Haryana

Ambala

CC/168/2021

Jatin Kaushik - Complainant(s)

Versus

National Insurance Co Ltd - Opp.Party(s)

Adit Aggarwal

01 Jun 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	168 of 2021
Date of Institution	:	22.04.2021/10.05.2021
Date of decision	:	01.06.2023

 

Jatin Kaushik, s/o Sh. Anil Kaushik, r/o 34-B, Raja Park, Ambala Cantt.

          ……. Complainant.

                                                Versus

1. National Insurance Company Limited, SCO 57, Sector - 26D, Chandigarh - 160019; through its Chairman cum Managing Director.
2. National Insurance Company Limited, 106, Railway Road, Ambala Cantt; through its General Manager.
3. Mr. Samay Singh, official of National Insurance Company Limited, 106, Railway Road, Ambala Cantt.                                                                                                                          ….…. Opposite Parties.

Before:        Smt. Neena Sandhu, President.

                             Smt. Ruby Sharma, Member,

          Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Adit Aggarwal, Advocate, counsel for the complainant.

                     Shri Mohinder Bindal, Advocate, counsel for OPs.      

Order:        Smt. Neena Sandhu, President.

1.                Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Parties (hereinafter referred to as ‘OPs’) praying for issuance of following directions to them:-

1. To pay the remaining claim amount of Rs.30,451/-, i.e. the difference of the amount between the assessed loss and the amount paid by the OPs, alongwith interest @18% p.a.;
2. To pay Rs.3,00,000/- as compensation for harassment, mental pain, shock and tension:
3. To pay Rs.20,000/- on account of interest @ 18% pa on the delayed payment of Rs.1,27,149/- for 21 months i.e. from the date of claim upto the date of payment;
4. To pay litigation expenses of Rs.22,000/-

Or

Grant any other relief which this Hon’ble Commission may deems fit and proper

2.             Brief facts of the case are that the complainant got his car make Honda City bearing registration No.CH 01AW 3773 insured from OP No.1 vide policy no.42010031183100086730 valid for the period from 04.02.2019 to 03.02.2020, on making payment of premium of Rs.15,683/-. On 28.03.2019 the said car met with a road side accident near Ambala Chandigarh Road, Ambala within the area of PS Baldev Nagar. He lodged a claim with the OPs for reimbursement of his loss due to accident of the insured vehicle and the same was investigated by the Surveyor and Loss Assessor of the OPs namely Er.Rajesh Verma, who conducted the survey of the insured car on 12.04.2019 and re-inspected the same after more than 2 months on 29.06.2019. After conducting the complete enquiry/investigation, Er. Rajesh Verma submitted his Motor Final Survey Report dated 17.10.2019 to the effect that the OPs are liable to pay Rs.1,57,600/- to the complainant in respect of the said claim. Even after that the OPs did not release the amount as passed by the surveyor, despite the fact that number of requests were made by him in the matter. OP No.3 was dealing with the claim case of the complainant, who is very arrogant and rude and was expecting something from the complainant for passing his claim. It was only on 08.01.2021 i.e. after almost 15 months of the surveyor report, the OPs paid Rs.1,27,149/- to the complainant by directly transferring the said amount to the bank account of the complainant and retained the amount of Rs.30,451/- without any justification or even intimation to the complainant. When the complainant contacted OP No.2 for it, OP No.3 told him that he is penalized for not listening to him. By not paying the amount of Rs.30,451/-, the OPs have committed deficiency in service. Hence, the present complaint.
3.           Upon notice, the OPs appeared and filed written version raising preliminary objections to the effect that the complaint is not maintainable either in law or on facts and liable to be dismissed in limine; the complainant has not approached this Commission with clean hands as he has suppressed the material facts; the present claim petition is ex-facie misconceived, vexatious, untenable and devoid of any merit; the present complaint has been filed without any cause of action; the complainant has tried to manipulate the facts  etc. On merits, it has been stated that the complainant himself is responsible for entire issues involving his claim which was otherwise liable to be repudiated and discarded due to manipulations to exaggerate the loss to have higher claim deceitfully just to make fortune out of fortune. As a matter of fact the reported claim of the complainant without going into the maintainability aspect of this claim was duly entertained on receipt of the intimation about the alleged loss to his car bearing registration no. CH-01AW-3773 in an accident alleged to have occurred on 28.03.2019 near Ambala Chandigarh Road, Ambala City within the area of PS Baldev Nagar, Ambala City. One IRDA approved/licensed independent surveyor Er. Rajesh Verma, Surveyors and Loss Assessors was immediately deputed to inspect and assess the loss and to give their fact finding report as per terms of the insurance policy and norms as envisaged under the insurance byelaws. However, since the complainant had shifted his said car from authorized workshop M/s Joshi Automotives, Chandigarh, where it was shifted after the accident for repair and got estimate of repair therefrom, to a local workshop at Ambala Cantt. namely M/s Om Motors, Ambala Cantt, thus the said surveyor after getting intimation about the shifting of said car, inspected it at Om Motors, Ambala Cantt. After giving consideration to the loss associated with the incident in question and as per insurance byelaws and in consultation with the said workshop and the insured, he recommended the payable loss to the tune of Rs.1,57,599/- subject verification of papers and bills and approval of the competent authority with no certainty to his assessment as he has only a recommending power and not approval power as per insurance byelaws. During the supervision of repair process, he was informed that the complainant was not interested to have certain new parts fitted in his car as replacement to avoid heavy depreciation of 50% due to 2014 model car and requested to have reconditioned old parts in place of new parts to which the surveyor accorded his approval subject to approval of the competent authority about exact approved cost of such reconditioned parts. Consequently upon submitting the bills of repair by the insured, the same were handed over to investigator Ms Sonia Madan, Advocate for verification, who visited the concerned authors of submitted bills and got them verified as true except a bill of Rs.58,000/- issued on a letter pad against the purchase of reconditioned dashboard with airbags from alleged supplier M/s Ganpati Motors, Chandigarh which was found fake being denied by the owner of the said shop-M/s Ganpati Motors. On finding such manipulation on the part of the insured, he was asked to give explanation and was also asked to supply his bank details for the release of compensation amount, vide letters dated 11.03.2020 and 20.03.2020 but to no avail. Thus finding no alternative, the said claim file was closed as no claim as per procedure. Later, in the month of December, 2020, on being supplied the requisite bank details, the said claim file was again reopened just to give best possible services and his claim was approved for Rs.1,27,149/- after getting opinion from another locally available surveyor about the actual cost of the reconditioned parts as the earlier surveyor was not available. The surveyor M/s Ametek Insurance Surveyors & Loss Assessors (P) Ltd. after verification of rates from the different markets confirmed vide their report dated 18.12.2020 the actual cost of the reconditioned dashboard with airbags amounting to Rs.29,650/- instead of Rs.58,000/- as alleged and submitted by the insured to the surveyor Mr. Verma and they also confirmed the cost of other reconditioned part bonnet assembly as Rs.1700/- instead of Rs.2500/- as claimed by the complainant. Had the complainant got the new dashboard with airbag then he could have been allowed Rs.44,500/- out of Rs.85000/- (cost of new one) after application of 50% applicable depreciation then how he can be allowed Rs.58,000/- for such reconditioned part thus highlighting technical mistake on the part of the surveyor Mr. Verma that was the subject matter of the competent authority while affording approval a claim while going through the recommendation made by the surveyor. Although the claim of the complainant was liable to be repudiated on the ground of fake bill but due to mischief being stated to be on the part of workshop, thus after getting discharge voucher from the complainant countered signed by the workshop M/s Om Motors about receiving the approved amount of Rs.1,27,149/- in full and final settlement, the said amount of compensation was released to the complainant. The insurance company is bound to perform strictly within the ambit and purview of the terms and conditions of the policy. The complainant is very much aware about the scope and limitations of the OPs while receiving the compensation amount and was rather apprised about complete details of assessment letters when he sought reopening of his claim file but, now in order to put undue pressure, the complainant leveled false and baseless allegations against the dealing official and filed this false complaint by exploiting the process of law. The complainant had already received the entire compensation amount after submitting a discharge voucher without any pressure or coercion and received compensation amount in full and final settlement. Rest of the averments of the complainant were denied by the OPs and prayed for dismissal of the present complaint with costs.
4.           Learned counsel for the complainant tendered affidavit of complainant as Annexure C-A alongwith documents as Annexure C-1 to C-4 and closed the evidence on behalf of complainant. On the other hand, learned counsel for the OPs tendered affidavit of Shri Raman Chabra, Authorized Signatory, National Insurance Co. Ltd., Divisional Office, Ambala Cantt., Shri Rajesh Verma, Surveyor and Loss Assessor and Ms.Sonia Madaan, Advocate and Investigator, resident of House No.70, Ekta Vihar, Ambala Cantt. as Annexure OP-A, OP-B and OP-C respectively, alongwith documents as Annexure OP-1 to OP-10 and  closed evidence on behalf of the OPs.
5.           We have heard the learned counsel for the parties and have also carefully gone through the case file.
6.           Learned counsel for the complainant submitted that by deducting substantial amount of Rs.30,451/- out of the claim amount of Rs.1,57,599/- which amount was assessed by the surveyor of the OPs only, the OPs are deficient in providing service and adopted unfair trade practice.
7.           On the other hand, learned counsel for the OPs submitted that since the complainant himself has got fitted some old parts while getting accidental repairs, as such, the amount of Rs.30,451/- was rightly deducted by the OPs. He further submitted that the said fact came to the knowledge of the OPs upon submission of the bills of repair by the insured, whereafter the same were handed over to investigator Ms Sonia Madan, Advocate for verification. He further submitted that the said Advocate visited the concerned authors of submitted bills and got them verified as true except a bill of Rs.58,000/- issued on a letter pad against the purchase of reconditioned dashboard with airbags from alleged supplier M/s Ganpati Motors, Chandigarh which was found fake being denied by the owner of the said shop-M/s Ganpati Motors. He further submitted that the complainant has received the amount of Rs.1,27,149/-, as full and final settlement of the claim, vide satisfaction certificate Annexure OP-4, as such, he has no locus-standi to file the present complaint.
8.           It may be stated here that the bill dated 02.12.2019, vide which complainant purchased the reconditioned dashboard with airbags from alleged supplier M/s Ganpati Motors, Chandigarh, was found to be fake as is evident from letters dated  11.03.2020 and 20.03.2020, Annexure OP-9 and OP-10 having been written to the complainant in that regard. However, there is nothing on record that the complainant even replied to those letters, what to speak of denial of the same. Moreso, in the satisfaction certificate dated 28.03.2019, Annexure OP-4 which stood signed by the complainant himself, it is clearly stated that he discharges the insurance company, on payment of Rs.1,27,149/-, to the repairer who had repaired the insured/accidental vehicle in question, in full and final settlement of all claims, present or future, arising out of the said accident. There is nothing on record that the said satisfaction note has been signed by the complainant under protest nor such contention has been raised by him in his complaint that the said satisfaction certificate has been obtained from him by the OPs under fraud, misrepresentation or under coercion. Under these circumstances, we are of the considered view that once the complainant himself has signed the satisfaction note towards claim amount of Rs.1,27,149/- as full and final settlement of the claim, now he cannot wriggle out of the same. In United India Insurance Vs. Ajmer Singh Cotton & General Mills & Ors. Etc. 1999 (2) CPC 601 (SC), the Hon’ble Supreme Court has held  that once insurance claim has been accepted by way of full and final settlement, claimant cannot be allowed any further relief, unless until it is proved that the discharge voucher was obtained by fraud, misrepresentation or under coercion.
9.           In view of the aforesaid discussion, it is held that the complaint filed by the complainant is devoid of merits, consequently, we dismiss the same with no order as to costs. Certified copy of the order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room

  Announced:- 01.06.2023.

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President