office of the insurance ombudsman (gujarat)

AHMEDABAD

OFFICE OF THE INSURANCE OMBUDSMAN (GUJARAT)

2nd Floor, Ambica House, Nr C.U. Shah College, Ashram Road, Ahmedabad-380014

Phone : 079-27546840, 27545441 Fax : 079-27546142

Ahmedabad Ombudsman Centre

Case No.11-010-0218-10

Mr. Manilal H. Gohil Vs.

Iffco-Tokio Gen. Ins. Co. Ltd.

Award dated 13-10-2009

Motor Insurance Claim

Claim lodged towards reimbursement of repair expenses of the

Complainant’s damaged vehicle due to accident was partially settled by the

Respondent in a manner that aggrieved the Complainant. Total claim

amount was Rs.12,000/-, 50% of the claim amount paid by the Respondent.

As a result of mediation by this forum, both the parties agreed for a sum of

Rs.3000/- as full and final settlement, thus grievance was resolved.


Case No.11-002-0238-10

Mrs. Bhartiben S. Shah V/s.

The New India Assurance Co. Ltd.


Motor Insurance Policy

Complainant’s insured vehicle met with an accident and claim lodged for

damage expenses was repudiated by the Respondent. The claim was repudiated invoking terms and conditions of the policy which stipulate that at the time of accident the person driving the insured vehicle must holds an

effective driving license and is not disqualified from holding or obtaining such a license.

An examination of material on record reveals that the person driving the vehicle, (driver of the Complainant) was not holding an effective driving

license, at the time of accident. Thus, Motor O.D Claim is not payable because of the driver was not holding effective Driving License as on date of accident.

Section 3 (1) of M.V. Act 1939 specifically provides for the need to have a

license to drive a Motor Vehicle and a special authorization to drive

transport vehicle. Thus the Respondent’s decision to repudiate the claim is

justified.


Case No.11-011-0250-10

Mr. Narendrabhai T. Patel V/s.

Bajaj Allianz Gen. Ins. Co. Ltd.


Two Wheeler Comprehensive Policy

P.A. Claim lodged by the Complainant under the policy was rejected by

Respondent on the ground that the permanent disability of the Complainant

does not fall under disability as defined under Sec. III Personal Accident

cover for owner driver of the policy. Hospital has certified disability to the

extent of 50% of whole body and permanent partial disability 39% and 12%

of right lower limb and right upper limb respectively. So disability caused to

the Complainant does not fall under Section-III of the policy.

In the result complaint fails to succeed.


CASE NO.11-007-454-10

MR.MIHIR H. PATEL V/S

ICICI LOMBARD GENERAL INSURANCE CO. LTD.

Award Date: 22.03.2010

Partial repudiation of Motor Own Damage claim. Respondent deducted the

amount on the grounds that the subject vehicle was running on road

without CPI (Certificate of Periodical inspection). Respondent submitted set

of papers, it is established from the available papers that the subject vehicle

was running on road without having valid CPI. The Respondent’s decision to

settle the claim after deducting of CPI is upheld, without any relief to the

complainant.


Case no 11-009-200-10

Mr.Indravadan B.Panchal Vs

Reliance General Insurance Company Ltd

Award Date : 30-10-2009

Repudiation of Claim under Mediclaim policy: The complainant has

submitted the claim for reimbursement of expenses incurred in

hospitalization for treatment of HTN SAH with history of Meningitis before 6

years. The Respondent has repudiated the claim by invoking exclusion

clause 1 and terms and conditions No 2 of Health Wise Policy .The

respondent has produced an Investigation Report stating that the insured

was having Aneurysm which is a malformation and subarachnoid

hemorrhage was due to rupture of it due to hypertension which was for the

last 6 years .The discrepancies and contradiction observed in hospital record

in history of illness in various records submitted and it require calling for

further documents and witnesses ,examination and cross examination for

the same on oath which is beyond the jurisdiction of this forum. Hence

without getting into merits of the case and passing any quantative award for

the same ,leaving it for the complaint to other means to resolve the

grievances either within the frame work of govt.rules. The complaint stands

disposed off.


Case No. 11-09-0258-10

Mr Mahesh Kumar B Shah Vs

Reliance General Insurance Co.Ltd.

Award Date: 09-12-2009

Repudiation of Claim under Vehicle Insurance: The claim has been lodged

for RS 245965/ for reimbursement of charges incurred in repairing the

vehicle caused due to accident while the vehicle was being driven during

heavy rain claimant. The respondent has repudiated the claim stating that

the damage to the engine is not related to any external accident but inlet of

water into the engine during the period the vehicle stranded into the water

and subsequent cranking and this is mechanical failure and also sub

sequential loss as result of failure on your part to protect the vehicle .The

respondent has not convincing proved of negligence by the complainant

Hence the decision to settle the

claim only for RS 6728/ by the respondent is set aside and directed to settle

the claim as per opinion of independent surveyor taken by this forum and

directed to pay RS 125499/ to the Complainant .The complaint succeeds

partially.


Case no 11-05-0455-10

Mr. M D Joshi Vs

ICICI Lombard General Insurance Company Ltd

Award Date : 31-03-2010

Short Payment of Vehicle Accidental Claim : The vehicle of the claimant

has met an accident on 25.09.2009and again on 18.11.2009 .He has

submitted the claim for repairing stating that the car was damaged because

heavy piece of stone lying on road which resulted into dash with rear side of

car. The respondent has settled the bill in partial and rejected the balance

claim stating that the cause of accident was misrepresented and damages

were old .The surveyor report and photographs has confirmed that the

damages were old ,therefore the decision of the respondent to repudiate the

claim is justified .The complaint fails to succeed.


Case no 11-05-0419-10

Mr Prakash S Patel Vs

The Oriental Insurance Co .Ltd

Award Date : 31-03-2010

Non Settlement of Accidental Claim under PA policy : The complainant

has submitted the claim for CNG /LPG kit and personal accidental death

claim .The complainant has pleaded that the additional premium for

CNG/LPG kit has been charged hence it can not be treated as Accessories

and the premium for personal accident for 4 persons in addition to driver

has been paid hence the cover for his demised wife was available .The

panchnama /post mortem report and FIR confirms that there were 4

persons traveling at the time of car accident . Therefore the decision of the

respondent to deny the claim of accidental amount and cost of CNG /LPG is

not justified .Hence the respondent has directed to pay RS 16600/ being

sum insured for the kit and RS 100000/ towards Personal Accident Death

Benefit .The complaint stands succeed.


CASE NO.11-007-454-10

MR.MIHIR H. PATEL V/S

ICICI LOMBARD GENERAL INSURANCE CO. LTD.

Award Date: 22.03.2010

Partial repudiation of Motor Own Damage claim. Respondent deducted the

amount on the grounds that the subject vehicle was running on road

without CPI (Certificate of Periodical inspection). Respondent submitted set

of papers, it is established from the available papers that the subject vehicle

was running on road without having valid CPI. The Respondent’s decision to

settle the claim after deducting of CPI is upheld, without any relief to the

complainant.


CASE NO.11-009-0258-10

Mr. M B SHAH V/S

RELIANCE GENERAL INSURANCE CO.LTD.

Award Dated : 09.12.2009

Motor OD claim was partially settled by the Respondent for Rs. 6728/-.

The vehicle Honda CR was adequately insured having sum insured of

R.12, 77091/-. The damages sustained due to flood / water to

hydrostatic locking and not accidental loss. There is no question of External

accidental arise. Total expenses incurred by the complainant is sum of Rs.

2,45,965/-. Respondent got investigated the vehicle through independent

Surveyor. As per surveyor’s report and other documentary evidences

produced before the Ombudsman, it is decided to pay the sum of Rs.

125449/- after deducting Depreciation and excess amount.

BHUBANESWAR (1)

BHUBANESWAR OMBUDSMAN CENTER

Complaint No.11-002-0595

Sri Mukti Kant Padhy

Vrs

New India Assurance Co. Ltd., Bhubaneswar DO I

Award dated 14 th October, 2009

Complainant had insured his vehicle with new India Assurance Co. Ltd. from

04.02.2007 to 03.02.2008 which met with an accident on 31.01.2008 . The

Insurer repudiated the claim on the ground that the date of accident is after the

expiry of the policy period but on the alleged date claimed by the insured.

Hon’ble Ombudsman heard the case on 14.10.2009 where both the insurer and

insured were present. The Insurer presented the letter of the IIC of the P.S.

which stated that the copy of the SDE submitted by the insured is a fabricated

one and the accident relates to another vehicle. After hearing both the parties

and perusing the documents Hon’ble Ombudsman held that the insurance

company has rightly repudiated the claim.

*************

(2)



Sri Amaresh Satpathy

Vrs

Reliance General Insurance Co. Ltd., Bhubaneswar

Award dated 6 th October, 2009

Complainant had insured his vehicle with Reliance General Insurance Co.

Ltd. which met with an accident on 25.04.2008. The Insurer has not settled the

claim till date. Hon’ble Ombudsman heard the case on 14.09.2009 where

insurer was absent despite prior intimation and no Self Contained Note was

produced. The Insured submitted the bill from the authorized garage and copy

of the policy. The only discrepancy in the policy was that it has a different

chassis and engine number. On receipt of the policy the insured has written to

the insurer regarding the discrepancy. The insured has submitted an affidavit

that he owns only this vehicle and has submitted the vehicle delivery certificate

and RC Book showing the same chassis and engine number. On perusing the

documents & hearing the insured Hon’ble Ombudsman held that the owner of a

new vehicle would never supply a wrong Engine & chassis number for

insurance and hence the claim made by the insured should be settled within a

month considering that the vehicle is duly insured.

*************

(3)



Sri Anjan Kumar Patel

Vrs

Reliance General Insurance Co. Ltd., Bhubaneswar

Award dated 13th

October, 2009

Complainant had insured his vehicle with Reliance General Insurance Co. Ltd.

The vehicle met with an accident on 29.09.2008.Complainant informed both

Insurer and the police. A survey was carried out the Insurance Company

through its surveyor. The amount claimed was Rs 1,08.840/- where as the

surveyor assessed loss for Rs 41,000/.Complainant was dissatisfied with the

assessment.

Hon’ble Ombudsman heard the case on 14.09.2009 where insurer was absent

despite prior intimation and Self Contained Note was also not submitted.

Verification of delivery slips showed that the insurer have received the letters

sent from the forum well in advance. In absence of any rebuttal material the

claim made by complainant is taken to be genuine and the Insurer is directed to

pay the complainant, full amount claimed, within 30 days of receipt of consent

letter.

*************

(4)



Sri Ashok Kumar Mishra

Vrs

Bajaj Allianz General Insurance Co. Ltd., Bhubaneswar

Award dated 16th

October, 2009

Complainant had insured his Maruti Alto vehicle with Bajaj Allianz General

Insurance Co Ltd and a claim was preferred for an accident which the vehicle

met on 08.03.2008.Insurance Company settled the claim for Rs4500/- as against

a claim of Rs12,000/-.

Hon’ble Ombudsman heard the case on 14.09.2009 where insurer was

present but the complainant did not attend. After hearing insurer and perusing

the documents Hon’ble Ombudsman observed that the assessment done by the

surveyor was proper and the repairs carried out for the portion not affected in

the accident is naturally not assessed for the claim. Hence held that the

complaint stands dismissed.

*************

(5)



Smt Dharitri Behera

Vrs


Award dated 19th

October, 2009

Complainant had insured his vehicle with Bajaj Allianz General Insurance

Co Ltd and a claim was preferred for an accident which the vehicle met on

22.03.2009.Insurance Company repudiated the claim on the ground that a false

claim was preferred by complainant.

Hon’ble Ombudsman heard the case on 14.09.2009 in presence of both

the parties. After hearing insurer and perusing the documents Hon’ble

Ombudsman observed that the grounds of repudiation were not justified as the

incident was reported to the police and the explanation of inconsistency was

clarified in writing on 30.03.2009.There fore complaint was allowed and the

insurer directed to pay Rs24,141.73 within one month of receipt of consent

letter.

*************

(6)



Sri Dinabandhu Nayak

Vrs

ICICI Lombard General Insurance Co. Ltd., Bhubaneswar

Award dated 12th

October, 2009

Complainant had insured his Tipper with ICICI Lombard General Insurance Co

Ltd and a claim was preferred for loss of the vehicle by forceful acquisition by

some miscreants on 18.012008,while vehicle was plying at Rajamunda bypass.

Both Insurance Company and the police were informed. The claim has not been

settled as yet.

Hon’ble Ombudsman heard the case on 14.09.2009 where insurer was

absent and has not submitted the self contained note either. After hearing

complainant and perusing the documents, which included the final police report

under section 392 of IPC, Hon’ble Ombudsman observed that the insurer is

liable to settle the claim. By the time the order was prepared the insurer settled

the claim and hence complaint disposed off accordingly.

*************

(7)



Ms Pragyan Parimita Dutt

Vrs

National Insurance Co. Ltd., Bhubaneswar DO-I

Award dated 04th

November, 2009

Complainant had insured his Tata truck with National Insurance Co Ltd and a

claim was preferred for an accident which the vehicle met on

02.11.2008.Complainant submitted estimate for Rs 8.59,160/- and bills of repair

for Rs 3.4 lacs. But insurer has settled the claim for Rs 1.698 lacs with the

financer ie Tata Finance.

Hon’ble Ombudsman heard the case on 28.10.2009 where both parties

were present. After hearing both parties and perusing the survey reports and

vehicle inispection report, Hon’ble Ombudsman observed that the assessment

has been properly done and nothing unjustified could be either found or

established by the complainant. Hence held that the complainant has got his due

entitlement and dismissed the complaint.

*************

(8)



Sri Rabindra Kumar Sahu

Vrs

National Insurance Co. Ltd., Bargarh Branch

Award dated 25th

November, 2009

Complainant had insured his Maruti car with National Insurance Co Ltd and a


26.07.2007.Complainant claimed Rs 62,247/- but insurer has settled the claim

for Rs 26,210/-.


were present. After hearing both parties and perusing the survey reports and the

assessment sheet submitted by the complainant, Hon’ble Ombudsman observed

that the assessment has been properly done and nothing unjustified could be

either found or established by the complainant. As the vehicle was more than 3

years old, the deduction of salvage at 35% was as per the norm. Hence held that

the complainant has got his due entitlement and dismissed the complaint.

*************

(9)



Md Moiz Alam

Vrs

United India Insurance Co. Ltd., Barbil Branch

Award dated 11th

November, 2009

Complainant had insured his Scorpio vehicle with United India Insurance Co

Ltd. The vehicle met with an accident on 13.02.2007, within policy period. A

claim was lodged and the same was settled for Rs 3,09,000/- by insurer as

against claimed amount of Rs 7,01,020/-.


were present. After hearing both parties and perusing the documents Hon’ble

Ombudsman held that the assessment of loss was just and proper. Directed

insurer to settle the claim as per assessment and in the event the complainant is

not satisfied , insurer is free to take recourse as per Insurance Act.

*************

(10)



Sri Rudra Narayan Sahoo

Vrs

Reliance General Insurance Co. Ltd., Bhubaneswar Branch

Award dated 18th

December, 2009

Complainant had applied for insurance cover for a Tata Indica car as he was

planning to purchase one and accordingly paid the premium of Rs 12,987/-. A

cover note to the effect was issued by the insurer without any engine number or

chassis number. Subsequently a policy was also issued to him with details of

Engine and Chassis number of a car which he never purchased. He brought the

facts to the notice of the insurer and as per their requirement produced the

details of ownership of the vehicle as mentioned on the policy from the dealer.

Still the premium paid by him was not refunded.

Hon’ble Ombudsman heard the case on 24.11.2009 where complainant

was present alone. After hearing complainant and perusing the documents

Hon’ble Ombudsman directed the insurer to pay Rs 12,987/- with 18% interest

from the date of intimation till date of payment to the complainant.

*************

(11)



Sri Nirmala Mallick

Vrs

Cholamandalam MS General Insurance Co. Ltd., Bhubaneswar Branch

Award dated 01st January’, 2010

Complainant had insured his vehicle with Cholamandalam General Insurance

Company Ltd and an accident took place within the policy period. A claim for

Rs 1,05,000/- was preferred by complainant. Insurer settled the claim for Rs

1431/- only.


was present alone. Insurer was absent. After hearing complainant and perusing

the documents Hon’ble Ombudsman observed that, in spite of, prior written

communication, insurer neither submitted the self contained note, nor attend the

hearing and hence directed insurer to pay the amount claimed by complainant,

as per bills and cash memos produced during hearing.

*************

(12)



Sri Pradeep Kumar Sahoo

Vrs

National Insurance Co. Ltd., Link Road Branch,Cuttack

Award dated 30th

December, 2009

Complainant had insured his vehicle with National Insurance Co Ltd and a


21.02.2008.Complainant lodged a claim. Insurance company repudiated the

claim on the ground that the driver did not possess valid Driving Licence.


was absent. After hearing insurance company and perusing the documents

including the Driving Licence verification report, Hon’ble Ombudsman

observed that the driver was not having a valid Driving Licence to drive a

Transport vehicle. Hence up held the repudiation decision of insurer and

dismissed the complaint

*************

(13)



Sri Ajit Kumar Das

Vrs

National Insurance Co. Ltd., Rourkella DO

Award dated 04th

January, 2010

Complainant had insured his vehicle with National Insurance Co Ltd and a


10.01.2009.Complainant preferred a claim which was repudiated for the reason

that the vehicle was not having fitness certificate to ply on road.


were present. After hearing both parties and perusing the documents of the

vehicle including the fitness certificate, Hon’ble Ombudsman observed that the

vehicle was not having fitness certificate to ply on the road long before the

accident date. Since it was a commercial vehicle, held that the repudiation

decision of insurer is just and proper and dismissed the complaint.

*************

(14)



Sri Bijay Kumar Yadav

Vrs

Oriental Insurance Co. Ltd., CBO ,Bhubaneswar

Award dated 31st December, 2009

Complainant had insured his vehicle with Oriental Insurance Co. Ltd. which

met with an accident on 10.07.2007 within the policy period. The complainant

claimed Rs 264211/-,where as insurer settled it for only Rs 40,000/-.

Hon’ble Ombudsman heard the case on 24.11.2009 in presence of both parties.

After hearing both sides and perusing the documents produced including the

bills and cashmemos ,Hon’ble Ombudsman held that the bills produced by

complainant are not genuine. Therefore, relying on the assessment of a senior

surveyor for replacement of a second hand cabin assembly, directed insurer to

pay Rs 1,43,000/- .If Rs 40,000/- has already been paid the said amount to be

deducted from Rs 1,43,000/-

*************

(15)



Sri Sudhansu Kumar Swain

Vrs

Reliance General Insurance Co. Ltd., Bhubaneswar Branch

Award dated 7th

January, 2010

Complainant had insured his tipper with the above insurance company. The

vehicle met with an accident causing damage to its hydraulic jack. A claim was

reported. Insured did not pay the claim on the ground that the damage was not

due to accident.


was present alone. Neither self contained note was filed nor any one appeared

on behalf of the insurer during hearing. After hearing complainant and perusing

the documents available on record, Hon’ble Ombudsman set aside the “no

claim” decision of insurer and directed the insurer to pay the claim on the basis

of bills and cash memos produced by complainant.

*************

(16)



Smt Smruti Sikha Das

Vrs

Bajaj Allianz General Insurance Co. Ltd., Balasore

Award dated 21st January, 2010

Complainant had insured her truck with Bajaj Allianz General Insurance Co

Ltd and a claim was preferred for an accident which the vehicle met on

21.07.2008.Insurance Company repudiated the claim on the ground that the

documents called for was not submitted by complainant.



Ombudsman observed that the complainant was not able to submit documents

for lack of communication .Therefore complaint was allowed and the insurer

directed to pay the claim on the basis of the documents submitted during

hearing.

*************

(17)



Sri Pradipta Kumar Mishra

Vrs


Award dated 12th

January, 2010

Complainant had insured his truck with Bajaj Allianz General Insurance Co Ltd

and a claim was preferred for an accident which the vehicle met on 14.06.2009.

A claim for Rs 1,96,885/- was lodged but insurer settled it for Rs 86,500/- only.



Ombudsman observed that the surveyor had assessed the loss for Rs 91,915/-

and after deduction of depreciation the net amount worked out to be Rs 86,500/-

. The assessment of the surveyor was found to be justified and directed insurer

to settle the claim for Rs 86,500/- as decided by them.

*************

(18)



Sri Basant Kumar Suar

Vrs

National Insurance Co. Ltd., Bhubaneswar DO-I

Award dated 08th

February, 2010

Complainant had insured his truck with National Insurance Co Ltd and a claim

was preferred for an accident which the vehicle met on 13.04.2009.Complainant

preferred a claim which was repudiated for the reason that the driver at material

time was not having valid Driving License.


were present. After hearing both parties and perusing the documents of the

vehicle including the Driving License and the report of Bokaro RTO on the

Driving License, Hon’ble Ombudsman observed that the driver of the truck was

not possessing valid Driving License and up held the repudiation decision of

insurer. Complaint was accordingly dismissed.

*********

(19)



Sri Saroj Kumar Behera

Vrs

ICICI Lombard General Insurance Co. Ltd., Angul Branch

Award dated 11th

February, 2010

Complainant had insured his Truck with ICICI Lombard General Insurance Co

Ltd and a claim was preferred for an accident which the vehicle met with on

30.01.2008., very much within policy period. Complainant lodged the claim for

Rs 67,000/-, where as insurer settled the claim for Rs 11,900/-.

Hon’ble Ombudsman heard the case on 19.01.2010 where both sides

were present.

The complainant stressed on the repair bills submitted by him. Insurer relied on

the discharge voucher submitted by complainant, where he agreed for Rs

11,900/- as full and final settlement. After hearing both sides and perusing

documents on record, including the explanation of surveyor on his report,

Ombudsman held that the assessment of surveyor is just and proper. Hence

dismissed the complaint.

*************

(20)



Sri Subash Chandra Pal

Vrs

New India Assurance Co. Ltd., Balasore DO

Award dated 24 th March, 2010


10.12.2008 to 09.12.2009 which met with an accident on 09.08.2009 . The

Insurer settled the claim for Rs 31,000/- as against a claim of Rs 2,04,833/-

Hon’ble Ombudsman heard the case on 19.01.2010, where insured was present

but the insurer did not attend. The forum in absence of insurer and proper

explanation regarding the lower assessment of surveyor was not in a position to

quantify the loss. Hence Insurer was directed to discuss with complainant and

the surveyor regarding the assessment and settle the claim accordingly. If the

complainant is still not satisfied he is at liberty to approach this forum afresh

with all developments.

*************

(21)



Sri Somnath Sethy

Vrs

New India Assurance Co. Ltd., Bhubaneswar DO I

Award dated 26th

March, 2010


25.02.2008 to 24.02.2009, which was stolen on 16.05.2008.A claim was lodged

with insurer. The Insurer repudiated the claim on the ground of in consistency in

the statements of driver/ owner on the incident.

Hon’ble Ombudsman heard the case on 25.02.2010, where complainant was

present but the insurer did not attend. The insurer submitted the self contained

note supported by a decision of National Consumer Dispute Redressal

Commission, pronounced on 09.12.2009, almost in an identical case. Hon’ble

Ombudsman observed that the complainant has reported the loss to insurance

company after 12 days, which is a violation to policy condition, as observed by

NCDRC in a similar case and hence up held the repudiation decision of insurer.

*************

(22)



Smt Naliniprabha Biswal

Vrs

New India Assurance Co. Ltd., Mangalabag Branch

Award dated 29th

March, 2010


25.02.2008 to 24.02.2009, which met with an accident on 12.04.2009.A claim

was lodged with insurer. The Insurer repudiated the claim on the ground that the

driver of the vehicle at the material time did not possess a valid Driving

License.

Hon’ble Ombudsman heard the case on 25.02.2010, where both sides were

present. The insurer submitted that the Driving license was not renewed from

13.03.2009 to 29.04.2009.As per MV Act a grace period of 30 days is allowed

from the date of expiry, but beyond which the driver is supposed to be not

possessing a valid DL. Accordingly in the present instant the driver was not

having a valid DL on date of accident and hence the repudiation decision is up

held. *************

(23)



Sri Biswa Ranjan Mohapatra

Vrs

Oriental Insurance Co. Ltd., Kendrapada Extn Counter

Award dated 29th

March 2010

Complainant had insured his vehicle with Oriental Insurance Co. Ltd., which

was stolen on 28/29.11.2007 night. Both police and Insurance Company were

informed. Subsequently the police traced and handed over the vehicle to

complainant on Zimma. The complainant reported missing of several important

parts of the vehicle and claimed Rs 1,50,000/- on that behalf. The Insurer

repudiated the claim on the ground that the surveyor assessing the loss observed

the parts were removed fresh from the vehicle and there were all the reasons the

complainant has removed such parts for claim purpose.

Hon’ble Ombudsman heard the case on 25.02.2010 where both sides were

present. After going through the police papers including the Zimmanama and

the surveyor’s report held that no where the police investigation report revealed

the missing of important vehicle parts. Zimanama is also silent on the issue.

Moreover, the complainant while taking vehicle to possession from the police,

neither reported to the insurer nor gave an opportunity for a survey of the

vehicle. Taking all aspects into consideration, the complaint was dismissed.

*************

(24)



Smt Snigdha Das

Vrs


Award dated 12th

January, 2010

Complainant had insured his truck with Bajaj Allianz General Insurance Co Ltd

and a claim was preferred for an accident which the vehicle met on 10.02.2009.

A claim was lodged , which the insurer repudiated on the ground that the driver

did not possess a valid Driving Lisence.

Hon’ble Ombudsman heard the case on 25.02.2010 in presence of

complainant but insurer did not attend. After hearing complainant and going

through documents submitted by both parties held that the Driver did not have

valid DL and hence dismissed the complaint.

*************

CHANDIGARH

CHANDIGARH OMBUDSMAN CENTRE

CASE NO. GIC/347/NIA/14/10

Desh Raj Saini Vs. New India Assurance Co. Ltd.

ORDER DATED: 01st October, 2009 MOTOR

FACTS: Shri Desh Raj Saini had been having a Motor Insurance Policy vide covernote No.

282574 issued by The New India Assurance Co Ltd. covering his Tata Indica car No. HR-04-B-

8791 for the period 13.05.2009 to 12.05.2010 for sum insured of Rs. 2,10,000/-. The said

car was stolen on 17.05.09. All the claim documents were submitted but till date his claim

was not settled. Parties were called for hearing on 01.10.09 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that there was a doubt about the

use of the vehicle as it was being used for hire and reward. This is given in the statement

made by the complainant to the investigator.

DECISION: Held that there is no irrefutable proof to show that the vehicle was used for

hire and reward except as stated by the complainant to carry his labourers as he was a

contractor. Moreover, the theft has taken place when the vehicle was parked in Panchkula.

The basic point is that there was a theft and there was valid insurance on the date of theft.

Hence Giving the benefit of doubt to the complainant, and taking a fair and just view, the

claim is payable. However to give weightage to the statement of the insurer, settlement of

the claim on non-standard basis to the extent of 75% of IDV less excess clause would, in my

opinion, meet the ends of justice. It is hereby ordered that 75% of IDV less excess clause

should be paid by the insurer to the complainant within 20 days of submission of

untraceable report from the police, signing of Form 29, letter of subrogation and ignition

key etc.


CASE NO. GIC/363/NIC/14/10

Parvinder Pal Singh Vs National Insurance Co. Ltd.

ORDER DATED: 09th October, 2009 MOTOR

FACTS: Sh. Parvinder Pal Singh had taken a motor insurance policy No. 420400/31/07/6300001934

for the period 08.08.2007 to 07.08.2008 covering tata Truck No. HR 58 A – 2634 for IDV Rs.

5,00,000/-. It is stated by the insured that vehicle was stolen on 22.05.2008. The theft was intimated

to police on 23.05.2008 and to insurer on 26.05.2008. As per the insured, he has submitted

untraceable report and other formalities to the insurer. However, he has not been informed

anything from the company. Parties were called for hearing on 09.10.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the vehicle was given to workshop

for repairs. As per investigator report, it was unlocked and unattended. Since the vehicle was given

to workshop, it is a contractual liability between the complainant and the workshop. He should ask

compensation from the workshop.

DECISION: Held that the contention of the insurer that it is a contractual liability between the

complainant and the workshop is not justified. The owner of the workshop has not run away with

the vehicle. The vehicle has been stolen by a third party. As far as leaving the vehicle unlocked is

concerned, there is no proof or witness to substantiate this statement as no one was present at the

time of theft. Hence, giving the benefit of doubt to the complainant, the claim is payable. However,

to give weightage to the view of the insurer that there was negligence on the part of the

complainant, the settlement of claim on non-standard basis to the extent of 75% of the insured

amount would meet the ends of justice. It is hereby ordered that 75% of IDV amount less excess

clause should be paid by the insurer to the complainant.


CASE NO. GIC/361/OIC/11/10

Jasvir Singh Vs Oriental Insurance Co. Ltd.


FACTS: Sh. Jasvir Singh had taken a motor insurance policy vide cover note No. CHD-C529024 for the

period 26.10.2008 to 25.10.2009 for Vehicle No. PB 12L – 1943 for sum insured of Rs. 32500/-. The

said vehicle was stolen on 05.06.2009 for which an FIR was lodged. The vehicle was found after 3-4

days in totally damaged condition. When the estimate for repairs was taken, M/s Pankaj Motors

estimated it as beyond repairs and termed it as total loss. When the claim was preferred to the

insurer, only Rs. 20300/- was settled instead of the total sum insured of Rs. 32500/-. Parties were

called for hearing on 09.10.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the estimate was for Rs. 23,000/-

which is less than 75% of the IDV. The vehicle was recovered in a burnt position and is repairable.

Moreover, the vehicle has been released under Superdari with the condition that it cannot be sold

and the colour of the vehicle cannot be changed. In view of the above circumstances, the only

alternative is to get the vehicle repaired from authorised workshop. However the complainant was

insisting for making the vehicle as total loss and was not giving consent to get the vehicle repaired.

DECISION: Held that the contention of the complainant that the vehicle should be made as

total loss is not justified not only on account of the estimate for repairs being less than 75% of IDV

but also due to the fact that he has given an undertaking to the court of Roop Nagar Magistrate that

the vehicle will not be disposed off or its colour changed. The making of the vehicle as total loss

would result in transfer of ownership of the vehicle from the complainant to the insurer which is not

possible in view of the Court’s order. Taking all the above into consideration, the vehicle should be

got repaired from authorized workshop and the complainant should cooperate and give his consent

for the repair accordingly.



Harjit Singh Vs Oriental Insurance Co. Ltd.


FACTS: Sh. Harjit Singh had taken a motor insurance policy vide cover note No. CHD-C328780 for

Vehicle No. PB 10 CG – 5768 for the period 13.02.2008 to 12.02.2009. The vehicle met with an

accident on 26.04.2008. The said vehicle was totally damaged and an estimate of Rs. 492000/-

approx. was submitted by the dealer. He also lost his son in the accident. In spite of submitting all

the documents in time he has not received any claim nor any reply. Parties were called for hearing

on 09.10.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that that the vehicle was purchased in

Feb. 2008. The accident took place in April 2008. Only temporary RC was available at the time of

accident which was valid only for 30 days. Regular RC was not available on the date of accident. RC

was made in May 2008. Hence the claim was made as no claim, since valid RC was not available on

the date of accident.

DECISION: Held that non-availability of RC alone should not stand in the way of settling the

claim in favour of the complainant. The RC is basically a document to show the ownership of the

vehicle. As far as insurance cover is concerned the ownership is established as soon as the insurance

policy is issued. Since there was a valid insurance policy on the date of accident, the claim in my view

is payable. The last documentary requirement was submitted in Jan. 2009. Giving sufficient time for

the insurer to settle the claim, the interest @8% per annum should also be paid by the insurer to the

complainant w.e.f. 01.03.2009 till the date of payment. Payment of IDV less excess clause alongwith

interest should be made by the insurer to the complainant subject to completion of usual

documentary formalities like transfer of RC, signature on the Form 29 and discharge voucher etc.

Towing charges as per rules should also be paid.



Ashim Ali Vs National Insurance Co. Ltd.


FACTS: Sh. Ashim Ali had taken a vehicle policy No. 0311580 covering his Hero Honda Passion

Motorcycle No. HR 51 AB – 9301 for the period 09.06.08 to 08.06.09 for IDV Rs. 39805/-. His vehicle

was stolen on 14.11.2008 for which FIR was written on 01.12.2008. He intimated the loss to insurer

also. However, the insurer rejected the claim. Parties were called for hearing on 07.10.2009 at New

Delhi.

FINDINGS: The insurer clarified the position by stating that the theft took place on 14.11.2008.

FIR was lodged with the police on 01.12.2008 after 17 days. The intimation to the insurer was given

after 24 days. Hence the claim was repudiated under policy condition 1 of terms and conditions of

the policy. The insurer was asked to show the terms and conditions of the policy. He showed the

terms and conditions of the policy. The condition No. 1 states that in case of theft, the police should

be informed immediately. The insured was asked as to when he had informed the police, he stated

that it was done on the same day but the police took time to lodge the FIR. On a query, whether

written communication was made, the complainant replied that it was done orally for a few days

regularly.

DECISION: Held that the contention of the insurer that the there was delay in reporting to the

insurer and the police is justified. However, since it is a theft case, information to the police takes

priority. As stated by the complainant that he had approached the police soon after the theft but the

same was not recorded in DDR. Giving the benefit of doubt to the complainant, the claim is payable.

However, the complainant should be penalized for not informing the police in writing. Therefore,

settlement of the claim to the extent of 65% of IDV less excess clause would meets the ends of

justice. It is hereby ordered that 65% of IDV less excess clause should be paid by the insurer to the

complainant.



Saroj Bala Vs Oriental Insurance Co. Ltd.


FACTS: Smt. Saroj Bala had taken a motor insurance policy No. 235401/31/2009/3242 on

19.09.2008. Her vehicle PB 08 –AY 6551 (Innova) met with an accident 24.06.2009. She got her car

repaired in which she incurred an expenses of Rs. 124197/-. All the documents were sent to the

surveyor who was appointed. But till date she has not received her claim amount. Parties were


FINDINGS: The insurer clarified the position by stating that the vehicle was insured with them

w.e.f. 19.09.2008. Before that the vehicle was insured with National Insurance Co. Ltd. The

complainant had claimed NCB of 20% whereas as National Insurance Co. Ltd. had stated that the

complainant was not entitled to NCB because there was a claim during the time the vehicle was

insured with them. On a query, whether clarifications regarding NCB were sought from the previous

insurer within 30 days of commencement of the present policy and whether the complainant had

signed a declaration that she would forfeit all claims in case NCB was wrongly claimed, the insurer

replied in the affirmative. The insurer furnished a letter dt. 26.09.08 written to the National

Insurance Co. Ltd. asking for confirmation of NCB.

DECISION: Held that the insurer had completed all documentary formalities for confirmation of

NCB. Since there is a declaration by the complainant that she would forfeit all the claim, if there was

wrong information about NCB, the claim is not payable. The repudiation of the claim is, therefore, in

order. No further action is called for. The complaint is dismissed.

CHANDIGARH OMBUDSMAN CENTRE CASE NO. GIC/410/OIC/14/10

Prem Pushpa Vs. Oriental Insurance Co. Ltd.


FACTS: This complaint was received from Smt. Prem Pushpa on 02.09.2009. Brief facts of the case

are that her husband late Sh. Om Parkash Sharma had insured his truck trolla No. RJ 31 G – 5425 vide

Cover Note No. 316397 for the period 21.11.2008 to 20.11.2009 for sum insured of Rs. 575000/-.

The said vehicle alongwith the loaded goods was hijacked by dacoits in Maharashtra on 26.01.09,

while it was on its way to Mumbai, killing the driver and the cleaner. An FIR was lodged at

Gameshpuri (Maharashtra). The insurer was informed about the loss of trolla, life/ lives and had

completed all the formalities. In spite of several follow-ups the company had not settled the claim.

She stated that her husband expired on 01.07.2009 as he was suffering from cancer. She had also

submitted the untraceable report issued by Police Station, Ganeshpuri. She further stated that she is

80 years old and had lost her son and husband and has no male member to pursue the case. Hence

she requested this forum in getting the claim settled with 18% interest. Parties were called for

hearing on 30.10.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that since it was a commercial vehicle,

acceptance of the court of the untraceable report was required. Hence the claim could not be

settled.

DECISION: Held that delay has occurred because of non-available of the untraceable report till

July 2009 and thereafter because of its lack of acceptance by the court.. The acceptance of the

untraceable report by the court is not a must for settling the claim as per terms and conditions of

the policy. The claim should be settled without waiting for any further documents. It is hereby

ordered that the admissible amount of claim should be paid by the insurer to the complainant.


CASE NO. GIC/480/IFFCO TOKIO/11/10

Subodh Jindal Vs IFFCO Tokio General Ins Co.

ORDER DATED: 03rd November, 2009 MOTOR

FACTS: This complaint has been received from Sh. Subodh Jindal on 25.09.09. It has been

stated by the complainant that he had been having a Motor Policy bearing no. 38412695

issued by Iffco Tokio General Insurance Co. Ltd covering his Toyota Innova car bearing no.

HR-38-N-3936 for the period 08.03.07 to 07.03.08 for sum insured of Rs. 9,87,782/-. On the

night of 26.02.09, he went to attend a marriage ceremony held at a Banquet at Mangolpuri,

New Delhi. The driver parked the car at parking place. The driver returned to the parking

place after having a meal within 20-30 minutes. The driver was standing with the car and

the car was open. He came forward to receive him. Suddenly an unknown person came

there and started the car and went away. The driver tried to chase him but he could not

catch him. The matter was immediately reported to police. The case was registered vide

FIR no. 61 dated 27.02.09. The claim was reported to insurance company. They repudiated

the claim on the ground of violation of Condition no. 5 that they had not taken the

reasonable step to the security of the vehicle. Parties were called for hearing on 03.11.09 at

New Delhi.

FINDINGS: The insurer clarified the position by stating that the theft took place when

the vehicle was parked in the open parking. The door of the vehicle was open and the

ignition key was in the vehicle. This was a case of negligence and an open invitation to the

thief to steal the vehicle. Hence the claim was repudiated under condition 5 of not taking

due care by the insurer.

DECISION: Held that the contention of the insurer that the vehicle was not properly

guarded and left unattended is justified. The repudiation of the claim is, therefore, in order.

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


CASE NO. GIC/494/ICICI/11/10

Sanjay Vs. ICICI Lombard


FACTS: Shri. Sanjay had been having a Motor Insurance Policy bearing no. 3003/53872075/00/000

issued by ICICI Lombard General Insurance Co. Ltd. covering his Tata Trailer bearing no. HR-63-A-

1544 for the period 06.04.08 to 05.04.09 for sum insured of Rs. 13,00,000/-. The said vehicle met

with an accident on 30.01.09. The claim was lodged with the insurance company. The insurance

company agreed to settle the claim for Rs. 7,00,000/- but later on they repudiated the claim. After

some time he received a telephone call from the insurance company that they are ready to pay 50%

of the claim which he refused. Parties were called for hearing on 03.11.09 at New Delhi.

FINDINGS: The insurer clarified the position by stating that as per hospital records of Govt.

Hospital, Sirohi the driver was smelling of Alcohol. Since he was under the influence of alcohol, the

claim was made as no claim. On a query, as to what was the gross estimate / invoice, the insurer

stated that it was of Rs. 12.00 lakh.

DECISION: Held that on going through the terms and conditions of the policy and hospital

records of Govt. Hospital, Sirohi, It was found that the judicial authority of the hospital clearly stated

that the driver had consumed alcohol but was not under the influence of alcohol. Giving the benefit

of doubt to the complainant, the claim, in my view, is payable. The claim should be settled on net of

salvage basis with IDV of Rs. 13.00 lakh and salvage of Rs. 1.00 lakh. However, to give weightage to

the contention of the insurer that the driver had consumed alcohol, payment of claim on non-

standard basis to the extent of 75% would meets the ends of justice. Net of salvage being Rs. 12.00

lakh, therefore Rs. 9.00 lakh less excess clause is payable. It is hereby ordered that Rs. 9.00 lakh less

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


CASE NO. GIC/444/Reliance/14/10

Sant Ram Vs Reliance Gen. Insurance Co. Ltd.


FACTS: Shri Sant Ram had been having a Motor Insurance Policy bearing no. 2005782334003674

issued by Reliance Gen. Ins. Co. Ltd. covering his Tata Truck no. HR-69-8895 for the period

22.12.2008 to 21.12.2009. The said truck met with an accident on 06.05.09. The claim was lodged

with the insurance company. All the claim formalities were completed but till date his claim was not

settled. Parties were called for hearing on 03.11.09 New Delhi.

FINDINGS: The insurer clarified the position by stating that the driver at the time of accident

was Sh. Chaman Lal alias Sonu whereas the driving licence of Sh. Mahavir has been furnished. If the

driving licence of Chaman Lal is furnished, the claim would be settled on merits. The complainant

was asked to clarify whether driving licence of Sh. Chaman Lal was available. He showed a driving

licence made in Nagaland but on which the address given is of Sonipat.

DECISION: After hearing the complainant in the presence of the insurer and scrutinizing the

driving licence in detail, I find that while the driving licence has been issued by Govt. of Nagaland

there appears to be lacuna as the address of the driver is not of Nagaland. The two should normally

match. It was not possible for Chaman Lal to get himself tested without residing there. Moreover,

the name of the driving test authority has not been mentioned. I am not satisfied with the bonafides

of the driving licence. The repudiation of the claim on the basis of non-effective and non-valid

driving licence is, therefore, in order. No further action is called for. The complaint is dismissed.


CASE NO. GIC/401/Roysun/11/10

Vinay Pandey Vs. Royal Sundram

ORDER DATED: 04th November, 2009 MOTOR

FACTS: Shri Vinay Pandey had been having a Motor Insurance Policy bearing no.

VPC0061920000100 issued by Royal Sundaram Alliance Insurance Company Ltd. covering his

Mahindra Bolero for the period 26.09.2008 to 25.09.2009 for sum insured of Rs. 5,55,275/-.

The said vehicle was stolen on 08.03.2009. All the claim formalities were completed but the

insurance company repudiated the claim on baseless grounds. Parties were called for hearing on

04.11.09 at New Delhi.

FINDINGS: The complainant stated that the claim has been repudiated on account of non-

availability of the second key and delay in reporting to insurer by 4 days.

DECISION: Held that on going through the repudiation letter, it was found that claim has been

repudiated on flimsy grounds. Mere loss of one key should not stand in the way of settlement of the

claim. As far as delay is concerned, the complainant informed the police on the day of theft. Delay in

intimating insurer by 4 days is not a major delay. The fact is that there was a theft and there was a

valid insurance cover on the date of theft. The repudiation of the claim is not in order. The claim is

payable. However, the complainant should be penalized for submitting only one key to the extent of

25% of IDV. The settlement of claim on 75% of IDV less excess clause would meet the ends of justice.

It is hereby ordered that 75% of IDV less excess clause should be paid by the insurer to the

complainant.



Rajneesh Gupta Vs Oriental Insurance Co. Ltd.


FACTS: Sh. Rajneesh Gupta stated that the agent of the Oriental Insurance Co. Ltd. had approached

him for insurance of his vehicle (Tata Safari) car bearing No. CH 04 E – 7502, model 2008. After

completing the formalities, a cover note was handed over to him and Rs. 12000/- for insurance of his

vehicle was demanded without prescribing the terms and conditions of the contract and without

enquiry about the value of the vehicle. When he received the cover note he was shocked to see that

IDV was fixed at Rs. 5.00 lakhs and no electrical accessories were covered. He stated that the value

of the vehicle when purchased on 31.05.2008 was Rs. 740518/-. He was misguided by the agent and

the IDV should have been more than Rs. 6.00 lakhs as per the rules and regulations of the company.

He had written to the company on 26.07.2009 for which he received the reply on 11.08.09 and is not

acceptable to him. Hence he requested this forum in getting the IDV fixed to an amount which is

more than Rs. 6.00 lakhs. Parties were called for hearing on 06.11.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the cover note was given as per the

proposal form filled up by the complainant. He had applied for an IDV of Rs. 5.00 lakh and the

premium was charged accordingly. On a query, whether the IDV was correlated with previous

insurer viz. New India Assurance Co. Ltd. where the sum insured was

Rs. 7.40 lakh, the insurer replied in the negative.

DECISION: Held that there was a definite case of under insurance of vehicle which is in

contravention of fixed norms of fixing the IDV. The insurer has erred in not scrutinizing the previous

policy while arriving at the new IDV. Taking the above into consideration, the actual IDV should have

been Rs. 7.40 lakh minus 20% which works out to Rs. 5.92 lakhs. It is hereby ordered that an IDV of

Rs. 5.92 less excess clause should be paid by the insurer to the complainant after deducting the

difference of premium for higher IDV.



Ashwani Kumar Vs National Insurance Co. Ltd.

ORDER DATED: 06TH November, 2009 MOTOR

FACTS: Sh. Ashwani Kumar stated that the vehicle No. HP 07 – 5162 was registered in the name of

his father Sh. Prabhu Dayal and was insured vide policy No. 421101/31/08/6300000998. Later the

vehicle was transferred in his name. Subsequently the RC of the vehicle was also transferred in his

name and a fresh insurance policy was taken. While transferring the vehicle in his name, they had

approached the concerned authority for change the name in the route permit. They confirmed that

since Sh. Prabhu Dayal is the father of the present RC holder, there was no violation of traffic rules

and the same can be amended at the time of renewal. The said vehicle met with an accident. All the

claim documents were submitted, however, the claim was rejected on the ground of non-transfer of

route permit in the name of new owner. He stated that route permit is for plying the vehicle in a

particular area/ locality which was not violated at any stage. Hence he requested for settlement of

the case. Parties were called for hearing on 06.11.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the insurance cover was in the name

of Sh. Ashwani Kumar S/o Sh. Prabhu Dayal whereas the road permit in the name of Sh. Prabhu

Dayal, the father of the owner of the vehicle as per insurance policy.

DECISION: Held that the vehicle permit is in the name of Sh. Prabhu Dayal which was issued in

July 2006 and valid upto Nov. 2010 which was not transferred in the name of his son Sh. Ashwani

Kumar when the vehicle was transferred in the name of his son. Mere Non-transfer of road permit in

the name of the insurance policy holder who is the son of the route permit holder is not a major

lapse as far as accident claim is concerned. However, to give weightage to the contention of the

insurer that both the documents should have been got transferred simultaneously in the name of Sh.

Ashwani Kumar, the settlement of claim on non-standard basis to the extent of 75% of admissible

amount of claim would meet the ends of justice. It is hereby ordered that 75% of admissible amount

of claim should be paid by the insurer to the complainant.


CASE No. GIC/455/OIC/11/10

Baljeet Singh Vs Oriental Insurance Co. Ltd.


FACTS: Sh. Baljeet Singh had taken a motor insurance policy vide cover note No. CHD-C356793 on

22.03.08 for his Indica car No. CH 03 Z – 6670. He stated that his nephew Sh. Manjinder Singh had

taken his car to visit his grand parents at Rajpura on 23.08.08. On his way, he had given a lift to a

gentleman who intoxicated him and stole his car. An FIR was lodged and the claim was preferred to

the insurer. After submitting all the documents, the claim was repudiated on 25.08.09 on the

grounds that there was violation of conditions no. 4 of the policy. Parties were called for hearing on

06.11.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that as per Clause 4 of terms and

conditions of the policy, the insured is supposed to take reasonable care of the vehicle. In this case,

the person who was driving the vehicle was negligent in getting out of the vehicle in an intoxicated

condition and allowing the culprit to drive away with the vehicle. Hence the claim was repudiated

under clause 4 of terms and conditions of the policy.

DECISION: Held that the contention of the insurer that there was negligence on the part of the

driver of the vehicle in giving a lift to an individual is not wholly substantiated as he was doing a

good turn to a human being. While doing the good turn if somebody had played mischief on him and

got him intoxicated, it should be a part of an unfortunate incident rather than a wilful negligence.

Giving the benefit of doubt to the complainant and taking a fair and just view, the claim, in my view,

is payable. However, to give weightage to the contention of the insurer that there was negligence in

giving open invitation to an unknown person to drive the vehicle, the complainant should be

penalized to extent of 25% of the IDV. Therefore, settling the claim on 75% of IDV would meet the

ends of justice. The insurer should make payment of 75% of IDV less excess clause to the

complainant.


CASE NO. GIC/475/UII/11/10

Darshana Devi Vs United India Insurance Co. Ltd.


FACTS: Smt. Darshana Devi’s husband Late Shri Khariti Lal had insured his vehicle, Eicher Canter

bearing No. HR-57-2530 under Policy No. 3107012521 for the period 2.3.2008 to 01/03/2009. The

vehicle met with an accident on 03.09.2008 and the owner/policyholder expired due to accident.

The front cabin of the vehicle was highly damaged. An FIR was lodged and claim preferred to the

insurer. After completing all the formalities the company settled Rs. 1,50,000/- out of Rs. 2,00,000/-

on 19/03/2009 towards Personal Accident claim and Rs. 44,250/- out of Rs. 1,25,000/- on 26.08.2009

towards loss of vehicle. She had sought clarification but the company did not give any reasons for

deduction in both the claims. Parties were called for hearing on 06.11.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that it was a commercial vehicle and it

was not road-worthy on the date of accident. Hence the claim was made as non-standard and

settled at 75% of the amount payable. As far as the deduction of bill for Cabin Assy. is concerned, the

bill was verified by the investigator and he found some discrepancies in the bill. Hence the same was

deducted from the payable amount.

DECISION: Held that the contention of the insurer that claim should be paid on non-standard

basis because the vehicle was not road-worthy is justified. Their contention of deduction of Cabin

Assy. on account of bonafides of the bills not having being established is also justified. The action

taken by the insurer is, therefore, in order. As far as the personal accident claim is concerned,

making the claim on non-standard basis, in my view, is not correct as the life assured was insured for

Rs. 2.00 lakh and this amount should not be reduced. Therefore, the personal accident claim should

be settled at Rs. 2.00 lakh. Since Rs. 1.50 lakhs has already been paid, an additional amount of Rs.

50000/- should be paid by the insurer to the complainant in respect of shortfall of personal accident

claim.



Banwari Lal Vs United India Insurance Co. Ltd.


FACTS: Sh. Banwari Lal had insured his vehicle bearing No. PB-10-BP-3641 for sum insured of Rs.

4,75,000/- vide Pol. No. 110204/31/08/01/0000198 for the period 25.04.08 to 24.04.09. The said

vehicle was stolen on 03.10.2008. The claim was lodged immediately and all the formalities were

completed. After 8 months he was told that an amount of Rs. 4,47,000/- was approved. At the time

of insurance he was told that full sum insured would be payable if there is a total loss or theft and

now the company is paying less claim amount after charging the premium for the whole year.

Parties were called for hearing on 06.11.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the IDV fixed by the previous insurer

viz. Oriental insurance co. Ltd. was wrongly done and was not fixed as per the invoice for the

purchase of the vehicle. The IDV has been recalculated based on the original invoice and legal

amount due to the insured as per re-fixed IDV viz. Rs. 4.47 lakhs has been paid to the complainant.

DECISION: Held that the contention of the insurer that the IDV was wrongly fixed earlier

appears justified. The action taken by the insurer to pay an amount of Rs. 4.47 lakhs is what is legally

due to the complainant. Hence no further amount is payable as far as loss of vehicle is concerned.

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



Santosh Gandhi Vs. United India Insurance Co. Ltd.


FACTS: Smt. Santosh Gandhi had insured her Bolero jeep No. HR 03 J – 0208 vide policy No.

112100/31/07/01/00003991 for the period 29.08.2007 to 28.08.2008 for sum insured of Rs.

552000/-. The said vehicle was stolen for which an FIR was lodged on 20.08.2008. The untraceable

report was issued by the police on 21.02.09. In spite of submitting all the requirements and

reminding them regularly, the company has failed to settle the claim. Parties were called for hearing

on 30.10.2009 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the untraceable report was awaited.

As soon as the untraceable report was received, the claim will be settled on merits. The contention

of the insurer that untraceable report is required is justified. The complainant is advised to approach

SP Office, Panchkula for getting the untraceable report accordingly. He stated that he had obtained a

letter from S.P. Panchkula addressed to the Ombudsman, in which the details of the whereabouts of

the vehicle after its theft were furnished.

DECISION: On going through the report signed by S.P. Panchkula, in which he has stated that

there were reports of vehicle having been sold to some party in Nagaland which they were unable to

trace so far. Although it is not clearly mentioned that the vehicle is not traceable, the details of the

action taken by the police to trace out the vehicle have been furnished. Since it is more than one

year when the vehicle was stolen, this should be taken as an unauthentic untraceable report signed

by Superintendent of Police himself. However, there is a little bit of vagueness about the location of

the vehicle, settlement of the vehicle on non-standard basis to the extent of 75% of IDV amount less

excess clause would meet the ends of justice. It is hereby ordered that 75% of IDV amount less

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



Virender Singh Vs. ICICI Lombard


FACTS: Shri. Virender Singh was having a Motor Insurance Policy bearing no.

3004/54110056/00/000 issued by ICICI Lombard General Insurance Co. Ltd. covering his Tata Sumo

Taxi bearing no. HR-55-DT-8498 for the period 29.06.08 to 28.06.09 for sum insured of Rs. 4,07,938/-

. On 10-11-08, his driver, Sh. Dalbir Singh parked the vehicle at about 9 p.m at 33 Foota Road Opp.

Yadav Palace, Delhi and gone to market, when he returned back, he found that the vehicle was

stolen. The matter was immediately reported to police and they registered the case vide FIR no. 414

dated 20.11.08. The claim was reported to insurance company. The insurance company vide letter

dated 10.08.09, repudiated the claim on flimsy grounds. Parties were called for hearing on 10.11.09

at Chandigarh.

FINDINGS: The insurer clarified the position by stating that there was no insurable interest of

the complainant as the vehicle was purchased by one Sh. Dalbir Singh who was pursuing the case.

Moreover, the FIR was lodged after 10 days and the insurer was informed after 14 days. Also, only

one key was given. The whereabouts of second key were not available. On a query, as to in whose

name were the RC and the insurance policy the insurer replied that it was in the name of Sh.

Virender Singh. On a query, as to who had filled up the claim form, the insurer replied that it was Sh.

Virender Singh.

DECISION: Held that the contention of the insurer that the complainant did not have insurable

interest is not justified as both the RC and the insurance policy are in the name of the complainant.

Although there is a delay in filing FIR but this could be due to normal departmental procedures of

the police and hence the claim cannot be repudiated solely because of FIR being filed after 10 days.

As far as loss of one key is concerned, the complainant should be penalized to the extent of 25% of

the IDV. Therefore, settlement of claim on non-standard basis to the extent of 75% of IDV less excess

clause would meet the ends of justice.


CASE NO. GIC/430/Shriram/11/10

Rajinder Parshad Vs Shriram Gen. Insurance Co. Ltd.

ORDER DATED: 18th January, 2010 MOTOR

FACTS: Shri Rajinder Parshad had been having a Motor Insurance Policy bearing no.

105009/31/10/001230 issued by Shriram General Insurance Co. Ltd. covering his Hero Honda

Motorcycle bearing no. HR-03-E-0248 for the period 01.07.09 to 30.06.2010. The said motorcycle

met with an accident on 29.07.09 and claim was lodged with the insurance company. The said claim

was repudiated by the insurance company without giving any proper reason. Parties were called

for hearing on 18.01.2010 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the since there is an imposed excess

of Rs. 1,500/- under the policy and assessed amount was less than imposed excess, nothing is

payable to the complainant. The complainant submitted that he was not explained about the

imposed excess at the time of taking the policy and there is nothing mentioned on the cover note.

DECISION: Held that the claim is payable for Rs. 1420/-. It is hereby ordered that Rs. 1420/-

should be paid by the insurer to the complainant.


CASE NO. GIC/435/IFFCO TOKIO/11/10

Gurlal Singh Vs IFFCO Tokio General Ins Co.


FACTS: Shri Gurlal Singh was having a Motor Policy bearing No. 38735286 issued by Iffco

Tokio General Insurance Co. Ltd. covering his Tata Truck bearing no. HR-37-B-8296 for the

period 15.04.08 to 14.04.09. The said vehicle was stolen on 26.04.08 while parked at the

Petrol Pump. The door of the cabin of the truck was locked. The thieves had broken window

glasses and taken away the truck. The matter was immediately reported to Police and they

registered the case vide FIR No. 61 dated 10.05.08. The claim was reported to insurance

company but they have rejected the claim vide letter dated 30.07.09. Parties were called for

hearing on 18.01.2010 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the vehicle was left

unattended and the same got stolen while original keys was inside the vehicle and quoted

the clause 5 of terms and conditions of the policy which stipulate that the insured should

take all reasonable steps to safeguard the vehicle from loss or damage. The complainant

insisted on the fact that they had taken due care of the vehicle and the vehicle was not left

unattended as it was parked at a Petrol Pump and the vehicle was left in the care of the

attendants of the petrol pump.

DECISION: Held that the allegation of the insurer that the vehicle was left unattended is partly

true. On the other hand, the complainant is also right, when he said that he had taken proper care of

the vehicle and taken reasonable steps to safe guard the vehicle from loss. Taking the fair and just

view, the settlement of claim on non-standard basis to the extent of 50% of claim amount would

meet the ends of justice. It is hereby ordered that 50% of the claim amount on non-standard basis

should be paid by the insurer to the complainant.



Chanchal Singh Vs. ICICI Lombard


FACTS: Shri. Chanchal Singh had been having a Motor Insurance Policy bearing no.

3001/52760849/01/000 issued by ICICI Lombard General Insurance Co. Ltd. covering his Scorpio car

bearing no. PB-10-BX-5667 for the period 27.10.08 to 26.10.09 for sum insured of Rs. 5,42,150/-. The

said vehicle met with an accident and a claim of Rs. 1,30,000/- was reported to insurance company.

All the claim documents were submitted. But the insurance company vide their letter dated

19.06.09 repudiated the claim on the ground that the vehicle was plied for hire & reward. Parties

were called for hearing on 19.01.10 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that the complainant himself had given

the statement that he had taken loan from bank for the purchase of vehicle and the installments are

paid by using the vehicle on hire. This statement is also signed by his driver and the Panch of village

Sh. Santokh Singh. The complainant submitted that he is an uneducated person and he was asked to

put signature on some statement which he signed without understanding the contents. The insurer

also failed to produce any convincing evidence to prove that vehicle was being used for hire and

reward and agreed to settle the claim of Rs. 32000/- as assessed by their surveyor.

DECISION: Held that since the insurer failed to produce any convincing evidence to prove that

the vehicle was being used for hire and reward, it would be fair to settle the claim for Rs. 32000/- as

assessed by the surveyor. It is hereby ordered that Rs. 32000/- should be paid by the insurer to the

complainant.



Harbhajan Singh Vs United India Insurance Co. Ltd.

ORDER DATED: 15th February, 2010 MOTOR

FACTS: Sh. Harbhajan Singh had insured his Sakoda Car No. CH 03 B – 6596 under cover note No.

494656. The said vehicle met with an accident on 08.08.2009. The claim was passed for Rs.

3,75,000/- as against the IDV of Rs. 4,80,000/-. The car was totally damaged and hence he had

applied for full claim amount. Parties were called for hearing on 15.02.2010 at Chandigarh.

FINDINGS: The insurer clarified the position by stating that there is on record a report dated

30.09.2009 from the surveyor. The report states that the assessed loss to the vehicle would be less

than 75% of the IDV, so the vehicle cannot be declared as total loss. If complainant is not prepared

to get the vehicle repaired then claim can be settled on net of salvage/cash loss basis for a sum of

Rs.2,04,000/- (Market value of car being Rs. 3,75,000 and value of wreck Rs. 1,70,000/- less excess

Rs.1000/-).

DECISION: Held that as per IRDA regulations, the concept of market value has been replaced by

the IDV and it is a practice to be accepted by all the insurance companies. So it is not correct to

settle claim on market value. However, if we apply the same percentage on IDV, the total amount

payable to complainant would be more than the IDV. Using the principle of averages, in my opinion

the end of justice would be met if the insurer pays a sum of Rs. 2,30,000/- less compulsory excess

which the complainant has also agreed. So the insurer is directed to pay Rs. 2,30,000/- less excess

within 15 days of the award under intimation to this office.


CASE NO. GIC/579/Bajaj/11/10

Jia Lal Vs Bajaj Allianz Gen. Ins. Co. Ltd.

ORDER DATED: 18th February, 2010 MOTOR.

FACTS: Sh. Jia Lal had a Motor Policy bearing no. OG-09-1201-1803-00000345 issued by Bajaj Allianz

General Insurance Co. Ltd. covering his Truck bearing no. HR-68-3146. The said truck was stolen

from Barotiwala Union on 24.01.09. FIR could not be submitted to the insurer immediately because

he could get the FIR copy on 14.03.2009. All the claim documents were submitted but insurance

company repudiated the claim. Parties were called for hearing on 18.02.2010 at Chandigarh.

FINDINGS: The insurer was requested to submit a self contained note giving the facts of the

case on 11.11.2009. Till the date of hearing, they did not submit a self contained note giving the full

facts of the case and the copy of the documents. During the course of hearing, the insurer submitted

that the complainant has submitted a letter to the fact that the keys of the vehicle were kept in the

cabin of the truck which was stolen. In claim form, also the same information was given. The

complainant specifically stated that registration certificate, fitness certificate, driving licence of the

driver and the keys of the truck were also in the truck itself and they were stolen along with the

truck. During the course of hearing, the complainant stated that the investigator of insurer

requested him to give a statement to this effect so as to expedite settlement of the claim.

DECISION: Since the allegation made by the complainant require legal procedure like calling of

people for witness and recording of evidence which is beyond the scope of this forum. So without

deciding the case on quantitative basis the complaint is considered as beyond the jurisdiction of this

forum. The complainant is free to take up the matter against the insurer in any other forum or court

of competent jurisdiction as he may deem fit. The case is thus closed.



Sarwan Kumar Vs United India Insurance Co. Ltd.

ORDER DATED: 18th February, 2010 MOTOR

FACTS: Sh. Sarwan Kumar’s car Hundai Accent bearing No. HR 07 G – 8556 was insured under policy

No. 110301/31/08/01/00005406 for the period 08.11.2008 to 07.11.2009. The car met with an

accident on 01.12.2008. The insurance company was informed about the accident. The company

advised him to get the vehicle repaired from M/s Vishal Autos and promised to settle the expenses

incurred. Accordingly, the vehicle was repaired incurring a total cost of Rs. 64000/-. When the claim

was preferred to the company through its authorized agent, the same was repudiated. Despite

several personal visits and legal notice, the company has failed to take any action. Parties were


FINDINGS: The insurer clarified the position by stating that the vehicle insured by them was

being run on LPG gas and this information was not given by the assured in the proposal form. A

vehicle run on LPG is insured after charging an extra premium. As per terms and conditions of the

policy, the accident claim is not payable.

DECISION: Held that on going through the records carefully, it is established that at the time of

accident, the insured vehicle was being run on LPG and extra premium for the same was not paid.

The claim is, therefore, not payable as per terms and conditions of the policy. No further action is

called for. The complaint is dismissed.



Amir Singh Vs Oriental Insurance Co. Ltd.

ORDER DATED: 19TH February, 2010 MOTOR

FACTS: Sh. Amir Singh had purchased a motor insurance policy vide cover Note No. 291363 for the

period 17.03.2008 to 16.03.2009 for sum of Rs. 145000/-. His vehicle, Tata 407 bearing registration

No. PB 10 BT – 3819 met with an accident on 29.10.2008. The claim was lodged alongwith relevant

documents. But till date he has not received the claim amount. He stated that the company officials

delayed the matter on one pretext or the other. Parties were called for hearing on 19.02.2010 at

Chandigarh.

FINDINGS: The insurer clarified the position by stating that the claim has been repudiated on

the ground the driver at the time of accident was holding a licence for driving Light Motor Vehicle

(Non Transport). The insured vehicle was a transport vehicle and since the driver was not holding

valid driving licence, the claim is not payable as per terms and conditions of the policy.

DECISION: Held that the insurer is justified in repudiating the claim as the driver of the vehicle

was not holding valid driving licence. No further action is called for. The complaint is dismissed.



Parminder Singh Vs National Insurance Co. Ltd.

ORDER DATED: 15th March, 2010 MOTOR

FACTS: Sh. Parminder Singh had taken a motor policy covering his motor cycle No. PB 36 C – 9368

vide policy No. 401801/31/05/6200001452 for the period 01.06.2005 to 31.05.2006. His vehicle was

stolen by some unknown person. He submitted all the document relating to claim to the insurer.

However, he received his non-traceable report of Judicial Court after long time which he submitted

to the insurer. The insurer, however, in its letter dt. 06.11.09 has stated that the said claim was

closed as no claim on 28.02.2006 due to non submission of non-traceable report of the court and the

insured has submitted the same to insurer on 26.08.2009 i.e. after a gap of 3½ year. The insurer put

the insured's request for opening claim file before the competent authority, who has declined the

request of the insured. Parties were called for hearing on 15.03.2010 at Chandigarh.

FINDINGS: The insurer submitted that their Divisional Office refused to settle the claim because

the claim was treated as closed three and half year back.

DECISION: Since complainant had no control over time taken by the court to give the final

report, he is entitled for the payment of IDV. The insurer is hereby directed to settle the claim for an

IDV of Rs. 38012/- within 15 days from the date of receipt of consent and other requirements from

the complainant. The complaint is thus disposed.



Gurpreet Singh Vs Oriental Insurance Co. Ltd.


FACTS: Sh Gurpreet Singh had insured his motor bike, Hero Honda under policy No.

231102/31/2009/3554 for the period from 31.03.2009 to 30.03.2010. The said vehicle was stolen on

31.03.2009. The claim was preferred to the insurer. However, the same was repudiated vide letter

dt. 03.12.2009 on the grounds that the vehicle was not registered within one month of its purchase

as per Motor Vehicle Act and FIR was lodged after one month of the theft of the vehicle. Parties

were called for hearing on 15.03.2010 at Chandigarh.

FINDINGS: The insurer clarified the position by stated that the claim could not be settled

because the complainant had lodged the FIR after one month of theft of the vehicle whereas as per

terms and conditions of the policy, the FIR should be lodged within 48 hours from the date of theft.

The insurer further submitted that the insured vehicle was not registered within one month of its

purchase and the temporary registration was valid up to one month from its purchase.

DECISION: The apprehension of the insurer was that if in future the vehicle is recovered then

there will be problem about its transfer in their favour. Looking into the facts of the case and papers

on record. The insurer is hereby directed to settle the claim on Non standard basis for an amount

equal to 75% of the sum assured after obtaining indemnity bond with surety from the complainant.

The complaint is thus disposed.

Chandigarh Ombudsman Centre


Ajmer Singh Vs United India Insurance Co. Ltd.

ORDER DATED: 15TH March, 2010 MOTOR

FACTS: The complainant, Sh Ajmer Singh’s vehicle Hero Honda No. PB 49 – 8769 was insured under

policy No. 281401/3107/01/00001899. The said vehicle was stolen on 15.02.2009 while he was

attending a marriage at Kamal Palace, Ropar. All the formalities were completed. However, the

company refused to make the payment as the key was left inside the vehicle. He further submitted

that the marriage palace was under security arrangement and they had failed to secure his vehicle.

Also he had paid all the premiums regularly and no instructions were given to him by the agent for

locking the vehicle. Parties were called for hearing on 15.03.2010 at Chandigarh

FINDINGS: The insurer clarified the position by stating that the theft claim was reported under

above policy. Investigation was carried out. During the investigation, insured has given an

undertaking that "He forgot to lock the motorcycle because he was in hurry, he was to come

immediately". The investigator submitted the report that at the time of the theft vehicle was not

locked. Hence claim is not payable under the policy.

DECISION: Held that as per the terms and conditions of the policy all reasonable care has to be

taken by the insured for the safeguard of the vehicle. He left the vehicle unlocked so was negligence

in not taking care of the vehicle. As per terms and conditions of the policy, the claim is not payable.

The complaint is thus dismissed.



Jagbir Singh Vs Oriental Insurance Co. Ltd.


FACTS: Sh. Jagbir Singh had purchased a motor insurance policy No. 31/08/4436. His car registration

No. PB 11 AE – 9508 met with an accident on 21.06.08. FIR was lodged and survey was conducted by

the insurance company. The claim was repudiated on the ground that the driver who was driving the

vehicle was holding a licence for LMV (Private) whereas he was driving a Mahindra Matrix (Pick-up)

which came under the category of LMV (Commercial). Complainant submitted that the licence is

valid for both the purpose. Hence he requested intervention of this forum in getting the claim

settled. Parties were called for hearing on 15.03.2010 at Chandigarh.

FINDINGS: In support of repudiation of the claim the insurer submitted a certificate from the

DTO, Patiala that the subject vehicle was registered as commercial vehicle. The insurer is justified in

rejecting the claim on the ground that the person driving the vehicle was not holding a valid and

effective licence. The complainant has submitted that the certificate from DTO Patiala submitted by

the insurer through their investigator to the effect that vehicle is registered as a commercial vehicle

is not genuine. He also submitted a print out of web site of Indian Driving School stating that there is

no provision for commercial vehicle licence. The subject vehicle was being used to transport his

personal goods and for driving such a vehicle a licence to drive L.M.V. is valid.

DECISION: An analysis of materials on record reveals that the licence issued to Aman Deep

Singh, the person driving the vehicle at the time of accident was the licence to drive a Motor Vehicle

other than a Transport Vehicle. Since the subject vehicle was Mahindra Matrix (Pick up) which is

used to transport goods and the licence of Shri Amandeep Singh was to drive Motor Vehicle other

than Transport Vehicle as per terms and conditions of the policy, claim is not payable and insurer is

justified in rejecting the claim. The complaint is thus dismissed.

DELHI

Case No. GI/137/NIC/09

In the matter of Shri Pushpender Singh Vs

National Insurance Company Limited

AWARD dated 03.11.2009

1. This is a complaint filed by Shri Pushpender Singh (herein after referred to as the

complainant) against the National Insurance Company Limited (herein after referred

to as respondent insurance company) for not settling the claim in respect of an

accident to his vehicle No.DL-9CC-4394 covered under policy

No.360300/31/07/6100008043.

2. The brief facts of the case are as under:

3. The complainant had taken a Motor Package policy with respondent company in

respect of his vehicle No.DL-9CC-4394. The said vehicle had met with an accident on

22.09.2008. Thereafter, the complainant had lodged a claim with the respondent

company. However, while admitting the claim as a total loss, the respondent

company had offered two options to the complainant. (i) Either the complainant

could keep the scrap for which an amount between Rs.2000/- to Rs.2500/- could be

deducted from the total IDV of the vehicle, that is, Rs.1,33,000/- (ii) Or, to get the

total IDV subject to removal of superdari from the court. The claim is pending only

for want of requirements as sought by the respondent company vide their letter

dated 25.05.2009 (EX: R1). The following requirements were made by the

respondent company: (i) Get the superdari deleted (ii) get RC transferred in the

name of the respondent company (iii) To deposit the salvage to the company’s

godown.

4. I find from the above requirements that since the vehicle in question met with an

accident, the said vehicle will always remain subject to superdari and it may not be

possible for the complainant to get the same deleted.Therefore, the Condition No.1

as sought by the respondent company may not be insisted upon. The respondent

company should be able to settle the claim on total loss basis as per the IDV. In the

result, I direct the respondent company not to insist on getting the superdari deleted

and after getting the condition No.II & III which the complainant is very much willing

and ready, the respondent company is directed to settle the claim as total loss basis

for the IDV amount.

5. With this direction, the complaint is disposed of.

Case No. GI/39/UII/09

In the matter of Shri V.R.Jagannathan Vs

United India Insurance Company Limited


1. This is a complaint filed by Shri V.R.Jagannathan (herein after referred to as the

complainant) against the decision of the United India Insurance Company Limited

(herein after referred to as respondent insurance company) in repudiating his claim

in respect of theft of his Maruti Zen Car No.DL-9C-L-9504. The reason for the

respondent company for rejecting the claim is that the complainant had already sold

the vehicle to somebody else and as such he has no insurable interest.

2. The base on which the respondent company has come to this conclusion is the

investigating report submitted by one Shri Paritosh Paul (EX: R1). The investigator

has concluded that the insured had in fact sold the car before going abroad to one

Shri Hitesh Gulani and even paid the consideration besides having filled in form

No.29 & 32 towards the transfer of the vehicle in the RTO office. However, as on the

date of loss admittedly the RC book is still in favour of the insured. Though the

insured would have negotiated the sale of the car, the sale is not said to be complete

unless the ownership is transferred from the seller to the buyer by way of change in

the registration book. It is erroneously on the part of the respondent company to

come to a conclusion that the vehicle has already sold and consequently the insured

does not have an insurable interest. The sale of the vehicle nor the ownership of the

vehicle does not transfer to the buyer unless and until necessary changes are made

in the RC book. (EX: C1) is the copy of the RC book where it is clearly mentioned the

owner’s name as Shri V.R.Jagannathan.

Therefore, it is not fair on the part of the respondent company to rely on mere

circumstantial evidence to infer that the vehicle has been sold which is not

supported by any documentary evidence. As regard the theft itself, the company is

not denying the genuineness of the theft nor the amount be settled. There only

contention is that the insured is no longer the owner of the vehicle.

3. As already discussed above, the ownership of the vehicle as per RC record is still in

the name of the insured and as such the repudiating of the claim by the respondent

company is unjustified. As a result, I direct the respondent company to settle the

claim as per policy conditions in connection with the theft of the vehicle to the

complainant owner of the vehicle.

4. The complaint is disposed of accordingly.

5. 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.

6. Copies of the Award to both the parties.

Case No. GI/122/ICICI Lomb/09 In the matter of Dr. Ajay Aggarwal Vs.

ICICI Lombard General Insurance Company Limited


1. This is a complaint filed by Dr. Ajay Aggarwal (herein after referred to as the

complainant) against the decision of ICICI Lombard General Insurance Co. Ltd.

(herein after referred to as respondent Insurance Company) in limiting his claim in

respect of accident to his vehicle to Rs.105627/- only as against his total claim of

Rs.379359/-.

2. The brief facts of the case are as follows:

3. The complainant had taken a motor package policy in respect of his vehicle DL-2FC-

0048 Mercedes Benz Car for total IDV of Rs.12 Lacs. Between the period 10.09.2007

to 09.09.2008. The said vehicle allegedly had an accident on 07.09.2008 as per the

facts already available on the file that complainant was driving his car on the fateful

day around 09.30 pm there was very heavy rain. At that point of time his car

suddenly entered into a ditch filled with rain water. The car due to sudden jerk at

that point of time had a crack in the windscreen. There after the vehicle was

removed to a workshop. The workshop gave estimate of Rs.273732/- towards

repairs of the vehicle. However, the respondent company had allowed only

Rs.105627/- excluding the cost of repairs in respect of the engine. The two grounds

on which the claim was partially repudiated by the respondent company are as

follows:

(1) There was no external impact to the vehicle of the engine from outside.

(2) Engine cannot be impacted by merely coming in contact with water and

damages to engine can only by attributed to mechanical failure or trying

to start/run the engine when it is still in contact with water.

4. Thereafter the matter came before the then Ombudsman who had a hearing and

based on various data available he made an interim report (EX.O.1). Various

circumstances were discussed in this report. However, the main issues coming for

consideration are as follows:

(i) Whether the kind of damage to the engine that has occurred is

possible only because of using self starter in the specific

circumstances of this case?

(ii) Can there conceivably be other reasons for the damage, that is, other

than self starting?

(iii) Is there any violation of the manufacturer’s manual relating to driver’s

conduct relevant to this accident? If so, specify the same.

(iv) What is the meaning of “Consequential Loss” in terms of para 2 of the

policy condition? Is it consequential to the incident or human failure?

(v) Assuming for sake of arguments that Dr. Aggarwal had tried to re-

start the engine by use of self-starter and that caused damage to the

engine, can it still be called “consequential loss” in terms of the policy

document?

5. The Ombudsman also directed the respondent company to give a speaking order on

the above points before 15.09.2009. The personal hearing on this matter before me

was held on 03.11.2009. On that day the respondent company did not present any

clarification on those issues as directed by this Forum. Therefore, I would like to

pass an Award on the issues based on various documents, statements, provision in

the motor policy and also general experience of motor claims. Taking the first

objection of the respondent company that “there was no external impact to the

vehicle of the engine from outside”, I would like to refer to the wordings of the

policy section ‘1’ “Loss of or damage to the vehicle insured”. It is explicit that

damage to the vehicle should be by “accidental external means”. From the above

definition it postulates that the damage to any part of the vehicle need not be any

impact. The damage should have been caused by any factors and it should be

accidental. I, therefore, fail to understand the logic of the respondent that the

instant case that there was no impact to the vehicle. As established in the instant

case the damage to the engine is admittedly caused due to entry of water into

engine. As already discussed in the interim report in EX.O.1, it is established that

entry of the water into engine happened due to attempt of the driver/complainant

to start the engine while the vehicle is submerged partially in the water. In normal

course in such panic situation it is not uncommon for any

man of ordinary prudence in a panic situation to attempt to start the engine in his

anxiety to get out of the water, especially when it is raining heavily. Therefore there

has been no deliberate intention on the part of the complainant to cause any

damage to the engine intentionally. Therefore, it has to be considered that entry of

water into engine is purely by accidental means and not by any intentional act.

Having held so, I would now like to elucidate on some of the important points raised

by this forum to the respondent company. Whether there is any violation of

manufacture’s manual relating to driver’s conduct relevant to the accident. I have

been supplied by the complainant the user’s manual. On pursuing the same I find

that there no mention about any directions to the users about the manner in which

one should take precautions about not starting the car in that situation. I would also

like to state that respondent cannot attribute any malafied intentions to the

complainant for having attempted to start an engine in the circumstances already

discussed. I also referred to a judgement of the District Consumer Disputes

Redressal Forum (New Delhi) vide their order dated 01.07.2009 where in fact the

same Insurance Company is a respondent. The forum succinctly held “it is quite

common that during rainy season there is water logging on the roads and the vehicle

have to ply through that water and if the car like Mercedes gets stuck mid way

because of water entering in engine or its cylinder, the respondent cannot escape its

liability coming under exclusion of consequential loss”. Now coming to the other

points referred by this forum as whether the damage caused to the engine is

consequential loss or not, it is well established principle of Insurance that this cannot

be termed as consequential loss and the word consequential is always connected to

the incident and not necessarily human failure. In the normal course consequential

loss is in fact the financial loss caused to the insured as a result of damage to insured

property. Therefore the application of consequential loss term on the present

circumstances is not correct. Coming to the last point, it goes without saying that act

on the part of the complainant having attempted to start the engine at that point of

time can not be termed as consequential loss. In fact, this also has been held in the

negative by the Hon’ble District Consumer Disputes Redressal Forum as already

discussed above.

6. For the reasons elaborately discussed above, I find that the repudiation of the claim

for the damage to the engine and repairs replacement caused to the engine part is

not justified at all.

1. I find from the interim report of previous Ombudsman that the total claim is for

Rs.273732/-. However, the complainant had vide his letter undated submitted to

this forum, had sought to claim Rs.379359/- as the total claim amount spent by him.

This forum is not able to give any final figure for the total claim amount to

be settled, in the absence of proper bills, labour charges etc. Therefore, the

respondent company is directed to scrutinize the balance bills repairs, replacement,

labour charges etc. and than release the balance amount.


compliance of the same shall be intimated to my office for information and record.

9. Copies of award to both the parties.


In the matter of Shri Chander Prakash Talreja Vs



1. This is a complaint filed by Shri Chander Prakash Talreja (herein after referred to as

the complainant) against the decision of the National Insurance Company Limited

(herein after referred to as respondent insurance company).

2. The brief facts of the case are that his vehicle Maruti Zen DL 2CV 6438 had met with

an accident. The claim has already been agreed and settled on Net Salvage Value

basis. Though the complainant is not happy as to the shortage received for his

salvage vehicle as against the IDV, the main complaint as to his final notice given to

the respondent company vide his letter dated 30.12.2008 is limited to the following

expenses only:

Rs.4900/- towards towing charges

Rs.50000/- towards harassment with 18% of interest

3. From the fact available on the file, the present claim of the complainant is limited to

only those above two amounts. As regards, towing charges are concerned, in

Annexure A accompanied in his complaint, he had elaborated as follows:

“As it was decided that my car would be sold on a net salvage value then I was

required to make efforts to find a seller for the same. I could not leave my car at the

service centre of the BSS as it was decided that the car would not be repaired now

and BSS was charging parking charges on a per day basis for the space occupied by

my car in the service station. This again would have left to additional cost to be

incurred by me. Due to this, I was forced to bring the car back to home and incur

additional toeing charges for the back journey.”

4. From the above, it is clear that the towing charges had to be entailed by him for valid

reasons as described above. I am pained to note that the respondent company has

given a reply to the forum vide their letter dated 11.06.2009 in the briefest possible

form not giving any elaboration in regard to the various points raised by the

complainant which reflects the indifference of the respondent company even to this

Forum. This only strengthens the complainant’s version that he has been made to

run from pillar to post to get his claim settled.

5. I, therefore, pass the Award the following amounts to the complainant:

(i) Rs.4900/- towards towing charges

(ii) Rs.5000/- towards various misc. expenses by him as ex-gratia amount.

As regards his claim for Rs.50000/- towards damage and sufferings, they are not

maintainable in this forum. In the result, I direct the Insurance Company to pay him

a total sum of Rs.9900/- as enumerated above.





In the matter of Shri Deepankar Roy Vs



1. This is a complaint filed by Shri Deepankar Roy(herein after referred to as the

complainant) against the decision of the National Insurance Company Limited

(herein after referred to as respondent insurance company) in rejecting the claim in

respect of theft of his vehicle Maruti 800 No.DL 7CR 1363.

2. The brief facts of the case are that the complainant had bought Maruti 800 car from

someone else and applied for change of registration. He also got the policy obtained

in his favour from the respondent company for the period 23.05.2008 to 22.05.2009.

The vehicle admittedly was stolen on intervening night of 22-23.06.2008. The

respondent company has rejected the claim vide their letter dated 09.06.2009

interalia on the ground that the RC was transferred in the name of the complainant

only on 24.06.2008, that is, one day after the theft of the vehicle. Since on the day

of the theft, he did not have insurable interest, the claim is rejected.

3. The point for consideration is whether the insurance company is justified in denying

the claim on the above ground. From the circumstances and facts available, it

postulates the very fact that RC was changed in favour of the complainant on

24.06.2008 implies that he would have submitted the necessary forms for change of

registration much before that date. It is common knowledge in India that RTO takes

their own sweet will to deal with such matters. The complainant also confirms that

at the time of giving the policy, the respondent did not insist for the R.C. Therefore,

the policy as on the date of theft is in favour of the complainant and the respondent

company is estopped from taking the plea of insurable interest. Secondly as already

discussed the ownership in the vehicle transferred/ obviously to the complainant the

moment he paid full consideration of the vehicle. As on the date of theft, he had

apparently submitted the necessary forms to transfer of ownership in the RTO.

Therefore, I am fully convinced that the complainant was not at fault for the events

that happened which are unfortunate. For all purposes de-facto, he is the owner of

the vehicle as on the date of theft and he has insurable interest notwithstanding the

fact that actual RC was not issued.

4. In the result I hold that repudiation of the claim by the respondent company is

unjustified. As such, I direct the respondent company to settle the claim for IDV

subject to usual procedure followed in the theft claim.




Case No. GI/121/UII/09

In the matter of Shri Rajat Surana Vs

United India Insurance Company Limited


1. This is a complaint filed by Shri Rajat Surana (herein after referred to as the

complainant) against the decision of the United India Insurance Company Limited

(herein after referred to as respondent insurance company) in repudiating his claim

for theft of his vehicle No.RJ 04-2M-7076.

2. The brief facts of the case are that the complainant had taken a Motor Package

policy with the respondent company in respect of his vehicle No.RJ 04-2M-7076.

From the facts available, it appears that the vehicle was bought by the complainant

from somebody else. The respondent company has rejected the claim according to

their own reply on the ground that when the complainant had approached them for

transfer of insurance policy on his name, that is, on 30.08.2007, the vehicle was

already stolen on the same day. The reason for repudiating the claim is that he had

suppressed the fact about the theft of his vehicle in the morning at the time of

seeking transfer of the insurance policy in his name. As could be gathered from the

brief reply letter of the respondent company that barring this objection, all other

formalities such as police report etc must be in order. I also have gone through the

complainant’s letter wherein he has submitted FIR and other documents relevant to

the settlement of the claim. It is also admitted by the respondent company that R.C.

was transferred on 29.08.2007 in favour of the complainant, obviously having

purchased the vehicle from somebody else. Therefore, on the date of theft of the

vehicle, that is, 11.00 a.m. on 30.08.2007, the complainant had insurable interest

and he was in fact the owner of the vehicle.

3. Now going to the objection of the respondent company alleging that there was mis-

representation of facts/suppression about the theft at the time of seeking transfer, I

have sought the explanation from the complainant during the course of personal

hearing. He had explained that he was in very nervous state of mind and just he was

approaching insurance company and after he had got the RC transferred in his name,

this unfortunate incident had shaken him. He was nervous and chose not to inform

about the theft of the vehicle which has happened just immediately on the day after

the transfer of the vehicle.

4. I am convinced from the fact on the file as well as circumstances explained to me by

the complainant that there is no fraud involved in this case. The complainant’s

explanation seems to be very natural and genuine. I, therefore, hold that the theft is

genuine and the complainant was having insurable interest on the date of theft. The

reasons for suppression about the theft of the vehicle at the time of seeking transfer

of insurance policy have been explained to my satisfaction.

5. I, therefore, feel that the rejection of the claim in the instant case is not justified. I

direct the respondent company to settle the claim as per IDV subject to complying

with other procedural formalities under the policy.





In the matter of Shri Surender Kumar Mittal Vs



1. This is a complaint filed by Shri Surender Kumar Mittal (herein after referred to as

the complainant) against the decision of the National Insurance Company Limited

(herein after referred to as respondent insurance company) in repudiating the claim

in respect of an accident to his vehicle Tata Indica No.RJ 13 CA 0759 covered under

the policy with the respondent company.

2. The brief facts of the case are that the Tata Indica vehicle belonging to the

complainant had met with an accident on 17.07.2008. The respondent company had

engaged a surveyor to assess the loss. However, after the loss has been assessed

the respondent company has rejected the claim on the ground that though the

driver was having admittedly a transport vehicle license at the time of accident but

he did not have a valid LMV vehicle driving license for at least one year which is a

pre-condition under the Motor Vehicles Rules.

3. I have gone through the relevant circular dated 29.03.2005 issued by Rajasthan

Government, Transport Department. They have clarified that a person who is having

a transport driving license can drive car, Omni bus, tractor and road roller whose

total weight not exceeding 7500 Kgs. It has also however prescribed that transport

vehicle license could be issued only to those who have held a LMV driving license for

a period of at least one year.

4. I have also gone through the investigation report submitted by the respondent

company (EX : R1) wherein the investigating officer who checked the previous and

pack papers and connected with the issuance of the transport driving license to the

driver of the vehicle.He had confirmed as per his investigation that the driver

concerned did not ever have a license to driver LMV vehicle and as such in

accordance with the above quoted circular, he was not entitled to have transport

vehicle driving license. The only point for consideration is whether or not the driver

was having a valid driving license within a meaning of drivers’ clause of the policy.

No doubt it has been held time and again by the highest judicial forums in the

country, that driving a vehicle without having a valid driving license vitiates a claim

completely. Unfortunately, the respondent company could not establish in the

instant case, that he was not having a valid driving license. The driver is undoubtedly

having a transport vehicle license (EX: C1). Having held a license to hold a motor

vehicle in accordance with the above quoted circular, he is entitled to driver a LMV

policy subject to weight limitations. Now as long as the driver concerned is having

transport vehicle license with him, it is not for this forum to go back to the history

beyond as to how the Transport Department has given such license if he did not

comply with any of the mandatory pre-requisites for getting such license issued.

That should have been the job of the Transport Department to ascertain the same

and it is not for this Forum to challenge the back ground of the circumstances under

which a driving license has been purportedly obtained fraudulently.

5. In the result, as on the date of the accident, the driver of the vehicle was authorized

to hold LMV vehicles as per the circular quoted above. As such, I hold that the driver

of the vehicle was in fact holding a valid driving license on the date of the accident to

the vehicle being in possession of a valid transport vehicle license.

6. In these circumstances, I direct the respondent company to process the claim as per

the assessment already made by the surveyor and settle the claim subject to

scrutiny, excess or any other clause under the policy.




Case No. GI/190/OIC/09

In the matter of Shri S.K. Mittal Vs

Oriental Insurance Company Limited

ORDER dated 01.12.2009

1. This is a complaint filed by Shri S.K. Mittal (herein after referred to as the

complainant) against the decision of the Oriental Insurance Company Limited (herein

after referred to as respondent insurance company) in not settling the motor claim

in respect of theft of his motor cycle No.RJ 14 35M 4278 on 28.03.2008.

2. The brief facts of the case are that the complainant had taken a Motor Package

policy with the respondent company for the period 06.03.2008 to 05.03.2009. The

main reason for rejecting the claim given by the respondent company is based on

the following facts. The vehicle was allegedly stolen on 28.03.2008 whereas the

information to the company’s office was given after a lapse of 26 days which is a

clear contradiction of the policy conditions which requires notice of theft to be

intimated within 48 hours of the incident. There is also a delay in informing the

police authorities. Since there is clear violation of policy conditions, the claim has

been rejected.

3. While the facts mentioned above by the respondent company are true, I have, in the

course of personal hearing, sought the explanation from the complainant as to why

such delays have occurred. He had explained to me that he was actually living in

Jodhpur where the theft took place and the policy was taken from Jaipur. He had

mentioned about the difficulties he faced in getting the FIR registered with the police

authorities. He had explained to me that after the above happening of the theft, he

was shattered. He had pleaded that he had no intention of any fraud but all these

mistakes were happened inadvertently due to he being shaken due to sudden theft

of the vehicle.

4. On going through all the records, I find, no doubt, there are basic violation of the

policy requirements especially in the case of theft. An inordinate delay in informing

the theft would effect the right of the Insurance Company in getting the matter

investigated. As regards the delay in informing the police is concerned, I find that FIR

was registered on 03.04.2008 whereas the theft has occurred on 28.03.2008,

therefore, the delay was about 6 days.

5. On going through the oral submissions made by the complainant, I am convinced

that these lapses in complying with the policy conditions have happened due to the

unfortunate circumstances faced by the complainant who is responsible & a

respectable citizen working in Jodhpur. I do not suspect any foul play regarding

genuineness of theft etc. The only problem is the violation of policy condition and I

cannot blame the respondent company for having rejected the claim in accordance

with the policy conditions and their inability to get the matter investigated due to

this delay in intimation. However, for the circumstances stated above, I take a

lenient view and direct the respondent company to settle the claim on non-standard

basis, not exceeding 75% of the IDV of the vehicle, as a special case without creating

precedent in these matters.





In the matter of Shri Alok Johari Vs



1. This is a complaint filed by Shri Alok Johari (herein after referred to as the

complainant) against the decision of the National Insurance Company Limited

(herein after referred to as respondent insurance company) in repudiating his motor

theft claim.

2. The brief facts of the case are that the complainant had taken a motor private car

package policy in respect of his vehicle Maruti/Wagon R No.DL 9CR 2013 for the

period 25.03.2008 to 24.03.2009 for an IDV of Rs.2,68,000/-. The said vehicle was

stolen on 09/10/08.2008. However, the claim of the complainant for the theft of his

vehicle has been rejected by the respondent company on the ground that the

intimation of loss to the company was made after a lapse of 7/8 months from the

date of theft.

3. I have gone through the various records of the policy and also heard both the parties

on the date of personal hearing. From the records available, it is true that there is

no written intimation of theft of the vehicle from the complainant. It is a very

important condition of the policy which makes it mandatory that the loss or damage

to the vehicle has to be immediately brought to the notice of the respondent

company and breach of this condition can lead to repudiation of the claim itself.

Repudiation of the claim for non-intimation within time has been hold to be a valid

ground even by Apex Consumer Forum. Therefore, from the facts available on the

file that in the absence of intimation of loss within reasonable time can definitely

give rise for repudiation of the claim.

4. The main purpose for this condition is that the respondent company shall have

sufficient scope to investigate the veracity of the theft and can come to the

conclusion about the genuineness of the claim. In the absence of such intimation,

the insurance company will be deprived of the opportunity to get the matter

investigated. In the course of personal hearing, the complainant has submitted that

he had informed his agent who happens to be the Motor dealer himself about the

loss of the vehicle. Since the original certificate of insurance has been lost with the

vehicle, the agent-cum-dealer of the vehicle (M/S.Bagga Link Motors Ltd., Delhi) has

given him a duplicate copy of the insurance certificate. The complainant also

pleaded before me that he had sent even the fax about the loss of the vehicle and

intimated even the bank which was a financer for this loss.

5. On going through the facts, I am convinced that the lack of intimation about the loss

to the insurance company could have been escaped, may be due to the ignorance of

the requirements. Though that could not conclusively be proved, that they had in

fact sent a fax to the respondent company, however, circumstantial evidences

suggest that the Bagga Link Motors Ltd., has provided a duplicate copy of the policy

which confirms the fact that he had in fact intimated the loss. The other

corroborated evidence available is that the FIR has been lodged in the police station

on 10.08.2008, that is, the day after the theft. A copy of the FIR is also available in

the file.

6. From the above facts, therefore, there cannot be any doubt that the vehicle had in

fact stolen on the intervening night of 09/10.08.2008 itself and that fact is

corroborated by FIR filed with the police. I also find the Final Report of the police

dated 20.11.2008. The only short coming in the claim is the non-receipt of written

communication about the happening of the theft in the office of the respondent

company.

7. In the circumstances, I direct the respondent company to settle the claim subject to

complying with the normal procedural requirements in a theft claim. However, since

there has been a technical breach of a policy condition, the claim can be limited to

90% of the IDV on a compromise basis.

8. With these observations, the complaint is disposed of accordingly.


Case No. GI/201/ICICI Lombard/09

In the matter of Shri Narendra Kumar Vs



1. This is a complaint filed by Shri Narender Kumar (herein after referred to as the

complainant) against the decision of the ICICI Lombard General Insurance Company

Limited (herein after referred to as respondent insurance company) in repudiating

his motor claim.

2. The brief facts of the case are that the complainant had got his Tata Truck No.RJ13-

GA 2590 comprehensively insured with the respondent company for an IDV of

Rs.698720/- for the period 16.02.2009 to 15.02.2010. As per the facts available, the

said vehicle caught fire on 25.05.2009. The complainant’s vehicle was also

immediately attended by the fire-brigade and subsequently the matter was brought

to the notice of the respondent company who has deputed Shri Keshav Agarwal who

had conducted the spot survey on the vehicle and submitted his report dated

20.06.2009 (EX:R1). In the said report, the surveyor had confirmed that the cause of

fire as probably due to short-circuiting. He had inspected various parts of the vehicle

damaged by fire and gave a report. As per his report, the driver of the vehicle Shri

Bittu Singh was proceeding with the loaded vehicle and the accident is supposed to

happened somewhere between Sri Ganganagar (Rajasthan) to Gurgaon (Haryana).

Subsequently the respondent company had deputed a final surveyor Shri Narinder

Singh Sidhu who has submitted his report marked (EX:R2). In the report interalia, he

had also confirmed that there was extensive damage to the vehicle due to fire in the

vehicle. He had also expressed that probable cause of fire to the vehicle is short-

circuit in the cabin system and electrical wiring. He had conducted a thorough

assessment of the damage to the vehicle and assessed the same at net amount of

Rs.259939/-. Since the IDV of the vehicle is Rs.698720/- and the percentage of the

loss assessed is below 75% of the IDV, the same cannot be considered on a total loss

basis. Subsequently, I find that the respondent company had merely rejected the

claim vide their letter dated 29.06.2009 (EX:R3) on the ground that “there was a mis-

representation of facts regarding the driver of said vehicle at the time of accident.” I

also find that there is a letter written by respondent company to the complainant

dated 28.12.2009 (EX:R4) wherein they have turned about from their stand taken in

their refusal letter and have now admitted the claim advising the complainant to get

the vehicle repaired as per the assessment made by the surveyor.

3. In the course of personal hearing, the respondent company’s representative Shri

Sumeet Bajaj had categorically pleaded that the cause of fire is probably due to

manufacturing defect and therefore they are not liable.

4. On going through the various facts and figures I come to the conclusion that

(i) The vehicle got extensively burnt down on 25.05.2009

(ii) The preliminary surveyor has confirmed the cause and nature of accident which

corroborated the statement of the complainant.

(iii) The final surveyor also confirmed the cause and nature of the loss and also

assessed the various damages to the vehicle.

5. I am really surprised as to the various stands taken by the respondent company from

time to time. In the first instance, they have taken a stand that there is inconsistency

in the name of the driver. On the second occasion, during the personal hearing at

Jaipur, they have taken a stand that the fire has broken out due to manufacturing

defect. On a letter dated 28.12.2009, that is, after the hearing, they are now coming

out with an offer to get the vehicle repaired as per the assessment made by the final

surveyor. I have also gone through the estimates given by Dunac Automobiles Pvt.

Ltd., a dealer of Tata Motors at Sri Ganganagar (EX:C1) amounting to Rs.871,551/-.

5. Now taking the whole situation, the reasons tendered by the respondent company

from time to time are very inconsistent. There is no doubt that this vehicle had met

with a most unfortunate and inevitable accident which cannot be denied. The

respondent company coming out with a very weak ground for rejecting the claim on

such as inconsistency in the name of driver is most reprehensible. On second

occasion before this forum they have come out with a desperate ground that it could

be due to manufacturing defect. The respondent Insurance Company is probably

not understood that when an accident takes place to the vehicle it is not for the

insured as to what caused the accident including the alleged manufacturing defect as

long as the accident is caused without any malafied intension from the insured.

6. I record that even this stand is another desperate attempt to reject the claim. Now

at this belated stage obviously sensing the mood of the forum, the respondent

company has now come out with their letter that the vehicle could be repaired as

per the assessment made by the final surveyor. I am afraid that it is too late a stage

and considerable time has passed since the date of the accident is 25.05.2009.

Under these circumstances, I do not think the vehicle could be made road worthy

and in a running condition to the satisfactory of the insured especially after

extensive fire damage. Had the respondent company attended to these repairs

immediately after the final survey report, there could have been a scope for this

forum to assess the veracity and reasonableness of the assessment. At this stage

having failed in their attempts to reject the claim on some ground or the other, now

coming out with a proposal to get the vehicle repaired on the assessed value is not

at all proper.

7. In the result, I direct the respondent company to settle the claim on total loss basis

on the IDV as appearing on the face of the policy which is Rs.698720/-. The salvage

of the vehicle could be taken over by the respondent company.

8. With these directions, the complaint is disposed of accordingly.


Case No.GI/148/ICICI Lombard/09 In the matter of Shri S.K. Dhingra Vs



1. This is a complaint filed by Shri S.K. Dhingra (herein after referred to as the

complainant) against the decision of ICICI Lombard General Insurance Co. Ltd

(herein after referred to as respondent Insurance Company) regarding non-settlement

of motor claim.

2. During the course of hearing, the representative of the respondent Company assured

to pay the claim, if the complainant takes his vehicle to the authorized dealer and got

it repaired from them. The insured Mr. S.K. Dhingra has got his vehicle repaired

from M/s. D.D. Motors, Peeragarhi, New Delhi and incurred an expense of

Rs.16902/- vide their bill no. BR09009842 dated 30.11.2009 and submitted the same

to the Insurance Company on 04.12.2009 which was duly received by the Company

but till date they have not settled his claim as promised.

3. Therefore, the respondent company is directed to settle the claim bill of Rs.16902/- to

the complainant.

Case No. GI/29/BA/09

In the matter of Dr.Dilip Dubey Vs

Bajaj Allianz General Insurance Company Limited


1. This is a complaint filed by Dr.Dilip Dubey (herein after referred to as the

complainant) against the decision of the Bajaj Allianz General Insurance Company

Limited (herein after referred to as respondent insurance company) in repudiating

his motor claim.

2. The brief facts of the case are that the complainant had got his Maruti Baleno Car

No.RJ148C 9638 comprehensively insured with the respondent company for the

period 20.02.2008 to 19.02.2009. The said vehicle met with an accident on

07.09.2008. Thereafter the complainant had informed the respondent company

about the damage to the vehicle. The respondent company having appointed a

surveyor and subsequently vide their letter dated 26.09.2008 have repudiated the

claim interalia on the ground that the complainant had got his vehicle dismantled

without giving an opportunity to the surveyor to assess the loss. Secondly, they had

also contended that the complainant had deliberately removed the vehicle from the

spot of the accident without the consent of the respondent company. The only point

coming for consideration is whether the respondent company is justified in

repudiating the claim.

3. On going through the facts available, the complainant (who happens to be a highly

respected doctor of Jaipur) and according to his statement, the said vehicle, while

driving, went down in a pit full of water on a rainy day and stopped at once.

Thereafter he had removed the vehicle to a workshop and informed the respondent

company. The respondent company had appointed one surveyor Shri Pramod who

had submitted his report dated 23.09.2008. In the report, he had confirmed the

version of the complainant that the said vehicle fell in to a ditch of water. From the

statement and letter written by the complainant, it is also established that the

surveyor had taken photographs and inspected the vehicle in the workshop.

Subsequently, the complainant had got his vehicle repaired in the same workshop

and entailed expenditure for getting the car repaired.

4. On going through the rejection letter given by the Insurance Company, I find that

one of the reasons mentioned by them is that the complainant had deliberately and

with intention to suppress the nature of accident had removed the vehicle without

their consent and not having given an opportunity to appoint a spot surveyor. I

would like to comment on this point, first of all, that this contention of the

respondent company is absolutely baseless and cannot be sustained for the simple

reason that they cannot expect the insured to keep the car on the same spot where

it was struck that too in a rainy day and alleging malafied intention to the

complainant without any material. They are very improper. Secondly it is well

established practice of insurance that spot survey is not resorted to in a private

vehicle. It is generally deputed where a commercial vehicle met with an accident.

Therefore, the reason quoted by them is absolutely baseless and cannot be

entertained. Taking the second ground on which they have rejected the claim is that

the complainant had dismantled the vehicle without the inspection from their

surveyor. I am afraid that this is also not true as only after the surveyor had taken

photographs, the vehicle was dismantled

5. I do not understand what more permission the Insurance Company wants from the

surveyor and in fact the surveyor can assess more loss only after the engine is

dismantled. Therefore, the stand taken by the Insurance Company for rejecting the

claim purely on these two non-sustainable grounds is most regrettable.

6. Besides, the complainant has rightly pointed out that he is a doctor and would be

the last person to keep the vehicle in a workshop and deprive himself from the

mobility in the city that too when his past history confirms that he was enjoying no

claim bonus ever since. I am afraid the respondent company had acted in a most

irresponsible way and not assessing and settling the claim of the complainant.

Therefore, at this stage, it is not possible for us to actually assess the loss etc. and

the survey having not done his job at the appropriate time, I have no other option

but to accept the expenditure already spent by the complainant to repair and keep

his vehicle in a road worthy condition as per the bill available on the file submitted

by Alfa Motors, the amount works out toRs.43179.

7. I, therefore, direct the respondent company to settle the claim for the said amount

to the complainant immediately without applying any amount towards depreciation

etc. since the settlement of the claim has been unduly & without any justification

delayed especially for no fault of the complainant.

8. With these directions, the complaint is disposed of accordingly.


Case No.GI/166/NIA/09

In the matter of Shri V.K. Rohilla Vs

The New India Assurance Co. Ltd.

ORDER dated 25.02.2010

1. Shri V.K. Rohilla has made a complaint to this Forum on 23.06.2009, against The New

India Assurance Co. Ltd. regarding non settlement of Motor claim under policy no.

320303/31/08/01/00003759.

2. On intervention of this office, we have now been informed by The New India

Assurance Co. Ltd. that they have settled the claim of Shri V.K. Rohilla for

Rs.3,19,500/- vide cheque no. 429762 dated 10.07.2009 drawn on Canara Bank.

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

4. Hence the complaint is disposed of.

5. Copies of the Order to both the parties.

office of the insurance ombudsman (gujarat)

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