Before the District Consumer Disputes Redressal Forum, Room No. 208 2^nd Floor, District Administrative Complex, Tarn Taran

Consumer Complaint No  : 21 of 2017

Date of Institution                      : 11.04.2017

Date of Decision               : 31.07.2019

Narinder Pal Singh son of Piara Singh r/o village Kadh Gill, Tehsil and District Tarn Taran.

                                                ...Complainant

Versus

1. United India Insurance Company Ltd. through its Branch Manager,  near S.S.P Office Amritsar Road, Tarn Taran Tehsil and District Tarn Taran,
2. United India Insurance Company Ltd. through its Branch Manager 283, East Mohan Nagar Amritsar Tehsil and District Amritsar,
3. United India Insurance Company Ltd. through its Branch Manager,  24, Whites Road, Chennai.

…Opposite Parties.

Complaint Under Section 11, 12 and 13 of the Consumer Protection Act, 1986.

Quorum:               Sh. Charanjit Singh, President

Smt. Jaswinder Kaur, Member

For Complainant                     Sh. M.P. Arora Advocate

For Opposite Parties               Sh. Sandeep Khanna Advocate

ORDERS

Charanjit Singh, President;

1        The complainant Narinder Pal Singh has filed the present complaint under Section  11, 12 and 13 of the Consumer Protection Act (herein after called as 'the Act') against United India Insurance Company Ltd. through its Branch Manager,  near S.S.P Office Amritsar Road, Tarn Taran Tehsil and District Tarn Taran and others (Opposite Parties) on the allegations of deficiency in service and negligence in service on the part of opposite parties with prayer to direct the opposite parties to pay amount of Rs.1,60,000/- spent on repair of truck and Rs. 2,00,000/- of accidental cover and Rs. 10,691/- as interest and also prayed Rs.20,000/- as compensation and Rs.  10,000/- as costs of litigation.

2        The case of the complainant in brief is that he has purchased Vehicle Insurance Policy bearing No. 2002043115P116377231 in his favour for his Tata Truck bearing registration No.PB 46-F-9804 from the opposite party and the insured declared value of vehicle is Rs.7,00,000/-  and insurance policy valid for the period of 26.3.2016 to 25.3.2017. The above truck of the complainant/insured is covered under the above said policy, which covers all the risks to the truck and the opposite parties are under obligation to settle the claim of the insured/complainant, in case of any loss occurs during the insurance period. Further, the policy also covers personal accident covers for owners-driver for Rs.2,00,000/- as such, the company is under further obligation to indemnify the loss or settle the claim for personal accident to owner/ driver up to Rs.2,00,000/-. On 7.5.2016,  Narinder Pal Singh was going from Mumbai to Jammu via Faridkot to Talwandi Bhai after loading Chemical from Mumbai. At about 11.15 a.m. when the complainant crossed G.T. Road, Talwandi Bhai, then suddenly a stray cow had come in front of the truck of the complainant. In order to save the animal, the complainant had turned his truck and suddenly the truck struck with the other tipper bearing No.PB06-K-2887 coming from the side of Zira. Resultantly, both the vehicle got damaged badly, the complainant and the driver of the other tipper had got severe injuries in the accident. Afterwards, the complainant was got admitted in the Civil Hospital by the nearby persons through 108 Ambulance and further the complainant was got transferred into Guru Ramdas Hospital, Amritsar by his brother. Due to this accident, the truck was damaged badly and the complainant had received multiple injuries and in this respect a rapat bearing No. 21 dated 15.5.2016 regarding the accident was registered at Police Station Talwandi Bhai, Ferozepur. Due to the above said accident, the complainant /insured has spent Rs.1,60,000/-  on the repair of the truck and such kind of damage is covered under the insurance policy. Further the complainant got severe injuries in his legs and other parts of body as such, the complainant has spent Rs.40,000/- on his treatment and the complainant also remained admitted in Guru Ramdas Charitable Hospital, Amritsar from 7.5.2016 to 17.5.2016 and further has spent 2 months on bed rest and further remained unable to go for his work for 8 months due to fatal injuries on legs. As such, the complainant has suffered big loss due to the above accident. The complainant has given the intimation to the insurance company on time and has requested the company to give the claim of the insured vehicle i.e. the money spent by the complainant of the damage cause to the truck as per policy and further requested to give money spent on the treatment of the complainant and further to compensate the complainant for not carrying on his business for 8 months due to fatal injuries on legs as per accidental cover. Afterwards, the opposite party has asked the complainant to submit certain documents. The complainant has provided all the required documents i.e. R.C. of Vehicle, copy of insurance, Police report, bills of repair of vehicle, medical treatment bills of the complainant 7 other documents to the company i.e. the officials of the company. Further the investigator sent by the company has demanded amount of Rs.10,691/- for investigation purpose, when the complainant objected to this as the same should be borne by the company then the company has flatly refused to consider the claim of the complainant as such, the complainant has paid Rs. 10,691/-  to the investigator on 12.7.2016. Afterwards, the complainant has requested the opposite parties many times to admit his genuine claim but the opposite parties are lingering on the matter on one & other pretext and finally, the opposite parties have deposited Rs. 1,05,000/- on 24.10.2016 in the account of the complainant in an arbitrary manner without assigning any reason as to why such small amount has been deposited instead giving full amount spent on the repair of the truck as well as on the treatment of the complainant & for loss of business income due to accident. The policy of the truck is of Rs. 7,00,000/- as such, the complainant is entitled to Rs. 1,60,000/- in full as spent on the repair of the truck. Further the policy also covers accidental risk upto Rs. 2,00,000/- to which the complainant is entitled as the complainant has spent Rs. 50,000/- on his treatment and complainant has spent 2 months on bed rest & could not do his work of driving for 8 months due to fatal leg injuries and the complainant was earning Rs.15,000/- per month from his business of driving, as such has suffered big loss in his income to the tune of Rs. 1,50,000/- due to the accident. The complainant has requested many times to the company that he has purchased the insurance policy, which covers the risk of the vehicle as well as personal accident cover for the owner driver but the company has neither released the total amount of repairs to the vehicle nor released the amount spent by the complainant on his medical treatment as the company has just deposited a meager amount of Rs.1,05,000/- in the account of the complainant, which is not in accordance with the risk cover by the policy.  The complainant has requested many a times to the company in this regard but no positive response has been given by the company till yet. The concerned officials of opposite parties have orally told the complainant that the company will not give further a single penny to the complainant and he has to satisfy with the claim amount deposited by the company in his account. The above act of the company is deficiency in services as the company is avoiding its obligations regarding the policy as such, the company has wrongly declined to consider the genuine request of the complainant as the complainant/insured has not breached any known conditions of the policy but the opposite parties had done nothing to justify the full genuine claim of the complainant/insured.  The above act of the company is deficiency in services as the company is avoiding its obligations regarding the policy as such the company has wrongly declined to consider the genuine request of the complainant as the complainant/insured has not breach any known conditions of the policy but the opposite parties had done nothing to justify the full genuine claim of the complainant/insured. Feeling dissatisfied by the act and conduct of the opposite parties, the complainant perforce has filed this complaint against the opposite parties.

3        After formal admission of the complaint, notice was issued to Opposite Parties and opposite parties appeared through counsel and filed written version contesting the complaint on the preliminary objections that the complainant has got no cause of action to file the present complaint. The competent authority of the opposite parties had approved the OD claim of the complainant for an amount of Rs 1,05,000/- which was duly paid by the opposite parties on 24.10.2016. As such, the present complaint is not maintainable since the claim in question already stands fully satisfied.  The complainant is estopped by his own act and conduct from filing the complaint. The opposite parties had appointed Baldev Kumar, Surveyor & Loss Assessor in the present case who has assessed the present loss and as per his report dated 9.9.2016, the actual assessment came to be Rs 1,11,650/- after deduction of depreciation, salvage and excess clause. In this regard, it is submitted that loss assessed by the surveyor is best piece of evidence and same has to be taken as correct one unless the other party produces any cogent evidence to show that the said loss assessed by the surveyor is incorrect. This view has been taken by the National Commission in so many cases in which it has also been held that the surveyor is the best person to assess the loss and the Forum cannot assume role of surveyor. Hence, the loss assessed by the surveyor is to be taken as final one. In the present case, the claim has been already paid by the opposite parties on the basis of assessment of Baldev Kumar, Surveyor & Loss Assessor. Moreover, neither the said report of Baldev Kumar was challenged nor any separate survey was got conducted by the complainant, which clearly makes it evident that the complainant was satisfied with the said assessment mentioned above and now the report dated 9.9.2016 is completely binding upon the complainant. As far as the claim pertaining to medical treatment is concerned, the same is not payable in the light of Section IV of the Insurance policy. As per Section IV, only following injuries are covered under the policy: -

(i)           Death 100%

(ii) Loss of two limbs or sight of two eyes or one limb and sight of one eye - 100%

iii) Loss of one limb or sight of one eye - 50%

Injuries allegedly suffered by the complainant do not fall within the ambit of the provisions of Section IV mentioned above and resultantly the claim pertaining to alleged treatment is not covered under the policy in question. Hence, no liability can be fastened against the opposite parties in that regard.  The complainant has violated the basic terms and conditions of the insurance policy in question and hence the complainant is not entitled to the relief claimed for. The complainant has not approached this Forum with clean hands and has tried to conceal the material facts. In number of judgments, it has been held that any person who approaches the court with unclean hands is not entitled to get any relief. The claim in question stands fully satisfied, no consumer dispute survives. Hence, the Complainant has got no right to file the present complaint. The OD claim of the complainant for an amount of Rs 1,05,000/- was duly paid by the opposite parties on 24.10.2016 and the said claim stands fully satisfied. As far as the claim pertaining to medical treatment is concerned, the same is not payable in the light of Section IV of the Insurance policy. Hence, there is no deficiency on the part of opposite parties and the relief towards interest and damages, etc. is not payable as such, in this regard it is submitted that basically neither there is any provision under the Consumer Protection Act nor there is any agreed clause in the contract of insurance to pay such relief. On Merits, it was pleaded that the parties are governed as per terms and conditions of contract of insurance and exclusions contained therein and the claim which is not covered under the policy is not at all payable by the opposite parties.  The contract of insurance is based on utmost faith and in this regard, it is submitted that as per general conditions of the contract of Insurance, it has been clearly held that the Insurance Company will not be liable to pay any claim, if the claim is not covered under the policy or if any, false declaration be made or used in support thereof or if any fraudulent means or devices are used by the insured or any one act is done on his behalf to take benefit under the policy, all the benefits under the said policy shall be forfeited. In this regard, it is further submitted that it has been held by various courts that public money cannot be thrown away by way of charity by the public sectors. Even otherwise, there is no provision under the Consumer Protection Act as well the policy in question for compensating the complainant for alleged loss of income. Hence, the complainant is not entitled to relief claimed for and the opposite parties have reiterated the stand as taken in the preliminary objections and all the other allegations in the complaint have been denied by the opposite parties and prayer was made for dismissal of the complaint with costs. 

4        In order to prove his case, the complainant has tendered in evidence his affidavit Ex. C-1 alongwith documents Ex. C-2 to Ex. C-57 and closed the evidence.  Ld. counsel for the opposite parties also tendered in evidence affidavit of Surinder Singh Senior District Manager Ex. OPs/1, affidavit of Baldev Singh Ex. OPs/2 alongwith documents Ex. OPs/3 and Ex. OPs/4 and closed the evidence.

5        We have heard the Ld. Counsel for the complainant and opposite parties and have gone through the evidence and documents placed on the file by the parties.

6        In the present case, main issue is that the complainant has claimed Rs. 1,60,000/- from the opposite party for repair of vehicle, but in lieu of that the opposite party has made the payment of Rs. 1,05,000/- only. The opposite parties have approved the OD claim of the complainant for an amount of Rs.1,05,000/- which was duly paid by the opposite parties on 24.10.2016. the opposite parties have appointed Baldev Singh Surveyor & Loss Assessor in the present case who has assessed the present loss and as per his report dated 9.9.2016, the actual assessment came to be Rs. 1,11,650/- after deduction of depreciation, salvage and excess clause. The opposite parties have placed on record affidavit of Baldev Kumar surveyor & Loss Assessor Ex. OP/2 and Surveyor, Loss Assessor & Valuator Ex. OPs/3 but the complainant has not produced on record any evidence contrary to the report of surveyor. Moreover the Surveyor assessed the total loss as ₹1,05,000/-. Hon’ble National Commission held in “Suryachem Industries Vs. Oriental Insurance Co. Ltd.” I (2007) CPJ-278 (NC) that the surveyor report, being an important document, has to be given due weightage, unless rebutted by some cogent evidence on the record. The complainant has not produced any cogent and convincing evidence to rebut the report of the surveyor and there is no reason to disbelieve the said report. Accordingly, the complainant is entitled to the claim as assessed by the surveyor.

7        Second point in the present case is that the complainant has claimed Rs. 2,00,000/- as accidental cover for owner driver. The case of the opposite parties is that the claim pertaining to medical treatment is concerned, the same is not payable in the light of Section IV of the Insurance policy. As per Section IV, only following injuries are covered under the policy: -

(i)           Death 100%

(ii) Loss of two limbs or sight of two eyes or one limb and sight of one eye - 100%

iii) Loss of one limb or sight of one eye - 50%

Injuries allegedly suffered by the complainant do not fall within the ambit of the provisions of Section IV mentioned above and resultantly the claim pertaining to alleged treatment is not covered under the policy in question. On the other hands, the case of the complainant is that he has received severe injuries in his legs and other parts of body. But the complainant has not placed on record any document showing the permanent total disablement from the injuries to the complainant. The opposite parties have validly made the payment of Rs. 1,05,000/- to the complainant as per report of surveyor. There is no deficiency in services on the part of the opposite parties. The complainant is bound by the terms and conditions of the Insurance policy in dispute and the terms and conditions of the Insurance policy cannot be interpreted in the manner either to subtract or add anything therefrom . Reliance in this connection can be had in M/s. Suraj Mal Ram Niwas Oil Mills (P) Ltd-Appellant Vs. United India Insurance Co.Ltd. & another –Respondents  2010(4) RCR (Civil), wherein it has been laid down that in a contract of insurance , rights and obligations are strictly governed by the terms of the policy and no exception of relaxation can be given on the ground of equity. It has further been held in this judgment that  in construing the terms of a contract of insurance, the words used therein must be given paramount importance, and it is not open for the court to add, delete or substitute any words. In this judgment it has been further held by the Hon’ble Supreme Court that where there is  breach of conditions of the insurance contract by the insured, the insurance company is not liable to pay compensation in case of loss. This position of law has been further fortified in the latest judgment of Hon’ble National  Commission titled as M/s. V.K. Karyana Store Vs. Oriental Insurance Co. Ltd. 2014(3) CLT page 47 wherein it has been held that it is well settled principle of law that parties are bound by terms and conditions of the insurance policy and none of the parties can seek any  relief beyond those terms and conditions.

8        In the light of above discussion, complaint fails and same is hereby dismissed. However, keeping in view the peculiar circumstances of the case, the parties are left to bear their own costs. Copy of order be supplied to the parties free of costs as per rules. File be consigned to record room.