State Consumer Disputes Redressal Commission
Bajaj Allianz General Insurance ... vs Anil Kumar Sao on 27 September, 2016
NRrhlx<+ jkT;
miHkksDrk fookn Áfrrks"k.k vk;ksx] i.Mjh] jk;iqj vihy Øekad% FA/16/301 lafLFkr fnukad%09.06.2016 ctkt ,yk;at tujy ba';ksjsal da-fy-] }kjk& 'kk[kk izca/kd] f}rh; ry] f'koeksgu Hkou] fo/kku lHkk jksM] eaMh xsV] iaMjh] jk;iqj] ftyk& jk;iqj ¼N-x-½ -----vihykFkhZ fo:) vuhy dqekj lko] vkRet es:/kj lko] fuoklh& nars'ojh fogkj dkyksuh] nars'ojh eafnj ds ihNs] HkkBkxkao jk;iqj] ftyk& jk;iqj ¼N-x-½ ----mRrjoknh le{k% ekuuh; U;k;ewfrZ vkj-,l-'kekZ] v/;{k ekuuh; lqJh fguk BDdj] lnL;k ekuuh; Jh Mh-ds-iksn~nkj] lnL;
i{kdkjksa ds vf/koDrk vihykFkhZ dh vksj ls Jh ,u-ds-Bkdqj] vf/koDrkA mRrjoknh dh vksj ls Jh vkj-ds-Hkkoukuh] vf/koDrkA vkns'k fnukad% 27@09@2016 }kjk% ekuuh; lqJh fguk BDdj] lnL;k vihykFkhZ us ;g vihy /kkjk&15 miHkksDrk laj{k.k vf/kfu;e 1986 ds vUrxZr ftyk miHkksDrk fookn izfrrks"k.k Qksje] jk;iqj¼N-x-½ ¼ftls vkxs laf{kIr esa *ftyk Qksje* lacksf/kr fd;k tk,xk½ ds ifjokn izdj.k dzekad 396/2014**vfuy dqekj lko fo:) ctkt vkfy;kat tujy ba';ksjsal da-fy-** esa ikfjr vkns'k fnukad 21-04-2016] ls {kqC/k gksdj izLrqr // 2 // dh xbZ gSA ftyk Qksje }kjk ifjoknh dh ifjokn dks Lohdkj dj vknsf'kr fd;k x;k fd vukosnd ifjoknh dks okgu dh chfer ewY; dh jkf'k 5]14]563@&¼ikap yk[k pkSng gtkj ikap lkS frjlB :i;s½ ifjokn fnukad ls vnk;xh fnukad rd 9% lk/kkj.k okf"kZd C;kt] ekufld d"V ds fy;s 20]000@&:-¼chl gtkj :i;s½] okn O;; 5]000@&:-¼ikap gtkj :i;s½ iznku djsaA 2- izdj.k esa Lohd`r rF; ;g gS fd ifjoknh QksMZ okgu dzekad &lh- th-04@ds-D;w-8002 dk Lokeh gSA ifjoknh us vius mDr okgu dk O;kid chek] vukosnd chek daiuh ls ikWfylh dzekad vks-th- &14&2303&1801&00000222 ds rgr~ oS/krk vof/k fnukad 12-04-2013 ls 11-04-2014 rd ds fy;s okgu dk vkbZ-Mh-Ogh- ewY; 5]14]563@&:- gsrq 17]323@&:- izhfe;e vnk dj djok;k FkkA ifjoknh dh ifjokn dk la{ksi lkj ftyk Qksje ds le{k bl izdkj gS fd ifjoknh dh mDr okgu fnukad 04-02-2014 dks nq?kZVukxzLr gks xbZ ftldh rRdky lwpuk vukosnd dks nh xbZA ifjoknh ds }kjk vukosnd }kjk iznRr Dyse QkeZ dks Hkjdj leLr nLrkostksa lfgr vukosnd dks iznku fd;k x;k ftlesa th-ds-QksMZ }kjk okgu esa vkus okys [kpsZ dk ,LVhesV 5]04]830-87@&:- dk Hkh FkkA vukosnd }kjk le;≤ ij ifjoknh ls nLrkostksa dh ekax dh xbZ ftls ifjoknh us vukosnd dks iznku fd;kA vukosnd ds }kjk fu;qDr losZ;j ds }kjk ;g fjiksVZ nh xbZ fd okgu esa dqy [kpZ 3]21]901@& dk gSA ifjoknh ds }kjk losZ{kd Jh fgrs'k fprkfy;k ls okgu dk losZ djk;k x;k ftuds }kjk laiw.kZ okgu dks fujh{k.k dj ;g fjiksVZ nh xbZ fd mDr okgu esa 3]89]866@&:- [kpZ vk;sxkA mDr losZ fjiksVZ dks Hkh ifjoknh us vukosnd dks iznku fd;k rFkk fuosnu fd;k fd pwafd okgu esa vkus okyk dqy [kpZ vkbZMhOgh ewY; ds 75 izfr'kr ls vf/kd gS] blfy;s okgu dks // 3 // VksVy ykWl dh Js.kh esa ekuk tkos ysfdu vukosnd ds }kjk vkt fnukad rd nkos dk fujkdj.k ugha fd;k x;k gSA ifjoknh us fnukad 28-04-2014 dks vukosnd dks bZ&esy dj fuosnu fd;k fd nkos dk fujkdj.k VksVy ykWl ds vk/kkj ij fd;k tk;s ftldk tokc vukosnd }kjk fnukad 14-05-2014 dks nsrs gq, fnukad 17-05-2014 rd nkos ds laca/k esa tkudkjh nsus dk vk'oklu fn;k ysfdu vkt fnukad rd vukosnd ds }kjk dksbZ Hkh dk;Zokgh ugha dh xbZ vkSj u gh nkos dk fujkdj.k fd;k x;kA ifjoknh us bl laca/k esa vukosnd dks vf/koDrk ds ekQZr~ fnukad 05-06-2014 dks iathd`r lwpuk i= Hkh izsf"kr fd;k ftldk dksbZ tokc ugha fn;k x;kA vukosnd dk mDr d`R; Li"V :i ls vuqfpr O;kikj rFkk lsok esa fuEurk dh Js.kh esa vkrk gSA vr% ifjoknh us ;g ifjoknh is'k dj vukosndx.k ls dafMdk&1 ds vuqlkj okafNr vuqrks"k fnyk;s tkus dk fuosnu fd;k x;kA 3- vukosnd }kjk ftyk Qksje ds le{k mRrj izLrqr dj viuh izfrj{kk esa vfHkdFku fd;k gS fd vukosnd chek daiuh ds }kjk ifjoknh ds okgu dk chek] chek ikWfylh ds 'krZ ,oa fu;e ds rgr~ fd;k x;k FkkA ifjoknh ds }kjk okgu nq?kZVuk fnukad 04-02-2014 dh dksbZ Hkh fjiksVZ iqfyl Fkkuk esa ntZ ugha djk;h xbZ vkSj nq?kZVuk dh lwpuk Hkh chek daiuh dks fnukad 11-02-2014 dks nh xbZ vFkkZr~ nq?kZVuk dh lwpuk 07 fnuksa ds foyac ls nh xbZ tks fd chek ikWfylh dh 'krZ dzekad&1 Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the Company shall be required. dk mYya?ku gSA chek ikWfylh dh 'krZ ds vuqlkj nq?kZVuk dh lwpuk rRdky nh tkuh pkfg;s ijarq ifjoknh }kjk chek ikWfylh dh 'krksZa dk mYya?ku fd;k x;kA ifjoknh }kjk nq?kZVuk dh // 4 // lwpuk nsjh ls fn;s tkus ij chek daiuh }kjk vkbZvkjMh, }kjk vf/kd`r losZ;j Jh xksiky d`".k ds ek/;e ls {kfrxzLr okgu dk losZ djk;k x;k gSA losZ;j ds }kjk {kfrxzLr okgu ds {kfr dk ewY;kadu 3]21]901@&:-
fd;k x;k gSA chek daiuh ds losZ;j ds vk/kkj ij ifjoknh ds {kfrxzLr okgu dks fjis;fjax gsrq dgk x;k vkSj fjis;fjax ds fcy ,oa Hkqxrku dh jlhn gsrq fnukad 09-07-2014] 07-08-2014 ,oa 17-08-2014 ds }kjk lwfpr fd;k x;k ijarq ifjoknh }kjk vius nkok ds fujkdj.k esa dksbZ :fp ugha fn[kkbZ xbZ vkSj uk gh okgu dh fjis;fjax ,oa Hkqxrku dh fcy jlhn iznku dh xbZA ifjoknh }kjk {kfrxzLr okgu ds fcy ,oa Hkqxrku dh jlhn izLrqr ugha fd;s tkus ds dkj.k losZ;j }kjk vkadfyr jkf'k 3]21]901@&:- Hkh izkIr djus dk ik= ugha gSA vr% is'k ifjokn fujLr fd;s tkus dh izkFkZuk dh xbZA 4- fo}ku ftyk Qksje }kjk fu"d"kZ fn;k x;k fd chekdaiuh }kjk ifjoknh ds nkos dk fujkdj.k u dj lsok esa fuEurk o O;olkf;d dnkpj.k fd;k gS ,oa chek daiuh ifjoknh dks okgu dk chfer ewY; 5]14]563@&:- Hkqxrku djus gsrq nkf;Rok/khu gSA ifjokn Lohdkj dj vuqrks"k iznku fd;s x;sA 5- vk;ksx ds le{k vihykFkhZ dh vksj ls Jh ,u-ds-Bkdqj vf/koDrk mRrjoknh dh vksj ls Jh vkj-ds-Hkkoukuh vf/koDrk }kjk vafre rdZ izLrqr fd;s x;sA gekjs }kjk ewy vfHkys[k dk ifj'khyu fd;k x;kA 6- vukosnd@vihykFkhZ ds fo}ku vf/koDrk }kjk gekjs le{k eq[;r% ;g rdZ fd;k x;k fd ftyk Qksje }kjk vukosnd@vihykFkhZ ds vfHkopu dk xyr vFkkZUo;u fd;k gSA ifjoknh@mRrjoknh chek daiuh // 5 // dks ekaxs x;s leLr nLrkost iznku djus esa foQy jgk Fkk] tcfd vusdks ckj i= izsf"kr dj ekax dh xbZ FkhA bl izdkj ifjokn vifjiDo Fkh tks fujLr fd;s tkus ;ksX; FkhA ftyk Qksje }kjk ;g fofu'p; djus esa Hkh =qfV dh xbZ gS fd ifjoknh@mRrjoknh VksVy ykWl ds vk/kkj ij Hkh {kfriwfrZ izkIr djus dk vf/kdkjh gSA tcfd losZ vfHkys[k esa izLrqr losZ fjiksVZ ds vuqlkj ifjoknh@mRrjoknh ek= 3]21]901@&:- lq/kkj O;; fu/kkZfjr fd;k x;k okgu lq/kkj ;ksX; FkhA ifjoknh dks okgu lq/kkj dj fcy o jlhnsa chek daiuh ds lkeus izLrqr djuh FkhA ek= fgrs'k fprkfy;k }kjk ewY;kafdr jde ds vk/kkj ij ftyk Qksje }kjk ;g fu/kkZfjr fd;k x;k fd chek daiuh VksVy ykWl ds vk/kkj ij {kfriwfrZ nsus gsrq nkf;Rok/khu gSA ;fn okLro esa {kfr VksVy ykWl ds varxZr vkrh rks ifjoknh@mRrjoknh vius okgu dk iath;u vkj-Vh-vks- ls fujLr dj jn~n djokuk FkkA ijarq vHkh rd mlus ,slk ugha fd;kA bl izdkj ftyk Qksje }kjk fcuk fdlh vk/kkj fofu'p; ysdj fof/kd =qfV dh gSA ftyk Qksje }kjk lkYost ds laca/k esa Hkh dksbZ funsZ'k ugha fn;s gSaA vihy Lohdkj dj vkyksP; vkns'k vikLr djus dk fuosnu fd;k x;kA 7- ifjoknh@mRrjoknh ds fo}ku }kjk eq[;r% ;g rdZ fd;k x;k fd ftyk Qksje }kjk ikfjr vkns'k mfpr o U;k;laxr gS mlesa gLr{ksi dh vko';drk ugha gSA vihy fujLr fd;s tkus dh izkFkZuk dh xbZA 8- vihy esa ;g Lohd`r rF; gS fd ifjoknh@mRrjoknh dh okgu lh-th-04 ds-D;w8002 vukosnd@vihykFkhZ chek daiuh }kjk chfer Fkh ;g Hkh Lohd`r rF; gS fd chek vof/k esa gh okgu nq?kZVukxzLr gqbZ FkhA gekjs le{k ;g iz'u fopkj.kh; gS fd ifjoknh fdruh {kfriwfrZ izkIr djus dk vf/kdkjh gS\ // 6 // 9- ifjoknh@mRrjoknh }kjk izLrqr chek ikfylh izek.k i= ds vuqlkj mDr okgu dk chfer ewY; 5]14]563@&:- gSA mDr okgu fnukad 04-02-2014 dks nq?kZVukxzLr gqbZ FkhA ifjoknh@mRrjoknh }kjk chek daiuh dks lwfpr fd;s tkus ij izkjafHkd losZ{k.k fnukad 05-02-2014 dks losZ;j xksiky jko }kjk fd;k x;kA losZ fjiksVZ fnukad 27-03-2014 izLrqr dh xbZ] ftlds vuqlkj {kfr ewY;kadu 3]21]901@&:- fd;k x;k] losZ{k.k fnukad 05-02-2014 mYysf[kr gS] blls Li"V gS fd ifjoknh@mRrjoknh }kjk le; ij lwpuk nh xbZ FkhA ifjoknh@mRrjoknh }kjk Lo;a ,d losZ;j fu;qDr fd;k x;k] ftlds }kjk okgu dk losZ{k.k fd;k x;kA losZ;j fgrs'k dqekj fprkfy;k }kjk fnukad 15-04-2014 dks losZ fd;k x;kA losZ fjiksVZ ds vuqlkj gh {kfr dk ewY;kadu 3]89]866@&:- fd;k x;kA izdj.k esa okgu dk chfer ewY; 5]14]563@&:- Lohd`r gSA chek daiuh }kjk izkjafHkd losZ ds vuqlkj okgu dks lq/kkj ;ksX; ik;k o ifjoknh@mRrjoknh dks i= fnukad 17-04- 2014 izsf"kr dj ejEer fcy o fMLpktZ okmpj ij gLrk{kj dj iznku fd;s tkus dh ekax dh xbZA okgu dk vafre losZ djk;s fcuk {kfr dk ewY;kadu izkjafHkd losZ ds vuqlkj fd;k tkuk fu;e fo:) FkkA ifjoknh@mRrjoknh }kjk chek daiuh dks i= izsf"kr dj lwfpr fd;k x;k fd okgu {kfr ewY;kadu gsrq vkbZ-vkj-Mh-,- dh fn'kk funsZf'kdk ds vuqlkj {kfriwfrZ dk ewY;kadu djus gsrq loZs;j fu;qDr fd;k x;kA ftlds vuqlkj {kfr dk ewY;kadu 3-89 yk[k :i;s fd;k x;k gSA tks fd 75% chfer ewY; ls vf/kd gSA ifjoknh@mRrjoknh }kjk chek daiuh dks fy[ks x;s i= fnukad 28-04-2014 ds egRoiw.kZ va'k fuEukuqlkj gS%& Babaj Allianz General Insurance Co. Ltd. Date 28-4-2014 Raipur//Pune Ref: Claim Settlement of My Vehicle No. CG-04-KQ 8002 against // 7 // Sir, I have already given a mail to you on 26th March 2014 for Injustice with me. I have recd seven letters from your company to repair the accident vehicle till date But it is already informed to you several times via email to your branch office that there are differences in assessment of loss as per survey report of Mr. Gopal Rao.
We had requested to Mr. Gopal Rao and your branch office over cell phones that please come in front of my vehicle at Repairer's shop and explain us why so many spares left in assessment which actually damaged due to same accident and why difference in Labour charges allowed whereas Labour charges demanded as per Company schedule. But Neither Mr. Gopal Rao nor Branch Representation made any efforts/made vist, till date, to settle the claim. It understood from Repairer that it is not economical to repair the vehicle as estimated cost of Repair over Rs. 5 Lacs and further after dismantle it is likely to increase by Min Rs. 50,000.00 Now, I have arranged at my own cost for second opinion regarding Loss assessment as per IRDA guideline and get report of Another Surveyor Mr. Hitesh Chitalia, Raipur and he has also inspected the accidental and issued report mentioningthat the claim may be settled as Total/Wreck/Cash loss basis as not economical to repair and Repair Liability assessed for Rs. 3.89 Lacs by him exceeds 75% of IDV as per Policy.
Whereas as per Survey Report of Mr. Gopal Rao, Insurance co Liability is restricted upto Rs. 3.21 Lacs, seems prejudice and not a complete report as many spares not included which actually damaged.
10- vukosnd@vihykFkhZ ds vf/koDrk }kjk ;g rdZ fd;k x;k fd ftyk Qksje }kjk bl rF; dks vuns[kk fd;k x;k gS fd ifjoknh@mRrjoknh }kjk ekaxs tkus ij Hkh ejEer ds fcy jlhnsa chek daiuh dks iznku ugha fd;s FksA blfy;s mls losZ;j }kjk ewY;kafdr jkf'k // 8 // iznku ugha dh tk ldh o mldk nkok fujLr fd;k x;k gSA gekjs }kjk vukosnd@vihykFkhZ chek daiuh ds vfHkdFku dk ifj'khyu fd;k x;k] ftlds vuqlkj izkjafHkd vkifRr dafMdk 1 esa vfHkdFku fd;k x;k gS fd ^^ifjoknh@mRrjoknh }kjk izLrqr nkos dh QkbZy nLrkost izLrqr u fd;s tkus ds dkj.k can dj nh xbZ o mlh dafMdk esa ;g Hkh dFku fd;k x;k gS fd mldk nkok fujLr fd;k x;k gSA** chek daiuh }kjk ;g Hkh vfHkdFku fd;k x;k gS fd lkr fnol ds Hkhrj nq?kZVuk dh tkudkjh fyf[kr esa chek daiuh dks lwfpr fd;k tkuk vfuok;Z Fkk ijarq ifjoknh@mRrjoknh }kjk ugha fd;k x;kA ijarq izkjafHkd losZ{k.k izfrosnu esa mYysf[kr losZ{k.k rkjh[k ls ;g Li"V gksrk gS fd nq?kZVuk ds nwljs fnu gh losZ{k.k fd;k x;k Fkk vFkkZr~ ifjoknh@mRrjoknh }kjk fu;ekuqlkj le;kof/k esa chek daiuh dks lwfpr dj fn;k FkkA chek daiuh }kjk izkjafHkd losZ nq?kZVuk dk dkj.k ,oa uqdlku dk vkjafHkd iw.kZ tk;tk ysus gsrq izkjafHkd losZ{k.k o vUos"k.k djok;k tkrk gS] ijarq okgu esa nq?kZVuk ds ifj.kkeLo:i gqbZ {kfr dk okLrfod ewY;kadu djus gsrq vafre losZ{k.k djok;k tkrk gSA ijarq bl izdj.k eas izkjafHkd losZ{k.k esa gh {kfr ewY;kadu dj fn;k gS] ftlls Li"V gS fd ifjoknh@mRrjoknh }kjk chek daiuh ds losZ{kd dks {kfr vuqekfur O;; ds laiw.kZ fooj.k iznku dj fn;s FksA pwafd ifjoknh@mRrjoknh dks izkjafHkd losZ{kd }kjk fd;s x;s ewY;kadu ls vkifRr Fkh] i= fnukad 28-04-2014 ds vuqlkj ewY;kadu esa {kfrxzLr ikV~Zl dk ewY; o lq/kkj O;; ugha tksM+k x;k Fkk o chek daiuh }kjk bl ckcr~ lg;ksx u fd;s tkus ij Lo;a losZ{kd fu;qDr dj izfrosnu izLrqr fd;kA chek daiuh }kjk losZ{kd fgrs'k fprkfy;k ds izfrosnu dk [kaMu ugha fd;k gSA vfirq >wBs vk/kkjksa ij ifjoknh@mRrjoknh dk nkok fujLr fd;k gS] ftlls Li"V gS fd {kfriwfrZ dh jkf'k iznku ugha djuk pkgrh gSA gekjs erkuqlkj ifjoknh@mRrjoknh ds chfer okgu dh nq?kZVuk esa gqbZ {kfr ftldk // 9 // {kfriwfrZ ewY;kadu chfer ewY; ds 75% vf/kd gSA vr% ftyk Qksje }kjk VksVy ykWl ds vk/kkj ij okgu dk chfer ewY; iznku djus dk tks vkns'k ikfjr fd;k gS og mfpr gSA 'ks"k iznRr vuqrks"k Hkh U;k;ksfpr izrhr gksrs gSaA pwafd fgrs'k fprkfy;k }kjk {kfriwfrZ dk ewY;kadu 3]89]866@&:- fd;k gSA mDr jde esa lkYost dh jde 10]000@&:-
?kVk;k x;k gS vr% ftyk Qksje }kjk VksVy ykWl dks fu/kkZfjr djus gsrq chfer ewY; ds 75% x.kuk gsrq 'kq) {kfriwfrZ jkf'k ls gh x.kuk dh FkhA vr% ftyk Qksje dks lkYost ds laca/k esa ifjoknh@mRrjoknh dks funsZ'k nsuk Fkk fd ^^lkYost dh jkf'k izkIr djus ij lkYost chek daiuh dks iznku djsaA** D;ksafd mDr lkYost ysuk ;k u ysuk ifjoknh@mRrjoknh dk fu.kZ; gSA tc rd ifjoknh@mRrjoknh fu'pk;d fLFkfr esa u gks fd mls lkYost j[kuk gS ;k ugha j[kuk gSA blfy;s ftyk Qksje }kjk lkYost ds laca/k esa ;fn funsZ'k ugha fn;k x;k gS rks vkns'k =qfViw.kZ ugha ekuk tk ldrk gSA 11- chek daiuh ds vf/koDrk }kjk ;g rdZ fd;k x;k gS fd ifjoknh@mRrjoknh }kjk mDr okgu ds iath;u dks fujLr ugha fd;k x;kA ftyk Qksje us bl rF; dks vuns[kk fd;k gSA mHk; i{kdkjksa ds e/; {kfr jkf'k ds ewY;kadu gsrq fookn py jgk FkkA chek daiuh }kjk fu;eksa ds fo:) izkjafHkd losZ{kd }kjk ewY;kafdr jkf'k dks gh Lohdkj djus gsrq ifjoknh ij ncko cuk;k] tcfd vafre losZ{kd fu;qDr djus gsrq chek daiuh ckf/kr FkhA pwafd chek daiuh }kjk nkok gh fujLr dj fn;k Fkk rks ,slh fLFkfr esa ifjoknh@mRrjoknh }kjk okgu dk iath;u jn~n ugha djok;k tk ldrk FkkA chek daiuh dk ;g rdZ Lohdkj ;ksX; ugha gSA // 10 // 12- izdj.k ds rF;ksa ij fopkj&foe'kZ djus ds mijkar o nLrkostksa ds ifj'khyu i'pkr~ ge bl fu"d"kZ ij igqaprs gS fd vukosnd@vihykFkhZ }kjk izLrqr vihy lkjghu vk/kkjghu gksus ls fujLr fd;s tkus ;ksX; gS vr% fujLr dh tkrh gSA ftyk Qksje }kjk ikfjr vkns'k mfpr o U;k;laxr gksus ls laiq"V fd;k tkrk gSA chek daiuh dks funsZf'kr fd;k tkrk gS fd bl vkns'k fnukad ls 30 fnu dh vof/k ds Hkhrj vihy O;;
5]000@&:- ifjoknh dks iznku djsaA
¼U;k;ewfrZ vkj--,l-'kekZ½ ¼lqJh fguk BDdj½ ¼Mh-ds-iksn~nkj½
v/;{k lnL;k lnL;
27@09@2016 27@09@2016 27@09@2016