Punjab

Ludhiana

CC/14/799

Kunal Sofat - Complainant(s)

Versus

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

Compl.in person

10 Jun 2015

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, LUDHIANA.

 

                                                                    Complaint No: 799 of 25.11.2014

                                                                   Date of Decision: 10.06.2015

                    

Kunal Sofat s/o Sh.Sat Pal Sofat, r/o 57, Friends Colony, Pakhowal Road, Village Daad, Ludhiana.

.…Complainant

Versus 

1. National Insurance Company Limited, SCO-38, 2^nd Floor, Feroze Gandhi Market, Ludhiana, through its Branch Manager.

2. Surveyor, J.S.Khurana & Associates, SCO 5, Gurudwara Singh Sabha Market, near Kochar Market, Model Gram, Ludhiana.

…..Opposite parties

 

COMPLAINT UNDER SECTION 12 OF THE

CONSUMER PROTECTION ACT, 1986.

 

Quorum:    Sh.R.L.Ahuja, President

                    Sh.Sat Paul Garg, Member

 

Present:     Sh.Kunal Sofat complainant in person.

                   Sh.D.R.Rampal, Advocate for OP1.                 

                   OP2 exparte.

 

 

ORDER

 

 (SAT PAUL GARG, MEMBER)

1.               Present complaint under Section 12 of The Consumer Protection Act, 1986 (herein-after in short to be referred as ‘Act’) has been filed by Sh.Kunal Sofat s/o Sh.Sat Pal Sofat, r/o 57, Friends Colony, Pakhowal Road, Village Daad, Ludhiana (herein-after in short to be referred as ‘complainant’) against National Insurance Company Limited, SCO-38, 2^nd Floor, Feroze Gandhi Market, Ludhiana, through its Branch Manager and others (herein-after in short to be referred as ‘OP’)- directing them to pay the claim amount of Rs.29,850/- plus 25% Hike of rates and to pay Rs.1,60,000/- as compensation to the complainant.

2.                Brief facts of the complaint are that the complainant purchased a comprehensive Household Insurance policy from OP1 that covers all the losses to the articles including the losses house from inside. On 18.9.13, complainant intimated the OP1 on his mobile phone as well as through e-mail that due to breakdown/leakage of underground pipe of the bathroom some parts of the floor of the house of the complainant go down from its actual position, which needs to be repaired. On the asking of the OP1, the complainant also sent the estimate of Rs.29,850/- to branch Manager by hand. Then the OP1 deputed Surveyor Mr.J.S.Khurana to access the loss. On 25.9.13 the surveyor visited first time at his resident to access the loss of the floor and also taken the required photographs of loss and asked the complainant to dismantle all the front inside portion of floor. Thereafter due to some busy schedule, complainant fails to start the repair work of the said floor, then the surveyor sent two notices to the complainant dated 9.11.13 and 3.12.13, in which he asked the complainant to submit the papers required to update the claim file and also asked the complainant to start the repair works after dismantle the whole of front side floor. Thereafter, the complainant had dismantle whole of the floor of the front side of his residence and on 16.12.13 informed the surveyor regarding the same and surveyor visit the same day at loss spot and taken the required photographs of broken pipe. Thereafter complainant received a letter dated 19.12.14 from the surveyor in which he had stated that the loss of claim is not payable, as the underground leakage loss is not payable under claim in any circumstances. Complainant visited so many times at branch office to settle the claim matter, but with no effect. Thereafter, complainant received a letter from the Insurance Company dated 2.5.14, in which the company closed the file as ‘No Claim’. Claiming the above act as deficiency in service on the part of the Ops, the complainant has filed this complaint.

3.                On notice of the complaint, OP1 appeared through his counsel and filed written statement taking preliminary objections that complaint is not maintainable in the present form; the complaint 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 has suppressed the material facts; the complainant is stopped by his act and conduct from filing this complaint and demanding any compensation; Intricate question of law and facts are involved in this case and this case cannot be summarily decided by this Forum and facts of the case require elaborate evidence. On merits, denying the contents of all other paras of the complaint submitted that the complainant gave intimation dated 18.9.13 with regard to alleged damages and J.S.Khurana and Associates were deputed as surveyor to survey and assess the said loss. The said surveyor visited the premises of the complainant to survey the damages and to assess the loss caused to the floor of the building. The surveyor issued letter dated 9.11.13 to the complainant calling upon him to complete the required documents as mentioned in letter dated 9.11.13 and thereafter reminder dated 3.12.13 was again issued to the complainant to complete the required documents which were demanded vide letter dated 9.11.13 and 3.12.13 and surveyor received on call from the complainant on 17.12.13 to inspect the floor during repair. The surveyor visited the premises of the complainant on 17.12.13. The surveyor at the time of visiting the premises of the complainant took the photographs. The Surveyor also issued one letter dated 19.12.13 to the complainant that loss has been discussed with him and on going through the nature of the loss the alleged loss caused to the flooring is not maintainable under the terms and conditions of the insurance policy. The said surveyor also submitted survey report dated 19.12.13 to OP1 stating that on going through the detailed inspection it is found that floor of the insured premises got damaged due to leakage of the water from the joint of the water pipeline which is due to general wear and tear and he further stated that he also discussed the nature of the loss with the insured and loss caused to the flooring is not maintainable under the terms and conditions of the policy and file be treated as no claim. On receipt of said survey report dated 19.12.13 issued the surveyor the competent authority of OP1 has also minutely scrutinized the claim of the complainant and found that same is not payable one and alleged cause of loss is not covered under the policy and leakage of the water from the joint of water pipeline is not covered under the policy and same is due to general wear and tear and repudiation/no claim letter dated 29.01.14 was duly posted to the complainant. The complainant issued one e-mail dated 2.5.14 to the OP1 and in response to said e-mail the OP1 again issued one letter dated 2.5.14 to the complainant and informed him that his claim has been treated as No claim and No claim/repudiation letter dated 29.1.14 has already been sent to him. As such, there is no deficiency in service on the part of OP1.

4.                On notice of the complaint, OP2 had come present in person and filed his written reply, wherein submitted that as per instructions from the Branch Manager, National Insurance Co. Ltd. on dated 24.9.13, he visited the premises of the insured in order to inspect the loss caused to the floor of the corridor of the insured’s house. After detailed inspection, he asked the insured to fulfill the requirement and reminded the insured through letters dated 9.11.13  & 3.12.13 (Speed Post), which is mandatory for getting the claim. The requirements are given as under:-

a)        Claim form duly filled and signed (Not submitted by the insured)

b)        Cancelled Cheque of the bank account (Not submitted by the insured)

c)         Detailed Estimate of Loss (Not submitted by the insured)

d)        Copy of Building Plan (Not submitted by the insured)

e)         Copy of insurance Policy (Not submitted by the insured)

f)         Weather Report/Newspaper cutting (Asked for this because initially insured told that loss occurred due to flood/inundation) (Not submitted by the insured)

g)        2 Nos. Neighbor’s statement regarding the confirmation of loss (Not submitted by the insured)

h)        History of occurrence of Loss (Not submitted by the insured)

i)         Kindly show us the floor during dismantling condition. (Shown by the insured as per his convenience as he has to get the floor repaired in any condition either claim is payable or not).

                   Further submitted that he visited at the premises of the insured during dismantling of the floor on dated 17.12.13 after receiving a call from the insured and on going through detailed inspection, it was found that loss caused to the floor due to leakage of join (Faulty fitting) is not maintainable. In this case, if the loss has occurred to flooring due to bursting of street mains of overflowing of the sewerage pipers, then it was maintainable.

5.                It is pertinent to mention here that at the stage of evidence of OPs none had come present on behalf of OP2. As such, OP2 was proceeded exparte, vide order dated 5.6.15.

6.                Complainant has adduced the evidence by way of his duly sworn affidavit Ex.CA, wherein, the same facts have been reiterated as narrated in the complaint and also attached documents Ex.C1 to Ex.C5. On the other hand, Ld. counsel for OP1 has adduced the evidence by way of duly sworn affidavit of Sh.Kamaljit Singh, Deputy Manager, National Insurance Co. Ltd. DO-IV, Kesar Ganj Chowk, Ludhiana Ex.RA, wherein, the same facts have been reiterated as narrated in the complaint and attached duly sworn affidavit of Sh.J.S.Khurana, M/s J.S.Khurana Associates, SCO 5, Gurudwara Singh Sabha Market, Near Kochar Market, Model Gram, Ludhiana Ex.RB also attached documents Ex.R1 to Ex.R27.

7.                Complainant argued that the policy issued by the Ops clearly mentions the following items for which the complainant will be liable to indemnify the insured in respect of loss or other damages to the Contents/Building whilst contained in the insured premises by under the Heading Section I Building and Contents:-

a)         Fire, Lightning, Explosion of as in domestic appliance

b)         Bursting and overflowing of water tanks, apparatus or pipes

c)         Aircraft or articles dropped there from

d)         Riot, Strike or Malicious Act

e)         Earthquake Fire and/or Shock, Subsidence and Landslide (including Rockslide) damage.

f)         Flood, Inundation, Storm, Tempest, Typhoon, Hurricane, Tornado or Cyclone.

g)         Impect damage

 

                   Meaning thereby that the damage caused to the building to the complainant is very much covered under the abovesaid condition no.(b).

8.                Refuting the allegations leveled by the complainant, Ld. counsel for OP1 argued that floor of the insured premises got damaged due to leakage of the water from the joint of the water pipeline which is due to general wear and tear and the nature of the loss with the insured and loss caused to the flooring is not maintainable under the terms and conditions of the policy as mentioned in Section VIII Baggage, under sub head Special Exceptions at point (K) of the policy, which is as follows:

k)        loss destruction or damage caused by or arising from the leakage spilling of exploding of liquid Oils or materials of a like nature of articles of a dangerous or damaging natures.

 

 9.               We have gone through the pleadings of the complainant as well as defence taken by OP1 and also perused the entire record placed on file.

10.              It is evident that the delay of filing of the documents was undue on the part of the complainant himself and he is habitual of this act. Ex.C1 to Ex.C3 clearly depicts that the delay on his part. Ex.C4 shows that the loss occurred due to breakage of underground bathroom pipe of his house, which is not covered under the policy condition (k) under Section VII Baggage sub head Special Exceptions. The claim was not settled as per clause special exception ‘K’ of the policy while it is for spilling or liquid of dangerous in nature. It is evident that complainant has got his house hold goods insured from the OPs and from Ex.R26 it is apparently clear that Section- I Building and Contents that the complainant will individual insured in respect of following:-

a)         Fire, Lightning, Explosion of as in domestic appliance

b)         Bursting and overflowing of water tanks, apparatus or pipes

c)         Aircraft or articles dropped there from

d)         Riot, Strike or Malicious Act

e)         Earthquake Fire and/or Shock, Subsidence and Landslide (including Rockslide) damage.

f)         Flood, Inundation, Storm, Tempest, Typhoon, Hurricane, Tornado or Cyclone.

g)         Impect damage

 

                   But the Special Exception clause ‘K’ is not applicable to the present case for the leakage spilling or exploding for liquid oils or materials of a like nature or articles of a dangerous or damaging nature. Further maintainability of the claim is not within the purview of the surveyor.

11.              In view of the above discussion, the present complaint is allowed and OPs are directed to settle and pay the claim of the complainant as assessed, which would be allowable to the complainant. Further OPs are directed to pay Rs.4000/-(Four thousand only) as compensation and litigation expenses compositely assessed to the complainant. Order be complied within 30 days of receipt of the copy of the order, which be made available to the parties, free of costs. File be consigned to record room.

 

                             (S.P.Garg)                               (R.L.Ahuja)

                               Member                                   President

Announced in Open Forum.

Dated:10.06.2015 

Hardeep Singh