1.   This appeal under section 19 of The Consumer Protection Act, 1986 is in challenge to the Order dated 10.10.2018 of the State Commission in complaint no. 40 of 2006.

2.       We have heard learned counsel for the appellant (the ‘insurance co.’) and for the respondent (the ‘complainant medical college’) and have perused the record.

3.       The appeal has been filed with reported delay of 06 days. Learned counsel for the complainant medical college has no objection to the short delay being condoned. In the interest of justice, to rather decide the matter on merit than to dismiss it on the threshold of limitation, the delay in filing the appeal is condoned.

4.       The matter relates to repudiation of an insurance claim. Briefly, the complainant medical college, a charitable institution, purchased a new machine and obtained insurance therefor by paying a sum of Rs.5,91,913/- as annual premium. On 24.11.1999 the machine broke down. The complainant medical college immediately contacted the service engineers of the supplier. The service engineers opined that the component concerned was a complete module which cannot be rectified, and advised that the complete unit may be replaced. The complainant medical college made a claim with the insurance co. The insurance co. appointed its surveyors. V. Lakshminarayanan made the preliminary survey report dated 07.03.2000. S. Raghunathan Associates made the final survey report dated 20.11.2002, in which it assessed the loss at Rs. 20,87,164/-. The insurance co. repudiated the claim vide its letter dated 26.04.2006. The State Commission found the repudiation to be unjustifiable and awarded a sum of Rs. 20,87,164/- for the loss, in consonance with the assessment made by the surveyor, along with Rs. 3,00,000/- for deficiency in service and Rs. 25,000/- as litigation expenses. It also stipulated that the awarded amount be made good within 06 weeks from the date of its Order, failing which the said amount shall carry interest at the rate of 12% per annum from the date of its Order.   

5.       Learned counsel for the insurance co. submits that the terms and conditions of the subject policy had been violated. He refers to the repudiation letter, which, in his opinion, contains valid grounds for repudiation.

6.       The grounds for repudiation, as contained in the insurance co.’s repudiation letter dated 26.04.2006, are being reproduced below for reference:

      M/s S. Raghunathan Associates submitted their report stating that they were neither given an opportunity to acertain the extent of damage nor provided analytical report of Holland Philips to whom the unit was said to have been sent for study. Also, M/s Philips Medical System India Private Limited have expressed their inability to give the detailed failure report vide their letter reference dated 08/03/2005.

        We also note from the claim papers that Sky II processor found to be defective / failed on 24/11/1999 but it was informed to us vide your letter dated 03.02.2000 after a delay of more than 2 months.

7.       Learned counsel for the insurance co. argues that the surveyor S. Raghunathan Associates mentioned in its report that it was neither given an opportunity to ascertain the extent of damage nor provided the analytical report of Holland Philips to whom the unit had been sent for study. Also, Philips Medical System India Pvt. Ltd. expressed its inability to provide the detailed failure report. Further, though the defect / failure occurred on 24.11.1999 the written intimation was given on 03.02.2000 after a delay of more than 02 months. Submission is that due to the afore reasons the claim is not tenable.

8.   Learned counsel for the complainant medical college submits that the preliminary surveyor V. Lakshminarayanan had suitably inspected the machine which was duly available for inspection at the time. The final surveyor S. Raghunathan Associates has nowhere mentioned in its report about non-cooperation by the complainant medical college or non-availability of the analytical report or the failure report. Submission is that the surveyor found the claim to be genuine and made an unbiased assessment of the loss, but the insurance co., for reasons best known to it, made objections from outside the survey report, which approach, in the opinion of the learned counsel, is inexplicable. Learned counsel further submits that oral information in the routine course had been immediately given to the insurance co. and the process of survey and claim had been initiated, which was then also followed by a formal written communication. She submits that after the defect / failure occurred some natural time was also taken to attempt to get the machine repaired from the service engineers and only when the service engineers opined that the defect could not be rectified and advised for replacement were the steps taken for getting the machine replaced and for making the claim with the insurance co. Submission is that it is not even the insurance co.’s case that the claim was not genuine or that the loss had in fact not occurred and further that in no way has the insurance co. been handicapped or obstructed from getting its survey conducted or from processing the claim, the ground of delayed intimation is just an objection for the sake of objection with no worth intrinsic.

9.   A perusal of the record shows that the final survey report raised no question marks at all in respect of the genuineness of the claim. The surveyor appears to have made a fair assessment of the loss in the routine course. In so far as the opportunity to inspect the machine is concerned, the same was duly provided at the relevant time to the preliminary surveyor, who had physically inspected the machine. It is also quite evident that the complainant medical college has in no manner impeded or obstructed the process of survey and it has dutifully provided the information as available with it to the insurance co. There is nothing on record as may give to show that it did not function with clean hands. It is not even disputing the assessment of the loss made by the surveyor. We find no reason, howsoever faint, to take a different view of the matter than what has been taken by the State Commission, which has passed a speaking order giving unassailable reasons for allowing the claim.

10. In such an open-and-shut-case, one may wonder as to what were the actual reasons behind finding excuses from outside the survey report or finding objections which were rationally in no way fatal to the claim or which in no manner could reasonably give to raise any doubts on its genuineness. We are refraining from elaborating further, suffice is to say that even at best this appears to be a plain and simple case of outright harassment. The claim ought to have been ordinarily satisfied in the normal wont of the insurance co.’s functioning.

11. Being frivolous and vexatious, the appeal merits to be dismissed with cost of Rs.10,000/- to be deposited by the insurance co. with the consumer legal aid account of the State Commission within 06 weeks from today. So ordered.

The award made by the State Commission stands confirmed. The amount as any deposited by the insurance co. with the State Commission in compliance of this Commission’s Order dated 10.05.2019 along with interest as any accrued thereon shall be forthwith released by the State Commission to the complainant medical college. The balance awarded amount shall be made good by the insurance co. to the complainant medical college within 06 weeks from today, failing which the State Commission shall undertake execution for ‘enforcement’ and for ‘penalty’, as per the law.

12. The Registry is requested to send a copy each of this Order to the parties in the appeal and to their learned counsel as well as to the State Commission immediately. The stenographer is requested to upload this Order on the website of this Commission immediately.

      ‘Dasti’, in addition.