Dose IRDA Succeed to protect policy holder’s interest?
My client case
Mr. Mohan Madhvi of Anjar (GUJARAT) had got insured his Trailor Registration No. GJ-12-Z-2669, for sum insured Rs. 21,02,350/= with M/s. Royal Sundaram Alliance Insurance Company Limited under comprehensive Insurance Policy dated 11.7.2008. On 28.11.2008 vehicle met with an accident and had been severely damaged and beyond repairs. As such an own damage claim was lodged with the Insurance Company. On 3.12.2008 surveyor Shri Hitesh R. Raval of Gandhidham (Gujarat) was appointed by Insurance Company who had given a final survey report wherein he had suggested three options for settlements. As a matter of fact as per the contentions and provision of Insurance Policy there are only two mode of settlement i.e. either Repair Basis or if the cost of repairs/replacements is more than 75% of the IDV, then it should be consider on Total Loss Basis and the extent of damage as assessed by the surveyor Shri Hitesh R. Raval was Rs. 16,55,000/= and it was more than 75 % of IDV Rs. 21,02,350/-.This was straight forward a case of Total Loss. still however the surveyor had suggested 3rd mode of settlement which was quite partial, violation of the terms and condition of Insurance policy, as well as out of scope of the Motor Vehicle Act and favouring the insurance company and to superimpose himself, and this type of the actions initiated by the surveyor and accepted by insurance company is simply a breach of the Code of conduct framed by IRDA as well as by Insurance Company.
On 24.2.2009 the insured raised a protest on the ground that since the extent of damages to the vehicle was more than 75% of sum insured and not advisable to be repaired. The petitioner also demanded for appointment of 2nd Surveyor as 1st surveyor mislead the insurance company by giving false and fake survey report. Also the fact was brought to the notice of Insurance Regulatory And Development Authority (IRDA) with a request to intervene in the subject as settlement suggested by the Underwriters was arbitrary and unjustifiable taking into account the bargain power of a corporate body. On 22.4.2009 IRDA gave a funny reply that “ Insurance company have been informed us that the offer of settlement of claim is just and proper. Such actions of IRDA are providing space to the Insurance Company to finalize claims on their will and wish keeping aside all rules and regulations and also develop the scope of corruption and to escape from the accountability of the Government Body and the purpose of framing such a regulatory body is vanished.
As such the Insured filed a writ petition on 27.10.2010 vide Special Civil Application No. 14291of 2010 with Hon’ble Gujarat High Court, Ahmedabad against the respondents IRDA and Insurance Company. On 28.3.2011 The Hon’ble Gujarat High court Ahmedabad, vide its Judgment, order to the Insurance Company the Name of a Senior Surveyor Mr. Prakash J. Malkan Gandhidham and to appoint him as second surveyor. On 27.10.2013 Mr. Prakash J. Malkan Gandhidham, the 2nd Surveyor, issued a report and as per the report, the assessed liabilities of the claim exceed the 75% of the Total Sum Insured and the Claim falls to be treated as TOTAL LOSS. The report has been submitted by the 2nd Surveyor to the Insurance Company, but till date, the insurance company has not settled the genuine claim.
It is quite surprising that even in minor issues the IRDA impose penalties on the Insurance Companies to the tune of lakhs of rupees and for such a Major Scam where the Insurance Act as well as Motor Vehicle Act have vastly been violated by the 1st surveyor as well as Insurance Company, whether the IRDA shall initiate any severe actions or shall remain under the GRIP OF CORPORATES, and remain silent and thereby whether the insured shall once again have to knock the doors of Competent Judiciary for his Genuine and legitimate claim. It is quite apparent from the present issue that Rules framed and stipulated by IRDA are merely for reading & filing in the Library and as it is well known and established fact known to the Insurance Companies and surveyors they both do not implement the rules framed by IRDA and thus the IRDA Institution framed by Government is merely a Drama.
What is remedy for this case ?