Insurer Not Liable For Unreasonable Delay In Claim Intimation, Goa State Commission Dismisses Appeal Against Oriental Insurance Company

Brief Facts:

The Complainant was the registered owner of a Suzuki Access-UZ 125 and held a valid driving license until 24/01/2025. He insured the scooter with Oriental Insurance Co. Ltd. (“Insurance Company”) till the midnight of 09/02/2022, with a premium of Rs.1,430/-.

During the subsistence of the policy, while travelling from his residence in Chorao to his workshop in Campal, the scooter was involved in an accident near Madel Ferry. Not only did the scooter get damaged, but the Complainant also sustained serious fractures leading to a 3-week bed rest. Subsequently, the Complainant wrote a letter to the divisional manager of the Insurance Company. He explained that the delay in intimation was due to the unrepaired scooter's custody with the police station.

The Insurance Company's officials verbally instructed the Complainant to submit a repair estimate, but due to the prevailing COVID-19 situation in Goa, he could not obtain it immediately. After the pandemic restrictions eased, he acquired the estimate and submitted it to the divisional manager. The Insurance Company rejected the claim by citing a two-month delay in intimation as a breach of policy condition. Despite the Complainant's request for reconsideration, the Insurance Company confirmed the claim rejection and closure by a letter. Feeling aggrieved, the Complainant filed a consumer complaint before the District Consumer Disputes Redressal Commission, North Goa (“District Commission”).

The Insurance Company contended that the policy issued to the Complainant was subject to specific terms and conditions, and any claim's admissibility was governed by the insurance contract. The Complainant was requested to submit a damage estimate when there was no COVID lockdown in Goa. Despite the request, the first written intimation was received two months after the accident, and the estimate was submitted more than six months later. The delay violated the policy conditions and thus, the repudiation was justified.

The District Commission relied on the policy condition which stipulated a time limit and held that the Complainant failed to submit the claim within the required period. Therefore, the complaint was dismissed. Feeling aggrieved, the Complainant filed an appeal in the State Consumer Disputes Redressal Commission, Goa (“State Commission”)

Observations by the State Commission:

The State Commission observed that the Complainant informed the Insurance Company more than two months after the accident. Further, the damage estimate was submitted after a delay of approximately six months. The Insurance Company deemed it as a violation of the policy's T&C and repudiated the claim.

The Complainant argued that the COVID-19 pandemic in Goa prevented him from obtaining the estimate immediately. However, the State Commission noted that there were no Covid-19 restrictions in Goa during that period. The lockdown ended on 31st May 2020, and the accident occurred on 20th August 2021, with documents submitted on 10th March 2022. The State Commission found the Complainant's explanations unsupported and noted that the delay in informing the Insurance Company was unjustified and unproven.

The Complainant also failed to provide medical records to justify the six-month delay. The State Commission concluded that the Complainant did not demonstrate any illegality in the District Commission's order and failed to establish his case. The Insurance Company correctly repudiated the claim based on the terms and conditions, with no deficiency in its service.

As a result, the appeal was dismissed, and the District Commission's order was upheld.

Case Title: Mr Paul Colaco vs Divisional Manager, The Oriental Insurance Co. Ltd.

Case No.: First Appeal 31 of 2023

Advocate for the Appellant: Ms Apeksha Kalokhe

Advocate for the Respondent: Shri Savio Noronha