Punjab

Ludhiana

CC/14/622

Chaman Lal Anand Bhushan - Complainant(s)

Versus

National Ins.Co.Ltd - Opp.Party(s)

M.S.Sethi

29 Jan 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

       C.C. No: 622 of 08.09.2014

                                                                      Date of Decision:30.01.2015

1.M/s Chaman Lal Anand Bhushan, Opp Pipal Chowk, Mali Ganj, Partap Bazar, Ludhiana through its Prop.Sandeep Kumar.

2.Anand Bhushan Prop M/s Chaman Lal Anand Bhushan, Opp Pipal Chowk, Mali Ganj, Partap Bazar, Ludhiana.

……Complainants

                                                    Versus          

National Insurance Company Limited, Unit 404500, Kesar Ganj Chowk, Ludhiana-141001 through authorized signatory.

                                                                                       ……...Opposite Party

        Complaint under section 12 of the Consumer Protection Act,1986.

         

Quorum:     Sh.R.L.Ahuja, President.                 

                   Sh.Sat Paul Garg, Member.             

                 

Present:       Sh.M.S.Sethi, Adv. for complainants.

Sh.D.R.Rampal, Adv. for Op.

 

ORDER

R.L.AHUJA, PRESIDENT

 

1.                 Present complaint under Section 12 of the Consumer Protection Act, 1986 (herein-after in short to be described as ‘Act’) has been filed by M/s Chaman Lal Anand Bhushan, Opp Pipal Chowk, Mali Ganj, Partap Bazar, Ludhiana through its Prop.Sandeep Kumar and others(hereinafter in short to be referred as ‘complainants’) against National Insurance Company Limited, Unit 404500, Kesar Ganj Chowk, Ludhiana-141001 through authorized signatory (herein-after in short to be described as ‘Op’)- directing them to set aside the repudiation letter dated 7.9.2012 and surveyor report and to pay/settle the claim of Rs.4,46,648/- as per term and condition of the policy on the basis of the documents already supplied to Ops and surveyor without further delay alongwith interest @18% p.a. from the date of filing of the complaint till realization besides compensation of Rs.25,000/- and Rs.11,000/- as litigation costs to the complainant.

2.                In brief, the case of the complainant is that the complainant no.2 is running its shop for sarees, suits, lehnga including all kinds of clothes etc at the address as mentioned in the headnote of the complaint for earning its self employment and livelihood with the help of three workers. The complainant no.2 with the aim to secure risk of loss from any kind of its stock/material consisting all kind of clothes and building consisting furniture, fixture and fittings, got insured its building and stock of all kind of clothes, suiting, shirting dress material alongwith earthquake(fire and shock) for the period 24.7.2010 to 23.7.2011 against the total sum insured for Rs.1,44,40,000/- and paid the premium of Rs.20,358/- to the OP. The Ops issued the policy of Standard Fire & Special Perils bearing Sr.No.404500/11/10/3100000095 for the period 24.7.2010 to 23.7.2011 consisting two pages only. During the period of insurance, there was heavy rain on the night of 16.6.2011 and rain-water entered the shop of the complainant on the night of 16-17/6/2011 but said facts was acknowledged by the complainant no.2 on the morning of 17.6.2011 when shop was opened by the complainant no.2 and found that due to over flow of rain water from the darasi side comes to the area of the complainant Opp.Pipal Chowk, Mali Ganj, Partap Bazar also entered in the premises of the shop of the complainant, they suffered huge losses of clothes/suiting, shirting, wedding, lehnga and duppatta material lying in the basement/ground floor. Due intimation was given to the OP in time and on the same date, officials of OP and surveyor inspected the premises and the surveyor checked the effected stock kept in the semi basement/basement and with the help of complainant and workers, the stock was segregated and quantumised and thereafter, claims of Rs.4,46,648/- as lodged with the OP through surveyor. Thereafter, the surveyor claimed the long list of certain documents but the complainant failed to provide the long list of document as demanded by the surveyor which also takes time to collect the same from the concern parties etc but taking benefit of such reason, the OP succeeded in repudiating the claim which was never conveyed to the complainant then, the complainant vide its letter dated 8.8.2012 requested the OP to reopen the claim but the OP vide its letter dated 7.9.2012 disclosed that claim has been repudiated as ‘No Claim’ without issuing any show cause notice in this regard till date. Even the repudiation letter dated 7.9.2012 is not served on the complainant till date. Said fact of repudiating the claim was however acknowledged by the complainant thereafter in October 2012 and the complainant made various request to the OP to reconsider the claim but the OP refused to accept the genuine request of the complainant. Hence, this complaint.

3.                Upon notice of the complaint, OP was duly served and appeared through Sh.D.R.Rampal, Advocate and filed the written reply, in which, OP took up certain preliminary objections that complaint is not maintainable in the present form as the same is false and frivolous one; the complaint is bad for non-joinder and mis-joinder of necessary parties; the complainant has not come to this Forum with clean hands and he has suppressed the material facts qua the facts that he has failed to co-operate with the surveyor and has failed to supply the required documents and its claim was treated as ‘No Claim’ and No claim/repudiation letter was issued to the complainant. Complainant again gave the request dated 8.8.2012 regarding reopening of the claim and the said request was reconsidered by the answering OP and the complainant has failed to submit the required documents and due to non-submission of the document, the claim of the complainant was treated as ‘No Claim’ and no claim letter dated 7.9.2012 was duly posted to the complainant absolving the liability of the answering OP. The complaint is also barred by time. The complainant is estopped by its act and conduct from filing the present complaint and demanding any compensation and the intricate question of law and facts are involved in this case and this case cannot be summarily decided by this Hon’ble Forum and the facts of the case require elaborate evidence and only Civil Court is competent to decide the present case after providing due opportunities to the parties to lead their evidence. On merits, it is submitted that the parties are governed by terms and conditions of the insurance policy in question and also to follow the guidelines for settling the claim as per manual of Head office of answering OP. Further, it is submitted that on giving intimation with regard to the alleged loss, the answering OP deputed Er.Jogesh Kumar surveyor to survey and assess the loss. The officials of answering OP also inspected the alleged loss of the complainant. The surveyor deputed in this case issued letter dated 25.8.2011 calling upon the complainant to supply the required documents and complainant was time and again called upon by the surveyor to submit the required document and information to proceed further but the complainant did not respond to those notices and reminders issued by the surveyor and on the failure of the complainant to supply the required documents and information, the claim of the complainant was treated as ‘No Claim’ and No Claim Letter was issued to the complainant. The complainant gave request dated 8.8.2012 for reopening the claim and said request of the complainant was minutely scrutinized by the competent authority of answering OP and facts of the case were also considered and it was found that due to non submission of the required documents and information, the claim of the complainant could not be reopened and same was treated as ‘No Claim’ and no claim letter dated 7.9.2012 was posted to the complainant. However, the answering OP also sought the information from the surveyor vide letter dated 21.8.2012 and requested the surveyor to go through the documents which were supplied by the complainant and on the basis of those documents, surveyor gave one report dated 24.8.2012 and opined that the insured has not supplied the complete record and claim should not be reopened due to reason mentioned in said report dated 24.8.2012 of the surveyor. The answering OP again issued letter dated 12.9.2012 to the surveyor to assess the quantum of loss on the basis of physical inspection for its statistical purpose and surveyor gave his survey report dated 25.9.2012, whereby he assessed the loss of the complainant at Rs.86,617/- less average and excess clause as applicable and that report was purely for the statistical purpose of the answering OP. Due services have been rendered by the answering Op and surveyor Er.Jogesh Kumar and there is no deficiency in service on the part of the answering Op. At the end, denying all other allegations of the complaint, answering OP prayed for the dismissal of the complaint.

4.                In order to prove the case of the complainant, learned counsel for the complainant tendered into evidence affidavit of complainant as Ex.CA1 in which, he has reiterated all the allegations made by him in the complaint and Further, learned counsel for the complainant has proved on record the documents Ex.C1 to Ex.C5.

5.                On the other hand, in order to rebut the case of the complainant, learned counsel for the OP adduced evidence by placing on record affidavit Ex.RA of Sh.Kamaljit Singh, its Deputy Manager, in which, he has reiterated all the contents of written reply filed by OP and refuted the case of the complainant. Further, learned counsel for the Op tendered into evidence affidavit Ex.RB of Er.Jogesh Kumar, who was deputed as surveyor and loss assessor by the Op in order to conduct the survey and assess the loss suffered by the complainant, in which, he has proved his reports dated 24.8.2012 and 12.9.2012, vide which, he had assesses the loss of the complainant at Rs.86,617/- alongwith documents Ex.R1 to Ex.R8. Further, learned counsel for the OP has proved on record documents Ex.R1 to Ex.R12.

6.                We have heard the learned counsel for the parties and have also perused the record on the file very carefully.

7.                Perusal of the record reveals that it is an admitted fact that the complainant no.2 who is the proprietor of M/s Chaman Lal Anand Bhushan, Opp.Pipal Chowk, Mali Ganj, Partap Bazar, Ludhiana, is running the said shop for sarees, suits, lehnga including all kinds of clothes etc., with the help of three workers. Further, it is a proved fact that the complainant had purchased the Special Standard Fire & Special Perils Policy bearing Sr.No.404500/11/10/3100000095 from the OP which was valid for the period from 24.7.2010 to 23.7.2011 against the total sum insured for RS.1,44,40,000/- on payment of premium in order to secure risk of loss from any kind of its stock/material consisting all kind of clothes and building consisting furniture, fixture and fittings, got insured its building and stock of all kind of clothes, suiting, shirting dress material alongwith earthquake(fire and shock). As per the allegations of the complainant that during the period of insurance, there was heavy rain on the night of 16.6.2011 and rain-water had entered the shop of the complainant on the night of 16-17/6/2011 but said facts were acknowledged by the complainant no.2 on the morning of 17.6.2011, when shop was opened by the complainant no.2 and he had found that due to over flow of rain water from the darasi side comes to the area of the complainant Opp.Pipal Chowk, Mali Ganj, Partap Bazar also entered in the premises of the shop of the complainant and they had suffered huge losses of clothes/suiting, shirting, wedding, lehnga and duppatta material lying in the basement/ground floor.

8.                Further, it is an undisputed fact between the parties that due intimation qua the loss was given by the complainant no.2 to the OP and the claim was lodged which was duly registered and processed. However, the same was repudiated by the OP as ‘No Claim’ vide letter dated 7.9.2012 Ex.C2(Ex.R12).

9.                As per the allegations of the complainants that he came to know about the repudiation of the claim as ‘No Claim’ by the Ops only on 7.9.2012 and they made request to the OP to reconsider the claim. However, OP did not reconsider the claim and they got the information under Right to Information Act on 14.5.2014 and thereafter, filed the present complaint.

10.              Perusal of the letter dated 25.8.2011 Ex.R2 reveals that the complainants were called upon by the surveyor Er.Jogesh Kumar to submit the papers/documents/details/information as per the aforesaid letter and as per the report dated 25.9.2012 Ex.R8 of the surveyor and loss assessor Er.Jogesh Kumar that the complainants did not submit the required documents which were necessary for the settlement of the claim, as a result of which, OP had no other option except to treat the claim of the complainants as ‘No Claim’. So, it is apparently clear that claim of the complainants has not been repudiated and the same was only closed as ‘No Claim’ by the OP due to non-production of the documents. 

11.              So, it appears from the evidence of the parties that it will be in the fitness of things that if the present complaint is partly allowed and necessary directions are given to the complainants to submit the requisite documents as demanded by the Op and their surveyor for settling their claim, within 15 days from the date of receipt of the copy of this order and thereafter, necessary directions are given to Op to settle and pay the claim of the complainants as per the terms and conditions of the insurance policy.   

12.              Hence, in view of the above discussion, the present complaint is partly allowed with the directions to the complainants to submit the requisite documents as demanded by the Op and their surveyor within 15 days from the date of receipt of copy of this order, in order to settle their claim and thereafter, Op is directed to settle and pay the claim of the complainants as per the terms and conditions of the insurance policy, if the same is payable, in accordance with law and as per the terms and conditions of the insurance policy, within 45 days from the date of receipt of aforesaid documents from the complainants, failing which, Op shall be liable to pay interest @9% p.a. on the payable amount from the date of lodging of claim till its realization. Further, Op is burdened with Rs.2000/-(Two thousand only) as litigation costs to the complainants. Keeping in view the facts and circumstances of the present case, no order as to compensation is passed. Order qua litigation costs be also complied within 45 days of receipt of copy of the order, which be made available to the parties free of costs. File be completed and consigned to record room.

 

                   (Sat Paul Garg)              (R.L.Ahuja)

                                 Member                     President.  

Announced in Open Forum

Dated:30.01.2015

Gurpreet Sharma.