National Insurance Company Limited v. Shafiq-ur-Rehman Nengroo
2015-05-18
ALI MOHAMMAD MAGREY, N.PAUL VASANTHAKUMAR
body2015
DigiLaw.ai
JUDGMENT N. Paul Vasanthakumar 1. These appeals are filed against the common order passed by the J&K State Consumer Disputes Redressal Commission, Srinagar, dated 02.01.2015, wherein the Commission has directed the appellant to entertain/register the claims made by the respondents in these appeals for settlement of their insurance claims on merits. The brief facts necessary for disposal of these appeals are as follows:- (a) The complainants/ respondents herein being aggrieved over the rejection of their insurance claims, stating that within 15 days of the alleged loss/damage of the insured properties the policy holders have not submitted their claims, filed complaints before the J&K State Consumer Disputes Redressal Commission, Srinagar (for short ‘the Commission’). The case of the claimants before the Commission was that they have insured their buildings / goods with the appellant under policy Nos. 421008/48/14/3600000131 and 421001/11/13/3100000936 and due to the unprecedented floods faced in Srinagar in 2014 their buildings/goods, which were having insurance coverage, were damaged and the respondents lodged insurance claims on 20.11.2014 and 27.11.2015 respectively i.e. after 81 and 83 days of loss. The said claims were not entertained by the appellant-Company for the reason that claims for indemnification of loss could be lodged within 15 days as per the terms and conditions of the Insurance Policy and the policy does not allow admission of any such claim and assumes no risk in case the claim is beyond the period prescribed under the policy of insurance. According to the appellant, the Insurance Company was accepting intimations up to 01.10.2014 for flood victims, keeping in view the sensitivity of the floods. (b) The Commission, relying on the Circular issued by the Insurance Regulatory and Development Authority dated 20.09.2011, set aside the rejection order as the claimants were presumptively prevented by the situation due to Jhelum flood of September, 2014 which reduced Srinagar City to a ghost city with everybody effected in total shock to the point of induced inertia for weeks together during which time even offices of Insurance Company were totally disarrayed and directed the appellant to register the claims and settle the same on merits according to law. 2. The contention of Mr.
2. The contention of Mr. J. A. Kawoosa, learned counsel for the appellant is that the Commission has passed the order without appreciating the conditions contained in the Insurance policy, wherein it is stated that on the happening of any loss or damage, the insured shall forthwith give notice thereof to the Company within 15 days of the loss or damage or such further time as the Company may in writing allow in that behalf, and in these cases the devastating floods having pondered the Srinagar City, if the respondents have sustained any loss due to the said floods they should have submitted their claims within 15 days and taking note of the ground situation the Company itself has extended the period up to 01.10.2014, there cannot be any further delay and in these cases there is delay of more than two months in submitting the claims, as such the Commission is not justified in giving directions to entertain the claims and decide them on merits. In support of the said contention the learned counsel for the appellant has relied on the decisions of Hon’ble the Supreme Court reported in AIR 1966 SC 1644 , (2004) 8 SCC 644 (United India Insurance Co. Ltd v. Harchand Rai Chandan Lal), and (2010) 10 SCC 567 (Suraj Mal Ram Niwas Oil Mills Pvt. Ltd v. United India Insurance Co. Ltd. and ors). 3. Mr. S. M. Ayoub, learned counsel appearing for the respondents, on the other hand, submitted that the policy itself enables the Insurance Company to entertain claims beyond 15 days and discretion is given to the Insurance Company officers and the Company also chose to extend the time noting the situation. Thus there is no prohibition in extending the time as sufficient cause is shown by the respondents for submitting the delayed claims and, therefore, the Insurance Company is bound to register their claims, process the same and consider their claims on merits. The learned counsel further stated that the action of the appellant in not registering the claims only on the ground of delay was rightly set aside by the Commission and no interference is called for.
The learned counsel further stated that the action of the appellant in not registering the claims only on the ground of delay was rightly set aside by the Commission and no interference is called for. Learned counsel also submitted that since Srinagar City was effected by the fury of floods for more than two months the people in the locality went to safer places and only on their return they could submit their insurance claims and as such there occurred delay and the said delay having been properly explained the claims were rightly directed to be registered. Learned counsel also relied on a Division Bench judgment of this Court rendered in CIMA No. 4/2015 (National Insurance Company Ltd. v. Alfa Home Appliances) dated 10.02.2015 and submitted that issue raised in these appeals are covered by the said judgment. 4. We have considered the rival submissions made by respective counsel for the parties, perused the insurance policies and the judgments cited on rival sides. 5. Admittedly the respondents have insured their buildings/ goods and they have paid the premium also. The Insurance policy though contained a clause that on the happening of any loss or damage the insured shall forthwith give notice to the company within 15 days, ample power is given to the Insurance Company to consider belated claims and by virtue of that power only the appellant has granted extension in time to submit the claims till 01.10.2014. The fact namely the flood has caused heavy damage to the buildings/offices and whole Srinagar City became standstill is beyond doubt. Hence the respondents have a reasonable cause to submit their claims belatedly i.e. after more than two months. In such circumstances, the delay in lodging their claims is not willful and due to the peculiar circumstances under which the respondents were put in. 6. The Insurance Companies are registered under the Insurance Act, 1938. Under sub Section (1A) of Section 2 of the Act, the authority means the Insurance Regulatory and Development Authority established under sub-section (1) of Section 3 of the Insurance Regulatory and Development Authority, Act, 1999. The Insurance Company is defined under Section 2 (8) which means any insurer being a company association or partnership which may be wound up under the Companies Act, 1956 or to which the Indian Partnership Act, 1932 applies.
The Insurance Company is defined under Section 2 (8) which means any insurer being a company association or partnership which may be wound up under the Companies Act, 1956 or to which the Indian Partnership Act, 1932 applies. Insurer is defined under Section 2(9), which reads as follows:- “(9) "Insurer" means- (a) any individual or unincorporated body of individuals or body corporate incorporated under the law of any country other than India, carrying on insurance business not being a person specified in sub-clause (c) of this clause which- (i) carries on that business in India, or (ii) has his or its principal place of business or is domiciled in India, or (iii) with the object of obtaining insurance business, employs a representative, or maintains a place of business, in India; (b) any body corporate [not being a person specified in sub-clause (c) of this clause] carrying on the business of insurance, which is a body corporate incorporated under any law for the time being in force in India; or stands to any such body corporate in the relation of a subsidiary company within the meaning of the Indian Companies Act, 1913 (7 of 1913), as defined by sub-section (2) of section 2 of that Act, and (c) any person who in India has a standing contract with underwriters who are members of the Society of Lloyd's whereby such person is authorised within the terms of such contract to issue protection notes, cover notes, or other documents granting insurance cover to others on behalf of the underwriters.” Section 3 contemplates registration of Insurance business and states that no insurer carrying on any class of insurance business shall, after the expiry of three months from the commencement of this Act, continue to carry on any such business, unless he has obtained a certificate of registration from the Authority. Thus it is manifest that Insurance Companies are registered under the Insurance Act, 1938 and the Insurance Regulatory and Development Authority is created to supervise the Insurance Companies under the Insurance Regulatory and Development Authority, Act, 1999. The Insurance Regulatory and Development Authority is vested with the duties, powers and functions under Section 14 of the Act.
Thus it is manifest that Insurance Companies are registered under the Insurance Act, 1938 and the Insurance Regulatory and Development Authority is created to supervise the Insurance Companies under the Insurance Regulatory and Development Authority, Act, 1999. The Insurance Regulatory and Development Authority is vested with the duties, powers and functions under Section 14 of the Act. In exercise of the said powers conferred under Section 14, the Insurance Regulatory and Development Authority issued a circular on 20.09.2011 stating that all the insurers need to develop a sound mechanism of their own to handle such claims with utmost care ad caution and the insurers were advised that they must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time. For proper appreciation, the circular dated 20.09.2011 is extracted herein below:- “ To: All Life Insurers and non-life insurers. Re: Delay in claim intimation/documents submission with respect to: i. All life insurance contracts and ii. All Non-life individual and group insurance contracts. The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents. The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, 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. The insurers decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policyholder’s losing confidence in the insurance industry, giving rise to excessive litigation. Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution.
Rejection of claims on purely technical grounds in a mechanical fashion will result in policyholder’s losing confidence in the insurance industry, giving rise to excessive litigation. Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time. The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers’ stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured.” 7. The appellant Insurance Company being registered under the Insurance Act and is controlled by the Insurance Regulatory and Development Authority. Hence directions issued by the said Authority are binding on the Insurance Company. The said Circular mandates the Insurance Companies not to reject the claims on the ground of delay alone. On the contrary, the Authority directs the Insurance Companies to entertain the claim, process it and if there is no basis for the claim, it can be rejected. Thus it is evident that no claim of the insured can be rejected only on the ground of delayed claim and in these cases the delay according to the appellant is only 81 days, the said delay having been explained, which is also not very much disputed by the appellant due to the unprecedented flood situation prevailed during September, 2014 to January, 2015, the Commission exercised its discretion and set aside the order of the appellant Company in not entertaining the claims of the respondents. 8. The Division bench of this Court in one similar case (National Insurance Company Limited v. Alfa Home Appliances, CIMA No. 4/2015 decided on 10.02.2015) held that the claim sought to have been made in the shortest period of time cannot be accepted because the delay was caused due to unprecedented flood situation and Hon’ble the Supreme Court also gave directions to consider the rehabilitation of victims of floods due to which the State as well as the Central Government released some compensation to the flood victims.
In the said case the similar contention was negative by this Court by holding that it is not the case of the Insurance Company that the Commission has allowed the claim of the insured and the only order passed is to entertain the claim/claims, process it and consider the claim on merits without reference to the delayed submission of the claim. 9. The decision cited by the learned counsel for the appellant is distinguishable. In these cases the policy itself contemplates extension of time, therefore the submission of claim within 15 days of the loss is directory and not mandatory. In exercise of that power only the Insurance Company extended the time to submit the claims by the insured persons who sustained loss up to 01.10.2014. Moreover, this Court in CMP No. 3/2014 in PIL No. 1-Gupkar/2014 (G. A. Lone and anr v. Union of India and ors dated 01.10.2014) noticed the number of claims received by the Insurance Companies including that of the appellant and insofar as the Bajaj Allianze was concerned, up to the date of order that was on 01.10.2014, 4870 intimations/claims were received and the Company could settle only 197 cases. Similarly the ICICI Lambard General Insurance Company had received 266 intimations/claims but not even a single claim was finalized. Insofar as the United India Insurance Company received 2431 claims and it could finalize only 26 claims. The National Insurance Company which has received 2962 claims could finalize only 85 claims. Thus it is clear that even the claims received in time could not be settled due to flood situation prevailing as the Insurance Companies could not assess the damages through surveyors. It is thus beyond doubt that when the Insurance Companies themselves could not process the claims submitted within time, they cannot be permitted to plead that the insured were not prevented due to floods in submitting their claims within the stipulated time. 10. It is a well settled law that while interpreting the provisions/clauses, the ground realities should be borne in mind and whether the claims made are bonafide or purposely delayed, has to be determined on the facts of each case.
10. It is a well settled law that while interpreting the provisions/clauses, the ground realities should be borne in mind and whether the claims made are bonafide or purposely delayed, has to be determined on the facts of each case. In such circumstances the Commission was perfectly right in set aside the rejection order of not entertaining the claims of the respondents on the ground of delayed submission and was justified in issuing directions to the appellant to register the claims and process the claims on merits without reference to the delay in submission of the claims. 11. There is no merit in these appeals and the same are dismissed. No costs.