Haryana

Karnal

08/2013

Palwinder S/o Harnam Singh - Complainant(s)

Versus

ICICI Lombard General Insurance Company - Opp.Party(s)

Sh. Balvinder Singh

11 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                               Complaint No. 08 of 2013

                                                             Date of instt.07.01.2013

                                                               Date of decision 11.07.2016

 

Palwinder son of Harnam Singh resident of Ward no.8, Virk market, near S.D. Mandhir, Charaunda, District Karnal.

 

                                                                                      ……..Complainant.

                                      Versus.

ICICI Lombard General Insurance Company Limited, Sector-12, Karnal through its Divisional Manager.

 

                                                                   ………… Opposite Party.

 

                     Complaint u/s 12  of the Consumer Protection Act.

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

                   Sh.Anil Sharma…….Member.

 

Present:      Sh. Balwinder Singh Advocate for the complainant.

                   Sh. Vineet Rathore Advocate for opposite party.

 

 ORDER:

 

                   This complaint has been filed by the complainant u/s 12 of the Consumer Protection Act 1986, on the averments that he got insured his motorcycle bearing registration no.HR-05-AC-7120 from opposite party, vide policy no.3005/1316361/1060/000, valid from 12.4.2011 to 11.4.2012, for insured value of Rs.39,853/-. On 4.3.2012 at about 12.00 noon he parked motorcycle in main Bazar, Gharaunda and went for purchasing some goods. When he returned after short time, he found that the motorcycle was stolen. He searched for the motorcycle and made enquiries from all nearby shopkeepers and other persons, but the same could not be traced. Ultimately, he got registered First Information Report no.88 dated 14.3.2012 in Police Station Gharaunda. Registration certificate, insurance policy and pollution certificate were lying in the dickey of the motorcycle. After lodging First Information Report, he informed the opposite party regarding theft of the motorcycle. The investigation was got conducted by the opposite party. All the formalities were completed by him, but opposite party did not settle the claim and postponed the matter on one pretext or the other. Such conduct on the part of the opposite party amounted to deficiency in service, which caused him mental pain and harassment apart from financial loss.

2.                Notice of the complaint was given to opposite party, who put into appearance and filed written statement controverting the claim of the complainant on various grounds. Objections have been raised that the complainant has not approached this forum with clean hands as the complaint is false, frivolous and vexatious to the knowledge of the complainant; that the complainant has no cause of action to file the present complaint and that the complaint is not maintainable as the complainant violated the terms and conditions of the policy as he did not inform the opposite party about the theft immediately as per condition of the policy.

                   On merits it has been submitted that the complainant was extremely negligent as he failed to exercise even reasonable care and caution for ensuring safety and security of the motorcycle. The theft of the motorcycle had taken place on 4.3.2012. The complainant lodged First Information Report on 14.03.2012 and gave intimation to the opposite party on 15.3.2012. Complainant was required to inform the police and opposite party about the loss of the vehicle immediately. Complainant violated the condition of the policy, therefore, no liability can be fastened upon the opposite party, because there was no deficiency in service on its part. 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 and C2 have been tendered.

4.                On the other hand, in evidence of the opposite party, affidavit of Meenu Sharma Legal Manager Ex.OP1/A and documents Ex.OP1/B to OP1/I 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.                It is admitted fact that the motorcycle of the complainant bearing registration no.HR-05-AC-7120 was insured with the opposite party and the same was stolen by some person during subsistence of the insurance policy on 4.3.2012. First Information Report regarding the theft was lodged by the complainant on 14.3.2012.  As per case of the complainant, the claim was lodged by him with opposite party, but the same was not decided by the opposite party and the matter was postponed on one pretext or the other.

7.                Learned counsel for the opposite party put a great thrust upon the contention that the complainant failed to exercise even reasonable care and caution in ensuring safety and security of the motorcycle and he parked the same in the market unattended. Moreover, the theft of the motorcycle had  taken place on 4.3.2012, but the First Information Report was lodged on 14.03.2012 and the intimation  was given to the opposite party on 15.3.2012 i.e. after delay of 11 days, which was violation of the condition of the insurance policy, therefore, the opposite party is not liable to pay any compensation to the complainant.

8.                To wriggle out the aforesaid contention, learned counsel for the complainant vehemently argued that the complainant initially tried to search the motorcycle at his own level and when the same could not be traced out the matter reported to the police immediately.  Thereafter, intimation was given to the opposite party. Thus, there was no unreasonable delay on the part of the complainant, but the opposite party refused to settle his claim on false ground of delay of 11 days in intimation.

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 in National Insurance Co.Ltd. Versus Kulwant Singh IV (2014) CPJ 62 (NC) .

11.              In the instant case, the vehicle of the complainant was stolen on 4.3.2012. The First Information Report was lodged on 14.3.2012. As per the case of the complainant, the motorcycle was parked by him in the market and he went to purchase some articles, but when he returned he found the motorcycle stolen. Whenever, a person would go to market to purchase some articles, he would certainly park the motorcycle at some place in the market, where there is no authorized place of parking, because it would not be possible to drive motorcycle in busy market. Therefore, it cannot be said that the complainant had no taken reasonable care regarding security and safety of the motorcycle. The plea raised by the opposite party in this regard cannot be accepted under such facts and circumstances of the case.

12.              Generally, the owner of the vehicle first tries to search the vehicle at his own level, but when he fails to trace out the same, the matter is reported to the police. It is also a matter of common knowledge that the police does not register the First Information Report immediately after getting information of theft of any vehicle, either the complainant is asked to trace out the vehicle at his own level or efforts are made by the police for searching the vehicle, but when the vehicle is not traced out, then only the First Information Report is registered. Such attitude is adopted by the police just to check increase in the  number of criminal cases registered during particular period. Therefore, it cannot be said that there was any unreasonable delay on the part of the complainant in lodging the First Information Report. It is not the case of the opposite party that the motorcycle of the complainant was not stolen and the story of theft putforth by him in the First Information Report was false. Thus, the claim of the complainant regarding theft of the motorcycle was genuine and never disputed by the opposite party. Under such circumstances, the repudiation of the claim of the complainant by the opposite party was contrary to the spirit of the letter of Insurance Regulatory and Development Authority, because intimation to the opposite party after 11 days of theft 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 party.

13.              As a sequel to the foregoing discussion, we accept the present complaint and direct the opposite party to pay Rs.39,853/- 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 party 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: 11.07.2016

                                                                                      (K.C.Sharma)

                                                                                          President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member