Haryana

Karnal

CC/274/2019

Ramesh Kumar - Complainant(s)

Versus

Universal Sompo General Insurance Company Limited - Opp.Party(s)

Sanjeev Kumar

18 Nov 2021

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL  COMMISSION, KARNAL.

 

                                                         Complaint No. 274 of 2019

                                                          Date of instt. 17.05.2019

                                                          Date of Decision: 18.11.2021.

 

Ramesh Kumar aged about 41 years son of Sh. Jai Parkash, r/o vill. Dhanora Jagira, Distt. Karnal, Adhar No. 7411 2043 6606.

 

                                                 …….Complainant.

                                      Versus

 

Universal Sompo General Insurance Co. Ltd., SCF-55, 3^rd Floor, Sector-6, Main Market, Karnal through its Manager.

                                                                      …..Opposite Party.

 

Complaint Under section 12 of the Consumer Protection Act, 1986 as amended Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

 

 Argued by: Shri Sanjeev Kumar,     counsel for complainant.

                     Shri Y.P. Arora, counsel for opposite party.

 

                    (Jaswant Singh President)

ORDER:

 

                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 as after amendment Under Section 35 of Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that complainant is the registered owner of one Canter bearing No. HR-45A-4122, which was insured with OP, vide cover note No. PSID155305 and policy No. 2315/59260663/00/000, valid from 25.12.2018 to 24.12.2019. On 21.01.2019, Sunil Kumar son of Rishi Pal, resident of village Badondi, District Kurukshetra was going from Kurukshetra to Shamli (U.P.) while on canter No. HR-45A-4122 after loading potatoes alongwith one Raghubir Singh son of Nanha Ram, resident of village Badshami who was doing the job of Helper/ Conductor on said canter. The canter was being driven by said Sunil Kumar at a slow and moderate speed on its due left hand side of the road at Karnal Shamli road and when they reached in front of Pawan Dhaba near village Andhera, then all of sudden one truck bearing registration No.PB-11CB-9750 came from behind side and same was being driven by its driver in a rash and negligent manner at a very high speed and after over taking the said canter, suddenly driver of the truck applied brakes of truck in front of canter without giving any indication. Even there was no light on the rear side of said truck as a result of which said canter struck into the rear side of the truck. It is further averred that Raghbir Singh who was sitting on conductor seat received serious and multiple injuries on his various parts of body and later on he died due to the injuries suffered by him and said canter was also totally damaged. Thereafter, complainant informed the OP about the accident and filed the claim form regarding total damage of vehicle with OP after completing all the formalities as per directions issued by OP. Thereafter, OP directed the complainant to get the said canter repaired and to submit the bills on the assurance that company will reimburse the amount spent on its repair. Accordingly, complainant got said damaged vehicle repaired after spending huge amount of Rs.1,75,000/- approximately and submitted the bills to the OP.  It is further averred that thereafter the complainant contacted and visited the office of OP several times for settling his claim but OP postponed the matter on one pretext or the other. The OP also demanded certain documents from complainant which were also supplied by him and thereafter also he requested the OP for settlement of his claim as per policy but till date the OP has not done any needful, rather the OP issued a letter dated 6.3.2018 to the complainant declining the claim of complainant. Complainant also got served a legal notice upon OP on 22.4.2019, it also did not yield any result. In this way there was deficiency in service and unfair trade practice on the part of the OP. Hence, this complaint.

2.               On notice, OP appeared and filed written version raising certain preliminary objections regarding no locus standi, estopal and involvement of complicated questions of law and facts and concealment of true and material facts. On merits, it is pleaded that infact the complainant lodged the claim with the OP and given the name of driver as Mr. Sunil Kumar. The OP deputed an investigator to investigate the matter and found that at the time of accident, Mr. Raghubir Singh was driving the vehicle and he was sitting alone in the vehicle and the complainant concealed the actual facts and misrepresented the details to the OP which are the violation of the insurance policy. Therefore, the OP was unable to consider this claim. The insurance company rightly did not consider the claim of complainant and intimated the insured/ complainant through letter dated 06.03.2018 as per terms and conditions of the insurance policy. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             The parties then led their respective evidence.

4.             Complainant has tendered in evidence his affidavit Ex.CW1/A, copy of FIR Ex.C1, copy of policy schedule Ex.C2, copy of certificate of registration Ex.C3, copy of pollution certificate Ex.C4, copy of authorization certificate of N.P. (Goods) Form 47 Ex.C5, copy of certificate of fitness Ex.C6, copy of letter dated 6.3.2018 (it should be 6.3.2019) Ex.C7, copy of legal notice Ex.C8 and copies of bills Ex.C9 to Ex.C14 and copy of tax invoice (job card) Ex.C15.

5.             On the other hand, op has tendered in evidence affidavit of Sh. Piyush Shankar, Assistant General Manager Ex.OP1/A, copy of survey report Ex.OP1, copy of investigation report Ex.OP2, copy of insurance claim form Ex.OP3.

6.             The complainant then moved an application for additional evidence for tendering copy of driving licence of driver Sunil Kumar and certified copy of FIR which was allowed. Thereafter, complainant tendered in additional evidence documents i.e. copy of DL of Sunil Kumar Ex.C16 and certified copy of FIR dated 22.1.2019 Ex.C17.

7.             In rebuttal to additional evidence of complainant, OP has tendered copy of statement of Ramesh Kumar complainant Ex.OP4.

8.             We have heard learned counsel for the parties and have perused the case file carefully.

9.             Learned counsel for the complainant has contended that vehicle in question i.e. Canter bearing registration No. HR45-A-4122 which was duly insured with the OP for the period 25.12.2018 to 24.12.2019 met with an accident on 21.1.2019 during the subsistence of the policy in question and it was badly damaged. The complainant lodged the claim with the OP and the officials of the OP asked the complainant to get the vehicle repaired and accordingly he got repaired the vehicle by spending an amount of Rs.1,75,000/- but thereafter, the OP has wrongly declined the genuine claim of the complainant on the ground of concealment of material facts regarding driver of the vehicle at the time of accident whereas the complainant has not concealed anything from the OP. The police after visiting the place of accident and due investigation registered the FIR on the statement of driver Sunil Kumar finding the version of said driver Sunil Kumar to be true and therefore, OP has arbitrarily and wrongly declined the genuine claim of the complainant and prayed for acceptance of complaint.

10.           Per contra, learned counsel for OP has strongly contended that after lodging of claim of complainant, matter was got investigated from Secure Risk Management & Insurance Services and Mr. Amandeep Chief Investigating Officer of the said agency has submitted his investigation report Ex.OP2 to the effect that complainant has misrepresented the actual facts as there was only one person i.e. driver Raghubir Singh available at the time of accident in the canter and Sunil Kumar was not present at the time of accident and vehicle was being driven by an unauthorized person who was not competent to drive the insured vehicle and therefore, complainant has violated the terms and conditions of insurance policy. He has further contended that OP has rightly not considered the claim of complainant and prayed for dismissal of complaint.

11.           We have duly considered the rival contentions of both the parties.

12.           Admittedly, the canter of the complainant bearing registration No.HR-45A-4122 was insured with the OP from 25.12.2018 to 24.12.2019 which fact is also evident from copy of policy schedule Ex.C2. There is also no dispute of the fact that vehicle in question met with an accident on 21.01.2019. According to complainant on the assurance given by OP to reimburse the amount on repair of the vehicle, he got repaired the vehicle by spending an amount of Rs.1,75,000/- but thereafter, OP vide letter dated 6.3.2019 has declined to reimburse the claim amount to the complainant which is wrong and illegal. The complainant has also placed on file copy of letter dated 06.03.2018 of OP (the date has been wrongly shown in the letter as 06.03.2018 and it should be 06.03.2019 as date of accident is 21.1.2019) as Ex.C7 and the relevant portion of the said letter is reproduced as under:-

        “We have perused the pertinent claim documents submitted by you alongwith the Survey report of the independent Surveyor appointed for assessing the loss and observed that:

• While claim intimation to us the driver name is reported Mr. Sunil Kumar however as per investigation report, at the time of loss Mr. Raghubir Singh was driving the vehicle & he was sitting alone in the vehicle.
• You hide the actual facts and misrepresented the details to us which are the violation of policy condition.
•  
•  
•  

Announced

Dated:18.11.2021

                                                                       

                                                                  President,

                                                       District Consumer Disputes

                                                       Redressal Commission, Karnal.

 

(Vineet Kaushik)       

                         Member