C.F. CASE No. : CC/2013/37
COMPLAINANT : Prabhat Kumar Sinha
B-4/230, P.O. Kalyani,
Dist. Nadia, PIN- 741235
OPPOSITE PARTIES/OPs : 1) Divisional Manager, Barasat Division
Oriental Insurance Co. Ltd.
40/2, Jessore Road,
Dak Bungalow More,
Barasat - 700124
2) The Chairman cum Managing Director,
Oriental Insurance Co. Ltd.
A-25/27, Asaf Ali Road,
New Delhi – 110002
3) The Branch Manager,
Kalyani Branch,
Oriental Insurance Co. Ltd.
A 9/9 (S) 2nd Floor,
Kalyani - 741235
PRESENT : SHRI PRADIP KUMAR BANDYOPADHYAY, PRESIDENT
: SHRI SHYAMLAL SUKUL, MEMBER
: SMT REETA ROYCHAUDHURY MALAKAR, MEMBER
DATE OF DELIVERY
OF JUDGMENT : 12th December, 2013
: J U D G M E N T :
The instant case was instituted by one Prabhat Kumar Sinha, S/o Late S.P. Sinha, a resident of B-4/230, P.O. & P.S. Kalyani, Dist. Nadia, against the Oriental Insurance Co. Ltd. with an allegation of deficiency in service.
Shorn off the unnecessary details, the material facts of the instant case are:
That the complainant obtained a House holders Insurance Policy from the Oriental Insurance Co. Ltd. on 14.08.2007 bearing No. 313301/821/2008 and the policy was in vogue upto the midnight at 13.08.2008. During the subsistence of the said House holders Insurance Policy a burglary took place at about 02.00 hours in the premises of the complainant on 31.11.2007. The complainant lodged a complaint with Kalyani P.S. and simultaneously informed the Oriental Insurance Company Ltd., Kalyani Branch. Thereafter, the complainant filed a claim of Rs. 58,820/- alongwith requisite documents in the Kalyani Branch of the Insurance Company. The Insurance Company got investigation done through a surveyor. While assessing the loss the surveyor asked the complainant to provide him with FIR and final Police Report but the complainant failed to provide the same. Thereafter, the Insurance Company requested the complainant to submit the FIR and Final Police Report otherwise, they would be unable to dispose the claim. But the complainant refused to comply with their request. Subsequently the matter was taken up with the Insurance Ombudsman but nothing was done. Ultimately, the Insurance Company had settled the claim for a sum of Rs. 11,700/- and repudiated the remaining claim. When the grievance of the complainant was not redressed, left no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986, was filed by the complainant praying for reliefs as stated in the petition of complaint.
On notice, opposite parties Insurance Company entered appearance and contested the case by filing written version challenging, inter alia, the very maintainability of the case. The opposite party, Insurance Company have got to say the proceeding is misconceived, malafide, groundless and unsustainable in law. On such ground the opposite party Insurance Company pray straightway dismissal of the case.
The core points for consideration before us are:
- Whether there was any deficiency in service from the side of the opposite party Insurance Company in deducting claim amount?
- Whether the complainant is entitled to get relief, if so, to what extent?
DECISIONS WITH REASONS
We have given our anxious thoughts to the arguments advanced by ld. Advocate for the parties and perused the materials available in the record.
The fate of the present complaint hinges on the answer to the question is as to whether the opposite party Insurance Company are justified in deducting Rs. 47,120/- from the claim amount of the complainant and in doing so whether they have committed any negligence / deficient in service.
The complainant submits that it is a glaring example of utter negligence on the part of the opposite parties Insurance Company as because he submitted claim of Rs. 58,820/- along with all documents pertaining loss due to burglary in his premises but the opposite parties Insurance Company arbitrarily and unwarrantedly settled the claim for a sum of Rs. 11,700/- and repudiated the remaining claim starting that some items, viz, cost bold ornament etc mentioned in the complaint would not come within the scope of liability cover by the said House holders, Insurance Policy. That apart, as regard to the cost of repairs of the damaged items like the door lock and other items repudiated for not providing the corresponding repairing estimate from any valid fabricator or repaired the claimed amount. But at the time of signing proposal form the opposite party Insurance Company neither furnish the complainant, the guidelines / terms and conditions regarding deduction nor explained the same to the complainant. Thus, the opposite party Insurance Company fall squarely within the mischief of unfair trade practice as well as deficiency in service. Under the circumstances, the complainant is entitled to get compensation for harassment and lost of the procedure in addition to the repudiated amount.
In rebuttal the ld. Advocate for the opposite party Insurance Company pleads that the opposite party Insurance Company have strictly followed the terms and conditions of the said House Hold Policy in deducting the claim amount. “Policy of Insurance is a contract between insured and the insurer and the terms and conditions are binding upon the policy. Terms and conditions are required to be read reference to the stipulation contained in the policy. Non-observance of the terms of the policy can vitiate the policy and absolve the Insurance Company of its liability to indemnify the loss “II (2013) CPJ 122 (NC). In the present case, as per the General Condition No. 5 (b) of the said House holders Insurance Policy, the complainant / insured was asked to submit FIR and Final Police Report to the opposite party Insurance Company and two reminders were sent on 05.02.2009 and 04.03.2009 to this effect but to no avail. The ld. Advocate invites our attention to the Clause 5 (b) of the General Conditions of the House holders Insurance Policy which reads as under: “The insured shall upon occurrence of any event giving rise or likely to give rise to a claim under this policy … (b) .. give immediate notice thereof to this company and shall within fourteen (14) days. Thereafter furnish the company at his own expenses detailed particulars of the amount of loss or damage together with such explanations and evidence to substantiate the claim as the company may reasonable require”. As per the said conditions, it is the prerogative of the Insurance Company to decide what is reasonable requirement to substantiate a claim and it is the bounded duty on the part of the complainant / insured to comply with such requirements.
In case of settlement of a theft/burglary claim for FIR and FRT are not only reasonable but more essential document since police is a statutory authority to investigate any theft/burglary case and certify the authenticity of the occurrence of the alleged theft/burglary and quantum of loss suffered. Final Police Report usually reveals the details of investigation and recoveries (if any) made by police. Therefore, without the copy of Final Police Report, (declared as true, and accepted by the court of law the quantum of loss suffered by the insured cannot be substantiated, Investigation carried out by the Insurance Company’s investigator it for their internal purpose to find out “Prime Facie” cause only and the same is not acceptable to the Court of law. But the complainant is in no mood submit the FIR and FRT to the Insurance Company rather contrarily he claims that it is the duty of the Insurance Company to collect the FIR and FRT from police. Such ridiculous claim is not acceptable for the opposite party Insurance Company as because it not the duty of the Insurance Company as per provisions of the subject of Insurance Policy. Under the facts and circumstances, the opposite party Insurance Company are unable to settle the claim properly. In this connection it pertinent to mention that it is well-settled in the light of various judgments of the Apex Court that the terms and conditions have be constituted strictly and if there is any violation of the terms, the party cannot claim relief.” Despite the above said observation of the Apex Court being a reputed company in the insurance arena the opposite party Insurance Company settled the claim for a sum of Rs. 11,700/- and repudiating remaining claim justifiably. Thus, the opposite party Insurance Company acted bonafide without fraud and deception and within the bounds of their authority and there is no deficiency in service on the part of the opposite party Insurance Company. Under the facts and circumstances, the opposite party Insurance Company pray the present petition of complaint be rejected outright.
We have heard the arguments by both parties and perused the evidence on record.
In view of this solid and unflapple evidence of the opposite party Insurance Company the case of the complainant pales into insignificance the opposite party Insurance Company have firmly established their case with cogent and plausible evidence. Under the circumstances, the complainant has no bone to pluck with the opposite party Insurance Company.
It is important to mention here that the conspectus of the aforementioned facts shows that the entire problem cropped up due to non-observance of the clause 5 (b) of the General Conditions of the said House Holders Insurance Policy of the complainant. Since there was a breach of the fundamental condition of the policy, the Insurance Company was justified in repudiating the claim partly. Hon'ble Supreme Court in Suraj Mal Ram Nivas Oil Mills (P) Ltd’s case (Supro) after considering the earlier judgments in Harchand Rai’s case and Sony Cherian Cases (Supra) in extensor has held that the terms of the contract of insurance have to be strictly construed and no exception can be made on the ground of equity. That interpreting documents relating to a contract of insurance, the duty of the court is interpret the words in which the contract is expressed by the parties, because it is not for the court to make new contract, however, reasonable, if the parties have not made it themselves. That nothing can be added or subtracted in the terms and conditions.
In view of the above mentioned observations, we feel that the present petition of complaint is nothing but a gross abuse of the process of the law and the petition is totally devoid of merit for which the complainant is not entitled to get any relief and the same is liable to be dismissed. Accordingly it is
Ordered,
That the present petition of complaint is dismissed without any order as to cost.
Let a copy of this judgment be delivered to the parties free of cost.
