Ombudsman Cases

AHMEDABAD
Ahmedabad Ombudsman Centre

Case no 11-004-302-11
Mr. Minesh R Shah
Vs
United India Insurance Company Ltd
Award Date: 23.07.2010
Non Settlement of Claim under Motor claim policy: The complainant

has submitted the claim for reimbursement of loss occurred due to theft
of the vehicle. The respondent has rejected the claim stating that the
intimation was submitted late. As a result of mediation by this forum,
both the parties mutually agreed for payment of the claim for Rs 23500/
.The grievances thus resolved.
Case No.11-010-0531-10
Mr. Shaji Sadasivan
V/s.
IFFCO Tokio General Insurance Co. Ltd.
Award dated 23-06-2010
Partial repudiation of Claim under Motor Car O.D Policy.
The Respondent had decided to partially settle the claim of

Motorcar damaged due to accident on the basis of the Surveyor’s Report
treating the damage as partial loss.
The complainant submitted that his damaged jeep was handed
over to the authorised dealer of the manufacturing company and the
surveyor has advised to change the body of the jeep, but the surveyor
had submitted his report to the Respondent without giving intimation
and without obtaining his signature for lesser amount than the actual
charges.
The Respondent submitted that they had settled the claim based
on the surveyor’s report after deducting expected salvage value.
This forum also obtained independent opinion from a surveyor who
opined that body shell was repairable and not required to be replaced.
Therefore the Respondent’s decision of settling the claim based on their
surveyor’s report was upheld.
In the result, the complaint fails to succeed.
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Case No.11-003-0268-11
Mrs. Geetaben H. Pathak
V/s.
National Insurance Co. Ltd.
Award dated 18-08-2010
Delay in settlement of Motor OD and PA claim:
The claims were not paid by the Respondent on the grounds of non
submission of driving license of the deceased insured who was driving
the vehicle at the time of accident and died in the accident.
The Complainant submitted that driving license scattered on the
road along with other materials at the time of accident and could not be
traced.
This forum decided that Respondent was justified in rejecting the
subject claim as per terms and conditions of the motor policy.
In the result, complaint fails to succeed.
Award dated 15.6.2010

Case No. 11-008-0110-11
Mr. Dipak J Thakkar
Vs.
Royal Sundram Insurance Co. Ltd
Motor Car Policy
The claim was repudiated on the grounds that damage to the
vehicle was not due to any external impact.
Hence the point for determination is whether the documents adduced,
prove the ground for Repudiation. To its examination, we turn now.
The Respondent was requested to submit full facts of the case along
with the copies of the documents in support of their decision however
they have not submitted any document or evidence in support of their
decision till date. This shows that they have no document or evidence to
support their decision.
It shows that respondent processed the claim and then called for
requirement as per their letter dated 10.12.2009 to confirm genuineness
of payment by the complainant. Subsequent action of repudiation by the
respondent has no logical sequence. Further the respondent has not
submitted facts of the case along with the copies of the documents in
support of their decision. Respondent was also not present during the
hearing.
In the absence of any representation by the respondent and
considering the facts of the case and materials on record. Respondent’s
decision to reject the claim was not justified.
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Case No. 11-013-0096-11
Mr. Dharmesh B Patel
Vs.
ICICI Lombard Gen.Insurance Co. Ltd
Motor Car Policy
Claim had been repudiated on the ground that the complainant had
violated condition of the policy provisions while lodging the claim
rendering the same as inadmissible.
Condition 1 of the policy provision. The said condition interalia
requires that the insured should give notice in writing to the company
immediately upon the occurrences of any accidental loss or damage.
Date wise activity chart made it obvious that the FIR was lodged after 14
days from the date of loss and that the intimation of loss was made available with
Respondent with in 23 days thereafter.
In the case of theft where no bodily injury has been caused to the insured,
it is incumbent upon the complainant to inform the police about the theft
immediately, say within 24 hours, otherwise, valuable time would be lost in
tracing the vehicle. Similarly, the insurer can verify as to whether any theft had
taken place and also to take immediate steps to get the vehicle traced. The
insurer can coordinate and cooperate with the Police to trace the vehicle. Delay
in reporting to the insurer about the theft of the vehicle for 23 days, would be a
violation of condition of the Policy as it deprived the insurer of a valuable right to
investigate as to the commission of the theft and to trace/help in tracing the
vehicle.
The case was dismissed

Case No. 11-011-0345-11
Mr. Jitendra Gajera
Vs.
Bajaj Allianz General Insurance Co.Ltd.
Vehicle Insurance Policy
A claim relating to two wheeler Insurance Policy for theft of the
vehicle was repudiated invoking clause 4 on the ground that the
complainant had not taken all reasonable steps to safeguard the vehicle
from loss.
The Respondent produced FIR dated 17.12.2009 lodged by father
of the complainant according to it the vehicle was parked near RMC
office without handle lock.
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It was observed that the Respondent has convincingly proved and
produced evidence to the effect that the loss was caused by gross
negligence of the complainant and he had not taken reasonable steps to
safeguard the vehicle from loss. So the rejection of the claim by the
Respondent was justified.
BHOPAL
CATEGORY: MOTOR O.D.

SUB CATEGORY: TOTAL REPUDIATION OF CLAIM
Mrs Preeti Kaushal……….……………………………………....Complainant
V/s
Oriental Insurance Co. Ltd., Indore………………… ………….Respondent
Order No.: BPL/GI/10-11/006 Case No.: GI/OIC/0912/95

Order Dated 8.04. 2010
Brief Background
Mrs. Preeti Kaushal (hereinafter called Complainant) had obtained a Motor Policy No.
151208/31/2008/08982 for her Hero Honda Motor Cycle No.MP09/JQ/3673 under
Motorized Two Wheeler Package Police for the period from 08.03.2008 to 07.03.2009
for I.D.V. Rs. 14800/- from Oriental Insurance Co. Ltd. Indore (Hereinafter called
Respondent).
As per the complainant her vehicle stolen by unknown on 13.11.2008 when it was
parked at Military Canteen, Shahjahanabad, Bhopal and the matter was reported to
Policy station Shahjahanabad on same day and the intimation to Respondent was sent
by ordinary post on 2.12.2008 and by fax on 17.12.2008 and all the relevant documents
were submitted for Theft Claim but the claim is repudiated by Respondent for the reason
of Delay in intimation for Theft Claim. The complainant further approached higher office
of Respondent but there also no response. Aggrieved with the decision of the
Respondent, complainant approached this forum for necessary settlement of claim.
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The Respondent vide its Self contained letter dated 3.4.2009 along with Investigation
report and other related documents submitted that the Theft of vehicle was intimated to
office on 17.12.2008 i.e. after 34 days of theft whereas the same should have been
given within 48 hours of its occurrence as per our Policy condition therefore, the claim
was repudiated and was conveyed to complainant vide their letter dated 25.6.2009.
Observations:
It is an admitted fact that the Complainant‟s vehicle was covered under the above
mentioned Policy and stolen on 13.11.2008 by unknown for which the intimation to
Police was given on same day and the case is registered by Police vide F.I.R.No.626
dated 13.11.2008 under section 379 IPC and also that there is Delay in intimation of
Theft to the Respondent. During hearing the complainant Reiterated almost all the points
as mentioned in the main complaint letters and stated that the Policy is issued from
Indore Office and theft was occurred in Bhopal and they were in the impression that the
intimation to Respondent should have been given after issuance of Final Report by
Police therefore, there is delay in intimation to Respondent. On the other side the
Respondent stated that there is only delay in intimation to their office and to the RTO as
well which found violation to the Policy condition therefore, the claim is repudiated but
otherwise the claim seems to be in order. On asking the Respondent explained that
there is no saving in premium and contribution to loss by delay in intimation to office
because the matter is timely reported to Police and their own investigator also confirmed
the occurrence of theft. The Respondent also stated that the F.R. submitted by
complainant is issued by S.P.Office and not duly approved by Court then the forum
asked the Respondent that what is the need of court approved F.R. when the
investigation is closed by Police and certificate to this effect is issued by S.P.Office? The
Respondent could not reply in positive but stated that it is a usual requirement in Theft
claim.
In view of the circumstances stated above, it is found that the Repudiation of Theft
claim due to delay in intimation of Theft of Vehicle to Respondent office is not just and
fair if otherwise the claim is genuine and payable. In above case the theft is promptly
intimated to Police authority that is the legal and authenticate agency for the above case
and there is no negative comment neither in Police investigation nor in the Investigation
report done by Mr. Uma Shankar Das deputed by Respondent and the Final
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investigation report has been issued by S.P.Office being undetected and unrecovered.
Simultaneously, the Complainant is also found fail to comply with the Policy condition as
regards to intimation of theft within 48 hours and there is also an inordinate delay ( after
4 months) in intimation to R.T.O. Since there is violation of Policy condition is
established but the same violation is neither contributory to the loss nor saving in
Premium, hence, the claim may be settled after imposing some penalty in the claim
amount. Therefore, the Respondent is directed to settle the claim upto 75% of total
payable claim amount which comes to Rs. 11100/- to the complainant within 15 days
from the receipt of consent letter and other usual compliances i.e. letter of
subrogation, Letter of Indemnity etc. (without waiting for the court approved Final
Report,), as required in Motor theft claim from the Complainant, failing which it will
attract a simple interest of 9% p.a. from the date of this order to the date of actual
payment.
========================END=============================
CATEGORY: MOTOR
SUB CATEGORY: TOTAL REPUDIATION OF CLAIM
Shri Yogesh Singh Chauhan... ……………………..…..……… Complainant

V/s
Iffco Tokio General Insurance Co.Ltd,.………...…...............Respondent
Order No.: BPL/GI/10-11/008 Case No.: GI/ITG/0912/096

Order Dated 12.04.10
Brief Background
Shri Yogesh Singh Chauhan (hereinafter called Complainant) reportedly paid premium in
cash to the Agent of Respondent for the Insurance of his Vehicle No. UP95 B-0572
Toyota Innova Car for the Sum Insured of Rs. 588000/- and received a Cover note No.
36783370 for the period from 2.8.2008 to 1.8.2009 later on received a Motor Policy No.
39581796 from Iffco Tokio Gen. Insu. Co. Ltd., Jabalpur (Hereinafter called Respondent)
As per the complainant premium for Rs. 14042/- in cash was paid to Respondent‟s
Agent Mr. Kamal Kant on 2.8.2008 for the Insurance of his Toyota Innova No. UP95 B-
0572 and received cover note for the same later received Policy for the same and
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vehicle met with an accident on 22.5.2009 which was informed to the Respondent for the
claim but no action has been taken till now. The complainant approached in writing to
the Respondent‟s Bangalore Office vide his letter dated 23.9.2009 along with the Bills of
Repairing of vehicle but no action has been taken. Aggrieved with the non settlement of
claim, complainant approached this forum for necessary settlement of claim for Rs.
425000/-
The Respondent vide its letter dated 25.02.2010 together with claim related documents
submitted that the said case and claim is not reported to their any of office and only the
documents are received from the Insurance Ombudsman office and after verifying the
antecedents of above case they observed that the above cover note book is issued to
their authorized Agent Mr. Pradeep Tiwari under his Agency code No. 2100253 and
there is no agent naming Mr. Kamal kant and the signature on the cover note are also of
Mr. Pradeep Tiwari who has issued the above cover note No. 36783370 for the
insurance of vehicle No. UP95 B-0572 after receiving the premium Cheque No. 364895
dated 2.8.2008 drawn on S.B.I. Khajuraho which was deposited by their underwriting
Office, Jabalpur to Bank vide their Deposit slip No. U22812980 on 19.8.2008 for clearing
but the same cheque dishonored by Bank due to Insufficient Funds. The Respondent
further added that the intimation about the Cancellation of above Policy due to Cheque
Dishonored was given to Complainant by their Jablapur office by Regd. Post on
14.11.2008 at the complainant‟s address available in the Policy. It is also mentioned by
Respondent that his intimation for claim was registered on the toll free No. vide Ref.
Nos. 5-AqL70A and 2 ADF1-GH but the claim could not be registered because the
Policy was not in force and the same was also conveyed courteously to complainant that
due the aforementioned reason “Cheque Bounced” his claim would not be registered
and they are not liable for aforementioned claim. The Respondent further mentioned
that the matter is also investigated by Mr. Sher Singh, Investigator deputed by them and
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as per the Investigation report it is found that the above vehicle is attached to M/s Travel
add Tours and Travels, Khajuraho under the Proprietorship of one Mr. Shailendra
Upadhyay who is well known to Owner of vehicle Mr. Yogesh singh Chauhan and the
above Insurance was obtained by giving the Cheque issued by Mr. Shailendra
Upadhyay which got bounced and accordingly the Policy was cancelled vide their
registered letter dated 14.11.2008 well before the date of Accident. It is finally
concluded by Respondent in the self contained note that the claim was not registered as
the Policy was not in force and they are not liable for above claim.
For the sake of natural justice the hearing was held on 09.04.2010 at Bhopal where the
Complainant was represented by his brother Mr. Sarvesh Singh Chauhan duly
authorized by Complainant in writing while the Respondent was represented by Mr.
Saaju Anthony, Business Head, Bhopal.
Observations:
It is an admitted fact that the cover note No. 36783370 was issued to the Complainant
by Respondent for the Insurance of above mentioned Vehicle for the period from
2.8.2008 to 01.08.2009. During the course of hearing the complainant‟s authorized
representative reiterated almost all the points as mentioned in the main complaint letter
and stated that the Premium was paid in cash to the Authorized Agent Mr. Kamalkant
but the same was deposited by Agent to Respondent‟s office through his Cheque hence
they are not responsible for the Dishonor of Cheque. On asking it is stated by
Complainant that the Premium in cash was given to Mr. Kamal Kant by their relative
driver Mr. Vinod Singh for the Insurance of Innova Car. On asking the Complainant also
stated that the intimation of claim was given on Phone and not in writing and also there
are no claim form, Estimate of Loss and other documents are submitted to Respondent
and also that the vehicle got repaired without Survery by any Surveyor as not deputed
by Respondent. On asking that why the claim form and Estimate of Loss are not
submitted to Respondent for claim and why the vehicle repaired without the survey of
Respondent‟s Surveyor?, it is stated by Complainant that they waited for 3 days for
Surveyor but no surveyor visited hence they got repaired. On asking that why the claim
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is not intimated in writing and why the claim is not followed up in writing with the
Respondent? It is stated by complainant that it is their mistake that they did not follow-up
the matter in writing. On asking it is also stated by Complainant that his brother Mr.
Yogesh singh was not at Khajuraho on the day of Insurance and the same is arranged
by their representative only. On the other side the Respondent by producing the
Investigation report, Letter written to complainant about the Cancellation of Policy etc.
stated that the Policy issued to above vehicle stands cancelled ab initio due to Cheque
dishonor by Bank for the reason of insufficient Fund therefore, there is no question of
Claim for the damages to above vehicle. The Respondent firmly stated that Mr. Kamal
kant is not their Authorized Agent and even their company don‟t know about Mr. Kamal
kant. The Respondent also shown the Regd. Post Receipt dated 14.11.2008 of Post
Office and written Statement of Mr. Pradeep Tiwari, an Authorized Agent. I have
personally gone through the above produced Statement of Agent Mr. Pradeep Tiwari
and as per statement it found that the above cover note was issued after receiving
the Cheque No. 364895 and previous insurance documents and the same were
sent to Jabalpur office by the agent and after some time it was came into the
knowledge of agent that the cheque is bounced for which the information was
given to complainant over phone. The forum asked the complainant to produce any
evidence confirming that the premium was paid in cash to Authorized Agent Mr. Pradeep
Tiwari but the same could not be produced by Respondent‟s representative. I have also
gone through the aforesaid Cover note in question and observed that there is no
mention about the collection of Premium in CASH.
In view of the circumstances stated above and on going through the documents
i.e. cover note, Investigation report, Statement of Agent Mr. Pradeep Tiwari etc. as made
available by both parties, it is found that the above Policy was not in force as on the date
of Accident being cancelled ab initio by the Respondent on 14.11.2008 due to Dishonor
of Premium Cheque. There is sufficient ground to understand that the premium was
paid by cheque issued by Mr. Shailendra Upadhyay from his S.B.I. account, who
later established as close Associate of owner of the vehicle. Simultaneously there is no
documentary evidence proving that the Premium was given in cash to Mr. Pradeep
Tiwari, an Authorized Agent. Under the circumstances the Respondent can not be held
liable to pay the above claim. The complaint is dismissed without any relief.
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=========================END=========================
CATEGORY: MOTOR
SUB CATEGORY: DELAY IN SETTLEMENT OF CLAIM
Smt. Pushpawanti Batra………..,………………………………. Complainants

V/s
National Insurance Co. Ltd…...............................................Respondent
Order No.: BPL/GI/1011/009 Case No.: GI/NIC/1001/98

Order Dated 12.04.2010
Brief Background
Smt. Pushpawanti Batra, (hereinafter called Complainant) had taken a Motor Policy No.
321102/31/2006/6300007892for the period from 31.01.2007 to 30.01.2008 from National
Insurance Co. Ltd., Indore (Hereinafter called Respondent) covering his Tata Truck
No. MP-09-GE-1473 for S.I. of Rs. 900000/-
As per the complainant the insured vehicle was met with an accident on 14.05.2007 and
the claim was submitted to Respondent but the same was rejected by Respondent vide
their letter dated 16.7.2008 on the ground that the driver on wheel at the time of accident
does not have valid and effective Driving License. It is further mentioned that the first
Driving License No. M-2795/JHS/88 for the period from 13.5.1988 to 12.5.1993 was
issued by Licensing Authority, Jhansi and got subsequent renewed from Licensing
Authority Ujjain where the original No. of D.L. issued by Jhansi is mentioned as
7975/JHS/88 while other details are same by Ujjain RTO. The Respondent further
mentioned that the above mistake was noticed when the same is investigated by
Investigator deputed by Respondent. The Complainant further mentioned that it is a
mistake done at RTO but the D.L. was valid at the time of Accident hence the claim
should be paid. The complainant further approached the higher authority of Respondent
but the claim is not settled. Aggrieved with the non settlement of claim, complainant
approached this forum for the necessary settlement of claim for 163493/-
The Respondent vide its Self contained letter dated 18.01.2010 submitted that on
representation by complainant they have advised the complainant vide their letter dated
10
6.11.2009 where in it is mentioned that on verification from RTO Jhansi the Driving
License No. 2795/JHS/88 as produced by complainant found not issued by RTO Jhansi
and in response thereof the complainant produced another Driving License containing
D.L.No. M-2795/JHS/88 but the same Number is different from the record of Ujjain RTO
where the same License is said to be renewed by them. The Respondent asked the
complainant to get the correction in the record of Ujjain RTO in support of their
contention that it is done by an oversight by Ujjain RTO.
Observations:
It is an admitted fact that the Complainant‟s vehicle was covered under Motor Policy No.
321102/31/2006/6300007892for the period from 31.01.2007 to 30.01.2008 from National
Insurance Co. Ltd., Indore covering his Tata Truck No. MP-09-GE-1473 for S.I. of Rs.
900000/- It is also an admitted fact that the above Truck met with an accident on
14.5.2007. During the course of hearing the complainant‟s representative reiterated
almost all the points as mentioned in complaint letters and stated that it is a mistake by
RTO Ujjain and now they are not correcting the same but the Driving License is valid
and effective. On the other side the Respondent stated by submitting the D.L.verification
report of Investigator Mr. Hari Mohan Gupta that in the above case the D.L. as produced
by complainant in the above claim was got verified from Ujjain R.T.O. where it was found
that originally the above License is issued by Jhansi RTO vide their No. 7975/Jhansi/88
for the period from 13.5.88 to 12.5.93 then the same was got verified from RTO Jhansi
and on verification from Jhansi it was informed by the In-charge Licensing Section of the
ARTO Jhansi that the “General D.L. Numbers are comprising 5 digits Numerical
numbers issued in the year 1988 and the concerning D.L.No. 7975/JHS/88 has not
been issued in the year 1988 from RTO Jhansi” causing the above D.L. as Bogus,
consequently, the Claim was repudiated on the above ground and was conveyed to
complainant vide their registered letter dated 16.7.2008. The Respondent further stated
that the on receipt of complainant‟s representation letter dated 7.7.2009 along with the
copy of Duplicate License said to be issued by LA Jhansi on 9.1.2009 they observed that
the D.L.Number M-2795/JHS/88 as mentioned in the Duplicate License is different from
the Number 7975/88/JHS as mentioned in the record of Ujjain RTO, therefore, it was
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advised to the complainant to get it corrected in the RTO Ujjain if it is a mistake done by
RTO Ujjain in their Record but the same is not being produced by Complainant. The
forum asked the complainant to produce any document from Ujjain RTO confirming that
it is a mistake in their record, it is replied that the RTO is not providing the same.
In view of the circumstances stated above and on going through the documents
made available by both the parties, it is established that the instant case raises
complicated questions of facts for which there is need for verification of above Driving
License record at Jhansi RTO and Ujjain RTO as well and also need for
Admission/Denial of documents, summoning of witnesses, examination and cross
examination etc., for which this Forum is not Empowered. Therefore, to the sake of
natural justice, the Complainant is advised to take recourse to any other Redressal
Forum considered appropriate for the resolution of the subject grievance.
==========================END==========================
BHUBANESWAR
BHUBANESWAR OMBUDSMAN CENTER
Complaint No.11-012-0659
Sri Gopal Chandra Sahoo
Vrs
ICICI Lombard General Insurance Co. Ltd., Bhubaneswar
Award dated 01st April, 2010

Complainant had insured his car with ICICI Lombard General Insurance Co Ltd and a
claim was preferred for an accident which the vehicle met with on 03.07.2009, very much
within policy period. Complainant lodged the claim which insurer repudiated on the
ground that complainant misrepresented facts on his previous insurance and enjoyed no
claim bonus, where as he had lodged and received payment in 2 claims under previous
insurance policy with IFFCO TOKIO Gen Insurance Company.
Hon‟ble Ombudsman heard the case on 25.02.2010, where complainant was
present but insurer was not represented. Neither the proposal form in original was
produced nor ,the circumstance under which the bonus was granted ,explained. But
strong exception was taken by the ombudsman on the fact that the insurance company did
not bother to verify the previous policy particulars and claims immediately after receiving
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the premium, in which event the policy could have been cancelled. Checking previous
policy after reporting of a claim is highly irregular. Hence set aside the repudiation
decision of insurer and directed them to settle the claim.
*************
Sri Dillip Kumar Bej
Vrs
Future Generali Insurance Co. Ltd., Bhubaneswar
Award dated 13th April, 2010

Complainant had insured his truck with Future Generali Insurance Co Ltd and a claim
was preferred for an accident which the vehicle met on 10.07.2009. A claim was lodged ,
which the insurer repudiated on the ground that the loss to the vehicle was not in an
accident.
Hon‟ble Ombudsman heard the case on 25.02.2010 in presence of both the

parties. After hearing complainant and going through documents submitted by both
parties held that the load challan, the bone of contention was issued without quoting any
weight, as weighing of sand is never done at the sand quary and was there fore wrongly
filled up before submitting to insurance company. However the quarry owner has
clarified in an affidavit that the truck was carrying normal load. There fore the decision of
repudiation was set aside and insurance company was directed to pay Rs 85,000/- as per
surveyors assessment.
*************
Smt Sabita Rani Panda
13
Vrs
National Insurance Co. Ltd., Bhubaneswar DO-II
Award dated 21st April, 2010

Complainant had insured her bus, bearing, Regn No- OR 07 P 8373, with National
Insurance Co Ltd and a claim was preferred for an accident which the vehicle met on
27.10.2008.Complainant preferred a claim which was settled on non standard basis for
the reason that the number of passengers carried was in excess of permissible capacity.
Hon‟ble Ombudsman heard the case on 25.02.2010 where both parties were
present. After hearing both parties and perusing the documents of the vehicle including
the police report, Hon‟ble Ombudsman observed that there is no mention of excess
passengers either in police report or any investigation findings by the insurance company.
Rather complainant produced document to prove the list of passengers submitted to the
RTO. Hence the settlement of the claim on non standard basis is not proper. Insurer is
directed to pay Rs 1,22,965/- as assessed by the re inspection surveyor
*************
Sri Surendra Kumar Kar
Vrs
Reliance General Insurance Co. Ltd., Bhubaneswar
Award dated 23rd April, 2010

Complainant had insured his Tata Truck bearing Regn No- OR-09-C-7010 with the above
insurance company. The vehicle met with an accident on 28.08.2008. A claim was
reported. Insured did not settle the claim for a long time.
Hon‟ble Ombudsman heard the case on 16.03.2010 where complainant was
present alone. Neither self contained note was filed nor any one appeared on behalf of
insurer during hearing. After hearing complainant and perusing the documents available
on record, Hon‟ble Ombudsman directed insurer to settle the claim as admissible within
one month, failing which to pay interest @ 18% from date of order till date of payment.
*************
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Sri Surendra Kumar Kar
Vrs

Complainant had insured his Tata Truck bearing Regn No- OR-09-C-7010 with the above
insurance company. The vehicle met with an accident on 28.08.2008. A claim was

on record, Hon‟ble Ombudsman directed insurer to settle the claim as admissible within
one month, failing which to pay interest @ 18% from date of order till date of payment.
*************
Smt Namita Mishra
Vrs
New India Assurance Co. Ltd., Bhubaneswar DO-I
Complainant had insured her truck bearing Regn No- ORE-09E-2140 with new India
Assurance Co. Ltd., which met with an accident on 26.03.2009.A claim for Rs 3,52,750/-
was lodged with insurer. The Insurer settled the claim for only Rs 66,000/-.
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Hon‟ble Ombudsman heard the case on 16.03.2010, where both sides were present. The
insurer submitted that the claim was settled after deducting some amounts, where bills
were not submitted. The settlement was agreed to by the husband of the insured. On the
other hand the settlement was challenged to be on lower side by the complainant.
Ombudsman held that the assessment of the surveyor has not been challenged and is
found to be in order and hence dismissed the complaint.
*************
Md Rahish Alam
Vrs

Complainant had insured his Tata Indica Car, bearing Regn No- OR-02-AY-8754 with
the above insurance company. The vehicle met with an accident on 18.10.2009. A claim
was reported. Insured repudiated the claim.
on record, Hon‟ble Ombudsman held that the contention of insurer is wrong as the
premium was paid in cash for the cover note issued to the vehicle, rather than by cheque
as reported and hence directed insurer to settle the claim as admissible within one month,
failing which to pay interest @ 18% from date of order till date of payment.
*************
Smt Bishnu Priya Sahoo

Vrs
Oriental Insurance Co. Ltd., CBO, Bhubaneswar
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Award dated 29th April 2010
Complainant had insured his Tata Indica Car OR-05-W-2157 with Oriental Insurance Co.
Ltd., which met with an accident on 17.01.2007 night. Both police and Insurance
Company were informed. The claim was assessed. But insurer repudiated the claim on
the ground that the salvage of the vehicle was not returned to insurer for releasing
payment.
Hon‟ble Ombudsman heard the case on 16.03.2010 where both sides were present. After
hearing both sides and perusing documents held that there is nothing wrong in the stand
point of insurer for demanding salvage as the claim was assessed for a total loss
settlement. There fore directed insurer to settle the claim on cash loss basis in absence of
salvage , within a month if salvage is not produced.
*************
Smt Samita Lenka
Vrs
New India Assurance Co. Ltd., Jajpur Road DO.
Complainant had insured her Jeep bearing Regn No- OR-02AU-6141 with New India
Assurance Co. Ltd., which met with an accident on 16.11.2008.A claim was lodged. But
insurance company repudiated the claim on the ground that there was miss representation
of material facts while availing insurance.
insurer submitted that the claim was repudiated because of the fact that while taking
insurance the complainant disclosed the vehicle to be a commercial vehicle but got it
registered as a private vehicle. This amounts to change in classification of the vehicle and
miss representation of material fact. Ombudsman agreed to the contention of insurer and
dismissed the complaint.
*************
17
Sri Suresh Kumar Sahoo
Vrs

Complainant had insured his Leyland Truck bearing Regn No- OR-04F-6047 with the
above insurance company. The vehicle met with an accident on 20.11.2009. A claim was
present alone. Neither self contained note was filed, nor, any one appeared on behalf of
insurer during hearing. After hearing the complainant and perusing the documents
available on record, Hon‟ble Ombudsman directed insurer to pay Rs 51,600/- to
complainant within one month of receipt of consent letter, failing which to pay interest @
18% from date of order till date of payment.
*************
Sri Binoy Bhushan Pattnaik
Vrs
National Insurance Co. Ltd., Jajpur Road Branch
Award dated 20 Aug, 2010

Complainant had insured his Indica Car, bearing, Regn No- OR 02 AR 8751, with
National Insurance Co Ltd and a claim was preferred for an accident which the vehicle
met on 29.09.2009.Complainant preferred a claim for Rs 2,60,000/-, where as insurance
company offered only Rs 1,60,000/-.
18
present. After hearing both parties and perusing the documents including the estimate,
survey report, bills and cash memos etc, opined that a few items which were in estimate
and were also repaired / replaced has not been assessed. There fore considering such
omissions, directed insurance company to settle the claim for Rs 1,80,204/-, as against
the offer of Rs 1,60,000/-.
*************
Sri Prafulla Kumar Sahoo
Vrs
Oriental Insurance Co. Ltd., Cuttack Br -I.
Award dated 18 Aug 2010

Complainant had insured his Tata Ace Goods carrying vehicle, Regn No OR-05X-1800
with Oriental Insurance Co. Ltd., which met with an accident on 06.08.2008 . A claim
was lodged. Insurance Company repudiated the claim for the reason that the driver did
not possess Valid Driving License.
Hon‟ble Ombudsman heard the case on 18.08.2010., where both sides were present.
After hearing both sides and perusing documents, held that the driver Sri Prasant Kumar
Behera was holding a Driving Licence of Light Motor Vehicle , non transport category,
where as the vehicle was a transport vehicle as per Registration Certificate. Hence,up
held the decision of repudation.
*************
Sri Manoj Kumar Panda
19
Vrs
National Insurance Co. Ltd., Jajpur Road Branch
Award dated 20 Aug, 2010

Complainant had insured his bus, bearing, Regn No- OR 04 B 8505, with National
Insurance Co Ltd and a claim was preferred for an accident which the vehicle met on
12.10.2007.Complainant preferred a claim for Rs 1,49,200/-, where as insurance
company offered only Rs 2,000/-, after deducting compulsory excess and imposed
excess.
present. After hearing both parties and perusing the documents including the estimate,
survey report, bills and cash memos etc, opined that a few items which were in estimate
and were also repaired / replaced has not been assessed. There fore considering such
omissions, directed insurance company to settle the claim for Rs 23,000/-, as against the
offer of Rs 2,000/-.
*************
Sri Krusna Prasad Sahu
Vrs
IFFCO TOKIO General Insurance Co. Ltd., Bhubaneswar Branch
Award dated 20th August, 2010
Complainant had purchased a Mahendra Bolero vehicle from a financer. The vehicle was
seized for default in instalment payment. As the ownership was not transferred the
insurance was taken in the name of previous owner. Vehicle met with an accident on
18.07.2009. Complainant lodged a claim. Insurance company refused to settle the claim
as the claimant did not possess insurable interest on the vehicle on date of loss.
insurer submitted a letter dated 29.12.2008, stating that he had written to insurance
company on that day for transfer of policy to his name. The insurer on the other hand
produced an application dated 18.07.2009, ie after the accident, complainant requested
for policy transfer to his name. Ombudsman observed that for 9 months the complainant
20
did not bother to transfer the policy to his name, even though the vehicle was on road
these days. He up held the repudiation decision of the insurer.
*************
Sk Safraj Alam
Vrs
Oriental Insurance Co. Ltd., CDO-II, BHUBANESWAR
Award dated 21 Sept 2010

Complainant had insured his Ambassador Car, Regn No OR-02AC-5555 with Oriental
Insurance Co. Ltd., which met with an accident on 13.02.2010. A claim was lodged for
Rs 26,147/-. Insurance Company paid only Rs 8800/-
Hon‟ble Ombudsman heard the case on 21.09.201010, where complainant was absent
but the OP appeared.
Complainant explained in his P forms that his claim should have been settled for Rs
26147/- as he had submitted retail invoice for Rs 16,047/- and repair bill for Rs 10,100/-.
OP, explained that they settled for Rs 8800/- on the basis of surveyor‟s assessment after
deducting policy excess and salvage as per rule.
After hearing both sides and perusing documents, Ombudsman held that the claim has
been properly assessed by the surveyor and insurance company has rightly settled for Rs
8800/- after carrying out statutory deductions under a motor policy.
*************
21
Sri Mohan Kumar Sahoo
Vrs
New India Assurance Co. Ltd., Jajpur Road DO.
Award dated 21st Sept, 2010

Complainant had insured his Tata Truck , bearing Regn No- OR-09E- 0484 with New
India Assurance Co. Ltd. The truck was forcefully taken away by dacoits within policy
period. A claim was reported. The insurer repudiated the claim on the ground that out
siders were permitted entry ,violating policy conditions.
Hon‟ble Ombudsman heard the case on 21.9.2010, where both sides were present.
The complainant submitted that the vehicle was loaded with iron ore and the dacoits
forcefully stole the vehicle, throwing out the driver and helper out of the vehicle.
Insurance Company took the stand that 4 strangers were allowed entry,thus policy
condition was violated.
Ombudsman hearing both sides and perusing documents on record observed that the
truck was taken away at pistol point after over powering driver and cleaner. There is no
merit in the contention that safety of truck was compromised, when strangers were
allowed entry. Hence directed insurer to settle the claim for Rs 5,49,000/-.
*************
Smt. Harapriya Rout
Vrs
United India Insurance Co. Ltd., Nayapalli Branch
Award dated 21st Sep, 2010
22
Complainant had insured her TATA Truck which met with an accident and claim
was lodged with the insurer for Rs. 1,99,340/-.The insurer offered to settle the claim for
Rs.57,600/- as against the bills and cash memos for Rs.199340/-. Being aggrieved , she
filed a complaint with the Ombudsman. Hon‟ble Ombudsman on studying the documents
submitted, observed that the surveyor‟s assessment was rather conservative. He also
noted that the surveyor had assessed the cabin repair taking the estimate as Rs.70,000/-
instead of Rs.80,000/- .
Therefore, Hon‟ble Ombudsman ordered to settle the claim for Rs.72,600/- which
is Rs.15,000/- more than the original assessment being Rs.10,000/- towards the cabin &
Rs.5000/- towards the cowl repair.
*************
Sri Jibesh Kumar Swain
Vrs
Oriental Insurance Co. Ltd., Jajpur Road Br.
Award dated 22 Sept 2010

Complainant had insured his truck, Regn No OR-09C-9087 with Oriental Insurance Co.
Ltd., which met with an accident on 2.12.2009 . A claim was lodged. Insurance Company
repudiated the claim for the reason that the insurance was in the name of Babu Ram
Swain, where as vehicle was registered in the name of Jibesh Kumar Swain.
Hon‟ble Ombudsman heard the case on 21.09.2010., where both sides were present.
Complainant explained that the transfer of registration of the vehicle from the name of his
father was carried out on 24.7.2009 but because of the treatment of his mother he could
not inform to insurance company. Insurer on the other hand pleaded that they were
informed about change of ownership only after 5 days of the accident.
After hearing both sides and perusing documents, Ombudsman held that technically the
insurer is justified in repudiating the claim. Equally, the owner of the truck, de facto and
23
de jure, would be put to irreparable loss. Finally observed that the case deserves some
latitude and hence awarded Rs 50,000/- to be paid to complainant.
*************
Sri Biranchi Patra
Vrs
The New India Insurance Co. Ltd., DO II, Cuttack
Award dated 23rd Sep, 2010
Complainant had insured the stock of silk sarees, threads and other raw materials
under a fire insurance policy for . He sustained loss from damage of his stock to the tune
of Rs.86,420/- due to Storm and lodged a claim with the insurer. The claim was
repudiated by the insurer on the ground that no evidence of storm at that locality was
produced .
The case was heard on 23.09.2010 in presence of both the parties . The insurer
pleaded that in spite of several reminders the insured had failed to produce the weather
report confirming storm in that area & the damaged stocks for inspection by the surveyor.
Hon‟ble Ombudsman on observing the documents , held that decision by the insurer
is in order and the case was dismissed.
*************
Sri Krupasindhu Gahan
Vrs
24
National Insurance Co. Ltd., Angul DO
Award dated 22st Sep, 2010
Complainant had insured her TATA Truck which met with an accident and claim
was lodged with the insurer for Rs. 1,50,000/-.The insurer rejected the claim on the
ground that the driving licence of the driver whose name is mentioned in the Trip Sheet
was not valid. Hon‟ble ombudsman heard the case on 20.09.2010 . The complainant
stated that the driver whose name is mentioned in the Trip sheet left the job and another
driver was engaged by him to drive the truck which is also evidenced by the SDE made at
the Police Station whose DL is valid.
Hon‟ble Ombudsman held that the repudiation of the claim was not proper and
ordered for payment of the assessed amount subject production of bill & Money Receipts.
Sri Jivan Kumar Sahoo
Vrs
New India Assurance Co. Ltd., Angul Branch.
Award dated 23rd Sept, 2010
Complainant had insured his Auto Rickshaw, bearing Regn No- OR-19H-3717 with New
India Assurance Co. Ltd., which met with an accident on 1.2.10.A claim was lodged. But
insurance company repudiated the claim on the ground that the driver did not possess a
valid DL.
The complainant submitted that the damage to his vehicle was due to a bull fight and
nothing to do with the driver or driving license. The insurer submitted that the driver at
the material time , was not possessing a valid DL.
25
damages were inevitable regardless of the person who other wise drove the vehicle.
Surveyor assessed the loss for Rs7500/-and therefore awarded the same amount on the
insurer for payment to complainant.
*************
Sri Samarendra Das
Vrs
Cholamandalam MS General Insurance Co. Ltd
Award dated 24th Sept, 2010
Complainant had insured his Mahendra Scorpio , bearing Regn No- JH 01 J 2068 with
Cholamandalam MS Gen Insurance Co. Ltd. The vehicle went missing while sent to
receive relatives. A claim was lodged. The insurer repudiated the claim on the ground of
violation of policy condition.
The complainant submitted that the vehicle was stolen and the driver was murdered as
investigated by the police and accepted by the SDJM court.
Insurance Company pleaded that the vehicle was used for hire and reward and against the
policy condition.
contention of insurer can not be brushed aside as FIR states that the vehicle was in use for
hire and reward. Under the circumstances, a negotiated settlement was tried. Both parties
agreed for a settlement of Rs3,00,000/-. Ombudsman directed insurer to pay Rs
3,00,000/-.
*************
26
Smt. Puspanjali Mohapatra
Vrs
Award dated 24th September, 2010

The Complainant‟s husband had insured his motor cycle from 27.01.2008 to 26.01.2009
and met with an accident on 02.02.2008 and died on the spot. The motor cycle was
damaged and claim was reported to the company. But the insurer did not pay the claim
even after 2 ½ years. Hence the complainant filed this complaint.
Hon‟ble Ombudsman heard the case on 24.09.2010 & the insurer contended that the
claim was lodged on 25.06.2008 and hence it was rejected due to delay in intimation of
the claim by the company. The complainant informed that immediate notice of accident
was given to the local office. But on 25.06.2008 at the direction of the local office she
informed about the accident of the vehicle and the death of her husband to the call centre.
The Investigation Report presented by the insurer confirmed the accident and the
accidental death of the insured. Though the intimation to the local office by the
complainant could not be proved, the same can not be brushed off either .The insurer has
admitted that the call centre was informed on 25.06.08 i.e. after 4 months from the date of
accident.
Hon‟ble Ombudsman held that the complainant was in great grief after the sudden demise
of her husband and rejection of the claim on this ground only is not justified. Hence he
passed the award for payment of Rs.1,00,000/- towards PA claim and Rs. 4500/- towards
OD claim of the vehicle together with interest @ 8% p.a. from 1.9.08 till the date of
payment.
*************
CHANDIGARH
CHANDIGARH OMBUDSMAN CENTRE
27
CASE NO. GIC/689/ICICI/11/10
Baldev Singh Vs. ICICI Lombard
ORDER DATED: 26TH July, 2010 MOTOR
FACTS: Shri Baldev Singh had taken a Motor Insurance Policy bearing no.
3003/52233170/00/000 issued by ICICI Lombard General Insurance Co. covering his
TATA LPT truck bearing no. HP-64-4177 for the period 19.07.2007 to 18.07.2008 for
sum insured of Rs. 8,93,001/-. The said truck was stolen on 05.03.2008 from village
Jangeshu, near Nazara Hotel, Tehsil-Kasauli. The case was reported to Police. They
registered the FIR vide FIR No. 19 dated 06.03.2008. The claim was reported to
insurance company. All the claim documents were submitted but the insurance company
repudiated the claim. Parties were called for hearing on 26.07.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the claim has been
rejected on the ground that the complainant left vehicle unattended as the key of ignition
was present in the truck. As per terms and conditions of the policy the insured has to take
reasonable care to safeguard his vehicle from any loss or damage.
DECISION: Held that the insured failed to take reasonable steps for safeguard of the
vehicle and the insurer is justified in repudiating the claim. However, at the intervention
of this forum, the insurer offered to consider the claim on ex-gratia basis for a sum equal
to 50% of the IDV under the policy. The case is thus resolved for partial payment on ex-
gratia basis as per rule 18 of RPG Rules 1998. No further action is called for. The case is
closed.
CASE NO. GIC/801/Bajaj/11/10
Hardeep Singh Vs Bajaj Allianz Gen. Ins. Co. Ltd.
ORDER DATED: 30th July,2010 MOTOR
28
FACTS: Sh. Hardeep Singh‟s father, Late S. Kulwant Singh was owner of Maruti
Zen car bearing no. PB-18-K-0108 financed by Bank of Punjab, Batala. His father
expired on 05.01.2008. The official of Bajaj Allianz Gen. Ins. Co. Ltd. contacted him for
insurance of Maruti Zen Car on 08.02.2008. The complainant told them that the owner of
the car has expired on 05.01.2008. But, the concerned official insured the car vide Policy
no. OG-08-1210-1801-00001891 for the period 08.02.2008 to 07.02.2009 in the name of
his father, S. Kulwant Singh. The car was stolen on 02.02.2009 from Golden View
Palace, Amritsar. The complainant lodged an FIR no. 56 dated 06.02.2009. The claim
was reported to insurance company. They deputed an investigator. All the claim
documents were completed but the company rejected the claim without any valid reason.
Parties were called for hearing on 30.07.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the policy was purchased
in the name of deceased person. So, the insurance contract was void ab-initio. The
complainant has stated that one of the keys of alleged stolen vehicle has been misplaced,
hence the possibility of the key being left in the vehicle itself, contributing to the alleged
theft cannot be ruled out. The complainant has not submitted the original RC of the
vehicle, NOC from Financier, Form 35, Letter to RTO informing about the theft,
repayment schedule of financier, Non traceable report. Hence, the claim was rightly
repudiated.
DECISION: Held that the insurance on the car was obtained in the name of Late S.
Kulwant Singh, the father of the complainant when he was not alive. The complainant
himself has admitted that he has signed the proposal form for the insurance on behalf of
deceased. The insurer has issued the policy in good faith presuming it to be the signature
of S. Kulwant Singh and having no knowledge that he has expired on 05.01.2008. Now at
the time of claim, the insurer came to know that the insured is not alive at the time of
taking policy. Thus, the insurance contract was void ab-initio. The complaint is
dismissed.
29
CASE NO. GIC/796/UII/11/10
O.P. Gupta Vs United India Insurance Co. Ltd.
ORDER DATED: 30th July, 2010 MOTOR
FACTS: Sh. O.P. Gupta had insured his car bearing no. PB 23G – 3104 vide policy
No. 200604/1/8/1/00003187 by United India Insurance Co. Ltd. A claim was submitted
for Rs. 17808/- on 11.11.2009 for reimbursement. But the insurance company has
rejected his claim on the ground that prior to taking the policy; he had declared that he
has availed no claim bonus from their office at Khanna. However, on enquiry from their
Khanna Office it was found that he had preferred a claim. So by suppressing the
information, he availed no claim bonus from them. Parties were called for hearing on
30.07.2010 at Chandigarh
FINDINGS: The insurer clarified the position in its reply letter dt. 15.03.2010 that
insured lodged an own damage claim and availed no claim bonus from this office against
renewal of policy. The car was earlier insured with D.O. Khanna and on enquiry for
confirmation of NCB, they came to know that there was one claim lodged by the insured
on the previous policy. Thus the insured had wrongly availed NCB from the company.
The insured has concealed these facts at the time of insurance. Hence the file was closed
as NO CLAIM.
DECISION: Held that no claim bonus was availed by the complainant without
informing about previous claim. However, the insured has also not obtained declaration
as per GR 27 of GMT from the insured. The insurer has produced a letter from their own
development officer that he had verbally inquired from the complainant whether there
was any claim in the previous policy year. In view of these observations, the end of
justice would be met if the claim is considered on non-standard basis deducting 25%
from the claim amount alongwith the amount given as no claim bonus. The insurer is
directed to make the payment within 15 days from the receipt of this order. The case is
thus disposed off.
30
CASE NO. GIC/671/UII/11/10
Pawan Kumar Arora Vs United India Insurance Co. Ltd.
FACTS: Sh Pawan Kumar Arora‟s vehicle No. CH 03 X – 0196 was insured under
policy No. 112101/31/08/01/00001755 dt. 25.09.2008 which met with an accident on
08.09.2009. The car was struck on the lower side with a stone lying on the road thereby
damaging the car. The spot survey was done. He paid an amount of Rs. 98106/- on
30.09.09 for repair of his car. But till date he neither received any payment nor any
reply. Parties were called for hearing on 26.07.2010 at Chandigarh.
FINDINGS: The insurer clarified the position by stating that the engine was seized
because the vehicle was driven after the chamber was broken, so the seizure of engine is
consequential loss which is not payable. Since the complainant was not satisfied, it was
considered to get the re-assessment of the claim and to assess whether damage to engine
of the car was consequential or not. A report from Sh. Parvinder Kumar, an independent
surveyor was produced for reassessment of claim. As per the report, the car kept running
for about one kilometer after it hit the stones lying on the road side. The car was in
running condition after the external impact on the oil sump of the engine, but the driver
kept driving till the time engine got seized and stopped running. The photographs of the
engine in dismantled condition indicate that the rotating parts of the engine were
overheated due to running dry after the engine oil leaked out through the hole in the oil
sump.
DECISION: Held that the engine of the car did not seize due to any direct impact of the
stones on the oil sump but it got seized due to driving the car further after the actual
accident occurred, which is the extension of the damage sustained due to external means.
The damage to the insured vehicle was a consequential loss which is not covered as per
31
terms and conditions of the policy. The insurer is, therefore, justified in settling the claim
for damage to the cover for oil sump only.
CASE NO. GIC/736/NIA/11/10
Pushap Kumar Bali Vs The New India Assurance Co. Ltd.
FACTS: Shri Pushap Kumar Bali had a Motor Insurance Policy bearing no.
353000/31/08/01/00001336 issued by The New India Assurance Co. Ltd. covering his
Bajaj Chetak scooter bearing no. CH-01-H-8980 for the period 30.05.08 to 29.05.09 for
sum insured of Rs. 5,000/-. The said scooter was stolen on 25.12.08 from his house. The
theft was reported to police station. They registered the case vide FIR no. 11 dated
12.01.09. The claim was intimated to insurance company. All the claim documents were
submitted but the insurance company repudiated the claim on the ground that the R.C of
the vehicle was not valid at the time of theft of the vehicle. Parties were called for hearing
on 29.07.2010 at Chandigarh
FINDINGS: The insurer clarified the position by stating that the claim was rejected on
the basis that the RC was not valid at the time of theft. Their contention is that the
insured vehicle was 1993 Model and the date of issue of RC is 23.02.1993 and it was
valid for 15 years i.e up to 22.02.08. After expiry of the RC, the insured has to produce
the vehicle again to Registering Authority for getting it certified that the vehicle is still in
road worthy condition. The fitness of the vehicle has to be obtained from the Registering
Authority to revalidate the Registration Book which was not done in this case and the
claim was filed as No Claim.
DECISION: Held that as per Section 39 of Motor Vehicle Act Registration of a vehicle
is a must because insurance is also taken out under Section 39. The insurer is justified in
repudiating the claim since the RC is not valid. No further action is called for. The
complaint is dismissed.
32
CHENNAI
Complaint No.IO (CHN) 11.03.1378/ 2009-10
AWARD No. IO (CHN)/G/02/2010-11 dated-24 th May 2010
(motor claim)
Mr.K.Janardhan vs National Insurance Co Ltd
-------------------------------------------------------------
The complainant had taken a Motor Package Policy and the vehicle met with an
accident on 24.05.2008. According to the insured after the accident RC book was
seized by the RTO since the vehicle was beyond repair and not road worthy. In
view of severe damage the insured was insisting for total loss settlement of the
vehicle from the beginning .The surveyor had given different mode of settlement
and since cash loss settlement was found economical the insurer had offered it
which was not accepted by the insured.
In the meantime the insurer had sent letters to the driver who has driven the
vehicle at the time of accident to appear before them for certain clarification and
he has not appeared before the insurer. The insurer has also mentioned that they
had requested Supdt. of Police for further investigation.
Further, the investigator has not brought out the inconsistencies in the various
records after thorough scrutiny. The crucial factors like age of the persons in the
hospital records, educated persons affixing thumb impressions, different
versions of the accident in FIR & MACT records all points out that the
documents submitted lacks authenticity. In view of the major discrepancies
noticed in the various claim records, the complaint was dismissed.
Complaint No.IO(CHN) 11.07.1562 / 2009-10

AWARD No. IO (CHN) /G/06/2010-11
(Motor)
Mr .C.D.Satheesh vs Tata AIG General Insurance Co.Ltd
-----------------------------------------------------------------------
The complainant had insured his vehicle with the above insurer from
3.08.2009 to 02.08.2010.and the vehicle met with an accident. On 14.10.2009.The
claim lodged by the insurer was rejected on the ground that the insured had
given a false declaration in respect of his claim settled by the previous insurer
and in view of this the present insurer Tata AIG had wrongly allowed NCB in
the current policy. The insurer had also cancelled the policy as per condition 5 of
policy and sent a refund cheque of Rs.4,674/-on 19.11.2009 stating that the policy
stands cancelled from 9.11.2009.The insurer had mentioned that it was confirmed
by the previous insurer about a claim settled by them in respect of policy issued
33
to the insured last year. The insurer had stated that they have repudiated the
claim and cancelled the policy as per terms and conditions of the policy.
Award dated –24th May 2010.

---------------------------------------
The policy was taken by the insured through telemarketing.based on the
declaration made by the insured on telephone.The complainant had mentioned
during the conversation that he has not made any claims in the previous year
policy with Royal Sundaram and based on his declaration he was given the
benefit of no claim bonus.On verification it was observed that the insured had
made claim with the previous insurer twice. The complainant had mentioned
that he did not remember the conversation he had during telemarketing at the
time of taking the policy but on listening to the voice recording the complainant
is heard informing the caller that he had not made any claims in the previous
policy period.On the present insurer taking up the matter with the previous
insurer they have confirmed that two claims have been paid during 2008-
09.Therefore it is a clear case of nondisclosure on the part of the insured.In the
light of all the above the insurer is justified in repudiating the claim and also
cancellation of the policy.
The complaint is dismissed.

AWARD No. IO (CHN)/G/12/2010-11
(Motor)
Mr.S.Sankaran vs Oriental Insurance Co Ltd
-------------------------------------------------------
The complainant had insured his car with the above insurance co for a sum
insured of rs 7,00,000/- from 12/07/2008 to 11/07/2009.and the car met with an
accident on 09/04/2009.The insurer had arranged for a spot survey and Final
survey and offered to settle the claim on Cash Loss Basis and obtained the
consent from the insured.But subsequently they arranged for an investigation
who has mentioned in his report that the car was used for hire purpose.To
support his stand he has submitted a letter collected from one of the
passengers.In view of this the insurer had rejected the claim and they have also
mentioned in the rejection letter that 9 persons had traveled in the car as against
the permissible limit of 8 persons.
Award dated-14thJune2010.
-------------------------------------
The insured had mentioned that he had given the vehicle to his friend
for visiting the temple and denied having taken rs10,000/- as rent from one of
the occupant.He also mentioned that he has not used the vehicle for commercial
34
purpose.He informed that third party claim was lodged by 5 persons including
the driver.He contended that only 8 persons were traveling in the car.The insurer
had mentioned that the IDV of the vehicle was rs7,00,000/-,the surveyor assessed
the loss on cash loss basis for rs 5,41,752/-and also obtained consent letter from
the insured to retain the salvage for rs 2,85,000/-.The total number of passengers
in the vehicle at the time of accident was 8+1=9 persons.Since the vehicle was
insured under private car policy and the same was used for commercial purpose
the claim was repudiated.The decision of the insurer was mainly based on a
letter collected by the investigator from one of the passengers who has stated that
he has paid rs10,000/- towards rent for engaging the car.
It has been observed from the records that the investigator has not
collected any other evidence like enquiry from the locality,receipts to prove that
the vehicle was used for hire.It has been mentioned in the FIR that the vehicle
belongs to the friend of MRShankar and does not mention about the car being
used for hire.As per FIR the number of persons traveled in the car was 7
including Driver and there was no evidence to prove that 9 persons were
traveling in the car at the material time of accident.Therefore the insurer’s
ground of repudiation of the claim on the basis of exceeding permissible number
of seating capacity at the material time of accident as well the argument of the
vehicle was used for hire is not justified.Hence the insurer is directed to process
and settle the claim as per other terms and conditions of the policy subject to
taking into account the value realized by selling of the wreck by the insured.
The complaint is allowed.
Complaint No.IO (CHN) 11.12.1677 / 2009-10

AWARD No. IO (CHN) /G/14/2010-11 dated-14thJune 2010
(Motor).
Mr.M.Vibin Paul vs ICICI Lombard General Ins Co Ltd.
---------------------------------------------------------------------
The complainant had taken a two wheeler policy with the above
insurance co from 01/05/2009 to 30/04/2010.and the vehicle was stolen on
05/06/2009 at about 7 PM . He had immediately informed the police station but
according to him the police registered the complaint only on 01/07/2009.The
claim was lodged with the insurer only on 04.09.2009.and the insured had stated
that he was not aware of the procedure to lodge the claim.The insurer had
rejected the claim on the ground of delayed intimation of claim to them as well as
to the police.As per the policy terms the claim should have been intimated to the
insurer and the police immediately after occurrence of theft.
The complainant had mentioned that he had insurance cover for the last
10 years for his vehicle and as this was his first claim he did not know where to
lodge claim and in this confusion delay has occurred. According to the insured
35
the police had informed him that all neighbouring stations would be informed
and if vehicle is not found then they would register the case. The insurer had
mentioned that whenever there is theft ,loss or accident the same should be
intimated to the insurer immediately. He mentioned that toll free number is
printed on the document and the same could be used to lodge complaint on the
theft immediately if not in writing. The insured is having policy for the last 10
years and he is supposed to know the important policy terms compared to a
person having policy for the first time. Further it was also observed that the
insured had complained to the police without date and have also not obtained
any acknowledgement As pointed out by the insurer nothing prevented the
insured in lodging the claim with the insurance company either through toll free
facility or online complaint registration. Hence the decision of the insurer in
rejecting the claim on the grounds of delayed intimation to the insurance
company and delayed filing of FIR is in order.

AWARD No. IO (CHN)/G/19/2010-11 dated-30thJune2010
(Motor)
Mr.A.K.Sudarmani vs United India Insurance Co Ltd.
------------------------------------------------------------------
The complainant had taken Motor Insurance Policy for his Vehicle from 28.08.2009
to 01.06.2010.for a sum insured of rs 2,70,000/-The original policy period was from
02.06.2009 to 01.06.2010 and the vehicle was purchased by the complainant and after
purchase the insurance was transferred in his name from 28.08.2009.On 22.10.2009
the vehicle met with an accident resulting in damages to the front portion of the
vehicle.The insured had lodged a complaint with the police on 23/10/2009.The car
was repaired and the insured submitted the bill for rs 50,893/-and according to the
insured he has not received the decision from the insurer.The insurer was not
convinced about the police endorsement dated 23.10.2009 and they have appointed
an investigator to verify the police report.The investigator has stated in his report
that the police endorsement was not issued by the police station as stated by the
claimant.The police has confirmed that the insured has given the complaint.Insurer
has stated that malafide intention of the insured is proved and hence claim is not
payable.
The insured had mentioned that on intimating the accident to his vehicle to the
insurer they had asked for FIR,police report being insufficient.Accordingly he
requested the police station to issue an FIR the police informed him that since it was
not a road accident and the accident took place in his own premises ,FIR is not
required.The insured had informed that even after surveyor had inspected the
vehicle insurer had not communicated about the status of the claim.The insurer had
represented that when FIR was called for a typed Police endorsement signed by SI of
Police ,Traffic Investigation Team-1 dated 23.10.2009 was submitted which did not
36
bear the vehicle no but later it was incorporated by hand.The insurer had also
appointed an investigator to know the genuineness of the Police endorsement who
has mentioned in his report that the certificate said to have been issued by the Police
was found to be a bogus one.In view of the above the insurer had argued that the
claim is not tenable.
Normally in a vehicle accident Police department issues FIR only and they do not
issue any endorsement.In the instant case noting on the backside of the insured’s
letter dated 23/10/2009 addressed to the police has been made available.The noting
mentions that the police have received the complaint and the accident is true.There
is also another Police endorsement dated 23/10/2009 in a particular typed format
where the vehicle number alone is handwritten.The letter dated 03/03/2010
addressed to Senior Branch Manager signed by sub inspector mentions that police
endorsement referred for confirmation was but however they have mentioned that
verification was done about the accident.It has also been observed that the insurer
has kept the claim pending for a long time and they were advised to take a decision
on the admissibility of the claim on a priority basis.The insurer had sent a letter to
the insured on 18.06.2010 repudiating the claim.In view of the inconsistencies
leading to substantive issues of law and taking into account ,the facts mentioned in
the earlier paras the insurer is justified in repudiating the claim.
Complaint No. IO (CHN) 11.12.1011 / 2010-11

AWARD No. IO (CHN) /G/ 020/2010-11 dated-5thJuly2010
(Motor)
Mr.H.Jagan vs ICICI Lombard GIC Ltd.
----------------------------------------------------
The complainant had mentioned that his father had taken a vehicle
policy for a sum insured of rs 4,40,928/-from 30.12.2008 to 29.12.2009.The
complainant’s father died on 21.11.2008 and the name transfer in the RC was not
made within the stipulated period after the death of his father.In the meantime
the policy was renewed in the name of the father even after his death to maintain
continuity of cover and the vehicle met with an accident on 27/06/2009.After the
accident the vehicle was not repaired and it got burnt also .The complainant had
lodged a claim for rs 4,40,000/-and it was rejected by the insurer on the ground
that (a)Reasonable steps were not taken to protect the vehicle and also(b)Name
transfer in the RC book was not made within the stipulated period as per policy
terms.
---------------------------------
The complainant had reported the accident and subsequent burning of
the vehicle to the insurer.The insurer had rejected the claim since the
37
complainant had no insurable interest since the policy and the RC stood in the
name .of Mr G.Haridoss and the name transfer was not applied for by the legal
heirs of Mr Haridoss after his death on 21.11.2008.In accordance with policy
terms and conditions the condition no 9 reads as under “In the event of death of
the sole insured The policy will not immediately lapse but will remain valid for a
period of 3 months from the date of the insured or till the expiry of the policy
whichever is earlier.During the said period legal heir(s) of the insured to whom
the custody and use of the vehicle passes may apply to have this policy
transferred in the name of the heir(s) or may obtain a new policy and such heir(s)
should make an application with other documents to the insurance company.In
view of the specific stipulation under the terms and conditions of the
policy,requiring the legal heir to apply for the name transfer in the policy within
the stipulated time limit the rejection of the complainant’s claim by the insurer is
justified.

Award no-IO(CHN)/G/27/2010-11 dated30thJuly2010
(Motor)
MrB.S.Rajasekar vs Tata AIG Gen Ins Co Ltd
----------------------------------------------------------
The complainant had insured his car with the above insurance co for a sum
insured of rs2,71,107/-from 25.06.2009 to 24.06.2010 and the car was heavily
damaged due to an accidental fire on 14.11.2009.The insurer has agreed to settle
the claim on repair basis as assessed by the surveyor for rs1,26,836/ and while
assessing the loss the surveyor has applied depreciation on various parts which
require replacement.-The complainant had sought the claim to be settled on the
basis of constructive Total loss since the aggregate cost of retrieval and /or repair
of the vehicle before applying depreciation on various parts as mentioned in the
survey report exceeds 75% of the IDV as per GR8 of the IMT.The insurer had
mentioned that the surveyor has assessed the loss on repair basis for rs 1,26,836/-
which is within 75%of the IDV and hence the claim could not be considered as a
CTL as demanded by the insured.
The insured had stated that he had already depreciated the cost of the vehicle to
arrive at the IDV of Rs2,71,107/-and the insurer is again applying depreciation
on parts for the purpose of deciding the eligibility for constructive total loss
settlement.The insurer had argued that since the cost of repair or retrieval did
not exceed 75% of IDV the claim could not be considered as constructive total
loss.They are agreeable for settlement on repair basis.From the records it is
observed that there is no dispute in fixing up the IDVfor the vehicle at the time of
inception of the policy and only dispute is about the application of depreciation
38
on parts while determining whether the loss has to be assessed on total loss basis
or not.The policy wording state as “The insured vehicle shall be treated as CTL if
the aggregate cost of retrieval and /or repair of the vehicle subject to terms and
conditions of the policy exceeds 75%of the IDV of the vehicle.”Nothing specific is
mentioned about application of depreciation in case TL/CTL and merely
mentions “subject to terms and conditions of the policy”This is very vague.
Though the insurer has no contractual obligation to accept the insured’s desired
mode of settlement ,judging from the severity of damages to the vehicle and also
the fact that the cost of retrievel/repairof the vehicle as per estimate exceeds
75%of IDV,the insured is justified in seeking settlement on constructive total loss
basis.Considering all the factors the decision of the insurer in considering the
claim only on repair basis is not correct and hence they are directed to settle the
claim on total loss basis subject to terms and conditions of the policy.
Complaint No.IO(CHN) 11.08.1126/ 2010-11

AWARD No. IO (CHN)/G/030/2010-11 dated 20.8.2010
(Motor)
Mrs.R.Sowmya vs Royal Sundaram Alliance Ins Co Ltd.
---------------------------------------------------------------------
The complainant had taken a motor policy with the above insurance for a sum
insured of rs4,72,357/-and the vehicle met with an accident on 08.01.2010.After
lodging FIR the damaged vehicle was sent to authorized Dealer for repairs after
informing the insurer.According to the insured the vehicle was severely
damaged on all sides and since it was a new car the repairer had agreed for
replacement of body shell.The insurer had advised the repairer to carry out
repairs of the vehicle without allowing the replacement of body shell and it was
repaired.After repair the vehicle was taken delivery under protest by the insured
on cashless basis for rs1,38,615/-The insured requested the insurer to send her
copy of survey report to know the basis of assessment but it was not complied
with by the insurer.
The complainant had stated that his vehicle which was only 68 days old had met
with an accident and after inspection of the vehicle by Police and RTO the
vehicle was left with an authorized service provider for carrying out repair to the
vehicle.The insured had mentioned that the estimate prepared by the repairer
included body shell replacement.Subsequently he was informed by the repairer
that the insurer had not allowed replacement of body shell but allowed only
repair.He has also informed that MP3 player which is inbuilt in the vehicle is not
39
covered.The insurer had argued that the insured can not demand replacement of
the body shell and based on the discussion with the repairer by the surveyor
only repair to the body shell was allowed.The insurer informed that
bumper,both front and back bonnet ,rear dickey were replaced;since roof and
floor were not damaged the same was not replaced.
On a perusal of the papers it is found that the complainant had agreed for repair
to the vehicle and the main difference is only in replacement of body shell .The
insurer/surveyor after discussing with the repairer have decided that by
allowing replacement of panels which were heavily damaged the body shell can
be brought back to original shape.The reinspection report has also confirmed the
replacement of body panels and other mechanical spares with new ones.The
repairer/surveyor and the insurer on the basis of discussion have decided the
best possible ways on how to carry out the repair and they should have involved
the insured also in the discussion.As per policy condition the insurer can decide
the best mode in which the loss or damage could be indemnified.The insured
had mentioned that the repair was not done to his satisfaction for which both the
repairer and the insurer had agreed to carry out supplementary repair.Taking all
factors into account the insurer is justified in allowing only repair to the body
shell .
Complaint no11.12.1204 (Motor)

Award no-IO(CHN)/G/ 32/2010-11 dated 27thAug 2010.
Mr.M.Suresh vs ICICI Lombard Gen Ins Co Ltd
(Motor)
The complainant’s two wheeler is covered for a sum insured of rs19,600/-/-from

15.04.2009 to 14.04.2010.and according to the complainant the vehicle was stolen
on17.04.2009.He stated that when he went to the police station to lodge FIR he
was asked to wait for 10 days to trace his vehicle and then filed the FIR.He
waited for some more time to get non traceable certificate from the court and
then lodged the claim with the insurer.The claim was rejected by the insurer on
the ground that the claim was intimated after a delay of 113 days and intimated
to the police after 10 days from the date of theft.Since the policy condition
stipulate immediate intimation to police and insurer the claim is not admissible.
The complainant had stated that his vehicle was stolen from a parking area of a
market on 17.04.2009.On 18.04.2009 he lodged a complaint with the police and
according to the insured Police had informed him that they will search for the
vehicle for 10 days and if it is not traceable then they will issue FIR.FIR was
lodged on 27.04.2009 When enquired why it took him 113 days to lodge claim
40
with the insurer he replied that the police had informed him to lodge the claim
with the insurer after obtaining Non Traceable certificate.The insurer had
mentioned that as per policy terms and conditions the claim should be intimated
to the insurer immediately and the claim was not payable for delayed
intimation.Since in the present case the theft was informed after 113 days the
claim was denied.
On a perusal of the papers it is observed that the complainant had not adduced
any compelling circumstances which prevented him from approaching the
insurer for preferring the claim.The provisions of condition no 1 of the policy
states that Notice shall be given in writing to the company immediately upon the
occurrence of any accident or loss or damage and in the event of any claim the
insured shall give all information as the company shall require The insurer has
also mentioned that because of undue delay they were not in a position to carry
out any meaningful investigation regarding the stolen vehicle.Hence the decision
of the insurer in rejecting the claim due to undue delay in intimating the theft of
the claim is in order.
41
Complaint no-11.12.1197 (Motor).
Award no-IO(CHN)/G/33/2010-11 dated 30thAug2010.
Mr.D.Dayalan vsICICI Lombard General Insurance.Co Ltd.
(Motor)
-------------------------------------------------------------------
The complainant had taken vehicle insurance policy for his car for a sum insured
of rs 6,00,000/-from 23.05.2009 to 22.05.2010.The complainant had stated that his
vehicle got fire 20.11.2009 and he had lodged a claim with the insurer.It is
observed from the repudiation letter that the claim was repudiated due to the
fact that the burning of insured vehicle was not due to any accident or malicious
act as confirmed by the survey report.They stated that the loss could be due to
electrical or mechanical failure or breakdown and hence the claim is not
admissible
The complainant had informed that suddenly his neighbours had informed him
around 11pm that his vehicle was burning.with the help of public the fire was
put off but the front portion of the car was badly damaged.The accident was
reported to the insurer and they have also appointed a surveyor.He stated that
he had some problem with the head light and fixed halogen lights.The insurer
had mentioned that the burning of the vehicle was not due to any accident or
malicious act but due to electrical issue and hence the claim could not be
admitted.The insurer had mentioned that the Halogen lights would not have
been fitted by the dealer as they would very well know how to safely fit the
lights.In this case it seems that the wiring has been done in an unprofessional
manner. At the same time they have also admitted that they have no proof as to
the fixation of lights not done by the dealer.The insurer also could not clearly say
the relevant policy clause /condition under which the claim was repudiated.
On a perusal of various papers it is observed that in the survey report the

surveyor has not mentioned about the cause of loss and they have stated that
since there was no external element of cause they have treated it as an internal
technical problem.The insurer’s rejection letter also has not pointed out the
relevant condition under which the claim was repudiated.The insurer could not
prove that the fixation of halogen lamp was not done properly and it has
contributed to the accident.Hence the contention of the insured that the fire was
accidental and sudden one can be accepted .Taking all factors into account the
insurer is not justified in repudiating the claim and they are therefore directed to
process and settle the claim as per other terms and conditions of the policy.
Complaint no-11.03.1206 (Motor)

Award no-IO(CHN)/G/35/2010-11 Dated 31st August 2010.
42
Mr A.Kumar vsNational Insurance Co Ltd
-----------------------------------------------------
The complainant had covered his two wheeler for a sum insured of rs29,995/-
from 19.09.2008 to 18.09.2009 and the vehicle was stolen on 20.09.2008.when
parked outside the house of the complainant. The insured had filed FIR on
27.09.2008.The insured had also obtained non traceable certificate and submitted
the claim papers to the insurer.The insurer rejected the claim on the ground that
the colour of the vehicle was recorded as red in the FIR (subsequently corrected
as black) whereas as per RC book it was black.
The insured had lodged claim for theft of his vehicle on 20.09.2008 night after
11PM when parked outside his residence.He lodged a complaint with the police
on 21.09.2008 and the FIR was lodged on 27.09.2008.The insured had mentioned
that he has submitted all claim related documents to the insurer but the claim
was rejected by the insurer.The insurer had stated that the claim was denied for
the reason that the loss of vehicle could not be established as there was
discrepancy in the colour of the vehicle.In the claim form and FIR the colour has
been mentioned as RED and in the RC book it is mentioned as Black.
It appears that the insured was of mistaken idea that the vehicle was RED in
colour due to a sticker fixed on the Petrol Tank ,front and back side of the vehicle
without noticing that its real colour was black as per RC book.When it was
pointed out the insured had obtained corrected FIR from police.Though the
colour of the vehicl is one of the identifying features there are other factors which
could be verified for establishing the loss of the vehicle.The basic records and the
investigation of the claim prove the claim as genuine.In view of the above the
decision of the insurer in rejecting the claim is not in order and therefore they are
directed to process and settle the claim in accordance with the other terms and
conditions of the policy.
Complaint no-11.09.1222 (Motor)

Award no-IO(CHN)G/37/2010-11 dated 31.08.2010
Mr.P.Premkumar vs Reliance General Insurance Co Ltd
---------------------------------------------------------------------
The complainant had taken a two wheeler policy with the above insurance co for
a sum insured of Rs 41,657/-from 25.02.2008to 24.02.2009.The vehicle was stolen
on 29.06.2008 and informed the insurer.According to the insured he has also
submitted original policy and FIR to the insurer on 18/07/2008.The non
traceable could not be obtained immediately and the insured approached the
43
insurer with non traceable certificate after obtaining then same along with other
related papers like Form 29,30,35 and as per the complainant the insurer offered
settlement of the claim with a deduction of 40% of the claim amount.As per the
version of the insurer they had requested the insured to submit the required
documents and they have also sent reminder to him.Since they have not received
the documents they have closed the file.
The complainant stated that after lodging FIRhe reported the claim to the insurer
and wanted to submit the original keys of the vehicle ,RC book,form29,30and
35,nocof financier.The insured had stated that since he has not accepted their
offer of 40% settlement the insurer has not accepted the documents submitted by
him.The insurer had denied having offered 40%and further informed that in
spite of reminders the insured has not sent some of the documents and hence the
file was closed.The insurer added that they could even deny the claim for non
compliance by the insured under condition no 4and 5of the policy.The insurer
was willing to settle the claim on receipt of required documents and the insured
was advised to submit all the documents.In view of acceptance of the insurer to
settle the claim as mentioned the Insurer is directed to process and settle the
claim.
The complaint is allowed. .
DELHI
Case No. GI/164/UII/09
In the matter of Smt.Deepti Gupta
Vs
United India Insurance Company Limited
AWARD dated 02.07.2010 - Motor claim
1. This is a complaint filed by Smt.Deepti Gupta (herein after referred to as the

complainant) against the decision of the United India Insurance Company Limited
(herein after referred to as respondent insurance company) in respect of non-
settlement of motor claim.
2. The complainant submitted that the Tata Indica car bearing registration No.UP 14
AQ6774, Engine No.RZP22276, chasis No.RZP26043 was insured by the United
India Insurance Company Limited vide policy No.40300/31/08/01/0000495 for a
44
period of one year from 19.05.2008 to 18.05.2009. The policy was issued with
the assurance of availing cashless facility in case of any untoward incident occurs
to the vehicle. The Insurance Company had arrangement for cashless facilities
with M/S.Shree Vasu Automobiles Limited, Meerut. The vehicle was insured for
an IDV of Rs.3,72,085/-.
3. The said car was stolen on 09.07.2008 from Ghaziabad. This information was
passed on to the concerned police station at Indirapuram and also to the Insurance
Company on 10.07.2008 and 11.07.2008 respectively. The Insurance Company
appointed a surveyor Shri M.S.Pawar for inquiry and investigation. The car was
later recovered by police and the police had intimated this fact to the insured. The
Insurance Company was also informed. On investigation, the surveyor at the
police station found that the thieves had replaced/misplaced certain critical parts
of the vehicle, Tyre, as well as tampered with the original chasis No.(punched on
body) and engine No. along with chasis number plate (which was missing).
On the assurance of Shri Pawar and Mr.Neelam Sharma, Division Officer-3, the
complainant took the possession of the car from the court on supardari and the
said car was sent to M/S.Vasu Automobiles, Meerut for further loss assessment.
M/S.Vasu Automobiles after thoroughly checking the vehicle gave estimation of
Rs.3,10,000/- for the repairs and parts of the said vehicle. It is submitted by the
complainant that Mr.Neelam Sharma advised the insured to wait for the final
sanction but another surveyor Shri A.S.Duggal was appointed to investigate the
matter. Shri Duggal was only interested in forcing the insured to buy his idea
without listening the insured. He said that car repair can be done without
changing body shell that too on Him Motors, Patparganj. The complainant visited
Him Motors along with the car but Him Motors refused to repair the vehicle
stating that chasis number punching cannot be arranged at TATA authorized
Centre. Thereafter complainant conveyed her agony to Shri P.k.Arora,
RSM(Motors) who unofficially admitted that it was a total loss case but refused to
take any action and insisted upon the complainant to send the car again to Vasu
45
Automobiles, Meerut. The original chasis number and engine number of the
vehicle were damaged along with other parts and the Insurance company had
assured to get the vehicle repaired but did not get the vehicle repaired for one
pretext or the other. The vehicle was lying at Vasu Automobiles gathering dust.
Nothing was done even after writing to Grievance Cell of the Insurance Company
at Chennai. It is further submitted by the complainant that the vehicle was stolen
just after purchase of the same. Now after recovering by the police, the vehicle
was lying in the garage since long and the same could not be repaired though
assured by the company. Thus it is a total loss to him that he should be
compensated on the total loss basis.
4. The Insurance Company asked for certain details for settling the claim such as
Cash Memo for purchase of parts for replacement, final bills of repairs of the
vehicle along with receipt of payment thereof, convenient date for inspection of
the vehicle. It was conveyed to the complainant that compliance for these
requirements should be immediately made so that claim can be settled. It has
been fairly admitted by the Insurance Company that the vehicle was insured while
theft took place. The vehicle was recovered by the police. The matter was also
investigated by the surveyor. During the course of hearing, the representative of
the Insurance Company admitted that claim of the complainant could not be
settled due to non-submission of certain details. It is further argued by the
representative of the company that it did not fulfill the requirements of total loss,
therefore, the complainant should not be given the insured amount. The
complainant had not got the vehicle repaired and had not submitted the requisite
details for settling its claim. The claim is approved on the basis of independent
survey report and final report. The claim was not settled only because the
compliance report was not submitted and bills for repairs and parts were not
produced.
5. I have duly considered the details submitted by both the parties and also verbal submissions made
during the course of hearing. After due consideration, it is not considered proper to accept the
arguments of the complainant that it is a case of total loss to him and he be given insured amount
46
by way of compensation because requirements of total loss were lacking in this case. However, it
is a fact that the claim of the complainant was delayed inordinately. It is also a fact that after
recovering of the vehicle after almost a month of theft, it is lying for want of repairs at Vasu
Automobiles, Meerut. The fact remains that the complainant could not utilize his vehicle for so
long and suffered mental agony due to theft of the vehicle just after 14 days of its purchase and
thereafter he could not use the vehicle till date. Having due regards of the circumstances, I
consider fair and reasonable to pass the Award that the complainant be paid Rs.1,71,000/-by the
insurance company as full and final settlement without requiring to submit any documents/bills.
6. The Award shall be implemented within 30 days of receipt of the same. The
compliance of the Award shall be intimated to my office for information and
record.
7. Copies of the Award to both the parties.
Case No. GI/156/IFFCO/09

In the matter of Shri Lakhan Pal
Vs
IFFCO TOKIO General Insurance Company Limited
1. This is a complaint filed by Shri Lakhan Pal (herein after referred to as the
complainant) against the decision of the Iffco Tokio General Insurance Company
Limited (herein after referred to as respondent insurance company) in respect of
repudiation of motor claim.
2. The complainant filed a complaint stating therein that his claim was repudiated by the Insurance
Company. He had approached the CSD of the insurance company to look into the matter but his
claim was not settled. It has been submitted that his truck No.HR 55F-7497 which was insured
vide policy No.37811776 was stolen on 15.12.2007. FIR to this effect was duly lodged at police
station. He was informed by the company that his claim was not admissible as per policy
condition 5 stating that the vehicle was left unattended without proper precaution. It has been
submitted by the complainant that it is wrong to state that vehicle was left unattended. As a matter
of fact, it was properly locked. Although ignition key was inside the cabin but the cabin was duly
locked. The same is evident from the fact that the cabin keys were handed over to the investigator
47
while investing the case. It was submitted further that FIR was duly registered with police
authorities under 379 of the IPC. The vehicle was insured for a sum of Rs.9,00,000/- and it has
insurance coverage at the time of theft. It was further submitted by him during the course of
hearing that the vehicle which was stolen was being driven by his driver Shri Nicholas S/O Shri
Raghuraj Singh. On 14.12.2007 at about 9 p.m., the vehicle was coming to Delhi filled with
Roddy.
At about 1 „O‟ clock at night, the driver parked the vehicle in front of Panchvati
Hotel and had gone for taking meals. Ignition key was lying in the vehicle and
the vehicle was locked from outside. He had gone for sleep and when the driver
woke up at 5 „O‟ clock in the morning, he found the vehicle was missing.
Thereafter FIR was lodged. It is submitted by him that the original RC, insurance
cover, Permit etc. were inside the vehicle when the vehicle was stolen and the
same were also lost due to theft of the vehicle. It has been argued by him that his
claim should be settled at an early date.
3. During the course of hearing, the company has submitted reply wherein claim of
the complainant was repudiated. The representative of the company attended the
hearing and reiterated the reasons for repudiation of the claim as given in the
written submissions. It was stated that the complainant has not taken due care and
the ignition key was left in the vehicle. He further stated that the company had
investigated the matter and found that the claim was not admissible. It has been
admitted by the insurer that the vehicle No.HR 55F 7497 was insured with the
insurance company vide policy No.37811776 from 12.10.2007 to 11.10.2008. It
is also admitted by the insurance company that the theft claim with ITGI in
respect of insured vehicle was lodged. Thereafter an independent investigator
M/S.All India Claims Recovery Consultants was deputed to investigate the
matter. The investigator reported that the insured vehicle was being driven by
Shri Nicholas S/O Shri Raghuraj Singh. On 14.12.2007/ 15.12.2007 at 1.00 a.m.
the said vehicle was parked at the main road in front of Panchvati Hotel, Jhajjar
and after keeping the one original ignition key inside the cabin and then locked
the door from outside. He went for taking meal in the hotel. After taking meal,
48
the driver moved inside the hotel for sleep. On 15.12.2007 at around 5.00 a.m.
the driver noticed that the vehicle was missing. He reported the matter to the
police and FIR was also lodged about the theft of the insured vehicle. It is argued
by the representative of the insurance company that it is clear from the contents of
the FIR as well as written statements that the insured vehicle was left unattended
and its original ignition key was inside the locked cabin. It is further submitted
that the act on the part of the driver in leaving the vehicle unattended and leaving
the ignition key within the vehicle is a clear violation of Condition 5 of the policy
which states that the insured shall take all reasonable steps to safeguard the
vehicle from loss, damage. It has been submitted that the insured has violated the
condition 5 of the policy terms and conditions, hence the claim is not admissible
and the company has rightly rejected the claim.
4. I have very carefully considered the detailed submissions made by the

complainant that the insurance company was not justified in repudiating his claim
on account of loss sustained due to theft of the vehicle. I also perused the reply of
the insurance company and also carefully examined the reasons submitted for no
accepting the claim of the complainant. After due consideration of the matter I
find that the insurance company was not justified in repudiating the claim of the
complainant because the complainant had taken due care to protect his vehicle. It
is a fact that while leaving the vehicle, the driver had locked the vehicle from
outside of course after leaving the ignition key inside the vehicle along with other
papers such as registration, insurance and permit etc. It is not correct to mention
on the part of executive claims that the vehicle was left unattended and the same
got stolen while its original ignition key was inside the locked cabin. The original
ignition key was not inside the ignition lock as has been mentioned in letter dated
June,2008 because the fact as to whether original key was inside the ignition lock
could not have been verified independently as nobody saw the original ignition
key inside the locked cabin. It is clear from the letter dated 16.05.2008 signed by
the complainant that the driver had parked the vehicle in front of Panchvati Hotel
and had gone for taking meal. He kept the ignition key inside the vehicle from
49
which the vehicle could have been started and locked the cabin from outside and
had gone for taking rest. He had nowhere mentioned that he had left the original
key inside the ignition lock. I fail to understand as to what other pre-cautions
could have been taken by the driver apart from locking the cabin door from
outside.
5. Therefore, in my view, the company was not justified in stating that

reasonable care was not taken to safeguard the vehicle at the time of its theft.
In my considered opinion the complainant had not violated the condition
No.5 of the policy which reads as under:
“The insured shall take all reasonable steps to safeguard the vehicle from loss
or damage and maintain it in efficient condition and the company shall have
t all times free and full access to examine the vehicle insured or any part
thereof or any driver or employee of the insured. In the event of any
accident or breakdown, the vehicle insured shall not be left unattended
without proper precautions being taken to prevent further damage or loss
and if the vehicle insured be driven before the necessary repairs are effected
any extension of the damage or any further damage to the vehicle shall be
entirely at the insured’s own risk.”
Accordingly it is held that the claim of the complainant is admissible. I,

therefore, direct the insurance company to make payment of Rs.9,00,000/-
less Rs.1500/- as policy excess clause for which the vehicle was insured.
record.
50
Case No. GI/169/NIC/09
In the matter of Shri Mahender Pal Jain
Vs
National Insurance Company Limited
1. This is a complaint filed by Shri Mahender Pal Jain (herein after referred to as the
complainant) against the decision of the National Insurance Company Limited
(herein after referred to as respondent insurance company) in respect of Partial
2. The complainant submitted that the Insurance Company was not justified in
making partial payment of his claim. He claimed for total loss of his Car No. DL
4C 4344. He was given only a sum of Rs.12000/- out of claimed amount of
Rs.27300/-. Thus he pleaded that his claim in respect of balance amount should
be given to him. It is also submitted by him that he had made a number of
requests to the insurance company for making the payment of the balance amount
but so far the same was not paid by the company. He had demanded not only the
balance amount but also penal interest for not making the payment of balance
amount.
3. The Insurance Company agreed for making payment of Rs.7500/- to the insured
but insisted upon the production of valid certificate of registration as on the date
of accident. It has been mentioned by the company that certificate of registration
of the car was only valid up to 10.06.2005 and the claim lodged under the policy
on 29.12.2008. The insurance company stated that various reminders were given
by the surveyor and to the concerned agent of the insured to provide valid
certificate of registration as on the date of loss i.e. on 22.12.2008 which is
mandatory as per Motors Vehicle Act.
51
4. I have duly considered the submissions of the complainant. I have also seen the
correspondence of letters of the insurance company. I find that the insurance
company had treated the case as a total loss and proceeded accordingly. The
salvage value of the vehicle was agreed upon at an amount of Rs.12000/- by
salvage buyer and that amount was given to the insured. The insurance company
also admitted the liability in respect of remaining amount of Rs.7500/-. Since at
the time of sale of vehicle to salvage buyer, the registration papers were also
given to the salvage buyer, it became virtually impossible for the insured to
provide valid certificate of registration on the date of accident at this stage. As a
matter of fact, Branch Manager wrote to the Divisional Manager recommending
the waiver of this requirement of submitting of valid certificate of registration.
Accordingly, the insurance company is hereby directed to make the payment of
Rs.7500/- as agreed upon along with penal interest at the rate of 8% from
01.04.2009 to the date of payment.
record.
Case No.GI/191/ICICI Lomb/09

In the matter of Shri Devender Kumar
Vs
ICICI Lombard General Insurance Company Limited
1. This is a complaint filed by Shri Devender Kumar (herein after referred to as the
complainant) against the decision of ICICI Lombard General Insurance Co. Ltd
52
(herein after referred to as respondent Insurance Company) for Repudiation of
Motor claim.
2. Complainant submitted that his vehicle no- DL-1Y-B-4520 was insured with
ICICI Lombard General Insurance Co. Ltd. The vehicle met with an accident on
02.02.2009 at Satya Niketan Bus stop. The police was informed about the
incident and the vehicle was removed to M/s. Doaba Motors work shop for
repairing and M/s. Doaba Motors submitted an estimate of repair which was
submitted to the Insurance Company along with all other documents and final
bills were submitted to the Insurance Company. It has been submitted by him that
the Insurance Company vide letter no.-DEL/MOTOR CLAIM/1016877/08-09
dated 27.03.2009 rejected the claim on the ground that vehicle was fitted with
CNG Gas Kit. It has been submitted by him that CNG Kit did not cause any
damage to the vehicle. CNG Kit was not responsible in any manner to the
occurrence of the accident.
3. It has been submitted by the Insurance Company that claim was rejected due to
the fact that vehicle was fitted with CNG gas kit and same was not endorsed in the
policy. Only because the vehicle was fitted with CNG Gas Kit, the Insurance
Company has not processed the claim filed by the complainant. During the
course of hearing it was submitted by the representative of the Insurance
Company that the claim is not admissible as CNG gas kit was not endorsed in the
policy.
4. I have considered the submission of the complainant and also that of the
Insurance Company very carefully and after due consideration of the matter I hold
that Insurance Company was not justified in rejecting the claim of the
complainant because it is a fact that the insured vehicle met with an accident and
the accident in no was caused by the CNG kit. Though it is a mistake on the part
of the policy holder for not endorsing the fact of fitting of CNG gas kit in policy.
Yet the claim of the complainant on this very ground cannot be rejected. I direct
53
the Insurance Company to make the payment of 75% of the assessed loss by the
Company Surveyor to the policy holder.
compliance of the same shall be intimated to my office for information and
record.
Case No. GI/205/OIC/09

In the matter of Shri Saurabh Mittal
Vs
Oriental Insurance Company Limited
AWARD dated 21.07.2010 - Motor-claim
1. This is a complaint filed by Shri Saurabh Mittal (herein after referred to as the
complainant) against the Oriental Insurance Company Limited (herein after
referred to as respondent insurance company) in respect of non-settlement of
motor-claim.
2. The complainant filed the complaint on account of non-settlement of motor claim

under policy No. 271602/31/2009/599 of his Motor-cycle No.DL-5S Z-6447. It
has been submitted by him that his claim has been repudiated by the Oriental
Insurance Company Limited, Chandni Chowk, Delhi vide its letter dated
23.03.2009 on vague and untenable grounds. The vehicle was stolen on
07.03.2009, intimation of this incident was given on 09.03.2009 to the insurance
company. The insurance company had given the reason of non-accepting the
claim that it was informed late after the incident of theft. Theft took place on
07.03.2009 whereas it got intimation on 23.03.2009. It has been submitted by the
complainant that motor cycle was stolen from his residence in the night of
07.03.2009, on Saturday. Immediately he informed to the police on 100 number
and on Monday, 09.03.2009 he informed telephonically to the Branch Office of
54
the insurance company about this incident and the branch asked him to furnish
intimation with a copy of FIR and policy. On 09.03.2009, the required
information was sent to Branch Office by his sister by courier No.85057 dated
09.03.2009. As the said letter was not accepted by the company, it was returned
to him by courier being undelivered.
On 16.03.2009, FIR No.77 was registered by PS Shahdara. On 17.03.2009, he

personally visited Chandni Chowk Branch of the insurer, but none was inclined to
accept the letter together with FIR & cover note on the plea that the branch
manager is on leave during the week. It was further stated by the complainant
that there was no delay on his part in intimating the insurer and accordingly the
insurer is liable to compensate the loss that occurred due to theft of the vehicle.
He had approached Grievance Redressal office of the insurer but the complaint
remained unredressed.
3. On the part of the insurance company a letter dated 28.12.2009 is placed on

record, it has been stated that though incident of theft took place on 07.03.2009
but the company got the information on 23.03.2009, that is, after a gap of 16 days.
Thus, there is a breach of policy condition which stipulates that incident must be
reported within 48 hours. During the course of hearing, the representative of the
company also attended. The photocopy of the letter dated 23.03.2009 was
procured from him and placed on record which reads that the claim form received
on 23.03.2009, rejected.
4. I have very carefully considered the submissions of the complainant as made in

writing and also made during the course of hearing. I have also perused the letters
dated 23.03.2009 and 28.12.2009 of the insurance company placed on record. I
55
have also heard the representative of the insurance company. After due
consideration of the matter, I hold that the insurance company was not justified in
treating the claim of the complainant as no-claim. As a matter of fact, insurance
company had not applied its mind to the admissibility of the claim. At one place
it said that information was received late by 16 days on 23.03.2009, on the very
same day, it conveyed to the complainant that claim is treated as no claim. The
company had not even registered the claim of the complainant. It appears that the
insurance company did not apply its mind at all and was in a hurry to convey to
the complainant its decision that it was a no claim case. It appears that the
company was bent upon treating the claim as no claim. What else could be
expected from the complainant? There is no denying the fact that motor cycle
was stolen on 07.03.2009 and on the same day, the complainant informed the
police and also to the insurance company. He was demanded by the insurer the
copy of the FIR. He had taken reasonable care in informing the insurance
company in the shortest time. Intimation of theft given by the complainant on
phone appears to be timely & correct. Thus he informed the police as well as
insurance company within 48 hours of the theft of his motor cycle. In my
considered view, insurance company was not at all justified in treating the claim
of the complainant as no claim as it did not apply its mind while taking the
decision. I, therefore, direct the insurance company to make the payment of
insured amount along with penal interest @ 8% from the date of repudiation
of the claim till the time the payment is made.
record.
56
Case No.GI/216/IFFCO Tokio/09
In the matter of Shri J.S. Khatri
Vs
IFFCO Tokio General Insurance Company Limited
1. This is a complaint filed by Shri J.S. Khatri (herein after referred to as the
complainant) against the decision of IFFCO TOKIO General Insurance Co. Ltd
(herein after referred to as respondent Insurance Company) for partial repudiation
of Motor claim.
2. The complainant submitted that he had purchased Santro Car from Himgiri
Motors, Wazirpur, New Delhi for a sum of Rs.3,31,726/- under insurance tie up
agreement with the insurer, the dealer got insured the car. It is his submission that
the insurer had insured the car for a sum of Rs.3,12,022/- as against the cost of the
vehicle as per rules of the Insurance Company. This vehicle was stolen within
short time of the purchase. He lodged a claim with the Insurance Company and
the Insurance Company had paid a sum of Rs.2,90,916/- which is Rs.21,206/- less
than the insured value of the car. It has been submitted by him that he is entitled
to the entire insured amount of the vehicle i.e. to say the vehicle has been insured
and the premium paid for a sum of Rs.3,12,122/-, he should be paid this amount
on account of total loss. The Insurance Company had paid him less by an
amount of Rs.21206/-.
3. It has been stated on behalf of the Insurance Company that a sum of Rs.2,90,916/-
has been paid to the complainant as per rules of the insurer. He gave working as
follows for settling the claim:
EX-showroom price of the IV=Rs.3,06,754/-
IDV=95% of the EX-showroom price= Rs.2,91,416/-
Claim Amount = Rs.2,91,416-Rs.500/-= Rs.2,90,916/-
57
It has been submitted by the representative of the Insurance Company that the
amount paid to the policy holder is the amount is payable to him as per terms and
conditions of the policy. He stated that while insuring the vehicle, wrong amount
has been taken. It is his submission that the vehicle should have been insured for a
sum of Rs.3,06,754/- only,
being EX- Showroom price of the vehicle including VAT. Whereas the vehicle
was insured for a sum of Rs.3,12,122/-. It appears to be a bonafide mistake of the
underwriter, who had taken the value for insurance purpose with a total amount
paid by the policy holder while purchasing the vehicle with a reduction of 5%. As
a matter of fact for the purpose of Insurance the cost of vehicle should have been
taken by the underwriter, a sum of Rs.3,06,754/- with a reduction of 5%. He
admits that the premium has been charged a little more, than actually due to the
Insurance Company by taking higher cost, than the cost actually to be taken and
the Insurance Company is willing to refund that excess premium charged.
4. I have considered the submissions of the complainant and also verbal arguments
submitted by the representative of the Insurance Company. After due
consideration of the matter I hold that since vehicle was insured for as sum of
Rs.3,12,022/-, the complainant is entitled to this amount, in case of total loss of
the vehicle as against the payment made by the Insurance Company amounting to
Rs.2,90,916/-. The underwriter ought to have been little more cautious while
taking the insured value of the vehicle. Complainant/policyholder is under
bonafide belief while paying the premium that he will be entitled to the insured
amount in case of total loss of the vehicle. Accordingly I direct the Insurance
Company to make the payment of Rs.20706 = (3,12,122 – 500 – 2,90,916).
record.
58
Case No. GI/187/ICICI Lombard/09
In the matter of Shri S.K. Gupta
Vs
1. This is a complaint filed by Shri S.K.Gupta (herein after referred to as the

complainant) against the decision of the ICICI Lombard General Insurance
Company Limited (herein after referred to as respondent insurance company)
repudiating his motor claim.
2. The complainant submitted that his Car No.DL 8CR-2062 was purchased from
Delhi and the same was insured with ICICI Lombard General Insurance Company
Limited vide policy No.MAR 10037242 from 24.10.2008. Unfortunately, his
vehicle met with an accident in the night of 12.02.2009 with other car. The
vehicle was sent for repairing in a workshop M/S.Saya Automobiles. The
workshop had repaired the vehicle and handed over the same to the complainant
on 24.02.2009. The complainant had paid a sum of Rs.11052/-. The complainant
submitted that the insurance company has not paid the claim payment of
Rs.11052/-. He had written a number of letters to the company but nothing was
done. The complainant submitted that the insurance company is directed to make
the payment of Rs.11052/- along with interest.
3. No written reply was received from the insurance company. However, during the
course of hearing, representative of the Insurance Company attended. She
promised to make the payment within a week. The representative of the company
had given in writing that excess amount charged by the garage from the
complainant will be paid within a week. Such commitment was made on
12.07.2010 but this office is still to receive any communication from the
insurance company.
59
4. I have considered the submissions of the complainant and have also considered
the assurance given by the representative of the Insurance Company during the
course of hearing for making payment to the complainant as has been charged by
the workshop. Since no letter has been received from the company honouring the
commitment made by the representative of the company during the course of
hearing, I direct the company to make the payment of Rs.9852/- which the
complainant had paid to the Saya Automobilies Limited in cash on 01.03.2009.
record.

In the matter of Shri Manohar Singh
Vs
1. This is a complaint filed by Manohar Singh (herein after referred to as the

(herein after referred to as respondent Insurance Company) for repudiation of
Motor claim.
2. The complainant submitted that he had taken the Insurance policy bearing no.
54198141 for his vehicle no. DL-3C AF 8621 Tata Indigo from ICICI Lombard
General Insurance Co. Ltd. His car met with an accident on 11.04.2009 and he
lodged a claim to the Insurance Company, the claim no is MOT 01087062. He
filed the claim and submitted the estimates of the repair of M/s. Vivek
Automobile. The Insurance Company gave the assurance that surveyor will come
to inspect the vehicle and settle the claim in the workshop. The surveyor had
inspected the vehicle but he did not settle the claim. He requested a number of
times to settle his claim but the same was not done. Thereafter he got done the
60
repair of the vehicle himself and paid for a sum of Rs.93653/- to the workshop
M/s. Vivek Automobile on 25.05.2009.
3. The letter dated 30.06.2009 of Insurance Company is placed on record which

states that the vehicle was inspected by the surveyor at the workshop M/s. Vivek
Automobile, New Delhi on 13.04.2009 in respect of the subject claim. After
investigation of the documents it has been found that the subject vehicle was
being used for Hire & reward. Since the private car package policy does not
cover the vehicle being used for hire & reward, the Insurance Company was
unable to process the claim for the said reasons.
4. I have very carefully considered the submission of the complainant and also gone
through the Insurance Company‟s letter wherein the reasons have been stated for
repudiation of the claim. After due consideration of the matter, I hold that the
Insurance Company was not justified in repudiating the claim because, there is no
evidence on record that the vehicle which met with an accident was being run on
hire. The argument t of the Insurance Company that such vehicle was being used
for hire and reward is unsubstantiated. During the course of hearing Manager
Legal stated that claim will be settled within 15 days time, however, no report was
submitted on such assurance. I hold that the claim of the complainant is
admissible and Insurance Company was not justified in repudiating the claim. I
therefore direct the Insurance Company to settle the claim on the basis of assessed
loss less policy excess as applicable.
record.
Case No.GI/229/NIA/09
In the matter of Shri Nihal Chand
Vs
The New India Assurance Company Limited
61
1. This is a complaint filed by Shri Nihal Chand (herein after referred to as the
complainant) against the decision of The New India Assurance Co. Ltd (herein
after referred to as respondent Insurance Company) for repudiation of Motor
claim.
2. The complainant submitted that he lodged a theft claim no.

323401/31/08/01/90000025 under policy no. 323401/31/08/07/01/0001709 in
respect of vehicle no. DL-6C-C-6895. Theft took place on 17.03.2008 an FIR
was lodged vide FIR No. 99 dated 15.04.2008 under section 379 IPC at Sarai
Rohilla Police Station. This information was also submitted to the Branch office.
M/s. Ipso Facto, the fact finding people were deputed by the Insurance Company
who visited the site of the loss and demanded requisite documents. It was
submitted by him that branch office repudiated his theft claim on the ground that
the insured used to ply the vehicle as taxi, due to breach of policy condition. He
was not satisfied with the decision of the Insurance Company and he requested
DRO-II of New India Assurance Co. Ltd. for reviewing the decision of
repudiation. He was again informed that his claim was not payable. It was
submitted by him during the course of hearing that the vehicle was never used as
a taxi; the vehicle was used by him and by his family members. The claim of the
complainant was repudiated and also communicated to the complainant. The
complainant stated that under the instruction of the investigator, complainant‟s
wife wrote a letter in Hindi, which the complainant was made to sign; he only
knows how to put sign. The letter was written by his wife at the instructions of
the investigator wherein this fact was mentioned that the vehicle was running on
hire but it is not correct. It is a fault of the investigator and not his.
3. It has been mentioned by the Insurance Company that claim was repudiated based
on investigation report of independent investigator. It has been further stated that
62
the claim was repudiated due to breach of policy conditions “limitation to use”.
The vehicle was insured as Private Vehicle whereas insured in his written
statement given to independent investigator has stated that the vehicle was being
used as Taxi.
4. I have very carefully considered the submission of the complainant. I have also
seen the reasons recorded by the Insurance Company for repudiation of theft
claim. After due consideration of he matter I hold that Insurance company was
not justified in repudiating the claim of the complainant because, the Insurance
company had not given supporting facts for the conclusion drawn by it i.e. to say
the Insurance company had not given any facts individually to support their view
that the vehicle was being used for commercial purposes. The letter which was
got attached by the Investigator of the wife of the complainant does not seem to
be a reliable fact for rejecting the claim. In my view the claim is admissible.
Accordingly I direct the insurance company to make the payment i.e.
Rs.49,500/- (Rs.50,000/- less Rs.500/- excess ) as per norms.
record.
63
Case No.GI/228/OIC/09
In the matter of Shri Abdul Aziz
Vs
The Oriental Insurance Company Limited
1. This is a complaint filed by Shri Abdul Aziz (herein after referred to as the
complainant) against the decision of The Oriental Insurance Co. Ltd (herein after
referred to as respondent Insurance Company) for repudiation of Motor claim.
2. The complainant submitted that he had got the vehicle with registration no. HR-
38L-6039 which was covered by a policy no. 215201/31/2008/3129. The vehicle
was insured from 21.05.2007 to 20.05.2008. The vehicle was stolen on
22.03.2008 and matter was reported to the police and FIR was lodged on
04.04.2008. The police registered the case under section 379 IPC. He
approached the Insurance Company for settling his claim but so far his claim was
not settled. He had gone to Regional Office also. This vehicle le was insured for
a sum of Rs.7,50,000/-. At the time of theft, the vehicle was insured and the
premium was also paid. He stated that the Insurance company wanted to settle his
claim on compromise basis and he was offered a sum of rs.5,24,000/- as full and
final settlement of the claim but he insisted the Insurance company to pay him the
insured amount.
3. Insurance company informed the complainant vide their letter dated 24.06.2009
that his claim can be settled on compromise basis to the extent of 70% of the IDV
less policy excess of Rs.1,000/- i.e, Rs.5,24,000/-, due to the reason that the
complainant have violated the policy condition „5‟ which states that “it is the
responsibility of the insured to take all necessary steps at his end to safeguard his
vehicle”. In his case vehicle was left unattended as the driver proceeded to his
64
village in Rajasthan on 21.03.2008 and later on cleaner also went to home on
21.03.2008 at about 10.00p.m. on the pretext of illness.
4. I have considered the submissions of the complainant. I have also duly

considered the submissions placed on record on behalf of the Insurance Company.
After due consideration of the matter I hold that the claim of complainant is
admissible on total loss basis. The vehicle which was stolen was not traceable.
All formalities have been complied with by the complainant which is lodging of
loss claim, lodging of FIR, untraceable report. I find that Insurance Company is
also convinced about the total loss of the vehicle and had tried to settle the claim
by offering a compensatory amount of Rs.5,24,000/- i.e. 70% of the insured
amount less Rs.1000/-. As regards reasons for payment of 70% of IDV insured
value, it has been mentioned that the complainant had not taken adequate care in
guarding the vehicle. The reason cited by the Insurance Company appears to be
unconvincing. The vehicle was insured for a sum of Rs.7,50,000/- as regards
complainant it was a total loss of the vehicle as the same was stolen and untraced,
therefore he has to be compensated as per the assurance given by the Insurance
Company at the time of issuing the cover note of the vehicle. I fail to understand
as to what manner reasonable care, the policy holder was required to take in
regard to safeguard of the vehicle as precautions for safeguarding the insured
vehicle has not been prescribed. I therefore, direct the Insurance Company to
make the payment to the complainant the insured value less policy excess as
per norms.
record.
65
In the matter of Shri Manjeet Singh
Vs
7. This is a complaint filed by Shri Manjeet Singh (herein after referred to as the
Motor claim.
8. The complainant submitted that his vehicle was covered under the passenger
carrying package policy no./cover note no. 3004/54127438/00/000 from ICICI
Lombard General Insurance Co. ltd. The vehicle registration no. DL-IPB-6995
and the claim no. is MOT01043529. His vehicle was burnt on 28.02.2009 at
Nahar Road, Vikas Nagar, Near Shiv Vihar, New Delhi and matter was reported
to the Insurance Company and claim was registered. He had submitted complete
documents including police report, fire brigade report and other documents, as
required by the investigator. After discussion with the investigator, he had
submitted his report to the Insurance Company. On 06.04.2009 he had received a
letter from the Insurance Company repudiating his claim. He had gone to number
of offices with regard settlement of his claim but so far his claim has not been
settled. It was stated by him that he was called by the investigator in his office at
Karol Bagh and made to sign a letter written by him in his own hand writing. It
was also signed by Shri Mandeep Singh wherein it was mentioned that while
welding the vehicle, he started the vehicle and press the accelerator which caused
some sparking in the vehicle and the vehicle was subsequently burnt. He stated
categorically that such letter was written by the investigator himself and he along
with one Mr. Mandeep Singh made to sign such letter. He signed the letter
without any thought and implication. He was in a hurry to settle his claim
66
therefore he had gone there. Such letter was notarized also in the month of March
2009.
9. The Insurance Company informed the complainant vide his letter dated
06.04.2009 that t was unable to entertain his claim of loss because based on
scrutiny of documents furnished by him and subsequent investigation it was found
that there is misrepresentation of the facts relating to the cause of accident.
10. I have considered the submission so the complainant, I also perused the
investigation report and other documents placed on record on behalf of the
Insurance Company. I also considered the verbal arguments of the representative
of the Insurance Company who reiterated the reasons given for repudiation of the
claim. After due consideration of the matter I hold that the Insurance Company
was not justified in repudiating the claim of the complainant, because claim is
admissible as the vehicle was burnt completely. I find that there is a variation in
the cause of fire as mentioned in the FIR and as mentioned in the investigation
report. The fact of welding was missing in the FIR whereas it was highlighted in
the investigation report. The investigation report is based on a letter which
appears to have been attached by the investigator rather than that of the
complainant. Therefore to my mind, decision cannot be based on such letter. The
investigator had assessed the total loss case with salvage value of Rs.32500/-.
During the course of hearing the representative of the Insurance Company appears
to be fair in stating that claim will be settled on the production of No Due
certificate from the financer. If the complainant wants to take amount of the
claim he had to deposit first no due claim of the financer M/s. Kotak Mahindra
Bank. The complainant also assured to no due certificate from the financer to the
Insurance Company. I therefore, direct the Insurance Company to make the
payment to the complainant Rs.553980/- {Rs. 587480 (IDV)-Rs.32500
(Salvage value) - Rs.1000 (Policy excess)} on the production of no due
certificate from the financer.
67
record.

In the matter of Mrs.Bharti Makkar
Vs
1. This is a complaint filed by Smt.Bharti Makkar (herein after referred to as the

complainant) against the National Insurance Company Limited (herein after
referred to as respondent insurance company) in respect of non-settlement of
motor claim.
2. The complainant submitted that she along with her husband Shri Dinesh Kumar
were travelling in a car No.DL-2C AA-7035 and the vehicle had met with an
accident. The car was insured with the National Insurance Company Limited
with policy No.70203532. The surveyor submitted the report and said that
running and multiple damages are not covered in the policy hence treated the
claim as No Claim. It has been submitted by her that observations of the surveyor
were not correct. Her car got damaged causing dents and scratches at various
places. Accidents are not pre-planned so that damage to the vehicles is caused at
one point only. She put up a claim for a sum of Rs.23166/-. It is her submission
that since her car is insured, the company is legally and morally bound to allow
the claim.
During the course of hearing, husband of the complainant attended the hearing
and he reiterated that the vehicle was damaged and insurance company is bound
68
to compensate the damages. Further it has been stated by him that the car was
still unrepaired.
3. No written submission is placed on record on behalf of the company. However,
the representative of the company attended the hearing. During the course of
hearing, the representative of the company was asked as to why the claim was not
settled and why the policy holder was not paid for the damages occurred to his
car. The representative of the company submitted surveyor report from where I
found that assessed loss is minus . Thus according to the surveyor nothing is
payable to the policy holder. However, during the course of hearing, the surveyor
reassessed the loss on the basis of photographs of vehicle which got accident.
The surveyor accompanied with the representative of the company and it was
submitted that the insurance company can pay to the policy holder a sum of
Rs.7300/- + service tax as applicable subject to production of the payment details
to the company.
4. I have considered the submissions of the complainant and have also considered
the verbal arguments and discussions held with the representative of the insurance
company. After due consideration of the matter, it is held that the complainant is
to be compensated for the damages of the vehicle as per reassessment of the
surveyor during the course of hearing. It was agreed by the representative of the
insurance company that the company will pay to the policy holder a sum of
Rs.7300/- + service tax as applicable. Accordingly, I direct the insurance
company to pay a sum of Rs.7300/- + service tax as applicable to the policy
holder subject to production of bills to the company by complainant.
record.
69
Case No. GI/235/Bajaj/09
In the matter of Shri O.P.Gupta
Vs
Bajaj Allianz General Insurance Company Limited

1. This is a complaint filed by Shri O.P.Gupta (herein after referred to as the
complainant) against the Bajaj Allianz General Insurance Company Limited
(herein after referred to as respondent insurance company) in respect of
2. The complainant submitted that the insurance company was not justified in not
settling the claim properly. Damages to L.H. and R.H. not approved as they are
old and pre-existing which is after thought only to cover up the misbehavior done
by one of their executive Shri Manohar Adhikari. It was crystal clear that
L.H.side was approved by the surveyor for which 2nd clause of Rs.500/- was also
recovered by the repairer from him and deposited to the insurer, that is, Rs.1000/-
Accordingly, R.H. side was also justified and payable to him for which he was
claiming since beginning. The complainant further submitted that he be given
Rs.8500/- for replacement of AC condenser. An amount of Rs.2000/- is also
payable to him on account of repairs of R.H.side of the vehicle. He also
submitted that excess deduction of Rs.500/- was twice and also demanded a
refund of Rs.1500/- on account of cancellation of the policy. He also stated that
behavior of the company‟s executive was not proper.
3. During the course of hearing, the representative of the insurance company was
present. He tried to satisfy the complainant verbally. He agreed for making
payment of Rs.1500/- to the complainant on account of refund of cancellation of
the policy. He refused to make any payment on account of damages done to
R.H.side of the vehicle. As regards, AC condenser, it was stated by him that the
same was replaced by the workshop including gas charges. Therefore, no further
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amount to be paid to the complainant on account of functioning of the AC
condenser.
4. I have considered the submissions of the complainant. I have also heard the
arguments of the representative of the insurance company during the course of
hearing. After due consideration of the matter, I find that the complainant needs
to be compensated for R.H.side damages to the vehicle, plus policy excess of
Rs.500/- which was deducted twice and refund of Rs.1500/- on account of
cancellation of the policy. As regards other claims demanded by the complainant
in his complaint letter dated 31.07.2009, the same are not payable. I, therefore,
direct the insurance company to pay an amount of Rs.4000/- as full and final
settlement of the claim.
record.

In the matter of Shri Bhupesh Jain
Vs
1. This is a complaint filed by Shri Bhupesh Jain (herein after referred to as the
complainant) against the decision of the ICICI Lombard General Insurance
Company Limited (herein after referred to as respondent insurance company) in
respect of repudiating his motor claim.
2. The complainant submitted that his vehicle No.CG 04-1371 had met with an
accident with a truck at about 2.00 a.m. in the night on 07.05.2008. When the car
met with an accident he along with his wife besides other passenger were in the
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car. He along with his wife and other occupants of the vehicle were injured
badly. Car was also damaged. He had lodged a claim with the company which
was turned down by the company. He requested that the insurance company was
not justified in rejecting the claim. Repudiation of the claim was on account of
unjustified reasons. During the course of hearing, the complainant attended the
hearing along with his wife and narrated the incident in detail.
3. The company informed the complainant on 21.05.2009 that his vehicle was
inspected by the surveyor at the workshop of M/S.K.J.A.Antony Automobiles (P)
Ltd., Kailash Colony, New Delhi on 27.08.2008. Based on scrutiny of the
documents furnished by the complainant and subsequent investigations, it was
found that he had misrepresented the facts regarding the driver of the vehicle at
the time of accident. Therefore, the insurance company is unable to process the
claim and company shall not have any liability in respect of the claim filed by the
complainant.
4. I have considered the submissions of the complainant. I have also considered the
arguments of the representative of the insurance company during the course of
hearing. After due consideration of the matter, I hold that the insurance company
was not justified in repudiating the claim of the complainant. The insurance
company had given vague reasons for not admitting the claim of the complainant.
During the course of hearing, the representative of the company has also admitted
that the claim is payable. There is absolutely no justification on the part of the
company to repudiate the claim. I, therefore, direct the insurance company to
make the payment of Rs.1,06,750/-to the policy holder as worked out below:
IDV of the Vehicle : Rs.1,37,250.00

Less: Salvage Value : Rs.30000.00
As assessed by Surveyor Policy Excess : Rs. 500.00
: Rs. 30,500.00
Total amount payable : Rs. 1,06,750.00
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The company is further directed to make penal interest @ 8% from the date
of repudiation of the claim till the time payment is made.
record.

In the matter of Shri Anil Kumar Gupta
Vs
1. This is a complaint filed by Shri Anil Kumar Gupta (herein after referred to as the
(herein after referred to as respondent insurance company) in respect of partial
2. The complainant submitted that his car No.DL 6CH-4785 was insured with the
National Insurance Company Limited vide policy No. 360203/31/07/6100002201
for the period 22.08.2007 to 21.08.2008. The car was stolen from the main
market Rajouri Garden on 06.09.2007. Information was given to the police on
same day. FIR No.702 was registered on 09.09.2007. The car was traced out by
the police authority and after receiving the information from the policy authority,
he immediately informed the insurance company about the recovery of the
vehicle. When the vehicle was recovered the complainant and the surveyor
noticed that many of its parts were missing. As per the assessment of DD Motors
it was a case of total loss. The same is also confirmed by the surveyor Shri
Avinesh Kumar from the insurance company. It is submitted by him that since it
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was a case of total loss, the insurance company was not justified in settling the
claim only for Rs.34125/-. The complainant still demanded a sum of
Rs.1,09,000/- towards total loss and further a sum of Rs.9326/- paid to DD
Motors on account of other losses. Complainant stated that he had paid
Rs.1,25,000/- for repairs of the vehicle.
3. The insurance company stated that the vehicle was stolen and recovered in
damaged condition and some parts were missing. Shri Lalit Mohan surveyor
conducted the spot survey of the car. The vehicle was shifted to DD Motors for
repairs and the loss assessed was of Rs.63180/- towards labour charges and cost
of the parts. The surveyor and the insured could not reach any settlement. The
insured had given a letter offering Rs.60000/- towards claim without getting the
insured vehicle repaired. Since settlement was not reached, the surveyor assessed
the loss at Rs.50965/-subject to submission of bills by the insured. But the
insured did not produce the bill. A sum of Rs.34125/- was paid on the basis of
survey report as no repair bills were submitted by the complainant.
4. I have considered the submissions of the complainant. I have also seen the reply
submitted by the insurance company. After due consideration of the matter, I find
that complainant was not suitably compensated for the loss which he had suffered
in his vehicle. The complainant had paid a sum of Rs.1,26,526/- for getting the
car repaired. Such payment however is not supported by bill and vouchers
because repairing was got gone from the local repairer by using second hand
spare parts. The vehicle was insured a sum of Rs.1,00,000/-. It was not a case of
total loss as contended by the policy holder because the car was repaired.
Accordingly, I consider fair and reasonable if the insurance company pay a
further payment to the complainant worked out as under:
Agreed amount as per DD Motors = Rs.63180.00

Less : Vat @ 12.5% on the parts = 7898.00
Already paid = 34125.00 = Rs.42023.00
Net payable = Rs.21157.00
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Accordingly the company is directed to pay a sum of Rs.21157/- to the
complainant.
record.
Case No. GI/241/RGI/09

In the matter of Ms. Aarti Singh
Vs
Reliance General Insurance Company Limited
1. This is a complaint filed by Ms.Aarti Singh (herein after referred to as the

complainant) against the Reliance General Insurance Company Limited (herein
after referred to as respondent insurance company) in respect of repudiation of
motor claim.
2. The complainant stated that she had taken the package insurance policy in respect
of the vehicle No.DL-7CC-2167 covering the risk from 01.02.2008 to 31.01.2009
under above referred policy. It was stated by her that during the validity of the
policy on 09.06.2008 the said insured vehicle was parked in front of office shop,
Mukherjee Nagar, Delhi-110 009 and on the very next day it was discovered that
it was stolen from the parked place. She immediately reported the matter to
police and lodged the FIR. She informed the insurance company accordingly.
Investigator required some documents which were supplied by her to him.
Request was made to the company to settle the claim but the company informed
the complainant that the claim has been repudiated for breaching of Condition
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No.4 of the policy. It has been submitted by her that Condition No.4 applied by
the company for repudiating the claim was not applicable in her case because
such condition was not made available by the insurance company. The claim was
wrongly rejected by the company. She contested that she had not left her vehicle
unattended at an isolated place, the place where the car was parked is having a
duly parking area, with a security guard employed during the nights and the same
could not be regarded as the isolated area. It has been further stated by her that
the act of not settling the genuine and bonafide claim amounts to deficiency in
service on the part of the insurance company.
During the hearing, father of the complainant attended vehemently argued that the
company was not justified in repudiating the claim. However, it was admitted by
him that the car was parked at a placed which was away from the residence where
the policy holder resides.
3. It has been stated on behalf of the insurance company that a private car
comprehensive policy was issued to the complainant. The theft was reported to
the company on 12.06.2008. On scrutiny of the documents, it was found by the
company that the insured had misplaced original second key and for that
explanation was demanded by the company from the complainant. She was also
required to state as to what reasonable steps were taken to safeguard the vehicle
from theft. The company found that car was parked outside the office of the
brother of the policy holder when theft took place and it was left unattended. The
insurance company had repudiated the claim on 07.02.2009 citing condition No.4
stating therein inter-alia that the insurer had not taken reasonable steps to
safeguard the vehicle from the loss.
4. I have very carefully perused the contents of the complainant filed by the
complainant. I have also gone through the reasons as given by the insurance
company for repudiating the claim of the complainant. After due consideration of
the matter, I hold that the insurance company was not justified in repudiating the
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claim because a car was parked in a place where other vehicles were also parked.
There is no denying the fact that the vehicle was stolen. Policy holder had made
compliance all the requirements of the reporting the accident to the police and to
the insurance company and submitted all requisite documents. The loss has
occurred to the policy holder for which the policy holder needs to be
compensated. The car was insured when theft took place. Therefore, Award is
passed with the direction to the insurance company to make the payment of
insured declared value less policy excess of Rs.500/-.
record.

In the matter of Shri Binod Kumar Jain
Vs
AWARD dated 13.08.2010 – Motor claim
1. This is a complaint filed by Shri Binod Kumar Jain (herein after referred to as the
complainant) against the ICICI Lombard General Insurance Company Limited
(herein after referred to as respondent insurance company) repudiating his motor
claim.
2. The complainant submitted that his vehicle Scoda Octavia bearing registration
No.DL 6CJ 5913 met with an accident on 05.07.2009 between Deval and Ganga
Barrage on Bijnor-Meerut highway at approximately 4.00 p.m. The car was being
driven by his friend Shri Sumeet Bali and he was also in the car along with
another gentleman Dr.Sanjeev goel. In order to save a cyclist, the car hit and fell
off the culvert and rolled over, finally coing to rest on its wheels. No one was
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injured in the accident. The matter was reported to police station Ramraj, District
Muzaffarnagar, who duly stamped and received the report of the accident made
by them. The vehicle was recovered with the help of a crane and then using a
truck, it was brought to the workshop of M/S.Giriraj Motors, Gurgaon who are the
main dealers and authorized workshop for Skoda Auto on July 6, 2009. All
papers were duly filled, signed by him and forwarded by M/S.Giriraj Motors to
ICICI Lombard General Insurance Company Limited for processing the insurance
claim. The insurer appointed Shri Subhanshu Jain as the surveyor who surveyed
the accidental vehicle. Despite repeated calls to Shri Jain to enquire about the
progress and the status of the report being prepared by him, Shri Jain kept on
delaying the matter. Finally Shri Jain went back on the assurance and told him
that he could not divulge anything with regard to his report or settlement to the
claim and advised him to contact the verification department of the company and
speak to one Shri Nitin as the file had been put up there for verification.
He had made a number of calls in the company. It has been submitted by him that
the company had been deliberately delaying the settlement of his claim and he felt
harassed and intimidated. Shri Harendra Prasad of the insurer gave him frivolous
reasons and had not rendered the desired help. The company‟s officers had lied
repeatedly by giving him the mobile numbers that were from Delhi but saying that
the same are from their legal department in Mumbai. It was stated by him that the
vehicle was insured with ICICI Lombard company for a value of Rs.9.69 lakh and
that M/S. Giriraj Motors estimated for repairs at Rs.11.5 lakh and this value
exceeds more than 70% of the insured value and thus his claim is fit to be settled
on total loss basis. The company did not cooperate despite his best efforts. The
company initially repudiated his genuine claim vide their e-mail dated 11.08.2009
on flimsy ground stating that he has willfully deliberately conceal the facts
relating to the accident. Thereafter, he refuted such allegations and submitted e-
mails on 15.08.2009. Thereafter the company suddenly agreed to admit its
liability though partial vide letter dated 24.08.2009. Final survey report dated
10.07.2009 of Shri Sanjay Kumar Verma was arranged by the company. This
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report was full of errors and omissions and could not be relied upon.
Accordingly, he had arranged an independent survey report from M/s. S.K.Bakshi
and Company, Gurgaon. He was surprised to know that despite the fact the
surveyor appointed by the company recommended to admit the liability and also
agreed to the fact of occurrence of the accident and admits damages sustained by
the vehicle, the company repudiated his genuine claim vide letter dated
24.08.2009. The complainant vehemently argued that his vehicle damaged to the
extent due to the accident that it was a fit case to be declared as the total loss case
and the company be directed to settle his claim as a total loss case. He further
stated that the company‟s officials insisted for repair of the vehicle and for giving
the consent to M/s.Giriraj Motors for repairing the vehicle but since the vehicle
was not repairable as it was a total loss case, he had not given consent for repair
the vehicle. He had further submitted that he had answered each and every query
raised on behalf of the company with regard to damage done to the vehicle and
accident. He also placed on record the investigation report of the independent
surveyor in support of his argument that it was a total loss case as extensive
damages were done to the vehicle.
3. During the course of hearing, the representative of the company was present and
argued that the vehicle could not be repaired but the owner of the vehicle did not
given his consent to M/S.Giriraj Motors to do the repair work. It is submitted by
him that the vehicle was repairable and, therefore, it cannot be a case of total loss
case. Written submissions along with report of surveyor were placed on record.
Photocopies of the damaged vehicle were also placed on record. Assessment of
loss was made of the vehicle and opined that if the vehicle is opened, such
estimate can increase.
4. I have very carefully considered the submissions of the complainant and also
perused various correspondence entered into between the policy holder and the
insurer. I have also perused the investigation report of the surveyor as placed on
record on behalf of the company and also submitted by the complainant. After
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due consideration of the matter, I hold that looking to the damages suffered by the
vehicle due to accident, it appears to be a fit case for total loss. As a matter of
fact, Shri Sanjay Kumar Verma surveyor appointed by the company prepared the
report which suggests due to the extensive damage of vehicle as a result of
accident, it was a total loss. He has worked out the salvage value of the vehicle at
Rs.4 lakh at that time. He assessed the loss at net of salvage basis and not on
repair basis. Accordingly, I consider fair and reasonable to pass the Award
with the direction to the insurer to make the payment of insured amount
after taking the damaged vehicle in their custody. The insurance company is
further directed to pay penal interest to the complainant @ 8% from
11.08.2009 till the time payment is made.
record.
Case No.GI/262/RSA/09
In the matter of Shri Prem Babu
Vs
Royal Sundaram Alliance Insurance Company Limited
1. This is a complaint filed by Shri Prem Babu (herein after referred to as the
complainant) against the decision of Royal Sundaram Alliance Insurance Co. Ltd
Motor claim.
2. Complainant stated that the Insurance Company had not settled the claim. His
vehicle met with an accident and got considerably damaged.
80
3. The claim of the complainant had been settled and a sum of Rs.262828/- was paid
vide cheque/ DD No. 772653 dated 01.07.2010 as full and final settlement of the
claim, however, the total bill of the repairs amounted to Rs.364237/-. Accidental
claim of the complainant has been settled by the Insurance Company.
4. The complaint of the complainant is disposed of accordingly.

In the matter of Shri Parvesh Rathore
Vs
1. This is a complaint filed by Shri Parvesh Rathore (herein after referred to as the
complainant) against the decision of ICICI Lombard General Insurance Co. Ltd.
Motor claim.
2. Complainant submitted that his motorcycle bearing registration no. DL-8S- AG-
7133 met with an accident twice and he had lodged a claim with the Insurance
Company. The vehicle was insured but the claim has not been settled. He had
approached various offices of the Insurance Company but so far he had not been
paid his claim amount. The motor cycle was financed by ICIC Bank however he
is making the payment of the loan amount.
3. During the course of hearing the complainant as well as the representative of the
Insurance Company were present. It had been agreed by the representative of the
Insurance Company to make the payment of Rs.8929/- as full and final payment
for settlement of the claim. As a matter of fact this was the claim made by the
81
complainant and the Insurance Company agreed. Accordingly Award is passed
with the direction to the Insurance Company to make the payment of Rs.8929/-
less policy clause, if any.
In the matter of Shri Saurabh Sahdev
Vs
1. This is a complaint filed by Shri Saurabh Sahdev (herein after referred to as the
complainant) against the decision of The Oriental Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) for Repudiation of Motor claim.
2. The complainant stated that his vehicle met with an accident on 17.04.2007 near
Udaipur and the vehicle was surveyed at the spot of accident. The Branch Office
was informed and the vehicle was inspected by the surveyor Shri B.S. Dhillon and
the same was re-inspected by the surveyor and confirmed the repair-replacement
of the parts. The bills of the repair and parts were submitted to the office along
with other requirements for settlement of the claim. He submitted further that
inspite of completing all requirements and replying to all the queries raised on
behalf of the Insurance Company, and various reminders to the Insurance
Company for the settlement of the claim, the claim was not settled. He had
requested to direct the Insurance Company to settle the claim on an early date.
3. Various letter were placed on record on behalf of the Insurance Company,

especially letter dated 03.11.2009. it has been confirmed by the Insurance
Company that complainant had taken the policy no. 215503/31/2007/5983 from
the insurer in respect of his Tata 2515 Refrigerated Van bearing registration no.
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HR 55 C 8019. On 03.05.2007 insured informed the insured regarding the
accident of the vehicle on 17.04.2007 at Udaipur. He also informed that Udaipur
office did spot survey and FIR was lodged with PS Kailashpuri, Udaipur for the
said accident. Shri B.S. Dhillon was appointed to assess the loss and vide his
survey report no. OIC/BSD5349 dated 17.09.2007 has assessed the loss for
Rs.366639/-. The Insurance Company had appointed Shri R. Chaudhary as
investigator to verify the bills submitted by the insured. The investigator reported
that most of the bills were found fraudulent. Shri R. Chaudhary was again
requested to verify the bills and he submitted his report and recommended to
repudiate the claim as bills were fraudulent. Shri Dhillon surveyor had assessed
the loss at Rs.366639/- and appended a note in the report which reads as under:
“Note: Undersigned re-inspected the vehicle on 30.08.2007 and
photographs were taken along with the salvage at workshop and found that
all the parts allowed by the undersigned were found replaced and vehicle
was repaired quite satisfactorily.”
On the basis of the observation of Shri R. Chaudhary, the Insurance Company had
repudiated the claim of the insured.
4. I have very carefully considered the documents placed on record particularly the
observation of the Insurance Company as mentioned in letter dated 03.11.2009
whereby implication the claim of the insured had been repudiated. I have also
perused the surveyor report as submitted by Shri B.S. Dhillon, Automobile
Engineering. After due consideration of the matter I find that the Insurance
Company was not justified in repudiating the claim. It had confirmed that the
vehicle had met with an accident, it got damaged, loss was also assessed, all
formalities have been complied with by the insured. As it is evident from the
report given by the surveyor, the vehicle was repaired satisfactorily. In view of
the certification given by the surveyor Shri B.S. Dhillon, the observation of the
Shri R. Chaudhary investigator did not carry much weight as the surveyor was the
competent person to inspect the vehicle and assess the loss. I would therefore
hold that the Insurance Company has wrongly repudiated the claim of the policy
83
holder. Accordingly award is passed with the direction to the insurer to make
the payment of Rs.340139/- (Rs.366639/- -Salvage Value Rs.25000/- less
policy excess clause of Rs.1500/-). Since there does not appear to be
appropriate justification with insurer not to settle the claim of the insurer, it
is further awarded that Insurance Company will pay interest @ 8% from
In the matter of Shri Saurabh Sahdev
Vs
1. This is a complaint filed by Shri Saurabh Sahdev (herein after referred to as the
complainant) against the decision of The Oriental Insurance Co. Ltd. (herein after
referred to as respondent Insurance Company) for Repudiation of Motor claim.
2. The complainant stated that his vehicle met with an accident on 17.04.2007 near
Udaipur and the vehicle was surveyed at the spot of accident. The Branch Office
was informed and the vehicle was inspected by the surveyor Shri B.S. Dhillon and
the same was re-inspected by the surveyor and confirmed the repair-replacement
of the parts. The bills of the repair and parts were submitted to the office along
with other requirements for settlement of the claim. He submitted further that
inspite of completing all requirements and replying to all the queries raised on
behalf of the Insurance Company, and various reminders to the Insurance
Company for the settlement of the claim, the claim was not settled. He had
requested to direct the Insurance Company to settle the claim on an early date.
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3. Various letter were placed on record on behalf of the Insurance Company,
especially letter dated 03.11.2009. it has been confirmed by the Insurance
Company that complainant had taken the policy no. 215503/31/2007/5983 from
the insurer in respect of his Tata 2515 Refrigerated Van bearing registration no.
HR 55 C 8019. On 03.05.2007 insured informed the insured regarding the
accident of the vehicle on 17.04.2007 at Udaipur. He also informed that Udaipur
office did spot survey and FIR was lodged with PS Kailashpuri, Udaipur for the
said accident. Shri B.S. Dhillon was appointed to assess the loss and vide his
survey report no. OIC/BSD5349 dated 17.09.2007 has assessed the loss for
Rs.366639/-. The Insurance Company had appointed Shri R. Chaudhary as
investigator to verify the bills submitted by the insured. The investigator reported
that most of the bills were found fraudulent. Shri R. Chaudhary was again
requested to verify the bills and he submitted his report and recommended to
repudiate the claim as bills were fraudulent. Shri Dhillon surveyor had assessed
the loss at Rs.366639/- and appended a note in the report which reads as under:
“Note: Undersigned re-inspected the vehicle on 30.08.2007 and
photographs were taken along with the salvage at workshop and found that
all the parts allowed by the undersigned were found replaced and vehicle
was repaired quite satisfactorily.”
On the basis of the observation of Shri R. Chaudhary, the Insurance Company had
repudiated the claim of the insured.
4. I have very carefully considered the documents placed on record particularly the
observation of the Insurance Company as mentioned in letter dated 03.11.2009
whereby implication the claim of the insured had been repudiated. I have also
perused the surveyor report as submitted by Shri B.S. Dhillon, Automobile
Engineering. After due consideration of the matter I find that the Insurance
Company was not justified in repudiating the claim. It had confirmed that the
vehicle had met with an accident, it got damaged, loss was also assessed, all
formalities have been complied with by the insured. As it is evident from the
report given by the surveyor, the vehicle was repaired satisfactorily. In view of
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the certification given by the surveyor Shri B.S. Dhillon, the observation of the
Shri R. Chaudhary investigator did not carry much weight as the surveyor was the
competent person to inspect the vehicle and assess the loss. I would therefore
hold that the Insurance Company has wrongly repudiated the claim of the policy
holder. Accordingly award is passed with the direction to the insurer to make
the payment of Rs.340139/- (Rs.366639/- -Salvage Value Rs.25000/- less
policy excess clause of Rs.1500/-). Since there does not appear to be
appropriate justification with insurer not to settle the claim of the insurer, it
is further awarded that Insurance Company will pay interest @ 8% from
Case No.GI/265/Reliance/09
In the matter of Shri Anuj Kumar
Vs
Reliance General Insurance Company Limited
1. This is a complaint filed by Shri Anuj Kumar (herein after referred to as the
complainant) against the decision of Reliance General Insurance Co. Ltd. (herein
after referred to as respondent Insurance Company) for non-settlement of Motor
claim.
2. The complainant stated that he had purchased a new Honda City Car with a loan
of Rs.7,20,000/- from Bank Of Baroda for Rs.8,69,000/- on 15.01.2009. The
Insurance Company M/s. Reliance General Insurance Co. Ltd. had insured his
vehicle for a sum of Rs.8,25,000/- i.e. 5% less than the showroom selling price.
His car was badly damaged in an accident in Gurgaon on 16.05.2009 at about
9.45 pm. The Insurance Company was informed about the accident and claim no.
2091106476 dated 17.05.2009 was lodged. The damaged car was shifted to
86
nearest authorized workshop of M/s. Honda i.e. M/s. Ring Road Honda, Udyog
Vihar Phase-IV, Gurgaon which submitted the necessary repair estimate to the
insurer. It is submitted by him that cost of repair of the damaged car as per
estimate of M/s. Ring Road Honda was more than the insured value of the
vehicle, therefore the complainant felt that it was a case of total loss. The
Insurance Company assigned the survey to Shri Vinay Kumar and then to Shri
Ashwani Thapar. He was informed by the Insurance Company that preliminary
estimate is Rs.4,78,520/-. He was not associated with the survey. M/s. Ring Road
Honda also does not have such details with regard to preliminary estimate report
of the surveyor. It has been submitted by him that the car is lying at the garage
and he had to suffer for the same as he had to pay charges for parking of the
vehicle. His claim has not been settled so far. The complainant is insisting it for
making it a case of total loss and he is not prepared to get his vehicle repaired.
Repairer had given it in consent for repair of the vehicle as per estimate of the
repairer. During the course of hearing also the complainant insisted for making it
a case of total loss. He is adamant to treat the case as total loss case whereas the
dealer/ workshop was prepared to repair the vehicle, but the complainant has not
given his consent for repair.
3. The insurance Company submitted a reply on the date of hearing which is placed
on record. Wherein it has been stated that policy under reference is a Private Car
Comprehensive Policy and it was issued to the complainant from 15.01.2009 to
14.01.2010. The vehicle was damaged due to accident on 16.05.2009 and
intimation to this effect were received in the office on 16.06.2009 which violated
the policy terms and conditions. It was mentioned further that the insured himself
stated that the loss occurred due to head on collusion with an oncoming Maruti
Car and after seeing the condition of the vehicle, it is hard to believe that there is
no third party loss and no FIR has been registered. Since intimation was received
late it was unable to ascertain the actual case of the loss. Shri Ashwani Thappar
& Associates were appointed to conduct the survey and assess the loss was to the
tune of Rs.4,78,520/- on repair basis. The insured is adamant to get the claim
87
declared as a total loss, whereas vehicle is very much repairable as per the
estimate by the Honda workshop was to the tune of Rs.7,50,000/- whereas repair
liability worked out by the surveyor was to the tune of Rs.4,78,520/- after
deducting the salvage value of Rs.30,000/-. The Insurance Company requested
the policy holder to get the vehicle repaired but the vehicle was not repaired so far
and the claim is still pending. It has been submitted by the Insurance Company
that the insured vehicle is very much repairable.
4. I have very carefully considered the submission of the complainant. I have also
perused the reply on behalf of the Insurance Company. After due consideration of
the matter I hold that having due regard to the fact that the vehicle is repairable as
it is evident from the documents placed on record, the submission of the
complainant that it is a case of total loss cannot be accepted. When vehicle is
repairable, it would not be fair and reasonable to make it a total loss case.
However, the complainant continued to argue that due to the accident of the
vehicle, extent of damage damage to the vehicle, it ought to be a total loss case
but the same cannot be accepted. The Insurance Company is liable to compensate
for the repair as per terms and conditions of the policy. After the scrutiny of the
case, I consider it fair to direct the insurer to make the payment of
Rs.4,48,520/- as assessed by the surveyor without completion of any formality
on the part of the insured. It is awarded accordingly.
Case No. GI/192/OIC/09

In the matter of Shri Sadhu Ram
Vs
Oriental Insurance Company Limited
1. This is a complaint filed by Shri Sadhu Ram (herein after referred to as the
complainant) against the decision of the Oriental Insurance Company Limited
88
settlement of Motor claim.
2. The complainant submitted that he is the owner of Truck No.HR-47A-6881. The

truck met with an accident on 20.05.2006. The complaint was filed on
20.05.2006 itself with the company. The survey was done on 22.05.2006 and
whatever documents were required from him for settling the claim, the same were
also submitted by him with the company. He has also submitted bills and
vouchers relating to purchase of spare parts etc. for repairing the vehicle but the
claim was not settled. He has requested that his claim may kindly be settled at an
early date. He also claimed interest for not settling the claim so far.
3. The Insurance Company has not settled the claim so far. The company has not
furnished any reply also to this forum. However its representative attended the
hearing.
4. I have considered the submissions made by the complainant very carefully and
also perused the papers which the representative of the company brought on the
date of hearing. Photocopies of certain documents were also procured and also
placed on record. After due consideration of the matter, I find that despite
furnishing all relevant details and documents as required for settling the claim, the
claim of the complainant was not settled by the Company. Though on file, the
claim is approved on 16.02.2007 yet the complainant is being requested to submit
certain details which were already on record. The claim is approved on file as per
noting on motor claim assessment sheet on 16.02.2007, it goes without saying that
the claim is admissible but one fails to understand as to why the claim has not
been settled so far. The complainant is hard hit due to accident to the vehicle and
badly needed the compensation but the same was not unfortunately done.
Accordingly, Award is passed with the direction to the company to make a
payment of Rs.1,99,500/-. Since there is inordinate delay on the part of the
company in settling the claim, the company is further directed to pay penal
89
interest @ 8% from the date of filing the claim till the time the payment is
made.
record.
Case No. GI/295/HDFC ERGO/09

In the matter of Shri S.B. Dwibedy
Vs
HDFC ERGO General Insurance Company Limited
1. This is a complaint filed by Shri S.B.Dwibedy (herein after referred to as the

complainant) against the decision of the HDFC ERGO General Insurance
Company Limited (herein after referred to as respondent insurance company)
repudiating motor claim.
2. The complainant submitted that he had received a letter from the HDFC ERGO
General Insurance Company Limited after 10 months of constant pursuance. The
insurance company had made his claim as No Claim and suggested that in case
complainant is not satisfied with the decision of the company, he can go to
Ombudsman. Accordingly, he had made a complaint to this forum. The
complainant further stated that in the early morning of 18.09.2008, his son along
with his friend and a hired driver were returning from late night party and on the
way, the vehicle met with an accident with a parked truck in the middle of the
flyover on the descent, hence could not be visible when going up the flyover. As
a result, the speeding car reaching the top was not able to avert the accident and
crashed into the behind of the truck. There were three occupants in the car: One
Shri Narender Kumar was brought dead into AIIMS Trauma Centre whereas his
90
son and his friend were brought at AIIMS Trauma Centre in the injured condition.
His son Shri Gautam Dwibedy had deep long cut on left side of head severely
bleeding were attended to in AIIMS and given blood.
Later on, he was taken to Moolchand Hospital for further check up where he was
diagnosed with fracture on left hand and physiotherapy was recommended for left
leg which was badly bruised. The complainant further submitted that his son‟s
friend Shri Stefano Diemmi was critically injured and admitted in ICU for first
week in state of unconsciousness for several days and then was moved to Max
Saket for 6 weeks. He had several clots in brain and internal bleeding. In
addition, left side of the head/face was completely restricted with titanium
implants. As a result, he had to undergo 3 major surgeries over a period of 3
months. It was further stated by him that the valuables of all occupants in the
accident vehicle were stolen including the driving license of the deceased driver.
He had stated that he had been paying about Rs.20000/- EMI regularly to ICICI
Bank for unused damaged vehicle. Initially the company was cooperative and
was persistently demanding the driving license as if it was only road block for
settlement of the claim. All investigations and necessary survey activities were
done in November,2008 and when the driving license was made available in
April,2009, the insurer gave consent to get the car repaired which was heavily
damaged and in fact beyond repairs. The total repair estimate was Rs.8.5 lakh
which was more than 75% of the IDV making it a case of total loss. He was
asked to pay Rs.3 lakh towards depreciation. When he was not ready to negotiate
to settle with them with this option, the company stopped receiving the call.
However, no approval was given by him for repair of the vehicle and demanded
justified compensation as a total loss. The complainant further stated that one has
to appreciate that when the car met with an accident, it was only 6 to 7 months
old. It is submitted by him that survey and investigations were conducted only in
favour of insurance company and the company was always on the lookout for
excuses for not making the claim. The company came with a theory that the car
was being driven by his son Shri Gautam Dwibedy who was drunk so that the
91
claim may be rejected on this ground. One fails to understand why the company
was insisting upon the production of driving license of driver and when the same
was made available to them, they gave different cause for making the claim as No
Claim. They harassed his son‟s friend and his son also when they recovered after
the injury due to accident. He had suffered financially and could not wait longer
for settlement of the claim. He had to buy a new car for business purposes. He
had already paid a sum of Rs.2 lakh towards the instalment of the damaged car.
The car could not be repaired and it is in the workshop for which he had to pay
parking charges. The accident had strongly affected all victims in his family in a
strong manner which he is trying to combat. He had been paying insurance for
his vehicle; however such accident had taken place for the first time. He
requested that his claim be settled.
3. Written submissions were placed on record on behalf of the company. The

representative of the company also attended the hearing and stated that claim had
been made as No Claim. The company in its reply stated that the complainant
insured his vehicle No.DL1YB0947 with the insurer under Private Car Package
Policy No.VP00364783000100 valid for the period 29.02.2008 to 28.02.2009.
The complainant had filed a claim on 05.11.2008 for damage of the vehicle stated
to be occurred on 18.09.2008. On receiving the intimation of the claim on
05.11.2008 an independent surveyor, Shri Mukesh kumar Aggarwal was deputed
to assess the loss. For the first few months, the complainant did not provide the
driving license of the person as claimed to be driving at the time of the accident
and on each reminder insured said that he is not in possession of the driving
license of that person and arranging the same. Since there was death reported in
the accident, case was assigned for investigation to independent investigator
M/S.Suraksha enterprises and during investigation the agency collected the
documents and submitted its report. It was submitted that on the night of
17.09.2008, Shri Gautam Dwibedy took the car to attend the party and picked his
friend Shri Stefano Diemmi who parked his car near Andharia mode and board
the car with his driver Narender Kumar and went to attend a party. Around 2.30
92
a.m. along with his friend on returning back from the party near Nehru Place
flyover the vehicle met with an accident with a parked truck. The occupants got
badly injured and were shifted to AIIMS Trauma Centre wherein the driver was
declared dead and Shri Gautam Dwibedy and Shri Stefano Diemmi were treated
in the hospital. The independent investigator had given the details of the injury to
the occupants. The MLC of other occupant of the car was also done and it was
stated that son of the complainant and his friend were under the influence of the
alcohol. The surveyor inspected the vehicle and took photograph of the damaged
vehicle. On the basis of the investigation, it was observed that Shri Gautam
Dwibedy and his friend were under the influence of alcohol at the time of
accident. It was further observed by the investigator that the car hit the standing
truck in the back from the left side and the whole impact in the damaged car is on
the left side. Even the blood stains are on the left side of the car and not on the
driver seat whereas as per insured‟s version, deceased Shri Narender Kumar was
driver of the car and sitting on the front right seat. It was observed by the
investigator that since the damage to the vehicle was mainly on the left side and
since Shri Narender Kumar died who was a driver, the car was being driven by
son of the complainant because due to impact on the left side Shri Narender
Kumar died whereas other occupants of the car were injured.
4. The insurer repudiated the claim vide its letter dated 25.06.2009 stating that the
company shall not be liable to make any payment in respect of any accident loss
or damage suffered whilst the insured or any person driving the vehicle with the
knowledge consent of the insured is under the influence of intoxication liquor or
drugs. That is to say, the company presumed that the complainant‟s son Shri
Gautam Dwibedy was driving the car at the time of accident and since as per
MLC, he was under the influence of liquor, the claim was made as No Claim.
5. I have considered the submissions of the complainant very carefully and have also
perused the replies of the company which are placed on record. After due
consideration of the matter, I hold that the company was not justified in
93
repudiating the claim of the complainant because admittedly vehicle met with an
accident and was badly damaged due to such accident. One of the occupants of
the car was dead due to the impact of the accident which goes to show that the car
was excessively damaged. No documentary evidence was placed on record for
the conclusion that it was the son of the complainant, that is, Shri Gautam
Dwibedy, who was driving the vehicle at the time of accident. The impact was so
much as the speeding vehicle collided with stationary truck which could have
caused fatal injury to any of the occupant. From the death of the driver, Shri
Narender Kumar, one cannot conclude that he was sitting on the left side of the
vehicle. The vehicle was damaged may be extensively on the left side but it was
also damaged in the right hand side. There was nothing brought on record to deny
the claim of the complainant and the surviving occupants of the vehicle that Shri
Narender Kumar was not driving the vehicle. Admittedly Shri Narender Kumar
was the driver who was brought by the friend of complainant‟s son and they were
returning from the late night party in the early hours and the purpose of the driver
in the vehicle may be only to drive the vehicle otherwise complainant‟s son‟s
friend could not have brought him. Moreover, both Shri Guatam Dwibedy and
his friend were returning from the late night party and were drunk and in such
circumstances one can safely conclude that Shri Narender Kumar who was not
found drunk and who sustained fatal injury due to the accident was the one who
was driving the vehicle at the time of accident.
Therefore, in my considered view, the company was not justified in making it a

No claim case. Moreover, there appears to be some deficiency in the
investigation report so much so no enquiry was conducted from the persons who
brought the occupants of the vehicle to the trauma centre at AIIMS. Only persons
who had seen the accident and actually extricated Shri Narender Kumar and other
occupants of the car from the damaged vehicle were in a position to state as to
which was on the driving seat at the time of accident. The car could not be
repaired as the complainant thought it was a case of total loss because the estimate
of repair of the car was more than 70% of the insured value of the car. The
94
company insisted upon giving approval of repair. The damaged to the car as a
result of accident was assessed by Shri M.K.Aggarwal and as is evident from the
report submitted by him on 20.02.2009, it appears that he had allowed most of the
parts as demanded by the repairer and thus assessment made by him appears to be
reasonable. However labour charges were assessed by him were on the lower
side, the same needs to be suitably increased. It is considered fair and reasonable
if the labour charges are allowed at Rs.64882/- instead of Rs.48944/- allowed by
the surveyor. Accordingly, I consider it fair and reasonable to pass the Award
with the direction to the company to make payment of Rs.4,56,554/- along with
penal interest @ 8% from the date of repudiation to the date of actual payment.
record.

In the matter of Shri Satish Gupta
Vs
1. This is a complaint filed by Shri Satish Gupta (herein after referred to as the
2. The complainant submitted that his Hero Honda Motor cycle No.DL 6S-Q 4739
was stolen on 20.08.2008 at around 10.00 p.m. from outside the premises No.RZ-
74A, Ravi Nagar Extn., Vishnu Garden, Khyla, New Delhi. The motor cycle at
that time was with his younger brother, Shri Shushil Gupta. He was having valid
95
driving license. He immediately contacted PCR at 100 number and brought the
matter to their notice. PCR police came and recorded the statement of his brother.
He went to Tilak Nagar police station to lodge FIR. The duty officer told him to
wait for 10 to 15 days as the vehicle might be traced. He was informed by the
police that vehicle has been traced and he may reach the police station for
verification. The motor cycle was recovered but it was found that many part of
the motor cycle were missing. His FIR was not registered despite his constant
efforts. Only after the intervention of high officials of police, the FIR was
registered on 22.10.2008 under Section 379 of the IPC. The vehicle was released
by the police in his favour later on. The vehicle was insured for a sum of
Rs.20000/-. His claim was not settled by the company.
He contacted Shri N.L.Sharma, loss assessor on the advice of Shri Neeraj Tiwari,
insurance agent for lodging his claim with the insurance company. He was
advised to get the estimate prepared from the authorized Hero Honda dealer. He
took the motor cycle to the authorized Hero Honda dealer M/s. Khanna
Automobiles, Nawada, New Delhi which prepared the estimate of Rs.49091/-
towards the repair of the motor cycle and charged him Rs.1000/- towards
preparing the estimate. Such estimate was handed over to the surveyor and loss
assessor by speed post. He requested the Forum to direct the insurer to settle his
claim in respect of his motor cycle and make payment of Rs.20000/- being
insured amount without any further delay.
3. The Insurance Company repudiated the claim of the complainant on the ground
that there had been inordinate delay in intimating the claim to the company. The
company stated the complainant ought to have intimated the fact of theft of Motor
cycle to the insurance company immediately but he had taken considerable time
and the delay was inordinate. Therefore, the claim was not payable. However
damaged vehicle was surveyed by independent surveyor who had submitted his
report with the assessment on repair basis of Rs.18124/- and also on net salvage
96
basis at Rs.13950/-. However, the claim was denied on account of late intimation
about the theft of motor cycle to the insurance company by the insured.
4. I have considered the submissions of the complainant very carefully and have also
perused the reply of the company which is placed on record. After due
consideration of the matter, I hold that insurer was not justified in repudiating the
claim on the ground of late intimation of the occurrence of the theft to it. The
complainant had to make a lot of efforts to register the FIR. The delay in
intimation to the insurer was not intentional. The delay occurred mainly due to
his efforts to get the FIR registered with the police authorities. He made sincere
efforts firstly to get the FIR registered which took considerable time. As a matter
of fact, he immediately rang at 100 number to call the PCR. He had not only
made considerable efforts in getting the FIR registered but also had to make a lot
of efforts in getting the vehicle released. In my considered view, only on account
of late intimation of occurrence of theft to the insurer, the otherwise admissible
claim cannot be denied.
The claim is payable. Admittedly, the vehicle was stolen, the same was recovered
with missing parts, estimate of repair was given, loss was also assessed by the
approved surveyor of the company. Further I find that the surveyor has
excessively estimated the salvage value. The engine which is the main part of the
motor cycle was missing when the same was recovered. Therefore, it appears fair
and reasonable if the salvage value of the vehicle is estimated Rs.3000/- as against
Rs.6000/- estimated by the surveyor. Having due regards to the facts of the
case, it appears reasonable if salvage value is taken at Rs.3000/-. Accordingly
Award is passed with direction to the company to make the payment of
Rs.16950/-along with penal interest @ 8% from the date of repudiation of the
claim to the date of actual payment.
97
record.

In the matter of Swami Surender Dev Ji Maharaj
Vs
1. This is a complaint filed by Swami Surender Dev Ji (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) for non settlement of
Motor claim.
2. The complainant submitted that he had insured his Innova Car against all risk
w.e.f. 08.11.2007 to 07.011.2008 and he was issued a policy no.
3001/52907570/00/000. His vehicle was stolen on 22.11.2008 and FIR No. 623
dated 23.11.2008 U/S 379 was registered with the Police Station Rajouri Garden,
West Delhi. Police had given untraceable report on 06.01.2009. The claim was
lodged on 24.11.2008. It has been submitted by the complainant that the claim
was settled late and Insurance Company had taken considerable time in settling
the claim. The claim was settled and the requisite amount of cheque was issued
on 18.01.2010 which was received on 27.01.2010. It was further submitted by
him that mental harassment was caused to him in pursuing the claim and on
number of calls no response was given by the officers of the Insurance Company.
3. No reply was given by the Insurance Company. However, on the date of hearing
representative of the Insurance Company attended. She had stated that the
98
Insurance Company had already paid a sum of Rs.880392/- vide cheque no.
814341 on 15.01.2010 as full and final settlement of the claim. However, she was
not able to state as to why the claim was not settled at early date and why the
Insurance Company had taken undue time in settling the claim.
4. I have considered the submission of the complainant. I also considered the verbal
submissions as put forth by the representative of the Insurance Company. After
due consideration of the matter I find that there has been undelay in settling the
claim. Formalities were complied with by the policy holder. The claim was
settled by making payment on 18.01.2010. It is a case of theft and the Insurance
Company took lot of time in conducting investigation. However, I am of the
considered view that there has been delay in settling the claim and the Insurance
Company is liable for penal interest. It would be fair and reasonable if an
Award is passed with a direction to the Insurance Company to make the
payment of penal interest @8% for 6 months i.e. amounting to Rs.35216/-. It
is awarded accordingly.
GUWAHATI
GUWAHATI OMBUDSMAN CENTRE

Complaint No. 11 -004-0008/10-11
Mr. Dhiraj Mahanta
- Vs -
The United India Insurance Co. Ltd.
Date of Order : 17.05.2010
99
The vehicle bearing Registration No. AS – 01 / AC – 5196 belonging to the
Complainant and insured with the above Insurer under the policy in question met
with an accident on 17.01.2009 sustaining damages. Police as well as the Insurer
were informed and a formal claim was lodged before the Insurer. It is alleged
that the Insurer has treated the claim as “No Claim” without any justified ground.
The Insurer has contended in their “Self Contained Note” that the Insured vehicle
did not have a valid route permit on the date of accident on 17.01.2009 and due
to such violation of the policy condition, the claim was repudiated.
The report dated 23.01.2009 issued by the Police as well as the report of M.V.I.,
Kamrup proves about the involvement of the vehicle in an accident sustaining
damages. The report of the M.V.I. further proves that complete right side body of
the vehicle was damaged and the Surveyor has assessed the loss at
Rs.1,83,972.00. However, the Survey Report states that the insured vehicle was
not having a valid permit at the time of accident. According to the representative
of the Insurer, the claim submitted by the Complainant was repudiated on the
ground that there was no valid route permit of the vehicle as on the date of the
accident. According to the Complainant, the vehicle was involved in the accident
on 17.01.2009 and the term of previous route permit of the vehicle expired on
04.01.2009. He has clearly admitted that there was no valid route permit of the
vehicle as on the date of the accident on 17.01.2009. As per policy terms and
conditions “Limitation as to use”, the policy in question covers use of the vehicle
only under a permit within the meaning of M.V. Act. 1988. Since the vehicle was
running and involved in the accident on 17.01.2009 at a time when there was no
valid route permit, the condition of the policy appears to have been violated. The
Insurer had repudiated the claim only on such a violation of the policy conditions
and considering the circumstances, I find no irregularity in the settlement process
and hence I find that the decision of the Insurer cannot be questioned. This being
the position, the complaint is treated as closed.

Complaint No. 11 -009-0029/10-11
Mr. Kushal Ch. Hazarika
- Vs -
Reliance General Insurance Co. Ltd.
Vehicle bearing Registration No. AS – 01 / AF – 2939 belonging to the Complainant

and insured with the above Insurer covering the period from 01.01.2009 to
31.12.2009 met with an accident on 03.11.2009 sustaining heavy damages. Insurer
was informed and a formal claim was lodged. It is alleged that although the
damaged vehicle was repaired at a cost of Rs.1,72,000/- and claimed
100
reimbursement but the Insurer has deducted a substantial amount from the same
and settled the claim at Rs.95,000/-.
According to the Insurer, although the loss was assessed at Rs.1,27,061/- by the
Surveyor but the claim was settled at Rs.95,203/- after deducting certain amounts
from the assessed loss due to delayed intimation. The Complainant has stated that
the Insurer was informed after 10 days of the occurrence and the formal claim
was lodged after 12/13 days from the date of accident. The representative has
submitted that though the loss has occurred on 03.11.2009 but the Insurer was
informed only on 26.11.2009 and due to this, certain amounts from the assessed
loss was deducted while settling the claim under Non Standard Basis. He has also
submitted that as per policy Condition No. 1, notice of loss is to be given in
writing to the Company immediately after such occurrence but in the instant case,
the Insured had violated the policy Condition No. 1 in not giving written notice
about the loss immediately after occurrence. His contention is that giving
information after about 23 days is a clear violation of such policy Condition No.
1 and hence the claim was settled after deducting 25% from the assessed amount.
It is seen that as per Condition No. 1 of the policy, notice of loss is to be given
in writing to the Company immediately upon the occurrence of any accidental
loss or damage relating to the claim. It is also noted that in order to bring
liability of the Company to make any payment under the policy, Condition No. 8
of the policy conditions requires due observance of the policy terms and
conditions by the Insured which are found to be condition precedent. Although
the Complainant has stated about giving information to the Insurer about the loss
after 10 days of the occurrence but he has not been able to produce any proof
thereof. The Insurer has produced the claim assessment sheet wherein it was
recorded that the claim intimation was received on 26.11.2009. The Insurer also
appears to have appointed the Surveyor on that date. Settlement of the claim on
Non-Standard Basis deducting 25% from the assessed is not found to be an
irregularity in the settlement process. Hence, the complaint is treated as closed.

Complaint No. 11 -013-0194/09-10
Mr. Subrata Chakraborty

- Vs -
HDFC ERGO Gen. Insurance Co. Ltd.

The vehicle Registration No. AS – 11 / A – 3060 belonging to the Complainant and
insured with the above Insurer under the above policy sustained damages in an
accident on 15.06.2009. It is alleged that as per instruction of the Company, the
vehicle was placed for repairing before the approved Repairer M/s Mayan Motors
and after repairing, the same was taken delivery on payment of Rs.1,01,084/- on
101
09.12.2009. The Complainant thereafter submitted the bill claiming the repairing
charges amounting to Rs.1,01,084/- and it is alleged that as against that amount,
the Insurance Company has settled the claim only at Rs.32,895/-.
According to the Insurer, their Surveyor noticed that the charges for parts being
charged by the repairer was exorbitant for a model which was no more in
production worldwide and because of that cashless facility was denied. The
Insurer has also submitted that the Surveyor had collected prices of those parts
from two other motor dealers and the rates given by them are found to be
contrary to what was submitted by the Insured.
According to the Complainant, he had placed the vehicle for repairing before that
firm wherein the Surveyor of the Insurer had inspected the damaged vehicle.
It is not in dispute that M/s Mayan Motors is their authorized dealer wherein the
vehicle was placed for repairings, under instruction from the Insurer. The fact of
issuing the repairing bill amounting to Rs.1,01,084/- by the Garrage which has
been paid by the Insured, is also not disputed. The Insurer, through their
Surveyor, procured rates from other two firms, in respect of repairing charges /
parts, who were not connected with the repairings of the vehicle. The bill has
been paid by the Insured to the firm after repairing of the insured vehicle and
the parts were also supplied by the said firm. Although the lowest rates quoted
by other two firms procured by the Surveyor for similar parts were accepted by
the Insurer during settlement process, but parts at such rates were also not
supplied by any of those firms or by the Insurer. In such a circumstance,
ignoring the bill issued by the firm after repairing which was paid by the Insured
and placing reliance on rates quoted by other firms, who were not connected with
the repairings appears to be not proper and justified. The Insurer should have
considered the bill dated 16.11.2009 in respect of labour charges / spare parts and
applying depreciation, claim should have been settled. In view of such facts and
circumstances, settlement of the claim at Rs.32,895/- appears to be an irregularity
which is set aside.
In view of the above facts and circumstances, the Insurer was directed to settle
the claim, on the basis of bill dated 16.11.2009 submitted by the Complainant,
within 15 days.
HYDERABAD
HYDERABAD OMBUDSMAN CENTRE

COMPLAINT No. I.O.(HYD) G -11. 013.379. 2009-10
Sri Visahl Kumar S V/s HDFC ERGO Gen. Ins. Co. Ltd
Award No:G-002/05.04.2010
102
Sri Vishal Kumar took motor comprehensive policy for his auto rikshaw with
registration number KA 05C 7769 for Rs.1,30,000. The said auto was stolen on
15.5.2009 near his house. He reported the matter to the police on 1.6.2009. The
Insurance Company, M/s HDFC ERGO, rejected the claim on grounds of delayed
intimation to them and in filing FIR with the police. The insurer also alleged that the
previous policy submitted as that of IFFCO Tokio was found to be invalid.
Aggrieved by repudiation of the claim, the Sri Vishal Kumar lodged a complaint
for settlement of the claim.
The complainant contended that police registered the complaint after he made
three visits to them. He was advised to come after a week and after thorough search.
He clarified that the policy of IFFCO Tokio was taken by the previous owner of the
Auto. He further clarified that he was asked to submit the FIR number when he tried to
intimate the incident of theft to the insurer‟s call centre. Hence, he could not register
the claim intimation with the call centre immediately.
The insurer stated that the complainant had suppressed material facts about
previous insurance before obtaining the policy from them. The claim was rejected
under condition no.1 of the policy that notice shall be given immediately in writing to
the company upon occurrence of any accident/incident such as theft. The insurer stated
that the theft occurred on 15.5.2009 but the claim was intimated to them on 2.6.2009.
The police was also informed only on 1.6.2009.
ORDER
The case was fixed for hearing but neither party attended the hearing. It is learnt
that the insurer had offered to settle the claim with the complainant after he preferred a
complaint with this office. The complaint, therefore, is treated as disposed.
In the result, the complaint is treated as allowed for statistical purposes.

103
Sri Ansu A Suseelan V/s National Insurance Co. Ltd.
Award No:G-004/06.04.2010
Sri Suseelan insured his 2003 model Lancer with National Ins. Co. at Mangalore
for Rs.5,96,000. The car met with accident on 16.11.2004 and he reported the matter
to insurer‟s Trivandrum Office the next day. Later he submitted the claim along with
police report and other documents. In the meantime, he went abroad and came back in
Dec. 2005. When he checked with the insurer‟s Trivandrum office, he was informed
that the papers were sent to the base office, that is, Mangalore office. The claim was
finally processed and offered for settlement for an amount of Rs.20,929. While
offering the settlement, the insurer regretted the delay in settlement offering the
reasons for the same. The complainant accepted the offer as partial settlement and
approached this office with a complaint for settlement of balance amount.
The complainant stated that his car was damaged in an accident and he complied
with the requirements for processing the claim. He was pursuing the matter with
insurer‟s Trivandrum office where he took the policy. While the claim was still under
process, he went abroad and returned towards the end of 2005. The base office at
Mangalore finally got the claim papers from Trivandrum and processed the claim for
Rs.20,929 which he accepted and complained for balance amount.
The insurer while approving the claim for Rs.20,929 conveyed that the said
assessment was made by an IRDA approved surveyor and based on the bills submitted
by the complainant. The insurer also contended that the claim was processed even
without the final bills. The insurer stated that the final bills were not submitted so far.
The voucher was sent again for the discharge of the complainant which was discharged
without qualification.
ORDER
The case was fixed for hearing but neither party attended the hearing. It is learnt
that the insurer had offered to settle the claim with the complainant after he preferred a
complaint with this office. The complaint, therefore, is treated as disposed.
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Sri Rasul Sab V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-005/07.04.2010
The complainant‟s bike with Regn No. KA-E-6911 of Bajaj make insured for
Rs.39,501 was stolen while was parked in front of his house on 14.5.2009. He claimed
that he lodged a complaint with police on the next day. He also informed the insurer
about the theft and preferred a claim. The said claim was repudiated by insurer on the
grounds of delay in intimating the loss. The complainant is aggrieved and hence this
complaint.
The complainant stated that he took all necessary steps to intimate the theft of his
vehicle to the police on the day following the day of theft. He informed the insurer and
made a number of requests. He also issued a legal notice but the insurer did not settle the
claim.
The insurer repudiated the claim stating that the complainant lodged FIR only
after 73 days which amounted to violation of terms and conditions of the policy. The
claim intimation was given to the insurer after 81 days which again was a breach under
the policy. The insurer‟s representative also relied upon the decision of the Apex Court
in United India Insurance Co. Ltd. V HarchandRai Chandan Lal MANU/SC/0803/2004
in support of his claim that the policy conditions have to be construed strictly. The
insurer‟s representative, therefore, urged that the rejection of the claim was in order.
ORDER
The policy envisages intimation of theft immediately. The span of time comprised
in the term „immediately‟ has not been indicated. The policy condition, therefore, has to
be construed to mean that the intimation has to be given as soon as possible or without
much loss of time. Theft occurred on 14.5.2009. FIR was lodged with the police 73
days after the theft. The complainant stated that the SI of Police asked him to wait till
they completed the search. This claim is not credible. The insurer also was not
105
informed. There is no evidence to suggest that the complainant approached either the
police or the insurer with the information that the vehicle was stolen. Only after 73 days
did it occur to the complainant that someone outside of himself should know about the
theft. The policy condition envisaging immediate report of theft or loss is intended to
help the insurer to launch an investigation into the claim, if it so desired and if it
suspected perpetration of a fraud. It is obvious that the complainant did not allow the
insurer a fair chance to verify the claim of theft.
In view of the above, it was upheld the decision of the insurer in repudiating the
claim on breach of policy conditions.
In the result, the complaint is dismissed.

Sri Sevapuraju Sree Vijay V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-006/07.04.2010
Sri Sevapuraju Sree Vijay‟s bike was found missing from his apartment
compound during his absence when he along with his friends went to Tirupati. When
he went to report the matter to the Police, he was asked to get clearance from the
financiers. The financier would not grant clearance until the loan was cleared. Sri
Sevapuraju Sree Vijay had to arrange for finance and clear the loan to get the NOC.
This process took some time. When he went to the police station armed with the NOC,
the writer in the police station was not available for two days. Thus occurred delay of
seven days in lodging the complaint with police. His claim was rejected on grounds of
delay in intimation to police as well as to the insurer. The complainant is aggrieved and
hence this complaint.
Sri Vijay stated that he took all necessary steps to intimate the theft of his vehicle
to police in time but the procedures involved were such that there occurred delay. He
was advised at the insurer‟s office to get non-traceable certificate from the police and
that also took about a month. Now, after completing the formalities, his claim was
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declined due to delay. He pleaded that the delays, if any, were for sufficient reasons and
his conduct was above board.
The insurer repudiated the claim stating that the complainant lodged FIR only after 7
days and intimated theft to them after 5 months. The policy condition that “Notice shall
be given in writing to the company immediately” was violated and hence the claim was
not payable and requested this forum to absolve them of any liability under the policy.
ORDER
The policy envisages intimation immediately. The span of time comprised in the
term „immediately‟ has not been indicated. The policy condition, therefore, has to be
construed to mean that the intimation has to be given as soon as possible. The question
for consideration is whether the complainant complied with this or not. The
complainant approached the police without any loss of time. The police did not register
the case on the plea that probably the financier had towed away the vehicle and before
the case could be registered, they needed an NOC from the financier. The financier
would not give NOC unless the complainant paid all the instalments. The complainant,
therefore, had to procure funds and clear the dues. This obviously took some time.
Then when he went to the police with the NOC, the writer was not available. Then,
when he went to the insurer for filing the claim, the insurer demanded „non traceability
certificate‟. This entailed investigation by the police and closure of the case. This again
took time. Only when all these formalities were gone through, the insurer registered the
claim.
The complainant had to comply with a few formalities which were time
consuming. He had no ability to dictate the pace of completion of those formalities. He
had no control over the delays that occurred. Probably, the complainant made the claim
as immediately as possible. It cannot be deduced deliberate negligence on the part of
the complainant in making the claim. Most importantly, nothing was discern any fraud
in the claim. The insurer has also not hinted at any fraud in the claim. The policy
condition requiring immediate intimation is to ensure that the insurer has an
opportunity to unravel a fraud, if any, before the trail went cold.
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The insurer‟s representative relied on the decision of the Supreme Court in United
India Insurance Co. Ltd. v. Harchand Rai Chandan Lal (supra) in support of his
contention that the complainant failed to report loss of theft immediately. In the case
that the insurer‟s representative relied upon, the Apex Court was dealing with a claim
in the context of the definition of „burglary‟ in the policy as opposed to the general
meaning of the term „burglary‟ and it was in this context that the Hon‟ble Court held
that insurance is a contract, the terms of which bind either party.
In the instant case, the policy condition required report of theft immediately and
the only issue for consideration is the meaning to be assigned to the word
“immediately”. It is evident that the insurer‟s representative‟s reference to the decision
of the Apex Court is contextually not relevant to the case on hand. Further, it is well
documented that the courts encourage substantive justice, and, in furtherance of such an
ideal, they are liberal in condoning delays if the aggrieved party adduces evidence
showing that delay was for unavoidable and valid reasons.
Condonation of delay has to be considered if valid reasons exist for delay and
especially when a claim otherwise is bona fide and rejection occurs only because of
delay. This is so even in a case where time limit is specified. When the time limit is not
specified in exact terms, valid reasons for delay, if any, in normal parlance, would
oblige examination of a claim on merits.
In the light of the foregoing, it was viewed that the complainant acted quickly
enough in complying with the formalities under the policy. The delay was condoned, if
any, in filing the claim because such delay was for good and unavoidable reasons. The
insurer is directed to settle the claim as per the policy.
In the result, the complaint is allowed.

Sri M Ram Mohan Rao V/s United India Insurance Co. Ltd.
Award No:G-010/19.04.2010
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Sri Rammohan Rao‟s Maruti car of 1991 model was burnt in a fire accident. On
20.04.2009, there was electrical short circuit in the shed where he had kept the car.
The resulting fire burnt the car. Sri Rammohan Rao filed a claim with insurer and
submitted police panchanama and other documents. His claim was rejected on
10.12.2009 stating that the insured did not reveal the fact that LPG kit was installed in
the vehicle. The faulty wiring in the kit aggravated the fire. Moreover, the insured did
not pay the required premium for installing LPG kit. Sri Rammohan Rao is aggrieved
and hence this complaint.
The complainant submitted that the insurer‟s surveyor negotiated for Rs.25,000
for final settlement of the claim for which he did not agree. He also alleged that the
surveyor conveyed to him that the car was insured for higher value. The complainant
denied it by stating that the car had been insured for almost 10 years and the value
was not a dispute all these years. The insurer took six months to convey the decision
of rejecting the claim on the ground that he did not inform the installation of the LPG
kit. He contended that the electrical short circuit originated in the shed.
The insurer contend that the insured had taken the policy filling up a proposal
form wherein he had not disclosed material facts about the bi-fuel system such as
petrol/diesel and CNG/LPG as permitted by the concerned RTA. Accordingly, he was
not charged any extra premium for LPG kit. It is further contended that the accident
took place at Mohammed Auto Garage on 21.4.2009 but he intimated the accident on
18.5.2009. The relevant condition of the policy cast a duty on the insured to intimate
the accident immediately. He came up with a request on 22.6.2009 for inclusion of
the LPG kit by way of an endorsement. Hence, the claim was rejected.
ORDER
The insurer‟s contention that the value of the car would not be more than
Rs.25,000 is not acceptable as the car had been in continuous coverage with them. The
value of insurance was never a point of dispute at any stage and, therefore, the
contention cannot be entertained. The complainant had not insured the LPG kit. The
contention that the insurer would have known about installation of LPG kit owing to an
antecedent inspection cannot be accepted. It was also convinced that the fire was a
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result of short circuit of the shed but equally the damage would have increased due to
the blast of LPG cylinder in the car. It is difficult to apportion the loss with precision.
The insurer is directed attribute 50% of the total damage to the direct impact of the
short circuit and the other 50% to the LPG kit.
Accordingly, the insurer is directed to settle the claim on IDV of Rs.65,000 on
loss basis at Rs.28,000 [being (Rs.65,000 less salvage Rs.8,000)×50% minus policy
compulsory excess Rs.500].
In the result, the complaint is partly allowed.

COMPLAINT No. I.O.(HYD) G -11. 009. 0391. 2009-10
Sri. B Santosh Kumar V/s Reliance General Insurance Co. Ltd.
Award No:G-012/21.04.2010
Sri B. Santosh Kumar‟s Tempo Trax Cab with registration No. AP 28 TB 3301
met with an accident on 15.8.2009 in which five persons died and another five persons
were injured. The vehicle was completely damaged. When Sri. Santosh Kumar preferred
a claim with the insurer, the insurer rejected the claim stating that 17 persons were
traveling in the vehicle against the seating capacity of only 12 persons at the time of
accident in contravention of the policy condition. Sri Santosh Kumar is aggrieved and
hence this complaint.
Sri Santosh Kumar contended that as per the charge sheet filed by the police only
10 people were traveling in the cab including the driver, i.e. himself. The complainant
submitted an addendum report filed with the police which clarified that while filing the
original FIR, the complainant erred in mentioning the number of injured as 13 instead of
3.
The insurer repudiated the claim vide letter dated 18.12.2009 stating that
passengers in excess of the seating capacity were being carried at the time of accident.
The insurer quoted the relevant portion of the policy condition which mentioned that the
insured was not indemnified if the vehicle was used or driven otherwise than in
accordance with the provisions of the schedule. Hence, the claim was repudiated.
110
ORDER
The accident occurred while the complainant was driving the tempo vehicle. The
eye witness who informed the police mentioned that 4 persons died on the spot while 13
others were injured. This was the basis of the FIR.
The insurer turned down the claim citing violation of MV Act, 1988 with regard
to the number of passengers carried vis-à-vis the seating capacity of the vehicle. The
seating capacity of the vehicle was certified to be 12 including the driver whereas the FIR
mentioned that 17 persons were traveling in the vehicle at the time of the accident. The
person who filed the FIR subsequently appears to have informed the police that the
injured were only 3 and the number was recorded as 13 incorrectly in the FIR.
An unrelated person reported the accident to the police. He had reported that there
were 13 injured persons. The complainant would like me to believe that there were only 3
injured persons beside himself. The complainant has filed a letter dated 21-11-2009
purported to have been written by the same person that inadvertently he had mentioned
the number of injured persons as 13 instead of only 3 persons. The eye witness who
reported the matter to the police could not have made a mistake in reporting the number
of injured persons. The letter dated 21-11-2009, much after the date of accident cannot be
taken as correct. It is obvious that the letter would have been written at the instance of the
complainant.
That the number of passengers in the taxi could not have been only nine (4 dead
on spot, one dead before reaching hospital and 3 injured and one driver-cum-owner) is
evident from the complainant‟s complaint dated 6-1-10 that there were 10 in the cab
including himself. The complainant stated that the charge sheet mentioned the number of
persons in the vehicle as only 10. This is not correct since the charge sheet dated 23-11-
09 refers to the FIR wherein it was stated that 4 died on the spot while 13 others were
injured out of whom one died while receiving treatment. Further, memo of evidence in
Crime No.230/2009 cites 5 persons, who were grievously wounded, as witnesses. From
the papers filed before me, it appears to me that 5 persons died, 5 were grievously injured
and the others including the complainant were injured but not grievously. In view of this,
the claim that there were only 9 passengers in the vehicle is inaccurate and, hence, not
acceptable.
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As per the charge sheet filed, the accident occurred ostensibly due to rash and
negligent driving of the driver. Overloading of the vehicle also would have contributed to
the accident. Overloading was a clear breach of the policy conditions. Such overloading
also contravened the provisions of the Motor Vehicles Act. In the circumstances,
repudiation of the claim by the insurer deserves to be upheld.

Sri Dilip Kumar K N V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-025/14.05.2010
The complainant‟s bike with Regn No.KA-04EY-6804 of TVS make insured
Rs.37,320/-was stolen while it was parked near Raghavendra Hotel on 11.06.2009. He
lodged a complaint with police on the third day but the police booked FIR after 27 days.
He also informed the insurer about the theft after 37 days. When he preferred a claim
with the insurer, it was rejected on the grounds of delayed intimation.
The complainant pleads that he took all necessary steps to intimate the theft of
his vehicle to police at the earliest. He submitted that police have assured him that his
bike would be traced and no FIR was filed immediately. Police took action and registered
his complaint only after 25 days. He submitted that he also contacted the toll free number
of the insurer who gave reference number of his claim. However, he received a letter
recently rejecting his claim.
The insurer did not submit any note but the repudiation of the claim was on
grounds of delayed lodging of FIR only after 27 days which amounted to violation of
terms and conditions of the policy. The claim intimation was given to the insurer after 37
days which again is a breach under the policy. Hence, the claim cannot be entertained.
ORDER
It is observed that the complainant acted negligently in not approaching the police
immediately on noticing the theft of his vehicle. His reasons for police not accepting his
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complaint to register FIR may be true but his carelessness in not informing the insurer is
indefensible. He took more than a month to log in to the call centre of the insurer to lodge
his claim thereby committed breach of the policy condition. The insurer is right in their
contention that chances of tracing the stolen bike are negligible after 30days. The insurer
has strong reasons for rejecting the claim. However, it is observed that there appears no
foul play in so far as the theft of the bike is concerned. The complainant has definitely
contributed to loss of recovery chances by delaying the steps he aught to have taken for
which he has to pay the price. But, the complainant would suffer irreversible loss if the
bike remains untraced. Hence, tanking a sympathetic view on the complainant, the
insurer is directed to pay Rs.20000/- as an ex-gratia.
In the result the complaint is allowed in part as ex-gratia.

Sri PV Raghavaiah V/s Bajaj Allianz Gen. Insurance Co. Ltd.
Award No:G-032/28.05.2010
Sri Sai Durga Prasad, an Engineering Student, died on 22.3.09 while riding
his mobike. The insurer repudiated the claim stating that the seating capacity of the
bike was only 2 persons whereas there were three persons on the bike at the time of
the accident, thus violating a policy condition. Sri PV Raghavaiah, father of the
insured, is aggrieved and has filed this complaint.
The complainant contended that his son was riding the bike while only his
friend by name Praveen Kumar was sitting in the pillion seat. The accident occurred
only when he saw another friend of him by name Swaroop who happened to stand by
the road side at Souripuram village. He explained that the FIR was wrongly booked
on the hearsay that his son drove the vehicle with two pillion riders. The insurer, on
the other hand, contended that the accident occurred while the insured drove the bike
with two persons as pillion riders. This was in violation of the policy condition. The
insurer, therefore, justified repudiation.
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Since both the parties to the dispute have arrived at a settlement, the complaint
does not survive for consideration. Accordingly, the complaint is treated as disposed.

Dr. K Swatantra Kumar V/s Oriental Insurance Co. Ltd.
Award No:G-037/4.06.2010
Dr Swatantra Kumar took private car package policy from Oriental Insurance Co.
for his Maruti Omni Van. The van was damaged in an accident on 22.12.07. He spent
about Rs.1,25,000 on repairs and submitted his claim with supporting documents and
receipts. The insurer settled the claim for Rs.34,250 and a voucher was sent for the
complainant‟s signature. The complainant rejected the settlement and represented the
matter to the Regional Office of the insurer at Visakhapatnam. As he did not get a
satisfactory response, he approached this office with a complaint seeking relief.
The complainant submitted that he spent about Rs.1,25,000 to get his damaged
car repaired and lodged a claim with the insurance company. The insurer after conducting
the survey has offered to settle an amount of Rs.34,250 which was too little and
unacceptable to him.
The insurer contended that they appointed Sri B Narendranath from
Rajahmundry, a surveyor, while the vehicle was kept at S B Motors Corporation. The
surveyor made initial inspection of the vehicle. However, the complainant shifted the
vehicle to another workshop and submitted a new estimate for Rs.1,09,500 on 25.11.08.
The repairs were completed only by 20.3.09. The final surveyor submitted his report
assessing the loss at Rs.37,865. The claim was finally settled at Rs.34,250 after deducting
policy excess and value of the salvage.
ORDER
It is seen that the difference between the claim and the settled amount was mainly
due to over billing on account of some of the parts not damaged in the accident and yet
charged in the bill. The photographs of the damage suggest that the complainant indeed
114
got some parts replaced although they did not suffer damage due to the accident. Another
reason was that the parts actually repaired were billed as new parts replaced. The
complainant challenged this in his reply although without any evidence. The
complainant‟s version cannot be accepted in the absence of any evidence in support
thereof. In the circumstances, I have to accept the insurer‟s version as correct.
In his letter dated 25-5-10, the complainant stated that he gained an impression
that the ombudsman appeared to agree with the insurer and the surveyor. He failed to
recognize, wantonly, that the institution of Ombudsman has no stakes in the matter and
that it is his duty to settle contentious issues between the insurer and the policy holder
expeditiously. Needless to say that hearing in the case was conducted in a fair manner
with both the parties allowed full opportunity to present their case. The hearing was
adjourned because the issues could not be resolved and in order to arrive at a fair
decision, further evidence was needed.
The complainant did not sense any bias when the case was adjourned. The
insurer‟s representatives complied with the directions issued and furnished reconciliation
statement to the complainant. The complainant should have found fault, if any, with the
said statement and contested the same in the hearing scheduled. He did not do this.
Instead, he resorted to abuse of the institution of ombudsman. He accuses bias only when
the insurer confronted him with the reconciliation statement and when he realized that his
claim has no basis. For the complainant, it appears to be a case of mistaken faith in the
adage „offence is the best defence‟.
Obviously, the complainant can be content only if his claim is accepted. He finds
no virtue in those who cannot agree with him. He first cast aspersions on the insurer. His
own letters were shown to disprove his statements. He then made an allegation against
the surveyor but he could not substantiate the allegation. Now, instead of addressing the
gaps/deficiencies, if any, in the insurer‟s statement of reconciliation, he has audaciously
accused the ombudsman of bias. The complainant has a tendency to prevaricate, which he
has demonstrated time and again. This is most unfortunate.
The complainant failed to support his claim with evidence. The insurer, on the
contrary, justified its action. It was held that the insurer correctly settled the claim at
Rs.34,250.
115

Smt. M Vasantha Laxmi V/s United India Insurance Co. Ltd.
Award No:G-041/14.06.2010
The Insurer issued tailor-made Personal Accident Policy covering Engineering
students. Sri M. Naga Madhu Kumar opted for this policy cover while joining Engg.
Course at MVSR Engg. College. The policy is operative from the date of joining the
Engg. Course till its completion (i.e. up to 4 years). During this period, if the earning
parent dies due to accident, the policy provides PA benefit of Rs.3.00 Lakhs +
reimbursement of tuition fee for the remaining period of study + Lodging and Boarding
expenses, if any. Smt. M Vasantha Laxmi lodged a claim for payment of benefit under
the policy stating that her husband [father of Sri M. Naga Madhu Kumar, Engg. Student]
died due to accident. The insurer sent the claim forms and requested to submit the same
along with FIR, PM Report, etc. The complainant submitted claim forms and stated that
the death occurred due to internal accident and hence there were no FIR & PM Reports.
The insurer repudiated the claim stating that the death occurred due to natural cause and
not due to accident. Aggrieved, Smt. M Vasantha Laxmi filed this complaint.
The complainant claimed that her husband suddenly slipped while fetching water
from the ground floor to the first floor, fell down and became unconscious. Immediately,
he was shifted to the hospital, underwent various tests and died without regaining
consciousness. The test reports mentioned that he suffered from hemorrhagic brain stem
stroke. He was hale and hearty and had no previous history of hypertension or any illness.
The complainant claimed that sudden fall on the floor caused brain hemorrhage and
rupture of major blood vessel. She stated that the death of her husband was due to the
accident and the insurer wrongly repudiated her claim.
The insurer contended that death of the complainant‟s husband was due to a
natural cause and not due to any accident. The insurer stated that External, Violent &
Visible means was a pre-requisite for PA Claim. The insurer also contended that no
116
claim was payable in the absence of FIR & PM Report as per condition No. 3 of the
policy. In the claim form, it was stated by the complainant that her husband died due to
Cardio Respiratory Arrest – Hemorrhagic Brain Stem Stroke. The LIC also had not paid
accidental benefit under their policy. They also referred to exception No. 1[d] of the
policy which declines liability for general disease or insanity.
ORDER
The complainant‟s husband was taken to a hospital on 21.6.08 with complaints of severe
pain in his left hand. He died of brain hemorrhage on 23.6.08. The investigator appointed
by the insurer also reported that the deceased had acute hypertension and finally died due to
brain stem stroke. While filling up the claim form submitted, the complainant stated that
her husband suffered Cardio Respiratory Arrest at their residence. The version that he had a
fall while carrying water does not appear convincing. On the contrary, the insurer‟s claim
that the complainant‟s husband died otherwise than due to an accident is credible. Further,
accidental death has to be on account of external, visible and violent means. These are
absent in this case. Moreover, the claim is devoid of police report and post mortem report,
which are vital to establish death due to accident.
In view of the above, it was held that the complainant‟s husband did not die due to
an accident. Consequently, Ombudsman concurred with the insurer‟s decision to repudiate
the claim.
In the result, the complainant is dismissed without any relief.

Sri V Shiv Shankar V/s Bajaj Allianz Gen. Insurance Co. Ltd.
Award No:G-042/14.06.2010
Sri V Shiv Shankar took Motor Package Policy with Bajaj Allianz Gen.
Insurance Co. Ltd. covering his Lancer Car No.:AP 10 M 3377. The vehicle was
damaged in an accident. He intimated to the insurer‟s call center on 27.12.2009
about the accident. The insurer deputed a surveyor on 29.12.2009 who made
117
preliminary inspection and took photographs and asked for claim documents.
The complainant submitted the claim documents on 12.01.2010 and the surveyor
visited the work shop for finalization of assessment. On his visit, he found that
the vehicle had already been repaired. He submitted his assessment basing on
his first visit and assessed the loss for Rs.2925 only. On verification of claim
documents, the insurer repudiated the claim on the ground that the name of the
driver was different in the original intimation given to the call centre from the one
specified in the claim form. On submission of DL of Sri V Shiv Shankar, the
insurer noted that the DL had expired as on the date of the accident. The insurer
repudiated the claim on this ground. Aggrieved, Sri V Shiv Shankar filed this
complaint.
The complainant claimed that the details of his old driving licence were intimated by
oversight. He alleged that the surveyor manipulated/tampered the repair quotation. He
reconfirmed in P-II form that on the date of the accident, while standing outside of the car in the
garage where his car was parked, he turned the ignition key to the right and that such an act
accidentally ignited the engine. The car was parked in reverse gear and moved back dragging him
for about 10 ft and halted after hitting his own compound wall, confirming that he was the driver
of the car at the time of the accident.
The insurer stated that the complainant did not have valid driving licence as on the date
of the accident as it had expired on 26.11.2008. Being an advocate by profession, the complainant
knew the MV Rules, Motor Policy terms and conditions and violation of DL clause under the
policy. To overcome this, he altered the name of the driver in the Claim Form and submitted
someone else‟s DL. The insurer also contended that the vehicle was repaired without final survey
by the surveyor. The insurer stated that there was delay in submission of claim documents and
cited MV Rules and Act provisions on DL in support of their repudiation.
ORDER
The complainant‟s vehicle was damaged in a freak accident. The vehicle was not
being driven at the time of the accident. The complainant gave his own licence details to
the call centre. In the claim form, he filled in the details of a driver. As explained by the
complainant, he gave his driving licence particulars to the call centre as he was present at
the time of the accident and, while filling up the claim form, he gave his paid driver‟s
licence particulars, as the form asked for the same without any reference to the accident.
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On such facts, it was held that the complainant could not be accused of stating any
falsehood.
The complainant had driving licence but it had expired on the date of the accident.
The complainant was not barred to hold a valid driving licence by disqualification. In any
case, validity or otherwise of DL did not matter in the case because the vehicle was not
being driven when the accident occurred. The vehicle was set in motion by an accident
and got damaged in the process. In view of the above, the claim of the complainant was
valid.
The insurer‟s representative submitted that the claim was processed for Rs.2,925
basing on the surveyor‟s recommendation. It is understood that the surveyor had no
opportunity to inspect the vehicle after dismantling and finalized the assessment on the
basis of documents submitted such as the estimate and bill. It is noticed that the surveyor
reduced the labour charges drastically. There can be no justification for such ad hoc
reduction. Damage to the bumper and replacement thereof is not disputed. The cost of
replacement of bumper after depreciation @ 50% is admissible. In view of this, the
assessment is computed as under:
Rear Bumper (after depreciation) Rs.2,000
Labour charges for damaged parts Rs.8,000
Rs10,000
Less policy excess Rs.1,000
Net Rs. 9,000
The insurer is directed to settle the claim at Rs.9,000 (nine thousand rupees only).
In the result, the complaint is allowed partly.

Smt. M Ramyasree V/s United India Insurance Co. Ltd.
Award No:G-043/14.06.2010
Sri M. Rajabhushanam had taken Motor Liability Policy for his vehicle No.:
AP 10 C 2120 with United India Insurance Co. Ltd. which provided PA benefit of
Rs.2 lakhs to owner-driver. Sri M. Rajabhushanam, while driving his insured car on
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22.08.2008, along with his two sons met with an accident and all of them died on the
spot. Smt. M Ramyasree [wife and legal heir of the insured] made a claim on the
policy benefit after a lapse of 11 months. The insurer declined the claim as it was not
preferred within one calendar month, as per PA benefit clause and terms and
conditions of policy. Her representation too was rejected. Aggrieved, Smt. M
Ramyasree filed this complaint.
The complainant stated that she was in deep sorrow and shock due to death of
her husband and her two sons in the accident. Moreover, she was not aware of policy
benefit under Motor Car Insurance Policy. She pleaded for condonation of delay and
for payment of benefit under the policy.
The insurer contended that the complainant failed to intimate the claim within
the stipulated time as per condition no.1 of the policy consequent to which the insurer
correctly repudiated the claim.
ORDER
The submissions of both the parties were heard and perused the documents
submitted. There is no doubt that the complainant‟s husband died in a road accident.
The complainant admitted that she did not even know the existence of the policy until
it was discovered. She was shell shocked by the tragic accident which claimed her
husband and her two sons. It took a long time for her to recover from the shock. It is
obvious that delay in making the claim did not jeopadrdise the interests of the insurer
in any manner since it was clearly a case of accident and no one suspected any
mischief. The insurer would have allowed the claim if the complainant made the
claim in time since there was nothing to investigate in the claim. Thus, delay cannot
militate against the claim. The policy, however, provides that the claim has to me
made within a month. The complainant did not make the claim within the stipulated
time. Thus, the insurer repudiated the claim in deference to a policy condition.
This is a case involving a tragic accident. The complainant‟s husband and
children died on the spot. The complainant was in bereavement for long. In the
circumstances, denial of the claim would amount to injustice. On the facts of the case,
it was considered this to be fit case for award of ex gratia. Accordingly, the insurer is
directed to pay ex gratia of Rs.2,00,000 (two lakh rupees only) to the complainant.
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In the result, the complainant is allowed as ex gratia.

COMPLAINT No. I.O.(HYD) G -11. 12 035. 2010-11
Sri Gattla Srinivas V/s ICICI Lombard Gen. Insurance Co. Ltd.
Award No:G-044/15.06.2010
Sri Gattla Srinivas‟s motor cycle with registration No. AP 10 AL 7581 was
covered by the insurer. Sri Srinivas preferred a claim for theft of the vehicle. He
intimated that he left the ignition-cum-lock key on the vehicle while he went to
an ice-cream parlor closeby and when he returned, he found the vehicle missing.
The insurer rejected the claim on the ground of “gross negligence”. Aggrieved,
Sri Srinivas filed this complaint.
The complainant stated that he had left the vehicle for a short while and his
forgetfulness should not be construed as „gross negligence‟. He requested for settlement
of claim.
The insurer contended that the policy did not cover “gross negligence” as per
condition no. 4 of the policy and the complainant failed to take reasonable care to
safeguard his vehicle. The insurer thus justified repudiation of the claim.
ORDER
Both the parties were heard and all the documents furnished were perused. The
policy issued to the complainant covers loss by theft of the vehicle under Section I of the
policy. The complaint filed by the complainant is against rejection of claim for theft of
his bike whilst it was parked in a public place. The insurer repudiated the claim under
condition no. 4 of the policy, which envisaged the insured to take all reasonable steps to
safeguard the vehicle from loss.
The complainant had forgotten to take out the key from the vehicle and this must
have helped the cause of the thief. It has to be stated that the complainant‟s forgetfulness
had a major role to play in the loss of the vehicle. He contravened condition no.4 of the
policy. Thus, the insurer cannot be found fault with repudiation of the claim.
Notwithstanding the foregoing, it is possible to assume that a professional thief
would have stolen the vehicle in any case. The presence of the key would have only
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helped him get away from the scene quickly. However, if the key had not been left on the
vehicle, there would have been a chance of the vehicle being traced out. Yet the
complainant left the vehicle in front of a parlour and was away for only a short time. The
complainant deserves some latitude. Accordingly, this case is considered as a fit case for
grant of ex gratia.
Considering the totality of the facts and the circumstances of the case, the insurer is
directed to pay an amount of Rs.10,000 (Rs.Ten thousand only) as ex gratia to the
complainant.
In the result, the complaint is partly allowed as ex gratia.

COMPLAINT No. I.O.(HYD) G -11.002.049.2010-11
Sri Thomson V Thomson V/s Royal Sundaram Alliance Ins. Co. Ltd.
Award No:G-049/5.07.2010
Sri Thomson V Thomson took Motor Package Policy covering his Ford car
with the insurer M/s Royal Sundaram Alliance Ins. Co. The car was stolen on
17.11.2008 night hours when it was parked at his residence compound. The matter
was reported to the concerned police station and necessary claim documents were
submitted to insurer for settlement of claim. The insurer rejected the claim on the
ground that Sri Thomson V Thomson failed to take reasonable care and steps to
safe guard his vehicle. The appeal made to the Grievance Dept. of insurer was not
replied to by them. Aggrieved, Sri Thomson V Thomson filed this complaint.
The complainant stated that the vehicle was brought from the authorized
repair work shop after attending suspension problem by their workman and it was
parked at his residence on Saturday. He had manually locked the car since the
central locking system did not function properly. Further, he also had left the side
glass window open. The complainant noticed the problem with the lock and took
it to the workshop but the workshop was closed, being holiday on Sunday. The
complainant, therefore, raised the window glass pane and manually locked the
car and left it in the parking place where he had been parking the vehicle since
long. He found the car missing the next day. Both the original keys along with all
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claim documents were submitted including Non-Traceable Certificate issued by
police. He had taken all reasonable care and steps to safeguard his vehicle. He,
therefore, stated that the claim was wrongly rejected by the insurer.
The insurer contended that the complainant had kept open the window
glass and left the compound gate unlocked. The complainant failed to take
reasonable steps to protect and safeguard his vehicle from loss. The complainant
was under a contractual obligation to safeguard his vehicle. He, therefore,
justified rejection of the claim.
ORDER
The complainant had noticed that the car window had not been closed by the
mechanic. He, therefore, closed the window. The insurer assumed that the window was
left open on the day the car was stolen. This is not correct. The complainant always stated
that he had closed the side window, which was kept open by the workshop mechanic. He
found malfunctioning of the central locking system. When repair of the same was not
possible that day, he locked the car manually. He had parked the car in the same
compound in which he usually parked it for long. In spite of these precautions, the car
was stolen. In the context of these irrefutable facts, the contention of the insurer of
negligence by the complainant is devoid of merit.
In view of the above, it was held that the insurer erred in repudiating the claim.
Accordingly, the insurer is directed to admit and pay the claim amount of Rs.6,51,500/-
[IDV less policy excess of Rs.500/-].
In the complaint, the complainant sought relief of Rs.10 lakhs from the insurer.
This is impermissible. The relief is restricted to Rs.6,51,500 as above.
In the result, the complaint is allowed in part.

Smt. Kalpana Prabhakar V/s Oriental Insurance Co. Ltd.

Award No:G-050/5.07.2010
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Smt. Kalpana Prabhakar insured her Alto Car bearing No. KA 03 MG 5309
under Motor Package Policy for IDV of Rs.2 lakhs with Oriental Insurance Co.
Ltd. BO 7, Peenya, Bangalore. The vehicle, while being used by her son, with her
permission, met with an accident on 8.11.2009. All the occupants of the vehicle
sustained injuries in the accident and they were shifted to a hospital in Bangalore
for treatment. Father of one of the occupants of the car lodged a police
complaint with Chikballapura Police accusing the son of the insured as
responsible for accident. The police registered a case vide FIR No.: 334/2009 u/s
279 & 337 of IPC. The vehicle was shifted to the garage and the insured
submitted repair estimate. Considering the extent of damage, it was declared by
the surveyor that the claim was to be settled on “Constructive Total Loss” basis.
The insured‟s claim was repudiated by the insurer on the ground that the vehicle
was not driven by the insured‟s son at the time of the accident and no other
occupant in the vehicle had valid DL. Aggrieved by the decision, the insured
referred the claim to the grievance dept. of the insurer and the decision to
repudiate the claim was upheld by the grievance department. Aggrieved, Smt.
Kalpana Prabhakar filed this complaint for redressal.
The complainant stated that she was at Dubai and on hearing the news of
the accident to her son, she immediately rushed to India by the next flight to take
care of her son. After recovery of her son, she preferred a claim on the insurer for
damages to the car and submitted claim documents along with repair estimate.
The insurer deputed their surveyor and he declared that the claim was to be
treated as Total Loss since the repair cost exceeded 75% of IDV. She claimed
that her son only was driving the car at the time of the accident. There also was a
complaint with the police lodged by an occupant‟s father accusing the
complainant‟s son for the accident. She did not know how the hospital doctor
noted in the hospital records that her son sustained injuries while driving a two
wheeler. On taking up the case with the doctor, the doctor gave a sworn affidavit
confirming that her son was an occupant of Alto car. The police issued Final
Charge Sheet, after their investigation, found her son guilty and framed charges
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against him. He came out on bail. She alleged that for not bribing the investigator
and insurance officials, her claim was repudiated on false grounds.
The insurer that on receipt of the claim intimation, they deputed a surveyor
for assessment of loss who declared that the claim needed to be considered as
Constructive Total Loss. On submission of the required claim documents by the
insured, they took up the investigation of the cause and the nature of accident.
Their investigators visited the scene of accident, contacted police officials, made
enquiries at the scene of accident, then visited the hospital and collected the
hospital records. The observations of them were that the vehicle hit a heap of
rock on left side and there was extensive damage to the vehicle on the left side
only. The persons sitting on left side only would have sustained severe injuries
rather than the persons at the right side. Among all the 5 occupants, only the
insured‟s son and another sustained grievous injuries as compared to other
occupants. It clearly established that the complainant‟s son was not on the right
side and in driving seat. Other than the complainant‟s son, no other occupant
had valid DL to drive the car. The noting in hospital records were on the first
information given to the doctor and it was noted that the complainant‟s son met
with an accident while driving a two wheeler. This was recorded prior to lodging
of police complaint / registration of FIR. The doctor later had gave an affidavit
correcting his noting as “patient was in Alto vehicle whose driver swerved to
avoid a two wheeler hit……” again confirming their version. The nature of
injuries sustained by the complainant‟s son was in conformity of damages to the
left side of vehicle. The complainant changed the driver in order to get the claim
under the policy.
ORDER
The complainant‟s vehicle met with an accident and sustained damages beyond
economical repairs. The surveyor declared it to be considered as CTL. The insurer‟s
representative contended that the driver‟s name was changed in order to validate the
claim under the policy. When asked in the hearing to specifically furnish the name of the
person who drove the vehicle, he remained silent. When asked if there was a suspicion
that the driver, whoever the person might have been, did not have a valid driving licence,
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he stated that he had no information on this. When put to him specifically that in either
situation, i.e. if the complainant‟s son drove the vehicle or if another diver drove the
vehicle, claim was still payable, the insurer‟s representative insisted that the
complainant‟s son did not drive the vehicle at the time of the accident. He had nothing to
say in regard to the other scenario.
During hearing, the insurer‟s representative was asked about the complaint made
by the complainant against the investigator. He replied that the investigator was a private
person and action was taken against him. When he was asked to specify the action taken,
he stated that the investigator was blacklisted. Investigators who besmirch the fair name
of the insurers should be visited with exemplary penalty.
The police accused the complainant‟s son and framed charges against him for
having caused the accident. Charge sheet also has been issued against him. He has since
come out on bail. The hospital record was obviously wrong because all the injured were
admitted in the same hospital and all of them could not have been injured in a two
wheeler accident while simultaneously damaging the car.
The insurer has no convincing evidence to show that the complainant‟s son did
not drive the vehicle when it met with an accident. The insurer excessively relied upon an
investigator‟s report, whose bona fides are suspect. The case booked by the police against
the complainant‟s son also helps the case of the complainant.
The insurer‟s representative stated that the insurer would take possession of wreck
in the event of claim settlement.
On a fair consideration of the facts and the circumstances of the case, the insurer
is directed to admit the claim, treating the complainant‟s son as driver of the vehicle and
pay the claim amount of Rs.1,99,500/- [IDV of the vehicle less policy excess]. The
complainant is directed to handover the wreck to the insurer on settlement of claim after
clearing garage charges if any by her. Since it was held that the insurer erred in
repudiating the claim, interest @ 8% on the claim amount from 1.2.2010 till the date of
payment was allowed.
The complainant sought relief of Rs.12,30,000, being car loss of Rs. 2 lakhs,
demurrage of Rs.30,000 and compensation towards mental agony of Rs.10 lakhs. The
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relief sought is excessive. Relief to the complainant is restricted to Rs.1,99,500 and
interest as stated in the preceding paragraph.

Sri. T. Paramasivan V/s ICICI Lombard General Ins. Co. Ltd.
Award No:G-051/5.07.2010
Sri T. Paramasivan renewed his two wheeler Motor Package Policy through ICICI
portal online and paid premium of Rs.658/-. He received hard copy of the renewal policy
wherein the renewal premium was shown as Rs.458/- only. This showed excess payment
of Rs.200/-. He took up the matter with the insurer and the insurer sent another policy for
Rs.658/-. He sought clarification as to how the premium could go up when there was
reduction in IDV and increase in NCB. This was not clarified and the insurer repeatedly
sent the same copy of the policy for Rs.658/-. Peeved and aggrieved by the deficiency in
service, and for charging excess premium, Sri T. Paramasivan filed this complaint.
The premium charged by the insurer in 2010 was much more than the premium
charged in 2009 though the IDV came down by 16.67% and NCB had gone up by 10%.
He paid premium of Rs.759/- for IDV of Rs.25,435/- in 2008, Rs.611/- for IDV of
Rs.21,802/- in 2009. He wondered how the insurer could charge more premium in 2010.
The insurer collected Rs.200/- more and failed to clarify position. The insurer also failed
to refund the excess amount collected.
The insurer contended that the premium charged by them was in order for renewal
as they had charged it as per the premium rates filed by them with IRDA.
ORDER
The insurer sent two documents to the complainant revising/adjusting the
premium paid by him. The Motor premium rates are governed by All India Motor Tariff
and are common for all Indian insurers. There was no revision of Motor Premium rates
by IRDA. The insurers were permitted to allow discount on AIMT rate or to load for OD
only basing on individual claims experience. In the instant case, the insurer first issued
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the policy document showing renewal premium of Rs.458/-. It is noted that the OD
premium rate charged is similar to the previous year. There, however, was an error in
NCB calculation. On Rs.248/- OD premium 45% NCB is shown as 201.68 which is
incorrect. The document also shows discount for side car. There is no side car attached to
the vehicle insured.
It is evident that the insurer did not check the document sent to the complainant and
simply adjusted the excess premium in OD basic and sent a revised copy without any
explanation. The renewal premium, as per AIMT applicable rate with 20% de-tariff
discount [as was given in previous year policy] and 45% NCB, works out to Rs.536/-
only. Obviously, there was excess charging of Rs.122/- by the insurer. The insurer is
directed to rectify the policy by making the necessary endorsement and to send the hard
copy to the complainant to avoid further complications, if any, in this regard. The insurer
lacked grace in settling the dispute. It was deemed it fit to award compensation to the
insured at Rs.78.
In view of the above, the insurer is directed to refund the excess amount charged of
Rs.122/- and compensation of Rs.78/-. The total amount of relief under this order is
Rs.200 which the insurer should pay to the complainant.

Sqn. Ldr. Arvind R Mahadik V/s Reliance General Ins. Co.

Award No:G-053/5.07.2010
Sqn. Ldr. Arvind R Mahadik insured his Fiat Palio car with Reliance General Ins.
Co.‟s Motor Package Policy. The vehicle which met with accident on 21.11.09. He
preferred a claim for the accidental damages to the car. The vehicle repairs were
estimated by the authorized dealers, M/s Concorde Motors [India] Pvt. Ltd., Bangalore at
Rs.2,24,961/-. The vehicle was insured for an IDV of Rs.1,80,000/-. The insurer deputed
an IRDA Licensed surveyor for assessment of the loss. He submitted his report for repair
loss for Rs.1,05,807.50. The insured referred to the policy condition under Sum Insured-
Insured‟s Declared Value [IDV] which read as “The Insured Vehicle shall be treated as a
CTL if the aggregate cost of retrieval and /or repair of the vehicle, subject to terms and
conditions of policy, exceeds 75% of the IDV of the vehicle” and insisted for settlement of
claim on CTL basis. This was not acceptable to the insurer and requested the insured to
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submit the repair bills and invoices after repairs for payment of the claim. Aggrieved by
the decision of insurer, the insured made this complaint for redressal.
The complainant submitted that the actual repair cost was estimated by the
repairer is Rs.1,70,000/- which exceeded 75% of IDV and, therefore, merited settlement
on CTL basis. The surveyor refused to accept or recommend the claim on CTL basis. He
had discussion with Claims Manager which was of no avail. The insurer sent their
assessment report assessing the repair cost at Rs.1,05,808/- after a month of leaving the
vehicle at garage and that too after a lot of persuasion. The insured requested settlement
of the claim on CTL basis.
The insurer contended that the repairs were allowed for Rs.1,05,808/- and the insured had
to undertake repairs and submit repair bills and also produce vehicle for re-inspection. On
production of the receipts, payment would be made to the insured.
ORDER
Motor insurance policies are governed by the terms and conditions stipulated
under All India Motor Tariff and all the insurers are bound to issue policies according to
them. The insurer‟s policy also conforms to the standard. Condition 3 of the policy allows
the insurer the right to choose the mode of indemnity. If repair mode is looked at, the
liability of the insurer would be restricted to the cost of repairs and spare parts as reduced
by depreciation. If the repairs after depreciation work out to less than IDV on CL basis,
the insurer has the option to choose the former.
On perusal of the repair estimate submitted by the complainant and the
assessment made by the surveyor, it is noted that major aggregates like engine, gear box,
etc. were not damaged and damages were only to the external visible parts. They were all
repairable without affecting the performance of the vehicle.
In view of the foregoing, the repair loss offered by the insurer as per the repair
estimate submitted by the insured is reasonable. The offer also is in accordance with the
policy terms and conditions. In the circumstances, there is no infirmity in the decision of
the insurer. Following this, it was upheld the decision of the insurer.
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Sri S Jayachandra V/s Oriental Insurance Co. Ltd.
Award No:G-055/5.07.2010
Sri Jayachandra insured his Motor Cycle with registration No. KA 04 EE 5413
under motor package policy from 18.3.09 to 17.3.10. The motor cycle was stolen on
23.10.09. This was intimated to the police the same day. However, there was a delay of
12 days in intimating the theft to the insurer. The complainant complied with
submission of the required documents for processing the claim. The claim was rejected
by the insurer on ground of delayed intimation of the theft. The complainant‟s appeal
for reconsideration of the decision was also rejected. Aggrieved, Sri Jayachandra filed
this complaint for redressal.
The complainant stated that he immediately reported the theft of his vehicle to
the concerned police station and there was delay in issuing FIR by them. Immediately
after receipt of FIR, he lodged the claim with the insurer. The complainant also
alleged that there was no clause in the policy which required him to inform the theft
within 48 hours of the incident.
The Insurer repudiated the claim on the basis of policy condition that any
claim for theft of vehicle was not payable if theft was not reported to the company
within 48 hours of its occurrence.
ORDER
The insurer relied on a condition of the policy for repudiating the claim. Such a
condition was not a part of the policy document issued to the complainant. The
insurer‟s attempt to demonstrate existence of the condition in the policy issued to the
complainant must fail. Accordingly, it was held that the condition that theft had to be
intimated to the insurer within a specified period was not a part of the contract between
the parties. Invoking a non-existent condition by the insurer cannot be accepted. In any
case, the complainant made a complaint to the police immediately and he informed the
insurer as soon as he obtained copy of FIR from the police.
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In view of the above, it was held that the insurer was not justified in repudiating
the claim. The insurer is directed to settle the claim at Rs.18,000/- being the sum
insured under the policy forthwith.

Sri M.Krishna Reddy V/s The National Ins. Co. Ltd.
Award No:G-057/12.07.2010
Sri M. Krishna Reddy insured his truck under Motor Package Policy with the insurer for
an IDV of Rs.10,00,000/-. The vehicle was stolen on 20.4.08 when it was parked near a
transporter‟s office for load purpose in Ahmedabad, Gujarat State. The claim was
intimated to the insurer on 6.5.08 and in turn the insurer called for the required claim
documents for processing of theft claim. Sri M. Krishna Reddy requested for time to
submit duplicate records as the original records were also stolen along with the vehicle.
There was delay in submission of claim documents. He submitted a few claim documents
and insurer called for Temporary Permit / Permit to enter Gujarat State and Non-
traceable Certificate issued by Police for settlement of claim. The insurer closed the claim
file after sending Regd. Notices to the complainant for the above documents. Aggrieved,
Sri M. Krishna Reddy filed this complaint for redressal.
The complainant stated that he had submitted all the claim documents.
While crossing the Gujarat State boarder, Road Tax was paid at the MVI Check
Post for one week period and proof of payment of road tax was submitted to the
insurer. The police issued Final Charge sheet closing the case as non-traceable
and the same was submitted to the insurer for settlement of claim. Instead of
settling the claim, the insurer repeatedly asked him to submit Temporary Permit
& Non-Traceable Certificate from the RTO and the Police which neither of them
issues.
The insurer contended that for vehicle claimed to have been stolen in
Gujarat State, the permit to enter Gujarat State was a pre-requisite, which the
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complainant had not furnished. The complainant furnished only Final
Investigation Report from the Police. “Non-Traceable Certificate” was not
furnished by the complainant in spite of several reminders sent to him. After
sending a regd. notice, the claim was closed for non-compliance.
ORDER
The complainant‟s vehicle was stolen in Ahmedabad. The vehicle entered Gujarat
after payment of border tax, which permitted the complainant to ply the lorry in Gujarat
State for the period 15.4.2008 to 21.4.2008 covering the date of theft of vehicle at Gujarat
State. The police issued a Final Charge Sheet confirming the investigation taken up by
them and stating the reasons for not proceeding further with investigation and closing of
FIR itself. This indeed was as good as Non-Traceable Certificate. In any case, the
complainant could not have asked the police to issue a certificate which suited him. The
act of the driver in leaving the key in vehicle could not be deemed as “Gross Negligence”
as trucks can easily be started with any key. Further, the insured could not be visited with
denial of a claim for the driver‟s failure to exercise caution.
In view of the above, it was held that the insurer has cause to deny the claim or
treat the claim as non-standard. The insurer is direct the insurer admit the claim and settle
by collecting the documents on their rights of recovery.

Smt. M. Prasuna V/s The National Ins. Co. Ltd.
Award No:G-058/12.07.2010
Smt. M. Prasuna insured her truck under Motor Package Policy with the
insurer for an IDV of Rs.10,00,000/-. The vehicle met with an accident on
28.03.2009 while proceeding from Ujjain to Chennai with a load of 16 tons of
wheat. The IV driver while averting collision with opposite vehicle steered to left,
went out of road margin, hit a tree and turned turtle. Due to electrical short circuit,
it caught fire and burnt partially along with the cargo. The driver and the cleaner
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sustained bleeding injuries in the accident and they were shifted to the hospital
by police while giving intimation to Fire Brigade. Fire brigade put off the fire. After
spot survey, Smt. M. Prasuna shifted the vehicle to her place and submitted
repair estimate of Rs.21,31,757/- from a local garage. The insurer appointed a
surveyor for assessment of loss. He noticed that the repair estimate was
exaggerated and another estimate from authorized dealer was obtained and it
was given by them for Rs.13,68,960/- for replacement of parts and Rs.2,09,900/-
for labour. In lieu of extensive damage both due to accident and fire, Smt. M.
Prasuna requested for settlement of claim on Total Loss or Constructive Total
Loss basis. The surveyor arrived at net assessment of loss for Rs.6,46,320/-
which was below the stipulated norm for considering the claim as TL/CTL. The
insurer rejected the request and intimated Smt. M. Prasuna to carry out repairs
for settlement of claim. Smt. M. Prasuna sought clarifications on the assessment
made by the surveyor and appealed that surveyor had not considered certain
parts which were damaged due to fire in the accident. The insurer again
informed Smt. M. Prasuna to carry out repairs for admission of claim under the
policy. Aggrieved by the decision of insurer, Smt. M. Prasuna made this
complaint for redressal of her grievance.
The complainant stated that she had submitted all claim documents and
made a request to consider the claim as CTL which was denied by insurer on the
basis of surveyor‟s assessment who had not assessed the loss properly. All
major parts damaged in the accident and total assemblies were to be replaced
instead of individual parts. Most of the parts lost their strength due to fire. She
requested settlement on CTL basis.
The insurer stated that the vehicle was surveyed by „A‟ Category surveyor
and on physical inspection of all the damaged parts and aggregates, he
submitted his assessment report assessing the loss. In a meeting with the
complainant, the details of assessment were furnished and the issues raised by
the complainant were also clarified. The net assessed loss did not exceed 75%
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of IDV to consider the claim on CTL basis. The complainant was asked to carry
out repairs and submit repair bills for admission of claim.
ORDER
The authorized dealer‟s repair estimate was for Rs.15,00,000/- and the loss was
assessed by the surveyor for Rs.7,05,320/- and after depreciation and policy excess it
worked out to Rs.6,46,320/-. The difference between the two is too vast casting doubt on
the correctness of the estimates. If the claim on CTL was to be considered, there was a
gap of Rs.1,04,000/-. The complainant‟s grievance that the surveyor had not considered
some of the parts which were damaged, such as Cylinder Block [Rs.38,584/-], Crank
Shaft [Rs.23,948/-] and gear box housing [Rs.21,265/-], appears well founded, thus
rendering the surveyor‟s assessment suspect. The surveyor apparently was keen on
reducing the claim below the norm in order to force the complainant to undertake repairs.
The demand of the insurer to go for repairs on the basis of an unfair assessment is
palpably unjustified. On the facts and the circumstances of the case, Ombudsman is
convinced that the complaint is correct and the complainant has to succeed.
In view of the above, the insurer is directed to admit the claim on CTL/Salvage
Loss basis. The insurer would deduct reasonable wreck value, assessed as per usual
practice by three independent surveyors.
In the result, the complaint is allowed to the extent indicated above.

Sri M.Babu Rao V/s The National Ins. Co. Ltd.
Award No:G-059/14.07.2010
Sri M. Babu Rao insured his truck under Motor Package Policy with the
insurer for an IDV of Rs.10,00,000/-. While proceeding from Kolkata to
Vijayawada, the vehicle met with an accident on 31.03.2009. While averting
collision with an oncoming vehicle, the driver steered to the left, lost control and
hit a culvert and ran over it. Due to heavy impact, major aggregates like front and
rear axles and all under chassis parts dislocated and the vehicle sustained major
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damage. Sri M. Babu Rao submitted all the documents and repair estimate, after
shifting the vehicle to garage, and it was surveyed by the surveyors deputed by
the insurer. Sri M. Babu Rao stated that the repair estimate was given for
Rs.18,69,204/- and due to health problem and not being interested in carrying
the transport business, he accepted the offer made by the surveyor for cash loss
settlement for Rs.5,78,500/-. He further stated that even after a lapse of 5
months, the claim was not settled by the insurer. The vehicle was once more
inspected by a team of officers of the insurer along with the surveyor, who
revised the offer by reducing a sum of Rs.50,000/- from his original offer. Sri M.
Babu Rao also stated that thereafter, there was neither a communication from
the insurer nor settlement. Aggrieved by the delay in settlement of claim by the
insurer, Sri M. Babu Rao made a complaint for redressal.
The complainant stated that because of heavy damage to the vehicle
which would cost around Rs.12,00,000/-, he accepted the offer made by the
surveyor for settlement of claim on Cash Loss basis for Rs.5,78,000/- and gave
his consent. Due to his ill-health, he accepted for further reduction of Rs.50,000/-.
After a lapse of 5 months, the insurer insisted to carry out repairs for payment of
claim. He was not ready for this. The complainant further stated that he had paid
vehicle road tax, national permit taxes and monthly installments to the financiers
and incurred heavy expenses for keeping the vehicle at the garage.
The insurer contended that the claim amount on cash loss basis exceeded
the powers vested in the branch and so the claim was referred to their RO and
the RO in turn advised the branch to admit the claim on repair basis. The
decision was communicated to the complainant to carry out repairs whereas the
complainant insisted settlement of the claim on cash loss basis.
ORDER
It was not disputed by the insurer‟s representatives that there was an offer made
by the surveyor for settlement of claim on Cash Loss basis. The BO/DO referred the file
to their RO on the recommendations of the surveyor, appointed by them.
The reasons of the insurer to insist complainant to carry out repairs is not known.
If the insurer suspected the correctness of the insurer assessment made by the surveyor,
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they had the option to go for resurvey/reassessment. It is generally accepted that Cash
Loss mode is more economical to the insurer than repair basis. The offer made for
settlement at Rs.5,28,500 appears to be adverse to the complainant rather than the insurer
especially in the context of the repair estimate given by the authorized show room. Yet,
the complainant opted for cash loss basis settlement as a matter of expediency
considering the high cost of repairs and his failing health. The insurer‟s representatives
seemed to agree that the insurer did not derive any advantage in asking the complainant
to go for repairs.
In view of above, the insurer is directed to admit the claim on Cash Loss basis for
Rs.5,28,500/-. The complainant sought relief for the taxes paid by him and also expenses
incurred for safeguarding the vehicle from date of accident. They are not permissible
under the policy terms and conditions and not allowed.

Sri M.V. Rama Rao V/s The National Ins. Co. Ltd.
Award No:G-060/12.07.2010
Sri M. V. Rama Rao insured his tanker under Motor Package Policy with
the insurer for an IDV of Rs.12,00,000/-. The vehicle while proceeding from
Palvancha to Parashakthi Cements met with accident on 11.4.08 due to
loosening of turn plate lock and bulk tanker sustained severe damage. It was
surveyed by the surveyors deputed by the company. Sri M. V. Rama Rao
submitted repair bills after repair along with all the vehicle documents. The
insurer pointed out that as per permit given to the vehicle, it was permitted to
carry only “Edible Oil” whereas at the time of accident, it was carrying “Fly Ash”.
For permit violation, the claim was denied by the insurer. Sri M. V. Rama Rao
stated that there was a mistake in issuing the permit by the RTO officials and
submitted corrected the permit to the insurer. The insurer did not accept the
revised „permit‟ stating that the correction was made after the accident.
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Aggrieved by the rejection of claim, Sri M. V. Rama Rao made this complaint
seeking redressal of his grievance.
The complainant stated that he noticed the discrepancy in the Permit
document only after the mistake was pointed out by the insurer. He stated that
after purchasing a new vehicle, he submitted the vehicle documents along with
tanker design papers and the manufacturer‟s specifications for registration of the
vehicle and issuance of necessary permit. There was a mistake committed by the
RTO officials in stamping that the tanker was permitted to carry only edible oils
as his vehicle was not meant for carrying edible oil at all. He got the mistake
corrected by the RTO officials and submitted the permit authorizing his vehicle to
carry all general goods except prohibited. The complainant stated that denial of
the claim by the insurer on the ground of “claim not supported by valid
documents/information” was erroneous.
The insurer contended that the vehicle documents submitted by the

complainant stated that the vehicle was not authorized to carry fly ash. For
violation of permit condition, the claim was rejected correctly.
ORDER
The photographs of the tanker that met with accident were perused. The tanker
obviously was not meant for carrying edible oil. The RTO corrected its mistake and
issued a fresh permit without changing the dates of validity. In other words, the RTO
substituted the permit document with a fresh one. The complainant produced the original
revised permit the genuineness of which is not in doubt.
In view of the above, rejection of claim by the insurer is not justifiable. The
surveyor recommended admission of claim for Rs.3,96,350/- and the complainant
submitted required repair cash bills. In view of above the insurer is directed to admit the
claim for Rs.3,96,350/- as against relief of Rs.4,00,000 sought by the complainant.

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Sri Chintapally Bal Reddy V/s ICICI Lombard Gen. Insurance Co. Ltd.
Award No:G-061/12.07.2010
Sri Chintapally Bal Reddy took motor package policy with the insurer
covering his Tata 407 Lorry with registration No. AP 29 V 1586 for an IDV of
Rs.5,75,820/-. The said vehicle met with an accident on 2.5.09 resulting in
extensive damages. He intimated the accident to the insurer and submitted
estimate for Rs.2,52,446/-. The surveyor deputed by the insurer assessed the
loss at Rs.70,390/- whereas Sri Bal Reddy was billed for Rs.1,15,111/- for
carrying out the repairs. The insurer refused to pay the difference. Aggrieved, Sri
Bal Reddy filed this complaint.
The complainant submitted that the assessed amount and the amount settled was
much than the damage to the vehicle and loss sustained by him. He also had to incur
heavy loss on account of damage caused to the cargo. He submitted that the insurer
should settle the claim in full as per the repairer‟s bill and he was also entitled to interest
@24% on the difference and he should be compensated for loss of business and mental
agony to the tune of Rs.1,00,000.
The insurer contended that they settled the claim in full as per the
recommendations of the surveyor who assessed the loss at Rs.70,390/-. The Insurer
submitted a copy of the survey report. They also submitted that they discharged their
liability under the policy and requested for dismissal of the complaint.
ORDER
In the course of hearing, the insurer was asked to reprocess the claim in the light
of the difference arrived at after considering deductions such as depreciation, salvage,
certain disallowed expenses applicable to commercial vehicle, as per the policy
conditions, etc. The insurer was directed to reprocess the claim and come out with
specific reasons for the difference.
The insurer has since responded stating that the claim file was referred to another
independent surveyor, who recommended an additional amount of Rs.9318/-ing paid to
the complainant.
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As per the complaint, the complainant furnished estimate dated 4-5-09 for repairs
at Rs.2,52,466. The actual expenditure towards repairs as per the complaint aggregated to
Rs.1,15,111. The insurer settled the claim at Rs.70,390. After the complainant filed the
complaint to this office, the insurer paid to the complainant a further amount of Rs.3318.
Vide letter dated 7-7-10, the insurer committed to pay a further amount of Rs.9318 to the
complainant. Thus, the total amount settled by the insurer aggregated to Rs.83,006. Thus,
the difference between the claim and the amount settled is Rs.32,105.
The difference of Rs.32,105 stated above cannot be paid to the complainant
because one item – crank case assembly without clutch - which appears to have been
charged in invoice dt.22-6-2009 twice, one at Rs.30,355/- and the other at Rs.19,505/-.
Only the latter figured in estimate dated 4-5-09 furnished by the complainant. Thus, the
complainant is not entitled to claim the former as payable by the insurer.
If the cost of crank case assembly without clutch in invoice dt.22-6-2009 at
Rs.30,355 is reduced from the billed amount, the difference between the complainant of
claim and the amount settled would be marginal.
In view of the above, it was held that settlement of the claim at Rs.83,006
(Rs.70,390 plus Rs.3318 plus Rs.9318) as made by the insurer until date is fair and
nothing more is payable to the complainant.

Sri M. Surya Kiran V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-063/23.07.2010
Sri M. Surya Kiran insured his motor cycle bearing No.: AP-09BM-5119 under
Motor Package Policy with the insurer for the period 29.01.2009 to 28.01.2010 for an
IDV of Rs. 58,767/-. He preferred a claim for theft of vehicle. He intimated that he
parked the vehicle in front of Kamat Hotel, Koti on 16.3.2009 at about 2.00 PM and went
to have lunch in the hotel. After finishing lunch, he returned to the place where he had
parked the vehicle and found the vehicle missing. He lodged a written complaint with
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concerned police on 20.05.2009 and thereafter gave intimation of theft on 18.06.2009 to
the insurer. The insurer rejected the claim on the ground of delay in intimation.
Aggrieved, Sri M. Surya Kiran filed this complaint.
The complainant stated that he approached the concerned police station
immediately after he found the vehicle missing. He stated that the duty constable
made an entry in the General Dairy and asked him to come afterwards to collect
FIR, as they were busy with the General Elections. There was delay in collecting
the FIR due to non-availability of the concerned officials. He further stated that as
he did not know the claim procedure, he approached the insurer‟s Punjagutta
Office, obtained toll free number and intimated the insurer. The delay was
unavoidable.
The insurer stated that the complainant‟s vehicle was covered by them
and the complainant intimated the theft to the police after a delay of 65 days and
to them after a delay of 94 days. The insurer further stated that the complainant
violated condition No.1 of the policy specifically required the complainant to
inform the event of theft immediately. The relevant condition is as under:
“…. In case of theft or other criminal act which may be the subject of a
claim
under the policy the insured shall give immediate notice to the police
and
co-operate with the Company in securing the conviction of the
offender.”
The insurer thus justified rejection of the claim.
ORDER
The complainant inordinately delayed in reaching the police with the complaint of
theft. There was even more delay in intimating the theft to the insurer. The complainant
had left the key on the vehicle, when it was stolen, suggesting gross negligence.
In view of the above, there is a clear breach of the policy conditions by the
complainant. Consequently, it was found no merit in the complaint. It was held that the
insurer correctly repudiated the claim of the complainant.
In the result, the complaint is dismissed, without any relief.
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Sri D.V. Ramana Reddy V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-065/23.07.2010
Sri D.V. Ramana Reddy insured his Eicher Truck bearing No.AP 28 X
6124 with the insurer under Motor Package Policy for an IDV of Rs. 4,62,140/-.
The vehicle sustained damages while transporting granite stones [marble slabs]
on 18.03.2010. The vehicle driver took a deep turn and the load in the truck
moved to the right side of the vehicle. As a result, the load hit the side panel and
the floor damaging the body of the vehicle. When claimed for repairs, the insurer
repudiated the claim stating that damages sustained to the vehicle by its own
load were not covered under the policy. Aggrieved, Sri D.V. Ramana Reddy
filed this complaint for redressal.
The complainant stated that while proceeding to Donthi Village with the load
of granite stones, the driver steered the vehicle to the left to avert collision with on-
coming vehicle at a deep turn. The load fell on the right side body and body panel
and floor sheared and the load fell on vehicle. The vehicle sustained damage
accidentally and this was intimated to the insurer, keeping the vehicle at spot. The
insurer deputed a surveyor to the spot and after his survey, the complainant shifted
the vehicle to the garage and submitted repair estimate. Then another surveyor
came and took photographs. After that, he received repudiation letter from the
insurer stating that the damage due to load of the vehicle was not payable. The
complainant sent a representation seeking reconsideration but no reply had been
received.
The insurer stated that the complainant‟s vehicle was covered by them and
it sustained damage due to load carried in the vehicle. The damage caused to the
vehicle was not due to any accidental external means. They further stated that due
to the sudden turning of the vehicle, the load of granite stones shifted towards the
right side of the vehicle, which caused the damage and it could not be considered
as an accident that occurred due to external means. The causative factor of the
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damage had to be external. The cause of the damage was not falling under the
scope of the policy and hence it was rightly repudiated by them.
ORDER
The complainant agreed that there was no damage to the vehicle by any external
means. The damage sustained by the vehicle was due to the impact of the load carried in
the vehicle, when the load fell to one side. The indemnification section of the policy
states that loss or damage to the vehicle “by accidental external means” [Sect. I.i]
only entitles the insured for indemnification. It is evidenced from the spot photographs
that the loss was due to the load carried in the vehicle. Further Sec.I of the policy
excludes loss or damage to the vehicle by “Overloading or Strain”.
It was held that improper stacking / clamping of the load or even overloading was
the cause of the damage. Such damage is not covered by policy for indemnification.
Consequently, merit was found in the complaint. It was held that the insurer rightly
repudiated the claim.
In the result, the complaint is dismissed without any relief.

Sri Pappu Ravi Kumar V/s IFFCO-TOKIO General Ins. Co. Ltd.
Award No:G-068/28.07.2010
Sri P. Ravi Kumar insured his Mahindra & Mahindra LMV Goods Vehicle
with the insurer vide Motor Cover Note No.: 34948546 Dt. 03.10.2007 for an IDV
of Rs. 5,18,000/- for the period from 3.10.2007 to 2.10.2008 and paid premium of
Rs.16,681/-. The insurer issued their Motor Package Policy No.37574328 dt.
15.10.2007 holding the risk in confirmation of genuineness of Motor Cover Note.
The vehicle met with an accident while carrying brick load from Nallabelli [V] to
Oglapur [V] on 18.12.2007. The insured along with his driver by name Sri B.
Rajender sustained injuries along with labourers. The insured‟s father, on
knowing about the accidental shifted his son by 108 ambulance to the hospital
and then lodged a police complaint with Atmakur PS. The Police registered a
case vide FIR No. 189/07 Dt. 18.12.2007. The matter was intimated to the
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insurer and the insurer deputed Sri Indra Reddy, their Surveyor, for inspection of
the vehicle. He collected the relevant documents from the insured. As per the
surveyor‟s instructions, the vehicle was shifted to Mahindra Showroom, Warangal
and submitted repair estimate of Rs.3,00,000/- to the insurer for deputing final
surveyor. The insurer had not sent any final surveyor. After waiting for more than
3 months and making repeated calls to the insurer, the vehicle got repaired by
him, as he was losing his revenue. After repairs, legal notice was sent by him
and there was no response. Several reminders were also sent to the Head Office
of the Insurer but in vain. Aggrieved, the insured submitted a complaint to our
office for redressal.
The complainant stated that he was injured in the accident and he took
treatment in a private hospital. His father, under a wrong impression and not
knowing the real facts, lodged a police complaint stating that two persons sat on
the brick load and they sustained injuries in addition to himself, driver and
another laborour who sat in the vehicle cabin. The same was stated to the
surveyor, Sri Indra Reddy, and he obtained a written statement from his father.
The complainant stated that his father was un-educated and so the surveyor
himself wrote the statement and took his father‟s signature. There were no
persons sitting on the load and only 3 persons including the driver were there in
the cabin. On investigation by the Police, they confirmed it and Charge Sheet
was filed by them accusing the complainant‟s driver of rash and negligent driving.
The Charge Sheet was showing only three persons who were traveling and
injured in the vehicle at the time of the accident. In spite of various reminders
sent and telephone calls made to insurer, there was no response from them.
The insurer did not furnish the Self Contained Note although this office sent a
notice calling for the note vide letter No.: IO:HYD:G.11.10.167/2010-11/4520 &
4521 dated 21.6.2010 to insurer‟s HO at Gurgaon and a copy to their local office.
ORDER
The record submitted shows that the insured‟s vehicle met with an accident. The
charge sheet filed by the police does not mention any transgression of law other than rash
driving by the driver. The complainant incurred expenditure to repair the vehicle. The
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complainant waited for a long time for the final survey but the insurer did not bother to
appoint a final surveyor. The insurer did not respond to notices of this office. As a result,
this order is being issued without the self contained note mandated under the RPG Rules.
There is no response to the hearing notice as well. Thus, recalcitrance of the insurer is
evident. In view of our own experience with the insurer, there was absolutely no reason
to disbelieve the statements of the complainant.
On the facts and the circumstances of the complaint, Ombudsman allowed the
complaint. The insurer is directed to admit the claim by allowing all the damages basing
on the spot report of surveyor, Sri Indra Reddy.

Sri T.S. Raghavan V/s Bajaj Allianz General Ins. Co. Ltd.
Award No:G-073/2.08.2010
Sri T.S Raghavan purchased new Santro Xing Car and it was insured with
M/s Bajaj Allianz Gen. Ins. Co. under their Motor Package Policy for an IDV of
Rs.3,30,941/- from 16.5.09 to 15.5.10. He engaged a paid driver Sri K. Yuvaraj to
drive his vehicle. He was instructed by him on 12.01.10 evening around 5.30 PM to
wash the cow dung on the tyres. The driver ran away with the vehicle. He
immediately approached the police and informed the incident and as per their
instructions, he waited for a few days, searched the surrounding areas and finally
lodged a complaint which was registered by the police vide their FIR No. 23/2010
dated 17.01.2010. The theft was intimated to the insurer and claim was registered
by them. The insurer intimated non-admissibility of claim to the complainant on
20.02.10 stating that FIR was registered u/s 381 of IPC which implied that loss
took place due to breach of trust. Sri T.S Raghavan sent a legal notice seeking
review of the decision. The insurer did not reply to this. Aggrieved, Sri T.S.
Raghavan filed this complaint for redressal.
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The complainant stated that he instructed his driver to wash the cow dung
on tyres of car which was parked in front of his house. The driver stole away the
vehicle and he immediately approached police and also informed the insurer. The
police registered FIR after 5 days and it was sent to the insurer for settlement of
claim. He was not aware the section under which his complaint was registered by
the police. He stated that the insurer misconstrued sec. 381 of IPC and wrongly
rejected the claim.
The insurer stated that the Police registered the FIR u/s 381 of IPC which
implied that loss had taken place due to breach of trust leading to violation of the
contract between the insured and his driver. The insurer stated that it was not
liable under the policy for any claim arising out of contractual liability as per the
general exclusions of the policy.
ORDER
The insurer rejected the claim stating that the act of stealing the vehicle by the
driver, which was given by complainant for washing, did not fall under the definition of
“Theft”. The complainant entrusted the vehicle to his driver, i.e. given consent, to wash
cow dung on tyres and not to run away with it. This act of the driver falls under the
definition of “Theft” as defined under sec. 378 of IPC. The insurer misconstrued the
concept of „consent‟ in the context of Sec.378. Dishonestly taking of movable property
by the driver did not amount to consent. The Police register a case depending on the
degree of offence to charge the accused with appropriate punishment under IPC. If a case
is booked under sec. 378 of IPC for “Theft” the punishment is “imprisonment of either
description for a term which may extend to three years, or with fine, or with both”. If a
case is booked under sec. 381 of IPC for theft by servant, the punishment is
“imprisonment of either description for a term which may extend to seven years, and
shall also be liable to fine”. In case of theft by known persons there is difference in
maximum term of punishment and so the police charged the accused under sec. 381
instead of sec. 378. In both the sections “Theft” is the material incident. The insurer is not
absolved from liability on the pretext that the driver breached trust and the act was out of
ambit of theft. It was held that the driver stole the vehicle and so it was a case of theft
nevertheless.
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The other contention of insurer that the liability arose under contractual liability
and hence excluded under the policy is rather perverse. The contract between the
complainant and his driver was to discharge the duties of a paid driver and not to do any
unlawful acts. The liability arose here due to dishonesty of driver and it did not fall under
General Exclusion No.2 of the contract.
The insurer‟s rejection was even before the completion of investigation by the
police and issuance of Final „C‟ Report. The complainant submitted Notice issued by the
police stating that the vehicle was “undetectable” and closing of FIR.
In view of above, it was held that insurer erred in rejecting the claim. The
complaint is allowed and the insurer is directed to admit the claim and to pay a sum of
Rs. 3,30,441/- [ IDV Rs. 3,30,941/- Less: Policy Excess – Rs.500/-].
In the complaint, the complainant sought relief of Rs.5 lakhs from the insurer.
This is impermissible. The relief is restricted to Rs.3,30,441/- as above. The complainant
may submit necessary documents to the insurer, if so desired, to protect the rights of
recovery of the insurer.

Sri K. Parthasarathy V/s Oriental Insurance Co. Ltd.

Award No:G-081/9.08.2010
Sri K. Parthasarathy insured his Honda City car with Oriental Ins. Co. under their
Motor Package Policy. The vehicle met with an accident on 16.8.2009. He preferred a
claim for the accidental damages to the car. The vehicle repairs were estimated by the
authorized dealers, M/s Sundaram Honda, Secunderabad at Rs.7,58,715/-. The vehicle
was insured for an IDV of Rs.5,40,000/-. The insurer deputed an IRDA Licensed
surveyor for spot inspection and, on shifting the vehicle to the garage, for final
assessment of loss. After external inspection of physical damages, the surveyor requested
for dismantling of the vehicle to assess the accidental internal damages to the vehicle.
The repairer stated that he needed instructions for dismantling the vehicle from the owner
as also payment of deposit of Rs.1,00,000/- to begin repairs. Since the owner did not
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respond, the surveyor released his report, as per external visible damages, assessing the
loss for Rs.1,39,537/-. Sri K. Parthasarathy stated that his vehicle sustained damages
beyond repairs and even if it was repaired, as per recommendations of surveyor, the car
might not be roadworthy. He took up the matter with the insurer and discussed with the
RM for settlement of the claim on total loss basis. He was called for a discussion by the
insurer and they decided to re-survey the accident vehicle and entrusted the claim to
another senior surveyor. The new surveyor inspected the vehicle and obtained fresh
estimate of repairs, which was given by the repairer for Rs.10.75 lakhs. The second
surveyor also requested for dismantling of vehicle to know the internal damages but the
complainant insisted for settlement of claim on total loss basis only. The second surveyor
submitted his report for repair loss for Rs.2,58,029/- with a provision for internal
damages of Rs.30,000/-. He further stated that net repairs did not exceed 75% of IDV to
treat the claim as Constructive Total Loss [CTL]. The insured referred to the policy
condition under Sum Insured-Insured‟s Declared Value [IDV] which read as “The
Insured Vehicle shall be treated as a CTL if the aggregate cost of retrieval and /or repair
of the vehicle, subject to terms and conditions of policy, exceeds 75% of the IDV of the
vehicle” and insisted for settlement of claim on CTL basis. The insurer did not accept this
and requested the insured to submit repair bills and invoices after repairs for payment of
the claim on repair loss basis. Aggrieved by the decision of the insurer, the insured made
this complaint for redressal.
The complainant submitted that the actual repair cost was estimated by the
repairer at the time of re-survey for Rs.10,75,000/- and it might further shoot up by Rs.2
to 3 lakhs if the vehicle was dismantled for repairs. The estimated repairs exceeded 75%
of IDV and, therefore, merited settlement on CTL basis. The surveyors refused to accept
or recommend the claim on CTL basis. He had discussion with Regional Manager of
insurer which was of no avail. He prayed for redressal of his grievance.
The insurer contended that the accident vehicle was surveyed by two IRDA “A”
Grade surveyors and both of them assessed the loss on repair basis only. The assessed
repair loss was not exceeding 75% of IDV to treat the claim as CTL. The complainant
had to undertake repairs and submit repair bills and also produce the vehicle for re-
inspection. On production of the receipts, payment would be made to the insured on
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repair mode only. They referred to condition No.3 of the policy and stated that the right
to choose the mode of indemnity rested with the insurer and the complainant had no
choice.
ORDER
Motor insurance policies are governed by the terms and conditions stipulated
under All India Motor Tariff and all the insurers are bound to issue policies according to
them. The insurer‟s policy also conformed to the standard. Condition 3 of the policy
allows the insurer the right to choose the mode of indemnity. In the repair mode, the
liability of the insurer would be restricted to the cost of repairs and spare parts as reduced
by depreciation. If the cost of repairs after depreciation exceeded 75% of IDV, the claim
could be considered on CTL basis. If, however, the cost of repairs after depreciation did
not exceed 75% of IDV, the insurer has the option to choose repairs mode. The insured
has no choice in the matter.
In view of the foregoing, the repair loss offered by the insurer as per the repair
estimate submitted by the insured cannot be found fault with. The insurer also agreed to
allow internal damages on dismantling over and above the loss assessed now. The offer
also is in accordance with the policy terms and conditions. In the circumstances, there is
no infirmity in the decision of the insurer. Following this, it was upheld the decision of
the insurer.

Sri Bonagiri Srinivas V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-085/12.08.2010
Sri Bonagiri Srinivas‟s Hero Honda Passion Plus bike with Regn No. AP 36 R
2290 was insured with the insurer for an IDV of Rs.29995/-. The bike was stolen on
12.1.2010 while it was parked at the parking place of K.R & M.S. Reddy Complex,
Hanmakonda. He made his own efforts to trace out the vehicle at Hanmakonda and
finally lodged a complaint with police on 5.3.2010, i.e. after 52 days and it was registered
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by police vide their FIR No. 49/2010. Before that, he informed the insurer about the theft
on 3.2.2010, i.e. after a delay of 22 days. When he preferred a claim with the insurer, it
was rejected on the grounds of delayed intimation. Aggrieved by the rejection, Sri
Bonagiri Srinivas filed this complaint for redressal.
The complainant stated that he diligently searched for the vehicle at everywhere
in Hanmakonda and, after losing the hope of its irretrievability, he filed the complaint
with the police for registration of FIR. Before this, he had intimated the insurer about
theft of his vehicle. He stated that he handed over the vehicle keys and the RC Book to
the representative of the insurer who called on him after registration of the complaint by
the insurer. He further stated that there was no intentional delay in intimating the theft
either to the police or to the insurer. However, he received a rejection letter dated
11.5.2010 from the insurer rejecting his claim for delayed intimation.
The insurer stated that their repudiation of the claim was on the ground of delayed
lodging of FIR after 52 days which amounted to violation of terms and conditions of the
policy. The claim intimation was given to the insurer after 22 days which again was a
breach under the policy. Hence, the claim was rightly denied.
ORDER
The complainant obviously was negligent. He ought to have approached the
police immediately on noticing the theft of his vehicle. It is possible, as contended by the
complainant, that he did approach the police immediately but the police delayed in
registering the FIR on the day the complainant reached the police with his complaint of
theft. But his negligence in informing the insurer of theft of the vehicle is difficult to
understand and indefensible. He took 22 days to inform the insurer. This was a clear
breach of the policy condition. The insurer is right in its contention that chances of
tracing the stolen bike are negligible after 10 days of theft although it is rarely ever that
the insurer‟s investigators lay their hand on stolen property. Nevertheless, Ombudsman
agreed that the insurer has had good reasons and support of the policy conditions for
rejecting the claim.
The insurer‟s representative suspected foul play by the complainant. This has not
been substantiated by any credible evidence. Yet, it cannot be denied that the
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complainant definitely contributed to loss of recovery chances by delaying the steps he
ought to have taken. But, the complainant would suffer irreversible loss if the bike is not
retrieved. Hence, taking a sympathetic view on the complainant, the insurer is directed to
pay an amount of Rs.10,000 to the insured as ex gratia.
In the result, the complaint is allowed in part as ex gratia.

Sri S. Roshan Basha V/s Reliance General Insurance Co. Ltd.

Award No:G-086/12.08.2010
Sri Roshan Basha took Motor Package Policy covering his Skoda car by paying a
premium of Rs.19,776/- through his cheque No. 20645 dt. 22.8.2009 drawn on
UBI Kamalapur Br. Hyderabad. The insurer issued their Motor Cover Note No.
10900 724794 holding the risk and it was followed by their policy bearing No.
1816792311 003621. The earlier insurance was with M/s ICICI Lombard Gen.
Ins. and it expired on 16.7.2009, i.e. it was a case of delayed renewal with new
insurer. The vehicle met with an accident on 7.9.2009 and it was stated to have
been intimated to insurer on 8.9.2009. The insurer informed Sri Roshan Basha
on 17.9.2009 that the cheque was dishonored. The cheque presented for
clearing was unpaid on 2.9.2009 by service branch of the Bank stating the
reason “Insufficient Funds in the Account”. Sri Roshan Basha stated that he
approached his banker to ascertain how the cheque bounced when there was
sufficient balance. Sri Roshan Basha stated that while issuing cheque book the
account number was wrongly mentioned in his book and later it was manually
corrected by the bank. He stated that the bank erred in dishonoring the cheque.
Sri Roshan Basha stated that the insurer was asked to re-present the cheque but
it was bounced again for the same reason. He went to the insurer‟s office and
paid cash and the insurer‟s office issued him receipt bearing No: 592154
dt.06.10.2009 towards re-instatement of policy. T Sri Roshan Basha received
claim rejection letter dated 14.11.2009 rejecting the claim for dishonor of the
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cheque. Sri Roshan Basha complained to the Banking Ombudsman for
deficiency in service by the bank. The Ombudsman heard the case but closed it
under clause 13 [c] of Banking Ombudsman Scheme 2006. The complainant had
not under taken repairs of the vehicle and it was still lying in work shop.
Aggrieved by rejection of the claim by the insurer, Sri Roshan Basha filed this
complaint for redressal.
The complainant stated that the vehicle was surveyed by the surveyor and he was not
given permission to repair the vehicle. The insurer accepted cash premium to revive the
policy from its inception and subsequently rejected the claim. Repeated reminders were
sent to review their decision and yet there was no response from the insurer.
The insurer stated that they covered the insured vehicle by accepting the cheque and
immediately issued their policy. Due to dishonor of cheque the policy became void
abinitio. They further stated that on receipt of claim intimation on 08.09.2009, their
claims department deputed the surveyor for assessment of loss. After physical
verification of the damaged vehicle, the loss was assessed by him for Rs.4,32,718/- as per
terms and conditions of policy. On further processing of the claim, it was noted by them
that the cheque was bounced and it was not realized. The complainant had not brought it
to the notice of the insurer while cash was being accepted in lieu of the bounced cheque.
It was further noted by them that the account number stated in the cheque was manually
corrected and it was confirmed to them by the Branch Manager of UBI Kamalapuri Br.
that he was not aware of correction in account number given to the complainant. The
complainant further submitted a letter from the Bank, without mentioning the account
number, that there were sufficient funds in the account and made a request to honor the
insurance policy. On the date of loss, there was no insurance cover to the vehicle. The
claim was rejected due to dishonor of cheque and the policy automatically was cancelled
from inception.
ORDER
The question is whether or not acceptance of cash premium after the date of
accident rendered the contract between the parties enforceable from its date of inception
contravening the provisions of Section 64 V [B] of the Insurance Act 1939.
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The fact of “operational error” by Bank was confirmed by Banking Ombudsman,
Hyderabad in their award No. BO(H)/PRM/1437/C.No.3431/2009-10 Dated 8.6.2010.
There is no dispute that the cheque was bounced twice. The policy was ab initio void
when the cheque was unrealized. Further, the insurer could not have accepted premium
when there was an accident. Acceptance of premium in cash after the accident to the
vehicle occurred owing to a gap in information.
In the circumstances, it was held that there was no cover available to the
complainant for the car when the car met with an accident. The insurer, therefore, had no
obligation to settle any claim against the damaged car.

Sri GM Abdul Jabbar V/s Bajaj Allianz Gen. Ins Co. Ltd.
Award No:G-088/12.08.2010
Sri GM Abudl Jabbar insured his car No.AP-05-AR9456 with Bajaj Allianz Gen.
Ins. Co. under their Motor Package Policy. The vehicle met with an accident on
18.4.2010 while on the way from Hyderabad to Gooty. He preferred a claim for the
accidental damages to the car. The vehicle repairs were carried out at Maximus
automobile Engrs. Hyderabad and the bill was settled for Rs.11,435=00 by the insurer.
Subsequently, the insured noticed damage to the gear box of the car as oil was leaking
from it. He reported the same to the insurer and got the repair for gear box at the same
garage and sought reimbursement but the insurer orally rejected the claim on the ground
that it was not relevant to the accident. The insured submitted a bill for Rs.11,865=27 for
reimbursement but he did not receive any reply from the insurer in-writing. So, he
approached this office for redressal of his grievance.
The complainant submitted that the car met with an accident while he was
proceeding to Gooty from Hyderabad and he reported the same to the insurer. He was
asked to hand over the car to M/s.Maximus Automobile Engrs. garage for repairs. After
the survey was done by the surveyor, the mechanic of the garage informed him that the
gear box was also damaged and repairs were to be carried out for the same. He then
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personally met the surveyor and informed about this but the surveyor refused to admit the
claim for repairs as there was delay in getting the repairs. He tried to explain the
surveyor that the surveyor deputed by the insurer refused to come to Gooty from Kurnool
for survey which was informed to the insurer and he took their acceptance for repairs at
Hyderabad after return from Gooty which would take about 10 days. The surveyor told
him that the damage to the gear box was not relevant to the accident, as it might have
occurred earlier or after the accident. Repairs were carried out at M/z Maximus
Automobile Engrs. and cashless facility was extended and the bill for the same was
settled by the Insurer. He got the repair for gearbox damage and paid Rs.11,865=00 to the
garage and submitted the bill to the Insurer. But the reimbursement claim submitted for
repair of gear box was not given any attention by the Insurer and no reply was received
by him.
The insurer contended that the claim was settled long back and they had
discharged their liability as per the survey report. They extended cashless facility for
Rs.11,435=00 to the Maximus automobiles Engrs. Hyderabad and the insured gave
discharge voucher for the amount towards full and final settlement. The insured litigated
after executing discharge voucher that no payment was made in respect of damaged gear
box. The damage to the gear box was not detailed in the survey report. The settlement of
claim was strictly as per the surveyor‟s report and hence the company was not
responsible to pay any more sum to the complainant.
ORDER
It was noted that the damage to the gearbox was informed to the insured by the
mechanic of the garage while the car was handed over for repairs. The insured also
brought this to the notice of the surveyor which was not taken cognizance of by the
surveyor. The assumption that the damage might have occurred prior to the accident or
after the accident does not hold water since the damage to the gear box was noticed while
the car was being repaired after the accident. The survey report must have taken
cognizance of damage to the gear box also. Ombudsman agreed with the insured that the
car must have had no damaged gear box prior to the accident, for otherwise such a long
journey would not have been undertaken.
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In view of the above, it was held that the damage to the gearbox was not
consequential in nature. The damage to the gear box also occurred in the accident. Since
the repair has already been carried out to the gear box, no purpose would be served in
asking for a survey afresh. In the circumstances, it was deemed it fit to direct the insurer
to pay an amount of Rs.8,000 towards the repairs of the gearbox, inclusive of labour
charges, to the complainant.

Sri T. Laxmi Srinivas V/s Bajaj Allianz General Ins. Co. Ltd.
Award No:G-092/31.08.2010
Sri T Laxmi Srinivas covered his new Bajaj Pulsar Motor Cycle under
insurer‟s Motor Package Policy for the period from 30.11.2009 to 29.11.2010 which
was registered with RTA Guntur vide registration. No.: AP 07 AV / 0516. He
preferred a claim for vehicle damage which met with an accident on 7.3.2010 at
9.30 a.m. while he was proceeding to Lam Village from Guntur to pick up his
relative. He stated that the accident took place when he saw his relative late Sri T.
Hemanth Manikanta on the opposite side of the road and suddenly a dog came
running from the opposite direction. He turned the vehicle left to avoid the dog and
lost control and hit his relative. With the hit by the bike, his relative dashed against
a pole and sustained head injuries. The bike also fell and rolled down from the
road margin. He further stated that he escaped without any physical injuries in the
accident. His relative was shifted to hospital by 108 EMRI Ambulance vehicle. He
stated that all the claim documents were submitted to insurer for approval of claim.
After survey of the vehicle by the surveyor, the vehicle was repaired by him and he
stated that he had incurred a sum of Rs.54289/- for repairs of his damaged vehicle.
In spite of repeated reminders, the claim was not approved nor any communication
received from the insurer. Aggrieved, Sri T.L. Srinivas filed this complaint for
redressal.
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The complainant stated that immediately after accident, the claim was
intimated to the insurer on 8.3.2010 and all claim documents were submitted for
approval of cashless facility for repairs of the vehicle. In spite of repeated phone
calls and reminders sent to the insurer, there was no response.
The insurer stated that the accident was investigated by them and, as per
their investigators report, the deceased Sri T. Hemanth Manikanta was driving the
vehicle at the time of alleged accident and he did not hold any driving licence. It
was further stated by them that, apart from the deceased, two other persons, Sri
Phani Kumar and Sri Jayadeep, were also traveling on the vehicle. All of them
sustained injuries and Sri T.H. Manikanta succumbed to injuries. It was further
stated by them that the insured person was a student and studying at Rajamundry
and he was not at Guntur on the date of accident. The claim was repudiated by
them for triple riding which was violation as per sec. 128 of the MV Act.
ORDER
Ombudsman carefully examined the spot photographs submitted by the
complainant‟s representative. The photographs show the damaged vehicle resting on a
broken pole, which is at a considerable distance from road kerb. The road has a kerb of
6” height. The narration of the cause of the accident in the claim form does not
corroborate with the scene of the accident. The damage to the vehicle as it rested on the
pole, in the photograph, was not much. Such minimal damage could not imply repairs in
excess of Rs.54000.
The complainant claimed that the accident occurred in the morning hours, near
Lam village. Had the accident actually occurred as stated by the complainant, it would
have drawn the attention of passersby. Further, carrying of injured persons by 108
ambulance service would have resulted in filing of FIR. One person died in the accident
and even then FIR was not filed. The complainant filed a document describing the
accident claiming it as a certificate issued by the police. The said certificate turns out to
be fabricated/forged.
The complainant‟s vehicle obviously met with an accident. A person was killed
on the spot. Yet, there was no FIR. The complainant filed a forged certificate in support
the accident. The damage to the vehicle as per the photographs taken on the spot was
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minimal. Yet, the complainant claimed repairs of over Rs.54000 when the new vehicle
costed about Rs.67000. If he could get a new vehicle for Rs.13000 more, no one would
opt for repairs costing over Rs.54000.
The complaint obviously has been built on false premises. The insurer‟s plea that
it was a case of triple riding is not established but it was possible. It also is possible that
the complainant‟s vehicle was driven by someone who did not possess a valid driving
licence. It is quite possible, as stated by the insurer‟s representative, that the complainant
was not at the scene of the accident at all. The claim that the complainant incurred repairs
in excess of Rs.54000 is highly exaggerated. It has been established that the complainant
produced a forged certificate in support of the complaint. This is despicable.
In view of the above, it was held that the complainant made a claim founded on
falsehood. Consequently, the complaint is dismissed.

COMPLAINT No. I.O.(HYD) G -11. 04 193 2010-11
Smt. Ch.Riguna V/s United India Insurance Co. Ltd.

Award No:G-094/31.08.2010
Sri Ch. Tulasaiah covered his private car bearing No.AP 23 F 9997 under the insurer‟s
Act Liability Policy for the period from 28.9.2007 to 27.9.2008. The policy was extended
to cover Owner-Driver PA risk by charging additional premium of Rs.100/- for an
amount of Rs.2,00,000/- as per GR 36 of All India Motor Tariff. By this extension, the
insurer undertakes to pay compensation for bodily injury / death sustained by the owner-
driver of the vehicle in direct connection with the vehicle insured. The cover is subject to:
[a] the owner-driver was the registered owner of the vehicle insured herein [b] the owner-
driver is the insured named in the policy and [c] the owner driver holds an effective
driving licence, in accordance with the provisions of Rule 3 of the Central Motor
Vehicles Rules 1989, at the time of the accident. The owner-driver Sri Ch. Tulasaiah met
with an accident on 4.1.2008 and died in the accident.
Smt. Ch. Riguna, the complainant, and wife of the owner-driver preferred claim
for payment of owner-driver PA benefit under the policy and submitted necessary claim
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documents. The insurer investigated the accident and verified the claim documents. It
was found by them that the owner-driver Late Sri Ch. Tulasiah was holding two Driving
Licenses - one for Two Wheeler and the other for Four Wheeler - obtained from two
different RTAs. Holding of two DLs by the deceased and also owner-driver was in
contravention of provisions of MV Act and also against the law of land. The insurer,
therefore, rejected the claim. Aggrieved by the decision of insurer, she filed this
complaint for redressal.
The complainant stated that all the claim documents required by the insurer were
submitted to them for settlement of claim. As there was no nomination under the Motor
Policy, the insurer called for succession certificate and the same was submitted to them
on 31.7.2009. In spite of repeated reminders sent to them, the claim was not settled by
them. Finally, the insurer sent a repudiation letter dated 19.4.2010 stating that the claim
was rejected by them for holding two Driving Licenses by her late husband.
Representation made to review the decision to the Grievance dept. of the insurer was also
not considered.
It was contended by the insurer that the deceased and the owner-driver was holding two
DLs for two categories of vehicles separately obtained from two different RTAs. This
was in contravention of provisions of Central Motor Vehicle Rules 1989 and AP Motor
Vehicle Rules 1989. They referred to the Hand Book on Motor Driving Licenses
compiled by the AP Transport Dept. Employees Association wherein the following is
stated:
Can we hold more than one Licence?
No. A person can have only one licence irrespective of number of categories
of vehicles such person is authorized from time to time.
It was stated by the insurer that the address was wrongly declared to obtain the second
driving licence, violating the law of the land. It was further stated by them that the
deceased obtained LMV driving licence in contravention of the procedure laid down in
the Transport Laws and LMV licence obtained by him was not a valid one. The RTA
concerned was empowered to disqualify him from holding such driving licence or revoke
it. It was also stated that the complainant had to prove that the LMV driving licence was
obtained by her husband by following the due process of law and that the same was valid.
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The claim was rejected by them treating the LMV licence as invalid since it was obtained
without following provisions of MV Act.
ORDER
The insurer furnished photocopies of the two Driving Licences of the deceased. A
perusal of both the copies of licences submitted shows that Car Licence [Four Wheeler]
was issued on 25.5.1996 and no date was specified in Two Wheeler licence against date
of 1st issue and it was issued on 28.7.2004. In the same two wheeler licence, the RTA
mentioned the original DL No. as 15358/MDK/1987. Whether it was continuously
renewed or there was any break in renewal is not known.
The question is whether or not the deceased possessed a valid DL on the date of
accident. The evidence that the deceased owner-driver possessed two DLs, one for LMV
and another for MC, on the day of the accident is not in dispute.
The policy document contains a condition relating to the person or the persons
entitled to drive. The relevant condition is reproduced below:
Any person including Insured provided that a person driving holds an effective
driving licence at the time of the accident and is not disqualified from holding or
obtaining such licence.
The aforesaid policy condition stipulates that the insured should possess an effective DL
and that he should suffer no disqualification to hold the said DL. The only relevant issue,
therefore, is whether the deceased held an effective DL and whether he suffered any
disqualification in holding the said DL. The insurer held that the deceased person
contravened the law by holding two licences simultaneously and, owing to that reason,
the insurer repudiated the claim.
It is noticed that both the licences held by the DLA were valid in that both were
issued by the RTA. Section 6 of the MV Act appears to have been relied upon by the
insurer to hold that the LMV licence was not effective. Sub sec.(1) of sec.6 is reproduced
below:
No person shall, while he holds any driving licence for the time being in force,
hold any other driving licence except a learner's licence or a driving licence
issued in accordance with the provisions of section 18 or a document
authorising, in accordance with the rules made under section 139, the person
specified therein to drive a motor vehicle.
The aforesaid provides that no one could hold two DLs. The consequences for
contravention, however, are not specified.
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Sections 19 and 20 of the MV Act refer to disqualifications. Sec.19 empowers the
licencing authority to disqualify from holding a licence in case of a criminal or a habitual
offender and the like. Likewise, section 20 empowers a court to hand out a
disqualification. It is not in dispute that the deceased was not disqualified from holding
the DL either by the RTA or a court.
Section 182(1) of the MV Act, reproduced below, provides for punishment in
respect of offences relating to licences:
Whoever, being disqualified under this Act for holding or obtaining a driving
licence drives a motor vehicle in a public place or in any other place, or applies
for or obtains a driving licence or, not being entitled to have a driving licence
issued to him free of endorsement, applies for or obtains a driving licence without
disclosing the endorsement made on a driving licence previously held by him
shall be punishable with imprisonment for a term which may extend to three
months, or with fine which may extend to five hundred rupees or with both, and
any driving licence so obtained by him shall be of no effect.
It is not alleged that the deceased driver cum owner obtained the LMV driving licence he
had without disclosing the endorsement made on a driving licence previously held by
him. Therefore, the provisions of sec.182 did not apply to him. The provisions also did
not have any adverse impact on the DL obtained by him. Thus, it is clear that the
deceased held an effective DL for LMV as on the date of the accident.
The foregoing analysis suggests that while section 6 provides that no one could
hold two DLs it does not state the consequences for non compliance. There is nothing
under the MV Act stating that holding two DLs would make the DL ineffective or that
the driver is guilty of an offence on that score. Section 6 expects people to hold a single
DL for the sake of convenience. If, out of ignorance, someone holds two DLs, section 6
of the MV Act probably renders it a procedural irregularity. The MV Act does not regard
it as an offence or the said DL ineffective.
The policy condition is that the insured has to have an effective driving licence at
the time of the accident and he is not disqualified from holding or obtaining such licence.
The deceased driver-owner possessed an effective DL and he was not disqualified from
holding the said DL.
In view of the above, it becomes clear that the insurer did not correctly appreciate
the provisions of the MV Act consequent to which it erroneously repudiated the claim in
this case. Following this, the insurer is directed to pay the claim of Rs.2,00,000/- to the
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complainant. The complainant sought interest from the date of the claim. Since the
complainant had to furnish succession certificate and thereafter the insurer required time
to process the claim, it was deemed it fit that the insurer should pay interest @ 7% on
Rs.2,00,000 from 1-9-2009 till the date of payment of the amount to the complainant.
In the result, the complaint is partly allowed.

Smt. Umadevi V/s Oriental Insurance Co. Ltd.

Award No:G-095/14.09.2010
Smt. Umadevi was the wife of Late Sri Suresh Chari. He met with an
accident while driving his own two wheeler and died due to accidental injuries. The
vehicle was covered under Motor Package Policy of the insurer and it was extended
to cover owner-driver PA cover for Rs.1,00,000/-. Smt. Umadevi, being the wife of
the deceased, preferred claim on the insurer by submitting the required
documents. As there was no nomination in the policy, the insurer requested her to
submit Legal Heir Certificate from the concerned authorities. Smt. Umadevi stated
that she had not received any communication in spite of submitting all the
necessary documents. Aggrieved, she filed the complaint for redressal.
The complainant stated that she had submitted Vehicle RC book copy
wherein the ownership was transferred on her name and also Voter ID card
specifying that she was the legal wife of the deceased. In spite of several
reminders, the insurer had not settled the claim.
The insurer stated that the complainant failed to submit Legal Heir
Certificate for payment of the claim under the policy. They sent a letter to the
complainant to submit Succession Certificate in August 2010 and on submission
of certificate they would settle the claim.
ORDER
The complainant has provided enough evidence such as Voter ID card and RC
book copy, wherein the vehicle ownership was transferred on her name, as the legal heir
of the deceased. There was no dispute in regard to the accidental death of the insured, i.e.
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owner-driver and breach of any policy terms and conditions. The claim has been kept on
hold. The insurer could have got investigated the claim of the complainant and verified
the legal status of the complainant. The insurer could have settled the claim by obtaining
Indemnity Bond from the complainant and “No Objection” bonds from the other heirs, if
any. The delay in settling the claim, which is pending for more than 1 ½ years, has
defeated the very purpose for which insurance is taken.
In view of the above, the insurer is directed to pay the claim of Rs.1,00,000/-
immediately to the complainant after obtaining necessary indemnity from her.

Sri Anil Kumar Agarwal V/s Oriental Insurance Co. Ltd.

Award No:G-099/14.09.2010
Sri Anil Kumar Agarwal, Prop. M/s Lotus Polymers, insured a TVS XL Super
Heavy Duty vehicle for IDV Rs.12,000. The vehicle was given to the employee Sri
Indramani for business use. The vehicle was stolen on 1.12.2008 when it was parked at
# 255, Peenya Industrial area, 2nd Stage, Bangalore. The theft was intimated to
Rajagopalanagar police station and it was registered by them vide FIR No. 520.
However, there was delay in intimating the theft to the insurer. Sri Anil Kumar
Agarwal complied with submission of the required documents for processing the claim.
The claim was rejected by the insurer on ground of delayed intimation of theft. Sri Anil
Kumar Agarwal‟s appeal for reconsideration of the decision was also rejected.
Aggrieved, Sri Anil Kumar Agarwal filed this complaint for redressal.
The complainant stated that he immediately reported theft of his vehicle to the
concerned police station and there was delay in issuing FIR by them. Immediately
after receipt of FIR, he lodged the claim with the insurer. The complainant also
alleged that there was no clause in the policy which required him to inform the theft
within 48 hours of the incident to the insurer.
The Insurer repudiated the claim on the basis of policy condition that any
claim for theft of vehicle was not payable if theft was not reported to the company
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within 48 hours of its occurrence. The complainant had not submitted the Final
Report and „Un Detectable‟ certificate which were required for settlement of theft
claim.
ORDER
The insurer relied on a condition of the policy for repudiating the claim. Such a
condition was not a part of the policy document issued to the complainant. The
insurer‟s attempt to demonstrate existence of the condition in the policy issued to the
complainant failed. Accordingly, I hold that the condition that theft had to be intimated
to the insurer within 48 hours was not a part of the contract between the parties.
Invoking a non-existent condition by the insurer cannot be accepted. In any case, the
complainant lodged a complaint with the police immediately and he informed the
insurer as soon as he obtained a copy of FIR from the police. Nevertheless, the
complainant took unduly long time in intimating theft of the vehicle to the insurer. Had
the complainant sent the intimation as soon as theft occurred, the insurer also would
have made efforts to trace the vehicle. Because of the delay in intimation to the insurer,
complainant may have jeopardized recovery chances, if any. It was held that the insurer
was not justified in repudiating the claim on the strength of a non existing condition.
Simultaneously, it was held that the complainant did not help the cause of recovery of
the vehicle.
In view of the above, it was deemed it fit to direct the insurer to pay Rs.10,000/-
(Rs. Ten thousand only) ex gratia to the complainant on submission of UN-
DETECTABLE certificate issued by police and Final Report along with any other
documents required for settlement of theft claim by insurer.

Sri K.N. Darshan V/s Oriental Insurance Co. Ltd.

Award No:G-101/14.09.2010
Sri K.N. Darshan covered his India Taxi cab, bearing No. KA 02C 3697, under
the insurer‟s Motor Package policy, for the period from 22.11.2008 to 21.11.2009. The
162
vehicle met with accident on 13.9.2009. The accident was reported to the concerned
police station and a case was registered by them vide FIR No. 264/2009. The driver of
the vehicle died due to accidental injuries. The vehicle sustained heavy damage and the
claim needs to be considered as Total Loss. On submission of claim documents, the
insurer rejected the claim stating that the driver was not holding “valid & effective”
licence to drive the vehicle at the time of accident. The Transport Endt. on the DL of
the driver expired 40 days before the accident. Sri K.N. Darshan stated that the renewal
details of transport endorsement were not available as the original DL was lost and not
traceable. His appeal for reconsideration of the decision was also rejected. Aggrieved,
Sri K.N. Darshan filed this complaint for redressal.
The complainant stated that due to loss of original DL, he could not furnish
the renewal details to the insurer. The photocopy of DL which was available with
him was furnished to the insurer for settlement of the claim. The DL could be
renewed at any RTO and he was unable to ascertain the renewal details of DL from
local RTOs. The Transport endorsement on DL expired just 40 days before the
accident and there was a grace period of 30 days from its expiry to apply for renewal.
The complainant stated that he would suffer irreparable loss if the claim was not
admitted by the insurer.
The Insurer stated that they repudiated the claim on the basis of “driver
clause” of the policy which stipulated “valid and effective” driving licence to the
vehicle driver at the time of the accident. In support of their repudiation, the insurer
relied upon the judgment of the Apex Court in Oriental Insurance Co. Ltd. v. Angad
Kol & Others (AIR Supreme Court 2151).
ORDER
The insurer relied on the driver clause of the policy for repudiating the claim.
The driver of the vehicle who died in the accident had obtained licence to drive a taxi
except that the endorsement lapsed 40 days before the accident. The complainant stated
that the driver must have got the endorsement renewed although he did not have any
evidence thereof. He stated that the original DL was lost at the site of the accident. The
insurer‟s representative stated that the RTA which issued the original licence certified
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that the licence was not renewed. The complainant contended that the driver could have
obtained renewal from any other RTA.
The insurer‟s repudiation on a strict construction of the terms of the policy is
justified. The insured, however, believed that the driver had renewed the endorsement.
The driver was entitled to drive the taxi under the MV Act until 10 days (owing to
grace period of 30 days) before the accident. It is probable that the driver had got the
endorsement renewed although the complainant has no evidence therefor. If the driver
had not renewed the endorsement on his DL, it would be a case of technical default
since he was otherwise eligible to drive the taxi.
On the facts and the circumstances of the case, it was held that the complainant
would suffer irreparable loss if the claim is disallowed totally on the basis of a strict
construction of the terms of the policy. Such a denial would be unjust. Accordingly, it
was held that this is a fit case for grant of ex gratia. The insurer stated that the surveyor
had assessed repairs at about Rs.1,20,000.
On a careful consideration of the various submissions, the insurer is directed to
pay a sum of Rs.80,000 (Rs. Eighty thousand only) as ex gratia to the complainant.

COMPLAINT No. I.O.(HYD) G -11. 02. 245 2010-11
Smt. B. Suvarna V/s New India Assurance Co. Ltd.

Award No:G-102/14.09.2010
Smt. B. Suvarna stated that her late husband Sri B. Kushal had covered his
passenger auto bearing No. AP 09V 7943 under the insurer‟s Act Liability Policy for the
period from 18.6.2009 to 17.6.2010 by paying adequate premium to the insurer. She
further stated that the insurer, without following the regulations of All India Motor Tariff,
issued the policy without extending Owner-Driver PA cover as per GR 36 and shown the
premium paid for such cover as loading under the policy. She stated that her husband
met with accident during night hours of 1.3.2010 while driving the said auto and
succumbed to accidental injuries on 8.3.2010. She stated that she preferred a claim on
the insurer for payment of PA benefit and also approached the insurer‟s Regional Office
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and submitted application on 25.6.2010 as there was no response from the concerned
office but in vain. Aggrieved, Smt. B. Suvarna filed this complaint for redressal.
The complainant stated that all the claim documents required by the insurer were
submitted to them for settlement of claim. She stated that neither the claim was settled by
the insurer nor did she receive any communication from the insurer.
The insurer contended that the photocopy of the policy sent by the complainant
showing the policy number 630300/31/06/0000354562 did not pertain to them and they
did not have any office with office code „630300‟. Further, there was no office
functioning at the address stated in the photocopy of the policy. The insurer further stated
that a communication was sent to the complainant vide Regd. Post Ack due letter on
28.7.2010 intimating that the policy was not issued by them and so the claim was not
accepted.
ORDER
The complainant‟s claim is based on a photocopy of policy bond. There are strong
reasons to hold that the copy of the policy submitted by the complainant is not a true
copy of any original document issued by the insurer covering the accident vehicle in
question. The complainant failed to produce the original policy bond. The insurer cannot
be fastened with any liability for a policy document which is forged.

Sri N. Santosh Rao V/s ICICI Lombard Gen. Ins. Co. Ltd.
Award No:G-104/14.09.2010
Sri N. Santosh Rao insured his Hero Honda Passion+ bike with Regn No. AP 36R
9160 under the insurer‟s Motor Package Policy for the period 21.9.2009 to 20.9.2010 for
an IDV of Rs. 27,650/-. The vehicle was stolen on 30.9.2009 when it was parked near
Reddy chicken centre, Hanumakonda when he along with his friend parked their vehicles
and went to meet another friend. He stated that both vehicles were stolen at the same
time. He further stated that when he reported the theft to the police immediately, they did
not register the case and asked him to search for the vehicles and the police registered the
165
FIR belatedly. After registration of FIR, he intimated the claim to the insurer. The insurer
rejected the claim on the ground of delayed intimation. Aggrieved, Sri N. Santosh Rao
filed this complaint seeking redressal of his grievance.
The complainant stated that he intimated the theft of his vehicle to the police
immediately after its occurrence but the police had assured him that his bike would be
traced and, on lot of persuasion, they took action and registered his complaint only after
40 days. He submitted that he also contacted the toll free number of the insurer who gave
the reference number of his claim. He stated that he submitted all the necessary claim
documents for settlement of the claim. He received a letter of rejection dated 29.03.2010
from the insurer and request made to review the decision was also not considered.
The insurer contended that there was unreasonable delay in lodging of complaint
to the police by the complainant. The theft was reported to the police only on 9.11.2009
i.e. after 40 days of occurrence of theft. The complainant failed to intimate the theft to the
insurer immediately and there was delay even after registration of FIR. There was total
delay of 59 days in intimating the claim to the insurer. This was a breach under the
policy. Hence, the claim was rightly denied by the insurer.
ORDER
The complainant acted negligently in not approaching the police immediately on
noticing the theft of his vehicle. The reasons cited by him for the delay in intimating the
theft to the police and the insurer do not appear credible. He is an educated person and
therefore his plea that he did not know the relevant policy condition cannot be accepted.
There is no doubt that the complainant committed breach of an important policy
condition. The insurer is right in their contention that the chances of tracing the stolen
bike would be slim unless investigations are caused immediately after occurrence of
theft.
In view of foregoing, it was held that insurer rightly rejected the claim

Sri T Ravi Shankar Goud V/s United India Insurance Co. Ltd.
166
Award No:G-109/30.09.2010
Sri T Ravi Shankar Goud covered his Indica Taxi Cab bearing Regd. No. AP 10
V 4077 under the insurer‟s Passenger Carrying Motor Package Policy for an IDV of
Rs.1,41,045/- for the period from 5.12.08 to 4.12.09. The vehicle met with an accident on
1.11.09. The insurer arranged spot, final and re-inspection surveys to the damaged
vehicle. The loss was assessed by the surveyor as Rs.1,00,850/- subject to policy terms
and conditions. On scrutiny of claim papers submitted by Sri T Ravi Shankar Goud, the
insurer found that the Fitness Certificate (FC) of the insured vehicle had expired on
6.1.2008 and it was not renewed till the date of the accident. The insurer rejected the
claim stating that FC was mandatory for any vehicle for admission of the claim. Sri
T.Ravi Shankar Goud made an appeal for review of the decision but it was not considered
by the insurer. Aggrieved, Sri T. Ravi Shankar Goud filed this complaint for redressal.
The complainant stated that he was not aware of the mandatory
requirement of FC for the vehicle. He stated that he was dependent on the
earnings of the vehicle and requested for settlement of the claim by the insurer.
The insurer stated that the FC of the vehicle had expired 22 months
before the date of the accident. As per sec.56 of the MV Act, 1939, registration of
vehicle is treated as valid only if the vehicle has valid Fitness Certificate. On
expiry of Fitness, the RC and Permit granted to the vehicle under Chapter V shall
be deemed to be suspended until FC is obtained. The insurer further stated that
the insured would be held responsible for plying the vehicle without FC and the
insurer was absolved from any liability in the absence of valid FC.
ORDER
The complainant used the vehicle without Fitness Certificate for 22 months. The
vehicle was not road worthy without FC. The vehicle did not have FC when the accident
occurred. The insured, therefore, violated the provisions of the MV Act, 1989. The
mandatory requirement of FC is to ensure safety of passengers carried in the vehicle
given by concerned RTOs on physical examination of vehicle for its roadworthiness.
In view of the above, the insurer violated a key condition of the policy. The
insurer, therefore, was absolved of any liability under the policy. Consequently, I hold
that there is no infirmity in the decision of the insurer in rejecting the claim.
167
KOCHI
OFFICE OF THE INSURANCE OMBUDSMAN, KOCHI
Complaint No.IO/KCH/GI/11-003-006/2010-11
A.Hashim
Vs
National Insurance Co.Ltd.
AWARD DATED 04.06.2010
The car, which was registered in the name of LIC of India, was given to the complainant
as a marketing official in Class I cadre. It met with an accident while in the custody of
the complainant. The surveyor submitted a report assessing the net damages at
Rs.6,797/-. Later, a final bill was submitted for Rs.16,756/- based on supplementary
estimate. The insurer settled the claim as per the original estimate. The claim amount
was received by LIC as full and final settlement of the claim. Thereafter, the
complainant filed an application complaining partial repudiation.
It is held that the insurance is not taken in personal lines, but in the name of the company
viz., LIC. As such the complainant has no insurable interest and the complaint is not
maintainable at all. It is also held that the claim under the supplementary estimate is not
sustainable too, as the replacement of certain parts was done without informing the
surveyor, who had assessed the damages. The complaint is, therefore, DISMISSED.
MUMBAI
14.6.2010 Private Car Comprehensive Insurance Policy
MOTOR
BEFORE THE INSURANCE OMBUDSMAN
(MAHARASHTRA & GOA)
MUMBAI
Complaint No.GI-1184 of 2009-2010
Award No.IO/MUM/A/ 83/2010-2011 dt. 14.06.2010
Complainant : Smt. Paramjit Kaur
168
Respondent : Bharti AXA General Insurance Co. Ltd.
Smt. Paramjit Kaur had insured her Honda City car Reg. No.MH-43-R-9704 with
Bharti AXA General Insurance Co. Ltd. under SmartDrive – Private Car Comprehensive
Insurance Policy No.FPV/I0143864/23/12/ M1231A for IDV of Rs.5,00,000/- for the
period 03.12.2009 to 02.12.2010. The policy was issued with 50% No Claim Bonus. The
complainant lodged a claim under the Policy for accident to the vehicle on 27.12.2009.
After survey, the loss was assessed at Rs.2,83,802/-. However, the claim was repudiated
by the Insurer on the ground that the insured had made a false declaration w.r.t. NCB in
the proposal form. Not satisfied with the decision, she approached this Forum for
intervention in the matter of settlement of the claim.
A personal hearing of the parties to the dispute was held. Shri Prashant Shet,
husband of the complainant stated that prior to issuance of the policy the Company
should have checked the previous claim history with the previous insurer. After
inspecting the car and issuing the policy, rejecting the claim is not justified on the part of
the Company. He further stated that the car could not be repaired due to delay on the part
of the Insurance Company in processing the claim and he had to incur huge parking
charges at the workshop. It was contended on behalf of the Insurance Company that that
the proposer had declared about eligibility for 50% NCB stating that no claim had arisen
under the previous policy; however on enquiry it is found that two claims were lodged by
the insured under the previous Policy with Reliance General Insurance Co. Ltd., which
amounted to breach of Policy conditions as well as principle of utmost good faith.
From the facts of the case it can definitely be said that the insured had given a
false declaration with regard to NCB entitlement and thus there was a breach of condition
no. 8 as mentioned in the proposal form. But, at the same time, Tariff provisions stipulate
that the insurer allowing the NCB will be obliged to write to the Policy issuing Office of
the previous insurer by recorded delivery calling for confirmation of the entitlement and
rate of NCB for the particular insured and failure of the insurer to do so within 21 days
after granting the cover will also constitute a breach of Tariff. In the instant case, from
the documents on record, it was observed that the Insurance Company after allowing the
NCB of 50% to the Insured did not act according to the provisions of India Motor Tariff.
This was definitely a serious lapse on the part of the Insurance Company and it was not
fair to penalize the Insured by rejecting his claim as the Insurance Company was also
equally at fault for not following the tariff provisions strictly. Further, the breach on the
part of the Insured has no direct bearing on the loss i.e. it has not directly contributed to
the damage to the vehicle or in any way aggravated the loss. Therefore, total rejection of
claim was not justified and the Company was directed to settle the claim upto 50% of
admissible amount on non-standard basis, as there was misrepresentation and violation
of Policy condition of the Motor Policy, after recovery of NCB as per norms. It was
further held that the complainant shall not be entitled to any consequential damages.
20th day of July, 2010
THE OFFICE OF THE INSURANCE OMBUDSMAN

(MAHARASHTRA & GOA)
169
MUMBAI
Complaint No. GI- 853 of 2009-2010
Award No. IO/MUM/A/ 134 /2010-2011

Complainant : Shri L.P. Karia
V/s
Respondent: The New India Assurance Co. Ltd.
Shri L.P. Karia had taken a Private Car Package Policy No.40085965 to cover his
Maruti Esteem bearing Regn. No.MH-02BD 2951 under a tie-up arrangement between
Maruti dealer and the New India Assurance Company Limited for IDV Rs.4,69,833/-
valid from 22/9/2007-2008.
A claim arose under the above policy, when the complainant reported damage to
his vehicle due to flood on 28/7/2008. Surveyor, M/s. A.R. Momin was deputed to
survey and assess of the loss. M/s Spectra Motors, the dealer raised a bill of Rs.53,976/-
/-, the Insurance Co. however settled the claim for Rs.12,000/- disallowing the rest on
the ground that damages to the engine parts were an aggravation of loss caused due to the
vehicle being driven in flood water.
The analysis of the complaint reveals that reportedly on 28/7/2008, the Insured
was proceeding from Malad towards Borivli on the S.V. Road and near Kandivli Fire
Brigade, his vehicle got stuck in traffic jam due to heavy rains. The area was badly
flooded ahead and since there was no „U‟ turn and other vehicles behind were honking,
he had no other alternative but to move the vehicle ahead but a little while after, he could
not start his vehicle due to which he towed it to a Maruti Workshop.
Since the vehicle was insured under a tie up arrangement with the Maruti
Workshop (Spectra Motors) and New India, the surveyor, Shri A.R. Momin was
appointed by Spectra Motors who assessed the loss for Rs. 12,000/- as against the claim
of Rs. 53,976/- disallowing the rest under consequential loss which mainly consisted of
expenses for repairing the engine. The Surveyor contended that the damage to the engine
had occurred due to the Insured‟s attempt to drive the vehicle in flooded waters.
From the correspondence it is evident that the complainant was advised by the
surveyor, Shri Momin to shut down the Engine and move the vehicle aside manually
therefore, the complainant‟s plea that he drove the car in flood water by mistake as he
had no knowledge about such a precaution to be taken is not acceptable.. Further, it is
revealed from the claim form that at the material time, the vehicle was driven by his paid
driver, Shri Dinesh Muradkar and the complainant could have instructed his driver to
push the vehicle aside, however, this was not done.
It would also pertinent to mention here that after the great deluge in Mumbai in
the year 2005 , it was widely publicized by Insurance Companies and Citizens‟
Awareness Group in the interest of Public Welfare that whenever a car got stuck in flood
waters, no attempt should be made to start the engine as this could result in mechanical
failure of the engine. Though the complainant might not have expected such major
damages as a consequence of his driving the vehicle in flooded water, there is no doubt
that said damage to the engine have occurred purely because of his action. Generally, the
170
engine cannot be impacted merely by coming in contact with water and hence damages if
any can be attributed to either mechanical failure or trying to run the engine of the vehicle
when it is still in contact with the water. Mere ingress of water on its own will not cause
damage to the engine. Had the engine not been started there would have been no major
damages. Then perhaps, the car would have only needed to be drained out of water,
cleaned, dried and oiled and would have required some minor repairs, if any.
Condition no.4 of the Motor Policy states that the insured should not drive the
vehicle before the necessary repairs are effected otherwise extension of the damage or
any further damage to the vehicle shall be entirely at his own risk.
As per the observations of the surveyor, the loss to the engine parts were
consequential in nature, for which the Insurance Company is not liable to pay. Under the
circumstances, the balance claim of Shri Laxmidas Karia towards damages to his vehicle
Maruti Esteem No. MH-02BD 2951 is not sustainable.
Dated at Mumbai, this 20th day of July, 2010.
THE OFFICE OF THE INSURANCE OMBUDSMAN

(MAHARASHTRA & GOA)
MUMBAI
Complaint No. GI- 1073 of 2009-2010
Award No. IO/MUM/A/199/2010-2011

Complainant : Shri Moti Kaul
V/s
Respondent: Royal Sundaram Alliance Insurance Co. Ltd.
Shri Moti Kaul had taken a comprehensive Motor car package policy
bearing No.VPC0113244000100 in respect of his vehicle No. MH 02 JP 2864
valid from 12/2/2009 to 11/2/2010 from Royal Sundaram Alliance Insurance
Company for IDV Rs. 6.30 lakhs.
The complainant‟s son had parked the vehicle duly locking it, as usual on
the road next to their residence. The following morning i.e. on 21 st May, 2009 at
around 8.30 a.m. the complainant found the car missing from the parked place.
The complainant reported the matter to the police and lodge a claim with the
Insurance Company along with the supporting papers. The Insurance Company
got the matter investigated and based on the investigator‟s findings, rejected the
claim on the ground of violation of condition no.4 of the policy (safeguarding of
property insured). All the documents submitted by the Complainant as well as by
the Insurance Company have been perused and it is noted that the vehicle was
reported to have been stolen on 20th May, 2009. The matter was immediately
reported to the police on 23/5/2009 after confirming from the RTO/Traffic Police
171
that the vehicle was not towed by them. The FIR was filed with Amboli Police
Station and the case was registered under No. 173/2009 under section 379 IPC.
The Final Report was also issued by the Police authorities classifying the theft as
„true but undetected‟ which was also duly certified by the Metropolitan Magistrate
dated 19/4/2009.
The Insurance Company, after due scrutiny of the claim papers, rejected
the claim invoking condition no. 4 stating that the Insured had not taken
reasonable steps to safeguard the vehicle from loss/damage as he had lost the
vehicle‟s second key. They found fault with the complainant‟s action of not
replacing/altering the locking system post the loss of second key thereby paving
way for commission of theft.
Scrutiny of the papers reveal that the police authorities have classified the
theft as „genuine but undetected‟ therefore genuinity of claim was not under
suspicion. The complainant had submitted all documents substantiating theft
of his vehicle from various concerned authorities. From the documents
submitted, particularly the police report, there is no indication that the loss of
second key had directly contributed to the incident in the present case. There is
no denial that there was a lapse on the part of the complainant in respect of
losing the second key, but the vehicle had adequate safety devices like central
locking system and an anti-theft alarm system fitted for which some benefit
should go to the Insured. Therefore, it would only be proper to impose some
deduction of about 25% and allow the claim for settlement on non-standard
basis..
Dated at Mumbai, this 28th of August, 2010
172

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AHMEDABAD

Ahmedabad Ombudsman Centre

Non Settlement of Claim under Motor claim policy: The complainant

Partial repudiation of Claim under Motor Car O.D Policy.

The Respondent had decided to partially settle the claim of

Award dated 15.6.2010

Award dated 30.8.2010

CATEGORY: MOTOR O.D.

Mrs Preeti Kaushal……….……………………………………....Complainant

Order No.: BPL/GI/10-11/006 Case No.: GI/OIC/0912/95

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Shri Yogesh Singh Chauhan... ……………………..…..……… Complainant

Order No.: BPL/GI/10-11/008 Case No.: GI/ITG/0912/096

Dishonored was given to Complainant by their Jablapur office by Regd. Post on

14.11.2008 at the complainant‟s address available in the Policy. It is also mentioned by

Smt. Pushpawanti Batra………..,………………………………. Complainants

Order No.: BPL/GI/1011/009 Case No.: GI/NIC/1001/98

contention that it is done by an oversight by Ujjain RTO.

Sri Gopal Chandra Sahoo

ICICI Lombard General Insurance Co. Ltd., Bhubaneswar

Award dated 01st April, 2010

BHUBANESWAR OMBUDSMAN CENTER

Sri Dillip Kumar Bej

Future Generali Insurance Co. Ltd., Bhubaneswar

Award dated 13th April, 2010

Hon‟ble Ombudsman heard the case on 25.02.2010 in presence of both the

BHUBANESWAR OMBUDSMAN CENTER

Smt Sabita Rani Panda

National Insurance Co. Ltd., Bhubaneswar DO-II

Award dated 21st April, 2010

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Sri Surendra Kumar Kar

Reliance General Insurance Co. Ltd., Bhubaneswar

Award dated 23rd April, 2010

Sri Surendra Kumar Kar

Reliance General Insurance Co. Ltd., Bhubaneswar

Award dated 23rd April, 2010

Hon‟ble Ombudsman heard the case on 16.03.2010 where complainant was

BHUBANESWAR OMBUDSMAN CENTER

Smt Namita Mishra

New India Assurance Co. Ltd., Bhubaneswar DO-I

Award dated 26th April, 2010

BHUBANESWAR OMBUDSMAN CENTER

Reliance General Insurance Co. Ltd., Bhubaneswar

Award dated 28rd April, 2010

BHUBANESWAR OMBUDSMAN CENTER

Smt Bishnu Priya Sahoo

Oriental Insurance Co. Ltd., CBO, Bhubaneswar

BHUBANESWAR OMBUDSMAN CENTER

Smt Samita Lenka

New India Assurance Co. Ltd., Jajpur Road DO.

Award dated 29th April, 2010

Sri Suresh Kumar Sahoo

Reliance General Insurance Co. Ltd., Bhubaneswar

Award dated 30th April, 2010

BHUBANESWAR OMBUDSMAN CENTER

Sri Binoy Bhushan Pattnaik

National Insurance Co. Ltd., Jajpur Road Branch

Award dated 20 Aug, 2010