Punjab

Faridkot

CC/19/174

Satish Grover - Complainant(s)

Versus

Bajaj Allianz General Insurnace co. Ltd. - Opp.Party(s)

Rajneesh Garg

03 Mar 2020

ORDER

 DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FARIDKOT

 

Complaint No. :      174 of 2019

Date of Institution:   18.07.2019

Date of Decision :     03.03.2020

 

Satish Grover aged about 48 years s/o Tek Chand, r/o House No.B-1/322, Ward No.17, Back Side Quila, Mohalla Khokhran, Faridkot.

 

...........Complainant

Versus

1. Bajaj Allianz General Insurance Company Limited at Aggarsain Chowk, 1^st Floor, Mall Road, Near Vijay Bank, Ferozepur City.
2. Bajaj Allianz General Insurance Company Limited at 5^th Floor, Sandhu Towers, B-XX, 3369, Gurdev Nagar, Ferozepur Road, Ludhiana.
3. Tarun Sharma son of Satish Chander Sharma, resident of Sarafan Bazar, Faridkot.
4. Brar Automotive, Moga Road, Ferozepur through its Manager/Authorized Signatory/Owner.

................Ops

Complaint under Section 12 of the

Consumer Protection Act, 1986.

 

Quorum: Sh. Ajit Aggarwal, President,

               Smt Param Pal Kaur, Member.

 

Present: Sh Rajneesh Garg, Ld Counsel for complainant,

              Sh S K Jain, Ld Counsel for OP-1 and OP-2,

              Sh Jashanpreet Singh, Ld Counsel for OP-4,

              OP-3 Ex-parte.

ORDER

(Ajit Aggarwal, President)

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                                                           Complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against OPs seeking directions to them to make payment of full insurance claim with interest and for further directing OPs to pay Rs.50,000/- as compensation for harassment, inconvenience, mental agony and Rs.15,000/-as litigation expenses.

2                                        Briefly stated, the case of the complainant is that complainant owns a car and on advice of OP-3, he got insured his car with OP-1 and OP-2 vide Private Car Package Policy No.OG-19-1213-1801-00000098 valid from 03.02.2019 to 02.02.2020 against all kinds of risks and paid premium of Rs.26,807/-to OPs. It is submitted that during the validity of insurance period on 106.2019, said car of complainant met with an accident in Uttarakhand when he was travelling with his relative and in said accident front glass, side mirror and back side of vehicle got damaged. Thereafter, complainant immediately informed OP-1 to 2 regarding said accident and on directions of OP-1 to 3, he delivered his car to OP-4 Service Station for repair purpose and supplied requisite documents and completed other formalities, but after repair of vehicle, when complainant approached OP-4 to take delivery of his vehicle, he was astonished to see that OP-4 gave him bill for Rs.20,613/- and even OP-4 did not repair his vehicle properly upto his satisfaction. Complainant submitted before OP-1 to 3 that insurance policy purchased by him was a cashless policy, but OP-4 did not allow him to take his

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vehicle without clearing their bill and then, complainant had to pay the bill from his own pocket, which was required to be paid by Insurance Company. All this act of OPs has caused huge harassment and mental agony to him, which amounts to deficiency in service on their part. Complainant has prayed for directions to OPs to refund the amount illegally charged by OP-4 and for further directing OPs to pay compensation  of Rs.1,00,000/- for harassment and Rs.10,000/- as cost of litigation besides the main relief. Hence, the present complaint.

3                                             The counsel for complainant was heard with regard to admission of the complaint and vide order dated 23.07.2019,  complaint was admitted and notice was ordered to be issued to the opposite party.

4                                            On receipt of the notice, the opposite party no.1 and 2 filed written statement taking preliminary objections that complainant has not produced before the Forum any copy of FIR or DDR regarding accident dated 1.06.2019 that occurred in Uttarakhand. Due to non submission of requisite documents and non cooperation on the part of complainant, his claim was closed on 26.07.2019 and before repudiation, letter dated 25.06.2019 was issued to complainant asking him to provide essential documents consisting of Discharge Cum Satisfaction Voucher duly signed by insured and claim amount confirmation sheet duly signed by assured, but complainant did not cooperate with them and therefore,

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his claim was repudiated vide letter dated 26.07.2019. It is further averred that Surveyor and Loss Assessor appointed by answering Ops to inspect the vehicle and to assess the loss and as per terms and conditions of the policy, he assessed the loss to the tune of Rs.11,428/-. However, on merits OP-1 and OP-2 have denied all the allegations levelled by complainant being wrong and incorrect but admitted before the Forum that vehicle of complainant was insured with them and said accident occurred during the subsistence of policy in question. It is reiterated that claim of complainant was closed by them due to non submission of requisite documents and non cooperation by complainant. there is no deficiency in service on the part of OP-1 and OP-2 and made prayer for dismissal of complaint with costs.

5                                        OP-4 also filed reply through counsel where took preliminary objections that no cause of action arises against them as there is no deficiency in service on their part. There is no privity of contract between complainant and answering OP and it is the prerogative of Insurance Company to settle the insurance claim of the complainant. He is stopped by his own act and conduct to file the present complaint and even complaint is bad for non joinder of necessary party. He has not come to the Forum with clean hands and complaint filed by him is liable to be dismissed. On merits, OP-4 has denied all the allegations of complainant being wrong and incorrect and it is reiterated that there is no deficiency in service on their part. Prayer for dismissal of complaint with costs is made.

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6                                               Notice issued to OP-3 was fully served, but despite repeated calls, nobody appeared in the Forum on behalf of OP-3 either in person or through counsel on date fixed to contest the allegations of complainant. after long waiting till 4.00 O’ clock when, no one appeared for OP-3 then, it was presumed that OP-3 is not interested in contesting the complaint and therefore, vide order dated 2.09.2019 OP-3 was proceeded against exparte.

7                                          Parties were given proper opportunities to prove their respective case. The complainant tendered in evidence his affidavit Ex.C-1, and documents Ex C-2 to C-5 and then, closed his evidence.

8                                                        In order to rebut the evidence of the complainant, the OP-1 and OP-2 tendered in evidence, affidavit of Sh Jai Singh as Ex OP-1,2/1 and documents Ex OP-1,2/2 to OP-1,2/8 and then, closed the evidence. Ld Counsel for OP-4 tendered in evidence affidavit of Manjit Singh Dhaliwal Ex OP-4/1 and also closed the same on behalf of OP-4.

9                                                We have heard the ld counsel for complainant as well as OPs and have also very carefully gone through the documents placed on record by respective parties.

 

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10                                          Ld counsel for complainant vehementally argued that complainant owns a car and he got insured his car with OP-1 and 2 vide insurance policy valid from 3.02.2019 to 2.02.2020 against all kinds of risks and also paid premium of Rs.26,807/-to OPs. During the validity of insurance period, said car of complainant met with an accident on 1.06.2019 in Uttarakhand when he was travelling there with his relatives. He informed OP-1 to 3 and on their directions, he delivered his car to OP-4 Service Station for repair. He supplied requisite documents and also completed other formalities. As per terms and conditions of the policy, he was entitled for  repair without any cost as it was a cashless policy, but OP-4 charged Rs.20,613/-to complainant for repair and did not allow him to take his vehicle without clearing their bill. He had to pay the bill from his own pocket, which was required to be paid by Insurance Company. Act of OPs in not clearing the claim of complainant amounts to deficiency in service and it has caused huge harassment and mental agony to him. Complainant has prayed for accepting the present complaint and stressed on documents Ex C-1 to Ex C-5.

11                                           To controvert the allegations of complainant, ld counsel for OP-1 and OP-2 argued before the Forum that there is no deficiency in service on their part and stressed mainly on the point that complainant has not produced on record any document like FIR or DDR  to prove the occurrence of said accident in Uttarakhand. Complainant did not cooperate with investigation and due to non cooperation on his part

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and due to non submission of requisite documents by him, his claim was closed. Vide letter dated 25.06.2019, he was asked to provide Discharge Cum Satisfaction Voucher and claim amount confirmation, but he failed to supply the same and therefore, vide letter dated 26.07.2019, his claim was rightly repudiated by them. Surveyor and Loss Assessor assessed the loss to the tune of Rs.11,428/-, but his claim was closed due to non submission of documents by him. It is further argued that there is no deficiency in service on the part of OP-1 and OP-2 and prayer for dismissal of complaint with costs is made.

12                                       Ld Counsel for OP-4 also argued that there is no deficiency in service on their part as there is no privity of contract between complainant and OP-4 and it is the liability of Insurance Company to settle the insurance claim of the complainant. OP-4 has denied all the allegations of complainant being wrong and incorrect and prayed for dismissal of complaint with costs.

13                                   From the careful perusal of record and evidence produced by parties, it is observed that case of the complainant is that his insured car met with an accident during the validity of insurance period.  He intimated OP-1 to 3 regarding said accident and as per directions, he gave his car to OP-4 Service Station for repair. As per terms and conditions of the policy, he was entitled for repair without any cost because it was a cashless policy, but OP-4 charged Rs.20,613/-from

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complainant for repair and did not allow him to take his vehicle without clearing their bill. He had to pay the bill from his own pocket, which was required to be paid by Insurance Company. Act of OPs in not clearing the claim of complainant amounts to deficiency in service and it has caused huge harassment to him. On the contrary, OP-1 to 3 stressed that vide letter dated 25.06.2019, Discharge Cum Satisfaction Voucher and claim amount confirmation was demanded from complainant, which he failed to supply and therefore, his claim was rightly repudiated  by them. Surveyor and Loss Assessor assessed the loss to the tune of Rs.11,428/-, but his claim was closed due to non submission of documents by him. It is further argued that there is no deficiency in service on the part of OP-1 and OP-2 and prayer for dismissal of complaint with costs is made. OP-4 stressed mainly on the point that liability to settle the insurance claim of complainant lies only with Insurance Company and they have no role in making payment of insurance claim of complainant and there is no deficiency in service on their part.

14                                                    To prove his case, complainant has relied upon document Ex C-3 /copy of insurance policy, that proves that car of complainant was insured with Ops and accident occurred during the subsistence of insurance period, Ex C-4  and Ex C-5 copy of bill dated 14.06.2019 vide which OP-4 charged Rs.20,613/-from complainant. Through his affidavit Ex C-1 he has narrated his grievance and made prayer for imparting justice to him.

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15                                            It is admitted case of the parties that vehicle of complainant was insured with OPs, which met with an accident during the subsistence of insurance period and complainant duly gave intimation regarding accident to OPs. From the careful perusal of record Ex OP-2, which is produced by Insurance Company itself, it is clear that this document is copy of Discharge Cum Satisfaction Voucher duly signed by insured Satish Grover/complainant, there remains no doubt that this is the same document which is sought by OP-1 and Op-2 from complainant.  Thus, plea taken by OP-1 and 2 that complainant did not supply requisite document has no legs to stand upon. It is observed that act of OP-1 to 3 in not clearing the claim of complainant amounts to deficiency in service and now, OPs are trying to evade payment of insurance claim by taking false pleas on the basis of wrong terms and conditions of the Policy.

16                                    It is general tendency of Insurance Companies to show green gestures to customers at the time of selling the policies and make lame excuses to reject the claim of customers at the time of payment of claim on the basis of false terms and conditions. He placed reliance on citation 2001 (1) CPR 93 (Supreme Court) 242 titled as M/s Modern Insulators Ltd Vs The Oriental Insurance Company Ltd, wherein Hon’ble Apex Court held that clauses which are not explained to complainant are not binding upon the insured and are required to be ignored. Furthermore, it is generally seen that Insurance Companies are only interested in earning the premiums and find ways and means to decline the claims. He 

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further placed reliance on citation 2008(3)RCR (Civil) Page 111 titled as New India Assurance Company Ltd Vs Smt Usha Yadav & Others, wherein our Hon’ble Punjab & Haryana High Court held that it seems that Insurance Companies are only interested in earning premiums and find ways and means to decline the claims. The conditions, which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any Policy.

17                                                From the above discussion, we are of considered opinion that he claim of complainant is wrongly repudiated by OP-1 and OP-2 on false grounds, which amounts to deficiency in service and trade mal practice on the part of OP-1 and 2. Therefore, complaint in hand is hereby allowed against OP-1 and OP-2. Accordingly, OP-1 and OP-2 are directed to pay Rs.11,428/- as loss assessed by Surveyor and Loss Assessor alongwith interest at the rate of 9% per anum from 26.07.2019, when they repudiated the claim of complainant till final realization. They are further directed to pay Rs.5,000/-to complainant as compensation for harassment and mental agony suffered by him besides Rs.2000/- as litigation expenses. Compliance of this order be made within one month of the receipt of the copy of the order, failing which complainant shall be entitled to proceed under Section 25 and 27 of Consumer Protection Act. As OP-3 and OP-4 have no role in making payment of insurance claim on account of repair of damaged vehicle of complainant, therefore, complaint against them stands hereby dismissed.

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Copy of the order be supplied to parties free of cost as per law. File be consigned to record room.

Announced in Open Forum

Dated : 03.03.2020

(Param Pal Kaur)              (Ajit Aggarwal)

                                                   Member                          President