DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II
Udyog Sadan, C-22 & 23, Qutub Institutional Area
(Behind Qutub Hotel), New Delhi-110016
Case No.249/2012
Shri Virender Kumar
S/o Shri Kishan Lal,
R/o C-1/11, Sewa Sadan,
Sangam Vihar,
New Delhi-110062 ….Complainant
Versus
- Branch Manager
Shriram General Insurance Co. Ltd.
Issue Office: 101006-
K-18, Second Floor, Lajpat Nagar-2
New Delhi-110024.
- Head/ Authorised Signatory
Claim Department
Shriram General Insurance Co. Ltd.
E-8, EPIP, RIICO Industrial Area,
Sitapura, Jaipur, Rajasthan-302022.
….Opposite Parties
Date of Institution : 16.05.2012 Date of Order : 20.10.2018
Coram:
Sh. R.S. Bagri, President
Ms. Naina Bakshi, Member
Ms. Kiran Kaushal, Member
ORDER
Member - Kiran Kaushal
Briefly stated facts of the complaint are that:
1.1 The complainant, Shri Virender Kumar got his auto-rikshaw ‘Gramin Seva’ insured from Shriram General Insurance Co. Ltd. (OP-2) through its branch office in New Delhi hereinafter referred to as OP-1. It was in the period of insurance i.e. 12.03.11 to 11.03.12 that the vehicle met with an accident and was damaged.
1.2 It is stated that immediately after the accident i.e. on 18.05.2011, the complainant informed the opposite party about the accident on the helpline number wherein the person who attended the call told him that the complainant should get the damaged vehicle released from the police station and after getting it released he should leave the same at any authorized JSA workshop of the complainant for repair, then inform the insurance company and thereafter the surveyor shall visit the workshop and do the needful as per procedure.
1.3 It is further averred that on 09.06.2011, after getting the damaged vehicle released from the police station the complainant left the same at authorized JSA workshop i.e. Yuvraj Motors at Sahibabad, Ghaziabad (U.P.) and intimated the opposite party No. 1. Thereafter, surveyor visited the said workshop, he conducted the survey and completed requisite formalities. The surveyor at that point of time had obtained relevant documents from the complainant, prepared estimate etc.
1.4 It is next stated that within 20 days the above said damaged vehicle was repaired and bill of Rs.22,240/- was raised by the workshop and the same was paid by the complainant in cash. Complainant handed over the said bill of Rs.22,240/- to opposite party No.1. The OP No.-1 took the bank account details of the complainant and told him that the cheque of the said bill amount shall be deposited in his bank account within a period of one month. After not receiving the amount for about two months, complainant again checked with OP No.1 and he was informed that he has to bring some documents namely copy of FIR, copy of court order, releasing the damaged vehicle etc. The said documents were submitted to the OP No.1 and again was assured that money will be transferred to his bank account within a period of one month. It was again after about one and half months when the cheque was not deposited the complainant contacted one Mr. Naveen, Incharge Claim Section in the office of OP No.1 who informed the complainant that he will have to submit the documents again as the documents submitted by him had been misplaced. Accordingly on 21.10.2011, the complainant again sent all the required documents on Mr. Naveen’s email ID.
1.5 It is further averred that after one month when nothing was deposited in the bank account of the complainant, he contacted Mr. Naveen who orally told him that “opposite party No.2 had raised an objection that claimant had intimated about the accident to the insurance company late, therefore you are not entitled for any claim against the damaged vehicle from the insurance company.” The complainant was shocked to know about the reason for repudiation as he had intimated the insurance company immediately after the accident and after constant follow up with the OPs he had not received his claim amount.
1.6 Alleging deficiency in service and unfair trade practice of the OPs, the complainant approached to this Forum with the prayer to direct the OPs to pay the complainant a sum of Rs.22,240/- along with interest @ 18% per annum, direct the OPs to pay the complainant a lumpsum of Rs.50,000/- for mental harassment and agony and Rs.7,500/- towards the cost of the complaint.
2. OP resisted the complaint on the ground that there was huge delay of about 155 days in informing the OP about the accident of the vehicle which was alleged to have happened on 18.05.2011 and OP for the first time was informed on 21.10.2011. It is further stated that the complainant has submitted that he telephonically informed the OPs on customer care helpline numbers. OP states that telephonic information cannot be considered as the information in writing, as the help line numbers are only to provide guidance or help to the customers and not for the purpose of information regarding accident or loss. OP further averred that it is specifically provided in the conditions of the policy that in case of loss/ damage formal written notice is mandatory which the complainant failed to provide.
2.1 OP averred that the inspection by the surveyor is not the approval of claim, it is mere estimate of damages and thereafter, the claim was considered by the claim department on the basis of the documents which were never supplied by the complainant. OPs have further admitted that the complainant was informed regarding the repudiation of the claim on the ground of huge delay caused by the complainant in informing the accident in writing and claiming the damages after 155 days which amounted to serious breach of conditions of the policy. Hence, the claim was repudiated on genuine and legal ground of delay which does not amount any deficiency in service on the part of OPs. Therefore, the complaint be dismissed with costs.
3. Rejoinder and evidence by way of affidavit are filed by the complainant with two sale in voices, order of Presiding Officer of Motor Accident Claims Tribunal, New Delhi.
4. Affidavit of Shri Vikas Goyal, Assistant Legal Manager of Shriram General Insurance Co. Ltd. has been filed on behalf of the opposite parties.
5. Written arguments have been filed on behalf of the parties.
6. On perusal of records, it is observed that the main contention of OPs is that no immediate information was sent to the OPs regarding the accident dated 18.05.2011 and for the first time accident was reported on 21.10.2011, i.e. after delay of about 155 days. Further the OP alleges that the complainant did not provide the documents in time. It is pertinent to notice here that the complainant is the owner of an auto-rickshaw an illiterate person and as per his understanding he complained at the help line number provided by the OPs immediately after the accident. OP took cognizance of this telephonic information and appointed a surveyor. Further the complainant did supply the documents as he was guided by the person on the help line numbers only then the surveyor conducted the survey and had submitted his report. The OPs are therefore estopped from claiming that they had no intimation regarding the incident.
Further it is observed that the surveyor report which is annexed with written arguments filed on behalf of OPs is dated 02.07.2011. Therefore, the claim of the OPs that they were informed about the accident for the first time on 21.10.2011 seems to be false and concocted. Further the guidelines provided by the Insurance Regulatory and Development Authority (IRDA) in the circular no. IRDA/HLTH/ MISC./CIR/216/09/2011 DATED 20.09.2011 is very clear regarding such claims as it states that :-
“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 conditions that the claims shall be intimated to the insurer with prescribed documents with 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 exercise 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.”
Even as per the IRDA guidelines the claim should not have been rejected on the ground of delayed intimation, whereas there was no delay in the present case..
7. OPs in their reply in para No. 11 submit that the complaint is admitted to the extent that the complainant was informed regarding the repudiation of the claim on the ground of huge delay caused by the complainant in informing the accident in writing and claiming the damages after a period of 155 days which amounts to serious breach of the terms and conditions of the policy. Whereas in evidence by way of affidavit filed on behalf of the OPs in Para No. 2, it is stated as follows:-
“That the complainant has got no cause of action to prefer the present complaint as the claim of the complainant was neither repudiated nor closed and has dragged the O/P company into litigation with the sole motive to extract money and harass the O/P for no fault on its part.”
8. From reading the above paragraphs, it is very much evident that the OPs in their written statement stating that they have repudiated the claim whereas in evidence by way of affidavit they are stating that the claim of the complainant was never repudiated or closed. It seems that OPs are making all false, frivolous and concocted stories to deny the claim of the complainant.
9. Hence, this forum is of the opinion, OPs are grossly deficient in service and indulging in unfair trade practice of not granting the claim due to the complainant.
10. Therefore, in view of the facts and circumstance mentioned above, we allow the complaint with direction to the OPs to pay the complainant sum of Rs.22,240/- along with interest @ 12% per annum from the date of the surveyor report i.e. 02.07.11 till realization. In addition to above payment OPs are also directed to pay Rs.25,000/- towards mental agony and harassment to the complainant within 30 days of receipt of copy of this order.
Failing which OPs shall be liable to pay Rs.22,240/- alongwith interest @ 16% per annum from the date of the surveyor report i.e. 02.07.11 till the date of 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 20.10.18.
