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Office of the Insurance Ombudsman,

3rd Floor, Jeevan Seva Annexe,


S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.:- 022-26106928/360/889

Date: 18th Dec 2014

Subject:

Regarding

total

repudiation

of

claim

in

claim

no

400501201114110073601 & 400501201114110073701


Sir
1. That I had purchased a policy bearing number 201140050113100093800000 from
Liberty Videocon General Insurance Company having its registered office at 10th
floor, Tower A ,Peninsula Business Park,Ganpatrao Kadam Marg,Lower Parel,
Mumbai 400 013 for vehicle number RJ-14-UB-2907. The term of policy extends
from 31.03.2014 to 30.03.2014. The policy cover note and its entire wording are
marked and annexed as Annexure 1 and 2 respectively.

2. That the insured vehicle was taken to the Authorized Workshop situated at
Sitapura Industriual Area, Jaipur on 07.12.2014 for getting it repaired and claim

no 400501201114110073601 and 400501201114110073701 was filed on


08.12.2014. At the very outset, on the date of survey, the claim was repudiated in
totality without assigning any reasons.

3. A complaint was filed against the said repudiation with the customer care
executive of the insurance company Mr Chetan. Further Mr Arun Gupta who is
presently the Claims Manager called up to inform that the damage in claim no
400501201114110073601 was caused due to hailstorm that occurred 4 months
back and since the information was not given within 7-10 days, the claim was
liable to be rejected.

4. A written representation against the said denial was made to the insurance
company on 09.12.2014 and vide letter dated 16.12.2014 the following reasons
were assigned for repudiation of claim by the insurer company

a. Claim number 400501201114110073701: cause and nature of nature of


loss mentioned while intimating the claim did not correlate with the
damages and there is no direct impact on the loss and it is regular wear
and tear.
b. Claim number 400501201114110073601: the alleged accident took
place on 03.08.2014 and information was given on 08.12.2014, as much
as delay of more than 4 months. In view of non-adherence to material

terms and condition of policy on your part we disclaim all liability


towards your subject claim
The written representation made against the repudiation dated 09.12.2014 and the
reply dated 16.12.2014 given by insurance company for repudiation of claim no
400501201114110073701 and 400501201114110073601 are marked and annexed as
Annexure 3, 4 and 5 respectively.
Aggrieved by the said repudiation, I prefer this application under Rule 12 r/w Rule 13 of
Redressal of Public Grievance Rules 1998

GROUNDS
1. That claim no 400501201114110073601 was repudiated on the ground of
inordinate delay and reference was made to Clause 1 of the CONDITIONS to the
policy which is reproduced here under:
1. Notice shall be given in writing to the Company immediately upon the
occurrence of any accidental loss or damage in the event of any claim and
thereafter the insured shall give all such information and assistance as the
Company shall require
It is pertinent to mention that there is no whisper in the said clause of any
quantified time limit for the insured to bring into the knowledge of company about
accidental loss. The aggrieved herein is a doctor by profession. He owns and runs

a hospital in the name of Royal Hospital, situated at Bajrang Vihar, Jaipur. Due to
paucity of time as well as unawareness of the said clause the information was not
brought into the knowledge of insurer. The said reasons justifies the act of insured
for inordinate delay in bringing the accidental loss and damage to the knowledge
of insured on 8th Dec 2014.
2. That claim no 400501201114110073701 has been repudiated arbitrarily and
malafidely. It is emphatically stated that the claims manager was willing to allow
this claim until written representation was made against the repudiation of first
mentioned claim. Infuriated over the written representation, he telephonically
informed the aggrieved that he wont be able to help now as he is bound by the
terms and conditions of the policy and since the matter was brought grievance
redressal, it is now their discretion to either process it or repudiate it. Moreover the
claim was disallowed on the ground that the loss was caused due to wear and tear
but in reality the insurer took the garb of wear and tear to harass the insured.

NATURE AND EXTENT OF LOSS


1. Complete paint and repair of roof and bonnet of the car having marks caused due
to hailstorm.
2. Paint and repair of front bumper

RELIEF PRAYED
In light of aforesaid facts, it would be in the interest of justice to allow claim no
400501201114110073701 and 400501201114110073601in totality and to direct the
insurer to expedite the process.
Dr. Suresh Kr. Verma
(Complainant)
205 Vasundara Colony
Tonk Road , Jaipur 302016
9414209291

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