Fire001-National Insurance Co Ltd Vs Raja Poultry Farm: The poultry farm damaged due to cyclone and the claim amount assessed by the Surveyor was challenged and the National Commission held that the depreciation cannot be applied without any supporting documents if the damaged is within 2 months from the date of issue of policy. Learn More
Fire003-Subash Chander Jain Vs United India Insurance Co Ltd : The loss due to cyclone was not paid as the policy taken by the Bank of Maharashtra but the location of risk was wrongly mentioned on the policy. The claim was repudiated. Learn More
Fire 005- Ganga Smirti Khadi Sewa Sansathan Vs National Insurance Co Ltd : The loss due to fire was under paid which was disputed by the Insured. The Surveyor claimed that the policy does not include Finished goods as the policy mentioned only raw material. The detailed policy is clearly written that finished goods and work in progress, hence the claim amount should include the loss on account of FG and WIP. Learn More
Fire 006-Sadhu Ram Mittal Vs United India Insurance Co. Ltd: The loss due to peril fire but the loss was occurred on the first floor of the premises which was taken on rent subsequent to the policy but not endorsed in the policy , hence the claim is not payable. Learn More
Fire 009-M/s NVS Group Farms Vs United India Insurance Co Ltd : The building was destroyed by the Naxalites and threatened the staff not to inform the police otherwise face dire consequences. The claim was filed but repudiated by the Insurer. National Commission held the claim is payable as per assessment made by the Surveyor. Learn More
Fire 010-M/s Jeewan Parkash Oil (P) Ltd Vs National Insurance Co Ltd: The loss of stock by fire assessed at very nominal value based volumetric analysis but the Surveyor appointed by the Insured assessed by the at full value and the Insurer did not counter that report hence the claim is payable. Learn More
Fire 011- M/s Kintex Overseas P Ltd Vs United India Insurance Co Ltd: The fire took place in the factory but the loss was repudiated on the various reasons mainly as on the date of fire there was bandh in the city. The Insurer produced the production records and letter of Labour Department that the production took place. Hence the claim is payable. Learn More
Fire043-M/S. ARFAT PETRO – CHEMICALS PVT. LTD. Vs New India Assurance Co Ltd: The signing of discharge voucher will not bar the insured to file the legal case for justice. The claim allowed after depreciation. Learn More
Fire 050- M/s Roshan Oil Mill Ltd Vs United India Insurance Co Ltd : The visible flame is not compulsory due spontaneous combustion and claim is payable if the it is opted as Add on cover. Learn More
Fire 051-National Insurance Co. Ltd. vs M/S. Ruchira Papers Limited: An
explosion took place in the rag digester working in the factory for manufacturing of kraft paper, which caused extensive damage to the building and injuries to the workers resulting in the death of two workers. The Surveyor stated that it was mechanical failure not explosion so not covered under the policy. It was held that it is covered as it is explosion. Learn More
Fire 101- M/s A. I. CHAMPDANY INDUSTRIES LTD., Versus M/s NEW INDIA ASSURANCE CO. LTD. & 2 ORS. (2019): In the repudiation letter the Insurance Company had not given any reason as to why the loss assessed by the Surveyor was not accepted. The reason mentioned for repudiating the claim was beyond the scope of the contract. The grounds of repudiation of the claim do not relate to any terms and conditions of the Policy. The loss as assessed by the Surveyor, as genuinely suffered by the insured, needs to be fully compensated and cannot be denied on unrelated considerations. Learn More
Fire102-M/S. JANHVI MAHI SELECTION Vs NEW INDIA ASSURANCE (2019): The pecuniary jurisdiction will be based on the claim amount plus premium paid not the total sum insured. Learn More
Fire103-AVALON COSMETICS PVT. LTD. Versus ORIENTAL INSURANCE CO. LTD. & ANR. (2019)- The loss of fire was paid by the Insurer subsequently the building was under major repair but the stock was also stored there and fire re-occurred but the claim was repudiated as the change in the risk. Learn More
Engg104-ORIENTAL INSURANCE CO. LTD. Versus DR. ABHIJIT PURSHOTTAM PATHAK, EEI (2019): The X-ray tube was damaged but the claim was repudiated as per special exclusion no. 1 the tube is not covered but the Commission held that X-ray tube does not fall under this exclusion hence the claim is payable. Learn More
Fire105- NEW INDIA ASSURANCE CO. LTD. Vs MANAGING DIRECTOR, M/S. A POWER HIMALAYA LTD. (AERIAL ROPEWAY PROJECTS) (2019) : The claim on account of avalanche was repudiated as it is not defined peril in the policy but the Commission held that avalanche is part of storm hence the claim is payable. Learn More
Fire106-M/s WIMPLAST LTD., Versus M/s ORIENTAL INSURANCE CO. LTD., (2019): The fire claim was repudiated based on the police report that the claim is not genuine but Police report did not incorporate the name of the person who informed to the police. In forensic report the claim found be genuine hence the claim is payable. Learn More
Fire106-M/s WIMPLAST LTD., Versus M/s ORIENTAL INSURANCE CO. LTD., (2019): The fire claim was repudiated based on the police report that the claim is not genuine but Police report did not incorporate the name of the person who informed to the police. In forensic report the claim found be genuine hence the claim is payable. Learn More
Fire107-M/S. CRYSTAL CROP PROTECTION PVT. LTD. Versus NEW INDIA ASSURANCE CO. LTD (2019): The claim was repudiated on the ground that there was insurable interest. In fact, the company was merged with the another company as per order of Hon’ble High Court. The policy was issued but some godown was in the name of the insured. The Commission held that claim is payable. Learn More
Engg108-SAHELI EXPORTS PVT. LTD. Versus CHOLAMANDALAM MS GENERAL INSURANCE CO. LTD. & ANR. MBD (2019): The crank shaft was damaged but the claim was repudiated as per exclusion no 4 of the policy but the Commission held the claim of Rs 1.45 crs is payable as the insured is following the maintenance procedure defined by the manufacturer. Learn More
Fire109-NEW INDIA ASSURANCE CO. LTD. Versus SHREE SHANKAR SAHKARI SAKHAR KARKHANA LTD, (2019): The material (Baggase) lying in open was destroyed due to fire but the claim was repudiated as the policy did not cover the material lying in open. The Commission held the claim is payable as the Insurer pre-inspected the premises before issuing the policy. Learn More
Fire203-MONGA TRADERS Versus UNITED INDIA INSURANCE CO. LTD & ANR (2019): The loss due to fire was assessed as per the terms and conditions of the policy as a result the assessed loss was reduced due to under insurance. The Insured took the plea that terms and conditions were supplied by the Insurer along with the Policy Document. The Commission held that the principle of good faith is applicable to Insurer as well Insured therefore the Insurer should ensure to provide the terms and conditions and the Insured is also equally responsible to ask from Insurer to provide the terms an conditions. Hence, the claim is assessed as per the condition of average defined in the policy. Learn More
Marinecargo201- M/S. J.K. DALL MILL Vs NEW INDIA ASSURANCE CO. LTD. (2019): The claim was repudiated on the ground that the policy was issued after the consignment was dispatched from the foreign port. The ship had started its voyage on 11.01.1997 while the marine insurance cover note issued on 16.01.1997 and it became void. The Commission held that the insurance interest should be held at the time of loss as per Marine Insurance Act and at the time of loss i.e. at destination Mumbai the loss occurred hence the claim is payable. Learn More
Marinecargo202-UNITED INDIA INSURANCE CO. LTD. Versus M/S. POONGDHAI TEXTILES (P) LTD. (2019): The claim was repudiated on the ground of insufficient packing but the pre inspection clearly stated the how these machines were stored. It is also certified that the storage in container is as per standard practice. The Commission held that claim is payable. Learn More
Burglary204-ORIENTAL INSURANCE COMPANY LTD. Versus CANDOR BIOTECH LIMITED & ANR.(2019): The theft took place in the insured premises but the claim was repudiated as there was no forceful entry in the premises and it was proved that theft with the connivance with the Security Guard. The Insured took the plea of non-providing of terms and conditions of the policy but the Commission did not accept this plea and held the claim is not payable. Learn More
Contractor All Risk 205-M/S. PATEL ENGINEERING LTD. Versus BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD. & ANR. (2019): The loss was due to landslide 4 times within 2 months at one site the claim was repudiated by the Insurer as for the reasons that claim was not tenable as the losses were due to defect in design and the rock being softer, and that there were continuing landslides because of nature of works and landslides were caused due to inadequate slope protection measures for the project and the soil conditions. The plea was taken that it is “Act of God” not man-made peril. The Commission held that first loss may be paid not the subsequent losses. Learn More
Fire 206-AJIT KRIYANA STORE BHIWANI Vs UNITED INDIA INSURANCE CO. LTD: The Fire policy was taken in the name of “Ajit Kriyana Stor” but the board was hanging with the name “Sumer Kiryana Store”. The Insurer repudiated the claim as there was no insurable interest in the policy hence the claim was repudiated. The Commission agreed to pay 50% claim amount. Learn More
Fire 207-M/S SIGMA DIAGNOSTICS LTD. Versus BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD. (2019) : The MRI machine amounting to Rs 1.35 cr (second hand purchased) was damaged in fire but the claim was settled for the lower amount by applying the advance technology and deprecation for 10 years. The Commission held that depreciation should be charged from the date of policy not from the date of manufacture as the Insurer has accepted the value while insuring the equipment. Learn More
Jeweller Block 208- MANASI JEWELLERS (P) LTD. Versus THE ORIENTAL INSURANCE CO. LTD.(2019): The gold was missing when the an employee was returning by Volvo bus from Banglore to Mumbai, the claim was filed but the same was repudiated as the Claim falls under exclusion No. 5 of the policy which reads as under:
‘Theft or Disappearance of property hereby insured from road vehicle of every description owned or hired by or under the control of the Insured and / or their partners servants, agent or representatives where such vehicles are left unattended and also our condition no. 10 of the policy reads as under:
“The Insured shall use due diligence and concur in doing all efforts reasonable, practicable to avoid or diminish and loss under this policy.’
The Commission also held that the claim is not payable. Learn More
PA 209-LIBERTY VIDEOCON GENERAL INSURANCE CO. LTD. Versus AHILYA BAI & ANR. (2019): The claim was filed by the legal heir for the death due to electric shock while he was attempting to start pump on. The Insurer repudiated the claim as the electrical connection was illegal. The Commission upheld the decision of the Insurer. Learn More
CPM 210-M/S. PRECIOUS MINERALS AND SMELTING LIMITED Versus UNITED INDIA INSURANCE COMPANY LIMITED (2019). The excavator was damaged by the Naxalites and the claim was repudiated by the Insurer on the ground that the damaged of the excavator took place other than the place mentioned in the policy. The Policy stipulated the location “ Industrial Area” but not specified which Industrial Area therefore the Commission directed to 60% of the claim amount. Learn More
Fire 211-M/S. SUPER SEEDS PVT. LTD. Versus ORIENTAL INSURANCE CO. LTD. & ORS.(2019): The loss was due to “Inundation” but the Surveyor assessed the loss and stated partial loss due to Inundation and partial due to seepage of water in seeds bags. The Insurer paid the partial loss of inundation not of seepage but the Commission held that seepage is not an exclusion and seepage is due to inundation is covered under the policy. The full claim as assessed by the Surveyor is payable. Learn More
Misc (fire) 212-M/S. SHRI MOOKAMBIGA SPINNING MILLS Versus NEW INDIA ASSURANCE CO. LTD. (2019): The claim was repudiated and in the Consumer Forum the plea was taken that the policyholder is not a Consumer under Consumer Protection Act. The Commission held that inasmuch as a person who takes an insurance policy to cover the envisaged risk does not take the policy for commercial purpose. Section 2(1)(d) of the Act. Learn More
Fire 213-GROUPE SEB INDIA PRIVATE LIMITED Versus ORIENTAL INSURANCE CO. LTD. & ANR.(2019): The claim was repudiated the Insured is sick unit and non-disclosure of collaboration with multinational company for its business. The Surveyor also took the plea that storage is lower by 2 ft from the road level. The Insurer also took the plea before the Commission that Insured is not consumer as per Consumer Act and Commission has no pecuniary jurisdiction. The Commission held that Insured is Consumer and the Commission also has the pecuniary jurisdiction. Further non-disclosure of sick unit and tied up with multinational company is not material information, hence, the claim is payable. Learn More
Fire 214- KUMAR COLD STORAGE Versus NEW INDIA ASSURANCE CO. LTD.: There was fire in the premises of the Insured and stock of third parties was destroyed but the Insurer repudiated the claim of stock of third parties as it was not shown in the policy document. The Policy document produced by the Insured is having the word (Stock of various parties). But it was found that it was written after words by the Development Officer of the Insurer. Hence, the claim of stock of third parties is not covered. Learn More
Jeweller Block 215-B.A. SHAH & BROS. Vs NATIONAL INSURANCE CO. LTD. (2019): The theft took place in the shop but the claim was repudiated on the ground that the jewellery not kept in safe at night as per the condition of the policy. The jewellery was kept in steel almirah. The Commission provide an opportunity to the Insured to produce the certificate from the steel almirah that this almirah is equivalent to safe as desired by the Insurer. The Insured produced the certificate stating “ as good as safe”. The Commission did not agree that the almirah is safe as this certificate hence the claim is not payable. Learn More
Health009- United India Insurance Vs Jain Prakash Tayal (2010): The claim was rejected as it fell under exclusion of the policy. The Commission held that no additional exclusion can be added in the renewal. Hence the claim is payable. Learn More
Health008- Royal Sundram GIC Ltd Vs Meliane Das (2010): Under OMP the claim was repudiated for the reason pre-existing but the Insured proved there was no prior symptoms before talking the trip. The claim was paid. Learn More
Health006-Dr Bihari lal Singhania Vs United India Insurance Co Ltd (2010): The removal of glad bladder with stone is an exclusion for 2 years in the policy but the removal of glad balder without stone is covered. The claim is payable. Learn More
Health003-United India Insurance Co Ltd Vs S K Gandhi (2010): Insured had a heart attack the claim was repudiated as the he was having BP for the last 8-9 years as per discharge summary. The claim was repudiated as non- disclosure of facts. The Commission held the claim is payable as the Insurer could not prove that the insured was suffering from BP at the time of purchase of the policy. Learn More
Health101- RELIGARE HEALTH INSURANCE CO. LTD. Versus GAURAV HANDA THROUGH HIS LEGAL HEIR MRS. POOJA HANDA (2019) : The insured due to cancer but the medical claim was repudiated by the Insurer for the reason that he was smoker and taking alcohol which has caused cancer which is exclusion under the policy. The commission held that the report described that cancer can cause due to smoking and taking alcohol but nor certify that the Insured was suffering from cancer due to this. Hence the claim is payable. Learn More
PA Cocver 501 ROYAL SUNDARAM ALLIANCE INSURANCE CO. LTD. Versus SUMIT J. RAMCHANDANI (‘2020): The Insured went to kailesh parvat and fell down , the claim was filed but repudiated as the insured could not prove the accident but the dieses diagnosis by hospital was pre-existing. Learn More
Health 502-NATIONAL INSURANCE CO. LTD. Versus AMARESH MISHRA (‘2020): The claim was rejected as the LSG (Laproscopic Sleeves Gastrectomy) is a cosmetic procedure not covered under the policy. It is not exclusion in the policy of Senior citizen hence the claim is payable. Learn More
Life 503-FUTURE GENERALI INDIA LIFE INSURANCE CO. LTD. Versus HARINDER UDAYRAJ SINGH (‘2020): The Insured died because of kidney stone and jaundice and the claim was repudiated as it was pre-existing. The Commission held that claim is payable as non-disclosure such dieses is not material fact. Learn More
Fire 504-M/S. HIKAL LTD. Versus 1. CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED 2. UNIVERSAL SAMPO GENERAL INSURANCE CO. LTD. (‘2020): Universal Sampo refused to settle the claim to the extend its share of 5% for the reason the premium was not accepted by them. It was sown that the premium was transferred to their account. So it share to be paid. Learn More
JCB505-IFFCO TOKIO GENERAL INSURANCE CO. LTD. Versus JAYSUKHLAL JENTILAL NAKUM (2020): A light motor vehicle license is required to drive JCB (Excavator). The claim cannot be repudiated on this ground. Learn More
Vehicle 506-ORIENTAL INSURANCE COMPANY LTD. Versus MANJU RATHORE & ANR. (2020): The LMV license holder can drive taxi as it depended upon the weight of the vehicle. The vehicle with up to 7500 Kgs can run by the LMV license holder. Learn More
Fire 507-THE ORIENTAL INSURANCE COMPANY LIMITED Versus NECTAR LIFESCIENCES LIMITED (2020): The Claim filed under Bursting of Tanks and piping and the same was repudiated on the plea it covers only water tanks and pipes not chemical etc. The Commission held that all types of tanks and pipes are covered. The claim paid. Learn More
Life 508-PRAMOD PODDAR Versus BIRLA SUN LIFE INSURANCE COMPANY LIMITED (‘2020): The claim was repudiated due to non-disclosure other life insurance policies taken prior to this policy. The upheld the decision of the Insurer. Learn More
Vehicle 509- RANBIR Versus BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD (‘2020): The car borrowed by the friend and left the car on roadside to ease himself and key inside. The car was taken away by some persons. The claim was filed but repudiated. The Commission held that the car was visible from the place he was easing himself therefore no negligence the claim payable. Learn More
Fire 510- New India Assurance Vs Hamdard (2018): The voltage fluctuation, due to Lightening, damaged the telephone exchange and the claim was filed under peril “Lightening” of Standard Fire and Special Perils policy. There was no fire in the telephone exchange or otherwise. As per the practice the Surveyor repudiated the claim was repudiated by stating the exclusion clause no. 7
But it is held by the National Commission that this loss does not fall under the exclusion no 7 as there was no fire and this excludes only particular machine or apparatus.
Further it is to emphasis that the peril lightening does not any have any specific exclusion under its own peril as in the case of other perils. Moreover, the lightening can result into three types of losses i.e. Fire, Physical damage and voltage fluctuation and the exclusion no 7 is applicable in the case of fire only not otherwise. Learn More
Vehicle 511-UNITED INDIA INSURANCE CO. LTD. Versus. KULWINDER SINGH KANG (2020): The claim settled as per Surveyor but the claim amount was increased for the reasons the Surveyor has not justification for deducting the amount from the claim bill. Learn More
Vehicle 512- UNITED INDIA INSURANCE CO. LTD. Versus PRAHALLAD RAI SULTANIA(DECEASED) THROUGH LRS (“2020): The claim was repudiated because the endorsement of hazardous goods in the license is missing. The Commission held that the driver has undergone the training course as per MV Act therefore the non-endorsement by Authority is formality hence the claim is payable. Learn More
Marine Cargo 513-NATIONAL INSURANCE CO. LTD. Versus APEX TRADING COMPANY (“2020): The marine policy was not assigned hence the claim was repudiated. Learn More
Cash in Transit 301-M/S. D.D. MOTORS Versus NEW INDIA ASSURANCE COMPANY LTD. (2019): “The only question to be answered by us in this case is that, whether keeping the amount in a cash bag in a Filing Cabinet duly locked, could be a valid substitute of cashbox in a Steel Almirah as stipulated in the insurance policy? The Commission held that the claim is payable. Learn More
Fire 302- M/S. PREMIUM COMPOSTOS INDIA PRIVATE LIMITED Versus NEW INDIA ASSURANCE CO. LTD. (2019): The building, P& M and stock was damaged due to fire but the claim was repudiated for the reasons condition no 8 as the Insurer did not disclose that the rent agreement for the period 72 months is not registered. The Commission held that the claim is payable. Learn More
Vehicle 303-UNITED INDIA INSURANCE CO. LTD. & ANR. Versus S. NARAYANAN (2019): The crane while lifting the vehicle from the sea water, hook was broken and the crane was damaged. The claim was repudiated as the damaged due to overturning which is exclusion in the policy. The Commission held while the Surveyor has not given the reason of overturning the claim is payable. Learn More
Jeweller Block 304-M/S. S.B. JEWELLERS Versus UNITED INDIA INSURANCE CO. LTD. & ANR. (2019): The claim was repudiated on the following grounds:-
“(1) proper stock and account books has not been maintained in which all sales and purchases are recorded.
(2) By keeping master key in the showcase due diligence was not used.
(3) There has not kept any watchman particularly for this premises / building.”
The Commission held that the claim is not payable. Learn More
Shopkeepers Policy 305-ORIENTAL INSURANCE CO. LTD. Versus M/S. SHRADDHA TRADERS (2019): The loss due to burglary because of earthquake was repudiated for the reason there was no forceful entry. The Commission held that the policy document should clearly explain the meaning of the word “ Burglary” which is not in this case as the Insurer did not proved the terms and conditions of the policy to the Insured. Hence the claim is payable. Learn More
Cash in Transit 306-NEW INDIA ASSURANCE CO. LTD. Versus M/S. PRADEEP KUMAR TRILOKCHAND (2019): Mr. Khemchand a partner of the complainant firm collected Rs.5,15,000/- from various customers and boarded a bus for returning to Indore on 1.7.2005, carrying the cash collected by him in a canvas bag which was then kept in a briefcase. This is also the case of the complainant in the consumer complaint that the briefcase had been tied with the pipe of the bus using a chain for the purpose. When the bus reached village Bhudhni, the driver, conductor and most of the bus passengers got down from the bus to take refreshments. The partner of the complainant firm also went out to ease himself. When he returned to the bus after 3-4 minutes, he found the briefcase broken and the canvas bag containing the cash missing. The claim was repudiated as per exclusion of the policy that bag left unattended. The Commission held that some of the bus passengers were in the bus hence the bag is not left unattended hence the claim is payable. Learn More
Marine cargo 307- UNITED INDIA INSURANCE CO. LTD. Versus EXOTIC INDIA & ANR.& U.P.S. JET AIR EXPRESS (P) LTD (2019): The claim was repudiated on the ground that the packing was insufficient as per Terms and conditions. The Commission held that there was loss of 10% of the items and if the packing was insufficient all the material got damaged hence the claim is payable. Learn More
Health 308-FUTURE GENERALI INDIA INSURANCE COMPANY LTD. Versus INDERJIT SINGH (2019): The claim of the complainant has been repudiated by the Insurer on the ground that the complainant has concealed the previous ailment i.e. Alcoholic Liver Cirrhosis on the basis of exclusion clauses III.12 & III.2. It is based on the discharge history that the insured was suffering from chronic dieses. The Commission held that that by merely writing on the discharge history would not amount to pre-existing dieses . The Insurer should produce the document where it can be proved that the dieses was pre-existing. Hence the claim is payable. Learn More
Jeweller Block 309-M/S AVIRAJ GEMS Versus NEW INDIA ASSURANCE COMPANY LTD. (2019): The reasons in the repudiation letter being that the complainant did not inform the Opposite Party the periods of operation of CCTV, and the safe in the premises not being attached to the floor of the premises. The Commission held that claim is payable. Learn More
Bankers Indemnity Insurance 310-UNITED INDIA INSURANCE CO. LTD. Versus JILA SAHAKARI KENDRIYA BANK MARYADIT (2019): The claim was filed for the encashment of demand draft by an employee but repudiated as per exclusion clause of the policy. The Commission held that claim is payable as the conditions defined in the policy is ambiguous hence the claim is payable. Learn More
Vehicle 311- SHRIRAM GENERAL INSURANCE CO. LTD. Versus ABDUL REHMAN SAHABUDDIN SIDDIQU (2019): The vehicle was stolen, and the claim was repudiated on the ground the delay filing of FIR and the key was left in the dashboard. The Commission held the claim is payable as the intimation was given to Policy the same day as per policy condition and the date of FIR may be on the later date. The duplicate key was in the dashboard not the original. Learn More
Fire401-VEDIC RESORTS & HOTELS PVT. LTD. Versus NATIONAL INSURANCE COMPANY LTD. (2019): The hotel was damaged due to riots and strike which was repudiated vide exclusion (b) of peril (V) Riots , Strike and malicious Act but the Commission held that the claim is payable the loss does not fall under the exclusion. Learn More
MBD 402-NEW INDIA ASSURANCE COMPANY LTD. Versus M/S. ABROL ENGINEERING COMPANY PVT. LTD. (2019): The claim was repudiated on the ground that the damaged due to normal wear and tear. The Commission held as per the Engg of manufacturer it was breakdown no wear and tear hence the claim is payable. Learn More