Mr. Shyamal Kumar Ghosh, Presiding Member
The instant consumer case has been filed by the complainant against the opposite party praying for direction upon the op to make payment of Rs.22,36,960/- as per terms and conditions of the policy along with interest, cost and compensation.
The fact of the case is that the complainant was an IT enabled Services Export company and the said company took a policy from the opposite party insurance company in order to cover the customer risk, political risk etc. The opposite party issued the policy after thorough scrutiny of the proposal form along with the schedule presented by the complainant. The policy had been issued to indemnify in the event of loss in respect of exports of IT enabled services and purpose of insurance policy was to cover the insurable interest of the complainant. The complainant entered into an agreement with HME consulting engineers Dubai wherein the complainant provided building information Modelling consulting services to client for in flight catering facilities at Muscat International Airport. The contract of the complainant with the client was broken up into 4 intermediate progress delivery stages for the purpose of having a milestone where a part invoice could be raised so as to keep the proper cash flows. As a result a schedule of deliveries was also settled between the parties which are as follows :
Interim design stage by 8th February 2014
Detail design stage by 1st March 2014
Final design stage by 31st March 2014
Coordinated working drawings stage by 31st May 2014.
However, the schedule of dates was revised subsequently and accordingly the dates were rescheduled which are as follows:
Detail design stage to 23rd March 2014
Final design stage to 15th April 2014
Coordinated working drawings stage to 30th June 2014.
The same was confirmed by the client vide email dated 22nd March 2014.
4. The complainant, in email dated 24th March 2014, informed the op about the revised the dates for the schedule of deliveries. The complainant thereafter filled the proposal form and submitted the same on 25th March 2014, with the opposite party with a loss limit of Rs.37,00,000/- only. Subsequently on 26th March 2014 the complainant sent a mail to the opposite party addressed to a particular officer explicitly to bring to his notice that the coverage of the policy should include the following specific milestones as per the aforesaid revised schedule i.e.
a. Detail design stage by 23rd March 2014, (RO 18600)
b Final design stage by 15th April 2014, (RO 3100)
c. Coordinated working drawings stage by 30th June 2014, (RO 1550)
5. The complainant had explicitly stated the progress delivery. After submission of the proposal, the complainant from time to time went to the office of the op asking them to issue the policy but the op did not make any clarification. The complainant as per terms and conditions of the contract with the client already started performing IT enabled service and made intermediate progress deliveries of the same and also raised the invoice no HME Hilarion consulting 3/2014 and HME Hilarian consulting 4/2014 both dated March 31/03/2014 (Anx-D). After lapse of 7 weeks from the date of submission of the proposal, the op issued the policy being no – SITES -0050009312 with date of commencing from 26/03/2014 to 25/03/2015 for a premium of Rs. 66,600/-. (Anx-E).
6. The first progress report for the period from 26/03/2014 to 30/04/2014 was submitted to the op immediately after receiving the policy covering the letter on 13th May 2014. (A-F). The complainant also submitted the progress report, for the subsequent periods along with specific details of the work done. The op accepted the same and did not raise any query or objection with regard to the policy periods involved in the said insurance coverage. Thereafter in the month of January 2015 the complainant submitted the revised progress report for the period 01/01/2015 to 31/01/2015 wherein it was clearly mentioned that due to delay in payment by the client the progress delivery of further work has not been made. (A-G). Till January the client made part payment of 50% against the aforesaid invoice being no. 3/2014 dated 31/03/2014. The entire amount was overdue in respect of invoice being no.4/2014. The fact remains that the complainant did not receive any payment against the aforesaid invoices and accordingly the complainant did not deliver any further works to the client. The complainant further informed the op and as per the insurance policy rules submitted the defaulter notice in Form no 205. The same was received by the op on 6th March 2015. (A-H). Thereafter the op sent a letter dated 10/03/2015 wherein the complainant has been directed to appoint a debt collection agency and accordingly on 6th April 2015 the complainant appointed the said agency. At last the complainant submitted the claim form along with annexure on 4th May 2015 for non-payment from the end of the client. (A-I). After lapse of two months the op raised some query against the claim of the complainant which were duly replied vide email dated 14/07/2015 within a day from the date of receipt of the query. Thereafter the op kept silence. The complainant sent reminders on 10/09/2015, 21/09/2015, 01/10/2015, 08/10/2015 respectively.
7. Ultimately by a letter dated 13/10/2015 the op for the first time rejected the claim of the complainant on 4 various grounds which are described as follows:
a. As per contract dt 6/2/2015 the buyer ie client confirmed that down payment would be made immediately along with work order dated 17/02/2014 but the buyer actually paid on 28/02/2014.
b. The payment of interim stage should have been paid by 1st March 2014 but the same was paid on 02/09/2014 ie after lapse of 6 months.
c. The buyer was already defaulter for payment when the complainant asked for coverage but the fact was not disclosed.
d. That it is observed from the correspondence that buyer has raised dispute in the transactions which is not covered under the policy.
8. However the complainant gave the details by way of reply dated 01/12/2015 against the queries raised by the op. The op raised further query that the part of the project was delivered before the date of proposal and the same was not disclosed before the issue of the policy. The complainant vide letter dated 21/01/2016 stated further reply over the issues. Thereafter the claim was re-examined by the op but the same was again rejected. The rejection was made on the following grounds which are as follows:
Risk not insured as the services rendered and delivered to the buyer prior to the policy period.
The invoices dated 31/03/2016 were not part of the insured debt.
Non disclosure of material information of non payment by the buyer on 01/03/2014.
9.By the letter dated 02/05/2016 the complainant gave proper clarification of all queries on the basis of which the claim was rejected. Thereafter no clear response was forth coming from the end of the op. The complainant made several remainders through e-mails dated 24/05/2016, 02/06/2016 and 11/08/2016. It is the further case that the opposite party accepted the consideration as premium and issued the policy based upon the proposal and other communications before issue of the policy, being fully aware of the progress delivery already made. The opposite party all along accepted the same and never raised any objection with regard to the policy coverage. The opposite party deliberately repudiated the claim of the complainant on very flimsy grounds on 13/10/2015. Having no other alternative the complainant knocked at the door of the Commission for getting proper relief/reliefs as prayed for.
10.The opposite party contested this case by filing written version stating inter alia that by the proposal dated 25/03/2014 the complainant had requested for issuance of exports (IT Enabled Services) Policy–Specific customer insurance policy. The policy being no–0050009312 dated 09/05/2014 was issued on 13/05/2014 having the period of the policy from 26/03/2014 to 25/03/2015 with a loss limitof Rs. 37.00 lakh to the complainant to cover the risks enumerated in the policy bond. The complainant had lodged claim on 04/05/2015 for the services rendered to the insured buyer on 24/03/2014. The period of policy being 26/03/2014 to 25/03/2015 the services were rendered prior to the issue of the policy. The proposal itself was submitted on 25/03/2014 and the premium remitted on 28/03/2014 and as such the matter does not come well within the purview of the policy condition. The complainant was aware that the insurance would be available from the date 26/03/2014 or any date thereafter and in any case not before 26/03/2014. The claim of the complainant was rightly repudiated vide the letters dated 13/10/2015, 01/03/2016 and 08/11/2016. There is no negligence and deficiency in service on the part of the op. The petition of complaint filed by the complainant is totally frivolous, vexatious and baseless and accordingly the said petition of complaint is liable to be dismissed with exemplary costs.
At the time of hearing the ld advocate appearing for the complainant argued that the complainant took a policy from the op/insurance company to cover the debt arising from the credit and it has to provide to the customer for 35 days after raising each bill and the risk associated with it. The complainant had disclosed all about the functioning of the complainant and the work as well as the schedule of delivery and billing. After careful scrutiny, the op/insurance company issued the policy to indemnify the loss in respect of exports of IT enabled services. The complainant had taken the policy on 25th March 2014 and the said policy was taken for total of RO 23,250 which is converted in INR ie Rs.37,00,000/- only.
The break-up of the above policy was for the following invoices:
Model of detailed design RO 18,600 ie Rs.29,60,000/- invoice raised on 31st March 2014.
Model of final design RO 3,100 Rs.4,93,333/-
Model at co-ordinated working drawings RO 1,550 ie Rs.2,46,667/-.
Total RO 23,250 ie Rs.37,00,000/-.
12. The ld advocate further argued that the claim in respect of two invoices such as invoice no – 3/2014 and 4/2014 dated 31/03/2014 respectively for RO 9300 have been raised at the office of op/insurance company. But another invoice RO 3100 has not been raised. The client HME Hilarion had partly paid 50% of invoice no – 3/2014 and as such total outstanding of the complainant against the HME Hilarion was RO 17,050. The complainant therefore raised a claim of 80% of the outstanding invoice which turns into RO 13,640 or INR 27,96,200/- only (as per Indian money). But the op/insurance company repudiated the aforesaid claim on the various grounds and to that effect the complainant tried to meet up all queries by providing cogent and sufficient reply. But ultimately no proper relief was received from the end of the op/insurance company. Accordingly the ld advocate has prayed for passing proper order so that the complainant is entitled to get relief/reliefs as prayed for against the OP.
13. At the time of final hearing the ld advocate appearing for the op/insurance company argued that by a proposal dated 25/03/2014 the complainant had requested for issuance of the policy. The policy was issued having the period of policy from 26/03/2014 to 25/03/2015 with a loss limit of Rs.37.00 lakh. The complainant had lodged the claim on 04/05/2015. Not only that the proposal itself submitted on 25/03/2014 and the premium was remitted on 28/03/2014. So, all the events do not come within the purview of the policy period.
14. Ld counsel has further argued that the repudiation of claim of the complainant made by the op/insurance company is just and proper. There is no such wrong or error on the part of the op/insurance company.
15. Lastly the ld counsel has urged about the principle of Uberrima Fide which was violated by the complainant as per policy terms and conditions and the aforesaid suppression of material facts are one of the most important cause for repudiation of claim of the complainant. The ld counsel further argued that the complainant does not come well within the purview of the consumer as per Consumer Protection Act and accordingly the ld advocate has prayed for dismissal of the petition of complaint with exemplary costs.
16. I have heard the ld advocates appearing for both sides at length and in full.
17. I have considered the submissions of the both sides.
18. I have meticulously perused all materials available on the record alongwith all citations submitted by the Ld. Advocates.
19. The final hearing has been concluded.
20. I have framed the following issues in order to provide proper justice to the parties:
a. Whether the complainant is consumer in pursuant to the provisions of the Consumer Protection Act 1986.
b. Whether the repudiation of the claim of the complainant is justified or not.
c. Whether there is any negligence or deficiency in service on the part of the op/insurance company.
d. Whether the complainant is entitled to get any relief/reliefs as per Consumer Protection Act 1986.
For the sake of convenience all the point are taken up together for consideration in order to settle the aforementioned issues framed by this Commission.
21. Though there is no such straight jacket formula in order to ascertain as to whether the complainant is to be treated as consumer or not as per provision of Consumer Protection Act yet I can examine the instant case carefully as to whether the complainant comes well within the purview of the definition of the consumer as per aforesaid Act or not. In the instant case, it is settled principle of law that hiring or availing the service from the op/insurance company is an act for indemnifying the loss or damage on the happening of the unforeseen event and there is no such nexus to generate profits. From the policy certificate it is evident that the complainant has already paid the amount of premium of Rs.66,600/- as consideration and to that effect the op/insurance company has issued policy certificate being no-SITES 0050009312 with date of commencing from 26/03/2014 to 25/03/2015 in favour of the complainant /insured. Hence there is no hesitation to hold that the complainant herein is to be treated as consumer in pursuant to the provision of the C.P. Act and in this respect I can safely rely upon a case law viz. National Insurance Company Ltd vs Harsolia Motors & others reported in (2023) 8 SCC 362, wherein the Hon’ble Apex Court has been pleased to hold that the complaint filed by the respondent insured herein has no close or direct nexus with the profit generating activity and the claim of insurance is to indemnify the loss which the respondent insured had suffered and the Commission has rightly held that the respondent is a consumer under section 2(1) of the C.P. Act 1986. In United India Insurance Company Ltd. vs Levis Strauss (India) Pvt Ltd. the Hon’ble Court has also been pleased to hold that a contract of insurance is and always continues to be one for indemnity of the defined loss, no more no less. In the case of specific risks, such as those arising from loss due to fire, etc. the insured cannot profit and take advantage by double insurance. The contract of insurance is a contract of indemnity.
22. Upon careful perusal of letter dated 25.03.2014(Annex-B), it appears to me that the complainant submitted Policy Proposal Form alongwith KYC, other relevant documents and Cheque No. 000118 dated 24.03.2014 amounting to Rs. 2000/- drawn on HDFC Bank , Kolkata at the office of OP/ Insurance Company on 25.03.2014 and upon receiving the same OP/Insurance Company acknowledged it on 25.03.2014 affixing their seal and signature with date. So it is very clear to me that the negotiation was started on and from 25.03.2014 with the OP/Insurance Company.
23. I have carefully perused the policy certificate issued by the OP/Insurance Company on 13.05.2014 wherefrom it appears to me that on the strength of proposal dated 25.03.2014 and upon receiving the amount of premium of Rs. 66,600/- the OP/Insurance Company issued the Policy being Policy no. SITES 0050009312 dated 09.05.2014 covering the Policy period on and from 26.03.2014 to 25.03.2015 with a loss limit of Rs. 37,00,000/- alongwith 80% coverage.
24. Upon careful perusal of Annexure-C.( e-mail dt. 26.03.2014) it is evident that Sri Prabir Kr. Santra, Sr. Executive – Finance and Administration Quilters AE, through e-mail dt. 26.03.2014 informed the OP/Sri Sirsendu Mukherjee, Assistant Manager , ECGC about the revised dates regarding schedule of deliveries alongwith need of coverage of policy which are as follows :
Detail Design stage by 23rd March, 2014 (earlier 1st March, 2014) RO 18600 (60% of Project value).
Final Design stage by 15th April , 2014 ( earlier 31st March, 2014) RO 3100(10% of Project value).
Coordinated working drawings stage by 30th June, 2014 (earlier 31st May, 2014) RO 1550 ( 5% of Project value).
For the sakeof convenience RO is to be read asRIAL OMANI.
In pursuance to the Policy issued by OP/Insurance Company , it is evident that in case of suffering loss in respect of exports made to the insured customer owing to non–realization of payments due thereon by reason of the occurrence of any of the insured perils such as customer risks, bank risks and political risks, the OP/Insurance Company will indemnify the insured upto the insured percentage clearly specified in the schedule of insured loss, provided however that under no circumstances the liability of OP/Insurance Company under this Policy shall exceed the amount of loss limit specified in the schedule. As per policy schedule, the loss limit of Rs. 37,00,000/- has been fixed for covering I.T. enabled services policy (single customer).
In pursuant to the policy schedule it is admitted that the complainant is an insured and HME HILARION CONSULTING ENGINEERS is an insured buyer having the buyer code no. 1000565639, working for gain in Dubai, UAE.
We have carefully perused two invoices being no. 3/2014 and 4/2014 dated 31.03.2014 wherefrom it appears to me that the complainant has raised the bill amount RO 9300 ( USD 24180) i.e. INR Rs.14,20,816/- and another bill RO 9300 (USD 24180) i.e. INR Rs. 14,20,816/- i.e. total bill amount to INR Rs. 28,41,632/-. The annexure ‘H’ ( submission of defaulter notice in Form no. 205) clearly reveals that in respect of bill no. 3/2014, 50% of Rs. 14,20,816/- i.e. Rs. 7,10,408/- has already been paid to the complainant and rest amount of Rs. 7,10,408/- is still due. In respect of Bill No. 4/2014 the total bill amount of Rs. 14,20,816/- is still due. So, the total due /outstanding amount of Rs. 21,31,224/- raised by the complainant has been clearly reflected in the annexure ‘H’ i.e. letter dated 6th March, 2015.
- In pursuant to the policy schedule it is evident that the credit period for payment has been fixed for 35 days and after expiry of such period the insured is entitled to claim the unpaid outstanding amount from the OP/Insurance Company. In this particular case the bill has been submitted on 31.03.2014 and due to non-payment of bill amount from the end of insured buyer , the claim has been submitted at the office of OP/Insurance Company and the same was received on 04.05.2015. The cause of loss has been reflected in the aforesaid claim form as default of the buyer.
- As per report of Roy & Company, Chartered Accountants dated 25.04.2015, it is crystal clear that total outstanding against the two invoices is amounting to Rs. 21,31,224/- and to that effect one certificate has been issued in favour of the complainant by the aforesaid chartered accounts. In this respect Ld. Advocate appearing for OP/Insurance Company argued for suppression of material fact on the part of the complainant. But I do not find any such remark regarding suppression of material fact in this certificate.
- Though the compliance of the terms and conditions of the policy schedule is very vital yet the interest of the consumer as per Consumer Protection Act should be looked into by this Commission as the preamble of this Act clearly reveals to provide better protection to the consumer/consumers. Accordingly I cannot throw out the petition of complaint filed by the complainant. In this respect, I try to cite some important terms and conditions which are clearly enumerated in the policy schedule. In the policy schedule the insurance company agrees to indemnify the loss when the insured suffers from loss in respect of the export made to the insured customer owing to non realization of payments due thereon by the reason of the occurrence of any of the insured perils. But under no circumstances the liability of the insurance company does not exceed the loss of the limit which is clearly appended in the policy schedule. This policy also reveals that for a claim to be payable under the policy, the insured/complainant must submit the claim on the prescribed form issued by the insurance company within one year from the due date of payment of the insured debt.
- In this respect, I have carefully perused form no 205 for the month of March 2015 in respect of the aforesaid policy being no – SITES 0050009312 wherefrom it appears to me that the date of shipment has been figured as 24/03/2014. On earlier discussion I have mentioned the credit period for the time which has been fixed for 35 days in pursuant to the policy schedule and accordingly 35 days period has been clearly mentioned or reflected in the column of the terms of payment and the due date has been calculated as 05/05/2014 which is within the policy period. But in this regard ld advocate appearing for the opposite party/insurance company has argued that the services rendered to the insured buyer on 24/03/2014 which was prior to the issue of the policy and the amount of premium has been paid by the complainant on 28/03/2014. Therefore the matter does not come well within the purview of the policy conditions. In this regard it would be decided at first that as to whether the cause of action has been arisen within the policy period or not that should be looked into by this Commission in order to settle the disputes between the parties. Though the date of the shipment has been written 24/03/2014 in the Form no-205 (monthly declaration for the month of March 2015) but upon careful perusal of the two invoices being nos. 3/2014 and 4/2014 it appears to me that the aforesaid two invoices have been issued by the complainant on 31/03/2014 and if I calculate the due date of 35 days from the date 31/03/2014, the due date would be figured as 05/05/2014 which has been correctly and properly recorded or written in the Form no – 205 and the date of the invoice ie 31/03/2014 has also been correctly recorded or written in the claim form submitted by the complainant on 29/04/2015 and the same has been received by the op/insurance company on 04/05/2015 which is within the one year from the due date ie 05/05/2014. So mere silly mistake or fault on the part of the complainant does not constitute the suppression of material facts at the behest of the complainant. In this regard I cannot shake the hand of the ld advocate appearing for the opposite party/insurance company.
- In this respect I can cite a remarkable case law Haris Marine Products vs Export Credit Guarantee Corporation (ECGC) Limited wherein in Civil Appeal no-4139/2020 the Hon’ble Supreme Court has been pleased to hold that “this court is of opinion that the date of loading goods onto the vessel, which commenced one day prior to the effective date of the policy, is not as significant as the date on which the foreign buyer failed to pay for the goods exported, which was well within the coverage period of the policy. Thus, the claim could not be dismissed simply on such basis, especially given that the date of loading the goods onto the vessel was immaterial to the purpose for which the policy was taken by the appellant. The Hon’ble Apex court has also been pleased to hold that it is settled position in law that if there is any ambiguity or a term is capable of two possible interpretations, one beneficial to the insured should be accepted consistent with the purpose for which the policy is taken, namely, to cover the risk on the happening of certain event.
- From the four corners of the record it is revealed that the complainant has sent the progress reports from time to time and the same have been received by the op/insurance company. Not only that as per direction of op/insurance Company, the complainant has appointed a debt collection agency on 6th April 2015. At that time the OP/Insurance company did not raise any question regarding the policy schedule. Rather, at the time of claim submitted by the complainant, the numbers of query have been evolved from the end of the op/insurance company. The complainant had provided answer/reply against the said query but ultimately they have repudiated the claim of the complainant. Under such circumstances, I can safely rely upon a remarkable citation viz. Gurshinder Singh vs Sriram General insurance Company Ltd and another (2020) 11 SCC 612 wherein the Hon’ble Apex Court has been pleased to hold that the Consumer Protection Act aims at protecting the interest of the consumers and it being a beneficial legislation deserves pragmatic construction. The mere delay in intimating the insurance company about the theft should not be a shelter to repudiate the insurance claim which has been otherwise proved to be genuine.
- Upon careful perusal of the record it appears to me that the bill amount of Rs. 5,08,400/- has not been raised in earlier and as such the complainant is not entitled to get any relief against the aforesaid bill amount.
- Upon careful perusal of the policy schedule it is clearly noted that if the complainant insured has reason to believe that the insured customer is unable to or is likely to be unable to perform or comply with or duly discharge his obligations to the insured complainant under any contract for export which shall include non-payment of a bill of exchange or an invoice on due date and in such consequences it is the duty of the insured complainant to inform the matter in writing immediately to the insurance company but in any case by not later than 30 days after the awareness of the event at the behest of the complainant insured. Upon careful perusal of the records, it appears to me that the due date has been recorded as 05.05.2014. So, it is the duty of the insured complainant to inform the matter regarding non-payment of dues to the OP/Insurance Company within 30 days i.e. within 04.06.2014. In this regard, I have carefully perused e-mail dated 13.06.2014 sent by Shri Prabir Santra wherefrom it is revealed that the progress report for the period 01.05.2014 to 31.05.2014 has been transmitted to the OP/Insurance Company. So, it is crystal clear that the detailed report as on 05.05.2014 has already been included in the aforesaid period i.e. 01.05.2014 to 31.05.2014. But I find that the said report has been transmitted to the OP/Insurance Company on 13.06.2014 causing 9 days clear delay in intimation. But reliance upon the case law Gursihinder Singh (Supra) the Hon’ble Apex Court has been pleased to hold that the mere delay in intimating the Insurance Company should not be a shelter to repudiate the claim of the complainant which has been otherwise proved to the genuine.
- In pursuant to the above discussion in detail, there is no hesitation to say that the cause of action has been clearly arisen within the policy period i.e. within the period from 26.03.2014 to 25.03.2015.
- It appears from the record that the complainant has filed questionnaire against the evidence filed by OP/insurance company on 15.01.2029 which has been clearly reflected vide order no. 9 dated 15.01.2019. The Commission has been pleased to fix 28.03.2019 for filing reply by the OP. The order no. 10 dated 28.03.2019 clearly reveals that no reply has been filed by the OP. However, the Commission has been pleased to fix another date i.e. 08.07.2019 for filing reply by the OP. But on the said date i.e. 08.07.2019 none appeared on behalf of the OP and accordingly the OP has been debarred from filing reply which is clearly revealed from the order no. 11 dated 08.07.2019 and accordingly the evidence filed by the OP/Insurance Company has no evidentiary value at all. It is the settled principles of law that the written version should be corroborated by adducing proper and clear evidence at the behest of the OP. Since the reply supported by an affidavit has not been given/filed by the opposite party, the aforesaid evidence is not at all admissible in the eye of law despite availing the opportunity to file the same. So, there is no hesitations to hold that the allegations stated in the petition of complaint against the opposite party alongwith the claim of the complainant is absolutely genuine one. Accordingly, the repudiation of the aforesaid claim of the complainant is not justified and proper. At the time of final hearing Ld. Advocate appearing for the OP/Insurance Company has submitted some rulings regarding suppression of material fact and commencement of the policy period but mere submission of the rulings does not constitute the actual defence at the behest of the OP when the written version filed by the opposite party has not been corroborated with the evidence filed by the opposite party. Since the repudiation is not justified and proper, the deficiency in service/fault on the part of the OP/Insurance Company is hereby proved and hereby the complainant is entitled to get the relief against the opposite party. All the points issues framed by their Committee are hereby decided accordingly in pursuant to the above observations.
- Considering all aspects from all angles and keeping in view the present position of law as well as regard being had to the submissions of the ld advocates and citations of Hon’ble Apex Court/Commission, the petition of complaint cannot be and should not be rejected in limini or dismissed against the opposite party/insurance company though there are some silly mistake/fault on the part of the complainant earlier discussed in detail. However, it is my careful observations that the op/insurance company is not entitled to repudiate the claim of the complainant in toto, rather the complainant is entitled to get relief on non-standard basis @ 75% of the total outstanding claim/demand which are settled by this Commission as indicated in table below:-
Invoice no | Invoice amount INR | Paid amount | Dues amount | 80% coverage amount | Total outstanding dues | Non-standard basis claim 75% |
01/2014 | 5,08,929.00 | Full paid | Nil | Nil | Nil | Nil |
02/2014 | 7,01,520.00 | Full paid | Nil | Nil | Nil | Nil |
03/2014 | 14,20,816.00 | 50% paid | 7,10,408.00 | 14,20,816,x,80%=11,36,653.00-710408.00 | 4,26,245.00 | 3,19,684.00 |
04/2014 | 14,20,816.00 | Not paid | 14,20,816.00 | 11,36,653.00 | 11,36,653.00 | 8,52,490.00 |
| | | | | 15,62,898.00 | 11,72,174.00 |
Accordingly the petition of complaint is allowed on contest with costs of Rs.20,000/- against the opposite party/insurance company.
Hence
Ordered
That the opposite party/insurance company is hereby directed to pay Rs.11,72,174/- (Rupees eleven lakhs seventy-two thousand one hundred seventy-four )only to the complainant within 45 days from the date of this order.
That the opposite party /insurance company is further directed to pay litigation costs of Rs.20,000/- (Rupees twenty thousand) to the complainant within the aforesaid period of time.
If the awarded amount is not paid within the aforesaid period of time, the whole awarded amount ie Rs. (11,72,,174.00 + 20,000.00) = Rs.11,92,174.00 (Rupees eleven lakhs ninety-two thousand one hundred seventy-four) only shall carry interest @8% pa from the date of default till full realization.
In case of non-compliance of aforesaid order by the op/insurance company, the complainant is at liberty to put the order in execution.
The instant consumer case stands disposed of as per aforesaid observations.
Note accordingly.
