Orissa

Kendujhar

CC/1/2016

Ranjit Kumar Barik - Complainant(s)

Versus

1.Branch Manager,ICICI Lombard Genral Insurance Co.Ltd.& others - Opp.Party(s)

M.Parida,G.Mohapatra & G.N.Jena

22 Feb 2017

ORDER

IN THE COURT OF THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

KENDUJHAR

CONSUMER COMPLAINT CASE NO. 01 OF 2016

    Ranjit Kumar Barik, 26 years,

    S/o- Harish Chandra Barik,

    At- Dudhaposi, P.O- Raigoda,

    P.S- Nayakote, Dist- Keonjhar…………………………………..Complainant

                             Vrs.

1. Branch Manager,

    ICICI Lombard General Insurance Co. Ltd.

   APJ House, 15 Park Street, Kolkata- 700016

2. Swasati Behera, Unit Sales Manager,

    ICICI Lombard General Insurance Co. Ltd.

    At- Parida Market Complex,

    2^nd Floor, Near PWD Office, Keonjhar,

   At/Post- Keonjhargarh,

    P.S- Town, Dist- Keonjhar

3. Abhaya Kumar Roul,

    Agent ICICI Lombard General Insurance Co. Ltd.

    Vide Agency Code No. 5706667,

    At- Parida Market Complex,

    2^nd Floor, Near PWD Office, Keonjhar,

    At/Post- Keonjhargarh,

    P.S- Town, Dist- Keonjhar

4. Authorized Person,

    ICICI Lombard House, 414, Veer Savarkar Marg,

    Near Sidhi Vinayak Temple, Prabhadevi,

    Mumbai- 400025……………………………..Op. Parties

PRESENT:

 Shri Purushottam Samantara, President

 Smt. B. Giri, Member (W)

 Adv. for the Complainant - Sri Mohan Parida, Ganesh Mohapatra & G.N. Jena

 Adv. for the OPs - Sri Aswin Kumar Pattnaik & R.R. Rana

__________________________________________________________________________________________ 

Date of Filing- 01.01.2016                                                                                           Date of Order- 22.02.2017

SHRI PURUSHOTTAM SAMANTARA, PRESIDENT

1. Succinctly put, the complainant owned a vehicle (TATA Tipper) bearing Regd. No. OR 09J 7574, Model No.SK1613TC being insured under Goods Carrying Vehicles package and the Policy No. 3003/68006545/00/B00, dt.8.12.2011. The vehicle stands with Chassis No.373134 KSZ 123580 & Engine No.697TC56KSZ143654 of Manufactured of 2007 and Cubic capacity-2000.

2. The complainant also averred, the truck bearing Regd. No. OR 09J 7574 was plied to earn livelihood financed by Magma Finance Co. Ltd. and subsequently referenced by IndusInd Bank Ltd. Barbil.

3. Submitted the vehicle under Goods Carrying Vehicles package Policy covered Insurance from the date of 30.11.2011 to 29.11.2012 but unfortunately get stolen on the date of 31.7.2012 at about 11 pm. while the driver at its dinner at Bileipada Dhaba.   

4. On the occurrence, FIR lodged on dt.2.8.2012 at Joda, the P.S Case No.125/dt.2.8.2012 under section 379/34 IPC.

5. The incident intimated to the Insurer with require claim form and document. The claim No.MOT 02648437, the Insurer failed to settle the claim and lastly intimating on dt.13.7.2015 that the claim is closed for non-submission of document.

6. The complainant further submitted, the Insurer playing hide and seek non-settling a genuine claim since last three years on vague ground of repudiation though submitted with necessary documents which is above unfair trade practice and deficiency of service non-settling the claim within statutory time limit.

7. Prayed, the too belated delay urged him to institute the case, same be redressed as per the law necessary direction be passed in providing reliefs as deems under the law. Relied affidavit on Policy certificate, RC Book and documents in photo copies.

8. In pursuant to notice, the OPs appeared in filing the version at too belated time. Averred ICICI Lombard General Insurance Co. Ltd. is the Insurer and insured the vehicle in question.

9. Further submitting the chronology of issuance of letter and subsequent investigation speaks the meticulous performance in rendering service to the Insured and no way, it turnout to be a case of deficiency of service.

10. But, it is a fact, the complainant’s non-submission, non-response in giving the requisite material and document impel to close the claim on non-submission ground.

11. Further to say, the case lacks cause of action, for mis-joinder and non-joinder of parties, hopelessly barred of limitation and having no merit is not tenable under law.

12. Prayed, in the above circumstance, the case is liable to be dismissed with cost.          

13. Heard the learned counsels and perused the materials on record.

14. Perusal reveals, the P.S Case No.125/2012 U/s.379 has been lodged. The corresponding GR Case No.490/2012 has decided on dt.6.11.2013, the accused Bidesi @ Balaram Munda, get acquitted on the case and pending against other accused. The final order passed on the seized property.

15. As regards to policy, it is come across, the period of insurance covers from dt.30.11.2011 to 29.11.2012 and the alleged theft incident occurred on dt.31.07.2012 at about 11 pm. So it is observed the occurrence as reported is within Insured period. Post claim intimation, the letter dated 13.07.2015 by the Insurer closed the claim due to non-submission required documents. However the complainant advanced the required documents has been sent with registered post. The Ops rebuttal not supported any documentary material as evidence such as issue register, claim process file and surveyor report in extensive and comprehensive perusal, so same advance is not sustainable. Even if the non-production document can be taken into post institution of the case in settlement of the matter, which shows insurer for no reason dragging case to his ulterior end.      

16. In this context we prefer to mention and made reference the statute and authorities as declared.

IRDA Regulation, 2002, Sub-clause 5 of clause 9- reads -

(3) If an Insurer, on the receipt of survey report, finds that it is incomplete in any respect, he shall require the surveyor under intimation to the Insured, to furnish an additional report on certain specific issues as may be required by the Insurer. Such a request may be made by the Insurer within 15 days of the receipt of the original survey report.

                Provided that ……………………………………….

…………………………………………case of a claim.

(4) The surveyor on receipt of this communication shall furnish an additional report within three weeks of the date of receipt of communication from the Insurer.

(5) On receipt of the survey report or the additional survey report, as the case may be, an Insurer shall within a period of thirty days after a settlement of the claim to the Insured. If the Insurer, for any reason to be recorded in writing and communicated to the Insured, decide to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of the survey report or the additional survey report, as the case may be.

And the Authority speaks- “Claim not decided/ repudiated within 30 days from the date of receipt of the survey report as per sub-clause 5 of Regulation No-9- Deficiency of service by Insurer-

National Insurance Company Ltd. V/s. Rajesh Kumar Kalia 2013 (2) CLT 417 (PB)

The circular dated September 20th, 2011 (Annexure-A) issued by INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY is as under:-

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY Ref.

IRDA/HLTH/MISC/CIR/216/09/2011 Date: 20.09.2011 CIRCULAR To: All life insurers and non-life insurers Re:

Delay in claim intimation/documents submission with respect to.     

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 merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.

J. Harinarayan CHAIRMAN

17. On other hand and it is a fact that OP deputed surveyor & loss assessor named Prabal Bose, who has already received the requisite document as advised by him, which is contented vehemently by the petitioner so the ground of rejection made by the Insurer is not subscribed by us and also not believable. As to the OP pleadings in para 9 the reliance made on Investigation report is not tabled before the Forum, so entire cream of the proceedings do not stand by with any substantative document placed by the OP. The submissions are hallow based and contravenes the laws and regulation, thus we believe, the claim be allowed as same found to be genuine and the complainant deserves compensation due to willful sufferance that made out in the case. Thus Op is liable.

18. On the nature of settlement, we prefer to place reliance on the principle as laid down in the decision- “National Insurance Co. Ltd. Versus Prem Chand” decided on 12.3.2001, “(2001) CPJ 60 (NC) that where the terms and conditions of the policy were violated, the Insurance company settled the claim on “Non- Standard” basis.

The relevant portion of the same is reproduced:-

It is settled by Four Members Bench of the Hon’ble National Commission in “National Ins. Co. Ltd. versus Prem Chand” decided on 12.3.2001, II (2001) CPJ 60 (NC) that where the terms and conditions of the policy were violated, the insurance companies settled the claim on “non-standard” basis.

“Following types of claims shall be considered as non-standard and shall be settled as indicated below are recording the reasons:-

Sr. No.	Description	Percentage of settlement
(i)	Under declaration of licensed carrying capacity	Deduct 3 years’ difference in premium from the amount of claim or deduct25% of claim amount, whichever is higher.
(ii)	Overloading of vehicles beyond licensed carrying capacity	Pay claims not exceeding 75% of admissible claim.
(iii)	Any other breach of warranty/ condition of policy including limitation as to use	Pay up to 75% of admissible claim.

  

   The IDV is                                       Rs.6,07,966/-

   75% of the IDV is                            Rs.4,55,974/-

   ( - )  Policy excess                            Rs.2,500/-

  _________________________________________

       Net Total  -                                   Rs. 4,53,474/-

 

       In view of the above made discussion, we considered the petitioner’s entitlement is allowed and the OPs advancement has no leg to stand. Hence ordered:

 

O  R  D  E  R

 The case is allowed on contest. The OPs are hereby directed to pay the settled amount i.e. a sum of Rs.4,53,474/- (Four lakh fifty three thousand four hundred seventy four) to the financer (IndusInd Bank) within four weeks of this order, failing @6% interest per annum will be accrued on the same amount till realization.

(ii) The financer (IndusInd Bank) is directed to disburse the rest amount to the petitioner besides the amount, that the petitioner owes to the bank without any demur.

(iii) No order as to cost and compensation.

 

Copy of the Order be made available to the parties as per rule.

File be consigned to record room.

Pronounced, 22^nd February 2017.        

                                                                                                                                                            

         I agree                                                

    (Smt. B. Giri)                                                                                            (Shri Purushottam Samantara)

    Member (W)                                                                                                              President                    

DCDRF, Keonjhar                                                                                                   DCDRF, Keonjhar                                                    

          

                                                                               Dictated & Corrected by me

                                                                              (Shri Purushottam Samantara)

                                                                                          (President)

                                                                                    DCDRF, Keonjhar