Order by:
Smt.Priti Malhotra, President
1. The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 stating that complainant purchased Motor Cycle Splendor Plus Self bearing registration no.PB29AA1801 and got the said vehicle insured from Opposite Parties, vide policy no.3410/01554703/000/00 for the period 19.03.2023 to 18.03.2024. On 22.05.2023, complainant gone to Sarafa Bazar at 10.50 and parked the vehicle in front of shop. When complainant had come out of shop after doing his work, he found his motorcycle missing. The complainant tried to find the motorcycle everywhere, but did not find the same and thereafter lodged the complaint regarding the said theft vide Rapat no.106 dated 16.06.2023 u/s 379 IPC, PS City South, Moga and intimation about the said theft was given to Opposite Parties and to the agency and lodged the claim with Opposite Parties, but the Opposite Parties, vide letter dated 01.04.2024 repudiated the claim of the complainant on the ground of delay. The complainant also issued a legal notice to Opposite Parties, but to no effect. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:-
a) Opposite Parties may be directed to release the amount of Rs.25,099/- i.e. insured amount.
b) To pay an amount of Rs.20,000/- as compensation on account of mental tension and harassment.
c) To pay an amount of Rs.20,000/- on account of deficient services.
d) And any other relief which this Commission may deem fit and proper be granted to the complainant in the interest of justice and equity.
2. It is pertinent to mention here that vide separate statement, the complaint against Opposite Party No.1 was withdrawn by the complainant.
3. Upon service of notice, Sh.Harmeet Singh Batth, Advocate appeared on behalf of Opposite Party No.2, but failed to file written reply within stipulated period of 30 days. Hence, defence of Opposite Party No.2 was struck of, vide order dated 17.09.2024.
4. In order to prove the case, the complainant has placed on record her affidavit Ex.CW1/A alongwith copies of documents Ex.C1 to Ex.C7.
5. We have heard the ld. counsel for both the parties and also gone through the record.
6. It is not disputed that the complainant purchased a Motor Cycle Splendor Plus Self bearing registration no.PB29AA1801 and got the said vehicle insured from Opposite Parties, vide policy no.3410/01554703/000/00 for the period 19.03.2023 to 18.03.2024. It is also not disputed that on 22.05.2023, the vehicle in question of the complainant got stolen and in this regard an FIR was got registered vide no.106 dated 16.06.2023 u/s 379 IPC, PS City South, Moga and intimation about the said theft was also given to Opposite Parties, but the Opposite Parties, vide letter dated 01.04.2024 repudiated the claim of the complainant on the ground of delay.
7. The perusal of the repudiation letter reveals that the Opposite Parties repudiated the claim of the complainant on the ground that there was delay in intimation and also delay in lodging FIR. For the sake of convenience, the contents of the said letter are reproduced as under:-
“This is with reference to the claim document submitted by you, it has been observed that theft of your vehicle took place on 22-May-22 and the claim was intimated to us belatedly as on 20-Jun-23 and also FIR was lodged belatedly after 25 days of theft incident. Hence there is delay in intimation to insurer and Delay in register FIR. This constitutes serious breach of condition Nos.1 and 8/9 of the insurance policy. Clarifications given by you vide your letter regarding the delay in intimation of the claim is not found to be satisfactory. This has prejudiced possibilities lies of recovery of the vehicle.”
8. The repudiation of the claim by the Opposite Parties on the abvoesaid ground is not genuine, as the complainant has produced on record copy of a letter dated 22.05.2023 (Ex.C8), vide which, he intimated the Police Station South, Moga about the theft of his motorcycle. Meaning thereby that the complainant intimated the police authorities concerned about the theft in time i.e. on the same day when theft of the vehicle in question took place and the delay occurred, if any, in lodging the FIR, is on the part of the police authority. Copy of the letter dated 22.05.2023 is scanned as under:-
9. The Opposite Parties also taken the plea that theft/accident allegedly took place on 22nd May, 2023 and the claim was intimated to them belatedly as on 20th June, 2023. In this regard, the complainant has also written a letter dated 09.11.2023 to the Opposite Party-Company clarifying the delay in intimation and produced on record copy of the said letter as Ex.C10, which is scanned as under:-
From the contents of the letter above, it is clear that the complainant duly explained the reasons of delay for lodging the claim with Opposite Parties. Thus in our considered opinion, the repudiation of the claim of the complainant by the Opposite Parties on the ground of delay in intiamtion is also not justified as per the IRDA circular issued to the Insurance Companies stating that the genuine claims shall not be rejected on hyper technical grounds i.e. delay etc. which for the sake of convenience is reproduced as under:-
“INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY
Ref. IRDA/HLTH/MISC/CIR/216/09/2011 Dated:20.09.2011 CIRCULAR
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 insurer’s 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 policyholders 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.”
In view of the circular mentioned above, it is quite clear that repudiation of the claim on hyper technical grounds in case of genuine claims is unreasonable and not sustainable. Further, in the instant case, the Opposite Parties have not challenged the theft in question and has not raised any objection regarding the same. Hence, the repudiation of the claim of the complainant by Opposite Parties is wrong and illegal.
10. Perusal of policy document Ex.C6 reveals that as per the policy in question, the IDV of the vehicle in question is Rs.25,098/-. Hence we allow the same.
11. Sequel to the above discussion, the present complaint is allowed in part and Opposite Parties are directed to pay Rs.25,098/- (Rupees Twenty Five Thousand Ninety Eight only) as IDV of the vehicle in question to complainant, subject to furnishing the letter of subrogation, power of attorney, indemnity bond and other required documents for transfer of Registration certificate of the vehicle in question, NOC from the financiers of the vehicle in question if any, by the complainant in favour of the Opposite Party-Insurance Company. Opposite Parties are further directed to pay compository cost of Rs.5000/-(Rupees Five Thousand only) to be paid to the complainant on account of compensation and litigation expenses. The pending application(s), if any also stands disposed of. The compliance of this order be made by the Opposite Parties within 30 days from the date of receipt of copy of this order, failing which, the Opposite Parties are burdened with additional cost of Rs.5,000/-(Rupees Five Thousand only) to be paid to the complainant for non compliance of the order. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.
Announced on Open Commission
