The National Consumer Disputes Redressal Commission heard an appeal in relation to an Insurance complaint against New India Assurance.
Background:
The complainant, MAC Remedies Pvt. Ltd took an insurance policy from New India Assurance for its goods in transit for the amount of Rs. 1 Cr. for the period of 2005-2006. In 2005, a consignment of medicines was dispatched through a truck owned by Economic Logistic Ltd. During transit, this truck met with an accident and thus, the complainant made a claim of Rs. Rs.31,35,841. New India Assurance repudiated this claim due to which, a complaint was filed under the Maharashtra State Consumer Disputes Redressal Commission.
However, through an order in 2013, the State forum dismissed the complaint. Aggrieved, the complainant filed an appeal in the National Commission. However, the dismissal was considered well-reasoned. The repudiation was based on an investigation report in 2006.
Investigation Report:
The investigator concluded the report stating that it was proved that the claim by the insurer was fake, fabricated and fraudulent. It was seen that the insurer themselves had their goods damaged to obtain undue benefit of the insurance. It also mentioned that goods belonging to different companies, carried in the same vehicle were not damaged. The documents submitted were fake and further, the goods were being dispatched to parties who do not engage in trade of pharmaceutical goods. There was also no police panchanama. The accident was also not such that the goods could have fallen out of the vehicle. Thus, circumstantial evidence proved the mala-fide intention of the insurer.
Based on this, the Insurance company repudiated the claim, stating the same reasons in their letter to the complainant.
Decision:
Presiding Member, Dinesh Singh stated that it was abundantly clear from the investigation report and repudiation letter that the claim made by the complainant was fraudulent.
“Investigation by an insurance company is fundamental in determining the amount payable to the insured. Investigation cannot be disregarded or dismissed without cogent reasons (it, but, also goes concomitantly that the rationale recorded in the Investigation should be convincing and pass credence in scrutiny).”
He further stated that the report was well reasoned, facts were unearthed and was rational in its decision. No reasons or questions were made on the investigation either.
He said that consumer forums were not vehicles to further “fake, fabricated and fraudulent” claims as what the complainant had tried.
Thus, for the ill-conceived appeal, the commission imposed a cost of Rs. 50,000/- to the complainant, dismissing the complaint. This was to be paid within four weeks failing which the State Commission may take actions as per law.
Story by Sai Kulkarni-Intern
