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

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Complaint Case No  :   51 of 2010

Date of Institution :  25.01.2010

Date of  Decision   :  08.02.2011

Pritam Singh Sandhu son of Sh. Kharar Singh, r/o Kothi No. 15, Sector 19, Chandigarh through his power of attorney holder Parvinder Singh son of Sh. Gurdial Singh, Village Chanalon, Village Kurali, Tehsil Kharar, District Mohali.

….…Complainant

V E R S U S

[1]  The Manager, M/s Reliance General Insurance Co. Limited, Regd. Office: 19, Reliance Centre, Watchand Harchand Marg, Ballard Estate, Mumbai (Maharashtra) – 400001.

[2]     Branch Manager, M/s Reliance General Insurance Co. Limited, SCO No. 212-214, 1^st Floor, Sector 34-A, Chandigarh.

                         ..…Opposite Parties

CORAM:     SH.LAKSHMAN SHARMA              PRESIDENT

SH.ASHOK RAJ BHANDARI            MEMBER

          MRS. MADHU MUTNEJA              MEMBER

PRESENT: Sh. Sandeep Bhardwaj, Adv. for Complainant.

         Sh. Yogesh Saini, Adv. for OPs.

PER ASHOK RAJ BHANDARI, MEMBER

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        Concisely put, the Complainant had got his TATA Winger 4DLTCI Model 2008 bearing Regn. No. CH-04-F-5511 insured from OP No. 2, which was valid from 29.11.2008 to 28.11.2009, with IDV of Rs.6,30,472/-. Unfortunately, on 28.6.2009, when the said vehicle was being driven by his driver Sh.Parvinder Singh, it met with an accident near Khanpur Bus Stand, when an animal came running in front of the car and was badly damaged. Accordingly, the OPs were informed about the accident and the vehicle was taken to authorized dealer - M/s Speed Motors, Indl. Area, Phase-I, Chandigarh, which charged a sum of Rs.1.00 lakh as workshop advance vide receipt dated 27.7.2009 and vide estimate dated 29.6.2009 intimated that the entire body shell of the vehicle was to be replaced. The OPs appointed a Surveyor, who inspected the vehicle, but did not disclose his report to the Complainant. Thereafter, the car was repaired and bill dated 14.9.2009 to the tune of Rs.2,95,436/- and bill dated 14.9.2009 of Rs.3800/- towards the cost of tyres, were raised, which were duly paid by the Complainant to the authorized dealer. But to the utter surprise of the Complainant, the OPs paid only an amount of Rs.2,00,518/- on 16.10.2009 against the bill amount of Rs.2,95,436/- for the complete repairs and replacements and Rs.3800/- towards the cost of tyres (total Rs.2,99,236/-), without any basis. However, the said amount was received by the Complainant under protest and he took up the matter with the OPs, who initially assured him to release the balance amount, but when nothing positive could came out, the present complaint has been filed, alleging the above act of OPs as gross deficiency in service and unfair trade practice, directing the OPs to pay a sum of Rs.94,914/- towards the repair charges of the car, besides an amount of Rs.3800/- paid towards the cost of tyres, along with compensation of Rs.1.00 lakh for mental agony & harassment and Rs.21,000/- towards costs of litigation.

2]      Notice of the complaint was sent to OPs seeking their version of the case.

3]      OPs in their joint written statement/ reply, while admitting the factual matrix of the case/reply, pleaded that immediately upon the receipt of the intimation of the accident, a Surveyor was appointed, who after physically verifying the vehicle vis-à-vis the estimate of repairs and the terms and conditions of the insurance policy approved a sum of Rs.2,00,518/- which was paid to the Complainant vide Cheque No. 397780, dated 06.10.2009. It was also pleaded that no assurance was ever given to the Complainant that any amount over and above the amount as assessed by the Surveyor would be given to him. All other material contentions of the Complainant were controverted. Pleading that there was no deficiency in service on their part, a prayer has been made for dismissal of the complaint with heavy costs.

4]      Parties led evidence in support of their contentions.

5]      We have carefully gone through the entire case thoroughly, including the complaint and the relevant documents tendered by the complainant / OPs. We also heard the arguments put forth by the learned counsel for the parties. As a result of the detailed analysis of the entire case, the following points/issues have clearly emerged and certain conclusions/arrived at, accordingly:-

i]  The basic facts of the case in respect of the Complainant having got his TATA Winger 4DLTCI Model 2008 bearing Regn. No. CH-04-F-5511 insured from OP No. 2, valid from 29.11.2008 to 28.11.2009, with IDV of Rs.6,30,472/- and that the said vehicle met with an accident on 28.06.2009, for which a claim was lodged with the OPs, have all been admitted. It is also a fact that the vehicle was taken by the Complainant to the authorized dealer M/s Speed Motors, Chandigarh and the same was repaired by them and raised a bill of Rs.2,95,436/- dated 14.09.2009 and also a subsequent bill of Rs.3800/- for the cost of tyres. The amounts of all these bills were paid by the Complainant to the Dealer. Subsequently, when the claim was finally passed by the OPs, the amount paid on 16.10.2009 was only Rs.2,00,518/-. The contention of the Complainant is that since he had comprehensively insured his vehicle with the OPs for a sum of Rs.6,30,472/- and the vehicle had been repaired by an authorized dealer, he is entitled to receive the full amount spent by him on repairs and replacements to the tune of Rs.2,99,236/-; whereas, he has been paid only Rs.2,00,518/-. The Complainant has claimed the balance amount of Rs.94,914/- from the OPs, which has not been paid by them. This has led to the present complaint. 

ii] The OPs, in their joint written statement/ reply, while admitting the core facts of the case, pleaded that, immediately, upon receipt of the intimation of the accident, a Surveyor was appointed, who after conducting physical verification vis-à-vis the estimate of repairs and as per the terms and conditions of the Insurance Policy, had approved the claim for a sum of Rs.2,00,518/-, which was paid to the Complainant vide Cheque No. 397780 dated 06.10.2009, in full and final settlement of the accident insurance claim. It has denied having given an assurance to the Complainant that any amount over and above the amount assessed by the Surveyor would be paid to him. After controverting all other contentions of the Complainant, the OPs have prayed for dismissal of the complaint with heavy costs.

iii] After going through the entire case thoroughly, including the documents enclosed, especially the pleadings of the respective parties, the other evidence tendered and finally, the Survey Report, we find that admittedly, the Surveyor appointed by the OPs had submitted his report (Annexure R-1), in which the total amount assessed for the settlement of the accident insurance claim has been listed as Rs.2,16,930.05/-. This includes the gross assessment amount, labour charges, less salvage and indicating net claim amount recommended by him. In the said survey report, it has been acknowledged by the Surveyor that the bill amount was Rs.2,95,436/-, out o which he had recommended the payment of Rs.2,16,930.05/- by the insurance co. and the balance amount of Rs.78,505.95/- was to be borne by the insured himself. It is not understandable and quite surprising as to how the OPs have paid the sum of Rs.2,00,518/- to the Complainant in full and final settlement of the accident insurance claim, instead of paying the recommended sum of Rs.2,16,930.05/-. There is no explanation or any kind of justification in the entire case file taking into account the differential amount of Rs.16,412.05/-, which the Insurance Company was liable to pay to the Complainant, but the same has not been paid to the Complainant so far for the reasons best known to company.

iv] As per the standard practice of the Insurance Companies, as well as in view of the large number of judgments passed by the Hon’ble National Commission and various State Commissions, Survey Report is a very important document for passing the insurance claims and which cannot be ignored or bypassed by any of the parties, unless there are compelling reasons for doing so. By and large, the OPs are duty bound to pay to the Complainant, at least the amount as approved by the Surveyor to the extent of Rs.2,16,930.05/-, if the not the whole amount of the bill i.e. Rs.2,95,436/-. On the contrary, it may not be reasonable and justified to pay the entire amount of the bill i.e. Rs.2,95,436/- to the Complainant on account of the fact that the bill raised by the Company may not contain only the charges for repairs and replacements, which were absolutely necessary for bringing the accidented vehicle into functional order. Quite likely, there might have been some parts and components, which the Complainant got replaced on his own and the same were neither required, nor approved by the Surveyor. Therefore. All said and done, the only admissible amount payable to the Complainant in our view is the amount as approved by the Surveyor i.e. Rs.2,16,930.05/-.

6]      Keeping in view the above details, in our considered opinion, the present complaint has a lot of merit, weight and substance and it must succeed. We, therefore, decide the complaint in favour of the Complainant and against the OPs.

7]      The OPs shall, jointly and severally, make the following payments to the Complainant:-

(i) The OPs shall pay Rs.16,412.05/- to the Complainant, being the differential amount of the sum as assessed and recommended by the Surveyor and the amount already paid by the OPs to the Complainant.

(ii) The OPs shall pay a compensation of Rs.15,000/- for causing physical harassment, mental agony and pain to the Complainant, on account of non-settlement of his insurance claim in full and at least as per Survey Report, despite the lapse of a long time.

(iii)   The OPs shall pay a sum of Rs.7,000/- as litigation costs to the Complainant.

8]      The aforesaid order be complied with by the OPs, within a period of 30 days from the receipt of its certified copy, failing which OPs shall, jointly and severally, pay Rs.31,412.05/-, along with interest @18% per annum with effect from 16.10.2009 i.e. the date on which part payment was made by the OPs to the Complainant, till the date of realization, besides paying the costs of litigation of Rs.7,000/-.

9]     Certified copy of this order be communicated to the parties, free of charge. After compliance, the file be consigned to the record room.

Announced

08.02.2011

                                    Sd/-     

(LAKSHMAN SHARMA)

PRESIDENT

               Sd/-                                           

                                (ASHOK RAJ BHANDARI)

MEMBER

                              Sd/-    

(MRS. MADHU MUTNEJA)