Consumer Connect: ‘After Receiving Report, Insurance Firm Has To Offer Settlement In 30 Days,’ Says Expert

Consumer Connect: ‘After Receiving Report, Insurance Firm Has To Offer Settlement In 30 Days,’ Says Expert

The questions are answered by Adv. Shirish V. Deshpande, Chairman – Mumbai Grahak Panchayat.

FPJ News ServiceUpdated: Monday, December 11, 2023, 08:51 AM IST
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Consumer Connect | FPJ

My warehouse at Bhiwandi caught fire following an electrical short-circuit in December 2022. I suffered a financial loss of Rs90 lakh. I reported the incident to the insurance company immediately. However, the company took quite some time to appoint a surveyor for investigation. The surveyor kept on demanding documents in piecemeal from time to time over a period of more than six months. During his visits, he was indicating to me that I should pay him some amount so that he would recommend a more beneficial settlement. Since I did not entertain such hints he has recommended settlement by offering me barely Rs21 lakh. The insurance company has accordingly offered to settle the claim by paying Rs21 lakh. This is not acceptable to me. Can I approach the insurance ombudsman?

Tejinder Singh, Bhiwandi

Although the insurance ombudsman regulations do not prescribe any pecuniary jurisdiction for the ombudsman, its power to grant compensation is up to Rs50 lakh. Since your claim amount exceeds Rs50 lakh, it is advisable that you approach the appropriate consumer commission. If the premium paid for the policy is less than Rs50 lakh you may approach the appropriate district consumer commission where your warehouse is located.

The Insurance Regulatory & Development Authority (Protection of Policyholders’ Interest) Regulations, 2017, specifies the timelines for appointment of surveyor, for surveyor’s report and consequent settlement of claims. In your case the surveyor is bound to submit its final report to the insurance company within 90 days of his appointment, barring some exceptional circumstances.

After receiving the said report the company has to offer the settlement within 30 days. In case of any delay beyond the prescribed timelines the company is liable to pay interest at the rate of 2% more than the bank rate. You can therefore approach the district consumer commission with your revised claim, including compensation for the delay.

I had a Mediclaim policy and my claim of Rs4,65,000 is not fully settled by the insurance company. It has offered me Rs1,30,000 and is insisting that I sign the ‘full and final settlement’ voucher. Should I approach the consumer forum or the insurance ombudsman?

Sadanad Dalvi, Mumbai

In the absence of details, I am unable to comment whether your claim has been decided rightly or not. Nonetheless, if you are aggrieved with the decision of the insurance company, I strongly recommend that you approach the insurance ombudsman in your jurisdiction. In order to do that you don’t have to pay any fee or engage an advocate.

At the first instance the ombudsman acts as a mediator and tries to resolve the dispute amicably. If the mediation fails then the ombudsman proceeds further to decide the case on the basis of the evidence produced by both the parties and delivers an award that is binding on the company. This entire process is expected to be completed within three months. If you are not satisfied with the award, then you can approach the consumer commission. Hence, it is beneficial for you to first approach the insurance ombudsman.

Our group of 24 tourists had undertaken Kesari Tours’ package to Thailand, Malaysia and Singapore in March 2020. We left for Bangkok on March 10, 2020, and completed the visits to Thailand and Malaysia. However, due to the outbreak of Covid-19, we had to cut short the visit and return to Mumbai without visiting Singapore. I read in the press that the CCPA has directed Kesari Tours to refund the money to all the tourists whose tours were cancelled due to the pandemic. I want to know if our group would be entitled to get the partial refund for Singapore’s non-performed tour, as per the Central Consumer Protection Authority order?

Deepak Kadam, Mumbai

Your case is peculiar in as much as your tour was substantially completed and only the last leg was not performed. The complaint filed by Mumbai Grahak Panchayat (MGP) was pertaining to cases where tours could not take off at all and had to be cancelled due to Covid lockdown. Kesari refused to refund the amount to such tourists and wrongly insisted that the tourists undertake future tours and that too by paying extra amounts in the name of cancellation charges, rescheduling charges, etc. The MGP had challenged such practices of Kesari as Unfair Trade Practice. The CCPA has upheld the complaint of MGP and has directed refunds in such cases. Your case, being peculiar and exceptional, is not covered by the CCPA order. Hence, you may therefore pursue the matter with Kesari, failing which you may file a complaint in an appropriate consumer forum.

Adv Shirish V Deshpande, Chairman, Mumbai Grahak Panchayat

Email: shirish50@yahoo.com

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