Presented by Sri B.K. Pati, Member .<br /> The present complaint pertains to deficiency in service as envisaged under the provision of Consumer Protection Act-1986 and its brief fact is as follows:-<br /> <br /> The Complainant, proprietor of M/s Shyam Rice Mill at Pirda in the District of Mahasamund of Chhatishgarh State had incurred a term loan of Rs. 5,20,000/-(Rupees five lac twenty thousand)only and working capital of Rs. 4,00,000/-(Rupees four lac)only from the Opposite Party No.1(one) at Basna for setting up of a rice mill for self employment to earn livelihood. The Opposite Party No.1(one) used to pay the premium for insurance of Complainant's mill and its stock to the Opposite Party NO.2(two) including for period from Dt. 20/07/2004 to Dt.19/07/2005 and also premium for insurance for earth quake of the period from Dt.29/01/2004 to Dt.28/01/2005 debiting the said premium amount from the account of the Complainant. The Opposite Party No.1(one), before expiry of the insurance coverage again debited an amount of Rs.8,153/-(Rupees eight thousand one hundred fifty three)only from the account of the Complainant on Dt.05/07/2005 and directly paid the same to the Opposite Party No.2(two) towards premium of insurance of the Complainant's mill and stock for the period from Dt.20/07/2005 to Dt.19/07/2006 under policy No. 550901/11/05/00208, the insurance covering fire and special perils policy, for a declared value of Rs. 8,00,000/-(Rupees eighty lac)only. On Dt.29/30.07.2005 fire broke out in the Complainant's mill premises causing loss of Rs.2,80,000/-(Rupees two lac eighty thousand)only which the Complainant intimated to both the Opposite Parties. The Opposite Party No.2(two) deputed a surveyor to assess the loss but even after completion of investigation insisted for a fire brigade report relating to the fire in question though it was known to both the Opposite Party No.2(two) and the surveyor that the nearest fire station from the mill situated at a distance of 110(one hundred ten) kilometers, which could neither be contacted during fire nor could be of any use.<br /> <br /> The Opposite Party No.2(two) vide its letter Dt.04/09/2006 that in want of fire brigrade report it agreed to consider the claim to a maximum of 75%(seventy five percent) insisting for a consent of acceptance of such amount from the Complainant. Not agreeing to it, the Complainant compliant before the Insurance Ombudsmen who in his letter Dt.22/08/2008 intimated that the case is closed on the ground that the insurance case is not taken at personal line i.e. the policy is not taken or given in an individual capacity. On Dt.21/01/2008 the Opposite Party No.2(two) informed the Complainant it was ready to settle the claim to a maximum of 75%(seventy five percent) of the assessed loss.<br /> <br /> The Complainant contends that his mill and stock were insured with the Opposite Party No.2(two) having its office at distant Bargarh. It is the Opposite Party No.1(one) who had stipulated condition of comprehensive insurance of the mill and stock and always insisted to insured the same by debiting the premium amount from the account of the Complainant each year from the date of finance since 2002. Also that is the reason why he could not insure the same in his name but failed to do it in his firm name. It is for the above fault of the Opposite Party No.1(one) that the Ombudsmen holds that the insurance is not in personal line or individual capacity. Apprehending that the Complainant may go bankrupt and that the loan account may become N.P.A., the Opposite Party No.1(one) insisted to arranged fund to repay the loan even after the Complainant sustained a loss of Rs.2,80,000/-(Rupees two lac eighty thousand)only. The Complainant says that the Opposite Party No.1(one) who had insured the Complainant's mill and stock with Opposite Party No.2(two) out of the fund of the Complainant, should not have insisted for repayment of loan amount to the tune of the loss and it should also have pursed the matter with Opposite Party No.2(two) for payment of the insured/loss amount and also should have charged interest on the premium amount paid by the Complainant through his account.<br /> <br /> The insistence of Opposite Party No.2(two) before the Complainant to accept the claim on a compromise basis to a maximum of 75%(seventy five percent) of the assessed loss, amounts to deficiency in service and unfair trade practice, asserts the Complainant. He claims, jointly and severally, from both the Opposite Parties the insured amount of loss of Rs. 2,80,000/-(Rupees two lac eighty thousand)only, a compensation of Rs.2,00,000/-(Rupees two lac)only towards financial and moral deterioration of the Complainant and towards mental agony and harassment, besides an amount of Rs.10,000/-(Rupees ten thousand)only towards litigation expenses.<br /> <br /> The Opposite Party No.1(one) in its version admit debiting the premium of the insurance in question from the account of M/s Shyam Rice Mill and not from the account of the Complainant. This Opposite Party also admits that the insurance covered fire and special perils policy of the Complainant's mill and stock, the premium being paid by Opposite Party No.1(one) directly to Opposite Party No.2(two). The premium amount were collected by Opposite Party No.1(one) from the Complainant by debiting the same from the Complainant's account. It says that the Complainant had intimated to this Opposite Party about the breaking out of fire in the mill but denies the amount of loss of Rs.2,80,180/-(Rupees two lac eighty thousand one hundred eighty)only as the same is required to be assessed and proved in the court of law. The Opposite Party No.1(one) denies any fault on its part for which the Ombudsmen rejected the Complainant's petition because it was filed in individual capacity. M/s Shyam Sundar Rice, Mill PIRDA debtor failed to pay debt amount outstanding against it and entered into compromise with the Bank and consequently, part of the outstanding debt amount was paid and finally the account of M/s Shyam Rice Mill was closed, hence the recovery of interest on premium by Opposite Party No.1(one) from M/s Shyam Rice Mill does not arise. The Opposite Party No.1(one) denies all allegations against it and the case being false it denies its claim of compensation from the Complainant. It contends that the Complainant is not entitled to file Complaint individually and so the complaint is not sustainable in the eye of law, and liable to be rejected.<br /> <br /> The Opposite Party No.2(two) in its version while questioning the maintainability of the complaint against it on various factual and legal aspects, contends that after receiving information over Fax from the Opposite Party No.1(one) on Dt.31/07/2005 along with intimation of M/s Shyam Rice Mill to the Bank and the Police information recorded under Section 155 of the Cr.P.C, it engaged Surveyor and Loss Assessor Sri S.S. Rayat on Dt.01/08/2005 to assess the loss in respect of the two policies of the Complainant. The Surveyor in his report Dt.17/04/2006 assessed the loss of Rs.1,24,540/-(Rupees one lac twenty four thousand five hundred forty)only and Rs.6,050/-(Rupees six thousand fifty)only in respect of policy No.550901/11/05/00208 and No.550901/11/05/00206 respectively. As regards the latter policy as the amount of loss came within the policy access of minimum Rs.10,000/-(Rupees ten thousand)only for each claim, the Surveyor had opined for “No Claim” under the said policy. The Surveyor had asked for the Fire Brigade Report which was not submitted by the Complainant.<br /> <br /> This Opposite Party says that it accepted the report of the Surveyor “as it is”. It has not liability as regards policy No. 550901/11/05/00206 as per the survey report. However under policy No. 550901/11/05/00208 this Opposite Party accepted the loss assessed by the surveyor at Rs.1,24,540/-(Rupees one lac twenty four thousand five hundred forty)only and deducted there-from the policy access and salvage, being the legal requirement. Because the insured failed to submit the Fire Brigade Report which is required for the settlement of the claim, this Opposite Party calculated the amount of Rs.86,392/-(Rupees eighty six thousand three hundred ninety two)only which is 75%(seventy five percent) of the assessed amount. The insured was asked vide Regd. Letters to accept the compromise amount of a maximum of 75%(seventy five percent) of the assessed loss. Since the insured neither submitted the Fire Brigade Report nor gave any information to the Insurance Company, the claim was closed as “NO CLAIM” and the matter was intimated to the insured vide letter Dt.08/02/2008.<br /> <br /> This Opposite Party concludes that there is no deficiency of service on its part towards the Complainant and the complaint be dismissed with cost.<br /> <br /> Perused the complaint the version of the Opposite Parties along with copies of documents filed and find as follows:-<br /> <br /> The Opposite Party No.2(two), the insurance company contends that it accepted the report of the Surveyor engaged by it, “as it is” i.e. in to-to. The Surveyor in his report Dt.17/04/2006 assessed the loss of Rs. 1,24,540/-(Rupees one lac twenty four thousand five hundred forty)only in respect of policy No.550901/11/05/00208 and Rs. 6,050/-(Rupees six thousand fifty)only in respect of policy No.550901/11/05/00206. As regard the latter policy as the amount of loss came within the policy access of minimum of Rs.10,000/-(Rupees ten thousand)only for each claim, the surveyor had opined for “NO CLAIM” under the policy. The surveyor had asked for the Fire Brigade Report which was not submitted by the Complainant. <br /> <br /> The Opposite Party No.2(two) contend that as insured failed to submit the Fire Brigade Report for settlement of the claim it calculated the amount of Rs.86,392/-(Rupees eighty six thousand three hundred ninety two)only which is 75%(seventy five percent)of the assessed amount and as the insured neither submitted the Fire Brigade Report nor gave information to the insurance company, the claim was closed as “NO CLAIM”.<br /> Now, it need be seriously examined as to whether the Opposite Party No.2(two) was justified to reduce the claim to 75%(seventy five percent) of the assessed amount on the solitary ground that the Fire Brigade Report was not submitted even though it accepts the assessed amount with out disputes and also not paying the assessed amount of Rs.6,050/-(Rupees six thousand fifty)only in respect of policy No. 550901/11/05/00206 because the amount of loss came within the policy access of minimum Rs.10,000/-(Rupees ten thousand)only.<br /> <br /> It is not disputed by any of the Opposite Parties nor the Surveyor that the nearest Fire Station from the mill situated at a distance of 110 kilometers which could neither be contacted during the fire nor could be of any use in the matter. It is but natural that no report to the fire station could have been made and in the circumstance the Complainant cannot be faulted for non submission of such a report. The other assessed loss of Rs. Rs.6,050/-(Rupees six thousand fifty)only having been treated as “NO CLAIM” because the amount of loss came within the policy access of minimum of Rs.10,000/-(Rupees ten thousand)only, is also farcical. When the policy in question and the incident of fire is not disputed and the loss assessed by the insurer's own surveyor is accepted “as it is”, the principle of natural justice and equity demand that the insured can not be deprived of his legitimate dues on the ground of trivial technicalities as he has paid premium so that the insurer comes to his succor at the time of unforeseen mishaps covered under the risk factor. The other grounds taken as plea by the insurer to reject the claim of the insured can never be accepted. <br /> <br /> The fact and circumstance as discussed above compels an irresistible conclusion that the Opposite Party No.2(two), by not making the payment of the total assessed amount in respect of both the policies in question has committed deficiency of service towards the Complainant.<br /> <br /> There is no case against the Opposite Party No.1(one) which is exempted from the ambit of adjudication.<br /> <br /> In the result, the Opposite Party No.2(two)is directed to pay to the Complainant both the assessed amount of Rs. 1,24,540/-(Rupees one lac twenty four thousand five hundred forty)only in respect of policy No.550901/11/05/00208 and Rs. 6,050/-(Rupees six thousand fifty)only in respect of policy No.550901/11/05/00206 along with 9% interest per annum(nine percent interest per annum) over both the amount chargeable w.e.f. Dt.17/04/2006, the date of submission of the Surveyor's report till the date of Order, besides, a cost/compensation of Rs. 15,000/-(Rupees fifteen thousand)only. The order shall be carried out within thirty days hence, failing which the amounts in question shall carry 18%(eighteen percent) interest per annum till payment.<br /> <br /> Complaint allowed accordingly.<br />