Driver implant allegation on insured, in a motor od insurance claim. Fight story

ashok.1224@rediffmail.com

Observation and conclusions: 

Pursuant to the hearing notice, both parties attended the hearing and reiterated their respective contentions. The forum observes the following: - 
1) The insurer submitted a Self-contained Note (SCN) dated 31/03/2025 and 01/04/25referencing 9 key annexures (policy certificate, claim form, Survey report and Assessment Sheet, photos of damaged vehicle, investigation report, insured statement and additional photos) but failed to provide them to the forum despite follow-up. This omission materially hindered the forum’s ability to examine the complaint. 
2) The complainant also submitted that he did not receive a survey report despite request. 
3) Google Timeline cannot be considered conclusive proof of location, and the availability of CCTV footage is not mandated under the policy. The insured vehicle was not required to record video data, and a 10-day period is insufficient to establish that the insured was personally driving at the time of the accident. It is entirely plausible that he was receiving assistance on that day and in the days prior to accident. Therefore, the insurer has failed to conclusively prove any misrepresentation regarding the driver's identity. 
4) As per Chapter I (10)(e) of Master Circular on IRDAI (Insurance Product)Regulations, 2024-General Insurance, any delay in settlement of the claims beyond the stipulated timelines is a violation of legislation/regulations and the insurer is liable to be imposed a penalty for such delay. 
5) Regulation5(3) of IRDAI (Protection of Policyholders ‘Interests, Operations and Allied Matters of Insurers) Regulations, 2024 read with Part C(V)(3) on Master Circular on Protection of Policyholders’ Interests, 2024, in case the claim is not settled within the specified timelines, then the claimant is entitled for interest at bank rate plus 2 percent from the date of receipt of intimation to till the date of payment. Such interest shall be paid by the insurers suo-moto. 
AWARD COMPLAINT REF:NO:HYD-G-020-2425-0207 

The insurer did not conclusively prove misrepresentation of driver details. Hence, the forum directs the insurer to pay the claim, as per policy terms and conditions, along with applicable interest as per the extant IRDAI Regulations and guidelines.

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