Kathmandu. The Insurance Authority of Nepal (BEE) has issued an order in favour of the insured to pay the claim of fish insurance from IGI Prudential Insurance Limited (erstwhile IME General Insurance). The authority has ruled in favor of the insured after it was found that the employees of the insurance company had rejected the claim by forging the bill submitted by the insured.
Subject of Controversy
The main dispute is that Puja Commercial Animal Husbandry and Fisheries Farm in Gaur Municipality-1 of Rautahat has not been paid the claim of damage caused by the floods. The insured had insured around 92,000 fish worth Rs 61,99,040 and had submitted a claim of Rs 67,27,500 after the floods of 2017 swept away all the fish. However, the insurance company refused to pay the claim saying that the bill was fake and there was no record of the production.
Facts of the case:
}
Heavy rains and floods from August 11 to 29, 2017 had completely washed away the fish in the six ponds of the insured. The insured had submitted a bill for the purchase of the fingerlings from Simraungadh Matsya Hatchery Farm for the claim process. However, the insurance company sent a written reply to the authority and the hatchery operator submitted a signed document stating that the bills were not from my farm. On the basis of this, the company stopped the payment of the claim and caused financial hardship to the insured.
Basis of Decision and Employee Disclosure:
}
The authority has concluded that the claims of the insurance company were false and ill-intentioned after collecting details and factual evidence from all the parties in the case. The main grounds for the decision are as follows:
Owner of Simraungadh Fish Hatchery, Om Prakash Kushwaha, wrote a letter to the NEA, claiming that the employees of the insurance company had deceived him. “When the insurance staff asked me if the bill was my own, I signed it with my name and address in the photocopy, but later the employee wrote it on the top without me knowing that the bill was not from my farm,” he wrote. The operator informed the authority by writing a letter claiming that the bills were issued from his own farm. (The issue of whether or not Kushwaha, a fish fry seller, has declared the income of selling fish fingerlings to Pooja Commercial Animal Husbandry and Fisheries Farm in the accounts of that year has not been included in the decision of the NRA)
Technical confirmation: The District Agriculture Development Office, Rautahat and local bodies had submitted technical recommendations and reports of complete loss of fish due to floods.
Fair Compensation: Considering that the insured does not have a clear record of the sale of fish and that the principle of insurance is not to make a profit, the Authority has taken a middle path. Out of the total number of 92,200 fish, 50 percent access has been deducted and in the case of the remaining number, compensation has been ordered according to the formula of the policy.
What did the insurer do?
The ruling also discourages fraudulent practices by insurance company employees to undermine claims. On the other hand, it is also a matter of concern what action the insurer took in the case of Nabin Poudel, an employee of the insurer who submitted the investigation report by forging the original bill. If Poudel’s report is correct, then the insurance company should have filed an appeal at the Patan High Court challenging the NEA’s decision.
Delayed justice, justice or injustice?
It took more than five years to settle the case registered on behalf of the insured on April 21, 2018. This is a very interesting matter. When the flood swept away the entire capital investment of the fish farmers, they may be forced out of the business until they get compensation from the insurance company. The main objective of insurance is to ensure the continuity of the business by getting immediate compensation at the time of loss. It is very difficult for the insured to take a long time of 5 years and 4 months to settle the issue of such a common type of dispute.
