While the primary aim of the consumer forum is to ensure consumers rights in many instances insurance claim complaints require evidential proof to come to a conclusion, finds out Diana Fernandes
The Consumer Disputes Redressal Forum, South Goa at Margao has this year, as they have in previous years received several cases against insurance companies looking to settle claims related to vehicle, general or life insurance.
Being meticulous in their reasoning, the forum has had the task of taking into account not only the complainant but the claims of the insurance company and pass orders ensuring consumers are protected by provisions of the Consumer Protection Act 1986.
Take for example the case of one Kalaginamani who had filed a complaint against the insurer of his vehicle, Iffco- Tokio General Insurance Company Ltd claiming insurance after his insured vehicle worth Rs. 3.64 lakh skidded off the road, dashed a tree and caught fire.
Though the insurance company claimed that the cause of the action was not in sync with the damages sustained, the presence of two eye witnesses confirmed that the fire had been caused as a result of the accident. In this particular case, the consumer forum ordered the vehicle amount of Rs. 3.64 lakh along with interest of seven per cent per annum to be paid to the complainant along with a compensation of Rs. 10,000.
In another case, a housewife from Curtorim filed a complaint against the SBI General Insurance Company Ltd. after her son drowned in the River Irrigation Water Canal at Sirvoi, Quepem. He was insured for Rs two lakh under a personal accident policy and despite lodging the claim for the insured sum furnishing the relevant documents, the insurance company repudiated the claim as being baseless and concocted grounds and disowned their liability to pay compensation stating that the deceased was under the influence of alcohol due to which he had drowned.
Relying on the autopsy report of the deceased however the forum held that the cause of death was due to asphyxia as a result of drowning in the water and eventually ordered the insurance company to pay the insured amount of Rs two lakh along with compensation of Rs 50,000.
Consumers have also received relief in cases of jewellery and valuables like in the case of Carvalho from Margao who had a household insurance policy that would indemnify them against all risks in respect of loss or damage to jewellery and valuables, so also caused by accident or misfortune or theft.
The Carvalho’s valuables and jewellery worth Rs 79.54 lakh were insured but after the loss of a pair of earrings that had been removed from the locker and deposited in her purse which was later stolen, the insurance company denied their claim. They rejected the claim saying that the solitaire diamond was lost due to gross negligence of the insured’s wife. The forum pointed to the policy as being covered for accidents, misfortune or theft and ordered the insurance company to pay a sum of Rs 13.23 lakh and Rs 50,000 as compensation to the complainant.
In some cases though the consumer is not always king. Like the case of a truck owner from Quepem. The insurance company made a case against the truck owner whose vehicle valued at Rs 5.20 lakh caught fire while kept at a garage.
During the proceedings, the Oriental Insurance Company managed to prove that the truck owner could not be classified under the ambit of a consumer. Since the forum is ruled by the Consumer Protection Act, and having proven the truck owner was not a consumer, the forum said they didn’t have the jurisdiction to decide the complaint, eventually, dismissing the claim.