Hello
@DHARMENDRA KHAIRNAR
I'm sorry to hear about the challenges you're facing with your car insurance claim from SBI General Insurance. Denial of a legitimate claim can be distressing, but there are structured steps you can take to seek redressal. Here's a comprehensive guide to assist you:
Summary of Your Complaint
- Insurer: SBI General Insurance
- Issue: Denial of claim for car damage resulting from an accident.
- Claim Status: Claim rejected without satisfactory justification.
- Loss Amount: ₹18,000/-
Legal Framework
Under the Consumer Protection Act, 2019, consumers are entitled to services that are free from deficiencies. An unjustified denial of an insurance claim constitutes a deficiency in service. Additionally, the Insurance Regulatory and Development Authority of India (IRDAI) mandates that insurers must settle claims within 30 days of receiving all necessary documents. Failure to do so may attract interest penalties.
Few details copied from Consumer Case
Haryana - Sonipat - SBI General Insurance Co. Ltd. V/S Smt. Sumitra Chauhan W/o Shailender Singh
Sumitra Chauhan (hereinafter referred to as “the complainant”) has filed the present complaint under the Consumer Protection Act against the respondents (hereinafter referred to as “OPs™) stating that that she is registered owner of vehicle no.HR-10V-9027, which has been purchased from OP no. 2 in the year 2013 and the same is insured by OP no. 1 through the OP no. 2 vide policy n0.HSB/00238184. IDV of the vehicle was Rs.8,32,500/- and same was got renewed by OP no. 2 for the period 11.12.2018 to 10.12.2019. It is further averred that on 11.05.2019 when the said vehicle was being driven by Rakesh returning from village Jakholi District Sonepat met with an accident on Bahalgarh Flyover. The vehicle got badly damaged from front as well as from rear side. Intimation of the said accident was given to OP, upon which Mr. Pankaj Rohilla, Insurance Surveyor and Loss Assessor was appointed who inspected the vehicle. The vehicle was shifted to authorized workshop of Hyndai i.e. OP No. 2 who prepared an estimate of repairing the said vehicle to the tune of Rs.10,73,127/- but OP no. 1 did not indemnify the loss. The vehicle was parked with OP no. 2 for which complainant has paid Rs.10,000/- as parking charges and other miscellaneous charges. Claim was lodged with OP No. 1 vide claim no. MV0116714 and also fulfilled all the formalities, but OP No. 1 repudiated the said claim vide letter dated 19.08.2019 with false assertion that the damages to the vehicle claimed are not corroborated with cause of loss as mentioned in the claim form. As such, there is a great deficiency in service on the part of OPs causing harassed the complainant mentally and financially.
(i) To pay Rs.8,32,500/- IDV of the vehicle alongwith interest @ 8% per annum from the date of filing of the complaint till its actual realization.
(i1)To pay Rs.25,000/- as compensation on account of harassment, humiliation, mental agony, pain, sufferings etc.
(iii) To pay Rs.11,000/- as litigation expenses to complainant.
Consumer Court Case against SBI General Insurance Co. Ltd. V/S Smt. Sumitra Chauhan W/o Shailender Singh - Consumer Court Case against - SBI General Insurance Co. Ltd.
www.consumercourt.in
Steps to Seek Redressal
1. Review the Rejection Reason
- Obtain a written explanation for the claim denial from SBI General Insurance.
- Ensure the reason aligns with the terms and conditions outlined in your policy document.
2. Gather Supporting Documents
- Policy document and schedule.
- Claim form and acknowledgment receipts.
- Correspondence with the insurer regarding the claim.
- Photographs of the damaged vehicle.
- FIR or police report, if applicable.
- Repair estimates and bills.
3. File a Complaint with SBI General Insurance
Provide all relevant details and documents to support your case.
SBI General Insurance
4. Escalate to the Grievance Redressal Officer (GRO)
If the initial response is unsatisfactory, escalate the matter to the GRO:
Ensure you receive an acknowledgment of your complaint.
5. Approach the Insurance Ombudsman
If the insurer does not resolve your complaint within 30 days or if you're dissatisfied with the resolution, you can approach the Insurance Ombudsman.
- Website: Policyholder.gov.in
- Procedure:
- Identify the Ombudsman office based on your jurisdiction.
- Submit a written complaint along with all supporting documents.
- The Ombudsman will facilitate a resolution between you and the insurer.
6. Send a Legal Notice:
- Draft a legal notice addressing SBI, detailing the grievances and demanding:
- Full claim payment.
- Compensation for mental harassment and deficiency in service.
- Provide a reasonable timeframe (typically 15 days) for them to respond.
7. File a Complaint in the Consumer Forum:
As a last resort, you can file a complaint with the District Consumer Disputes Redressal Commission.
- Procedure:
- Draft a complaint detailing the issue and relief sought.
- Attach all relevant documents: policy, correspondence, evidence of claim denial.
- Submit the complaint along with the requisite fee.
- Attend hearings and present your case.SBI General Insurance
Additional Tips
- Timeliness: Act promptly to ensure your complaint is within the statutory limitation period.
- Legal Assistance: Consider consulting with a legal professional to assist with drafting complaints and representing you in legal proceedings.
- Documentation: Maintain a comprehensive record of all communications, including emails, letters, and call logs.
By diligently following the above steps, you can seek redressal for the grievances faced due to the denial of your car insurance claim. It's essential to assert your rights and ensure that service providers adhere to fair and transparent practices.
Important Tip:
Before taking legal action, it is advisable to first send a legal notice to the Opposite Party.
Note:
We can assist in:
- Drafting professional legal notices.
- Filing consumer complaints for deficiency in service.
Feel free to contact us if you wish to proceed with a
legal notice draft or
complaint preparation.
Regards,
Support Team
