Vehicle Insurance Policy

Vehicle Insurance Policy

Ahmedabad Ombudsman Centre Case No. 11-003-0365

Mr. L. A. Sardar Vs

National Insurance Co. Ltd. Award Dated : 3.10.2007

Repudiation of Claim under Motor OD Policy: The Complainant’s Motor Vehicle was stolen. The Respondent repudiated the Claim on encountering several anomalies during the process of claim settlement. The Complainant had deliberately misled the RTO by submitting forged sale letter and a non-existent insurance cover while registering the Vehicle. Thus suppression of material facts led to the Insurance Contract to become void ab-init io. No satisfactory reasons could be attr ibuted by the Complainant. As such, the decision of the Respondent to repudiate the Claim was upheld.


Mr. S N Bharwad Vs

Oriental Insurance Company Ltd. Award Dated: 13.11.2007

Repudiation of Claim under Motor OD Policy. The Insured Vehicle was an Eicher 10.90 FSD Truck with GVW 8800 kgs as per the RC Book. Hence as per the Motor Vehicles Act, the Insured Vehicle was classif ied as Medium Motor Vehicle. The Insurance was granted under Package Policy (Goods carrying Commercial Vehicles). The Vehicle met with an accident. Claim was repudiated since the Complainant had a driving licence authorised to drive Motor Cycle with Gear, Light Motor Vehicle, Transport Vehicle. The breach of the policy conditions regarding the Driver Clause being established, the decision of the Respondent to repudiate the Claim was upheld.


Ms. R R Keshwani Vs

New India Assurance Company Ltd. Award Dated : 27.11.2007 Repudiation of Claim under Motor OD Policy. The Insured vehicle was damaged in a f lood. The Respondent repudiated the Claim on the ground that the Complainant did not have insurable interest on the date of the accident. Papers on record showed that the Insured did not take care in the last 10 years to verify under whose name the vehicle was registered. Scrutiny was done only after the claim had arisen. The copies of the earlier policies issued showed that the said Motor OD Policy was issued in the name of Mr. R R Keshwani (corrected to Mr. R D Keshwani) in 1999 and for the first 5

years in the name of Mr. R R Keshwani and in 2004 to 2007 was the name changed to Ms. Rashmi R Keshwani. The Insurer could not offer any explanation as to how the name was changed and full No Claim Bonus allowed even when the name of the insured was changed. Thus it is clear that the Insurer had wrongly put the name of the insured person in the policy. Thus the fault l ies on the Insurer and not on the Complainant. As such, the Respondent was directed to settle the claim as assessed by the Surveyor.


Smt. N R Thakkar Vs

Life Insurance Corporation of India Award Dated : 10.12.2007 Repudiation of Claim under Life Insurance Policy: While proposing for Insurance, the Assured had not disclosed the fact of suffering from severe macrocytic anaemia and that he had been hospitalised for blood transfusion and that he had undergone several pathological investigations l ike Liver Function Tests, Blood Examination Reports etc only 4 months prior to f i l l ing up the proposal of insurance. The Respondent could produce papers to this effect. The assured died within 3 months of taking the Insurance Policy. Claim on death of the deceased Life Assured was repudiated by the Respondent. Since, the non-disclosure sniped Utmost Good Faith, which formed the cornerstone of Insurance Contract, the decision to repudiate the Claim was upheld.


Smt. R M Vyas Vs

Life Insurance Corporation of India Award Dated : 10.12.2007 Repudiation of Claim under Life Insurance Policy: While proposing for Insurance, the Assured had not disclosed the fact of his being on leave for 2 months on sick grounds for treatment of Acute Interior Wall Myocardial Infarction about 4½ years prior to proposing for insurance. The disease was critical enough for one who suffered not to ignore its mention. Non disclosure of the said disease precluded the Respondent to call for special medical examination. The assured died due to Heart Attack which again had a nexus with the disease not disclosed. Claim on death of the deceased Life Assured was repudiated by the Respondent. Since, the non-disclosure sniped Utmost Good Faith, which formed the cornerstone of Insurance Contract, the decision to repudiate the Claim was upheld.


Mr. P R Rawal Vs

Oriental Insurance Company Ltd. Award Dated : 13.12.2007 Repudiation of Claim under Motor OD Policy. The Claim was offered to be settled on a total loss basis subject to the owner to comply with formalities like submission of original registration book duly endorsed in the name of the Insurance Company etc.

The Complainant argued that the process of getting such entries recorded in the RC Book is cumbersome and costly. As such, it was agreed that a certif icate be obtained from the RTO Office confirming that in view of the extensive damage to the vehicle due to the accident, it is rendered unroadworthy and on the basis of such compliance, the Claim be settled.


Mr. S H Kandoliya Vs

Oriental Insurance Company Ltd. Award Dated : 26-12-2007 Repudiation of Claim under Motor OD Policy: The Claim for total loss was proposed to be settled for Rs. 25000/- on the basis of market value of the same type of make and year of manufacture of the stolen Motor Cycle. The Complainant demanded that he should be paid the full Insured Declared Value (IDV) of the Vehicle. As per GR 8 of Indian Motor Tariff, in case of theft, IDV wil l be considered for claim settlement without any depreciation. As such, it was decided to settle the claim on the basis of IDV of the Vehicle.


Mr. T V Antala Vs


Repudiation of Claim under Motor-OD Policy: The Complainant’s Motor Cycle was stolen while being parked in an open place. The Vehicle was parked ‘without lock’. The Claim was repudiated since it violated the condit ion that the Insured would take all reasonable care to safeguard the vehicle from loss. The crit ical document viz. FIR lodged with the City Police Station also noted the fact that the Vehicle was parked without lock. Since the ‘reasonable safeguard’ condition was not complied with, the decision of the Respondent to Repudiate the Claim was upheld.


Mr. B B Patel Vs

ICICI Lombard General Insurance Co. Ltd. Award Dated : 21.02.2008

Repudiation of claim under Motor OD Policy: The Complainant’s Car was stolen. Claim was repudiated cit ing that the Car was being used for Travel business for hire/reward and had violated the policy ‘condit ions as to use’. A closer look at the FIR lodged by the Complainant showed that besides business, he owned a TATA Indica Car. This has been interpreted by the Respondent as the TATA Indica Car is being used for business. The Respondent has no evidence to prove that the vehicle stolen was used for commercial purposes. As such, they were directed to pay the full claim.


Mr. D B Patel Vs


Repudiation of Motor Own Damage Claim. The Complainant’s Private Car had met with an accident. Claim was repudiated by stating that on investigation, it was found that the Car was being used for commercial purposes otherwise than in accordance with ‘Limitations as to use’ Clause of the Policy. The Milometer of the Car showed a Total Run of 119856 kms within 24 months. Average works to 166 kms per day suggesting that the Vehicle was used for the purpose of getting hired. As such, the Respondent’s decision to repudiate the Claim was upheld.


Dr. V Arya Vs

HDFC General Insurance Co. Ltd. Award Dated : 29.02.2008 Partial settlement of Claim under Motor OD Policy. The Insured Car met with an accident. Claim was lodged for Rs.38092/- while the Insurer settled the same for Rs.35299/- on advice of Surveyor. The Surveyor in his report has stated that the Garage owner had used locally made parts in the Vehicle. Hence he allowed charges as per the local quotations. In any case, Surveyors are independent authorit ies l icensed by IRDA, whose decision is usually not t inkered with while deciding the quantum of sett lement. As such, the decision of the Respondent was upheld with no further relief to the Complainant.


Mr. Y B Rahevar Vs

ICICI Lombard General Insurance Co. Ltd. Award Dated : 05.03.2008 Repudiation of claim under Motor OD Policy. The Insured demanded payment of interest for delay in settlement of the Claim, which was found to be admissible as per the IRDA (Protection of Policyholder’s Interests) Regulations 2002 and was awarded.


Mr. G V Rathod Vs

United India Insurance Co. Ltd. Award Dated : 14.03.2008 Repudiation of Claim under Motor-OD Policy: The Complainant’s Vehicle was stolen while being parked in the compound of the house. The Vehicle was parked ‘without lock’. The Claim was repudiated since it violated the condition that the Insured would take all reasonable care to safeguard the vehicle from loss. The crit ical document viz.

FIR lodged with the City Police Station also noted the fact that the Vehicle was parked without lock. Since the ‘reasonable safeguard’ condition was not complied with, the decision of the Respondent to Repudiate the Claim was upheld.


Mr. P J Kochar Vs

Bajaj Allianz General Insurance Co. Ltd. Award Dated : 14-3-2008 Repudiation of claim under Motor OD Policy: The Respondent produced a Transfer Form to show that the vehicle which suffered a total loss due to an accident was actually sold off to a third party about 4 months prior to the accident. However, the ownership was not changed both in the RTO Book and in the Policy Certif icate. Since, neither the Complainant nor the purchaser had Insurable Interest in the vehicle, the Claim was repudiated. During the course of hearing, the Complainant strongly refuted that he had signed the said Transfer Form to sell the vehicle. It was concluded that the instant case raises complicated questions of facts for which there is need for Admission/Denial of documents, summoning of Witnesses, examination and cross examination, Affidavits on oath etc for which the Forum is neither infrastructurally equipped nor geared to judiciously get into such a task. As such, the Complainant was advised to take recourse to any other Redressal Forum considered appropriate for resolution of the subject grievance.


Ms. S H Shah Vs

New India Assurance Co. Ltd. Award Dated : 24.03.2008 Repudiation of Mediclaim under Motor Vehicle Policy: The Insured was hospitalised for Angiography and for Coronary Artery Bypass Surgery. The Discharge Summary of the Hospital as also the Cashless request by the Hospital mentioned that the Insured was suffering from hypertension since 10 years. The policy had commenced only 5 years back. As such, the decision of the Respondent to repudiate the claim was upheld.


Mr. P V Rathod Vs

Oriental Insurance Co. Ltd. Award Dated : 31.03.2008 Repudiation of Claim under Motor OD Policy. The Claim was intimated after 63 days of the accident due to which the same was treated on a non-standard basis and 75% amount was paid after obtaining a discharge voucher from the Insured. It was neither alleged nor established that the Insured had used any fraudulent method to procure the discharge voucher. As such, it was considered in the fitness of things not to re-open the matter.

Bhubneshwar Ombudsman Centre

Case No. 14-005-0147 Mr. Satyabrata Tripathy

Vs Oriental Insurance Co. Ltd.

Award Dated : 04.10.2007 Insured Complainant insured his Tata Indica Taxi under commercial vehicle insurance policy of Oriental Insurance co. Ltd. During currency of policy vehicle met with an accident. Insurer’s appointed surveyor assessed the loss for an amount of Rs 87,000. Insured complainant replaced the parts as allowed by final surveyor and Re inspection surveyor has certif ied that parts have been replaced as directed by final surveyor. During verification of bil ls and cash memos it was found that parts were purchased from M/s Suman Sales Corporation did not exist as per investigation made by investigator. Moreover CST Number mentioned in that cash memo has not been issued by Commissioner Commercial Tax,West Bengal. Insurer repudiated the claim due to fake and fictit ious cash memos.

During Hearing insurer stated that the bil ls and cash memos submitted by insured are false. Complainant stated that he has purchased the parts from that shop.

Hon’ble Ombudsman directed the insurer to settle the claim by deducting 25% of claim amount as the insured has sustained the loss and repaired the vehicle with the replacement of parts as advised by final surveyor. Since the damaged occurred on 2003 and parts purchased in 2004 and enquiry made in 2007 the total repudiation of claim by insurer is not justif ied.

Bhubneshwar Ombudsman Centre Case No. 11-004-0188

Mr. Bikram Keshari Routray Vs

United India Insurance Co. Ltd. Award Dated : 22.10.2007

Insured Complainant insured his Santro Car bearing registration No: OR-02T-3884 under private car Insurance Policy of United India Insurance co. Ltd. During currency of policy due to fall of cocoanuts the vehicle got damaged. Insured complainant repaired the vehicle in M/s Utkal Hyundai, an authorised garage and submitted a bil l of Rs 13,640/. Insurer appointed surveyor slashed the labour charges of Rs 3145 as some amount of labour charges are not genuine. Insurer offered an amount of Rs 10495/ to the complainant as per survey report. Insured did not accept that amount and being dissatisfied with the quantum of settlement preferred this complaint.

During Hearing insurer stated that as per survey report they have settled the loss. Insured stated that he has repaired the vehicle in authorised garage and no parts have been replaced only labour charges have been paid by him why his claim wil l be trimmed.

Hon’ble Ombudsman directed the insurer to pay Rs 13,640/ to the insured as the assessment of surveyor based on surmise and without any basis.The surveyor ha not tendered any plausible reason for the deduction of that amount.

Bhubneshwar Ombudsman Centre Case No. 11-012-0339

Smt. Anusruta Singhdeo Vs

ICICI Lombard General Insurance Co. Ltd. Award Dated : 30.10.2007 Insured Complainant insured her Tavera Car bearing registration No: OR-02AD-6234 under private car Insurance Policy of ICICI Lombard General Insurance Co. Ltd. During currency of policy the vehicle met with an accident while it was returning from Puri to Bhubaneswar.Incident was reported to Pipili P.S. vide FIR No: 148 dated 16-6-2006. As per Final police report P.Ananda Rao Dora was the driver at the t ime of accident. Insurer repudiated the claim on the ground that as per substantiation and investigation the driver at the time of accident of the subject vehicle was different than the details of driver furnished by the insured. Insured being dissatisfied with the decision of insurer preferred this complaint. During Hearing insurer stated that they wil l settle the claim within 22-09-2007. Since the insurer did not sett le the claim nor apprised this forum regarding the constraints which prevented them to keep their commitment. Hon’ble Ombudsman directed the insurer to pay Rs 172920/ /immediately to the insured with 18% interest per annum from the date of claim til l date of payment as insurer signally failed to prove that driver at the time of accident was different as per their substantiation and investigation.

Bhubneshwar Ombudsman Centre Case No.11– 004-0215 Sri Pryadarshi Mishra

Vs United India Insurance Co. Ltd.

Award Dated : 5.11.2007 Insured Complainant insured his Tata Indica Car under private Car policy of United India Insurance Co. Ltd for a period of one year commencing from 21-03-2005 for an IDV of Rs 345,000/.. On 25-5-2005 insured vehicle met with an accident and sustained the damages. Insurer appointed surveyor assessed the loss for an amount of Rs 56,000/ against a bill of Rs 67,362/ . Insurer appointed Sri B. Patnaik for re inspection of the vehicle after repairing. The surveyor has stated that parts l ike assy- wheel rim and aasy,front eyebrow have not been replaced. Some of salvage parts have not been produced for verif ication. Insurer settled the loss for Rs. 53006/-. Insured accepted the amount but being dissatisfied with the quantum of settlement approached his forum.

Insurer f i led Self Contained Note stating that as per f inal survey report and re inspection survey report the claim has been settled for Rs 53006/..

During hearing Insurer stated that they have settled the claim as per f inal survey report and re inspection survey report. Insured complainant stated that he has repaired the vehicle in a authorised garage why the labour charges wil l be deducted. Honourable Ombudsman directed the insurer to pay addit ional amount of Rs 2192.75 / as the settlement made by surveyor is arbitrary.

Bhubneshwar Ombudsman Centre Case No.11– 005-0284 Mr. Gopabandhu Dani

Vs

Oriental Insurance Co. Ltd. Award Dated : 13.11.2007 Insured Complainant insured his Ambassador taxi under commercial vehicle policy of Oriental Insurance Co. Ltd for a period of one year commencing from 27-04-2004. On 12-12-2004 insured vehicle dashed against a tree and met with an accident . Insured complainant lodged acclaim for compensation of Rs 71,662/. Insurer repudiated the claim on the ground that driver Sri Ajambila Sahu did not have valid D/L at the time of accident. Being aggrieved the complainant approached this forum. Insurer f i led Self Contained Note stating that Ajambila Sahu having D/L No: 984/93 issued by RTA ,Bolangir was authorised to drive goods carrying vehicle not public service vehicle . The Said D/L did not have PSV badge too. RTA, Bolangir vide their letter dated 24-09-2005 categorically stated that Sri Sahu was authorised to drive Tractor, LMV and Heavy Goods Vehicle which is a transport vehicle. But to drive a Taxi i.e passenger carrying vehicle one should hold D/L authorised him to drive PSV with badge. During hearing Insurer stated that driver Ajambila was authorised to drive LMV but he was driving a taxi which is a PSV vehicle and D/L No: 954/93 did not have PSV badge endorsement. Driver did not have valid D/L to drive that taxi . Complainant stated that taxi being LMV type of vehicle driver had the valid D/L to drive LMV and HMV. Honourable Ombudsman directed the insurer to settle the claim as PSV badge does not provide any extra skil l to drive Passenger carrying vehicle except to observe certain duties at the time of accident.

Bhubneshwar Ombudsman Centre Case No.11– 002-0286 Dr. Kali Prasad Mishra

Vs The New India Assurance Co. Ltd.

Award Dated : 13.11.2007 Insured Complainant insured his Santro Car under private Car policy of New India Assurance Co. Ltd for a period of one year commencing from 23-03-2005 for an IDV of Rs 349905/.. On the same day i.e 30-03-2005 while the vehicle was driven by driver to deliver the vehicle at the residence of insured complainant the vehicle met with an accident. Insurer appointed surveyor assessed the loss for an amount of Rs 129325/ against a bill of Rs 219928/ of OSL Hyundai Motors which is the authorised repairer of the vehicle. Insurer settled the claim for an amount of Rs 119,000/ and paid to the garage. Insured accepted the amount but being dissatisfied with the quantum of sett lement approached his forum.

Insurer fi led Self Contained Note stating that as per f inal survey report the claim has been settled for Rs 119,000/ .

During hearing Insurer stated that they have settled the claim as per f inal survey report. Insured complainant stated that it was a brand new car and repaired in a authorised garage how his claim wil l be assessed for such an amount.

Honourable Ombudsman directed the insurer to pay addit ional amount of Rs 53,755/ as the settlement made by surveyor is arbitrary .

Bhubneshwar Ombudsman Centre Case No.11– 002-0295

Sri. Pitabas Pradhan Vs

New India Assurance Co. Ltd. Award Dated : 14.11.2007 Insured Complainant insured his Tata truck bearing Registration No.OR 06 0393 under commercial Vehicle B policy of New India Assurance Co. Ltd. On 16.04.2004 at about 10.30PM while driver Nakul Sahu parked the insured vehicle near Manguli Chhak and went for his dinner some miscreants fled away with that vehicle. Incident was reported to Tangi P.S vide F.I.R No. 55 dated 16.04.2004. Police authorities submitted FRT No Clue. Insured lodged a claim of Rs. 300000.00 towards compensation. Insurer repudiated the claim on the ground that driver did not take reasonable care to safeguard the vehicle and driver did not have valid driving licence. Being aggrieved the complainant approached this forum. In self-contained note Insurer stated that as per report of Investigator Sri. S. K. Sahu the vehicle was properly locked as per the statement of insured owner and other witnesses. Whereas the statement recorded by police authorit ies of driver Nakul Sahu U/S 161 CrPC the vehicle was not locked and key was inside the vehicle at the material time of theft. On verification of D/L No. 1362/82 issued by L.A. Jhansi, Insurer’s Jhansi Divisional Office reported that no such D/L has been issued by Jhansi L.A. During hearing Insurer faled to produce any documentary evidence from L.A. Jhansi regarding the fakeness of the D/L. Insured stated that the vehicle was properly locked and driver went for his dinner. When he returned he found the vehicle has been stolen by the miscreants. Honourable Ombudsman upheld the decision of the Insurer as the driver himself has stated that he did not lock the vehicle before he left it on the road side which has been recorded by the police authorit ies. It has been clearly established that the driver being the representative of the insured did not take reasonable care to safeguard the vehicle.


Mr. Rajesh Ray Vs

National Insurance Co. Ltd. Award Dated : 22.11.2007 Insured Complainant insured his Tata Truck under Goods Carrying Commercial Vehicle policy B package of National Insurance Co. Ltd. On 25-12-2004 insured vehicle met with accident due to sudden break down of Front Right Main Spring Leaf of that vehicle. Insurer appointed surveyor assessed the loss for an amount of Rs 83,000/ against an estimate of Rs 162,120/ . At the time of accident Sri S. Kisan was driving the vehicle. During verification of D/L of Sri Kisan it has been established that D/l No: 3045/R/93 has been renewd by RTO, Sambalpur against original D/L No: 8167/GHT/88 issued by DTO, Guwahati. On verif ication of D/L No: 8167/GHT/ 88 DTO, Guwahati stated that they have not issued such l icence from their end. Insurer repudiated the claim on the ground of fake D/L possessed by driver at the time of accident Being aggrieved the complainant approached this forum. Insurer has fi led Self Contained Note stating that original D/L No: 8167/GHT/88 issued by DTO, Guwahati found to be fake and claim stands repudiated due to such fake D/L.

During hearing Insurer reiterated their stand taken in self contained note and exhibited the letter written by DTO, Kamrup, Guwahati regarding non issuance of such licence by them Complainant stated that D/L of Sri Kisan has been renewed by RTO Sambalpur since 1993 and driver had possessed the valid D/L at the time of accident. Honourable Ombudsman uphold the repudiation as the D/L possessed by driver found to be fake and insured complainant fai led to prove that accident was due to mechanical defect and driver had no role to play in that accident.

Bhubneshwar Ombudsman Centre Case No.11– 003-0184 Sri Tusharkant Patnaik

Vs National Insurance Co. Ltd.

Award Dated : 12.12.2007 Insured Complainant insured his Tata Indica Taxi under passenger carrying commercial vehicle policy of National Insurance Co. Ltd for a period of one year commencing from 20-10-2003 for an IDV of Rs 329983/.. On 26-01-2004 insured vehicle met with an accident and sustained the damages and insured got injured. Insurer appointed surveyor assessed the loss for an amount of Rs 275,000/ on net of salvage basis against an estimate of Rs 627,709/ . As per claim form Sk Issac Khan was driving the vehicle at the time of accident. Police authorit ies have seized the D/L of Sk. Issac Khan. Insurer appointed Sri S. Mishra for investigation of the incident. As per investigator’s report insured Sri Tushar Patnaik was driving the vehicle at the time of accident but he did not have valid D/L to drive that taxi but managed Sk. Issac Khan to claim as driver at the time of accident. Investigator obtained the statement from vil lagers that insured was driving the vehicle at the time of accident. On the strength of investigator’s report insurer repudiated the claim. Being aggrieved insured fi led this complaint. Insurer f i led Self Contained Note stating that as per investigator’s report insured was driving the vehicle at the time of accident and he had no valid D/L to drive that taxi.Insured managed Sk. Issac Khan to claim as driver. During hearing Insurer re iterated their stand taken in self contained note. Insured complainant stated that vehicle was driven by Sk. IssacKhan and police has seized his l icence. Police f inal report is abundantly clear regarding this. He has received the injury during that accident. Sk. Issac Khan has given his statement to the investigator that he was driving the vehicle at the time of accident. Honourable Ombudsman directed the insurer to pay Rs 275,00/ to the complainant net of salvage basis as the police report has clearly stated Sk .Issac Khan was driving the vehicle at the time of accident.


Smt. Sujata Kalia Vs

National Insurance Co. Ltd. Award Dated : 15.01.2008 Insured Complainant insured her dumper OR-14M-1981 under Goods carrying Commercial policy of National Insurance Co. Ltd for a period of one year commencing

from 31-10-2006. Insured vehicle met with an accident on 31-01-2007 and sustained the damages. Insured lodged a claim for compensation of Rs 89195/. Insurer repudiated the claim on the ground that driver Lehru Lal did not have valid D/L to drive this Heavy motor vehicle. Insured complainant being aggrieved of the decision of insurer approached this forum. Insurer f i led Self Contained Note stating that Lehru Lal was driver at the time of accident. D/L No: 504/1983-84 was issued by RTA, Sundargarh to Sri Lal to drive LMV non professional. On 22-09-1983 and subsequently he was authorised to drive LMV (transport) and Heavy Motor vehicle by L.A. Sambalpur wef 24-04-1992. On verification by insurer L.A.,Sambalpur has stated that no such endorsement was issued in favour of Sri Lal. Since driver did not have valid D/L to drive that vehicle the claim has been repudiated. During hearing Insurer re iterated their stand taken in SCN. Insured complainant stated that D/L of Sri Lal has been renewed by RTO, Sundargarh since 1992 and driver possessed the valid D/L to drive that vehicle.

Honourable Ombudsman uphold the repudiation as the insured complainant failed to prove with material evidence that driver Sri Lehru Lal had valid D/L to drive that heavy goods vehicle.


Sri Bimal Prasad Mohanty Vs


Insured Complainant insured his Hero Honda motor Cycle bearing registration No: OR-05M-22557 under Motor Cycle policy of National Insurance Co. Ltd for a period of one year for an IDV of Rs. 21500/-. Insured vehiclewasw stolen on 22-04-2006 while it was parked near Kalimandir ,Cuttack. Incident was reported to police on 23-04-2003 at 1P.M..

Insured lodged a claim for compensation of Rs 21,500/. Insurer settled the claim for an amount of Rs 14181/ on non standard basis by deducting 30/% of claim amount as the incident was not reported to police immediately insured had not taken corrective measures warranted under circumstances.

Insured complainant being aggrieved of the decision of insurer approached this forum.

Insurer f i led Self Contained Note stating that incident was reported after one day of occurrence violating policy conditions and matter was reported to insurer after two days of theft of vehicle.

During hearing Insurer re iterated their stand taken in SCN.

Insured complainant stated that when he went to police on 22-04-2006 police authorit ies advised him to wait for a night then lodged FIR. Accordingly he has lodged FIR on 23-04-2006. Police submitted Final report and arrested accused who had sold vehicle some where. Moreover he has submitted affidavit regarding loss of a key.

Honourable Ombudsman directed insurer to pay Rs 21450/ as the reason tendered by insured is convinced one.

Bhubneshwar Ombudsman Centre Case No.11-003-0237 Sri Panchanan Sethi


Award Dated : 22.01.2008 Insured Complainant insured his Tata Indica Car bearing registration No: OR-19-8099 under passenger carrying commercial vehicle policy of National Insurance Co. Ltd for a period of one year . Insured vehicle met with an accident on 19-10-2003. Insured lodged a claim for compensation . Insurer repudiated the claim on the ground that vehicle was registered as taxi but insured under private car policy. Insured complainant being aggrieved of the decision of insurer approached this forum. Insurer f i led Self Contained Note stating that vehicle was insured under private car policy but registered under taxi which violates the condition of the policy as regards to the use of vehicle.On verif ication of R.C. Book it was found vehicle was registered as taxi. Insured suppressed the material facts for paying less premium under the policy. During hearing Insurer re iterated their stand taken in SCN. Insured complainant stated that he was not aware of the facts and subsequently intimated the insurer foe change of use of vehicle to insurer. Honourable Ombudsman uphold the repudiation as the vehicle was used as taxi at the time of accident which violates the policy condit ion.

Bhubneshwar Ombudsman Centre Case No.14-005-0255 Sri Rajeswar Thakur

Vs Oriental Insurance Co. Ltd.

Award Dated : 25.01.2008 Insured Complainant insured his Hitachi Excavator (EX-70) under Motor Miscellaneous vehicle policy of Oriental Insurance Co. Ltd for a period of one year commencing from 3-6-2004 . Insured vehicle caught fire while it was in parking condition on 8-6-2004 11 P.M. .Insured complainant lodged a claim with the insurer . Incident was reported to police on 9-6-2004. Insured complainant informed the incident to Fire Brigade Authorities . Insurer appointed Sri S.K. Neura for spot survey and Sri K.K. Sharma for f inal assessment. Sri Sharma has assessed the loss for Rs 10,00,000/ on net of salvage basis and Rs 1390,861/ on repairing basis. Again insurer appointed Sri S.C. Senapati for investigation . Sri Senapati has opined that insured vehicle might have caught f ire before the taking insurance coverage granted by insurer. Insurer repudiated the claim on the strength of investigators report. Insured complainant being aggrieved of the decision of insurer approached this forum. Insurer fi led Self Contained Note stating that the cause of loss and genuineness of reported time and date of loss has not been proved beyond reasonable doubt. During hearing Insurer re iterated their stand taken in SCN. Insured complainant stated that he has insured his vehicle with insurer on 3-6-2004 but caught fire on 8-6-2004. Insurer has appointed their surveyor to assessed the loss but denied the claim without any basis.

Honourable Ombudsman directed the insurer to pay Rs 10,00,000/ as assessed by surveyor as the investigation report of Sri Senapaty does not have any concrete evidence that vehicle was damaged before insurance was granted.


Sri Mohan Sahoo Vs

New India Assurance Co. Ltd. Award Dated : 28.01.2008

Insured Complainant insured a Truck bearing registration No: OR-14D-2698 under Goods carrying Commercial policy of New India Assurance Co. Ltd for a period of one year . Insured vehicle met with an accident on 28-04-2003 and sustained the damages.

Insured lodged a claim for compensation of Rs 167,100/. Insurer repudiated the claim on the ground that driver did not have valid D/L at the time of accident .


Insurer f i led Self Contained Note stating that driver Sri Krishna Rai did not have valid D/L at the time of accident. As per their investigator D/L No: 460/85 is not effective on the date of accident.

During hearing Insurer re iterated their stand taken in SCN.

Insured complainant stated that initially D/L No: 460/85 was issued by RTO, Durgapur in favour of Sri Krishnma Rai which was renewed by DTO, Patna from 6-7-2000 to 5-7-20003. As the accident took place on 28-04-2003 the D/L renewed by DTO, Patna is very much effective. Insured complainant submitted the original D/L of Sri Krishna Rai before this forum for perusal.

On perusal of said D/L it has been clearly stated the D/L No: 460/85 has been renewed by DTO, Patna from 6-7-2000 to 5-7-20003.

Honourable Ombudsman directed insurer to pay Rs 40,100/ as assessed by surveyor as repudiation does not have any merit .


Sri M.K. Agarwal Vs

National Insurance Co. Ltd. Award Dated : 28.01.2008 Insured Complainant insured Chevrolet Tavera bearing engine No: 3LD O8201 and Chasis No: MA6AB6C ion No: OR-06D-7102 under passenger carrying commercial vehicle policy of National Insurance Co. Ltd for a period of one year for an IDV of Rs 630800/. . Insured vehicle met with an accident on 11-02-2005. Insured lodged a claim for compensation . Insurer repudiated the claim on the ground that vehicle was allowed to plying on the public road without registration and vehicle was registered under private car but insured under commercial vehicle policy. Insured complainant being aggrieved of the decision of insurer approached this forum.

Insurer f i led Self Contained Note stating that vehicle was insured under commercial vehicle policy. It was registered under private car policy after the five months of the accident. Moreover vehicle was plying on the public road without registration . During hearing Insurer re iterated their stand taken in SCN. Insured complainant submitted a temporary registration certif icate where it has been clearly stated M/s Shivalik Motors Ltd ( Mukesh Kumar Agarwal)is the owner of vehicle. It was valid t i l l 3-3-2005 and that document was signed on 4-2-2005. Accident took place on 11-02-2005. From that document it is crystal clear M/s- Shivalik Motors Ltd is the owner but they are not complainant. But registration book reveals complainant was the owner of vehicle. At the time of issuance of registration no temporary registration was produced. Complainant failed to give any plausible reason regarding the ownership and registration of vehicle. Honourable Ombudsman dismissed the complaint as insured complainant was not the owner of vehicle at the time of accident.


Sri N.N.C. Behera Vs

United India Insurance Co. Ltd. Award Dated : 29.01.08 Insured Complainant insured his Matiz Car bearing registration No: OR-06D-7102 under Private Car policy of United India Insurance Co. Ltd for a period of one year for an IDV of Rs 200,000/. . Insured vehicle met with an accident on 14-11-2004 . Insured lodged a claim for compensation of Rs 43,739.93. Insurer settled the claim for an amount of Rs 13,928/ as per the survey report . The said surveyor has not considered some of the bills as it was found top be fake. Insured complainant did not accept that amount as he had paid Rs 43739.93 Insured complainant being aggrieved of the decision of insurer approached this forum. Insurer f i led Self Contained Note stating that vehicle was repaired in M/s –Deepa Automobiles . The surveyor has assessed the loss for Rs 13,928/. The said surveyor has verif ied the bil ls from that garage who has given in writ ing that some of the bil ls has not been issued by them though accident vehicle was repaired in that garage. During hearing Insurer re iterated their stand taken in SCN. Insured complainant stated that bil ls submitted by him were issued by M/s Deepa Automobiles. Honourable Ombudsman dismissed the complaint as insured complainant signally failed to give any satisfied reply and the amount settled by insurer is just and proper.

Bhubneshwar Ombudsman Centre CaseNo.11-004-0202

Sri Rakesh Sinha Vs


Insured Complainant insured his Maruti car with United India Insurance Co. Ltd under private car comprehensive policy for a period of one year commencing from 17-08-2004.Insured vehicle met with an accident on 4-4-2005. Insured complainant lodged a

claim for an amount of Rs 40,395/. Insurer repudiated the claim on the ground that driver did not have valid D/L at the time of accident.. Insured complainant being aggrieved of the decision of insurer approached this forum. Insurer f i led the Self Contained Note stating that driver K. Chanda Rao was authorised to drive transport vehicle for the period 22-10-1999 to 18-07-2004. That l icence has been renewed from 7-7-2005 to6-7-2008 . But same was not renewed from 19-07-2004 to 6-7-2005. As the accident took place on 4-4-2005 the driver did not have valid D/L at the time of accident . During hearing Insurer’s representative stated that driver did not have valid D/L at the time of accident.. Insurer submitted a certif ied copy from RTO, Bhubaneswar that D/L No: 3864 has not been renewed for the period 19-07-2004 to 6-7-2005.

Insured complainant stated that driver had valid D/L.

Honourable Ombudsman uphold the repudiation as the driver did not have valid D/L at the time of accident.

Bhubneshwar Ombudsman Centre Case No.14-005-0138

Smt. Tilatoma Samantaray Vs

Oriental Insurance Co. Ltd. Award Dated : 12.03.2008

Insured Complainant insured her Bajaj Auto Rickshaw with Oriental Insurance Co. Ltd under commercial vehicle comprehensive policy for a period of one year commencing from 19-09-2003. .Insured vehicle met with an accident on 23-10-2003 while it was driven by Sri Ajay Kumar Behera having D/L No: 3428 dated 6-5-1989 issued by RTo, Bhubaneswar . Insured lodged a claim for an amount of Rs 40,000/.. Insurer repudiated the claim on the ground that driver did not have valid D/L at the time of accident..


Insurer f i led the Self Contained Note stating that driver Ajay Kumar Behera was driving the vehicle at the time of accident . D/L No: 3428 dated 6-5-1989 expired on 2-4-2003 where as the accident took place on 23-10-2003. Driver did not have valid D/L at the time of accident.

During hearing Insurer’s representative stated that driver did not have valid D/L at the time of accident..

Insured complainant exhibited the original D/L No: 3428 dated 6-5-1989 issued by RTO .Bhubaneswar stated that driver is authorised to drive Transport vehicle 9HGV) upto 2-4-2003 with effect from 4-4-2000.

Honourable Ombudsman uphold the repudiation as the driver did not have valid D/L at the time of accident.


Sri Dhiresh Kumar Mohanty Vs


Insured Complainant insured his Ashok Leyland Bus with Oriental Insurance Co. Ltd under commercial vehicle comprehensive policy for a period of one year commencing from 18-03-2001. .Insured vehicle met with an accident on 1-9-2001 . Insured complainant lodged a claim for an amount of Rs 466,365/ . Insurer appointed surveyor has assessed the loss for an amount of Rs 60,762/. Insurer settled the claim for an amount of 57,000/. Insured complainant being aggrieved of the decision of insurer approached this forum. Insurer f i led the Self Contained Note stating that as per survey report the claim has been settled for Rs 57,000/. During hearing complainant stated that bus was completely damaged and he spent Rs 239,214 / towards repairing of vehicle but insurer offered him only Rs 57,000/. Insurer representative re iterated their stand taken in self contained note. Hon’ble Ombudsman directed the insurer to pay Rs 86,500/ to the complainant as the surveyor has drastically slashed the labour charges without any rhyme and reason and did not allow the replacement cost of battery though it has been damaged.


Smt. Jyotsnamayee Mohapatra Vs

New India Assurance Co. Ltd. Award Dated : 14.03.2008 Insured Complainant insured her Tata Indica Taxi under passenger Carrying Commercial Vehicle Policy with New India Assurance Co. Ltd. for a period of one year commencing from 23-03-2004. During currency of the policy while the insured vehicle was parked in front of marine department of Paradeep Port Trust during night t ime some unknown vehicle dashed the parking vehicle and caused damaged to it. Incident was reported to Paradeep P.S. and insured lodged a claim for Rs 25603/. Insurer appointed surveyor has assessed the loss for Rs. 14692/. Insurer repudiated the claim as the driver did not have valid D/L at the time of accident. Being aggrieved the insured complainant approached this forum. Insurer fi led self-contained note stating that as per claim form Sri Niranjan Das was driver at the time of accident and during verif ication it has been observed D/L No: 204/98-99 was issued in favour of Sri Laxmi Narayan Mohanty. Hence the claim has been repudiated due to fake D/L. During hearing Insurer reiterated their stand taken in the self-contained note whereas the insured stated that since the vehicle was in parking condition D/L has no bearing causing the accident. Hon’ble Ombudsman directed the insurer to pay Rs 14692/ to the complainant as the Insurer fai led to prove that accident took place due to negligence of driver and D/L has no bearing on loss.


Niranjan Mishra Vs

New India Assurance Co. Ltd.

Award Dated : 26.03.2008 Insured Complainant insured his Tata truck under Goods Carrying Commercial Vehicle Policy with New India Assurance Co. Ltd. for a period of one year commencing from 18.12.2003. During currency of the policy the vehicle met with an accident. As per the claim form submitted by the insured, Sri. Niranjan Mohapatra having D/L No. 80/73 issued by L.A. Cuttack was driving the vehicle. Insurer appointed surveyor who assessed the loss for an amount of Rs. 63000.00. Insurer repudiated the claim on the ground that the driver had a fake driving l icence. Being aggrieved the insured complainant approached this forum. Insurer fi led self-contained note stating that as per the affidavit submitted by their advocate Mrs. Madhuri Badani the original D/L No. 9783/66 has not been issued by D.T.O Jamshedpur which was subsequently renewed by L.A. Cuttack vide D/L No. 80/73. Hence the claim has been repudiated due to fake D/L.

During hearing Insurer reiterated their stand taken in the self-contained note whereas the insured stated that driver had valid driving l icence at the time of accident. During hearing insurer was directed to submit documentary evidence from D.T.O Jamshedpur regarding fakeness of D/L No. 9783/66.

Hon’ble Ombudsman directed the insurer to pay Rs 63,000/ to the complainant as the Insurer fai led to submit any documentary evidence from D.T.O Jamshedpur regarding fake-ness of D/L No. 9783/66.

Chandigarh Ombudsman Centre Case No. : GIC/220/ICICI/14/08

Sawinder Kumar Joshi Vs

ICICI Lombard Award Dated : 4.10.07

FACTS : Shri Sawinder Kumar Joshi got his vehicle bearing no. PB-02-AQ-7196 insured from the insurer. The vehicle met with an accident on 11.3.07. It was taken to Dada Motors, Jalandhar on 12.3.07 and was duly surveyed by the surveyor the same day. The vehicle was repaired by paying Rs. 55,043/-. When the claim was lodged with the insurer, the same was repudiated on the ground that the vehicle was being used for commercial purposes.

FINDINGS : The insurer informed that the vehicle was being used for commercial purposes as is evident from the fact that mileage covered by the vehicle is in excess of 84,000 Km over a period of 15 months which works out to above 5000 Km per month. This does not appear to be the average running of a vehicle for domestic use. Moreover, there was no FIR, DDR or spot survey. Hence the claim was repudiated on the plea that the vehicle was being used for commercial purposes.

DECISION : Held that there is substance in the contention of the insurer that the vehicle was exceeding the usual mileage. Hence their view that the vehicle was being used for commercial purposes has some weight because circumstantial evidence points towards that. The claim was not payable and repudiation of the claim by the insurer was in order. The complaint was dismissed.


Kashmiri Lal

Vs ICICI Lombard

Award Dated : 4.10.07

FACTS : Shri Kashmiri Lal got his vehicle bearing no. HP12 B –1371 insured from the insurer after paying Rs. 12,845/- as premium. Since the vehicle was insured for the last 3 years NCB benefit was also availed. The vehicle met with an accident on 29.6.07. The insurer was informed and he was advised to shift the vehicle to M/s Apex Motors for cashless settlement. FIR and spot survey was got done and the claim was preferred with the insurer. However, the same was repudiated on the plea that the vehicle was being used for commercial purposes. He contended that at the time of accident his family members were traveling in the vehicle.

FINDINGS : The insurer informed that the driving l icence had not be been verif ied and the vehicle mileage appeared to be on the higher side. The complainant produced original driving l icence of Shri Jaipal Singh which was found in order. The complainant clarif ied that since it was a joint vehicle for all members of the family and they were using from time to t ime for outstation duties, the mileage was high.

DECISION : Held that the repudiation of the claim by the insurer on the ground of vehicle being used for commercial purposes was not in order. The claim was payable. Hence ordered that the admissible amount of claim should be paid by the insurer to the complainant.


Mehar Singh Chopra Vs

ICICI Lombard Award Dated : 9.10.07

FACTS : Shri Mehar Singh Chopra got his Tata Indica bearing no. HR-11B-6310 insured from the insurer for the period 29.8.06 to 28.8.07. The vehicle met with an accident in Feb’07. The claim lodged with the insurer was repudiated on the ground that the CNG kit was installed in the vehicle. He also stated that CNG kit had been registered in the RC and the insurer had been informed accordingly.

FINDINGS : The insurer informed that entry in insurance endorsement was LPG while in RC it was CNG. On a query as to whether the complainant was responsible for wrong entry in the insurance document, the insurer could not give a satisfactory reply.

DECISION : Held that the repudiation of the claim on the basis of CNG installation in the car was not in order, as it had no nexus with the cause of the accident. The claim was payable. Hence ordered that the admissible amount of claim should be paid by the insurer to the complainant.

Chandigarh Ombudsman Centre Case No. : GIC/239/OIC/14/08

Ajeet Singh Vs


FACTS : Shri Ajit Singh got his Tata Indica bearing no. CH-02-1449 insured for the period 23.6.06 to 22.6.07 for sum insured of Rs. 2,30,000/-. The vehicle met with an accident on 15.5.07. The insurer was intimated and spot survey was done. The final survey was also done. But the claim had not been settled so far.

FINDINGS : The insurer informed that the surveyor had assessed the loss at Rs. 1,37,062/-. This was on the assumption that body shell was repairable. However, the complainant wanted the body shell to be replaced. On a query, why the body shell needed to be replaced, the complainant produced a letter from the workshop in which it was stated that due to internal damages, proper alignment after repair of the body shell may not be plausible.

DECISION : Held that the vehicle should be surveyed afresh based on replacement of the body shell. If the assessed amount works out to be more than 75% of IDV, the claim should be settled on total loss basis after deducting salvage value. Otherwise on repair or any other mode agreeable to both the parties.

Chandigarh Ombudsman Centre Case No. : GIC/191/NIC/11/08

Arvinder Singh Vs


FACTS : Shri Arvinder Singh purchased a new Fiat Sienna car on 16.7.01 and got it insured from DO-III Chandigarh for the period 13.07.01 to 12.07.02 for sum insured of Rs. 6,12,000/-. The vehicle was stolen during the night of 12.7.02. An investigator was appointed and all formalities relating to settlement of the claim were completed including transfer of RC in the name of the insurer. However, the claim had been repudiated.

FINDINGS : The insurer informed that the theft took place on 13.7.02 as per FIR submitted by the complainant. The vehicle was insured from 13.07.01 to 12.07.02. Thus on 13.7.02 there was no insurance cover on the vehicle. On a query as to how the insurance cover could be given from 13.07.01 when the vehicle was purchased on 16.7.01, the insurer stated that part payment for the vehicle was made on 13.7.01 and payment for insurance premium was also made on 13.7.01. Hence cover note was valid from 13.7.01 to 12.7.02. On a query whether any documentary evidence was available to prove that vehicle was transferred in the name of the complainant on 13.7.01, the insurer replied in the negative.

DECISION : Held that part payment was made on 13.7.01, the actual delivery of the vehicle and transfer of deed was done on 16.7.01. Hence insurance cover should have appropriately been from 16.7.01 to 15.7.02. Moreover the theft took place on 12/13.7.02. Hence it could have been before the midnight of 12.7.02. Giving the benefit of doubt to the complainant regarding the timing of theft and the commencement of insurance cover from 16.7.01, ordered that 75% of assessed survey report of Rs. 3.25 lakhs should be paid by the insurer to the complainant.

Chandigarh Ombudsman Centre Case No. : GIC/265/UII/14/08

Sanjay Jain Vs


FACTS : Dr. Sanjay Jain got his vehicle bearing no. HR 06H-7976 insured from DO Panipat. The vehicle met with an accident on 12.2.06. The surveyor was deputed by the insurer and all formalities were completed when the claim was lodged with the insurer. However, the claim had not been settled by the insurer so far. Only a letter was received from the insurer that driving l icence of the driver Shri Vikram was not in order as he was under age at the time of issue of l icence on 3.8.04 by over four months. FINDINGS : The insurer informed that the driving l icence at the time of making the l icence, showed the age of driver as 17 years 7 months and 7 days. Hence the driver was under age at the time of making of the l icence. Hence the l icence was being verified. DECISION : Held that delay in settlement of the claim on the basis of wrong driving l icence was not in order. The insurer should have informed the complainant on the very f irst day that driving licence was not in order. Moreover, the fault in issuing an incorrect driving l icence was that of the Licensing Authority and not of the complainant. Even if the driver was under age in 2004, he had crossed the age of 18 years which was eligible age for driving the vehicle at the time of accident in Feb’06. Hence driving l icence should be accepted as valid on the date of accident and the claim should be paid by the insurer to the complainant.


Jagir Singh Vs

United India Insurance Co. Ltd. Award Dated : 17.10.07 FACTS : Shri Jagir Singh got his Tata Qualis bearing no. PB 10AV 5890 insured from DO Ludhiana for sum insured of Rs. 5 lakhs. The vehicle was stolen on 19.12.05 and FIR no 183 dated 21.12.05 was lodged the Police Station. However, they settled the claim for Rs.3,49,000/- and not the IDV of Rs. 5.00 lakhs. He contended that he had been paying premium on the basis of IDV of Rs.5.00 lakhs. He wanted the claim to be settled for Rs.5.00 lakhs. FINDINGS : The insurer informed that the surveyor had assessed the loan at Rs.3.49 lakhs and hence this amount was offered. On a query, whether the IDV of Rs.5.00 lakhs was fixed as per Motor Tariff rules, the insurer stated that IDV had been wrongly f ixed for Rs.5.00 lakhs. The IDV was reworked out to 60% of Rs. 6,78,555/-. This worked out to Rs.4,07,133/-. DECISION : Held that on the principle that public should not suffer for the mistake of an individual, the correct IDV as per rules was payable. Hence, ordered that Rs.4,07,133/- after deducting excess clause of Rs.1,000/- was payable to the complainant by the insurer alongwith refund of excess premium taken by them.


Krishna Devi Vs

ICICI Lombard

Award Dated : 18.10.07 FACTS : Smt. Krishna Devi purchased a Tata Indica car bearing no. HR 03 D1536 in July’06 in her own name. The RC was transferred in her name but the insurance remained in the name of Shri Rajesh K Grover, the seller. The papers for transfer of RC in her name were completed on 6.4.07. The vehicle met with an accident on 9.5.07. The company could not be informed in the interim period and the complainant’s name could not be incorporated in the insurance policy. The claim lodged by her was repudiated on the ground of not having any insurable interest. FINDINGS : The insurer informed that the vehicle was sold by Shri Rajesh K Grover to the complainant and the RC was accordingly transferred on 6.4.07. However, the insurance policy had not been transferred and it was sti l l in the name of Shri Rajesh K Grover. Thus on the date of accident neither Shri Rajesh K Grover nor the complainant had any insurable interest. Therefore, the claim was repudiated. DECISION : The Hon’ble High Court in the case of National Insurance Co. Ltd. Vs Purshotamdas Maheshwari & Others, (Misc. Appeal No. 195 of 1980 decided on 5.12.1985) held that insurer was not l iable as the contract of insurance between the insurer and the transferor came to an end when the vehicle was transferred without the prior consent or permission of the insurer and there was no contract of insurance between the insurer and the transferee. Similar judgement had been passed by Hon’ble High Court of Madras in the case of New India Assurance Co. Ltd. Vs Parvathy Ammal & Others (AAO No. 537) decided on 15.10.1987. In view of the judgements the claim was not payable and the repudiation of the claim by the insurer was in order. The case was closed.


Varinder Singh Gandhi Vs

United India Insurance Co. Ltd. Award Dated : 18.10.07 FACTS : Shri Varinder Singh Gandhi had taken a Motor Policy for his Santro car bearing no. PB-10BD-6373 from 14.6.06 to 13.6.07. The car met with an accident on 13.11.06. There was a death of a person and settlement had been made with members of the family. An amount of Rs. 86,000/- was spent on repairs. The claim lodged with the insurer had not been settled so far. FINDINGS : The insurer informed that neither the FIR, DDR, spot survey nor PMR of the victim who died as a result of the accident was available. In the absence of any of these documents it was not possible to settle the claim, as third party claim can be lodged against the insurer at any time. DECISION : Held that since it was a case of accidental death it was imperative to report the matter to the police authorit ies rather than settl ing the case mutually and closing the case. Because of absence of FIR and any other document it would not be possible for the insurer to settle the claim. The claim was not payable. The complaint was dismissed.


Jagdish Bundela Vs

National Insurance Co. Ltd.

Award Dated : 18.10.07 FACTS : Shri Jagdish Bundela got his vehicle bearing no. HR-39A-2257 insured with DO Rohtak. He renewed the policy with New India Assurance Co. Ltd. The policy was renewed with insurer viz. NIC, Rohtak. The insurer, NIC Rohtak had informed that he was eligible for zero percent NCB, whereas he was eligible for 20%. His claim was pending with NIA due to NCB confirmation. FINDINGS : The insurer informed that there was third party claim with MACT in respect of this vehicle when it was insured with them. Accordingly, the NCB was shown zero percent as per the software programme. On a query whether third party claim is l inked with NCB, the insurer replied in the negative. On a query whether in the undertaking given by the insured the claim should be for OD or third party, the insurer replied that this was not clear and matter stands referred to their higher off ice for clarif ication. As per Motor Tariff Rules for forfeiture of claims under Section-I are normally l inked with OD claims. The declaration to be given by the insured reads “ I/We declare that the rate of NCB claimed by me/us is correct and that no claim has arisen in the expiring policy period (copy of the policy enclosed). I/We further undertake that if this declaration is found to be incorrect, al l benefits under the policy in respect of Section 1 of the Policy wil l stand forfeited”. There is no mention of the fact that third party claim wil l make the insured ineligible for NCB. No clarif ication had been given by the Head Office although more than two months had elapsed. DECISION : Held that the third party claim should be de-l inked from the claim taken by the insured and it should be treated as no claim as far as insured is concerned. Hence ordered that NCB certif icate should be given by the insurer to the complainant.

Chandigarh Ombudsman Centre Case No. : GIC/268/Tata AIG/11/08

S. Sathappan Vs

Tata AIG Award Dated : 19.10.07 FACTS : Shri S. Sathappan got his Hyundai Santro Xing XO insured under Private Car Package Policy. His vehicle was stolen on 8.6.06, but the theft was not registered immediately. A Temporary Registration Certif icate was given to the insurer. Based on this the insurer offered Rs. 2,10,511/- (60% of IDV) which was less than the eligible claim. He wanted the claim to be settled on the basis of 100% IDV. FINDINGS : The insurer informed that registration of the vehicle was not applied for by the complainant within 30 days of the purchase of the vehicle. Hence plying of the vehicle on road was not as per MV Act. Moreover the theft of the vehicle was not reported to the Registering & Licensing Authority. The FIR did not mention engine and chassis number but only temporary registration number. The insurer quoted National Consumer Dispute Redressal Commission (NCDRC) case no. 4(2006) CPJ 62(NC) in the case of Aeroflot Soviet Airl ines Vs UII Appeal No. 504 of 1997 decided on 31.7.06. In this the NCDRC had held that the insurer was not l iable for payment in case the RC of the vehicle was not available on the date of theft. However, taking a lenient view they had settled the claim on 60% of IDV since it was a new vehicle. DECISION : Held that the action taken by the insurer to settle the claim on the basis of 60% of IDV was a good gesture to earn goodwill for the company. The complainant was advised to accept the offer made by the insurer since there were serious

deficiencies on his part in respect of the claim lodged by him with the insurer. The complaint was dismissed.

Chandigarh Ombudsman Centre Case No. : GIC/301/NIA/11/08

Dalbir Singh Vs

New India Assurance Co. Ltd. Award Dated : 5.11.07 FACTS : Shri. Dalbir Singh got his Hero Honda motorcycle bearing no PB-16B-6731 insured from BO Mehatpur for the period 31.7.06 to 30.7.07 for sum insured of Rs. 32,000/-. The vehicle met with an accident on 18.2.07. The claim lodged with the insurer had been repudiated on the ground that the vehicle had been sold to one Shri Gurdeep Singh on 8.2.07. Hence the complainant had no insurable interest on the date of accident. FINDINGS : The insurer informed that as per the investigation report the vehicle had been sold by the complainant to Shri Gurdeep Singh on 8.2.07. He showed affidavits signed by both Shri Dalbir Singh and Shri Gurdeep Singh in this regard. On a query whether RC and insurance policy had been transferred in the name of Shri Gurdeep Singh, the insurer replied in the negative. However, he showed a letter from the complainant in which he had stated that if the claim was not payable to him it should be paid to Shri Gurdeep Singh. DECISION : Held that the repudiation of the claim by the insurer on the ground of absence of insurable interest of the complainant was in order. The payment also cannot be made to Shri Gurdeep Singh, the purchaser of the vehicle since there was no contract between him and the insurer, as the insurance cover had not been transferred in his name. The repudiation of the claim was justif ied. The complaint was dismissed.


Anil Shukla Vs


FACTS : Shri Anil Shukla got his Hero Honda motorcycle bearing no. HR-29P-2366 insured for the period 17.2.06 to 16.2.07. His vehicle was stolen on 31.7.06 for which an FIR was lodged the same day. All relevant papers including claim form, FIR, RC and driving l icence were submitted with the insurer. However, the claim was made as ‘no claim’ on the ground of delay in reporting to the insurer.

FINDINGS : The insurer informed that they received the intimation about the theft only in Jan’07. Hence the claim was made as ‘no claim’ on the basis of delay in reporting. On a query whether no information was given earlier than Jan’07, the complainant stated that the intimation was given soon after the theft. However, since he had to go out of station for four months, he could not fol low up the case.

DECISION : Held that FIR was lodged on the very day of the theft of the motorcycle. However, the complainant erred in not fol lowing up the same with the insurer and hence the communication gap with the insurer could not be covered. Since there was

lapse on the part of the complainant in fol lowing up the case it does not mean that the theft had not taken place. Hence ordered that 50% of the admissible claim amount of claim should be paid by the insurer to the complainant.


Harbans Singh Cheema Vs

National Insurance Co. Ltd. Award Dated : 26.11.07 FACTS : Shri Harbans Singh Cheema got his Indica car bearing no PB-23F-1210 insured from BO Sirhind from 26.2.07 to 25.2.08. The insurance cover was taken for commercial purposes. While using for personal use the vehicle met with an accident on 1.6.07. The claim lodged with the insurer was repudiated on the ground that the company was not informed about the change in usage and class of vehicle which was of a material nature. He contended that the change in usage could not be endorsed in policy document, as he had to go abroad. He also requested for refund of excess premium charged under commercial vehicle tariff from the date of endorsement for personal use ti l l the date of expiry of insurance. FINDINGS : The insurer informed that the vehicle was being used for commercial purposes while being used in Delhi. On transfer to Punjab, the same was being used for personal purposes which was got endorsed in the RC but this was not done on the insurance policy before the date of accident. This has since been endorsed. Hence the claim was repudiated on the ground of l imitation to usage.

DECISION : Held that the usage of commercial vehicle for personal usage is not excluded as per terms and conditions of the policy. Therefore, the repudiation of the claim by the insurer on the ground of l imitation to usage was not in order. Hence ordered that the admissible amount of claim should be paid by the insurer to the complainant. The additional premium charged under commercial usage tariff after the endorsement for personal use ti l l the date of expiry of insurance should be refunded on short term basis along with the claim amount.


Satish Kumar Vs

National Insurance Co. Ltd. Award Dated : 27.11.07 FACTS : Shri Satish Kumar Gupta got the Indica Car No.JK-02M-8745 owned by his father Shri Mohan Lal Gupta insured with the insurer for the period 27.12.2006 to 26.12.2007 for sum insured of Rs.70,000/-. The vehicle met with an accident on 1.1.07 when it coll ided with a Punjab Roadways bus. The accident resulted in the death of 5 persons and vehicle was totally damaged. The claim lodged with the insurer was rejected on the ground that the number of persons seated in the car at the time of accident were six against permitted seating capacity of 5 persons. He contended that out of 6 persons, 3 occupants were minors and this fact should be taken into account while counting the no. of passengers.

FINDINGS : The insurer clarif ied the posit ion by stating that when the RC was verif ied from the RTO, it was mentioned that the seating capacity was 4. Hence the claim was repudiated on the ground of overloading of the vehicle. DECISION : Held that as per the letter of repudiation the seating capacity was 4+1. Taking 4+1 as the seating capacity and 3 minors occupying the car at the time of accident, the seating capacity is permissible. Moreover, the number of passengers has not resulted in the accident, since as per the mechanical inspection report issued by the J&K State Road Corporation, the failure of the brake could have been the cause of the accident. The repudiation of the claim on the ground of over seating which could have affected the driving capability of the driver, is not in order. Hence ordered that the payment of admissible amount of claim, on the basis of net of salvage as recommended by the surveyor, should be paid by the insurer to the complainant.


Sukhrah Singh Natt Vs

United India Insurance Co. Ltd. Award Dated : 4.12.07 FACTS : Shri Sukhraj Singh Natt got his Scorpio bearing no. PB-31-E-0455 insured from BO Malout for sum insured of Rs .6,81,000/-. It met with an accident on 04.7.07 at Bhathinda whilst being driven by his fr iend Kulwinder Singh who was holder of valid l icence no. 20257/BTI for Scooter/LMV and which was valid upto 2024. He got the vehicle repaired. When the claim was lodged with the insurer, the same was repudiated on the ground that the driving l icence was for Motor Cycle/ Scooter/ Car/ Jeep and not for LMV. FINDINGS : The insurer informed that the carrying capacity of Scorpio is 7 + 1, which falls under the category of LMV. Since the driving l icence was valid for car only, the driver was not authorized to drive the vehicle with 7 + 1 seating capacity. Hence, the claim was repudiated. Further the driving licence was valid for car and jeep, which on verification was found that it was valid only for scooter and car. DECISION : Held that this was a case of interpretation of relevant rules regarding driving licence. The definit ion of Light Motor Vehicle is the vehicle in which gross unladen weight does not exceed 7500 kg. While the driving l icence of Sh. Kulwinder Singh has a category of car/ jeep as well as LMV, it does not specifically mention that he was authorized to drive LMV as per the categorization of the vehicle. There is a thin l ine of demarcation as per the contention of the insurer regarding capacity of car / jeep and a vehicle seating capacity of 7+ 1. Further, Supreme Court in the case of Malla Parkasarao vs Malla Janaki has held that “a decision has to be taken whether the fact of the driver possessing l icence for one type of vehicle but found driving another type of vehicle, was the main or contributory cause of accident. The complainant also showed a copy of the judgement of District Consumer Forum, which was published in the newspaper on 26.04.2007, wherein it has been mentioned that the person authorized to drive a car and jeep can drive a Scorpio also. Taking all these factors into account, held that Sh. Kulwinder Singh was holding an effective driving licence on the date of accident to drive a Scorpio and hence the repudiation of claim on the ground of invalid l icence was not in order. The insurer was ordered to pay admissible amount of claim to the complainant.

Chandigarh Ombudsman Centre

Case No. : GIC/407/NIC/11/08 Satish Arora


Award Dated : 11.12.07 FACTS : Shri Satish Arora got his Alto car bearing no HP-15-5475 insured from the insurer for sum insured of Rs. 2,16,000/-. The vehicle met with an accident on 14.2.07 near Nurpur. He informed M/s Modern Automobiles Ltd., Jassur from whom he got the insurance done and a copy of intimation was sent to DM, New Delhi. The insurer took time to depute surveyor. After regular follow up the surveyor submitted his report. When the claim was lodged with the insurer, the same was repudiated on the ground that the driver did not have valid and effective driving l icence on the date of accident. He submitted that his driving l icence expired on 1.2.07. A grace period of 30 days was provided to get the licence renewed. The accident took place on 14.2.07 and he had another f if teen days to get the l icence renewed. However, the driving l icence was in the custody of Police. Hence he could not get it renewed. He contended that repudiation of the claim on the basis of not possessing valid and effective driving l icence was not satisfactory and the claim should be paid to him. He also wanted compensation for parking charges for the last one year @ 150/- per day. FINDINGS : The insurer informed that the driving l icence was not renewed during the grace period of 30 days and if i t were renewed now, it would not be done retrospectively in continuation. Hence as per their contention the driving l icence was not valid and effective on the date of accident. DECISION : According to the judgement of Supreme Court in the case of Malla Prakasarao v. Malla Janaki CA No 1613 of 1996, the Supreme Court has held that proviso appended to Section 15 of MV Act states in irrevocable terms that driving l icence remains valid t i l l 30 days from the day of its expiry. Also there has been no disqualif ication conveyed to the driver of the vehicle that he was disqualif ied from driving the vehicle. Hence the driving licence is both valid and effective on the date of accident. Ordered that insurer should pay admissible amount of claim to the complainant. Regarding parking charges the same should be borne by the insurer upto the date of repudiation viz. 10.10.07.


Meenakshi Kaushal Vs

ICICI Lombard Award Dated: 12.12.07 FACTS : Ms. Meenakshi Kaushal got her Indica car bearing no CH-03-8457 insured for sum insured of Rs. 2,85,000/- for the period 05.8.07 to 04.8.08. On 16.10.07 her vehicle whilst being driven by her husband Shri Parveen Kaushal got submerged in water under Railway Bridge near CTU Workshop. The Fire Brigade was informed who rescued their vehicle along with other vehicles. The claim was lodged with the insurer but the same was repudiated on the ground that it was not a case of f lood which was declared by the Government. FINDINGS : The insurer informed that there was clear warning for the driver at the spot not to venture into the water when the level was more than 1 ft. Moreover this was not a f lood in the real sense of the term and it was not declared as such by the Government. Thirdly, there were other vehicles stranded at the place and the

complainant’s husband should not have ventured into the water seeing the other vehicles stranded. DECISION : Held that it was flash flood, which lasted for short duration. Moreover it has not been mentioned in the terms and conditions of the policy that the flood should be declared as such by the Government. However, the complainant’s husband could have been careful in venturing into the area when there was heavy downpour and to that extent they have erred in not observing the necessary precautions. The insurers were within their r ights to penalize the complainant on this issue. However, the repudiation of the claim may not be in the interest of justice and fair play especially when the fire brigade had given certif icate that the vehicle was rescued by them. Hence ordered that 50% of the admissible amount of claim be paid by the insurer to the complainant.

Chandigarh Ombudsman Centre Case No. : GIC/408/OIC/11/08

Sharad Jhalaria Vs

Oriental Insurance Co. Ltd. Award Dated : 12.12.07 FACTS : Shri Sharad Jhalaria purchased a new motorcycle bearing no HR-25A-9952 and got it insured from DO-III Chandigarh for the period 07.7.06 to 6.7.07 for sum insured of Rs. 41,796/-.His fr iends Shri Amit Nagpal and Shri Sunil Sharma were riding the vehicle on the night intervening 31.12.06 and 1.1.07 (on the eve of New Year), when the motorcycle had a mechanical breakdown near Topiary Park, Sec-6, Panchkula. It was in such a condit ion that it could not be pushed or dragged. Leaving the motorcycle at the site, his fr iends went to call the nearby mechanic to repair the vehicle. When they came back, they found the vehicle missing. He tr ied to lodge an FIR the same day but the police did not take any action. After continuous efforts an FIR was recorded by the Police Station Sec-5, Panchkula on 5.1.07. The untrace report was issued by the police on 13.6.07. The claim lodged with the insurer had not been settled so far. FINDINGS : The insurer stated that there were some basic f laws regarding the contravention of condition no 4 of the policy which enjoins upon the vehicle owner to take due care of the vehicle. Firstly the vehicle was left unattended since it could not be dragged whereas the thief appears to have gone with the same vehicle without any repairs. Secondly, the duplicate key of the vehicle is not available which implies that the key would have been left with the motorcycle which was another lapse on the part of another person driving the vehicle. Hence the claim was repudiated on the ground of not taking due care under condition no .4 of terms and conditions of the policy. DECISION : Held that the vehicle had been stolen and the insurance cover was valid on the date of theft. However, since condition 4 of the terms and condit ions of the policy had been violated especially since the duplicate key of the vehicle was not available, the repudiation of the claim by the insurer was in order.

Chandigarh Ombudsman Centre Case No. : GIC/272/Chola/11/08

Jagjeet Singh Vs

Cholamandalam Gen. Ins. Co. Ltd. Award Dated : 08.01.08

FACTS : Shri Jagjeet Singh got his car bearing no. HR-10-H-0880 insured from the insurer for the period 31.8.05 to 30.8.06 for sum insured of Rs. 6,37,000/-. The vehicle was stolen on 23.8.06 for which FIR was lodged with Police Station, Prashant Vihar, New Delhi. The insurer was also intimated on 2.9.06 and they deputed M/s G.B. Mathur & Co for investigations. All the documents asked for by the insurer/investigator were submitted. On 31.10.06 he received a letter from the insurer expressing their inabil i ty to settle the claim on the ground of delayed intimation. He represented to the insurer stating that the delay occurred, because he was not conversant with the procedure of lodging the claim. The parties were called for hearing on 06.12.2007. FINDINGS : During the course of hearing the insurer clarif ied that intimation was received after 10 days and hence the action for recovery/ investigation got delayed. Moreover, no intimation was given to the transport authorit ies about the theft of the car. DECISION : Held that the complainant has erred on two accounts. First, the intimation was given to the insurer 10 days later. Secondly, transport authorit ies had not been intimated to prevent re-registration of vehicle. As per National Consumer redressal forum judgement in the case of Devender Singh Vs New India Assurance Co Ltd. & others, the claim was repudiated on the ground of late intimation to the police by 4 days and to the insurer by about a month. On the same analogy, there has been delay in this case. However, since in the instant case the FIR was lodged on 25.8.07, presuming the theft to be on 24.8.07, this was within 24 hours. Hence conceding that there had not been any delay in intimating the police,the repudiation of the claim in totality on the ground of late intimation is not in order as the police was informed in t ime. Accordingly, taking a fair and just view, it is hereby ordered that 50% of IDV should be paid to the complainant.

Chandigarh Ombudsman Centre Case No. : GIC/431/IFFCO TOKIO/14/08

R.L. Moga Vs

IFFCO Tokio General Ins Co. Award Dated : 08.01.08 FACTS : Dr. R.L. Moga got his vehicle bearing no. HR-51-M-0551 insured for the period 9.5.07 to 8.5.08 for IDV of Rs. 4 lakhs. Following water logging, hydrostatic locking took place on 2.8.07 and the vehicle was taken to Galaxy Toyota on 4.8.07 where the vehicle’s engine oil was changed at the complainant’s request to save the vehicle from further damage. On 5.8.07 the engine chamber burst and since the vehicle was not in a running condition it was towed away to Galaxy Toyota, New Delhi on 19.8.07. The insurer was informed on 7.8.07 and the claim was lodged but his claim was made ‘no claim’. He stated that the vehicle was not used after the occurrence of loss except that it was driven to Faridabad on 4.8.07 that too on the advice of Galaxy Toyota who assured that there would be no harm if the vehicle was driven. The very next day i.e. on 5.8.07 the engine chamber burst. It was further stated that the hydrostatic locking of the engine had already damaged the engine substantial ly on 2.8.07 because there was a noise in the engine. Parties were called for hearing on 8.1.08. FINDINGS : During the course of hearing the insurer clarif ied that the complainant was advised to get the engine overhauled on 4.8.07 but he went on running the vehicle and covered a distance of about 400 Kms. As a result, the engine burst. The cost for

overhauling would have been about Rs. 30,000/- which had not aggravated to Rs. 1,86,000/- after the vehicle had run for 400 Kms. DECISION : Held that the complainant has not taken due care to avoid further damage to the vehicle even after he was advised by the workshop to do so. Hence, the claim is payable to the extent of original damage since aggravated damage is due to not taking due care of the vehicle. The claim should be restricted to Rs. 30,000/- plus actual towing charges or Rs. 1500/- whichever is minimum.


Gurvinder Kaur Vs

United India Insurance Co. Ltd. Award Dated : 11.01.08 FACTS : Ms Gurvinder Kaur’s husband Late Sh. Malkit Singh got his motorcycle bearing no. PB 02-AV-4678 insured from BO Amritsar. He met with an accident on 10.3.07 in which he passed away. She lodged a claim with the insurer which was made ‘no claim’ on the ground that road tax for the said motorcycle was not deposited within 30 days from the date of i ts purchase. As such the vehicle was plying on the road unlawfully, which was violation of MV Act, 1988. She stated that instead of paying the claim the insurer rejected the claim on fl imsy grounds. Parties were called for hearing on 11.1.08. FINDINGS : During the course of hearing the insurer stated that although the l iabil i ty of the accident was admitted, there has been a procedural f law since the motorcycle was not registered and was running on temporary registration at the time of accident. After the death of the owner the RC was got made in the name of the deceased Shri Malkit Singh. Hence they were finding it difficult to make the payment of the claim. On a query whether driving of the vehicle with temporary registration was against the terms and conditions of the insurance policy, the insurer replied in the negative. DECISION : Held that although there may be a procedural f law in getting the RC issued after the death of the owner, this is an issue between the widow of the owner and the Transport Authorit ies. As far as payment of insurance claim is concerned, since the vehicle had a valid insurance on the date of accident and it was not being driven by a person without having a valid l icence, the claim is payable. Regarding in whose favour the cheque was to be made, I am of the opinion that cheque should be made in favour of the complainant Smt Gurvinder Kaur who is the wife of the deceased and next of kin. The payment can be made after she submits an aff idavit that she is the legally wedded wife of the deceased and in case of rival claimant she would refund the amount to the extent required.


Rupinder Kaur Vs

National Insurance Co. Ltd. Award Dated : 11.01.08 FACTS : Smt Rupinder Kaur got her vehicle bearing no. PB-26C-9500 insured for the period 10.3.07 to 9.3.08 for sum insured of Rs. 4 lakh. The vehicle met with an accident on 17.3.07. She lodged a claim with the insurer, which had not been settled. She enclosed a letter dated 19.11.07 of BO Sirhind repudiating her claim on the ground

that claim had been denied by DO Patiala as per investigation report. Parties were called for hearing on 11.1.08. FINDINGS : During the course of hearing the insurer clarif ied that as per the investigation report the major damage to the vehicle has been on the driver side. The maximum injury had been sustained by the 14 year old son of the complainant Shri Saghundeep Singh. Since it was a head on collision the investigator opined that Saghundeep Singh was probably driving the vehicle. Since he was minor he was not authorized to drive the vehicle. Hence the claim was repudiated. DECISION : Held that the repudiation of the claim on presumption alone is not in order. The complainant who is a responsible lecturer in a college has stated that she was driving the vehicle at the time of accident and I have no reason to doubt the veracity of her statement. In my opinion the investigator’s report should not form the basis of repudiation unless there are supporting documents to confirm that Shri Saghundeep Singh was driving the vehicle at the time of accident. Therefore taking a fair and just view the repudiation of claim is not in order. The claim is payable.


Bachan Kaur Vs

ICICI Lombard Award Dated : 11.01.08 FACTS : Smt. Bachan Kaur purchased a new Tata Safari bearing temporary registration no CH-01-T-8300 and got it insured from the insurer for the period 07.4.06 to 6.4.07. The said vehicle was stolen in the night intervening 7/8.6.06 whilst it was standing outside her residence. FIR was lodged with the Police Station, Phase-I, Mohali. The claim lodged with the insurer was repudiated on 13.1.07 on the ground that the vehicle was not registered at the time of theft. Parties were called for hearing on 11.1.08. FINDINGS : The insurer stated that the vehicle was not registered at the time of theft which was a violation of MV Act. Moreover, there appears to be no reasonable care having been taken to affect the safety and security of the vehicle as there was a presumption that ignit ion key was left in the vehicle when it was stolen. On a query whether any terms and condit ions of the policy have been violated, the insurer stated that by not getting the registration done the risk factor for theft had increased. On a query whether all the three keys including one available with the financer were handed over to the insurer, the insurer replied that only one key was available with them. DECISION : Held that the complainant should as a f irst step handover all the three keys to the insurer to prove that due care was taken for the safety and security of the vehicle. When all the keys are made available, the same should be intimated to the insurer and this off ice so that another date of hearing can be fixed. In case one of the keys was missing it would be presumed that it was left in the vehicle at the time of theft and the condition of ‘not taking due care’ would come into operation as per terms and condit ions of the policy. The complainant is advised to hand over all the three keys to the insurer by 31.1.08. On receipt of information of submission of keys with the insurer, another hearing would be held regarding repudiation of the claim. However if all the keys cannot be produced the insurer is at l iberty to settle the claim on merits based on the keys handed over to them.

Chandigarh Ombudsman Centre

Case No. : GIC/491/ICICI/11/08 Motia Khan

Vs ICICI Lombard

Awrd Dated : 08.02.08 FACTS : Shri Motia Khan purchased a new Accent car and got it insured from the insurer. The vehicle was under hire and purchase agreement with ICICI Bank from where the loan was taken for purchase of vehicle. The vehicle met with an accident on 3.10.06. The insurer was informed and surveyor was deputed for survey and assessment of loss. The claim lodged with the insurer was denied on the ground that the vehicle was not registered in t ime. He stated that due to unavoidable family reasons he could not get the vehicle registered. However it was got registered after the accident i.e. on 17.2.06. Parties were called for hearing on 8.2.08. FINDINGS : The insurer clarif ied the posit ion by stating that the vehicle was plying without proper registration which was against the Motor Vehicle Act. The registration had now been done in the name of M/s Sunshine Hotel, Mandigobindgarh. DECISION : Held that after going through the Registration Certif icate which is in the name of M/s Sunshine Hotel, Mandigobindgarh. Since the vehicle is registered in the name of a firm, the case does not fall within the ambit of this forum in view of Rule 12(2) read with Rules 4-(i) and 4-(k) of Redressal of Public Grievances Rules,1998. The case is, accordingly, closed.

Chandigarh Ombudsman Centre Case No. : GIC/492/HDFC/11/08

Sunita Sharma Vs

HDFC Gen Ins Co Ltd. Award Dated : 08.02.08 FACTS : Smt. Sunita Sharma got her Ford Fiesta car bearing no HR-01V-5188 insured from the insurer for the period 17.8.06 to 16.8.07 for IDV of Rs. 6,89,700/-. The vehicle met with an accident on Jalandhar Pathankot Road on 19.6.07. The insurer was informed immediately and the vehicle was given for repairs. However the claim lodged with the insurer was made ‘no claim’ on the ground that Shri Ashwani Sharma, driver of the vehicle at the time of accident was not holding a valid driving l icence. The driving l icence was found to be valid upto 2.8.06. However, the accident took place on 19.6.07. Hence the l icence had expired on the date of accident. She stated that Shri Ashwani Sharma was having licence no 1613/Ambala/77-78 which was valid from 16.12.03 to 15.12.08. She was never asked for a copy of driving licence during the processing of the claim and now she has been put to unnecessary loss due to mishandling of the case. Parties were called for hearing on 8.2.08. FINDINGS : The insurer clarified that the driving l icence submitted to them in respect of Shri Ashwani Sharma was valid upto 2.8.06 whereas accident took place on 19.6.07. Hence on the date of accident the driving l icence was not valid. On a query whether they had a copy of the valid l icence from 16.12.03 to 15.12.08, the complainant produced the same. On a query whether the other licence was seen by the insurer, the insurer replied in the negative. DECISION : Held that after hearing both the parties and scrutinizing the two driving l icences produced by the insurer and the complainant, I f ind that between 2003 and 2006 the complainant was having two driving l icences. Possession of two driving

l icences is against the Motor Vehicle Laws and Rules. Moreover while the complainant is permanent resident of Ambala City, it is not clear why the other l icence was obtained from Mathura. Also in 2003 the main l icence was not due for renewal. In view of the above, I would tend to agree with the contention of the insurer that the driving l icence was not valid on the date of accident viz. 19.6.07. The repudiation of the claim on the basis of terms and conditions of the policy is, therefore, in order and is upheld.


Jeevan Prabhat Jain Vs

United India Ins Co. Ltd. Award Dated : 08.02.08 FACTS : Shri Jeevan Prabhat Jain got his Scorpio car bearing no DL 3CA-7074 insured from the insurer for the period 01.4.06 to 31.3.07. The vehicle met with an accident at Goa and was surveyed there. The surveyor submitted his report in which loss was assessed at Rs. 3 lakhs. However the claim lodged with the insurer was repudiated on the ground that the driving l icence was not valid on the date of accident. Parties were called for hearing on 8.2.08. FINDINGS : The insurer clarif ied that the driver of the vehicle, Shri Gaurav Prabhat Jain, was holding a licence for motor car and not for LMV at the time of accident. Hence the driving licence was not considered valid for driving the Scorpio. DECISION : Held that a clarification is required from Punjab State Transport Commissioner whether Scorpio car being used for private purposes could be treated as car or not. I rang up Shri Saraon Additional Transport Commissioner, Punjab who clarif ied on the telephone that if Scorpio car is used for private purposes then driving l icence for car was valid. However if i t was used for commercial purposes an endorsement for Transport Vehicle is required on the driving licence. Since the car being used by the complainant at the time of accident was for private use only, i t is considered that the claim is payable after the clarif ication given by the Additional Transport Commissioner, Punjab. It is hereby ordered that admissible amount of claim should be paid by the insurer to the complainant.


Jasbir Singh Vs

United India Insurance Co. Ltd. Award Dated : 12.02.08 FACTS : Shri Jasbir Singh got his Santro car bearing no PB-10-BN-8425 insured from BO Mata Rani Road Ludhiana. The vehicle was stolen on 26.6.07 from his residence. All the papers as desired by the insurer were submitted. However he was surprised to receive a letter dated 3.1.08 from the insurer stating that his claim had been rejected.Parties were called for hearing on 12.2.08. FINDINGS : The insurer clarified that as per the report of the surveyor the complainant had gifted the car to his sister and on the basis of legal opinion the claim was repudiated as the complainant did not have an insurable interest on the vehicle after gift ing the vehicle. On a query as to what was the basis for presuming that the car was gifted, the insurer gave a letter on plain paper supposedly signed by the complainant that he had gifted the car to his sister at the time of her marriage. On a query as to in whose name the RC was on the date of theft, the insurer replied that it was in the name

of the complainant/insured. On a query as to in whose name was the insurance policy on the date of theft, the insurer replied that it was in the name of the complainant. DECISION : Held that the sole basis of treating the ownership in the name of a person other than the complainant is a note allegedly signed by the complainant on a plain paper which has no legal locus standii. The two legal documents are the RC and the insurance policy which are both in the name of the complainant. Hence in my view the ownership rests with the complainant and he has insurable interest on the date of theft. The claim in my view is, therefore, payable.

Chandigarh Ombudsman Centre Case No. : GIC/500/NIA/11/08

Ishwar Singh Thakur Vs

New India Assurance Co. Ltd. Award Dated : 12.02.08 FACTS : Shri Ishwar Singh Thakur got his vehicle M&M bearing no HP-63-0980 insured under Goods carrying commercial vehicle for the period 29.12.05 to 28.12.06 for sum insured of Rs. 3,50,000/-. The vehicle met with an accident on 15.11.06. FIR was lodged in Police Station, Nerwa. In the accident, the said driver Shri Gani and the labourer Mohd. Taslim got injuries. The surveyor assessed the loss of Rs. 2,10,000/- on net of salvage basis. But the insurer rejected the claim on the ground that one unauthorized passenger was travell ing in the vehicle at the time of accident. The complainant stated that the carrying capacity of the vehicle is 4+1 and the labourer was sitt ing with the driver and not any unauthorized passenger. Parties were called for hearing on 12.2.08. FINDINGS : The insurer clarified that the driver Shri Ghani was travell ing with one of his fr iends Mohd. Taslim, since he had to bring empty oil drums and he needed a helper to load those drums. The matter was referred to Head Office through Regional Office who advised to repudiate the claim on the ground that Mohd. Taslim was traveling as unauthorized passenger and sustained injuries in the accident. On a query as to what is the definit ion of unauthorized passenger, the insurer could not give a satisfactory reply. On a query whether the carrying of Mohd. Taslim in the vehicle was the main contributory factor to the cause of accident, the insurer could not give a satisfactory reply. DECISION : Held that by carrying Mohd. Taslim in the vehicle, the driving skil l of the driver had not undergone any effective change which could result in the accident, since the number of passengers were within the carrying capacity of the vehicle as mentioned in the RC. Even if the carrying capacity had exceeded by 1 or 2 passengers beyond the permissible l imit the claim is payable as per judgement given by the Supreme Court in the case of B. V Nagaraju Vs OIC Civil Appeal No. 6296 of 1995-decided on 20.5.1996. Hence in my opinion the repudiation of the claim is not in order and the same is set aside. The claim is payable alongwith interest @ 8%p.a.


Karnail Singh Vs

National Insurance Co. Ltd. Award Dated : 12.02.08 FACTS : Shri Karnail Singh got his Indica car bearing no HR-03-E-4171 insured from the insurer for the period 14.7.06 to 13.7.07 for sum insured of Rs. 3,37,878/-. The vehicle met with an accident on 12.6.07 when a Scorpio car hit his car near HMT Pinjore. His car was severely damaged and sent for repairs to M/s Joshi Auto Zone, the

authorized dealer of Tata Motors. DDR was lodged with the Police Station Pinjore the same day. The claim was however closed by the insurer on account of fake driving l icence of the driver at the time of accident. Despite giving clarifications to the insurer that it was he who was driving the vehicle and not Baldev Singh, his friend, the insurer denied the claim. Parties were called for hearing on 12.2.08.

FINDINGS : The insurer clarif ied that the report of the accident was given by Shri Baldev Singh. Secondly in the claim form it had been mentioned by the complainant that Shri Baldev Singh, his brother was driving the vehicle at the time of accident. The complainant submitted photocopies of driving licence no. 6754 of Shri Baldev Singh and his own. The driving l icence of Shri Baldev Singh was got verif ied from Licensing Authority, Karnal who had stated that it was not a genuine licence as licence no 6754 belonged to one Shri Manoj Kumar and not Baldev Singh.

DECISION : Held that there are contradictions in the statements given by the complainant from time to t ime. While in the claim form he has stated that Shri Baldev Singh was his brother, in the complaint he had stated that he was his fr iend. Secondly, driving licence no 6754 submitted in respect of Baldev Singh appears to be fake as confirmed by the Licensing Authority, Karnal. The complainant also stated that in police report (DDR) it was mentioned that he was driving the vehicle but on checking up the police report i t has been seen that there is no mention of driver at the time of accident. From all this information, the contention of the insurer that the driver at the time of accident was Baldev Singh appears to be correct and since he was not holding a valid driving l icence at the time of accident, the repudiation of the claim by the insurer is in order.


Ashu Mahajan Vs

ICICI Lombard Award Dated : 14.02.08 FACTS : Shri Ashu Mahajan got his Innova car insured for the period 08.2.07 to 7.2.08. The vehicle met with an accident on 7.10.07. The insurer was informed and the surveyors were deputed for survey and assessment of loss. All the required documents were submitted with the insurer. He stated that att itude of the surveyor was rude and impolite. He allegedly stated that the surveyor demanded certain amount as i l legal gratif ication, which was refused by him. The surveyor threatened to get the loss repudiated as ‘no claim’. Later the insurer repudiated his claim vide letter dated 31.10.07 stating that at the time of loss the vehicle was being used for commercial purposes. Parties were called for hearing on 14.02.08. FINDINGS : The insurer clarif ied that the vehicle had covered 41,629 Kms within 8 months of its purchase. This worked out to 5,200 Km per month and an average of 170 Km daily in a small town l ike Batala or around. Moreover the cost of diesel, EMI for the loan, driver’s salary, insurance cost etc did not justify the income which was given in the proposal form. The surveyor had a conversation with the complainant in which it came out that the vehicle could have been used for commercial purposes. Hence the claim was repudiated on the ground of ‘use for commercial purposes’. On a query how the vehicle had run 41,000 Km in 8 months, the complainant could not give a satisfactory reply.

DECISION : Held that the contention of the insurer that the heavy running of the vehicle implies commercial use, is justif ied. However, since he could not prove conclusively that the vehicle was being used for ‘hire or reward’, in my opinion, some benefit goes to the complainant. Taking a fair and just view, I am of the opinion that sett lement of claim on sub-standard basis would meet the ends of justice. In my view, 50% of the admissible claim on repair basis should be sufficient compensation to the complainant for the loss suffered by him. It is hereby ordered that 50% of the admissible claim on repair basis should be paid by the insurer to the complainant.


Nilesh Aggarwal Vs

United India Insurance Co. Ltd. Award Dated : 17.03.08 FACTS : Shri Nilesh Aggarwal got his car Hyundai Accent bearing no HR-01R-8485 from the insurer for the period 13.01.06 to 12.01.07. The car met with an accident on 21.4.06 between Zirakpur and Dera Bassi. He lodged a claim with the insurer, which was repudiated on 14.12.06 on the ground that his father Shri Rakesh Kumar who was driving the vehicle at the time of accident was not holding a valid and effective driving l icence. Parties were called for hearing on 17th March, 2008. FINDINGS : The Insurer clarif ied that the original driving l icence as per the investigation report was for Motorcycle/Scooter only. The Transport Authority, Ambala by their endorsement dated 28.08.2006 have confirmed that the licence was valid for Motorcycle/Scooter only and there was no endorsement made later on for Car/Jeep. They also confirmed that the renewal in 2006 was by paying licence fee for Motorcycle/Scooter only. On a query whether any endorsement was available for Motorcar/Jeep on the earl ier l icence, the Insurer replied in the aff irmative and stated that he was having the endorsement given by the Licensing Authority dated 13.08.2007 in which it had been mentioned that the driving l icence was valid for Car/Jeep only. DECISION : Held that the Licensing Authority, Ambala had given contradictory reports in August, 2006 and August, 2007. It was the duty of the Insurer to get the bonafides of the two statements verif ied by sending a responsible off icer to the office of the Licensing Authority. I have also seen the driving l icence no. 967 of Sh. Rakesh Kumar which I find has an endorsement for Motorcar/ Jeep and is valid upto 28.11.2010. I have no reason to believe that the endorsement for Car/Jeep was wrongly made by the Licensing Authority in the absence of any letter which makes Sh. Rakesh Kumar ineligible to drive a car. The driving l icence should be treated as valid and the admissible amount of claim should be paid by the Insurer to the complainant.

Chennai Ombudsman Centre Case No. : IO(CHN) 11.05.1200/2007 – 08

Smt. Sri Padma Priya Vs

The Oriental Insuraance Co. Ltd Award Dated : 31.10.07 The Complainant Smt Sri Padma Priya had obtained motor insurance policy in respect of her vehicle AP9 AJ 6679 from the Oriental Insurance Co. Ltd. The car met with an accident on 26.01.2007. Spot survey conducted and insurer has not instructed for repair of the vehicle t i l l March 2007. The insured had to shift her family to Vijayawada

for personal reasons and took the vehicle with the insurer’s consent. She requested for fresh survey at Vijayawada and since there was no progress, she had approached the forum. The insurer’s representative informed that category B surveyor was deputed for survey at Salem. Bagawan Motor works where the insured left the vehicle for repairs is neither an authorized service centre nor equipped with major accident repair facil it ies. The insured insisted for sett lement on total basis and insurer did not agree for the same since the assessed repair cost did not exceed 75% of the IDV. The assessment was for Rs.61,295/-. After the insured took the vehicle to Vijayawada, survey was arranged by insurer’s Divisional off ice and the assessment was more or less similar to the one carried out at Salem. After perusal of all the records submitted, it was found that the delay in process of the claim was due to insured not co-operating with the insurer at different stages of the claim process. In the light of the above, the insurer is directed to settle the claim as per the survey carried out by the surveyor appointed by Insurer’s Vijayawada office subject to policy terms and conditions. The insured is directed to cooperate with the insurer in the processing and settlement of the claim.

Chennai Ombudsman Centre Case No. : IO(CHN) 11.08.1232/2007 - 08

Mr. Praveen Kumar Vs

Tata AIG General Insurance Co. Ltd Award Dated : 07.12.2007 The complainant Mr.Praveen Kumar purchased a Ford Ikon car on 28.12.2006 and effected transfer in the Registration Certif icate in his favour with effect from 28.12.2006.The insurance policy was in the name of Mrs Valsala Madhu, the previous owner and the policy period was from 04.09.06 to 03.09.2007. The complainant informs that he approached the insurance company and was told that the transfer of insurance would be carried out only after the registration certif icate of the vehicle is transferred. The RC book was given to the agent for transfer and received only in the last week of January 2007. In the meantime the vehicle met with an accident. When approached for transfer of insurance , the insurance company refused to effect the same and informed that no transfer endorsement could be made after an accident and also denied l iabil ity for the OD claim. The representative of the Insurer stated that the complainant had intimated the claim only on 09.02.07 after one month from the date of accident and confirmed through copies of their call centre records. Against the contention of the complainant for visit ing the insurance company, since insurer maintain visitors book, they were able to prove that no such visits have been made. The complainant had not applied with in fourteen days from the date of transfer in writing under recorded delivery to the insurer and could not establish that he made such an application for transfer of the vehicle with in the stipulated time. It is observed that neither specific request from the transferee along with consent of transferor nor evidence of sale/fresh proposal submitted for effecting transfer of insurance. Since the insurable interest in respect of Mrs. Valsala Madhu ceased to exist after the sale of vehicle and the new owner Mr. Praveen Kumar’s interest not transferred as per the provisions of the Motor Vehicle Tariff under GR.17, the complaint is dismissed.

Chennai Ombudsman Centre Case No. : IO (CHN) 11.04.1247-2007-08

Smt.S.Anavaratham Vs

United India Insurance Co. Ltd. Award Dated : 24.01.2008 The complainant stated that her husband had been travelling in their car driven by their driver, when the car hit a tree in order to avoid a cyclist and met with an accident . Her husband died on the spot of the accident. The driver was admitted to the hospital and he died after 10 days. The vehicle was completely damaged and it was brought to Coimbatore. She submitted the claim form along with necessary documents. The insurer had asked for the driving licence of the driver. She tried to trace out but could not get the same. The driver’s family did not cooperate in getting the l icence. They even contacted the previous employer and tr ied for a copy of the l icence but in vain. The insurer had repudiated the claim as she could not produce the driving l icence. Since she had to pay the demurrage and also pay the outstanding loan, she sold the wreck along with the Registration Certiff icate. It was pointed out to her that she should have sold the wreck with the consent of the insurer. Despite her best efforts she had not been able to get the copy of the driving l icence. The insurer stated that without driving l icence they could not settle the claim. It was a contract between the insured and the insurance company. The driver should have a valid proper l icence at the time of accident. Even a Xerox copy of the l icence would suffice. However, only if the if the driving licence was produced and the assessed loss was more than 75% of the insured value they could consider the claim on total loss basis. Further, the complainant had informed them that she had disposed off the wreck only after sale of the vehicle. After hearing the parties and scrutinizing the documents such as FIR it was established that the complainant had not submitted a copy of the certif icate or attempted to obtain a certif icate to the effect from the RTO. A copy of the MV inspection report was also not submitted by the complainant. It was seen that the insurer had expressed their wil l ingness to settle the claim even if a copy of the DL had been produced, which the complainant had not complied with. Since the complainant was unable to produce even a copy of the DL or any other proof to confirm that the driver had a valid and effective DL, the complaint was dismissed.

Chennai Ombudsman Centre Case No. : IO(CHN)/ 11.02.1386/2007-08

Shri A. Albert Jones Vs

The New India Assurance Co. Ltd. Award Dated : 25.02.2008 The Complainant Shri A.Albert Jones has stated that a car owned by his father had been insured with the New India Assurance Co. Ltd from 2003 onwards right from purchase of the car. His father expired on 26.03.2006. After the death of his father the policy was renewed for the period from 11.07.2006 to 10.07.2007 and the agent had collected the renewal premium cheque from them. On arrangement within the family, the car was given to him and he started using the car. Mr.Rajan, the agent had collected the cheque for renewal and he was well aware of his father’s demise. The Development Officer was also aware of his father’s death. The vehicle met with an accident on 05.02.2007. The insurer rejected the claim stating that the policy was in

the name of the deceased person. Without knowing the implications they have renewed the policy in the existing name. The insurer stated that while scruitinising the claim file they found that the insured had expired on 26.03.2006 and the complainant neither intimated the RTO nor the insurer to comply with the requirements as per terms and condit ions of the policy. The policy was renewed in the name of the deceased. They had repudiated the claim as the policy was not transferred within 90 days from the date of death of insured nor on the expiry of the policy. After repudiation, the complainant had changed the name of the owner in the R.C. as well in the insurance policy. After hearing the parties and scrutinizing the documents such as policy copy, death certif icate, RC book, legal heir certif icate it was held that Condition No 9 of the policy stipulated the procedure to be adopted in case of death of the owner of the vehicle. Sec 56 of the MV Act also stipulates that transfer in such cases can be done within 3 months, provided intimation to this effect has been made to the competent authority within 30 days. The complainant has not complied either with the policy condit ions or with the MV Act even after the lapse of a considerable t ime after the demise of the insured. The complainant has taken the plea that he did not know the implications. Ignorance of rules and law is not justif iable when it comes to the question of law and mandates. The Complaint was dismissed.

Chennai Ombudsman Centre Case No. : IO(CHN)/11.04.1429/2007-08

Shri K Gurunathan Vs

United India Insurance Co. Ltd Award Dated : 31.03.2008 The complainant had availed a vehicle loan from ICICI Bank and purchased a Toyota Qualis vehicle for his personal use. His driver who collected the vehicle from the garage where it had undergone minor repairs did not return unti l late in the night. Later, the complainant’s brother had contacted the driver and the driver informed him that he was going to Chennai airport with a passenger. The same night, the complainant was informed by a Police station in Chennai that his driver had lodged a complaint with them that the vehicle was stolen by the passenger. The complainant stated that his driver had taken away the vehicle without his permission and knowledge and suspected his involvement in the theft. He preferred a claim with his insurer but they had repudiated his claim. He had not been able to meet the driver after the incident. The police had appointed a special squad to trace the vehicle but they could not. He submitted the non-traceable certif icate, FIR etc. to the insurance company. Init ial ly the case was booked under Section 420 since the driver has given the complaint and later changed to Sec 379 since they suspected that the driver himself may have stolen the vehicle. He reiterated that the vehicle was used only for personal purposes and not for commercial purposes. The insurer stated that Mr.Gurunathan has been running a Travel agency. He had given a statement to the investigator that the driver of vehicle while informing his brother has said that he was taking a “passenger” to the Airport. The use of the word “Passenger” (Savari) meant it was used for commercial purposes. It also proves that he has been in the habit of taking people in the vehicle. Init ial ly the complaint was registered under IPC section 420-cheating and subsequently they have changed the IPC Sec.379 - theft. Insurance policy does not cover Sec 420. Only Theft was covered.

Hence, it has been changed for insurance purposes. The use of the vehicle for commercial purpose was a gross violation of private car insurance policy terms and condit ions. So they repudiated the claim. The documents l ike Comprehensive Private car policy, RC Book ,Repudiation letter ,FIR under Sec 420 of the IPC, Statement from Vadapalani Police station to the XVII Metropolitan Magistrate Saidapet (Chennai 15) informing that the crime under the said FIR is being investigated under Sec 420 IPC and also under Sec 379 (theft), Non-Traceable certif icate, Investigation report were scrutinized. The insurer has held that the vehicle was used for hire based on the statement of the investigator and use of the word “passenger” by the driver. There is no other evidence. The only Authority that can throw some light on the matter is the Police department. The police department has registered the complaint under Sec 420 IPC (cheating) as well as Sec 379 IPC (Theft) and after due investigation, the vehicle has been declared as untraceable and Non traceable Certif icate issued. The l iabil ity of the insurer has been confirmed in a similar situation in the case of National Insurance Co. Ltd Vs Sanjay Shivhare reported in 2007 (4) CPJ 366 (NC). On scrutiny of the statement of the Police authorit ies, it is clearly seen that Sec 420 has not been changed to Sec 379 but Sec 379 has been added to the existing Sec 420. However, whether the case is registered under Sec379 IPC as theft, Sec 420 IPC as cheating or Sec 406 IPC as criminal breach of trust, so far as the liabili ty to the insurer is considered, it does not materially alter the situation. The direct and binding l iabil ity of the insurer has been established in United India Insurance Co. Ltd Vs Ravi Kant Gopalka in 2007(4) CPJ 32 (NC). As per documents, the vehicle, registered as a private car, has been insured as such. The onus of breach of policy condition by the insured vests with the insurer. There must be substantial evidence for the breach. Mere doubt or suspicion wil l not do. There has to be “flagrant violation” to warrant a denial. As per the records produced, it cannot be stated without doubt that the vehicle was used for hire. The repudiation letter of the insurer acknowledges “theft”. Unless the collusion or mala fide intention of the insured himself is actually established, insurer cannot deny his liabil i ty. In the circumstances, the decision of the insurer to repudiate the claim in total is not justif ied. However, the complainant has also not been able to satisfactorily explain several facts such as how a newly appointed paid driver could take away the car without his permission to a place so far away from home, why he also used the word “passenger’ in his letter to the insurer, despite being an experienced tourist taxi operator how the complainant could entrust his costly vehicle to a new driver without checking his antecedents and verifying the original DL. There were lapses and negligence on his part too. He has not taken adequate precautions l ike a normal, prudent, uninsured person is expected to do. In the circumstances, insurer was directed to settle the claim on Exgratia basis at 50% of the IDV. The complaint was partly allowed on Ex-gratia basis.

Delhi Ombudsman Centre Case No.GI/297/Tata AIG/06

Shri Navin Kalra Vs

Tata AIG General Insurance Company Limited Award Dated : 18.09.2007

Shri Navin Kalra had lodged a complaint with this Forum on 18.07.2006 against Tata AIG General Insurance Co. Ltd. regarding inadequate settlement of Motor claim under policy no. 015002740800. The complaint was fixed for hearing on 04.06.2007 and 14.09.2007. The complainant Shri Navin Kalra did not attend the hearing on both the dates, whereas the Insurance Company was represented by Shri Azar Wasi, Sr. Manager (Claims) and Ms. Deepa Chacko, Asstt. Manager (Claims). It is therefore presumed that Shri Navin Kalra is not interested to pursue his case to be resolved through this Forum. Hence his complaint is dismissed. The complaint is disposed of finally.

Delhi Ombudsman Centre Case No.GI/338/Bajaj/07

Smt. Sangeeta Gupta Vs

Bajaj Allianz General Insurance Company Limited Award Dated : 18.09.2007 The complaint was heard on 06.06.2007 and 14.09.2007. The complainant Smt. Sangeeta Gupta was represented by her husband Shri Sunil Gupta and the Insurance Company was represented by Shri Ashish Rao and Shri Nitin Arora. Smt. Sangeeta Gupta had lodged a complaint with this Forum on 22.03.2007 that she had insured her Honda City car no. DL-4 CN C0408 with Bajaj All ianz General Insurance Co. Ltd. As per the policy, the car accessories were covered. The stereo had been stolen by someone. Her husband Shri Sunil Gupta had followed the required process of claim settlement. Surveyor was appointed. The company deducted 50% depreciation on stereo treating it as a plastic part. On the other hand, Tata AIG had deducted only 20% from the cost of the stereo of his other Santro Car no. DL 2C W9957. The accident happened on the same day and the modus operandi used by the thieves was same. At the time of hearing, the representative of the complainant was asked whether he had covered the stereo separately as an accessory and paid extra premium for the same. On perusal of policy no. OG-07-1102-1801-00004291 covering the concerned vehicle, it was observed that the vehicle was covered under single sum insured of Rs.680887/-. There is no separate sum insured of the stereo. The representative confirmed that the stereo was supplied by the manufacturer as part of the vehicle and along with it and the sum insured was for the full value of the vehicle including the stereo. On further enquiry about the policy issued by Tata AIG for complainant’s Santro car, whose stereo was stolen on the same night in the same incident, i t emerged that the stereo which had been there in the Santro car was not supplied by the manufacturer. It had been purchased separately and it was also insured separately as an accessory in the policy issued by Tata AIG. It was because of this reason that, the Insurance Company has paid the claim after deducting depreciation of 20% only according to the age of the vehicle. In the instant case the stereo was part of the vehicle and depreciation of 50% has been deducted treating it as plastic part as per Motor tariff which imposes a depreciation of 50% on all plastic parts. I am therefore in agreement with the decision of the Insurance Company that they have rightly deducted a depreciation of 50 % on the stereo. The complaint stands dismissed.

Delhi Ombudsman Centre Case No. GI/265/OIC/06

Shri Ranjit Singh Vs

Oriental Insurance Company Limited Award Dated : 15.10.2007 The complaint was heard on 08.10.2007. The complainant, Shri Ranjit Singh, was accompanied by Shri Arun Mehta, relative and Shri Harish Sharma, friend. The Insurance Company was represented by Shri Rajinder Singh, Senior Branch Manager. Shri Ranjit Singh has lodged a complaint with this Forum on 23.10.2006 that he had taken a motor policy from the Oriental Insurance Company Limited. His Car No.DL6CH 0089 had met with an accident on 30.05.2001 at Jalandhar. He gave the intimation to Jalandhar Divisional Office of the Insurance Company. He had already submitted the bil ls/cash memo in original to them. He requested the Forum that his claim be paid to him. At the time of hearing, Shri Ranjit Singh informed the Forum that vehicle No.DL 6CH 0089 had met with an accident on 30.05.2001 which was surveyed by M/S.S.K.Mittal and Associates, surveyor. He has not received any payment of his claim. He was informed by the Insurance Company that Shri Shyam Chadha has already been paid the claim amount of Rs.56178/-on 25.11.2001. He informed that he had already applied to RTO, Mukatsar for transfer of the vehicle for which he produced a receipt dated 28.05.2001 wherein the R.C. has been received and duly acknowledged by them. He further informed the Forum that all the bills and cash memo which were submitted to the Insurance Company were in his name and the receipt from Impact Motors from where the vehicle was repaired was also issued in his name. The payment receipt was also issued by them for Rs.22850/- in his name. The Insurance Company has, therefore, wrongly paid the claim to Shri Shyam Chadha as he had already made the payment of the vehicle to him and the same was under his possession. He has been trying to contact the Insurance Company but he was always given vague replies. He however informed that he came to know today itself that the claim has been settled in favour of Shri Shyam Chadha. He requested the Forum that his claim be paid to him. The representative of the Insurance Company informed the Forum that the vehicle No.DL 6CH 0089 was insured under their cover Note No.738979 in favour of Shri Shyam Chadha and the same had met with an accident on 30.05.2001.After they had received the surveyor’s report, they have deputed Shri B.D.Kapoor and Associates to investigate the matter and as per his investigation report, the vehicle was registered in the name of Shri Shyam Chadha. The Delhi RTO where the vehicle was registered had not received any transfer request nor request for NOC and on the basis of the investigation report and documents, they have accordingly settled the claim in favour of Shri Shyam Chadha. After hearing both the parties and on examination of the documents submitted, it is observed that claim has been paid by the Oriental Insurance Company Limited to Shri Shyam Chadha and Shri Ranjit Singh, the complainant, was asked to settle the matter with Shri Shyam Chadha. Shri Ranjit Singh informed the Forum that he had purchased the vehicle through a broker, Shri Harjeet Singh of Gulati Motors on 30.03.2001 and he did not know Shri Shyam Chadha. Since the claim had already been paid, it is for the Insurance Company to ascertain whether the claim has been paid correctly or not. I would, therefore, request the Chief Vigilance Officer of the Oriental Insurance Company Limited, Headquarters Delhi, should investigate and take appropriate steps in the matter as per their f indings.

Delhi Ombudsman Centre

Case No.GI/303/NIA/06 Ms. Vornica Sharma

Vs The New India Assurance Company Limited.

Award Dated : 16.10.2007 The complaint was heard on 04.10.2007. The complainant Ms. Vornica Sharma was present along with her uncle Shri Chander Mohan and the Insurance Company was represented by Shri V.K. Handa, A.O. Ms. Vornica Sharma had lodged a complaint with this Forum on 09.11.2006 that she had taken a motor policy from the New India Assurance Co. Ltd., New Delhi. The vehicle no. DL-2CW 3629 was stolen on 17.02.2004 and her claim had not been settled. In view of unprofessional att itude of investigator she has requested this Forum that such investigators should not be deputed by Insurance Companies to examine such claims. At the time of hearing Ms. Vornica Sharma informed the Forum that the vehicle was purchased under higher purchase from ABN Amro Bank for a sum of Rs.339000/- and the balance amount of Rs.39064/- was paid as down payment since at the time of marriage, her in-laws demanded the vehicle to be given to her as dowry. The car was in possession of her in-laws as she had some differences with her husband and she had lodged a complaint with ACP, Crime Against Women, Parliament Street, New Delhi. In the complaint she had mentioned that on enquiry with her husband that the installments towards the payment of the loan to be made, her husband informed her that the same would be paid by the Taxi person. Her mother had paid the two installments of the loan to the recovery agents. The car was in possession of her in-laws whom Shri Sanjay Kumar is known and he took the vehicle with their consent and she was informed of the theft of the car and FIR was lodged in this connection. She further mentioned that the investigator had sent number of letters to her and she had been replying to the various queries raised by him and submitt ing documents. However, he was repudiating her claim and as such he has submitted his f irst report after nearly 9 months of this theft of the vehicle. She has requested that her claim may be paid. The representative of the Insurance Company informed the Forum that the theft of the vehicle was investigated by Shri Sanjeev Nijhawan and as per his report the insured did not cooperate as mentioned in the report and he could not correlate the cause of theft. Further, as per the complaint letter dated 23.03.2004 to ACP, CAW, Parliament Street, New Delhi that the subject vehicle was being used as Taxi by Shri Puneet Dhawan her then husband. She had mentioned in the complaint to the police that the subject car was assigned for hiring purposes to a Traveling Company and she had persuaded her husband to pay the Bank Loan installments regularly which her husband promised to pay after getting payment from the Travel Company where the subject car was attached. The investigator has finally concluded that the subject car was being used as a Taxi during the tenure of the policy which does not cover use for Hire or/ reward. On enquiry by this Forum as the proximate cause of the loss of vehicle was theft, what relations as a use of vehicle have? The representative of the Insurance Company informed the Forum that the vehicle was taken once by Shri Sanjay Kumar from father-in-law of Ms. Vornica Sharma and from Gurgaon he had to travel to Ghaziabad which in itself raises suspection. He further informed the Forum that her earl ier claim was also fi led as No Claim as her father-in-law had a fake driving l icense. On enquiry by the Forum that, whether the Insurance Company had any prove to establish that, the vehicle was being used as a Taxi ? The representative of the Insurance Company was not able to give any reply. They further informed that they

have rightly repudiated the claim based on the investigation report of Shri Sanjeev Nijhawan who has mentioned that as per the complaint of Ms. Vornica Sharma dated 23.03.2004 to ACP, CAW, Parliament Street, New Delhi, the vehicle was assigned for hiring purposes to a Traveling Company. After hearing both the parties and on examination of the papers submitted it is observed that the vehicle no. DL-2CW 3629 was stolen on 17.02.2004, which was investigated by Shri Sanjeev Nijhawan, the FIR no. 54/04 dated 18.02.2004 was found in order as well as the untraced/Final Report dated 07.05.2004 was also found in order and as per the police records the subject car is not traced. The Insurance Company has repudiated the claim on the grounds that it was being used as Taxi, which is based on the complaint lodged by the complainant with ACP, CAW, Parliament Street, New Delhi on 23.02.2004. The complainant during the course of hearing had explained to the Forum that she was having some differences with her husband and the complaint was lodged wherein she had listed out all the property given to her in her marriage. As she did not know how to drive and she did not possess any driving l icense and she had enquired from her husband that how they would be paying the installments to the financers, her husband had advised her that it was given to the travel agency who would be paying the amount and subsequently he would settle the installments. The Insurance Company or the investigator is not been able to establish that the vehicle was being used as a Taxi, however, the proximate cause is theft and motor policy being a named peri l policy, theft does not have any relations with the purpose of use. However, the investigator during the investigation has also not mentioned nor established that Shri Sanjay Kumar who had borrowed the vehicle from the father-in-law of the complainant any consideration was to be paid for its use. In view of the foregoing I am not in agreement with the basis of repudiation of the claim by the Insurance Company since the proximate cause being theft, the Insurance Company is l iable to make payment of the claim. I therefore pass an Award that the Insurance Company should pay the IDV of the vehicle along with 8% interest from 01.06.2004 ti l l the date of this Award. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No.GI/171/OIC/06

Shri Ramesh Panduranga Vs

The Oriental Insurance Company Limited Award Dated : 06.11.2007 The complaint was heard on 21.09.2007 and 02.11.2007. The complainant Shri Ramesh Panduranga was present along with Shri B.R. Sharma and the Insurance Company was represented by Shri Yogesh Dayal, Sr. Branch Manager. Shri Ramesh Panduranga had lodged a complaint with this Forum on 07.07.2006 that he had insured his Toyoto Qualis, vehicle no. DL 4CP 6074 with Oriental Insurance Co. Ltd., Delhi. The vehicle had met with an accident on 17.02.2005. The Company appointed the Surveyor Shri Ashwani Sethi on 25.02.2005 who assessed the loss for Rs.97472/-. The Company also got the vehicle re-inspected by the same surveyor on 09.06.2005 vide his report dated 04.07.2005. He has requested the Forum that his claim be paid. At the time of hearing, Shri Ramesh Panduranga informed the Forum that the vehicle had met with an accident on 17.02.2005 at Meerut bypass. He had already explained to

the Insurance Company that the difference in the cause of accident as per the claim form and the police report vide his letter dated 27.01.2006, informed the Forum that his car collided with the tractor as a result of which his car got badly damaged and he became sub conscious and his wife got seriously injured who was sitt ing in the front seat and other relatives in the back side who got minor injuries. He was immediately taken to the nearby hospital when huge crowd pushed his car with such a force that the car moved towards its fixed direction of the left side which stopped touching a tree and the car was subsequently towed to the Police Station. The difference in the two versions is because of his relatives who had come from Delhi had reported the matter after the final inspection of the car which was towed to the nearby police station and they were asked to give a letter to the police authorit ies accordingly. On enquiry by this Forum to the representative of the Insurance Company that there was a loss to the vehicle as a result of accident which was established by the police was the cause of accident material? The representative of the Insurance Company replied that it was not very material once it has been established that there was an accident to the vehicle. Further, Shri Ramesh Panduranga informed the Forum that re-inspection of the vehicle was got done by Shri Ashwani Sethi on 09.06.2005 at the work shop and he had submitted his re-inspection report no. 16313/SR/2005 dated 04.07.2006 as such the demand for the same by the Insurance company is not justif ied. Further, he had subsequently sold the vehicle after repairs. On enquiry by this Forum with the representative of the Insurance Company that after repair of the vehicle was it necessary for the insured to take permission before selling the vehicle? The representative of the Insurance Company informed the Forum that it was not necessary for the insured to take permission to sell the vehicle after formalit ies of the claim had been complied with.

The representative of the Insurance Company informed that they had repudiated the claim because of the difference in cause of the accident. However, the Forum enquired whether the surveyor had ascertained the true cause of accident and assessed the loss based on the same. The representative of the Insurance Company informed that the surveyor had taken into consideration the cause of accident was as a result due to the collusion with a tractor.

After hearing both the parties and on examination of the documents submitted it is observed that vehicle no. DL 4CP 6074 met with an accident on 17.02.2005 which was surveyed by the Surveyor Shri Ashwani Sethi and he had assessed the loss for Rs.97472/- The claim has been repudiated on the grounds that the cause of accident as per the claim form and police report was different and the vehicle was not re-inspected after its repairs. The police report established that there was an accident to the vehicle and the cause is only material to the extent of damages to the vehicle and the surveyor Shri Ashwani Sethi in his report has clearly mentioned that the vehicle had actually coll ided with the tractor and accordingly issued his survey report no. 16313/SR/2005 dated 04.07.2005 assessing the loss for Rs.97472/-. The Insurance Company has wrongly repudiated the claim on the grounds of difference in the cause of accident. The vehicle has been re-inspected and there is re-inspection report of Shri Ashwani Sethi dated 04.07.2005 wherein he has inspected the vehicle on 09.06.2005 after its repairs in the work shop. Therefore, the basis of rejection of the claim by the Insurance Company is therefore not justif ied, since, it has been established that the vehicle had met with an accident and was re-inspected after repairs on 09.06.2005.

I, therefore, pass an Award that the sum of Rs.97472/- be paid to Shri Ramesh Panduranga after completion of formalities along with 8% interest from 15.08.2005 ti l l the time of payment.

The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No.GI/235/ICICI- Lomb/06

Mohd. Nasir Ahmed Vs

ICICI Lombard General Insurance Company Limited Award Dated : 17.12.2007 The complaint was heard on 19.09.2007 and 27.11.2007. The complainant Shri Mohd. Nasir Ahmed was present along with Shri Rakesh Garg. Insurance Company was represented by Shri Vishal Jain, Manager (Legal). Shri Mohd. Nasir Ahmed had lodged a complaint with this Forum on 08.12.2006 that he had insured his Motor Car No. TN 01 Q 4858 with ICICI Lombard General Insurance Co. Ltd. They have been requesting the Insurance Company to settle the claim but of no avail. The representative of Shri Mohd. Nasir Ahmed informed the Forum that the vehicle was completed gutted and so it had no salvage value and it was the negligence of the Insurance Company that they did not take the possession of the vehicle immediately after the loss as repairer was not prepared to give an estimate for the damages since the vehicle was completely gutted. He requested the Forum that his claim may be settled for the I.D.V. and he should be paid interest on the same. After hearing both the parties and on examination of the documents submitted it is observed that vehicle no. TN 01 Q 4858 which was insured with ICICI Lombard General Insurance Co. Ltd. under policy no. 3001/1743469/00/001, the I.D.V. is of Rs.229600/-. As per surveyor report of Shri Rameshwar Dayal Bansal no. RDB/Interim/TL/07/4858 dated 08.08.2006; the vehicle was in badly burnt condition with missing of certain parts l ike gear box assly, complete suspension with all tyres and many more parts. The wreck value would be around Rs.15000/-. Keeping in view the observation of the surveyor, I pass an award that the Insurance Company pay 75% of IDV of Rs.229600/- less policy clause without collection of the salvage of the burnt vehicle. The deduction of 25% is on account of the negligence of the Insured for not protecting the vehicle as the same it appears was abandoned which is contrary to the Principles of Insurance, where the insured is to protect the property as if he is not insured. Shri Mohd. Nasir Ahmed be paid 8% interest from 11.07.2006 ti l l the time of payment on the amount payable. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.


Ms. Anubha Thakkar Vs

ICICI Lombard General Insurance Company Limited Award Dated : 19.12.2007 The complaint was heard on 13.06.2007, 17.08.2007 and 27.11.2007. The complainant Ms. Anubha Thakkar was represented by Shri P.S.N. Murthy. Insurance Company was represented by Shri Vishal Jain, Manager (Legal).

Ms. Anubha Thakkar had lodged a complaint with this Forum on 24.01.2007 that her car no. DL-4CAD 0633 was insured with ICICI Lombard General Insurance Co. Ltd. under policy no. 3001/50540422/00/000. She has requested that a fresh policy be issued by rectifying the voluntary excess clause as also voluntary deductible and also refund the amount of Rs.5000/- which has been deducted from the claim amount. At the time of hearing the representative of Ms. Anubha Thakkar informed the Forum that the calculation sheet was given by the agent of ICICI Lombard agreed to which the premium had been paid. On enquiry by this Forum that the total premium as per the calculation showed worked out as Rs.20067/-, how they had paid a sum of Rs.17500/- whereas even after discount in the calculation it is mentioned as Rs17743/-. The representative informed the Forum that it was utmost good faith that they paid this amount. However, they had never agreed to voluntary excess of Rs.5000/-. The Insurance Company was asked by this Forum to produce the proposal Form which was produced and shown to the representative, in the proposal form it is clearly indicated that voluntary excess of Rs.5000/-. The representative contested that the signature in the proposal form is neither of Ms. Anubha Thakkar nor any of her representatives. On enquiry by this Forum that when the policy was received by the insured they should have examined the policy where it is clearly mentioned voluntary deductions of Rs.5000/- and they should have raised the query. The representative informed the Forum that there was no apprehension or doubt about the terms and condit ions at the time of taking the policy and the same was not looked into. He has requested the Forum that his policy be corrected and he should be paid a sum of Rs.5000/- which has been deducted from his claim amount. The representative of the Insurance Company informed the Forum that the complainant on receipt of the policy should have raised objection regarding the deductibles of Rs.5000/- and they would have looked into the matter. Since she had agreed for this deductible in the proposal form and they have accordingly paid the claim. After hearing both the parties and on examination of the documents submitted it is observed that Ms. Anubha Thakkar has submitted calculation sheet by the agent of ICICI Lombard General Insurance Co. Ltd. and the total premium worked out to be Rs.20067/- and after discount the premium worked out as Rs.17743/-. However, she had paid Rs.17500/-. This document could not be taken at the face value since there was no signature of the person submitt ing this quotation nor it is on the letter head of the Insurance Company. On perusal of the proposal Form it is observed that it is not signed by Ms. Anubha Thakkar as the signature can be compared with the complainant signature on the complaint letter. However, as per the proposal form there was voluntary deduction of Rs.5000/- and the policy has been issued accordingly. Ms. Anubha Thakkar should have immediately raised objection on receipt of the policy and her contention that she has not looked into the terms and conditions is not justif ied reason after a claim has been reported on the Policy. The Insurance policy is contract and once both the parties have agreed to execute the contract by means of policy as such terms and conditions are binding. As Ms. Anubha Thakkar has not raised any objection on receipt of the policy she is to be governed by the same in case of any eventuality. The Insurance Company has therefore rightly interpretated the policy and has deducted Rs.5000/- from the claim amount which is clearly mentioned in the policy terms and conditions. I therefore uphold the decision of the Insurance Company making the payment of Rs.2902/- which is as per the terms and conditions of the policy. The complaint stands dismissed.

Delhi Ombudsman Centre Case No. GI/69/NIA/06 Smt. Bhupinder Kaur

Vs New India Assurance Company Limited

Award Dated : 15.01.2008 The complaint was heard on 06.07.2007, 07.09.2007, 14.11.2007 and on 04.01.2008. The complainant, Smt. Bhupinder Kaur, was present accompanied by her brother-in-law Shri Surj it. The Insurance Company was represented by Shri Sanjay Uppal, Senior Divisional Manager. Smt. Bhupinder Kaur has lodged a complaint with this Forum on 23.03.2006 that her husband Shri Sant Prakash Singh had met with an accident on 04.08.2003 and expired on the spot. He was traveling along with the driver in Tata-407 No.DL-1LB 1442 which was insured with the New India Assurance Company Limited under policy No.320301/31/03/01617. He was the owner of the vehicle. She had lodged death claim as well as Personal Accident claim at Shahdara Branch Office of the Insurance Company but t i l l date the claim has not been settled. She has requested the concerned officer to settle the claim. Since almost three years have passed but the claim has not been settled, she has requested the Forum that her claim may be settled. At the time of hearing, the complainant informed the Forum that the Insurance Company have repudiated their claim on the grounds that the driving l icense of Shri Banwari Lal was found to be fake whereas her husband Shri Sant Prakash Singh’s driving license was not valid at the time of accident. Smt. Bhupinder Kaur produced a photocopy of another driving l icense of Shri Banwari Lal issued by RTO, Mathura which the Insurance Company was required to get it verif ied before the Forum could consider the matter. The Insurance Company at the time of hearing on 04.01.2008 informed the Forum that the driving license of Shri Banwari Lal issued by RTO, Mathura was found to be genuine and a valid document. The complainant also contested that the driving l icense of her husband which had expired on 12.07.2003 should have been renewed within one month from the retrospective date and since he had died on 04.08.2003, there was enough time to renew the l icense. She requested the Forum that the own damage claim along with Personal Accident claim be paid to her. The representative of the Insurance Company contested that vehicle No.DL-1LB-1442 had met with an accident on 04.08.2003. The Own Damage claim was repudiated because the driver Shri Banwari Lal was not having a valid driving l icense. On enquiry by this Forum that the complainant had produced a photocopy of another driving l icense which was found to be valid, the representative of the Insurance Company informed the Forum that as per the Motor Vehicles Act, no person is supposed to have two driving l icense. Since the earlier driving l icense was found to be fake, there is no l iabili ty of the Insurance Company. As far as Personal Accident claim is concerned, there is no FIR, Post Mortem conducted, therefore, the Insurance Company is not l iable to pay the claim. On enquiry by this Forum from the complainant why FIR was not lodged nor post mortem was conducted, she informed that she was unaware that her husband was covered under Personal Accident policy. As such, they lodged a complaint with the police on 04.08.2003 that the body of late Shri Sant Prakash Singh be handed over to them to perform last rights as they did not expect any foul play. Had they known that the deceased had a personal accident cover and post mortem is required, they would accordingly get the same conducted. After hearing both the parties and on examination of the documents submitted, it is observed that the Insurance Company had rejected the own damage claim of the

vehicle on the grounds that the driver Shri Banwari Lal had a fake driving l icense. As regards the Personal Accident claim, since there was no FIR lodged nor post mortem conducted so as to establish that the death was due to accident, they have rejected the claim. Moreover, the driving l icense of Shri Sant Prakash Singh had also expired. I would l ike to deal both the cases separately as under: ( i) Own Damage Claim : The Insurance Company has rejected the claim of the vehicle on the grounds that the driver Shri Banwari Lal had a driving l icense No.79365/2001/Agra issued by RTO-Agra which was found to be fake. The Insurance Company subsequently have confirmed that the 2nd l icense of Shri Banwari Lal issued by RTO Mathura is valid and genuine document. A person when hiring a driver only sees that he has a valid Driving License and conducts a driving test and after both these aspects are fond to be met, he hires the person and does not wait to get his driving license checked from the Regional Transport Authority, i f he does so he wil l never be able to hire a driver. On this front, I am guided by the Order passed by Honourable Supreme Court of India in the case of United India Insurance Company Limited Vs Lehru and Other (Civil Appeal No.1959 of 2003) where the Honourable Court has said: “When an owner is hiring a driver he wil l therefore, have to check whether the driver has a driving l icense. If the driver produces a driving license which on the face of it looks genuine, the owner is not expected to f ind out whether the l icense has in fact been issued by a competent authority or not. The owner would then take the test of the driver. If he finds that the driver is competent to drive the vehicle, he wil l hire the driver. We find it rather strange that insurance Companies expect owners to make enquiries with RTO’s which are spread all over the country, whether the driving license shown to them is valid or not. Thus, where the owner has satisfied himself that the driver has a l icense and is driving competently there would be no breach of Section 149(2) (a)(ii). The Insurance Company would not then be absolved of l iabil i ty. If i t ult imately turns out that the l icense was fake the insurance company would continue to remain l iable unless they prove that the owner/insured was aware or had noticed that the l icense was fake and sti l l permitted that person to drive.” In view of foregoing, the Insurance Company has not been able to establish that the late Shri Sant Prakash Singh had been negligent in employing Shri Banwari Lal and as per the Judgement of Honourable Supreme Court with regard to the fake driving l icense, I feel that the Insurance Company has wrongly repudiated the claim keeping in view that the driving license issued by RTO, Mathura was genuine and Shri Banwari Lal was authorized to drive Heavy Motor Vehicles. The contention of the Insurance Company that a person cannot hold two driving l icense does not entit le them to avoid their l iabil ity. I do not consider it reasonable and hence pass the Award that the Insurance Company is l iable to pay the Own Damage Claim. (i i) Personal Accident Claim : The Insurance Company has rejected the claim on the grounds that there was no FIR nor post mortem conducted which establishes that the death was due to accident. The Insurance Company is guided by the report of M/S.Surya Claims Bureau Limited. I have examined the report of M/S.Surya Claims Bureau Limited wherein Shri Banwari Lal, driver informed the family of the insured on phone that one bus came from opposite side of the truck and dashed it very badly. On 04.08.2003 at around 5 a.m. trying to overtake a Haryana Roadways bus hit i t on the conductor side result ing in the insured being hit badly and died on the spot. Further, the investigation report mentioned that the brother of the deceased took the body of Shri Sant Prakash Singh away from the accident. The complainant at the time of hearing submitted a document

bearing the stamp of Police Station (Dahat), Bulandshahar mentioning that at 9.10 hours on 04.08.2003, Pushpajeet Singh S/O late Shri Sant Prakash Singh resident of U-27, Naveen Shahdra, Delhi along with Shri Surjeet Singh came to the police station that Sant Prakash Singh in his vehicle DL 1 LB 1442 whilst met with an accident as a result his father Shri Sant Prakash Singh died at about 5 a.m. and requested the police authority to register the complaint. The complaint was handed over to Head Constable Shri Shakoo Ahmed for investigation. A copy has been given to the complainant. It is also surprising that the police had handed over the dead body without conducting the Post Mortem. It was their duty to get the post mortem done keeping in view that the vehicle had met with an accident with another vehicle as mentioned in the complaint. The reasons best known to the police authorit ies as to why they had not conducted the post mortem in this case. As such, I feel that the death had occurred due to accident and the dead body of Shri Sant Prakash Singh was taken away by the family members without post mortem which has been recorded in the statement provided by the police and the same is also acknowledged. As far as driving l icense of Shri Sant Prakash Singh which was valid up to 12.07.2003 can be renewed effective from the date of expiry within 30 days as per Section 14 of Motor Vehicles Act 1988 and Shri Sant Prakash Singh died on 04.08.2003 which was within the grace period of 30 days as such it should be treated to be valid. In view of the foregoing, it is clearly established that Shri Sant Pal Singh’s personal Accident claim can be paid as the documents submitted by the complainant and duly acknowledged by the police establishes death due to Road Accident and the driving l icense was also valid at the time of death of Shri Sant Prakash Singh. I, therefore, pass the Award that the Insurance Company is l iable to pay (i) the Own Damage Claim to the vehicle (i i) the Personal Accident claim for owner/driver late Shri Sant Prakash Singh. The Award shall be implemented within 30 days of receipt of the same. The compliance of the Award shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No. GI/148/NIC/06

Shri B.L. Kohli Vs

National Insurance Company Limited Award Dated : 30.01.2008 The complaint was heard on 09.01.2008. The complainant, Shri Bansi Lal Kohli, was present accompanied by his son Shri Arun Kohli. The Insurance Company was represented by Shri H.C.Pandey, Assistant Manager. Shri Bansi Lal Kohli has lodged a complaint with this forum on 15.05.2006/24.07.2006 that the National Insurance Company Limited has rejected his motor claim. He has requested that he be paid IDV of Rs.4,50 lakhs being the value of the vehicle stolen along with 12% interest from the date of loss unti l the realization of the same, a sum of Rs.10000/- towards li t igation expenses, Rs.25000/- towards mental agony and harassment and Rs.25000/- towards various other expenses l ike travel, postage, t ime spent etc. At the time of hearing, Shri Bansi Lal Kohli reiterated the points raised by him in his complaint letter dated 15.05.2006/24.07.2006 and in his rejoinder dated 14.11.2007. He emphasized that he had complied with the provisions of GR-17 since the vehicle was transferred in his name only on 03.11.2004 and if there were any formalities to be completed, the Insurance Company should have got the same completed by sending

their representative. Most of the formalities mentioned in their letter were already with the Insurance Company. However, in case the new proposal form was to be fi l led in, the same should have been sent along with their letter dated 17.11.2004. As far as the policy is concerned, the same could have been submitted to them if they so desired. However, provisions of GR-17 only talks about the surrender of insurance certif icate and not the policy. As regards the inspection of the vehicle, there is no such provision under GR-17 and the vehicle had already been inspected when the Insurance was effected on 23.07.2004 by their Branch Manager. With regard to the letter from the original owner of the vehicle, Shri Prabhakar V. Modak, the letter dated 08.09.2004 was already submitted and the Insurance Company have nowhere mentioned that such a letter was required in init ial stage when he had visited the off ice on 08.11.2004. Shri Kohli has also informed that he sent a letter by courier so as to record its dispatch and has not visited the off ice as he had already done on 08.11.2004 when he was not apprised of all the formalities to be completed. He requested the Forum that he had complied with the provisions of GR-17 by applying on 17.11.2004 about the transfer of his vehicle in his name. He should be paid his claim along with 12% interest, cost and compensation for mental harassment. The representative of the Insurance Company informed the Forum that Shri Kohli had not applied for the transfer of vehicle within the stipulated time and there were a number of formalities which the transfer could be effected as per the provisions of Motor Tariff and GR-17 which was communicated to him vide their letter dated 17.11.2004 and the cheque was returned to Shri Kohli in view of the that the vehicle had already been stolen on 15/16.11.2004. Due to non compliance of requirements detailed as per GR-17, the Insurance Company has rightly repudiated the claim. Both the parties were heard and detailed complaint and rejoinders have been examined by me. The main questions, therefore, remain that whether Shri Bansi Lal Kohli had approached the Insurance Company for transfer of insurance as per GR 17 within the stipulated 14 days as stated therein and whether he was entitled to receive the claim from the National Insurance Company Limited. The National Insurance Company Limited issued policy NO.361501/31/04/6101092 insuring vehicle No.MH-12-AX-3379 against comprehensive risk from 23.07.2004 to 22.07.2005 in the name of Shri Prabhakar V.Modak. Shri Bansi Lal Kohli had purchased this vehicle on 02.08.2004 by making the payment against the purchase of the vehicle on 31.07.2004. The vehicle was transferred in the name of Shri Bansi Lal Kohli by RTO, Delhi on 03.11.2004. Shri Kohli has mentioned about the HO Circular Ref: HO/MOT/0506/003 dated 02.06.2005 of the National Insurance Company Limited wherein certain guidelines have been laid down for transfer of insurance. This circular has been issued after the vehicle had already been stolen, which only clarif ies the provision of Motor Tariff. This Forum is not guided by the circulars issued by Insurance Company but the terms and conditions of the policy which is the basis of Contract. The vehicle was transferred in the name of Shri Bansi Lal Kohli on 03.11.2004. As per the provisions of GR-17, 14 days are provided so as to give some time for the new owner to apply for the transfer of insurance and complete the formalities which may be required for transfer of Insurance. Shri Kohli has written a letter to the Insurance Company on 11.11.2004 enclosing therewith a blank cheque towards the cost of transfer. The Insurance Company has returned the cheque after it was received in their office on 16.11.2004 asking Shri Kohli to comply with certain formalities. As per their letter dated 17.11.2004, the Insurance Company required the proposal form to be completed which is a requirement as per GR-17 of the Motor Tarif which they according to them had enclosed with their letter but Shri Kohli has not received. With regards to the proceedings of the purchase of the vehicle and date of purchase of the vehicle, Shri

Kohli had submitted the details of his draft as well as bank statement of Shri Modak (the transferor) wherein a sum of Rs.4.50 lakh has been credited in Shri Modak’s account in the month of August, 2004 and the draft was dated 31.07.2004 drawn on Indian Bank, Kashmere Gate, Delhi. Original Insurance policy has been demanded by the Insurance Company. As per GR-17, the old certif icate is required to be submitted and not the policy. The policy only rectif ied by an endorsement and I do not agree with the contention of the Insurance Company that the old policy was required. In case the old certif icate of insurance is not available, a proper declaration from that effect is to be taken from the transferee before a new certif icate is issued as per provision of GR 17. A letter from Shri Prabhakar V.Modak has already been sent on 08.09.2004 and the requirement of the Insurance Company that the vehicle is to be inspected before transfer of insurance as per Shri Kohli has no where mentioned in GR-17 and I am also in agreement with Shri Kohli since it is not a fresh insurance, it is only a transfer and in case the transfer request is more than 14 days old then the Insurance Company could insist on the inspection of the vehicle but since Shri Kohli has made a transfer request well before the completion of 14 days, that is on 11.11.2004, the same is well within the stipulated period as Shri Kohli had become the registered owner of the vehicle on 03.11.2004. Even the Insurance Company’s guidelines stipulate that once a cheque has been dispatched by insured, the risk is to commence or to be renewed from the date of dispatch of the cheque. Since Shri Kohli had sent the cheque on 11.11.2004 by courier which was received by the Insurance Company on 16.11.2004, the three intervening days being holidays the fresh cover is seamless and it does not warrant an inspection of the vehicle. The Insurance Company has also mentioned that Shri Kohli could have approached their office for transfer of insurance as the office is very close to his office, the same applies to the Insurance Company. The Insurance Company could have sent their agent or Development Officer to get the formalit ies completed immediately on receipt of the letter of Shri Bansi Lal Kohli and should not have returned the cheque and this amounts to deficiency in service as far as Insurance Company is concerned since they are supposed to cater to the requirements of the insured. The Insurance Company, as per Shri Kohli, has even failed to attach the proposal form with their letter. The contention of the Insurance Company that retention of the cheque would have amounted to their agreement to transfer the insurance, I do not agree with their contention as I see that all formalit ies which the Insurance Company has asked were not very material to transfer of Insurance except the letter from the previous owner Shri P.V. Modak as he was earning 35% NCB for he may l ike to retain the Insurance. Shri Kohli has mentioned that he, Shri Modak had already written to the Insurance Company for transfer of Insurance on 08.09.2004 this formality was also complied with as the Insurance Company has not been able to establish the non receipt of this letter. Further, the Insurance Company in its reply has also mentioned that 14 days were to be counted from 08.09.2004 which is not correct since Shri Kohli became the registered owner of the vehicle on 03.11.2004. The Insurance Company has been deficient in service by not sending their Agent/ Development Officer when they had received the request for Transfer of Insurance as their office according to them was in the same area. I, therefore, conclude that Shri Bansi Lal Kohli had applied to the Insurance Company within 14 days of the vehicle being registered in his name, that is, on 03.11.2004 and he had submitted his request vide his letter dated 11.11.2004 which was well within the stipulated time as per GR-17 of the Motor Tariff. The Insurance Company cannot deny its l iabil ity by not entertaining the claim. I, therefore, pass the Award that the National Insurance Company Limited is to pay to Shri Bansi Lal Modak the IDV of Rs.4,50,000/- along with 8% interest from one month

after the final investigation report was received by the Insurance Company ti l l the date of this Award since Shri Kohli would be required to comply with other formalit ies only after which the Insurance Company is able to make the payment of the claim. The Insurance Company should collect the charges which are recoverable for transfer of the Insurance fom Shri Kohli. This forum is not competent to pass any Award for mental harassment and cost incurred by Shri Bansi Lal Kohli. The Award shall be implemented within 30 days of receipt of the same. The compliance of the Award shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No. GI/447/OIC/07

Shri Niranjan Singh Vs

Oriental Insurance Company Limited Award Dated : 05.02.2008 The complaint was heard on 01.02.2008. The complainant, Shri Niranjan Singh, was present. The Insurance Company was represented by Shri Shampa Khastgir, Senior Branch Manager and Ms.Geeta Dayal, Administrative Officer. Shri Niranjan Singh has lodged a complaint with this Forum on 28.04.2006 that he had insured his vehicle No.DL 1LE 0377 with the Oriental Insurance Company Limited. The said vehicle was stolen from Gurgaon on 4/5 October,2006 night. He has requested the Forum that he be paid his genuine claim. At the time of hearing, Shri Niranjan Singh informed the Forum that his vehicle was parked by his driver on 4/5th night where the vehicle was usually parked and early in the Morning at 5.00 a.m. on 5t h morning, he was informed that the vehicle was not there. He along with his driver tr ied to search the vehicle but could not f ind the same. He immediately informed the Insurance Company’s office at Palam since he thought that the vehicle may be insured there. He informed the Insurance Company on 06.10.2006. Further, he had contacted the police authorit ies who told him that they would lodge police report after they have searched the vehicle. They only registered the case on 10.10.2006 and at the time of release of the letter, they collected the original intimation letter from him. He requested the Forum that there was no delay in intimating the theft case to the Insurance Company as well as to the police authorit ies and he should be paid his r ightful claim. The representative of the Insurance Company informed the Forum that they had rejected the claim because of late intimation of the claim to the police authorit ies as well as he had informed not the policy issuing office of the Insurance Company. On enquiry by this forum that when did Shri Niranjan Singh inform the Insurance Company, the representative of Insurance Company informed that it was on 06.10.2006 that he had submitted a written application informing about the theft of the vehicle to their Palam office. Further the Insurance Company representative informed that 100 Number (PCR) was not informed. On enquiry by the Forum that whether Gurgaon had the facil ity of 100 number (PCR), a facil ity available at Delhi, the representative of the Insurance Company had no answer. After hearing both the parties and on examination of the papers submitted, it is observed that Shri Niranjan Singh, the owner of the vehicle No.DL 1LE-0377 informed the Oriental Insurance Company Limited on 06.10.2006 that the said vehicle was stolen and had also informed the police. The Insurance Company has repudiated the claim on account of late intimation of 5 days to the police authorit ies. The representative of the

Insurance Company has confirmed that their Palam Office was informed about the theft of the said vehicle on 06.10.2006. As such, according to me, there is no delay since the vehicle was stolen from Gurgaon and the insured has informed the nearest off ice of the Insurance Company and the Insurance Company should have coordinated with their Sansad Marg Office (policy issuing off ice) about the insurance of the vehicle. The insured has also informed the police and it is an established fact that the police take time to register the FIR since they normally try to locate the vehicle and a formal FIR takes at least 2 to 3 days before it is accepted. The Insurance Company mentioned that there was no DD registered on 06.10.2006 but was on 10.10.2006, Shri Niranjan Singh had mentioned that the police authorit ies asked him to search for the vehicle and they took his complaint letter on 10.10.2006 and gave him the FIR. The Insurance Company having being informed on 06.10.2006, after the theft of vehicle on 05.10.2006, could have immediately deputed the investigator to trace the vehicle and Shri Niranjan Singh has not prejudiced their interest. The Insurance Company has therefore, wrongly repudiated the claim that there was a delay in intimation since Shri Niranjan Singh has lodged a complaint with the Insurance Company on 06.10.2006 which is immediately after the theft of the vehicle. I, therefore, pass the Award that Shri Niranjan Singh be paid the IDV of the vehicle by the Oriental Insurance Company Limited. The Award shall be implemented within 30 days of receipt of the same. The compliance of the Award shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No.GI/412/NIC/07

Ms. Mini S. Joseph Vs

National Insurance Company Limited Award Dated : 07.02.2008 The complaint was heard on 04.01.2008. The complainant Ms. Mini S. Joseph was present along with her husband Shri Siby Joseph. The Insurance Company was represented by Shri Bhupender Kumar, Administrative Officer. Ms. Mini S. Joseph had lodged a complaint with this Forum on 02.07.2007 that she has a Motor Policy for Maruti Car No. UP 16B 9795 from National Insurance Co. Ltd. from 04.10.2006. She lodged a claim with the National Insurance Co. Ltd. and they replied her that the same was treated as no claim. She has mentioned that she is in service and since she has lost her car is a great loss to her and has asked the Forum to consider her case sympathetically. At the time of hearing Ms. Mini S. Joseph requested the Forum that her genuine claim for the loss of her car should be paid which has been repudiated by the Insurance Company on the grounds that the registration book was in the name of her brother-in-law Shri Thomas Lukose whereas the insurance was in her name and nobody informed her that the insurance is to be transferred in the name of the new owner. On enquiry by this Forum that when the vehicle was driven and the police wanted to check the papers of the vehicle RC would have been in the name of Shri Thomas Lukose whereas the vehicle was insured in the name of Ms. Mini S. Joseph, whether the person driving would be in a posit ion to explain to the authorities why the vehicle did not have a valid insurance since the policy was in the name of another person. Ms. Mini S. Joseph did not have any explanation for this discrepancy.

The representative of the Insurance Company informed the Forum that there was no insurable interest of Ms. Mini S. Joseph the policy holder; as such the claim was repudiated. After hearing both the parties and on examination of the documents submitted, Ms. Mini S. Joseph had transferred the vehicle Maruti Car no. UP 16 B 9795 in favour of Shri Thomas Lukose on 16.04.2007 and the vehicle met with an accident on 12.05.2007 and the insurance policy was in the name of Ms. Mini S. Joseph. Since the insurance was not transferred in the name of new owner Shri Thomas Lukose, Ms. Mini S. Joseph did not have any insurable interest and had violated condit ion no. GR 17 of the Motor Tariff. The Insurance Company has therefore rightly repudiated the claim. I, therefore, uphold the decision of the Insurance Company. The complaint stands dismissed.


Shri Satyavir Singh Vs

ICICI Lombard General Insurance Company Limited Award Dated : 21.02.2008 The complaint was heard on 19.09.2007, 27.11.2007, 23.01.2008 and 06.02.2008. The complainant Shri Satyavir Singh was present. The Insurance Company was represented by Shri Ashwani Tyagi, Manager. Shri Satyavir Singh had lodged a complaint with this Forum on 20.03.2007 that his vehicle No. UP 16K 6644 Tavera, Engine No. 3GE19437, Chassis No. MA6AB6G765HG18861 was insured with ICICI Lombard General Insurance Co. Ltd. and he was issued a cover note no. PD 3095020. His vehicle was stolen on 05.11.2006 At the time of hearing Shri Satyavir Singh informed the Forum that he has not received the cheque said to have been sent by the Insurance Company and as such the Insurance Company was on risk and they should pay his claim for theft of his vehicle. He further informed the Forum that he had written number of letters dated 09.11.2006, 06.12.2006 and 09.02.2007 which were sent by courier and he has already submitted the Courier Challans to this Forum proving that he had already lodged a claim on the Insurance company and it is a after thought by them that they have not received the papers and also that the cheque submitted by him, there was a discrepancy in the words and figures of the premium amount therein. He requested the forum that his claim should be paid. The representative of the Insurance Company informed the forum that since they had found discrepancy in the premium cheque and they had returned the same vide their letter dated 07.10.2006. The cover note was not valid since the premium was not received since inception and there is no liabil ity of the Insurance Company. After hearing both the parties and on examination of the documents submitted it is observed that the Insurance Company have maintained that Shri Satyavir Singh had submitted the premium cheque for Rs.19616/- wherein the words and figures there was a discrepancy and they had written to him to submit a fresh cheque which he has not done so, as such the cover note was not valid and since there was non compliance of Section 64 VB of the Insurance Act where premium is to be received prior to acceptance of risk even cheques are subject to realization and the cover note is valid only if the premium has been credited to the Company’s Account. At the time of hearing the Forum enquired from Shri Satyavir Singh to prove that his account had been debited or not since he had not received the premium cheque from Insurance

Company for rectif ication. He was hesitant and reluctant to disclose any details of his account whether the amount was debited or not. Since Shri Satyavir Singh was not prepared to disclose his bank account details and he being fully aware that the cheque given to the Insurance company has not been realized he should have enquired from the Insurance Company the reasons for non presentation of the cheque which he has not done so. The Insurance Company having not received the premium and as per their letter dated 07.10.2006 there being discrepancy in the amount words and figures have no l iabil i ty to pay the claim as the cover note is void abinit io. I, therefore, uphold the decision of the Insurance Company. The complaint stands dismissed.

Delhi Ombudsman Centre Case No.GI/388/NIC/07

Smt. Nathi Devi Vs

National Insurance Company Limited Award Dated : 22.02.2008 The complaint was heard on 11.12.2007 and 19.02.2008 at Jaipur. The complainant Smt. Nathi Devi was represented by Shri Shanker Lal. The Insurance Company was represented by Shri R.K. Chhatwal, Branch Manager. Smt. Nathi Devi had lodged a complaint with this Forum on 21.05.2007 that her late husband Shri Banwari Lal had met with a Road Accident on 14.03.2006 and had suffered serious injuries. She has submitted the Deep Hospital discharge certif icate and her husband expired because of the injuries sustained in the road accident. She has requested the Forum that her claim may be paid. At the time of hearing the representative of Smt. Nathi Devi informed the Forum that Shri Banwari Lal was covered under the Motor Policy for Driver/Owner Personal Accident and his claim has been repudiated by the Insurance Company on account of non submission of Post Mortem report. He informed the Forum that she was not well aware that her husband was covered under Personal Accident nor she was educated but could only sign as such she was not aware that it was necessary to get post mortem report done nor the hospital authorit ies asked her to do so. As the road accident took place there is an FIR and Shri Banwari Lal did not gain consciousness after the accident. He requested the Forum his claim should be paid. The representative of the Insurance Company informed the Forum that since the post mortem was not conducted and Shri Banwari Lal had died after 61 days of the accident, i t was not established that he was died as a result of injuries sustained at the time of road accident. On enquiry by this Forum whether, any investigation had been carried out. The representative of the Insurance Company informed the Forum that investigation was conducted by M/s. Arihant Investigation Bureau, Jaipur. As per the investigation report the case of Shri Banwari Lal was referred to Dr. Ramesh Vijay of Jaipur. However, it was not clearly establish that the death was due to accident since no post mortem have been conducted accordingly they have repudiated the claim. After hearing both the parties and on examination of the documents submitted it is observed that Shri Banwari Lal, owner of vehicle no. RJ-14-43M-5441 which was insured with National Insurance Co. Ltd. had met with an accident near Dodo on 14.03.2006 and FIR no. 70/06 under IPC Section 279 and 337 has been lodged mentioning that the vehicle no. RJ 02 C 1464 came from Jaipur side driven rash and negligently hit the vehicle no. RJ 14 43M 5441 of Shri Banwari Lal driver of the motor

cycle and Shri Sohan Lal who was sitt ing behind Shri Banwari Lal fell down from the Motor Cycle Shri Banwari Lal sustained serious injuries in his head. He was admitted in SMS Hospital on 14.03.2006. Shri Sohan Lal who had received small injuries was discharged from the hospital and he lodged a FIR. Shri Banwari Lal expired on 31.05.2006 at Deep Hospital, Jaipur while he was admitted in hospital on 30.05.2006. Smt. Nathi Devi w/o. Shri Banwari Lal lodged a claim on the Insurance Company under Personal Accident Cover of Driver/ Owner, since Shri Banwari Lal was the driver and was also the owner of the vehicle no. RJ 14 43M 5441. National Insurance Co. Ltd. vide their letter dated 01.05.2007 repudiated the claim on the grounds that no post mortem report was conducted and the same has not been submitted. I have examined the Investigation report of M/s. Arihant Investigation Bureau, Jaipur report dated 21.08.2006, under the conclusion it is mentioned that there is no doubt that Shri Banwari Lal had died due to the injuries he had sustained in the road accident while driving the motor cycle. However, the body was not subject to post mortem, however, the vil lage sarpanch have confirmed the accidental death of Shri Banwari Lal. He further recommends that the Company may seek the opinion of a medical expert and settle the claim as per the terms and condit ions of the policy. The Insurance Company had referred his case to Dr. Ramesh Vijay, whereas the doctor has mentioned that in his opinion the proximate cause of death was head injury Dubacanal bleed leading to pyrecei with septicemic that is responsible for Cardiomyopathy arrest. However, certif icate issued by Deep Hospital dated 09.11.2006 mentioned that Shri Banwari Lal s/o. Shri Chanda Lal aged 25 years Hindu male r/o. Sobner is declared dead on 31.05.2006 at 11.30 p.m. Proximate cause of death is RTA – (HC Bleed in internal capsule, 3.0 ventricles) pyrecia septicemic cardiomyopathy arrest. The Insurance Company has repudiated the claim on the grounds that there is no post mortem report. I do not agree with the Insurance Company’s contention that post mortem report is required as per policy terms and conditions. The Policy terms and conditions are silent which mentions that the nominee of the deceased is to establish that the death was due to road accident. The Investigator Dr. Ramesh Vijay as well as Dr. P. Joshi of Deep Hospital where Shri Banwari Lal was last admitted on 30.05.2006 confirms that the proximate cause of death is road accident which resulted in bleed leading to pyrecei with septicemic that is responsible for Cardiomyopathy arrest. The opinion of the two doctors can be relied upon and I have no hesitation in passing an Award that the Insurance Company should pay Personal Accident claim to the deceased nominee/ claimant. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.


Shri Ravi Kumar Soni Vs

ICICI Lombard General Insurance Company Limited Award Dated : 25.02.2008 The complaint was heard on 11.12.2007 and 19.02.2008 at Jaipur. The complainant Shri Ravi Kumar Soni was present along with his friend Shri K.K. Nagpal. The Insurance Company was represented by Shri Vishal Jain, Manager- Legal. Shri Ravi Kumar Soni had lodged a complaint with this Forum on 07.04.2007 that his car no RJ-14-5C-5626 Toyota Qualis was insured with ICICI Lombard General Insurance Co. Ltd. vide their policy no.3001/1439468/00/000 from 23.04.2006 to 22.04.2007. Vehicle had met with an accident on 08.10.2006 and he had informed the

Insurance Company of the same on 09.10.2006. He received a letter dated 25.01.2007 that his claim has been rejected on the grounds that the vehicle was used for commercial purposes. He has never used his car for hire or reward racing and as such his claim may be paid. At the time of hearing Shri Ravi Kumar Soni reiterated what he had written in his letter dated 07.04.2007. He further informed the Forum that he is running a travel agency but this car no. RJ 14 5C 5626 is being used for his private and professional purposes and is not given on hire or reward racing. Since his family is a large family and there is always a requirement of the car. He further informed the Forum that his driver has also submitted the statement to this effect to the Insurance Company. He requested the Forum that his claim may be paid. The representative of the Insurance Company informed the Forum that Shri Ravi Kumar Soni was running Tours and Travels Agency and investigator had got quotation from him dated 25.07.2007 wherein it established that he was running cars on hire and he has also quoted for the Qualis which clearly establishes that he has been using the car for Hire and reward. On enquiry by this Forum that this quotation letter mentions various types of car whether the Insurance Company had any evidence to show that vehicle no. RJ 14 5C 5626 was however used as taxi, such as bil ls mentioning there in this vehicle number or any other evidence. The representative of the Insurance Company was unable to submit such evidence. After hearing both the parties and on examination of the documents submitted it is observed that vehicle no. RJ 14 5C 5626 had met with an accident on 08.10.2006 as a result of rash driving of the driver of the vehicle no. RJ 14P 8955. The Insurance Company has repudiated the claim on the grounds that Shri Ravi Kumar Soni was running a travel agency and the vehicle was being used for hire and reward but they have failed to establish that the vehicle was being hired out to the clients of Soni Tours and Travels. Merely giving quotation does not prove that the vehicle was being used for hire and reward. The Insurance Company having failed to establish that the vehicle was being used for hire and reward, I do not agree with the decision of the Insurance Company in repudiating the claim. I therefore pass an Award that the Insurance Company should make the payment of the claim of Shri Ravi Kumar Soni. Further, the Insurance Company vide their letter dated 25.01.2007 has canceled the policy and as per the contention of Shri Ravi Kumar Soni he has not received the refunded premium. The Insurance Company is advised to make the payment of balance refund of premium from 02.02.2007 ti l l 22.04.2007 in case the refund is already not been made as the Insurance Company was not able to establish that they had issued a cheque for the refund of premium or not. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No. GI/432/IFFCO/07

Smt. Mahender Kumari Vs

IFFCO TOKIO General Insurance Company Limited Award Dated 25.02.2008 The complaint was heard on 08.02.2008. The complainant, Smt. Mahender Kumari, was present accompanied by her son Shri Anil Sadana. The Insurance Company was represented by Shri Amit Kumar, Legal Executive.

Smt. Mahender Kumari has lodged a complaint with this forum on 01.05.2007 that her husband late Shri Hari Ram was the owner of the vehicle No.DL 4SA W 2389 which was insured with Iffco Tokio General Insurance Company Limited. She said that her claim was genuine which was not considered by the Insurance Company.

At the time of hearing, the representative of the complainant informed the Forum that his father Shri Hari Ram was the registered owner of the vehicle who had died as a result of road accident on 21.06.2005. The claim of which has been repudiated by the Insurance Company on the grounds that the deceased did not have a valid driving l icense. The complainant contested that since her husband was covered under Personal Accident policy, the claim was payable even though the driving l icense was not valid. She requested the Forum that the claim may be paid.

The representative of the Insurance Company informed the Forum that as per the terms and condit ions of the policy, Shri Hari Ram did not hold a valid driving l icense at the time of accident and as such it violated the terms and conditions of the policy. As such, the claim is not payable.

After hearing both the parties and on examination of the documents submitted, it is observed that Shri Hari Ram, owner of the vehicle No. DL 4SA W 2389, died as a result of road accident on 21.06.2005. He was holding a driving license valid from 23.06.1999 to 22.06.2004. Since the driving license was not valid at the time of accident, the claim is not payable as it has violated the terms and condit ions of the policy which reads as follows “ Provided that a person holds an effective Driving License at the time of accident and is not disqualif ied from holding or obtaining such a l icense.” The Insurance Company has rightly repudiated the claim.

I uphold the decision taken by Iffco Tokio General Insurance Company Limited repudiating the claim of Smt. Mahendra Kumari.

There is no further relief to be granted to the complainant.

Complaint is disposed of f inally.

Delhi Ombudsman Centre Case No.GI/464/NIA/07 Shri Gurbaksh Singh

Vs The New India Assurance Company Limited

Award Dated : 11.03.2008 The complaint was heard on 07.03.2008. The complainant Shri Gurbaksh Singh was present. The Insurance Company was represented by Shri Mahesh Chandra, Branch Manager. Shri Gurbaksh Singh had lodged a complaint with this Forum on 14.08.2007 that he had insured his Tata indigo car No. DL 3CY 7037 with New India Assurance Co. Ltd. under policy No. 31/06/0574. The vehicle had met with an accident on 11.02.2007. He has requested that he is dealing with Insurance Company which works like a government department and takes time and his claim may be settled. At the time of hearing Shri Gurbaksh Singh informed the Forum that he had lodged a claim for his Tata Indigo car and had furnished all the documents required by the Insurance Company from time to t ime and his claim has not been settled up ti l l now. He requested the Forum that his claim may be settled immediately. The representative of the Insurance Company informed the Forum that Shri Parminder Singh who was driving the vehicle at the time of accident holding an international

l icense which was valid from 01.12.2004 for one year and they had deputed the investigator Shri Suresh Kumar to verify the genuineness of the l icense. However, as per the investigator report the date of issuance of the license was 01.12.2004 and not 01.12.2006 and hence the claim was not payable as per the terms and conditions of the policy. They had deputed another senior surveyor to re-verify the l icense by M/s. ABM Engg. & Consultants who have contacted department of Highway Safety & Motor Vehicles, State of Florida who informed them that this license does not belong to Florida. Shri Gurbaksh Singh immediately informed the Forum that the l icense of Shri Parminder Singh was not issued by the State of Florida but by the Automobile Association, Heathrow, Florida USA. He produced the original l icense for its examination. Further, he also drew the attention of the Forum that to the letter dated 18.09.2007 issued by M/s. Chicago Motor Club confirming that the l icense permit No. 70085132 was issued to Shri Parminder Singh on 01.12.2006 and wil l be valid for one year from that date. This Forum informed the representative of the Insurance Company that even in India, Automobile Association were authorized to issue international Driving License, and they should have verif ied the same with the Automobile Association at Delhi. The representative of the Insurance Company pleaded ignorance of the prevailing practice in India. After hearing both the parties and on examination of the documents submitted it is observed that vehicle No. DL 3CY 7037 met with an accident on 11.02.2007 and Shri Jeewan Agarwal had been appointed to assess the loss. Shri Agarwal had submitted his report no. 0702/43 dated 16.03.2007 for Rs.105747/-. In his report Shri Agarwal has mentioned that Driving License is to be checked. Shri Parminder Singh who was the driver at the time of accident was holding an International l icense and the expiry date of the license could not be read clearly by the Insurance Company whether it was 01.12.2004 or 01.12.2006, since the l icense was valid only for one year from the date of issue. They had contacted the Highway Safety & Motor Vehicles, Florida and were informed that this license did not belong to their State of Florida. Shri Gurbaksh Singh has produced the original l icense to this Forum and on examination of the same it is found that the l icense has been issued by Automobile Association, Heathrow, Florida, USA. The date of issue which was the bone of contention for the Insurance Company has been confirmed by M/s. Chicago Motor Club vide their letter dated 18.09.2007 that this Driving Permit No. 70085132 was issued on 01.12.2006 as such the same was valid at the time of accident. Letter dated 18.09.2007 was submitted by Shri Gurbaksh Singh on 20.09.2007 to the Insurance Company and I do not see any reason for deputing two investigators to get the particulars verif ied. The Insurance Company could have written to the issuing authority immediately on receipt of this certif icate whether they have issued this l icense or not instead of referring the matter to various investigators for investigation. I therefore, conclude that the Driving License issued to Shri Parminder Singh was valid at the time of accident and pass an Award that Shri Gurbaksh Singh be paid a sum of Rs.105747/- as per the surveyor report no. 0702/43 of Shri Jeewan Agarwal dated 16.03.2007 along with 8% interest from 01.11.2007. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.

Delhi Ombudsman Centre Case No.GI/523/OIC/07

Shri Naveen Pangti

Vs Oriental Insurance Company Limited

Award Dated : 18.03.2008 The complaint was heard on 12.03.2008. The complainant Shri Naveen Pangti was present. The Insurance Company was represented by Shri H. Jaswani, Assistant Manager and Shri Anil Nagpal, Administrative Officer. Shri Naveen Pangti had lodged a complaint with this Forum on 22.10.2007 that he had insured his Mahindra Bolero No. HR 26 AB 3083 with Oriental Insurance Co. Ltd. under policy No. 272100/31/2006/8596. The vehicle was stolen from his residence on 20.07.2006 an FIR was lodged with Udyog Vihar Police Station, Gurgaon on 20.07.2006 and the Insurance Company was immediately informed. He has incurred a loss of more than Rs.150000/- apart from the mental harassment because of the delay in settlement of his claim. He has also requested that Insurance Company be directed to initiate action against the Surveyor Shri Sanjay Dwivedi for using coercive means against a claimant for the reasons best to known him. At the time of hearing Shri Naveen Pangti reiterated the facts which he has mentioned in his complaint. The Forum advised Shri Naveen Pangti that it was not competent to pass an Award against Mental Harassment and in case he desired to withdraw the complaint he can do so to approach an appropriate Forum where his case could be dealt with in totality including mental harassment. Shri Naveen Pangti however, informed the Forum that he would l ike this Forum to decide in the matter. He further stated that cover note was issued by the Insurance Company showing an IDV for Rs.572249/- whereas the policy was issued for Rs.565000/- and he should be paid Rs.572249/- and not as per the policy where the IDV is Rs.565000/-. The representative of the Insurance Company informed the Forum that IDV at the time of Insurance was wrongly accepted and accordingly they had re-worked the IDV and Shri Naveen Pangti having given his consent for the same, the Insurance Company is not l iable to pay any additional amount and therefore rightly settled the claim. After hearing both the parties and on examination of the documents submitted the vehicle No. HR 26 AB 3083 was stolen on 20.07.2006 the Insurance Company had settled the claim for Rs.508500/-. He has requested that the difference between the IDV and the amount paid to him should be paid by the Insurance Company since as per policy condition that the IDV wil l be treated as the ‘Market Value’ throughout the currency of the policy reimburse to him in case of Total Loss/ Constructive Total Loss. I am in agreement with the complainant Shri Naveen Pangti that he should have been paid IDV as per the policy which is Rs.56500/-. The Insurance Company is l iable to pay the difference of amount along with 8% interest from 20.09.2006 ti l l the time of payment. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.

Guwahati Ombudsman Centre Case No. : 11-012-0044/07-08

Mrs. Rajani Sharma @ Rajni Sharma Vs

ICICI Lombard General Insurance Co. Ltd Award Dated : 26.11.2007 Brief Facts leading to Complaint

This complaint was lodged by Mrs. Rajani Sharma @ Rajni Sharma wherein it was alleged that her claim in respect of policy no. 3001/50613020/00/000 has been repudiated by the insurer/OP above named. The case of the complainant, in brief, is that she insured her private TATA INDICA DLS E-II vehicle bearing no.AS 01 X 5686 was insured with the above insurer/OP and accordingly the policy certif icate no.3001/50613020/00/000 was issued. On 10.04.07, she took the vehicle to the market at about 07.30 p.m. and after getting down in the market, she instructed the driver to park it at the designated parking place. At about 08.45 p.m. , the driver telephonically informed her that he did not f ind any parking place and on receipt of such communication, she instructed him to wait for sometime as she has finished her marketing. Thereafter, she went to that place and found that the driver was missing with the vehicle. She reported the matter to Pan Bazar Police Station and at about 11.45 p.m., she got a message that Dispur Police Station recovered the vehicle which was found involved in an accident near Janata Bhawan. Thereafter, she approached police and arranged to take the vehicle from the PS on 14.04.07 and placed it for repairing at M/s. Ghosh Brothers. The insurer above named was also informed and submitted this claim with all the relevant documents regarding the damage of the vehicle. The insurer, has however, repudiated her claim on the ground that the vehicle has been used for commercial purpose (read “HIRE AND REWARD”) which violates the policy condition. She clarif ied the matter but the insurer ultimately did not take any action in the matter. Opponent’s Views The insurer/OP has informed vide letter Ref: Mum/Legal/22192 dtd. 26.07.2007 that the complainant obtained Private Motor Car Insurance Policy no.3001/5061 3020/00/000 from his Company. The complainant lodged her claim pertaining to a loss suffered by the insured vehicle during an accident and the same was registered as claim no. 00331543. The matter was investigated by their investigator who ascertained that the vehicle was used for Hire and Reward. The insurer also stated that the complainant has stated in her income tax return that the insured vehicle was util ized for hiring business. The vehicle was registered as a Private Vehicle and usage of such vehicle for commercial purposes is a clear violation of policy terms and conditions and as such, the Insurance Company is not l iable to indemnify the loss. The Insurance Company, has referred to the income tax statement, submitted by the complainant for the assessment year 2006-2007 wherein she had stated her net income from TATA INDICA DLS E-II vehicle after deducting all expenses/depreciations, as Rs.15,600/-. Hence, according to the insurer the claim is not payable due to violation of policy condit ions. Decisions & Reasons Insuring TATA INDICA vehicle bearing registration no. AS 01 X 5686 by the above named insurer has been admitted and the policy document furnished also shows that it was a Private Car Policy and cover note was numbered 50613020. The policy was issued on 10.11.2006 having validity upto 09.11.2007. The vehicle was the property acquired by the policyholder/complainant during the income tax assessment year 2006-2007. The income tax statement submitted by the complainant Rajni Sharma for the assessment year 2006-07 giving details about business income contained that her net income was Rs.15,600/- from the TATA INDICA DLS E-II vehicle and that was the income from her business after deducting all the expenses/depreciations etc. The insurance company, on receipt of the claim documents, appointed surveyor and ascertained the fact of using the above vehicle as a commercial vehicle and because of violation of the policy conditions, the claim was repudiated vide letter dtd. 23.04.07 and

the complainant was accordingly informed. Submission of statement of income tax returns showing the net income of Rs.15,600/- from the above insured TATA INDICA vehicle in the income tax statement by the complainant has not been disputed. The complainant, has however, revised her income tax statement on receipt of the repudiation intimation letter from the insurer and submitted a fresh statement to the income tax authority on 24.04.07 and in the said revised statement, income from the vehicle was not shown. This was done on 24.04.07 after getting the repudiation intimation. In both the statements, the income from business source of the complainant was shown to be the same and what she did was that in her original income tax statement, she showed only an income of Rs.37,704/- from her business establishment M/s. Amit Stores and Rs.15,600/- was shown as an income from vehicle business source making a total income from these two sources at Rs.53,304/- whereas in her revised statement, after repudiation of the claim by the insurer, she showed the entire income of Rs.53,304/- from her business source M/s. Amit Stores. She has also produced a certif icate from her Advocate who prepared those statements which shows that the above changes were done on verif ication of the registration certif icate of the vehicle which appears to be not a document to disclose income. Anyway, the income tax statement is a document to be fi led before the income tax authority for payment of taxes for the income. Once the source was disclosed by the complainant that she had an income of Rs.15,600/- from her vehicle and subsequently, when that matter was detected by the insurer for the purpose of claim settlement, the revised income was shown modifying the earl ier source. Payment of tax is one thing and that is to be seen by the income taxes authority whereas we are only concerned in what way the vehicle insured was used. From the income tax return, duly f i led by the complainant shows that the insured vehicle was used as a commercial vehicle for business purposes and that appears to be a clear violation of the policy condit ions as the vehicle insured was registered only as a private vehicle. Repudiation of the claim, on the aforesaid ground, appears to be justif ied because of violation of the policy condit ion by the insured.

In view of my discussions above, I do not find any material to interfere with the decision taken by the insurer in repudiating the claim of the complainant.

Guwahati Ombudsman Centre Case No : 11-005-0012/07-08

Mr. Akhil Kumar Boro Vs

The Oriental Insurance Co. Ltd. Award Dated : 10.12.2007 Grievance The grievance of the complainant is that the claim lodged by him in respect of his vehicle no.AS-01/N-5594 under the above policy coverage has been totally repudiated by the insurer/OP without any justif ied ground. The prayer for review has also been rejected. The facts involved in the complaint is that the complainant, being registered owner of Truck (Oil Tanker) bearing no. AS-01/N-5594 insured his vehicle with the OP/insurer above named and the coverage period was for the period from 06.09.2006 to 05.09.2007. The insured vehicle met with an accident on 04.10.06 near Chenikhowa Bridge under North Salmarah OP and the vehicle sustained damages. The insurer was informed and the complainant, later on, lodged his claim before the insurer which has been rejected as stated above. Reply

The insurer forwarded its self-contained note under cover of letter dtd. 24.05.07 which goes to show that the existence of insurance coverage has not been disputed. But since the driver has no effective driving licence pertaining to hazardous certif icate at the material time of the accident, there is no other alternative but to close the fi le as ‘NO CLAIM’ and the Insured/Complainant was informed vide our Regd. A/D letter dt. 31/01/2007. Decisions & Reasons The policy document in respect of the vehicle bearing no.AS-01/N-5594 shows that the aforesaid vehicle was a tanker used for carrying CNG/LPG which are highly explosive items. The policy condition provides that the vehicle is to be driven by a person having effective driving l icence and he must have the same at the time of accident. Since the truck is used for carrying hazardous explosive items, naturally the driver is also required to have l icence for driving hazardous vehicle. It is an admitted fact that the driver of the vehicle Shri A. Das had a l icence for driving hazardous vehicle which was obtained in the year 1995 and the validity of the said l icence had expired as back as in the year 1996 and since then here is no proof of its renewal. The police report available on record also goes to show that the said oil tanker met with the accident at Chenikhowa while it was coming towards Bongaigaon from Jogighopa side. The driver, who drove the vehicle at the relevant time, appears to have driven the vehicle which was used for carrying CNG/LPG without any such valid l icence and that appears to be a clear violation of the policy condition. Since policy condition has been violated by the insured by allowing the vehicle to be driven by a driver having no valid driving l icence, the repudiation of the claim appears to be in conformity with the policy condit ions. Thus repudiation of the claim by the insurer appears to be justif ied and I see no material to interfere with it. The complaint is treated as closed.

Guwahati Ombudsman Centre Case No : 14-005-0037/07-08

Mrs. Jaya Bhattacharjee Vs

The Oriental Insurance Co. Ltd. Award Dated : 11.02.2008 Facts (Statements and counter statements of the Parties) The complainant Mrs. Jaya Bhattacharjee had insured her vehicle bearing no.AR-01/A-9474 with the above insurer/OP and obtained the above policy under scheme “Package Policy for Passenger Carrying Commercial Vehicle” covering the period from 15.12.05 to 14.12.06. The vehicle met with an accident on 07.05.06 sustaining extensive damage. The insurer was informed who appointed surveyor and the surveyor duly inspected and assessed the losses. The complainant submitted her claim along with all the relevant documents and she had agreed for sett lement of the claim settled under scheme “Cash Loss Basis” as offered but the insurer has not yet settled the claim to her satisfaction. The insurer has also submitted the ‘self-contained note’ wherein they have admitted about existence of the above policy for the period from 15.12.05 to 14.12.06 in respect of vehicle No.AR-01/A-9474 issued by their Itanagar Office. The insurer has also admitted about the involvement of the vehicle in an accident and surveying the same by their surveyor Shri Achyut Chandra Das, Guwahati. According to the Insurer, the surveyor assessed the losses on various modes viz., repairing basis, cash loss basis

and total loss basis with special recommendation for sett lement of the claim on “Cash Loss Basis”. The insurer further contended that the surveyor has also convinced the complainant to accept the settlement on “Cash Loss Basis” at Rs.1,50,478.62. It has further been contended that the assessment made by surveyor Achyut Chandra Das, on Cash Loss Basis, was found to be on the higher side as he had considered replacement of chassis frame and backdoor assembly which were very much repairable and they have accordingly obtained the technical opinion from another surveyor namely, Shri Aswini Sarma, who had recommended the settlement on Cash Loss Basis only at Rs.1,30,157/- and they have accepted the same and sent their proposal to the complainant who, of course, refused to accept the said offer. According to the insurer, the amount of Rs.1,30,157/- on “Cash Loss Basis” is very much reasonable and justif iable with reference to the principle of indemnity, extent of damage, rate of depreciation, cash loss deduction, salvage value etc. The insurer has also forwarded the copies of reports submitted by the above two surveyors. Decisions & Reasons As per the ‘self-contained note’, the insurer has not disputed about the existence of the policy and also the fact of involvement of the insured vehicle in an accident on 07.05.06. The survey report submitted by Achyut Ch Das dated 03.07.06 goes to show that the surveyor had duly inspected/surveyed the insured vehicle and its documents. The above surveyor after making assessment, suggested settlement of the claim on repairing basis at Rs.2,17,083.75, on Cash Loss Basis at Rs.1,50,478.62 on Total Loss Basis at Rs.3,48,382.30 and on Net Loss Basis at Rs.1,56,500/-, but recommends settlement of the claim on Cash Loss Basis at Rs.1,50,478.62. Vide letter dated 14th August, ’06, the insurer informed the complainant Mrs. Jaya Bhattachjarjee about the intention of the insurer to settle the claim at Rs.1,50,479.00 on the basis of recommendations of the surveyor above named and wanted few documents from the complainant which includes the letter of agreement to the effect that she has agreed to accept settlement of the claim on Cash Loss Basis which stands at Rs.1,50,479.00 as full and final sett lement of her claim. The letter of the complainant without date discloses that she has sent her consent to accept the settlement/claim either on Cash Loss Basis, Net Loss Basis or Total Loss Basis. The complainant had given her consent to accept settlement/claim on any of the above schemes. Letter dated 04.08.06 issued by the insurer/OP clearly shows that they have accepted the report of the surveyor to settle the claim at Rs.1,50,479/- and this was duly communicated to the complainant. Vide ‘self-contained note’ the insurer stated about appointing another surveyor Mr. Aswini Sarma and copy of his report has also been sent. The report dated 05.05.07 submitted by Aswini Sarma goes to show that he has neither seen the insured damaged vehicle nor visited any other authority for collecting informations but only on assessment of the report submitted by the Surveyor Achyut Chandra Das, he has disputed the amount suggested by Achyut Chandra Das to settle the claim on “Cash Loss Basis” and recommended settlement of the claim at Rs.1,30,157.00 holding that the same was done considering the nature and extent of damages reported and the photographs. He was of the opinion that replacement of Chassis frame and backdoor is not felt necessary. The surveyor Achyut Ch Das duly verified the vehicle and also felt the necessity for the replacement of the aforesaid parts and it was quite natural to suggest after verification of the vehicle and assessing the extent of damages. It is he who has seen the vehicle on the site and made proper assessment of the damages. The subsequent report submitted by Aswini Sarma appears to be not justif ied as he has not physically verif ied the vehicle and only on perusal of the photographs he cannot be expected to say like that. The report of second surveyor Aswini Sarma cannot be said to be a justif ied one.

The insurer has also initial ly accepted the recommendations of the surveyor Achyut Ch Das and offered to settle the claim at Rs.1,50,479/- on Cash Loss Basis and informed their intention to the complainant vide letter dated 04.08.06. When once the insurer offered to settle the claim at Rs.1,50,479/- and communicated it to the policyholder/complainant , there appears to be no reason as to why the insurer should come back therefrom. Considering the facts and circumstances, it is seen that the insurer was in a posit ion to settle the claim on 04.08.06 at Rs.1,50,479.00 accepting the recommendation made by their appointed surveyor Achyut Ch. Das and subsequent action appears to be unwarranted. Accordingly, i t is felt that a direction is to be given to the insurer to settle the claim at Rs.1,50,479/- on Cash Loss Basis as has been offered to the insured/complainant vide letter dated 04.08.06 and allow interest for delayed settlement for the period from 04.08.06 ti l l the amount is actually released. The Insurer is accordingly directed to settle the claim at Rs.1,50,479/- allowing interest as stated.


Md. Yunus Ali Vs

National Insurance Co. Ltd. Award Dated : 14.02.2008 Brief Facts leading to complaint Md. Yunus Ali, being the policyholder under the above policy, lodged this complaint for repudiating his claim under the policy by the insurer/OP above named. The fact is that his vehicle bearing no.AS-23E-3225 was insured obtaining policy under schemes “Goods Carrying Commercial Vehicle (Open) Policy” – “B Package” from the above insurer/OP covering the period from 30.04.06 to 29.04.07. The vehicle was taken on hire on 17.06.06 and since then, the vehicle was missing. The vehicle was driven at that t ime by Md. Sonu and his dead body was subsequently recovered from river Bali jan under Tengakhat P.S. on 20.06.06. Police was informed who registered Tinsukia P.S. Case No.282/2006. On completion of usual investigation, police submitted the charge sheet in the case holding that the miscreants, after ki l l ing the driver Sonu, took away the vehicle to unknown destination by the miscreants, out of whom, one was arrested and another was shown to be absconder. The post mortem examination was also done on the dead body of the driver Sonu. Usual claim was lodged by the complainant/owner of the vehicle but the insurer has repudiated the claim on the ground that the vehicle was driven by Md. Sonu and his Driving Licence (DL) was found to be fake at the relevant t ime. For repudiating the claim, the complainant has approached this Authority, being dissatisfied with the action of the insurer. Opponent’s Views The insurer vide letter dated 06.11.07 submitted its ‘self-contained note’ stating that the vehicle bearing No. AS-23E-3225 was insured under the above Package Policy which was found to have been stolen away by miscreants after ki l l ing the paid driver Md. Sonu. The complainant had submitted claim papers including the copy of the DL of Md. Sonu and on verification of the DL of Md. Sonu, through investigator Sunil Kumar at DTO, Gumla, (Jharkhand) Office, the l icence is found to be fake one. The insurer accordingly repudiated the claim as the vehicle was driven by the driver with a fake DL at the time of the occurrence contrary to policy condition.

Decisions & Reasons The information lodged with police goes to show that on 17.06.06 at 2 p.m. the vehicle was taken on hire towards Naharkatia but on the way the miscreants ki l led the driver and took away the vehicle to unknown destination. On 20.06.06, the dead body of the driver Sonu was recovered and police accordingly did the post mortem examination. The police report dated 18.08.06 also goes to show that the driver Sonu was kil led by the miscreants and the dead body was recovered from river Balijan and then the concerned vehicle bearing no. AS-23E-3225 was taken away by the miscreants. The copy of the post mortem report on record also goes to show that death of Sonu was caused due to Asphyxia as a result of Strangulation (manual) during life which was homicidal in nature. On completion of usual investigation, police has also found that the driver Sonu was kil led by miscreants out of whom they could arrest one and submitted the charge sheet against him showing another as absconder involved in this case. Death of driver Sonu due to manual Strangulation by miscreants has also not been disputed nor taking away the vehicle to unknown destination by the miscreants has been denied. The papers on record also shows that the vehicle was taken on hire from Tinsukia to Nahakatia but before reaching Naharkatia, the driver was kil led on the way at Tengakhat and thrown his dead body to Balijan river. The miscreants had taken possession of the vehicle after ki l l ing the driver and took it away. The record further shows that nothing untoward happened while the driver was alive and had driven the vehicle to Tengakhat. The insurer has also not raised anything ti l l then and the claim is lodged for taking away the vehicle after ki l l ing the driver. The insurer repudiated the claim on the ground that the vehicle was driven by Md. Sonu with a fake DL. The insurer appears to have relied upon the report submitted by Sunil Kumar who was appointed as the Investigator. The report of Sunil Kumar was forwarded by Ranchi Divisional Office of the OP. On a perusal of the report of Sunil Kumar dated 14.06.07, it appears that he could not obtain any report from DTO, Gumla, regarding the DL of Md. Sonu and according to him, he physically verified the DL maintaining register of the year 1998 but did not find any record of issuing l icence in the name of Md. Sonu. The report submitted by Sunil Kumar about verifying the official registration by himself appears to be not acceptable although the insurer has given importance on it. He has failed to procure any report from the DTO concerned and thus, the statement of the investigator cannot be taken to be reliable. Consequently, DL of Md. Sonu cannot be treated to be fake one in the absence of any report from the Issuing Authority. Besides above, the policy condition requires that the person driving the vehicle shall hold effective DL at the time of accident and he shall not be disqualif ied from holding an effective licence. This is a mandatory provision under M.V. Act as provided under Section 3 of the Motor Vehicles Act. But the posit ion is that the claim has not been lodged for any accident of the vehicle and it was only lodged because of theft of the vehicle committed by miscreants. The vehicle was driven by Md. Sonu upto Tengakhat and no untoward happened ti l l that place but only after ki l l ing the driver at Tengakhat, the miscreants committed the theft of the vehicle and the claim has been lodged for committ ing theft of the vehicle. The question of driving the vehicle by a driver having valid DL is a must when the vehicle is involved in an accident but theft cannot be termed to be an accident and that too when the appointed driver was not involved therein. On consideration of what has been discussed above, what I feel is that repudiation of the claim under the circumstances appears to be not justif ied and the insurer should reopen and settle the claim in terms of the policy. The insurer is accordingly directed to settle the claim.

Guwahati Ombudsman Centre

Case No. : 11-012-0041/07-08 Mr. Anand Kand

Vs ICICI Lombard General Insurance Co. Ltd.

Award Dated : 22.02.2008 Grievance The grievance of the above named complainant is that the claim lodged by him in respect of his insured vehicle bearing no. AS 01 AB 7027 was repudiated by the above insurer on the ground that the vehicle was used for commercial purposes in violation of the policy condition. The facts, in brief, is that the complainant insured his vehicle no. AS 01 AB 7027 with the above insurer and obtained the above policy. It was a Private Car Package Policy covering the risk from 09.11.06 to 08.11.07. On 11.02.07, the vehicle met with an accident while it was being parked which causes damage to the vehicle and the monetary loss to the complainant amounting to Rs.22,000/- for repairing. The insurer was informed and usual claim was submitted. The insurer repudiated the claim on the ground that the vehicle was being used for commercial purposes in violation of the policy condit ion. According to the complainant, the vehicle was never used for any commercial purposes. Reply The Insurer has submitted its ‘self-contained note’ describing the reasons as to why they have treated the claim as ‘Not Admissible’. Para 2 of the ‘self-contained note’ reads as under :- “The complainant had taken private car insurance policy No.3001/50661091/00/000 for the period November 9, 2006 to November 8, 2007. The vehicle met with an accident on February 11, 2007. The complainant lodged a claim for own damage vide claim No.00286663. During scrutiny of claim, a suspicion arose as to usage of the vehicle. Hence an investigator was appointed. The investigator submitted his report confirming that the vehicle was being used for commercial purpose. The insured vehicle was found enrolled with a travel agency named “Dee Dee Travels”, Shahajahan Market, Dispur, Guwahati and routinely ferries passengers for the said travel agency. The insured had thus committed a clear breach of policy terms and conditions and as such the insurance company is not l iable to indemnify the loss. We annex a Daily Vehicle Movement Sheet Receipt No.737 of the said travel agency indicating the vehicle was made available for hire for your ready reference. In the l ight of above submissions, it is therefore submitted that the claim is not payable and the Hon’ble Ombudsman may be pleased to absolve us of the liabil ity.” Decisions & Reasons The insurer has not disputed about the existence of the above policy in respect of the vehicle no.AS-01-AB-7027 and also its involvement in the occurrence leading to f i l ing of the claim in question which has been rejected on the ground stated in the ‘self-contained note’. The copy of the policy document proves that the complainant obtained “Private Car Package Policy” in respect of the above vehicle covering the risk period from 09.11.2006 to 08.11.2007. The alleged claim was also lodged for the occurrence covered under the policy. The ‘self-contained note’ submitted by the insurer discloses that during scrutiny of the claim, suspicion arose as to the use of the vehicle and accordingly, the matter was investigated by Investigator who submitted his report confirming that the vehicle was being used for commercial purposes. According to the insurer, the insured vehicle was found enrolled with a travel agency named “Dee Dee Travels”, Shahajahan Market, Dispur, Guwahati and routinely ferries passengers for

the said travel agency and that is the ground for repudiating the claim. In proof of the above contention, the insurer has also annexed a daily vehicle movement sheet being receipt no.737 of the above travel agency. The copy of the alleged movement sheet (serial no.737) shows that the above travel agency mentioned the vehicle no. & type as AS 01 AB 7027 which has also not been signed by anybody. The unsigned document appears to be not acceptable and a reliable document. The insurer has neither obtained any statement from any of the office personnel of the above travel agency nor could produce any agreement to show renting out the insured vehicle to the above travel agency by the insured. Thus, repudiation of the claim on the basis of the sole unsigned receipt appears to be unjustif ied. Hence, the insurer should reopen the matter and settle the claim in the interest of justice and fair play. The insurer is accordingly directed to settle the claim in terms of the policy.


Mr. Manas Pratim Saikia Vs

National Insurance Co. Ltd. Award Dated : 25.02.2008 FACTS The grievance of the above named complainant is that the claim lodged by him in respect of his Maruti 800 vehicle insured with the above insurer obtaining the above policy, has been repudiated by the Insurance Company. The facts involved is that the complainant purchased a Maruti 800 Car bearing engine no.3537567 and Chassis No.2533455 on 17.01.06 which was insured with the above insurer on the same day covering the period from 17.01.06 to 16.01.07. On 31.01.06, the above vehicle was stolen away by unknown miscreants from the garage where the vehicle was parked. Police was informed on the same day when Borpathar P.S. Case No. 16/06 U/S. 380 IPC was registered. Subsequently, insured/complainant also informed the insurer and usual claim was lodged. The insurer after usual process, repudiated the claim on the ground that the vehicle was not registered which is a violation of the M.V. Act and the complainant failed to provide any scope to the insurer for carrying out proper investigation due to belated intimation of the claim. The copy of the letter dated 10.07.07 issued by the insurer addressing the complainant however discloses that the claim has been repudiated on the ground that the vehicle was not registered which is a violation of the provisions of M.V. Act and the insured has also not given any scope to the Insurance Company for carrying out the proper investigation due to belated intimation of the claim. Decisions & Reasons The copy of the policy document shows that the vehicle belonging to the complainant was insured with engine no & chassis no covering the risk period from 17.01.06 to 16.01.07. The theft incident occurred on 31.01.06 in the garage of the complainant where the said insured vehicle was parked and such occurrence was committed before the vehicle was registered with the Registering Authority. The copy of the F.I.R., Police Investigation Report are made available along with the copy of report submitted by Supdt. of Police, Golaghat under Memo no.GLT/CB/62/06/8830 dated 21.12.06 wherein it was clearly stated that new Maruti Car bearing Engine no.3537567 & chassis no.2533455 has been stolen away by some unknown miscreants from the house of Debeswar Saikia of Borpabhajan Gaon under P.S. Borpathar and on receipt of the information, Police registered Borpathar case no.16/06 U/S 380 IPC. According to this

report, after investigation, police submitted the Final Report stating that the occurrence is true but no clue of the culprits vide Final Report no.10/06 dated 19.05.06. From the above police report, theft of the above insured vehicle on the night of 31.01.06 has been proved and police has also failed to recover the same. The vehicle was insured with the above insurer on the date of purchase of the same. The insured vehicle was stolen away by the miscreants on 31.01.06 before obtaining registration no. The insurer has not disputed about theft of the vehicle but repudiated the claim on the ground of non-registration. Under Rule 47 of Motor Vehicles Rules, 1989, an application for registration of Motor Vehicle is to be made in Form 20 before the Registering Authority within 7 days from the date of taking delivery of such vehicle excluding the period of journey enclosing therewith certain documents. So, it is mandatory for a purchaser to apply for registration within 7 days in the prescribed form for registration before the Registering Authority and failure to apply and obtain registration certif icate within the specif ied period attracts action under the M.V. Act and non-availabil i ty of registration documents has been made a penal offence. In the instant case also due to non-registration of the vehicle even beyond 7 days from the date of taking delivery of the vehicle by the complainant, appears to be a violation of the provisions of M.V. Act but things remained is that the vehicle was insured on the date of taking delivery covering the risk period from 17.01.06 with engine no. & chassis nos and such policy was in force when the theft occurred. The policy failed to bear any exclusion clause to cover the situation. Repudiation of the claim for non-registration and under the circumstances appears to be not justif ied when other things are not disputed and the occurrence had also taken place within the period covered under the policy.

The insurer is accordingly directed to settle the claim in terms of the policy.

Hyderabad Ombudsman Centre Case No.G-11-012.152 Sri P.Bala Kishan Rao

Vs ICICI Lombard Gen. Ins. Co.

Award Dated : 11.10.2007 Brief Facts : The complainant insured his new Tata Safari vehicle for Insured Declared Value of Rs. 6,76,638/-. The vehicle met with an accident on 09.05.2007 and the accident was reported to the police. The vehicle was moved to the workshop for survey and repairs. The complainant did not receive any information from the insurer regarding the claim. Decision : The insurer stated that the vehicle was carrying 9 persons in violation of the registered seating capacity at the time of accident. Therefore the claim was repudiated on 20.06.2007 but the repudiation letter was returned undelivered. The complainant contended that the police had fi led a charge sheet stating that 5 persons were injured in the accident. The complainant stated that the vehicle was lying in the same condition without repairs as no surveyor was deputed by the insurer. The insurer stated that surveyor was deputed and the claim was repudiated on the basis of a report in the newspaper that 9 persons were travelling in the vehicle at the time of accident. The investigator deputed by the insurer in his report had stated that 6 persons were travell ing in the vehicle at the time of accident. The FIR and charge sheet do not indicate that 9 persons were travell ing in the vehicle. The insurers instead of relying on newspaper reports which cannot be considered as substantial piece of evidence ought to substantiate their contention with cogent independent evidence. They failed to do

so. The survey report available in the fi le shows that the loss was assessed at Rs. 3,55,347/-. Therefore the insurers are directed to settle the claim as assessed by the independent l icensed surveyor.

Hyderabad Ombudsman Centre Case No.G-11-002-0198

Smt. Leelavathi Sunder Raj Vs

The New India Insurance Co. Ltd. Award Dated : 8.11.2007 Brief facts : Smt. Leelavathi Raj had insured her new Honda Civic car with the insurer for the period from 7.11.2006 to 6.11.2007. The IDV of the vehicle was Rs.10,91,455/-. The vehicle met with an accident on 14.5.2007 and was moved to Whitefield Motors (P) Ltd. for repairs. An estimate of repairs for Rs.56,228/- was submitted to the insurance company. Sri Pramod Jannu was deputed by the company for survey. The repairs were carried out and a bil l for Rs.40,572/- was submitted to the insurance company. The claim was settled for Rs.22,737/- only. The insured represented to the RO of the insurer for payment of the balance of claim, but she did not get any posit ive response. Aggrieved, the insured fi led the present complaint. Contentions of complainant: Her car was insured comprehensively. The claim occurred in the first year and hence it should be settled without any depreciation. The insurer did not give any basis for admitt ing her claim for a reduced amount. Insurer’s contentions: They settled the claim by following all prescribed procedures and they replied to the insured’s queries. The amount of Rs.13,667/- towards head light was not paid, as this amount was not mentioned in the estimate of repairs. The amount mentioned was Rs.2524/- only and the same was not recommended by their surveyor. The claim settled by them was on the basis of surveyor’s recommendations subject to depreciation, salvage and excess as per policy conditions. Decision : The complaint’s contention is that she should get full amount of the claim without any deductions as her claim occurred in the first year of the policy. The insurer contended that they received two sets of estimates. In one of them it was mentioned that the damaged one was the right side unit head light and in the other it was the left unit. The amount was mentioned as Rs.2524/- in both estimates. Due to this discrepancy, their surveyor did not recommend payment for this loss. The bil l submitted for this item was for Rs.13,667/-.The surveyor also participated in the hearing session and he confirmed that there were some damages to the right side head light assembly. The complainant submitted a f inal bil l without revising the estimates. She was advised to furnish the same to the insurers. The surveyor having confirmed the damage, the insurer was directed to consider the estimate and settle the claim for the damaged headlight after allowing depreciation as per policy conditions.


Smt. D. Narasamma Vs

New India Assurance Company Ltd. Award Dated : 15.11.2007 Brief facts : Sri D. Laxmi Rajam owned a motor cycle No. AP-15-2018 which was insured with New India Assurance Co. Ltd., Peddapall i branch, for the period 17.3.2004

to 16.3.2005. Sri Rajam met with a road accident on 25.7.2004 and died ion 24.11.2004. Police had registered an FIR on 25.7.2004 under Sec. 337 of IPC against the lorry driver, who had caused the accident. The deceased’s family having spent money on his treatment did not get the motor cycle repaired nor did they pursue with the insurance company for sett lement of benefits under the motor insurance policy. Only on 14.2.2007, a formal claim was lodged with the insurance company and the insurer rejected the claim on 5.4.2007 on the ground of unreasonable delay. The claimant appealed to the RO of the insurer on 6.7.2007, but her representation did not evoke any response.

Complainant’s contentions: She was ignorant about the procedures for claiming insurance amount. Thus Inquest and Post Mortem were not conducted. M/s UII Co. Ltd. has settled a claim under Andhra Bank Account Holders’ Group Personal accident policy on the directions of Insurance Ombudsman. She should be paid claim in the present case also on similar l ines.

Insurer’s Contentions: The claim was lodged with an undue delay and hence not entertainable and they were denied the opportunity to conduct an inquiry into the merits of the claim.

Decision : The complainant contended that delay in intimation of claim was not wilful, but only because she was not aware of the procedures for making a claim.

From the records submitted, it was established that the police had taken cognizance of the accident and had investigated the same. Since the claim was rejected only on the ground of delayed intimation, it was decided to condone the delay. Accordingly, the insurer was directed to process the claim without insisting for Post Mortem report and Police Inquest Report. The complaint was admitted for statistical purposes.


Sri M.J.Joseph Vs

TATA AIG General insurance Co. Ltd. Award Dated : 3.12.2007

Brief facts : Sri M. J. Joseph had insured his Maruthi Car No. AP 10AA 8827 with M/s TATA AIG Ins. Company Ltd., for the period 16.5.2006 to 15.5.2007. In 04/2007, he had issued a cheque dated 10.5.2007 for Rs.2716/- towards renewal premium to the insurer and the cheque was encashed on 12.5.2007. However, the insured did not receive the policy bond for the year 2007-08 til l 9t h July,2007, even after calling the insurer’s helpline in the first week of 07/2007.

Then he obtained another policy for his vehicle from M/s Oriental Insurance Co. Ltd., for the period 10.7.2007 to 9.7.2008 and wrote to TATA AIG on 10.7.2007 requesting them to refund the amount paid by him with interest. Having not received any response to his letter, he approached this office for relief.

Complainant’s contentions: He stated that the renewal premium cheque was collected by the local representative of TATA AIG on 19.4.2007. Though on enquiry, he was informed on 4.7.2007 that the matter would be sorted out within 48 hours, it did not happen. Later, on telephone, helpline staff told him that it would take 7 working days to get information on the status of his policy from the concerned department. They had also refused to transfer his call to any senior executive. He sought compensation for

the inconvenience and financial loss suffered by him due to the casual approach of the insurer.

Insurer’s contentions: They conveyed that they cancelled the policy and refunded the amount on 18.9.2007. They also stated that they retained pro-rata premium for the period the policy was in force i.e. from 16.5.2007 to 9.7.2007.

Decision : Both sides were heard on 14.11.2007. Sri Joseph stated that he received refund of premium, but the insurer had not given any reason for the inordinate delay and partial refund. The insurer expressed regrets for the delay in release of policy document. They also stated that they issued a cover note on 19.4.2007 showing the full period of insurance and the vehicles details. They also stated that the insurance was very much in force ti l l the insured sought its cancellation. They also stated that cover note is a valid document for all practical purposes.

Sri Joseph, though claims to have paid traffic penalties and suffered business losses has not produced any documents to support his claim on this count. He confirmed that he received a cover note. During the hearing proceedings it was observed that the insurer was not prompt in attending to the enquiries of the insured. The insured’s problem was not solved despite his calls to helpline and e-mail messages. Considering the negligent att itude of the insurer, i t was decided to allow an ex gratia payment of Rs. 3000/- to the insured.


Sri S. Ravindranath Vs


Brief facts: The complaint is about non settlement of PA claim under motor policy. Sri Surendranath had insured his new Hero Honda Splendor Plus motor cycle with UII Co. Ltd., Habsiguda, Hyderabad for the period 23.12.2004 to 22.12.2005. He met with an accident while driving the insured vehicle on 16.6.2005 and died. The policy included PA coverage to owner-driver of the vehicle for a sum of Rs.100, 000/-. Sri Ravindranath, father of the insured Sri Surendranath made a claim with the insurer and submitted all documents except driving l icense of the insured. The insurance company rejected the claim stating that it is mandatory to submit valid DL for sett lement of PA claim under a motor vehicle policy.

Complainant’s contentions: His son was having a driving l icense at the time of death but he is unable to locate the same. He pleaded for settlement of the claim without production of DL.

Insurer’s contentions: They received all documents except DL and Registration certif icate in support of the claim. As per Section III of motor cycle insurance policy which extends Personal Accident benefit to the owner-driver it is mandatory for the owner-driver to hold an effective driving l icense at the time of accident. As the claimant did not produce DL, they are unable to settle the claim.

Decision: The insurers submitted that PA coverage extended in the motor policy is subject to three condit ions namely (i) The owner–driver is the registered owner of the vehicle (ii) The owner–driver is the insured named in the policy and (i i i) The owner-driver holds an effective driving license, in accordance with the provisions of Rule 3 of Central Motor Vehicle Rules, 1989 at the time of accident.

The complainant expressed his inabil i ty to produce a DL and in the absence of the same, the insurer is found to be justif ied in rejecting the claim. Thus the complaint was not allowed.


Sri A. Manish Reddy Vs

ICICI Lombard General insurance Co. Ltd. Award Dated : 20.12.2007 Nature of complaint: Non settlement of motor claim Brief facts : Sri Manish Reddy had insured his new Ford Fiesta No. AP 09 BF 1204 with M/s ICICI Lombard General insurance Company Ltd. for the period 11.10.2006 to 10.10.2007 with IDV of Rs.6,50,750/- under a private car package policy by paying a total premium of Rs.24,793/-. On 20.6.2007 the vehicle was caught in water logging and the vehicle was damaged. The insured submitted repair estimate for Rs. 4,88,199.98. The insurer deputed their surveyor to assess the loss and rejected the claim for the internal parts of the engine but agreed to pay for (i) engine flushing charges (i i) Air f i lter element (ii i) cylinder head gasket. The insurer stated that they rejected claim for the remaining parts as consequential loss was not payable as per policy condit ions. Complainant’s contentions: He disputed the insurer’s conclusion of consequential loss. Insurer’s contentions: The damage was caused due to cranking of engine after f looding of the engine with water. It amounts to consequential loss and hence cannot be paid as per policy conditions. Decision : Both sides were heard on 28.11.2007. As per insurer, the amount admissible was Rs.4,981.83 only and they are wil l ing to release the amount if the insured agrees to give a discharge. The insurers’ argument that the entire damage to the engine parts occurred as a consequential loss and that no part of the damage to the engine occurred in the incident of flooding is far fetched and not substantiated. In the absence of reliable evidence / l iterature that such damage would occur only as consequential loss, the insurers’ argument cannot be accepted in its entirety. As per the initial estimates, the repairer had estimated the repair cost at Rs.105645.57. Considering the totality of the situation, it was decided to award an ex gratia payment of Rs. 1,00,000/-. The complaint was thus allowed partially.


Sri R. Varaprasad Vs

United India Insurance Co. Ltd. Award Dated : 20.12.2007 Nature of complaint : Non settlement of Motor OD claim Brief facts : Sri R. Vara Prasad had insured his tanker lorry No. HR 38H 0821 with M/s UII Co. ltd., for the period 9.8.2004 to 8.8.2005. The vehicle met with an accident on 14.8.2004 and a claim was lodged with the insurer. The claim was repudiated on 6.8.2007 stating genuineness of the DL of the driver was not confirmed by the RTO. Sri Varaprasad represented to the RO of the insurer on 27.8.2007 but to no avail. Aggrieved, the complainant approached this office for a review of the matter.

Complainant’s contentions: The claim is more than three years old and reason given by the insurer for repudiation of the claim is not proper. Insurer’s contentions: Their surveyor assessed the loss at Rs.86,500/-. The insured had given l icence No.WB-23-063666 of Sri Rakesh Kumar as the l icence number of the driver of the vehicle at the time of accident. During their enquiry with RTA officials, it came to their knowledge that the said licence was fake. After learning this, the insured submitted another l icence in the name of Sri Rakesh Rai on 28.3.2006. They sent the second licence to RTA but did not receive any confirmation about authenticity of the l icence. Hence, they rejected the claim. They referred to the Hon’ble Supreme court decision in case nos. 4883 of 2007 in UII vs. Davinder Singh wherein it was held that the insurer is not l iable to pay own damage when the Driving Licence was found fake. Decision : The complainant stated that he submitted a second l icence and the insurer could not establish that it was a fake one. Hence he should be paid the claim. The insurer contended that they had sent two surveyors for loss assessment and both were given the name of the driver as Sri Rakesh Kumar. It was noted that in the police records the name of the driver was shown as Rakesh Kumar. The l icence submitted in the name of Sri Rakesh Kumar was certif ied by the authorit ies to be fake. Hence the complaint was dismissed.


Sri M. Muralikrishna Vs

Oriental Insurance Company Ltd. Award Dated : 24.12.2007

Brief facts : The complaint is about rejection of motor claim. Sri M. Muralikrishna insured his truck No. AP 20W 7340 with M/s Oriental Insurance Co. Ltd., Khammam for the period 22.2.2006 to 21.2.2007 The vehicle met with an accident on 4.11.2006, near Jangareddygudem and a claim was lodged with the insurer. The surveyor deputed by the insurer assessed the loss at Rs.34,000/- On submission of necessary papers, the insurer refused to pay the claim stating that the driver of the vehicle did not possess a valid l icense at the time of accident.

As per the insurer, the driving l icense expired on 13.5.2006, while the accident took place on 4.11.2006. After the claim was rejected on 2.2.2007, the complainant submitted a second extract of the l icence which indicated its renewal for the period from 14.5.2006 to 13.5.2009. The first extract was obtained on 9.1.2007, in which the expiry date was shown as 13.5.2006. The claim was not paid in view of the discrepancy in the date of expiry of the license.

Decision : The insurers contended that the Driving Licence was scrutinised by their officer on 5.1.2007 and also by the final surveyor in 11/2006. On both occasions, the renewal for the period from 14.5.2006 to 13.5.2009 was not shown in the document. They expressed the view that renewal said to be done in 05/2006 was doubtful and contended that a re-verif ication of the subsequent changes produced by the insured was necessary. The insurer’s plea for some more time to get the l icense details verif ied was not accepted since the insurer did not raise this point earl ier. Also it is on record that the Licencing authority vide letter dt 25.5.2007 confirmed the details of renewal

upto May 2009. Hence, the insurer was directed to settle the claim as per the assessment of their Surveyor.


Sri T.Venkataramana Vs

United India Insurance Co. Ltd. Award Dated : 31.12.2007 Brief facts : The complaint is about non settlement of motor claim. The complainant had insured his Maruti Omni van with M/s UII Co. Ltd., for the period from 7.9.2005 to 6.9.2006. The car met with an accident on 21.5.2006 and the claim lodged by the complainant was not sett led by the insurer despite follow up from the complainant.

According to the complainant, the car was purchased for his own use and on the date of accident he was proceeding to Hyderabad to fetch his son who had undergone treatment at Secunderabad. Some friends of his brother-in-law who were proceeding to Hyderabad also accompanied him. He contended that the car was not used for hire. He also stated that on the advice of off icials from UII, he submitted a consent letter for sett l ing the claim for 80% of the assessed loss.

According to the insurer, the vehicle was used for hire at the time of accident and hence there was a clear violation of the ‘l imitations as to use’ clause. Their investigator had obtained statements from passengers who were injured in the accident.

Decision : The insured stated that he was proceeding to Hyderabad on the date of accident on his personal work when the accident took place. The insurers stated that the vehicle was being used for hire purpose when the accident occurred. The insurance cover was obtained under a private car policy and hence the claim was rejected.

The insurer sent their surveyor for loss assessment and an investigator to look into the merits of the claim. There were no documents l ike FIR, police reports etc., in the absence of which it is difficult to establish the investigator’s report. It came out that the insurer did not do a thorough job in investigating the claim. It was also observed that the insurers committed themselves to settle the claim on a compromise basis and also obtained consent from the complainant. The insured was thus given hopes of a settlement of the claim. It was decided to award an ex-gratia payment of Rs.40,000/-.

Hyderabad Ombudsman Centre Case No.G-11-002-0289 Sri L.G.Parashiva Murty

Vs New India Assurance Company Ltd.

Award Dated : 21.01.2008 Brief facts : The complaint is about non settlement of motor theft claim. A Toyota Qualis No.KA 02 B4256 was insured in the name of Smt. Sudha Rao by M/s New India Assurance Co Ltd for the period 28.11.2005 to 27.11.2006 with an IDV of Rs.2,50,000/-. The vehicle was purchased by Sri L.G.Parashiva Murty on 3.8.2006. The RTA, Jayanagar, Bangalore transferred the RC of the vehicle in the name of Sri Murty on 18.8.2006. The vehicle was stolen on 21.9.2006 and a police case was registered on 22.9.2006. Sri Murty informed the insurance company about the theft on 23.11.2006 and sought sett lement of the claim. Vide the same letter; Mr. Murty also sought transfer

of insurance of the vehicle in his name. The insurer, on 13.12.2006 informed Smt. Sudha Rao that the claim file was closed by them as ‘No Claim’ stating that she had no insurable interest in the vehicle at the time of theft. Sri Murty represented that some unknown persons threatened his driver with a knife and stole the vehicle on the night of 21.9.2006.He confirmed that insurance of the vehicle stood in the name of Smt. Sudha Rao at the time of theft. He also stated that he could not get the insurance transferred in his name due to his il lness and sought settlement of claim for Rs.3.85 lakhs. The insurers contended that the registration of the vehicle was transferred in RTA records on 18.8.2006, but the information of this change was given to them only after a lapse of two months. As per MV act, the transferee ought to have applied for transfer of insurance policy within 14 days of transfer of vehicles registration. They stated that the vehicle’s new owner is not entitled to any benefit under the own damage section of the policy when he does not intimate the change of ownership within 14 days. Decision : The complainant reiterated that due to his il lness he could not communicate about change of ownership. The insurer stated that there is no provision to condone the delay and cited IRDA’s circular dated 5.7.2007 in this regard. They also added that insurance of motor vehicle was done in accordance with the India Motor Tariff and submitted General Regulation No.17 therein. Based on the submissions made by both sides, it was found that the insurers had rejected the claim as per norms. Hence, the complaint was disallowed.


Sri Rohinton J Gotla Vs

HDFC General Insurance Co. Ltd. Award Dated : 31.01.2008 Brief facts : The complainant insured his 2006 model Hyundai Verna car No. AP 09BF 7474 for the period 11.11.2006 to 10.11.2007 for an IDV of Rs.6,98,724/-. The vehicle met with an accident on 6.2.2007 near Gulbarga in Karnataka. Sri Venkatesh Services, Gulbarga gave a repair estimate of Rs.1,01,247/- and the insurer’s surveyor gave a survey report on 30.8.2007. Based on the survey report, the insurer offered to admit the claim for Rs.8,130/- The complainant sett led a bil l of Rs.81,180/- to the garage on 31.3.2007 and followed up with the insurer for settlement of the claim. Decision : The cause of initial damage to the car was due to the car hitt ing stones on the road. According to the insurer, the car was driven after damage to the vehicle and consequentially the engine got damaged due to loss of coolant and overheating of the engine. It was held that as per policy condit ions, damages caused to the engine in the circumstances of this case are not covered. However, several shortcomings were observed in the processing of the claim. The survey report was unduly delayed by about six months after the survey was conducted on 10.2.2007. The insurer’s representative who was present during hearing session could not give a proper explanation to the deficiencies pointed out by the complainant. Hence, it was decided to offer an ex-gratia payment of Rs.5000/- in addit ion to the claim amount offered by the insurer. The complaint was allowed partially.


Sri V.Shankariah

Vs New India Assurance Co. ltd.

Award Dated : 31.01.2008 Brief facts : Sri Shankariah insured his goods vehicle bearing No. AP28V 3860 with New India Assurance Co. Ltd. for an IDV of Rs.3,94,800/- for the period 12.7.2006 to 28.4.2007. The vehicle met with an accident on 20.1.2007 in which it sustained heavy damages and a person travelling in the vehicle was injured. The insurer deputed a surveyor to assess the loss and rejected the claim on the plea that the vehicle was carrying a passenger, in violation of policy condit ions. As per the contentions of the complainant, the driver of the vehicle gave l i ft to a person as there was no bus service in the forest area in which the vehicle was travell ing at that night t ime. He further stated that as per policy condit ions , three persons were authorized to travel while only two persons were there in the vehicle (including driver) at the t ime of accident. The insurer stated that the insured had violated the policy conditions on “ l imitations as to use” and hence claim is not payable. Decision : The insurers have a system of settl ing claims on non-standard basis up to 75% of the assessed loss in cases of breach of policy condit ions. The insured vehicle has a seating capacity for three persons (including driver) and this condition was not violated, but the person carried in the vehicle was not connected with the use of the vehicle as a goods carriage. The insurers also have not established that the presence of a passenger has contributed to the accident. For these reasons, the insurer was directed to settle the claim for 75% of the assessed loss. The complaint was allowed partially.

Hyderabad Ombudsman Centre Case No.G-11-004-0328 Sri Kona Muralikrishna

Vs United India Insurance Co. Ltd.


Brief facts : Sri Muralikrishna had insured his taxi cab bearing No. AP 05V 6177 for the period from 11.2.2006 to 10.2.2007 for an IDV of Rs.5,00,000/-. The insured vehicle met with a road accident on 20.5.2006 and sustained damages. A survey was conducted and estimate of repairs for Rs.4, 94,606/- was submitted to the insurers. In the final survey, the loss was assessed at Rs. 2,28,000/-. The insured submitted repair bi l ls amounting to Rs. 3,57,425/- in 07/2006. The insurer offered to settle the claim for Rs.2,27,000/- in 01/2007 which was not accepted by the insured.

Decision: The complainant stated that he submitted repair bil ls to the insurer on 21.7.2006 and sought compensation from the insurer for the loss caused to him on account of the delay in processing of the claim. The insurer did not accept the contention of the insured regarding delay and they stated that the claim was delayed due to non acceptance of the amount offered by them.

Both sides were heard on 6.2.2008. The insured stated that cost of the body shell has gone up from the time of init ial survey to the time of actual repairs. The part was estimated to cost Rs. 1,32,000/- but it was bil led for Rs.1,60,303/-. The insurer further stated that they processed the claim in

accordance with policy condit ions. The complainant had written a detailed letter on 23.1.2007 raising objections for settlement at a reduced amount of Rs.2,27,000/- but the insurer has not explained to him about the reasons for offering a reduced claim. Since the body shell was purchased from authorised dealer, the insurers ought to consider that bil l in full. The insurer was directed to settle the claim for Rs.2, 50,000/- together with interest from 1st March 2007.


Sri R. Goutham Vs

National Insurance Co. Ltd. Award Dated : 15.2.2008 Brief facts : Sri Goutham insured his motor cycle bearing regn. No.AP 20F-5112 for the period 11.11.2005 to 10.11.2006 for an IDV of Rs.17,325/-. The vehicle was stolen on 7.11.2006 from his house and a police case was made. The police have also f i led a not traced report before the court, but the claim was not sett led by the insurer. The complainant f i led this complaint for payment of an amount of Rs.20,000/- from the insurer. Decision: The insurers asked for a duly transferred RC Book in their name, but the same could not be produced by the complainant as RTA officials had reportedly refused to transfer ownership of a stolen vehicle. The insurers stated that the duly transferred RC in their name is a requirement for sett lement of the claim. As per Section 44 of the MV Act, 1988, a vehicle is to be produced before the RTO for inspection to proceed with the registration of the vehicle. In this case, it is not possible for the complainant to comply with the rule as his vehicle was stolen. Hence, the insurers were directed to settle the claim after obtaining documents namely (1) Registration certif icate (2) Requisite transfer forms (3) letter of indemnity and subrogation.


Sri V.Venkat Reddy Vs

HDFC General Insurance Co. Ltd., Hyderabad Award Dated : 25.2.2008 Brief facts : Sri Reddy had insured his Tata Indica Car with regn. No.AP 10 AE 8678 for the period 31.3.2007 to 30.3.2008, for an IDV of Rs.2,23,060/-. The car coll ided with a lorry on 12.4.07 and sustained extensive damages. After survey, the damages were assessed at Rs.143,678/- and the garage was advised to carry out the repairs. After repairs, the insurance company refused to settle the bil ls stating that the insured had misrepresented about the no-claim bonus earned in the past. The claim was repudiated under India Motor Tariff General Regulations No.27F.

Decision : The complainant contended that he had paid premium as sought by the insurance company’s representative and he was not aware about NCB. The insurers stated that the policy was issued with 25% no-claim bonus as per details furnished by the insured. On seeking confirmation about NCB from previous insurer, they came to know that the insured had wrongly furnished information to them. This amounted to

wrong submission of material fact and hence the claim was rejected under GR 27 of the Indian Motor Tariff.

During hearing, the complainant submitted that he was at Bangalore when the proposal was submitted and the premium cheque as advised by the insurer’s representative was handed over by his brother. He mentioned that he had not given any false information regarding NCB. The insurer submitted a copy of the said rule but has not placed any proof that a declaration regarding NCB as required was actually given by the insured. The insurer produced a copy of the proposal form in which it was written “NCB 25%”, but the insured denied having signed it. The insurer had also not placed any material to prove that the complainant had given a false declaration and that he was aware of the discount in premium under the policy. In the absence of a clear proof, it was decided that the complainant should not be deprived of the claim in full. It was ordered for payment of 75% of the loss assessed by the surveyor on ex-gratia basis.


Sri M. Khaja Hussain Vs

New India Assurance Co. Ltd. Award Dated : 10.3.2008 Brief facts: Sri Khaja Hussain insured his goods carriage vehicle (HMV) No.AP 21 X 7007 for the period 17.1.07 to 16.1.08 for an IDV of Rs.11,40,000 paying a premium of Rs.28,481/-. The vehicle met with an accident on 5.7.07 near Kadapa and the police registered FIR init ial ly under Sec.337/338 of IPC and later under Sec.304A. The insured vehicle rammed into the foregoing truck when the other vehicle suddenly came to a halt after overtaking the insured vehicle. There were three persons in addit ion to the driver and cleaner in the lorry at the time of the accident. The surveyor appointed by the insurer assessed the loss at Rs.1,34,689/-, but the insurers rejected the claim on 29.10.07 stating that there were unauthorised persons in the vehicle at the time of accident and that the vehicle was carrying load in excess of the permissible limit. The complainant fi led the present case, claiming an amount of Rs.2,24,278/- from the insurers. Decision: The complainant stated that his claim was rejected by the insurer on trivial grounds. The insurers contended that allowing unauthorised passengers to travel in the vehicle was a violation of the policy conditions and also the Motor Vehicle Act. They stated that as per registration certif icate only three persons were permitted to travel in the cabin of the vehicle. The insurers also stated that the vehicle was carrying 420kgs in excess of the permitted carrying capacity and this was established from the delivery challan of Coromandel Ferti l isers whose product was being transported in the lorry at the time of accident. The vehicle owner contended that the driver carried extra passengers without his knowledge. As per the investigator’s report, the other vehicle involved in the accident overtook the insured vehicle and came to a sudden halt that caused the accident. Further, as per the investigation report, the driver of the insured vehicle drove at a normal speed and obviously presence of passengers in the vehicle was not the cause of the accident. All insurers have a provision to settle claims on a non-standard basis, when there are violations of the policy conditions which have not directly led to the accident. The objection regarding overloading of the vehicle is also found to be trivial.

The claim was ordered to be settled on ex-gratia basis at 60% of the loss assessed by the surveyor.

Hyderabad Ombudsman Centre Case No.G-11-011-0388 Sri B. Vijayender Reddy

Vs Bajaj Allianz General Insurance Co. Ltd.

Award Dated : 10.3.2008 Brief facts : Sri Vijayender Reddy had insured his new Tata Indigo car for the period 3.9.2007 to 2.9.2008 for an IDV of Rs. 4,86,700/-. The vehicle was damaged on 9.9.07 due to f lood water entering the engine of the car. The vehicle was shifted to a garage where an estimate of repairs was prepared for Rs.1,77,628/-. The l icensed surveyor estimated the loss at Rs.23,554/- and disallowed the remaining amount. The vehicle again met with an accident after repairs when it was taken out by the garage for a ‘tr ial’ run. The estimate for damages in this accident was for Rs.2,33,313/-. Decision : The complainant stated that the claim for f lood water damages was settled for Rs.23,554/- as against repair bil ls for Rs.1,41,420/-. The second accident occurred on11.11.2007 when the vehicle was in the custody of the garage and the complainant stated that the insurer is not justif ied in rejecting the second claim in full and in reducing the first claim. The insurer stated that their surveyor estimated the flood damaged loss at Rs.23,554/- and the insured had accepted the same without protest. According to them the liabil ity for the second claim fell within the purview of general exceptions clause 3-A (l imitations as to use). As regards the first claim, the insured accepted the cheque given by the insurer without any protest. Hence, there is no justif ication in raising a dispute on this point. The second claim occurred when the vehicle was taken out for a test run after repairs. According to the insurer, such a test run amounts to reliabil ity tr ial and hence fell under the exclusion clause. The insurer was asked to submit authentic l iterature on reliabili ty tr ials, but they could not submit any information on the same. Hence the insurer was asked to honour the second claim for loss caused in accident. They were directed to process the claim and settle within two months from the date of the order.

Hyderabad Ombudsman Centre Case No. G 11.012.0360

Sri M. Madhavan Vs

ICICI Lombard Gen. Ins. Co.Ltd. Award Dated : 25.03.2008 Brief facts : Sri Madhavan had insured his Ford Fiesta Car bearing No. AP 9BE 3599 with ICICI Lombard General Insurance Co. for the period 21.08.2007 to 20.08.2008 . The vehicle met with an accident on 03.12.2007 when a stone hit the bottom of the car. Against an estimate of Rs. 1,70,128/- the surveyor assessed the loss for Rs. 8799/-.

Decision : The complainant stated after the stone hit the car, he stopped but could not f ind anything. The car did not start and it was confirmed by the mechanic that oil sump was damaged. The insurers stated that the engine oil got drained of. The insured tr ied to start the engine and due to lack of oil the piston and other internal parts were

damaged. They stated that their l iabil i ty was l imited to the direct damages in the accident and that consequential losses were excluded. The damage to internal parts were as a result of consequential loss and condition pertaining to damages caused subsequent to an accident were placed on record. The insurer was advised to reinspect the vehicle and confirm the replacements. They confirmed that only the engine parts were replaced and revised their claim offer to Rs. 9287/- The insurer was directed to settle the same and the complainant’s claim for engine parts which were not due to direct impact was dismissed.

Hyderabad Ombudsman Centre Case No.G-11-011- 425

Smt. N. Srilaxmi Vs

Bajaj Allianz General Ins. Co. Ltd. Award Dated 31.3.2008

Brief facts : Smt. Sri laxmi had insured her new Ford Fiesta car for the period 2.10.06 to 1.10.07 for an IDV of Rs.6,88,759/-. The vehicle met with an accident on 5.12.06 when it hit a road divider and sustained damages. The insurer arranged for survey of the vehicle on being reported about the accident. An estimate of repairs for Rs.3,48,380/- was given by the garage and the insurance surveyor assessed the loss at Rs.1,64,000/-. As per the claim forms submitted by the complainant, one Sri D. Goutham Kumar was the driver of the vehicle at the time of accident. His driving l icence was for two-wheeler only. The insurers informed the same to the insured seeking her response and show cause as to why the claim should not be repudiated. Smt. Sri laxmi wrote back to the insurer enclosing a copy of FIR as per which one Mr. Bala Balaji was the driver at the time of accident who was duly l icenced to drive a LMV. She pleaded for sett lement of the claim but the claim was not sett led. Hence the complaint.

Decision : The complainant submitted that she was hospitalised after the accident and that she submitted claim form after her discharge from the hospital. The insurers’ contention was that name of the driver was changed by the complainant to get benefit of the claim. During the hearing, the complainant submitted that her driver received simple injuries and fled from the accident spot. She stated that her signature on the claim form was taken by a person from Ford Showroom and she was not aware of the driver’s name fil led in the form. She contended that the driver at the time of accident was Mr. Bala Balaji and not D.Goutham Kumar. The dispute between both sides is about who was the driver and the insurers have not taken any decision on the claim. Some inconsistencies were observed in the narration of the events. Hence the insurers were directed to arrange proper investigation into the relevant facts and dispose of the claim.


Sri T. Purushottam Reddy Vs

New India Assurance Co. Ltd. Award Dated : 31.3.2008

Brief facts : A Tata Indicab bearing Regn. No. AP 09X 9600 was insured for an IDV of Rs.2,80,000 from 11.2.2006 to 10.2.2007. The vehicle was purchased by Sri Pururshottam Reddy and ownership was transferred in his name by the RTA on 2.2.2007. The vehicle met with an accident on 4.2.2007 and survey was arranged by the insurer. The insured had submitted all claim papers and repair bil ls, but the claim was not settled. Hence the present grievance. Decision : The insurers contended that the policy was in the name of Sri Ashok Kumar, the original owner of the cab and it was not transferred in the name of the present complainant as on the date of claim and that they had not received any request for transfer. Thus the policy was not transferred within 14 days they submitted. The complainant produced a receipt of fax transmission dated 8.2.2007, whereby the insurer was intimated about change of ownership of the vehicle. As per the facts of the case, the vehicle met with an accident two days after the transfer of Registration and the accident was promptly intimated by the new owner to the insurer. The insurer ought to have guided him properly and they should have advised him about procedure for transfer of insurance. The insurers having received the fax message on 8.2.2007, did not ask for any further details. Hence, the insurer was directed to settle the claim for the assessed loss of Rs.43,500/-.


Sri V.Venkata Rao Vs

United India Insurance Co. Ltd. Award Dated : 31.3.2008 Brief facts : Sri Venkata Rao obtained a motor insurance policy for his Tata Indicab bearing No. AP 15X 0350, for an IDV of Rs. 200,000. The period of insurance was from 8.5.2007 to 7.5.2008. The vehicle met with an accident on 14.5.07 and on intimation, a survey was arranged by the insurer. An estimate for Rs.1,75,783/- was prepared by a garage and the Surveyor assessed the loss at Rs.83,788/-. On submission of repair bil ls for Rs.141,813/, the insurance company init ially offered to settle the claim for Rs. 67,200/- and the insurers revised their offer of reimbursement to Rs.87,000/-. His grievance was that the insurance company has not given any reasons for the details of settlement offered. Decision : According to the insurer, they inadvertently applied depreciation twice and as a result the claim offer came to Rs. 67,200/-. They rectif ied their mistake and offered Rs. 87,000/-. During the hearing, the complainant made certain allegations against the surveyor. The complaint against behaviour of the Surveyor is beyond the scope of this off ice. In view of the insurers having based their offer of Rs 87,000 on the report of an IRDA licenced surveyor, they were directed to settle the claim for that amount together with interest as per IRDA guidelines from 17.9.07 (the date of their f irst offer) to the date of sett lement. The complaint was partial ly allowed.


Dr. N.Ranganayakulu Vs

Bajaj Allianz General Insurance Co. Ltd. Award Dated : 31.3.2008

Brief facts : Sri Ranganayakulu had insured his 1999 model Tata Indica car for an IDV of Rs.49,750/-, for the period 18.1.07 to 17.1.2008. The car met with an accident on 15.6.07 and the vehicle was repaired before the insurance company could inspect the damages. The insurer rejected the claim for the same reasons, which led to the present grievance. Decision : The complainant stated that he had to leave the car on the day of accident, to attend a patient and that the repairs were carried out by his driver at a cost of Rs.30,805/-. He contended that rejection of the claim is not justif ied and wanted settlement of his claim for repair bil ls. The insurers stated that they received claim intimation after 17 days from the date of accident and they were deprived of the opportunity of inspecting the damaged vehicle. They contended that the complainant had violated condit ion No.1 of the policy by not intimating them about accident in t ime. The insurer’s representative submitted that claim intimation was given to them only vide letter dated 2.7.2007 along with repair bil ls. The complainant submitted that the vehicle was not repaired for 10 days after the accident, but it was observed that the repair bil ls speak otherwise. The insurer established sufficient proof that the repairs were carried out one day after the alleged accident. The complainant could not submit any proof that he intimated the accident immediately after its occurrence. Hence, the complaint was dismissed.


Sri Sk.Subhan Vs

Oriental Insurance Co. Ltd. Award Dated : 31.3.2008 Brief facts : Sri Subhan had insured his new Tata Indicab vehicle bearing Regn No. AP 16 TV 6303 for the period of 9.6.2006 to 8.6.2007, for an IDV of Rs.315000/-. The vehicle met with an accident on 28.4.2007 and suffered damage when it was hit by a van. The damaged vehicle was inspected by the l icensed surveyor and the loss was assessed on repair basis as well as cash loss basis. The insured submitted an estimate of repairs for Rs. 3,44,420/-. The insurer processed the claim for Rs.77,689/- and intimated the same to the insured. The insured represented to the insurer for sett lement of the claim on total loss, which was refused by the insurer. Decision : The insured contended that the amount offered by the insurer is too low compared to the damage suffered and submitted that the insurers remained silent without considering his request for sett lement on total loss basis. The insurers stated that the surveyor assessed the loss on two counts. The loss on cash loss basis was Rs.83,920/- and loss on repair loss basis was Rs.1,32,500/-. The insured submitted his consent for cash loss basis and hence they offered a net of Rs.77689/-. During hearing the insurer’s side represented that they cannot consider the claim on total loss basis and placed before me the relevant policy condition which reads as follows: “ The insured vehicle shall be treated as a CTL if the aggregate cost of retrieval and/or repair of the vehicle subject to terms and conditions of the policy exceeds 75% of the IDV of the vehicle”. During the hearing it also came out that the insured was under the wrong impression that the insurer was considering replacement value for the

body shell while the insurer did not consider replacement of body shell altogether while assessing the loss. It also came out during hearing that the insured vehicle was used for commercial purposes and hence a higher percentage of depreciation was made by the insurer. Considering the facts of the case, it was decided to order for payment of Rs.83,920/- as assessed by the surveyor on cash loss basis as the insured expressed his inabil ity to carry out repairs. The complaint was partly allowed.

Kochi Ombudsman Centre Case No. : IO/KCH/GI/11-003-112/2007-08

Sri.C.S.Salim Vs

National Insurance Co. Ltd. Award Dated : 09.10.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998. The complainant had insured his Swaraj Mazda medium goods vehicle with National Insurance Co. for the period from 28.3.06 to 27.3.07. While the policy was inforce, the vehicle met with an accident on 14.5.06 and his claim for reimbursement of loss due to accident amounting to 3.40 lakhs was repudiated by the insurer on the ground that the vehicle which was a medium goods vehicle was driven by a driver who was l icensed only to drive a Light Motor Vehicle and also at the time of accident passengers other than the employees of insured or representative of the owner of goods were taken as passenger, which is a violation of motor vehicle Act. It was argued on behalf of the insured quoting AIR 1996 SC 205 that if violation of permit condit ion has not contributed to the accident, the claim wil l not be effected. Even if two passengers were carried in the vehicle it has not contributed anything to the accident. It was also argued that the driver was having a valid and effective l icence to drive the vehicle. The copy of driving l icence was also produced. There it is stated as he was l icenced to drive LMV through out India w.e.f. 23.2.83 and subsequently on 5.3.86 a further authorization was given to drive a ‘transport vehicle’ and the licence was renewed continuously ti l l date of accident. Hence the question to be decided is whether a person l icenced to drive a Transport vehicle authorised to drive Medium Goods Vehicle. Formerly there were classes such medium goods vehicles, medium goods passenger motor vehicle, heavy goods vehicles etc. But these categories were deleted in 1994 and in its place a common category was substituted as Transport vehicles. Now the question is whether the MGV is a Transport vehicle. Transport vehicle is defined in Sec.2(47) of MV Act as a Public service vehicle, a goods carriage and educational institution bus or a private service vehicle. Hence it is clear that all goods carriage comes within the category of Transport vehicle. In the case he was l icenced to drive a Transport vehicles w.e.f. 5.3.86 and this licence was renewed from time to time and hence the driver was having a valid l icence to drive the vehicle at the time of accident. Also the insurer has not put forward any convincing argument to establish that the presence of two persons in the cabin has contributed to the accident also. Hence the decision of insurer to repudiate the claim is faulty and the insurer is directed to pay a sum of Rs.3,40,000/- with an interest at 8% ti l l date of payment.


Dr.Sujith S Warrier Vs.

The New India Assurance Co. Ltd. Award Dated : 02.11.2007

The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant Dr.Sujith S Warrier had taken a Package policy in respect of his Maruti 800 CC car bearing no.KL6/215. The vehicle met with an accident on 20.4.05 and entrusted the vehicle for repair to one Mr.Manoj, a garage owner. On 6.5.05 Sri.Manoj f i led a claim for Rs.26000/- for the repairs. But the repair work was delayed, and when the complainant reached the workshop to take delivery of the vehicle it was not available in the workshop. Later it was found out in another workshop in a stripped condit ion and some of the parts were missing. It was brought to the notice of insurer on 7.7.06. The claim was repudiated by the insurer on the ground that the claims comes under the category “cheating” and does not cover as per policy condition. He was also directed to fi le FIR before police authorit ies. Aggrieved by this the insured approached this Forum for justice. It was submitted by the insurer that a surveyor was deputed to assess the loss due to accident. But the vehicle was not available in the workshop for verification. Inspite of his repeated request the vehicle was not made available for verif ication ti l l 19.9.05 and hence the surveyor surrendered all papers to insurance co. The contention of insurance co. is that actually there was no such accident and the vehicle was entrusted to the repairer for some other purpose. The transaction between the petitioner and workshop owner is purely a personal dealing with them. The claim against repair work was not settled as the petit ioner has not given an opportunity to inspect the vehicle. It was also submitted that most of the parts alleged to be missing were not covered under the policy. They are consumable items which are intended for one time use only. Due to the use of vehicle for 14 or 16 years on account of wear and tear such parts would have worn out requiring replacement. The repairer himself had removed these items for the purpose of replacement and hence no claim is payable for such items also. The complainant himself had stated that the accident was a minor accident only. Even then it took more than 10 months to get the vehicle repaired. The vehicle was not made available for verif ication by the surveyor inspite of his repeated requests and hence the surveyor has to surrender all papers to insurance co. after 4 ½ months. There is no explanation to that by the complainant. As per policy condition the accident must be brought to the notice of insurer and he should render all assistance to the insurer. Hence it is clear that no loss had been occurred on account of an accident and that is why the vehicle was not made available for inspection. The vehicle was in the custody of the repairer, but some parts were found missing. It does not mean that it was removed by somebody else. It might have removed by repairer for replacement as these items were consumable items which are intended for one time use only. Also those parts are not covered as per policy condition. The complainant himself had entrusted the vehicles with the repairer and the repairer was holding or possessing the same in trust for the complainant under a contract. The obligation is only a contractual obligation. If he removed certain articles it wil l amount to breach of contract or breach of trust only and not theft. Even if the items were removed by the repairer it wil l not come under the coverage of policy. As the repairer fai led to return the vehicle in proper condit ion it is a case of cheating. There is no case that anybody has taken or removed the parts from the possession of repairer(bailee). Hence the claim for compensation is not sustainable and complaint is therefore dismissed.


Sri.Marath Vasudevan Vs

United India Insurance Co. Ltd.

Award Dated : 14.11.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant took an insurance policy covering his house and compound wall for the period from 21.4.07 to 20.4.08. While the policy was in force the compound wall was damaged due to heavy rain and flood, but the claim was repudiated on the ground that the damage to the wall was not due to any insured peri l but due to old age. The case of the complainant is that it was really on account of seepage of water into the red soil and bulging the wall was damaged, but in the claim form it was written as f lood as advised by insurance officials. Though the wall was about 30 years old it was well maintained and was in good condit ion. It was submitted on behalf of insurance company that they have deputed an authorized surveyor immediately on receipt of claim. The surveyor has reported that the damage was not due to any insured peri l . The wall appears to be of 30 years old and the retaining wall was eroded due to its old age and that had resulted into projection of basement due to its inabil ity to withstand the pressure of soil inside the wall. He also observed gradual development of cracks in the wall. He has reported that there was no flood on that day. It was admitted that there was no flood or inundation. The photograph also shows that the compound wall was standing elevated from the road on the sides. The wall constructed on the side of the road passes at the lower level of three meters. There was no canal or stream on its side and hence there was no possibil ity of having any flood. As the property is lying on the side of the road at a higher level there is no scope of having any inundation too. Of course due to heavy rain water was seeping down into the earth and it may cause damage to the wall. But that was not covered by policy. Even if the damage was occurred due to heavy rain it wil l not come under any of insured peril, surveyor report is also very specific that the damage is not due to any insured peri l. Hence the repudiation made is correct and complaint is therefore dismissed.


Sri.V.A.Anas Vs

The Oriental Insurance Co. Ltd. Award Dated : 15.11.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant had insured his Medium Goods Vehicle KL 41-3671 before its registration. The vehicle met with an accident on 19.3.07 but the claim was repudiated on the ground that the driver was not having valid and effective driving l icence at the time of accident. It was submitted by the insurer that as per exclusion clause 3(b) of policy a damage sustained in an accident while driven by a driver not having effective licence is excluded from the coverage of policy. Also as per drivers clause the driver must have an effective driving l icence at the time of accident. In the present case the licence had lapsed 10 months before accident and hence they are not entitled to make any payment. It was submitted by the complainant that though the l icence was expired on 28.5.06 it was later renewed on 29.5.07 and hence he is eligible to get claim under the policy. The copy of driving l icence produced verif ied. The driver was licenced to drive transport vehicle only upto 28.5.06. Though later the l icence was renewed on 29.5.07 the fact remains that at the time of accident the driver was not having an effective driving l icence. The insurer is not l iable to make any payment and the repudiation is upheld. The complaint is therefore dismissed.


Smt.A.C.Chinnamma Vs

Bajaj Allianz General Insurance Co.Ltd. Award Dated : 20.11.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant had purchased an Opel Corsa car in 2003. AT the time of purchase on 9.4.03 insurance cover under a package policy with National Insurance Co. was provided by Opel Co. to the purchaser. It was effected as a private car. Subsequently the vehicle was registered as a taxi on 16.4.03. After the expiry of initial policy with National, the policy was renewed with Bajaj al l ianz by submitt ing a proposal dated 7.4.04. The policy was issued as a package policy for private cars. The policy was renewed periodically and while the policy was in force, the vehicle met with an accident on 11.1.06. The claim was repudiated on the ground that the policy was taken as a private car where as the vehicles was registered as a transport vehicle (taxi). It was submitted by the insurer that at the time of renewal with them the RC book was not produced, only the vehicle and the cover note of the previous insurance was produced. The insurance was effected on the basis of this cover note and that is why the date of commencement was noted as 9.4.03, the date of purchase. Had the RC book been produced, the date would have noted as 16.4.03, the date of registration and also no claim bonus would not have been given. As the RC book was not produced the insurance coverage was given for private car collecting premium for private car insurance only after allowing no claim bonus and hence they are not l iable to make any payment as the vehicle was registered and used as a commercial vehicle. The complainant had stated that she has produced the vehicle and RC book for inspection at the time of effecting insurance. But without looking into the RC book insurance Co. had issued policy and insurance Co. is at fault. The first insurance policy with National Insurance Co. was issued on 9.4.03, the date of purchase. The vehicle was not registered at the time, the vehicle was registered only on 16.4.03. It appears that at the time of renewal with Bajaj Ins.Co. only the cover note was produced. Had the RC book been produced the date wil l be noted as 16.4, the date of registration. Also the insurer wil l not allow any NCB. It is also to be noted the name plate of the vehicle was that of a private car in white back ground. Hence there was no material for insurer to verify whether it was a private care or a taxi car. The proposal was also made in the format of private vehicle insurance. According to them even at the time of accident he was using a white number plate and not a yellow number plate. Though the complainant has purchased and registered the vehicle as a taxi, he was playing fraud by exhibiting a number plate of a private car and he had wil l fully suppressed and obtained insurance for private vehicle, though it was a taxi car. The complainant has submitted that at the time of accident the number plate was that of a private vehicle (white board) but at the t ime of regn. it was bearing yellow number plate. Witness may tell l ie, but circumstances wil l not. If it was a taxi car, and if i t was brought to the notice of the insurer they would have certainly issued policy for taxi car as the premium for commercial vehicle is much morethan that of private vehicles. Here insurance was effected as a private vehicle where as the vehicle was registered and used as a commercial vehicle and hence insurance co. is not l iable to make any payment. The complaint is therefore dismissed.


Sri.Sojan P Jose Vs

United India Insurance Co. Ltd. Award Dated : 28.11.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. On 11.8.06 the complainant purchased Tata Indica car KL7-AP75 from Sri.G.Binukumar, the registered owner. The RC was got transferred on that day. The package policy taken by Sri.Binukumar was inforce on that day. But that was not changed and the vehicle met with an accident and the claim was rejected on the ground that the complainant has no insurance policy with him and Sri.Binukumar, the owner of the policy has no insurable interest. It was submitted by the complainant that he has submitted all records to RTO Office for transferring ownership to his name. He was told that the policy can be transferred only after getting the RC transferred in his favour. He got the RC transferred to his name w.e.f. 11.8.06 only on 31.8.06 and by the time the vehicle met with an accident on 20.8.06. His contention is that he is eligible for compensation as accident took place within 14 days of transfer. It was submitted by the insurer that for transferring the policy in the name of present registered owner, they require a request in writ ing from the buyer and seller and also a specif ic proposal from the buyer. But these conditions have not been complied with and at the t ime of accident the owner of the vehicle has no policy in his name and also the owner of policy has no insurable interest on the vehicle. Hence they are not in a posit ion to compensate the loss either to the buyer or to the seller. Though the change of ownership has brought in the Certif icate of Registration, the policy continued in the name of Sri.Binukumar. A contract of insurance is a personal contract. The contract is to indemnify the loss sustained to the vehicle. A policy cannot be transferred by the insured without the consent of insurer. The transfer of subject matter of insurance policy wil l not operate as an assignment of policy unless there is an express or implied agreement to that effect. It is argued that the insured had 14 days time to effect transfer of insurance in his favour. This argument has been advanced on the basis of General Regulation 17 of MVAct. On a close reading of the regulation it can be seen that 14 days is allowed only for transfer the statutory risk cover (act cover) whether it is under Act only liabil i ty policy or Package policy. In order to transfer own damage section of policy a specif ic request from transferee with the consent of transferor is required. A new policy has to be issued after collecting the required charges. There is no automatic transfer of policy. The 14 days time is applicable only for endorsement of transfer of act only covers. Here in this case no steps have been taken to transfer the policy and the complainant has no insurance on his name and Sri.Binukumar has lost his insurable interest also. Hence own damage risk cover was not there and the repudiation is to be upheld and complaint is therefore dismissed.


Sri.James Mathew Vs

ICICI Lombard General Ins. Co. Ltd. Award Dated : 17.12.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant had insured his Mini Tipper lorry bearing Regn. No.KL-35 4328 under a

Package policy for the period from 2.3.07 to 1.3.08. During the currency of policy, the vehicle met with an accident on 21.3.07 and sustained damage. The claim was repudiated by the insurer on the ground that there was no permit for the vehicle to ply as goods carriage which is a violation of Motor Vehicles Act. It was submitted by the insurance company that there is an implied liabil i ty on the part of the insured that he wil l abide all the applicable law. As the loss was sustained as a result of an i l legal act, plying the vehicle on the road without permit, they are not l iable to make any payment. The only contention of insurer in repudiating the claim is that no permit was taken under Sec.66 of MV Act. Sec.66 prevents the user of a vehicle in any public place not in accordance with permit condit ion Sub Sec.2 of Sec.79 of MV act deals with condit ions with which permits can be granted. But there is no case that any condition stated in Sec.79(2) has been violated. It is not even stated that the accident occurred while using the vehicle for carrying goods. At any case there is no case that the accident occurred while carrying the goods in violation of any condition that could have been made while taking permit. Another contention of the insurer is that by operating the vehicle without permit is an i l legal act. Section 39 of MV act only envisages that by registration of vehicles one gets a right to drive the vehicle on public road. Sec.66 does not prohibit the user to ply the vehicle without permit. It is relevant to note that without insurance a vehicle cannot be driven through road and also without registration a vehicle cannot be driven through road. Only after taking insurance and registration the question of getting permit arise. Permit is not a condition precedent to taking insurance and registration, but insurance is a precedent for taking registration and getting permit. Hence if an accident occurs before taking a permit, he wil l certainly get the benefit of insurance. Hence the mere fact that the permit was not taken is not a valid ground for repudiating insurance claim. There is another ground too. Registration and fitness etc relates for fi tness of vehicle but permit has nothing to do with the fitness. Permits are issued only for collecting tax and also to have a control and management over road transport and not as a measure to control accidents. What is insured is the safety of vehicles and passengers and also third parties. In National Ins.co. Vs.Anjana Syam (2007) Supreme Court has held that inspite of the relevant provision of MV Act insurance sti l l remains as a contract between owner and insurer and the parties are covered by terms of contract. Hence in the absence of any specif ic contractual provision in the policy that in case of violation of any provision of any statute the insurance would be affected insurer will be l iable to be indemnify the insured even if there is any non-compliance of any statutory provision. Hence the repudiation is faulty which is l iable to be reversed and the insurer is directed to pay the amount of Rs.44145/- with 8% interest t i l l date of payment.


Sri.Babu P.N. Vs

ICICI Lombard General Insurance Co.Ltd. Award Dated : 19.12.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant’s vehicle KL-7-AV 5137 Tempo Traveller Mini Bus was insured with ICICI Lombard Gen.Ins.Co. under a package policy. While the policy was inforce the vehicle met with an accident on 12.6.07 while returning from Kodaikanal to Palani with some tourist. The claim was repudiated on the ground that the l ist of passengers traveled in the il l fated vehicle differs from the list of passengers as per permit issued.

The claim was repudiated only the ground that the list of passengers in the vehicle at the time of accident differ from the l ist of passengers obtained from the check post while issuing permit. The owner of vehicle has done a permit violation and insurer is l iable to indemnify only loss that suffered in the process of doing an activity not prohibited by law. There is an implied representation on the part of the insured that he wil l abide by all laws of land. As the owner has violated the permit condition insurer is not bound to indemnify the insured. The complainant has submitted that on 8.6.07 Heena Travels had placed an order by e.mail for carrying some tourist from Coimbatore. As the exact names of persons were not known some names were given to take permit to take the vehicle beyond state boundary. Only the first name in the l ist wil l be correct and this is the usual practice followed. The only ground of repudiation is that the l ist of passengers obtained from Walayar check post from where permit was taken differs from the l ist of passengers actually traveled in the vehicle. The fact that there is a difference in the names of passengers was admitted by the complainant himself. The vehicle has a capacity of 18 persons. The special permit was taken only to take the vehicle beyond state boundary. The permit was given only to operate the vehicle through the State of Tamilnadu. As far as the insurance co. is considered the exact name of persons are immaterial as the claim raised is for loss sustained to the vehicle and not to the passengers. In B.V.Nagaraju Vs.Oriental Ins.Co.Ltd. AIR 1996 SC 2054 – Supreme Court had held that merely by l i ft ing a person or two, it cannot be termed as a fundamental breach that the owner should be denied of indemnification. In terms of decision of Supreme Court in order to put an end to the contract the breach must be of fundamental nature. In the present case the name of the persons carried in the vehicle is immaterial. There is no case that persons exceeding the capacity of vehicle is carried in the vehicle. By mere taking a different set of persons in the vehicle, it wil l not amount to permit violation and hence the repudiation is set aside. Insurer is directed to pay a sum of Rs.431130/- together with interest at 8% til l day of payment with a cost of Rs.3000/-.


Sri.Janani Kumar Vs

Bajaj Allianz General Ins. Co. Ltd. Award Dated : 18.12.2007 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant had insured his vehicle KL 14E 8065 Maruti vehicle paying a total premium of Rs.7040/- w.e.f. 15.6.06. On 10.7.06 the vehicle met with an accident while it was driven by his brother, Sri.Jayakumar who died in the accident. The claim was repudiated on the ground that the claim was lodged after 6 months of accident and also the driver was not having an effective driving l icence at the time of accident. It was submitted by the complainant that his brother took the vehicle for shoping purpose and he was having a l icence to drive Light Motor Vehicle. He also submitted as he lost his brother in the accident he was in a great mental agony and he has instructed the garage to claim the amount. In the self-contained note the insurer had admitted that “All the averment regarding the genuinity of the accident is admitted”. Hence the factum of accident occurred on that day and vehicle was totally damaged was admitted by the insurer. It is clear that on account of the delay no prejudice has been caused to the insurer in assessing the loss. Such a condit ion is given only to assess the insurer the genuineness of the case and also for assessing the loss. Nowhere it was stated

that in the absence of such an immediate notice the claim wil l not be entertained. As such the insurer is not entit led to repudiate the claim on that ground. Another ground for repudiation is that the driver of vehicle was not having an effective l icence at the time of accident which is a pre-requisite for driving a commercial vehicle. As per the Motor Vehicles Act to drive a commercial vehicle on public road an endorsement to drive commercial vehicle is necessary. The vehicle is a taxi or a commercial vehicle and the policy issued was also for a commercial vehicle. The driver was having only an LMV licence. But it is to be noted the vehicle was a 4 wheeler having a capacity to carry not more than 6 persons with unlaiden wt. of 860 kg. Hence it was a l ight motor vehicle, but registered as a tourist taxi. On a reading of Sec.3 of MV Act it can be seen that special authorization is not required for driving a motor cab or motor cycle hired for ones own use or rented out under any scheme. On a close reading of Sec.3(1) along with Sec.75 it is clear that where there is no scheme under Sec.75(2) the person who got the vehicle rented can drive, if he is having on LMV licence and if the transport vehicle is rented out under the scheme it can be driven not only by the person got rented out but also can be driven through other drivers, who are having LMV licence. From the above discussion it can be seen that even if it is a transport vehicle it can be driven by a driver having only LMV licence, if it is hired for his own personal use. Hence he was having an effective licence to drove the vehicle and the repudiation is faulty. Insurer is directed to pay Rs.168500/- with interest at 9% ti l l date of payment.


Sri.T.Shakir Vs

National Insurance Co. Ltd. Award Dated : 05.02.2008 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant had insured his Hero Honda splender motor bike with registration no. KL02W/4441 for a sum assured of Rs.32500/-. On 4.11.06, he returned from his off ice and placed his vehicle in front of his house and went into the house. On his return after 10 or 20 minutes the vehicle was missing. Enquiries were made but the vehicle could not be traced out. The matter was reported to police and FIR was registered. The claim for insurance amount was declined on the ground that the owner left the vehicle in front of his house without locking. He has not exercised proper care and not taken all possible steps to safeguard the vehicle from loss or damage. The contention of insurer is that as per Cl.IV of policy condit ion the owner of vehicle should take all reasonable care to safeguard the vehicle from loss or damage. The insured had violated this condition by leaving the vehicle unlocked and hence they are justif ied in repudiating the claim. It was submitted by the complainant that he has left the vehicle unlocked with the intention of taking vehicle within 10 minutes. It is to be noted that the theft happened in front of insured’s residence. It is near to railway track on eastern side of Kollam-Paravoor railway line. This is a residential area. The vehicle was parked in front of his residence, and not in a public road. It is a secluded place. Though it was not locked, the ignit ion key was taken and carried by him and hence vehicle could not be started and taken off. His intention was to return immediately within 10 minutes time for the purpose taking the vehicle for shopping. So the vehicle was not locked. This is the normal conduct of a man of ordinary prudence. While temporari ly parking the vehicle unlocked in front of his house it could not be said that he has not exercised reasonable care, though he has not exercised absolute care.

Hence repudiation made cannot be justif ied. Insurer is therefore directed to pay Rs.32470/- being the amount payable under the policy with 8% interest from date of claim til l date of payment.


Sri.Jayakumar T Vs

National Insurance Co.Ltd. Award Dated : 20.02.2008 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The Pickup van bearing No.KL-02 Q4246 was insured for the period 28.7.04 to 28.7.05 under a Package policy. On 2.5.05 the vehicle met with an accident, but the claim was repudiated on the ground that the insured has no insurable interest on the vehicle and also the driver has no valid driving l icence. Aggrieved by this the insured approached this Forum. The complainant has stated that the repudiation was made on flimsy ground as he has not violated any of policy conditions. As there was a valid insurance he is eligible to get the amount claimed for. The claim was repudiated mainly on the ground that the insured had no insurable interest either at the time of taking policy or at the time of accident. It was submitted that Sri.Jayakumar, the complainant had sold the vehicle to one Sri.Siju on 9.2.04 for valuable consideration. But the RC book was not transferred in favour of Sri.Siju as the vehicle was under a hire purchase agreement. The documents also reveal that Sri.Siju is the owner of vehicle 3 months before accident the vehicle was seized by Forest Dept. for carrying timber without permit. As per Court Order the vehicle was released to Sri.Siju on executing bank guarantee, as if he was the owner of vehicle. The copy of sale agreement was also produced, where in it was stated that the vehicle was sold to Sri.Siju and it was under taken that the amount due to the financier will be paid by Sri.Siju, the purchaser in 42 instalments. The genuineness of this agreement was not disputed by the complainant. On 29.12.05 Sri.Jayakumar made a request to Manager of Insurance Co. to consider his claim favourably and in this letter he has stated that the vehicle was sold to Sri.Siju on 9.2.04. Hence it is clear that neither at the time of accident nor at the time of taking policy Sri.Jayakumar was having insurable interest on the vehicle. The motor vehicle is a movable property, the transfer of which can be effected by delivery. The fiction of deemed transfer of policy to transferee under 157 of M V Act is applicable to third party risk only. Hence the action of insurer in repudiating the claim is justif iable and the complaint is therefore dismissed.


Sri.Mohammed Hashim Vs.

New India Assurance Co. Ltd. Award Dated : 04.03.2008 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. The complainant had insured his vehicle KL 10H 9006 having a declared value of Rs.1,20,000/- under private car package cover for the period 28.9.05 to 27.9.06. On 19.1.06 the vehicle met with an accident and the claim was repudiated on the ground that at the time of accident the vehicle was used on hire and hence it is a violation of policy condit ion. Aggrieved by this the complainant approached this Forum for justice.

The claim was repudiated on the ground that at the time of accident the vehicle was used on hire. Their decision was mainly based on FI statement given by one Mr.Nawas, who was traveling in the vehicle at the time of accident. He has stated that he and some of his fr iends has taken the vehicle on hire. But it was submitted by the complainant that the statement given in the FIR is a wrong statement and Mr.Nawas had never given such a statement and also a statement in the FIR cannot be taken as an evidence. The copy of FIR was produced by the complainant himself. It looks that the FIR was registered on the basis of statement given by Mr.Nawas. The statement was recorded and his signature was obtained as FIR statement for registering the crime. In the FIR statement it was specif ically stated that the accident took place at 3.40 a.m. and the FI statement was recorded at 7.00 am. From this it is clear that the informant Sri.Nawas was traveling in the vehicle and the statement was taken within a short span of accident. He was unequivocally stated that the vehicle was hired by them. It is a well established law that FI statement can be considered as an item of evidence. There was absolutely no necessity for him to give a false statement at that t ime, against the interest of the owner of the vehicle. The policy condit ion is very specific that insurance coverage wil l not be available if the vehicle was being used as taxi. Here repudiation made is correct and l iable to be upheld.


Sri.Joyce Vs

New India Assurance Co. Ltd. Award Dated : 07.03.2008 The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Late Njanadas, the husband of the complainant had insured his transport vehicle KL 5Q 8098 with New India Assurance Co. under package cover covering the period 21.3.07 to 20.3.08. On 30.3.07 the vehicle was involved in an accident, and Sri.Njanadas, the owner cum driver of vehicle died on the spot. The claim was repudiated on the ground that at the time of accident the driver was not having effective and valid driving l icence and also the fitness certif icate of vehicle expired on 22.3.07. Aggrieved by this he approached this Forum. The policy condit ion is very specific that the claim under a policy wil l be only if the driver is having a valid and effective driving l icence to drive the vehicle at the time of accident and also he has not been disqualified from getting such a l icence. There is no dispute to the fact that the l icence of the driver to drive a transport vehicle expired on 27.2.06 and the accident took place on 30.3.07 after 13 months of expiry of l icence. It was submitted by the complainant that the l icence was given for renewal to an agent. But the extract of driving l icence obtained from road transport authorit ies produced which states that the l icence to drive transport vehicle expired on 27.2.06. This extract was taken on 4.5.07 about one month after accident. Hence it is clear that at the time of accident there was no valid and effective driving l icence. The policy condition is very specific about its exclusion clause, the repudiation is to be upheld and the complaint is therefore dismissed.

Lucknow Omdudsman Centre Case No.G-12/11/05/07-08

Shri.Ajai Singh Vs

ICICI Lombard General Insurance Co. Ltd.

Award Dated : 04.10.2007 Ajai Singh, the complainant insured fi led a complaint with this forum against the order of ICICI Lombard General Insurance Co. Ltd for repudiating his accidental damage motor claim. Facts : A private vehicle Toyota Innova was comprehensively insured for the period 30.1.06 – 29.1.07. The policy mentions only engine no./ chasis no. of vehicle. Vehicle met with an accident on 23.3.06 near Hoshiarpur in Punjab. Vehicle was not registered as on the date of issue of policy as also on the date of accident. Hence claim repudiated by the Co. as vehicle used in violation of law. Findings : The respondent Co. contended that a vehicle has to be registered before it can ply in a public place as per section 39 of Motor Vehicle Act. Further Motor Vehicle rule(4) also provides for applying for registration within 7 days of taking delivery of vehicle. A valid policy existed on date of accident is not disputed. Damages are also assessed for Rs.193349/- as per surveyor’s report. Vehicle was plying in a far away place without registration, in violation of law is also established. But this is to be seen by RTA which may impose a penalty or impound the vehicle. Point to be considered is whether this conduct on part of the complainant vit iates the contract in toto. Decision : Blatant act of gross negligence and scant respect for law and procedure by the complainant insured cannot be overlooked. However, the lacuna on part of the respondent Co. in granting a policy without Engine no./ Chasis no./registration no. is a serious lapse as the identity of the vehicle insured becomes doubtful. In such circumstances, forum allowed claim on compromise basis, l imiting the claim to 60% of admissible amount. Complaint disposed off accordingly.


Shri.Vinod Kumar Vs

United India Insurance Co. Ltd. Award Dated : 23.11.2007 Shri.Vinod Kumar, the complainant Insured, has fi led a complaint with this forum against the decision of the respondent Co. for repudiating his claim on the grounds that the claim is not genuine. Facts : The complainant had taken out a motor cycle comprehensive policy for a sum insured of Rs 23000/- for the period 23.01.06 – 22.01.07 from the respondent Co.M/s United India Insurance Co. Ltd. The vehicle met with an accident on 27.05.06. Surveyor was deputed who assessed loss for 5166/- Doubting veracity of claim, Branch Manager appointed a second surveyor, who perused claim papers, photos etc and opined claim appears fabricated. On his report, the claim was repudiated by the Co. Findings : Original surveyor had personally inspected the vehicle and then submitted the report whereas the second surveyor had only opined based on the papers and photographs. No clarif ications ever sought by the underwrit ing off ice from the original surveyor nor the opinion of the 2nd surveyor passed on to the 1st surveyor for his comments. The second surveyor should not have been appointed without recording reasons and without the consent of the higher off ice. Decision : It was not just on part of the respondent Co. to repudiate claim on mere suspicion without substantiating the fraud. Respondent Co. directed to pay as per

assessment of original surveyor subject to policy terms and condit ions. Complaint was disposed off accordingly.


Shri.O.N.Bansal Vs

United India Insurance Co. Ltd. Award Dated : 10.01.2008 Complainant Insured, Shri.O.N.Bansal fi led a complaint with this off ice for rejection of Maruti car theft claim by M/s United India Insurance Co.( the respondent Co.) Facts : The complainant had taken out a motor car comprehensive policy for his Maruti car with M/s United India Insurance Co for a sum insured of Rs 30000/- for the period 27.06.06 – 26.06.07. The said vehicle was stolen on 18.09.06. The loss was assessed for 29500/- However the claim was repudiated by the Co. on the following ground: The vehicle was registered in february 1990 for a period of 15 years and the period had expired in February 2005. As per law, the vehicle can be registered for 15 years only and renewed by re-registration. Although all other papers were in order, claim was repudiated on sole ground that the vehicle was not registered as on date of theft ie.18.09.06. Findings : Section 39 of the Motor Vehicle Act makes it mandatory for all vehicles to be registered. Section 41(7), the relevant clause for this case further states “A certif icate of registration issued under sub-section(3) whether before or after the commencement of this act, in respect of a motor vehicle other than transport vehicle shall subject to the provision contained in this act be valid only for a period of f i fteen years from the date of issue of such certif icate and shall be renewable.” The above clause establishes vehicle is to be registered after 15 years. However act is si lent on the effect of non-registration in such a case. No penalties are prescribed for failure to register implying non registration of vehicle is not such a serious offence as to render the claim invalid. Also the date of registration is mentioned on Cover note and Co. was aware that on date of renewal of policy ie.27.06.06 it was not registered. Having granted the policy with full knowledge of non-registration of vehicle, the respondent Co. cannot take shelter on non registration as a ground for repudiation of claim. Decision : It was held that total rejection of claim was unjustif ied. However, the owner insured too cannot get away with breach of law which is against public policy. Hence, claim was allowed on compromise basis not exceeding 90% of the admissible claim. Further an 8% interest was awarded on the admissible amount from expiry of 7 days from receipt of investigation report for delay on part of the Insurer for unjustif iable reasons. Complaint was disposed off accordingly.


Shri.Pradeep Kumar Shrivastava Vs

Cholamandalam M.S.General Insurance Award Dated : 08.02.2008

Complainant Insured fi led a complaint against repudiation letter dated 27/07/07 of M/s Cholamandalam M.S.General Insurance for theft of his motor cycle. Facts : A motorcycle was comprehensively insured for the period 25/04/06 to 24/04/07. The vehicle was stolen on 13/02/07. The claim was repudiated due to inordinate delay in intimation of claim to the Co. ie. a period of 34 days and relied upon the condition no.1 of the policy regarding notice of claim to Co. in case of loss. Findings : The Insured showed a letter dated 15/2/07 regarding intimation of claim, duly acknowledged by a signature and office seal of the Co.The investigator appointed by the Co. also confirmed genuineness of theft. The respondent Co. did not deny the genuineness of the signature or seal of the Co. on the intimation letter. The Co.’s representative contended that notice given to an agent is not notice given to the Co. His attention was drawn to section 229 of Indian Contract Act which is explicit with regard to any notice or information being given to an agent. Decision : Notwithstanding above circumstances, alleged delay did not actually prejudice the rights of the respondent Co. in any way as their investigation report established the veracity of theft on that day. Respondent Co. directed to pay claim in full as per IDV subject to policy terms and conditions.


Shri.Ram Kumar Yadav Vs


Complainant Shri. Ram Kumar Yadav fi led a complaint with this office against ICICI Lombard General Insurance Co. Ltd for repudiation of his motor theft claim. Facts : Complainant had a motor comprehensive package policy for his Bolero Jeep (privately insured) for an IDV of Rs.466081 for the period 2/6/07 – 1/6/07. Vehicle was allegedly stolen on 7/2/07. Investigator submitted a report stating vehicle used for commercial purpose. Even the complainant had given a statement that the vehicle was being run on ‘Thekedari’ by his son implying commercial use of vehicle and hence violation of “ l imitation as to the use” condit ion of the policy. Findings : Use as a commercial vehicle was established. Such a use tremendously increase the risk exposure in case of own damage claim.But same may not be the case when vehicle is involved in a theft-as they are mostly stolen whilst parked. Therefore, no nexus between theft and l imitations as to use of vehicle. However, the insured cannot get away with such deliberate violation of policy condit ion so as to undermine the very sanctity of the contract itself.

Decision : The above violation would render the contract viodable, as the use of vehicle for commercial purpose does not constitute a very serious breach of contract in case of theft. Award is passed for 50% of the admissible claim. Complaint is disposed off accordingly.

Mumbai Ombudsman Centre Case No. : GI-180 of 2006-2007

Smt. Puja Chodankar Vs

National Insurance Company Ltd.

Award Dated : 17.10.2007 Smt. Puja Chodhankar, had taken a Policy from National Insurance Company Ltd., Goa, to cover her vehicle Premier Padmini. Smt. Puja Chodankar, intimated to the company that her vehicle was stolen on 26.6.2003. The Company sent an offer letter dated 28th March, 2005 “Without Prejudice” to Smt. Puja Chodankar, to exercise the option to replace the vehicle of same model and make in place of the vehicle lost by her due to theft, as per Policy Condition No.3 of Private Car Policy. But during final scrutiny, it was found that the vehicle did not belong to Smt. Puja Chodankar, but to Shri Chandrakant Bablo Parab, who had purchased the vehicle before the occurrence of theft from Smt. Puja Chodankar. The Company, therefore, vide letter dated 25.10.2005 informed Smt. Puja C. Chodankar, that the claim is treated as “No Claim”. The Insured vehicle according to the complaint made by Shri Chandrakant B. Parab, to Mapusa Police station on 3.10.2003 was purchased by him seven months back from her but the same was not transferred in his name ti l l date. It was noted that the R.C Book and Insurance was in her name and the person preferring the claim (as the owner of IV) and the person named in the Policy/RC Book were different. As per Policy Condition the owner has to be the registered owner of the vehicle and Insured name in the policy, hence the claim was repudiated. Not satisfied with the decision, Smt. Chodankar, represented to the company vide letter dated 17.1.2006 and thereafter vide letter dated 6.2.2006 approached the Ombudsman seeking his intervention in the matter of settlement of her claim with the company. The company in their detailed written submission to this Forum has stated that when the claim was lodged by Smt. Puja Chodankar stating that her vehicle was stolen on 26.6.2003, an offer letter “Without Prejudice” was sent to her to exercise the option to replace the vehicle of same model and make in place of stolen vehicle as per Policy Condition No.3 which reads as “The Company may at its own option repair reinstate or replace the vehicle insured ……”. But during the final survey it was found that the vehicle does not belong to Smt. Chodankar but to Shri Chandrakant B. Parab, who had purchased it before the occurrence of theft. It was noted that after the theft of the vehicle, Shri Chandrakant B. Parab, on 3.10.2003 (i.e 3 months after the theft of the vehicle) reported to the Police that he had purchased one Fiat Car No.GDF 0235 from Smt. Puja Chodankar and paid Rs.15,000/- for the said car and it was stolen on 26.6.2003 while it was in his custody. The police authority had also made a remark about the delay on FIR. As per Policy Condition No.1 “ In case of theft or criminal at which may be the subject of a claim under this policy the insured shall give immediate notice to the police and cooperate with the company in securing the conviction of the offender”. The Company justif ied their decision to reject the claim for the following reasons: l Smt. Puja Chodankar, is not the owner of the vehicle and neither does she have

Insurable Interest to claim under the policy. l Because of the delay in reporting to the Police, owner has not given the opportunity

to do the proper investigation. l Delayed complaint itself is a violation of Policy condition. l Applicant has no locus standi to make the claim. l The claim is t ime barred. If the Company disclaim liabili ty to the Insured for any

claim hereunder and such claim shall not within twelve calendar months from the date of such disclaimer have been made the subject matter of a suit in a court of

law, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable.

On analysis of the records, it is observed that the vehicle was in the name of Smt. Puja Chodankar and insured under Policy No.270905/31/02/6110722 for the period 7.1.2003 to 6.1.2004. Thereafter the vehicle was sold by her to Shri Chandrakant Bablo Parab. The vehicle was stolen on 26.6.2003 and 3 months after the theft of the vehicle, i.e. on 3.10.2003 Shri Chandrakant B. Parab, (the new owner of the IV) reported to Mapusa Police station that the vehicle was purchased by him seven months back from Smt. Puja Chodankar. The new owner had neither claimed under the policy nor he applied for transfer of Insurance policy, which he should have done within 14 days of transfer of the vehicle and the ownership was not transferred in his name as per R.C. book also. The Motor Vehicle Act, 1988 regarding transfer of ownership is quoted below: 50. Transfer of ownership – (1) Where the ownership of any motor vehicle registered under this Chapter is transferred – (a) the transferor shall – “( i) in the case of a vehicle registered within the same State, within fourteen days of the transfer, report the fact of transfer, in such form with such documents and in such manner, as may be prescribed by the Central Government to the registering authority within where jurisdiction the transfer is to be effected and shall simultaneously send a copy of the said report of the transferee; and ………. (b) the transferee shall, within thirty days of the transfer, report the transfer to the registering authority within whose jurisdiction he has the residence or place of business where the vehicle is normally kept, as the case may be, and shall forward the certif icate of registration to that registering authority together with the prescribed fee and a copy of the report received by him from the transferor in order that particulars of the transfer of ownership may be entered in the certif icate of registration. General Rule 17 of the Indian Motor Tariff which is quoted below: ‘The transferee shall apply within 14 days from the date of Transfer in writ ing under Recorded Delivery to the Insurer who has insured the vehicle, with the details of the Registration of the Vehicle, the date of the transfer of the vehicle, the previous Owner of the vehicle and the number and date of insurance policy so that the Insurer may make necessary changes in his record and issue a fresh certif icate’. Motor Insurance is governed by All India Motor Tariff, which is in l ine with Motor Vehicles Act, which is a Statutory Act and compliance with the provisions of the Act is mandatory. In this case, there was a violation of the motor tariff guidelines regarding transfer of vehicle and the policy was not endorsed in the name of the new owner before the loss took place. In terms of the above provision, as on the date of theft, there was no Insurable Interest of Smt. Pooja Chodankar, in the said vehicle as the vehicle was sold to Shri Chandrakant Bablo Parab, the Company’s decision to repudiate the claim is held sustainable.


Shri Sitaram N. Sirsalewala Vs

Royal Sundaram Alliance Insurance Company Limited Award Dated : 31.01.2008

Shri Sitaram N. Sirsalewala, had insured his vehicle Skoda Octiva Ambienet TDI, with Royal Sundaram All iance Insurance Company Limited under Private Car Package Policy for IDV of Rs. 6,50,000/- for the period 10.6.2005 to 9.6.2006. He lodged a claim with the company for damages to the insured vehicle on account of f loods. The Company deputed their Surveyor to survey and assess the damages sustained by the vehicle. The Insured after getting his vehicle repaired with the authorized dealer submitted an invoice for Rs.2,77,050/- based on which the Surveyor’s assessment of the l iabil i ty was worked out to Rs.1,68,560/-. The Insured accepted the cheque for Rs.1,68,560/- dated 1.2.2006 and thereafter vide letter dated 4th July, 2006 approached the Ombudsman, enclosing a copy of the claim computation sheet stating that the company settled only Rs.15,000/- labour charges as against his bil l of Rs.92,200. The Company has vide letter dated 18.1.2008 informed this Forum that subsequent to the Hearing, the Surveyor had requested the insured to produce the salvage of the spare parts replaced in FIP in the month of December 2007, which the insured has failed to surrender ti l l date, hence the complaint should be dismissed. On an analysis of the records pertaining to the case, it is noted that the company had settled the claim and the dispute is regarding the FIP repair charges for which an opportunity was not given to the Surveyor for inspecting FIP before repairs and after repairs the salvage of the spare parts replaced in the FIP was not produced for inspection by the Surveyor and hence the company settled the claim without taking into account the FIP repair charges. The Insured did not provide any proof to show that the damaged spares in the FIP was actually repaired to assess the liabil ity. During the Hearing the company has also stated that the estimate was dated 19.9.2005 and the bil l submitted was dated 15.9.2005 and the company failed to understand how the bil l was raised before the estimate. It was the responsibil ity of the Insured to give full cooperation to the Surveyor of the Company and safeguard the insured property until the l iabil i ty was admitted by the Insurance Company, instead of leaving the matter between the Surveyor and the Workshop. It should be noted that any claim has to be substantiated under the policy and the company can make payment after satisfying themselves about the claim being established under their policy with all terms and conditions. Since in this case no opportunity was given to the Surveyor to inspect the damages to the FIP before repairs and after repairs the salvage of the spare parts was not produced, the decision of the company to settle the claim without taking into account the FIP repair charges is sustainable.


Shri Narayan S. Patil Vs

Cholamandalam General Insurance Co.Ltd. Award Dated : 19.02.2008 Shri Narayan S. Pati l, had insured his vehicle Tata Indica, Registration No.MH-06-AB-6032, Model 2005, under Private Car Policy No.VPC-00084961-000-00 for the period 28.10.2006 to 27.10.2007 with Cholamandalam MS General Insurance Co.Ltd., for an IDV of Rs.3,14,211/-. As stated in his claim form on 23.12.2006, the vehicle was stolen from the parking area below his residence. An FIR was fi led at the Panvel Police Station of Raigad district on 8.1.2007.

He intimated the theft to the Company on 18.1.2007. The Company vide letter dated 18.1.2007 informed Shri Narayan Patil , that the claim was reported belatedly, thus denying the company the opportunity to check the veracity of the claim. The belated intimation thus constitutes breach of conditions 1 and 9 of the policy issued, rendering the claim inadmissible. He was asked to clarify the reasons for the delay to see if they could re-examine the aspect of admissibil ity of the claim on this count. Not satisfied with the decision, he represented to the company stating that his son had informed to the Panvel Police Station on 23.12.2006 i.e. on the same day when the car was stolen. As per their practice, Police Officials advised him to search for the vehicle for 10 to 12 days and only after that to register the FIR for the theft. Thus following their advice, he searched the vehicle with the help of his friends and family but could not f ind it, hence finally police officials recorded his FIR on 8.1.2007. On the same day he intimated the facts of theft verbally to Shri Sandip Sharma of Vashi Branch and was under the impression that he must have intimated the company and hence there was a delay and he contacted the office belatedly on 18.1.2007.

The Company vide letter dated 3.5.2007 informed Shri Pati l, that the claim was reviewed by the competent authorit ies, who resolved to reiterate the stand of repudiation as there were serious violations of the condit ion Nos.1 and 9 of the policy. Thereafter, the Advocate of the Insured Shri D.R. Shelke, on behalf of the insured issued a Notice to the company on 17.5.2007. However, the company stated that they are not l iable for the demands made therein.

Not satisfied with the decision, he approached the Ombudsman for intervention in the matter of settlement of his claim with the company.

On an analysis of the records pertaining to the case, it is observed that there was a theft of the vehicle on 23.12.2006 and the insured lodged the claim on 18.1.2007. The company had asked the Insured the reasons for the delayed intimation of 25 days apart from the delay of 13 days in intimating the police authorities. The complainant in reply had admitted the delay on his part and attr ibuted the same to lack of information on the claim procedures. An Investigator, M/s One Point Services, was deputed by the company and he had confirmed the theft. The company repudiated the claim on account of violation of policy conditions, which stipulate that the insured shall immediately intimate the insurer upon the occurrence of loss and in the event of theft or criminal act to immediately intimate the police which was not complied by the insured. The Insured thereafter submitted a letter from the Panvel Police Station, which stated that the complaint was lodged by him on 23.12.2006 and as the vehicle was not traceable they registered the complaint on 8.1.2007.

The Investigator has concluded that the insured has provided all the relevant documents of RTO and the vehicle was used by the Insured for personal use. It was clear from the letter issued by the police subsequently that the complaint was lodged by him on the day of the theft on 23.12.2006. Although the Insured has admitted that he was not aware of the policy procedures and had informed the agent, in strict terms there was a violation of policy condit ion as the company was not immediately informed which is necessary in case of theft claims. However, the police has issued a supplementary letter clarifying that the complaint was lodged with them on the day of the theft and the Insured had complied with all the other requirements and the reasons mentioned for late intimation was dependent on the information given to the Agent. In the facts and circumstances, the total repudiation is set aside but the Insured should bear a penalty of 5% for not informing the company in t ime about the theft of the vehicle.

Cholamandam MS General Insurance Company Ltd, is directed to settle the claim of Shri Narayan Pati l, in respect of his vehicle Tata Indica, to the extent of 95% of the admissible claim. There is no order for any other relief. The case is disposed of accordingly.


Shri Narotam Roygaga Vs

United India Insurance Company Limited Award Dated : 21.02.2008

Shri Narotam Roygaga, had insured his vehicle Hyundai Santro LS(Euro II), with United India Insurance Company Limited, under Private Car Package Policy for IDV of Rs.1,46,000/- for the period 30.8.2007 to 29.8.2008. The car was submerged in f lood waters on 26th July, 2005 at Juhu, Mumbai.

The Company settled the claim for Rs.3481/- against the repair of Rs.7337/- in full and final sett lement of the claim. Not satisfied with the settlement, Shri Narotam Roygaga, represented to the company seeking details of deductions from the claim amount and stating that the amount was not acceptable to him. The company by its letter dated 6.6.2007, informed him that at the time of transfer of insurance i.e. from New India to United India, they had imposed excess of Rs.1000/- and compulsory excess of Rs.500/- and that it was their normal practice to accept transferred business in such a manner.

On taking up the matter with the company by this Forum, we have received a reply which is quoted below:

“As a measure of loss minimization, we are imposing excess in fresh motor insurance or for the transferred business from the other insurers. We are also imposing excess in case of continuous claims by the Insured or for having preferred major claim.

In the captioned case, excess was imposed since the business was transferred from the other insurer and it is our regular practice that whenever we impose excess, we always inform the agent/Insured about it and after getting the consent either oral or in writ ing, we accept the proposal. After getting the oral consent, this proposal had been accepted by us at that t ime. The imposed excess in the above matter was from the inception of the policy with them and continued thereafter as it was. The said excess could have been removed, if the insured would have requested at the time of renewal or before the occurrence of loss. Since the Insured had not requested to remove the excess on subsequent renewals, it was there in the policy ti l l the current policy and based on the excess in the policy, they have finalized and approved the claim”.

Aggrieved with the decision, Shri Narottam Roygaga, approached the Ombudsman for intervention in the matter of sett lement of his claim with the company.

A joint hearing was held on 6t h February, 2008. Shri Narotam Roygaga, Complainant, appeared and deposed before the Ombudsman. He submitted that he had lodged a claim and the company deducted Rs.1000/- as imposed excess and Rs.500/- as compulsory excess from the claim. Earlier also when his car was damaged during July 2005 floods in Mumbai there was a deduction of Rs.1500/- towards imposed and compulsory excess. He stated that the policy does not give details as to why the imposed excess and compulsory excess is deducted.

Since underwrit ing aspect does not fal l within the purview of the Ombudsman’s jurisdiction and moreover the Complainant has not raised the issue at the appropriate t ime, accordingly the complaint is dismissed.

Mumbai Ombudsman Centre Case No. : 338 of 2007-2008

Shri Siddharth C. Parekh Vs

The New India Assurance Co.Ltd. Award Dated : 28.02.2008 Shri Siddharth C. Parekh, had insured his new vehicle Chevrolet Tavera, under Private Car Package with The New India Assurance Co.Ltd., for the period 27.9.2006 to 26.9.2007 for IDV of Rs.8,81,941-. The vehicle was stolen during the night of 8.10.2006 and morning of 9th October, 2006, when it was parked at his residence at Khar, Mumbai, and he reported to the Khar Police Station and lodged an FIR No.393/06 on 9.10.2006. The Company vide letter dated 26th July, 2007 informed the Insured that the claim was settled by them on non-standard basis @75% of IDV of the vehicle, on the ground that there was a delay of 38 days in intimating the loss to them, thereby jeopardizing the chances of recovery of the vehicle by their Investigator. His attention was drawn to Policy Condition No.1, which states that notice shall be given in writ ing to the Company immediately upon occurrence of loss and asked him to accept their offer of Rs.6,59,706/- inspite of breach of Policy condit ion No.1 and to discharge the voucher and return the same to them to release the cheque at an early date. Not satisfied with the decision of the company, Shri Parekh represented to the Grievance Cell on 13.8.2007 asking the reason for deducting the amount of Rs.2,22,235/- from the claim of Rs.8,81,941/- and asked the company to reconsider his case and sanction the full amount of his claim. He refused to accept the claim amount and returned the discharge voucher to the company. He stated that it was the fault of the agent and that the agent had collected the claim form duly signed by him on 9t h October, 2006 and later on he took another claim form on 15.11.2006 on the pretext that the earl ier form was lost/misplaced and he had faxed the copy of FIR to their office. Aggrieved by the decision of the company, the Insured approached the Ombudsman vide his letter dated 15.10.2007 for intervention in the matter of sett lement of his claim with the company. Shri Biplab Roy, Investigator, in his Investigation Report dated 20.2.2007 has mentioned that on 8.10.2006 at 9.45 p.m. the insured Mr. Parekh properly locked and parked his new car just 5 days old on the main road in front of his residence and the next day early morning at 6 o’clock when he went downstairs he found that his car was stolen. During investigation, he had collected the original invoice and other documents pertaining to the sale and delivery of the stolen vehicle and obtained certif ied copy of RTO stating that the vehicle is stolen. During his interrogation with the security person of the residential building, he came to know that the insured had two more vehicles and since there was insufficient authorized parking space inside, the insured had to park the vehicle outside the premises along the road where many other vehicles were parked. The vehicle was not used for commercial purpose and the detection goes in goodwil l of the insured. After his enquiry with all concerned and through all the available documents obtained by him, it was revealed that the vehicle had been stolen from the roadside parking place in front of insured’s residence and that it was a

genuine claim. Later Khar Police Station investigated the same but they could not recover the vehicle t i l l date. The insured vehicle was not found and the police had given the final report stating that there are no possibil it ies of getting the vehicle.

On an analysis of the records, it is observed that the vehicle was stolen on 8t h October, 2006 and the insured lodged the claim after 38 days. The company settled the claim on Non-standard basis @75% of IDV of the vehicle on the ground that there was a delay of 38 days in intimating the loss thus jeopardizing the chances of recover of the vehicle and had sought his explanation for the delay. During the hearing the complainant stated that on the day of the theft he had called the agent and fil led the claim form and faxed a copy of the FIR to the company and the Agent assured him that the claim would be delivered to the company. When he called up the company after a few days, he came to know that the claim form was not received and thereafter the agent got another claim form fi l led by him and submitted the same to the company. He stated that he had completed all the formalit ies in good faith and all along the agent could not be contacted. The Investigator has concluded that the insured has complied with all the requirements and the vehicle was used by the Insured for personal use and the claim is genuine Although the Insured has stated that he had informed the agent, in strict terms there was violation of policy condition as the company was not immediately informed which is necessary in case of theft claims. However, the reasons given for late intimation to the Insurance Company was dependence on the information given to the Agent.

In this case, the Insured has failed to intimate the insurer immediately denying them the opportunity of recovery of the vehicle. However, a penalty of 25% does not commensurate with the non-compliance of the policy condit ion, instead a penalty of 5% is imposed to the insured for not informing the company in t ime about the theft of the vehicle.

The New India Assurance Co.Ltd., is directed to settle the claim of Shri Siddharth Parekh, in respect of his vehicle Chevrolet Tavera, to the extent of 95% of the admissible claim. There is no order for any other relief. The case is disposed of accordingly.


Shri Roopesh C. Shah Vs

United India Insurance Company Ltd. Award Dated : 07.03.2008 Shri Roopesh C. Shah, had taken a Motor Policy from United India Insurance Company Ltd., to cover his vehicle Maruti Zen, for IDV of Rs.2,36,000/- under Private Car Package Policy for the period 18.8.2004 to 17.8.2005. Shri Roopesh C. Shah, intimated to the company on 2.8.2005 that his vehicle got damaged due to heavy rains on 26.7.2005 near his residence. The Company informed Shri Roopesh C. Shah, that the claim is treated as No Claim as the “policy was in the name of Shri Roopesh Shah whereas Registered in the name of Shri Vilas Shirke”. Not satisfied with the decision, Shri Vilas Shike, the Registered owner of the vehicle as per the RC Book represented to the company vide letter dated 30.4.2007 requesting the company to send the claim form/discharge voucher for his signature and to release the amount of claim in favour of Shri Roopesh C. Shah, the present owner of the car. Thereafter vide letter dated 26.7.2007, Shri Roopesh C. Shah, approached the

Ombudsman stating that the claim was rejected by the company on the ground that the vehicle was not registered in his name. However, the previous owner Vilas Shirke, also wrote to the company stating that the claim can be paid to him, being the registered owner of the vehicle in R.T.O. records but there has been no reply from the company inspite of fol low-up. He had paid two yearly premiums and agreement was made between himself and the seller on 18.6.2004. He requested the intervention of the Ombudsman in the matter of settlement of his claim alongwith interest with the company. The company in their detailed written submission to this Forum had stated the Insured had submitted the final bil l of repairs quite late on 2.8.2006 after sending 3 reminders for the compliance of the required documents, but the insured did not submit the original R.C. Book for verification. Hence they appointed an Investigator, Shri Sunil Dhavan to collect the extract of Registration Book from R.T.O. As per his report and RTO’s record the name of the registered owner is Shri Vilas Shirke and not in the name of the Insured. It was contradictory and ambiguous to decide Insurable Interest, especially when Registered Owner on the date of accident was found not to be the Insured and the Insured/Claimant found not to be the registered owner of the vehicle. Hence the claim was rejected and was duly informed to the claimant on 16.4.2007. On analysis of the records, it is observed that Shri Roopesh C. Shah, had purchased the vehicle from Shri Vilas Shirke on 18.6.2004 and had insured the vehicle with United India as per proposal dated 16.8.2004. The vehicle was damaged due to f lood on 26.7.2005 and Shri Roopesh C. Shah submitted a claim to the company on 2.8.2005. In the proposal form Shri Roopesh Shah, had mentioned that the vehicle is being transferred in his name and he had not declared that the vehicle was hypothecated. In the proposal form, he had submitted the details of previous insurer as United India Insurance Co, Vashi, with policy number and period of insurance from 18.8.2003 to 17.8.2004. The company has submitted that even after sending reminders, the Insured did not submit the original R.C. Book for verification. Hence they appointed the Investigator to collect the extract of Registration Book from RTO from which it was noted that the registered owner of the vehicle was Shri Vilas Shirke and not the insured. Although Shri Roopesh Shah, had insured the vehicle in his name, he had not submitted the original R.C. Book for verification and the company was not in a position to know that the vehicle was not transferred in his name.

Motor Insurance is governed by All India Motor Tariff, which is in l ine with Motor Vehicles Act, which is a Statutory Act and compliance with the provisions of the Act is mandatory. In this case, there was a violation of the motor tariff guidelines regarding transfer of vehicle. As per Policy Condition the owner has to be the registered owner of the vehicle and Insured name in the policy. In terms of the above provision, the company’s decision to repudiate the claim on the ground that the Insured, Shri Roopesh Shah, was not the registered owner of the vehicle, is held sustainable. In the facts and circumstances, the claim of Shri Roopesh C. Shah, in respect of damage to his vehicle under Private Car Package Policy for the period 18.8.2004 to 17.8.2005 is not tenable. The case is disposed of accordingly.


Shri J.V.R. Bhatta Vs

ICICI Lombard General Insurance Company Ltd.


Shri J.V.R. Bhatta, Complainant was approached by ICICI Lombard General Insurance Company Ltd., representative for Car Insurance for which he issued a premium cheque dated 18.9.2006 for an amount of Rs.3107/- and submitted the proposal form to cover his car Maruti 800 DX, Vehicle.

As he did not receive the policy, he wrote to the Company stating that he visited the insurance counter on 6.10.2006 as he had not received the policy but he was informed that the cheque was bounced and hence the policy could not be issued.

Aggrieved with the company, Shri J.V.R. Bhatta, approached the Ombudsman stating that his car insurance policy was expiring on 30.9.2006. As some official from ICICI Lombard General Insurance Co.Ltd., personally approached him, he agreed to take a fresh policy from them and issued a cheque for Rs.3107/- on 18.9.2006. He was informed that he wil l get the policy within next 10 days, however, he did not receive the policy. He personally approached their outlet in ICICI Bank, Vashi on 3.10.2006 and was informed that his cheque was bounced and hence the policy was not issued. But the actual fact was that the cheque was credited to ICICI Lombard and they had not even issued the cover note, though the amount was credited to their account on 27.9.2006. He asked the company to refund his money as he did not want the policy. As nothing moved, he had to get a policy to run his car, hence he approached Bajaj All ianz and obtained a motor policy. He requested the intervention of the Ombudsman for refund of his money with penal interest as the matter was stil l not resolved.

As per the company, the policy was delivered by courier to the Insured at the address given by him in the proposal form but the courier came back twice mentioning “person already shifted”. The company has provided the proof of dispatch of the policy to the insured by DTDC Courier. However, a scrutiny of the photocopy of the POD reveals that there is no date of dispatch/return or remarks thereof and the company has not come forth with any documentary evidence to substantiate their stand. When the insured approached the company for return of premium on 24.11.2006, they insisted for the policy copy taken with any other company and on 15.2.2007 when the insured produced a copy of policy issued by Bajaj All ianz, they cancelled the policy and refunded the prorata premium as per rules of GR 12 of IMT of Rs.919/- vide cheque No.422424.

Pursuant to the Hearing, the Insured has enclosed copies of Electricity bil ls for the months of September and October 2006, to prove that he was residing at the address, where the policy was dispatched by courier. He has stated that he wrote to the company on 24.11.2006 asking for refund of premium as he had taken a policy with Bajaj All ianz which was personally given at the counter at Vashi Branch which was init ialed, but they did not put their seal on the copy of his letter. He was again approached by the company’s representative for a copy of the policy and he gave the copies of cover note and policy taken from Bajaj All ianz to him on 16.12.2006 and made a note on the copy. He has also enclosed a copy of the email wherein the company had again asked him to submit the proof of policy taken with another Insurer on 26.6.2007 although they confirmed during the hearing that the proof was received by them on 15.2.2007 and the refund endorsement also shows effective date as 15.3.2007.

The analysis of the complaint reveals that the cover note was issued by ICICI Lombard on 1.10.2006 covering the risk of the vehicle for the period 1.10.2006 to 30.9.2007. The copy of Cover Note was not provided to the Insured, inspite of his personal fol low

up with the company. The company has not confirmed whether the cover note was issued to the Insured nor produced proof of delivery of the policy to the Insured to substantiate their stand that they had sent the policy by courier. As the Insured could not use his car without a valid insurance policy, he had no other alternative but to subsequently approach another Insurance Company on 19.10.2006 for a motor policy and hence he requested ICICI Lombard to refund the premium vide his letter dated 24.11.2006. The Insured was kept in the dark all along as he was informed that the cheque bounced despite being encashed, copy of cover note was not produced to him and inspite of informing him that the policy was sent by courier he had not received the same and probably due to a deficiency on their part, they agreed to refund the premium on prorata basis from the date of his submitting proof of policy taken from another Insurance Company i.e. 15.2.2007. The company could not produce any convincing documents to prove that the Insured’s vehicle was covered under the policy by furnishing him with a copy of the cover note nor proof of delivery of the policy sent to him and hence the company should refund the premium on prorata basis from the date on which the Complainant requested for refund of the premium i.e. 23.11.2006 with interest as prescribed by IRDA to resolve the dispute.

ORDER

ICICI Lombard General Insurance Co. Ltd., is directed to refund the premium on prorata basis from the date of his request for refund of premium i.e. 23.11.2006 (as another policy was taken w.e.f 19.10.2006) with interest as prescribed by IRDA after taking into consideration the prorata premium already refunded in respect of the vehicle of Shri J.V.R. Bhatta. There is no order for any other relief. The case is disposed of accordingly.


Shri Paresh C. Shah Vs

United India Insurance Company Ltd. Award Dated : 31.03.2008

Shri Paresh C. Shah, had taken a Private Car Package Policy from United India Insurance Company Ltd., to cover his vehicle Hyundai Tavera, for IDV of Rs.5,29,000/- for the period 20.10.2005 to 19.10.2006. The vehicle was stolen on the night of 14.5.2006 when it was parked outside his off ice at Goregaon(W).

The Company vide their letter dated 22nd March, 2007 requested the Insured to comply with the necessary documents/records and also to let them know whether he was having other vehicles apart from this vehicle. It was observed from the Profit & Loss A/c as on 31.3.2006 that an amount of Rs.9,22,706/- was shown as income on ‘hire charges’ and he was asked to explain the source of income under this heading.

The Company instituted an enquiry through M/s Smart Investigators, who submitted their Report on 22.1.2007 to the company and thereafter obtained a legal opinion from M/s KMC Legal Venture, and on the basis of their f indings dated 11.4.2007, the company repudiated the claim as the vehicle was used in contravention of the ‘ l imitation to use’ clause of policy.

Not satisfied with the Company, Shri Paresh C. Shah vide his letter dated 3.7.2007 represented to the Regional Office of the Company which was turned down. Aggrieved

with the company, he approached the Ombudsman for intervention in the matter of sett lement of his claim with the company.

M/s KMC Venture, in the Legal Opinion had stated there are chances of success by the Insured only if he proves in evidence that the subject vehicle was not stolen during the time that the same was not subject to hire and reward.

It is a common knowledge that the vehicles like Toyota Qualis, Tata Sumo etc., which are 7 seater vehicles are generally being used for ‘hire and reward’ and the Insured is also in the business of travel and tours and this fact has been corroborated in the Profit & Loss Statement, records provided by the Company and the findings in the Investigation Reports that the Vehicle was being used for commercial purpose in violation of the terms and conditions of the Insurance Policy. It is also noted that the vehicle was parked near the office and not at the residence and the key was kept in the office. As per the Registration Certif icate the vehicle was hypothecated to Citi Bank, but no copy of agreement was produced as regards use of the vehicle. The Insured has also not provided any documentary evidence to substantiate his stand that the vehicle was used for his personal use. This Forum has got l imited authority under the RPG Rules 1998. It can only hear the parties at dispute without call ing fresh witnesses, summon them for deposit ion, ask for various evidences including cross-examining outside parties which is beyond the scope of this Forum. In order to resolve the issue, calling other witnesses may help in arriving at a decision. Under this circumstances, the complaint is closed at this Forum with a l iberty to the Complainant to approach some other Forum to resolve the dispute.

Date post:	16-Mar-2023
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