ICICI Lombard asked to pay Rs 1.20L compensation for not honoring claim

Hyderabad: Hyderabad Consumer Disputes Redressal Forum has directed ICICI Lombard General Insurance to pay a compensation of Rs. 1.20 lakh to a customer for causing "hardship, mental agony, and inconvenience" by not honoring the claim.

Complainant Ravinder Singh, a resident of Troop Bazar of the city, had purchased the policy by paying Rs.34,338 for his Mahindra XUV 500 Sedan car which was valid from August 2017 to July .2018.

In November 2017, he along with his friends went on a trip from Hyderabad to Goa. They hired B.Shiva Kumar as a driver for the tour. Kumar possessed a valid licence.

“While on their way, the car met with an accident at Bagalkot, Sirur Road near Neelappa Hallara field, Karnataka. The car hit the divider and turned over. Fortunately, as the airbags inflated, the lives of the passengers were saved. However, they suffered multiple injuries and the car was damaged very badly. However, with the help of villagers, they were shifted to a nearby hospital. Police registered a case against the driver. He pleaded guilty and was convicted,” said Ravinder Singh.

The complainant filed a claim before the insurer since the policy was still subsisting. However, they rejected the claim in March 2018.

The complainant alleged that the insurer reasoned, “misrepresentation of facts (Driver details are misrepresented at intimation /claim form from actual and try to hide the material facts.)”

“The insurance company instructed the complainant to approach the grievance redressal on their website. However, he did not receive any satisfactory response from the customer service center. I once again made a claim in May 2018 by submitting all the required documents. They received the claim application but neither replied nor complied with,” said the complainant.

The company on the other hand said: “There is no proof filed by the complainant to show that the driver was driving the car and not the complainant. The accident took place on November 23, 2017, whereas the complainant had informed the opposite party's call center on November 23, 2017, and made a claim on December 23, 2017, thereby depriving us of conducting spot survey of the accident.”

The insurance company noted that they got an investigator appointed to look into the claim of the complainant. The company said the investigator filed a report stating that the complainant was driving the car at the time of the accident. It said the nature of injuries sustained by the complainant and the damage caused to the vehicle exactly co-relate with each other.

“Having received the expert opinion we found that the complainant had misrepresented the fact that ‘he was not driving the car and the driver was driving the car’. On the other hand, the investigator report and the expert opinion goes to show that the ‘complainant was driving the car’. Due to such misrepresentation of fact by the complainant the claim has been rejected under ‘exception’ in terms and condition of the policy,” said the insurance company.

After examining the facts of the case, the Forum said: “FIR along with conviction order passed by the civil judge is the conclusive proof to prove that the driver Shiva Kumar was driving the vehicle at the time of the accident.”

The Forum also observed that throughout the written version, evidence affidavit and arguments and also the documents filed, the insurance company has been trying to prove the misrepresentation made by the complainant by filing investigation report and accident reconstruction report.

“Since it is proved that the insurance coverage is valid and effective at the relevant time when the accident took place. We are of the considered view that the insurance claim of the complainant is honored by the opposite parties,” said the forum.

It added that the complainant is entitled to the compensation due to the hardship, mental agony, and inconvenience caused by the opposite party by not honoring the insurance claim immediately.

The Forum ordered to pay Rs.11,00,000 towards the insurance claim, Rs.1,00,000 as compensation for causing mental agony, inconvenience, and hardship. And Pay Rs.20,000 towards the cost of litigation, it said.