(Sl.no.1) Bhopal Ombudsman Center - Insurance Ombudsman

BHOPAL

(Sl.no.1)

Bhopal Ombudsman Center

Case No. GI/OIC/0208/174

Mr. N.P.Shrivastava

V/s The Oriental Insurance Co. Ltd.

Order No.: BPL/GI/08-09/01 Award Dated: 17.04.2008

Brief Background

Mr. N.P. Shrivastava had taken a Motor policy No. 152905/2007/9086 for the period

12.03.2007 to 11.03.2008 from M/s The Oriental Insurance Co. Ltd. City Branch-5,

Jabalpur covering his Maruti Wagon R Car No. MP-20 CA-3073 & his vehicle met with

an accident on 13.08.2007 while a motorcycle suddenly came speedily and hit the

vehicle from left side. Subsequently on intimation to the Respondent, they appointed

surveyor Mr. Pradeep Mehra, Surveyor & Loss Assessor for investigation into the case

and assessment of loss. The Surveyor negotiated the loss with repairer and assessed

the loss as against estimated cost Rs. 25076/-. The vehicle was repaired and bills

were submitted accordingly for Rs. 15288/-. But the Respondent settled his claim for

Rs. 11150/-, which he did not receive with full satisfaction and discharge of the claim.

The Respondent vide its letter dated 22.02.2008 submitted that on receipt of claim

related documents the Surveyor was deputed and inspection was made on the same

day As per surveyor’s report, the loss was assessed for Rs. 12894/- and later on

receipt of cash memos/bills of repair after applying excess and salvage amount, the

net payable amount comes to Rs. 11150/- which the complainant refused to accept as

full & final settlement of the claim. Further the Respondent contended that the

complainant was asking charges for denting/painting/opening fitting of L/s rear door,

which was not damaged on account of the said accident.

Findings: - It was an admitted fact that the Complainant’s vehicle covered under the

within mentioned policy met with an accident on 13.08.2007 when a speedy

motorcycle hit the vehicle from left side. During hearing the respondent contended

that the left rear door denting/painting and opening fitting charges were disallowed,

as there was no effect of accident. Some photographs of the damaged vehicle were

placed before forum, which showed there was no impact of accident in rear left door of

the damaged vehicle. Subsequently the complainant found not entitled for the cost of

denting/painting of left rear door of the vehicle. Similarly, an amount of Rs. 1026/-

deducted towards salvage value of damaged parts by respondent as against the

complainant’s willingness to submit the salvage parts found not fair.

Decision:

Held that the decision of the Respondent to repudiate the claim partially is fair

and just except the amount deducted against the salvage value. The

complainant is entitled for the salvage value of Rs. 1026/- if he deposits the

salvage to the Respondent within 15 days from receipt of this order failing

which he is entitled only for the sanctioned amount of Rs. 11150/- without any

further relief.

****************END of 1************

(Sl.No. 2)

Bhopal Ombudsman Center

Case No. GI/ICI/0208/177

Mr. Rohit Kalyan V/s

The ICICI LOMBARD GEN INS. Co. Ltd

Order No.: BPL/GI/08-09/02 dtd.21.4.07 Case No.:GI/ICI/0208/177

Brief Background

Mr. Rohit Kalyan, had insured his Tavera Car Bo. MP-04-BA-0582 under private car

comprehensive Motor policy/Covernote No. 50366121 for the period 28.09.2006 to

27.09.2007 for Sum Insured Rs. 5,94,700/- from M/s ICICI Lombard General

Insurance Co. Ltd. Bhopal & met with an accident on 19.05.2007. Subsequently

intimated to the Respondent for the appointment of surveyor/Investigator. The vehicle

was repaired in Company’s authorized service station M/s Super Cars Limited, Bhopal

and bills were submitted accordingly on 13.09.2007. A rejection letter dated

29.07.2007 received by him on 29.10.07 repudiating the claim on the grounds that

the vehicle used for commercial (hire and reward) & the insured breached the trust of

insurance company by giving wrong and misleading information.

The Respondent vide its letter dated 13.03.2008 submitted that the claim was

investigated as per their procedure. On the basis of the statement of the complainant,

it repudiated the claim as the vehicle was used for hire & reward and the insured

committed breach of policy condition enumerated in General Exception of the policy.

It contended that the complainant is paying a monthly installment of Rs. 11,145/-

while he was earning a salary of Rs. 5000/- per month. In support of its contention, it

submitted a copy of the statement of the complainant.

Findings:

It was an admitted fact that the Complainant’s vehicle was covered under Motor

Package Policy No. 3001/50366121/00/000 as private Car & the accident had taken

place on 19.05.2007 when the vehicle was on its way from Bhopal to Gwalior and the

vehicle was collided with a tractor from opposite direction. The vehicle damaged badly

and it was repaired with Respondent authorized service station M/s Super Cars

Limited, Bhopal. When there was no reply from Respondent side, the repairs was

carried out and an amount of Rs. 1,66,995/- was paid. The Respondent Appointed

Mr. Anand Rathore, Insurance Claim Investigator for assessment/investigation into

the loss who submitted his report dated 09.07.07 recommending for repudiation of

claim on the basis of information, statement collected by him. During hearing the

statement of the complainant and service record of the vehicle as well as the

photocopy of the joint account pass book of the complainant was placed before the

forum. Further it was observed that the complainant’s father was retired from BHEL

and the payment of EMI are going to be paid from his joint account with State Bank of

India and there is no relevance with repudiation of claim. Further, the Respondent

placed the service record of the vehicle, which shows that the vehicle was used for

50000 kms. During 8 months is again not relevance with the rejection of claim.

Respondent also failed to place any concrete proof that the vehicle was plied for hire

and reward at the material time of accident. The Respondent contention that the

complainant had 4 vehicles in his family is not sufficient proof to repudiate the claim.

Decision:

Held that the decision taken by Respondent to repudiate the claim is unfair

and unjust. Since the Respondent had not assessed the loss at the time of

accident, it is liable to pay the amount as per its authorized repairers Invoice

No. R503416 dated 30.06.2007. The Respondent is directed to pay the claim

amount of Rs. 1,66,995/- within 15 days from receipt of consent letter from the

Complainant failing which it will attract a simple interest of 6% p.a. from the

date of this order to the date of actual payment.

***************************end of 2 *******************************

(Sl.No. 3) BHOPAL OMBUDSMAN CENTRE Smt. Kamla Rai V/s The New India Assurance Co. Ltd., Bhopal Order No.: BPL/GI/08-09/06 Case No.: GI/NIA/0408/08

Order dated: 23.05.2008

Brief Background Smt. Kamla Rai had taken a Motor policy No. 450102/31/06/01/00002969 for the

period 10.01.2007 to 09.01.2008 from M/s The New India Assurance Co. Ltd, City

Branch-Bhopal covering her Indica Car No. MP-04-T-7402 for S.I. of Rs. 2,51,887/-.

The vehicle with an accident on 09.03.2007 and the Respondent was informed. The

Respondent’s surveyor Mr. S.K. Khanna assessed the loss to the tune of Rs.

1,25,000/- (on net of salvage basis). The Respondent after verifying various vehicular

documents pointed out that the vehicle was sold prior to obtaining insurance cover

and the subject vehicle was being plied on the date of accident without permit and

authorization which is contravention as to the terms and conditions of the policy and

repudiated the claim on producing false and fabricated fitness certificate vide its letter

dated 27.11.2007.

The Respondent vide its letter dated 03.04.2008 submitted that on verification of

various vehicular documents, they found that the subject vehicle was sold prior to

obtaining insurance coverage i.e. on 23.11.06 to Mr. Mukesh Rathore and there was

no insurable interest at the material time of accident. Further the subject vehicle was

being plied on the date of accident without permit and authorization which is

contravention as to the terms and conditions of the policy and Section 66 of M.V. Act

1988. Moreover, the complainant has suppressed the material fact that the vehicle

was being used after obtaining fitness certificate but the verification of the vehicular

documents reveals that the fitness certificate was expired on 22.01.07 i.e. prior of

accident. The Respondent repudiated the claim vide their letter dated 27.11.07 and

intimated the same to the complainant. In support of its contention, the Respondent

submitted the copy of survey report and photographs of damaged vehicle and copy of

Certificate of Regional Transport Officer, Bhopal showing the period of fitness of

subject vehicle.

Observations:

It was an admitted fact that the Complainant’s vehicle was covered under

Motor Policy No. 450102/31/06/01/00002969 taken from the Respondent.

The accident had taken place on 09.03.2007 when a speedy motorcycle hit the

vehicle from left side. On intimation of loss, the Respondent appointed the

surveyor for assessment of loss who assessed the loss as Rs. 1,25,000/-(net of

salvage basis) after taking into consideration the terms and conditions under

the policy. Moreover, the subject vehicle was being plied on the date of accident

without permit and authorization which is contravention as to the terms and

conditions of the policy as well as the Section 66 of M.V. Act 1988.

On going through the record, it was also found that the subject vehicle was sold to Mr.

Mukesh Rathore and the sale agreement was executed w.e.f. 13.11.06 i.e. prior to

Insurance Policy period. Thus the complainant was not having insurable interest at

the time of accident. Further the fitness certificate was expired on 19.01.07 and the

complainant could not renew the same till the time of accident. Again the vehicle was

being plied at the material time of accident without permit and authorization, which

shows gross violation of Section 66 of M.V. Act 1988.

Decision: -

In view of the circumstances stated above, the decision of the Respondent to

repudiate the claim on the grounds mentioned above found fair & justified.

Therefore, there was no reason to interfere with the decision taken by the

Respondent. The complaint was dismissed without any relief.

**********************end of sl.no.3********************

(Sl.no.4) BHOPAL OMBUDSMAN CENTRE Shri Prabhat Dubey V/s The Oriental Insurance Co. Ltd., Sagar

Order No.: BPL/GI/08-09/07 Case No.: GI/OIC/0408/17


Brief Background

Mr. Prabhat Kumar Dubey had taken a Motor policy No.

153700/31/2007/2682 for the period 07.12.2006 to 06.12.2007 from M/s The

Oriental Insurance Co. Ltd, Sagar covering his Mahindra Max Pick Up No. MP-

15-G-1733, which met with an accident on 25.10.2007 near Dehgaon while

saving two cows on road. The driver steered the vehicle on left side but the

vehicle went out of control and went off the road and overturned causing

damages to the vehicle. On intimation to the Respondent, they appointed a

spot surveyor Mr. Kamal Kapoor who inspected the vehicle and submitted his

report-dated 29.10.07 to the Respondent. As per complainant the estimated

cost for repair of the vehicle was Rs. 60,000/- The Respondent after verifying

various vehicular documents pointed out that the vehicle was driven by Mr.

Prabhat Kumar Dubey, the owner of the vehicle at the time of accident which

was revealed by the Surveyor’s report. The complainant submitted a claim for

Rs. 60000/-, which was repudiated by the Respondent, as the driver was not

holding valid driving license to drive particular vehicle at the time of accident.

The complainant made an appeal to Respondent’s higher offices for necessary

settlement of his claim but there was no response from their side. Aggrieved

with the repudiation of his claim, the complainant approached this office for

justice.

The Respondent vide its letter dated 03.04.2008 submitted that A motor OD claim was

preferred by the complainant and accordingly they appointed Spot Surveyor Mr.

Kamal Kapoor from Bhopal who inspected the vehicle and submitted his report dated

29.10.07. In the Spot Survey Report, the driver name was mentioned as Mr. Prabhat

Kumar, the owner of the vehicle, who does not have valid driving license to drive

particular vehicle at the time of accident. They repudiated the claim taking into

consideration the D.L. of Mr. Prabhat Kumar Dubey.

Observations:

It is an admitted fact that the Complainant’s vehicle was covered under Motor Policy

No. 153700/31/2007/2682 for the period 07.12.2006 to 06.12.2007. The accident

had taken place on 25.10.2007, which is within the policy period. It is evident that

Respondent never mentioned about the final survey in their self-contained note dated

08.04.08. The Final Survey Report was presented at the time of hearing.

During hearing the complainant contended that the accident was informed to the

Respondent and they deputed Spot Surveyor for verification of the accident. At the

time of inspection, he informed about the driver Mr. Mukesh Kumar but the Spot

Surveyor asked the driving license of the owner and the same was produced. Further,

at the time of Final Survey, he reported about his driver Mr. Mukesh Kumar who was

driving the vehicle at the material time of accident and the Final Surveyor Mr. Mustafa

Husain itself verified the licence. He revealed that there was no injury to the driver

but the cleaner was slightly injured, hence he did not lodge an FIR in the police

station.

During hearing the Respondent reiterated that the Spot surveyor Mr. Kamal Kapoor

inspected the vehicle and verified Driving Licence of the owner driver Mr. Prabhat

Kumar Dubey who is authorized to drive Motorcycle and LMV only. On verification the

D.L. from L.A. Sagar (M.P.) it was pointed out that the owner was not authorized to

drive particular vehicle. On the basis of Spot Surveyor’s report, they repudiated the

claim and not bothered to look after the details collected by Final Surveyor. Hence

gross negligence was found on the part of the Respondent. .

On going through the record, it was found that the Final Surveyor verified the D.L.

where Mr. Mukesh Kumar was driving the vehicle at the material time of accident. The

Respondent cannot ignore the fact verified by their Final Surveyor Mr. Mustafa

Husain. Further, the report of Mr. Deepak Pathak, Surveyor & Loss Assessor reveals

that driver was Mr. Mukesh Kumar S/o Ram Ratan in the Claim form as well as in

Final Surveyor Report. In my opinion the driver Mr. Mukesh Kumar was holding a

valid driving licence at the material time of accident and the Respondent cannot ignore

the claim, which was assessed by their Final Surveyor Report. As per Final Surveyor

Report dated 03.11.2007, the claim assessed was for Rs. 37,630.26 after deduction of

depreciation on spares and excess clause amount.

DECISION:

Held that the decision of the Respondent to repudiate the claim is unfair and

unjust. Since the final surveyor deputed from the Respondent itself verified the

driving license, the Respondent is liable to pay the assessed amount as per

Surveyor’s Report dated 03.11.07 i.e. for Rs. 37,630.26 The Respondent is

hereby directed to pay the claim amount of Rs. 37,630.26 within 15 days from

receipt of consent letter from the Complainant failing which it will attract a

simple interest of 6% p.a. from the date of this order to the date of actual

payment.

………………..END ON 4…………………………

(Sl.No.5) Bhopal Ombudsman Center

Mr. Maninder Singh Sethi

V/s

The New India Assurance Co. Ltd., Indore

Order No.: BPL/GI/08-09/14 Case No.: GI/NIA/0208/186

Order dated 27/06/2008

Brief Background

Mr. Maninder Singh had insured his Tata Truck No. MP-09-KC-8872 under Goods

Carrying Vehicle package motor policy No. 450800/31/05/01/00010276 for the

period 03.02.06 to 02.02.07 for IDV of Rs. 5, 25,000/- from M/s The New India

Assurance Co. Ltd.

As per complainant his vehicle met with an accident on 19.04.2006 near Ruthiyai on

A.B. Road. Subsequently on intimation to the Respondent, it appointed spot surveyor

Mr. Subhash Katyal, for investigation into the loss. The Final Survey was conducted

by Mr. Sanjay Joshi who also re-inspected the vehicle after its repairs. The Final

Surveyor settled his claim for Rs. 75373/- All the vehicular documents and bills

related to claim were submitted with the Respondent. There was a query of driver’s

license, which was produced for verification. After investigation into driving license,

the Respondent arbitrarily deducted 25% of his claim amount and final discharge

voucher for Rs. 53,500/- was sent to him for full & final receipt of the claim. He

refused to accept this amount and made various correspondences with the

Respondent but there was no response from their side. Finally he made an appeal to

higher offices of the Respondent but again there was no response. Aggrieved with the

partial repudiation of his claim, the complainant approached this office for justice.

The Respondent vide its letter dated 26.03.2008 submitted that complainant TDV

Truck No. MP09-KC-8892 was met with an accident and claim was filed. The claim

was properly attended and spot survey was done by Mr. Subhash Katyal. The final

survey was conducted by Mr. Sanjay Joshi who also re-inspected the said vehicle. On

scrutiny of claim papers, it was observed that Mr. Dan Singh was driving the vehicle at

the material time of accident whereas insured has declared in claim form that Mr.

Ranvir Singh was driving the vehicle. The D.L. of Mr. Dan Singh was asked from the

complainant vide its various letters. When the insured was failed to produce the

license for verification, the file was closed as No Claim after serving the final notice.

However, Insured produced the license for verification on 30.08.07 but the police do

not confirm the father’s name of Driver and death of person. The matter was

investigated by its Shivpuri Branch to confirm full name of driver and to get the

complete case diary/criminal papers. On scrutiny of police record, it was revealed that

unauthorized passengers were traveling in the said goods carrying vehicle at the

material time of accident, which is a breach of policy condition. Since there was

breach of policy condition, the claim was treated as non-standard and voucher was

sent for discharge.

Observations:

It was an admitted fact that the Complainant’s vehicle was covered under Motor

Package Policy No. 450800/31/05/01/00010276 for the period 03.02.06 to 02.02.07

as goods carrying vehicle. The accident had taken place on 19.04.2006 when the

vehicle was plying on its way from Indore to Delhi. Suddenly a truck coming from

opposite direction recklessly driven hits insured’s vehicle from right. Both the vehicles

collided with each other damaging right front corner badly. As per my observations,

the partial repudiation was focused that the vehicle was carrying unauthorized

passengers at the time of accident. For this, I have gone through both the survey

reports i.e. Spot & Final and found there was no mention of unauthorized passengers.

Further, I have also gone through the FIR dated 19.04.06, which was lodged by one

Mr. Gopi Lal, Watchman who disclosed that the driver was seriously injured and there

were no mention of unauthorized passengers. It is also observed from the investigation

report of Mr. Dileep Goyal, Advocate of Shivpuri that the vehicle was driven by Mr.

Ram Vir Singh at the time of accident and his license was very much valid at the time

of accident. In the Spot & Final Survey Report, the driver was Mr. Ram Vir Singh and

his driving license was found valid. In the claim form he mentioned the name of co-

driver Mr. Dan Singh, his driving license was also verified and found to be valid. The

Respondent at the time of hearing shown two statements of M/s Manish Kumar &

Dinesh Kumar who mentioned that some people were injured sitting in the said truck

but this fact was not disclosed in FIR and the statement given by Mr. Gopi Lal himself

who informed to police hence the question of carrying unauthorized passengers is not

tenable and the Respondent is liable to pay full OD claim assessed by its Final

Surveyor Mr. Sanjay Joshi.

Decision:-

Held that the decision of the Respondent to repudiate the claim is unfair and

unjust. Since the Final Surveyor assessed the amount of Rs. 70888.50 after

deducting excess clause for Rs. 1000/-, the Respondent is directed to pay the

claim amount of Rs. 70888.50 within 15 days from receipt of consent letter

from the Complainant failing which it will attract a simple interest of 6% p.a.

from the date of this order to the date of actual payment.

*****************End of 5*************************

(Sl.no. 06)

BHOPAL OMBUDSMAN CENTER Mr. Subhash Pandey V/s ICICI Lombard General Insurance Co. Ltd., Bhopal

Order No.: BPL/GI/08-09/18 Case No.: GI/ICI/0408/21

Order dtd: 4th day of August 2008

Brief Background

Mr. Subhash Pandey had insured his Indica Car No. HR-17-4317 under Private Car

package Motor Covernote No. PE 4184182 for the period 24.05.07 TO 23.05.08 for

IDV of Rs. 3,00,000/- from M/s ICICI Lombard General Insurance Co. Ltd.

Gwalior/Bhopal.

As per complainant his vehicle met with an accident on 15.07.2007 at Bhopal. He

shifted the vehicle at Authorised dealer M/s Mechmen Motors Pvt. Ltd. At the time

of accident his policy was delivered to him. When he approached to the

Respondent, they refused to lodge the complaint because the policy was not issued

till that time. Finally he lodged a complaint with their call center and got the claim

No. MOT-00694814. He preferred an estimate along with his letter dated 21.01.08

to the Respondent but they refused to settle his claim due to reasons that the

insurance policy was not forced at the time of loss and the premium for the policy

was not paid by the insured. Aggrieved with the repudiation of his claim, the

complainant approached this office for justice.

During hearing the Respondent’s Representative Mr. Saurabh Jaiswal, Legal

Manager, admitted that there was a lapse from their side and they are ready to

settle the claim within a week from the date of hearing. Based on the statements

of Respondent’s Legal Manager, the proceedings was adjourned for a week. But

again we have received a letter dated 29th July 2008 from the Complainant that the

claim is still pending without any decision on the part of Respondent.

Observations:

It is an admitted fact that the Complainant’s vehicle was covered under Motor

Covernote No. PE-4184182 for the period 24.05.07 to 23.05.08 as private vehicle

issued by the Respondent. The accident had taken place on 15.07.07 when the

vehicle was plying on the road and collided with road divider. An estimate dated

21.01.08 from the authorized dealer M/s Mechmen Motors Pvt. Ltd., Bhopal for Rs.

2,56,870/- was preferred with the Respondent for necessary survey of the vehicle

and settlement of the claim. But inspite of taking any efforts toward settlement of

the claim, the Respondent opted a simple method to repudiate the claim on the

baseless grounds that the insurance was not forced at the time of loss and the

premium for the policy was not paid by insured. During hearing the Respondent

was asked to clarify the points for repudiation but he was not in a position to

submit his self-contained note. Finally he accepted the liability on behalf of

Respondent and assured to settle the claim within a week before this forum.

Further, It was also observed that the letter of M/s Mechmen Motors Pvt. Ltd.,

Bhopal addressed to the complainant for the demand of parking charged w.e.f.

16.07.08 up to the date of taking delivery of the vehicle from the complainant. The

repudiation grounds from the Respondent were set aside as there was no reason to

say that the Insurance was not effective at the time of loss. Further it is very

serious to take casual approach towards the comments asked by this forum.

Decision: -

Held that the decision of the Respondent to repudiate the claim is unfair and unjust.

Since the Respondent failed to take any decision on the instant claim even after

commitment before this forum, the Respondent is directed to pay the claim for an

estimated amount of Rs. 256870/- along with the parking charges @ Rs. 200/- per

day w.e.f. 16.07.07 up to the date of necessary settlement of claim within 15 days

from receipt of this order failing which it will attract a simple interest of 6% p.a.

from the date of this order to the date of actual payment.

*************END OF 6***************

(Sl.No. 7)

BHOPAL OMBUDSMAN CENTRE,

Shri Bhupendra Sharma…V/s Reliance General Insurance Co. Ltd.

Order No.: BPL/GI/08-09/22 Case No.: GI/RGI/0408/06


Brief Background As per complainant he along with one of his friend had gone to Piparia via Barelli on

24.02.07 by his Car No. MP04 HA-6905 insured with Reliance Gen. Insu. Co. to collect

some payment from one of his client on the day of accident. At night he was driving

the vehicle, suddenly he lost control over the vehicle, it went off the road and fell down

into a ditch and got damaged. They caught Trax Jeep and came to Bhopal. He did not

inform anybody about the accident and left his vehicle without any security. He visited

Pipariya on 26.02.07 to bring the vehicle back. The matter was reported to police on

26.02.08 and the vehicle was removed to Landmark Automobile through tractor No.

MKG-8211, who had given the loss estimate to the Insurance Company. The matter

was informed to the Insurance Company on 08.03.07 but the matters was delayed for

5 months with verbal assurance and finally vide letter dated 23.07.07, the claim was

denied on fictitious ground. Aggrieved with the decision of the Respondent’s, he

approached this office for settlement of his claim.

The Respondent vide its letter dated 07.08.08 submitted that the complainant has

manipulated/fabricated the documents and somehow managed to get the insurance

policy from them by providing wrong information. After receipt of intimation from the

complainant, they deputed Mr. Sanjay Shrivastava for investigating into the matter,

who submitted his report on 28.04.08 along with various documentary proof and

statements. The Respondent vide point no. 3 reiterated that the intimation of accident

was given to police after 3 days and they were informed on 08.03.08 i.e. after a week’s

time. Further it submitted that the statements of the Tractor driver Mr. Laxman Singh

who brought the damaged vehicle in workshop stated that the vehicle was lying on

Piparia-Bhopal road but as per the complainant the accident took place on Piparia-

Bareily Road. The insured used all the facts/manipulated documents to take the

insurance policy for his vehicle from insurer. The insured submitted a fake cover note

of M/s Iffco Tokyo General Insurance Co. Ltd, which was issued for two-wheeler in the

name of Mr. Bhagwan Das of Tikamgarh. The insured has got one more TP insurance

policy from another insurer M/s United India Insurance Co. Ltd that was in force at

the time of taking insurance from them.

Observations:

It was also noted that the existing policy was taken from the Respondent by

submitting the photocopy of Cover note No. 32691921 of M/s Iffco Tokyo General

Insurance Co. Ltd., as previous insurance which found that the cover note was issued

to Mr. Bhagwan Das, Tikamgarh for the period of 12.01.06 to 11.01.07 for two

wheeler. But the complainant showed his ignorance about this document. The

Respondent placed some photographs of pre-inspection and damaged vehicle, which

shows some difference in identity of the insured vehicle. The letter dated 22.05.07 of

M/s Landmark Automobiles, Bhopal also viewed, which says that the vehicle came on

1st March, 2007 for repairing work and the same was carried on 24.04.07 after the

engine was started by providing service battery from their side which shows that the

vehicle was not repaired till today. During hearing various documents, which require

physical witness/examination on oath to prove the genuineness of the claim, were also

showed. Further as per report-dated 28.04.07of Investigator Mr. Sanjay Shrivastava;

it requires various confirmations from the earlier owner of the vehicle and other

witnesses. For the equity of justice, it

would require evidences, which may necessitate examination on oath. Since,

This Forum has no power to summon and examine witnesses on oath. In the

above circumstances, it is held that this forum has no jurisdiction and power

to entertain the complaint, hence the complaint is filed.

***************End of 7****************

CHANDIGARH

Chandigarh Ombudsman Centre

CASE NO. GIC/075/OIC/14/09

Krishna Devi Vs. Oriental Insurance Co. Ltd.

Order dated 01.07.08

FACTS: Smt. Krishna Devi got her vehicle No. HR 55 ET-1363 (Make Tata Indica) insured with the insurer.

As per the complaint, no details of accident have been provided by the insured. However, it has been

mentioned in the complaint that her claim was made ‘NO CLAIM” by the company. As per the

photocopy of motor claim form submitted by the insured, all details relating for ‘detail of accident’ and

‘damage for insured vehicle’ have been leaving blank. Parties were called for hearing on 01.07.08. at

New Delhi.

FINDINGS: During the course of hearing the insurer stated that the insurance was valid from

22.08.07 to 21.08.08. The accident reported by took place on 02.11.07. However, intimation was given

to the insurer on 12.11.07. No spot survey could be done. There was no FIR. The Insurer stated that the

cause of the accident given in the claim form was that the vehicle was parked near a hotel and a vehicle

hit it while reversing. The vehicle hit a tree from the back side. However, investigation revealed that

there was no tree as alleged near the site of accident. Moreover, investigator could not meet the

complainant. At another place, it is stated that a truck driver was reversing the vehicle. If no one had

seen the accident how was it knows that a truck had caused the accident. In view of these contradictory

statements, the bonafides of the accident could not be established.

DECISION: Held that the bonafides of the accident not being established is in order. No claim is

justified.

Chandigarh Ombudsman Center

CASE NO. GIC/172/NIA/11/09

Amarjit Singh Vs. New India Assurance Co. Ltd.


FACTS: Shri Amarjit Singh had got his Mahindra Scorpio bearing no. HR-51-M-6886 insured for

the period 20.06.06 to 19.06.07 with the insurer. On 30.01.07, the said vehicle met with an

accident. At the time of accident, the vehicle was driven by his son Mr. Gurinder Singh. All the

claim documents were submitted by the complainant for settlement of claim. But the

insurance company repudiated the claim on the ground that the driver, Mr Gurinder Singh, did

not have valid driving licence at the time of accident. Parties were called for hearing on

25.07.08.

FINDINGS: The insurer stated that the complainant Sh. Amarjit Singh had an insurance

policy for his Mahindra Scorpio bearing no. HR-51-M-6886 which was valid for the period

20.06.06 to 19.06.07 with the insurer. The vehicle met with an accident on 30.01.07. At the

time of accident the vehicle was driven by his son Sh. Gurinder Singh. The claim was duly

lodged with the insurer. Surveyor was appointed by the insurer to conduct the survey who

assessed the loss to the tune of Rs. 1,41,700/-. However on checking up it was found that the

driving licence of Sh. Gurinder Singh was valid for motor car only whereas the vehicle is an LMV

as per RC and having seating capacity 7+1. Therefore, the driving licence was not valid and

affective for driving an LMV and the claim had been repudiated.

DECISION: Held that on going through the Section 10 (2) of Motor Vehicle Act 1988

carefully, I find that the driving licence for category of vehicle as ‘car’ is nowhere mentioned in

the Motor Vehicle Act 1988. It should therefore be presumed that a driving licence for car in

effect is valid for LMVs also so long as the LMV is are not being used for commercial purpose. In

this case, since the vehicle was being used for private purpose, the claim is payable and the

repudiation of the claim is not in order. It is hereby ordered that the admissible amount of

claim should be paid by the insurer to the complainant.



Dev Raj Vs. New India Assurance Co. Ltd.


FACTS: Shri Dev Raj’s wife Smt. Champa Devi had got her Eicher truck bearing no. HP-11B-

0378 insured for the period 24.10.06 to 23.10.07 with the insurer. On 12.05.07, the said truck

collided with a bus at Vaknaghat, Distt. Solan. The matter was reported to the police . Since

there was no loss of human life and serious injury, the matter was compromised between the

parties and only DDR was registered by the police authorities. The claim was reported to the

insurance company and they deputed Shri Umed Sood, Surveyor for spot survey. After spot

survey the vehicle was shifted to Sidhu Motors, Manimajra. Before repair, the vehicle was again

surveyed by an other surveyor, Sh. Goyal. The vehicle was duly repaired and the total

expenditure of Rs. 73,661/- was incurred. All the claim documents were submitted to the

insurance company but claim was not paid. Parties were called for hearing on 25.07.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that

they had asked for two documents viz. DGR and copy of the Log Book which the complainant

had not furnished. Hence the claim was made as no claim. On a query, whether DGR was

essential for settling the claim, the insurer replied in the affirmatives. On a query, whether the

complainant was aware of the requirement of DGR as communicated in the terms and

conditions of the policy, the complainant replied in the negative.

DECISION: Held that holding up of a claim merely on the ground of the non-availability of a

document which was not in the knowledge of the complainant at the time of giving the

insurance cover is not a healthy practice and the settlement of the claim should not be delayed

only on that account. However, since the insurer was of the opinion the DGR was a must to

establish whether the vehicle was overloaded or not so that approximate cause of accident

could be ascertained, the payment of the claim on non-standard basis would meet the ends of

justice. As per the assessment made by the surveyor the assessed amount of payment after

deducting Rs. 1000/- as excess clause, works out to Rs. 43935/-. Therefore, payment of Rs.

40000/- on non-standard basis plus towing charges of Rs. 1500/- should be paid by the insurer

to the complainant.


CASE NO. GIC/177/UII/14/09

Dharminder Kumar Vs. United India Insurance Co. Ltd.


FACTS: Shri Dharminder Kumar had got his car No. PB 10 BG – 6407 insured for the period 09.03.05 to

08.03.06. The vehicle met with an accident and was repaired at Gulzar Motors, Ludhiana. The cost

incurred was about Rs. 55000/-. However since he did not have the money he could not pay the garage

and the vehicle kept lying at Gulzar Motors. He was able to make the payment to the Garage on

24.04.08 and provided the receipt to the insurance company. They however refused to pay the claim. It

was further requested that the company should be instructed to re-open the file and pay the claim at

the earliest. Parties were called for hearing on 12.08.2008.

FINDINGS: During the course of hearing the insurer clarified the position by stating that the amount

assessed by the surveyor was Rs. 40,125 after accounting for depreciation etc. Letters were written to

the complainant to complete the formalities for setting the claim. However, he did not comply with the

requirements. Hence, the case was closed as no claim.

DECISION: Held that mere delay in submission of the bills should not be a cause for non payment

of a claim since intimation of the accident was given in time and the surveyor had been deputed

accordingly. However, the complainant should be penalized for extra ordinary delay in submitting the

bills. Taking a fair and just view, the payment of the claim on non standard basis to the extent of 75% of

the assessed amount by the surveyor would meet the ends of justice The insurer is advised to reopen

the case and make payment accordingly by 31.08.08 subject to completion of all documentary

formalities as required. The delay in submission of the bills is hereby condoned.


CASE NO. GIC/147/ICICI/14/09

Dilbagh Rai Vs. ICICI Lombard General Insurance Co. Ltd.


FACTS: Shri Dilbagh Rai had purchased a Santro vehicle no. CH 03 K 1005 and had got it financed from

ICICI Bank through Dynamic Financial services who had also arranged the insurance of the vehicle for

which he had paid cash amount of Rs. 7034/- and a covernote no. PF 6650294 was issued. The vehicle

met with an accident on 04.5.2008. It was inspected by Shri Avinash of ICICI Lombard and the vehicle

was repaired. When the company started processing the claim they asked him for a copy of the policy.

He informed them that he had been issued a covernote and the policy was not issued to him. The

officials refused to acknowledge the letters and he was rudely informed by Shri Avinash that no claim

would be given to him. Parties were called for hearing.

FINDINGS: During the course of hearing the insurer clarified the position by stating that they had

received a letter from Dynamic Financial Services stating that the covernote had been lost. Since neither

the money nor the covernote was available with them, the complainant could not be treated as a policy

holder with a valid insurance for the car. Moreover, he had paid cash to the procuring agent contrary to

the instructions/warning written on the covernote in bold letters that no cash should be given as a

consideration amount. Hence they were not liable to make the payment.

DECISION: Held that the contention of the insurer that there was no valid insurance cover in

respect of Santro Vehicle no. CH 03 K 1005 on the date of the accident is in order. No further action is

called for. The case is closed.



Kanta Arora Vs. United India Insurance Co.


FACTS: Smt. Kanta Arora had been stated that her Hyundai Santro No. UP

14 AB – 7194 was stolen on 31.10.07 from Delhi. All the documents were

completed and handed over the surveyor in Feb. 2008. Even after regular follow

up there was no progress. She was told that the claim would be examined in

the next financial year. She was asked by the B.M. on 08.05.08 to give consent

letter for Rs. 3.03 lakhs although the IDV was Rs. 3,30,000/-. Her son was told

by the Regional Manager to accept the claim for Rs. 3.03 lakh only. It was

further stated by her that she was not interested in any reduction in the IDV.

She also expected that she should be paid inconvenience charges of Rs.

10000/- and also paid interest.

Parties were called for hearing on 04.09.08.

FINDINGS: During the course of hearing the insurer clarified the position by

stating that the IDV was fixed wrongly earlier. As per calculations, it should

have been lower. The invoice of the car is Rs. 351648/-. Since this was the

second year of the purchase, 20% of depreciation was to be deducted. Thus the

IDV works out to Rs. 2,81,318/-. After deducting excess clause of Rs. 500/-,

the net amount payable works out to Rs. 2,80,818/-

DECISION: Held that the amount of Rs. 2,81,818/- is the correct amount

payable by the insurer to the complainant. It is hereby ordered that an amount

of Rs. 2,81,818/- alongwith interest 8% per annum w.e.f. 01.05.08 till the date

of payment should be paid by the insurer to the complainant by 25.09.08. Also,

excess premium charged due to wrong fixing of IDV at Rs. 3.30 lakhs should

also be refunded by the insurer to the complainant by 25.09.08.



Koushalya Rani Vs. United India Insurance Co. Ltd.


FACTS: Smt. Koushalya Rani has been stated that her Toyata Qualis No. HR 25 B – 1488 was insured with

the insurer vide Policy NO. 200101/31/06/01/00000593. The vehicle met with an accident on 29.04.07.

She lodged the claim with the insurance company but the claim was rejected on the grounds that the

vehicle was being used as a Taxi. She requested them many times to reconsider but no result has been

forthcoming. Parties were called for hearing on 22.07.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that the vehicle

had run for about 40000 km in 10 months which is very heavy for domestic use. Moreover, the vehicle

was carrying a singing party at the time of accident, the members of which had no relationship with the

complainant. This was stated by the complainant in her affidavit. She also stated that heavy running of

the vehicle was due to a joint family business of farming.

DECISION: Held that the contention of the insurer that the vehicle was being used as a taxi appears

more plausible as a singing party would normally not travel in a private car and the transportation of

singing party was a case of hire and reward. Accordingly, the claim is not payable as per the terms and

conditions of the policy. The repudiation of the claim is in order. No further action is called for. The case

is closed.


CASE NO. GIC/096/Bajaj/11/09

Ranjeet Singh Vs. Bajaj Allianz Gen. Ins. Co. Ltd.


FACTS: Shri Ranjit Singh’s motorcycle CD 100 Regd. No. PB 65 C – 9761 was stolen on 18.06.07 from in

front of the district court. The FIR was duly lodged. The insurance company, however, was refusing to

pay the claim.

FINDINGS: During the course of hearing the insurer clarified the position by stating that as per the

investigation and as per the FIR, it was revealed that the complainant had left the key in the motorcycle

which was unattended. As per condition 4 of the terms and conditions of the policy, the insured has to

take all reasonable steps for safety of the vehicle. In this case such reasonable steps had not taken by

the complainant as he left the key in the motorcycle which was unattended. Hence as per the conditions

of the policy, the claim is not payable. On a query, whether the terms and conditions of the policy were

dispatched to the complainant, the insurer replied in the affirmative. On a query, whether the terms and

conditions were received by him, the complainant replied in the negative. On a query, whether proof of

dispatch could be shown, the insurer replied that they would make an effort. The insurer clarified the

position by stating that the courier company was contacted by them regarding dispatch of the policy

terms and conditions. They informed that it was sent through normal post, hence there was no proof of

dispatch/ delivery given by them. Moreover, not only was the key left in the vehicle but there was no

parking slip obtained from the parking place. Hence they were justified in repudiating the claim.

DECISION: Held that there is clear violation of the terms and conditions of the policy which states

that the owner of the vehicle shall take due and reasonable care to avoid loss or theft of the vehicle

which in this case had not been done. Even if the terms and conditions of the policy had not been

received, it is a matter of general prudence that the goods should be kept in proper and safe custody.

Moreover, not taking the parking slip is another instance of not taking proper care. Hence while

sympathizing with the complainant about the loss due to theft, I am of the opinion that leaving the key

in the vehicle was a temptation for the thief and was a clear violation of terms and conditions of the

policy. Hence the repudiation of the claim in my view is justified.



Nitin Talwar Vs. United India Insurance Co. Ltd.


FACTS: Sh. Nitin Talwar has been stated that the car No. HR 01T – 7700 was insured for the period

16.08.07 to 15.08.08 had met with an accident on 24.01.2008. At the time of accident the vehicle was

being driven by one Akhilesh Chopra. The complainant has further written that the surveyor got a blank

claim form signed from his father and wrote things in the forms that were not true. He suspected that a

coterie was at work which altered the facts of the case. The B.O. Ambala vide letter dt. 04.04.08

repudiated the claim on the grounds that the Driving Licence of Sh. Akhilesh Chopra was valid only till

07.09.07 as per verification that was got done through Sh. Manmohan Singh, Surveyor and hence the

claim was not payable. It was further written that it was just not possible for Sh. Chopra’s Driving

Licence to expire on 07.09.2004 as he had got the Driving Licence NO. 4695 on the basis of Matriculation

Certificate, which showed his date of birth as 08.09.1974. Since the Driving Licence should be valid till

the licence holder attains the age of 40 years, the date of expiry should be 07.09.2014. Parties were

called for hearing on 16.09.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that as per

verification from DTO, the licence was valid till 2004. However, in a photocopy of the licence, it was

shown as valid upto 2014. The company relied upon the verification done by the investigator. Moreover,

the claimant stated in the claim form that there was sudden break applied to the vehicle and a vehicle

hit his vehicle from behind.

DECISION: Held that on scrutinizing the Driving Licence of Sh. Akhilesh Chopra carefully, I find that

he had two running concurrently one expiring in 2014 and the other in 2013. If the Driving Licence

expiring in 2014 was valid, there was no reason to have another licence made valid upto 2013. If it was a

renewal, it was because the records of the DTO showed that earlier licence was valid till 2004. The

renewed licence was made in March 2008. Since the accident took place in Jan 2008, the Driving

Licence, which was made in March 2008 is not valid. If the earlier Driving Licence was valid upto 2014,

then there was no reason to get another Driving Licence made. Hence, in my opinion, the repudiation of

the claim on the ground of non-effective and valid licence on the day of accident is justified. No further

action is called for. The complainant is dismissed.


CASE NO. GIC/296/Reliance/11/09

Mukesh Ajmani Vs Reliance Gen. Insurance Co. Ltd.


FACTS: Shri Mukesh Ajmani had been stated that he was the owner of Tata Indica bearing No. DL 3C AF

– 2678. The insurance of the car with OIC. Ltd. expired on 30.09.07. On 3rd Oct., he got his car insured by

Reliance General Ins. Co. Ltd. The agent who met him, told him that he would also get a discount in the

premium. He was asked to pay premium of Rs. 6116/- which he did. In May 2008, the car got damaged.

He informed the company and lodged the claim. The surveyor assessed the claim of Rs. 1,55,000/-.

However, the complainant received a letter on 21.07.08 from the company wherein he had been

informed that the claim was repudiated because he had taken a claim from the previous insurance

company and not disclosed this fact and availed 20% NCB from Reliance General Insurance Co. Ltd. .


FINDINGS: During the course of hearing the insurer clarified the position by stating that during

investigations, it was learnt that there was a claim against the vehicle when the vehicle was insured with

OIC . Hence the claim was repudiated on grounds of false declaration. The insurer showed a letter dt.

16.10.07 addressed to OIC. Ltd. regarding confirmation of NCB. However, he stated that the declaration

regarding forfeiture of the claim, in case of wrong claiming of NCB was not obtained and upto that

extent it was an unintentional lapse.

DECISION: Held that the claiming of NCB by the complainant in respect of car No. DL 3C AF – 2678

was not justified. However, the insurer has committed a lapse in not getting the declaration of forfeiture

of the claim amount signed. Accordingly, in my view, giving benefit of doubt to the complainant,

payment of 50% of claim amount on net of salvage basis as non-standard claim settlement would meet

the ends of justice. It is hereby ordered that the an amount of Rs. 42225/- being 50% of the admissible

amount of Rs. 84500/- on net of salvage basis less the amount of NCB claimed should be paid by the

insurer to the complainant.



Pardeep Thakur Vs. ICICI Lombard


FACTS: Shri Pardeep Thakur had insured his new Honda City with ICICI Lombard vide cover note No.

PF6455804 dt. 17.11.07. On 10.03.08, the vehicle met with an accident on Chandigarh Ambala Highway.

He was paid only Rs. 620000/- whereas the estimate was Rs. 641000/-. The company also took

possession of the damaged vehicle. He further stated that the actual value of car was Rs. 7,36,000/- and

the IDV was Rs. 6,95,400/-. He also had to pay interest on finance amount of Rs. 6,00,000/- as the

vehicle was financed from State Bank of India. Parties are called for hearing on 08.07.2008.

FINDINGS: During the course of hearing the insurer clarified the position by stating that the

surveyor had assessed the loss on net of salvage basis for Rs. 6,20,000/- out of which salvage for Rs.

3,15,000/- was paid and Rs. 3,05,000/- in cash by the insurer to the complainant. The surveyor was

asked to clarify as to how the IDV had been reduced from 6.95 lakhs to 6.20 lakhs. He stated that as per

the circular issued by the OIC Ltd. the repair amount has to be reduced by taxes, salvage parts and

another 25% of the net amount. This worked out to be Rs. 3.05 lakhs. Another Rs. 3.15 lakhs was

realized from the sale of the accidented vehicle as salvage value. Hence Rs. 6.20 lakhs was given. On a

query, whether he was satisfied with the clarifications given by the insurer, the complainant stated that

he wanted the case to be settled on total loss basis. On a query, whether it was possible to settle the

claim on total loss basis, the insurer replied that since the estimate was less than 75% of IDV, the same

could not be settled on total loss basis.

DECISION: Held that the amount of Rs. 6.20 lakhs paid by the insurer to the complainant is justified

as per the rules and the complainant is advised to bear with the same. No further action is called for.

The case is closed.



Sh. Rajesh Negi Vs Reliance Gen. Insurance Co. Ltd.


FACTS: Sh. Rajesh Negi lost his Silver coloured Bajaj Pulsur No. CH 03 J – 7729 on 24.01.08. FIR was duly

lodged on 25.01.08. However, when he checked the documents of the vehicle, he saw that he had not

received the policy and only the cover note was with him. He spoke to the Reliance Call centre and was

told that it would reach within a week. When he did not receive it, he spoke to the vendor of the vehicle

who assured him that it would reach within next 10 days. After a lot of delay, he finally got the policy on

24.02.08. He was, however, told to lodge the claim only through call centre. On 04.03.08, he got an SMS

to contact the advocate for claim. He was given a letter to complete the related documents. He finally

received the untraceable report on 27.05.08 from the police station. On 20.06.08, he received a letter

from the company stating that they were unable to proceed further with the claim because of late

intimation. Parties were called for hearing on 07.08.08.


intimation was received by them in the 1st week of March 2008, after more than 50 days. As per terms

and conditions of the policy, they are to be intimated in writing immediately. On a query, whether terms

and conditions of the policy were received by him, the complainant replied in the negative.

DECISION: Held that although there is delay in intimation by the complainant to the insurer in

writing, FIR was lodged the very next date and the call centre was intimated sufficiently in time. The

delay appears more because of non receipt of policy document . The basic fact is that the theft of the

motorcycle had taken place on 24.01.08 when the vehicle was covered under a valid insurance policy.

Procedural delay should not stand in the payment of a claim. Therefore, the repudiation of the claim by

the insurer is not in order. The claim is payable.


CASE NO. GIC/181/NIC/14/09

Ranbir Singh Vs. National Insurance Co. Ltd.


FACTS: Shri Ranbir Singh had got his Maruti Alto car insured vide policy No. 2432036 from the period

23.08.07 to 22.08.08 from the insurer. The insured vehicle met with an accident. The survey was carried

out by Sh. Daya Ram Gupta, Surveyor. The insurer vide his letter dt. 20.05.08 informed the insured that

as per the survey report there were 6 persons traveling in the car at the time of accident instead of 5

persons allowed. This is a breach of the terms and conditions of the policy and also of the Motor Vehicle

Act. The insured was asked to explain the purpose of use of car at the time of accident and why there

were more persons in the car than allowed as per the policy. The insured in his letter dt. 28.05.08

replied to the insurer that car was being used for attending a marriage and there were six occupants in

the car including one child. As per the insured’s letter, it was not possible to leave one child alone at

home. The insured had submitted his reply to insurer on 28.05.08, yet his claim had not been settled.


FINDINGS: During the course of hearing the insurer clarified the position by stating that the RC of

the vehicle stated that carrying capacity was only 5. There were six persons in the car at the time of

accident. Hence it was a case of overloading. The insurer had not given proof of the age of the child.

Hence they were willing to settle the claim on non-standard basis up to 75% of the amount calculated

on net of salvage basis.

DECISION: Held that carrying of one child as an extra passenger has not affected the driving

capability of the driver. As far as age is concerned, I have no reason to doubt the statement of the

complainant that the sixth passenger was a child. Hence the claim should be paid as per survey report

and not as a non-standard claim. It is hereby ordered that the admissible amount of claim should be

paid by the insurer to the complainant.



Waryam Singh Vs Reliance Gen. Insurance Co. Ltd.


FACTS: Sh. Waryam Singh has been stated that the Chevrolet Tavera Regd. No. PB 08 AT – 1400 was

insured with the Reliance General Insurance Com Ltd. in the name of Mr. Jarnail Singh S/o Sh. Surat

Singh vide policy No. 2003372311106280 for the period 29.11.07 to 28.11.08. The vehicle met with an

accident on 15.02.08 and the claim was lodged with the insurance company. The surveyor M/s Arun

Kumar & Co. surveyed the vehicle and submitted his report on 10.04.08. Now after a lapse of three

months, the insurance company had denied the claim vide their letter dt. 18.04.07 received by him on

dt. 02.07.08 through registered post on the ground that the insured passed away on 07.11.05 and that

the policy was valid only for a period of three months after his death. It was also stated that the contract

was void ab-initio as it was not possible to obtain contract in the name of a dead person. Parties were

called for hearing on 27.08.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that the policy

was void ab-initio as the insured had expired before the commencement of the policy.

DECISION: Held that the repudiation of the claim by the insurer is justified as the policy was in the

name of a person who had expired before the commencement of the policy and hence the contention

of the insurer that the policy was void ab-initio is in order. However, since the policy is void it would be

in the fitness of things if the premium paid by the complainant is refunded to him after retaining third

party premium. The payment should be made by the insurer to the complainant by 15.9.08. The cheque

should be made in the name of the complainant who is the son of late Sh. Jarnail Singh.



Shashi Bala Vs. United India Insurance Co. Ltd.


FACTS: Smt Shashi Bala was the owner of a Scooter No. PB 08 AE-9499 that was insured by the

Industrial Area, Ludhiana Branch of the insurer vide Policy No. 201002/31/06/01/0000034. The said

scooter was stolen. On 17.4.2008. She wrote to the office of the company that in case of theft/total loss,

she was entitled to the full IDV i.e. Rs. 12000/ and not Rs. 8000/- that were being offered to her by the

company. Parties were called for hearing on 22.07.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that amount of

Rs. 12000/- was IEV not IDV. Since the insurance was done in 2001-02 IEV was applicable. On a query,

whether the IEV was applicable in 2006, the insurer replied in the negative.

DECISION: Held that the insurance of Rs. 12000/- IDV was fixed after mutual agreement between

the insurer and the insured. The IDV once fixed cannot be altered during the currency of the policy for

365 days. Once IDV had been fixed Rs. 12000/- reducing it to Rs. 8000/- unilaterally is not as per the

terms and conditions of the policy. Hence, in my opinion, the payment of Rs. 8000/- is not in order. An

amount of Rs. 12000/- less excess clause is payable. It is hereby ordered that an amount of Rs. 12000/-

less excess clause should be paid by the insurer to the complainant.



Sumit Sehgal Vs. New India Assurance Co. Ltd.


FACTS: Shri Sumit Sehgal’s friend Sh. Rampal purchased a Trax Cruiser bearing no. HR-69T-

6037. The vehicle was covered under Policy no. 710501/31/06/4411 issued at Rohtak for the

period 17.05.06 to 16.05.07 for the sum insured of Rs. 4,44,600/-. The vehicle collided with the

tractor trolly coming from the opposite side on 24.10.06 near Triveni Factory, Mathura (U.P).

The accident was reported to Police Station Mathura. Due to traffic jam, the police authority

shifted both the vehicles to Police Station. Since the police, after prima facie investigation

found that the fault was that of the driver of the tractor trolly, his vehicle was not impounded

and released. Thereafter, the said vehicle was shifted to M/S Sehgal Automobiles, Gohana for

repair. The estimate, amounting to Rs. 2,61,079.08/- was prepared and claim was reported to

the insurance company. All the documents were submitted to the insurance company. But the

insurance company vide letter dt. 31.08.07 refused to pay the claim on the grounds that he had

not paid the tax to enter Mathura, Uttarpradesh and had no record of trip sheet, confirming the

number of persons carried in the vehicle. Parties were called for hearing on 15.07.08.


vehicle had a National Permit but it was mentioned in the permit that the State Tax will be paid

at the time of entry in a State. Moreover, the no.of passengers being carried had not been

mentioned. Since it was a commercial vehicle, entry permit for Mathura was must as per terms

and conditions of the policy. The claim was accordingly repudiated.

DECISION: Held that the non-payment of state tax at the time of entry into state of UP was

must as per terms and conditions of the policy and also as required under Section-66 of Motor

Vehicle Act 1988. This is further relied upon on the basis of Judgement given by the Supreme

Court in case of National Assurance Company versus Chella Bharathamma Case No.

Appeal(civil) 6178 of 2004. Taking the above facts into consideration, the repudiation of the

claim by the insurer is in order.



Sunita Rani Vs. ICICI Lombard


FACTS: Smt. Sunita Rani has been stated that her late husband Sh. Kuldeep Singh was employed as a

driver with Sh. Rajesh Aggarwal, owner of Indigo car Reg. No. CH 03 V – 5897. The said vehicle met with

an accident in which her husband sustained grievous injuries and later passed away. She submitted a

claim for Rs. 2.00 lakhs but the claim was rejected by the company on the grounds that there is no cover

for Personal Accident for paid driver / unnamed passenger as per policy. She stated that this was

incorrect. An amount of Rs. 25/- has been charged by the company for covering paid driver and Rs. 100/-

for Personal Accident cover for owner/ driver. It was further stated by her that this amply proved that

her husband was covered by the ICICI Lombard General Insurance Co. and the claim amount should be

paid to her. Parties were called for hearing on 10.09.08.

FINDINGS: During the course of hearing the insurer stated that the complainant is the wife of Sh.

Kuldeep Singh who was employed as a driver with Sh. Rajesh Aggarwal owner of Indigo car Regd. No. CH

03 V – 5897. The vehicle was insured with them and an amount of Rs. 25/- was being paid by the insured

against IMT 28. Any claim relating to IMT 28 can be considered under Workmen’s Compensation Act

1923 and Fatal Accident Act 1865. Therefore the complainant should approach the concerned Labour

Commissioner for redressal of her grievance.

DECISION: Held that the contention of the insurer that the claim should be considered under

Workmen’s Compensation Act 1923 and Fatal Accident Act 1865 is in order. The complainant is advised

to approach the concerned Labour Commissioner for compensation of the claim under these Acts.



Suraj Pal Vs. United India Insurance Co.


FACTS: Shri Suraj Pal’s Ashoka Leyland Cargo bearing No. CH 04 – 3916

was insured by the office of insurer situated at Sector 17-C, Chandigarh for the

period 20.07.07 to 19.07.08. The said vehicle met with an accident on 21.09.07

at Nawa Shahar. The DDR was duly lodged. The claim was lodged with the

insurer on 12.11.07. Despite repeated requests, the company has not taken

any action. Reminders were also issued to the company but there has been no

response. Parties were called for hearing on 08.07.08.

FINDINGS: During the course of hearing the insurer clarified the position by

stating that as per terms and conditions of the policy there are limitations

about the use of transport vehicle. The transport vehicle can be used in

accordance with sub-section (3) of section 66 of Motor Vehicle Act 1988, which

states that a goods vehicle should ply only with the proper route permit signed

by the competent transport authority. In this case, the route permit was not

available on the date of accident was obtained by the complainant after the

accident. Hence this was a violation of terms and conditions of the policy and

the claim was therefore repudiated.

DECISION: Held that since the vehicle was plying in violation of sub-section

(3) of section 66 of Motor Vehicle Act 1988, the insurer is justified in

repudiating the claim as it was a violation of terms and conditions of the policy.

No further action is called for. The case is dismissed.



Vipan Kumar Vs Reliance Gen. Insurance Co. Ltd.


FACTS: Shri Vipan Kumar was the owner of an Indica car bearing Regn. No. PB 02-AR 6677 that was

insured from Reliance General Insurance Co. Ltd. for the period 20.01.07 to 19.01.08. The said car was

stolen on 29.10.07. Even after the completion of all the formalities, the claim had not been paid. In

December 2007, he was verbally told by the surveyor that if he was prepared to accept Rs. 2,75,000/-

instead of Rs.3,00,000/- the company would release the payment. Parties were called for hearing on

17.06.08.

FINDINGS: During the course of hearing the insurer stated that an agreement had been arrived at

with the complainant for settling the case at Rs. 293500/-. The insurer was asked to clarify as to how

the amount of Rs. 2,93,500/- was arrived at for making payment to the complainant when the IDV was

Rs. 3.00 lakhs. He clarified that the IDV was fixed erroneously. The correct IDV on the basis of the sale

price of the car on the date of renewal works out to Rs. 2,93,500/-.

DECISION: Held that on going through the calculations given by the insurer and hence satisfied that

the IDV of Rs. 3.00 lakhs was fixed erroneously. It should have been Rs. 2,93,500/-. Hence the payment

of claim for an amount of Rs. 2,93,500/- is in order. The insurer is advised to make the payment by

15.07.08 after the completion of required formalities.



Virender Miglani Vs Reliance Gen. Insurance Co. Ltd.


FACTS: Shri. Virender Miglani has been stated he had taken a policy for his motorcycle Regd. No. HR 06

J – 5380 which was effective from 21.04.07 to 20.04.08. The vehicle was stolen on 27.12.07. The

information was given to the Police Chowki of Sector 11-12, HUDA which falls under P.S. Chandni Bagh

Panipat. The police, however, registered FIR on 24.01.08 i.e. after almost one month despite regular

requests and visits to the particular Police Station. After getting the FIR report, the company was

informed who deputed M/s Royal Associates for investigation. Now the company has repudiated the

claim on the ground of delayed information to the police. It was further stated that the time delay was

because the police refused to register the FIR in time. Parties were called for hearing on 19.08.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that the FIR was

lodged after one month and they were informed after one and a half month. Hence as per the terms

and conditions of the policy the claim was repudiated.

DECISION: Held that while it was a fact that police/ insurer were informed late the delay in lodging

the FIR has been clarified by the complainant. As far as the insurer is concerned, the intimation was

delayed as he was waiting for FIR. In my opinion, procedural delays should not stand in the way of

settling a claim as there was valid insurance on the date of theft. However, the complainant should be

penalized for late intimation. Therefore, taking an overall view, I am of the opinion that the settlement

of claim on non-standard basis to the extent of 75% of the IDV would meet the ends of justice. It is

hereby ordered that 75% of the IDV should be paid by the insurer to the complainant.



Yograj A. Chauhan Vs. National Insurance Co. Ltd.


FACTS: Shri Yograj A. Chauhan had taken an insurance policy covering his Scorpio vehicle bearing no. HR

23G 0005. The complainant had mentioned in his complaint that insurer has wrongly and illegally

repudiated the claim on the excuse that Driver was holding the DL no. 6610 dated 21.08.06, who was

driving the Scorpio, this driving licence was valid for Scooter and Car only but as per RC the seating

capacity of the said vehicle is 8 passengers. As such the vehicle having seating capacity of eight

passengers falls under Light Motor Vehicle as per Motor Vehicle Act, whereas Sh. Arvind Mottoo is

authorized to drive Motorcycle and Car only as per the D.L. produced. As per the complainant the

Scorpio Vehicle bearing no. HR 23G 0005 is a Private Vehicle and the same is registered in the name of

Claimant/Appellant and is being used as a private vehicle. Thus the licence was produced by the

claimant in the name of Arvind Mottoo in which the driver was authorized to drive the car and above

mentioned Scorpio Vehicle falls under the definition of Car and not under the definition of L.M.V. Parties

were called for hearing on 10.06.08 at Chandigarh.


was having a capacity of eight passengers whereas a car has a capacity of 5 passengers only including

driver. Hence the licence was not valid for light motor vehicles, the category in which the Scorpio car

falls.

DECISION: Held that on going through the relevant provisions of the motor vehicle act, there is no

specific category of car for which licence can be issued. The category mentioned is light motor vehicle.

Accordingly, licence for car should also include light motor vehicle and should be treated as valid for

Scorpio or any other light motor vehicle. Therefore, the repudiation of the claim is not in order and the

same is set aside. The claim is payable. It is hereby ordered that admissible amount of claim on repair

basis should be paid by the insurer to the complainant.



Annkaur Devi Vs National Insurance Co. Ltd.


FACTS: Smt. Annkaur Devi got her vehicle Maruti Zen Estilo insured with the insurer from 14.11.07 to

13.11.08. The vehicle met with an accident on 15.12.07 in which two occupants of car Sh. Sandeep and

Sh. Hardik (Child) died on the spot. The survey of the vehicle was carried out by Dr. D.R. Gupta. He

recommended the claim of Rs. 2,70,500/- on net of salvage basis and sent the report to the insurer. The

insurer vide letter dated 26.03.08 stated that on going through the claim papers, it was observed that

there were seven persons travelling in the insured vehicle against the five, which is the prescribed limit

as per the R.C. Book. This is a breach of policy conditions. Hence the claim was not payable. Further,

insured was given seven days time to send clarifications in this regard if any to insurer. The insured in his

letter dated 02.04.08 clarified that the total number of passengers in the vehicle at the time of accident

was five adults and one child. He referred to the FIR in this regard. Insurer has submitted its reply his

vide letter dated 14.05.08 in which it has been stated that they had written a letter to insured on

24.04.08 informing them about the decision of the competent authority to settle the claim on sub

standard basis by deducting 25% of the claim amount. The reply of the insured by the insurer is still

awaited.


was overloaded and this was a violation of the terms and conditions of the policy as it was not as per

limitation as to use. On a query whether it was specifically mentioned that overloading was violation of

limitation as to use, the insurer could not give a satisfactory reply.

FACTS: Held that overloading, if any, is not a violation as per limitations as to use given in the policy

documents. The carrying of one 5 year old child in addition to the normal carrying capacity of the car did

not alter the driving skills of the driver and hence cannot be termed overloading. Hence, the claim is

payable. It is hereby ordered that admissible amount of claim should be paid by the insurer to the

complainant on net of salvage basis.



Bal Krishan Sood Vs. National Insurance Co. Ltd.


FACTS: Shri Bal Krishan Sood got his Maruti Car bearing no. CH-01V-2464 insured for the period

20.3.06 to 19.3.07 for sum insured of Rs. 70,000/- from BO Sector-35-B, Chandigarh. On

14.05.06 his Maruti Car was stolen from his house at night. He reported the theft to Police

Station Sector 34, Chandigarh vide FIR no. 158 dt. 15.05.06 and intimation was given to

insurance company on dt. 22.09.2006. The insurance company rejected his claim on the basis of

late submission of intimation. He stated that the reason for late intimation was that two elders

of his family had died during this period but his claim was repudiated by imposing condition no.

1 of the policy, i.e. immediate intimation upon occurrence of loss. He sought intervention of

this forum in getting the claim paid to him. The insurer informed vide letter dated 05.03.08 that

the theft took place on 14.05.06 and intimation was given to their office on dt. 07-11-06 i.e.

after 6 months and delayed intimation took away the opportunity to get the matter

investigated. So they repudiated the claim. Parties were called for hearing on 15.04.08.

FINDINGS: During the course of hearing the the insurer clarified the position by stating that

the vehicle theft took place on 14.05.06 and intimation was given to their office on 07.11.06

which is after six months of the date of theft. The claim was therefore repudiated.

DECISION: Held that the complainant had lodged FIR with the police, he had failed in his

duty to intimate the insurer soon after the theft. In the normal course, the claim would not

payable because of late intimation. However since the police authorities who are the

investigating agencies for theft, were intimated in time benefit of doubt partly goes to the

complainant. Moreover, untraced report was also available which was also submitted to the

insurer. Therefore, settlement of the claim on non-standard basis by payment of 50% of insured

amount to the complainant by the insurer would meet the ends of justice. No further

investigation is required as untraced report is available. It is hereby ordered that 50% of the IDV

should be paid by the insurer to the complainant within 15 days of the date of submission of

RC duly transferred and handing over of the keys along with completion of the other

formalities.



Harbhajan Singh Gill Vs. National Insurance Co. Ltd.


1. FACTS: Shri Harbhajan Singh Gill insured his vehicle no. PB 10BD 9538 (Tata Safari) from

02.01.04 to 01.01.05. The vehicle met with an accident on 01.01.05. The complainant filed the claim

with the insurer. However, the same was rejected by the insurer on the ground that the person who was

driving the vehicle at the time of accident was having Driving Licence valid for Motorcycle/Car only

which is not valid for driving the vehicle in question and accordingly the claim was repudiated.

Complainant has mentioned in his complaint that in MACT case related to the accident the driver

appeared and presented his proper Driving Licence bearing no. 8623/MTR/96 dated 28.12.1996 issued

by L.A. Mathura which has been accepted by learned court and have decided the MACT case accordingly

against the insurance company. Since company has already accepted the judgement of court

pronounced on 31.07.07 and have deposited the decreed amount in court, hence the OD claim of the

vehicle also becomes payable. Parties were called for hearing on 10.06.08.

FINDINGS: During the course of hearing the insurer clarified the position by stating that there were

two driving licences, one for HTV and another for Motor Cycle/ Motor Car. The driving licence for HTV

was produced in respect of MACT Claim. The Motor Cycle/ Motor Car driving licence was not valid as the

Tata Safari was having more than 5 seats capacity.

DECISION: After hearing both the parties and going through the relevant provisions of the Motor

Vehicle Act, the driving licence is valid for Motor Car which should also be treated valid for LMV. Hence

the claim is payable and repudiation was not in order. However, since the complainant had got two

driving licences made at the same time, he should be penalised for circumventing the system.

Accordingly, the claim should be settled on non-standard basis. It is hereby ordered that 75% of the

assessed amount should be paid by the insurer to the complainant.



Harinder Kaur Vs. National Insurance Co. Ltd.


FACTS: Smt. Harinder Kaur insured her scooter Honda Activa bearing no. MP-20-JC-8609 for the period

27.12.05 to 26.12.06. On dt. 21.09.06, the scooter was stolen. All the requisite documents were

submitted but her claim was not paid. The insurance company was insisting for R.C duly transferred in

its name. To transfer the R.C in the name of insurance company, when the complainant approached the

Registing Authority Jabalpur, the Registering Authority quoted rule 50, 54 and 55 of the Motor Vehicle

Act which states that at the time of registration of the vehicle the vehicle should be produced to the

Registering Authority for its physical verification. So it is not possible for the complainant to transfer the

R.C in the name of company. Parties were called for hearing on 19.05.08 at Jalandhar.

FINDINGS: During the course of hearing the insurer clarified the position by stating that the claim

has been approved. But R.C transfer is a must for transferring the claim in the name of the company. On

a query why R.C cannot be transferred, the complainant stated that while new R.C had been made, for

transfer, they need to verify the bonafides of the vehicles.

DECISION: Held that the contention of the insurer is in order. The complainant is advised to get the

R.C transferred by showing the order to the Transport Authority in Madhya Pradesh. Before the order

could be issued, a clarification was sought telephonically from RTO Jabalpur regarding transfer of RC if

the vehicle was stolen. He categorically stated that transfer of RC was not possible without production

of the vehicle and confirmed the same in writing. In view of the letter from RTO Jabalpur, the condition

imposed by the insurer to get the RC transferred is not practicable. Moreover, there is no such mention

in the terms and conditions of the policy documents. Hence, the claim should be paid without insisting

on RC transfer. It is hereby ordered that admissible amount of the claim should be paid by the insurer to

the complainant on the basis of available documents without insisting on transfer of RC after completion

of other requisite formalities.



Jai Bhagwan Vs. Oriental Insurance Co. Ltd.


FACTS: Shri Jai Bhagwan insured his vehicle no. HR-61-0764. The vehicle met with an accident on

26.03.2007, the information of accident was given to police on 27.03.07 and a FIR was lodged and

insurer was also informed. An estimate of Rs. 1,93,368/- was submitted. The surveyor assessed the loss

of Rs. 52,000/-. However, insurer repudiated the claim on the ground that his vehicle was being used as

taxi at the time of accident whereas the vehicle was insured as Private Vehicle. Insured has mentioned in

his complaint that vehicle for the previous year i.e. 23.02.06 to 22.02.07 was insured for “Passenger

Carrying Vehicle”. The complainant while taking the policy for 2007-2008, requested the insurer to

renew the policy taken which was issued for “Passenger Carrying Vehicle”.Parties were called for

hearing on 13.05.08.

FINDINGS: During the course of hearing the insurer clarified that the vehicle was insured as a

private car by filling by a first proposal form signed by the complainant. On a query as to whether it was

registered for private use and from which date, the complainant stated that it was converted from

commercial use to private use in September, 2007, after the accident. This was because the vehicle was

not being used. The insurer was asked to clarify of there was documentary proof to show that the use of

the vehicle had been converted from commercial to private use. He clarified that no such document was

available.

DECISION: Held that the vehicle was insured as private vehicle without any supporting document

from RTA to change the use from commercial to private. Hence the repudiation of claim on account of

commercial use is not in order. The claim is payable. However, the complainant has erred in giving a

proposal form and has not pointed out the private use of the vehicle wrongly entered in the cover note.

He is therefore liable to be penalised for these lapses. Therefore payment of admissible amount of

claim on non-standard basis to the extent of 75% of the admissible amount would meet the ends of

justice.



Kulbir Singh Vs. National Insurance Co. Ltd.


FACTS: Shri Kulbir Singh got his TDK Truck bearing no. HR-37A-1488 insured under Package Policy. The

vehicle met with an accident on 30.8.05. The claim was lodged with the insurer and all the requisite

documents were submitted. However, the claim had been made ‘no claim’ for want of original

documents. He stated that original documents were in police custody as there were two deaths at the

time of accident and the case was with MACT. Parties were called for hearing on 28.2.08.


complainant was asked to produce the estimate of repairs and vehicular documents for verification.

Reminders were sent but only photocopies of the documents were submitted and no original

documents were produced. Moreover there were two deaths in this accident for which summons from

MACT, Shimla had been received. Since the complete documents were not received the claim was made

as ‘no claim’. The verification of DL done by the investigator has cast doubt on the validity of the licence.

The Insurer stated that they had got the driving licence verified from RLA, Kangra, who had certified that

the licence issued in favour of Sh. Sravan Kumar, S/o Sh. Amit Chand was valid from 27.01.2005 to

26.01.2008 for HP/MV Vehicles.

DECISION: Held that since the main objection of the Insurer was the non validity of DL for HP/MV

vehicles, The Insurer should make payment for the admissible amount of claim after the complainant

had submitted documents like vouchers, bills etc. A letter was received from Sh. Gulzar Singh Gill stating

that the payment had not been received by him despite the order. The insurer was asked as to why

payment was not made. He stated that the bills were of a different place and the voucher were of a

different firm. Moreover, the claim form was not signed by the complainant. It was signed by one Sh.

Jagdish Chander and he had also witnessed the same. The non-production of proper vouchers and non-

signature of the claim form is a serious lapse on the part of the complainant. Hence, the repudiation of

the claim is in order.



Sarwan Singh Vs. New India Assurance Co. Ltd.


FACTS: Shri Sarwan Singh purchased vehicle bearing no. PB 11U 9853 from M/S Global

Enterprises. It was transferred in his name on dt. 30.10.07 and within 7 days i.e. on dt. 07.11.07

the vehicle met with an accident. He stated that at the time of accident his son was driving the

vehicle and he got serious injuries and admitted in the Rajindra Hospital and PGI. So he could

not pursue with the claim formalities and now his son was better but now the insurance

company was not responding. The insurer informed vide letter dated 05.03.08 that at the time

of accident, the Registered Owner of the vehicle, as per R.C., was Mr. Sarwan Singh but the

policy was in the name of M/S Global Enterprises so the complainant did not have any

insurable interest. Moreover, the complainant never submitted any specific request in writing

for transfer of vehicle in his name. So they repudiated the claim. Parties were called for

hearing on 15.04.08.

FINDINGS: During the course of hearing the insurer stated that the vehicle was insured in

the name of M/s Global Enterprises. It was transferred in the name of the complainant on

30.10.07. The vehicle met with an accident on 07.11.07 viz within 7 days of the transfer of the

vehicle in the name of the complainant. However, since the insurance was not transferred in

the name of the complainant, the claim was repudiated. On a query whether there was a grace

period of 15 days for the transfer of insurance, the insurer replied in the affirmative.

DECISION: Held that since the grace period of 15 days for transfer of Insurance was not over, the

complainant was within his rights to get the claim. It is hereby ordered that admissible amount of claim

should be paid by the insurer to the complainant.



Scott G. Gensinger Vs. Oriental Insurance Co. Ltd.


FACTS: Shri Scott G. Gensinger had got his Scorpio Car No. CH-03Q-0217 insured from the Sector 9,

office of Oriental Insurance. Two claims were lodged with the company. However, both were rejected

on the ground that he was holding a D/L from California, USA although the company did admit that he

was exempted from the Driving Test being as foreign licence holder. He further stated that he had

processed two judgements. One from the Distt. Consumer Despite Redressal Forum, Jalandhar & the

other from the State Commissioner, Delhi, that was in his favour. Parties were called for hearing on

23.04.08.

FINDINGS: During the course of hearing the insurer stated that as per Motor Vehicle Rules, a

driving licence held by a foreign national is required to endorse for driving within the Territory of India.

In this connection, he referred to Section No. 9 (3)(a)(iii) of Motor Vehicle Laws and Rules in which it is

mentioned that for getting a driving licence, a test is required. However in the case of a foreign national

no such test shall be necessary when the applicant produces proof to show that the applicant holds a

driving licence to drive such class of vehicles issued by a competent authority of any country outside

India subject to the fact that medical certificate will not be required for licence to drive a vehicle other

than a transport vehicle. In the instant case while the exemptions of driving test and medical test are

valid, there is no rule to show that a vehicle can be driven by a foreign national either without

endorsement on the original licence or absence of a fresh driving licence issued by the competent

authority in India. This position was confirmed by them from the local transport and licencing authority

also before repudiating the claim.

DECISION: Held that the contention of the insurer that either endorsement on the foreign licence

or a new driving licence is required by the driver driving the vehicle at the time of the accident, which in

this case unfortunately was missing, is justified. Hence, the repudiation of the claim is in order. No

further action is called for. The case is closed.

CHENNAI

Chennai Ombudsman Centre

Case No.IO(CHN) 11.08.1444/2007 – 08

Mrs. K. Kavitha

Vs

Royal Sundaram Alliance Insurance Co. Ltd

Award No.013 dated 30.05.08

The insured had covered her vehicle Yamaha Rx 135 for an IDV of Rs.35,560/-. The vehicle was stolen

and the insurer offered Rs.20,000/- only as indemnity or alternatively offered equivalent model of

vehicle as per policy conditions.

The vehicle was accepted for insurance after due inspection and fixed the IDV at Rs.35,560/- and

mentioning that the model is obsolete. The IDV of vehicles beyond 5 years of age and of obsolete

models are to be fixed on the basis of an understanding between the insurer and the insured. Also, the

purpose of fixing IDV at the commencement of insurance cover is to avoid dispute regarding value at the

time of a claim. Hence, the contention of the insurer that the IDV was in excess of thee actual market

value is not acceptable because the insurer has not given any valid reason as to why he value of the bike

had fallen so very drastically in such a short period of time after commencement of insurance. The

insurer was advised to settle the claim as per the IDV agreed and subject to other applicable terms and

conditions of the policy issued.


Case No.IO(CHN) 11.05.1458/2007 – 08

Mrs. Nalina Devi

vs

The Oriental Insurance Co. Ltd

Award No.018 dated 10/06/2008

The Complainant’s husband had insured his car with Oriental Insurance Co . Her spouse passed away on

08/12/2003 before any endorsement was made in the RC Book. The policy came up for renewal on

02/01/04. The insurer accepted the renewal premium in the name of her deceased husband although

his death had been widely publicized by the media. Her son, while driving this car had a major accident

and passed away on 24/01/2004. The insurer rejected the total loss claim of the vehicle for (1) delay in

the submission of documents and also (2) for the reason that the insured person was not alive on the

date of renewal of the policy and the contract of insurance with a dead person was void ab initio.

On the basis of a judgement of the Punjab & Haryana High Court (ACJ 547/1997), it is held that the

insurance company having mechanically renewed the policy on receipt of premium, is not right in

rejecting the policy as unenforceable. The insurer cannot absolve themselves of their duty and still

blame the claimant of their duty. Though the insurer can be faulted for mechanically renewing the

policy without finding out the existence of the insured, there is also a deficiency on the part of the

development officer of the Company, insured’s family and other office staffs of the firm in not informing

in writing the death of the insured as envisaged by the policy terms.

The insurer is not justified in rejecting the claim when one of their employees attended the funeral of

the insured. The insured and one of his legal heirs passed away in quick succession under peculiar

circumstances. Taking into account all this, the complaint of the insured is allowed and ex-gratia of

Rs.one lakh is awarded and the legal heirs of the original insured were advised to retain the wreck.


Case No.IO(CHN) 11.09.1523/2007-08

Mr. K. Perumal

Vs

Reliance General Insurance Co. Ltd,

Award No.039 dated 13.08.08

The complainant stated that his daughter had insured her two-wheeler with the Insurer. . His

daughter died in a road accident and he had lodged the claim for Rs.1,00,000/- in terms of the P.A

cover under the package policy. But the Insurer repudiated the claim on the ground that the

complainant’s daughter who was having L.L.R was not accompanied by any licence holder as pillion

rider at the time of the accident as required under central M.V. rules.

However, considering the peculiar circumstances of the case, it is not enough to interpret the rules

in their dictionary meaning but with the spirit of the law. Consideration must be given for the fact

that the claim under the PA policy is not merely for accident benefit for injuries. The insured at the

time of accident was having a Learner’s driving licence, which is valid to drive the two-wheeler, and

she was not disqualified from obtaining a permanent licence in future. It means that she was having

the required licence for driving the vehicle on the date of accident.

The insured was hit from behind by a bus and her death was caused by the rear wheel of the bus

that accidentally ran over her head while she was lying on the road. Similar cases involving various

types of vehicles decided by Courts have taken the view that consideration should be given where

the driving skills of the deceased have not contributed to the accident which were beyond their

control. In the circumstances, the decision of the insurer to repudiate the personal accident claim in

totality is unjustified and a sum of Rs 50,000/- is awarded as Exgratia..


Case No.IO(CHN) 11.12.1059 / 2008-09

Shri T Sukumaran

Vs

ICICI Lombard General Insurance Co.Ltd,

Award No. 047 dated 25.09.08

The complainant had taken a private car package policy. The CD player and speaker which were fixed in

the car and valued at Rs.14,000/- were stolen. The insured filed a claim for Rs.14,000/-. Although the

insurer registered the claim immediately, there was no response thereafter from them, either admitting

or denying the liability.

In their self-contained note the insurer stated that as per the policy certificate, the insured did not opt

and pay extra premium in accordance with Clause 24 of Indian Motor Tariff for coverage of the above

said electrical accessory. The claim was therefore not payable and they were to be absolved of any

liability.

The following documents were persued:-

1. Motor Insurance Cover Note where in the Insured’s Declared Value (IDV) including accessories is shown as Rs 3,42,127/-.

2. Motor Insurance policy copy No 3001/51346601/00/000 which states IDV as Rs 3,42,327/-, value of Non-Elec Acc and Electrical/Electronic Acc has been indicated as “NIL” the policy is subject to IMT Endorsement Nos 16,17,22,28 and 7 as well as Memorandum printed herein/attached thereto.

3. Copy of invoiuce which indicates the cost of the vehicle as Rs.3,60,134/- including Vat Tax @ 12.5 % of Rs 40,015/-.

It is seen that no value has been shown against “electrical/electronic accessories value”. At the time of

purchase of the vehicle the CD player and the speakers had neither been purchased nor fitted in the

vehicle. Also, IDV had been worked out at 95% of the invoice. No extra premium had been charged

towards covering electrical/electronic accessories under the policy. Therefore, the contention of the

insured that the IDV was fixed after deleting the VAT component and including the approximate cost of a

CD player and stereos, which he proposed to buy in the future, is not established. Further no additional

premium, had been paid to cover the accessories. Besides, the insured had also accepted the amount

paid under a subsequent claim without disputing the amount taken as the IDV.

Held that the decision of the insurer to reject the claim valid. The complaint is dismissed.

DELHI

Vehicle Insurance Policy

Delhi Ombudsman Centre

Case No. GI/14/UII/08

In the matter of Shri Dhoom Singh

Vs

United India Insurance Company Limited

AWARD

The complaint was heard on 11.06.2008. The complainant, Shri Dhoom Singh, was

present accompanied by Smt. Munesh wife of the insured. The Insurance Company was

represented by Shri B.B.Goel, Assistant Manager.

Shri Dhoom Singh has lodged a complaint with this Forum on 03.01.2008 that his late son Shri Satinder

had insured his car No.UP-16F-0792 with the United India Insurance Company Limited. His son Shri Satinder had

met with an accident on 13.01.2005 and had died on the spot. The motor claim and Personal Accident claim have

been lodged with the Insurance Company but they have not settled the claim even after 3 years. He had complaint

to the Grievance Cell of the Insurance Company and had received a reply on 18.10.2007 where it has been

mentioned that they are taking up the matter with the concerned office and he would be hearing from them. He

has not received any reply since then. The deceased insured had left behind his wife and two kids and she has no

bread earner to look after her children. He has requested that the Motor Claim and Personal Accident claim be

paid.

At the time of hearing, the representative of the Insurance Company informed the Forum that they were

prepared to settle the Personal Accident claim of Shri Satinder provided the deceased wife produced succession

certificate. Shri Dhoom Singh along with the widow of the insured was given a letter by the Insurance Company

and the deceased father was explained to submit various documents to the insurance company so that the

Personal Accident claim can be paid.

With regard to the own damage claim of Maruti Car No.UP-16F-0792, the Insurance Company informed

that they were prepared to settle the claim for Rs.1,40,000/- as assessed by the surveyor provided he produced

cancellation of RC as per Section 55 of the Motor Vehicles’ Act.

Shri Dhoom Singh at the time of hearing informed the Forum that the surveyor of the Insurance Company

had advised them to dispose of the vehicle and he had done accordingly and at no point of time, the Insurance

Company had asked them to get the RC book cancelled. They have accordingly done the job. He requested the

Forum that the claims be paid to the widow of the insured.

After hearing both the parties and on examination of the documents submitted, it is observed that Shri

Dhoom Singh father of the deceased Shri Satinder had lodged a complaint for two claims which are as under:

1. Personal Accident Claim : The Insurance Company have agreed to release the payment of

Rs.2,00,000/- after the deceased’s wife submits the succession certificate.

2. Own Damage Motor Claim : The Insurance Company are prepared to settle the own damage claim

provided the complainant gets the RC book cancelled. Shri Janak Raj who has conducted the final survey of the

vehicle has submitted his report NO.JR/UII/1473 dated 26.04.2005 and it is only on 10.10.2005, the Insurance

Company has requested Shri Dhoom Singh to get the RC book cancelled. There has been a deficiency in service

since as per IRDA ( Protection of Policyholders’ Interest) Regulations 2002, the Insurance Company should have

taken up the matter within 30 days on receipt of survey report which was received by them on 28.04.2005 by the

Insurance Company for compliance of the formalities which they have not done so. The surveyor has worked out

the liability of the Insurance Company on repair basis to Rs.1,76,966/- + Rs.1500/- towing + Rs.5000/- (Cost of

hidden parts like engine) = Rs.1,83,467/- less salvage Rs.5000/- = Rs.1,78,467/-. On total loss basis, the IDV of the

vehicle Rs.1,95,660/- and parts were missing worth Rs.18000/-. The liability comes to Rs.1,77,660/-. Matter of

assessment was discussed with insured’s brother Shri Yatendra who agreed full and final settlement on total loss

basis for Rs.1,60,000/-. The salvage value of Rs.20000/-without RC. After deducting the salvage value liability

comes to Rs.1,40,000/-. He has recommended to settle the claim for Rs.1,40,000/-. The surveyor has nowhere

mentioned in his report that RC book has to be cancelled and he has not even issued any letter to this effect to the

complainant. There is clear deficiency in service by the Insurance Company in non-communicating and claim

having been settled after deducting the salvage value of the vehicle and not on IDV basis which appears to be a

settlement of cash loss basis. I am of the opinion that cancellation of RC is not required since the damaged vehicle

has become the property of the insured and if he so desired as per the surveyor, the same could be repaired which

would cost him Rs.1,76,966/-. In view of the foregoing, I am of the opinion that the claim can be settled by the

Insurance Company without the cancellation of the RC.

I, therefore, pass the Award that the Insurance Company should pay Rs.1,40,000/- as recommended by

the surveyor Shri Janak Raj.



GI/27/NIC/08

In the matter of Smt.Sheela Kathiwala

Vs

National Insurance Company Limited AWARD

The complaint was heard on 13.06.2008. The complainant, Smt. Sheela Kathiwala, was represented by

her husband Shri Davender Kumar and her nephew Shri Sushil Jain. Shri Desh Raj Arora, Senior Assistant from the

Insurance Company was not allowed to represent the Company since he was not Class I officer of the Company.

Smt. Sheela Kathiwala has lodged a complaint with this Forum on 16.07.2007 that she had insured her

Hyundai Santro XO bearing registration No.DL 8C N-4619 with the National Insurance Company Limited vide policy

No.360803/31/06/6100003901 from 05.09.2006. On 61.01.2007, she visited her sister’s house at Laxmi Nagar and

returned at around 2130 hours on 06.01.2007. The vehicle was properly locked and parked outside her house

where she generally used to park her vehicle. The vehicle was stolen in the intervening night of 06-07/01/2007

from outside her residence. She came to know about the theft only on 07.01.2007. The matter was reported to

the Shalimar Bagh police station immediately and the authorities latter issued a FIR No.13/2007 dated 08.01.2007.

She also informed the Insurance Company about the theft of the vehicle from outside her house. That one Shri

Kirpal Singh Hans contacted her and informed that he has been deputed by the Insurance Company to carry out

and investigate into the theft of the stolen vehicle. That she made several visits to the office for settlement of her

claim to the office concerned but every time she was given a blank answer that the investigator/surveyor has not

submitted his report. She pleaded that she had submitted all the documents as asked by their surveyor and why is

there delay in settlement of her claim. She was told to contact Shri Kirpal Singh Hans and asked him to submit his

report. That she submitted all the documents like copy of FIR, report under section 173 Criminal Procedure Code,

Untraced Report under Section 173, copy of insurance policy, copy of Registration Certificate, copy of driving

license. On 19.04.2007, she got a letter from the office stating tht the theft took place at her sister’s place at Laxmi

Nagar and not at Shalimar Bagh. Shri Kirpal Singh Hans and the insurance company corroborated and with the

intention of denying the claim has manipulated with the facts. Shri Kirpal Singh Hans’s assistant approached Smt.

Savitri Devi at Laxmi Nagar and asked her to give her written statement that the vehicle was stolen from in front of

her house and not from Shalimar Bagh as claimed by her to which Smt. Savitri Devi said that no theft took place

from in front of her house and Smt. Sheela returned the same night on 06.01.2007 to her house at Shalimar Bagh.

She again received a letter dated 15.05.2007 from the Insurance Company that the vehicle is insured for

Rs.3,33,981/- whereas the IDV of the vehicle comes to Rs.3,17,282/-. Thay asked her, her written consent for a

Rs.3,17,282/- so that the claim is settled which she gave them only to avoid further delay and harassment from the

insurance company. The Insurance Company has issued her the policy with the IDV of Rs.3,33,981/- and has

charged accordingly. Now at the time of settlement of the claim, they have found that they have insured the

vehicle for a higher sum. Strangely they have not found that they have overcharged her and would have never

come to notice if the claim never took place at the first place. This is unfair practice followed by the Company and

only God knows how many more people have befooled this way. On 28.06.2007, she again received a letter from

the Insurance Company stating that the claim is repudiated due to concealment of facts. She has requested that

she has cooperated with the Company and has given consent for lesser amount so that the claim may be settled.

She has requested the Forum that she be paid a sum of Rs.3,55,188/- + Interest + compensation for mental

harassment minus excess clause as per rules.

At the time of hearing, complainant’s representative drew the attention of the Forum that the vehicle was

insured for Rs.3,55,188/- and the Insurance Company had taken a consent for Rs.3,17,282/- but later repudiated

the claim vide their letter dated 28.06.2003 due to concealment of the facts which is not so since the vehicle was

stolen from outside the house of Smt.Sheela Kathiwala at Shalimar Bagh which has also been recorded by police

authorities under whose jurisdiction her house falls. No police will register a case of theft outside their

jurisdiction. The representative requested the Forum that the IDV of the vehicle be paid to complainant, interest

along with compensation for mental harassment..

The Forum drew the attention of the representative of the complainant that it is not competent to pass

any award for mental harassment. And if they so desire to get compensation for mental harassment, they can go

to any other court of law. At this the representative of the complainant requested the Forum that she be paid the

claim for IDV of the vehicle along with interest and would not press of compensation for mental harassment.

Shri Desh Raj Arora, Senior Assistant from the Insurance Company came and submitted a letter dated

06.06.2008 wherein the Insurance Company has approved to settle the claim for Rs.3,16,782/- and the letter to

this effect was written to Smt. Sheela Kathiwala to get the formalities completed. Shri Arora was not allowed to

attend the proceedings since he was not a Class I officer of the Insurance Company.

The Insurance Company further informed the basis of calculation of IDV which comes to Rs.3,16,782/-as

under:

Show Room Price = Rs. 2,96,872.00

12.5% Vat = Rs. 37,109.00

= Rs. 3,33,981.00

Minus 5% Ex-show room = Rs. 16,699.05

Price = Rs. 3,17,281.95

Minus Excess Clause = Rs. 500.00

= Rs. 3,16,781.95

= Rs. 3,16,782.00

After hearing the complainant and on examination of the documents submitted, it is observed that the

National Insurance Company Limited vide their letter dated 06.06.2008 have decided to settle the claim of

Smt.Sheela Kathiwala for Rs.3,16,782/- as per the basis of IDV mentioned above. I have gone through the Invoice

of Himgiri Cars Private Limited dated 05.09.2006 submitted by the complainant and find that the price of Car

Price of Santro XO = Rs. 2,96,872.00

Vat 12.5% = Rs. 37,109.00

Other Charges = Rs. 27,350.00

Total = Rs. 3,61,331.00

The other charges pertains to the registration and insurance which according to me are revenue items as

such they cannot constitute the basis for insurance policy since based on the Principal of Indemnity, it is only the

cost of subject matter of insurance which in this case would be the price of Santo Car along with Vat for which

insurance is granted. Accordingly, the IDV of the vehicle should have Rs.3,17,281.95. Since there was no

representation from the Insurance Company, it was not possible to ascertain how the IDV was calculated as

Rs.3,55,188/-. As per the policy, no accessories are covered as such the correct IDV should be Rs.3,17,281.95.

After deduction of Excess Clause of Rs.500/-, the net liability of the Insurance Company comes to Rs.3,16,782/-.

I, therefore, pass the Award the National Insurance Company Limited should pay Rs.3,16,782/- to

Smt.Sheela Kathiwala along with 8% interest from 05.02.2007 till 06.06.2008 as per IRDA Regulation. Further, the

Insurance Company should refund excess premium collected on the difference of IDV (Rs.3,55,188.00 –

Rs.3,17,282.00) along with 8% interest from 05.09.2006 till the time the payment is made.



Case No. GI/569/OIC/07

In the matter of Shri Puneet Aghi .

Vs

Oriental Insurance Company Limited AWARD

The complaint was heard on 05.05.2008. The complainant, Shri Puneet Aghi, was present accompanied

by his neighbour Shri Surinder P.Singh. The Insurance Company was represented by Shri Manjit Bhatia.

Shri Puneet Aghi has lodged a complaint with this Forum on 04.12.2007 that he had insured his motor

cycle No.DL 7SG 8811 with the Oriental Insurance Company Limited from 31.12.2003 to 30.12.2004. On

09.09.2004, the motor cycle was stolen and he had lodged a claim with the Insurance Company. He has not

received any reply from the Insurance Company. He had written to Divisional Manager on 10.05.2006 for which he

has not received any reply. He has been contacting the Insurance Company continuously on telephone. He

received a letter dated 15.12.2006 wherein he was requested to comply certain requirements which he had

complied on 12.02.2007. Subsequently he had made enquiries from the Insurance Company and he has been

informed that the file is not traceable. He has requested the Forum that his claim may be paid.

At the time of hearing, Shri Puneet Aghi informed the Forum that his vehicle was stolen on 09.09.2004

and he preferred a claim with the Insurance Company but till date the Insurance Company has not settled his

claim. He requested the Forum that his claim may be paid along with interest.

The representative of the Insurance Company informed the Forum that the claim file is not traceable and

has requested the Forum that they be given some more time to trace the file. The Forum informed the

representative that since the motor cycle has been stolen on 09.09.2004 and it is already more than three and half

years, there has been deficiency in service as far as Insurance Company is concerned, and as such, no adjournment

is possible.

After hearing both the parties and on examination of the documents submitted, it is observed that Shri

Puneet Aghi had insured his motor cycle No.DL 7SG 8811 with the Oriental Insurance Company Limited which was

stolen on 09.09.2004. FIR No.472/04 registered on 11.09.2004 and final report for the same has been issued by

the police authorities on 24.11.2004. The Insurance Company has requested the insured to comply with certain

requirements which he had done on 12.02.2007. Subsequently, the Insurance Company has not replied to the

insured.

Keeping in view the above facts, I, pass the Award that Shri Puneet Aghi be paid for the IDV of the vehicle,

that is, Rs.15000/- less police clause along with 8% interest from 01.03.2007 till the time the payment is made.

GUWAHATI

BEFORE THE OFFICE OF THE INSURANCE OMBUDSMAN

AT GUWAHATI CENTRE

Complaint No. 11-003-0205/07-08

Mr. Brijlal Taparia …….. Complainant/Insured

- Vs -

The National Insurance Co. Ltd. …….. Opposite Party/Insurer

Date of Order : 07.08.2008

The Insured / Complainant insured his vehicle bearing No.AS-05 A / 8117 with the opposite

party / Insured covering the period from 04.03.2005 to 03.03.2006. During the currency of the

policy, insured vehicle met with an accident on 03.06.2005 sustaining heavy damages. After

repairing of the vehicle, all the requisite documents alongwith bills worth Rs.1,03,106.25 were

submitted to the Insurer. The Insurer approved the claim for Rs.43,547/- and accordingly a loss

voucher for Rs.43,547/- dated 05.04.2006 by Registered Post was sent to the Insured. But the

Insured refused to accept the above settled amount.

Being aggrieved the Complainant approached this forum.

During the course of hearing, Mr. Brijlal Taparia, Complainant has stated that due to the

involvement of his vehicle in the accident at Raha, the vehicle sustained heavy damages and he

had spent Rs.1,20,000.00 in repairing and he has produced vouchers for about Rs.1,04,000.00

before the Insurer in support of his claim. Of course, he does not know whether any report was

produced in proof of such damages, as according to him, his nephew was managing and looking

after the vehicle. Mr. B.K. Munka, representative of the Insurer has stated that after getting

information about involvement of the vehicle in the accident, inspection of the vehicle was done

by the Asstt Engineer of ASTC, Nagaon on Police requisition. He has also stated that the

estimate was prepared by one Amar Garrage about the repairing to be done involving the

expenses. It was reported that Rs.95,000/- will be required for parts to be replaced and

Rs.23,000/- will be required as Labour Charges for repairings. The vehicle was also inspected by

the Surveyor deputed by the Insurance Company prior to and post-dismantling stage who

verified the parts damaged. According to him, after repairing, the Surveyor assessed the loss at

Rs.47,500/-. Mr. Munka has admitted that all the repairings were done as per estimate.

On scrutiny, it is found that the vehicle was inspected after repairing by Mr. Atanu

Mondal, Surveyor & Loss Assessor, on being deputed by the Insurer, who in his report dated

28.07.2005 commented as follows :-

“i) The vehicle was duly repaired and restored to a nicely road worthy condition.

ii) All the repairing / re-making / reconditioning works as previously recommended by the

final surveyor and colum labour charges was carried out satisfactorily on the captioned

vehicle.

iii) The following aggregates are replaced on the vehicles :

1) Fr. Axle beam (2) Fr. Cross member (3) Engine chamber (4) Radiator (5) Spring leafs (6)

U bolt (7) Hanger (8) Jhulla (9) Tyre (10) Head light (11) Bumper

The Final Surveyor excluded the expenses incurred in replacement of some parts and partially

allowed some of them although the Surveyor confirmed such replacement in the re-inspection

report. Complainant had to spend Rs.4,000/- as towing charge of the vehicle from the site of the

accident to Roha P.S. besides spending Rs.1500/- as towing charge from Roha PS to Amar

Garrage for repairing. The Insurer has allowed only Rs.1500/- although the Surveyor has allowed

Rs. 2500/- for the same. After involvement of the vehicle in the accident, the vehicle was

required to be taken to Raha PS and the Complainant had to bear the expenses required but

not at his choice and hence the Insurer should consider, if the said amount of Rs.4,000/- can be

allowed keeping in view, the fact that it was an act of law. Apart from all that, the amount

allowed by the Final Surveyor has also not been paid in full by the Insurer. Thus considering the

above facts and circumstances, the Insurer is asked to reconsider and reassess the matter and

arrange to settle the claim on the lines suggested above.

The Award shall be implemented within 15 days of receipt of the same. The Compliance

of the same shall be intimated to my Office for information and record.


AT GUWAHATI CENTRE

Complaint No. 11-002-0200/07-08

Sri Rabinder Singh …….. Complainant/Insured

- Vs -

The New India Assurance Co. Ltd. …….. Opposite Party/Insurer

Award Date : 02.07.2008

Facts :- The Complainant Sri Rabinder Singh had taken a Motor Policy for his vehicle bearing No.

AS-01/W-7311 from the above Insurer covering the period from 21.09.2006 to 20.09.2007. On

08.03.2007, the insured vehicle met with an accident and sustained damages. Rs.27,251/- was

claimed by the complainant against repairing the vehicle but the Insurer has offered to settle

the claim at lesser amount.

Opposite Party’s view :- The Final Surveyor had assessed the loss at Rs.21,400/-. The Insurer

deputed another Surveyor for re-inspection of the vehicle who had submitted a report wherein

he stated that the Insured could not show most of the major replaced parts, salvages which are

essentially required to ascertain the quantum of actual loss. The Insurer has also stated that the

Insured did not submit the Cash Memos of few replaced parts and few parts which are claimed

by the Insured are not mentioned in the estimate. Accordingly, the Insurer has finally

ascertained the loss at Rs.6,300/- which they have offered.

Decisions & Reasons :- It appears from the report of the Surveyor who was deputed after

repairing, the vehicle was completely repaired and such repairings were done as per Final

Surveyor report and he has also mentioned the parts replaced. It clearly indicates that repairing

was done properly as per estimate and parts were also replaced. The Complainant also

mentioned in his statement, that he has got all the salvages of the replaced parts. If required,

he can produce all the salvages before the Insurer even now.

In that case, it would also not be difficult for the Insurer to reconsider and settle the claim

afresh. The Complainant shall have to produce the Cash Memos, if any, and also the salvages of

the replaced parts as and when required by the Insurance Company.

We are of the opinion that the claim is genuine and the Insurance Company is duty bound to

settle the same in letter and spirit of the Survey Report submitted by the Surveyor which report

is not in dispute and supposed to have been accepted by the Insurance Company.

In view of the aforesaid discussions and in the guidelines given, it is hereby directed the

Insurance Company to settle the claim at the earliest.


AT GUWAHATI CENTRE

Complaint No. 11-005-0179/07-08

Mr. Samarendra Nath Das …….. Complainant/Insured

- Vs -

The Oriental Insurance Co. Ltd. …….. Opposite Party/Insurer

Award Date : 01.07.2008

This petition was filed by the Complainant against total repudiation of a claim due to

accident of his insured vehicle.

The petitioner, Mr. Samarendra Nath Das stated that his vehicle was insured with the

Oriental Insurance Co. Ltd. covering the period from 29.09.2006 to 28.09.2007 under “Package

Policy for Goods Carrying Commercial Vehicle”. The insured vehicle met with an accident on

02.05.2007 and he lodged a claim to the Insurance Company. But the Insurer has repudiated the

claim on the ground that the Driver was holding a Fake Driving Licence at the relevant time.

The representation lodged by him was also not considered.

The Insurance Company, in their Self Contained Note stated that on receipt of the claim,

they have deputed a Surveyor to assess the loss. After assessing the same, he had submitted

the survey report quantifying the loss for Rs.1,99,572/-. The vehicle was being driven by Sh.

Shyamlal Chouhan, Driver at the material time of the accident having the D/L No. 12756/CH and

D/L No. F/863/98/EZ/K. On verification of original Driving Licence No.12756/CH/Proff through their

Investigator M/s. Bureau of Investigation Agency, the said Driving Licence No. 12756/CH was

found to be Fake. The DTO, Churachandpur has specifically stated in the Investigator’s letter that

the licence was not issued by them. Since the original Driving Licence is established as Fake as

such all subsequent renewals are also fake. It is clearly mentioned in the Driver’s Clause of the

Policy Schedule that any person including insured : provided that a person driving holds an

effective driving licence at the time of the accident and is not disqualified from holding or

obtaining such a licence. Provided also that a person holding and effective learner’s licence may

also drive the requirements of Rule – 3 of the Central Motor Vehicles Rules 1989.

During the course of hearing, according to the Complainant, the D/L No.12756/CH held

by his Driver Sh. Shyamlal Chouhan was valid and he himself went to DTO Office, Churachandpur

who had issued the report wherein he had stated that the licence referred to above was found

genuine as per record. The Complainant has also produced another report in respect of “No

Objection Certificate” issued by the DTO, Churachandpur regarding the said licence.

Mr. A.C. Shome, representing the Insurer has however produced another report submitted by their

Investigator wherein the DTO, Churachandpur has stated that D/L No. 12756/CH/Proff was not

issued by them. It appears that the report of the said DTO, Churachandpur produced by the

Insurer in respect of D/L No. 12756/CH/Proff held by Sh. Shyamlal Chouhan appears to be quite

contradictory with that of the reports issued by the same authority. Mr. Shome however

admitted about receiving reports from the Complainant which were issued by the DTO,

Churachandpur subsequently in respect of the said D/L and according to him on receipt of the

aforesaid reports, the Insurer deputed Mr. Pronay Das, another Investigator to investigate the

said reports who approached DTO, Churachandpur and the said Office confirmed, that the said

licence was genuine as per record. After obtaining the report from DTO, Churachandpur, the

Investigator Mr. Pronay Das has submitted his report wherein he clarified that the D/L records

were not properly checked earlier by the DTO, Churachandpur who subsequently confirmed the

licence to be genuine. In view of the report of the Insurance Investigator, the D/L No.

12756/CH/Proff held by Sh. Shyamlal Chouhan was found to be genuine and there remained no

doubt about it. Hence, repudiation of the claim by the Insurer on the basis of incorrect reports,

appears to be not justified.

Hon’ble Ombudsman directed the Insurer to settle the claim at the earliest as the

Driving Licence of the Driver Sh. Shyamlal Chouhan of the insured vehicle is genuine one and

repudiation is not justified. Thereafter the complaint is disposed of.


AT GUWAHATI CENTRE

Complaint No. 11-012-0182/07-08

Mrs. Anu Deori …….. Complainant/Insured

- Vs -

ICICI Lombard General Insurance Co. Ltd. …….. Opposite Party/Insurer

Award Date : 17.06.2008

Insured / Complainant insured her vehicle No. AS -01 D / 0019 with ICICI Lombard General

Insurance Co. Ltd. covering the period from 29.01.2008 to 28.01.2008. On 20.07.2007, the vehicle

met with an accident sustaining damage. The claim was lodged with the Insurer which was

repudiated by the Insurer on the ground that the vehicle was used for commercial purposes in

violation of the policy conditions.

Being aggrieved the Complainant approached this forum.

The Insurer contended that on receipt of the claim an Investigator was appointed and it

was ascertained that the vehicle was used for hire and reward which was in violation of the

policy terms & conditions and hence, no liability attaches with the Insurer. The claim is

accordingly repudiated.

During the course of hearing, the complainant stated that the vehicle was used all along

as a private car and it was never rented out nor used for commercial purposes as stated by the

Insurer in repudiating the claim. Ms. Banhea Ray, representative of the Insurer cited that on

receipt of the claim, the Insurer appointed a surveyor for assessing the loss and also an

investigator to investigate into the matter. It was found that the vehicle was used in violation of

the policy condition on that ground the claim could not be settled. Though there is no

document proofs that the vehicle was used for commercial purposes but the Insurer has

recorded a telephonic conversation wherein the owner / insured admitted about using the vehicle

for commercial purposes. Ms. Ray, representative of the Insurer also revealed that she could not

say who answered to their questions over telephone admitting about using the vehicle for such

purposes. The complainant was neither approached in person nor recorded her statement as to

how the vehicle was being used by her.

The Insurer appears to have placed reliance on a telephonic conversation and repudiated

the claim without having any other authentic proof. In the absence of any cogent and reliable

proof, the decision taken by the Insurer in repudiating the claim is unjustified and hence the

same is set aside. The Insurer should settle the claim in terms of the policy.

The repudiation of the claim was, therefore, not in order. Hence, ordered that the

admissible amount of claim be paid by the Insurer to the complainant.


AT GUWAHATI CENTRE

Complaint No. 11-005-0038/08-09

Mrs. Kiran Thakuria …….. Complainant/Insured

- Vs -

The Oriental Insurance Co. Ltd. …….. Opposite Party/Insurer

Award Date : 08.09.2008

Mrs. Kiran Thakuria, Insured / Complainant, insured his vehicle bearing No. AS – 25 B / 0892

with Oriental Insurance Co. Ltd. covering the period from 05.12.2006 to 04.12.2007.

During the currency of the policy on 12.12.2006 insured vehicle met with an accident.

The Insurer appointed a Surveyor who assessed the loss at Rs.44,152/-. On verification of the

vehicular documents, it was found that driving licence held by the driver Mr. Suranjan Das, who

drove the vehicle at the relevant time of accident, was a fake one.

Being aggrieved of the decision of Insurer, the Complainant approached this forum.

During the course of hearing, Mrs. Kiran Thakuria, Complainant, has admitted in her

statement that at the time of the accident, her insured vehicle was driven by the Driver

Suranjan Das who was holding the D/L No. F/1093/90/K which was renewed at Guwahati but she

has not seen the original driving licence. She even could not say wherefrom the original licence

was procured. Mr. A.C. Shome, speaking for the Insurance Company, has stated that the

Insurance Company has verified the licence No. F/1093/90/K through Investigator Ramen Das who

approached the DTO, Kamrup and procured a letter wherein it was stated that the said licence

was renewed at DTO Office, Kamrup, Guwahati on the basis of the original D/L No. 3991/CH

(Manipur). Mr. Shome, further stated that the original licence No. 3991/CH was also verified

through Investigator Y Bhishma Singh who has reported that the above D/L was issued in the

name of Bhop Singh and not in the name of Suranjan Das. According to Mr. A.C. Shome stated

that the D/L No. 3991/CH was issued in the name of one Bhop Singh and not in the name of

Suranjan Das. The DTO, Churachanpur has confirmed it. This proves that the original licence

allegedly shown to have been issued to Suranjan Das was fake. Though on the basis of such

fake D/L No. 3991/CH, the DTO, Kamrup issued renewal licence No.F/1093/90/K, but the same

cannot cure the defect. So, claim deserves repudiation.

Hon’ble Ombudsman upheld the repudiation as the driving licence submitted by insured

is a fake one and said driving licence was issued in favour of one Bhop Singh not in favour of

Suranjan Das. Mr. Suranjan Das did not have valid D/L at the time of accident. Insured /

Complainant failed to prove the genuineness of the driving licence submitted.

HYDERABAD

Office of Insurance Ombudsman

Hyderabad

Complaint No. G 11.04.460

AWARD NO 6 dated : 30.04.2008

Sri B Gangadhar Vs. United India Insurance Co.Ltd

Brief facts: United India had insured a Hero Honda motor cycle in the name of Md.

Shabbir Ali for the period 27.04.2004 to 26.04.2005. The vehicle was stolen on

17.01.2005 from the house of Sri B Gangadhar. The police and the insurance company

were intimated. The claim was rejected by the insurance company stating that Sri Shabbir

Ali had no insurable interest as it was sold to Sri Gangadhar as on the date of accident.

The complaint before this office was filed by Sri Gangadhar.

Decision:

The complainant confirmed that he purchased the vehicle but the transfer of registration

and insurance were not done. The insurers stated the contract of insurance was with Sri

Shabbir Ali and therefore Sri Gandadhar had no legal right to lodge the complaint and

they would, as per terms of the policy, indemnify their insured.

The claim was filed by Sri Shabbir Ali and all the documents were submitted by him and

the repudiation letter was sent to him. The insurer had conveyed that they would

indemnify the insured and Sri Gangadhar had no locus standi to complain. There the

complaint filed by Sri Gangadhar was dismissed.

KOLKATA

Total repudiation

Kolkata Ombudsman Centre

Case No. 356/11/012/NL/09/2007-08

Shri Dilip Mehra

Vs.

ICICI Lombard General Insurance

Order Dated: 09.04.2008

Facts & Submissions:

This petition was in respect of repudiation of an own damage claim under Private

Car Package Policy issued by ICICI Lombard General Insurance Company Ltd.

The petitioner, Shri Dilip Mehra in his petition dated 03.09.2007 stated that his

private car bearing no. WB 02U 3286 was insured under Motor policy No.

3001/50066422/00/000 for the period 26.07.2006 to 25.07.2007. On 29.09.2006

at about 2 A.M his car was burnt, local police was informed and a claim was

lodged with the insurance company, but the insurance company repudiated the

claim by their letter dated 09.10.2006 mentioning that the burning of the vehicle

was not caused by any accident or malicious act. According to them the cause

could be attributed to electrical/mechanical breakdown which was not covered

under the policy. The insured sent representation to the insurance company on

27.07.2007 expressing his non-acceptance on the repudiation decision and

requested the insurance company to pay the claim. As he did not get any

favourable reply he approached this forum for redressal of his grievance seeking

relief of Rs.2 lakhs on total loss basis.

The insurance company in their self-contained note sent on 05.04.2008 stated

that the complainant took a Private Car Policy and the insured vehicle caught fire

on 28.09.2006 and the same was intimated to the insurance company.

Accordingly, a surveyor was appointed to assess the loss. As per the surveyor’s

report the vehicle caught fire due to fixing of non-standard music system of high

amperage. Therefore, the surveyor requested the complainant to get the vehicle

inspected by the manufacturer as the same fell under the manufacturing

warranty. Further the insurance company submitted that the vehicle was a new

vehicle and there was no accident or external hazard due to which the vehicle

caught fire. According to them there was a possibility that the vehicle could have

caught fire due to electrical breakdown as confirmed by the surveyor. According

to them electrical breakdown came under the General Exceptions as per the

policy terms and conditions. Therefore, they felt that the claim was not payable.

Decision: This office was unable to agree with the arguments of the insurance company.

The surveyor did not give any reason for electrical breakdown excepting stating

that the complainant used a non standard music system of high amperage. This

office did not understand how there would be a spark due to a short circuit when

the music system was not in use and when the car was parked in the night at 2.00

A.M. We were also not sure how even if a short circuit occurred the fire took

place unless the wiring used was inferior. There were no answers for such

questions in the surveyor’s report excepting the fact that the manufacturer had

recalled all the vehicles in a particular lot for fresh wiring as there was a defective

wiring in that lot. In fact the complainant was not in the knowledge that there

was such a recall from the manufacturer with regard to the particular lot to which

this vehicle which caught fire belonged. There were many questions that had not

been answered by the insurance company with regard to above. Therefore,

Hon’ble Ombudsman felt that the insurance company should appoint another

independent surveyor and get a report conclusively with regard to the reasons for

the fire in the vehicle and take a review of the repudiation decision already made.

The complainant was also advised to communicate with the manufacturer

regarding the manufacturing defects of his vehicle which caught fire.

--0—


Case No. 663/11/011/NL/02/2007-2008

Smt. Asha Devi Fatehpuria

Vs.

Bajaj Allianz General Insurance Co. Ltd.

Order Dated : 26.08. 2008

Facts & Submissions :

This complaint was filed against the repudiation of a claim on the ground that the driver who was driving the

vehicle did not have a valid Driving Licence in his possession at the time of accident under Motor Insurance

Policy.

The petitioner, Smt. Asha Devi Fatehpuria stated that she took a Motor Insurance policy from Bajaj Allianz

General Insurance Co. Ltd., against Vehicle which met with an accident on 28.07.2007. Accordingly, an own

damage claim of Rs.55,094/- was lodged to the insurance company and subsequently inspection was carried

out. A sanction letter to this effect was issued to the repairer’s i. e. M/s. B. B. Motors Pvt. on 25.8.2007 by

the insurance company sanctioning the claim amount worth Rs.40,648/-. Subsequently, a registered letter

dt.4.9.2007 was received by the complainant repudiating the claim on the ground that the driver i. e. Shri

Montu Paul was having an invalid driving licence in his possession at the time of accident. The complainant

contended that his driving licence was valid upto 9.5.2009. She also submitted a Third Party Claim of

Rs.12,013/- to the insurance company against the payment she made to the West Bengal Electricity

Distribution Co. Ltd. for damages. A representation was made on 21.09.2007 against the decision of

repudiation in both the cases to the insurance company to reconsider the same, but they did not get any

response from the insurance company. Being aggrieved, she approached this forum for compensation of

Rs.67,107/- including third party claim.

In the self-contained the insurance company stated that the Vehicle was insured by a Motor Insurance policy

with an IDV of Rs.3,30,000/-. The said vehicle met with an accident on 28.7.2007 and a claim intimation was

lodged on 29.6.2007 stating that at the material time of the accident, Shri Montu Paul drove the same. The

driving licence of the driver was verified from RTO authority, Barasat and the insurance company came to

know that the subject licence was valid from 1.5.2000 till 9.5.2006. On the basis of that report, the insurance

company repudiated the claim. The Insurance Company also stated that in view of policy terms and

conditions vis-à-vis Motor Vehicle Act, they were unable to pay any compensation under any circumstances

for arising out or resulting from the insured committing any breach of the terms and conditions under the

policy and Motor Vehicle Act.

Decision :

It was observed that a number of decisions were cited by the insurance authorities of

which the latest being the decision given by the Hon’ble Apex Court in the year 2004 in

the case of National Insurance Co. Ltd. Vs. Swaran Singh where it was decided that an

invalid licence need not be necessarily stand in the way of a claim of own damage (OD), if

it was proved that the owner of the vehicle had used his due diligence and without

negligence then the claim of the own damage (OD) would liable to be paid.

Keeping in view of the above, the complainant was asked to find out from the R.T.O. why

there was a discrepancy between the dates 9.5.2006 and 9.5.2009; after that he would be

able to adduce a reasonable cause. Thereafter, the insurance company was directed by

the Hon’ble Ombudsman to review the decision of repudiation of the claim after the

insured produces verification.

-----O------


Case No. 767/11/003/NL/03/2007-08

Shri Tapan Kumar Maity

Vs.

National Insurance Company Ltd.



This petition was against repudiation of a claim under Certificate of Insurance of

Motorcycle/ Scooter issued by National Insurance Company Ltd. on the basis of

recovery of stolen motor cycle which was duly been supported by the Ld. Court.

The petitioner, Shri Tapan Kumar Maity stated that his Hero Honda Splender (+) Motor Cycle

Registration No. WB-34-L-3100 was insured with National Insurance Company Ltd. from 01.11.2005 to

31.10.2006. On 30.08.2006 at 6.35 P.M his motor cycle was snatched by some miscreants at Batur Pukur

under Narayangarh Police Station, Paschim Medinipore. He lodged a claim for Rs.32,800/- with the

insurance company but the insurance company did not pay his claim on the ground that the vehicle was

recovered by police authority. The engine and chassis number was badly tampered and therefore his

appeal to the Court to give him possession of the vehicle was turned down by the Ld. Court. He

represented to the insurance company but the same was not considered. Therefore, he approached this

forum for redressal of his grievance.

The insurance company in their self-contained note dated 21.05.2008 stated that the incidence of loss

of the vehicle was genuine but the vehicle was recovered by the police. The complainant made prayer to

the Hon’ble Court for return of his vehicle from the police custody, but the Hon’ble Court rejected his

prayer. Since the discrepancy in engine number and chassis number which was tampered by the

miscreants, the police authority did not give the F.R.T report as the stolen vehicle was recovered. Then

the insurance company obtained legal advice on the basis of which they treated the claim as “No Loss”.

Decision:

On going through the opinion of the Ld. Advocate, Hon’ble Ombudsman found that according to him the

Ld. Magistrate’s decision was in-conclusive with regard to rejecting the prayer of the insured for return of

the seized /recovered motor vehicle and he suggested that the insured should again go to the Court for

return of the same. He further stated that the Ld. Magistrate confirmed the earlier orders he should go to

the session court with an application to cancel the order of rejection. He was unable to agree with such an

opinion as the insurance company should not burden the insured with heavy expenditure of trying the luck

of the insured to further court procedure.

As per the facts available the Ld. Magistrate had rejected the claim of recovery of seized vehicle on the

evidence available. He had also taken into consideration the forensic laboratory report before rejecting the

prayer of the insured. On the strength of the order Hon’ble Ombudsman felt that the insurance company

should try that the vehicle had not yet been traced.

Keeping in view the above, Hon’ble Ombudsman directed the insurance company to obtain all the

required documentation – if not already received and as it was a fact that the vehicle had not yet been

traced – and settle the claim as per policy terms and conditions.

-----O------

Delay in settlement


Case No. 542/14/013/NL/12/2007-08

Smt. Ritika Nigam (Agarwal)

Vs.

HDFC General Insurance Company Ltd.



This petition was against delay in settlement of Motor Own Damage Claim under

Certificate of Insurance cum Policy.

The petitioner, Smt. Ritika Nigam (Agarwal) stated that her Vehicle Santro Zip Plus Le No.WB-02P 7992

was covered under Policy No.VP00033082000103 for the period 31.10.2006 to 30.10.2007 with HDFC

General Insurance Company Ltd. The concerned vehicle met with an accident on 29.04.2007. She lodged

a claim with the insurance company for a sum of Rs.2,01,000/- and submitted all required documents to

the insurance company. But the insurer did not settle the claim rationally. The car was badly damaged

and the cost of repair was exceeded to the IDV. She wanted total loss settlement while the insurer

insisted on repairing basis. She took up the matter with the insurance company but no acceptable

solution was suggested by the insurance company and therefore, she approached this forum for

redressal of her grievance seeking monetary relief of Rs.2,01,000/- (IDV) plus interest plus any charge to

be levied by the repairers and compensation for harassment and hardship.

The insurance company in their self-contained note dated 29.05.2008 stated that the surveyor had

requested the complainant to go ahead with repairs. She was also intimated about the depreciation

which she had to bear. Several letters were sent to the complainant for resolving the issue but she

delayed the matter without undertaking the repairing job.

Decision:

Since the matter was amicably settled and the grievance had been satisfactorily redressed, Hon’ble

Ombudsman felt that no further intervention was called for. The petition was dismissed.

-----O------


Case No. 619/14/005/NL/01/2007-08

Shri Dhuruva Narayan Thakur

Vs.

The Oriental Insurance Company Ltd.



This petition was against delay in settlement of claim under Private Car Package Policy

issued by the Oriental Insurance Company Ltd.

The petitioner, Shri Dhuruva Narayan Thakur stated that his Maruti Car was insured with the above

insurance company. His car met with an accident on 19.01.2007 and an estimate for Rs.84,503/- was

submitted to the insurance company. As per surveyor’s advice the vehicle was dismantled taking several

essential spares, labour and service charge, the assessment was made at Rs.56,825/- which was not fair

or just. He appealed to the insurance company for settlement of total loss basis. The repairer also was

not agreeable to repair the vehicle at the cost allowed by the surveyor. The insurance company agreed

to consider the case on total loss basis with a “condition to bring the damaged vehicle in the shape and

condition where it was prior to any dismantling”. It was not possible and accordingly he appealed to the

insurance company to review the matter. His appeal was not considered and therefore, he approached

this forum for redressal of his grievance seeking relief of Rs. 2,19,600/- against the sum insured for

Rs.80,000/- + interest, harassment physical and mental torture etc. Subsequently, the branch office

advised the insured to transfer the ownership in the name of the insurance company; he wanted to see

the circular from the Oriental Insurance Company Ltd. whether the application in respect of transfer of

ownership had to be made by the insured. No response in this regard was received from the insurance

company. In the meantime the repairer demanded rent from the insurance company.

The insurance company in their self-contained note dated 14.05.2008 stated that the surveyor assessed

the loss at Rs.60,861/- on repairing basis (without deducting the policy and compulsory excess) and

Rs.78,500/- on total loss basis. Thereafter the insured was informed to bring the damaged vehicle in

prior condition of dismantling. The insured did not comply with the formalities and approached their

Customer Service Department. The insurer then sent the loss voucher to the insured with a request to

comply submission of original keys and transfer of R.C. Book in the name of insurance company. The

insured did not comply with the requirements and therefore the claim is still pending.

Decision :

On going through the papers submitted by the complainant this office found that transfer of ownership of

registered vehicle had to be done by the purchaser by filing of the form no. 30. Therefore, respectively

following the decision of Ahmedabad Ombudsman, Hon’ble Ombudsman held that the burden of transfer

of the vehicle was on the insured (the complainant). Therefore, Hon’ble Ombudsman directed the

complainant to make efforts to transfer the vehicle in the name of the insurance he directed the insurance

company to pay Rs.60,000/- immediately and remaining Rs.18,500/- to be paid after the complainant

completed the formalities of the transfer of the vehicle to the insurance company.

Partial Repudiation


Case No. 652/11/003/NL/02/2007-08

Shri Chandra Sen Singh

Vs.

National Insurance Company Ltd.



This petition was against partial repudiation of a claim under Certificate of Insurance

of Goods Carrying (other than 3-WH) Public Carriers issued by National Insurance

Company Ltd.

The petitioner, Shri Chandra Sen Singh stated that his vehicle No.WB-37B/061 was covered under policy

No. 150501/31/06/6300001688 for the period 14.08.2006 to 13.08.2007 with National Insurance

Company Ltd., Raniganj Branch. The vehicle was stolen on 08.02.2007 and the claim for Rs.12,09,268/-

(IDV – Policy Excess of Rs.1,500/-) was lodged with the insurance company, but his claim was settled for

Rs.10,88,618/- after deducting 10% of IDV. He did not accept that amount. He appealed to the

insurance company stating that it was new vehicle and therefore, there should be no deduction. His

appeal was turned down by the insurance company and therefore he approached this forum for a

monetary compensation of Rs.15,08,500/- (consisting of Rs.12,06,500/- loss by theft of vehicle +

Rs.1,70,000/- expenses for searching + Rs.1,32,000/- bank interest upto March 2008). He stated in his

application that 10% deduction was made by the insurance company as they put a rubber stamp on the

policy mentioning that in case of total loss by theft of 10% excess of IDV will be imposed on all vehicles.

The insurance company in their letter dated 31.03.2008 stated that the condition was imposed as per

India Motor Tariff No. 21and motor loss minimization procedure. No dispute was raised at the time of

accepting the policy either by the insured or by the financing bank. The Divisional office also did not

raise any question when the matter was referred to them for ratification.They were imposing the

condition since 2006, as usual. The insured’s statement that his claim got full amount in respect of his

car was a different case as it was a Private Car Policy.

Decision:

On going through the documents shown by the complainant and also the documents shown by the

representatives of the insurance company, Hon’ble Ombudsman came to a conclusion that the branch of

the insurance company had the discretion to impose the above condition.

Keeping in view the above, the complainant was suggested with payment of ex-gratia amount to avoid

further litigation. He was informed that 50% ex-gratia payment would be sufficient to meet the ends of

justice and at the same time not violating the condition that had already been stamped on the policy

documents. This offer was accepted by the complainant.

Under these circumstances, Hon’ble Ombudsman directed the insurance company to pay an ex-gratia

amount of Rs.60,000/-.

-----O------

AHMEDABAD

OFFICE OF THE INSURANCE OMBUDSMAN (GUJARAT)

2nd

Floor, Ambica House, Nr C.U. Shah College, Ashram Road, Ahmedabad-380014

Phone: 079-27546840, 27545441 Fax: 079-27546142

===================================================================

SYNOPSES OF AWARDS YEAR: 2008-09

FROM 01.04.2008 TO 30.09.2008

AHMEDABAD OMBUDSMAN CENTRE

Case No.11-008-0410-08

Shri Mukeshbhai S.Garg Vs. Royal Sundram Alliance Ins. Co.Ltd

Award dated 21.05.08

The Car shield Private Car Package policy was issued. The claim was lodged for loss of insured vehicle in

March 2007 due to fire. The dispute was raised as the claim was repudiated by Respondent.

During hearing of both sides it was revealed that:-

The insured/complainant suppressed the fact that LPG kit was installed in car and had not paid any

premium for covering the risk pertaining to LPG kit violating the terms and conditions of policy. In proof of the same

photograph was submitted by respondent, taken on spot survey dated 16-05-2007 and also prove that the gas fuel

tank was for large amount of force for near door.

The case was dismissed and decision to repudiate the claim was upheld.

________________________________________________________________


Case No.11-007-0411-08

Shri Rakesh J.Parikh Vs. Tata AIG Gen.Ins.Co.Ltd.


Late Jitendra Parikh had Scorpio Vehicle had insurance cover under ‘Auto Secure’ Private Car Package with

respondent.

The vehicle was stolen when parked in front of house. The claim lodged was repudiated and dispute was

raised under RPG Rules 1998.

After perusal of documents submitted and hearing of both sides, following facts was recorded.

Main fact was to conform if the policy was in force as on the date of loss. As per terms and conditions of

policy in the event of death of sole insured the policy will not immediately laps, but will remain in force (valid) for 3

months from the date of death or until expiry of policy (whatever earlier). During the said period, the legal heir of

insured to whom the custody and use of motor vehicle passes may apply to have policy transferred to the name of

heirs. In this case after death the insurance was not transferred and as such (Clause 9) expired on 30-11-2006. The

Complainant’s plea was ruled out as was not fact based.

Case was dismissed.

________________________________________________________________


Case No.14-005-0025-09

Mr.Arvindbhai Z.Shah Vs.Oriental Insurance Co.Ltd.


A Motor O.D Claim was lodged by the complainant against the theft of the vehicle.

The complainant pleaded that the claim payment is inordinately delayed in-spite of complying all the

requirements such as police final investigation report, handing over the keys and Registration/Taxation books. The

information of theft was already informed to RTO.

The Respondent agreed to all the above but pleaded that the mandatory requirement to transfer the

ownership of the vehicle is yet pending and on completion of the transfer of vehicle through Registration book of RTO

the claim can be settled without further delay.

Award was given directing complainant to submit transfer of ownership of vehicle in frond of Respondent and

Respondent to settle the claim subsequently.


Case No.11-002-0002-09

Mr.Dhanjibhai S.Patel Vs. New India Assurance Co.Ltd.


A claim under Motor Own Damage and Motor Personal Accident was lodged by the Complainant. The claim

was inordinately delayed without any letter to the complainant.

Complainant’s son was driving the Motor Cycle- insured vehicle when he met with accident and died. The

Surveyor assessed the loss of Rs.10,000/- for damaged vehicle.

Complainant pleaded that all the requirements and formalities are completed still the claim is delayed.

Respondent submitted that since the vehicle was driven by the Insured’s son who was not covered in P.A in

owner-driver policy the P.A claim is not payable. To this complainant agreed. As regards own damage,

Respondent pleaded that the accident was hit and run case and case is pending with Hon. Tribunal for Third Part

claim and claim can be settled after its verdict.

Since the Tribunal case is differently dealt for TP claim and Surveyor has assessed the loss of Rs.10,

000/- and award was given directing the Respondent to settle OD claim for Rs.10, 000/-.

________________________________________________________________


Case No.11-003-0050-09

Mrs.Minaxiben V.Jani Vs. National Insurance Co.Ltd.


Complainant’s Car was insured for comprehensive risk. The claim lodged for accidental damage was

considered as non standard basis.

The insured vehicle met with accident resulting into total loss. The Registration of insured vehicle had

expired before the date of accident and was not renewed as it was required under Motor Vehicle Act.

Surveyor’s report assessed loss for net amount of Rs.24, 250/-.

Respondent pleaded that as the registration of the vehicle was not renewed under MV act as on date of

accident the claim was settled on non-standard basis and since electrical accessories were not found those expenses

were disallowed to which complainant refused.

Though section 39 of MV act prevents driving in public place and there was first breach of law by insured, it

could have been liable for fine as per section 192 but Respondent does not get right/empowerment to repudiate

claims policy condition applicable in section 1 (OD liability) is not supporting about disallowing claim.

Thus award given directing Respondent to settle claim as agreed after transfer of vehicle.

________________________________________________________________


Case No.14-005-0041-09

Mr.Ashokkumar Datta Vs. Oriental Insurance Co. Ltd.


Claim under Motor O.D was lodged for damage due to accident which was not settled in the manner

required.

The claim for Rs.13, 620/- was submitted but was settled for Rs.9, 241/-.

The accident took place in Delhi when the vehicle was transferred from Ahmedabad. Though all the

formalities were completed such as NOC from RTO, Ahmedabad. Claim papers were lodged in Delhi, but the claim

was inordinately delayed by the Respondent for which Respondent was solely responsible.

Thus the complainant’s plea for claiming interest stands.

Award directing the Respondent to pay interest on total claim amount from the date of lodgment of claim till

date of settlement was given.

Thus, the case was disposed.

___________________________________________________________


Award dated 07-08-2008

Case No.11-011-0056-09

Mr.Kantibhai B.Solanki Vs. Bajaj Alliance Gen.Ins.Co.Ltd.

Motor Insurance Policy, Car damaged due to accident. The claim was repudiated on the

grounds that the material vehicle was not transferred to the owner.

The complainant pleaded that the car which was insured for comprehensive insurance

was transferred in his name on 30-12-2006 by RTO registration authority at Anand on 30-12-

2006 and accident occurred on 15-05-2007.

The Insurance policy covering the vehicle was with Mr.D.A.Dalal as insured when the

later had no insurable interest. The complainant had ownership without insurance.

Respondent pleaded that claim was lodged by Mr.D.A.Patel who had transferred the

vehicle had no insurable interest on date of accident as ownership was in the name of

Mr.K.B.Solanki- Complainant.

Claim was repudiated for non-compliance by complainant as per IMV act, which require

that transferee shall apply within 14 days from the date of transfer to the insured for making

required changes in Insurance certificate.

Thus complaint was dismissed.

______________________________________________________________________



Case No.11-005-0075-09

Mr.Jigar R.Shah Vs. Oriental Insurance Co. Ltd.

Motor Vehicle Policy. Complainant lodged the claim against theft of the vehicle and was

not settled by the Respondent.

During hearing, the Respondent informed that on the process through the claim was

delayed the office has settled the claim for Rs.55, 000/- as full and final claim and copy of

discharge voucher was submitted.

As the matter was resolved, the Respondent was directed to settle the claim within 15

days from the date of subrogation and letter of undertaking & TTO form. The case was thus

disposed.



Case No.11-014-0055-09

Mr.Satishbhai I. Kalwani Vs. Cholamandalam MS Gen.Ins. Co.Ltd.

Motor O.D. Claim. The complainant lodged claim against the accidental loss of the

insured vehicle and was repudiated on the ground that the subject vehicle at the material

time was used otherwise than accordance with “Limitations as to use”. The policy clearly

specifies the use of vehicle for hire and reward under the said “limitation as to use”. It was

confirmed from papers and hearing that subject vehicle used as a hired vehicle at the time

of accident violating the policy rules and conditions and entitles respondent to restrain from

liability. The record confirmed that driver who was friend of the complainant hired vehicle @

Rs.5/- per K.M and started journey with 9 passengers in vehicle and the case was dismissed

____________________________________________________________________.



Case No.11-009-0135-09

Mr.Kanayalal P. Pate Vs. Reliance General Ins. Co.Ltd.

A claim for Vehicle accident under Motor (O.D) was lodged by the complainant and was

repudiated by Respondent.

During hearing and on the basis of documents on record, it was confirmed that vehicle

was driven by niece of the complainant while learning and was bit accompanied by person

who had valid driving license as pillion. The ‘L’ sign board also was not attached.

The complainant confirmed the fact but he said he was on the said though not as pillion

rider.

The complaint was dismissed as there was no merit in the claim.

______________________________________________________________

END OF SYNOPSIS-APRIL’08 TO SEPT’08

(Sl.no.1) Bhopal Ombudsman Center - Insurance Ombudsman

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