DELHI OMBUDSMAN CENTRE

Transcription

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

21 1. This is a complaint filed by Sh. Vinod Patel (herein after referred to as the complainant) against the decision of Reliance Gen. Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of motor claim. 2. Complainant stated that he had lodged a complaint relating to settlement of claim. It was further submitted that his car bearing no. DL4 C AF 2210, Ford Fiesta was insured w.e.f This car met with an accident on It is further stated that there was delay in informing the Ins. Company. There after the claim was lodged with the company. It was further stated that his son could not trace the documents insurance cover note/ policy to inform the insureds. After he arrived in Delhi the process to filing the claim was taken up. The claim was repudiated by the Ins. Company due to late submission of the claim. The repairers M/s City Car care, New Delhi repaired his car after the surveyor s authorided the workshop to do the needful. The amount demanded by the workshop was dully paid. During the course of hearing complaint argued that company was not justified in denying the claim. However, he agreed that there was delay in informing the Ins. Company. 3. Representative of the company stated that claim is not payable as there was inordinate delay in intimating the damage. Company also filed written reply dated wherein it has been stated that policy no was issued to Sh. Dhawal Patel for the period to Complainant s vehicle met with an accident on and the same was intimated to the company on that after the delay of almost 35 days with no plausible explanation. The claim was registered and claim was repudiated. The claim was repudiated due to late intimation of the claim. 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 repudiating the claim due to late intimation because there were circumstances beyond the control of the complainant to intimate the company timely. Complainant was not available with the vehicle infact, he was ill and admitted in the hospital at Ahmed nagar therefore, intimation was not given on time. Admittedly insured vehicle met with an accident and got damaged. The damage was assessed by the surveyor. Therefore, claim is payable. Merely because there was delay in intimation, the admissibility of claim could not be denied particularly when reasonable explanations have been given. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 52,335 which is the loss assessed by the surveyor. ***********

22 Case No. GI/34/Bajaj/11 In the matter of Sh. S.K. Chaudhary Vs Bajaj Allianz Ins. Company Ltd. AWARD DATED NON SETTLEMENT OF CLAIM 1. This is a complaint filed by Shri. S.K. Chaudhary (herein after referred to as the complainant) against the decision of Bajaj Allianz Ins. Co. Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of motor claim. 2. Complainant stated that his vehicle was insured for the period to On his vehicle met with an accident. The vehicle later on was sent to an authorized work shop M/s Uttam Tyota and the Ins. Company was informed. The Ins. Company refused the cashless facility and there by forced him to pay the total cost of repair of Rs. 91,370. The company sent the approval for Rs /-only. After scrutiny of the bill it was found that the amount of the taxes on page-2 of the bill was not accounted for while settling the claim. The amount of the taxes was not taken to the account which amounted to Rs He has made efforts but he cannot get the relief. He has come to this forum for ensuring the payment of balance amount along with the interest and harassment charges. During the course of hearing also complainant stated that company was under obligation to provide cashless facility. 3. Representative of the company stated that claim was settled as per term 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 assessment sheet of the company and payment bills placed on record. After due consideration of the matter, I hold that complainant is entitled to assessed amount of Rs. 53,439. The taxes were already accounted for by the company while assessing the loss which is very much clear from the assessment sheet. Company is liable to pay the insured only the assessed loss. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 53,439.

23 Case No. GI/05/ICICI/11 In the matter of Sh. Deepak Kumar Vs ICICI Lombard Gen. Insurance Company Ltd. AWARD DATED : NON SETTLEMENT OF BIKE THEFT CLAIM 1. This is a complaint filed by Sh. Deepak Kumar (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of motor bike theft claim. 2. Complainant stated that he had a grievance against ICICI Lomb. Gen. Insurance Company Ltd., as company had not settled the claim of his bike. He submitted that he put up a claim relating to bike theft. The claim no. is MOT and the vehicle registration no. is DL 35 BJ He submitted that he was not justified with the reasons given by the company for repudiation of the claim. He had made representation to the GRO of the company also but he did not get any reply. He has come to this forum with a request to get the claim settled. During the course of hearing complainant stated that he did not sell the motor bike to his friend. However, he admitted that vehicle was stolen from the residence of his friend. 3. Representative of the company stated that vehicle was sold by the complainant and therefore there is no insurable interest of the complaint in the present claim. Company also filed a written reply dated where in it has been stated that complainant had taken a motor insurance policy no. 3005/ /10692/000 valid from till The insured vehicle was parked outside the house of Mr. Tarun Gupta which was stolen on FIR was registered on and theft intimation was given by Sh. Tarun Gupta. On investigation it was found that insured vehicle was already sold to the Tarun Gupta. Hence there is no insurable interest to insured on the date of theft. 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 repudiating the claim on the ground that complainant had no insurable interest because complainant was the owner of the insured vehicle and the same was stolen. He was the registered owner of the vehicle. Insurance was also taken by him. Merely because such bike was being used by his friend, company was not justified in stating that complainant had no insurable interest. There is no evidence placed on record that insured bike was sold by the complainant before the date of theft. In my considered view claim is payable

24 because complainant had suffered a total loss because his insured bike was stolen during the currency of the insurance policy. All formalities relating to settlement of the claim have been complied with. The argument of the company that complainant had no insurable interest on the date of theft is not tenable in absence of the evidence of sale. The facts of the case relied upon by the representative of the company were not identical with the facts of the present case. Therefore, the decision given in case by National Consumer Disputes Redressal Commission is not applicable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of IDV less Rs. 50. Case No. GI/65/IFFCO/11 In the matter of Sh. Ashutosh Mittal Vs IFFCO Tokio Gen. Insurance Company Ltd. AWARD DATED INADEQUATE SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Sh. Ashutosh Mittal (herein after referred to as the complainant) against the decision of Iffco Tokio Gen. Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to inadequate settlement of motor theft claim. 2. Complainant stated that his vehicle was insured under motor policy bearing no He had submitted all requisite documents for settlement of the claim. It was a claim related to theft of the vehicle. Company had settled the claim only for Rs. 2,30,067 whereas the vehicle was insured for sum of Rs. 2,80,000. He further submitted that insurance company had forced him to take the lesser amount than the IDV. He has come to this forum for ensuring payment of balance amount. During the course of hearing, it was argued that claim was partially settled because as against the IDV of the vehicle, he was paid a sum of Rs. 2,30, Representative of the company stated that claim was settled properly as vehicle was insured for more amount than the required amount. 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

25 in paying less than the IDV on account of total loss suffered by the insured due to theft of the insured vehicle. Since complainant suffered a total loss on account of the fact that his insured vehicle was stolen during the currency of the policy. He is entitled to IDV of the vehicle as compensation. Accordingly complainant is further found entitled to the difference of the IDV and the amount actually paid to him. Accordingly an Award is passed with the direction to the Ins. Company to make further payment of Rs. 49,433 (IDV 2,80, excess clause -2,30,067 amount already paid). Case No. GI/87/ICICI Lomb./11 In the matter of Smt. Ashma Bhasin Vs ICICI Lombard Gen. Insurance Company Ltd. AWARD DATED INADEQUATE SETTLEMENT OF CLAIM 1. This is a complaint filed by Smt. Ashma Bhasin (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to inadequate settlement of motor OD claim. 2. Complainant stated that she had submitted all requisite documents to the company but the company had not settled the genuine claim amounting to Rs. 1,47,202. However company had settled the claim by sending her a cheque of Rs. 75,686 dated Despite several communications the company had not heard her. Therefore, she has come to this forum to intervene to direct the company to pay her full claim. During the course of hearing also it was argued that claim was not settled adequately. More over the claim was settled late. It was pleaded that full claim is payable. 3. Representative of the company stated that claim was settled as per terms of the policy. IMT was not insured and company paid the assessed loss by the surveyor amounting to Rs. 75,686. Company also filed written reply dated wherein it has been stated that complainant had taken a motor insurance policy no. 3003/ /00/000 for the period starting from to Insured vehicle was surveyed by the

26 licensed surveyor and survey report was submitted to the company. Complaint was settled by making payment of Rs. 75,686 by cheque no I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the company s written reply and also surveyor s report. After due consideration of facts on record I find that complainant was not adequately compensated for the damage caused to the vehicle due to accident. Though it is a fact that damage loss as assessed by the surveyor was already paid to the insured but insured further needs to be compensated on the basis of the spot survey and loss assessed by the surveyor, the insured is further found entitled to a sum of Rs. 15,300. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 15,3000. Case No. GI/76/ICICI Lomb./11 In the matter of Sh. Rakesh Mohan Vs ICICI Lombard Gen. Insurance Company Ltd. AWARD DATED NON SETTLEMENT OF THEFT CLAIM 1. This is a complaint filed by Sh. Rakesh Mohan (herein after referred to as the complainant) against the decision of ICICI Lombard Gen. Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of motor theft claim. 2. Complainant stated that company was not justified in repudiating the claim stating that the key of the vehicle was inside the vehicle and the same was stolen. He submitted that while going to office one day in hurry the vehicle was locked while key was inside. It was opened by duplicate key and the vehicle was stolen along with certain documents were there in the locked vehicle. The facts remained that the vehicle was stolen when it was locked and thus there was no carelessness on his part to leave the key inside of the vehicle. One key was already given to the insurance company along with other documents to settle the claim. During the course of hearing complainant argued that company was not justified in denying the claim and when the vehicle was stolen it was already locked.

27 3. Representative of the company stated that claim is not payable firstly because of late submission and secondly due to negligence of the insured. Company also filed written reply dated wherein it has been stated that complainant had taken a motor insurance policy no. 3001/ /00/000 for a period starting from to It has been found by the company that as per statement, the complainant left the key of the vehicle in to the insured vehicle itself. Thus complainant failed to take reasonable care to safeguard the vehicle. Moreover, claim was intimated to the company late and it is the violation of policy condition and accordingly claim was not found payable to the insured. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also pursued the written reply and also repudiation letter. After due consideration of the matter, I hold that company was not justified in repudiating the claim merely because intimation was given late particularly when the insured stated that immediately on knowing the theft of the vehicle, he intimated the police on PCR and company was intimated on the next day on phone. The insured had submitted all requisite documents and complied with all formalities. In my view complainant had suffered a total loss as insured vehicle was stolen during the currency of the policy, the claim is payable. Accordingly an Award is passed with the direction to the insurance company to make the payment of Rs. 4,81,924 (4,82, ). Case No. GI/98/NIC/11 In the matter of Sh. Amit Gupta Vs National Ins. Company Ltd. AWARD DATED REPUDIATION OF CLAIM 1. This is a complaint filed by Sh. Amit Gupta (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 repudiation of motor claim. 2. Complainant stated that surveyor fee for an amount of Rs. 7285/- was not paid to him. Company was not justified in repudiating the entire claim of Rs. 62,200. He had taken NOC for Mumbai on , however vehicle could not be registered in Mumbai as he was asked for lot of documents by RTO for registration and found process tedious. He thought NOC will expire in 3 months time. His first claim was passed but with wrong

28 deductions. Second claim was not settled due to the fact that vehicle could not be registered either in Mumbai or at Ghaziabad. Therefore, he started the process of NOC and registration of the vehicle at Ghaziabad. The vehicle was finally registered in Ghaziabad on He pursued the matter, with the Ins. Company and he was informed that claim could not be processed as vehicle was not registered on date of accident. It was against the earlier communication from National Ins. Company in writing to him that claim will be settled once he gets his vehicle registered in Mumbai or Ghaziabad. It is further submitted that owner ship of the vehicle has not changed since purchase and also he never informed by the company that he had to transfer the registration only then he will be entitled for the claim. He submitted that claim is payable. 3. Representative of the company stated that claim is not payable due to lack of insurable interest. 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 correctly the first claim and also not paying the second claim put up by the complainant because claims are payable. The argument of the representative of the company that claim is not payable due to lack of insurable interest is not tenable because registered owner of the vehicle remained the same. More over vehicle is registered at Ghaziabad. Insurance of the vehicle continued throughout. Vehicle met with an accident during the currency of the policy. Therefore, company is under obligation to settle both the claims correctly. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of first claim amounting to Rs and second claim amounting to Rs. 62,420 as assessed by the company s surveyor. 6 Copies of the Award to both the parties. Case No. GI/28/Bajaj/11 In the matter of Sh. Thirvinder Singh Anand Vs Bajaj Allianz Gen. Insurance Company Ltd. AWARD DATED PARTIAL SETTLEMENT OF CLAIM 1. This is a complaint filed by Sh. Thirvinder Singh Anand (herein after referred to as the complainant) against the decision of Bajaj Allianz Gen. Ins. Co. Ltd. (herein after

29 referred to as respondent Insurance Company) relating to partial settlement of motor claim. 2. Complainant stated that he had taken a Motor Car Insurance Policy from M/s Bajaj Allianz Gen. Insurance Company in respect of his civic car no. DL4CAH8975. The premium was paid of Rs. 15,037 for comprehensive cover and the period of insurance was to He further submitted that on his car was caught in heavy rains and subsequent massive traffic jam outside khalsa college, Delhi University. The water level on the road continued to rise and while he was sitting helplessly because of the traffic jam the water slowly started entering inside the sitting cabin of the car. It continued to pour heavily and when the rain stopped his daughter who was driving the car asked him for advice as to what to do as the water had entered the driver s cabin. He took advice from mechanic of the work shop Sh. C. Lal who advised that car should not be started because the water had already entered the cabin and it surely would have entered the engine through the silencer as civic is a low lying car. He acted on his advice and towed the car to his residence with the help of his other car Toyota Corolla with the help of rope. M/s Ring Road Honda was informed whose engineer came to inspect the car and it was advised to him that car would have to be taken to Honda Work shop and the same was done. Claim form was duly filed and signed was given to M/s Ring Road Honda (Honda Car Dealers) for submission and liaisoning with the insurance company for processing the claim. The company s surveyor categorically stated that insurance company will not pay the claim as the damage was on account of flooding and floods have not been notified by the government. He was surprised by the observation of the surveyor. The matter was further perused with the Insurance Company. However, on the company sent him a cheque for Rs. 28,351 dated which was valid only for 3 months and whose validity in any case had expired even before it was sent to him. This shows the carelessness attitude of the company. He had requested this forum with a request to direct the Insurance company to pay the claim along with an amount of Rs. 2,36,665 paid by him to M/s Ring Road Honda and Rs. 5,500 was paid for the car battery which also became dead along with penal interest. During the course of hearing complainant argued vehemently that vehicle was not driven once water entered the cabin due to heavy rain but it was towed to the residence first and thereafter to the garage (authorized workshop) and therefore the argument of the company s representative that engine was ceased with the consequence damage as someone tried to start the vehicle. He further argued that claim was partially settled and company is under obligation to settle the claim fully. 3. Representative of the company stated that claim is not payable as required by insured of the vehicle and whatever claim was found payable under the facts and circumstances of the case the same was already paid. The damage to the engine was caused due to the fact that it was started and that being the resulting of the loss the same is not payable. 4. I have considered very carefully the submissions of the complainant as made in the complaint and also as made during the course of hearing. I have also considered the verbal arguments of the representative of the company. I have also perused both the reports of the surveyor. After due consideration of the matter, I hold that company had

30 not adequately settled the claim of the complainant. Having due regards to the facts and circumstances under which damage was caused to the vehicle and circumstances narrated by the insured and I have no reason not to accept the version of the insured in this regard, I hold that company was not justified in not settling the claim fully on the plea that consequential loss is not payable. When vehicle was damaged due to entering of water due to heavy rain and there was no evidence that attempt was made to start the vehicle while water was in the driver s cabin, in my view whatever damage was caused to the vehicle, the company is liable to compensate the insured for the damage caused to the engine also. The surveyor of the company had assessed the loss on that account also at Rs. 1,73,526. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of assessed loss to the insured amounting to Rs. 1,73,526. Case No. GI/89/OIC/11 In the matter of Sh. Narayan Singh Bisht Vs Oriental Insurance Company Ltd. AWARD DATED REPUDIATION OF CLAIM 1. This is a complaint filed by Sh. Narayan Singh Bisht (herein after referred to as the complainant) against the decision of Oriental Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of claim. 2. Complainant stated that vehicle with registration no. HR55G/8662 was insured by Oriental Insurance Company Ltd. which was valid from to , met with an accident on near Kazi Kund in the state of J & K and suffered a heavy loss due to leakage of gas and also due to accident of vehicle. Qadeer Ahmed, S/o Mohd. Shafi was driving the vehicle. Claim was examined by the company and the same was refused on the ground that license of the driver to carry hazardous goods was wrong. During the course of hearing, the complainant argued that company was not justified in repudiating the claim. He submitted all requisite documents for enabling the company for settling the claim. He further argued that later on driver s license was also got verified by him and therefore there is no reason not to allow the claim. During the course of hearing, he produced a certificate issued by T.I.T Motor Driving Training College which states that driver (Qadeer Ahmed) was authorized to carry hazardous goods.

31 3. Representative of the company stated that driver of the vehicle was not having valid license for carrying hazardous goods. Company also filed written reply dated which is placed on record wherein, it has been stated that as per claim form submitted by the insured, the driver at the time of accident was Mr. Qadeer Ahmed S/o Mohd. Shafi. His driving license details as per claim form is D/L No. 1098/R/2000 issued by Licensing authority Rajouri, J & K. Original driving license was not produced at the time of final survey and the same was not got verified by the concern authority. It was revealed that the license was not for hazardous goods. The claim was closed and this was conveyed to the insured. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the repudiation letter dated and also the written reply dated After due consideration of the matter, I hold that company was not justified in closing the claim because one could not deny the fact that insured vehicle met with an accident and got damaged. Due to the accident the vehicle fell below the road not only vehicle got damaged due to accident but also the gas it was carrying also leaked. Survey was conducted and assessment was also done. Ultimately, the insured proved that the driver was having a valid license and he was authorized to carry hazardous goods. Therefore, in my considered view damage appears to be genuine and claim is payable. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of assessed loss of Rs. 1,23,000. Case No. GI/112/NIC/11 In the matter of Sh. Dipankar Dutta Vs National Insurance Company Ltd. AWARD DATED NON SETTLEMENT OF ACCIDENT CLAIM 1. This is a complaint filed by Sh. Dipankar Dutta (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 accident claim. 2. Complainant stated that his car bearing registration no. HR 26 BC 1149 met with an accident on As he got the car insurance from Maruti on behalf of the insurance company, he approached the Maruti for insurance claim. Maruti informed that

32 he got the car for inspection and other process. Maruti denied to visit the sight. There after he approached the insurance company. Company also advised him to contact the Maruti as the policy was taken from the Maruti on behalf of the company. Maruti stated that repair estimate is required to get the claim which will be preparedby Maruti workshop engineer. The workshop specialists/engineers thoroughly inspected the car and prepared the repair estimate on which is 90% of IDV and after that they forwarded the claim to National Insurance Company. Infact surveyor himself rejected the repair option because the repair cost was very high. After survey insurance company offered him total loss amount which were less than IDV but he rejected the offer thereafter the surveyor and the insurance company were forcing him to take the car for re-inspection. He further mentioned that he was not interested to get the repair as repair cost of the car is very high i.e. 86% of the IDV. During the course of hearing, complainant stated that due to accident his car got damaged to the extent that the same could be treated as a total loss. This is also evident from the estimate which is more than 75% of the IDV. As a matter of fact, he was assured for total loss but less than IDV which he had rejected. 3. Representative of the company stated that vehicle is repairable but the insured did not get the car repaired and because the car is repairable, the claim could not be settled as a total loss. He also filed a surveyor report. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused various correspondences between the insured and the insurer and surveyor report. I have also seen photographs. After due consideration of the matter, it appears to me fair and reasonable that the complainant is entitled to the claim as a total loss claim. Due to accident the car was extensively damaged. It could be considered as a total loss case. More over complainant was also given to understand rightly so that the claim could be settled as a total loss case. The surveyor of the company also assessed the loss as a total loss claim. However, it appears reasonable if the insured is compensated net of salvage basis. The salvage value of the vehicle is Rs. 80,000 as assessed by the surveyor. Accordingly an Award is passed with the direction to the Insurance Company to make the payment of Rs. 4,29,448 ( ,000+ towing charges 1500).

33 Case No. GI/140/Bharti/11 In the matter of Smt. Krishna Dahiya Vs Bharti Axa Gen. Insurance Company Ltd. AWARD DATED NON SETTLEMENT OF CAR BURNT CLAIM 1. This is a complaint filed by Smt. Krishna Dahiya (herein after referred to as the complainant) against the decision of Bharti Axa Gen. Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of car burnt claim. 2. Complainant stated that she had submitted all requisite documents and clarification regarding the claim to the Insurance Company but so far the claim was not settled. She has come to this forum with a request to get the claim settled. During the course of hearing which was attended by the son of the complainant, it was pleaded that company had not settled the claim so far though all requisite documents have been submitted as demanded by the Insurance Company. 3. Representative of the company argued that claim was not settled due to non compliance on the part of the complainant. Complainant was required to submit forensic report but the same was not submitted so far. Therefore, the claim could not be decided. Company also filed a written reply dated wherein it has been stated that company had issued a policy bearing no to the complainant for the period to It further stated that on receipt of the intimation of loss company had deputed investigator Mr. G.B. Mathur to conduct investigation in the matter. The investigator submitted his report dated The investigator vide his various letters dated , , and and various reminders to submit the final police report and the forensic report however, the such documents were not submitted till date. Due to the peculiar circumstances of the case, it was requested to submit final police report and the forensic report because such documents were material to examine the liability of the company. Company however appointed the surveyor Mr. Alok Garg who submitted his report. 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 also investigator report besides the survey report. After due consideration of the matter, I hold that company was not justified in not settling the claim so far because complainant had already submitted requisite documents and clarifications to enable the company to settle the claim. Complainant suffered a total loss in the sense that the vehicle was found burnt along with the occupant of the car who was incidentally the husband of the complainant. The complainant had suffered a loss due to burning of the vehicle during the currency of the

34 policy. One thing is certain that insured vehicle was found burnt and thus insured had suffered a total loss. Accordingly it is held that claim is payable despite the fact that policy had not submitted final report in this case and also not submitted the forensic report. The surveyor had already assessed the wreckage value of the burnt car having due regards to the facts and circumstances of the case. Accordingly an Award is passed with the direction to the Ins. Company to make the payment of Rs. 6,29,500 ( IDV 6.60,000 - wreckage value 30,000 policy access 500). Vs Case No. GI/171/IFFCO/11 In the matter of Sh. Ranjit Bhawani Rai IFFCO Tokio General Insurance Company Ltd. AWARD DATED REPUDIATION OF THEFT CLAIM 1. This is a complaint filed by Sh. Ranjit Bhawani Rai (herein after referred to as the complainant) against the decision of IFFCO Tokio General Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of Motor Theft Claim. 2. Complainant stated that his Tyota Innova vehicle with registration no. DL3CBD 3766 was stolen from Defence Colony on The fact that his car was stolen from his residence on has not been disputed by the Insurance Company. However, the claim has been denied by insurance company. His representation to the GRO of the company has also been rejected. He submitted that his claim was rejected mechanically. He further elaborated that his driver Tinku Kumar was in the process of washing the car and the car was not unattended. The theft was immediately reported on emergency tel 100 and a police alert was sent out on the wireless. The police inspector to whom the case was assigned also visited the site to in investigate the case and took full evidence. The report clearly mentioned that the driver was in the process of washing the car and it was not unattended. At the time of theft of the vehicle, his driver was in the vicinity of the car he was just 2 to 3 feet away from the car. The matter was immediately reported by him and the police noted it in the diary on and the FIR 9/11 was immediately registered. It was mentioned that the driver was just outside the place of theft the miscreants suddenly jumped in to the car. As the car was facing Ring Road, the same was driven away at high speed. He further submitted that he had taken reasonable care and condition no. 4 was not applicable to him when has been made the basis for rejection of the claim by the Ins. Company. He has come to this forum with a request to get the claim

35 settled. During the course of hearing also the complainant almost repeated what he had mentioned in details in the complaint. He vehemently argued that insurance company was not justified in repudiating the claim because he had taken reasonable care of the vehicle and since he had suffered a total loss he needs to be totally compensated. 3. Representative of the company stated that claim is not payable as insured had not taken reasonable care to safe guard his vehicle. Company also filed written reply dated It was mentioned in the repudiation letter that ignition key of the vehicle was left inside the ignition switch of the vehicle and this aided the miscreants in their act of stealing the vehicle.. Leaving the vehicle unlocked with its ignition key inside the vehicle is gross negligence and a failure to take reasonable care to prevent and protect the vehicle from loss or damage. This letter also contains condition no. 5 of the policy and it has been sated that claim is not admissible. 4. I have considered the submissions of the complainant as well as of the representative of the company. I have also considered the verbal arguments of the representative of the company and also perused the reasons mentioned for repudiation of the claim in the repudiation letter dated After due consideration of the matter, I hold that company was not justified in repudiating the claim on the ground which are mentioned in the repudiation letter dated because in my view the insured had not violated the condition no. 5 of the policy. The driver was in attendance of the vehicle at the time of theft. He was only few paces away from the vehicle when the same was taken away by the miscreants. When the driver noticed that miscreants have taken away the vehicle, he chased them but in vain. The driver of the insured was washing the vehicle and he had gone few paces away from the vehicle to fetch water and when he returned he saw the vehicle was being taken away by the miscreants. He ran after them but of no use. The vehicle was parked just in front of the residence. In my view claim is payable and company was not justified in denying the claim. Accordingly an Award is passed with the direction to the insurance company to make the payment of Rs. 9,79,244 (9,80, access clause). Case No. GI/155/IFFCO/11 In the matter of Sh. Rajender Singh Vs IFFCO Tokiyo General Insurance Company Ltd. AWARD DAATED REPUDIATION OF THEFT CLAIM

36 1. This is a complaint filed by Sh. Rajender Singh (herein after referred to as the complainant) against the decision of IFFCO Tokiyo General Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of theft Claim. 2. Complainant stated that his truck bearing no. DL1GB3955 was stolen in the night of 23/24/2010. He had intimated the occurrence of theft on 100 number on The case was reported vide FIR no. 33/10 on He also intimated to the Insurance Company and company had deputed M/s Bhola & Associates to investigate the matter. The representative of the surveyor had visited the site from where the truck was stolen and he collected the relevant papers. He also assured him to settle his claim. It is highly regretted that despite his telephonic discussion with the company he was not given any satisfactory reply. During the course of hearing it was argued by the complainant that claim is payable and company was not justified in repudiating the claim. He further argued that driver is semiliterate i.e. he is literate up to 8 th or 10 th class and he did not make statement that the ignition key of the truck was in the ignition switch. He further argued that the truck was locked from the outside. This fact was also admitted by the company. He can produce the driver to prove that he did not make such a statement. 3. Representative of the company stated that claim is not payable because driver made a statement before the surveyor that key was left in the ignition switch while locking the cabin from outside and thus due to negligence the claim is not payable. 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 repudiating the claim because admittedly insured had suffered a loss due to the theft of insured vehicle during the currency of the policy. Insurance Company itself admitted that the insured vehicle was locked from outside. Therefore, it can t be said that the insured had not taken reasonable care. In my considered view claim is payable because insured had suffered a total loss due to theft of the vehicle. Accordingly an Award is passed with the direction to the Insurance Company to make the payment of Rs. 1,78,500 (1,80, ). Case No. GI/160/RGI/11 In the matter of Sh. Mohit Chaudhry Vs Reliance General Insurance Company Ltd. AWARD DATED REPUDIATION OF THEFT CLAIM

37 1. This is a complaint filed by Sh. Mohit Chaudhry (herein after referred to as the complainant) against the decision of Reliance General Insurance Co. Ltd. (herein after referred to as respondent Insurance Company) relating to repudiation of motor theft claim. 2. Complainant stated that his vehicle with registration no. HR 26 AJ 6009 was stolen on which was insured with the Reliance General Insurance Company Ltd. Delhi. He reported the matter to the police and lodged a FIR no. 70 on and a copy of which was sent to the insurance company. He further mentioned that all relevant documents were in the vehicle and the same was stolen along with such documents. After that he visited insurance office but the insurance office denied to lodge his complaint without any policy number. He went to his home where he find the policy number which was written in his diary and then the insurance company registered the claim but the insurance company repudiated his claim due to late intimation. It is quite illegal act. He had immediately informed the matter to the state police authority for searching the vehicle. He has come to this forum to get his claim settled. During the course of hearing also complainant stated that company was not justified in repudiating the claim. He further stated that he informed the insurance company as soon as he came to know about the theft of the vehicle. He did not intentionally delay in intimating the company about the theft of the vehicle. He further submitted that he informed the occurrence of theft of the insurance company on tall free number on the same day but since he could not state the policy number, the insurance company had not registered the claim. 3. Representative of the company stated that claim is not payable due to late intimation. Company also filed written reply on wherein it was stated that Reliance Private Car Package Policy was issued for the period to to the complainant. Though the vehicle was stolen on but the intimation was received only on i.e. after delay of 45 days. It was further mentioned in the reply that there was violation of condition no. 1 because the insurance company was not immediately informed about the loss of vehicle and therefore, claim was rightly repudiated. 4. I have considered the submission of the complainant as well as of the representative of the company. I have also perused the written reply dated which is placed on record and also repudiation letter. After due consideration of the matter, I hold that company was not justified in repudiating the claim on the ground of delay in intimation of occurrence of theft to the insurance company because complainant had intimated the insurance company on the day of theft on toll free number but he could not convey the policy number because of the fact that document were also stolen along with the vehicle. There is no reason not to believe the version of the complainant that as soon as he came to know the policy number from his diary he gave the intimation, admittedly the complainant had informed the state police authority about the occurrence of theft on the same day. In my considered view the circumstances due to which intimation was given late to the insurance company could not be altogether ignored and thus I hold that claim

38 is payable. Accordingly an Award is passed with the direction to the insurance company to make the payment of Rs. 1,54,500(1,55, ). KOLKATA CLAIM Order Dated : Facts & Submissions : Kolkata Ombudsman Centre Case No. 587/11/005/NL/01/ Dr. Sibiram Mahapatra Vs The Oriental Insurance Company Ltd. This complaint was originally filed with Delhi Ombudsman Centre and the same was transferred from Delhi Ombudsman Centre to Kolkata Ombudsman Centre due to jurisdictional issue. The complaint is against partial repudiation of claim under Private Car Package Policy Zone B issued by The Oriental Insurance Company Ltd. The complainant AVM Dr. Sibiram Mahapatra stated that his vehicle No. HR 26 V4756 (Honda City Car) was extensively damaged in transit shipment from Shillong to Delhi on when the container truck,carrying his car and household goods met with an accident near Shillong. The incident was immediately reported to the local police station and the insurance company s Shillong Office. The insurance company arranged for a spot survey and permitted the vehicle to be moved to Delhi by another carrier for repairs. The car was brought to New Delhi on and was handed over to the workshop under intimation to the insurance company s Delhi office. He requested for deputing a surveyor to assess the damage and permit the garage to proceed with the repair. The insurance company deputed a surveyor who assessed the loss at Rs.50,000/- against his estimated cost of Rs.1,80,000/-. The insurance company settled Rs.50,000/- after six months and he has accepted it under protest. He represented to the

39 insurance company on against partial settlement and requested them to review his claim and pay the balance amount. The insurance company stated that the above claim was reported to them through their Shillong branch office who had requested to depute a final surveyor as the vehicle was being repaired at Delhi. Shri Vikas Malhotra, surveyor was deputed to conduct the final survey for the above claim who has submitted his report assessing the loss for Rs.50,000/-. The insured has written to them vide his letter dated that the report of the surveyor was not submitted and therefore he requested for early submission. The surveyor s report was received by them on and the same was shown to the insured during his personal visit to their office on However, the insured was not satisfied with the assessment made by the surveyor and gave a representation dated requesting for a review. They forwarded the representation along with bills/ cash memos to the surveyor and called for his comments regarding the huge difference between the estimated loss and assessed loss. The surveyor vide his letter dated stated that the loss has been assessed prudently, in a judicious manner in accordance with the coverage provided within the four corners of the policy taking into consideration the spot survey report. The report of the spot surveyor dated also could not justify the losses which were not allowed by the final surveyor Shri Malhotra i.e., damages to suspension assembly and steering. DECISION: The photographs and other documentary evidences, surveyor s report etc. submitted by the parties to this forum, Hon ble Ombudsman found that there is a huge gap of Rs.1.30 lakh between the claimed amount and the loss assessed by the surveyor. The insurance company has called for the comments of the surveyor regarding this difference. The surveyor has explained that the loss has been assessed prudently and in a judicious manner in accordance with the policy conditions. The loss assessed by the surveyor has been fully paid by the insurer and insured has accepted the cheque under protest. However, it is seen from the surveyor s report that the difference of amount between the bills is due to the fact that the insured did not purchase the parts from the authorized dealers of the Honda cars; instead he acquired the parts from local market. He has also opined that the suspension/ steering parts were replaced but the damaged was not resultant of the subject accident. To contradict the surveyor s findings, the complainant has submitted photographs showing extensive damage to the suspension assembly and the radiator of the car. From these photographs, we find that the possibility of the damage to the radiator and suspension assembly resulting from the accident cannot be ruled out. Why the same was not considered is not very clear from the surveyor s report. After careful evaluation of all the facts and circumstances of the case, she opined that total rejection of the cost of the radiator and suspension assembly is not justified in this case. Since the insured had spent Rs.41,000/- for replacement of these part, Hon ble Ombudsman allowed an ex-gratia payment of Rs.25,000/- to

40 the insured which included labour charges and depreciation and the insurance company was directed to pay the same accordingly. Kolkata Ombudsman Centre Kolkata Ombudsman Centre Case No. 603/11/013/NL/01/ Smt. Kusum Berlia Vs. HDFC ERGO General Insurance Co. Ltd. Order Dated : Facts & Submissions : This complaint was filed against partial repudiation of claim under Private Car Package Policy issued by HDFC ERGO General Insurance Company Ltd. The complainant Smt. Kusum Berlia stated that her insured vehicle Hyundai Car No. WB-74/N met with an accident. The matter was informed to the insurance company and the insurance company deputed a surveyor to assess the loss. The vehicle was repaired at Durga Hyundai, Dagapur, Pradhan Nagar, an authorized workshop of Hyundai Motors. The repairs were carried out as per instruction of the surveyor of the insurance company. The surveyor has assessed the loss for Rs.15,603/- only for the damages. She lodged a claim for Rs.20,627/- towards repair of the vehicle. The insurance company vide their letter dated settled Rs.7,221/- towards full and final settlement of the claim. But she did not accept the cheque and returned the same on She represented to the insurance company on against partial settlement and requested them to settle the claim as per loss assessed by their surveyor. Her appeal was not considered by them. Being aggrieved, she approached this forum for redressal of her grievance seeking monetary relief of Rs.15,603/-. The insurance company stated that the insured vehicle Hyundai Car No. WB-74N-7951 with an IDV of Rs.3,05,942 met with an accident on and the own damage claim was registered in their office. Shri Berlia has submitted his claim form explaining the cause of the accident as under

41 during turning an unknown auto rickshaw hit the rear side of the car and fled away and his vehicle got unbalanced and dashed to one parked vehicle and left side bumper got damaged. This suggested that only the left hand side and right hand rear side damages were consistent with the cause of accident. However, during inspection they observed that damage sustained was on right rear and a different damage at the different height on right front bumper. On perusal of damage it was very clear that the damage is not in continuation and it is definitely not possible for a vehicle to move towards the same side as it has been hit. They further stated that on receiving the intimation, Shri Ratan Das, IRDA approved surveyor was appointed for survey and assessment of the said loss. Upon receipt of the survey reports and other relevant claim papers, the claim was processed and settled by issuing a cheque vide cheque no dated for Rs.7,221/- towards full and final settlement of the claim. However, it was declared in the counterpart of the cheque stating that if the enclosed amount is not acceptable to you, please do not deposit the cheque/draft into your bank account and return the same to HDFC ERGO GIC Limited along with a letter giving reason for non-acceptance.. DECISION: It is seen that the insured had mentioned in his claim form that his car was hit on the rear side by an unknown auto rickshaw and the left side of the bumper got damaged as the vehicle got unbalanced and dashed to another parked vehicle. This is quite understandable. The survey report has not been filed by the insurer and therefore, it is difficult to determine how the loss was assessed by him. The insurer has filed some photographs, from which we find that the damage occurred more on the right side. However, some damages are also seen on the left side of the vehicle. The complainant has not given the details of the accident in her complaint she has simply mentioned that her car had met with an accident and all the repairs were done at the authorized workshop of Hyundai Motor as per the instruction of the surveyor. Since she was not present during the course of hearing, we could not verify the details of the accident from her. As per the claim form, the cause of accident mentioned by the claimant is during turning, an unknown auto rickshaw hit the rear side of the car and fled away and his vehicle got unbalanced and dashed to one parked vehicle and left side bumper got damaged. From this it appears that rear side of the car and left side bumper suffered damages. Under the circumstances, we find some merit in the contention of the insurer that impact of the accident could not cause damages on both side of the vehicle. The possibility of some damages already existing and not caused by the accident, cannot be ruled out. The complainant has claimed that the repair was done as per the instruction of the surveyor but she has not filed any estimate given by the surveyor. The surveyor s report has also not been filed by the insurance company. We are therefore unable to determine the exact loss assessed by the surveyor and whether the repairs work was carried out under his supervision. The

42 company, also could not explain how they have arrived at an amount of Rs.7,221/- towards full and final settlement of claim. After evaluation of all the facts and circumstances of the case Hon ble Ombuidsman was of the opinion that settlement of the claim at Rs.7,221/- was not justified and the insurer was directed to pay a further amount of Rs.5,000/- by way of ex-gratia payment over and above the amount of Rs.7,221/-. They are further directed to pay the amount of Rs.5,000/- (Rupees Five thousand only) to the complainant. CLAIM Order Dated : Facts & Submissions : Kolkata Ombudsman Centre Case No. 671/11/005/NL/02/ Shri Ayub Mondal Vs. The Oriental Insurance Co. Ltd. This complaint has been filed against repudiation of a claim under Goods Carrying Goods Carrying Commercial Vehicle (other than 3 wheeler) Policy issued by the Oriental Insurance Company Ltd. on the ground that the driver was not holding a proper license to drive a Heavy Goods Vehicle at the material time of accident. The complainant Shri Ayub Mondal has stated in his complaint dated that his Vehicle (Tata Truck) No. WB-23/B-1168 with an IDV of Rs lakh had met with an accident on at Bankura Durgapur Highway near Ratanpur and suffered severe damages. The accident was reported to the Bankura Police Station and all the formalities were completed by the police. Subsequently he placed the vehicle at M/s Autotech Services Ltd., an authorized garage of M/s Tata Motors for repair and intimated the insurance company accordingly. The Company deputed a surveyor to inspect the damaged vehicle and assessed the loss. The surveyor submitted an estimate of loss of Rs.4,29,712/- vide his letter dated Before that, the insurance company vide their letter dated repudiated the claim on the ground that at the material time of accident, the driver Shri Pinku Taran did not have the license to drive HGV (Heavy Goods Vehicle). He represented to the insurance company against such repudiation on stating that a driver holding a H.P.M.V (Heavy Passenger Motor Vehicle) driving license was eligible to drive HGV and requested them to settle his claim.

43 The insurance company stated that the complainant s TATA truck bearing no. WB23B-1168 with an IDV of Rs lakh met with an accident on The insurer appointed a surveyor Shri J.L. Kaul, to assess the loss. The surveyor estimated the loss at Rs.4,29,712/-. The claim was processed and sent to their regional office who further appointed Shri Jitendra Narayan Chakraborty and others to investigate and verify the driving license of the driver Shri Pinku Taran and it was found that the driver was authorized to drive Heavy Passenger Motor Vehicle (HPMV) only. The insured vehicle was Heavy Goods vehicle and accordingly, their regional office repudiated the claim for breach of driver clause. DECISION: It was seen that the motor claim of the insured was repudiated on the basis of the investigator s report that as per the particulars obtained from DTO, Barasat on , the holder of Driving License No. WB was entitled to drive HPMV (Heavy Passenger Motor Vehicle) only. The vehicle involved was a HGV (Heavy Goods Vehicle) and therefore, there was a breach of driver clause. Perusal of the documents submitted by the complainant as mentioned above, clearly showed that the holder of driving license no. WB was granted due permission to drive HMV w.e.f and HPMV w.e.f The accident took place on Hence, on that date, the said driver was entitled to drive both HMV and HPMV. The insurer has argued that as per the verification report of the investigator, the driver was eligible to drive only HPMV. But, we find that the investigator is silent about other types of vehicle he was eligible to drive and there is no specific denial from the licensing authority that the driver could not drive HGV. Accordingly, it was evident that the certificate issued by DTO, Barasat only mentioned the last endorsement by which he was permitted to drive HPMV without mentioning other category of vehicles like LMV, HGV etc. After careful evaluation of all the facts and circumstances of the case, Hon ble Ombudsman was of the opinion that the complainant had produced conclusive evidence to show that the driver was entitled to drive HMV (HGV) from which we can conclude that there was no breach of driver clause. The Insurance Company never raised objection/comments on the documentary evidence produced by the complainant. Under the circumstances, Hon ble Ombudsman held that the decision of the Insurer to repudiate the claim was erroneous the insurer was directed to admit the claim and settle the same as per terms and conditions of the policy. Kolkata Ombudsman Centre Case No. 084/11/011/NL/05/ Shri Debjit Singha Roy Vs. Bajaj Allianz General Insurance Company Ltd.

44 Order Dated : Facts & Submissions : This complaint was filed against repudiation of claim under Commercial Vehicle Package policy issued by Bajaj Allianz General Insurance Company Ltd. as per exclusion clause no. 1 of the policy. The complainant stated that his ten wheeler truck (Ashok Leyland) bearing no. WB-15A-4781 was insured with an IDV of Rs.9.50 lakh. The vehicle was loaded at Jangalpur (Bombay Raod) on 25 th February 2009 and left on 26 th February 2009 from Sheoraphuli for its destination at Amingaon, Guwahati, Assam with his driver Sri Gopal Yadav. The expected date of return of the vehicle was 10 th March When it did not return on the expected date and other two vehicles returned in time, he asked the other drivers about the instant vehicle, but they could not clarify about it and he suspected that his vehicle was untraceable. He lodged an F.I.R to the Serampore Police Station on Subsequently on , he served official intimation to the insurance company for settlement of his claim. However, the insurance company vide their letter dated repudiated the claim stating that as per our policy condition no. 1, notice shall be given in writing to the company immediately upon the occurrence of any accident or loss or damage.. He represented to the insurance company on against repudiation stating that the date of loss should be counted only after the expiry of the expected date of return i.e., and he lodged the F.I.R only 2 days after the loss and intimated the insurance company within 7 days of the loss and 4 days of filing the F.I.R. The insurance company stated that the complainant had insured his vehicle bearing No. WB- 15A-4781 for the period to for a sum insured of Rs.9.50 lakh. On , the said vehicle started from Sheoraphuli and did not return after delivering the consignment in Assam by the expected date (as per the claimant) on An FIR was lodged on vide General Diary and they were intimated about the loss on On receiving the intimation, they appointed an independent investigator for finding the exact cause and extent of loss. On the basis of the investigator s report, they denied the claim on the ground of delayed intimation and negligence of the owner in handing over the insured vehicle and its keys to an unknown person and for not taking reasonable care of the vehicle. The delay in intimating the loss further hampered the chances of recovery of the stolen vehicle. They wrote a letter to the complainant asking for an explanation on the above mentioned defaults on his part, but did not receive any satisfactory reply. Under the circumstances, they repudiated the claim. It was stated that the insured s failure to take reasonable care was a fundamental breach of the terms and conditions of the policy. Considering that the date of loss was and the intimation was given on , there was a delay in intimation of about 3 months. The delay and the non adherence of the policy terms and condition is not bonafide on the part of the complainant and therefore, they have denied the claim under condition no. 1 of the policy, which reads as under: Notice shall be given in writing to the company immediately upon the occurrence of any accident or loss or damage and in the event of any claim and thereafter, the insured shall give all such information and assistance as the company shall require.

45 DECISION The claim was repudiated for delay in giving intimation to the insurance company in contravene of the condition no.1 of the policy. Analysis of the case records shows that the complainant made a police diary on , i.e. after 15 days of the departure of the loaded vehicle on for its destination in Assam. He intimated to the Insurance Company about this loss on As the police did not take steps to trace the vehicle, he lodged an F.I.R on through court intervention vide Court s order dated received by him The said order of the court was communicated to the insurance company by the counsel on and a formal F.I.R was lodged on These facts were not disputed by either party. Further, the date of loss as per police final report is i.e. the date of departure of the vehicle and as per the complainant s statement, it is i.e. the date of the expected arrival of the vehicle. In the former case, there was a delay of 20 days and in the later case, the delay was of 8 days. Thus, in both the situations, there was a clear contravention of the policy condition no. 1 that requires the owner to give a notice immediately upon occurrence of the loss. The insurer s contention that the delay hampered the chances of recovery of the vehicle is found to be correct. Now, coming to the reason of delay in intimation, Hon ble Ombudsman found that it was mainly on account of the negligence of the complainant. Analysis of the facts shows that the complainant failed to take reasonable care of the insured vehicle. He handed over the vehicle to the driver, who was not well known to him without ascertaining the details of the consignee, the route of the vehicle, expected date of unloading, emergency contact nos. etc. The explanation of the complainant that he did not suspect anything wrong till (the expected date of return) is not very satisfactory. It is seen that he lost contact with the driver/helper soon after their departure and yet he did not consider it necessary to make enquiries from the consignee/transport company or reach for police help to know their whereabouts. He made a police diary on i.e. after 4 days and intimated the insurer on i.e. after 7 days of the expected date of arrival of the vehicle. This delay has not been satisfactorily explained by him. It is quite surprising that he did not get alert when the driver stopped contacting him and he did not make independent efforts to track the vehicle. An owner of a vehicle, whose driver has not contacted him for 15 days, is not expected to sit coolly waiting for him to return. During oral submission, the complainant stated that he could not contact the driver as his mobile phone was not working in Assam. This does not appear to be a reasonable cause, as the owner would be anxious and suspicious if he lost contact with the driver for so many days and try to contact him through alternate source. Such a casual approach in a serious matter like theft of vehicle was not normal and supported the allegation of the insurer that he did not take reasonable care of the insured vehicle. Under the circumstances, she agreed with the contention of the insurance company that the complainant had violated the mandatory condition no.1 of the policy and could not give any satisfactory explanation for the delay in intimation and non adherence of the policy terms and conditions. There was no doubt that timely intimation of loss to police/insurer was vital to chances of recovery and delay in this respect can hamper the chances. But, in our opinion, a mere delay in filing FIR or intimating the insurer cannot close all doors of justice. This office read the

46 contents of F.I.R and the police final report, which did not reveal any malafide intention on the part of the complainant. The police investigation report had established the incident of theft and a prima facie case had been registered against the driver. Under the circumstances, the only lapse on the part of the claimant was his casual and negligent approach to the matter, which definitely amounted to breach of contract. After careful evaluation of all the facts and circumstances of the case, Hon ble Ombudsman was of the opinion that total repudiation of the claim was definitely not justified but the complainant must also bear a part of the loss for not taking adequate care of the insured vehicle. Hon ble Ombudsman directed the insurance company to settle the claim on non-standard basis upto 60% of the IDV. Order Dated : Facts & Submissions : Kolkata Ombudsman Centre Case No. 143/11/018/NL/06/ Shri Mainak Ghosh Vs. Future Generali India Insurance Company Ltd. This complaint was filed against repudiation of claim under Future Secure Commercial Vehicle Package Insurance Policy issued by Future Generali India Insurance Company Ltd. due to misrepresentation. The complainant stated that his insured vehicle TATA SFC 407 bearing no. WB 41D-9417 with an IDV of Rs.5,51,500/- met with an accident on when it was returning from Dhaniakhali to Bhadreswar which caused death of driver and the vehicle was badly damaged. The same was reported to Chandannagar Police Station, Hooghly vide F.I.R no. 26/10 under section 279/338 dated He lodged a claim along with all relevant documents to the insurance company on for settlement of accidental claim. Subsequently, the insurance company appointed a surveyor as well as investigator to investigate and assess the loss. However, the insurance company vide their letter dated repudiated the claim stating that during physical verification of the policy validity status & claim status of the caption cover note with your previous insurer, it has been confirmed by them that insurance policy was issued against the said cover note but the

47 same stood cancelled from the date of inception because of reason of non-compliance of Section 64VB of the Insurance Act 1938 (Dishonour of Premium Cheque). A written confirmation from your previous insurer in this regard is in our records. This act of yours goes against the declaration in your proposal form and thus it is proved beyond doubt that facts were misrepresented in proposal form that your vehicle was previously insured. In view of above, we are left with no other option but to repudiate your captioned claim under policy terms and conditions. He represented to the insurance company on against repudiation stating that he was fully unaware about this matter and requested them to reconsider his claim. The insurance company stated that the complainant Shri Mainak Ghosh got an insurance cover for his truck with regtd. no. WB-41-D-9147 for the period from to On , they received a motor claim from the complainant, wherein he stated that the said truck met with an accident while it was returning back from Dhaniakhali to Bhadreswar. They appointed a surveyor as well as investigator to assess the loss and to verify the facts of the alleged accident. After receiving all the documents, they found that the accident is genuine but the complainant s declaration in the proposal that he was previously insured with Reliance General Insurance Company vide cover note no is false as the cover was cancelled by the insurer due to non-compliance of 64VB as the cheque for the premium had bounced for insufficient funds. So, due to misrepresentation of facts, which is a breach of policy terms and conditions, they repudiated the claim vide their letter dated They had further stated that insurer issued the policy on good faith but there was a clear breach of faith and misrepresentation of fact on the part of the insured. DECISION: It was not a disputed fact that the complainant had intended to take an insurance cover for the vehicle from Reliance General Insurance Company Ltd., but due to dishonour of the cheque for insufficient fund, the policy was declined. However, while taking a fresh policy from the present insurer, the complainant failed to disclose the fact that his earlier policy was declined by the insurer. Such an omission, although vital, was not found to be intentional and the company had admitted that it had not affected the underwriting decision. Moreover, we find from the application form, that Col. 7 was not properly filled up by the agent. The period for insurance cover was not mentioned and the option for decline/ cancellation of policy was also not ticked. Thus, the proposal form was incomplete and since it was accepted by the insurance company without filling of the mandatory columns, they cannot raise the issue of misrepresentation and breach of policy condition. Moreover, the insurance company had not suspected any mala fides or fraudulent intention on the part of the complainant and therefore, total repudiation of the claim based simply on this point is extremely harsh and unjustified. After careful evaluation of all the facts and circumstances of the case, we are of the opinion that the incomplete/incorrect information given in the proposal form regarding previous insurance has not affected the underwriting decision. Moreover, there is no fraud or mala fide intention involved. Therefore, the decision of the insurance company to deny the claim on the ground of

48 misrepresentation and breach of policy condition was erroneous and the insurance company was directed to admit the claim and settle the same as per terms and conditions of the policy.