State Consumer Disputes Redressal Commission
Mohan Lal vs Shri Ram General Insurance Co. Ltd. on 28 February, 2022
Daily Order STATE CONSUMER DISPUTES REDRESSAL COMMISSION, U.T., CHANDIGARH Complaint case No. : 77 of 2019 Date of Institution : 08.04.2019 Date of Decision : 28.02.2022 Mohan Lal son of Shri Dayal Chand, resident of village Kanguwala, Tehsil Kalka, District Panchkula. ......Complainant V e r s u s Shri Ram General Insurance Co. Ltd. SCO No.178 East, 1st Floor, Sector 38-C, Chandigarh Through its branch Manager. Alok Kumar Singh, Branch Manager, Shri Ram General Insurance Co. Ltd. SCO No.178-East, 1st Floor, Sector 38-C, Chandigarh Shri Ram General Insurance Co. Ltd. E-8, EPIP, Riico Industrial Area, Sitapura, Jaipur (Rajasthan)-302022 Through its Managing Director/authorized signatory. ....Opposite parties BEFORE: JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT. MRS. PADMA PANDEY, MEMBER.
MR.RAJESH K. ARYA, MEMBER.
Present through Video conferencing:-
Sh.Kirti Kumar, Advocate for the complainant.
Sh.Gaurav Bhardwaj, Advocate for the opposite parties.
PER JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT The complainant has filed this complaint against the opposite parties, as he is aggrieved of repudiation of his insurance claim, filed by him, against his insured Truck-Tipper bearing no.HR-68-B-5073, which met with an accident on 22.02.2018. It has been averred by him that despite the fact that when the vehicle in question met with an accident, it was under insurance cover i.e. for the period from 15.11.2017 to 14.11.2018 under policy no.10509/31/18003037) and also all the formalities were completed by him qua supply of documents including estimate of repairs dated 24.02.2018, to the tune of Rs.22,90,050/- towards the damage caused to the vehicle, even then his genuine claim was repudiated by the opposite parties, on flimsy grounds. It was further averred in para nos.3 to 6 as under:-
"......3. That unfortunately, on 22.02.2018 the vehicle of the complainant was met with an accident when the driver Rajesh Kumar was going to unload of soil loaded in the vehicle in question at Neel Kanth Brick Killen. Vehicle of the complainant was being driven by driver Rajesh Kumar and when Rajesh Kumar was going to unload the soil loaded at Neel Kanth Brick Killen in the mean time, one car tried to overtake the other truck in rash and negligent manner and in order to save the said Car the driver of vehicle in question turn his vehicle in left side and due to this process of the complainant the vehicle unbalanced and fall down from the bridge and the driver and cleaner of the vehicle in question had also suffered simple injuries in the said accident. Thereafter, Rajesh Kumar has intimated about the said accident to the complainant and the complainant reached driver to at spot and taken his driver to Shori Hospital, Pinjore, where he his was treated. Thereafter, the matter was reported to the police of P.S. Pinjore and DDR No.027 dated 22.02.2018 was lodged with the police of P.S. Pinjore on the statement made by the cleaner namely Riyaz Khan and driver namely Rajesh Kumar.
4. That the complainant also intimated about the said accident to the Opposite Parties and officials of the Opposite Parties directed the complainant brought the said vehicle to the authorized service centre where the surveyor visit and assess the loss to the vehicle in question and only thereafter, the case of the complainant will be processed.
5. That accordingly the authorized center as per direction of surveyor and the Opposite Parties got estimated the repair charges of the vehicle of the complainant and made total estimate of Rs.22,90,050/ vide estimate date 24.02.2018.
6. That thereafter, the complainant visited the office of the Opposite Party No.1 and met the Opposite Party No.2 and the Opposite Party No.2 raised certain objection and asked the complainant to complete some required formalities and demanded the DL of Rajesh Kumar and PAN Number, RC and insurance policy alongwith the copy of the DDR etc. and accordingly, the complainant submitted the said documents demanded and completed all the documentary formalities as suggested by the Opposite Parties........"
It was further averred by the complainant that despite the fact that in the earlier consumer complaint bearing no.198 of 2018, which was dismissed as withdrawn vide order dated 08.05.2018, the opposite parties were directed by this Commission to process his claim and pay him the requisite amount, they failed to do so. Hence this complaint.
In the reply filed by the opposite parties, while admitting factual matrix of the case, pleaded as under:-
that number of letters were sent to the complainant, on 28.05.2018, 15.06.2018 and 15.02.2019, to provide certain documents required for settlement of his claim but he failed to do so;
that he failed to provide the repair bills and on the other hand provided estimate of repairs only;
that though surveyor appointed by the opposite parties assessed the loss to the tune of Rs.7,50,595/- as per terms and conditions of the policy, yet, the claim could not be processed in the absence of repair bills;
that even spot survey was also not got conducted, which snatched the valuable rights of the opposite parties to verify the genuineness of the accident as well as driver;
that though it was told by the complainant that Rajesh Kumar was driving the vehicle, but the weighing slip bears the signatures of Riyaz Khan as well as Rajesh Kumar; and that injury report, suffered by the driver as well as cleaner was not produced by the complainant Thus, it was stated that since the complainant failed to provide the aforesaid documents/details, as such, his claim was right rejected by the opposite parties.
The parties led evidence in support of their case.
We have considered the rival contentions of the parties and scanned the material available on the record, very carefully.
It is not in dispute that the vehicle in question, met with an accident on 22.02.2018 i.e. within the currency of the policy in question. It is also not in dispute that DDR No.027 dated 22.02.2018 in respect of the said accident was lodged with the Police Station, Pinjore. However, it is coming out from the record and also from the arguments raised by the parties that thereafter, surveyor was appointed by the opposite parties, who submitted his survey report wherein he assessed the loss to the tune of Rs.7,50,595/-. When the claim was raised by the complainant, it was repudiated by the opposite parties, on the ground that certain documents such as injury details, Repair bills tax invoice, Vehicle running details, Original royalty verification, Original spot photos with load, Driving license of driver of Mr. Rivaz khan as per load challan Aadhar card, Pan card, KYC form NEFT detail (blank cheque or copy of bank passbook) were not provided.
On the other hand, Counsel for the complainant contended with vehemence that all the documents which could be made available were provided to the opposite parties, yet, they failed to settle the claim of the complainant.
During arguments, Counsel for the opposite parties, while admitting the factual matrix of the case regarding accident of the vehicle in question, pressed his arguments mainly on the ground that since the complainant failed to provide repair bills and on the other hand, provided only the estimate of repairs, as such, the opposite parties could not come to know about the actual amount spent by the complainant and when the said document was not provided to them, despite making number of requests, his claim was rightly rejected by the company. The fact that other than actual repair bills, the remaining documents were supplied by the complainant, has candidly been admitted by the opposite parties in para nos.12-13 of their written reply. Relevant part of the said para is reproduced hereunder:-
"......The complainant submitted certain documents and repair estimate but repair bills were not submitted to the opposite parties till date..."
Be that as it may, it may be stated here that it is not in dispute that the accident took place. The surveyor has also verified and found the claim to be correct, after investigation and came to the conclusion that the liability of the insurance company came to Rs.7,50,595/-, meaning thereby that the claim was genuine, though the loss was assessed to the tune of Rs.7,50,595/- against the estimate of repairs of Rs.22,90,050/- provided by the complainant. In our considered opinion, it will not be reasonable to reject genuine claim which had already been verified and found to be correct by the Surveyor/Investigator. Thus, the only ground that the complainant could not provide the repair bills and on the other hand, provided estimate of repair, shall not be a shelter to repudiate the insurance claim, especially, which have been otherwise proved to be genuine. Our this view is supported by the principle of law laid down in the case titled as 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, wherein the Hon'ble Supreme Court 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...."
In the present case also, it is evident from the surveyor report dated 23.02.2018, that the surveyor did not question the genuineness of the accident. Thus, when the surveyor itself has assessed the loss to the tune of Rs.7,50,595/-, meaning thereby the fact that the accident in question took place has not been disputed, and as such, it can be said that the claim raised by the complainant is not fabricated and false. In this view of the matter also, in our considered view, once it has been proved that the claim filed by the insured is not fabricated and false, it would not be fair and reasonable for the insurance company to reject the claim, already found and verified to be correct by the investigator, only on the ground that repair bills were not produced by the complainant. By repudiating the genuine claim of the complainant, the opposite parties indulged into unfair trade practice and were also deficient in providing service.
For the reasons recorded above, this complaint stands partly allowed with costs. The opposite parties, jointly and severally are directed to :-
To reimburse the claim amount of Rs.7,50,595/- as assessed by the surveyor, alongwith interest @9% p.a. from the date of repudiation of claim, to the complainant.
To pay compensation to the tune of Rs.15,000/- for causing mental agony and harassment to the complainant.
To pay cost of litigation to the tune of Rs.15,000/- 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 the aforesaid entire amount shall entail interest @12% p.a. from the date of filing of this complaint till realization.
Certified Copies of this order be sent to the parties, free of charge.
The file be consigned to Record Room, after completion.
Pronounced.
28.02.2022 Sd/-
[JUSTICE RAJ SHEKHAR ATTRI] PRESIDENT Sd/-
(PADMA PANDEY) MEMBER Sd/-
(RAJESH K. ARYA) MEMBER Rg.