Tamil Nadu

Ariyalur

CC/20/2018

S.Silambarasan, - Complainant(s)

Versus

1)Divisional Manager, Muthoot Finance Private Ltd, Madurai 2)Liberty Videocon, General Insurance Com - Opp.Party(s)

K.Uthamarajan

15 Mar 2023

ORDER

Date of filing:  12/07/2018

                                                                                              Date of order: 15/03/2023

 

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

                                                                  ARIYALUR      

 

PRESENT:  THIRU. DR. V.RAMARAJ.  M.L., Ph.D., PRESIDENT

                     THIRU          N.BALU    B.A., B.L.     :    MEMBER I

                     TMT              V.LAVANYA B.A., B.L:     MEMBER II

           

 

 CC. No. 20/2018.

Wednesday the 15^th Day of March 2023.

 

Silambarasan                                                                                               Complainant.

 

Vs

1. The Zonal Manager

Muthoot Finance Pvt.Ltd.

Madurai.

2. The Branch Manager

Muthoot Finance Pvt.Ltd.

Sendurai

3. Liberty Videocon

General Insurance Company

Mumbai.                                                                                                     Opposite   Parties.

Counsel for the Complainant:-                     Mr.K.Utthamarajan

Counsel for the 1^st & 2^nd Opposite Parties:- Mr.S.Karikalan

Counsel for the 3^rdOpposite Party: -             Mr. S. Arunan

 

1.      This Complaint has come before us for final hearing on 02/03/2023.  Perused the complaint and exhibits marked by the complainant. Op1&Op2, Op3 filed written version, Proof affidavit. Upon perusing the Material facts of the Complainant and Opposite Parties and having stood for Consideration, this Commission passed the following:-

ORDER

Pronounced by the Member II Tmt. V.LAVANYA B.A., B.L.,

Adopted by President Dr.V.Ramaraj M.L., Ph.D., & N.Balu Member I.

 

1.     The complainant has filed this complaint as against the opposite party under section 12 of the Consumer Protection Act, 1986 and prays to direct the opposite parties to pay a sum of Rs. 5, 00,000/- compensation for deficiency of service and mental agony and Rs.4, 04,250/- as per the certificate for the building construction issued by the engineer, in total Rs.9,04,250/-.

 

            Brief averments of the complainant.

2.     The complainant is the customer of the 2^nd opposite party who has taken loan by pledging his jewels. The opposite party is operating at various places in Tamilnadu. It is the case of the complainant that when he visited the 2^nd opposite party office to get loan by pledging jewellery, they showed a pamphlet advertisement notice called Muthoot Home Product, it was `advertised that the house can be insured against Fire, earthquake, flood and other natural calamities. Relying on the words of the 2^nd opposite party the complainant took Policy by paying Rs.1000/- with the 3^rd opposite party a joint venture company with the 1^st and 2^nd opposite parties and issued Policy No. 3514500 dated 20/06/2017.

3.         On 08/08/2017 due to incessant rain the house was surrounded, flooded with water causing damage to the building. Thus on 10/08/2017  the complainant gave claim form to the 2^nd opposite party after receiving the claim form the 2^nd opposite party instructed the complainant to get an civil engineer’s valuation report and produce building damage certificate. Hence the complainant approached one Sudhan Constructions and got certificate with an estimation for Damage to the house for Rs. 4,04,250/- and submitted to the 2^nd opposite party on 27/09/2017 and thereupon the certificate was submitted to the 3^rd opposite party by the 1^st and 2^nd opposite parties . On 30/11/2017 a repudiation letter was sent to the complainant stating that the claim cannot be approved since the damage caused was due to heavy rains and not due to natural calamity as per the Insurance policy terms and conditions. The denial of the claim has caused the complainant lot of mental agony due which he is not able to go to work.

4.         On 2/02/2018, a lawyer’s notice was sent to the 1^st, 2^nd and 3^rd opposite parties by Registered post. The 1^stopposite party notice was returned. 2^nd opposite party gave a false reply notice on 14/02/2018. 3^rd opposite party did not give any reply notice. In order to evade from giving compensation to the complainant, the opposite party has given false and frivolous reply notice. Hence due to deficiency of service, mental agony, mental distress, mental anguish and loss of salary due to inability to go for work, this complainant has asked compensation of Rs. 5, 00,000/- and Rs.4, 04,250/- as per the certificate for the building construction issued by the engineer, total compensation amount of 9, 04,250/- from the opposite parties jointly and severally. Hence the complaint may be allowed.           

 

 

The Complainant relied on two citations;-

1. M/s Opg Energy (P) Ltd.

Vs

The New India Assurance Company Ltd.,

2. United India Insurance

Vs

M/s Kiran Combers Spinners.

 

Brief averments of the 1^st and 2^nd opposite party.

5.         The opposite parties deny all the allegations in the complaint except those that are specifically admitted. It is an admitted fact that the 1^st and 2^nd opposite parties are agent of the 3^rd opposite party. The 3^rd opposite party is the General Insurance Company. An Insurance policy was availed by the complainant with policy no. 35745003011510000020000. The complainant was briefed and explained about the terms and conditions of the Insurance policy by the 3^rd opposite party. The complainant paid the policy amount to the 2^nd opposite party who acted as an agent of the 3^rd opposite party. The 2^nd opposite party denies the allegation that the complainant induced the minds of the complainant to join the insurance policy. The 2^nd opposite party never insisted the complainant to get a certificate from the qualified engineer regarding the valuation certificate. There was no clause in the policy which covers that any damage caused by rain can be compensated either orally or legally as per the terms and conditions.

6.         The complaint has been filed to extort money from the opposite parties by filing a frivolous statement in the complaint by the complainant. All the documents filed are all cooked up, not entitling the complainant from claiming any benefits therefore the opposite parties are not responsible for the damages caused to the complainant. Hence the complaint is devoid of any merits and is liable to be dismissed with cost.

 

Brief averments of the 3^rd opposite party.

7.         The 3^rd opposite party are the General Insurance Company (formerly known as Liberty Videocon) General Insurance Company Limited. This answering opposite party after thorough scrutiny of facts and figures on basis terms and conditions of contract of insurance had repudiated /denied the claim of then complainant. Moreover the repudiation was not attributable to any of the named peril covered by the policy. The loss has not occurred because of any Peril covered by the policy.

8.         The damage to the house wall has not occurred because of Fire Lightening, Explosion,Aircraftdamage,Riot,Strike,Storm,Cyclone,Tyhoon,Tempest,Hurricane, Tornado, Flood and Inundation. If the claimed damages are not due to such perils the loss is out of scope of insurance coverage and thus this answering party is not liable to pay any claim or compensation to the complainant.

9.         The 3^rd opposite party has issued Business Package Insurance Policy to the complainant with the policy no. 3514-500301-15-1000002-00000 for the period 23/06/2017 to 22/06/2018 for covering risk of property located at 3/1, East Street, Elaikaddambur PO, Periyalurichi, Ariyalur, and Tamilnadu-621719. The risk is covered subject to the terms and conditions thereof.

10.       The 3^rd opposite parties after receiving the claim intimation  about the House wall damaged due to rain immediately on 31/08/2017 deputed an independent IRDAI Licensed Surveyor and Loss Assessor, IAR Insurance Surveyors, Loss Assessors Pvt. Ltd.,to inspect the items and ascertain exact cause of loss and extent of liability of insurer . The Surveyor made inspection of the property and submitted his report on 30/11/2017. The remarks given by the Surveyor was that due to heavy rain wall of the Insured has fallen down and need to be repaired, however Peril operated (Rainfall) does not fall under the purview of Insurance policy. No evidence of unusual heavy rain or storm reported in the given locality on the specified date. Such loss does not fall under the purview of the Insurance Policy held by the Insured. As per the findings of the Surveyor Report the 3^rd opposite party closed the subject claim as no claim.

 

The Data given for the Risk Details/ Coverage

Coverage	Risk Covered Sections	Sum insured (Rs)
Building Structure-reconstruction cost	Fire & Allied Perils including Earthquake &STFI	2,00,000/-
Furniture and Fixture, Household contents(Clothing, Linen) utensils and crockery, household appliances;- T.V. fridge,WM,Microwave/Oven, Music system DVD Player, Personal Computer, Air Conditioner and Air Cooler.	Fire & Allied Perils including Earthquake &STFI	100,000/-
Furniture and Fixture, Household contents(Clothing, Linen) utensils and crockery, household appliances;-T.V.fridge,WM,Microwave/Oven, Music system DVD Player, Personal Computer, Air Conditioner and Air Cooler.(Excluding Jewellery)	Burglary	100,000/-
	Limit per item	10,000/-
Jewellery contained in Home kept safe	Burglary	15,000/-
Television, Refrigerator, Washing machine	Mechanical/Electrical/Electronic breakdown	15,000/-
	Limit per item	10,000/-

           

11.       Therefore the claim of the complainant is rightly repudiated by the 3^rd opposite party. The complaint with an ulterior motive has filed this complaint against this opposite party with false and fabricated allegations. There is no deficiency in service on the part of this opposite party insurance company. They are acting as per the terms and conditions there is no coverage for the alleged damages of the complainant. Hence the complainant is not entitled for the claim. No such pamphlets were issued by this opposite party. Therefore the complaint has to be dismissed.

12.       On Perusal of material records, the complainant has filed his Proof Affidavit along with exhibits A1 to A6, Complainant side witness proof affidavit with A7 exhibit, 1^st and 2^nd opposite party B1 exhibit, 3rd opposite party filed P.A. Marked exhibits B2 to B5 on 14/03/2023 belatedly after the Reopen petition was allowed.

Points for Consideration

1. Whether the opposite parties have committed deficiency of service?      

2. Whether the complainant is entitled for the compensation as prayed for in the complaint?

Point No.1

13.       The Complainant has availed an Insurance policy from the 3^rd opposite through its agent 1^st and 2^nd opposite parties. The policy availed by the complainant  was Business Package Insurance Policy with the Policy no. 3514-500301-15-1000002-00000 for the period from 23/06/2017 to 22/06/2018 for covering risk of property located at 3/1, East Street, Elaikaddambur PO, Periyalurichi, Ariyalur, TamilNadu-621719. The policy was subsisting at the time of the damage. It is the submission of the complainant in his pleadings that the 2^nd opposite party has issued pamphlet relating to insurance policy and convinced to avail the service of the 3^rd opposite party. It is learnt from the pleadings of the complainant that on 08/08/2017 due to incessant rain the house was surrounded flooded with water causing damage to the building. From the exhibit A1 it is perceived that the advertisement pamphlet did not have any name related to 3^rd opposite party. The pamphlet had the name Muthoot Home Product, no endorsement is found in the pamphlet.  Further exhibit A3 the Sudhan Building Construction has given the Abstract Estimate for the proposed construction of Bangalore Tiles with all the Repair works to the Tune of Rs. 4.04.250/- by one Engineer M.Subramanian. There is no iota of evidence to show for what purpose the engineer report was produced; mere pleadings cannot be taken as admission it should be proved by evidence. The Complainant has not proved by way of any evidence which has been stated in his pleading that the 2^nd opposite party had instructed to get a Civil Engineer Damage Valuation Certificate

14.       On Perusing the exhibit A2 it is envisaged that the complainant has paid Rs.502/- as premium amount for the sum assured for Rs,2,00,000/- and the Coverage was for STFI, i.e., Storm,Typhoon,Flood and Inundation. For the period from 23/06/2017 to 22/06/2018.

15.       Moreover, exhibit A2 the policy terms and conditions are clear that the Insurance coverage applies to only certain calamities ie, STFI , whereas the damage caused to the complainant’s house was due to heavy rain, which was intimated  by the IRDAI approved Surveyor Report.

16.       The 2^nd opposite party as soon as receiving the claim letter from the complainant forwarded it to the 3^rd opposite party for appropriate action. The approved Surveyor after inspection and enquiry submitted his report stating that during their visit to the premises of the complainant on 06/09/2017 wall of house was observed in damaged/collapsed condition. Moreover without prejudice the surveyor had given report that no sign of unusual heavy rainfall flood has occurred in the premises of the complainant. Therefore the 3^rd opposite Party gave a repudiation letter stating that the claim does not come under the Purview of the Coverage. The Complainant has not filed any document to prove that his house and the area were inundated with flood on the respective date. In order to claim compensation from the 3^rd opposite parties for the flood  the complainant should have obtained a letter from Revenue authorities like RDO, District Collector or VAO or Panchayat President and submitted to the 3^rd opposite party. No such document filed by the complainant to prove that there was flood in the locality of the complainant on the respective date. If there had been a flood declared by the government on the above specific dates, a Government Notification would be mandatory. Hence the Repudiation letter fully justifies the 3^rd opposite party’s stand, as they have acted upon the Principle of Natural Justice and in a Fair Manner. Hence Point no.1 is answered against the complainant.

Point No.2.

17.       The complainant has not mentioned anywhere in his pleadings about the witness one Mr. Vetrivel 3^rd party filed his Proof affidavit with a document belatedly on 27.2.2020. The witness has not specified in his Affidavit on which date the complainant and himself had visited the 2^nd opposite party’s branch and the document filed by him is no way related to the complainant’s claim. Further the complainant has not filed any photographs of the damaged house due to flood as exhibits. The citations submitted by the complainant do not apply to this case. Therefore the complainant has not proved his case; hence the complainant is not entitled to claim compensation as per the prayer in the complaint. Point no.2 is answered against the complainant.

 

In the result the complaint is dismissed as not proved. No cost.

Typed by Member II corrected by Steno and Pronounced by us in the open commission, on Wednesday the 15^th day of March 2023.

 

N.BALU. B.A.B.L                           V.LAVANYA B.A.B.L                         V. RAMARAJ. M.L., PhD.

  MEMBER I                                         MEMBER II                                               PRESIDENT

 

 

 

Complainant Side Exhibits

S.no	Date	Description	Remarks
Ex-A1		Advt.Pamphlet	Original
Ex-A2	20/06/2012	Insurance policy	Original
Ex-A3	27/09/2017	Sudan Construction valuation report	Xerox
Ex-A4	30/11/2017	Repudiation Letter	Xerox
Ex-A5	02/02/2018	Legal notice to 1,2,3 opposite parties with ack due card	Office copy  original ad card
Ex-A6	09/02/2018	Reply notice send by 2nd opposite party	Office copy

1^st and 2^nd opposite party Exhibits

S.no	Date	Description	Remarks
Ex-B1	20/04/2017	Business package Insurance Policy	Printed copy

3^rd Opposite party exhibits

S.no.	Date	Description	Remarks
Ex-B2	20/06/2017	Business Package insurance policy certificate	Printed copy
Ex-B3	31/08/2017	Claim intimation	Xerox
Ex-B4	30/11/2017	Survey Report	Printed
Ex-B5	30/11/2017	Repudiation letter	Office copy

 

 

3^rd Party Witness of Complainant Exhibit

S.no.	Date	Description	Remarks
Ex-A7	12/10/2019	MuthootGroup Hospicash policy	Xerox

 

Complainant side Witness:- 1.   Mr. Silambarasan (Complainant)

                                                   2.   Mr. Vetrivel s/o Krishnamoorthy(3^rd Party)

 

1^st and 2^nd opposite party             Mr. K.Amudhan

Witness                                  :-

3^rd opposite party witness:-       Mr. Ajit Rengaswamy

 

 

 

N.BALU. B.A.B.L                          V.LAVANYA  B.A.B.L                         V. RAMARAJ. M.L., Ph.D.,

  MEMBER  I                                         MEMBER II                                               PRESIDENT