DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION ERNAKULAM
Dated this the day of 5th day of October 2023.
Filed on: 27/08/2020
PRESENT
Shri.D.B.Binu President
Shri.V.Ramachandran Member Smt.Sreevidhia.T.N Member
C.C No.242/2020
COMPLAINANT
Anulakshmi K V, 7D, West Rock One Apartment, PJ Antony Road, Ernakulam.
(By Adv.Abhishek Kurian, 36, DD Oceano Mall, Near Taj Gateway, Marine Drive, Ernakulam, Cochin-682 011)
VS
OPPOSITE PARTIES
- United India Insurance Company Ltd, Represented by its Managing Director, United India Insurance Co. Ltd.#19, Nungambakkam High Road, IV Lane, Chennai 600 034
(o.p1 rep. by Adv.Jayasree S., 38/2519E, “SUKRITH”, Sanathan Enclave, Opp. SNDP Hall, Near Kathrikkadavu ROB, Kaloor-Kadavanthra Road, Ernakuolam-682 017)
2. Policy Bazar Web Aggregator Pvt Ltd, Represented by its Managing Director, Plot No.119, Sector - 44, Gurgaon, Haryana 122 001.
(O.p2 rep. by Adv.Dileep MS, Chamber No.448, Kerala High Court, Golden Jubilee Chamber Complex, Ernakulam)
3. Mr Joy, Insurance Surveyor, United India Insurance Company Ltd, RRA 21, Bank Road, Kaloor, Ernakulam.
F I N A L O R D E R
D.B. Binu, President.
- A brief statement of facts of this complaint is as stated below:
The complaint is filed under Section 35 of the Consumer Protection Act, 2019. The brief facts, as averred in the complaint, are that the complainant owns a car with registration number KL69B0050, and the opposite parties are United India Insurance Company and its associates and officials. The complainant had purchased a "zero depreciation comprehensive insurance policy" from the first opposite party on February 25, 2020, through the second opposite party. During the policy purchase, the first and second opposite parties assured the complainant that there would be no depreciation in service/repair charges or damages, and they promised to reimburse any claims within 3 working days.
On July 13, 2020, the complainant's car was hit by a scooter, resulting in damage to some body parts. The complainant promptly informed the first and second opposite parties, and the car was taken to a service centre on the same day as per their instructions. On July 14, 2020, the third opposite party inspected the car, verified necessary documents, and directed the service centre to proceed with the repairs. The third opposite party also agreed to reimburse the claim amount within three working days. The car was repaired and returned to the complainant on July 17, 2020, with a repair cost of Rs 14,500. However, the opposite parties have not yet reimbursed this amount to the complainant.
The delay in reimbursing the claim amount has caused the complainant significant mental agony, stress, and financial difficulties. The complainant believes that the actions of the opposite parties constitute unfair trade practices and deficiency in service, and they are liable to pay compensation to the complainant.
The complainant is requesting to the Commission to issue directions to the opposite parties for the following: (1) reimburse the insurance claim of Rs 14,500/- to the complainant and to provide compensation of Rs 25,000/- for mental agony, stress, and financial constraints, and to allocate Rs.10,000/- towards costs of the proceedings.
2) Notice
The Commission sent notices to the opposite parties, but only the first and second opposite parties submitted their versions.
3) VERSION OF THE FIRST OPPOSITE PARTY.
The first opposite party acknowledged that the complainant had purchased a Nil Depreciation Private Car Package policy for her Hyundai I20 car with registration number KL 69 B 0050, valid from 25.02.2020 to 24.02.2021, through the second opposite party. The policy was issued by the Gurgaon, Haryana branch of the first opposite party.
The complaint arises from the non-settlement of an own damage claim filed by the complainant. The complainant reported her vehicle's damage on 13.07.2020, and the first opposite party promptly sent an independent licensed surveyor to assess the damage on 15.07.2020, who had submitted the survey report on 17.07.2020, valuing the loss at Rs. 10,488.
The first opposite party states that they requested the complainant to submit the payment receipt from the workshop for claim processing. Despite multiple reminders, the complainant did not provide necessary documents. As a result, on 21.09.2020, the first opposite party closed the claim due to the complainant's failure to submit the required document.
The first opposite party emphasizes that the "Nil Depreciation policy" indicates that depreciation does not apply to replaced spare parts. Both the complainant and the first opposite party are bound by the terms, conditions, definitions, and exclusions of the insurance policy. They deny the claim that the opposite parties assured reimbursement within three days, stating that the insurer is obligated to settle or decide the claim within 30 days, as per IRDA rules.
The complainant's failure to submit necessary documents by 21.09.2020 had resulted in the inability to process the claim. Therefore, they assert that they are not liable to reimburse the claim amount or provide compensation for mental agony, stress, or litigation costs as claimed in the complaint.
The first opposite party maintains that their liability and indemnification are governed by the terms, definitions, conditions, and exclusions of the insurance policy and the Survey Report. The complainant's negligence and omission to submit the required documents has caused the claim processing delay, and thus, they request that the complaint do not have any merit and only to be dismissed.
4) THE VERSION OF THE SECOND OPPOSITE PARTY.
The 2nd Opposite Party acts only as an intermediary between service providers and customers and has no involvement in the workings of merchants or service providers. It facilitates services on behalf of third-party service providers and helps customers make informed choices regarding insurance policies.
They have further stated that they have clearly stated in its Legal and Admin Policies that it is a service facilitator, not a service provider. It cannot be held liable for the acts of service providers, including delays or policy cancellations.
The Information Technology Act exempts intermediaries from liability for third-party information, data, or communication hosted by them.
The Opposite Party is regulated by the Insurance Regulatory and Development Authority as a web aggregator, providing information about insurance products and price comparisons.
The complainant had directly purchased insurance from Opposite Party No.1 without any assistance from the second Opposite Party. Hence, Opposite Party No.1 is liable for the services mentioned in the insurance policy.
The claim was rejected by Opposite Party No.1 due to non-compliance with document submission.
The Complainant's relationship with the Opposite Party No.2 is non-existent as no consideration was paid to it, and the Complainant did not seek assistance when purchasing the policy or when the claim was rejected.
The present complaint is deemed false, bad, and frivolous, and no cause of action is said to have arisen against the Opposite Party.
The Complainant has not approached the commission with clean hands and has suppressed facts and documents.
No case of "Deficiency of services" or unfair trade practices has been made out against the Opposite Party.
In summary, the second Opposite Party is strongly denying the allegations made in the complaint and argues that the complaint should be dismissed, as no cause of action has been established against them.
5) . Evidence
The complainant filed proof affidavit and 3 documents and which are marked as Exhibit A1 to Exhibit A3. (which are seen omitted in endorsing in the order sheet and marked as Exbt.A1 to A3)
Exhibit A-1. True copy of insurance policy.
Exhibit A-2. True copy of advertisement of the first opposite party.
Exhibit A-3. True copy of the Email communication between the complainant and the first opposite party.
The first opposite party filed 6 documents and which are marked as Exhibit B1 to Exhibit B6.
Exhibit B-1. A true copy of insurance policy for the year 2020-2021.
Exhibit B-2. A true copy of Survey Report dated 17.07.2020.
Exhibit B-3. A true copy of email dated 21.08.2020.
Exhibit B-4. A true copy of email dated 01.09.2020.
Exhibit B-5. A true copy of email dated 14.09.2020
Exhibit B-6. A true copy of email sent from regional office to Haryana office of the insurance company and their reply.
The second opposite party filed 6 documents along with version.
1 Copy of the Board Resolution Dated 30.01.2017.
2. Copy of the Legal Admin Policies of the Opposite Party.
3 Copy of the email dated 01 September 2020
4 Copy of the email dated 1st September 2020 and 03rd September 2020
5. Copy of the email 11 September 2020and and 23rd September 2020
6 Copy of the email dated 21st October 2020
6) The main points to be analysed in this case are as follows:
i) Whether the complaint is maintainable or not?
ii) Whether there is any deficiency in service or unfair trade practice from the side of the opposite parties to the complainant?
iii) If so, whether the complainant is entitled to get any relief from the side of the opposite parties?
iv) Costs of the proceedings if any?
7) The issues mentioned above are considered together and are answered as follows:
In the present case in hand, as per Section 35 of the Consumer Protection Act, 2019, a consumer is a person who buys any goods or hires or avails of any services for a consideration that has been paid or promised or partly paid and partly promised, or under any system of deferred payment. The complainant had produced a copy of insurance policy (Exhibit A-1). Hence, the complainant is a consumer as defined under the Consumer Protection Act, 2019, (Point No. i) goes against the opposite parties.
In the present case, the complainant has raised serious concerns regarding the significant service deficiencies and unfair trade practices attributed to the opposite parties, particularly regarding the apparent responsibility of the opposite parties for the delay in reimbursing the claim amount
Heard the learned counsel appearing for the complainant. It is submitted that the complainant a consumer of the opposite parties who are engaged in the business of general insurance in India. The complainant is the registered owner of a car with the registration number KL69B0050 and had purchased a "zero depreciation comprehensive insurance policy" for their car from the first opposite party on 25.02.2020, facilitated through the second opposite party. During the policy purchase, it was agreed by the first and second opposite parties that there would be no depreciation applied to service/repair charges or damages, and they assured that claim amounts would be reimbursed within three working days.
On 13.07.2020, the complainant's car was damaged in an accident with a scooter, resulting in becoming the body parts defective. This was promptly reported to the first and second opposite parties, who instructed the car to be taken to an authorized service centre on the same day. Subsequently, the third opposite party inspected the car on 14.07.2020, collected the necessary documents, and directed the service centre to perform the required repairs. The car was repaired and returned to the complainant on 17.07.2020, with a service charge of Rs 14,500. The workshop manager informed the complainant that the opposite parties had forwarded the payment receipt and documents to the third opposite party loss assessor for claim settlement.
The third opposite party, who claimed to be an authorized agent of the first opposite party, assured the complainant that the claim would be reimbursed within three working days. However, after a delay, the complainant received communication from the first opposite party on 21.08.2020 and 01.09.2020, requesting the previous year's policy and payment receipt. The complainant responded by informing them that these documents had already been submitted to the third opposite party on 17.07.2020, but there was no response from the first opposite party, and they did not reimburse the service charges or claim amount. This delay has caused significant mental agony, stress, and financial strain. They contend that the actions of the opposite parties constitute unfair trade practices and a deficiency in service, warranting compensation. The third opposite party failed to appear before the Commission despite notice, leading to an ex parte decision against them.
The complainant has provided documentary evidence, including a copy of the insurance policy, an advertisement from the first opposite party regarding claim reimbursement within three business days, and email communications demonstrating their submission of documents to the third opposite party.
The first opposite party, in their response, claimed that the complainant did not submit the original invoice and the previous year's policy, which the complainant disputes with email evidence (Exhibit A3). They also allege that reminders were sent for these documents, which the complainant refutes with evidence from Exhibit A3.
The complainant requests to the Commission to issue direction to the opposite parties to reimburse the insurance claim of Rs 14,500/-, order the payment of compensation amounting to Rs 25,000/- for mental agony, stress, and financial constraints, and to impose a litigation cost of Rs.10,000/- on the opposite parties.
After careful consideration of the facts presented in the case and taking into account the arguments presented by the complainant and the first opposite party, along with the relevant provisions of the Consumer Protection Act, 2019, the Commission reached into the following inferences.
The complainant purchased a "zero depreciation comprehensive insurance policy" for their car from the first opposite party, facilitated through the second opposite party. During the policy purchase, it was assured by the first and second opposite parties that there would be no depreciation applied to service/repair charges or damages, and they promised to reimburse any claims within 3 working days.
On July 13, 2020, the complainant's car was damaged in an accident, and the complainant promptly reported it to the first and second opposite parties. The car was taken to an authorized service centre as per their instructions. Subsequently, the third opposite party inspected the car, collected the necessary documents, and directed the service centre to perform the required repairs. The car was repaired and returned to the complainant, incurring a service charge of Rs 14,500. The workshop manager informed the complainant that the opposite parties had forwarded the payment receipt and documents to the third opposite party loss assessor for claim settlement. However, there was a delay in reimbursing the claim amount.
Deficiency in Service and Unfair Trade Practices:
The complainant alleges that the opposite parties engaged in unfair trade practices and deficient services. The first opposite party, in its response, claimed that the complainant did not submit the original invoice and the previous year's policy. However, the complainant provided email evidence (Exhibit A3) to refute these claims and demonstrated that reminders were not sent for these documents. Therefore, the delay in reimbursing the claim amount appears to be due to the actions of the opposite parties and there is deficiency in service from the side of the opposite parties. .
We find the issue Nos. (I) to (IV) are also in favour of the complainant for the serious deficiency in service that happened on the side of the opposite parties. Naturally, the complainant had suffered a lot of inconvenience, mental agony, hardships, financial loss, etc. due to the negligence on the part of the opposite parties.
In view of the above facts and circumstances of the case, we are of the opinion that the opposite parties are liable to compensate the complainant.
Hence the prayer is partly allowed as follows:
- The first opposite party shall reimburse the insurance claim of Rs 14,500/- to the complainant.
- The Opposite Parties shall pay Rs.20,000/- towards compensation for the mental agony, stress, and financial constraints caused to the complainant due to the delay in reimbursing the amount to the complainant.
- The Opposite Parties shall also pay the complainant Rs.5,000/- towards the cost of the proceedings.
The opposite parties be liable for the above-mentioned directions which shall be complied with by the Opposite Party within 30 days from the date of the receipt of a copy of this order failing which the amount ordered vide (i) and (ii) above shall attract interest @9% from the date of receipt of a copy of this order till the date of realization.
Pronounced in the Open Commission on 5th day of October 2023.
Sd/-
D.B.Binu President
Sd/-
V.Ramachandran Member
Sd/-
Sreevidhia TN., Member
Forwarded by Order
Assistant Registrar
Assistant Registrar
Appendix
Complainant’s Evidence
Exhibit A-1. True copy of insurance policy.
Exhibit A-2. True copy of advertisement of the first opposite party.
Exhibit A-3. True copy of the Email communication between the complainant and the first opposite party.
The first opposite party filed 6 documents and which are marked as Exhibit B1 to Exhibit B6.
Exhibit B-1. A true copy of insurance policy for the year 2020-2021.
Exhibit B-2. A true copy of Survey Report dated 17.07.2020.
Exhibit B-3. A true copy of email dated 21.08.2020.
Exhibit B-4. A true copy of email dated 01.09.2020.
Exhibit B-5. A true copy of email dated 14.09.2020
Exhibit B-6. A true copy of email sent from regional office to Haryana office of the insurance company and their reply.
