Haryana

Karnal

CC/143/2021

Balram - Complainant(s)

Versus

The Manager, New India Assurance Company Limited - Opp.Party(s)

Uttam Chand

11 Oct 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                        Complaint No. 143 of 2021

                                                        Date of instt.09.03.2021

                                                        Date of Decision:11.10.2023

 

Balram son of Shri Ram Kumar, resident of village Gangatheri Tehsil Assandh District Karnal now posted in Indian army as (Head Constable) station Cell, HQ MB area, Jabalpur.

 

                                               …….Complainant.

                                              Versus

 

1. The Manager, New India assurance Co. Ltd. 5406, 2^nd floor, Cross Road 3, Punjabi Mohalla, Ambala Cantt.

 

2. The Manager, New India Assurance Co., Serving Office: DO 122200, New India Centre, 1^st floor, 17A, Cooper Road, Mumbai, Maharashtra.

                                                                      …..Opposite parties

 

Complaint Under Section 35 of Consumer Protection Act, 2019.

 

Before   Sh. Jaswant Singh……President.       

      Sh. Vineet Kaushik…….Member

 

 Argued by: Shri Uttam Chand, counsel for complainant.

                    Shri Naveen Khetarpal, 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 is working in Indian Army and is owner of vehicle (Tata Tiago) bearing no.HR-40G-1743 which was insured with the OPs no.1, vide policy no.12220031171350102684, valid from 31.03.2018 to 30.03.2019. The said policy was cashless policy. The complainant used to drive the car only when he came to his house on leave from his duty, complainant drives the said car very less. The said vehicle of complainant met with an accident in January, 2019 near Ambala, at that time complainant driving himself the said vehicle as complainant was coming back from Mata Vaishno Devi to his home and when he reached near Ambala meantime a vehicle tried to overtake the said vehicle  and complainant during that process tried to save his vehicle and vehicle of complainant was imbalanced and got struck with a big stone and vehicle dropped in to ditches then complainant took the vehicle to the Metro Motors Pvt. Ltd. Karnal to get it repaired where the competitive authority of insurance company declined his insurance claim on the ground that his driving license is not valid as driving license category allowed to drive only two wheeler and complainant was told that the said vehicle cannot repaired under the insurance policy. So, complainant repaired the said vehicle on 29.01.2019 from the agency and dropped the vehicle to a local mechanic Vikas Auto Care, Jind Road, Assandh in the evening on same day i.e.29.01.2019 to get it repaired. Complainant has paid Rs.11800/- to the said agency as repair charges. After that complainant join his duty again in Indian Army and the said vehicle was parked at his home as usual. On 12.03.2019 the real elder brother of complainant namely Kuldeep Singh alongwith complainant’s family was going to Haridwar to perform religious rituals and Kuldeep Singh was driving the said vehicle and when they were 15kms behind from Muzaffar Nagar on the way towards Haridwar. Then suddenly a Neel cow came on the road and to save the Neel cow, the car was hit into the Khokha (wooden room) and car was turned turtle at the spot. Thereafter, vehicle was taken to Metro Motors Pvt. Ltd. Karnal through crane namely Guru Nanak Crane Service. Ajay Sharma and Ashwani both were the employee of Metro Motors Pvt. Ltd. who deal with the complainant. The complainant was told by the agency employee that his policy is cashless policy and he will has to pay only Rs.1500/- and rest of the amount of bill be paid by the insurance company. But on 29.03.2019 at the time of delivery of vehicle after repair, company employee told the complainant that his cashless scheme is not working and he will pay the full amount and lateron his bill will be reimbursed by the insurance company. A bill of Rs.78127/- was prepared by the Metro Motors and complainant paid the said amount. Then complainant visited the office of OPs and requested to reimburse the said amount but OPs did not pay any heed to the request of complainant and lastly rejected the claim of the complainant on the ground that claim is not maintainable or payable due to violation of terms and conditions of the policy. Thereafter, complainant wrote a letter dated 01.09.2019 to insurance company and requested to reimburse the aforesaid bill but the said letter has also no 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 and concealment of true and material facts. On merits, it is pleaded that the claim submitted by the complainant for the damage to their car occurred in month of January, 2019. The driver of the vehicle at the time of accident did not possess a valid and effective driving licence and hence the complainant took the vehicle without repaired on 29.01.2019. The claim is not maintainable and repudiated. However, with regard to alleged accident dated 12.03.2019. On receipt of intimation regarding damage of vehicle, company appointed an IRDA approved independent licensed surveyor Er. Arvind Koesis for survey and loss assessment. He submitted his report and pointed out that he inspected the car on 16.03.2021 and during inspection of car it is found old damages on  the right side of insured car. On enquiry, he found that car was got accident in January, 2019 and survey was conducted by Shri G.P. Singh surveyor Karnal. As the driving license submitted by insured, was not valid for driving the car. Hence, the insured took away the car on 29.01.2019 without getting repairs work done. The meter reading of car was at that time was 7718kms. The complainant belongs to Assandh. He checked the gate register for the month of March, 2019 and found the car brought again on 07.03.2019 for accidental repairs, but in intimation and claim form submitted by the insured, the date of accident is mentioned as 12.03.2019 and place of accident is mention Roorkkee Road Muzaffarnagr. At the time of survey, surveyor found meter reading as 7970 Kms. It means the vehicle run 252 kms. within 1½ months. It is further pleaded that during survey, surveyor found scratches of tree also on right side of insured car. It seems that these damages were manipulated were old and further manipulated, as nature of damages and even place of damages are same as of reported in earlier claim. Moreover, the material facts regarding the loss have been concealed by the insured, which amounts to gross violation of condition no.8 of the policy. Thus, the claim of the complainant was rightly repudiated by the OPs. 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.             Complainant has tendered into evidence affidavit of complainant Ex.C1, copy of insurance policy Ex.C2, copy of bill of Vikas Auto care Ex.C3, copy of bill of Nanak Crane Service Ex.C4, copy of bill Metro Motors Pvt. Ltd. Ex.C5, copy of letter to complainant dated 19.04.2019 Ex.C6, copy of letter to complainant dated 20.11.2019 Ex.C7, copy of RC Ex.C8, copy of letter dated 07.09.2019 Ex.C9, copy of driving licence Ex.C10 and closed the evidence on 23.02.2022 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of R.K. Mittal Manager Ex.RW1/A, copy of repudiation letters dated 20.11.2019 and 19.04.2019 Ex.R1 and Ex.R2, copy of survey report dated 09.04.2019 of Er. Arvind Koesis Surveyor and Loss Assessor Ex.R3, copy of claim form Ex.R4, copy of driving licence Ex.R5, copy of aadhar card and PAN card Ex.R6, copy of insurance policy Ex.R7, copy of terms and conditions of policy Ex.R8, copy of survey report dated 14.02.2019 of G.P. Singh Surveyor and Loss Assessor Ex.R9, copy of claim form Ex.R10, copy of insurance policy Ex.R11 and closed the evidence on 24.05.2023 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, the complainant got insured his vehicle with the OPs. The said vehicle of complainant met with an accident in January, 2019 near Ambala. Complainant took the vehicle to the Metro Motors Pvt. Ltd. Karnal to get it repaired where the competitive authority of insurance company declined his insurance claim on the ground that his driving license is not valid. So, complainant got repaired the said vehicle on 29.01.2019 from the other agency and paid Rs.11800/- as repair charges. He further aqrgued that on 12.03.2019 the brother of complainant namely Kuldeep Singh alongwith complainant’s family was going to Haridwar and when they reached near Muzaffar Nagar,  suddenly a Neel cow came on the road and to save the Neel cow, the car was hit into the Khokha  and badly damaged.  The vehicle was taken to Metro Motors Pvt. Ltd. Karnal through crane. Complainant spent Rs.78127/- on the repair of the vehicle in question. Complainant submitted the claim with the OPs and requested to reimburse the said amount but OPs did not pay the same  and lastly rejected the claim of the complainant on the false and frivolous ground and lastly prayed for allowing the complaint.

8.             Per contra, learned counsel for the OPs, while reiterating the contents of written version, has vehemently argued that complainant filed the claim for the damage to his car occurred in month of January, 2019. At the time of accident, complainant did not possess a valid and effective driving licence. He further argued that on receipt of intimation regarding the second accident dated 12.03.2019, company appointed an IRDA approved independent licensed surveyor, who submitted his report and pointed out that during inspection of car it is found old damages on the right side of insured car.  On checking the gate register for the month of March, 2019 found the car brought again on 07.03.2019 for accidental repairs, but in intimation and claim form submitted by the insured, the date of accident is mentioned as 12.03.2019 and place of accident is mention Roorkkee Road Muzaffarnagar. It means the vehicle run 252 kms. within 1½ months.  During survey, surveyor found scratches of tree also on right side of insured car. It seems that these damages were manipulated were old and further manipulated, as nature of damages and even place of damages are same as of reported in earlier claim. So, the claim of the complainant was rightly repudiated by the OPs and lastly prayed for dismissal of the complaint.

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

10.           Admittedly, complainant got his vehicle insured with the  OPs for the IDV of Rs.4,26,870/-. It is also admitted that the vehicle of the complainant also met with an accident in the month of January, 2019. It is also admitted that the said claim also repudiated by the OPs.

11.           The claim of the complainant has been repudiated by the OP, vide repudiation letter Ex.C7 dated 20.11.2019 on the following ground, which is reproduced as under:-

“On perusal of the claim documents while processing the  claim we have observed that vehicle was brought for repairs in January, 2019 and claim was also reported with us and surveyor namely Shri G.P. Singh was deputed to assess the loss but on that particular point of time driver on wheels was not possessing a valid and effective driving licence and hence you took the vehicle in question without getting the same repaired on 29.01.2019 and meter reading at that point of time was 7718 Kms and in the current loss meter reading is 7970Kms meaning by vehicle run 252 Kms within one and half month and further during the inspection in current loss, it has been pointed out by the surveyor that the current damages have been manipulated to cover the old damages, as nature of damages and even place of damages are same as of reported in earlier claim. Hence, it is very clear that at the time of intimating the claim your have concealed these material facts intentionally, which amounts to misrepresentation and further you have manipulated the things to get the unjustified claim in a justified condition.

We regret out inability to consider your claim on the above ground. Hence your claim is not payable and does not require any further consideration”.

12.           The claim of the complainant has been repudiated by the OPs on the above mentioned ground. The OPs have alleged that damages have been manipulated to cover the old damages, as nature of damages and even place of damages are same as of reported in earlier claim. On the other hand, the complainant alleged that all the damages occurred in the accident took place on 12.03.2019.

13.           The onus to prove his case was relied upon the complainant but he has miserably failed to prove the same by leading any cogent and convincing evidence. The complainant alleged that when his brother namely Kuldeep Singh alongwith complainant’s family was going to Haridwar and when they reached near Muzaffarnagar, the vehicle met an accident. The brother of complainant has not got lodged any DDR/FIR to prove the said accident. The persons who travelled in the said car would have received injuries in the said accident but no treatment record has been produced by the complainant. As per gate pass registered of the OPs for the month of March, 2019, the vehicle in question was brought on 07.03.2019 for accidental repairs in the workshop of the OPs. The alleged accident had taken on 12.03.2019. Thus, it appears that damages in the vehicle had occurred prior to 12.03.2019. Earlier accident claim has already been repudiated by the OPs on the ground of invalid driving licence. The surveyor of the OPs come to the conclusion that damages were manipulated were old and further manipulated as nature of the damages and place of damages are same as of reported in earlier claim. In view of the above, we are of the view that no accident took place as alleged by the complainant.

14.           Thus, as a sequel to abovesaid discussion, the present complaint is devoid of merits and same deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 11.10.2023

                                                                President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

                  (Vineet Kaushik)      

                      Member