This complaint under C.P. Act., 1986 was initially filed against O.P.-01, Reliance General Insurance Company Limited, Gitanjali Complex, 2nd Mile, 2nd Floor, Post Office- Sevoke Road, Police Station - Bhaktinagar, District- Jalpaiguri, 735224 who contested the case by filing Written Version and ex- parte against the Proforma O.P.- 01, Bank of India, Maynaguri Branch, Maynaguri Town, Police Station- Maynaguri, Post Office- Maynaguri District- Jalpaiguri, Pin Code- 734001 (West Bengal) .
The case of the complainant as per his complaint is as follows-
The complainant told in his plaint that he is the owner of a shop- room premises admeasuring about 08ft. x 10ft (approximately), located at Maynaguri town, wherein he carries-on / conducts his retail business relating to sale of electrical goods being his sole bread- earning source. The said shop-room premise was purchased by the complainant on/ after obtaining cash credit loan from the Proforma- O.P. bank who sanctioned complainant’s loan after thoroughly scrutinized his all documents. The cash credit sanctioned loan amount was Rs. 3.5 lacs (Rupees Three Lacks and Fifty Thousand) only, which was sanctioned by the Proforma- O.P. bank to the complainant vied its Sanction Letter bearing Ref. No, 4358/18-19 dated 05/09/2018. Subsequently, the said shop-room had been duly insured by the complainant with the O.P.-01, Reliance General Insurance Company Limited, vied its ‘Reliance Standard Fire and Special Perils Policy’ bearing Insurance Policy No. – 613692021111000195. The total sum insured had been Rs. 4,40,000/- (Rupees Four Lacs and Forty Thousand) only. The coverage period of the said insurance was from 00:01 hours of 21/02/2020 to midnight of 20/02/2021.
The complainant also said in his complaint that on 13/09/2020 (at about 01:30 a.m.) all of a sudden the complainant’s said shop-room was engulfed by a devastating fire and as a result the complainant’s shop-room premises along with five other adjoining shop-rooms were completely destroyed and turned into ashes. This entire horrifying incident was broadcasted in almost all media channels and daily newspapers. Subsequently, the complainant along with other five other shop- owners, viz. Sri Sajan Banik, Sri Shyamal Dey Sarkar, Sri Amal Dey Sarkar, Sri Krishna Das and Sri Swapan Das whose shops had been destroyed due to said devastating fire intimated I.C. of Maynaguri Police Station through a written letter on 14/09/2020 and forwarded the said written diary to the Pradhan, B.D.O., Panchayet Samaty, Fire Service, Babasayi Samity and to the Maynaguri Block Savapati- Sri Manoj Roy. The said written complaint lodged by the complainant along with five other shop- owners before the I.C. of Maynaguri Police Station, dated 14/09/2020, had been duly registered as M.N.G. P.S. G.D.E. No. 659 dated 14/09/2020.
The complainant argued that on 16/09/2020 he informed the Proforma O.P.- 01, Bank of India, Maynaguri Branch, about the said incident and to enquire about his aforesaid loan and to consider his case and relieve him of his liabilities and also requested them to settle his legitimate insurance claims but the Proforma O.P.- 01, Bank of India, Maynaguri Branch told the complainant that his loan related papers and documents could not be handed over to him at that moment due to the extreme rush hours for the/ then ensuing ‘Puja’ season and told him to visit their bank after ‘Puja’ vacations gets over. That apart, the officials of the Proforma O.P.- 01 also made it clear to the complainant that their bank had no such liabilities towards settling his insurance claims and directed him to make contact with the O.P. No- 01 Insurance Company for sanctioning his legitimate claim.
The complainant also argued that on 23/09/2020 the representative of the O.P. No.- 01 Insurance Company, i.e., I.R.D.A. approved independent surveyor ‘ Excellentia Insurance Surveyor and Loss Assessor Private Limited’ visited his ruined shop premises to enquire and investigate the matter and on/ after completing their investigations they asked him to gather certain documents related to his insurance policy. Likewise, the complainant again went to the Proforma O.P.- 01, Bank of India, Maynaguri Branch, to collect the statement of accounts in connection to his cash credit loan but again the officials of the said bank told that his loan related papers and documents could not be handed over to him at that moment due to the extreme rush hours for the/ then ensuing ‘Puja’ season and told him to visit their bank after ‘Durga Puja’ vacations. The complainant many times visited the bank but he did not get any result.
The complainant also argued in his plaint that on 13/10/2020 while he was again going to the said Proforma O.P.- 01 bank to enquire his loan related papers and documents by riding his tow- wheeler (bike), he met an accident and sustained serious injuries at his right knee. As a consequence of which, the complainant had to be carried to an Orthopedic Surgeon, viz. Dr. Sanjany Bal, M.B.B.S.(Kol ) and D. Ortho (Kol), at Jalpaiguri Eveland Clinic Private Limited, Hospital Road, Jalpaiguri and thereafter, as per said Doctor’s advice on 14/10/2020 the complainant underwent various medical tests such as X- Ray- Knee AP/LAT, etc. The said X- Ray report revealed that the complainant had fractured his right knee (Proximal Fibula) and for this injury he had to remain completely bed- ridden for a long time. The complainant also added that due to this knee injury still he is unable to make free movement.
The complainant also argued that due the delay conducted on the part of the officials of the Proforma O.P.- 01 bank towards non supplying of his loan related papers and documents and also due to his deteriorating health condition for which he got entirely bed- ridden, he was not in a position to hand- over the required papers and documents before the O.P.- 01 and for which the complainant had duly intimated the O.P.- 01 regarding the entire episode over phone and had requested the O.P. No.- 01 to grant him some more adequate time for submitting his papers and documents. But , instead of understanding his genuine requests, the O.P. No.- 01 Insurance Company sent him a claim rejection letter under reference letter ref: RGICL, Claim No.: 219520000696, Policy No. 613692021111000195 dated 24/12/2020 whereby the complainant’s legitimate claim had been shockingly rejected on some unjustifiable source/ ground. The complainant also added that the said letter was sent to him in a wrong address at Coochbehar and the same was received by him on 12/01/2021.
The complainant also argued in his plaint that the callous, negligent, deficient, intentional, high- handed and harsh attitude, imperfection in service and obnoxious conduct exhibited on the part of the O.P. N0.- 01, has proved deficiency in services and unfair trade practice of grossest nature beyond comprehension and that too, sans any fault on his the part in any way or at all, causing untold mental agony, anguish, unbearable harassment to him amenable to remedies in this learned Commission.
The complainant therefore prays for-
- Pass an order directing the O.P. No.- 01 to pay to the complainant, his legitimately receivable amount of insurance claim to the tune of Rs. 4,40,000 /- (Rupees Four Lacs and Forty Thousands) only, as per the Insurance Policy.
- Pass an order directing the O.P. No.- 01 for payment of 12% per annum interest upon the claim amount.
- Pass an order directing the O.P. No.- 01 to pay to the complainant, an amount to the tune of Rs. 1,00,000/- (Rupees One Lac) only, as compensation against the constant tremendous mental stress and agony caused to him and his family members.
- Pass an order directing the O.P. No.- 01 to pay to the complainant, an amount of Rs. 60,000 /- (Rupees Sixty thousands) only, for the cost of litigation.
- Pass an order directing the O.P. No.- 01 to pay to the complainant, a total claim amounting to (Rs. 4,40,000 /-) + (Rs. 1,00,000 /-) + (Rs. 60,000 /-) = Rs. 6,00,000 /- (Rupees Six Lacs) only.
List of documents furnished by the complainant are as follows-
Sl. No. 01 -Photocopy of Loan Sanction Letter vide. Ref. No.- 4358/18-19 dated 05/09/2018 issued by Bank of India, Maynaguri Branch along with cash credit book.
Sl. No. 02 – Photocopy of Insurance Policy No. 613692021111000195.
Sl. No. 03 – Photocopy of Newspaper cutting published in ‘ Uttarbanga Sambad’ on 14/09/2020.
Sl. No. 04 – Photocopy of Written Complaint dated 14/09/2020 addressed to the I.C., Maynaguri P.S.
Sl. No. 05 – Photocopy of the complainant’s forwarding letter dated 14/09/2020addressed to the Fire Service Officer, Maynaguri Fire Service.
Sl. No. 06 – Photocopy of the complainant’s letter dated 15/09/2020 addressed to the Officer in Charge, Maynaguri Fire Station.
Sl. No. 07 – Photocopy of the complainant’s forwarding letter dated 15/09/2020 addressed to the B.D.O., Maynaguri.
Sl. No. 08 – Photocopy of the medical prescription dated 13/10/2020 issued by Dr. Sanjay Ball with Bill dated 14/10/2020 and X- Ray Report dated 15/10/2020.
Sl. No. 09 – Photocopy of the o.p. No.- 01’s claim rejection letter dated 24/10/2020 along with postal envelop and acknowledgement receipts.
The O.P., Reliance General Insurance, Gitanjali Complex, 2nd Mile, 2nd Floor, Sevoke Road, Siliguri, Post Office- Sevoke Road, Police Station- Bhaktinagar, District- Jalpaiguri, Pin Code- 734001 (West Bengal) contested the case and as per his Written Version (W.V.) the case is as follows –
The O.P. No.- 01 submitted in his W.V. that the allegation made in the petition false and denied and nothing stated in the petition contrary to this reply, should be considered to be admitted by the answering O.P. No.- 01 for want of traverse. It is submitted that the petition is not maintainable either on facts are in law against this O.P. No.- 01 and hence, the petition is liable to be dismissed in limine with costs against the O.P. No.- 01.
The O.P. No.- 01 also stated in his W.V. that the present complaint is premature and there is no cause of action which arose for filing the present case against these respondents and hence, the complaint deserves to be dismissed on this ground alone. The O.P. No.- 01 also added that he does not admit and deny all the allegations made in different paragraphs of the petition and the complainant is put to strict proof of all the allegations except those, which are specially admitted hereunder. The O.P. No.- 01 also added that the case has been filed by suppression of facts only to put the law in motion and to gain illegally under the shade of the present case. The O.P. No.- 01 also stated that the complainant is not a ‘Consumer’ within the meaning of Consumer Protection Act and thus he has right to file the present case.
The O.P. No.- 01 argued in his W.V. that the complainant had taken the policy for insurance of his commercial shop and thus availed the services for a commercial purpose and thus it is substituted that the complainant is not covered under the Consumer Protection Act and the complaint is not maintainable and deserves to be dismissed on this ground.
The O.P. No.- 01 argued in his W.V. that the complainant had not provided the documents required for assessing the claim and is seeking the full IDV amount under the subject policy without providing an opportunity to the answering the O.P. No.- 01 to evaluate and assess the claim because the complainant failed and neglected to provide the documents required to assess the claim.
The answering O.P. No.- 01 has closed the claim for want of documents on 24/12/2020 and not repudiated the claim on merits and if the complainant would have provided the documents, the O.P. No.- 01 would have been able to process and scrutinized the claim. The O.P. No.- 01 added that the complainant is solely responsible for non sanctioning the claim and there is no deficiency of service or unfair trade practice attributable to the answering O.P. No. -01 as alleged or at all.
The O.P. No.- 01 also argued that the fact at paragraph-02 are admitted to the extent the office of answering O.P. No.- 01 is situated at the address mentioned at paragraph but the O.P. No.- 01 does not admit the averments made at paragraph-03 of the complaint. The O.P. No.- 01 stated that if a cash credit loan of Rs. 3.5 lacs (Rupees Three Lacs and Fifty Thousand only) had been sanctioned by the Proforma O.P. No.- 01 in favour of the complainant on 05/09/2018 for running his business, then why it took almost one and half years late for the complainant to cover his shop premises on 21/02/2020 under the mentioned insurance policy. The O.P. No.- 01 also submitted that the complainant had applied and availed the Reliance Standard Fire and Special Perils Policy after understanding the terms and conditions and the said policy bearing no. 613692021111000195 was issued by the answering O.P., subject to the terms and conditions where it has mentioned that the complainant is required to submit the claim and the information and documents required by the Insurance Company, failing which the claim is not payable by the answering O.P. No.- 01.
The O.P. No.- 01 also argued that he does not admit and denies the allegation made in paragraph no. 04 to 10 of the complaint in respect destruction of his shop- room by fire on 13/09/2020 and subsequent lodging of complaint to the local police and to the Proforma O.P. No.- 01 and the lame excuse for not having proper loan and insurance policy documents. The O.P. No.- 01 added that it is admitted position that upon receipt of the claim, the claim was registered by them and a surveyor was appointed to scrutinized the claim of the complainant and the surveyor requested the complainant to provide the documents vied email dated 07/10/2020, 19/11/2020 and 24/12/2020 but the complainant had failed and neglected to provide the documents to the surveyor for which the surveyor could not assess the claim and submitted his report assessing the loss to the extent of Rs. 2,00,000 /- (Rupees Two Lacs only).The O.P. No.- 01 also submitted that the liability of insurance company shall not exceed the loss assessed by the surveyor. The O.P.No.- 01 also added that the claim could not processed as the documents in support of the claim were not provided by the complainant to the answering O.P. No.- 01 and thus the claim could not be verified and settled by the answering O.P. No.- 01. The O.P. No.- 01 also added that the complainant could have submitted the documents to them through any other family members or through any known person to process the claim but the complainant did not have any intention to do so.
The O.P. No.- 01 also argued that he does not admit and denies all the allegations made in paragraph nos. 09 to 12 of the complaint in respect of informing the respondent over phone for the cause of delay in submitting of all the relevant documents to them rather despite of communications issued by the O.P. No.- 01 the complainant did not make any response and thus the O.P. No.- 01 supports the letter of repudiation as because a claim could not be settled if there is no documents be available in time in respect of any claim and if any delay occurred in service of the said letter this O.P. No.- 01 is no way responsible for the same. The O.P. No.- 01 also added that he denied the facts stated in paragraph nos. 13 to 16 because there is no deficiency in services or unfair trade practice committed by O.P. No.- 01 and the complainant himself failed to provide claim related required documents to the O.P. No.- 01 and thus the claim could not be verified and settled by them.
The O.P. No.- 01 also argued that the contents of paragraph no. 17 and 18 of the complaint are denied by them for want of knowledge and the contents of paragraph no. 19 are denied as the complainant is not bonafide.
The O.P. No.- 01 also argued in his W.V. that in response to the complaint of the petitioner, all the contents of the paragraphs are false and concocted stories fabricated with an ulterior motive for making illegal gain out of an insurance policy by misleading the Hon’ble Commission.
The documents filed by the O.P. are as follows …
Annex A - Photocopy of the Policy.
Annex B - Photocopy of the e- mails sent by the surveyor.
Annex C - Photocopy of Surveyor’s report.
Annex D - Photocopy of closure letter.
Points for consideration
- Whether the complainant consumer?
- Whether the case is maintainable under the C.P. Act 2019?
- Whether there is any deficiency in service in the part of the O.P. as alleged by the complainant?
- Is the complainant is entitled to get any award and relief as prayed for?
All the points are taken up together for consideration and decision.
Seen and perused the complaint petition and Written Version filed by the parties which are supported by the affidavit, documents filed by the parties. We are also heard arguments advanced by both parties in full length.
It is very much clear from the evidence by the O.P. No.- 01 that the shop was duly insured under the ‘Reliance Standard Fire and Special Perils Policy’ issued by Reliance General Insurance Company Limited vied policy no. 613692021111000195 which was valid from 21/02/2020 to 20/02/2021 and the accident was took place on 13/09/2020. So, the insurance policy was valid at the time of the said accident and based on the statement of the complainant the Commission is very much clear that the complainant was running his shop for his daily business to maintain his livelihood. Thus, the Commission has no doubt that the complainant is a very much consumer as per the Consumer Protection Act- 2019 and also there is no doubt that this Commission has its jurisdiction to decide this case.
It is very much clear from the evidence of the complainant that the said shop was destroyed by a devastating fire on 13/09/2020 (at about 01:30 a.m.) from where the complainant was running his business. It is also cleared from the evidence it is also cleared that the complainant informed this matter to the different authorities and the said incident was published in Uttarbanga Sambad, a daily circulated local newspaper.
From the evidence of the O.P. No.- 01 it is very much clear that the insurance company has a knowledge of this accident and after satisfying the fact they have engaged a surveyor from their end. In the report of that surveyor it is clear that they had conducted a survey and assessed some losses.
The insurance company (O.P. No- 01) stated that they have required documents to settle the claim but it is clear from the evidence from the complainant that many items were destroyed in that said incident. Subsequently, the complainant tried to collect those required documents from bank but unfortunately he did not get any result.
It should be remembered that this is a small shop and the complainant is a small scale businessman. So, it is not possible for him to maintain his business accounts large and professional manner. Moreover, as per decision of the Hon’ble Supreme Court in a Gurmel Sing vs. National Insurance Co. Ltd., S.C.C. online S.C. 666, decided on 20/05/2022 that “The insurance company has become too technical while settling the claim and has acted arbitrarily. The appellant has been asked to furnish the documents which were beyond the control of the appellant to procure and furnish. Once, there was a valid insurance on payment of huge sum by way of premium and the Truck was stolen, the insurance company ought not have become too technical and ought not to have refused to settle the claim on non- submission of the duplicate certified copy of certificate of registration, which the appellant could not produce due to the circumstances beyond his control.”
So, as per the above discussion it is very much clear that there was a deficiency of service from the part of Insurance Company and the Commission here followed the decision of the National Insurance Company Limited vs ALI CLOTH HOUSE & ANR reported in I (2022) CPJ91 (NC) – “ that the Insurance Company was not justified in repudiating the claim of the Insured Complainant and hence, the Insurance Company is liable to compensate the insured for the loss suffered by him due to fire in Shop to the tune of Rs. 1,45,000 as claimed by him. However, since the Stock and Account Registers were not being maintained by the Insured, we hold the deduction of 25% made by the Insurance Company on that Account”. That in the instance case the complainant is entitled to get Rs. 3,30,000 /- (Rupees Three Lacs Thirty Thousands) only for his claim, Rs. 10,000 /- (Rupees Ten Thousand) only for mental pain and agony and Rs. 5,000 /- (Rupees Five Thousand) only for litigation cost.
ORDERED
That the Consumer Case No. 14/21 be and same is allowed in contest against the O.P. No.- 01 (Reliance General Insurance Company Limited) and ex-parte against the Proforma O.P. No.- 01 (Bank of India).
The complainant do get an award of Rs. Rs. 3,30,000 /- (Rupees Three Lacs Thirty Thousands) only for his claim, Rs. 10,000 /- (Rupees Ten Thousand) only for mental pain and agony and Rs. 5,000 /- (Rupees Five Thousand) only for litigation cost. The total payable amount is Rs. 3,45,000 /- (Rupees Three Lacs and Forty Five Thousand) only and this amount will be paid to the complainant by the O.P. No.-01 within 30 days (Thirty days) from the date of this order failing which the complainant will be entitled to get a simple interest of 6 % per annum from the date incident, i.e. from 13/09/2020.
The O.P. No.- 01(Reliance General Insurance Company Limited) is directed to pay Rs. 3,45,000 /- (Rupees Three Lacs and Forty Five Thousand ) only by issuing account payee cheque in favour of complainant within 30 days (Thirty days) from the date of this order failing which the complainant will be entitled to get a simple interest of 6 % per annum from the date of incident, i.e. from 13/09/2020.
Let a copy of this judgment be given to the parties directly or through their representative Ld. Advocate for compliance free of cost.
