• Cheating by Insurance company

I own a Toyota automobile which I purchased brand new from the Toyota dealer. At the time of purchase, I also purchased insurance from Toyota called “Toyota Protect” which was sold to me as the best insurance available in the market. It is an add-on policy and I was provided a policy number by Toyota. What I found later is that Toyota is just a broker and the actual insurer is another entity with a separate policy number.
My car was damaged by the floods in Chennai last year. First I took it to the Toyota dealer to file a claim with Toyota Protect. A claim number was generated with Toyota Protect. But since the actual insurer is another entity, the insurer also generated a separate claim number. At that point, Toyota Protect just became a messenger service and passed me over to the insurance company. 
The insurance company surveyor first obtained an estimate from the dealer which was higher than the IDV and tried to declare it a total loss. He also submitted a survey report for this estimate. The company also tried to sell my vehicle without my permission and received money from a buyer for the same. I disputed this estimate and demanded that my car be repaired instead of it being declared a total loss since I felt that the car could be repaired for a cost less than 75% of the IDV as stated in the policy. The insurance company told me that I should have a “second survey” if I wanted it repaired and asked me to send an email requesting a “second survey”. I was also asked to submit a second estimate. Accordingly, I obtained a repair estimate from a local garage to repair it at a cost which is less than 75% of the IDV. The insurance company appointed a different surveyor who verbally approved my estimate. I repaired the car for a cost which is a little higher than the original estimate from another local garage but still less than 75% of the IDV. The first local garage could not complete the repairs. Now the second surveyor submitted a second survey report which is significantly lower than the repair cost of even the first local garage and differs from the first survey report by several lakhs of rupees. The insurance company's objective is to pay the same amount of money under the total loss or the repair scenario. If the car was declared a total loss, they would have sold the car and paid an amount after the sale proceeds. The second survey report matches this amount. They are using the 2 survey reports to accomplish this objective and the fact that the 2 reports for the same car and the same accident differ by several lakhs of rupees suggests that the 2 reports are fabricated. I filed a criminal complaint with the police for cheating. The police attempted to negotiate with the insurance company but are refusing to register an FIR and claim that this is strictly a civil issue. I do feel that it is a criminal issue. Can someone give me some advice?
Also, the second survey report does not provide the benefits promised by Toyota Protect. I feel that Toyota is liable for the benefits promised in the add on and the main portion of the policy since the policy and claim number were both generated by Toyota Protect. But when I address the issues with Toyota Protect, they keep telling me that all they can do is negotiate with the insurer and the ultimate decision will come from the insurer.
Asked 6 months ago in Criminal Law from Chennai, Tamil Nadu
Religion: Hindu
This dispute will continue for sometime without giving any relief to you.
What I find most suitable is to seek redress from consumer forum where the ongoing dispute would not only be expeditiously adjudicated to your advantage, you would additionally awarded with damages and compensation.
Devajyoti Barman
Advocate, Kolkata
5248 Answers
54 Consultations
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1) your remedy is to file complaint before consumer forum against the insurer for deficiency in service to direct insurer to pay the repair charges of the vehicle damaged in floods 

2) it is civil dispute  and police have rightly declined to lodge any complaint 

3) you can in consumer forum claim litigation costs and also compensation from the insurer
Ajay Sethi
Advocate, Mumbai
23386 Answers
1229 Consultations
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There is prima facie criminality involved in this. If police does not register the FIR then seek binding directions from the court to the police to set the process of criminal law in motion. This apart, you can also move the consumer forum against toyota and insurance agency to recover the insurance amount and also compensation for deficiency in service. 
Ashish Davessar
Advocate, Jaipur
18259 Answers
450 Consultations
5.0 on 5.0
Also, the second survey report does not provide the benefits promised by Toyota Protect. I feel that Toyota is liable for the benefits promised in the add on and the main portion of the policy since the policy and claim number were both generated by Toyota Protect. But when I address the issues with Toyota Protect, they keep telling me that all they can do is negotiate with the insurer and the ultimate decision will come from the insurer.

You Have an action against the insurer as well as the toyoto company.
Both are responsible for the losses you suffered or the injustice meted out to you.
No doubt there is no criminal complaint maintainable.
You can file consumer case for compensation and deficiency of service agaisnt the insurer as well as the broker i.e., toyota company.
You can seek the compensation of the loss of the vehicle or damage to the vehicle as well for the mental stress cause to you due to their deficiency of service.
T Kalaiselvan
Advocate, Vellore
14166 Answers
128 Consultations
5.0 on 5.0
Also, all of you have advised going to the consumer court. The insurance company with whom I did not directly deal with has an arbitration clause in the policy. So am I restricted to Arbitration? As mentioned in my earlier question, I purchased my policy and filed my claim with Toyota Protect. But they are a broker and underwrote the policy with the insurance company.

The arbitration clause imposed by the insurance company will not have a binding effect. you can approach consumer court, let the court decide about the effect of arbitration clause especially when the fraud committed involves the insurance company too. 
T Kalaiselvan
Advocate, Vellore
14166 Answers
128 Consultations
5.0 on 5.0
1)you can file complaint before consumer forum inspite of arbitration clause 

2) C.P. Act provides an additional remedy to consumer - Mere existence of an arbitration
clause does not oust consumer jurisdiction - 2008(1) CPC 448 N.C.

3) --In spite of a clause in agreement for referring the matter to the Arbitration, Consumer Fora have jurisdiction to take
cognizance of the matter in view of section 3 of C.P. Act which provides an additional remedy – 2012(3) CPC 132 H.P.

4) it is difficult to prove that insurance company fabricated survey reports
Ajay Sethi
Advocate, Mumbai
23386 Answers
1229 Consultations
5.0 on 5.0
1. It is forgery when you make a false document and present it as true. So according to me this is forgery without a shade of doubt. Launch a penal prosecution for forgery and see how the company will dance to your tune sooner or later. 

2. Since there is arbitration clause the doors of consumer forum are closed for you.
Ashish Davessar
Advocate, Jaipur
18259 Answers
450 Consultations
5.0 on 5.0
The claim amount is based on your assessment for the loss of use of automobile and for mental tortures you experienced.
You can mention a figure which shall be reasonable and justified. 
There is no specific law about the quantum of compensation that can be claimed.
T Kalaiselvan
Advocate, Vellore
14166 Answers
128 Consultations
5.0 on 5.0
1) amount spent by you towards transportation charges during period of repairs can be claimed by you 

2) in addition claim litigation costs incurred by you 

3) towards mental agony claim around 2 lakhs or so 
Ajay Sethi
Advocate, Mumbai
23386 Answers
1229 Consultations
5.0 on 5.0
You cannot move the consumer forum if there is arbitration clause. The award of the arbitrator can be challenged in the civil court though.
Ashish Davessar
Advocate, Jaipur
18259 Answers
450 Consultations
5.0 on 5.0

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