National Consumer Disputes Redressal
National Insurance Co. Ltd. vs Sukram Pal on 13 March, 2015
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVIEW APPLICATION NO. 33 OF 2015 IN RP/3765/2014 1. NATIONAL INSURANCE CO. LTD. ...........Appellants(s) Versus 1. SUKRAM PAL ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE V.K. JAIN, PRESIDING MEMBER
For the Appellant : For the Respondent : MR. GAUTAM GODARA
Dated : 13 Mar 2015 ORDER
The facts of this case have been noted in our order dated 14.01.2015, which to the extent it is relevant for the purpose of this Review Petition, reads as under:-
"The complainant/respondent, owner of Mahindra Bolero vehicle bearing registration No.HR-05AD-1840 got the same insured with the petitioner company for the period from 16-07-2011 to 15-07-2012. The case of the complainant/respondent is that the aforesaid vehicle was stolen in the night intervening 11/12-09-2011, when parked in front of a house and an FIR in this regard was duly lodged with the concerned police station. This is also the case of the complainant that when he went to the nearest branch of the insurance company at Jind to intimate the theft of the vehicle, a written intimation was handed over by him to the concerned branch manager who promised to send the same through fax to the concerned branch. This is also his case that when he again visited the branch at Jind on 07-10-2011 to inquire about the intimation, he was informed by the branch manager that the said intimation had been misplaced. Thereupon the complainant allegedly sent intimation through courier on 07-10-2011. The claim submitted by the complainant, however, came to be rejected by the insurance company on account of delay in giving intimation of the theft to them.
2. Being aggrieved from rejection of his claim the complainant approached the concerned District Forum by way of a complaint. The complaint was resisted by the insurance company primarily on the ground that there was a delay of more than six months in reporting the theft to them, thereby violating clause 5 of the insurance policy issued to the complainant.
3. The District Forum vide its order dated 24-10-2013 dismissed the complaint filed by the respondent, on the ground that he had contravened the terms of the policy by sending intimation to the insurance company after a gap of more than six months.
4. Being aggrieved from the order passed by the District Forum the complainant approached the State Commission by way of an appeal. The State Commission, relying upon the decision of this Commission in Shriram General Insurance Company Ltd. Vs. Rajesh Kumar, FA No.43 of 2014 decided on 10-03-2014, allowed the appeal and directed the insurance company to pay a sum of Rs.6,50,703/- to the complainant, along with interest on that amount at the rate of 6% per annum, from the date of repudiation of the claim. Being aggrieved from the order of the State Commission the insurance company is before this Commission by way of this revision petition.
5. Clause 5 of the terms & conditions of the insurance policy as reproduced in the reply of the petitioner reads as under:
"Notice shall be given in written to the company immediately upon the occurrence of any accident or loss or damage and in the event of any claim and thereafter the insured shall give all such information and assistance as the company shall require."
It would, thus, be seen that the insured/complainant was under a contractual obligation to intimate the insurance company immediately on coming to know of the theft of his vehicle. This is complainant's own case that the vehicle came to be stolen in the night intervening 11/12-09-2011. In Rajesh Kumar (supra) this Commission relied upon a circular dated 22-09-2011 issued by the Insurance Regulatory and Development Authority, which to the extent it is relevant reads as under:
"INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY Ref. IRDA/HLTH/MISC/CIR/216/09/201 Date: 20.09.2011 CIRCULAR To: All life insurers and non-life insurers Re: Delay in claim intimation/documents submission with respect to All life insurance contracts and 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 activities like investigation, loss assessment, provisioning, 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 insurers' decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.
Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle 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 for delayed claims where the delay is proved to be for reasons beyond the control of the insured.
J.Harinarayan CHAIRMAN"
6. It would, thus, be seen that even the aforesaid circular enjoins upon the insurance companies to settle genuine claims when there is a delay in intimating the loss to them due to unavoidable circumstances. Therefore, in a case where the complainant is unable to give convincing explanation for the delay in intimating the loss of the vehicle to the insurance company, the aforesaid circular would not ipso fact apply.
7. As noted earlier, the case of the complainant in the complaint filed by him was that when the Branch Manager at Jind informed him on 07-10-2011 that the intimation which he had given to him for sending the same to the concerned branch office had been misplaced and then he sent the intimation through courier dated 07-10-2011. No other intimation is alleged to have been given. The learned counsel for the petitioner has drawn my attention to the intimation which insurance company had received from the complainant. The aforesaid intimation is a handwritten intimation in Hindi and it bears the date 03-04-2012. As per the endorsement made on the document it was received by the insurance company only on 03-04-2012. Though there is some over writing on the date noted on this letter and it appears that initially the date of March 2012 was written which was later on changed to 03-04-2012, that would be of no consequence considering that the case of the complainant is that he had sent the intimation through courier on 07-10-2011. An intimation sent on 07-10-2011 would not bear a date of March 2012. Though the complainant did file, a courier receipt before the District Forum, a perusal of the order of the said forum would show that on scrutiny of the said courier receipt it transpired that the intimation vide that receipt was sent only on 03-04-2012 after a delay of more than six months. Moreover, in the order of the State Commission there is no reference to any courier receipt dated 12-09-2011. I also find that in the hand written intimation received by the insurance company, there is no specific averment that the complainant had delivered the intimation of theft of the vehicle in the Jind office of the insurance company, though it is alleged that when the complainant made inquiry at Fatehabad office he was asked to give the documents again at Jind office. As rightly pointed out by the learned counsel for the petitioner company, in the complaint, the complainant does not claim to have visited Fatehabad office of the insurance company. Moreover, in the complaint he did not disclose the exact date on which he had allegedly visited Jind office and handed over the intimation to the concerned Branch Manager at Jind. In these circumstances, I am convinced that the complainant intimated the theft of the vehicle to the insurance company for the first time on 03-04-2012 i.e. more than six months after the alleged theft.
8. The State Commission in para 12 of the impugned order observed that there was delay of 12 days in intimating the insurance company which was not significant. The aforesaid observation is clearly wrong since the intimation came to be given to the insurance company after more than six months of the alleged theft of the vehicle.
9. The purpose of requiring the insured to give immediate intimation of the loss of the vehicle to the insurance company is to enable the said company to independently verify the alleged loss and ascertain the circumstances in which the vehicle came to be stolen. If immediate intimation of the theft of the vehicle is not given to the insurance company, it will not be possible for them to verify the alleged theft as also the circumstances surrounding the alleged theft. A late intimation obviously defeats the aforesaid purpose since, on account of the passage of time, the evidence which could be available immediately on the happening of the theft may not be available to the representative of the insurance company.
10. In the case before us not only the delay in intimating the loss of the vehicle to the insurance company is abnormal, the same being more than six months, there is no convincing explanation for the said delay. I am, therefore, satisfied that the State Commission was not justified in reversing the order passed by the District Forum and allowing the complaint. The impugned order dated 09-05-2014 passed by the State Commission is, therefore, set aside and the complaint is hereby dismissed. No order as to cost."
2. The case of the complainant as advanced by his counsel is that intimation of the theft was given by him to Jind branch of the Insurance Company on 12.09.2011 and when he again visited the aforesaid branch on 07.10.2011 to make inquiry about his claim he was informed by the Branch Manager at Jind that the said intimation had been misplaced by them and on the advice of the Branch Manager, the complainant sent an information of the stolen vehicle through a courier company.
3. However, there is documentary proof of the complainant having given any intimation to the Jind Branch of the Insurance Company on 12.09.2011. There is no explanation as to why the complainant did not take any acknowledgment from the said branch when he allegedly intimated the theft of the vehicle on 12.09.2011. Though the complainant claims to have again visited at Jind branch on 07.10.2011, there is no documentary proof of his having visited at Jind branch even on that date. Even in the intimation, on the basis of which the claim was processed by the Insurance Company, there is no allegation that the theft was earlier intimated to the Jind office on 12.09.2011. It has a reference only to the intimation to Fatehabad Branch without indicating the date of the said intimation. It has no reference even to any visit to the Jind Branch on 07.10.2011. In these circumstances, it would be difficult for us to accept the contention that intimation of the theft of the vehicle was given to the Insurance Company at its Jind office on 12.09.2011.
4. The learned counsel for the complainant states that the intimation on 07.10.201 was sent to Fatehabad Branch and not to the Jind Branch of the Insurance Company. We have perused the intimation which the Insurance Company had received from the complainant and it is available on page no. 104 of our paper book. This intimation is addressed to the Jind Branch and not to the Fatehabad Branch. Had the complainant sent an intimation to the Fatehabad Branch of the Insurance Company on 07.10.2011, as is stated by his counsel, it would have been addressed to the said Branch and not to the Jind Branch. More importantly, the aforesaid intimation bears date 03.04.2012. I fail to appreciate how an intimation dated 03.04.2012 could possibly have been sent to the Insurance Company on 07.10.2011. The aforesaid date on the intimation clearly shows that the stand taken by the complainant in this regard is false and in fact, the intimation of the theft was given by him for the first time only on 03.04.2012.
5. The learned counsel for the complainant states that in fact the intimation available on page no. 104 of our paper book was obtained by the Jind Branch of the Insurance Company from the complainant at a later date. However, I find no such averment in the complaint. In the absence of such an averment in the complaint, I cannot accept the oral contention made by the learned counsel for the complainant in this regard.
6. The learned counsel for the complainant/review petitioner submits that in para 7 of the order dated 14.01.2015, this Commission had observed that the District Forum on scrutiny of the courier receipt filed before it had found that the intimation vide that receipt was sent only on 03.04.2012 after a delay of more than six months, whereas in fact no such observation was recorded by the District Forum. I find that the District Forum, on perusal of Ex. R-11 & R-12 concluded that intimation to the company was given only on 03.04.2012. If neither Ex. R-11 nor Ex. R-12 (which have not been filed before this Commission) was the Courier receipt, there could possibly be an error in making the said observation by this Commission. What is really relevant is that there is no documentary proof of the complainant having intimated the theft of the vehicle to the Insurance Company at any time prior to 03.04.2012. In the absence of such a proof, I cannot accept the plea taken by him in this regard and therefore, I have rightly held in the order dated 14.01.2015 that there was a delay of more than six months in intimating the theft to the Insurance Company. Since, there is no explanation for the aforesaid delay in intimating the loss of vehicle to the Insurance Company, the said Company is not liable to make any payment to the complainant on account of the alleged theft of the vehicle since, delay in intimating the theft of vehicle to the Insurance Company amounted to contravention of a mandatory term of the insurance policy and consequently, relieved the Insurance Company of its obligation to reimburse the insured in case of the loss of a vehicle.
7. For the reasons stated hereinabove, I find no merit in the review petition and the same is accordingly dismissed.
......................J V.K. JAIN PRESIDING MEMBER