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AHMEDABAD OMBUDSMAN CENTER
Case No.11-009-0573-12
Shri Ghanshyamsingh P. Bhati V/s. Reliance General Insurance Co. Ltd.
Award dated 17th April 2012
Repudiation of theft claim under Motor Package Policy
Motor theft claim lodged by the complainant was repudiated by the Respondent
due to late intimation.
On scrutiny of FIR proved that the owner of the vehicle was other some one and
insurance was in the name of the complainant. The complainant had not informed to RTO
or to Insurance Company about his vehicle sold to other some one and also not informed
the stolen in time.
In view of the above, the Respondent’s decision is just and proper.
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Case No.11-010-046-12
Shri Vikas Kanubhai Patel V/s. Iffco Tokio General Insurance Co. Ltd.
Award dated 8th May 2012
Repudiation of Private Car Package Policy
Complainant’s insured car was stolen and claim lodged for loss suffered was
repudiated by the Respondent as per policy condition No.4.
The insured vehicle was left unattended without applying proper lock which
confirms theft occurred due to careless of the user. Even complainant not attended the
Hearing scheduled by this Forum.
In view of this Respondent rightly repudiated the claim.

Case No.11-004-0294-12
Mrs. Bharti K. Vyas V/s. United India Insurance Co. Ltd.
Repudiation of damage claim
An accidental damage claim for Rs.22,821/- was lodged by the complainant for her
insured car which was repudiated by the Respondent as per policy condition No.4.
Respondent’s Surveyor opined that due to negligence of the driver, the vehicle’s
engine damaged but that is not a concrete evidence to repudiate the claim. Therefore the
Forum advised to settle the claim as per rules.
In the result complaint succeeds.
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Case No.11-004-0301-12
Shri Atul N. Dave V/s. United India Insurance Co. Ltd.
Partial settlement of Motor OD Claim
Complainant’s accidentally damaged car repaired and claimed for Rs.28,552/- was
settled by the Respondent for Rs.22,929/-as per Surveyor report and bill check report.
Complainant demanded that he had paid Rs.38,216/- to the repairer and the
Respondent should refund 70% of IDV of the vehicle is Rs.38,070/-.
The Respondent had admitted claim for Rs.22,929/- as per IRDA approved Surveyor’s
assessment, so complainant cannot demand 70% of IDV.
In the result complaint fails to succeed.
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Case No.11-013-0428-12
Shri Hitesh C. Shah V/s. HDFC Ergo General Insurance Co. Ltd.
Repudiation of Motor OD Claim
A motor OD claim lodged by the Complainant for accidental damage of the Insured
Vehicle was repudiated by the Respondent.
Complainant had not submitted any detailed estimate of Repairer for damage to
his car. The Forum has sent letter to the Complainant for submitting the same but not
submitted.
Respondent had not attended the Hearing scheduled by this Forum, also not
submitted Self Contained Note or P-IV Form. Policy copy is not available.
In absence of all these the Forum decided to close the file without passing any
quantitative Award.
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Case No.11-020-0576-12
Shri Rajesh L Mehta V/s. Universal Sompo General Insurance Co. Ltd.
Loss suffered to the insured vehicle for Rs.1,14,534/- due to accident and claimed
by the Complainant was settled by the Respondent only for Rs.8,283/-(cashless facility)
invoking clause 4(1) – The company shall not be liable under this policy in respect of any
accidental loss or damage to any property whatsoever resulting or arising there from any
consequential loss.
Therefore, there is no new ground to interfere in the decision of the Insurer to

reject the partial claim.
Case No.11-005-0410-12
Shri Naresh K. Thakker V/s. Oriental Insurance Co. Ltd.
Award dated 11th June 2012
Complainant claimed for Rs.46,400/- for damage expense was repudiated by the
Respondent giving reason that fake invoice was submitted by the Complainant.
No police complaint was lodged. Vehicle was damaged as it was dashed from
backside by bus on the road. Bill was in handwritten. Rubber stamp is affixed on top of
the receipt. Estimated loss was Rs.21,500/-.
In view of all these, decision of the Respondent to repudiate the claim is

appropriate without any relief to the complainant.
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Case No.11-004-0552-12
Shri Dhamjibhai J. Mehdapara V/s. United India Insurance Co. Ltd.
Complainant claimed a Motor theft claim for Rs.12,000/- was repudiated by the
Respondent due to late intimation and late submission of claim papers.
Date of loss was 14-03-2010, date of FIR was 07-05-2010 and date of intimation to
the Insurer was 11-05-2010.
As per Policy condition No.1, Notice shall be given in writing to the Company
immediately upon the occurrence of any type of loss.

AHMEDABAD OMBUDSMAN CENTRE
Case No.11-013-0428-12
Shri Hitesh C. Shah V/s. HDFC Ergo General Insurance Co. Ltd.
Repudiation of Motor OD Claim
A motor OD claim lodged by the Complainant for accidental damage of the Insured
Vehicle was repudiated by the Respondent.
Complainant had not submitted any detailed estimate of Repairer for damage to
his car. The Forum has sent letter to the Complainant for submitting the same but not
submitted.
Respondent had not attended the Hearing scheduled by this Forum, also not
submitted Self Contained Note or P-IV Form. Policy copy is not available.
In absence of all these the Forum decided to close the file without passing any
quantitative Award.
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Case No.11-020-0576-12
Shri Rajesh L Mehta V/s. Universal Sompo General Insurance Co. Ltd.
Loss suffered to the insured vehicle for Rs.1,14,534/- due to accident and claimed
by the Complainant was settled by the Respondent only for Rs.8,283/-(cashless facility)
invoking clause 4(1) – The company shall not be liable under this policy in respect of any
accidental loss or damage to any property whatsoever resulting or arising there from any
consequential loss.
Therefore, there is no new ground to interfere in the decision of the Insurer to

reject the partial claim.
Case No.11-005-0410-12
Shri Naresh K. Thakker V/s. Oriental Insurance Co. Ltd.
Complainant claimed for Rs.46,400/- for damage expense was repudiated by the
Respondent giving reason that fake invoice was submitted by the Complainant.
No police complaint was lodged. Vehicle was damaged as it was dashed from
backside by bus on the road. Bill was in handwritten. Rubber stamp is affixed on top of
the receipt. Estimated loss was Rs.21,500/-.
In view of all these, decision of the Respondent to repudiate the claim is

appropriate without any relief to the complainant.
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Case No.11-004-0552-12
Shri Dhamjibhai J. Mehdapara V/s. United India Insurance Co. Ltd.
Complainant claimed a Motor theft claim for Rs.12,000/- was repudiated by the
Respondent due to late intimation and late submission of claim papers.
Date of loss was 14-03-2010, date of FIR was 07-05-2010 and date of intimation to
the Insurer was 11-05-2010.
As per Policy condition No.1, Notice shall be given in writing to the Company
immediately upon the occurrence of any type of loss.

Case No.11-005-0684-12
Mrs. Pannaben S. Naik V/s. Oriental Insurance Co. Ltd.
Award dated 16th July 2012.
Repudiation of theft claim under Motor Package Policy.
A theft claim for Rs.32,000/- lodged by the complainant for loss of her Honda
Activa was repudiated by the Respondent due to late intimation.
As per terms and condition of the policy, the intimation should be within 48 hours
from the date of theft. The complainant intimated to the Insurer after 26 days from the
date of theft, so the complaint refused to accept by the Respondent.
Complainant failed to produce concrete evidence for delay of intimation and also
lost R.C book on the same day.
In view of these the complaint fails to succeed.

Case No.11-011-0735-12
Mr. Tushar V. Bhingradia V/s. Bajaj Allianz General Insurance Co. Ltd.
Award dated 12th September 2012
Complainant lodged an accidental damage loss of Rs.12,250/- to his insured Car

was repudiated by the Respondent on the ground of pre-existing damage because when
the proposal form filled by the Complainant, the same damages shown in the Motor Car
Inspection Report.
The Complainant had not produced any concrete evidence to prove the loss
suffered is due to fresh accident. However, Respondent’s decision to repudiate the claim
is upheld without any relief to the complainant.
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Case No.11-004-0747-12
Shri Rahul R. Patel V/s. United India Insurance Co. Ltd.
Award dated 28th September 2012
Repudiation of Motor theft claim
Complainant lodged a theft claim for his Honda City Car stolen was repudiated by
the Respondent invoking Policy condition No.1 and 4.
While driving the Car in the late night, one of the tires punctured and there was no
extra tire so he left the vehicle on the way unattended.
Claim intimation also 5 days late from the date of stolen.
In view of these, Respondent’s decision to repudiate the claim is right and proper.
Chennai Ombudsman Centre
Case No.11.11.1662/2011-12.
I.Aloysious Anand
Vs
Bajaj Allianz General Insurance Co Ltd
Award No. IO(CHN)/G/003/2012-13 dt.20/4/12
The complainant, Shri Aloysious Anand contended that his car which was insured with the
insurer met with an accident on 17/11/2011. His claim lodged with the insurer was
repudiated stating that the vehicle could not be inspected by the insurer at the time of
renewal of the policy, due to his furnishing the wrong “date of expiry” of the previous
policy with them while remitting online renewal premium, since the policy expired 2 days
before the remittance, which is construed as a lapse on his part.
The insurer contended that the complainant had given false details on the “Roll over
renewal” link of the website by furnishing the previous policy expiry date as 3/9/2011
when it is actually 1/09/2011. Due to this ‘misrepresentation’ an opportunity for
inspection of the vehicle before renewal was not given to the insurer and hence, the claim
was repudiated.
It was observed by the forum that the insurer had issued the policy with its hard copy
dispatched to the insured after 20 days of online proposal, obviously after verifying and
satisfying with the details of previous policy and NCB particulars etc. If any of the details
are found to be incorrect the policy should have been cancelled immediately at the time
of processing the policy-proposal form which was submitted online. The insurer’s system
of acceptance of such proposals should be fool-proof in order to ensure that the policy is
not availed of by the customers by providing either deliberate wrong information or by
mistake. The insurer had called for some details from the insured to confirm that the
vehicle was in a reasonably good condition prior to the accident and after the renewal of
the policy, which was complied with by the insured by submitting the vehicle’s relevant
service records, which to some extent off sets the customary non-inspection of the vehicle
at the time of renewal of the policy after a break. The surveyor’s report would have given
the details of the nature of accident and the damages sustained including the
confirmation that the damages are relevant to the accident. Since the alleged
“misrepresentation” of facts has not been established by the insurer as to whether it was a
willful act and whether the same has prejudiced the interests of the insurer by way of
admitting the claim in any manner, the insurer is directed to process the claim and settle it
subject to other terms and conditions of the policy.
The complaint was allowed.
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Case No.IO (CHN) 11.08.1706/2011-12
Mrs. Sadaf Shaheen
vs
Royal Sundaram Alliance Insurance Co. Ltd.
Award No.006 dated 23.04.12
The Complainant stated that her vehicle covered under the policy of the insurer
met with an accident resulting in damages. The insurer approved the claim
partially and disallowed the engine damages under consequential loss.
The issue to be decided is whether the engine damages were part of the original accident
or happened independently due to continued driving of the vehicle after the accident
without the required coolant. The surveyor’s contention was that the vehicle could have
been driven after the accident resulting in consequential damages which are not payable
under the policy. The surveyor had not mentioned in detail in his report why aggravation
of loss had happened. The stand of the insurer rejecting the claim for engine damages on
the grounds that the insured should have driven the vehicle for 10-15 kms after the
happening of the accident seems to be an assumption without proving that alone had
caused the engine damages. In view of the same, the decision of the insurer rejecting the
engine damages as per condition No.4 of the policy is not tenable and the complaint was
allowed in respect of damages to the engine parts.
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Case No.IO (CHN) 11.11.1754/2011-12
Mr. Pakala Ramadas
vs
Bajaj Allianz General Insurance Co. Ltd
The Complainant’s car got seized because of the leakage of oil due to a stone hitting
under the engine. The claim was rejected by the insurer for the engine damage stating
that the same was a consequential damage and allowed the amount towards oil sump
damage only. The complainant’s contention was that the claim did not fall under
consequential loss exclusion of the policy.The insurer while settling part of the claim has
recognized some sort of impact damage which has resulted in the leakage of engine oil
also. It is found that the insured had not felt or noticed any hit arising out of impact
damage to the vehicle and perhaps the insured had been forced to take cognizance of
some unknown problem to the vehicle, as the vehicle had stopped abruptly. The surveyor
had not elaborately discussed about the probable reason with at least logical and
circumstantial facts. The final survey report is also not available for any better
understanding of what has actually happened. In view of the conflicting versions, neither
the insured nor the insurer could be entirely blamed for their respective positions.
However, the end result of the damage to the engine and the consequent repair expenses
incurred is a matter of fact and in order to provide equity and justice to both the parties
to the dispute, an ex-gratia payment of Rs.15,000/- was awarded.
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Case No.IO (CHN) 11.05.1749/2011-12
Mr. J. Karthik Raja
Vs
The Oriental Insurance Co. Ltd.
The Complainant’s claim for the loss suffered by him due to an accident to his car
insured with the insurer was repudiated on the grounds that the cause of accident and
the nature of damages are quite contradictory as revealed by investigation.
The vehicle insured under the policy of the insurer met with an accident resulting in
damages to the vehicle as well as to the electric pole. The contention of the insurer for
rejection of the claim was that the insured had intentionally suppressed the
information regarding the cause of accident and nature of damages sustained by the
vehicle. The police, spot surveyor and final surveyor have not commented anything on
the cause and nature of accident but on the other hand have confirmed that the
damages are relevant to the accident. The insurer depending purely on oral versions
regarding the nature of accident and damages had failed to prove with clinching
evidence that the complainant drove the car in a drunken condition and also
suppressed the factual information while lodging a claim with them and hence the
complaint was allowed.
Case No.IO (CHN) 11.03.1760/2011-12
Mr. S.V.Sellappan
Vs
National Insurance Co. Ltd.
The Complainant stated that his car was stolen and the insurer has offered settlement for a
value far lesser than the IDV and being the previous OD claim settled during the same policy
period.
When insured had been following up with the insurer for an earlier claim and fulfilling all
formalities relating to the same till receipt of claim cheque on 19/04/10, it is strange that the
theft of the vehicle happened during the above process on 25/03/10 was reported to the police
but the insurer was kept in dark about the same.
Though the delay on the part of the insurer in sending a communication of claim rejection is
not in tune with the Company’s policy of customer service, the same can not be taken as an
excuse by the insured for his inordinate delay in claim intimation as explained above which is a
breach of policy condition. The relevant policy condition No.1 states that “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 the Company shall require”. It was also pointed out by the complainant in his letter
dated 23/04/12 that the insurer has given a false statement mentioning that investigator was
appointed during the last week of November 2010 whereas as per their letter dated 23/05/11
addressed to the investigator, it was revealed that the appointment was on 13/01/11. Even
though this shows delay on the part of insurer in appointing the investigator, but it will not
alter the fact that there was inordinate delay on the part of the insured in intimating the theft
of his vehicle to the insurer which was done on 23/11/10 as per the claim form submitted by
the insured. Since insured had not intimated the insurer the theft of his vehicle as per the terms
of the policy, the decision of the insurer to reject the claim for breach of policy condition
cannot be faulted and the Insurance Ombudsman is not inclined to interfere with the decision
of the insurer.
The complaint is dismissed.

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Case No.IO (CHN) 11.05.1770/2011-12
Mr. M. Annadurai
vs
The Oriental Insurance Co. Ltd.,
The Complainant’s two wheeler was stolen when it was parked inside his house
compound wall and duly locked. The theft of the vehicle was reported to the police
and the FIR was filed. The claim was reported to the insurer also. His claim was
rejected due to delayed intimation of claim.
As per policy condition “Claim for theft of vehicle not payable if theft not reported to
Company within 48 hours of its occurrence”. Insurance policies being contract of
indemnity, its terms and conditions are to be complied with by both the parties to the
contract. In the instant case, the insured had lodged complaint with the police and
FIR filed after 2 days, the claim intimation to the insurer was after 9 days of theft of
the vehicle exceeding the time limits stipulated under the policy terms rendering the
claim not payable under the policy. The complaint was dismissed.
Case No.IO (CHN) 11.05.1781/2011-12
Mr. John Britto
vs
The Complainant stated that his two wheeler was stolen and reported the theft to the
police and RTO immediately after the occurrence of loss. The claim was reported to
the insurer. His claim was rejected due to delayed intimation of claim. As per policy
condition “Claim for theft of vehicle not payable if theft not reported to Company
within 48 hours of its occurrence”. In the instant case, the insured had lodged
complaint with the police and FIR filed after 2 days, the claim intimation to the
insurer was after 78 days of theft of the vehicle exceeding the time limits stipulated
under the policy terms rendering the claim not payable under the policy. The
complaint was dismissed.
Case No.IO (CHN) 11.05.1772/2011-12
Mr. K. Saravanan
vs
The Complainant’s car was stolen and the loss was informed to the financier and FIR
was filed. Claim intimation was given to the insurer. The claim was rejected by the
insurer, after a period of nearly two years, stating that the claim intimation was given
after a lapse of 16 days and it should have been given within 48 hours of the
occurrence of the loss. The insured had lodged complaint with the police and FIR
filed after 41 days, the claim intimation to the insurer was after 16 days of theft of
the vehicle exceeding the time limits stipulated under the policy terms rendering the
claim not payable under the policy. The complaint was dismissed.
Case No.IO (CHN) 11.05.1774/2011-12
Mr. G. Ashwin
vs
The New India Assurance Co. Ltd.
The complainant’s car met with an accident and police issued G.D. report, wherein the name
of the driver is mentioned. The insurer rejected claim on the grounds that the car was not
driven by the driver at the time of accident, but by the insured himself, quoting some
discrepancy in the GD report.
From the perusal of the records it was found that though the complainant’s driving license
expired on 26/06/11, efforts were made to renew the same only on 02/08/11 after the
accident on 30/07/11 (ii) insertion noticed in the copies of the GDR without any
authentication by the issuing authorities and (iii) the complaint to the traffic police
mentioning that the complainant himself was driving the vehicle as alleged by the insurer,
there are possibilities that the complainant only could have driven the vehicle and substituted
the name of the driver the police records. In view of the above, the decision of the insurer to
reject the claim on the grounds that the complainant had misrepresented material facts with
reference to the driver of the vehicle at the time of accident, to the insurer and also as per
Driver’s clause of the policy, the complaint is dismissed.
Office of Insurance Ombudsman, Chennai
Case No.11.04.1718/2011-12
Mrs.V.Kamala Devi
Vs
United India Insurance Co Ltd
Award No. IO(CHN)/G/018/2012-13
The Complainant stated that her claim for the loss of her insured vehicle by theft was
rejected by the insurer on the ground that the insured had not taken reasonable steps to
safe guard the insured vehicle and thus violated condition No.4 and also stated that
condition No 1 and Sec.126 and 127 of MV Act are violated. She represented to the
Grievance cell of the insurer pleading that there was no violation of any condition, but her
representation did not yield any result. Aggrieved by this, the complainant has
approached this forum.
The Insurer submitted that the claim was repudiated on the basis of the instructions from
the Regional Office, on the ground that there was violations of the policy conditions No. 1
(immediate notice of theft to the insurer), No.4 (reasonable steps to safe guard the
vehicle) and sec.126 &127 of MV Act.(Stationary vehicle and vehicle abandoned
unattended in public place).
The forum was of the view that insured’s car was parked underneath the Royapettah
bridge opposite her residence, which is not a No parking area, where they used to park it
for the past 2 ½ years, as done by other nearby residents guarded by a common
watchman during day-time. The car which was parked at that usual place on 10/8/2010
morning was found missing the next day morning. On the same day the insured has stated
to have informed the police but the FIR was prepared only the next day ie, 12/8/2010.
Hence, the Insurer’s stand that there was inordinate delay on the part of the insured in
making complaint to the police is not correct. The investigators appointed by the insurer
have confirmed the theft as genuine and physical possession of the vehicle prior to the
date of loss was also ascertained by the investigators, since the physical verification of
one of the insurer’s official of an office other than the policy issuing office was questioned
by the competent authority. In view of the facts that no objection was raised by any
authorities concerned for parking the vehicle at the place where the car was parked
though it was a public place, there does not appear to be negligence on the part of the
insured for parking the car at the said place. More over, the provisions of Sec.126 and 127
of MV Act which are applicable for vehicles which are left unattended in a public place,
cannot be strictly made applicable in the instant case, since the insured used to park the
car at the same place regularly, as their house-cum-office was nearby, as confirmed by
the investigators also, and on that particular day, it so happened that the vehicle was not
used and had to remain there for the whole day and the next day morning only the
vehicle was found missing. Since the area is not treated as ‘legally prohibited area’, the
Sec.126 and 127 of MV Act cannot be strictly made applicable for this case. In view of the
above points, the repudiation of the claim by the insurer is not justified.
It is also stated that IDV shall be treated as the Market Value throughout the policy period
without any further depreciation for the purpose of Total Loss claims.
Therefore, the insurer was advised to process and settle the claim for the IDV of
Rs.4,00,000/- mentioned in the policy subject to policy excess and other terms and
conditions mentioned in the policy.

Case No.11.05.1756/2011-12
Mrs.Hazara Begum
Vs
Oriental Insurance Co Ltd
The Complainant’s claim lodged with the insurer for the theft of her new two wheeler
was rejected stating that the claim intimation was delayed beyond 48 hours after
occurrence of theft. She represented to the Grievance cell of the insurer for settlement of
the claim pleading ignorance of the policy condition, but of no avail. The Insurer
submitted their Self contained note (SCN) wherein they stated that the intimation of
theft was given to them after 4 days. As per policy condition claim intimation of theft
should be given in writing within 48 hours of its occurrence. Hence the claim was not
payable.
It is noted from the records that the cover note was given to the insured on 19/11/2010,
the policy document along with full terms and conditions were delivered to the insured
only on 13/12/2010. When the theft had taken place on 12/12/2010, the complainant
had given complaint to the police on the next day itself and FIR was issued. Thereafter on
receiving the policy document on 13/12/2010 from the dealer, she had intimated the
insurer preferring the claim on 16/12/2010.
Though there was a delay in the claim intimation by 4 days as stated by the insurer from
the time of occurrence of theft, considering the facts that (1) the vehicle being a new one
was taken delivery of just a month back by the insured, and the policy (with the terms
and conditions) was given to the insured nearly after a month along with the RC book,
thereby there was no occasion for the insured to get familiarized with the policy terms
especially relating to the theft claim. (2) On noticing the condition, affixed by way a
Rubber Stamp relating to theft claim by which the intimation was required to be given
within 48 hours, the insured immediately notified the loss to the insurer on 16/12/2010.
(3) The investigator has confirmed the theft as genuine. (4) The insurer has not stated
that they are prejudiced in any manner because of the delayed intimation of claim
considering the aspect of loss minimization, inasmuch as the loss had been reported to
the police within a reasonable time, and the insurer’s investigator had submitted his
report only after about a month, without mentioning the date of investigation.
Therefore, the decision of the insurer rejecting the claim is not justified.
The complaint was allowed and the insurer was advised to process the claim subject to
other terms and conditions of the policy.
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Case No.11.05.1748/2011-12
Mrs. K. Mahalakshmi
Vs
Award No. IO(CHN)/G/021/2012=13
The Complainant stated that her motor cycle which was insured with the insurer was lost
on 5/02/2011 when her husband took it for a shopping. Her claim lodged with the insurer
was rejected stating that there was misrepresentation on her part in informing the insurer
about the actual date of theft. The claim was also rejected due to delayed intimation of
claim beyond 48 hours.The Insurer submitted their Self contained note (SCN) wherein
they stated that the intimation of theft was given to them after 12 days. As per policy
condition claim intimation of theft should be given in writing within 48 hours of its
occurrence. More over the actual date of theft was found to be 5/2/2011 as per FIR where
as in the intimation letter it was stated as 15/2/2011, which amounts to misrepresentation
of facts. Hence the claim was not payable.
In the present case, the insured had not complied with the policy condition which states
that “Claim for theft of vehicle not payable if theft not reported to company within 48
hours of its occurrence”. Insurance being a contract between the two parties- the insured
and the insurer- the terms and conditions of which are to be observed by both the parties
scrupulously. It appears from the documents submitted that there was no compelling
reasons beyond the control of the insured or reason to believe that she was under any
extenuating circumstances which prevented her from intimating the insurer within the
stipulated time limit. Therefore, the decision of the insurer in rejecting the claim on the
ground that the claim intimation was delayed beyond 48 hours, which is a violation of the
policy condition stipulated, is justified.
The complaint stands dismissed.
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Case No.11.05.1745/2011-12
Shri R.Rajendran
Vs
The Complainant stated that his motor cycle which was insured with the insurer was lost
on 11/07/2011 .His claim lodged with the insurer was pending with the insurer even after
submission of all the documents. He represented to the Grievance cell of the insurer for
early settlement of the claim. His representation to the Grievance Cell of the insurer also
did not yield any result.
The Insurer submitted that the intimation of theft was given to them after a delay of 24
days. As per policy condition claim intimation should be given in writing within 48 hours
of its occurrence. Hence the claim was not payable and the claim repudiation letter was
sent to the insured.
On perusal of the documents it is noted that the vehicle was said to be stolen on
11.07.2011 at about 10 pm and the theft was noticed the next day morning. The
complainant stated that though he had informed the police in writing immediately on
noticing the theft, no acknowledgement was given by the police for the intimation and he
could get the FIR only on 17/07/2011. The complainant had informed the insurer of the
theft of the vehicle only on 4th August 2011 in writing, and no proper justification for the
delayed intimation to the insurer has been furnished by him. Though he contends that all
necessary documents were submitted to the insurer for processing the claim, the policy
condition relating to intimation of claim to the insurer within the stipulated time limit of
48 hours was not complied with by the insured. It is noted that there was no compelling
circumstances beyond the control of the insured preventing him from informing the
insurer of the claim within the stipulated time limit of 48 hours. The page 3 of the policy
schedule contains the condition that “Claim for theft of vehicle not payable if theft not
reported to company within 48 hours of its occurrence.” Insurance is a contract between
the two parties- the insured and the insurer- and the same is governed by the terms and
conditions which are to be observed by both the parties scrupulously. Therefore the
decision of the insurer in rejecting the claim on the ground that the claim intimation was
delayed by 24 days, which is termed as a violation of the policy condition stipulated, is
justified. However,the forum expressed its concern over the casual attitude of the insurer
in handling such claims and the Grievance-redressals.
The complaint stands dismissed.
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Case No.IO (CHN) 11.11.1803/2011-12
Mr. J. Reegan
vs
The Complainant’s claim for the accidental damages to his car was not considered by the
insurer stating that the insured had given false declaration of NCB while availing the
policy. The insured contended that he had not given or furnished any wrong declaration
in the proposal form.
The insurer had written for confirmation of NCB and had not received any reply regarding
the NCB eligibility and its quantum from the previous insurer, as per the Motor Tariff
provisions within the stipulated number of days, it is deemed that the insured was eligible
for NCB. In the light of the above, the rejection of the claim by the insurer is not tenable
and the complaint of the insured allowed.
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Case No.IO (CHN) 11.11.1803/2011-12
Mr.Krishna Loganathan
vs
Royal Sundaram Alliance Insurance Co. Ltd
The Complainant’s car was damaged due to Fire accident and the claim rejected
by the insurer on the ground that the LPG fitment was not incorporated in the policy. The
complainant contended that his vehicle had the LPG kit even before his purchasing the
car, and the same had been endorsed on the RC book also.
The policy had been renewed by him as per the premium worked out by the insurer and
the claim is in no way connected to the LPG kit. Two surveyors visited for survey, while
first surveyor attributed the cause of loss to electric circuit problem, the second surveyor
had not mentioned anything regarding LPG. The insurer would not be in a position to
charge the premium for the LPG kit if the value of the kit is not mentioned in the proposal
as per GR42 of the Indian Motor Tariff. The insurer’s argument that some alteration need
to be done while fixing the LPG kit and these changes would have been the cause of loss
cannot also be ignored completely. The insurer could have noted the details while
verifying the RC book and the insured as per the Motor Tariff Provisions should have
declared such information in the proposal form. Taking all these factors an ex-gratia
payment of Rs.10,000/- (Rupees Ten thousand only) was awarded.
********************************************************************************************
Case.No. 11.05.1833/2011-12
Mr.S.Sathish Kumar
Vs
Oriental Insurance
The Complainant stated that his motor cycle which was insured with the insurer was lost
on 11/12/2011 .His claim lodged with the insurer was rejected stating that the intimation
of the claim was not made within 48 hours of occurrence of the theft.
The Insurer submitted that the intimation of theft was given to them after a delay of 8
days. As per policy condition claim intimation should be given in writing within 48 hours
of its occurrence. Hence the claim was not payable.
It is observed that the vehicle which was parked in front of the insured’s house in the car
shed on 11/12/2011 at night was found missing the next day morning and immediately
the insured had notified the theft to the police. The complainant stated that though he
had informed the police in writing immediately on noticing the theft, no
acknowledgement was given by the police for the intimation and he could get the FIR
only on 19/12/2011. The complainant had informed the insurer of the theft of the vehicle
only on 19/12/2011 in writing. Thereafter the insurer had arranged for an investigation
and the Investigator vide his Report dt.31.12.2011 confirmed the genuineness of the theft.
The insurer repudiated the claim vide their letter dt.4/01/2012, quoting the delayed
intimation as the reason for rejection. The complainant had stated that he was not aware
of the policy condition relating to intimation of claim to the insurer within the stipulated
time limit of 48 hours; otherwise he would have complied with the same. It is observed
that there appears to be no compelling reason beyond the control of the insured for
having intimated the insurer about the theft of the insured vehicle beyond the stipulated
time limit of 48 hours, except his ignorance about the said condition. It appears that he
waited for the FIR from the police, before informing the insurer.
The page 3 of the policy schedule contains the condition that “Claim for theft of vehicle
not payable if theft not reported to company within 48 hours of its occurrence.” The
policy does not insist on production of FIR at the time of claim intimation. Insurance is a
contract between the two parties- the insured and the insurer- and the same is governed
by the terms and conditions which are to be observed by both the parties scrupulously.
Therefore the decision of the insurer in rejecting the claim on the ground that the claim
intimation was delayed beyond 48 hours from the time of occurrence of theft of the
vehicle, which action is termed as a violation of the policy condition, is justified. Hence
the complaint stands dismissed.
Case.No. 11.05.1001/2012-13
Mr.M.Radhakrishnan
Vs
Oriental Insurance Co. Ltd
The Complainant stated that his claim for the accidental damages to his car was settled by
the insurer for a lesser amount than the actuals in respect of two different accidents. The
Insurer submitted that the claim had been considered for settlement in accordance with
the policy conditions and as per the Surveyor’s assessment in respect of both the
accidental damages claims, taking into account the appropriate depreciations.
The insurer stated that the insured was expected to inform the insurer about the accident
immediately while the vehicle was in the accident spot to enable them to arrange a
surveyor to inspect the vehicle at the spot and assess the damages to some extent, which
would help the final surveyor to correlate the extent of damages noticed on dismantling
the vehicle. The insurer contended that a Rubber stamp to that effect has been affixed on
all the policies to bring it to the attention of the policy holders. But the said Rubber stamp
is not found on the copy of the policy submitted by the insured. However, the insured was
aware of the stipulation of the insurer in respect of notifying the insurer for the purpose
of Spot Survey after the first accident’s claim experience, since he had been specifically
informed about the need for Spot survey after the first accident. Therefore, his not
informing the insurer after the second accident also, cannot be construed as an action
committed inadvertently. The insurer’s insistence of Spot Survey and / or FIR in respect of
major accidents wherever the Estimate would be around Rs.50,000/- or above, cannot be
faulted, as the same falls within the accepted procedure of claim processing, in order to
arrive at an equitable assessment of the loss. In view of the above points, the decision of
the insurer in deducting the penalty of 25% on the net admissible claim is justified.
However, the Rubber Stamp said to have been affixed on all policies to the effect that
“Spot Survey is a must- otherwise only 75% of the claim would be allowed” was not found
on the copy of the policy issued to the insured. Therefore, in order to render justice to
both the parties to the dispute, the Insurance Ombudsman is inclined to grant an Ex-
gratia of Rs.5,000/-.
Complaint allowed as an ex-gratia.
********************************************************************************************
Case.No. 11.05.1018/2012-13
Mr.Bonson
vs
Oriental Insurance Co.Ltd
The Complainant stated that his two wheeler which was insured with the insurer was
stolen on 31/01/2011 and on the same day he reported the matter to the Police. With the
FIR, he informed the insurer on 04/02/11, about the theft of the vehicle to the insurer.
The insurer rejected the claim on the ground that the intimation of theft was given to
them beyond the lapse of 48 hours from the time of loss which was a violation of their
policy condition.
The Insurer submitted that the insured had intimated the theft of the vehicle to them on
04/02/11, which was 4 days after the date of theft. As per policy condition, the intimation
should be given within 48 hours from the date of occurrence of theft. Since, the insured
had not complied with the policy condition, they have rejected the claim.
The vehicle was said to be stolen on 31/01/2011 as stated in the FIR copy dt.31/01/2011,
indicating that the Police was promptly informed and FIR was issued on the same day.
Thereafter the insured had intimated the insurer on 4/2/2011, preferring the claim.
Though there was a delay in the claim intimation by 4 days as stated by the insurer from
the time of occurrence of theft, considering the facts that (1) the intimation to the police
was given immediately after the occurrence of the theft and FIR also was issued
immediately, the process of tracing the vehicle by the Police authorities was supposed to
have commenced. (2) On noticing the condition relating to theft-claim which is required
to be reported within 48 hours, the insured immediately notified the loss to the insurer on
4/2/2011. Here, though there was a delay of only 2 days beyond the permissible 48 hours,
the said delay could not have prejudiced the interests of the insurer in any manner in the
aspect of loss minimization, inasmuch as the loss had been reported to the police
immediately and the action which the insurer would have initiated might have been
carried out by the Police. (3) the insurer’s investigator had submitted his report only
19/04/2011, after about two and half months, without mentioning the date of assignment
for the investigation by the insurer and also the actual date of conducting the
investigation with the insured, Police Dept and other witnesses; nor the insurer could
confirm the date of investigation assigned, thereby the condition of “claim intimation
within 48 hours” does not seem to have been considered by the insurer in the real spirit
behind the condition. However, the Insurer had followed the condition in its letter. (4)
From the investigator’s report it is noted that the theft of the vehicle was ascertained and
the same was not stated to be “Non-genuine", but only mentions that the claim should
not be considered due to the discrepancy in the date of occurrence of theft in the claim
intimation letter. Therefore, in view of the foregoing points, such a tough stand of
repudiation of the claim merely because of the lapse of 4 days for the claim intimation by
the insured, without considering the other aspects fulfilled by the insured and also by
invoking the said vital policy condition which was not highlighted on the face of the
policy by way of any prominent Rubber-Stamp as claimed by the insurer, is not justified.
The complaint was allowed. The insurer was advised to process the claim and settle as per
other policy conditions.
**********************************
Case No.IO (CHN) 11.11.1803/2011-12
Mr. S. Srithar
vs
Reliance General Insurance Co. Ltd
The complainant’s two wheeler covered under the policy of the insurer was stolen and he
had submitted all the claim documents to the insurer. There was no communication from
the insurer regarding the decision on the claim and during the hearing the insurer stated
that they were not in receipt of claim documents from the complainant.
During the hearing, the insured had stated that all claim documents were submitted which was
not acknowledged. The receipt of claim documents was not denied by the insurer which means
that the same were received yet no communication was sent to the insured. Despite submitting
all the required documents, the decision on the claim was delayed without any valid reason.
From the records available, the insured had complied with the requirements relating to
processing of the claim. Hence the decision of the insurer to close the file as “No Claim” for non
submission of claim documents by the insured is not tenable and the complaint was allowed.
Case No.IO (CHN) 11.03.1799/2011-12
Mr. G. Ramamoorthy
vs
National Insurance Co. Ltd
The complainant’s claim for accidental damages to his car was settled by the insurer
partially and damages relating to rear axle was not considered stating that the damages
to the same was not as a result of the accident.
It is found from the records that the vehicle was having regular maintenance and hence
wear and tear cannot be the reason for the damages. The insurer depended on the theory
that the impact of the accident was not severe so as to cause damages to the rear axle
and also because of non bursting of air bags and no damages to shock absorbers of the
vehicle. Merely harping on the probability and in the absence of insurer proving with
clinching evidence that the damages to the rear axle had happened not due to accident,
the damages to the disallowed part should have happened as a result of accident only and
hence the complaint is allowed.
Case No.11.13.1088/2012-13.
Mr.G.Gananathan
Vs
HDFC Ergo GeneralInsurance Co Ltd
The Complainant stated that that his car met with an accident and the insurer had settled
the claim for a sum of Rs.12,500/- as against the total bill of Rs.86,239/-, without
mentioning any reason for the sort settlement. On further representation the insurer had
replied that the damages to the engine parts are consequential in nature arising out of oil
leakage and hence not payable.
The Insurer submitted that the claim for the repair of parts of the Engine is not payable
since it is construed as a consequential damage as a result of leakage of oil.
The main point to be focused is to get it confirmed as to whether the damages to the
parts of engine and related components are due to the impact of the accident or it is
independent of the accident and termed as “the consequential loss arising out of the
leakage of oil from the engine oil sump and because of driving the car with the efforts of
engine without engine oil”. The insurer has contended that some of the parts connected
with engine would not get damaged or would require replacement unless the vehicle is
driven in an oil-starved condition. This argument has been put forth by the insurer only
based on surmises and not on concrete evidence and any technical reports thereon. The
insurer has not produced any clinching evidence to establish beyond doubt that the car
was driven for atleast a distance of 100 metres to cause damage to the engine and its
components consequent to oil starvation. The surveyor in his report has confirmed that
the damages are relevant to the cause of accident. Therefore, the decision of the insurer
to restrict the claim disallowing the expenses relating to Engine and its components from
the total repair bills is not justified. The insurer is directed to reopen the claim and process
the same allowing the expenses relating to repair/replacement of parts relating to Engine
and its components as per the final bill of the repairer, considering the same as “only due
to accidental damages”, subject to other terms and conditions of the policy.

Case No.IO (CHN) 11.12.1123/2012-13
Mr. R. Eswaran
vs
ICICI Lombard General Insurance Co. Ltd
The complainant’s claim for loss of his two wheeler was rejected by the insurer since the
intimation of loss of vehicle was delayed and had not considered the claim as per policy
terms. As per policy condition No.1 “Notice shall be given in writing to the Company
immediately upon the occurrence of any accidental loss or damage and in the event of
any claim and there after the insured shall give all such information and assistance as the
company shall require. In case of theft or other criminal act which may be subject of a
claim under this policy, the insured shall give immediate notice to the police and co-
operate with the Company in securing the conviction of the offender”. In the instant case,
the insured had neither lodged complaint with the police nor intimated the claim with the
insurer as per the time limits stipulated under the policy terms rendering the claim not
payable under the policy. In view of the non compliance with the policy terms regarding
intimation of claim by the insured the complaint was dismissed.
Case No.IO (CHN) 11.11.1803/2011-12
Mrs. P. Vichitra Dinakaran
vs
The complainant informs that while obtaining the cover, she had disclosed
the claims history under her earlier policy to the agent of the present
insurer. When a claim was reported under the present policy, the insurer had
rejected the claim on the grounds of wrong declaration of NCB by her.
The insurer as per the provisions of Indian Motor Tariff Guidelines GR.27.(f) had sought
the information regarding the eligibility in respect of NCB of the insured, from the
previous insurer. While seeking information regarding NCB from the previous insurer, no
action was taken in obtaining the report of the final surveyor and there was no clarity on
whether final survey was conducted. The insurer offered claim settlement during the
hearing without being sure of the quantum of settlement and whether the insured is
satisfied with that or not. The final survey report was not available till the date of
hearing, the insurer is unable to confirm whether the signature of the insured appearing
in the proposal is that of the insured and could not explain how the premium was arrived
at along with discount for allowing NCB. Though the insurer had not received any reply
regarding the NCB eligibility, the insured has also not denied about the claim made under
the previous insurer’s policy. The insurer on their part had done little in assessing the loss
by way of final survey and also could not establish that the insured had deliberately
furnished wrong information regarding NCB. All the above clearly establish that the
insurer has not handled the claim in a professional way and handled it in a casual manner.
At the same time, we have to take into account the fact that insured has confirmed that
she had made claim with the previous insurer and hence she is not eligible for NCB of 20%
allowed in the current policy. Taking all facts into account, an amount of Rs.25,000/- is
awarded as EXGRATIA.
Case No.IO (CHN) 11.04.1173/2012-13
Mrs. Ruchi Gupta
vs
The New India Assurance Co. Ltd
The complainant’s claim for total loss of the vehicle in an accident and PA claim for death
of her husband –owner driver were not settled by the insurer. The insured was not
informed in writing regarding the reasons for non settlement of the claim.
The records submitted by the complainant establish that the death of the owner-driver of the
insured vehicle was not due to any of the excluded provisions of the policy but as a result of
circumstances providing coverage under the policy. The inordinate delay at various levels of the
insurer had resulted in the long wait of the spouse of the deceased insured in realizing her claim
for PA as well as OD claim despite submitting all the required documents. In view of the
compliance of claim requirements, the complaint, was allowed.
Case No.IO(CHN) /11.03.1806/2011-12
A.M.Govindaraj
Vs
The Complainant car met with an accident on 24/08/2011. The insurer settled the repair bills
directly to the repairer for a sum of Rs.1,25,000/-as against the total bill of Rs.2,09,159,
without informing any reasons for the difference. He came to know that the major difference
was due to disallowing charges relating to repairs of non-accidental damages. He contends
that all repairs were arising out of accidental damages only.
The Insurer stated that the claim was settled as per the Surveyor’s assessment for Labour and
Parts after applying appropriate depreciation as per policy and accordingly a sum of
Rs.1,25,000/- was paid to the repairer. Major difference is in respect of Labour charges and
the same is due to the repairer carrying out maintenance and repairs other than accidental
damages also.
On perusal of the Survey Report and the Final Bill of the Repairer it is observed that a sum of
Rs.15,821/- has been disallowed due to expenses incurred towards “Consumables” and
repairs “Not due to accident” and the Net allowed for Parts being =Rs.90,506/02, after
deducting Depreciation at 10 % and 50 % for respective parts to the extent of Rs.12,205/70
and adding the Tax @14.5% valuing Rs.11461.46. The Surveyor has clarified that the repair
works relating to the front portion of the car has not been considered since the same is not
relevant to the cause of accident as narrated by the insured and also no damages to the front
portion was noticed. The insurer also has stated that the repairer has informed that works
other than accidental damages were also carried out. The photograph of the damaged
vehicle also does not show any visible damages to the front portion of the car. Therefore, the
surveyor’s assessment on the accidental damages accepted by the insurer for the claim
settlement is found to be in order. However, the insurer should take note that the Sales Tax
(VAT) as mentioned in the Bill, for the respective allowed Parts should be considered in full
and not on the depreciated values, as shown in the calculation sheet. The difference may be
worked out and the same may be paid to the insured.
The reason for disallowing the labour charges to the extent of Rs.43,000/-is stated to be that
the repair works relating to other than accidental damages including maintenance works
were carried out by the repairer, for which the corresponding labour charges were deducted
by the Surveyor. It is to be noted that the policy envisages settlement of the claim subject to
various conditions like Depreciation, Excess and Salvage Value and also taking into account
the expenses which are relevant to the cause of damages. The decision of the insurer in
settling the claim as per the Surveyor’s assessment with regard to the Parts and Labour
charges is found reasonable. The complaint is dismissed.

DELHI OMBUDSMAN CENTRE
Case No. GI/217/RGI/11

In the matter of Sh. Ram Singh Rajawat
Vs Reliance General Insurance Company Ltd.
AWARD DATED 9.4.2012 PAARTIAL SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Ram Singh Rajawat (herein after referred to as the
complainant) against the decision of Reliance Gen. Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) relating to partial settlement of motor
claim.
2. Complainant stated that his claim was not adequately settled as against the IDV of Rs.
8,88,000 he was paid only a sum of Rs7,00,000. He further submitted that the claim
was settled as Net of Salvage basis. He had received only a sum of Rs. 2,7000 on
account of the salvage of the vehicle whereas he agreed at Rs. 3 lacs. Complainant
further stated that he was virtually forced to accept the settlement of his claim to the
tune of Rs. 7 lacs only. He had received a sum of Rs. 2,70,000 on account of selling of
the wrack and balance amount of Rs. 4,30,000 by the company. Thus he had been paid
less by an amount of Rs. 1,88,000 (IDV 8,88,000 – 7,00,000).
3. Representative of the company stated that claim was settled as per terms and
conditions of the policy and complainant is not entitled to any further amount.
4. I have considered the submissions of the complainant as well as of the representative

of the company. I have also perused the facts on record. After due consideration of the
matter, I hold that company had not settled adequately the claim of the complainant
because there is no justification what so ever to settle the claim at a value lesser then
the IDV. Thus complainant is further entitled to an amount of Rs.1,87,000 (8,80,000-
policy access Rs. 1000- receipt on account of selling of Rack 2,70,000- Rs. 4,30,000
already paid by the company). Accordingly an Award is passed with the direction to
the Ins. Company to make the further payment of Rs. 1,87,000 along with the penal
interest at the rate of 8% from the date of release of Rs. 4,30,000 to the date of actual
payment on amount of Rs. 1,87,000.
5. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
**************************************************************************************
Case No. GI/145 & 252/NIC/11

In the matter of Sh. Dwarka Prassad Sharma
Vs National Insurance Company Ltd.
AWARD DATED 10.4.2012 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Dwarka Prassad Sharma (herein after referred to as
the complainant) against the decision of National Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) relating to non settlement of motor
claim.
2. Complainant stated that his car bearing registration no. RJ-20-C-A-0969 was
insured wide policy no. 378803/31/09/6100008982 by National Insurance Company
Ltd., Kota. He submitted that his vehicle met with an accident on 26.07.2010 at 11
O’clock and due to over taking the vehicle hit a tree and got damaged. The claim
has not been settled so far though considerable time has passed. During the course
of hearing, complainant stated that details of the payment made for repair of the
vehicle were made available.
3. Representative of the company stated that company will consider the claim on
receipt of the reply.
4. I have considered the submissions of the complainant as well as of the

representative of the company. I have also perused the surveyor’s report and also
company’s reply. After due consideration of the matter, I hold that company was
not justified in repudiating the claim because an insured vehicle met with an
accident and got damaged the vehicle was repaired and the repaired vehicle was
surveyed and the surveyor assessed the loss. In my considered view, the claim is
payable. Accordingly an Award is passed with the direction to the insurance
company to make the payment of assessed loss by the surveyor subject to
production of payment bills by the insured.

In the matter of Sh. Shyam Sunder Yadav
Vs
Reliance General Insurance Company Ltd.
AWARD DATED 9.4.2012 NON SETTLEMENT OF MOTOR THEFT CLAIM
1. This is a complaint filed by Sh. Sunder Yadav (herein after referred to as the
complainant) against the decision of Reliance General Insurance Co. Ltd. (herein
after referred to as respondent Insurance Company) relating to non settlement of
Motor Theft claim.
2. Complainant stated that he made a complaint regarding theft of his vehicle to the
Insurance Company. He also made his representation to the Insurance Company for
redressal of his grievance but the company had not redressed his grievance.
Complainant stated that his vehicle was stolen on 30.01.2011 09:00 pm to
01.02.2011 , 08.00 pm. He parked the vehicle at about 08:00 pm on 30.01.2011 and
when found subsequently that the car was stolen, he had gone to Ajmer. When he
returned from Ajmer, he came to know that his vehicle was stolen. He further
submitted that the vehicle was insured by Bajaj Allianz Insurance Company Ltd. up
to 30.01.2011 and he changed the insurer Reliance General Insurance Company Ltd.
and insured the vehicle for the period 31.01.2011 to 30.01.2012. During the course
of hearing also complainant stated that his insured vehicle was stolen during the
period 30.01.2011 to 01.02.2011. He had complied with all requirements and
submitted all requisite documents for settlement of the claim but the company had
not settled the claim so far.
3. Previous insurer i.e. Bajaj Allianz Ins. Co. Ltd. with the subsequent insurer i.e.
Reliance General Insurance Company were represented during the course of
hearing. Bajaj General Insurance Company’s representative refused to admit the
claim on the ground that vehicle was not stolen during the period insured by it as
its period of insurance expired on midnight of 30.01.2011. The representative of
the Reliance General Insurance Company argued that since time of the theft is not
accurate it can pay only half of the IDV that is to say the Reliance Gen. Insurance
which insured the vehicle with effect from 31.01.2011 to 30.01.2012 owned the
liability but only to the extent of 50% of the IDV but the previous insurer expressed
its inability to own any liability for theft of the vehicle.

representative of both the companies. After due consideration of the matter, I hold
that the Reliance Gen. Ins. Company Ltd. is under obligation to pay the loss
sustained by the insured because complainant came to know about the theft of the
vehicle only on 01.02.2011 when the vehicle was parked by him at 08:00 pm of
30.01.2011 and he returned back from Ajmer in 01.02.2011 and came to know
about the theft of the vehicle. Under the facts and circumstances of the case, I
considered it far and reasonable to hold the Reliance General Insurance Company
to own the liability for the loss due to theft of vehicle. Accordingly an award is
passed with the direction to the Insurance Company to make the payment of Rs.
2,65,500/- ( IDV 2,66,000 – 500 policy access).

**************************************************************************************
Case No. GI/373/Bajaj/11

In the matter of Smt. Shanta Devi
Vs Bajaj Allianz General Insurance Company Ltd.
AWARD DATED 10.4.2012 NON SETTLEMENT OF MOTOR THEFT CLAIM
1. This is a complaint filed by Smt. Shanta Devi (herein after referred to as the
complainant) against the decision of Bajaj Allianz General Insurance Co. Ltd.
(herein after referred to as respondent Insurance Company) relating to non
settlement of Motor theft claim.
2. Complainant stated that she purchased a Tata truck LPT 3118 which has
registration no. RJ 14 GC 5561 on 08.12.2009 for an amount of Rs. 1,661,007. For
purchasing this truck, she had taken a loan from Reliance Capital Ltd., 511, Neel
Kant Tower-I, Bhawani singh Road, C-Scheme, Jaipur (Raj). This truck was insured
by Bajaj Allianz Gen. Insurance Co. Ltd. with policy no. OG-0-1401-1803-00002294
for the period 08.12.2009 to 07.12.2010. The IDV of this truck was Rs. 18,62,950.
She further stated that this truck was parked near Balitha Bombay Restaurant on
01.09.2010 and the driver had gone to Super Haryana Transport Company. The
cabin of the truck was locked on both sides and the truck was stolen. It was noticed
after half an hour. She further stated that this truck was stolen from the Hotel
Vapi, Gujrat and complaint was lodged at Vappi Town Police station. Company was
also informed about the claim. She was required to clarify about the keys such
clarification was also given. Investigator of the insurance company also made
inquiry and he was given all requisite documents which were available. He also
visited the spot where the truck was stolen. She further stated that the company
had repudiated the claim on 23.12.2010 stating that the key was kept in the truck
while the same was stolen. She has made written representation to the head office
of the company but no response was received by her. She further stated that this
truck was financed and the financer is pressing for the payment of the loan and she
is being harassed. Complainant attended the hearing and argued that claim is
payable that the company is wrongly denying it. All requisite documents were
made available to the investigator.
3. Representative of the company stated that claim is not payable as insured had not
taken reasonable care. Insurance company also filed a written reply wherein it has
been stated that insurance company not liable to make any payment to the
complainant as reasonable care to safe guard the vehicle was not taken. The
vehicle was stolen due to gross negligence on the part of the driver who left the
key in the vehicle and also left the vehicle unattended.

representative of the company. I have also perused the written reply which is
placed on record. After due consideration of the matter, I hold that insured had
suffered total loss due to theft of the insured vehicle during the currency of the
policy. As regards reasonable care of the insured vehicle, in my considered view
company was not justified in repudiating the claim because when theft took place,
the insured truck was locked from both the sides. Therefore, it could not be stated
that the gross negligence was on the part of the driver. There appears to be no
violation of any terms and conditions, the claim is payable. Accordingly an award is
passed with the direction to the Insurance company to make the payment of Rs.
18,61,450 (IDV 1862950–1500 ).

Case No. GI/258/UII/11

In the matter of Sh. Kamlesh Bhandari
Vs United India Insurance Company Ltd.
AWARD DATED 12.4.2012 REPUDIATION OF MOTOR THEFT CLAIM
1. This is a complaint filed by Sh. Kamlesh Bhandari (herein after referred to as the
complainant) against the decision of United India Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) relating to repudiation of motor
theft claim.
2. Complainant stated that his Qualis car was stolen from his premises at Delhi in
August, 2009. Complete details of this claim were submitted to the United India
Insurance Company Ltd., Divisional Office at Subhash Marg, jaipur in August, 2009.
It was further mentioned that the theft of the vehicle occurred on the midnight of
23/24- August, 2009. His driver Ramsingh immediately went to the Lajpat Nagar
police station and lodged the complaint of theft. Company was also informed
about the theft on 25.08.2009 that is within 48 hours. The company deputed M/s
Auto Risk Management Services Pvt. Ltd., Delhi to investigate in to the incidence of
theft of this vehicle. During the course of hearing it was argued that the theft of
the vehicle took place on 23/24 August, 2009. All documents relating to claim
were submitted and company was also informed about the occurrence of theft on
25.08.2009. Company was not justified in repudiating the claim.
3. Representative of the company stated that claim is not payable due to late
intimation.

representative of the company. I have also perused the correspondence placed on
record. After due consideration of the matter, I hold that claim is payable and
company was not justified in repudiating the same because the insured has
informed the Insurance Company about the theft of the vehicle on 25.08.2009 and
I do not have any reason not to accept this version of the insured. Therefore, there
is no delay what so ever in intimating the theft to the insurance company. The
claim was rejected on the flimsy ground. Insured had suffered a total loss as his
insured vehicle had been stolen and that remained untraced. Therefore, in my
considered view claim is payable. There appears to be flaw in the investigation
report as the report does not mention the places visited by the investigator for
verification. Moreover, the claim is also payable on the ground that the
investigator also clarified that theft is took place. Accordingly an Award is passed
with the direction to the Insurance company to make the payment of Rs. 4,04,000
(IDV 4,05,000 – 1000).

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Case No. GI/399/OIC/11

In the matter of Sh. Pankaj Sharma
Vs Oriental Insurance Company Ltd.
AWARD DATED 12.4.2012 REPUDIATION OF CLAIM

1. This is a complaint filed by Sh. Pankaj Sharma (herein after referred to as the
complainant) against the decision of Oriental Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) relating to repudiation of claim.
2. Complainant stated that his motor cycle with registration no. HR 35 D-1153 was
insured by the Insurance company vide policy no. 242306/31/2011/5982. He had
given this vehicle to his nephew Sh. Sumit kumar Sharma who was studding at
Dehradun. This vehicle was damaged by some person and he submitted the claim
but the insurance is not settling the claim and he had not received any satisfactory
reply even after six months of submitting the claim. Company had not settled the
claim on the ground that FIR was not registered whereas the fact remained that his
nephew had filed FIR but he was not issued any receipt for that. He has come to
this forum with the request to get the claim settled. Complainant did not attend on
the date of hearing.
3. Representative of the company stated that documents were not submitted

therefore, claim is not payable. However, surveyor assessed the loss. Company also
filed the written reply dated 26.12.2011 wherein it has been stated that in such
type of loss falls within the definition of malicious damage where FIR is required to
establish cause of loss. The same is required from the claimant on 22.06.2011,
16.08.2011 and 20.10.2011 which insured failed to submit. In absence of the same
the claim filed is closed. Insured himself stated that his nephew tried to register the
FIR but this was not lodged there. This is a vital document which proves that cause
of loss was malicious damage. If the insured submits the same, the claim may be
reopened and deal with on merits of all papers on record.

representative of the company. I have also perused the written reply submitted by
the company which is placed on record. I have also perused the repudiation letter.
After due consideration of the matter, I hold that companywas not justified in
repudiating the claim because damage was done to the insured vehicle by some
persons and such damage was assessed by the surveyor of the company. There is
no reason not to believe the contention of the complainant that his nephew
informed the damage done to the vehicle by some persons to
the police station, Dehradun but police had not issued any receipt to him. If the
surveyor had assessed the loss that meant the insurance company was informed
about the loss and therefore, claim is payable. In my considered view complainant
is entitled to the loss assessed by the surveyor. Accordingly an Award is passed
with the direction to the insurance company to make the payment of Rs. 6,450.

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Case No. GI/152/NIC/11

In the matter of Sh. Sanjay Chauhan
Vs National Insurance Company Ltd.
1. This is a complaint filed by Sh. Sanjay Chauhan (herein after referred to as the
complainant) against the decision of Nationl Gen Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) relating to repudiation of claim.
2. Complainant stated that his motor cycle bearing registration no. HR 29 U3076 was
stolen from Alaknanda Market, New Delhi on 18.10.2011 at around 14:05 Hrs. He
informed the nearby police booth immediately and he was required to inform the
Police Station. He rushed to the concerned CR Park police station and gave the
information in writting within one hour of the incident occurred. He was required
to come after 2-3 days. There after he had gone to the police station and again he
was required to come after some days. However he got an FIR on 22.11.2010 and
with the copy of the FIR, he informed the insurance company but his claim was
repudiated stating that information was given late. He has come to this forum
with request to get the claim paid. During the course of hearing also he repeated
the same story that his bike was stolen and he informed the police immediately but
the FIR could not be lodged by the policy immediately though he had informed the
police immediately.
3. Representative of the company stated that complainant had sent intimation very
late to the insurance company about the theft of the vehicle. Company also filed
written reply dated 02.09.2011 wherein it has been stated that the vehicle was
stolen on 18.08.2010 from C R Park, New Delhi. Insured intimated about the loss
on 27.09.2010 which is violation of policy condition no.1. He also lodged FIR on
22.09.2010 whereas theft occurred on 18.08.2010. Therefore, claim is not payable
due to late intimation of the claim.

representative of the company. I have also perused the written reply of the
company which is placed on record. After due consideration of the matter, I hold
that company was not justified in repudiating the claim because insured had
suffered a total loss on account of theft of thevehicle during the currency of the
policy. He has promptly intimated the policy about the occurrence of theft. The
delay in obtaining FIR was the main reason for late intimation to the insurance
company. In my considered view claim is payable. Accordingly an Award is passed
with the direction to the Insurance Company to pay a sum of Rs. 31590.

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Case No. GI/179/ICICI Lomb./11

In the matter of Sh. Lallan Prasad
Vs ICICI Lombard Gen. Insurance Company Ltd.
AWARD DATED 15.5.2012 PARTIAL SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Lallan Prasad (herein after referred to as the
complainant) against the decision of ICICI Lombard Gen. Insurance Co. Ltd. (herein
after referred to as respondent Insurance Company) relating to Partial settlement
of motor claim.
2. Complainant stated that his vehicle Tata 709 was stolen on 25.11.2010. FIR was
lodged on 27.11.2010. The vehicle was insured with ICICI Lombard Gen. Insurance
Company Ltd. but the company had first repudiated the claim. It has been
requested by him that company be directed to settle the claim within a month. He
had already visited the insurance company office a number of times and he is
feeling embarrassed. He is being harassed by the financer infact financer is
threatening him to send him in jail and for other legal action. He has come to this
forum with request to get the claim paid at an early date. During the course of
hearing, it was argued by the complainant that company had not settled the claim
partialy that is to say that company had not given him the IDV. As against the IDV
of Rs. 4,41,000, company had paid him only a sum of Rs. 3,82,500. He requested
that company be directed to make him pay the balance amount.
3. Representative of the company apprised this office that claim was settled as per
consent given by the insured. Since claim was settled as per consent of the insured,
complainant is not entitled to further relief. Company also filed written reply dated
03.01.2012 wherein it has been stated that claim was settled and complainant had
been paid a sum of Rs. 3,82,500 vide cheque bearing no. 242865.

representative of the company. I have also perused written reply of the company.
After due consideration of the matter, I hold that company was not justified in
partially settling the claim because insured had suffered a total loss due to theft of
the vehicle which was insured at the time of theft. Therefore, insured was entitled
to the IDV of the vehicle whereas company had settled the claim at laser amount.
In my view complainant is further entitled to the balance amount of Rs. 58500
(4,41,000 – 3,82,500). Accordingly an Award is passed with the direction to the
insurance company to make the payment of Rs. 58500.
MAY 12 -MOTOR

In the matter of Sh. Prem Singh
Vs ICICI Lombard General Insurance Company Ltd.
AWARD DATED 28.5.2012 NON SETTLEMENT OF MOTOR OD CLAIM
1. This is a complaint filed by Sh. Prem Singh (herein after referred to as the
complainant) against the decision of ICICI Lomb. General Insurance Co. Ltd. (herein
Motor OD claim.
2. Complainant stated that his truck with registration no. RJ-10 GA 2936 was
purchased by him in July 2010. It was insured by ICICI Lombard Gen. Insurance
Company. This truck met with an accident on 10.05.2011 at Bawari near Jodhpur.
The surveyor of the company had visited and pressurized him to get the truck
repaired from the mechanic/workshop of his choice but the same was not accepted
by him because the recommended workshop/mechanic was very costly and
notorious for using duplicate parts. He spent Rs. 3 lacs for getting his truck
repaired and the surveyor had intentionally passed claim only for Rs. 1,45,700
which is less than 50% of the actual amount expended on repair. He has come to
this forum with a request to instruct the company to pass the balance amount at
the earliest. Sh. Ganesh Singh attended the hearing on behalf of the complainant.
He pleaded that a sum of Rs. 2,84,300 was spent on repairs of the truck but
company had paid only a sum of Rs. 1,45,700. He further requested that the
insured needs to be further compensated for the expenses incured on the repair of
the truck. Company was duly informed and surveyor visited the spot.
3. Representative of the company stated that claim was settled as per loss assessed by
the surveyor of the company. During the course of hearing, complainant was
required to submit original payment bill but the same was not made available.
Company also filed written reply dated 27.12.2011 wherein it has been stated that
complainant had taken a motor insurance policy no. 300360253004/00/000 for the
period 13.07.2010 to 12.07.2011. The insured vehicle met with an accident on May
10,2011 and subsequently the claim was filed. The claim was settled with the
cashless network garage on June 21, 2011.
representative of the company. I have also perused written reply of the company
which is placed on record. After due consideration of the matter, I hold that the
claim was not adequately settled by the insurance company because the insured
had spent a sum of Rs. 2,84,300 whereas insured was paid only a sum of Rs.
1,45,700 which appears to be on the lowerr side. Having due regards to the photos
of the damaged truck in my considered opinion the assessment done was on the
lower side. Due to the accident cowl assembly more damaged and needed to be
replaced completely whereas company had compensated only for bare cabin
whereas insured ought to have been compensated for entire assembly more over
labour was also not allowed for the repair of the cabin and body of the damaged
truck. I considered it fair and reasonable if the insured is further compensated by
an amount of Rs. 44,895. Accordingly an Award is passed with the direction to the
insurance company to make the further payment of Rs. 44,895.

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

In the matter of Smt. Sheela Devi
Vs Reliance General Insurance Company Ltd.
AWARD DATED 21.6.2012 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Smt. Sheela Devi (herein after referred to as the
complainant) against the decision of Reliance General Insurance Co. Ltd. (herein
motor claim.
2. Complainant stated that she is the owner of the vehicle with registration no. DL
8C3412 which was stolen. She desires to draw the attention of this forum towards
the distressing and harassing feeling. She further stated that her car was insured
with Reliance General Insurance Company Ltd. She had approached the various
departments and authorities of the said company for so many months but
unfortunately, the company is not paying proper attention to her request and the
company’s attitude in this regard is indifferent. She further stated that she is a
Government servant and she has been subjected to mental harassment due to long
drawn grievance redressal mechanism. Moreover, she had to pay interest on the
loan which she had taken while purchasing car. She has come to this forum with
request to get her genuine claim settled with appropriate amount of
compensation. During the course of hearing it was submitted by the complainant
that vehicle was stolen on 18.03.2010. All requisite documents relating to
settlement of the claim were submitted but company had not settled the claim so
far.
3. Representative of the company stated that company is now ready to pay the claim
but so far claim was not settled.
4. I have considered the submissions of the complainant as made in the complaint

and as verbally made during the course of hearing. I have also considered the
verbal arguments of the representative of the company. I have also perused the
letter dated 12.10.2010 written by the company to the insured. After due
consideration of the matter, I hold that company was not justified in not settling
the claim so far because theft of the vehicle took place on 18.03.2010 and insured
had met the requirement for settlement of the claim. Insured had suffered total
loss because of the fact that her insured vehicle was stolen and the same remained
untraceable. In my considered view, the claim is genuine and the same ought to
have been paid much earlier. Accordingly an Award is passed with the direction to
the insurance company to make the payment of Rs. 2,96,500 along with the penal
interest at the rate of 8% from 1.07.2010 to the date of payment.

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Case No. GI/248/NIC/11

In the matter of Sh. Ajay Kumar Aggarwal
Vs National Ins. Company Ltd.
1. This is a complaint filed by Sh. Ajay Kumar Aggarwal (herein after referred
to as the complainant) against the decision of National Ins. Co. Ltd. (herein
after referred to as respondent Insurance Company) relating to repudiation
of claim.
2. Complainant stated that his insurer M/s National Insurance Company Ltd.
repudiated the theft claim which infact should have been paid. He has come
to this forum with the intervention and for help in getting the claim settled.
Complainant had already approached the GRO of the company. During the
course of hearing complainant stated that vehicle was stolen on 18.03.2011
but intimated the insurance company in the month of April. He informed
the police on 100 number immediately.
intimation of loss to the company. Company also filed written reply dated
19.03.2011 wherein it has been mentioned that information of the alleged
theft of vehicle was given to the company after 37 days which is
contravention of condition no. 1 of motor comprehensive policy and
therefore, claim was rightly repudiated due to breach of policy condition no.
1.

representative of the company. I have also perused the repudiation letter
dated 2504.2011 and also the subsequent letters dated 03.05.2011,
15.07.2011, and 05.08.2011. After due consideration of the matter, I hold
that company was not justified in repudiating the claim because vehicle was
stolen during the currency of the policy and the insured had suffered a total
loss. Insured had intimated the police in time on 100 number. The claim
otherwise admissible cannot be declined on technical ground. Therefore,
claim is payable and company was not justified in denying the same.
Accordingly an Award is passed with the direction to the insurance company
to make the payment of Rs. 2,93,500 (2,94,000 – 500).
compliance of the same shall be intimated to my office for information and
record.
******************************************************************************************

In the matter of Sh. Mohd. Shariq
Vs ICICI Lombard General Ins. Company Ltd.
AWARD DATED 17.7.2012 REPUDIATIN OF MOTOR CLAIM
1. This is a complaint filed by Sh. Mohd. Shariq (herein after referred to as the
complainant) against the decision of ICICI Lombard General Ins. Co. Ltd. (herein
after referred to as respondent Insurance Company) relating to repudiation of
motor claim.
2. Complainant stated that his son had kept his bike bearing registration no.
DL4SBM7049 on 14.11.2010 at about 09:45 pm. Outside the residence, it was found
by him in the morning on 15.11.2010 that his motor bike was stolen and the FIR
was lodged on the same day. Company was also intimated though after some time.
Company was not justified in denying the claim only on the ground of late
intimation of the claim.
3. Representative of the company stated that claim is not payable due to delay in
intimating the loss to the company. FIR was also filed late. Investigation report
dated 22.02.201 and repudiation letter dated 29.03.2011 were also filed.

representative of the company. I have also perused the investigation report. I have
also considered the reply. After due consideration of the matter, I hold that
company was not justified in repudiating the claim because insured had suffered
the total loss due to the fact that insured vehicle was stolen during the currency of
the policy. The claim otherwise admissible cannot be denied on technical grounds.
Complainant intimated the insurance company and also filed the FIR late but
intimated the policy on 100 number immediately. Therefore, in my considered view
claim is payable and company was not justified in repudiating he same.
Accordingly an Award is passed with the direction to the insurance company to
make the payment of Rs. 54,528 (54578 – 50).

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In the matter of Sh. Parvesh Kumar
1. This is a complaint filed by Sh. Parvesh Kumar (herein after referred to as the
complainant) against the decision of ICICI Lombard General Insurance Company
Ltd. (herein after referred to as respondent Insurance Company) relating to
repudiation of motor theft claim.
2. Complainant stated that his motor cycle bearing registration no . DL-87NB-6520

which was insured vide policy no. 3005/2010543418/00000000185 was stolen on
02.11.2010. He lodged the FIR on 06.11.2010 with police station Ranjeet Nagar and
he also informed police station Ranjeet Nagar on 02.11.2010 at about 12:40 pm
about the theft on the same day. He approached the insurance company along
with relevant documents. Thereafter, he approached the insurance company
several times but he had not been compensated for the loss he suffered due to
theft of the motor bike. He has come to this forum with request to instruct the
insurance company to settle his claim immediately. During the course of hearing
complainant stated that his claim is payable but company had denied it. He further
informed that he sent intimation to the police on 100 number.
intimation of the loss to the company. Company also filed written reply dated
15.11.2011 wherein it has been stated that the vehicle was stolen on 02.11.2010
but the police was intimated only on 05.11.2010 and FIR was registered on
06.11.2010. Company was informed by the insured on 08.12.2010. Thus due to
inordinate delay, the claim is not payable.

representative of the company. I have also perused the reply of the company dated
15.11.2011 which is place on record. After due consideration of the matter, I hold
that company was not justified in denying the claim because he had suffered a
total loss due to the fact that his insured motor bike was stolen during the currency
of the insurance and that remained untraced. In my considered view, the claim
payable on merits could not be denied only on the ground that intimation was
given late. The insured had intimated the police about the loss almost immediately.
Therefore, the claim is payable. Accordingly an award is passed with the direction
to the insurance company to make the payment of Rs. 38,350 (38,400 – 50).

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In the matter of Sh. Nikhil Sood
AWARD DATED 1.8.2012 REPUDIATION OF MOTOR CLAIM
1. This is a complaint filed by Sh. Nikhil Sood (herein after referred to as the
complainant) against the decision of ICICI Lombard General Insurance Company
Ltd. (herein after referred to as respondent Insurance Company) relating to
repudiation of claim.
2. Complainant stated that his car Maruti Ritz with registration no. DLZ CAL 7299,
which was insured vide policy no. 600022804 was stolen from outside his residence
153, Jagriti Enclave, Vikas Marg Extn. Delhi – 110092 on 01.02.2011. FIR was
lodged in this regard at Anand Vihar police station on the same day. The company
was also intimated on the same day telephonically and through e-mail. Executive
from ICIC Lombard General Insurance Company Ltd. also visited his residence and
investigated the matter. Whatever documents where requisitioned from him, the
same were made available to him. He continued to approach the insurance
company for settlement of the claim but his claim was rejected by the insurance
company. He was shocked to see the response of the company. He explained that
the key was not left inside due to negligence but for a purpose. As an employee of
the bank, he had to travel a lot to various places in and around the Delhi. The key
was hidden inside of the car at the place without knowledge to any body and he
was only one who was knowing about the key. He has come to this forum with
request to get his claim settled. During the course of hearing, complainant argued
that claim is payable but company denied it. He kept the second key in the car and
locked the same. The car was parked in front of the residence and was duly locked
as usual.
3. Representative of the company stated that claim is not payable because insured
did not take reasonable care to safe guard the vehicle from loss. As a matter of
fact, he facilitated the theft by keeping the second key in the dash board inside the
vehicle. Company also filed written reply dated 15.11.2011 wherein it has been
stated that complainant was issued motor insurance policy bearing no.
3001/60434746/00/000 for the period 02.02.2011. An investigator was deputed
and it was found by him that insured had provided only one key of the vehicle. On
persuasion of the documents it was found that key was left in the vehicle.
Sufficient care was not taken of the insured vehicle and therefore, claim is not
found payable.

company which is placed on record. After due consideration of the matter, I hold
that company was not justified in repudiating the claim because claim is payable.
Insured had suffered a total loss due to theft of the vehicle which was insured and
theft took place during the currency of the policy period. The car was parked in
front of the residence and it was locked from outside. Even if second key was in the
vehicle in the dash board but since the vehicle was locked from outside, in my
considered view company is not justified in stating that insured had not taken
reasonable care. In my considered view complainant had suffered a loss and as per
terms and condition of the policy, he needs to be compensated for such loss.
Accordingly an Award is passed with the direction to the insurance company to
make the payment of Rs. 4,50,299 ( 4,50,799 – 500).
*********************

In the matter of Sh. Hari Om Singh
1. This is a complaint filed by Sh. Hari Om Singh (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) relating to repudiation
of Motor Theft Claim.
2. Complainant stated that his bike was taken away while he was attending the
personal call. When he was on his way to his village to Delhi. He further stated that
three persons came and showed revolver to him and had run away with his bike.
He submitted further that ignition key was there in the motor bike. He submitted
the claim but the claim was repudiated by the insurance company. During the
course of hearing also complainant pleaded that company was not justified in
repudiating the claim because bike was stolen during the currency of the policy.
intimation of the claim. company also filed written reply dated 31.10.2011 wherein
it was stated that investigation was conducted and it was found that insured had
returned only one key of the vehicle and thus insured had not taken sufficient care
to safe guard the vehicle from loss or damage.

company and other documents placed on record. After due consideration of the
matter, I hold that company was not justified in repudiating the claim because
under the facts and circumstances of the case, the claim is payable. Accordingly an
Award is passed with the direction to the insurance company to make the payment
of Rs. 33105 ( 33155-50).
****************
Case No. GI/355/UII/11

In the matter of Sh. Harsharan Singh
Vs United India Insurance Company Ltd.
AWARD DATED 14.9.2012 DELAY IN SETTLEMENT OF MOTOR THEFT CLAIM
1. This is a complaint filed by Sh. Harsharan Singh (herein after referred to as the
complainant) against the decision of United India Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) relating to delay in settlement of
motor theft claim.
2. Complainant stated that his Hyundai i10 car bearing registration number DL7CJ
5410, was stolen on 20.03.2010 from his residence. He immediately reported the
matter to the police on 100 number and also got a complaint registered with a
police but the car was not traced. This car was insured from United India Insurance
Company Ltd. vide policy no. 040700/31/09/01/00010711 for the period
20.03.2010 to 19.03.2011. he informed the insurance company also about the theft
on 01.04.2010. He submitted all requisite documents to the insurance company for
settlement of the claim. His son Pawandeep Singh has visited the Regional office of
the insurance company a number of times but of no use. This car was financed by
HDFC bank. He is paying regular installment to the bank even after theft of the
vehicle. He has been facing a lot of difficulties due to theft of his vehicle. The
company did not settle the claim so far. He has come to this forum for getting his
claim settled with penal interest. During the course of hearing, complainant stated
that claim is payable but company denied it without any valid reasons.
3. Representative of the company stated that claim is not payable and the matter was
referred to Vigilance department. Company also filed written reply dated
01.11.2011 wherein it has been stated that vehicle was stolen on 20.03.2010 that is
on first day of commencement of insurance with the company. Several
irregularities were noted due to which claim was referred to company’s vigilance
department.
representative of the company. I have also perused reply of the company and also
other letter of the company addressed to the insured whereby it has been
conveyed by the company that company had referred the matter to Vigilance
department and it has denied its liability. After due consideration of the matter, I
hold that company was not justified in not taking decision so far. Company ought
to have paid by now the claim of the complainant. Undoubtedly insured had
suffered a total loss as his vehicle was stolen. It is also not doubted that vehicle was
not insured when theft took place. Since insured had suffered the total loss as
vehicle was stolen during the currency of the policy, company is under obligation
to compensate the insured for the total loss sustained by him. Accordingly an
Award is passed with the direction to the insurance company to make the payment
of Rs. 3,09,500 (3,10,000 – 500).
********************************************************************************************
GUWAHATI OMBUDSMAN CENTRE
Complaint No. 11-020-056/11-12
Mr. Ajoy Adhikary
- Vs -
Universal Sompo General Ins. Co. Ltd.
Date of Order : 07.06.2012
(a) Complainant: The Complainant stated that the his vehicle bearing Registration
No. AS – 01 / BC – 5617 was insured with the above Insurer under Policy No.
2315/50078486/00/000 covering the period from 26.03.2009 to 25.03.2010. While
the policy was in force, the insured vehicle met with an accident on 13.04.2009
sustaining frontal damages. Police as well as the Insurer were informed and a
formal claim for Rs.1,80,000.00 was lodged before the Insurer for the loss
sustained. But, the Insurer has repudiated the claim without any justified ground.
Feeling aggrieved, the Complainant has lodged this complaint.
Insurer : The Insurer has stated in their “Self Contained Note” that on 13.04.2009
the vehicle while plying on the road met with an accident resulting in frontal
damage. The spot survey for the loss was conducted on 14.04.2010 and the final
survey conducted from 28.04.2009 and on other various dates. However, from the
documents submitted by the Insured, it was observed that the temporary route
permit provided by the Insured had its inception date as 21.04.2009 i.e. eight days
after the date of loss. Consequently, the claim of the Insured was rejected for non
possession of a valid route permit on the day of the loss.
Decision : The copy of the policy document shows that the vehicle bearing
Registration No. AS – 01 / BC – 5617 belonging to the Complainant was insured with
the Universal Sompo General Insurance Co. Ltd. under Goods Carrying Package Policy
covering the period from 26.03.2009 to 25.03.2010. According to the Complainant,
his insured vehicle met with an accident on 13.04.2009 sustaining frontal damages
when he brought the vehicle to a Temple for worship from workshop to Mirza. He
also stated that on the date of accident, he had no route permit, but, he applied
for the same. He further stated that at the time of accident the vehicle was not
plied for carrying any articles. Thereafter, he lodged a claim for Rs. 1,80,000.00
before the Insurer along with all supporting documents. He alleged that the
Insurer has repudiated his claim without any justified ground. The representative of
the Insurer stated that they deputed their Surveyor who assessed the liability of
the Company to be Rs.1,43,478. However, from the documents submitted by the
Insured, it was observed that the temporary route permit provided by the Insured
had its inception date as 21.04.2009 i.e. eight days after the date of loss.
Consequently, the claim of the Insured was rejected for non possession of a valid
route permit on the day of the loss. The Police Report dated 24.05.2009 issued by
Bijoynagar Police Station, Kamrup goes to show that the vehicle bearing No. AS – 01
/ / BC – 5617 sustained damages in an accident on 13.04.2009 and on getting
information, Police registered Bijoynagar G.D. Entry No. 365 dated 13.04.2009. The
M.V.I. of Kamrup (R&L) has also inspected the insured vehicle on 17.04.2009 who
has reported the damages like Front show, Bumper, Bonnet, Radiator sustained by
the insured vehicle on 13.04.2009. It is ample clear from the Police Report and
MVI report that the insured vehicle of the Complainant met with an accident on
13.04.2009. The Copy of Survey Report shows that the insurance company’s
liability is Rs. 1,43,478.00. The Surveyor mentioned in the column of Nature and
Cause of Accident that at the material time of accident the Insured vehicle was
plying towards Guwahati from Boko side, when it reached at Rampur on NH – 37
collided with an opposite coming tanker bearing Regn. No. AS – 14 / C – 0171. Thus
the Insured vehicle sustained substantial damages to its Cabin, Chassis & other
frontal parts. It is clear from the copy of Survey Report that the vehicle was not
plied for carrying any articles. The Insurer has repudiated the claim on the ground
that there was no valid route permit at the time of accident. The Complainant in
his statement has categorically made it clear that as it was a new vehicle, he
brought the vehicle to a Temple for worship only from workshop to Mirza and in
between the vehicle met with an accident. It is crystal clear from the statement of
the Complainant as well as from report of the Surveyor that on the date of
accident the vehicle was not plied for carrying any articles. So, the Complainant
used his vehicle for personal purpose for a worship only. Route permit is not
necessary for taking the vehicle to a Temple for worship.
Considering all the papers available on record, photographs taken before dismantle
and the occurrence of accident, I am of the view that the decision of the Insurer
in repudiating the claim is not just and proper. The Insurer is directed to re-
consider the claim and arrange to settle the claim at Rs.1,43,478.00, as assessed by
the Surveyor.
********************************************************************************************
Complaint No. 11- G 2 - 001/12-13
Mr. Jitu Baruah
- Vs -

Complainant: The Complainant stated that the vehicle with Engine No. 63100174
and Chassis No. BIC06579 (Tata LPT 2518) belonging to him and insured with the
above Insurer covering the period from 24.3.2011 to 23.03.2012 met with an
accident on 23.03.2011 sustaining heavy damages while it was coming from
Dealer’s Show Room, Guwahati to Golaghat. He informed Police as well as the
Insurer about the accident of his vehicle. Thereafter, he lodged a claim before the
Insurer along with all supporting documents. But the Insurer has repudiated the
claim without any justified ground. Feeling aggrieved, the Complainant has lodged
this complaint.
Insurer : The Insurer has stated in their “Self Contained Note” that the date of
accident is 23.03.2011 i.e. prior to policy period which commences from 24.03.2011
for a period of 12 months. Therefore, their system could not allot any claim
number and the loss is beyond the period of policy and accordingly the claim was
repudiated as the policy does not cover the date of loss.
Decision : According to the Complainant Mr. Jitu Baruah, his vehicle was involved
in an accident sustaining damages near Murhabahi under Bokakhat PS while it was
coming from Guwahati Show Room to Golaghat. The copy of the Police Report
dated 11.04.2011 issued by the Bokakhat P.S. also shows that the insured vehicle
met with an accident at Murhabahi on 37 National Highway on 23.03.2011. As a
result of which the vehicle was badly damaged. Police accordingly recorded
Bokakhat P.S. G.D.E. N0. 586 dated 23.03.2011. The above document proves that the
insured vehicle sustained damages due to involvement in the accident. The
Complainant, being the Insured, preferred his claim before the Insurer. The said
claim was however repudiated by the Insurance Company on the ground that the
date of accident is 23.03.2011 i.e. prior to policy period which commences from
24.03.2011 for a period of 12 months. The representative of the Insurer stated that
they deputed their Surveyor who assessed the loss at Rs. 3,67,986.50. The claim of
the Complainant was repudiated as the accident occurred before coverage of the
insurance policy. The policy coverage period was from 24.03.2011 to 23.03.2012.
But, the accident occurred on 23.03.2011 i.e. prior to commencement of the policy.
The Complainant, however, stated that he deposited Rs.36,661/- on 22.03.2011 as
insurance premium to the Dealer of the vehicle. He was informed by the Dealer of
the vehicle that there was a tie-up with the National Insurance Co. Ltd. So, his
insurance coverage should have been started from 22.03.2011 to 21.03.2012. In
support of his contention, he produced a copy of proposal form which was filled
in and submitted before the Dealer of the vehicle. On perusal of the proposal
form, it appears that the Complainant deposited Rs.36,661/- along with the duly
filled up proposal form before the Dealer of the vehicle wherein the period of
insurance stated to be from 22.03.2011 to 21.03.2012 and somebody on behalf of
the Insurer had signed on the proposal form on 22.03.2011. The Complainant has
also produced a copy of Cheque for Rs.36,661/- dated 22.03.2011 drawn on Axis
Bank Ltd. in proof of his contention. The Insurer has stated in their “Self
Contained Note” that they received the cheque dated 22.03.2011 along with
proposal dated 22.03.2011 only on 24.03.2011. Accordingly policy was issued with
effect from 24.03.2011 to 23.03.2012. The copy of policy document itself discloses
the date of commencement from 24.03.2011 to 23.03.2012. It amply proves that
there was no policy coverage at the relevant time of accident of the vehicle on
23.03.2011. In view of the above, the Complainant is not entitled to get his claim
amount under the above policy as it was prior to coverage of the policy.
Under the above facts and circumstances, I have no hesitation to hold that the
Insurer has rightly repudiated the claim of the Complainant. Finding no ground to
interfere with the decision of the Insurer, the complaint is dismissed and is treated
as closed.
Complaint No. 11-011-034/11-12
Mr. Ravi Ranjan
- Vs -
Bajaj Allianz General Insurance Co. Ltd.
(a) Complainant: The Complainant stated that he procured private car policy No.
OG-11-2437-1801-00000695 from the above Insurer in respect of his vehicle No. AS
– 06 / J – 1621 covering the period from 07.07.2010 to 06.07.2011. While the policy
was in force, his vehicle met with an accident on 17.01.2011 sustaining heavy
damages. Thereafter he lodged a claim for Rs. 91,649/- before the Insurer along
with all supporting documents. But the Insurer offered him Rs. 14,591/- which he
refused the accept the same. Being aggrieved, he has lodged this complaint.
(b) Insurer : The Insurer has stated in their “Self Contained Note” that they
deputed their Surveyor who assessed the loss at Rs.14,591.00 as final amount
payable in settlement of his claim. They sent the discharge voucher for the said
amount to the Complainant and he has also signed the discharge voucher
accepting the amount of Rs.14,591/- in full and final settlement of the claim. It is
also stated by the Insurer that the Complainant has accepted the amount of
Rs.14,591/- in full and final settlement of the above claim and they are prepared
to settle the claim on such amount as assessed by the Surveyor and accepted by
him.
Decision : The copy of the policy document has been submitted by the
Complainant which goes to show that his vehicle bearing Registration No. AS – 06 /
J - 1621 was covered under Private Car Policy No. OG-11-2437-1801-00000695
covering the period from 07.07.2010 to 06.07.2011. According to the Complainant,
during the coverage of the policy, his vehicle met with an accident on 17.01.2011
sustaining heavy damages. Thereafter, he lodged a claim for Rs.91,649/- before the
Insurer along with all supporting documents. The Surveyor Mr. S. Goswami
contacted him and took signature on blank discharge voucher stating that it is a
part payment of his claim. The Insurer sent two cheques for Rs. 4,197/- and
Rs.10,394/-. The Complainant refused to accept the same and returned the above
cheques to the Insurer. He further stated that the Insurer cheated him by taking
signature on the blank discharge voucher. The representative of the Insurer stated
that they deputed their Surveyor who assessed the loss at Rs.14,591/-. Therefore,
they offered Rs.14,591/- to the Complainant. He further stated that the
Complainant has accepted the amount of Rs.14,591/- as full and final settlement of
the claim by signing the discharge voucher. It appears from the copy of payment
receipt dated 13.06.2011 from Pashupati Traders that the Complainant had to pay
Rs.91,649.00 for repairing of the vehicle. It is clear from the Claim Discharge Cum
Satisfaction Voucher that the Insurer took signature of the Complainant on the
blank voucher. Thereafter, the Insurer issued cheques for the settled amount of
Rs.14,591/- to the Complainant. It is really very much surprising to note that for
what reason Insurer did not write the settled amount in the discharge voucher. It
indicates that there might have intension behind them to mislead the Complainant.
After going through the entire documents, it is observed that the Insurer’s offered
amount of Rs.14,591.00 is not at all sufficient and the Complainant refused to
accept the cheque and returned the same to the Insurer. Considering all the facts
and circumstances, the Insurer is asked to pay to the tune of Rs.40,000/- to the
Complainant instead of the offered amount of Rs.14,591.00 which I consider to be
just and reasonable. The Insurer was directed to settle the claim within 15 days
from the date of receipt of this Order.
********************************************************************************************
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No. IO/ KCH/GI/11-004-224/2011-12
Shri C J Antony
Vs.
United India Insurance Co.Ltd.
Award dated 11.4.2012
The complainant’s motorcycle, which was insured with the above Insurer, was stolen from
his residential premises. When a claim was preferred, only 75% of the IDV was sanctioned
by the Insurer. As he felt that he is entitled to receive the entire amount, this complaint.
Records were perused and hearing held. The respondent-insurer’s representative

submitted that records were available which would reveal that the ignition key of the
vehicle was left in the vehicle itself which facilitated theft of the vehicle. Hence, he
contended that the complainant had not taken reasonable care of the vehicle. On the
theft of the vehicle, the complainant had lodged a complaint with the police and as per
their investigation report, the original RC book and the keys were not lost. This finding is
against the contention of the respondent-insurer that the complainant had left the
ignition key in the vehicle itself. Also, the theft was committed in broad day light. The
vehicle was kept in the car porch of the residential building. All this shows that the
complainant had taken sufficient care of the vehicle. In such a circumstance, there is no
justification in settling the claim on non-standard basis. Admittedly, the IDV of the
vehicle is Rs. 25300/-. Compulsory excess deductible is Rs. 50/-. So, normally, the
complainant is entitled to receive Rs. 25250/- out of which he had already received Rs.
18925/-.
In the result, an award is passed directing the respondent-insurer to pay Rs. 6325/- to the
complainant within the period prescribed failing which he shall pay interest @ 9% pa on
the amount from 17.6.2011 (date of filing of complaint) till payment is effected. No cost.
********************************************************************************************
Smt.Valsamma Abraham
Vs.
Reliance General Insurance Co.Ltd.
The complainant’s car was insured with the above Insurer. In June, 2010, due to flooding
of the road, the vehicle stopped and could not be restarted. The vehicle was taken to a
workshop. The complainant got the loss assessed by an authorized surveyor which came
to Rs. 179676/-. When a claim was preferred, the same was rejected by the respondent
insurer as the loss suffered is a consequential one which falls beyond the purview of the
policy. Hence this complaint.
Records were perused and hearing held. The fact that flood water entered the engine of
the car while it was being plied is not disputed by the Respondent-insurer. There is no
case for the insurer that the driver of the car was negligent in driving the vehicle. So also,
there is no contention that the complainant did not take reasonable care against loss or
damage. Their only contention is that the damage suffered is a consequential loss.
However, the term consequential loss does not find a place in the policy conditions. In
the absence of a definition, the term can be stretched to take any accidental damage,
direct or indirect to suit the imagination of the Insurer. There is another survey report of
another authorized surveyor deputed by the insurer who assessed the loss at Rs. 75159.60
after taking into account such facts as depreciation. Also, the surveyor deputed by the
complainant had inspected the vehicle much after the surveyor deputed by the
respondent-insurer had presented his report. After comparing both the reports, this
Forum is inclined to accept the report submitted by the surveyor deputed by the
respondent insurer.
In the result, an award is passed directing the respondent-insurer to pay to the

complainant an amount of Rs. 75160/- with 9% interest pa from the date of complaint
(17.6.11) till the date of this award (16.4.12). The payment shall be made within the
period prescribed failing which the amount shall carry further interest at 9% pa from
16.4.12 till payment is effected. No cost.
V Ramachandran
Vs.
New India Assurance co Ltd.
Car owned by the complainant was insured with the respondent-insurer. For damages
sustained to the car, he submitted a claim for Rs. 11500/-. The insurer offered Rs. 500/-
for settlement of claim. Now only the complainant knew that there is a provision for
deduction of Rs. 5000/- as per the policy from the claim. Such provision was incorporated
in the policy without his knowledge or consent. As he felt that he is entitled to receive
the entire amount, this complaint.

submitted that the surveyor appointed by them assessed the damage sustained to the
vehicle at Rs. 6000/-. After deducting policy excess of Rs. 5500/-, the rest Rs. 500/- was
offered. A perusal of the policy schedule for the relevant period revealed that that there
is provision for imposed excess of Rs. 5000/- and compulsory excess of Rs. 500/-. The
complainant has no case that he did not go through the policy document. The insurer’s
surveyor had assessed the loss at Rs. 6618/-. After deduction of excess, Rs. 1118/- needs
to be paid to the complainant.
In the result, an award is passed directing the respondent-insurer to pay Rs. 1118/- to the
complainant within the period prescribed failing which it shall carry interest @ 9% pa
from the date of complaint (27.6.11) till payment is effected. No cost.
********************************************************************************************
Biju Mathew
Vs.
Oriental Insurance Co. Ltd.
Complainant purchased a car from its previous owner. The vehicle was insured under
Motor Vehicle Package policy for the period from 11.6.2009 to 10.6.2010. The vehicle was
involved in an accident on 30.11.09. The policy was transferred in the name of the
complainant wef 2.2.2010. The respondent-insurer rejected the claim of the complainant
who submitted an estimate of Rs. 203585/- for effecting repairs to the damaged vehicle.
Hence, the complaint.

submitted that as on the date of the accident, the insured was the previous owner of the
vehicle and the complainant had not approached the insurer for transfer of policy prior to
the date of accident. On a perusal of relevant documents, it could be easily concluded
that on the date of the accident, the complainant was the registered owner of the vehicle.
However, the insurance policy stood in the name of the previous owner. Hence, the
complainant ceased to have any insurable interest in the vehicle. Though the complainant
was the registered owner of the vehicle when the accident took place, there was no policy
in his name as far as own damage liability was concerned. There was no privity of
contract between the complainant and the insurer as on the date of accident with regard
to insurance cover for own damage. In the circumstances, repudiation of claim is proper
and legal.
In the result, the complaint is dismissed. There is no order as to cost.
********************************************************************************************
A A Arif
Vs.
Shriram General Insurance Co. Ltd.
The complainant had purchased a goods carriage vehicle. For taking a policy on the
vehicle, he had issued a cheque dated 14.8.10 for Rs. 12546/-. On 30.9.10, the vehicle
involved in an accident. When a claim was submitted, it was repudiated by the
respondent insurer alleging that there was no endorsement of policy in his name. As the
ground taken by the respondent-insurer for repudiating the claim is not acceptable, the
complaint.
Records were perused and hearing held. As per the respondent-insurer, though the
vehicle ownership was transferred in the name of the complainant wef 19.8.10, there was
no transfer of policy in his name as on the date of accident. On scrutiny of records, it
came to light that there is complete lack of evidence that the complainant had taken
insurance cover for the vehicle in his name or made application for transfer of existing
policy in his name. The complainant had failed to produce new policy, if any, taken by
him, in relation to the vehicle in his name or endorsement made by the insurer in his name
in the earlier policy which stood in the name of the previous owner. As there was no
transfer of policy in the name of the complainant in relation to own damage portion of
package policy issued by the respondent-insurer to the previous owner of the vehicle, the
respondent-insurer has no liability to make good the loss suffered by the complainant.
In the result, the complaint is dismissed. There is no order as to cost.
********************************************************************************************
Kolkata Ombudsman Centre
Case No. 241/14/012/NL/07/2011-12
Smt. Sabia Begum
Vs.
ICICI Lombard General Insurance Company Ltd.
Order Dated : 29th June, 2012
Facts & Submissions :
The first hearing of the case was held on 19.03.2012. The complainant attended with her
husband Sk. Nazir Ahammad and narrated the facts and grounds of complaint. She stated
that her motor claim was arbitrarily rejected by the insurance company on a false ground
that there was material change to the insured property which was not intimated to the
insurance company. She vehemently denied the allegation that the vehicle was
remodelled into a luxury sleeper coach after obtaining insurance cover. The
representatives of the insurance company on the other hand reiterated their stand as
mentioned in their written submission dated 30.11.2011 and discussed above. They also
submitted copies of the photographs of the vehicle and the surveyor’s report in support
of their contentions. The hearing was adjourned allowing the parties to make further
submissions and the next hearing was held on 07.06.2012, which was attended by both
the parties. During the hearing, the complainant submitted further documents to prove
that the body was constructed before taking the insurance cover and it was duly inspected
by the insurance company before issue of the policy. The complainant asserted that no
bunks were built for sleeping purpose and since the bus was being used for long distance
journey, they had provided for adequate space for luggage storage which was mistook for
sleeper berth. The representative of the insurance company clarified that the vehicle was
insured and premium was charged for 52 seater caoch. She also referred to the surveyor’s
report which states that the body construction of the bus indicated that it was a sleeper
coach. This material change was not intimated to them or to the RTO which is mandatory
under the Motor Vehicle Act 1988. She claimed that the seating capacity and the interior
decoration of the bus were altered and interior electrical wiring connection were also
changed which resulted in the vehicle catching fire. Had the complainant intimated the
alteration to the RTO officials, proper inspection could have been carried out to check the
fitness of the vehicle by the RTO officials. As no inspection was carried out either by the
insurer or by RTO, the quality of the electrical connections and modifications could not be
ascertained. However, the company did not reply clearly whether the vehicle was
inspected before allowing the policy cover and could not produce the pre-inspection
report also.
DECISION:
The complainant has approached this forum against repudiation of her motor claim (total
loss of the vehicle) on the ground that there were material change to the body and the
electrical connections of the vehicle, which were not intimated to the insurance company
or the RTO officials.
From the analysis of the facts of the case we find that the complainant had taken an
insurance cover for a 54 seater bus (Reg. No.WB-41-D/0808) from ICICI Lombard General
Insurance Company Ltd., vide their policy no. 3004/54313264/02/000 for the period of
22.06.2010 to 21.06.2011 for sum insured of Rs.10,51,050/-. The bus was booked by a
party for tour to various places in North India. Accordingly, the bus should have been at
Lucknow on 23.09.2010, but due to bad weather conditions (as stated by the complainant),
the party did not proceed to Lucknow and returned to Kolkata. After returning, the bus
was parked at Kona Express Highway on 23.09.2010, where it caught fire at mid night. The
insurer was intimated who deputed a surveyor for assessment of loss. The surveyor
reported that the said bus was converted to Sleeper Luxury Bus, but this change was not
brought to the notice of the Insurer/ Transport Authority.
From the photographs and other documents submitted to this forum by the Insurance
Company, it is difficult to establish conclusively that the said bus was converted from 54
seater bus into a sleeper coach. Since the vehicle was fully charred, the surveyor also
could not reach a definite conclusion. The surveyor has also not established that change
to the body structure if any, had contributed to the fire accident and the loss. Moreover,
the fire occurred when the bus was in stationery condition and therefore, chances of its
catching fire due to technical defect is remote.
The insurer has stated that motor tariff does not provide separate classification for
Ordinary Bus and Luxury Sleeper Bus. The premium chargeable depends upon the
following factors –
a) IDV (Insured’s declared value)

b) License carrying capacity
c) Geographical Zones where it is registered.
d) Age of Vehicle.
Thus it is clear that even if there has been a change in the bus from ordinary to luxury
sleeper bus, no extra premium would be attracted. On the other hand owner would get
less amount of claim against higher value of the bus.
The representative of the insurance company confirmed during hearing that the vehicle
was inspected prior to issue of the policy and agreed to submit the inspection report. But
subsequently, the company vide their letter dated 20th June 2012 has confirmed that
there was no inspection of vehicle at the time of policy issuance as it was a roll over case
with no break-in in the policy. But during hearing a clear reference was made to the pre-
inspection at the time of the first insurance in 2008-09 on which the Company is silent. It
therefore, appears that they never inspected the vehicle before accident and relied on the
surveyor’s report, which also could not establish conclusively that there were material
changes to the body structure. Existence of bunks does not prove that the bus structure
was modified. As per the policy schedule, the vehicle was insured first time in 2008-09
with seating capacity of 53 and premium was charged for 53 passengers with separate
cover for the driver. It was renewed with same provision in 2009-10, but in 2010-11 the
policy shows the seating capacity as 52. However, no supporting document like proposal
form etc. was produced to explain reduction of one seat by the insurer. They have also not
raised this issue at the time of renewal or afterwards. This aspect was also raised with
insured. The insured has clarified the position vide their letter dated 01.04.2012, pointing
out that in the insurance policy schedule under ‘Model’ head it was clearly mentioned as
“LPO1612 54 STR” which indicates that bus was of 54 seater. It was insurer’s prerogative
to charge premium accordingly. But they have mentioned 53 & 52 under carrying capacity
in the policy for 2009-10 and 2010-11 respectively. As the insured has not submitted any
proposal form for renewal in 2009-10 & 2010-11 it can not be said that there was
deliberate suppression of facts.
It is also noted that there is no system in West Bengal under M.V. Act 1988 to register the
sleeper bus and ordinary bus separately. They are registered under vehicle class ‘Bus’ only.
Hence, surveyor’s comment that as per R.C. Book it was found that class of vehicle was
Bus of 54 seater but according to the body construction of bus it was found that this was
a sleeper bus, has no bearing in the absence of any initial inspection certifying its nature
of construction. As per M.V. Act both the buses i.e., sleeper bus and ordinary bus will
classify as “Bus”.
After careful evaluation of all the facts and circumstances of the case we are of the
opinion that the decision of the insurance company to repudiate the claim is not based on
valid grounds. The insurer could not establish with credible evidence that there was any
material change (modification) in the bus subsequent to its initial building. We
accordingly set aside erroneous decision of the insurer and direct them to admit the claim
and settle the same as per terms and conditions of the policy within 15 days from the date
of receipt of this award along with consent letter.
********************************************************************************************

Case No. 001/11/G3/NL/04/2012-13
Smt. Mahua Roychowdhury (Sarkar
Vs.
United India Insurance Company Ltd
Order Dated : 25th June, 2012
Both the parties were called for a personal hearing on 18.06.2012. The complainant did
not attend the hearing and sent a letter dated 16.06.2012 stating that she would not
able to attend the hearing. We, therefore, propose to deal with the matter on the basis of
her written submission and other materials submitted to this forum.
The representative of the insurance company on the other hand reiterated their stand as
mentioned in their written submission dated 23.02.2012 and discussed above. He stated
that the claim was settled as per the assessment of the surveyor who has given full
justification for the deductions made for excessive labour charges.
DECISION:
The complainant has approached this forum against arbitrary deduction of labour charges
by the insurance company. On verification of the documents, we find that the main
dispute centres around 3 issues as under:-
Items Estimate Amount allowed by

surveyor
a)Painting charges Rs.7000/- Rs.6500/-
b)Nickel Plated Hood For nickel plate Allowed Non plated

Moulding hood moulding Hood for Rs.777.17
Rs.3273/-
c)Repairing/Denting Rs.10000/- Rs.3585/-

charges for i) Rear RH
Quarter Panel, ii) Hood,iii)
Rear RH Door
It is seen from the surveyor’s report that that painting charges have been restricted to the
damage consistent with the accident and Rs. 6500/- has been allowed against total
estimate of Rs.7000/-, which is reasonable. Regarding Nickel Plated Hood, the Surveyor
has obtained clarifications from Toyota Kirloskar Motor Ltd (TKML) and TKML has
confirmed that ‘Nickel plated hood’ is not serviceable in the referred model of vehicle.
Hence, it was not allowed by Surveyor. This disallowance is in order. As regards
repairing/denting charges for i) rear RH quarter panel, ii) hood and iii) rear RH door, the
surveyor has allowed only Rs. 3585/- against estimate of Rs. 10000/- and actual bill of Rs.
8000/-. The surveyor has explained that the complainant has obtained the estimate from
local repairer and not from the authorized dealer and the amount allowed by him is based
on the experience for such repairs in the local market where the rates vary between 10%
to 15% from garage to garage. Going by this estimate, disallowance of more than 50% out
of billed amount of Rs 8000/- does not appear to be justified.
After careful evaluation of all the facts and circumstances of the case, we are of the
opinion that a deduction of 15% due to cost variation in the local market and other
factors as pointed out by the surveyor would be reasonable. Accordingly, we further allow
a further amount of Rs.3,200/- over and above the amount already settled by the
insurance company.
The insurance company is directed to pay Rs.3,200/- (Rupees three thousand two hundred
only) to the complainant within 15 days from the date of receipt of this award along with
consent letter.
********************************************************************************************

Case No. 346/11/013/NL/09/2011-12
Shri Mithilesh Kumar Gupta
Vs.
HDFC ERGO General Insurance Company Ltd.,
.
Order Dated : 23rd July, 2012
Both the parties were called for a personal hearing on 16.07.2012. The complainant
attended and explained the facts and grounds of his complaint. He vehemently denied
that the surveyor had visited the garage on 16.12.2010 as stated in the survey report. He
alleged that the estimate was prepared on 17.12.2010 after discussion with the surveyor
and an amount of Rs.14,990/- was agreed upon, but the insurance sanctioned only Rs.
4262/- which he has refused to accept on the basis of a fabricated survey report.
The representatives of the insurance company on the other hand reiterated their stand as
mentioned in their written submission dated 26.06.2012 and discussed above. They stated
that the surveyor had surveyed the damage vehicle after the prima job was done and
therefore, it was not possible for him to assess the loss of the damaged bonnet and some
other parts. He approved only the repair of broken windshield. They have settled the
claim as per the amount estimated by the surveyor.
DECISION:
The complainant has approached this forum against partial repudiation of his claim on the
basis of the surveyor’s report disallowing accidental damages to the bonnet etc. From the
analysis of the facts, we find that the complainant had purchased a brand new Chevrolet
Beat car on 19.11.10 and obtained an insurance cover from HDFC ERGO General Insurance
Company for the period from 29.11.2010 to 28.11.2010. The date of loss/damage was
12.12.2012 i.e. just within 22 days of the purchase. This fact is not disputed. However, no
police diary was made, nor any intimation was given to the Insurance Company on the
date of loss or on the next day. When asked about the reason, the complainant explained
that he was not aware of the requirements/ procedure for claim settlement. It is further
seen that the complainant took the car to the workshop on 14.12.2010 and the manager
informed the surveyor about the incident and thereafter, on the advice of the surveyor he
made a police diary on 14.12.2010 and lodged a claim on 15.12.2012. The complainant has
disputed that the surveyor had inspected the vehicle on 16.12.2010 when his car was
under repair. As per his statement, the workshop informed him on phone that the
surveyor had not inspected the car till 17.12.2010. The complainant could not explain why
at this stage he did not consider it necessary to contact the insurer or the surveyor directly
to ascertain the position. Instead he asked the workshop for an estimate and received it
by fax for an amount of Rs. 18,960/- which was not approved by the surveyor. On
18.12.2010, he was informed by the workshop that the survey had been done and the
repair sanctioned. Based on the telephonic intimation, he asked the workshop to complete
the job without waiting for the written estimate of the surveyor.
From the above facts it is clear that the complainant was all along communicating with
the workshop owner and acting as per his advice instead of directly communicating with
the insurer or the surveyor. If there was any delay on the surveyor’s part, the complainant
should have given a notice to the Insurance Company before starting the job. The
insurance company on the other hand, have stated that the surveyor had visited the
garage on 16.12.2010 and found that the vehicle was already given for repairs and the
prima work was completed due to which the surveyor could not inspect the damaged
parts and approved the claim only for wind shield glass as it was not replaced prior to
inspection. A copy of the survey report has been filed, which shows the date of survey as
16.12.2010. But we find that the survey report is silent on the following points.
 The surveyor found the vehicle under repair and some parts (Bonnet) in prima
condition. This clearly indicates that there were some damages for which prima
was used before final painting. These damages were totally ignored by the
surveyor.
 The car was purchased just 20 days back and the probability of accumulated
damages is very low.
 In the police diary made on 14.10.2010, the complainant had reported damage on
the bonnet and the side bar of the windshield. This has not been disputed by the
police.
 There was no written agreement/disagreement between the surveyor and the
workshop on the items disallowed by the surveyor.
In view of the above points the surveyor’s report cannot be accepted in totality,
After careful evaluation of all the facts and circumstances of the case, we are of the
opinion that there are contradictions in the statements and submissions of both the
parties. The insurer has failed to establish that there were accumulated damages in the
new care purchased few days back. The date of survey also remains unconcluded and the
absence of any note of agreement makes it difficult to know what exactly transpired
between the surveyor and the workshop. Under the circumstances, total denial of claim
for repair of bonnet and other parts under prima etc is not justified. The complainant also
cannot get full relief as he repaired the vehicle without waiting for the surveyor’s
estimate. We, therefore, allow a total relief of Rs.11,000/- which will meet the ends of
justice. Insurer has already paid Rs.4,263/-. We direct the insurance company to pay
balance amount of Rs.6,737/- (Rupees Six thousand seven hundred thirty seven) only to
the complainant..
********************************************************************************************
Case No. 346/11/013/NL/09/2011-12
Smt. Chaitali Mishra
Vs.
HDFC ERGO General Insurance Company Ltd.,
Order Dated : 28th August, 2012
Both the parties were called for a personal hearing on 23.08.2012. The complainant was
represented by her husband Shri Piyush Kumar Mishra who explained the grounds of
complaint. He stated that he had lodged an F.I.R with the local police station but did not
take a copy. However, the F.I.R number was duly intimated to the insurer through the
claim form, which could have been investigated by the Insurer. Moreover, the surveyor
has stated in his report that the pre accidental condition of the vehicle was good. He
further stated that although the insurer has expressed doubt about the nature of damages,
but the accident stands established by the Surveyor report.
The representatives of the insurance company on the other hand reiterated their stand as
mentioned in their written submission dated 07.08.2012 and discussed above. They also
produced the photographs of the damaged vehicle taken by their surveyor.
DECISION:
The complainant has approached this forum against repudiation of her motor vehicle
claim on the ground that the damages sustained to the insured vehicle are not relevant to
the cause of accident as mentioned in the claim form. From the documents submitted to
this forum we find that the insured had taken a Private Car Package Policy for the period
from 30.06.2010 to 29.06.2011. The insured vehicle met with an accident on 22.05.2011
near N.R.S Hospital, APC Road. The complainant mentioned in her claim form that the
insured vehicle had hit the rear portion of a truck which came all of a sudden from a by
lane. Due to the impact the vehicle was badly damaged on the front. The incident was
reported to the Muchipara Police Station vide F.I.R No. 79/11 dated 22.05.2011. The
insurance company was also intimated in time and surveyor was deputed to assess the
loss. The surveyor assessed the loss at Rs.35,119/- as against the claimed amount of
Rs.1,00,109/-. The surveyor did not make any enquiry with the local police station,
although the F.I.R number was provided to the insurance company. The reason for not
enquiring with the local police could not be explained by the representative of the insurer.
The surveyor has given his own reasons for coming to the conclusion that the damages
sustained to the vehicle are not relevant with the cause of accident. However, we find that
the surveyor has not doubted the genuineness of the accident and the damages. The
difference is only in the perception of the accidental situation. The complainant has
mentioned that her vehicle had hit a mini truck whereas the surveyor’s opinion is that the
nature of damage sustained by the vehicle can arise from being hit by some stationery
object. From the photographs produced by the insurer, we find that there were heavy
damages on the front side of the vehicle. This has also been mentioned in the surveyor’s
report. Looking at the nature of the damages, it cannot be said that these were pre-
existing. We also find that the surveyor has mentioned in his report that the pre-accident
condition of the vehicle was good which clearly means that the vehicle was damaged by
the accident. The way it occurred may be different as per the versions of two parties. The
insurer has not checked the contents of the F.I.R which was an important document to
establish the cause of the accident. The complainant, on the other hand, has duly
mentioned the F.I.R no. 79/11 dated 22.05.2011 in the claim form which proves her
bonafide intentions.
In view of the above, the repudiation of the claim simply because there was no proper
declaration of the cause of the accident is not justified. The surveyor should have asked
for the detailed cause of the accident before repudiation of the claim. The decision of the
insurance company to repudiate the claim is erroneous and the same is set aside. They are
directed to settle the claim as per survey report.
********************************************************************************************
Lucknow Ombudsman Centre
Complaint No. G-57/11/22/12-13

Award No.IOB/LKO/04/376/22/12-13
Sri Afak Ahmad vs United India Insurance Company Ltd
Fact: A complaint was filed by Sri Afak Ahmad against the decision of United India
Insurance Company Ltd. in repudiating his motor own damage claim on the ground that
the complainant’s dumper was insured as Misc & Special Type of Vehicle with Zero GVW,
while it should have been insured as Commercial Vehicle. The complainant’s submission
was that whatever premium he was asked to deposit, he paid the same to the agent of
respondent company. Now it was the duty of insurer to look that proper underwriting was
done at their end. Aggrieved with the decision of respondent company the complainant
approached this forum.
Finding: It was found by this forum that Respondent co. has made some underwriting
lapse/mistake while insuring the vehicle. Therefore, Efforts for mediation succeeded and
the respondent company’s officials sought some time from this forum to pursue the
matter with their regional office. They were given ten days time to resolve the dispute
involving their regional office.
Decision: During hearing respondent insurance company agreed to settle the claim subject
to deposit the difference amount of premium by the complainant to enable respondent
insurance company to settle the claim. In the light of above the complaint closed at our
end as the dispute is amicably settled.
OFFICE OF INSURANCE OMBUDSMAN
UTTARPRADESH & UTTARAKHAND
6th Floor, Jeevan Bhawan Phase-2,
Nawal Kishore Road, Hazaratganj,
LUCKNOW
Mrs. Poonam Arora VS Shriram General Insurance Company Ltd.
Fact: The complainant’s Truck no. UP42T/5609 was insured with Shriram General
Insurance Company Ltd. for period 31.10.2011 to 30.10.2012 having sum insured Rs.
8,25,000/-. On 04.06.2012 the vehicle loaded with stones, while going from Sukrut to
Faizabad , fell into a dry river by breaking side walls of the bridge. It was taken out of the
river with help of a crane and was shifted to a workshop at Faizabad. The insured
submitted repair estimates for Rs. 15,68,994/-. The insurer arranged for spot and final
survey but as per complainant’s submission the insurers have not asked her to dismantle
the vehicle and start repairs.
Findiing:The respondent company’s surveyors Sri V.K. Srivastava and Sri H.K.
Singh have assessed the loss for Rs. 2,27,362/- and Rs. 2,19,981/- only without
dismantling the vehicle and without considering loss to load body. If the vehicle got
dismantled, then naturally the losses would go upward. But there was a vast difference
between estimated and assessed amount.
Decision: This forum decided to seek opinion of an external expert. Accordingly a

very senior surveyor was asked to submit his opinion on the subject. He assessed the loss
for Rs. 2,68,830/- on repair basis ( Taking load body also into consideration ) and Rs
2,15,297/- on cash loss basis. The complainant had shown his willingness for settlement
on cash loss basis. This forum directed the respondent insurance company to settle the
claim for Rs. 2,15,297/- on cash loss basis .
OFFICE OF INSURANCE OMBUDSMAN
UTTARPRADESH & UTTARAKHAND
6th Floor, Jeevan Bhawan Phase-2,
Nawal Kishore Road, Hazaratganj,
LUCKNOW
Sri Arsh Preet Singh
VS
National Insurance Company Ltd
Fact: Sri Arsh Preet Singh ,The complainant insured his Scorpio Jeep NO. PB09J-
3984 with the respondent insurance company having sum insured Rs.360000.00. The
vehicle got stolen in the night of 24-25 May 2011. FIR was lodged on 25.05.2011 with
police station Mandawali in East Delhi. The insurers were intimated on 21.06.2011 after
about one month of the incident. The insurer observed that there was breach of policy
condition no.1 of private car package policy which states that on happening of any
accident or loss the insurer should be informed immediately. The respondent company
repudiated the claim in the light of above condition.
Findings: The complainant submitted before this forum that he had approached
insurer’s Connaught Place Office and informed the officials who advised him to contact
their Bareilly Office personally. But no corroborative evidence has been produced to prove
this point. FIR no.228 dated 25.05.2011 has been lodged by Sri Iqbal Singh S/o Sri Iswar
Singh whereas as per the complainant, the vehicle was owned by him. The complainant
fell ill just after the incident and could visit the insurer’s office Bareilly only after his
recovery from illness. However no medical certificate or any other reliable evidence has
been placed before this forum to prove this argument. Hence in all fairness, they are
unreliable. The only short coming in this case is default of the complainant in giving
immediate intimation to the company. Vehicle Un- trace report has been duly accepted by
the competent court.
Decision:From the above facts it is established that there is breach of the policy
condition of immediate intimation of the loss to Insurance Company. Hon’ble National
Consumer Disputed Redressal Commission in first Applea no. 321 of 2005. “The New India
Assurance Company Ltd. Vs Trilochan Tahe has held that “Delay in reporting to the insurer
about the theft of the car for 9 days would be a violation of condition of the policy as it
deprives the insurers of a valuable right to investigate the theft and to trace/help in
tracing the vehicle”.
This forum cannot go beyond the express terms & conditions governing the
contract of insurance. Thus the Supreme Court in General Assurance Society Vs
Cahndramauli Jain & other(1966) 3SCR 500 held that “duty of the court is to interpret the
words in which the contract is expressed by the parties because it is not for the court to
make a new contract.”
Forum do not find any room to interfere with the decision of the respondent
company in repudiating the theft claim.

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AHMEDABAD OMBUDSMAN CENTER

Shri Ghanshyamsingh P. Bhati V/s. Reliance General Insurance Co. Ltd.

Award dated 17th April 2012

Repudiation of theft claim under Motor Package Policy

In view of the above, the Respondent’s decision is just and proper.

AHMEDABAD OMBUDSMAN CENTER

Award dated 8th May 2012

Repudiation of Private Car Package Policy

In view of this Respondent rightly repudiated the claim.

Mrs. Bharti K. Vyas V/s. United India Insurance Co. Ltd.

Award dated 9th May 2012

Repudiation of damage claim

In the result complaint succeeds.

AHMEDABAD OMBUDSMAN CENTER

Shri Atul N. Dave V/s. United India Insurance Co. Ltd.

Award dated 14th May 2012

Partial settlement of Motor OD Claim

In the result complaint fails to succeed.

Award dated 29th May 2012

Repudiation of Motor OD Claim

AHMEDABAD OMBUDSMAN CENTER

Award dated 11th April 2012

Partial settlement of Motor OD Claim

Therefore, there is no new ground to interfere in the decision of the Insurer to

Shri Naresh K. Thakker V/s. Oriental Insurance Co. Ltd.

Award dated 11th June 2012

Repudiation of Private Car Package Policy

In view of all these, decision of the Respondent to repudiate the claim is

AHMEDABAD OMBUDSMAN CENTER

Shri Dhamjibhai J. Mehdapara V/s. United India Insurance Co. Ltd.

Award dated 13th June 2012

Repudiation of theft claim under Motor Package Policy

In the result complaint fails to succeed.

Award dated 29th May 2012

Repudiation of Motor OD Claim

AHMEDABAD OMBUDSMAN CENTRE

Award dated 11th April 2012

Partial settlement of Motor OD Claim

Therefore, there is no new ground to interfere in the decision of the Insurer to

Shri Naresh K. Thakker V/s. Oriental Insurance Co. Ltd.

Award dated 11th June 2012

Repudiation of Private Car Package Policy

In view of all these, decision of the Respondent to repudiate the claim is

AHMEDABAD OMBUDSMAN CENTRE

Shri Dhamjibhai J. Mehdapara V/s. United India Insurance Co. Ltd.

Award dated 13th June 2012

Repudiation of theft claim under Motor Package Policy

In the result complaint fails to succeed.

Mrs. Pannaben S. Naik V/s. Oriental Insurance Co. Ltd.

Award dated 16th July 2012.

Repudiation of theft claim under Motor Package Policy.

In view of these the complaint fails to succeed.

Award dated 12th September 2012

Repudiation of Private Car Package Policy

Complainant lodged an accidental damage loss of Rs.12,250/- to his insured Car

AHMEDABAD OMBUDSMAN CENTRE

Shri Rahul R. Patel V/s. United India Insurance Co. Ltd.

Award dated 28th September 2012

Repudiation of Motor theft claim

Claim intimation also 5 days late from the date of stolen.

Bajaj Allianz General Insurance Co Ltd

Award No. IO(CHN)/G/003/2012-13 dt.20/4/12

The complaint was allowed.

Chennai Ombudsman Centre