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Thread: ICICI Lombord

  1. #16
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    COMPLAINANT


    BY-SRI. M. LOKESH,
    ADVOCATE, BELLARY.
    //VS//
    SRI. HUSSAIN SAB,
    S/O LAL SAB,
    R/O VADDU VILLAGE,
    SANDUR TALUK, BELLARY DIST.
    RESPONDENTS



    BY-SRI.B.VENKATESWARA
    PRASAD, ADVOCATE,
    BELLARY.


    1. THE BRANCH MANAGER,
    ICICI LOMBARD MOTOR INSURANCE,
    MAYURA COMPLEX, DOUBLE ROAD,
    BELLARY.

    2. THE DIVISIONAL MANAGER,
    ICICI LOMBARD MOTOR INSURANCE
    CO.LTD., CORPORATION OFFICE,
    ZENITH HOUSE, KESHAVARAO KHANDE
    MARG., MAHALAKSHMI,
    MUMBAI- 400 034.



    //JUDGMENT//




    This is the complaint filed by Complainant Hussain Sab against Respondents ICICI Lombard Motor Insurance Co. under Sec-12 of C.P. Act, for to direct the Respondents to pay a sum of Rs.2,00,000/- towards expenditures incurred by him for repairing his damaged vehicle with interest @ 12% p.a. and for to award a sum of Rs.20,000/- towards deficiency in service with cost and other reliefs as deems fit to the circumstances of this case.

    2. The brief facts of the Complainant’s case are that;

    He is the owner of Maxi Cab bearing Regn. No.KA-35/9541 which comprehensively insured with Respondents Insurance Company met with an accident on 08/01/2008 at about 3.00 a.m. while Insurance Policy was in force and in the said accident his vehicle badly damaged. He informed the fact of accident to the Police as well as to the Respondents Insurance Company. Thereafter, he filed claim petition along with necessary records. The Respondents appointed Surveyor, he inspected the damaged vehicle and assessed the net loss for Rs.1,80,000/-. He filed bills for Rs.2,00,000/- towards expenditure incurred by him for repairing the said vehicle. The Respondents shown their negligence in settling his claim petition inspite of several oral and written requests and thereby Respondents found guilty under deficiency in their service towards him. Accordingly, he prayed for to grant the reliefs as prayed in it.


    3. The Respondent Nos.1 and 2 appeared in this case through their advocate, but not filed their Written Version inspite of sufficient time granted to them. Accordingly, case proceeded and affidavit evidence of Complainant was recorded and his documents appreciated.

    4. In view of the facts and circumstances stated above, now the points that arise for our consideration and determination are that;

    1.
    Whether the Complainant proves that, his maxi cab bearing Regn.No.KA-35/9541 comprehensively insured with Respondents Insurance Company met with an accident on 08/01/2008 at 3.00 a.m. on Bellary-Vaddu public road and in the said accident, his vehicle badly damaged, he informed the same to the Police as well as to the Respondents, he got repaired it from private auto garage, thereafter, he filed claim petition along with all necessary records and bills, but Respondents Insurance Company shown its negligence in settling his claim, inspite of several oral and written requests and thereby both Respondents found guilty under deficiency in their services towards him?

    2.
    Whether the Complainant is entitled for reliefs as prayed in this complaint?

    3.
    To what relief the Complainant is entitled for?
    //POINTS//














    5. Our findings on the above points are as under.

    Point No.1:
    In Affirmative.



    Point No.2:
    As discussed in detail in the body of this Judgment.



    Point No.3:
    In view of the findings on Point Nos.1 and 2, we pass the final order for the following;





    //REASONS//
    Point Nos.1 & 2: -


    6. In order to prove the facts involved in these two Points, affidavit evidence of Complainant was filed, he was noted as P.W.1 and documents Ex.P.1 to Ex.P.17 are marked. The Respondents not filed their Written Version, documents and not filed affidavit evidence of any one.

    7. In the light of circumstances stated above, as regards to the ownership of vehicle of Complainant is supported by Ex.P.2 R.C. extract of the said vehicle, as regards to the accident met by it is supported by copy of FIR Ex.P.5 with copy of complaint, statement of witness Ex.P.6, IMV report Ex.P.7. As regards to the coverage of insurance of the said vehicle is supported by Ex.P.1 copy of Insurance Policy.


    8. All these documents are unchallenged documents by the Respondents. In the similar way, the affidavit evidence of P.W.1 in respect of those documents is also unchallenged by the Respondents.

    9. Now further evidence of P.W.1 with regard to damage to his vehicle he contended that, he got repaired the said vehicle with M/s Eresh Auto Concern, Bellary, Benz Automobiles, Bellary, Sagar Automobiles, Hospet, Kiran Glass Works, Bellary and Afroz Builders, Bellary and in support of this fact he has produced bills Ex.P.8 to Ex.P.15. It is contended by the Complainant in his affidavit evidence that, after informing the fact of accident to the Respondents, it appointed Surveyor and assessed the damage to the extent of Rs.1,80,000/-, but he incurred expenditure to the extent of Rs.2,00,000/-. Accordingly, he submitted bills Ex.P.8 to Ex.P.15.

    10. It appears from the affidavit evidence of P.W.1 and the copy of legal notice Ex.P.17 that, the Respondents Insurance Company not settled his claim petition even though he filed necessary documents with bills in support of his claim. Hence, the Complainant established the fact that the Respondents shown their negligence in settling his claim and both Respondents found guilty under deficiency in their service towards him.


    11. The Complainant has not produced copy of Surveyor’s report to hold that, the said Surveyor assessed the damage to the extent of Rs.1,80,000/-. However, documents Ex.P.8 to Ex.P.15 which are bills of M/s Eresh Auto Concern, Bellary, Benz Automobiles, Bellary, Sagar Automobiles, Hospet, Kiran Glass Works, Bellary and Afroz Builders, Bellary totally works out to Rs.1,81,567/-. The Complainant himself admitted the fact that the Surveyor of Respondents Insurance Company assessed loss and damage to the extent of Rs.1,80,000/- as such, the Complainant is entitled to get an amount of Rs.1,80,000/- towards expenditure incurred by him for repair of his damaged vehicle.

    12. As regards to the claim of Complainant for Rs.20,000/- towards deficiency in service is not based on any principles. We have noticed the deficiency in service on the part of these Respondents to the Complainant as such, we are of the view that, granting an amount of Rs.3,000/ to the Complainant under the head of deficiency in service by these Respondents is proper and reasonable amount. Accordingly, it is granted.
    13. As regards to the cost of complaint is concerned, he is entitled to recover an amount of Rs.2,000/- from the Respondents jointly and severally under this head.

    14. As regards to the rate of interest, it is proper and just to grant interest @ 9% p.a. from the date of this complaint till realization of full amount on the above said total sum. Accordingly Point No.1 and 2 answered.


    Point No.3: -

    15. In view of findings on Point Nos.1 & 2, we pass the following;
    //ORDER//
    The complaint filed by the Complainant is partly allowed with cost.


    The Complainant is entitled to recover total sum of Rs.1,85,000/- including cost (rupees one lakh eighty five thousand only) from the Respondents jointly and severally.

    The Complainant is entitled to recover future interest @ 9% p.a. on Rs.1,85,000/- from the date of this complaint i.e. 01/01/2009 till realization of full amount from the Respondents jointly and severally.



    The Respondents jointly and severally are hereby granted two months time from the date of this Judgment for to make the payment of total sum and interest as stated above to the Complainant.

  2. #17
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    Sri. S.B. Krishna, S/o Late K. Narasimha Murthy, R/at No.175, 5th Main Road, Avalahalli Extension, BSK III Stage, Bangalore-85. Complainant

    V/S

    Authorised Signatory, ICICI Bank Ltd., Credit Card Collection, Bommanahalli, Bangalore-68. Opposite Party


    ORDER By the President Sri. S.S. Nagarale


    This is a complainant filed under Section 12 of the Consumer Protection Act, 1986 claiming refund of Rs.11,411-41/- from the opposite party Bank. The brief facts of the case are that, the complainant is the Credit Card Holder in the opposite party Bank bearing No. 3770 413164 23002 and he was prompt in making payment of all the dues raised in respect of the said credit card. The complainant was paying his monthly premium in respect of his Lombard Insurance Policy through Credit Card. Due to personal reasons, the complainant got the said insurance policy cancelled in February-2008. The premium paid was transferred back to this credit card. This entry is also reflected in the statement dated 3/3/2008. After that entry there was another entry charging Rs.5,719/-. The complainant questioned about this the opposite party Bank staff given narration as “EMI Principal”.
    An amount of Rs.5,719/- had been mentioned as EMI Principal for the transaction held on 28/2/2008. In fact the complainant had not made any transactions on 28/2/2008 and there was no outstanding amount as on that date. During the period of statement there were two transactions one for Rs.140/- and another was for Rs.3,892/-.
    According to the Bank website there was no transaction of Rs.5,719-09. The opposite party Bank has recovered an amount of Rs.5,719-09 from the S.B A/c bearing No. 004701501413 of the complainant. Except this transaction the complainant had no objections about the other transactions mentioned in the said bill. Complainant requested the Bank to furnish the details of the outstanding amount mentioned in the bank statement dated 3/3/2008, but the bank instead of furnishing the details of the amount an irrelevant reply was given stating that an enquiry can not be conducted after 90 days and as such they had not furnished the details to the complainant. The opposite party Bank has not shown any interest to furnish the required information sought by the complainant. The opposite party Bank has deducted an amount of Rs.7,519.41. In spite of repeated requests and correspondence by the complainant, the opposite party Bank has not furnished the details as sought by the complainant and this amounts to negligence. The complainant issued legal notice on 15/1/2009 but failed to furnish the reply to the legal notice issued by the complainant. The opposite party has deducted an amount of Rs.7,519.41 from the S.B A/c of the complainant along with Rs. 3,892/- received from the Lombard Insurance totaling amount of Rs.11,411-41. The Bank has neither refunded the said amount nor replied to the complainant after issue of legal notice dated 12/1/2009. Hence, the complaint.


    2. Notice was issued to opposite party. Notice was served. In spite of service of notice the opposite party has not appeared. Defense version not sent even by post also. Therefore the opposite party placed as exparte.

    3. Affidavit evidence of complainant filed. Arguments are heard.


    REASONS


    4. Perused the complaint and documents. It is the case of the complainant that, opposite party Bank has debited an amount of Rs.7,514-41 from the complainant’s S.B A/c bearing No. 004701501413. But complainant submitted that this amount has already been debited from S.B A/c on 15/12/2008 itself. Statement of transaction in Savings Account for the period 01/10/2008 to 31/10/2008 has been produced by the complainant. As per this statement Rs.7,519/- has been shown as withdrawn on 15/12/2008. Therefore, the complainant submitted that he had requested the opposite party to furnish details of outstanding amount as mentioned in the credit card statement. In spite of his request opposite party Bank has not furnished details as sought by the complainant. Therefore, this is a deficiency in service on the part of the opposite party Bank. Opposite party Bank has failed to furnish the required information to the complainant. The complainant has submitted that he has made repeated correspondence and representations and requested over telephones and even on his personnel visits also opposite party Bank has not furnished the details of amount recovered.
    The complainant had issued legal notice to the opposite party Bank. In spite of the notice the opposite party Bank has failed to reply to the legal notice. Since an amount of Rs.7,519/- shown as EMI principle on 28/02/2008 in the credit card account is not proper and correct. It is the case of the complainant that he was paying monthly premium towards Lombard General Insurance policy and got the said insurance policy in February-2008, accordingly the premium paid was transferred back to his credit card account.

    The complainant submits that the amount received in respect of refund of the policy amount had not been credited to his S.B A/c. Therefore, the complainant wants that the said amount shall be credited to the S.B A/c. The amount of Rs. 5,719/- which has been shown as EMI principle for the transaction held on 28/02/2008. The complainant submitted that he has not made any transaction on 28/02/2008 and there was an outstanding amount as on that date.

    Therefore, the entry as EMI principle dated 28/02/2008 appears to be wrong and not proper. The case made out by the complainant has gone unchallenged. The opposite party Bank has not appeared before this Forum in spite of service of notice. There are no reasons to disbelieve the case put up by the complainant.

    The opposite party Bank by remaining absent/exparte has accepted the facts stated by the complainant. Therefore, taking into consideration of all the documents and the affidavit evidence filed by the complainant, the complaint deserves to be allowed. In the result, I proceed to pass the following:- ORDER 5. The complaint is allowed. The opposite party Bank is directed to reverse back/credit an amount of Rs.5,719/-(shown as EMI principal) and also credit Rs.3,892/- received from the ICICI Lombard General Insurance to the S.B A/c of the complainant (since the complainant got cancelled the health insurance policy). 6. The opposite party is directed to pay Rs.1,000/- towards costs of the present proceedings to the complainant. 7. Send the copy of this Order to both the parties free of costs immediately as per statutory requirement.

  3. #18
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    Default ICICI Lombard General Insurance Company Ltd

    Shri Mukesh Kumar Juneja

    S/O late Shri Krishan Kumar Juneja,

    Resident of Sarna Cottage near Rana Cottage,

    Jakhoo, Shimla-171001.



    … Complainant

    Versus



    1. The Manager, UTI Bank,

    S.D.A. Complex, Kasumpti, Shimla-171009.



    2. M/S ICICI Lombard General Insurance Company Ltd.

    ICICI Bank Towers, Bandra Kurla Complex,

    Bandra (East) Mumbai- 400 051.



    …Opposite Parties


    O R D E R:

    Pritam Singh (District Judge) President:- This order shall dispose of complaint filed under section 12 of the Consumer Protection Act, 1986. Briefly stating the facts of as set out in the complaint are that the father of the complainant late Shri Krishan Kumar Juneja had opened saving bank account with the OP No.1 and as per the scheme prevalent at the relevant time, has father was duly insured for a sum of Rs.2,00,000/- in case of accidental death policy. That his father late Shri Kishan Kumar Juneja met with fatal accident on 01.11.2002 at Panchkula, who later on succumbed to the injuries on 04.11.2002 at Panchkula. That intimation about the death of the insured was sent to the OPs and subsequently he preferred the insurance claim with OPs. But, the OPs instead of settling his insurance claim repudiated the same on frivolous grounds. Hence, feeling dissatisfied and aggrieved by the act of the OPs, the complainant perforce filed this complaint against the OPs.



    2. The OPs while filing reply took preliminary objections regarding maintainability of the complaint, jurisdiction of the Forum to try and entertain the present complaint, etc. On merits, the OP No.1 admitted that the deceased Shri Krishan Kumar Janeja had opened saving Bank account with them. That as per the scheme of free accidental policy the debit card holders between age group of 18 years and 70 years were duly insured with them. But according to OPs, the injured had already crossed the age of 70 years at the time of his death. As such he or his nominee was not entitled for any claim after death of insured K.K juneja. Hence, there being no deficiency in service, the complaint is sought to be dismissed. Thereafter, the parties led evidence in support of their claim/counter claim.



    3. We have heard the learned counsel for the parties at length and have also thoroughly scanned the entire record of the complaint.

    4. Admittedly, the deceased Krishan Kumar Juneja had opened a saving bank account with the OP No.1 who was duly insured under free accidental policy with the OPs and the persons between age group of 18 to 70 years were given Insurance Coverage under this free Accidental Policy. It is the case of the complainant that his father met with a fatal accident on 01.11.2002 who later on succumbed to his injuries at Panchkula on 04.11.2002. That, he sent intimation about the death of the insured to the OPs and subsequently preferred the insurance claim. But the OPs instead of settling the same repudiated it on frivolous grounds.



    5. As stated above, the OPs have not disputed the factum of providing insurance coverage to the deceased Krishan Kumar under free accidental policy in vogue at relevant time. But their case is that this insurance coverage was available to the persons between age group of 18 to 70 years but the deceased Krishan Kumar had already crossed the age of 70 years when he expired. Therefore, the claim preferred by the complainant was rightly repudiated by them being not admissible.



    6. In this connection it may be submitted that the parties have relied upon claim form Annexure C-1, wherein the age of deceased Krishan Kumar Juneja has been shown 74 years after interpolation from figure 64 without any explanation. The Annexure C-2 is also relied upn by parties wherein the date of birth of deceased Krishan Kumar is shown as 20.04.1929. But, it a document of OP. No copy of birth certificate showing the date of birth of deceased Krishan Kumar has been placed on record by OP in support of their plea that the insured was above 70 years at the time of his death. Needless to state that it was for OPs to prove that the deceased had already crossed the age of eligibility to maintain this insurance claim by complainant under the scheme. Thus, in the absence of cogent oral or documentary evidence led on record by OP, it cannot be held by any stretch of imagination that the deceased Krishan Kumar Juneja had crossed the age of 70 years at the time of his death and that the complainant is not entitled to the payment of insured sum. Thus, the act of OPs by repudiating the insurance claim of the complainant on this unjustified and illegal ground would certainly amount to deficiency in service and unfair trade practice.



    7. For the foregoing reasons, we allow this complaint and direct both OPs to jointly and severally indemnify the complainant to the extent of Rs.2,00,000/- alongwith interest at the rate of 9% per annum with effect from the date of filing of the complaint, i.e. 22.09.2004 till making full payment of the aforesaid amount. The OPs are also directed to pay litigation cost of Rs.1000/- to the complainant. This order shall be complied with by the OPs jointly and severally within a period of forty five days, after the date of receipt of copy of this order.

  4. #19
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    Default ICICI Lombard General Insurance

    Harnek Singh son of Sh. Bachittar Singh, resident of village Ranian, Post Office Sangowal, Ludhiana.

    Complainant.

    Versus



    1- ICICI Lombard General Insurance Co. Ltd. The Mall, Ludhiana through its Manager.

    2- ICICI Lombard General Insurance Co. Ltd., SCO 174-175, Ist Floor, Sector 9-C, Madhya Marg, Chandigarh through its Manager.

    3- ICICI Bank Towers Bandra Kurla Complex, Mumbai-400051 through its Chairman/MD. Opposite parties.



    COMPLAINT UNDER SECTION 12 OF THE CONSUMER PROTECTION ACT, 1986.

    Quorum:

    Sh. T.N. Vaidya, President.

    Sh. Rajesh Kumar, Member.



    Present: Sh. K.S. Mand Adv. for complainant.

    Sh. Amandeep Singh Adv. for opposite parties no.1 & 2.

    Opposite party no.3 exparte.



    O R D E R



    T.N. VAIDYA, PRESIDENT:



    1- Tata Indica car bearing registration no.PB-10BZ-1041, Engine no.60020, Chassis no.72304, was purchased by complainant from Garison Motors, Ludhiana, for Rs.3,82,500/-. The same was got insured vide cover note no.1763893 dated 24.5.2006 from opposite parties no.1 & 2. The insured vehicle met with an accident on 28.4.2007 in village Gill, District Ludhiana, qua which, intimation was given to opposite party. Claim was lodged for total damage with opposite party, who got the surveyor appointed, but repudiated the claim vide letter dated 5.8.2007, on ground that the vehicle was used for commercial purpose. This repudiation is challenged to be wrong, null and void, illegal and arbitrary, by filing the present complaint u/s 12 of the Consumer Protection Act, 1986. Hence, sought value of the car Rs.3,63,,375/- from opposite party with Rs.50,000/- as compensation for deficiency in service and Rs.10000/- as litigation costs.

    2- Opposite party admitted obtaining insurance policy qua the car from them by the complainant. Lodging accidental claim is also conceded alongwith repudiating the same. They have justified the repudiation, on the ground that the vehicle was being used for commercial purpose. Though had obtained insurance coverage, as a private vehicle. The vehicle at the time of accident, was being plied as a taxi. Complainant is running a travelling agency in the name and style of Kargil Taxi Stand on Alamgir Road. As such, by plying the private vehicle, as taxi, he infringed conditions of the policy and claim consequently, was rightly repudiated.

    3- Contesting parties led evidence in support of their claims and stood heard through their respective counsels.

    4- The only and sole question requiring determination is whether the car owned by complainant, was used by him, as a taxi and at the time of accident, was being plied, as a taxi, in violation of the terms and conditions of the insurance policy. To support such plea that the vehicle was being plied as a taxi, opposite party have placed reliance on Annexure-R1, report of investigator Sh. Sachin Gulati, who was engaged by opposite party, after lodging accidental claim with them by the complainant. Vide his report, he intimated that the complainant is running a travelling agency in the name and style of Kargil Taxi Stand, which fact was also admitted by his sister in law. He also snapped photographs of the taxi stand of the complainant, bearing his name. Ex.R2 are copies of those photographs, relied in support of such report.

    5- The investigator has also mentioned after investigation that the vehicle was used for carrying passengers at the time of accident. The insured complainant had admitted that was also having a tempo traveller and school bus and that there is a religious place in his village and religious people travel in his vehicle easily for visiting Brindaban, Haridwar and other places.

    6- But in proof of this report Annexure-R1, its author Mr. Gulati has not been examined, nor copy of statement of the persons, testifying before him that the complainant was operating Kargil Taxi Stand, is placed on the record. Furthermore, affidavit of Mr. Sachin Gulati, in support of the plea, is also not filed. Had affidavit of Mr. Gulati been filed, alongwith statements of persons, testifying running of taxi stand by the complainant, we would have been able to accept such plea. But without evidence, we are unable to believe this plea of the opposite party. Consequently, there is no legal material worth the name on the record that at the time of accident, vehicle of the complainant was being used as a taxi, for commercial purpose.

    7- Taking of insurance policy by the complainant for his vehicle vide certificate of policy Ex.C1 and Ex.C2, no doubt, shows that the vehicle was insured as a private car, but in violation of the policy, it was being used for commercial purpose, as a taxi, there is no evidence worth the name. Consequently, the repudiation of the claim vide letter dated 5.8.2007 Annexure-C3, on ground that the vehicle was being used for commercial purpose, being without foundation, consequently, can not be sustained.

    8- Complainant qua his claim, had also lodged notice Ex.C6 with the opposite party, which was received by them under acknowledgement Ex.C5, but failed to settle the same.


    9- Be it stated that opposite party also engaged services of Sh. G.S. Sohal & Co. surveyor and loss assessor, who vide report Annexure-R4 dated 19.12.2002, had assessed loss of Rs.34803/- only to the insured vehicle of the complainant. Report of loss assessor is a valuable document, help of which can be taken, to ascertain the damage suffered by the insured. In this behalf, reliance placed on Prithvi Raj Vs Oriental Insurance Co. Ltd. reported in II (2005) CPJ-69(NC).


    10- In these circumstances, we allow this complaint and sequel thereto, direct opposite party, to pay Rs.34803/-, as assessed by its surveyor to the complainant with 9% p.a. interest from the date of complaint till payment and also to pay Rs.5000/- as compensation for causing harassment and Rs.2000/- as litigation expenses, within 45 days of receipt of copy of order, which be supplied to the parties free of costs.

  5. #20
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    Default ICICI Lombord

    Pawan Kumar Sharma (aged 37 years) son of Sh.Badri Parshad Sharma, resident of House No.1282, Street No.7-8, Jawahar Nagar, Moga, Tehsil & Distt.Moga.

    Complainant.

    Versus



    ICICI Lombard General Insurance Company Ltd. through its Branch Manager, ICICI Bank Tower, Bandra, Kurla Complex, Mumbai-400051.



    Opposite Party.

    Pawan Kumar Sharma complainant has filed the present complaint under section 12 of the Consumer Protection Act, 1986 (herein-after referred to as ‘Act’) against the ICICI Lombard General Insurance Company Ltd. through its Branch Manager, ICICI Bank Tower, Bandra, Kurla Complex, Mumbai-400051 (herein-after referred to as ‘ICICI Lombard’) -opposite party directing them to pay medical claim of Rs.230383/- and also to pay Rs.50000/- as compensation for causing mental tension and harassment or any other relief to which this Forum, may deem fit be granted.

    2. Briefly stated, Pawan Kumar Sharma, complainant got himself insured vide policy no.4034/FSH/ 01626380/00/000 for the period w.e.f. 27.11.2006 to 26.11.2007 for a sum of Rs.3 lacs. and paid premium of Rs.7200/-. That the complainant got medical treatment w.e.f. 25.11.2007 to 30.11.2007 and sent the claim alongwith requisite documents to them for payment, but they rejected the same under exclusion clause no.3.1 (i.e. pre-existing disease). That the rejection of the claim is not valid as Exclusion Clause no.3.1 is not applicable to the case of complainant because the disease was not pre-existing. The OP-ICICI Lombard itself stated that if a disease relates back to 4 years, it will not be termed as pre-existing disease & clause 3.1 will not applicable.

    That in the present case, the disease occurred about 5 years back and after medical treatment it was properly cured and the complainant was leading a healthy life. That the OP-ICICI Lombard was asked number of times for the reimbursement of his claim, but to no effect. Thereafter, the complainant also served a legal notice through his counsel on 22.9.2008, but the OP-ICICI Lombard refused to admit his rightful claim. Hence the present complaint.

    3. Notice of the complaint was given to the OP-ICICI Lombard, who appeared through Sh.H.S.Lodhi, Advocate and filed their written reply contesting the same. They took up preliminary objections that the complainant has filed the present complaint only to injure their reputation and goodwill and it deserves to be dismissed with special costs u/s 26 of Act; that the intricate questions of law and facts are involved which requires voluminous documents; that the complainant has concealed the material facts and documents from the knowledge of this Forum; that the complainant has concealed the material fact that he was suffering from Coronary Artery disease for the last five years i.e. prior to the date of inception of policy; that the treatment was taken by the complainant for Coronary Artery disease, acute inferior wall MI.

    Since the claim arose on account of and in connection with pre-existing disease, the same was excluded from the scope of the policy in question and claim was rightly repudiated as per exclusion clause 3.1 of the policy. That the claim has been decided and repudiated by TTK Health Care Pvt.Ltd. Marol, a third party administrator appointed and authorised to administer and decide the claim under the policy but they were not impleaded as a necessary party; that the complaint is not maintainable in the present form and that the complainant has got no locus standie and cause of action to file the present complaint. On merits, the OP-Insurance Company took up the same and similar pleas as taken up by them in preliminary objections. It was averred that the complainant is estopped from his act and conduct because in the Pre-Authorization Request Form duly filled and signed by him and counter signed by the hospital, it was mentioned that the complainant had heart disease for the last about five years.

    All other allegations made in the complaint were specifically denied being incorrect. Hence, it was prayed that the complaint filed by the complainant is false and frivolous and the same be dismissed with costs.



    4. In order to prove his case, the complainant tendered in evidence his affidavit Ex.A1, insurance policy Ex.A2, bills cum receipts Ex.A3 to Ex.A11, legal notice Ex.A12, acknowledgement Ex.A13, postal receipt Ex.A14 and closed her evidence.



    5. To rebut the evidence of the complainant, the OP-ICICI-Lombard tendered affidavit Sh.Ravinder Dhull Ex.R1, copies of letters Ex.R2 and Ex.R3, copy of form Ex.R4, copy of policy Ex.R5, copy of terms and conditions Ex.R6 and closed their evidence.



    6. We have heard the arguments of Sh.Pardeep Synghal ld. counsel for the complainant and Sh.H.S.Lodhi ld.counsel for the OP-ICICI Lombard and perused the written arguments filed by Sh.H.S.Lodhi ld. counsel for the OP-ICICI Lombard and have very carefully perused the evidence on the file.



    7. Sh.Pardeep Synghal ld.counsel for the complainant has mainly argued that the OP-ICICI Lombard has wrongly and illegally repudiated the claim of the complainant to the extent of Rs.230383/- on the false and fictitious ground of pre-existing disease. This contention of the ld.counsel for the complainant has full force.

    The evidence on the file shows that the complainant had not concealed any material fact or disease at the time of obtaining the medi-claim policy in question. In the Pre-Authorization Request Form Ex.R4 submitted by the complainant at the time of purchase of the medi-claim policy Ex.A2 (Ex.R5 same document) he has mentioned that he was suffering from Coronary Artery disease, acute inferior wall MI. Thus, it shows that he had not concealed from the OP-ICICI Lombard regarding his illness of Coronary Artery disease, acute inferior wall MI which he suffered about 5 years back.

    Hence, the case of the complainant is not covered under the exclusion clause 3.1 when the complainant himself had disclosed about his pre-existing disease in the Pre-Authorization Request Form Ex.R4. Therefore, the OP-ICICI Lombard had no right, title or interest to repudiate his claim on the ground of pre-existing disease. Had the complainant not disclosed about the pre-existing disease in the Pre-Authorization Request Form Ex.R4, then the case of the OP-ICICI Lombard repudiating his claim would have been covered under the exclusion clause 3.1 of the policy. In the instant case, the exclusion clause 3.1 mentioned in the policy Ex.A2 do not apply to the facts of the present case. Hence, we hold that the OP-ICICI Lombard had wrongly and illegally repudiated the claim of the complainant under exclusion clause 3.1 of the policy. On this point, the rulings 2005(1) CLT page 215 (SC), 2007(2) CLT page 186 (SC), 2008(3) CLT page 71 and 1996(3) SCR page 500 (SC) cited by ld.counsel for the OP-ICICI Lombard do not apply to the facts of the present case and are quite distinguishable.



    8. Admittedly, the complainant got himself insured for 3 lacs vide policy Ex.A2. During his treatment, he spent Rs.230383/- and produced the bills Ex.A3, Ex.A7 to Ex.A11 amounting to Rs.201321/- of Metro Hospitals & Heart Institute, Noida and bill Ex.A6 amounting to Rs.29062/- of DMC & Hospital, Ludhiana in his evidence. In rebuttal, the OP-ICICI Lombard has failed to adduce any evidence to prove that the complainant had not spent the aforesaid amount or any amount lesser than the claimed amount on his treatment for the period w.e.f. 25.11.2007 to 30.11.2007. Thus, the complainant is entitled to the claimed amount of Rs.230383/-.



    9. To prove the aforesaid contentions, the complainant has produced his affidavit Ex.A1, insurance policy Ex.A2, bills cum receipts Ex.A3 to Ex.A11, legal notice Ex.A12, acknowledgement Ex.A13, postal receipt Ex.A14 and we believe and rely upon the same. On the other hand, no reliance could be placed on the affidavit of Sh.Ravinder Dhull Ex.R1 and documents Ex.R2 to 6 and we discard the same.


    10. In view of the aforesaid facts and circumstances, the complaint filed by the complainant has merit and the same is accepted. The OP-ICICI is directed to pay Rs.230383/- i.e. the claimed amount to the complainant alongwith interest @ 6% per annum from the date of repudiation of the claim till its payment within 30 days from the date of receipt of copy of this order. Copies of this order be supplied to the parties free of cost and the file be consigned to record room after compliance.

  6. #21
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    Default ICICI Lombard General Insurance

    Arai Jayanthi,
    W/o. Late A. Gopi,
    Hindu, aged about 40 years,
    Residing at D.No.19-1-13-1AB,
    Srinivasapuram, Renigunta Road,
    Tirupati, Chittoor District. … Complainant

    And

    1. M/s. ICICI Lombard General Insurance Co. Ltd.,
    Rep. by its Branch Manager,
    Holding its office at Ground Floor, Harini Towers
    Near Head Post Office, Gangamma Temple Road,
    Tirupati, Chittoor District.

    2. India Inofline Insurance Services Ltd.,
    Rep. by its Branch Manager
    Holding its office at Ground Floor, Harini towers,
    Gangamma Temple Road,
    Tata Nagar, Tirupati.

    3. ICICI Lombard General Insurance Co. Ltd.,
    403, Center Point, JB Nagar,
    Andheri Kurla Road, Andheri East,
    Mumbai. … Opposite parties


    ORDER


    This complaint is filed under Section 12 of Consumer Protection Act, 1986 to direct the opposite parties to pay a sum of Rs.1,00,000/- being the policy amount with interest at 18% per annum from the date of claim till the date of realization, to pay a sum of Rs.20,000/- towards damages and to award Rs.5,000/- towards the costs of the complaint.


    2. The averments of the complaint in brief are as follows :
    The complainant states that the opposite party No.1 has issued a policy bearing No.4005 / 0005612 under Group Personal Accident Policy in favour of her husband A. Gopi, S/o. A. Damodar Naidu on 17.05.2007. The said policy came into force from 17.05.2007 to 16.05.2008, i.e., for a period of one year.

    The opposite party No.1 issued a certificate bearing No.622439. In the said certificate her name was mentioned as a nominee to her husband A. Gopi. That as per the terms and conditions of the said policy, the nominee is entitled to a sum of Rs.1,00,000/- in case of accidental death of the insured. To that effect the opposite party No.1 has issued a policy certificate in favour of her husband. Herself and her husband are residing at Renigunta Road, Tirupati. Her husband was maintaining the family by running a petty teashop. The entire family is solely depending income of the said teashop run by her husband. That on 02.05.2008 at about 10.20 a.m., her husband met with fire accident due to leakage of gas from cylinder. In the said fire accident her husband received the burning injuries to his entire body.

    Herself and her son A. Balaji also received burning injuries on their face and other parts of the body in the said fire accident. Immediately one P. Munirathnam, the house owner came to their rescue and shifted all of them to the SVRRGG hospital, Tirupati in a auto. Subsequently, all of them were shifted to KMC hospital at Chennai. But her husband died due to the severe burning injuries on 04.05.2008 at KMC Hospital, Chennai. With great difficulty herself and her son survived and recovering slowly. To that effect an FIR in crime No.136 of 2008 is registered by the Alipiri Police, Tirupati. That she has approached the opposite party No.1 and submitted claim application for insurance amount of Rs.1,00,000/- due to the death of her husband in the fire accident. But without any reason, the opposite party No.1 has bluntly refused to settle her claim by stating that the policy will not cover for the death in the fire accident.
    The denial of her claim by the opposite party No.1 is illegal and amounts to deficiency of service. The complainant issued a legal notice dated 18.10.2008 to the opposite party No.1 calling him to settle her claim. The opposite party No.1 received the legal notice but neither gave reply nor complied with the demands. The complainant is put to severe mental agony and torture. She is also entitled to the damages.
    Hence, this complaint.


    3. The opposite party No.1 filed counter denying most of the allegations made in the complaint and stated as follows : The opposite party No.1 states that there is no contract of insurance between this opposite party and the deceased. In the absence of any contract, the payment of compensation by this opposite party does not arise. Further according to the complainant, the policy is issued under the Group Personal Accident Policy and the policy does not cover the risk of fire accidents. This Forum has no jurisdiction to entertain this complaint and on this ground alone this petition is liable to be dismissed.
    The petition is bad for non-joinder of the proper and necessary parties and the alleged accident alleged to have been caused on 02.05.2008 at about 10.20 a.m. As per the statement of the deceased, he was taken to the SVRRGG Hospital immediately by P. Munirathnam. But his statement was recorded on 03.05.2008 at 10.45 p.m. at Chennai. The delay in lodging the FIR raises suspicion about the alleged accident and that investigator was appointed to investigate the alleged accident and the report is pending. In the absence of the investigation report, it is not possible to come to a conclusion whether this opposite party is liable to pay compensation or not.

    Hence the petition may be dismissed with costs.
    4. The opposite parties 2 and 3 were absent.


    5. On behalf of the complainant Exs.A1 to A8 are marked.


    Ex.A1 is the certificate issued in favour of A. Gopi by the opposite party No.1 dated
    17.05.2007
    Ex.A2 is the letter issued by the opposite party No.1 in favour of A. Gopi dated
    17.05.2007
    Ex.A3 is the Xerox copy of FIR in crime No.136 of 2008 of Alipiri Police Station,
    dt.04.05.2008
    Ex.A4 is the Xerox copy of post mortem certificate dated 05.05.2008.
    Ex.A5 is the Xerox copy of the death certificate issued by the KMC, Hospital,
    Chennai, dt.21.07.2008
    Ex.A6 is the Xerox copy of household card of the complainant.
    Ex.A7 is the office copy of legal notice by the complainant to the opposite party No.1,
    dt. 18.10.2008
    Ex.A8 is the courier receipt relating to opposite party No.1
    On behalf of the opposite party No.1, Ex.B1 is marked.
    Ex.B1 is the Attested copy of Group Accident Insurance Policy.
    The complainant and the opposite party No.1 filed their written arguments.



    6. The points for consideration are :

    1. Whether there is deficiency of service on the part of the opposite parties?


    2. Whether the complainant is entitled to interest at 18% per annum on Rs.1,00,000/- from the date of complaint?


    3. Whether the complainant is entitled to Rs.20,000/- for mental agony suffered by her?


    4. Whether the complainant is entitled to Rs.5,000/- towards the costs of the complaint?


    5. To what relief?


    Point No.1:- The case of the complainant is that on 02.05.2008 at about 10.20a.m., her husband A. Gopi met with a fire accident due to leakage of gas from the cylinder. According to the complainant, the opposite party No.1 issued a policy bearing No.4005 / 0005612 under Group Personal Accident Policy in favour of her husband by name A. Gopi. On 17.05.2007 the opposite party has issued a certificate bearing No. 642439 for the period from 17.05.2007 to 16.05.2008 and the said document is marked as Ex.A1. According to the complainant, her husband was shifted to SVRRGG Hospital for treatment by Munirathnam and subsequently he was shifted to KMC hospital at Chennai where he died on 04.05.2008. In the instant case, FIR is marked as Ex.A3.

    The opposite party No.1 in his counter stated that an investigator was appointed to investigate the alleged incident and report is awaited and there is delay in registration of FIR by Alipiri Police Station. Ex.A1 clearly reveals that there was a contract between the deceased A. Gopi and the opposite party No.1. If really, the opposite party No.1 appointed a investigator for investigation with regard to the fire accident, the opposite party No.1 should have filed the alleged report of the investigator. This he failed to do so. The fire accident alleged to have taken place on 02.05.2008 and the police registered the crime on 04.05.2008 on intimation from the hospital.

    Therefore, it cannot be said that there is a delay in giving report to the police. The complainant issued Ex.A7 to the opposite party No.1 and the courier receipt was marked as Ex.A8. Failure on the part of opposite party No.1 in giving reply to Ex.A7 goes to show that the case of the opposite party No.1 is far from truth. The policy certificate issued by the opposite party No.1 clearly mentioned the scope of cover of risk and the exclusion of the risk coverage. No where in Ex.B1, it is mentioned that the risk will not cover for the fire accidental death. In the above said circumstances, the District Forum is of the opinion that the acts of the opposite party No.1 amounts to deficiency of service. This point is answered accordingly.


    Point No.2:- In view of our finding on Point No.1, we are of the opinion that the complainant is entitled to interest at 9% per annum on Rs.1,00,000/- from the date of legal notice, i.e., 18.10.2008 till the date of realization. This point in answered accordingly.


    Point No.3:- In view of our finding of Point No. 1&2, we are of the opinion that the complainant is not entitled to any damages for mental agony suffered by her. This point is answered accordingly.


    Point No.4:- The complainant claimed Rs.5,000/- towards the costs of the litigation. The amount claimed by the complainant is excessive and abnormal. Therefore, the District Forum is of the opinion that if a sum of Rs.1,500/- is awarded towards the litigation expenses, it will meet the ends of justice. This point is answered accordingly.


    Point No.5:- In the result, the complaint of the complainant is allowed in part directing the opposite parties to pay a sum of Rs.1,00,000/- with interest at 9% per annum from the date of legal notice, i.e., 18.10.2008 till the date of realization and also to pay Rs.1,500/- towards the costs of the complaint to the complainant.

    Time for compliance is 6 weeks.

  7. #22
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    Default ICICI Lombard General

    Complainant:



    Mr. Abraham Joseph

    No.17, Palm Groove

    Mattackal

    Abey Bhavan

    Bangalore- 560 043




    /vs/


    Opposite Parties:


    1. The Divisional Manager

    The ICICI Lombard General

    Insurance Ltd.,

    Richmond Road

    Bangalore-560 025




    O R D E R


    This is a complaint filed by the complainant under section 12 of the Consumer Protection Act, 1986 against the Opposite parties (Ops in short) for the payment of Rs.52,545/- with costs and damages of Rs.10,000/-.



    The brief facts of the case are that the complainant and his wife are the policy holders of the Op bearing policy No.4034/RIS/RIS 0029276/00/000. The complainant was hospitalized for surgery of cyst at his gum at Hosmat Hospital, Bangalore on 26th December 2007 and discharged on 28th December 2008. After the discharge, as per the assurance of the Ops, the complainant submitted all documents, bills and claimed the medical expenses under medi claim policy No.4034/RIS/RIS0029276/00/000 for an amount of Rs.51,545/-. The complainant approached the OP, it was assured that it was being under the process and complainant continuous request with the Op, assured that medi claim would be settled, but all of a sudden it was rejected by the Op. The complainant issued a legal notice to the Op through an Advocate, to settle the medi claim for Rs.52,545/- and the complainant received the evasive reply from the OP. Hence the complainant approached this forum.



    Ops appeared through their counsel, filed their version and also gave evidence by way of affidavit. Complainant gave his evidence by way of affidavit. Complainant submitted written arguments and counsel of Op submitted oral arguments.



    In this case, all the facts have been admitted, reason for the repudiation of the claim of the complainant was, as per the exclusion clause No.3.3 “Expenses incurred on treatment of following disease within the first two years from the commencement of the policy will be payable”. In this clause among other disease, the following ailment is also included. The said ailments are “skin and all internal tumors/cysts/nodules/polyps of any kind including the disease limits unless malignant/adenoids and hemorrhoids’. According to learned counsel for Ops, the complainant is also a party to the agreement and as per the exclusion clause, complainant is not entitled for any reimbursement because the treatment taken by the complainant was within two years from the commencement of the policy.

    No doubt there is an exclusion clause under which the complainant is not entitled for the reimbursement of the amount spent for his ailment. All these schemes are for the benefits of the persons who obtains the policy anticipating the disease. The persons will not be knowing of their disease they will get in future at the time of obtaining the policy. At the time of obtaining the policy majority of persons will not go through the details of terms and conditions. It is also not known as per the pleadings of Ops these terms and conditions were brought to the knowledge of the complainant. Therefore complainant is entitled for the reimbursement of the amount spent for his ailment. Non-payment of the said amount, amounts to deficiency in service.


    In view of the discussions made above, we are of the opinion that the complainant has proved the deficiency in service on the part of the Ops. Accordingly, we pass the following order.

    O R D E R

    Complaint is allowed. Opposite parties 1 to 3 are jointly and severally.

    Opposite parties 1 to 3 are directed to reimburse an amount of Rs.52,545/- (Rupees Fifty Two Thousand Five Hundred Forty Five only) to the complainant within six weeks from the date of this order with costs of Rs.2,000/- (Rupees Two Thousand only)

  8. #23
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    Default I.C.I.C.I. – Lombard General Insurance

    Complainant:



    Mukul Sarkar,

    Son of Pashiruddin Sarkar,

    Vill.: Parsha, P.O.: Itahar,

    P.S. : Itahar, District: Uttar Dinajpur.

    VS

    Opposite Parties:



    1. I.C.I.C.I. – Lombard General Insurance Company Limited,

    Represented by the Regional Manager,

    I.C.I.C.I. – Lombard General Insurance Company Limited,

    3rd Floor, Block – B, J.K. Millennium Centre,

    46 D, Chowringee Road, Kolkata: 700 071.



    2. M/s – Roy Enterprise,

    Represented by -

    Pradip Kumar Roy (Proprietor),

    Vill.: Sudarshanpur (Siligurimore),

    P.O. & P.S.: Raiganj, District: Uttar Dinajpur.


    Record is put up today for delivery of order arising out of the hearing over the W.V. submitted O.P. / Accused No. 2. The matter is heard on the other day in presence of both sides by filing this W.V. the O.P. / Accused No. 2 claimed certain amount i.e. Rs.25,000/- of compensation against the complainant.


    The main contention of O.P. / Accused No. 2 is that he has been unnecessarily dragged into this execution case. His contention is that in original case i.e. in Consumer Case Number 05/2007, he was the O.P. / Accused No. 2. He appeared in the said case and contested it through out and this Forum finally ordered an award in favour of the complainant against the O.P. / Accused No. 2, I.C.I.C.I. – Lombard General Insurance Company Limited; but no award in any amount was passed against this O.P. / Accused No. 2. The last submission is that in spite of the complainants within knowledge that no award was passed against the O.P. / Accused No. 2, yet he has been made a party to this execution case.


    Decisions with reasons:


    It is a very peculiar case we have never come across to, here one of the O.P. is demanding compensation against the petitioner against his frivolous prosecution. If we go through the relevant portion of the Judgment passed in C.R. Case No. 05/2007, we get it very very clear that actually, no order of award has been passed against this O.P. / Accused No. 2. Ld. Lawyer for the petitioner submits that the present C.R. case is not a complaint within the meaning of Consumer Protection Act, 1986. So, in case of frivolous complaint the question of payment of compensation to the O.P. by the complainant does arise.


    We never dispute that this C.R. case is not a complaint, but a execution case. But we can not ignore the cogent fact that no award was passed by this Forum against this accused No. 2. So, we may raise a pertinent question, then why this accused No. 2 has been dragged into this execution case. He has appeared through his lawyer, contested this execution case till today, though there is no demand made against him by the complainant. It is needless to say that throughout the period of hearing of this execution case the O.P. / Accused No. 2 has certainly incurred a substantial expenditure. Now, we do find that this Act provides compensation only for filing of frivolous complaint. But at the same time we cannot bypass the unnecessary implication of a person in any execution case with which he has no concern at all. It is the principal of general law that when Act itself is silent about any relief which a person is entitle to, principal of natural justice will prevail and govern the further proceeding of the case or the matter in dispute. No where from the record nor from the submission of the Ld. Lawyer for the petitioner, we are convinced that dragging the O.P. / Accused No. 2 into this Execution Case is justified. So, finally in our view an award of token compensation in favour of the O.P. / Accused No. 2 against the complainant, Mukul Sarkar will meet ends of justice.


    So, the complainant is directed to pay of Rs.1000/- (rupees one thousand) only as a token compensation to the O.P. / Accused No. 2 within one month from the date of this order failing which an annual interest at the rate of 9% will be levied till realization.

  9. #24
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    Default ICICI Lombard General Insurance

    Mohamad Ali son of Yusuf Resident of village DudluNala, Post Office Kautla, , Tehsil Sadar, District Mandi, H.P.

    …Complainant

    V/S


    ICICI Lombard General Insurance Ltd through its Manager ,C/0 Sahib Complex Ist Floor Plot No.118/9 College Road, Mandi, H.P.

    …..Opposite party

    ORDER.

    This order shall dispose of a complaint under Section 12 of the Consumer Protection Act, 1986( hereinafter referred to as the “Act”) instituted by the complainant against the opposite party .The case of the complainant is that he was owner of buffalo which was got insured with the opposite party vide policy No. 4057/0000098 Annexure C-1 and tag No 148934 for the period from 27-3-2008 to 26-3-2011. During the currency of the policy, the buffalo died . The complainant reported the matter to the Veterinary Doctor and post mortem of the dead animal was conducted there.
    It has been averred that the matter was thereafter reported to the opposite party for settlement of the claim and all the requisite documents were also supplied. It has been alleged that the opposite party has repudiated the claim vide letter dated 23-8-2008 Annexure C-2without any reasonable ground . The complainant has alleged that the repudiation of the claim is arbitrary, without application of mind and amounts to unfair trade practice as well as deficiency in service on the part of the opposite party. On these facts , the complainant has sought a direction to the opposite party to pay Rs.14,000/- , the assured sum of the cattle with interest at the rate of 12% PA from the date of death and also to pay Rs.5500/- as litigation charges and Rs.5000/- as compensation.

    2. The opposite party resisted the complaint and raised preliminary objections that there is no deficiency in service on its part , that the complaint is not maintainable that the opposite party has insured the cattle subject to certain limitations , exceptions and conditions and if these terms and conditions are not complied with ,the insured is not entitled for any compensation, that negligence is one of the exceptions and the same is not covered under the policy of insurance, that the claim has been repudiated after having given a deep thought to it, that the animal had died in an accident i.e. falling from a height while leaving the buffalo for grazing and it was the duty of the owner to take due care and caution and the owner was negligent while leaving the buffalo for grazing . Also it was the duty of the insured to make better arrangements to feed the animal in tough circumstances .
    On merits , it has been admitted that the cattle was insured with it and rest of the allegations have been denied . It has also been averred that the complainant must be put to strict proof whether the buffalo which has died in accident was the same buffalo which was insured with it or some other cattle . It has further been averred that the claim submitted by the complainant was rightly repudiated . It has been averred that no cause of action accrued in favour of the complainant to file the present complaint . The opposite party had prayed for dismissal of the complaint.

    4. The complainant had filed rejoinder reiterating the contents of the complaint and denying those contrary to the complaint.

    5. We have heard the ld. counsel for the parties and have carefully gone through the record of the case . It is admitted case of the opposite party that the animal in question was insured with it and it died during the currency of the insurance policy.. However , the claim of the complainant has been repudiated only on the ground that the animal died due to the negligence on the part of its owner as it died of an accident on account of falling from a height and it was the duty of the owner to keep the animal away from heights .

    6 Now the question which arises for consideration before this forum is as to whether the opposite party was justified in repudiating the claim only on this ground . The onus was upon the opposite party to prove that the animal died due to negligence on the part of its owner . . However , no material has been placed on record by the opposite partyto show that the owner of the cattle was negligent . It was incumbent upon the opposite party to place on record statements of witnesses or their affidavits to establish negligence on the part of the complainant but the same had not seen the light of the day. There is no concrete material on record on the basis of which it can be concluded that the complainant was negligent .In the absence of any evidence with respect to negligence on the part of the complainant, we have no hesitation to conclude that the complainant has proved that the opposite party had been deficient in providing service. As per the cover note Annexure C-1,the cattle was insured in the sum of Rs.14,000/- on 27-3-2008 with the opposite party. Hence the complainant is held entitled to Rs.14,000/- on account of death of the insured cattle.

    7 In the light of above discussion, the complaint is allowed and the opposite party is directed to pay Rs.14,000/- to the complainant with interest at the rate of 9% p.a. from the date of filing of the complaint till realization. Apart from this the opposite party is also directed to pay to the complainant Rs.2000 /- on account of compensation for harassment suffered by him due to deficiency in service and also to pay a sum of Rs.1500/- as costs of litigation.

  10. #25
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    Default ICICI Lombard

    Gurdev Singh son of Partap Singh resent of Village Jandiali, Tehsil and District Ludhiana.
    Versus

    1. Sanjivini Med Save health Care Ltd. Through its Chairman/Director, ICICI Bank Feroze @@@@hi Market, Ludhiana.

    2. ICICI Lombard through its Chairman/Director/Manager, Feroze @@@@hi Market, Ludhiana.

    3. Jandiali Gillan Cooperative Agricultural service society Limited through President/Secretary.

    Complainant has filed the present complaint under section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as ‘Act) against the Sanjivini Med Save health Care Ltd. through its Chairman/Director and others for directing the OPs to pay Rs.188405/- claim of the complainant and to pay Rs.10000/- as compensation on account of mental torture and agony besides costs of litigation.

    2. Brief facts are that complainant is an agriculturist by profession and member/share holder in OP.3. That OP.3 had insured him medically through OP.1 and 2 under “Sanjivini Health Care Scheme” upto Rs.2 lacs and paid the complainant had Rs.400/- as premium. Complainant was issued policy number 4016/0000968 which was valid from 14.1.2006 to 31.3.2007 and a card bearing no.8601100004587A and society code cum account no.279-J-253 was given to him.

    That on one unfortunate day complainant suffered from a heart attack on 1.7.2006 and was admitted to CMC and Hospital, Ludhiana, he was admitted vide admission no.C7050598 and remained there till 08.07.2006 during that period he spent Rs.44631/-. That the condition of the complainant worsened and he was shifted to Oxford Hospital Pvt. Ltd, Lajpat Nagar, Bhagwan Mahavir Marg, Nakodar Chowk, Jalandhar, where a bypass surgery was performed on him. There he remained admitted from 8.7.2006 to 27.7.2006 and spend Rs.138635/- on treatment and Rs.5139/- on medicines purchased from Gujral Medical Hall, 305, Lajpat Nagar, Jalandhar. That total amount spent by the complainant on his treatment was amounting to Rs.188405/- for the period from 1.7.2006 to 27.7.2006. That the complainant was hale and hearty when got insured. That he was not in a position to inform the Ops as he was not having Insurance Identity Card with him, whereas, his family members had informed the Ops accordingly within 24 hours of the complainant getting admitted in CMC and Hospital, Ludhaina, but got no satisfactory answer. Lateron, the complainant himself went to the Ops alongwith card and bills of his medical expenses, they returned him on the ground that he had not presented the claim within time. That the Ops were deficient in service and are liable to pay the claim of the complainant alongwith compensation. Hence this complaint.

    3. OPs no.1 & 3 did not appear despite service, so they were proceeded against exparte.

    4. OP.2 took up preliminary objections that the complaint is barred under section 26 of the Act; that the complaint is not maintainable as the complainant had not produced any documents on record of the Forum; that the complaint is bad for misjoinder of parties since OP.2 is not a necessary/proper party; that the complainant is not a consumer under the Act; that the present claim is not maintainable in terms of clause 13 and sub clause 12 of the insurance policy. On merits, it was admitted that the complainant has obtained the insurance policy for its members under the scheme called Sanjivni Health Care Scheme. It is averred that the complainant was suffering from the disease ie. Heart ailment for which he was treated as alleged. That the complainant had the knowledge of such disease but had willfully and intentionally suppressed the material information from Ops at the time of obtaining the insurance policy in question. Further, submitted that the complainant has not lodged any claim with the Ops regarding the alleged claim. That the complainant never informed the Ops within 24 hours as alleged nor visited them. The story put forward is false frivolous, afterthought and concocted one. All other allegations made by the complainant were denied by Ops being wrong and incorrect. So, the complaint deserves dismissal.

    5. In order to prove their versions, both the parties led their evidence by way of affidavits and documents and stood heard through their respective counsels.

    6. The complainant argued that he got insured under “Sanjivini Health Care Scheme” upto Rs.2 lacs and paid the premium of Rs.400/- of policy no..4016/0000968 which was valid from 14.1.2006 to 31.3.2007 and was having a card bearing no.8601100004587A. That complainant argued that he suffered from a heart attack on 1.7.2006 and his condition was critical and admitted to CMC and Hospital, Ludhiana, and remained in the hospital till 08.07.2006 with admission no.C7050598 and spent Rs.44631/- for this period Ex.C1 to Ex.C.32. He further argued that as condition worsened and he was shifted to Oxford Hospital Pvt. Ltd, Lajpat Nagar, Bhagwan Mahavir Marg, Nakodar Chowk, Jalandhar, where a bypass surgery was performed on him and remained admitted from 8.7.2006 to 27.7.2006 and from this period he paid medical expenses amounting to Rs.138635/- bills Ex.C33 to Ex.C42 and Ex.C50. Further medicines for Rs.5139/- purchased from Gujral Medical Hall, 305, Lajpat Nagar, Jalandhar Ex.C43 to Ex.C49. He also argued that my family members informed the Insurance Company-OP2 within 24 hours but did not get any satisfied answer when after discharge from the hospital himself went to OPs and presented his card and medical bills but they returned the same as not presented within time. Therefore my total claim for Rs.188405/- is genuine and legal.

    7. Whereas, the OP.2 has argued that the complainant has not lodged any claim with the company regarding the alleged treatment Ops also argued that the complainant was suffering from disease i.e. heart ailment treatment as alleged before the inception of Insurance Policy.

    8. Op.2 also argued that non-payment of claim is not the case of deficiency in service and that the Ops are not liable to pay the claim which comes up to Rs.188405/- which the complainant spent during the stay for the period from 1.7.2006 to 8.7.2006 at CMC Hospital Ludhiana and from 8.7.2006 to 27.7.2006 at Oxford Hospital Pvt. Ltd, Lajpat Nagar, Bhagwan Mahavir Marg, Nakodar Chowk, Jalandhar, he has spent Rs.138635/- and also purchased medicines for Rs.5139/- purchased from Gujral Medical Hall, 305, Lajpat Nagar, Jalandhar.



    9. The Op.2 also argued that the complainant willfully, intentionally suppressed and withhold the material the information of his disease which he was having prior knowledge and at the time of inception of the policy. Therefore, Op.2 argued that the total expenditure of Rs.188405/- for his treatment during the period from 1.7.2006 to 27.7.2006 during the stay at CMC Hospital Ludhiana and Oxford Hospital Pvt. Ltd, Lajpat Nagar, Bhagwan Mahavir Marg, Nakodar Chowk, Jalandhar, is ingenuine and illegal.

    10. It is also mentioned here by the Ops that the complainant has not submitted any documents proving his treatment and stay at the hospital at CMC and Hospital, Ludhiana and at Oxford Hospital Pvt. Ltd, Lajpat Nagar, Bhagwan Mahavir Marg, Nakodar Chowk, Jalandhar.

    11. It is further noted that regarding the General Health Insurance Policy at Para 6 (Ex.R2) the Ops argued that the claimant must file the claim within 30 days from the date of completion of the treatment. In this case, no claim has been filed with the OPs. The OP.2 argued that no claim has been lodged by them till date.

    12. From the above facts and figures it is clear that the complainant has not filed any claim with the OPs. In fact as per General Health Insurance Policy Ex.R2 at para 6 the claim must be filed within 30 days form the date of application of the treatment but in this case no claim has been filed to the Ops.

    13. The complainant could not produce any proof before the Forum in support of any documents which he has submitted to the OP for claim of Rs.188405/- which he spent on his treatment. While going through the discussions and facts at the case the Forum has reached at the conclusion that the complainant has not submitted any claim for Rs.188405/- which he has spent on his treatment during the hospitalization and treatments for the period 1.7.2006 to 08.7.2006 at CMC hospital, Ludhiana and 08.07.2006 to 27.07.2006 at Oxford Hospital Pvt. Ltd, Lajpat Nagar, Bhagwan Mahavir Marg, Nakodar Chowk, Jalandhar.

    14. Hence the complaint filed by the complainant has no merits and the same is dismissed. No order as to cost. Copies of this order be supplied to the parties free of cost and file be consigned to record room after compliance.

  11. #26
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    Default ICICI Lombard General Insurance Company Limited

    Pawan Kumar son of Sh. Banarasi Dass, resident of 3209, Sector 41-D, Chandigarh presently, ward no.7, Purana Bazaar, Machhiwara, Tehsil and District Ludhiana.

    Versus

    1- ICICI Lombard General Insurance Company Limited, 108, Surya Tower, 5th Floor, Space no.1, The Mall, Ludhiana-141001 through is Branch Manager.

    2- ICICI Lombard General Insurance Company Limited, Regd. Office ICICI Bank Towers, Bandra Kurla Complex, Mumbai-400051, India through its Chief Executive Officer.


    1- Complainant being owner of Innova vehicle bearing no.PB-23E-8550, go it insured vide policy no.3001/52353524 with opposite party, valid from 21.8.2007 to 20.8.2008. The vehicle was driven by son of the complainant. On 6.3.2008, son of the complainant had gone to Gobindgarh on the vehicle to see his sister Suman. On 7.3.2008, he left for Machhiwara from Gobindgarh earlier in the morning, on account of thick fog, son of he complainant could not see parked Tata-407 vehicle, as the same as parked without light. Consequently, due to fog, son of complainant rammed his Innova car with Tata-407. Accident was immediately reported to opposite party, who allotted claim no.MOT-00731172. They appointed Sh. Jaswinder Singh Surveyor and Loss Assessor, who advised them to take the vehicle to Radiant Toyota, Ludhiana, for repair. The vehicle was taken to Radiant Toyota, where Jaswinder Singh reached and engineers of the company, opened the car in presence of Jaswinder Singh. Estimate was prepared and Jaswinder Singh allowed to get the vehicle repaired as per estimate. He spent Rs.1,39,061/- on repairs. But opposite party till now did not grant the claim with malafide intention, amounting to deficiency in service on their part. Hence, entitled for Rs.1,39,061/- spent on repairs with interest @ 12% p.a., to which they failed o pay despite service of notice. Also entitled for compensation of Rs.1 lac on account of harassment and Rs.11000/- as litigations expenses.

    2- Opposite party claimed in reply that this Fora has no jurisdiction, as there is no deficiency in service on their part. Getting his vehicle insured by the complainant and lodging claim qua such vehicle under the policy is admitted. But averred that on receipt of claim, it was duly registered, entertained and processed. After completing formalities and applying their mind, claim was repudiated in terms of the insurance policy, as no claim vide letter dated 24.3.2008. It was done, as he vehicle was plied for hire and reward, which is exclusion as per terms and conditions. Because he had obtained insurance of the vehicle, as a private vehicle and he violated conditions of he policy by plying the vehicle for hire and reward. Therefore, complaint is not maintainable. However, averred that on receipt of claim from the complainant, Sh. Arpan Gupta Surveyors and Loss Assessors, was appointed to assess the loss, who personally inspected the vehicle and prepared report dated 17.3.2008, assessing loss of Rs.88,664/-. Sh. A.P. Singh was appointed investigator, to investigate own damage claim. He made thorough investigation and submitted his report that the vehicle was used as a taxi on hire and reward and son of the complainant Sh. Sanjeev Kumar was running business of taxi service from Dashmesh Taxi Stand, Machhiwara. Sh. Sanjeev Kumar before the investigator, also confirmed running the vehicle as taxi. After receipt of such reports, claim was rightfully repudiated. They have denied that Sh. Jaswinder Singh was appointed as surveyor and loss assessor and he had advised the complainant, to get the vehicle repaired from Radiant Toyota, Ludhiana. Rather, they had appointed Sh. Arpan Gupta Surveyor and Loss Assessor.

    3- Both parties adduced evidence in support of their claims and stood heard through their respective counsels.

    4- It is contended on behalf of the complainant that opposite party have taken false plea of not appointing Jaswinder Singh as surveyor and loss assessor and secondly, that they are guilty of not deciding claim of the complainant till filing of the claim and fabricating false evidence, to repudiate the claim. The investigator had given false report and such fact is established on the record. On the other hand, on behalf of Insurance Company, it was argued that no false plea was ever taken and whatever defence by opposite party, is based on material on record. There is no deficiency in service on their part and claim is rightfully repudiated, as it was proved to the hilt that the insured vehicle was being run on hire and reward basis by son of the complainant. Complainant simply retired as class-IV employee, had purchased vehicle, to operate and run by his own son on hire and reward, which fact is fully established.

    5- Be it stated that obtaining of insurance policy from opposite party by the complainant, is no at all in dispute. Therefore, we shall straightaway look into the reasons of repudiating the claim. But before we do so, would prefer contentions of the parties.

    6- Complainant has alleged that opposite party had engaged Sh. Jaswinder Singh surveyor and loss assessor and at his advice, took the vehicle for repairs to Radiant Motors, Ludhiana and it was he, who had prepared the estimate. Whereas, opposite party had denied it specifically, by claiming that surveyors and loss assessors appointed by them was Sh. Arpan Gupta and not Jaswinder Singh. Ex.R6 is report dated 25.4.2009 of surveyor Arpan Gupta. Though report Ex.R6 bears signatures and stamp of Arpan Gupa. But assessment print Ex.R7 contains signatures and seal of Arpan Gupta, but also mentions about surveyor as Jaswinder Singh. Jaswinder Singh as per assessment print, had assessed loss on 24th March, 2008. So, contended on behalf of complainant that opposite party stands falsified, by denying claim that Jaswinder Singh was not appointed surveyor by them. But as per affidavit of Arpan Gupta, he was appointed surveyor and loss assessor and submitted the report. If for assessment of the loss to he vehicle, Arpan Gupta had deputed his employee, associate or technical person named Jaswinder Singh, to assess the loss, same would not convert status of said assessor Jaswinder Singh, as engaged by opposite party. Because they directly never engaged Jaswinder Singh for the purpose. Therefore, this aspect that opposite party denied appointing Jaswinder Singh as loss assessor, would be of no consequence. Consequently, we can believe affidavit of the complainant that it was on asking of Jaswinder Singh that he took the vehicle to Radiant Toyota and got it repaired from them.

    7- Second discrepancy referred by the complainant is that as per opposite party, they had repudiated the claim vide letter Ex.R3 dated 24.3.2008. Loss to the vehicle of the complainant was also assessed by Jaswinder Singh as per Ex.R7 dated 24.3.2008. He says these circumstances that opposite could not have been so fast, to repudiate the claim, the day assessment of loss was made by is representative. However, repudiation of the claim vide letter Ex.R3 dated 24.3.2008 , can not be tagged with assessment dated 24.3.2008, recorded in Ex.R7. Because assessment was qua the loss. Whereas, the repudiation was on account of infringement of the policy, by plying the vehicle on hire and reward. That repudiation that the vehicle was plied in violations of the policy for hire and reward, was based upon the investigator report Ex.R4 of Sh. A.P. Singh investigator. To pove this repot, Sh. A.P.Singh appeared as witness, by filing own affidavit Ex.RW3/A. So, we feel that no benefit can drawn by the complainant from the fact that loss was assessed on 24.3.2008 by Jaswinder Singh, on which date, claim was repudiated by the opposite party vide letter Ex.R3. Because repudiation is not based upon report of the surveyor, but on report Ex.R4 of the investigator Sh. A.P. Singh. Therefore, no benefit flows from such aspect to the complainant.

    8- Now adverting to policy of the complainant. Complainant had taken insurance policy under private car package policy(Ex.C1) from the opposite party. This policy contains limitations as to use of motor vehicle. It covers use for any purpose other than (i) hire and reward ; (ii) carriage of goods; (iii) organized racing etc. So, opposite party has taken defence that the vehicle was insured under private car package, but in violation of the policy, was being used for hire and reward.

    9- Sh. A.P. Singh investigator vide repot Ex.R4, found, concluded and conveyed to opposite party that Pawan Kumar is retired as class-IV employee from Irrigation Department, getting pension of Rs.5000/- per month. His son Sanjeev Kumar purchased the vehicle in question and using the same, as taxi. The vehicle had travelled more than 1 lac kms in just 2 years of purchase. He had also recorded statement Ex.R5 of son of the complainant Sh. Sanjeev Kumar, admitting that using the vehicle as taxi on hire and from income, paying installments of the vehicle. But on behalf of the complainant, argued that Ex.R5 statement was never made by son of the complainant Sh. Sanjeev Kumar to investigator A.P.Singh and it is a forged document. We have no material to reflect that this document is false. If it is so, then we would not be competent to decide question of forgery. As such matter can only be decided by civil court and not in summary inquiry by the Consumer Forum.

    10- The investigator had also conducted inquiry in the taxi stand, Machhiwara, to conclude his findings. But argued that no such evidence has been produced by opposite party, to prove allegations of using the vehicle for hire and reward. No doubt, evidence of oher persons, who had conveyed to investigator that son of he complainant was using the vehicle as taxi, was recorded or produced. But we feel that there is no necessity to do so in view ofown admission of Sanjeev Kumar son of the complainant before the investigator.

    11- It is settled law that if private vehicle is used as taxi for hire and reward, claim can be repudiated. Reliance placed on cases reported as Joginder Singh Vs Oriental Insurance Company Limited & Ors. IV(2008)CPJ-240(NC); National Insurance Company Limited Vs R. Raghunath I(2004)CPJ-589(Tamilnadu State Commission); United India Ins. Co. Ltd. Vs Deepakkumar Manubhai Patel II(2003)CPJ-572(Gujarat State Commission).

    12- We shall not be fair to the complainant, if fails to discuss his contention. It was argued on behalf of the complainant that his claim is liable to be granted as non standard claim and in support, has drew our attention to cases reported as Rattan Chand Vs New India Assurance Co. Ltd. 2006(2)CPC-754(Punjab State Commission) and National Insurance Co. Ltd. Vs Nitin Khandelwal 2008(3)CPC-559(SC). But question of granting damages on non standard basis, would have arisen, had there been no violation of he insurance policy. So, such contention would be of no help to the complainant.

    13- Also, it was argued that opposite party has no placed on record any proof about issuance of repudiation letter Ex.R3 dated 24.3.2008 to the complainant. No doubt, no proof qua sending of such communication to the complainant has been placed on record. But there being no deficiency in service on part of opposite party, complainant has already filed complaint in which, we found no merits, so this aspect of leading no proof of communication of letter Ex.R3 would be of non consequence.

    14- Gist of the discussions is that opposite party, in our view, was justified in repudiating the claim, as the vehicle proved to have been used for hire and reward against terms and conditions of the insurance policy. Therefore, finding the complaint meritless, we dismiss the same.

  12. #27
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    Default ICICI Lombard General Insurance

    Md. Afzal, S/o. Khuthubuddin, age 40 years, Occ: Pvt. Employee, R/o. H.No.6-2-909, Hussainpura, Karimnagar proper and dist.

    …Complainant


    1. ICICI Lombard General Insurance Co. Ltd., R/by Authorized Signatory, Osman Plaza, H.No.6-3-352/1, 2nd and 3rd Floor, Road No.1,

    Banjanara Hills, Hyderabad – 500 034.

    2. The Branch Manager, ICICI Lombard General Insurance Co. Ltd., Hanamkonda X-Road, Warangal dist.

    3. M/s. Garuda Motors, R/by its Authorized Dealer for Piaggio Vehicles Pvt. Ltd., Kothirampur, Hyderabad road, Karimnagar.


    1. The averments in brief of the complaint are that the complainant is consumer of opposite party no.1 & 2 and he purchased one APE Pick-up Van bearing no.AP-15-T/R-3662 under hypothecation with Cholamandal DPC Finance Ltd., Hyderabad branch for his self-employment. The vehicle is insured with opposite parties through opposite party no.3 namely Garuda Motors vide policy no.303/0082113/00/000 Dt: 21.8.2006 covering risk of damage in accident showing the value of the vehicle is of Rs.1,22,597/-. On 9.11.2006 while the vehicle was returning to Karimnagar when it was reached near Chalimeda Anand Rao Mango Tree garden at Muqdumpoor village at about 6.30 one Lorry bearing no.AP-11-W-2353 coming from its opposite party direction with rash and negligent manner dashed his vehicle and due to which his driver died on the spot and the Auto was also damaged.

    A case in Crime No.348/06 is registered for the offence U/s. 304-A of I.P.C. by the Police, Karimnagar Rural. After the accident he got repaired the vehicle with opposite party no.3 who issued estimated bill for Rs.90,829/-. He intimated about the accident and damage to the opposite parties by letter Dt: 18.11.2006 and submitted all necessary documents at their request. But the opposite parties rejected the claim by their letter Dt: 30.11.2006 on the ground that at the time of accident the driver is not having valid driving license. Infact the driver is having license and the same was misplaced at the time of accident. The opposite parties made a false plea to evade payment inspite of issuance of legal notice Dt: 5.5.2006 they did not pay the amount. Hence, it is prayed to direct the opposite parties to pay an amount of Rs.90,829/- with 18% interest and Rs.20,000/- towards mental agony and costs of complaint.


    2. The opposite party no.1 filed counter alleging that the APE Pick-up Van bearing no.AP-15-T/R-3662 was insured with opposite party no.1 by the complainant on 21.8.2006 which is valid upto 20.8.2007 under certain terms and conditions to cover own damages including condition that any person including insured is entitled to drive provided that a person driving holds an effective driving license at the time of accident and he is not disqualified from holding or obtaining such a license and it is also provided that he is not holding an effective driving license may also drive. Hence they repudiated the claim of the complainant. On examining the documents submitted by the complainant it is found that the driver is not holding valid driving license at the time of accident. Hence, they rejected the claim of the complainant by letter Dt: 30.11.2006. There after the complainant did not approach at any time but after lapse of one and half year he has issued a legal notice with a false claim and prayed to dismiss the claim of the complainant since he violated the terms and conditions of the complaint.


    3. The complainant filed sworn affidavit reiterating the contents of the complaint. On behalf of complainant Ex.A1 to A12 are marked and on behalf of opposite parties Ex.B1 to B5 are marked. Ex.A1 is the Sales Certificate issued by opposite party no.1 in favour of petitioner for purchase of the Auto for a sum of Rs.1,25,200/- Dt: 24.8.2006. Ex.A2 is the policy issued in respect of the said vehicle in favour of complainant valid from 21.8.2006 to 20.8.2007. Ex.A3 is the FIR in Crime No.348 of 2006 Dt: 9.11.2006 issued by Sub Inspector of Police, Police Station, Karimnagar Rural (in 3 sheets). Ex.A4 is the letter from opposite party no.2 addressed to complainant Dt: 18.11.2006 requesting to send documents. Ex.A5 is repudiation letter Dt: 30.11.2006. Ex.A6 is the Estimates of opposite party no.3 Dt: 11.12.2006 for Rs.90,829/-(in 3 sheets). Ex.A7 is the Legal Notice issued by counsel for complainant addressed to opposite party no.2. Ex.A8 to A10 are the postal acknowledgement cards addressed to opposite party no.2. Ex.A11 is the copy of Temporary Certificate of Registration of complainant for vehicle bearing no.AP-15 T/R D - 3622. Ex.A12 is the Motor Vehicles Schedule Form of Piaggio Motor Vehicles.


    4. Ex.B1 and A2 are one and the same documents. Ex.B2 is the original Motor Insurance claim form submitted by complainant, Dt: 9.11.2006. Ex.B3 and A5 are one and the same documents. Ex.B4 is the Xerox copy of license of deceased. Ex.B5 is the Surveyor's Report Dt: 9.11.2008 submitted to opposite party no.2 (in 3 sheets).


    5. Heard, the learned counsel for the complainant contended that the complainant is owner of APE Pick-up Van bearing no.AP-15-T/R-3662 purchased from opposite party no.3, and the same was insured with opposite party no.1 & 2 under policy no.303/0082113/00/000 Dt: 21.8.2006 covering the risk of damages and in the accident occurred on 9.11.2006 caused by the driver of Lorry bearing no.AP-11-W-2353, the driver of the complainant died and the Auto is also damaged to the extent of Rs.90,829/- as estimated by the opposite party no.3, and the complainant is entitled for the said damages since the accident is occurred during the enforcement period of the policy.


    6. Interalia the learned counsel for the opposite parties contended that the driver of the complainant who died in the accident Md. Saleem has no valid driving license at the time of accident since there is violation of the terms and conditions of the policy they repudiated the claim of the complainant under Ex.B3.


    7. In view of the contentions it is to be seen whether the petitioner is entitled for the claim of Rs.90,829/- with interest along with Rs.20,000/- towards compensation?

    8. From the above referred facts there is no dispute that the petitioner is the owner of the Van bearing no. AP-15-T/R-3662 and purchased from opposite party no.3 and insured the vehicle through opposite party no.3 with opposite party no.1 & 2 by vide policy no. 303/0082113/00/000 as evident under Ex.A1. Ex.A1 is the Sales Certificate issued by opposite party no.1 in favour of petitioner for purchase of the Auto for a sum of Rs.1,25,200/-. Ex.A2 is the policy issued in respect of the said vehicle in favour of complainant valid from 21.8.2006 to 20.8.2007. Ex.A3 is the FIR in Crime No.348 of 2006 Dt: 9.11.2006 which is registered basing on a complaint of wife of driver of the opposite party no.1 Md.Saleem. Ex.A3 FIR is clinchingly proving that not only the driver died but also Auto was also damaged due to accident. Ex.A4 is the letter Dt: 18.11.2006 issued by the opposite party no.1 & 2 to complainant requesting to submit documents of Registration Certificate, Driving license, Tax paid receipt, Fitness Certificate. Ex.A11 is the original Registration Certificate of the Van bearing no.AP-15-T/R-3662 of the opposite party no.1. Thus it is clear after the accident the complainant informed about the damage caused to the Auto along with an estimate given by opposite party no.3 for a sum of Rs.90,829/-. The claim of the complainant is rejected by the opposite party that the driver is not having any valid license. On perusal of Ex.B5 can be of driving license filed by the opposite party is proving the driver is having non-transport license LMB (MCWG) with gear vehicle valid upto 18.5.2005 and transport vehicle for Motor Cab valid till 2.11.2009. This document itself is sufficient to hold that at that time of accident the driver of the complainant is having valid driving license of transport and non-transport. Even otherwise as per clause 5 of the policy Ex.A2 postulates as follows:

    "Any person including the insured provided that a person driving holds and effective Driving License at the time of the accident and is disqualified from holding or obtaining such a license. Provided also that the person holding an effective Learner's License may also drive the vehicle and such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989".



    9. Further the Surveyor report filed by the opposite parties under Ex.B5 is proving that the Auto was damaged in the accident due to hit of a Lorry. The Surveyor opined that the driving license of driver is not valid to drive the Piaggio APE model make which is the Pick-up Van purchased by the complainant. When Ex.B4 is indicating that the deceased is having transport license for Motor Cab. I do not understand how the Surveyor opined that he has not competent to drive the Piaggio which is similar to that of Motor Cab. Therefore, the rejection of the claim by the opposite party is illegal.



    10. If we come to the extent of damages the petitioner submitted estimated bill issued by the opposite party no.3 for a sum of Rs.90,829/- He did not file any photographs of the damaged Auto to enable the Forum to assess the damage. Further, he did not appoint any independent Surveyor to assess the actual value. Any how the Surveyor Report filed by the opposite party under Ex.B5, the Surveyor assessed the actual damages caused to the vehicle is Rs.25,187/-. Hence, in the absence of any proof about the damages claimed by the complainant in the interest of justice we hold that the complainant is entitled only for Rs.25,187/- as assessed by the Surveyor appointed by the opposite parties. Except the damages the complainant is entitled for any damages as claimed by him as no proof to that effect. Since the rejection of the claim of the complainant is deficiency of service, we feel the complainant is liable to be allowed partly to the extent of Rs.25,187/- with interest.


    11. In the result the complaint is partly allowed directing the opposite parties to pay Rs.25,187/- with interest @ 7.5% per annum from the date of submission of claim petition by the complainant under Ex.B2 Dt: 9.11.2006 with costs of Rs.1,000/- within one month from the date of receipt of this order.

  13. #28
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    Default ICICI Lombard General Insurance Co. Ltd.

    1. Thatikonda Prabhakar, S/o. Venkataiah, age 50 years, Occ: Employee.

    2. Thatikonda Kalavathi, W/o. Prabhakar, age 48 years, Occ: House wife.

    R/o. H. No.18-3-88/2, Ganeshnagar, Markendeya Colony, Godavarikhani town of Karimnagar district.

    …Complainants

    The ICICI Lombard General Insurance Co. Ltd., R/by Manager, Penchala Complex, 1st Floor, Opp: Court Building, Jyothingagar, Karimnagar city – 505 002.

    1. The averments in brief of the complaint are that on 6.11.2007 deceased Naresh Kumar and his friends were traveling to Godavarikhani from Hyderabad on Bajaj Discovery Motor Cycle bearing no.AP-9-BG-492, on their way when they reached near outskirts of Mogdumpur village of Karimnagar Mandal at about 6.10 AM one unknown lorry driven by its driver came in rash and negligent manner with high speed came from opposite director by over taking another vehicle and dashed to the motor cycle of the deceased. As a result first pillion rider died at the spot, and the second pillion rider sustained severe injuries and the rider of vehicle undergoing treatment in NIMS Hospital succumbed to injuries. The Police Karimnagar Rural registered a case in Cr.No.259/2007 U/s 304-A of IPC against the driver of the lorry. The Motor Cycle bearing no.AP-9-BG-492 belongs to the deceased Naresh Kumar is insured with opposite party by vide policy no.3005/50785692/00/000 valid from 27.11.2006 to 26.11.2007. And he also paid an extra premium towards the coverage of personal accident risk (P.A>0 i.e. the risk of owner-driver for sum of Rs.1,00,000/-. As on the date of accident he has also possessing valid driving license. After the accident the complainants informed the opposite parties about the accident and requested to settle the claim and issued the Legal Notice Dt: 29.4.2008 as there is no response. Hence prayed to grant assured sum of Rs.1,00,000/- with 12% interest per annum from the date of death of insured till realisation and Rs.10,000/- towards compensation and costs.



    2. The opposite parties filed counter denying the contents of the complaint alleging that the case of complainant is revealing that the accident was caused due to rash and negligent driving of driver of lorry. As such the complainants are entitled to claim compensation against the owner and insurer of said vehicle and three persons were traveling on the said vehicle at the time of accident is violation under terms and conditions of the policy. As per terms and conditions of the policy if any issue in respect of vehicle to cover risk of owner insured he must ride insured vehicle and must have possessed a valid and subsisting driving license to drive the vehicle. The complainants have not submitted any relevant documents to prove his claim and prayed to dismiss the complaint.



    3. The complainants filed their proof of affidavits reiterating the contents of the complaint and filed the documents which are marked as Ex.A1 to A10. The opposite party also filed the proof of affidavit reiterating the contents of counter and further alleged that as per the documents available the deceased was not possessing valid driving license and no documents are marked on behalf of opposite party. Ex.A1 is the attested copy of FIR with complaint Dt: 6.11.2007. Ex.A2 is the attested copy of Inquest Report Dt: 7.11.2007. Ex.A3 is the attested copy of PME Report Dt: 7.11.2007. Ex.A4 is the Xerox copy of RC, Dt: 6.1.2007. Ex.A5 is the Xerox copy of Driving License of deceased Dt: 12.6.2007. Ex.A6 is the Xerox copy of Insurance Policy Dt: 30.11.2006. Ex.A7 is the Legal Notice issued by counsel for complainant addressed to opposite party Dt: 29.4.2008. Ex.A8 is the postal receipt Dt: 29.4.2008. Ex.A9 is the Acknowledgement Card. Ex.A10 is the Xerox copy of Death Certificate Dt: 8.1.2008.



    4. The learned counsel for the complainant contended that the Motor Cycle bearing no.AP-9-BG-492 belongs to Naresh Kumar son of complainant no.1 & 2. On 6.11.2007 deceased Naresh Kumar and his 2 friends were traveling on the said Motor Cycle an unknown lorry came from their opposite party direction and hit. As a result one pillion rider died on the spot and second pillion riders sustained severe injuries and rider of vehicle died in the hospital i.e. son of complainants died in the accident since the vehicle is insured with opposite party, it has to pay the accidental benefit coverage to the complainants.



    5. The learned counsel for the opposite parties vehemently opposed the case of the complainant on the ground that the vehicle was carrying three persons at the time of accident which is violation of conditions and deceased Naresh Kumar was also not driving the vehicle at that time and he was not having any valid driving license, as such they are not entitled for any claim.



    6. Now the point arises for consideration is whether the complainants are entitled for the claim as prayed for?



    7. There is no dispute that deceased T.Naresh Kumar son of complainants herein is owner of Bajaj Discovery Motor Cycle bearing no.AP-9-BG-492 and the same was insured with opposite party by vide policy No.3005/50785692/00/000 valid from 27.11.2006 to 26.11.2007 as evident under Ex.A6. It is also in dispute that in the accident caused on 6.11.2007 the deceased died due to head injury as evident under Ex.A3 PME Report and Death Certificate Ex.A10. As seen from the FIR Ex.A1 registered in crime no.259/2007 basing on the complaint of one Chintam Venu who is one of the pillion rider and traveled with the deceased is clinchingly proving at the time of accident the deceased was only driving the vehicle and one unknown lorry came and hit the deceased. Ex.A5 copy of Driving License is clinchingly proving that deceased Naresh Kumar is having valid driving license as on date of accident 6.11.2007 and the said license is valid till 11.6.2007. Further Ex.A6 is also proving that the policy covering risk of owner-driver for Rs.1,00,000/- and necessary premium is paid. It appears that inspite of receipt of Legal Notice from the complainant under Ex.A7 the opposite party did not settle the claim and even not chosen to give any reply mentioning the reason for repudiating the claim. When documents clinchingly proving that the policy is in force as on date of accident 6.11.2007 and the deceased is having valid driving license as on date of accident and the accident is occurred while he was driving the vehicle rejection of claim by opposite party is nothing but deficiency of service, hence, the opposite parties are liable to pay Rs.1,00,000/- to the complainants with 7.5% interest per annum.



    8. In the result the complaint is allowed directing the opposite parties to pay Rs.1,00,000/- to the complainants with 7.5% interest per annum from the date of legal notice i.e. 29.4.2008 till realisation and costs of Rs. 1,000/- within one month from the date of receipt of this order. After depositing the amount the complainant no.1 & 2 are entitled to half share each.

  14. #29
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    Default ICICI Lombard

    Matena Rama Raju, S/o Rama Raju, Hindu, aged 40 years

    Cultivation, Modi village, H/o Kalavapudi

    Village, Kalla Mandal, W.G. Dist., -- Complainant



    1. The Branch Manager, ICICI Lombard General Insurance Co., Ltd.,

    Rajahmundry



    2. The Regional Manager/Operations

    Manager, ICICI Lombard General Insurance Co., Ltd.,

    Osman Plaza, 6-3-352/1,3rd and 4th floor, Road No.1

    Banjara Hills, Hyderabad



    3. The Authorised Signatory

    The Care 4 U Services India Pvt., Ltd.,

    103, MYM Estates, Tagore Mansion Lane

    Somajiguda, Hyderabad -082 -- Opposite Parties


    O R D E R

    The complainant filed the present complaint under Sec. 12 of the Consumer Protection Act with a prayer to direct the opposite parties 1 to 3 to pay a sum of Rs.1,00,000/- towards Personal Accident Policy under the Policy No. 4005/00057639, Rs.2,00,000/- towards damages for mental agony, negligence and deficiency in service together with costs of the complaint to the complainant. The averments of the complaint brief are that :

    2. The complainant having attracted by the wide publicity made by the opposite parties, by paying a sum of Rs.400/-, obtained Personal Accident Insurance Policy from the 1st opposite party on 10-4-2006 which is having a tie-up with the 3rd opposite party. The object of the policy is whenever the person dies or sustained any permanent disability, the company will pay Rs.1,00,000/- to the said person towards personal accident policy. The opposite parties accordingly issued Policy bearing No. 4005/0005739 to the complaint which was in force up to 9-4-2007. While the matter stood thus, the complainant met with an accident on 21-5-2006 when the rider of motor cycle TVS Victor bearing No. AP 37 6911 drove his vehicle in a rash and negligent manner without following traffic rules and blowing hors and dashed against the complainant while he was riding on his motor cycle bearing No. AP 37 AJ 4634 at the outskirts of Akiveedu near White Bridge, Ajjamuru village near Prawn tanks,.

    As a result of which, the complainant sustained grievous injuries and fractures and fell on the ground unconsciously. The rider of TVS Victor also received injuries in the said accident. Thereupon, the father of the complainant gave a report to the SHO, Akividu and a case was registered in Crime No. 72/2006 under Sec. 338 IPC against the rider of the TVS Victor and that the injured person was shifted to Bhimavaram Hospitals for treatment and subsequently due to seriousness on the part of the complainant’s life, the complainant was brought to Dr. Myneni V. Subbarao hospital, Vijayawada for better treatment wherein he underwent treatment in unconscious state for about 22 days. Due to the negligent treatment of Vijayawada Hospital, the right leg and his right hand are completely damaged and because of that he was shifted to Yasoda Hospital, Hyderabad and from there to Chennai and later on Bangalore for which the blood relatives of the complainant spent laks of ruppes over him towards treatment.

    While he was undergoing treatment at Yasoda Hospitals, his right leg was removed by the hospital authorities thereafter he was referred to Right Hospitals at Chennai and from there to Bangalore. During the course of undergoing treatment, the complainant underwent operation in Bangalore hospital to his fracture and the doctors fixed steel rods and plates in his body. Due to the tragic accident, the complainant’s entire physical structure was damaged and his right leg was removed and his right hand remained functionless. As a result, he is unable to perform his day to day duties. It is further averred that in the mean time, in the month of January, 2007 the wife of the complainant and blood relatives submitted claim from with all necessary enclosures to the 1st opposite party for reimbursement of the expenditure at about Rs.1,50,000/- incurred for the complainant and the 1st opposite party inturn sent the same to the 3rd opposite party since it has got tie-up. In spite of several approaches made by the complainant’s wife and the blood relatives personally and in writing, the opposite parties did not come forward to pay the insurance amount of Rs.1,00,000/- to the complainant. Because of the non-payment of the policy amount, the complainant sustained lot of mental agony etc., The act of the opposite parties in not paying the insurance amount amounts to deficiency in rendering service to the complainant therefore the opposite parties are liable to pay compensation. Thus the present complaint is filed with the aforesaid reliefs.

    3. The opposite parties 1 and 2 filed their version jointly denying the averments of the complaint and stated that as per the conditions of the policy the claimant has to inform the hospitalization within 14 days from the date of such accident and in the case on hand, the complainant having involved in the accident on 21-5-2006, intimated by way of claim in the month of March, 2007. As such, the complainant miserably failed to follow the terms and conditions of the policy in intimating his hospitalization and the alleged claim that on processing the claim of the complainant, this opposite party requested to furnish necessary documents such as, case-sheet, alcoholic report which are essential documents to process the medi-claim policy but the complainant miserably failed to produce the required documents for processing the claim that thereupon after waiting for a considerable time, this opposite party repudiated the claim as “not payable” since the complainant has not complied with the requirements as per the conditions of the policy and the same was accordingly intimated to the 3rd opposite party as such there is no deficiency in service on the part of the present opposite parties thus the complaint is liable to be dismissed with costs.

    4. The 3rd opposite party filed version separately and contended that he is carrying on business as insurance agent for General Insurance Companies that this opposite party having purchasing the policies in bulk assigns the policies to its customers as per the terms and conditions agreed between the parties, as such, he is only the agent the 1st opposite party and therefore he is not by himself liable to pay any compensation to the complainant if at all any compensation is paid which shall be paid by the insurance company and as per the terms and conditions of the policy, the complainant within 14 days from the date of the accident is obliged to intimate the accident by furnishing case sheet, status of alcoholic history at the time of taking initial treatment to show that the claim does not arise out of intentional self-injury or suicide or attempt to suicide or accident caused whilst under intoxication due to alcohol or drugs. But the complainant failed to do so and that there is absolutely no deficiency in service on his part because it has followed up the matter with the complainant diligently by addressing the letter to the hospital concern and E-mails to the opposite parties 1 and 2 to follow up the claim of the complainant. It is further stated that even to the legal notice got issued by the complainant also this opposite party accordingly given a suitable reply and therefore the complaint is liable to be dismissed with exemplary costs.

    5. The complainant in support of his case filed his proof affidavit corroborating the averments of the complaint and got marked Ex A.1 to Ex A.10. On the other hand, the opposite parties 1 and 2 filed their affidavit jointly and got marked Ex B.1 to B.3. Similarly, the 3rd opposite party filed the affidavit in support of its contentions in its version and got marked Ex B.4 to B.13.

    6. The points for determination now are :


    1) Whether the repudiation made by opposite parties 1 and 2 constitutes any deficiency in rendering service to the complainant ?


    2) Whether the complainant is entitled for the relies sought for by him against the opposite parties ? if so, on whom ?


    3) To what relief ?

    POINT No. 1:

    As seen from the material placed on record by both sides, there is no dispute about the complainant obtaining Personal Accident insurance Policy from the 1st opposite party through the 3rd opposite party who is having tie-up with the opposite parties 1 and 2. There is also no dispute with regard to the complainant met with an accident and sustaining severe injuries on the eventful day and his undergoing treatment in various hospitals for a longer period. There is also no dispute in the matter about the claim made by the complainant with the opposite parties. As per the version and affidavit filed by the opposite parties 1 and 2, their only contention is that the complainant failed to furnish necessary documents such as case-sheet and alcoholic report which are basic and essential documents to process the medi-claim. As such, the claim made by the complainant was repudiated.

    As per the complaint and affidavit filed by the complainant, it is the case of the complainant that while submitting the claim form, all the necessary documents such as copy of wound certificate, Scanning Report, discharge summary and the reports issued by the Rights Hospital, Chennai etc were enclosed. The complainant got marked the copies of such documents as Ex A.6 to Ex A.10. A perusal of the recitals of Ex A.6 to Ex A.10 clearly goes to show that there is no where mentioned in them that the injured/complainant was found under alcoholic condition at the time of their observations which itself is sufficient to come to a conclusion that the complainant at the time of the accident was not under the influence of any alcohol. It may be no doubt true that as per the conditions of the policy at Exclusion Clause No.1, “the insurance company shall not be liable for payment of any claim inter-alia arising out of intentional self-injury or suicide or attempt to suicide or accident caused whilst under intoxication due to alcohol or drugs” that means if the claimant is under the influence of intoxication intentionally involved in a self-injury or suicide or attempted to suicide then the General insurance company shall not be liable for payment of the claim. But in the case on hand, it is clearly established by the complainant that he sustained such severe injuries due to road accident which is not disputed by the opposite parties. Further, the sustaining of such severe injuries in the road accident by the complainant is also supported by FIR/ExA.3. Further the contention of the opposite parties that because of the complainant failed to produce the alcoholic report etc., they have repudiated the claim made by the complainant is not tenable.

    If at all the opposite parties 1 and 2 are having any doubt with regard to the sustaining of injuries by the complainant, it is for them to establish that at the time of accident the complainant was under the influence of alcohol. So, when it is the clear case of the accident that the complainant sustained such severe injuries in the road accident and when there is no where mentioned in the medical record that the complainant was under the influence of alcohol at the time of examination by various doctors, the contentions of the opposite parties that they have repudiated the claim as not payable since the complainant failed to comply with the requirements as per the conditions of the policy is not tenable.

    Further it is also not specifically mentioned that the alcohol report is required to settle the claim in the conditions of the policy against the column “documents required to be submitted for settling the claim”.

    In other words, it can be clearly said that the opposite parties 1 and 2 having taken such plea, ultimately failed to establish the grounds for their repudiation of the claim of the complainant.

    Under the said circumstances, the repudiations made by the opposite parties 1 and 2 is not justifiable.

    POINT NO: 2 & 3

    For the reasons stated above, we hold that the complainant is entitled to the reliefs sought for by him against the opposite parties 1 and 2 and since the 3rd opposite party is only an agent who simply processed the claim made by the complainant with the opposite parties 1 and 2, the complaint against the opposite parties 1 and 2 is to be allowed while dismissing the complaint against the 3rd opposite party. The points are accordingly answered.



    In the result, the complaint is allowed directing the opposite parties 1 and 2 to pay to the complainant the assured sum of Rs.1,00,000/- (Rupees one lakh only) with interest at 9% pa., from the date of complaint ie., 23-7-2008 till the date of realization besides a sum of Rs.5,000/- (Rupees five thousands only) towards compensation for mental agony suffered by the complainant along with a costs of Rs.500/- within 30 days from the date of due dispatch of free copy of this order.

    The complaint against the 3rd opposite party is dismissed with no costs.

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    Default I.C.I.C.I. Lambord General

    Shaik Abdul Wahab,

    11/396, R.R.K.Street,

    Palamaner,
    Chittoor District. … Complainant

    Vs.

    The I.C.I.C.I. Lambord General

    Insurance Co., Ltd.,

    6-3-352/1, 2 and 3rd Floor,

    Road No.1, Banjara Hills,

    Hyderabad-34. …Opposite party

    ORDER

    This complaint is filed by the complainant under section 12 of Consumer Protection Act seeking for direction to the opposite party to pay him Rs.1,77,500/- as assessed by the surveyor, Rs.50,000/- towards the loss of income, Rs.3,125/- towards surveyor fees and costs of Rs.3,000/-.


    2. The averments of the complaint in brief are as follows:

    The complainant is the registered owner of the vehicle bearing registration No. AP 03 U 5589 and the vehicle was insured with the opposite party under the policy No.3003/1026291/00/00 which was valid from 02.02.2006 to 01.02.2007. While the policy was inforce the vehicle met with an accident on 24.09.2006 at about 2 a.m. on National Highway No.5 near Gurivindapudi Cross Road in Manubolu Mandal of Nellore District and in that accident the vehicle was badly damaged. The Manubolu Police registered a case about the accident in Crime No.125/2006. The complainant informed the opposite party about the accident. The spot survey was conducted by the authorized officer of the opposite party. On the instructions of the opposite party, the complainant took the vehicle to the company showroom garage at Chittoor who estimated the loss at Rs.3,34,517/-. The Surveyor and Loss Assessor assessed the loss at Rs.1,77,500/-. The complainant was earning Rs.500/- per day from the vehicle. The complainant submitted the claim by producing all necessary documents before the opposite party. The opposite party repudiated the claim on the ground that at the time of accident the vehicle was over loaded. The repudiation made by the opposite party amounts to deficiency in service. Hence the complaint.

    3. The opposite party filed the counter stating in brief as follows:

    They admitted the allegations that the vehicle of the complainant was insured with them and it met with an accident on 24.09.2006 and in that accident the vehicle was badly damaged and that the Manobolu police registered a case about the accident. They denied the other allegations made in the complaint and stated that they repudiated the claim in accordance with the terms and conditions of the policy. They stated that only 3 persons including the driver were permitted to sit in the cabin but at the time of accident there were 4 persons including the driver in the cabin and therefore there is violation of the terms and conditions of the policy and as such they are justified in repudiating the claim of the complainant. Since they repudiated the claim in accordance with the terms and conditions of the policy, the complainant cannot allege any deficiency in their service. Hence the complaint is liable to be dismissed.

    4. The points for consideration are:

    1) Whether there is deficiency in the service of the opposite party?

    2) Whether the complainant is entitled to the reliefs sought for?

    3) To what relief is the complainant entitled?


    5. The complainant filed his affidavit and produced the documents which are marked as Ex.A1 to Ex.A5. The opposite party filed the affidavit of its Authorized Signatory but they did not produce any documents.


    6. POINT NO.1: Ex.A4 is the xerox copy of the certificate of insurance relating to the vehicle bearing registration No.AP 03 U 5589. As per Ex.A4, the seating capacity is 3 including the driver. Ex.A1 is the xerox copy of the FIR in crime No.125/2006 of Manobolu Police Station. As per the contents of FIR 4 persons including the driver were sitting in the cabin at the time of the accident. Ex.A2 is the xerox copy of the Private and Confidential Accident Vehicle Loss Assessment report submitted by one H.Hyder Saheb, Surveyor and Loss Assessor, Chittoor. It is stated in Ex.A2 that two persons died and two persons were injured in that accident. So it is clearly proved that 4 persons including driver were sitting in the cabin of the lorry when the accident took place. So there is clear violation of the terms and conditions of the policy. The learned counsel for the opposite party submitted that since there is violation of the terms and conditions of the policy the repudiation of the claim made by the opposite party is valid and justified.

    In support of his contention he placed reliance on the decision of National Consumer Disputes Redressal Commission, Circuit Bench, Karnataka at Bangalore which was passed in First Appeal No.138/2002 between M/s.Oriental Insurance Co. Ltd., Vs. N.Rajkumar. He produced the copy of the judgment. We have gone through the entire judgment. No principle is laid down in that judgment. The order of the State Commission was set aside and the matter was remanded to State Commission for deciding the case afresh on the basis of the evidence that may be produced by the parties. He placed reliance on one more decision of Supreme Court of India reported in MANU/SC/0459/2009. In that judgment also no principle is laid down and the matter was remitted back to the District Forum for deciding the fact as to who was actually driving the vehicle at time of accident. So both these decisions are not helpful to the contention of the learned counsel for the opposite party. In B.V.Nagaraju Vs. Oriental Insurance Co. Ltd. reported in 1996 ACJ 1178. The Supreme Court of India held that the breach of carrying persons in a goods vehicle more than the number permitted in terms of the insurance policy is not so fundamental a breach so as to afford ground to the insurer to eschew liability altogether.



    It is further held that the terms of the policy of insurance need not be construed strictly but be read down to advance the main purpose of the contract. We have gone through the entire judgment of the Supreme Court of India. In that case 9 persons were traveling in the vehicle at the time of accident whereas the permitted number was only 6. In the instant case the permitted number is 3 including the driver but 4 persons including the driver were traveling at the time of accident. So in view of the decision of Supreme Court of India the insurance Company cannot escape from their liability to pay the amount as claimed by the complainant. Failure to pay the amount amounts to deficiency in service. Hence we answer this point in favour of the complainant.



    7. POINT NO.2: As per the Private and confidential Accident Vehicle Loss Assessment report which is marked as Ex.A2 the loss is estimated at Rs.1,77,500/-. The complainant is claiming the same amount. Therefore we hold that the complainant is entitled to claim Rs.1,77,500/- as compensation. The complainant claimed Rs.50,000/- for the loss of income and Rs.3,125/- towards survey fees. Having regard to the facts and circumstances of the case, we are of the view that the complainant is not entitled to claim any of those two amounts. Hence we answer this point accordingly.



    8. TO WHAT RELIEF: IN THE RESULT, the complaint is partly allowed directing the opposite party to pay to the complainant Rs.1,77,500/-(Rupees one lakh seventy seven thousand five hundred only), within 30 days from the date of communication of this order. No order as to costs.

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