The present complaint has been preferred by the titled complainant against the titled opposite parties (for short, jointly the OP insurers/singularly as the OP1, the OP2) at the arbitrary repudiation of his otherwise a valid fire-claim succeeding the alleged fire-incident occurred at 1:30 AM on the night between the 5th/ 6th June' 2019 at his work-place of Women Saloon Business under the brand name of Khan Unisex Saloon at the Ground Floor of Property # 135, Mission Road, Pathankot; in which all his insured stocks/consumables valued at > Rs.7.0 Lac were reduced to ashes (total-loss). The complainant has been availing an Overdraft Business Loan of Rs.5.0 Lac from the local branch of UCO Bank and in compliance to the Sanction Terms had purchased 'Business Suraksha' Insurance Policy # 2019-M1288504-FSS from the OP insurers @ a premium of Rs.2,370/- covering his stocks/consumables (having undergone the joint verification by bankers & insurers) valued @ Rs.6.67 Lac w.e.f 14.05.2019 to 13.05.2020.
2. However, on the night intervening 5th /6th June' 2019, a major fore broke out in the building and the entire furniture/fixtures, stocks/stores/consumables and all others were burnt down to ashes/total-loss. The OP insurers were duly intimated and their Surveyor visited the incident-site on 12.06.2019 and the related DDR # 36 (08.06.2019) was also filed with the local police authorities. The OP Insurers' Surveyor has been quizzing his queries as well as requisitioning various documents in a piece-meal fashion till 19.06.2019 and all these were duly responded/supplied by the complainant to the optimum feasible level. Thereafter, the complainant has queried of his claim-status from the OP insurers as well as from the Surveyor through various mails followed by many reminders mailed on various dates. After having waited for more than three months, the complainant got served one Legal Notice upon the titled OP insurers on 09.01.2020 resulting into an unceremonious repudiation of his claim and hence prompted the present complaint seeking appropriate directives to the OP insurers to pay the claim to its full amount of Rs.6.67 Lac with interest @ 18% PA from the date of the fire-incident till realization, in the interest of justice. The complainant has filed the listed documents in evidence to support prosecution of her complaint.
Listed Documents produced in evidence by the complainant:
i) Ex.CW1/A - Affidavit by Md Anish Khan deposing the contents of his complaint;
ii) Ex.C1 – Copy of the Policy Schedule;
iii) Ex.C2-Copy of the DDR;
iv) Ex.C3 - Copy of the Claim Form/Correspondence etc;
v) Ex.C4 & Ex.C5 – Copies of published news of the fire-incident;
vi) Ex.C6 – Copy of the Fire Report;
vii) Ex.C7 – Copy of Rent Agreement;
viii) Ex.C8 to Ex.C10 – Legal Notice and the related postal-receipts;
ix) Ex.C11 & Ex.C12 – UCO Bank Stock Statement & Certificate;
x) Ex.C13 – Copy of UCO Bank Stock Register: Stocks Rs.7,19,140/- (31.05.2019);
xi) Ex.C14 – Copy of UCO Bank Hypothecation Deed.
3. The OP Insurers, in compliance to the Commission’s Summons, appeared through its counsel and filed its written-reply comprised of preliminary-submissions & objections preliminary as well as on merits. The OP insurers have introduced themselves as having been duly registered U/provisions of the Companies and the Insurance Act and having authorized one of its officers with requisite authority to represent them here before the commission. The submissions summarize the formal rights that the OP are inclined to exercise and have addressed the present complaint filed with malafide and dishonest intentions, twisted and distorted facts etc that have itself rendered it to dismissal. Further, the OP in its preliminary objections have addressed the present complaint as vague, false, vexatious and frivolous filed to injure the goodwill and reputation of the OP Also, the complaint has failed to demonstrate any deficiency in service on the OP Part. On the other hand the complainant has violated the terms of the insurance contract and that absolves the OP insurers of their liability under the contract. The OP have quoted here six judgments of senior courts that have been respectfully noted for peruse during the present trial at the appropriate stage. The OP have been objecting maintainability in absence of any cause of action favoring the complainant and deficiency in service on their part. The complainant has filed a false and frivolous complaint and has himself failed to fulfill his part of the obligations and has not been entitled to any relief. On merits, the OP have denied and/or side-tracked most of the contents of the complaint addressing these as wrong/incorrect and have been repeatedly putting emphasis on non-cooperation by the complainant in providing assistance to the OP Surveyor who has assessed the loss @ Rs.87,800/- only and that was offered by the OP but refused by the complainant. However, the fire-incident total-loss claim was not payable on merits as the same stocks were also insured from another insurer by the complainant's mother and loss claimed, in the same fire incident. The complainant has been duly intimated in writing of the OP sanction, in part, on 04.11.2019 and thus the present complaint truly deserves dismissal being devoid of any merits.
4. Lastly, the OP insurers have prayed for dismissal of the present complaint with costs and have produced the Affidavit Ex.OP1,2/A of Nitin Hanumant Tawre its Senior Executive Legal along with other documents (in evidence) as: Ex.OP1,2/1 to Ex.OP1,2/3 – Copy of Policy Wordings (Business Surakha); Copy of the Surveyor's Assessment of Loss/Copies of correspondence between insured/insurer, in support of their defense.
5. We have examined the available documents/evidence as available on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective litigants. We observe that the present dispute has arisen for of non-sanction/partial-repudiation of the fire-loss claim of the complainant by the OP insurers on account of the complainant claiming cover over the stocks that stood insured/covered by another insurer by his mother who runs a similar styled business on the First Floor of the same building and also non-cooperation by the complainant in violation of the terms of the related policy. Although, there's no proof of delivery/ acknowledgment of Terms of the related Policy to the complainant.
6. We observe that the OP insurers have failed to produce any cogent evidence to prove their charge of violation of the policy terms. It has not been understandable that on one side the OP insurers have been offering Rs.87,800/- as fire-incident claim and on the other hand and in the same breath they have pleaded no-loss to the complainant as the stocks, in question, stood hypothecated to another Bank & also covered by another Insurer as claimed to have been owned by his mother in the building. Here, the OP have not explained as to how and why these stocks were got insured by the two insurers and also financed by the two banks. It has been merely a bald allegation sans any cogent evidence exhibiting an employ of unfair trade practices leading to deficiency in service on the OP insurers' part holding them liable to an adverse award under the Act.
7. Further, the complainant's cooperation is very much vivid from the e-mail copies qua the inter-se exchange of communication, between the two sides. Thus, the allegations as put forth by the insurers are bald-statements only in the absence of any cogent evidence. Further, the Surveyor's Assessment of Loss Report has been filed sans the mandatory affidavit as such the same shall not be admissible in evidence. Moreover the report does not disclose the basis of valuation of stocks/stores vide which the loss has been assessed. The complainant has duly filed the Banker's Certificate confirming the joint inspection (by the banker as well as the insurer) of the stocks and its valuation at more than Rs.7.0 Lac on the date of purchase of the related policy and thereafter qua the stock-statement as on 31.05.2019. Thus, we set-aside the OP insurers' arbitrary rejection of the fire-loss claim since that amounts to but an employ of unfair practices and also leads to affirm deficiency in service on their part and that surely attracts an adverse statutory award.
8. In the light of the all above, we partly allow this complaint and ORDER the OP insurers to withdraw the impugned repudiation of the impugned claim and to pay the fire-loss claim, in full, besides to pay him Rs.10,000/- in lump sum as cost and compensation within 45 days of receipt of the certified copy of these orders otherwise the awarded amount shall attract interest @ 9% PA from the date of the complaint till paid, in full.
9. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
10. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Naveen Puri)
President.
ANNOUNCED: (R.S.Sukhija)
AUG. 24, 2022. Member.
YP.
