Chandigarh

DF-II

CC/1059/2016

Rampal - Complainant(s)

Versus

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

Sh. Devinder Kumar adv.

18 Jul 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

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Consumer Complaint  No	:	1059 of 2016
Date  of  Institution	:	29.12.2016
Date   of   Decision	:	18.07.2017

 

 

 

 

Rampal son of Sh.Mam Raj, r/o VPO Mauli, Panchkula  

             …..Complainant

Versus

SBI General Insurance Company Limited, 1^st Floor, SCO No.457-458, Sector 35-C, Chandigarh through its Manager. 

                          ….. Opposite Party

 

BEFORE:  SH.RAJAN DEWAN                 PRESIDENT

         MRS.PRITI MALHOTRA             MEMBER

                                SH.RAVINDER SINGH              MEMBER 

 

Argued by: Dr.Joseph, Adv. proxy for Sh.Devinder Kumar,  

 Advocate for complainant.

 Sh.Gaurav Bhardwaj, Advocate for OP

 

 

 

PER PRITI MALHOTRA, MEMBER

 

 

          Briefly stated, the complainant got insured his Tata Truck bearing Regd. NO.HR-38M-9876 with Opposite Party vide policy Ann.C-1 effective from 01.10.2013 to 30.9.2014 as ‘Goods Carrying vehicle’ package policy.  The said insured vehicle was got stolen from village Mauli, Panchkula during the intervening night of 19/20.1.2014.  It is averred that the said theft was immediately reported to the police on 20.1.2014 (Ann.C-3) and then FIR NO.14, dated 31.1.2014 was registered by Police Post Mauli.  The intimation qua the theft of the insured vehicle was also given to the Opposite Party.  It is also averred that Untraced Report in respect of insured stolen vehicle has also been issued on 16.5.2015 (Ann.C-5). It is submitted that the complainant submitted all necessary documents to the OP Insurance Company and also replied the letter dated 6.11.2015 issued by the OPs demanding some document/clarification (Ann.C-6 & C-7 colly.).  It is pleaded that despite receipt of all required documents and information, ever after passage of one year, the Opposite Party has failed to settle the claim of the complainant.  A legal notice was also sent to the Opposite Party, but to no avail. Hence, this complaint. 

 

2]       The Opposite Party has filed reply and while admitting the factual matrix of the case, stated that the vehicle in question was a commercial goods carrying vehicle and as such, was required to process the fitness certificate, permit, road tax receipt, but the said documents, inspite of regular following ups, request & reminders (Ann.OP-1 to OP-8), have not been supplied by the complainant to the Opposite Party for processing the claim.  It is submitted that the complainant has failed to give justification as to how the date of theft on the FIR has been mentioned as 09.01.2014 and the information to the policy authority has been given for the first time on 31.1.2014 i.e. after a delay of more than 21 days, which amounts to breach of terms & conditions of the policy under which the intimation of theft is to be given immediately without any delay and demur to the company.  It is denied that the complainant had given all documents required by the Opposite Party to process the claim.  Pleading no deficiency in service and denying rest of the allegations, the Opposite Party has prayed for dismissal of the complaint.

 

3]       Replication has also been filed by the complainant thereby reiterating the assertions as made in the complaint and controverting that of the reply filed by OP.

 

4]       Parties led evidence in support of their contentions.

 

5]       We have heard the ld.Counsel for the parties and have also perused the entire record.

 

6]       The matter in issue is in regards to the theft claim qua the insured vehicle i.e. Tata Truck bearing Regd. NO.HR-38M-9876, insured vide policy Ann.C-1 effective from 01.10.2013 to 30.9.2014 as Goods Carrying vehicle package policy.

 

7]       It is the grouse of the complainant that till the filing of the complaint, the OP failed to settle and pay the theft claim of his insured vehicle, despite having been supplied with all requisite documents. 

 

8]       On the contrary, it is the defence of the Opposite Party that since the complainant failed to submit certain documents/information required by the Opposite Party for processing the claim of the complainant, despite sending reminders dated 4.11.2014, 8.9.2014, 10.3.2014, 22.1.2014, 8.9.2015, 6.11.2015, 8.12.2015 and 18.12.2015 (Ann.OP-1 to OP-8), so there is no deficiency in service on its part in not settling the claim of the complainant.

 

9]       During the course of arguments, the counsel for the complainant vehemently submitted that the complainant duly delivered the Untraced Report duly accepted by the competent court of law along with all the requisite documents as required by the Opposite Party for the settlement of his claim qua insured vehicle. The ld.Counsel for the complainant has also placed on record the copies of all these relevant documents in evidence.  The record on file reflects that there is gross deficiency in service on the part of the Opposite Party as it failed to settle and pay the genuine claim of the complainant. 

 

         This opinion of our’s is based on the facts that the complainant intimated to the police authorities regarding the theft of his insured vehicle in question, as per the requirement of Opposite Party. Ann.OP-4 i.e. Theft Claim Acknowledgement letter, dated 22.1.2014 reveals that the intimation qua the theft was timely given to the OP Insurance Company by the complainant whereby they acknowledged that the intimation qua theft was given to them on 21.1.2014.  In the light of the above, it is highly questionable on the part of the Opposite Party to ask the complainant to explain about the delay of 21 days in lodging the FIR as the date of lodging of FIR is mentioned as 31.1.2014 (Ann.C-4). After going through the contents of the FIR, it is quite clear that the theft of the vehicle in question occurred during the intervening night of 19/20.1.2014 and inadvertently the date in FIR has been recorded as 9.1.2014. 

 

11]      The defence put forth by the Opposite Party that it issued numerous reminders to the complainant to submit documents detailed therein, is not tenable as the said reminders carries no evidentiary value for want of any proof with regard to their dispatch.  It seems that the Opposite Party in order to defeat the genuine claim of the complainant has created these reminder letters.

 

12]      Further, it is right to mention here that in the ‘Theft Claim Acknowledgement Letter’ dated 22.1.2014 (Ann.OP-4), it is intimated by the Opposite Party to the complainant that they had duly appointed M/s Bee Vee Investigations to investigate the claim of the complainant. However, the Opposite Party has failed to place on record the Investigator’s Report, submitted by the Investigator, which it claimed to have been submitted on 27.2.2014 in the reminder letters placed on record by it. The absence of Investigator’s Report again points towards the malafide of the Opposite Party.

 

13]      It needs to be added that the Opposite Party failed to materialize its own instructions, as mentioned in policy document under clause “Claim Settlement”, which reads as under:-

“The Company will settle the claim under this Policy within 30 days from the date of receipt of necessary documents required for assessing the claim.  In the event that the Company decides to reject a claim made under this Policy, the Company shall do so within a period of thirty days of the Survey Report or the additional Survey Report, as the case may be, in accordance with the provisions of Protection of Policyhoders’ Interest Regulations, 2002”

 

14]      It is pertinent to mention that the record on the file clearly reveals that till date the Opposite Party has not settled the fate of the claim in question. The Opposite Party also violated the provisions incorporated in Regulation No.9 of Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002, which stipulates as under:-

 

“9. Claim procedure in respect of a general insurance policy

 

(1) An insured or the claimant shall give notice to the insurer of any loss arising under contract of insurance at the earliest or within such extended time as may be allowed by the insurer. On receipt of such a communication, a general insurer shall respond immediately and give clear indication to the insured on the procedures that he should follow. In cases where a surveyor has to be appointed for assessing a loss/ claim, it shall be so done within 72 hours of the receipt of intimation from the insured.

 

(2) Where the insured is unable to furnish all the particulars required by the surveyor or where the surveyor does not receive the full cooperation of the insured, the insurer or the surveyor as the case may be, shall inform in writing the insured about the delay that may result in the assessment of the claim. The surveyor shall be subjected to the code of conduct laid down by the Authority while assessing the loss, and shall communicate his findings to the insurer within 30 days of his appointment with a copy of the report being furnished to the insured, if he so desires. Where, in special circumstances of the case, either due to its special and complicated nature, the surveyor shall under intimation to the insured, seek an extension from the insurer for submission of his report. In no case shall a surveyor take more than six months from the date of his appointment to furnish his report.

 

(3) If an insurer, on the receipt of a survey report, finds that it is incomplete in any respect, he shall require the surveyor under intimation to the insured, to furnish an additional report on certain specific issues as may be required by the insurer. Such a request may be made by the insurer within 15 days of the receipt of the original survey report.

 

Provided that the facility of calling for an additional report by the insurer shall not be resorted to more than once in the case of a claim.

 

(4) The surveyor on receipt of this communication shall furnish an additional report within three weeks of the date of receipt of communication from the insurer.

 

(5) On receipt of the survey report or the additional survey report, as the case may be, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be recorded in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of the survey report or the additional survey report, as the case may be.

 

(6) Upon acceptance of an offer of settlement as stated in sub-regulation (5) by the insured, the payment of the amount due shall be made within 7 days from the date of acceptance of the offer by the insured. In the cases of delay in the payment, the insurer shall be liable to pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by it.”

 

 

15]      From the discussion above, it is quite clear that the non-settlement of the genuine claim of the complainant, not only amounts to deficiency in service but also reflects unfair trade practice on the part of the Opposite Party. Therefore, we are of the opinion that the complaint deserves to be allowed.  Accordingly, the complaint is allowed against Opposite Party.  The Opposite party is directed as under:-

1. To pay the Insured Declared Value of Rs.7.00 lacs (Ann.C-1) of the insured vehicle to the complainant along with interest @9% p.a. from 21.4.2014 i.e. after three months of loss, till realization;

 

2. To pay an amount of Rs.30,000/- as compensation for the harassment suffered by the complainant on account of deficient service and unfair trade practice on the part of OP;

 

3. To pay litigation expenses to the tune of Rs.10,000/-.

 

         This order shall be complied with by Opposite Party within a period of 45 days from the date of receipt of copy of this order, failing which it shall also be liable to pay interest @9% per annum on amount of compensation from the date of filing this complaint till realization, apart from complying with direction as at sub-para (a) & (c) above.

16]       However, the complainant shall sign all necessary papers/documents, in respect of the vehicle in question, if any, required by the OP.

        Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

18^th July, 2017             

 

                                                                                      Sd/-

                                                                   (RAJAN DEWAN)

PRESIDENT

 

 

                                                Sd/-

 (PRITI MALHOTRA)

MEMBER

 

Sd/-

(RAVINDER SINGH)

MEMBER