office of the insurance ombudsman (gujarat)
TRANSCRIPT
AHMEDABAD
OFFICE OF THE INSURANCE OMBUDSMAN (GUJARAT)
2nd Floor, Ambica House, Nr C.U. Shah College, Ashram Road, Ahmedabad-380014
Phone : 079-27546840, 27545441 Fax : 079-27546142
Ahmedabad Ombudsman Centre
Case No.11-010-0218-10
Mr. Manilal H. Gohil Vs.
Iffco-Tokio Gen. Ins. Co. Ltd.
Award dated 13-10-2009
Motor Insurance Claim
Claim lodged towards reimbursement of repair expenses of the
Complainant’s damaged vehicle due to accident was partially settled by the
Respondent in a manner that aggrieved the Complainant. Total claim
amount was Rs.12,000/-, 50% of the claim amount paid by the Respondent.
As a result of mediation by this forum, both the parties agreed for a sum of
Rs.3000/- as full and final settlement, thus grievance was resolved.
Ahmedabad Ombudsman Centre
Case No.11-002-0238-10
Mrs. Bhartiben S. Shah V/s.
The New India Assurance Co. Ltd.
Award dated 30-10-2009
Motor Insurance Policy
Complainant’s insured vehicle met with an accident and claim lodged for
damage expenses was repudiated by the Respondent. The claim was repudiated invoking terms and conditions of the policy which stipulate that at the time of accident the person driving the insured vehicle must holds an
effective driving license and is not disqualified from holding or obtaining such a license.
An examination of material on record reveals that the person driving the vehicle, (driver of the Complainant) was not holding an effective driving
license, at the time of accident. Thus, Motor O.D Claim is not payable because of the driver was not holding effective Driving License as on date of accident.
Section 3 (1) of M.V. Act 1939 specifically provides for the need to have a
license to drive a Motor Vehicle and a special authorization to drive
transport vehicle. Thus the Respondent’s decision to repudiate the claim is
justified.
Ahmedabad Ombudsman Centre
Case No.11-011-0250-10
Mr. Narendrabhai T. Patel V/s.
Bajaj Allianz Gen. Ins. Co. Ltd.
Award dated 30-11-2009
Two Wheeler Comprehensive Policy
P.A. Claim lodged by the Complainant under the policy was rejected by
Respondent on the ground that the permanent disability of the Complainant
does not fall under disability as defined under Sec. III Personal Accident
cover for owner driver of the policy. Hospital has certified disability to the
extent of 50% of whole body and permanent partial disability 39% and 12%
of right lower limb and right upper limb respectively. So disability caused to
the Complainant does not fall under Section-III of the policy.
In the result complaint fails to succeed.
Ahmedabad Ombudsman Centre
CASE NO.11-007-454-10
MR.MIHIR H. PATEL V/S
ICICI LOMBARD GENERAL INSURANCE CO. LTD.
Award Date: 22.03.2010
Partial repudiation of Motor Own Damage claim. Respondent deducted the
amount on the grounds that the subject vehicle was running on road
without CPI (Certificate of Periodical inspection). Respondent submitted set
of papers, it is established from the available papers that the subject vehicle
was running on road without having valid CPI. The Respondent’s decision to
settle the claim after deducting of CPI is upheld, without any relief to the
complainant.
Ahmedabad Ombudsman Centre
Case no 11-009-200-10
Mr.Indravadan B.Panchal Vs
Reliance General Insurance Company Ltd
Award Date : 30-10-2009
Repudiation of Claim under Mediclaim policy: The complainant has
submitted the claim for reimbursement of expenses incurred in
hospitalization for treatment of HTN SAH with history of Meningitis before 6
years. The Respondent has repudiated the claim by invoking exclusion
clause 1 and terms and conditions No 2 of Health Wise Policy .The
respondent has produced an Investigation Report stating that the insured
was having Aneurysm which is a malformation and subarachnoid
hemorrhage was due to rupture of it due to hypertension which was for the
last 6 years .The discrepancies and contradiction observed in hospital record
in history of illness in various records submitted and it require calling for
further documents and witnesses ,examination and cross examination for
the same on oath which is beyond the jurisdiction of this forum. Hence
without getting into merits of the case and passing any quantative award for
the same ,leaving it for the complaint to other means to resolve the
grievances either within the frame work of govt.rules. The complaint stands
disposed off.
Ahmedabad Ombudsman Centre
Case No. 11-09-0258-10
Mr Mahesh Kumar B Shah Vs
Reliance General Insurance Co.Ltd.
Award Date: 09-12-2009
Repudiation of Claim under Vehicle Insurance: The claim has been lodged
for RS 245965/ for reimbursement of charges incurred in repairing the
vehicle caused due to accident while the vehicle was being driven during
heavy rain claimant. The respondent has repudiated the claim stating that
the damage to the engine is not related to any external accident but inlet of
water into the engine during the period the vehicle stranded into the water
and subsequent cranking and this is mechanical failure and also sub
sequential loss as result of failure on your part to protect the vehicle .The
respondent has not convincing proved of negligence by the complainant
Hence the decision to settle the
claim only for RS 6728/ by the respondent is set aside and directed to settle
the claim as per opinion of independent surveyor taken by this forum and
directed to pay RS 125499/ to the Complainant .The complaint succeeds
partially.
Ahmedabad Ombudsman Centre
Case no 11-05-0455-10
Mr. M D Joshi Vs
ICICI Lombard General Insurance Company Ltd
Award Date : 31-03-2010
Short Payment of Vehicle Accidental Claim : The vehicle of the claimant
has met an accident on 25.09.2009and again on 18.11.2009 .He has
submitted the claim for repairing stating that the car was damaged because
heavy piece of stone lying on road which resulted into dash with rear side of
car. The respondent has settled the bill in partial and rejected the balance
claim stating that the cause of accident was misrepresented and damages
were old .The surveyor report and photographs has confirmed that the
damages were old ,therefore the decision of the respondent to repudiate the
claim is justified .The complaint fails to succeed.
Ahmedabad Ombudsman Centre
Case no 11-05-0419-10
Mr Prakash S Patel Vs
The Oriental Insurance Co .Ltd
Award Date : 31-03-2010
Non Settlement of Accidental Claim under PA policy : The complainant
has submitted the claim for CNG /LPG kit and personal accidental death
claim .The complainant has pleaded that the additional premium for
CNG/LPG kit has been charged hence it can not be treated as Accessories
and the premium for personal accident for 4 persons in addition to driver
has been paid hence the cover for his demised wife was available .The
panchnama /post mortem report and FIR confirms that there were 4
persons traveling at the time of car accident . Therefore the decision of the
respondent to deny the claim of accidental amount and cost of CNG /LPG is
not justified .Hence the respondent has directed to pay RS 16600/ being
sum insured for the kit and RS 100000/ towards Personal Accident Death
Benefit .The complaint stands succeed.
Ahmedabad Ombudsman Centre
CASE NO.11-007-454-10
MR.MIHIR H. PATEL V/S
ICICI LOMBARD GENERAL INSURANCE CO. LTD.
Award Date: 22.03.2010
Partial repudiation of Motor Own Damage claim. Respondent deducted the
amount on the grounds that the subject vehicle was running on road
without CPI (Certificate of Periodical inspection). Respondent submitted set
of papers, it is established from the available papers that the subject vehicle
was running on road without having valid CPI. The Respondent’s decision to
settle the claim after deducting of CPI is upheld, without any relief to the
complainant.
Ahmedabad Ombudsman Centre
CASE NO.11-009-0258-10
Mr. M B SHAH V/S
RELIANCE GENERAL INSURANCE CO.LTD.
Award Dated : 09.12.2009
Motor OD claim was partially settled by the Respondent for Rs. 6728/-.
The vehicle Honda CR was adequately insured having sum insured of
R.12, 77091/-. The damages sustained due to flood / water to
hydrostatic locking and not accidental loss. There is no question of External
accidental arise. Total expenses incurred by the complainant is sum of Rs.
2,45,965/-. Respondent got investigated the vehicle through independent
Surveyor. As per surveyor’s report and other documentary evidences
produced before the Ombudsman, it is decided to pay the sum of Rs.
125449/- after deducting Depreciation and excess amount.
BHUBANESWAR (1)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-002-0595
Sri Mukti Kant Padhy
Vrs
New India Assurance Co. Ltd., Bhubaneswar DO I
Award dated 14 th October, 2009
Complainant had insured his vehicle with new India Assurance Co. Ltd. from
04.02.2007 to 03.02.2008 which met with an accident on 31.01.2008 . The
Insurer repudiated the claim on the ground that the date of accident is after the
expiry of the policy period but on the alleged date claimed by the insured.
Hon’ble Ombudsman heard the case on 14.10.2009 where both the insurer and
insured were present. The Insurer presented the letter of the IIC of the P.S.
which stated that the copy of the SDE submitted by the insured is a fabricated
one and the accident relates to another vehicle. After hearing both the parties
and perusing the documents Hon’ble Ombudsman held that the insurance
company has rightly repudiated the claim.
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(2)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-009-0593
Sri Amaresh Satpathy
Vrs
Reliance General Insurance Co. Ltd., Bhubaneswar
Award dated 6 th October, 2009
Complainant had insured his vehicle with Reliance General Insurance Co.
Ltd. which met with an accident on 25.04.2008. The Insurer has not settled the
claim till date. Hon’ble Ombudsman heard the case on 14.09.2009 where
insurer was absent despite prior intimation and no Self Contained Note was
produced. The Insured submitted the bill from the authorized garage and copy
of the policy. The only discrepancy in the policy was that it has a different
chassis and engine number. On receipt of the policy the insured has written to
the insurer regarding the discrepancy. The insured has submitted an affidavit
that he owns only this vehicle and has submitted the vehicle delivery certificate
and RC Book showing the same chassis and engine number. On perusing the
documents & hearing the insured Hon’ble Ombudsman held that the owner of a
new vehicle would never supply a wrong Engine & chassis number for
insurance and hence the claim made by the insured should be settled within a
month considering that the vehicle is duly insured.
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(3)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-009-0599
Sri Anjan Kumar Patel
Vrs
Reliance General Insurance Co. Ltd., Bhubaneswar
Award dated 13th
October, 2009
Complainant had insured his vehicle with Reliance General Insurance Co. Ltd.
The vehicle met with an accident on 29.09.2008.Complainant informed both
Insurer and the police. A survey was carried out the Insurance Company
through its surveyor. The amount claimed was Rs 1,08.840/- where as the
surveyor assessed loss for Rs 41,000/.Complainant was dissatisfied with the
assessment.
Hon’ble Ombudsman heard the case on 14.09.2009 where insurer was absent
despite prior intimation and Self Contained Note was also not submitted.
Verification of delivery slips showed that the insurer have received the letters
sent from the forum well in advance. In absence of any rebuttal material the
claim made by complainant is taken to be genuine and the Insurer is directed to
pay the complainant, full amount claimed, within 30 days of receipt of consent
letter.
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(4)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-011-0600
Sri Ashok Kumar Mishra
Vrs
Bajaj Allianz General Insurance Co. Ltd., Bhubaneswar
Award dated 16th
October, 2009
Complainant had insured his Maruti Alto vehicle with Bajaj Allianz General
Insurance Co Ltd and a claim was preferred for an accident which the vehicle
met on 08.03.2008.Insurance Company settled the claim for Rs4500/- as against
a claim of Rs12,000/-.
Hon’ble Ombudsman heard the case on 14.09.2009 where insurer was
present but the complainant did not attend. After hearing insurer and perusing
the documents Hon’ble Ombudsman observed that the assessment done by the
surveyor was proper and the repairs carried out for the portion not affected in
the accident is naturally not assessed for the claim. Hence held that the
complaint stands dismissed.
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(5)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-011-0603
Smt Dharitri Behera
Vrs
Bajaj Allianz General Insurance Co. Ltd., Bhubaneswar
Award dated 19th
October, 2009
Complainant had insured his vehicle with Bajaj Allianz General Insurance
Co Ltd and a claim was preferred for an accident which the vehicle met on
22.03.2009.Insurance Company repudiated the claim on the ground that a false
claim was preferred by complainant.
Hon’ble Ombudsman heard the case on 14.09.2009 in presence of both
the parties. After hearing insurer and perusing the documents Hon’ble
Ombudsman observed that the grounds of repudiation were not justified as the
incident was reported to the police and the explanation of inconsistency was
clarified in writing on 30.03.2009.There fore complaint was allowed and the
insurer directed to pay Rs24,141.73 within one month of receipt of consent
letter.
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(6)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.14-012-0609
Sri Dinabandhu Nayak
Vrs
ICICI Lombard General Insurance Co. Ltd., Bhubaneswar
Award dated 12th
October, 2009
Complainant had insured his Tipper with ICICI Lombard General Insurance Co
Ltd and a claim was preferred for loss of the vehicle by forceful acquisition by
some miscreants on 18.012008,while vehicle was plying at Rajamunda bypass.
Both Insurance Company and the police were informed. The claim has not been
settled as yet.
Hon’ble Ombudsman heard the case on 14.09.2009 where insurer was
absent and has not submitted the self contained note either. After hearing
complainant and perusing the documents, which included the final police report
under section 392 of IPC, Hon’ble Ombudsman observed that the insurer is
liable to settle the claim. By the time the order was prepared the insurer settled
the claim and hence complaint disposed off accordingly.
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(7)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-003-0611
Ms Pragyan Parimita Dutt
Vrs
National Insurance Co. Ltd., Bhubaneswar DO-I
Award dated 04th
November, 2009
Complainant had insured his Tata truck with National Insurance Co Ltd and a
claim was preferred for an accident which the vehicle met on
02.11.2008.Complainant submitted estimate for Rs 8.59,160/- and bills of repair
for Rs 3.4 lacs. But insurer has settled the claim for Rs 1.698 lacs with the
financer ie Tata Finance.
Hon’ble Ombudsman heard the case on 28.10.2009 where both parties
were present. After hearing both parties and perusing the survey reports and
vehicle inispection report, Hon’ble Ombudsman observed that the assessment
has been properly done and nothing unjustified could be either found or
established by the complainant. Hence held that the complainant has got his due
entitlement and dismissed the complaint.
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(8)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-003-0625
Sri Rabindra Kumar Sahu
Vrs
National Insurance Co. Ltd., Bargarh Branch
Award dated 25th
November, 2009
Complainant had insured his Maruti car with National Insurance Co Ltd and a
claim was preferred for an accident which the vehicle met on
26.07.2007.Complainant claimed Rs 62,247/- but insurer has settled the claim
for Rs 26,210/-.
Hon’ble Ombudsman heard the case on 28.10.2009 where both parties
were present. After hearing both parties and perusing the survey reports and the
assessment sheet submitted by the complainant, Hon’ble Ombudsman observed
that the assessment has been properly done and nothing unjustified could be
either found or established by the complainant. As the vehicle was more than 3
years old, the deduction of salvage at 35% was as per the norm. Hence held that
the complainant has got his due entitlement and dismissed the complaint.
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(9)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.14-004-0614
Md Moiz Alam
Vrs
United India Insurance Co. Ltd., Barbil Branch
Award dated 11th
November, 2009
Complainant had insured his Scorpio vehicle with United India Insurance Co
Ltd. The vehicle met with an accident on 13.02.2007, within policy period. A
claim was lodged and the same was settled for Rs 3,09,000/- by insurer as
against claimed amount of Rs 7,01,020/-.
Hon’ble Ombudsman heard the case on 28.10.2009 where both parties
were present. After hearing both parties and perusing the documents Hon’ble
Ombudsman held that the assessment of loss was just and proper. Directed
insurer to settle the claim as per assessment and in the event the complainant is
not satisfied , insurer is free to take recourse as per Insurance Act.
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(10)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.12-009-0629
Sri Rudra Narayan Sahoo
Vrs
Reliance General Insurance Co. Ltd., Bhubaneswar Branch
Award dated 18th
December, 2009
Complainant had applied for insurance cover for a Tata Indica car as he was
planning to purchase one and accordingly paid the premium of Rs 12,987/-. A
cover note to the effect was issued by the insurer without any engine number or
chassis number. Subsequently a policy was also issued to him with details of
Engine and Chassis number of a car which he never purchased. He brought the
facts to the notice of the insurer and as per their requirement produced the
details of ownership of the vehicle as mentioned on the policy from the dealer.
Still the premium paid by him was not refunded.
Hon’ble Ombudsman heard the case on 24.11.2009 where complainant
was present alone. After hearing complainant and perusing the documents
Hon’ble Ombudsman directed the insurer to pay Rs 12,987/- with 18% interest
from the date of intimation till date of payment to the complainant.
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(11)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.14-014-0632
Sri Nirmala Mallick
Vrs
Cholamandalam MS General Insurance Co. Ltd., Bhubaneswar Branch
Award dated 01st January’, 2010
Complainant had insured his vehicle with Cholamandalam General Insurance
Company Ltd and an accident took place within the policy period. A claim for
Rs 1,05,000/- was preferred by complainant. Insurer settled the claim for Rs
1431/- only.
Hon’ble Ombudsman heard the case on 24.11.2009 where complainant
was present alone. Insurer was absent. After hearing complainant and perusing
the documents Hon’ble Ombudsman observed that, in spite of, prior written
communication, insurer neither submitted the self contained note, nor attend the
hearing and hence directed insurer to pay the amount claimed by complainant,
as per bills and cash memos produced during hearing.
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(12)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-003-0634
Sri Pradeep Kumar Sahoo
Vrs
National Insurance Co. Ltd., Link Road Branch,Cuttack
Award dated 30th
December, 2009
Complainant had insured his vehicle with National Insurance Co Ltd and a
claim was preferred for an accident which the vehicle met on
21.02.2008.Complainant lodged a claim. Insurance company repudiated the
claim on the ground that the driver did not possess valid Driving Licence.
Hon’ble Ombudsman heard the case on 24.11.2009 where complainant
was absent. After hearing insurance company and perusing the documents
including the Driving Licence verification report, Hon’ble Ombudsman
observed that the driver was not having a valid Driving Licence to drive a
Transport vehicle. Hence up held the repudiation decision of insurer and
dismissed the complaint
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(13)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-003-0638
Sri Ajit Kumar Das
Vrs
National Insurance Co. Ltd., Rourkella DO
Award dated 04th
January, 2010
Complainant had insured his vehicle with National Insurance Co Ltd and a
claim was preferred for an accident which the vehicle met on
10.01.2009.Complainant preferred a claim which was repudiated for the reason
that the vehicle was not having fitness certificate to ply on road.
Hon’ble Ombudsman heard the case on 04.01.2010 where both parties
were present. After hearing both parties and perusing the documents of the
vehicle including the fitness certificate, Hon’ble Ombudsman observed that the
vehicle was not having fitness certificate to ply on the road long before the
accident date. Since it was a commercial vehicle, held that the repudiation
decision of insurer is just and proper and dismissed the complaint.
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(14)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-005-0636
Sri Bijay Kumar Yadav
Vrs
Oriental Insurance Co. Ltd., CBO ,Bhubaneswar
Award dated 31st December, 2009
Complainant had insured his vehicle with Oriental Insurance Co. Ltd. which
met with an accident on 10.07.2007 within the policy period. The complainant
claimed Rs 264211/-,where as insurer settled it for only Rs 40,000/-.
Hon’ble Ombudsman heard the case on 24.11.2009 in presence of both parties.
After hearing both sides and perusing the documents produced including the
bills and cashmemos ,Hon’ble Ombudsman held that the bills produced by
complainant are not genuine. Therefore, relying on the assessment of a senior
surveyor for replacement of a second hand cabin assembly, directed insurer to
pay Rs 1,43,000/- .If Rs 40,000/- has already been paid the said amount to be
deducted from Rs 1,43,000/-
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(15)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-009-0639
Sri Sudhansu Kumar Swain
Vrs
Reliance General Insurance Co. Ltd., Bhubaneswar Branch
Award dated 7th
January, 2010
Complainant had insured his tipper with the above insurance company. The
vehicle met with an accident causing damage to its hydraulic jack. A claim was
reported. Insured did not pay the claim on the ground that the damage was not
due to accident.
Hon’ble Ombudsman heard the case on 22.12.2009 where complainant
was present alone. Neither self contained note was filed nor any one appeared
on behalf of the insurer during hearing. After hearing complainant and perusing
the documents available on record, Hon’ble Ombudsman set aside the “no
claim” decision of insurer and directed the insurer to pay the claim on the basis
of bills and cash memos produced by complainant.
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(16)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.14-011-0650
Smt Smruti Sikha Das
Vrs
Bajaj Allianz General Insurance Co. Ltd., Balasore
Award dated 21st January, 2010
Complainant had insured her truck with Bajaj Allianz General Insurance Co
Ltd and a claim was preferred for an accident which the vehicle met on
21.07.2008.Insurance Company repudiated the claim on the ground that the
documents called for was not submitted by complainant.
Hon’ble Ombudsman heard the case on 21.01.2010 in presence of both
the parties. After hearing insurer and perusing the documents Hon’ble
Ombudsman observed that the complainant was not able to submit documents
for lack of communication .Therefore complaint was allowed and the insurer
directed to pay the claim on the basis of the documents submitted during
hearing.
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(17)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-011-0641
Sri Pradipta Kumar Mishra
Vrs
Bajaj Allianz General Insurance Co. Ltd., Bhubaneswar
Award dated 12th
January, 2010
Complainant had insured his truck with Bajaj Allianz General Insurance Co Ltd
and a claim was preferred for an accident which the vehicle met on 14.06.2009.
A claim for Rs 1,96,885/- was lodged but insurer settled it for Rs 86,500/- only.
Hon’ble Ombudsman heard the case on 22.12.2009 in presence of both
the parties. After hearing insurer and perusing the documents Hon’ble
Ombudsman observed that the surveyor had assessed the loss for Rs 91,915/-
and after deduction of depreciation the net amount worked out to be Rs 86,500/-
. The assessment of the surveyor was found to be justified and directed insurer
to settle the claim for Rs 86,500/- as decided by them.
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(18)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-003-0645
Sri Basant Kumar Suar
Vrs
National Insurance Co. Ltd., Bhubaneswar DO-I
Award dated 08th
February, 2010
Complainant had insured his truck with National Insurance Co Ltd and a claim
was preferred for an accident which the vehicle met on 13.04.2009.Complainant
preferred a claim which was repudiated for the reason that the driver at material
time was not having valid Driving License.
Hon’ble Ombudsman heard the case on 19.01.2010 where both parties
were present. After hearing both parties and perusing the documents of the
vehicle including the Driving License and the report of Bokaro RTO on the
Driving License, Hon’ble Ombudsman observed that the driver of the truck was
not possessing valid Driving License and up held the repudiation decision of
insurer. Complaint was accordingly dismissed.
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(19)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-012-0649
Sri Saroj Kumar Behera
Vrs
ICICI Lombard General Insurance Co. Ltd., Angul Branch
Award dated 11th
February, 2010
Complainant had insured his Truck with ICICI Lombard General Insurance Co
Ltd and a claim was preferred for an accident which the vehicle met with on
30.01.2008., very much within policy period. Complainant lodged the claim for
Rs 67,000/-, where as insurer settled the claim for Rs 11,900/-.
Hon’ble Ombudsman heard the case on 19.01.2010 where both sides
were present.
The complainant stressed on the repair bills submitted by him. Insurer relied on
the discharge voucher submitted by complainant, where he agreed for Rs
11,900/- as full and final settlement. After hearing both sides and perusing
documents on record, including the explanation of surveyor on his report,
Ombudsman held that the assessment of surveyor is just and proper. Hence
dismissed the complaint.
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(20)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-002-0653
Sri Subash Chandra Pal
Vrs
New India Assurance Co. Ltd., Balasore DO
Award dated 24 th March, 2010
Complainant had insured his vehicle with new India Assurance Co. Ltd. from
10.12.2008 to 09.12.2009 which met with an accident on 09.08.2009 . The
Insurer settled the claim for Rs 31,000/- as against a claim of Rs 2,04,833/-
Hon’ble Ombudsman heard the case on 19.01.2010, where insured was present
but the insurer did not attend. The forum in absence of insurer and proper
explanation regarding the lower assessment of surveyor was not in a position to
quantify the loss. Hence Insurer was directed to discuss with complainant and
the surveyor regarding the assessment and settle the claim accordingly. If the
complainant is still not satisfied he is at liberty to approach this forum afresh
with all developments.
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(21)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-002-0654
Sri Somnath Sethy
Vrs
New India Assurance Co. Ltd., Bhubaneswar DO I
Award dated 26th
March, 2010
Complainant had insured his vehicle with new India Assurance Co. Ltd. from
25.02.2008 to 24.02.2009, which was stolen on 16.05.2008.A claim was lodged
with insurer. The Insurer repudiated the claim on the ground of in consistency in
the statements of driver/ owner on the incident.
Hon’ble Ombudsman heard the case on 25.02.2010, where complainant was
present but the insurer did not attend. The insurer submitted the self contained
note supported by a decision of National Consumer Dispute Redressal
Commission, pronounced on 09.12.2009, almost in an identical case. Hon’ble
Ombudsman observed that the complainant has reported the loss to insurance
company after 12 days, which is a violation to policy condition, as observed by
NCDRC in a similar case and hence up held the repudiation decision of insurer.
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(22)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-002-0655
Smt Naliniprabha Biswal
Vrs
New India Assurance Co. Ltd., Mangalabag Branch
Award dated 29th
March, 2010
Complainant had insured his vehicle with new India Assurance Co. Ltd. from
25.02.2008 to 24.02.2009, which met with an accident on 12.04.2009.A claim
was lodged with insurer. The Insurer repudiated the claim on the ground that the
driver of the vehicle at the material time did not possess a valid Driving
License.
Hon’ble Ombudsman heard the case on 25.02.2010, where both sides were
present. The insurer submitted that the Driving license was not renewed from
13.03.2009 to 29.04.2009.As per MV Act a grace period of 30 days is allowed
from the date of expiry, but beyond which the driver is supposed to be not
possessing a valid DL. Accordingly in the present instant the driver was not
having a valid DL on date of accident and hence the repudiation decision is up
held. *************
(23)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-005-0656
Sri Biswa Ranjan Mohapatra
Vrs
Oriental Insurance Co. Ltd., Kendrapada Extn Counter
Award dated 29th
March 2010
Complainant had insured his vehicle with Oriental Insurance Co. Ltd., which
was stolen on 28/29.11.2007 night. Both police and Insurance Company were
informed. Subsequently the police traced and handed over the vehicle to
complainant on Zimma. The complainant reported missing of several important
parts of the vehicle and claimed Rs 1,50,000/- on that behalf. The Insurer
repudiated the claim on the ground that the surveyor assessing the loss observed
the parts were removed fresh from the vehicle and there were all the reasons the
complainant has removed such parts for claim purpose.
Hon’ble Ombudsman heard the case on 25.02.2010 where both sides were
present. After going through the police papers including the Zimmanama and
the surveyor’s report held that no where the police investigation report revealed
the missing of important vehicle parts. Zimanama is also silent on the issue.
Moreover, the complainant while taking vehicle to possession from the police,
neither reported to the insurer nor gave an opportunity for a survey of the
vehicle. Taking all aspects into consideration, the complaint was dismissed.
*************
(24)
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-011-0657
Smt Snigdha Das
Vrs
Bajaj Allianz General Insurance Co. Ltd., Bhubaneswar
Award dated 12th
January, 2010
Complainant had insured his truck with Bajaj Allianz General Insurance Co Ltd
and a claim was preferred for an accident which the vehicle met on 10.02.2009.
A claim was lodged , which the insurer repudiated on the ground that the driver
did not possess a valid Driving Lisence.
Hon’ble Ombudsman heard the case on 25.02.2010 in presence of
complainant but insurer did not attend. After hearing complainant and going
through documents submitted by both parties held that the Driver did not have
valid DL and hence dismissed the complaint.
*************
CHANDIGARH
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/347/NIA/14/10
Desh Raj Saini Vs. New India Assurance Co. Ltd.
ORDER DATED: 01st October, 2009 MOTOR
FACTS: Shri Desh Raj Saini had been having a Motor Insurance Policy vide covernote No.
282574 issued by The New India Assurance Co Ltd. covering his Tata Indica car No. HR-04-B-
8791 for the period 13.05.2009 to 12.05.2010 for sum insured of Rs. 2,10,000/-. The said
car was stolen on 17.05.09. All the claim documents were submitted but till date his claim
was not settled. Parties were called for hearing on 01.10.09 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that there was a doubt about the
use of the vehicle as it was being used for hire and reward. This is given in the statement
made by the complainant to the investigator.
DECISION: Held that there is no irrefutable proof to show that the vehicle was used for
hire and reward except as stated by the complainant to carry his labourers as he was a
contractor. Moreover, the theft has taken place when the vehicle was parked in Panchkula.
The basic point is that there was a theft and there was valid insurance on the date of theft.
Hence Giving the benefit of doubt to the complainant, and taking a fair and just view, the
claim is payable. However to give weightage to the statement of the insurer, settlement of
the claim on non-standard basis to the extent of 75% of IDV less excess clause would, in my
opinion, meet the ends of justice. It is hereby ordered that 75% of IDV less excess clause
should be paid by the insurer to the complainant within 20 days of submission of
untraceable report from the police, signing of Form 29, letter of subrogation and ignition
key etc.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/363/NIC/14/10
Parvinder Pal Singh Vs National Insurance Co. Ltd.
ORDER DATED: 09th October, 2009 MOTOR
FACTS: Sh. Parvinder Pal Singh had taken a motor insurance policy No. 420400/31/07/6300001934
for the period 08.08.2007 to 07.08.2008 covering tata Truck No. HR 58 A – 2634 for IDV Rs.
5,00,000/-. It is stated by the insured that vehicle was stolen on 22.05.2008. The theft was intimated
to police on 23.05.2008 and to insurer on 26.05.2008. As per the insured, he has submitted
untraceable report and other formalities to the insurer. However, he has not been informed
anything from the company. Parties were called for hearing on 09.10.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the vehicle was given to workshop
for repairs. As per investigator report, it was unlocked and unattended. Since the vehicle was given
to workshop, it is a contractual liability between the complainant and the workshop. He should ask
compensation from the workshop.
DECISION: Held that the contention of the insurer that it is a contractual liability between the
complainant and the workshop is not justified. The owner of the workshop has not run away with
the vehicle. The vehicle has been stolen by a third party. As far as leaving the vehicle unlocked is
concerned, there is no proof or witness to substantiate this statement as no one was present at the
time of theft. Hence, giving the benefit of doubt to the complainant, the claim is payable. However,
to give weightage to the view of the insurer that there was negligence on the part of the
complainant, the settlement of claim on non-standard basis to the extent of 75% of the insured
amount would meet the ends of justice. It is hereby ordered that 75% of IDV amount less excess
clause should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/361/OIC/11/10
Jasvir Singh Vs Oriental Insurance Co. Ltd.
ORDER DATED: 09th October, 2009 MOTOR
FACTS: Sh. Jasvir Singh had taken a motor insurance policy vide cover note No. CHD-C529024 for the
period 26.10.2008 to 25.10.2009 for Vehicle No. PB 12L – 1943 for sum insured of Rs. 32500/-. The
said vehicle was stolen on 05.06.2009 for which an FIR was lodged. The vehicle was found after 3-4
days in totally damaged condition. When the estimate for repairs was taken, M/s Pankaj Motors
estimated it as beyond repairs and termed it as total loss. When the claim was preferred to the
insurer, only Rs. 20300/- was settled instead of the total sum insured of Rs. 32500/-. Parties were
called for hearing on 09.10.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the estimate was for Rs. 23,000/-
which is less than 75% of the IDV. The vehicle was recovered in a burnt position and is repairable.
Moreover, the vehicle has been released under Superdari with the condition that it cannot be sold
and the colour of the vehicle cannot be changed. In view of the above circumstances, the only
alternative is to get the vehicle repaired from authorised workshop. However the complainant was
insisting for making the vehicle as total loss and was not giving consent to get the vehicle repaired.
DECISION: Held that the contention of the complainant that the vehicle should be made as
total loss is not justified not only on account of the estimate for repairs being less than 75% of IDV
but also due to the fact that he has given an undertaking to the court of Roop Nagar Magistrate that
the vehicle will not be disposed off or its colour changed. The making of the vehicle as total loss
would result in transfer of ownership of the vehicle from the complainant to the insurer which is not
possible in view of the Court’s order. Taking all the above into consideration, the vehicle should be
got repaired from authorized workshop and the complainant should cooperate and give his consent
for the repair accordingly.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/359/OIC/14/10
Harjit Singh Vs Oriental Insurance Co. Ltd.
ORDER DATED: 09th October, 2009 MOTOR
FACTS: Sh. Harjit Singh had taken a motor insurance policy vide cover note No. CHD-C328780 for
Vehicle No. PB 10 CG – 5768 for the period 13.02.2008 to 12.02.2009. The vehicle met with an
accident on 26.04.2008. The said vehicle was totally damaged and an estimate of Rs. 492000/-
approx. was submitted by the dealer. He also lost his son in the accident. In spite of submitting all
the documents in time he has not received any claim nor any reply. Parties were called for hearing
on 09.10.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that that the vehicle was purchased in
Feb. 2008. The accident took place in April 2008. Only temporary RC was available at the time of
accident which was valid only for 30 days. Regular RC was not available on the date of accident. RC
was made in May 2008. Hence the claim was made as no claim, since valid RC was not available on
the date of accident.
DECISION: Held that non-availability of RC alone should not stand in the way of settling the
claim in favour of the complainant. The RC is basically a document to show the ownership of the
vehicle. As far as insurance cover is concerned the ownership is established as soon as the insurance
policy is issued. Since there was a valid insurance policy on the date of accident, the claim in my view
is payable. The last documentary requirement was submitted in Jan. 2009. Giving sufficient time for
the insurer to settle the claim, the interest @8% per annum should also be paid by the insurer to the
complainant w.e.f. 01.03.2009 till the date of payment. Payment of IDV less excess clause alongwith
interest should be made by the insurer to the complainant subject to completion of usual
documentary formalities like transfer of RC, signature on the Form 29 and discharge voucher etc.
Towing charges as per rules should also be paid.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/358/NIC/11/10
Ashim Ali Vs National Insurance Co. Ltd.
ORDER DATED: 14th October, 2009 MOTOR
FACTS: Sh. Ashim Ali had taken a vehicle policy No. 0311580 covering his Hero Honda Passion
Motorcycle No. HR 51 AB – 9301 for the period 09.06.08 to 08.06.09 for IDV Rs. 39805/-. His vehicle
was stolen on 14.11.2008 for which FIR was written on 01.12.2008. He intimated the loss to insurer
also. However, the insurer rejected the claim. Parties were called for hearing on 07.10.2009 at New
Delhi.
FINDINGS: The insurer clarified the position by stating that the theft took place on 14.11.2008.
FIR was lodged with the police on 01.12.2008 after 17 days. The intimation to the insurer was given
after 24 days. Hence the claim was repudiated under policy condition 1 of terms and conditions of
the policy. The insurer was asked to show the terms and conditions of the policy. He showed the
terms and conditions of the policy. The condition No. 1 states that in case of theft, the police should
be informed immediately. The insured was asked as to when he had informed the police, he stated
that it was done on the same day but the police took time to lodge the FIR. On a query, whether
written communication was made, the complainant replied that it was done orally for a few days
regularly.
DECISION: Held that the contention of the insurer that the there was delay in reporting to the
insurer and the police is justified. However, since it is a theft case, information to the police takes
priority. As stated by the complainant that he had approached the police soon after the theft but the
same was not recorded in DDR. Giving the benefit of doubt to the complainant, the claim is payable.
However, the complainant should be penalized for not informing the police in writing. Therefore,
settlement of the claim to the extent of 65% of IDV less excess clause would meets the ends of
justice. It is hereby ordered that 65% of IDV less excess clause should be paid by the insurer to the
complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/395/OIC/11/10
Saroj Bala Vs Oriental Insurance Co. Ltd.
ORDER DATED: 30th October, 2009 MOTOR
FACTS: Smt. Saroj Bala had taken a motor insurance policy No. 235401/31/2009/3242 on
19.09.2008. Her vehicle PB 08 –AY 6551 (Innova) met with an accident 24.06.2009. She got her car
repaired in which she incurred an expenses of Rs. 124197/-. All the documents were sent to the
surveyor who was appointed. But till date she has not received her claim amount. Parties were
called for hearing on 21.10.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the vehicle was insured with them
w.e.f. 19.09.2008. Before that the vehicle was insured with National Insurance Co. Ltd. The
complainant had claimed NCB of 20% whereas as National Insurance Co. Ltd. had stated that the
complainant was not entitled to NCB because there was a claim during the time the vehicle was
insured with them. On a query, whether clarifications regarding NCB were sought from the previous
insurer within 30 days of commencement of the present policy and whether the complainant had
signed a declaration that she would forfeit all claims in case NCB was wrongly claimed, the insurer
replied in the affirmative. The insurer furnished a letter dt. 26.09.08 written to the National
Insurance Co. Ltd. asking for confirmation of NCB.
DECISION: Held that the insurer had completed all documentary formalities for confirmation of
NCB. Since there is a declaration by the complainant that she would forfeit all the claim, if there was
wrong information about NCB, the claim is not payable. The repudiation of the claim is, therefore, in
order. No further action is called for. The complaint is dismissed.
CHANDIGARH OMBUDSMAN CENTRE CASE NO. GIC/410/OIC/14/10
Prem Pushpa Vs. Oriental Insurance Co. Ltd.
ORDER DATED: 30th October, 2009 MOTOR
FACTS: This complaint was received from Smt. Prem Pushpa on 02.09.2009. Brief facts of the case
are that her husband late Sh. Om Parkash Sharma had insured his truck trolla No. RJ 31 G – 5425 vide
Cover Note No. 316397 for the period 21.11.2008 to 20.11.2009 for sum insured of Rs. 575000/-.
The said vehicle alongwith the loaded goods was hijacked by dacoits in Maharashtra on 26.01.09,
while it was on its way to Mumbai, killing the driver and the cleaner. An FIR was lodged at
Gameshpuri (Maharashtra). The insurer was informed about the loss of trolla, life/ lives and had
completed all the formalities. In spite of several follow-ups the company had not settled the claim.
She stated that her husband expired on 01.07.2009 as he was suffering from cancer. She had also
submitted the untraceable report issued by Police Station, Ganeshpuri. She further stated that she is
80 years old and had lost her son and husband and has no male member to pursue the case. Hence
she requested this forum in getting the claim settled with 18% interest. Parties were called for
hearing on 30.10.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that since it was a commercial vehicle,
acceptance of the court of the untraceable report was required. Hence the claim could not be
settled.
DECISION: Held that delay has occurred because of non-available of the untraceable report till
July 2009 and thereafter because of its lack of acceptance by the court.. The acceptance of the
untraceable report by the court is not a must for settling the claim as per terms and conditions of
the policy. The claim should be settled without waiting for any further documents. It is hereby
ordered that the admissible amount of claim should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/480/IFFCO TOKIO/11/10
Subodh Jindal Vs IFFCO Tokio General Ins Co.
ORDER DATED: 03rd November, 2009 MOTOR
FACTS: This complaint has been received from Sh. Subodh Jindal on 25.09.09. It has been
stated by the complainant that he had been having a Motor Policy bearing no. 38412695
issued by Iffco Tokio General Insurance Co. Ltd covering his Toyota Innova car bearing no.
HR-38-N-3936 for the period 08.03.07 to 07.03.08 for sum insured of Rs. 9,87,782/-. On the
night of 26.02.09, he went to attend a marriage ceremony held at a Banquet at Mangolpuri,
New Delhi. The driver parked the car at parking place. The driver returned to the parking
place after having a meal within 20-30 minutes. The driver was standing with the car and
the car was open. He came forward to receive him. Suddenly an unknown person came
there and started the car and went away. The driver tried to chase him but he could not
catch him. The matter was immediately reported to police. The case was registered vide
FIR no. 61 dated 27.02.09. The claim was reported to insurance company. They repudiated
the claim on the ground of violation of Condition no. 5 that they had not taken the
reasonable step to the security of the vehicle. Parties were called for hearing on 03.11.09 at
New Delhi.
FINDINGS: The insurer clarified the position by stating that the theft took place when
the vehicle was parked in the open parking. The door of the vehicle was open and the
ignition key was in the vehicle. This was a case of negligence and an open invitation to the
thief to steal the vehicle. Hence the claim was repudiated under condition 5 of not taking
due care by the insurer.
DECISION: Held that the contention of the insurer that the vehicle was not properly
guarded and left unattended is justified. The repudiation of the claim is, therefore, in order.
No further action is called for. The complaint is dismissed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/494/ICICI/11/10
Sanjay Vs. ICICI Lombard
ORDER DATED: 03rd November, 2009 MOTOR
FACTS: Shri. Sanjay had been having a Motor Insurance Policy bearing no. 3003/53872075/00/000
issued by ICICI Lombard General Insurance Co. Ltd. covering his Tata Trailer bearing no. HR-63-A-
1544 for the period 06.04.08 to 05.04.09 for sum insured of Rs. 13,00,000/-. The said vehicle met
with an accident on 30.01.09. The claim was lodged with the insurance company. The insurance
company agreed to settle the claim for Rs. 7,00,000/- but later on they repudiated the claim. After
some time he received a telephone call from the insurance company that they are ready to pay 50%
of the claim which he refused. Parties were called for hearing on 03.11.09 at New Delhi.
FINDINGS: The insurer clarified the position by stating that as per hospital records of Govt.
Hospital, Sirohi the driver was smelling of Alcohol. Since he was under the influence of alcohol, the
claim was made as no claim. On a query, as to what was the gross estimate / invoice, the insurer
stated that it was of Rs. 12.00 lakh.
DECISION: Held that on going through the terms and conditions of the policy and hospital
records of Govt. Hospital, Sirohi, It was found that the judicial authority of the hospital clearly stated
that the driver had consumed alcohol but was not under the influence of alcohol. Giving the benefit
of doubt to the complainant, the claim, in my view, is payable. The claim should be settled on net of
salvage basis with IDV of Rs. 13.00 lakh and salvage of Rs. 1.00 lakh. However, to give weightage to
the contention of the insurer that the driver had consumed alcohol, payment of claim on non-
standard basis to the extent of 75% would meets the ends of justice. Net of salvage being Rs. 12.00
lakh, therefore Rs. 9.00 lakh less excess clause is payable. It is hereby ordered that Rs. 9.00 lakh less
excess clause should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/444/Reliance/14/10
Sant Ram Vs Reliance Gen. Insurance Co. Ltd.
ORDER DATED: 03rd November, 2009 MOTOR
FACTS: Shri Sant Ram had been having a Motor Insurance Policy bearing no. 2005782334003674
issued by Reliance Gen. Ins. Co. Ltd. covering his Tata Truck no. HR-69-8895 for the period
22.12.2008 to 21.12.2009. The said truck met with an accident on 06.05.09. The claim was lodged
with the insurance company. All the claim formalities were completed but till date his claim was not
settled. Parties were called for hearing on 03.11.09 New Delhi.
FINDINGS: The insurer clarified the position by stating that the driver at the time of accident
was Sh. Chaman Lal alias Sonu whereas the driving licence of Sh. Mahavir has been furnished. If the
driving licence of Chaman Lal is furnished, the claim would be settled on merits. The complainant
was asked to clarify whether driving licence of Sh. Chaman Lal was available. He showed a driving
licence made in Nagaland but on which the address given is of Sonipat.
DECISION: After hearing the complainant in the presence of the insurer and scrutinizing the
driving licence in detail, I find that while the driving licence has been issued by Govt. of Nagaland
there appears to be lacuna as the address of the driver is not of Nagaland. The two should normally
match. It was not possible for Chaman Lal to get himself tested without residing there. Moreover,
the name of the driving test authority has not been mentioned. I am not satisfied with the bonafides
of the driving licence. The repudiation of the claim on the basis of non-effective and non-valid
driving licence is, therefore, in order. No further action is called for. The complaint is dismissed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/401/Roysun/11/10
Vinay Pandey Vs. Royal Sundram
ORDER DATED: 04th November, 2009 MOTOR
FACTS: Shri Vinay Pandey had been having a Motor Insurance Policy bearing no.
VPC0061920000100 issued by Royal Sundaram Alliance Insurance Company Ltd. covering his
Mahindra Bolero for the period 26.09.2008 to 25.09.2009 for sum insured of Rs. 5,55,275/-.
The said vehicle was stolen on 08.03.2009. All the claim formalities were completed but the
insurance company repudiated the claim on baseless grounds. Parties were called for hearing on
04.11.09 at New Delhi.
FINDINGS: The complainant stated that the claim has been repudiated on account of non-
availability of the second key and delay in reporting to insurer by 4 days.
DECISION: Held that on going through the repudiation letter, it was found that claim has been
repudiated on flimsy grounds. Mere loss of one key should not stand in the way of settlement of the
claim. As far as delay is concerned, the complainant informed the police on the day of theft. Delay in
intimating insurer by 4 days is not a major delay. The fact is that there was a theft and there was a
valid insurance cover on the date of theft. The repudiation of the claim is not in order. The claim is
payable. However, the complainant should be penalized for submitting only one key to the extent of
25% of IDV. The settlement of claim on 75% of IDV less excess clause would meet the ends of justice.
It is hereby ordered that 75% of IDV less excess clause should be paid by the insurer to the
complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/427/OIC/13/10
Rajneesh Gupta Vs Oriental Insurance Co. Ltd.
ORDER DATED: 06th November, 2010 MOTOR
FACTS: Sh. Rajneesh Gupta stated that the agent of the Oriental Insurance Co. Ltd. had approached
him for insurance of his vehicle (Tata Safari) car bearing No. CH 04 E – 7502, model 2008. After
completing the formalities, a cover note was handed over to him and Rs. 12000/- for insurance of his
vehicle was demanded without prescribing the terms and conditions of the contract and without
enquiry about the value of the vehicle. When he received the cover note he was shocked to see that
IDV was fixed at Rs. 5.00 lakhs and no electrical accessories were covered. He stated that the value
of the vehicle when purchased on 31.05.2008 was Rs. 740518/-. He was misguided by the agent and
the IDV should have been more than Rs. 6.00 lakhs as per the rules and regulations of the company.
He had written to the company on 26.07.2009 for which he received the reply on 11.08.09 and is not
acceptable to him. Hence he requested this forum in getting the IDV fixed to an amount which is
more than Rs. 6.00 lakhs. Parties were called for hearing on 06.11.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the cover note was given as per the
proposal form filled up by the complainant. He had applied for an IDV of Rs. 5.00 lakh and the
premium was charged accordingly. On a query, whether the IDV was correlated with previous
insurer viz. New India Assurance Co. Ltd. where the sum insured was
Rs. 7.40 lakh, the insurer replied in the negative.
DECISION: Held that there was a definite case of under insurance of vehicle which is in
contravention of fixed norms of fixing the IDV. The insurer has erred in not scrutinizing the previous
policy while arriving at the new IDV. Taking the above into consideration, the actual IDV should have
been Rs. 7.40 lakh minus 20% which works out to Rs. 5.92 lakhs. It is hereby ordered that an IDV of
Rs. 5.92 less excess clause should be paid by the insurer to the complainant after deducting the
difference of premium for higher IDV.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/453/NIC/11/10
Ashwani Kumar Vs National Insurance Co. Ltd.
ORDER DATED: 06TH November, 2009 MOTOR
FACTS: Sh. Ashwani Kumar stated that the vehicle No. HP 07 – 5162 was registered in the name of
his father Sh. Prabhu Dayal and was insured vide policy No. 421101/31/08/6300000998. Later the
vehicle was transferred in his name. Subsequently the RC of the vehicle was also transferred in his
name and a fresh insurance policy was taken. While transferring the vehicle in his name, they had
approached the concerned authority for change the name in the route permit. They confirmed that
since Sh. Prabhu Dayal is the father of the present RC holder, there was no violation of traffic rules
and the same can be amended at the time of renewal. The said vehicle met with an accident. All the
claim documents were submitted, however, the claim was rejected on the ground of non-transfer of
route permit in the name of new owner. He stated that route permit is for plying the vehicle in a
particular area/ locality which was not violated at any stage. Hence he requested for settlement of
the case. Parties were called for hearing on 06.11.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the insurance cover was in the name
of Sh. Ashwani Kumar S/o Sh. Prabhu Dayal whereas the road permit in the name of Sh. Prabhu
Dayal, the father of the owner of the vehicle as per insurance policy.
DECISION: Held that the vehicle permit is in the name of Sh. Prabhu Dayal which was issued in
July 2006 and valid upto Nov. 2010 which was not transferred in the name of his son Sh. Ashwani
Kumar when the vehicle was transferred in the name of his son. Mere Non-transfer of road permit in
the name of the insurance policy holder who is the son of the route permit holder is not a major
lapse as far as accident claim is concerned. However, to give weightage to the contention of the
insurer that both the documents should have been got transferred simultaneously in the name of Sh.
Ashwani Kumar, the settlement of claim on non-standard basis to the extent of 75% of admissible
amount of claim would meet the ends of justice. It is hereby ordered that 75% of admissible amount
of claim should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE No. GIC/455/OIC/11/10
Baljeet Singh Vs Oriental Insurance Co. Ltd.
ORDER DATED: 06TH November, 2009 MOTOR
FACTS: Sh. Baljeet Singh had taken a motor insurance policy vide cover note No. CHD-C356793 on
22.03.08 for his Indica car No. CH 03 Z – 6670. He stated that his nephew Sh. Manjinder Singh had
taken his car to visit his grand parents at Rajpura on 23.08.08. On his way, he had given a lift to a
gentleman who intoxicated him and stole his car. An FIR was lodged and the claim was preferred to
the insurer. After submitting all the documents, the claim was repudiated on 25.08.09 on the
grounds that there was violation of conditions no. 4 of the policy. Parties were called for hearing on
06.11.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that as per Clause 4 of terms and
conditions of the policy, the insured is supposed to take reasonable care of the vehicle. In this case,
the person who was driving the vehicle was negligent in getting out of the vehicle in an intoxicated
condition and allowing the culprit to drive away with the vehicle. Hence the claim was repudiated
under clause 4 of terms and conditions of the policy.
DECISION: Held that the contention of the insurer that there was negligence on the part of the
driver of the vehicle in giving a lift to an individual is not wholly substantiated as he was doing a
good turn to a human being. While doing the good turn if somebody had played mischief on him and
got him intoxicated, it should be a part of an unfortunate incident rather than a wilful negligence.
Giving the benefit of doubt to the complainant and taking a fair and just view, the claim, in my view,
is payable. However, to give weightage to the contention of the insurer that there was negligence in
giving open invitation to an unknown person to drive the vehicle, the complainant should be
penalized to extent of 25% of the IDV. Therefore, settling the claim on 75% of IDV would meet the
ends of justice. The insurer should make payment of 75% of IDV less excess clause to the
complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/475/UII/11/10
Darshana Devi Vs United India Insurance Co. Ltd.
ORDER DATED: 06th November, 2009 MOTOR
FACTS: Smt. Darshana Devi’s husband Late Shri Khariti Lal had insured his vehicle, Eicher Canter
bearing No. HR-57-2530 under Policy No. 3107012521 for the period 2.3.2008 to 01/03/2009. The
vehicle met with an accident on 03.09.2008 and the owner/policyholder expired due to accident.
The front cabin of the vehicle was highly damaged. An FIR was lodged and claim preferred to the
insurer. After completing all the formalities the company settled Rs. 1,50,000/- out of Rs. 2,00,000/-
on 19/03/2009 towards Personal Accident claim and Rs. 44,250/- out of Rs. 1,25,000/- on 26.08.2009
towards loss of vehicle. She had sought clarification but the company did not give any reasons for
deduction in both the claims. Parties were called for hearing on 06.11.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that it was a commercial vehicle and it
was not road-worthy on the date of accident. Hence the claim was made as non-standard and
settled at 75% of the amount payable. As far as the deduction of bill for Cabin Assy. is concerned, the
bill was verified by the investigator and he found some discrepancies in the bill. Hence the same was
deducted from the payable amount.
DECISION: Held that the contention of the insurer that claim should be paid on non-standard
basis because the vehicle was not road-worthy is justified. Their contention of deduction of Cabin
Assy. on account of bonafides of the bills not having being established is also justified. The action
taken by the insurer is, therefore, in order. As far as the personal accident claim is concerned,
making the claim on non-standard basis, in my view, is not correct as the life assured was insured for
Rs. 2.00 lakh and this amount should not be reduced. Therefore, the personal accident claim should
be settled at Rs. 2.00 lakh. Since Rs. 1.50 lakhs has already been paid, an additional amount of Rs.
50000/- should be paid by the insurer to the complainant in respect of shortfall of personal accident
claim.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/471/UII/11/10
Banwari Lal Vs United India Insurance Co. Ltd.
ORDER DATED: 06TH November, 2009 MOTOR
FACTS: Sh. Banwari Lal had insured his vehicle bearing No. PB-10-BP-3641 for sum insured of Rs.
4,75,000/- vide Pol. No. 110204/31/08/01/0000198 for the period 25.04.08 to 24.04.09. The said
vehicle was stolen on 03.10.2008. The claim was lodged immediately and all the formalities were
completed. After 8 months he was told that an amount of Rs. 4,47,000/- was approved. At the time
of insurance he was told that full sum insured would be payable if there is a total loss or theft and
now the company is paying less claim amount after charging the premium for the whole year.
Parties were called for hearing on 06.11.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the IDV fixed by the previous insurer
viz. Oriental insurance co. Ltd. was wrongly done and was not fixed as per the invoice for the
purchase of the vehicle. The IDV has been recalculated based on the original invoice and legal
amount due to the insured as per re-fixed IDV viz. Rs. 4.47 lakhs has been paid to the complainant.
DECISION: Held that the contention of the insurer that the IDV was wrongly fixed earlier
appears justified. The action taken by the insurer to pay an amount of Rs. 4.47 lakhs is what is legally
due to the complainant. Hence no further amount is payable as far as loss of vehicle is concerned.
No further action is called for. The complaint is dismissed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/398/UII/14/10
Santosh Gandhi Vs. United India Insurance Co. Ltd.
ORDER DATED: 09th November, 2009 MOTOR
FACTS: Smt. Santosh Gandhi had insured her Bolero jeep No. HR 03 J – 0208 vide policy No.
112100/31/07/01/00003991 for the period 29.08.2007 to 28.08.2008 for sum insured of Rs.
552000/-. The said vehicle was stolen for which an FIR was lodged on 20.08.2008. The untraceable
report was issued by the police on 21.02.09. In spite of submitting all the requirements and
reminding them regularly, the company has failed to settle the claim. Parties were called for hearing
on 30.10.2009 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the untraceable report was awaited.
As soon as the untraceable report was received, the claim will be settled on merits. The contention
of the insurer that untraceable report is required is justified. The complainant is advised to approach
SP Office, Panchkula for getting the untraceable report accordingly. He stated that he had obtained a
letter from S.P. Panchkula addressed to the Ombudsman, in which the details of the whereabouts of
the vehicle after its theft were furnished.
DECISION: On going through the report signed by S.P. Panchkula, in which he has stated that
there were reports of vehicle having been sold to some party in Nagaland which they were unable to
trace so far. Although it is not clearly mentioned that the vehicle is not traceable, the details of the
action taken by the police to trace out the vehicle have been furnished. Since it is more than one
year when the vehicle was stolen, this should be taken as an unauthentic untraceable report signed
by Superintendent of Police himself. However, there is a little bit of vagueness about the location of
the vehicle, settlement of the vehicle on non-standard basis to the extent of 75% of IDV amount less
excess clause would meet the ends of justice. It is hereby ordered that 75% of IDV amount less
excess clause should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/493/ICICI/11/10
Virender Singh Vs. ICICI Lombard
ORDER DATED: 10th November, 2009 MOTOR
FACTS: Shri. Virender Singh was having a Motor Insurance Policy bearing no.
3004/54110056/00/000 issued by ICICI Lombard General Insurance Co. Ltd. covering his Tata Sumo
Taxi bearing no. HR-55-DT-8498 for the period 29.06.08 to 28.06.09 for sum insured of Rs. 4,07,938/-
. On 10-11-08, his driver, Sh. Dalbir Singh parked the vehicle at about 9 p.m at 33 Foota Road Opp.
Yadav Palace, Delhi and gone to market, when he returned back, he found that the vehicle was
stolen. The matter was immediately reported to police and they registered the case vide FIR no. 414
dated 20.11.08. The claim was reported to insurance company. The insurance company vide letter
dated 10.08.09, repudiated the claim on flimsy grounds. Parties were called for hearing on 10.11.09
at Chandigarh.
FINDINGS: The insurer clarified the position by stating that there was no insurable interest of
the complainant as the vehicle was purchased by one Sh. Dalbir Singh who was pursuing the case.
Moreover, the FIR was lodged after 10 days and the insurer was informed after 14 days. Also, only
one key was given. The whereabouts of second key were not available. On a query, as to in whose
name were the RC and the insurance policy the insurer replied that it was in the name of Sh.
Virender Singh. On a query, as to who had filled up the claim form, the insurer replied that it was Sh.
Virender Singh.
DECISION: Held that the contention of the insurer that the complainant did not have insurable
interest is not justified as both the RC and the insurance policy are in the name of the complainant.
Although there is a delay in filing FIR but this could be due to normal departmental procedures of
the police and hence the claim cannot be repudiated solely because of FIR being filed after 10 days.
As far as loss of one key is concerned, the complainant should be penalized to the extent of 25% of
the IDV. Therefore, settlement of claim on non-standard basis to the extent of 75% of IDV less excess
clause would meet the ends of justice.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/430/Shriram/11/10
Rajinder Parshad Vs Shriram Gen. Insurance Co. Ltd.
ORDER DATED: 18th January, 2010 MOTOR
FACTS: Shri Rajinder Parshad had been having a Motor Insurance Policy bearing no.
105009/31/10/001230 issued by Shriram General Insurance Co. Ltd. covering his Hero Honda
Motorcycle bearing no. HR-03-E-0248 for the period 01.07.09 to 30.06.2010. The said motorcycle
met with an accident on 29.07.09 and claim was lodged with the insurance company. The said claim
was repudiated by the insurance company without giving any proper reason. Parties were called
for hearing on 18.01.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the since there is an imposed excess
of Rs. 1,500/- under the policy and assessed amount was less than imposed excess, nothing is
payable to the complainant. The complainant submitted that he was not explained about the
imposed excess at the time of taking the policy and there is nothing mentioned on the cover note.
DECISION: Held that the claim is payable for Rs. 1420/-. It is hereby ordered that Rs. 1420/-
should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/435/IFFCO TOKIO/11/10
Gurlal Singh Vs IFFCO Tokio General Ins Co.
ORDER DATED: 18th January, 2010 MOTOR
FACTS: Shri Gurlal Singh was having a Motor Policy bearing No. 38735286 issued by Iffco
Tokio General Insurance Co. Ltd. covering his Tata Truck bearing no. HR-37-B-8296 for the
period 15.04.08 to 14.04.09. The said vehicle was stolen on 26.04.08 while parked at the
Petrol Pump. The door of the cabin of the truck was locked. The thieves had broken window
glasses and taken away the truck. The matter was immediately reported to Police and they
registered the case vide FIR No. 61 dated 10.05.08. The claim was reported to insurance
company but they have rejected the claim vide letter dated 30.07.09. Parties were called for
hearing on 18.01.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the vehicle was left
unattended and the same got stolen while original keys was inside the vehicle and quoted
the clause 5 of terms and conditions of the policy which stipulate that the insured should
take all reasonable steps to safeguard the vehicle from loss or damage. The complainant
insisted on the fact that they had taken due care of the vehicle and the vehicle was not left
unattended as it was parked at a Petrol Pump and the vehicle was left in the care of the
attendants of the petrol pump.
DECISION: Held that the allegation of the insurer that the vehicle was left unattended is partly
true. On the other hand, the complainant is also right, when he said that he had taken proper care of
the vehicle and taken reasonable steps to safe guard the vehicle from loss. Taking the fair and just
view, the settlement of claim on non-standard basis to the extent of 50% of claim amount would
meet the ends of justice. It is hereby ordered that 50% of the claim amount on non-standard basis
should be paid by the insurer to the complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/518/ICICI/11/10
Chanchal Singh Vs. ICICI Lombard
ORDER DATED: 19th January, 2010 MOTOR
FACTS: Shri. Chanchal Singh had been having a Motor Insurance Policy bearing no.
3001/52760849/01/000 issued by ICICI Lombard General Insurance Co. Ltd. covering his Scorpio car
bearing no. PB-10-BX-5667 for the period 27.10.08 to 26.10.09 for sum insured of Rs. 5,42,150/-. The
said vehicle met with an accident and a claim of Rs. 1,30,000/- was reported to insurance company.
All the claim documents were submitted. But the insurance company vide their letter dated
19.06.09 repudiated the claim on the ground that the vehicle was plied for hire & reward. Parties
were called for hearing on 19.01.10 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the complainant himself had given
the statement that he had taken loan from bank for the purchase of vehicle and the installments are
paid by using the vehicle on hire. This statement is also signed by his driver and the Panch of village
Sh. Santokh Singh. The complainant submitted that he is an uneducated person and he was asked to
put signature on some statement which he signed without understanding the contents. The insurer
also failed to produce any convincing evidence to prove that vehicle was being used for hire and
reward and agreed to settle the claim of Rs. 32000/- as assessed by their surveyor.
DECISION: Held that since the insurer failed to produce any convincing evidence to prove that
the vehicle was being used for hire and reward, it would be fair to settle the claim for Rs. 32000/- as
assessed by the surveyor. It is hereby ordered that Rs. 32000/- should be paid by the insurer to the
complainant.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/539/UII/11/10
Harbhajan Singh Vs United India Insurance Co. Ltd.
ORDER DATED: 15th February, 2010 MOTOR
FACTS: Sh. Harbhajan Singh had insured his Sakoda Car No. CH 03 B – 6596 under cover note No.
494656. The said vehicle met with an accident on 08.08.2009. The claim was passed for Rs.
3,75,000/- as against the IDV of Rs. 4,80,000/-. The car was totally damaged and hence he had
applied for full claim amount. Parties were called for hearing on 15.02.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that there is on record a report dated
30.09.2009 from the surveyor. The report states that the assessed loss to the vehicle would be less
than 75% of the IDV, so the vehicle cannot be declared as total loss. If complainant is not prepared
to get the vehicle repaired then claim can be settled on net of salvage/cash loss basis for a sum of
Rs.2,04,000/- (Market value of car being Rs. 3,75,000 and value of wreck Rs. 1,70,000/- less excess
Rs.1000/-).
DECISION: Held that as per IRDA regulations, the concept of market value has been replaced by
the IDV and it is a practice to be accepted by all the insurance companies. So it is not correct to
settle claim on market value. However, if we apply the same percentage on IDV, the total amount
payable to complainant would be more than the IDV. Using the principle of averages, in my opinion
the end of justice would be met if the insurer pays a sum of Rs. 2,30,000/- less compulsory excess
which the complainant has also agreed. So the insurer is directed to pay Rs. 2,30,000/- less excess
within 15 days of the award under intimation to this office.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/579/Bajaj/11/10
Jia Lal Vs Bajaj Allianz Gen. Ins. Co. Ltd.
ORDER DATED: 18th February, 2010 MOTOR.
FACTS: Sh. Jia Lal had a Motor Policy bearing no. OG-09-1201-1803-00000345 issued by Bajaj Allianz
General Insurance Co. Ltd. covering his Truck bearing no. HR-68-3146. The said truck was stolen
from Barotiwala Union on 24.01.09. FIR could not be submitted to the insurer immediately because
he could get the FIR copy on 14.03.2009. All the claim documents were submitted but insurance
company repudiated the claim. Parties were called for hearing on 18.02.2010 at Chandigarh.
FINDINGS: The insurer was requested to submit a self contained note giving the facts of the
case on 11.11.2009. Till the date of hearing, they did not submit a self contained note giving the full
facts of the case and the copy of the documents. During the course of hearing, the insurer submitted
that the complainant has submitted a letter to the fact that the keys of the vehicle were kept in the
cabin of the truck which was stolen. In claim form, also the same information was given. The
complainant specifically stated that registration certificate, fitness certificate, driving licence of the
driver and the keys of the truck were also in the truck itself and they were stolen along with the
truck. During the course of hearing, the complainant stated that the investigator of insurer
requested him to give a statement to this effect so as to expedite settlement of the claim.
DECISION: Since the allegation made by the complainant require legal procedure like calling of
people for witness and recording of evidence which is beyond the scope of this forum. So without
deciding the case on quantitative basis the complaint is considered as beyond the jurisdiction of this
forum. The complainant is free to take up the matter against the insurer in any other forum or court
of competent jurisdiction as he may deem fit. The case is thus closed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/562/UII/14/10
Sarwan Kumar Vs United India Insurance Co. Ltd.
ORDER DATED: 18th February, 2010 MOTOR
FACTS: Sh. Sarwan Kumar’s car Hundai Accent bearing No. HR 07 G – 8556 was insured under policy
No. 110301/31/08/01/00005406 for the period 08.11.2008 to 07.11.2009. The car met with an
accident on 01.12.2008. The insurance company was informed about the accident. The company
advised him to get the vehicle repaired from M/s Vishal Autos and promised to settle the expenses
incurred. Accordingly, the vehicle was repaired incurring a total cost of Rs. 64000/-. When the claim
was preferred to the company through its authorized agent, the same was repudiated. Despite
several personal visits and legal notice, the company has failed to take any action. Parties were
called for hearing on 18.02.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the vehicle insured by them was
being run on LPG gas and this information was not given by the assured in the proposal form. A
vehicle run on LPG is insured after charging an extra premium. As per terms and conditions of the
policy, the accident claim is not payable.
DECISION: Held that on going through the records carefully, it is established that at the time of
accident, the insured vehicle was being run on LPG and extra premium for the same was not paid.
The claim is, therefore, not payable as per terms and conditions of the policy. No further action is
called for. The complaint is dismissed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/605/OIC/14/10
Amir Singh Vs Oriental Insurance Co. Ltd.
ORDER DATED: 19TH February, 2010 MOTOR
FACTS: Sh. Amir Singh had purchased a motor insurance policy vide cover Note No. 291363 for the
period 17.03.2008 to 16.03.2009 for sum of Rs. 145000/-. His vehicle, Tata 407 bearing registration
No. PB 10 BT – 3819 met with an accident on 29.10.2008. The claim was lodged alongwith relevant
documents. But till date he has not received the claim amount. He stated that the company officials
delayed the matter on one pretext or the other. Parties were called for hearing on 19.02.2010 at
Chandigarh.
FINDINGS: The insurer clarified the position by stating that the claim has been repudiated on
the ground the driver at the time of accident was holding a licence for driving Light Motor Vehicle
(Non Transport). The insured vehicle was a transport vehicle and since the driver was not holding
valid driving licence, the claim is not payable as per terms and conditions of the policy.
DECISION: Held that the insurer is justified in repudiating the claim as the driver of the vehicle
was not holding valid driving licence. No further action is called for. The complaint is dismissed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/639/NIC/11/10
Parminder Singh Vs National Insurance Co. Ltd.
ORDER DATED: 15th March, 2010 MOTOR
FACTS: Sh. Parminder Singh had taken a motor policy covering his motor cycle No. PB 36 C – 9368
vide policy No. 401801/31/05/6200001452 for the period 01.06.2005 to 31.05.2006. His vehicle was
stolen by some unknown person. He submitted all the document relating to claim to the insurer.
However, he received his non-traceable report of Judicial Court after long time which he submitted
to the insurer. The insurer, however, in its letter dt. 06.11.09 has stated that the said claim was
closed as no claim on 28.02.2006 due to non submission of non-traceable report of the court and the
insured has submitted the same to insurer on 26.08.2009 i.e. after a gap of 3½ year. The insurer put
the insured's request for opening claim file before the competent authority, who has declined the
request of the insured. Parties were called for hearing on 15.03.2010 at Chandigarh.
FINDINGS: The insurer submitted that their Divisional Office refused to settle the claim because
the claim was treated as closed three and half year back.
DECISION: Since complainant had no control over time taken by the court to give the final
report, he is entitled for the payment of IDV. The insurer is hereby directed to settle the claim for an
IDV of Rs. 38012/- within 15 days from the date of receipt of consent and other requirements from
the complainant. The complaint is thus disposed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/678/OIC/11/10
Gurpreet Singh Vs Oriental Insurance Co. Ltd.
ORDER DATED: 15th March, 2010 MOTOR
FACTS: Sh Gurpreet Singh had insured his motor bike, Hero Honda under policy No.
231102/31/2009/3554 for the period from 31.03.2009 to 30.03.2010. The said vehicle was stolen on
31.03.2009. The claim was preferred to the insurer. However, the same was repudiated vide letter
dt. 03.12.2009 on the grounds that the vehicle was not registered within one month of its purchase
as per Motor Vehicle Act and FIR was lodged after one month of the theft of the vehicle. Parties
were called for hearing on 15.03.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stated that the claim could not be settled
because the complainant had lodged the FIR after one month of theft of the vehicle whereas as per
terms and conditions of the policy, the FIR should be lodged within 48 hours from the date of theft.
The insurer further submitted that the insured vehicle was not registered within one month of its
purchase and the temporary registration was valid up to one month from its purchase.
DECISION: The apprehension of the insurer was that if in future the vehicle is recovered then
there will be problem about its transfer in their favour. Looking into the facts of the case and papers
on record. The insurer is hereby directed to settle the claim on Non standard basis for an amount
equal to 75% of the sum assured after obtaining indemnity bond with surety from the complainant.
The complaint is thus disposed.
Chandigarh Ombudsman Centre
CASE NO. GIC/670/UII/11/10
Ajmer Singh Vs United India Insurance Co. Ltd.
ORDER DATED: 15TH March, 2010 MOTOR
FACTS: The complainant, Sh Ajmer Singh’s vehicle Hero Honda No. PB 49 – 8769 was insured under
policy No. 281401/3107/01/00001899. The said vehicle was stolen on 15.02.2009 while he was
attending a marriage at Kamal Palace, Ropar. All the formalities were completed. However, the
company refused to make the payment as the key was left inside the vehicle. He further submitted
that the marriage palace was under security arrangement and they had failed to secure his vehicle.
Also he had paid all the premiums regularly and no instructions were given to him by the agent for
locking the vehicle. Parties were called for hearing on 15.03.2010 at Chandigarh
FINDINGS: The insurer clarified the position by stating that the theft claim was reported under
above policy. Investigation was carried out. During the investigation, insured has given an
undertaking that "He forgot to lock the motorcycle because he was in hurry, he was to come
immediately". The investigator submitted the report that at the time of the theft vehicle was not
locked. Hence claim is not payable under the policy.
DECISION: Held that as per the terms and conditions of the policy all reasonable care has to be
taken by the insured for the safeguard of the vehicle. He left the vehicle unlocked so was negligence
in not taking care of the vehicle. As per terms and conditions of the policy, the claim is not payable.
The complaint is thus dismissed.
CHANDIGARH OMBUDSMAN CENTRE
CASE NO. GIC/533/OIC/11/10
Jagbir Singh Vs Oriental Insurance Co. Ltd.
ORDER DATED: 15th March, 2010 MOTOR
FACTS: Sh. Jagbir Singh had purchased a motor insurance policy No. 31/08/4436. His car registration
No. PB 11 AE – 9508 met with an accident on 21.06.08. FIR was lodged and survey was conducted by
the insurance company. The claim was repudiated on the ground that the driver who was driving the
vehicle was holding a licence for LMV (Private) whereas he was driving a Mahindra Matrix (Pick-up)
which came under the category of LMV (Commercial). Complainant submitted that the licence is
valid for both the purpose. Hence he requested intervention of this forum in getting the claim
settled. Parties were called for hearing on 15.03.2010 at Chandigarh.
FINDINGS: In support of repudiation of the claim the insurer submitted a certificate from the
DTO, Patiala that the subject vehicle was registered as commercial vehicle. The insurer is justified in
rejecting the claim on the ground that the person driving the vehicle was not holding a valid and
effective licence. The complainant has submitted that the certificate from DTO Patiala submitted by
the insurer through their investigator to the effect that vehicle is registered as a commercial vehicle
is not genuine. He also submitted a print out of web site of Indian Driving School stating that there is
no provision for commercial vehicle licence. The subject vehicle was being used to transport his
personal goods and for driving such a vehicle a licence to drive L.M.V. is valid.
DECISION: An analysis of materials on record reveals that the licence issued to Aman Deep
Singh, the person driving the vehicle at the time of accident was the licence to drive a Motor Vehicle
other than a Transport Vehicle. Since the subject vehicle was Mahindra Matrix (Pick up) which is
used to transport goods and the licence of Shri Amandeep Singh was to drive Motor Vehicle other
than Transport Vehicle as per terms and conditions of the policy, claim is not payable and insurer is
justified in rejecting the claim. The complaint is thus dismissed.
DELHI
Case No. GI/137/NIC/09
In the matter of Shri Pushpender Singh Vs
National Insurance Company Limited
AWARD dated 03.11.2009
1. This is a complaint filed by Shri Pushpender Singh (herein after referred to as the
complainant) against the National Insurance Company Limited (herein after referred
to as respondent insurance company) for not settling the claim in respect of an
accident to his vehicle No.DL-9CC-4394 covered under policy
No.360300/31/07/6100008043.
2. The brief facts of the case are as under:
3. The complainant had taken a Motor Package policy with respondent company in
respect of his vehicle No.DL-9CC-4394. The said vehicle had met with an accident on
22.09.2008. Thereafter, the complainant had lodged a claim with the respondent
company. However, while admitting the claim as a total loss, the respondent
company had offered two options to the complainant. (i) Either the complainant
could keep the scrap for which an amount between Rs.2000/- to Rs.2500/- could be
deducted from the total IDV of the vehicle, that is, Rs.1,33,000/- (ii) Or, to get the
total IDV subject to removal of superdari from the court. The claim is pending only
for want of requirements as sought by the respondent company vide their letter
dated 25.05.2009 (EX: R1). The following requirements were made by the
respondent company: (i) Get the superdari deleted (ii) get RC transferred in the
name of the respondent company (iii) To deposit the salvage to the company’s
godown.
4. I find from the above requirements that since the vehicle in question met with an
accident, the said vehicle will always remain subject to superdari and it may not be
possible for the complainant to get the same deleted.Therefore, the Condition No.1
as sought by the respondent company may not be insisted upon. The respondent
company should be able to settle the claim on total loss basis as per the IDV. In the
result, I direct the respondent company not to insist on getting the superdari deleted
and after getting the condition No.II & III which the complainant is very much willing
and ready, the respondent company is directed to settle the claim as total loss basis
for the IDV amount.
5. With this direction, the complaint is disposed of.
Case No. GI/39/UII/09
In the matter of Shri V.R.Jagannathan Vs
United India Insurance Company Limited
AWARD dated 04.11.2009
1. This is a complaint filed by Shri V.R.Jagannathan (herein after referred to as the
complainant) against the decision of the United India Insurance Company Limited
(herein after referred to as respondent insurance company) in repudiating his claim
in respect of theft of his Maruti Zen Car No.DL-9C-L-9504. The reason for the
respondent company for rejecting the claim is that the complainant had already sold
the vehicle to somebody else and as such he has no insurable interest.
2. The base on which the respondent company has come to this conclusion is the
investigating report submitted by one Shri Paritosh Paul (EX: R1). The investigator
has concluded that the insured had in fact sold the car before going abroad to one
Shri Hitesh Gulani and even paid the consideration besides having filled in form
No.29 & 32 towards the transfer of the vehicle in the RTO office. However, as on the
date of loss admittedly the RC book is still in favour of the insured. Though the
insured would have negotiated the sale of the car, the sale is not said to be complete
unless the ownership is transferred from the seller to the buyer by way of change in
the registration book. It is erroneously on the part of the respondent company to
come to a conclusion that the vehicle has already sold and consequently the insured
does not have an insurable interest. The sale of the vehicle nor the ownership of the
vehicle does not transfer to the buyer unless and until necessary changes are made
in the RC book. (EX: C1) is the copy of the RC book where it is clearly mentioned the
owner’s name as Shri V.R.Jagannathan.
Therefore, it is not fair on the part of the respondent company to rely on mere
circumstantial evidence to infer that the vehicle has been sold which is not
supported by any documentary evidence. As regard the theft itself, the company is
not denying the genuineness of the theft nor the amount be settled. There only
contention is that the insured is no longer the owner of the vehicle.
3. As already discussed above, the ownership of the vehicle as per RC record is still in
the name of the insured and as such the repudiating of the claim by the respondent
company is unjustified. As a result, I direct the respondent company to settle the
claim as per policy conditions in connection with the theft of the vehicle to the
complainant owner of the vehicle.
4. The complaint is disposed of accordingly.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
Case No. GI/122/ICICI Lomb/09 In the matter of Dr. Ajay Aggarwal Vs.
ICICI Lombard General Insurance Company Limited
AWARD dated 06.11.2009
1. This is a complaint filed by Dr. Ajay Aggarwal (herein after referred to as the
complainant) against the decision of ICICI Lombard General Insurance Co. Ltd.
(herein after referred to as respondent Insurance Company) in limiting his claim in
respect of accident to his vehicle to Rs.105627/- only as against his total claim of
Rs.379359/-.
2. The brief facts of the case are as follows:
3. The complainant had taken a motor package policy in respect of his vehicle DL-2FC-
0048 Mercedes Benz Car for total IDV of Rs.12 Lacs. Between the period 10.09.2007
to 09.09.2008. The said vehicle allegedly had an accident on 07.09.2008 as per the
facts already available on the file that complainant was driving his car on the fateful
day around 09.30 pm there was very heavy rain. At that point of time his car
suddenly entered into a ditch filled with rain water. The car due to sudden jerk at
that point of time had a crack in the windscreen. There after the vehicle was
removed to a workshop. The workshop gave estimate of Rs.273732/- towards
repairs of the vehicle. However, the respondent company had allowed only
Rs.105627/- excluding the cost of repairs in respect of the engine. The two grounds
on which the claim was partially repudiated by the respondent company are as
follows:
(1) There was no external impact to the vehicle of the engine from outside.
(2) Engine cannot be impacted by merely coming in contact with water and
damages to engine can only by attributed to mechanical failure or trying
to start/run the engine when it is still in contact with water.
4. Thereafter the matter came before the then Ombudsman who had a hearing and
based on various data available he made an interim report (EX.O.1). Various
circumstances were discussed in this report. However, the main issues coming for
consideration are as follows:
(i) Whether the kind of damage to the engine that has occurred is
possible only because of using self starter in the specific
circumstances of this case?
(ii) Can there conceivably be other reasons for the damage, that is, other
than self starting?
(iii) Is there any violation of the manufacturer’s manual relating to driver’s
conduct relevant to this accident? If so, specify the same.
(iv) What is the meaning of “Consequential Loss” in terms of para 2 of the
policy condition? Is it consequential to the incident or human failure?
(v) Assuming for sake of arguments that Dr. Aggarwal had tried to re-
start the engine by use of self-starter and that caused damage to the
engine, can it still be called “consequential loss” in terms of the policy
document?
5. The Ombudsman also directed the respondent company to give a speaking order on
the above points before 15.09.2009. The personal hearing on this matter before me
was held on 03.11.2009. On that day the respondent company did not present any
clarification on those issues as directed by this Forum. Therefore, I would like to
pass an Award on the issues based on various documents, statements, provision in
the motor policy and also general experience of motor claims. Taking the first
objection of the respondent company that “there was no external impact to the
vehicle of the engine from outside”, I would like to refer to the wordings of the
policy section ‘1’ “Loss of or damage to the vehicle insured”. It is explicit that
damage to the vehicle should be by “accidental external means”. From the above
definition it postulates that the damage to any part of the vehicle need not be any
impact. The damage should have been caused by any factors and it should be
accidental. I, therefore, fail to understand the logic of the respondent that the
instant case that there was no impact to the vehicle. As established in the instant
case the damage to the engine is admittedly caused due to entry of water into
engine. As already discussed in the interim report in EX.O.1, it is established that
entry of the water into engine happened due to attempt of the driver/complainant
to start the engine while the vehicle is submerged partially in the water. In normal
course in such panic situation it is not uncommon for any
man of ordinary prudence in a panic situation to attempt to start the engine in his
anxiety to get out of the water, especially when it is raining heavily. Therefore there
has been no deliberate intention on the part of the complainant to cause any
damage to the engine intentionally. Therefore, it has to be considered that entry of
water into engine is purely by accidental means and not by any intentional act.
Having held so, I would now like to elucidate on some of the important points raised
by this forum to the respondent company. Whether there is any violation of
manufacture’s manual relating to driver’s conduct relevant to the accident. I have
been supplied by the complainant the user’s manual. On pursuing the same I find
that there no mention about any directions to the users about the manner in which
one should take precautions about not starting the car in that situation. I would also
like to state that respondent cannot attribute any malafied intentions to the
complainant for having attempted to start an engine in the circumstances already
discussed. I also referred to a judgement of the District Consumer Disputes
Redressal Forum (New Delhi) vide their order dated 01.07.2009 where in fact the
same Insurance Company is a respondent. The forum succinctly held “it is quite
common that during rainy season there is water logging on the roads and the vehicle
have to ply through that water and if the car like Mercedes gets stuck mid way
because of water entering in engine or its cylinder, the respondent cannot escape its
liability coming under exclusion of consequential loss”. Now coming to the other
points referred by this forum as whether the damage caused to the engine is
consequential loss or not, it is well established principle of Insurance that this cannot
be termed as consequential loss and the word consequential is always connected to
the incident and not necessarily human failure. In the normal course consequential
loss is in fact the financial loss caused to the insured as a result of damage to insured
property. Therefore the application of consequential loss term on the present
circumstances is not correct. Coming to the last point, it goes without saying that act
on the part of the complainant having attempted to start the engine at that point of
time can not be termed as consequential loss. In fact, this also has been held in the
negative by the Hon’ble District Consumer Disputes Redressal Forum as already
discussed above.
6. For the reasons elaborately discussed above, I find that the repudiation of the claim
for the damage to the engine and repairs replacement caused to the engine part is
not justified at all.
1. I find from the interim report of previous Ombudsman that the total claim is for
Rs.273732/-. However, the complainant had vide his letter undated submitted to
this forum, had sought to claim Rs.379359/- as the total claim amount spent by him.
This forum is not able to give any final figure for the total claim amount to
be settled, in the absence of proper bills, labour charges etc. Therefore, the
respondent company is directed to scrutinize the balance bills repairs, replacement,
labour charges etc. and than release the balance amount.
8. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the same shall be intimated to my office for information and record.
9. Copies of award to both the parties.
Case No. GI/144/NIC/09
In the matter of Shri Chander Prakash Talreja Vs
National Insurance Company Limited
AWARD dated 17.11.2009
1. This is a complaint filed by Shri Chander Prakash Talreja (herein after referred to as
the complainant) against the decision of the National Insurance Company Limited
(herein after referred to as respondent insurance company).
2. The brief facts of the case are that his vehicle Maruti Zen DL 2CV 6438 had met with
an accident. The claim has already been agreed and settled on Net Salvage Value
basis. Though the complainant is not happy as to the shortage received for his
salvage vehicle as against the IDV, the main complaint as to his final notice given to
the respondent company vide his letter dated 30.12.2008 is limited to the following
expenses only:
Rs.4900/- towards towing charges
Rs.50000/- towards harassment with 18% of interest
3. From the fact available on the file, the present claim of the complainant is limited to
only those above two amounts. As regards, towing charges are concerned, in
Annexure A accompanied in his complaint, he had elaborated as follows:
“As it was decided that my car would be sold on a net salvage value then I was
required to make efforts to find a seller for the same. I could not leave my car at the
service centre of the BSS as it was decided that the car would not be repaired now
and BSS was charging parking charges on a per day basis for the space occupied by
my car in the service station. This again would have left to additional cost to be
incurred by me. Due to this, I was forced to bring the car back to home and incur
additional toeing charges for the back journey.”
4. From the above, it is clear that the towing charges had to be entailed by him for valid
reasons as described above. I am pained to note that the respondent company has
given a reply to the forum vide their letter dated 11.06.2009 in the briefest possible
form not giving any elaboration in regard to the various points raised by the
complainant which reflects the indifference of the respondent company even to this
Forum. This only strengthens the complainant’s version that he has been made to
run from pillar to post to get his claim settled.
5. I, therefore, pass the Award the following amounts to the complainant:
(i) Rs.4900/- towards towing charges
(ii) Rs.5000/- towards various misc. expenses by him as ex-gratia amount.
As regards his claim for Rs.50000/- towards damage and sufferings, they are not
maintainable in this forum. In the result, I direct the Insurance Company to pay him
a total sum of Rs.9900/- as enumerated above.
6. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and record.
1. Copies of the Award to both the parties.
Case No. GI/132/NIC/09
In the matter of Shri Deepankar Roy Vs
National Insurance Company Limited
AWARD dated 17.11.2009
1. This is a complaint filed by Shri Deepankar Roy(herein after referred to as the
complainant) against the decision of the National Insurance Company Limited
(herein after referred to as respondent insurance company) in rejecting the claim in
respect of theft of his vehicle Maruti 800 No.DL 7CR 1363.
2. The brief facts of the case are that the complainant had bought Maruti 800 car from
someone else and applied for change of registration. He also got the policy obtained
in his favour from the respondent company for the period 23.05.2008 to 22.05.2009.
The vehicle admittedly was stolen on intervening night of 22-23.06.2008. The
respondent company has rejected the claim vide their letter dated 09.06.2009
interalia on the ground that the RC was transferred in the name of the complainant
only on 24.06.2008, that is, one day after the theft of the vehicle. Since on the day
of the theft, he did not have insurable interest, the claim is rejected.
3. The point for consideration is whether the insurance company is justified in denying
the claim on the above ground. From the circumstances and facts available, it
postulates the very fact that RC was changed in favour of the complainant on
24.06.2008 implies that he would have submitted the necessary forms for change of
registration much before that date. It is common knowledge in India that RTO takes
their own sweet will to deal with such matters. The complainant also confirms that
at the time of giving the policy, the respondent did not insist for the R.C. Therefore,
the policy as on the date of theft is in favour of the complainant and the respondent
company is estopped from taking the plea of insurable interest. Secondly as already
discussed the ownership in the vehicle transferred/ obviously to the complainant the
moment he paid full consideration of the vehicle. As on the date of theft, he had
apparently submitted the necessary forms to transfer of ownership in the RTO.
Therefore, I am fully convinced that the complainant was not at fault for the events
that happened which are unfortunate. For all purposes de-facto, he is the owner of
the vehicle as on the date of theft and he has insurable interest notwithstanding the
fact that actual RC was not issued.
4. In the result I hold that repudiation of the claim by the respondent company is
unjustified. As such, I direct the respondent company to settle the claim for IDV
subject to usual procedure followed in the theft claim.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
Case No. GI/121/UII/09
In the matter of Shri Rajat Surana Vs
United India Insurance Company Limited
AWARD dated 30.11.2009
1. This is a complaint filed by Shri Rajat Surana (herein after referred to as the
complainant) against the decision of the United India Insurance Company Limited
(herein after referred to as respondent insurance company) in repudiating his claim
for theft of his vehicle No.RJ 04-2M-7076.
2. The brief facts of the case are that the complainant had taken a Motor Package
policy with the respondent company in respect of his vehicle No.RJ 04-2M-7076.
From the facts available, it appears that the vehicle was bought by the complainant
from somebody else. The respondent company has rejected the claim according to
their own reply on the ground that when the complainant had approached them for
transfer of insurance policy on his name, that is, on 30.08.2007, the vehicle was
already stolen on the same day. The reason for repudiating the claim is that he had
suppressed the fact about the theft of his vehicle in the morning at the time of
seeking transfer of the insurance policy in his name. As could be gathered from the
brief reply letter of the respondent company that barring this objection, all other
formalities such as police report etc must be in order. I also have gone through the
complainant’s letter wherein he has submitted FIR and other documents relevant to
the settlement of the claim. It is also admitted by the respondent company that R.C.
was transferred on 29.08.2007 in favour of the complainant, obviously having
purchased the vehicle from somebody else. Therefore, on the date of theft of the
vehicle, that is, 11.00 a.m. on 30.08.2007, the complainant had insurable interest
and he was in fact the owner of the vehicle.
3. Now going to the objection of the respondent company alleging that there was mis-
representation of facts/suppression about the theft at the time of seeking transfer, I
have sought the explanation from the complainant during the course of personal
hearing. He had explained that he was in very nervous state of mind and just he was
approaching insurance company and after he had got the RC transferred in his name,
this unfortunate incident had shaken him. He was nervous and chose not to inform
about the theft of the vehicle which has happened just immediately on the day after
the transfer of the vehicle.
4. I am convinced from the fact on the file as well as circumstances explained to me by
the complainant that there is no fraud involved in this case. The complainant’s
explanation seems to be very natural and genuine. I, therefore, hold that the theft is
genuine and the complainant was having insurable interest on the date of theft. The
reasons for suppression about the theft of the vehicle at the time of seeking transfer
of insurance policy have been explained to my satisfaction.
5. I, therefore, feel that the rejection of the claim in the instant case is not justified. I
direct the respondent company to settle the claim as per IDV subject to complying
with other procedural formalities under the policy.
6. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and record.
7. Copies of the Award to both the parties.
Case No. GI/154/NIC/09
In the matter of Shri Surender Kumar Mittal Vs
National Insurance Company Limited
AWARD dated 01.12.2009
1. This is a complaint filed by Shri Surender Kumar Mittal (herein after referred to as
the complainant) against the decision of the National Insurance Company Limited
(herein after referred to as respondent insurance company) in repudiating the claim
in respect of an accident to his vehicle Tata Indica No.RJ 13 CA 0759 covered under
the policy with the respondent company.
2. The brief facts of the case are that the Tata Indica vehicle belonging to the
complainant had met with an accident on 17.07.2008. The respondent company had
engaged a surveyor to assess the loss. However, after the loss has been assessed
the respondent company has rejected the claim on the ground that though the
driver was having admittedly a transport vehicle license at the time of accident but
he did not have a valid LMV vehicle driving license for at least one year which is a
pre-condition under the Motor Vehicles Rules.
3. I have gone through the relevant circular dated 29.03.2005 issued by Rajasthan
Government, Transport Department. They have clarified that a person who is having
a transport driving license can drive car, Omni bus, tractor and road roller whose
total weight not exceeding 7500 Kgs. It has also however prescribed that transport
vehicle license could be issued only to those who have held a LMV driving license for
a period of at least one year.
4. I have also gone through the investigation report submitted by the respondent
company (EX : R1) wherein the investigating officer who checked the previous and
pack papers and connected with the issuance of the transport driving license to the
driver of the vehicle.He had confirmed as per his investigation that the driver
concerned did not ever have a license to driver LMV vehicle and as such in
accordance with the above quoted circular, he was not entitled to have transport
vehicle driving license. The only point for consideration is whether or not the driver
was having a valid driving license within a meaning of drivers’ clause of the policy.
No doubt it has been held time and again by the highest judicial forums in the
country, that driving a vehicle without having a valid driving license vitiates a claim
completely. Unfortunately, the respondent company could not establish in the
instant case, that he was not having a valid driving license. The driver is undoubtedly
having a transport vehicle license (EX: C1). Having held a license to hold a motor
vehicle in accordance with the above quoted circular, he is entitled to driver a LMV
policy subject to weight limitations. Now as long as the driver concerned is having
transport vehicle license with him, it is not for this forum to go back to the history
beyond as to how the Transport Department has given such license if he did not
comply with any of the mandatory pre-requisites for getting such license issued.
That should have been the job of the Transport Department to ascertain the same
and it is not for this Forum to challenge the back ground of the circumstances under
which a driving license has been purportedly obtained fraudulently.
5. In the result, as on the date of the accident, the driver of the vehicle was authorized
to hold LMV vehicles as per the circular quoted above. As such, I hold that the driver
of the vehicle was in fact holding a valid driving license on the date of the accident to
the vehicle being in possession of a valid transport vehicle license.
6. In these circumstances, I direct the respondent company to process the claim as per
the assessment already made by the surveyor and settle the claim subject to
scrutiny, excess or any other clause under the policy.
7. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and record.
8. Copies of the Award to both the parties.
Case No. GI/190/OIC/09
In the matter of Shri S.K. Mittal Vs
Oriental Insurance Company Limited
ORDER dated 01.12.2009
1. This is a complaint filed by Shri S.K. Mittal (herein after referred to as the
complainant) against the decision of the Oriental Insurance Company Limited (herein
after referred to as respondent insurance company) in not settling the motor claim
in respect of theft of his motor cycle No.RJ 14 35M 4278 on 28.03.2008.
2. The brief facts of the case are that the complainant had taken a Motor Package
policy with the respondent company for the period 06.03.2008 to 05.03.2009. The
main reason for rejecting the claim given by the respondent company is based on
the following facts. The vehicle was allegedly stolen on 28.03.2008 whereas the
information to the company’s office was given after a lapse of 26 days which is a
clear contradiction of the policy conditions which requires notice of theft to be
intimated within 48 hours of the incident. There is also a delay in informing the
police authorities. Since there is clear violation of policy conditions, the claim has
been rejected.
3. While the facts mentioned above by the respondent company are true, I have, in the
course of personal hearing, sought the explanation from the complainant as to why
such delays have occurred. He had explained to me that he was actually living in
Jodhpur where the theft took place and the policy was taken from Jaipur. He had
mentioned about the difficulties he faced in getting the FIR registered with the police
authorities. He had explained to me that after the above happening of the theft, he
was shattered. He had pleaded that he had no intention of any fraud but all these
mistakes were happened inadvertently due to he being shaken due to sudden theft
of the vehicle.
4. On going through all the records, I find, no doubt, there are basic violation of the
policy requirements especially in the case of theft. An inordinate delay in informing
the theft would effect the right of the Insurance Company in getting the matter
investigated. As regards the delay in informing the police is concerned, I find that FIR
was registered on 03.04.2008 whereas the theft has occurred on 28.03.2008,
therefore, the delay was about 6 days.
5. On going through the oral submissions made by the complainant, I am convinced
that these lapses in complying with the policy conditions have happened due to the
unfortunate circumstances faced by the complainant who is responsible & a
respectable citizen working in Jodhpur. I do not suspect any foul play regarding
genuineness of theft etc. The only problem is the violation of policy condition and I
cannot blame the respondent company for having rejected the claim in accordance
with the policy conditions and their inability to get the matter investigated due to
this delay in intimation. However, for the circumstances stated above, I take a
lenient view and direct the respondent company to settle the claim on non-standard
basis, not exceeding 75% of the IDV of the vehicle, as a special case without creating
precedent in these matters.
6. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and record.
7. Copies of the Award to both the parties.
Case No. GI/199/NIC/09
In the matter of Shri Alok Johari Vs
National Insurance Company Limited
AWARD dated 27.01.2010
1. This is a complaint filed by Shri Alok Johari (herein after referred to as the
complainant) against the decision of the National Insurance Company Limited
(herein after referred to as respondent insurance company) in repudiating his motor
theft claim.
2. The brief facts of the case are that the complainant had taken a motor private car
package policy in respect of his vehicle Maruti/Wagon R No.DL 9CR 2013 for the
period 25.03.2008 to 24.03.2009 for an IDV of Rs.2,68,000/-. The said vehicle was
stolen on 09/10/08.2008. However, the claim of the complainant for the theft of his
vehicle has been rejected by the respondent company on the ground that the
intimation of loss to the company was made after a lapse of 7/8 months from the
date of theft.
3. I have gone through the various records of the policy and also heard both the parties
on the date of personal hearing. From the records available, it is true that there is
no written intimation of theft of the vehicle from the complainant. It is a very
important condition of the policy which makes it mandatory that the loss or damage
to the vehicle has to be immediately brought to the notice of the respondent
company and breach of this condition can lead to repudiation of the claim itself.
Repudiation of the claim for non-intimation within time has been hold to be a valid
ground even by Apex Consumer Forum. Therefore, from the facts available on the
file that in the absence of intimation of loss within reasonable time can definitely
give rise for repudiation of the claim.
4. The main purpose for this condition is that the respondent company shall have
sufficient scope to investigate the veracity of the theft and can come to the
conclusion about the genuineness of the claim. In the absence of such intimation,
the insurance company will be deprived of the opportunity to get the matter
investigated. In the course of personal hearing, the complainant has submitted that
he had informed his agent who happens to be the Motor dealer himself about the
loss of the vehicle. Since the original certificate of insurance has been lost with the
vehicle, the agent-cum-dealer of the vehicle (M/S.Bagga Link Motors Ltd., Delhi) has
given him a duplicate copy of the insurance certificate. The complainant also
pleaded before me that he had sent even the fax about the loss of the vehicle and
intimated even the bank which was a financer for this loss.
5. On going through the facts, I am convinced that the lack of intimation about the loss
to the insurance company could have been escaped, may be due to the ignorance of
the requirements. Though that could not conclusively be proved, that they had in
fact sent a fax to the respondent company, however, circumstantial evidences
suggest that the Bagga Link Motors Ltd., has provided a duplicate copy of the policy
which confirms the fact that he had in fact intimated the loss. The other
corroborated evidence available is that the FIR has been lodged in the police station
on 10.08.2008, that is, the day after the theft. A copy of the FIR is also available in
the file.
6. From the above facts, therefore, there cannot be any doubt that the vehicle had in
fact stolen on the intervening night of 09/10.08.2008 itself and that fact is
corroborated by FIR filed with the police. I also find the Final Report of the police
dated 20.11.2008. The only short coming in the claim is the non-receipt of written
communication about the happening of the theft in the office of the respondent
company.
7. In the circumstances, I direct the respondent company to settle the claim subject to
complying with the normal procedural requirements in a theft claim. However, since
there has been a technical breach of a policy condition, the claim can be limited to
90% of the IDV on a compromise basis.
8. With these observations, the complaint is disposed of accordingly.
9. Copies of the Award to both the parties.
Case No. GI/201/ICICI Lombard/09
In the matter of Shri Narendra Kumar Vs
ICICI Lombard General Insurance Company Limited
AWARD dated 28.01.2010
1. This is a complaint filed by Shri Narender Kumar (herein after referred to as the
complainant) against the decision of the ICICI Lombard General Insurance Company
Limited (herein after referred to as respondent insurance company) in repudiating
his motor claim.
2. The brief facts of the case are that the complainant had got his Tata Truck No.RJ13-
GA 2590 comprehensively insured with the respondent company for an IDV of
Rs.698720/- for the period 16.02.2009 to 15.02.2010. As per the facts available, the
said vehicle caught fire on 25.05.2009. The complainant’s vehicle was also
immediately attended by the fire-brigade and subsequently the matter was brought
to the notice of the respondent company who has deputed Shri Keshav Agarwal who
had conducted the spot survey on the vehicle and submitted his report dated
20.06.2009 (EX:R1). In the said report, the surveyor had confirmed that the cause of
fire as probably due to short-circuiting. He had inspected various parts of the vehicle
damaged by fire and gave a report. As per his report, the driver of the vehicle Shri
Bittu Singh was proceeding with the loaded vehicle and the accident is supposed to
happened somewhere between Sri Ganganagar (Rajasthan) to Gurgaon (Haryana).
Subsequently the respondent company had deputed a final surveyor Shri Narinder
Singh Sidhu who has submitted his report marked (EX:R2). In the report interalia, he
had also confirmed that there was extensive damage to the vehicle due to fire in the
vehicle. He had also expressed that probable cause of fire to the vehicle is short-
circuit in the cabin system and electrical wiring. He had conducted a thorough
assessment of the damage to the vehicle and assessed the same at net amount of
Rs.259939/-. Since the IDV of the vehicle is Rs.698720/- and the percentage of the
loss assessed is below 75% of the IDV, the same cannot be considered on a total loss
basis. Subsequently, I find that the respondent company had merely rejected the
claim vide their letter dated 29.06.2009 (EX:R3) on the ground that “there was a mis-
representation of facts regarding the driver of said vehicle at the time of accident.” I
also find that there is a letter written by respondent company to the complainant
dated 28.12.2009 (EX:R4) wherein they have turned about from their stand taken in
their refusal letter and have now admitted the claim advising the complainant to get
the vehicle repaired as per the assessment made by the surveyor.
3. In the course of personal hearing, the respondent company’s representative Shri
Sumeet Bajaj had categorically pleaded that the cause of fire is probably due to
manufacturing defect and therefore they are not liable.
4. On going through the various facts and figures I come to the conclusion that
(i) The vehicle got extensively burnt down on 25.05.2009
(ii) The preliminary surveyor has confirmed the cause and nature of accident which
corroborated the statement of the complainant.
(iii) The final surveyor also confirmed the cause and nature of the loss and also
assessed the various damages to the vehicle.
5. I am really surprised as to the various stands taken by the respondent company from
time to time. In the first instance, they have taken a stand that there is inconsistency
in the name of the driver. On the second occasion, during the personal hearing at
Jaipur, they have taken a stand that the fire has broken out due to manufacturing
defect. On a letter dated 28.12.2009, that is, after the hearing, they are now coming
out with an offer to get the vehicle repaired as per the assessment made by the final
surveyor. I have also gone through the estimates given by Dunac Automobiles Pvt.
Ltd., a dealer of Tata Motors at Sri Ganganagar (EX:C1) amounting to Rs.871,551/-.
5. Now taking the whole situation, the reasons tendered by the respondent company
from time to time are very inconsistent. There is no doubt that this vehicle had met
with a most unfortunate and inevitable accident which cannot be denied. The
respondent company coming out with a very weak ground for rejecting the claim on
such as inconsistency in the name of driver is most reprehensible. On second
occasion before this forum they have come out with a desperate ground that it could
be due to manufacturing defect. The respondent Insurance Company is probably
not understood that when an accident takes place to the vehicle it is not for the
insured as to what caused the accident including the alleged manufacturing defect as
long as the accident is caused without any malafied intension from the insured.
6. I record that even this stand is another desperate attempt to reject the claim. Now
at this belated stage obviously sensing the mood of the forum, the respondent
company has now come out with their letter that the vehicle could be repaired as
per the assessment made by the final surveyor. I am afraid that it is too late a stage
and considerable time has passed since the date of the accident is 25.05.2009.
Under these circumstances, I do not think the vehicle could be made road worthy
and in a running condition to the satisfactory of the insured especially after
extensive fire damage. Had the respondent company attended to these repairs
immediately after the final survey report, there could have been a scope for this
forum to assess the veracity and reasonableness of the assessment. At this stage
having failed in their attempts to reject the claim on some ground or the other, now
coming out with a proposal to get the vehicle repaired on the assessed value is not
at all proper.
7. In the result, I direct the respondent company to settle the claim on total loss basis
on the IDV as appearing on the face of the policy which is Rs.698720/-. The salvage
of the vehicle could be taken over by the respondent company.
8. With these directions, the complaint is disposed of accordingly.
9. Copies of the Award to both the parties.
Case No.GI/148/ICICI Lombard/09 In the matter of Shri S.K. Dhingra Vs
ICICI Lombard General Insurance Company Limited
AWARD dated 29.01.2010
1. This is a complaint filed by Shri S.K. Dhingra (herein after referred to as the
complainant) against the decision of ICICI Lombard General Insurance Co. Ltd
(herein after referred to as respondent Insurance Company) regarding non-settlement
of motor claim.
2. During the course of hearing, the representative of the respondent Company assured
to pay the claim, if the complainant takes his vehicle to the authorized dealer and got
it repaired from them. The insured Mr. S.K. Dhingra has got his vehicle repaired
from M/s. D.D. Motors, Peeragarhi, New Delhi and incurred an expense of
Rs.16902/- vide their bill no. BR09009842 dated 30.11.2009 and submitted the same
to the Insurance Company on 04.12.2009 which was duly received by the Company
but till date they have not settled his claim as promised.
3. Therefore, the respondent company is directed to settle the claim bill of Rs.16902/- to
the complainant.
Case No. GI/29/BA/09
In the matter of Dr.Dilip Dubey Vs
Bajaj Allianz General Insurance Company Limited
AWARD dated 29.01.2010
1. This is a complaint filed by Dr.Dilip Dubey (herein after referred to as the
complainant) against the decision of the Bajaj Allianz General Insurance Company
Limited (herein after referred to as respondent insurance company) in repudiating
his motor claim.
2. The brief facts of the case are that the complainant had got his Maruti Baleno Car
No.RJ148C 9638 comprehensively insured with the respondent company for the
period 20.02.2008 to 19.02.2009. The said vehicle met with an accident on
07.09.2008. Thereafter the complainant had informed the respondent company
about the damage to the vehicle. The respondent company having appointed a
surveyor and subsequently vide their letter dated 26.09.2008 have repudiated the
claim interalia on the ground that the complainant had got his vehicle dismantled
without giving an opportunity to the surveyor to assess the loss. Secondly, they had
also contended that the complainant had deliberately removed the vehicle from the
spot of the accident without the consent of the respondent company. The only point
coming for consideration is whether the respondent company is justified in
repudiating the claim.
3. On going through the facts available, the complainant (who happens to be a highly
respected doctor of Jaipur) and according to his statement, the said vehicle, while
driving, went down in a pit full of water on a rainy day and stopped at once.
Thereafter he had removed the vehicle to a workshop and informed the respondent
company. The respondent company had appointed one surveyor Shri Pramod who
had submitted his report dated 23.09.2008. In the report, he had confirmed the
version of the complainant that the said vehicle fell in to a ditch of water. From the
statement and letter written by the complainant, it is also established that the
surveyor had taken photographs and inspected the vehicle in the workshop.
Subsequently, the complainant had got his vehicle repaired in the same workshop
and entailed expenditure for getting the car repaired.
4. On going through the rejection letter given by the Insurance Company, I find that
one of the reasons mentioned by them is that the complainant had deliberately and
with intention to suppress the nature of accident had removed the vehicle without
their consent and not having given an opportunity to appoint a spot surveyor. I
would like to comment on this point, first of all, that this contention of the
respondent company is absolutely baseless and cannot be sustained for the simple
reason that they cannot expect the insured to keep the car on the same spot where
it was struck that too in a rainy day and alleging malafied intention to the
complainant without any material. They are very improper. Secondly it is well
established practice of insurance that spot survey is not resorted to in a private
vehicle. It is generally deputed where a commercial vehicle met with an accident.
Therefore, the reason quoted by them is absolutely baseless and cannot be
entertained. Taking the second ground on which they have rejected the claim is that
the complainant had dismantled the vehicle without the inspection from their
surveyor. I am afraid that this is also not true as only after the surveyor had taken
photographs, the vehicle was dismantled
5. I do not understand what more permission the Insurance Company wants from the
surveyor and in fact the surveyor can assess more loss only after the engine is
dismantled. Therefore, the stand taken by the Insurance Company for rejecting the
claim purely on these two non-sustainable grounds is most regrettable.
6. Besides, the complainant has rightly pointed out that he is a doctor and would be
the last person to keep the vehicle in a workshop and deprive himself from the
mobility in the city that too when his past history confirms that he was enjoying no
claim bonus ever since. I am afraid the respondent company had acted in a most
irresponsible way and not assessing and settling the claim of the complainant.
Therefore, at this stage, it is not possible for us to actually assess the loss etc. and
the survey having not done his job at the appropriate time, I have no other option
but to accept the expenditure already spent by the complainant to repair and keep
his vehicle in a road worthy condition as per the bill available on the file submitted
by Alfa Motors, the amount works out toRs.43179.
7. I, therefore, direct the respondent company to settle the claim for the said amount
to the complainant immediately without applying any amount towards depreciation
etc. since the settlement of the claim has been unduly & without any justification
delayed especially for no fault of the complainant.
8. With these directions, the complaint is disposed of accordingly.
9. Copies of the Award to both the parties.
Case No.GI/166/NIA/09
In the matter of Shri V.K. Rohilla Vs
The New India Assurance Co. Ltd.
ORDER dated 25.02.2010
1. Shri V.K. Rohilla has made a complaint to this Forum on 23.06.2009, against The New
India Assurance Co. Ltd. regarding non settlement of Motor claim under policy no.
320303/31/08/01/00003759.
2. On intervention of this office, we have now been informed by The New India
Assurance Co. Ltd. that they have settled the claim of Shri V.K. Rohilla for
Rs.3,19,500/- vide cheque no. 429762 dated 10.07.2009 drawn on Canara Bank.
3. There is no further relief to be granted to the complainant.
4. Hence the complaint is disposed of.
5. Copies of the Order to both the parties.