Page 56 - The Insurance Times November 2024

Insurance Caselaws

The Himachal Pradesh State Commission ordered the insurance firm to submit an insurance claim for
Rs. 7,90,000 to the complainant, along with Rs. 50,000 to
orders Oriental Insurance Co. to pay Rs.
cover the costs of the case.
7.9 lakhs for repudiating an insurance claim
Sudharang, Tehsil Kalpa, District Kinnaur, Himachal Pradesh,
solely because of delayed notification. is home to Mr. Gita Ram Negi ("Complainant"), who owned

Case Title: Gita Ram Negi vs The Oriental a two-story home there. The State Bank of India ("SBI")
provided a loan for the house's construction, while Oriental
Insurance Company Ltd and others
Insurance Company Ltd. ("Insurance Company") insured the
Summary asset. The Complainant's house fell in late July 2014 as a
Oriental Insurance Company Limited was held accountable result of floods, land erosion, and slides brought on by the
for a deficiency in service by the State Consumer Disputes heavy rains and snowfall in June 2013, especially in the
Redressal Commission Shimla, led by Justice Inder Singh Sudharang area. Even though the Complainant informed the
Mehta. The insurance company's delayed notification of insurance company of this, the insurance company rejected
damage led to the rejection of a claim, which the the claim without assigning a surveyor and told the
complainant filed with the District Commission. The Complainant it was false, unlawful, and without merit. After
insurance company argued that the complainant had not that, the complainant filed a consumer complaint against
followed the terms and conditions of the contract, and that the bank and the insurance firm with the District Consumer
the bank had contacted the insurance company as soon as Disputes Redressal Commission in Shimla, Himachal Pradesh
it received the claim. The District Commission denied the (hereafter, the "District Commission").
complaint, and the complainant appealed to the State
Commission for Consumer Disputes Redressal in Shimla. In response, the insurance provider confirmed the coverage
but argued that the complainant had not followed the terms
The State Commission found that the insurance company and conditions of the contract. It contended that the failure
was responsible for deficiency in service and unfair trade on the part of the Complainant to swiftly notify them of the
practice, as it was unlawful to reject the claim on the basis loss in June 2013 hindered an inspection in a timely manner
of delayed notice. The State Commission ordered the and the taking of steps to limit additional construction
insurance provider to submit an insurance claim for Rs. damage. In an attempt to have the case dismissed, the
7,90,000 to the complainant, along with an extra payment insurance firm refuted any service shortcomings and unfair
of Rs. 50,000 for litigation costs. business practices.In a second reply, the Bank claimed that
it had contacted the insurance company as soon as it
About the case
received the Complainant's claim and pushed for an early
Oriental Insurance Company Limited was held accountable
for a deficiency in service by the State Consumer Disputes settlement. It maintained that neither an unfair trading
Redressal Commission Shimla (Himachal Pradesh) bench, practice nor a service deficit existed on its end.
which is led by Justice Inder Singh Mehta (President). The Upon evaluating the breach of the policy's terms and
rejection of a claim was based solely on the insurance conditions, the District Commission denied the complaint.
company's delayed notification of the damage. The bench As a result, the Complainant appealed to the State
overturned the Shimla District Commission's ruling and Commission for Consumer Disputes Redressal in Shimla. In

The Insurance Times November 2024 49