Miscellaneous Policy (General) - Gbic.co.in

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Taking into consideration all the records available in the file and also the contentions of theparties concerned, the Ombudsman ruled that the Insurer could not take a decision forwant of satisfactory proof as to the cause of death. In the absence of any concreteevidence to prove otherwise, the cause of death can be attributed to accident. Thecomplainant is entitled for the amount as per the policy conditions. Setting aside thedecision of the respondent, this Authority directs the Insurer to release the sum insuredwithin 15 days from the date of receipt of this order.As for his claim for interest, this Authority does not find any justification to allow hisprayer, as he was also equally responsible for the delay in taking a decision on his claim.In the above premises the complaint is disposed of as above.Kochi Ombudsman CentreCase No. IO / KCH / 11 / NIC / 22 / 2004 - 05M/s Kerala StateCo-op Rubber Marketing Federation LtdVs.National Insurance Co.Ltd.Award Dated 16.11.2004Consequence of partial repudiation and adjustment of claim amounts for alleged short fallin insurance premia by the Insurer under two separate claim – one relating to a flood in thegodown of the insured and the other in relation to a burglary in a separate godown. Theinsured had claimed Rs. 7.74 lakhs for both the claims together. However, the surveyors ofthe Insurer had assessed the claim at Rs. 2,15,964/- only. Even this amount of Rs.2,15,964/- was not paid to the complainant by the Insurer stating that there was a short fallin the premium collected by them earlier and so the amount was adjusted towards the saidshort fall. On a perusal of the records, it was found that the Insurer had originally underquoted the rate so as to secure the business, which resulted in a complaint by anotherInsurer before the Tariff Advisory Committee, and the TAC had asked the respondentcompany to set right the mistake. Obviously, the complainant was not responsible for themess created by the Insurer and there was no meaning in asking the complainant to makegood the short fall in an as much the Insurer had done it intentionally as proved by thecircumstances. Consequently, the Insurer was asked to settle the claim to the complainantas computed by the surveyors and suffer the shortage of premium themselves as thecomplainant was not responsible for the muddle created by the Insurer.Kochi Ombudsman CentreCase No. IO / KCH / GI / 11-002-037 / 2004 - 05Shri K. V. SebastianVs.New India Assurance Co.Ltd.Award Dated 19.11.2004The Complaint under Rule No. 12(1)(b) read with Rule 13 the RPG Rules, 1998 relates tothe repudiation of a Marine – Hull claim by the Respondent Insurer. The Vessel MFVKUNNEL was insured with the respondent and during the period of insurance coverage, itwas capsized in the rough sea near Chellanam on 03.04.2002. The Insurer repudiated theclaim invoking a number of technical points like (1) the rules regarding regulation andlicencing was violated (2) the vessel was altered and fitted with an engine after insurance(3) the fitting of the engine after the insurance was not registered with the Fishingauthorities etc. However, on verification of the records, it was clear that the Complainanthad informed the Insurer about fitting of an engine and the Insurer’s surveyor hadinspected the vessel and certified it as sea worthy with the Engine No. etc. duly quoted inthe report. The surveyor had also given a valuation of Rs. 6,00,000/- for the vessel (Rs.3,00,000/- for the Engine + Rs. 3,00,000/- for the other accessories). Now when a claim
had arisen, the, Insurer was troubling a semi-literate person with all technical requirementsabout which they could have enlightened him when the vessel was inspected by theInsurance Surveyor after the engine was installed. However, ignorance being no excuse inlaw and some contributing negligence having been found on the complainant also, theclaim was allowed as Ex-gratia (non-standard) to the extent of Rs. 2,00,000/-.Kochi Ombudsman CentreCase No. IO/KCH/GI/11/NIA/51/2004 - 05Ms. Zareena Akbar AliVs.New India Assurance Co.Ltd.Award Dated 02.12.2004The Complaint under Rule No. 12(1)(b) read with Rule 13 the RPG Rules, 1998 relates to aGroup Policy Covering member of Asianet Satellite Communications Ltd, which promiseda sum of Rs. 50,000/- on the death of a member during the currency of the policy. Theinsurance was arranged through the Respondent Company. The Insured Shri Akbar Ali diedin a road traffic accident on 21.01.2003. The claim was rejected by the Insurer for thereason that the subscription of late Akber Ali was in arrears for about 8 months as on thedate of his death. As per the enrolment form received by the Insurer on 20.9.2003, theSubscription covering a period of 8 months up to August 2003 was sent to the Insurer inone lot. The accident being on 21.01.2003, the enrolment form as well as the remittance ofsubscription was received only the date of death of Shri Akbar Ali and the Insurer has noliability under the Policy. Thus the complaint having been found devoid of merits wasdismissed.Kochi Ombudsman CentreCase No. IO/KCH/GI/11-005-054/2004 - 05M/s Popular Vehicles & Service LtdVs.Oriental Insurance Co.Ltd.Award Dated 06.12.2004The complaint under Rule No. 12(1)(b)read with Rule 13 the RPG Rules, 1998 was inconsequence of partial repudiation of claim by the Insurer. The insured had claimed Rs.145565.69 as compensation for the damage he had sustained. However, the Respondenthad allowed only Rs. 1,00,755/- disallowing Rs. 11195/- being the profit margin. Thecomplainant approached this Forum praying to reopen the case and allow the towingcharges and other expenses incurred by them in full.The Insurer contented that as per the policy conditions the maximum amount allowable astowing charges is Rs. 2500/- and they have allowed it in full. As the popular Automobiles,Trichur is sister concern of the complainant, they have deducted Rs. 11,195/- from thegross amount payable as the profit margin.Taking into consideration all the records available in the file and also the contentions of theparties concerned, the Ombudsman ruled that the Popular Automobiles and PopularVehicles & Service belong to the same person, the accounts are kept separately and theirassets and liabilities are not interchangeable. As such the Respondent’s action indisallowing profit margin of Rs. 11195/- is untenable. Therefore, partially setting aside thedecision of the Insurer this Authority directs the respondent to pay Rs. 11,195/- inadditional to Rs. 1000/- already agreed to by them.Kochi Ombudsman CentreCase No. IO/KCH/GI/11-005-068/2004 - 05Shri A. George
Page 1 and 2: Miscellaneous Policy (General)Ahmed
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 16 and 17: the loss at Rs. 5,03,120/- which in
Page 18 and 19: expressed his inability to produce
Page 20 and 21: only for a day or two and the exten
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
Page 30 and 31: Not getting any response from the C
Page 32 and 33: Award Dated 14.12.2004Shri Bahadur

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