Chandigarh
The Chandigarh Consumer Forum has directed an insurance firm to pay Rs 52,000 to a city woman for rejecting her insurance claim on SUV tyres which were stolen.
Neetu Rani of Sector 21, Chandigarh, stated that she got her vehicle (Scorpio) insured for the period from October 21, 2015, to December 2, 2015, through National Insurance Company.
Rani alleged that on the intervening night of December 2 and 3, 2015, the left hand side two tyres of the vehicle were stolen when it was parked outside her house. The police station as well as the insurance firm were intimated on December 3, 2015. After this, an FIR was registered regarding the theft. Rani stated that she was asked to supply a copy of the FIR along with the untraceable report. The complainant moved an application to the police in 2017 under RTI for obtaining a copy of the FIR and the non-traceable report. Thereafter, she submitted the copy of the FIR, untraceable report on July 21, 2017, and the estimate of loss to the tune of Rs 47,000 prepared by Swami Automobiles to the insurance company. However, the insurance firm rejected the claim on August 11, 2017, on the grounds of delay in lodging the FIR. The complainant filed a formal complaint in the forum on July 29, 2019.
The National Insurance Company in reply submitted that they were informed on December 3, 2015, regarding the loss of the tyres and they immediately appointed a surveyor and loss assessor. However, the complainant has violated the terms and conditions of the insurance policy as the FIR was registered after a delay of one year and 26 days from the alleged date of loss. Therefore, the claim was rightly rejected on August 11, 2017.
After hearing the arguments, the forum held that the complainant has tried her level best and did everything whatever she can do to get the genuine claim but despite all this, the insurance company preferred to reject the claim.
“The insurers decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time. The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured,” the forum held.
The forum directed the insurance firm to refund Rs 35,292 as assessed by the surveyor to the complainant along with interest at 9 per cent per annum from the date of rejection of the claim, along with Rs 7,000 as compensation and Rs 10,000 as litigation expenses.
