Before the District Consumer Disputes Redressal Commission, Rohtak.
Complaint No. 186
Instituted on : 25.03.2022
Decided on :28.10.2024
Pardeep Kumar (Age 31 Years) S/o Sh. Om Parkash, resident of Village Dholi, District, Mahendergarh.
….Complainant.
Vs
Universal Sompo General Insurance Ltd. , Unit no.601-602, 6th Floor, Reliable Tech Park, Cloud City Campus, Gate no.31, Mouju Eltham, Thane, Belapur Road, Airoli, New Mumbai, 400708, service be effected through Managing Director/Manager/Authorized representative.
....Opposite Party
COMPLAINT U/S 35 OF CONSUMER PROTECTION ACT, 2019.
BEFORE: SH. NAGENDER SINGH KADIAN, PRESIDENT.
DR. TRIPTI PANNU, MEMBER.
DR. VIJENDER SINGH, MEMBER.
Present: Sh. Upender Singh, Advocate for complainant.
Sh. PuneetChahal, Advocate for opposite party.
ORDER
SH. NAGENDER SINGH KADIAN, PRESIDENT:
1. Brief facts of the present complaint, as per the complainant, are that he is registered owner of a car bearing registration no. HR-34K-4891 duly insured with the opposite party- Universal Sompo General Insurance Co. Ltd. vide insurance policy no. AVO/2367/10066685 valid from 17.12.2021 to 16.12.2022 for Insured Declared Value (IDV) of Rs.6,86,000/-. On 01.01.2022, the said car was being driven by Paras and met with the accident at Sampla Railway station and in the said accident, Paras sustained injuries. He got admitted in Positron Multispecialty and Cancer Hospital Rohtakw.e.f. 01.01.2022 to 04.01.2022. Thereafter, the said vehicle was brought through crane at Jai Mata Motors, Sheela Bye Pass Road, Rohtakby paying Rs.3000/-. After intimation of accident of the said vehicle to the insurance company, a surveyor was deputed by the company who surveyed the damaged vehicle. An estimate of loss to the tune of Rs.3,92,096/- was also issued by Jai Mata Motors and the complainant got lodged the claim vide claim no. C121235076 and completed all the required formalities of opposite party for disbursal of the claim. But despite several visits and requests of complainant, the opposite party refused to pay the claim vide its letter dated 07.01.2022 which is illegal, unwanted, arbitrary and against the law and principal of natural justice. As such there is deficiency in the services on the part of opposite party. Hence this complaint and it has been prayed that opposite party may kindly be directed to the pay the claim amount of Rs.3,92,096/- on account of damage of insured car, Rs.3000/- as crane charges with interest, compensation of Rs.50,000/- on account of deficiency in service and Rs.11,000/- as litigation expenses besides any other relief which this Commission may deem fit and proper.
2. Upon notice, the opposite party appeared and filed the written statement submitting therein that opposite party had appointed an IRDA accredited independent surveyor/investigator to investigate and assess the losses pertaining to the incident. After perusal of survey report and claim documents submitted by the complainant, the opposite party had observed that as per medical documents, smell of alcohol was found present; as per claim form submitted by the complainant, the loss date was 05.01.2022 but the actual date was 01.01.2022 as confirmed by real time photographs and medical documents and further that the brother of user (Paras) confirmed that they have purchased the subject vehicle from the insured. Hence, in view of above reasons, the opposite party denied to pay the claim of complainant vide letter dated 21.02.2022. It is further submitted thatopposite party is not liable to pay any claim and accordingly dismissal of the claim has been prayed for, having no merits.
3. Learned counsel for the complainant in his evidence has tendered affidavit Ex. CW1/A, documents Ex. C-1 to Ex. C-7 in his evidence and closed the same on dated 10.11.2022. On the other hand, learned counsel for the opposite party tendered affidavit Ex. RW1/A, documents Ex R-1 to Ex. R-5 in his evidence and closed the same on dated 22.12.2022.
4. In the present case, the claim of the complainant has not been paid by the opposite party on the below mentioned grounds.:
i). As per Medical document it is mentioned that the smell of alcohol was present.
ii). Mis-representation of facts-As per claim form, the loss date was 5th Jan 2022 but the actual loss date was 1st Jan 2022 confirmed by real time photographs and medical document.
iii). During the verbal discussion the user’s(Paras) brother verbally confirmed to us that they have purchased the subject vehicle from the insured(video recording available).
The intimation of the same was given by the opposite party to the complainant vide their letter placed on record as Ex.R1. We have minutely perused the documents placed on record by both the parties. As per our opinion the insurance company considered the fact that the driver of vehicle was under the influence of liquor at the time of accident. To prove this fact the respondent insurance company has placed on record an outdoor slip as Ex.R5, in which it has been mentioned that alcohol smell is present. On the other hand, the complainant has placed on record Ex.C5, a copy of intimation given by Positron Hospital to the police station Urban State, Rohtak regarding the admission of Mr. Paras in their hospital in a road side accident. It has been further mentioned in this document that the patient received injuries on right elbow. But it has not been mentioned in this document that the driver of the vehicle i.e. Paras was under the influence of liquor at that time. The second objection of the insurance company is that there is misrepresentation of fact that as per the claim form the date of loss was mentioned as 5th January 2022 but the actual loss date was 1st January 2022. As per our view, the insurance company failed to place on record any claim form to prove the fact that complainant has mentionedthe date of loss as 5th January 2022 in the claim form. The insurance company only placed on record five documents in its evidence i.e. Ex.R1 No Claim letter, Ex.R2 Policy, Ex.R3 final survey report, Ex.R4 investigation report, Ex.R5 photocopy of OPD Card. Moreover as per the Ex.R4, the summary of claim has been mentioned and on the first page of this report, the date and time of loss is mentioned as 1st January 2022 at 5.30A.M. The 3rd objection is verbal that there is no insurable interest of the complainant in the vehicle in question. The user’s(Paras) brother verbally confirmed that they have purchased the vehicle in question from the complainant but to prove this fact, any evidence has not been placed on record by the respondent. So the objections raised by the opposite party are on false and illegal grounds and the opposite party is liable to pay the insurance claim to the complainant. Through this complaint, the complainant has demanded a sum of Rs.312096/- from the respondent insurance company. The complainant has placed on record simply an estimate Ex.C4 whereas as per survey report Ex.R3 the loss assessed by the surveyor is Rs.263501/-. Hence the complainant is entitled for the amount of Rs.263501/-.
5. In view of the facts and circumstances of the case, we hereby allow the complaint and direct the opposite party to pay Rs.263501/-(Rupees two lac sixty three thousand five hundred and one only) alongwith interest @ 9% p.a. from the date of filing the present complaint i.e.25.03.2022 to till its realisation and also to pay Rs.5000/-(Rupees five thousand only) as compensation on account of deficiency in service and Rs.5000/-(Rupees five thousand only) as litigation expenses to the complainant. Order shall be complied within one month from the date of decision.
6. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
7. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
28.10.2024.
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Nagender Singh Kadian, President
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TriptiPannu, Member.
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Vijender Singh, Member
