Repudiation of insurance claim by the OP1 has irked the policy holder of the OP1, herein the complainant to lodge this complaint u/s 12 of the CP Act 1986 for adjudication & redressal.
The quint-essence of the complaint goes that the complainant has the fire insurance policy bearing No.2114/52974722/0330 with effect from 2003 with the OP1. The policy was purchased at the time of taking loan from the OP-2 with which the OP-1 has a MOU. The complainant’s business centre has caught fire on 16.11.2016 at about 9 pm and GDE in this respect has been lodged with Gangarampur Police station on 17.11.2016 having GDE No. 1589 dt. 17.11.2016. The complainant has also lodged his complainant with West Bengal Fire Service Department on the very date, on the basis of which the officer in charge of the West Bengal Fire Service made an investigation and sent a report of loss amounting about Rs.5 lakh 98 thousand and it was noted in the said report that the cause of fire is short circuit . The complainant on 17.11.2016 brought the matter of the damage to the knowledge of the OP-1 and a survey had been conducted by a surveyor appointed by the OP1. The complainant has filed the documents of GDE with Gangarampur Police station the report of the West Bengal Fire Service Department, insurance policy a copy of agreement with the OP2 (kept in record) to this Forum. The OP1 on the basis of his survey report agreed to pay Rs 115881/- as full and final settlement which the complainant declined to accept. The complainant in his complaint has claimed Rs 5 lakh with an interest @ 9% as principal amount and a compensation of Rs. 4 lakh 40 thousand and litigation cost of Rs. 10 thousand.
In his written version the OP1 has denied all the averments of the complainant and demanded that the complaint has violated the terms and condition of the insurance policy. They had in writing given an account of calculating the risk coverage of the insurance policy and claimed that the complainant had been requested by the surveyor through his latter dt.21.11.2016, 22.12.2016 and 19.01.2017 to submit some documents, the copy of which has been said to be submitted to this Forum, actually not enclosed with the written version by the OP1. The OP1 has claimed that the present complaint is liable to be dismissed without looking into any other aspects of the matter.
The OP2 in his written version has claimed that though the complainant is a bona-fide consumer of his bank having cash credit loan account No. 22370844245 with effect from 01.11.2004 but he is really a misjoinder in the instant case. In the written version the OP2 has admitted that the complainant has the insurance coverage for the period from 29.03.2016 to 28.03.2017 with the OP1 having the said policy number with the sum insured value of Rs. 5 lakh for the complainant’s stock. The complainant has also regularly submitted the stock report to the OP2. and also admitted that the complainant’s place of business caught fire on 16.11.2016 and he had made the claim to the OP1 vide No.C216070661. It is also admitted that the insurance company had sent a surveyor who had made the survey and calculated the loss or damage of the insurance stock. So the part repudiation of the claim by the OP1 is not his responsibility. So he is a misjoinder and should be exempted from the instant case.
On argument the complainant had admitted that he was offered a compensation of Rs.115881/- from the OP1 but he had declined to accept it as the damage or loss caused to his stock as assessed by the West Bengal Fire Service Department is Rs. 5 lakh 98 thousand. He has the insured value of Rs. 5lakh with the OP1 and he is paying the premium for the insurance police since 2003. And he has never claimed any amount for any loss/damage from insurance company earlier. He questioned how a surveyor appointed by the insurance company estimates less value of his loss or damage of stocks than the estimated value of the West Bengal Fire Service Department. So his claim is proper.
On argument the ld. Lawyer for the OP1argued that according to the insurance policy the complainant is liable to get his claim on the act of terrorism and not for fire. He argued further that the loss estimated by the fire service department is meant for the damage due to fire on the building but not on the stocks. The premium paid is meant for terrorism premium. He has filed a document in this respect. But this Forum on the basis of the document where in it is clearly written “Standard Fire and Special Perils Policy Schedule cum Tax Invoice” has questioned the Ld. Lawyer his basis of argument regarding terrorism policy. But the Ld. Lawyer for the OP1 failed to make satisfactory answer.
On argument the Ld. Lawyer for the OP2 stated what he has stated in his written version and prayed for an exemption from the instant case as he is a misjoinder.
Points for Discussion:
- Is the complainant a consumer to the OP1 and OP2?
- Is there any deficiency in service on the part of the OP1 by partly repudiating the claim?
- Is the OP2 is really a misjoinder or have some deficiency in service on his part?
DECISION WITH REASONS
The complainant is a consumer to OP1 as a policy holder and to OP2 as an account holder which have never been denied by the OP1 and OP2. So in terms of section 2(1) (d) of the C.P Act,1986 the complainant is a consumer. From the above discussion it is clear that the occurrence of fire had on 16.11.2016 and the damage was caused to the goods of the complainant, the value of which according to the report of the West Bengal Fire Service Department is Rs. 598000/-. We are not convinced on the surveyor report how the assessed value of the damage stock becomes less than what has been assessed by the West Bengal Fire Service Department. The document filed by the OP2 also proves that the stock in the premises of the complainant was not less than Rs 11lakh 50thousand. The complainant has also submitted all records of his stock to the surveyor as claimed for. In adjudicating the instant case we have taken refuge to the Revision petition No. 2582 of 2016under National Consumer Disputes Redressal Commission, New Delhi in the case between Murari Tile vs Branch Manager, New India Insurance Company Ltd [ 2017 (2) CPR 9 )NC)], the important point of which is ‘a bona fide insurance claim cannot be repudiated by insurance company’. We further may take refuge to the important point observed by the Hon’ble NCDRC in revision petition No. 825 of 2016 in the case between National Insurance company ltd. Vs Aata Naina Devij Fuel Centre “unless Insurance Company is able to show that insurance claim falls within some exclusion or exception provided in terms and conditions, insurance company cannot evade its liability under insurance claim” [2018(2) CPR 378(NC)]. From the written version and argument of the OP1 we are not convinced about the basis of the assessment by the surveyor and part repudiation on the basis of the surveyor report by the OP1. We are also convinced that the OP2 is a misjoinder in the instant case.
Hence, it is
O R D E R E D
The OP1 is directed to pay Rs 5 lakh of the insured value for the damage goods of the complainant within 30 days from the date of this order, a compensation of Rs.40 thousand along with litigation cost of Rs. 6000/- is to be paid to the complainant by the OP within 30 days from the date of this order, failing which the principal amount of Rs. 5 lakh and the compensation amount will bear interest @ 9% till the full realization of the amount.
The complainant is directed to deposit Rs 10.000/- to the S.C.W.F, W.B immediately after receiving the compensation amount from the OP1 by cheque or demand draft.
The case be and the same succeeds on contest.
Let a plain copy of this order be furnished to the parties forthwith free of cost.
