Insurance companies must honor claims consistent with factual damage assessments while consumers should provide substantiated evidence of claims.

The following order of the Commission was delivered by Dr.(Mrs) Monika Malik, Member :

This is an appeal by the complainant / appellant directed against the order dated 05.09.2019 passed by the District Consumer Disputes Redressal Commission, Gwalior (for short ‘District Commission’) in complaint case no.19/2019, whereby the District Commission has dismissed the complaint filed by him.

2. Briefly stated facts of the case are that the complainant / appellant is the owner of Tavera Car bearing registration no.MP04 BA 4139 which was insured with the opposite party / respondent – National Insurance Company Limited (hereinafter referred to as ‘Insurance Company’) for a period w.e.f 10.11.2017 to 19.11.2018. On 14.07.2018 when the subject vehicle was being driven by the complainant’s driver from Gwalior to Morena in order to attend a wedding ceremony, in an attempt to save a cow appearing on its way, it got overturned. Complete body of the subject vehicle got damaged. The Insurance Company was intimated and a Surveyor was appointed in the matter. The Surveyor in his survey report assessed loss to the extent of 3,67,268/-. When the claim form alongwith the requisite documents was presented before the Insurance Company, the Insurance Company only paid damages towards body of the subject vehicle i.e. Rs.82,798/- and the remaining amount of Rs.2,78,268 was not paid by the Insurance Company. He therefore, alleging deficiency in service and unfair trade practice on part of the Insurance Company, seeking Rs.2,78,268/- as compensation and cost with Advocate fees of Rs.10,000/-, filed the instant complaint before the District Commission, seeking relief.

3. The Insurance Company resisted the complaint on the ground that the Surveyor, Ashok Kumar Agrawal who was appointed by the Insurance Company had assessed loss at Rs.82,798/- and the same has also been paid to Surbhi Global Pvt. Ltd., Gwalior towards repairs of the subject vehicle, on 18.12.2018, after obtaining consent from the complainant / appellant. The final bill which was issued to the Insurance Company was also of the same amount. No further amount is payable to the complainant / appellant and therefore, no deficiency in service or unfair trade practice could be attributed on part of the Insurance Company.

4. Heard.

5. Learned counsel for the complainant / appellant argued that the Insurance Company had assured the complainant / appellant that claim of the engine would also be provided. But, in the case there has been misrepresentation on the part of the Insurance Company. The complainant / appellant upon obtaining assurance from the Insurance Company had signed the documents towards the settlement of the claim. He had therefore, signed the documents under pressure and influence as the Insurance Company was the presiding authority to decide the claim at that point of time. Therefore, the appellant at that time was left with no option but to sign the documents. Also the defence taken by the Insurance Company that the engine of the subject vehicle does not require repairs/ replacement is frivolous as the engine got severely damaged due to such a serious accident. The survey report available on record do not carry any information regarding the defects in the engine, whereas the photographs submitted before the District Commission show that the engine requires repairs / replacement. Therefore, the survey report is ambiguous in nature. In view of the above, learned counsel argued that the complainant deserves the amount as was sought for the financial loss and discomfort faced by him and therefore the impugned order be modified.

6. Learned counsel for the Insurance Company argued that the complainant / appellant, out of his own will had signed the discharge voucher and had accepted Rs.82,798/- towards full and final settlement of his claim. He is therefore, not entitled to any further amount.

7. We observe that the complainant / appellant had categorically alleged before the District Commission