Haryana

Karnal

CC/688/2022

Prankush - Complainant(s)

Versus

Universal Sompo General Insurance Company Limited - Opp.Party(s)

Pratap Singh

07 Nov 2024

ORDER

aaBEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No.688 of 2022

                                                        Date of instt.02.12.2022

                                                        Date of Decision: 07.11.2024

 

Prankush(Age 28 years) son of Shri Vivek Kumar, resident of 4/6, Mohalla Khattarwara, Kurukshetra (HR).

                                                                        …….Complainant.

                                              Versus

 

1. Universal Sompo General Insurance Company Limited, # Block “B”, Ground Floor, Plot no.52, Sector-44, Gurugram, District Gurugram, through its Branch Manager.
2. Universal Sompo General Insurance Company Limited, # 3^rd floor, SCF-55, Main Market, Sector-6, Karnal through its Branch Manager.

                                                                …..Opposite Parties.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.     

              Ms. Neeru Agarwal…….Member

      Ms. Sarvjeet Kaur…..Member

 

Argued by: Prof. Pratap Singh Panwar & Sarvajeet Singh

                   Panwar, counsels for the complainant.

                   Shri Virender Sharma, counsel for the OPs.

 

                     (Jaswant Singh, President)

 

                     (Jaswant Singh, President)

ORDER:

  

                    The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as ‘OPs’) on the averments that complainant is the registered owner of the car make Ford Endeavour 3.0L,4x4 got registered bearing no.HR-06T-0039 with the Registration Authority for which, the registration certificate was issued in favour of the complainant. The said car was insured with the OP, vide insurance policy AVO/2311/10096437 for IDV of Rs.7,46,000/-, valid from 17.02.2022 to 16.02.2023 and the premium to the tune of Rs.34312/- was also paid to the OPs. On 14.05.2022 at about 11.30 p.m., the car met with an accident near Taraori while Joginder was driving the car in moderate speed by following all traffic rules, on the way to Chandigarh because a stray animal came in front of a trolla which was going ahead of car of complainant and the driver applied sudden break and his car was struck from back side of the trolla and damaged the same. A FIR/Daily Dairy report no.24 dated 16.05.2022 against the complaint no.845 dated 16.05.2022 got registered at Police Station Taraori, District Karnal and factum of accident was informed to the OP and all necessary formalities were completed. It was case of total loss as per surveyor report as informed to the complainant by the surveyor. But the OP did not settle the claim and committed deficiency in service. The necessary intimation was given to the company without any delay for damages his car in roadside accident, upon which, surveyor had also been appointed by the company and the claim was assessed by surveyor in its report as total loss assessed of Rs.7,46,000/-. The complainant has submitted all the relevant documents to the OPs for getting insurance claim of his damaged car but OPs did not pay the claim despite his repeated requests and sent a letter dated 24.08.2022, vide which OPs denied to pay the claim of the complainant. The driver was driving the car with valid driving licence issued by the  Registration Authority and without under the influence of alcohol, however, the incident was took place due to the unavoidable circumstances as mentioned in General Dairy Report. The abovesaid letter was issued by the OP without any basis and documents and substantial evidence, only in order to harass the complainant. In this way there is deficiency in service and unfair trade practice on the part of the OPs. Hence, complainant filed the present complaint seeking direction to the OPs to pay Rs.7,46,000/-the insured declared value  of the vehicle alongwith interest @ 24% per annum from the date of accident till its actual payment, to pay Rs.1,50,000/- as cost of harassment and mental agony and to pay Rs.50,000/- as cost of litigation expenses.

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 complainant is registered owner of the said vehicle which was insured with the OPs from 17.02.2022 to 16.02.2023. It is denied that on 14.05.2022 at about 11.30 p.m. the car met with an accident near Taraori while Joginder was driving the car in moderate speed by following all the traffic rules on the way to Chandigarh as alleged. It is further denied that a stray animal came in front of Tralla, which was going ahead of the car and applied sudden brakes and his car struck from back side of the Tralla and got damaged the same. The complainant has put forward a concocted story in the complaint. The complainant got registered DDR no.24 on 16.05.2022 in connivance with the Police Station, Taraori, with a view to grab compensation from the OPs fraudulently. It is submitted that as per the investigation report, it is found that the time of incident, driver of the insured vehicle namely Joginder was under the influence of alcohol, which is a clear cut violation of terms and conditions of the Motor Vehicle Act, thus, the complainant is not entitled to get any claim from the Insurance Company. 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.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of RC Ex.C1, copy of insurance policy Ex.C2, copy of GDR no.24 dated 16.05.2022 Ex.C3, copy of repudiation letter dated 24.08.2022 Ex.C4, copy of driving licence Ex.C5 and closed the evidence on 23.08.2023 by suffering separate statement.

5.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Ankita Bose Ex.OP1, copy of survey report Ex.OP2, copy of insurance policy Ex.OP3, copy of claim intimation sheet Ex.OP4, copy of motor insurance claim form Ex.OP5, copy of letter dated 22.05.2022 Ex.OP6, copy of claim repudiation letter Ex.OP7, copy of Motor-Driver Car Package Policy Ex.OP8 and closed the evidence on 15.05.2024 by suffering separate statement.

6.             We have heard the learned counsel for 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 that during the subsistence of insurance policy, on 14.05.2022 the car of the complainant met with an accident and badly damaged. A Daily Dairy report was got registered and intimation regarding accident was given to OPs. OPs appointed a surveyor, who assessed the loss of vehicle as total loss. Complainant submitted all the documents but OPs has repudiated the claim of the complainant on the false and frivolous ground. Complainant has cleared all the loan amount and there is nothing due against the complainant and lastly prayed for allowing the complaint. Learned counsel for the complainant has relied upon the case law titled as United India Insurance Co. Ltd. Vs. Shri Deepak Sharma and Another in appeal no.23 of 1995, decided on 02.09.1996.

8.             Learned counsel for OPs, while reiterating the contents of the written version, has vehemently argued that at the time of accident, the complainant was under the influence of liquor and as per terms and conditions of the insurance policy, complainant is not entitled to any claim thus the claim of complainant has rightly been 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, the complainant got insured his vehicle with the OPs and the same was met with an accident during the subsistence of the insurance policy. It is also admitted that the insured declared value of vehicle is Rs.7,46,000/-.

11.           The claim of the complainant has been repudiated by the OPs, vide repudiation letter Ex.C4/OP7 dated 24.08.2022 on the ground, which is reproduced as under:-

•  

Any accidental loss or damage suffered whilst the insured or any person driving the vehicle with the knowledge and consent of the insured is under the influence of intoxicating liquor or drugs.”

In view of foregoing, we regret to inform you that subject claim cannot be considered and is treated as “No Claim”.

 

12.           The claim of the complainant has been repudiated by the OPs on the abovesaid ground. The onus to prove its case was relied upon the OPs but OPs have miserably failed to prove the same by leading cogent and convincing evidence. To prove its version blood and urine report of the driver was required but OPs have failed to place on file blood and urine report to ascertain that at the time of accident, the driver of the vehicle was under the influence of liquor or drugs, etc. Without the medical examination/ documentary evidence, it cannot be proved that at the time of accident, the driver was under the influence of liquor. The case of the OPs is based on only on the hearsay version, which is not admissible in the eyes of law. Thus, the plea taken by the OPs is having no force. 

13.           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, 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”.

14.           Keeping in view the ratio of the law laid down in aforesaid judgments, facts and circumstances of the present complaint, the act of the OPs while denying the claim of the complainant amounts to deficiency in service and unfair trade practice.

15.           As per surveyor report Ex.OP4, the surveyor has assessed the repairing cost of the vehicle is Rs.8,00,485.79/-. The Insured Declared Value of the vehicle is Rs.7,46,000/-. The repairing cost of the vehicle is more than the IDV of the vehicle. Hence, vehicle falls inthe category of total loss. Hence, the complainant is entitled for the Insured Declared Value of the vehicle i.e. Rs.7,46,000/- alongwith interest, compensation for mental pain, agony and harassment and litigation expenses etc.

16.           The case law cited by the learned counsel for the complainant is fully applicable to the present case.

17.           In view of the above discussion, we allow the present complaint and direct the OPs to pay Rs.7,46,000/- (Rs.Seven Lac fourty six thousand only) to the complainant with interest @ 9% per annum from the date of repudiation of the claim i.e. 24.08.2022  till its realization. We further direct the OPs 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 expense. However, the complainant is also directed to complete all the formalities with regard to transfer/cancel of the RC of the vehicle in question. This order shall be complied within 45 days from the 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.

Announced

Dated:07.11.2024                                                                     

                                                                President,

                                                   District Consumer Disputes

                                                   Redressal Commission, Karnal.

 

                  (Neeru Agarwal)                (Sarvjeet Kaur)

               Member                             Member