Orissa

Jajapur

CC/70/2020

Samarendra Jena. - Complainant(s)

Versus

Universal Sompo General Insurance Co.Ltd. - Opp.Party(s)

Mr. Biraja Prasanna Das.

10 Dec 2021

ORDER

                IN THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JAJPUR.

                                                        Present:    1.Sri Pitabas Mohanty, Member,

                                                                          2.Miss Smita Ray,  Member (w).                       

                                                      Dated the 10th day of December ,2021.

                                                      C.C.Case No.70 of 2020

Samarendra Jena   S/O Late Sachidananda Jena   

In front of Union Bank  of India Near V.N. High school

Jajpur Road , P.O/P.S.Jajpur Road   ,

 Dist.-Jajpur.                                                                                           …… ……....Complainant .                                                                       

                   (Versus)

1.Universal Sampoo General Insurance Co.Ltd ,represented through its

Chairman-cum-Managing Director ,Unit no.401,4^th floor,Sangam complex

127,Andheri East,Mumbai.     

2. Branch Manager,Universal Sampoo General Insurance Co.Ltd,

House no.461,2^nd  floor,Gugnani,Heights Lewis Road, Goutam Nagar,Bhubaneswar

3. Branch Manager,Karnataka Bank, Jajpur Road, Dt. Jajpur.

                                                                                                               ……………..Opp.Parties.                                                                                                                                            For the Complainant:                             Mr. B.P.Das, P.K.Dhal,   Advocates.

For the Opp.Party: No.1  and 2              Sri P.Kanoongo,  Advocates.

For the Opp.Party : No. 3                      Sri P.K.Daspattnaik, Advocate                                                                                                   

                                                                                                    Date of order:  10.12.2021

SHRI PITABAS MOHANTY, PRESIDING  MEMBER .                                                  

The petitioner has filed the present dispute against the O.ps mainly against O.P.no.1 and 2 since the O.P.no.1 and 2 illegally have repudiated the Insurance claim of the petitioner.

            The facts of the case shortly as per complaint petition are that the petitioner had purchased a Tata Ultra AC Bus for commercial purpose  and the said bus was insured with O.P.no.1 and 2 .The alleged vehicle has been purchased by the petitioner with the financial assistance from O.P.no.3 as well as  though the status of the vehicle is commercial but it is used to maintain the lively hood by mean of self employment. In the mean time during subsistence of policy  while the above cited vehicle was playing near Tata Steel Kalinagar Duburi on 05.04.2019 met with an accident . The   tire  structure of the bus got severally damaged  for which the accident bus was taken to the nearest service center i.e Sai Sudha Motors Pvt.Ltd which is registered service center  of Tata Motors. Accordingly  a technical report was prepared  with the help of loss assessor relating to claim in respect of the  bus .  The petitioner on 16.04.19  submitted claim  form to O.p.no.1 and 2 . The Tax invoice of Sai Sudha  motors (p) Ltd dt.30.06.19 would show that Rs.11,10,352/- spent towards repairing the vehicle  and the same report was submitted to O.p.no.1 and 2  for realization of the claim  in respect of claim No.CL/900302/ policy No.2314/56717859/02/000 pertaining to vehicle No.OD-04-J-3018. As against such claim the O.p.no.1 and 2 had not taken any proper steps  to release the claim of the petitioner. After several correspondence the O.p.no.1 ( M.D Insurance  company vide his letter dt.13.12.2019 rejected  the Insurance claim  of the petitioner on the ground the claim Is not due to external means and mechanical failure which is excluded from the policy term and condition . As against such rejection the petitioner vide his letter dt.27.01.2020  though again submitted elaborate explanation with some additional documents in support of his claim but the M.D of Universal Sampoo General Insurance Co.Ltd  again rejected the claim of the petition on 20.02.2020. Accordingly the petitioner finding no other way has filed the present dispute with the prayer to direct the O.p.no.1 and 2  to pay Rs.11,10,352/-  towards repairing cost  +  Rs.2,50,000/- towards payment of loan dues  + Rs.1,00,000/- towards travelling expenses  + Rs.3,00,000/- towards the loss of income + Rs.1,00,000/- towards mental agony and harassment  + Rs.50,000/- towards litigation expenses.

            After appearance the O.P.no.1 and 2  has filed the written version taking the stand  that the petitioner submitted the proposal form for Insurance of the above cited bus bearing No.OD-04-J-3018 through Karnatak Bank,Jajpur Road Branch. The Insurance policy bearing No.2118PR0000021072 was issued covering the risk period from 25.11.2018 to 24.11.2019 under passenger carrying package policy subject to term and conditions. On receipt of the claim intimation regarding loss sustained to the petitioner due to burst of AC system of the Insured vehicle on 05.04.2019  the O.P.no.2 in  consultation with its superior authority has deputed surveyor Arunadayaleswar  Das for assessment  of the Loss  in the matter who subsequent to re-inspection on 13/07/2019 and assessment of loss has submitted his report to O.p.no.2 .In this context it is stated by O.P.no2  that as per version of the petitioner/ insured while the bus was plying on the road all of a sudden a stone came from a tire of an unknown truck and came in contact with the insured vehicle’s AC condenser  service pipe and there by Ac  system got burst and some glass and body of bus damaged. In this regard the petitioner also has submitted an affidavit dt.24.04.2019 before the Insurance company . Thereafter O.P.no.2  deputed Investigator in rapid claim(p) Ltd for investigation in the matter in order to ascertain the genuineness of the claim and the investigator after investigation submitted his report corroborating the aforesaid nature of accident / damage sustained to insured vehicle subsequently after due scrutiny it came to the notice of the O.P that the aforesaid nature of incident falls under policy exclusion as the damages are consequential  in nature since there is no involvement of any external means which is excluded from the policy term and condition and thereby the claim was recommended for repudiation and the competent authority of these O.ps repudiated the claim as “ no claim” as well as intimated to the petitioner/ insured vide letter dt.13.12.2019. As such there is no deficiency in service on the part of the O.ps for which the dispute is liable to be dismissed against the O.ps with cost.

            In view of the above assertion and counter assertions of both the parties after perusal of the record  along with documents filed from both the sides we are inclined to decide the dispute as per our observations below:-

1.Admittedly the above cited bus has been insured with O.P.no.1 and 2 which was valid from 25.11.2018 to 24.11.2019 .During subsistence  of policy period the bus met with an accident on 05.04.19 at Duburi .After receipt of the claim intimation the O.p.no.2  not only deputed the surveyor but also the investigator to ascertain the loss / nature of  accident and genuineness of claim who submitted their respective  report to the insurance company. Thereafter the Insurance company after due scrutiny repudiated the Insurance claim of the petitioner on 13.12.2019 on the ground  “ the aforesaid nature of accident falls under policy exclusion as the damages are consequential in nature since there is no involment of any external means which is excluded from the policy term and condition “ As against such stand from the side of the Insurance company  we have come across with the following observations as detailed below.

            A. 2013(2)CLT-395-Chandigarh-Bhupender Singh Vrs National Insurance Company where in it is held that

“surveyor is required to supply the copy of the survey report to insured so to give his clarification in respect of the survey conducted by surveyor”.

            B. 2021(1)CPR-192-N.C North India  p)Ltd Vrs United India Insurance Co

            “Copy of Surveyor’s report mandatorily ha s to be provided to insured “.

            C. 2007(4) TAC-372-Odisha

“ The report of investigator in Insurance claim can not be taken as evidence since he is a private person “.

            D. 2008(2) CLT-402-N.C

            “Investigator report not acceptable “.

            In view of the above observations of appellant forums it  is observed that the O.p.no.1 and 2 without considering/ following  the above settled principle of law partially has repudiated the Insurance claim         on the survey report which is not supported by affidavit as well as surveyor’s bread comes from his employer i.e O.P.no.1 and 2 .

            Owing to the above factual aspects surveyor’s report is not binding either to insurer or insured in view of the observations of Hon’ble Supreme court reported in 2010(1)CLT-266-SC. As such insurance company can not deny his liability since C.P.Act is benevolent legislation as per observation of Hon’ble State Commission –Odisha reported in 2009(3)CPR-53-Odisha.

Hence this Order

            The dispute is allowed against O.p.no.1 and 2 and dismissed against O.p.no.3. The O.p.no.1 and 2 are directed to pay the insurance claim amounting to  Rs.11,10,352/- ( Eleven lakh ten thousand three hundred fifty two ) to the petitioner along with Rs.50,000/- ( Fifty thousand ) as compensation and cost of the  litigation  .The above awarded amount shall be paid by O.P.no.1 and 2 within 45 days after receipt of this order ,failing which the above awarded amount will carry 9% interest per annum from the date of filing of the dispute till its realization .

                    This order is pronounced in the open Commission on this the 10th day of  December,2021. under my hand and seal of the Commission .