DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

Consumer Complaint No. : 42 of  15.01.2015

Date of Decision            :   19.08.2015

Harjinder Singh son of Shri Gurdev Singh, resident of House No.2948, Street No.7, Near A.T.I., New Janta Nagar, Ludhiana.

….. Complainant

Versus

1.United India Insurance Company Limited, 455, Mall Road, Ludhiana through its Branch Manager.

2.United India Insurance Company Limited, Regd. & Head Office : 24, Whites Road, Chennai-600014 through its Managing Director.

…Opposite parties

                             (Complaint U/s 12 of the Consumer Protection Act, 1986)

QUORUM:

SH.G.K.DHIR, PRESIDENT

SH.SAT PAUL GARG, MEMBER

MS.BABITA, MEMBER

COUNSEL FOR THE PARTIES:

For complainant                      :         Sh.N.S.Oberoi, Advocate

For Ops                         :         Sh.D.R.Rampal, Advocate

PER G.K DHIR, PRESIDENT

1.                          Sh.Harjinder Singh filed complaint under Section 12 of the Consumer Protection Act, 1986(hereinafter referred to as ‘Act’) against the OPs, by alleging that he is owner of a Motor Cycle bearing No.PB-10-DA-4979. That Motor Cycle was got insured from Ops vide policy No.2007003113P100926029 for the period from 14.05.2013 to 13.05.2014. Premium amount of Rs.1057/- was paid. That Motor Cycle met with an accident on 21.05.2013, when Mr.Jasbir Singh, son of the complainant was traveling thereon. DDR No.19 dated 21.05.2013 was lodged at P.S.Focal Point, Ludhiana regarding that accident. Said Mr.Jasbir Singh sustained injuries and he was got admitted in Mohandai Oswal Hospital, Ludhiana on 21.05.2013, vide CR No.25386. Said Mr.Jasbir Singh remained admitted there until 27.5.2013. The motor cycle was got repaired by spending an amount of Rs.21,406/-. Claim for reimbursement of this amount was lodged with Ops by supplying all the necessary documents. A surveyor of name of Sh.Munish Kapila visited the house of the complainant for putting queries, which were answered by the complainant. However, due to mistake, date of accident was mentioned as 25.05.2013 instead of 21.05.2013. Claim of the complainant wrongly repudiated and that is deficiency of service alleged. Despite service of legal notice dated 31.07.2014 posted on 4.8.2014 to the OPs, the claimed amount of Rs.50,000/- not paid. So directions sought for payment of the said amount of Rs.50,000/- alongwith litigation expenses of Rs.22,000/-.

2.                          Ops appeared and filed written statement by claiming interalia as if the complaint is not maintainable in the present form; complaint is bad for non joinder and mis joinder of necessary parties; complainant has not approached this Forum with clean hands; complainant is estopped by his act and conduct from filing the present complaint. Moreover, it is pleaded that intricate questions of law and fact are involved, due to which, an elaborate evidence is required. In view of this, it is pleaded that Civil Court alone is competent to decide the present complaint. Admittedly, the insurance policy regarding the motor cycle in question was valid for the period w.e.f.14.05.2013 to 13.05.2014. It is claimed that the complainant has not supplied the copy of DDR No.19 dated 21.05.2013, but he has disclosed this fact through this complaint for the first time. In legal notice, it is mentioned as if DDR No.14 dated 23.05.2014, alleged to be lodged regarding the accident in question. So, concealment of material facts pleaded. Admittedly, Sh.Munish Kapila, the surveyor assessed the loss. However, the complainant has not submitted the required documents. Claim of the complainant rightly repudiated because of concealment of material facts and submission of wrong declaration. Intimation regarding the accident was submitted on 09.06.2013 by disclosing the date of accident as 25.05.2013. It was also submitted as if Mr.Jasbir Singh, son of the complainant remained admitted in Grewal Hospital. Surveyor assessed the loss of motor cycle at Rs.10,912/- excluding the value of the salvage assessed at Rs.400/-. Complainant disclosed the date of accident to the surveyor as 25.05.2013. Another survey was got conducted at the premises of M/s Shree Dadu Autos Pvt. Ltd. on 09.06.2013. Complainant submitted acceptance for the assessed loss of Rs.10,511/- by the surveyor. ECS Mandate Form dated 10.08.2013 alongwith blank cheque in that respect was submitted by the complainant with the surveyor. Even in the Claim Form, date of accident disclosed as 25.05.2013. Despite notice dated 8.7.2013 sent by the surveyor Sh.Munish Kapila, the requisite documents were not submitted. Reminder dated 20.7.2013 was also sent to the complainant, but despite that the documents were not submitted. Despite repeated requests, insured has failed to submit the driving license of Mr.Jasbir Singh in original and that is why, the claim file was closed as case of ‘No Claim’. Complainant also got deputed Sh.H.C.Kalia as Investigator, who after thoroughly investigating the facts of the case, submitted report dated 20.11.2013 after recording the findings that son of the complainant sustained injuries on 21.5.2013, due to which, he remained admitted in Mohandai Oswal Hospital on 21.05.2013. Son of the complainant remained admitted in Grewal Hospital, Gill Road, Ludhiana on 7.7.2013 and discharged there from on 9.7.2013. Certificate dated 16.11.2013 was also issued by Grewal Hospital, Gill Road, Ludhiana. Complainant submitted one affidavit duly attested by Notary Public on 3.9.2013 for disclosing the date of accident as 25.05.2013. Same date was mentioned by the complainant in the statement got recorded by him with investigator. Reply to legal notice sent by the complainant even was sent. Each and every other allegation of the complaint denied.

3.                Complainant to prove his case tendered his affidavit Ex.CA alongwith documents EX.C1 to Ex.C10 and thereafter, Sh.N.S.Oberoi, Advocate closed the evidence on behalf of complainant.

4.                On the other hand, counsel for the OPs tendered in evidence affidavit Ex.RA of Sh.R.R.Sethi, Manager United India Insurance Co.Ltd alongwith affidavit Ex.RB of Er.Manish Kapila, surveyor and loss assessor and Ex.RC of Sh.H. C. Kalia, Investigator  and  even  tendered  documents  Ex.R1  to                   Ex.R51 in evidence and thereafter, closed the evidence on behalf of Ops.

5.                          Written arguments not submitted by any of the parties. Oral arguments addressed and were heard. Records gone through minutely. 

6.                The bone of contention remains as to whether there is suppression of material facts qua date of accident and place of admission of son of complainant namely Mr.Jasbir Singh in a hospital. Certainly, the complainant has mentioned different date of accident in statement with surveyor than the one mentioned in the complaint. However, the complainant has submitted explanation through para no.3 of complaint and corresponding para of affidavit that date of accident mistakenly mentioned by him as 25.05.2013 instead of 21.05.2013. Copy of DDR No.19 dated 21.05.2013 Ex.C3 there on record to establish that intimation regarding the date of accident was submitted for the first time on 21.05.2013 itself with P.S.Focal Point, Ludhiana. Present complainant, being the father of Mr.Jasbir Singh claimed as if his son lying admitted in Mohandai Oswal Hospital in injured condition, but he is unfit to suffer statement. Record of admission of said Mr.Jasbir Singh s/o Sh.Harjinder Singh(complainant) in Mohandai Oswal Hospital Ex.C4 even has been produced. Perusal of these documents reveals that actually intimation regarding the accident in question was submitted to the Police Station on the date of accident itself namely 21.5.2013 and injured even was admitted in Mohandai Oswal Hospital on that date itself. So, if subsequently date of accident mentioned as 25.5.2013, then the same may be due to some willy-nilly mistake.

7.                If in the legal notice dated 31.7.2014 Ex.C6 sent by the complainant to the Ops through postal receipts Ex.C7 and Ex.C8, mention of DDR No.14 dated 23.5.2014 made, then the same may be due to mistake of the counsel because complainant never claimed about taking place of accident on 23.5.2014. It is well settled that litigants must not suffer due to mistake of counsel and as such, wrong mentioning of the DDR number or the date in notice Ex.C6 alone cannot be considered as fatal because technicalities must not come in the way of the administration of justice.

8.                 As per law laid down in case Sunil Sharma vs. National Insurance Co.Ltd-II(2015)Consumer Protection Judgments-46(Delhi State Commission), an otherwise genuine claim should not be rejected on flimsy and technical grounds. In case, it is so done, then the confidence of the people in the insurance companies will stand deeply eroded. Further in this case it was held that disputes are to be decided on yardsticks of reasonableness, probability and principle of natural justice. As per ratio of this case, in case different dates of theft of the vehicle mentioned, then the same will not imply that the vehicle was not stolen. Analogy of the law laid down in this case is applicable to the facts of the present case and as such, in case, different dates mistakenly mentioned qua the date of accident, then the same will be no ground for holding that  in fact the accident in question has not taken place.

9.                Even in case of New India Insurance Company Limited vs. Mohan Jyoti Chavan and another-III(2015)CPJ-6B(CN)(Maharashtra State Commission), it is held that insurance scheme is a social legislation and as such, claim must not be repudiated on technical grounds. Therefore, repudiation of the claim cannot take place just due to technical fault of not mentioning correct date of accident in notice Ex.C6 or in statement suffered by the complainant with investigator, the copies of which are produced on record as Ex.R39 and Ex.R40. Even if in affidavit Ex.R37, date of accident mentioned as 25.05.2013, but despite that contents of   Ex.R39  cannot  be  ignored,  in which, complainant disclosed that he was under lot of stress and strain due to injuries sustained by his son in an accident, on account of which, he could not give intimation qua the accident to Ops at earliest. As and when a person is perplexed after knowing about the serious injuries suffered by his son in an accident, then he may forget the exact date of accident and as such, mentioning of different date of accident is not the sole criteria for ascertaining that complainant deliberately suppressed the material facts.

10.              Investigation Report Ex.R42 of the Surveyor and Loss Assessor namely Sh.H.C.Kalia appointed by insurance company also discloses as if the date of accident was 21.5.2013, due to which, Mr.Jasbir Singh remained admitted in M/s. Mohandai Oswal Hospital, Sherpur, Ludhiana w.e.f.21.5.2013. Confirmation in that respect was obtained by the said surveyor from M/s Mohandai Oswal Hospital, Sherpur, Ludhiana is a fact born from perusal of page no.3 of Ex.R42 itself. So surveyor appointed by the insurance company himself found as if the date of accident was 21.5.2013. So, if in documents referred above, different date of accident is mentioned, then the same may be due to mistake only.

11.              It is also contended by Sh.D.R.Rampal, Advocate that complainant has given distinct version regarding his admission at Grewal Hospital, Gill Road, Ludhiana and Mohandai Oswal Hospital, Sherpur, Ludhiana. Perusal of Ex.R34 to Ex.R36 reveals that Investigator Sh.H.C.Kalia even found as if complainant remained admitted in Grewal Hospital, Gill Road, Ludhiana on 9.7.2013 & 20.8.2013. These dates of admission in the Grewal Hospital, Gill Road, Ludhiana were for getting follow up treatment of facture of right leg injury. So if name of Grewal Hospital, Gill Road, Ludhiana also disclosed as the place of admission of Mr.Jasbir Singh, then the same was because of the fact that this admission was on different dates than the date of accident. Contents of Ex.R41 further establishes that investigator of Ops themselves found as if Mr.Jasbir Singh did not remain admitted in Grewal Hospital, Gill Road, Ludhiana after the accident, but he was admitted in some other hospital. So, evidence collected by the Ops themselves establishes that Mr.Jasbir Singh after the accident of 21.5.2013 remained admitted in Mohandai Oswal Hospital. Discharge Summary Ex.R43 alongwith investigation report(Text Type) of Mohandasi Oswal Hospital Ex.R44 further establishes as if Mr.Jasbir Singh remained admitted in Mohandai Oswal Hospital from 21.5.2013 to 27.5.2013. Ex.R45 is the certificate issued by Grewal Hospital, Gill Road, Ludhiana to show admission of Mr.Jasbir Singh in the said hospital on 7.7.2013. So, repudiation of the claim through Ex.R48 on the grounds that different date of accident mentioned is not proper.

12.              Record regarding amount of expenses born on treatment of Mr.Jasbir Singh is not much material because through this complaint, compensation with respect to the damage of motor cycle owned by the complainant alone is sought. Copy of Certificate of Registration Ex.C1 of motor cycle in question establishes as if the complainant is the registered owner thereof. So, certainly the complainant entitled to get the compensation amount as per the terms and conditions of the insurance policy Ex.C2.

13.              It is vehemently contended by Sh.D.R.Rampal, Advocate that for getting claim under the insurance policy, the person driving the insured vehicle must have been holding effective driving license. That driving license in original or copy is alleged to be not produced with the surveyor and  as such, it is claimed that repudiation of claim is proper. However, after going through letter of repudiation Ex.R47, it is made out as if the claim has been repudiated due to mis-representation of material facts regarding the date of accident as well as with regard to the name of the hospitals, where Mr.Jasbir Singh remained admitted. Position in that respect is already discussed in detail above, for finding that there is no mis-representation virtually in mentioning the wrong date of accident. Admission in different hospital was at different intervals and as such there is no suppression of facts in that respect. The repudiation of claim through Ex.R47 not ordered due to non production of driving license and as such, said fact pails into insignificance.

14.              Submission of Sh.D.R.Rampal, Advocate has no force that necessary documents were not submitted by the complainant. It is so because after going through the report Ex.R45 of Sh.Munish Kapila, the surveyor, it is made out that particulars of the vehicle, driving license, policy number and cause of accident has been specifically mentioned therein. Not only in Ex.R5, but even in other investigation report Ex.R42, it has been found that accident of the motor cycle in question actually took place and thereafter, damage to the same caused. Photostat copies of photographs of the damaged motor cycle are produced on record as Ex.R9 to Ex.R27. How those particulars came to the knowledge of the surveyor/investigators qua that no explanation offered and as such, inference is obvious that actually these particulars were supplied by the complainant and none else.

15.              Even if the bills of repair have not been produced by the complainant, but despite that Sh.Munish Kapila, surveyor through report Ex.R5, assessed the loss to the motor cycle at Rs.10,912/- including the salvage value assessed at Rs.400/-. After this report Ex.R5 as well as Ex.R42, complainant was made to handover blank signed cheque Ex.R8 alongwith ECS Mandate Form Ex.R7 by the Ops. Through acceptance letter Ex.R6, complainant was made to agree to accept an amount of Rs.10,511/- as claim amount under the policy of the motor cycle in question. Question of obtaining of this acceptance letter Ex.R6 to arise only, if really Ops found entitlement of complainant. So, even if the bill of repair not produced by the complainant, but despite that by giving due consideration to report Ex.R5 of surveyor appointed by Ops, it is fit and appropriate to allow Rs.11,000/- as insurance amount in favour of the complainant. As claim of the complainant erroneously and illegally repudiated and as such, there was deficiency in service on the part of the Ops. So compensation of Rs.5000/- alongwith litigation expenses of Rs.4000/- more needs be allowed in favour of the complainant and against the Ops.

16.              Therefore, as a sequel of the above discussion, the present complaint allowed in terms that OPs will pay Rs.11,000/-(Eleven Thousand only), the insurance amount to the complainant. In addition, Ops are also directed to pay Rs.5000/-(Five Thousand Only) as compensation and Rs.4000/-(Four Thousand only) as litigation expenses to the complainant. Compliance of the directions be made by the OPs within 30 days from the date of receipt of copy of order, which be made available to the parties free of costs as per rules.

17.                        File be indexed and consigned to record room.

 (Babita)                                  (Sat Paul Garg)                            (G.K.Dhir)

 Member                                   Member                                       President

Announced in Open Forum

Dated:19.08.2015

Gurpreet Sharma.