Delhi

South Delhi

CC/632/2012

AJAY AHUJA - Complainant(s)

Versus

ICICI LOMBARD GENERAL INSURANCE CO. LTD - Opp.Party(s)

01 Feb 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi- 110016

 

Case No. 632/12

Sh. Ajay Ahuja on behalf of

Late Smt. Pushpa Ahuja

R/o General Manager-4/197

Safdarjung Enclave

New Delhi-110029

….Complainant

Versus

1. I.C.I.C.I Lombard General Insurance

S-13, 1^st Floor Green Park Extension,

Uphar Cinema Complex

New Delhi-110016

 

2. Birla Tower, 5^th Floor

 25, Barakhamba Road,

 New Delhi-110001

 

       ….Opposite Party

    

 Date of Institution    :  23.11.2012      

 Date of Order            : 01.02.2023     

 

Coram:

Ms. Monika A Srivastava, President

Ms. Kiran Kaushal, Member

Sh. U.K. Tyagi, Member

 

ORDER

 

 

Member: Ms. Kiran Kaushal

 

1. Briefly put, complainant got his house insured from ICICI Lombard General Insurance Company (OP) on 24.11.2006 for 10 years.

It is stated that on 20.05.2012, complainant found that there was leakage from the roof of the front bathroom which had considerably damaged the house and needed immediate repair. The complainant informed OP Company telephonically regarding the same. Pursuant to the information surveyor of OP company came to the house of the complainant and inspected the damaged portion of the house.Thereafter complainant submitted the claim form vide receipt dated 04.06.2012 in the office of OP Company.

2. The complainant was shocked to receive the repudiation letter from OP company stating that the claim of the complainant was inadmissible as per policy terms & conditions and was closed as ‘nil liability’. OP in the repudiation letter stated that under special conditions Point no. 4 Leakage/seepage is excluded under the policy. Moreover, bursting of GI pipe is construction default which is also excluded under the home insurance policy.
3. It is stated by the complainant that as per policy there is no such special condition mentioned in the policy book of OP company. Rather as per Clause ‘9’ of the Insurance Policy, bursting of GI pipe is very much covered under the insurance policy hence the reply establishes the malafide intention of OP. It is stated that the clause mentioned by OP for not admitting the claim does not exist in the policy document issued alongwith insurance policy. Complainant got the estimate of the repairs of the damaged portion of the house which came to be around Rs. 7,60,000/-appended at page     of the complaint.
4. Alleging that the claim of complainant was wrongly repudiated complainant prays for direction to OP to pay Rs. 7,60,000/- with interest @ 18% p.a. and also to award 50,000/- for causing mental pain and harassment to the complainant. Additionally Rs. 22,000/- towards cost of litigation is sought for.
5. OP filed its written version stating interalia that the policy terms & conditions clearly mentioned ‘special conditions’ which specifically exclude ‘seepage’ from the scope of its coverage. It is submitted that the said repudiation letter dated 12.06.2012 makes it clear that the bursting of internal GI pipe is a construction default which is excluded under the said policy. Accordingly the claim was closed as Nil liability .It is reiterated that seepage/leakage is a gradual

deterioration phenomena and is specifically excluded under the policy by virtue of special conditions, Point no.4 the same is reproduced as under:-

‘Seepage is excluded under the policy. Moreover, bursting of internal GI pipe is construction default which is also excluded under the home insurance policy’.

6. OP prays that as the claim of the complainant has been rightly                  repudiated, complaint be dismissed.

Rejoinder is filed on behalf of the complainant. Evidence by way of affidavit and written arguments are filed on behalf of parties. Material placed on record is perused. Submissions made on behalf of parties are heard. 

7. Admittedly Ms. Pushpa Ahuja, mother of the complainant took Home Insurance policy for her house for a period from 24.11.2006 to 23.11.2016. To clear the confusion whether the ground of Seepage/Leakage is admissable or not ,relevant portions of the policy are reproduced as under:-

This policy is only applicable to dwellings that are not “Kutcha” construction.

Note: Amongst the following covers,

“Fire-Building” and “Earthquake-Building” and/or

Fire-Contents” and “Earthquake-Contents” and “Burglary” are basic covers that every insured shall be necessarily  provided with every Home Insurance Policy issued. However, the  other covers as mentioned  below are optionally available  wherein  all  or  any of  them,  individually  or  in  combination, may  be  offered,

 

alongwith the basic coverage, at the Company’s sole discretion.

 

Section 1 Fire

Section a     -         Applicable to Building

Section        -         Applicable to Contents

Section 2 Earthquake (Fire and Shock)

Section a     -         Applicable to building

Section b     -         Applicable to Contents

Sum insured under the policy

S.No.	Covers	Sum Insured (INR)	Premium with Service Tax (INR)	Represents	Excess
1.	Structure-Fire and Special Perlis	1,000,000	2806.00	Reinstatement
2.	Structure-Earthquake	1,000,000	1122.40	Reinstatement
Premium Before Service Tax (INR) :			3500.00
Service Tax(INR):			419.83
Education Cess (INR) :			8.57
Total Premium Value INR :			3928

 

Surveyor in his Survey report states the following-

Policy conditions, Warranties, Liability under policy	We are of the opinion that the losss/damage has occurred due to seepage/leakage of rain water from the roof/side walls of the house which is a gradual deterioration phenomenon. And no peril as per Std. Fire &Special perils policy is operated. Moreover, GI pipe burst due to inferior construction quality or due to ageing.
Claim Amount	The Insured have put up their claim for Rs. 0/- (No estimate received from insured )

 

8. After going through the scope of insurance cover, in the terms & conditions of the policy, provided to the complainant it is seen that only the structure, in case of fire and special perils and earthquake was insured by the policy holder. Premium was paid by policy holder for these two covers only. Complainant has not been able to show any peril as per Std. Fire & Special Perils.  Therefore it is clear from the home insurance policy as well as the terms & conditions that the GI pipe bursting and the consequent damage is not covered under the said insurance policy. In view of the same we are of the opinion that the claim was rightly repudiated by OP. Thus the complaint has failed to prove any deficiency of service and is accordingly dismissed.

File be consigned to the record room and order be uploaded on the website.