Versus
The United India Insurance Company Limited, LIC Building, Chandigarh Road, Above PNB, Samrala, District Ludhiana, through its Manager/authorized signatory. …..Opposite party
Complaint under the Consumer Protection Act.
QUORUM:
SH. SANJEEV BATRA, PRESIDENT
MS. MONIKA BHAGAT, MEMBER
COUNSEL FOR THE PARTIES:
For complainant : Sh. Amarjeet Rawal, Advocate
For OP : Sh. D.R. Rampal, Advocate.
ORDER
PER SANJEEV BATRA, PRESIDENT
1. Shorn of unnecessary details, the facts of the case are that the complainant is owner of Hyundai car make I-20 bearing registration No.PB-43D-0097 which was insured with the OP vide policy No.2006013119C05357—1/1 valid from 08.02.2019 to 07.02.2020. on 29.12.2019, at about 9/10 PM, the complainant was going in the said car on main Chandigarh-Samrala Road when a truck No.PB07(T)-1219 being driven by one Bhira Singh son of Mohan Singh, resident of Beas, District Amritsar coming at a very high speed hit his car from rear side due to which the car went off the road and knocked into the heap of bricks alongside the road. Resultantly, front portion of the car also got badly damaged. The driver of the truck succeeded to flee from the spot. The Police registered a case bearing FIR No.0039 dated 09.03.2020 under Section 279 and 427 IPC. On 15.01.2020, the vehicle was taken to M/s. Grover Automobiles Pvt. Ltd., Opposite Dhandari Kalan Railway Station, G.T. Road, Ludhiana for repair where an estimate of Rs.3,80,000/- was made by the said agency. However, the repair work was not initiated due to decision pending at the end of insurance company. The complainant further stated that TPA of the OP namely M/s. R.P. Bhasin & Company, 80-J, Sarabha Nagar, Ludhiana conducted survey and asked for certain information/documents from the complainant vide letter dated 02.03.2020 which were supplied by the complainant. The vehicle was required to be cleared for repair by insurance company and the claim was to be settled accordingly. However, the OP demanded documents including RC, driving license, copy of FIR etc. which the complainant personally deposited in the office of the OP. But the OP vide letter dated 07.07.2020 closed the claim of the complainant by mentioning as “No Claim” due to non-submission of the documents.
The complainant further stated that he deposited Rs.50,000/- with M/s. Grover Automobiles for repair and the remaining payment was supposed to be paid by the OP directly to the repairer with whom the car is lying parked for a long time. However, the OP has not settled the claim of the complainant due to which the complainant has suffered mental torture and agony etc. In the end, the complainant has prayed for issuing direction to the OP to revive the claim as well as to issue directions to M/s. Grover Automobiles Private Limited, Ludhiana to carry our repairs and also directed to pay the repair charges to the said repairer directly. The complainant also prayed for grant of compensation of Rs.1,00,000/- along with litigation expenses of Rs.22,000/- and also to direct the OP to pay parking charges, if any levied by the repairer.
2. Upon notice, the OP appeared and filed written statement assailed by complaint by taking preliminary objections on the grounds of maintainability; the complaint being bad for non-joinder and mis-joinder of necessary parties; the complainant has not come with clean hands; suppression of material facts etc. The OP stated that the complainant has equally efficacious remedy available to him to claim the damages/compensation from the driver, owner and insurer of the said truck No.PB-07(T)-1219 who was driving the truck rashly and negligently.
On merits, the OP reiterated the crux of averments made in the preliminary objections. The OP averred that the complaint has submitted two estimates one of Rs.3,80,000/- and other of Rs.5,02,680/- given to the surveyor. Rather it is the complainant who did not cooperate with the surveyor and even failed to provide the requisite documents and as such, his claim was closed as NO Claim vide letter dated 07.07.2020. The OP further averred that the complainant has not given intimation immediately after accident and no spot survey was conducted by the complainant. The complainant gave intimation dated 04.01.2020 with regarding to the alleged accident on 06.01.2020 and in said intimation he alleged estimate loss to the tune of Rs.5,00,000/-. M/s. R.P. Bhasin & Co. was appointed as surveyor for survey and assessing the loss but the complainant did not cooperate the surveyor nor supplied the required documents despite notice dated 02.03.2020 as well as reminder dated 04.06.2020 to provide the documents, which are reproduced as under:-
- Repair Estimate in original
- Produce the Original Registration Certificate for verification.
- Produce the Original Driving Licnece of the person who was driving the vehicle at the time of accident for verification.
- Copy of Police report (DDR/FIR) duly attested by the police station if the matter is reported to the police.
- Details of injuries sustained by the driver/occupants and their medical records if any are also required.
- Detail of "Third Party Loss if any.
- Spot photos if privately arranged by the complainant.
- Also give a reason for not getting spot survey.
- Copy of Purchase bill for valuation.
- No T.P. Loss affidavit
- KYC from duly filed and signed
- Towing receipt in original.
The OP further stated that in the reminder dated 04.06.2020 it was specifically pointed out that vehicle is lying in open and is uncovered further any consequential loss due to environmental affects, prolonged parking and theft of parts or deterioration of parts shall not be considered. The complainant was requested to take immediately action in this regard and he was further requested that repairer be informed to start the repair of the vehicle at the earliest. The OP also called the status report from the surveyor from time to time and surveyor also replied the emails so issued by the OP with regard to progress in this case. The complainant did not supply the required documents. However, the surveyor gave his assessment on the basis of estimate submitted by the insured and on physical inspection of the vehicle and it is specifically mentioned that said assessment is subject to vehicle being repaired at the workshop and subject to inspection by the surveyor during and after repairs for confirmation of repairs/replacement of damaged parts. The said surveyor gave Motor Survey Report (Final) dated 20.06.2022 assessing the loss at Rs.2,53,058/- subject to vehicle being actually repaired and said tentative loss was assessed by the surveyor. The insured also gave one letter dated 19.06.2020 to the OP on 22.06.2020. The surveyor M/s R.P. Bhasin & Co. submitted its survey report dated 20.06.2020. The OP issued one registered letter dated 25.06.2020 to the complainant and in said letter the reference of letters dated 02.03.2020 and 04.06.2020 sent by surveyor Mr. Rishi Bhasin of M/s R.P. Bhasin & Co. was also given and complainant was requested to send the documents as required by the surveyor vide his letters and complainant was also informed that in case he will not submit the required documents then it will be considered that he is not interested in his OD Claim and his claim will be closed as No claim. The said letter was duly received by the complainant, but the complainant has failed to provide the required documents. The OP sent the file to its Divisional Office vide letter dated 06.07.2020 recommending to treat the said claim as No claim, and competent authorities of the Ops minutely scrutinized claim of the complainant. The complainant has failed to submit the required documents and information and he did not start the repair works despite various reminders and his claim was treated as No Claim and No claim letter dated 07.07.2020 was duly posted to the complainant through registered post. The complainant thereafter gave one representation dated 24.08.2020 requesting to re-open the claim of the complainant and on said letter the OP has sent one intimation/letter dated 25.08.2020 informing the complainant that the claim was closed as No Claim as OP has already sent registered letter dated 07.07.2020. Cashless approval will be allowed only if you submit all documents i.e. Repair Bill, Payment Receipt, Validation of D/L and R/C etc. After receiving these documents, company can ask more documents and competent authority will reopen the claim file and will approve the cashless subject to admissibility of claim. The complainant has failed to provide the said documents and his claim file is still considered as No Claim as complainant has not supplied the required documents and information. The OP has also deputed Sh. Pardeep Kumar Bedi for verification of D/L of Dhanwant Singh and said investigator moved one application dated 26.08.2020 to the Licensing Authority, Ludhiana and on that application L.A, Ludhiana gave the verification report regarding D/L of complainant and said investigator according submitted his verification report dated 01.09.2020 regarding D/L of Dhanwant Singh. The lapse is on the part of complainant and even the complainant has not disclosed this fact in his complaint that he has given one representation dated 24.08.2020 after receiving the No Claim letter dated 07.07.2020 issued by the OP. According to the OP, due and proper services have been rendered by the OP and there is no lapse on the part of the OP and claim of the complainant was rightly treated as No Claim and now the complainant is not entitled to any claim or damages so alleged by the complainant. The OP has denied that there is any deficiency of service and has also prayed for dismissal of the complaint.
3. In evidence, the complainant tendered his affidavit as Ex. CA and reiterated the averments of the complaint. The complainant also placed on record documents Ex. C1 to Ex. C11 and closed the evidence.
4. On the other hand, the counsel for the OP tendered affidavit Ex. RA of Ms. Rekha Mathur, Manager of the OP as well as affidavit Ex. RB of Sh Rishi Bhasin, Proprietor of M/s. R.P. Bhasin & Company, 80-J, Sarabha Nagar, Ludhiana along with documents R1 to Ex. R55 and closed the evidence.
5. We have heard the arguments of the counsel for the parties and also gone through the complaint, affidavit and annexed documents as well as written statement, affidavit and documents produced on record by the parties.
6. The complainant, being owner of Hyundai I-20 Car bearing registration No.PB-43D-0097 obtained a Private Car Package Policy vide policy Ex. C1 w.e.f. 08.02.2019 to 07.02.2020. The IDV value of the vehicle was to the tune of Rs.4,00,000/- only. On 29.12.2019, the vehicle met with an accident in the area of Civil Hospital, Samrala when a tipper No.PB07-(T)-1912 being driven rashly and negligently with a high speed hit the car of the complainant, resultantly the car of the complainant got badly damaged. An FIR No.39 dated 09.03.2020 Ex. C9 U/s. 279/427 of IPC was got registered at Police Station Samrala, District Khanna. The vehicle was taken to M/s. Grover Automobiles, Pvt. Ltd., Opposite Dhandari Kalan Railway Station, G.T. Road, Ludhiana on 15.01.2020 for repairs, who prepared an estimate of Rs.3,80,000/- as per their certificate dated 12.03.2020 Ex. C10 as well as estimate of Rs.5,02,680/- as per estimate form Ex. R6. On 04.01.2020, the complainant gave intimation to the OP and later on, lodged claim with the OP vide claim form dated 17.03.2020 Ex. R5. However, the repair could not be carried out due to pending decision of the OP regarding settlement of the claim of the complainant. The OP appointed M/s. R.P. Bhasin & Company for conducting survey and assessing the loss of the accidental vehicle who visited M/s. Grover Automobiles Pvt. Ltd. and took photographs of the damaged vehicle Ex. Ex. R20 to Ex. R39. The surveyor sent notice dated 02.03.2020 Ex. C8 = Ex. R8 to the complainant requiring certain documents from him. The surveyor also sent reminders dated 04.06.2020 Ex. R12, last reminder dated 25.06.2020 Ex. R41. Thereafter, the surveyor submitted his report dated 20.06.2020 Ex. R18 with the OP vide which the surveyor assessed the loss of the vehicle to be Rs.2,53,058/- only. The OP also sent last reminder dated 25.06.2020 Ex. R41 for submission of documents as demanded by the surveyor through his letters dated 02.03.2020 and 04.06.2020, which the complainant failed to submit the same as per version of the OP. However, the complainant claimed that he submitted all the demanded documents with the surveyor. Thereafter, the OP vide their letter dated 07.07.2020 Ex. R44 closed the claim of the complainant as “No Claim”. The operative part of repudiation letter dated 07.07.2020 Ex. R44 is reproduced as under:-
“This is with reference to your grievance for delay in settlement of Motor OD Claim of above said vehicle and reference to our/Surveyor letter No.UIC-8035/19-20, UIC-8035/20-21 & No.707 dated 02.03.2020, 04.06.2020 & 25.06.2020 respectively.
Your claim file has been closed as NO CLAIM due to non-submission of documents/information from your end. This is for your information.”
Even the OP got verified the driving license of the complainant by deputing Sh. Pardeep Kumar Bedi, who got verified the same from Licensing Authority, Ludhiana and submitted his report dated 01.09.2020 Ex. R53 and found the driving license to be genuine as per record of Licensing Authority, Ludhiana.
7. From the facts and circumstances of the case in hand, the only point of issue arises that whether the OP was justified closing the claim of the complainant as No Claim due to non-submission of documents to the OP demanded through letter 02.03.2020 Ex. C8 = Ex. R8 followed by reminders dated 04.06.2020 Ex. R12 and dated 25.06.2020 Ex. R41?
8. It is established on record that the car in question, duly insured with the OP, got damaged in an accident, which was insured with the OP and an FIR was lodged in this regard. Intimation was given to the OP in time. Further the OP after receipt of claim, appointed the surveyor cum loss assessor who submitted his report by assessing the loss of the vehicle to be Rs.2,53,058/-. However, due to non-submission of document as per letter 02.03.2020 Ex. C8 = Ex. R8, reminder Ex. R12 and last reminder Ex. R41, the OP closed the claim of the complainant as No Claim vide letter dated 07.07.2020 Ex. R44. The insurance companies are required to be more liberal in their approach without being too technical while settling the genuine claims.
9. In this regard, reference can be made to 2022(2) Apex Court Judgment 281 (SC) in case title Gurmel Singh Vs Branch Manager National Insurance Company Ltd. whereby it has been held by the Hon’ble Supreme Court of India that the insurance company has become too technical while settling the claim and has acted arbitrarily. The appellant has been asked to furnish the documents which were beyond the control of the appellant to procure and furnish. Once, there was a valid insurance on payment of huge sum by way of premium and the Truck was stolen, the insurance company ought not to have become too technical and ought not to have refused to settle the claim on non-submission of the duplicate certified copy of certificate of registration, which the appellant could not produce due to the circumstances beyond his control. In many cases, it is found that the insurance companies are refusing the claim on flimsy grounds and/or technical grounds. While settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due to circumstances beyond his control.
As such, in the given set of circumstances, it would be just and proper if the complainant is directed to submit the available documents as demanded through letter 02.03.2020 Ex. C8 = Ex. R8 with the OP within 30 days from the date of receipt of copy of order and after the receipt of the documents from the complainant, the OP shall settle and pay the claim within a period of 30 days from the date of receipt of documents from the complainant. Further if the complainant is not in possession of remaining documents, then the OP shall settle and pay the claim to the complainant on the basis of already submitted documents within 45 days from the receipt of copy of this order.
11. As a result of above discussion, the complaint is partly allowed with direction to the complainant to directed to submit the available documents as demanded through letter 02.03.2020 Ex. C8 = Ex. R8 with the OP within 30 days from the date of receipt of copy of order and after the receipt of the documents from the complainant, the OP shall settle and pay the claim within a period of 30 days from the date of receipt of documents from the complainant. Further if the complainant is not in possession of remaining documents, then the OP shall settle and pay the claim to the complainant on the basis of already submitted documents within 45 days from the receipt of copy of this order. However, there shall be no order as to costs. Copies of order be supplied to parties free of costs as per rules. File be indexed and consigned to record room.
12. Due to huge pendency of cases, the complaint could not be decided within statutory period.
(Monika Bhagat) (Sanjeev Batra) Member President
Announced in Open Commission.
Dated:09.10.2024.
Gobind Ram.
