KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

VAZHUTHACAUD, THIRUVANANTHAPURAM

C.C. No. 58/2019

JUDGMENT DATED: 19.11.2024

PRESENT:

SRI. AJITH KUMAR D.                                                    : JUDICIAL MEMBER

SRI. RADHAKRISHNAN K.R.                                        : MEMBER

COMPLAINANT:

Dr. Sajesh Asokan, S/o late Dr. N.N. Asokan, Kavumpady P.O., Muvattupuzha, Ernakulam-686 661.

(By Adv. P. Balakrishnan, Adv. Philip T. Varghese, Adv. Thomas T. Varghese and Adv. Sunanda Sukumaran)

                                                Vs.

OPPOSITE PARTIES:

1. M/s Royal Sundaram General Insurance Company Ltd., represented by its Managing Director, No. 1, 11 Floor, Subramanian Building, Club House Road, Chennai-600 002.

2. M/s Royal Sundaram General Insurance Company Ltd., represented by its Manager, II Floor, 40/1045, D1, Amritha Towers, Opposite Maharajas Ground, M.G. Road, Kochi-682 011.

(By Adv. Jacob Mathew)

JUDGMENT

SRI. AJITH KUMAR D.    : JUDICIAL MEMBER

This is a complaint filed under Sec. 17 of the Consumer Protection Act, 1986 against the Royal Sundaram General Insurance Company, alleging deficiency in service. 

2.  The averments contained in the complaint are that the complainant had insured his residential building with the opposite parties under the “Secure Home Policy” bearing No. DC00005005000100 covering the period from 27.05.2011 to 26.05.2026.  As per the policy, the building and the contents in the house were insured for a total amount of Rs. 60,00,000/- (Rupees Sixty Lakh only).  The complainant had remitted Rs. 59,562/- (Rupees Fifty Nine Thousand Five Hundred and Sixty Two only) as premium.  In the month of August 2018, the residence of the complainant was totally damaged as flood occurred.  The entire building and all structures therein including furniture, fixtures and interiors were damaged in the flood.  The complainant had to vacate the house along with his family.  As the house was completely flooded the complainant would estimate the loss at Rs. 45,00,000/- (Rupees Forty Five Lakh only).  As per the request of the complainant one insurance surveyor was appointed by the opposite parties who had inspected the premises.  He had assessed the loss suffered by the complainant at Rs. 4,00,000/- (Four Lakh only) and asked the complainant to give consent for settlement of the amount. The complainant objected the proposal as the amount assessed by the surveyor was meagre.  The complainant informed the opposite parties that he was not amenable for settlement at the rate offered by the insurance surveyor.  According to the complainant, the name of the policy itself denotes that it covers not only the building but the structures and other belongings kept in the residence.  The insurance surveyor had calculated depreciation at a higher rate.  The assessment done by the insurance surveyor is grossly inadequate.  The opposite parties ought to have taken an independent decision disregarding the report of the surveyor.  So far, the complainant never raised any claim though the policy was availed in 2011.  The complainant would allege deficiency in service and sought for realization of an amount of Rs. 41,00,000/- (Rupees Forty One Lakh only) along with interest @ 18%, Rs. 1,00,000/- (Rupees One Lakh only) as compensation for the mental agony and Rs. 20,000/- (Rupees Twenty Thousand only) as legal expenses. 

3.  The opposite parties had entered appearance and filed a joint written version with the following contentions:  The complaint is not maintainable as there is no cause of action against the opposite parties.  As per the terms and conditions in the policy, only the building is covered.  The insured had submitted duly filled proposal form which is the basis of the contract as per which he never opted to cover the contents in the house.  Based on the proposal made by the complainant the opposite parties had issued a valid policy with terms and conditions which covers only the building.  Copy of the proposal form and the policy certificate and its terms and conditions were also enclosed along with the written version.  The allegation regarding total damage of the house, furniture and other belongings is denied.  Opposite parties had appointed an approved IRDAI licensed surveyor who had visited the premises, conducted the investigation and assessed the loss of the building by invoking the correct standard.  The General Rules and Regulations stipulate that the wordings of the policy shall be as shown in Sec. II of the tariff under sub section (d) i.e. policy covering building and/or contents shall show block wise separate amounts on building.  The opposite parties had sent a reply to the legal notice to accept the settlement.  As per IRDA circular dated 07.06.2016 if the amount offered by the insurance company is disputed by the insured, the insurance company would take steps to pay the amount assessed without waiting for the voucher discharge by the insured or claimants.  The opposite parties would seek for dismissal of the complaint. 

4.  On the side of the complainant, PW1 was examined and Exhibits A1 to A6 were marked.  No oral evidence was let in by the opposite parties.  Exhibits B1 to B6 were marked on their side. 

5.  Heard both sides.  

6.  The points that would arise for determination are:

1. Is there any deficiency in service on the part of the opposite parties as alleged?
2. Whether the complainant is entitled to get any of the reliefs as sought for?
3. What order as to costs?

7.  Points (i) to (iii) : PW1 had sworn before this Commission in support of the pleadings contained in the complaint.  Exhibit A1 is the copy of the policy document which would prove that the residential building of the complainant was insured from 27.05.2011 to 26.05.2026.  The alleged flood had taken place in the month of August 2018 which is within the period covered by Exhibit A1.  Exhibit A2 is the report prepared by Sri. V.V.S. Sitaram, insurance surveyor and loss assessor.  He would estimate the amount of loss covered by the insurance policy as Rs. 4,00,000/- (Rupees Four Lakhs only).  Exhibit A3 is the copy of the e-mail sent by the insurance surveyor that the building alone was covered as per the policy.  As per the escalation clause the sum insured automatically increased by 10% after completion of 12 months from the date of commencement of the cover.  The insurance surveyor through Exhibit A3 had clarified that his assessment was true and correct.  Exhibit A4 is the copy of the lawyer notice and its postal receipt sent on behalf of the complainant requesting the opposite parties to grant adequate compensation since the assessment done by the surveyor was improper.  Exhibit A5 is the copy of the acknowledgement card.  Exhibit A6 is the reply dated 03.12.2018 sent by the opposite party.  During cross examination PW1 was confronted with the recitals in Exhibit A1 that the building alone was insured which fact was conceded by PW1.  The description of the property insured is separately shown in Exhibit A1.  The building alone was insured and the sum insured is Rs. 60,00,000/- (Rupees Sixty Lakhs only).  It would further show that the compound wall of the building was not insured as per the policy.  So, the contract of insurance would clearly stipulate that the building alone was insured.  The opposite parties had caused production of the true copy of the proposal form submitted by the complainant for availing the policy.  The proposal form is also specific that home building alone was insured and premium was paid under that head.  Exhibit B2 is the covering letter along with the insurance policy sent by the opposite parties to the insured.  It also stipulates that the building alone was insured.  Exhibit B3 is the terms and conditions in the policy.  Exhibit B4 is the final survey report prepared by the insurance surveyor and loss assessor by assessing the net loss as Rs. 4,00,000/- (Rupees Four Lakhs only). Exhibit B5 is the General Rules and Regulations issued by the Tariff Advisory Committee which stipulates the policy covering buildings and/or contents shall show block wise separate amounts as building, machinery and accessories, stock and stock-in-process, furniture and other contents.  Exhibit B6 is the copy of the letter issued by the opposite parties wherein the opposite parties had again  reiterated that the policy provides coverage only for the building and not for the contents.  Exhibit B6 was issued as per the IRDA circular.  Here the proposal form submitted by the insured and the policy document would clearly show that the building alone was insured.  The insurance policy bears description of the property insured in capital letters wherein the building alone was insured.  The Hon’ble Apex Court in Export Credit Guarantee Corporation India Ltd. vs M/s. Garg Sons International reported in 2013 (4) CPR 373 (SC) declared that the insured cannot claim anything more than what is covered by the insurance policy.  The terms of the contract have to be construed strictly without altering the nature of the contract as the same may affect the interests of the parties adversely.  Here the policy document and the proposal form submitted would establish that the building alone was insured and we cannot find any illegality or impropriety on the part of the opposite parties in restricting the claim pertaining to the building alone. 

8.  The insurance surveyor had properly assessed the loss inclusive of the properties not covered under the policy.  But he had subsequently noted the items covered under the policy and reached a finding that the insured had suffered a loss of Rs. 4,00,000/- with respect to the building which was covered under the policy.  The report prepared by the licensed insurance surveyor is a relevant document in assessing the loss suffered by the insured.  We find no mistake in the assessment done by the insurance surveyor with respect to the valuation.  Since the opposite parties had acted strictly in accordance with the stipulations contained in the policy, no deficiency in service could be established.  Since the complainant has failed to prove any deficiency in service or unfair trade practice, the complaint is only to be dismissed.  The points are found accordingly.

In the result, the complaint is dismissed.  On a consideration of the facts and circumstances of the case, the parties shall bear their respective costs. 

AJITH KUMAR  D. : JUDICIAL MEMBER

                                                                        RADHAKRISHNAN K.R.  : MEMBER

jb

APPENDIX

I.       COMPLAINANT’S WITNESS:

          PW1  - Dr. Sajesh Asokan

II.      COMPLAINANT’S DOCUMENTS:

A1     - Copy of the policy document

A2     - Copy of the survey report

A3     - Copy of e-mail sent by the insurance surveyor

A4     - Copy of lawyer notice and its postal receipt

A5     - Copy of acknowledgement card

A6     - Copy of reply letter dated 03.12.2018 sent by opposite party to complainant .

III.     OPPOSITE PARTY’S WITNESS:

NIL

IV.     OPPOSITE PARTY’S DOCUMENTS:

B1     - Copy of enrolment/Declaration form

B2     - Copy of covering letter along with policy certificate

B3     - Copy of terms and conditions of the policy

B4     - Copy of final survey report

B5     - General Rules and Regulations issued by the Tariff Advisory      Committee

B6     - Copy of the letter issued by the opposite parties dated 23.01.2019.

AJITH KUMAR  D. : JUDICIAL MEMBER

jb                                                                     RADHAKRISHNAN K.R.  : MEMBER