Punjab

Patiala

CC/14/352

Tejinder Pal Singh - Complainant(s)

Versus

Manager ICICI - Opp.Party(s)

Sh Ravinder Singh

10 Jul 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

PATIALA.

 

                                      Complaint No. CC/14/352  of 19.12.2014

                                      Decided on:         10.7.2015

 

Tejinder Pal Singh son of Sh.Harvinder Singh resident of 1130/3 Angurawali Masjid,Khalsa Moh.Patiala.

                                                                   …………...Complainant

                                       Versus

1.      Manager, ICICI Lombard GIC Ltd., Ist Floor, SCO-24-25 Sector-8-C,Madhya Marg, Chandigarh.

2.      ICICI Lombard GIC Ltd., Ist Floor SCO-24-25,Madhya Marg, Chandigarh through its M.D./Manager.

3.      Manager, ICICI Lombard GIC Ltd. H.O. Leela Bhawan, Patiala.

                                                                   …………….Ops

 

                                      Complaint under Section 12 of the

                                      Consumer Protection Act.

 

                                      QUORUM

 

                                      Sh.D.R.Arora, President

                                      Smt.Neelam Gupta, Member

                                      Smt.Sonia Bansal, Member                               

                                                                            

Present:

For the complainant:    None

For Ops:                        Sh.Dhiraj Puri, Advocate               

                                     

                                         ORDER

D.R.ARORA, PRESIDENT

1. The complainant got his motor cycle No.PB-11-AT-5622 make Hero Honda, bearing engine No.HK-10-EF-BHB30966 and chassis No.MCBHA-10-EZEHB, insured with the Ops vide  policy No.3005169378980/00/000.
2. The said motor cycle of the complainant was stolen , in respect of which the complainant lodged FIR with P.S.Sunlight Colony, New Delhi, vide FIR No.265 dated 5.8.2012. The complainant lodged the claim with the ops because of the motor cycle having not been traced out by the complainant and the members of his family. However, the ops failed to disburse the claim, which is said to be a deficiency of service on the part of the Ops. Accordingly the complainant has brought this complaint against the Ops under Section 12 of the Consumer Protection Act,1986 ( for short the Act) for a direction to the Ops to disburse the insurance amount; to pay Rs.60,000/-by way of compensation on account of the harassment and further to award the costs of the complaint.
3. On notice, the ops appeared and filed their written version. The Ops have admitted that the complainant had got his motor cycle insured with the Ops. The Ops had received the intimation regarding the theft of the vehicle on 15.11.2012 after a delay of 132 days. Thereafter, the complainant through his brother Sh.Ravinder Pal Singh submitted the claim with the Ops, who had also submitted a letter dated 24.11.2012 alongwith copy of the FIR and statement of the owner. Vide letters dated 29.1.2013 and 4.2.2013, the ops asked the complainant the circumstances for the delay in lodging the FIR as also in giving the intimation to the Ops but despite receipt of the letters by the complainant, he failed to give any reply and ultimately the claim of the complainant was repudiated vide letter dated 11.3.2013 as per the terms and conditions of the policy in as much as there was a violation of condition, which provided: “Notice shall be given in writing to the company immediately upon the occurrence of any theft loss or damage, 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, writ, summons and/or process or copy thereof shall be forwarded to the company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately 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 or criminal act which may be the subject of a claim under the policy the insured shall give immediate notice to the police and co-operate with the company in securing the conviction of the offender”.
4. Due to the late intimation of the incident by the complainant, the Ops had lost their value able rights to conduct the investigation and to recover the vehicle. The complaint is said to be frivolous and fictitious and it is alleged that the same is liable to be dismissed under Section 26 of the Act. Ultimately, it was prayed to dismiss the complaint.
5. In support of his complaint, the complainant produced in evidence Ex.CA, his sworn affidavit alongwith documents Exs.C1 to C4 and his counsel closed the evidence.
6. On the other hand, on behalf of the Ops, their counsel tendered in evidence Ex.OPA, the sworn affidavit of Meenu Sharma, legal manager of the ops at Mohali alongwith documents Exs.OP1 to OP6 and closed their evidence.
7. The complainant filed the written arguments. We have examined the same, heard the learned counsel for the parties and gone through the evidence on record.
8. Ex.OP6 is the copy of the letter bearing reference No.MOT/RR/Feb/2013 dated 11^th March,2013, written by the Ops to the complainant on the subject: Reference Claim No.MOT02795263 against Two Wheeler Package Policy No.3005/69378980/00/000 against bearing vehicle registration number PB-11-AT-5622 and informed the complainant that after having received the claim submitted by him and having scrutinized the same, they regret their inability to honour the claim for the below mentioned reasons: “Your above mentioned vehicle was stolen on 06^th July 2012 and FIR for the same has been lodged on 13^th July,2012.The FIR for the stolen vehicle is lodged after 7 days of the theft of the vehicle. This is violation of terms and conditions of Insurance Policy. The FIR should have been immediately lodged after the theft. The Motor Insurance Policy issued to you states-In case of theft or criminal act which may be the subject of claim under the policy the insured shall give immediate notice to the police and co-operate with the company in securing the conviction of the offender.

We have to further draw your attention that you have intimated claim to insurer after 132 days of date of loss. This is violation of policy condition. After the incidence took place, the claim should have been immediately lodged with the insurer. As per policy conditions-Notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured shall give all such information and assistance as the Company shall require.

In the circumstances, you are therefore, informed that the above captioned claim as made by you hereby stands as ,”No Claim”.

9. The complainant has not disclosed having received the said letter from the Ops. The Ops have also failed to disclose that the complainant was informed about his claim having been filed as ‘No claim”. The Ops have also not lead any evidence to show that the said letter was sent to the complainant through registered post/speed post.
10. Now coming  to the grounds, taken up by the Ops, in the letter Ex.OP6, whereby the claim of the complainant was filed as ‘No Claim”, first of all, it is the plea taken up by the Ops that theft of the vehicle had taken place on 6^th July.,2012 but the FIR was lodged on 13^th July,2012 i.e. after a lapse of seven days of the loss. In this regard, the complainant has produced  in evidence Ex.C4, the copy of FIR no.265 dated 13.07.2012 lodged with P.S.Sunlight Colony, South East District New Delhi and a perusal of the same would go to show that the motor cycle No.PB-11-AT-5622 bearing engine No.30996, chassis No.20705 black colour and model 2011 was lying parked in front of his H.No.27 at Hari Nagar Ashram and on 12.7.2012 the same was found missing from the site. The complainant moved the application in writing before Head Constable Rajesh Kumar No.659/SE PIS No.28961000 PS SL Colony New Delhi in the police station and on the basis of the same the FIR was recorded. In this way, it would appear that the theft of the vehicle had taken place in the morning of 12.7.2012 and the complainant lodged the FIR with the police of P.S.Sun Light Colony, New Delhi on 13.7.2012. Therefore, the ground taken up by the Ops in the repudiation letter Ex.OP6, is not found correct. There was not a delay of seven days as alleged in Ex.OP6 and rather there was a delay of one day only. The complainant might have tried to search out the vehicle in a period of one day at his own level and when he could not find out the same that he lodged the FIR with the police.
11. The other plea taken up by the Ops, in the letter,Ex.OP6 is that there occurred a violation of policy condition which provides: “Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage  in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require”.
12. In our case, the loss of the motor cycle had not occurred on account of any accidental loss or damage and rather it was a simple case of theft. In order to appreciate the plea of the Ops, we quote condition no.1 given in Ex.OP2 containing the terms and conditions of the policy attached with certificate-cum policy schedule, Ex.OP1 as under: “Notice shall be given in writing to the company immediately upon the occurrence of any accidental 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, writ, summons and/or process or copy thereof shall be forwarded to the Company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution, inquest or fatal injury in respect of any occurrence, which may give rise to a claim under this policy. In case of theft or 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 in securing the conviction of the offender”. The word ‘or’ used in second line of the condition after the word ‘accidental’  appears to have been put under a typographical mistake because the same does not figure in condition no.1 quoted by the Ops in their letter,Ex.OP4 dated 29.1.2013 and letter Ex.OP5 dated 4.2.2013 written to the complainant.
13. In the case of the citation First Appeal No.1510 of 2012 Randhir Singh Vs. Cholamandlam MS General Insurance Co.Ltd. & others, decided on 20.11.2014 by the Hon’ble State Consumer Disputes Redressal Commission Punjab, Chandigarh, the same  condition verbatim in policy Ex.C12 issued by Cholamandlam MS General Insurance Co.Ltd.was  a matter of interpretation and the Hon’ble State Commission observed: “This condition consists of two parts; the first part relates to accidental loss or damage and the second part relates to the theft or criminal act. Where the loss or damage is accidental, it is mandatory to give a notice in writing to the insurance company immediately upon the occurrence of such an accident and thereafter the insured is to give all the information and assistance as required by insurance company. In case of theft the only requirement was to give immediate notice to the police and co-operate with the insurance company in securing the conviction of the offender. There is no other term or condition in the insurance policy regarding giving of the intimation. As it was a case of theft of vehicle, so the complainant was required to give immediate notice to the police. There was no requirement of giving immediate intimation to the insurance company. The District Forum, while recording the finding in favor of the opposite parties-Insurance Company, mis-directed itself by holding that there was breach of condition no.1 in not giving the immediate information to the insurance company itself”.
14. Thus, it would appear that it is only in a case of accidental loss  or damage that the insured is obliged to give the intimation to the insurer but where the loss is because of theft or criminal act, the insured is obliged only to give the intimation to the police immediately and to co-operate with the Company in securing the conviction of the offender. The insured is not obliged to give any intimation  in case of theft or criminal act to the Company. Therefore, the second ground taken up by the Ops in the repudiation letter, Ex.OP6, is also found not tenable.
15. Moreover, in the case of the citation First Appeal No.58 of 2014 Shriram General Insurance Company Limited and others Vs. Joginder Singh, decided on 13.5.2014, by the Hon’ble State Consumer Disputes Redressal Commission Haryana,Panchkula,  a reference was made to the circular dated September 20^th,2011,(Annexure-A)  issued by ‘INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY   as under:

:INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY

Ref:IRDA/HL TH/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 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”.

It was observed by the Hon’ble State Commission,Haryana: ““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”.

16. In our case, there has not occurred any delay in the lodging of the FIR and even the complainant ( insured)  was not obliged to give any intimation to the insurer regarding theft and therefore, we are of the considered view that the filing of the claim of the complainant by the Ops as  ‘no claim’ vide letter, Ex.OP6, cannot be up held by us. The claim of the complainant was very much genuine and the same should have been disbursed in the light of the circular Annexure A as referred to in First Appeal No.58 of 2014(supra).We accordingly accept the complaint and direct the Ops to make the payment of Rs.33,560/-, IDV of the vehicle as given in two wheeler certificate –cum-policy schedule,Ex.C2 with interest @9% per annum from the date of the repudiation i.e. 11.3.2013 till final payment. In view of the facts and circumstances of the case, the complaint is accepted with costs assessed at Rs.5000/-.The order be complied by the Ops within one month on receipt of the certified copy of the order.

Pronounced

Dated:10.7.2015

 

                   Sonia Bansal                 Neelam Gupta                        D.R.Arora

          Member                         Member                                  President