Hello
@Harinakshi H
File a Complaint with IRDAI:
Issue a Legal Notice: A legal notice should be sent to Care Health Insurance demanding reimbursement, failing which you will initiate legal proceedings.
File a Complaint in Consumer Forum: You are advised to file a complaint before the
District Consumer Disputes Redressal Commission, Nashik, seeking:
- Full claim amount with interest
- ₹1–2 lakhs as compensation for mental agony and harassment
- ₹10,000–25,000 as litigation cost
Legal Precedents Supporting Your Case
Karnataka - Dakshina Kannada -
Bajaj Allianz General Insurance Co. Ltd, V/S Veena S Rai
View attachment 2089
Consumer Court Case against 1. Bajaj Allianz General Insurance Co. Ltd, Represented by its Manager/ Authorized Signature, Maruti V/S 1. Veena S Rai, W/o Late Sanjeeva Rai M, Aged 47 years, - Consumer Court Case against - 1. Bajaj Allianz General Insurance Co. Ltd, Represented by its Manager/...
www.consumercourt.in
Jammu and Kashmir - Srinagar -
Bajaj Allianz General Insurance Co. Ltd & anr. V/S Ashiq Hussain Shah
Complainant, being in possession of residential house situated at Gundi Nowgam, Sumbal which he had constructed/renovated after availing financial assistance from opposite party (in short referred to as OP} no. 2, had insured the said house with OP No. 1 vide Standard Fire & Special Perils Policy bearing No. OG-15-1205-4001-00016416 for a sum assured of Rs 10.00 lacs. The OP1 agreed to indemnify the complainant subject to the terms and conditions laid down therein, the loss, if any, to the insured property (supra) due to insured perils during the period of twelve months w.e.f. 18.06.2014 to 17.06.2015. To his ill luck, the insured property (supra) during the validity of the insurance policy suffered extensive damage due to devastating floods of September, 2014 that hit the Valley of Kashmir. The property remained submerged in flood waters for a considerable period of time and resultantly the structure, load bearing walls, partition walls, flooring and other household goods got severely damaged and ultimately the building got collapsed necessitating its reconstruction. The occurrence came to be reported by the concerned Police Station. The complainant intimating the loss to OP1 claimed indemnification. This prompted appointment of Surveyor by OP1 who visited the spot, took photographs and demanded various documents from the complainant. The complainant rendered every sort of assistance by way of submitting all the necessary documents including copy of policy of insurance, claim form duly signed,estimate of loss, ownership proof etc. to the Surveyor who after receipt of the documents assured the complainant that the assessed amount would be paid to him within reasonable time. However, after lapse of more than four months, the complainant while visiting the office of OP1 came to know that OP1 has credited an amount of Rs 1,22,726/- into the account of the complainant being operated by him with OP2 which the complainant refused to accept and protested for being meager amount. Complainant not satisfied with the Indemnification amount served a legal notice upon OP1 and also requested them to provide a copy of survey report for examination and comparison with the actual loss suffered by him. It is being alleged that since the building remained submerged in flood waters for more than ten days, as such, the structure including partition walls, load bearing walls, floor etc developed deep cracks and need exhaustive repairs/renovations at estimated cost of Rs 8,13,839/-. Although, the OP1 was orally as well as through written representations requested to re-assess the loss with jeopardizing the rights of the complainant in the face of series of directions passed by the Hon'ble High Court in similarly situated matters, yet all these pleas fell to the deaf ears and nothing positive came to be done by them. It is being alleged that the OPs are hand in glove with each other which paved way to OP1 to credit a sum of Rs 1,22,726/- as indemnity amount into the account of the complainant without his knowledge and consent. Complainant maintained that failure of OPs to make the payment as per the actual loss tantamounts to unfair trade practice as defined under the provisions of Consumer Protection Act. Hence, this complaint is being laid by the complainant before this Commission for redressal of his grievances.
Accordingly, complaint is allowed and OP1 is directed as under:-
1. To pay Rs 5,00000/- (minus whatever has already been paid to the complainant) alongwith simple interest @ 9 % per annum.
2. To pay Rs 8,000/- {Rupees six thousand) as litigation
Additional Tips
- Maintain Records: Keep copies of all communications, documents, and acknowledgments.
- Timely Action: Adhere to the timelines specified for each redressal mechanism.
- Seek Clarifications: If any aspect of the rejection is unclear, request detailed explanations from the insurer.
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
