This is a discussion on Bajaj Allianz within the Insurance forums, part of the Financial Services category; This is in regard with the issuance CLAIM FOR MY HUSBAND WHO WAS SUFFERING FROM VERY NORMAL BACK PAIN. SO ...
- 02-16-2010, 10:03 PM #76madhusudhanan Guest
Bajaj allianz Medical claim
This is in regard with the issuance CLAIM FOR MY HUSBAND WHO WAS SUFFERING FROM VERY NORMAL BACK PAIN. SO WE CONSULTED A GENERAL DOCTOR AND HE DIAGNOSED IT AS BACK pain ONLY AND GAVE Some MEDICINES. later on after six months,my husbands back ache became very serious because of continuous travel. therefore we had to take him to a specialized doctor. there he was asked to get admitted for 24hrs. it was purely for observation. during this time my husband had to take MRI scan. all these issues were clearly explained when we had requested the bajaj group of insurance company. they also accepted everything. they had also asked for additional request.they had asked for past five months treatment, which was of no use to the insurance company. as the doctor who later diagnosed wrote in the discharge summary that the patient has had the complain of back pain for the past 5 months. the insurance people are keeping this as a reason and not issuing the claim. moreover they are saying that it cannot be claimed. because they are saying that we took the claim after the occurance of the back pain.but is not at all true, because my husband had a minor pain at the time of undertaking the policy . The insurance company told us many times that the y will call and inform us about the claim but already 2 months have passed by now and they are still telling that the claims are under process and that only after the doctors see the complete profile they can decide if the amount can be reimbursed or not. we are in a pathetic situation now.
Now they have completely fooled they are not giving the reimbursement. All my original documents are with the company and they haven't sent back the documents.
While signing up the policy insurance people are even ready to lick our foot but after signing the case turns other way round.Insurance is after just beating beating the bush story.
- 02-18-2010, 10:08 AM #77Senior Member
- Join Date
- Jan 2010
Consumer Complaint No: 45/2008
Date of presentation: 20.03.2008
Date of decision: 15.01.2010
Padam Dev S/O Shri Govind Ram,
Village Kalyan, P.O. Materni, Tehsil
Arki, District Solan, H.P.
The Bajaj Allianz General Insurance Company,
S.C.O. Sector 8-C, Chandigarh,
Through its Manager.
For the complainant: Mr. D.K. Kaushal, Advocate.
For the Opposite Party: Mr. Umesh Sharma, Advocate.
O R D E R:
Sureshwar Thakur (District Judge) President:- The instant complaint has been filed by the complainant, by invoking the provisions of Section 12 of the Consumer Protection Act, 1986. The complainant, avers that he, is, registered owner of vehicle Pick up Van bearing registration No.HP-11B-0305, which was insured by him with the OP-Company. The complainant further proceeded to aver that the aforesaid vehicle met with an accident, on, 11.08.2007. The factum of vehicle having met with an accident, was reported to the OP-Company. Thereafter, it is averred, that the claim was lodged with the OP-Company, who instead of settling withheld the indemnification amount, on one pretext or the other. The complainant further avers that he had entered into an agreement with Shri Jay Pal S/O Shri Dhari Ram with regard to sale of the above vehicle on payment of balance sum of Rs.15,000/-, which payment was to be made on or before 15.3.2007, who filed to make the payment of Rs.15,000/- and also committed default in monthly installments. Hence, it is averred that there is apparent deficiency in service on the part of the OPs and accordingly relief to the extent as detailed in the relief clause be awarded in favour of the complainant.
2. The OPs, in its written version, to the complaint, raised preliminary objections vis-à-vis maintainability of the complaint, privity of contract and estoppel. On merits, it is contended that at the time of loss, the vehicle had already been sold to one Shri Jai Pal S/O Shri Dhari Ram, in pursuance of the affidavit executed interse the parties, on, 01.09.2007. Hence, it is denied, that, there was any deficiency in service on their part or that they have indulged in an unfair trade practice.
3. Thereafter, the parties adduced evidence, by way of affidavits, and, documents in support of their respective, contentions.
4. We have heard the learned counsel for the parties at length and have also thoroughly scanned the entire record of the case.
5. The complainant avers that during the currency of the insurance policy, purchased by him from the OP-Company, and while it was in his possession it, met with an accident, on, 11.08.2007, as is, revealed from, a, copy of FIR placed on record and which bears Annexure-C. However, the OP-Company resists the claim of the complainant on the score, that, during the currency of the insurance policy, the, complainant, had, already sold the vehicle to one Shri Jai Pal S/O Shri Dhari Ram, hence, their was, an, active concealment by the complainant of the fact, that, the transfer of vehicle, by, him has been effected in favour of Shri Jai Pal, hence, the concealment to the above extent, is, canvassed to be tantamounting, to, suppressio veri, as well, as militating against the solemn principle of ubberima fides on which principle all contracts of insurance are anchored and which principle, gets, vitiated by suggesio falsi which, in, turn also, vitiates, the, insurance cover purchased by the complainant from the insurer, consequently, making the repudiation of the claim of the complainant, to, be tenable.
6. The OP-Company, in, canvassing the above contention relies upon Annexures OP-1, OP-2 & OP-3, which, are, copies of the affidavits and receipt, executed interse the parties. Undisputedly, the insurance cover as was purchased by the complainant from the OP-Company was valid upto 23.11.2007, whereas, the accident, took place on 11.08.2007, and, the affidavits were executed interse the parties, on, 24.11.2006. The, recital by Shri Padam Dev in the copy of the affidavit of his having sold the vehicle to Shri Jai Pal, is, contemporaneous to the policy, covering, the, risk as detailed in the comprehensive insurance policy purchased by the complainant from the OP-Company, inasmuch, as, both, have been executed on 24.11.2006. Assuming, that, entire sale consideration, had, passed in favour of the registered owner from Shri Jai Pal, as also, its, possession had been transferred to the later, nonetheless, with the purported purchaser of the vehicle, which was the subject matter of incident, having, not adhered to the procedure prescribed by the law or having omitted to get it registered in his name, in our considered view, would not result in a complete and effective conveyance of the ownership of the vehicle, in, his favour in accordance with the rules. Therefore, when the complainant continued to be the registered owner of the vehicle, which, was, subject matter of incident, it, was open for him to seek the insurance cover from the OP-Company encompassing the risks as detailed in it and which policy obliges the OP-Company to indemnify the complainant, in case the subject matter of the insurance cover, which is the vehicle, is, subjected, to, accident as was so subjected to.
7. Moreover, for lack of the passing, of, the title of the vehicle in favour of Shri Jai Pal, the, OP-Company cannot allege, on, the strength of a recital, in, the affidavit, that, he had become owner of the said vehicle by paying to the complainant the sale consideration, thereof, and, that ,hence, with, the, complainant having received the sale consideration of the vehicle, which was the subject matter of incident, he, had, divested himself from the ownership of the vehicle. Nor also, the OP-Company cannot canvass before, us, in the absence of Shri Jai Pal having not become the registered owner of the vehicle, on, the strength of a recital in the affidavit made by the purported unregistered purchaser Shri Jai Pal, that, their was a breach of ubberima fides by the complainant, hence, vitiated the contract of insurance, consequently, debarring, or interdicting the OP-Company from honouring the insurance cover executed by it in favour of the complainant. More so, when, the purported transferee, under affidavit, could well after a valid conveyance in his favour, could, also, in accordance with rules seek transfer, of the insurance cover, in his favour which he omitted to do. As also, when it was an act of sagacity of the owner to seek insurance, so as to, hence, clothe, it, with an indemnifiable insurable interest, which, as aforesaid was transferable.
8. The upshot of the above discussion, is, that the contention as canvassed before us by the OP-Company in seeking to repudiate the claim of the complainant are wholly unfounded and untenable and amount to deficiency in service
9. Now it is to be determined as to what amount of indemnification is payable by the OP-Company to the complainant. The vehicle was insured for an amount of Rs.3,00,000/-, on IDV, as is evident from the existence of copy of insurance cover Annexure-A, place don record by the complainant. The complainant claims an amount of Rs.3,74,701/- from the complainant. The OP-Company, has not placed on record survey report to assess the loss caused to the damaged vehicle. In the absence of cogent, convincing and apposite evidence having been adduced by the OP-company, we are left with no other option, but, to, direct the OP-Company, to indemnify the complainant to the extent of Rs.3,00,000/-, on repair basis, on account of the fact that the vehicle was insured on, insured’s declared value.
10. Consequently, we allow this complaint and direct the OP-Company, to indemnify the complainant to the extent of Rs.3,00,000/- on repair basis, along with interest at the rate of 9% per annum, with effect from the date of filing of the complaint, i.e.20.03.2008, till actual payment is made. In addition to this, the OP-Company shall also pay litigation cost, which in the given facts and circumstances of the case is quantified at Rs.3500/-. This order shall be complied with by the OP-Company within a period of forty five days after the date of receipt of copy of this order. The learned counsel for the parties undertook to collect the certified copy of this order from the office, free of cost, as per rules. The file after due completion, be consigned to record room.
- 02-18-2010, 10:37 AM #78Senior Member
- Join Date
- Jan 2010
Consumer Complaint No: 08/2008
Date of presentation: 01.01.2008
Date of decision: 06.01.2010
Shri Bir Singh S/O Shri Atla Ram,
Resident of Village Kyala, P.O. Kedi,
Tehsil Chopal, District Shimla, H.P.
Bajaj Allianz General Insurance Company Ltd.
SCO-139, Sector-8/C, Chandigarh,
Through its Branch Manager.
For the complainant: Mr. I.S. Chandel, Advocate.
For the Opposite Party: Mr. Chandan Goel, Advocate.
O R D E R:
Sureshwar Thakur (District Judge) President:- This complaint has been filed by Shri Bir Singh- complainant, by invoking the provisions of Section 12 of the Consumer Protection Act, 1986. The complainant avers that, he, is, registered owner of Mahindra Tractor bearing registration No.HP-08B-0257, which was insured, by him with the OP-Company, for a period of one year commencing from 08.08.2006 to 07.08.2007. He further avers that the aforesaid vehicle, unfortunately, met with an accident, on, 07.04.2007, when the tractor was coming back from village Atal, during the currency of the insurance policy and suffered total loss. He further avers that at the time of the accident, it was without trolley, hence, was not being used for commercial purpose. It is further averred that, the factum of the vehicle, having met, with an accident, was reported to the OP-Company, as also, to the Police. Thereafter, the insurance claim, was lodged with the OP-Company, who instead of settling it, dilly-dallied, on one pretext or the other. Hence, it is averred that, there is apparent deficiency in service on the part of the OPs and accordingly relief to the extent as detailed in the relief clause be awarded in favour of the complainant.
2. The OP No.1-Company, in its written version, to the complaint, raised preliminary objections vis-à-vis maintainability of the complaint, and breach of terms and conditions of the insurance policy. On merits, it is contended that, the complainant took the farmers package policy as the premium of the same is less than commercial package policy, whereas, he was using the tractor for commercial purpose for loading mud, stones for widening the road, as such had violated the terms and conditions of the insurance policy. Hence, it is denied, that, there was any deficiency in service on their part or that they have indulged in an unfair trade practice.
3. Thereafter, the parties adduced evidence, by way of affidavits, and, documents in support of their respective, contentions.
4. We have heard the learned counsel for the parties at length and have also thoroughly scanned the entire record of the case.
5. The complainant, is, aggrieved by the act of the OP-Company, in, not settling his insurance claim, so lodged by him with it, qua damage caused to the insured tractor bearing registration No.HP-08B-0257. The OP-Company, has, repudiated the claim, of, the complainant, inasmuch, as, with, the complainant, having obtained a farmer package policy, and his using the tractor for commercial purpose, comprised an infraction of the terms and conditions of the policy, therefore, the OP-company, is, exculpating form their liability.
6. Though, the OP-Company, has, contended that, the tractor in question was being used for commercial purpose, inasmuch, as, the complainant was at the relevant time plying the tractor for carrying mud and stone, as excavated during the course of the HP PWD constructing the road, yet, the said contention has remained only in the realm of pleadings, for substantiation of the said fact, therefore, it places reliance on the report of the Investigator Shri Kamal Narian, Annexure R-4. No. reliance can be imputed to the FIR as, it does not comprise substantive evidence qua the fact, as, recited on it. Nor also reliance can be imputed to Annexure R-4, being wholly anvilled upon the FIR. What weakens, further, the, probative value of the aforesaid, is, lack of the OP, placing on record the affidavit of Mr. Naresh Kumar, a Nepali, purportedly working for the complaint. Now given, the fact, that, the complainant has filed affidavit conveying the fact of the tractor, while, at, the relevant time, not, carrying a trolley behind it, hence, belying the fact of, its, purported use for the commercial purpose aforesaid, also, it, communicating, the, fact, that, the tractor, after ploughing the fields was returning home, which fact has been corroborated by the affidavit of its driver, hence, the deposition on oath of the complainant gains immense probative value, especially, when the depositions of both, has, remained un-impeached for lack of their being cross-examined. Moreover, with the complainant placing on record agreements with land owner whose lands were ploughed, and the said agreements having not been proved to be fictitious, hence, the inference, of, user of the tractor, for, agricultural purpose as reflected in the depositions on oath, of the owner dully corroborated by its driver, is, readily made out. Therefore, for absence of cogent, satisfactory and apposite evidence brought on record by the OP-Company, to prove the fact, that, the tractor was being used, for purposes other than the insured purpose, it, cannot be construed that, the tractor was being used, for, a, commercial purpose. Rather, we firmly conclude, that, as, envisaged by the insurance cover, it, was at the relevant time being plied for agricultural purposes.
7. Now, adjudicating the indemnifiable amount payable to the complaint, given, the fact that, undisputedly, the tractor was insured, for, a sum of Rs.3,91,400/-, as is evident from the existence of Annexure-A, which is, a, copy of insurance cover, valid up to 07.08.2007, and with the insured tractor having met with an accident, on, 07.04.2004, during the currency of the insurance policy, and suffered having been affected total loss, as is evident from the existence of copy of survey report Annexure R-3. Therefore, as, the tractor was insured for a sum of Rs.3,91,400/-, on IDV basis, hence, in our considered opinion, the OP-Company, is, liable to indemnify the loss of the complainant, to the extent of Rs.3,91,400/-.
8. As a sequitor to above, we allow this complaint and direct the OP-Company, to indemnify the complainant, to the extent of Rs.3,91,400/- minus excess clause, alongwith interest at the rate of 9% per annum, with effect from the date of filing of the complaint, i.e. 01.01.2008, till actual payment, is made. In addition to this, the OP-Company, shall also pay Rs.2500/- as costs, of litigation to the complainant. Since, the complainant has been ordered to be indemnified, for the entire insured sum, therefore, the complaint shall surrender the key and registration of the damaged tractor to the OP-Company, along with salvage, within a period of one month after the date of receipt of copy of this order and thereafter, the OP-Company, shall proceed to indemnify the complainant, within a further period of one month. In view of the above terms, the complaint stands disposed of. The learned counsel for the parties have undertaken to collect the certified copy of this order from the office. The file after due completion, be consigned to record room.
9. The learned counsel for the parties undertook to collect the certified copy of this order from the office, free of cost, as per rules. The file after due completion, be consigned to record room.
- 02-18-2010, 11:04 AM #79Senior Member
- Join Date
- Jan 2010
Consumer Complaint No: 378/2008
Date of presentation: 05.11.2008
Date of decision: 06.01.2010
1. Promila Devi W/O late Shri Deva Chand Negi
2. Bhagat Singh S/O late Shri Deva Chand Negi
3. Monika D/O late Shri Deva Chand Negi
4. Kapila D/O late Shri Deva Chand Negi
5. Laxmi Devi D/O late Shri Deva Chand Negi,
4 to 6 are minor through their mother Smt. Promila Devi,
All R/O Village Yangupa, P.O. Huri, Tehsi Nichar, District Kinnaur, H.P. Presently residing at Monika Niwas, Kamla Nagar, Bhattakufar, Sanjauli, Shimla-6.
1. General Manager,
Telecom District, Block -35,
SDA Complex, Kasumpti, Shimla, H.P.
2. Manager (Claim),
The Bajaj Alliance General Insurance Company Ltd.,
Ground Floor, Ashoka Plaza, Next to Weikfiled Company,
32/2, Nagar Road, Pune-Maharashtra-411014.
… Opposite Parties.
For the complainant: Mr. Dalip Kaith, Advocate
For the Opposite Party No.1: Mr. Peeyush Verma, Advocate.
For the Opposite Party No.2: Mr. Chandan Goel, Advocate.
O R D E R:
Sureshwar Thakur (District Judge) President:- This instant complaint, has been filed by Shri Rajesh Manta, by invoking the provisions of Section 12, of the Consumer Protection Act, 1986. The complainant avers that, their predecessor-in-interest late Shri Deva Chand Negi, was the subscriber of landline telephone bearing No.01780-262358, which was under insured the scheme launched by the OP No.1, with the OP No.2, for a sum of Rs.50,000/-. It is averred that the deceased subscriber died on 23.02.2008, in a road accident. After the death of the deceased, the claim was lodged with the OPs, who instead of settling, it, repudiated vide letter dated 22.09.2008. Hence, it is averred that there is apparent deficiency in service on the part of the OP and accordingly relief to the extent as detailed in the relief clause be awarded in favour of the complainant.
2. The OP No.1, in its written version to the complaint, raised various preliminary objections, regarding maintainability of the complaint, and contended that the insurance cover was provided by the OP No.2 and it was the OP No.2, alone who was to make payment of the insurance sum, subject to fulfillment of the conditions.
The OP No.2, in its written version contended that the OP No.1 took the Group Insurance Policy for its Landline subscribers vide policy No.OG-08-1113-9902-00000157. It is contended that as per exclusion clause No.4, the insured was supposed to inform the insurer company of the claim within 60 days, whereas, in the present case the death took place on 23.02.2008, and the intimation was given to it, on, 29.08.2008, after lapse of six months hence, it being infraction of insurance policy, the claim is not payable. Hence, it is contended that their, is, no deficiency in service on their part.
3. Thereafter the parties led evidence by way of affidavits and documents in support of their respective rival contentions.
4. We have heard the learned counsel for the parties, at, length and, have, also, thoroughly scanned the entire record of the case meticulously.
5. The complainants, being the legal heirs of late Shri Deva Chand Negi, who was the subscriber of land line telephone bearing No.01780 262358, are, aggrieved by the act of the OPs, in repudiating their claim, so lodged by them with the OPs, on account of the sudden demise of their predecessor-in-interest, whose risk was duly covered under ‘Group Insurance Policy, by the OP No.1, with the OP No.2. The ground taken by the OPs, in repudiating the claim, and as canvassed before us, is, that, since the claim was submitted after lapse of six months, whereas, as per terms and conditions of the policy, it was supposed to be submitted within 60 days from the date of death, hence, its comprising an infraction of insurance policy, the repudiation of the claim, hence, is, contended to be tenable.
6. It is, not, in, dispute, that, deceased Shri Deva Chand Negi, was the holder of landline telephone so installed by the OP No.1, at his residential premises. The parties, also, do not wrangle over the fact, that, the, risk of the landline subscriber was duly covered under Group Insurance Policy, so obtained by the OP No.1, from the Op No.2. The sum of Rs.50,000/-, payable after his death, is, also not in dispute. The demise of the deceased having occurred, at the time when the policy was in existence, is, also not in dispute.
7. The OP No.2-Company, while repudiating the claim, has contended that, their action, in, repudiating the claim, cannot be construed to, be, a deficiency in service, as their was infraction of terms and conditions of the policy, inasmuch, as the claim was lodged belatedly after the lapse of six months, whereas, it was to be lodged within a period of sixty days, hence, comprises a breach of the policy conditions necessitating repudiation. We have, also, examined the said insurance cover note, which obliged the insured to submit the claim within 60 days. Undisputedly, the policy was purchased, for, the benefit of the subscriber of landline telephone, from, the OP No.2, and with the OP No.1, as, an, intermediary. The occupation of the deceased as a rustic villager and his not having executed the insurance cover directly with insurer, is, also, apparent from the fact that, the OP No.1, was, an intermediary. Hence, when a direct contract was not executed interse the insurer and the insured, then, compliance with its mandatory binding condition cannot be insisted upon. Besides, no, evidence has been adduced on record, that, the terms and conditions of the insurance cover, envisaging the requirement of the policy and its mandating, that, the deceased family members in the event of his demise, were, required to submit the claim within sixty days, were ever communicated to them, hence, they acquired their knowledge. Therefore, it, has to be concluded, that, breach, if any, of, the conditions mandating the submission claim within sixty days, remained un-complied with, merely, for their being, not, in the know of their being enjoined, to, comply with them. More so, when, no affidavit has been filed by the OP No.2-Company, to the effect that the said solemn condition was communicated nor certificate exists at the foot of the insurance cover, marking the fact of the beneficiary being apprised by the OP-Company, of the said condition, so as to then, insists on its compliance by them.
8. In the light of the aforesaid, we, hold that optimum injustice would be occasioned, if, we, in, the face of want of evidence demonstrative of acquaintance of the deceased or his family members with the requirements, of, the policy, which is, contended by the OP No.2-Company, to be breached, hence, necessitating repudiation, is, countenanced by us, as, it would obviously beget hardship to the family members of the deceased, merely, for non-submission of the claim within sixty days, for, reasons aforesaid, when, the necessity of its submission with time aforesaid, was, neither, in the knowledge nor in the notice of the deceased or his family members, so, as, to, then, in, the event of proved communication to them by the OPs of its requirement the necessity of, its, compliance on their part could have been insisted. For lack of proof of communications of the contents of the policy to the deceased or the complainants, concomitantly, they were not obliged to comply with the requirements enshrined in it. For reiteration, its, insistence, by the OP, was untenable.
9. Hence, we have no hesitation to conclude, that, since, the, deceased died in an accident, therefore, in our considered view, the OP No.2-Company, indulged in both, deficiency in service as well, as, in an unfair trade practice, when, it did not settle the claim and on wholly misconceived grounds, repudiated the same, hence, cannot exculpate, its liability, to, indemnify the legal heirs of the deceased insured.
10. As a sequel to above, we allow this complaint and direct the OP No.2-Company, to indemnify the complainants in equal shares to the extent of Rs.50,000/- along with interest at the rate of 9% per annum, with effect from the date of filing of the complaint, i.e. 05.11.2008, till actual payment is made. In addition to this, the OP No.2-Company, shall also pay litigation costs of this complaint, which we proceed to assess, at, Rs.500/-. These payments shall be defrayed to the complainants in equal shares and the amount falling to the share of minors shall be deposited by the OP No.2-Company before this Forum, in, the fixed term deposit. In the above terms, the complaint stands disposed of.
11. The learned counsel for the parties undertook to collect the certified copy of this order from the office, free of cost, as per rules. The file after due completion, be consigned to record room.
- 02-18-2010, 12:22 PM #80Senior Member
- Join Date
- Jan 2010
Consumer Case No. 52 /2008
Kola Govinda Rao, s/o.Papa Rao, aged 27 years,
Owner of Lorry Tipper AP5 TT 7257, 1-112,
Pothuluru village, Prathipadu Mandal. … Complainant.
The Branch Manager, M/s. Bajaj Allianz Insurance
Co. Ltd., Prakash Nagar, Near Round Park,
Rajahmundry. … Opposite party
This case coming on 20-1-2010 for final hearing before this Forum in the presence of Sri A.V.Ch.S.S.Murthy, advocate for the complainant and Sri M.S.N. Murthy, advocate for the opposite party, and having stood over to this date for consideration, this Forum made the following:-
O R D E R
(By Sri A. Balachandra Reddy, President on behalf of the Bench)
This complaint under Section 12 of the Consumer Protection Act, 1986, was filed by the complainant against the opposite party for a direction to pay the damage bill amount of Rs.2,67,582/- and to pay Rs.2,000/- towards costs of the complaint.
2. The case of the complainant is as follows:- The complainant is the owner of a Tipper Lorry bearing No.AP5 TT 7257 and he obtained insurance policy No.OC 081814180300000771 dated 11-6-2007 for a period of 12 months from the opposite party. During the policy period, the insured vehicle met with an accident on 16-7-2007 at about 5 A.M. as this vehicle dashed the back side of the another tipper due apply of sudden breaks by that vehicle. As a result of the accident, the cabin of the insured vehicle was fully damaged. Immediately after the accident, the complainant informed the same to the opposite party. Thereby the opposite party deputed his surveyor, who visited the accident’s spot and obtained photographs. The insured vehicle was repaired in the workshop of S.R.M.T., Kakinada and the complainant submitted all original bills dated 17-8-2007 to the opposite party to a tune of Rs.2,67,582/- for reimbursement of the same. But the opposite party postponed the same without paying the amount. Thereby the complainant got issued a notice on 10-12-2007 and the same was received by the opposite party but in vain. Hence the complaint for the reliefs as prayed for.
3. The opposite party filed counter denying all the allegations and containing inter alia that the complainant replaced the entire cabin without the knowledge of the surveyor and without intimation to the opposite party. As per the surveyor, the cabin and body shall be repairable. But the complainant is claiming Rs.2,67,582/- which is highly exaggerated and it is a self made claim. After assessment of the surveyor, the complainant approached the opposite party and requested to pay the claim as per the estimation. Finally the opposite party agreed to pay an amount of Rs.1,50,000/- towards full and final settlement of the claim for which the complainant also agreed for the same and thereby the claim satisfaction-cum-discharge voucher was sent to the complainant for resubmitting the same duly signed. But the complainant instead of resubmitting the same filed the present complaint with false allegations. The complainant is entitled for Rs.84,393/- as per the assessment given by the independent surveyor. The complainant submitted the bills worth of Rs.2,32,133/- whereas he is claiming Rs.2,67,582/-. Being the insurer, the opposite party undertakes to compensate the loss suffered by the insured complainant on account of risks covered by the insurance policy. The terms of the agreement have to be strictly construed to determine the extent of liability of the insurer. There was no deficiency in service on the part of the opposite party. The opposite party requested for the dismissal of the complaint with costs.
4. In order to prove the case of the complainant, his affidavit has been filed and Exs.A1 to A9 have been got marked. Ex.B1 and B2 got marked on behalf of the opposite party.
5. Heard both sides.
6. In view of the pleadings and in the light of arguments addressed by both sides’ advocates, the following points arise for consideration:-
1) Whether there was any deficiency in service on the part of the
opposite party in not settling the claim of the complainant.
2) Whether the complainant is entitled for the claim amount of Rs.2,67,582/-?
3) To what relief?
7. Point No.1:- The complainant is the owner of Tipper Lorry. The complainant purchased a Lorry Tipper AP5 TT 2257 and has obtained an Insurance comprehensive policy from the opposite party who is an insurance company for his vehicle. The opposite party has issued a Policy No.OC 081814180300000771 with cover note No.CW 061027/Code 10016089 dated 11-6-2007 for a period of 12 months for the said lorry tipper AP5 TT 7257 valid up to 10-6-2008. The complainant vehicle is a commercial vehicle under the comprehensive policy of the opposite party under Ex.A1. During the policy validity period, the complainant lorry Tipper AP5 TT 7257 was engaged to transport the said load from Rajahmundry to Kodada. On the way to Kodada near Kammari Lova of Kodada, the complainant vehicle Lorry Tipper AP5 TT 7257 met with an accident on 16-7-2007 at about 5 A.M., dashed the backside of the another tipper due to apply of sudden breaks by that vehicle. Due to the said accident, the complainant vehicle cabin fully damaged. But there is no life damage. Immediately after knowing the accident, the complainant informed to the opposite party about the same. The opposite party has deputed his surveyor Sri Srinivasa Rao of Rajahmundry who visited the spot of accident and photos were also taken to the accident vehicle and the said vehicle lorry tipper AP5 TT 7257 was brought to the S.R.M.T. workshop, Kakinada. The vehicle was repaired in the workshop of S.R.M.T., Kakinada and the complainant have submitted all the original repair bills dated 17-8-2007 and transport bills to the opposite party. The expenditure for repairs and transport is Rs.2,67,582/-. The opposite party has promised to reimburse the same to the complainant within a week. But since 4 months, no payment made to the complainant. The complainant got issued a legal notice to the opposite party on 10-12-2007 under Ex.A2 demanding the opposite party to pay the claim amount. The opposite party received the legal notice under Ex.A3 acknowledgement. Ex.A4 is the letter issued by the opposite party to the complainant on 20-12-2007 offering Rs.1,50,000/- by the opposite party towards full and final settlement of the claim. Ex.A5 is the Tax invoice-cum-statement of repairs and replacement of parts given to the damaged vehicle by S.R.M.T., Kakinada for a sum of Rs.2,32,133/-. Ex.A6 is the bills issued by S.R.M.T., Kakinada to the complainant on 17-8-2007 for a sum of Rs.17,589-54/-. Ex.A7 is the receipt issued by Sri Venkateswara Engineering Works, Kodada on 16-7-2007 for loading the damaged vehicle into another vehicle for a sum of Rs.4,000/-. Ex.A8 is the receipt issued by G. Subrahmanyam to the complainant on 16-7-2007 for transporting the damaged vehicle to Kakinada for a sum of Rs.12,000/-. Ex.A9 is the bunch of bills issued by Sri Savitha Motors, Kakinada for a sum of Rs.100/-, Sri Lakshmi Agencies, Pithapuram for a sum of Rs.200/-, Vasudeva Electrical Works, Kakinada for a sum of Rs.208/-, Sri Savitha Motors, Kakinada for a sum of Rs.230/-, Sri Chaitanya Automobiles, Kakinada for a sum of Rs.1020/- and Durga Balaji Automobiles, Kakinada for a sum of Rs.80/-. The complainant claiming the damages under Exs.A5 to A9 for a sum of Rs.2,67,582/-.
8. On analysis of the arguments of the complainant’s advocate and the opposite party’s advocate that there is no dispute with regard to the occurrence of the accident and damage of the vehicle. Further there is no dispute by the opposite party that the vehicle was validly insured at the relevant time of the accident with the opposite party. The insurance company admittedly appointed a surveyor who was present although at the time of repairing the vehicle of the complainant by the S.R.M.T. The surveyor noted the damages of the vehicle relating to the cabin also and admittedly the vehicle cabin has been damaged maximum extent. On perusal of the surveyor report dated 28-8-2007 under Ex.B2 shows that the nature of damages observed by the surveyor corroborated with the cause of accident as mentioned in the surveyor report.
1) Front wind shield glass and LH door glass broke – Needs replacement.
2) Cabin Assy:- Cabin assy. On LH side crushed/folded, LH door crushed/folded, LH wind shield frame pillar bent, RH Pillar also bent, Rear wall bent, bottom flooring at front end folded, front stricture/cowl panel pressed/folded, dash board panel on LH side pressed/bent, LH show piece severely buckled and folded, Center shell also pressed/folded – Cabin to be repaired, and damaged LH door, Lh show piece, and center shell needs replacement.
3) Inter cooler pressed/twisted, inter cooler RH tube bolt fixing zone cut, core pipes scored and cut – Inter cooler Needs Replacement.
4) Radiator Core Scored and pipes cut, fan shored broker – needs replacement.
5) Cabin rear Shock observes bent/seized – Needs replacement.
But to satisfy the opposite party by their surveyor who was appointed by the opposite party has mentioned in his final report, the cabin was replaced without prior intimation, though even according to his report, he was although present at the repair place SRMT, Kakinada. Admittedly the vehicle was new vehicle which was insured with the opposite party and the policy is comprehensive policy and instead of payment of the entire repair bills the insurance company only to avoid created the final report of the surveyor with that query. The insurance company has mentioned in the policy that the insured declared value for the
vehicle Tata Tipper F/R Rs.16,46,602/- and collected the comprehensive premium of Rs.23,055/-, the insurance company admitted the fact of comprehensive policy and admitted the information of accident immediately and appointment of surveyor themselves and shifted the vehicle at the advise of the their surveyor to the SRMT, Kakinada and in his presence. The vehicle was repaired, all these admitted facts categorically shows the genuinity in the claim made by the complainant with the opposite party. The opposite party is also liable for interest to the complainant compensation amount as the damages has not settled immediately. As per the Exs.A5 to A9, the total amount is Rs.2,67,582/- in spite of issuing of legal notice under Ex.A2 demanding to pay damages caused to the vehicle and though there is a valid insurance policy, the opposite party failed to reimburse the damages caused to the insured vehicle. Hence, there is deficiency in service caused by the opposite party. Hence, the complainant is entitled for a sum of Rs.2,67,582/- with interest at 6% p.a. from the date of complaint till date of realization. Point No.1 is answered accordingly.
8. The learned counsel for the opposite party has relied on the decision reported in National Consumer Disputes Redressal Commission, New Delhi in First Appeal Nos.81 and 201 of 1999, decided on 27-1-2006 in New India Assurance Co. Ltd., Vs. Kamal Nayan. So far as the first citation is concerned, the surveyor was present at the time of repairs. Subsequent loss is not applicable to the case on hand. As seen it is not applicable. The learned counsel for the opposite party has relied on the decision reported in Supreme Court of India in Ravneet Singh Bagga Vs. Royal Dutch Airlines in C.A.No.8701/97 decided on 2-11-1999. So far as the second citation is concerned, the refusal of the correct and just claim on the complaint is amounting to deficiency of service. Both citations are not applicable to the case on hand.
9. Point No.2:- In view of the findings on point No.1, the complainant is entitled for claim amount of Rs.2,67,582/- with interest at 6%.
10. Point No.3:- In the result, the opposite party is directed to pay the complainant an amount of Rs.2,67,582/- with interest at 6% p.a. from the date of complaint i.e. 21-1-2008 till date of realization and pay Rs.1,000/- towards costs of the complaint. The above directions shall be complied within a period of two months from today.
- 02-18-2010, 12:53 PM #81Senior Member
- Join Date
- Jan 2010
C.C.No.195 of 2008
Guntur district. … Complainant
1.Bajaj Allianz General Insurance Co.Limited,
Rep. by its Branch Manager,
Peejay Plaza, 10-1-44/9, III floor,
VIP Road, CBM compound,
2. Bajaj Auto Finance Limited,
Rep. by its Branch Manager,
4/14 Brodiepet, Guntur. … Opposite parties
This complaint coming up before us for hearing on 30-12-09 in the presence of Sri K.V.R.H. Prasad, Advocate for complainant and of Sri S. Satyanarayna, Advocate for opposite parties, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following:
O R D E R
Per Sri M.V.L.Radha Krishna Murthy, Member:
This complaint is filed under section 12 of Consumer Protection Act, 1986 by the complainant praying to direct opposite party to pay an amount of Rs.45,194/- (comprising of Rs.43,624/- for insurance amount and Rs.1500/- towards mental agony) and for subsequent interest @12% p.a. from the date of complaint till date of realization and for costs.
The averments of complaint in brief are as follows:
The complainant purchased motor cycle model discovery DTS I 125 CC in a show room at Pedaparimi on 16-04-07 for an amount of Rs.43,624/- which was financed by 2nd opposite party. Transport Department issued a temporary certificate b.No.AP 7 VJ TR 3658. At that time the 1st opposite party insured vehicle and collected a sum of Rs.1213/- from complainant and issued insurance policy covering the risk from 16-04-07 to 15-04-08. The vehicle was insured for an amount of Rs.43,624/- with 1st opposite party. While so, some unknown persons committed theft of said motor cycle on 12-01-08 when it kept in front of a library at Pedaparimi. The complainant immediately gave a complaint in Thullur police station and a case was registered in Cr.No.9/2008 U/s 379 IPC by Thullur police. The police investigation into the case and gave a certificate that the vehicle was not recovered. As the vehicle was insured with OP1, the complainant gave claim form to OP1 and requested to pay the insured amount. The complainant submitted all documents demanded by OP1. OP1 repudiated the claim on the ground that there is violation of section 39 of Motor Vehicles Act as complainant did not obtain valid registration number from the Transport Department. The valid registration certificate can be obtained after due period by paying penalty. The opposite party No.1 has no right to repudiate the claim of complainant on the said ground. Hence, there is deficiency of service on the part of OP1. OP2 is shown as formal party and no claim is sought against OP2. Hence, the complaint.
Opposite parties filed their version which is in brief is as follows:
The material allegations made in the complaint are not true, valid and binding on opposite party No.1. The complainant is not a consumer and the complaint does not come under the purview of Consumer Dispute. Hence, this Forum has no jurisdiction to entertain the complaint. The temporary registration of Motor cycle of the complainant is valid for a period of one month only and expired as on the date of alleged theft of said vehicle. On receipt of claim this opposite party requested complainant to submit required documents, registration certificate of vehicle, police documents, claim form duly filled and singed, driving license etc. But complainant failed to submit registration certificate of his vehicle. The said vehicle was plied without registration certificate as on the date of alleged theft. As per terms and conditions of policy, the vehicle should not be plied without registration certificate and plying the vehicle without registration is violation under the provisions of MV Act and policy issued to vehicle is subject to the provisions of MV Act. Hence, plying the vehicle without registration is a violation of terms and conditions of the insurance policy. As per Sec.39 of MV Act “no person shall drive/use any motor vehicle and no owner of a motor vehicle shall cause or permit the vehicle be driven or using in any public place or in any other place, unless the vehicle is registered in accordance with the provisions of MV Act and certificate of registration of vehicle has not been suspended and cancelled and the vehicle carries registration mark described in the prescribed manner”.
The complainant had knowingly and willfully violated the terms and conditions of policy by plying the vehicle without registration certificate, hence OP1 is not at liable to indemnify him. The allegation of complainant that the valid registration can be obtained after due period by paying a penalty or that OP1 had no right to repudiate the claim are denied. There is no deficiency of service on the part of OP1. The complaint is filed with false allegations hence the same may be dismissed with exemplary costs. The OP1 prays to direct complainant to pay an amount of Rs.25,000/- towards exemplary costs for filing false case.
The complainant filed affidavit in support of his version reiterating the facts mentioned therein. The 1st opposite party filed affidavit in support of its version reiterating the facts mentioned in the version.
On behalf of complainant Exs.A-1 to A-6 are marked. On behalf of 1st OP Exs.B-1 and B-2 are marked.
Now the points for consideration are that:
1. Whether there is any deficiency of service on the part of 1st opposite party?
2. To what relief the complainant is entitled?
POINT No. 1 :-
It is not in dispute that the complainant has purchased motor cycle and insured the same with 1st opposite party and insurance policy was issued for the period from 16-04-07 to 15-04-08. The said vehicle was committed theft of by some unknown offenders at Pedaparimi when it was kept in front of a library on 12-01-08 during the existence of insurance policy. The complainant gave a police complaint regarding theft of vehicle at Thullur police station and the same was duly registered by police and after investigation the police issued a final report dated 26-04-08 under Ex.A-3 referring the case as ‘undetectable’. The policy under Ex.B-1 was issued to complainant in accordance with the provisions of Chapter X and XI of MV Act, 1988. The complainant has obtained a temporary registration certificate from the Transport Department on 16-04-07. The said temporary registration is valid till 15-05-07. Subsequently, complainant has to obtain a permanent registration certificate from the Transport Department. But complainant has not obtained permanent registration from the Transport Department and plying the vehicle against the provisions of Section 39 of Motor Vehicles Act. Since, complainant has not obtained a permanent registration and plying the motor cycle without registration against the provisions of the Motor Vehicles Act, the claim of the complainant was repudiated by the 1st opposite party. Hence, we find that there is no deficiency of service on the part of the 1st opposite party. The 1st opposite party has rightly repudiated the claim of complainant under Ex.A-6. Accordingly, this issue is answered in favour of opposite party and against the complainant.
POINT No.2:- As the claim of complainant was rightly repudiated by the OP1 and as there is no deficiency of service on the part of OP1, the complainant is not entitled for any relief.
In the result, the complaint is dismissed. In the circumstances of the case each party shall bear their own costs.
Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 7th day of Janauary, 2009.
- 02-18-2010, 01:21 PM #82Senior Member
- Join Date
- Jan 2010
S/o Venkateswarlu, Hindu,
R/o 1st lane, Gopalanagar,
Ongole, Prakasam District. ... Complainant.
Bajaj Allianz General Insurance Company Ltd.,
Rep.by its Branch Manager, 58-8-13(2)
GNR Complex, Opp: Raja Matha Devi towers,
Santhapet, Ongole. …Opposite party.
COUNSEL FOR COMPLAINANT: SRI. ABBURI VENKATESWARLU,
COUNSEL FOR OPPOSITE PARTY: SRI K. SRINIVASULU,
This complaint is coming on 19.01.2010 for final hearing before us and having stood over this day for consideration this Forum delivered the following:
1. This is a complaint filed by the complainant under Section 12 of Consumer Protection Act, 1986 against the opposite party.
2. The averments in the complaint are as follows: The complainant is the owner of the lorry bearing No.AP 27 V 8680 and the same was insured with the opposite party. On 27.09.2008 while the policy was inforce the said lorry met with an accident near Beddivolu Cross Road of Manubrolu Mandal of Nellore District and the lorry was completely damaged. The complainant informed about the accident of the opposite party and also to the concerned police. On information given by the complainant the opposite party appointed a surveyor who assessed the loss as Rs.2,23,401/-. The complainant submitted claim forms to the opposite party, but the opposite party fail to settle the claim of the complainant. The opposite party repudiated the claim on the ground that the driver who was present at the time of accident has no valid driving licence. Inspite of sending driving licences of the drivers who were the present at the time of accident and inspite of legal notice, the opposite party fail to settle the claim. It amounts to deficiency in service on the part of the opposite party. Hence, the complaint.
3. The opposite party filed its counter and additional counter contending as fallows: It is true that the complainant is the owner of the lorry bearing No.AP 27 V 8680 and the said lorry was insured with the opposite party. It is true that the complainant informed the opposite party about the damage to the vehicle in the accident that occurred on 27.09.2008. On verification of the claim forms submitted by the complainant it is observed that in the claim form the name of the driver at the material time of accident is shown as K.Tirupal whereas in the certificate issued by the police the name of the driver is shown as Kanaparthi Srinivasarao. This clearly reveals that the driver was changed after the accident for the purpose of getting the claim fraudulently from the opposite party. On receipt of the claim forms and other vehicle records the opposite party requested the complainant to submit the driving licence of K. Srinivasulu, but the complainant fail to submit the same. Hence, the claim of the complainant is repudiated on 04.03.2009. There is no deficiency in service on the part of the opposite party and the complaint is liable to be dismissed with costs.
4. On behalf of the complainant Exs.A1 to Ex.A8 were marked. The Ex.A1 is the Legal notice dated 12.03.2009 to the opposite party. Ex.A2 is the Reply issued by opposite party dated 19.03.2009. Ex.A3 is the Letter dated 17.12.2008 by the opposite party. Ex.A4 is the Letter dated 05.02.2009 by the opposite party. Ex.A5 is the Letter dated 04.03.2009 by the opposite party. Ex.A6 is the Reply Notice dated 26.03.2009 to the opposite party. Ex.A7 is the Acknowledgement dated 31.09.2009. Ex.A8 is the Xerox copy of the policy schedule.
5. On behalf of the opposite party Exs.B1 to Ex.B6 were marked. Ex.B1 is the Certificate cum Policy Schedule. Ex.B2 is the Motor Final Survey report dated 26.11.2008. Ex.B3 is the Letter dated 17.12.2008. Ex.B4 is the Letter dated 05.02.2009. Ex.B5 is the Letter dated 04.03.2009. Ex.B6 is the Letter dated 19.03.2009.
6. The point for consideration is whether the complainant is entitled for the reliefs in the complaint.
7. It is an admitted case that the complainant is the owner of the lorry bearing No. AP 27 V 8680 and the same was insured with the opposite party. It is also not in dispute that the said lorry met with an accident on 27.09.2008 while the policy was inforce and the vehicle was badly damaged.
8. The case of the complainant is that he spent Rs.2,23,401/- for effecting repairs to the vehicle and when he made a claim with the opposite party along with all necessary documents the opposite party repudiated the claim without any reasonable cause and hence, he filed the complaint.
9. The learned counsel for the opposite party argued that in the claim form submitted by the complainant name of the driver at the time of accident was shown as K. Tirupal whereas in the police report driver’s name is shown as K. Srinivasulu. He further argued that driver’s name was changed to claim the amount fraudulently from the opposite party. The complainant was asked to submit the driving licence of K. Srinivasulu and as the complainant fail to submit the driving licence the claim was rightly repudiated by the opposite party and there is no deficiency in service.
10. It is not in dispute that the opposite party appointed a surveyor to assess the loss. In the survey report, the surveyor mentioned the name of the driver as K. Tirupal and his driving licence was valid up to 29.11.2010. On 17.12.2008 opposite party issued notice to the complainant under Ex.B3 asking him to submit the driving licence of K. Srinivasulu. On 26.03.2009 the complainant sent reply notice marked as Ex.A6 along with copies of the driving licences of K. Tirupal and K. Srinivasulu to the opposite party. Same was received by the opposite party on 31.03.2009 under Ex.A7 Acknowledgement. This shows that the contention of the opposite party that driving licences were not submitted to the opposite party is false. Without waiting for the reply the opposite party repudiated the claim on 04.03.2009 on the ground that the driver has no valid driving licence. Even after filing the complaint on 25.07.2009 the opposite party fail to verify the driving licences already received by it and settle the claim of the complainant. It amounts to deficiency in service on the part of the opposite party.
11. The complainant is claiming Rs.2,23,401/- as damages to the vehicle. But the complainant fail to produce bills and examine the concerned work shop mechanics to prove his claim. The opposite party appointed a surveyor and the surveyor assessed the loss as Rs.87,000/-. Ex.B2 is the survey report. The loss assessed by the surveyor appears to be reasonable and the same can be accepted.
12. In the result, petition is allowed in part directing the opposite party to pay Rs.87,000/- together with interest @ 9% p.a., from the date of survey report i.e., from 26.11.2008 till realization to the complainant. The opposite party is further directed to pay Rs.5,000/- as compensation for mental agony and Rs.2,000/- towards costs of litigation to the complainant.
- 02-18-2010, 01:28 PM #83Senior Member
- Join Date
- Jan 2010
Puvvada Ramachandra Rao,
S/o Hanumantha Rao,
Aged 35 years, Hindu, Business,
Ratnam Diamond Towers,
37-1-169(58A), Kurnool Road,
Resident of Ongole,
Prakasam District. ... Complainant.
Bajaj Allianz L.I.C. Limited,
Rep. by its Branch Manager,
Near L.I.C. Office, Ongole,
Prakasam District. …Opposite party.
COUNSEL FOR COMPLAINANT: SRI. P. SINGAIAH,
COUNSEL FOR OPPOSITE PARTY: EX-PARTE.
This complaint is coming on 07.01.2010 for final hearing before us and having stood over this day for consideration this Forum delivered the following:
PER SRI A. PRABHAKARA GUPTA:
1. This is a complaint filed by the complainant under Section 12 of Consumer Protection Act, 1986 against the opposite party.
2. The averments in the complaint are as follows: The mother of the complainant by name Meenakshamma has taken two policies from the opposite party bearing Nos. 32751751 and 32739973 which are inforce from 20th December 2006. The term of the policy is 10 years and assured sum is Rs.1,00,000/- each, and the date of maturity is 20th December’2016. The premium amount of Rs.20,000/- each for both the policies has been paid under receipt No.4418863, 4418864 dated 11.12.2006. The said two policies are having the name of the present complainant her nominee. Unfortunately, the said Meenakshamma died on 06.02.2007 due to heart attack. After her admise the present complainant submitted a claim form with all required documents and the same was repudiated by the opposite party on 18.04.2007 on the ground of non-discloser of material facts at the time of taking policy. The said repudiation letter has been received by the complainant in the month of May’2007, and on 21.05.2007 he preferred a representation to the review committee of the opposite party at Pune. The said review committee intimated the present complainant that they are going to review the matter and will inform the decision to the complainant within 30 days. This intimation was made by the review committee on 22.12.2007. As the complainant not received any intimation from the review committee of the opposite party since this day, he attributed deficiency of service on the part of the opposite party on the ground that they repudiated the claim without any proper reason and violated the terms and conditions of the policies.
3. On behalf of the opposite party one advocate represented and filed vakalat and requested this fora for grant of time to file counter. Inspite of several adjournments the opposite party failed to file his counter, and this fora made them as ex-parte.
4. On behalf of the complainant Exs.A1 to Ex.A8 were marked. The Ex.A1 is the policy deposit receipts dated 11.12.2006 bearing Sl. No. 4418863 and 4418864 for Rs.20,000/- each, issued by opposite party. Ex.A2 is the covering letter dated 26.12.2006 alongwith policy schedule and initial unit statement regarding policy No.32751751 and 32739973. Ex.A3 is the death certificate of P. Meenakshamma. Ex.A4 is the repudiation letter dated 18.04.2007 issued by opposite party to the complainant. Ex.A5 is the representation dated 21.05.2007 issued to opposite party claims review committee alongwith postal receipt 28.05.2007. Ex.A6 is the Two letters dated 22.12.2007 addressed to complainant by opposite party claims review committee. Ex.A7 is the Burial/Cremation report of deceased P. Meenakshamma dated 07.02.2007. Ex.A8 is the brochure of bajaj allianz unit gain scheme.
5. The point for consideration is whether the complainant is entitled for the reliefs of the complaint.
6. The learned counsel for complainant argued that the death of the policies holder occurred due to heart attack only. Neither she possesses any ailment or any decease prior to taking of policies nor after the policies. Further, he argued that the opposite party repudiated the claim of the complainant without any proper reason and without any documentary proof. Since, the opposite party made the repudiation of the claim under Ex.A4, the claim of the complainant is maintainable and acceptable, though the policy document not filed. Finally, he requested the fora to grant the reliefs as mentioned in the complaint.
7. On hearing of the arguments of the learned counsel for the complainant and with the strength of exhibits filed by the complainant, it is an admitted fact that the policy holder Meenakashamma paid the premium amount under Ex.A1 and after the payment date the opposite party issued the Ex.A2 stands in the name of the policy holder Meenakashamma. It can be presumed that the deceased Meenakashamma is the policy holder though, the complainant not filed the policy copies. Further this fact asserted by the Ex.A4 which issued by the opposite party, which is having the nature of repudiation of both policies and bearing the policy numbers. So, this fora confirms that the deceased Meenakashamma is the policy holder of two policies as mentioned in the complaint. Ex.A5 and A6 eliciting that inspite of efforts made by the complainant even to the review committee of the opposite party, they failed to settle the claim, atleast they failed to intimate their decision within 30 days as mentioned in the Ex.A6. So, it is a clear fact to confirm the negligence on the part of the opposite party. Further, this fora observed that inspite of several adjournments the opposite party failed to file their counter. So, the acts of opposite party is not tenable towards their customers.
8. In the result, petition is allowed directing the opposite party to pay Rs.2,00,000/- under the said two policies towards sum assured together with interest @ 10% p.a., from the date of filing of this petition till realization and to pay Rs.5,000/- towards mental agony of the complainant and Rs.1,000/- towards costs of the complaint.
- 02-19-2010, 12:27 PM #84Senior Member
- Join Date
- Jan 2010
Dated of this 21st day of January 2010
Smt.Girija Lady Member
Smt.Hemavathi @ Hema,
W/o. late Kumar,
Aged about 26 years, Complainant
R/o. Gulaharive village,
K.Palasandra post, Gulur hobli,
(By Sri.Srinivasamurthy, Advocate)
1. The Manager,
Bajaj Allianz General Insurance Co. Ltd,
Branch office: KNV complex, 4th cross,
Vidyanagar, BH Road, Tumkur-572103 Opposite parties
2. The Manager,
Bajaj Allianz General Insurance Co. Ltd
Division office, # 31, Ground floor,
TBR Towers, 1st Cross, New Mission Road,
Next to Bangalore Stock Exchange,
(OPs- by Sri.N.V.Naveen Kumar, Advocate)
This is a complaint filed Under Section 12 of the Consumer Protection Act, 1986 (hereinafter called as Act for short)
2. Through this complaint, the complainant prays for an award and order against the Opposite Parties (hereinafter called as the OPs for short) to settle personal accident and damages claim amounting to Rs.1,00,00/- with interest at 12% per annum from 22-5-2009 till realization.
3. The facts given rise to institute the complaint may be summarized as thus:
It is her grievance that, her husband Kumar @ Kumaraiah s/o. late Doddeeraiah had purchased the TVS Super XL bearing Reg.No.06-Y-5243 from Sri.Balaji Motors, Tumkur. At the time of purchase of the said vehicle, her husband had insured the vehicle with the 1st OP on 7-5-2007. On the same day, the 1st OP had issued cover note in favour of her husband Kumar. The cover note package policy bearing No.PC0610847165 was valid from 7-5-2007 to 6-5-2008.
4. It is further contended that, her husband Kumar died in a road accident on 14-10-2007 at about 4-30 PM near Maruthi Eye Hospital, Shettihalli Ring Road, Tumkur on account of an unknown Tempo dashed against him. He died on the spot. The Tumkur Traffic Police have registered a case in Cr.No.139/2007 under Sec.279 and 304 (A) of IPC R/W 134 (a) and (b) and 187 of IMV Act. The Govt. General Hospital duty doctor has conducted the postmortem.
5. It is further contended that, after obtaining the documents like RC, police records and other documents from the concerned authorities, the complainant approached and filed an application alongwith documents for settlement of personal accident claim (PA) and damages of the vehicle to the 1st OP on 22-5-2009 and the same day the 1st OP had issued an endorsement to the complainant.
6. It is further contended that, on 4-6-09 the 2nd OP gave a letter to the complainant seeking clarification of DL of the deceased Kumar i.e. owner of the vehicle. On 19-6-2009 the complainant has replied the same to the 2nd OP. Thereafter, the OPs have not settled the claim till today. The complainant has approached to the 1st OP on several times to settle the claims. But the OPs have given one or other reasons and intentionally avoided the settlement of the claim. Hence, this complaint.
7. The OPs who have been notified of the complaint put in their appearance through their counsel and resisted the same by filing objections.
8. The gist of the OPs objections is as follows:
In the common objections filed by the OPs, they admitted the complaint averments made in para no.2, 4 and 5. However, they pleaded lack of knowledge of other complaint averments. It is contended that, the complainant has not produced the driving license of the deceased.
9. It is further submitted that, as far as the OD claim is concerned, immediately upon intimation of alleged accident, the OP has appointed an IRDA approved surveyor and assessed the loss/damage of the vehicle is Rs.7,887/-. But the claim was repudiated as there was no valid and effective DL.
10. It is further submitted that, the complainant has not fulfilled the terms and conditions of the policy to seek the relief. It is contended that, (a) “as per section 3 of MV Act (a) no person shall drive a motor vehicle in any public unless he holds an effect licence issued to him authorizing him to drive the vehicle; (b) as per Section III of policy that, 1) This cover is subject to (a) the owner – driver is the registered owner of the vehicle insured herein; (2) The owner-driver is the insured named in this policy; (3) The owner-driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motor Vehicle Rules, 1989, at the time of the accident”.
11. It is further submitted that, the OPs have not at all committed any deficiency in service to the complainant. Accordingly, they pray for dismissal of the complaint with exemplary costs.
12. In support of the cases of the parties, the complainant and OPs have filed their affidavits. The documents produced by the complainant and OPs came to be marked as Ex.C-1 to 17 and Ex.R-1 to 6 respectively. The complainant has also filed written argument.
13. We have heard the learned counsel appearing for the parties and also examined the materials available on record.
14. The questions that arise for our considerations are:
1. Is there any deficiency of service by the OPs?
1. Is the complainant entitled for the relief as prayed for?
15. Our findings on the above questions are here under:
Point No.1: No
Point No.2: As per order
16. It is pertinent to note that, the Hon’ble Supreme Court in Ravaneet Singh Bagga –vs- KLM Royal Dutch Airlines (2000) I SCC 66 has laid down certain guidelines for testing the concept of deficiency in service. It is as here under;
“The deficiency in service cannot be alleged without attributing fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be performed by a person in pursuance of a contract or otherwise in relation to any service. The burden of proving the deficiency in service is upon the person who alleges it. The complainant has, no facts been found to have not established any willful fault, imperfection, shortcoming or inadequacy in the service of the respondent. The deficiency in service has to be distinguished from the tortuous acts of the respondent. In the absence of deficiency in service the aggrieved person may have a ready under the common law to file a suit for damages but cannot insist for grant of relief under the Act for the alleged acts of commission and omission attributable to the respondents which otherwise do not amount to deficiency in service. In case of bonafide disputes no willful fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance in the service can be informed (sic). If on facts it is found that the person or authority rendering service had taken all precautions and considered all relevant facts and circumstances in the course of the transaction and that their action or the final decision was in good faith, it cannot be said that there had been any deficiency in service. If the action of the respondent is found to be in good faith, there is no deficiency of service entitling the aggrieved person to claim relief under the Act. The rendering of deficient service has to be considered and decided in each case according to the facts of that case for which no hard and fast rule can be laid down. Inefficiency, lack of due care, absence of bona fides, rashness, haste or omission and the like may be the factors to ascertain the deficiency in rendering the service”.
17. Keeping the principles enunciated wherein it is to be examined as to whether there is any deficiency in service committed by the OPs. It is seen from the contents of Ex-R-6 a letter dated 4-1-2009 addressed to the complainant, the OPs had called for the original DL of late Kumar for further action in the matter. From the documents produced by the complainant at Ex-P-1 to 17 nowhere it is seen that, the original DL of the deceased had been submitted by the complainant to process her claim. Unless and until, the requirement of law is fulfilled, the claim of the complainant can not be examined and processed. Therefore, we find no deficiency in service on the part of the OPs. On other hand, the complainant herself is guilty of her own lapses in not submitting the original DL of the deceased for needful action. Therefore, we hold that, the complaint is liable to be rejected with a direction to the complainant to produce the original DL of the deceased for seeking necessary reliefs.
18. Being that opinion, we proceed to pass the following:
The complaint is dismissed but without costs with a direction to the complainant to produce the original DL of the deceased to the OP for processing her claim. Should the complainant produce the DL of the deceased, the OPs shall process and settle her claim within one month from the date of receipt of DL in accordance with law.
Dictated to the stenographer, typed by him, corrected and pronounced on open forum this 21st day of January 2010.
- 11-29-2010, 04:31 PM #85rishikeshwara Guest
Complaining towards New Family gain
My Name is N.M.Rishikeshwara and i had taken New family gain policy at 2007 located by the agent i.e, i have to pay 10,000 per annum till 3 years and he assured me that after 4th year you will get 20 to 40 % benefit but after a fourth year ending i am having only around Rs.29000 in my account but according to his detail more than Rs.40000 i am not understanding what you people are doing with my money.
Note: on basis of my 4 years experience with bajaj allianz i wont recommend to anybody to go with bajaj allianz
- 04-30-2011, 04:59 PM #86Ashwani 9311090311 Guest
Madiclaim card lost
I own a bjaj aliianz my faimly first mediclaim.but i have lost m wallet and mediclaim card provided by bajaj allianz is in inside.Pls tell me the procedure of geting a DUPLICATE MEDICLAIM CARD.As it is a mandatory thing to have any mediclaim
- 05-10-2012, 07:56 PM #87Junior Member
- Join Date
- May 2012
I request suggestion for claiming Insurance for ceased engine of my Ford Fiesta vehicle in running due to damage to coolent sump. I have paid Rs. 1.80 lakhs.to Ford company for replacing new engine.
- 05-14-2012, 01:16 PM #88Senior Member
- Join Date
- Sep 2010
We have received your request and will forward to the concerned department. Could you to send your contact details to firstname.lastname@example.org?
Once we receive the details from your end, we would be in a better position to help you.
We would also like to inform you that we have created a separate customer care portal Bajaj Allianz Help and Support | Help and Support: FAQs, Queries, Complaints and Interaction where you can post your queries.
Bajaj Allianz Customer Care
- 09-25-2012, 11:59 AM #89Junior Member
- Join Date
- Sep 2012
Bajaj Allianz Sarve shakti suraksha---- Fraud!!
Master Policy Holder CITI BANK N.A Master Policy Number 0177206484
The Bajaj Allianz Agents are a big cheat!!
They are misguiding customers and selling This policy.
When I opened a suidha account in Citi Bank their agents told me that they have a ULIP type of scheme but instead of locking period of 5 years this one has a locking period of just 1 year. Your money will grow and you can withdraw after 1 year without any penalty.
I agree and subcribed. I kep asking them for the policy document which till date even after 2 years I haven't received.
Then through other sources I came to know about this fraud with other consumers as well.
They will deduct as high as 40 % of the premium.
even After I have filed a complaint to stop the policy they are telling that premium would be deducted through ECS.
They dd not give me any information about the money and charges that would be deducted and instead asked me to get in touch with a separate team of which they gave me a number.
Tat number is SWITCHED OFF!!
I am left all stranded and cheated in this nexus!!
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