PRESENT

                   Complainant by Adv.Shri.Ganesh Shirke  present.  

                   Opponent-  Ex-parte.                  

ORDER

(Per- Mr. S. D. MADAKE, Hon’ble President.

1. The complainant has taken a fidelity guarantee insurance policy from opponent i. e. National Insurance co. Ltd. Vide policy No.261601/46/12/78000 00043 for a period from 28.092012 to 27.09.2013.
2. The complainant paid premium Rs. 2,06,476 /- ( Two lacs  six thousand four hundred seventy six ) and total paid up capital under the policy was up rupees 15 crores. The risk covered is fidelity covered is fidelity cover on floater basis for 700 named employees covered handing cash at offices and 11719named employee covered handling cash at CSP centre in India. 
3. The complainant submits that, one of their staff Mr. Ajay Dube was posted in Tahsil Dhangata, sant kabir Nagar in state of U. P. The requisite training was given to all mployees regarding handling of cash.
4. Mr. Dube misappropriated an amount of Rs. 67,43,716/-( Sixty seven lacs forty three thousand seven hundred sixteen ) by practicing fraud upon complainant.  The F.I.R. was lodged against said shri Dube and the company lodged claim with Insurance Company by email on 19.10.2013.
5. The insurance company appointed surveyor who filed report on 16.02.2015. The report shows that prima facie surveyor does not find any breach of policy condition that could affect the admissibility of claim.
6. The insurance company repudiated the claim on 03.12.2015 on the ground that peril/cause of loss not covered in the policy.
7. The official surveyor Nitinkumar agarwal investigated the case. He called for explanation on various points raised by him by letter 15.05.2014. the complainant replied the queries raised by surveyor.
8. The complainant in Para No. 14 stated that fraud played by the employee of complaint is Rs. 67,43,716/- and an amount of Rs. 11,17,781 /- ( Eleven lacs seventeen thousand seven hundred eighty  one )  is recovered causing thus total loss of Rs. 56,15,935/-.( Fifty six lacs fifteen thousand nine hundred thirty five)
9. The complainant submit that opponent is a state within the meaning of Article 12 of Constitution of India and is expected act fairly while dealing with issues in furtherance of public interest.
10.  The rejection of claim by one line cryptic order amounts to deficiency in service coupled with willful negligenced unfair trade practice.  The claim was not decided within reasonable time.
11.  The complainant prayed for direction to opponent Insurance company to pay Rs. 10 lacs with interest along with compensation of Rs. 3,00,000/- ( Three lacs ) and cost of Rs. 50,000/- ( Fifty thousand ).
12.  The forum admitted complaint on 23.08.2016.  The notice was issued to opponent for filing written version.  The sufficient time was granted to file written statement As the opponent failed to file W. S. and appear the matter was proceeded ex – parte by order dated 30.09. 2016.
13.  On 18.11.2016 the complainant filed affidavit of evidence on record and 18.01.2017 filed written argument. We have heard Ld. Advocate for complainant.
14.  The complainant filed on record fidelity Guarantee Insurance policy, copy of complaint with police dated 11.10.2013, intimation dated 19.10.2013, survey report dated 16.02.2015, repudiation letter dated 03.12.2015 and the letters exchanged between Insurer and Insured.
15. The policy shows that sum insured per person is Rs. 10,00,000/-( Ten lacs ) The misappropriation is made during insurance period to the tune of Rs. 67 lacs. The record show that Mr. dube is an employee of complainant.
16.  The record shows that alleged fraud was committed during the month of June-July 2013 i.e. during  Insurance period.  Admittedly F. I. R. was registered on 11.10.2013.
17.  The documents show that complainant failed to file F. I. R. within reasonable time. The complainant is not justified to state that, they approached police station many times for filing F. I. R.  The company was expected to approach superior officers of police for informing about the commission of offence.
18.  The record shows that mr. Dube has misappropriated the amount of complainant and case is pending for final disposal before appropriate court. Admittedly some amount is recovered however the complainant sustained loss as on today more than 56 lacs.
19.   The Insurance company failed to prove that there is a breach of condition of condition of policy by filing evidence. The surveyor has observed that loss is caused due to misappropriation of amount by an employee.
20.  The investigation and trial is still not concluded. The complainant is entitle to claim  Rs. 10,00,000/- as per contract of insurance.
21.  The complainant shall execute indemnity bond stating that if the amount is recovered in future as per order of court or otherwise amount shall be refunded to Insurance company.
22. The complainant is entitle to receive amount on the basis of non standard claim as there is delay in filing complaint.  In view of this we award 75 % amount.
23. The complainant is entitle for compensation for mental agony to the amount of Rs. 25000/- and cost Rs. 10,000/-
24.  In the result, pass the following order.  

                                    ORDER

1.                Consumer Complaint No. 76/2016  is party allowed.

2.                The national Insurance co. Ltd is directed to pay to compensation  Rs. 7,50,000/- (Seven lacs fifty thousand ) with interest at

                   6% p. a.  from the date of rejection of  claim till realization of amount.

3.                The opponent is directed to pay Rs. 25,000/- ( Twenty five thousand)  as compensation for mental agony and

                    Rs. 10,000/-( Ten thousand)  as cost to compensation.

4.                The complainant shall execute indemnity bond undertaking to refund  amount if the company receives amount as per order of

                    court.                     

5.                Copy of this order be sent to both parties.