NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
AVM J. Rajendra, AVSM VSM (Retd.), Presiding Member
Sanjib Kumar Behera – Petitioner
versus
Divisional/Regional Manager, ICICI Lombard Geneal Insurance Co. Ltd. and Anr. – Respondent
Revision Petition No.1196 of 2021
(Against the Order dated 30/08/2019 in Appeal No. 49/2018 of the State Commission Orissa)
Decided on 3.7.2024
Consumer Protection Act, 1986 – Section 21(b) [Consumer Protection Act, 2019 – Section 58(1)(b)] – Services – Insurance – Repudiation of Claim – On facts, it is an admitted position that the Technical Committee reassessed the loss to the vehicle in question to the tune of Rs.2,70,000/-. It is also undisputed that the Petitioner/Complainant failed to give any cogent reason and evidence for diverting from the report of the Technical Committee and further has not adduced any cogent evidence as to any this report should not be relied – Thus, learned State Commission has rightly modified the order of the District Forum dated 03.01.2018 and directed the Respondents/Insurance Company to pay Rs.90,000/- and not the IDV value of the vehicle in question – petition dismissed. [Paras 10 to 16].
Result: Petition dismissed.
ORDER
This Revision Petition No. 1196 of 2021 challenges the order of Odisha State Consumer Disputes Redressal Commission, Cuttack (‘State Commission’) dated 30.08.2019, vide which, the learned State Commission disposed of the Appeal No.49/2018 filed by the Insurance Company and the Appeal No.221/2018 filed by the Petitioner/Complainant by modifying the District Consumer Disputes Redressal Forum, Keonjhar (‘District Forum’) order dated 03.01.2018 in C.C. No.36/2016 and directed the Insurance Company to pay Rs.90,000/- to the insured towards settlement of the claim and affirming the rest part of the order of the District Forum.
2. As per report of the Registry, there is 754 days delay in filing this Revision Petition. For the reasons stated in IA No.10785 of 2021, the Revision Petition is treated to have been filed within limitation.
3. Brief facts of the case, as per the Complainant, are that he purchased a Mahindra Scorpio vehicle insured with the OPs from 29.04.2013 to 28.04.2014. The vehicle met with an accident on 13.03.2014 during the subsistence of the policy. He informed the OPs about the accident, who deputed a surveyor to assess the loss. The surveyor conducted the assessment in his absence and the final survey was completed on 22.03.2014, and the claim was settled for Rs.1,80,000/, an amount the Complainant alleged to be arbitrary. He approached the Insurance Ombudsman, who observed that the claim form, signature, and consent submitted were fabricated. The Ombudsman ordered a reassessment, which the OPs failed to comply with. He sought direction to the OPs to settle the claim based on the Insured Declared Value (IDV), deducting the amount already paid, along with compensation and costs.
4. The OPs contended that the Complainant received the amount as full and final settlement by executing a discharge voucher and asserted that his acceptance of the settlement amount precludes any further claims and therefore, pray for dismissal of the complaint.
5. The District Forum, vide order dated 03.01.2018, allowed the complaint and directed the OP as under:
“The O.Ps. are hereby liable to pay a sum of (Rs.3,47,839 -Rs.1,80,000) i.e. Rs.1,67,839/- (one lakh sixty seven thousand eight hundred & thirty nine only) towards IDV value settlement & along with a sum of Rs.5,000/- (five thousand only) towards compensation inclusive of cost within 45 days of this order, failing @9% p.annum interest will accrue on same from the date of application till complete realization.”
6. Being aggrieved by the impugned order, the OPs filed Appeal No.49/2018. The Complainant also filed Appeal No.221/2018. The learned State Commission vide order dated 30.08.2019 modified the District Forum order dated 03.01.2018 in CC No.36/2016 and OPs were directed to pay Rs.90,000/- to the insured towards settlement of the claim and affirmed the rest of the District Forum order as under:
“7. We heard Mr. G. P. Dutta, learned counsel for appellants- Insurance Company in F.A. no.49 of 2018 and respondents in F.A. no. 221 of 2018. We also heard Mr. R. K. Pattanaik, learned counsel for respondent in F.A. no. 49 of 2018 and appellant in F.A. no.221 of 2018. We also perused the impugned order along with District Forum record.
8. On thorough perusal of materials available on record it has come to light that Ombudsman had observed that settlement made by insurer on the basis of the report of the Loss Assessor suffers from many infirmities. Insurer was, therefore, directed to reassess the loss suffered by insured vehicle.
9. The matter was referred to the ‘Technical Committee’ (Motors) for their opinion on the assessment made by the final Survey Mr. S. K. Sadhu of Jamshedpur. The Committee arrived at the following conclusions:—
“We observed that the loss assessed by the final surveyor is not reasonable and on lower side in respect of assessment spare parts as well as labour charges. It is observed from the photographs taken by him that the body shell has sustained
The insurance company's surveyor's assessment governs the claim under the Consumer Protection Act in instances of dispute over damages.
(1) No cause is forthcoming to disregard or dismiss the self-contained self-speaking survey Report.(2) Insurance Co. settled the claim in consonance with its Surveyor’s Report.
Report of Surveyor cannot be simply brushed aside.
Court upheld the significance of a surveyor's report in assessing insurance claims, emphasizing adherence to policy conditions regarding total loss determinations.
(1) Limited Scope of Revisional Jurisdiction – The NCDRC, under Section 21(b) of the 1986 Act (pari materia to Section 58(1)(b) of the 2019 Act), cannot act as a second court of appeal. It cannot int....
National Commission in exercise of revisional jurisdiction cannot re-appreciate evidence led by parties like appellate Court.
“Compensation in insurance claim are subject to terms and conditions of policy.”
Surveyor – The report submitted by a duly appointed surveyor is an important piece of evidence that must be given due weight, though it is not sacrosanct and may be disregarded if there is cogent evi....
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