Haryana

Charkhi Dadri

cc/85/2021

Rajbala - Complainant(s)

Versus

The New India Assurance Co. Ltd - Opp.Party(s)

Ms. Poonam Sangwan

06 May 2024

ORDER

 

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, CHARKHI DADRI

 

                                                                   Complaint Case No. 85 of 2021

                                                                   Date of Institution:  06.04.2021

                                                                    Date of Decision:     06.05.2024     

       

                      Rajbala wife of Ramanand  aged about 52 years and permanent resident of                     village and post office Sankroad, Tehsil  and District Charkhi Dadri

                                                                                                                    …Complainant

                                                                        VERSUS

 

1. The New India Assurance co. Ltd. through its MD/CEO, Regd Office 87 MG Road, Fort, Mumbai-400001.
2. Manager/Prop./Owner, Supreme Mobile Ltd. (authorized dealer of Mahindra & Mahindra Vehicles) Bhiwani

…Opposite parties

                        Complaint under the Consumer Protection Act. BEFORE:            Hon’ble Sh. Manjit Singh Naryal............ President

Hon’ble  Sh. Dharam Pal Rauhilla….,……Member.

 

PRESENT:           Mrs. Poonam Sangwan, Advocate for complainant.

Sh. Sanjay Sharma, Advocate for the opposite party no.1.

Sh. Pardeep Parmar, Advocate for the opposite party no.2.

ORDER:

 

The brief facts of the complaint are that the complainant was the registered owner of the vehicle Mahindra Bolero power plus bearing Registration No. HR-19P-0651, Engine No. WJK6E38626, Chassis No.MA1XK2WJXK5E42032, which was insured with opposite party for the period from 17.06.2019 to 16.06.2020 vide policy No. 140103311909500004373. As per terms and conditions of the insurance policy, the risk of accident, theft and damages etc. have been covered

2. It was submitted that on 21.01.2020, complainant went to Delhi to meet her relatives by own vehicle Mahindra Bolero and vehicle was parked near Mother Dairy Bagdola (Delhi). On 22.01.2020 at about 7 AM, when complainant came to parking area, the vehicle was found missing. It was stolen by some unknown person. She searched the vehicle here and there but the same was not found. Then the complainant made a complaint to the police. The police lodged FIR No.02620 dated 22.01.2020, under section 379 IPC at Crime Branch Delhi.
3. It was further submitted that the complainant gave information to the opposite party about this theft and lodged the claim in opposite party’s office. The complainant visited to the opposite party office many times and requested to pass claim but opposite party lingered on the matter on one pretext or the other.
4. It was further submitted that the local police tried to find out the culprits and the stolen vehicle but all in vain. The local police failed to trace out the said vehicle. The police had filed an untraced report dated 24.02.2020 passed by the court of Arun Kumar Garg, ACMM-01, Sout West District Dwarka Courts, Delhi.
5. It was further submitted that all the documents were already taken by the insurance company and all formalities were completed but the opposite party evaded the matter by one way or other ground by making false excuses and did    not pass the claim.
6. It was further submitted that the complainant served a legal notice upon the opposite party sent by regd. post through his counsel but the opposite party did not reply the same. The complainant sent all the requisite papers. The aforesaid act of opposite party amounted to deficiency in service and the complainant had filed this complaint with a prayer to direct the OP to pay Rs. 9,50,000/- alongwith interest, compensation and litigation expenses. Any other relief, which this Hon’ble Commission deems fit and proper was also prayed for.
7. Notice of the complaint was given to the opposite parties which appeared and filed reply. On merits, it was submitted by OP no.1 that the vehicle was got insured by the complainant on 17.06.2019 and it was stolen on 21.01.2020. The answering OP got the claim investigated and after receipt of the investigation report, approved the claim for a sum of Rs.8,16,950/- subject to compliance of post disbursement formalities. However, the complainant had failed to comply with the said formalities and as such the competent authority after applying its judicial mind recommended to close the case file as ‘No Claim’. As such, OP no.1 denied for any deficiency in service on their part and prayed for dismissal of the complaint.
8. OP no.2 in its written statement that the vehicle was insured  by OP no.1 and if any liability comes then only OP no.1 would be responsible. Hence, complaint  against OP no.2 may kindly be dismissed.
9. To prove his case, the complainant tendered into evidence his affidavit, Ex. CW1/A and documents Ex.C-1 to Ex.C8 and closed the evidence on 30.05.2022
10. On the other hand, the learned counsel for the opposite party  no.1 tendered into evidence his affidavit Ex. RW1/A and documents Ex.R-1 to Ex.R4 and closed the evidence on 01.05.2023. Learned counsel for the opposite party  no.2 tendered into evidence his affidavit Ex. RW2/A and closed the evidence on 01.05.2023
11. Learned counsel for the complainant reiterated the contents of the complaint and drawn attention of this Commission to the documents exhibited and placed on record raised the contention that from the evidence on record it was proved that the complainant was the registered owner of the vehicle bearing Registration No. HR-19P-0651, Model 2019, Engine No. WJK6E38626, Chassis No.MA1XK2WJXK5E42032 and the same was insured with opposite party no.1 for the period from 17.06.2019 to 16.06.2020 vide policy No. 14010331190950004373. The insured declared value of the vehicle was Rs.8,17,950/-.
12. Learned counsel for the opposite party raised the contention that the complainant failed to furnish required documents. Therefore, it is the violation of fundamental condition of the policy. Thus this claim is not payable and present complaint is liable to be dismissed.
13. It was further argued that complainant has contravened the terms and conditions of the insurance policy as she parked his vehicle unattended carelessly which is a clear cut negligence on the part of the complainant himself and the answering opposite party is not liable to pay for such theft claim.
14. It was further argued that the complainant has no cause of action to file the present complaint as complainant is not ready to furnish the required documents despite of repeated reminder and request which are necessary for theft claim. Hence, there is no negligence on the part of answering opposite party no.1 and is clear cut negligence of the complainant himself who instead of furnishing these documents filed present complaint just to pressurize the answering opposite party.
15. It was further argued that the complainant has failed to file the reply of the letter issued by the answering opposite party regarding original final untraced report certified by Judicial Magistrate, Invoice copy of purchase of vehicle, Letter to the RTO for safe custody of vehicle, reason why the intimation to insurer given after 57 days of the theft etc. vide letter dated 21.08.2020. Instead of giving the satisfactory reply to the aforesaid queries, in order to pressurize the answering opposite party, to concede his illegal demands, the complainant filed the instant complaint thus the present complaint is not maintainable and liable to be dismissed. It was further argued that the complaint being meritless was liable to be dismissed.
16. We have heard the learned counsel for the parties besides going through the case file very carefully.
17. Before come to conclusion in the present case, we deem it appropriate to recall instructions issued by IRDA from time to time.
18.  

“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 the prescribed documents within a specified number of days is necessary for insurer 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 insurer’s 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 reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if recorded in time.

The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurer’ stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.”

 

18. Strong observations made by the IRDA, while issuing the above said circular dated 20.09.2011, which undisputedly binding on the Insurance Companies. However, the same are generally altogether ignored by insurance companies, with a view to repudiate the most genuine claim of the complainant, by proceeding purely on a technical approach. This seems to be the reason that IRDA had to issue the above said circular but unfortunately there seems no visible improvement in the working of Insurance Companies like the opposite party, which most of the times, have been found to bent upon to repudiate the genuine claims of the insured, on one or the other flimsy grounds. The end result of this arbitrary working of the insurance companies is that even poor and genuine-citizens insured are being made to suffer and most of the times, for none of their fault, defeating the very purpose of insurance policies.
19. It is not uncommon that all the insurance companies, be it public sector undertaking or private sector insurance companies, would issue lucrative offers and incentives, so as to attract maximum number of citizens. However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company. Most of the times, as it has been experienced in the recent past, even the genuine claim are rejected on one or the other technical or flimsy ground, giving rise to such kind of avoidable litigation.
20. In view of the latest instructions issued by IRDA in September, 2011, referred to herein before, to all the insurance companies, no such objection was to be raised by the companies in respect of receipt of late information in the claims which otherwise legally maintainable. If the claim of the complainant is otherwise maintainable, the delay, if any, in providing intimation to the insurance company about the theft of the insured vehicle would not render the case of the complainant to be doubtful on any score and the insurance company would not be justified to repudiate the claim of the complainant on account of delay in intimating the theft of the insured vehicle to the insured.

 

21. On perusal of the Report dated 08.07.2020 (Ex.R2) of Mohinder Kumar Mittal, Motor Theft Claim Surveyor & Recovery Agent appointed on 18.03.2020 by the insurance company (OP-1), the Claim of the complainant is genuine. In this connection, conclusion given by the  Surveyor is reproduced below:-

“Conclusion:- As per our investigation and the documents submitted by the insured the concerned theft claim is genuine and is covered under the policy. So, insurer may decide the concerned theft claim by keeping the above points in view.”

Based on this report, the insurance company passed claim for Rs. 8,16,950/- subject to compliance of post disbursement  formalities as admitted in its written statement submitted before this Commission. The ground taken by the  OP-1 that desired documents were not submitted by the complainant are not tenable as  RC & insurance are  in the name of the complainant and letter to RTO are required subsequently after payment of claim. As regards intimation to the insurer after 57 days of the theft, the OP-1 has not produced any document in support of delay. The complainant had affirmed that OP-1 (insurance company) informed immediately about the incident. Mr. Mohinder Kumar Mittal in his report referred hereinabove had mentioned that the claim pertaining to the theft of the vehicle was entrusted to them on 18.03.2020. Prior to that there might have been internal process of OP in regard to processing of claim and appointment of surveyor. However, we find no strength in contention of OP no.1 in respect of delayed intimation to OP no.1. Nevertheless, the delay if any, is condoned in view of IRDA guidelines referred hereinabove.

22. In view of the facts and circumstances of the case and law point referred to herein before, this Commission is of the view that the opposite party no.1 has wrongly not paid the claim. In this case, an authorized signatory of National India Assurance Co. Ltd. has filed his affidavit as Ex. RW1/A to support the case of the opposite party but he is not the eye witness of the occurrence. From his affidavit, it cannot be assumed that the complainant had contributed towards the cause of the theft of the insured vehicle. Immediately, FIR was lodged by the complainant and further action was taken and untraced report was also filed by the police authorities. The averments made in the complaint have been supported by the affidavit of the complainant, Ex. CW1/A, wherein he has reiterated the averments made in the complaint and specifically deposed that he reported the matter. There is no reason to disbelieve the complainant. During the course of argument, it was not disputed that the theft of the insured vehicle had taken place during the subsistence of the insurance policy. The same could not be traced out by the police and the police have filed untraced report which has been placed on record as Ex.C-4. The complainant has deposed that he had reported the matter to police by registering FIR and also informed the opposite party. During the investigation, it was not found that the complainant had in any way contributed towards the cause of the theft or that he had lodged false case of theft for the insured vehicle. The documents required for passing the claim are already on the record of this case. It has come on record that the complainant had requested the opposite party to release the claim. The insurer has failed to pass the claim of the complainant despite repeated requests for the same. The complainant had also served a legal notice upon the opposite party but despite that the opposite party failed to pay the claim. It is not disputed that the theft of the insured vehicle had taken place during the subsistence of the insurance policy. Since the complainant has been residing within the territorial the jurisdiction of this Commission, therefore, this Commission has jurisdiction to entertain the instant complaint.
23. In view of above facts and documents  placed on record, the complaint is allowed and following award is pronounced:-

1. The New India Assurance Co. Ltd (OP-1) is directed to pay Rs. 8,17,950/- (IDV of the vehicle) to the complainant alongwith interest @9% per annum from the date of filing of the complaint i.e. 06.04.2021 till date of making payment, subject to  Complainant giving (a) indemnity bond stating that if vehicle is found subsequently then the complainant will not have any right and the insurance company  will have all rights on the vehicle in question Mahindra Bolero power + ZLX micro hybrid BS4 bearing Registration No. HR-19P-0651, Engine No. WJK6E38626, Chassis No.MA1XK2WJXK5E42032. (b) Applicable Form 29 and/or Form 30 to the insurance company (c) NOC from financer viz. Indusind Bank Ltd. in whose favour vehicle has been hypothecated in RC.

24. The opposite party no.1 is directed to pay Rs.10,000/- as compensation towards pain and mental agony.
25. The opposite party no.1 is also directed to pay Rs.5,000/- as litigation expenses.
26. The above order be complied within 45 days from the date of this order, failing which insurer shall be liable to pay interest on the said amount @ 12% per annum from the date of defaulted period till its realization.
27. Copy of this order be given to the parties concerned free of costs. File be consigned to the record room.

                   Announced

                   Dated 06.05.2024