CONSUMER DISPUTES REDRESSAL FORUM – X
GOVERNMENT OF N.C.T. OF DELHI
Udyog Sadan, C – 22 & 23, Institutional Area
(Behind Qutub Hotel)
New Delhi – 110 016
Case No.486/2011
MS. RENU MOHINDRA
PROPRIETOR OF
M/S CONTACT COMMUNICATIONS
R/O B-32, SOUTH EXT., PART-1,
NEW DELHI
…………. COMPLAINANT
VS.
- M/S RELIANCE GENERAL INSURANCE CO.
HEAD OFFICE
MUMBAI
- THE GENERAL MANAGER
M/S RELIANCE GENERAL INSURANCE CO. LTD.,
OKHLA INDUSTRIAL AREA, PHASE-III,
NEW DELHI-110020
………….. RESPONDENTS
Date of Order:26.11.2015
O R D E R
A.S. Yadav – President
Complainant is proprietor of M/s Contact Communications. She is owner of vehicle Maruti Wagon R having its registration number DL-9CK 9215. The said vehicle was duly insured with OP for the period from 11.06.2009 to midnight on 10.06.2010. The said vehicle was stolen on 08.12.2009. Accordingly a complaint was made on the same date to P.S., Kotla Mubarak Pur, New Delhi.
It is further stated that another complaint was made by the employee of complainant, namely, Mohd. Babu Jaan on 16.12.2009 regarding the theft of the vehicle in question on which an FIR was registered on the same day vide FIR No.348/2009 u/s 379 IPC, P.S. Kotla Mubarak Pur.
It is further stated that complainant thereafter submitted necessary documents alongwith the claim form which included copies of FIR, Insurance Policy, Registration Certificate of the vehicle, etc. to one Nikhil Dixit (representative of OP-2) on 17.12.2009.
Since neither the stolen vehicle was traced nor the offender was caught, accordingly an untraced report was filed on 10.01.2010. It is further stated that OP informed the complainant that claim has been closed on the ground that the complainant has not cooperated in the process of the claim while the fact of the matter is that there was no communication from the OP. complainant wrote a letter dated 23.03.2011 to OP requesting for reopening of claim No.2091290667. The complainant had brought to the notice of OP-1 and OP-2 that she has not received any reminder letter from the company as her office was under renovation at the alleged time.
It is further stated that complainant again requested OP-1 on 02.09.2011 for reopening of the claim file. However OP-1 vide their letter dated 09.09.2011 refused to reopen the claim on the ground that complainant has committed breach of condition No.1 of the policy and has not completed the requirements of claim in spite of their letter dated 01.12.2010, 20.12.2010 and 01.02.2011. The contents of condition No.1 are reproduced as follows:-
“Condition No.1 – 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. 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 this Policy the insured shall give immediate notice to the police and co-operate with the Company in securing the conviction of the offender.”
It is further stated that complainant had already informed OP-2 that she had not received any such letter dated 01.12.2010, 20.12.2010 and 01.02.2011 as her office was under renovation at that time. OP acted malafide in not reopening the claim case even after furnishing of alleged letters or the information sought by OP through such alleged letters.
It is further stated that in terms of condition No.1 or otherwise, there has been no such letter, claim, writ, summons and/or process so that a copy thereafter could be forwarded to the company immediately on receipt by the complainant. Since there was no prosecution, inquest or fatal inquiry in respect of the occurrence which had given rise to a claim under the policy, there was no question of informing the same to OP. Since it was only and purely a case of theft of the vehicle and an FIR had been registered, and even a copy of the FIR had duly been communicated to OP, there was absolutely no breach of the said condition No.1.
It is stated that the claim of the complainant has been rejected by OPs without given reasonable opportunity. It is prayed that OP be directed to pay Rs.2,60,000/- as Insurance claim and also to pay Rs.1 lakh for compensation.
OP-1 in the preliminary objection stated that there was no deficiency in service on the part of OP. OP appointed P. Kumar Associates as Surveyor and Loss Assessor to estimate the loss occurred to the complainant. But complainant has not cooperated and has not submitted relevant documents to the surveyor. Complainant has not provided required documents despite several reminders from time to time and has failed to adhere to the terms and conditions of the insurance policy.
It is stated that OP issued letter dated 01.12.10, 20.12.10 and 01.2.11 asking the complainant to submit the documents detailed in these letters but the complainant has not complied with the same and accordingly the claim was closed.
It is further stated that complainant itself has admitted in the latter dated 23.3.11 that due to construction and renovation in her office, documents could not be provided to the company OP has considered the request of reopening of the claim but then also complainant has not provided the required documents to process the claim. Complainant has violated condition no.1 of the policy hence the claim was rightly rejected. It is prayed that the complaint be dismissed.
We have heard Ld. Counsel for the parties and carefully perused the records.
It is proved on record from the registration certificate that vehicle was owned by complainant and the same was duly insured with the OP at the time of theft of the vehicle. It is also proved on record that matter was reported to the police on the same day when the vehicle was stolen and FIR was registered and the same is placed on record. It is also proved on record that untraced report filed by the police. The complaint has proved that on 18.12.09 the relevant papers i.e. copies of FIR, Insurance Policy, Registration Certificate of the vehicle, etc. were submitted to OP.
The case of OP is that certain documents were desired by OP from complainant vide letters dated 01.12.2010, 20.12.2010 and 01.02.2011, however, the complainant has not furnished the relevant information despite repeated reminders and thereby violated condition No.1 of the Insurance Policy which has been reproduced above and the OP was justified in repudiating the claim.
On the other hand it is submitted by Ld. Counsel for complainant that repudiation was totally unjustified and against the principle of natural justice. It is submitted that aforesaid letters were not received by the complainant as the office of complainant at the relevant time was under renovation and this fact was brought to the notice of the OP vide letter dated 23.3.11 which was duly received in the office of OP on the same day. Vide this letter the complainant has also requested OP to reopen the case and release the payment as they had come to know through website that the claim has been closed due to the no response from the complainant. Complainant has also proved on record a letter dated 02.9.11 which was duly received by the OP and wherein they have stated the reason for not completing the requirement of the claim was that complainant did not receive the letters since at that time their office was under renovation. It is further stated in that letter that now they have completed all requirement hence OP was requested to reopen the above said claim file and settle the claim. OP vide their letter dated 09.9.11 declined to reopen the case and stated that once again on the request of complainant they have reviewed the claim file of complainant and are of the opinion that at this stage they are not in a position to consider the request of OP to reopen their claim since there is a breach of condition No.1 of the policy which is reproduced as under:-
“Condition No.1 – 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. 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 this Policy the insured shall give immediate notice to the police and co-operate with the Company in securing the conviction of the offender.”
It is significant to note that in the letter dated 02.09.2011, complainant has specifically stated that she has completed all the requirements hence requested to reopen the said claim file but the claim file was not reopened in view of condition No.1 of the policy.
Regarding the repudiation of claim on the basis of the conditions like condition No.1 reproduced above, Insurance Regulatory and Development Authority vide their letter Ref-IRDA/HLTH/MISC/CIR/216/09/2011 dated 20.09.2011 has stated:-
“To: All life Insurers and non-life insurers
Re: Delay in claim intimation/documents submission with respect to
- All life insurance contracts and
- All Non-life individual and groups 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 policyholders 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 reason 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 roved to be for reasons beyond the control of the insured.
Sd/-
J Harinarayan
CHAIRMAN “
The Insurance Company wrongly rejected the claim of the complainant on grounds of non-furnishing of relevant documents as vide letter dated 02.09.2011, complainant has furnished all the relevant information. This was against the principle of natural justice. Repudiation was unjustified. It amounted to deficiency in service on the part of OP.
Complainant is entitled for a sum of Rs.2,60,000/- alongwith 10% interest p.a. from the date of filing of complaint. The OP shall also pay Rs.5,000/- to the complainant towards compensation and Rs.5000/- towards cost of litigation.
Let the order be complied within one month of the receipt thereof. The complaint stands disposed of accordingly.
Copy of order be sent to the parties, free of cost, and thereafter file be consigned to record room.
(D.R. TAMTA) (A.S. YADAV)
MEMBER PRESIDENT
