DELHI OMBUDSMAN CENTRE

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1 Case No. GI/560/UII/10 In the matter of Shri. Shantanu Chatterjee Vs United India Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Shri. Shantanu Chatterjee (herein after referred to as the complainant) against the decision of United India Ins. Company Ltd. (herein after referred to as respondent Insurance Company) regarding non- settlement of Motor theft claim. 2. Complainant stated that he is the owner of a Maruti 800 car bearing registration no. DL4CK0990 which was stolen from his residence at Gurgaon in January The theft was reported to local police station in Sushant Lok-I, and also to the company United India Ins. Co. Ltd. from which it was insured. The Ins. Company settled the claim and paid a sum of Rs. 41,500 only as against the insured amount of Rs. 55,000. The company had not given any reason for making less payment than the IDV. He had already approached the GRO of the company. He had requested this forum for getting paid the balance amount. During the course of hearing also complainant submitted that he was paid less than the IDV while settling the claim which was not just and fair. 3. Representative of the company did not attend the hearing. 4. I have considered the submissions of the complainant. After due consideration of the matter, I hold that company was not justified in settling the claim by making payment less than the IDV because insured had suffered a total loss on account of the theft of the vehicle which was insured for a sum of Rs. 55,000. In case of total loss, insured is entitled to full value of the IDV. Accordingly complainant is further entitled to a sum of Rs. (55,000 41, ) = 13,000. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 13, The Award shall be implemented within 30 days of receipt of the same. The compliance

2 Case No. GI/393/ICICI/10 In the matter of Shri. Ishwar Singh Vs ICICI Lombard Gen. Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Shri. Ishwar Singh (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) regarding repudiation of Motor cycle theft claim. 2. Complainant stated that his motor cycle Splender Plus bearing Reg. no. DL-9SZ-2122 was stolen from IMT Manesar on He has informed the police control room on 100 and also informed police station, IMT Manesar about this incident. He had submitted all the requisite documents to the Ins. Company, but the Ins. Company repudiated the claim. He also approached the GRO of the company but nothing has happened. He has come to this forum for getting his claim paid. During the course of hearing, complainant stated that he informed the policy on No. 100 and also informed the Ins. Company about the incident. 3. Representative of the company stated that claim is not payable because there was delay in intimating the theft to the police as well as to the company. Company also submitted written reply dated , wherein it has been stated that vehicle was stolen on and the same was intimated to police on and to the company on The claim was denied due to late intimation to the company and to the police about the theft of 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 written reply of the company. After due consideration of the matter, I hold that the company was not justified in repudiating the claim because complainant had immediately intimated the theft of the motor cycle to the police on No. 100 and also to the police station. The insured had lodged the claim for theft of the vehicle. Therefore in my view claim is payable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs (IDV Rs ).

3 Case No. GI/551/RGI/10 In the matter of Shri. Rajesh Kalra Vs Reliance Gen. Ins. Company Ltd. AWARD DATED INADEQUATE SETTLEMENT OF CLAIM 1. This is a complaint filed by Shri. Rajesh Kalra (herein after referred to as the complainant) against the decision of Reliance Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) regarding inadequate settlement of Motor accident claim. 2. Complainant stated that his truck bearing registration no. HRSSE-9233 was insured wide policy no met with an accident on at Aligarh. He had informed the Ins. Company on phone about the incident and also filed claim. The vehicle was surveyed at Aligarh by Shri. Ravinder Kumar (surveyor). The surveyor had taken all relevant documents from the driver of the truck. This vehicle was taken to Delhi and again final survey was under taken by Shri. Avnish Kumar (surveyor). He got the settlement through surveyor and received a cheque of Rs /- whereas settlement was done with the surveyor for an amount of Rs /- when he inquired from the company about this, it was informed by the company that he did not get the spot survey done and therefore he was given 25% less, but the fact remained that the spot survey was done at Aligarh by the surveyor. He stated that there was no justification for too much deduction by the company. He came to this forum for ensuring payment of balance amount. Representative of the complainant stated that spot survey was got done and the complainant had also given the Mob. No. to the surveyor who had done the survey and there was no justification for the deduction of 25%. 3. Representative of the company stated that the claim was settled as per policy though loss was assessed by the surveyor at Rs /- but insured was paid less by making deduction. He also referred to written reply dated wherein the company had justified deduction on account of spot survey. 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. After due consideration of the matter, I hold that company was not justified in making deduction of 25% for settling the claim on loss assessed by the surveyor. The spot survey was got conducted by the insurer as desired thus there is no justification on the part of the company to make any deduction. The company ought to have paid the loss assessed by the surveyor. It had paid only sum of Rs /- as against the assessed loss of Rs Complainant is entitled to the balance amount of Rs. (95200

4 70680) = Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 24,520. Case No. GI/567/Future/10 In the matter of Shri. RanBir Singh Vs Future Generali India Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF CLAIM 1. This is a complaint filed by Shri. Ranvir Singh (herein after referred to as the complainant) against the decision of Future Generali India Ins. Company Ltd. (herein after referred to as respondent Insurance Company) regarding non- settlement of Motor claim. 2. Complainant stated that he had taken comprehensive insurance policy no. V valid from to in respect of his Skoda-2004 Model car from the Ins. Company e.g. Future Generali India Gen. Ins. Company Ltd. He is a practicing advocate and has been maintaining Skoda-2004 model since March 2004 purely for his personal use only and has followed all instructions given in the Skoda-Manual. The company was not justified in rejecting the claim in respect of the components used for repairs of the vehicle. He further stated that the company willfully delayed his claim from to which caused the roof of the car to fall, due to excessive temperature inside the closed cabin of the car, due to sun heat and moisture. He reiterates his arguments that company delayed his claim willfully and maliciously as claim was filed on but it had replied on , without examining the clauses of the insurance contract. It is further submitted by him that he had to engage vehicle for day to day basis to attend his profession therefore, Ins. Company is liable to pay and compensate him for transportation. The company has not implemented its own insurance contract. He submitted further that his Scoda Car did not start in the evening as lot of water had accumulated in the parking lot. It was towed from Delhi High Court to his residence at D2/2209 DDA Flats, Vasant Kunj, New Delhi. He had further submitted that he had parked his car in the parking area in the parking lot and in the evening his car did not start this happened on On he had given his car to M/s Giriraj Motors and requested them to expedite the claim. During the course of hearing the insured pleaded that the claim is payable.

5 3. Representative of the company stated that claim as filed by the insured is not payable and filed the written reply dated in this regard wherein it has been stated that vehicle no. DL9CG6393 was insured by the company for the period from to under private car comprehensive policy. Company received the intimation on regarding the loss dated as per surveyor. The observations of the surveyor also narrated. The company informed the insured vide its letter dated that its liability is restricted to flushing and cleaning charges but the insured was not satisfied with the decision of the company and continued correspondence with the company. The surveyor submitted the final report and assessed the loss of Rs which is payable. Company also approved the payment as assessed by the surveyor under conditions as mentioned in the report. 4. I have very carefully considered the submissions of the complainant as made in the complaint and also verbal arguments made during the course of hearing. I have also considered the verbal arguments of the representative of the company and also written submissions given by the company dated After due consideration of the matter, I hold that company is liable only to the extent to the loss assessed by the surveyor amounting to Rs. 29,556 under the circumstances of the case. It will not be possible to accede to the request of the insured as given in para 12 (A). it has been stipulated in the terms and conditions of the policy vehicle is not liable to cover in the terms and conditions of the policy. it is not possible to accede to the request of the insured to direct the Ins. Company to pay claim of Rs. 1,75000 except the amount of Rs. 29,556. It is also not possible to accede request of the insured as mentioned in para 12(B) and 12 (C). Insured is only entitled to loss assessed by the surveyor in respect of damage caused due to water logging in the parking lot where his insured vehicle was parked. Accordingly an Award is passed with the direction to the Ins. company to make the payment of Rs. 29,556. Case No. GI/451/NIC/10 In the matter of Shri. Dilbagh Rai Vs National Insurance Company Ltd. AWARD DATED REPUDIATION OF CLAIM

6 1. This is a complaint filed by Shri. Dilbagh Rai (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 repudiation of Motor accident claim. 2. Complainant stated that he along with his family while going in his vehicle bearing no. HR-01-T-2883 met with an accident on on account of cow hit with his car. Due to accident bonnet cover of the car got dented, there was no damage to engine, chassis and lights hence he continued to travel. On , he gave the vehicle to M/s Rana Motors Pvt. Ltd., A-3, Wazirpur Industrial Area, Main Ring Road, New Delhi. He had gone to collect the vehicle on , He found that work shop did not carry any repair. He was informed that surveyor detailed by the Ins. Company had not cleared any repairs to the car, therefore he collected the car unrepaired and came back to Ambala as there was some emergency. He informed the local branch of the Ins. Company, a surveyor was deputed and he left the carfor repair with M/s Ravi Motors (Authorized Repair Agency). It repaired the vehicle and he paid the repair charges amounting to Rs. 6564/- vide check no in addition to surveyor fee of Rs. 900/- in cash. He received a letter from National Ins. Company Ltd. (New Delhi) dated The surveyor which was detailed by Local National Ins. Company, Ambala estimated the repairs at Rs. 7479/- and assessed loss for Rs including surveyor fee of Rs. 900 thereby total loss was assessed at Rs He has come to this forum with a request to direct the Ins. Company to reimburse him the expenses paid by him for repairs of the vehicle. Complainant did not attend the hearing. 3. Representative of the company stated that claim was filed at two places one at Delhi and another at Ambala. The vehicle which met with an accident had been repaired at Ambala, it has further been submitted by him that complainant had not got his vehicle repaired at Delhi. However he submitted that the vehicle was repaired by the insured at Ambala and the loss was assessed by the surveyor of Branch of Ins. Company at Ambala. He further stated that the claim was misconceived as date, day and time were mentioned different. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the facts mentioned in both the surveyors report and also repudiation letter dated of the insured. After due consideration of the matter, I hold that claim is payable because insured vehicle met with an accident and got damaged during the currency of policy. The surveyor assessed the loss to the vehicle due to accident at Rs Accordingly claim is not payable due to mis-representation of the facts. The complaint filed by the complainant is hereby dismissed.

7 Case No. GI/573/Bajaj/10 In the matter of Shri. H.C. Rajpal Vs Bajaj Allianze Gen. Ins. Company Ltd. AWARD DATED PARTIAL SETTLEMENT OF CLAIM 1. This is a complaint filed by Shri. H.C. Rajpal (herein after referred to as the complainant) against the decision of Bajaj Allianze Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) relating to partial settlement of Motor claim. 2. Complainant stated that company was not justified in not paying the claim relating to engine parts. The company had not so far admitted the rightful claim amount. This shows abundant negligence and breach of trust on the part of the company. He had been harassed for about 20 days for getting his vehicle repaired. He also approached the GRO of the company. He has come to this forum with a request to instruct the insurance company to pay him the total amount of Rs It was case where the insured vehicle met with an accident and got damaged. During the course of hearing, it has been submitted by the insured that due to accident his car was damaged. He was given front side damage only though due to accident damage was also caused to the engine. Survey of the vehicle was not done immediately. 3. Representative of the company stated that claim was settled as per terms and conditions of the policy. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the details of the payment made by the insured. I have also perused the survey report. After due consideration of the matter, I find that the surveyor had not assessed the loss caused to the insured vehicle on account of damage to engine due to accident. He had only assessed the loss other than the damage caused to engine. It was quite clear from photos that not only the front side of the vehicle got damaged but also engine due to impact. Accordingly company was not justified in settling the claim only relating to front side damage to the vehicle because engine also got damaged due to accident. The insured had also made payment on account of over wholing of the engine. Thus in my view, the company is also liable for making the payment on account of damage to the engine due to accident under the policy. Accordingly an Award is passed with the direction to the insurance company to make the payment of (Rs 21, towing charges) = Rs. 22,180.

8 Case No. GI/577/IFFCO/10 In the matter of Shri. Himanshu Arora Vs IFFCO Tokio Gen. Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF THEFT CLAIM() 1. This is a complaint filed by Shri. Himanshu Arora (herein after referred to as the complainant) against the decision of IFFCO Tokio Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of Motorbike theft claim. 2. Complainant stated that he insured his motor cycle with IFFCO Tokio Gen. Ins. Company Ltd. His motor bike was stolen on He had submitted all requisite documents relating to the claim to the insurance company. He pursued the matter with the company. He was informed that he would not be paid this claim. He has requested this forum for getting the claim settled. During the course of hearing also he stated that claim was not paid. Though he pursued the matter relentlessly but the company did not respond. He informed the PCR on 100 about the theft of the motorcycle. Company was also duly informed about the loss. 3. I have considered the submissions of the complainant and also representative of the company. After due consideration of the matter, I hold that company was not justified in not so far settling the claim. Insured had suffered a total loss on account of theft of his motor cycle which was insured. The theft was informed by the insured on PCR on 100 and also to the company. In my view claim is payable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 29,950 (IDV 30,000 50). 4. The Award shall be implemented within 30 days of receipt of the same. The compliance 5. Copies of the Award to both the parties.

9 Case No. GI/496/ICICI/10 In the matter of Shri. Rishi Kumar Vs ICICI Lombard Gen. Ins. Company Ltd. AWARD DATED REPUDIATION OF THEFT CLAIM 1. This is a complaint filed by Shri. Rishi Kumar (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of Motor theft claim. 2. Complainant stated that his car bearing no. DL 7CJ 4234, Santro modal 2008 was insured. It was purchased by him. He stated further that he had not sold the vehicle to Shri. Krishna Singh. The car was standing/parked in the house of Shri. Krishna Singh, during his absence. The report with the police station was lodged by Shri. Krishna Singh, during his absence. The car was registered in his name and he was paying the loan amount to loaning agency. It is submitted that Shri. Krishna Singh is a handicap person. The allegations of having sold the vehicle to Shri. Krishna Singh was false and imaginary and without any base. This vehicle was stolen and such vehicle was insured by him and he was the registered owner of the vehicle. He has come to this forum with a request to get the claim paid. During the course of hearing complainant argued vehemently that he never sold the vehicle to anybody and such vehicle was in his name and it is he who insured the vehicle. 3. Representative of the company promised to settle the claim and to submit report within 15 days but the claim is still unsettled and no report had been submitted by the company till today. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also considered the written reply dated of the company wherein it has been stated that this vehicle was sold by complainant to Shri. Krishna Singh for Rs. 1,04,000 and thus complainant did not have insurable interest and thus claim is not payable. After due consideration of the matter, I hold that company was not justified in repudiating the claim because claim is payable. Company had not brought on record any evidence to the effect that complainant had sold this vehicle to someone. The vehicle is still owned by the complainant Shri. Rishi Kumar. It is he who insured the vehicle. Since complainant had suffered the total loss due to theft of the vehicle which was insured and which remained untraced, The Company is under obligation to pay to the insured the IDV. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 2, 83,858 (2,84, ).

10 Case No. GI/496/ICICI/10 In the matter of Shri. Rishi Kumar Vs ICICI Lombard Gen. Ins. Company Ltd. AWARD DATED REPUDIATION OF THEFT CLAIM 1. This is a complaint filed by Shri. Rishi Kumar (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of Motor theft claim. 2. Complainant stated that his car bearing no. DL 7CJ 4234, Santro modal 2008 was insured. It was purchased by him. He stated further that he had not sold the vehicle to Shri. Krishna Singh. The car was standing/parked in the house of Shri. Krishna Singh, during his absence. The report with the police station was lodged by Shri. Krishna Singh, during his absence. The car was registered in his name and he was paying the loan amount to loaning agency. It is submitted that Shri. Krishna Singh is a handicap person. The allegations of having sold the vehicle to Shri. Krishna Singh was false and imaginary and without any base. This vehicle was stolen and such vehicle was insured by him and he was the registered owner of the vehicle. He has come to this forum with a request to get the claim paid. During the course of hearing complainant argued vehemently that he never sold the vehicle to anybody and such vehicle was in his name and it is he who insured the vehicle. 3. Representative of the company promised to settle the claim and to submit report within 15 days but the claim is still unsettled and no report had been submitted by the company till today. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also considered the written reply dated of the company wherein it has been stated that this vehicle was sold by complainant to Shri. Krishna Singh for Rs. 1,04,000 and thus complainant did not have insurable interest and thus claim is not payable. After due consideration of the matter, I hold that company was not justified in repudiating the claim because claim is

11 payable. Company had not brought on record any evidence to the effect that complainant had sold this vehicle to someone. The vehicle is still owned by the complainant Shri. Rishi Kumar. It is he who insured the vehicle. Since complainant had suffered the total loss due to theft of the vehicle which was insured and which remained untraced, The Company is under obligation to pay to the insured the IDV. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 2, 83,858 (2,84, ). Case No. GI/525/Shri Ram/10 In the matter of Shri. Surat Singh Dhokwal Vs Shri Ram Gen. Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Shri. Surat Singh Dhokwal (herein after referred to as the complainant) against the decision of Shri Ram Gen. Ins. Company Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of Motor Theft Claim. 2. Complainant stated that he is a registered owner of the vehicle no. DL-4 CAD 3382, Chevrolet-Tavera, model This vehicle was insured by the Ins. Company for the period from to vides policy no /31/10/ On this vehicle was found stolen, he reported the matter to the police station K.N. Katju Marg, Delhi and FIR was also lodged. Company was also informed as well as the bank ICICI from whom the loan was taken. Though the efforts were made but the vehicle remained untraceable. The police gave the final report that is untraced report. He submitted all requisite documents to the Ins. Company for settling the claim. He submitted that he had been suffering financial loss on account of theft of the vehicle company is not making the payment despite the fact that he has submitted all requisite documents. He has approached this forum for getting the claim settled. During the course of hearing also complainant argued that claim is payable but the company is not settling the claim. 3. Representative of the company also admitted that claim is payable but the claim is pending on account of the fact that insured was required to refund certain amount which was paid to him earlier but insured did not refund such amount to the company.

12 4. I have considered the submissions of the complainant as well as of the representative of the company. After due consideration of the matter, I hold that company was not justified in not settling the claim. Claim is payable because complainant had suffered a total loss on account of a theft of vehicle. Complainant had complied with all requirements. Therefore claim is payable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 5, 7, Case No.GI/444/UII/10 In the matter of Shri. Mahesh Bhola Vs United India Gen. Ins. Company Ltd. AWARD DATED NON PAYMENT OF CLAIM 1. This is a complaint filed by Shri. Mahesh Bhola (herein after referred to as the complainant) against the decision of United India Gen. Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to non- payment of motor claim. 2. Complainant stated that his vehicle Hyundai Santro Car no. DL 2C W 2491, insured with United India Gen. Ins. Company Ltd., vide policy no /31/09/01/ met with an accident on and got damaged. It was further stated by the complainant that despite the submission of all requisite documents, he had not been given his claim so far. He had pursued the matter at different levels, but his claim could not be settled so far. During the course of hearing complainant stated that he had spent a sum of Rs towards repair of the damaged vehicle due to accident. Survey was also done and the surveyor has assessed the loss at Rs. 27,000 but the company did not settle the claim so far. 3. It is quite surprising that despite allowance of 3 opportunities none attended on behalf of the Ins. Company. 4. I have considered the submissions of the complainant. I have also perused the details including bills for payment for the repair of the vehicle. After due consideration of the matter, I consider it fair and reasonable if the complainant is paid a sum of Rs. 27,500 on account of damage caused to the vehicle due to accident. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 27,500.

13 Case No. GI/620/Tata/10 In the matter of Smt. Saroj Saberwal Vs Tata AIG Gen. Ins. Company Ltd. AWARD DATED :NON SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Smt. Saroj Saberwal (herein after referred to as the complainant) against the decision of Tata AIG Gen. Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of motor theft claim. 2. Complainant stated that her husband Sh. Pravish Sabharwal had taken a motor policy from Tata AIG Gen. Ins. Company Ltd.(comprehensive policy) valid from to in respect of his vehicle bearing registration no. DL 8 CB The said vehicle was stolen from Paschim Vihar on FIR of theft was lodged at Paschim Vihar Police station on She stated further that her husband expired on , due to this episode there was delay in getting vehicle transferred as she was mentally disturbed, hence before she could transfer the vehicle in her name the vehicle was stolen. Claim was lodged with Insurance Company and the same was repudiated by the company vide its letter dated she has come to this forum for getting the claim paid. During the course of hearing also she argued that claim is payable but the insurance company denied the claim without proper justification. 3. Representative of the company stated that claim is not payable because vehicle was stolen much after the death of the insured. The claim is not payable as per policy. Company also furnished written reply wherein it has been stated that a private car package policy bearing no was issued to Sh. Pravesh Sabharwal for the period to In the reply it was further stated that insured had expired on whereas insured vehicle was stolen on Since the complainant was the legal heir of the insured, she had time till to get the policy transferred in her name. However, complainant had failed to get the policy transferred in her name in stipulated time frame. No intimation regarding the same was given to the company. The claim was rightly repudiated by the company.

14 4. I have very carefully considered the submissions of the complainant as well as of the representative of the company. I have also perused the detailed note of the insurance company which is placed on record. After due consideration of the matter, I hold that company was not justified in repudiating the claim only because the insurance policy was not transferred in the name of the complainant being a legal heir. Admittedly, insured vehicle was stolen during the currency of the policy and this event took place after the death of policy holder. However, theft took place much after the death of a insured and the complainant being legal heir could not get the policy transferred in her name. But there were circumstances due to which the policy could not be transferred. Obviously insured was the husband of the complainant and his death caused a lot of disturbance in her life and that may be the reason due to which the policy could not transferred within the stipulated period. Having due regard to the fact that loss occurred during the currency of the insurance policy, in my view claim other- wise payable cannot declined an claim only on this technical ground that policy was not transferred within 90 days of the death of the insured in the name of legal heir. In my considered view it appears to be fit case where claim is payable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 46,931 ( ). Case No. GI/645/Bajaj/10 In the matter of Sh. K.K. Garg Vs Bajaj Allianz Gen. Ins. Company Ltd. AWARD DATED PARTIAL SETTLEMENT OF CLAIM 1. This is a complaint filed by Sh. K.K. Garg (herein after referred to as the complainant) against the decision of Bajaj Allianz Gen. Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to partial settlement of claim. 2. Complainant stated that he had taken a car policy bearing no. OG from Bajaj Allianz Gen. Ins. Company Ltd., his vehicle met with an accident but the Ins. Company had settled the claim inadequately. It had deducted the amount of paint at the rate of 50%. Bumpers paint was not allowed though his bumpers were painted when he got the Insurance from the company. Tail light was not allowed whereas, it got damaged due to accident. Company had inspected his vehicle at the time of insuring it and both bumpers were painted. He had paid full premium as demanded by the Ins. Company. He has requested this forum to ensure payment from the company amounting

15 to Rs which were for both the damages and paint of parts which were replaced due to repair but the same was not given. 3. Representative of the company stated that claim was settled as per policy term and condition and complainant is not entitled to any further relief. As against the total bill of Rs. 16,230, company paid a sum of Rs. 9, I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the survey report. After due consideration of the matter, I hold that the company had settled the claim inadequately and accordingly the complainant needs to be further compensated on the account of damage sustained by vehicle. I considered it fair and reasonable, if the complainant further given a sum of Rs Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs Case No. GI/03/ICICI Lomb./11 In the matter of Ms. Parul Vs ICICI Lombard Gen. Ins. Company Ltd. AWARD 1. This is a complaint filed by Ms. Parul (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to delayed settlement of motor theft claim. 2. Complainant stated that his motor theft claim no. MOT was repudiated by the Ins. Company on despite the fact that he had submitted all requisite documents. He had approached Greivance Cell of the company on but has received no response. He had come to this forum to get the claim paid. During the course of hearing complainant argued that there has been inordinate delay in settlement of the claim. He had submitted all requisite documents to the company by June 2010 but company had settled the claim only in July Representative of the company stated that complainant had received the claim without raising objection and argued that the claim was reasonably settled. He also referred to company s reply dated wherein, it has been stated that claim of the complainant has been settled vide cheque no for an amount of Rs. 6,29,000 as per policy terms.

16 4. I have considered the submissions of the complainant as well as of the company. After due consideration of the matter, I hold that there is considerable force in the arguments of the complainant that company had taken unreasonable time in settlement of the claim because complainant had submitted all requisite documents by June 2010 whereas, claim was settled somewhere in July In my considered view claim was settled late by the Ins. Company and therefore, complainant needs to be given some relief. Accordingly company is liable for late settlement of the claim. Accordingly an Award is passed with the direction to the Ins. Company to pay penal interest to the insured at the rate of 8% from the date of no claim to the date of actual payment. Case No. GI/570/RSA/10 In the matter of Sh. Sanjay Aggarwal Vs Royal Sundaram Alliance Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Sh. Sanjay Aggarwal (herein after referred to as the complainant) against the decision of Royal Sundaram Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to non- settlement of motor theft claim. 2. Complainant stated that his vehicle bearing registration no. DL-7CE-6363 was stolen on Company was intimated about this fact. The claim was preferred under policy no. VPC Insurance company required him to complete certain formalities and the same were completed by the insured. But he had not received any communication from the company in this regard and he is suffered due to non settlement of the claim. He submitted police report and untraced report has been accepted by the court. He has come to this forum for resolution of his grievance. During the course of hearing also he submitted that the vehicle which was insured was stolen. He informed the police on PCR on 100 number and FIR was also lodged 3. Representative of the company stated that FIR was filed late and also company was intimated late about the theft of the vehicle. Complainant had given only one key. Representative of the company also refered to written reply of the company dated

17 wherein it has been stated that complainant had taken private car package policy in respect of vehicle valid from to On the complainant belatedly informed that vehicle was stolen from Rohini, as the parked vehicle was found missing. It is further stated that even though the vehicle was purchased by the complainant but the vehicle was being used by his Guruji Shree Nam Dev Ji. There was delay in intimating the matter of theft to the company which deprived the company to investigate the theft. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the reply of the company and repudiation letter. After due consideration of the matter, I hold that company was not justified in repudiating the claim mainly on account of delay in intimation. The complainant had complied with all requirements for settlement of the claim. Police was informed immediately on PCR admittedly. There was a delay but that would not deprive the insured of his due claim. In my considered view claim is payable. Complainant had suffered a total loss due to the fact that his insured vehicle was stolen and that remained untraced. Accordingly an award is passed with the direction to the Ins. Company to make the payment of Rs. 4,58,000 (IDV 4,59, ). Case No. GI/617/ICICI Lomb./10 In the matter of Sh. Gaurav Chabra Vs ICICI Lombard Gen. Ins. Company Ltd. Award DATED : PARTIAL SETTLEMETN OF CLAIM 1. This is a complaint filed by Shri. Gaurav Chabra (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to partial settlement of motor claim. 2. Complainant stated that his vehicle with registration no. DL-4C-NA1854 which was insured by ICICI Lombard Ins. Company Ltd. Company, met with an accident and company had not settled the claim adequately. Company settled the claim only for Rs where he had incurred an expenditure of Rs. 3,56,000 on the repair of the vehicle. He had submitted all requisite documents to the Ins. Company for settlement of the claim. He has come to this forum for redressal of his grievance. Complainant did not attend the hearing on

18 3. Representative of the company stated that claim was settled as per survey report and company is not liable for consequences loss. Company also filed written reply dated wherein it has been stated that complainant had taken a motor insurance policy no. 3001/ /00/000 for the period to The insured was driving his vehicle from Ashoka Hotel, Chanakya Puri and was heading towards patel Nagar on The insured car jumped and hit the speed breaker from below causing damage to the oil tank. The insured however, continued to drive the vehicle, due to which the engine of the vehicle got seized. Thereafter an OD claim was lodged with the insurance company. Survey was conducted and it was found that engine was seized/jammed, due to lack of proper oil quantum, leaving deep seizure marks over the crankshaft. The seizure had taken place because of the driving of the car even after it hit on the bottom. As per policy, the admissible claim is for an amount of Rs. 21,465 and as per survey report the same was paid to the Recent Garage Pvt. Ltd. It is further stated that the claim as preferred by the complainant is not payable. 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. After due consideration of the matter, I hold that company was not justified in partially settling the claim. Company is not correct in stating that due to consequence loss the entire claim is not6 payable. If one carefully considers the circumstances under which the vehicle was damaged the irresistible conclusion is that the damage occurred to insured vehicle was on account of accident. In my considered view damage could not be split in to two parts as has been done by the Ins. Company. The damage occurred to the vehicle due to impact of the speed breaker. This fact is also confirmed by the surveyor. Therefore company is liable to compensate the complainant for the damage occurred to the vehicle due to accident. Thus the company is under obligation to make the payment of Rs. 2,60,000 (after adjustment of salvage and depreciation). Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 2,60,000. Case No. GI/39/NIC/11 In the matter of Sh. Virender Singh Vs National Ins. Company Ltd. Award dated : NON SETTLEMENT OF THEFT CLAIM

19 1. This is a complaint filed by Shri. Virender Singh (herein after referred to as the complainant) against the decision of National Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to settlement of motor theft claim. 2. Complainant stated that he has submitted all requisite documents and finally his claim was approved on approximately after 2 years. The company informed him that his file has been closed and the same needs to be reopened. He gave application for reopening of the case, he was assured by the company on that he will be getting cheque but he was not given. He visited the company s office, a number of times but he was communicated that claim has been rejected. He felt harassed for the reason that his claim was not settled so far. He has come to this forum to get the claim settled. During the course of hearing also, he argued that claim is payable but the company denied it. He submitted all requisite documents. 3. Representative of the company stated that claim file was closed due to non submission of requisite documents. Later on request was made to reopen the case that was not allowed. 4. I have considered the submissions of the complainant as well as of the representative of the company. After due consideration of the matte, I hold that claim is payable and company is not justified in not paying the claim so far. Accordingly an Award is passed to with the direction to the Ins. Company to make the payment of Rs. 21,450 (21,500 50) along with the penal interest with effect from the date of no claim to the date of actual payment. Case No. GI/17/NIC/11 In the matter of Sh. Rajbir Singh Vs National Ins. Company Ltd. AWARD DATED : NON SETTLEMENT OF CLAIM 1. This is a complaint filed by Sh. Rajbir Singh (herein after referred to as the complainant) against the decision of National Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to non- settlement of motor claim.

20 2. Complainant stated that he was being harassed by the company for the last two years and his claim has not been settled. He further stated that he has been ensuring his vehicle bearing no. DLILE-9344 for the last 4 years. His vehicle met with an accident on and also a cleaner was injured in this accident. He completed all the formalities and submits the bills in time. He had reached the Ins. Company office and was informed that his claim would be settled only after verification of the driving license from Mathura Authority. In the month of May he was informed that License was verified and file has been sent to regional office for approval. Later on he was informed that his claim could not be opened as the file was already closed. He has come to this forum for settlement of the claim. During the course of hearing, complainant stated that his vehicle met with an accident. It was repaired and he paid 50,000 approximately. He submitted the bill to the company but the claim was not settled so far. 3. Representative of the company stated that requisite documents were filed late meanwhile case was closed on account of non receipt of the documents. Request was made for reopening the case to the higher officer but the same was refused. 4. I have considered the submissions of the complainant as well as of the representative of the company. After due consideration of the matter, I hold that company was not justified in closing the case as complainant had submitted all requisite documents. Admittedly insured vehicle met with an accident and got damaged. Survey was also conducted and the surveyor had assessed the loss. Vehicle was repaired therefore, in my view claim is payable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 41,500 along with the penal interest at the rate of 8% from the date of closing the case to the date of actual payment. Case No. GI/45/RGI/11 In the matter of Sh. Vinod Patel Vs Reliance Gen. Insurance Company Ltd. AWARD DATED REPUDIATION OF CLAIM

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