SMT. RAVI SUSHA: PRESIDENT
Complainant filed this complaint U/S 12 of Consumer Protection Act 1986 against OP seeking to get an order directing OPs to pay Rs.33137/- to him as repair charge of his vehicle along with Rs.25000/- towards compensation for the mental agony suffered by him due to the deficiency in service on the part of OPs.
Complainant get insured his vehicle of Auto bearing Registration No.KL-13-S-4548 with the OP vide policy No.220554-2339 000204 for a period from 02/06/2014 to 01/06/2015. The insured declared value of the vehicle was Rs.65610/-. The vehicle met with an accident by dashed against a small dump of sand dune and over turned on 10/05/2015. Complainant was the driver at that time and he sustained severe bodily multiple injuries and fractures on his body. He was admitted in Tajaswini Hospital Mangalore from 11/05/2015 to 25/06/2015,
03/07/2015 to 05/07/2015 and 20/07/2015 to 25/07/2015. FIR No.334 was lodged in the police station Kannur on 11/05/2015. Complainant gave claim intimation to the OP on 15/07/2015 for loss occurred to the vehicle. The claim intimation of complainant was repudiated by the OP vide letter dated 21/07/2015 (Ext.A7) on the ground that complainant had violated condition No.1 of policy condition ie claim intimation was given after 67 days from the date of accident. Hence complainant filed this complaint.
OP contested the complaint by filing written version denying the averments of the complainant. It was pleaded that the complainant had intimated the claim to the OP after 67 days of the accident. Thus the insured has violated condition No.1 of the Insurance policy. It is also pleaded that OP had issued letters to complainant seeking clarification for the delay in intimation for which complainant had not given any reply. Moreover complainant has not repaired the vehicle with the authorized workshop and the damage caused to the vehicle was not assessed by the authorized surveyor of the Insurance Company. It was pleaded that there is no deficiency in service on their part and the claim of the complainant was rightly repudiated.
Evidence in this case consists of oral evidence and documentary evidence. Complainant filed his chief affidavit and five documents. He was examined as Pw1 and documents were marked as Ext. A1 to ext.A7. Ext.A1 is the copy of Insurance policy. Ext. A2 is Registration certificate of Auto rickshaw, Ext.A3 is FIR Ext. A4 are the medical bills, Ext.A5 is the repudiation letter of OP. Ext.A6 is Auto guarage certificate and Ext.A7 is the Letter of OP date 21/07/2015. The Proprietor of Shalom Auto Guarage where the complainant repaired his vehicle was examined as a witness (PW2) from the side of complainant. On the side of OP, Motor claim Form of complainant dated 07/09/2015 was marked as Ext.B1 and General Insurance policy with terms and conditions was marked as Ext.B2.
After that both learned counsels for complainant and for OP filed written argument notes. The learned counsel for complainant also submitted one decision of Hon’ble Supreme
Court of India Civil Appeal No.653 of 2020 Gurshinder Sing Vs.Shriram General Insurance Company.
We have perused the pleadings of the parties, evidence brought on the records, submissions of both learned counsels and decision of Hon’ble Supreme Court.
The main submission of the learned counsel for the OP is that there was delay of 67 days in giving intimation to the OP, which is a clear violation of the Insurance policy condition No.1 (Ext.B2). On perusal of condition No.1 of Ext.B2 states that “notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage and in the event of any claimed there after the insured shall give all such information and assurance as the company shall require.”
In the present case indisputably the FIR was lodged with the police without any delay and the complainant had informed the Insurance Company about the accident of his vehicle on 15/07/2015 that is after 67 days. Apex Court held that delay in informing the Insurance company would not debar the insured to get the insurance claim if the delay is genuine and it was satisfactorily explained. Here complainant has stated that he had admitted in hospital on the very next day onwards till 24/06/2015 ie 38 days and after that from 03/07/2015 to 05/07/2015. Further from 20/07/2015 to 25/07/2015. Complainant proved the said fact by producing original case records from the hospital. Case records reveal that due to accident complainant had sustain severe bodily injuries and fractures.
Here there is no dispute that the claim submitted by the complainant to OP was a bonafide claims. In such situation the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded.
In the instant case the vehicle met with accident on 10/05/2015 and FIR was lodged in the police station on the next day itself. From the case records of the hospital show that complainant was admitted in hospital as impatient on the next day due to fracture. In such situation a person was not in a position to intimate the incident to Insurance company. Ext.A3 FIR shows that FIS was given by one Seema K which clears that complainant was not in a position to give his statement on that period. OP contended that complainant has not responded to their Letter dated 21/07/2015 (Ext.A7) seeking clarification for the delay in intimation. Complainant during cross-examination admitted the said fact. We can see that
from 20/07/2015 to 25/07/2015, complainant was admitted as impatient on Tejasvini Hospital Mangalore. On that condition non-responding the letter cannot be taken as a significant reason. Under these circumstance, it was a deficiency in service on the part of the OP for repudiation complainant’s bonafide claim on flimsy ground. There may be condition in the policy regarding delay
in intimation but that does not mean that insures can repudiate claim of the claimant whose the vehicle got damaged, which was being used by him for earning livelihood. Another contention of OP is that the complainant had repaired the vehicle in an unauthorized workshop and authorized Insurance Surveyor was not inspected the vehicle and prepared report. But Pw2 the proprietor of workshop gave evidence that he had informed the insurance company on the same day when the vehcle was taken to his workshop and the authorized surveyor came and inspected the vehicle. Hence from the above facts the contention of OP with regard to said fact cannot be accepted and there is deficiency in service on the part of OP on repudiating the genuine claim of the complainant.
Next point to be decided is what amount complainant is eligible to get as claim? Pw2 indentified Ext. A6 series and deposed that Ext.A6 series was issued by him. On perusal of A6 series show that the bills were connected with the vehicle of complainant. Hence complainant is entitled to get Rs.33137/- as claim amount from the OP.
In the result complaint is allowed in part. OP is directed to give 33137/- as claim amount to the complainant. OP is further directed to give Rs.10000/- as compensation for mental agony caused to complainant. Op shall comply; the order within one month from the date of receipt of this order, failing which Rs.33137 carries interest @9% per annum from the date of order till realization. Complainant is at liberty to file execution application against OP under provision of Consumer Protection Act 2019.
Ext.
A1 - Copy of Policy
A2 - Registration Certificate
A3 - FIR
A4 - Medical bills (photo copy) objected (subject to proof)
A5 - Repudiation Letter
A6 (Series) - Auto guarage certificate
A7 - Letter issued by OP dated 21/07/2015
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Senior Superintendent
