DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi-110016
Case No.447/2013
Shri Nazar Mohammad
S/o Rasul Mohd.
R/o G-I-24/9,
Sangam Vihar, New Delhi ….Complainant
Versus
M/s Shriram General Insurance Co. Ltd.
having its corporate office at:
K-18, Lajpat Nagar-II,
New Delhi-110024 ….Opposite Parties
Date of Institution : 12.09.13 Date of Order : 16.04.19
Coram:
Sh. A.S. Yadav, President
Ms. Kiran Kaushal, Member
Ms. Kiran Kaushal, Member
ORDER
Brief facts as pleaded by the complainant are :-
- The complainant, Nazar Mohammad got his Hero Honda CD Deluxe CCR motor-cycle bearing registration No. DL-3S-BN-6348 insured with M/s Shriram General Insurance Company Ltd. hereinafter referred to as OP. The motor cycle was insured for a period from 27.10.2011 to 26.10.2012 and Rs.792/- was paid towards the premium of the insurance. A cover note was provided to the complainant and later, he received the certificate-cum-policy from OP company which are annexed as Annexure-C and Annexure-D respectively.
- Motor-cycle of the complainant went missing on 17.07.2012 and upon knowing the same; the complainant called at 100 number and later on at other numbers to inform the Greater Noida Control Room regarding the theft of the vehicle. The complainant also gave a written complaint to the Station House Officer and was asked by the police official concerned to come some other day and collect the FIR of the complaint.
- The complainant on next day i.e. 18.07.2012 informed the agent of OP company on his mobile about the theft of the vehicle. Thereafter, complainant provided the requisite documents and copy of the FIR to the investigator and the OP company. To utter shock and dismay of the complainant, the complainant received a letter dated 31.10.2012 wherein OP company had repudiated the claim on the grounds that the complainant was late in reporting the theft of the vehicle to the police as well as to OP company. The letter dated 31.10.2012 is annexed as Annexure-1.
- On receiving the repudiation letter, the complainant along with his son visited the office of the OP and requested them to pay the claim but OP company paid no heed to his request.
- Therefore, the present complaint with the prayer to direct OP to refund Rs.24,700/- (Insured value of the motor-cycle) along with interest @ 2% per month. Additionally to direct OP to pay Rs.1,00,000/- towards compensation for mental torture and cost of litigation.
2. OP resisted the complaint on the ground that the complainant’s said insured vehicle was stolen on 17.07.2012. Subsequently, OP was intimated after a delay of four days on 21.07.2012 and FIR was lodged by the complainant after undue delay of 16 days on 03.08.2012 thereby breaching condition No.1 of the terms and conditions of the policy. Relevant portion of the said condition No. 1 is given as below:-
“Condition 1:-
Notice shall be given in writing to the company immediately upon the occurrence of any accident 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.”
2.2 It is next submitted that as the complainant stands in clear violation of the terms and conditions of the said policy therefore, OP is in no manner liable to honor the present claim, as the liability of OP is strictly limited to the said policy’s terms and conditions. Therefore, OP has very rightly repudiated the claim of the complainant and it is prayed that complaint be dismissed with costs.
3. No rejoinder has been filed by the complainant.
4. Evidence by way of affidavit has been filed by the complainant reiterating the averments made in the complaint. OP was proceeded exparte on 22/4/14. However, affidavit of Shri Vishal Gupta, Assistant Manager (Legal) has been filed in evidence on behalf of OP on 17/04/15 and the same was taken on record.
5. Written arguments have been filed on behalf of the parties.
6. Submissions on behalf of the complainant are heard and record is perused very carefully.
7. Admittedly, the complainant had taken a motorized two-wheeler package policy for a period from 27.10.2011 to 26.10.2012. Complainant’s insured vehicle went missing on 17.07.2012 and OP repudiated the claim of the complainant stating that there was undue delay of four days in reporting the theft to OP company. FIR was lodged after inordinate and undue delay of 16 days thereby breaching condition No. 1 of the terms and conditions of the policy. On perusal of the documents, it is noticed that the complainant has placed usage details/ call records annexed as Annexure-E which clearly shows that two calls were made at 100 number and three others calls were made to Greater Noida Police Station on 17.07.2012. Further, it is very clear and evident from the call records that on 18.07.2012 the complainant had called the agent of OP company Mr. Paramjeet Singh regarding the theft of the vehicle which has not been specifically denied by OP. It is also not clear from the pleadings whether a copy of the terms and conditions which is being referred to by OP was provided to the complainant at the time of issuing the policy.
8. Further, the case of the complainant with respect to delay in lodging the claim also rests upon the circular dated 20.09.2011 issued by insurance Regulatory and Development Authority (IRDA). Relevant portion of the said circular is provided below for ready reference:-
“The Authority has been receiving several complaint 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 intimation 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 needs 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 action of OP is in violation of the letter and spirit of the above extracted circular.
9. In the light of above discussions, Forum is of the opinion that OP is grossly deficient in service by not providing the rightful claim to the insurer. Therefore, we direct OP to refund Rs.24,700/-, the insured value of the motor-cycle with interest @ 10% per annum from the date of filing the claim till realization. Additionally OP is directed to pay Rs.15,000/- towards compensation and litigation cost within three month of receipt of copy this order, failing which OP shall become liable to pay interest @ 15% p.a. on the amount of Rs.24,700/- from the date of filing of the claim till realization.
Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations. Thereafter file be consigned to record room.
Announced on 16.04.19
