Haryana

Karnal

CC/23/2015

Nasib Singh S/o Om Parkash - Complainant(s)

Versus

National General Insurance Company Limited - Opp.Party(s)

R.K. Kashyap

01 Jun 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                               Complaint No.23 of 2015

                                                             Date of instt.: 12.02.2015

                                                                Date of decision:01.06.2016

 

Nasib Singh son of Shri Om Parkash, resident of village Raipur Jattan, tehsil Nilokheri, P.S. Butana, District Karnal.

 

                                                                   ……..Complainant.

                                      Vs.

1. The National General Insurance Company Limited, Divisional Office, Santokh Market, over the building of State Bank of Patiala, Railway Road, Karnal through its Branch Manager.

2. The National General Insurance Company Limited, Railway Road, Kurukshetra, through its Branch Manager.

                                                                   ………… Opposite Parties.

                     Complaint u/s 12  of the Consumer Protection Act.

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

                   Sh.Anil Sharma…….Member.

 

Present:-      Sh. R.K. Kashyap Advocate for the complainant.

                    Sh. L.S. Lote Advocate for the Opposite parties.

                  

 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 Hero Splendor Motorcycle bearing registration no.HR-05-AM-4254, engine no.HA10EJEHFG-8131 and chasis no.MBLHA10AMEHF82549 with the opposite parties, vide policy no.3901023114620140760 valid from 11.07.2014 to 10.07.2015. On 28.10.2014 he alongwith Ram Kumar had gone to the fields of Master Rajinder for getting spray instruments. The motorcycle was parked near a Tea Stall  at G.T. Road in the area of village Barana. When they returned the motorcycle was found stolen. He immediately informed the police of police station  Butana. The police circulated message to the Control Room Karnal and all police stations through V.T. Thereafter, he searched for his motorcycle, but was unable to trace the same. First Information Report no.439 dated 30.10.2014 was registered in Police Station Butana regarding the said theft. Information was also given to the opposite parties about the theft of the motorcycle. He lodged claim with the opposite parties, but the opposite parties repudiated his claim, without any basis, vide letter dated 10.1.2015. There was no delay on his part in giving information to the police as well as the opposite parties, but his claim illegally repudiated. In this way, there was deficiency in service and unfair trade practice on the part of the opposite parties, which caused him mental pain, agony and harassment apart from financial loss.

2.                Notice of the complaint was given to the opposite parties, who appeared and filed written statement disputing the claim of the complainant. Objections have been raised that the complaint is not maintainable; that the complainant has suppressed the material facts from this Forum; that the complainant has no locus standi; that the complainant is estopped from filing the complaint by his own acts and conduct; that the complainant has violated the terms and conditions of the insurance policy and that the complaint is bad for mis-joinder and non-joinder of necessary parties.

                   On merits, it has been submitted that the complainant had parked his motorcycle on unsafe place in the fields far away from the tea stall. Moreover, he lodged First Information Report after two days and informed the opposite parties regarding theft of the motorcycle after lapse of 16 days on 14.11.2014. Thus, the investigation could not be effected immediately and the complainant wasted valuable time of the investigator, which amounted to violation of terms and conditions of the insurance policy. Therefore, the opposite parties are not liable to pay any compensation to him the and the claim was rightly repudiated.

3.                In evidence of the complainant, his affidavit EX.CW1/A and documents Ex.C1 to C7 have been tendered.

4.                On the other hand, in evidence of the opposite parties, affidavit of Yashpal Assistant Manager Ex.OP1 and documents Ex.OP2 to OP9 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.                The motorcycle of complainant bearing registration no. HR-05-AM-4254 was insured with the opposite parties and the same was stolen during subsistence of the insurance policy on 28.10.2014. First Information Report regarding theft was lodged with Police Station Butana on 30.10.2014. Claim was lodged with the opposite parties on 14.11.2014, but the opposite parties repudiated the claim on the grounds that the motorcycle was parked by the complainant at unsafe place, the First Information Report was lodged after two days and intimation to the opposite parties was given after 16 days, which amounted to violation of the terms and conditions of the policy.

7.                As per the case of the complainant the motorcycle was parked by him near a tea stall. Whenever a person would go to the fields he would certainly park the motorcycle at some distance, because it would not be possible to drive the motorcycle to the fields, if there is no direct passage or road to such fields. Therefore, the place near tea stall cannot be termed as unsafe for parking a motorcycle.

8.                Admittedly, the opposite parties appointed investigator, who after investigation submitted report Ex.OP3, according to which he found the theft of the motorcycle as genuine. The complainant has produced the copy of the V.T. sent by police station Butana to control room Karnal and all Police stations Ex.C1, which is sufficient to prove that the complainant had informed the police regarding theft of the motorcycle on 28.10.2014 itself. Therefore, lodging of First Information Report after two days on 30.10.2014 was immaterial and the insurance company cannot take any advantage of the same.

9.                The complainant has alleged that the intimation regarding theft of the motorcycle was given immediately to the opposite parties. However, the opposite parties have submitted that the intimation was given on 14.11.2014 i.e. after 16 day. The copy of the claim lodged by the complainant is Ex.OP7, which shows that the claim was lodged on 14.11.2014. Generally, the insured persons inform the insurance company on telephone regarding the loss/damage and thereafter claim is lodged after few days. No record of such telephonic message is maintained. Therefore, the plea raised by the complainant that he immediately intimated the opposite parties cannot be discarded altogether. Moreover, even if it is accepted that there was delay of 16 days in giving intimation to the opposite parties, then also the opposite parties were not justified in repudiating the claim of the complainant on that ground.

10.              For proper appreciation of the matter the circular dated 20.09.2011 issued by Insurance Regulatory and Development Authority 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.”

 

11.              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. In this context reference with advantage may be made to orders of the Hon’ble State commission in case Shriram General insurance Company limited Versus Rajesh Kumar 2014(2) CLT 290 and Shriram General Insurance Company Limited Vs. Manoj 2014(3) CLT 447.

12.              In the instant case, the complainant had informed the police regarding theft of his motorcycle on 28.10.2014 itself and the police had sent the V.T. message to the Control Room Karnal and other police stations in that regard. The First Information Report was lodged after two days when the motorcycle was not traced. Thus, the repudiation of claim by the opposite parties was contrary to the spirit of the letter of Insurance Regulatory and Development Authority, because intimation to the insurance company after 16 days 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. The complainant had even furnished explanation for delay in lodging the claim to the surveyor as is evident from his report, the copy of which is Ex.OP3.  Under such circumstances, deficiency in service on the part of the opposite parties is established.

13.              As a sequel to the foregoing discussion, we accept the present complaint and direct the opposite parties to pay Rs.42,225/- 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 parties 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: 01.06.2016

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member