Per Mr. Atul D. Alsi, Hon’ble President

1. The complainant filed present complaint against non disbursement of Insurance claim under Fire and special policy for the claim of Rs.9,78,386/- alongwith interest of 18% and thereby claiming compensation of  Rs.2,00,000/- along with cost of litigation of Rs.20,000/-.

The story in short.

2. The complainant and his family members Pushpadevi, Ritadevi, Mr. Ghanshyam and Satnayua are jointly were employed themselves as a self employment for earning their livelihood under firm M/s Santoshi Industries  and insured under Fire and Special policy bearing no.271108/2001/3100728 on dated 25.1.2002.  The complainant firm has suffered loss and damages of Rs.9,78,386/- due to heavy rain on 24.8.2002 and the entire raw material and finish material including machineries caused damages. The nature of complainant work is to purchase DRS coal , slack coal and hard coal dust from Western Coal Field and also from open market and use to stock in their premises. The slack coal and hard coal dust grand with the help of grinder machine and get converted in to coal powder. The mixture is put into machine and it became finish material as brikets.  After drying the brikets it was packed into polythin bags of average 20 kg. and sold in loose form. The complainant firm has obtained loan for the process of brikets from OP.No.4  Shikshak Sahakari Bank to purchase raw material of coal. 
3. On 24.8.2002 there were heavy rain and entire raw material and finish material was damaged. The intimation of incident was given to insurance company OP.No.3. The O.P. appointed surveyor Mr.D.K. Khedkar who inspected the spot and access the loss.  On 12.2.2003 the OP.No.1 has surprisingly and illegally repudiated the insurance claim for the breach of policy condition No.6(i)(b) and further forfeited under condition no.8. The OP.No.1 to 3.  has repudiated the insurance claim illegally which is Unfair Trade Practice and therefore liable to compensate damages arising out of insurance claim as per prayed in complaint.
4. The O.P.No.1 to 3 filed reply and denied allegation against them and submitted that the complainant are not consumer. The complainant industry has carrying the manufacturing of coal with several machines on large scale to earn profit having turnover of more than one core and registered under Factory Act.1948., therefore this Commission has no jurisdiction to adjudicate the matter.  The fact and circumstances required oral evidence hence it is not possible through summery proceeding to decide the matter.  The complainant has not submitted the requisite documents for scrutiny of claim and when demanded by OP.No.1 to 3.  Complainant failed to comply the formalities and submission of documents therefore the present case is not maintainable. The complainant failed to submit requisite document to the surveyor for proper scrutiny and assessment of claim. During the investigation it was observed that the accumulation of water level was 1 to 1.5 and not 4 to 5 as claimed by complainant. The teen sheet of shade at compound wall was found intake, the bricks wall of compound wall was not damaged, and the coal dust stored in factory and one lot found outside were intake.  The complainant failed to supply L.R. copy octroi receipt, account books, original bills for verification. No loss has been cause to the machinery.  The estimated damaged to the tune of Rs.48,982/- is true and correct.  The entire claim preferred by complainant is found to be false and fabricated and the O.P. rightly repudiated the claim for exorbitant amount after due verification.  Therefore there is no deficiency on the part of OP. As per investigation report of surveyors the water did not enter in to the premises from any side and sheet compound wall were intake, there were no signs of water following to factory premises and there is no possibility of washing out stock.  The drainage pipe line was also not chocked, therefore considering the factory position the investigator the claim of Rs. 978386/- execrated hypothecated and imaginary.  The complainant business is in loss since prior to incidents and therefore the complainant failed to pay the dues to the OP.No.4-Bank., therefore complainant filed false complaint case. Moreover the complainant fail to produce proof of loss to substantial the case, therefore repudiation of claim was rightly repudiated vide letter date 12.2.2003 and complainant is entitled to receive the amount of Rs.48,982/- as accessed by the Surveyor, therefore the present complaint has no merit and deserve to be dismiss with cost.
5. The O.P.No.4 financed loan of Rs.5,50.000/- and Rs.11,00,000/- by executing loan agreement and therefore liable for repay with interest and complainant is defaulter in repayment of loan amount .  The O.P.-Bank has no role in adjudication of insured claim. Hence case is deserves to be dismissed against O.P.No.4
6. The counsel for complainant argued that due to heavy rain on 24.8.2002 the complaint has filed the present insurance claim which has been wrongly assessed by  OP.No.1 to 3 while adjudicating the insurance claim filed under Fire and Special Insurance policy for the period between 24.1.2002  to 23.1.2003 for the sum assured of Rs.15,00,000/-. The complainant has intimated for loss cause to the insurance company and submitted all requisite documents to the insurance Surveyors. The complainant has filed copy of newspaper published at page no. 20 to 22. The complainant has submitted the detail of coal dust purchased from the parties along with bill no. with amount on page no. 47 and 48.  The complainant filed spot panchanama dated 24.8.2002 prepared by Tahsildar at page no. 48 and 50. The OP. No.1 to 3 has arbitrarily rejected the insurance claim is true and correct insurance amount of Rs.9,86,200/- without considering the spot inspection report of Tahsildar and stock of bill at relevant period of time. Therefore the rejection of insurance claim does amount deficiency of service.
7. Counsel for OP.No.1,2,3, argued that the business of complainant firm is commercial activity therefore it is beyond jurisdiction of this commission. The complainant failed to submit license to purchase coal and bill of octori for the purchase of coal which were damaged. The complainant fails to submit audited balance sheet or proof of purchase of raw material at relevant period of time against cash payment. The accumulation of water is 1.5 inch, the boundary walls and roof were intake, the complainant fail to submit requisite document to surveyor and the survey after inspection of spot and records available estimated loss of Rs.48,982/- which is just and reasonable and therefore execrated insurance claim for the damages of Rs.9,78,386/- has been repudiated, therefore the act does not amount to deficiency of service and the complaint is deserve to be dismissed with cost.
8. The counsel for O.P.NO.4 argued that the O.P.NO.4 –Bank has no role in adjudication of insurance claim, hence no order shall be passed against  O.P.No.4 .

                                                      Reasoning

9. The OP. has failed to file the proof of the person employed in the premises of complainant firm and the complainant has other business or source of income so as to prove its contention. that the complainant is not consumer and doing business for commercial purposes. The complaint has file insurance claim for the damages for the loss of raw material and machinery due to heavy rain occurred on 24.8.2002 for the insurance covered under the policy for the sum assured of Rs. 15,00,000/- lac. As per spot inspection report of Tahsildar there were heavy rains and due to accumulation of water the raw materials and machinery were badly damaged.  The Tahsildar inspected the spot on 23.8.2002 at 11.00 pm.  As per report of Indian Metrological Department of Government of India dated 12.9.2009 located at Nagpur Airport furnished that on 23.8.2002 the rain started from 19.20 hours of 22.8.2002 to 2.20 hours IST. of 23.8.2002. along with thunder storm with wind speed of 36km per hour and total rainfall recorded during 24 hours was 11.3 mm on 23.8.2002 and 119.8 mm on 24.8.2002.  Therefore the estimated loss calculated by investigator  Mr. D.K. Khedkar for O.P. insurance company without considering the bills of purchases of raw materials filed on record and therefore the complainant is entitle for the insurance claim of  75%  of estimated loss of Rs.9,78,386/- that is Rs. 7,33,789/- from O.P.No.1 to 3 on non standard basis of policy.  O.P.No.4 has no role in awarding insurance claim hence no order is passed against O.P.No.4.

                                                      O R D E R

1. Complaint is partly allowed.
2. O.P.No.1 to 3 are directed to pay complainant the  Insurance claim of  75%  of estimated loss of Rs.9,78,386/-  amounted to Rs.7,33,789/- on non standard basis of policy without awarding any cost and interest thereon. 
3. No order is passed against O.P.No.4.
4. Copy of order be furnished to both parties, free of cost.