Haryana

Karnal

CC/41/2020

Sanjeev Kumar - Complainant(s)

Versus

The Manager, Shriram General Insurance Company Limited - Opp.Party(s)

Muddit Arora

06 May 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 41 of 2020

                                                        Date of instt.20.12.2020

                                                        Date of Decision:06.05.2024

 

Sanjeev Kumar son of Shri Satpal, resident of house no.228, Gharaunda District Karnal, age 32 years.

                                                                        …….Complainant.

                                              Versus

 

The Manager, Shri Ram General Insurance Co. Ltd. Sector-3, Karnal, shop no.10.

 

                                                                …..Opposite Party.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.      

      Sh. Vineet Kaushik…….Member

      Dr.  Suman Singh…..Member

 

 Argued by: Shri Mudit Arora, counsel for the complainant.

                    Shri Vineet Rathore, counsel for the OP.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that complainant is owner of vehicle (TATA Ace) bearing no.HR-65-6270, which was insured with OP, vide policy no.10003/31/18/511929, valid from 28.01.2018 to 27.01.2019. The said vehicle met with an accident and was totally damaged and in this regard an FIR no.660 dated 18.09.2018, under section 279/337/338 IPC has been registered in Police Station Gharaunda. Intimation regarding said accident was given to the OP within time. Complainant lodged a claim with the OP and submitted all the required document for settlement of the claim. Thereafter, complainant contacted the OP several times and requested them to pay the said claim but OP did not pay any heed to the request of complainant and till date has not paid the said claim. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence complainant filed the present complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that the accident allegedly took place on 16.09.2018 and as per the version of the informant before the police, it has been stated that TATA Magic bearing registration no.HR656270 was being driven by one Sanjay son of Satpal alongwith Shyamlal son of Telu Ram was hit by a  Tractor Trolley coming from front side. Due to this impact Sanjay received serious head injuries and was taken to GH, Karnal, then shifted to PGI Rohtak and thereafter was referred to AIIMS Delhi. This information qua the accident was shared after delay of 17 days on 03.10.2018 with the OP without any explanation. This fact suggests that complainant has filed the present false and frivolous complaint against the OP in order to harass the OP. It is further pleaded that  after receiving the belated information, an independent surveyor namely Shri Manmeet Singh Makkar was deputed by the OP, who surveyed the vehicle and assess the loss and intimation of same was given to complainant. The Insured Declared Value of the vehicle was Rs.188744/-. The surveyor asked the complainant to produce the original documetns and/or the copies of the remaining documents on several occasions but the complainant, who is insured had not forwarded any response and lingered on the matter knowing fully well that person driving the vehicle at the time of alleged accident was not authorized to drive the vehicle in question and there is reasonable delay in providng the intimation and information to police with ulterior motive. After that the surveyor had submitted his survey report by assessing the loss as Rs.55250/-towards company liability on the basis of survey subject to compliance of terms and conditions of the insurance policy so incorporated therein. Further, the complainant was asked to supply the driving licence of Sanjay son of Satpal at the material time of accident as he was not authorized to drive the vehicle in question. It is further pleaded that after considering all the facts, the reminders/notices were given to the complainant for supplying, complying and providing the documents to process the claim but complainant miserably failed to comply and provide the requisite documents. As such there is clear cut violation of terms and conditions of the policy and behavior of complainant was not supportive, as such claim was closed and complainant was intimated with closure of claim letter dated 22.10.2018. As such the complainant was not interested in taking the claim, hence claim was closed and complainant was satisfied with the justified ground of repudiation of claim and not reverted back. It is further pleaded that the complainant has not arrayed the driver the owner of offending vehicle i.e. Tractor Trolley as necessary party. The complainant be directed at this stage to array the offending vehicle as necessary party and to seek compensation if any. It is further pleaded that the vehicle in question hypothecated with Shri Ram Transport Finance Company, as such finance company is just, proper and necessary party for just decision of matter. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of driving licence Ex.C1, copy of RC Ex.C2, copy of insurance policy Ex.C3 and closed the evidence on 20.10.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Santosh Kumar Sharma, Senior Executive (Legal) Ex.OP1/A, copy of policy cover Ex.OP1, copy of commercial policy Ex.OP2, copy of letter dated 22.10.2018 Ex.OP3, copy of driving licence detail Ex.OP4, copy of driving licence Ex.OP5, copy of FIR Ex.OP6, copy of claim history report Ex.OP7, spot detail Ex.OP8, copy of Audit Summarized sheet Ex.OP9, copy of report accident photos documents Ex.OP10, copy of Motor Claim Approval Sheet Ex.OP11, copy of claim detail Ex.OP12 and closed the evidence on 09.05.2023 by suffering separate statement.

6.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that complainant is the registered owner of vehicle TATA Ace and the said vehicle was insured by the complainant with OP. The said vehicle met with an accident on 16.09.2018 and was totally damaged. An FIR no.660 dated 18.09.2018 under section 279/337/338 IPC has been registered in Police Station Gharaunda. Intimation was given to the OP and on receipt of intimation, OP appointed a surveyor. The surveyor of the OP verified the facts of accident and prepared his report.  Complainant submitted all the required documents with the OP and also requested to disburse the claim amount but OP did not pay the same and lastly denied the claim of complainant on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that the accident occurred on 16.09.2018. The intimation qua the said accident was given to the OPs after delay of 17 days without any explanation. On receipt of intimation, an independent surveyor, namely Shri Manmeet Singh Makkar was deputed by the OP, who surveyed the vehicle and assessed the loss to the tune of Rs.55250/-. The person driving the vehicle at the time of alleged accident was not authorized to drive the vehicle in question. Thus, the OP has rightly closed the claim of complainant and lastly prayed for dismissal of the complaint

9.             We have duly considered the rival contentions of the parties.

10.           Admittedly, the vehicle in question met with an accident during the subsistence of the insurance policy. It is also admitted that the insured declared value of the vehicle in question was  Rs.188744/-11.           The claim of the complainant has been closed by the OP, vide letter Ex.OP3 dated 22.10.2018 on the grounds, which are reproduced as under:-

                1.     Attached Claim form completely filled and duly signed.

                2.     Verified copy of fitness certificate.

                3.     Verified copy of Route Permit (if applicable)

                4.     Repairs estimate.

                5.     Certified copy of FIR and Chargesheet.

 

12.           The claim of the complainant has been closed by the OP on the abovesaid ground. It is not possible that the complainant has not  submitted the signed claim form. When the OP himself has placed on file, copy of FIR Ex.OP6, then as to why, complainant has not submitted the same to the OP. Other, queries raised by the OP are baseless. Moreover, it is also unbelievable an insured whose personal interest is involved for such huge amount why he will not supply the documents to the insurance company for getting his claim amount and will indulge himself in unwanted litigation. Hence, in view of the above, the plea taken by the OP has no substance.

13.            OP has further alleged that the vehicle in question met with an accident on 16.09.2018 but intimation in this regard was given to the OP on 03.10.2018 i.e. after the delay of 17 days. The complainant has lodged the FIR bearing no.660 dated 18.09.2018 in Police Station Gharaunda regarding the said accident after two days. But complainant has alleged that he intimated to the police on the same day but police has lodged the FIR on 18.09.2018.  Therefore, it cannot be said that there was any unreasonable delay on the part of the complainant in lodging the FIR and intimation to OP. The rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy holder in the insurance industry. If the reason for delay in making a claim is satisfactory explained, such a claim cannot be rejected on the ground of delay.

15.  

“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy”.

16.           Keeping in view, the ratio of the law laid down in aforesaid judgments, facts and circumstances of the present complaint, the act of the OP while repudiating the claim of the complainant amounts to deficiency in service, which is proved otherwise genuine.

17.           Complainant has claimed Rs.1,64,730/- but he has not placed on file any repair bill/invoice. On the other hand, surveyor of the OP, vide his report Ex.OP11, has assessed the loss to the tune of Rs.75250/- whereas the OP has alleged that the surveyor has assessed the loss as Rs.55250/- but it cannot be relied upon as in surveyor report Ex.OP11, it is clearly evident that the assessed loss of Rs.75,250/- but Rs.55250/- is simply written by hand and no further explanation is given for the same. Hence the surveyor report will prevail and the complainant is entitled for Rs.75,250/-. In this regard we are relying upon the judgment 2(2008) CPJ paged 182 (NC), United India Insurance Co. Vs. Maya, wherein it has been held that a surveyor report should not be dismissed summarily as the surveyor is independent and qualified person under the relevant provision of Insurance Act, 1938. In view of this authority as well as the facts and circumstances of the case, we are of the considered view that the OP are liable to pay the loss assessed by the surveyor alongwith interest, compensation for mental agony and harassment and litigation expenses.

18.           In view of the above discussion, we partly allow the present complaint and direct the OP to pay Rs.75250/- (Rs.seventy five thousand two hundred fifty only) as the loss assessed by the surveyor of the OP alongwith interest @ 9% per annum from the date of closing the claim till its realization to  the complainant. We further direct the OP to pay Rs.20,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.11,000/- for the litigation expenses. This order shall be complied within 45 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 06.05.2024                         

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Suman Singh)

                          Member                     Member