Vehicle Gen27 PDF

In the matter of
Mr. Rajesh K. Parmar

V/s
Oriental Insurance Co. Ltd.
Complaint Ref. No. AHD-G-051-1718-0200
Date of Award : 14.07.2017 Policy No 0605003115P-107247257
The Complainant’s Scooter was stolen on 10.05.2016 when it was parked near his shop at Kamal
Complex, I.O.C. Road, Chandkheda, Ahmedabad. The intimation of theft of vehicle was given by
complainant to the respondent on 13.05.2016 i.e. after three days. The FIR of theft of the vehicle
was lodged on 25.06.2016. As the intimation of loss due to theft was not given to the Respondent
immediately, the claim was repudiated by the Respondent under Condition No. 1 of the policy.
After review of the claim on receiving appeal in Grievance Redressal Deptt., the higher authorities
had considered to settle the claim on sub-standard basis for Rs.18,750/- (i.e. 75 %) after
deducting Rs.6250/-. The vehicle was stolen on 10.05.2016. The complainant had lodged the
FIR on 25.06.2016. The insured ought to have had lodged the complaint as per the policy
condition No.1 immediately The insured had informed the insurance company after 3 days of the
theft of the vehicle. The complainant had not bothered to lodge an intimation of loss of the vehicle
with the Insurer immediately even after his coming to know about the loss. Further, the insured
had lodged FIR of the theft of the vehicle on 25.6.2016 i.e. after 45 days. Hon’ble Supreme Court
Oriental Insurance Co. Ltd. vs. Parvesh Chander Chadha (Civil Appeal No. 6739 of 2010 decided
on 17.8.2010) dismissed the complaint holding that in terms of the policy issued by the insurance
company, the insured was duty bound to inform about the theft of the vehicle immediately after
the loss. The complainant had failed to give intimation of theft immediately to the insurance
company and police authority as per policy Condition No. 1.The insurance company, after receipt
of grievance appeal, had gracefully settled the claim on sub –standard basis by paying 75 %
claim amount and paid it to the complainant.
In view of the foregoing, the complaint failed to succeed.
In the case of Ashish B. Monpura v/s Iffco Tokio General Ins.co.ltd.

Complaint Ref:No.AHD-G-023-1617-1560
Award Date:20.04.2017 Pollicy No.96798666
The complaint was regarding deduction made from the car repairing claim after accidental damage. Claim made for
Rs.19854/- was settled for RS.12381. The insurer could prove that the amount was deducted towards the repair for
old damage. Moreover other amounts were settled after the consent of the complainant. The amounts deducted
towards compulsory excess and salvage were found to be in order.
The complaint failed to succeed.
In the case of Ravi Thakkar v/s Cholamandalam M S General Ins.co.ltd.

Complaint Ref:No.AHD-G-012-1617-1514
Award Date:20.04.2017 Policy No. 3362/01014370/000/00
The complainant had purchased a second hand car and the ownership of the vehicle was transferred in his name in
the books of the RTO.on 24.11.5015 a day before the accident. He informend the insurer on 24.11.2015 about the
change of the ownership of the insured vehicle through SMS. The claim for owndamage of the vehicle was not paid
stating that the policy covering the vehicle could not be endorsed before the happening of the accident as the
intimation for endorsement and the necessary payment for affecting the change was done on 27.11.2015, after the
accident. The insurer denied having received the intimation through SMS on 24.11.2015. G R 17 of India Motor
Tariff rule relating to transfer of vehicle allows 14 days time to the purchaser of the vehicle to informthe insurer to
record the change of ownership. Here in this case the insurer was informed within this time limit. Unfortunately the
accident happened so suddenly on the next day and it did not allow the purchaser to inform the insurer before the
misshape.
Inview of this, the complaint was admitted and awrd for RTs.11651/- was made in favor of the complainant.
In the case of Mr. Hitesh K. Khusalani v/s Iffco Tokio General Ins.Co.Ltd.
Complaint No:AHD-G-023-1718-0187
Award Date:13.07.2017 Policy No. 99219956
Claim for theft of two wheeler vehicle was rejected on the ground that the intimation of the theft was not
given to the insurer in time. The vehicle was stolen on 25.09.2016. FIR was lodged with the police on
14.102016 and the insurer was intimated on 17.10.2016. the insurer submitted that policy condition No.1
necessitated immediate intimation to the insurer as well as to the police authorities. The representative of
the respondent stressed the need for the urgent intimation in order to enable both the insurer and the
police authorities to take immediate steps to trace the stolen vehicle. In this case the intimation was late
by 22 days and it deprived the insurer of the opportunity to trace the vehicle. Therefore the claim was
repudiated. Repudiation was upheld.
The complaint failed to succeed.
Complaint No: BNG-G-035-1617-0794

Case of: SHRI CHANDRU KUMAR V/s RELIANCE GENERAL INS CO LTD
Date of Award: 8th May, 2017.
Repudiation of OD claim for delay in reporting to Police – Compromised
Claim was repudiated for the delay of 7 days in reporting the Claim to the Respondent Insurer
and a delay of 15 days in reporting to the Police.
Upon mediation of this Forum on the ground that the theft was informed to the Police on the day
of theft and the same was recorded in their records which did not result any delay in reporting to
the Police, the Respondent Insurer settled the claim.
` *****
Case of: SHRI PAVAN KUMAR TRIPATHI V/s BAJAJ ALLIANZ GENERAL INS CO LTD
Date of Award: 9th May, 2017
Repudiation for damages not being pertinent to the Accident - Upheld
The Insured vehicle suffered engine damages and the claim thereof was repudiated stating that the same
was not on account of the accident. The manufacturer arranged replacement of engine at no extra cost.
The Complainant contended that there was delay in informing him about the non-admissibility of the gasket
leakage claim by the Respondent Insurer and also there was delay on the part of the repairer to identify the
problem and arrange rectification of the same. This had resulted him to incur an additional expenditure to
arrange for alternate arrangements and approached this Forum for making good his consequential loss.
The prime concern of the Complainant, as expressed during the Personal Hearing, was that the
Surveyor did not hold any kind of discussion with him before releasing the Survey Report for the
accidental repairs and also for the engine damage repairs. Further, he was not a party to the e-
mail correspondence, the repairer had with the surveyor and vice-versa. The Complainant kept
the Respondent Insurer under loop in all his e-mail correspondence with the
Manufacturer/Repairer for the engine damages. He did not receive any communication from the
Respondent Insurer, except a brief mail dated 07.09.2016 stating that the engine damage was
not relevant to the accident,
The Respondent Insurer submitted that besides the cited mail stating the head gasket damage
due to overheat was not payable. They had also conveyed through another mail dated 12.09.2016
that the consequential loss, loss or damage due to mechanical breakdown was not payable.
The Forum concurs that the engine damages arose out of mechanical breakdown, as the vehicle was run
for 3968 kms after being delivered to the Complainant after carrying out the accidental repairs
(manufacturer replaced under warranty duly supports) and the resultant consequential loss for hiring
alternative transportation was not payable. However, the Respondent Insurer has failed to send a detailed
reply expressing it in the clear terms and conditions of the Policy, instead of conveying them in staggered
mails, which were brief too.
The Forum opines that the surveyor deputed by the Respondent Insurer, should have had discussion with
the Complainant (since the issue of coolant ran out being reported), when the vehicle was shifted to the
repairer for accidental repairs, even though the accidental repairs were carried out on cash loss basis
without involving any payment from the Insured.
The Forum further confirmed that any dispute with regard to the deficiency of service of the Repairer in
handling this issue falls outside the purview of this Forum.
Therefore, the Forum had no opportunity interfere the decision of the Respondent Insurer.
*****
Case of: SHRI VIKAS OSTWAL V/s LIBERTY VIDEOCON GENERAL INS CO LTD
Date of Award: 9th May, 2017

Repudiation for false description of cause of accident – Upheld
The repudiation of own damage claim of the Insured vehicle, was on account false description of the cause
of accident. False description could be ascertained only during the investigation arranged by the
Respondent Insurer. The Complainant represented to the Respondent Insurer stating that the incorrect
accident description was given upon the advice of a Police Constable, who suggested to sort out the matter
without filing FIR. Further, it was not made with any malafide intention.
On careful scrutiny of the documents on record, the Forum observed that the Complainant
knowingly provided an incorrect cause of accident and was amended to the actual position, after
his statement being reduced to be incorrect.
Therefore, the Forum had no opportunity interfere the decision of the Respondent Insurer.
*****

Case of: Shri PRASHANT KUMAR V/s ICICI LOMBARD GENERAL INS CO LTD
Date of Award: 10.05.2017.
Theft of vehicle – Delay in FIR - Compromised.
The Complainant was for the theft of Motor cycle and there was a delay of 49 days in lodging FIR. The
Respondent Insurer repudiated the claim on the ground of delay. With the intervention of this Forum, claim
was settled amicably.
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Case of: Shri SANTOSH KRISHNA MURTHY V/s ICICI LOMBARD GENL INS CO LTD
Date of Award: 10.05.2017.
Imposition of 50% depreciation on metal part reduction of Labour charges. – ALLOWED
The Complaint is for imposition of 50% depreciation on all parts and reduction of labour charges on 2 year
old vehicle, though the vehicle was repaired with the dealer. This Forum having examined the policy terms
and conditions, opined that imposing 50% depreciation on carburettor and reduction of labour charges
pertaining to accidental repairs charges by the dealer was not in order. Hence, the Complaint was Allowed.
************
Case no. BHP-G-020-1617-0184

Mr.Mohd. Shabbir Khan v/s ICICI Lombard Gen.Ins.Co.Ltd.,
Date of Award:17/04/2017
Policy no.3005/2010850283/80/0000002231
Facts of the case:
The complainant stated that his motor cycle was insured with the respondent Insurance company under Package policy.
On 28/12/2015, this vehicle was stolen. He lodged claim with respondent company, which was repudiated on the
grounds of violation of policy condition of immediate intimation to police and to the respondent.
Findings & Decision:
The respondent company stated that the complainant lodged FIR with police after 6 days of loss and intimated to them
after 9 days of loss, which is a violation of policy condition no.1, accordingly claim was repudiated since not payable.
I heard both the sides the complainant as well as Insurance Company.
On perusal of papers on record and submission made during hearing is clear that there was a delay on the part of
complainant in filing FIR as well as intimation to the Company.
Therefore, I see no reason to interfere with the decision of the Insurance Company.
Case no. BHP-G-051-1617-0201

Mr.Gaurav Bhale V/s United India Insu.Co. Ltd., Indore
Policy no.1903003115P113679050
Facts of the case:
Insured vehicle stolen on 24/08/2016.The claim for payment of loss lodged with the Respondent Company. The
respondent company repudiated the claim on the ground of delay of FIR by 6 days and intimation to the respondent
company after 11 days of the theft.
The respondent company stated that the complainant lodged FIR after 6days of loss i.e. on 30/08/2016 and intimated
to Insurance Company after 11 days of loss which is violation of terms and conditions of policy, accordingly claim
was repudiated.
On perusal of papers on record and submission made during hearing, I find that there was a delay in intimation to
police and Insurance Company.
Accordingly the complaint filed by the complainant is hereby (dismissed) disposed off.
Case No. BHP-G-048-16-17-020----

Mr. Vinod Sharma V/s National Insurance Co.Ltd.
Date of Award 17/04/2017
Policy No. 320201/31/1456100009639
Facts of Case :-
The complainant had filed the complaint related to repudiation of own damage claim of complainant’s Swift car
No.MP-04/CJ-1641 on the ground of non disclosure of material facts i.e. No claim bonus rebate was wrongly enjoyed
by the insured whereas there was a claim on previous policy.
Finding and Decision :-

On perusal of the records I find that the first policy fo the period of 2012-13 was issued from ICICI Lombard General
Insurance Company and subsequently renewed from National Insurance Company till 2016-17. The no claim bonus
45% allowed by the respondent from 14.02.2016 to 13.02.2017. The respondent National Insurance company had not
taken the confirmation of NCB from ICICI Lombard within the stipulated time period as per provision of GR-27 of
India Motor Tariff-2002. The vehicle was renewed with the same insurance company, the insurance company could
easily detected the mis-representation of facts. The Insurance company would not be justified in repudiating the claim.
Hence, the Insurance Company is directed to settle the claim.
Case No. BHP-G-030-1617-0180
Mr. M.C. Nagaria V/s Megma HDI Gen.Ins.Co.Ltd.
Award Date : 17/04/2017
Policy No. P0014200005/4103/346154
Facts of case:-
The complainant’s insured vehicle was on route from Rewa to Haryana suddenly its tyre got burst and due to heat
generation entire vehicle was burnt but his claim was not settled by the respondent.
Finding & Decision :
The respondent contended that they have issued registered letter dtd 02.09.2016 regarding compliance of various
formalities and submission of relevant documents but complainant has chosen to pursue the matter through this forum.
On perusal of record, I find that it is a premature case before this forum. The complainant had not submitted the
original document and Insurance Company had not shared to survey report with the insured. Therefore, complainant
is advised to submit the required documents to the Insurance Company and insurance company is directed to share
the survey report with the complainant and to decide the case after compliance of formalities.
Case No. BHP-G-023-1617-0195

Mr. Dinesh Parmar V/s IFFCO Tokio Gen.Ins.Co.Ltd.
Date of Award : 17.04.2017
Policy No.84852378
Facts of case:-
The complainant had filed a complaint related to repudiation of vehicle claim on the ground of delayed intimation and
FIR.
Insurance company contending that insured has not informed immediately to the Insurance Company and FIR was
lodged after 15 days. As per documents submitted by both the parties it is observed that theft case was finally closed
by Shujalpur court vide their order dated 13.12.2014 and complainant informed the respondent on 03.10.2016. In view
of records & circumstances and the fact that there is an abnormal delay in filing the claim. I am of the considered view
that decision taken by the respondent company is justified. Accordingly, complaint stands dismissed.
COMPLAINT NO- BHU-G-020-1718-0005

Sri Brajabandhu Jena
Vrs
ICICI Lombard General Insurance Co. Ltd.
Date of Order 23.05.2017
Brief Facts of the Case: The complainant is the owner of Hero HF Deluxe Motor Cycle no. OD 25 1285 which has
been insured by the present Insurer for the period from 21 10 2015 to 20 10 2016 with IDV of Rs.26068/-.
Unfortunately, on 02.02.2016 when he had parked his vehicle in the Bhubaneswar court premises it was stolen. On
the same day he lodged FIR in the Badagada PS, Bhubaneswar. The police registered the FIR only on 16.02.2016,
investigated in to the matter and submitted Final Report no.102 dated 30.06.2016 as FRT No Clue U/S 379 IPC. On
06.02.2016 the complainant intimated the claim to the insurer. He submitted all the relevant documents before the
Insurer but it made the claim ‘No Claim’ although delay in FIR was not intentional. Under such circumstances, he
approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that there was delay of 15 days in intimation of the theft to the
Police and delay of 6 days in intimation to the Insurer. Further, the Insurer issued a letter on 13.06.2016 seeking
explanation for the delay, but no justifiable/reasonable response was received. This violated policy condition and as
such, the claim was made ‘no claim’.
Result of hearing with both parties(Observations & Conclusion)
I have elaborately gone through all the papers placed before this Forum. As it appears, on 02.02.2016 the complainant
had gone to Bhubaneswar court on some work after parking his motor cycle in the premises. On returning from work
he found that the motor cycle had been stolen by unknown miscreants. Immediately he rushed to Badagada PS,
Bhubaneswar and filed FIR. But after a lot of persuasion the police registered the FIR on 16.02.2016 as PS Case no.30
U/S 397 IPC. The complainant had intimated the loss to the Insurer on 06.02.2016. The police investigated in to the
matter and submitted final report no. 102 on 30.06.2016 as FRT no clue . Thereafter the complainant submitted all the
relevant documents to the Insurer which repudiated the claim on grounds of 15days delay in lodging FIR and 6 days
delay in intimating the loss to the Insurer. It opined that the above lapses on the part of the Insured violated the policy
condition of immediate intimation in case of loss. But, at the time of hearing the Insurer unconditionally declared that
it is ready and willing to settle the claim after collecting relevant documents. As the Insurer admitted liability, further
discussion on the merit of the complaint seems to be redundant. Therefore, the Insurer is hereby directed to process
the claim and release the amount of IDV less policy excess of Rs.100/-to the complainant at the earliest.
*************
Mr Musasar Nazaer Khan
vrs
Reliance General Insurance Co. Ltd.
Date of Award: 24.05.2017
Brief Facts of the Case: The complainant is the owner of TATA LPT 2515 Truck no OR-04H-5486 insured with the
above Insurer for the period from 20.06.2012 to19.06.2013 with IDV of Rs.9,00,000/-. Unfortunately, the vehicle was
stolen at Lalpol Balibhasa on 22.07.2012 and FIR no.318/12 under section 394 was lodged with Jhargram PS, West
Bengal. The complainant submitted all the relevant original documents to the investigator except the police final report
due to delay in receipt of the same. Immediately after receiving the same on 28.06.2015, he submitted the Final Report.
But the Insurer closed the claim due to non receipt of documents. He wrote various letters to the Company but no
response was received. Under such circumstances he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that after receiving the claim intimation one Investigator was
appointed to investigate the matter. He went to the spot of theft and also met the complainant. But, the complainant
neither submitted required papers nor cooperated with him. Further, it was ascertained from the investigation report
that the driver had allowed the miscreants to enter the vehicle and intoxicate him. Moreover, the claim was devoid of
any merit due to lapse of limitation period. Hence the claim was closed as ‘no claim’.
Result of hearing with both parties(Observations & Conclusion) I have gone through all the papers placed
before this Forum with utmost care and caution. As it appears, the vehicle was stolen on 22.07.2012 by unknown
miscreants at Balibhasa Lalpole while returning after unloading at destination. The complainant lodged FIR no
318/12 in the Jharagram P S, West Bengal which undertook steps for investigation of the matter. The police
submitted final report in 2015 vide FRT No.84/15 under section 394/IPC with conclusion “ Final Report as True”.
The complainant obtained certified copy of the police final report on 28.06.2015and thereafter forwarded the
documents to the Insurer. The Insurer, in the meantime, had closed the claim as no claim for non submission of
documents and intimated its decision to the complainant by letter dated 17.11.2014. The complainant resubmitted
relevant documents before the Insurer through speed post on 23.06.2016 and sent various e-mails in the month of
May, August & Ocober,2016 giving details of his visit to Insurer’s Kolkata office and documents sent to it. On
31st August, 2016 the Insurer informed the complainant by e-mail that a fresh NOC was required as the previous
one had expired. The above exchange of correspondences between the complainant and the Insurer indicates that
the claim was reopened and live in August, 2016 for further processing by the Insurer subject to submission of
documents by the complainant. In view of the above, the contention of the Insurer that the complaint has been
devoid of merit due to the limitation period is not sustainable. Therefore, the Insurer is liable as the theft of the
vehicle took place during the policy period and the same has inflicted severe financial loss upon the Insured. In
such circumstances, the complainant is entitled to get the IDV under the policy towards the claim and the Insurer
is hereby directed to release Rs.9,00,000/- less policy excess of Rs.1500/- to the complainant as early as possible.
Sri Lalatendu Nayak
Vs.
New India Assurance Co. Ltd.
Date of Award 06.06.2017
Brief Facts of the Case: The complainant was the owner of Swift Dzire Car No.OD-02Y-9147 insured for the period
from 31.10.2016 to 30.10.2017 for IDV of Rs.6,50,000/-. Unfortunately, the vehicle met an accident on 18.11.2016
and was severely damaged. He intimated the claim to the Insurer which deputed a surveyor to assess the loss.
Subsequently, the car was repaired, but the Insurer intimated that the claim had been made ‘no claim’ due to false
declaration regarding NCB. Under such circumstances, he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that the previous Insurer of the vehicle confirmed that a claim
was reported under the policy. At the time of proposal for the current period the complainant misrepresented the above
fact and availed NCB. As such, the claim was made ‘no claim’ as per G R 27 of IMT.

All the documents submitted before this Forum are perused with utmost care and caution. As it appears, the
vehicle met an accident on 18.11.2016 near Choudwar. A claim intimation was given to the Insurer and the car
was shifted to Narayani Motors, Bhubaneswar for inspection and repair. The Insurer deputed a surveyor who
inspected the damaged car and submitted his report assessing the loss at Rs.2,94,500/-. But, surprisingly the
Insurer made the claim ‘no claim’ on the ground that the complainant availed 20% NCB by declaring no claim
under the previous year’s policy. In this connection the Insurer produced copy of the proposal form where the
proposer appears to have signed on a rubber stamp declaration about availing NCB. Further, premium calculation
on the body of the proposal reveals that an amount of Rs.1908/- is granted to the proposer towards 20% NCB.
The Insurer also produced a print out of the mail dated 24.11.2016 received from MBIL confirming a claim in
the previous year policy issued by Royal Sunderam General Insurance Co. But, no confirmation was received
directly from the previous Insurer. Although the complainant agreed to have availed a claim for Rs.9000/- he
could not provide any other details. In this context, it is well known that the new Insurer is required to send a
letter seeking NCB confirmation by Regd. Post to the previous Insurer and if no response is received within 30
days, NCB granted will be treated as confirmed. No such procedure appears to have been adopted in the case in
hand. In such circumstances, the Insurer is hereby directed to settle the claim immediately deducting the NCB
amount of Rs.1908/-from the claim and release the amount in favour of the complainant as early as possible.
******************

Mr.Manoj Kumar Sahoo
Vs.
United India Insurance Co. Ltd.
Date of Award: 23.05.2017
Brief Facts of the Case: The complainant is the owner of the Mahindra pick up van no. OR 05 AH 5272 insured for
the period from 29.12.2010 to 28.12.2011 with IDV of Rs.2,80,000/-. Unfortunately, in the night of 27/28.09.2011
the vehicle was lost due to theft and FIR was lodged with Dhenkanal Sadar PS. A claim was intimated to the Insurer
and all required documents including the Final Police Report was submitted before it on 05.06.2015. Subsequently,
the Insurer settled the claim and transferred an amount of Rs.2,09,500/- to his bank account without assigning any
reason for short payment. After lot of correspondences, the Insurer replied by letter dated 25.10.2016 that the claim
was settled on non-standard basis as the driver‘s friend was travelling in a goods carrying vehicle. Under such
circumstances, he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that the driver took an unauthorized passenger in the vehicle
other than the persons covered by the policy. So, there was violation of policy condition and accordingly the claim
was settled deducting 25% of the claim amount.
Result of hearing with both parties(Observations & Conclusion) : I have elaborately gone through all the papers
placed before this Forum. As it appears ,the driver stopped the pick up van at Baladiabandh Grama Panchayat
Office to drink tea while proceeding from Cuttack to Angul with load. After drinking tea, when the driver was on
the driver’s seat to start his onward journey suddenly a group of 10/11 people came in a Bolero, captured him and
forcefully put him in the Bolero. Then they fled away with the stolen vehicle and on the way dropped the driver
near Patia forest. The complainant lodged FIR in the Dhenkanal Sadar PS which registered P S case
no.280/28.09.2011 and investigated in to the matter. A claim was also lodged with the Insurer. The police
submitted final investigation report No.519 dated 31.12.2013 as FRT no clue under section 395 IPC in the said
case. The complainant submitted all relevant documents including the police final report before the Insurer on
05.06.2015.The Insurer processed the claim and settled for an amount of Rs.2,09,500/- with reason that another
person was carried in the vehicle. This violated the policy condition and therefore the claim was settled on non
standard basis deducting 25% of the claim amount. Although FIR reflects that driver’s friend was travelling,
actually he was not in the vehicle when the theft took place. Further, the presence of the other person with the
driver is within the registered seating capacity and does not exceed it. The Insurer also could not provide any
evidence so as to prove that only a particular type of person is authorized to be present in the vehicle and covered
by the policy. More so, non standard settlement of the claim is not contemplated under the policy terms and
conditions and as such, the Insurer is liable for the full IDV as the theft occurred during the policy period.
Therefore, the Insurer is hereby directed to settle the claim and pay the balance amount of Rs.70,000/- to the
complainant at the earliest.
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Mr. Soumya Ranjan Pattanaik
Vs.
National Insurance Co. Ltd.
Award Dated 24th May., 2017
Brief Facts of the Case: The complainant is the owner of the Bajaj Motor Cycle No.OR-02BK-4159 insured with the
present insurer for the period from 10.02.2016 to 09.02.2017 with IDV of Rs.36,000/-. Unfortunately, the motor cycle
was stolen by unknown miscreant on 20.02.2016 while it was parked with properly locked condition in front of
Hanuman Temple at Garage square, Bhubaneswar. After some futile search in the nearby areas, he lodged FIR in the
Lingaraj PS, Bhubaneswar. But the local police registered the case on 03.03.2016 following his repeated visit to the
police station and a copy of FIR was given to him. A claim had also been lodged with the Insurer on 22.02.2016 and
all relevant documents were submitted before it. But the Insurer rejected the claim arbitrarily. Under such
circumstances he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that the complainant intimated the theft to the police after 12
days of occurrence and after 2 days to the Insurer. This violated policy condition no.1 which stipulated immediate
notice to police and as such, the claim was rejected. More so, the insured failed to submit one number of ignition key
and there was no proof that the key was lost.
Result of hearing with both parties(Observations & Conclusion):
I have elaborately gone through all the papers placed before this Forum. As it appears, the theft of the motor cycle
took place on 20.02.2016 while parked in properly locked condition. The complainant lodged FIR with Lingaraj PS,
Bhubaneswar but the local police registered the case on 03.03.2016 i.e. after 12 days of the theft. The Insurer was
intimated about the loss on 22.02.2016.The Insurer also asked the complainant by letter dated 09.03.2016 to explain
the delay which violated policy condition no. 1. But the complainant remained silent and did not comply. The relevant
policy condition no. 1 reflects that in case of a theft or criminal act leading to a claim, the Insured shall give immediate
notice to the police and co-operate with the Company in securing conviction of the offender. Here, although
opportunity was given to the complainant he failed to comply and did not explain the delay in lodging FIR. The Insurer
waited patiently for more than nine months and thereafter repudiated the claim by letter dated 30.11.2016. In view of
the above, it is clear that the complainant had, presumably, no reasons to explain the delay in intimating the police
after the theft of the Motor Cycle. Therefore, the Insurer is justified in rejecting the claim and as such, no intervention
is required in the decision of the Insurer.
***************************

Mr. Madhu Behera
Vs.
Magma HDI General Insurance Co. Ltd.
Award Dated 17th July, 2017
Brief Facts of the Case:

The complainant is the owner of the TATA Indigo car no.OD-02Q-2824 insured with the above Insurer for the period
from 05.04.2016 to 04.04.2017. The vehicle met an accident during the policy period. All the reports have been
submitted to the Insurer, but the Insurer made it ‘no claim’ on 07.07.2016. In such circumstances, he approached this
Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that the vehicle met an accident on 13.06.2016 and on receiving
the intimation a surveyor was appointed who inspected the damaged car and assessed the loss. Subsequently, on
scrutiny of vehicle papers it was noted that at the time of accident the vehicle did not have certificate of fitness Motor
Vehicle Act. As such, the Insurer rejected the claim.
Result of hearing with both parties(Observations & Conclusion).
I have elaborately gone through all the documents placed before this Forum. As it appears, the TATA Indigo car of
the complainant was registered as a passenger carrying (contract carriage) vehicle. As per M V Act and rules thereof
a Fitness certificate is required to be maintained in respect of the said vehicle by the complainant. But, it was found
from the certificate issued by the concerned RTO that the same was valid up to 08.05.2016 and again renewed from
05.07.2016 till 04.07.2017. Unfortunately, the vehicle met an accident on 13.06.2016 when it did not have a valid
fitness certificate in flagrant violation of the M V Act. In such circumstances the liability of the Insurer under the
insurance policy does not arise. So, the Insurer’s action in rejecting the claim appears to be justified. Since the vehicle
in question was a passenger carrying vehicle and since because it was plying without a valid fitness certificate at the
relevant point of time in gross violation of M V Act, the complainant is not entitled to the claim as advanced nor to
any other relief whatsoever.
******************
Mr. Rashmi Ranjan Sahoo
Vs.
Reliance General Insurance Co. Ltd.

The complainant is the owner of Bajaj Vikrant bike no. OD 02 AB 4424 insured with the aforesaid Insurer for the
period from 29.03.2016 to 28.03.2017 with IDV of Rs.61,837/-. Unfortunately, the vehicle was stolen by unknown
miscreants in the night of 05.08.2016. The matter was intimated to the Insurer and FIR was lodged with the local
police on 06.08.2016. But the police registered the FIR on 11.08.2016. So, there was no delay or negligence on his
part to intimate the theft to the police. The Insurer by letter dated 19.12.2016 offered to settle the claim on non-standard
basis at 75% of the IDV due to delay in FIR. The complainant sent representation to the Insurer to settle the claim in
full but there was no response. Under such circumstances, he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that the complainant was offered settlement on non-standard
basis due to delay in FIR subject to submission of all required documents for processing of the claim. Subsequently,
the Insurer intimated the complainant for submission of relevant documents but it was not complied. It had already
sent Regd. Letter with AD to the complainant and closed the claim as ‘no claim’ due to non submission of relevant
document Result of hearing with both parties(Observations & Conclusion):
I have elaborately gone through all the papers placed before this Forum. As it appears, the vehicle was stolen by
unknown miscreants in the night of 5/6.08.2016. The complainant immediately intimated the matter to the Insurer and
the local police, but the police registered the FIR after a lot of persuasion on 11.08.2016. The police investigated in to
the matter and submitted final report under section 379 IPC as FRT no clue. In the mean while the Insurer offered to
settle the claim on non-standard basis at 75% of IDV and advised the complainant to submit relevant papers. But, the
complainant did not submit any document except the vehicle papers and the keys as he did not agree with the amount
of offer. In this connection records submitted by the Insurer before this Forum does not reveal any communication by
the Insurer asking the complainant to explain the cause of delay in FIR. Therefore, closing the claim as ‘no claim’
without giving any opportunity to explain delay is not justified. Moreover, the complainant has explained that he
lodged FIR on 06.08.2016 but police delayed its registration and hence, there was no manner of latches or negligence
on his part. More so the alleged settlement on non standard basis as offered by the Insurer is totally foreign to the
policy terms and condition. I do not understand how the Insurer offered for such a settlement which is not contemplated
in the relevant policy condition. In view of the above the Insurer is directed to settle the claim for Rs.61,737/- i.e. IDV
less Compulsory excess of Rs.100/- and the complainant is ,also, directed to submit all relevant documents before the
Insurer for settlement of the claim at an early date.
*********************

Mr. Bhagaban Gouda
Vs.
Royal Sunderam Alliance Insurance Co. Ltd.
Award Dated 17th July. 2017
Brief Facts of the Case: The complainant was the owner of Mahindra Tractor no.OD-32-2262 insured with the
present Insurer for the period from 02.09.2014 to 01.09.2015 with IDV of Rs.5,36,000/-. Unfortunately, the tractor
was stolen on 11.08.2015 by unknown miscreant and the complainant intimated the matter to the L & T Finance as
the vehicle was under its finance. He submitted all required documents before the Insurer but no satisfactory action
was taken to settle the claim. Under such circumstances he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that on receiving claim intimation an Investigator was appointed
to investigate in to the theft. The Investigator received all required documents from the complainant and submitted his
investigation report. The claim was neither settled nor repudiated but pending for statement of the last driver of the
tractor.

I have gone through all the documents placed before this Forum with utmost care and caution. As it appears, the
tractor insured with the present Insurer was stolen by unknown miscreants in the night of 11.08.2015. The complainant
intimated the matter to the Insurer and Bhanjanagar police who registered FIR no.253/12.08.2015. The police
investigated into it and submitted final report as FRT no clue under section 379 of IPC. The Investigator appointed by
the Insurer also collected all relevant documents from the complainant and submitted his investigation report
concluding the theft to be genuine. In spite of all the above compliances, settlement of the claim was held up on
ground that the complainant failed to produce the driver before the investigator for interrogation. As a matter of fact,
no clause or condition of the policy contract is noted which makes it mandatory on the part of the Insured to produce
the driver for interrogation. Moreover, the police had submitted final report clearly declaring the theft to be true and
no clue. Therefore, the contention of the Insurer does not hold any ground. In such circumstances, the Insurer is hereby
directed to settle the claim at IDV less policy excess of Rs. 2930/- at an early date, as the vehicle was stolen during
the policy period.
***********************

Mr. Pradip Kumar Samal
Vs.
Oriental Insurance Co. Ltd., Puri
Award Dated 12th July 2017

The complainant is the owner of Hundai Verna car no OD-02D-2585 insured with the above Insurer for the period
from 23.02.2015 to22.02.2016 with IDV of Rs.5,75,000/-. Unfortunately, the vehicle met an accident on 25.08.2015
causing substantial damage to the car. He intimated the claim to the Insurer who deputed a surveyor to inspect the
damaged car and assess the loss. But till date the Insurer has not settled the claim in spite of my several letters. Under
such circumstances, he approached this Forum for Redressal.
On the other hand, the Insurer filed SCN and pleaded that after receiving the claim intimation one surveyor was
appointed to inspect the vehicle and assess the loss. The surveyor inspected the damaged vehicle and assessed the loss
at Rs.85,500/-and submitted report. Finally, the claim was settled by the Insurer on 10.04.2017 and loss voucher was
sent to the complainant by regd. post but it returned undelivered.
Result of hearing with both parties(Observations & Conclusion

I have gone through all the papers placed before this Forum with utmost care and caution. As it appears, the
vehicle met an accident during the policy period i.e. on 25.08.2015. The complainant immediately informed the
loss to the Insurer who deputed a surveyor to inspect the damaged car and assess the loss. The complainant
submitted before the Insurer the cash memos & bills on 11.12. 2015 after repair of the vehicle at OSL Motors (P)
Ltd. The surveyor assessed the loss for Rs.85,500/-and submitted report on 28.02.2016. No infirmity is noticed
in his mode of assessment. However,the Insurer settled the claim after much delay on10.04.2017 although the
survey report was submitted before it on 28.02.2016. The claim was finally settled for Rs.85,180/-as the
complainant had not submitted the bill for link assembly allowed by the surveyor and accordingly the loss voucher
was sent to the complainant. Since because the liability has been admitted by the Insurer and the claim already
settled by it there is no need to further delve deep into the matter. Therefore, the Insurer is herby directed to
immediately release the amount to the complainant without any further delay.
AWARD
***************************
Taking into account the facts & circumstances of the case and the submissions made by both the
parties during the course of hearing, a sum of Rs.85,180/-(Rupees eighty five thousand one
hundred eighty only) is hereby awarded to be paid by the Insurer to the Insured, towards full and
final settlement of the claim.
Hence, the complaint is treated as allowed accordingly.
Mr. Prafulla Kumar Sahu
Vs.
Oriental Insurance Co. Ltd.
The complainant was the owner of JCB no OR-08H-3216 and while it was engaged in pipeline work at Benaguda,
some mischievous people burnt down his vehicle on 30.05.2015. He lodged FIR with local police vide M.Rampur PS
case no.104/2015 and intimated the loss to the Insurer. The police investigated the matter and submitted FRT no clue.
The complainant approached the Insurer several times and submitted all the relevant papers but it did not settle the
claim. Finding no other alternative, he approached this Forum for Redressal.
The Insurer filed SCN and informed that the claim has already been approved by the competent authority for an
amount of Rs.14,76,375/- and the same has been intimated to the complainant. On compliance of the pre payment
formality by the complainant the amount will be released.
I have elaborately gone through all the papers placed before this Forum. The JCB engaged in road work at Benaguda
was set on fire by unknown miscreants in the night of 30.05.2015. The complainant lodged FIR and intimated the loss
to the Insurer. However, the Insurer’s representative informed the Forum at the time of hearing that the claim has
already been settled for an amount of Rs.14,76,375/-and the complainant has already complied the pre payment
formalities. The Insurer, further, declares that the claimed amount will be released in a week. In view of the above,
there is no need to go deep in to the merits of the case. Therefore, the Insurer is directed to pay an amount of
Rs.14,76,375/- to the complainant at the earliest.
Case no. CHD-G-023-1617-0436

In the matter of Mr. Ashok Kumar Vs Iffco Tokio General Insurance Company Ltd.
ORDER DATED 26.05.2017 (Motor)
FACTS: The complainant submitted that his Skoda car was insured for Rs. 9, 97,780/-. It
was stated to be a total loss. The insurance company invoked condition no. 3 of the
policy and offered the insured replacement of damaged vehicle with another vehicle
of same make and model, substantially in the same condition in which the insured
vehicle was prior to the date of occurrence.
FINDINGS: The complainant’s Skoda car model 2009 insured for Rs. 9, 97,780/- was stated to
have been damaged in an accident on 28.01.2016. The insurance company stated
that as per condition no. 3 of the policy an option is vested with the company either
to repair the damaged vehicle or reinstate or replace the vehicle or part thereof or
pay in cash the amount of loss or damage but not exceeding IDV. In the instant
case, the insurance company had opted to replace the damaged vehicle with another
vehicle of the same make and model and substantially in the same condition in
which the insured vehicle was prior to the occurrence given rise to claim.
DECISION: There was no dispute about the damage to the vehicle in the accident. Issue before
this forum was the mode of indemnity. The claimant had asked for settlement of
loss to the extent of IDV whereas the insurance company had opted to replace the
vehicle with same make, model and in the substantially same condition under
condition no. 3 of the policy. In view of the policy terms and conditions, no ground
was found to interfere in the decision of the insurance company and the complaint
was dismissed.
Case no. CHD-G-023-1617-0543

In the matter of Mr. Rajwinder Singh Vs Iffco Tokio General Insurance Co.
ORDER DATED 17.04.2017 (Motor)
FACTS: Complainant’s car was stolen on 17.10.2014 and FIR was lodged on 03.11.2014.
The claim was stated to have been intimated to the insurance company on
29.10.2014.The claim was denied on the grounds of delay in lodging the FIR and
late intimation to the insurance company.
FINDINGS: The car was reported to have been stolen on 17.10.2014. The complainant stated
that he immediately reported the theft on Police helpline No. 100. He also submitted
written request to the police but the police lodged the FIR only on 03.11.2014. He
also stated that he contacted the insurance company but was advised to submit
written intimation with a copy of FIR. The complainant had also submitted a
confirmation from the Police that intimation of theft was received by the Police on
17.10.2014 but the FIR was lodged only on 03.11.2014 as the Police and the owner
of the vehicle kept searching the vehicle. The insurance company also submitted
that apart from late lodging of FIR, delayed intimation of claim, non-traceable
report was also not submitted for a long time. The complainant stated that the court
issued the non traceable report only on 30.04.2016 and it was beyond his control.
DECISION: There was no dispute with regard to the theft of vehicle on 17.10.2014. The Police
had confirmed that the intimation of the claim had been submitted on 17.10.2014.
There was 12 days delay in written intimation of loss to the insurance company.
Denial of claim on technical ground of delayed intimation was found not in order.
IRDA had issued instructions that in case of delayed intimation, the reasons of
delay should be examined and claim should not be mechanically dealt with. It was
decided that the insurance company to pay 80% of the admissible claim as per terms
and conditions of the policy subject to completion of usual formalities.
SHRI. B.N.MISHRA, INSURANCE OMBUDSMAN
TAMIL NADU AND PONDICHERRY
Mr P Pradeep Kumar Vs HDFC Ergo General Insurance Co. Ltd
COMPLAINT REF: NO: CHN-G-018-1617-0585
Award No: IO/CHN/A/GI/0004/2017-2018
The complainant had insured his car with the respondent insurance company.
The complainant’s vehicle suffered damages on account of rat bite and a claim
of Rs151159 was preferred on the respondent insurer. But the claim was settled
for Rs5935 only. The complainant took up the matter with grievance on
26/10/2016. The Grievance cell vide letter dt 01/11/2016 replied that the
damage to meter assembly was not relevant to the cause of loss and hence only
wiring repair alone (caused by rat bite) was considered and settled. Not satisfied
with grievance reply the complainant approached this Forum.
As per survey report submitted along with the SCN by the respondent insurer,
the Cluster Assembly costing Rs141957.09 was disallowed. As per the surveyor
there was no link between wiring which was damaged by rat bite and the cluster
assembly. In other words rat bite was not the cause of cluster assembly
damage/repair. As per complainant, the cause of loss is rat bite. Since the repair
to cluster assembly was not caused by rat bite, the respondent insurer limited
the settlement of claim to Rs5935, being the cost of repair of wiring damaged by
rat bite.
Taking into account the facts & circumstances of the case and the submissions
made during the course of hearing, it is proved that the settlement of claim by
insurer is in order and no scope for reviewing the claim. Hence, the insurance
Ombudsman is not inclined to interfere in the decision of the insurer.
Thus the complaint is Dismissed.

OMBUDSMAN – SHRI B N MISHRA
Case of Mr. Kuppam V Reddy Vs Chola MS General Ins. Co. Ltd.
Complaint Ref: NO: CHN-G-012-1617-0661
The complainant’s insured car bearing Regn No. AP 03 AK 1008 got damaged in
Chennai floods during December 2015. The claim was lodged and the insurer
had agreed to settle the claim on total loss basis. Accordingly, the insurer had
arranged salvage buyer and fixed the salvage rate for Rs. 1,00,000/- and the
balance amount of Rs. 2,00,000/- was to be paid by the insurer. The
complainant was asked to submit some documents vide letter dated 23/05/2016
which the complainant was not aware of. As there was no response from the
insured/complainant, the insurer had closed the claim.
It was observed that the complainant’s vehicle was registered in Tirupati and as
Andhra Pradesh was the newly formed state, there was considerable delay in
getting the NOC from RTO. It is understandable that the delay in getting the
documents due to administrative inconvenience when the State is divided. In
spite of the difficulties, the complainant had submitted the required documents
on 12/07/2016 and the same was lost by the insurer. Hence he had re-
submitted the documents afresh on 15/10/2016. However, the insurer again
sent claim closure letter dated 17/06/2016.
The insurer sent notice of claim closure letter dated 23/05/2016 giving seven
days notice to comply with the requirements, without mentioning the relevant
clause of the policy. Subsequently the claim closure letter was sent on
02/06/2016 which is not acceptable.
The Forum questioned the inordinate delay on the part of insurer in settling the
claim and objected the insurer’s act of asking the complainant to submit the
documents again and again. The insurer’s representative agreed to settle the
claim within a fortnight time. The representative also agreed to settle the claim
after deducting the excess without asking any further documents as all the
relevant documents have already been submitted to the insurer.
Hence, the insurer is directed to settle the claim of Rs. 1,99,000/- (Rupees One
Lakh and Ninety Nine Thousand only) along with interest as mentioned in the
Insurance Ombudsman Rules, 2017, subject to other terms and conditions of
the policy and deductibles. Thus the complaint is Allowed.
OMBUDSMAN – SHRI B N MISHRA
Case of Mrs. Karpagam S Vs ICICI Lombard General Health Insurance Co. Ltd.
Complaint Ref: NO: CHN-G-020-1617-0673
The complainant’s insured vehicle met with an accident on 08/11/2016. As the

tyre got flattened, she could not push the vehicle, hence parked in the nearby
college. Next day she informed the mechanic and the mechanic dismantled the
vehicle to check the veracity of damage. Then it was reported to the insurer.
Seeing the vehicle in a dismantled condition, the surveyor had sought
clarification and the mechanic had replied him the situation under which the
vehicle has been dismantled. When the claim was lodged, the insurer had
rejected the claim stating that the vehicle was dismantled even before our initial
inspection and hence no opportunity to assess the loss was given to the
Company.
It is true that the damaged vehicle should be dismantled in front of the surveyor.
In a situation where it was dismantled before arrival of the surveyor, it is to be
ascertained whether the principle of Res ipsa loquitor will apply on seeing the
damaged/dismantled portion of the vehicle. No valid reason was given by the
insurer as to how the dismantling of the vehicle has technically affected the
assessing of loss/damage to the vehicle.
Copy of the survey report should have been submitted, irrespective of the fact
whether the claim was payable or not. Moreover, from the claim rejection letter
it was observed that the claim was rejected as no opportunity was given to the
insurer to assess the loss.
Hence, the insurer is directed to settle the claim in favour of the insured subject
to other terms, conditions and deductibles under the policy if any.
Thus the complaint is Allowed.

In the matter of Mr. Vijay Singh Gehlot
Vs
HDFC Ergo General Insurance Company Ltd.
1. The complainant had stated that the vehicle met with an accident on 25/02/2017. The complainant gave claim
intimation on next working day i.e. 27/02/2017 being Monday and the complainant also applied on same day
for the transfer of insurance policy in favour of insured Mrs. Savita. The complainant had
pleaded that the 14 days grace period for applying insurance transfer should be calculated from 13/02/2017
i.e. the date of transfer of ownership of vehicle. The representative of Insurance Company had reiterated that
the sale of vehicle took place on 12th Jan.17 so on the day of the accident i.e. 25.02.2017 no insurable interest
exists for Mrs. Savita. During the course of hearing the Insurance Company had referred a Judgment of
National Consumer Disputes Redressal Commission in the case of Future Generali India Insurance V/s Sombir
on 16.08.2016 it was held that “The transfer of vehicle is governed by the provision of sale of goods Act”. In
the absence of any agreement to the contrary payment of price and delivery of vehicle make the sale complete
and the title passes to the purchaser. The obligation to register the vehicle is for the purpose of controlling and
regulating the movement of vehicle by the authorities under the Act and they do not stand in the way of passing
title to the purchaser.”
2. On scrutiny of papers I find that as per GR-17 of India Motor Tariff-2002 “The transferee shall apply within
fourteen days from the date of transfer in writing under recorded delivery to the insurer who has insured the
vehicle, with the details of the registration of the vehicle, the date of transfer of the vehicle, the previous owner
of the vehicle and the number and date of the insurance policy so that the insurer may make the necessary
changes in his record and issue fresh Certificate of Insurance”. The complainant had made available the duly
verified R.C. particulars by the Registering Authority, Wazirpur, wherein the date of transfer of ownership in
favour of Mrs. Savita is 13.02.2017. As per the provision of Motor Vehicle Act-1988 and under GR-17 of
India Motor Tariff, the 14 days grace period for applying the insurance transfer ends on 26.02.2017, whereas
the date of accident was 25.02.2017. The Insurance Company had stated in the self contained note that the
complainant applied for transfer of insurance on 27.02.2017 which was beyond the grace period of 14 days
from 12.01.2017. With regard to the applicability of the judgment of National Consumer Disputes Redressal
Commission, as mentioned above it was held that transfer of vehicle is governed by the provisions of sale of
Goods Act. In the absence of any agreement to the contrary payment of price and delivery of vehicle make the
sale complete and the title passes to the purchaser. In view of cited judgment of National Consumer Disputes
Redressal Commission it is clear that the sale of the vehicle in the case was completed on 12.01.2017. The
complainant could not apply for transfer of insurance within 14 days from 12.01.2017. Even if the date transfer
as mentioned in the RC is taken into consideration for application that too, falls beyond the 14 days grace
period. Under the provision of GR 17, it was duty of the complainant to apply to the insurer within 14 days of
transfer of ownership, failing which he cannot be held eligible to get the claim of the vehicle. Accordingly I
uphold the decision of Insurance Company for repudiation of claim.
In the matter of Mr. Satish Gupta v. National Insurance Company Ltd.
1. Mr. Satish Gupta has made a complaint to this office of Insurance Ombudsman on 13.02.2017
against National Insurance Company Ltd. alleging non- settlement of his Motor claim under
policy number 35101031146136263711.
2. The complainant had lodged the complaint of theft of his vehicle from road side immediately
on 10.07.2015 on PCR No. 100, and FIR was lodged by police on 13.07.2015 in spite of
completing all the formalities. The Insurance Company had rejected his theft claim on the
ground that the insured had not taken sufficient care of the vehicle by not locking it properly,
which constitutes violation of policy condition no. 4. The car was later discovered by police
and company’s surveyor prepared loss assessment report for Rs.50220/-, but the company
again rejected the Damage claim on the ground that “once the claim for the theft, which is the
primary reason, has been repudiated by the company, the subsequent loss cannot be accepted/
validated by the company.”
3. On scrutiny of papers and presentations from both sides during the course of hearing, Hon’ble
Insurance Ombudsman found that the theft of his vehicle from road side took place on
10.07.2015. The theft claim was rejected on the ground of misrepresentation of incident by
insured, and that the insured had not taken sufficient care of the vehicle by not locking it
properly, which constitutes violation of policy condition no. 4. Nature of misrepresentation
was not made clear in the rejection letter. Further, the vehicle was recovered on 02.07.2016,
and damages were assessed by the surveyor, deputed by the company. The damage to the
vehicle occurred whilst the vehicle was not in the custody of the insured. The second claim is,
thus, not related to the first claim. Therefore, the company cannot escape from its liability to
pay expenses for the damage claim. Accordingly, the Insurance Company was directed to treat
the claim as admissible and settle the claim as per policy terms and conditions within 30 days
from the date of receipt of the Award. There is no further relief to be granted to the
complainant.
4. Hence, the complaint is disposed off accordingly. Copies of the Order to both the parties have
been delivered.
In the matter of Mr. Arun Kumar Saxena
Vs
Bajaj Allianz General Insurance Company Ltd.
1. Mr. Arun Kumar Saxena (herein after referred to as the complainant) had filed the complaint
to this forum on 30.05.2017 against the decision of Bajaj Allianz General Insurance Company
Ltd. (herein after referred to as respondent Insurance Company) regarding the repudiation of
motor insurance claim of theft of vehicle.
2. The Insurance Company had repudiated the claim of the complainant on the grounds that the
complainant had no insurable contract with insurer as at the time of theft of car, the ownership
of the vehicle was in the name of the complainant Mr. Arun Kumar Saxena in the Registration
Certificate, but the Insurance policy was still in the name of previous insured i.e. Hero Motors.
Therefore, the complainant failed to get the insurance policy transferred in his favour within
stipulated time of 14 days after the ownership of vehicle got transferred on 04.04.16 and the
vehicle stolen on 09.05.2016.
3. In view of the breach of policy condition of GR 17 which speaks as “ the transferee shall apply
within fourteen days from the date of transfer in writing under recorded delivery to the insurer
who has insured the vehicle, the date of transfer of the vehicle, the previous owner of the
vehicle and the number and date of the insurance policy so that the insurer may make the
necessary changed in his record and issue fresh certificate of insurance” this forum had uphold
the decision of Insurance Company for rejection of claim as there was no contract of Insurance
between complainant and Insurance Company.
4. There is no further relief to be granted to the complainant.
5. Hence, the complaint is disposed off.
6. Copies of the order to both the parties have been delivered.

In the matter of Ms. Anjani Kumar Mishra
Vs
ICICI Lombard General Insurance Company Ltd.
1. Ms. Anjali Kumar Mishra (herein after referred to as the complainant) had filed the complaint
to this forum on 12.06.2017 against the decision of ICICI Lombard General Insurance
Company Ltd. (herein after referred to as respondent Insurance Company) under policy no.
3001/98480173/00/000.
2. The complainant was asked by the Insurance Company to submit/provide certain documents
to initiate the repairs to the vehicle, which the complainant had claimed to have already
submitted to the Insurance Company.
3. On intervention of this office, the Insurance Company had agreed to settle the claim on net of
salvage basis for which the complainant had also given the consent.
5. Hence, the complaint was disposed off.
In the matter of Mr. Shubham Bansal

Vs
National Insurance Company Ltd.
1. The complainant alleged that his vehicle was stolen, on 05/06.09.2015 (night) FIR was lodged
on 07.09.2015 and claim intimation was given to the company same day inspite of completing
all the formalities, the Insurance Company had rejected the claim. He sought relief of
Rs. 5,60,000/- from this forum.
2. The Insurance Company had repudiated the claim due to non-submission of satisfactory keys by
insured. The keys submitted by the insured were quite different in shape and size and cannot
belong to the same vehicle. Also the insured could not submit any satisfactory explanation
regarding the keys.
3. During the course of personal hearing the complaint stated that he had submitted both the keys
to the Insurance Company. He had purchased the 2nd hand vehicle along with the keys obtained
from the dealer were used to start the vehicle. The Insurance Company reiterated that both keys
were different in shape and size and produced one key during the personal hearing but could not
produce the 2nd key in support of their contention. On perusal of papers on record I find that
vehicle was stolen during the currency of the policy. The fact of theft was not denied by the
company. The Insurance Company had only key, and could not produce the 2nd key (although
the complainant had submitted two keys) to substantiate the rejection ground that both keys
submitted by the complainant were different in size and shape. The Insurance Company could
not prove their contention with cogent & reliable documents. Accordingly an award is passed
with the direction to the Insurance Company to settle the claim on sub-standard basis (75%
of IDV of the vehicle) as per terms and condition of the policy.
In the matter of Mr. Dev Kalra

Vs
ICICI Lombard General Insurance Company Ltd.
1. The complainant had stated that his vehicle was stolen on 09.07.2016 and the incident of
theft was immediately reported to the police and the Insurance Company. The complainant
had pleaded that he had submitted both the original key to the Insurance Company.
2. The representative of the Insurance Company reiterated that claim was rejected on the
grounds that the keys submitted by the complainant were different and one of the key was of
local make. As per the forensic report submitted by the TRUTH LABS FORENSIC
SERVICES, the keys were found to be different from each other. This was considered as a
case of misrepresentation and claim was rejected.
3. On scrutiny of papers, I find that the complainant had submitted both the keys to the Insurance
Company. The Insurance Company obtained the forensic report and which showed that the
keys were different. However the fact of theft of the vehicle was beyond doubt. During the
personal hearing both the parties had agreed for the settlement of claim on sub-standard basis.
Accordingly, Insurance Company is directed to settle the claim on substandard basis @
75% of IDV within 30 days of receipt of the Award.
In the matter of Mr. Ajeet Singh
Vs
Bajaj Allianz General Insurance Company Ltd. (New Delhi)
1. The complainant had stated that he was not aware that after the transfer of ownership of
vehicle from R.T.O., the insurance policy was also required to be transferred in
complainant’s name. The representative of Insurance Company reiterated that there was no
insurance contract between the complainant and the Insurance Company as the insurance
policy was in the name of Neeru Choudhary. The vehicle was purchased by the complainant
Mr. Ajeet Singh and the ownership was transferred in R-C. on 29.12.2015, whereas the
vehicle was stolen on 17.10.2016 and till that time the insurance policy was not applied for
transfer in favour of the complainant and the policy was still in the name of Neeru Choudhary
and the policy expiring date was 10.11.2016. The theft took place on 17.10.2016 and the
policy remained in the name of Neeru Chaudhary, from whom he had purchased the vehicle.
2. On scrutiny of papers, I find that the complainant failed to get the insurance policy transferred in
his favour till the expiry date of policy period, which clearly indicate that there was no insurable
contract between Insurance Company and the complainant. Hence, in view of the breach of policy
condition of GR 17 which speaks as “ the transferee shall apply within fourteen days from the
date of transfer in writing under recorded delivery to the insurer who has insured the vehicle, the
date of transfer of the vehicle, the previous owner of the vehicle and the number and date of the
insurance policy so that the insurer may make the necessary changed in his record and issue fresh
certificate of insurance”. Accordingly, I uphold the decision of the Insurance Company to
repudiate the claim. Accordingly, the complaint of the complainant is disposed off.
In the matter of Mr. Devender Kumar

Vs
Oriental Insurance Company Ltd.
1. The complainant stated that his vehicle was stolen on 21.09.16 and he used to drive his vehicle for his family
purposes only.
2. The Insurance Company stated in the hearing that the vehicle of the complainant was registered as private car
but he used to drive his vehicle for the purpose of business, hence his claim was rejected by them.
3. During hearing, we found that the Insurance Company could not substantiate their case to prove that the
complainant used to drive his vehicle for commercial purposes. The complainant stated that he used to drive his
car only for family purpose. Accordingly, we directed the Insurance Company to settle the admissible claim of
the complainant as per terms and conditions of the policy.
5. Hence, the claim is disposed off.
COMPLAINT REF:NO: GUW-G-049-1617-0072 (Awarded on 24/04/2017)

Partha Protim Bharali V/S The New India Assurance Co. Ltd.
It was a Claim for Material damage repudiated by the Respondent Insurer “DUE TO
CONCEALMENT OF FACTS (3 PREVIOUS CLAIMS WITH OTHER INSURERS)”. Policy was
taken online by the Insured without disclosing the fact vis-à-vis claims in previous years.
Having taken into account facts & circumstances of the case and the submissions (oral &
documentary) made by both the parties during the course of hearing, this Forum does not
have an iota of doubt that there was indeed deliberate suppression of facts with reference to
previous claims history on the part of the Insured/Complainant and hence this Forum does
not deem it necessary to intervene with the Insurer’s decision, which stands upheld.
The Complaint is therefore disposed of without any relief to the Insured.
COMPLAINT REF:NO: GUW-G-005-1718-0005 (Date of Order 30/05/2017)

Atul Garg V/S Bajaj Allianz General Insc Co. Ltd.,
Case of Extensive material damage to the Vehicle (Private Car) having IDV wroth Rs.
258479/- apparently resulting in Total Loss.
Having taken into account facts & circumstances of the case and the submissions (oral as
well as documentary) during the course of hearing, it has been observed that the Dispute is
solely on who the Driver was at the material time. There are contrasting Claims by the
Complainant/Respondent and there are conflicting Reports submitted by the same authority
(in this case the Superintendent of Police, East Khasi Hills, Meghalaya - while naming the
Driver at the material time) reconciliation of which is NOT within the
jurisdiction/wherewithals of this Forum.
In view of the above it is considered reasonable to close the complaint by this Forum. The
Complainant is, however, allowed leave of approaching other appropriate Forum if he so
desires.
The complaint is thus treated as CLOSED.

COMPLAINT REF:NO: GUW-G-005-1718-0009 (Awarded on 29/06 & modified on
03/08/17)
Anwari Khatoon V/S Bajaj Allianz General Insc Co. Ltd.,
Case of Total Loss of a Private Car arising out of a road accident also resulting in death of
the owner and grievous injuries to four others. Repudiated by Insurer based on
Administrative instruction (by the Govt. of Nagaland notification) that DL not converted to
Sarathi Smart Card Format by 01/12/2014 has to be treated as NOT VALID even if
otherwise found genuine. In the instant case the DL was otherwise found to be
genuine.
This Forum is of the opinion that mere adherence by the Insurer to the Notification
issued by the Transport Commissioner, Govt. of Nagaland & absolutely mechanical
application thereof (in the instant case/claim) cannot nullify the validity of an
admittedly effective License. As such, the Respondent’s decision is hereby set
aside and an amount equivalent to IDV of Rs. 416826/- MINUS Compulsory Excess
is hereby awarded to be paid by the Insurer, towards full and final settlement of
the claim.
Corrigendum
In view of the inadvertent mistake and omission as pointed by the Complainant vide her
Letter dated 26/07/2017, the Award dated 29/06/2017 against the Complaint No. as stated
above be and is modified as below:
a) Name of the Insured …. Late Shahzada Ansari in place of

Mrs. Anwari Khatoon.
b) Operative part of the Award

(modified)
“As such, the Respondent’s decision is hereby set aside and an amount equivalent
to IDV of Rs. 416826/- MINUS Compulsory Excess is hereby awarded to be paid by
the Insurer. ‘Since the dispute regarding Validity of the Owner-Driver’s licence
has been resolved/set to rest and the entire claim has been allowed, the
compulsory Owner-Driver’s PA cover also be and is hereby allowed to be settled
by the Insurer in favour of the Complainant along with the OD claim towards full
and final settlement of the claim.”
AHMADUL HAQUE LASKAR V/S SBI General Insurance Co. Ltd.
It was a case of Repudiation of a high-value Motor OD Claim also upheld by the highest
Appellate Authority of the Insurer because of the vehicle allegedly carrying 4 (four) persons
at the material time beyond the permissible limit of 3 (three).
After taking into account facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, it has been observed that the Insurer’s action
was NOT based on any conclusive documentary evidence. On the other hand all relevant
documents including GDE, Police Report and MVI Report submitted by the Complainant
unfailingly point to the fact that there were three persons on board including the Driver.
Besides the mere factum of the presence of just one more person in the vehicle could not be
germane to rendering the claim a nullity and thus disentitling the Insured from claiming
compensation.
Considering totality of circumstances it is therefore held that repudiation was not in order
and is liable to be set aside. Accordingly an amount equivalent to the SI minus Compulsory
Excess (Rs. 11,19,000 – 1000 = Rs.11,18,000/-) is hereby awarded to be paid by the
Insurer, towards full and final settlement of the claim. That the cost of lifting the vehicle is
prohibitive and the vehicle was not economically repairable stood intimated to the Insurer
by the Insured.
Hence, the complaint is treated as CLOSED in favor of the Complainant.

Ijaz Ahmed V/S Cholamandalam MS Gen. Insu.Co. Ltd.
Motor OD Claim was repudiated by the Insurer on the ground THAT THE VEHICLE WAS
PLYING AT THE MATERIAL TIME WITHOUT A VALID ROUTE PERMIT in violation of Sec.84 of
the MV Act and consequently in violation of terms & conditions of the Policy. Complainant
maintains that he was not aware of such
Mandatory precondition and the Dealership has also gone on record stating that they also
did not educate the Customer about the requirement.
After taking into account facts & circumstances of the case and the submissions (oral &
documentary) made by both the parties during the course of hearing, following points stand
out as significant:
1) It was a case of Motor Own Damage Claim arising out of a road accident involving a
Transport Vehicle;
2) The claim was repudiated by the Respondent Insurer on the ground
that the vehicle was plying without any Route Permit;
2) Even though the Insurer did not specify anything in their SCN as to
the relevant Section (Sec 66) of the MV Act 1988, violation of which
indeed renders the Claim of compensation liable for repudiation;
the provisions as elaborately spelt out under Section 66 of the MV Act 1988 read
with its various sub-sections vis-à-vis Necessity for Permits, clearly make the Claim
untenable.
This Forum, therefore, finds no reason to interfere with the decision taken by the Respondent
and the complaint is treated as dismissed and closed without any relief to the Complainant.
Nazrul Islam V/S The National Insurance Co. Ltd.
It is a case of Motor OD Claim. According to Insurer, due diligence was carried out in every
sense of the term BUT the Insured allegedly failed to comply with the required documents
despite repeated entreaties (verbal & written). Insured expressed dissatisfaction with the
quantum of assessment to which the Insurer ‘verbally’ requested the Surveyor for a review.
But the Surveyor chose to stick to his original assessment. Insured by a letter dated
15/11/16 asked for a copy of the Survey Report, but the Insurer preferred to ignore the
request “as the file has already been closed as NO CLAIM”.
On the basis of the available documents placed before this Forum and after taking into
account facts & circumstances of the case including the submissions made by both the
parties during the course of hearing, we are of the opinion that both the Respondent and
the Complainant (in that order) are guilty of resorting to opaque and obviously unwarranted
actions rendering us unable to accept or deny the veracity of facts and authenticity vis-a-vis
Estimate of Repairs as well as the Survey Report, which need thorough investigation
(conforming to the time, place & nature of the accident besides the place where the repair
work was undertaken). Such matters are beyond the jurisdiction and wherewithal of this
Forum.
In view of the above it is considered reasonable to close the complaint from this Forum.
The Complainant is, however, allowed leave of approaching other appropriate Forum if he so
desires.
Hence, the complaint is treated as CLOSED.
COMPLAINT REF:NO: GUW-G-038-1718-0007 (Awarded : 29/06/2017)
Sopiar Rahman V/S ROYAL SUNDARAM ALLIANCE INSURANCE CO. LTD.
In a case of Motor OD Claim Unknown miscreants set the Tractor afire

in a remote place of Meghalaya leading to extensive material damage to the vehicle.
Insurer insists that the claim was formally closed in 2013 for non-submission of required
documents despite numerous letters. But the Insured maintains that except for the first
letter he did not receive any other communication. Moreover, the Insured belongs to a
remote border area of the state of Assam whereas the incident occurred in the state of
Meghalaya (West) rendering it difficult to complete the formalities and obtain the required
documents within a set deadline. It is also worth mentioning that there is an e-mail dt.
04/06/2015 from the Insurer to the Dealership (who were handling the matter on behalf of
a virtually illiterate Insured) hinting at REOPENING OF THE CLAIM FILE which, however,
never happened.
It was a case of Closure of Motor OD Claim in September 2014 for alleged non submission
of documents inspite of ‘reminder letters’ sent to the Complainant who however maintains
that he received only one letter from the Insurer. The Insurer could not adduce any
evidence towards dispatch of ‘reminder letters’ by way of Postal/Courier Receipts. Prima
facie, the Insurer’s conduct was that of absolute indifference in as much as Insured’s
repeated request letters, personal visits to Insurer’s Guwahati Office for consideration of the
claim went in vain despite Insurer’s emailed communication on June 4, 2015 to the
Dealership stating inter alia that ‘based on the Insured’s request letter, we will try to take
special approval from our HO….’. The Complainant reiterated the sequence of events during
the course of hearing with no rebuttal whatsoever from the Insurer’s Representative
In view of the foregoing and considering the totality of circumstances this Forum is of the
opinion that repudiation of the Claim was not in order and is liable to be set aside.
Accordingly an amount equivalent to the Preliminary Assessment (Rs. 1,50,000/-) is
considered to be the bare minimum payable and is therefore awarded to be paid by the
Insurer, towards full and final settlement of the claim.
The complaint may now be treated as CLOSED.
Ajoy Kumar Ghosh V/S The National Insurance Co. Ltd.
It was a case of Repudiation of a Vehicle Theft Claim on the grounds of a) Driver NOT
HOLDING a VALID D/L at the material time; b) Non-disclosure/misrepresentation vis-à-vis
NCB earned with the previous Insurer.
Complainant, however, refutes both the charges.
Considered the submissions of the complainant. Also perused the detailed written
submissions of both sides which are placed on record and also verbal arguments made
during the course of hearing including the submission of the Respondent that their objection
vis-à-vis validity of DL. no longer exists. After due consideration of the matter it is held that
the insurance company was not justified in repudiating the claim because vehicle was
stolen, which was not found. The insurance company was informed about the loss and FIR
was also lodged with the police. Insurance company could not produce any evidence to the
effect that while renewing the policy with the present insurer, the insurer had claimed NCB.
Therefore insured cannot be held liable and cannot be further penalized for not allowing
rightful claim to him. The complainant had complied with all the formalities with regard to
the loss of the vehicle. Complainant had suffered total loss for the vehicle. Accordingly,
claim is payable and award is passed with the direction to the Insurance Company to make
the payment of Rs. 560000/- MINUS Policy Excess i.e., Rs.559000/-.
A K Deuri V/S The National Insurance Co. Ltd.
Case of Total Repudiation of a Motor OD Claim obviously laying emphasis on

Repairer’s Statement leading to the point of casting explicit aspersions on the Insured by
the Insurer/Respondent followed by repudiation of the Claim.
After taking into account available documents on record as well as facts & circumstances of
the case and the submissions made by both the parties during the course of hearing, it is
found there are contradictions aplenty vis-à-vis the submissions (documentary & oral) by
both the parties with regard to 1) Garage Receipt (Rs.343644 instead of Rs.90000/- as per
written admission by the Garage Owner); 2) Garage Bill (where Cost of Labour and Spares
when calculated separately are found to be at variance and fail to add up to the total bill
worth Rs.343644/-); besides Garage owner’s Letter to the Insurer dated 03/01/2017
requesting, inter alia, not to consider the Bill at face value.
Reconciliation of all such Conflicting Claims and Counter Claims needs a through
investigation across several domains – which is beyond the jurisdiction and wherewithal of
this Forum.
In view of the above it is considered reasonable to close the complaint from this Forum.
The Complainant is, however, allowed leave of approaching other appropriate Forum if he so
desires.
Nazuma Ara Begum V/S The National Insurance Co. Ltd.
It was a case of Vehicle Theft Claim. Vehicle was given on hire to Speed Express who set
out for a trip to Agartala carrying Godrej & Boyce’s A.Cs. & Refrigerators on 30/04/2014
from Godrej’s warehouse at Boragaon, Guwahati towards Agartala. The Insured was
informed on 02/05/14 by Speed Express about non-arrival of the vehicle at
Agartala, following which the Complainant lodged an FIR on 03/05/2014 at
Garchuk PS, Ghy (nearest to the point of loading) and informed the Insurer on
06/05/2014. Insurer objected to 1) delayed intimation & 2) Violation of Route Permit and
repudiated the Claim. IRDA Circulars dated 28/06/17 and 20/09/11 regarding ‘delay in
intimation’ were obviously not taken into consideration.
After taking into account facts & circumstances of the case and the submissions made by
both the parties during the course of hearing, the following points emerged worth
consideration:
a) According to the Insurer, Route Permit is no longer an issue which
stands sorted out and resolved in favour of the Insured;
b) As for alleged late intimation, the clause appears to have been
applied purely on mechanical grounds in a mechanical fashion without going into the
merits of related circumstances and the reasons behind.
c) It was a theft case for which the FIR was lodged in time and the
Insurance Company was notified within 4 (four) days. The complainant also
complied with all the formalities with regard to the loss of the vehicle.
Accordingly the decision of the Respondent is held liable to be set aside and the
Complainant is hereby awarded to be paid an amount of Rs. 520000/- MINUS Policy Excess
of Rs. 1000/- by the Insurer, towards full and final settlement of the claim.
Sidharth Agarwal V/S Bharti AXA General Insurance Co.Ltd.
Case of Material Damage Claim arsing out of an accident to a Private Car. Complainant not
agreeable to the assessed amount because according to him the Surveyor initially/verbally
approved for a higher amount in the presence of the repairers following which the repair
work was undertaken. However, Surveyor scaled down the assessed amount by nearly half
while submitting his Report.
Perused the detailed written submissions of both sides which are placed on record and also
considered verbal arguments made during the course of hearing.
Complainant’s argument that “the Surveyor resorted to unfair practice of allowing higher
assessment (albeit verbally) in the presence of Dealership’s Workshop Manager (on the
basis of which Repair Work was undertaken) but ultimately assessed the loss at nearly half
the amount” could not be SUBSTANTIATED by producing any documentary evidence.
Under the circumstance, the Respondent’s decision to settle the Claim as assessed by the
Surveyor is upheld and the Complainant is hereby awarded Rs.11,000/- to be paid by the
Insurer, towards full and final settlement of the claim and the Complaint is treated as
CLOSED by this Forum.
Surajit Kalita V/S Cholamandalam MS Gen. Insu.Co. Ltd.
Case pertains to CLOSURE of a high value MOTOR OWN DAMAGE claim “without any
communication by the Insurance Company till date” consequently resulting in harassments
including financial hardship (Complaint letter dated 15/05/2017 is a vivid testimony).
After taking into account facts & circumstances of the case and the submissions (oral &
documentary) made by both the parties during the course of hearing, the following salient
points emerged worth consideration:
a) The plea of ‘delayed intimation’ has been applied purely on technical grounds in a
mechanical fashion without going into the merits of related circumstances and the
reasons behind and in
contravention of the relevant IRDA Circulars 20/09/2011 and
28/06/2017.
b) No documentary evidence towards alleged ‘delay in intimation
by 19 days’ could be produced/provided by the Respondent even
as the accident was reported to the Police without any delay despite
Insured’s preoccupation with the medical help to the handyman/helper of the vehicle
who got seriously injured in the accident.
c) On the other hand one particular document available on record suggests that the
Date of Assessment was on 31/03/2015 (01.05 pm) even though the Surveyor’s
Appointment (for the job) was on 03/03/2015. Surprisingly, a delay of 28 days was
not considered
material in the context of the decision taken by the Respondent.
In view of the above, the decision of the Respondent is held liable to be set aside and the
Complainant is hereby awarded to be paid towards full and final settlement of the Claim an
amount of Rs. 492250/- as assessed by the Surveyor with the right to retention of
‘wreckage’ and disposal thereof vested on the Complainant himself.
****************
Complaint No. I.O.(HYD) G -11.047.0008 / 2017-18
Mr. N. Naveen Reddy VS. TATA AIG Gen. Ins. Company Ltd.
Award No. I.O. (HYD)/A/GI/0005/ 2017-18 Dt.11.08.2017
FACTS
The complainant, Sri N. Naveen Reddy insured his Maruti Swift VDI car bearing No. AP 29 BF 9630
with the respondent insurer under Auto Secure – Private Car Package Policy for an IDV of Rs.2.50
Lacs from 21.08.2015 to 20.08.2016. The vehicle met with an accident on 29.11.2015. The
Complainant shifted the vehicle to Pistons & Spanners, Amberpet, Hyderabad garage and repairs
were estimated by them at Rs.38,293/-. Basing on the surveyor’s observations in his report, the
insurer rejected the claim on the ground that the parts were cannibalized and cause of loss did
not corroborate with the damages claimed.
FINDINGS
The complainant reported that the surveyor deputed by the insurer approved the claim partially
and he had not given proper reply for partial rejection of the claim. He escalated the matter to
the Grievance Cell of the insurer. In the mean while the repairs were carried out by the repairer
and the repair bills were collected by a surveyor deputed by the insurer on 21.12.2015. After
that he received a mail stating that his claim was declined and the insurer quoted several
irrelevant reasons to repudiate his genuine claim. The insurer in their SCN contended that the
surveyor deputed noted several discrepancies and the damages to the vehicle were not
corroborating with cause of loss stated in the claim form and there was cannibalization of parts
and hence the claim was declined.
DECISION
The Forum analyzed the survey report and the claim form. It is observed that the complainant
proceeded with repairs without any authorization or approval from the insurer. It is also observed
that the queries raised by the surveyor were all relevant and the damages were not corroborating
with the cause of the accident as stated in the claim form. During the hearing the representative
of the insurer stated that the surveyor visited the garage immediately after receipt of the
intimation and having found the scoring marks on nuts and bolts, he advised the garage people to
dismantle the vehicle. After dismantling of the vehicle the repair estimate submitted did not
corroborate with the cause of accident. The insurer sent a detailed letter 21.12.2015 to the
complainant wherein 8 clarifications were sought for which the complainant replied but only to
the first query vide his e-mail dated 04.02.2016 while denying the rest of the observations of the
surveyor. The complainant-insured is supposed to give satisfactory replies to all the queries raised
by the insurer before initiating/authorizing repairs. He further chose to take delivery of the vehicle
without giving an opportunity to the insurer to re-inspect the vehicle after repairs. Hence, the
insurer is justified in rejecting the claim.

Mr. B. Gowtham Reddy VS. Liberty Videocon Gen. Ins. Company Ltd.
Award No. I.O. (HYD)/AGI/0017/ 2017-18 Dt.11.08.2017
FACTS
The complainant, Sri Baddam Gowtham Reddy insured his Mahindra Scorpio vehicle bearing No.
TS 07 FL 7477 with the respondent insurer from 09.02.2017 to 08.02.2018 for an IDV of
Rs.10,30,033/- under the Motor Private Car Package Policy. The insured vehicle completely got
damaged due to fire on 05.03.2017. The claim filed by him was repudiated by the insurer stating
that there was alteration of wiring harness and it resulted in a loss and hence the claim was not
payable.
FINDINGS
The insurer contended that the vehicle manufacturer, after inspection of damaged vehicle,
confirmed vide their e-mail dated 10.05.2017 that the Fire was not caused due to manufacturing
defect and there was no external means/impact to cause fire in the vehicle. Thus the only thing
remains to conclude on the cause of Fire was that the fitment of non OE electrical accessories. By
fitment of higher capacity audio systems and speakers, the wiring harness was altered and it
resulted in cause of Fire. Hence, the claim was repudiated under Section I 2 (a) and condition no.
8 of the policy.
DECISION
The main ground on which claim rejected was installation of non official equipment like music
system and speakers. The brand new vehicle was burnt on 5.3.2017 and the insurance was
effective from 09.02.2017. The FIR confirmed the loss as Fire and manufacturer’s representatives
inspected the vehicle and confirmed that there was no manufacturing defect but they observed
that additional accessories were fitted which were non original equipment (OE) electrical fitment
and but they did not comment in this regard which is beyond the scope of the manufacturer. The
owner’s manual of the vehicle confirms that this model Scorpio (Model S4+) does not have inbuilt
audio system with CD/USB/Aux. The cause of fire was attributed by the insurer to the tampering
of the wiring harness by the insured. The survey report was verified to know whether the surveyor
attributed either remotely or directly the cause of fire to change of wiring harness. The surveyor
in his report confirmed presence of speakers and manufacturer’s remarks. No specific reason for
origination of Fire was found out by the surveyor. In these circumstances, since the insurer failed
to attribute the cause of fire to the excluded perils, the insurer is not justified in rejecting the claim
totally. However, the insured should not be allowed to get absolved of his omission to notify the
insurer about installation of non original equipment in his vehicle and paying additional premium
for the accessories fitted. Hence, the claim may be allowed on non-standard basis at 75% of the
IDV amount of Rs.10,30,033/- along with interest in terms of Rule 17(7) of Insurance Ombudsman
Rules, 2017.

Mr. R. Nitin Joseph VS. The New Indi Assurance Company Ltd.
FACTS
The complainant, Mr. Raja Nitin Joseph insured his Bajaj Discover Motor Cycle bearing No. TS 10
ED 1676 with the insurer under Two Wheeler Package Policy for an IDV of Rs.50,000/- from
23.01.2016 to 22.01.2017. The insured’s father Mr. R. R. Karunakaran took the vehicle on
27.02.2016 and went to Parade Grounds for morning walk. He parked the vehicle in front of the
gate and forgot to collect the key. The vehicle was stolen from the parked place. The theft of
vehicle was registered vide FIR No. 91/2016 by PS Begumpet and closed the FIR by issuing Final
Report as ‘Undetectable’. The relevant claim documents were filed for settlement of theft claim.
The insurer rejected the claim invoking condition No. 4 of the policy.
FINDINGS
The insurer submitted that as per the statement given by insured’s father, i.e. Mr. Karunakaran
for registration of FIR, it is noted that he left the vehicle ignition key on the vehicle itself. The
insured had failed to ensure safety of the vehicle while parking the vehicle by leaving the key to
the vehicle itself. Had he taken the precaution of removing the key from the vehicle after locking
the vehicle, he could have taken care to protect his vehicle from theft. Hence, the claim was
repudiated.
DECISION
The subject claim is for theft of motor cycle and all the documents, right from claim intimation
to final investigation report confirm the fact that the father of the insured left the keys of the
vehicle on the vehicle itself while parking the vehicle at parade ground. The insurer is justified in
repudiating the liability since the representative of the insured did not properly safe guard the
vehicle. Hence, the insured violated the condition No. 4 of the policy. Therefore, there is no scope
for this forum to intervene in favour of the complainant.
.
Mr. Rizwan Khan VS. Bajaj Allianz Gen. Ins. Co. Ltd.
FACTS
The complainant, Mr. Rizwan Khan purchased Ford Ecosport Car bearing No. AP 10 BG 5967 from
Mrs. Anamica Wagharay in July 2016 and he applied for transfer of ownership to the RTA
authorities on 15.07.2016. The vehicle was insured with the Respondent insurer, M/s Bajaj Allianz
Gen Ins. Co., from 08.04.2016 to 07.04.2017 by the previous owner under Private Car Package
Policy, for an IDV of Rs. 764395/-. The insured vehicle met with an accident on 25.07.2016 near
Bhiknoor Toll Plaza, Shivnoor village. The own damage claim preferred by the complainant was
repudiated by the insurer on the ground that he did not have any insurable interest at the time of
the accident
FINDINGS
The complainant submitted that he applied to the RTA for transfer of ownership on 15.07.2016
and he got the new Registration Certificate by post only on 26.07.2016, i.e. a day after the
accident and so he could not approach the insurer for affecting transfer of the name in the policy.
The complainant further contended that as per the GR – 17 referred by the insurer, “the
transferee shall apply within fourteen days from the date of transfer in writing………” the accident
occurred within 10 days of transfer in RTA records and he was entitled to the claim. The insurer
stated that the name transfer was affected in the RC and he failed to apply to the company in
writing along with the consent of the previous owner, i.e. Mrs. Anamika Wagharay. Thus he
violated the procedure laid down in GR-17 of IMT. Hence, the claim was rejected.
DECISION
The insurer repudiated the motor own damage claim of the complainant since there is no
insurable interest at the time of the loss. The policy was issued in the name of Mrs. Anamica
Waghre from 08.04.2016 to 07.04.2017. The insured vehicle’s ownership was transferred to Mr.
Rizwan Khan on 15.07.2017, and the new Registration Certificate card was dispatched by the RTA
on 19.07.2017 and the RC was received by the new owner on 26.07.2016 where as the accident
occurred on 25.07.2016. The insured stated during the hearing that he approached the
Nizamabad Office of the insurer to get the vehicle transferred in his name prior to application to
the RTA. But he was informed by the branch officials to wait for transfer of RC in his name. At
this stage the complainant was asked to produce any evidence in confirmation of his statement
for which he stated that he did not make any written request. As per GR 17 of Indian Motor Tariff
the transferee has to make a request to the insurer for affecting transfer of insurance in his name
by submitting a proposal to the insurer. The complainant could not prove that he made such an
effort from his side. Thus the complainant cannot be given the beneficial interpretation of GR 17
in his favour. Hence, this Forum does not see any infirmity in the decision of the insurer.
Mr. Maruthi Dasari VS. Royal Sundaram Gen. Ins. Co. Ltd.
FACTS
Mr. Maruthi Dasari insured his Jaguar XF 2.2 Luxury Car, bearing Regd. No. TS 09 EJ 6688, under
Motor Package Policy of the respondent insurer, from 29.10.2016 to 28.10.2017, for an IDV of Rs.
42,60,000/-. The insured vehicle sustained damage due to rat bite and it was noticed on 08.01.2017
after parking the vehicle in a parking area on 31.12.2016. The claim was intimated to the insurer
and the vehicle was inspected by a surveyor deputed by the insurer on 10.01.2017. There after there
was no response from the insurer. The repairs were carried out by the insured without prejudice to
his rights and contentions. The insurer sent rejection letter on 21.02.2017 alleging that the damage
to the vehicle was not relevant to the cause of loss stated in the claim form.
FINDINGS
The complainant stated that the repairs to the vehicle was completed on 28.02.2017 and the
vehicle was taken delivery by him after making payment of Rs.3,95,828/-. Since insurer had not
responded he had requested another surveyor to inspect the damaged vehicle and to give him
loss assessment report. The report given by an independent surveyor, who assessed the
admissible loss in terms of policy for Rs.390817/-, was filed to the perusal of this Forum. The
insurer contended that the surveyor deputed by them after inspection of the damaged vehicle,
intimated that the damage did not tally with the cause and nature of the steering stiffness and
no damage was caused by rat bite. There was no damage was caused due to external
means/impact. Hence the claim was not admitted.
DECISION
It is observed that the vehicle ran for 8000 KMs from its date of purchase by the complainant. This
shows that the vehicle is sparingly used and used to be kept in parking lot for many days. The
insured complainant also stated that the vehicle was last parked in parking on 31.12.2016 and it was
taken for use on 08.01.2017. Thus there was every possibility of rat biting the cables. The surveyor
appointed by the insurer did not properly analyze the cause of loss and jumped to the conclusion of
manipulation without proper evidence. After 30 days, the insured undertook the services of
another IRDA licensed surveyor Mr. Sudhakar Babji who had conducted the survey on the vehicle
and concluded that the damages to the insured vehicle is due to rat bite and assessed the loss at
Rs.3,90,817/-. In view of the sparing use of the vehicle, the possibility of rat bite cannot be ruled
out and it falls under accidental damage. Therefore, the complaint is allowed for Rs.3,48,584/- as
assessed by the surveyor and insurer is directed to pay the amount with interest in terms of Rule
17(7) of Ins. Ombd. Rules, 2017.
Mrs. N. Shailaja VS. ICICI Lombard Gen. Ins. Co. Ltd.
FACTS
The complainant, Smt. N. Shailaja insured her Honda Activa Scooter bearing registration No. AP
29 AE 0314 with insurer under Two Wheeler Package Policy for an IDV of Rs. 28,207/- from
12.04.2016 to 11.04.2017. The insured vehicle was stolen on 25.07.2016 when it was parked in
front of a wine shop by her father-in-law Mr. N. Laxmi Narsaiah. The theft of vehicle was reported
to Kushaiguda Police Station and they registered the FIR vide crime No. 495/2016 dt. 05.08.2016.
After receipt of FIR the claim was intimated to the insurer on 08.08.2016. The complainant filed
claim and submitted required claim documents. The respondent insurer rejected the claim
stating that there was unreasonable delay in giving intimation to the Police (11 days) and to the
Company (18 days).
FINDINGS
After filing the complaint by the complainant, and on sending hearing notices by this Forum, the
complainant vide her letter dated 02.08.2017 intimated that the vehicle was traced by
Kushaiguda Police officials on 07.07.2017 and it was surrendered to the Hon’ble XX Metropolitan
Magistrate Court, Cyberabad at Malkajgiri. She was asked to approach the Hon’ble Court to take
possession of the vehicle and after completing required formalities, the vehicle was taken
possession by her on 11.07.2017. Hence, the complainant withdrawn her complaint against
Respondent insurer for theft of her vehicle and requested to close the complaint
DECISION
The complaint is treated as resolved and closed.
Mr. Prateek Sanadhya Vs HDFC ERGO General Insurance Company

(Motor accidental claim) Date of award: 27.05.2017
The complainant alleged that he had taken a motor insurance policy bearing number
231120151847540003 wef 06.10.2016 to 05.10.2017 covering his Hyundai SPORTZ, the vehicle
was delivered on 06.10.2016. Insured vehicle met with an accident on 12.10.2016 and he preferred
an accidental motor claim and submitted an estimate for the damages. The Insurance Company in
its SCN stated that the above OD claim was surveyed by the surveyor. As per intimation given by
the insured, date of loss informed was 12.10.2016 whereas during the investigation, it was revealed
that the vehicle met with an accident on 10.10.2016. This was misrepresentation of material facts
relevant to the accident which amounts to fraud. Further, during the investigation/verification of
the documents it was found that his vehicle was not registered at the time of the accident and
registration of the vehicle was mandatory as per law.
During the course of personal hearing, the complainant submitted that no rejection letter was
received by him. The insurance premium was also paid on 10.10.2016. The registration of the
vehicle was done on 10.10.2016 evening after the accident occurred. It was revealed that at the
time of the accident the vehicle was not registered, but it was having a temporary registration
number. As per MV Act 1988, Section 43 subsection (2) temporary registration shall be valid for
a period of one month. In view of the facts, it was awarded that the Insurance Company shall
consider this case and settle the claim of the complainant for Rs. .
Case No. 048.1617.0688

Victor Banerjee
Vs
The National Insurance Co. Ltd.
Award Dated 27/04/2017
Complainant had purchased a second-hand Taxi with erstwhile registration no. WB-19-9249 under
control of RTO-Alipore . Due to overage , the registration no. of the vehicle was changed to WB-
19G-2475 under the control of RTO-South 24 PRGS with the earlier permit no. P.Co.P 115
transferred in the name of the Complainant . The Taxi was insured under a Passenger Car Vehicle
Package Policy for the period from 08/05/2016 to 07/05/2017 with IDV of Rs.3,90,800/- An own
damage claim in respect of accidents dated 24/06/2016 & 08/08/2016 was lodged but repudiated
on grounds that the permit was not valid being non-compliance of LIMITATIONS AS TO USE
clause of the motor vehicle Act,1988. On scrutiny of the submitted documents the following facts
emerged :-
that RTO dated 23/12/2015 had received from the Complainant Permit fees for Rs.10,040/- for the
replaced new Taxi with Reg. No. WB19G-2475 under the same Permit No. P.Co.P 0115 in the
name of the Complaint.
that RTO had endorsed Part-A & Part-B of the same Permit No. P.Co.P 0115 in favour of the
Complainant clearly stating the effective date to be 23/09/2013 with expiry date as 23/09/2018.
The Complaint was allowed and Respondent directed to pay Rs.59,273/- towards aggregate Claim
Amount as per Surveyor’s Repair Assessments and in line with Policy T&C.
Case No. 049.1617.0729
Safina Begum
Vs
The New India Assurance Co. Ltd.
Complainant took a Private Car Package Policy for her Maruti Dzire private car with Registration
No. WB-38-AB-6015 period 12/07/2014 to 11/07/2015 with IDV for Rs.6,90,000/- being
Hypothecated with State Bank of Jaipur & Bikaner . The sole insured of the captioned vehicle died
dated 12/11/2014. The vehicle met with an accident dated 11/04/2015 whilst the Surveyor had
assessed the loss on CTL basis . The Claim was repudiated due to absence of Insurable Interest at
the time of the loss , the Policy having not been transferred in the name of the Legal Heir upon the
death of the Sole Insured within stipulated time frame. It is opined that Complainant has breached
Condition-9 of the Insurance Contract thereby rendering the Contract as void with non-existence
of Insurable Interest. Decision of the Respondent upheld without any relief to the Complainant.
Case No. 012-1718-0024

Md. Asfaque Ali
Vs
Cholamandalam MS General Insurance Co. Ltd.
Complainant took a Goods Carrying Vehicle - Package Policy for his Tata Motor Truck with
Registration No. WB-11-C-2529 period 30/01/2016 to 29/01/2017 with IDV for Rs.7,20,000/-
being Hypothecated with HDB Financial Services Ltd. . The vehicle met with an accident dated
31/01/2016 whilst the Surveyor had assessed the loss for Rs.1,99,635/- . However the Claim was
repudiated due to absence of Insurable Interest at the time of loss , the vehicle having been sold
dated 28/11/2014 by executing a sale deed for an initial consideration of Rs.75,000/- being part
sale value . On scrutiny , it was discovered that although the Sale deed was inadvertently executed
dated 28/11/2014 it was revoked the next day dated 29/11/2014 , the possession , custody & Title
of the vehicle remained with the Complainant. Further the insurer as well as the RTO was not
informed of the sale details necessary under MV Act for change of Ownership. It is worthwhile to
note that the vehicle having been financed by M/s HDB Financial Services Ltd. has been sold
vide Sale Deed dated 28/11/2014 without their NOC . That Insurable Interest of the Complaint
existed during the entire period of Insurance and also at the time of Loss is evidenced by the
aforesaid facts. The Complaint was allowed and Respondent directed to pay Rs.1,99,635/- towards
aggregate Claim Amount as per Surveyor’s Assessments and in line with Policy T&C.
DATE OF AWARD :- 29/05/2017

COMPLAINT REF: KOL-G-005-1617-0746
Smt. Diti Chakrabarty
-VS
The Bajaj Allianz general Insurance Co Ltd, Kolkata
Breif facts of the case:-
The complainant, Smt. Diti Chakrabarty, had stated that on 02/01/2017 she parked the vehicle on
A.P.C. Road near Rajabazar, Kolkata, to purchase some hardware items for household purpose, as she
came back , she found that her vehicle had been found damaged (scratches all over the car body) , she
reported the matter to the Amherst street Police station, Kolkata on 09/01/2017.
Ombudsman Award/recommendation
The repudiation letter of the insurance co. dated 27/01/2017, revealed that the said claim was rejected
under section 2a of the policy it says that “The company shall not be liable to make any payment in
respect of (a) Consequential loss , depreciation , wear and tear mechanical or electrical breakdown ,
failures or breakages.” Apart from this 2a section, the insurance co. Failed to mention other exclusions
clauses.
However, Ombudsman office had examined the photographs of the damages /scratches of the
complainant’s car , and it appeared that, such scratches were made / manifested by some unknown
person with any malicious/ malafide intentions, It was a total malicious act , thus as per your policy
coverage own damage section 1 (vii) of the policy ( by malicious Act) the Insurance co. can’t ignore the
liability under the policy,. It was not a normal wear tear loss .It was a loss of malicious act. thus Insurance
co is liable to indemnify the complainant as per the estimate of repair from M/s Ultracraft (a Maruti
authorised service station) an amount of Rs. 19665.00.(subject to any deductions as per Policy terms and
conditions).
OFFICE OF INSURANCE OMBUDSMAN
MUMBAI & GOA
METROPOLITAN REGION EXCLUDING NAVI MUMBAI & THANE
(Under Rule No. 15(1)/16 of the Redressal of Public Grievances Rules,1998 )
Brief Facts of the Case : The insured Vehicle under Private Car Package Policy for the policy period from
27.04.2016 to 26.04.2017 for an Insured Declared Value of Rs.1850875/-. On 11th September,2016 while
returning from Malwan to Goa on highway road suddenly a cattle crossed the road to which he got
panicked and to save the cattle he drove his vehicle to left side of the road and lost control on vehicle and
crashed into the Electricity pole. Police Panchanama was filed as there was third party property damage
(Electricity Department) and the vehicle was in police custody. The Electricity Department penalized the
insured and after completing the formalities the vehicle was released four days after the accident. As he
was to travel out of India the accidented vehicle was towed to the workshop. After his return from Dubai
he went to the workshop and came to know that claim of the vehicle was registered by Dealer and the
same was submitted along with claim form duly filled in. Then M/s B Investigator was appointed by the
Company for investigation and the complainant answered all the questions with facts and matters
genuinely but later he realized that investigator wanted him to convince that claim is admissible on the
grounds of facts declared are not to be true. Further he said that claim below Rs.60000/- is not to be
claimed due to loss of No claim Bonus at the time of renewal and he managed to take a blank letter signed
and said he shall revert through Company later. Then the complainant was shocked to receive a second
letter dated 17th December,2016 that claim is not pursued on the basis of letter declaration signed by the
insured and treated the same as claim withdrawal letter. The complainant has represented in his written
statement that he is not agreeable with the decision of the Company.
Observations/Conclusion: The Forum observed in this case that though there is misrepresentation of facts
on the part of the complainant with regard to claim form, withdrawal letter, etc, but the accident is
genuine which is also surveyed and assessed by the Insurance Company. The Forum notes that there is
no evidence that insured was under the influence of alcohol at the time of accident as per Company’s
contention. The Forum also observes that insured has sent a mail to the Company where he has informed
them that the estimate would be more than Rs.200000/- and he is interested in pursuing the claim to
which the Company has not given any reply to the insured and they have maintained their stand of claim
being withdrawn by the complainant.
It is noted that complainant has repaired his vehicle from the workshop on 8 th March,2017 and has paid
Rs.258828/-. Under the circumstances Company’s denial of claim on the ground of claim being withdrawn
by the insured and misrepresentation of facts is not sustainable and the Company is directed to revisit the
claim afresh and calculate the admissible claim amount and submit the same within a period of two working
days and the complainant is directed to submit the required original documents by the Company
immediately. Accordingly the Company has calculated the admissible claim amount payable as
Rs.241797/-.
Dated: 29.08.2017
--------------------------
Brief Facts of the Case : Complainant’s Scooter was stolen on 15.02.2013 for which he lodged a claim
with the Respondent. The claim was repudiated on the ground that there was delay of 53 days in intimating
the loss to the Company.
Observations/Conclusion: Analysis of the entire case reveals that the Company has based its
repudiation mainly on the ground of delayed intimation amounting to violation of Condition No.1 of the
Policy, besides the other points as raised by it. In the instant case, it is accepted that no immediate written
intimation of theft was given by the insured to the Company. In this regard the complainant has clarified
that in the absence of availability of policy details with him, he had to rely on the dealer for proceeding
with the claim formalities. However the police compliant was lodged on the same day. The police have
investigated the case and submitted their final report as “true and undetected” to JMFC which has accepted
the ‘A’ summary. Thus the genuineness of the theft is not in doubt and also the Respondent has not denied
the fact of occurrence of theft.
As regards the other discrepancies pointed out by the Respondent that the policy was taken with a delay of
77 days of taking delivery, insurance was obtained by avoiding pre-inspection and fake insurance details
were generated and submitted to the RTO for registration of the vehicle, there are no documents on record
to show that the Respondent has carried out any investigations in this direction or questioned the dealer
who is basically involved in completing all these formalities. The role of the complainant in all these
alleged manipulations has not been established and therefore penalizing him for the same would not be
justified.
Hence in the absence of concrete evidence which leads the Insurer to conclude that delayed intimation of
the claim is an attempt to cover the fraudulent intention on the part of the insured, the Forum is of the view
that total denial of liability under the claim only on account of delay in intimation does not seem justified
when the fact of theft is not in dispute. However, in view of the fact that there has been some amount of
lapse on the part of the complainant in not giving immediate intimation of loss to the Respondent, it would
be in order that the complainant bears certain portion of the loss as well. Respondent is directed to settle
the claim for 75% of the IDV which works out to Rs.35,000/- in favour of the complainant, towards full
and final settlement of the complaint.
Dated: 12.04.2017
--------------------
Brief Facts of the Case : Complainant’s vehicle Maruti Swift Dzire – 2012 model was stolen on
23.08.2016 while it was parked in front of his residence. Respondent rejected the claim lodged under the
policy on the ground that the policy-holder had sold his vehicle to the complainant on 24.04.2016; however
the transfer was not effected in the R.C. as well as in the insurance policy which continued to be in the
name of the old owner as on the date of theft.
Forum’s Observations/Conclusion : On scrutiny of the documents produced on record coupled with

the depositions of both the parties, it is observed that the complainant purchased the vehicle from the
previous owner on 26.04.2016. He then gave the documents to the agent for completing the transfer
formalities. The NOC for transfer of the vehicle was received from Thane RTO on 01.07.2016. After that
he should have applied for transfer of the vehicle in his name to the RTO within whose jurisdiction his
place of residence falls within the stipulated time-limit. However, he failed to do so and consequently the
insurance policy was also not transferred in his name. The vehicle was stolen on 23.08.2016. Thus, on the
date of loss, the vehicle as well as the insurance policy was not transferred in the name of the purchaser i.e.
the complainant. Consequently he was not recognized by the Insurance Company under the contract of
insurance as the owner of the vehicle without corresponding effect of such change in the existing policy.
There is no provision of automatic transfer of the “Own Damage” Section of the insurance policy in favour
of the transferee subsequent to the transfer of ownership and the same shall be made by the insurer only on
receipt of a specific request from the transferee along with consent of the transferor on getting acceptable
evidence of sale. Insurance Policy is always a contract between the parties to the contract and any change
in the existing status must be brought to the knowledge of the Insurance Company. The same was not done
by the complainant in the instant case. The decision of the Respondent therefore to repudiate the claim
cannot be faulted with and consequently no relief can be granted to the complainant.
Dated: 21.08.2017
-------------------
Brief Facts of the Case :
Mr A had insured his Vehicle for an Insured Declared Value of Rs.120000/-. This vehicle met with an
accident on 14th July,2016. The Company had appointed Mr K Surveyor to assess the loss and accordingly
he has made survey and submitted the Surveyor Report with claim assessment of Rs.17900/-. The vehicle
at the time of accident was more than ten years old and hence as per policy condition it attracted depreciation
of around 50% for rubber/nylon/plastic parts, tyres and tubes, batteries and air bags, for fibre glass
components – 30%. The complainant accepted Rs.17900/- under protest as he has actually incurred
Rs.27897/- in the garage and he has represented in his written statement that he is not agreeable with the
decision of the Company.
Observations/Conclusion
The Forum observed in this case that complainant has not been properly communicated the final assessment
of his claim and therefore the Company was directed to send a detailed letter to the complainant explaining
the assessment of the above claim with a copy to the Forum immediately.
Accordingly the Company has sent a mail to the complainant with a copy to us dated 28th April,2017 which
reads as under :
“This is with reference to the above subject, wherein the hearing in respect of the above complaint
took place on 27/04/2017 at the Office of the Insurance Ombudsman, Mumbai.
As per the directives of the Hon'ble Insurance Ombudsman, we are providing the Scanned Copy of
the Bill check Report of the Surveyor, which would explain the detailed assessment of your claim for
vehicle. The said assessment is done by the surveyor based on the bill dated 10.10.2016 amounting to
Rs. 27,897/-. Further, we would like to inform you that the vehicle at the material time of accident
was more than 10 years old and hence as per the policy conditions, it attracts depreciation at the
following rates:
1) For all rubber/nylon/plastic parts, tyres and tubes, batteries and air bags – 50%.
2) For all fibre glass components – 30%
3) For all parts made of glass -Nil
4) Rate of depreciation for all other parts including wooden parts for the age of the vehicle exceeding
10 years – 50%
Also the excess as per policy is Rs.1000/-.
In view of the above, as assessed by the surveyor, the claim was been approved for Rs. 17,900/- fully
considering the invoice dated 10.10.2016 amounting to Rs. 27,897/-. Thus, any amount paid by you to
the garage in excess of the said invoice, has to be recovered by you from your Garage”.
Based on the above clarification given by the Company, the Forum do not find any ground to intervene
with the same and pass the following Order. The complaint of Mr A against B in respect of partial
repudiation of his Vehicle accident claim on 14.07.2016 does not sustain.
02.04.2017
Case no. BHP-G-020-1617-0184
Mr.Mohd. Shabbir Khan v/s ICICI Lombard Gen.Ins.Co.Ltd.,
Policy no.3005/2010850283/80/0000002231
Facts of the case:
The complainant stated that his motor cycle was insured with the respondent Insurance company under Package policy.
On 28/12/2015, this vehicle was stolen. He lodged claim with respondent company, which was repudiated on the
grounds of violation of policy condition of immediate intimation to police and to the respondent.
The respondent company stated that the complainant lodged FIR with police after 6 days of loss and intimated to them
after 9 days of loss, which is a violation of policy condition no.1, accordingly claim was repudiated since not payable.
I heard both the sides the complainant as well as Insurance Company.
On perusal of papers on record and submission made during hearing is clear that there was a delay on the part of
complainant in filing FIR as well as intimation to the Company.
Therefore, I see no reason to interfere with the decision of the Insurance Company.
Case no. BHP-G-051-1617-0201

Mr.Gaurav Bhale V/s United India Insu.Co. Ltd., Indore
Policy no.1903003115P113679050
Facts of the case:
Insured vehicle stolen on 24/08/2016.The claim for payment of loss lodged with the Respondent Company. The
respondent company repudiated the claim on the ground of delay of FIR by 6 days and intimation to the respondent
company after 11 days of the theft.
The respondent company stated that the complainant lodged FIR after 6days of loss i.e. on 30/08/2016 and intimated
to Insurance Company after 11 days of loss which is violation of terms and conditions of policy, accordingly claim
was repudiated.
On perusal of papers on record and submission made during hearing, I find that there was a delay in intimation to
police and Insurance Company.
Accordingly the complaint filed by the complainant is hereby (dismissed) disposed off.
Case No. BHP-G-048-16-17-020----
Mr. Vinod Sharma V/s National Insurance Co.Ltd.
Date of Award 17/04/2017
Policy No. 320201/31/1456100009639
Facts of Case :-
The complainant had filed the complaint related to repudiation of own damage claim of complainant’s Swift car
No.MP-04/CJ-1641 on the ground of non disclosure of material facts i.e. No claim bonus rebate was wrongly enjoyed
by the insured whereas there was a claim on previous policy.
Finding and Decision :-

On perusal of the records I find that the first policy fo the period of 2012-13 was issued from ICICI Lombard General
Insurance Company and subsequently renewed from National Insurance Company till 2016-17. The no claim bonus
45% allowed by the respondent from 14.02.2016 to 13.02.2017. The respondent National Insurance company had not
taken the confirmation of NCB from ICICI Lombard within the stipulated time period as per provision of GR-27 of
India Motor Tariff-2002. The vehicle was renewed with the same insurance company, the insurance company could
easily detected the mis-representation of facts. The Insurance company would not be justified in repudiating the claim.
Hence, the Insurance Company is directed to settle the claim.
Case No. BHP-G-030-1617-0180
Mr. M.C. Nagaria V/s Megma HDI Gen.Ins.Co.Ltd.
Award Date : 17/04/2017
Policy No. P0014200005/4103/346154
Facts of case:-
The complainant’s insured vehicle was on route from Rewa to Haryana suddenly its tyre got burst and due to heat
generation entire vehicle was burnt but his claim was not settled by the respondent.

The respondent contended that they have issued registered letter dtd 02.09.2016 regarding compliance of various
formalities and submission of relevant documents but complainant has chosen to pursue the matter through this forum.
On perusal of record, I find that it is a premature case before this forum. The complainant had not submitted the
original document and Insurance Company had not shared to survey report with the insured. Therefore, complainant
is advised to submit the required documents to the Insurance Company and insurance company is directed to share
the survey report with the complainant and to decide the case after compliance of formalities.
Case No. BHP-G-023-1617-0195
Mr. Dinesh Parmar V/s IFFCO Tokio Gen.Ins.Co.Ltd.
Date of Award : 17.04.2017
Policy No.84852378
Facts of case:-
The complainant had filed a complaint related to repudiation of vehicle claim on the ground of delayed intimation and
FIR.
Insurance company contending that insured has not informed immediately to the Insurance Company and FIR was
lodged after 15 days. As per documents submitted by both the parties it is observed that theft case was finally closed
by Shujalpur court vide their order dated 13.12.2014 and complainant informed the respondent on 03.10.2016. In view
of records & circumstances and the fact that there is an abnormal delay in filing the claim. I am of the considered view
that decision taken by the respondent company is justified. Accordingly, complaint stands dismissed.
(a) CASE OF MR. A. PRASAD V/S LIBERTY VIDEOCON GENERAL INSURANCE CO. LTD.
(Hearing dated: 22.08.2017)

The complainant has stated that his Honda City car met with an accident on 07.11.2016. Immediately, intimation was
given to the insurer who deputed a surveyor to assess the loss. He had submitted all the claim papers and replies to
various queries raised by the surveyor/insurer but the surveyor had levelled some illegal and unnecessary allegations
and had told him that the claim of the accident was false. Thereafter, instead of finding out the facts, the insurer had
straightway repudiated the claim stating that the damages were not corroborating with the cause and nature of the loss.
The insurer further explained that the insured had mentioned in the Claim Form that a vehicle coming from back side
had hit on the rear portion of his car, which got dis-balanced, went off the road and collided with a tree resulting in
damages on the left side of his car. To ascertain the facts, the surveyor had inspected the spot of accident and observed
that the said tree was on the edge of the road and not away from the road as claimed by the insured. This clearly
indicated that the insured had not revealed the facts about nature and place of accident and there was manipulation of
the alleged incidence of accident. On going through the documents exhibited and the oral submissions it was observed
that the issue was nothing but simply a matter of interpretation of words and the insurer had just unnecessarily tried
to find excuse for repudiation of claim as the surveyor has not denied the existence of the damages which were not
old but fresh. That the tree was on the edge of the road or few feet away from the road does not make much of
difference. As a matter of fact, such minor discrepancies observed by the surveyor could have been ignored by the
insurer and the claim should have been settled by giving benefit of doubt to the insured. Hence, an award was passed
directing the insurance company to settle the claim.
(b) CASE OF MR. RAMESH CHAND V/S UNITED INDIA INS. CO. LTD.

The complainant has stated that his car had met with an accident on 18.04.2017. Although he had purchased the
insurance policy with add on cover of Zero Depreciation from the insurer but the insurance company had settled the
claim after deducting depreciation at the rate of 50% on the replacement cost of tyres and tubes which were damaged
in the accident. The insurance company stated that there were two different clauses namely Depreciation clause and
Limitation clause under section 1 of the policy. In the subject case, the insured had opted for deletion of depreciation
clause by paying additional premium but limitation clause was still applicable which provided for limitation of
maximum liability of 50% on the replacement cost of tyres and tubes. Hence, the deduction was not made on account
of depreciation but on account of limitation clause. On perusal of Section 1 of the policy, it is observed that although
the section, broadly deals with payment of loss or damages to the insured vehicle, the section has four clauses, all
dealing with separate situations. While clause (1) speaks about percentage of depreciation applicable in case of
damage to the vehicle parts and lists out the percentage of deduction on account of depreciation, Clause (2) deals with
certain specific situations under which a claim cannot be entertained at all with some exceptions like damage to tyres
and tubes under which the liability would be limited to only 50% of cost of replacement. The net result under both
clauses mean; whether the client buys a zero depreciation policy or not, he cannot claim damages beyond 50% of the
cost of tyres and tubes. In other words, a holder of zero depreciation policy does not stand on an exalted platform in
comparison to non-zero depreciation policy so far as it relates to replacement of tyres and tubes. This is in spite of a
very bold declaration under UIIC- 7 clause which states that notwithstanding anything to the contrary contained in the
policy, no depreciation as specified in Section 1 of the policy shall apply in consideration of payment of additional
premium. However, this bold declaration also has a whining tail “ subject otherwise to the terms, conditions,
limitations and exceptions of the policy” The concept of zero depreciation policy is, thus, nothing but travesty of a
scheme in which the insured gets unwittingly trapped under wrong belief that he had insured everything and would
not be subjected to any depreciation. The scheme, thus, lacks transparency and is not only dubious in nature and gives
something from one hand and takes it back from another, section 1 of the policy also stands in direct conflict with
section 7 of the policy. In view of the glaring inconsistency in the framing of the policy, the deduction of 50% on the
replacement cost of tyres and tubes under the concept of limitation is illegal and improper. An award was passed
directing the Insurance company to pay the cost of tyres and tubes in full.
(c ) CASE OF MR. RAVI BATRA V/S THE ORIENTAL INSURANCE CO. LTD.
(Hearing dated; 20.06.2017)
The complainant has stated that he had purchased a new motorcycle and temporary registration valid for one month
was arranged by the dealer and he had also paid necessary charges/fees to the dealer for arranging permanent
registration of the vehicle but during the intervening period, the vehicle was stolen before expiry of temporary
registration. Although, the claim was approved by the insurer but the claim amount was not released on the ground
that the claim could be paid only after transfer of the vehicle in the name of the insurer. During the hearing, the insured
stated that in spite of his best efforts, the Registering Authority refused to transfer ownership of the vehicle in the
name of the insurer as the vehicle was not permanently registered with them. He further stated that he was ready to
sign necessary documents for transfer of ownership if desired by the insurance company. The insurer admitted that as
per prevailing norms of registering authority, ownership of a vehicle under temporary registration cannot be
transferred to any other person or organization. On-going through the documents exhibited and the oral submissions,
it was observed that the insurer was unnecessarily holding release of approved claim on the pretext of transfer of
ownership of the vehicle, while the insurance company was fully aware that transfer of ownership was not possible
under the circumstances. Moreover, there is no such condition in the policy making it mandatory for the insured to
arrange transfer of the vehicle in favour of the insurance company. Keeping in view the unreasonable approach of the
insurer, an award was passed directing the insurance company to pay the claim along with interest at the rate of 6%
per annum from the date the claim was lodged along with all documents, till the date of payment.
(d ) CASE OF SH.PREM PAL SINGH VS BHARTI AXA GENERAL INSURANCE COMPANY LTD.
This complaint is filed by Sh. Prem Pal Singh against Bharti Axa Insurance Company relating to repudiation of
claim .The complainant stated that his car was stolen on 08-03-2017 from his residence. He submitted copy of F.I.R.
along with copy of final report & R.C .and copy of D.L. to the insurance company for settlement of claim but the
insurer rejected the claim. Hearing in the said case was held on 20-09-2017. The insurer stated that the complainant
had not revealed that he had taken three OD Claims from previous insurer, instead he had opted 20% no claim bonus.
As this was a case of misrepresentation of material information i.e. wrong NCB declaration, claim was rejected. The
complainant stated that he was not aware that NCB had to be declared and he had not received policy document except
cover note. Even insurer had not confirmed NCB from previous insurer. Thus this was a case of contributory
negligence and lapses on both sides. The repudiation of claim by the insurer was not valid. Therefore the case was
settled on sub-standard basis at 75% of the admissible claim amount.
(e) CASE OF MR. HEMCHAND AGGARWAL VS NEW INDIA ASSURANCE COMPANY LTD.
The complainant had taken Motor Policy with IDV of Rs.4,57,133/-. The car of the complainant met with an accident
on 01.05.2007 and the complainant and his wife were seriously injured in the accident. The loss was surveyed by the
surveyor. The claim of the complainant was rejected by the company on 28.07.2017 on the ground that the road tax
was deposited after the date of accident. The complainant stated that he purchased a new Wagon R car from M/s
Prem Motors Pvt. Ltd. Agra on 27.04.2017. The Registration fees of Rs.40,595/- was paid by him to the dealer on
the date of purchase i.e. 27.04.2017 whereas the accident of his car was occurred on 01.05.2017 after depositing the
Registration fees to the dealer, The company stated that the vehicle met with an accident on 01.05.2017 whereas Road
Tax was deposited in RTO on 02.05.2017; hence the claim was rejected by the company. The same was not only
gross violation of Section 192 of MV Act but also fundamental breach of the terms and conditions of the policy. Both
sides appeared for personal hearing and reiterated their submissions. The complainant stated that he had purchased a
new car in exchange of his old car and had deposited the due amount for registration. He has submitted the internal
circular Reference HO/MTD/OD/CIR.NO.o/IBD:ADMN:268 dated 25.03.2015 of the company, stating that “In case
where the material on record available show that the insured had deposited the requisite registration fee and road
tax on the vehicle either with the RTO or with the dealer/sub-dealer from where the vehicle was purchased before the
vehicle meets with an accident while the registration is still in process/pending after such deposit of registration fee
and road tax claims arising out of such an accident may be settled on Standard basis, subject to submission of the RC
Book by the insured.” The complainant also submitted billing-checklist of the dealer dated 27.04.2017 to prove that
RTO charges of Rs.40,595/- was deposited before the date of accident. The insurer had only a lame excuse to offer
that invoice was not tendered to them. He admitted that claim was payable as per circular and had never demanded
copy of invoice. It appears to be a clear case of harassment as the claim has been delayed for no reason. Hence an
award was passed directing the insurance company to pay the admissible claim to the complainant.
(f) CASE OF MR. PRAVEEN MASAND VS ICICI LOMBARD GENL. INSURANCE CO. LTD.
The complainant took Private Car Package Policy with Add-on cover for Engine Protect Plus, Zero Depreciation for
covering his Car. When he was returning back from Meerut on 09.11.2016, he suddenly heard a noise coming from
underneath of his car. Due to late night, the complainant did not stop the car and drove it to his residence but next
morning, when he tried to start the car, it failed to start. The vehicle was towed away to the workshop and the intimation
of claim was given to the insurance company. The claim of the complainant had been rejected by the company on the
ground of vehicle suffering mechanical failure, which does not fall under the ambit of insurance
The complainant sated that he specifically opted for “Engine Protect Cover” yet the claim of damage to the engine of
his car was rejected by the company. The vehicle was surveyed by the surveyor, he observed that the engine head was
intact but oil chamber cover was pressed/cut from the lower side and oil chamber and engine block was broken.
However, there was no damage whatsoever on any part of the engine thereto. During hearing the Insurer stated that
the damage to the vehicle was not on account of any accident but mainly due to mechanical failure or manufacturing
defect. The survey report thus confirms that the loss was not due to any accident.
Since, the plea of the insurer did not appear convincing and it was not clear whether the loss to the engine was caused
due to accident or due to mechanical failure, hence an independent surveyor was deputed by the Honorable
Ombudsman for investigation and verification of the case, who visited the workshop, took photographs of engine in
dismantled condition and discussed the matter with the manager of the workshop. He thoroughly examined the engine
and found accidental marks at the bottom of oil pan as well as a small hole at the bottom probably caused by some
stone/boulder. The vehicle was driven by the insured to his house in the accidental state as it was late at night and
probably the engine oil had leaked completely when insured reached his house or may have leaked completely in the
parked state in his house. That the vehicle reached the house of the insured in operational state shows that engine was
getting lubrication while driving; hence it did not stop on the way. Further the insured had opted for add on coverage
Zero depreciation + engine protect plus coverage, hence consequential loss was also covered under the policy, hence,
the decision of insurance company of rejecting the claim is totally unjustified. Hence an award was passed directing
the insurance company to pay the admissible claim to the complainant along with interest from the date of claim
papers filed at 6% till the date of payment.

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In the matter of

Mr. Rajesh K. Parmar

In the case of Ashish B. Monpura v/s Iffco Tokio General Ins.co.ltd.

In the case of Ravi Thakkar v/s Cholamandalam M S General Ins.co.ltd.

Complaint No: BNG-G-035-1617-0794

Date of Award: 8th May, 2017.

Repudiation of OD claim for delay in reporting to Police – Compromised

Date of Award: 9th May, 2017

Repudiation for damages not being pertinent to the Accident - Upheld

Date of Award: 9th May, 2017

Complaint No: BNG-G-020-1617-0715

Date of Award: 10.05.2017.

Theft of vehicle – Delay in FIR - Compromised.

Date of Award: 10.05.2017.

Imposition of 50% depreciation on metal part reduction of Labour charges. – ALLOWED

Case no. BHP-G-020-1617-0184

Findings & Decision:

Case no. BHP-G-051-1617-0201

Case No. BHP-G-048-16-17-020----

Finding and Decision :-

Case No. BHP-G-030-1617-0180

Mr. M.C. Nagaria V/s Megma HDI Gen.Ins.Co.Ltd.

Award Date : 17/04/2017

Policy No. P0014200005/4103/346154

Case No. BHP-G-023-1617-0195

COMPLAINT NO- BHU-G-020-1718-0005

Result of hearing with both parties(Observations & Conclusion)

COMPLAINT NO- BHU-G-051-1718-0004

Award Dated 24th May., 2017

COMPLAINT NO- BHU-G-030-1718-0064

Award Dated 17th July, 2017

Brief Facts of the Case:

Brief Facts of the Case:

COMPLAINT NO- BHU-G-038-1718-0063

Result of hearing with both parties(Observations & Conclusion):

COMPLAINT NO- BHU-G-050-1718-0008

Award Dated 12th July 2017

Result of hearing with both parties(Observations & Conclusion

Result of hearing with both parties(Observations & Conclusion)

Case no. CHD-G-023-1617-0436

ORDER DATED 26.05.2017 (Motor)

Case no. CHD-G-023-1617-0543

ORDER DATED 17.04.2017 (Motor)

Thus the complaint is Dismissed.

The complainant’s insured vehicle met with an accident on 08/11/2016. As the

Thus the complaint is Allowed.

4. There is no further relief to be granted to the complainant.

5. Hence, the complaint is disposed off.

6. Copies of the order to both the parties have been delivered.

4. There is no further relief to be granted to the complainant.

5. Hence, the complaint was disposed off.

6. Copies of the order to both the parties have been delivered.

In the matter of Mr. Shubham Bansal

In the matter of Mr. Dev Kalra

In the matter of Mr. Devender Kumar

4. There is no further relief to be granted to the complainant.

5. Hence, the claim is disposed off.

6. Copies of the order to both the parties have been delivered.

COMPLAINT REF:NO: GUW-G-049-1617-0072 (Awarded on 24/04/2017)

The Complaint is therefore disposed of without any relief to the Insured.

COMPLAINT REF:NO: GUW-G-005-1718-0005 (Date of Order 30/05/2017)

The complaint is thus treated as CLOSED.

a) Name of the Insured …. Late Shahzada Ansari in place of