Order dictated by:

Sh.S.S. Panesar, President.

1        Mrs.Kiran Bansal has brought the instant complaint  u/s 12  of the Consumer Protection Act on the allegations that complainant is taking insurance policy for his household risks coverage from the opposite party since last many years and lastly he took the Insurance policy having Policy No. 401900/48/13/3600003548 covering the risk period from 31.3.2014 to 30.3.2015. Copy of the cover note is annexed. The said Insurance coverage in the said policy included the risk coverage to the tune of Rs. 3 lacs for the loss of jewellery & valuables.  The complainant alongwith her husband was travelling from Hazrat Nizamudin Railway Station to Lalitpur . Unfortunately at the midnight on 4.10.2014 theft occurred in the running train near Mathura and the purse of the complainant was snatched . The jewellery and valuable articles like her jewellery watch make CARTIER, mobile phones and other articles were stolen. The complainant immediately lodged report with the Railway police and an FIR was registered with the Police Station, Mathura.  Opposite party appointed its surveyor/Investigator to assess the loss  and provided all the details as demanded from time to time. It is pertinent to mention over here that the valuables and jewellery loss was though for more than Rs. 3 lacs as the risk coverage was for Rs. 3 lacs the claim of Rs. 3 lacs was made with the opposite party.  Opposite party vide their letter dated 1.6.2015 repudiated the genuine claim of the complainant on frivolous grounds . The complainant replied to the said repudiation letter vide its own letter dated 9.6.2015 clarifying all the points of repudiation and requested for reconsideration of their repudiation of genuine claim of the complainant, but the opposite party vide their letter dated 12.6.2015 rejected the representation of the complainant. The complainant made several visits to the opposite party to  settle the genuine claim, but to no effect. The complainant has sought for the following reliefs vide instant complaint:-

(a)       Opposite party be directed to pay the claim of Rs. 3 lacs alongwith interest @ 12% p.a. from 4.10.2014 till realization.

(b)       Opposite party be directed to pay compensation to the tune of Rs. 5,00,000/- alongwith adequate litigation expenses.

Hence, this complaint.

2.         Upon notice, opposite party appeared and contested the complaint by filing written statement taking certain preliminary objections therein inter-alia that in the present case, the claim has already been repudiated by the opposite party on merits. In this regard it is submitted that on receipt of intimation regarding alleged occurrence under the House Hold Insurance Policy, the opposite party deputed independent Investigating Agency M/s. S.A. Investigating & Consulting Agency  which carried out detailed investigation and came to the conclusion  that there were so many discrepancies  and as such it was recommended that the insurer may proceed for settlement of the claim file purely on merits and findings of the investigation. Under these circumstances the claim was considered by the competent  authority as per findings of the investigation  as well as in the light of terms and conditions and exclusions of the policy in question . Pre-repudiation letter dated 1.6.2015 was written to the complainant  informing the following discrepancies in the claim:-

1. That incidence has been occurred on the night of 3.10.2014 in the train ; whereas FIR No. 161/2014 was registered on 26.11.2014 at GRP Mathura Police Station.
2. In the FIR at the time of lodging complaint, the detail of articles stolen was not mentioned.
3. The belongings after stolen must be in your knowledge and what has been stolen it  should have been declared in the complaint lodged.
4. The police final investigation report u/s 173 Cr.P.C. is awaited from your end. This report is mandatory document to be duly approved by the competent authority .
5. It has been pointed out by the investigator that the person who is travelling in the train would wear the jewellery and not to keep in the purse and that too when it is so expensive.
6. The Insurance policy does not show coverage of the article being claimed to have been stolen. Only one article cannot be insured under sec.III of the policy ; whereas , it is clearly mentioned (hand-written) jewellery and valuables and total sum insured granted is Rs. 3,00,000/- but the list is missing. If one article was insured, then there was no reason to write jewellery and other valuables. Simply diamond ring could have been mentioned on the cover note to specify the same. Your policy is continuous insurance from 2006 with sum insured of Rs. 3,00,000/- in 2006, Rs.2.80 lacs in 2007 and thereafter Rs. 3 lacs constant upto date. The current policy in which loss occurred without any detail of articles inspite of huge variation in prices of gold and jewellery
7. You have not been able to establish the age and value of the article allegedly stolen.
8. The Insurance Policy (house hold), terms and conditions which read as under:-

“That no one article or pair of article is deemed to be more than 10% insured under this section unless separately specified and valued.”

9. Wealth tax report confirms that the value of the ring  is declared as Rs. 3,09,701/- as on 31.3.2011 meaning thereby that the value of diamond ring is more than sum insured. So how this can be insured for lower value meaning thereby that the diamond ring is not the insured article.
10. Since this is an  audited wealth return, there is no occasion of not having the purchase bill of the article (as declared by the insured in the e-mail). The document would have been handy to ascertain the age of diamond ring being claimed to have been stolen).
11. That you are the owner of the diamond jewellery for an amount of Rs. 17,95,431/- as on 31.3.2011.
12. The diamond ring in question is appearing at Sr.No. 9 of this wealth tax return (list of articles).
13. You have gone for a partial insurance (as declared i.e . only one article) which is not possible because the person would be using the jewellery in rotation and this leave no reason for insuring only one article.
14. The value of article insured under the policy is different to the actual sum insured.

Keeping in view the investigation report and other facts mentioned above, we are of the opinion that the claim is not maintainable  and it should be repudiated.”

3.               That the insured tried to satisfy the opposite party by sending reply dated 9.6.2015 and the same was again reconsidered  and final repudiation letter dated 12.6.2015 informed the insured repudiating his claim; that the complainant herself admitted receipt of pre-repudiation letter dated 1.6.2015, reply sent by her on 9.6.2015 and final decision of the opposite party dated 12.6.2015 ; that in the light of repudiation already made on the part of the opposite party, there is no question of deficiency in service.  On merits facts narrated in the complaint have been specifically denied and a prayer for dismissal of the complaint has been made.

4.               In her bid to prove the case Sh.Deepinder  Singh,Adv.counsel for the complainant tendered into evidence affidavit of the complainant Ex.C-1, copy of cover note Ex.C-2, letters Ex.C-3 to Ex.C-6, copy of FIR Ex.C-7, claim form Ex.C-8 and closed the evidence on behalf of the complainant.

5.               To rebut the aforesaid evidence Sh.P.N.Khanna,Adv.counsel for the opposite party tendered into evidence affidavit of Sh.R.L.Mehta ,Div.Manager Ex.OP1, affidavit of Sh.Sarv Daman Bhatia of M/s.S.A. Investigating and Consulting Agency Ex.OP2 alongwith documents Ex.OP3 to  Ex.OP7 and closed the evidence on behalf of the opposite party.

6.               We have heard  the ld.counsel for the parties and have carefully gone through the record on the file as well as written synopsis of arguments submitted on behalf of the opposite party.

7.               On the basis of the evidence on record, ld.counsel for the complainant has vehemently contended that it is not disputed that  complainant is holder of Household Risks Coverage from the opposite party bearing policy No. 401900/48/13/3600003548 covering risk period w.e.f. 31.3.2014 to 30.3.2015 including risk coverage to the tune of Rs. 3 lacs for the loss of jewellery and valuables. Copy of the Insurance policy is Ex.C-2. The complainant alongwith her husband was travelling from Hazrat Nizamudin Railway Station to Lalitpur and unfortunately  during midnight as on 4.10.2014 theft occurred in the running train near Mathura and purse of the complainant was snatched containing jewellery, watch mobile phones and other articles. The complainant lodged complaint with Railway police and also opposite party was duly informed at the earliest. Ultimately on the said complaint  FIR was registered  at P.S. Mathura,  copy whereof is Ex.C-7 on record. Opposite party appointed its surveyor and investigator to assess the loss  and he was provided all the details as demanded from time to time and all the documentation and assistance was provided. Although the loss occasioned by the complainant in the snatching incident was more than Rs. 3 lacs , yet the complainant was entitled to receive Rs. 3 lacs in view of the prescribed coverage of the Insurance policy in dispute. However, claim of the complainant was repudiated by the opposite party vide its letter dated 1.6.2015, copy whereof is Ex.OP5. The complainant issued letter dated 9.6.2015 clarifying all the  points of repudiation  for reconsideration of the repudiation of the genuine claim of the complainant, copy of the same is Ex.C-4. But however, opposite party vide their letter dated 12.6.2015 rejected the representation of the complainant, copy whereof is Ex.OP6. It is the case of the complainant that opposite party has repudiated the genuine claim of the complainant which amounts to deficiency in service , unfair trade practice, mal practice and is not sustainable in the eyes of law  and it is contended that complaint filed by the complainant may be allowed and the opposite party may also be directed to pay compensation as well as litigation expenses to be assessed by this  Forum.

8.               But, however on the other hand ld.counsel for the opposite party has vehemently contended that claim of the complainant has rightly been repudiated by the opposite party . The Insurance claim pertained to jewellery and other house hold articles. But, however, the item(s) of jewellery  and other house hold articles were not separately valued nor any insurance coverage was provided for each of the articles separately. In such a situation, the claim of the complainant has rightly been repudiated. The complainant was issued a query vide letter dated 1.6.2015  a period of 15 days was granted to the complainant to seek her comments with respect to pre-repudiation, if so  desired by her. The queries are reproduced hereinbelow:-

1. That incidence has been occurred on the night of 3.10.2014 in the train ; whereas FIR No. 161/2014 was registered on 26.11.2014 at GRP Mathura Police Station.
2. In the FIR at the time of lodging complaint, the detail of articles stolen was not mentioned.
3. The belongings after stolen must be in your knowledge and what has been stolen it  should have been declared in the complaint lodged.
4. The police final investigation report u/s 173 Cr.P.C. is awaited from your end. This report is mandatory document to be duly approved by the competent authority .
5. It has been pointed out by the investigator that the person who is travelling in the train would wear the jewellery and not to keep in the purse and that too when it is so expensive.
6. The Insurance policy does not show coverage of the article being claimed to have been stolen. Only one article cannot be insured under sec.III of the policy ; whereas , it is clearly mentioned (hand-written) jewellery and valuables and total sum insured granted is Rs. 3,00,000/- but the list is missing. If one article was insured, then there was no reason to write jewellery and other valuables. Simply diamond ring could have been mentioned on the cover note to specify the same. Your policy is continuous insurance from 2006 with sum insured of Rs. 3,00,000/- in 2006, Rs.2.80 lacs in 2007 and thereafter Rs. 3 lacs constant upto date. The current policy in which loss occurred without any detail of articles inspite of huge variation in prices of gold and jewellery
7. You have not been able to establish the age and value of the article allegedly stolen.
8. The Insurance Policy (house hold), terms and conditions which read as under:-

“That no one article or pair of article is deemed to be more than 10% insured under this section unless separately specified and valued.”

9. Wealth tax report confirms that the value of the ring  is declared as Rs. 3,09,701/- as on 31.3.2011 meaning thereby that the value of diamond ring is more than sum insured. So how this can be insured for lower value meaning thereby that the diamond ring is not the insured article.
10. Since this is an  audited wealth return, there is no occasion of not having the purchase bill of the article (as declared by the insured in the e-mail). The document would have been handy to ascertain the age of diamond ring being claimed to have been stolen).
11. That you are the owner of the diamond jewellery for an amount of Rs. 17,95,431/- as on 31.3.2011.
12. The diamond ring in question is appearing at Sr.No. 9 of this wealth tax return (list of articles).
13. You have gone for a partial insurance (as declared i.e . only one article) which is not possible because the person would be using the jewellery in rotation and this leave no reason for insuring only one article.
14. The value of article insured under the policy is different to the actual sum insured.

9.         It is further contended on behalf of opposite party that  complainant has failed to make any reply to the queries posed by the opposite party for the reasons best known to her. Even in the comments dated 9.6.2015 submitted by the complaint, nothing has been stated regarding the aforesaid queries stated above. Since the parties are bound by the terms and conditions of the Insurance policy and in this connection the complainant cannot ask for grant of the entire loss  occasioned to her in the snatching incident and it is contended that question raised by the complainant vide instant complaint are intricate questions of law and fact for which detailed investigation is required  besides producing of enormous evidence in the shape of  documents  which is not permissible in proceedings before this Forum because proceedings before this forum are summary in nature and it is contended that appropriate Forum for adjudicating the matter was the Civil Court. The complainant may accordingly be relegated to Civil Court for adjudication in accordance with law.

10.       But however, from the appreciation of the facts and circumstances of the case, it becomes evident that the opposite party has over looked section 3 of the Insurance policy, wherein it has clearly been mentioned  that in case any articles or pair of articles is deemed to be more than 10% insured value has to be separately specified and valued. As in the present case there is no separate specified value of the diamond ring in dispute , therefore stolen ring cannot be deemed to be  more than 10% of the insured sum. Relevant extract of special condition of section III is reproduced as under :-

Section III : Special Conditions: “No one article or pair of article is deemed to be more than 10% insured under this section unless separately specified and valued.”

In such a situation, the value of the diamond ring shall have to be evaluated 10% of the insured value of Rs. 3 lac, which comes to Rs.30,000/- in the instant case. But the opposite party without applying the aforesaid provisions of the contract/insurance policy, have  repudiated the claim of the complainant in its entirety,  which is not sustainable at law.

11.       Consequently , we hold that  complainant is entitled to insurance claim to the tune of Rs. 30,000/- on account of snatching incident in which  burglary regarding jewellery articles of the complainant took place on 4.10.2014 at Mathura in the running train  and we partly allow the complaint accordingly. Since the opposite party is deficient in service, therefore, complainant is also entitled to compensation to the tune of Rs. 3000/-  besides that the  complainant is also entitled to receive Rs. 2000/- as litigation expenses. Compliance of this order be made within a period of 30 days from the date of receipt of copy of this order ; failing which, awarded amount shall carry interest @ 9% p.a. from the date of filing of the complaint until full and final recovery. Copies of the orders be furnished to the parties free of costs. File is ordered to be consigned to the record room.

Announced in Open Forum

Dated : 06.09.2016

/R/