By Sri. Mohamed Ismayil.C.V, Member
The complainant alleged deficiency of service against the opposite party in the following manner:-
1. The complainant is the owner of a car bearing No. KL-10-BA-7746 and the samewas insured with the opposite party. The opposite party issued a Private Motor Car Comprehensive Policy (No.2311202367544200000) for a period of 20/08/2018 to 19/08/2019. According to the complainant, the insurance policy was purchased from AM Motors, the authorised dealer of Maruti in Malappuram. On 25/11/2018 at about 12.10 PM while proceeding to Parappanangadi from Devadiyal, the car met with an accident at BEMHSS, Parappanangadi, as a result Parappanangadi Police Station registered a crime numbered as 355/2018 alleging offences under sections 279,304 A IPC. It is stated in the complaint that at the time of accident, the vehicle was driven by one Jabir Ahammed with care and slowly. The driving licence of Jabir Ahammed was valid at the time of accident. It is further stated in the complaint that the vehicle suffered heavy damage in the accident and the complainant followed all the legal formalities and informed all authorities including the opposite party. Subsequently the vehicle was taken in to the service centre of AM Motors, Malappuram for repairing work. It is averred in the complaint that a surveyor is appointed by the opposite party on the basis of instruction given by AM Motors and the surveyor inspected the vehicle and assessed the damages. On the basis of assessment of the report was submitted. According to the complainant for repairing the damages of the car Rs. 1,79,185/- as incurred as expenses for labour charges and cost of spare parts. It is contended by the complainant that under the coverage of insurance policy, the opposite party is liable to reimburse the entire expenses incurred for repair work. But the opposite party did not reimbursed the expenses incurred for the repair work. According to the complainant, the opposite party violated the conditions of insurance policy and thereby caused much loss, damages and hardship to the complainant. So the complainant was compelled to pay the entire amount to take back the repaired vehicle from the service centre. It is further contended by the complainant that he did not violate any conditions of the policy. On 22/05/2019, the opposite party issued a letter to the complainant stating false, illegal and unsustainable contentions. It is stated in the complaint that the complainant used the vehicle for private purposes. The allegation of use of vehicle for commercial purpose is not correct and can be considered as a manoeuvre to escape from the liability by the opposite party. So the complainant approached the Commission to get redressed his grievances. The complainant prayed for an order to direct the opposite party to refund Rs. 1,79,185/- to the complainant towards the expenses incurred for the repair work of the vehicle insured with the opposite party. The complainant claimed Rs. 1,00,000/- as compensation from the opposite party and also claimed Rs. 50,000/- as compensation for mental agony suffered by the complainant due to the act of opposite party.
2. The complaint is admitted on file and issued notice to the opposite party. The opposite party appeared and filed version.
3. The opposite party denied allegation raised in the complaint. In the version it is contended by the opposite party that the parties are bound by terms and conditions of the policy, which approved by IRDA, the statutory authority. The opposite party admitted the policy coverage to the vehicle of the complainant and is valid from 20/08/2018 to 19/08/2019. According to the opposite party, the intimation of accident received only on 05/02/2019 and i.e. belated for more than 2 months. It is further stated that complainant violated the condition No.1 of policy, delaying the intimation of the claim to the opposite party. It is contended that because of delay in availing details of accident, the opposite party has lost valuable time for enquiry and to find out true circumstances of the accident and to get evidence of violation of terms and conditions, if any. It is stated in the version that the investigation conducted by the opposite party revealed hiring of insured vehicle for reward and accident occurred when the vehicle was being used by the hirer. According to the opposite party, the insured vehicle is registered and insured as Private Vehicle and not intended to be used for hired purposes. So the complainant has breached the conditions of limitations as to use of policy and has forfeited his right to be indemnified by the opposite party. It is the case of the opposite party that if the complainant had informed immediately about the accident, then the opposite party would have been in a position to collect positive evidence regarding the accident. But complainant suppressed material facts by delaying the conveyance of information of accident an order to hide the factual situation of hiring of insured vehicle. The opposite party admitted the letter sent on 22/05/2019 rejecting the claim of the complainant. As per the investigation discreetly conducted by the opposite party, it has revealed that the insured vehicle was given to some friends on a hire and reward basis. So under these circumstances the opposite party had a legitimate right to repudiate the claim of reimbursement made by the complainant. It is contended that the opposite party has not committed any deficiency in service or has not indulged in any unfair trade practices and so prayed for dismissal of the complaint. It is added in the version that the opposite party had appeared an IRDA licensed surveyor to assess the loss of the insured vehicle and submitted a report. As per the report, the loss is Rs. 1,33,465/- less excess of Rs.1000/- and if any reason this Commission finds that the complainant is entitled to be reimbursed, then the order may limited to the amount assessed by the surveyor.
4. The complainant and the opposite party filed affidavit. The complainant produced the documents and marked as Ext.A1 to A5 documents. Ext. A1 document is the copy of Certificate of Registration of the insured vehicle. Ext.A2 document is the copy of Certificate –Cum- Policy Schedule issued by the opposite party to the complainant. Ext. A3 document is the copy of First Information Report showing the Crime No.355/2018 registered by the Parappanangadi Police Station. Ext.A4 document is the copy of repudiation letter dated 22/05/2019 issued by the opposite party. Ext. A5 document is the copy of Job card retail bill dated 31/03/2019 issued by the service centre of AM Motors. The documents produced by the opposite party are marked as Ext. B1 to Ext B4 documents. Ext.B1 document is the copy of Private Car Comprehensive Policy Certificate issued to complainant by the opposite party. Ext. B2 document is the copy of Claim form dated 05/02/2019 submitted before the opposite party by the complainant. Ext. B3 document is the copy of repudiation letter dated 22/05/2019 issued by the opposite party to the complainant. Ext. B4 document is the copy of Motor Final Survey Report dated 07/06/2019 prepared by the surveyor of the opposite party.
5. Heard both sides. Perused documents and affidavits. Both parties also filed notes of arguments. The points arisen for the consideration of the Commissions are as follows:-
- Whether the opposite party had committed deficiency in service or unfair
trade practice towards the complainant?
- If yes, then the relief and cost?
6. Point No.1 and 2:-
The complainant stated that he insured his vehicle with the opposite party and insurance coverage was valid between 20/08/2018 to 19/08/2019. The complainant produced Ext. A1 and Ext.A2 documents to prove this statement. Ext.A1 document shows that the complainant is the Registration Certificate Owner of the insured car. Ext.A2 document is the Certificate – Cum-Policy Schedule which shows the insurance coverage of the vehicle with the opposite party. It is further comes out that the insured vehicle met with an accident and damage was caused to the vehicle. The complainant produce Ext. A3 document which is the copy of FIR registered by the Police station, Parappanangadi in connection with the accident. According to the complainant, the damaged vehicle was taken in to the service centre of AM Motors, Malappuram for repairing work. An insurance surveyor was appointed by the opposite party and after conducting inspection report was filed. The complainant submitted an application before the opposite party to reimburse the amount spent for repairing work of turned down by issuing repudiation letter dated 22/05/2019 to the complainant and same is produced and marked as Ext. A4 document. The complainant contended that reason stated in the repudiation letter is false and the opposite party violated conditions of insurance policy. The complainant stated that he spent a total Rs. 1,79,185/- for repairing work of the insured vehicle and produced Ext. A5 document to prove that aspect. The contention raised by the complainant is that he did not act against the conditions stipulated in the insurance policy and the opposite party is liable to reimburse the expenses incurred for repairing work of the insured vehicle. On the contrary, the contention raised by the opposite party in the version as well as in the affidavit is that the complainant had violated conditions of insurance policy and produced Ext.B1 document to support the contentions. Ext.B1 document is the Private Car Comprehensive Policy Certificate issued by the opposite party to the complainant. The opposite party admitted the insurance coverage of the vehicle owned by the complainant. It is also stated by the opposite party that a claim application dated 05/02/2019 is received from the complainant and same is produced before the Commission and marked as Ext.B2 document. The opposite party contented that accident was occurred on 25/11/2018 and intimation of accident was received only on 05/02/2019, in a belated stage. The delay caused lapse of evidence of alleged occurrences. Moreover, according to the opposite party, the insured vehicle was given to some friends of the complainant on hire and reward basis and at the time of accident, the insured vehicle was used by the hirer. This kind of act from the side of the complainant is also a violation of condition of the agreement insurance coverage and policy is covered for private use only. So the opposite party repudiated the claim of the complainant and issued Ext. B3 document dated 22/05/2019 to the complainant. Same repudiation letter is also produced by the complainant in this proceeding and already marked as Ext. A4 document (Ext.B3 and Ext. A4 are one and same). When going through the entire evidence, it can be concluded that the reason for the repudiation of claim of the complainant is untenable and unsustainable and need to be interfered by this Commission. The opposite parties admitted the case of the complainant to the extend of occurrence of accident and consequent damages of the insured vehicle only. According to the complainant the date of accident is on 25/11/2018. Ext. A5 document shows that huge damage was occurred to the vehicle in the accident. The complaint and affidavit filed by the complainant revealed that the complainant had to comply formalities after occurrence of accident and informed all authorities including the opposite party. In an accident case, as we know, the owner of the vehicle, involved in the accident is liable to follow legal formalities to release the vehicle from the judicial custody especially when a crime was registered under Section 279, 304 A of Indian Penal Code. Moreover investigation report secured by the opposite party filed along with version also revealed that insured vehicle was kept in police custody for 2 months and after getting an order from the honourable Court the insured vehicle was released. The affidavit filed by the opposite party also says about investigation report secured by the opposite party. Even though investigation report is produced along with version, the opposite party did not take any step to mark that document as part of the evidence. But this Commission consider the document of investigation report as part of the pleadings of the version and it is supported by the affidavit of the opposite party. Moreover Ext. A5 document also shows that the vehicle was taken back on 31/03/2019 by the complainant. So the Commissioner finds that there is no unreasonable delay in filing claim application by the complainant. It is highly pertinent to note that the opposite party repudiated the claim application even before the preparation of survey report dated 07/06/2019 filed by insurable surveyor and same report is marked as Ext. A4 document by the Commission. So it is found by the Commission that hasty steps were taken by the opposite party to repudiate the claim application without applying reasonable prudence which is expected from an insurer. According to the opposite party, investigation conducted by the opposite party is revealed that the insured vehicle has been hired out for reward and the accident happened while it is being used by the hirer. But the opposite party failed to bring out evidence on the aspect of hiring of insured vehicle by an outsider. This Commission cannot accept allegation of use of insured vehicle by the hirer at the time of accident. There is nothing to show to prevent the use of insured vehicle by a person other than the owner. So the reasons stated for repudiation of claim amount cannot be acceptable by this Commission. It is stated by the opposite party that if for any reason complainant is entitled to be reimbursed the repair charges, then the order can be limited to the amount stated in the surveyor report. As per surveyor report gross loss assessed to the insured vehicle is Rs. 1,33,465.60/-. But according to the complainant, he spent total Rs. 1,79,185/- for repairing the damages of the vehicle. Ext. A5 document shows that the expenses incurred for repairing the vehicle is Rs. 1,77,644/-. So considering the entire evidence adduced by the both side, the Commission finds that there deficiency in service on the part of the opposite party in considering the claim application for reimbursement of expenses incurred by complainant. So the Commission allows the complaint in the following manner:-
- The opposite party is directed to pay Rs. 1,77,644/- (Rupees One lakh seventy seven thousand six hundred and fourty four only) to the complainant as amount reimbursement for the expenses incurred for the repairing of insured vehicle.
- The opposite party is directed to pay Rs. 50,000/-(Rupees Fifty thousand only) to the complainant as compensation for mental agony and hardships suffered due to deficiency in service on the part of the opposite party.
- The opposite party is directed to pay Rs. 10,000/-(Rupees Ten thousand only) as the cost of the proceedings to the complainant.
The opposite party shall comply this order within one month from the date of receipt of copy of this order otherwise the entire amount shall bear 9% interest from the date of this order till the realization
Dated this 18th day of January , 2023
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
APPENDIX
Witness examined on the side of the complainant : Nil
Documents marked on the side of the complainant : Ext.A1to A5
Ext.A1 : Document is the copy of Certificate of registration of the insured vehicle
Ext.A2 : Document is the copy of Certificate –Cum- Policy Schedule issued by the
opposite party to the complainant.
Ext A3 : Document is the copy of first information report showing the Crime No.
355/2018 registered by the Parappanangadi Police Station.
Ext A4 : Document is the copy of repudiation letter dated 22/05/2019 issued by the
opposite party.
Ext A5 : Document is the copy of Job card retail bill dated 31/03/2019 issued by the
service centre of AM Motors.
Witness examined on the side of the opposite party : Nil
Documents marked on the side of the opposite party : Ext. B1 to B4
Ext.B1 : Document is the copy of Private Car Comprehensive Policy Certificate issued
to complainant by the opposite party.
Ext.B2 : Document is the copy of Claim form dated 05/02/2019 submitted before the
opposite party by the complainant.
Ext.B3 : Document is the copy of repudiation letter dated 22/05/2019 issued by the
opposite party to the complainant.
Ext.B4 : Document is the copy of Motor Final Survey Report dated 07/06/2019
prepared by the surveyor of the opposite party.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
