Haryana

Charkhi Dadri

CC/220/2021

Vinay Kumar - Complainant(s)

Versus

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

Kulvir Singh

12 Aug 2024

ORDER

 

insured car totally burnt due to fire in electric wiring  within the area of jurisdiction of police post Achina Taal . The complainant informed the police regarding the fire incident and DDR dated 15-11-2018 was recorded in Police post Achina Taal, District Charkhi Dadri.

3. It was further submitted that the complainant informed the opposite party regarding the fire incident and lodged his claim and fulfilled all the formalities.
4. It was further submitted that the complainant asked the opposite party to pass the claim but the opposite party postponed the matter by making false excuses. Thereafter the complainant served a legal notice dated 24-03-2021 upon the opposite party through his counsel but to no effect and the opposite party refused to give any claim to the complainant. Hence this complaint.
5. Notice of the complaint was given to the opposite party which appeared and filed reply wherein it has been averred that the present complaint is false and the same is not maintainable either on the facts or law against the answering opposite party. Hence the complaint is liable to be dismissed in limine with cost.
6. It was further submitted that complainant being registered owner had lodged the DDR No.7 on 15.11.2018 whereas intimation to opposite party regarding accident was given by complainant only on 21.11.2018 i.e. after a delay of 8 days. The DDR was also lodged after a delay of 02 days.
7. It was further submitted that after receiving the delayed intimation from the complainant, opposite party appointed an independent government approved investigator namely S.K.Vashisth to investigate the facts of the case.

 

That said investigator submitted his report and sought the clarification regarding the following points with regard to the occurrence.

1. Was this occurrence/accident reported in any newspaper?
2. Please inform number of persons in the vehicle at the time of occurrence/incident and inform their names and mobile number.
3. Was any person was injured in this occurrence/incident? If yes, provide copy of his medical treatment chart.
4. Please provide/inform name and phone number of the person to whom you contacted immediately  after this occurrence/incident.
5. Please provide details to repayment loan account of your above noted vehicle.
6. Please provide details of WARRANTY of your above noted vehicle and WARRANTY CLAIM preferred to principal manufacturer.
7. Please provide copy of Fire Brigade Report.
8. Please inform exact location of occurrence/incident.
9. Please provide copy of vehicle history.

8. It was further submitted that after availing two opportunities  on 24.12.2018 and reminder dt. 05.02.2019, the complainant did not reply with the classification on the above discussed points were ever submitted by the complainant. It is gross negligence on the part of complainant and is not covered under the terms and conditions of the subject policy. It was further submitted that the complaint being meritless was liable to be dismissed
9. The parties led evidence in support of their respective versions.

 

10. To prove his case, the counsel for the complainant tendered into evidence affidavit Ex. CW1/A and documents Annexure C1 to Annexure C13 and closed the evidence on 09.01.2023.
11. On the other hand, the learned counsel  for the opposite party has tendered into evidence affidavit of Sh. Anjana Mistry, authorized signatory, The New India Assurance  Co. Ltd., Ex. RW1/A and documents Ex.R1 to Ex.R4 and closed the evidence on 04.12.2023.
12. Learned counsel for the complainant 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-19L-1050, which was insured with opposite party vide policy No. 14010331180300000182 for the period from 04.04.2018 to 03.04.2019. The insured declared value of the vehicle was Rs. 4,51,000/-.
13. It was argued that on 15.11.2018, the above said insured car totally burnt due to fire in electric wiring within the area of jurisdiction of police post Achina Taal . The complainant informed the police on the same day.
14. It was further submitted that regarding the fire incident, DDR dated 15-11-2018 was recorded in Police post Achina Taal, District Charkhi Dadri.
15. It was further argued that the complainant informed the opposite party regarding the incident and lodged his claim and fulfilled all the formalities.
16. It was further argued that the complainant asked the opposite party to pass the claim but the opposite party postponed the matter by making false excuses. Thereafter the complainant served a legal notice dated 24.03.2021 upon the opposite party through his counsel but to no effect. The aforesaid act of opposite party amounted to deficiency in service.
17. On the other hand, learned counsel for the opposite party raised the contention that the complaint is not maintainable in the present form and this commission has no jurisdiction to entertain the instant complaint. It was further argued that the complainant has no locus standi to file the present complaint and he could not file complaint regarding burning of the vehicle in fire incident. The complainant has no cause of action to file the complaint. The complaint was barred by limitation. The complainant did not fulfill the conditions of the insurance policy.
18. It was further argued that the complainant has lodged a false DDR in collusion with the police. It was further argued that the complainant failed to furnish the requisite documents to the opposite party. It was further argued that the complaint being meritless was liable to be dismissed.
19. We have heard the learned counsel for the parties besides going through the case file very carefully.

                        The counsel for the complainant has reiterated contents of the complaint and submitted to decide the case based on documents already placed on record.

                   The counsel for OP has argued that there has been in delay in intimation of the incident to OP and lodging of DDR. Hence the complaint is liable to be dismissed.

20. A Motor Survey  Final Report dated 24.12.2018 submitted by I.B.Mehta, Surveyor & Loss Assessor, Marked A has been placed on record by OP wherein liability  of the insurer on NET of Salvage basis  has been given Rs.4,03,400/- (i.e. IDV Rs.4,51,000/- less consented less wreck value without RC46,600/-, less excess  clause Rs.1000/-. The same is authentic document to determine liability of OP.
21. Before coming to final conclusion, it is relevant to refer to the  Instructions dated 20.09.2011 issued by the Insurance Regulatory and Development Authority (‘IRDA’ for short), which are binding on the insurance company/opposite party as well, and the same read as under:

“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.”

22. Strong observations made by the IRDA, while issuing the above said circular dated 20.09.2011, which undisputedly binding on the Insurance Company, are generally altogether ignored by it, with a view to repudiate the most genuine claim of the complainant, by proceeding purely on a technical approach. Such a stand taken by an Insurance Company would not be permissible in law. 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.

23. It is not uncommon that all the insurance companies, be it public sector undertaking or private insurance company, 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 would be rejected on one or the other technical or flimsy ground, giving rise to such kind of avoidable litigation.
24. In fact, thrust of the insurance companies is, as to how and on what grounds, including baseless ones, claims can be repudiated, instead of settling the same proceeding on a reasonable approach. They always keep their consumers misinformed or misguided. At the time of accepting premiums, there would be no technical grounds in their schemes. However, when any insured puts his genuine claim, the insurance companies will repudiate that claim on technical and super technical grounds, which were not even known to the insured. The conditions of the Insurance agreements are so minutely printed that a person gets hardly any time to go through such conditions to make it legally binding in any appropriate manner. Thus, even genuine policyholders are losing faith in the institution and insurance industry is getting infamous, earning a bad name.
25. In view of the facts and circumstances of the case and law on the point referred to herein before, this Commission is of the view that the opposite party has wrongly failed to pass the claim. In this case, Anjana Mistry, authorized signatory, The New India Assurance Company filed his affidavit as Ex. RW1/A to support  the case of the opposite party but he is not the eye witnesses of the occurrence. From his affidavit, it cannot be assumed that the complainant had contributed towards the cause of fire to the insured vehicle. 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 the insured vehicle caught fire and got completely burnt. He reported the matter to the police. He had supplied all the required documents for passing the claim but the opposite party postponed the matter on one pretext or the other. He sent legal notice to the opposite party by post through his counsel but despite that the opposite party failed to pass the claim. He had filed claim with OP and  completed all the formalities of the documents required by the opposite party. During the course of argument, it was not disputed that the fire incident had taken place during the subsistence of the insurance policy. There is nothing on record that the complainant had contributed towards the fire incident. The documents required to get claim were filed by the complainant. From the DDR No.7 dt. 15.11.2018, it is apparent that the insured vehicle got completely damaged in the fire incident in question. The insured declared value of the vehicle is Rs.4,51,000/-. It is a case of total loss of the vehicle. As per repudiation letter Annexure C-4 dated 19.04.2019, the opposite party has repudiated the claim on the ground  that a letter of intimation  dated 21.11.2018 in respect of alleged accident of vehicle bearing registration no. HR-19L-1050 was submitted in the company after inordinate delay a period of 8 days from the date of alleged accidental loss of vehicle bearing registration no. HR-19L-1050 and in this regard a DDR No.7 was reported to be lodged in PS Achinatal, Distt. Charkhi Dadri on 15.11.2018 after delay a period of 2 days from the date of alleged accidental loss of vehicle bearing registration no.HR-19L-1050.
26. In view of IRDA guidelines the delay is of 8 days in intimation to OP is condoned. Accordingly, in order to do complete justice the present complaint is allowed and the opposite party is directed as under:-

1. To pay Rs.403400/- on net of salvage basis to the complainant subject to cancellation of Registration Certificate and furnishing the NOC from the financer or loan account statement, if any.
2. To pay Rs.10,000/- towards mental harassment.
3. To pay Rs. 5500/-on account of litigation expenses

                   The above order be complied within 45 days from today, failing which insurer shall be liable to pay interest on the said amount @ 9% per annum from the date of filing of the complaint till its actual realization. The complaint is disposed of accordingly. Copy of this order be given to the parties concerned free of costs. File be consigned to the record room.