Skip to main content

Insurance - Filling of claims within 7 days


Five years after losing her husband in an accident, Manisha Devi, the widow of a CRPF jawan, will finally get insurance after a district consumer forum in Delhi ruled in her favour.

Noting that the insurance company's action was "unjustified", District Consumer Disputes Redressal Forum (East) has asked Oriental Insurance Company to pay Rs 4.5 lakh as insurance to the widow and an additional Rs 1 lakh as compensation for "harassment, mental pain and agony".

The forum also directed the company to deduct the compensation from the salary of the branch manager who rejected Manisha's claim. "We direct that this amount of Rs 1 lakh shall be recovered by the insurance company from the salary of the branch manager who rejected the claim of the complainant... The amount of compensation is the result of an unjustified action of the insurance company authorities who rejected the bona fide claim of the complainant," the order passed by N A Zaidi, president of the forum, and T Vijayan, a member, said. The bench also remarked that "we have been observing in case of insurance companies that they are interested in prolonging the insurance and their main object is to deny the claim on one ground or the other, whether that ground is available or not".

Manisha had filed a complaint with the district forum in the capital in 2010, alleging the insurance company repudiated her claim. Vijay Kumar had two insurance policies amounting to Rs 4,50,500, in which Manisha was a nominee. Before approaching the east Delhi forum, Manisha had filed a complaint with Narnaul's district forum and the Haryana state consumer disputes redressal commission. The Narnaul district forum had dismissed the claim on the grounds of "lack of territorial jurisdiction" .

Manisha had sought Rs 1 lakh by way of compensation and Rs 50,000 as litigation expense along with the sum she was entitled to. The company said the "claim filed by the complainant was against the terms and conditions" stipulating that a claim made later than seven days from the date of loss will not be entertained. "The intimation of loss was received on June 11, 2007, whereas the accident had taken place on June 1, 2007," the insurance company argued.

But the forum said that in such cases the families are always in shock; so it takes some time before they can lay hands on the documents and think about filing the claim.

Most companies seem to be interested in prolonging the insurance and their object is to deny the claim, the bench said.

It is actions like these which put the insurance companies in such bad light. This mess when IRDA has clearly mentioned back in Sept, 2011, that "insurance companies not to mechanically reject claims on technical grounds, like delay in filing claim documents. 

IRDA has issued these directives following complaints that claims are being rejected on grounds of delay in intimation and submission of documents to insurers. 

"Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation," the regulator said in a communication to life and non-life insurance companies. 

Although the policyholders are required to file claims within a prescribed time frame, the IRDA said, "this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances." 
Advising insurers to suitably enunciate their stand to condone delay on merit in policy papers, the regulator said "..such limitation clause (of filing documentation) does not work in isolation and is not absolute". 

It further said insurers should develop a mechanism to handle such claims with "utmost care and caution". 

Insurers, it said, must not repudiate claims unless the reasons of delay are specifically ascertained and recorded.

Besides, the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time."

In view of such unequivocal statement, the unyielding attitude of the insurance companies is unfortunate.

Comments

Post a Comment

Most viewed this month

Court approached in the early stages of arbitration will prevail in all other subsequent proceedings

In National Highway Authority of India v. Hindustan Steelworks Construction Limited, the Hon'ble Delhi High Court opined that once the parties have approached a certain court for relief under Act at earlier stages of disputes then it is same court that, parties must return to for all other subsequent proceedings. Language of Section 42 of Act is categorical and brooks no exception. In fact, the language used has the effect of jurisdiction of all courts since it states that once an application has been made in Part I of the Act then ―that Court alone shall have jurisdiction over arbitral proceedings and all subsequent applications arising out of that agreement and arbitral proceedings shall be made in that Court and in no other Court. Court holds that NHAI in present case cannot take advantage of Section 14 of the Limitation Act, 1963 for explaining inordinate delay in filing present petition under Section 34 of this Act in this Court.
Post a Comment
Read more

No Rebate For Stamp Duty Paid In Another State - Bombay HC

A three judge bench of the Hon'ble Bombay High Court (Bombay HC) in a recent judgment in the matter of Chief Controlling Revenue Authority, Maharashtra State, Pune and Superintendent of Stamp (Headquarters), Mumbai v Reliance Industries Limited, Mumbai and Reliance Petroleum Limited, Gujarat1 has held that orders in case of a scheme of arrangement under Section 391 to 394 of the Companies Act, 1956 (Act) involving different High Courts in multiple states, are separate instruments in themselves. Accordingly, stamp duty would be payable on all the orders (and consequently, all the states) without the benefit of remission, rebate or set-off.
Post a Comment
Read more

The recovery of vehicles by the financier not an offence - SC

Special Leave Petition (Crl.) No. 8907  of 2009 Anup Sarmah (Petitioner) Vs Bhola Nath Sharma & Ors.(Respondents) The petitioner submitted that  respondents-financer had forcibly taken away the vehicle financed by them and  illegally deprived the petitioner from its lawful possession  and  thus,  committed  a crime. The complaint filed by the petitioner had been  entertained  by  the Judicial Magistrate (Ist Class), Gauhati (Assam) in Complaint Case  No.  608 of 2009, even directing the interim custody of the vehicle (Maruti  Zen)  be given to the petitioner vide order dated  17.3.2009.  The respondent on approaching the Guwahati High  Court against this order, the hon'ble court squashed the criminal  proceedings  pending   before  the  learned Magistrate. After hearing both sides, the Hon'ble Supreme Court decided on 30th...
7 comments
Read more