State Consumer Disputes Redressal Commission
United India Insurance Co. Ltd. vs Hanish Kumar on 21 March, 2023
ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.244 of 2022
Date of institution : 29.03.2022
Reserved on : 06.03.2023
Date of decision : 21.03.2023
United India Insurance Company Limited, through its Branch Manager
Gaushala Road, Mansa, Tehsil and District Mansa through its
regional office i.e. United India Insurance Company, 136, Feroze
Gandhi Market, Ludhiana through Shama Arora, Assistant Manager
(Legal), United India Insurance Company.
.....Appellant/Opposite party
Versus
Hanish Kumar S/o Ramesh Chand R/o Jatinder Fauji Wali Gali, Ward
No.9, Mansa, Tehsil and District Mansa.
....Respondent/Complainant
First Appeal under Section 41 of the
Consumer Protection Act, 2019 against the
order dated 16.12.2021 passed by the
District Consumer Disputes Redressal
Commission, Mansa.
Quorum:-
Mr. H.P.S. Mahal, Presiding Judicial Member
Mrs. Kiran Sibal, Member Present:-
For the appellant : Sh. Munish Goel, Advocate
For respondent : Ex-Parte
KIRAN SIBAL, MEMBER
The instant appeal has been filed by the appellant/opposite party against the order dated 16.12.2021 passed by District Consumer Disputes Redressal Commission, Mansa (in short, the "District Commission"), whereby the complaint filed by complainant against opposite party (in short 'OP'), under the Consumer Protection Act, was partly allowed with the following relief:-
FA No.244 of 2022 2
"19. Resultantly, complaint is partly accepted with consolidated costs and compensation of Rs.1,000/-. OP is directed to pay insurance claim of Rs.98,376/- alongwith interest @ 9% p.a. from the date of repudiation i.e. 28.09.2020 till actual realization."
2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Commission.
3. Brief facts for the disposal of the appeal are that the complainant got insured his Toyota Etios Car bearing Registration No.PB-11-CB-0880 from the OP vide insurance policy No.2004033117 P118057443, which was valid from 15.03.2018 to 14.03.2019 and paid the requisite premium. Unfortunately, on 02.09.2018, the said car met with an accident on Mansa Bhikhi Road, near village Kotra and was damaged badly. The complainant informed the OP about the accident and as per directions of the OP, he parked his vehicle at EM Pee Motor, Bathinda. An estimate of Rs.3,26,940/- was prepared for repair charges, but the OPs failed to pay the same. The complainant was compelled to park his vehicle at Anand Motors, Mansa for its repair and an estimate of Rs.2,22,387/- was prepared by the said agency. The complainant approached the OP and submitted the documents for release of claim. The OP appointed the Surveyor, who prepared the survey report and assessed the loss to the tune of Rs.98,376/- on the basis of estimate prepared by Anand Motors i.e. Rs.2,22,387/-. However, the OP repudiated the genuine claim of the complainant vide letter dated 09.08.2019 on the ground that the Register Containing the Driving License No.5362 of driver Gagandeep Singh, had not been found in the DTO office, Mansa. It was alleged by the complainant that FA No.244 of 2022 3 the DL has been issued by the office of the DTO, Mansa in the name of Gagandeep Singh, which is valid from 27.08.2009 to 26.08.2029. The DTO Mansa has never reported that DL is fake or false. The OPs illegally repudiated the genuine claim of the complainant. Alleging deficiency in service on the part of the OP, the complainant filed a consumer complaint before the District Commission and sought directions against the OP to pay the claim amount of Rs.3,26,940/- along with interest @12% per annum and compensation of Rs.50,000/- and litigation expenses of Rs.11,000/-.
4. The complaint was contested by the OP, who filed written reply and raised certain legal objections, inter alia, that the complainant had no locus standi to file the complaint and the same was not maintainable. On merits, OP stated that neither the information regarding accident was given nor the claim was lodged by the complainant in time. There is no document to prove that who was driving the vehicle at the time of accident. Initially, the complainant got the assessment of loss from Em Pee Motors, Bathinda in the absence of OP and when OP appointed Er.Rakesh Gupta as Surveyor for watching and assessing the actual loss, subsequently the complainant, without any information shifted the vehicle to Anand Motors, Mansa which reflects the fact that complainant got wrong assessment from 'Em Pee Motors' and in order to conceal malafide intention and in connivance with 'Em Pee Motors' the complainant shifted his vehicle. The Surveyor sent letters dated 22.12.2018 and 5.2.2019 to the complainant in this regard to explain reasons for FA No.244 of 2022 4 shifting the vehicle without information, but he failed to explain the same which disqualifies him from seeking the claim. The Surveyor assessed the damages to the tune of Rs.98,376/-, subject to terms and conditions, but the complainant was not entitled for even such a claim. It was further submitted that Advocate Mohit Jindal submitted an application dated 22.1.2018 to DTO Mansa for verifying the license and vide report dated 29.1.2019 it was informed that license of the driver was not found to be genuine. It clearly violates the terms and conditions of the policy. Without complying with the terms and conditions of the policy, complainant was not entitled to seek any claim. The claim was correctly repudiated and there was no deficiency in service on the part of the OP. After denying the other averments made in the complaint OP prayed for dismissal of the complaint.
5. The parties led their evidence in support of their respective contentions and the District Commission after going through the record and hearing learned counsel for the parties, partly accepted the complaint of the complainant, vide impugned order as above. Aggrieved with the same this appeal has been filed by the appellant/OP.
6. Notice of the appeal was issued to the respondent/complainant, but he failed to appear to contest this appeal despite service. Hence, respondent/complainant was proceeded against ex-parte vide order dated 17.05.2022 passed by this Commission.
FA No.244 of 2022 5
7. We have heard learned the counsel for the appellant/OP and have also gone through written submissions filed by it and the record of the case.
8. The learned counsel for the appellant/OP vehemently contended that the District Commission has illegally allowed the complaint irrespective of the fact that there is no deficiency in service on the part of the appellant/OP and the complaint is baseless, wrong, vague, self contradictory, illegal and against the fact and circumstances. The learned counsel further contended that the respondent/complainant did not inform the insurance company immediately after the accident and violated the terms and conditions of the policy. The District Commission has not taken into consideration the fact that as per report of DTO, Mansa, it has been clearly endorsed by DTO, Mansa that DL No.5362, dated 27.08.2009 was not issued by their office. The report of the DTO Mansa clearly shows that the driver was not holding valid and effective driving license at the time of the accident. The appellant/OP has rightly filed the claim of the respondent/complainant as 'No Claim'. Alleging no deficiency in service on the part of the appellant/OP, the learned counsel prayed for acceptance of the present appeal by setting aside the impugned order.
9. We have given thoughtful consideration to the contentions raised by the learned counsel for the appellant.
10. The admitted facts of the case are that the complainant got insured his vehicle i.e. Toyota Etios Car bearing Registration No.PB- 11-CB-0880 from the OP vide insurance policy No.2004033117P FA No.244 of 2022 6 118057443, Ex. OP-1, which was valid from 15.03.2018 to 14.03.2019 for the sum assured of Rs.3,50,000/-. It is also an admitted fact that the vehicle in question met with an accident during the currency period of the policy. The intimation of the alleged accident was given by the respondent/complainant to the appellant/OP, who appointed a Surveyor namely; Sh. Rakesh Kumar Gupta. The said surveyor submitted final survey report dated 03.08.2019, Ex. C-9. The OP after investigation repudiated the claim of the respondent/complainant, vide letter dated 09.08.2019, Ex. C-6. Alleging deficiency in service, the respondent/complainant filed consumer complaint before the District Commission, which was partly allowed, vide impugned order as above. Aggrieved by the said impugned order, the present appeal has been filed by appellant/OP for setting aside the impugned order.
11. The foremost ground of appeal raised by the appellant/OP is that the District Commission has illegally allowed the complaint without taking into consideration the fact that as per report of the DTO, Mansa, the driver of the insured vehicle was not holding valid and effective driving license at the time of the accident, which violated the policy terms and conditions. To adjudicate the said point, we have perused the documentary evidence placed on record by the parties. A perusal of letter dated 22.01.2018, Ex. OP-7, shows that Sh. Mohit Jindal, Advocate had written a letter, on behalf of the insurance company, to District Transport Officer, Mansa for verification of Driving License No.5362 issued on 27.08.2009 in the name of Gagandeep Singh. On the said letter the Registering and Licensing Authority, Mansa reported that "there is no register at their office regarding the FA No.244 of 2022 7 DL No.5362/2009". Further, a perusal of letter dated 29.01.2019 shows that Sh. Mohit Jindal Advocate, informed the insurance company regarding the said verification report obtained by him from DTO, Mansa. On the basis of said information, the OP repudiated the claim of the respondent/complainant, vide letter dated 09.08.2019, Ex. OP-10. The relevant part of the said letter is reproduced as under:-
"Moreover as per intimation and survey report it is seen that Sh. Gagandeep Singh, having DL No.5362, was driving the captioned vehicle at time of accident but as per verification report of DL submitted by Sh. Mohit Jindal, it is mentioned that, no register for said license at DTO office is present. Hence genuineness of the DL cannot be ascertained.
Hence on the above basis claim file we have closed your claim file as 'No Claim'".
The appellant/OP had closed the claim file as 'No Claim' on the basis that genuineness of the Driving License cannot be ascertained. On the other hand, the respondent/complainant has also placed on record a letter written by the driver Gagandeep Singh, Ex. C-8, to DTO, Mansa for verification of his license, which shows his bonafide that he was holding a valid and effective Driving License. The Registering and Licensing Authority, Mansa has casually written on the said letter that "at this stage there is no record available with them", which cannot be called a genuine report for arriving at a conclusion that the driving license is fake one. The insurance company has rejected the claim on the basis of the said report of the Licensing Authority. The onus was heavily on the insurance company to prove that the said Driving License was fake and not genuine. The insurance company should have conducted more enquiry and investigation to prove its case, FA No.244 of 2022 8 which it failed to do so. Hence, we do not find force in the contention raised by the appellant/OP and reject the same.
12. Another contention raised by the appellant/OP is that the respondent/complainant did not inform the Insurance Company immediately after the accident and violated the terms and conditions of the policy. A perusal of final survey report dated 03.08.2019, Ex.C-9, prepared by Sh. Rakesh K. Gupta, Surveyor shows that the date and time of the accident is 02.09.2018 at about 10:30 p.m. It is also mentioned in the said report under the heading 'Inspection and Assessment" that the insurers submitted spot survey report of Mr. Mohan Geol vide Ref. No.MG/Motor/UIIC/2018-19 dated 04.09.2018, which shows that the respondent/complainant informed the appellant/OP regarding the accident within reasonable time. Moreover, we would like to discuss and place reliance on the fact that the IRDA has specifically issued the circular to deal with the delay in claim intimation, vide circular bearing Ref.IRDA/HLTH/MISC/ CIR/216/09/2011 dated 20.09.2011, which is re-produced as under:-
"The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.
The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances. The insurer's decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without FA No.244 of 2022 9 compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policyholders losing confidence in the insurance industry, giving rise to excessive litigation.
Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.
The insurers are advised to incorporate additional wordings in the policy documents, suitable enunciating insurers' stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured".
Accordingly, in view of the guidelines of IRDA vide above said circular, we do not find force in this contention of Learned counsel for the appellant/OP and the same is hereby also rejected.
13. Sequel to our above discussion, we find that the District Commission has rightly decided the case and there is no material infirmity and irregularity in the order of the District Commission. Finding no merit in this appeal filed by the appellant/OP, the same is hereby dismissed & the order of the District Commission is upheld.
14. The appellant/OP had deposited an amount of Rs.25,000/- at the time of filing the appeal with this Commission and further deposited an amount of Rs.31,361/- in compliance of order of this Commission. These amounts alongwith interest, which has accrued thereon, if any, shall be remitted by the registry to the District Commission forthwith. Respondent/complainant may approach the District Commission for the release of the above amounts and the District Commission may pass the appropriate order in this regard after the expiry of limitation period in accordance with law. FA No.244 of 2022 10
15. The appeal could not be decided within the stipulated period due to heavy pendency of Court cases.
(H.P.S. MAHAL) PRESIDING JUDICIAL MEMBER (KIRAN SIBAL) MEMBER March 21st, 2023.
(Dv)