DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
DATED THIS THE 6th DAY OF AUGUST, 2024.
PRESENT : SRI. VINAY MENON .V, PRESIDENT.
: SMT. VIDYA .A, MEMBER.
: SRI. KRISHNANKUTTY N .K, MEMBER.
Date of filing: 24.02.2023.
CC/58/2023
Manikandan.M, S/o.Mani, - Complainant
Sorryachira Pudussery,
New residing at 19/378,
Sreejith Nivas, Mechiripadam,
Elappully PO, Palakkad 678 662.
(By Adv.M/s.Bindu & N.Abhilash)
VS
1. M/s.Cholamandalam MS General Insurance Co. Ltd., -Opposite Parties
443, Magnum Towers, 3rd Floor,
Dr.Nanjappa Road, Gandhipuram,
Coimbatore-641 108.
2. M/s.Cholamandalam MS General Insurance Co. Ltd.,
443, Magnum Towers, 3rd Floor,
Dr.Nanjappa Road, Gandhipuram,
Coimbatore-641 108.
By its Managing Director/Manager/Authorised signatory
(Both OPs by Adv.P.Prasad)
ORDER
BY SRI. KRISHNANKUTTY N .K, MEMBER.
1. Pleadings of the complainant in brief
The complainant is about the repudiation of vehicle insurance claim of the complainant by the opposite party insurance company. The ISUZU-D MAX car owned by the complainant bearing registration No.KL/09/AP-4430 was insured with the opposite party for the period from 23.05.2022 to 22.05.2023. On 11.09.2022, the vehicle met with an accident while returning from his estate in Santhanpara, Idukki district. The vehicle hit on a rock due to heavy rain. The incident was intimated to the opposite party in time and the vehicle was entrusted to M/s.KUN Auto Company ltd, Coimbatore. Thereafter, the insurance surveyor cum loss assessor examined the vehicle and assessed the damages caused to the vehicle. The vehicle was got repaired spending Rs.2,31,815/- and the claim was submitted to the opposite party on 12.09.2022. On 17.10.2022, the opposite party rejected the claim with reason “We have noticed that the damages in the vehicle were not by any accidental external means.”
Aggrieved by this, the complainant has approached this Commission seeking direction to settle the claim for Rs.2,31,815/- along with interest, a compensation of Rs.1,00,000/-; cost and other incidental reliefs.
2. Complaint was admitted and notices were issued to the opposite parties. They entered appearance and filed joint version reiterating their stand that the accident has not happened due to external means and hence, not eligible for cover as per Section 1 of the policy conditions and sub section 2(a) of the India Motor Tariff.
3. The case was referred for mediation, but no settlement could be reached.
4. Based on the pleadings of the complainant and opposite parties the following issues were framed.
1. Whether the repudiation of insurance claim is as per the terms and condition of the policy?
2. Whether there is any deficiency in service on the part of the opposite parties?
3. Whether the complainant is entitled to the reliefs claimed?
4. Reliefs as to cost and compensation.
5. The complainant filed proof affidavit and marked Ext.A1 to A5 as evidence. Marking of Ext.A2 was objected to as it does not conclusively prove completion of a monetary transaction, as receipt seal is not affixed. The opposite parties filed proof affidavit and marked Exts.B1 to B4 as evidence.
6. Issue No.1
As per the proof affidavit filed by the complainant, the accident occurred by the vehicle hitting a rock in heavy rain. The only reason quoted by the oppsotie parties for repudiating the claim is that the “damages in the vehicle were not caused by any accidental external means”, and that the complainant did not produce any proof or documents or evidence of eye witness or FIR to prove the incident. Ext.B1, the policy document clearly shows that the policy (Section 1-loss of damage to vehicle insured item No.vi) covers damage to the vehicle by accidental external means. The contention of opposite parties is that this accident, “is hitting a stone in heavy rain” shall not came under the definition of accidental external means. But “accidental external means” is covered under Ext.B1. It is to be noted that the event covered is not “violent accidental external event”. Since accidental is not defined in Ext.B1, dictionary meaning of “accidental” can be relied on. Accidental means an unforeseen and unexpected event. Ext.B4 report also shows the cause of accident as “driver dashed with stone”. The Surveyor has not questioned this cause or raised any doubt. The opposite party also has not rejected Ext.B4 report. This Commission is of considered opinion that any damage which has occurred in the situation herein is to be treated as damage due to external means. Moreover, the opposite party has not mentioned these deficiencies in their repudiation letter dated 17.10.2022 (Ext.B2) and 03.11.2022 (Ext.B3). As the accident happened in a remote area of Idukki district, it is quite possible that there was no eye witness for the incident. Further, as no third party/third party property was involved in the incident, there was no necessity to file FIR in the matter. Hence, the denial of claim on this count is not justified. The insurance surveyor has already assessed and certified the damages caused to the vehicle in the accident without giving any indication that the damages caused is not out of any external means. The opposite party has also quoted the clause relating to consequential loss in their proof affidavit and argument notes. Consequential loss is a loss secondary to the primary loss which is not relevant in the present case. As far as the loss assessment is concerned, the complainant has not objected to the surveyor report marked as Ext.B4.
7. Issue No.2 to 4
Hence, as the repudiation of the claim by the opposite party is not on justifiable grounds. So, the Complaint is allowed ordering following reliefs.
1. The opposite party is directed to settle the claim for Rs.1,91,168/75 as per the loss assessment report submitted by the insurance surveyor.
2. The opposite party is directed to pay interest @ 10% pa for the said amount from 17.10.2022 till the date of payment.
3. The opposite party is also directed to pay Rs.50,000/- as compensation for deficiency in service.
4. The opposite party is also liable to pay Rs.10,000/- as cost of litigation.
The above amounts are to be paid within 45 days of receipt of this order, failing which the opposite parties are liable to pay Rs.500/-as solatium per month or part thereof from the date of the order till the date of final payment.
Pronounced in open court on this the 6th day of August, 2024.
Sd/-
VINAY MENON .V, PRESIDENT.
Sd/-
KRISHNANKUTTY N .K, MEMBER.
APPENDIX
Documents marked from the side of the complainant:
Ext.A1: Claim rejection letter dated 17.10.2022.
Ext.A2: Invoice of the KUN Auto Company Pvt. Ltd dated 15.10.2022.
Ext.A3: Insurance policy cum certificate dated 20.05.2022.
Ext.A4: Lawyer notice copy and Ack. Card dated 30.12.2022.
Document marked from the side of Opposite party: Nil
Ext.B1: The policy copy with conditions.
Ext.B2 and B3: Repudiation letter respectively dated 17.10.2022 and 30.11.2022.
Ext.B4: The survey report.
Witness examined on the side of the complainant: Nil.
Witness examined on the side of the opposite party: Nil
Court witness: Nil
Cost : 10,000/-.
NB: Parties are directed to take back all extra set of documents submitted in the proceedings in accordance with Regulation 20(5)of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.
