Vehicle Insurance Policy - Gbic.co.in

Vehicle Insurance PolicyAhmedabad Ombudsman CentreCase No. 11-003-0365Mr. L. A. SardarVsNational Insurance Co. Ltd.Award Dated : 3.10.2007Repudiation of Claim under Motor OD Policy: The Complainant’s Motor Vehicle wasstolen. The Respondent repudiated the Claim on encountering several anomaliesduring the process of claim settlement. The Complainant had deliberately misled theRTO by submitting forged sale letter and a non-existent insurance cover whileregistering the Vehicle. Thus suppression of material facts led to the InsuranceContract to become void ab-initio. No satisfactory reasons could be attributed by theComplainant. As such, the decision of the Respondent to repudiate the Claim wasupheld.Ahmedabad Ombudsman CentreCase No. 11-005-0113Mr. S N BharwadVsOriental Insurance Company Ltd.Award Dated: 13.11.2007Repudiation of Claim under Motor OD Policy. The Insured Vehicle was an Eicher 10.90FSD Truck with GVW 8800 kgs as per the RC Book. Hence as per the Motor VehiclesAct, the Insured Vehicle was classified as Medium Motor Vehicle. The Insurance wasgranted under Package Policy (Goods carrying Commercial Vehicles). The Vehicle metwith an accident. Claim was repudiated since the Complainant had a driving licenceauthorised to drive Motor Cycle with Gear, Light Motor Vehicle, Transport Vehicle. Thebreach of the policy conditions regarding the Driver Clause being established, thedecision of the Respondent to repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. 11-002-0116Ms. R R KeshwaniVsNew India Assurance Company Ltd.Award Dated : 27.11.2007Repudiation of Claim under Motor OD Policy. The Insured vehicle was damaged in aflood. The Respondent repudiated the Claim on the ground that the Complainant didnot have insurable interest on the date of the accident. Papers on record showed thatthe Insured did not take care in the last 10 years to verify under whose name thevehicle was registered. Scrutiny was done only after the claim had arisen. The copiesof the earlier policies issued showed that the said Motor OD Policy was issued in thename of Mr. R R Keshwani (corrected to Mr. R D Keshwani) in 1999 and for the first 5

years in the name of Mr. R R Keshwani and in 2004 to 2007 was the name changed toMs. Rashmi R Keshwani. The Insurer could not offer any explanation as to how thename was changed and full No Claim Bonus allowed even when the name of theinsured was changed. Thus it is clear that the Insurer had wrongly put the name of theinsured person in the policy. Thus the fault lies on the Insurer and not on theComplainant. As such, the Respondent was directed to settle the claim as assessed bythe Surveyor.Ahmedabad Ombudsman CentreCase No. 21-001-0206Smt. N R ThakkarVsLife Insurance Corporation of IndiaAward Dated : 10.12.2007Repudiation of Claim under Life Insurance Policy: While proposing for Insurance, theAssured had not disclosed the fact of suffering from severe macrocytic anaemia andthat he had been hospitalised for blood transfusion and that he had undergone severalpathological investigations like Liver Function Tests, Blood Examination Reports etconly 4 months prior to filling up the proposal of insurance. The Respondent couldproduce papers to this effect. The assured died within 3 months of taking the InsurancePolicy. Claim on death of the deceased Life Assured was repudiated by theRespondent. Since, the non-disclosure sniped Utmost Good Faith, which formed thecornerstone of Insurance Contract, the decision to repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. 21-001-0123Smt. R M VyasVsLife Insurance Corporation of IndiaAward Dated : 10.12.2007Repudiation of Claim under Life Insurance Policy: While proposing for Insurance, theAssured had not disclosed the fact of his being on leave for 2 months on sick groundsfor treatment of Acute Interior Wall Myocardial Infarction about 4½ years prior toproposing for insurance. The disease was critical enough for one who suffered not toignore its mention. Non disclosure of the said disease precluded the Respondent to callfor special medical examination. The assured died due to Heart Attack which again hada nexus with the disease not disclosed. Claim on death of the deceased Life Assuredwas repudiated by the Respondent. Since, the non-disclosure sniped Utmost GoodFaith, which formed the cornerstone of Insurance Contract, the decision to repudiatethe Claim was upheld.Ahmedabad Ombudsman CentreCase No. 11-005-0127Mr. P R RawalVsOriental Insurance Company Ltd.Award Dated : 13.12.2007Repudiation of Claim under Motor OD Policy. The Claim was offered to be settled on atotal loss basis subject to the owner to comply with formalities like submission oforiginal registration book duly endorsed in the name of the Insurance Company etc.

The Complainant argued that the process of getting such entries recorded in the RCBook is cumbersome and costly. As such, it was agreed that a certificate be obtainedfrom the RTO Office confirming that in view of the extensive damage to the vehicle dueto the accident, it is rendered unroadworthy and on the basis of such compliance, theClaim be settled.Ahmedabad Ombudsman CentreCase No. 11-005-0135Mr. S H KandoliyaVsOriental Insurance Company Ltd.Award Dated : 26-12-2007Repudiation of Claim under Motor OD Policy: The Claim for total loss was proposed tobe settled for Rs. 25000/- on the basis of market value of the same type of make andyear of manufacture of the stolen Motor Cycle. The Complainant demanded that heshould be paid the full Insured Declared Value (IDV) of the Vehicle. As per GR 8 ofIndian Motor Tariff, in case of theft, IDV will be considered for claim settlement withoutany depreciation. As such, it was decided to settle the claim on the basis of IDV of theVehicle.Ahmedabad Ombudsman CentreCase No. 11-003-0216Mr. T V AntalaVsNational Insurance Co. Ltd.Award Dated : 31.01.2008Repudiation of Claim under Motor-OD Policy: The Complainant’s Motor Cycle wasstolen while being parked in an open place. The Vehicle was parked ‘without lock’. TheClaim was repudiated since it violated the condition that the Insured would take allreasonable care to safeguard the vehicle from loss. The critical document viz. FIRlodged with the City Police Station also noted the fact that the Vehicle was parkedwithout lock. Since the ‘reasonable safeguard’ condition was not complied with, thedecision of the Respondent to Repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. 11-012-0194Mr. B B PatelVsICICI Lombard General Insurance Co. Ltd.Award Dated : 21.02.2008Repudiation of claim under Motor OD Policy: The Complainant’s Car was stolen. Claimwas repudiated citing that the Car was being used for Travel business for hire/rewardand had violated the policy ‘conditions as to use’. A closer look at the FIR lodged bythe Complainant showed that besides business, he owned a TATA Indica Car. This hasbeen interpreted by the Respondent as the TATA Indica Car is being used for business.The Respondent has no evidence to prove that the vehicle stolen was used forcommercial purposes. As such, they were directed to pay the full claim.

Ahmedabad Ombudsman CentreCase No. 11-012-0239Mr. D B PatelVsICICI Lombard General Insurance Co. Ltd.Award Dated : 29.02.2008Repudiation of Motor Own Damage Claim. The Complainant’s Private Car had met withan accident. Claim was repudiated by stating that on investigation, it was found thatthe Car was being used for commercial purposes otherwise than in accordance with‘Limitations as to use’ Clause of the Policy. The Milometer of the Car showed a TotalRun of 119856 kms within 24 months. Average works to 166 kms per day suggestingthat the Vehicle was used for the purpose of getting hired. As such, the Respondent’sdecision to repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. 11-013-0319Dr. V AryaVsHDFC General Insurance Co. Ltd.Award Dated : 29.02.2008Partial settlement of Claim under Motor OD Policy. The Insured Car met with anaccident. Claim was lodged for Rs.38092/- while the Insurer settled the same forRs.35299/- on advice of Surveyor. The Surveyor in his report has stated that theGarage owner had used locally made parts in the Vehicle. Hence he allowed chargesas per the local quotations. In any case, Surveyors are independent authoritieslicensed by IRDA, whose decision is usually not tinkered with while deciding thequantum of settlement. As such, the decision of the Respondent was upheld with nofurther relief to the Complainant.Ahmedabad Ombudsman CentreCase No. 11-012-0313Mr. Y B RahevarVsICICI Lombard General Insurance Co. Ltd.Award Dated : 05.03.2008Repudiation of claim under Motor OD Policy. The Insured demanded payment ofinterest for delay in settlement of the Claim, which was found to be admissible as perthe IRDA (Protection of Policyholder’s Interests) Regulations 2002 and was awarded.Ahmedabad Ombudsman CentreCase No. 11-004-0242Mr. G V RathodVsUnited India Insurance Co. Ltd.Award Dated : 14.03.2008Repudiation of Claim under Motor-OD Policy: The Complainant’s Vehicle was stolenwhile being parked in the compound of the house. The Vehicle was parked ‘withoutlock’. The Claim was repudiated since it violated the condition that the Insured wouldtake all reasonable care to safeguard the vehicle from loss. The critical document viz.

FIR lodged with the City Police Station also noted the fact that the Vehicle was parkedwithout lock. Since the ‘reasonable safeguard’ condition was not complied with, thedecision of the Respondent to Repudiate the Claim was upheld.Ahmedabad Ombudsman CentreCase No. 11-011-0331Mr. P J KocharVsBajaj Allianz General Insurance Co. Ltd.Award Dated : 14-3-2008Repudiation of claim under Motor OD Policy: The Respondent produced a TransferForm to show that the vehicle which suffered a total loss due to an accident wasactually sold off to a third party about 4 months prior to the accident. However, theownership was not changed both in the RTO Book and in the Policy Certificate. Since,neither the Complainant nor the purchaser had Insurable Interest in the vehicle, theClaim was repudiated. During the course of hearing, the Complainant strongly refutedthat he had signed the said Transfer Form to sell the vehicle. It was concluded that theinstant case raises complicated questions of facts for which there is need forAdmission/Denial of documents, summoning of Witnesses, examination and crossexamination, Affidavits on oath etc for which the Forum is neither infrastructurallyequipped nor geared to judiciously get into such a task. As such, the Complainant wasadvised to take recourse to any other Redressal Forum considered appropriate forresolution of the subject grievance.Ahmedabad Ombudsman CentreCase No. 11-002-0179Ms. S H ShahVsNew India Assurance Co. Ltd.Award Dated : 24.03.2008Repudiation of Mediclaim under Motor Vehicle Policy: The Insured was hospitalised forAngiography and for Coronary Artery Bypass Surgery. The Discharge Summary of theHospital as also the Cashless request by the Hospital mentioned that the Insured wassuffering from hypertension since 10 years. The policy had commenced only 5 yearsback. As such, the decision of the Respondent to repudiate the claim was upheld.Ahmedabad Ombudsman CentreCase No. 11-005-0289Mr. P V RathodVsOriental Insurance Co. Ltd.Award Dated : 31.03.2008Repudiation of Claim under Motor OD Policy. The Claim was intimated after 63 days ofthe accident due to which the same was treated on a non-standard basis and 75%amount was paid after obtaining a discharge voucher from the Insured. It was neitheralleged nor established that the Insured had used any fraudulent method to procure thedischarge voucher. As such, it was considered in the fitness of things not to re-openthe matter.Bhubneshwar Ombudsman Centre

Case No. 14-005-0147Mr. Satyabrata TripathyVsOriental Insurance Co. Ltd.Award Dated : 04.10.2007Insured Complainant insured his Tata Indica Taxi under commercial vehicle insurancepolicy of Oriental Insurance co. Ltd. During currency of policy vehicle met with anaccident. Insurer’s appointed surveyor assessed the loss for an amount of Rs 87,000.Insured complainant replaced the parts as allowed by final surveyor and Re inspectionsurveyor has certified that parts have been replaced as directed by final surveyor.During verification of bills and cash memos it was found that parts were purchasedfrom M/s Suman Sales Corporation did not exist as per investigation made byinvestigator. Moreover CST Number mentioned in that cash memo has not been issuedby Commissioner Commercial Tax,West Bengal. Insurer repudiated the claim due tofake and fictitious cash memos.During Hearing insurer stated that the bills and cash memos submitted by insured arefalse. Complainant stated that he has purchased the parts from that shop.Hon’ble Ombudsman directed the insurer to settle the claim by deducting 25% of claimamount as the insured has sustained the loss and repaired the vehicle with thereplacement of parts as advised by final surveyor. Since the damaged occurred on2003 and parts purchased in 2004 and enquiry made in 2007 the total repudiation ofclaim by insurer is not justified.Bhubneshwar Ombudsman CentreCase No. 11-004-0188Mr. Bikram Keshari RoutrayVsUnited India Insurance Co. Ltd.Award Dated : 22.10.2007Insured Complainant insured his Santro Car bearing registration No: OR-02T-3884under private car Insurance Policy of United India Insurance co. Ltd. During currency ofpolicy due to fall of cocoanuts the vehicle got damaged. Insured complainant repairedthe vehicle in M/s Utkal Hyundai, an authorised garage and submitted a bill of Rs13,640/. Insurer appointed surveyor slashed the labour charges of Rs 3145 as someamount of labour charges are not genuine. Insurer offered an amount of Rs 10495/ tothe complainant as per survey report. Insured did not accept that amount and beingdissatisfied with the quantum of settlement preferred this complaint.During Hearing insurer stated that as per survey report they have settled the loss.Insured stated that he has repaired the vehicle in authorised garage and no parts havebeen replaced only labour charges have been paid by him why his claim will betrimmed.Hon’ble Ombudsman directed the insurer to pay Rs 13,640/ to the insured as theassessment of surveyor based on surmise and without any basis.The surveyor ha nottendered any plausible reason for the deduction of that amount.Bhubneshwar Ombudsman CentreCase No. 11-012-0339

Smt. Anusruta SinghdeoVsICICI Lombard General Insurance Co. Ltd.Award Dated : 30.10.2007Insured Complainant insured her Tavera Car bearing registration No: OR-02AD-6234under private car Insurance Policy of ICICI Lombard General Insurance Co. Ltd. Duringcurrency of policy the vehicle met with an accident while it was returning from Puri toBhubaneswar.Incident was reported to Pipili P.S. vide FIR No: 148 dated 16-6-2006. Asper Final police report P.Ananda Rao Dora was the driver at the time of accident.Insurer repudiated the claim on the ground that as per substantiation and investigationthe driver at the time of accident of the subject vehicle was different than the details ofdriver furnished by the insured.Insured being dissatisfied with the decision of insurer preferred this complaint.During Hearing insurer stated that they will settle the claim within 22-09-2007.Since the insurer did not settle the claim nor apprised this forum regarding theconstraints which prevented them to keep their commitment.Hon’ble Ombudsman directed the insurer to pay Rs 172920/ /immediately to theinsured with 18% interest per annum from the date of claim till date of payment asinsurer signally failed to prove that driver at the time of accident was different as pertheir substantiation and investigation.Bhubneshwar Ombudsman CentreCase No.11– 004-0215Sri Pryadarshi MishraVsUnited India Insurance Co. Ltd.Award Dated : 5.11.2007Insured Complainant insured his Tata Indica Car under private Car policy of UnitedIndia Insurance Co. Ltd for a period of one year commencing from 21-03-2005 for anIDV of Rs 345,000/.. On 25-5-2005 insured vehicle met with an accident and sustainedthe damages. Insurer appointed surveyor assessed the loss for an amount of Rs56,000/ against a bill of Rs 67,362/ . Insurer appointed Sri B. Patnaik for re inspectionof the vehicle after repairing. The surveyor has stated that parts like assy- wheel rimand aasy,front eyebrow have not been replaced. Some of salvage parts have not beenproduced for verification. Insurer settled the loss for Rs. 53006/-. Insured accepted theamount but being dissatisfied with the quantum of settlement approached his forum.Insurer filed Self Contained Note stating that as per final survey report and reinspection survey report the claim has been settled for Rs 53006/..During hearing Insurer stated that they have settled the claim as per final survey reportand re inspection survey report. Insured complainant stated that he has repaired thevehicle in a authorised garage why the labour charges will be deducted.Honourable Ombudsman directed the insurer to pay additional amount of Rs 2192.75 /as the settlement made by surveyor is arbitrary.Bhubneshwar Ombudsman CentreCase No.11– 005-0284Mr. Gopabandhu DaniVs

Oriental Insurance Co. Ltd.Award Dated : 13.11.2007Insured Complainant insured his Ambassador taxi under commercial vehicle policy ofOriental Insurance Co. Ltd for a period of one year commencing from 27-04-2004. On12-12-2004 insured vehicle dashed against a tree and met with an accident . Insuredcomplainant lodged acclaim for compensation of Rs 71,662/. Insurer repudiated theclaim on the ground that driver Sri Ajambila Sahu did not have valid D/L at the time ofaccident.Being aggrieved the complainant approached this forum.Insurer filed Self Contained Note stating that Ajambila Sahu having D/L No: 984/93issued by RTA ,Bolangir was authorised to drive goods carrying vehicle not publicservice vehicle . The Said D/L did not have PSV badge too. RTA, Bolangir vide theirletter dated 24-09-2005 categorically stated that Sri Sahu was authorised to driveTractor, LMV and Heavy Goods Vehicle which is a transport vehicle. But to drive a Taxii.e passenger carrying vehicle one should hold D/L authorised him to drive PSV withbadge.During hearing Insurer stated that driver Ajambila was authorised to drive LMV but hewas driving a taxi which is a PSV vehicle and D/L No: 954/93 did not have PSV badgeendorsement. Driver did not have valid D/L to drive that taxi . Complainant stated thattaxi being LMV type of vehicle driver had the valid D/L to drive LMV and HMV.Honourable Ombudsman directed the insurer to settle the claim as PSV badge does notprovide any extra skill to drive Passenger carrying vehicle except to observe certainduties at the time of accident.Bhubneshwar Ombudsman CentreCase No.11– 002-0286Dr. Kali Prasad MishraVsThe New India Assurance Co. Ltd.Award Dated : 13.11.2007Insured Complainant insured his Santro Car under private Car policy of New IndiaAssurance Co. Ltd for a period of one year commencing from 23-03-2005 for an IDV ofRs 349905/.. On the same day i.e 30-03-2005 while the vehicle was driven by driver todeliver the vehicle at the residence of insured complainant the vehicle met with anaccident. Insurer appointed surveyor assessed the loss for an amount of Rs 129325/against a bill of Rs 219928/ of OSL Hyundai Motors which is the authorised repairer ofthe vehicle. Insurer settled the claim for an amount of Rs 119,000/ and paid to thegarage. Insured accepted the amount but being dissatisfied with the quantum ofsettlement approached his forum.Insurer filed Self Contained Note stating that as per final survey report the claim hasbeen settled for Rs 119,000/ .During hearing Insurer stated that they have settled the claim as per final surveyreport. Insured complainant stated that it was a brand new car and repaired in aauthorised garage how his claim will be assessed for such an amount.Honourable Ombudsman directed the insurer to pay additional amount of Rs 53,755/ asthe settlement made by surveyor is arbitrary .Bhubneshwar Ombudsman CentreCase No.11– 002-0295

Sri. Pitabas PradhanVsNew India Assurance Co. Ltd.Award Dated : 14.11.2007Insured Complainant insured his Tata truck bearing Registration No.OR 06 0393 undercommercial Vehicle B policy of New India Assurance Co. Ltd. On 16.04.2004 at about10.30PM while driver Nakul Sahu parked the insured vehicle near Manguli Chhak andwent for his dinner some miscreants fled away with that vehicle. Incident was reportedto Tangi P.S vide F.I.R No. 55 dated 16.04.2004. Police authorities submitted FRT NoClue. Insured lodged a claim of Rs. 300000.00 towards compensation. Insurerrepudiated the claim on the ground that driver did not take reasonable care tosafeguard the vehicle and driver did not have valid driving licence. Being aggrieved thecomplainant approached this forum.In self-contained note Insurer stated that as per report of Investigator Sri. S. K. Sahuthe vehicle was properly locked as per the statement of insured owner and otherwitnesses. Whereas the statement recorded by police authorities of driver Nakul SahuU/S 161 CrPC the vehicle was not locked and key was inside the vehicle at thematerial time of theft. On verification of D/L No. 1362/82 issued by L.A. Jhansi,Insurer’s Jhansi Divisional Office reported that no such D/L has been issued by JhansiL.A.During hearing Insurer faled to produce any documentary evidence from L.A. Jhansiregarding the fakeness of the D/L. Insured stated that the vehicle was properly lockedand driver went for his dinner. When he returned he found the vehicle has been stolenby the miscreants.Honourable Ombudsman upheld the decision of the Insurer as the driver himself hasstated that he did not lock the vehicle before he left it on the road side which has beenrecorded by the police authorities. It has been clearly established that the driver beingthe representative of the insured did not take reasonable care to safeguard the vehicle.Bhubneshwar Ombudsman CentreCase No.11– 003-0191Mr. Rajesh RayVsNational Insurance Co. Ltd.Award Dated : 22.11.2007Insured Complainant insured his Tata Truck under Goods Carrying Commercial Vehiclepolicy B package of National Insurance Co. Ltd. On 25-12-2004 insured vehicle metwith accident due to sudden break down of Front Right Main Spring Leaf of thatvehicle.Insurer appointed surveyor assessed the loss for an amount of Rs 83,000/ against anestimate of Rs 162,120/ . At the time of accident Sri S. Kisan was driving the vehicle.During verification of D/L of Sri Kisan it has been established that D/l No: 3045/R/93has been renewd by RTO, Sambalpur against original D/L No: 8167/GHT/88 issued byDTO, Guwahati. On verification of D/L No: 8167/GHT/ 88 DTO, Guwahati stated thatthey have not issued such licence from their end. Insurer repudiated the claim on theground of fake D/L possessed by driver at the time of accidentBeing aggrieved the complainant approached this forum.Insurer has filed Self Contained Note stating that original D/L No: 8167/GHT/88 issuedby DTO, Guwahati found to be fake and claim stands repudiated due to such fake D/L.

During hearing Insurer reiterated their stand taken in self contained note and exhibitedthe letter written by DTO, Kamrup, Guwahati regarding non issuance of such licence bythemComplainant stated that D/L of Sri Kisan has been renewed by RTO Sambalpur since1993 and driver had possessed the valid D/L at the time of accident.Honourable Ombudsman uphold the repudiation as the D/L possessed by driver foundto be fake and insured complainant failed to prove that accident was due to mechanicaldefect and driver had no role to play in that accident.Bhubneshwar Ombudsman CentreCase No.11– 003-0184Sri Tusharkant PatnaikVsNational Insurance Co. Ltd.Award Dated : 12.12.2007Insured Complainant insured his Tata Indica Taxi under passenger carrying commercialvehicle policy of National Insurance Co. Ltd for a period of one year commencing from20-10-2003 for an IDV of Rs 329983/.. On 26-01-2004 insured vehicle met with anaccident and sustained the damages and insured got injured. Insurer appointedsurveyor assessed the loss for an amount of Rs 275,000/ on net of salvage basisagainst an estimate of Rs 627,709/ . As per claim form Sk Issac Khan was driving thevehicle at the time of accident. Police authorities have seized the D/L of Sk. IssacKhan. Insurer appointed Sri S. Mishra for investigation of the incident. As perinvestigator’s report insured Sri Tushar Patnaik was driving the vehicle at the time ofaccident but he did not have valid D/L to drive that taxi but managed Sk. Issac Khan toclaim as driver at the time of accident. Investigator obtained the statement fromvillagers that insured was driving the vehicle at the time of accident. On the strength ofinvestigator’s report insurer repudiated the claim.Being aggrieved insured filed this complaint.Insurer filed Self Contained Note stating that as per investigator’s report insured wasdriving the vehicle at the time of accident and he had no valid D/L to drive thattaxi.Insured managed Sk. Issac Khan to claim as driver.During hearing Insurer re iterated their stand taken in self contained note.Insured complainant stated that vehicle was driven by Sk. IssacKhan and police hasseized his licence. Police final report is abundantly clear regarding this. He hasreceived the injury during that accident. Sk. Issac Khan has given his statement to theinvestigator that he was driving the vehicle at the time of accident.Honourable Ombudsman directed the insurer to pay Rs 275,00/ to the complainant netof salvage basis as the police report has clearly statedSk .Issac Khan was driving the vehicle at the time of accident.Bhubneshwar Ombudsman CentreCase No.11– 003-0402Smt. Sujata KaliaVsNational Insurance Co. Ltd.Award Dated : 15.01.2008Insured Complainant insured her dumper OR-14M-1981 under Goods carryingCommercial policy of National Insurance Co. Ltd for a period of one year commencing

from 31-10-2006. Insured vehicle met with an accident on 31-01-2007 and sustainedthe damages.Insured lodged a claim for compensation of Rs 89195/. Insurer repudiated the claim onthe ground that driver Lehru Lal did not have valid D/L to drive this Heavy motorvehicle.Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed Self Contained Note stating that Lehru Lal was driver at the time ofaccident. D/L No: 504/1983-84 was issued by RTA, Sundargarh to Sri Lal to drive LMVnon professional. On 22-09-1983 and subsequently he was authorised to drive LMV(transport) and Heavy Motor vehicle by L.A. Sambalpur wef 24-04-1992. On verificationby insurer L.A.,Sambalpur has stated that no such endorsement was issued in favour ofSri Lal. Since driver did not have valid D/L to drive that vehicle the claim has beenrepudiated.During hearing Insurer re iterated their stand taken in SCN.Insured complainant stated that D/L of Sri Lal has been renewed by RTO, Sundargarhsince 1992 and driver possessed the valid D/L to drive that vehicle.Honourable Ombudsman uphold the repudiation as the insured complainant failed toprove with material evidence that driver Sri Lehru Lal had valid D/L to drive that heavygoods vehicle.Bhubneshwar Ombudsman CentreCase No.11– 003-0374Sri Bimal Prasad MohantyVsNational Insurance Co. Ltd.Award Dated : 15.01.2008Insured Complainant insured his Hero Honda motor Cycle bearing registration No: OR-05M-22557 under Motor Cycle policy of National Insurance Co. Ltd for a period of oneyear for an IDV of Rs. 21500/-. Insured vehiclewasw stolen on 22-04-2006 while it wasparked near Kalimandir ,Cuttack. Incident was reported to police on 23-04-2003 at1P.M..Insured lodged a claim for compensation of Rs 21,500/. Insurer settled the claim for anamount of Rs 14181/ on non standard basis by deducting 30/% of claim amount as theincident was not reported to police immediately insured had not taken correctivemeasures warranted under circumstances.Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed Self Contained Note stating that incident was reported after one day ofoccurrence violating policy conditions and matter was reported to insurer after twodays of theft of vehicle.During hearing Insurer re iterated their stand taken in SCN.Insured complainant stated that when he went to police on 22-04-2006 policeauthorities advised him to wait for a night then lodged FIR. Accordingly he has lodgedFIR on 23-04-2006. Police submitted Final report and arrested accused who had soldvehicle some where. Moreover he has submitted affidavit regarding loss of a key.Honourable Ombudsman directed insurer to pay Rs 21450/ as the reason tendered byinsured is convinced one.

Bhubneshwar Ombudsman CentreCase No.11-003-0237Sri Panchanan SethiVsNational Insurance Co. Ltd.Award Dated : 22.01.2008Insured Complainant insured his Tata Indica Car bearing registration No: OR-19-8099under passenger carrying commercial vehicle policy of National Insurance Co. Ltd for aperiod of one year . Insured vehicle met with an accident on 19-10-2003.Insured lodged a claim for compensation . Insurer repudiated the claim on the groundthat vehicle was registered as taxi but insured under private car policy.Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed Self Contained Note stating that vehicle was insured under private carpolicy but registered under taxi which violates the condition of the policy as regards tothe use of vehicle.On verification of R.C. Book it was found vehicle was registered astaxi. Insured suppressed the material facts for paying less premium under the policy.During hearing Insurer re iterated their stand taken in SCN.Insured complainant stated that he was not aware of the facts and subsequentlyintimated the insurer foe change of use of vehicle to insurer.Honourable Ombudsman uphold the repudiation as the vehicle was used as taxi at thetime of accident which violates the policy condition.Bhubneshwar Ombudsman CentreCase No.14-005-0255Sri Rajeswar ThakurVsOriental Insurance Co. Ltd.Award Dated : 25.01.2008Insured Complainant insured his Hitachi Excavator (EX-70) under Motor Miscellaneousvehicle policy of Oriental Insurance Co. Ltd for a period of one year commencing from3-6-2004 . Insured vehicle caught fire while it was in parking condition on 8-6-2004 11P.M. .Insured complainant lodged a claim with the insurer . Incident was reported topolice on 9-6-2004. Insured complainant informed the incident to Fire BrigadeAuthorities . Insurer appointed Sri S.K. Neura for spot survey and Sri K.K. Sharma forfinal assessment. Sri Sharma has assessed the loss for Rs 10,00,000/ on net ofsalvage basis and Rs 1390,861/ on repairing basis. Again insurer appointed Sri S.C.Senapati for investigation . Sri Senapati has opined that insured vehicle might havecaught fire before the taking insurance coverage granted by insurer. Insurer repudiatedthe claim on the strength of investigators report.Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed Self Contained Note stating that the cause of loss and genuineness ofreported time and date of loss has not been proved beyond reasonable doubt.During hearing Insurer re iterated their stand taken in SCN.Insured complainant stated that he has insured his vehicle with insurer on 3-6-2004 butcaught fire on 8-6-2004. Insurer has appointed their surveyor to assessed the loss butdenied the claim without any basis.

Honourable Ombudsman directed the insurer to pay Rs 10,00,000/ as assessed bysurveyor as the investigation report of Sri Senapaty does not have any concreteevidence that vehicle was damaged before insurance was granted.Bhubneshwar Ombudsman CentreCase No.11– 002-0229Sri Mohan SahooVsNew India Assurance Co. Ltd.Award Dated : 28.01.2008Insured Complainant insured a Truck bearing registration No: OR-14D-2698 underGoods carrying Commercial policy of New India Assurance Co. Ltd for a period of oneyear . Insured vehicle met with an accident on 28-04-2003 and sustained the damages.Insured lodged a claim for compensation of Rs 167,100/. Insurer repudiated the claimon the ground that driver did not have valid D/L at the time of accident .Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed Self Contained Note stating that driver Sri Krishna Rai did not have validD/L at the time of accident. As per their investigator D/L No: 460/85 is not effective onthe date of accident.During hearing Insurer re iterated their stand taken in SCN.Insured complainant stated that initially D/L No: 460/85 was issued by RTO, Durgapurin favour of Sri Krishnma Rai which was renewed by DTO, Patna from 6-7-2000 to 5-7-20003. As the accident took place on 28-04-2003 the D/L renewed by DTO, Patna isvery much effective. Insured complainant submitted the original D/L of Sri Krishna Raibefore this forum for perusal.On perusal of said D/L it has been clearly stated the D/L No: 460/85 has been renewedby DTO, Patna from 6-7-2000 to 5-7-20003.Honourable Ombudsman directed insurer to pay Rs 40,100/ as assessed by surveyoras repudiation does not have any merit .Bhubneshwar Ombudsman CentreCase No.11– 003-0293Sri M.K. AgarwalVsNational Insurance Co. Ltd.Award Dated : 28.01.2008Insured Complainant insured Chevrolet Tavera bearing engine No: 3LD O8201 andChasis No: MA6AB6C ion No: OR-06D-7102 under passenger carrying commercialvehicle policy of National Insurance Co. Ltd for a period of one year for an IDV of Rs630800/. . Insured vehicle met with an accident on 11-02-2005.Insured lodged a claim for compensation . Insurer repudiated the claim on the groundthat vehicle was allowed to plying on the public road without registration and vehiclewas registered under private car but insured under commercial vehicle policy.Insured complainant being aggrieved of the decision of insurer approached this forum.

Insurer filed Self Contained Note stating that vehicle was insured under commercialvehicle policy. It was registered under private car policy after the five months of theaccident. Moreover vehicle was plying on the public road without registration .During hearing Insurer re iterated their stand taken in SCN.Insured complainant submitted a temporary registration certificate where it has beenclearly stated M/s Shivalik Motors Ltd ( Mukesh Kumar Agarwal)is the owner of vehicle.It was valid till 3-3-2005 and that document was signed on 4-2-2005. Accident tookplace on 11-02-2005. From that document it is crystal clear M/s- Shivalik Motors Ltd isthe owner but they are not complainant. But registration book reveals complainant wasthe owner of vehicle. At the time of issuance of registration no temporary registrationwas produced. Complainant failed to give any plausible reason regarding the ownershipand registration of vehicle.Honourable Ombudsman dismissed the complaint as insured complainant was not theowner of vehicle at the time of accident.Bhubneshwar Ombudsman CentreCase No.11– 004-0285Sri N.N.C. BeheraVsUnited India Insurance Co. Ltd.Award Dated : 29.01.08Insured Complainant insured his Matiz Car bearing registration No: OR-06D-7102under Private Car policy of United India Insurance Co. Ltd for a period of one year foran IDV of Rs 200,000/. . Insured vehicle met with an accident on 14-11-2004 .Insured lodged a claim for compensation of Rs 43,739.93. Insurer settled the claim foran amount of Rs 13,928/ as per the survey report . The said surveyor has notconsidered some of the bills as it was found top be fake. Insured complainant did notaccept that amount as he had paid Rs 43739.93Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed Self Contained Note stating that vehicle was repaired in M/s –DeepaAutomobiles . The surveyor has assessed the loss for Rs 13,928/. The said surveyorhas verified the bills from that garage who has given in writing that some of the billshas not been issued by them though accident vehicle was repaired in that garage.During hearing Insurer re iterated their stand taken in SCN.Insured complainant stated that bills submitted by him were issued by M/s DeepaAutomobiles.Honourable Ombudsman dismissed the complaint as insured complainant signallyfailed to give any satisfied reply and the amount settled by insurer is just and proper.Bhubneshwar Ombudsman CentreCaseNo.11-004-0202Sri Rakesh SinhaVsUnited India Insurance Co. Ltd.Award Dated : 7.02.2008Insured Complainant insured his Maruti car with United India Insurance Co. Ltd underprivate car comprehensive policy for a period of one year commencing from 17-08-2004.Insured vehicle met with an accident on 4-4-2005. Insured complainant lodged a

claim for an amount of Rs 40,395/. Insurer repudiated the claim on the ground thatdriver did not have valid D/L at the time of accident..Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed the Self Contained Note stating that driver K. Chanda Rao was authorisedto drive transport vehicle for the period 22-10-1999 to 18-07-2004. That licence hasbeen renewed from 7-7-2005 to6-7-2008 . But same was not renewed from 19-07-2004to 6-7-2005. As the accident took place on 4-4-2005 the driver did not have valid D/L atthe time of accident .During hearing Insurer’s representative stated that driver did not have valid D/L at thetime of accident.. Insurer submitted a certified copy from RTO, Bhubaneswar that D/LNo: 3864 has not been renewed for the period 19-07-2004 to 6-7-2005.Insured complainant stated that driver had valid D/L.Honourable Ombudsman uphold the repudiation as the driver did not have valid D/L atthe time of accident.Bhubneshwar Ombudsman CentreCase No.14-005-0138Smt. Tilatoma SamantarayVsOriental Insurance Co. Ltd.Award Dated : 12.03.2008Insured Complainant insured her Bajaj Auto Rickshaw with Oriental Insurance Co. Ltdunder commercial vehicle comprehensive policy for a period of one year commencingfrom 19-09-2003. .Insured vehicle met with an accident on 23-10-2003 while it wasdriven by Sri Ajay Kumar Behera having D/L No: 3428 dated 6-5-1989 issued by RTo,Bhubaneswar . Insured lodged a claim for an amount of Rs 40,000/.. Insurer repudiatedthe claim on the ground that driver did not have valid D/L at the time of accident..Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed the Self Contained Note stating that driver Ajay Kumar Behera was drivingthe vehicle at the time of accident . D/L No: 3428 dated 6-5-1989 expired on 2-4-2003where as the accident took place on 23-10-2003. Driver did not have valid D/L at thetime of accident.During hearing Insurer’s representative stated that driver did not have valid D/L at thetime of accident..Insured complainant exhibited the original D/L No: 3428 dated 6-5-1989 issued by RTO.Bhubaneswar stated that driver is authorised to drive Transport vehicle 9HGV) upto 2-4-2003 with effect from 4-4-2000.Honourable Ombudsman uphold the repudiation as the driver did not have valid D/L atthe time of accident.Bhubneshwar Ombudsman CentreCase No.11-005-0232Sri Dhiresh Kumar MohantyVsOriental Insurance Co. Ltd.Award Dated : 14.03.2008

Insured Complainant insured his Ashok Leyland Bus with Oriental Insurance Co. Ltdunder commercial vehicle comprehensive policy for a period of one year commencingfrom 18-03-2001. .Insured vehicle met with an accident on 1-9-2001 . Insuredcomplainant lodged a claim for an amount of Rs 466,365/ . Insurer appointed surveyorhas assessed the loss for an amount of Rs 60,762/. Insurer settled the claim for anamount of 57,000/.Insured complainant being aggrieved of the decision of insurer approached this forum.Insurer filed the Self Contained Note stating that as per survey report the claim hasbeen settled for Rs 57,000/.During hearing complainant stated that bus was completely damaged and he spent Rs239,214 / towards repairing of vehicle but insurer offered him only Rs 57,000/.Insurer representative re iterated their stand taken in self contained note.Hon’ble Ombudsman directed the insurer to pay Rs 86,500/ to the complainant as thesurveyor has drastically slashed the labour charges without any rhyme and reason anddid not allow the replacement cost of battery though it has been damaged.Bhubneshwar Ombudsman CentreCase No.11-002-0199Smt. Jyotsnamayee MohapatraVsNew India Assurance Co. Ltd.Award Dated : 14.03.2008Insured Complainant insured her Tata Indica Taxi under passenger CarryingCommercial Vehicle Policy with New India Assurance Co. Ltd. for a period of one yearcommencing from 23-03-2004. During currency of the policy while the insured vehiclewas parked in front of marine department of Paradeep Port Trust during night timesome unknown vehicle dashed the parking vehicle and caused damaged to it.Incident was reported to Paradeep P.S. and insured lodged a claim for Rs 25603/.Insurer appointed surveyor has assessed the loss for Rs.14692/. Insurer repudiated the claim as the driver did not have valid D/L at the time ofaccident.Being aggrieved the insured complainant approached this forum.Insurer filed self-contained note stating that as per claim form Sri Niranjan Das wasdriver at the time of accident and during verification it has been observed D/L No:204/98-99 was issued in favour of Sri Laxmi Narayan Mohanty.Hence the claim has been repudiated due to fake D/L.During hearing Insurer reiterated their stand taken in the self-contained note whereasthe insured stated that since the vehicle was in parking condition D/L has no bearingcausing the accident.Hon’ble Ombudsman directed the insurer to pay Rs 14692/ to the complainant as theInsurer failed to prove that accident took place due to negligence of driver and D/L hasno bearing on loss.Bhubneshwar Ombudsman CentreCase No.11-002-0201Niranjan MishraVsNew India Assurance Co. Ltd.

Award Dated : 26.03.2008Insured Complainant insured his Tata truck under Goods Carrying Commercial VehiclePolicy with New India Assurance Co. Ltd. for a period of one year commencing from18.12.2003. During currency of the policy the vehicle met with an accident. As per theclaim form submitted by the insured, Sri. Niranjan Mohapatra having D/L No. 80/73issued by L.A. Cuttack was driving the vehicle. Insurer appointed surveyor whoassessed the loss for an amount of Rs. 63000.00. Insurer repudiated the claim on theground that the driver had a fake driving licence. Being aggrieved the insuredcomplainant approached this forum. Insurer filed self-contained note stating that as perthe affidavit submitted by their advocate Mrs. Madhuri Badani the original D/L No.9783/66 has not been issued by D.T.O Jamshedpur which was subsequently renewedby L.A. Cuttack vide D/L No. 80/73. Hence the claim has been repudiated due to fakeD/L.During hearing Insurer reiterated their stand taken in the self-contained note whereasthe insured stated that driver had valid driving licence at the time of accident. Duringhearing insurer was directed to submit documentary evidence from D.T.O Jamshedpurregarding fakeness of D/L No. 9783/66.Hon’ble Ombudsman directed the insurer to pay Rs 63,000/ to the complainant as theInsurer failed to submit any documentary evidence from D.T.O Jamshedpur regardingfake-ness of D/L No. 9783/66.Chandigarh Ombudsman CentreCase No. : GIC/220/ICICI/14/08Sawinder Kumar JoshiVsICICI LombardAward Dated : 4.10.07FACTS : Shri Sawinder Kumar Joshi got his vehicle bearing no. PB-02-AQ-7196insured from the insurer. The vehicle met with an accident on 11.3.07. It was taken toDada Motors, Jalandhar on 12.3.07 and was duly surveyed by the surveyor the sameday. The vehicle was repaired by paying Rs. 55,043/-. When the claim was lodged withthe insurer, the same was repudiated on the ground that the vehicle was being used forcommercial purposes.FINDINGS : The insurer informed that the vehicle was being used for commercialpurposes as is evident from the fact that mileage covered by the vehicle is in excess of84,000 Km over a period of 15 months which works out to above 5000 Km per month.This does not appear to be the average running of a vehicle for domestic use.Moreover, there was no FIR, DDR or spot survey. Hence the claim was repudiated onthe plea that the vehicle was being used for commercial purposes.DECISION : Held that there is substance in the contention of the insurer that thevehicle was exceeding the usual mileage. Hence their view that the vehicle was beingused for commercial purposes has some weight because circumstantial evidence pointstowards that. The claim was not payable and repudiation of the claim by the insurerwas in order. The complaint was dismissed.Chandigarh Ombudsman CentreCase No. : GIC/224/ICICI/11/08Kashmiri Lal

VsICICI LombardAward Dated : 4.10.07FACTS : Shri Kashmiri Lal got his vehicle bearing no. HP12 B –1371 insured from theinsurer after paying Rs. 12,845/- as premium. Since the vehicle was insured for the last3 years NCB benefit was also availed. The vehicle met with an accident on 29.6.07.The insurer was informed and he was advised to shift the vehicle to M/s Apex Motorsfor cashless settlement. FIR and spot survey was got done and the claim was preferredwith the insurer. However, the same was repudiated on the plea that the vehicle wasbeing used for commercial purposes. He contended that at the time of accident hisfamily members were traveling in the vehicle.FINDINGS : The insurer informed that the driving licence had not be been verified andthe vehicle mileage appeared to be on the higher side. The complainant producedoriginal driving licence of Shri Jaipal Singh which was found in order. The complainantclarified that since it was a joint vehicle for all members of the family and they wereusing from time to time for outstation duties, the mileage was high.DECISION : Held that the repudiation of the claim by the insurer on the ground ofvehicle being used for commercial purposes was not in order. The claim was payable.Hence ordered that the admissible amount of claim should be paid by the insurer to thecomplainant.Chandigarh Ombudsman CentreCase No. : GIC/254/ICICI/11/08Mehar Singh ChopraVsICICI LombardAward Dated : 9.10.07FACTS : Shri Mehar Singh Chopra got his Tata Indica bearing no. HR-11B-6310insured from the insurer for the period 29.8.06 to 28.8.07. The vehicle met with anaccident in Feb’07. The claim lodged with the insurer was repudiated on the groundthat the CNG kit was installed in the vehicle. He also stated that CNG kit had beenregistered in the RC and the insurer had been informed accordingly.FINDINGS : The insurer informed that entry in insurance endorsement was LPG whilein RC it was CNG. On a query as to whether the complainant was responsible forwrong entry in the insurance document, the insurer could not give a satisfactory reply.DECISION : Held that the repudiation of the claim on the basis of CNG installation inthe car was not in order, as it had no nexus with the cause of the accident. The claimwas payable. Hence ordered that the admissible amount of claim should be paid by theinsurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/239/OIC/14/08Ajeet SinghVsOriental Insurance Co. Ltd.Award Dated : 12.10.07

FACTS : Shri Ajit Singh got his Tata Indica bearing no. CH-02-1449 insured for theperiod 23.6.06 to 22.6.07 for sum insured of Rs. 2,30,000/-. The vehicle met with anaccident on 15.5.07. The insurer was intimated and spot survey was done. The finalsurvey was also done. But the claim had not been settled so far.FINDINGS : The insurer informed that the surveyor had assessed the loss at Rs.1,37,062/-. This was on the assumption that body shell was repairable. However, thecomplainant wanted the body shell to be replaced. On a query, why the body shellneeded to be replaced, the complainant produced a letter from the workshop in which itwas stated that due to internal damages, proper alignment after repair of the body shellmay not be plausible.DECISION : Held that the vehicle should be surveyed afresh based on replacement ofthe body shell. If the assessed amount works out to be more than 75% of IDV, theclaim should be settled on total loss basis after deducting salvage value. Otherwise onrepair or any other mode agreeable to both the parties.Chandigarh Ombudsman CentreCase No. : GIC/191/NIC/11/08Arvinder SinghVsNational Insurance Co. Ltd.Award Dated : 12.10.07FACTS : Shri Arvinder Singh purchased a new Fiat Sienna car on 16.7.01 and got itinsured from DO-III Chandigarh for the period 13.07.01 to 12.07.02 for sum insured ofRs. 6,12,000/-. The vehicle was stolen during the night of 12.7.02. An investigator wasappointed and all formalities relating to settlement of the claim were completedincluding transfer of RC in the name of the insurer. However, the claim had beenrepudiated.FINDINGS : The insurer informed that the theft took place on 13.7.02 as per FIRsubmitted by the complainant. The vehicle was insured from 13.07.01 to 12.07.02.Thus on 13.7.02 there was no insurance cover on the vehicle. On a query as to how theinsurance cover could be given from 13.07.01 when the vehicle was purchased on16.7.01, the insurer stated that part payment for the vehicle was made on 13.7.01 andpayment for insurance premium was also made on 13.7.01. Hence cover note was validfrom 13.7.01 to 12.7.02. On a query whether any documentary evidence was availableto prove that vehicle was transferred in the name of the complainant on 13.7.01, theinsurer replied in the negative.DECISION : Held that part payment was made on 13.7.01, the actual delivery of thevehicle and transfer of deed was done on 16.7.01. Hence insurance cover should haveappropriately been from 16.7.01 to 15.7.02. Moreover the theft took place on12/13.7.02. Hence it could have been before the midnight of 12.7.02. Giving the benefitof doubt to the complainant regarding the timing of theft and the commencement ofinsurance cover from 16.7.01, ordered that 75% of assessed survey report of Rs. 3.25lakhs should be paid by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/265/UII/14/08Sanjay JainVs

United India Insurance Co. Ltd.Award Dated : 12.10.07FACTS : Dr. Sanjay Jain got his vehicle bearing no. HR 06H-7976 insured from DOPanipat. The vehicle met with an accident on 12.2.06. The surveyor was deputed bythe insurer and all formalities were completed when the claim was lodged with theinsurer. However, the claim had not been settled by the insurer so far. Only a letterwas received from the insurer that driving licence of the driver Shri Vikram was not inorder as he was under age at the time of issue of licence on 3.8.04 by over fourmonths.FINDINGS : The insurer informed that the driving licence at the time of making thelicence, showed the age of driver as 17 years 7 months and 7 days. Hence the driverwas under age at the time of making of the licence. Hence the licence was beingverified.DECISION : Held that delay in settlement of the claim on the basis of wrong drivinglicence was not in order. The insurer should have informed the complainant on the veryfirst day that driving licence was not in order. Moreover, the fault in issuing anincorrect driving licence was that of the Licensing Authority and not of the complainant.Even if the driver was under age in 2004, he had crossed the age of 18 years whichwas eligible age for driving the vehicle at the time of accident in Feb’06. Hence drivinglicence should be accepted as valid on the date of accident and the claim should bepaid by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/234/UII/11/08Jagir SinghVsUnited India Insurance Co. Ltd.Award Dated : 17.10.07FACTS : Shri Jagir Singh got his Tata Qualis bearing no. PB 10AV 5890 insured fromDO Ludhiana for sum insured of Rs. 5 lakhs. The vehicle was stolen on 19.12.05 andFIR no 183 dated 21.12.05 was lodged the Police Station. However, they settled theclaim for Rs.3,49,000/- and not the IDV of Rs. 5.00 lakhs. He contended that he hadbeen paying premium on the basis of IDV of Rs.5.00 lakhs. He wanted the claim to besettled for Rs.5.00 lakhs.FINDINGS : The insurer informed that the surveyor had assessed the loan at Rs.3.49lakhs and hence this amount was offered. On a query, whether the IDV of Rs.5.00lakhs was fixed as per Motor Tariff rules, the insurer stated that IDV had been wronglyfixed for Rs.5.00 lakhs. The IDV was reworked out to 60% of Rs.6,78,555/-. This worked out to Rs.4,07,133/-.DECISION : Held that on the principle that public should not suffer for the mistake ofan individual, the correct IDV as per rules was payable. Hence, ordered thatRs.4,07,133/- after deducting excess clause of Rs.1,000/- was payable to thecomplainant by the insurer alongwith refund of excess premium taken by them.Chandigarh Ombudsman CentreCase No. : GIC/252/ICICI/11/08Krishna DeviVsICICI Lombard

Award Dated : 18.10.07FACTS : Smt. Krishna Devi purchased a Tata Indica car bearing no. HR 03 D1536 inJuly’06 in her own name. The RC was transferred in her name but the insuranceremained in the name of Shri Rajesh K Grover, the seller. The papers for transfer ofRC in her name were completed on 6.4.07. The vehicle met with an accident on 9.5.07.The company could not be informed in the interim period and the complainant’s namecould not be incorporated in the insurance policy. The claim lodged by her wasrepudiated on the ground of not having any insurable interest.FINDINGS : The insurer informed that the vehicle was sold by Shri Rajesh K Grover tothe complainant and the RC was accordingly transferred on 6.4.07. However, theinsurance policy had not been transferred and it was still in the name of Shri Rajesh KGrover. Thus on the date of accident neither Shri Rajesh K Grover nor the complainanthad any insurable interest. Therefore, the claim was repudiated.DECISION : The Hon’ble High Court in the case of National Insurance Co. Ltd. VsPurshotamdas Maheshwari & Others, (Misc. Appeal No. 195 of 1980 decided on5.12.1985) held that insurer was not liable as the contract of insurance between theinsurer and the transferor came to an end when the vehicle was transferred without theprior consent or permission of the insurer and there was no contract of insurancebetween the insurer and the transferee. Similar judgement had been passed by Hon’bleHigh Court of Madras in the case of New India Assurance Co. Ltd. Vs Parvathy Ammal& Others (AAO No. 537) decided on 15.10.1987. In view of the judgements the claimwas not payable and the repudiation of the claim by the insurer was in order. The casewas closed.Chandigarh Ombudsman CentreCase No. : GIC/261/UII/14/08Varinder Singh GandhiVsUnited India Insurance Co. Ltd.Award Dated : 18.10.07FACTS : Shri Varinder Singh Gandhi had taken a Motor Policy for his Santro carbearing no. PB-10BD-6373 from 14.6.06 to 13.6.07. The car met with an accident on13.11.06. There was a death of a person and settlement had been made with membersof the family. An amount of Rs. 86,000/- was spent on repairs. The claim lodged withthe insurer had not been settled so far.FINDINGS : The insurer informed that neither the FIR, DDR, spot survey nor PMR ofthe victim who died as a result of the accident was available. In the absence of any ofthese documents it was not possible to settle the claim, as third party claim can belodged against the insurer at any time.DECISION : Held that since it was a case of accidental death it was imperative toreport the matter to the police authorities rather than settling the case mutually andclosing the case. Because of absence of FIR and any other document it would not bepossible for the insurer to settle the claim. The claim was not payable. The complaintwas dismissed.Chandigarh Ombudsman CentreCase No. : GIC/266/NIC/14/08Jagdish BundelaVsNational Insurance Co. Ltd.

Award Dated : 18.10.07FACTS : Shri Jagdish Bundela got his vehicle bearing no. HR-39A-2257 insured withDO Rohtak. He renewed the policy with New India Assurance Co. Ltd. The policy wasrenewed with insurer viz. NIC, Rohtak. The insurer, NIC Rohtak had informed that hewas eligible for zero percent NCB, whereas he was eligible for 20%. His claim waspending with NIA due to NCB confirmation.FINDINGS : The insurer informed that there was third party claim with MACT inrespect of this vehicle when it was insured with them. Accordingly, the NCB was shownzero percent as per the software programme. On a query whether third party claim islinked with NCB, the insurer replied in the negative. On a query whether in theundertaking given by the insured the claim should be for OD or third party, the insurerreplied that this was not clear and matter stands referred to their higher office forclarification.As per Motor Tariff Rules for forfeiture of claims under Section-I are normally linkedwith OD claims. The declaration to be given by the insured reads “ I/We declare thatthe rate of NCB claimed by me/us is correct and that no claim has arisen in theexpiring policy period (copy of the policy enclosed). I/We further undertake that if thisdeclaration is found to be incorrect, all benefits under the policy in respect of Section 1of the Policy will stand forfeited”. There is no mention of the fact that third party claimwill make the insured ineligible for NCB. No clarification had been given by the HeadOffice although more than two months had elapsed.DECISION : Held that the third party claim should be de-linked from the claim taken bythe insured and it should be treated as no claim as far as insured is concerned. Henceordered that NCB certificate should be given by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/268/Tata AIG/11/08S. SathappanVsTata AIGAward Dated : 19.10.07FACTS : Shri S. Sathappan got his Hyundai Santro Xing XO insured under Private CarPackage Policy. His vehicle was stolen on 8.6.06, but the theft was not registeredimmediately. A Temporary Registration Certificate was given to the insurer. Based onthis the insurer offered Rs. 2,10,511/- (60% of IDV) which was less than the eligibleclaim. He wanted the claim to be settled on the basis of 100% IDV.FINDINGS : The insurer informed that registration of the vehicle was not applied for bythe complainant within 30 days of the purchase of the vehicle. Hence plying of thevehicle on road was not as per MV Act. Moreover the theft of the vehicle was notreported to the Registering & Licensing Authority. The FIR did not mention engine andchassis number but only temporary registration number. The insurer quoted NationalConsumer Dispute Redressal Commission (NCDRC) case no. 4(2006) CPJ 62(NC) inthe case of Aeroflot Soviet Airlines Vs UII Appeal No. 504 of 1997 decided on 31.7.06.In this the NCDRC had held that the insurer was not liable for payment in case the RCof the vehicle was not available on the date of theft. However, taking a lenient viewthey had settled the claim on 60% of IDV since it was a new vehicle.DECISION : Held that the action taken by the insurer to settle the claim on the basisof 60% of IDV was a good gesture to earn goodwill for the company. The complainantwas advised to accept the offer made by the insurer since there were serious

deficiencies on his part in respect of the claim lodged by him with the insurer. Thecomplaint was dismissed.Chandigarh Ombudsman CentreCase No. : GIC/301/NIA/11/08Dalbir SinghVsNew India Assurance Co. Ltd.Award Dated : 5.11.07FACTS : Shri. Dalbir Singh got his Hero Honda motorcycle bearing no PB-16B-6731insured from BO Mehatpur for the period 31.7.06 to 30.7.07 for sum insured of Rs.32,000/-. The vehicle met with an accident on 18.2.07. The claim lodged with theinsurer had been repudiated on the ground that the vehicle had been sold to one ShriGurdeep Singh on 8.2.07. Hence the complainant had no insurable interest on the dateof accident.FINDINGS : The insurer informed that as per the investigation report the vehicle hadbeen sold by the complainant to Shri Gurdeep Singh on 8.2.07. He showed affidavitssigned by both Shri Dalbir Singh and Shri Gurdeep Singh in this regard. On a querywhether RC and insurance policy had been transferred in the name of Shri GurdeepSingh, the insurer replied in the negative. However, he showed a letter from thecomplainant in which he had stated that if the claim was not payable to him it should bepaid to Shri Gurdeep Singh.DECISION : Held that the repudiation of the claim by the insurer on the ground ofabsence of insurable interest of the complainant was in order. The payment alsocannot be made to Shri Gurdeep Singh, the purchaser of the vehicle since there wasno contract between him and the insurer, as the insurance cover had not beentransferred in his name. The repudiation of the claim was justified. The complaint wasdismissed.Chandigarh Ombudsman CentreCase No. : GIC/348/NIC/14/08Anil ShuklaVsNational Insurance Co. Ltd.Award Dated : 15.11.07FACTS : Shri Anil Shukla got his Hero Honda motorcycle bearing no. HR-29P-2366insured for the period 17.2.06 to 16.2.07. His vehicle was stolen on 31.7.06 for whichan FIR was lodged the same day. All relevant papers including claim form, FIR, RC anddriving licence were submitted with the insurer. However, the claim was made as ‘noclaim’ on the ground of delay in reporting to the insurer.FINDINGS : The insurer informed that they received the intimation about the theft onlyin Jan’07. Hence the claim was made as ‘no claim’ on the basis of delay in reporting.On a query whether no information was given earlier than Jan’07, the complainantstated that the intimation was given soon after the theft. However, since he had to goout of station for four months, he could not follow up the case.DECISION : Held that FIR was lodged on the very day of the theft of the motorcycle.However, the complainant erred in not following up the same with the insurer andhence the communication gap with the insurer could not be covered. Since there was

lapse on the part of the complainant in following up the case it does not mean that thetheft had not taken place. Hence ordered that 50% of the admissible claim amount ofclaim should be paid by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/347/NIC/11/08Harbans Singh CheemaVsNational Insurance Co. Ltd.Award Dated : 26.11.07FACTS : Shri Harbans Singh Cheema got his Indica car bearing no PB-23F-1210insured from BO Sirhind from 26.2.07 to 25.2.08. The insurance cover was taken forcommercial purposes. While using for personal use the vehicle met with an accident on1.6.07. The claim lodged with the insurer was repudiated on the ground that thecompany was not informed about the change in usage and class of vehicle which wasof a material nature. He contended that the change in usage could not be endorsed inpolicy document, as he had to go abroad. He also requested for refund of excesspremium charged under commercial vehicle tariff from the date of endorsement forpersonal use till the date of expiry of insurance.FINDINGS : The insurer informed that the vehicle was being used for commercialpurposes while being used in Delhi. On transfer to Punjab, the same was being usedfor personal purposes which was got endorsed in the RC but this was not done on theinsurance policy before the date of accident. This has since been endorsed. Hence theclaim was repudiated on the ground of limitation to usage.DECISION : Held that the usage of commercial vehicle for personal usage is notexcluded as per terms and conditions of the policy. Therefore, the repudiation of theclaim by the insurer on the ground of limitation to usage was not in order. Henceordered that the admissible amount of claim should be paid by the insurer to thecomplainant. The additional premium charged under commercial usage tariff after theendorsement for personal use till the date of expiry of insurance should be refunded onshort term basis along with the claim amount.Chandigarh Ombudsman CentreCase No. : GIC/350/NIC/11/08Satish KumarVsNational Insurance Co. Ltd.Award Dated : 27.11.07FACTS : Shri Satish Kumar Gupta got the Indica Car No.JK-02M-8745 owned by hisfather Shri Mohan Lal Gupta insured with the insurer for the period 27.12.2006 to26.12.2007 for sum insured of Rs.70,000/-. The vehicle met with an accident on 1.1.07when it collided with a Punjab Roadways bus. The accident resulted in the death of 5persons and vehicle was totally damaged. The claim lodged with the insurer wasrejected on the ground that the number of persons seated in the car at the time ofaccident were six against permitted seating capacity of 5 persons. He contended thatout of 6 persons, 3 occupants were minors and this fact should be taken into accountwhile counting the no. of passengers.

FINDINGS : The insurer clarified the position by stating that when the RC was verifiedfrom the RTO, it was mentioned that the seating capacity was 4. Hence the claim wasrepudiated on the ground of overloading of the vehicle.DECISION : Held that as per the letter of repudiation the seating capacity was 4+1.Taking 4+1 as the seating capacity and 3 minors occupying the car at the time ofaccident, the seating capacity is permissible. Moreover, the number of passengers hasnot resulted in the accident, since as per the mechanical inspection report issued bythe J&K State Road Corporation, the failure of the brake could have been the cause ofthe accident. The repudiation of the claim on the ground of over seating which couldhave affected the driving capability of the driver, is not in order. Hence ordered thatthe payment of admissible amount of claim, on the basis of net of salvage asrecommended by the surveyor, should be paid by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/367/UII/11/08Sukhrah Singh NattVsUnited India Insurance Co. Ltd.Award Dated : 4.12.07FACTS : Shri Sukhraj Singh Natt got his Scorpio bearing no. PB-31-E-0455 insuredfrom BO Malout for sum insured of Rs .6,81,000/-. It met with an accident on 04.7.07 atBhathinda whilst being driven by his friend Kulwinder Singh who was holder of validlicence no. 20257/BTI for Scooter/LMV and which was valid upto 2024. He got thevehicle repaired. When the claim was lodged with the insurer, the same was repudiatedon the ground that the driving licence was for Motor Cycle/ Scooter/ Car/ Jeep and notfor LMV.FINDINGS : The insurer informed that the carrying capacity of Scorpio is 7 + 1, whichfalls under the category of LMV. Since the driving licence was valid for car only, thedriver was not authorized to drive the vehicle with 7 + 1 seating capacity. Hence, theclaim was repudiated. Further the driving licence was valid for car and jeep, which onverification was found that it was valid only for scooter and car.DECISION : Held that this was a case of interpretation of relevant rules regardingdriving licence. The definition of Light Motor Vehicle is the vehicle in which grossunladen weight does not exceed 7500 kg. While the driving licence of Sh. KulwinderSingh has a category of car/ jeep as well as LMV, it does not specifically mention thathe was authorized to drive LMV as per the categorization of the vehicle. There is a thinline of demarcation as per the contention of the insurer regarding capacity of car / jeepand a vehicle seating capacity of 7+ 1. Further, Supreme Court in the case of MallaParkasarao vs Malla Janaki has held that “a decision has to be taken whether the factof the driver possessing licence for one type of vehicle but found driving another typeof vehicle, was the main or contributory cause of accident. The complainant alsoshowed a copy of the judgement of District Consumer Forum, which was published inthe newspaper on 26.04.2007, wherein it has been mentioned that the personauthorized to drive a car and jeep can drive a Scorpio also. Taking all these factorsinto account, held that Sh. Kulwinder Singh was holding an effective driving licence onthe date of accident to drive a Scorpio and hence the repudiation of claim on theground of invalid licence was not in order. The insurer was ordered to pay admissibleamount of claim to the complainant.Chandigarh Ombudsman Centre

Case No. : GIC/407/NIC/11/08Satish AroraVsNational Insurance Co. Ltd.Award Dated : 11.12.07FACTS : Shri Satish Arora got his Alto car bearing no HP-15-5475 insured from theinsurer for sum insured of Rs. 2,16,000/-. The vehicle met with an accident on 14.2.07near Nurpur. He informed M/s Modern Automobiles Ltd., Jassur from whom he got theinsurance done and a copy of intimation was sent to DM, New Delhi. The insurer tooktime to depute surveyor. After regular follow up the surveyor submitted his report.When the claim was lodged with the insurer, the same was repudiated on the groundthat the driver did not have valid and effective driving licence on the date of accident.He submitted that his driving licence expired on 1.2.07. A grace period of 30 days wasprovided to get the licence renewed. The accident took place on 14.2.07 and he hadanother fifteen days to get the licence renewed. However, the driving licence was inthe custody of Police. Hence he could not get it renewed. He contended thatrepudiation of the claim on the basis of not possessing valid and effective drivinglicence was not satisfactory and the claim should be paid to him. He also wantedcompensation for parking charges for the last one year @ 150/- per day.FINDINGS : The insurer informed that the driving licence was not renewed during thegrace period of 30 days and if it were renewed now, it would not be doneretrospectively in continuation. Hence as per their contention the driving licence wasnot valid and effective on the date of accident.DECISION : According to the judgement of Supreme Court in the case of MallaPrakasarao v. Malla Janaki CA No 1613 of 1996, the Supreme Court has held thatproviso appended to Section 15 of MV Act states in irrevocable terms that drivinglicence remains valid till 30 days from the day of its expiry. Also there has been nodisqualification conveyed to the driver of the vehicle that he was disqualified fromdriving the vehicle. Hence the driving licence is both valid and effective on the date ofaccident. Ordered that insurer should pay admissible amount of claim to thecomplainant. Regarding parking charges the same should be borne by the insurer uptothe date of repudiation viz. 10.10.07.Chandigarh Ombudsman CentreCase No. : GIC/395/ICICI/11/08Meenakshi KaushalVsICICI LombardAward Dated: 12.12.07FACTS : Ms. Meenakshi Kaushal got her Indica car bearing no CH-03-8457 insured forsum insured of Rs. 2,85,000/- for the period 05.8.07 to 04.8.08. On 16.10.07 hervehicle whilst being driven by her husband Shri Parveen Kaushal got submerged inwater under Railway Bridge near CTU Workshop. The Fire Brigade was informed whorescued their vehicle along with other vehicles. The claim was lodged with the insurerbut the same was repudiated on the ground that it was not a case of flood which wasdeclared by the Government.FINDINGS : The insurer informed that there was clear warning for the driver at thespot not to venture into the water when the level was more than 1 ft. Moreover this wasnot a flood in the real sense of the term and it was not declared as such by theGovernment. Thirdly, there were other vehicles stranded at the place and the

complainant’s husband should not have ventured into the water seeing the othervehicles stranded.DECISION : Held that it was flash flood, which lasted for short duration. Moreover ithas not been mentioned in the terms and conditions of the policy that the flood shouldbe declared as such by the Government. However, the complainant’s husband couldhave been careful in venturing into the area when there was heavy downpour and tothat extent they have erred in not observing the necessary precautions. The insurerswere within their rights to penalize the complainant on this issue. However, therepudiation of the claim may not be in the interest of justice and fair play especiallywhen the fire brigade had given certificate that the vehicle was rescued by them.Hence ordered that 50% of the admissible amount of claim be paid by the insurer to thecomplainant.Chandigarh Ombudsman CentreCase No. : GIC/408/OIC/11/08Sharad JhalariaVsOriental Insurance Co. Ltd.Award Dated : 12.12.07FACTS : Shri Sharad Jhalaria purchased a new motorcycle bearing no HR-25A-9952and got it insured from DO-III Chandigarh for the period 07.7.06 to 6.7.07 for suminsured of Rs. 41,796/-.His friends Shri Amit Nagpal and Shri Sunil Sharma were ridingthe vehicle on the night intervening 31.12.06 and 1.1.07 (on the eve of New Year),when the motorcycle had a mechanical breakdown near Topiary Park, Sec-6,Panchkula. It was in such a condition that it could not be pushed or dragged. Leavingthe motorcycle at the site, his friends went to call the nearby mechanic to repair thevehicle. When they came back, they found the vehicle missing. He tried to lodge anFIR the same day but the police did not take any action. After continuous efforts an FIRwas recorded by the Police Station Sec-5, Panchkula on 5.1.07. The untrace reportwas issued by the police on 13.6.07. The claim lodged with the insurer had not beensettled so far.FINDINGS : The insurer stated that there were some basic flaws regarding thecontravention of condition no 4 of the policy which enjoins upon the vehicle owner totake due care of the vehicle. Firstly the vehicle was left unattended since it could notbe dragged whereas the thief appears to have gone with the same vehicle without anyrepairs. Secondly, the duplicate key of the vehicle is not available which implies thatthe key would have been left with the motorcycle which was another lapse on the partof another person driving the vehicle. Hence the claim was repudiated on the ground ofnot taking due care under condition no .4 of terms and conditions of the policy.DECISION : Held that the vehicle had been stolen and the insurance cover was validon the date of theft. However, since condition 4 of the terms and conditions of thepolicy had been violated especially since the duplicate key of the vehicle was notavailable, the repudiation of the claim by the insurer was in order.Chandigarh Ombudsman CentreCase No. : GIC/272/Chola/11/08Jagjeet SinghVsCholamandalam Gen. Ins. Co. Ltd.Award Dated : 08.01.08

FACTS : Shri Jagjeet Singh got his car bearing no. HR-10-H-0880 insured from theinsurer for the period 31.8.05 to 30.8.06 for sum insured of Rs. 6,37,000/-. The vehiclewas stolen on 23.8.06 for which FIR was lodged with Police Station, Prashant Vihar,New Delhi. The insurer was also intimated on 2.9.06 and they deputed M/s G.B. Mathur& Co for investigations. All the documents asked for by the insurer/investigator weresubmitted. On 31.10.06 he received a letter from the insurer expressing their inabilityto settle the claim on the ground of delayed intimation. He represented to the insurerstating that the delay occurred, because he was not conversant with the procedure oflodging the claim. The parties were called for hearing on 06.12.2007.FINDINGS : During the course of hearing the insurer clarified that intimation wasreceived after 10 days and hence the action for recovery/ investigation got delayed.Moreover, no intimation was given to the transport authorities about the theft of thecar.DECISION : Held that the complainant has erred on two accounts. First, the intimationwas given to the insurer 10 days later. Secondly, transport authorities had not beenintimated to prevent re-registration of vehicle. As per National Consumer redressalforum judgement in the case of Devender Singh Vs New India Assurance Co Ltd. &others, the claim was repudiated on the ground of late intimation to the police by 4days and to the insurer by about a month. On the same analogy, there has been delayin this case. However, since in the instant case the FIR was lodged on 25.8.07,presuming the theft to be on 24.8.07, this was within 24 hours. Hence conceding thatthere had not been any delay in intimating the police,the repudiation of the claim intotality on the ground of late intimation is not in order as the police was informed intime. Accordingly, taking a fair and just view, it is hereby ordered that 50% of IDVshould be paid to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/431/IFFCO TOKIO/14/08R.L. MogaVsIFFCO Tokio General Ins Co.Award Dated : 08.01.08FACTS : Dr. R.L. Moga got his vehicle bearing no. HR-51-M-0551 insured for theperiod 9.5.07 to 8.5.08 for IDV of Rs. 4 lakhs. Following water logging, hydrostaticlocking took place on 2.8.07 and the vehicle was taken to Galaxy Toyota on 4.8.07where the vehicle’s engine oil was changed at the complainant’s request to save thevehicle from further damage. On 5.8.07 the engine chamber burst and since the vehiclewas not in a running condition it was towed away to Galaxy Toyota, New Delhi on19.8.07. The insurer was informed on 7.8.07 and the claim was lodged but his claimwas made ‘no claim’. He stated that the vehicle was not used after the occurrence ofloss except that it was driven to Faridabad on 4.8.07 that too on the advice of GalaxyToyota who assured that there would be no harm if the vehicle was driven. The verynext day i.e. on 5.8.07 the engine chamber burst. It was further stated that thehydrostatic locking of the engine had already damaged the engine substantially on2.8.07 because there was a noise in the engine. Parties were called for hearing on8.1.08.FINDINGS : During the course of hearing the insurer clarified that the complainant wasadvised to get the engine overhauled on 4.8.07 but he went on running the vehicle andcovered a distance of about 400 Kms. As a result, the engine burst. The cost for

overhauling would have been about Rs. 30,000/- which had not aggravated to Rs.1,86,000/- after the vehicle had run for 400 Kms.DECISION : Held that the complainant has not taken due care to avoid further damageto the vehicle even after he was advised by the workshop to do so. Hence, the claim ispayable to the extent of original damage since aggravated damage is due to not takingdue care of the vehicle. The claim should be restricted to Rs. 30,000/- plus actualtowing charges or Rs. 1500/- whichever is minimum.Chandigarh Ombudsman CentreCase No. : GIC/400/UII/11/08Gurvinder KaurVsUnited India Insurance Co. Ltd.Award Dated : 11.01.08FACTS : Ms Gurvinder Kaur’s husband Late Sh. Malkit Singh got his motorcyclebearing no. PB 02-AV-4678 insured from BO Amritsar. He met with an accident on10.3.07 in which he passed away. She lodged a claim with the insurer which was made‘no claim’ on the ground that road tax for the said motorcycle was not deposited within30 days from the date of its purchase. As such the vehicle was plying on the roadunlawfully, which was violation of MV Act, 1988. She stated that instead of paying theclaim the insurer rejected the claim on flimsy grounds. Parties were called for hearingon 11.1.08.FINDINGS : During the course of hearing the insurer stated that although the liabilityof the accident was admitted, there has been a procedural flaw since the motorcyclewas not registered and was running on temporary registration at the time of accident.After the death of the owner the RC was got made in the name of the deceased ShriMalkit Singh. Hence they were finding it difficult to make the payment of the claim. Ona query whether driving of the vehicle with temporary registration was against theterms and conditions of the insurance policy, the insurer replied in the negative.DECISION : Held that although there may be a procedural flaw in getting the RCissued after the death of the owner, this is an issue between the widow of the ownerand the Transport Authorities. As far as payment of insurance claim is concerned,since the vehicle had a valid insurance on the date of accident and it was not beingdriven by a person without having a valid licence, the claim is payable. Regarding inwhose favour the cheque was to be made, I am of the opinion that cheque should bemade in favour of the complainant Smt Gurvinder Kaur who is the wife of the deceasedand next of kin. The payment can be made after she submits an affidavit that she is thelegally wedded wife of the deceased and in case of rival claimant she would refund theamount to the extent required.Chandigarh Ombudsman CentreCase No. : GIC/418/NIC/14/08Rupinder KaurVsNational Insurance Co. Ltd.Award Dated : 11.01.08FACTS : Smt Rupinder Kaur got her vehicle bearing no. PB-26C-9500 insured for theperiod 10.3.07 to 9.3.08 for sum insured of Rs. 4 lakh. The vehicle met with anaccident on 17.3.07. She lodged a claim with the insurer, which had not been settled.She enclosed a letter dated 19.11.07 of BO Sirhind repudiating her claim on the ground

that claim had been denied by DO Patiala as per investigation report. Parties werecalled for hearing on 11.1.08.FINDINGS : During the course of hearing the insurer clarified that as per theinvestigation report the major damage to the vehicle has been on the driver side. Themaximum injury had been sustained by the 14 year old son of the complainant ShriSaghundeep Singh. Since it was a head on collision the investigator opined thatSaghundeep Singh was probably driving the vehicle. Since he was minor he was notauthorized to drive the vehicle. Hence the claim was repudiated.DECISION : Held that the repudiation of the claim on presumption alone is not inorder. The complainant who is a responsible lecturer in a college has stated that shewas driving the vehicle at the time of accident and I have no reason to doubt theveracity of her statement. In my opinion the investigator’s report should not form thebasis of repudiation unless there are supporting documents to confirm that ShriSaghundeep Singh was driving the vehicle at the time of accident. Therefore taking afair and just view the repudiation of claim is not in order. The claim is payable.Chandigarh Ombudsman CentreCase No. : GIC/413/ICICI/11/08Bachan KaurVsICICI LombardAward Dated : 11.01.08FACTS : Smt. Bachan Kaur purchased a new Tata Safari bearing temporaryregistration no CH-01-T-8300 and got it insured from the insurer for the period 07.4.06to 6.4.07. The said vehicle was stolen in the night intervening 7/8.6.06 whilst it wasstanding outside her residence. FIR was lodged with the Police Station, Phase-I,Mohali. The claim lodged with the insurer was repudiated on 13.1.07 on the ground thatthe vehicle was not registered at the time of theft. Parties were called for hearing on11.1.08.FINDINGS : The insurer stated that the vehicle was not registered at the time of theftwhich was a violation of MV Act. Moreover, there appears to be no reasonable carehaving been taken to affect the safety and security of the vehicle as there was apresumption that ignition key was left in the vehicle when it was stolen. On a querywhether any terms and conditions of the policy have been violated, the insurer statedthat by not getting the registration done the risk factor for theft had increased. On aquery whether all the three keys including one available with the financer were handedover to the insurer, the insurer replied that only one key was available with them.DECISION : Held that the complainant should as a first step handover all the threekeys to the insurer to prove that due care was taken for the safety and security of thevehicle. When all the keys are made available, the same should be intimated to theinsurer and this office so that another date of hearing can be fixed. In case one of thekeys was missing it would be presumed that it was left in the vehicle at the time of theftand the condition of ‘not taking due care’ would come into operation as per terms andconditions of the policy. The complainant is advised to hand over all the three keys tothe insurer by 31.1.08. On receipt of information of submission of keys with the insurer,another hearing would be held regarding repudiation of the claim. However if all thekeys cannot be produced the insurer is at liberty to settle the claim on merits based onthe keys handed over to them.Chandigarh Ombudsman Centre

Case No. : GIC/491/ICICI/11/08Motia KhanVsICICI LombardAwrd Dated : 08.02.08FACTS : Shri Motia Khan purchased a new Accent car and got it insured from theinsurer. The vehicle was under hire and purchase agreement with ICICI Bank fromwhere the loan was taken for purchase of vehicle. The vehicle met with an accident on3.10.06. The insurer was informed and surveyor was deputed for survey andassessment of loss. The claim lodged with the insurer was denied on the ground thatthe vehicle was not registered in time. He stated that due to unavoidable familyreasons he could not get the vehicle registered. However it was got registered after theaccident i.e. on 17.2.06. Parties were called for hearing on 8.2.08.FINDINGS : The insurer clarified the position by stating that the vehicle was plyingwithout proper registration which was against the Motor Vehicle Act. The registrationhad now been done in the name of M/s Sunshine Hotel, Mandigobindgarh.DECISION : Held that after going through the Registration Certificate which is in thename of M/s Sunshine Hotel, Mandigobindgarh. Since the vehicle is registered in thename of a firm, the case does not fall within the ambit of this forum in view of Rule12(2) read with Rules 4-(i) and 4-(k) of Redressal of Public Grievances Rules,1998.The case is, accordingly, closed.Chandigarh Ombudsman CentreCase No. : GIC/492/HDFC/11/08Sunita SharmaVsHDFC Gen Ins Co Ltd.Award Dated : 08.02.08FACTS : Smt. Sunita Sharma got her Ford Fiesta car bearing no HR-01V-5188 insuredfrom the insurer for the period 17.8.06 to 16.8.07 for IDV of Rs. 6,89,700/-. The vehiclemet with an accident on Jalandhar Pathankot Road on 19.6.07. The insurer wasinformed immediately and the vehicle was given for repairs. However the claim lodgedwith the insurer was made ‘no claim’ on the ground that Shri Ashwani Sharma, driver ofthe vehicle at the time of accident was not holding a valid driving licence. The drivinglicence was found to be valid upto 2.8.06. However, the accident took place on19.6.07. Hence the licence had expired on the date of accident. She stated that ShriAshwani Sharma was having licence no 1613/Ambala/77-78 which was valid from16.12.03 to 15.12.08. She was never asked for a copy of driving licence during theprocessing of the claim and now she has been put to unnecessary loss due tomishandling of the case. Parties were called for hearing on 8.2.08.FINDINGS : The insurer clarified that the driving licence submitted to them in respectof Shri Ashwani Sharma was valid upto 2.8.06 whereas accident took place on 19.6.07.Hence on the date of accident the driving licence was not valid. On a query whetherthey had a copy of the valid licence from 16.12.03 to 15.12.08, the complainantproduced the same. On a query whether the other licence was seen by the insurer, theinsurer replied in the negative.DECISION : Held that after hearing both the parties and scrutinizing the two drivinglicences produced by the insurer and the complainant, I find that between 2003 and2006 the complainant was having two driving licences. Possession of two driving

licences is against the Motor Vehicle Laws and Rules. Moreover while the complainantis permanent resident of Ambala City, it is not clear why the other licence was obtainedfrom Mathura. Also in 2003 the main licence was not due for renewal. In view of theabove, I would tend to agree with the contention of the insurer that the driving licencewas not valid on the date of accident viz. 19.6.07. The repudiation of the claim on thebasis of terms and conditions of the policy is, therefore, in order and is upheld.Chandigarh Ombudsman CentreCase No. : GIC/489/UII/11/08Jeevan Prabhat JainVsUnited India Ins Co. Ltd.Award Dated : 08.02.08FACTS : Shri Jeevan Prabhat Jain got his Scorpio car bearing no DL 3CA-7074insured from the insurer for the period 01.4.06 to 31.3.07. The vehicle met with anaccident at Goa and was surveyed there. The surveyor submitted his report in whichloss was assessed at Rs. 3 lakhs. However the claim lodged with the insurer wasrepudiated on the ground that the driving licence was not valid on the date of accident.Parties were called for hearing on 8.2.08.FINDINGS : The insurer clarified that the driver of the vehicle, Shri Gaurav PrabhatJain, was holding a licence for motor car and not for LMV at the time of accident.Hence the driving licence was not considered valid for driving the Scorpio.DECISION : Held that a clarification is required from Punjab State TransportCommissioner whether Scorpio car being used for private purposes could be treated ascar or not. I rang up Shri Saraon Additional Transport Commissioner, Punjab whoclarified on the telephone that if Scorpio car is used for private purposes then drivinglicence for car was valid. However if it was used for commercial purposes anendorsement for Transport Vehicle is required on the driving licence. Since the carbeing used by the complainant at the time of accident was for private use only, it isconsidered that the claim is payable after the clarification given by the AdditionalTransport Commissioner, Punjab. It is hereby ordered that admissible amount of claimshould be paid by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/524/UII/11/08Jasbir SinghVsUnited India Insurance Co. Ltd.Award Dated : 12.02.08FACTS : Shri Jasbir Singh got his Santro car bearing no PB-10-BN-8425 insured fromBO Mata Rani Road Ludhiana. The vehicle was stolen on 26.6.07 from his residence.All the papers as desired by the insurer were submitted. However he was surprised toreceive a letter dated 3.1.08 from the insurer stating that his claim had beenrejected.Parties were called for hearing on 12.2.08.FINDINGS : The insurer clarified that as per the report of the surveyor the complainanthad gifted the car to his sister and on the basis of legal opinion the claim wasrepudiated as the complainant did not have an insurable interest on the vehicle aftergifting the vehicle. On a query as to what was the basis for presuming that the car wasgifted, the insurer gave a letter on plain paper supposedly signed by the complainantthat he had gifted the car to his sister at the time of her marriage. On a query as to inwhose name the RC was on the date of theft, the insurer replied that it was in the name

of the complainant/insured. On a query as to in whose name was the insurance policyon the date of theft, the insurer replied that it was in the name of the complainant.DECISION : Held that the sole basis of treating the ownership in the name of a personother than the complainant is a note allegedly signed by the complainant on a plainpaper which has no legal locus standii. The two legal documents are the RC and theinsurance policy which are both in the name of the complainant. Hence in my view theownership rests with the complainant and he has insurable interest on the date of theft.The claim in my view is, therefore, payable.Chandigarh Ombudsman CentreCase No. : GIC/500/NIA/11/08Ishwar Singh ThakurVsNew India Assurance Co. Ltd.Award Dated : 12.02.08FACTS : Shri Ishwar Singh Thakur got his vehicle M&M bearing no HP-63-0980insured under Goods carrying commercial vehicle for the period 29.12.05 to 28.12.06for sum insured of Rs.3,50,000/-. The vehicle met with an accident on 15.11.06. FIR was lodged in PoliceStation, Nerwa. In the accident, the said driver Shri Gani and the labourer Mohd.Taslim got injuries. The surveyor assessed the loss of Rs. 2,10,000/- on net of salvagebasis. But the insurer rejected the claim on the ground that one unauthorizedpassenger was travelling in the vehicle at the time of accident. The complainant statedthat the carrying capacity of the vehicle is 4+1 and the labourer was sitting with thedriver and not any unauthorized passenger. Parties were called for hearing on 12.2.08.FINDINGS : The insurer clarified that the driver Shri Ghani was travelling with one ofhis friends Mohd. Taslim, since he had to bring empty oil drums and he needed ahelper to load those drums. The matter was referred to Head Office through RegionalOffice who advised to repudiate the claim on the ground that Mohd. Taslim wastraveling as unauthorized passenger and sustained injuries in the accident. On a queryas to what is the definition of unauthorized passenger, the insurer could not give asatisfactory reply. On a query whether the carrying of Mohd. Taslim in the vehicle wasthe main contributory factor to the cause of accident, the insurer could not give asatisfactory reply.DECISION : Held that by carrying Mohd. Taslim in the vehicle, the driving skill of thedriver had not undergone any effective change which could result in the accident, sincethe number of passengers were within the carrying capacity of the vehicle asmentioned in the RC. Even if the carrying capacity had exceeded by 1 or 2 passengersbeyond the permissible limit the claim is payable as per judgement given by theSupreme Court in the case of B. V Nagaraju Vs OIC Civil Appeal No. 6296 of 1995-decided on 20.5.1996. Hence in my opinion the repudiation of the claim is not in orderand the same is set aside. The claim is payable alongwith interest @ 8%p.a.Chandigarh Ombudsman CentreCase No. : GIC/523/NIC/11/08Karnail SinghVsNational Insurance Co. Ltd.Award Dated : 12.02.08FACTS : Shri Karnail Singh got his Indica car bearing no HR-03-E-4171 insured fromthe insurer for the period 14.7.06 to 13.7.07 for sum insured of Rs. 3,37,878/-. Thevehicle met with an accident on 12.6.07 when a Scorpio car hit his car near HMTPinjore. His car was severely damaged and sent for repairs to M/s Joshi Auto Zone, the

authorized dealer of Tata Motors. DDR was lodged with the Police Station Pinjore thesame day. The claim was however closed by the insurer on account of fake drivinglicence of the driver at the time of accident. Despite giving clarifications to the insurerthat it was he who was driving the vehicle and not Baldev Singh, his friend, the insurerdenied the claim. Parties were called for hearing on 12.2.08.FINDINGS : The insurer clarified that the report of the accident was given by ShriBaldev Singh. Secondly in the claim form it had been mentioned by the complainantthat Shri Baldev Singh, his brother was driving the vehicle at the time of accident. Thecomplainant submitted photocopies of driving licence no. 6754 of Shri Baldev Singhand his own. The driving licence of Shri Baldev Singh was got verified from LicensingAuthority, Karnal who had stated that it was not a genuine licence as licence no 6754belonged to one Shri Manoj Kumar and not Baldev Singh.DECISION : Held that there are contradictions in the statements given by thecomplainant from time to time. While in the claim form he has stated that Shri BaldevSingh was his brother, in the complaint he had stated that he was his friend. Secondly,driving licence no 6754 submitted in respect of Baldev Singh appears to be fake asconfirmed by the Licensing Authority, Karnal. The complainant also stated that in policereport (DDR) it was mentioned that he was driving the vehicle but on checking up thepolice report it has been seen that there is no mention of driver at the time of accident.From all this information, the contention of the insurer that the driver at the time ofaccident was Baldev Singh appears to be correct and since he was not holding a validdriving licence at the time of accident, the repudiation of the claim by the insurer is inorder.Chandigarh Ombudsman CentreCase No. : GIC/478/ICICI/11/08Ashu MahajanVsICICI LombardAward Dated : 14.02.08FACTS : Shri Ashu Mahajan got his Innova car insured for the period 08.2.07 to7.2.08. The vehicle met with an accident on 7.10.07. The insurer was informed and thesurveyors were deputed for survey and assessment of loss. All the required documentswere submitted with the insurer. He stated that attitude of the surveyor was rude andimpolite. He allegedly stated that the surveyor demanded certain amount as illegalgratification, which was refused by him. The surveyor threatened to get the lossrepudiated as ‘no claim’. Later the insurer repudiated his claim vide letter dated31.10.07 stating that at the time of loss the vehicle was being used for commercialpurposes. Parties were called for hearing on 14.02.08.FINDINGS : The insurer clarified that the vehicle had covered 41,629 Kms within 8months of its purchase. This worked out to 5,200 Km per month and an average of 170Km daily in a small town like Batala or around. Moreover the cost of diesel, EMI for theloan, driver’s salary, insurance cost etc did not justify the income which was given inthe proposal form. The surveyor had a conversation with the complainant in which itcame out that the vehicle could have been used for commercial purposes. Hence theclaim was repudiated on the ground of ‘use for commercial purposes’. On a query howthe vehicle had run 41,000 Km in 8 months, the complainant could not give asatisfactory reply.

DECISION : Held that the contention of the insurer that the heavy running of thevehicle implies commercial use, is justified. However, since he could not proveconclusively that the vehicle was being used for ‘hire or reward’, in my opinion, somebenefit goes to the complainant. Taking a fair and just view, I am of the opinion thatsettlement of claim on sub-standard basis would meet the ends of justice. In my view,50% of the admissible claim on repair basis should be sufficient compensation to thecomplainant for the loss suffered by him. It is hereby ordered that 50% of theadmissible claim on repair basis should be paid by the insurer to the complainant.Chandigarh Ombudsman CentreCase No. : GIC/580/UII/14/08Nilesh AggarwalVsUnited India Insurance Co. Ltd.Award Dated : 17.03.08FACTS : Shri Nilesh Aggarwal got his car Hyundai Accent bearing no HR-01R-8485from the insurer for the period 13.01.06 to 12.01.07. The car met with an accident on21.4.06 between Zirakpur and Dera Bassi. He lodged a claim with the insurer, whichwas repudiated on 14.12.06 on the ground that his father Shri Rakesh Kumar who wasdriving the vehicle at the time of accident was not holding a valid and effective drivinglicence. Parties were called for hearing on 17 th March, 2008.FINDINGS : The Insurer clarified that the original driving licence as per theinvestigation report was for Motorcycle/Scooter only. The Transport Authority, Ambalaby their endorsement dated 28.08.2006 have confirmed that the licence was valid forMotorcycle/Scooter only and there was no endorsement made later on for Car/Jeep.They also confirmed that the renewal in 2006 was by paying licence fee forMotorcycle/Scooter only. On a query whether any endorsement was available forMotorcar/Jeep on the earlier licence, the Insurer replied in the affirmative and statedthat he was having the endorsement given by the Licensing Authority dated 13.08.2007in which it had been mentioned that the driving licence was valid for Car/Jeep only.DECISION : Held that the Licensing Authority, Ambala had given contradictory reportsin August, 2006 and August, 2007. It was the duty of the Insurer to get the bonafides ofthe two statements verified by sending a responsible officer to the office of theLicensing Authority. I have also seen the driving licence no. 967 of Sh. Rakesh Kumarwhich I find has an endorsement for Motorcar/ Jeep and is valid upto 28.11.2010. Ihave no reason to believe that the endorsement for Car/Jeep was wrongly made by theLicensing Authority in the absence of any letter which makes Sh. Rakesh Kumarineligible to drive a car. The driving licence should be treated as valid and theadmissible amount of claim should be paid by the Insurer to the complainant.Chennai Ombudsman CentreCase No. : IO(CHN) 11.05.1200/2007 – 08Smt. Sri Padma PriyaVsThe Oriental Insuraance Co. LtdAward Dated : 31.10.07The Complainant Smt Sri Padma Priya had obtained motor insurance policy in respectof her vehicle AP9 AJ 6679 from the Oriental Insurance Co. Ltd. The car met with anaccident on 26.01.2007. Spot survey conducted and insurer has not instructed forrepair of the vehicle till March 2007. The insured had to shift her family to Vijayawada

for personal reasons and took the vehicle with the insurer’s consent. She requested forfresh survey at Vijayawada and since there was no progress, she had approached theforum.The insurer’s representative informed that category B surveyor was deputed for surveyat Salem. Bagawan Motor works where the insured left the vehicle for repairs is neitheran authorized service centre nor equipped with major accident repair facilities. Theinsured insisted for settlement on total basis and insurer did not agree for the samesince the assessed repair cost did not exceed 75% of the IDV. The assessment was forRs.61,295/-.After the insured took the vehicle to Vijayawada, survey was arranged by insurer’sDivisional office and the assessment was more or less similar to the one carried out atSalem.After perusal of all the records submitted, it was found that the delay in process of theclaim was due to insured not co-operating with the insurer at different stages of theclaim process. In the light of the above, the insurer is directed to settle the claim asper the survey carried out by the surveyor appointed by Insurer’s Vijayawada officesubject to policy terms and conditions. The insured is directed to cooperate with theinsurer in the processing and settlement of the claim.Chennai Ombudsman CentreCase No. : IO(CHN) 11.08.1232/2007 - 08Mr. Praveen KumarVsTata AIG General Insurance Co. LtdAward Dated : 07.12.2007The complainant Mr.Praveen Kumar purchased a Ford Ikon car on 28.12.2006 andeffected transfer in the Registration Certificate in his favour with effect from28.12.2006.The insurance policy was in the name of Mrs Valsala Madhu, the previousowner and the policy period was from 04.09.06 to 03.09.2007. The complainant informsthat he approached the insurance company and was told that the transfer of insurancewould be carried out only after the registration certificate of the vehicle is transferred.The RC book was given to the agent for transfer and received only in the last week ofJanuary 2007. In the meantime the vehicle met with an accident. When approached fortransfer of insurance , the insurance company refused to effect the same and informedthat no transfer endorsement could be made after an accident and also denied liabilityfor the OD claim.The representative of the Insurer stated that the complainant had intimated the claimonly on 09.02.07 after one month from the date of accident and confirmed throughcopies of their call centre records. Against the contention of the complainant forvisiting the insurance company, since insurer maintain visitors book, they were able toprove that no such visits have been made. The complainant had not applied with infourteen days from the date of transfer in writing under recorded delivery to the insurerand could not establish that he made such an application for transfer of the vehiclewith in the stipulated time.It is observed that neither specific request from the transferee along with consent oftransferor nor evidence of sale/fresh proposal submitted for effecting transfer ofinsurance. Since the insurable interest in respect of Mrs. Valsala Madhu ceased toexist after the sale of vehicle and the new owner Mr. Praveen Kumar’s interest nottransferred as per the provisions of the Motor Vehicle Tariff under GR.17, thecomplaint is dismissed.

Chennai Ombudsman CentreCase No. : IO (CHN) 11.04.1247-2007-08Smt.S.AnavarathamVsUnited India Insurance Co. Ltd.Award Dated : 24.01.2008The complainant stated that her husband had been travelling in their car driven by theirdriver, when the car hit a tree in order to avoid a cyclist and met with an accident . Herhusband died on the spot of the accident. The driver was admitted to the hospital andhe died after 10 days. The vehicle was completely damaged and it was brought toCoimbatore. She submitted the claim form along with necessary documents. Theinsurer had asked for the driving licence of the driver. She tried to trace out but couldnot get the same. The driver’s family did not cooperate in getting the licence. Theyeven contacted the previous employer and tried for a copy of the licence but in vain.The insurer had repudiated the claim as she could not produce the driving licence.Since she had to pay the demurrage and also pay the outstanding loan, she sold thewreck along with the Registration Certifficate. It was pointed out to her that she shouldhave sold the wreck with the consent of the insurer. Despite her best efforts she hadnot been able to get the copy of the driving licence.The insurer stated that without driving licence they could not settle the claim. It was acontract between the insured and the insurance company. The driver should have avalid proper licence at the time of accident. Even a Xerox copy of the licence wouldsuffice. However, only if the if the driving licence was produced and the assessed losswas more than 75% of the insured value they could consider the claim on total lossbasis. Further, the complainant had informed them that she had disposed off the wreckonly after sale of the vehicle.After hearing the parties and scrutinizing the documents such as FIR it was establishedthat the complainant had not submitted a copy of the certificate or attempted to obtaina certificate to the effect from the RTO. A copy of the MV inspection report was alsonot submitted by the complainant. It was seen that the insurer had expressed theirwillingness to settle the claim even if a copy of the DL had been produced, which thecomplainant had not complied with. Since the complainant was unable to produce evena copy of the DL or any other proof to confirm that the driver had a valid and effectiveDL, the complaint was dismissed.Chennai Ombudsman CentreCase No. : IO(CHN)/ 11.02.1386/2007-08Shri A. Albert JonesVsThe New India Assurance Co. Ltd.Award Dated : 25.02.2008The Complainant Shri A.Albert Jones has stated that a car owned by his father hadbeen insured with the New India Assurance Co. Ltd from 2003 onwards right frompurchase of the car. His father expired on 26.03.2006. After the death of his father thepolicy was renewed for the period from 11.07.2006 to 10.07.2007 and the agent hadcollected the renewal premium cheque from them. On arrangement within the family,the car was given to him and he started using the car. Mr.Rajan, the agent hadcollected the cheque for renewal and he was well aware of his father’s demise. TheDevelopment Officer was also aware of his father’s death. The vehicle met with anaccident on 05.02.2007. The insurer rejected the claim stating that the policy was in

the name of the deceased person. Without knowing the implications they have renewedthe policy in the existing name.The insurer stated that while scruitinising the claim file they found that the insured hadexpired on 26.03.2006 and the complainant neither intimated the RTO nor the insurerto comply with the requirements as per terms and conditions of the policy. The policywas renewed in the name of the deceased. They had repudiated the claim as the policywas not transferred within 90 days from the date of death of insured nor on the expiryof the policy. After repudiation, the complainant had changed the name of the owner inthe R.C. as well in the insurance policy.After hearing the parties and scrutinizing the documents such as policy copy, deathcertificate, RC book, legal heir certificate it was held that Condition No 9 of the policystipulated the procedure to be adopted in case of death of the owner of the vehicle.Sec 56 of the MV Act also stipulates that transfer in such cases can be done within 3months, provided intimation to this effect has been made to the competent authoritywithin 30 days. The complainant has not complied either with the policy conditions orwith the MV Act even after the lapse of a considerable time after the demise of theinsured. The complainant has taken the plea that he did not know the implications.Ignorance of rules and law is not justifiable when it comes to the question of law andmandates.The Complaint was dismissed.Chennai Ombudsman CentreCase No. : IO(CHN)/11.04.1429/2007-08Shri K GurunathanVsUnited India Insurance Co. LtdAward Dated : 31.03.2008The complainant had availed a vehicle loan from ICICI Bank and purchased a ToyotaQualis vehicle for his personal use. His driver who collected the vehicle from thegarage where it had undergone minor repairs did not return until late in the night.Later, the complainant’s brother had contacted the driver and the driver informed himthat he was going to Chennai airport with a passenger. The same night, thecomplainant was informed by a Police station in Chennai that his driver had lodged acomplaint with them that the vehicle was stolen by the passenger. The complainantstated that his driver had taken away the vehicle without his permission and knowledgeand suspected his involvement in the theft. He preferred a claim with his insurer butthey had repudiated his claim. He had not been able to meet the driver after theincident. The police had appointed a special squad to trace the vehicle but they couldnot. He submitted the non-traceable certificate, FIR etc. to the insurance company.Initially the case was booked under Section 420 since the driver has given thecomplaint and later changed to Sec 379 since they suspected that the driver himselfmay have stolen the vehicle. He reiterated that the vehicle was used only for personalpurposes and not for commercial purposes.The insurer stated that Mr.Gurunathan has been running a Travel agency. He hadgiven a statement to the investigator that the driver of vehicle while informing hisbrother has said that he was taking a “passenger” to the Airport. The use of the word“Passenger” (Savari) meant it was used for commercial purposes. It also proves that hehas been in the habit of taking people in the vehicle. Initially the complaint wasregistered under IPC section 420-cheating and subsequently they have changed theIPC Sec.379 - theft. Insurance policy does not cover Sec 420. Only Theft was covered.

Hence, it has been changed for insurance purposes. The use of the vehicle forcommercial purpose was a gross violation of private car insurance policy terms andconditions. So they repudiated the claim.The documents like Comprehensive Private car policy, RC Book ,Repudiation letter,FIR under Sec 420 of the IPC, Statement from Vadapalani Police station to the XVIIMetropolitan Magistrate Saidapet (Chennai 15) informing that the crime under the saidFIR is being investigated under Sec 420 IPC and also under Sec 379 (theft), Non-Traceable certificate, Investigation report were scrutinized.The insurer has held that the vehicle was used for hire based on the statement of theinvestigator and use of the word “passenger” by the driver. There is no other evidence.The only Authority that can throw some light on the matter is the Police department.The police department has registered the complaint under Sec 420 IPC (cheating) aswell as Sec 379 IPC (Theft) and after due investigation, the vehicle has been declaredas untraceable and Non traceable Certificate issued. The liability of the insurer hasbeen confirmed in a similar situation in the case of National Insurance Co. Ltd VsSanjay Shivhare reported in 2007 (4) CPJ 366 (NC).On scrutiny of the statement of the Police authorities, it is clearly seen that Sec 420has not been changed to Sec 379 but Sec 379 has been added to the existing Sec 420.However, whether the case is registered under Sec379 IPC as theft, Sec 420 IPC ascheating or Sec 406 IPC as criminal breach of trust, so far as the liability to the insureris considered, it does not materially alter the situation. The direct and binding liabilityof the insurer has been established in United India Insurance Co. Ltd Vs Ravi KantGopalka in 2007(4) CPJ 32 (NC).As per documents, the vehicle, registered as a private car, has been insured as such.The onus of breach of policy condition by the insured vests with the insurer. Theremust be substantial evidence for the breach. Mere doubt or suspicion will not do. Therehas to be “flagrant violation” to warrant a denial. As per the records produced, it cannotbe stated without doubt that the vehicle was used for hire. The repudiation letter of theinsurer acknowledges “theft”. Unless the collusion or mala fide intention of the insuredhimself is actually established, insurer cannot deny his liability. In the circumstances,the decision of the insurer to repudiate the claim in total is not justified.However, the complainant has also not been able to satisfactorily explain several factssuch as how a newly appointed paid driver could take away the car without hispermission to a place so far away from home, why he also used the word “passenger’in his letter to the insurer, despite being an experienced tourist taxi operator how thecomplainant could entrust his costly vehicle to a new driver without checking hisantecedents and verifying the original DL. There were lapses and negligence on hispart too. He has not taken adequate precautions like a normal, prudent, uninsuredperson is expected to do.In the circumstances, insurer was directed to settle the claim on Exgratia basis at 50%of the IDV.The complaint was partly allowed on Ex-gratia basis.Delhi Ombudsman CentreCase No.GI/297/Tata AIG/06Shri Navin KalraVsTata AIG General Insurance Company LimitedAward Dated : 18.09.2007

Shri Navin Kalra had lodged a complaint with this Forum on 18.07.2006 against TataAIG General Insurance Co. Ltd. regarding inadequate settlement of Motor claim underpolicy no. 015002740800.The complaint was fixed for hearing on 04.06.2007 and 14.09.2007. The complainantShri Navin Kalra did not attend the hearing on both the dates, whereas the InsuranceCompany was represented by Shri Azar Wasi, Sr. Manager (Claims) and Ms. DeepaChacko, Asstt. Manager (Claims).It is therefore presumed that Shri Navin Kalra is not interested to pursue his case to beresolved through this Forum. Hence his complaint is dismissed.The complaint is disposed of finally.Delhi Ombudsman CentreCase No.GI/338/Bajaj/07Smt. Sangeeta GuptaVsBajaj Allianz General Insurance Company LimitedAward Dated : 18.09.2007The complaint was heard on 06.06.2007 and 14.09.2007. The complainant Smt.Sangeeta Gupta was represented by her husband Shri Sunil Gupta and the InsuranceCompany was represented by Shri Ashish Rao and Shri Nitin Arora.Smt. Sangeeta Gupta had lodged a complaint with this Forum on 22.03.2007 that shehad insured her Honda City car no. DL-4 CN C0408 with Bajaj Allianz GeneralInsurance Co. Ltd. As per the policy, the car accessories were covered. The stereo hadbeen stolen by someone. Her husband Shri Sunil Gupta had followed the requiredprocess of claim settlement. Surveyor was appointed. The company deducted 50%depreciation on stereo treating it as a plastic part. On the other hand, Tata AIG haddeducted only 20% from the cost of the stereo of his other Santro Car no. DL 2CW9957. The accident happened on the same day and the modus operandi used by thethieves was same.At the time of hearing, the representative of the complainant was asked whether hehad covered the stereo separately as an accessory and paid extra premium for thesame. On perusal of policy no. OG-07-1102-1801-00004291 covering the concernedvehicle, it was observed that the vehicle was covered under single sum insured ofRs.680887/-. There is no separate sum insured of the stereo. The representativeconfirmed that the stereo was supplied by the manufacturer as part of the vehicle andalong with it and the sum insured was for the full value of the vehicle including thestereo. On further enquiry about the policy issued by Tata AIG for complainant’s Santrocar, whose stereo was stolen on the same night in the same incident, it emerged thatthe stereo which had been there in the Santro car was not supplied by themanufacturer. It had been purchased separately and it was also insured separately asan accessory in the policy issued by Tata AIG. It was because of this reason that, theInsurance Company has paid the claim after deducting depreciation of 20% onlyaccording to the age of the vehicle.In the instant case the stereo was part of the vehicle and depreciation of 50% has beendeducted treating it as plastic part as per Motor tariff which imposes a depreciation of50% on all plastic parts. I am therefore in agreement with the decision of the InsuranceCompany that they have rightly deducted a depreciation of 50 % on the stereo.The complaint stands dismissed.Delhi Ombudsman CentreCase No. GI/265/OIC/06

Shri Ranjit SinghVsOriental Insurance Company LimitedAward Dated : 15.10.2007The complaint was heard on 08.10.2007. The complainant, Shri Ranjit Singh, wasaccompanied by Shri Arun Mehta, relative and Shri Harish Sharma, friend. TheInsurance Company was represented by Shri Rajinder Singh, Senior Branch Manager.Shri Ranjit Singh has lodged a complaint with this Forum on 23.10.2006 that he hadtaken a motor policy from the Oriental Insurance Company Limited. His Car No.DL6CH0089 had met with an accident on 30.05.2001 at Jalandhar. He gave the intimation toJalandhar Divisional Office of the Insurance Company. He had already submitted thebills/cash memo in original to them. He requested the Forum that his claim be paid tohim.At the time of hearing, Shri Ranjit Singh informed the Forum that vehicle No.DL 6CH0089 had met with an accident on 30.05.2001 which was surveyed by M/S.S.K.Mittaland Associates, surveyor. He has not received any payment of his claim. He wasinformed by the Insurance Company that Shri Shyam Chadha has already been paidthe claim amount of Rs.56178/-on 25.11.2001. He informed that he had already appliedto RTO, Mukatsar for transfer of the vehicle for which he produced a receipt dated28.05.2001 wherein the R.C. has been received and duly acknowledged by them. Hefurther informed the Forum that all the bills and cash memo which were submitted tothe Insurance Company were in his name and the receipt from Impact Motors fromwhere the vehicle was repaired was also issued in his name. The payment receipt wasalso issued by them for Rs.22850/- in his name. The Insurance Company has,therefore, wrongly paid the claim to Shri Shyam Chadha as he had already made thepayment of the vehicle to him and the same was under his possession. He has beentrying to contact the Insurance Company but he was always given vague replies. Hehowever informed that he came to know today itself that the claim has been settled infavour of Shri Shyam Chadha. He requested the Forum that his claim be paid to him.The representative of the Insurance Company informed the Forum that the vehicleNo.DL 6CH 0089 was insured under their cover Note No.738979 in favour of ShriShyam Chadha and the same had met with an accident on 30.05.2001.After they hadreceived the surveyor’s report, they have deputed Shri B.D.Kapoor and Associates toinvestigate the matter and as per his investigation report, the vehicle was registered inthe name of Shri Shyam Chadha. The Delhi RTO where the vehicle was registered hadnot received any transfer request nor request for NOC and on the basis of theinvestigation report and documents, they have accordingly settled the claim in favour ofShri Shyam Chadha.After hearing both the parties and on examination of the documents submitted, it isobserved that claim has been paid by the Oriental Insurance Company Limited to ShriShyam Chadha and Shri Ranjit Singh, the complainant, was asked to settle the matterwith Shri Shyam Chadha. Shri Ranjit Singh informed the Forum that he had purchasedthe vehicle through a broker, Shri Harjeet Singh of Gulati Motors on 30.03.2001 and hedid not know Shri Shyam Chadha.Since the claim had already been paid, it is for the Insurance Company to ascertainwhether the claim has been paid correctly or not. I would, therefore, request the ChiefVigilance Officer of the Oriental Insurance Company Limited, Headquarters Delhi,should investigate and take appropriate steps in the matter as per their findings.Delhi Ombudsman Centre

Case No.GI/303/NIA/06Ms. Vornica SharmaVsThe New India Assurance Company Limited.Award Dated : 16.10.2007The complaint was heard on 04.10.2007. The complainant Ms. Vornica Sharma waspresent along with her uncle Shri Chander Mohan and the Insurance Company wasrepresented by Shri V.K. Handa, A.O.Ms. Vornica Sharma had lodged a complaint with this Forum on 09.11.2006 that shehad taken a motor policy from the New India Assurance Co. Ltd., New Delhi. Thevehicle no. DL-2CW 3629 was stolen on 17.02.2004 and her claim had not beensettled. In view of unprofessional attitude of investigator she has requested this Forumthat such investigators should not be deputed by Insurance Companies to examinesuch claims.At the time of hearing Ms. Vornica Sharma informed the Forum that the vehicle waspurchased under higher purchase from ABN Amro Bank for a sum of Rs.339000/- andthe balance amount of Rs.39064/- was paid as down payment since at the time ofmarriage, her in-laws demanded the vehicle to be given to her as dowry. The car wasin possession of her in-laws as she had some differences with her husband and shehad lodged a complaint with ACP, Crime Against Women, Parliament Street, NewDelhi. In the complaint she had mentioned that on enquiry with her husband that theinstallments towards the payment of the loan to be made, her husband informed herthat the same would be paid by the Taxi person. Her mother had paid the twoinstallments of the loan to the recovery agents. The car was in possession of her inlawswhom Shri Sanjay Kumar is known and he took the vehicle with their consent andshe was informed of the theft of the car and FIR was lodged in this connection. Shefurther mentioned that the investigator had sent number of letters to her and she hadbeen replying to the various queries raised by him and submitting documents.However, he was repudiating her claim and as such he has submitted his first reportafter nearly 9 months of this theft of the vehicle. She has requested that her claim maybe paid.The representative of the Insurance Company informed the Forum that the theft of thevehicle was investigated by Shri Sanjeev Nijhawan and as per his report the insureddid not cooperate as mentioned in the report and he could not correlate the cause oftheft. Further, as per the complaint letter dated 23.03.2004 to ACP, CAW, ParliamentStreet, New Delhi that the subject vehicle was being used as Taxi by Shri PuneetDhawan her then husband. She had mentioned in the complaint to the police that thesubject car was assigned for hiring purposes to a Traveling Company and she hadpersuaded her husband to pay the Bank Loan installments regularly which her husbandpromised to pay after getting payment from the Travel Company where the subject carwas attached. The investigator has finally concluded that the subject car was beingused as a Taxi during the tenure of the policy which does not cover use for Hire or/reward. On enquiry by this Forum as the proximate cause of the loss of vehicle wastheft, what relations as a use of vehicle have? The representative of the InsuranceCompany informed the Forum that the vehicle was taken once by Shri Sanjay Kumarfrom father-in-law of Ms. Vornica Sharma and from Gurgaon he had to travel toGhaziabad which in itself raises suspection. He further informed the Forum that herearlier claim was also filed as No Claim as her father-in-law had a fake driving license.On enquiry by the Forum that, whether the Insurance Company had any prove toestablish that, the vehicle was being used as a Taxi ? The representative of theInsurance Company was not able to give any reply. They further informed that they

have rightly repudiated the claim based on the investigation report of Shri SanjeevNijhawan who has mentioned that as per the complaint of Ms. Vornica Sharma dated23.03.2004 to ACP, CAW, Parliament Street, New Delhi, the vehicle was assigned forhiring purposes to a Traveling Company.After hearing both the parties and on examination of the papers submitted it isobserved that the vehicle no. DL-2CW 3629 was stolen on 17.02.2004, which wasinvestigated by Shri Sanjeev Nijhawan, the FIR no. 54/04 dated 18.02.2004 was foundin order as well as the untraced/Final Report dated 07.05.2004 was also found in orderand as per the police records the subject car is not traced. The Insurance Companyhas repudiated the claim on the grounds that it was being used as Taxi, which is basedon the complaint lodged by the complainant with ACP, CAW, Parliament Street, NewDelhi on 23.02.2004. The complainant during the course of hearing had explained tothe Forum that she was having some differences with her husband and the complaintwas lodged wherein she had listed out all the property given to her in her marriage. Asshe did not know how to drive and she did not possess any driving license and she hadenquired from her husband that how they would be paying the installments to thefinancers, her husband had advised her that it was given to the travel agency whowould be paying the amount and subsequently he would settle the installments. TheInsurance Company or the investigator is not been able to establish that the vehiclewas being used as a Taxi, however, the proximate cause is theft and motor policybeing a named peril policy, theft does not have any relations with the purpose of use.However, the investigator during the investigation has also not mentioned norestablished that Shri Sanjay Kumar who had borrowed the vehicle from the father-inlawof the complainant any consideration was to be paid for its use. In view of theforegoing I am not in agreement with the basis of repudiation of the claim by theInsurance Company since the proximate cause being theft, the Insurance Company isliable to make payment of the claim. I therefore pass an Award that the InsuranceCompany should pay the IDV of the vehicle along with 8% interest from 01.06.2004 tillthe date of this Award.The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No.GI/171/OIC/06Shri Ramesh PandurangaVsThe Oriental Insurance Company LimitedAward Dated : 06.11.2007The complaint was heard on 21.09.2007 and 02.11.2007. The complainant ShriRamesh Panduranga was present along with Shri B.R. Sharma and the InsuranceCompany was represented by Shri Yogesh Dayal, Sr. Branch Manager.Shri Ramesh Panduranga had lodged a complaint with this Forum on 07.07.2006 thathe had insured his Toyoto Qualis, vehicle no. DL 4CP 6074 with Oriental Insurance Co.Ltd., Delhi. The vehicle had met with an accident on 17.02.2005. The Companyappointed the Surveyor Shri Ashwani Sethi on 25.02.2005 who assessed the loss forRs.97472/-. The Company also got the vehicle re-inspected by the same surveyor on09.06.2005 vide his report dated 04.07.2005. He has requested the Forum that hisclaim be paid.At the time of hearing, Shri Ramesh Panduranga informed the Forum that the vehiclehad met with an accident on 17.02.2005 at Meerut bypass. He had already explained to

the Insurance Company that the difference in the cause of accident as per the claimform and the police report vide his letter dated 27.01.2006, informed the Forum that hiscar collided with the tractor as a result of which his car got badly damaged and hebecame sub conscious and his wife got seriously injured who was sitting in the frontseat and other relatives in the back side who got minor injuries. He was immediatelytaken to the nearby hospital when huge crowd pushed his car with such a force that thecar moved towards its fixed direction of the left side which stopped touching a tree andthe car was subsequently towed to the Police Station. The difference in the twoversions is because of his relatives who had come from Delhi had reported the matterafter the final inspection of the car which was towed to the nearby police station andthey were asked to give a letter to the police authorities accordingly. On enquiry by thisForum to the representative of the Insurance Company that there was a loss to thevehicle as a result of accident which was established by the police was the cause ofaccident material? The representative of the Insurance Company replied that it was notvery material once it has been established that there was an accident to the vehicle.Further, Shri Ramesh Panduranga informed the Forum that re-inspection of the vehiclewas got done by Shri Ashwani Sethi on 09.06.2005 at the work shop and he hadsubmitted his re-inspection report no. 16313/SR/2005 dated 04.07.2006 as such thedemand for the same by the Insurance company is not justified. Further, he hadsubsequently sold the vehicle after repairs. On enquiry by this Forum with therepresentative of the Insurance Company that after repair of the vehicle was itnecessary for the insured to take permission before selling the vehicle? Therepresentative of the Insurance Company informed the Forum that it was not necessaryfor the insured to take permission to sell the vehicle after formalities of the claim hadbeen complied with.The representative of the Insurance Company informed that they had repudiated theclaim because of the difference in cause of the accident. However, the Forum enquiredwhether the surveyor had ascertained the true cause of accident and assessed the lossbased on the same. The representative of the Insurance Company informed that thesurveyor had taken into consideration the cause of accident was as a result due to thecollusion with a tractor.After hearing both the parties and on examination of the documents submitted it isobserved that vehicle no. DL 4CP 6074 met with an accident on 17.02.2005 which wassurveyed by the Surveyor Shri Ashwani Sethi and he had assessed the loss forRs.97472/- The claim has been repudiated on the grounds that the cause of accidentas per the claim form and police report was different and the vehicle was not reinspectedafter its repairs. The police report established that there was an accident tothe vehicle and the cause is only material to the extent of damages to the vehicle andthe surveyor Shri Ashwani Sethi in his report has clearly mentioned that the vehiclehad actually collided with the tractor and accordingly issued his survey report no.16313/SR/2005 dated 04.07.2005 assessing the loss for Rs.97472/-. The InsuranceCompany has wrongly repudiated the claim on the grounds of difference in the cause ofaccident. The vehicle has been re-inspected and there is re-inspection report of ShriAshwani Sethi dated 04.07.2005 wherein he has inspected the vehicle on 09.06.2005after its repairs in the work shop. Therefore, the basis of rejection of the claim by theInsurance Company is therefore not justified, since, it has been established that thevehicle had met with an accident and was re-inspected after repairs on 09.06.2005.I, therefore, pass an Award that the sum of Rs.97472/- be paid to Shri RameshPanduranga after completion of formalities along with 8% interest from 15.08.2005 tillthe time of payment.

The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No.GI/235/ICICI- Lomb/06Mohd. Nasir AhmedVsICICI Lombard General Insurance Company LimitedAward Dated : 17.12.2007The complaint was heard on 19.09.2007 and 27.11.2007. The complainant Shri Mohd.Nasir Ahmed was present along with Shri Rakesh Garg. Insurance Company wasrepresented by Shri Vishal Jain, Manager (Legal).Shri Mohd. Nasir Ahmed had lodged a complaint with this Forum on 08.12.2006 that hehad insured his Motor Car No. TN 01 Q 4858 with ICICI Lombard General InsuranceCo. Ltd. They have been requesting the Insurance Company to settle the claim but ofno avail.The representative of Shri Mohd. Nasir Ahmed informed the Forum that the vehicle wascompleted gutted and so it had no salvage value and it was the negligence of theInsurance Company that they did not take the possession of the vehicle immediatelyafter the loss as repairer was not prepared to give an estimate for the damages sincethe vehicle was completely gutted. He requested the Forum that his claim may besettled for the I.D.V. and he should be paid interest on the same.After hearing both the parties and on examination of the documents submitted it isobserved that vehicle no. TN 01 Q 4858 which was insured with ICICI Lombard GeneralInsurance Co. Ltd. under policy no. 3001/1743469/00/001, the I.D.V. is of Rs.229600/-.As per surveyor report of Shri Rameshwar Dayal Bansal no. RDB/Interim/TL/07/4858dated 08.08.2006; the vehicle was in badly burnt condition with missing of certain partslike gear box assly, complete suspension with all tyres and many more parts. Thewreck value would be around Rs.15000/-. Keeping in view the observation of thesurveyor, I pass an award that the Insurance Company pay 75% of IDV of Rs.229600/-less policy clause without collection of the salvage of the burnt vehicle. The deductionof 25% is on account of the negligence of the Insured for not protecting the vehicle asthe same it appears was abandoned which is contrary to the Principles of Insurance,where the insured is to protect the property as if he is not insured. Shri Mohd. NasirAhmed be paid 8% interest from 11.07.2006 till the time of payment on the amountpayable.The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No.GI/279/ICICI- Lomb/06Ms. Anubha ThakkarVsICICI Lombard General Insurance Company LimitedAward Dated : 19.12.2007The complaint was heard on 13.06.2007, 17.08.2007 and 27.11.2007. The complainantMs. Anubha Thakkar was represented by Shri P.S.N. Murthy. Insurance Company wasrepresented by Shri Vishal Jain, Manager (Legal).

Ms. Anubha Thakkar had lodged a complaint with this Forum on 24.01.2007 that hercar no. DL-4CAD 0633 was insured with ICICI Lombard General Insurance Co. Ltd.under policy no. 3001/50540422/00/000. She has requested that a fresh policy beissued by rectifying the voluntary excess clause as also voluntary deductible and alsorefund the amount of Rs.5000/- which has been deducted from the claim amount.At the time of hearing the representative of Ms. Anubha Thakkar informed the Forumthat the calculation sheet was given by the agent of ICICI Lombard agreed to which thepremium had been paid. On enquiry by this Forum that the total premium as per thecalculation showed worked out as Rs.20067/-, how they had paid a sum of Rs.17500/-whereas even after discount in the calculation it is mentioned as Rs17743/-. Therepresentative informed the Forum that it was utmost good faith that they paid thisamount. However, they had never agreed to voluntary excess of Rs.5000/-. TheInsurance Company was asked by this Forum to produce the proposal Form which wasproduced and shown to the representative, in the proposal form it is clearly indicatedthat voluntary excess of Rs.5000/-. The representative contested that the signature inthe proposal form is neither of Ms. Anubha Thakkar nor any of her representatives. Onenquiry by this Forum that when the policy was received by the insured they shouldhave examined the policy where it is clearly mentioned voluntary deductions ofRs.5000/- and they should have raised the query. The representative informed theForum that there was no apprehension or doubt about the terms and conditions at thetime of taking the policy and the same was not looked into. He has requested theForum that his policy be corrected and he should be paid a sum of Rs.5000/- which hasbeen deducted from his claim amount.The representative of the Insurance Company informed the Forum that the complainanton receipt of the policy should have raised objection regarding the deductibles ofRs.5000/- and they would have looked into the matter. Since she had agreed for thisdeductible in the proposal form and they have accordingly paid the claim.After hearing both the parties and on examination of the documents submitted it isobserved that Ms. Anubha Thakkar has submitted calculation sheet by the agent ofICICI Lombard General Insurance Co. Ltd. and the total premium worked out to beRs.20067/- and after discount the premium worked out as Rs.17743/-. However, shehad paid Rs.17500/-. This document could not be taken at the face value since therewas no signature of the person submitting this quotation nor it is on the letter head ofthe Insurance Company. On perusal of the proposal Form it is observed that it is notsigned by Ms. Anubha Thakkar as the signature can be compared with the complainantsignature on the complaint letter. However, as per the proposal form there wasvoluntary deduction of Rs.5000/- and the policy has been issued accordingly. Ms.Anubha Thakkar should have immediately raised objection on receipt of the policy andher contention that she has not looked into the terms and conditions is not justifiedreason after a claim has been reported on the Policy. The Insurance policy is contractand once both the parties have agreed to execute the contract by means of policy assuch terms and conditions are binding. As Ms. Anubha Thakkar has not raised anyobjection on receipt of the policy she is to be governed by the same in case of anyeventuality. The Insurance Company has therefore rightly interpretated the policy andhas deducted Rs.5000/- from the claim amount which is clearly mentioned in the policyterms and conditions.I therefore uphold the decision of the Insurance Company making the payment ofRs.2902/- which is as per the terms and conditions of the policy.The complaint stands dismissed.

Delhi Ombudsman CentreCase No. GI/69/NIA/06Smt. Bhupinder KaurVsNew India Assurance Company LimitedAward Dated : 15.01.2008The complaint was heard on 06.07.2007, 07.09.2007, 14.11.2007 and on 04.01.2008.The complainant, Smt. Bhupinder Kaur, was present accompanied by her brother-in-lawShri Surjit. The Insurance Company was represented by Shri Sanjay Uppal, SeniorDivisional Manager.Smt. Bhupinder Kaur has lodged a complaint with this Forum on 23.03.2006 that herhusband Shri Sant Prakash Singh had met with an accident on 04.08.2003 and expiredon the spot. He was traveling along with the driver in Tata-407 No.DL-1LB 1442 whichwas insured with the New India Assurance Company Limited under policyNo.320301/31/03/01617. He was the owner of the vehicle. She had lodged death claimas well as Personal Accident claim at Shahdara Branch Office of the InsuranceCompany but till date the claim has not been settled. She has requested the concernedofficer to settle the claim. Since almost three years have passed but the claim has notbeen settled, she has requested the Forum that her claim may be settled.At the time of hearing, the complainant informed the Forum that the InsuranceCompany have repudiated their claim on the grounds that the driving license of ShriBanwari Lal was found to be fake whereas her husband Shri Sant Prakash Singh’sdriving license was not valid at the time of accident. Smt. Bhupinder Kaur produced aphotocopy of another driving license of Shri Banwari Lal issued by RTO, Mathura whichthe Insurance Company was required to get it verified before the Forum could considerthe matter. The Insurance Company at the time of hearing on 04.01.2008 informed theForum that the driving license of Shri Banwari Lal issued by RTO, Mathura was foundto be genuine and a valid document. The complainant also contested that the drivinglicense of her husband which had expired on 12.07.2003 should have been renewedwithin one month from the retrospective date and since he had died on 04.08.2003,there was enough time to renew the license. She requested the Forum that the owndamage claim along with Personal Accident claim be paid to her.The representative of the Insurance Company contested that vehicle No.DL-1LB-1442had met with an accident on 04.08.2003. The Own Damage claim was repudiatedbecause the driver Shri Banwari Lal was not having a valid driving license. On enquiryby this Forum that the complainant had produced a photocopy of another drivinglicense which was found to be valid, the representative of the Insurance Companyinformed the Forum that as per the Motor Vehicles Act, no person is supposed to havetwo driving license. Since the earlier driving license was found to be fake, there is noliability of the Insurance Company. As far as Personal Accident claim is concerned,there is no FIR, Post Mortem conducted, therefore, the Insurance Company is notliable to pay the claim. On enquiry by this Forum from the complainant why FIR was notlodged nor post mortem was conducted, she informed that she was unaware that herhusband was covered under Personal Accident policy. As such, they lodged acomplaint with the police on 04.08.2003 that the body of late Shri Sant Prakash Singhbe handed over to them to perform last rights as they did not expect any foul play. Hadthey known that the deceased had a personal accident cover and post mortem isrequired, they would accordingly get the same conducted.After hearing both the parties and on examination of the documents submitted, it isobserved that the Insurance Company had rejected the own damage claim of the

vehicle on the grounds that the driver Shri Banwari Lal had a fake driving license. Asregards the Personal Accident claim, since there was no FIR lodged nor post mortemconducted so as to establish that the death was due to accident, they have rejected theclaim. Moreover, the driving license of Shri Sant Prakash Singh had also expired. Iwould like to deal both the cases separately as under:(i) Own Damage Claim : The Insurance Company has rejected the claim of thevehicle on the grounds that the driver Shri Banwari Lal had a driving licenseNo.79365/2001/Agra issued by RTO-Agra which was found to be fake. The InsuranceCompany subsequently have confirmed that the 2 nd license of Shri Banwari Lal issuedby RTO Mathura is valid and genuine document. A person when hiring a driver onlysees that he has a valid Driving License and conducts a driving test and after boththese aspects are fond to be met, he hires the person and does not wait to get hisdriving license checked from the Regional Transport Authority, if he does so he willnever be able to hire a driver.On this front, I am guided by the Order passed by Honourable Supreme Court of Indiain the case of United India Insurance Company Limited Vs Lehru and Other (CivilAppeal No.1959 of 2003) where the Honourable Court has said: “When an owner ishiring a driver he will therefore, have to check whether the driver has a driving license.If the driver produces a driving license which on the face of it looks genuine, the owneris not expected to find out whether the license has in fact been issued by a competentauthority or not. The owner would then take the test of the driver. If he finds that thedriver is competent to drive the vehicle, he will hire the driver. We find it rather strangethat insurance Companies expect owners to make enquiries with RTO’s which arespread all over the country, whether the driving license shown to them is valid or not.Thus, where the owner has satisfied himself that the driver has a license and is drivingcompetently there would be no breach of Section 149(2) (a)(ii). The InsuranceCompany would not then be absolved of liability. If it ultimately turns out that thelicense was fake the insurance company would continue to remain liable unless theyprove that the owner/insured was aware or had noticed that the license was fake andstill permitted that person to drive.”In view of foregoing, the Insurance Company has not been able to establish that thelate Shri Sant Prakash Singh had been negligent in employing Shri Banwari Lal and asper the Judgement of Honourable Supreme Court with regard to the fake drivinglicense, I feel that the Insurance Company has wrongly repudiated the claim keeping inview that the driving license issued by RTO, Mathura was genuine and Shri Banwari Lalwas authorized to drive Heavy Motor Vehicles. The contention of the InsuranceCompany that a person cannot hold two driving license does not entitle them to avoidtheir liability. I do not consider it reasonable and hence pass the Award that theInsurance Company is liable to pay the Own Damage Claim.(ii) Personal Accident Claim : The Insurance Company has rejected the claim on thegrounds that there was no FIR nor post mortem conducted which establishes that thedeath was due to accident. The Insurance Company is guided by the report ofM/S.Surya Claims Bureau Limited.I have examined the report of M/S.Surya Claims Bureau Limited wherein Shri BanwariLal, driver informed the family of the insured on phone that one bus came fromopposite side of the truck and dashed it very badly. On 04.08.2003 at around 5 a.m.trying to overtake a Haryana Roadways bus hit it on the conductor side resulting in theinsured being hit badly and died on the spot. Further, the investigation reportmentioned that the brother of the deceased took the body of Shri Sant Prakash Singhaway from the accident. The complainant at the time of hearing submitted a document

earing the stamp of Police Station (Dahat), Bulandshahar mentioning that at 9.10hours on 04.08.2003, Pushpajeet Singh S/O late Shri Sant Prakash Singh resident ofU-27, Naveen Shahdra, Delhi along with Shri Surjeet Singh came to the police stationthat Sant Prakash Singh in his vehicle DL 1 LB 1442 whilst met with an accident as aresult his father Shri Sant Prakash Singh died at about 5 a.m. and requested the policeauthority to register the complaint. The complaint was handed over to Head ConstableShri Shakoo Ahmed for investigation. A copy has been given to the complainant. It isalso surprising that the police had handed over the dead body without conducting thePost Mortem. It was their duty to get the post mortem done keeping in view that thevehicle had met with an accident with another vehicle as mentioned in the complaint.The reasons best known to the police authorities as to why they had not conducted thepost mortem in this case. As such, I feel that the death had occurred due to accidentand the dead body of Shri Sant Prakash Singh was taken away by the family memberswithout post mortem which has been recorded in the statement provided by the policeand the same is also acknowledged. As far as driving license of Shri Sant PrakashSingh which was valid up to 12.07.2003 can be renewed effective from the date ofexpiry within 30 days as per Section 14 of Motor Vehicles Act 1988 and Shri SantPrakash Singh died on 04.08.2003 which was within the grace period of 30 days assuch it should be treated to be valid.In view of the foregoing, it is clearly established that Shri Sant Pal Singh’s personalAccident claim can be paid as the documents submitted by the complainant and dulyacknowledged by the police establishes death due to Road Accident and the drivinglicense was also valid at the time of death of Shri Sant Prakash Singh.I, therefore, pass the Award that the Insurance Company is liable to pay (i) the OwnDamage Claim to the vehicle (ii) the Personal Accident claim for owner/driver late ShriSant Prakash Singh.The Award shall be implemented within 30 days of receipt of the same. The complianceof the Award shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No. GI/148/NIC/06Shri B.L. KohliVsNational Insurance Company LimitedAward Dated : 30.01.2008The complaint was heard on 09.01.2008. The complainant, Shri Bansi Lal Kohli, waspresent accompanied by his son Shri Arun Kohli. The Insurance Company wasrepresented by Shri H.C.Pandey, Assistant Manager.Shri Bansi Lal Kohli has lodged a complaint with this forum on 15.05.2006/24.07.2006that the National Insurance Company Limited has rejected his motor claim. He hasrequested that he be paid IDV of Rs.4,50 lakhs being the value of the vehicle stolenalong with 12% interest from the date of loss until the realization of the same, a sum ofRs.10000/- towards litigation expenses, Rs.25000/- towards mental agony andharassment and Rs.25000/- towards various other expenses like travel, postage, timespent etc.At the time of hearing, Shri Bansi Lal Kohli reiterated the points raised by him in hiscomplaint letter dated 15.05.2006/24.07.2006 and in his rejoinder dated 14.11.2007.He emphasized that he had complied with the provisions of GR-17 since the vehiclewas transferred in his name only on 03.11.2004 and if there were any formalities to becompleted, the Insurance Company should have got the same completed by sending

their representative. Most of the formalities mentioned in their letter were already withthe Insurance Company. However, in case the new proposal form was to be filled in,the same should have been sent along with their letter dated 17.11.2004. As far as thepolicy is concerned, the same could have been submitted to them if they so desired.However, provisions of GR-17 only talks about the surrender of insurance certificateand not the policy. As regards the inspection of the vehicle, there is no such provisionunder GR-17 and the vehicle had already been inspected when the Insurance waseffected on 23.07.2004 by their Branch Manager. With regard to the letter from theoriginal owner of the vehicle, Shri Prabhakar V. Modak, the letter dated 08.09.2004was already submitted and the Insurance Company have nowhere mentioned that sucha letter was required in initial stage when he had visited the office on 08.11.2004. ShriKohli has also informed that he sent a letter by courier so as to record its dispatch andhas not visited the office as he had already done on 08.11.2004 when he was notapprised of all the formalities to be completed. He requested the Forum that he hadcomplied with the provisions of GR-17 by applying on 17.11.2004 about the transfer ofhis vehicle in his name. He should be paid his claim along with 12% interest, cost andcompensation for mental harassment.The representative of the Insurance Company informed the Forum that Shri Kohli hadnot applied for the transfer of vehicle within the stipulated time and there were anumber of formalities which the transfer could be effected as per the provisions ofMotor Tariff and GR-17 which was communicated to him vide their letter dated17.11.2004 and the cheque was returned to Shri Kohli in view of the that the vehiclehad already been stolen on 15/16.11.2004. Due to non compliance of requirementsdetailed as per GR-17, the Insurance Company has rightly repudiated the claim.Both the parties were heard and detailed complaint and rejoinders have been examinedby me. The main questions, therefore, remain that whether Shri Bansi Lal Kohli hadapproached the Insurance Company for transfer of insurance as per GR 17 within thestipulated 14 days as stated therein and whether he was entitled to receive the claimfrom the National Insurance Company Limited. The National Insurance CompanyLimited issued policy NO.361501/31/04/6101092 insuring vehicle No.MH-12-AX-3379against comprehensive risk from 23.07.2004 to 22.07.2005 in the name of ShriPrabhakar V.Modak. Shri Bansi Lal Kohli had purchased this vehicle on 02.08.2004 bymaking the payment against the purchase of the vehicle on 31.07.2004. The vehiclewas transferred in the name of Shri Bansi Lal Kohli by RTO, Delhi on 03.11.2004. ShriKohli has mentioned about the HO Circular Ref: HO/MOT/0506/003 dated 02.06.2005of the National Insurance Company Limited wherein certain guidelines have been laiddown for transfer of insurance. This circular has been issued after the vehicle hadalready been stolen, which only clarifies the provision of Motor Tariff. This Forum is notguided by the circulars issued by Insurance Company but the terms and conditions ofthe policy which is the basis of Contract. The vehicle was transferred in the name ofShri Bansi Lal Kohli on 03.11.2004. As per the provisions of GR-17, 14 days areprovided so as to give some time for the new owner to apply for the transfer ofinsurance and complete the formalities which may be required for transfer ofInsurance. Shri Kohli has written a letter to the Insurance Company on 11.11.2004enclosing therewith a blank cheque towards the cost of transfer. The InsuranceCompany has returned the cheque after it was received in their office on 16.11.2004asking Shri Kohli to comply with certain formalities. As per their letter dated17.11.2004, the Insurance Company required the proposal form to be completed whichis a requirement as per GR-17 of the Motor Tarif which they according to them hadenclosed with their letter but Shri Kohli has not received. With regards to theproceedings of the purchase of the vehicle and date of purchase of the vehicle, Shri

Kohli had submitted the details of his draft as well as bank statement of Shri Modak(the transferor) wherein a sum of Rs.4.50 lakh has been credited in Shri Modak’saccount in the month of August, 2004 and the draft was dated 31.07.2004 drawn onIndian Bank, Kashmere Gate, Delhi. Original Insurance policy has been demanded bythe Insurance Company. As per GR-17, the old certificate is required to be submittedand not the policy. The policy only rectified by an endorsement and I do not agree withthe contention of the Insurance Company that the old policy was required. In case theold certificate of insurance is not available, a proper declaration from that effect is tobe taken from the transferee before a new certificate is issued as per provision of GR17. A letter from Shri Prabhakar V.Modak has already been sent on 08.09.2004 and therequirement of the Insurance Company that the vehicle is to be inspected beforetransfer of insurance as per Shri Kohli has no where mentioned in GR-17 and I am alsoin agreement with Shri Kohli since it is not a fresh insurance, it is only a transfer and incase the transfer request is more than 14 days old then the Insurance Company couldinsist on the inspection of the vehicle but since Shri Kohli has made a transfer requestwell before the completion of 14 days, that is on 11.11.2004, the same is well withinthe stipulated period as Shri Kohli had become the registered owner of the vehicle on03.11.2004. Even the Insurance Company’s guidelines stipulate that once a chequehas been dispatched by insured, the risk is to commence or to be renewed from thedate of dispatch of the cheque. Since Shri Kohli had sent the cheque on 11.11.2004 bycourier which was received by the Insurance Company on 16.11.2004, the threeintervening days being holidays the fresh cover is seamless and it does not warrant aninspection of the vehicle. The Insurance Company has also mentioned that Shri Kohlicould have approached their office for transfer of insurance as the office is very closeto his office, the same applies to the Insurance Company. The Insurance Companycould have sent their agent or Development Officer to get the formalities completedimmediately on receipt of the letter of Shri Bansi Lal Kohli and should not havereturned the cheque and this amounts to deficiency in service as far as InsuranceCompany is concerned since they are supposed to cater to the requirements of theinsured. The Insurance Company, as per Shri Kohli, has even failed to attach theproposal form with their letter. The contention of the Insurance Company that retentionof the cheque would have amounted to their agreement to transfer the insurance, I donot agree with their contention as I see that all formalities which the InsuranceCompany has asked were not very material to transfer of Insurance except the letterfrom the previous owner Shri P.V. Modak as he was earning 35% NCB for he may liketo retain the Insurance. Shri Kohli has mentioned that he, Shri Modak had alreadywritten to the Insurance Company for transfer of Insurance on 08.09.2004 this formalitywas also complied with as the Insurance Company has not been able to establish thenon receipt of this letter. Further, the Insurance Company in its reply has alsomentioned that 14 days were to be counted from 08.09.2004 which is not correct sinceShri Kohli became the registered owner of the vehicle on 03.11.2004. The InsuranceCompany has been deficient in service by not sending their Agent/ Development Officerwhen they had received the request for Transfer of Insurance as their office accordingto them was in the same area.I, therefore, conclude that Shri Bansi Lal Kohli had applied to the Insurance Companywithin 14 days of the vehicle being registered in his name, that is, on 03.11.2004 andhe had submitted his request vide his letter dated 11.11.2004 which was well within thestipulated time as per GR-17 of the Motor Tariff. The Insurance Company cannot denyits liability by not entertaining the claim.I, therefore, pass the Award that the National Insurance Company Limited is to pay toShri Bansi Lal Modak the IDV of Rs.4,50,000/- along with 8% interest from one month

after the final investigation report was received by the Insurance Company till the dateof this Award since Shri Kohli would be required to comply with other formalities onlyafter which the Insurance Company is able to make the payment of the claim. TheInsurance Company should collect the charges which are recoverable for transfer ofthe Insurance fom Shri Kohli.This forum is not competent to pass any Award for mental harassment and costincurred by Shri Bansi Lal Kohli.The Award shall be implemented within 30 days of receipt of the same. The complianceof the Award shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No. GI/447/OIC/07Shri Niranjan SinghVsOriental Insurance Company LimitedAward Dated : 05.02.2008The complaint was heard on 01.02.2008. The complainant, Shri Niranjan Singh, waspresent. The Insurance Company was represented by Shri Shampa Khastgir, SeniorBranch Manager and Ms.Geeta Dayal, Administrative Officer.Shri Niranjan Singh has lodged a complaint with this Forum on 28.04.2006 that he hadinsured his vehicle No.DL 1LE 0377 with the Oriental Insurance Company Limited. Thesaid vehicle was stolen from Gurgaon on 4/5 October,2006 night. He has requested theForum that he be paid his genuine claim.At the time of hearing, Shri Niranjan Singh informed the Forum that his vehicle wasparked by his driver on 4/5 th night where the vehicle was usually parked and early inthe Morning at 5.00 a.m. on 5 th morning, he was informed that the vehicle was notthere. He along with his driver tried to search the vehicle but could not find the same.He immediately informed the Insurance Company’s office at Palam since he thoughtthat the vehicle may be insured there. He informed the Insurance Company on06.10.2006. Further, he had contacted the police authorities who told him that theywould lodge police report after they have searched the vehicle. They only registeredthe case on 10.10.2006 and at the time of release of the letter, they collected theoriginal intimation letter from him. He requested the Forum that there was no delay inintimating the theft case to the Insurance Company as well as to the police authoritiesand he should be paid his rightful claim.The representative of the Insurance Company informed the Forum that they hadrejected the claim because of late intimation of the claim to the police authorities aswell as he had informed not the policy issuing office of the Insurance Company. Onenquiry by this forum that when did Shri Niranjan Singh inform the Insurance Company,the representative of Insurance Company informed that it was on 06.10.2006 that hehad submitted a written application informing about the theft of the vehicle to theirPalam office. Further the Insurance Company representative informed that 100 Number(PCR) was not informed. On enquiry by the Forum that whether Gurgaon had thefacility of 100 number (PCR), a facility available at Delhi, the representative of theInsurance Company had no answer.After hearing both the parties and on examination of the papers submitted, it isobserved that Shri Niranjan Singh, the owner of the vehicle No.DL 1LE-0377 informedthe Oriental Insurance Company Limited on 06.10.2006 that the said vehicle was stolenand had also informed the police. The Insurance Company has repudiated the claim onaccount of late intimation of 5 days to the police authorities. The representative of the

Insurance Company has confirmed that their Palam Office was informed about the theftof the said vehicle on 06.10.2006. As such, according to me, there is no delay sincethe vehicle was stolen from Gurgaon and the insured has informed the nearest office ofthe Insurance Company and the Insurance Company should have coordinated with theirSansad Marg Office (policy issuing office) about the insurance of the vehicle. Theinsured has also informed the police and it is an established fact that the police taketime to register the FIR since they normally try to locate the vehicle and a formal FIRtakes at least 2 to 3 days before it is accepted. The Insurance Company mentionedthat there was no DD registered on 06.10.2006 but was on 10.10.2006, Shri NiranjanSingh had mentioned that the police authorities asked him to search for the vehicle andthey took his complaint letter on 10.10.2006 and gave him the FIR. The InsuranceCompany having being informed on 06.10.2006, after the theft of vehicle on05.10.2006, could have immediately deputed the investigator to trace the vehicle andShri Niranjan Singh has not prejudiced their interest. The Insurance Company hastherefore, wrongly repudiated the claim that there was a delay in intimation since ShriNiranjan Singh has lodged a complaint with the Insurance Company on 06.10.2006which is immediately after the theft of the vehicle.I, therefore, pass the Award that Shri Niranjan Singh be paid the IDV of the vehicle bythe Oriental Insurance Company Limited.The Award shall be implemented within 30 days of receipt of the same. The complianceof the Award shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No.GI/412/NIC/07Ms. Mini S. JosephVsNational Insurance Company LimitedAward Dated : 07.02.2008The complaint was heard on 04.01.2008. The complainant Ms. Mini S. Joseph waspresent along with her husband Shri Siby Joseph. The Insurance Company wasrepresented by Shri Bhupender Kumar, Administrative Officer.Ms. Mini S. Joseph had lodged a complaint with this Forum on 02.07.2007 that she hasa Motor Policy for Maruti Car No. UP 16B 9795 from National Insurance Co. Ltd. from04.10.2006. She lodged a claim with the National Insurance Co. Ltd. and they repliedher that the same was treated as no claim. She has mentioned that she is in serviceand since she has lost her car is a great loss to her and has asked the Forum toconsider her case sympathetically.At the time of hearing Ms. Mini S. Joseph requested the Forum that her genuine claimfor the loss of her car should be paid which has been repudiated by the InsuranceCompany on the grounds that the registration book was in the name of her brother-inlawShri Thomas Lukose whereas the insurance was in her name and nobody informedher that the insurance is to be transferred in the name of the new owner. On enquiry bythis Forum that when the vehicle was driven and the police wanted to check the papersof the vehicle RC would have been in the name of Shri Thomas Lukose whereas thevehicle was insured in the name of Ms. Mini S. Joseph, whether the person drivingwould be in a position to explain to the authorities why the vehicle did not have a validinsurance since the policy was in the name of another person. Ms. Mini S. Joseph didnot have any explanation for this discrepancy.

The representative of the Insurance Company informed the Forum that there was noinsurable interest of Ms. Mini S. Joseph the policy holder; as such the claim wasrepudiated.After hearing both the parties and on examination of the documents submitted, Ms.Mini S. Joseph had transferred the vehicle Maruti Car no. UP 16 B 9795 in favour ofShri Thomas Lukose on 16.04.2007 and the vehicle met with an accident on 12.05.2007and the insurance policy was in the name of Ms. Mini S. Joseph. Since the insurancewas not transferred in the name of new owner Shri Thomas Lukose, Ms. Mini S. Josephdid not have any insurable interest and had violated condition no. GR 17 of the MotorTariff. The Insurance Company has therefore rightly repudiated the claim.I, therefore, uphold the decision of the Insurance Company.The complaint stands dismissed.Delhi Ombudsman CentreCase No.GI/332/ICICI- Lomb/06Shri Satyavir SinghVsICICI Lombard General Insurance Company LimitedAward Dated : 21.02.2008The complaint was heard on 19.09.2007, 27.11.2007, 23.01.2008 and 06.02.2008. Thecomplainant Shri Satyavir Singh was present. The Insurance Company wasrepresented by Shri Ashwani Tyagi, Manager.Shri Satyavir Singh had lodged a complaint with this Forum on 20.03.2007 that hisvehicle No. UP 16K 6644 Tavera, Engine No. 3GE19437, Chassis No.MA6AB6G765HG18861 was insured with ICICI Lombard General Insurance Co. Ltd.and he was issued a cover note no. PD 3095020. His vehicle was stolen on 05.11.2006At the time of hearing Shri Satyavir Singh informed the Forum that he has not receivedthe cheque said to have been sent by the Insurance Company and as such theInsurance Company was on risk and they should pay his claim for theft of his vehicle.He further informed the Forum that he had written number of letters dated 09.11.2006,06.12.2006 and 09.02.2007 which were sent by courier and he has already submittedthe Courier Challans to this Forum proving that he had already lodged a claim on theInsurance company and it is a after thought by them that they have not received thepapers and also that the cheque submitted by him, there was a discrepancy in thewords and figures of the premium amount therein. He requested the forum that hisclaim should be paid.The representative of the Insurance Company informed the forum that since they hadfound discrepancy in the premium cheque and they had returned the same vide theirletter dated 07.10.2006. The cover note was not valid since the premium was notreceived since inception and there is no liability of the Insurance Company.After hearing both the parties and on examination of the documents submitted it isobserved that the Insurance Company have maintained that Shri Satyavir Singh hadsubmitted the premium cheque for Rs.19616/- wherein the words and figures there wasa discrepancy and they had written to him to submit a fresh cheque which he has notdone so, as such the cover note was not valid and since there was non compliance ofSection 64 VB of the Insurance Act where premium is to be received prior toacceptance of risk even cheques are subject to realization and the cover note is validonly if the premium has been credited to the Company’s Account. At the time ofhearing the Forum enquired from Shri Satyavir Singh to prove that his account hadbeen debited or not since he had not received the premium cheque from Insurance

Company for rectification. He was hesitant and reluctant to disclose any details of hisaccount whether the amount was debited or not. Since Shri Satyavir Singh was notprepared to disclose his bank account details and he being fully aware that the chequegiven to the Insurance company has not been realized he should have enquired fromthe Insurance Company the reasons for non presentation of the cheque which he hasnot done so. The Insurance Company having not received the premium and as per theirletter dated 07.10.2006 there being discrepancy in the amount words and figures haveno liability to pay the claim as the cover note is void abinitio.I, therefore, uphold the decision of the Insurance Company.The complaint stands dismissed.Delhi Ombudsman CentreCase No.GI/388/NIC/07Smt. Nathi DeviVsNational Insurance Company LimitedAward Dated : 22.02.2008The complaint was heard on 11.12.2007 and 19.02.2008 at Jaipur. The complainantSmt. Nathi Devi was represented by Shri Shanker Lal. The Insurance Company wasrepresented by Shri R.K. Chhatwal, Branch Manager.Smt. Nathi Devi had lodged a complaint with this Forum on 21.05.2007 that her latehusband Shri Banwari Lal had met with a Road Accident on 14.03.2006 and hadsuffered serious injuries. She has submitted the Deep Hospital discharge certificateand her husband expired because of the injuries sustained in the road accident. Shehas requested the Forum that her claim may be paid.At the time of hearing the representative of Smt. Nathi Devi informed the Forum thatShri Banwari Lal was covered under the Motor Policy for Driver/Owner PersonalAccident and his claim has been repudiated by the Insurance Company on account ofnon submission of Post Mortem report. He informed the Forum that she was not wellaware that her husband was covered under Personal Accident nor she was educatedbut could only sign as such she was not aware that it was necessary to get postmortem report done nor the hospital authorities asked her to do so. As the roadaccident took place there is an FIR and Shri Banwari Lal did not gain consciousnessafter the accident. He requested the Forum his claim should be paid.The representative of the Insurance Company informed the Forum that since the postmortem was not conducted and Shri Banwari Lal had died after 61 days of the accident,it was not established that he was died as a result of injuries sustained at the time ofroad accident. On enquiry by this Forum whether, any investigation had been carriedout. The representative of the Insurance Company informed the Forum thatinvestigation was conducted by M/s. Arihant Investigation Bureau, Jaipur. As per theinvestigation report the case of Shri Banwari Lal was referred to Dr. Ramesh Vijay ofJaipur. However, it was not clearly establish that the death was due to accident sinceno post mortem have been conducted accordingly they have repudiated the claim.After hearing both the parties and on examination of the documents submitted it isobserved that Shri Banwari Lal, owner of vehicle no. RJ-14-43M-5441 which wasinsured with National Insurance Co. Ltd. had met with an accident near Dodo on14.03.2006 and FIR no. 70/06 under IPC Section 279 and 337 has been lodgedmentioning that the vehicle no. RJ 02 C 1464 came from Jaipur side driven rash andnegligently hit the vehicle no. RJ 14 43M 5441 of Shri Banwari Lal driver of the motor

cycle and Shri Sohan Lal who was sitting behind Shri Banwari Lal fell down from theMotor Cycle Shri Banwari Lal sustained serious injuries in his head. He was admitted inSMS Hospital on 14.03.2006. Shri Sohan Lal who had received small injuries wasdischarged from the hospital and he lodged a FIR. Shri Banwari Lal expired on31.05.2006 at Deep Hospital, Jaipur while he was admitted in hospital on 30.05.2006.Smt. Nathi Devi w/o. Shri Banwari Lal lodged a claim on the Insurance Company underPersonal Accident Cover of Driver/ Owner, since Shri Banwari Lal was the driver andwas also the owner of the vehicle no. RJ 14 43M 5441. National Insurance Co. Ltd.vide their letter dated 01.05.2007 repudiated the claim on the grounds that no postmortem report was conducted and the same has not been submitted. I have examinedthe Investigation report of M/s. Arihant Investigation Bureau, Jaipur report dated21.08.2006, under the conclusion it is mentioned that there is no doubt that ShriBanwari Lal had died due to the injuries he had sustained in the road accident whiledriving the motor cycle. However, the body was not subject to post mortem, however,the village sarpanch have confirmed the accidental death of Shri Banwari Lal. Hefurther recommends that the Company may seek the opinion of a medical expert andsettle the claim as per the terms and conditions of the policy. The Insurance Companyhad referred his case to Dr. Ramesh Vijay, whereas the doctor has mentioned that inhis opinion the proximate cause of death was head injury Dubacanal bleed leading topyrecei with septicemic that is responsible for Cardiomyopathy arrest. However,certificate issued by Deep Hospital dated 09.11.2006 mentioned that Shri Banwari Lals/o. Shri Chanda Lal aged 25 years Hindu male r/o. Sobner is declared dead on31.05.2006 at 11.30 p.m. Proximate cause of death is RTA – (HC Bleed in internalcapsule, 3.0 ventricles) pyrecia septicemic cardiomyopathy arrest. The InsuranceCompany has repudiated the claim on the grounds that there is no post mortem report.I do not agree with the Insurance Company’s contention that post mortem report isrequired as per policy terms and conditions. The Policy terms and conditions are silentwhich mentions that the nominee of the deceased is to establish that the death wasdue to road accident. The Investigator Dr. Ramesh Vijay as well as Dr. P. Joshi ofDeep Hospital where Shri Banwari Lal was last admitted on 30.05.2006 confirms thatthe proximate cause of death is road accident which resulted in bleed leading topyrecei with septicemic that is responsible for Cardiomyopathy arrest. The opinion ofthe two doctors can be relied upon and I have no hesitation in passing an Award thatthe Insurance Company should pay Personal Accident claim to the deceased nominee/claimant.The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No.GI/347/ICICI- Lomb/07Shri Ravi Kumar SoniVsICICI Lombard General Insurance Company LimitedAward Dated : 25.02.2008The complaint was heard on 11.12.2007 and 19.02.2008 at Jaipur. The complainantShri Ravi Kumar Soni was present along with his friend Shri K.K. Nagpal. TheInsurance Company was represented by Shri Vishal Jain, Manager- Legal.Shri Ravi Kumar Soni had lodged a complaint with this Forum on 07.04.2007 that hiscar no RJ-14-5C-5626 Toyota Qualis was insured with ICICI Lombard GeneralInsurance Co. Ltd. vide their policy no.3001/1439468/00/000 from 23.04.2006 to22.04.2007. Vehicle had met with an accident on 08.10.2006 and he had informed the

Insurance Company of the same on 09.10.2006. He received a letter dated 25.01.2007that his claim has been rejected on the grounds that the vehicle was used forcommercial purposes. He has never used his car for hire or reward racing and as suchhis claim may be paid.At the time of hearing Shri Ravi Kumar Soni reiterated what he had written in his letterdated 07.04.2007. He further informed the Forum that he is running a travel agency butthis car no. RJ 14 5C 5626 is being used for his private and professional purposes andis not given on hire or reward racing. Since his family is a large family and there isalways a requirement of the car. He further informed the Forum that his driver has alsosubmitted the statement to this effect to the Insurance Company. He requested theForum that his claim may be paid.The representative of the Insurance Company informed the Forum that Shri Ravi KumarSoni was running Tours and Travels Agency and investigator had got quotation fromhim dated 25.07.2007 wherein it established that he was running cars on hire and hehas also quoted for the Qualis which clearly establishes that he has been using the carfor Hire and reward. On enquiry by this Forum that this quotation letter mentionsvarious types of car whether the Insurance Company had any evidence to show thatvehicle no. RJ 14 5C 5626 was however used as taxi, such as bills mentioning there inthis vehicle number or any other evidence. The representative of the InsuranceCompany was unable to submit such evidence.After hearing both the parties and on examination of the documents submitted it isobserved that vehicle no. RJ 14 5C 5626 had met with an accident on 08.10.2006 as aresult of rash driving of the driver of the vehicle no. RJ 14P 8955. The InsuranceCompany has repudiated the claim on the grounds that Shri Ravi Kumar Soni wasrunning a travel agency and the vehicle was being used for hire and reward but theyhave failed to establish that the vehicle was being hired out to the clients of Soni Toursand Travels. Merely giving quotation does not prove that the vehicle was being usedfor hire and reward. The Insurance Company having failed to establish that the vehiclewas being used for hire and reward, I do not agree with the decision of the InsuranceCompany in repudiating the claim. I therefore pass an Award that the InsuranceCompany should make the payment of the claim of Shri Ravi Kumar Soni. Further, theInsurance Company vide their letter dated 25.01.2007 has canceled the policy and asper the contention of Shri Ravi Kumar Soni he has not received the refunded premium.The Insurance Company is advised to make the payment of balance refund of premiumfrom 02.02.2007 till 22.04.2007 in case the refund is already not been made as theInsurance Company was not able to establish that they had issued a cheque for therefund of premium or not.The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No. GI/432/IFFCO/07Smt. Mahender KumariVsIFFCO TOKIO General Insurance Company LimitedAward Dated 25.02.2008The complaint was heard on 08.02.2008. The complainant, Smt. Mahender Kumari, waspresent accompanied by her son Shri Anil Sadana. The Insurance Company wasrepresented by Shri Amit Kumar, Legal Executive.

Smt. Mahender Kumari has lodged a complaint with this forum on 01.05.2007 that herhusband late Shri Hari Ram was the owner of the vehicle No.DL 4SA W 2389 whichwas insured with Iffco Tokio General Insurance Company Limited. She said that herclaim was genuine which was not considered by the Insurance Company.At the time of hearing, the representative of the complainant informed the Forum thathis father Shri Hari Ram was the registered owner of the vehicle who had died as aresult of road accident on 21.06.2005. The claim of which has been repudiated by theInsurance Company on the grounds that the deceased did not have a valid drivinglicense. The complainant contested that since her husband was covered underPersonal Accident policy, the claim was payable even though the driving license wasnot valid. She requested the Forum that the claim may be paid.The representative of the Insurance Company informed the Forum that as per the termsand conditions of the policy, Shri Hari Ram did not hold a valid driving license at thetime of accident and as such it violated the terms and conditions of the policy. As such,the claim is not payable.After hearing both the parties and on examination of the documents submitted, it isobserved that Shri Hari Ram, owner of the vehicle No. DL 4SA W 2389, died as a resultof road accident on 21.06.2005. He was holding a driving license valid from 23.06.1999to 22.06.2004. Since the driving license was not valid at the time of accident, the claimis not payable as it has violated the terms and conditions of the policy which reads asfollows “ Provided that a person holds an effective Driving License at the time ofaccident and is not disqualified from holding or obtaining such a license.” TheInsurance Company has rightly repudiated the claim.I uphold the decision taken by Iffco Tokio General Insurance Company Limitedrepudiating the claim of Smt. Mahendra Kumari.There is no further relief to be granted to the complainant.Complaint is disposed of finally.Delhi Ombudsman CentreCase No.GI/464/NIA/07Shri Gurbaksh SinghVsThe New India Assurance Company LimitedAward Dated : 11.03.2008The complaint was heard on 07.03.2008. The complainant Shri Gurbaksh Singh waspresent. The Insurance Company was represented by Shri Mahesh Chandra, BranchManager.Shri Gurbaksh Singh had lodged a complaint with this Forum on 14.08.2007 that hehad insured his Tata indigo car No. DL 3CY 7037 with New India Assurance Co. Ltd.under policy No. 31/06/0574. The vehicle had met with an accident on 11.02.2007. Hehas requested that he is dealing with Insurance Company which works like agovernment department and takes time and his claim may be settled.At the time of hearing Shri Gurbaksh Singh informed the Forum that he had lodged aclaim for his Tata Indigo car and had furnished all the documents required by theInsurance Company from time to time and his claim has not been settled up till now. Herequested the Forum that his claim may be settled immediately.The representative of the Insurance Company informed the Forum that Shri ParminderSingh who was driving the vehicle at the time of accident holding an international

license which was valid from 01.12.2004 for one year and they had deputed theinvestigator Shri Suresh Kumar to verify the genuineness of the license. However, asper the investigator report the date of issuance of the license was 01.12.2004 and not01.12.2006 and hence the claim was not payable as per the terms and conditions of thepolicy. They had deputed another senior surveyor to re-verify the license by M/s. ABMEngg. & Consultants who have contacted department of Highway Safety & MotorVehicles, State of Florida who informed them that this license does not belong toFlorida. Shri Gurbaksh Singh immediately informed the Forum that the license of ShriParminder Singh was not issued by the State of Florida but by the AutomobileAssociation, Heathrow, Florida USA. He produced the original license for itsexamination. Further, he also drew the attention of the Forum that to the letter dated18.09.2007 issued by M/s. Chicago Motor Club confirming that the license permit No.70085132 was issued to Shri Parminder Singh on 01.12.2006 and will be valid for oneyear from that date. This Forum informed the representative of the Insurance Companythat even in India, Automobile Association were authorized to issue internationalDriving License, and they should have verified the same with the AutomobileAssociation at Delhi.The representative of the Insurance Company pleaded ignorance of the prevailingpractice in India.After hearing both the parties and on examination of the documents submitted it isobserved that vehicle No. DL 3CY 7037 met with an accident on 11.02.2007 and ShriJeewan Agarwal had been appointed to assess the loss. Shri Agarwal had submittedhis report no. 0702/43 dated 16.03.2007 for Rs.105747/-. In his report Shri Agarwalhas mentioned that Driving License is to be checked. Shri Parminder Singh who wasthe driver at the time of accident was holding an International license and the expirydate of the license could not be read clearly by the Insurance Company whether it was01.12.2004 or 01.12.2006, since the license was valid only for one year from the dateof issue. They had contacted the Highway Safety & Motor Vehicles, Florida and wereinformed that this license did not belong to their State of Florida. Shri Gurbaksh Singhhas produced the original license to this Forum and on examination of the same it isfound that the license has been issued by Automobile Association, Heathrow, Florida,USA. The date of issue which was the bone of contention for the Insurance Companyhas been confirmed by M/s. Chicago Motor Club vide their letter dated 18.09.2007 thatthis Driving Permit No. 70085132 was issued on 01.12.2006 as such the same wasvalid at the time of accident. Letter dated 18.09.2007 was submitted by Shri GurbakshSingh on 20.09.2007 to the Insurance Company and I do not see any reason fordeputing two investigators to get the particulars verified. The Insurance Company couldhave written to the issuing authority immediately on receipt of this certificate whetherthey have issued this license or not instead of referring the matter to variousinvestigators for investigation.I therefore, conclude that the Driving License issued to Shri Parminder Singh was validat the time of accident and pass an Award that Shri Gurbaksh Singh be paid a sum ofRs.105747/- as per the surveyor report no. 0702/43 of Shri Jeewan Agarwal dated16.03.2007 along with 8% interest from 01.11.2007.The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Delhi Ombudsman CentreCase No.GI/523/OIC/07Shri Naveen Pangti

VsOriental Insurance Company LimitedAward Dated : 18.03.2008The complaint was heard on 12.03.2008. The complainant Shri Naveen Pangti waspresent. The Insurance Company was represented by Shri H. Jaswani, AssistantManager and Shri Anil Nagpal, Administrative Officer.Shri Naveen Pangti had lodged a complaint with this Forum on 22.10.2007 that he hadinsured his Mahindra Bolero No. HR 26 AB 3083 with Oriental Insurance Co. Ltd. underpolicy No. 272100/31/2006/8596. The vehicle was stolen from his residence on20.07.2006 an FIR was lodged with Udyog Vihar Police Station, Gurgaon on20.07.2006 and the Insurance Company was immediately informed. He has incurred aloss of more than Rs.150000/- apart from the mental harassment because of the delayin settlement of his claim. He has also requested that Insurance Company be directedto initiate action against the Surveyor Shri Sanjay Dwivedi for using coercive meansagainst a claimant for the reasons best to known him.At the time of hearing Shri Naveen Pangti reiterated the facts which he has mentionedin his complaint. The Forum advised Shri Naveen Pangti that it was not competent topass an Award against Mental Harassment and in case he desired to withdraw thecomplaint he can do so to approach an appropriate Forum where his case could bedealt with in totality including mental harassment. Shri Naveen Pangti however,informed the Forum that he would like this Forum to decide in the matter. He furtherstated that cover note was issued by the Insurance Company showing an IDV forRs.572249/- whereas the policy was issued for Rs.565000/- and he should be paidRs.572249/- and not as per the policy where the IDV is Rs.565000/-.The representative of the Insurance Company informed the Forum that IDV at the timeof Insurance was wrongly accepted and accordingly they had re-worked the IDV andShri Naveen Pangti having given his consent for the same, the Insurance Company isnot liable to pay any additional amount and therefore rightly settled the claim.After hearing both the parties and on examination of the documents submitted thevehicle No. HR 26 AB 3083 was stolen on 20.07.2006 the Insurance Company hadsettled the claim for Rs.508500/-. He has requested that the difference between theIDV and the amount paid to him should be paid by the Insurance Company since as perpolicy condition that the IDV will be treated as the ‘Market Value’ throughout thecurrency of the policy reimburse to him in case of Total Loss/ Constructive Total Loss.I am in agreement with the complainant Shri Naveen Pangti that he should have beenpaid IDV as per the policy which is Rs.56500/-. The Insurance Company is liable to paythe difference of amount along with 8% interest from 20.09.2006 till the time ofpayment.The Award shall be implemented within 30 days of receipt of the same. The complianceof the same shall be intimated to my office for information and record.Guwahati Ombudsman CentreCase No. : 11-012-0044/07-08Mrs. Rajani Sharma @ Rajni SharmaVsICICI Lombard General Insurance Co. LtdAward Dated : 26.11.2007Brief Facts leading to Complaint

This complaint was lodged by Mrs. Rajani Sharma @ Rajni Sharma wherein it wasalleged that her claim in respect of policy no. 3001/50613020/00/000 has beenrepudiated by the insurer/OP above named.The case of the complainant, in brief, is that she insured her private TATA INDICA DLSE-II vehicle bearing no.AS 01 X 5686 was insured with the above insurer/OP andaccordingly the policy certificate no.3001/50613020/00/000 was issued. On 10.04.07,she took the vehicle to the market at about 07.30 p.m. and after getting down in themarket, she instructed the driver to park it at the designated parking place. At about08.45 p.m. , the driver telephonically informed her that he did not find any parkingplace and on receipt of such communication, she instructed him to wait for sometimeas she has finished her marketing. Thereafter, she went to that place and found thatthe driver was missing with the vehicle. She reported the matter to Pan Bazar PoliceStation and at about 11.45 p.m., she got a message that Dispur Police Stationrecovered the vehicle which was found involved in an accident near Janata Bhawan.Thereafter, she approached police and arranged to take the vehicle from the PS on14.04.07 and placed it for repairing at M/s. Ghosh Brothers. The insurer above namedwas also informed and submitted this claim with all the relevant documents regardingthe damage of the vehicle. The insurer, has however, repudiated her claim on theground that the vehicle has been used for commercial purpose (read “HIRE ANDREWARD”) which violates the policy condition. She clarified the matter but the insurerultimately did not take any action in the matter.Opponent’s ViewsThe insurer/OP has informed vide letter Ref: Mum/Legal/22192 dtd. 26.07.2007 that thecomplainant obtained Private Motor Car Insurance Policy no.3001/5061 3020/00/000from his Company. The complainant lodged her claim pertaining to a loss suffered bythe insured vehicle during an accident and the same was registered as claim no.00331543. The matter was investigated by their investigator who ascertained that thevehicle was used for Hire and Reward. The insurer also stated that the complainanthas stated in her income tax return that the insured vehicle was utilized for hiringbusiness. The vehicle was registered as a Private Vehicle and usage of such vehiclefor commercial purposes is a clear violation of policy terms and conditions and assuch, the Insurance Company is not liable to indemnify the loss. The InsuranceCompany, has referred to the income tax statement, submitted by the complainant forthe assessment year 2006-2007 wherein she had stated her net income from TATAINDICA DLS E-II vehicle after deducting all expenses/depreciations, as Rs.15,600/-.Hence, according to the insurer the claim is not payable due to violation of policyconditions.Decisions & ReasonsInsuring TATA INDICA vehicle bearing registration no. AS 01 X 5686 by the abovenamed insurer has been admitted and the policy document furnished also shows that itwas a Private Car Policy and cover note was numbered 50613020. The policy wasissued on 10.11.2006 having validity upto 09.11.2007. The vehicle was the propertyacquired by the policyholder/complainant during the income tax assessment year 2006-2007. The income tax statement submitted by the complainant Rajni Sharma for theassessment year 2006-07 giving details about business income contained that her netincome was Rs.15,600/- from the TATA INDICA DLS E-II vehicle and that was theincome from her business after deducting all the expenses/depreciations etc. Theinsurance company, on receipt of the claim documents, appointed surveyor andascertained the fact of using the above vehicle as a commercial vehicle and because ofviolation of the policy conditions, the claim was repudiated vide letter dtd. 23.04.07 and

the complainant was accordingly informed. Submission of statement of income taxreturns showing the net income of Rs.15,600/- from the above insured TATA INDICAvehicle in the income tax statement by the complainant has not been disputed. Thecomplainant, has however, revised her income tax statement on receipt of therepudiation intimation letter from the insurer and submitted a fresh statement to theincome tax authority on 24.04.07 and in the said revised statement, income from thevehicle was not shown. This was done on 24.04.07 after getting the repudiationintimation. In both the statements, the income from business source of the complainantwas shown to be the same and what she did was that in her original income taxstatement, she showed only an income of Rs.37,704/- from her business establishmentM/s. Amit Stores and Rs.15,600/- was shown as an income from vehicle businesssource making a total income from these two sources at Rs.53,304/- whereas in herrevised statement, after repudiation of the claim by the insurer, she showed the entireincome of Rs.53,304/- from her business source M/s. Amit Stores. She has alsoproduced a certificate from her Advocate who prepared those statements which showsthat the above changes were done on verification of the registration certificate of thevehicle which appears to be not a document to disclose income. Anyway, the incometax statement is a document to be filed before the income tax authority for payment oftaxes for the income. Once the source was disclosed by the complainant that she hadan income of Rs.15,600/- from her vehicle and subsequently, when that matter wasdetected by the insurer for the purpose of claim settlement, the revised income wasshown modifying the earlier source. Payment of tax is one thing and that is to be seenby the income taxes authority whereas we are only concerned in what way the vehicleinsured was used. From the income tax return, duly filed by the complainant shows thatthe insured vehicle was used as a commercial vehicle for business purposes and thatappears to be a clear violation of the policy conditions as the vehicle insured wasregistered only as a private vehicle. Repudiation of the claim, on the aforesaid ground,appears to be justified because of violation of the policy condition by the insured.In view of my discussions above, I do not find any material to interfere with thedecision taken by the insurer in repudiating the claim of the complainant.Guwahati Ombudsman CentreCase No : 11-005-0012/07-08Mr. Akhil Kumar BoroVsThe Oriental Insurance Co. Ltd.Award Dated : 10.12.2007GrievanceThe grievance of the complainant is that the claim lodged by him in respect of hisvehicle no.AS-01/N-5594 under the above policy coverage has been totally repudiatedby the insurer/OP without any justified ground. The prayer for review has also beenrejected.The facts involved in the complaint is that the complainant, being registered owner ofTruck (Oil Tanker) bearing no. AS-01/N-5594 insured his vehicle with the OP/insurerabove named and the coverage period was for the period from 06.09.2006 to05.09.2007. The insured vehicle met with an accident on 04.10.06 near ChenikhowaBridge under North Salmarah OP and the vehicle sustained damages. The insurer wasinformed and the complainant, later on, lodged his claim before the insurer which hasbeen rejected as stated above.Reply

The insurer forwarded its self-contained note under cover of letter dtd. 24.05.07 whichgoes to show that the existence of insurance coverage has not been disputed.But since the driver has no effective driving licence pertaining to hazardous certificateat the material time of the accident, there is no other alternative but to close the file as‘NO CLAIM’ and the Insured/Complainant was informed vide our Regd. A/D letter dt.31/01/2007.Decisions & ReasonsThe policy document in respect of the vehicle bearing no.AS-01/N-5594 shows that theaforesaid vehicle was a tanker used for carrying CNG/LPG which are highly explosiveitems. The policy condition provides that the vehicle is to be driven by a person havingeffective driving licence and he must have the same at the time of accident. Since thetruck is used for carrying hazardous explosive items, naturally the driver is alsorequired to have licence for driving hazardous vehicle. It is an admitted fact thatthe driver of the vehicle Shri A. Das had a licence for driving hazardous vehicle whichwas obtained in the year 1995 and the validity of the said licence had expired as backas in the year 1996 and since then here is no proof of its renewal. The police reportavailable on record also goes to show that the said oil tanker met with the accident atChenikhowa while it was coming towards Bongaigaon from Jogighopa side. The driver,who drove the vehicle at the relevant time, appears to have driven the vehicle whichwas used for carrying CNG/LPG without any such valid licence and that appears to bea clear violation of the policy condition. Since policy condition has been violated by theinsured by allowing the vehicle to be driven by a driver having no valid driving licence,the repudiation of the claim appears to be in conformity with the policy conditions.Thus repudiation of the claim by the insurer appears to be justified and I see nomaterial to interfere with it.The complaint is treated as closed.Guwahati Ombudsman CentreCase No : 14-005-0037/07-08Mrs. Jaya BhattacharjeeVsThe Oriental Insurance Co. Ltd.Award Dated : 11.02.2008Facts (Statements and counter statements of the Parties)The complainant Mrs. Jaya Bhattacharjee had insured her vehicle bearing no.AR-01/A-9474 with the above insurer/OP and obtained the above policy under scheme “PackagePolicy for Passenger Carrying Commercial Vehicle” covering the period from 15.12.05to 14.12.06. The vehicle met with an accident on 07.05.06 sustaining extensivedamage. The insurer was informed who appointed surveyor and the surveyor dulyinspected and assessed the losses. The complainant submitted her claim along with allthe relevant documents and she had agreed for settlement of the claim settled underscheme “Cash Loss Basis” as offered but the insurer has not yet settled the claim toher satisfaction.The insurer has also submitted the ‘self-contained note’ wherein they have admittedabout existence of the above policy for the period from 15.12.05 to 14.12.06 in respectof vehicle No.AR-01/A-9474 issued by their Itanagar Office. The insurer has alsoadmitted about the involvement of the vehicle in an accident and surveying the sameby their surveyor Shri Achyut Chandra Das, Guwahati. According to the Insurer, thesurveyor assessed the losses on various modes viz., repairing basis, cash loss basis

and total loss basis with special recommendation for settlement of the claim on “CashLoss Basis”. The insurer further contended that the surveyor has also convinced thecomplainant to accept the settlement on “Cash Loss Basis” at Rs.1,50,478.62. It hasfurther been contended that the assessment made by surveyor Achyut Chandra Das, onCash Loss Basis, was found to be on the higher side as he had consideredreplacement of chassis frame and backdoor assembly which were very much repairableand they have accordingly obtained the technical opinion from another surveyornamely, Shri Aswini Sarma, who had recommended the settlement on Cash Loss Basisonly at Rs.1,30,157/- and they have accepted the same and sent their proposal to thecomplainant who, of course, refused to accept the said offer. According to the insurer,the amount of Rs.1,30,157/- on “Cash Loss Basis” is very much reasonable andjustifiable with reference to the principle of indemnity, extent of damage, rate ofdepreciation, cash loss deduction, salvage value etc. The insurer has also forwardedthe copies of reports submitted by the above two surveyors.Decisions & ReasonsAs per the ‘self-contained note’, the insurer has not disputed about the existence of thepolicy and also the fact of involvement of the insured vehicle in an accident on07.05.06. The survey report submitted by Achyut Ch Das dated 03.07.06 goes to showthat the surveyor had duly inspected/surveyed the insured vehicle and its documents.The above surveyor after making assessment, suggested settlement of the claim onrepairing basis at Rs.2,17,083.75, on Cash Loss Basis at Rs.1,50,478.62 on Total LossBasis at Rs.3,48,382.30 and on Net Loss Basis at Rs.1,56,500/-, but recommendssettlement of the claim on Cash Loss Basis at Rs.1,50,478.62.Vide letter dated 14 th August, ’06, the insurer informed the complainant Mrs. JayaBhattachjarjee about the intention of the insurer to settle the claim at Rs.1,50,479.00on the basis of recommendations of the surveyor above named and wanted fewdocuments from the complainant which includes the letter of agreement to the effectthat she has agreed to accept settlement of the claim on Cash Loss Basis which standsat Rs.1,50,479.00 as full and final settlement of her claim. The letter of thecomplainant without date discloses that she has sent her consent to accept thesettlement/claim either on Cash Loss Basis, Net Loss Basis or Total Loss Basis. Thecomplainant had given her consent to accept settlement/claim on any of the aboveschemes. Letter dated 04.08.06 issued by the insurer/OP clearly shows that they haveaccepted the report of the surveyor to settle the claim at Rs.1,50,479/- and this wasduly communicated to the complainant. Vide ‘self-contained note’ the insurer statedabout appointing another surveyor Mr. Aswini Sarma and copy of his report has alsobeen sent. The report dated 05.05.07 submitted by Aswini Sarma goes to show that hehas neither seen the insured damaged vehicle nor visited any other authority forcollecting informations but only on assessment of the report submitted by the SurveyorAchyut Chandra Das, he has disputed the amount suggested by Achyut Chandra Das tosettle the claim on “Cash Loss Basis” and recommended settlement of the claim atRs.1,30,157.00 holding that the same was done considering the nature and extent ofdamages reported and the photographs. He was of the opinion that replacement ofChassis frame and backdoor is not felt necessary. The surveyor Achyut Ch Das dulyverified the vehicle and also felt the necessity for the replacement of the aforesaidparts and it was quite natural to suggest after verification of the vehicle and assessingthe extent of damages. It is he who has seen the vehicle on the site and made properassessment of the damages. The subsequent report submitted by Aswini Sarmaappears to be not justified as he has not physically verified the vehicle and only onperusal of the photographs he cannot be expected to say like that. The report ofsecond surveyor Aswini Sarma cannot be said to be a justified one.

The insurer has also initially accepted the recommendations of the surveyor Achyut ChDas and offered to settle the claim at Rs.1,50,479/- on Cash Loss Basis and informedtheir intention to the complainant vide letter dated 04.08.06. When once the insureroffered to settle the claim at Rs.1,50,479/- and communicated it to thepolicyholder/complainant , there appears to be no reason as to why the insurer shouldcome back therefrom.Considering the facts and circumstances, it is seen that the insurer was in a position tosettle the claim on 04.08.06 at Rs.1,50,479.00 accepting the recommendation made bytheir appointed surveyor Achyut Ch. Das and subsequent action appears to beunwarranted. Accordingly, it is felt that a direction is to be given to the insurer to settlethe claim at Rs.1,50,479/- on Cash Loss Basis as has been offered to theinsured/complainant vide letter dated 04.08.06 and allow interest for delayedsettlement for the period from 04.08.06 till the amount is actually released.The Insurer is accordingly directed to settle the claim at Rs.1,50,479/- allowing interestas stated.Guwahati Ombudsman CentreCase No. : 11-003-0137/07-08Md. Yunus AliVsNational Insurance Co. Ltd.Award Dated : 14.02.2008Brief Facts leading to complaintMd. Yunus Ali, being the policyholder under the above policy, lodged this complaint forrepudiating his claim under the policy by the insurer/OP above named. The fact is thathis vehicle bearing no.AS-23E-3225 was insured obtaining policy under schemes“Goods Carrying Commercial Vehicle (Open) Policy” – “B Package” from the aboveinsurer/OP covering the period from 30.04.06 to 29.04.07. The vehicle was taken onhire on 17.06.06 and since then, the vehicle was missing. The vehicle was driven atthat time by Md. Sonu and his dead body was subsequently recovered from riverBalijan under Tengakhat P.S. on 20.06.06. Police was informed who registeredTinsukia P.S. Case No.282/2006. On completion of usual investigation, policesubmitted the charge sheet in the case holding that the miscreants, after killing thedriver Sonu, took away the vehicle to unknown destination by the miscreants, out ofwhom, one was arrested and another was shown to be absconder. The post mortemexamination was also done on the dead body of the driver Sonu. Usual claim waslodged by the complainant/owner of the vehicle but the insurer has repudiated theclaim on the ground that the vehicle was driven by Md. Sonu and his Driving Licence(DL) was found to be fake at the relevant time. For repudiating the claim, thecomplainant has approached this Authority, being dissatisfied with the action of theinsurer.Opponent’s ViewsThe insurer vide letter dated 06.11.07 submitted its ‘self-contained note’ stating thatthe vehicle bearing No. AS-23E-3225 was insured under the above Package Policywhich was found to have been stolen away by miscreants after killing the paid driverMd. Sonu. The complainant had submitted claim papers including the copy of the DL ofMd. Sonu and on verification of the DL of Md. Sonu, through investigator Sunil Kumarat DTO, Gumla, (Jharkhand) Office, the licence is found to be fake one. The insureraccordingly repudiated the claim as the vehicle was driven by the driver with a fake DLat the time of the occurrence contrary to policy condition.

Decisions & ReasonsThe information lodged with police goes to show that on 17.06.06 at 2 p.m. the vehiclewas taken on hire towards Naharkatia but on the way the miscreants killed the driverand took away the vehicle to unknown destination. On 20.06.06, the dead body of thedriver Sonu was recovered and police accordingly did the post mortem examination.The police report dated 18.08.06 also goes to show that the driver Sonu was killed bythe miscreants and the dead body was recovered from river Balijan and then theconcerned vehicle bearing no. AS-23E-3225 was taken away by the miscreants. Thecopy of the post mortem report on record also goes to show that death of Sonu wascaused due to Asphyxia as a result of Strangulation (manual) during life which washomicidal in nature. On completion of usual investigation, police has also found thatthe driver Sonu was killed by miscreants out of whom they could arrest one andsubmitted the charge sheet against him showing another as absconder involved in thiscase. Death of driver Sonu due to manual Strangulation by miscreants has also notbeen disputed nor taking away the vehicle to unknown destination by the miscreantshas been denied. The papers on record also shows that the vehicle was taken on hirefrom Tinsukia to Nahakatia but before reaching Naharkatia, the driver was killed on theway at Tengakhat and thrown his dead body to Balijan river. The miscreants had takenpossession of the vehicle after killing the driver and took it away. The record furthershows that nothing untoward happened while the driver was alive and had driven thevehicle to Tengakhat. The insurer has also not raised anything till then and the claim islodged for taking away the vehicle after killing the driver.The insurer repudiated the claim on the ground that the vehicle was driven by Md.Sonu with a fake DL. The insurer appears to have relied upon the report submitted bySunil Kumar who was appointed as the Investigator. The report of Sunil Kumar wasforwarded by Ranchi Divisional Office of the OP. On a perusal of the report of SunilKumar dated 14.06.07, it appears that he could not obtain any report from DTO, Gumla,regarding the DL of Md. Sonu and according to him, he physically verified the DLmaintaining register of the year 1998 but did not find any record of issuing licence inthe name of Md. Sonu. The report submitted by Sunil Kumar about verifying the officialregistration by himself appears to be not acceptable although the insurer has givenimportance on it. He has failed to procure any report from the DTO concerned andthus, the statement of the investigator cannot be taken to be reliable. Consequently,DL of Md. Sonu cannot be treated to be fake one in the absence of any report from theIssuing Authority. Besides above, the policy condition requires that the person drivingthe vehicle shall hold effective DL at the time of accident and he shall not bedisqualified from holding an effective licence. This is a mandatory provision under M.V.Act as provided under Section 3 of the Motor Vehicles Act. But the position is that theclaim has not been lodged for any accident of the vehicle and it was only lodgedbecause of theft of the vehicle committed by miscreants. The vehicle was driven by Md.Sonu upto Tengakhat and no untoward happened till that place but only after killing thedriver at Tengakhat, the miscreants committed the theft of the vehicle and the claimhas been lodged for committing theft of the vehicle. The question of driving the vehicleby a driver having valid DL is a must when the vehicle is involved in an accident buttheft cannot be termed to be an accident and that too when the appointed driver wasnot involved therein. On consideration of what has been discussed above, what I feel isthat repudiation of the claim under the circumstances appears to be not justified andthe insurer should reopen and settle the claim in terms of the policy.The insurer is accordingly directed to settle the claim.Guwahati Ombudsman Centre

Case No. : 11-012-0041/07-08Mr. Anand KandVsICICI Lombard General Insurance Co. Ltd.Award Dated : 22.02.2008GrievanceThe grievance of the above named complainant is that the claim lodged by him inrespect of his insured vehicle bearing no. AS 01 AB 7027 was repudiated by the aboveinsurer on the ground that the vehicle was used for commercial purposes in violation ofthe policy condition. The facts, in brief, is that the complainant insured his vehicle no.AS 01 AB 7027 with the above insurer and obtained the above policy. It was a PrivateCar Package Policy covering the risk from 09.11.06 to 08.11.07. On 11.02.07, thevehicle met with an accident while it was being parked which causes damage to thevehicle and the monetary loss to the complainant amounting to Rs.22,000/- forrepairing. The insurer was informed and usual claim was submitted. The insurerrepudiated the claim on the ground that the vehicle was being used for commercialpurposes in violation of the policy condition. According to the complainant, the vehiclewas never used for any commercial purposes.ReplyThe Insurer has submitted its ‘self-contained note’ describing the reasons as to whythey have treated the claim as ‘Not Admissible’. Para 2 of the ‘self-contained note’reads as under :-“The complainant had taken private car insurance policy No.3001/50661091/00/000 forthe period November 9, 2006 to November 8, 2007. The vehicle met with an accidenton February 11, 2007. The complainant lodged a claim for own damage vide claimNo.00286663. During scrutiny of claim, a suspicion arose as to usage of the vehicle.Hence an investigator was appointed. The investigator submitted his report confirmingthat the vehicle was being used for commercial purpose. The insured vehicle was foundenrolled with a travel agency named “Dee Dee Travels”, Shahajahan Market, Dispur,Guwahati and routinely ferries passengers for the said travel agency. The insured hadthus committed a clear breach of policy terms and conditions and as such theinsurance company is not liable to indemnify the loss. We annex a Daily VehicleMovement Sheet Receipt No.737 of the said travel agency indicating the vehicle wasmade available for hire for your ready reference.In the light of above submissions, it is therefore submitted that the claim is not payableand the Hon’ble Ombudsman may be pleased to absolve us of the liability.”Decisions & ReasonsThe insurer has not disputed about the existence of the above policy in respect of thevehicle no.AS-01-AB-7027 and also its involvement in the occurrence leading to filingof the claim in question which has been rejected on the ground stated in the ‘selfcontainednote’. The copy of the policy document proves that the complainant obtained“Private Car Package Policy” in respect of the above vehicle covering the risk periodfrom 09.11.2006 to 08.11.2007. The alleged claim was also lodged for the occurrencecovered under the policy. The ‘self-contained note’ submitted by the insurer disclosesthat during scrutiny of the claim, suspicion arose as to the use of the vehicle andaccordingly, the matter was investigated by Investigator who submitted his reportconfirming that the vehicle was being used for commercial purposes. According to theinsurer, the insured vehicle was found enrolled with a travel agency named “Dee DeeTravels”, Shahajahan Market, Dispur, Guwahati and routinely ferries passengers for

the said travel agency and that is the ground for repudiating the claim. In proof of theabove contention, the insurer has also annexed a daily vehicle movement sheet beingreceipt no.737 of the above travel agency. The copy of the alleged movement sheet(serial no.737) shows that the above travel agency mentioned the vehicle no. & type asAS 01 AB 7027 which has also not been signed by anybody. The unsigned documentappears to be not acceptable and a reliable document. The insurer has neitherobtained any statement from any of the office personnel of the above travel agency norcould produce any agreement to show renting out the insured vehicle to the abovetravel agency by the insured. Thus, repudiation of the claim on the basis of the soleunsigned receipt appears to be unjustified. Hence, the insurer should reopen thematter and settle the claim in the interest of justice and fair play.The insurer is accordingly directed to settle the claim in terms of the policy.Guwahati Ombudsman CentreCase No. : 11-003-0136/07-08Mr. Manas Pratim SaikiaVsNational Insurance Co. Ltd.Award Dated : 25.02.2008FACTSThe grievance of the above named complainant is that the claim lodged by him inrespect of his Maruti 800 vehicle insured with the above insurer obtaining the abovepolicy, has been repudiated by the Insurance Company. The facts involved is that thecomplainant purchased a Maruti 800 Car bearing engine no.3537567 and ChassisNo.2533455 on 17.01.06 which was insured with the above insurer on the same daycovering the period from 17.01.06 to 16.01.07. On 31.01.06, the above vehicle wasstolen away by unknown miscreants from the garage where the vehicle was parked.Police was informed on the same day when Borpathar P.S. Case No. 16/06 U/S. 380IPC was registered. Subsequently, insured/complainant also informed the insurer andusual claim was lodged. The insurer after usual process, repudiated the claim on theground that the vehicle was not registered which is a violation of the M.V. Act and thecomplainant failed to provide any scope to the insurer for carrying out properinvestigation due to belated intimation of the claim.The copy of the letter dated 10.07.07 issued by the insurer addressing the complainanthowever discloses that the claim has been repudiated on the ground that the vehiclewas not registered which is a violation of the provisions of M.V. Act and the insuredhas also not given any scope to the Insurance Company for carrying out the properinvestigation due to belated intimation of the claim.Decisions & ReasonsThe copy of the policy document shows that the vehicle belonging to the complainantwas insured with engine no & chassis no covering the risk period from 17.01.06 to16.01.07. The theft incident occurred on 31.01.06 in the garage of the complainantwhere the said insured vehicle was parked and such occurrence was committed beforethe vehicle was registered with the Registering Authority. The copy of the F.I.R., PoliceInvestigation Report are made available along with the copy of report submitted bySupdt. of Police, Golaghat under Memo no.GLT/CB/62/06/8830 dated 21.12.06 whereinit was clearly stated that new Maruti Car bearing Engine no.3537567 & chassisno.2533455 has been stolen away by some unknown miscreants from the house ofDebeswar Saikia of Borpabhajan Gaon under P.S. Borpathar and on receipt of theinformation, Police registered Borpathar case no.16/06 U/S 380 IPC. According to this

eport, after investigation, police submitted the Final Report stating that the occurrenceis true but no clue of the culprits vide Final Report no.10/06 dated 19.05.06. From theabove police report, theft of the above insured vehicle on the night of 31.01.06 hasbeen proved and police has also failed to recover the same.The vehicle was insured with the above insurer on the date of purchase of the same.The insured vehicle was stolen away by the miscreants on 31.01.06 before obtainingregistration no. The insurer has not disputed about theft of the vehicle but repudiatedthe claim on the ground of non-registration. Under Rule 47 of Motor Vehicles Rules,1989, an application for registration of Motor Vehicle is to be made in Form 20 beforethe Registering Authority within 7 days from the date of taking delivery of such vehicleexcluding the period of journey enclosing therewith certain documents. So, it ismandatory for a purchaser to apply for registration within 7 days in the prescribed formfor registration before the Registering Authority and failure to apply and obtainregistration certificate within the specified period attracts action under the M.V. Actand non-availability of registration documents has been made a penal offence. In theinstant case also due to non-registration of the vehicle even beyond 7 days from thedate of taking delivery of the vehicle by the complainant, appears to be a violation ofthe provisions of M.V. Act but things remained is that the vehicle was insured on thedate of taking delivery covering the risk period from 17.01.06 with engine no. & chassisnos and such policy was in force when the theft occurred. The policy failed to bear anyexclusion clause to cover the situation. Repudiation of the claim for non-registrationand under the circumstances appears to be not justified when other things are notdisputed and the occurrence had also taken place within the period covered under thepolicy.The insurer is accordingly directed to settle the claim in terms of the policy.Hyderabad Ombudsman CentreCase No.G-11-012.152Sri P.Bala Kishan RaoVsICICI Lombard Gen. Ins. Co.Award Dated : 11.10.2007Brief Facts : The complainant insured his new Tata Safari vehicle for InsuredDeclared Value of Rs. 6,76,638/-. The vehicle met with an accident on 09.05.2007 andthe accident was reported to the police. The vehicle was moved to the workshop forsurvey and repairs. The complainant did not receive any information from the insurerregarding the claim.Decision : The insurer stated that the vehicle was carrying 9 persons in violation ofthe registered seating capacity at the time of accident. Therefore the claim wasrepudiated on 20.06.2007 but the repudiation letter was returned undelivered. Thecomplainant contended that the police had filed a charge sheet stating that 5 personswere injured in the accident. The complainant stated that the vehicle was lying in thesame condition without repairs as no surveyor was deputed by the insurer. The insurerstated that surveyor was deputed and the claim was repudiated on the basis of a reportin the newspaper that 9 persons were travelling in the vehicle at the time of accident.The investigator deputed by the insurer in his report had stated that 6 persons weretravelling in the vehicle at the time of accident. The FIR and charge sheet do notindicate that 9 persons were travelling in the vehicle. The insurers instead of relying onnewspaper reports which cannot be considered as substantial piece of evidence oughtto substantiate their contention with cogent independent evidence. They failed to do

so. The survey report available in the file shows that the loss was assessed at Rs.3,55,347/-. Therefore the insurers are directed to settle the claim as assessed by theindependent licensed surveyor.Hyderabad Ombudsman CentreCase No.G-11-002-0198Smt. Leelavathi Sunder RajVsThe New India Insurance Co. Ltd.Award Dated : 8.11.2007Brief facts : Smt. Leelavathi Raj had insured her new Honda Civic car with the insurerfor the period from 7.11.2006 to 6.11.2007. The IDV of the vehicle was Rs.10,91,455/-.The vehicle met with an accident on 14.5.2007 and was moved to Whitefield Motors (P)Ltd. for repairs. An estimate of repairs for Rs.56,228/- was submitted to the insurancecompany. Sri Pramod Jannu was deputed by the company for survey. The repairs werecarried out and a bill for Rs.40,572/- was submitted to the insurance company. Theclaim was settled for Rs.22,737/- only. The insured represented to the RO of theinsurer for payment of the balance of claim, but she did not get any positive response.Aggrieved, the insured filed the present complaint.Contentions of complainant: Her car was insured comprehensively. The claim occurredin the first year and hence it should be settled without any depreciation. The insurerdid not give any basis for admitting her claim for a reduced amount.Insurer’s contentions: They settled the claim by following all prescribed procedures andthey replied to the insured’s queries. The amount of Rs.13,667/- towards head lightwas not paid, as this amount was not mentioned in the estimate of repairs. The amountmentioned was Rs.2524/- only and the same was not recommended by their surveyor.The claim settled by them was on the basis of surveyor’s recommendations subject todepreciation, salvage and excess as per policy conditions.Decision : The complaint’s contention is that she should get full amount of the claimwithout any deductions as her claim occurred in the first year of the policy. The insurercontended that they received two sets of estimates. In one of them it was mentionedthat the damaged one was the right side unit head light and in the other it was the leftunit. The amount was mentioned as Rs.2524/- in both estimates. Due to thisdiscrepancy, their surveyor did not recommend payment for this loss. The billsubmitted for this item was for Rs.13,667/-.The surveyor also participated in thehearing session and he confirmed that there were some damages to the right side headlight assembly.The complainant submitted a final bill without revising the estimates. She was advisedto furnish the same to the insurers. The surveyor having confirmed the damage, theinsurer was directed to consider the estimate and settle the claim for the damagedheadlight after allowing depreciation as per policy conditions.Hyderabad Ombudsman CentreCase No.G-11-002-0181Smt. D. NarasammaVsNew India Assurance Company Ltd.Award Dated : 15.11.2007Brief facts : Sri D. Laxmi Rajam owned a motor cycle No. AP-15-2018 which wasinsured with New India Assurance Co. Ltd., Peddapalli branch, for the period 17.3.2004

to 16.3.2005. Sri Rajam met with a road accident on 25.7.2004 and died ion24.11.2004. Police had registered an FIR on 25.7.2004 under Sec. 337 of IPC againstthe lorry driver, who had caused the accident.The deceased’s family having spent money on his treatment did not get the motor cyclerepaired nor did they pursue with the insurance company for settlement of benefitsunder the motor insurance policy. Only on 14.2.2007, a formal claim was lodged withthe insurance company and the insurer rejected the claim on 5.4.2007 on the ground ofunreasonable delay. The claimant appealed to the RO of the insurer on 6.7.2007, buther representation did not evoke any response.Complainant’s contentions: She was ignorant about the procedures for claiminginsurance amount. Thus Inquest and Post Mortem were not conducted. M/s UII Co. Ltd.has settled a claim under Andhra Bank Account Holders’ Group Personal accidentpolicy on the directions of Insurance Ombudsman. She should be paid claim in thepresent case also on similar lines.Insurer’s Contentions: The claim was lodged with an undue delay and hence notentertainable and they were denied the opportunity to conduct an inquiry into themerits of the claim.Decision : The complainant contended that delay in intimation of claim was not wilful,but only because she was not aware of the procedures for making a claim.From the records submitted, it was established that the police had taken cognizance ofthe accident and had investigated the same. Since the claim was rejected only on theground of delayed intimation, it was decided to condone the delay. Accordingly, theinsurer was directed to process the claim without insisting for Post Mortem report andPolice Inquest Report. The complaint was admitted for statistical purposes.Hyderabad Ombudsman CentreCase No.G-12-007-0216Sri M.J.JosephVsTATA AIG General insurance Co. Ltd.Award Dated : 3.12.2007Brief facts : Sri M. J. Joseph had insured his Maruthi Car No. AP 10AA 8827 with M/sTATA AIG Ins. Company Ltd., for the period 16.5.2006 to 15.5.2007. In 04/2007, hehad issued a cheque dated 10.5.2007 for Rs.2716/- towards renewal premium to theinsurer and the cheque was encashed on 12.5.2007. However, the insured did notreceive the policy bond for the year 2007-08 till 9 th July,2007, even after calling theinsurer’s helpline in the first week of 07/2007.Then he obtained another policy for his vehicle from M/s Oriental Insurance Co. Ltd.,for the period 10.7.2007 to 9.7.2008 and wrote to TATA AIG on 10.7.2007 requestingthem to refund the amount paid by him with interest. Having not received any responseto his letter, he approached this office for relief.Complainant’s contentions: He stated that the renewal premium cheque was collectedby the local representative of TATA AIG on 19.4.2007. Though on enquiry, he wasinformed on 4.7.2007 that the matter would be sorted out within 48 hours, it did nothappen. Later, on telephone, helpline staff told him that it would take 7 working days toget information on the status of his policy from the concerned department. They hadalso refused to transfer his call to any senior executive. He sought compensation for

the inconvenience and financial loss suffered by him due to the casual approach of theinsurer.Insurer’s contentions: They conveyed that they cancelled the policy and refunded theamount on 18.9.2007. They also stated that they retained pro-rata premium for theperiod the policy was in force i.e. from 16.5.2007 to 9.7.2007.Decision : Both sides were heard on 14.11.2007. Sri Joseph stated that he receivedrefund of premium, but the insurer had not given any reason for the inordinate delayand partial refund. The insurer expressed regrets for the delay in release of policydocument. They also stated that they issued a cover note on 19.4.2007 showing the fullperiod of insurance and the vehicles details. They also stated that the insurance wasvery much in force till the insured sought its cancellation. They also stated that covernote is a valid document for all practical purposes.Sri Joseph, though claims to have paid traffic penalties and suffered business losseshas not produced any documents to support his claim on this count. He confirmed thathe received a cover note. During the hearing proceedings it was observed that theinsurer was not prompt in attending to the enquiries of the insured. The insured’sproblem was not solved despite his calls to helpline and e-mail messages. Consideringthe negligent attitude of the insurer, it was decided to allow an ex gratia payment ofRs. 3000/- to the insured.Hyderabad Ombudsman CentreCase No.G-11-004-0268Sri S. RavindranathVsUnited India Insurance Co. Ltd.Award Dated : 11.12.2007Brief facts: The complaint is about non settlement of PA claim under motor policy. SriSurendranath had insured his new Hero Honda Splendor Plus motor cycle with UII Co.Ltd., Habsiguda, Hyderabad for the period 23.12.2004 to 22.12.2005. He met with anaccident while driving the insured vehicle on 16.6.2005 and died. The policy includedPA coverage to owner-driver of the vehicle for a sum of Rs.100, 000/-. SriRavindranath, father of the insured Sri Surendranath made a claim with the insurer andsubmitted all documents except driving license of the insured. The insurance companyrejected the claim stating that it is mandatory to submit valid DL for settlement of PAclaim under a motor vehicle policy.Complainant’s contentions: His son was having a driving license at the time of deathbut he is unable to locate the same. He pleaded for settlement of the claim withoutproduction of DL.Insurer’s contentions: They received all documents except DL and Registrationcertificate in support of the claim. As per Section III of motor cycle insurance policywhich extends Personal Accident benefit to the owner-driver it is mandatory for theowner-driver to hold an effective driving license at the time of accident. As the claimantdid not produce DL, they are unable to settle the claim.Decision: The insurers submitted that PA coverage extended in the motor policy issubject to three conditions namely (i) The owner–driver is the registered owner of thevehicle (ii) The owner–driver is the insured named in the policy and (iii) The ownerdriverholds an effective driving license, in accordance with the provisions of Rule 3 ofCentral Motor Vehicle Rules, 1989 at the time of accident.

The complainant expressed his inability to produce a DL and in the absence of thesame, the insurer is found to be justified in rejecting the claim. Thus the complaint wasnot allowed.Hyderabad Ombudsman CentreCase No.G-11-012-0242Sri A. Manish ReddyVsICICI Lombard General insurance Co. Ltd.Award Dated : 20.12.2007Nature of complaint: Non settlement of motor claimBrief facts : Sri Manish Reddy had insured his new Ford Fiesta No. AP 09 BF 1204with M/s ICICI Lombard General insurance Company Ltd. for the period 11.10.2006 to10.10.2007 with IDV of Rs.6,50,750/- under a private car package policy by paying atotal premium of Rs.24,793/-. On 20.6.2007 the vehicle was caught in water loggingand the vehicle was damaged. The insured submitted repair estimate for Rs.4,88,199.98. The insurer deputed their surveyor to assess the loss and rejected theclaim for the internal parts of the engine but agreed to pay for (i) engine flushingcharges (ii) Air filter element (iii) cylinder head gasket. The insurer stated that theyrejected claim for the remaining parts as consequential loss was not payable as perpolicy conditions.Complainant’s contentions: He disputed the insurer’s conclusion of consequential loss.Insurer’s contentions: The damage was caused due to cranking of engine after floodingof the engine with water. It amounts to consequential loss and hence cannot be paid asper policy conditions.Decision : Both sides were heard on 28.11.2007. As per insurer, the amountadmissible was Rs.4,981.83 only and they are willing to release the amount if theinsured agrees to give a discharge. The insurers’ argument that the entire damage tothe engine parts occurred as a consequential loss and that no part of the damage tothe engine occurred in the incident of flooding is far fetched and not substantiated. Inthe absence of reliable evidence / literature that such damage would occur only asconsequential loss, the insurers’ argument cannot be accepted in its entirety. As perthe initial estimates, the repairer had estimated the repair cost at Rs.105645.57.Considering the totality of the situation, it was decided to award an ex gratia paymentof Rs. 1,00,000/-. The complaint was thus allowed partially.Hyderabad Ombudsman CentreCase No.G-11-004-0250Sri R. VaraprasadVsUnited India Insurance Co. Ltd.Award Dated : 20.12.2007Nature of complaint : Non settlement of Motor OD claimBrief facts : Sri R. Vara Prasad had insured his tanker lorry No. HR 38H 0821 withM/s UII Co. ltd., for the period 9.8.2004 to 8.8.2005. The vehicle met with an accidenton 14.8.2004 and a claim was lodged with the insurer. The claim was repudiated on6.8.2007 stating genuineness of the DL of the driver was not confirmed by the RTO. SriVaraprasad represented to the RO of the insurer on 27.8.2007 but to no avail.Aggrieved, the complainant approached this office for a review of the matter.

Complainant’s contentions: The claim is more than three years old and reason given bythe insurer for repudiation of the claim is not proper.Insurer’s contentions: Their surveyor assessed the loss at Rs.86,500/-. The insuredhad given licence No.WB-23-063666 of Sri Rakesh Kumar as the licence number of thedriver of the vehicle at the time of accident. During their enquiry with RTA officials, itcame to their knowledge that the said licence was fake. After learning this, the insuredsubmitted another licence in the name of Sri Rakesh Rai on 28.3.2006. They sent thesecond licence to RTA but did not receive any confirmation about authenticity of thelicence. Hence, they rejected the claim. They referred to the Hon’ble Supreme courtdecision in case nos. 4883 of 2007 in UII vs. Davinder Singh wherein it was held thatthe insurer is not liable to pay own damage when the Driving Licence was found fake.Decision : The complainant stated that he submitted a second licence and the insurercould not establish that it was a fake one. Hence he should be paid the claim.The insurer contended that they had sent two surveyors for loss assessment and bothwere given the name of the driver as Sri Rakesh Kumar. It was noted that in the policerecords the name of the driver was shown as Rakesh Kumar. The licence submitted inthe name of Sri Rakesh Kumar was certified by the authorities to be fake. Hence thecomplaint was dismissed.Hyderabad Ombudsman CentreCase No.G-11-005-0266Sri M. MuralikrishnaVsOriental Insurance Company Ltd.Award Dated : 24.12.2007Brief facts : The complaint is about rejection of motor claim. Sri M. Muralikrishnainsured his truck No. AP 20W 7340 with M/s Oriental Insurance Co. Ltd., Khammam forthe period 22.2.2006 to 21.2.2007 The vehicle met with an accident on 4.11.2006, nearJangareddygudem and a claim was lodged with the insurer. The surveyor deputed bythe insurer assessed the loss at Rs.34,000/- On submission of necessary papers, theinsurer refused to pay the claim stating that the driver of the vehicle did not possess avalid license at the time of accident.As per the insurer, the driving license expired on 13.5.2006, while the accident tookplace on 4.11.2006. After the claim was rejected on 2.2.2007, the complainantsubmitted a second extract of the licence which indicated its renewal for the periodfrom 14.5.2006 to 13.5.2009. The first extract was obtained on 9.1.2007, in which theexpiry date was shown as 13.5.2006. The claim was not paid in view of the discrepancyin the date of expiry of the license.Decision : The insurers contended that the Driving Licence was scrutinised by theirofficer on 5.1.2007 and also by the final surveyor in 11/2006. On both occasions, therenewal for the period from 14.5.2006 to 13.5.2009 was not shown in the document.They expressed the view that renewal said to be done in 05/2006 was doubtful andcontended that a re-verification of the subsequent changes produced by the insuredwas necessary. The insurer’s plea for some more time to get the license details verifiedwas not accepted since the insurer did not raise this point earlier. Also it is on recordthat the Licencing authority vide letter dt 25.5.2007 confirmed the details of renewal

upto May 2009. Hence, the insurer was directed to settle the claim as per theassessment of their Surveyor.Hyderabad Ombudsman CentreCase No.G-11-004-0260Sri T.VenkataramanaVsUnited India Insurance Co. Ltd.Award Dated : 31.12.2007Brief facts : The complaint is about non settlement of motor claim. The complainanthad insured his Maruti Omni van with M/s UII Co. Ltd., for the period from 7.9.2005 to6.9.2006. The car met with an accident on 21.5.2006 and the claim lodged by thecomplainant was not settled by the insurer despite follow up from the complainant.According to the complainant, the car was purchased for his own use and on the dateof accident he was proceeding to Hyderabad to fetch his son who had undergonetreatment at Secunderabad. Some friends of his brother-in-law who were proceeding toHyderabad also accompanied him. He contended that the car was not used for hire. Healso stated that on the advice of officials from UII, he submitted a consent letter forsettling the claim for 80% of the assessed loss.According to the insurer, the vehicle was used for hire at the time of accident andhence there was a clear violation of the ‘limitations as to use’ clause. Their investigatorhad obtained statements from passengers who were injured in the accident.Decision : The insured stated that he was proceeding to Hyderabad on the date ofaccident on his personal work when the accident took place. The insurers stated thatthe vehicle was being used for hire purpose when the accident occurred. The insurancecover was obtained under a private car policy and hence the claim was rejected.The insurer sent their surveyor for loss assessment and an investigator to look into themerits of the claim. There were no documents like FIR, police reports etc., in theabsence of which it is difficult to establish the investigator’s report. It came out that theinsurer did not do a thorough job in investigating the claim. It was also observed thatthe insurers committed themselves to settle the claim on a compromise basis and alsoobtained consent from the complainant. The insured was thus given hopes of asettlement of the claim. It was decided to award an ex-gratia payment of Rs.40,000/-.Hyderabad Ombudsman CentreCase No.G-11-002-0289Sri L.G.Parashiva MurtyVsNew India Assurance Company Ltd.Award Dated : 21.01.2008Brief facts : The complaint is about non settlement of motor theft claim. A ToyotaQualis No.KA 02 B4256 was insured in the name of Smt. Sudha Rao by M/s New IndiaAssurance Co Ltd for the period 28.11.2005 to 27.11.2006 with an IDV of Rs.2,50,000/-. The vehicle was purchased by Sri L.G.Parashiva Murty on 3.8.2006. The RTA,Jayanagar, Bangalore transferred the RC of the vehicle in the name of Sri Murty on18.8.2006. The vehicle was stolen on 21.9.2006 and a police case was registered on22.9.2006. Sri Murty informed the insurance company about the theft on 23.11.2006and sought settlement of the claim. Vide the same letter; Mr. Murty also sought transfer

of insurance of the vehicle in his name. The insurer, on 13.12.2006 informed Smt.Sudha Rao that the claim file was closed by them as ‘No Claim’ stating that she had noinsurable interest in the vehicle at the time of theft.Sri Murty represented that some unknown persons threatened his driver with a knifeand stole the vehicle on the night of 21.9.2006.He confirmed that insurance of thevehicle stood in the name of Smt. Sudha Rao at the time of theft. He also stated thathe could not get the insurance transferred in his name due to his illness and soughtsettlement of claim for Rs.3.85 lakhs.The insurers contended that the registration of the vehicle was transferred in RTArecords on 18.8.2006, but the information of this change was given to them only after alapse of two months. As per MV act, the transferee ought to have applied for transfer ofinsurance policy within 14 days of transfer of vehicles registration. They stated that thevehicle’s new owner is not entitled to any benefit under the own damage section of thepolicy when he does not intimate the change of ownership within 14 days.Decision : The complainant reiterated that due to his illness he could notcommunicate about change of ownership. The insurer stated that there is no provisionto condone the delay and cited IRDA’s circular dated 5.7.2007 in this regard. They alsoadded that insurance of motor vehicle was done in accordance with the India MotorTariff and submitted General Regulation No.17 therein. Based on the submissionsmade by both sides, it was found that the insurers had rejected the claim as per norms.Hence, the complaint was disallowed.Hyderabad Ombudsman CentreCase No.G-11-013-0287Sri Rohinton J GotlaVsHDFC General Insurance Co. Ltd.Award Dated : 31.01.2008Brief facts : The complainant insured his 2006 model Hyundai Verna car No. AP 09BF7474 for the period 11.11.2006 to 10.11.2007 for an IDV of Rs.6,98,724/-. The vehiclemet with an accident on 6.2.2007 near Gulbarga in Karnataka. Sri Venkatesh Services,Gulbarga gave a repair estimate of Rs.1,01,247/- and the insurer’s surveyor gave asurvey report on 30.8.2007. Based on the survey report, the insurer offered to admitthe claim for Rs.8,130/- The complainant settled a bill of Rs.81,180/- to the garage on31.3.2007 and followed up with the insurer for settlement of the claim.Decision : The cause of initial damage to the car was due to the car hitting stones onthe road. According to the insurer, the car was driven after damage to the vehicle andconsequentially the engine got damaged due to loss of coolant and overheating of theengine. It was held that as per policy conditions, damages caused to the engine in thecircumstances of this case are not covered. However, several shortcomings wereobserved in the processing of the claim. The survey report was unduly delayed byabout six months after the survey was conducted on 10.2.2007. The insurer’srepresentative who was present during hearing session could not give a properexplanation to the deficiencies pointed out by the complainant. Hence, it was decidedto offer an ex-gratia payment of Rs.5000/- in addition to the claim amount offered bythe insurer.The complaint was allowed partially.Hyderabad Ombudsman CentreCase No.G-11-002-0295Sri V.Shankariah

VsNew India Assurance Co. ltd.Award Dated : 31.01.2008Brief facts : Sri Shankariah insured his goods vehicle bearing No. AP28V 3860 withNew India Assurance Co. Ltd. for an IDV of Rs.3,94,800/- for the period 12.7.2006 to28.4.2007. The vehicle met with an accident on 20.1.2007 in which it sustained heavydamages and a person travelling in the vehicle was injured. The insurer deputed asurveyor to assess the loss and rejected the claim on the plea that the vehicle wascarrying a passenger, in violation of policy conditions.As per the contentions of the complainant, the driver of the vehicle gave lift to a personas there was no bus service in the forest area in which the vehicle was travelling atthat night time. He further stated that as per policy conditions , three persons wereauthorized to travel while only two persons were there in the vehicle (including driver)at the time of accident.The insurer stated that the insured had violated the policy conditions on “ limitations asto use” and hence claim is not payable.Decision : The insurers have a system of settling claims on non-standard basis up to75% of the assessed loss in cases of breach of policy conditions. The insured vehiclehas a seating capacity for three persons (including driver) and this condition was notviolated, but the person carried in the vehicle was not connected with the use of thevehicle as a goods carriage. The insurers also have not established that the presenceof a passenger has contributed to the accident. For these reasons, the insurer wasdirected to settle the claim for 75% of the assessed loss. The complaint was allowedpartially.Hyderabad Ombudsman CentreCase No.G-11-004-0328Sri Kona MuralikrishnaVsUnited India Insurance Co. Ltd.Award Dated : 8.2.2008Brief facts : Sri Muralikrishna had insured his taxi cab bearing No. AP 05V 6177 forthe period from 11.2.2006 to 10.2.2007 for an IDV of Rs.5,00,000/-. The insuredvehicle met with a road accident on 20.5.2006 and sustained damages. A survey wasconducted and estimate of repairs for Rs.4, 94,606/- was submitted tothe insurers. In the final survey, the loss was assessed at Rs. 2,28,000/-. The insuredsubmitted repair bills amounting to Rs. 3,57,425/- in 07/2006. The insurer offered tosettle the claim for Rs.2,27,000/- in 01/2007 which was not accepted by the insured.Decision: The complainant stated that he submitted repair bills to the insurer on21.7.2006 and sought compensation from the insurer for the loss caused to him onaccount of the delay in processing of the claim. The insurer did not accept thecontention of the insured regarding delay and they stated that the claim was delayeddue to non acceptance of the amount offered by them.Both sides were heard on 6.2.2008. The insured stated that cost of the body shell hasgone up from the time of initial survey tothe time of actual repairs. The part was estimated to cost Rs. 1,32,000/- but it wasbilled for Rs.1,60,303/-. The insurer further stated that they processed the claim in

accordance with policy conditions. The complainant had written a detailed letter on23.1.2007 raising objections for settlement at a reduced amount of Rs.2,27,000/- butthe insurer has not explained to him about the reasons for offering a reduced claim.Since the body shell was purchased from authorised dealer, the insurers ought toconsider that bill in full. The insurer was directed to settle the claim for Rs.2, 50,000/-together with interest from 1 st March 2007.Hyderabad Ombudsman CentreCase No.G-11-003-0314Sri R. GouthamVsNational Insurance Co. Ltd.Award Dated : 15.2.2008Brief facts : Sri Goutham insured his motor cycle bearing regn. No.AP 20F-5112 forthe period 11.11.2005 to 10.11.2006 for an IDV of Rs.17,325/-. The vehicle was stolenon 7.11.2006 from his house and a police case was made. The police have also filed anot traced report before the court, but the claim was not settled by the insurer. Thecomplainant filed this complaint for payment of an amount of Rs.20,000/- from theinsurer.Decision: The insurers asked for a duly transferred RC Book in their name, but thesame could not be produced by the complainant as RTA officials had reportedlyrefused to transfer ownership of a stolen vehicle. The insurers stated that the dulytransferred RC in their name is a requirement for settlement of the claim.As per Section 44 of the MV Act, 1988, a vehicle is to be produced before the RTO forinspection to proceed with the registration of the vehicle. In this case, it is not possiblefor the complainant to comply with the rule as his vehicle was stolen. Hence, theinsurers were directed to settle the claim after obtaining documents namely (1)Registration certificate (2) Requisite transfer forms (3) letter of indemnity andsubrogation.Hyderabad Ombudsman CentreCase No.G-11-013-0390Sri V.Venkat ReddyVsHDFC General Insurance Co. Ltd., HyderabadAward Dated : 25.2.2008Brief facts : Sri Reddy had insured his Tata Indica Car with regn. No.AP 10 AE 8678for the period 31.3.2007 to 30.3.2008, for an IDV of Rs.2,23,060/-. The car collidedwith a lorry on 12.4.07 and sustained extensive damages. After survey, the damageswere assessed at Rs.143,678/- and the garage was advised to carry out the repairs.After repairs, the insurance company refused to settle the bills stating that the insuredhad misrepresented about the no-claim bonus earned in the past. The claim wasrepudiated under India Motor Tariff General Regulations No.27F.Decision : The complainant contended that he had paid premium as sought by theinsurance company’s representative and he was not aware about NCB. The insurersstated that the policy was issued with 25% no-claim bonus as per details furnished bythe insured. On seeking confirmation about NCB from previous insurer, they came toknow that the insured had wrongly furnished information to them. This amounted to

wrong submission of material fact and hence the claim was rejected under GR 27 of theIndian Motor Tariff.During hearing, the complainant submitted that he was at Bangalore when the proposalwas submitted and the premium cheque as advised by the insurer’s representative washanded over by his brother. He mentioned that he had not given any false informationregarding NCB. The insurer submitted a copy of the said rule but has not placed anyproof that a declaration regarding NCB as required was actually given by the insured.The insurer produced a copy of the proposal form in which it was written “NCB 25%”,but the insured denied having signed it. The insurer had also not placed any material toprove that the complainant had given a false declaration and that he was aware of thediscount in premium under the policy. In the absence of a clear proof, it was decidedthat the complainant should not be deprived of the claim in full. It was ordered forpayment of 75% of the loss assessed by the surveyor on ex-gratia basis.Hyderabad Ombudsman CentreCase No.G-11-002-0386Sri M. Khaja HussainVsNew India Assurance Co. Ltd.Award Dated : 10.3.2008Brief facts: Sri Khaja Hussain insured his goods carriage vehicle (HMV) No.AP 21 X7007 for the period 17.1.07 to 16.1.08 for an IDV of Rs.11,40,000 paying a premium ofRs.28,481/-. The vehicle met with an accident on 5.7.07 near Kadapa and the policeregistered FIR initially under Sec.337/338 of IPC and later under Sec.304A. Theinsured vehicle rammed into the foregoing truck when the other vehicle suddenly cameto a halt after overtaking the insured vehicle. There were three persons in addition tothe driver and cleaner in the lorry at the time of the accident. The surveyor appointedby the insurer assessed the loss at Rs.1,34,689/-, but the insurers rejected the claimon 29.10.07 stating that there were unauthorised persons in the vehicle at the time ofaccident and that the vehicle was carrying load in excess of the permissible limit.The complainant filed the present case, claiming an amount of Rs.2,24,278/- from theinsurers.Decision: The complainant stated that his claim was rejected by the insurer on trivialgrounds. The insurers contended that allowing unauthorised passengers to travel in thevehicle was a violation of the policy conditions and also the Motor Vehicle Act. Theystated that as per registration certificate only three persons were permitted to travel inthe cabin of the vehicle. The insurers also stated that the vehicle was carrying 420kgsin excess of the permitted carrying capacity and this was established from the deliverychallan of Coromandel Fertilisers whose product was being transported in the lorry atthe time of accident.The vehicle owner contended that the driver carried extra passengers without hisknowledge. As per the investigator’s report, the other vehicle involved in the accidentovertook the insured vehicle and came to a sudden halt that caused the accident.Further, as per the investigation report, the driver of the insured vehicle drove at anormal speed and obviously presence of passengers in the vehicle was not the causeof the accident. All insurers have a provision to settle claims on a non-standard basis,when there are violations of the policy conditions which have not directly led to theaccident. The objection regarding overloading of the vehicle is also found to be trivial.

The claim was ordered to be settled on ex-gratia basis at 60% of the loss assessed bythe surveyor.Hyderabad Ombudsman CentreCase No.G-11-011-0388Sri B. Vijayender ReddyVsBajaj Allianz General Insurance Co. Ltd.Award Dated : 10.3.2008Brief facts : Sri Vijayender Reddy had insured his new Tata Indigo car for the period3.9.2007 to 2.9.2008 for an IDV of Rs.4,86,700/-. The vehicle was damaged on 9.9.07 due to flood water entering the engineof the car. The vehicle was shifted to a garage where an estimate of repairs wasprepared for Rs.1,77,628/-. The licensed surveyor estimated the loss at Rs.23,554/-and disallowed the remaining amount. The vehicle again met with an accident afterrepairs when it was taken out by the garage for a ‘trial’ run. The estimate for damagesin this accident was for Rs.2,33,313/-.Decision : The complainant stated that the claim for flood water damages was settledfor Rs.23,554/- as against repair bills for Rs.1,41,420/-. The second accident occurredon11.11.2007 when the vehicle was in the custody of the garage and the complainantstated that the insurer is not justified in rejecting the second claim in full and inreducing the first claim.The insurer stated that their surveyor estimated the flood damaged loss at Rs.23,554/-and the insured had accepted the same without protest. According to them the liabilityfor the second claim fell within the purview of general exceptions clause 3-A(limitations as to use).As regards the first claim, the insured accepted the cheque given by the insurer withoutany protest. Hence, there is no justification in raising a dispute on this point. Thesecond claim occurred when the vehicle was taken out for a test run after repairs.According to the insurer, such a test run amounts to reliability trial and hence fellunder the exclusion clause. The insurer was asked to submit authentic literature onreliability trials, but they could not submit any information on the same. Hence theinsurer was asked to honour the second claim for loss caused in accident. They weredirected to process the claim and settle within two months from the date of the order.Hyderabad Ombudsman CentreCase No. G 11.012.0360Sri M. MadhavanVsICICI Lombard Gen. Ins. Co.Ltd.Award Dated : 25.03.2008Brief facts : Sri Madhavan had insured his Ford Fiesta Car bearing No. AP 9BE 3599with ICICI Lombard General Insurance Co. for the period 21.08.2007 to 20.08.2008 .The vehicle met with an accident on 03.12.2007 when a stone hit the bottom of the car.Against an estimate of Rs. 1,70,128/- the surveyor assessed the loss for Rs. 8799/-.Decision : The complainant stated after the stone hit the car, he stopped but could notfind anything. The car did not start and it was confirmed by the mechanic that oil sumpwas damaged. The insurers stated that the engine oil got drained of. The insured triedto start the engine and due to lack of oil the piston and other internal parts were

damaged. They stated that their liability was limited to the direct damages in theaccident and that consequential losses were excluded. The damage to internal partswere as a result of consequential loss and condition pertaining to damages causedsubsequent to an accident were placed on record. The insurer was advised to reinspectthe vehicle and confirm the replacements. They confirmed that only the engine partswere replaced and revised their claim offer to Rs. 9287/- The insurer was directed tosettle the same and the complainant’s claim for engine parts which were not due todirect impact was dismissed.Hyderabad Ombudsman CentreCase No.G-11-011- 425Smt. N. SrilaxmiVsBajaj Allianz General Ins. Co. Ltd.Award Dated 31.3.2008Brief facts : Smt. Srilaxmi had insured her new Ford Fiesta car for the period 2.10.06to 1.10.07 for an IDV of Rs.6,88,759/-. The vehicle met with an accident on 5.12.06when it hit a road divider and sustained damages. The insurer arranged for survey ofthe vehicle on being reported about the accident. An estimate of repairs forRs.3,48,380/- was given by the garage and the insurance surveyor assessed the lossat Rs.1,64,000/-. As per the claim forms submitted by the complainant, one Sri D.Goutham Kumar was the driver of the vehicle at the time of accident. His drivinglicence was for two-wheeler only. The insurers informed the same to the insuredseeking her response and show cause as to why the claim should not be repudiated.Smt. Srilaxmi wrote back to the insurer enclosing a copy of FIR as per which one Mr.Bala Balaji was the driver at the time of accident who was duly licenced to drive a LMV.She pleaded for settlement of the claim but the claim was not settled. Hence thecomplaint.Decision : The complainant submitted that she was hospitalised after the accident andthat she submitted claim form after her discharge from the hospital. The insurers’contention was that name of the driver was changed by the complainant to get benefitof the claim. During the hearing, the complainant submitted that her driver receivedsimple injuries and fled from the accident spot. She stated that her signature on theclaim form was taken by a person from Ford Showroom and she was not aware of thedriver’s name filled in the form. She contended that the driver at the time of accidentwas Mr. Bala Balaji and not D.Goutham Kumar. The dispute between both sides isabout who was the driver and the insurers have not taken any decision on the claim.Some inconsistencies were observed in the narration of the events. Hence the insurerswere directed to arrange proper investigation into the relevant facts and dispose of theclaim.Hyderabad Ombudsman CentreCase No.G-11-002-0379Sri T. Purushottam ReddyVsNew India Assurance Co. Ltd.Award Dated : 31.3.2008

Brief facts : A Tata Indicab bearing Regn. No. AP 09X 9600 was insured for an IDV ofRs.2,80,000 from 11.2.2006 to 10.2.2007. The vehicle was purchased by SriPururshottam Reddy and ownership was transferred in his name by the RTA on2.2.2007. The vehicle met with an accident on 4.2.2007 and survey was arranged bythe insurer. The insured had submitted all claim papers and repair bills, but the claimwas not settled. Hence the present grievance.Decision : The insurers contended that the policy was in the name of Sri AshokKumar, the original owner of the cab and it was not transferred in the name of thepresent complainant as on the date of claim and that they had not received any requestfor transfer. Thus the policy was not transferred within 14 days they submitted. Thecomplainant produced a receipt of fax transmission dated 8.2.2007, whereby theinsurer was intimated about change of ownership of the vehicle. As per the facts of thecase, the vehicle met with an accident two days after the transfer of Registration andthe accident was promptly intimated by the new owner to the insurer. The insurer oughtto have guided him properly and they should have advised him about procedure fortransfer of insurance. The insurers having received the fax message on 8.2.2007, didnot ask for any further details. Hence, the insurer was directed to settle the claim forthe assessed loss of Rs.43,500/-.Hyderabad Ombudsman CentreCase No.G-11-004-0410Sri V.Venkata RaoVsUnited India Insurance Co. Ltd.Award Dated : 31.3.2008Brief facts : Sri Venkata Rao obtained a motor insurance policy for his Tata Indicabbearing No. AP 15X 0350, for an IDV of Rs. 200,000. The period of insurance was from8.5.2007 to 7.5.2008. The vehicle met with an accident on 14.5.07 and on intimation, asurvey was arranged by the insurer. An estimate for Rs.1,75,783/- was prepared by agarage and the Surveyor assessed the loss at Rs.83,788/-. On submission of repairbills for Rs.141,813/,the insurance company initially offered to settle the claim for Rs. 67,200/- and theinsurers revised their offer of reimbursement to Rs.87,000/-. His grievance was that theinsurance company has not given any reasons for the details of settlement offered.Decision : According to the insurer, they inadvertently applied depreciation twice andas a result the claim offer came to Rs. 67,200/-. They rectified their mistake andoffered Rs. 87,000/-. During the hearing, the complainant made certain allegationsagainst the surveyor. The complaint against behaviour of the Surveyor is beyond thescope of this office. In view of the insurers having based their offer of Rs 87,000 on thereport of an IRDA licenced surveyor, they were directed to settle the claim for thatamount together with interest as per IRDA guidelines from 17.9.07 (the date of theirfirst offer) to the date of settlement.The complaint was partially allowed.Hyderabad Ombudsman CentreCase No.G-11-011-0421Dr. N.RanganayakuluVsBajaj Allianz General Insurance Co. Ltd.Award Dated : 31.3.2008

Brief facts : Sri Ranganayakulu had insured his 1999 model Tata Indica car for an IDVof Rs.49,750/-, for the period 18.1.07 to 17.1.2008. The car met with an accident on15.6.07 and the vehicle was repaired before the insurance company could inspect thedamages. The insurer rejected the claim for the same reasons, which led to the presentgrievance.Decision : The complainant stated that he had to leave the car on the day of accident,to attend a patient and that the repairs were carried out by his driver at a cost ofRs.30,805/-. He contended that rejection of the claim is not justified and wantedsettlement of his claim for repair bills.The insurers stated that they received claim intimation after 17 days from the date ofaccident and they were deprived of the opportunity of inspecting the damaged vehicle.They contended that the complainant had violated condition No.1 of the policy by notintimating them about accident in time.The insurer’s representative submitted that claim intimation was given to them onlyvide letter dated 2.7.2007 along with repair bills. The complainant submitted that thevehicle was not repaired for 10 days after the accident, but it was observed that therepair bills speak otherwise. The insurer established sufficient proof that the repairswere carried out one day after the alleged accident. The complainant could not submitany proof that he intimated the accident immediately after its occurrence. Hence, thecomplaint was dismissed.Hyderabad Ombudsman CentreCase No.G-11-005-0404Sri Sk.SubhanVsOriental Insurance Co. Ltd.Award Dated : 31.3.2008Brief facts : Sri Subhan had insured his new Tata Indicab vehicle bearing Regn No.AP 16 TV 6303 for the period of 9.6.2006 to 8.6.2007, for an IDV of Rs.315000/-. Thevehicle met with an accident on 28.4.2007 and suffered damage when it was hit by avan. The damaged vehicle was inspected by the licensed surveyor and the loss wasassessed on repair basis as well as cash loss basis. The insured submitted anestimate of repairs for Rs. 3,44,420/-. The insurer processed the claim for Rs.77,689/-and intimated the same to the insured. The insured represented to the insurer forsettlement of the claim on total loss, which was refused by the insurer.Decision : The insured contended that the amount offered by the insurer is too lowcompared to the damage suffered and submitted that the insurers remained silentwithout considering his request for settlement on total loss basis.The insurers stated that the surveyor assessed the loss on two counts. The loss oncash loss basis was Rs.83,920/- and loss on repair loss basis was Rs.1,32,500/-. Theinsured submitted his consent for cash loss basis and hence they offered a net ofRs.77689/-.During hearing the insurer’s side represented that they cannot consider the claim ontotal loss basis and placed before me the relevant policy condition which reads asfollows:“ The insured vehicle shall be treated as a CTL if the aggregate cost of retrievaland/or repair of the vehicle subject to terms and conditions of the policy exceeds 75%of the IDV of the vehicle”. During the hearing it also came out that the insured wasunder the wrong impression that the insurer was considering replacement value for the

ody shell while the insurer did not consider replacement of body shell altogether whileassessing the loss. It also came out during hearing that the insured vehicle was usedfor commercial purposes and hence a higher percentage of depreciation was made bythe insurer. Considering the facts of the case, it was decided to order for payment ofRs.83,920/- as assessed by the surveyor on cash loss basis as the insured expressedhis inability to carry out repairs. The complaint was partly allowed.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-003-112/2007-08Sri.C.S.SalimVsNational Insurance Co. Ltd.Award Dated : 09.10.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998. Thecomplainant had insured his Swaraj Mazda medium goods vehicle with NationalInsurance Co. for the period from 28.3.06 to 27.3.07. While the policy was inforce, thevehicle met with an accident on 14.5.06 and his claim for reimbursement of loss due toaccident amounting to 3.40 lakhs was repudiated by the insurer on the ground that thevehicle which was a medium goods vehicle was driven by a driver who was licensedonly to drive a Light Motor Vehicle and also at the time of accident passengers otherthan the employees of insured or representative of the owner of goods were taken aspassenger, which is a violation of motor vehicle Act. It was argued on behalf of theinsured quoting AIR 1996 SC 205 that if violation of permit condition has notcontributed to the accident, the claim will not be effected. Even if two passengers werecarried in the vehicle it has not contributed anything to the accident. It was also arguedthat the driver was having a valid and effective licence to drive the vehicle. The copy ofdriving licence was also produced. There it is stated as he was licenced to drive LMVthrough out India w.e.f. 23.2.83 and subsequently on 5.3.86 a further authorization wasgiven to drive a ‘transport vehicle’ and the licence was renewed continuously till dateof accident. Hence the question to be decided is whether a person licenced to drive aTransport vehicle authorised to drive Medium Goods Vehicle. Formerly there wereclasses such medium goods vehicles, medium goods passenger motor vehicle, heavygoods vehicles etc. But these categories were deleted in 1994 and in its place acommon category was substituted as Transport vehicles. Now the question is whetherthe MGV is a Transport vehicle. Transport vehicle is defined in Sec.2(47) of MV Act asa Public service vehicle, a goods carriage and educational institution bus or a privateservice vehicle. Hence it is clear that all goods carriage comes within the category ofTransport vehicle. In the case he was licenced to drive a Transport vehicles w.e.f.5.3.86 and this licence was renewed from time to time and hence the driver was havinga valid licence to drive the vehicle at the time of accident. Also the insurer has not putforward any convincing argument to establish that the presence of two persons in thecabin has contributed to the accident also. Hence the decision of insurer to repudiatethe claim is faulty and the insurer is directed to pay a sum of Rs.3,40,000/- with aninterest at 8% till date of payment.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-002-126/07-08Dr.Sujith S WarrierVs.The New India Assurance Co. Ltd.Award Dated : 02.11.2007

The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant Dr.Sujith S Warrier had taken a Package policy in respect of his Maruti800 CC car bearing no.KL6/215. The vehicle met with an accident on 20.4.05 andentrusted the vehicle for repair to one Mr.Manoj, a garage owner. On 6.5.05 Sri.Manojfiled a claim for Rs.26000/- for the repairs. But the repair work was delayed, and whenthe complainant reached the workshop to take delivery of the vehicle it was notavailable in the workshop. Later it was found out in another workshop in a strippedcondition and some of the parts were missing. It was brought to the notice of insurer on7.7.06. The claim was repudiated by the insurer on the ground that the claims comesunder the category “cheating” and does not cover as per policy condition. He was alsodirected to file FIR before police authorities. Aggrieved by this the insured approachedthis Forum for justice.It was submitted by the insurer that a surveyor was deputed to assess the loss due toaccident. But the vehicle was not available in the workshop for verification. Inspite ofhis repeated request the vehicle was not made available for verification till 19.9.05 andhence the surveyor surrendered all papers to insurance co. The contention ofinsurance co. is that actually there was no such accident and the vehicle was entrustedto the repairer for some other purpose. The transaction between the petitioner andworkshop owner is purely a personal dealing with them. The claim against repair workwas not settled as the petitioner has not given an opportunity to inspect the vehicle. Itwas also submitted that most of the parts alleged to be missing were not covered underthe policy. They are consumable items which are intended for one time use only. Dueto the use of vehicle for 14 or 16 years on account of wear and tear such parts wouldhave worn out requiring replacement. The repairer himself had removed these items forthe purpose of replacement and hence no claim is payable for such items also. Thecomplainant himself had stated that the accident was a minor accident only. Even thenit took more than 10 months to get the vehicle repaired. The vehicle was not madeavailable for verification by the surveyor inspite of his repeated requests and hence thesurveyor has to surrender all papers to insurance co. after 4 ½ months. There is noexplanation to that by the complainant. As per policy condition the accident must bebrought to the notice of insurer and he should render all assistance to the insurer.Hence it is clear that no loss had been occurred on account of an accident and that iswhy the vehicle was not made available for inspection. The vehicle was in the custodyof the repairer, but some parts were found missing. It does not mean that it wasremoved by somebody else. It might have removed by repairer for replacement asthese items were consumable items which are intended for one time use only. Alsothose parts are not covered as per policy condition. The complainant himself hadentrusted the vehicles with the repairer and the repairer was holding or possessing thesame in trust for the complainant under a contract. The obligation is only a contractualobligation. If he removed certain articles it will amount to breach of contract or breachof trust only and not theft. Even if the items were removed by the repairer it will notcome under the coverage of policy. As the repairer failed to return the vehicle in propercondition it is a case of cheating. There is no case that anybody has taken or removedthe parts from the possession of repairer(bailee). Hence the claim for compensation isnot sustainable and complaint is therefore dismissed.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-004-213/07-08Sri.Marath VasudevanVsUnited India Insurance Co. Ltd.

Award Dated : 14.11.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant took an insurance policy covering his house and compound wall for theperiod from 21.4.07 to 20.4.08. While the policy was in force the compound wall wasdamaged due to heavy rain and flood, but the claim was repudiated on the ground thatthe damage to the wall was not due to any insured peril but due to old age. The case ofthe complainant is that it was really on account of seepage of water into the red soiland bulging the wall was damaged, but in the claim form it was written as flood asadvised by insurance officials. Though the wall was about 30 years old it was wellmaintained and was in good condition.It was submitted on behalf of insurance company that they have deputed an authorizedsurveyor immediately on receipt of claim. The surveyor has reported that the damagewas not due to any insured peril. The wall appears to be of 30 years old and theretaining wall was eroded due to its old age and that had resulted into projection ofbasement due to its inability to withstand the pressure of soil inside the wall. He alsoobserved gradual development of cracks in the wall. He has reported that there was noflood on that day. It was admitted that there was no flood or inundation. Thephotograph also shows that the compound wall was standing elevated from the road onthe sides. The wall constructed on the side of the road passes at the lower level ofthree meters. There was no canal or stream on its side and hence there was nopossibility of having any flood. As the property is lying on the side of the road at ahigher level there is no scope of having any inundation too. Of course due to heavyrain water was seeping down into the earth and it may cause damage to the wall. Butthat was not covered by policy. Even if the damage was occurred due to heavy rain itwill not come under any of insured peril, surveyor report is also very specific that thedamage is not due to any insured peril. Hence the repudiation made is correct andcomplaint is therefore dismissed.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-005-174/07-08Sri.V.A.AnasVsThe Oriental Insurance Co. Ltd.Award Dated : 15.11.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant had insured his Medium Goods Vehicle KL 41-3671 before its registration.The vehicle met with an accident on 19.3.07 but the claim was repudiated on theground that the driver was not having valid and effective driving licence at the time ofaccident. It was submitted by the insurer that as per exclusion clause 3(b) of policy adamage sustained in an accident while driven by a driver not having effective licence isexcluded from the coverage of policy. Also as per drivers clause the driver must havean effective driving licence at the time of accident. In the present case the licence hadlapsed 10 months before accident and hence they are not entitled to make anypayment. It was submitted by the complainant that though the licence was expired on28.5.06 it was later renewed on 29.5.07 and hence he is eligible to get claim under thepolicy. The copy of driving licence produced verified. The driver was licenced to drivetransport vehicle only upto 28.5.06. Though later the licence was renewed on 29.5.07the fact remains that at the time of accident the driver was not having an effectivedriving licence. The insurer is not liable to make any payment and the repudiation isupheld. The complaint is therefore dismissed.

Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-011-149/07-08Smt.A.C.ChinnammaVsBajaj Allianz General Insurance Co.Ltd.Award Dated : 20.11.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant had purchased an Opel Corsa car in 2003. AT the time of purchase on9.4.03 insurance cover under a package policy with National Insurance Co. wasprovided by Opel Co. to the purchaser. It was effected as a private car. Subsequentlythe vehicle was registered as a taxi on 16.4.03. After the expiry of initial policy withNational, the policy was renewed with Bajaj allianz by submitting a proposal dated7.4.04. The policy was issued as a package policy for private cars. The policy wasrenewed periodically and while the policy was in force, the vehicle met with an accidenton 11.1.06. The claim was repudiated on the ground that the policy was taken as aprivate car where as the vehicles was registered as a transport vehicle (taxi). It wassubmitted by the insurer that at the time of renewal with them the RC book was notproduced, only the vehicle and the cover note of the previous insurance was produced.The insurance was effected on the basis of this cover note and that is why the date ofcommencement was noted as 9.4.03, the date of purchase. Had the RC book beenproduced, the date would have noted as 16.4.03, the date of registration and also noclaim bonus would not have been given. As the RC book was not produced theinsurance coverage was given for private car collecting premium for private carinsurance only after allowing no claim bonus and hence they are not liable to make anypayment as the vehicle was registered and used as a commercial vehicle. Thecomplainant had stated that she has produced the vehicle and RC book for inspectionat the time of effecting insurance. But without looking into the RC book insurance Co.had issued policy and insurance Co. is at fault.The first insurance policy with National Insurance Co. was issued on 9.4.03, the date ofpurchase. The vehicle was not registered at the time, the vehicle was registered onlyon 16.4.03. It appears that at the time of renewal with Bajaj Ins.Co. only the cover notewas produced. Had the RC book been produced the date will be noted as 16.4, thedate of registration. Also the insurer will not allow any NCB. It is also to be noted thename plate of the vehicle was that of a private car in white back ground. Hence therewas no material for insurer to verify whether it was a private care or a taxi car. Theproposal was also made in the format of private vehicle insurance. According to themeven at the time of accident he was using a white number plate and not a yellownumber plate. Though the complainant has purchased and registered the vehicle as ataxi, he was playing fraud by exhibiting a number plate of a private car and he hadwillfully suppressed and obtained insurance for private vehicle, though it was a taxicar. The complainant has submitted that at the time of accident the number plate wasthat of a private vehicle (white board) but at the time of regn. it was bearing yellownumber plate. Witness may tell lie, but circumstances will not. If it was a taxi car, and ifit was brought to the notice of the insurer they would have certainly issued policy fortaxi car as the premium for commercial vehicle is much morethan that of privatevehicles. Here insurance was effected as a private vehicle where as the vehicle wasregistered and used as a commercial vehicle and hence insurance co. is not liable tomake any payment. The complaint is therefore dismissed.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-004-241/2007-08

Sri.Sojan P JoseVsUnited India Insurance Co. Ltd.Award Dated : 28.11.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. On11.8.06 the complainant purchased Tata Indica car KL7-AP75 from Sri.G.Binukumar,the registered owner. The RC was got transferred on that day. The package policytaken by Sri.Binukumar was inforce on that day. But that was not changed and thevehicle met with an accident and the claim was rejected on the ground that thecomplainant has no insurance policy with him and Sri.Binukumar, the owner of thepolicy has no insurable interest.It was submitted by the complainant that he has submitted all records to RTO Office fortransferring ownership to his name. He was told that the policy can be transferred onlyafter getting the RC transferred in his favour. He got the RC transferred to his namew.e.f. 11.8.06 only on 31.8.06 and by the time the vehicle met with an accident on20.8.06. His contention is that he is eligible for compensation as accident took placewithin 14 days of transfer. It was submitted by the insurer that for transferring thepolicy in the name of present registered owner, they require a request in writing fromthe buyer and seller and also a specific proposal from the buyer. But these conditionshave not been complied with and at the time of accident the owner of the vehicle hasno policy in his name and also the owner of policy has no insurable interest on thevehicle. Hence they are not in a position to compensate the loss either to the buyer orto the seller.Though the change of ownership has brought in the Certificate of Registration, thepolicy continued in the name of Sri.Binukumar. A contract of insurance is a personalcontract. The contract is to indemnify the loss sustained to the vehicle. A policy cannotbe transferred by the insured without the consent of insurer. The transfer of subjectmatter of insurance policy will not operate as an assignment of policy unless there isan express or implied agreement to that effect. It is argued that the insured had 14days time to effect transfer of insurance in his favour. This argument has beenadvanced on the basis of General Regulation 17 of MVAct. On a close reading of theregulation it can be seen that 14 days is allowed only for transfer the statutory riskcover (act cover) whether it is under Act only liability policy or Package policy. In orderto transfer own damage section of policy a specific request from transferee with theconsent of transferor is required. A new policy has to be issued after collecting therequired charges. There is no automatic transfer of policy. The 14 days time isapplicable only for endorsement of transfer of act only covers. Here in this case nosteps have been taken to transfer the policy and the complainant has no insurance onhis name and Sri.Binukumar has lost his insurable interest also. Hence own damagerisk cover was not there and the repudiation is to be upheld and complaint is thereforedismissed.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-012-225/2007-08Sri.James MathewVsICICI Lombard General Ins. Co. Ltd.Award Dated : 17.12.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant had insured his Mini Tipper lorry bearing Regn. No.KL-35 4328 under a

Package policy for the period from 2.3.07 to 1.3.08. During the currency of policy, thevehicle met with an accident on 21.3.07 and sustained damage. The claim wasrepudiated by the insurer on the ground that there was no permit for the vehicle to plyas goods carriage which is a violation of Motor Vehicles Act. It was submitted by theinsurance company that there is an implied liability on the part of the insured that hewill abide all the applicable law. As the loss was sustained as a result of an illegal act,plying the vehicle on the road without permit, they are not liable to make any payment.The only contention of insurer in repudiating the claim is that no permit was takenunder Sec.66 of MV Act. Sec.66 prevents the user of a vehicle in any public place notin accordance with permit condition Sub Sec.2 of Sec.79 of MV act deals withconditions with which permits can be granted. But there is no case that any conditionstated in Sec.79(2) has been violated. It is not even stated that the accident occurredwhile using the vehicle for carrying goods. At any case there is no case that theaccident occurred while carrying the goods in violation of any condition that could havebeen made while taking permit. Another contention of the insurer is that by operatingthe vehicle without permit is an illegal act. Section 39 of MV act only envisages that byregistration of vehicles one gets a right to drive the vehicle on public road. Sec.66does not prohibit the user to ply the vehicle without permit. It is relevant to note thatwithout insurance a vehicle cannot be driven through road and also without registrationa vehicle cannot be driven through road. Only after taking insurance and registrationthe question of getting permit arise. Permit is not a condition precedent to takinginsurance and registration, but insurance is a precedent for taking registration andgetting permit. Hence if an accident occurs before taking a permit, he will certainly getthe benefit of insurance. Hence the mere fact that the permit was not taken is not avalid ground for repudiating insurance claim. There is another ground too. Registrationand fitness etc relates for fitness of vehicle but permit has nothing to do with thefitness. Permits are issued only for collecting tax and also to have a control andmanagement over road transport and not as a measure to control accidents. What isinsured is the safety of vehicles and passengers and also third parties. In NationalIns.co. Vs.Anjana Syam (2007) Supreme Court has held that inspite of the relevantprovision of MV Act insurance still remains as a contract between owner and insurerand the parties are covered by terms of contract. Hence in the absence of any specificcontractual provision in the policy that in case of violation of any provision of anystatute the insurance would be affected insurer will be liable to be indemnify theinsured even if there is any non-compliance of any statutory provision. Hence therepudiation is faulty which is liable to be reversed and the insurer is directed to pay theamount of Rs.44145/- with 8% interest till date of payment.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-012-231/2007-08Sri.Babu P.N.VsICICI Lombard General Insurance Co.Ltd.Award Dated : 19.12.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant’s vehicle KL-7-AV 5137 Tempo Traveller Mini Bus was insured with ICICILombard Gen.Ins.Co. under a package policy. While the policy was inforce the vehiclemet with an accident on 12.6.07 while returning from Kodaikanal to Palani with sometourist. The claim was repudiated on the ground that the list of passengers traveled inthe ill fated vehicle differs from the list of passengers as per permit issued.

The claim was repudiated only the ground that the list of passengers in the vehicle atthe time of accident differ from the list of passengers obtained from the check postwhile issuing permit. The owner of vehicle has done a permit violation and insurer isliable to indemnify only loss that suffered in the process of doing an activity notprohibited by law. There is an implied representation on the part of the insured that hewill abide by all laws of land. As the owner has violated the permit condition insurer isnot bound to indemnify the insured. The complainant has submitted that on 8.6.07Heena Travels had placed an order by e.mail for carrying some tourist fromCoimbatore. As the exact names of persons were not known some names were given totake permit to take the vehicle beyond state boundary. Only the first name in the listwill be correct and this is the usual practice followed.The only ground of repudiation is that the list of passengers obtained from Walayarcheck post from where permit was taken differs from the list of passengers actuallytraveled in the vehicle. The fact that there is a difference in the names of passengerswas admitted by the complainant himself. The vehicle has a capacity of 18 persons.The special permit was taken only to take the vehicle beyond state boundary. Thepermit was given only to operate the vehicle through the State of Tamilnadu. As far asthe insurance co. is considered the exact name of persons are immaterial as the claimraised is for loss sustained to the vehicle and not to the passengers. In B.V.NagarajuVs.Oriental Ins.Co.Ltd. AIR 1996 SC 2054 – Supreme Court had held that merely bylifting a person or two, it cannot be termed as a fundamental breach that the ownershould be denied of indemnification.In terms of decision of Supreme Court in order to put an end to the contract the breachmust be of fundamental nature. In the present case the name of the persons carried inthe vehicle is immaterial. There is no case that persons exceeding the capacity ofvehicle is carried in the vehicle. By mere taking a different set of persons in thevehicle, it will not amount to permit violation and hence the repudiation is set aside.Insurer is directed to pay a sum of Rs.431130/- together with interest at 8% till day ofpayment with a cost of Rs.3000/-.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-011-281/2007-08Sri.Janani KumarVsBajaj Allianz General Ins. Co. Ltd.Award Dated : 18.12.2007The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant had insured his vehicle KL 14E 8065 Maruti vehicle paying a total premiumof Rs.7040/- w.e.f. 15.6.06. On 10.7.06 the vehicle met with an accident while it wasdriven by his brother, Sri.Jayakumar who died in the accident. The claim wasrepudiated on the ground that the claim was lodged after 6 months of accident and alsothe driver was not having an effective driving licence at the time of accident. It wassubmitted by the complainant that his brother took the vehicle for shoping purpose andhe was having a licence to drive Light Motor Vehicle. He also submitted as he lost hisbrother in the accident he was in a great mental agony and he has instructed thegarage to claim the amount. In the self-contained note the insurer had admitted that“All the averment regarding the genuinity of the accident is admitted”. Hence thefactum of accident occurred on that day and vehicle was totally damaged was admittedby the insurer. It is clear that on account of the delay no prejudice has been caused tothe insurer in assessing the loss. Such a condition is given only to assess the insurerthe genuineness of the case and also for assessing the loss. Nowhere it was stated

that in the absence of such an immediate notice the claim will not be entertained. Assuch the insurer is not entitled to repudiate the claim on that ground.Another ground for repudiation is that the driver of vehicle was not having an effectivelicence at the time of accident which is a pre-requisite for driving a commercial vehicle.As per the Motor Vehicles Act to drive a commercial vehicle on public road anendorsement to drive commercial vehicle is necessary. The vehicle is a taxi or acommercial vehicle and the policy issued was also for a commercial vehicle. The driverwas having only an LMV licence. But it is to be noted the vehicle was a 4 wheelerhaving a capacity to carry not more than 6 persons with unlaiden wt. of 860 kg. Henceit was a light motor vehicle, but registered as a tourist taxi. On a reading of Sec.3 ofMV Act it can be seen that special authorization is not required for driving a motor cabor motor cycle hired for ones own use or rented out under any scheme. On a closereading of Sec.3(1) along with Sec.75 it is clear that where there is no scheme underSec.75(2) the person who got the vehicle rented can drive, if he is having on LMVlicence and if the transport vehicle is rented out under the scheme it can be driven notonly by the person got rented out but also can be driven through other drivers, who arehaving LMV licence. From the above discussion it can be seen that even if it is atransport vehicle it can be driven by a driver having only LMV licence, if it is hired forhis own personal use. Hence he was having an effective licence to drove the vehicleand the repudiation is faulty. Insurer is directed to pay Rs.168500/- with interest at 9%till date of payment.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-003-334/2007-08Sri.T.ShakirVsNational Insurance Co. Ltd.Award Dated : 05.02.2008The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant had insured his Hero Honda splender motor bike with registration no.KL02W/4441 for a sum assured of Rs.32500/-. On 4.11.06, he returned from his officeand placed his vehicle in front of his house and went into the house. On his return after10 or 20 minutes the vehicle was missing. Enquiries were made but the vehicle couldnot be traced out. The matter was reported to police and FIR was registered. The claimfor insurance amount was declined on the ground that the owner left the vehicle in frontof his house without locking. He has not exercised proper care and not taken allpossible steps to safeguard the vehicle from loss or damage.The contention of insurer is that as per Cl.IV of policy condition the owner of vehicleshould take all reasonable care to safeguard the vehicle from loss or damage. Theinsured had violated this condition by leaving the vehicle unlocked and hence they arejustified in repudiating the claim. It was submitted by the complainant that he has leftthe vehicle unlocked with the intention of taking vehicle within 10 minutes. It is to benoted that the theft happened in front of insured’s residence. It is near to railway trackon eastern side of Kollam-Paravoor railway line. This is a residential area. The vehiclewas parked in front of his residence, and not in a public road. It is a secluded place.Though it was not locked, the ignition key was taken and carried by him and hencevehicle could not be started and taken off. His intention was to return immediatelywithin 10 minutes time for the purpose taking the vehicle for shopping. So the vehiclewas not locked. This is the normal conduct of a man of ordinary prudence. Whiletemporarily parking the vehicle unlocked in front of his house it could not be said thathe has not exercised reasonable care, though he has not exercised absolute care.

Hence repudiation made cannot be justified. Insurer is therefore directed to payRs.32470/- being the amount payable under the policy with 8% interest from date ofclaim till date of payment.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-003-305/2007-08Sri.Jayakumar TVsNational Insurance Co.Ltd.Award Dated : 20.02.2008The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. ThePickup van bearing No.KL-02 Q4246 was insured for the period 28.7.04 to 28.7.05under a Package policy. On 2.5.05 the vehicle met with an accident, but the claim wasrepudiated on the ground that the insured has no insurable interest on the vehicle andalso the driver has no valid driving licence. Aggrieved by this the insured approachedthis Forum.The complainant has stated that the repudiation was made on flimsy ground as he hasnot violated any of policy conditions. As there was a valid insurance he is eligible toget the amount claimed for. The claim was repudiated mainly on the ground that theinsured had no insurable interest either at the time of taking policy or at the time ofaccident. It was submitted that Sri.Jayakumar, the complainant had sold the vehicle toone Sri.Siju on 9.2.04 for valuable consideration. But the RC book was not transferredin favour of Sri.Siju as the vehicle was under a hire purchase agreement. Thedocuments also reveal that Sri.Siju is the owner of vehicle 3 months before accidentthe vehicle was seized by Forest Dept. for carrying timber without permit. As per CourtOrder the vehicle was released to Sri.Siju on executing bank guarantee, as if he wasthe owner of vehicle. The copy of sale agreement was also produced, where in it wasstated that the vehicle was sold to Sri.Siju and it was under taken that the amount dueto the financier will be paid by Sri.Siju, the purchaser in 42 instalments. Thegenuineness of this agreement was not disputed by the complainant. On 29.12.05Sri.Jayakumar made a request to Manager of Insurance Co. to consider his claimfavourably and in this letter he has stated that the vehicle was sold to Sri.Siju on9.2.04. Hence it is clear that neither at the time of accident nor at the time of takingpolicy Sri.Jayakumar was having insurable interest on the vehicle. The motor vehicle isa movable property, the transfer of which can be effected by delivery. The fiction ofdeemed transfer of policy to transferee under 157 of M V Act is applicable to third partyrisk only. Hence the action of insurer in repudiating the claim is justifiable and thecomplaint is therefore dismissed.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-002-349/2007-08Sri.Mohammed HashimVs.New India Assurance Co. Ltd.Award Dated : 04.03.2008The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. Thecomplainant had insured his vehicle KL 10H 9006 having a declared value ofRs.1,20,000/- under private car package cover for the period 28.9.05 to 27.9.06. On19.1.06 the vehicle met with an accident and the claim was repudiated on the groundthat at the time of accident the vehicle was used on hire and hence it is a violation ofpolicy condition. Aggrieved by this the complainant approached this Forum for justice.

The claim was repudiated on the ground that at the time of accident the vehicle wasused on hire. Their decision was mainly based on FI statement given by one Mr.Nawas,who was traveling in the vehicle at the time of accident. He has stated that he andsome of his friends has taken the vehicle on hire. But it was submitted by thecomplainant that the statement given in the FIR is a wrong statement and Mr.Nawashad never given such a statement and also a statement in the FIR cannot be taken asan evidence. The copy of FIR was produced by the complainant himself. It looks thatthe FIR was registered on the basis of statement given by Mr.Nawas. The statementwas recorded and his signature was obtained as FIR statement for registering thecrime. In the FIR statement it was specifically stated that the accident took place at3.40 a.m. and the FI statement was recorded at 7.00 am. From this it is clear that theinformant Sri.Nawas was traveling in the vehicle and the statement was taken within ashort span of accident. He was unequivocally stated that the vehicle was hired bythem. It is a well established law that FI statement can be considered as an item ofevidence. There was absolutely no necessity for him to give a false statement at thattime, against the interest of the owner of the vehicle. The policy condition is veryspecific that insurance coverage will not be available if the vehicle was being used astaxi. Here repudiation made is correct and liable to be upheld.Kochi Ombudsman CentreCase No. : IO/KCH/GI/11-002-345/2007-08Sri.JoyceVsNew India Assurance Co. Ltd.Award Dated : 07.03.2008The complaint falls under Rule 12(1)(b) read with Rule 13 of the RPG Rules 1998. LateNjanadas, the husband of the complainant had insured his transport vehicle KL 5Q8098 with New India Assurance Co. under package cover covering the period 21.3.07to 20.3.08. On 30.3.07 the vehicle was involved in an accident, and Sri.Njanadas, theowner cum driver of vehicle died on the spot. The claim was repudiated on the groundthat at the time of accident the driver was not having effective and valid driving licenceand also the fitness certificate of vehicle expired on 22.3.07. Aggrieved by this heapproached this Forum.The policy condition is very specific that the claim under a policy will be only if thedriver is having a valid and effective driving licence to drive the vehicle at the time ofaccident and also he has not been disqualified from getting such a licence. There is nodispute to the fact that the licence of the driver to drive a transport vehicle expired on27.2.06 and the accident took place on 30.3.07 after 13 months of expiry of licence. Itwas submitted by the complainant that the licence was given for renewal to an agent.But the extract of driving licence obtained from road transport authorities producedwhich states that the licence to drive transport vehicle expired on 27.2.06. This extractwas taken on 4.5.07 about one month after accident. Hence it is clear that at the timeof accident there was no valid and effective driving licence. The policy condition is veryspecific about its exclusion clause, the repudiation is to be upheld and the complaint istherefore dismissed.Lucknow Omdudsman CentreCase No.G-12/11/05/07-08Shri.Ajai SinghVsICICI Lombard General Insurance Co. Ltd.

Award Dated : 04.10.2007Ajai Singh, the complainant insured filed a complaint with this forum against the orderof ICICI Lombard General Insurance Co. Ltd for repudiating his accidental damagemotor claim.Facts : A private vehicle Toyota Innova was comprehensively insured for the period30.1.06 – 29.1.07. The policy mentions only engine no./ chasis no. of vehicle. Vehiclemet with an accident on 23.3.06 near Hoshiarpur in Punjab. Vehicle was not registeredas on the date of issue of policy as also on the date of accident. Hence claimrepudiated by the Co. as vehicle used in violation of law.Findings : The respondent Co. contended that a vehicle has to be registered before itcan ply in a public place as per section 39 of Motor Vehicle Act. Further Motor Vehiclerule(4) also provides for applying for registration within 7 days of taking delivery ofvehicle.A valid policy existed on date of accident is not disputed. Damages are also assessedfor Rs.193349/- as per surveyor’s report. Vehicle was plying in a far away place withoutregistration, in violation of law is also established. But this is to be seen by RTA whichmay impose a penalty or impound the vehicle. Point to be considered is whether thisconduct on part of the complainant vitiates the contract in toto.Decision : Blatant act of gross negligence and scant respect for law and procedure bythe complainant insured cannot be overlooked. However, the lacuna on part of therespondent Co. in granting a policy without Engine no./ Chasis no./registration no. is aserious lapse as the identity of the vehicle insured becomes doubtful. In suchcircumstances, forum allowed claim on compromise basis, limiting the claim to 60% ofadmissible amount. Complaint disposed off accordingly.Lucknow Omdudsman CentreCase No.G-24/11/04/07-08Shri.Vinod KumarVsUnited India Insurance Co. Ltd.Award Dated : 23.11.2007Shri.Vinod Kumar, the complainant Insured, has filed a complaint with this forumagainst the decision of the respondent Co. for repudiating his claim on the grounds thatthe claim is not genuine.Facts : The complainant had taken out a motor cycle comprehensive policy for a suminsured of Rs 23000/- for the period 23.01.06 – 22.01.07 from the respondent Co.M/sUnited India Insurance Co. Ltd. The vehicle met with an accident on 27.05.06.Surveyor was deputed who assessed loss for 5166/- Doubting veracity of claim, BranchManager appointed a second surveyor, who perused claim papers, photos etc andopined claim appears fabricated. On his report, the claim was repudiated by the Co.Findings : Original surveyor had personally inspected the vehicle and then submittedthe report whereas the second surveyor had only opined based on the papers andphotographs. No clarifications ever sought by the underwriting office from the originalsurveyor nor the opinion of the 2 nd surveyor passed on to the 1 st surveyor for hiscomments. The second surveyor should not have been appointed without recordingreasons and without the consent of the higher office.Decision : It was not just on part of the respondent Co. to repudiate claim on meresuspicion without substantiating the fraud. Respondent Co. directed to pay as per

assessment of original surveyor subject to policy terms and conditions. Complaint wasdisposed off accordingly.Lucknow Omdudsman CentreCase No.G-21/11/04/07-08Shri.O.N.BansalVsUnited India Insurance Co. Ltd.Award Dated : 10.01.2008Complainant Insured, Shri.O.N.Bansal filed a complaint with this office for rejection ofMaruti car theft claim by M/s United India Insurance Co.( the respondent Co.)Facts : The complainant had taken out a motor car comprehensive policy for his Maruticar with M/s United India Insurance Co for a sum insured of Rs 30000/- for the period27.06.06 – 26.06.07. The said vehicle was stolen on 18.09.06. The loss was assessedfor 29500/- However the claim was repudiated by the Co. on the following ground:The vehicle was registered in february 1990 for a period of 15 years and the period hadexpired in February 2005.As per law, the vehicle can be registered for 15 years only and renewed by reregistration.Although all other papers were in order, claim was repudiated on sole ground that thevehicle was not registered as on date of theft ie.18.09.06.Findings : Section 39 of the Motor Vehicle Act makes it mandatory for all vehicles tobe registered. Section 41(7), the relevant clause for this case further states “Acertificate of registration issued under sub-section(3) whether before or after thecommencement of this act, in respect of a motor vehicle other than transport vehicleshall subject to the provision contained in this act be valid only for a period of fifteenyears from the date of issue of such certificate and shall be renewable.”The above clause establishes vehicle is to be registered after 15 years. However act issilent on the effect of non-registration in such a case. No penalties are prescribed forfailure to register implying non registration of vehicle is not such a serious offence asto render the claim invalid. Also the date of registration is mentioned on Cover noteand Co. was aware that on date of renewal of policy ie.27.06.06 it was not registered.Having granted the policy with full knowledge of non-registration of vehicle, therespondent Co. cannot take shelter on non registration as a ground for repudiation ofclaim.Decision : It was held that total rejection of claim was unjustified. However, the ownerinsured too cannot get away with breach of law which is against public policy. Hence,claim was allowed on compromise basis not exceeding 90% of the admissible claim.Further an 8% interest was awarded on the admissible amount from expiry of 7 daysfrom receipt of investigation report for delay on part of the Insurer for unjustifiablereasons. Complaint was disposed off accordingly.Lucknow Omdudsman CentreCase No.G-27/11/14/07-08Shri.Pradeep Kumar ShrivastavaVsCholamandalam M.S.General InsuranceAward Dated : 08.02.2008

Complainant Insured filed a complaint against repudiation letter dated 27/07/07 of M/sCholamandalam M.S.General Insurance for theft of his motor cycle.Facts : A motorcycle was comprehensively insured for the period 25/04/06 to 24/04/07.The vehicle was stolen on 13/02/07. The claim was repudiated due to inordinate delayin intimation of claim to the Co. ie. a period of 34 days and relied upon the conditionno.1 of the policy regarding notice of claim to Co. in case of loss.Findings : The Insured showed a letter dated 15/2/07 regarding intimation of claim,duly acknowledged by a signature and office seal of the Co.The investigator appointedby the Co. also confirmed genuineness of theft. The respondent Co. did not deny thegenuineness of the signature or seal of the Co. on the intimation letter. The Co.’srepresentative contended that notice given to an agent is not notice given to the Co.His attention was drawn to section 229 of Indian Contract Act which is explicit withregard to any notice or information being given to an agent.Decision : Notwithstanding above circumstances, alleged delay did not actuallyprejudice the rights of the respondent Co. in any way as their investigation reportestablished the veracity of theft on that day. Respondent Co. directed to pay claim infull as per IDV subject to policy terms and conditions.Lucknow Omdudsman CentreCase No.G-35/11/12/07-08Shri.Ram Kumar YadavVsICICI Lombard General Insurance Co. Ltd.Award Dated : 27.03.2008Complainant Shri. Ram Kumar Yadav filed a complaint with this office against ICICILombard General Insurance Co. Ltd for repudiation of his motor theft claim.Facts : Complainant had a motor comprehensive package policy for his Bolero Jeep(privately insured) for an IDV of Rs.466081 for the period 2/6/07 – 1/6/07. Vehicle wasallegedly stolen on 7/2/07. Investigator submitted a report stating vehicle used forcommercial purpose. Even the complainant had given a statement that the vehicle wasbeing run on ‘Thekedari’ by his son implying commercial use of vehicle and henceviolation of “limitation as to the use” condition of the policy.Findings : Use as a commercial vehicle was established. Such a use tremendouslyincrease the risk exposure in case of own damage claim.But same may not be the casewhen vehicle is involved in a theft-as they are mostly stolen whilst parked. Therefore,no nexus between theft and limitations as to use of vehicle. However, the insuredcannot get away with such deliberate violation of policy condition so as to underminethe very sanctity of the contract itself.Decision : The above violation would render the contract viodable, as the use ofvehicle for commercial purpose does not constitute a very serious breach of contract incase of theft. Award is passed for 50% of the admissible claim. Complaint is disposedoff accordingly.Mumbai Ombudsman CentreCase No. : GI-180 of 2006-2007Smt. Puja ChodankarVsNational Insurance Company Ltd.

Award Dated : 17.10.2007Smt. Puja Chodhankar, had taken a Policy from National Insurance Company Ltd., Goa,to cover her vehicle Premier Padmini. Smt. Puja Chodankar, intimated to the companythat her vehicle was stolen on 26.6.2003.The Company sent an offer letter dated 28 th March, 2005 “Without Prejudice” to Smt.Puja Chodankar, to exercise the option to replace the vehicle of same model and makein place of the vehicle lost by her due to theft, as per Policy Condition No.3 of PrivateCar Policy. But during final scrutiny, it was found that the vehicle did not belong toSmt. Puja Chodankar, but to Shri Chandrakant Bablo Parab, who had purchased thevehicle before the occurrence of theft from Smt. Puja Chodankar.The Company, therefore, vide letter dated 25.10.2005 informed Smt. Puja C.Chodankar, that the claim is treated as “No Claim”. The Insured vehicle according tothe complaint made by Shri Chandrakant B. Parab, to Mapusa Police station on3.10.2003 was purchased by him seven months back from her but the same was nottransferred in his name till date. It was noted that the R.C Book and Insurance was inher name and the person preferring the claim (as the owner of IV) and the personnamed in the Policy/RC Book were different. As per Policy Condition the owner has tobe the registered owner of the vehicle and Insured name in the policy, hence the claimwas repudiated.Not satisfied with the decision, Smt. Chodankar, represented to the company vide letterdated 17.1.2006 and thereafter vide letter dated 6.2.2006 approached the Ombudsmanseeking his intervention in the matter of settlement of her claim with the company.The company in their detailed written submission to this Forum has stated that whenthe claim was lodged by Smt. Puja Chodankar stating that her vehicle was stolen on26.6.2003, an offer letter “Without Prejudice” was sent to her to exercise the option toreplace the vehicle of same model and make in place of stolen vehicle as per PolicyCondition No.3 which reads as “The Company may at its own option repair reinstate orreplace the vehicle insured ……”. But during the final survey it was found that thevehicle does not belong to Smt. Chodankar but to Shri Chandrakant B. Parab, who hadpurchased it before the occurrence of theft. It was noted that after the theft of thevehicle, Shri Chandrakant B. Parab, on 3.10.2003 (i.e 3 months after the theft of thevehicle) reported to the Police that he had purchased one Fiat Car No.GDF 0235 fromSmt. Puja Chodankar and paid Rs.15,000/- for the said car and it was stolen on26.6.2003 while it was in his custody. The police authority had also made a remarkabout the delay on FIR. As per Policy Condition No.1 “ In case of theft or criminal atwhich may be the subject of a claim under this policy the insured shall give immediatenotice to the police and cooperate with the company in securing the conviction of theoffender”. The Company justified their decision to reject the claim for the followingreasons:l Smt. Puja Chodankar, is not the owner of the vehicle and neither does she haveInsurable Interest to claim under the policy.l Because of the delay in reporting to the Police, owner has not given the opportunityto do the proper investigation.l Delayed complaint itself is a violation of Policy condition.l Applicant has no locus standi to make the claim.l The claim is time barred. If the Company disclaim liability to the Insured for anyclaim hereunder and such claim shall not within twelve calendar months from thedate of such disclaimer have been made the subject matter of a suit in a court of

law, then the claim shall for all purposes be deemed to have been abandoned andshall not thereafter be recoverable.On analysis of the records, it is observed that the vehicle was in the name of Smt. PujaChodankar and insured under Policy No.270905/31/02/6110722 for the period 7.1.2003to 6.1.2004. Thereafter the vehicle was sold by her to Shri Chandrakant Bablo Parab.The vehicle was stolen on 26.6.2003 and 3 months after the theft of the vehicle, i.e. on3.10.2003 Shri Chandrakant B. Parab, (the new owner of the IV) reported to MapusaPolice station that the vehicle was purchased by him seven months back from Smt.Puja Chodankar. The new owner had neither claimed under the policy nor he appliedfor transfer of Insurance policy, which he should have done within 14 days of transferof the vehicle and the ownership was not transferred in his name as per R.C. bookalso.The Motor Vehicle Act, 1988 regarding transfer of ownership is quoted below:50. Transfer of ownership – (1) Where the ownership of any motor vehicle registeredunder this Chapter is transferred –(a) the transferor shall –“(i) in the case of a vehicle registered within the same State, within fourteen days ofthe transfer, report the fact of transfer, in such form with such documents and in suchmanner, as may be prescribed by the Central Government to the registering authoritywithin where jurisdiction the transfer is to be effected and shall simultaneously send acopy of the said report of the transferee; and ……….(b) the transferee shall, within thirty days of the transfer, report the transfer to theregistering authority within whose jurisdiction he has the residence or place ofbusiness where the vehicle is normally kept, as the case may be, and shall forward thecertificate of registration to that registering authority together with the prescribed feeand a copy of the report received by him from the transferor in order that particulars ofthe transfer of ownership may be entered in the certificate of registration.General Rule 17 of the Indian Motor Tariff which is quoted below:‘The transferee shall apply within 14 days from the date of Transfer in writing underRecorded Delivery to the Insurer who has insured the vehicle, with the details of theRegistration of the Vehicle, the date of the transfer of the vehicle, the previous Ownerof the vehicle and the number and date of insurance policy so that the Insurer maymake necessary changes in his record and issue a fresh certificate’.Motor Insurance is governed by All India Motor Tariff, which is in line with MotorVehicles Act, which is a Statutory Act and compliance with the provisions of the Act ismandatory. In this case, there was a violation of the motor tariff guidelines regardingtransfer of vehicle and the policy was not endorsed in the name of the new ownerbefore the loss took place.In terms of the above provision, as on the date of theft, there was no Insurable Interestof Smt. Pooja Chodankar, in the said vehicle as the vehicle was sold to ShriChandrakant Bablo Parab, the Company’s decision to repudiate the claim is heldsustainable.Mumbai Ombudsman CentreCase No. : GI-397 of 2006-2007Shri Sitaram N. SirsalewalaVsRoyal Sundaram Alliance Insurance Company LimitedAward Dated : 31.01.2008

Shri Sitaram N. Sirsalewala, had insured his vehicle Skoda Octiva Ambienet TDI, withRoyal Sundaram Alliance Insurance Company Limited under Private Car PackagePolicy for IDV of Rs.6,50,000/- for the period 10.6.2005 to 9.6.2006. He lodged a claim with the companyfor damages to the insured vehicle on account of floods. The Company deputed theirSurveyor to survey and assess the damages sustained by the vehicle. The Insuredafter getting his vehicle repaired with the authorized dealer submitted an invoice forRs.2,77,050/- based on which the Surveyor’s assessment of the liability was workedout to Rs.1,68,560/-. The Insured accepted the cheque for Rs.1,68,560/- dated1.2.2006 and thereafter vide letter dated 4 th July, 2006 approached the Ombudsman,enclosing a copy of the claim computation sheet stating that the company settled onlyRs.15,000/- labour charges as against his bill of Rs.92,200.The Company has vide letter dated 18.1.2008 informed this Forum that subsequent tothe Hearing, the Surveyor had requested the insured to produce the salvage of thespare parts replaced in FIP in the month of December 2007, which the insured hasfailed to surrender till date, hence the complaint should be dismissed.On an analysis of the records pertaining to the case, it is noted that the company hadsettled the claim and the dispute is regarding the FIP repair charges for which anopportunity was not given to the Surveyor for inspecting FIP before repairs and afterrepairs the salvage of the spare parts replaced in the FIP was not produced forinspection by the Surveyor and hence the company settled the claim without taking intoaccount the FIP repair charges. The Insured did not provide any proof to show that thedamaged spares in the FIP was actually repaired to assess the liability. During theHearing the company has also stated that the estimate was dated 19.9.2005 and thebill submitted was dated 15.9.2005 and the company failed to understand how the billwas raised before the estimate.It was the responsibility of the Insured to give full cooperation to the Surveyor of theCompany and safeguard the insured property until the liability was admitted by theInsurance Company, instead of leaving the matter between the Surveyor and theWorkshop. It should be noted that any claim has to be substantiated under the policyand the company can make payment after satisfying themselves about the claim beingestablished under their policy with all terms and conditions. Since in this case noopportunity was given to the Surveyor to inspect the damages to the FIP before repairsand after repairs the salvage of the spare parts was not produced, the decision of thecompany to settle the claim without taking into account the FIP repair charges issustainable.Mumbai Ombudsman CentreCase No. : GI-342 of 2007-2008Shri Narayan S. PatilVsCholamandalam General Insurance Co.Ltd.Award Dated : 19.02.2008Shri Narayan S. Patil, had insured his vehicle Tata Indica, Registration No.MH-06-AB-6032, Model 2005, under Private Car Policy No.VPC-00084961-000-00 for the period28.10.2006 to 27.10.2007 with Cholamandalam MS General Insurance Co.Ltd., for anIDV of Rs.3,14,211/-. As stated in his claim form on 23.12.2006, the vehicle was stolenfrom the parking area below his residence. An FIR was filed at the Panvel PoliceStation of Raigad district on 8.1.2007.

He intimated the theft to the Company on 18.1.2007. The Company vide letter dated18.1.2007 informed Shri Narayan Patil, that the claim was reported belatedly, thusdenying the company the opportunity to check the veracity of the claim. The belatedintimation thus constitutes breach of conditions 1 and 9 of the policy issued, renderingthe claim inadmissible. He was asked to clarify the reasons for the delay to see if theycould re-examine the aspect of admissibility of the claim on this count.Not satisfied with the decision, he represented to the company stating that his son hadinformed to the Panvel Police Station on 23.12.2006 i.e. on the same day when the carwas stolen. As per their practice, Police Officials advised him to search for the vehiclefor 10 to 12 days and only after that to register the FIR for the theft. Thus followingtheir advice, he searched the vehicle with the help of his friends and family but couldnot find it, hence finally police officials recorded his FIR on 8.1.2007. On the same dayhe intimated the facts of theft verbally to Shri Sandip Sharma of Vashi Branch and wasunder the impression that he must have intimated the company and hence there was adelay and he contacted the office belatedly on 18.1.2007.The Company vide letter dated 3.5.2007 informed Shri Patil, that the claim wasreviewed by the competent authorities, who resolved to reiterate the stand ofrepudiation as there were serious violations of the condition Nos.1 and 9 of the policy.Thereafter, the Advocate of the Insured Shri D.R. Shelke, on behalf of the insuredissued a Notice to the company on 17.5.2007. However, the company stated that theyare not liable for the demands made therein.Not satisfied with the decision, he approached the Ombudsman for intervention in thematter of settlement of his claim with the company.On an analysis of the records pertaining to the case, it is observed that there was atheft of the vehicle on 23.12.2006 and the insured lodged the claim on 18.1.2007. Thecompany had asked the Insured the reasons for the delayed intimation of 25 days apartfrom the delay of 13 days in intimating the police authorities. The complainant in replyhad admitted the delay on his part and attributed the same to lack of information on theclaim procedures. An Investigator, M/s One Point Services, was deputed by thecompany and he had confirmed the theft. The company repudiated the claim onaccount of violation of policy conditions, which stipulate that the insured shallimmediately intimate the insurer upon the occurrence of loss and in the event of theftor criminal act to immediately intimate the police which was not complied by theinsured. The Insured thereafter submitted a letter from the Panvel Police Station, whichstated that the complaint was lodged by him on 23.12.2006 and as the vehicle was nottraceable they registered the complaint on 8.1.2007.The Investigator has concluded that the insured has provided all the relevantdocuments of RTO and the vehicle was used by the Insured for personal use. It wasclear from the letter issued by the police subsequently that the complaint was lodgedby him on the day of the theft on 23.12.2006. Although the Insured has admitted thathe was not aware of the policy procedures and had informed the agent, in strict termsthere was a violation of policy condition as the company was not immediately informedwhich is necessary in case of theft claims. However, the police has issued asupplementary letter clarifying that the complaint was lodged with them on the day ofthe theft and the Insured had complied with all the other requirements and the reasonsmentioned for late intimation was dependent on the information given to the Agent. Inthe facts and circumstances, the total repudiation is set aside but the Insured shouldbear a penalty of 5% for not informing the company in time about the theft of thevehicle.

Cholamandam MS General Insurance Company Ltd, is directed to settle the claim ofShri Narayan Patil, in respect of his vehicle Tata Indica, to the extent of 95% of theadmissible claim. There is no order for any other relief. The case is disposed ofaccordingly.Mumbai Ombudsman CentreCase No. : GI-355 of 2007-2008Shri Narotam RoygagaVsUnited India Insurance Company LimitedAward Dated : 21.02.2008Shri Narotam Roygaga, had insured his vehicle Hyundai Santro LS(Euro II), with UnitedIndia Insurance Company Limited, under Private Car Package Policy for IDV ofRs.1,46,000/- for the period 30.8.2007 to 29.8.2008. The car was submerged in floodwaters on 26 th July, 2005 at Juhu, Mumbai.The Company settled the claim for Rs.3481/- against the repair of Rs.7337/- in full andfinal settlement of the claim. Not satisfied with the settlement, Shri Narotam Roygaga,represented to the company seeking details of deductions from the claim amount andstating that the amount was not acceptable to him. The company by its letter dated6.6.2007, informed him that at the time of transfer of insurance i.e. from New India toUnited India, they had imposed excess of Rs.1000/- and compulsory excess of Rs.500/-and that it was their normal practice to accept transferred business in such a manner.On taking up the matter with the company by this Forum, we have received a replywhich is quoted below:“As a measure of loss minimization, we are imposing excess in fresh motor insuranceor for the transferred business from the other insurers. We are also imposing excess incase of continuous claims by the Insured or for having preferred major claim.In the captioned case, excess was imposed since the business was transferred fromthe other insurer and it is our regular practice that whenever we impose excess, wealways inform the agent/Insured about it and after getting the consent either oral or inwriting, we accept the proposal. After getting the oral consent, this proposal had beenaccepted by us at that time. The imposed excess in the above matter was from theinception of the policy with them and continued thereafter as it was. The said excesscould have been removed, if the insured would have requested at the time of renewalor before the occurrence of loss. Since the Insured had not requested to remove theexcess on subsequent renewals, it was there in the policy till the current policy andbased on the excess in the policy, they have finalized and approved the claim”.Aggrieved with the decision, Shri Narottam Roygaga, approached the Ombudsman forintervention in the matter of settlement of his claim with the company.A joint hearing was held on 6 th February, 2008. Shri Narotam Roygaga, Complainant,appeared and deposed before the Ombudsman. He submitted that he had lodged aclaim and the company deducted Rs.1000/- as imposed excess and Rs.500/- ascompulsory excess from the claim. Earlier also when his car was damaged during July2005 floods in Mumbai there was a deduction of Rs.1500/- towards imposed andcompulsory excess. He stated that the policy does not give details as to why theimposed excess and compulsory excess is deducted.

Since underwriting aspect does not fall within the purview of the Ombudsman’sjurisdiction and moreover the Complainant has not raised the issue at the appropriatetime, accordingly the complaint is dismissed.Mumbai Ombudsman CentreCase No. : 338 of 2007-2008Shri Siddharth C. ParekhVsThe New India Assurance Co.Ltd.Award Dated : 28.02.2008Shri Siddharth C. Parekh, had insured his new vehicle Chevrolet Tavera, under PrivateCar Package with The New India Assurance Co.Ltd., for the period 27.9.2006 to26.9.2007 for IDV of Rs.8,81,941-. The vehicle was stolen during the night of8.10.2006 and morning of 9 th October, 2006, when it was parked at his residence atKhar, Mumbai, and he reported to the Khar Police Station and lodged an FIR No.393/06on 9.10.2006.The Company vide letter dated 26 th July, 2007 informed the Insured that the claim wassettled by them on non-standard basis @75% of IDV of the vehicle, on the ground thatthere was a delay of 38 days in intimating the loss to them, thereby jeopardizing thechances of recovery of the vehicle by their Investigator. His attention was drawn toPolicy Condition No.1, which states that notice shall be given in writing to the Companyimmediately upon occurrence of loss and asked him to accept their offer ofRs.6,59,706/- inspite of breach of Policy condition No.1 and to discharge the voucherand return the same to them to release the cheque at an early date.Not satisfied with the decision of the company, Shri Parekh represented to theGrievance Cell on 13.8.2007 asking the reason for deducting the amount ofRs.2,22,235/- from the claim of Rs.8,81,941/- and asked the company to reconsider hiscase and sanction the full amount of his claim. He refused to accept the claim amountand returned the discharge voucher to the company. He stated that it was the fault ofthe agent and that the agent had collected the claim form duly signed by him on 9 thOctober, 2006 and later on he took another claim form on 15.11.2006 on the pretextthat the earlier form was lost/misplaced and he had faxed the copy of FIR to theiroffice.Aggrieved by the decision of the company, the Insured approached the Ombudsmanvide his letter dated 15.10.2007 for intervention in the matter of settlement of his claimwith the company.Shri Biplab Roy, Investigator, in his Investigation Report dated 20.2.2007 hasmentioned that on 8.10.2006 at 9.45 p.m. the insured Mr. Parekh properly locked andparked his new car just 5 days old on the main road in front of his residence and thenext day early morning at 6 o’clock when he went downstairs he found that his car wasstolen. During investigation, he had collected the original invoice and other documentspertaining to the sale and delivery of the stolen vehicle and obtained certified copy ofRTO stating that the vehicle is stolen. During his interrogation with the security personof the residential building, he came to know that the insured had two more vehicles andsince there was insufficient authorized parking space inside, the insured had to parkthe vehicle outside the premises along the road where many other vehicles wereparked. The vehicle was not used for commercial purpose and the detection goes ingoodwill of the insured. After his enquiry with all concerned and through all theavailable documents obtained by him, it was revealed that the vehicle had been stolenfrom the roadside parking place in front of insured’s residence and that it was a

genuine claim. Later Khar Police Station investigated the same but they could notrecover the vehicle till date. The insured vehicle was not found and the police hadgiven the final report stating that there are no possibilities of getting the vehicle.On an analysis of the records, it is observed that the vehicle was stolen on 8 th October,2006 and the insured lodged the claim after 38 days. The company settled the claim onNon-standard basis @75% of IDV of the vehicle on the ground that there was a delayof 38 days in intimating the loss thus jeopardizing the chances of recover of the vehicleand had sought his explanation for the delay. During the hearing the complainantstated that on the day of the theft he had called the agent and filled the claim form andfaxed a copy of the FIR to the company and the Agent assured him that the claimwould be delivered to the company. When he called up the company after a few days,he came to know that the claim form was not received and thereafter the agent gotanother claim form filled by him and submitted the same to the company. He statedthat he had completed all the formalities in good faith and all along the agent could notbe contacted. The Investigator has concluded that the insured has complied with all therequirements and the vehicle was used by the Insured for personal use and the claim isgenuine Although the Insured has stated that he had informed the agent, in strict termsthere was violation of policy condition as the company was not immediately informedwhich is necessary in case of theft claims. However, the reasons given for lateintimation to the Insurance Company was dependence on the information given to theAgent.In this case, the Insured has failed to intimate the insurer immediately denying themthe opportunity of recovery of the vehicle. However, a penalty of 25% does notcommensurate with the non-compliance of the policy condition, instead a penalty of 5%is imposed to the insured for not informing the company in time about the theft of thevehicle.The New India Assurance Co.Ltd., is directed to settle the claim of Shri SiddharthParekh, in respect of his vehicle Chevrolet Tavera, to the extent of 95% of theadmissible claim. There is no order for any other relief. The case is disposed ofaccordingly.Mumbai Ombudsman CentreCase No. : GI-297 of 2007-2008Shri Roopesh C. ShahVsUnited India Insurance Company Ltd.Award Dated : 07.03.2008Shri Roopesh C. Shah, had taken a Motor Policy from United India Insurance CompanyLtd., to cover his vehicle Maruti Zen, for IDV of Rs.2,36,000/- under Private CarPackage Policy for the period 18.8.2004 to 17.8.2005. Shri Roopesh C. Shah, intimatedto the company on 2.8.2005 that his vehicle got damaged due to heavy rains on26.7.2005 near his residence. The Company informed Shri Roopesh C. Shah, that theclaim is treated as No Claim as the “policy was in the name of Shri Roopesh Shahwhereas Registered in the name of Shri Vilas Shirke”.Not satisfied with the decision, Shri Vilas Shike, the Registered owner of the vehicle asper the RC Book represented to the company vide letter dated 30.4.2007 requestingthe company to send the claim form/discharge voucher for his signature and to releasethe amount of claim in favour of Shri Roopesh C. Shah, the present owner of the car.Thereafter vide letter dated 26.7.2007, Shri Roopesh C. Shah, approached the

Ombudsman stating that the claim was rejected by the company on the ground that thevehicle was not registered in his name. However, the previous owner Vilas Shirke, alsowrote to the company stating that the claim can be paid to him, being the registeredowner of the vehicle in R.T.O. records but there has been no reply from the companyinspite of follow-up. He had paid two yearly premiums and agreement was madebetween himself and the seller on 18.6.2004. He requested the intervention of theOmbudsman in the matter of settlement of his claim alongwith interest with thecompany.The company in their detailed written submission to this Forum had stated the Insuredhad submitted the final bill of repairs quite late on 2.8.2006 after sending 3 remindersfor the compliance of the required documents, but the insured did not submit theoriginal R.C. Book for verification. Hence they appointed an Investigator, Shri SunilDhavan to collect the extract of Registration Book from R.T.O. As per his report andRTO’s record the name of the registered owner is Shri Vilas Shirke and not in the nameof the Insured. It was contradictory and ambiguous to decide Insurable Interest,especially when Registered Owner on the date of accident was found not to be theInsured and the Insured/Claimant found not to be the registered owner of the vehicle.Hence the claim was rejected and was duly informed to the claimant on 16.4.2007.On analysis of the records, it is observed that Shri Roopesh C. Shah, had purchasedthe vehicle from Shri Vilas Shirke on 18.6.2004 and had insured the vehicle with UnitedIndia as per proposal dated 16.8.2004. The vehicle was damaged due to flood on26.7.2005 and Shri Roopesh C. Shah submitted a claim to the company on 2.8.2005. Inthe proposal form Shri Roopesh Shah, had mentioned that the vehicle is beingtransferred in his name and he had not declared that the vehicle was hypothecated. Inthe proposal form, he had submitted the details of previous insurer as United IndiaInsurance Co, Vashi, with policy number and period of insurance from 18.8.2003 to17.8.2004. The company has submitted that even after sending reminders, the Insureddid not submit the original R.C. Book for verification. Hence they appointed theInvestigator to collect the extract of Registration Book from RTO from which it wasnoted that the registered owner of the vehicle was Shri Vilas Shirke and not theinsured. Although Shri Roopesh Shah, had insured the vehicle in his name, he had notsubmitted the original R.C. Book for verification and the company was not in a positionto know that the vehicle was not transferred in his name.Motor Insurance is governed by All India Motor Tariff, which is in line with MotorVehicles Act, which is a Statutory Act and compliance with the provisions of the Act ismandatory. In this case, there was a violation of the motor tariff guidelines regardingtransfer of vehicle. As per Policy Condition the owner has to be the registered owner ofthe vehicle and Insured name in the policy. In terms of the above provision, thecompany’s decision to repudiate the claim on the ground that the Insured, ShriRoopesh Shah, was not the registered owner of the vehicle, is held sustainable. In thefacts and circumstances, the claim of Shri Roopesh C. Shah, in respect of damage tohis vehicle under Private Car Package Policy for the period 18.8.2004 to 17.8.2005 isnot tenable. The case is disposed of accordingly.Mumbai Ombudsman CentreCase No. : GI-782 of 2006-2007Shri J.V.R. BhattaVsICICI Lombard General Insurance Company Ltd.

Award Dated : 18.03.2008Shri J.V.R. Bhatta, Complainant was approached by ICICI Lombard General InsuranceCompany Ltd., representative for Car Insurance for which he issued a premium chequedated 18.9.2006 for an amount of Rs.3107/- and submitted the proposal form to coverhis car Maruti 800 DX, Vehicle.As he did not receive the policy, he wrote to the Company stating that he visited theinsurance counter on 6.10.2006 as he had not received the policy but he was informedthat the cheque was bounced and hence the policy could not be issued.Aggrieved with the company, Shri J.V.R. Bhatta, approached the Ombudsman statingthat his car insurance policy was expiring on 30.9.2006. As some official from ICICILombard General Insurance Co.Ltd., personally approached him, he agreed to take afresh policy from them and issued a cheque for Rs.3107/- on 18.9.2006. He wasinformed that he will get the policy within next 10 days, however, he did not receive thepolicy. He personally approached their outlet in ICICI Bank, Vashi on 3.10.2006 andwas informed that his cheque was bounced and hence the policy was not issued. Butthe actual fact was that the cheque was credited to ICICI Lombard and they had noteven issued the cover note, though the amount was credited to their account on27.9.2006. He asked the company to refund his money as he did not want the policy.As nothing moved, he had to get a policy to run his car, hence he approached BajajAllianz and obtained a motor policy. He requested the intervention of the Ombudsmanfor refund of his money with penal interest as the matter was still not resolved.As per the company, the policy was delivered by courier to the Insured at the addressgiven by him in the proposal form but the courier came back twice mentioning “personalready shifted”. The company has provided the proof of dispatch of the policy to theinsured by DTDC Courier. However, a scrutiny of the photocopy of the POD revealsthat there is no date of dispatch/return or remarks thereof and the company has notcome forth with any documentary evidence to substantiate their stand. When theinsured approached the company for return of premium on 24.11.2006, they insisted forthe policy copy taken with any other company and on 15.2.2007 when the insuredproduced a copy of policy issued by Bajaj Allianz, they cancelled the policy andrefunded the prorata premium as per rules of GR 12 of IMT of Rs.919/- vide chequeNo.422424.Pursuant to the Hearing, the Insured has enclosed copies of Electricity bills for themonths of September and October 2006, to prove that he was residing at the address,where the policy was dispatched by courier. He has stated that he wrote to thecompany on 24.11.2006 asking for refund of premium as he had taken a policy withBajaj Allianz which was personally given at the counter at Vashi Branch which wasinitialed, but they did not put their seal on the copy of his letter. He was againapproached by the company’s representative for a copy of the policy and he gave thecopies of cover note and policy taken from Bajaj Allianz to him on 16.12.2006 andmade a note on the copy. He has also enclosed a copy of the email wherein thecompany had again asked him to submit the proof of policy taken with another Insureron 26.6.2007 although they confirmed during the hearing that the proof was receivedby them on 15.2.2007 and the refund endorsement also shows effective date as15.3.2007.The analysis of the complaint reveals that the cover note was issued by ICICI Lombardon 1.10.2006 covering the risk of the vehicle for the period 1.10.2006 to 30.9.2007.The copy of Cover Note was not provided to the Insured, inspite of his personal follow

up with the company. The company has not confirmed whether the cover note wasissued to the Insured nor produced proof of delivery of the policy to the Insured tosubstantiate their stand that they had sent the policy by courier. As the Insured couldnot use his car without a valid insurance policy, he had no other alternative but tosubsequently approach another Insurance Company on 19.10.2006 for a motor policyand hence he requested ICICI Lombard to refund the premium vide his letter dated24.11.2006. The Insured was kept in the dark all along as he was informed that thecheque bounced despite being encashed, copy of cover note was not produced to himand inspite of informing him that the policy was sent by courier he had not received thesame and probably due to a deficiency on their part, they agreed to refund the premiumon prorata basis from the date of his submitting proof of policy taken from anotherInsurance Company i.e. 15.2.2007. The company could not produce any convincingdocuments to prove that the Insured’s vehicle was covered under the policy byfurnishing him with a copy of the cover note nor proof of delivery of the policy sent tohim and hence the company should refund the premium on prorata basis from the dateon which the Complainant requested for refund of the premium i.e. 23.11.2006 withinterest as prescribed by IRDA to resolve the dispute.ORDERICICI Lombard General Insurance Co. Ltd., is directed to refund the premium onprorata basis from the date of his request for refund of premium i.e. 23.11.2006 (asanother policy was taken w.e.f 19.10.2006) with interest as prescribed by IRDA aftertaking into consideration the prorata premium already refunded in respect of thevehicle of Shri J.V.R. Bhatta. There is no order for any other relief. The case isdisposed of accordingly.Mumbai Ombudsman CentreCase No. : GI-415 of 2007-2008Shri Paresh C. ShahVsUnited India Insurance Company Ltd.Award Dated : 31.03.2008Shri Paresh C. Shah, had taken a Private Car Package Policy from United IndiaInsurance Company Ltd., to cover his vehicle Hyundai Tavera, for IDV of Rs.5,29,000/-for the period 20.10.2005 to 19.10.2006. The vehicle was stolen on the night of14.5.2006 when it was parked outside his office at Goregaon(W).The Company vide their letter dated 22 nd March, 2007 requested the Insured to complywith the necessary documents/records and also to let them know whether he washaving other vehicles apart from this vehicle. It was observed from the Profit & LossA/c as on 31.3.2006 that an amount of Rs.9,22,706/- was shown as income on ‘hirecharges’ and he was asked to explain the source of income under this heading.The Company instituted an enquiry through M/s Smart Investigators, who submittedtheir Report on 22.1.2007 to the company and thereafter obtained a legal opinion fromM/s KMC Legal Venture, and on the basis of their findings dated 11.4.2007, thecompany repudiated the claim as the vehicle was used in contravention of the‘limitation to use’ clause of policy.Not satisfied with the Company, Shri Paresh C. Shah vide his letter dated 3.7.2007represented to the Regional Office of the Company which was turned down. Aggrieved

with the company, he approached the Ombudsman for intervention in the matter ofsettlement of his claim with the company.M/s KMC Venture, in the Legal Opinion had stated there are chances of success by theInsured only if he proves in evidence that the subject vehicle was not stolen during thetime that the same was not subject to hire and reward.It is a common knowledge that the vehicles like Toyota Qualis, Tata Sumo etc., whichare 7 seater vehicles are generally being used for ‘hire and reward’ and the Insured isalso in the business of travel and tours and this fact has been corroborated in theProfit & Loss Statement, records provided by the Company and the findings in theInvestigation Reports that the Vehicle was being used for commercial purpose inviolation of the terms and conditions of the Insurance Policy. It is also noted that thevehicle was parked near the office and not at the residence and the key was kept in theoffice. As per the Registration Certificate the vehicle was hypothecated to Citi Bank,but no copy of agreement was produced as regards use of the vehicle. The Insured hasalso not provided any documentary evidence to substantiate his stand that the vehiclewas used for his personal use.This Forum has got limited authority under the RPG Rules 1998. It can only hear theparties at dispute without calling fresh witnesses, summon them for deposition, ask forvarious evidences including cross-examining outside parties which is beyond the scopeof this Forum. In order to resolve the issue, calling other witnesses may help in arrivingat a decision. Under this circumstances, the complaint is closed at this Forum with aliberty to the Complainant to approach some other Forum to resolve the dispute.