| Final Order / Judgement | BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, JALANDHAR. Complaint No.466 of 2017 Date of Instt. 07.12.2017 Date of Decision: 28.09.2021 Sh. Rakesh Chauhan son of Shri Bhag Ram Chauhan, Resident of 216, Guru Gobind Singh Nagar, Jalandhar. ..........Complainant Versus M/s Royal Sundaram Alliance Insurance Co. Ltd, Corporate Office: Vishranthi Melaram Towers No. 2/319, Rajiv Gandhi Salai (OMR), Karapakkam, Chennai 600097 through its Managing Director/Chairman.
2. Standard Chartered Bank, G. T. Road, Near Arora Prime Towers, Jalandhar through its Branch Manager. ….….. Opposite Parties Complaint Under the Consumer Protection Act. Before: Sh. Kuljit Singh (President) Smt. Jyotsna (Member) Sh. Jaswant Singh Dhillon (Member) Present: Sh. Gulshan Arora, Adv. Counsel for the Complainant. Sh. R. K. Sharma, Adv. Counsel for OP No.1. Sh. V. K. Gupta, Adv. Counsel for OP No.2. Order Kuljit Singh (President) The instant complaint has been filed by the complainant, wherein he alleged that OP-1 is running insurance company and OP-2 has been provided agency at Jalandhar. Complainant purchased policy No.FMSTCB0011 with certificate No.DEB0000374000100 effective from 27.05.2014 to 26.05.2015 for a sum of Rs.20,00,000/- in respect of Home Contents Protector. Complainant deposited the premium of Rs.9,999/- with OP-2 being agent of OP-1 and policy was granted in the name of complainant. As ill luck would have it, on 20.08.2014 at about 4PM, a fire broke out in the house due to short circuit in which, the following articles were burnt and completely damaged:-Two Geysers, Two Air Conditioners, Five Fans, One Refrigerator, Kitchen Chimney, Microwave, Electric Tandoor, Laptop, Two Mobile Phone, Two Televisions, Twenty Tubes, Desktop, Printer, Washing Machine, Tredwill machine, Play station, Submersible Pump, Mixture – Juicer, CD Player and other electric appliances alongwith other house hold articles, value of which is more than Rs.10,00,000/- and the claimant is claiming a sum of Rs.10,00,000/- though the policy insured is of Rs.20,00,000/-. Due intimation was sent to OPs, regarding incident but no surveyor was deployed for the first about four months. After four months the surveyor visited the spot of incident and assured to settle claim of complainant. Complainant lodged complaint No.RSA/ 201411124/00016375 which was duly received and acknowledged and it was assured that the complainant shall receive response within 10 days, vide letter dated 25.11.2014, but till date the complainant has not received any intimation from their end. Complainant also served the Ops with legal noticed dated 29.11.2017 for Redressal of grievances, but it did not evoke any positive response. Earlier complainant filed complaint. There was some technical defects in the same as such withdrawn the same with permission to file a fresh complaint. Lastly, prayer has been made that OPs be directed to pay a sum of Rs.10,00,000/- out of value of policy of Rs.20,00,000/- and cost of present complaint. Notice of the complaint was given to the OPs and accordingly, OP-1 appeared through its counsel and filed written reply, whereby contested the complaint by submitting that purchase of policy is admitted; claim intimation was received on 3oth September, 2014 stating that the date of loss on 23.08.2014. In order to process the claim, the complainant was asked to submit relevant documents; on 25.11.2014, it was communicated to complainant that he may go ahead with the repair of TV and fridge, if the same is below Rs.10,000/- and he was also asked to submit certain documents to scrutinize the loss. Even a claim form was sent to complainant; the answering OP received the written claim form of complainant and according to the claim form, the complainant claimed for:- i. Television, ii. Refrigerator, iii. Personal Computer, iv. Air Conditioner, v. Submersible, vi. Electric Chimney; since the list got bigger in said claim form assuring it might go beyond Rs.10,000/- as per IRDA Guidelines, the answering OP-1 appointed IRDA licensed Surveyor and Loss Assessor to assess the said loss; as per survey report submitted by Mr. Ramit Bagga, (SLA No.73415), the surveyor was not able to assess the loss due to non-submission of relevant documents by complainant; Surveyor has submitted report that “ASSESSMENT OF LOSS:- It is not possible for the undersigned to assess the loss in the absence of an repair estimate/bill submitted by the insured”. As per agreed policy terms and conditions, the complainant was bound to submit requisite documents in the claims procedure; the said condition is mentioned under General Condition – Claim Procedure. Without prejudice to the things submitted supra it is further submitted that out of list given regarding the loss to goods, all are not covered under the policy. Under “household Appliances” from the list provided only Television and Refrigerator is covered under “Electronic Appliances” personal computer and Air Conditioner only. Further, it is submitted that 1. Section II of the policy provides benefits, specific conditions and exclusions for the “Household Appliances” (Television and Refrigerator). 2. Section IV of the policy provides benefits, specific conditions and exclusions for “Electronic Appliances” (Personal Computer and Air Conditioner”. In order to scrutinize, the loss under said policy terms and conditions, it is necessary to submit documents sought. Hereby not submitting the documents, the complainant had grossly violated the terms and conditions thereby the surveyor was not able to assess the loss. Complaint is pre-matured. Other averments of complaint are denied and prayed for dismissal of complaint. OP-2 has filed separate reply, whereby OP-2 contested the complaint by taking preliminary objections that complainant who was interested in carrying out investment and therefore the official of OP-2 advised him to approached the consultant of OP-1 so that complainant can seek the information regarding the various investment scheme of OP-1; the present case relates to allegations of complainant that the complainant has availed the insurance policy bearing No. FMSTCB0011 from RS through SCB in relation to the Home Contents Protector in May 2014 and as and when a claim was raised by complainant the same was refused by OP-1. By availing said insurance policy the complainant entered into a contract with OP-1. The contract was only between the complainant and OP-1 and there is no role of Standard Charted Bank. The policy agreement signed between both the parties i.e. complainant and OP-1. The OP-1 clearly bears the disclaimer clause that “The policies for Standard Chartered Bank customers is issued by Royal Sundram Alliance Company Limited will be settled by Royal Sundram Alliance Company limited as per the terms and conditions of the policy. Please refer to policy document for exact terms and conditions and specific details application to this Insurance. Standard Chartered Bank does not accept any responsibility nor give any warranty express of implied, as to accuracy, reliability and completeness of any statement made in or omission of any provisions of the contract of Insurance. Your participation in this Insurance product is purely on a voluntary basis. We advise you to take your own professional advise before you participate. In case the Insurance is approved, you will be receiving the policy within 15 working days from the date of your premium being received by Royal Sundaram”. There is no role of answering OP in the agreement signed between the complainant and OP-1. Complainant invested in the said Home Content Protector Policy after understanding the terms and conditions of said policy. The policy holder is bound by the terms and conditions of the insurance policy. It after taking the policy bond the complainant found anything in contrary to the understanding or unacceptable the complainant can apply for cancellation of policy within 15 days from taking the policy bond. But complainant did not apply for said cancellation and willfully gave his approval for terms and conditions of said policy. Complaint is frivolous in nature as the damages was 12,00,000/- and after four year the complainant by withdrawing his complaint made a change by claiming damages reduced from 12,00,000/- to 10,00,000/-. On merits, answering OP denied all other averments of complaint and prayed for dismissal of complaint. In order to prove her respective version, the counsel for the complainant produced on the file complainant’s evidence. We have heard the argument from learned counsel for the complainant and also gone through the case file as well as written arguments very minutely. The counsel for complainant has argued that complainant purchased policy No.FMSTCB0011 with certificate No.DEB0000374000100 effective from 27.05.2014 to 26.05.2015 for a sum of Rs.20,00,000/- in respect of Home Contents Protector. Complainant deposited the premium of Rs.9,999/- with OP-2 being agent of OP-1 and policy was granted in the name of complainant. As ill luck would have it, on 20.08.2014 at about 4 PM, a fire broke out in the house due to short circuit in which, the following articles were burnt and completely damaged:-Two Geysers, Two Air Conditioners, Five Fans, One Refrigerator, Kitchen Chimney, Microwave, Electric Tandoor, Laptop, Two Mobile Phone, Two Televisions, Twenty Tubes, Desktop, Printer, Washing Machine, Treadwill machine, Play station, Submersible Pump, Mixture – Juicer, CD Player and other electric appliances alongwith other house hold articles, value of which is more than Rs.10,00,000/- and the claimant is claiming a sum of Rs.10,00,000/- though the policy insured is of Rs.20,00,000/-. Due intimation was sent to Ops, regarding incident but no surveyor was deployed for the first about four months. After four months the surveyor visited the spot of incident and assured to settle claim of complainant. Complainant lodged complaint No.RSA/ 201411124/00016375 which was duly received and acknowledged and it was assured that the complainant shall receive response within 10 days, vide letter dated 25.11.2014, but till date the complainant has not received any intimation from their end. On the other hand, counsel for OP-1 argued that claim intimation was received on 3oth September, 2014 stating that the date of loss on 23.08.2014. In order to process the claim, the complainant was asked to submit relevant documents; on 25.11.2014, it was communicated to complainant that he may go ahead with the repair of TV and fridge, if the same is below Rs.10,000/- and he was also asked to submit certain documents to scrutinize the loss. Even a claim form was sent to complainant; the answering OP received the written claim form of complainant and according to the claim form, the complainant claimed for:- i. Television, ii. Refrigerator, iii. Personal Computer, iv. Air Conditioner, v. Submersible, vi. Electric Chimney; since the list got bigger in said claim form assuring it might go beyond Rs.10,000/- as per IRDA Guidelines, the answering OP-1 appointed IRDA licensed Surveyor and Loss Assessor to assess the said loss; as per survey report submitted by Mr. Ramit Bagga, (SLA No.73415), the surveyor was not able to assess the loss due to non-submission of relevant documents by complainant; Surveyor has submitted report that “ASSESSMENT OF LOSS:- It is not possible for the undersigned to assess the loss in the absence of an repair estimate/bill submitted by the insured”. As per agreed policy terms and conditions, the complainant was bound to submit requisite documents in the claims procedure; the said condition is mentioned under General Condition – Claim Procedure. Without prejudice to the things submitted supra it is further submitted that out of list given regarding the loss to goods, all are not covered under the policy. Under “household Appliances” from the list provided only Television and Refrigerator is covered under “Electronic Appliances” personal computer and Air Conditioner only. Further, it is submitted that 1. Section II of the policy provides benefits, specific conditions and exclusions for the “Household Appliances” (Television and Refrigerator). 2. Section IV of the policy provides benefits, specific conditions and exclusions for “Electronic Appliances” (Personal Computer and Air Conditioner”. In order to scrutinize, the loss under said policy terms and conditions, it is necessary to submit documents sought. Hereby not submitting the documents, the complainant had grossly violated the terms and conditions thereby the surveyor was not able to assess the loss. The counsel for Op-2 also argued that complainant has availed the insurance policy bearing No. FMSTCB0011 from RS through SCB in relation to the Home Contents Protector in May 2014 and as and when a claim was raised by complainant the same was refused by OP-1. By availing said insurance policy the complainant entered into a contract with OP-1. The contract was only between the complainant and OP-1 and there is no role of Standard Charted Bank. The policy agreement signed between both the parties i.e. complainant and OP-1. The OP-1 clearly bears the disclaimer clause that “The policies for Standard Chartered Bank customer is issued by Royal Sundram Alliance Company Limited will be settled by Royal Sundram Alliance Company limited as per the terms and conditions of the policy. Please refer to policy document for exact terms and conditions and specific details application to this Insurance. Standard Chartered Bank does not accept any responsibility nor give any warranty express of implied, as to accuracy, reliability and completeness of any statement made in or omission of any provisions of the contract of Insurance. Your participation in this Insurance product is purely on a voluntary basis. We advise you to take your own professional advise before you participate. In case the Insurance is approved, you will be receiving the policy within 15 working days from the date of your premium being received by Royal Sundaram”. There is no role of answering OP in the agreement signed between the complainant and OP-1. Complainant invested in the said Home Content Protector Policy after understanding the terms and conditions of said policy. The policy holder is bound by the terms and conditions of the insurance policy. It after taking the policy bond the complainant found anything in contrary to the understanding or unacceptable the complainant can apply for cancellation of policy within 15 days from taking the policy bond. But complainant did not apply for said cancellation and willfully gave his approval for terms and conditions of said policy. The bare reading of the averments of the parties, we observed that the case of complainant is fully covered under “Hon’ble National Commission in M/s United India Insurance Company Limited Vs. Sangeetha Singh (2010) (II) CPJ 237 NC) vide which it is held that failure to give necessary particular and documents as sought for by the insurer will make the claim investigation handicapped and hamper the entire claims process.”As the complainant has failed to submit the requisite documents with OPs. From this angle, the present complaint is premature in nature. Resultantly, keeping in view from the factum and circumstances of the case, we partly allowed the present complaint with directions to complainant to submit said requisite documents, if not supplied yet, with the OPs within 30 days, thereafter, the OPs will settle the insurance claim in dispute within 30 days from the date of receipt said documents. Further, if the complainant is not in possession of the requisite documents, then in that case, the OPs are directed to settle the claim of the complainant, as per documents placed on this case file and supplied to OPs, if any. The complainant is entitled for Rs.5000/- as litigation expenses of present complaint, which to be paid by OPs within 45 days. Copies of the order be sent to the parties, as permissible, under the rules. This complaint could not be decided within stipulated time frame due to rush of work.
14. File be indexed and consigned to the record room after due compliance. Announced in open Commission 28thof September 2021 Kuljit Singh (President) Jyotsna (Member) Jaswant Singh Dhillon Member | |
