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Claims Bazaar

12 months ago

BIMA SUGAM- INSURANCE EXCHANGE- what a disruption? Newer disruptions will follow ... See MoreSee Less

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Claims Bazaar

1 years ago

Claim can't be avoided by suppressing vital reportNATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHIFIRST APPEAL NO. 207 OF 2012(Against the Order dated 03/02/2012 in Complaint No. 84/2006 of the State Commission Maharashtra)1. NATIONAL INSURANCE CO. LTD.National Insurance Co. Limited., Ambar Plaza, Opp. S.T. Stand, Station Road,Ahmednagar-414001Versus1. M/S. NITIN INDUSTRIES & ANR.Through its Proprietor, Shri Nitin Champalal Bora, R/o Yashwant Colony,Ahmednagar- Maharastra2. AHMEDNAGAR MERCHANTS CO-OPBANK LTD.,Gulmohar Road, Branch, Opp. Civil Hospital, Saveeli Road,AHMEDNAGAR-414001 Mahasrastra...........Appellant(s)BEFORE:For the Appellant :For the Respondent :Dated : 24 May 2022Mrs. Nanita Sharma, Advocate Mr. Faeek-Ul-Farook, AdvocateFor the Respondent No.1 :For the Respondent No.2 : Mr. Nitin Bora (In Person) Ex-ParteORDERHON'BLE MR. C. VISWANATH,PRESIDING MEMBER HON'BLE MR. JUSTICE RAM SURAT RAM MAURYA,MEMBER...........Respondent(s) 1. The present Appeal is filed against the order dated 03.02.2012 passed by Maharashtra State Consumer Disputes Redressal Commission, Circuit Bench at Aurangabad (in short ‘State Commission’) in Consumer Complaint No.84 of 2006 whereby the Consumer Complaint filed by the Complainant/Respondent No.1 was partly allowed.-1-2. Alongwith the First Appeal, IA/2/2012, an application for condonation of delay has also been filed by the Appellant. In the application, the Appellant had not mentioned the number of days of delay. As per computation done by the Registry, there is a delay of 36 days. For the reasons stated in the application and in the interest of justice, IA/2/2012 is allowed and delay condoned.3. Complainant/Respondent No.1 is a proprietorship firm engaged in the business of plastic reprocessing. Appellant/Opposite Party No.1 is National Insurance Company. Respondent No.2/Opposite Party No.2 is Ahmednagar Merchant Co-op Bank.4. Case of the Complainant is that they took Standard Fire & Special Perils Insurance Policy No.271900/11/03/31/02847 for the period 10.03.2004 to 09.03.2005 for Rs.29 lakhs insuring the following:i. Buildingii. Machineriesiii. Stock of plastic goods,raw materials & finished goodsRs.5 lakhs Rs.8 lakhsRs.16 lakhs -------------------------Total Rs.29 lakhs -------------------------On 30.07.2004 at about 10.45 am, there was loud sound in the electric transformer in front of the factory premises. Proprietor of the Company came out of the factory and noticed that there was sparking from the transformer. He immediately returned to the factory and found that main switch of the factory burst causing huge sound and fire. The stock of plastic kept in the factory premises caught fire and the fire spread rapidly. He immediately called the Fire Brigade, which took many hours to extinguish the fire. The Complainant also intimated the Insurance Company. The Insurance Company deputed Mr. Thombre as Surveyor, who inspected the factory premises on 31.07.2004. The Surveyor sought Fire Brigade Certificate, FIR, Panchnama, Certificate of the Electrical Inspector, Income Tax Returns, Books of Account, Stock Books, Statement of Account and the documents of hypothecation etc. On 28.06.2005, the Insurance Company repudiated the claim of the Complainant on the ground that it was a fraudulent claim. The Complainant approached the Insurance Ombudsman. Though on 17.03.2006, the Insurance Ombudsman allowed the claim, on 31.03.2006, the claim was dismissed as non-sustainable. The Insurance Ombudsman, vide order dated 31.03.2006, clarified that as in the earlier order the word “None” remained un-typed, he replaced it. Aggrieved by dismissal of the claim, the Complainant filed Complaint before the State Commission with the following prayer: --2-“This Hon’ble commission direct, order/decree that the Opposite Party Insurance Company, to pay a sum of Rs.26,00,000/- (Rupees Twenty Six Lacs only) together with interest @ 18% from 30.07.2004 till payment and/or realization.”4. The State Commission after hearing the proprietor of the Complainant in person and the Learned Counsel for the Opposite Parties and perusing the record, partly allowed the Complaint with the following order: -“1. Complaint is partly allowed.2. Opponent Insurance Company is directed to pay Rs.13,30,000/- with 9% interest from the date of repudiation of the claim i.e. 28.06.2005 within a period of 30 days from the date of receipt of copy of this order, failing which the opponent shall be liable to pay the interest @ 9% p.a. on the entire amount due on the d ate of order till the realization of the entire amount.3. Opponent is directed to pay Rs.10,000/- for mental agony and Rs.5,000/- as cost of the complaint.”5. Aggrieved by the impugned order of the State Commission, the Opposite Party/Insurance Company has filed the instant First Appeal with the following prayer: -“(a) set aside the order and judgment dated 03.02.2012 passed by the Hon’ble State Commission, Mumbai Circuit Bench at Aurangabad in Complaint Case No.84/2006.(b) Pass any other order or orders as may be deem fit and proper in the interest of justice.”6. Heard the Learned Counsel for the Appellant and Respondent No.1 and carefully perused the record. This Commission, vide order dated 08.03.2022, observed that Respondent No.2 was not present on 04.11.2019, 20.01.2020, 11.08.2020 and 08.03.2022. Respondent No.2 was, therefore, proceeded ex-parte. Learned Counsel for the Appellant submitted that the State Commission failed to appreciate that the claim filed by the Complainant was fraudulent. The Appellant, on the basis of the documents submitted by the Complainant as also the Survey Report, repudiated the claim of the Complainant, vide letter dated 28.06.2005. The Insurance Ombudsman also, vide order dated 31.03.2006, dismissed the claim. The State Commission failed to appreciate the fact that the claim was covered under exclusion clause 8 of the Insurance Policy that in case of fraudulent claim, the Insurance Company would not be liable to honour it. He submitted that report of the Maharastra State Electricity Board dated 10.01.2005 showed that on 30.07.2004,😚there was no explosion in the transformer and there was no fire in the Complainant factory premises.7. Proprietor of Respondent No.1/Complainant submitted that the Appellant had not filed any document to establish that the claim filed by the Complainant was fraudulent. The incident of fire was also investigated by Thombare and Company. The Opposite Party totally ignored the investigation report and accepted the Surveyor’s Report. The Surveyor had not mentioned the cause of fire. The Survey Report regarding cause of action was, therefore, not acceptable. The Opposite Party on the basis of the Survey Report observed that the incident of cause of fire was concocted and repudiated the claim, which was not justified. There was, thus, no violation of clause 8 of the Insurance Policy. The Impugned order was justified and the Appeal deserved to be dismissed.8. It is admitted that the Complainant had taken an Insurance Policy from Opposite Party No.1. On the date of the incident, the Policy was effective. The incident of fire is also not disputed by Opposite Party No.1. The cause of fire is disputed by the Insurance Company. In this regard, the observation of the Surveyor is relevant, which reads as follows: -“We disagree with Insured’s approximation as regards to the proximate cause. The exact cause could not be ascertained.We have discussed the issue i.e. the exact origin of fire, spread or travel, if any of fire and finally the proximate cause is discussed separately elsewhere....REMARKS2) The origin of fire and the proximate cause could not be ascertained.”9. From the above, it is clear that the Surveyor observed that the exact cause of fire could not be ascertained. Surveyor also observed that the proximate cause was discussed separately elsewhere. This Commission, vide order dated 06.06.2017, passed the following order: -“It transpires that it is not clear whether there are two reports, one by the Surveyor and one by the Investigator. Counsel for the Appellant seeks time to obtain clarification on this and submit a copy of the investigator report, if such a report exists.”10. In compliance of the order dated 06.06.2017, the Appellant/Insurance Company filed a copy of the Investigation Report by the same Surveyor, wherein it was observed as follows: -“A) The M.S.E.B. transformer installed to feed the electricity to Nitin Industries developed technical snag causing fluctuation in current and sparking on 30.07.2004 this snag further percolated to the domestic switch-4-board in the premises of the factory causing short circuit, sparks and big noise. The sparks caused fire to the board up and engulfed the entire factory premises fanned by the blowing wind.😎a)b)technical fault.c) There was a recurring technical snag causing fluctuations in current and sparks in the M.S.E.B. transformer.d) The raw material used in production was highly inflammable which rapidly caught fire due to sparks emanating from the switch board....We conclude that the fire was accidental.”11. In the aforesaid report the Surveyor had specifically observed that the fire was accidental. The aforesaid report is a vital document on which the entire case rests. It appears that the Insurance Company deliberately tried to conceal the separate report submitted by the Surveyor regarding cause of fire and did not file the same alongwith the Appeal. The same was filed only on 06.07.2017, after direction of this Commission dated 06.06.2017. There is, thus, clear concealment of material fact on the part of the Insurance Company. Repudiation of the insurance claim on the ground that the Complainant filed a fraudulent claim was certainly not justified.12. Regarding quantum of claim, the Surveyor assessed the loss to the building at Rs.3,59,600/-; value of damaged machinery at Rs.75,000/-; value of damaged stock at Rs.22,500/-, totaling to Rs.4,57,100/-. After applying depreciations, the net loss was assessed at Rs.1,00,100/-.13. As per balance sheet ending on 31.03.2004, the value of the building was Rs.3,69,900/-. The State Commission, after applying necessary depreciation assessed the loss at Rs.3,20,000/-.13. The Complainant claimed Rs.8 lakhs towards loss to the machinery. The Surveyor observed that the Complainant had given an imaginary figure of loss without filing any evidence and assessed the loss to the machinery at Rs.75,000/-. In the balance sheet ending 31.03.2004, the cost of the machinery was shown at Rs.7,68,320/-. However, in the statement given to the Police, the loss was claimed at Rs.6 lakhs. The State Commission, therefore, considered Rs.6 lakhs towards loss to the machinery, which in our view seems to be justified.14. The Complainant claimed loss of stock at Rs.13 lakhs. The Surveyor, however, assessed the loss to the stock at Rs.22,500/-. The Surveyor observed that all transactions were imaginary and no evidence was placed by the Complainant. The State Commission, however, observed that inThe fire was accidental and not caused intentionally because,The police concluded that the fire was accidental and not intentional. The electrical Inspector opined that it was due to short circuit and-5-balance sheet of 31.03.2004, the value of stock was shown as Rs.10,10,000/-. When in the balance sheet the value of the stock was clearly shown as Rs.10,10,000/-, the observation of the Surveyor, that the transactions were imaginary and no evidence was placed by the Complainant, was not correct. We find that the State Commission was justified in relying on the balance sheet and assessing the loss at Rs.10,10,000/-.15. The State Commission, thus, assessed the total loss at Rs.19,30,000/- (Rs.6 lakhs towards machinery, Rs.3,20,000/- towards building plus Rs.10,10,000/- towards stock). The Surveyor assessed the cost of salvage at Rs.2,60,000/-. The State Commission, therefore, deducted the salvage cost of Rs.2,60,000/ from the net loss and assessed the loss at Rs.16,70,000/-. The State Commission also observed that the Complainant had not carried out any safety measures against the fire such as fire extinguisher piped water arrangement etc. For this reason, the State Commission found contributory negligence on the part of the Complainant and made 20% deduction on the amount of Rs.16,70,000/- and finally assessed the loss at Rs.13,30,000/-. We do not find any reason to disagree with the finding of the State Commission.16. For the foregoing discussion, the Appeal stands dismissed. As observed in para-11 above, there is concealment of material fact on the part of the Appellant. A cost of Rs.50,000/- is imposed on the Appellant, which shall be paid to the Complainant within two months from the date of this order.......................C. VISWANATH PRESIDING MEMBER ......................J RAM SURAT RAM MAURYA MEMBER-6- ... 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Claims Bazaar

1 years ago

BEWARE if your private car is not covered by Indian Motor Tariff clause 29. Carry your employees by insisting on this cover while taking a policy or renewing a policy.*UIIC vs Thriveni Earthmovers*Anyone know this? *Any friends/relatives travelling in a Private Car are not covered by any insurance unless specifically take the separate cover.*Supreme Court dismissed the SLP filed by claimants. Brief facts:Accident took place on 03.05.2011, wherein Mr. R. Krishnan, an employee of M/S Thriveni Earthmover Pvt. Ltd was travelling in a vehicle owned/insured by the M/S Thriveni Earthmover Pvt. Ltd. In this accident Mr. R. Krishnan an employee of M/S Thriveni Earthmover Pvt. Ltd. suffered major injuries and had to undergo several surgeries.Tribunal Findings :The Tribunal awarded total compensation of Rs. 2,61,10,091/- along with 7.5% p.a., and also awarded Rs. 2,68,000/- towards Advocate fee. We contended that the insurance company is not liable to pay the compensation to the employees of M/S Thriveni Earthmover Pvt. Ltd as additional premium under IMT-29 was not paid towards employees. But the Tribunal did not consider UIIC defence and fastened the liability on them.High Court Findings:As per UIIC appeal, Hon'ble High Court directed the IRDAI to clarify its stance. IRDAI filed a Memo before Hon'ble High Court and clarified that Insurance Company will not be liable for occupants in a private car who are employees of Insured/owner (except paid driver) without obtaining coverage under IMT 29.Hon'ble High Court Vide order dated 23.03.2020, has allowed UIIC appeal and shifted the liability for payment of compensation upon the M/S Thriveni Earthmover Pvt. Ltd. M/S Thriveni Earthmover Pvt. Ltd., filed SLP before Hon'ble Supreme Court.Senior counsel Ms. Meenakshi Arora was appointed by UIIC to defend the matter.Hon’ble Supreme Court vide its order dared 03.08.2022 has dismissed the SLP filed by the claimants. This is a landmark case impacting TP claims of the entire General insurance Industry. Kudos to the efforts of Hc Advocate Shri S Arunkumar, Coimbatore TP team, Corporate legal Team Delhi RO 1 and Senior Counsel Smt Meenakshi Arora for getting this judgment in UIIC favour. ... See MoreSee Less

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Claims Bazaar

1 years ago

Vehicle insurance policy doesn't lapse even if not transferred in buyers name.Read more at:m.timesofindia.com/articleshow/92943931.cms?frmapp=yes&utm_source=contentofinterest&utm_medium=te...Read more at:m.timesofindia.com/articleshow/92943931.cms?frmapp=yes&utm_source=contentofinterest&utm_medium=te... ... See MoreSee Less

timesofindia.indiatimes.com

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Claims Bazaar

1 years ago

Home Insurance Clarifications ... See MoreSee Less

Video | How To Claim Your Home Insurance

www.ndtv.com

Here are 5 things you must know about claiming your home insurance.

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Claims Bazaar

1 years ago

claimsbazaarindia.blogspot.com/2022/06/why-claims-bazaar.html ... See MoreSee Less

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Claims Bazaar

1 years ago

Hope wisdom prevailsInsurance companies should not seek documents which are beyond the control of the Insured rules Supreme Court. ... See MoreSee Less

While Settling Claims, Insurance Company Should Not Seek Documents Which Are Beyond The Control Of Insured To Furnish: Supreme Court

www.livelaw.in

The Supreme Court observed that while settling the claims, the insurance company should not be too technical and ask for the documents, which the insured is not in a position to produce due...

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Claims Bazaar

1 years ago

Sorry, you cannot make a profit says Supreme Court. ... See MoreSee Less

Double Insurance : Second Insurer Can Decline Claim When Loss Has Been Fully Indemnified By Other Insurer - Supreme Court

www.livelaw.in

The Supreme Court, recently, held that in cases ofoverlapping insu

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Claims Bazaar

1 years ago

1st Success 2022-23Mrs. X the daughter of Mrs.Y of Tirupur, had taken a Comprehensive Policy for her mother with Star Health and Allied Insurance Co. Ltd.On 11/2/2022 Mrs. Y was hospitalized at Royal Care Hospital, Coimbatore due to Covid19 and was discharged on 16/02/2022 and has incurred a sum of Rs.1,59,000/-. On submission of the claim papers the Insurer in his own wisdom settled an amount of Rs.39,200/- calling it Package charges.The Insured Mrs.X approached Claims Bazaar through her advisor. Claims Bazaar made a representation to the Grievance Cell of the Insurer stating that the policy issued did not state about the limitation of claim as Package Charges and any such revision of terms and conditions should have been informed 3 months in advance as per Clause 14 of the IRDAI Guidelines on Standardization General Terms and Clauses in Health Insurance Policy Contracts dated 11/6/2020, which has not been done. Claims Bazaar also referred to the apex court decision in Jacob Punnen Vs United India Insurance Co. Ltd., wherein it was held that after issue of policy imposing of cumbersome limitation was deficiency in service and did not augur well for the Insurance Company.On receipt of the representation the Insurer has duly settled Rs.69,800/- in addition to the amount of Rs.39200/- settled earlier totaling Rs.1,09,000/-. ... See MoreSee Less

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Claims Bazaar

1 years ago

Having issues with insurance claims: Contact- claimsbazaar@gmail.comvisit www.claimsbazaar.com(Courtesy Live Mint)Religare denies insurance claim; Cancer patient wins ₹6.7 lakh compensationIn an eight-month-long battle in a Consumer court, the judges lashed out at Religare for not caring about the ailing patient who paid his premium on timeA cancer patient from Bengaluru has won ₹6.7 lakh after he sued Religare Insurance company for denying him medical insurance for his treatment, according to a report by the Hindustan Times, Livemint's sister publication.As per the daily, the 60-year-cancer patient was denied medical insurance for his cancer treatment on the grounds that he had diabetes and hypertension that he did not disclose before taking the policy.In an eight-month-long battle in a Consumer court, judges reprimanded the private firm and said hypertension and diabetes are not diseases but common physical disorders and that they cannot be grounds to deny medical insurance.The court lashed out at Religare for not caring about the ailing patient who paid his premium on time.The court ordered the firm to pay the cancer patient ₹5 lakh with a 12% interest, a compensation of ₹1.1 lakh for additional trauma caused by the company for denying insurance to the ill patient, and ₹10,000 towards court expenses and damages.As per the daily, the 60-year-old patient had purchased the family cover insurance policy from Religare in November 2021. The man was diagnosed with cancer in 2018. And, when his cancer treatment started at the HCG hospital, the hospital handed him a bill of ₹11 lakh. The man approached Religare to get the insured sum of ₹5 lakh refunded.But the insurance firm denied his claim saying the man did not disclose his pre-existing health conditions of hypertension and diabetes. ... See MoreSee Less

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Insurance Claims Assistance For Individuals For Corporate Benefits: Reduce risk of no claim Get maximum compensation We cover life, fire, marine, motor,...

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