AHMEDABAD
VEHICLE INSURANCE
Case No.11-009-1038-12
Mr. Chandrakant V. Rajani Vs. Reliance General Insurance Co. Ltd.
Award dated 2
nd
April 2013
Repudiation of Theft Claim
A theft claim lodged by the complainant for his insured Activa Scooter for IDV of
Rs.20,358/- was repudiated by the Respondent as per policy condition No.1.
Complainant intimated loss of his vehicle to the Respondent after 71 days from the
date of theft and FIR registered after 21 days so claim repudiated as per terms and
condition of the policy.
Reason for delay was shown by the Complainant as at that time Diwali festivals
were going on so could not intimate in time.
In view of this complaint dismissed.
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AHMEDABAD CENTRE
Case No.11-004-1097-12
Mr. Pratish M. Kakad Vs. United India Insurance Co. Ltd.
Award dated 4
th
April 2013
Repudiation of Theft claim
A theft claim lodged by the complainant for his insured Innova Car for IDV of
Rs.10,32,585/- was repudiated by the Respondent under Private Car package policy
condition No.4 and condition No.1.
The car parked some where and key of the car was inside the car and driver gone
for dinner and sleeping to other somewhere that means careless of the driver which is
breach of condition No.4.
Further the intimation given by the complainant after 71 days from the date of loss
occurred, considered late intimation under condition No.1.
In view of this complaint dismissed.
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AHMEDABAD CENTRE
Case No.11-014-1167-12
Smt. Pramodaben R. Patel Vs. Cholamandalam MS. Gen. Ins. Co. Ltd.
Award dated 5
th
April 2013
Repudiation of Death Claim
Accidental loss of the insured vehicle lodged by the complainant for Rs.1,74,500/-
was settled by the Respondent but death claim of the paid driver was not settled because
such type of complaint was not received by the Respondent.
As per policy condition No. IMT-16 and IMT 28 – clearly explained death claim can
apply by legal heirs of the paid driver before MACT or WC Act with appropriate authority.
In this case there is no evidence to prove that who is the paid driver.
Therefore complaint dismissed.
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Case No.11-002-1120-12
Mrs. Diptiben S. Saini Vs. The New India Assurance Co. Ltd.
Award dated 26
th
April 2013
Repudiation of Motor Claim
Complainant was covered a Motor Claim for her Car for IDV of Rs.2,45,000/- and
accidental damage claim lodged for total loss was repudiated by the Respondent giving
reason that at the time of accident, the vehicle was used for hire or reward which is not
permissible under policy heading limitation to use.
As per investigation report, the insured vehicle was plying on hire which is a breach
of policy condition i.e. use of vehicle for hire or reward.
Looking to all these, the complaint dismissed.
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Case No.11-009-0145-13
Mr. Ashwin R. Nakshiwala Vs. Reliance General Insurance Co. Ltd.
Award dated 26
th
April 2013
Partial repudiation of Motor OD Claim
A Motor OD Claim lodged by the Complainant for Rs.12,000/- was partially settled
for Rs.4,508/- and partially deducted for Rs.7,492/- as per the assessment of the
Surveyor.
No FIR lodged with the policy for accident, No loss of life or injury to anybody.
Considering all the above, Respondent’s decision is upheld and complaint
dismissed.
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Case No.11-004-0020-13
Mr. Suresh O. Jogia Vs. United India Insurance Co. Ltd.
Award dated 30
th
April 2013
Repudiation of Damage Claim
Complainant’s insured car was accidentally damaged and estimate lodged for
repair for Rs.1,50,000/- was repudiated by the Respondent giving reason that the
complainant had taken claim from previous insurer as confirmed and declared about NCB
wrongly which is against Indian Motor Tariff Rules.
Complainant has not disclosed previous year’s claim history and got No Claim
Bonus in the current year.
Considering all the above, Respondent’s decision is upheld and complaint
dismissed.
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Case No.11-004-0147-13
Mr. Paresh T. Shah Vs. United India Insurance Co. Ltd.
Award dated 6
th
May 2013
Non receipt of NCB under Two wheeler package policy
Complainant had not received NCB benefit on 2
nd
year premium but thereafter
Respondent proved the NCB with excess premium collected from the Complainant had
refunded.
The Hearing was not attended by both the parties scheduled by this forum so it
was decided to proceed Ex-parte.
Complainant’s demand to punish the employee and agent of the Insurer and also
to get charges of postal, mental harassment etc to not acceptable by this forum hence
complaint dismissed.
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Case No.14-002-1075-12
Dr. Chaturbhai M. Raval Vs. The New India Assurance Co. Ltd.
Award dated 7
th
May 2013
Repudiation of death Claim
Complainant’s insured car met with an accident resulted into death of his wife and
son. He had received damage expense and P.A death claim of his wife but his son’s death
claim was repudiated by the Respondent giving reason that his deceased son is neither
owner nor paid driver so his risk was not covered hence there is no insurable interest at
the time of accident of the insured vehicle.
Respondent clearly proved that at the time of accident, complainant’s deceased
son was driving the insured vehicle as he was not owner of the vehicle, no cover is
available under the subject policy.
In the result complaint fails to succeed.
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Case No.11-009-1038-12
Mr. Chandrakant V. Rajani Vs. Reliance General Insurance Co. Ltd.
Award dated 2
nd
April 2013
Repudiation of Theft Claim
A theft claim lodged by the complainant for his insured Activa Scooter for IDV of
Rs.20,358/- was repudiated by the Respondent as per policy condition No.1.
Complainant intimated loss of his vehicle to the Respondent after 71 days from the
date of theft and FIR registered after 21 days so claim repudiated as per terms and
condition of the policy.
Reason for delay was shown by the Complainant as at that time Diwali festivals
were going on so could not intimate in time.
In view of this complaint dismissed.
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Case No.11-004-1097-12
Mr. Pratish M. Kakad Vs. United India Insurance Co. Ltd.
Award dated 4
th
April 2013
Repudiation of Theft claim
A theft claim lodged by the complainant for his insured Innova Car for IDV of
Rs.10,32,585/- was repudiated by the Respondent under Private Car package policy
condition No.4 and condition No.1.
The car parked some where and key of the car was inside the car and driver gone
for dinner and sleeping to other somewhere that means careless of the driver which is
breach of condition No.4.
Further the intimation given by the complainant after 71 days from the date of loss
occurred, considered late intimation under condition No.1.
In view of this complaint dismissed.
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Case No.11-014-1167-12
Smt. Pramodaben R. Patel Vs. Cholamandalam MS. Gen. Ins. Co. Ltd.
Award dated 5
th
April 2013
Repudiation of Death Claim
Accidental loss of the insured vehicle lodged by the complainant for Rs.1,74,500/-
was settled by the Respondent but death claim of the paid driver was not settled because
such type of complaint was not received by the Respondent.
As per policy condition No. IMT-16 and IMT 28 – clearly explained death claim can
apply by legal heirs of the paid driver before MACT or WC Act with appropriate authority.
In this case there is no evidence to prove that who is the paid driver.
Therefore complaint dismissed.
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Case No.11-002-1120-12
Mrs. Diptiben S. Saini Vs. The New India Assurance Co. Ltd.
Award dated 26
th
April 2013
Repudiation of Motor Claim
Complainant was covered a Motor Claim for her Car for IDV of Rs.2,45,000/- and
accidental damage claim lodged for total loss was repudiated by the Respondent giving
reason that at the time of accident, the vehicle was used for hire or reward which is not
permissible under policy heading limitation to use.
As per investigation report, the insured vehicle was plying on hire which is a breach
of policy condition i.e. use of vehicle for hire or reward.
Looking to all these, the complaint dismissed.
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Case No.11-009-0145-13
Mr. Ashwin R. Nakshiwala Vs. Reliance General Insurance Co. Ltd.
Award dated 26
th
April 2013
Partial repudiation of Motor OD Claim
A Motor OD Claim lodged by the Complainant for Rs.12,000/- was partially settled
for Rs.4,508/- and partially deducted for Rs.7,492/- as per the assessment of the
Surveyor.
No FIR lodged with the policy for accident, No loss of life or injury to anybody.
Considering all the above, Respondent’s decision is upheld and complaint
dismissed.
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Case No.11-004-0020-13
Mr. Suresh O. Jogia Vs. United India Insurance Co. Ltd.
Award dated 30
th
April 2013
Repudiation of Damage Claim
Complainant’s insured car was accidentally damaged and estimate lodged for
repair for Rs.1,50,000/- was repudiated by the Respondent giving reason that the
complainant had taken claim from previous insurer as confirmed and declared about NCB
wrongly which is against Indian Motor Tariff Rules.
Complainant has not disclosed previous year’s claim history and got No Claim
Bonus in the current year.
Considering all the above, Respondent’s decision is upheld and complaint
dismissed.
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Case No.11-004-0147-13
Mr. Paresh T. Shah Vs. United India Insurance Co. Ltd.
Award dated 6
th
May 2013
Non receipt of NCB under Two wheeler package policy
Complainant had not received NCB benefit on 2
nd
year premium but thereafter
Respondent proved the NCB with excess premium collected from the Complainant had
refunded.
The Hearing was not attended by both the parties scheduled by this forum so it
was decided to proceed Ex-parte.
Complainant’s demand to punish the employee and agent of the Insurer and also
to get charges of postal, mental harassment etc to not acceptable by this forum hence
complaint dismissed.
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Case No.14-002-1075-12
Dr. Chaturbhai M. Raval Vs. The New India Assurance Co. Ltd.
Award dated 7
th
May 2013
Repudiation of death Claim
Complainant’s insured car met with an accident resulted into death of his wife and
son. He had received damage expense and P.A death claim of his wife but his son’s death
claim was repudiated by the Respondent giving reason that his deceased son is neither
owner nor paid driver so his risk was not covered hence there is no insurable interest at
the time of accident of the insured vehicle.
Respondent clearly proved that at the time of accident, complainant’s deceased
son was driving the insured vehicle as he was not owner of the vehicle, no cover is
available under the subject policy.
In the result complaint fails to succeed.
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AHMEDABAD CENTRE
Case No.11-011-0361-13
Smt. Rita K. Patel V/s. Bajaj Allianz Gen. Co. Ltd.
Award dated: 30-09.2013
Partial Repudiation of Motor OD claim
The claim lodged under Private Car package policy, the damages sustained to Car
Ford, Model Figo, sustained accidental damages an d lodged estimate for Rs.1,47,547/-.
The Insurer offered Rs.24,688/- as per surveyors report after deducting depreciation etc.
as per norms of the policy conditions. Respondent stated that deduction were made for
internal damages since they would not be admissible as per General Exclusion no.4 and
2(a) of the policy. Further insured has given intimation of loss very late and no
satisfactory convincing reply submitted for delay in submission of late intimation. The
Respondent’s representative stuck to their decision for final settlement of claim at
Rs.25000/-, which is not acceptable to insured.
In the result complainant fails to succeed.
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Award Dated 05.06.2013
Case No. 11-002-0185-13
Sri P R Nimavat V/S New India Assurance Company Ltd.
Two Wheeler Package Policy- Total Repudiation
The theft claim was repudiated as insured failed to give intimation immediately
due to which Respondent deprived from carrying out investigation.
The decision of the Respondent was upheld.
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Case No. 11-012-0329-13
Complainant: - Prakash S. Patel V/S Respondent:- ICICI Lombard General Company Ltd.
Award dated 4
TH
Sep, 2013.
Complainant has lodged a claim for theft of his Motor Cycle on 12.07.2011. The Insurance
Company rejects the claim on the ground of late submission of claim paper and late
report of FIR to police authority. And as per policy condition no. 4 complainant has fails to
take all reasonable steps to safeguard to the vehicle from loss or damage.
The argument of complainant for late submission of FIR cannot be valid ground. Due to
delay valuable time was lost in tracing the vehicle. So there is no new ground to interfere
with the decision of the Respondent to partially repudiate the claims.
In the result complaint fails to succeed.
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Case No.11-009-0247-13
Award dated 15.7.2013
Shri Sanjay Dange Vs. The New India Assurance Co. Ltd.
Damages to Car (OD claim)
The complaint was regarding repair of motor vehicle which met with an accident. The
complainant informed that his wife was driving the car and submitted driving licence of
his wife. Whereas while intimating the Insurance Company, it was informed by the
Manager of the complainant that the complainant Insured was driving the car. Surveyor
approved the claim for Rs.7921/-. The claim was repudiated due to non submission of
driving licence of the complainant. There was no ground to interfere since the claim file
was closed due to non submission of vital document such as driving licence of the
complainant. The complaint was dismissed.
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Award dated 5.7.2013
Case No. 11-012-0218-13
Shri Praful G. Solanki Vs. ICICI Lombard General Insurance Co. Ltd.
Motor claim Policy
The Insured vehicle having IDV of Rs.38,314/- was lost by theft on 9.7.2011. Intimation of
loss was received by respondent on 8.9.2011 which was late by 61 days. Date of FIR
lodged with police 3.9.2011 which was late by 56 days. The claim was repudiated on the
grounds of late intimation and late lodging of FIR. The complaint was dismissed.
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CHANDIGARH OMBUDSMAN CENTER
CASE NO. GIC/167/0IC/11/11
Ram Narian Kakkar Vs Oriental Insurance Company Ltd.
ORDER DATED: 11th April, 2013 MOTOR POLICY
FACTS
This complaint was filed about a Motor Cover-note issued to insure the Private Car
for a period from 27.08.2008 to 28.08.2009. Thereafter, the vehicle was stolen on
16.05.2009 and its claim was not paid by the Company as Engine Number and
chassis number mentioned on Cover-note and policy didn't match with those of
stolen vehicle which were also mentioned by insured in the claim form.
FINDINGS
It was informed by the insurer that vehicle with "Engine No. 705245 and Chassis
No. 056646" was insured by them whereas particulars mentioned in FIR and RC of
stolen vehicle are "Engine No. 56504 & Chassis No. 05844". Insured was advised to
procure pencil tracing of Engine & Chassis numbers from the Registering
Authority. Likewise, Company was advised to make necessary verification from the
Dealer about the delivery of vehicle. It was observed that new vehicle was
purchased from Dealer at Ludhiana and since insurance of the vehicle was sought
from Sirsa Office, identification particulars of the new vehicle were conveyed on
phone to Sirsa based official of the Company. Accordingly, these numbers were
recorded on the cover note and policy. Actually car with these particulars was
delivered to another person by the dealer and insured received a car with different
particulars, which was registered with these new identification numbers. The
vehicle was stolen on 16.05.2009 and while lodging FIR its particulars appearing on
Registration Certificate were given to the Police.
DECISION
It was held that there is enough evidence in the form of Dealer's Invoice,
Temporary Registration Certificate and Delivery Receipt to confirm about purchase
of a car bearing different particulars by insured. The same vehicle was stolen from
his possession. In fact, due to inadvertence the particulars of another car were
wrongly conveyed and mentioned in the insurance documents. Hence, it is in order
to settle the claim. Accordingly, an award was passed with a direction to the
insurance company to settle a claim for admissible amount subject to fulfillment of
usual claim formalities.
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CHANDIGARH OMBUDSMAN CENTER
CASE NO. GIC/362/REL/11/11
Shiv Bhagwan Vs Reliance General Insurance Company Ltd.
ORDER DATED : 16
th
April, 2013 MOTOR POLICY
FACTS
The complaint was filed about a Motor Policy issued to insure private Car for a period
from 29.11.2009 to 28.11.2010. Thereafter, vehicle was damaged in an accident and its
claim, lodged on 23.02.2010, was not paid by the Company.
FINDINGS
The insurer submitted that vehicle was fitted with LPG Kit, without endorsement on
Registration Certificate/ Policy. The first claim was paid on a condition that necessary
endorsements in Registration Certificate and Policy would be completed to
incorporate LPG Kit, which could not be done by the insured till the time of second
claim. Hence, the second claim was denied.
DECISION
It was held that denial of the claim was justified since LPG Kit was endorsed on
15.09.2010, i.e., after the second claim. Therefore, complaint was dismissed.
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CHANDIGARH OMBUDSMAN CENTER
CASE NO. GIC/683/NIA/11/11
Narender Singh Vs The New India Assurance Company Ltd.
ORDER DATED : 8
th
May, 2013 MOTOR
FACTS
The complaint was filed about a Motor Policy issued to insure truck No. HR 46 B –
5623 for a period from 06.05.2009 to 05.05.2010. Thereafter, on 15.03.2010, vehicle
was damaged in an accident and its claim was not paid by the Company.
FINDINGS
The representative of the company explained that while processing claim file,
assessment reports of vehicle’s previous and current claim were compared and it was
observed that in the case of few major parts, identification numbers were different
which resulted in rejection. Insured submitted that although surveyor had assessed
the loss of truck for Rs. 1,50,000/- but the office deducted nearly half the amount and
offered him a sum of Rs. 78,000/-. Further, the company had doubts about the
replacement of some major parts on account of their different numbers. Actually, he
had replaced these parts in a routine manner in the interval between the previous and
the present accident.
DECISION
It was held that deduction of a sizeable amount from the assessment report of
surveyor in the absence of a satisfactory clarification is unwarranted. Accordingly, an
award was passed with a direction to the insurance company to settle a claim as per
the assessment report of Surveyor. The Award carried a simple interest @ 8% with
effect from 14.02.2011 till a date of its actual payment.
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CHANDIGARH OMBUDSMAN CENTER
CASE NO. GIC/382/Rel/11/11
Bhupinder Singh Vs Reliance General Insurance Company Ltd.
ORDER DATED : 13
th
May, 2013 MOTOR
FACTS
The complaint was filed about Motor Policy issued to insure a Scorpio no. PB 07X-1510
for a period from 18.05.2009 to 17.05.2010. Thereafter, vehicle was damaged in an
accident on 12.05.2010 and its claim was not settled for an appropriate amount.
FINDINGS
Insured submitted that vehicle met with an accident within 11 months after its
purchase and was insured for Rs. 6,46,000/-, but Company had finalized its loss on
total loss basis on the basis of its value as Rs. 5,10,000/-. Thus, a sum of Rs. 1,36,000/-
still remains to be paid. The insurer explained that loss was settled on ‘Net of Salvage
Basis’ with the consent of insured. It was further clarified that under the settlement,
company had made a direct payment of Rs. 2,39,000/-, after deducting compulsory
excess clause amount of
Rs. 1,000/-. In this connection, the salvage of the vehicle was disposed by the insured
in lieu of which an amount of Rs. 2,70,000/- was realized by him. In this context,
insurance company provided a copy of NCDRC judgment in support of the contention
that after specific consent and encashment of claim cheque, insured is not supposed to
re-open the matter.
DECISION
It was held that settlement of the claim is quite on the lower side, even after taking
into consideration consent of insured. Further, issue of ‘Insured Declared Value’ had
been over-looked as settlement of claim is more or less on total loss basis.
Accordingly, an award was passed with a direction to the insurance Company to pay an
additional amount of Rs. 68,000/-.
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CHANDIGARH OMBUDSMAN CENTER
CASE NO. GIC/700/UII/14/11
Anuj Wadhwa Vs United India Insurance Company Ltd.
ORDER DATED : 15
th
May, 2013 MOTOR
FACTS
The complaint was filed about a Motor Policy issued to insure a Maruti Esteem for a
period from 27.08.2010 to 26.08.2011. Thereafter, on 04.11.2010, vehicle was
damaged in an accident and its claim was not paid by the Company.
FINDINGS
The representative of the company explained that during survey, Gas Kit in the vehicle
was found, which resulted in denial of claim. He clarified that as per an Endorsement
made in the Registration Certificate, LPG Kit was installed in the vehicle on 18.09.2007,
whereas insurance was taken without disclosing it for saving premium. However,
insurance company did not provide proposal form to establish the matter. Insured
submitted that on 27.08.2009, he had shifted vehicle’s insurance to United India
Insurance Company Ltd. when a copy of Registration Certificate, confirming Gas Kit in
the vehicle, was also provided.
DECISION
It was held that out-right denial of the claim is not justified ; since while insuring
vehicle company was supposed to call for a copy of Registration Certificate for its
examination, which was not followed. Therefore, award was passed for settlement of
the claim on sub-standard basis with a direction to the insurance company to settle a
claim for 75% of assessed loss.
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CHANDIGARH OMBUDSMAN CENTER
CASE NO. GIC/128/REL/11/13
Atul Mittal Vs Reliance General Insurance Company Ltd.
ORDER DATED : 11
th
September, 2013 MOTOR
FACTS
This complaint was filed about a Motor Policy issued to insure a Private Car for a
period from 21.08.2011 to 20.08.2012. Thereafter, the vehicle was damaged in an
accident and against a claim for a reimbursement of repairing cost of Rs. 79,000/-,
Company offered to pay Rs. 3,875/-, disallowing a major portion of repair of engine.
FINDINGS
It was observed that on a state highway road between Saharanpur and Shamli owing
to a big hole, bottom of the engine of car hit the ground. However, due to timing and
area being unsafe, he continued driving of vehicle. After covering some distance,
engine stopped working as the engine oil had completely drained-out. The Company
however was of the view that engine of the vehicle had seized due to negligence on
the part of Insured, who continued driving vehicle even after spillage of engine oil; as
such all the damages from the accidental hitting with the ground of engine sump were
considered for payment, whereas subsequent damages attributable to insured’s
negligence were denied under exclusions of consequential losses.
DECISION
It was held that circumstances, compelling the insured to continue journey even after
the damage to engine, cannot be ignored. However, taking in account negligence on
the part of insured, which led to the aggravation of loss, and was not a deliberate act
from safety angle, consequential losses were allowed on partial basis and an award
was passed with a direction to the insurance company to revise the payable amount
after considering disallowing consequent damages on 60% basis of the admissible
amount.
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DELHI
DELHI CENTRE
Case No.GI/618/SHRIRAM/11
In the matter of Sh. Sandeep Goel.
Vs
Shri Ram Gen. Insurance Company Ltd.
AWARD DATED 12.4.2013 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Sandeep Goel (hereinafter referred to as the
complainant) against Shri Ram Gen. Ins. Co. Ltd. (Hereinafter referred to as
respondent insurance company) relating to motorclaim.
2. Complainant submitted that company was not justified in rejecting the claim
due to breach of condition no. 1. Company had not issued the detailed policy to
him. He had repeatedly requested the executive Mr. Himanshu Kumar for
complete information of the policy. Complainant submitted further that his
vehicle bearing registration no. which was insured, stolen on 22.12.2011. He
filed the FIR and intimated to the insurance company. He got the NOC from the
police regarding non-traceability of the vehicle. He further submitted that he
got his Maruti Swift Dezire insured last year on 3.06.2011 through their
executive Mr. Himanshu Kumar. He submitted further that his claim was legal
and valid therefore company ought to have allowed the claim. He has come to
this forum with a request to instruct the insurance company to settle the claim.
During the course of hearing, it was pleaded by him that claim was payable but
company had denied it for no worthwhile reasons.
3. Company was not represented on the date of hearing despite due intimation
given to it.
4. I have considered the submissions of the complainant very carefully as detailed
in the complaint and as verbally made during the course of hearing. I do not
have the benefit of the arguments of the representative of the company as
company was not represented by any its officers at the time of hearing. I have
perused minutely the repudiation letter and other documents placed on record.
After due consideration of matter, I hold that, claim was payable and the claim
otherwise admissible cannot be denied only on the ground that intimation was
given late. Admittedly insured had suffered a total loss as his vehicle which was
duly insured was stolen and remained untraced during the currency of the
policy. I hold that claim was payable. Accordingly an award is passed with the
direction to the insurance company to make payment of Rs. 4, 59,500.
5. The award shall be implemented within 30 days of receipt of the same. The
compliance of the award shall be intimated to my office for information &
record.
6. Copies of the Award to both the parties.
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DELHI CENTRE
Case No.GI/325/NIC/12
In the matter of Sh. Sudarshan Trivedi
Vs
National Insurance Company Ltd.
AWARD DATED 1.5.2013 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Sudarshan Trivedi (herein after referred to as the
complainant) against the decision of National Insurance Company Ltd. (herein after
referred to as respondent Insurance Company) relating to settlement of motor
claim.
2. Complainant submitted that surveyor has considered only some damages for
assessment of the loss. He had considered certain damages but had ignored certain
other damages which were caused to the vehicle due to the accident. His vehicle
met with an accident with motor cycle bearing registration no. RJ14BA-1090 and
got damaged. During the course of hearing, it was pleaded by the authorized
representative to the insured that damages sustained by the vehicle due to
accident were not considered an allowed in their entirety. The insured vehicle met
with an accident and got damaged. Surveyor ought to have considered all damages
sustained by the insured vehicle due to accident for the assessment but the same
was not done. He considered certain damages but had ignored other damages.
3. Representative of the company pleaded that all damages caused to the vehicle due
to accident were considered by the surveyor. On complaint submitted by the
insured that all damages to the vehicle were not considered by the surveyor,
surveyor was required to clarify and comment on the allegation of the
complainant, who stated that all damages suffered by the vehicle due to accident
were considered already and the loss was assessed by the surveyor. Company also
filed a written reply dated 18.01.2013 wherein, it was mentioned that insured
submitted the claim relating to vehicle which met with an accident on 15.06.2012.
The survey was done on 18.06.2012 and assessment report was submitted dated
28.06.2012 assessing the net payable amount of Rs. 2904 after deduction of
salvage. Office approved the claim for Rs. 2904 and sent a discharged voucher to
insured but he had not responded.
4. I have considered the submissions of the complainant as well as of the
representative of the company. I have also perused written reply of the company
which is placed on record. Surveyor report was also perused. After due
consideration of the matter I hold that assessed loss needed to be modified after
duly considering the damages to the vehicle due to accident. Since insured had not
sent discharged voucher duly signed, it became clear that he had not accepted the
loss as assessed by the surveyor. Accordingly an Award is passed with the direction
to the insurance company to make the payment of Rs. 6190.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
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DELHI CENTRE
Case No.GI/47/UII/12
In the matter of Sh. Amit Kumar
Vs
United India Insurance Company Ltd.
AWARD DATED 30.5.2013 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Amit Kumar (herein after referred to as the
complainant) against the decision of United India Insurance Company Ltd. (herein
after referred to as respondent Insurance Company) relating to non settlement of
motor claim.
2. Complainant submitted that his Esteem car bearing registration no. DL7CB 5963
met with an accident on 04.07.2010. He filed the claim. Company had settled the
claim after 6 months for an amount of Rs. 24728. He had not deposited the cheque
so far as he was not satisfied with the settlement. He had incurred an amount of
Rs. 77135 on account of repairs of his vehicle. Company had appointed surveyor.
He further submitted that claim was not adequately settled by the company. He
has come to this forum with request to instruct the insurance company to
adequately compensate the loss sustained by him due to damage to his vehicle on
account of accident.
3. Representative of the company pleaded that claim was correctly settled and a
deduction of 25% was made on account of the fact that though CNG was fitted in
the vehicle but the same was not declared for insurance purpose. Therefore,
company paid the claim after deduction of 25% of the assessed loss by the
surveyor due to non disclosure of CNG Kit while getting insure the vehicle.
4. I have considered the submissions of the complainant as well as of the
representative of the company. I have also perused the surveyor report. After due
consideration of the matter, I hold that company was not justified in deducting
25% of assessed loss on account of non declaration of CNG. Thus, company had,
paid entire amount of assessed loss to the insured. Accordingly company is here by
directed to make payment of assessed loss less 3 years premium relating to the
CNG Kit as penalty.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
*****************************************************************************************
DELHI CENTRE
Case No.GI/41/Shri Ram/12
In the matter of Sh. Madan Mohan
Vs
Shri Ram General Insurance Company Ltd.
AWARD DAATED 30.5.2013 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Madan Mohan (herein after referred to as the
complainant) against the decision of Shri Ram General Insurance Company Ltd.
(herein after referred to as respondent Insurance Company) relating to non
settlement of motor claim.
2. Complainant submitted that his insured vehicle was burnt. He had submitted all
requisite documents to the insurance company for settlement of the claim but
company had not settled the claim on one pretext to the other. Company
submitted that Chasis number was not given correctly though such information
was also given to the company. After collecting the same from the site. He had
already sent his representation to the GRO of the company but he did not get any
reply from there too. He was being mentally harassed. He has come to this forum
with a request to get the claim settled at an early date. During the course of
hearing, it was pleaded by him that claim was payable but company did not settle
the claim so far. He had suffered a total loss as his insured vehicle got burnt. He
had submitted all requisite documents to the company for settlement of the claim.
3. Representative of the company pleaded that insured had not submitted Chasis
number and therefore, claim could not be settled. Company also filed written reply
dated 13.12.2012 wherein, it was mentioned that vehicle bearing registration no.
DL 04 CAF 4593 was insured vide policy no. 101006/31/11/008997 for the period
02.01.2011 to 01.01.2012. This vehicle caught fire on 06.12.2011 while going to
village Johri. The insured reported the claim. It is further mentioned in the written
reply that since identity of the vehicle was not confirmed by the insured through
any documentary evidence, whether the insured vehicle got caught or not, claim
was made no claim. Insured had not submitted the fire brigade report in support of
the statement that vehicle caught fire. Therefore, claim file was closed.
4. I have considered the submissions of the complainant as well as of the
representative of the company. I have also perused the written reply of the
company which is placed on record. After due consideration of the matter, I hold
that company was not justified in not settling the claim so far because insured had
filed reasonable evidence that it was his insured vehicle which got burnt and lost
in fire. The claim was payable because insured had suffered a total loss due to the
fact that his insured vehicle got burnt during the currency of the policy.
Accordingly an Award is passed with the direction to the insurance company to
make the payment of Rs. 4,08,380 (4,18,880 – 10,000 Scrap Value of burnt vehicle –
500) along with penal interest at the rate of 8% from the date of no claim to the
date of actual payment.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
**************************************************************************************
***
DELHI CENTRE
Case No.GI/30/OIC/12
In the matter of Sh. Surrender Kumar
Vs
Oriental Insurance Company Ltd.
AWARD DATED 30.5.2013 INADEQUATE SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Surrender Kumar (herein after referred to as the
complainant) against the decision of Oriental Insurance Company Ltd. (herein after
referred to as respondent Insurance Company) relating to inadequate settlement of
motor claim.
2. Complainant submitted that he had purchased a new care bearing registration no.
DL8CT-7567 Hundai I-10 on 18.02.2011. This vehicle was insured under cover note
no. 101113. The insurance was valid up to 17.02.2012. This vehicle met with an
accident on 07.09.2011 due to negligence of one truck driver. Truck number could
not be noted, thus it was almost a case of hit and run on the national highway no. 8
near Mahipal pur, Delhi. After accident the vehicle was towed down and dropped
at Himgiri work shop, A-9/1, Jhilmil Industrial Area. Intimation was given to the
insurance company and also to the Himgiri Cars Pvt. Ltd. from where the car was
purchased. He specifically told the manager/service engineer available at the work
shop that it is a case of total loss as such he was not interested in repair of the
vehicle and manager/service engineer may advise the insurance company for
settlement of the claim at the earliest on that basis. No intimation was given as to
why the claim was not settled. He has been requesting the surveyor of the
company who had conducted the survey and submitted the report to the company.
Company has taken much time and he had been harassed on account of non
settlement of claim. However, surveyor agreed to a sum of Rs. 1,35,444 out of total
claim of Rs. 2,35,613. He has come to this forum with a request to instruct the
insurance company to make the payment of Rs. 99,169 being the difference of
Rs.2,35,613 and Rs. 1,35,444. He also desired that company be directed for further
sum of Rs. 1,00,000 due to mental agony and also for towing charges of Rs. 2000.
During the course of hearing, it was pleaded by the complainant that claim was not
adequately settled. Company had paid only Rs. 1,35,444 for repair and he paid the
balance amount to the repairer. He requested the balance amount to be paid to
him.
3. Company’s representative pleaded that claim was settled as per terms and
conditions of the policy and as assessed by the surveyor and complainant is not
entitled to any further amount.
4. I have considered the submissions of the complainant as well as of the
representative of the company. I have also perused the surveyor’s report. After
due consideration of the matter, I hold that company had not settled the claim
adequately and it needs to be modified. Accordingly an Award is passed with the
direction to the insurance company to make further payment of Rs. 25,000.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
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***
GUWAHATI
GUWAHATI OMBUDSMAN CENTRE
Complaint No. 14-G17-012/12-13
Mr.Bhutan Chandra Barman
- Vs -
Future Generali India Insurance Co Ltd.
Date of Order : 06/05/2013
Complainant : The Complainant stated that he procured a Private Car-
Comprehensive Policy under Policy No.2010-V0897561-FPV in respect of his new Fiat
Grande Punto 1.3 Emotion Car, bearing Registration No. AS-01 AQ/6616 covering the
period from 23.09.2010 to 22.09.2011. On 19.08.2011, at around 9.30 PM, near
Borchapori, NH-37, Dist-Golaghat insured vehicle met with an accident sustaining total
loss. He thereafter lodged a claim before the Insurer along with all supporting
documents. But, the Insurer has not yet settled the claim although considerable
period of time has elapsed. Being aggrieved, he has lodged this complaint.
Insurer : The Insurer contended that they deputed their Investigator to investigate
the matter. On receipt of Investigation Report, it was intelligibly evident that the
driver of the IV was under influence of intoxicating liquor and Golaghat Police had
also confirmed the same. It is distinctly mentioned in the policy schedule that if
the driver is under influence of intoxicating liquor, the Company is not liable to
pay the amount for OD damage.
Decision : The Insurer deputed Investigator namely Jayanta Madhab Dutta to
investigate the case and the copy of the survey report produced before this
Authority. It is mentioned in the cause of accident of the Investigation Report that
Insured’s son (Driver) at the time of accident was under influence of alcohol. The
Insurer has also produced a copy of Police Report before this Authority wherein it
is clearly mentioned that during inquiry, it is learnt that driver of the vehicle was
under influence of liquor. The Insurer has also produced the extract coy of
Bokakhat P.S. GD Entry No. 455 dated 19.08.2011 on the overleaf of the Police
Report. It is crystal clear from the Police Report that the driver (Insured’s son) was
under influence of liquor at the time of accident of the vehicle. The extract copy
of Bokakhat Police Station G.D. Entry No. 455 dated 19.08.2011 also extends
support of this fact. As per terms and conditions of the policy, the company shall
not be liable to make in payment in respect of any accidental loss or damage suffered
whilst the insured or any person driving the vehicle with the knowledge and consent of
the insured under the influence of intoxicating liquor or drugs. As there is violation of
policy condition, the Insured is not entitled to get the compensation for damage
of the insured vehicle.
Under the above facts and circumstances as discussed above, I am of the
considered view that the Insurer has rightly repudiated the claim of the
Complainant. Finding no ground to interfere with the decision of the Insurer, the
complaint is dismissed and is treated as closed.
GUWAHATI OMBUDSMAN CENTRE
Complaint No. 11-G4-040/12-13
Sri Bimal Sen
- Vs -
The Oriental Insurance Co. Ltd.
Date of Order : 25.06.2013
Complainant: The Complainant stated that he procured GCCV Public Carriers
Package Policy No. 321200/31/2010/6012 in respect of his vehicle (Truck) bearing
Registration No. AS – 25 / B – 8848 from the Oriental Insurance Co. Ltd. covering the
period from 06.01.2010 to 05.01.2011. On 29.07.2010 evening the Complainant left
the abovementioned Truck for repairing at Suresh Yadav Garage, Behabari,
Guwahati along with his handyman Md. Raja Ahmed, but on the next morning the
Truck was missing along with the handyman. Thereafter, the Complainant lodged a
claim on 02.08.2010 before the Insurer along with all supporting documents. But,
the Insurer has repudiated the claim without any justified ground. Being aggrieve
he has lodged this complaint.
Insurer : The Insurer has stated in their “Self Contained Note” that an FIR was
lodged to Basistha PS on 05.08.2010 and the case was registered under FIR No.
376 dated 26.08.2010 u/s 407 IPC. As per the Police Report, the owner intimated
that the vehicle was stolen from Choudhury Garrage, Beharbari by his handyman.
As per the Final Police investigation report, the vehicle was under repairing at
Suresh Yadav Garrage, but in the Police Report, the name of the garage was
mentioned as Choudhury Garrage. The claim was repudiated on the ground that
the vehicle was stolen by the handyman of the vehicle and FIR was registered u/s
407 IPC i.e. Criminal Breach of Trust and Criminal Breach of Trust is not covered
under the policy. In the claim form also the Insured had mentioned that the case
was registered U/S 407 IPC.
Decision : It is crystal clear from the Ejahar, FIR, and Police Final Report that the
vehicle bearing Registration No. AS – 25 / B – 8848 of the Complainant was stolen by
his engaged Handyman that means his Employee on 29.07.2010. The Complainant
himself stated in the Ejahar that his Handyman was missing along with the vehicle.
The copy of repudiation letter dated 30.09.2011, “Self Contained Note” and the
statement of the representative of the Insurer discloses that the claim was
repudiated on the ground that the vehicle was stolen by the handyman of the
vehicle and FIR was registered u/s 407 IPC i.e. Criminal Breach of Trust and
Criminal Breach of Trust is not covered under the policy. It appears that the
Insurer has repudiated the claim of the Complainant as per terms and conditions
of the policy. Therefore, the Complainant is not entitled to get the benefit under
the above policy.
Under the above factual back ground and the legal position, I have no hesitation
to hold that the decision of the Insurer in repudiating the claim of the
Complainant in respect of theft of the vehicle bearing Registration No. AS – 25 / B –
8848 of the Complainant on 29.07.2010 was just and reasonable. In the result, this
complaint is dismissed and is treated as closed
.
GUWAHATI OMBUDSMAN CENTRE
Complaint No. 11-G4-041/12-13
Mrs. Chhawang Dolma
- Vs -
The Oriental Insurance Co. Ltd.
Date of Order : 19.07.2013
Complainant: The Complainant stated that she procured GCCV-Public Carriers
Package Policy No. 321202/31/2010/240 in respect of her vehicle bearing
Registration No. AR – 04 / 1445 from the above Insurer covering the period from
25.04.2009 to 24.04.2010. While the policy was in force, her insured vehicle was
stolen away by some miscreants on 05.10.2009 from the Garage at Balipara Centre
Charduar, Assam when the vehicle was placed for repairing. She thereafter lodged a
claim before the Insurer along with all supporting documents. But the Insurer has
repudiated the claim without any justified ground. Being aggrieved, the
Complainant has filed this complaint.
Insurer : The Insurer has stated in their “Self Contained Note” that the vehicle was
stolen on 05.11.2009 at night from Tarun Garrage, Balipara and intimation was
received on 10.10.2009 by BO – Tezpur. The claim is repudiated in view of legal
opinion and as per the specific provision under Sec. 66 of MV Act. 1988. The
vehicle was stolen from Sonitpur District from M/s Tarun Garrage and the route
permit is valid for West Kameng District only, arunachal Pradesh. There was no
route permit for Assam. Hence the repudiation.
Decision : The fact of theft of the vehicle on 05.11.2009 has been clearly proved
by the F.I.R., Police Report and Police Final Report. The copy of repudiation letter
dated 02.01.2012 shows that the Insurer has repudiated the claim as per section
149 (2) of the Motor Vehicles Act, 1988, in absence of a Permit as required under
the Act. On perusal of copy of Temporary Permit issued by District Transport
Officer, West Kameng District (A.P), it appears that the above insured vehicle was
issued P. Tem. (No.) 475/BOL/05 dated 30.07.2005 which was renewed upto
29.01.2010 vide T/Ch.No. 48 dated 17.06.2009. On that basis the Insurer has
repudiated the claim of the Complainant. According to the Complainant, due to
non having of proper repairing shop in her District West Kameng of the State
Arunachal Pradesh, she sent her vehicle for the purpose of repairing at M/s Tarun
Garange at Balipara, Sonitpur District by pulling with a recovery van because the
vehicle was badly damaged and unable to move itself. In proof of her contention,
she produced a copy of payment receipt from Jyotish Crane Service, Balipukhuri
Tiniali, Sonitpur, Tezpur wherein it clearly mentioned that the vehicle No. AR-04 /
1445 was lifting and carrying from Black Perry to Balipara (Assam). It clearly
proves from the statement of the Complainant as well as from the Payment
Receipt that the insured vehicle was brought to Assam for the purpose of
repairing only and did not ply in Assam for any other purpose. When the
repairing of the vehicle was completed the vehicle was stolen away by some
culprits on 05.11.2009. I find nothing wrong on the part of the Complainant as
she did not mis-use the vehicle for carrying materials or any other things. Bringing
the vehicle to Assam through a Crane for repairing purpose cannot be said to be
a violation of rule.
Considering the entire facts and circumstances as discussed above, I am of the
view that the decision of repudiation of the claim of the Complainant by the
Insurer is not just and proper. The Insurer is liable to settle the claim of the
Complainant as per terms and conditions of the policy. Insurer was accordingly
directed to settle the claim within 15 days allowing penal interest @ 8% P.A. on
the premium amount.
GUWAHATI OMBUDSMAN CENTRE
Complaint No. 11-G1-076/12-13
Mrs. Bakul Roy
- Vs -
The New India Assurance Co.Ltd.
Date of Order : 10.09.2013
Complainant: The Complainant stated that her husband Nitindra Nath Roy procured
Policy No. 53070131050100000510 from the New India Assurance Co. Ltd. in respect
of his vehicle bearing Registration No. AS – 25 / A – 7067 covering the period from
04.06.2005 to 03.06.2006. Her husband Nitindra Nath Roy, the registered owner of
the vehicle, expired on 17.05.2004. While the policy was in force, his insured
vehicle was stolen away by miscreants from the Sankar Garage, Haiborgaon,
Nagaon. The vehicle was given for repairing. She immediately informed Police and
the Insurer about the loss of the vehicle Thereafter, she lodged a claim before the
Insurer along with all supporting documents. But, the Insurer has repudiated the
claim without any justified ground. Being aggrieved, he lodged this complaint.
Insurer :. The claimant did not submit the claim documents till 17.06.2007 although
the insured vehicle was stolen on 04.09.2005 and as such they closed the claim file
on 18.06.2007 with an intimation letter to the Insured. Later on, as per claimant’s
letter dated 07.12.2009 the claim documents excluding keys of the vehicle were
submitted which were received on 31.12.2009 and keys of the vehicle submitted in
the month of Oct., 2012. However, the Insured Late Nitindra Nath Roy died on
17.05.2004 as per death certificate submitted by the claimant while the Motor
Policy No. 53070131050100000510 commenced the risk w.e.f. 04.06.2005 to
03.06.2006. The date of theft of the vehicle was on 04.09.2005 at 8 p.m.
Therefore, it is clear that Late Nitindra Nath Roy died almost one year before the
commencement of the risk of the policy from 04.06.2005. Therefore, it is not
entertainable and repudiated the claim on the ground of non-existence of the
insurable interest of the Insured taking the provisions of the condition No. 10 of
the commercial vehicle insurance clause.
Decision : It is crystal clear from the policy condition that in case of death of the
Insured, the legal heir must apply before the Insurer for transfer of the policy or
for a new policy for the vehicle within three months from the date of death of
the Insured. But, in the instant case, the Insured admittedly died on 17.05.2004.
The claimant / legal heir did not apply for transfer of the policy within three
months from the date of death of the Insured. Moreover, the above policy was
renewed in the name of original Insured Nitindra Nath Roy covering the period
from 04.06.2005 to 03.06.2006 although Nitindra Nath Roy died almost one year
before commencement of the policy. The Complainant suppressed this material
facts about the date of death of the original Insured and renewed the policy. It is
ample clear that the claimant has no insurable interest under the above policy and
there is a serious fault on the part of the Complainant that she obtained the
insurance policy in the name of a dead person. Hence, the Insurer is not liable to
pay any claim amount under the above policy as the claimant has got no insurable
interest.
Under the circumstances, I find no irregularity on the decision of the Insurer in
repudiating the claim. Considering the entire matter, I find no justified ground to
interfere with the decision of the Insurer and accordingly the complaint is
dismissed and is treated as closed.
KOCHI
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-005-817/2011-12
C K Abdul Majeed
Vs
Oriental Insurance Co. Ltd
AWARD No. IO/KCH/GI/01/2013-14 dated 03.04.2013
The complainant had insured his car with the Respondent-Insurer. The car was stolen and
a crime of theft was registered by the police. The theft was intimated to the insurer and
the claim for the same was not processed by the insurer. Therefore, the complaint.
The insurer submitted that investigations revealed that the complainant was not the
owner of the car on the date of theft of the same. So, the complainant had no insurable
interest . Also it was submitted that the complainant did not file a proper claim seeking
compensation.
Decision:- The complainant has failed to produce a copy of the claim form evidencing
submission of the same. In the result, the complaint is disposed of as follows:-
1. The complainant shall promptly submit a proper claim with documents.
2. As and when the same is received , the insurer shall process the same in accordance
with policy conditions and provisions of law applicable.
3. The decision shall be promptly intimated to the complainant.
4. The right of the complainant to challenge the decision is reserved.
5. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/ KCH/GI/11-012-848/2011-12
K M Hassan
Vs.
ICICI Lombard General Insurance Co Ltd
Award No.GI/ 6/2013-14 dt. 9.4.2013
The complainant’s car was insured with the respondent insurer. The policy was issued on
28.10.10 on issuing a cheque for Rs. 4543/-. The vehicle met with an accident on 20.7.11.
The cheque issued towards premium was dishonoured on 15.12.10. The complainant was
informed of the same only nine months thereafter. The cheque was presented after 48
days from the date of issuance. The cancellation of policy is illegal. Hence, the complaint.
Respondent-insurer entered appearance and filed a self contained note. The cheque
issued by the complainant was dishonoured by the bank on the ground ‘funds
insufficient’. Accordingly, the policy was cancelled and the same was informed to the
complainant vide letter dated 10.1.11. The policy was issued subject to realization of
premium amount paid by cheque. As there was no premium, the policy was cancelled and
the respondent-insurer is not liable to indemnify the loss suffered by the complainant.
The point: The accident took place much after the cancellation of the policy. It is the
bounden duty of the drawer of the cheque to maintain sufficient balance in his account
to honour the cheque whenever it is duly presented for payment/ collection. The copy of
the letter of intimation of cheque dishonour (under ‘certificate of posting’)by the insurer
is produced before this Forum. Also, there is evidence that the cancellation of the policy
was intimated to the concerned RTO on 10.1.11 itself. The contention of the complainant
that the respondent had not issued a legal notice as per NI Act cannot be countenanced
for the reason that normally, insurance companies are not interested in filing complaints
against their customers under the above act in order to maintain friendly customer
relationship with them.
Decision. As on date of accident, there was no valid insurance cover for the vehicle.
Cancellation of policy on account of lack of premium and repudiation of claim on the
ground of cancellation of policy are in order. In the result, the complaint is dismissed. No
cost.
*****************************************************************************************
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/ KCH/GI/11-003-857/2011-12
P M Ranjith
Vs.
National Insurance Co Ltd
Award No.GI/ 7/2013-14 dt. 9.4.2013
The complainant had purchased a Stage Carriage from its previous owner and on the next
day itself, he had made an application to the RTO office for change of owner’s name.
While so, the vehicle met with an accident on 28.7.11. The complainant preferred a claim.
The claim was repudiated. Hence, this plea requesting the insurer to honour the claim.
Respondent-insurer entered appearance and filed a self contained note. On processing the
claim documents, it was observed that ownership of the vehicle was transferred in favour
of the complainant wef 14.7.2011 but the insurance policy was not transferred in favour
of the complainant within 14 days of the transfer of ownership. Hence the claim was
repudiated.
The point: As per the copy of the certificate of registration, the ownership of the vehicle
had been transferred in the name of the complainant wef 14.7.11 and from 14.7.11, the
previous owner had no insurable interest on the vehicle. As on the date of accident, the
complainant was the registered owner of the vehicle. Admittedly, the complainant did
not make any application for transfer of policy in his name prior to 1.8.11 which he ought
to have done within fourteen days from 14.7.11. As on date of accident, there was no
privity of contract of insurance between the complainant and the insurer. Hence, the
respondent-insurer has no liability to indemnify the loss suffered by the complainant.
Decision: The complaint is dismissed. No cost.
*****************************************************************************************
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-004-855/2011-12
Saidalavi
Vs
United India Insurance Co. Ltd
AWARD No. IO/KCH/GI/10/2013-14 dated 11.04.2013
The complainant had insured his car with the Respondent-Insurer. The car met with an
accident. Though survey was conducted, the claim for the same was not settled by the
insurer. Therefore, the complaint.
The complainant submitted that Surveyor deputed by the insurer assessed the loss and
thereafter, re-assessment was done without any reason and without assigning any
ground, the compensation was reduced. There is no reason not to settle the claim.
The insurer submitted that as there was some discrepancy in the value of the assessed
wreck, re-assessment of loss was done. Delay had occasioned on account of the non-co-
operation of the insured.
Decision:- Regarding the loss suffered, the only reliable piece of evidence is the Surveyor’s
report. As per the 1
st
survey report, on cash loss basis , the loss is assessed as Rs. 256558/-.
In this report, the Surveyor had given the extent of damage caused to the vehicle in detail.
In the additional report submitted later, he had not given the details of the revised
assessment. There is no mention as to how he quantified the loss. Which items were
excluded by him in the revised report is also not mentioned. The insurer had also not
disclosed any specific reason for re-assessment of loss. In the circumstances, the revised
report is not acceptable. So, the liability of the insurer will be as per the original Survey
report. In the result, an award is passed directing the insurer to pay an amount of Rs.
256558/- within the prescribed period failing which the amount shall carry interest at 9%
per annum from the date of filing of the complaint till the payment is effected. No cost.
*****************************************************************************************
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/ KCH/GI/11-002-865/2011-12
Shaju P Menon
Vs.
New India Assurance Co Ltd.
Award No.GI 11/2013-14 dt. 15.4.2013
Complainant’s vehicle, covered under a private car package policy with the respondent-
insurer, met with an accident on 30.10.11. When a claim was preferred for the damages, it
was partially settled. As the complainant felt that he is entitled to the balance amount,
this complaint.
Respondent-insurer entered appearance and filed a self contained note. They had, on
getting intimation regarding accident, deputed a licensed surveyor to assess the loss.
Whatever amount the complainant was entitled to, was paid to him.
The point: According to the complainant, he had spent Rs. 50964/- for repairing the
vehicle. The insurer settled the claim for Rs. 34530/-. One of the main contentions of the
complainant is that the complainant had met an expense of Rs. 3281.86 which was not
considered by the respondent-insurer while assessing the loss. On a perusal of the Survey
Report, it is noted that the surveyor had not taken into consideration, 16 items while
assessing the loss. The total value of spare parts less depreciation and salvage value
would come to Rs. 2221/-. Also, the additional survey report would reveal that the
surveyor had not taken into consideration the VAT component while quantifying the loss
to the AC condenser. This would come to Rs. 259/-. In the additional report, an amount
of Rs. 1804 (after depreciation and salvage value deduction) was recommended by the
surveyor towards cost of AC condenser.
Decision: An award is passed directing the respondent-insurer to pay to the complainant
an amount of Rs. 2480/- which the complainant is entitled to, within the prescribed period
failing which the amount shall carry interest @ 9% pa from the date of filing of complaint
till payment is effected. No cost.
*****************************************************************************************
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/ KCH/GI/11-003-887/2011-12
D Prabha
Vs.
National Insurance Co Ltd.
Award No/GI/ 12/2013-14 dt.16.04.2013
The complainant’s deceased husband was the registered owner of a car which met with a
road traffic accident on 26.11.2011. A claim was preferred towards damages incurred. It
was rejected. The complainant caused to issue a legal notice. As per the complainant, the
insurer is liable to indemnify the loss suffered, so this complaint.
Respondent-insurer entered appearance and filed a Self-contained note. While the
insured died on 16.6.2011, as per condition No. 9 of the policy, upon death of the
insured, the legal heir(s) of the insured has to apply for transfer of policy within a period
of three months from the date of death of the insured. As the same was not done, as on
the date of accident, there was no valid insurance cover for the vehicle.
The Point: By virtue of Condition 9, the life of the policy is extended for a period of three
months or till the expiry of the policy, whichever is earlier, on the death of the insured.
Admittedly, no application was made either by the complainant or any other legal heir
within three months of the death of the insured for transfer of the policy. So, the policy
lapsed on 15.9.2011 while the accident was on 26.11.2011. So, there was no insurance
cover for the vehicle on the date of accident.
Decision: The delay in getting the legal heirship Certificate cannot be urged as a ground
for not making application for transfer of policy in time. Such a contention is not seen
raised by the complainant in the complaint before this Forum. This contention cannot be
accepted.
In the result, the complaint is dismissed. No cost.
*****************************************************************************************
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-003-951/2012-13
M Ansari
Vs
National Insurance Co. Ltd
AWARD No. IO/KCH/GI/21/2013-14 dated 24.04.2013
The complainant had insured his Contract Carriage Vehicle with the Respondent-Insurer.
The vehicle caught fire on 16.02.2009 and the entire bus was burnt down. A Crime was
registered in the Chavakkad police station. The claim for total loss was repudiated by the
insurer on the ground that there was no insurable interest to the complainant. Therefore,
the complaint.
The complainant submitted that there was only transfer of possession and not transfer of
property in the goods as on the date of accident. The complainant was the registered
owner as on that date and so he is entitled to get the IDV.
The insurer submitted that Smt. Sreeja was the owner in possession of the vehicle by
virtue of the agreement dated 02.01.2008. So, the complainant had no insurable interest
in the vehicle after 02.01.2008 and as on the date of accident. So, the repudiation of the
claim is legal and proper.
Decision:- As per Section 4(3) of Sale of Goods Act, an agreement to sell becomes a sale
when the time elapses or the conditions are fulfilled s..to which the property in the goods
is to be transferred.. So, in an agreement to sell, the property is transferred on a future
date. As per copy of the Registration Certificate, the complainant is the registered owner
of the vehicle. Also the policy as on the date of accident is in the name of the
complainant. Contract Carriage Permit is also in his name. Also a demand for taxes due
from the complainant issued by the RTO, Kollam is also produced. The accident was
intimated to the insurer by the complainant himself. There is no piece of evidence that at
any point of time, before any authority, Smt. Sreeja had asserted her right as owner of the
insured vehicle. So, there is complete lack of evidence regarding sale of the vehicle by
virtue of document dt. 02.01.2008. All these facts reiterate that it was an agreement to
sell, which did not materialize till the date of fire accident. So, the complainant as owner is
entitled to compensation . As the complainant is not interested in taking back the wreck,
he is entitled to Rs. 313500/-. In the result, an award is passed directing the insurer to pay
an amount of Rs. 313500/- with cost of Rs. 2500/- within the prescribed period failing
which the amount shall carry interest at 9% per annum from 28.02.2013 till the payment is
effected.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-021-906/2011-12
John Mathew
Vs
Shriram General Insurance Co. Ltd
AWARD No. IO/KCH/GI/30/2013-14 dated 15.05.2013
The complainant had insured his Tipper Lorry with the Respondent-Insurer. The vehicle
met with a road traffic accident and he had to spend an amount of Rs. 61251/- for
effecting repair. The claim for the same was closed by the insurer on the ground that the
driver was not holding effective driving licence at the time of accident. Therefore, the
complaint.
The complainant submitted that the driver of the insured vehicle was holding valid
driving licence at the time of accident. The repudiation of the claim is without any basis.
The insurer submitted that the driver of the vehicle was having only licence to drive Light
Motor Vehicle whereas vehicle he was driving was registered under MGV(Medium Goods
Vehicle). So, the driver was not holding effective driving licence to drive the insured
vehicle. This is in violation of the policy conditions and the therefore, the claim was
closed.
Decision:- The registration certificate shows that the vehicle was registered as a MGV. As
per Motor Vehicles Act Section 2(23) , a vehicle whose gross weight exceeds 7500 kg and
does not exceeds 12000 kg is classified as a MGV. The driving licence of the driver shows
that he was authorized to drive LMV only. A conjoint reading of Section 3(1) and 2(10) of
the M.V. Act would reveal that to drive a specified class of vehicle, the driver must be
specifically authorized to do so in the driving licence issued to him. So, here the driver of
the vehicle was driving a vehicle which he was not authorized to drive. In the policy , it is
specifically stated that the person driving the vehicle should hold an effective driving
licence at the time of accident. So, in this case, there is violation of the provision of
M.V.Act as well as the policy conditions. So, the insurer is exonerated from liability to
compensate. In the result, the complaint is dismissed. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-005-912/2011-12
Mohanakumaran Nair
Vs
Oriental Insurance Co. Ltd
AWARD No. IO/KCH/GI/33/2013-14 dated 17.05.2013
The complainant had insured his Escorts Crane with the Respondent-Insurer. It met with
an accident and he had to spend an amount of Rs. 342827/- for effecting repair. The claim
for the same was repudiated by the insurer on the ground that the driver of the crane was
not holding valid driving licence to drive the crane. Therefore, the complaint.
The complainant submitted that it is not correct to state that the driver of the crane was
not holding effective driving licence. He was authorized to drive heavy transport vehicles.
No special endorsement is required for driving a crane. The repudiation of the claim is
without any basis.
The insurer submitted that the driver of the crane did not hold a valid driving licence to
drive crane. Specific endorsement to drive crane was not made in the driving licence. So,
the driver was not holding effective driving licence to drive the insured vehicle. The claim
was repudiated as there was violation of the policy conditions and the provisions of
M.V.Act.
Decision:-As per the certificate of registration, the crane is registered as MGV-Crane. From
R,C, and also the policy, it is seen that the gross vehicle weight of the insured crane is
less than 12000 kgs and above 7500 kgs. So, it is a Medium Goods Vehicle. At the time of
accident, the driver was holding driving licence authorizing to drive Heavy Transport
vehicles. The licencing Authority has certified that the driver was possessing driving
licence to drive transport vehicle and that authority is sufficient to drive crane vehicle
also. As per Section 13 of the M.V.Act , a driving licence issued shall be effective through
out India. As per circular issued by the Transport Commissioner of Kerala, a person
holding HGV licence is authorized to drive all lower category vehicles also. All the
concerned documents including survey report would reveal that the vehicle insured was a
MGV-Crane. So, there is no violation of the provisions of M.V.Act or the policy conditions
or the warranty on the policy schedule regarding driving licence. The repudiation of the
claim is not sustainable. The net repair charge was assessed as Rs. 299305/- in the survey
report. In the result, an award is passed directing the insurer to pay an amount of
Rs.299305 /- with interest @9% from the date of filing of the complaint till the date of
award within the prescribed period failing which the amount shall carry further interest at
9% per annum from the date of award till the payment is effected. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-003-915/2011-12
P K Abubecker
Vs
National Ins. Co. Ltd
AWARD No. IO/KCH/GI/34/2013-14 dated 22.05.2013
The complainant had insured his motorcycle with the Respondent-Insurer. It was stolen
while parked outside a restaurant. A police case was registered. The claim for the same
was rejected by the insurer on the ground that there was violation of policy condition No.
1. Therefore, the complaint.
The complainant submitted that the rejection of the claim by the insurer is on filmsy
grounds. He is entitled to get the claim amount.
The insurer submitted that there was inordinate delay in reporting the theft to the Police
as well as the insurer. It was done after nearly 3 months. There was violation of policy
condition No. 1. The repudiation of the claim is legal and as per policy conditions.
Decision:- FIR is dated 4.12.2010 and it is mentioned in it that the crime was first reported
on that date. So, the available evidence is to the effect that the Police was informed of
the theft, first in point of time, only on 04.12.2010. As per condition No. 1 of the policy, in
case of theft, it should be immediately intimated to the police as well as the insurer. Delay
would efface evidence and help the culprits to cause disappearance of the stolen
property. The term ‘immediate’ can not be extended or diluted to mean that ‘within
reasonable time’ as the policy conditions are to be construed strictly. The complainant had
not offered any acceptable explanation for the delay caused in reporting the theft to the
police and the insurer. Opportunity to make enquiry was denied to the insurer on account
of the delay. So, there is flagrant violation of condition No. 1 which cuts at the root of the
claim made by the complainant. The repudiation of the claim is in order and in tune with
policy conditions. In the result, the complaint is dismissed. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/14-014-978/2012-13
Siva Prasad
Vs
Cholamandalam General Ins. Co. Ltd
AWARD No. IO/KCH/GI/35/2013-14 dated 22.05.2013
Vehicle owned by the complainant and insured with the Resondent-Insurer met with an
accident resulting in damage to the vehicle. The claim was not allowed by the insurer. The
complainant approached the Grievance Cell on 23.12.2011. Thereafter he filed a fresh
complaint before this forum on 18.03.2013.
Decision:- As per Rule 13 (3)(a) & (b) of RPG Rules, as the present complaint is filed
before this Forum on 18.03.2013, beyond one year from 23.01.2012, the complaint is
barred by limitation. In the result, the complaint is dismissed as barred by limitation. No
cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-005-988/2011-12
R Jayasankar
Vs
Oriental Insurance Co. Ltd
AWARD No. IO/KCH/GI/43/2013-14 dated 28.05.2013
The complainant had insured his car with the Respondent-Insurer. The car met with an
accident on 02.11.2010 near Madurai and substantially damaged. The insurer offered to
settle the claim for Rs. 110000/- . He was not amenable for the settlement. Therefore, the
complaint.
The complainant submitted that the Surveyor recommended the claim on total loss
basis. The wreck was sold for Rs. 50000/- and he had consented to settle the claim for a
total amount of Rs. 185000/-.
The insurer submitted that they offered Rs. 110000/- to the complainant on Cash Loss
basis and the wreck has already been disposed of by the complainant.
Decision:-As per the Survey report, the wreck value is Rs. 50000/-. The loss is assessed on
repair basis at Rs.184000/-, on cash loss basis at Rs. 135605/- and on Salvage loss basis at
Rs. 150000/-. Now the claim can be settled only on Total loss basis and insured is entitled
to the IDV which is Rs. 2 lakhs. The complainant had executed a consent letter to settle
the claim by receiving the balance amount of Rs. 135000/- after deducting the wreck
value received. The insurer is liable to pay that amount to the complainant. In the result,
an award is passed directing the insurer to pay an amount of Rs. 135000/- with cost of Rs.
2500/- to the complainant within the prescribed period failing which the amount shall
carry interest at 9% per annum from the date of filing of the complaint till the payment is
effected.
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FICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-011-946/2011-12
Kunjumon & Narayanan Achari
Vs
Bajaj Allianz General Insurance Co. Ltd
AWARD No. IO/KCH/GI/46/2013-14dated 30.05.2013
The complainant had purchased a TATA Sumo vehicle from the 2
nd
complainant and the
ownership was changed to his name w.e..f. 25.08.2011. The vehicle met with an accident
on 02.11.2011 and the claim was repudiated by the insurer on the ground that the 2
nd
complainant had no insurable interest on the vehicle. Therefore, the complaint.
The complainant submitted that as on the date of accident the vehicle was covered by
the policy taken by the 2
nd
complainant. Change of ownership was effected only on
02.11.2011 and so the 1
st
complainant could not transfer the policy in his name. The
repudiation is not based on policy conditions.
The insurer submitted that transfer of ownership was effected on 25.08.2011 and there
was no application from the side of the 1
st
complainant to transfer the insurance in his
name. The 2
nd
complainant was not having any insurable interest on the vehicle and there
was no privity of contract between the 1
st
complainant and the insurer. So, they have no
liability to indemnify the loss.
Decision:- On account of transfer of ownership of the vehicle on 25.08.2011, the 2
nd
complainant did not have any insurable interest on the vehicle thereafter. As per GR 17,
on transfer of ownership, the liability only cover will be deemed to have been transferred
in favour of the transferee. Own damage section will be transferred only on receipt of
specific request from the transferee with the consent of the transferor and subject to
acceptable evidence of transfer and fresh proposal form duly filled and signed. Here there
was no application for transfer of policy in favour of the 1
st
complainant.So, as on date of
accident, there was no privity of contract between the 1
st
complainant and the insurer. In
view of these facts, the repudiation of the claim by the insurer is legal and proper. The
complainants are not entitled to any relief in the complaint. In the result, the complaint is
dismissed. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-004-894/2011-12
Sindhu
Vs
United India Insurance Co. Ltd
AWARD No. IO/KCH/GI/47/2013-14dated 30.05.2013
The complainant’s husband had insured his motor cycle with the Respondent-Insurer.
He met with an accident while riding it and died. The claim for damages of the vehicle as
well as the death benefit under the policy was rejected by the insurer. Therefore, the
complaint.
The complainant submitted that the insured was riding a modified motor cycle with one
additional wheel each on either side and he was driving the same with valid driving
licence. She is entitled to receive the claim amount.
The insurer submitted that modification or articulation done in the motor cycle was
without sanction of the RTO and insurer was also kept in dark. The insured was having a
licence to drive an Invalid Carriage. But he was riding a motorcycle without valid
authorization. He had violated the policy conditions and therefore, the repudiation of the
claim is legal and proper.
Decision:- As per the MV Act and also as per the policy schedule , a motor cycle with side
car is essentially a two wheeler. Here the motor cycle was fitted with two additional
wheels on the rear. It won’t come under the definition of the “Articulated vehicle” as per
MV Act. The evidence before this Forum is to the effect that the additional wheels were
fixed by the Dealer, who is competent to fix the same. In the instant case, the insured was
having a Motor cycle modified as Invalid Carriage at the time of delivery of the vehicle
and he was riding the same at the time of accident. So, the insured was holding valid
driving licence to ride the vehicle which was insured with the insurer. So, the repudiation
of the claim can not be sustained . In the result, an award is passed directing the insurer to
pay an amount of Rs.21200/- towards damages to the vehicle and Rs. 1 lac towards
Personal Accident Sum Assured to the complainant within the prescribed period failing
which the amount shall carry interest at 9% per annum from the date of filing of the
complaint till the payment is effected. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-009-955/2011-12
Suneesh C
Vs
Reliance General Insurance Co. Ltd
AWARD No. IO/KCH/GI/52/2013-14dated 11.06.2013
The complainant had insured his Mini Lorry with the Respondent-Insurer. The lorry was
damaged in an accidental fire on 10.02.2011. The claim for the same was repudiated by
the insurer on the ground that the lorry was overloaded and as a result came into contact
with electric line and caught fire. Therefore, the complaint.
The complainant submitted that the vehicle was loaded with corn hay below the
permissible height only. Spark from the overhanging electric line had occasioned the fire
accident and the entire vehicle was damaged beyond repair. The l;oad challan was also
burnt along with it. He is entitled to receive the IDV with interest and cost.
The insurer submitted that the fire accident occurred while corn hay, which was loaded
above the permissible height, touched the overhanging electric line. The accident
happened solely due to the negligence of the driver. As the insured/driver was negligent
and drove the lorry in violation of the policy conditions and the provisions of the M.V.
Act, the insurer has no liability to compensate the insured.
Decision:- For repudiation of the claim, the insurer is mainly relying on the Investigation
Report submitted by the investigator appointed by them. This is dated 18.07.2011 , much
after the accident on 10.02.2011. Here there is no mention as to the height of the load or
the height of the overhanging electric lines. In the police G.D. entry the cause of fire
accident is shown as “unknown reason”. In the Survey report, it is mentioned that the
vehicle was fully burnt out. In the fire report, the preliminary finding as to the cause of
fire accident is stated as “ electric short circuit” which negatives the contention of the
insurer that the corn hay touched the electric lines and the fire occasioned. Non-
production of challan is not very material for deciding the claim submitted by the
complainant. There is no evidence at all to prove that the accident occurred due to
overloading of the insured vehicle. Therefore, it can be concluded that the repudiation of
the claim is not sustainable. Salvage value was assessed at Rs. 50000/-. In the result, the
complaint is disposed of with a direction to the insurer to pay an amount of Rs. 599500/-
to the complainant within the prescribed period failing which the amount shall carry
interest at 9% per annum from the date of filing of the complaint till the payment is
effected. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-005-011/2012-13
Jijo Xavier
Vs
Oriental Insurance Co. Ltd
AWARD No. IO/KCH/GI/68/2013-14 dated 09.07.2013
The complainant had purchased a Maruti Omni from one Sri. Muraleedharan on
01.03.2011. The vehicle met with an accident on 12.03.2011 and the claim for the same
was repudiated by the insurer as the policy was not transferred in the name of the
complainant. Therefore, the complaint.
The complainant submitted that change of ownership was effected on 22.03.2011.and
the insurer conducted a survey also. The repudiation of the claim is illegal.
The insurer submitted that as on the date of accident, the previous owner had no
insurable interest in the vehicle. There was no contract of insurance entered between the
complainant and the insurer as on that date, as no application for transfer of insurance
was submitted by the complainant. The claim was repudiated based on G.R. 17 and the
policy conditions.
Decision:- On account of transfer of ownership of the vehicle in the name of the
complainant on 01.03.2011, the previous owner ceased to be the owner of the vehicle. So,
he had no insurable interest in the subject matter of insurance. There is no evidence to
show that the complainant had made an application for transfer of policy in his name
within 14 days from the date of transfer. He applied for transfer only on 25.08.2011.So, as
on the date of accident, there was no privity of contract between the complainant and
the insurer. In the absence of a contract of insurance between the complainant and the
insurer, the insurer has no liability to compensate the loss suffered by the complainant.
Therefore, the complainant is not entitled to any relief in the complaint. In the result, the
complaint is dismissed . No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-003-028/2012-13
Radhakrishnan
Vs
National Insurance Co. Ltd
AWARD No. IO/KCH/GI/86/2013-14 dated 08.08.2013
The complainant had insured his car with the Respondent-Insurer for an IDV of Rs. 6.30
lacs. The vehicle met with an accident during a pleasure trip to Bangalore and severely
damaged. The insurer repudiated the claim on imaginary grounds. Therefore, the
complaint.
The complainant submitted that there is no evidence that the insured car was sold or it
was being used on hire at the time of accident. The registration and insurance are still in
the name of the complainant. The repudiation is irregular and illegal. He is entitled to
compensation on total loss basis.
The insurer submitted that the vehicle was being used at the time of accident on hire.
The complainant had sold it to a Rent-a Car owner atleast 1 ¼ years prior to the accident.
Though he was the registered owner, the defacto owner was another person who was in
possession of the car. The complainant had violated policy conditions as to Limitations of
use, and also was not having any insurable interest on the vehicle at the time of accident.
The repudiation is legal and proper.
Decision:- A mere sticker on the rear glass will not confer ownership or possession of a
vehicle. The legally acceptable evidence is the Certificate of Registration and as per the
same, the complainant continues to be the owner of the insured vehicle. There is no
acceptable evidence regarding transfer of ownership and possession of the insured
vehicle. The investigation report obtained by the insurer is based on unsupported
surmises. No evidentiary value can be given to the Report relied on by the insurer
regarding transfer of ownership and possession of the vehicle. In the absence of any
independent supporting evidence, the newspaper reports that the vehicle was being used
on hire at the time of accident, have no value at all in the eye of law. Apart from the
newspaper reports, the insurer had not submitted any piece of evidence which would go
to show that the vehicle was on hire at the time of accident. From the facts and
circumstances available in this case, it can be found that the repudiation of the claim on
the grounds that the complainant had sold the vehicle and the vehicle was being used on
hire at the time of accident is not sustainable. The Surveyor had assessed the loss on total
loss basis at Rs. 629000/- So the liability of the insurer is fixed at Rs. 629000/- In the
result an award is passed directing the insurer to pay to the complainant an amount of
Rs.629000/- within the prescribed period failing which, the amount shall carry interest
@9% per annum from the date of complaint till payment is effected. No cost. The
complainant has to comply with the formalities for receiving the compensation on Total
Loss Basis.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-007-082/2012-13
K U Abdulkareem
Vs
TATA AIG General Insurance Co. Ltd
AWARD No. IO/KCH/GI/87/2013-14 dated 08.08.2013
The complainant had insured his car with the Respondent-Insurer. The vehicle was
involved in an accident and suffered substantial damage. The claim for the same was
partially settled by the insurer. Therefore, the complaint.
The complainant submitted that the insurer had settled only a meagre amount. He is
entitled to get the full re-imbursement and also cost.
The insurer submitted that as per the Final survey report, the loss was assessed at Rs.
16331/- and the same was paid to the complainant. The rear and right side damages were
not due to the accident and hence not considered for re-imbursement. Nothing more is
payable now.
Decision:- As per the Survey report loss was assessed at Rs. 16331/- and the same was
paid by the insurer. It is also stated that there was damage on the right side front door
and rear door of the vehicle but those damages were maliciously done by some unknown
and not related to the reported accident. The cost of repair for the same was assessed at
Rs. 4500/-. The survey report would reveal that most of the damage caused to the vehicle
are on its right side. There is nothing to rule out the possibility of damage caused to the
right hand front and rear doors in the accident. It is more so when the right side of the
vehicle hit against the bridge. No acceptable reason or ground is stated in the Survey
report for not considering the damage caused to the right hand side doors of the car. In
the absence of any acceptable ground for not considering the damage sustained to the
right hand side doors, the complainant is entitled to a further amount of Rs. 4500/-
towards loss sustained to the right side doors as assessed by the Surveyor. As there was
no delay on the part of the insurer in settling the claim, complainant is not entitled to any
compensation on that ground. As regards the injuries suffered by his wife, this Forum has
no jurisdiction, as it is a third party claim. In the result, the complaint is disposed of with a
direction to the insurer to pay an amount of Rs. 4500/- to the complainant within the
prescribed period failing which the amount shall carry interest at 9% per annum from the
date of complaint till the payment is effected. No cost.
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OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/KCH/GI/11-005-040/2012-13
P D Sabur
Vs
Oriental Insurance Co. Ltd
AWARD No. IO/KCH/GI/88/2013-14 dated 12.08.2013
The complainant had insured his Tempo Traveller with the Respondent- Insurer . It was
involved in an accident at Thamarassery on 31.12.2011 and got damaged. The claim for
the same was partially settled by the insurer. Therefore, the complaint.
The complainant submitted that the accident was promptly informed to the insurer and
on their instruction , the vehicle was removed to the workshop. The surveyor assessed the
loss. The insurer had provided a meager amount as compensation. He is entitled to get
the full repair charges.
The insurer submitted that the intimation of accident was received by them only on
03.01.2012 and So, they could not conduct the Spot Survey as the vehicle was moved by
that time. Policy conditions provide for deduction of 25% from the claim payable in case
Spot Survey is not done. The Surveyor assessed the loss at Rs. 22500/- and they settled Rs,
16875/- after deducting 25% . They had acted strictly based on policy conditions.
Decision:- The complainant could not bring out any circumstance to doubt the credibility
of the Survey Report. So, the same can be accepted. Now the dispute is limited to the
deduction made by the insurer. In the policy schedule it is stated that “ 25% will be
deducted from claim amount in the absence of Spot Survey”. Separate stamp is also
affixed highlighting the same. A reading of these provisions would clearly indicate that
25% deduction is imposed in the form of penalty for not arranging Spot Survey. A penalty
can be imposed if only there is violation of policy conditions. A penalty provision can not
have independent existence. There is no policy provision which mandates the insured to
arrange Spot Survey. After having received intimation regarding the accident, if there was
no Spot Survey in the instant case, it is an omission on the part of the insurer only. So, the
conclusion that can be arrived at is that the complainant had not violated any of the
policy conditions. There is no case that the complainant did not facilitate or prevented the
insurer from arranging Spot Survey. So, there is no ground/reason to deduct 25% from
the loss assessed. The penalty imposed is for non-observance of a non-existent policy
condition. In the result an award is passed directing the insurer to pay to the complainant
a further amount of Rs.5625/- with 9% interest from the date of filing of the complaint till
the date of award within the prescribed period failing which, the amount shall carry
further interest @9% per annum from the date of award till payment is effected. No cost.
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KOLKATA
MOTOR CLAIM
Kolkata Ombudsman Centre
Case No. 270/11/G11/ NL/07/2012-13
Shri Somnath Ghosh
-Vs-
ICICI Lombard General Insurance Co Ltd
Date of Order :12
th
April, 2013
FACTS/SUBMISSIONS
This complaint was filed against repudiation of Claim under Two wheeler Package Policy
issued by ICICI Lombard General Insurance Company Ltd.
The complainant had stated that on 16.01.2012 his motor cycle fell into a manhole and
was damaged. He was also injured in the accident and was treated by Dr. M.M Maity,
General Physician. He lodged a claim with the insurer on 19.01.2012 but they rejected
the claim vide their letter dated 11.4.2012, stating that the damage was not due to any
external means, rather the loss was due to normal wear and tear.
The insurance company had stated that the complainant had taken a Two Wheeler
Package Policy ( 3005/2010563473/0000002000) for his Motor Cycle for the period from
18.2.2011 to 17.02.2012. On 19.1.2012, the Insured informed that his vehicle had met with
an accident on 16.1.2012 and subsequently a claim was filed with them. The Insured
submitted an estimate for Rs.5,495/-. Survey was conducted by the licensed surveyor who
assessed the loss at Rs.4900/- but commented that the damages claimed were not due to
accidental external means. As per survey report and photographs submitted by the
surveyor, no external damage was found on the front portion of the vehicle and the
estimate of damages provided by the complainant did not match the actual damages
given in the photographs and they closed the claim as ‘No claim’. The same was informed
to the complainant vide their letter dated 11.4.2012.
DECISION:
The complainant had approached this forum against repudiation of his claim under two
wheeler package policy. From the facts presented to this forum we find that the insured
submitted two estimates for repairs; one from Gyas Honda Service Point for Rs.5,495/-
and the other from Gyas Auto Mobil for Rs.7,269/-. The enhanced estimate has not been
justified by the complainant. It is seen that both the service centres are located at the
same address and having a common phone number. Therefore, the lower estimate is to
be considered. Against this estimate, the surveyor assessed the loss at Rs.4,900/- but he
has also mentioned in the report that there was no external damage to the vehicle. Due to
this reason, the insurer repudiated the claim stating that the damage did not occur from
the accident. However, from the documents submitted to this forum we find that the
insurer never questioned regarding the occurrence of loss and the difference in opinion
was on account of the mode of accident. It is also strange that the surveyor assessed the
loss although he opined that the damage was not consistent with the accident; in which
case there was no point in assessing the liability of the insurance company. The
complainant has submitted Dr. M.M.Maity’s prescription which supports the occurrence of
accident. As the front wheel fell into the manhole, there is a possibility of damage of the
front mudguard and the parts/ chassis situated in the front portion. After careful
evaluation of all the facts and circumstances of the case, we are of the opinion that the
occurrence of accident is genuine as the same was not questioned by the insurer.
Considering the age of the motor cycle (2011) the damage did not appear to be on
account of wear and tear. So, the decision for repudiation of the claim was not justified
and the same was set aside. The insurance company was directed to pay Rs.4,900/-.
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Kolkata Ombudsman Centre
Case No. 106/14/G10/NL/05/2012-13
Shri Pramod Kr. Rai
-Vs-
Bajaj Allianz General Insurance Company Ltd.,
Date of Order : 31
st
May, 2013
FACTS/SUBMISSIONS
This complaint was filed against delay in settlement of claim under Commercial Vehicle -
Package policy issued by Bajaj Allianz General Insurance Company Ltd.
The complainant Shri Pramod Kumar Rai had stated in his complaints dated 07.05.2012
and 03.05.2012 that his vehicle (Tata Trailer) bearing no. No.NL-02K-4682 was insured with
an IDV of Rs.21 lakh for the period from 30.06.2011 to 29.06.2012. The said vehicle met
with an accident at Burdwan on 20.10.2011. The surveyor appointed by the Insurance
Company assessed the total loss as per the estimate given by Bhandari Motors. The
Insurance Company however, did not accept the report of the surveyor and arbitrarily
settled the claim at Rs.6,04,749/-.
The insurance company had stated that the complainant’s vehicle bearing No. WB
16R/0494 was covered under policy no. OG-12-9995-1803-00014765 for the period from
30.6.2011 to 29.06.2012 with a sum insured of Rs.21,00,000/-. The surveyor assessed the
total loss at Rs.6,04,749/- after adjusting the salvage value and policy excess. The said
vehicle was under hypothecation with Shriram Transport Finance Company Ltd. After
receipt of survey report, the insured was intimated about the assessed loss and the
insured had duly signed on the Discharge Voucher, acknowledging the estimated loss
amount. They have further stated that in such situation, IMT-7 is applicable and
accordingly, the agreed final loss amount of Rs.6,04,749/- was paid to the Financer M/s.
Shriram Transport Finance Company. Thus, they have duly discharged their liability.
DECISION:
The complainant has approached this forum against delay in settlement of his claim under
Commercial Vehicle Package Policy by the insurance company. From the facts presented
to this forum, we find that the insured vehicle met with an accident at Burdwan on
20.10.2011. The vehicle suffered major damages and initially the surveyor of the insurance
company assessed the loss based on the estimate submitted by the authorized repairer.
Accordingly, the insurance company paid Rs.6,04,749/- to the Financier without the
vehicle actually being repaired. The assessment has been vehemently disputed by the
complainant for which the complainant is before this forum. During hearing both the
parties agreed that the insurer would arrange a meeting for amicable settlement of the
claim. The insurer has now intimated us vide their letter dated 26.03.2013 that they had
arranged a meeting with the complainant and financier on 14.03.2012 and gave the offer
that if the complainant repair the vehicle on his own, they would consider the actual cost
of repair as per claim settlement procedure and subject to the terms and conditions of the
policy issued to him and in this process of settlement, if any difference of amount
between the claim paid and the claim payable is found they would consider the same. This
appears to be reasonable.
In view of the above, the complainant is directed either to accept the offer of the insurer
as discussed in the meeting with the insurer or to accept the claim amount already paid to
him.
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Kolkata Ombudsman Centre
Case No. 576/11/G25/NL/12/2012-13
Shri Kumar Mirtunjay
-Vs-
L & T General Insurance Co Ltd.,
Date of Order : 31
st
May, 2013
FACTS/SUBMISSIONS
This complaint is filed against repudiation of claim under Commercial & Miscellaneous
Vehicles Package Policy issued by L& T General Insurance Co Ltd.
The complainant had stated in his complaint dated 17.12.2012 that his truck bearing No.
JH-02-S-9435 was insured with IDV of Rs.20,17,000/- for the period from 21.04.2011 to
20.04.2012. On 08.03.2012 his Truck met with an accident and was badly damaged. He
intimated the insurer and lodged a claim for the damages. Subsequently he shifted his
Truck into the garage of Ashok Leyland- Rohtas Automobiles. The insurance company
deputed a surveyor to survey and assess the loss. The surveyor inspected the vehicle and
according to his advice the complainant repaired the vehicle and submitted the relevant
documents to the insurance company for settlement of his claim. The insurance company
vide their letter dated 17.08.2012 repudiated the claim on the ground of non payment of
VAT and service tax in some bills, which according to them were not in conformity with
the regulations of the concerned Tax Authorities. He represented to the insurance
company against repudiation but the same was turned down.
The insurance company in their written submission dated 15.03.2013 have stated that the
bills issued by M/s Rohtas Automobiles bearing reference numbers 3161, 3162, 3163,
3164, 3165 dated 20.05 2012 were hand written and VAT details were not mentioned in
those bills, which is against VAT Act 2005 of Bihar. Moreover, in the labour bills, no
service tax was charged, which throws doubt on the genuineness of the bills. Since those
bills were not in conformity with the regulations laid down by the concerned Tax
Authorities, they repudiated the claim and intimated to the Insured.
DECISION:
The complainant has approached this forum against delay in settlement of the vehicle
damage claim due to inflated and fake repair bills. From the facts presented to this forum,
we find that the insurance cover and the nature of accident are not disputed by the
insurer. The major point of difference is in respect of the assessed loss. The surveyor after
due inspection of the vehicle had assessed the net liability at Rs.4,02,364.50 as against
total claim of Rs.9,09,814/- lodged by the complainant. The insurance company is willing
to settle the claim at the assessed loss which has not been accepted by the complainant.
However, we find that the complainant has failed to give the details of the major items
which were not considered by the surveyor and the reason for the same. He has simply
lodged a claim without justifying its admissibility. The insurance company, on the other
hand has submitted an investigation report which shows that the bills submitted by the
claimant are highly inflated. The bills are all written in hand without charging any VAT
and Service Tax which indicate the fake nature of the bills. Since there is a major
difference between the assessed loss and the claimed loss which has not been explained
by the complainant and not supported by any documentary evidence, we are unable to
allow any further relief beyond what was assessed by the surveyor. The insurance
company was accordingly directed to pay the net liability of Rs.4,02,364.50 as per the
surveyor’s assessment.
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LUCKNOW
OFFICE OF INSURANCE OMBUDSMAN
UTTARPRADESH & UTTARAKHAND
6
th
Floor, Jeevan Bhawan Phase-2,
Nawal Kishore Road, Hazaratganj,
LUCKNOW
Award No.IOB/LKO/04/26/19/13-14
In the matter of
Ms Deepti Bhatnagar (Complainant)
vs
National Insurance Company Ltd. (Respondent)
Complaint No. G-06/11/19/13-14
FACT:-
Ms Deepti Bhatnagar, the complainant’s Maruti Omni van was insured with
National Insurance Company Ltd. having sum insured Rs. 84,800/- only. The vehicle got
stolen on 13.08.2010. The insurer primarily approved the claim for Rs. 84,300/- only but at
the time of verification of various documents it was observed that at the material time of
theft the vehicle was not having valid and effective fitness. The insurers repudiated the
claim on above ground.
FINDINGS:- Fitness certificate is mandatory for vehicles having seating capacity for
more than five passengers. The respondent insurance company’s representative submitted
that the fact of obtaining fitness certificate was well within the knowledge of insured as
she had obtained previous fitness for period 20.12.2008 to 19.12.2009. Had it not been in
her knowledge the insurance company would have settled the claim for 75% of IDV on
sub-standard basis. Here I observe that the vehicle did not meet with any accident rather a
theft took place where fitness did not have any direct bearing on the incident. A copy of
claim processing manual of a public sector insurer is very much before me. Section IV of
the manual reads as under:
Fitness Certificate
IV- where FC has expired at the time of accident
and if the surveyor has certified that the
unsatisfactory condition of the vehicle has
contributed to the accident
Repudiate the claim
Where FC has expired and the condition of the
vehicle had not contributed to the accident
Refer to H.O. Motor Technical
Department.
In the light of above provision The forum , Awarded 50% claim amount on ex-gratia basis
MUMBAI OIO
Complaint No. GI-1939 of 2012-2013
Complainant: Shri Shashank M Tawde
V/s
Respondent: United India Insurance Co. Ltd.,
Award dated 06/2013
Complainant, had covered his Hyuandai Accent vehicle bearing registration
number MH-06-M-5832 for a sum insured of Rs.1.20 lacs vide policy bearing number
120900/31/10/01/00004206. The policy was valid for the period 1.11.2010 to 31.10.2011.
Claim arose under the policy when the insured vehicle alleged got damaged due to
fire on 1.10.2011 whilst the complainant was travelling in the said vehicle from Mumbai to
Pune on express highway.
The claim when lodged on the Company was denied by them contending that the
accident occurred whilst the vehicle was being used under Reliability test and hence fell
beyond the scope of the policy.
The complainant represented but the Company however upheld their stand of
rejection and aggrieved by the same, the complainant approached this forum for
redressal.
Complainant, submitted that he was going from Mumbai to Pune along with his
parents and when he tried to start the vehicle after lunch enroute, he observed some jerks
and hence he stopped the car and called for the Hyuandai service people. A mechanic
from Vashi arrived and he along with the complainant and his family started the vehicle to
see what the problem was and at that time, the vehicle suddenly ignited and the whole
vehicle was burnt. When the claim was lodged on the Company, the same was denied
stating that the vehicle was undergoing a reliability test during the accident and hence
was not payable. He emphasized that he would not risk ferrying his family in a vehicle
whilst such testing if he had suspected any problem and the accident could have very well
occurred if he had continued to drive instead of the mechanic. He hence requested for
justice in his case.
The Company submitted that the claim was handled by their RO as it was a total
loss and as per the report of the surveyor who had opined that the loss had occurred
whilst reliability testing the claim was denied.
Observations of the forum:
The Reliability test is not defined under the policy and as such the reliability test
envisaged by the Company is not the occurrence which happened in the complainant’s
case. The reliability test is the one which is undertaken by the manufacturers/repairers
after assembling/repairing the vehicle under different circumstances. In the instant case,
the problem of the vehicle was not known and hence to get a feel of it, the mechanic
drove the vehicle. In fact, if the insured, instead of being cautious and calling for the
mechanic had chosen to simply drive the vehicle, the ignition would have occurred
nevertheless and perhaps injured the occupants. He has tried to be prudent enough by
calling the mechanic to avert a mishap. By driving with the mechanic, the insured has
neither enhanced the risk nor known of the problem. He has not chosen to drive willfully
or negligently. It was indeed an accident which would or could have occurred
notwithstanding the fact who drove the vehicle.
Recommendation of the forum:
The company is hereby directed to pay the claim as per their norms within 15 days
under information to the forum.
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