Haryana

Karnal

CC/166/2015

Anshul Bansal S/o Vijender Kumar - Complainant(s)

Versus

1. United India Insurance Company Pvt. Ltd - Opp.Party(s)

Somesh Garg

16 Jun 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                               Complaint No.166 of 2015

                                                               Date of instt.: 27.07.2015

                                                               Date of decision:16.06.2016

 

Anshul Bansal son of Vijender Kumar, resident of House no.17, Sector-14, Urban Estate, Karnal.

 

                                                                   ……..Complainant.

                                      Vs.

1. United India Insurance Co. Pvt. Ltd. Karnal through its Divisional Manager Karnal.

2. United India Insurance Co. Ltd. Motor Dealer Office SCO 123-124, Ground Floor Sector 17-B Chandigarh 160017 (U.T.)

3. United India Insurance Co. Ltd. Registered & Head Office; 24, Whites Road, Chennai-600014.

 

                                                                   ………… Opposite Parties.

                     Complaint u/s 12  of the Consumer Protection Act.

 

Before                   Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-        Sh. Suresh Garg  Advocate for the complainant.

                     Sh.Narinder ChaudharyAdvocate for the Opposite parties.

                    

 ORDER:

 

                        This complaint has been filed by the complainant u/s 12 of the Consumer protection Act 1986, on the averments that he got his Mahindra Bolero vehicle bearing registration no.HR05 Y9121 insured with the opposite parties, vide policy no.110701/31/12/P300539923. The said vehicle was stolen on 16.3.2013 by some unknown person from his house and in that regard first information report no.214 dated 16.3.2013 was lodged in Police Station Civil Lines Karnal. Intimation was also sent to the opposite parties. All the formalities were completed and requisite documents are submitted to the opposite parties. Police was unable to trace the said vehicle and ultimately submitted the untraced report on 19.5.2015, which was accepted by the learned Illaqa Magistrate. Thereafter, untraced report was also submitted to the opposite parties. However, the opposite parties repudiated his claim, vide letter dated 11.4.2014, on the ground that intimation regarding theft of the vehicle was given to the opposite parties after a period of 2 months 5 days from the date of theft. Repudiation of the claim on such false ground amounted to deficiency in service on the part of the opposite parties, which caused him mental pain and harassment, apart from financial loss.

2.                Notice of the complaint was given to the opposite parties, who appeared and filed written statement controverting the claim of the complainant.  Objections have been raised that the complainant has suppressed the material facts from this Forum; that there was unexplained delay in intimation of theft to the opposite parties; that the complaint is not legally maintainable and that there is no deficiency or unfair trade practice on the part of the opposite parties.

                   On merits, it has been submitted that the vehicle of the complainant was allegedly stolen on 16.3.2013, whereas the intimation was given and papers were submitted to the opposite parties on 22.5.2013 i.e. after the delay of two months five days from the date of theft, and such there was violation of terms and conditions of insurance policy wherein it has been specifically mentioned that insured has to give intimation regarding loss of the vehicle immediately after such loss. Therefore, the claim of the complainant was rightly repudiated as no claim. The other allegations made in the complaint have been denied.

3.                In evidence of the complainant,  his affidavit Ex. CW1/A and documents Ex.C1 to C3 have been tendered.

4.                On the other hand, in evidence of the opposite parties, affidavit of S.S.Vasudeva Deputy  Manager Ex.OP1and documents Ex.OP2 to Ex.OP5  have been tendered.

5.                We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.                Admittedly, the Mahindra Bolero vehicle bearing registration no.HR05 Y9121 of the complainant was insured with the opposite parties and the same was stolen from his house on 16.3.2013 during subsistence of the insurance policy. The claim lodged by the complainant with the opposite parties was repudiated, vide letter dated 11.4.2014, on the ground that the intimation of the theft to the opposite parties was given after two months five days, which was violation of condition of the insurance policy.

7.                 Learned counsel for the opposite parties put a great thrust upon the contention that as per the condition of the policy intimation regarding loss/theft of the vehicle was required to be given to the opposite parties immediately after loss, but the complainant did not give such intimation immediately, rather gave intimation on 22.5.2013 i.e. after a delay of two months five days from the date of theft i.e.16.3.2013. So, there was violation of the terms and conditions of the policy and claim of the complainant was rightly repudiated by the opposite parties on the ground of delayed intimation of theft.

7.                To wriggle out the aforesaid contention learned counsel for the complainant vehemently argued that intimation of the theft of the vehicle was given to the opposite parties immediately after theft, but no document supplied by the opposite parties regarding receiving such intimation. Lateron, written intimation was also given. When the claim was lodged by the complainant, the opposite parties illegally repudiated the same on false ground that intimation was given after delay of two months and five days.

8.                The complainant has alleged that information of the theft was given to opposite parties as well as their agent, who issued the policy. However, the opposite parties submitted that the written intimation was given by the complainant to the opposite parties on 22.5.2013 and the copy of the same is Ex.O5. Generally, insured persons inform the insurance company on telephone regarding the loss/damage, but record of such telephonic message is not maintained. The opposite parties had deputed investigator as is evident from the noting on Ex.O5. However, no report of the surveyor has been placed on the record. Neither it has been pleaded nor there is any evidence that the investigator did not find the theft of the vehicle as genuine. Therefore, under such circumstances, the opposite parties were not justified in repudiating the claim of the complainant on the technical ground that there was delay of two months five days in giving intimation of theft of the vehicle to the opposite parties.

9.                 Insurance Regulatory and Development Authority issued circular dated 20.9.2011 which is reproduced as under:-

“ To: All life insurers and non-life insurers.

  Re: Delay in claim intimation/documents submission with respect to

i.        All life insurance contracts and

ii.       All Non-life individual and group insurance contracts.

          The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.

         The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances.

          The insurers’ decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good ‘spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.

          Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.

          The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers’ stand to condone delay on merits fort delayed claims where the delay is proved to be for reasons beyond the control of the insured.

          J.Harinarayan

          CHAIRMAN.”

 

10.              It is clear from the above circular that insurance company cannot repudiate the theft claim on technical grounds like delay in intimation and submission of some required documents. The decision of insurer to reject a claim of the claimant should be based on sound logic and valid reasons. The limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holder losing confidence in the insurance industry, giving rise to excessive litigation. It has further been advised in the said letter that the insurer must not repudiate such claims unless and until the reasons for delay are specifically ascertained, recorded.

             What is the spirit of insurance policy, should be kept in mind by the officials dealing with the genuine claims of the sufferers and the same should not  be rejected on methodological grounds in a mechanical manner. The tendency of insurance companies in rejecting genuine claims is the reason of increasing litigation between the insurers and the insureds/their legal heirs. In this context reference with advantage may be made to orders of the Hon’ble State commission in  Shriram General insurance Company limited Versus Rajesh Kumar 2014(2) CLT 290 and Shriram General Insurance Company Limited Vs. Manoj 2014(3) CLT 447 as well as order of Hon’ble National Commission IV (2014) CPJ 62 (NC) National Insurance Co.Ltd. Versus Kulwant Singh .

11.              In the instant case, the vehicle of the complainant was stolen on 16.3.2013 from his house. The matter was immediately reported to the police and First Information Report no.214 dated 16.3.2013 was lodged in the Police Station Civil Lines Karnal. It is not the case of the opposite parties that the theft was not found genuine by the investigator deputed for investing the theft. The vehicle could not be traced out by the police and untraced report was submitted, which was accepted by the learned Judicial Magistrate Karnal, vide order dated 19.05.2015, the copy of which is Ex.C4. Under such circumstances, the repudiation of the claim of the complainant by the opposite parties was contrary to the spirit of the letter of Insurance Regulatory and Development Authority, because intimation to the insurance company after two months five days was not significant in genuine claim of the complainant. A person who lost his vehicle straightway may not go to the insurance company to claim compensation. At the first instance he himself makes efforts to search the vehicle. Filing of the claim with the insurance company is the last resort. Therefore, repudiation of the genuine claim of the complainant on the sole ground of delay in intimation amounted to deficiency in service on the part of the opposite parties.

12.              As a sequel to the foregoing discussion, we accept the present complaint and direct the opposite parties to pay Rs.4,00,000/- as insured amount to the complainant  alongwith interest thereon @ 9% per annum from the date of filing of complaint till its realization. We further direct the opposite parties to pay Rs.5500/- to the complainant on account of mental agony and harassment suffered by him and for the litigation expenses. This order shall be complied within 30 days from the receipt of copy of this order. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 16.06.2016

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member