Miscellaneous Policy (General) - Gbic.co.in

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the loss at Rs. 5,03,120/- which includes the commission paid by the insured to the sellerto the tune of 300 % on the invoice cost. The Insurer rstricted their liability on the basis ofinvoice cost plus freight (deleting the commission portion) and sent the voucher for Rs.1,57,568/-. The insured objected for releasing the claim voucher for a reduced amount andrequested the Insurer to settle the full amount. He also pointed out that the surveyorapplied an uniform rate of Rs. 760/- per piece whereas the items stolen was finishedleather also and its cost was around Rs. 1,320/- per piece.The insured approached this Forum with a request to consider his claim. A joint hearingwas conducted. With regard to the value of finished leather and the quantity lost it wasnoticed that there was a prima - facie evidence that the insured lost finished leather alsoapart from hide leather. Hence a direction was given to the Insurer to get an expert opinionon this matter and decide the case accordingly.With regard to the commission of 300 % said to have been paid, it was noticed that thesame sum insured was taken under fire and burglary policy. The sum insured of Rs. 55lakhs was not the value at risk on all the days and the value will vary from 0 to 55 lakhs.Just because there was a balance sum insured available, it could not be argued that otherexpenditure relating to procurement of stock were included in the value. The proposal formsubmitted by the insured at the time of inception of the policy did not mention anythingabout the same. It is noted that the purchaser have procured the leather at a lesser invoicecost facilitate the seller to pay a reduced sales tax and the balance was paid by way of acommission by the purchaser. This kind of clandestine transaction should not be basis onwhich the insured raised his demand for the balance amount. Therefore the insurer’s actionof restricting their liability, omitting the commission portion cannot be faulted.Chennai Ombudsman CentreCase No. 11.03.1275 / 2004 - 2005Mr. M. Harichandra RajuVs.The New India Assurance Co. Ltd.Award Dated 4.2.2005Mr. M. Harichandra Raju took a Rasta Aaptti Kavach Policy for the period 27.1.2003 to26.1.2004. The sum insured under Section I (PA cover) was Rs. 1 lakh and under Section II(Medical expenses for bodily injury caused by and arising out of road accident) was Rs. 1lakh. It was reported that when the insured was travelling a pillion rider in his motor cycle,the rear tyre of the motor cycle said to have been burst as a result of which the motor cycleskidded and both the rider and the insured fell on the road. The insured preferred a claimfor the hospitalisation expenses with the Insurer and the same was rejected by them on theground that the medical expenses resulting solely and directly from road accident whichwould normally give rise of third party claim under motor policies / Motor Vehicles Act onlywill be covered.The insured approached this Forum with a plea that the injuries suffered was directly andsolely due to the road accident and the Investigator appointed by the Insurance Companyalso verified and confirmed that the injury sustained was due to accident.The provision under the policy makes the position clear that an individual can be coveredand skidding of vehicle resulting in bodily injury to such an individual will also come withinthe cover offered under the policy. If the policy covers the above risks specifically, then theargument of the Insurer that the insured cannot claim for his own negligence under theRasta Aaptti Kavach policy lost its sanctity. Road accident, which would normally give riseto a third party claim, does not mean that the accident should essentially given rise to athird party claim. The medical records produced by the complainant to the InsuranceCompany and the Investigation Report proved beyond doubt that the accident resulted tothe injury and the the complaint was allowed for a sum insured of Rs. 1 lakh.
Chennai Ombudsman CentreCase No. IO (CHN) / 11.2.1343 / 2004 - 05Mr. RavikumarVs.The New India Assurance Co. Ltd.Award Dated 10.3.2005Mr. Ravikumar insured his personal computer under Electronic Equipment Policy with TheNew India Assurance Company Limited, Coonoor Branch Office for the period from17.6.2003 to 16.6.2004. It is reported that on 2.10.2003, his personal computer (Pentium 2)went out of order. The insured produced an estimate from the repairer for Rs. 16,725/- andinsisted that he is entitled for total replacement of computer. The hard disc, CPU and RAMwere in working condition. The surveyor appointed by the Insurance Company assessed theliability of the Insurer at Rs. 11,925/-. The insured did not agree with the recommendationof the surveyor who demanded replacement of computer with the improved version ofPentium 4. The insured argued that Pentium 2 model and its accessories become obsoleteand hence there is no other go for him than to going for replacing the damage computerwith Pentium 4. The Insurer appointed a second surveyor who assessed the loss at Rs.6,677/-, keeping in mind the replacement of the computer by a better model. A joint hearingwas conducted.The second surveyor, after considering the betterment involved, has applied 50 %deduction for processor and the mother board. This kind of deduction, as worked out by thesecond surveyor, is not envisaged under the policy - because the surveyor assessed onlyfor the loss of some individual parts and not treating the loss as total loss for the unit as awhole The insurer’s explanation for sending the second surveyor is totally unacceptable.Section I of the policy makes the position clear that the Insurer has the option for paymentof loss in cash. In other words, the insured will have no option to insists the Insurer thatthey must adopt only a particular method of loss assessment. The insured decided to go infor a new model as the old model became obsolete and parts were not available in themarket. Further, the processor, mother board and modem only were damaged and not otherparts. Hence, this forum come to the conclusion that this loss will not fall under “total lossof the unit category” - but to be treated as partial loss only. Hence direction was given tothe Insurer to process the claim as per the recommendation of the first surveyor along withthe service charges of Rs. 900/- paid for monitor, which was documentarily proved by theinsured.The surveyor applied the excess provision of Rs. 2,500/- treating the claim as total loss.This was also questioned by the insured. As the claim is considered under the partial losscategory, the correct excess to be deducted would be only Rs. 1,000/- as per policycondition. Accordingly, the claim payable was calculated.Chennai Ombudsman CentreCase No. IO(CHN) 11.4.1362 / 2004 - 05Mrs. Savithri VasudevanVs.United India Insurance Co. Ltd.Award Dated 15.03.2005Shri Vasudevan has availed House Holders insurance Policy for the period from 17.11.2002 to 16.11.2003 with United India Insurance Company Limited. Under Section III ofthe policy (All Risk), the insured covered jewellery and valuables for a sum insured of Rs.2,23,600/- and one of the items covered was Navarathinam ring for Rs.13,000/-During the month of June 2003, the insured preferred a claim for the loss of one diamondstone, which was red in the ring. The claim form signed by the party confirmed that thediamond stone in the ring was lost due to theft. The Insurer vide their various lettersrequested the insured of produce a copy of the FIR and missing certificate. The insured
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Page 4 and 5: Complainant failed to submit the af
Page 6 and 7: Bhubaneswar Ombudsman CentreCase No
Page 8 and 9: insurance cover was given on the ba
Page 10: conditions of the policy were not f
Page 14 and 15: Chennai Ombudsman CentreCase No. IO
Page 18 and 19: expressed his inability to produce
Page 20 and 21: only for a day or two and the exten
Page 22 and 23: Taking into consideration all the r
Page 24 and 25: Vs.Oriental Insurance Co.Ltd.Award
Page 26 and 27: Kochi Ombudsman CentreCase No. IO/K
Page 28 and 29: the Company repudiated the claim on
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Page 32 and 33: Award Dated 14.12.2004Shri Bahadur

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