West Bengal

Jalpaiguri

CC/43/2023

PROMILA BUILDERS, Represented by its Proprietor Smt. Sulakhi Saha - Complainant(s)

Versus

THE BRANCH MANAGER, BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED - Opp.Party(s)

MONOJIT ROY

23 Jul 2024

ORDER

District Consumer Disputes Redressal Forum,
JALPAIGURI
 
Complaint Case No. CC/43/2023
( Date of Filing : 28 Jun 2023 )
 
1. PROMILA BUILDERS, Represented by its Proprietor Smt. Sulakhi Saha
W/o Sri Shyamal Saha At Eastern ByPass Road, Ashighar More, Near Dadabhai Sporting Club P.O. Ghogomali, P.S Bhaktinagar( Ashighar Outpost) Dist. Jalpaiguri 734006
Jalpaiguri
West Bengal
...........Complainant(s)
Versus
1. THE BRANCH MANAGER, BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED
At Galaxy House (4th Floor) Beside P.C. Mittal Bus Terminus Sevoke Road 2nd Mile Siliguri P.O Siliguri P.S. Bhaktinagar Dist. Jalpaiguri 734001.
Jalpaiguri
West Bengal
2. BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED
At Bajaj Allianz House Airport Road Yerawada Pune 411006
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. APURBA KUMAR GHOSH PRESIDENT
 HON'BLE MRS. Arundhaty Ray MEMBER
 HON'BLE MR. DEBANGSHU BHATTACHARJEE MEMBER
 
PRESENT:
 
Dated : 23 Jul 2024
Final Order / Judgement

The Complainant has filed this case under Section 34 and 35  of the Consumer Protection Act 2019 and praying for following Order/ Relief :-

  1. Admission of the Complaint.
  2. Direction against the O.Ps to pay/ reimburse a sum of Rs. 5,88,382/- to the Complainant under the policy being no. OG-22-2404-4010-000003907 and claim no. OC-23-2404-4010-00000010.
  3. Direction against the O.Ps to pay a sum of Rs. 10,00,000/- to the Complainant for harassment and suffering caused to the Complainant on account of deficiency in service and unfair trade practice by the OPs.  
  4. Direction against the O.Ps to pay a sum of Rs. 15,000/- towards the cost of legal proceedings.
  5. Any other relief or reliefs to which the Complainant is entitled.  

 BRIEF FACTS OF THE COMPLAINT

  1. That, the Complainant purchased a Burglary Insurance Policy from the OPs for his business premises and the stocks stored and or kept and displayed therein/ the business premises is known in the name and style “Promila Builders” situated within the jurisdiction of Bhaktinagar Police Station Dist Jalpaiguri/ Policy was being in no. OG-22-2404-4010-000003907 and the tenure of the policy was from 25.01.2022 to 24.01.2023 and limit coverage was of Rs. 1,35,00,000/- / On several persuasions by the Complainant the OPs did not supply the Complainant with the policy certificate with respect to the said insurance policy.
  2. That, on 17.11.2022, burglary / theft took place when water proof Silicon Carbide Paper of Asian Paints, Colour of Asian Paints, Sanitary items of Asirbad Company, HP Laptop, Cell Phone with SIM Card were stolen away from the business premises of the Complainant / Complainant immediately informed the matter to the Officer-in-Charge, Ashighar Outpost and the Police of that PS, on the basis of that information started Bhaktinagar PS Case No. 1248/22 dated 17.11.2022 u/s 380 of IPC / The Complainant also informed the matter in writing to the Officer-in-Charge, Ashighar Outpost on 18.11.2022 about the items theft from the place of business and the Officer-in-Charge, Ashighar Outpost received the same on 18.11.2022 (Annexure A).
  3. That, on 17.11.2022the Complainant intimated the OPs about the said burglary and loss of stock estimated to an amount of Rs. 5,88,382/- and raised a claim with the OPs to that extent being claim no. OC-23-2404-4010-00000010.
  4. That, on the basis of that intimation the OPs on 18.11.2022 carried necessary survey of the affected place and assessment of loss incurred by the Complainant due to the burglary through their duly appointed IRDA approved surveyor Mr. Kabi Das / the surveyor’s report submitted to the OPs confirmed the said incident as well as estimated loss of the Complainant / As per request of the OPs the Complainant also detailed to the surveyor in writing on 01.02.2023 the estimated amount of its each stolen goods which was verified by the surveyor. (Estimated amount of the stolen good of Complainant is Annexure B).
  5. That, the OPs despite being in knowledge and confirmation of the incident and the consequential estimated loss of the Complainant through the said surveyor’s report repudiated the claim of the Complainant vide repudiation letter dated 30.03.2023 under a policy condition “24*7 word and watch” with respect to the policy of the Complainant and the said repudiation is absolutely arbitrary, unfair, and not tenable in the eye of law (Repudiation letter dated 30.03.2023 issued by the OPs is Annexure C).
  6. That, thereafter the Complainant sent a legal notice dated 16.05.2023 to the OPs by registered post with AD being postal receipt no. RW641678835IN dated 17.05.2023 and RW 641678813 IN dated 17.05.2023 asking the OPs through the said legal notice to pay/ reimburse the claim of Rs. 5,88,382/- to the Complainant for the policy being no. OG-22-2404-4010-000003907 and claim no. OC-23-2404-4010-00000010 within 15 days from the receipt of notice (Legal Notice dated 16.05.2023 along with postal receipts are Annexure D series).
  7. That, the said notice had duly been received by the OP No. 1 on 18.05.2023 and by the OP No. 2 on 26.05.2023 but they did not respond. (Delivery of legal notice to the OP No. 1 and 2 are Annexure E & F).
  8. That, again the Complainant visited the OP No. 1 in the 3rd Week of June, 2023 and requested to reimbursement of its insurance claim but the OP No. 1 only provided the copy of Policy Certificate to the Complainant and refused to reimburse the claim (Policy certificate being no. OG-22-2404-4010-000003907 is Annexure G).
  9. That, despite several request by the Complainant as well as persuasion the OP have not supplied the Policy Certificate with respect to the said the policy at the time of purchasing the policy or at any time before the burglary / theft so relying on the policy condition with respect to the aforesaid policy to repudiate the claim of the Complainant cannot be entertained in the eye of law.
  10. That, the Complainant is not a signatory to any terms and condition of the policy comprising the exclusion clauses of the policy and unaware about the same and the condition if any, are pre-drafted by the OPs without giving any opportunity to the Complainant to apply its mind and for which the exclusion clause relied on by the OPs in the repudiation letter dated 30.03.2023 is bad in law.
  11.  That, the exclusion clause and condition imposes on the Complainant an unreasonable condition which put the Complainant to disadvantage and thereby unfair contractual term not binding on the Complainant which jeopardize his right as a consumer under the OPs.
  12. That, the claim of the Complainant is genuine and the conduct of the OPs are tantamount to serious departure from consumer kindness, serious deficiency in service and unfair trade practice towards the complainant.
  13. That,  the cause of action of this case arose on 17.11.2022 when the burglary/ theft occurred and on 17.11.2022 when the Officer-in-Charge of Bhaktinagar PS started a case being no. 1248/22 u/s 380 IPC and when the Complainant intimated the incident of burglary and its consequential loss of stock and raised the claim before the OPs being no. OC-23-2404-4010-00000010, on 18.11.2022 when the Complainant detailed about its loss of items due to burglary to the Officer-in-Charge of Ashighar Outpost and when the said outpost received the complaint and on 18.11.2022 when the OPs carried out necessary survey of the affected place and assessed the loss incurred by the Complainant due to burglary through their duly appointed IRDA Approved surveyor Mr. Kabi Das and the surveyors’ report submitted to the OPs confirmed the incident and the consequential estimated loss of the Complainant and on 30.03.2023 when the OPs repudiated the claim of the Complainant despite having knowledge and confirmation of the incident and the consequential estimated loss of the Complainant through their surveyor’s report and on 17.05.2023 when the Complainant sent legal notice dated 16.05.2023 to the OPs and on 18.05.2023 and 26.05.2023 when the OP No. 1 and 2 received the legal notice respectively but did not respond the same and in the 3rd week of June 2023 when the OPs continued to refuse to reimburse the claim of the Complainant and thereafter on each and every day against the OPs within the jurisdiction of this Commission.

In support of the Complaint the Complainant has filed the following documents:-

  1. Written intimation dated 18.11.2022 to the Officer-in-Charge, Ashighar Outpost (Annexure A).
  2. Written estimate amount of stolen good. (Annexure B).
  3. Repudiation letter dated 30.03.2023 issued by the OPs to the Complainant (Annexure C).
  4. Legal notice dated 16.05.2023 along with postal receipts. (Annexure D series).
  5. Proof of delivery of the said legal notice to the OP No. 1 being postal receipt no. RW641678835IN (Annexure E).
  6. Proof of delivery of the said legal notice to the OP No. 2 being postal receipt no. RW 641678813IN (Annexure F).
  7. Policy certificate being no. OG-22-2404-4010-000003907 (Annexure G).
  8. Trade registration certificate of the complainant. (Annexure H).

Notice was sent from this Commission upon the O.P’s were duly served. On receipt of notice both the O.P’s have appeared before this Commission through Vokalatnama, filed their Written Version, denied all the allegations of the Complainant. In the Written Version both the O.P’s. have stated that the Complaint is not at all maintainable either in law or in facts / this Commission has no jurisdiction to entertain and determine the instant Complaint as the provisions of Consumer Protection Act are not attracted against the O.P’s. / non- compliance of claim or if the Insurance Policy is hit by britches of contract the in that case  the civil court is the only competent forum to adjudicate the matter in accordance with law / the Complainant has file this case by suppressing the material facts. In the Written Version both the O.P’s. have also stated that there is no cause of action against the O.P’s to file this case by the Complainant and he files this case against the O.P’s. with a ulterior motive to derive unlawful pecuniary gain and it is settled provisions of law that the point of maintainability must be decided at the first instance before considering the merit of a case / the complaint is frivolous vexatious and harassive and that’s why the Complaint is not maintainable in law or facts. In the Written Version the O.P’s have stated that the statements made in Pragraph No. 1 of the Complaint is true as the Complainant had taken the Burglary Insurance Policy Vide Policy No. OG-22-2404-4010-000003907 valid for the period from 25.01.2022 to 24.01.2023 in the name of Promila Builders for the total sum insured of Rs. 1,35,00,000/- (Rupees One Crore Thirty Five Lakhs Only) subject to Policy Terms and Conditions and warranties. In the Written Version, the O.P. No. 1 & 2 have also stated that the statement made in paragraph 2 - 4 & 6 - 8 of the Complaint are matters of record and the statements of Paragraph No. 5 is true. It is also stated in the Written Version that the statements made in Paragraph No. 9 – 11 of the Complaint are not true and no such cause of action arose against the O.P’s as stated in Paragraph No. 17 of the Complaint. There was no deficiency in service on the part of the O.P and the O.P’s. / Insurance Company has lawfully decided to repudiate the claim of the Complainant considering the terms and conditions of the Policy and exclusion Clause which are binding upon both the parties i.e. the Insured as well as the Insurer  and neither of them can go beyond that and the Complainant is not entitled to get any relief or reliefs as prayed for in Paragraph No. 24 of the Complaint.  The O.P. No. 1 & 2 have also stated that it is fact the Complainant had taken a Burglary Insurance Policy which was valid from 25.01.2022 – 24.01.2023 in the name of Promila Builders for the total sum insured of Rs. 1,35,00,000/- (Rupees One Crore Thirty Five Lakhs Only) subject to Policy Terms and Conditions, exclusions and warranties etc (Policy and the Policy Wordings  are Annexure I & II).

It is further stated that the incident of theft in the shop of the Complainant had occurred on the night of 16  / 17 November 2022 by some miscreants and thereafter on next date the Complainant inform and lodged a Written Complaint to the Ashigharh Out Put on 18.01.2022 and on the basis of the same, specific case being Bhaktinagar case No. 1248/2022 dt. 17.11.2022 under section 380 of I P C was started and the O.P. Insurance Company soon after receipt of the information from the Complainant on  17.11.2022 appointed an Independent I R D A License  surveyor and loss assessor namely Rabi Das who visited place of occurrence on 18.11.2022 and the surveyor after completion of Inspection/ Survey submitted his the report on 27.03.2023 and in view of the Surveyor Report statement of the Complainant / insured and their mail dt. 30.03.2023 it had been confirm that there was no security guard present at the business  premises on the date of incident / theft whereas the policy hold a warranty clause opted by the insured which its as under –“24*7 Ward and Watch”, which means a continuous watch or vigil, by or as by night and by day, especially for the purpose of guarding. (The copy of mail dated 28.03.2023 sent by the executive of the OP Insurance Company and reply mail dated March 30, 2023 of the Complainant / insured are Annexure III & IV).

In the written version, the OP No. 1 and 2 have stated the general conditions No. 5 & 5.1 of the policy wordings which is as follows-

“The due observance of and compliance with the terms, provisions, warranties and conditions of the policy in so far as they relate  to anything to be done or complied with by the insured shall be a condition precedent to any liability of the company under the policy”. It is also stated that, though the surveyor has assessed the loss valued at the tune of Rs. 2,16,890/- but the same is not payable by the insurance company because as per the policy in question there was clear violation of “Warranties” clause because there was no security guard at the business premises as confirmed by the mail dated 30.03.2023 (Surveyor’s report is Annexure V). They have also stated in the W/V that  on the basis  of surveyor’s report and also in view of the violation of the warranty condition the OP company had repudiated the claim vide letter dated 30.03.2023 and the claim of the Complainant is not at all admissible or payable by the OPs as per the terms and conditions of the policy in question and the complaint is liable to be dismissed as there was a gross and sole negligence on the part of the Complainant / insured who violated the policy condition and that’s why the Complainant cannot take advantage for his wrong committed by himself. By filing written version, the OP No. 1 and 2 praying for dismissal of the case of the complainant.

Perused the complaint, and documents filed by the complainant, written version along with the documents of the OPs, the following points are taken up together for discussion.

Points for consideration :-

  1. Whether the Complainant is a Consumer?
  2. Whether the case is maintainable under the Consumer Protection Act 2019?
  3. Whether there is any deficiency in service on the part of the O.P. as alleged by the Complainant?
  4. Whether the Complainant is entitled to get the relief as prayed for?                                          

   Decision with reasons

All the points are taken up together for discussion to avoid unnecessary repetition and for the sake of convenience and brevity of this case.

Complainant was given liberty to file its evidence.  To prove the case the Complainant has filed Evidence in the form of an Affidavit. In the Written Evidence the Complainant has specifically corroborated the statements so made in the Written Complaint. The Complainant has stated in its evidence that they purchased the Insurance Policy which was being in no. OG-222404-401000003907 and the period of insurance the policy was since 25.01.2022 to 24.01.2023 and he also stated the limit of coverage of Rs. 1,35,00,000/- . The Complainant has specifically stated in his evidence that, a incident of theft/ burglary was taken place on 17.11.2022 in the business premises of the Complainant and to that effect he lodged a complaint with the Police of Ashighar Out post and on the basis of written complaint of the Complainant a Bhaktinagar PS Case no. 1248/22 dated 17.11.2022 was started u/s 380 of IPC . The Complainant in his evidence has also stated the specification of articles which were stolen away from his business place and to that effect the Complainant informed the Police regarding the items which were theft and the Police received the intimation on 18.11.2022. In the written evidence the Complainant has further stated that they sustained loss of Rs. 5,88,382/- due to such burglary and they raised a claim to the OPs being claim no. OC-23-2404-4010-00000010 and on receipt of intimation dated 18.11.2022 independent IRDA approved surveyor Kabi Das was appointed by the OPs who confirmed the said incident of burglary as well as consequential loss of the Complainant and the Complainant intimated the surveyor in writing on 01.02.2023 about the estimated amount of its each stolen goods which was duly verified by the surveyor. The Complainant has further corroborated the statements of the complaint who stated that, the claim of the Complainant was repudiated by the OPs by a letter dated 30.03.2023 arbitrarily and thereafter the Complainant sent a legal notice dated 16.05.2023 to the OPs asking to pay / reimburse the Complainant the sum of Rs. 5,88,382/- vide its claim but the OPs despite receiving the demand notice did not respond. The Complainant has further stated in his evidence that, he again visited the OP No. 1 in the 3rd Week of June, 2023, requested for reimbursement of insurance claim but the OP No. 1 only provided the Complainant with the policy certificate and refused to reimburse the claim of the Complainant and prior to that, the OPs have not supplied the Complainant with the policy certificate in respect of the policy at the time of purchasing the policy or at the time before the burglary / theft.

At the time of argument, Ld. Advocate of the Complainant argued that, the Complainant has been able to prove its case against the OPs not only by filing written evidence but also by filing several documents including the written intimation which was given to the Police of Ashighar Outpost, written estimate about the stolen goods, repudiation letter dated 30.03.2023 issued by the OPs, legal notice dated 16.05.2023 including the policy certificate and trade registration certificate. Ld. Advocate of the Complainant further argued that, immediately after the incident of burglary / theft one surveyor as well as loss assessor was appointed by the OPs who was approved by the IRDA and after completion of its enquiry the surveyor had submitted its report admitting the loss which was caused in the business place of the Complainant due to burglary/ theft which was occurred on 17.11.2022. He further argued that, the OPs have repudiated the claim of the Complainant by assigning frivolous grounds which is not at all tenable in the eye of law and prior to repudiation of the claim for reimbursement the OPs have not served the policy certificate including its conditions to the Complainant which is nothing but the gross deficiency in service on the part of the OPs as well as unfair trade practice. Ld. Advocate of the Complainant further argued that, on the date of the incident of the burglary / theft the insurance policy was effective and there is no denial on the side of the OPs. He also argued that, the allegation of the OPs for violation of policy conditions are not tenable as the Complainant was not served with the policy certificate and no signature of the Complainant was taken on the said term and condition “24*7 Ward and Watch” in the said policy and the said condition are pre-drafted by the OPs in the said policy and no opportunity was given to the Complainant to apply its mind on the said terms and conditions and he also stated that, Annexure II (policy and policy wordings) of the OPs reveals that, nowhere contemplates warranty clause which read as “24*7 Ward and Watch”. He further argued that, in the Annexure III of the OPs it clearly reveals that, the security guard was deployed at all material times of the business premises of the Complainant and the date of burglary had been no exception to the same. It is further argument of the complainant, that the Annexure V of the OPs clearly admits that, the amount of loss payable to the Complainant is of Rs. 2,16,890/- but the surveyor has not given any reason as on what basis and for what reason claim of the Complainant of Rs. 5,88,382/- is not justified and the said reduction of the claim amount was not properly explained in the report of the surveyor.

At the time of hearing of argument, Ld. Advocate of the Complainant referred decisions reported in 2008 (69) AIC 650 (P & H) and in 2022 LiveLaw (SC) 937 & First Appeal No. 133/2020 decided on 08.02.2021 of the Hon’ble SCDRC, Punjab/ Chandigarh and (2008) 151 PLR 313 and (2007) CPJ 236 and (2005) CPJ 27 (NC) and by referring those decisions Ld. Advocate of the Complainant submits that, the Complainant has been able to prove the case against the OPs and thereby entitled to get the relief as prayed for.

To falsify the case of the complainant, the OPs were given liberty to file their Evidence in the form of an Affidavit but they did not file any evidence and subsequently they filed Written Notes of Argument in support of their written version.

At the time of hearing of argument, Ld. Advocate of the OP no. 1 and 2 has stated that, they have already filed written notes of argument on behalf of the OPs and in the said written notes of argument they specifically stated that, by suppressing the material fact the Complainant has filed this case to extort compensation amount knowing fully well aware that, the Complainant has violated / flouted the policy conditions and thereby the case is requires to be dismissed. Ld. Advocate of the OP No. 1 and 2 further argued that, the case is not maintainable either in law or in facts, and the Complainant has filed this case to harass the OPs and they have not come before this Commission in clean hands. Ld. Advocate of the OP No. 1 and 2 argued that, the Complainant had taken a Burglary Insurance Policy which was valid from 25.01.2022 to 24.01.2023 in the name of Promila Builders for the total sum insured of Rs. 1,35,00,000/- only subject to policy terms and conditions, exclusion and warranty etc. He further argued that, the incident of theft in the shop of the Complainant had occurred on the night of 16/17 November, 2022 by some miscreant and on the next day the Complainant lodged a written Complainant to the Ashirgarh Out post and on the basis of the written complaint the Police of Bhaktinagar PS started PS Case No. 1248/2022 dated 17.11.2022 u/s 380 IPC and on receipt of information of the Complainant the OPs have appointed an independent IRDA Approved surveyor and loss assessor namely Rabi Das who visited the place on 18.11.2022 and submitted its report on 27.03.2023 and on 30.03.2023 the Complainant sent an email confirmed that, there was no security guard present at the business premises on the date of incident whereas the policy holds a warranty clause opted by the insured and they violated the said warranty clause and though the surveyor has assessed loss value at the tune of Rs. 2,16,890/ only but the same is not payable by the insure company as per policy in question as there was clear violation of the Warranty’s clause because there was no security guard at the business premises which was confirmed by mail dated 30.03.2022. It is further argument of Ld. Advocate of the OP No. 1 and 2 that, the question of negligence in service comes only if there is no breach of contract and/ or violation of any such policy terms and conditions and as the Complainant has violated the policy conditions and the Complainant is not entitled to get any relief from this case.

Having heard the Ld. Advocate of both the sides, and on perusal of the complaint, written version of the OPs, documents filed by the parties, written evidence of the Complainant and brief notes of argument of the parties it is admitted fact by both the parties that, the Complainant was a policy holder of Burglary Insurance Policy which was taken from the OPs being Policy No. OG-22-2404-4010-00003907. It is further admitted fact by the parties that, the said Burglar Insurance Policy was valid and effective for the period from 25.01.2022 to 24.01.2023 in the name of Promila Builders. It is also admitted fact that, the total sum insured for the policy was of Rs. 1,35,00,000/- only. It is further admitted fact that, the incident of burglary/ theft was taken place in the shop of the Complainant on the night of 16/17th November, 2022. It is further admitted fact that, the Complainant lodged a written complaint with the police of Ashighar Outpost in writing on 17.11.2022 and on the basis of the said written complaint a police case was started being Bhaktinagar PS Case No. 1248/2022 dated 17.11.2022 u/s 380 IPC. It is also admitted fact by both the parties that, after getting information of theft / burglary from the Complainant the OPs had appointed IRDA approved surveyor cum loss assessor and the surveyor after completion of its survey submitted its report to the OPs. It is also admitted fact both the parties that the surveyor after holding the survey in the shop of the Complainant submitted his report admitting that,

  1. The amount of loss claim Rs. 5,88,382/- ,
  2. Amount of loss assessed Rs. 4,14,497/- &
  3. The amount of loss payable of Rs. 2,16,890/-. (Vide Annexure V filed by the OP)

Now let us see, how far the Complainant has been able to prove the case against the OPs or how far the OPs have been able to falsify / disprove the case of the Complainant or not?

It is specific case of the Complainant that, due to burglary / theft in the shop he sustained loss of Rs. 5,88,382/- and the Complainant intimated the OPs about the burglary and consequential loss of stock as estimated. It is also the specific case of the Complainant that, they raised claim within due time and after getting information from the Complainant , IRDA approved loss assessor/ surveyor was appointed by the OPs and the surveyor has submitted his report admitting the loss sustained by the Complainant.

            On the other hand, the OP No. 1 and 2 has claimed that, there was a clear violation of the ‘warranties’ clause of the Insurance Policy because there was no security guard at the business premises of the Complainant. The OPs have also claims that, on the basis of the Surveyor’s Report and in view of the violation of the warranty condition the claim of the Complainant was properly repudiated by the OPs vide letter dated 30.03.2023. The OPs have also claims that, the Burglary Insurance Policy holds a warranty clause opted  by the insured which was “24*7 Ward and Watch” i.e continuous watch or vigil, by or as by night and by day, especially for the purpose of guarding. But the OPs have failed to prove before this Commission by producing documents that, they supplied the Policy Certificate with respect to Burglary Insurance either at the time of purchase of the Policy or prior to the incident of theft/burglary.

            The OPs have also failed to prove the fact that, the Complainant had put its signature on any terms and condition of the said policy, unless and until the policy conditions as well as Policy Certificate is supplied to the insured prior to the incident of theft/ burglary it would be hard to swallow how the Complainant has violated the exclusion clause of the policy which the OP No. 1 and 2 claims.

            On the other hand, from careful perusal of the Annexure 1 and 2 of the OPs we don’t find any warranty clause “24*7 Ward and Watch”.

            According to the I.R.D.A Circular it is settled that, “the insurers decision to reject a claim shall be based on sound logic and valid grounds and rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the Insurance Industry, giving rise to excessive litigation”.

            In the case in hands the grounds assigned by the OPs for repudiation of claims of the Complainant are not convincing, rather hyper technical.

            It is also settled provisions of law that it is the duty of the insurer to disclose exclusion clause to the insured and non disclosure of that exclusion clause and failure to furnish a copy of the contract by following the procedure required by statute, make the said clause redundant (2022 Live Law (SC) 937. In the case in hand the OP No. 1 and 2 have failed to prove that, the exclusion clause of the Insurance Policy was duly intimated /disclosed to the Complainant prior to the incident of theft/ burglary.

            Considering all we are of the view that, the genuine claim of the Complainant was repudiated by the OPs by assigning hyper technical grounds and the said act of the OPs are nothing but the deficiency in service as well as restrictive trade practice. Accordingly, we are also of the view that, the Complainant has been able to prove its case against both the OPs.

Hence it is therefore,

 O R D E R E D

 

That the instant Consumer Case being in No. 43/2023 is hereby allowed on contest against the OPs but in part. The OPs are directed to pay a sum of Rs. 4,14,497/- (Rupees Four Lakh Fourteen Thousand Four Hundred Ninety Seven) only  to the Complainant towards reimbursement of the claim. The OPs are further directed to pay a sum of Rs. 50,000/- (Rupees Fifty Thousand ) only towards compensation for causing harassment, sufferings caused to the Complainant. The OPs are also directed to pay a sum of Rs. 10,000/- (Rupees Ten Thousand) only  to the Complainant towards the cost of legal proceedings. They are further directed to pay a sum of Rs. 10,000/- (Rupees Ten Thousand) only  in the Consumer Legal Aid Account of this Commission. The OPs are directed to pay interest @5% per annum to the Complainant on the awarded amount with effect from the date of filing of this case till making payment of the entire amount.

The OPs are also directed to pay the awarded amount within 45days from this day failing which the Complainant will have the liberty to take proper steps against the OPs as per law.

Let a copy of this Order / Judgment be given to the Complainant free of cost.

 

 
 
[HON'BLE MR. APURBA KUMAR GHOSH]
PRESIDENT
 
 
[HON'BLE MRS. Arundhaty Ray]
MEMBER
 
 
[HON'BLE MR. DEBANGSHU BHATTACHARJEE]
MEMBER
 

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