The complainant Dr. Devinder Pal Bansal (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986 (Now C.P. Act, 2019, here-in after referred to as 'Act') before this Forum (Now Commission) against The United India insurance Company Ltd (here-in-after referred to as opposite party.
Brief facts leading to this complaint are that the complainant is Retd. Medical Officer and got retired from C.H.C Bhagta Bhaika Distt Bathinda w.e.f 29/02/2016 and the complainant had taken insurance policy for his Verna car vide policy number 2004013118P117263978 from the opposite party company which is valid from period 30-03-2019 to 29-03-2020 and insured value is Rs.4,90,000/-. On dated 21/08/2019, said insured car had met with some accident i.e said car was parked at Green Avenue, Bathinda and due to heavy rain on that day, water level raised by 4 ft in the street and said car sinked in the rain water. Due to this natural calamity, the loss occurred.
It is stated that accordingly, the complainant had informed Mr.Yogesh, agent of the opposite party company about the said accident and loss. But the said agent had straight away refused to take up the said claim and told to the complainant that it does not cover under the opposite party company's policy. Hence you should get repair and maintain the said vehicle yourself, but when the complainant had agitated about the said insurance claim, then the said agent of opposite party had immediately forwarded the complainant's claim and asked the complainant to provide the estimate from the workshop and also told the complainant, that soon the opposite party company will send surveyor to inspect the said vehicle. Accordingly, the complainant had handed over the estimate for the said vehicle repair cost to the opposite party agent.
It is stated that when no intimation had been given to the complainant about the surveyor and inspection, then he started calling to the opposite party agent about the status. Accordingly, the opposite party had taken the motor claim intimation along with the claim form duly signed from the complainant on dated 30-08-2019, whenever the said loss was occurred on 21-08-2019. Despite this, the opposite party surveyor told to the complainant that the said loss does not cover under the insurance policy. So company could not pay to complainant a single penny for this loss. Accordingly, the complainant again agitated and shown the ruling regarding the natural calamity insurance, upon which the opposite party surveyor immediately confirmed the claim of the complainant and told that soon complainant will receive the amount in his account directly for the said loss.
It is stated that the complainant had paid Rs.22500/- + Rs.19,782/- i.e total Rs.42,282/- to get the said alleged vehicle repaired.The Complainant had demanded the report of surveyor several times from the opposite party and even from the said surveyor, but despite the repeated requests, the 0.P had declined the said requests and told the complainant that it is confidential report. So it is not accessible and could not be disclosed to any person.
It is stated that on dated 20-11-2019, the opposite party company had paid the said claim to the complainant in his bank account without any intimation i.e Rs.10,000/- only. When the complainant had approached the opposite party company, then the opposite party had stated that our surveyor has passed only Rs.10,000/- for his claim. When the complainant had demanded the documents and surveyor report from the opposite party, then the opposite party has totally refused to accede to the request of the complainant and even claimed that it is confidential report and could not be disclosed at any cost. Even, when the complainant had called to said surveyor and asked the reason behind the passage of very less amount reimbursement, then the opposite party surveyor told to the complainant that his claim was not good and even there is no rule to pass the said claim for said type of loss, as their company does not pass such type of claims of any motor vehicles.
It is further stated that the complainant had repeatedly approached the opposite party and requested the aforesaid full claim along with the documents and surveyor report but to no effect and to effect rather the opposite party kept on putting the matter off under one or the other false pretext and only supplied copy of surveyor report under RTI.
It is further submitted that the opposite party has kept the claim of complainant pending for more than 2 and half months initially and after the efforts done from the complainant side, the opposite party has paid only partial amount on the basis of avasive and concocded surveyor report and rest of amount is still pending with the opposite party. The complainant repeatedly requested the opposite party to pay pending amount of claim but to no effect rather the opposite party has refused to accede the lawful claim of the complainant, hence this complaint before the Hon’ble Court under compelling circumstances.
It is further pleaded that even complainant had sent legal notice through Sh.Ram Manohar Advocate Distt.Courts Bathinda dated 01-01-2020 and demanded his rights but to no effect. The opposite party has not given any reply on the legal notice which clearly shows that the opposite party has nothing to say in this matter and they are refusing to accede the lawful claim of the complainant.
In view of the submissions contained in the preceding paragraphs, the complainant prayed to direct the Opposite party to:
(a) Reimburse the pending bill amount of Rs.19782/- of Bill A after making depreciation as per the insurance policy.
(b) Reimburse the pending bill amount of Rs.10,500/- of Bill B.
(c) Reimburse the Less Excess Fees i.e. Rs.2000/-
(d) Pay interest @12% per annum on the entire amount w.e.f 21-08-2019 till its realization.
(e) Pay compensation as sum of Rs. 50,000/-(Rupees Fifty Thousands) for causing harassment, mental agony, pain.
(f) Pay also cost of petition and legal expenses i.e Rs.20,000/-(Rupees Twenty thousands).
(g) Any other relief which may be deemed fit by the court.
Notice registered A.D. was given to the opposite party who apeared through counsel Sh. I.P Singh, Advocate and filed written version taking preliminary objection that intrigate questions of law or facts are involved in present complaint, the complainant has concealed material facts from Hon'ble Forum as well as the replying opposite party, therefore the complainant is not entitled to any relief, The complainant has concealed the fact that after lodging claim by complainant ,party appointed surveyor Gurjinder Singh of GS Associates and the loss of the vehicle of the complainant was got assessd by surveyor and after inspecting the vehicle he assessed the loss of Rs.10,000/- (Ex.OP l/2 Survey Report) after deducting the Less Compulsory Excess of Rs. 2000/- as per term and conditions of the insurance policy & IMT and the same has been paid to complainant as full and final settlement of the claim as admissible, Which has also been admitted by the complainant, that complainant has no locus standi or cause affections, that complaint is not maintable and that this forum has got no territorial jurisdiction to try decide present complaint.
On merits, opposite party denied any deficiency in service or unfair trade practice and further denying averments of complaint prayed for dismissal of complaint.
In order to prove its case complainant tendered his affidavit Ex. C-1 and also tendered documents Ex. C-2 to Ex. C-8.
In order to rebut the evidence of complainant, opposite party tendered into evidence affidavit of Baldev Singh as Ex. OP 1/1 and documents Ex. OP 1/2 to Ex. OP 1/3.
We have heard the arguments advanced by learned counsel for the parties and perused the evidence lead by party.
Learned counsel for the parties have reitrated their stand as taken in their respective pleadings as detailed above.
Learned counsel for the Complainant argued that opposite party has not settled the claim of complainant as per terms and conditions of the insurance policy and wrongly paid less amount to complainant and made deductions for their own enrichment and prayed for releif claimed.
On the other hand learned counsel for the opposite party submitted that payable claim of the complainant is paid to the complainant as per terms and conditions of the insurance policy and nothing of complainant is due and complaint of complainant be dismissed with costs.
We have given thoughtful consitrations to rival contentions of learned counsel for the parties and perused evidence minutely.
Opposite party mainly relied upon final survey report dated 16.10.2019 (Ex. OP 1/2) whereby total cost of parts was assessed as rupees nil and total labour charges were assessed as Rs.12,000/-. Surveyor after applying less compulsory excess clause deducted Rs.2000/- and loss of the car of complainant was assessed to the tune of Rs. 10,000/- and it is admitted fact that the said amount of Rs. 10,000/- was paid to complainant thorugh his Bank Account.
Perusal of Survey Report Ex. OP 1/2 does not reveal that on the basis of which term and condition of policy, surveyor found the claim of parts mentioned in para no.15 of report (Assessment -A) as N.A. Moreover, from the persual of documents on file and final survey report it becomes clear that surveyor assessed the loss only on the basis of estimates of cost of parts and further not discussed and considered the final bill dated 10.9.2019 in his report. So the report of surveyor is not reasoned one rather vague and ambiguous. As per document
Ex.C-6 opposite party approved Rs.10,000/- as cost of parts. But ultimately amount was paid as labour charges. So, In this way opposite party themselves are not clear whether they have made payment to complainant on account of cost of parts or as labour charges.So in our view opposite party should re considered the claim of complainant.
Complainant placed on file bill dated 11.11.2019 (Ex.C- 4) but complainant has not filed any claim for reimbursment qua this bill with opposite insurance company. So, firstly complainant should sumbit his claim with opposite party.
So keeping in view facts and circumstances of present case and as discussed above, Complaint of complainant is hereby disposed off with a direction to opposite party to reconsider the claim of complainant qua labour charges as per terms and conditions of the insurance policy and further consider the claim of complainant qua bill dated 11.11.2019 (Ex.C-4) on its submission by complainant. Compliance of this order be made by opposite party within 45 days of submission of claim by complainant.
The complaint could not be decided within the statutory period due to heavy pendency of cases and vacancy of post of members.
Copy of order be sent to the party concerned free of cost and file be consigned to the record.
