State Consumer Disputes Redressal Commission
Bhupinder Pal Sharma vs Icici Lombard General Insurance ... on 1 October, 2015
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.
First Appeal No.1434 of 2014
Date of Institution : 21.10.2014.
Date of decision : 01.10.2015.
Bhupinder Pal Sharma S/o Bhola Ram R/o # 28911, Gali No. 3-D,
Partap Nagar, Bathinda, District Bathinda.
......Appellant/Complainant
Versus
1. ICICI Lombard General Insurance Company Limited having its
Branch Office at Near Power House Road, Goniana Road,
Bathinda.
2. ICICI Lombard General Insurance Company Limited having its
Branch Office at SCO 24-25, 1st Floor, Sector-8 C, Chandigarh.
3. ICICI Lombard General Insurance Company Limited having its
corporate office at IInd floor, Zeinith Hourse, Mahalaxami
Keshav Ra Khade Marg, Mumbai.
4. ICICI Lombard General Insurance Company Limited having its
Head Office at IInd 414 Veer Savarkar Marg, Near Siddhi
Vinayak Temple, Prabhadevi, Mumbai-400025.
...Respondents/Opposite parties
First Appeal against the order dated
08.09.2014 of the District Consumer
Disputes Redressal Forum, Bathinda.
Quorum:-
Hon'ble Mr. Justice Gurdev Singh, President
Sh.Baldev Singh Sekhon, Member
Sh.Vinod Kumar Gupta, Member Present:-
For the appellant : Sh. S.S. Brar, Advocate
For the respondents : Sh. Sandeep Suri, Advocate
SH.VINOD KUMAR GUPTA, MEMBER
This appeal has been preferred by the appellant/complainant against the order dated 08.09.2014 passed by District Consumer First Appeal No.1434 of 2014 2 Disputes Redressal Forum, Bathinda (in short, "District Forum"), vide which, the complaint filed by him was dismissed.
2. As per allegations made by the complainant, in the complaint, he purchased one Insurance Policy from the opposite parties (in short 'OPs') bearing No.3005/19567943/10005/000 dated 12.06.2013 for the period from 12.06.2013 to 11.06.2014 for his vehicle Hero Honda, Splendor Plus, bearing registration No. PB-03Y-3334 for IDV of Rs.29,540/-, after paying the premium of Rs.931/-. On 02.11.2013, he went to Balaji Mandir situated at Bathinda Road, Goniana Mandi and parked his motorcycle outside the Mandir. When he came out from Mandir at 7:15 PM, he found that his motorcycle was stolen by some unknown person and its RC was in its tool box. He lodged telephonic complaint to the police at '100 number' through his mobile. But, the police did not lodge FIR and avoided the matter on one pretext or the other. Thereafter, he made call on 181, then FIR No. 134 dated 20.11.2013 was lodged at PS Nehianwala, Bathinda. He submitted his claim with OP No.1. It gave him the customer care number and asked him to give full information through telephone. He gave the requisite information regarding the theft of his motorcycle to the official of the customer care. On the next day, he received a call from the customer care. Thereafter, he gave the whole information on phone and they asked him to submit the relevant documents. He completed all the formalities and submitted the copy of the RC, copy of insurance policy, bill of motorcycle and other documents to them. However, OPs rejected his claim, vide letter dated 24.03.2013 on the ground that he lodged FIR with delay. It was First Appeal No.1434 of 2014 3 pleaded that delay was caused on the part of the police and not on his part, as he had informed the police at 100 number immediately after the theft. He visited the office of the OPs many times to get his claim, but to no effect. It clearly amounted to deficiency in service on their part. He prayed for the issuance of the following directions to them ;
i) to pay Rs. 29,540/- alongwith interest till the date of payment.
ii) to pay Rs.1 Lac for mental agony and harassment; and
iii) to pay Rs.5,500/-, as litigation expenses.
3. The complaint was contested by OPs by filing joint written reply before the District Forum. Preliminary objections were taken that the complainant had concealed the facts that the date of theft was intimated as 02.11.2013 whereas FIR was lodged with the Police on 20.11.2013. Intimation to them was also given on 21.11.2013. It was pleaded that intricate question of facts and law were involved, which required voluminous documents and evidence for determination; which was not possible in the summary procedure under the Act. The complaint was not maintainable. As per the terms and conditions of the insurance policy, immediate intimation to the company and police was required, regarding the alleged theft. He violated these terms and conditions. As such, his claim was rightly repudiated, vide letter dated 24.03.2014. The delay in intimation to the police and insurer clearly debars the right of the insurer to investigate the matter and to make the efforts to recover the vehicle. Other allegations were denied and the OPs prayed for dismissal of the complaint.
First Appeal No.1434 of 2014 4
4. Both the sides produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel for both the parties dismissed the complaint of the complainant, vide aforesaid order.
5. We have heard the learned counsel for the parties and have carefully gone through the records of the case.
6. It was submitted by the learned counsel for the appellant/complainant that the District Forum committed a grave error by not allowing the application for additional evidence, which was a vital piece of evidence for claim. The District Forum failed to consider that there was no delay in informing the police because he informed the police on 100 number on the day of occurrence itself. But the police lodged the FIR on 20.11.2013. The District Forum without appreciating the evidence, committed a grave error by holding that there was delay in intimating the police about the theft and it did not consider the police report (annexure A-4). It was prayed that appeal be accepted and the order of the District Forum be set aside.
7. On the other hand it was submitted by the learned counsel for the respondents/opposite parties that there was no merit in the appeal and prayed for dismissal of the appeal.
8. The complainant got insured his motorcycle Hero Handa Splendor Plus bearing registration No. PB-03Y-3334 with OPs, vide policy bearing No.3005/19567943/10005/000 (Ex.C-4) for the period from 12.06.2013 to 11.06.2014 after paying the First Appeal No.1434 of 2014 5 premium of Rs.931/-. The IDV of the said vehicle was Rs.29,540/-. The vehicle was reportedly stolen on 02.11.2013 in the area of Bathinda. He proved in additional evidence Police report dated 02.11.2013 as Annexure A-4, in which it was mentioned that information to the police was given on 100 number on the same day of theft. However, FIR No. 134 dated 20.11.2013 (Ex.C-2) was lodged at Police Station Nehianwala, Bathinda. He submitted his claim with the opposite parties, but the same was repudiated, vide letter dated 24.03.2014 Ex.C-3; which is reproduced as under:-
"We wish to inform you that we have received the documents submitted by you for processing of your claim. On the basis of scrutinizing the documents and further surveying the facts of the claim, we regret our inability to honor the claim for further process due to the below mentioned reasons :
Your above mentioned vehicle was stolen on 02 Nov 13 and FIR for the same has been lodged on 20th Nov 13. The FIR for the stolen vehicle is lodged after 18 days of the theft of the theft of the vehicle. This is violation of terms and conditions of Insurance Policy. The FIR should have been immediately lodged after the theft. The Motor Insurance Policy issued to you states- In case of theft or criminal act which may be the subject to claim under the policy the insured shall give immediate notice to the Police and cooperate with the company in securing the conviction of the offender.
We have to further draw your attention that you have intimated claim to insurer after 19 days of date of loss. This is violation of policy condition. After the incidence took place, the claim should have been immediately lodged with the insured. As per policy conditions -Notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter, the insured shall give all such information and assistance as the Company shall require.
In the circumstance, you are therefore, informed that the above captioned claim as made by you hereby stands as "No Claim".First Appeal No.1434 of 2014 6
9. Thus, the claim of the complainant was repudiated on the ground that the complainant violated the terms and conditions of the policy, as FIR was lodged at Police Station Nehianwala, Bathinda after 18 days and the intimation was given to them after 19 days of the theft of motorcycle; which took place on 02.11.2013. We have perused the Circular dated September 20, 2011 issued by insurance "Insurance Regulatory & Development Authority". It provides as under :-
Circular "To: All life insurers and non-life insurers Re: Delay in claim intimation/documents submission with respect to :-
i. All life insurance contracts and ii. All Non-life individual and group insurance contracts The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents. The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances.
The insurer's decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.
The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers stand to condone delay on merit First Appeal No.1434 of 2014 7 for delayed claims where the delay is proved to be for reasons beyond the control of the insured."
10. In the instant case, the motorcycle of the complainant was stolen on 02.11.2013. Intimation was given to the police on 100 number on the day of theft itself i.e. on 02.11.2013 which is proved on record (Annexure A-4). FIR was lodged on 20.11.2013.
So, it was lapsed on the part of the police and was not the fault of the complainant. Even from the above circular it is very much clear that the OPs (insurance company) could not have repudiated the bonafide claim of the complainant on technical ground; like delay in intimation and submission of some required documents. So repudiation of the claim by the respondents/OPs was contrary to the spirit of Circular of IRDA. The District Forum did not properly appreciate the facts. So, the order of District Forum cannot be sustained. The complainant is entitled to the IDV of the motorcycle.
11. Sequel to the above, the appeal of the appellant is accepted. The order of the District Forum is set aside and the OPs are directed to pay Rs. 29,540/- alongwith interest @ 9% from the date of filing the complaint till realization besides Rs.2,000/- as litigation expenses within 30 days from the date of issue of copy of the order.
12. The arguments in this case were heard on 21.09.2015 and the order was reserved. Now the order be communicated to the parties as per rules.
First Appeal No.1434 of 2014 8
13. This appeal could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE GURDEV SINGH) PRESIDENT (BALDEV SINGH SEKHON) MEMBER (VINOD KUMAR GUPTA) MEMBER October 01, 2015 Lb/-