settled at Rs.3,95,534/-.
The O.P Insurance Company further contended that they appointed an Investigator for the verification of Driving License of the Complainant who submitted an application before the R.T.O., Cooch Behar on 16/04/2015 but till now received any information from the R.T.O. The O.P insurance company also mentioned in his W/V that “It is the rule formulated by the Insurance Regulatory & Development Authority (IRDA) a parent & autonomous body of all insurance companies that any claim for damages of vehicle submits by insured, he have to show that at the time of accident all vehicular documents were valid and effective including Driving License, it is also a policy condition”.
Afterwards for the verification of Driving License of the Complainant, the Investigator Mr. Sudip Das, appointed by the above O.P firstly he failed. Subsequently, he filed an application under the Right to Information Act, 2005 on 02/07/2015 at the office of the R.T.O., Cooch Behar. In reply, a letter dated 09/07/2015 was served to the Investigator and advising him to deposit Rs.70/- but the personnel at the R.T.O cash counter refused to accept the amount for the reason that Driving License particulars are not available (Ref. Letter dated 17/07/2015 Investigator inform to the O.P insurance company). On 07/08/2015 the above O.P received a Demand Note for Rs.70/- from the R.T.O, Cooch Behar in response to letter dated 28/07/2015 till then the matter is pending. The entire facts, transaction, correspondence with the R.T.O and circumstances were informed to the Complainant along with copies. It is within the knowledge of the present Complainant that delay in settling his claim caused subject to verification of Driving License of the Complainant.
Therefore, there was no intention to delay and/or repudiate the claim of the Complainant. But the settlement in such a motor accident claim and as per terms & conditions of policy without verification of Driving License of the Complainant, payment could not be made. The O.P Insurance Company also stated that the Complainant is not entitled to get any relief from this O.P as he prayed in his complaint. Relief only be available subject to verification of Driving License of the Complainant himself.
Ultimately, the O.P insurance company has prayed for dismissal of the case against this O.P with a direction to both Complainant and Licensing Authority, M.V. Section, Regional Transport Authority, Cooch Behar to submit Driving License Verification Report at the office of the above O.P for settlement of claim, if Driving License of the Complainant valid and effective at the time of accident, for ends of justice.
In the light of the contention of both parties, the following points necessarily came up for consideration.
POINTS FOR CONSIDERATION
- Is the Complainant is a Consumer as per Section 2(1)(d)(ii) of the C.P. Act, 1986?
- Has this Forum jurisdiction to entertain the instant complaint?
- Has the Opposite Party any deficiency in service by repudiating the claim of the Complainant and are they liable in any way?
- Whether the Complainant is entitled to get relief/reliefs as prayed for?
DECISION WITH REASONS
We have gone through the record very carefully, peruse the entire documents in the record also heard the argument advanced by the parties at a length.
Point No.1.
Evidently, the vehicle of the Complainant was insured with the O.P Insurance Company and the O.P. Insurance Company issued a policy in favour of the Complainant against certain payment.
Thus, the relation between the Complainant and the O.P so established from the record we have no hesitation but to hold that the Complainant is a consumer under the O.P Insurance Company U/S 2(1)(d) of the C.P. Act, 1986.
Point No.2.
The Branch Office of the O.P Insurance Company is situated at Cooch Behar town and total valuation of this case is Rs.15,73,620/- which is less than maximum limit of Rs.20,00,000/-.
So, this Forum has territorial and pecuniary jurisdiction to try this case.
Point No. 3 & 4.
Admittedly, the vehicle of the Complainant insured with the National Insurance Company Ltd. being Policy No.153901/31/13/6100008772.
It is the case of the Complainant that his vehicle bearing No.WB-64-G/8190 (Mahindra Xylo – E-9) met an accident on 13/09/2014 at Shalbari (near Himghar), P.S. Dhupguri due to mechanical failure of the vehicle. The Complainant was driving the vehicle at the material point of time of accident. Complainant’s father lodged an F.I.R within a short time of accident to the Dhupguri Police Station on 22/09/2014 and also informed the matter to the National Insurance Company Ltd., Cooch Behar Branch. The vehicle damaged badly and need to service for which after releasing the vehicle from Dhupguri P.S, the damaged vehicle brought to the Khokon Motors Works Pvt. Ltd. and the total cost of repairing assessed by the workshop is Rs.8,17,480.69 and preferred claim to the O.P Company. The Insurance Company did not settle the case on various pretexts. The Complainant is rightly entitled to get the said claim amount. The accident occurs within the valid period of the policy i.e. from 01/01/2014 to 31/12/2014.
It is the case of the O.P that the O.P insured a Private Carr Package Insurance Policy bearing No.153901/31/13/6100008772 for the period from 01/01/2014 to 31/12/2015 for the vehicle bearing Registration No. WB-64-G/8190 in the name of the present Complainant from the Cooch Behar Branch on 31/12/2013. After receiving completed claim form from the insured, the present Complainant on 08/10/2014 along with all bills, vouchers and after completion of all formalities, the Insurance Company completed the process of claim and settled the claim at Rs.3,95,534/- but cannot make payment due to non-verification of Driving License because the IRDA framed rule that any claim for damaged vehicle the insured have to show that at the time of accident all vehicular documents & Driving License were valid and effective, that is also a policy condition. The O.P made several attempts for verification of Driving License of the insured person before the R.T.O., Cooch Behar. But all efforts were in vain for which the claim of the Complainant has not been settled but the O.P. Insurance Company is ready to settle the claim but without verification of Driving License, payment could not be made as per terms & condition of the policy.
The Annexure filed by the O.P, Insurance Company it appears that on 16/04/2015 the O.P, Insurance Company wrote a letter to the R.T.O, Cooch Behar for obtaining certified copy of Registration Certificate of the damaged vehicle and Driving License of the driver of the said vehicle, Sri Anurag Das. The O.P also requested to obtain the same by an application under R.T.I Act, 2005 by the Advocate on 02/07/2015. The R.T.O also informed to the Advocate as well as the O.P to deposit requisite fee for obtaining Driving License particular by dated 09/07/2015 & 07/08/2015 but the O.P Company did not paid the same also no documents to show the payment of fees available in the record. By letter dated 12/06/2015 Annexure-“D” the O.P Company also requested to the Complainant to file the certified copy of his Driving License for verification.
Thus it appears that the O.P only for verification of Driving License or Registration Certificate of the damaged vehicle took many times i.e. from 28/10/2014 to till date. The O.P. was informed about the accident within a short period i.e. on 16.09.2014 and the accident happened on 14.09.2014. The claim by the Complainant preferred on 08.10.2014. The O.P. took initiative for the first time on 13.04.2015. and in the mean time no surveyor was appointed by the O.P. Insurance Company. Thus it is crystal clear that the O.P. did not provide proper service in due time for settling the claim of the Complainant.
In this juncture, reliance has been placed upon the ruling reported in (2012) CJ 797 (NC) cited by the Ld. Agent for the Complainant where in Hon’ble National Commission pleased to hold that delay in settlement of claim amount to deficiency in service.
In another case reported in (2015) CJ 114 (NC), Hon’ble National Commission observed that insurance claim must be settled or rejected within reasonable time of two months. In the present case the O.P. did not settle the claim till now though he received claim in due time. That being the position, the deficiency in service of the O.P. cannot be ruled out.
Admittedly, the vehicle of the Complainant insured with the O.P Insurance Company and the IDV of the said vehicle is Rs.8,61,422/-. The O.P. filed Surveyor Report along with some photographs of the said vehicle after accident. Perused the same. The Complainant files an attested copy of D.L. of the Complainant, perused also the original D.L. which reveals that the said D.L. is valid up to 04.04.2030 for which it is crystal clear that during the material time of accident the Complainant/driver bears a valid driving license.
The accident, damage of the vehicle all are admitted also we find that Driving License in the name of Anurag Das who drives the vehicle at the material time of accident is valid one. So, there is no reason to withhold the matter. The O.P had taken plea that due to non-verification of Driving License of the driver, who drives the vehicle at the material point of accident. There is no iota of evidence on record that the claim of a damaged vehicle be settle subject to verification of D.L. of the driver who drives the vehicle at the material time of accident. Only one document filed by the Ld. Agent for O.P. which reveals that the insured must be ready to produce D.L. of the driver before the surveyor when asked. Thus, it is very much clear that the O.P. Insurance Company withheld the matter of the claim of the Complainant in a flimsy ground that tantamount to deficiency in service.
It appears that the Complainant filed some bills of Khokon Motors where it is evident that for repairing the damaged vehicle Rs.6,33,198 and the Complainant claim before this Forum, total IDV i.e. Rs.8,61,422/-. In this juncture, reliance has been placed upon the rulings reported in 2016 (1) CPR 291 (NC) the Hon’ble National Commission observed that Insurance Company is required to pay IDV of insured vehicle to complainant when the cost of repair of the vehicle exceeded 75% of the IDV of the vehicle. In the present case the cost of repair did not exceed 75% of the IDV. Thus, the Complainant is not entitled to get the said amount. Considering the facts and circumstances, for proper adjudication of the present case we have to rely upon the report of the Surveyor dated 24.03.2015 as it is already settled in a case reported in 2016 (1) CPR 271 (NC) that Report of the Surveyor carries infinite value.
Annexure-“E” of the O.P is Surveyor Report who assessed the loss at Rs.3,95,534/-. During the course of argument the ld. Agent for O.P. frankly stated that the O.P. is ready to settle the claim as per surveyor report though verification of the D.L. has not been made till date. Thus, it can reasonably be presume that the O.P. took a false plea for settling the claim and delayed the matter whimsically. Moreover the O.P. Insurance Company appointed the surveyor after elapsing so many months though O.P. received the claim in due time that tantamount to deficiency in service.
In the light of the above discussions, we hold that the act and conduct of the O.Ps to our estimation must be termed deficiency in service that come within the purview of deficiency in service and accordingly that comes within the ambit of section 2(1)(g) of Consumer Protection Act, 1986. Thus, considering the facts and circumstances also relied on the documents made available in the record we are inclined to hold that the Complainant is entitled to get claim amount but in part also compensation for deficiency in service of the opposite party.
ORDER
Hence, it is ordered that,
The present Case No. CC/64/2015 is allowed on contest but in part with litigation costs of Rs. 10,000/-.
The O.P is hereby directed to pay the Complainant Rs. 3,95,000/- with interest @9% P.A. from the date of filing the present case i.e. 13/07/2015 till realization. The O.P. is further directed to pay Rs.50,000/- as compensation to the complainant for deficiency in service of the O.P., caused mental agony of the Complainant. The ordered amount shall pay to the Complainant by the O.P. within 45 days failure of which the Opposite Party shall pay Rs.100/- for each day’s delay and the amount to be accumulated shall be deposited in the “State Consumer Welfare Fund”, West Bengal.
Let a plain copy of this Order be supplied to the parties concerned by hand/by Registered Post with A/D forthwith, free of cost, for information & necessary action, as per rules.
Dictated and corrected by me.
President in- charge President in-charge
District Consumer Disputes District Consumer Disputes
Redressal Forum, Cooch Behar Redressal Forum, Cooch Behar
Member
District Consumer Disputes
Redressal Forum, Cooch Behar
