Karachi: Federal Insurance Ombudsman (FIO) Raeesuddin Paracha has ordered payment of an accumulative total of Rs 10.06 million monetary relief to policyholders in the form of amicable settlement of different claims filed to the secretariat.
Earlier, a widow had filed a complaint against a sister concern insurer of a bank regarding non settlement of the death claim of her husband under master insurance Policy, her husband had met an accident and died in 2011, the widow complainant kept perusing the claim but no progress was visible to her. Aggrieved by the continued non response by the respondent company for over 4 years. Eventually, widow sought redressal of grievances though the FIO forum.
During the course of hearing it was observed that the respondent company with held the claim for over 4 years on the flimsy ground of conditional submission of legal heirs succession certificate from the complainant. This compulsion has added to the woes and miseries of the widow to the cost and hassle already being faced by her due to the inordinate delay in settlement of her claim. After an extensive hearing FIO directed the settlement of the claim amount of Rs. 250,000 to the legal heir as nominated in the account opening form available with the bank or an indemnity bond, or the succession certificate as per prescribed banking procedure along with liquidated damages @ 5% over and above the prevailing bank rate on account of the inordinate delay to settle the genuine claim.
Respondent company implemented the order of FIO partly and paid claim amount of Rs. 250,000 while liquidated damages on account of inordinate delay to settle the claim was not paid. A show cause notice was served upon respondent company for non implementation of FIO’s order, as they failed to pay liquidated damages to claimant.
Later, the respondent company agreed to pay Rs 176,713 at prevailing bank rates in the corresponding last 5 years, which was rejected by FIO directing the company to pay liquidated damages by adding 5 percent more on the prevailing bank rate. In compliance thereof, the respondent company submitted another revised calculation of the liquidated damages amounting to Rs. 308,000. FIO approved the revised calculation and directed for it to be paid within a week.
In yet another case, a Director of Textile Mills filed a complaint for nonpayment of insurance claim of Rs. 5.04 million under marine cargo. Complainant stated they got insured their goods in transit including yarn and all kinds of fabric / dyed denim fabrics garments and imported merchandized in standard packing. They filed an insurance claim amounting to Rs. 5.04 million with the respondent company after snatching / robbery incident, but the respondent company failed to pay his claim even after completion of all the formalities and repeated requests by him. During the course of the hearing of the respondent company it was stated that as per the surveyor report FIR was lodged under 406 PPC against proprietor of goods carrier and driver of the vehicle in which the snatched cargo was being carried, after some time complainant got the FIR converted into section 392 PPC.
Surveyor assessed in his report that the case was “breach of trust” as the driver emblazed the cargo and absconded. Respondent company refused to settle the claim by taking a plea of non submission of amended survey report as FIR was converted into section 392 PPC.
Whereas complainant’s stance was that the respondent company was duly informed by him in writing with regard to conversion of the FIR, but the respondent company did not convey this information to the surveyor even after 5 months, thus his claim was neither paid not rejected. During proceeding FIO observed that the Respondent Company could not prove the inclusion of words “breach of trust” as was remarked by the surveyor in report, besides they could not justify the delay of 5 months by the surveyor for submission of the report and sharing of survey report with the complainant as required under relevant law.
After detailed deliberation FIO advised Responded Company to settle the claim as per amended survey report amounting to Rs. 4.03 million without any deduction within one month on written signed statement by both the parties.
