Haryana

Ambala

CC/271/2023

SHASHI. - Complainant(s)

Versus

UNITED INDIA INSURANCE COMPANY. - Opp.Party(s)

PARDEEP BATRA.

07 Oct 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	271 of 2023
Date of Institution	:	10.08.2023
Date of decision	:	07.10.2024

1.       Shashi widow of Charnjit Kumar

2.       Paras son of Charanjit Kumar

Both residents of House No.2607/2, Kaziwara, Ambala City

          ……. Complainants

                                                Versus

United India Insurance Company, Municipal Committee Road, Punjabi Mohalla, Ambala Cantt, through its Branch Manager.

                                                                                   ….….  Opposite party

Before:         Smt. Neena Sandhu, President.

                       Smt. Ruby Sharma, Member,

            Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Pardeep Batra, Advocate, counsel for the complainant.

                      Shri R.K. Vig, Advocate, for counsel for the OP.

              

 Order:        Smt. Neena Sandhu, President.

                   Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

(i) To settle the claim of the complainant and to pay Rs.7.50 lacs to as per policy.

(ii) To pay Rs.1,00,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.

(iii) To pay Rs.33,000/-, as litigation expenses

OR

Grant any other relief, which this Hon'ble Commission may deems fit.

 

2.             Brief facts of the case are that complainants are residents of above said address and are peace loving and law abiding citizen of the country. Charanjit Kumar, husband of the complainant No.1 and father of the complainant No.2 was the owner of Tempo Trax bearing No.HR-37B-7309 and the said vehicle was being driven by Charanjit kumar and the same was duly insured with the OP vide policy No.1101003121P111082420/1 for the period from 30.01.2022 to 29.01.2023. On 14.11.2022, at about 5:00PM, the said vehicle was being driven by Charanjit Kumar, met with an accident near Hari Palace, Ambala City, it first colluded with an Activa and then struck against cemented platform and due to this impact, the staring of Tempo Trax struck against the chest of Charanjit Kumar heavily and due to this reason, the condition of Charanjit Kumar became serious and then he was taken to Civil Hospital, Ambala City and remained admitted there for two days. Due to serious condition, the patient was referred to GMCH Hospital, Sector-32, Chandigarh and remained admitted for two days and then the patient was referred to PGI Chandigarh due to his critical condition and Charanjit Kumar while under treatment in PGI Chandigarh died on 20.11.2020. A report regarding the accident was also recorded by the Police vide DD No.20 dated 18.11.2022 in Police Chowki No.4, Ambala City. Thereafter, the complainant lodged claim as per the abovesaid policy vide claim No.1101003122C05055701 and submitted all relevant documents with the OP. But the claim of the complainants have been repudiated on flimsy grounds by mentioning therein “We are closing your claim file on account of the following reasons: Breach of Policy conditions-Material to Loss’ vide closure report dated 19.07.2023. The OP has wrongly mentioned in the closure report that ‘you have withdrawn your claim by giving your consent through your letter dated 04.05.2023 and 19.07.2023 whereas the complainant never gave any consent regarding withdrawal of claim. It seems that OP is not willing to pay the claim, without assigning any cogent reason. The claim of the complainants has been repudiated without any rhyme or reason and against the Rules and regulations and also against the principle of natural justice. The complainants are entitled to get compensation as per policy aforesaid, but the OP wrongly, illegally and erroneously repudiated the claim.   The said act and conduct of the OPs, amounts to deficiency in providing service. Hence, the present complaint.
3.           Upon notice, the OP appeared and filed written version wherein they raised preliminary objections to the effect that this complaint is not maintainable etc. On merits it has been stated that the tempo Trax bearing registration No.HR-37B-7309, was insured with the OP w.e.f 30.01.2022 to 29.01.2023, as per the terms and conditions of the policy. The complainant informed the OP that the said vehicle met with an accident on 14.11.2022. Accordingly, the OP appointed an IRDA approved surveyor Vishal Kumar, to assess the loss, who assess the loss to the tune of Rs.23,762/-, subject to terms and conditions of the policy. The OP after going through the documents and seeking opinion from Mr. D.P.Gupta, who in his opinion dated 28.04.2023, found that son of the insured made a statement that his father told him that the vehicle first met with an activa and thereafter the vehicle got struck to a cemented ramp. The investigator has also observed that the vehicle met with an accident with the truck and the insured vehicle was going towards wrong side. These facts were not disclosed by the son of the insured or even in the claim form which was submitted by one Shashi also not disclosed these facts to the company. As per condition No.4 of the policy, the insured was supposed to take reasonable steps to safe guard the vehicle from loss or damage. It is further stated that Op on the basis of these facts had taken decision to not to pay the claim. Based on the reasons, the reported claim is considered as no claim is payable due to “Breach of Policy conditions-Material to loss” under the policy.  Rest of the averments of the complainant were denied by the OP and prayed for dismissal of the present complaint with costs.
4.           Complainant No.2 tendered his affidavit as Annexure  C/A alongwith documents as Annexure C-1 to C-8 and closed the evidence of the complainants.  On the other hand, learned counsel for the OP tendered affidavit of Roshan Lal, Manager of the OP-Company-United India Insurance Co. Ltd., Divisional Office, Tirloki Chambers, 2^nd Floor, Ambala Cantt and Vishal Kumar, Surveyor and Loss Assessor, House No.508, Lal Kurti Bazaar, Ambala Cantt as Annexure OP-A and OP-B respectively alongwith documents as Annexure OP-1 to OP-15 and closed the evidence on behalf of the OP.
5.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
6.           Learned counsel for the complainants submitted that by repudiating the genuine claim, on flimsy ground that there is a breach of policy conditions-Material to Loss on the part of the insured (deceased) as he was driving the vehicle in question on wrong side which resulted into accident in question, the OPs have committed deficiency in providing service and also indulged into unfair trade practice. 
7.           On the contrary, the learned counsel for the OP submitted that since while processing the claim it was observed that the insured was driving the vehicle in question on wrong side, as a result of which the accident took place meaning thereby that the insured had failed to take reasonable steps to safeguard the vehicle from loss or damage, as such, the claim lodged by the complainants under the policy in question was rightly rejected by the insurance company, strictly as per terms and conditions of the insurance policy.
8.           Neither the issuance of the policy in question in respect of the vehicle in question in favour of the insured-deceased (husband of complainant no.1 and father of complainant no.2) nor the fact that its accident took place, wherein the insured had died; nor the fact that the complainants had filed claim under the policy in question, being legal heirs stood repudiated by the OPs are in dispute, therefore, the only question which needs to be adjudicated by us is whether, the said claim was rightly repudiated or not. Admittedly, the claim of the complainant was repudiated by the insurance company vide letter dated 19.07.2023, Annexure C-1 on the ground that BREACH OF POLICY CONDITION-MATERIAL TO LOSS. Misrepresentation for cause of accident also. As per Condition No.4 of the Policy. The insured was supposed to take reasonable steps to safeguard the vehicle from loss or damage. Insured was driving the vehicle in wrong lane. It is pertinent to mention here that this decision of repudiation taken by the OPs is based on the legal opinion dated 28.04.2023, Annexure OP-13, taken by the OPs from one Advocate, wherein it is mentioned that the report of the investigator is based upon statement of eye witness Harish Kumar. He told the investigator that the said Tempo Traveler Cruiser was coming from wrong side and struck into a truck.  We have gone through the surveyor report dated 11.04.2023, Annexure OP-3 and did not find that the surveyor has mentioned any such statement of alleged Harish Kumar to the effect that the insured was coming from wrong side in his vehicle and struck the other truck. In the entire report, the surveyor has not opined that the insured was coming from wrong side in his vehicle and struck the other truck nor the surveyor has raised any doubt qua the accident in question and death of the insured in the said accident. On the other hand, it is coming out from the surveyor report dated 11.04.2023, Annexure OP-3 that the total loss suffered to the vehicle in the said vehicle has arrived at, to the tune of Rs.23,762/-. There is not even a single document on record which establishes that the insured was coming from wrong side in his vehicle and struck the other truck. Under these circumstances, the ground taken by the OP in the rejection letter is devoid of merit and therefore, the repudiation letter dated 19.07.2023, Annexure C-1 stands quashed.
9.           The complainants are therefore held entitled to claim amount of Rs.23,762/-as assessed by the surveyor and loss assessor in his report dated 11.04.2023, Annexure OP-3, against which no contrary evidence has been placed on record by the complainants to challenge the said figure of Rs.23,762/-, instead of Rs.7,50,000/-, as prayed for by the complainants.
10.           In view of the aforesaid discussion, we hereby partly allow the present complaint and direct the OP, in the following manner:-
    1. To pay Rs.23,762/-, to the complainants alongwith interest @6% p.a. from the date of repudiation of the claim i.e 19.07.2023, till realization.
    2. To pay Rs.5,000/-, as compensation for the mental agony and physical harassment suffered by the complainants.
    3. To pay Rs.3,000/-, as litigation expenses.  

               The OP is further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OP shall pay interest @ 8% per annum on the awarded amount, from the date of default, till realization. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

 Announced:- 07.10.2024

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President