Haryana

Karnal

CC/327/2021

Narinder Singh - Complainant(s)

Versus

Royal Sundram General Insurance Co. Ltd. - Opp.Party(s)

M.R. Sangwan

28 Mar 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 327 of 2021

                                                        Date of instt.14.07.2021

                                                        Date of Decision:28.03.2023

 

Narinder Singh son of Shri Jagir Singh house no.307 Gali no.8, Hansi Road, Karnal.

                                               …….Complainant.

                                              Versus

 

1.     Royal Sundram General Insurance Company Ltd. through its Branch Manager Rider House, plot no.136 Sector 44 Gurgaon, Do, Regional office Gurgaon 122001.

 

2.     M/s Royal Sundram General Insurance Company Ltd. through its Senior Manager, SCO 82, 1^st and 2^nd floor, Sector-40C, Chandigarh-160040HDFC ERGO General Insurance Company Ltd. through its Branch Manager SCO no.237, 2^nd floor Sector-12, opposite mini Secretariat, Karnal.

                                                                      …..Opposite Parties.

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

      Dr. Rekha Chaudhary……Member

          

 Argued by: Shri Pardeep Nehra, counsel for the complainant.

                    Shri Sudershan Chaudhary, counsel for the OPs.

 

                    (Jaswant Singh President)

ORDER:   

                

                The complainant has filed the present complaint Under Section 35 of Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant got insured his car make Hundai Verna, bearing registration no.HR-09-C 4748 with the OPs, vide policy no.VPC10594080000100 commenced from 26.12.2018 to 25.12.2019 for the amount of Rs.4,50,000/-. On 14.07.2019 the said car of complainant met with an accident near Umri Chowk Kurukshetra at about 9.30 p.m. and front portion of the vehicle was totally damaged in the said accident. The complainant informed the OPs about the said accident and on the instruction of the OPs, on 15.07.2019 complainant picked the vehicle with the help of crane from the place of accident and was parked in the authorized parking of authorized service centre Sood Motors Pipli, Kurukshetra but lateron same was shifted to Divine Motors Pipli, Kurukshetra. The claim of the complainant was registered vide claim no.28745290 by OPs and the OPs appointed the surveyor, the surveyor had submitted the report on total loss basis and the complainant had submitted all the concerned documents with the claim form, which was duly received by the OPs. The claim of the complainant had not been settled till today and a letter was issued to complainant on 02.03.2020 asking irrelevant documents, which have no concern with the settlement of the claim. Complainant visited the office of OPs several times and requested to settle the claim but OPs did not pay any heed to the request of complainant and lingered the matter on one pretext or the other and lastly close the claim as No Claim on the false and frivolous ground. Then complainant sent a legal notice dated 01.12.2020 to the OPs but it also did not yield any result. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence this complaint.

2.             On notice, OPs appeared and filed its written version raising preliminary objections with regard to maintainability; jurisdiction and concealment of true and material facts. On merits, it is pleaded that OPs had appointed an independent investigation agency as Suraksha Enterprises and got the claim investigated, the Investigator has specified clearly in his report that there was a delay in intimation of claim and insured/complainant did not met with the Investigator, also reminder letters were sent to complainant dated 03.10.2019, 26.10.2019, 11.11.2019 and 21.11.2019 seeking several documents which were not provided by insured/complainant. Further, insurer had sent a final reminder letter dated 02.03.2020 seeking below mentioned documents were not provided due to which the claim of complainant was finally closed and could not be processed as per terms and conditions of the policy:

.       Complete purchase details including transaction details between   you and the seller of the car.

.       As the damage sustained by the vehicle is not relevant to the cause of loss as stated in the claim form, please provide the correct details.

.       Update the exact date, time and place of accident.

.       Spot photos taken at the accident spot.

.       FIR copy if available, if not available, whether the matter of loss informed to the police or not, please clarify.

.       Complete injury/treatment records of the driver.

.       Your mobile call data report for the period from 13^th July, 2019 to 20^th July, 2019.

.       Reason for delay in intimation.

.       Copy of previous policy.

.       Towing bill.

.       Spot verification.

.       Also, all the other queries raised by our investigator through his letter sent to you on various other dates through RPAD.

It is further pleaded that the OP had appointed an IRDAI licensed Surveyor Mr.Ajay Kanwar and after conducting the survey, he gave below mentioned recommendations:

.       Damages were not tallying with the case of loss and old fitment parts were done.

.       Major damages to vehicle have occurred but surprisingly no injury to driver.

.       No Police Report done and third party vehicle not available.

.       Towing Bill not available.

.       Insured did not provide spot verification.

.       Occupant details also not shared by insured.

.       Case/Claim is not genuine insured hiding material facts, recommendation for investigation.

.       Insured never met hence Insurable Interest suspected.

Though the insurer could not process the claim as the complainant/insured did not share the requested documents but if the claim would have been processed it would have been repudiated as per the findings of surveyor and investigator. It is further pleaded that complainant informed the OPs regarding the accident on 19.07.2019 i.e. after the delay of five days, hence complainant himself violated the terms and conditions of the policy. It is further pleaded that after receiving the claim intimation on 19.07.2019, OP appointed a surveyor namely Ajay Kumar for assessment of the loss of the vehicle, the surveyor inspected the vehicle parked at Divine Motors and after duly inspection of the vehicle and after deducting all necessary clauses the said surveyor assess the actual loss caused to the car in question to the tune of Rs.3,11,000/-. Complainant failed to furnish the required information and in this regard letter and reminders dated 03.10.2019, 26.10.2019, 01.11.2019, 11.11.2019 and 21.11.2019 were served through Suraksha Enterprises on behalf of OPs. Thereafter, keeping in view of the conduct of the complainant final letter dated 02.03.2020 was served upon the complainant and as per this letter the claim of the complainant was closed due to non-compliance of requirement as per terms and conditions of the policy. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of invoice Ex.C2, copy of OPD slip Ex.C3, copy of estimate Ex.C4, copy of crane service receipt Ex.C5 and closed the evidence on 02.03.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Jayesh Sharma, Assistant Manager Ex.OP1/A, copy of GST invoice Ex.OP1, copy of insurance policy Ex.OP2, copy of claim form Ex.OP3, copy of survey report Ex.OP4, copies of letters alongwith its postal receipt dated 03.10.2019, 26.10.2019, 01.11.2019 and 21.11.2019 Ex.OP5 to Ex.OP9, copy of final reminder dated 02.03.2020 Ex.OP10, copy of postal receipt Ex.OP11 and closed the evidence on 13.06.2022 by suffering separate statement.

6.             We have heard the learned counsel of the parties and perused the case file carefully and have also gone through the evidence led by the parties.

7.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that complainant got insured his vehicle with the OPs. On 14.07.2019, the vehicle of complainant met with an accident and badly damaged. Intimation in this regard was sent to OPs and on receipt of intimation, OPs appointed a surveyor, who inspected the vehicle and assessed the loss on total loss basis. Complainant visited the office of OPs so many times and requested to settle the claim but OPs had closed the claim of the complainant, vide letter dated 02.03.2020 on the false and frivolous ground and lastly prayed for dismissal of the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that complainant has not supplied required documents despite various repeated requests and reminders. In the absence of requisite documents, the OPs were unable to decide the claim and due to non-submission of documents, OPs closed the claim of complainant as “No Claim”, vide letter dated 02.03.2020 and lastly prayed for dismissal of the complaint.

9.             We have duly considered the rival contentions of both the parties.

10.           Admittedly, the vehicle in question was insured with the OPs for the sum inured of the vehicle is Rs.4,50,000/-.

11.           The claim of the complainant has been closed by the OPs vide letter Ex.OP10 dated 02.03.2020 on the ground of non-submission of documents.

12.           The OPs have taken a plea that complainant has not supplied the requisite documents as demanded by the OPs, vide letter dated  Ex.OP5 dated 03.10.2019 and reminders dated 26.10.2019, 01.11.2019 and 21.11.2019 Ex.OP6 to Ex.OP9, vide which OPs demanded on meeting with insured Mr. Narinder Singh, last user and occupant; copy of MLC and treatment of insured, last user and other occupants; reason for delay in intimation; copy of service record of insured vehicle; copy of purchase invoice/cash receipt; copy of previous policy; copy of towing bill and spot verification.

13.           As per the above letters, complainant has failed to submit the documents as required by the OPs. As per the version of the complainant he had supplied all the required documents to the OPs but in this regard complainant has not placed on file any receipts vide which he had submitted the documents with the OPs. Moreover, as per version of the OPs, no accident took place as alleged by the complainant and same is manipulated one.  Hence, it appears that complainant has failed to fulfill the formalities mentioned in the abovesaid letters. The claim of the complainant has not been repudiated by the OPs and the same has been closed, vide letter Ex.OP10 dated 02.03.2020 for non-submission of documents. Hence, we are of the considered view that, at this stage, the present complaint is pre-mature and OPs are not deficient in closing the claim of the complainant.

 14.         In view of the above observation, the present complaint is disposed off with the liberty to the complainant to submit the required documents mentioned in the letters Ex.OP5 to Ex.OP9 and after the submission of the same, OPs are hereby directed to settle the claim of the complainant within 30 days. No order as to costs. This order shall be complied with accordingly. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:28.03.2023                                                                     

                                                                President,

                                                    District Consumer Disputes

                                                    Redressal Commission, Karnal.

 

(Vineet Kaushik)        (Dr. Rekha Chaudhary)

  Member                   Member