Forum orders insurance firm to pay Rs 11.7 lakh with Rs 15,000 finehttps://indianexpress.com/article/cities/chandigarh/forum-orders-insurance-firm-to-pay-rs-11-7-lakh-with-rs-15000-fine-5001970/

Forum orders insurance firm to pay Rs 11.7 lakh with Rs 15,000 fine

The insurance company rejected the claim only on the basis of MLC (Medicolegal Cases) in which the doctor observed that the patient smells of liquor.

Forum orders insurance firm to pay Rs 11.7 lakh with Rs 15,000 fine
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ASHISH BAJAJ met with an accident while driving his father’s car and the estimated loss was more than Rs 9 lakh according to the survivor. But when his father Mohinder Bajaj moved SBI General Insurance Company for the claim, the latter rejected it claiming that Ashish was driving under the influence of liquor. However, following arguments, the Consumer Forum has directed the insurance company to pay the Insured Declared Value (IDV) of Rs 11.70 lakh for the damaged car with a fine of Rs 15,000 to the complainant at 6 per cent interest per annum from the date of rejection.

Mohinder, in his complaint, said his car, Volkswagen Passat, was insured with SBI General Insurance which was valid from December 15, 2014, to December 14, 2015, having an IDV of Rs 11.70 lakh. The complainant stated that his son Ashish had met with an accident while driving the car on September 13, 2015, on Prince Road, New Delhi, and the matter was reported at Model Town Police Station, Delhi, an FIR was registered and the cause of accident was due to the car’s front tyre burst, due to which the Volkswagen went out of control and hit a road divider, climbed it before ramming into an electric pole, causing damages. The insurance company surveyor assessed the loss to be Rs 9,12,850 after deducting the depreciation without dismantling the car, which is much more than 75 per cent of the IDV.

Mohinder said his son, who was driving the Volkswagen, also suffered injuries in the left arm and elbow and was taken to Shri Ganga Ram Hospital, Delhi, for treatment, where the doctor observed that the patient was breathing positive for alcohol and his blood sample was taken for alcohol test. But, as per the examination report of the Forensic Science Laboratory (FSL), Government of NCT, Delhi, in both the blood samples, the presence of ethyl alcohol could not be detected in the report. Mohinder then submitted his claim to the insurance company along with the FSL report and other documents.

But the insurance company rejected the claim only on the basis of MLC (Medicolegal Cases) in which the doctor observed that the patient smells of liquor. Mohinder also told the court that he had hired Vinesh Maini, Automobile Engineer, Surveyor and Loss Assessor, on his own and he had also submitted his report stating that Ajay Mahajan, Surveyor of the SBI Insurance, had assessed the loss by mere physical inspection without dismantling the car and the loss would increase further when the actual repairs shall be carried out as some unforeseen repairs/replacement would come into the picture and in such an eventuality, the actual loss shall exceed 75 per cent of the IDV. Then to claim a total loss, Bajaj lodged a complaint alleging rejection of the claim as well as wrong assessment of the loss by the insurance company surveyor.

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In reply, SBI General Insurance stated that at the time of the accident, the vehicle was being driven by Ashish under the influence in violation of the Motor Vehicles Act and terms of the insurance policy and thus the claim was righty repudiated.

The insurance company also denied that the loss of the vehicle was more than the assessed amount or car was total loss, as the loss of the vehicle was not assessed by an authorised surveyor and the insurance company’s liability cannot go beyond the amount assessed by the surveyor and Vinesh Maini’s report relied upon by the complainant as concoction and improved version.

After hearing the arguments, the forum said the insurance company by rejecting the claim of the complainant, even after going through the FSL report, had not only rendered deficient services but also resorted to unfair trade practice.