Vehicle Insurance - Financial Indiafinancialindia.weebly.com/uploads/8/7/0/4/8704738/vehicle-book2.pdf · Complainant’s Goods Carrying Vehicle insured under Comprehensive Vehicle

Vehicle Insurance

Ahmedabad Ombudsman Centre

Case No. GIC / NIA / 1 / 249 Mr. Yadukant M. Patel

Vs. The New India Assurance Co. Ltd.

Award Dated 28.10.2004

Tractor damaged by an accident. Claim lodged for Rs. 16225/-. Respondent sent Discharge Voucher for Rs. 6804/- which was not acceptable to the Complainant. Despite letter and telephonic contact, Complainant did not appear in the hearing. Respondent submitted that the Surveyor assessed the loss at Rs. 6804/- earl ier without including the labour charge and hence, he reassessed the loss at Rs. 7404/- based on which a Discharge Voucher was sent to the Complainant and the same was executed by the Complainant. It is observed from the documents on record that after f i l ing the complaint with this off ice, certain developments had been taken place between the Complainant and the Respondent which was not brought to the knowledge of this Forum. From the record, it is ascertained that the Complainant has received Rs. 7404/- from the Respondent and hence no Award is warranted except an order disposing of the case.

Ahmedabad Ombudsman Centre Case No. GIC / UIC / 1 / 139

Mr. Vijay K. Patel Vs.

United India Insurance Co. Ltd. Award Dated 05.11.2004

ST Bus coll ided with the Complainant’s Car. Respondent treated the Claim as No Claim, because of no endorsement of LPG in RTO Book. Complainant denied the allegation that the vehicle was run by him with LPG fuel at the t ime of accident and submitted Petrol bi l ls for last 5 / 6 months. Further, he contended that he purchased the vehicle in 2001 and he is the 4th owner and any one of the previous owners might have carried out such alterations. In this case, neither the factum of accident nor the extent of physical damage of the Vehicle is disputed and the f inancial impact was already ascertained by the Respondent. So the point taken for determination is that whether the alleged infirmity is proved by the Respondent. Documents and submissions perused. It is observed that presence of any LPG Cyl inder at or near about the place where accident occured had not been indicated by Survey Report. Secondly Police FIR fi led by the Driver of the State Transport Bus does not have any mention of LPG connection. Thirdly, other exclusions from (a) to (f) termed as l imitat ions as to use in the Insurance Certif icate also not been violated by the Complainant. Reference also has been made to judicial precedents in the case of United India Vs. Suraj Singh Asia (III 1999 CPJ 79 NC) wherein the repudiation was set aside by Hon’ble N.C for the reason that the accident was totally unrelated to any breach of Policy Condit ions. Remote nexus of al leged breach could not be established. Respondent to pay Rs. 14500/- to the Complainant.

Ahmedabad Ombudsman Centre Case No. 11.002.0025

Mr. Ajay R. Patel Vs.

The New India Assurance Co. Ltd.


Complainant’s Goods Carrying Vehicle insured under Comprehensive Vehicle Insurance Policy damaged. Claim repudiated. In course of Hearing both parties agreed to sett le the claim for Rs. 55,000/- and to that effect a consent letter was submitted to this Forum. Accordingly, the complaint is treated as resolved.

Ahmedabad Ombudsman Centre Case No. UIC / 1 / 128 Mr. P. G. Chaudhury

Vs. United India Insurance Co. Ltd.


Vehicle theft claim. Bolero Jeep was stolen. Respondent sent Discharge Voucher for Rs. 2,55,000/- being 75% of Rs. 3,40,000/- towards sett lement of the claim. Complainant submitted that the vehicle was only 9 months old and cost of it was Rs. 4,21,792/- as per Sale Certif icate of the Dealer. But the I.V of the vehicle was Rs. 4,91,000/- for which corresponding premium was collected by the Respondent. Respondent submitted that the loss was assessed by 3 Surveyors and they took the lowest of the 3 market values assessed for sett lement. It is observed that I.V. of the vehicle was Rs. 4,91,000/- and premium was also collected accordingly. Current market value of a used vehicle may vary between different assessors and it is diff icult to get a precise f igure unanimously. Since there was huge difference in quantum of loss, the principle of Golden Mean adopted by Hon’ble National Commission in the case of Rawal Bros. Vs. Oriental Insurance Co. took as a guiding factor to decide the subject case. Accordingly, an amount of Rs. 3,85,000/- is arrived at and both parties consented to sett le the claim for Rs. 3.85 lacs.

Ahmedabad Ombudsman Centre Case No. NIC / 1 / 98

Mr. Premji Patel Vs.

National Insurance Co. Ltd. Award Dated 19.11.2004

Motor Accident Claim. During Hearing both parties consented to sett le the claim for Rs. 17,000/- and the respondent is directed to pay the same.


Mr. Abdul Aziz Munshi Vs.


Complainant lodged an Own Damage Claim with the Respondent when his Vehicle met with an accident. Claim repudiated as per General Exception 3(a) of the Policy for breach as to the use of vehicle. The point taken for determination is whether the Respondent had been able to prove that the alleged breaches had been committed by the Complainant in l ine with the Policy Document and Permit issued by Designated Authority. Documents perused. It is observed that there were 9 (including Driver) passengers who were eligible and 4 other passengers as per copy of charge sheet who were not el igible and hence the violation had been gross and not marginal. Further considering the type of accident that the Driver lost

control and the vehicle dashed with a tree, the overloading of passengers was high. Breach of l imitation as to use is proved. Repudiation of O.D. Claim upheld.

Ahmedabad Ombudsman Centre Case No. UIC / 1 / 146

Mr. A. D. Patel Vs.


Complainant’s Car insured under Private Car Package Policy, met with an accident. Claim admitted and offered for a sett lement of Rs. 1.25 lacs which was not acceptable to the Complainant. Respondent submitted that to sett le the claim on Net Loss basis, they obtained 3 Survey Reports and towards the Salvages, they considered the highest of the two valuations. In this case the dispute is related to only quantum of claim amount. Documents and submissions perused. It is observed that one Survey Report amongst the three, contained reference to the factors which he took into account in assessment of the market value which is accepted as market value of the damaged vehicle. As regards the market value of salvages took into consideration by the Respondent, it is opined that the wrecks were in very bad state and further depreciated through passage of t ime and hence Rs. 35,000/- is reasonable instead of Rs. 75,000/-. Accordingly, Rs. 2,00,000/- (Rs. 2,35,000.Rs. 35,000) is awarded to the Complainant which is accepted by both the parties.


Mr. Vijay J. Patel Vs.


Complainant’s Car met with an accident and caught f ire. Claim for total loss of the Vehicle lodged. Respondent submitted that the loss was intimated to them after two days of loss and hence they could not conduct spot survey. Secondly the Vehicle was Insured as Petrol Car, but when the Survey was done, it was disclosed that alteration / modif ication was done to facil i tate LPG use as alternative fuel without approval from the Registering Authority. Documents and submissions perused. It is obseved that the damage caused by f ire was without any external impact and hence alternative fuel caused and / or contributed to the loss. The survey Reports revealed that Alteration / Modif ication was done on REAR FLOOR / FRH APRON. Further no endorsement was obtained from the Authorit ies for use of such alternative fuel. Repudation upheld.


Mr. Suresh S. Patel Vs.


Complainant’s Scooter met with an accident and Mr. Vasant S. Patel who was driving the vehicle died. Under Compulsory Personal Accident Cover, a death Claim was lodged by the Complainant, but it was repudiated. It is observed that as per GR 36(A), Compulsory Personal Accident Cover is restricted to Owner - Driver only who is holding a valid Driving Licence. Held that as the vehicle was driven by a person other than the Registered Owner

at the t ime of accident, Complainant is not entit led to get any benefit under Personal Accident Cover. Repudiation upheld.

Ahmedabad Ombudsman Centre Case No. 14.003.0071 Mr. Usman B. Shaikh

Vs. National Insurance Company Ltd.


Complainant took a Policy for his Vehicle on 31.3.03. Claim lodged against theft of Vehicle on 28.5.03. Claim repudiated because, as on date of theft the Registered Owner of the Vehicle was one Mr. Mohammed Hanif Shaikh, and was not the Complainant. Documents and submissions perused. It is observed that as on date of loss, the ownership of the vehicle was not transferred in the name of the Complainant. Referring to the infirmit ies in the Proposal Form such as different ownership of vehicle, non - mentioning of Regn. Number misstatement about Registering Authority / Location, i t is opined that these are all violat ive of the relevant Rules of Indian Motor Tariff and the Complainant is not lawfully entit led to get benefit of Claim. Repudiation sustained.


Mr. Natvarshinh M. Zala Vs.

The New India Assurance Company Ltd. Award Dated 20.12.2004 Motor Claim. Car met with an accident. Claim repudiated on the ground of non - insurable interest on the part of the Complainant. Complainant submitted that he purchased the Car on 25.3.01 but could not transfer the same in his name through oversight. He argued that he has paid the required fees to RTO on 4.4.02 for transfer of ownership in his name and the RTO approved the transfer on 3.5.02 giving effect of transfer from 25.3.01. Documents and submissions perused. It is observed that on the date of insurance on 23.01.02 and also on the date of accident on 28.1.02 the Registered Owner of the Vehicle was Smt.Natvarshinh M. Zala and not the Complainant. Repudiation upheld.

Ahmedabad Ombudsman Centre Case No. NIA / 1 / 235

Mr. Mukeshkumar Bhatt Vs.

The New India Assurance Company Ltd. Award Dated 30.12.2004

Complainant’s Matador vehicle met with an accident. On receipt of claim intimation, Respondent appointed Surveyor. After that, Respondent asked for certain requirements which was not responded by the Complainant. This led the Respondent to close the f i le as No Claim. The Complainant described during Hearing the extenuating circumstances led to non - compliance with the requirements of the Respondent and submitted a letter before this Forum to pay him at least Rs. 6250/- in ful l and f inal sett lement of the claim. Representative of the Respondent also agreed to this proposit ion. Directed the Respondent to pay Rs. 6250/-.

Ahmedabad Ombudsman Centre

Case No. 11.004.0141 Mr. Suresh A. Agarwal

Vs. United India Insurance Company Ltd.


Complainant’s Car met with an accident.Claim lodged for Own Damage of Rs. 261647/-. Respondent sent D.V. of Rs. 127700/- which was duly executed without any objection. After receiving the said amount, Complainant approached this Forum for further rel ief as the amount of sett lement had been too less. Respondent argued that even though there were violat ion of Policy Condit ions by overloading as well as non - f i l l ing of FIR, they viewed the Claim very leniently. Examined the crit ical issue in the context of decided cases that whether the Complainant is within Law in agitat ing the Claim for further rel ief after receiving the payment in his ful l satisfaction. The Case referred to is UIC Vs. Aajmer Singh Cotton & General Mills [(1999) 6 SCC 400). Held that the D.V was executed voluntari ly, having no compell ing undue circumstances on the part of the Respondent. No reason to interfere with the sett lement of the subject Claim. No further rel ief to the Complainant.


Mr. Mahendra P. Hirpara Vs.

United India Insurance Company Ltd. Award Dated 7.1.2005

Complainant’s Motor Cycle purchased on 5.1.04 was stolen on 18.1.04. Respondent repudiated the claim on the grounds that RTO transfer was effected only on 19.1.04 i.e. after the loss occurred and that the Complainant did not inform the RTO regarding theft on 18.1.04 thereby suspected the bonafide of conduct of the Insured. Documents and submissions perused. It is observed that the Respondent issued Certif icate of insurance in the name of Complainant after collecting necessary premium for Motor Package Policy and Transfer Fee which shows that the Insurer itself is satisf ied about the presence of insurable interest before the cover was transferred. As regards the allegation of moral hazard and doubt about bonafide of conduct of Complainant, It is observed that there was no adverse remarks in the Investigator’s Report. Respondent to pay Rs. 21000/- to the Complainant.

Ahmedabad Ombudsman Centre Case No. OIC / 1 / 136

Mr. Kamal Sud Vs.

Oriental Insurance Co.Ltd. Award Dated 31.1.2005 Motor Claim – Tata Sumo was stolen. Respondent offered Rs. 3/- lacs towards sett lement of the Claim. To resolve the dispute on quantum of loss, the principle of Golden Mean adopted and accordingly the average of three assessments done by the Respondent’s Surveyors took into consideration and arrived at Rs. 3.85 lacs. Respondent to pay Rs. 3.85 lacs alongwith 8% simple interest calculated from the date of last compliance.


Mr. Vijay S. Shah Vs.

Oriental Insurance Co.Ltd.

Award Dated 28.2.2005 Complainant’s Maruti Alto Car was stolen. The purchase price of the Car was Rs. 4,03,343/- and the insured amount was Rs. 4,00,000/- Respondent offered sett lement of Claim for Rs. 2,70,000/-. Respondent submitted that although the SI was Rs. 4,00,000/- , their l iabil i ty is based on Law of Indemnity and that the SI was not the Bench Mark for payment of the Claim. They cited an Order of Hon’ble NC in Revision Petit ion No.3228 of 2003 in support of their contention. To counter the said submission, the Complainant cited the Order of NC in the matter of NIC Vs. A. Lamba (2003 NCJ 286 NC) and (2003 NCJ 152 NC) in the matter of New India Vs. MRs. Inderjeet Kaur. Documents and submissions perused. It is observed that the subject car was only 1 year and 3 months old at the t ime of loss. Referring to the citations referred to above, i t is observed that al l the judicial precedents direct that the Vehicle Claims are to be quantif ied by application of stipulated Rate of Depreciation on the purchase price of the Vehicle. Held that the applicable depreciation for the vehicles between 1 to 2 years is 10% and accordingly, the value of the subject car works out to Rs. 3,60,000/-. Respondent to pay Rs. 3,60,000/- alongwith simple interest @ 8% p.a.

Ahmedabad Ombudsman Centre Case No. OIC / 1 / 166 Mr. Ramesh S. Bhut

Vs. Oriental Insurance Co.Ltd.

Award Dated 02.3.2005 Motor accident Claim. Complainant demanded sett lement on total loss basis which was not agreed by the Respondent as the vehicle was repairable. Documents perused. It is observed that the Complainant had written a letter to the Respondent agreeing sett lement on total loss basis at Rs. 1,10,000/-. During Hearing, mediation efforts reached a stage of both the parties agreeing for the sett lement of the claim on Total Loss basis and they submitted a joint statement to this Forum. Accordingly directed the Respondent to pay Rs. 90,000/- to the Complainant with retaining of Salvage by him.


Mr. Mittal V. Patel Vs.

Oriental Insurance Co.Ltd. Award Dated 07.3.2005 Motor Claim. While driving the Car through a heavily water logged Road, engine suddenly got off and did not get started. Claim lodged for Rs. 63384/- towards expenses of repair. Respondent offered Rs. 3364/- for sett lement towards cleaning and f lushing, denying l iabil ity for al l other expenses as the Surveyor reported that when the Car got stuck in water, efforts were made to start the car by non - methodical way (Push - start) which caused major damage to the Engine. Documents and submissions perused. It is observed that if the car was not driven through heavy water, the engine wil l not be got damaged and the amount what had been recommended by the Surveyor was suff icient to make the car road - worthy, i f i t was towed and repaired by applying technical method. Respondent’s offer of Rs. 3364/- upheld.


Mr. Chetankumar J. Patel Vs.

The New India Assurance Co. Ltd.


Complainant’s Car met with an accident. Based on Survey Report, Respondent decided to sett le the Claim for Rs. 2,40,000/- on total loss basis. But, a f ire broke out in the Garage and the said Car also burnt in f ire. The Respondent revoked the decision and appointed an Investigator, and not paid the Claim alleging breach of Utmost Good Faith, misleading information, creation of fraudulent papers for gett ing Claim etc., though it was not directly conveyed to the Complainant. Respondent submitted that the said vehicle was plying without Regn. Number which is violat ive of M.V.Act. Referring to the above allegations of the Respondent, it is opined that breach of Utmost Good Faith established in a generic sense is not suff icient, but proving of i ts material ity alongwith nexus between the alleged breach and cause of loss is necessary to attr ibute the loss to the alleged breach. Further opined that the objection raised by the Respondent with regard to towing bil l etc. do not controvert the basics of the subject loss to deny the Claim particularly when no fraudulent intention could be established by the Respondent. Held that in absence of specif ic breach of Policy Condit ion having been established, and in view of posit ive processing of the Claim before f ire broke out as well as no nexus between the infirmit ies al leged and the cause of loss having been established, the pleading of the Respondent is not sustained. During Hearing, through mediation of this Forum, the parties arrived at a decision to sett le the Claim for Rs. 1,70,000/- with salvage retained by the Complainant.


Mr. S.L.Mangrolia Vs.

Oriental Insurance Co.Ltd. Award Dated 16.3.2005

Rioters set f ire to the Complainant’s car. After the loss got assessed by the Surveyor, Respondent appointed a Private Investigator. Investigator reported that it was a false and fabricated Claim as the f ire was not set by Mob. Based on this Report, Claim repudiated. On perusal of documents on record, i t is observed that the Investigators Report was not supported by any documentary evidences from Public Authorit ies. On the other hand, there are documents on record from Chief Fire Officer and Police Stations pointing out to the fact that the vehicle was set f ire by criminals. I t is also observed from documents that the Complainant had left the vehicle in a residential area on 1.3.02 and knew about the loss on 7.3.02 and informed the Respondent on 26.3.02 which observed as the lack of seriousness on the part of the Complainant to his own property. Claim decided on Non - standard basis. Respondent to pay Rs. 67,500/- (75% of Rs. 90,000/- assessed by the Surveyor).


Mr. Suresh G. Patel Vs.

The New India Assurance Co. Ltd. Award Dated 21.3.2005

The second - hand vehicle purchased by the Complainant met with an accident. Respondent did not take any action against the Claim lodged by the Complainant, since the ownership as well as insurance Policy was not transferred in the name of Complainant. Hearing held. During hearing, i t was come to the knowledge of this Forum that the Complainant has f i led a petit ion with Consumer Redressal Forum and the same has been registered by the Hon’ble Consumer Forum. As the complaint is not entertainable by this Forum, under Section 13 (3)c) of RPG Rules, it is dismissed without further proceeding.


Mr. N.T.Parmar Vs.


Motor Accident Claim - Accident took place in 1999. Evenafter submission of compliances and constant follow - ups by the Complainant, the claim remained unsett led. According to the Complainant, the response from the Insurer was not at al l appreciable and he requested the Forum to put on record his resentment. Respondent submitted that they had sent several letters for compliance of different requirements for processing the Claim, as per the address available on the Policy, but all returned undelivered. Documents and submissions perused. It is observed from the copy of a letter written by Surendranagar Branch to Bhuj Branch of the Respondent Company that necessary papers such as Claim Form, FIR etc were stated to have sent to Bhuj Branch. Further, the Bills of repairing, Final Survey Report recommending to sett le the claim at Rs. 31625/- etc., are also available in the File. Held that lack of co - ordination between the two Branches of the Respondent Company as well as unsystematic dealing with the Claim File were the reasons led to non - sett lement of the Claim. Respondent to pay Rs. 31,625/- alongwith 8% simple interest.

Ahmedabad Ombudsman Centre Case No. NIA / 1 / 275 Mr. Gunvant K. Banker

Vs. The New India Assurance Co. Ltd.


Motor Accident Claim - Complainants car met with an accident while proceeding to Rajasthan. At the t ime of accident, there were 4 passengers travell ing in the Car, al l are members of same family. Respondent investigated the case, and the Investigator submitted his Report stat ing that the Occupants were fare paying passengeRs. The Investigator also obtained a statement from one of the Occupants that the Car that they had been traveling was taken by them on rental basis. Based on this, the Respondent repudiated the Claim on the ground of violation of Policy Condit ion as to l imitation of use. Complainant refuted the f indings of the Investigator during Hearing and submitted two Aff idavits of the same persons stat ing that they were not fare paying passengers and that the Car was provided to them for their use as their family fr iend. They also refused having given any such statement to the Investigator, and he is known to them. Since the case raised complicated questions of facts and Law, an Order is passed giving l iberty to the Complainant to take up his grievance with an appropriate Forum. The Complainant can also seek exclusion of t ime spent under Sec.14 of the Limitations Act.

Bhubaneswar Ombudsman Centre Case No. I.O.O. / BBSR / 11.454

Shri. Kasinath Nayak Vs.

New India Assurance Co. Ltd. Award Dated 25.10.04

Insured complainant insured his vehicle TATA - 709, bus with New India Assurance Co. Ltd. which met with an accident on 20.09.2002. The surveyor has assessed the loss for Rs. 14,300/- Insurer treated the claim as “No Claim” on the ground that the vehicle was dismantled prior to the inspection of f inal surveyor & insured complainant repaired the vehicle and failed to submit the bil ls / cash

memos of repair. The complainant has stated that after Spot survey f inal surveyor took the photographs at the garage and advised him to start the repairing. As per instruction of f inal surveyor insured repaired the vehicle and produced the salvage to f inal surveyor. Insured complainant stated that he had submitted the bi l ls / cash memos in Insurer’s off ice.

Insurance Ombudsman set aside the repudiation and directed the insurer to pay Rs. 14,300/- to the complainant as the policy condit ion no where stipulates production of bi l ls / cash memos much less meaning it a condit ion precedent for sett lement of claim.


M/s. Pentagon Steel Pvt. Ltd. Vs.


Insured complainant, insured his pvt. car with United India Insurance Co. Ltd. It met with an accident on 27.01.2002. Insuer’s surveyor assessed the loss for Rs. 14,457.50. Insurer repudiated the claim on the ground that driver was holding Light Motor Vehicle Licence but he had no professional Licence for being engaged as a paid drive of that accidented vehicle. R.T.O. Ganjam has certif ied that “that particular driver is entit led to drive his own vehicle only as he had no professional l icence”.

Insurance Ombudsman set aside the re pudiation on the ground that MV Act no where prescribes that a paid driver can not drive the very type of vehicle for which he holds valid driving l icence unless he has obtained professional l icence. More over Insurer has fai led to show any provision of the Act or Rules which provides that professional l icence is sine qua non for a paid driver. Insurer is directed to pay Rs. 14,457.50 to insured complainant.


Shri. Ramavtar Agarwal Vs.


Insured complainant’s vehicle met with an accident on 22.08.2003. The surveyor appointed by insurer assessed the loss for Rs. 23,481/-. Insurer has sett led the loss for Rs. 22,100/- as insured complainant fai led to submit some bil ls of the parts which have been allowed by the surveyor. Insured complaint did not accept that amount rather preferred a complaint against quantum of amount offered by insurer loss. Insurance Ombudsman directed the insurer to pay Rs. 23,481/- as policy condit ion do not mandate production of bi l ls / cash memos to substantiate the loss.


Shri. Md. Akhtar Vs.

Oriental Insurance Co. Ltd. Award Dated 29.10.04

Insured complainant, insured his bus with Oriental Insurance Co. Ltd. It met with an accident on 14.12.2002. Insurer’s surveyor assessed the loss for Rs. 36,000/-. Insurer repudiated the claim on the ground that driver did not have the effective D / L at the material t ime of accident. D / L no; 1481 / 83 was init ial ly issued by R.T.O., Balasore and it was subsequently renewed from t ime to t ime by R.T.O., Ganjam. On verif ication of D / L it

was observed that init ial D / L(1481 / 83) was not issued by R.T.O. Balasore. So, original l icence being fake, subsequent renewals by RTO, Ganjam became in effective.

Insurance Ombudsman set aside the repudiation cit ing the Hon’ble Apex court decision on United India Insurance Co. Ltd. - Vs - Lehru & others (3 SCC 388) & National Insurance Co. Ltd. - Vs - Swaran Singh & others (SLP (C) 9027 of 2003). It wil l be for the Insurer to prove that Insured complainant did not take adequate care & caution to verify the genuineness or otherwise of l icence held by the driver. More over Insurer have fai led to prove that the accident took place due to fault of driver.

Bhubaneswar Ombudsman Centre Case No. IOO / BBSR / 11.456

Shri. Kalimuddin Khan Vs.

New India Assurance Co. Ltd., Award Dated 19.11.2004 Insured complainant insured his Tata Mini Truck no: OR - 02E - 0825 with New India Assurance Co. Ltd. It met with an accident on 16.11.2002 result ing in to damage of vehicle & its occupants. One of the occupants of that vehicle lodged an F.I.R. with Badachana P.S. The surveyor has assessed the loss for Rs. 23,722/- Insurer repudiated the claim on the ground that vehicle was carrying unauthorized passengers exceeding the contractual l imitat ion. The complainant stated that there were three laborers on board at the t ime of accident. So, there was no violat ion of l imitation as to use clause of policy. Insurer submitted that there were ten passengers on board at the t ime of accident. Insurer has fai led to substantiate that carriage of four persons in excess of number specif ied in l imitat ion as to use clause of the policy is the proximate cause of accident Hon’ble Ombudsman directed the insurer to pay Rs. 23,722/- (as per the apex court decision on B.V.Nagaraju - Vs - Oriental Insurance Co.Ltd case) to the complainant within 15 days of the consent letter of insured complainant.

Bhubaneswar Ombudsman Centre Case No. I.O.O / BBSR / 11.457 Shri. Sangram Keshari Pradhan

Vs. United India Insurance Co. Ltd.,

Award Dated 23.11.2004 Insured complainant insured his motor vehicle no. OR - 02.D - 3351 with United India Insurance Co. Ltd. for sum insured of Rs. 20,000/-. On 24.12.2002 the vehicle was stolen while it was parked in front of Commerce department of Vani Vihar. The incident was reported to Saheed Nagar P.S. on 25.12.2002 Police authorit ies submitted FRT as no break through was achieved. Investigator appointed by insurer found the case of theft to be true & surveyor assessed the loss for Rs. 16,000/-. Insurer deducted Rs. 10,000/- towards imposed excess & paid Rs. 9,950/-. The policy condit ions do not spell out imposed excess of Rs. 10,000/-. As the entire policy cert i f icate & policy schedules were generated through computer where as imposed excess was inserted by hand behind the back of insured complainant. Hon’ble Ombudsman directed the insurer to pay Rs. 16,000/- to the complainant within 15 days of the consent letter of insured complainant.

Bhubaneswar Ombudsman Centre Case No. IOO / BBSR / 11.445

Shri. Shiv Kumar Agarwal Vs.

New India Assurance Co. Ltd.,

Award Dated 29.11.2004 Insured complainant insured his motor cycle no. : OR - 02K - 5388 with New India Assurance Co. Ltd. The vehicle was stolen on 18.05.2002. while it was parked in front of complainant’s residence. The complainant lodged an F.I.R. with Jatni P.S. on 19.05.2002. The police authorit ies have submitted the FRT as break through was achieved. Investigator stated the case of theft to be true & assessed the loss for Rs. 28,500/-. Insurer repudiated the claim on the ground that there was delay in lodging the F.I.R. Insured complainant submitted that he spent some time in searching for the stolen vehicle. Hon’ble Ombudsman directed the insurer to pay Rs. 28,500/- as the phraseology immediate has not spelt out how short or how long the insured shall give immediate notice to the police.


Shri. Dulichand Agarwal Vs.

New India Assurance Co. Ltd. Award Dated 29.11.2004 Insured complainant insured his Pvt. Car with New India Assurance Co. Ltd. for Rs. 2,00,000/- on insured declared value basis. It met with an accident on 14.02.2003 with an extensive damage. The surveyor has assessed the loss for Rs. 1,50,000/- on net of salvage basis. Insurer again negotiated with insured complainant and made him agreed for sett lement of Rs. 1,20,000/- on total loss basis net of salvage through their regional automobile engineer. Insurer again appointed Shri. D.Naik, an investigator for investigation in order to reduce the claim further. On the basis of investigation report insurer advised the complainant to dismantle the vehicle & claim wil l be sett led on repairing basis. By hearing both the parties Hon’ble Ombudsman directed the insurer to pay Rs. 1,20,000/- on net of salvage basis as recommended by surveyor & insurer’s regional; automobile engineer which has been agreed by the complainant.


Shri. Subash Chandra Das Vs.

New India Assurance Co. Ltd. Award Dated 30.11.2004 OR - 05 E - 5472, Oil Tanker of Insured complainant, insured under motor own damage & carrier’s legal l iabil ity policy met with an accident on 09.10.2001 result ing damage to the vehicle & loss of entire diesel consignment of consigner M/s – HPCL. Insurer sett led the motor claim. Surveyor Shri. S.Kumar assessed the carrier’s legal l iabil ity claim for Rs. 1,75,056/- on total loss basis. Insurer closed the claim on the ground that legal l iabil i ty of the complainant has not been adjudicated by a competent court of law. During the hearing complainant submitted that he has already paid Rs. 1,86,091/- to M/s. – HPCL towards cost of diesel and submitted the documentary evidence. Hon’ble Ombudsman directed the Insurer to pay Rs. 1,75,012/- as the claim is l imited to l iabil i ty covered under the policy within f i f teen days of submission of consent letter by insured complainant.


Mr. Kamal Kumar Khandelwal Vs.


Insured complainant insured his oi l tanker with United India Insurance Co. Ltd. It met with an accident on 26.03.2003. The surveyor has advised the complainant to dismantle the vehicle, which the complainant did not comply rather insist for assessment of loss on total loss basis. The surveyor has assessed the loss for Rs. 1,86,274/- on repairing basis. Insurer repudiated the claim on the ground that driver did not have the valid D / L at the t ime of accident. During the hearing insurer accused compliant for non co - operation. Insurer complainant stated that there was an extensive damage to vehicle & driver had valid D / L at the t ime of accident. There is no concrete proof that D / L of Sri.K.Rout, driver was fake. Hon’ble Ombudsman directed the insurer to pay Rs. 1,86,274/- as assessed by surveyor on repairing basis subject to production of f inal bil ls of repair by the complainant.


Smt. Renubala Sinha Vs.


OR - 13A - 5075, Tata Sumo belongs to Insured complainant, insured under passenger carrying commercial vehicle policy of United India Insurance Co. Ltd. While it was proceeded to Kharagpur from Puri near Jaganath Khunta under Bangiriposhi P.S. rubbers over powered the driver and drove off the vehicle. Police and investigator submitted the report that incident was genuine. Insurer repudiated the claim on the ground that the vehicle was plying from Puri in Orissa to Kharagpur of West Bengal under All Orissa Permit. Ombudsman directed the insurer to sett le the claim on total loss basis as the incident was happened within Orissa only, so, there was no violat ion of condit ion of the route permit by insured complainant.


Smt. Janhabi Rout Vs.


OR - O2K - 9631, Maruti Van belongs to Sri.Prasant Kumar Dhal insured with New India Assurance purchased by Smt.Janhabi Rout on 4.9.2002. The ownership of the vehicle has been transferred in the name of Smt.Rout on 5.9.2002 in R.C.Book, where as insurance particulars has remained in the name of Sri.P.K.Dhal. The vehicle met with an accident on 28.4.2003 near Baliguda. Insured complainant lodged the claim with Barbil branch of Insurer for the sett lement of loss. The surveyor has assessed the loss for Rs. 65,000/-, but Insurer repudiated the claim on the ground that the complainant has no insurable interest in that vehicle at the t ime of accident. Insurance Ombudsman uphold the repudiation of Insurer as the complainant has no insurable interest in the insured vehicle as vehicle was not transferred in her favour with change of ownership as per the Apex Court ruling in case of Complete Insulation (P) Ltd. - Vs - New India Insurance Co.Ltd. (Civi l Appeal No.2131 of 1994).


Smt. Anima Das Vs.

National Insurance Co. Ltd.


Insured complaint’s vehicle met with an accident on 5.1.2003. Insured complainant lodged a caim for an amount of Rs. 93,595/- towards repairing of that vehicl. The surveyor has assessed the loss for Rs. 28,000/- where as the insurer has sett led the claim for an amount of Rs. 24,910/- which the complainant did not accept. During the hearing complainant stated that she had spend Rs. 93,395/- towards repair ing of that vehicle but insurer arbitrari ly sett led the claim for this meager amount. Insurer contended that the surveyor has considered only the parts which have been damaged due to that accident and discarded the parts which are not caused by the accident. As per the station diary lodged by the driver it was revealed that r ight side mudguard, door were partial ly damaged. Considering the survey report and photographs of damaged vehicle Ombudsman directed the insurer to pay Rs. 31,730/- to the complainant as it can not be said that there was no other damages to the vehicle except stated in the stat ion diary.


Smt. Satya Bhama Hati Vs. United India Insurance Co. Ltd.

Award Dated 31.01.2005 Insured complainant insured her tractor and trai ler with United India Insurance Co.Ltd. under commercial vehicle policy. The insured vehicle met with an accident on 7.4.2003 as a result the tractor and trai ler fel l into the road side pond. The vehicle was towed to M/s – Sampark Motors, Bhubaneswar for repair. The complainant intimated the incident to the insurer on 11.04.2003 and lodged a claim for Rs. 30,751/-. Insurer repudiated the claim under the ground that damage to the tractor was not caused due to that al leged accident. During the hearing insurer stated that though the complainant did not intimated the accident in t ime rather the vehicle was dismantled before visit of the surveyor to the garage and there was no water and mud mark over air cleaner. The complainant representative stated that the vehicle was shifted by the driver without their knowledge. So, no intimation was given to the insurer while the vehicle was in accident spot. Ombudsman uphold the repudiation on the ground that insured complainant fai led to establish her claim.


Mr. Farid Khan Vs. Oriental Insurance Co. Ltd.

Award Dated 15.2.05 The Insured - Complainant’s Auto Rickshaw bearing Regn. No. OR - 05Q - 5771 insured with Oriental Insurance Co. Ltd., met with an accident on 16.10.2003 while the said vehicle was plying from Cuttack to Tangi. A speeding truck knocked it down from it behind causing severe damage to the vehicle. The surveyor assessed the loss for Rs. 7750. Insurer repudiated the claim on the ground that driver was not holding the effective Driving License to drive the transport vehicle. The complainant stated during the Hearing that vehicle was used for private purposes at the relevant t ime of accident. As per R.C. Book the vehicle was registered as transport vehicle and also insured as commercial vehicle. Hon’ble Ombudsman uphold the repudiation as per decision of Orissa High Court rul ing on Oriental Insurance Co. Ltd. - Vs - P.K. Dalai M.A.No.236 of 1996 on 6.3.2000.


Shri. Ashok Kumar Agarwal Vs.


Insured complainant insured his Qualis Car, with National Insurance Co.Ltd. under private car policy. The insured vehicle met with an accident on 29.6.2003. The vehicle was surveyed by Sri.D.K.Patnaik who has assed the loss for Rs. 61,849/- and deducted Rs. 6,849.88 towards cost of salvage and calculated the net loss for Rs. 55,000/-. Insurer sett led the claim for Rs. 54,980/- only against bil ls of Rs. 80,953/- submitted by insured complainant. After repairing of the vehicle complainant has written a letter to insurer that he was not interested to keep the salvage with him and requested the insurer to take back the salvage and return the deducted amount. Insured complainant accepted Rs. 54,980/- offered by the insurer without any protest. Surveyor in his report has stated that “salvages being the property of under writer, insured has been duly advised by the surveyor to surrender the same to the insurer prior to f inal sett lement of this claim.” During the hearing complainant has stated that insurer arbitrar i ly deducted the salvage amount and insurer stated that insured complainant has accepted that amount as ful l and f inal.

Hon’ble Ombudsman directed the insured to pay Rs. 6,870/- towards cost of salvage and take back the salvage from the complainant.

Bhubaneswar Ombudsman Centre Case No. I.O.O. / BBSR / 11.004.110(A)

Smt. Renubala Sinha Vs.


Insured complainant insured her Tata Sumo, with United India Insurance Co.Ltd. under commercial vehicle policy. The insured vehicle was stolen by the miscreants on 22.12.2002. Insurer repudiated the claim under the ground that the vehicle was moving towards West Bengal though it had a route permit for Orissa only. Hon’ble Ombudsman directed the Insurer to sett le the claim on Total Loss basis vide order dated 06.12.2004

(Complaint No: 14.444). Insurer offered Rs. 3,78,500/- as per the valuation report of surveyor and insured complaint accepted the amount. Again the complaint represented for the interest portion as her claim has been unnecessary delayed. Insurer submitted that since complainant has accepted the amount without any protest so there is no need to consider her complaint. Hon’ble Ombudsman directed the Insurer to pay interest @ 6% per annum from the date of complaint i.e. 23.02.2004 on amount of Rs. 3,78,500/- t i l l date of payment as the insurer had long delayed the claim due to wrong premise that vehicle was heading towards West Bengal where as the incident took place within Orissa only.

Bhubaneswar Ombudsman Centre Case No. I.O.O. / BBSR / 14.002.0014

Mr. Basant Kumar Sahu Vs. New India Assurance Co. Ltd.

Award Dated 18.2.05

Insured complaint Shri. Basant Kumar Sahu owner of Mini Truck OR - 04A - 4191. The said vehicle was insured under a goods carrying commercial vehicle. It met with an accident on 16.2.2002 when a t ipper dashed against the rear portion of the mini truck. Result ing the damage to the vehicle and injury and death of occupants. The surveyor has assessed the loss. Insurer repudiated the claim on the ground that some authorized passengers were traveling in that Truck which violates the l imitation as to use clause of the policy.

During the Hearing the complainant stated that besides the driver and helper, there were four labourers in side the vehicle at the t ime of accident. So, there was no violation of policy condit ions. Insurer submitted that there were two - business man and their labourers were on board. As per R.C.Book seating capacity of vehicle was mentioned two including the driver where as insurance policy provides carriage of six employees other than driver. No concrete proof was provided from either side in support of status of passengeRs. Insurer fai led to substantiate the carriage of al leged gratuitous passengers was the proximate cause of accident. Hon’ble Ombudsman directed the insurer to pay Rs. 47,800/- as per apex court decision in case of B.V.Nasgaraju.


Mr. Chiranjibi Patra Vs.


Insured complaint purchased a Hero Honda motor cycle on 29.11.2000. That motor cycle was insured with National Insurance Co. Ltd. from 2.12.2000 to 01.12.2001. Again it was renewed for one year commencing from 10.12.2001. The vehicle was stolen from the garage of his residence. The complainant lodged a FIR on 23.02.2002 at Koraput Town P.S. On completion of investigation the police submitted the charge sheet against Santisi la Kochin u / s 457 / 380 of IPC showing him absconder. Insurer repudiated the claim for non submission of R.C.Book and non registration of Motor Cycle. Insured complainant stated that he had applied to RTO Koraput for al lotment of reserved registration number. The theft occurred before allotment for which vehicle could not be registered. Hon’ble Ombudsman directed the insurer to refund premium of Rs. 444/- to the complaint along with penal interest of 18% from the date of complaint.


Mr. Basant Behera Vs.


This complaint has been f i led by Shri. Basant Kumar Nayak against New India Assurance Co. Ltd. for repudiation of motor claim.

The Complainant insured his auto rickshaw with New India Assurance Co. Ltd. On 23.04.2003 two miscreants masquerading as tourist hired the vehicle and dumped the driver on way side and sped away with the stolen vehicle. Fir was lodged with the police authority. As per Final Police Report Fact true no clue. Insurer repudiated the claim on the ground that driver did not have the transport endorsement in his Driving l icense though he has possessed only LMV license. Insurance Ombudsman directed the insurer to pay Rs. 94098/- as driving l icense has no bearing on cause of loss.


Mr. Silla Siva Narayan Vs.

National Insurance Co. Ltd. Award Dated 25.3.05 This is a complaint under Rule 12(1)(e) of the RPG Rules, 1998.

The details of the complaint is as fol lows: - The Insured Complaint had taken a private car policy for his Maruti Van OR - 02F - 1001. He lent that vehicle to his fr iend Shri. Avay Kumar Mishra for visit ing his brother - in - law’s house. During the night halt of Shri. Mishra the vehicle was parked in front of that house and it was stolen on 3.8.1998. During the investigation the policy recovered the vehicle in damaged condit ion. Insured complainant spent Rs. 90722 / towards repair ing of that vehicle. The claim has been repudiated by the insurer on the ground that due care was not taken for safe keeping of the vehicle in the night of occurrence. Hon’ble Ombudsman directed the insurer to sett le the claim as no watch and ward staff are engaged by private individuals to watch their vehicle in the night except commercial establishments. So, it can not be said that insured vehicle was abandoned as it was not kept inside a garage or under watch of security personnel.


Smt. Bidyutlata Das Vs.

Oriental Insurance Co. Ltd. Award Dated 25.03.2005 This complaint has been fi led by Smt. Bidyutlata Das against Oriental Insurance Co. Ltd for the partial sett lement of her Motor Cycle claim. Insured complainant is the owner of Motor cycle no.: OR - 05K - 9219. Her motor cycle was used by her husband. On 18.12.2001 some miscreants murdered her husband and took away the motor cycle. Insurer paid Rs. 25,000/- as on account payment on 15.03.2004. Despite of several representation balance amount has not been paid by the insurer. During the negotiat ion insurer agreed to pay Rs. 18,000/- to the complainant by end of March, 2005. Hon’bel Ombudsman directed the Insurer to pay Rs. 18,000/- by end of March, 2005. without fai l.


Shri. Raj Kishore Sahoo Vs.


Insured Complainant, Insured his Hero Honda Motor cycle which met with an accident on 10.1.2004. Complainant lodged a claim for an amount of Rs. 10,000/- towards repairing of the vehicle. The surveyor has assessed the loss for an amount of Rs. 3,700/- after deduction of Rs. 678/- towards salvage charges. During hearing complainant stated that the chasis of the motor cycle has been replaced by a new chasis. Insurer stated that chasis was very much repairable and accordingly surveyor or has allowed the repairing charges for the sale. Hon’ble Ombudsman directed the insurer to pay Rs. 4378/- while al lowing the insurer to retain the salvage, as there is no reason to al low cost of new chasis as the same is very much repairable.

Chandigarh Ombudsman Centre Case No. GIC / 46 / NIC / 11 / 05

Smt.Sushil Nanda Vs.

Royal Sundaram Alliance Insurance Co. Ltd. Award Dated 24.10.2004 FACTS : Smt.Sushil Nanda got her car insured for the period 11.11.2003 to 31.10.04 for sum assured of Rs. 3,57,050. The vehicle was stolen on 23.11.2003, i t was recovered by police the next day in a damaged condit ion. On receipt of report, the insurer deputed a

surveyor. The repairs were carried out and a claim for a sum of Rs. 2,27,403/- was lodged by the complainant. She stated that six months after the vehicle was got repaired, the insurer took the plea that it was got repaired by her on self authorization and the claim would be sett led on cash loss basis. The complainant felt that this was a highly unfair proposit ion. The modalit ies of sett lement should have been worked out by the insurer before the vehicle was dismantled. The insurer was forcing her to accept the claim for Rs. 1,67,050/- against Rs. 2,27,403/- due to her. FINDINGS : Init ial ly sett lement on cash loss was also suggested by insured, but the surveyor insisted on gett ing the vehicle repaired. The estimate for assembled parts worked out to Rs. 2,30,000/- while the cost of assembled engine was much lower. The surveyor gave the go ahead for instal lation of assembled engine after consultation with the insurer. The insured was informed vide letter dated 29.4.04 that the sett lement of cash loss basis would be beneficial to both the parties. There was no earl ier communication from the insurer unti l sett lement of the claim on cash loss basis was proposed. It is only when he pressed for payment of claim, a letter dated 28.5.2004 was received alleging that as the vehicle was got repaired on self authorization basis, the claim had been sett led on cash loss basis and the l iabil i ty for a sum of Rs. 1,67,050/- was accepted and consent was sought from the insured. DECISION : The proposal for sett lement on cash loss basis was made known to the complainant as late as on 29.4.2004, when the repairs had been carried out. The complainant would not have refused the offer for sett lement i f i t had been made before the repairs were carried out such a proposit ion could not be forced upon her just because it seems to be more beneficial to the insurer. While as per policy condit ions, option rests with the insurer to arrive at sett lement either on cash loss basis or repair basis, but this has to be exercised at the appropriate t ime. Held that having deputed a surveyor, who assessed the loss, gave go ahead for repairs and the repairs were carried out and the claim submitted, the claim cannot be sett led on cash loss basis, which puts her to an unintended loss. Ordered that the claim be processed on repair basis and sett led within three weeks.


Mr.Baljinder Singh Vs.

National Insurance Co. Ltd. Award Dated 1.11.2004 FACTS : Shri.Balj inder Singh got his Maruti Car insured from B.O.Malerkotla for the period 26.11.02 to 25.11.03. It met with an accident on 15.6.03. The insured f i led the claim, but it remained unsett led. The DL issued by DTO Ranchi on verif ication was found to be valid for heavy vehicle only. At the instance of the insurer the complainant got i t endorsed for car as well. The claim fi le was, however, closed as ‘no claim’ on the ground that on the date of accident the driving l icence was not valid for a car. FINDINGS : There were discrepancies in the reports submitted by the surveyors regarding the status of DL. The spot as well as f inal surveyor cert if ied that the l icence was valid for motor car and HGV. The DL submitted by the complainant was referred to DTO, Ranchi for verif ication despite the fact that against the column ‘Type of Licence’, it was specif ically stated that the l icence was for motor cycle and HGV only. The reference to DTO Ranchi was uncalled for as the claimant did not have a l icence for driving a motor car. DECISION : Held that there was no need for gett ing the confirmation about the genuineness of the l icence for the claim in question as the l icence was not issued for driving a car. The insured suffered f inancial loss and harassment. The l iabil i ty could have been disowned at the init ial stage. But he was misguided and asked to get the l icence endorsed for car as well. He travelled all the way to Patna and got it endorsed for car, but the claim was repudiated. The complainant incurred infructous expenditure of Rs. 10,000/- and wasted t ime. Having regard to the inordinate delay in processing the claim and the fact

that the complainant was made to suffer f inancial loss and put to considerable harassment, a sum of Rs. 10,000/- was awarded as ex - gratia payment.

Chandigarh Ombudsman Centre Case No. GIC / 16 / NIA / 11 / 05

Mr.Mohinderjeet Singh & Amritpal Singh Vs.


FACTS : Shri.Mohinderjeet Singh and Shri.Amritpal Singh co - owned a Tata tanker used for transportation of oi l. I t met with an accident on 3.11.02 at Lusar on Kaza Manali Road. The claim fi led by them was treated as ‘No Claim’ on the ground that Shri.Naginder Singh driver, who died in the accident, did not possess a valid and effective Driving Licence on the date of accident. Besides, four persons were found travell ing unauthorizedly in the said tanker.

FINDINGS : The driver admittedly had a valid l icence upto 15.10.2002, while the accident had taken place on 3.11.02. Under Section 15 of MV Act, a grace period of 30 days is permissible for applying for renewal and in case the application is made within this period, the l icence is renewed w.e.f. the date of expiry, not withstanding the fact that i t is renewed formally subsequently. Accordingly, plying of the vehicle by the deceased driver t i l l 15.11.2002 would have treated as if he had a valid and effective l icence.

The fact that unauthorized persons travelled in the vehicle was not in the knowledge of the insured. The investigation report suggested that the driver was coaxed / co - erced by the Kaza police off icials to let Shri. Ashok Kumar, A.S.I. board the tanker and leave in the evening to enable him to reach Manali at the earliest. Some other stranded persons also boarded the tanker. It was argued that the insurer could not disown the l iabil i ty on account of irregularity of l i f t ing some passengers without the knowledge of owners, as was held by the Supreme Court in the case of B.V.Nagaraju Vs. OIC(Civi l Appeal No.6296 of 1995).

DECISION : Held that the driver would be deemed to be in possession of valid and effective l icence at the t ime of accident since the accident had taken place within permissible grace period of 30 days for applying for renewal of l icence. Further held that in l ine with the judgement of Supreme Court in the case of B.V. Nagaraju Vs. OIC and considering the circumstances under which unauthorized persons boarded the tanker as reported by the investigator, indemnification of loss could not be total ly disowned. The claim was, therefore, ordered to be sett led for payment on non - standard basis @ 70% of admissible claim.


Shri. Bijender Singh Vs.


FACTS : The complainant owned a commercial vehicle bearing no. HR - 39A - 1770. He got i t insured for the period from 3.6.03 to 2.6.04 from BO, Narwana. The vehicle met with an accident on 2.7.03. Intimation was given to the insurer on 4.7.03 and a surveyor was deputed. The loss was assessed for 35,802. But the claim was approved for Rs. 27,101 only on non - standard basis. The complainant felt aggrieved in view of the short payment of Rs. 7,187 towards replacement of parts and Rs. 500 towards labour charges.

FINDINGS : The complainant was informed that the deduction in claim amount had been made on the ground that spot survey was not got conducted. He contended that he informed the Development Officer soon after the accident. The accident took place at 10.30 PM. The Development Officer came to the spot and tr ied to contact a number of surveyors but none was available. The complainant was under pressure from police authorit ies to remove the vehicle immediately because Chief Minister’s entourage was supposed to pass through the area. Thus he had no option but to remove the vehicle. However, photographs at the site were duly taken. The representative of insurer observed that spot survey is important in the case of commercial vehicles. Besides, FIR had not been lodged. Therefore, sett lement of claim on non - standard basis was justif ied. DECISION : Held that i f a claim is treated as admissible, it should not be sett led on non - standard basis. As the omission on the part of the complainant in not gett ing the spot survey was not wil l ful or deliberate, i t did not warrant any reduction in the claim amount. The balance amount was ordered be paid to the complainant.


Shri. Rajinder Singh Vs.


FACTS : The complainant’s father late Bachiter Singh got his vehicle bearing registration no.HR B - 1682 insured from BO, Malerkotla for the period from 7.5.2003 to 6.5.2004. The vehicle met with an accident on 27.7.2003. The claim intimation was given to the insurer on 28.7.2003 by the complainant’s father. The vehicle was got repaired after completing requisite formalit ies. The complainant’s father died on 20.7.2003. The complainant was informed on 15.6.2004 that the claim had been repudiated on the ground that the R.C as well as the insurance policy were not got transferred in the name of legal heirs of insured within three months after his death. This was reckoned as breach of condit ion no.9 of the policy and hence the claim was not payable. FINDINGS : The accident had taken place while the father of complainant was alive and the loss was reported by him only. As per the terms and condit ions of the policy, a claim arising within three months after death of the insured would have been payable without transfer of policy in the name of legal heiRs. The policy could not be transferred in the name of legal heirs as the vehicle was sold in November, 2003. The policy was in the name of late Shri. Bachiter Singh. It was admitted that both RC and the policy were valid when the accident took place, but the insurer came to know of the death of the insured only when a copy of an aff idavit for transfer of RC in favour of the buyer was given. DECISION : Held that a claim having arisen during the currency of the policy is payable and it is immaterial whether the policy is inforce or not at the t ime when the payment is actually made. Since the sett lement of claim was delayed it was payable to legal heiRs. Repudiating the claim by invoking condit ion No.9 in such a case is inappropriate. Directed that the claim be paid to the legal heirs or to any one whom they so authorize.


Smt. Amrit Gill Vs.


FACTS : Smt. Amrit Gil l got her Fiat Sienna (diesel ELX 2001) insured for the period from 5.5.2002 to 4.5.2003. It met with an accident on the 5.12.2002, near Moradabad. The vehicle was being driven from Pall ia to Delhi by Shri Gurnihal Singh Mann. The Divisional

Office, Moradabad was informed about the accident on 11.12.2002. A surveyor was deputed and the loss was assessed at Rs. 2 lac. The complainant was asked during May, 2003 to furnish a copy of DL of Shri. Mann along with a copy of FIR. The Licensing Authority Lakhimpur Kheri which renewed the l icence last confirmed the validity of D for the period 1.12.1994 to 24.12.2010. The Delhi Licencing Authority, which originally issued the l icence, however, informed that the DL had not been issued by Delhi Office. The insurer repudiated the claim on the ground that “DL of Shri Singh was not valid at the t ime of accident and had not been issued by the basic l icence issuing authority.” The complainant also approached Delhi Licencing Authorit ies at Tilak Marg and Mall Road for verif ication of DL, but was verbally informed that as the l icence was issued way back in the year 1979 and had not ever been renewed thereafter, the record was untraceable. However, nothing was given in writ ing. Findings : The DL of Shri Gurnihal Singh was originally issued by the Delhi Licensing Authority way back in 1979 and was later got renewed from Nalagarh and Lakhimpur Kheri where he maintanied residences. The insurer deputed surveyor for verif ication from LA, Delhi. The Licencing Authority, Delhi informed that the particulars of the said l icence were not available. It was also got verif ied from Licensing Authorit ies at Lakimpur Kheri and Nalagarth, both of which confirmed the genuineness of the l icence. However, LA, Delhi was non committal in giving any certif ication. DECISION : Held that the l icensing authority Delhi neither confirmed nor denied the genuineness of the l icence. It only reported that the record was not traceable or that the l icence might have been issued by LA Mall Road, New Delhi. In the absence of any confirmation from the LA to the contrary, the l icence originally issued by LA, Delhi cannot be treated as fake, especial ly when all subsequent renewals were confirmed to be genuine. As the repudiation was not on well founded grounds, the claim was ordered to be sett led on the basis of loss assessed.


Shri. K.C.Sharma Vs. National Insurance Co.


FACTS : Shri. K.C.Sharma happens to be owner of a Tata Indica car bearing no. HR 16 C - 8305, which was f inanced by M & M Financial Services, Hissar. He got i t insured from branch off ice, Oriental Insurance Company, Hissar for the period 17.7.2002 to 16.7.2003. The policy was, however, got renewed for the period 17.7.03 to 16.7.04 from BO, Hissar of the National Insurance Company on 9.7.2003. The premium was paid by the f inancier without the consent and knowledge of the insured. The covernote was issued by the Development Officer. No proposal form was obtained from the insured at the t ime of transfer of policy. The vehicle met with an accident on 28.1.2004. The insurer was duly informed who appointed a surveyor. The vehicle was inspected by him at the workshop of authorized repairer. Upon completion of repairs, charges were paid by the complainant and the claim was lodged with the insurer. However, he was asked to clarify as to why the claim should not be repudiated since he was given benefit of NCB at the t ime of renewal of policy, while he had taken a claim from the previous insurer. Findings : The renewal was got done by the f inancier without insured’s knowledge eight days before the expiry of the policy. He had no idea about the change of insurer. The letter for verif ication for NCB was sent by B.O, NIC to B.O, OIC on 15.7.2003 after renewal of the cover on 9.7.2003. The f inancier informed that the insured had not furnished any detail regarding previous claim. No undertaking was taken from the insured as required under GR 27 of the Motor Tariff , nor was the renewal notice from previous insurer verif ied. DECISION : Held that the insurer did not get an undertaking from the insured and NCB was allowed on an oral submission by the f inancier. On verfication, obtained after the claim was

lodged, it transpired that the insured had fi led a claim with the previous insurer as well. The insured had not made any misstatement or wrongly claimed NCB as he was not asked to give any declaration or show the renewal not ice from the previous insurer to verify his entit lement regarding NCB. Held that as the NCB was allowed without any verif ication and the insured had not claimed it, repudiation was not in order. The claim was, therefore, ordered to be paid.

Chandigarh Ombudsman Centre Case No. GIC / 64 / ROYSUN / 11 / 05

Shri. Durga Prasad Vs. Royal Sundaram


FACTS : Shri. Durga Prasad had taken an insurance cover for private use of vehicle No. DL - 3CW - 2611 for the period 13.3.2003 to 12.3.2004 from BO, Gurgaon. The car met with an accident on 7.3.2004. Intimation to the representative of insurer was given at M/S Autolink showroom. The car was got repaired and the claim was lodged. Since the sett lement was gett ing delayed, he took up the matter with the Regional Manager, but nothing concrete materialized. He fi led a complaint in the off ice of Insurance Ombudsman, Delhi which was transferred to this off ice on 17.7.03 being outside his territorial jurisdiction. FINDINGS : The vehicle was surveyed on 10.3.2003 and the complainant was authorized to get it repaired. Meanwhile, investigation revealed that the complainant was the proprietor of a taxi stand. To ascertain if the insured vehicle was also being used as taxi, the investigator booked it for travell ing to Vrindavan. However, another vehicle bearing no. HR - 55 AT - 6257 was sent. The driver informed that the booked vehicle was under maintenance. It was concluded that the complainant who was engaged in the business of running tourist taxi service, was plying the insured vehicle also as a taxi. DECISION : Held that since it was established conclusively that the vehicle was being used for hire against the provision relating to “l imitat ions as to use” set out in the policy, there was no ground for interfering with the decision of the insurer and the complaint was accordingly dismissed.

Chandigarh Ombudsman Centre Case No. GIC / 107 / Bajaj / 11 / 05

Shri. Narain Dass Vs.

Bajaj Allianz Gen Ins Co. Award Dated 04.03.05

FACTS : Shri. Narain Das got his car bearing registration no. HI 09 J - 0036 insured from Chandigarh off ice for the period 13.10.2003 to 12.10.2004. Due to heavy rain and consequent f looding on 3.8.2004, water reportedly entered the car engine and damaged it. He got it repaired from M/s Berkley Automall and f i led a claim for Rs. 36,403/- on 13.8.2004. He was given to understand by the surveyor that the claim would be sett led for Rs. 12,490/- only. This was also confirmed by the representative of the insurer when he met him. However, the l iabil ity was disowned. FINDINGS : The vehicle went out of order on 03.8.2004, for which intimation was duly given to the insurer and the surveyor inspected the vehicle on 05.8.2004. The repair work was completed by 13.8.2004. The surveyor’s report was submitted belatedly on 31.8.2004, while the vehicle was inspected on 5.8.2004. The delay in submission of report was not explained. The complainant was informed vide letter dated 10.9.04 that the damage to the engine was not related to the vehicle gett ing into water, but was due to mechanical failure or wear and tear or subsequent damage as a result of fai lure on his part to protect the

vehicle from deteriorating. The claim was repudiated without specifying any reason by letter dated 25.9.04. The vehicle was also under warranty on the date of loss. DECISION : Held that the insurer was unsure if the damage was caused by mechanical fai lure or some other reason. The repairer went ahead after survey on the presumption that repairs have been aurhotized by the surveyor. As the vehicle was under warranty, the complainant could have approached the manufacturer for replacement of defective parts, had he known that the claim was not admissible on account of alleged mechanical failure. The complainant was informed about non - admissibi l i ty of the claim after he got the vehicle repaired and by then he had foregone the option of gett ing the engine repaired or replaced by the manufacturer. The insurer ought to have informed the complainant in t ime giving specif ic reasons for non admissibil ity of the claim. Held that having regard to the total ity of circumstances, giving benefit of doubt to the insured, the claim be sett led on a non - standard basis for 75% of admissible claim amount.

Chennai Ombudsman Centre Case No. 11.04.1147 / 2004.2005

Shri. R. Das Gupta Vs.


A private car Toyota Qualis was insured by the original owner Mr. Natarajan for the period from 6.12.2003 to 5.12.2004 for a sum insured of Rs. 3,30,000/- with United India Insurance Company Limited. Mr. Das Gupta from Coimbatore had purchased the said vehicle on 6.2.2004. The vehicle met with an accident on 8.2.2004 when it was returning from Chennai. The accident was reported to the Insurance Company. The insurance was changed in favour of the new purchaser from 11.2.2004. The Insurer have withdrawn the no claim bonus of 35% enjoyed by the original owner and collected from Mr. Das Gupta. The surveyor appointed by the Insurance Company assessed the loss at Rs. 1,35,500/- on salvage loss basis. After gett ing the oral confirmation from the Insurer, the wreck was also disposed.

The Insurer repudiated the claim on the ground that on the date of accident the name of the owner of the vehicle as per RC book differs from the insurance policy. A joint hearing was held.

It was noted that the new purchaser did not suppress the information that the vehicle was in a damaged condit ion. The RC book also revealed that the vehicle transfer effected in the RC book only on 10.2.2004.but the transfer to the new owner was given with retrospective effect from 6.2.2004 itself based on his request. It is clear from the Motor Vehicle Act provision that the l iabil i ty only cover either under a TP policy or under a package policy is automatic. The Tariff Advisory Committee, a statutory body, al lowed a t ime of 14 days for the new owner for effecting transfer of insurance. Nothing is in the tarif f to show that the provision of 14 days is not applicable for package policy. While going through the tariff , it is noted that the TAC framed so many rules for smooth underwrit ing of the motor business in India. General Regulation 17 is for transfer of insurance as per which tariff provided a grace period of 14 days for effecting transfer of insurance. Unless the TAC has brought out any amendment to this effect, this Forum would not toe the idea of the insurer that the 14 days grace period is only for TP risk. The insured has produced the sale receipt copy and also the insurance transfer letter dated 6.2.2004 duly signed by buyer and seller. Based on these documents, the RC was changed in favour of the new purchaser. In other words, there is every reason to presume that the part ies intended to transfer insurance along with owner ship of the property. As there is a provision under the TAC Rules that the transferee shall apply within 14 days from the date of transfer and accodringly the purchaser also

applied within the dates. The insurance was also changed to the new purchaser with effect from 11.2.2004. Hence direction was given to the Insurer to process the claim and sett le it to the new purchaser.


Mr. Mathivanan Vs.

The New India Assurance Co. Ltd. Award Dated 29.10.2004 Mr. Mathivanan insured his 1996 model TVS Moped vehicle with The New India Assurance Company Limited, Cuddalore for a sum insured of Rs. 5,000/- for the period 15.4.2003 to 14.4.2004 and the previous insurance expired on 11.4.2003. When the insured approached the Insurer for renewal of the policy on 15.4.2003, the vachile was duty inspected by one of the off icials and the cover was granted. It was reported that the vehicle was stolen on the night of 1.5.2003 and in the early morning of 2.5.2003. The insured intimated the incident to the Cudalore Police Station through letter on 2.5.2003 and the Insurer on 5.5.2003. In the claim intimation lettter given to the Insurer, the insured mentioned that he had already intimated about the incident to the police. The FIR was registered on 13.5.2003 and the FIR mentioned that the complaint was lodged by post and the date of theft was mentioned as 11.5.2003. The non-traceable certi f icate and the f inal investigation report issued by Magistrate also confirmed that the date of the accident was 11.5.2003.

The Insurer repudiated the claim on 7.2.2004 on the ground that the date of theft as intimated to them was diff ierent from the date of theft as recorded by the FIR/Magistrate’s f inding. By delayed FIR, the Insurer also pointed out that the chances of recovery have been prejudiced.

A joint hearin was conducted. The Investigator appointed by the Insurance Company confirmed that the theft took place only on 1.5.2003 night. At the t ime of granting cover, the vehicle was inspected by one of the off icials of the Insurer. Under the circumstances, the insurance cover was in existence whether the loss has happend on 1s t night as confirmed by the insured or on 11t h night as recorded by Policy. Hence direction was given to teh Insurer to settle the calim.


Shri. A. Surendra Reddy Vs.


Mr. Surendra Reddy insured his Hero Honda Motorcycle with The New India Assurance Company Limited for the period 19.9.2002 to 18.9.2003 for a sum insured of Rs. 30,100/-. It was reported that the vehicle was stolen on 1.10.2002 when the vehicle was parked near the Computer Education Centre where the insured’s brother was studying. FIR was lodged on 2.10.2002. The insured intimated about the claim to the Insurance Company on 7.10.2002 and gave the information l ike policy number, date of insurance, place of theft, the name of police stat ion where the matter was reported. The insured submitted the completed claim form along with non - traceable cert i f icate on 17.9.2003 i.e. nearly after 11 months from the date of issuance of the claim form. The Insurer appointed an investigator after 17.9.2003 who confirmed that no independent confirmation could be obtained by him as more than a year had lapsed from the date of occurence. The claim was rejected by the Insurer on the ground that the claim form was submitted to them after a lapse of 11 months from theft.

A joint hearing was conducted. The complaint mentioned that when he obtained the claim form from the Off ice, he was instructed to submit the documents l ike RC, DL, Non - traceable Certif icate, etc., After great diff iculty he informed that he obtained the NTC from the Police and hence there was a delay. The insured gave all the vehicle information in his original claim intimation letter dated 7.10.2002 itself. I t is a theft case and hence the investigator has to go to the police and verify their records and also wil l make discrete enquiries in the nearby area with the insured’s neighbours / fr iends etc., Such being the case, the Insurere have fai led in arranging for investigation immediately based on the claim intimation letter. Instead they decided to send the investigator only after receiving the completed claim form. The insured also produced the non - traceable certif icate. The Judicial Magistrate also issued the order to this effect. Hence, the Insurer repudiating the claim on the above ground was not tenable and direction was given to them to sett le the claim.


Shri. R. Vijayakumar Vs.

United India Insurance Co. Ltd. Award Dated 9.12.04 Tata 1210 SE Lorry - 1991 model belonging to Mr. R. Vijayakumar was insured with United India Insurance Company Limited, Neyveli Branch Office for the period 11.6.2001 to 10.6.2002 for a sum insured of Rs. 2,00,000/-. I t was reported that the vehicle was stolen on 23.1.2002. After proper investigation, the Insurer issued the voucher for Rs. 1,50,000/- on 8.9.2004. Aggrieved by the decision of the Insurer, the insured approached this Forum on 30.9.2004 with a request to consider his claim for Rs. 2,00,000/-. The subject policy was issued on 11.6.2001 and the policy condit ion as applicable on that day (as per old tariff provision) was analysed. Three different surveyors, appointed by the Insurers, f ixed the market value of the stolen vehicle between Rs. 1,30,000/- to Rs. 1,50,000/-. The market value assessed by the surveyors were not supported by any documentary evidence. It was f ixed on ad - hoc basis. Based on the surveyors report, the Insurer released the loss voucher for Rs. 1,50,000/- and the same was not accepted by the insured / f inancier.

During the t ime of hearing, this Forum has shown to the Insurer about the chart indicating market value published by Surveyors Association and another chart issued by Automobile Engineers by one of the Subsidiaries of General Insurance Corporation of India at the relevant t ime. The Insurers were asked to re - look into the matter. But however the Insurers decided to stick on to their decision of restrict ing their l iabil ity at Rs. 1,50,000/-.

Based on the valuation chart, it was decided to f ix the market value of the stolen vehicle at Rs. 1,70,000/-. The non - traceable certi f icate was produced by the insured on 23.12.2002. It was noticed that there was an inordinate delay in issuing the f inal offer letter to the insured by the Insurance Company. This Forum allowed a reasonable t ime of one month from 23.12.2002 for f inalising the matter. Hence, the award carries a simple interest of 8% from 23.1.2003 t i l l the date of payment.


MRs. Varalakshmi Baskar Vs.

Cholamandalam Ms General Insurance Co. Ltd. Award Dated 13.12.04

Smt. Varalakshmi Baskar insured her three wheeler delivery van for the period 22.9.2003 to 21.9.2004 for a sum insured of Rs.117913/- with Cholamandalam Ms General Insurance

Co. Ltd., Chennai. The vehicle met with an accident on 6.5.2004 when the vehicle hit a water tanker lorry. The driver of the insured van died on the spot and another passenger travell ing in the van also died. The claim was rejected by the Insurer on the ground that there was a permit violat ion as passengers were carried in the goods vehicle. The insured pleaded that the claim preferred before this Forum was only for the vehicle and not for the death of the driver and passenger. As the vehicle was not used for which it was intended, there is a clear case of violat ion of permit. Hence the case was dismissed.


Mr. S. Subramanian Vs.


Mr. Subramanian insured his private car - Premier Padmini - 1991 Fiat - for the period 15.12.2003 to 14.12.2004. The vehicle was insured for Rs. 25,000/-. It is reported that when the insured while returning home, the car dashed against a projecting stone damaging the chassis and the insured produced an estimate of repair for Rs. 9,860/-. The surveyors in his report mentioned that only the cross member was sl ightly dented and there was no damage to the chassis. Since the chassis had corroded, the corroded portion was found hanging and the surveyors also taken the photos to prove their contention. The Insurer rejected for the cost of repair / replacement for the chassis. The insured approached this Forum with a request to consider his claim for chassis. The reports of the surveyors are acceptable and reliable as the surveyors prepared the survey report after having made a thorough inspection of the damaged property. In the absence of any evidence to f ind fault with the surveyors report or pointing out any infirmity in the survey report, the insured contention could not be agreed and hence the complaint was dismissed.

Chennai Ombudsman Centre Case No. IO(CHN) 11.4.1334 / 2004.05

Mr. P. Pandian Vs. United India Insurance Co. Ltd.

Award Dated 9.2.05

Mr. Pandian had insured his tanker lorry with United India Insurance Company Limited for the period from 25.8.2001 to 24.8.2002 under Carriers Legal Liabil ity policy and the l imit of l iabil ity per event was Rs. 3.5 lakhs. The insured is a regular contractor of Indian Oil Corporation for carrying the petrol product. When the vehicle was carrying lube oil from Chennai to Kottayam met with an accident on 29.1.2002. The accident happened due to the negligence of the driver of the other vehicle, which hit the insured vehicle from behind and caused the accident. After obtaining a legal opinion, the Insurer rejected the claim on the ground that there was no negligence on the part of the driver who drove the vehicle at the t ime of accident. A joint hearing was conducted. A mere statement of insured’s driver to the effect that the accident is on account of negligence on the part of the other driver cannot be rel ied upon in total ity for the simple reason that it could be self serving to avoid criminal l iabil ity. As per FIR fi led both the vehicles were in running condit ion. In other words the insured vehicle is not a stat ioned one. As the insured’s driver f i led the FIR on the next day of accident, he blamed the other driver for the accident. The Insurer has not carried out any investigation. The mere statement of the insured’s driver before the police could not be rel ied upon in the absence of criminal case records, copies of charge sheet f i led, penalty, etc., On the other hand, this Forum accessed the records of The Oriental Insurance Company Limited, Vijayawada, who have covered the other vehicle involved in the accident. The Oriental

Insurance Company Limited sett led the own damage claim of the vehicle. In the claim form submitted to the Insurer, the driver of the vehicle mentioned that at the accident spot, the foregoing truck stopped suddenly without any caution and inspite of the break applied, his vehicle dashed the foregoing truck. Hence, the contributory negligence on the part of the insured’s driver cannot be brushed aside. Hence, direction was given to the Insurer to process and sett le the claim under CLL policy according to the assessment made by the surveyor.

Chennai Ombudsman Centre Case No. IO(CHN) 11.5.1347 / 2004.05

Mrs. Sakunthala Vs.

The Oriental Insurance Co. Ltd. Award Dated 23.2.05

MRs. Sakunthala insured her private car - Tata Indica make - 2000 model with The Oriental Insurance Company Limited for the period 28.8.2003 to 27.8.2004 for Rs. 2 lakhs. The vehicle met with an accident on 14.8.2004. At the t ime the Insurance Company verif ied the vehicular records, i t was noticed that as per registration certif icate, the vehicle was converted as a T.Taxi with effect from 1.7.2004. Since the policy covers only the private car, the Insurer rejected the claim.

A joint hearing was conducted. When the car was parked in front of the insured’s premises at early morning hours, an unknown lorry hit and damaged the car. The accident was reported to the police.

This Forum pointed out that there was a provision to sett le certain claims on comproimse basis due to reasons l ike breach of policy condit ions, warranties, non - compliance of tariff provisions, charging of incorrect premium on account of either misrepresentation or mis - declaration or non - disclousre by the insured. In the instant case, the accident is said to have happened at the t ime when the vehicle was parked. The surveyor also mentioned that the damage found in the vehicle at the t ime of inspection are relevant to the cause and nature of accident. The police also confirmed that they have issued the certif icate after visit ing the place and enquiring with the witness. Hence it is reasonable to believe that the accident happened to the parked vehicle. The registration classif ication of the vehicle would be more relevant i f accident took place while the vehicle was on move. Hence, direction was given to the Insurer to sett le the claim at 50% of the net loss assessed by the surveyor and the necessary addit ional premium for converting the vehicle from private car to tourist taxi from the insured.

Chennai Ombudsman Centre Case No. IO (CHN) 11.4.1383 / 2004 - 05

MRs. Govindammal Vs.


Mr. Vedapuri insured his Hero Honda Motor cycle comprehensively with United India Insurance Company Limited for the period from 3.12.2002 to 2.12.2003 for a sum insured of Rs. 40,000/-. When he was driving the vehicle, the vehicle sl ipped due to pumpkin placed on the road. The insured died subsequently. Wife of the deceasd approached the Insurance Company for the compulsory persona accident cover of Rs. 1 lakh. The Insurer refused to pay thecompensation because of the reason that they have not collected an addit ional premium of Rs. 50/- to cover the risk.

A joint hearing was conducted. The main question involved in this case is whether the Insurer are bound to compensate the PA coverage of Rs. 1 lakh in the absence of the

collection of the addit ional premium of Rs. 50/-. The Insurer argued that the PA cover for the owner - cum - driver was neither sought nor granted. When the PA cover for the owner - cum - driver is mandatory, the plea of the Insurer that the insured has not sought the cover is meaningless. Further there was no column in the proposal form to el icit the information relating to the PA cover for the owner - cum - driver. The probable reason for the same not having been printed in the proposal form may be due to the fact that the said cover is compulsory and not optional. it is reasonable to believe that the Insurers are collecting the premium without applying the exact calculat ion like the statutory provision of PA cover to owner - cum - driver, etc., and after collecting an ad - hoc premium, the policies are issued after adjusting with the actual premium received. If the accident had not happened due to other’s negligence, natuarl ly the victims wil l have no recourse available to them before any legal forum. To meet such contingencies, this Forum feels that this kind of statutory provision was given to the owner - cum - driver. When the Insurer has not collected the addit ional premium of Rs. 50/- which they are supposed to collect, i t is not only leaving the public in a lurch in such a situation - but also against the tariff provision. There was no justif ication on the part of the Insurer in denying the compensation and the Insurer were directed to process the claim.

Delhi Ombudsman Centre Case No. GI / 231 / NIA / 04 Shri. Yudhvir Singh Saini

Vs. New India Assurance Co. Ltd.


The dispute was regarding allowing replacement of the engine assemble out of accident to the Insured vehicle. The Insurance Company was wil l ing to pay the claim on repair basis, without al lowing replacement of engine assembly because it was not damaged in any way as a result of the accident.

The surveyor inspected the damaged vehicle in the authorized workshop and the engine assembly was not opened. Neither the complainant nor the authorized workshop had insisted on the engine assembly being replaced. This was apparently because the engine assembly had not suffered any damage on account of the accident. If the complainant had any reason to think that the engine assembly had been damaged as a result of the accident then he should have opened the engine assembly at the t ime of the survey and should have shown to the surveyor. He did not do so. The engine assembly was opened only a few months later and that too in the absence of the surveyor of the Insurance Company and then it was made out that it had suffered damage on account of the accident. However, the surveyor opened that the engine assembly had not suffered any damage on account of the accident. The damage, if any, to engine assembly was not the result of accident but due to neglect in that matter of t imely servicing of the vehicle.

The stand of the Insurance Company was upheld.

Delhi Ombudsman Centre Case No. GI / 240 / NIA / 04

Shri. Vijay Singh Vs.


The complaint related to claim towards theft of the vehicle. The claim was unnecessary delayed for payment. The claim should have been sett led on total loss basis, as soon as untrace report was available.

Further the Insurance Company was offering Rs. 3,45,211/- as claim sett led amount (total loss) whereas, the IDV of the insured vehicle was f ixed at Rs. 3,52,000/-. The valuation report of the surveyor had observed that IDV was sl ightly on the higher side. However, the surveyor had not precisely stated what was wrong with the IDV and why it was not correct. The company also had no answer to that.

It was held that the Insurance Company is not justif ied in reducing the IDV at this stage. Once the IDV is determined, it remains constant throughout the policy period. It is not the case of the Insurance Company that the error in calculat ing the IDV was in any way induced by the complainant. The Insurance Company must compensate to the extent of the IDV (less compulsory deduction as per the policy).

Delhi Ombudsman Centre Case No. GI / 276 / NIA / 04

Shri. Subhash Chander Jain Vs.

New India Assurance Co. Ltd. Award Dated 09.11.2004 The complaint relates to a claim in respect of damage to the vehicle (good carrying commercial vehicle), caused by an accident. The accident was basically a f ire accident. The cotton bales with vehicle the truck had been overloaded came into contact with high tension wires above and caught f ire. The result f ire damaged the vehicle also. The claim of the complainant was repudiated by the Insurance Company mainly on the ground that the truck was over loaded with cotton bales; the loading was not within permissible l imit. This was an act of negligence on the part of the insured. The stand of the Insurance Company was endorsed. The Insurance Company is not l iable to pay any loss caused by clear negligence on the part of the complainant.

Delhi Ombudsman Centre Case No. GI / 323 / UII / 04

Shri. Piyush Gupta Vs.

United India Ins. Co. Ltd. Award Dated 17.12.2004 The Insurance Company has repudiated the claim of the complainant, on the ground that the damages to the insured car were normal wear and tear and the complaint’s car had not met with an accident. After verifying the survey report and photographs of the car Hon’ble Ombudsman held that damage are not caused by a road accident. The complaint was dismissed.

Guwahati Ombudsman Centre Case No. NL / NIA / 14 / 121 / 03.04 / GHY

Shri. Birendra Ch. Nath Vs.

New India Assurance Co. Ltd. Award Dated 23.11.2004 1. It is al leged that on 16.03.03 a bus met with an accident due to bomb blast. 6 persons

including the driver died on spot and the bus was entirely damaged. Soon thereafter claim was lodged. The Insurance Company / opposite party fai led to sett le the claim ti l l date of the complaint etc.

2. Without disputing the incident and genuineness of the claim, the opposite party has contended that for non - submission of necessary documents by the claimant the claim could not be sett led in t ime.

3. Opposite party admits that it had fai led to prove driving l icence in question as fake in spite of appointment of surveyor. If records are not available at Maniput D.T.O. the blame cannot be trusted upon the complainant. The driving l icence appears to have been issued on 20.02.80 and continued to be in force t i l l the date of accident.

DECISION

4. The opposite party be directed to sett le the claim within next f if teen days, if possible, or latest by next thirty days from the date of receiving copy of the award either by paying the ful l sum assured, i.e.Rs. 2,50,000/- or the sum assessed by the surveyor if and when it is reasonable and acceptable to the complainant. On the payment of such sum the vehicle wil l go to the opposite party by adjusting the salvage value, if any. The claimant wil l also be entit led to claim interest on the sum awarded @ 6% simple interest p.a. from 28.05.03.

Guwahati Ombudsman Centre Case No. NL / UII / 13 / 14 / 04.05 / GHY

Shri. Chandra Bahadur Bhattarai Vs.


1. Contention of the complainant is that his vehicle met with an accident on 20.3.04. That the complainant could learn while the surveyor visited him that there is an excess of Rs. 20,000/- that has been imposed on him which would mean that he would be deprived of a sum of Rs. 20,000/- from his claim.

2. Contention of the opposite party is that the Branch Manager imposed excess of Rs. 20,000/- whi le the insurance cover was renewed on 26.02.04 and it was done with the consent of the insured.

3. There is no dispute about the imposit ion of excess Rs. 20,000/- as contended by the claimant. There is no document to show that there was any consent. There is no document either to ascertain the age of the vehicle and accordingly the contentions of the opposite party is unjustif ied.

DECISION

4. The imposit ion of excess of Rs. 20,000/- in this case is to be treated as null and void. The claim wil l be sett led, i f not already done treating IDV of the vehicle concerned at Rs. 4,92,000/-

Guwahati Ombudsman Centre Case No. NL / OIC / 11 / 03 / 04.05 / GHY

Shri. Babulal Agarwalla Vs.


1. The complainant stated that his vehicle registered as private car was stolen on 09.11.02. He preferred his claim before the insurer which was sett led at Rs. 3,75,000/- although the vehicle was insured for Rs. 4,20,000/- and was only 5 months old at the t ime of theft.

2. The contention of the insurer is that they sett led the claim at Rs. 3,75,000/- after obtaining valuation report from Mr. A. Sarma, a category ‘A’ surveyor.

3. The issue to be sett led is whether the sum of Rs. 45,000/- deducted from the sum assured has any justif ication.

4. From copy of the ‘Private Car (B) Policy (India)’ i t is seen that percentage of depreciation for car upto 6 months is NIL which condit ion is applicable undisputedly in this case the vehicle being stolen within 4 months 29 days of purchase. Relevant extract of the survey report of Mr. A.Sarmagoes as fol lows : -

“Considering the model of the vehicle and the date of

loss i.e., the vehicle is only 4 months 29 days old only

& the uses & maintenance of the vehicle can be taken

in order, hence, the market value of the vehicle can be

taken Rs. 3,75,000.00 (Rupees three lac seventy f ive

thousand) only”.

Thus no elaborate reasons were recorded to f ix the market value at Rs. 3,75,000/-. The opposite party could not substantiate the ground for which the deduction of Rs. 45,000/- was made.

AWARD

5. It is hereby directed that the opposite party wil l pay the balance amount of Rs. 45,000/- to the complainant along with 6% simple interest p.a. w.e.f. 01.01.2004 t i l l the said sum is paid.

Guwahati Ombudsman Centre Case No. 11 / 003 / 0038 Smt. Morami Talukdar

Vs. National Insurance Co. Ltd.


FACTS

1. Complainant’s vehicle, bearing reistration No.AS 01 / H 5421, met with an accident on 10.01.03. The claim preferred was repudiated and hence this complaint.

2. Contention of the Insurance Company (National Insurance Co. Ltd.) is that the claim had to be repudiated on the grounds -

i) that vehicle was driven with abnormal high speed,

i i) that vehicle was driven negligently and carelessly,

i i i ) that vehicle was carrying seventy (70) passengers which was more than permissible l imit of 46 etc.

3. The relevant policy also has not been forwarded to this authority by the insurer in order to substantiate its stand that it has any power / authority to repudiate the claim for carrying passengers more than the permitted numbeRs. The fact of over loading is confl ict ing, because MVI of ASTC bus denied such fact and stated that accident was due to ‘steering fai lure’. There is no good ground to justify repudiation of the claim in question.

DECISIONS

4. Direction given to sett le the claim on non - standard basis al lowing upto 75% of the claim amount less deduction of premium as per GIC guidelines with interests depending upon the extent of violat ion of policy condit ion, i f any, provided there is substantial proof of such violat ion.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / NIC / 02 / 2004.05

Shri. Praveen Kumar Vs.


The complaint under Rule 12 (1) (b) read with Rule 13 of the RPG Rules, 1998, arose out of partial repudiation of a motor claim by the insurer.

A personal hearing of the parties was conducted on 06.10.2004 and the Insurance Ombudsman was able to mediate the dispute between the insurer and the complainant in relation to the quantum of the claim. Originally, the insurer had offered to setle the claim at Rs. 30,750/-. On successful mediation on the issue, the claim was decided to be sett led for a total of Rs. 40,000/- which was agreed upon by the complainant as well as the insurer. The complaint was, therefore, amicably sett led between the parties.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / UIIC / 08 / 2004.05

Smt. Susanna Vs.


The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998 was against repudiation of a motor claim preferred by the complainant by the insurer on the plea that after purchase of the Motor vehicle KL 7 Y 5077, the complainant had not changed the insurance certi f icate to her name within 14 days from the date of transfer of ownership as required under the MV Act. In the meantime, before transfer of the insurance certif icate, the vehicle met with an accident and the complainant had spent Rs. 13,944/- for the repaiRs. When the insurer was informed of the accident, they had promptly deputed a surveyor and the complainant was under the impression that the claim would be honoured by the insurer. Neither the insurer, when the claim was intimated, nor the surveyor, when he visited for the survey informed the complainant about the requirement of changing the insurance certi f icate immediately and the complainant was ignorant of it. I f the Insurance Company had not depuited a surveyor and thereby given a false hope of sett lement, the complainant states that she would have got the vehicle repaired at a cheqper rate elsewhere. The Insurance Ombudsman also found it logically true that the insurer had originally given a hope to the party and a Surveyor was also deputed. The surveyor had assessed the net payable repair charges at Rs. 2491/- only and therefore, the insurer was asked to pay it in ful l and f inal sett lement of the claim.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / NIC / 110 / 2003 - 04

Shri. K.J.George Vs.

National Insurance Co. Ltd. Award Dated 15.10.2004 The complaint before the Insurance Ombudsman arose against the partial repudiation of the Motor claim preferred by the complainant before the Insurer. The insured was the owner of a Toyota Qualis Private car with Registration No.KL 5L 7956. It was under insurance from the respondent. The vehicle met with an accident 10.04.2003. A claim preferred and the respondent had sett led the claim only for Rs. 1,07,746/- as a claim for taxi vehicle. The complainant prays to reopen the case and for awarding the balance amounts as compensation. The insurer contented that the proposal submitted for renewal did not contain any information as to the class of vehicle and the claim was sett led as per the assessment of their surveyoRs. Since the premium collected was less by Rs. 6048/- they had collected the same. After the accident only they had converted the class of the vehicle as Private Car. The compensation allowed is reasonable and adequate.

Taking into account the records available in the f i les and also the contentions of the parties, the Ombudsman held that the Insurer had not gone through the certif icate of registration of the vehicle. It was a mistake on the part of the Insurer to issue the policy for Commercial Vehicle instead of Private Car. The lapse on the part of the Insurer in not scrutinizing the material documents before issuing a policy is not as that l ight as that one on the part of the complainant. the Insurer had collected the difference of premium for the period 15.02.2003 to 14.02.2004 and the date of accident being 27.07.2003, the complainant is eligible for the legit imate repair charges of a Private Vehicle. As such the complainant is entit led for a further amount of Rs. 23585 / 80. By partially admitt ing the complaint, the respondent is directed to pay the amount of Rs. 23585 / 80 within 30 days from the date of receipt of the order. The complaint is thus disposed of on merits as aforesaid.


Shri. P. Sreekumar Vs.

National Insurance Co. Ltd. Award Dated 20.10.2004 The complaint before the Insurance Ombudsman arose against the repudiation of the Motor claim preferred by the complainant before the Insurer. The insured was the owner of a car with Registration No. KL 8R 9142. It was under insurance from the respondent. The vehicle met with an accident 10.04.2003. A claim was preferred and the respondent rejected the claim onthe grounds that the vehicle was not having f itness cert if icate at the t ime of accident. As such the vehicle was plying in contravention of the M.V.Act. The complainant prays to reopen the case and to award Rs. 55,000/- as compensation. The insurer contented that they are not l iable as the vehicle was in use without any valid f itness cert if icate. Moreover the vehicle was not on personal use; but running as a contract carriage, which again is in violat ion of the conditions of the policy. Rejection of the claim on these grounds is in order. Taking into account the records available in the f i les and also the contentions of the parties, the Ombudsman held that the Insured has violated the provisions of the M.V.Act and the repudiation was in order and does not warrant interference by this Authority. Being devoid of merits, this complaint is dismissed.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 14 / OIC / 124 / 2003 - 04

Shri. P. Reghunathan Vs. Oriental Insurance Co. Ltd.


The complaint before the Insurance Ombudsman arose against the partial repudiation of the Motor claim preferred by the complainant before the Insurer. The insured was the owner of a Maruthi Zen LX Private car with Registrarion No.KL 11J 570. It was under insurance from the respondent. The vehicle was stolen and his claim for Rs. 2,80,000/- considered by the respondent for Rs. 1,90,000/-. The Insured was not agreeable for that amount. His appeal to the Grievance Cell was also turned down upholding the decision of Divisional Office. The complainant prays to reopen the case and for awarding the balance amounts as compensation. The insurer contented that they are ready to honour the claim for Rs. 1,90,000/-. The quantum of the compensation was arrived at on the basis of the surveyor’s report. The amount payable was adequate and reasonable in view of the model of the car. The decision does not merit any modif ication. Taking into account the records available inthe f i les and also the contentions of the parties, the Ombudsman held that the Insurer had acted according to the market value as assessed

by their surveyor. They did not considered the condit ion of the car as on the date of theft. Part ially admitt ing the complaint this Authority directs the Insurer to pay Rs. 2,00,000/- as compensation. As such the complainant is entit led for a further amount of Rs. 10,000/- in addit ion to the amount already agreed to pay by the respondent. The complaint is thus disposed of on merits as aforesaid.


Dr. Tessy Sabitha Vs.


Dr. Tessy Sabitha has f i led this complaint challenging the decision of the Insurer to repudiate her claim under Motor Insurance Policy partial ly. The complainant was the owner of Motor Vehicle with Reg.No.KL-7U-3750. The vehicle was insured with National Insurance Co. under Policy No.570105 / 31 / 03 / 6203739. The vehicle met with an accident on 08.10.2003. A claim was preferred with the Insurer, but the respondent did not honour it in ful l, but for Rs. 700/- only. Aggrieved by the decision of the Insurer the complainant approached this authority praying an award of Rs. 572/-.

The Insurer argued that they had offered a sum of Rs. 700/- as repair charges as per the report of the surveyor. The amount quoted by the workshop people was an exorbitant one. The amount as recommended by the surveyor is reasonable and adequate. The partial rejection of the claim by the respondent is in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that though the complainant had incurred Rs. 1466.55 as repair charges, she is el igible for Rs. 760/- only towards repair charges and service tax. The Insurer having paid a sum of Rs. 700/- the complainant is el igible for the balance amount of Rs. 60/- / .

In the above premises the complaint is disposed of as above.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 14 / UIIC / 135 / 2004 - 05

Shri. V.G.Pradeep Vs.


Shri. V.G.Pradeep has f i led this complaint against the respondent for the inordinate delay in taking a decision on his claim for reimbursement of repair charges of his vehicle. He was the owner of the vehicle Tempo(Trax) with Registration No. KL - 11B - 4017. The vehicle met with an accident on 07.01.2001. He preferred a claim with the Insurer and the resondent as “No Claim” rejected the same. The complainant approached this forum for redressal of his grievances.

The Insurer argued that at no point of t ime the complainant had co - operated with the Insurer for an early disposal of the claim. He had not submitted the essential requirements such as R C Book of the vehicle, Driver’s l icence etc. in spite of repeated remindeRs. Natural ly, the Insurer rejected the claim treating it as “No Claim”. The decision to reject the claim on the presumption that the complaiant is not interested to pursue the matter further was in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the respondent had no other alternative but to reject the claim as the complainant had fai led to comply with the requirements as called for by the respondent. This Authority f inds no justif iable grounds to interfere in the highly justif ied decision of the respondent.

Being devoid of merits, this complaint is dismissed.


Shri. P.P.George Vs.


The complaint before the Insurance Ombudsman arose against the repudiation of the Motor claim preferred by the complainant before the Insurer. The insured was the owner of a Maruti Omni - 5 with Registration No.KL - 07.AM - 6835. It was under insurance from the respondent. The vehicle met with an accident 06.06.2003 causing extensive damage to the vehicle. He preferred a claim of repair charges, but the respondent declined it for the reason that the vehicle being driven by Mr. Benny Jacob who was not having an effective driving l icence to drive a Motor Cab and not by the driver intimated by the complainant. The complainant contents that Mr. Benny Jacob had the right to drive the vehicle in question. The decision of the respondent to reject his claim is i l legal and unjust. He prays to reopen the case and award the repair charges of Rs. 28947/- as compensation. The insurer contented that as per the investigation report the driver of the car at the t ime of accident was Mr. Benny Jacob who was not having effective driving l icence to drive a Motor Cab. He was authorized to drive L M Vehicles only. As per the Rule 3 of the Central Motor Vehicle Rules 1989 the driver should have an effective driving l icence at the t ime of the accident. The decision of the Insurer in rejecting the claim as he had violated this Rules, is in order.

Taking into account the records available in the f i les and also the contentions of the parties, the Ombudsman held that Mr. Benny Jacob, the son - in - law of the complainant was driving the vehicle at the t ime of accident. Of course, he was not having an effective driving l icence at that point of t ime. The complainant had contributed for the negligence by authorizing his son - in - law to drive the vehicle, though it can be argued that the tr ip was a personal one. The complainant is not entit led to benefit of the insurance coverage due to the ngeligence on his part. No infirmity or i l legality could be found in the decision of the respondent. Upholding the orders of repudiation this Authority dismisses this case.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / NIA / 06 / 2004 - 05

Ms. Babin Shadia M. Basheer Vs.


The complainant before the Insurance Ombudsman arose against the repudiation of the Motor claim preferred by the complainant before the Insurer. The insured was the owner of an Open Corsa Private car with Registration No. KL - 01.AB - 6334. It was under insurance from the respondent. The vehicle met with an accident 19.08.2003 cause extensive damage to the vehicle and minor injuries to the passengeRs. The car was transported to M/s. Anjaneya Motor Service, Sasthamangalam at a cost of Rs. 5,000/-. The repair of the car was completed on 17.10.2003. He preferred a claim of repair charges, but the respondent

declined it. The complainant prays to reopen the case and for awarding Rs. 2,69,223/- as compensation. The insurer contented that as per the investigation repor the driver of the car at the t ime of accident was Mr. Rasool Pookkutty, whereas the driver’s name as per the claim form as well as GD report was Mr. Saifudeen. The delay in taking a decision was due to this irregularity and the resultant confusion. As Mr. Rasool Pookkutty was not having a valid l icence, the rejection of the claim by the respondent was in order. Taking into account the records available inthe f i les and also the contentions of the parties, the Ombudsman held that Mr. Saifudeen who is having a valid l icence at the t ime of accident was driving the vehicle. The only bone of contention was the identity of the driver at the t ime of accident. Though the complainant had claimed Rs. 2,69,223/- as compensation, she is eligible for Rs. 1,54,318/- being the actual cost of repairs together with an interest at 6% from 18.10.2003 when the car was ready after repair. By admitt ing the complainant, the respondent is directed to pay the amount of Rs. 1,54,318/- with interest at 6% from 18.10.2003 t i l l the date of payment. The complaint is thus disposed of on merits as aforesaid.


Shri. T.K.Antony Vs.


Shri. T.K.Antony has f i led this complaint challenging the decision of the Respondent to repudiate his claim for compensation under his Motor Policy. The complainant has transferred the vehicle in the name of his wife Smt. Elizabeth on 16.04.2003, but the Insurance Policy could not be transferred on t ime due to delay in gett ing back the R C Book after transfer of ownership. The vehicle met with an accident on 08.05.2003. The respondent rejected his claim for repair charges for the reason that at the t ime accident the complainant had no insurable interest on the vehicle. Ms. Elizabeth did not have a policy on her name on the date of accident. Aggrieved by the decision of the respondent he had approached this Authority to reopen the case.

The Insurer contented that the complainant ceases to have any insurable interest on the vehicle once the ownership is transferred in his wife’s name. Ms. Elizabeth was not having a policy in her name. Being devoid of merits, the claim was rejected.

On the date of hearing, both the parties agreed to have a sett lement before the actual hearing is commenced. In the presence of this Authority both the parties agreed to have the case closed for a compensation of Rs. 3,700/- in ful l and f inal sett lement of the claim. The complainant is thus disposed of as aforesaid.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / 003 / 017 / 2004 - 05

Shri. E.K.Abdul Azeez Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 was in consequence of partial repudiation of claim by the Insurer. The complainant was the owner of a tourist bus with Registration No.KL 10Q 1213. It was insured with the Respondent company for Rs. 7,85,000/-. The vehicle was completely burnt by a f ire on 05.09.2003. The

Insurer had offered a sum of Rs. 5,25,000/- as compensation on Repair basis. The complainant insists to sett le the claim on Constructive Total Loss basis as according to him the vehicle could not be plied after the repair as tourist purposes.

The Insurer contented that as per the policy condit ions the case can be considered on Constructive Total Loss basis, only if the repair charges exceed 75% of IDV. Here the repair charges as assessed by their surveyor comes to Rs. 5,02,534/- only which much lower than the 75% of IDV of Rs. 7,85,000/-. The Insurer was ready to indemnify the complainant as per the terms and condit ions of the policy.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the vehicle was being used for tourist purposes. The complainant contention that even after repair, the condit ion of the vehicle may not be road worthy in view of the tr ips he has to undertake, is acceptable. The repair charges as assessed by M/s. TVS Ltd. authorised dealers and repairers of Ashok Leyland vehicles - though on a higher side, cannot be ignored. They have quoted Rs. 7,37,449/- as repair charges. Allowing a 10% discount, the repair charges wil l come around Rs. 6,64,000/- which is more than 75% if IDV. The depreciation for the purpose of Constructive Total Loss claims would be 15% of the IDV for the vehicles of age less than one year. As such the complainant is el igible for Rs. 6,67,250/- as compensation. The Insurer is directed to pay this amount subject to compulsory deductions as per policy condit ions. They are at l iberty to dispose off the salvage.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / UII / 21 / 2004 - 05

Shri. Dileep Thomas Vs.


Shri. Dileep Thomas has f i led this complaint challenging the decision of the Insurer to repudiate his Motor claim He was the owner of Motor Car, with Registration No. KL - 05.M - 696. The stereo set installed in his vehicle was stolen on the night of 09.1.2003. He preferred a claim for reimbursement of the stereo. The respondent rejected the claim on the ground that i t was not covered under the policy. Aggrieved by the decision of the respondent he has approached this authority for redressal of his grievances.

The Insurer argued that the stereo in question was an accessory to the car as the previous owner removed the built - in stereo at the t ime of sale. The complainant had instal led an imported stereo to his car. However, he had not intimated this fact to the Insurer. Being an accessory to the car, the same wil l be covered with appropriate addit ional premium only. As the complainant had fai led to do so, he is not el igible for reimbursement. The complaint is not sustainable. The decision to reject the claim was in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the respondent has acted only as per the policy condit ions. The complainant is not entit led to any compensation for theft of his stereo, as it was not covered under the policy. This Authority f inds no justif iable grounds to interfere in the decision of the respondent.


Kochi Ombudsman Centre Case No. IO / KCH / GI / 11 / UII / 24 / 2004 - 05

Shri. Dhananjai D Deo Vs.

United India Insurance Co. Ltd.


Shri. Dhananjai D Deo has f i led this complaint challenging the decision of the Respondent to repudiate his claim for compensation under his Motor Policy. His car involved in an accident during the validity period of insurance and he had incurred repair charges to the tune of Rs. 36,000/- But his claim for reimbursement was allowed by the respondent for Rs. 12,520/- only. The complainant declined to accept this amount and approached this Authority and prays to reopen the case and award the ful l amount spent for repair charges as compensation.

The Insurer contented that the damage to the vehicle was caused by various incidents during the period 19.05.2003 and 15.09.2003. The claim was sett led as recommended and agreed by the parties concerned for Rs. 12,520/- and the same was paid to the repairer on 09.12.2003. Taking into account the long - standing relationship with the complainant, the respondent had tr ied their level best to accommodate the complainant.

On the date of hearing, both the parties agreed to have a sett lement before the actual hearing is commenced. In the presence of this Authority both the parties agreed to have the case closed for a compensation of Rs. 10,000/- in full and f inal sett lement of the claim.

The complaint is thus disposed of as aforesaid.


Shri. N.P.Paily Vs.


Shri. N.P.Paily has f i led this complaint against the respondent for the inordinate delay in sett l ing his claim for reimbursement of repair charges of his vehicle. He was the owner of the vehicle with Registration No.KBF 4730. The vehicle met with an accident on 11.03.2003 and it had got repaired at an expense of Rs. 51,685/- only. The complainant approached this forum for redressal of his grievances.

The Insurer argued that as per the investigation of the surveyors, considering the nature of the accident, the Jack Assembly could not have been damaged. The insured had not given an opportunity to have a spot enquiry of the accident. During inspection it was found that the right hand side of the jack assembly foundation nuts and bolts were loosened and left hand side jack assembly was found in a dismantled condit ion. Though the accident had occurred on 11.03.2003, the insurer was informed of the same only on 18.03.2003. No satisfactory explanation could be offered for removing the vehicle to the workshop before giving due intimation to the Insurer. Putt ing all these factors together, a foul play is suspected. The decision to reject the claim on the presumption that the complainant is not interested to pursue the matter further was in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the respondent had acted on the basis of the reports of the surveyoRs. There is no reason to disbelieve the assessment of the surveyoRs. The compensation offered by the Insurer in consonance with the reports of the surveyors is adequate and reasonable. This Authority does not f ind any justif iable grounds to alter the highly justif ied decision of the respondent.


Kochi Ombudsman Centre Case No. IO / KCH / GI / 11.004.042 / 2004.05

Shri. K.B.Suresh Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 was in relation to the repudiation of a Motor Claim by the Respondent Insurer. The complainant’s Motor Bike bearing Registration No.KL - 04.3468 had accidentally hit against a coconut tree and sustained damage for which he claimed indemnity from the Insurer. The Insurer had allowed the claim for Rs. 1200/- only against his demanded claim of Rs. 1700/-. The Insurer had arranged for a survey of the damaged vehicle and the surveyor had given a green signal for the repairs including replacement of the T. Stem and Head l ight brackets of the vehicle. However, the repairs were found to have been done at the workshop owned by the complainant himself and on re - inspection of the vehicle after repairs, i t was noticed that the disputed parts viz. the T Stem and Headlight Brackets were not replaced although claimed for as replaced In the above circumstances, the complainant was not found to be straight forward in relation to the claim preferred and there was no reason to interfere with what was already done by the Insurer. The complaint was therefore dismissed.


Shri. K.K.Anwar Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 is as a result of repudiation of a motor claim by the Insurer in relation to vehicle No.KL 7 AQ - 1857 owned by the complainant and covered under Policy No.760401 / 31 / 02 / 05884 by the respondent Insurer. After submission of the claim papers, the Insurer was about to sett le the claim for Rs. 1,41,889/- when they came across a very valid f law. The driver’s name, at the t ime of accident, as per the claim form was Shri. Abhilash whereas in the police records it was Shri. Abdul Shameer. The complainant emphasized that he did not know anyone by name Shri. Abdul Shameer. The Investigator of the Insurer had collected information that at the material t ime of accident, the vehicle was being driven by the cleaner and the name of the driver was given to the police by the person who drove the vehicle. The complainant even went to the extent of saying that some error would have crept into the Police Records. It was also found that the complainant had produced before this Forum only a General Diary (Police) cert if icate instead of the usual G D Extract. issued by the Police. Although the complainant was given some more t ime to produce the G D Extract, he could not do it obviously for the reason that i t was not in his favour. On a perusal of the records and based on the oral testimony of the complainant as well as his advocate, it became clear that they had a lot more tom hide that to reveal. The case appeared to be very suspicious and in the absence of correct information as to that who was driving the vehicle at the t ime of accident, the Insurer’s inabil ity to process the claim was understandable. The complaint, being devoid of merits, was dismissed.


Smt. Rajinidevi Vs.


Smt. Rajinidevi has f i led this complaint challenging the decision of the Insurer to repudiate her Motor claim. She was the owner of Motor Car, with Registration No. K L - 04.E - 6690. The vehicle met with an accident on 17.08.2003. She had submitted the bil ls for Rs.75476/- towards repair charges. The Insurer rejected the claim for the reason that as at the t ime of

accident the claimant had no insurable interest on the vehicle. Her appeal to the grievance cell was of no use. Aggrieved by the decision of the respondent she has approached this authority for redressal of his grievances.

The Insurer argued that though she had purchased the car on 10.08.2003, the transfer of policy was effected from 19.08.2003 only. As such as on the date of accident i .e.17.08.2003 she had no insurable interest on the car. The complaint is not sustainable. The decision to reject the claim was in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that on the basis of the deeming provision as per Section 157 of Motor Vehicles Act, though the Insurance during the period from 10.08.2003 to 18.08.2003 was in the name of the previous owner, it is deemed to have been transferred in favour of the purchaser. In the circumstances, the order of repudiation is set aside. The insurer is directed to pay the actual repair charges as per the bil ls submitted, subject to compulsory deductions, if any, as per the policy condit ions.



Shri. K.K.Varghese Vs.


Shri.K.K.Varghese has f i led this complaint challenging the decision of the Insurer to repudiate the Motor claim. He was the owner of a motor cycle with Registration No. K L - 7J - 4038. The vehicle was stolen in the night of 19.11.1997. A complaint was lodged with the local police. He preferred a claim with the Insurer in 2002, after a lapse of 5 years from the date al leged theft. Though the case was a t ime barred one, the Insurer had arranged for investigation. Later the claim was rejected by the insurer for violat ion of policy condit ions i.e. fai lure to serve immediate notice to the insurer on loss. Besides, the complainant had no insurable interest as on the date of al leged theft as he had changed the ownership in the name of Shri. Saji Joseph i n February 1997. Aggrieved by the decision of the respondent, he has approached this authority for redressal of his grievances.

The Insurer argued that the Complainant had no insurable interest on the vehicle as on the date of loss. The claim was barred by l imitat ion and he had fai led to intimate the Insurer immediately after the loss of the vehicle. The intimation regarding the accident was given only in 2002, though the loss was in 1997. The decision to reject the claim was perfectly in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the respondent has acted only as per the policy condit ions. The Insurer in deprived of the privilege of conducting a detailed investigation of the case due this inordinate delay in giving intimation. The complainant is not entit led to any compensation for loss of his vehicle. This Authority f inds no justif iable grounds to interfere in the highly justif ied decision of the respondent.



Smt. Fousiya Mohammed Shaji Vs.

Oriental Insurance Co. Ltd.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 was in consequence of partial repudiation of the Motor claim by the Insurer in relation to Motor Car KL - 101.5183 allegedly stolen on 19.01.2002. The car was insured for Rs. 342450/- and the Insurer had sett led the claim for Rs. 254500/- based on the market value as assessed by two independent surveyoRs. The claimant, however, insisted on the insured amount as the claim. It was found from the records that the Insurer had deputed two independent and competent surveyors to f inalise the assessment. While on surveyor had given an estimation of Rs. 249000/- the other had assessed it at Rs. 260000/-. The Insurer had, therefore, gone by the average and sett led the claim at Rs. 254500/- , which was received by the complainant. On the whole there was nothing wrong inthe methodology of assessment and the complainant had also received the amount in ful l and f inal sett lement of the claim. In the aforesaid circumstances, the complaint being untenable, it was dismissed.


Shri. Albi Joseph Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 stems out of repudiation of the Motor claim by the respondent Insurer. The complainant had purchased a car from one Shri. Varghese Joseph on 08.08.2003. The car met with an accident on 24.08.2003. Since the ownership of the vehicle was not transferred in the insurance records, the Insurer refused to honour the claim.

On perusal of the records, it was found that the complainant had sought for change of ownership in the insurance records only on 10.09.2003, after the accident. As per GR 17 of the Indian Motor Tariff, the complainant should have applied for change of ownership in the insurance records within 14 days from the date of purchase of the vehicle. In the aforesaid circumstances, the complaint was found devoid of merits and the Insurer’s decision was up held.


Smt. R. Santhi Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 is due the repudiation of a motor claim by the Insurer for the reason that as on the date of accident, i .e. on 27.01.2004, the complainant had no insurable interest on the vehicle. The complainant had purchased the vehicle (KL - 01.U - 731) on 27.12.2003 whereas the Insurance records were transferred to her name only on 27.01.2004. She had no valid insurance contract with the company as on that date. As per G R 17 of the Indian Motor Tariff, the change of ownership had to be noted in the Insurance records within 14 days from the date of transfer. In this case although the vehicle was purchased on 27.12.2003, the transfer in the Insurance records was effected only on 29.01.2004, two days after the accident. The facts of the case as well as the Law being very clear, the Insurance

Company had rightly repudiated the claim. The complaint, being devoid of merits, was therefore dismissed.


Shri. B.Krishnakumar Vs.


Shri. B. Krishnakumar has f i led this complaint challenging the decision of the Insurer of repudiate the Motor claim. He was the owner of a motor cycle with Registration No. K L - 5H - 8633. The vehicle involved in two separate accidents, one on 13.09.2003 and the other on 07.10.2003. The Insurer rejected the f irst claim preferred by the original owner Shri. Davis George on the grounds that as per the RC book the vehicle is seen transferred to Shri. Krishnakumar on 17.08.2003. Similarly, when the claim for the second accident was preferred by the complainant it was rejected for the reason that the insurance was in the name of the original owner Shri. Davis George and the policy has not been transferred in the name of the complainant. Aggrieved by the decision of the respondent he has approached this authority for redressal of his grievances.

The Insurer argued that the Complainant had no insurable interest on the vehicle as on the dates of the accidents. The decision to reject the claim was perfectly in order.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the respondent has acted only as per the policy condit ions. The complainant had not complied with the formalit ies of gett ing transferred the policy in his name within the stipulated t ime l imit and so negating his claim for insurance benefits. he acted in a casual way in dealing with the matters and he had to pay for his laxity. The complainant is not entit led to any compensation for the accidents to his vehicle. This Authority f inds no justif iable grounds to interfere in the highly justif ied decision of the respondent.



Smt. Krishnamma Ravindranath Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 was in relation to the partial repudiation of the Motor claim by the Respondent Insurer. The complainant was the owner of a Motorcar with Registration No. KL 7 AF 596. The vehicle met with an accident on 20.08.2002 and sustained damage. Against her claim for Rs. 12535/- the Respondent had paid only Rs. 4100/-. The complainant refused to accept this amount and approached this Authority and prayed for reopening this case and awarding Rs. 14000/- as compensation.

The Insure argued that the intimation was received by them very late thereby negating their opportunity to have an on the spot enquiry on t ime. The complainant had not waited for their consent for gett ing the damaged parts replaced. The damaged parts could have been very well got repaired with an amount of Rs. 4100/- and they have already sanctioned that amount. The compensation allowed is adequate and reasonable and does not warrant any modif ication.

Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the compensation allowed by the respondent is just and reasonable. They had acted as per the assessment of the surveyor. The respondent Insurer is directed to pay the amount of Rs. 4100/- to the complainant in ful l and f inal sett lement of the claim.


Shri. K. Venugopalan Nair Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 is as a result of partial repudiation of a motor claim by the Insurer in relation to vehicle No.KL 14 C - 1820 (motor cycle) owned by the complainant and covered under Policy No.01 / 6209180 issued by the respondent insurer. The vehicle was stolen on 06.01.2003 and the Insurer at Rs. 28000/- f ixed the quantum of indemnif ication. The complainant claimed an addit ional amount of Rs. 1000/-. The dispute was compromised as between the parties at the instance of the Insurance Ombudsman and the Insurer agreed to pray an addit ional amount of Rs. 4000/- to the complainant in ful l and f inal sett lement of the claims. The compromise was duly recorded and thus the disupte was amicably resolved.


Shri. N. Narayanan Nair Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 is about partial repudiation of a Motor claim (vehicle No. K - 17.1475) preferred by the complainant before the Insurer. The dispute was basically due to application of depreciation components in relation to certain parts replaced. The complainant held one more dispute with the Insurer about the alleged overcharging of premium while renewing the policy in the subsequent year. The premium was found to be loaded under GR3B of Indian Motor Tariff due to adverse claims experience and the Insurer had done it according to the rules. The complaint was due to a wrong reading of the rules by the complainant and there was no substance in it . As for the partial repudiation of the claim too, the Insurer applied the depreciation factor properly. On the whole, the complaint had no force whatsoever and the complainant could not prove anything worth mentioning and hence it was dismissed.


Shri. M.K.Chandran Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 was in relation to an alleged excess collection of Motor Insurance premium by the Respondent Insurer. The complainant had adopted a methodology of his own to compute the premium based upon certain information furnished by some undisclosed sources and demanded refund of Rs. 323/- from the Insurer. However, going through the records and after hearing the Insurer, the posit ion had emerged in clear terms that there was no arbitrariness in what

the Insurer had done. It was due to a loading on third party insurance premium that the complainant had mistaken the issue. The Insurer had rightly computed the premium as per G R 3(B) of the Indian Motor Tariff and a loading of 100% became necessary in this case due to adverse claims experience. Since there was no substance in the complaint, this Forum had dismissed the complaint.


Shri. C.T.Titus Vs.

National Insurance Co. Ltd. Award Dated 03.12.2004 The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 was in relation to the partial repudiation of the Motor claim by the Respondent Insurer. The complainant was the owner of Maruti 800 car. The vehicle met with an accident on 07.11.2002 and sustained damage. Against his for Rs. 94864/- the Respondent had paid only Rs. 71000/-. His complaint is for the reopening the case and for awarding Rs. 12557/- together with interest. However, on going through the records and after hearing the Insurer, the posit ion had emerged in clear terms that there was no lapse on the part of the Insurer as they had acted only as per the provisions of the contract. The endeavor of the complainant to secure the total amount paid towards repair charges is out of place. The rate depreciation worked out by the Insurer is as per rules. Since there was no substance in the complaint, this Forum had dismissed the complaint.


Shri. A.K.Mohammed Azeem Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 centres around the repudiation of a Motor claim by the Respondent Insurer. The Motorcar bearing Regn.No.KL - 3G - 5680 of the complainant met with an accident on 23.07.2002 and he preferred a claim for Rs. 248638/-. The claim was repudiated by the Insurer cit ing mult ifarious inconsistencies in the claim papers, viz, (1) the car was insured as a Private Vehicle, whereas it was being used as a commercial vehicle on “Rent a Car basis” (2) the name of the driver who drove the car at the material t ime of a accident differed from the details furnished, (3) the driver Sri Eapen Babu was an NRI and had no valid driving l icence. The complainant was surprisingly enough absent for the hearing and the Insurance Company had f ielded certain very valid questions about the alleged accident, From the available papers, the version of the Insurer was found correct and their decision to repudiate the claim was also on solid grounds. The complaint was therefore dismissed.


Shri. V. Monivannan Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 the RPG Rules, 1998 resulted form the repudiation of a Motor claim by the Respondent Insurer. The Motorcar bearing Regn.No.KL - 01.5649 was originally in the name of the complainant who is a Senior Official of the United India Insurance Company and the vehicle was also under Hire

Purchase agreement with his employer. However, subsequently due to a change in the rules, the complainant was asked to transfer the ownership of the vehicle to the parent company although continued to use it for the off icial as well as personal purposes. Therefore, while the vehicle was transferred to the United India with effect from 01.03.2004, the Insurance sti l l remained in the name of the complainant himself. In the mean time, on 25.03.2004 the vehicle met with an accident i.e. while the transferee was the United India and the Insurance remained in the name of the complainant. As per G R 17 of the Indian Motor Tariff, the Insurance certif icate also should have been changed within 14 days from the date of transfer of the vehicle. Although both the parties are insurers themselves, they had not gone into the f iner aspects of the transcation. Having committed a technical f law, the claim was repudiated and this Forum upheld it . Being devoid of merits, the complaint stands dismissed.


Smt. Neena Gladstone Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules, 1998 arose as a consequence of repudiation of a Motor Claim (vehicle No.KL - 01.W - 6145.Pol.No.761401 / 31 / 03 / 11516) by the Insurer. The complainant had bought a Toyota Qualis Car from one Sumayya Beevi on 31.12.2003 after cancell ing the original Hire Purchase agreement with Kotak Mahindera and creating a fresh one with the HDFC Bank. The vehicle met with an accident, the complainant had not approached the insurer for changing the insurer to her name. The policy was, in fact, transferred to the complainant’s name only with effect from 30.4.2004 whereas the vehicle was transferred to her on 31.12.2003. As per GR 17 of the India Motor Tariff, the stand taken by the insurer was found correct. On transfer of ownership of a vehicle, the period prescribed for effecting change of ownership in insurance records is 14 days and having violated this provision, the Ombudsman found no il legality or infirmity of the decision taken by the insurer. The complaint was therefore Dismissed.


Shri. P.Manikandan Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules, 1998 is as a consequence of repudiation of a Motor claim by the insurer. The complainant had taken a Motor policy from the insurer for his autorikshaw KL - 10.3343 from the insurer and during the validity period of insurance the vehicle was reported stolen on 10.10.96. There were a number of doubts and suspicions in the case and the insurer could not sett le the claim. There was a sale agreement executed by the complainant and one Shri. Thajuddin on 1.7.95 transferring the rights on the vehicle to Shri. Thajuddin. On theft of the vehicle, i t was Shri. Thajuddin who had reported it to Police. As the insurance papers were in the name of Shri. Manikandan and the required clarif ications were not forth coming either form Shri. Manikandan or Shri. Thajuddin, the Insurance Company had fi led away the papers as “No claim”. It was in this context that Shri. Manikandan approached this Forum. From the correspondence produced by the insurance company it could be seen that the letter addressed to Shri. Manikandan were returned undelivered with Postal remarks as “No such person”. In al l probabil ity, i t was a benami transaction and the insurer contended that

probably there was no such person called Shri. Manikandan. It was observed from the papers that i t was a musky care and most probably the vehicle was involved in some clandestine activit ies and could have even been seized. In the circumstances, the insurer could not be found fault with and hence the complaint was dismissed.


Shri. M.P.Fernandes Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules, 1998 is in relation to rejection of the complainant’s request for cancellation of a Motor policy and refund of the proportionate premium thereof. The complainant had bought a second hand vehicle (KL 4 G 2100) in Apri l 2004 while there was a third party insurance existing in the name of the previous owner and tenable upto 7.3.2005. On 28.04.2004, the Respondent insurer transferred the insurance certi f icate in the name of the complainant after collecting the requisite fee of Rs. 50/-. On 4.5.2004, the respondent insurer received a letter from the complainant stat ing that he had taken a comprehensive insurance policy from another insurer and, therefore, wanted refund of the proportionate premium on the existing third party cover with the Respondent insurer. As per Rule 24 B of the Indian Motor Tariff, i f two policies are issued on the same vehicle, the later policy is to be cancelled and therefore the respondent insurer wrote to the complainant explaining the provision. It was in this context that he approached this Forum. On examination of the facts of the case, the respondent insurer’s plea was found correct as per Rule No.24 B of the Indian Motor Tariff and the complainant had only twisted the facts to suit his convenience. In the circumstances, the complaint having been found devoid of merits, was dismissed by this Forum.


Shri.V.M.Basheer Vs.


The complaint is against the order of repudiation of a claim for Rs. 26,169/- in respect of repair charges for his vehicle - Tata Indigo Car - Reg.No.KL8 Z 1607 covered by policy No.760300 / 31 / 02 / 04609 issued by the respondent company; the complaint fal ls under Rule 12(1)(b) read with Rule 13 of RPG Rules 1998.

The complainant had purchased the car from Ms.Aisha Badaruddin on 01.04.04 and had applied for transfer of the RC before the RTO, Ottappalam, on 18.4.2004 the car had accidentally hit against a scooter; the RC was returned only on 16.4.2004 and the complainant had approached the insurer for transfer of the insurance the same day. As per the complaint the transfer of the vehicle recorded in the RC is on 1.4.2004 and the RC was signed and sealed by the RTO on 15.4.2004. The complaint further reads that the complainant was made to learn that he had to apply for transfer of insurance within 15 days t ime from date of transfer recorded in the RC book.

Since the policy for the vehicle was in the name of Smt. Aisha Badarudheen who had no insurable interest over the vehicle as on the date of the accident and for want of transfer of policy in the name of the complainant / transferee t i l l the date of the alleged accident, the complainant is not entit led to realize the repair charges by way of compensation from the insurer. As rightly submitted on behalf of the insurer there was no privity of contract

between the complainant and the insurer as on the date of the accident. The order of repudiation by the insurer is free from any i l legailty or infirmity as such the said order is maintained.


Shri. C. Anilkumar Vs. Oriental Insurance Co. Ltd.

Award Dated 16.12.2004 The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules, 1998 is in relation to repudiation of a Motor claim (vehicle No.KL - 2.D - 2275.Policy No.2002 / 15780 for the period 17.1.2002 to 16.1.2003 for a sum insured of Rs. 4 lakhs) by the Respondent insurer M/s. Oriental Insurance Company Limited. The complainant was the owner of Ashok Leyland Lorry No.KL - 2.D / 2275 with National permit. I t is al leged that the, the vehicle was found missing at Kalamassery when the driver and later the cleaner had gone to euquire about the load to be taken to Kollam. The theft of the vehicle al leged occured between 2.15 p.m. and 2.30 p.m. on 6.11.2002. The vehicle was left unattended to by the complainant / his staff at Premier Junction, Kalamassery on 6.11.2002.between 2.15 p.m. and 2.30 p.m. with the ignit ion key and original RC etc. documents inside the vehicle itself. In other words, according to the insurer, the vehicle was left unguarded at or around the material point of t ime. The investigators deputed by the insurer could not establish the genuineness of the claim. At the personal hearing on 2.11.2004, the complainant was absent, but he was represented by his learned Counsel Shri. P.T.Dinesh. The respondent insurance company was represented by a duly authorized off icial. However, there was a dispute in relation to the alleged non - receipt of certain documents and, therefore, as agreed to by both the parties, suff icient t ime was given, and the complaint came up for a further hearing on 16.12.2004. During the hearing it was found that since the insurer has proved its case beyond all reasonable doubts, the repudiation of the complainants claim by the insurer invoking violat ion of condit ion Nos.5 & 8 of the policy is upheld by this Forum as Fair, proper and ful ly justif iable.


Ms. T.P.Rema Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 is in relation to partial repudiation of a motor claim (Mahindra Jeep KL 9 F 1881.period of insurance 24.3.2002 to 23.3.2003) by the respondent insurer. the vehicle was stolen on 12.5.2002 and the insurer had offered to sett le the claim at Rs. 1.5 lakhs whereas the Estimated value at the t ime of renewal of the policy on 24.3.2002 was Rs. 2.5 lakhs. It is said that the vehicle was well maintained by the complainant and according to him the market value of the vehicle at the t ime of theft would have been around Rs. 3 lakhs. The insurer had gone by the Surveyor’s assessment. However in the fact situation of the cse, it was impossible that the market value of the vehicle would have gone down by Rs. 1 lakh in just 50 days t ime (24.3.2002 to 12.5.2002). The complainant also insisted that the Estimated value for insurance was f ixed after examining the vehicle by the surveyors and therefore they could not raise a dispute on the market value at this stage. There was a lot of substance in the arguments of the complainant and it was clear that the surveyors had f ixed the loss at Rs. 1.5 lakhs arbitrari ly. Therefore, going by the circumstances of the case inclusive of the fact that the IEV was fixed by the insurer on 24.3.2002 after examination of the vehicle, it was decided that the market value of the vehicle at the t ime of theft would be

Rs. 2 lakhs and so the insurer was asked to pay Rs. 2 lakhs instead of Rs. 1.5 lakhs to the claimant in ful l and f inal sett lement of the claim.


Shri. V. K.Suneesh Vs.

United India Insurance Co. Ltd. Award Dated 04.01.2005 The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 was registered against the respondent insurer in relation to the repudiation of Motor Claim. The complainant Shri. V.K.Suneesh was the owner of a motor vehicle with Registration No.KL 11J 6642. The vehicle met with an accident causing heavy damage to the vehicle. The claim preferred by the complainant was rejected for some alleged technical reasons. Aggrieved by the decision of the Insurer, the complainant has approached this Forum. The Insurer contented that some of the bil ls produced by the complainant for claiming the compensation found to be false and doctored ones. The repudiation of the claim on the above grounds is correct and judiciously made. Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that some of the bil ls are proved to be false and the remaining bil ls are to be sett led along with the amount on which no disputes persist. Consequently the complainant is entit led for a sum of Rs. 35616/-. Therefore, the Insurer was directed to sett le the claim as per the estimation of the surveyors and the complaint is disposed off accordingly.


Shri. Abdul Rahiman Vs.

New India Assurance Co. Ltd. Award Dated 05.01.2005 The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules, 1998 was in relation to partial repudiation of the motor claim by the Respondent Insurer. The complainant was the owner of a Motor Cycle with Registration No.KL - 10H - 4849. The vehicle was stolen on 03.12.2002 at 7.30 p.m. from Rahmania Mosque Tirur. His claim for indemnif ication was turned down by the Insurer on the plea that at the t ime of the theft the Insured had no Insurable interest on the vehicle as the vehicle was already sold to one Mohammed Rafeek on 03.10.2002. Aggrieved by the decision of the Insurer, the complainant had approached this Authority for redressal of his grievances. Taking into consideration the contentions of the parties and the records available in the f i le, the Ombudsman ruled that the complainant had no insurable interest at the t ime of theft of the vehicle and the respondent had acted judiciously in repudiating the claim. The decision of the Insurer stands and being devoid of merits this complaint stands dismissed.


Dr. P.V.Anto Vs.

New India Assurance Co. Ltd. Award Dated 25.01.2005 The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 is as a result of repudiation of motor claim by the Insurer in relation to vehicle No.KL 7 AB - 2758 owned by the complainant and covered under Policy No.761101 / 31 / 03 / 01762 by the

respondent Insurer. The vehicle was stolen on 25.07.2003 and the matter was reported to the authorit ies concerned on t ime. The respondent had offered to sett le the claim for Rs. 140000/-. On his appeal to the Grievance Cell, the sett lement was proposed for Rs. 130000/- for the reason the vehicle was an obsolete model. Aggrieved by the decision of the respondent the complainant had approached this Authority for redressal of his grievances. Taking into consideration all the records available in the f i le and also the contentions of the parties concerned, the Ombudsman ruled that the report of the surveyor lacks transparency, as it was not having any date on it. The respondent had accepted the IDV of the vehicle as 2.01 lakhs on 24.06.2003 and within a short span of 30 days there is no logic to agree with the Insurer’s view that the market value of the vehicle is only Rs. 1.45 lakhs. The vehicle was an owner driven one and being maintained in perfectly good condit ion throughout, the vehicle would definitely fetch Rs. 170000/- as on the date of theft. Accordingly this Authority is incl ined to award Rs. 170000/- as compensation sett ing aside the decision of the Insurer part ial ly. Therefore, the Insurer was directed to sett le the claim as above and the complaint is disposed off as aforesaid.


Shri. S.Sudheeshkumar Vs.

National Insurance Co. Ltd. Award Dated 27.01.2005 The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 was in relation to an alleged excess collection of Motor Insurance premium by the Respondent Insurer. The complaint is in respect of premium loading under Policy Nos.570705 / 31 / 03 / 3708479 and 570705 / 31 / 03 / 67808480 for a 1965 model Ambassador car KLV 300 and a scooter with Regn.No.KL - 7E 1538. The complainant pleads that the respondent had collected Rs.460/- in excess and the insurer has refused to refund the same in spite of his demand at different levels. However, going through the records and after hearing the Insurer, the posit ion had emerged in clear terms that there was an excess collection of Rs. 460/- from the complainant. Sett ing side the orders of rejection this Authority directs the respondent to pay the said amount along with another sum of Rs. 500/- towards travell ing expenses incurred and Rs. 300/- towards the postages (Total 460+500+360=1260).


Shri. Md. Sheriff Vs.

New India Assurance Co. Ltd. Award Dated 10.02.2005 The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 is as a result of repudiation of a motor claim by the insurer for the reason that the vehicle was over loaded at the material t ime of accident. The only point of objection raised by the insurer was that while the seating capacity of the vehicle was 10 in al l , at the t ime of accident, there were 14 persons in the vehicle and that carrying excess passengers was against the prevail ing rules. However, i t was found from the records that 5 of the passengers were children including one infant. Most probably the accident would have been due to some human error although no omissions / commissions were attr ibuted to. The vehicle was surveyed and the surveyor had assessed the loss on Cash loss basis at Rs.70,000/-. However, considering the

element of contributory negligence on the part of the owner / driver, this Forum ordered a reduction of 10% on the amount recommended for by the surveyor and allowing the said amount the complaint was disposed off. The total repudiation of the claim by the insurer was set aside as the insurer’s case was weak and unsustainable.


Ms. Lissy Jeji Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 came up as a result of repudiation of a motor claim. The complainant is the registered owner of the Autorikshaw No.KL 7 Z 1812 and it was given on daily rental basis for Rs. 100/-. The vehicle was stolen on 5.5.2002 between 6 p.m. - 10 p.m. from Kaloor Jawaharlal Nehru Stadium and informed the police and the police had registered a crime No.240.02. The insurer’s view is that the complainant had sold the vehicle for Rs. 65,000/- on 27.12.2001 to one Mr. Jinu Chacko and Mr. Jinu Chacko had entrusted the vehicle to one Mr. Binu on a rental basis and the vehicle was stolen while it was in the custody of Mr. Binu and so the complainant had no insurable interest on the vehicle, so they repudiated the claim. The insurer also states that for want of privity of contract between Mr. Binu and the respondent co., Mr. Binu is not entit led to any benefits under the policy and that the deemed transfer envisaged under Sec.157 is applicable to third party l iabil i ty and not in respect of own damage claim. Relying on the records, i t is clear that the registration certi f icate as on the date of the theft of the vehicle was in the name of the complainant and the driver Mr. Binu had given the name of Ms. Lissy Jeji as the owner of the vehicle in the FI statement and so the insurer’s decision is untenable and this Forum directed the insurer to indemnify the loss of the complainant for the theft of the vehicle as per rules and regulations.


Ms. Daisy Idicheriya Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 arises from repudiation of a motor claim by the insurer. The complainant who owned a car had left i t before the old Casualty block of Trivandrum Medical College on 21.4.2003 and the car was found missing / lost somewhere between 12 hrs and 13.15 hrs of the day. A police complaint was lodged. However, the complainant had told the police that she had left the car unlocked and the ignit ion key was also inside the car. During the course of adjudication, she had denied having told the police that the ignit ion key was left inside the car and it was unlocked. However, the FIR, which contained the said information was lodged by the complainant her self. Besides, the theft of the car was intimated to the insurer only on 5.3.04 (date of theft 21.4.03). The complainant had violated the policy condit ions in not keeping the insured vehicle safe and secure as envisaged under cl.4 of the Motor policy and there was also no convincing explanation as to why the insurer was not informed of the theft upto 5.3.2004 although the theft took place on 21.4.03. Under these cicrumstances, there was no convincing case for the complainant and the insurer’s action in repudiating the claim was found just and proper. The complaint was dismissed accordingly.

Kochi Ombudsman Centre Case No. IO / KCH / GI / 11.005.133 / 11.005.134 / 2004 - 05

Shri. P.M.Paul & Shri. James Mathew Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 is resultant to the repudiation of a Motor claim by the insurer. A Maruthi Omni vehicle owned by the f irst complainant Shri. P.M.Paul was insured with the respondent insurer for the period from 1.2.2003 to 31.1.2004. There was an alleged accident to the vehicle on 24.6.2003 and the same was reported to the insurer by the RC owner on 27.6.2003. He also completed the claim form. When the original RC Book was called for by the insurer, it was observed that the class of vehicle was altered as Private service vehicle w.e.f. 7.1.2002 and the ownership was also transferred to the second complainant Shri. James Mathew w.e.f. 23.6.2003. The new owner had not revealed the changes to the insurer. In fact, the insurance policy was changed in the name of the new owner only from 6.10.2003 and the accident had occurred on 24.6.2003. In these circumstances, both the parties had no insurable interest on the vehicle on the date of accident. The complaints were f i led by both the old and new owners so that the claim could be sett led to either of them. Under a Package policy, the change of ownership is not automatic and the insurance formalit ies were not completed properly, i t was found that the action of the insurer in repudiating the claim was just and proper. Both the complaints were dealt with together and dismissed by this Forum.


Shri. Janardanan Nair Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 relates to repudiation of a Motor claim by the insurer. the complainant had taken out a Motor policy for his Maruti Zen Car for the period 28.9.2001 to 27.9.2002 for a sum insured of Rs. 2 lakhs. The vehicle was stolen from the house of one Shri. Ashraf on 14.2.2002 and as per the FIR, Shri. Ashraf had mentioned to the police that Shri. Janardanan Nair had sold the vehicle to one Shri. Nizam in January 2001 itself and Shri. Nizam had further sold it to him (Shri. Ashraf) in February 2001 for a consideration of Rs. 2,60,000/-. The Hire purchase agreement of Shri. Janardanan Nair also stood cancelled in January 2001 as the vehicle was sold in January 2001. In effect, Shri. Janardanan Nair had taken out the policy after he had sold the vehicle and on the date of theft none had any insurance interest thereon. Subsequently since the records were in the name of Shri. Janardanan Nair, he had executed a power of attorney in favour of Shri. Ashraf - the third owner in serial order. As there was no merit in the complaint, the action of the insurer in repudiating the claim was upheld by this Forum and the complaint was dismissed.


Shri. Shyam Sudheer Vs.


The complaint under Rule No.12(1)(b) read with Rule 13 of the RPG Rules 1998 arises due to partial repudiation of a Motor claim by the insurer. The complainant’s stage carrier bearing Reg.No.KL - 13.9378 had met with an accident and he claimed an amount of Rs. 1,17,511/- as indemnity from the insurer. The vehicle was 10 years old. The Surveyor of the insurer had estimated the net amount payable after depreciation of 50% at Rs. 47440/- without tax and the insurer had rounded off the amount to Rs. 47500/- and offered it to the complainant, which he refused to accept. The complainant’s estimate was rather far fetched and the workshop itself had come down on labor charges from Rs. 41000/- to Rs. 18700/- at the instance of the surveyor. Certain items were also to be disallowed as per policy condit ions in addit ion to the usual policy excess. The insurer had acted in the case with al l fairness and the estimate of the surveyor was also vary reasonable. 50% depreciation could not be escaped either as the vehicle was 10 years old. Having found the sett lement fair and reasonable, this Forum upheld the stand of the insurer and the amount of Rs. 47500/- already offered to the complainant was sustained in the award in ful l and f inal sett lement of the claim.

Kolkata Ombudsman Centre Case No. 203 / 2 / NL / 2003.2004

Shri. Triloki Nath Tiwari Vs.

The Oriental Insurance Co. Ltd. Award Dated 25.02.2005 Facts / Submissions : The Complainant had insured his Tata Sumo Vehicle under a Comprehensive Motor Policy. A claim arose due to theft of the vehicle. Despite investigation, the police could not recover the vehicle and f i led their f inal report. The insurance company also arranged investigation of the claim by two investigators and repudiated the claim given various reasons. The crux of their contention was use of the vehicle registered as private car for hire and reward at the material t ime. As per statement of the Insured, six unknown passengers were using the vehicle, when it went missing. The complainant contested the repudiation stat ing that the passengers were taken at the request of an influential person and use of the vehicle for such purpose was social, domestic, etc. and was covered as use for professional purpose. Held : The vehicle was registered and insured for private use only. The F.I.R. revealed that the unknown persons riding the vehicle had given intoxicating injection to the driver. The investigator appointed by the insurance company produced a letter from the complainant to the f inance company stat ing that the former’s source of income had stopped due to the theft of the vehicle. This indicated that the vehicle was used for hire and reward.

The policy condit ions specif ically excluded use of the vehicle for hire and reward and, given the facts and circumstances, it was held that the vehicle was not being used for the “purpose” which was covered by the policy. Accordingly, the repudiation was upheld.


Shri. P. K. Kantilal Kakkad Vs.

The New India Assurance Co. Ltd. Award Dated 28.03.2005 Facts / Submissions : An audio tape stereo system was stolen from the complainant’s maruti car while i t was parked. The incident was reported to the nearest police stat ion and a claim was f i led with the insurance company under Private Car Package Policy. However, the latter repudiated the claim on the ground of fai lure to lodge an F.I.R. and f inal Police Investigation Report as well as delay in submission of duly completed claim form. The

complainant contested stating that the insurance company was intimated the very next day. As regards, non - compliance of policy condit ion no. 1 relating to ‘securing the conviction of the offender’, the complainant argued that immediate notice was given to the police stat ion but nowhere it was mentioned in the said condit ion that F.I.R. was compulsory. The complainant also contended having paid extra premium to cover the stereo system and stated that there was no policy condit ions stipulating that payment of tax and entry in the R.C. Book about f itment of such extra f i t t ings, would influence the claim sett lement. The insurance company, on the other hand, contended that despite repeated written request, the complainant did not lodge a formal F.I.R at the police station and that the complainant did not incorporate this extra f it t ing in the R.C. Book, which was a statutory requirement. Held : The insurance company’s repudiation was on two basic grounds ; (a) The complainant did not f i le an F.I.R. under the appropriate section and therefore the police could not investigate the loss and submit a f inal police investigation report and (b) The R.C. Book did not mention about the extra f it t ings in the car in the form of Stereo system.

It was observed from the photo - copy of purchase invoice of Stereo system that the total price of Stereo system and 2 Speakers was Rs. 7,800/-. The policy covered addit ional electrical extra f it t ing amounting to Rs. 7,800/-. I t was, therefore, presumed that the complainant had covered the Stereo system under the policy. However, he did not declare the same to the Registering Authorit ies, and thereby he violated the registration Rules. But i t was also apparent that the insurance company would always have repudiated their l iabil ity in respect of the said Stereo system on the same ground since inception of the cover. In other words, they were never on risk for the Stereo system. Thus, having enjoyed the premium for the said extra f it t ings and then disallowing claim for the item, the insurance company would be doubly benefited.

In view of the above, the repudiation was upheld but the insurance company was directed to refund the extra premium collected on account of the stereo.


Shri. Narayan Chandra Ghosh Vs.

National Insurance Co. Ltd. Award Dated 31.03.2005 Facts / Submissions : The complainant’s truck no. WB - 33 / 1184 (TDV) was stolen by miscreants on 04.07.2000. The market value of the said truck was Rs. 3,25,000/- and the sum insured was Rs. 3,90,000/-. The insurance company assessed the loss at Rs. 2,08,500/-. The complainant represented against the decision that during his visit to the insurance off ice the amount for sett lement was mentioned at Rs. 2,50,000/- and he was asked to sign on documents required for sale of deed and for change of ownership in advance. The claim for Rs. 2,08,500/- was offered two years after from the date of loss and there was no explanation for such a delay. The vehicle was insured with IEV of Rs. 3,90,000/- and hence the sett lement was not accepted in view of the fact that the market value of the vehicle was Rs. 3,25,000/-

National Insurance Company stated that the vehicle was 1991 model with IEV of Rs. 3,90,000/-. The claim was investigated by Apex Surveyor Pvt. Ltd. and they found that the incident reported by the complainant was true as per the Final Police Report. Kharagpur Branch Office forwarded their f i le to Midnapore Divisional Office recommending sett lement of the claim for an amount of Rs. 2,48,500/- (Rs. 2,50,000/- less policy excess Rs. 1,500/-) on the basis of valuation made by Shri S.N. Gorai. The insurer found the valuation on the higher side and obtained two more valuations from surveyoRs. The insurance company accepted the valuation of Shri A.

K. Das, valuer and sent loss voucher dated 23.10.2002 for Rs. 2,10,000/- less policy excess of Rs. 1,500/-. Held : Insurance Company obtained three valuations of the loss in respect of the theft of the vehicle and unilaterally adopted the lowest of the valuation in order to sett le the claim. No specif ic reasons had been given either for adopting the valuation or for rejecting the other two valuations. The complainant could very well demand the highest of the three valuations for sett l ing his claim. Since the insurance company did not give the reason for adopting the lowest of the three valuations, claim should be sett led by taking arithmetical mean of the three valuations. Since there was delay in sett lement of claim, the loss of income arising out of theft of the vehicle and consequent harassment and mental agony, suitable compensation was allowed and the claim was sett led for a fair and reasonable amount of Rs. 2,50 ,000/-.

Mumbai Ombudsman Centre Case No. GI - 485 of 2003 - 04 Shri. Ranchhodlal M Chokshi

Vs. New India Assurance Co. Ltd.

Award Dated 14.10.2004 Shri. Ranchhodlal M Chokshi aggrieved by the decision of The New India Assurance Company Limited, for short sett lement of his claim under the Private Car policy No.31 / 02 / 03848 approached the off ice of the Insurance Ombudsman, seeking intervention of the Ombudsman in the matter of sett lement of his claim of Rs. 23331 (less depreciation on parts replaced) alongwith interest @ 15%. On perusal of the records it is observed that the Shri. Chokshi had preferred a claim to The New India Assurance Company Limited for Rs. 23331 for the repairs carried out on his Hyundai Santro car which met with an accident. The Company sett led the claim for Rs. 16,960/- and sent a voucher for the said amount which was not accepted by Shri. Chokshi. The Insured Shri. Chokshi has sent his detai led submissions to this Forum for sett lement.

After analysis of the records direction was given to The New India Assurance Company Limited, Divisional Office 111700 to resolve the matter with the Repairers as regards labour charges as outl ined in this Award fai l ing which New India wil l have to pay for the net balance amount of labour charges as paid by Shri. R.M.Chokshi directly and as offered by New India to Shri. Chokshi with 6% interest calculated from the date of offer made by New India t i l l the actual date of payment.

Mumbai Ombudsman Centre Case No. GI - 147 / 2003 - 04

Shri. Pradeep Goragandhi Vs.

Tata AIG General Insurance Co. Ltd. Award Dated 18.11.2004

Shri. Pradeep Goragandhi, had taken a Policy from Tata AIG General Insurance Company Ltd., Mumbai, to cover his Car Ford Mondeo, Model 2002, for an Insured Value of Rs. 15,76,648/- under Policy No.010065995 00 for the period 29.6.2002 to 28.6.2003. As per the complaint to this Forum, the car met with an accident on 1st February, 2003 by hitt ing a big speed braker. The Insured reported the accident to Tata AIG General Insurance Co. Ltd on the same day i.e. 1st February, 2003 on their tol l free 24 hours helpl ine and the complaint was registered under claim No.l32671. Tata AIG, appointed M/s. Shaman Motors Pvt. Ltd., the authorised service centre to survey and assess the loss.

Not gett ing any response from the Company, Shri. Pradeep Goragandhi, by letter dated 12.6.2003 complained to the Ombudsman’s Office. A joint hearing was held with the representative of the Company and the Complainant on 8.8.2003. Pursuant to the hearing, M/s. A.V.Jain, Associates, Advocates High Court on behalf of Shri. Pradeep Goragandhi, vide letter dated 10.12.2003 informed the company that the Engine and Chassis numbers submitted by Shri. Goragandhi in proposal form were mentioned by the Agent of the Company and the Insured was not aware of the same as the policy was taken by the Agent Smt. Reena Mil ind Wagle, on behalf of the Insured. Hence the contention of the company that chassis and engine number mentioned in proposal form, claim form and complaint before Ombudsman differs from one another is not relevant at this stage.

The exact version of the accident cannot be authenticated by this Forum as no report was made to the Police. Any aggravation of losses even due to negligence or ignorance would not come under the purview of the policy. From the date of accident varying from 1st February to 7th February and then to 14th February, i t could only point to some inconsistencies apart from the fact that the was used car after the accident and once that was done, i t was at the risk of the Insured only. Insurance of Motor vehicles is governed by a Statutory Act, i.e. Motor Vehicles Act, which enjoins on the Company this responsibi l i ty and at this stage, this Forum can only make a comment that the exact identity of the car insured is not established, unless the Engine and Chassis number are identif ied and tai led. It is felt, therefore, that the claim has some adverse features for which it is not ful ly substantiated to warrant an Award. At the same time, the Company has agreed on certain points and offered a sett lement but has also not f inally advised their decision on the representation made by the Insured / Complainant which is in the f ine spirit of customer service. Considering the technicalit ies involved as pointed out and to avoid further delay, Tata AIG should give the matter a fresh look to convince and satisfy the Insured. It should be noted here that this Forum has got l imited authority in the sense that it cannot summon witnesses, call outside parties, call for fresh evidences and cross examine them as necessary and decide in the matter. In the facts and circumstances, although basically agreeing with the approach of the Insurance Company, with regard to the handling of the claim in the face of the issues as highlighted, Tata AIG General Insurance Co. is hereby directed to convince the Insured with technical accuracy and a special ist approach on the sustainable items of the loss as a result of the accident and resolve the matter. The case is, therefore, reverted to Tata AIG for resolution keeping in mind broadly the foregoing comments made.


Shri. Rajiv Toshniwal Vs.

United India Insurance Company Limited Award Dated 06.12.2004

Shri. Rajesh Toshniwal, had taken a Policy from United India Insurance Company Ltd., Mumbai D.O.12, to cover his Motor Cycle Hero Honda, bearing Registration No.MH - 01.Q - 169, for Total Insured Estimated Value of Rs. 40,000/- under Policy No.021200 / 31 / 01 / 01376 for the period 30.6.2001 to 29.6.2002. The said vehicle was stolen between 9.3.2002 night to 10.3.2002 morning when it was parked in front of Danesh Tire Service, 2nd Khetwadi Lane, Mumbai.

Shri. Rajiv Toshniwal, submitted the claim to the Insurance Company, the Company appointed M/s Essex Investigators, to investigate into the matter and on the basis of the investigator’s report the Company by letter dated 27.5.2003 informed Shri. Rajiv Toshniwal, that as per R.C.Book vehicle was transferred in the name of Shri. Hiralal Chowdhary on

19.1.2002 whereas vehicle was stolen on 9.3.2002. As per R.C.Book, he was not the owner of the vehicle on the date of theft. Under the circumstances, claim for theft of the vehicle made by him was not tenable as he was not having insurable interest on the date of theft of vehicle.

Not satisf ied with the decision of the Company, Shri. Rajiv Toshnival, represented to the Company on 29.5.2003 stat ing that although he agreed that he was not the owner and had no insurable interest on the date of theft, he had transferred all his r ights on the vehicle to Shri. Hiralal Chowdhary. Hence, requested the company to compensate Shri. Hiralal Chowdhary, as he was the party to have insurable interest.

Not gett ing any response to his representation from the company, Shri. Rajiv Toshniwal, approached the Ombudsman by his letter dated 30.6.2003 seeking intervention in the matter of sett lement of claim of Rs. 25,000/-.

A joint hearing was held with the representative of the Insurer and the Complainant on 3.10.2003. As per the Investigator’s Report, the vehicle MH - 01 Q 169 was covered under the policy in the name of Shri. Rajiv Toshniwal from 30.6.2001 to 29.6.2002. The vehicle was transferred as per R.C.Book in the name of Shri. Hiralal Chowdhary on 19.1.2002, who had purchased the vehicle from Insured Shri. Rajiv Toshnival in the month of January 2002 by making cash payment of Rs. 28,000/-. Although the vehicle was transferred as per R.C.Book in the name of Shri. Hiralal Chowdhary, the Insurance Company was not informed for transfer of insurance. The Company has stated that the vehicle was stolen on 9.3.2002 and as per R.C.Book, Shri. Rajiv Toshniwal was not the owner of the vehicle on the date of theft and was not having any insurable interest. Motor Insurance is governed by all India Motor Tariff , which is in l ine with Motor Vehicles Act, which is a Statutory Act and compliance with the provisions of the Act is mandatory. In view of the above, the contention of Insured that as the policy was in force and the property insured was lost, the claim should be paid is not tenable and the Company’s decision to repudiate the claim is held sustainable.


Smt. Shalini Prasad Vs.


Smt. Shalini Prasad, an employee of ICICI, had purchased a Car Hyundai Santro, bearing Registration No. MH - 02.KA - 2894, under the loan sanctioned by ICICI and as a security for the loan of ICICI, the vehicle was hypothecated to ICICI, which was also noted under the Policy issued by The New India Assurance Co. Subsequently, the vehicle was purchased by ICICI in Jaunary 2002. Pursuant to the Scheme of ICICI and the security by way of hypothecation was cancelled which was duly noted in the Registration Book and the vehicle was transferred in the name of ICICI. Under the Scheme, Smt. Shalini Prasad was responsible for maintenance of the car, its security and for al l running expenses including the responsibil i ty for gett ing the vehicle insured. The policy which was issued by New India in the name of Smt. Prasad, was renewed by them even after transfer of the vehicle to ICICI without any specif ic advice to the contrary on payment to premium by Smt. Shalini Prasad to cover her Car, for a Depreciated Value of Rs. 2,80,000/- under the Policy No.140100 / 31 / 02 / 10177 for the period 17.10.2002 to 16.10.2003.

The said vehicle met with a serious accident on 3.4.2003 at Mumbai - Pune Expressway. Smt. Shalini Prasad lodged a claim with New India Assurance Company for Rs. 2.8lacs for total loss of the car. The Company vide their letter dated 7.10.2003, informed that the claim is not admissible since the vehicle was insured in the name of Smt. Shalini Prasad, whereas the Registration of the vehicle was in the name of ICICI Ltd. As such Smt. Prasad,

had no insurable interest in the vehicle. Not satisf ied with the decision of the Company, Smt. Shalini Prasad, approached the Ombudsman vide her letters dated 16.4.2004 and 12.6.2004 requesting his intervention in the matter of sett lement of her claim. A joint hearing was held with the representative of the Insurer and the Complainant on 19.10.2004.

Motor Insurance is governed by All India Motor Tariff , which is in l ine with Motor Vehicles Act, which is a Statutory Act and compliance with the provisions of the Act is mandatory. The clause clearly spells out the procedure for transfer of ownership / interest fol lowing sale or purchase or otherwise, of the vehicle presently insured, to incorporate the changes in the Certif icate of Insurance and Policy of Insurance in accordance with the change in the Registration Book. It is unfortunate and apparently unintell igible as to how both Smt. Prasad and particularly ICICI, could overlook to get the insurance policy duly endorsed as the deal was between them of which the Insurer i.e. New India was not aware. Hence technically, New India cannot be faulted with acceptance of renewal without a specif ic instruction giving the status of the vehicle fol lowing change of ownership. This is a very common approach, which strikes ordinary prudence and, therefore, the issue begs the question of so called insurable interest which was invoked number of t imes. Viewed in the context of this provision, which is a Statutory Provision, and is mandatory, the decision of the company to repudiate the claim cannot be questioned. As regards the administrative lapse committed by New India in deleting the hypothecation clause or reportedly paying a claim, it is upto New India Assurance Company Ltd., to take appropriate administrative action which, however, distinctly makes it open the lack of application of mind and incompetent handling.


Smt. Vina Parimal Parekh Vs.


Smt. Vina Parimal Parekh, had taken a Policy from The Oriental Insurance Company Ltd., Mumbai, to cover her car Tata Indica DLX, Model 2000, bearing Registration No.MH - 04.AK - 5738 for Total Insured Estimated Value of Rs. 3,50,000/- under private car Policy No.2002 / 988 for the period 23.6.2001 to 22.6.2002. Smt. Vina Parimal Parekh, int imated to the company that the car was total ly burnt due to f ire on 4.12.2001. The Company appointed their Panel Surveyor, Mr. B.N.Mehta, to inspect the vehicle and assess the loss on repair basis.

The Company vide letter dated 31.1.2002 informed the Insured that the Surveyors have assessed the l iabil ity on repair basis for Rs. 30,370/- towards labour charges + parts at 10% Metal & 50% Rubber & Plastic parts amounting to approximately Rs. 1,60,000/- in aggregate. After deducting depreciation and salvage the approximate l iabil ity of the Company would work out to Rs. 1,30,000/-. Further vide letter dated 10.6.2002, to the Company, she enclosed the Invoice of United Motors for the repairs carried out to her vehicle. Thereafter the Company informed the Insured that they were considering sett ing the claim on repair basis for an amount of Rs. 94,000/- (approx) on the basis of Survey Report of M/s. B.N.Mehta & Co. Thereafter the Company vide letter dated 1.10.2002 informed the Insured that her claim had been approved for Rs. 92,000/- and asked her to discharge the voucher in ful l and f inal sett lement of her claim. Vide her letter dated 18.10.2002, she informed the Company that she was accepting the amount of Rs. 92,000/- under protest, reserving her right to claim the balance. The Company, again got the matter examined by the Surveyor and accordingly revised l iabil ity was worked out and a voucher for Rs. 99,729/- was sent vide letter dated 19.2.2003 to the Advocates of the Insured giving details of amount disallowed under various heads.

Aggrieved by the decision of the Company, the Insured, approached the Ombudsman by letter dated 2.9.2003 giving facts of the case and seeking intervention in the matter of sett lement of her claim for Rs. 1,30,000/- with interest@18% per annum from due date t i l l sett lement of the claim and legal cost.

A joint hearing was held with the representative of the Insurer and the Complainant on 21.7.2004. This Forum wil l not and cannot now go on to take item by item for analysis, examination and verif ication of propriety. It is a job of the special ists and the Surveyors are duly approved by Insurance Regulatory & Development Authority (IRDA) and then empanelled by the Company to use their services as independent professionals. In view of this, their report is technically viable and, therefore, acceptable. The schedule given by the Company to this Forum or explained by them in a letter to the Insured giving respectively Insurer’s and Insured’s l iabil ity appears in order. Yet, I feel there is scope for improvement in the offer made considering the long delay and init ial improper handling by the Company. Further, the Insured wanted to take the offer twice with his r ight to approach any other Forum, which legally could not have been objected to by the Company and for which they were deprived of the reimbursement earl ier. In the end, the Company lost i ts credibi l ity as the Insured anyway approached this Forum for justice and in the bargain, precious t ime was lost. It is felt in such cases, there should have been more practical approach to resolve the matter. In the facts and circumstances, I feel the Company should improve their f inal offer by 15% on Rs. 1,00,000/- and resolve the dispute amicably. The Oriental Insurance Company Ltd., is directed to pay Rs. 1,15,000/- lumpsum to Smt. Vina Parimal Parekh in respect of her car Tata Indica DLX, bearing Registration No.MH - 04.AK - 5738 under Policy No.2002 / 988 for the period 23.6.2001 to 22.6.2002.


Smt. Hilla F. Dhondy Vs.

The New India Assurance Company Limited Award Dated 31.12.2004

Smt. Hil la F. Dhondy, had taken a Policy from The New India Assurance Company Ltd., D.O.130200, Mumbai, to cover her vehicle Mahendra Bolero, Model 2002, bearing Registration No.MH - 01.GA - 4722 under Private Car B, Policy No.130200 / 31 / 02 / 01177 for the period 28.9.2002 to 27.9.2003. She intimated the company that the vehicle met with a major accident on 10.1.2003 at Vapi. The Company appointed their Surveyor, M/s. S.P.Pati l & Co., to survey the vehicle and assess the loss. Smt. Hilla Dhondy vide letter dated 29.1.2003 informed New India that The Milestone, who are the authorized service agents for Mahindra & Mahindra’s Bolero, recommended replacement of the entire body shell whereas the Surveyor of the Company M/s. S.P.Pati l recommended replacement of the Body Shell. Thereafter Insured represented to the company vide letter dated 28th March, 2003 contesting the assessment and insisted for replacement of entire body shell. She further stated that she had instructed The Milestone, to proceed with the replacement of the body shell. The Company vide letter dated 19.4.2003 informed the Insured that the issue regarding replacement of body shell was once again referred to their Surveyor, M/s. S.P.Pati l & Co., and another technically qualif ied surveyor, and both had confirmed that the body shell is repairable. The Company stated that they would not be able to accede to the demand of replacement of body shell as the sett lement was reasonable.

Aggrieved by the decision of the Company, the Insured, approached the Ombudsman by letter dated 2.9.2003. A hearing was held on 15.9.2004 with both the parties. Smt. Dhondy further submitted that on the basis of letter f inally issued to the New India the vehicle has been repaired / replaced with new shell and entire cost has been paid to the ‘Milestone’ the repairers by her which has not been compensated. Ombudsman suggested that the dispute being total replacement of the shell vs repair of the shell and the insured having already

replaced shell, it would be advisable to f ind a solution by mutually discussing the vital issues including the impact of accident and the exact nature of the damage and the manufacturer’s responsibi l i ty in terms of the warranty given by them. New India has already agreed to pay an amount of Rs. 23,500 hence further discussion between parties invloved can resolve the matter. New India was asked to advise the forum within a fortnight.

Pursuant to the hearing the company informed the Ombudsman’s off ice that a meeting was held with the representative of the Insured on 15.10.2004 for f inalising the amount of the Body Shell. Considering the cost of replacement of the Body Shell and the expected salvage value of the Damaged Body Shell, it was decided and agreed by both the parties that Insurer’s l iabil ity on the Body Shell would be Rs. 29,418/- (net) instead of the original assessment of Rs.23,500/- on repair basis and rest of the claim amount wi l l be as per the routine procedure. Smt. Hil la Dhondy, in her letter dated 18.10.2004 to New India, has informed that the last paragraph of the Minutes of the Joint Meeting held on 15.10.2004, is clearly an error and it is not possible that she would agree to accept a sum lower than the company’s surveyor’s estimate / report.

This Forum is quite concerned at the turn of events even after the joint meeting was organised and duly participated by all parties. On the basis of the submission at this Forum vide Minutes of Hearing dated 15.9.2004, this Forum gave a direction as per Rule 15 of the RPG Rules 1998, to the parties to resolve the dispute on a single issue to enable sett lement of the claim. The Minutes are clear in i ts terms and it is evident that the Insured advised the Repairers to go ahead with ful l replacement which is a violation of policy terms. The consequences of this have been explained in the terms of Minutes of Joint Meeting held at off ice of New India, which has been signed by all parties. Any detraction after the Agreement is not fair and prudent. A point should be understood that this Forum has l it t le role in deciding the value of a Shell etc., which are matters of technicalit ies for which special ists are there. The Surveyors are now duly approved / l icensed by IRDA and are competent to recommend the best form of sett lement. It can only comment on propriety and equity in l ine with the terms and condit ions of the policy and not otherwise. I am reasonably satisf ied that there has been proper application of mind.

In view of the decision given by this Forum already, i t has no intention to take it back again as there is l i t t le scope for adjudication. It only returns the complaint to New India with a direction to explain once again the principles of Motor Insurance sett lement vis - a - vis, what has been done under the circumstances. Accordingly the complaint is dismissed from this Forum with the direction to the parties to honour their respective commitments at the Meeting and if that is required to be further re - visited, they may do so without involving this Forum.


Shri. Jagadambaprasad A Tiwari Vs.


Shri. Jagadambaprasad Tiwari had taken a Comprehensive Private Car (Zone B) policy from the New India Assurance Company Limited, Divisional Office 130600 to cover his Tata Sumo No.MH - 04 Y - 7941 for Total Insured Estimated Value of Rs. 3,87,000/- under policy No. 130600 / 31 / 00 / 01960 for the period 27.5.2000 to 26.5.2001. The said vehicle met with an accident on 27.4.2001 at Lakdia near Kutch in which the driver died and four persons were injured. The matter was reported to the Adhoi police stat ion and when Shri. Tiwari intimated about the accident to the Insurance Company on 7.6.2001, a Surveyor Shri. R.R.Thampi was appointed. Based on the investigation report the claim was repudiated by the Company on the ground that since the vehicle was registered as

“Private” car and the same was running on hire as per police report thereby, violating the policy condit ions of l imitat ion as to use, the claim was rejected.

Not gett ing any satisfactory reply and being aggrieved by the decision of the Company, Shri. Jagadambaprasad Tiwari approached the Ombudsman seeking his intervention in the matter of sett lement of his claim for ful l sum insured as the vehicle was total ly damaged. A close scrutiny of the case reveals that the Inquest Panchanama dated 28.4.2001 gave a detailed account of the accident and the people involved in the same who sustained injuries and succumbed to the injuries. However, further corroboration as to what were the terms of hire, with whom it was made, who used the vehicle for hire and further particulars on this were not produced. In fact i t was their responsibil ity to sustain their ground of repudiation in the face of an offer for sett lement actually made which was not withdrawn. Similarly the claimant and Insured should have also substantiated by some factual data about usage of the vehicle since the beginning.

As neither has been able to establish or counter and the f inal police report is also silent onthe particular case of the vehicle at the t ime of loss, it would be equitable to sett le the claim on an Ex - gratia basis @50% of the admissible cost, on the basis of sett lement which would have been done in similar cases fol lowing constructive total loss after the accident.

Mumbai Ombudsman Centre Case No. GI - 612 / 2003 - 04 Shri. Sachin Ramesh Bhoir

Vs. The New India Assurance Company Limited


Shri. Sachin Ramesh Bhoir preferred an accident claim of his vehicle - Toyota Qualis - which occurred on 24.11.2002 at Mumbai - Ahmedabad Highway in Godbunder vi l lage. The Company rejected his claim on the ground that the Complainant did not comply with the required papers / documents as also the Vehicle was used in contravention to l imitat ion as to use. Not satisf ied with the decision of the Company the Complainant approached the Ombudsman’s off ice for redressal of his claim against New India.

After going through the report of the claim Investigator M/s.A.K.Bajaj’s report and an analysis of the complaint with the documents made available particularly the Police Report, Police Panchanama and Survey and Investigation Reports. It appears New India has moved round and round in circles, employed as many as 3 Surveyors - cum - Investigators which produced some corroborative evidences, al l vouching the nature and extent of the loss without pointing out the bone of contention as to “l imitat ions as to use.” The statement how the accident occurred, supporting Panchanama and Police Report, extent of damage suffered by both the vehicles all tal l ied with various reports at different t imes. The statement of the Insured who was driving the vehicle, about his profession, residence together with his fr iends statements about residence and their occupation were all properly recorded. The Insured obviously used the car for his business, profession and also personal use. The participants and performers in a show were at least two of his fr iends who were returning with him and stayed in the same premises. There is no record by his using the vehicle for hire or reward and on the day of accident, the statements made by others did not suggest so.

It would have been appropriate to go into the off ice records, log book entry, any other Driver’s statement, neighbour’s statements, secret investigation with parties receiving benefits using the vehicle with on hire or reward and so on. Based on the circumstances and New India’s fai lure to prove that the vehicle was being used in contravention of “ l imitations as to use” for which the claim was repudiated, it remains inconclusive. However, i t is also a fact that the Insured Driver Shri. Bhoir made a statement before the

Police that the vehicle was hired, whatever may be the actual intention that is with or without money being paid. Granting some benefit of the doubt, I decide that without authentic proof the claim may be sett led on ex - gratia for 50% only of admissible expenses of repairs as assessed. In the facts and circumstances the complaint of Shri. Sachin R. Bhoir, New India Assurance Company Ltd. is directed to sett le the claim for 50% of admissible expenses only as a f inal sett lement.


Shri. Mahesh Madanlal Kalantri Vs.


Shri. Mahesh Madanlal Kalantri insured his new Tata Sumo vehicle No.MH - 15.AH - 8425 with New India Assurance Co. Ltd. for an IEV of Rs. 4,75,000/- and IDV of Rs. 4,00,000/- respectively. The vehicle was stolen from behind Ruia College while Shri. Kalantri came to Mumbai in his business connection. He duly lodged a police complaint and after necessary investigation the police could not trace the vehicle and a total loss claim which was lodged under the policy with New India was considered by them. new India sett led the claim for Rs. 3,87,000/- after adjusting the IDV appropriately against the Insured’s declared value of Rs. 4,00,000/- which led to the dispute of non - receipt of Rs. 13,000/- as per the Insured, Shri. Mahesh Kalantri. The analysis of the claim fi le refers to only a single point issue of dispute viz. the basis of Insured’s Declared Value or IDV concept. According to the Insured Shri. Kalantri, since he has insured the vehicle for Rs. 4,00,000/- and has paid the premium on that basis, the Company has no reason to deduct further Rs. 13,000/- by arriving at a different value as per their calculat ion of IDV. His second point is that by issuing the policy for Rs. 4,00,000/- New India has accepted this IDV as the Sum Insured and hence are bound to pay the same amount. New India, on the contrary, held the view that the Motor Tariff has clearly given the guidelines of arriving at the IDV with respective depreciat ion formula to be applied according to the age of the vehicle and hence they calculated on the same basis and arrived at the value of the car in December, 2002 from which Rs. 1000/- policy excess was deducted to arrive at the f inal f igure payable. Clearly, therefore, the dispute would be resolved if further examination of IDV as per India Motor Tariff which is mandatori ly applicable to al l Motor Insurances, is made. The next point would be whether on the basis of these guidelines the IDV was appropriately calculated. The Insured, Shri Kalantri insured his vehicle for Rs. 4,75,000/- which was his estimated value (IEV). After June, 2002 for whatever reason the Insured did not insure his vehicle for almost 6 (six) months and not only carried a great r isk but also committed a grave offence under MV Act which is a Statutory Act which makes Motor Insurance a compulsory Insurance. A shrewd analysis reveals that the Company should have informed the Insured that IDV arrived at by him was sl ightly higher though normally anybody would round off to the nearest Rs. 10,000/- l imit in such cases. Motor Insurance does not al low “Agreed Value” Policy under which the Sum Insured cannot be adjusted through depreciation once it is declared in the proposal. Only in respect of Vintage Car some exception has been made by the Tariff Advisory Committee (TAC). The Insured took it to be an Agreed Value policy since Rs. 4,00,000/- Sum Insured is given in the policy. True the Company should have pointed out to him the exact calculations when the Tariff got revised but there is nothing l ike “once done forever closed” type of matter as per the basis just mentioned above. As IDV can be arrived at by the guidelines, it can be applied even after the claim which is clearly given in the Tariff and tal l ied with the actual claim made. In the facts and circumstances, the decision of the Company to pay the claim on the basis given in their letter of 10.6.2004 for Rs. 3,87,000/- cannot be faulted.


Shri. Ashok Kumar Mantri Vs.

The Oriental Insurance Company Limited Award Dated 31.3.2005

Shri. Ashok K. Mantri alongwith his wife Smt. Lalita A. Mantri was insured with Oriental Insurance Company Ltd. for a sum insured of Rs. 3,00,000/- under Householders Insurance Policy which covers personal accident also. Shri. Ashok K. Mantri met with an accident when his scooter skidded and his left knee was hurt. He was admitted to Gandhi Hospital on 21.05.2003 under the care of Dr. Pramod Gandhi and diagnosed as fracture of the knee bones (Bicondylar Fracture of Tibia). After hospitalization, he preferred claim to the Company for Temporary Total Disabil i ty (TTD) under Personal Accident Policy. The Company had sent the f i le to its Medico - legal Consultant, Dr.M.S.Kamath and after gett ing his opinion, the Company sett led the claim for Rs. 15,216/- / .

The Company’s submission has been examined at this Forum coupled with the technical opinion received from the special ists with regard to similar type of fractures and consequent rehabil itation period. It is seen as an accepted medical theory and practice that i f there is no compression fracture with fragmentation, the recovery period is lesser. Going by the standard experience the basis adopted by the Company to grant six weeks plus two weeks total eight weeks for Temporary Total Disablement (TTD) is in order. The Insured’s injury was no doubt severe which was termed as ‘compound’ yet considering the fact that the union was achieved by traction. it was evident that while ful l recovery would take t ime, partial recovery and being on circulation through restricted movements with walker or cruches would prove mobil ity and thereby conclude the period of Temporary Total Disablement. Seen from this angle the Company’s approach based on the medicial opinion is acceptable. However, the calculat ion of the amount payable as per the policy terms and condit ions appears to be incorrect. In absence of any restrict ions on the policy to the extend of weekly payment for Temporary Total Disablement accept a ceil ing on Rs. 3,000/- per week being 1% of the Sum Insured, the Company prefer to calculate the total income and arrive at the weekly payment. This method should have been adopted at the inception of the policy by making it clear to the Insured that his claim would restricted accordingly. Since that was not done and the Sum Insured was Rs. 3 lakhs for Shri. Ashok Mantri and Rs. 1 lakh for Smt. Lalita A. Mantri, the Company should have calculated the amount accordingly. The complaint of Shri. Mantri for revision in the amount paid to him by Oriental Insurance is hereby upheld.

Mumbai Ombudsman Centre Case No. GI - 317 / 2004 - 05 Shri. Mohan D. Somwanshi

Vs. United India Insurance Co. Ltd.


Shri. Mohan D. Somwanshi lodged a claim with United India Insurance Co. Ltd. for theft of his Truck. Subsequently, the vehicle was traced and he intimated the Company about al leged damage / loss and requested for permission to carry out repaiRs. In the meanwhile, the Insured informed the surveyor that he started work and he purchased the spare parts from an authorised Tata dealer. The contention of the company was that the Insured had started the work of replacement of parts without the consent and contrary to the surveyor’s advice and also purchased the parts from some unauthorised vendors so they incur no l iabil ity and the claim was rejected.

The analysis of the claim fi le reveals that it was primari ly a theft claim. In a theft claim if the vehicle is found out with parts missing, it gives lot of clues to both Police, the State Administration and also to Insurance Companies. There is a Central Organisatin in Delhi which is doing all research activit ies to stop the racket, identify the offenders and the modus operandi. The Insurance Companies and the Police need to be more pro - active in dealing with the theft claims to stop unhealthy practices and recurrence of the crime by adopting strict control both in underwrit ing and sett lement of claims. This therefore need a special handling.

Viewed in this context, the Insurance Company, United India’s stand to get the vehicle inspected and issue instructions through the surveyor not to start repair work of the vehicle and to get the replacements only through specif ic authorised dealeys named by them could be taken as condit ions precedent to sett l ing the claim. In respect of parts replacements the need to have genuine parts only from recognized authorized dealers is important. The Insured did not take any notice of both these instructions which was a clear violat ion. A deeper study of the Survey Report issued by Shri. R.R.Thampi wil l reveal that the Insured had reported similar episode of thefts in the past where after a few days the vehicle was found with parts missing and those were replaced without wait ing for United India’s inspection or permission. The analysis further highlights certain adverse features about the ‘modus operandi’ of the alleged theft, retrieval of the vehicle with missing parts, placement of vehicle of repairs / replacement in a part icular garage, replacement of parts from a particular supplier, f it t ing of those without Insurer’s permission, inspection or reinspection etc. It is an established fact that any claim has got to be established under the Policy and for which all the terms and condit ions need to be observed and fol lowed meticulously. Any deviation would vit iate the claim. Here the earl ier claim was lodged in similar fashion and therefore, the Insurance Company insisted on certain aspects to establish genuineness of the claim which cannot be faulted. The Insured’s action would be taken as a violation of condit ion 2 as also condit ion 8 of the Commercial Vehicles Package Policy for which the repudiation of the claim by the Company is tenable.