The present complaint has been preferred by the titled complainant against the titled opposite parties (for short, jointly the OP insurers/singularly as the OP1, the OP2) at the arbitrary repudiation of her otherwise a valid fire-claim succeeding the alleged fire-incident occurred at 1:30 AM on the night between the 5th/6th June' 2019 at her work-place of Men Saloon Business under the brand name of Khan Unisex Saloon at the 1st Floor of Property # 135, Mission Road, Pathankot; in which all her insured stocks/consumables/stores valued at more than Rs.5.0 Lac were reduced to ashes (total-loss). The complainant has been availing an Overdraft Business Loan of Rs.5.50 Lac from the local branch of Bank of Baroda and in compliance to Sanction Terms had purchased the 'My Business My Choice' Insurance Policy # 2270189730 from the OP insurers at the premium of Rs.2,066/- covering her stocks/consumables (undergone joint verification by the bankers and insurers) valued @ Rs.5.0 Lac w.e.f 15.05.2019 to 14.05.2020.
2. However, on the night intervening 5th /6th June' 2019, a major fore broke out in the building and the entire furniture/fixtures, stocks/stores/consumables and all others were burnt down to ashes/total-loss. The OP insurers were duly intimated and their Surveyor visited the incident-site on 07.06.2019 and the related DDR # 36 (08.06.2019) was also filed with the local police authorities. The OP Insurers' Surveyor has been quizzing the queries as well as requisitioning various documents in a piece-meal fashion till 29.07.2019 and all these were duly responded/supplied by the complainant to the optimum feasible level. Thereafter, the complainant has queried of her claim-status from the OP insurers as well as from their Surveyor on 07.08.2019 through various mails followed by reminders on 22.08.2019 and again on 18.09.2019. After having waited for more than three months, the complainant got served one Legal Notice upon the titled OP insurers on 14.01.2020 resulting into an unceremonious repudiation of her claim and hence prompted the present complaint seeking appropriate directives to the OP insurers to pay the claim to its full amount of Rs.5.0 Lac with interest @ 18% PA from the date of the fire-incident till realization, in the interest of justice. The complainant has filed the listed documents in evidence to support prosecution of her complaint.
3. Listed Documents produced in evidence by the complainant:
i) Ex.CW1/A - Affidavit by Ms Salma deposing the contents of her complaint;
ii) Ex.C1 – Copy of the Policy Schedule;
iii) Ex.C2-Copy of the DDR;
iv) Ex.C3 - Copy of the Claim Form;
v) Ex.C4 & Ex.C5 – Copies of published news of the fire-incident;
vi) Ex.C6 – Copy of the Rent Agreement;
vii) Ex.C7 – Copy of the BOB Bank Certificate confirming presence of Stocks/Stores worth Rs 5.0 Lac as on 15.05.2019 during joint inspection;
viii) Ex.C8 & Ex.C9 – Complainant's affidavit and its Dispatch Postal Receipt;
ix) Ex.C10 – Copy of the GPA;
x) Ex.C11 – Fire-Brigade Report on the fire-incident;
xi) Ex.C12 to Ex.C14 – Legal Notice and its postal-receipts.
4. The OP Insurers, in compliance to the Commission’s Summons, appeared through its counsel and filed its written-reply preliminary objecting therein its maintainability in the absence of cause of action favoring the complainant and deficiency in service on their part. The complainant has filed a false and frivolous complaint and has herself failed to fulfill her part of the obligations and thus has not been entitled to any relief. On merits, the OP have denied/ side-tracked almost all of the contents of the complaint addressing these as wrong/incorrect and have been repeatedly putting emphasis on non-cooperation by the complainant in providing assistance to the OP Surveyor who has assessed the loss @ Rs.60,660/- only. However, the fire-incident total-loss claim was repudiated for violation of condition # 4 i.e., the notice/intimation in writing of incident of loss was not given by the insured within 15 days of the happening.
5. Lastly, the OP insurers have prayed for dismissal of the present complaint with costs and have produced the Affidavit Ex.OPW1/A of Amit Chawla Chief Manager along with other documents (in evidence) as: Ex.OP1 to Ex.OP4 – Copies of all the e-mail correspondence between the insured and the insurers; and, Ex.OP5 – the OP appointed Surveyor's Assessment of Loss Report; and other documents Ex.OP6 to Ex.OP-9 in support of their defense.
6. We have examined the available documents/evidence as available on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective litigants. We observe that the present dispute has arisen on account of repudiation of the fire-loss claim filed by the complainant by the OP insurers on account of violation of the 15 day clause for intimating the insurers of the loss from the date of the incident and also the alleged non-cooperation by the complainant. Although, there's no evidence of delivery/acknowledgment of Terms & Conditions of the related Policy by the complainant-side.
7. We observe that the OP insurers have failed to produce any cogent evidence to prove their charge of violation of clause 4. The uncontested visit by the OP appointed Surveyor to the Site on 07.06.2019 i.e., the very next day of the fire-incident and his initial queries of 10.06.2019 do prove that the OP insurers were duly intimated of the incident on the very next day of the fire-incident, itself. Further, the complainant's cooperation is very much vivid from the exhibited e-mail copies the inter-se exchange of communication(s). Thus, the allegations as put forth by the insurers are mere bald-statements in the absence of any cogent evidence. Further, the Surveyor's Assessment of Loss Report has been filed sans the mandatory affidavit as such the same shall not be admissible in evidence. Moreover the report does not disclose the basis of valuation of stocks/stores vide which the loss has been assessed. The complainant has duly filed the Banker's Certificate confirming the joint inspection (by the banker as well as the insurer) of the stocks and its valuation @ Rs.5.0 Lac on the date of purchase of the related policy. Thus, we set-aside the OP insurers' arbitrary rejection/repudiation of the fire-loss claim since that amounts to but an evidence of employ of unfair practices and also leads to affirm deficiency in service on their part and that surely attracts an adverse statutory award to their favor.
8. In the light of the all above, we partly allow this complaint and ORDER the OP insurers to withdraw the impugned repudiation of the impugned claim and pay the same in terms of the policy to pay the fire-loss claim, in full, besides to pay her Rs.10,000/- in lump sum as cost and compensation within 45 days of receipt of the certified copy of these orders otherwise the awarded amount shall attract interest @ 9% PA from the date of the complaint till paid, in full.
9. The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.
10. Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.
(Naveen Puri)
President.
ANNOUNCED: (R.S.Sukhija)
AUG. 18, 2022. Member.
YP.
