Haryana

Ambala

CC/49/2024

HARLAL. - Complainant(s)

Versus

THE BRANCH MANAGER,ORIENTAL INSURANCE CO.LTD. - Opp.Party(s)

PRIYANKA SAROYA

18 Dec 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA

Complaint case no.	:	49 of 2024
Date of Institution	:	15.02.2024
Date of decision	:	18.12.2024

 

Harlal son of Sh.Mahinder, resident of House No.247, Sunder Nagar, near Gurudwara, Ambala Cantt.

  ……. Complainant.

Versus

 

The Branch Manager, Oriental Insurance Co. Ltd. LIC Building, Opp. Gandhi Ground, Ambala Cantt.

                                                                                   ….…. Opposite Party

 

Before:         Smt. Neena Sandhu, President.

                       Smt. Ruby Sharma, Member,

           Shri Vinod Kumar Sharma, Member.           

 

Present:        Ms. Rashmi, Advocate, counsel for the complainant.

                    Shri R.K. Vig, Advocate, counsel for the OP.

Order:          Smt. Neena Sandhu, President.

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

1. To pay IDV of the vehicle in question to the tune of Rs.16,57,901/- alongwith interest more than 2% p.a. than the bank rate prevailing in the market at the time of incident.
2. To pay Rs.2,00,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.  
3. To pay Rs.22,000/-, as litigation expenses.
4. Grant any other relief which this Hon’ble Commission  may deem fit.  

 

2.             Brief facts of the case are that the complainant is the registered owner of car i.e AUDI A-4 bearing Registration No.HR-26G-1049, which he purchased under finance scheme. He got it insured with the OP vide insurance policy No.211200/31/2023/23518, for the period from 10.12.2022 to 09.12.2023. On 11.07.2023, due to heavy rain there was flood in the area of Ambala Cantt., where the house of the complainant is situated.  The vehicle of the complainant got totally damaged in flood. Soon after the incident, complainant reported the matter to the OP (Insurance co.) and it deputed a surveyor and the OP after confirming the correctness of the total damage of the said vehicle advised the complainant to submit the claim. Accordingly, the complainant lodged the claim with the Nodel Officer of the OP. When no information was received by the complainant from the OP, then on 30.11.2023, he reported the matter to OMBUDSMAN CHANDIGARH, who after hearing the parties passed the award and directed the OP to comply with the instructions mentioned in the award, but it failed to comply with the said directions. Thereafter, the complainant visited the OP and contacted Shri Dinesh Kumar and requested him to do the needful, but he did not give any satisfactory reply. Thereafter, the complainant reported the matter to IRDAI on 03.01.2024, but the Op did not appear before the IRDAI also. Complainant again contacted said Dinesh Kumar and asked about the fate of his claim, but he told the complainant to contact the Investigator Mr. Shubham Arora. The said investigator told to pay Rs.1,00,000/- (Rupees one lac), to him otherwise, he will reject the claim. He also told the complainant to pay him Rs. 10,000/-, in cash, as processing fee in addition to Rs.1,00,000/-. Complainant submitted the documents with the investigator but he starting putting hard cross question to the complainant, whereas, as per the condition of General Regulation Act, no person of the Insurance Company has a right or authority to put contradictory questions to the complainant. Complainant wrote following letters/complaints before the higher authorities of Insurance Co. with regard to matter in dispute:-

a) Before the IRDAI on 03.01.2024.

b) Before Nodel Officer Delhi vide complaint No.CIN-U- 66010DL1947G01007158.

3. Complaint against Investigator Mr. Shubham Arora, Mr. Dinesh and Mr. Sanjay for demanding 1,00,000/- from the complainant as bribe before Sandeep Thapa on 10.01.2024;

4. Complaint dated 28.12.2023 vide complaint       No. 21100@orientalinsurance.co.kn before Nodel Officer.

e) On 22.1.2024 before Minister of Finance Cooperate Affairs, noth Block New Delhi.

f) Complaint before RBI vide policy No. 202324023512.

It is stated that OP assessed the IDV of the vehicle of complainant to the tune of Rs. 16,57,901/- and had charged the premium accordingly and now raising objection that the IDV of the vehicle has been assessed in excess. The OP rejected the claim of the complainant without any valid reason. It is worth to mention here that in case the Insurance Co. fails to pay the claim amount within 30 days, in that event, as per The Gazette of India Notification REGD NO D.L. 33004/99 published on 30 June 2017/ASADHA 9, 1939, the Insurance Co. i.e. OP is liable to pay interest on the claim amount with 2% more interest than the Bank rate prevailing at that time. It is further stated that the complainant is running from pillar to post, to get the claim but the official of the OP are not co-operating the complainant and harassing him un-necessarily. Complainant is paying parking charges to the tune of Rs.3,000/- per month from the date of incident i.e. 11.07.2023, till date. The complainant has suffered a loss more than Rs. 42,00,000/- which is more then IDV i.e. Rs.16,57,901/-. It is further stated that the OP instead of paying the claim amount had filed a complaint against the complainant under section 138 of N.I. Act., which is pending in the court of Ld. J.M.I.C. and in that case, the complainant paid Rs.50,000/- as legal fee to his counsel besides other expenses on litigations. Due to non-receipt of claim amount of his damaged vehicle (i.e. flood loss), the complainant is facing heavy financial difficulties mental agony and harassment. By not paying the genuine claim amount, the OPs have committed deficiency in providing service, hence, the present complaint.

3.           Upon notice, the OP appeared and filed written version and raised preliminary objections with regard to maintainability, cause of action, not come with clean hands and suppressed the material facts etc.  On merits, it has been stated that the answering OP issued policy No.211200/31/2023/23518 w.e.f 10.12.2022 to 09.12.2023, in favour of the complainant subject to terms and conditions of the policy. Complainant informed the answering OP regarding damage of his vehicle due to flood. OP upon receipt of intimation for the subject loss immediately appointed IRDA Licensed surveyor Mr. Sudhir Dhingra, Ametek Insurance Surveyors and Loss Assessors Private Limited, to carry the survey and to assess the loss of vehicle No. HR-26G-1049, who in his detailed report dated 20.01.2024, observed as under:-

(a) The net assessed amount of insurer (without dismantling of the vehicle) on repair basis worked out is Rs. 1608460.76 & is liable to increase further,  therefore is uneconomical. 

(b) The net assessed amount of insurers on total loss basis worked out is Rs. 1655901/-. To this expenses to collect/scrutinize/advertise/store/sell the salvage which would be uneconomical

(c) The net assessed amount for insurers on net of salvage loss basis with RC worked out to Rs. 1433901/- is the most economical mode of settlement for the insurers, if the decision of salvage is taken within stipulated time limit. Also there will not be any further expenses. The surveyor acted within the four corners of Policy while forming is opinion in his report dated 20.01.2024.

 

It is further stated that the insurance company also appointed investigator Er. Shubham Arora, to investigate the matter who prepared the report dated 12.01.2024. Er. Shubham Arora, also wrote letter dated 24.11.2023 and 20.12.2023 in connection with the claim and asked the complainant to provide clarification but he did not bother to submit the requisite information to the investigator. The matter was also reported by the complainant before the Insurance Ombudsman, Chandigarh for redressal and the said complaint was resolved in terms of agreement of conciliation arrived at between insured and the Hon’ble Ombudsman, gave instructions to the insurance company to send the compliance report within 30 days, after receipt of the order dated 30.11.2023:-

(a) Being pre-mature compliant, at this point, it agreed between the two parties    that he is consultation with insurer will visit the office within. three days to   have meeting with surveyor & the investigator in the presence of insurer's   representative to clarify all his doubt & submit the requisite documents. After receipt of Survey and investigation report, insurer will process & settle the claim on merits as per Policy terms and conditions. 

(b) After online hearing you have visited the office on very next day in the presence of Surveyor M/S Ametek, Investigator, Mr. Shubham Arora, SVC In charge Sh. Dinesh Gupta & dealing officer Sh. Sanjay Kumar.

1. At the time of above meeting, investigator tries to handover letter for pending requirements for completion of investigation/survey. but you refused to accept the same in the presence of all.

2. Then investigator sent the letter through registered post at two addresses given by you; but no reply received from your side.

3. Requirements letters dated 24.11.2023, 04.12.2023, 15.12.2023 & 20.12.2023 by surveyor/investigator/SVC team were sent to you; but you have not replied to any of above letters.

4. A mail dated 29.12.2023 was also sent to you by dealing officer; for which you have replied on 30.12.2023 by mail (narrated below).

Query	Reply of Insured
Mode of payment statement for purchase of a vehicle	No such condition is there in Ombudsman award
	As per IRDA guidelines, it is not required to ask mode of payment at the time of claim
	As per GR-8, IDV is declared & that is fixe for both parties.
Loan statement of vehicle	Loan for closure is already given to surveyor/investigator
Complete service record of	Vehicle was being serviced by
The vehicle as per request of investigator	Local Market, so there is no record of service

From all the above replies, it is clear that you are not ready to co- operate with the insurer, where as Hon'ble Ombudsman have clearly directed, both parties that you in consultation with insurer, to clarify all their doubt and submit the requisite documents but you are neither submitting the documents nor clearing doubts to the Insurance Company. As per instructions of Hon'ble Ombudsman, you are failed to furnish/comply the requirements raised by the claim dealing officer/surveyor/investigator.

 Further the Company observed as follows:-

(a) While checking claim history from IIB Portal, it has been observed that a claim against the above vehicle was reported & paid by Go Digit Insurance Company on 24.04.2022 for Rs. 779426/-. We tried to contact our salvage partner M/S Cardekho to check details of first claim on this vehicle, where they have confirmed/informed that this is the second time when the vehicle is going to be total loss.

(b) There was continued rain in all over Ambala, Panchkula & Karnal with nearby areas from 6th July onwards, then at that time you left Car to your uncle's home on 07.07.2023, seems as if vehicle was intentionally kept there to claim total claim under the Policy.

(c) Diesel vehicle after 10 years of age are not allowed to use in NCR as per regulation of Delhi Government & hence value of these Diesel vehicles is considerably reduced and almost negligible.

(d) The said AUDI-A4 TDI Car vide registered No. HR-26-CG-1049 was model of 2014 and of Diesel only thereafter empanelled investigator appointed by the company who are duly competent to investigate the case & to submit the report.

 

He further stated that even otherwise, because there were reduction in the market value of the vehicle due to the National Green Tribunal’s (NGT) judgment fitness of the diesel variant vehicle was overruled from 15 years to 10 years, which allegedly lowered the IDV and therefore the complainant was not entitled for full IDV after total loss of the said vehicle. It is further stated that the net assessed amount of insurer (without dismantling of the vehicle) on repair basis worked out is Rs.16,08,460.76 & is liable to increase further, there is uneconomical and the net assessed amount of insurers on total loss basis worked out is Rs.16,55,901/-. Furthermore, the net assessed amount for insurers on net of salvage loss basis with RC worked out to Rs.14,33,901/- is most economical mode of settlement for the insurers, if the decision of salvage is taken within stipulated time limit.It is further stated that due to non-submission of the requisite documents by the complainant and in the absence of his support/co-operation, the claim was rightly repudiated vide letter dated 07.02.2024. Rest of the averments made by the complainant in his complaint were denied by the OP and prayed for dismissal of the present complaint with heavy costs.

4.           Learned counsel for the complainant tendered affidavit of the complainant as Annexure C-A alongwith documents as Annexure C-1 and C-10 and closed the evidence on behalf of the complainant.  Learned counsel for the OP tendered affidavit of Kapil Khapra, Deputy Manager of OP-Company-Oriental Insurance Company Limited, LIC Building, 2^nd Floor, Ambala Cantt.; Sudhir Dhingra, Ametek Insurance Surveyors and Loss Assessors Private Ltd.; and Er. Shubham Arora, Insurance Claim Investigator as Annexure OP-A, Op-B & OP-C respectively alongwith documents as Annexure OP-1 to OP-26 and closed the evidence on behalf of OP.
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 not paying the genuine claim arising out of total loss of the insured vehicle in question, as it got damaged during existence of the insurance policy and closing the same on vague ground of non supply of documents, the OP has indulged into unfair trade practice and also the said act amounts to deficiency in providing service on its part.
7.           Learned counsel for the OP submitted that the claim of the complainant was closed by the OP as “No Claim” via letter dated 07.02.2024 (Annexure OP-25) because of non supply of documents qua mode of payment towards the purchase of the vehicle; non-supply of loan statement of the vehicle; non-provision of a complete service record of the vehicle; the vehicle was intentionally parked at Ambala, where the flood occurred, to claim a total loss. He further submitted that even otherwise, because there were reduction in the market value of the vehicle due to the National Green Tribunal’s (NGT) order reducing the age of diesel vehicles in NCR to 10 years, which allegedly lowered the IDV and therefore the complainant was not entitled for full IDV after total loss of the said vehicle.
8.           It is not disputed that the vehicle in question was insured for the period from 10.12.2022 to 09.12.2023, with an Insured Declared Value (IDV) of Rs.16,57,901/-, as is evident from the insurance policy Annexure C-2 and C-3. It is also not disputed that the vehicle was severely damaged in a flood that occurred on 11.07.2023,  in the area of Ambala Cantt., while the said vehicle was parked, as confirmed in the surveyor's MOTOR FINAL SURVEY REPORT dated 20.01.2024, Annexure OP-8 also. The surveyor, Ametek Insurance Surveyors and Loss Assessors (P) Ltd., vide MOTOR FINAL SURVEY REPORT dated 20.01.2024, Annexure OP-8 opined that the loss can be attributed to the circumstances, and the damages were consistent with the reported cause of loss and were found to be fresh. Despite the said findings of the surveyor, the  OP  closed the complainant's claim as “No Claim” via letter dated 07.02.2024 (Annexure OP-25), citing the following grounds:

1. Non-supply of mode of payment towards the purchase of the vehicle.
2. Non-supply of the loan statement of the vehicle.
3. Non-provision of a complete service record of the vehicle.
4. The vehicle was intentionally parked at Ambala, where the flood occurred, to claim a total loss.
5. Reduction in the market value of the vehicle due to the National Green Tribunal’s (NGT) order reducing the age of diesel vehicles in NCR to 10 years, which allegedly lowered the IDV.

9.           The first three grounds no.1 to 3 aforesaid, cited by the OP relate to the alleged non-supply of documents, such as the mode of payment for the vehicle’s purchase, the loan statement, and the complete service record. The complainant, in his response, vide email dated 30.12.2023, Annexure OP-19  has clarified that he had provided the loan statement and RC to the investigator and has also informed the surveyor that the vehicle was serviced from local market thereby, thereby making the service record unavailable. However, as far as mode of payment for purchase of the said vehicle is concerned, the complainant justifiably stated in his above said email that the mode of payment for the purchase of the vehicle should have been required by the OP at the time of insuring the vehicle and not during the claim settlement process. The OP did not provide any plausible or legally justifiable reason for demanding these documents post-incident, especially when the surveyor’s report clearly established the cause of loss.
10.           It is essential to note that the failure to supply certain documents, does not absolve the insurance company from its liability, particularly when the surveyor’s findings align with the claim circumstances. The demand for these documents at this stage seems arbitrary and unreasonable, especially when the complainant has provided satisfactory responses and has made efforts to cooperate with the survey process. Under these circumstances, it is held that the OP was deficient in providing service by denying the claim on this ground.
11.           Now coming to the ground taken by the OP that the market value of the diesel vehicles in NCR was reduced due to the NGT’s ruling, which reduces the permissible age of diesel vehicles from 15 years to 10 years, and consequently, the IDV of the vehicle in question should be reduced to Rs.7-8 lakh. It may be stated here that the OP has failed to submit any cogent evidence, such as a circular or directive from the IRDA, mandating a reduction in the IDV of existing vehicles based on the NGT’s order, in the NCR region or in Ambala, wherein incident of flooding took place and vehicle suffered total loss. At the time of insuring the vehicle, the IDV was clearly stated as Rs.16,57,901/-, and there is no provision or legal directive that would allow the  OP  to unilaterally revise the IDV or adjust the claim amount based on the NGT’s ruling on the age of diesel vehicles. Without such substantiated evidence, the OP ’s claim to reduce the vehicle’s value is untenable and lacks legal basis.
12.           The OP also raised the ground that the vehicle may have been intentionally parked at the premises in Ambala, where the flood occurred, in order to claim a total loss. However, this allegation is based purely on conjecture and without any factual or evidentiary support. Such an assumption, without clear evidence, is not enough to deny the claim and constitutes an unjustified ground for rejection.
13.           In light of the above, it is clear that the OP’s denial of the complainant’s claim and closing it as NO CLAIM was based on vague, unsubstantiated, and legally unsound grounds.
14.           As stated above, the surveyor, Ametek Insurance Surveyors and Loss Assessors (P) Ltd., appointed by the  OP , confirmed that the damage to the vehicle was consistent with the reported cause of loss and was found to be fresh and that the net total loss is worked out to be Rs.16,55,901/-. In this view of the matter, we hold that the insurance is liable to pay the said amount to the complainant.  
15.           In view of the aforesaid discussion, we hereby allow the present complaint and direct the OP, in the following manner:-

1. To  pay Rs.16,55,901/- to the complainant against total loss of the vehicle as assessed by the surveyor in his report 20.01.2024, Annexure OP-8, alongwith interest @6% p.a. from the date of denying the claim i.e. from 07.02.2024 till realization.
2. To pay Rs.5,000/-, as compensation for the mental agony and physical harassment suffered by the complainant.
3. To pay Rs.3,000/-, as litigation expenses.

The OP is further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OP shall pay interest @ 8% per annum on the awarded amount, from the date of default, till realization.

However, the complainant shall handover the damaged vehicle to the OP alongwith its documents on receipt of the aforesaid amount.

                   Certified copy of this 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:- 18.12.2024

 

 

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