Page 46 - Insurance Times March 2017 Sample

DECISION: Since there was no proof for substantiating the delaying the matter rather it was due to circumstances
income of the insured, Hon'ble Ombudsman was unable to beyond her control. Repudiation of the claim only on the
agree with the arguments of the complainant. However, ground of non submission of the death intimation / docu-
non-mentioning of the correct income did not into to viti- ments in time appears to be not justified.
ate the contract of insurance. Therefore, he directed the
insurance company to pay an amount of Rs.2.50 lakhs (Ru- The Insurer was directed to settle the claim.
pees Two lakhs fifty thousand) as ex-gratia payment to meet
the ends of justice. Lucknow Ombudsman Centre

Guwahati Ombudsman Centre Case No.G-44/11/05/08-09
Shri. Ravindra Kumar Verma
Case No.11/003/0059/08-09
Vs
Smt. Bindu Barman
The Oriental Insurance Co. Ltd.
Vs
National Insurance Co. Ltd. Award Dated: 12.3.2009 Complaint filed against Oriental
Insurance Co. Ltd. by Shri. Ravindra Kumar Verma in respect
Policy No. 100300/42/04/8200012
of repudiation of his claim arisen due to loss of jwellery and
Award dated - 22.10.2008 other valuables.

The Complainant's husband procured the above policy from
Facts: Shri. Ravindra Kumar Verma, took out a house hold-
the National Insurance Co. Ltd. covering the period from
01.08.2004 to 31.07.2009. The Insured died on 06.11.2006 ers policy opting for all risk cover from Oriental Insurance
due to injuries sustained in a motor vehicle accident on Co. Ltd. for a S.I. of Rs.1,30,602/- for the period 9.2.07 to
05.11.2006 involving vehicle No. AS - 01 AA / 5462. The 8.2.08. On 7.11.07 while traveling on a motorcycle with his
claim lodged with the Insurer was repudiated treating the wife and child, a purse containing jewellery fell down some-
claim as "No Claim" due to non submission of death intima- where and could not be traced. The respondent repudiated
tion and relevant documents within specified time. Being the claim on the ground that the loss happened due to gross
negligence of the insured and no outside agency was in-
aggrieved, the Complainant approached this forum for
volved in the incident.
redressal of her grievances. The copy of the letter of repu-
diation of the claim shows that the Insurer treated the claim
Aggrieved with the decision of the insurer the claimant
as "No Claim" due to non giving information within 30 days
and non submission of papers / documents within 90 days approached this forum giving rise to the complaint. Find-
from the date of the death of the Insured as required. In ings : On careful examination of all the documents the fo-
the policy condition, it is clearly mentioned that written rum found that the valuables were carried in a bag by the
notice of death intimation is to be given to the Company complainant?s wife sitting as a pillion rider alongwith their
within one calendar month after death of the Insured but infant child and the bag has fallen off in between the jour-
ney but they could not realize it till they reached their des-
that stipulated period of one month can be relaxed in case
tination. Also it is mentioned by the complainant that the
where reasonable cause can be shown. So, strict compli-
ance of the said condition is not a must in deserving cases. jewellery were being taken for repair. It is also to be noted
that the valuables as per bills submitted were bought only
During hearing the Insurer remained absent. The Complain- in Feb.07 i.e. only 6 months back and repair of bangles es-
ant stated in her statement as well as in the P-Forms that pecially bought just 6 months back do not require any re-
the fact of existence of the policy was not known to her pair normally.
even long after the death of her husband and she came to
know about it later on from the Agent and immediately The circumstances leading to the loss of the item also is not
thereafter, she informed the Insurer and submitted the very convincing as the bag carrying the valuables was car-
claim alongwith the relevant documents. This proves that ried casually which is not natural, as any individual will take
due to her ignorance about the existence of the policy, she utmost care in carrying valuables. Decision: Held that the
was not in a position to intimate the death to the Insurer loss has occurred due to utter carelessness and disregard
in time. The Complainant appears to be not intentionally to the safety of such valuables which is known to be in high

46 The Insurance Times, March 2017

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