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When companies reject your claim

delhi Updated: Mar 25, 2012 01:31 IST

Taking an insurance cover for your home, household goods and valuables certainly makes you feel secure. But the feeling of security vanishes when the insurance firm comes up with innumerable excuses not to pay.

Here are two cases where the insurance ombudsmen had to step in to ensure that the policy holder got the insured amount.

Rakesh Bansal was to deposit jewellery in his bank locker. When he found the parking lot at the bank full, he decided to visit a doctor first. The jewellery, he perhaps thought, was safe underneath his seat. However, when he returned, he found his car itself missing.

He was fortunate to have an insurance cover for his vehicle and a householder's policy for the jewellery. Or so he thought till the insurance company repudiated his claim. After he lodged a complaint with the insurance ombudsman in Delhi, the company argued that it would indemnify the loss of the car, but not the jewellery, as he had not taken "due care and caution", as required under the policy.

The ombudsman, however, dismissed the contention and directed the insurer to pay. (Shri SN Bansal Vs Oriental Insurance Company Limited, decided on March 10, 2008.)

In Shri Sadhan Chakraborty Vs The New India Assurance Company Ltd (May 23, 2007), the insurance did not send a surveyor/investigator for three months after the theft of jewellery. And then, after the grills and the latch had been repaired by the policy holder, the insurance said there were no signs of "violent and forcible entry" and rejected the claim. The ombudsman held that this argument was unacceptable.

Prem Kumar Suri: My household insurance policy is for 18 years and covers everything. The insurance agent offered me a first-loss policy for jewellery that may be at home. I gave a list of 21 ornaments (total value of Rs 17.05 lakh) and the company issued me a policy effective from April 2009. On October 17 last year, our house got burgled and we lost a lot of jewellery - not just what was covered, but also those belonging to my daughter-in-law as well as my married daughter - we had gone to a wedding the previous day.

The insurance company is yet to pay. In fact, they are now coming up with all kinds of queries - asking us to produce bills of the jewellery, identify shops from which they were bought, give valuation report and wealth tax returns, which were never asked at the time of insurance cover. What do I do?

Answer: Please complain to the grievance cell of the insurance company and if there is no positive response, you can complain to the insurance regulator, Insurance Regulatory and Development Authority (www.irda.gov.in). You can also lodge a complaint with the insurance ombudsman. You can get the contact details of the ombudsman from the IRDA website. I would also suggest that you look at the decisions of the ombudsmen on householder's policies - the IRDA website gives you the link to the orders and it will be of help in your case.