State Consumer Disputes Redressal Commission
Sandeep Kumar vs United India Insurance Company Limited on 29 August, 2022
Daily Order STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH Complaint case No. : 65 of 2020 Date of Institution : 03.03.2020 Date of Decision : 29.08.2022 Sandeep Kumar S/o Sh. Ajmer Singh R/o House No.111, Ward No.4, Bhapra Road, Shastri Nagar, Samalkha, Distt. Panipat. ...Complainant V e r s u s United India Insurance Co. Limited through its Managing Director, SCO No.123-124, Floor No.3, Sector 17-B, Chandigarh. United India Insurance Co. Limited through its Regional Manager, SCO No.123-124, Floor No.3, Sector 17-B, Chandigarh. The Divisional Manager, United India Insurance Co. Ltd. through its Managing Director, LIC Building Rajguru Market, Near Bus Stand, Panipat, Haryana. ....Opposite Parties No.1 to 3 Cholamandalam Investment and Finance Company Limited through its Managing Director, Dare House, 2, N.S.C. Bose Road, Parrys, Chennai. ... Opposite Party No.4 BEFORE: JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT. MRS. PADMA PANDEY, MEMBER.
MR.RAJESH K. ARYA, MEMBER.
Present:- Sh. Abhineet Taneja, Advocate for the complainant. Sh. Nitin Gupta, Advocate for opposite parties No.1 to 3. Opposite party no.4 exparte vide order dated 04.04.2022. PER JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT Prelude:-
The narratives of the complainant reflect the apathetic, negligent and irresponsible behavior of the insurance company, which has caused a grave financial loss to the insured-Sandeep Kumar, by not disclosing the fate of his claim and further, by closing the same on flimsy grounds.
Factual Scenario:-
The facts necessary for disposal of this complaint are that the complainant got insured his vehicle bearing no.HR-67B-0098 make Mahindra and Mahindra Blazo 49 (in short the vehicle), for the period from 03.10.2017 to 02.10.2018, vide insurance policy (Annexure C-1), with opposite parties no.1 to 3, on making payment of premium to the tune of Rs.75,599/-. Insured Declared Value (IDV) of the said vehicle was fixed at Rs.33,99,500/-.
The said vehicle met with an accident on 17.05.2018, intimation whereof, was given to opposite parties no.1 to 3. The Surveyor appointed by opposite parties no.1 to 3 visited the spot and submitted his spot survey report on 21.05.2018 (Annexure C-4). The vehicle was taken to M/s Karan Automotives, Karnal (authorized dealer of Mahindra and Mahindra), for carrying out necessary repairs, which gave estimate of Rs.7,66,827/-. The final bill dated 08.10.2018 (Annexure C-6) was raised in the sum of Rs.6,45,573/-, by M/s Karan Automotives. It has been stated that thereafter, despite the fact that he made number of requests to opposite parties no.1 to 3 to disburse the final bill amount of Rs.6,45,573/- raised by M/s Karan Automotives towards repair of the said vehicle, as the same was covered under the insurance policy, yet they failed to give any reply. Thereafter, on receipt of information, obtained under Right to Information Act, 2005 (RTI), it came to the notice of the complainant that the insurance company had already closed the claim vide letter dated 05.09.2018 (Annexure C-8) on the ground that the complainant has not informed from where he got the vehicle repaired and also the name of the Surveyor was also not disclosed by him. It has been averred that despite the fact that all the facts were brought to the knowledge of the opposite parties and also the necessary documents were also provided to the insurance company, yet, his genuine claim was closed.
It has been averred in the complaint that since the vehicle in question was being used by the complainant for running his livelihood by plying the same, yet, on account of the facts narrated above, he lost his livelihood and could not repay monthly installments to the financer- Cholamandalam Investment and Finance Company Limited (opposite party no.4), from which the vehicle in question was got financed. As such, opposite party no.4 took the possession of the vehicle on 24th June 2019 from the workshop, where the vehicle was stationed for the purpose of repair. Now, the financer-Opposite party no.4 has sold the same to one Nitin Mohan Sharma on 26th July 2019 at a very low price of Rs.5.40 Lakhs, whereas, the value of the vehicle, which was purchased in the year 2017 was Rs.33,99,500/-. It has been stated that the vehicle of the complainant has been sold by opposite party no.4 without following the procedure.
Hence, by way of filing this complaint, following prayer has been made by the complainant:-
"......It is, therefore, respectfully prayed that the respondents/ OPs may be directed to pay:-
Sum of Rs.6,45,573/- along with 18% interest w.e.f. 17.05.2018 i.e. from the date of accident till its actual realization.
Rs.10,50,000/- on account of actual loss suffered by the complainant as detailed in para 11(a) above.
Compensation for mental harassment and inconvenience charges to the tune of Rs.20,00,000/- as detailed in para 11(b) above To pay the sum of Rs.50,000/- on account of expenses incurred by the complainant for pursuing his legitimate right as detailed in para 11(b) above.
To pay Rs. 2.00 lakhs as punitive damages to the complainant as detailed in para 11(d) above.
To pay Litigation expenses to the tune of Rs. 55,000/-..."
Despite service, none put in appearance on behalf of opposite party no.4, as a result whereof, it was proceeded against exparte vide order dated 04.04.2022.
Defence of opposite parties no. 1 to 3:-
In the reply filed by opposite parties no.1 to 3, while admitting factual matrix of the case regarding issuance of the insurance policy in respect of the vehicle in question and occurrence of the accident thereof, as per details given in the main complaint by the complainant, it has been stated as under:-
that the complainant has concealed material facts from this Commission;
that this Commission is not vested with pecuniary and territorial jurisdiction to entertain and decide this complaint;
that the claim of the complainant was closed as "no claim" because he failed to submit original repair bills, proof of payment made to the repairer and claim form;
that because the complainant has failed to deposit salvage parts of the vehicle (damaged parts) amounting to Rs.13,500/- and also failed to complete necessary formalities as such this complaint is premature;
that this complaint cannot be adjudicated under summary proceedings and as such the complainant be relegated to civil court; and that this complaint is barred by limitation.
However, it has not been disputed by opposite parties no.1 to 3 with regard to the spot survey conducted on 18.05.2018 by Sh.Lal Bahadur, Surveyor and Loss Assessor and thereafter another survey was got done by T.P. Singh, Surveyor, on 14.06.2018, who assessed the loss to the tune of Rs.4,84,201/- vide his report dated 01.10.2018. While denying the remaining averments made by the complainant in his complaint, prayer has been made by opposite parties no.1 to 3 to dismiss the complaint with heavy cost.
The contesting parties led evidence in support of their case including the written arguments. Alongwith, the written arguments, the complainant has placed on record settlement letter dated 23.04.2022, Annexure C-18, which transpired that the matter with regard to default in making payment of monthly installments against loan raised for purchase the said vehicle stood settled between the complainant and opposite party no.4-Financer-Cholamandalam Investment and Finance Company Limited.
Arguments of the parties:-
We have heard the contesting parties and scanned the material available on the record, including the written arguments.
Learned counsel for the complainant submitted that it was only at the instance of insurance company as well as Surveyor, that the vehicle in question was taken to M/s Karan Automotives, Kohand, Karnal, where it was duly inspected by Mr.T.P. Singh, Surveyor and Loss Assessor who also gave its report but the claim of the complainant was kept pending and no intimation was given to him by the insurance company, regarding its progress or repudiation; that thereafter, the complainant through RTI 2005, came to know that his claim has been closed as 'no claim' due to non-production of the vehicle for survey/inspection, which is factually wrong, because spot survey of the vehicle was carried out by Sh.Lal Bahadur, Surveyor and Loss Assessor and the vehicle was thereafter inspected by Mr.T.P. Singh, Surveyor and Loss Assessor at the premises of M/s Karan Automotives, Kohand, Karnal, where it was stationed for accidental repairs. He further submitted that by closing the claim of the complainant on frivolous grounds, opposite parties no.1 to 3 are deficient in service, negligent and guilty of adoption of unfair trade practice, as the said closing of the claim was illegal, unwarranted and against the principles of natural justice. He further submitted that the complainant is a poor person. He was earning his livelihood by plying the said vehicle but now for the last four years he is empty handed; facing huge financial constraints and his career has been ruined by opposite parties no.1 to 3.
Learned counsel for opposite parties no.1 to 3 has argued in the tune of defence taken in the reply and they submitted that claim was rightly closed for non submission of original repair bills, proof of payment made to the repairer and claim form.
Observations of this Commission:- We have considered the rival contentions and X-rayed the material available on the record. In this case, the following facts are not in dispute: -
Vehicle bearing no.HR-67B-0098 (Mahindra and Mahindra Blazo 49) was insured vide insurance policy (Annexure C-1) with opposite parties no.1 to 3, valid for the period from 03.10.2017 to 02.10.2018 and its Insured Declared Value (IDV) was Rs.33,99,500/-
Payment of premium to the tune of Rs.75,599/- by the complainant towards the said policy;
The said vehicle met with an accident on 17.05.2018, intimation whereof, was given to opposite parties no.1 to 3 immediately;
On 18.05.2018 Spot survey was got done by opposite parties no.1 to 3 through Sh.Lal Bahadur, Surveyor and Loss Assessor;
The vehicle was taken to M/s Karan Automotives for carrying out necessary repairs, which gave estimate of Rs.7,66,827/- and final bill dated 08.10.2018 (Annexure C-6) was raised in the sum of Rs.6,45,573/-, by M/s Karan Automotives.
Inspection of the said vehicle was also got done from Sh.T.P. Singh, Surveyor and Loss Assessor, during the period when the vehicle was stationed in the workshop for repairs, on 14.06.2018, who submitted his report dated 01.10.2018, (Annexure C-10) assessing the loss to the tune of Rs.4,84,201/-
Closing the claim file of the complainant as "No Claim" by opposite parties no.1 to 3 vide letter and claim note dated 05.09.2018 (Annexure C-8).
It is very significant to mention here that we have gone through the letter dated 05.09.2018 (Annexure C-8) and claim note dated 05.09.2018 (Annexure C-9) which were obtained by the complainant under RTI, wherefrom it transpires that it has been clearly mentioned by the insurance company therein that since the complainant has not informed as to where he has got the vehicle repaired; and also the vehicle was not produced for final survey, therefore, his claim is closed as "No Claim".
Questions which arise for consideration in this case:-
The following questions have emerged for adjudication in this case:-
Whether this Commission is vested with territorial jurisdiction and pecuniary jurisdiction to decide this complaint?
Whether this complaint is filed beyond the period of limitation?
Whether the vehicle in question was got inspected by Sh.Lal Bahadur, and Mr.T.P. Singh, Surveyor and Loss Assessors deputed by opposite parties no.1 to 3? And if question no.iii is answered in affirmative, then whether the act of the insurance company in closing the claim of the complainant is unwarranted, illegal and irresponsible?
Relief Question No.12 (i)-Jurisdiction of this Commission: -
Territorial Jurisdiction: -
First, coming to the question, as to whether, this Commission is vested with territorial jurisdiction to decide this complaint, it may be stated here that it is settled law that even an infinitesimal fraction of a cause of action will be a part of the cause of action and confer jurisdiction on the Court/Tribunal/Fora within the territorial limits of which that occurs. Furthermore, Section 17 (2) of Consumer Protection Act, 1986, under which this complaint has been filed, reads as under:-
".........[(2) A complaint shall be instituted in a State Commission within the limits of whose jurisdiction,--
(a) the opposite party or each of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides or carries on business or has a branch office or personally works for gain; or
(b) any of the opposite parties, where there are more than one, at the time of the institution of the complaint, actually and voluntarily resides, or carries on business or has a branch office or personally works for gain, provided that in such case either the permission of the State Commission is given or the opposite parties who do not reside or carry on business or have a branch office or personally works for gain, as the case may be, acquiesce in such institution; or
(c) the cause of action, wholly or in part, arises...."
Thus, in order to bring his case, within the territorial jurisdiction of this Commission, at Chandigarh, the complainant was required to establish the fact that his claim was being handled by the Regional Office of the Insurance Company (i.e. opposite parties no.1 and 2) which are admittedly located at Chandigarh and carrying on business for working gain. It is significant to mention here that we have gone through the contents of Survey and Assessment Report dated 01.10.2018 (Annexure C-10) and find that it has been clearly mentioned in the said report by Sh.T.P. Singh, Surveyor and Loss Assessor that he went to M/s Karan Automotives, Kohand, Karnal, to survey and assess the loss of the vehicle in question, under the instructions received from Regional office, Chandigarh, on 14.06.2018. Neither this report nor any of the contents therein, has been negated by opposite parties no.1 to 3 and rather, the said report has been admitted by them in their written reply.In this view of the matter, it is held that the Regional Office of the insurance company i.e. opposite parties no.1 and 2, admittedly, located at Chandigarh were handling the claim of the complainant and were voluntarily residing and carrying on business and were personally working for gain thereat. In this view of the matter, it is held that this Commission has territorial jurisdiction to entertain and decide this complaint. Objection taken by opposite parties no.1 to 3 in this regard stands rejected.
Pecuniary jurisdiction:-
The next question that falls for consideration is, as to whether, this Commission has pecuniary jurisdiction to entertain and decide this complaint? It may be stated here that this complaint has been filed under Section 17 of the Consumer Protection Act, 1986. Thus, for determining pecuniary jurisdiction of this Commission, it is necessary to reproduce Section 17 (1) (a) of CPA 1986, which reads as under:-
"17. Jurisdiction of the State Commission.--
(1) Subject to the other provisions of this Act, the State Commission shall have jurisdiction--
(a) to entertain--
(i) complaints where the value of the goods or services and compensation, if any, claimed exceeds rupees twenty lakhs but does not exceed rupees one crore]; and
(ii) appeals against the orders of any District Forum within the State; ............."
Section 17 (1) (a) (i) clearly says that the State Commission has pecuniary jurisdiction to entertain the complaints, where the value of the goods or services and compensation, if any, claimed exceeds rupees twenty lakhs but does not exceed rupees one crore. Thus, in the present case, it we add the value of the goods/services and also compensation claimed by the complainant, it exceeds Rs.20 lacsbut doesnot excess Rs.1 crore. In this view of the matter, it is held that this Commission has pecuniary jurisdiction to entertain and decide this complaint.Objectiontaken by opposite parties no.1 to 3 in this regard stands rejected.
Question No.ii:- Whether this complaint is filed beyond the period of limitation?
The vehicle in question met with an accident on 17.05.2018, the first survey of the vehicle was conducted by Sh.Lal Bahadur on 18.05.2018, the second survey was conducted by Sh.T.P. Singh on 14.06.2018 and the complainant first time came to know regarding closing of his claim through RTI Information (Annexure C-7) on12.11.2019. This complaint has been filed on 03.03.2020. Even counted from 17.05.2018 when the vehicle met with an accident, the complaint is filed within limitation. Even if we take two years from 05.09.2018 i.e. the date when the claim of the complainant was closed as "No Claim", even then this complaint has been filed within a period of two years from the said date (05.09.2018). In this view of the matter, objection taken in this regard stands rejected.
The next question that falls for consideration is, as to whether, opposite parties no.1 to 3 were justified in closing the claim of the complainant on the ground that he failed to inform with regard to the location/workshop where he has got the vehicle repaired and also did not produce the vehicle for final survey?
It is significant to mention here that in the written reply filed by opposite parties no.1 to 3, the ground which has been taken by them to justify their stand for closing the claim of the complainant as "No Claim" is that the complainant failed to submit original repair bills; proof of payment to the repairer; claim form; and also salvage parts of the vehicle amounting to Rs.13,500/- were not deposited. However, when we go through the letter dated 05.09.2018 (Annexure C-8) and claim note dated 05.09.2018 (Annexure C-9) which were obtained by the complainant under RTI, it transpires that it has been clearly mentioned by the insurance company therein that since the complainant has not informed as to where he has got the vehicle repaired; and also the vehicle was not produced for final survey, therefore, his claim is closed as "No Claim".
Firstly, we would like to mention here that perusal of grounds taken by opposite parties no.1 to 3 in their written reply for closing the claim of the complainant as "No Claim" are totally different to that of the grounds mentioned in the letter dated 05.09.2018 (Annexure C-8) and claim note dated 05.09.2018 (Annexure C-9) which were obtained by the complainant under RTI. In our considered opinion, if the insurance company has not taken any ground of non-submission of original repair bills; proof of payment to the repairer; claim form and also non deposit of salvage part of the vehicle amounting to Rs.13,500/- by the complainant, at the time of closing the claim of the complainant, in the claim note or letter dated 05.09.2018, they cannot do so, at the stage of hearing of the consumer complaint before this Commission or in their written version and the said grounds cannot be taken as a defence to the claim. Thus, it has been proved from the act of opposite parties no.1 to 3 themselves that they have travelled beyond the grounds mentioned in the letter dated 05.09.2018 (Annexure C-8) and claim note dated 05.09.2018 (Annexure C-9). It is a settled position that the insurance company cannot travel beyond the grounds mentioned in the letter of repudiation. Our this view is supported by the principle of law laid down by the Hon'ble Supreme Court of India in Saurashtra Chemicals Ltd. (Presently known as Saurashtra Chemicals Division of Nirma Ltd. VERSUS National Insurance Co. Ltd, Civil Appeal No. 2059 of 2015, decided on December 13, 2019, relevant part whereof is reproduced hereunder:-
".....It is a settled position that an insurance company cannot travel beyond the grounds mentioned in the letter of repudiation. If the insurer has not taken delay in intimation as a specific ground in letter of repudiation, they cannot do so at the stage of hearing of the consumer complaint before NCDRC....."
Be that as it may, it may be stated here that even if we consider the grounds taken by opposite parties no.1 to 3 and also urged by their Counsel during arguments that it was only because the complainant failed to submit original repair bills; proof of payment to the repairer; claim form; andalso salvage part of the vehicle amounting to Rs.13,500/- were not deposited,his claim was closed as "No Claim", even then we are of the considered view that the same does not merit acceptance because not even a single evidence has been placed on record by opposite parties no.1 to 3 to prove that any letter has been written by them to the complainant to submit the said repair bills; proof of payment to the repairer; claim form; and to deposit salvage parts of the vehicle.
Question No.iii:- Whether the vehicle in question was got inspected by Sh.Lal Bahadur, and Mr.T.P. Singh, Surveyor and Loss Assessors deputed by opposite parties no.1 to 3?
In the outset, it is apposite to reproduce hereunder the relevant part of the letter and claim note dated 05.09.2018 (Annexure C-8) vide which the claim of the complainant was closed as 'no claim':-
The above said vehicle had met with an accident on dated 17.05.2018 near TEDAWA Mirzapur. Mr. Lal Bahadur deputed for spot survey. But for final survey the insured has not informed where get the vehicle repaired. Our letter dated 26/6/18 no response from insured side. Hence the file is closed as No Claim..."
From the perusal of the above said letter C-8, it is very clear that claim was closed solely on the ground that complainant had not produced the vehicle for final survey. No such letter has been placed on record vide which complainant was asked to produce the vehicle at a particular place for final survey. Even otherwise, the vehicle was inspected at spot by the Surveyor-Sh.Lal Bahadur, on 18.05.2018 and, at workshop by Surveyor Sh.T.P. Singh on 14.06.2018, This fact has also been unequivocally admitted by opposite parties no.1 to 3 in their reply in para no.4, that on receipt of intimation of the accident, Sh.Lal Bahadur, Surveyor and Loss Assessor was deputed to conduct the spot survey, who conducted the same on 18.05.2018. In para no.9 of the complaint, it has been specifically asserted by the complainant that Sh.T.P. Singh, Surveyor and Loss Assessor was deputed, who inspected the vehicle in the premises of M/s Karan Automotives, Kohand, Karnal, where it was stationed for accidental repairs. Relevant part of the said paragraph is reproduced hereunder:-
"...9. That it is relevant and important to mention here that the opposite parties also supplied the copy of the surveyor report dated 01.10.2018 given by T.P. Singh and Co. who examined the vehicle in a dismantled condition during course of repairs and also took few more photographs of the vehicle at M/s Karan Automobiles, Kohand, Karnal where the vehicle was lying for repairs. A copy of the surveyor report dated 01.10.2018 is annexed herewith as Annexure C-10...."
The opposite parties no.1 to 3 have not specifically denied in the written statement, rather, in para no.9 it has been stated that it is a matter of fact. Thus, this fact is duly established being admitted by opposite parties no.1 to 3. Thus, this question is answered in the affirmative.
Question no.iv:- Whether the act of the insurance company in closing the claim of the complainant as no claim is unwarranted, illegal and irresponsible?
Under question no.iii, it has been established that the vehicle in question was inspected by Sh.Lal Bahadur, on 18.05.2018 and by Sh.T.P. Singh, Surveyor and Loss Assessors, on 14.06.2018 and on subsequent dates. Sh. T.P. Singh submitted in hisreport dated 01.10.2018(Annexure C-10)that the damages present on the vehicle are accidental in nature and do confirm with the nature of the accident; he recommended payment of amount of Rs.4,84,201/- to the repairer. In his report, he also opined that the damage to the vehicle is fresh, genuine and coincides with the history of accident. Significantly, in his report, he has in a very candid manner stated that stated by Mr.T.P. Singh, Surveyor and Loss Assessor, that it was only under the instructions received from Regional Office, Chandigarh on 14.06.2018 that he went to M/s Karan Automotives, Kohand, Karnal, to survey and assess the said loss. In this report also, it has been candidly stated by the said Surveyor that he only advised the repairer to dismantle the vehicle for inspection and that the vehicle in question was also inspected during the course of repairs and that he finalized the loss with the repairer and insured, keeping in view the damages noted by him with the nature of the accident. Relevant part of the said report is reproduced hereunder:-
"...Under instruction received from Regional office, Chandigarh on 14-06-2018, undersigned went to M/S KARAN AUTOMOTIVES, KOHAND, KARNAL to survey & assess the said loss. I was told that said vehicle has met with an accident near Tedawa, Mirzapur and after arranging spot survey by Sh. Lal Bahadur surveyor, Mirzapur has been brought to said workshop for repairs. I examined the vehicle and found its cabin assy. has been badly damaged since it hit with the back of forgoing truck. I took particulars, enquired about the cause of accident& took few snaps from different angles. I discussed the estimate of repairs with the repairers and advised him to dismantle the vehicle so it can be inspected in dismantle condition The vehicle was again inspected in dismantled condition & few more photographs were taken. The vehicle was also inspected during the course of repairs, 1 finalized the loss with the repairer & insured keeping in view the damages noted by me relevant with the nature of accident....."
Thus, it is well established from the record that the vehicle was inspected twice, firstly by Sh.Lal Bahadur, Surveyor and Loss Assessor on 18.05.2018 and secondly by Mr.T.P. Singh, Surveyor and Loss Assessor, on 14.06.2018 and that too on the instructions of opposite parties no.1 to 3. However, it is highly disheartening that the claim of the complainant was not paid and closed by giving a very evasive and irresponsible reply vide letter and claim note dated 05.09.2018 (Annexure C-8) to the effect that the complainant has failed to inform about the name of the repairer from which the vehicle was got repaired and also the contact number of the surveyor who conducted final survey.
Now we will like to deal with the plea taken by Counsel for the opposite parties no.1 to 3 to the effect that the claim was declared as "No Claim" because the complainant has failed to provide original repair bills, proof of payment made to the repairer and claim form. We are of the considered opinion that the said objection does not merit acceptance, in the face of survey report dated 01.10.2018 (Annexure C-10) submitted by Mr.T.P. Singh, Surveyor and Loss Assessor, wherefrom it is evident that he was in possession of claim intimation letter; estimate of repairs, claim form duly filled in, Xerox copy of driving licence; registration certificate; insurance policy; driving licence and registration certificate online verification certificate; spot survey report, survey fee bill and photographs of the damaged vehicle. Thus, the only inference available against the opposite parties no.1 to 3 is that those documents were duly supplied. Significantly, it has been mentioned by the said Surveyor and Loss Assessor that he has done survey on the vehicle in question on 14.06.2018. In his report, not even a single whisper has been made by the Surveyor and Loss Assessor that the complainant did not co-operate with him or that the complainant did not supply any relevant documents to him. It is evident from survey report dated 01.10.2018 (Annexure C-10) that the entire documents, necessary for assessing the loss and damage/survey of the said vehicle were provided to the Surveyor and Loss Assessor and it was only thereafter that he opined that the claim is genuine and coincide with the history of accident, as explained in the claim form. In this view of the matter, it is held that once all the requisite documents were in the custody of Surveyor and Loss Assessor on 14.06.2018 i.e. at the time of survey of the vehicle in question. The closing of the claim of complainant, in the circumstances of the case, amounts to repudiation thereof. As such, the act and conduct of opposite parties no.1 to 3 by closing the claim of the complainant on this ground too, amounts to adoption of unfair trade practice and deficiency in providing service.
A bare perusal of the record reveals that the Surveyor and Loss Assessor in his report dated 01.10.2018 (Annexure C-10) has clearly opined that the claim filed by the complainant is genuine and that it coincides with the history of the accident as claimed in the claim form, which fact in itself is sufficient to say that the claim has been found to be genuine. In our considered opinion, it will not be reasonable to reject genuine claim which had already been verified by the Surveyor/Investigator appointed by the insurance company itself. In Om Prakash Vs. Reliance General Insurance and ANR., [Civil Appeal No. 15611 of 2017 arising out of SLP (C) No.742 of 2015], decided on October 4, 2017, the Hon'ble Supreme Court has held as under: -
".....It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the Investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine. It needs no emphasis that the Consumer Protection Act aims at providing better protection of the interest of consumers. It is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten while considering the claims made under the Act...."
Thus, by not paying the amount of Rs.4,84,201/- as assessed by the Surveyor and Loss Assessor, opposite parties no.1 to 3 indulged into unfair trade practice and were also deficient in providing service.
At the same time, it is also held that it is a simple case of nonpayment of claim amount of a genuine claim, by the insurance company to the complainant, which fact has been proved by the documents provided by opposite parties no.1 to 3 only. As such, plea taken by opposite parties no.1 to 3 to the effect that this complaint needs to be relegated to the civil court and cannot be adjudicated under summary proceedings by this Commission, being devoid of merit stands rejected.
Genuine claim of the complainant has not been considered by opposite parties no.1 to 3. In Asgar Khan vs Permanent Lok Adalat & Anr., L.P.A. No.1409 of 2016 (O&M) in Civil Writ Petition No.2189 of 2016, decided on 17 February, 2020, it was held by the Hon'ble Punjab-Haryana High Court that ".....It is not uncommon that all the insurance companies, be it public sector undertaking or private insurance company, would issue lucrative offers and incentives, so as to attract maximum number of citizens. However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company. Most of the times, as it has been experienced in the recent past, even the genuine claim would be rejected on one or the other technical or flimsy ground, giving rise to such kind of avoidable litigation. In fact, thrust of the insurance companies is, as to how and on what grounds, including baseless ones, claims can be repudiated, instead of settling the same proceeding on a reasonable approach. They always keep their consumers misinformed or misguided. At the time of accepting premiums, there would be no technical grounds in their schemes. However, when any insured puts his genuine claim, the insurance companies will repudiate that claim on technical and super technical grounds, which were not even known to the insured. Thus, even genuine policyholders are losing faith in the institution and insurance industry is getting infamous, earning a bad name.....". In the present case, the complainant has not only suffered huge mental agony and harassment but also suffered a lot from the misleading statements of opposite parties no.1 to 3, which were highly irresponsible, unwarranted, illegal and false. As such, the said act and conduct of opposite parties no.1 to 3 need to be deprecated and the complainant needs to be suitably compensated in the matter.
Relief awarded:-
For the reasons recorded above, this complaint stands partly allowed with costs, against opposite parties no.1 to 3 and they are directed as under:-
To pay compensation to the tune of Rs.9,00,000/- (Nine lacs) to the complainant for causing him mental agony and harassment and also deficiency in providing service, negligence and adoption of unfair trade practice, by not paying his genuine claim, as a result whereof, he was deprived of earning his livelihood because of non-use of the vehicle in question and his future has been ruined.
To pay compensation to the tune of Rs.5,00,000/- (Five Lacs) towards the loss suffered by him, on account of the reason that because of non use of the said vehicle, he was unable to chalk out the monthly installment to opposite party no.4, as a result whereof, the vehicle in question stood recovered/seized by it and was sold for meager amount of Rs.5.40 lacs.
To pay cost of litigation to the tune of Rs.50,000/- to the complainant.
This order be complied within a period of 30 days from the date of receipt of a certified copy of this order failing which thereafter the aforesaid entire payable amount shall entail interest @12% p.a. from the date of passing of this order till realization.
Complaint against opposite party no.4 is dismissed with no order as to cost, in the face of settlement letter dated 23.04.2022 (Annexure C-18) having been placed on record by the complainant himself, which transpired that the matter with regard to default in making payment of monthly installments against loan raised by him for purchasing the said vehicle stood settled between the complainant and opposite party no.4.
It is also made clear that though the complainant in his complaint has sought directions to opposite parties no.1 to 3 to make payment of Rs.6,45,573/- incurred on repair of the vehicle in question, yet, during pendency of this complaint, on 17.08.2022, it was brought to the notice of this Commission that he has not paid any amount from his pocket to the repairer workshop towards the repair and replaced parts of the accidental vehicle, as such, under these circumstances, he is not entitled to claim any amount in respect of the same.
Certified Copies of this order be sent to the parties, free of charge.
The file be consigned to Record Room, after completion.
Pronounced.
29.08.2022 Sd/-
[JUSTICE RAJ SHEKHAR ATTRI] PRESIDENT Sd/-
(PADMA PANDEY) MEMBER Sd/-
(RAJESH K. ARYA) MEMBER Rg.