Punjab

Patiala

CC/14/315

Surjit Singh - Complainant(s)

Versus

Divisional Office,United india Insurance Co Ltd - Opp.Party(s)

24 Apr 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

PATIALA.

 

                                      Complaint No. CC/315 of 10.11.2014

                                      Decided on: 24.04.2015

 

Surjit Singh S/o Jang Singh R/o village Rahoti Khass, Tehsil Nabha, District Patiala (aged 37 yrs.)

                                                                   ….....Complainant

                                      Versus

Divisional Office, United India Insurance Co.Ltd., Ankur Bhawan, Lower Mall, Opp. Polo Ground , Sai Market, Patiala through its Divisional Manager.

                                                                  …............Op

                                      Complaint under Section 12 of the

                                      Consumer Protection Act.

 

                                      QUORUM

 

                                       Sh.D.R.Arora, President

                                      Smt.Neelam Gupta, Member                                 

Present:

For the complainant:        Sh.Amit Kumar Bedi, Advocate

For Op        :                  Sh.D.P.S.Anand,Advocate                

                                     

                                         ORDER

D.R.ARORA, PRESIDENT

1. The complainant had got his truck bearing registration No.PB-11-AP-9475 , engine No.AZF 100156 and chassis No.AIA00437 insured with the op vide policy No.1110003111P147190292 for the sum insured of Rs.10,04,144/- for the period 18.1.2012 to 17.1.2013.
2. The said truck of the complainant was snatched by some miscreants near  main Jawahar Nagar, Loni Road, near Mithlanchal Restaurant (U.P.)  on the intervening night of 4/5.12.2012 from its driver namely Lakhwinder Dass s/o Nirmal Dass, who was accompanied by his helper Kala, regarding which  FIR No.0 dated 7.12.2012 was lodged with P.S.Karawal Nagar, District North East Delhi. The complainant immediately informed Sh.Vijay Kumar, Development officer of the op about the said incident telephonically and without delay also gave the written intimation about the same to the op and  submitted requisite documents as demanded by the op. He also lodged formal claim and requested for the settlement of his claim.
3. A surveyor/Investigator was appointed by the op, who visited the complainant, the police station etc. All the necessary documents were supplied to the surveyor but he has wrongly stated in his report that the complainant failed to supply the necessary documents and did not co-operate. The complainant obtained his report under the RTI from the op. The complainant issued a reminder dated 14.3.2013 by hand to the office of the op at Patiala. However, the complainant received letter dated 18.4.2014 from the op having disclosed that his claim was processed as “No Claim” as he failed to provide the necessary documents and co-operate with the Investigator/Op. After receipt of the said letter, the complainant approached the op at Patiala and disclosed that he had submitted all the requisite documents before the Investigator. As regards the submission of the untraceable report  to be issued by the court, it was for the Investigator to have collected the same from the concerned court/police station as under the law, the complainant is not bound to provide the same particularly when the company had got the claim investigated. Despite best efforts made by the complainant, he failed to get his claim settled by the op although it should have been settled within a period of  two months from the date of the submission of the claim. The complainant has challenged letter dated 18.4.2014 whereby his claim was filed as “No Claim” to be false, wrong, illegal and to have been issued against rules and regulations of the IRDA. The act of the op in having issued the said letter is also said to be deficiency in service as also unfair trade practice, which resulted into the harassment and the mental agony experienced by the complainant. Accordingly the complainant brought this complaint against the Op under Section 12 of the Consumer Protection Act,1986 ( for short the Act) for a direction to the Op to pay him Rs.10,04,144/- towards the insured amount of the truck with interest; to pay him Rs.one lac by way of compensation on account of the harassment and mental agony experienced by the complainant and further to award him Rs.22000/-towards the expenses of the litigation.
4. On notice, the op appeared and filed the written version. It is admitted by the op that truck No.PB-11-AP-9475 of the complainant was insured with the op for the sum insured of Rs.10,04,144/- for the period 18.1.2012 to 17.1.2013. The Op has however, denied the version regarding the truck to have been taken away by some miscreants from the driver of the complainant and that the FIR regarding the same was lodged with P.S.Karawal Nagar, Delhi. It is denied that the complainant had immediately informed the development officer of the op telephonically or that the written intimation was given by the complainant to the op alongwith the documents. The complainant had informed the op on 24.12.2012 regarding the incident having taken place on 4.12.2012 and thereafter, the complainant had not lodged any claim with the op nor he supplied any documents. He was not co-operative. On receipt of the intimation of loss, the op had deputed Sh.Ajay Kumar Sharma, Surveyor and Loss Assessor, 124 Punjabi Bagh, Apartments Rohtak Road, New Delhi, who submitted his report dated 10.12.2013 having observed that he had contacted the complainant and requested him to submit the requisite documents in support of his claim and he also reminded the complainant in this regard but every time with no response and therefore, he recommended that the claim was pending for a long time for want of documents and that the insured was not co-operative and it appeared that he was not interested  to pursue his claim and recommended that the claim to be declared as ‘No Claim’ under the terms and conditions of the policy.
5. It is further averred that the claim of the complainant has been settled and the complainant was informed vide letter dated 18.4.2014.It is denied that the terms and conditions of the policy were not supplied by the op to the complainant or that only cover note was provided to him. It is also denied that that cause of action had accrued to the complainant on 4.12.2012 and 18.4.2014. He had no cause of action to file the complaint. After denouncing the other averments of the complaint, going against the op, it was prayed to dismiss the complaint.
6. In support of his complaint, the complainant produced in evidence Ex.CA, his sworn affidavit alongwith documents Exs.C1 to C6 and his counsel closed the evidence.
7. On the other hand, on behalf of the op, it’s counsel tendered in evidence Ex.OPA, the sworn affidavit of Smt.Kanta Devi, Deputy Manager  in the office of the Op, Ex.OPB, the sworn affidavit of Sh.A.K.Sharma, Surveyor and Loss Assessor, New Delhi alongwith the documents Exs.OP1 to OP6 and closed its evidence.
8. The Op filed the written arguments. We have examined the same, heard the learned counsel for the parties and gone through the evidence on record.
9. Ex.C3 is the copy of Zero-FIR No.20120001 dated 7.12.2012 lodged by Lakhwinder Dass s/o Nirmal Dass with P.S.Karawal Nagar, North East District Delhi and a perusal of the same would go to show that the author of the FIR namely Lakhwinder Dass was employed as driver with truck No.PB-11-AR-9475 owned by Sh.Surjit Singh S/o Jang Singh r/o Routi Khas ,Tehsil Nabha, P.S.Bakshiwala, District Patiala and that on 4.12.2012 at about 3:00AM, he had left the truck loaded with the goods accompanied by his helper Mr.Kala from Nabha for Jawahar Nagar Loni Road. After unloading the paper the truck was parked  on main road, Jawahar Nagar Loni Road. At about 5:00PM factory owner had given the freight , At about 6:00PM he alongwith his helper had been cleaning the truck that one person aged 40 years approached them. He was holding the Laddus (sweets) in his hand and  said that it was a Prashad of God. Both of them had taken one Laddu  each and they consumed the same. They had sit in the truck because the entry had to open at night and thereafter  they had not remained in their consciousness. He (Lakhwinder Dass) got his consciousness on the next day i.e. 5.12.2012 in the morning at 5:00 and he found himself lying on Jawahar Nagar Loni Road towards Loni. His truck and the helper were found missing. He also found the cash of Rs.14000/-  put in his right pocket and a sum of Rs.8000/- kept in his wallet as also his mobile phone to be  missing. He then reached the factory where he had unloaded the goods and with the help of the owner Surjit Singh informed telephonically  the owner of the truck in Punjab, who arrived at Delhi and tried to search out the truck. They also could not contact the helper on his mobile phone No.98152-16966.The truck as also Mr.Kala had been abducted by the person having served them with intoxicated  laddu (Prashad).
10. Ex.C6, is the copy of the letter dated 18 April,2014 written by the Sr.Divisional Manager of the Op to the complainant on the subject: Stolen of Truck No.PB-11AT-9475 of Sh.Surjit Singh insured under policy No.1110003111P147190292 Claim No.1110003113C050467001 Date of Loss 4.12.2012  and informed him, “ We are sorry to inform you that as per our Investigator Sh.Ajay Sharma report dated 10.12.2013 mentioned that the claim pening for a long time for want of requisite documents alongwith final police report duly accepted by the Hon’ble Court and other required documents. As per his version you have not been co-operated to Investigator for completion of required documents.

Keeping  in view the above we presume that you are not interested to complete the same and the Competent Authority marked the claim as No Claim. This is for your information”.

11. It was submitted by Sh.A.K.Bedi, the learned counsel for the complainant that as per letter,Ex.C6/OP1, the Op had filed the claim of the complainant as ‘No Claim’ as he failed to co-operate  in the matter of submitting the requisite documents but now in the written version filed by the Op,  they have said a good bye to the said plea taken up vide the repudiation letter Ex.C6/OP1 and have now come forward with the plea that the complainant had intimated the loss on   24.12.2012, the loss having taken place on 4.12.2012, which amounts to a violation of condition no.1 of the policy. It is also the plea taken up by the Op that the complainant had not lodged any claim with the Op nor supplied any documents. How it was possible for the Op to have filed the claim of the complainant as No Claim vide letter Ex.OP1 dated 18.4.2014 in case no claim was filed by the complainant with the Op. Sh.Bedi placed reliance upon the citations M/s National Insurance Co.Ltd. Vs. Aboobacker S/o C.H.Muhammed Appeal No.38/2013 decided on 20.12.2013 by the Hon’ble Kerala State Consumer Disputes Redressal Commission Vazhuthacad Commission Thiruvananthapuram  and  ICICI Lombard General Insurance Vs. Regula Ram Prasad FA.No.615/2007 decided on 24.11.2009 by the Hon’ble A.P.State Consumer Disputes Redressal Commission, Hyderabad  for the proposition that the Insurance company cannot take additional ground other than taken in the repudiation letter.
12. Sh.Bedi also submitted that even if there can be said to have occurred a delay of about 20 days in giving the intimation to the Op vide Ex.OP5, the claim of the complainant being genuine in as much as the FIR regarding the theft/abduction of the vehicle had been lodged by the victim Lakhwinder Dass on 7.12.2012 with P.S.Karwal Nagar North-East District Delhi and that  the Op has not got the matter investigated from its Investigator to belie the version of the theft/abduction of the truck as given by Sh.Lakhwinder Dass to the police and therefore merely on the ground of delay in giving the intimation of the loss to the Op by the insured could not be made a ground to repudiate the genuine claim of the complainant because the  Insurance Regulatory & Development Authority has issued Circular dated September 20,2011 as under:

:INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY

Ref:IRDA/HL TH/MISC/CIR/216/09/2011  dated 20.09.2011

18738202878.  

To:    All life insurers and non-life insurers

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

if supportLists]àI   [endif]àAll life insurance contracts

And

[if supportLists]àii  [endif]àAll 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”,

as quoted in the order dated 13.5.2014 passed by the Hon’ble State Consumer Disputes Redressal Commission, Haryana, Panchkula in First Appeal No.58 of 2014 titled as Shriram General Insurance Company Limited and others Vs. Joginder Singh, relied upon by the learned counsel for the complainant. In the case of the citation, the claim of the respondent-complainant was repudiated by the appellants /Insurance company vide letter,Ex.R3 which  stated: “This is with reference to the claim documents submitted by you, it has been  observed that loss allegedly took place on 26.11.2011 and the claim was intimated to us on 2.12.2011 as well as to the policy authorities belatedly as on 30.11.2013 which means that you had not given opportunities to police authorities  to investigate the matter immediately on that occurrence which has constituted overall loss. This constitutes serious breach of condition no.1 of the Insurance Policy…….”. The Hon’ble State Commission having made a reference to the aforesaid circular dated 20^th September,2011 of the IRDA observed, “ 9.       It is very clear from the above circular, that the insurance company cannot repudiate the bonafide claims on technical grounds like delay in intimation and submission of some required documents. The decision of insurers’ to reject a claim of the claimant should be based on sound logic and valid grounds. 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 procedural grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. It has been further advised in the above said letter that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded.

10.     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.

11.     In the instant case the vehicle was stolen on December 9^th,2010 and F.I.R. was lodged in the Police Station without any delay. Report of ‘Untraced’submitted by the Police is the best piece of evidence to prove that the vehicle was stolen.

12.     Thus, the repudiation of respondent’s claim was contrary to the letter Annexure-A, stated above because intimation to the insurance company after 12 days is not significant in genuine claim of the respondent-complainant. A person who lost his vehicle which was being used by him for earning livelihood 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 claim with the Insurance Company is the last resort. Under these circumstances, it was indeed a deficiency in service on the part of the appellant for repudiating respondent’s claim on flimsy ground. It    be fair or reasonable to reject even the genuine claims of the insuree which had been verified and found to be correct by the surveyor. There may be a condition in the policy regarding delay in intimation but that does not mean that the insurer can take the shelter under that condition and repudiate the claim of the claimant, which is otherwise proved to be genuine. In this view of the matter, the authority in Jagdish Parshad’s case(Supra) referred to by the learned counsel for the appellant is of no help to him”.

13. On the other hand, Sh.D.P.S.Anand, the learned counsel for the Op submitted that there is a clear violation of condition no.1 of the policy terms and conditions attached with the policy,Ex.C6 which provides: “Notice shall be given in writing  to the Company immediately upon the occurrence of any accident or loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the Company shall require. Every letter, claim, write summons and/or process shall be forwarded to the company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately by the insured shall have knowledge of any impending prosecution inquest or fatal inquiry in respect of any occurrence which may give rise to a claim under this Policy. In case of theft , criminal act which may be the subject of a claim under this policy the insured shall give immediate notice to the police and co-operate with the company securing the conviction of the offender”. He also placed reliance upon the citations Parveen Dalal versus Oriental Insurance Company & Ors. 1(2014)CPJ 546(NC), Budha Ganesh Versus New India Assurance Company Ltd. 1(2014)CPJ 411(NC), New India Assurance Co.Ltd. Vs. Ram Avtar 1(2014)CPJ 29(NC), Sagar Kumar Versus United India Insurance Company Ltd. II(2014)CPJ 33(NC) and Shish Pal Versus Reliance General Insurance Company Ltd.& others 2014(2)CLT 443 of the Hon’ble State Consumer Disputes Redressal Commission U.T.Chandigarh. In  the said citations, the delay of 16 days in giving the information to the Insurance company in the citation Parveen Dalal versus Oriental Insurance Company & Ors(supra), the delay of 9 days  in the case of the citation Budha Ganesh Versus New India Assurance Company Ltd. (supra), the delay of 35 days in the case of the citation New India Assurance Co.Ltd. Vs. Ram Avtar (supra), the delay of 6 months in the case of the citation Sagar Kumar Versus United India Insurance Company Ltd.(supra) and the delay of four days in the case of the citation Shish Pal Versus Reliance General Insurance Company Ltd.& others(supra) was treated to be fatal and violative of policy conditions and reference was also placed on the citation New India Assurance Company Vs. Trilochan Jane,IV(2012)CPJ 441(SC) to up hold the repudiation of the claim made by the insurer.

14.     We have considered the submissions and are of the considered view that in all the citations relied upon by the learned counsel for the Op, the circular dated 20^th September,2011 as quoted in the citation Shriram General Insurance Company Ltd. and other Vs. Joginder Singh (Supra) by the Hon’ble State Consumer Disputes Redressal Commiussion Haryana, Panchkula has not been discussed. It is important to note that in the said circular , at the end, the insurers were 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 our case, the complainant had purchased the policy Ex.C5 for the period 18.1.2012 to 17.1.2013 but surprisingly the same does not contain the additional wording about the powers of the insurer to condone delay on merit or delayed claims where the delay proved to be for reasons beyond the control of the insured, going to show that the instructions issued  by the IRDA vide circular dated  20.9.2011 have fallen on the deaf ear of the insurer. The Hon’ble State Consumer Disputes Redressal Commission Haryana, Panchkula in the case of the citation Shriram General Insurance Company Ltd. Vs. Joginder Singh (supra) observed that from the above circular it would appear that the insurance company can not repudiate bonafide claims on technical grounds like delay in intimation and submission of some required documents. The decision of insurers’ to reject a claim of the claimant should be based on sound logic and valid grounds. 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 procedural grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.

14. In our case the Op did not repudiate the claim of the complainant on the ground of delay in giving the intimation to the Op and rather they filed the claim as ‘No Claim’ as the claimant failed to furnish requisite documents alongwith final police report duly accepted by the Court as conveyed to the complainant vide letter,Ex.C6 dated 18^th April,2014. In the light of the citations M/s National Insurance Co.Ltd. Vs. Aboobacker S/o C.H.Muhammed (supra) and  ICICI Lombard General Insurance Vs. Regula Ram Prasad (supra) , the Op cannot be allowed to blow hot and cold in as much as in the repudiation letter they failed to take any ground regarding the violation of condition No.1 of the policy terms and conditions but now they have in the written version put forth the same. The Insurance company cannot take additional grounds other than taken in the repudiation letter.
15. It is important to note that the Investigator Sh.Ajay Sharma appointed by the Op submitted his report Ex.OP3 dated 10.12.2013 and he has no where found the version regarding the theft/ abduction of the truck to be doubtful and rather it is stated in the report that he had visited the insured’s place at Nabha and discussed the matter with him. He also enquired from the people in the surroundings and having gathered there. He also visited P.S.Karawal Nagar Delhi and met the I.O. who confirmed that the contents of the FIR are correct and the case was still under investigation and that till that date no clue of the culprits or the stolen vehicle had been found. Thus, it would appear that the Op has not been able to say that the claim of the complainant was not genuine. In case the complainant could not submit the untraceable report, to have been accepted the court of competent jurisdiction, it would not mean that the Op could repudiate the claim of the complainant. The  said report could easily be collected by the Investigator of the Op. The Circular dated 20^th September,2011 issued by the IRDA categorically provides that rejection of the claim on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. In our case, the Op has filed the claim of the complainant as ‘No claim’ on technical ground as the complainant could not furnish the final police report duly accepted by the court of Ilqua Magistrate as would appear from the repudiation letter, Ex.OP1 dated 8^th April, 2014.
16. Therefore, viewing the case of the complainant in the light of the repudiation letter, the same is to be treated as bad in the light of the circular  dated 20^th September,2011 issued by the Insurance Regulatory & Development Authority and the plea of the Op that there is a violation of condition No.1 of the Policy terms and conditions in giving the intimation to the Op immediately cannot be allowed to prevail because such a ground was not  taken by the Op in the repudiation letter and the same also  cannot come in the way of the Forum in granting the relief to the complainant because the claim of the complainant being genuine as can be said from the fact that the FIR regarding the theft/abduction of the vehicle was lodged immediately on 7.12.2012 by the victim Mr.Lakhwinder Dass vide Zero FIR No.20120001 with P.S.Karawal Nagar District North-East Delhi after he had called the owner of the truck telephonically with the help of the consignee of the goods delivered through the truck at Loni and therefore, in the light of the aforesaid circular of the IRDA, the Op could not repudiate the genuine claim of the complainant. We therefore, accept the complaint and direct the Op to pay the insured amount of the vehicle No.PB 11AP 9475 i.e. Rs.10,04,144/- with interest @9% per annum from the date of the repudiation i.e. 18.04.2014.  In view of the facts and circumstances of the case, the complaint is accepted assessed at Rs.4000/-. The order be complied by the Op within one month on receipt of the certified copy of the order.

Pronounced

Dated: 24.04.2015

 

                                      Neelam Gupta                           D.R.Arora

                             Member                                   President