Post on 11-Apr-2022
AWARD NO.IO/KOC/A/GI/0001/2021-2022
PROCEEDINGS OF
THE INSURANCE OMBUDSMAN, KOCHI
(UNDER RULE NO. 13 1(b) READ WITH RULE 14 OF
THE INSURANCE OMBUDSMAN RULES, 2017)
Complaint No. KOC-G-042-2021-0222
PRESENT: Ms. POONAM BODRA
INSURANCE OMBUDSMAN, KOCHI.
AWARD PASSED ON 17.05.2021
1. Name and Address of the complainant
: Mr. Arjun S
Elapatharayil House, Pathiyankara,
Thrikkunnapuzha P O, Alapuzha -
690515
2. Policy Number
: 419014/31/20/001131
3. Name of the Insured
: Mr. Arjun S
4. Name of the Insurer
: Shriram General Insurance Co. Ltd.
5. Date of receipt of Complaint
: 07.12.2020
6. Nature of complaint
: Rejection of motor claim
7. Amount of relief sought
: --
8. Date of hearing
: 04.03.2021
9. Parties present at the hearing
a) For the Complainant
: Mr. Arjun S (Online)
b) For the Insurer : Mr. Peeyush Jain (Online)
AWARD
This is a complaint filed under Rule 13 1(b) read along with Rule 14 of the Insurance Ombudsman Rules, 2017. The
complaint is regarding rejection of motor claim. The complainant, Mr. Arjun S is the policyholder.
1. Averments in the complaint are as follows:
The Complainant stated that he had taken insurance from the respondent insurer for his vehicle Maruti Ertiga ZXI, from
14.8.2019. This vehicle was involved in an accident on 13.11.2019, and as per the surveyor, the vehicle was a total loss.
All those documents which were required were submitted with the respondent insurer. The claim settlement is
pending.
2. The Respondent Insurer entered appearance and filed a self contained note. It is submitted that a policy bearing
no.419014/31/20/084425 for the period 14.8.19 to 13.8.20, for the vehicle bearing reg. no. KL 05 AM 2774. Upon
receiving the intimation of the accident, an IRDA approved surveyor appointed conducted the survey of the vehicle.
The survey report was subjected to pending documents & clarifications. Even after various reminders through letters,
sms & whatsapp the following documents were not produced. So also the vehicle was not brought for the final survey.
It is further submitted that as the reminder letters dated 3.2.19, 24.4.19, 1.5.20 & 10.5.20, were not replied by the
complainant. As there were no deficiency in services from the respondent insurer, the claim is to be dismissed.
3. I heard the Complainant and the Respondent Insurer. The Complainant submitted that his vehicle bearing Reg. No.
KL 05 AM 2774, was involved in an accident on 13.11.2019, while giving way to the oncoming vehicle. The vehicle fell,
into the nearby river and was totally damaged. The co travelers including the complainant had injuries and were
treated in the nearby hospital and after treatment, were taken to their native places by ambulance. Almost all those
documents requested by the respondent insurer were submitted. Further the complainant submitted that the
damaged vehicle was removed only after a few days as he was not having sufficient funds. The Respondent Insurer
submitted that a surveyor was deputed for surveying the motor vehicle which was involved in the accident. The survey
report was submitted subject to pending documents & clarifications. Several reminders were sent to the complainant
for submitting the pending documents which were required for processing the claim, but was not responded.
During the course of the hearing, clarifications were directed to be addressed:-
1. The Complainant was directed to submit the following documents within 7-days: i).The running record of the vehicle
ii). Injury details of the passengers iii). clarification as to how the passengers were taken to their respective native
places iv). Airport gate pass or toll fee paid(receipt).
2. The respondent insurer was directed to report back after 7-days, with the details of their assessment of the
damaged vehicle.
3. The reason for the delay in survey of the damaged vehicle ( i.e. date of accident :13.11.19, allotment of
survey:19.12.19, date of survey:13.2.20).
4. Non conduct of an investigation to probe into the cause of the accident.
A. The complainant responded vide e-mail date 12.4.21, with his submissions:-
1. Taxi Booking details :Booking through Facebook Chat(no documentary evidence submitted)
2. Running record of the vehicle :Lost in the accident(no documentary evidence submitted)
3. Clarification on how the co travelers in the vehicle
were taken to their destination :Ambulance (Receipt attached)
4. Injury details of co travelers :1. Mr.Adarsh (admitted:MCH, Alappuzha)
: 2.Mr.Arjun S(Not Admitted)
:3.Mr.Manjideth(OP ticket lost)
:4.Mr.Vishnu(OP ticket lost)
5. Airport Gate Pass : Not submitted(Lost)
6. Photographs of the damaged vehicle: submitted
B. The respondent insurer did not come up with their analysis of the claim and had not responded .
4. I heard the complainant and the respondent insurer and had gone through the records submitted by them. In this
complaint, the complainant`s commercial motor vehicle Maruti Ertiga ZXI, bearing reg. no. KL 05 AM 2774, was
involved in an accident while giving way to a vehicle which came from the opposite direction. The vehicle fell into the
river. It is observed that the prudent insurer instead of conducting the motor survey immediately on receipt of the
information of the accident , did allot for survey only on 19.12.20 and the survey was conducted on 13.2.20, i.e. after 3
months, of the accident, thereby chances of valuable information about the incident might have been lost . The
delayed appointment of the survey was not explained or clarified. Secondly, an investigation was not conducted to
throw more light into the incident. As per the Survey Report submitted, the assessed value of motor vehicle on `repair
basis` is given as Rs.4,41,588/-,( IDV of the vehicle is Rs.5,50,000/-). The assessed value worked out to more than 80%
of the IDV of the said vehicle, which tantamount to `Total Loss`. After the hearing on 4.3.20, the respondent insurer
was given 7-days time to report back with clarifications on the all the above mentioned, but failed to report back
within time frame instead requested for another 4 to 5 days more time vide their mail dated 27.4.21, for searching for
the appropriate value of the vehicle. The complainant could not submit FIR copy, witness details, copies of hospital OP
tickets of two co-travelers, Airport gate pass/toll receipt/ running details of the vehicle etc., since they were reportedly
lost or unavailable, which would have made the claim more stronger. The details/explanations therefore provided by
both the parties lacked clarity. Hence taking into consideration the available records/documents/ explanations
provided by both the parties and the time that had elapsed after the accident; in the interest of justice I find it
appropriate to direct the respondent to pay the assessed the claim amount of Rs.4,41,588/-,on `Total Loss Basis` as per
the policy terms and conditions.It is observed that the said motor vehicle is hypothecated to Mahindra & Mahindra
Finance Co. Ltd., Kochi.
In the result, an award is passed, directing the Respondent Insurer to pay an amount of Rs.4,41,588/ , as per the policy
terms & conditions, within the period mentioned hereunder. No cost.
As prescribed in Rule 17(6) of Insurance Ombudsman Rules, 2017, the Insurer shall comply with the award within 30
days of receipt of the award and intimate compliance of the same to the Ombudsman.
Dated this the 17th day of May 2021.
Sd/-
(POONAM BODRA)
INSURANCE OMBUDSMAN
AWARD NO.IO/KOC/A/GI/0002/2021-2022
PROCEEDINGS OF
THE INSURANCE OMBUDSMAN, KOCHI
(UNDER RULE NO. 13 1(b) READ WITH RULE 14 OF
THE INSURANCE OMBUDSMAN RULES, 2017)
Complaint No. KOC-G-012-2021-0203
PRESENT: Ms. POONAM BODRA
INSURANCE OMBUDSMAN, KOCHI.
AWARD PASSED ON 17.05.2021
1. Name and Address of the complainant
: Mr. Paul Kochukunjan
The White House, Near HP Petrol
Pump, Thuvanoor, Kechery P.O,
Thrissur 680501
2. Policy Number
: 3392/30020647/000/00
3. Name of the Insured
: Mr. Paul Kochukunjan
4. Name of the Insurer
: Cholamandalam MS Gen. Insu.Co. Ltd
5. Date of receipt of Complaint
: 01.01.2021
6. Nature of complaint
: Rejection of theft claim
7. Amount of relief sought
: --
8. Date of hearing
: 08.02.2021
9. Parties present at the hearing
a) For the Complainant
: Mr. Muhammed Sabith (Online)
b) For the Insurer : Mr. Aneesh(Online)
AWARD
This is a complaint filed under Rule 13 1(b) read along with Rule 14 of the Insurance Ombudsman Rules, 2017. The
complaint is regarding rejection of theft claim. The complainant, Mr. Paul Kochukunjan is the policyholder.
1. Averments in the complaint are as follows:
The Complainant stated that his goods carrying vehicle DOST PLUS, KL 46S 2368, was stolen from their godown
(Parapuram – Kadangod) between 16.30PM on 8.1.19 & 8.30AM on 9.1.19. A complaint was filed on 9.1.19 with the
Erumapetty Police Station. The FIR No. issued was 0011/2019. The vehicle was bought under finance from Syndicate
Bank. The insurance agreement with the Syndicate Bank was that the claim amount will go to the bank and the vehicle
loan will be terminated. The claim is lying pending though all documents were submitted. As per the insurer`s reply
dated 4.6.20, the delay was due to reduced staff on account of Covid. Later the claim was repudiated.
2. The Respondent Insurer entered appearance and filed a self contained note. It is submitted that the vehicle was
insured for the period 4.4.18 to 3.4.19 for an IDV of Rs.5,78,949/-. For the alleged loss dated 8.1.19, the claim
intimation was received on 11.1.19. A few documents were requested for vide regd. Letter dated 3.12.19, 19.2.20, such
as purchase invoice, repair bills, theft intimation letter to NCRB with postal receipt, RC particulars after theft with
stolen remarks, AML, FC, Police final report, court approved final report, original policy/cover note, original keys, letter
of subrogation, letter of indemnity, RTO forms 28, 29, 30, original RC, Discharge Voucher, Financier NOC, Form 35 etc.
Due to non submission of the said documents, the claim was closed on 6.3.20. Even after the closure of the claim, a
mail was send on 14.10.20, to the complainant for the mandatory documents but still the following were not received:
postal receipt , AD card for the copy letter to NCRB, RC particulars, RC details after theft, form 26, NOC & form 35. The
claim was thus closed on non-submission of documents.
3. I heard the Complainant`s representative and the Respondent Insurer. The Complainant`s representative submitted
that the complainant`s goods carrying vehicle DOST PLUS, KL 46S 2368, purchase under finance from Syndicate Bank,
Ariyannur, was stolen from their godown (Parapuram – Kadangod) between 16.30PM on 8.1.19 & 8.30AM on 9.1.19.
The FIR No. issued by the Erumapetty Police Station was 0011/2019. Even after submitting all necessary documents,
the claim was rejected. Form no.35 was not submitted as the bank finance had to be closed. The respondent insurer
submitted that the following documents were requested to be submitted for processing the claim: - purchase invoice,
repair bills, theft intimation letter to NCRB, with postal receipt, RC particulars after theft with stolen remarks, AML,
Fitness Certificate, Police final report, Court approved final report, original policy/cover note, original keys, letter of
subrogation, letter of indemnity, RTO forms 28,29,30, original RC, Discharge Voucher, Financier NOC, Form 35 etc. Due
to non- submission of these documents, the claim was closed on 6.3.20. A mail was again sent on 14.10.20, to the
complainant for the following mandatory documents:- postal receipt , AD card for the copy letter to NCRB, RC
particulars, RC details after theft, form 26, NOC & form 35. Since these were not received, the claim was closed.
During the hearing, the complainant was directed to submit the following documents:- Postal receipt & AD card for the
copy of the letter to NCRB, Completed RTO-forms-26,28,28,30, to the respondent insurer within 7-days from the date
of hearing and the respondent insurer on receipt of the same, to report with their analysis of the claim.
Though the respondent insurer vide email dated 7.4.21, informed that the above said documents were not submitted,
communicated vide email dated 15.4.21, that RTO form. no.26, copy of RC particulars after theft & vehicle loan
statement from the financier was handed over to them. The respondent insurer later vide email dated 20.4.21,
communicated the admissibility of the claim subject to the submission of relevant records/documents. Further the
respondent insurer by email dated 22.4.21, informed that mandatory documents required for processing the said
claim was submitted by the Complainant except for the Postal receipt and AD card for the copy of letter to NCRB. The
admissible claim amount worked out and submitted is as follows:-
IDV of the vehicle :Rs. 5,78,949/-
Less compulsory deductibles :Rs.500/-
Admissible amount :Rs.5,78,449/-
4. I heard the complainant`s representative as well as the respondent insurer and had gone through the records
submitted by them. In this complaint of non settlement of the theft claim, where the goods carrying vehicle DOST
PLUS, KL 46S 2368, parked in front of the complainant`s godown (Parapuram – Kadangod) was stolen between
16.30PM on 8.1.19 & 8.30AM on 9.1.19 , on considering the facts and the situation, the respondent insurer is directed
to pay the admissible claim amount of Rs.5,78,449/- , as per the terms & conditions of the policy . It is observed that
the above said vehicle is hypothecated to Syndicate Bank, Thrissur.
In the result, an award is passed, directing the Respondent Insurer to pay an amount of Rs.5,78,449/- , as per the
policy terms & conditions, within the period mentioned hereunder. No cost.
As prescribed in Rule 17(6) of Insurance Ombudsman Rules, 2017, the Insurer shall comply with the award within 30
days of receipt of the award and intimate compliance of the same to the Ombudsman.
Dated this the 17th day of May 2021.
Sd/-
(POONAM BODRA)
INSURANCE OMBUDSMAN
AWARD NO. IO/KOC/A/GI/0004/2021-2022
PROCEEDINGS OF
THE INSURANCE OMBUDSMAN, KOCHI
(UNDER RULE NO. 13 1(b) READ WITH RULE 14 OF
THE INSURANCE OMBUDSMAN RULES, 2017)
Complaint No. KOC-G-049-2021-0248
PRESENT: Ms. POONAM BODRA
INSURANCE OMBUDSMAN, KOCHI.
AWARD PASSED ON 17.05.2021
1. Name and Address of the complainant
: Mr. Siji Varghese
Niravath House, Kuthukuzhy P O,
Kothamangalam Pin-686691
2. Policy Number : 761604319100005982
3. Name of the Insured
: Mr. Siji Varghese
4. Name of the Insurer
: The New India Assurance Co. Ltd.
5. Date of receipt of Complaint
: 12.02.2021
6. Nature of complaint
: Extension of policy
7. Amount of relief sought
: --
8. Date of hearing
: 19.04.2021
9. Parties present at the hearing
c) For the Complainant
: Mr. Siji Varghese (Online)
d) For the Insurer : Ms. Hyma Soman (Online)
AWARD
This is a complaint filed under Rule 13 1(b) read along with Rule 14 of the Insurance Ombudsman Rules, 2017. The
complaint is Extension of policy. The complainant, Mr. Siji Varghese is the policyholder.
1. Averments in the complaint are as follows:
The Complainant submitted that he is the owner of Stage carriage vehicle insured with the respondent insurer bearing
Registration KL 44 D 8797 operating on the route Thodupuzha-Kothamangalam having Policy
No.7616043190100005982 . The period of insurance coverage is up to 22.08.2020. Due to Covid-19 the Government of
India implemented complete lockdown from 23.03.2020 onwards. So he was not able to conduct service from
23.03.2020 to 24.05.2020. The honourable chief minister of Kerala issued an order to extend the insurance policy for
two months. He was also entitled to get that privilege and hence his policy period is to be extended up to 23.10.2020,
paying an additional premium of Rs.185/- and he has paid the same on 16.06.2020. Due to the spread of Covid-19 in
the state he was unable to conduct the service as there was lack of passengers and employees. The complainant was
forced to laid down his vehicle from 01.07.2020 to 31.12.2020 by submitting needful documents and necessary fees to
the joint RTO, Kothamangalam. As the situation gradually became favourable to conduct service, he decided to operate
his vehicle from 01.01.2021 onwards. For that he informed the joint RTO, Kothamangalam and got laid up certificate
from RTO Muvattupuzha on 04.01.2021 to produce before the insurance company to extend his policy for the laid up
period of 115 days. But the respondent insurer refused to extend the policy. He took another policy from United India
Insurance Company on 14.01.2021 with premium amount of Rs.64000/-. In this panic situation it was a huge amount to
him. So the complainant requests this forum to issue an order to refund the premium amount for 115 days actually
entitled by him from the respondent insurer.
2. The Respondent Insurer entered appearance and filed a self-contained note. It is submitted that the policy availed by the insured was a Commercial Vehicle Liability Only Policy with Policy No: 76160431190100005482 an Ashok Leyland Bus. The Policy period was 23.08.2019 to 22.08.2020. The insured vehicle was laid up due to covid situation. Insured has given complaint for not giving extension for the second time
The policy availed by the insured was a Commercial Vehicle Liability Only Policy with Policy No: 76160431190100005482 an Ashok Leyland Bus. The Policy period was 23.08.2019 to 22.08.2020 According to GR.31 “expiry date of the current period of insurance under the policy may be extended for a period equal to the period the policy remained suspended on account of the layup” also GR.31 also states that the period of lay-up / suspension of policy shall not extend beyond twelve months from the expiry date of the policy period in which the lay-up has commenced The details of each policy as follows 76160431190100005482 - KL-44-D-8797 The original period of Insurance is from 01/08/2019 to 31/07/2020. The insured has submitted a laidup request from 24/03/2020 to 23/05/2020 and the policy was extended for 69 days. And on 04/01/2021 the insured has submitted another laidup request from 01/07/2020 to 31/12/2020, but as the policy was only till 22/08/2020 laidup extension was not given since there are only 53 days in the policy period for the second laidup and as per GR.31 laidup benefit should be given when there is a minimum laidup of two months. In this cases the insured has applied for laidup after the original policy period whereas the GR.31 clearly states that the extension can be only given for the period equal to a period the policy remains cancelled owing to the laidup We also refer to the judgment from honourable High Cour of Kerala (WP(C). No.22273 OF 2020(H)) where in a similar case the extension was not allowed beyond the original policy period.
- It is also to be noted that as per GR.31 the permit of the vehicles has to be suspended which are undergoing laidup for availing the laidup benefit in insurance policy has been waived of by the company owing to the current situation at RTOs.
- Considering the facts stated we request the honourable ombudsman to dismiss the complaint as we cannot violate the terms of Indian Motor Tariff.
3. I heard the Complainant and the Respondent Insurer. The Complainant submitted that the period of insurance coverage of his vehicle was up to 22.08.2020. Due to Covid-19 complete lockdown was implemented from 23.03.2020 onwards, he was not able to conduct service from 23.03.2020 to 24.05.2020. He was also entitled to get that privilege and hence his policy period is to be extended up to 23.10.2020, paying an additional premium of Rs.185/- An additional premium of Rs.185/- was paid on 16.06.2020. He requested the insurance company to extend his policy for the laid-up period of 115 days. But the respondent insurer refused to extend the policy. The Respondent Insurer submitted that the original period of Insurance
was from 01/08/2019 to 31/07/2020. The insured has submitted a laid-up request from 24/03/2020 to 23/05/2020 and the policy was extended for 69 days. And on 04/01/2021 the insured has submitted another laid up request from 01/07/2020 to 31/12/2020, but as the policy was only till 22/08/2020 laid up extension was not given since there are only 53 days in the policy period for the second laid up and as per GR.31 laid up benefit should be given when there is a minimum laid up of two months. According to GR.31 “expiry date of the current period of insurance under the policy may be extended for a period
equal to the period the policy remained suspended on account of the layup” also GR.31 also states that the period of
lay-up / suspension of policy shall not extend beyond twelve months from the expiry date of the policy period in which
the lay-up has commenced
4. I heard both the complainant and the respondent insurer. On scrutiny of the records it is found that initially laid up
extension of 69 days from 24.03.2020 to 23.05.2020 was allowed to the complainant. Later when he had applied for
laid up extension from 01.07.2020 to 31.12.2020, it was not allowed as there was only 53 days in the policy period for
the second laid up. The policy was only till 22.08.2020. (from 01.07.2020 to 22.08.2020). As per the GR-31, laid up
benefit should be given when there is a minimum period of two months. Hence as per the GR- 31, the respondent
insurer cannot allow the extension. The decision of the respondent insurer is right and as per the General Regulation
framed by the Government. Hence I do not want to interfere in to the decision.
In the result, an AWARD is passed for Dismissal of the complaint.
Dated this the 17th day of May 2021.
(POONAM BODRA)
INSURANCE OMBUDSMAN
PROCEEDINGS BEFORE THE INSURANCE OMBUDSMAN,Kolkata
(States of West Bengal, Sikkim and Union Territories of Andaman & Nicobar Islands)
(UNDER RULE NO.16/17 OF THE INSURANCE OMBUDSMAN RULES, 2017)
Ombudsman Name:P.K.RATH
CASEOFCOMPLAINANT– SHRI TAPAN KUMAR JANA
VS
RESPONDENT: THE ORIENTAL INSURANCE CO. LTD.
COMPLAINT REF: NO: KOL- G-050-2021-0117
AWARD NO: IO/KOL/A/GI/0008/2021-2022
1.
Name &Address OfThe Complainant Shri Tapan Kumar Jana S/O. Late Chittarajan Jana, Deulpota; P.O : Barbasudevpur, P.S: Sutahata, Dist : Purba Medinipur, PIN : 721 645.
2.
Type Of Policy: Life / Health / General
Policy Details: Policy Number Sum Assured From Date To Date DOC Premium Policy Term Paying Term 311900/31/20
18/1274 6,00,000 28-Sep-2017 27-Sep-2018 69240 One year One time
3. Name of insured Tapan Kumar Jana
4. Name of the insurer The Oriental Insurance Company Limited
5. Date of receipt of the Complaint 22-Mar-2021
6. Nature of Complaint Non-settlement of claim
7. Amount of Claim 1039900
8. Date of Partial Settlement
9. Amount of relief sought 1039900
10. Complaint registered under Insurance Ombudsman Rules 2017
Rule 13(1)(b) – any partial or total repudiation of claims by an insurer
11. Date of hearing Place of hearing
19-Apr-2021
Kolkata
12. Representation at the hearing
a)For the Complainant Shri Tapan Kumar Jana
b)For the Insurer Shri Biplab Das
13. Complaint how disposed By conducting online hearing
14. Date of Award 10-May-2021
Brief Facts of the Case:
As stated in the complaint, the insured vehicle met with an accident on 29-12-2017 at Purulia. The Insurance
Company deputed a surveyor to assess the loss. The insured lodged claim for Rs.10,39,900/- but the
Insurance Company settled the claim for Rs.1,39,500/-. The insured did not accept the claimed amount.
Hence, the Insurance Company closed the claim as per norms. The Insurance Company has stated in their
Self Contained Note that on receipt of Surveyor Report, the Insurance Company has deputed an Investigator
for verification of cash memos/bills issued by Maa Bargabhima Motor Parts, Midnapore, amounting to
Rs.8,83,350/- and investigations revealed that the Bill was false/fake and as such the same was not allowed
by the Insurance Company. Finally, the claim has been settled for Rs.1,39,500/- and Insurer issued Discharge
Voucher (DV) amounting to Rs.1,39,500/- towards full and final settlement of the claim. But the insured did
not duly sign and submit the DV to the Insurance Company. Hence, the Insurance Company has closed the
claim.
Contention of the complainant:
The complainant has stated in the hearing that he has submitted a written statement towards his submission
and except it he has nothing else to say. In the written statement the complainant has reiterated what he has
already stated in his written complaint letter submitted to this office.
Contention of the Respondent:
The representative of the Insurance Company has stated in the hearing that on receipt of the Surveyor Report,
the Insurance Company has appointed an Investigator for verification of the bill for Rs.8,83,350/- issued by
Maa Bargabhima Motor Parts. It is observed from the Investigator Report that there is no shop in the name of
Maa Bargabhima Motor Parts. At the same address, there is another shop named, Devi Bargabhima Motor
Parts. The mobile number is also in the name of the owner of a separate entity - Agni super Bus. The owner
of Devi Bargabhima Motor Parts has stated that the signature on the bill and cash memo does not pertain to
his shop. Hence, the Insurance Company has settled the claim for Rs.1,39,500/- but the Insured did not
submit the discharge voucher duly signed to the Insurance Company as he is not agreeable to this lesser
amount. As such, the claim has been closed as per norms.
Observation and conclusions:
It is observed that the complainant has attended the hearing physically at this office premises whereas the
representative of the Insurance Company has attended the hearing online. The complainant has stated in the
hearing that he has submitted a written statement as submission. The representative of the Insurance
Company has stated that the Insurance Company has settled claim for Rs.1,39,500/- after deduction of Bill
for Rs.8,83,350/- which is not genuine. Since the insured did not submit the discharge voucher duly signed to
the Insurance Company, the claim has been closed as per norms.
AWARD
Taking into account the facts and circumstances of the case, the submissions made by both the parties
during the hearing and after going through the documents on record, it is observed that though the
insured had lodged claim for Rs. 10,39,900/- against the reimbursement of repairing cost of the vehicle
damaged in accident but prima facie, it appears that identity of the entity - Maa Bargabhima Motor Parts
– which has issued the Bill of Rs 8,83,350/-, is not genuine. As such, the amount of Rs 1,39,500/- settled
by the Insurance Company, after making necessary deductions and adjustments, seems to be justified. In
view of the aforesaid, the settlement of claim made by the Insurance Company is upheld and the
complaint is dismissed without any relief to the complainant. The complaint is thus disposed of in favour
of the Insurance Company.
Dated at Kolkata on 10th Day of May, 2021 SHRI P K RATH
INSURANCE OMBUDSMAN