Haryana

Karnal

CC/400/2022

M/s Meet Trading Company - Complainant(s)

Versus

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

Baalwan Singh

24 Sep 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No.400 of 2022

                                                        Date of instt 15.07.2022

                                                        Date of Decision:24.09.2024

 

M/s Meet Trading Company, situated at 679, Sector-4, Transport Nagar, Part-II, Karnal through its proprietor Shri Jawahar Singh. Mobile no.8930200092.

                                                                        …….Complainant.

                                              Versus

 

The New India Assurance Co. Ltd. Divisional Office, opposite Bus Stand Old G.T. Road, Karnal through its Divisional Manager.

 

                                                                   …..Opposite Party.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.

              Ms. Neeru Agarwal……Member

      Ms. Sarvjeet Kaur..…..Member

 

 Argued by: Shri Balwan Singh Dhaunchak, counsel for the

                 complainant.

                 Shri Sudhakar Mittal, counsel for the OP.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that complainant got insured his vehicle i.e. Truck Tata Signa 5523 SCRE BS-4, bearing registration no.HR-45C-6913 with the OP for a sum insured of Rs.31,60,000/- under a package policy no.1222003120-1350041250 for the period of insurance 24.07.2020 to 30.07.2021 by paying a premium of Rs.77596/-. On 23.06.2021 at 3.00 a.m. when Mr. Sombir (paid driver) was driving the captioned vehicle laden with core sand from Ranjipur (Yamuna Nagar) to Kundli (Sonepat) on the way after crossing Bastara Toll barrier captioned vehicle hit into the back of another ahead going vehicle (reported truck) suddenly applied brakes causing extensive damages to the front portion of captioned vehicle. No injury to driver, no TPPD reported. The TP truck as informed sped away from the spot of accident after the accident. The intimation was given to the OP on the same day and the spot survey was got conducted. Thereafter, accidental vehicle was shifted to M/s Metro Motors, Karnal for its repairing and the OP was informed for appointment of final surveyor. OP deputed M/s Chhatwal & Associates Insurance Surveyors and Loss Assessors, Ambala Cantt. for final survey. The Surveyor inspected the vehicle, verified all claim documents and submitted the survey report with the OP. After sometime, OP deputed the investigator for verifying the facts of accident. Investigator inspected the site of accident and completed the documents as per his requirement. But the investigator submitted the fake and fabricated investigation report by mentioning that driver has been changed and that Shri Sombir was not driving the vehicle at the time of accident but the investigator could not bring out the name of other driver at the time of accident. OP did not settle the claim neither took any decision about the admissibility of the claim. The repaired vehicle of complainant was lying with the Metor Motors, Karnal for a long time but due to bad intention of OP, the claim was not settled. Then complainant took the matter to head office of OP, IRDAI, CVC and Ministry of Finance due to this aspect the Regional Manager of OP became annoyed with the complainant and bent upon to repudiate the claim. The Divisional office at Ambala of OP issued a letter on 06.12.2021 for some documents and clarifications. The D.O. Ambala asked for call details of proprietor Jawahar Singh of complainant and Driver Sombir alongwith asked for providing the original invoice of purchase of core sand loaded in the vehicle at the time of accident. All the relevant documents as desired by the OP were provided to the OP but inspite of that the claim of complainant has been repudiated by the OP, vide letter dated 23.12.2021 on the false and frivolous ground.

2.             It is further averred that a complaint reference no.CHD-G-049-2122-0292 was lodged with Insurance Ombudsman on 17.01.2022 and proceedings were held before the Insurance Ombudsman. During the online hearing the Insurance Ombudsman advised to the complainant to cooperate in the investigation and satisfy the queries of the OP and the same was agreed upon by the complainant. Accordingly an agreement by way of conciliation was arrived at between the insurer and complainant which was found fare and reasonable for both parties by the Insurance Ombudsman Award. Both the parties should implement this agreement within 30 days. But inspite of that the repudiation was not withdrawn by the OP rather the members of Committee formed were (Ms. Sonia Madan and Rakesh Chopra Investigators), Surveyor and Senior Divisional Manager of OP being the mere tools for and on behalf of OP who did not recommend the implementation of conciliation agreement. Since all the four were the same fellows, who earlier also were part of the process of repudiation of claim. Better it would have been if four independent/neutral persons were deputed in the Committee for taking the appropriate decision. However, no fruitful result came out and the end result was the same i.e. repudiation of genuine claim which was duly assessed as per survey report of M/s Chhatwal & Associates Insurance Surveyor and Loss Assessors to the tune of Rs.11,52,049/- subject to the terms and conditions of the insurance policy. The vehicle of the complainant is lying in the same damaged condition since 23.06.201 resulting into violation of the contract of insurance and genuine rights of the complainant by the OP. Due to this act and conduct of OP, complainant has been harassed mentally, socially and financially. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence, complainant filed the present complaint seeking direction to the OP to pay compensation of Rs.11,52,049/- on account of damage of the vehicle and Rs.2,00,000/- for mental pain, agony and harassment and to pay Rs.51,000/- as litigation expenses.

3.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; cause of action; locus standi and concealment of true and material facts. On merits, it is pleaded that the alleged accident took place on 23.06.2021 at about 3.00 a.m. when the truck was fully loaded with core sand. It was a major accident. The left hand side of the truck alongwith the driver seat was badly smashed. The alleged driver namely Sombir son of Mahender Singh, who was 8^th class pass did not suffer any injury and immediately left the spot. The second driver namely Pawan Kumar was also not accompanying him as he left the truck before the accident creating reasonable suspicion and that’s why independent surveyor and loss assessor namely Chhatwal & Associates, while submitting motor final survey report dated 03.09.2021, advised for investigation of the case before release of claim. The case file was entrusted to Karnal Associates, Investigator and Detective Agency for investigation purposes. During the course of investigation, the complainant alongwith his driver Sombir contacted the investigator and when the mobile location of the driver was found at some other place, instead of place of accident they started misbehaving with the investigator and even passed a threat to him. There was sufficient contradiction in their statement. The investigator lodged his complaint at Police Station Sector 32-33, Karnal where the complainant regretted for his behavior. The complainant assured the investigator to handover the desired documents and cooperates in the investigation but never did the same. The investigator submitted his report dated 09.09.2021 with remarks that he is unable to complete his investigation due to non co-operation of the complainant. The alleged accident was never reported before the Police despite the fact that it was a major accident and third party vehicle was damaged. The vehicle was immediately removed from the spot and its driver also left the spot immediately. The said driver is also facing one another trial in case FIR no.650 dated 26.10.2020, Police Station Samalkha, Panipat. Since the story put forward by the complainant regarding the alleged accident and no injury on the driver of the vehicle, was not believable and doubtful. The matter was referred to ICS Assure Services Pvt. Ltd. The same was investigated by Shri Suraj P Matondker, Automobile Engineer and Nivrtee R Magar, Senior Forensic Expert. The report dated 29.10.2021 was submitted by ICS Assure Services Pvt. Ltd. on the basis of scientific analysis, wherein ICS Assure Services Pvt. Ltd. was of opinion that:-

1. Insured vehicle’s cabin heavily damaged due to major frontal impact, at its left hand side.
2. Insure vehicle’s driver cannot escape unhurt in the said accident.
3. Sombir Singh (alleged driver) is not co-related to be seated on the driver seat, at the time of the said accident, as no injury is observed.
4. Considering vehicle’s specification, insured vehicle was overloaded by 600 Kgs, at the time of accident.

                From the bare perusal of the above mentioned facts, it is crystal clear that insured has not approached the insurer with clean hands and concealed the true and material facts by replacing the driver of the vehicle. The complainant has leveled false and frivolous allegation. The complainant himself manipulated the invoice, replace the driver, made contradictory statements, lodged false complaint before the police and raised complicated questions of law and facts, is not entitled to any relief under the provisions of Consumer Protection Act. It is further pleaded that all the authorities were of opinion that the complainant has not cooperated with them and concealed the true and material facts. On the basis of their opinions the claim was repudiated by the competent authority. There is no deficiency in service and unfair trade practice on the part of the OP. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of insurance policy Ex.C1, copy of estimate of damage vehicle Ex.C2, copy of Motor Survey Final Report dated 03.09.2021 of M/s Chhatwal & Associates, Insurance Surveyor and Loss Assessor Ex.C3, copy of letter from Senior Divisional Manager dated 06.12.2021, copy of reply of letter dated 16.12.2021 Ex.C4 and Ex.C5, copy of detail of proprietor Ex.C6, copy of letter dated 23.12.2021 from OP to complainant Ex.C7, copy of complaint dated 21.01.2022 to Insurance Ombudsman, Chandigarh Ex.C8, copy of letter dated 27.04.2022 from Senior Branch Manager to complainant Ex.C9, copy of appeal against repudiation of claim to General Manager (Motor-Technical) dated 28.12.2021 Ex.C10, copy of driving licence of Sombir, driver Ex.C11, copy of letter dated 04.04.2022 Ex.C12, copy of aadhar card of Jawahar Ex.C13 and closed the evidence on 10.02.2023 by suffering separate statement.

6.             On the other hand, learned counsel for the OP has tendered into evidence affidavit of Raj Kumar Mittal, Manager Ex.OP1/A, copy of intimation letter dated 23.06.2021 Ex.OP1, affidavit of Jawahar-complainant Ex.OP2, affidavit of Pawan Kumar Ex.OP3, copy of spot survey report dated 28.06.2021 Ex.OP4, copy of Motor Final survey report dated 03.09.2021 Ex.OP5, copy of investigation report Ex.OP6, copy of letter dated 27.10.2021 Ex.OP7, correspondence Ex.OP8, copy of motor accident reconstruction report Ex.OP9, copy of recommendation letter dated 16.11.2021 for repudiation of claim Ex.OP10, copy of investigation report by Shri Pankaj Goyal Ex.OP11, copy of letter dated 30.11.2021 Ex.OP12, copy of final opinion/addendum report dated 03.12.2021 Ex.OP13, copy of legal opinion dated 04.12.2021 Ex.OP14, copy of letter dated 06.12.2021 Ex.OP15, copy of mail dated 22.12.2021 Ex.OP16, copy of report under section 173Cr.P.C Ex.OP17, copy of complaint dated 25.10.2020 to SHO, Samalkha Ex.OP18, copy of repudiation letter dated 23.12.2021 Ex.OP19, copy of investigation report dated 01.04.2022 Ex.OP20, copy of compromise dated 09.09.2021 Ex.OP21, copies of GRs no. 230, 220, 226, 231, 235, 237 dated 22.06.2021 and 23.06.2021  Ex.OP22 to Ex.OP27 and closed the evidence on 11.10.2023 by suffering separate statement.

7.             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.

8.             Learned counsel for complainant, while reiterating the contents of the complaint, has vehemently argued that complainant got his vehicle insured with the OP. On 23.06.2021, the said vehicle met with an accident and was badly damaged. The matter was reported to the Police station and intimation was also given to the OP. Complainant lodged the claim with the OP and submitted all the required documents and requested to settle his claim but OP did not settle the claim and repudiated the claim of the complainant on the false and frivolous grounds and lastly prayed for allowing the complaint.

9.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that the alleged accident never reported to the police. The vehicle was immediately removed from the spot without any spot survey and OP has deprived its rights to inspect the vehicle. The alleged Sombir was not driving the vehicle in question at the time of alleged accident. Hence, there was a misrepresentation, concealment of true facts, manipulation of documents/information and violation of policy terms and conditions  of the policy and lastly prayed for dismissal of the complaint.

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

 11.          Admittedly, complainant got insured his vehicle with the OP. It is also admitted that the vehicle in question met with an accident during the subsistence of the insurance policy. It is also admitted that the insured declared value of the vehicle was Rs.31,60,000/-.

12.           The claim of the complainant has been repudiated by the OP, vide repudiation letter Ex.OP19 dated 23.12.2021 on the ground that of misrepresentation, concealment of true facts, manipulation of documents/information and violation of policy terms and conditions as alleged Sombir was not driving the vehicle in question at the time of alleged accident.

13.           The accident took place on 23.06.2021 at about 3.00 a.m. when the truck was fully loaded with core sand. The left side of the truck was badly smashed. The OP has alleged that the accident was a major and alleged Sombir driver did not suffer any injury in the said accident, it is not possible in the major accident driver did not receive any injury. Admittedly, the truck in question badly damaged from the left side, thus, it is not necessary that the driver should suffer injuries in the accident.

14.           The case was investigated by Karnal Associates, Investigator and Detective Agency by the OP. The OP has alleged that the mobile location of the driver was found at some other places instead of place of accident. They further stated that driver and complainant started misbehaving with the investigator and even passed a threat to him. The investigator lodged complaint at Police Station Sector 32-33 Karnal. The onus to prove its version was relied upon the OP but OP has miserably failed to prove the same by leading any cogent and convincing evidence. There is nothing on the file, the mobile location    of the driver was not         found at the place of accident and he misbehaved with the investigator of the OP and investigator moved complaint with the Police Station against the driver and complainant.

15.           The OP has alleged that complainant had lodged several complaints not only against the insurance company but also against the persons involved in the investigation and proceedings of the claim file. OP further alleged that complainant never cooperate with the insurer for assessing the claim and matter was re-submitted before the Chhatwal and Associates, Independent Surveyor and Loss Assessor, who alleged that insured failed to comply the formalities and also misrepresented the facts and made manipulation to take the claim. OP has failed to place on file copy of alleged complaints lodged against the insurance company and investigating agency. Reason behind repudiation of the claim appears the alleged complaints. It also appears that OP has made a concocted story just in order to repudiate the claim of the complainant.

16.           The sole reason for repudiation of the claim is changing the driver by the complainant at the time of accident. The OP has alleged that vehicle was not driven by Sombir at the time of accident. The accident took place on 23.06.2021 at about 3.00 a.m. On receipt of intimation, OP appointed independent surveyor namely Chhatwal and Associates, who submitted his final survey report on 03.09.2021. Case file was entrusted to Karnal Associates, Investigators and Detective Agency for investigation purposes. The investigator also submitted his report on 09.09.2021. The matter was again referred to ICS Assure Services Private Limited and same was investigated by Shri Suraj.P Matondker, Automobile Engineer and Nivrtee R Magar, Senior Forensic Expert and he submitted his report on 29.10.2021. The case was thoroughly investigated by the various agencies but no agency find out that at the time of accident, who was driving the vehicle instead of Sombir. It appears that OP has come to the conclusion that Sombir was not driving the vehicle at the time of accident, only on the basis of presumption and assumption, which is not admissible in the eyes of law.

17.           The matter was duly surveyed by the Chhatwal & Associates, Insurance Surveyor and Loss Assessor, who prepared Motor Final Survey Report dated 03.09.2021. OP supplied the said report to the complainant and same was placed on file by the complainant as Ex.C3. In the said report, the surveyor has assessed the loss to the tune Rs.11,52,049/-.  The said surveyor also supplied  the same report to the OP as Ex.OP5 dated 03.09.2021 but in the said report the surveyor has assessed the loss to the tune of Rs.14,58,891/-. Both the reports prepared by the Surveyor Chhatwal & Associates on the same day. But OP has supplied the surveyor report Ex.C3 to the complainant in which the loss has been assessed in lesser side and withheld the report Ex.OP5, vide which the surveyor has assessed the loss of higher side. It appears that OP has intentionally and deliberately supplied the surveyor report, vide which the loss has been assessed on lower side. Thus, it also appears that OP has harassed the complainant as every point of time.

 18.          Furthermore, now a days it has become a trend of insurance companies, they issue the policies by giving false assurances and when insured amount is claimed, they make such type of excuses. Thus, the denial of the claim of complainant is arbitrary and unjustified. In this regard, we place reliance on the judgment of Hon’ble Punjab and Haryana High Court titled as New India Assurance Company Ltd. Versus Smt. Usha Yadav & others 2008 (3) RCR (Civil) 111, wherein the Hon’ble Punjab and Haryana High Court has held as under:-

“It seems that the Insurance Companies are only interested in earning the premiums which are rather too stiff now a days, but are not keen and are found to be evasive to discharge their liability. In large number of cases, the Insurance companies make the effected people to fight for getting their genuine claims. The Insurance Companies in such cases rely upon clauses of the agreements, which a person is generally made to sign on dotted lines at the time of obtaining policy. This is, thus pressed into service to either repudiate the claim or to reject the same. The Insurance Companies normally build their case on such clauses of the policy, but would adopt methods which would not be governed by the strict conditions contained in the policy”.

19.           Keeping in view, the ratio of the law laid down in aforesaid judgment, facts and circumstances of the present complaint, the act of the OP while repudiating the claim of complainant amounts to deficiency in services and unfair trade practice.

20.           The complainant has claimed Rs.11,52,049/- as the loss assessed by the surveyor in his report Ex.C3 dated 03.09.2021. Hence, complainant is entitled for the said amount alongwith interest, compensation for mental pain, agony and harassment and litigation expenses.

21.           Thus, in view of the above discussion, we allow the present complaint and direct the OP to pay Rs.11,52,049/- alongwith interest @ 9% per annum from the date of the repudiation of the claim i.e. 23.12.2021 till its realization to the complainant. We further direct the OP to pay Rs. 25,000/- to the complainant on account of mental agony and harassment suffered by him and Rs.11,000/- for the litigation expenses. This order shall be complied within 45 days from the date of receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Dated: 24.09.2024                                                           

                                                                  President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal.

 

(Neeru Agarwal)         (Sarvjeet Kaur)

                 Member                    Member