Chandigarh

DF-II

CC/314/2014

Mr. Jaspal Singh - Complainant(s)

Versus

The Oriental Insurance Company Limited - Opp.Party(s)

Ajmer Lal Pundeer, Adv.

18 Aug 2015

ORDER

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

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Consumer Complaint  No	:	314 of 2014
Date  of  Institution	:	24.06.2014
Date   of   Decision	:	18.08.2015

 

 

 

 

 

Mr.Jaspal Singh s/o Sh.Narang Singh, R/o Village Madanpur, P.O. Ramgarh, Sector 26, Panchkula (Haryana).

 

             …..Complainant

Versus

 

1]  The Oriental Insurance Company Limited, Regional Office, SCO No.109-110-111, Batra Building, Sector 17-D, Chandigarh through its Chief Regional Manager.

 

2]  The Oriental Insurance Company Limited, Branch Office Panchkula, SCO No.325, 2^nd Floor, Sector 9, Panchkula (Haryana) through its Branch Manager.

 

….. Opposite Parties

 

BEFORE:  SH.RAJAN DEWAN                 PRESIDENT

         SH.JASWINDER SINGH SIDHU       MEMBER

         MRS.PRITI MALHOTRA             MEMBER

 

 

For complainant(s)      :     Sh.A.L.Pundeer, Counsel for                           complainant.

 

For Opposite Party(s)   :     Sh.Sukaam Gupta, Counsel for Opposite    Parties

 

 

PER PRITI MALHOTRA, MEMBER

 

 

          As per the case of the complainant, the complainant being the owner of vehicle Mahindra & Mahindra Scorpio Car bearing Regd.No.HR-68A-0075 availed a comprehensive insurance policy from the office of Opposite Party No.2 bearing No.231202/31/2011/5075 for the period from 18.9.2010 to 17.09.2011 by paying premium amount of Rs.8045/- (Ann.C-1). It is averred that on 19.9.2010 at about 5.15 P.M. when the complainant had gone to village Raipur Rani in his Car No.HR-68A-0075 in connection with purchase of agricultural land and after agreement of purchase, when the complainant left for his village at about 8.15 PM in his above said car and reached at Vilalge Mattanwala, suddenly a white coloured car over took his car and stopped their Skoda or lancer car ahead of car of the complainant.  Soon after, three young boys hiding their faces with clothes came out and pushed the complainant out of his car on gun point and snatched his Car No.HR-68A-0075 and fled away from the site taking his car, documents and Rs.10,000/- kept in the car.  The incident of snatching was intimated to the police as well as insurance company through fax. Accordingly, an FIR No.181, dated 20.9.2010 was registered with P.S. Chandimandir, under Section 392 IPC (Ann.C-2) and intimation to Opposite Party No.1 through Fax message was sent on 20.9.2010 (Ann.C-3 (I to iv).  The Investigator i.e. M/s Royal Associates, Investigating & Detective Agency, appointed by Opposite Party Insurance Company carried out the investigation and submitted its report to the OPs.  It is averred that the complainant along with claim papers submitted all requisite documents with the investigating agency and cooperated in all respect. It is also averred that the complainant also submitted the untraced report on 8.3.2013 apart from submitting NCRB Report (National Crime Records Bureau) report to the OPs on 28.4.2014.  It is further averred that despite submitted all the papers necessary for the settlement of the claim, the OPs failed to settle the claim and kept it pending for nearly 4 years and even the issuance of legal notice did not yield any result. It is pleaded that the OPs kept pending the said claim even after receipt of the investigation report against the provisions of sub-clause 5 of Regulation 9 of IRDA Regulations, 2002. Hence, this complaint has been filed alleging the said act of the OPs as gross deficiency in service.

 

2]       The OPs have filed reply and admitted the insurance of the vehicle in question, receipt of intimation about the snatching incident, registration of FIR about said incident, appointment of investigator to investigate the matter and lodging of claim.  However, it is submitted that the present complaint of the complainant is pre-mature as the claim of the complainant is still pending.  It is also submitted that after receiving the investigation report, the Opposite Parties kept on asking the complainant to comply with the pre-claim approval formalities and post claim approval formalities, but the complainant himself remained silent for a number of months and forced the OPs to issue letter dated 18.2.2011 asking the complainant to comply with the claim formalities which again were not fulfilled by the complainant. Rest of the allegations have been denied with a prayer to dismiss the complaint.

 

3]       The complainant has also filed rejoinder to the written reply of the Opposite Parties, thereby reiterating the assertions as made in the complaint and controverting that of the written reply of the Opposite Party.

 

4]       Parties led evidence in support of their contentions

 

5]       We have heard the ld.Counsel for the parties and have also perused the record as well as written arguments.  

 

6]       Admittedly, the complainant being the owner of vehicle Mahindra & Mahindra Scorpio Car bearing Regd.No.HR-68A-0075 availed a comprehensive insurance policy from the office of Opposite Party No.2 bearing No.231202/31/2011/ 5075 for the period from 18.9.2010 to 17.09.2011 by paying premium amount of Rs.8045/-.  The fact qua the snatching incident committed against the said vehicle is not disputed by the OPs, which occurred on 19.9.2010 at about 5.15 P.M..  Further, record proves that an FIR No.181, dated 20.9.2010 was registered with P.S. Chandimandir, under Section 392 IPC (Ann.C-2).  Due intimation was given to the office of Opposite Party No.1 through Fax message dated 20.9.2010 (Ann.C-3 (I to iv). It is proved on record that Investigator namely M/s Royal Associates, Investigating & Detective Agency, SCF No.132, First Floor, Sector 13, Market, Urban Estate Kurukshetra (Haryana), was appointed by the OPs to carry out the investigation & is also on record that the said Investigating agency submitted its report to the OPs.

 

7]       The ld.Counsel for the complainant submitted that the complainant submitted the claim papers with the investigating agency of the Opposite Party and cooperated in all respect for early settlement of the claim.  Further submitted that the complainant duly submitted the untraced report on 8.3.2013 as was asked for by the OPs and on the concerned day dated 8.3.2013 he was again asked for getting the NCRB Report (National Crime Records Bureau) issued by their Head Office at Delhi, which complainant gathered with much of difficulty and duly submitted it with the OPs on 28.4.2014.

8]       It is the main allegation of the complainant that despite the submission of all the papers necessary for the settlement of the claim, the OPs failed to settle the claim and kept it pending for nearly 4 years.  Further submitted that the legal notice was sent on 7^th June, 2014 and the same has yet not been responded by the OPs.  The complainant alleged that the OPs kept pending the said claim even after receipt of the investigation report against the provisions of sub-clause 5 of Regulation 9 of IRDA Regulations, 2002.

 

9]       On the other hand, it is submitted by the ld.Counsel for the OPs that the present complaint of the complainant is pre-mature as the claim of the complainant is still pending and claimed further that after receiving the investigation report, they kept on asking the complainant to comply with the pre-claim approval formalities and post claim approval formalities, but the complainant himself remained silent for a number of months and forced the OPs to issue letter dated 18.2.2011 asking the complainant to comply with the claim formalities which again were not fulfilled by the complainant.  Hence, there is no deficiency in service on the part of the OPs.

 

10]      It is duly proved on record that the OPs despite receiving the investigation report dated 14.1.2011 (Ann.R-1-2/B) from their investigating agency, kept pending the claim for uncertain period and inspite of settling the fate of the claim indulged in issuing directions to the complainant to supply the documents, which legally was not the duty of the complainant to supply and is also not  required under the policy terms, to be supplied by the complainant.  Even the OPs acted against the settled law as well as Regulation No.9 of Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002, which reads 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.”

 

 

11]      From the perusal of the above clause with special reference to sub-clause 5 & 6 of the same, it reveals that the insurer is duty bound to declare the fate of the claim within 30 days from the receipt of the report of their Surveyor/Investigating Agency.  In addition to that the insurer is bound to pay the amount due within 7 days from the date of acceptance of offer by the insured.  It is observed that the Opposite Parties did not bother to adhere to the provisions of the above mentioned regulations issued by the apex body i.e. Insurance Regulation and Development Authority (IRDA) and grossly violated the same.  Though, there is no formal offer of settlement made to the complainant, but the investigation report submitted by the Investigator of the OPs had the reference of the same in the column of opinion. The opinion of the Investigator, reads as under:-

 

“On the basis of above said findings, we are of the opinion that time, date and place of snatching seems to be genuine.  The insurance company was informed about the snatching of vehicle on 20/09/2010. Insured has consented to accept 10% less than IDV in lieu of theft claim of his vehicle from the insurance company.  Particulars of the vehicle as mentioned in the FIR, RC and Insurance Policy are same. Police investigation is still going on and untrace report is still awaited. Insurer may deal with claim as per terms and conditions of policy, keeping in view of above said findings.  This report is issued without prejudice.”

 

 

12]      In our opinion, the acceptance as recorded above is no more remained valid and the complainant is entitled for the claim in toto.  For this view, we are well guided by the following judgments placed on record by the complainants.

a)  Sundhudurg District Central Co-operative Bank Ltd. & Anr. Vs. National Insurance Co. Ltd. & Anr., 2012(1)CLT (NC);

b)  United India Ins. Co. Ltd. Vs. M.K.J.Corporation, 1998(2) CLT (SC);

c)  United India Insurance Company Vs. New India Rubber Works, 2005 (3)CLT (Punjab State Commission);

d)  Paramount Iron and Steel Works Pvt. Ltd. Vs. Oriental Insurance Co. Ltd. and another, 2007(2) CLT (NC);

e)  Vijay Gupta Vs. Oriental Insurance Co. Ltd. and another, 2007(1) CLT (NC);

f)  National Insurance Company Ltd. Vs. Rajesh Kumar Kalia, 2013(2) CLT (NC)

g)  Ram Niwas vs. Oriental Insur. Co. Ltd., CC No.703 of 2014, decided on 26.5.2015 (DCDRF-I UT Chandigarh).

 

13]      In view of the above discussion, it is clear enough that the complainant is duly entitled for the claim. Thus, the deficiency in service on the part of the OPs is proved.  Therefore, the complaint stands allowed and OPs No.1 & 2 are jointly & severally is directed as under:-

1. To pay the Insured Declared Value of the vehicle in question, as per policy, along with interest @9% per annum from the date of submission of investigation report i.e. 14.1.2011 till it is paid.
2. To pay Rs.20,000/- to the complainant as compensation for causing him mental & physical harassment;
3. To pay Rs.10000/- towards litigation expenses.

 

         This order be complied with by the OPs No.1 & 2 jointly & severally within a period of 45 days from the date of its receipt, failing which they shall be jointly & severally liable to pay the Insured Declared Value of the vehicle in question, as per policy, along with interest @18% per annum from the date of submission of investigation report i.e. 14.1.2011 till it is paid and also to pay interest @18% per annum on the compensation amount of Rs.20,000/- from the date of filing this complaint till it is paid, besides paying litigation cost of Rs.10,000/-.

          The certified copy of this order be sent to the parties free of charge, after which the file be consigned.

Announced

18^th August, 2015                                               

                                                                                                Sd/-

 (RAJAN DEWAN)

PRESIDENT

 

 

Sd/-

 (JASWINDER SINGH SIDHU)

MEMBER

 

 

Sd/-

(PRITI MALHOTRA)

MEMBER

                                                                                                                   

 

 

DISTRICT FORUM – II

CONSUMER COMPLAINT NO.314 OF 2014

PRESENT:   None   Dated the 18th day of August, 2015

O R D E R                        Vide our detailed order of even date, recorded separately, the complaint has been allowed against Opposite Party.                    After compliance, file be consigned to record room.

 

(Priti Malhotra)	(Rajan Dewan)	(Jaswinder Singh Sidhu)
Member	President	Member