Per Shri Pradeep G. Kadu, Hon’ble President

Brief Facts of the case :-

1. This is a consumer complaint filed by the abovenamed Complainant u/s 35 of the Consumer Protection Act, 2019 alleging deficiency in service and unfair trade practice against the Opposite Party-Insurance Company (in short ‘Insurance Company). 
2. According to the Complainant, the brief facts of the present complaint are as follows:

1. The Complainant is in a business of selling four wheelers’ car parts, materials and repairing work from the premises having license of part of Gala No.3, 1^st Floor, Behind Hiranandani Hospital, Opp. IIT Main Gate, Powai, Mumbai-400 076.  The Complainant is having a “Standard Fire and Special Peril Policy” from more than five years renewed continuously and have renewed policy bearing Policy No.240800592010000096 for the period from 9^th October, 2020 to 8^th October, 2021.
2. During the period of policy, on 29^th October, 2020, a fire incidence occurred due to electric short circuit in the business premises due to which the Complainant suffered huge losses to his stocks and furniture fixtures, office records, etc.  The Complainant informed the said fire incidence to the Insurance Company.  The Complainant submitted claim form on 7^th October, 2021 along with list of materials damaged in the said fire incidence dated 29^thOctober, 2020 which contain amount of materials and parts damaged amounting to Rs.11,29,421/-.
3. Before this, the Insurance Company on 9^th November, 2020, instructed a Surveyor Company namely Bhakuni Insurance Surveyors & Loss Assessors Pvt.Ltd. (in short ‘the Surveyor’), who on 10^th November, 2020 as per the procedure carried out the initial survey / inspectionand recorded the damages and as well as sequence of events leading to occurrence as represented by the insured’s representative.  The Surveyor had issued Letter of Requirements (in short ‘LOR’) on 12^th November, 2020.
4. According to the Complainant, he submitted the claim form for the losses on 7^th October, 2021 as per the procedure.  However, the Complainant could not file the claim immediately, as Covid lockdown period was going on and Complainant’s husband was affected and suffered from Covid-19 and was admitted in the hospital as also the Complainant herself was also suffering from blood related disease and therefore, her mind was not stable at that time and there was also financial crisis.
5. However, the Insurance Company did not sanction the claim amount and closed the claim of the Complainant which amounts to deficiency in service and unfair trade practice on the part of Insurance Company and therefore, the Complainant filed the present complaint praying the claim of Rs.11,29,421/- alongwith interest for the  damages occurred in the fire incidence.  The Complainant also prayed for compensation for mental agony alongwith litigation charges from the Insurance Company.

3. The complaint was admitted and notice was issued to Insurance Company and in response, the Insurance Company filed their written version.

Contentions of Opposite Party-Insurance Company

4. The Insurance Company in their written version contended as follows :-

1. The Insurance Company denied all the averment and statements made in the complaint.  The Insurance Company contended that the complaint is fabricated, false and frivolous and the claim is made with the intention to make profit out of the insurance policy.
2. The Complainant concealed material facts and brought limited documents before the Commission and hence, not came with clean hands before the Commission.
3. The present complaint is filed by Mr.Vinod Yadav without authority of owner of M/s Sejal Automobiles.
4. The Insurance Company admitted that Mr.Vinod Yadav of M/s Vinod Motors on behalf of M/s Sejal Automobiles sent an e-mail on 30^th October, 2020 at 10.27 p.m. informing about the fire incidence with request for survey.
5. The Surveyor did the survey as per the procedure and informed the Complainant about requirements of document as per LOR.  However, the Complainant  failed to comply the LOR and hence, the Surveyor on 2^nd January, 2021 sent final ‘No Claim Survey Report’ and accordingly, the Insurance Company after issuing Pre-Repudiation Letter to the Complainant closed the claim of the Complainant due to non-compliance of documentary requirement to establish the material facts.
6. The Insurance Company also contended that the cause of fire is claimed as short circuit, however, it is unverified and unsubstantiated, as no police complaint has been lodged or the fire brigade has not been called.
7. The Insurance Company relied upon documents such as correspondence with the Complainant, Surveyor’s report along with LOR and other related documents.

5. Thereafter, the Complainant filed his affidavit of evidence and written arguments in support of his claim.  The Complainant submitted various documents on which he relied such as Leave and License Agreement, GST and IT Registration, ITR, other relevant registrations related to business activity, copies of policy and fire claim form dated 7^th October, 2021 along with various compliances as per LOR of the Surveyor of Insurance Company.
6. The Insurance Company also filed their affidavit of evidence and written arguments and reiterated their defence as contended in their written version against the claim of the Complainant in the present complaint.

Observations of the facts on the documents submitted by both Parties

7. The said policy was issued in the name of Sejal Automobiles i.e, the Complainant herein with the address mentioned therein as Gala No.3, B/H Hiranandani Hosp., Ayappa Mandir Rd., Opp.I.I.T. Main Gate, Powai Dist: Greater Mumbai, Maharashtra-400076.
8. The fire incidence took place on 29^th October, 2020 and the Complainant informed the Insurance Company about the fire incidence on 30^th October, 2020.  The Complainant submitted claim form with estimate of loss at Rs.11,29,421/-.  The cause of fire mentioned was due to short circuit. The date and time of incidence was mentioned as 29^th October, 2020 at 9.30 p.m.
9. The Surveyor M/s Bhakuni Insurance Surveyors and Loss Assessors visited the fire incident site on 1^stNovember, 2020 and recorded the damages as well as sequence of events leading to occurrence of the fire.  Mr.Vinod Jadhav, insured’s representative was present at the site.
10. The Surveyor mentioned that proximate caused due to short circuit resulting in accidental fire which occurred, resulted in damage to the stocks of all kinds of spare parts, accessories, battery and other motor parts.
11. The Surveyor vide e-mail dated 2^nd November, 2020 informed the Complainant that initial fire survey inspection has been carried out at insured’s premises on 1^st November, 2020.  In the said e-mail, the said Surveyor informed the Complainant to submit the initial set of documents for their detail and final inspection and intimate to them.  In the said e-mail, the Surveyor asked to submit various documents related to the incident, premises and business activity.
12. The Surveyor further informed to the Insurance Company that they will issue Final Survey Report upon the receipt of the information listed above.  It is further informed that the final survey has not been carried out and only after conducting final detailed survey, the Surveyor would be able to ascertain a provisional amount and same would be mentioned in the preliminary report, in respect of the subject loss damage and to keep approval amount for underwriter liability, subject to policy terms and conditions.  The Surveyor also requested insurer to provide copy of proposal form and “Standard Fire and Special Peril Floater Policy” with all the terms and conditions and clauses attached to and forming part of the policy.
13. Further, the Surveyor sent few reminders in the month of November, 2020 itself in a periodicity of seven days.  In the first reminder, the Surveyor insisted for submission of the required documents at the earliest, mentioning IRDA Code of Conduct and Guidelines.  According to the Surveyor, IRDA Code of Conduct and Guidelines provided to the Surveyor on completion of survey, the Surveyor has to submit their final report within 30 days.  The claim cannot be remain open for indefinite period, more particularly in view of IRDA Regulations and Guidelines, whereby the Surveyor needs to release the Survey Report within timeframe stipulated by IRDA.  Hence, the compliance should be made by 16^th November, 2020 and in case, they do not receive the claim documents by the said date i.e, on 16^th November, 2020 it will be assumed that the Complainant is no longer interested in pursuing the claim.
14. The Surveyor on 27^th November, 2020 issued second reminder.  In the said reminder, the compliance date is mentioned as 4^th December, 2020.
15. On 10^th December, 2020, the Surveyor issued final notice to the Complainant mentioning therein that “It may kindly be noted that in case we do not receive the claim documents by the said date i.e, 17 December 2020, evidently we will be left with no alternative but to submit the Final Survey Report with ‘No Liability of Insurers’ in present claim since the liability of insurers could not be established for the reasons of Non-Compliance of requirements on your part& we will release the Survey Report accordingly to the Insurers.

Please note that no further communications will be entertained in the subject claim after the final date given to you for the compliances of the aforesaid claim documents”.

16. On 2^nd January, 2021, the Surveyor issued “No Claim Survey Report”, mentioning therein that, “as the insured is unable to provide required supporting documents even after constant follow-up, we are closing the file as mentioned above and non-submission of claim documents Tantamount to insured’s disinterest in pursuing the claim anymore& hence treated  as ‘NO CLAIM’. Hence, the subject claim being considered as ‘Claim Withdrawn’ and underwriter’s liability on subject claim matter has turned as ‘NO CLAIM’ due to non-compliance of claim documents and the insured’s subject claim has been closed at this stage accordingly”.
17. Accordingly, the Insurance Company issued Pre-Repudiation Letter to the Complainant on 18^th February, 2021.  In the said Pre-Repudiation Letter, it is mentioned to submit the required papers within next three days or claim shall be closed.
18. As far the Complainant’s submission, it is observed that :-

1. The Complainant’s Advocates letter dated 17^th January, 2022 mentioned that the requirements informed by the Surveyor have been complied with the claim department of the Insurance Company by letter dated 18^th February 2021.  However, the office of the Insurance Company had informed the Complainant that his claim file has been closed on account of non-compliance of requirement for information/ documents vide letter dated 10^th December, 2020 and final notice dated 24^th December, 2020 as per the Surveyor.
2. The Complainant further submitted that required documents for sanction of claim amount was submitted to the Insurance Company’s office, however, after retaining the same for 2-3 days, the said documents were returned to the Complainant stating that the time period was expired for submission of required documents for sanctioning the claim amount.
3. The Complainant submitted the fire Claim Form on 7^thOctober, 2021 to the Insurance Company.  The said Claim Form contains the description of material damaged in the fire dated 29^th October, 2020.
4. The Complainant vide his letter dated 5^th October, 2021 informed the Insurance Company that the fire incidence took place on 29^thOctober, 2020 at 9.30 p.m. was due to short circuit.  The said fire was controlled with the help of fire extinguisher available in the premises.  As it was extinguished by themselves, they have not informed fire brigade or police.  There was no loss of life and only material damage.

Conclusions

19. We heard the Advocates for the Complainant and the Insurance Company at length.   Learned Advocate Shri Anil Kharatmol for the Complainant submitted that the fire incidence happened during the lockdown period of Covid-19 i.e, on 29^thOctober, 2020 in the business premises of the Complainant.  He admitted that there is a delay in filing required documents to the Insurance Company as per the Surveyor’s LOR dated 12^th November, 2020, which the Surveyor sent to them after duly inspecting the premises.  However, it was submitted that during the crucial period the Complainant was hospitalized for Covid treatment and other blood related ailment equivalent to cancer.  On the other hand, Advocate Shri Sanjay Krishnan argued on behalf of Insurance Company and vehemently denied all the contentions of the Complainant made before this Commission and prayed for dismissal of the complaint.
20. We also perused the record available and produced by the parties herein before this Commission in the present case and after going through all the facts in the present case carefully, we framed the following issues to decide the present consumer complaint.

Reasons for the findings to Issue No.1 &2 :-

21. From the submissions made by the Complainant and after going through the Surveyor’s Report, it is confirmed that the fire incidence took place in the Complainant’s premises on the night of 29^th October, 2020.
22. The said premises of the Complainant was covered by the ‘Standard Fire and Special Perils Policy’ issued by the Insurance Company.  The said policy was in force on the date of incident of fire.
23. The Insurance Company is suspicious about the fire incident since it is not supported with any material evidence.  The Surveyor in his report confirmed the damage as well as cause of the fire.  The Surveyor’s Report doesn’t support any fabrication of event.  The said report did not make any comment on the incident of fire which can raise the suspicion on the occurrence of fire.
24. The Complainant in his letter dated 5^th October, 2021had explained the reasons why the fire brigade was not called and why FIR is not lodged.  The facts of the case confirm that there is no loss of lives and only material damages.  In such circumstances, it is up to the Complainant whether to approach police or fire brigade authorities or not.  Hence, merely not registering the incidence with such authorities doesn’t give any reason to raise suspicion on the incident occurred.  The Insurance Company would have done independent investigation had it been a case of fabrication or false incident.  Hence, we do not agree with the Insurance Company’s contention that the complaint is fabricated, false and frivolous and claim is made with the intention to make profit out of the insurance policy.
25. As far as the damage or loss to the goods is concerned, the Surveyor in their correspondence vide LOR informed the Complainant to submit the documents related to the business activity, purchases related documents such as invoices, stock registers, GST returns, etc.  The Surveyor also sent periodic reminders to the Complainant.  However, the Complainant didn’t respond to those correspondences when the available records perused.
26. It is very much established that the fire incident has occurred in the premises of the Complainant. There are certain damages to the goods and material at the premises. However, there is a genuine requirement from the Surveyor to substantiate the loss by submitting necessary evidence of purchases so that the claim can be processed further.
27. We do agree that there can be a damage to records of the business and purchases also. And in such situation, it would be difficult to comply with all requirements which the Surveyor conveyed through LOR.  However, the Complainant had alternate options such as,

1. To communicate about the difficulties in submitting such documents.,
2. The Complainant could have asked to the suppliers to provide such related documents.,
3. The Complainant could have submitted financial evidences such as bank statements which could have establish the purchases and sales activity of the business.,
4. The Complainant could have requested to give more time for compliance of LOR.

28. Instead the Complainant remained silent on this aspect and choose to not submit any supporting documents to the Surveyor or the Insurance Company in a given time period. No efforts or attempts seen from the records that Complainant had at least shown some initiations towards compliance of LOR.
29. We do agree that in a mentioned period Covid-19 pandemic was very much in existence.  There was every possibility that the Complainant or her family members could have suffered with such pandemic.  However, in subsequent period it was very much possible to act in the direction of at least on part compliance as per LOR given by the Surveyor.  The Complainant submitted a list of goods along with cost which she claimed as damaged in the fire incident.  However, such estimation of loss cannot be a basis to substantiate the cost of damage without some primary (purchase invoices, sales invoices, GST returns, etc.,) or secondary (bank statements, suppliers confirmations, etc.,) documentary evidence to authenticate the cost of goods as well as its existence. Merely submitting a list of goods and estimating its cost without any evidence as mentioned above will not suffice to accept the claim.
30. Hence, considering the detailed reasons for the issues framed in this case as above by us, it can be concluded that in the present case, the Complainant fails to bring all facts related to the incident on record, which can alter our opinion.
31. Therefore, we held that there is no deficiency in service in the said matter on the part of the Opposite Party-Insurance Company and hence, the present consumer complaint deserves to be dismissed in the light of above observations. Thus, we pass the following order.

ORDER

1. The Consumer Complaint No.CC/70/2022 is hereby dismissed.
2. No order at cost.
3. Copies this order be sent to the parties free of costs.