SMT. RAVI SUSHA: PRESIDENT

   This complaint has been filed by the complainant  against the opposite party for getting an order directing opposite party to  pay Rs.27,577/- the balance claim amount with Rs.25,000/- towards compensation  for the mental agony and harassment from the side of OP due to its  deficiency in service.

    Briefly stated, the facts of the case are ,that the complainant’s vehicle had been fully comprehensively ( bumber to bumber) insured with OP  and in case of an accident, the insured vehicle was to be treated as loss happened without any depreciation to the parts of the vehicle.  Complainant submitted that he had paid Rs.124577/- towards total  expense to the repair charge and replacement of  parts of the vehicle due to the accident.  But making a payment of only Rs.97,000/- after deducting  Rs.27577/-  under the liability clause, the act of the  OPs company by not  making the total claim amount as per the comprehensive insurance policy, amounts to unfair trade practice and deficiency in service. Hence the complaint

       Reply was filed by the  OP and admitted the policy to the complainant for the vehicle, subject to the terms and conditions as per the policy.  It is pleaded that  on receipt of the claim form from the complainant, the OP deputed the licensed surveyor and loss assessor  to conduct  a survey over the damaged vehicle and to make an assessment of the loss due to the damage caused to the vehicle . As per the terms and conditions of the policy and  the report of the  licensed surveyor and loss assessor, the OP allowed a sum of Rs.97,000/- to the complainant  against the  repair bill of the work shop for Rs.1,24,577/-. A sum of Rs.27,186.72 was disallowed by the OP because as per the estimate  made by the work shop, the surveyor found that the said amount is not allowable.  According to the  surveyor the bill for repair  of the  vehicle was not proper and correct, which are not covered under the policy.  The complainant has not  submitted all the relevant documents to process the claim along with the  claim form in order to enable the  OP to  process the claim at the earliest opportunity.  The OP had to issue letters after letters to alert the complainant to submit the documents including the copy of the FIR from the police station, which are the primary documents to process the claim.  Hence the normal time taken for processing the claim is due to the default  on the part of the complainant.  The complainant is  not entitled to claim  for Rs.27,577/- towards the balance  of the said repair bill.  The claim was settled as per the terms and condition of the insurance policy and as per the report of the surveyor and  loss assessor.  Hence prayed for the dismissal of the complaint.

    The parties led their evidence in support of their contentions.  Complainant has filed chief-affidavit and documents.  Examined as PW1, marked Exts.A1 to A4.  On the side of  OP, Manager of OP, has filed his chief-affidavit and examined as DW1.  Exts B1 to B3 were marked.  Insurance surveyor and Loss Assessor , Mr.A.K. Krishna kumar, who conducted the  inspection of the  insured vehicle was also examined as DW2 .

     After that the learned counsel of both parties made argument before us.

     It is submitted by the learned counsel of complainant that the vehicle had been fully comprehensively ( bumber to bumber) insured and in case of an accident, the insured vehicle was to be treated as loss happened without any depreciation to the parts of the vehicle.  Complainant alleged that he had paid Rs.124577/- towards total  expense to the repair charge and replacement of  parts of the vehicle due to the accident.  But making a payment of only Rs.97,000/- after deducting  Rs.27577/-  under the liability clause, the act of the  OPs company by not  making the total claim amount as per the comprehensive insurance policy, amounts to unfair trade practice and deficiency in service.

     OP contended that as per the terms and conditions of the insurance policy and on the basis of the report of the licensed surveyor and   loss assessor , the OP allowed a sum of Rs.97,000/- to the complainant against the repair bill  of the  workshop for  Rs.1,27,577/-.  It is submitted that according to the surveyor the bill for repair of the vehicle was not proper and correct because the items cable defer control( bill No.11), bulb (bill No.27), Reverse camera( bill No.28), Tail lamp garnish(bill.No.31) are replaced by the  complainant at his  discretion and cover shifting hole (bill No.12), back  door ornament( bill No.30) are not covered by insurance are seen replaced.  Surveyor also  deducted policy excess Rs.2000/- and salvage value Rs.1500.00/- , as per policy condition.  Total amount comes as Rs.27186.77 .  It is also submitted by the learned counsel of  OP that the OP had to issue letters after reletters to alert the complainant to submit the documents including the copy of the FIR from the police station, which are  the primary documents to process the claim.  Hence the normal time taken for processing the claim is due to the  default on the part of the complainant alone.  Further stated that the claim of the complainant was settled for Rs.97,000/- towards the full and final settlement of the claim, which was received by the complainant.  Further as per re-inspection report of the surveyor, he has observed that all the spare parts recommended by him to be replaced are found replaced.

    After giving through the facts of the case, we are of the opinion that the survey report  prepared by the authorized surveyor and loss Assessor was placed by the OP and marked it  as Ext.B2, through the surveyor(DW2), wherein   the total amount disallowed by the surveyor has been shown as Rs.27186.72/- and the amount assessed as Rs.97,000/-(Rs.97389/- rounded to Rs.97,000/-) which was duly accepted by the complainant as full and final settlement.  It is an admitted fact that the complainant has received the said amount without making any written objection.  As in this case, the  OP has already settled the claim of the complainant as per the surveyor report.  It is also a fact that the surveyor has not  deducted any amount as assessed towards  depreciation, to the replaced parts of the vehicle  as recommended by him.  Moreover  on perusal of Ext.B1, the cover description portion does not mention that the insured had opted  insurance to the  additional  fittings of the vehicle.  Complainant failed to prove that he had insured, items such as cover shifting hole item No.12 and back door ornament bill No.30 in Ext.A2, and paid premium  to those items.  Complainant also failed to prove that cable defer control Bill No.11, Bulb(Bill No.27) and Tail  lamp garnish Bill No.31 in Ext.A2 were recommended by the surveyor to be  replaced.  On perusal of  Ext.B2 survey report nowhere mentioned that those items were recommended by the insurance surveyor to be replaced.

     Therefore, we are of the view that there is no deficiency in service or unfair trade practice on the part of OPs.  So the  complainant is not entitled to get additional amount than  Rs.97,000/- as received by him.

      In view of the forgoing discussion, the complaint filed the complainant is dismissed .  No order as to cost.

Exts:

A1-Notice issued by OP

A2- Service centre bill

A3- Bank statement

A4- policy

B1-Insurance policy with condition

B2- survey report

B3- claim form

PW1-Mohammed Ashraf C.P- complainant

DW1-Haridasan.K- OP

DW2-A.K.Krishna Kumar-witness of OP

Sd/                                                   Sd/                                                     Sd/

PRESIDENT                                             MEMBER                                               MEMBER

Ravi Susha                                       Molykutty Mathew                                    Sajeesh K.P

eva           

                                                                        /Forwarded by Order/

                                                 ASSISTANT REGISTRAR