BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SIRSA.
Complaint Case No. 98 of 2021
Date of instt. 03.05.2021
Date of Decision: 30.04.2024.
Rakesh Kumar aged 31 years son of Shri Neki Ram, resident of village Chaharwala, Sirsa, Tehsil and District Sirsa.
…….Complainant.
Versus
1. Universal Sampo General Insurance Co. Ltd., SCO no.9, First Floor, Above Central Bank of India, Sector-10, Panchkula- 134109 through its authorized person/ Managing Director.
2. Universal Sampo General Insurance Co. Ltd., 5th Floor, Shakuntla Apartments, Flat no. 514, 59 Nehru Place, New Delhi- 110019.
3. Maruti Insurance Broking (P) Ltd., Plot No.1, Nelson Mandela Marg, Vasant Kunj, New Delhi- 110070 through its authorized person/ Managing Director.
4. Hisar Auto Mobile, Sirsa Road, Hisar through its authorized person.
…..Opposite Parties.
Complaint Under Section 35 of Consumer Protection Act, 2019.
BEFORE: SH. PADAM SINGH THAKUR…………. PRESIDENT
SMT. SUKHDEEP KAUR…………………MEMBER
Present: Sh. Pankaj Singhal, Advocate for complainant.
Sh. H.S. Raghav, Advocate for opposite parties no.1 and 2.
Sh. Gaurav Arya, Advocate for opposite party no.3.
Sh. N.K. Daroliya, Advocate for opposite party no.4.
ORDER:
The complainant has filed the present complaint under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’).
2. In brief, the case of complainant is that he is registered owner of vehicle i.e. Car Swift Dezire – LXI bearing registration No. HR-24AC-2294 model 2016 and same is being used by him as a private vehicle for personal use and he had purchased insurance policy bearing No. 2311/61037653/00/000 from ops no.1 and 2 for his said vehicle for the period 29.02.2020 to 27.02.2021 and had paid premium amount of Rs.14,404/- through op no.4. The vehicle was insured for the value of Rs.3,10,700/-. That on 19.10.2020 at about 8.30 a.m., driver of complainant namely Anoop Singh alongwith Mukesh son of Shri Dayanand were going to Gurgaon in their relation and when they reached near village Dadi Toye i.e. Jhajhar to Farukhabad road, a unknown truck came from the wrong side in rash and negligent manner. That in order to save themselves, the driver of complainant tried his best to avoid the accident but vehicle of complainant struck into the divider and back of the truck due to which Anoop Singh and Mukesh sustained minor injuries like jerk, pain and swelling etc., whereas vehicle of complainant sustained heavy loss i.e. total loss. It is further averred that complainant immediately intimated the ops telephonically and as per their instructions accidental vehicle was taken to Salasar Maruti Agency, Jindal Chowk, Hisar and the vehicle is lying there since then being unrepaired due to total loss. The ops deputed Mr. Anuj Jain, Loss Assessor and Surveyor from Hisar as well as Mr. Amandeep from Panchkula who had duly inspected the damaged vehicle and also got signed some papers and blank forms from complainant and assured to indemnify the loss and damages to the complainant. That since then complainant is taking round to the ops’ offices and also requesting them personally but they do not pay any heed to the requests of complainant and all the times they verbally told that claim has been referred to the head office for sanction and very soon claim amount would be disbursed to him. It is further averred that act and conduct on the part of ops clearly amounts to deficiency in service and unfair trade practice as well as gross negligence on account of which he has suffered unnecessary harassment. The complainant also got served a legal notice dated 23.03.2021 upon the ops but till date ops have not discharged their legal liability rather complainant received a letter issued by the ops vide which ops have taken false and vague excuse to avoid their liability and repudiated the claim of complainant. Hence, this complaint seeking direction to the ops to make payment of claim amount of Rs.3,10,700/- alongwith interest and also to pay compensation and litigation expenses.
3. On notice, ops appeared. Ops no.1 and 2 filed written version taking certain preliminary objections. It is submitted that as per investigation report, the complainant has given his statement that the car met with an accident on 19.10.2020. After intimation of the said incident by the complainant, the ops had engaged an IRDA approved Surveyor namely Anuj Jain who surveyed/ assessed the loss to the tune of Rs.5,04,918/-. It is further submitted that no FIR or DDR has been lodged in the said matter as has been verified by their Investigator, Secure Risk Management & Insurance Services from the nearby Police Station. That there has been an inordinate delay of claim intimation of about five days which is a gross violation of policy terms and conditions. Since, as per the insurance policy, the claim must be intimated to the ops immediately on the occurrence of such an accident, but the complainant has failed to comply with the terms and conditions, hence owing to the said situation, the complaint deserves to be dismissed. It is further submitted that complainant had provided wrong information initially to the insurance company that he was sitting with Anoop, but during the investigation, he confirmed that at the time of accident Mukesh was sitting. There has been a discrepancy and mismatch in the statements of the complainant due to which the ops are justified in rejecting the said claim of complainant. It is further submitted that as per the investigation report, car photographs which had been clicked by the Surveyor at Workshop were checked and it was found that there were blood marks on the conductor seat and door but as per the complainant, his friend Mukesh did not get any injury in that accident and did not take any treatment from any hospital. With these averments, dismissal of complaint prayed for.
4. Op no.3 also filed written version raising certain preliminary objections. It is submitted that answering op is an insurance broking entity licensed with IRDAI and mainly acts as a facilitator of motor insurance products offered by various insurance companies including ops no.1 and 2. The role of this op is to apprise the customers about the features and benefits of motor insurance products. After the facilitation by this op, customers buy insurance as per their own will and volition and pay insurance premium which goes to the concerned insurance company only. In lieu of the premium received, insurance company insurers the vehicle and issues insurance policy to the customers, subject to their terms and conditions/ IRDAI guidelines. It is further submitted that answering op has entered into a contract with op no.4 whereby op no.4 renders certain services, in its independent capacity to the answering op in the entire supply chain of insurance solicitation and distribution. That vehicle of complainant has been insured by ops no.1 and 2 in lieu of premium of Rs.14,404/- charged from complainant. The contract of insurance has been executed by ops no.1 and 2 with the complainant on the terms and conditions as mutually agreed. The insurance policy for the vehicle in question has been sourced through answering op by utilizing the services of op no.4. It is denied that complainant informed answering op about the accident as alleged. It is further submitted that Surveyors are appointed solely by insurance companies to investigate the accident and assess the accidental loss. The answering op is not an insurance company to settle the claim of complainant. Remaining contents of complaint are also denied to be wrong and prayer for dismissal of complaint qua op no.3 made.
5. Learned counsel for op no.4 suffered a statement that written statement filed on behalf of ops no.1 and 2 may also be read on behalf of op no.4.
6. The complainant in evidence has tendered his affidavit Ex. CW1/A and documents Ex.C1 to Ex.C21.
7. Ops no.1 and 2 have tendered affidavit of Ms. Ankita Bose, authorized representative as Ex. RW1/A and documents Ex.R1 to Ex.R23. Op no.3 has tendered affidavit of Sh. Surendra Srivastava, Chief Executive Officer as Ex. OPW3/A and documents Ex. OPW3/1 and Ex. OPW3/2. OP no.4 did not lead any evidence despite availing several opportunities and the evidence of op no.4 was closed by order.
8. We have heard learned counsel for the parties and have gone through the case file.
9. From the certificate cum policy schedule Ex.C10 placed on file by complainant, it is evident that car in question of the complainant was insured with ops no.1 and 2 for the period 29.02.2020 to 27.02.2021 for insured declared value of Rs.3,10,700/-. There is also no dispute of the fact that 19.10.2020 i.e. during the period of policy, said insured car of the complainant met with an accident near village Dadri Toye at Jhajhar to Farukhabad road. According to the complainant, his car was totally damaged in the accident and as such he is entitled to insurance claim amount of Rs.3,10,700/- from ops. However, the claim of complainant has been repudiated by ops no.1 and 2 on the above said grounds taken in the written version. We are of the considered view that ops no.1 and 2 have wrongly and illegally repudiated the claim of complainant on just very technical grounds and have avoided payment of genuine claim of complainant on lame excuses. If the complainant himself was actually present in the car in question at the time of accident, then it is not understandable that why he will change his statement and will ask the ops/ their surveyor that actually he was not present in the vehicle and his friend Mukesh was present in the vehicle and why he will change his statement showing Mukesh to be present in the car at the time of accident in his place. So, the alleged statement of complainant Rakesh Kumar placed on file by ops no.1 and 2 as Ex.R20 in which it is mentioned that actually Mukesh was present in the Car and he inadvertently got recorded that he was present in the Car at the time of accident seems to be manipulated and seems to be prepared later on and is only afterthought. From the statement Ex.R20 itself it is evident that signatures of complainant might have been obtained on blank papers and then same have been converted into his alleged statement later on. The another ground taken by ops no.1 and 2 that there is no any FIR or DDR in this accident is also baseless because there is no dispute about the place and manner of the accident and same has also been got verified by ops from their Surveyors, therefore, this ground is also immaterial because complainant can seek insurance claim for the damage of his insured vehicle from its insurer and as such lodging of DDR or FIR is not mandatory. Further the ground taken by ops is that as per insured, his friend Mukesh did not get any injury in this accident and did not take treatment from any hospital, but blood marks on conductor seat and door were found is also vague because Mukesh would have suffered some minor injuries like abrasions and some blood from his abrasions might have touched with conductor seat and door and therefore, this ground is also immaterial. The last and fourth ground taken by ops no.1 and 2 that there is five days delay in claim intimation by insured to insurance company is also baseless and immaterial because insurance companies cannot reject the genuine claim of insured on such mere technicalities of some delay. In this regard the Hon’ble Supreme Court in case titled as Gurshinder Singh vs. Sriram General Insurance Co. Ltd. decided on 24.01.2020 while giving the reference of judgment of the Hon’ble National Commission in case titled as New India Assurance Company Ltd., vs. Trilochan Jane FA No. 321 of 2005 decided on 9.12.2009 (NC) has held that “We concur with the view taken in the case of Om Parkash (supra) that in such a situation if the claimant is denied the claim merely on the ground that there is some delay in intimating the insurance company about the occurrence of the theft, it would be taking a hyper technical view.” The above said authority of the Hon’ble Supreme Court is fully applicable in this case. In these circumstances, the repudiation of genuine claim of the complainant by ops no.1 and 2 on above said technicalities is hereby set aside and complainant is entitled to the insured declared value of car in question i.e. Rs.3,10,700/- from ops no.1 and 2 as the car in question of complainant has been totally damaged in the above said accident which fact is evident from photographs of the car and the Surveyor also verified complete loss to the vehicle.
10. In view of our above discussion, we allow the present complaint qua ops no.1 and 2 insurance company and direct the opposite parties no.1 and 2 to pay the claim amount of Rs.3,10,700/- to the complainant alongwith interest at the rate of @6% per annum from the date of filing of present complaint i.e. 03.05.2021 till actual realization within a period of 45 days from the date of receipt of copy of this order. We also direct ops no.1 and 2 to further pay a sum of Rs.10,000/- as compensation for harassment and Rs.5000/- as litigation expenses to the complainant within above said stipulated period. The complainant will have to complete necessary formalities in favour of ops no.1 and 2 to the effect that he will not claim salvage of the vehicle in question. However, no liability of remaining ops no.3 and 4 is made out and as such complaint qua them is hereby dismissed. A copy of this order be supplied to the parties as per rules. File be consigned to the record room.
Announced: Member President
Dt. 30.04.2024.
District Consumer Disputes
Redressal Commission, Sirsa.
