Date of Filing: 11-08-2016 Date of Final Order: 26-04-2017
Smt. Runa Ganguly, Member.
The factual matrix of the present case is that the Complainant obtained Insurance Policy from the OP Insurance Company covering a risk of Rs.10,00,000/- for his residential house against fire and earth-quake. The Policy was valid from 18.02.15 to 17.02.16. The Complainant used to pay premium regularly. During the subsistence of the said Policy an earth-quake occurred on 4.1.2016 and the Complainant’s residential building was damaged majorly. The Complainant informed the OP and accordingly he was asked to submit a claim with estimate of loss and damages of his residential house. The Complainant engaged a Consultant Civil Engineer to assess the loss and damage who estimated the loss to the tune of Rs. 85,359/- only. The Complainant submitted his claim to the Office of the OP for an amount of Rs.85,359/- alongwith all necessary documents. The OP Insurance Company did not settle the claim even after elapsing so many months for which Complainant sent a letter/complaint on 12.05.16. Subsequently, the Complainant in the month of July, 2016 received a letter from OP which reveals that the claim of the Complainant has been settled as final settlement of Rs.37,900/-. By not settling the actual claim, the OP has caused deficiency of service. Finding no other alternative, the Complainant filed the present case seeking redress and relief as incorporated in the prayer petition of the Complainant.
Besides, the OP Insurance Company by appearing before this Forum contested the case through Ld. Agent.
The OP Insurance Company by filing w/v contending inter-alia that the present case is not maintainable in its present form as well as in law.
The OP admitted that this answering OP issued a House Holders Package Policy No.313202/48/2015/1328 for the period from 18.02.15 to 17.02.16 in the name of the present Complainant. The OP also admitted the fact of partly damage of the insured building due to earth-quake on 04.01.16 at 4.30 AM.
The main contention of this answering OP is that the Complainant engaged a Civil Engineer for his own satisfaction. The Insurance Company never asked the Complainant to submit estimated loss of this damaged house. It makes denial about the other allegation made by the Complainant in his complaint .
The further contention of OP is that after receiving the claim on 06.01.16 the OP appointed a surveyor. The Surveyor surveyed the spot on 07.01.16 and submitted his report on 17.03.16 after receiving required documents from the Complainant. Thereafter, the Branch Manager approved the claim after receiving the survey report on 13.05.16 and settled the claim to the tune of Rs.37,900/- and requested the Complainant to send Bank details but the Complainant ignored and filed the instant case.
The OP never repudiated the claim for which it had no deficiency in service and prayed for dismissal of the case with cost.
In the light of foregoing discussion, the following moot points came up for discussion to reach final decision:
POINTS FOR CONSIDERATION
- Is the Complainant Consumer as per provision under Section 2(1)(d)(ii) of the C.P. Act, 1986?
- Has this Forum jurisdiction to entertain the instant complaint?
- Has the O.P any deficiency in service as by not settling the claim of the Complainant?
- Whether the Complainant is entitled to get relief/reliefs as prayed for?
DECISION WITH REASONS
We have gone through the record very carefully and perused the documents made available in the record. Perused also the evidence on affidavit filed by the parties and heard the argument at a length advanced by the parties.
The Ld. Agent for the Complainant cited the ruling [2015] CJ 114 (NC):
The following rulings are cited by the Ld. Agent for the O.P.
i)[2015] CJ 956 (NC)
ii)[2015] CJ 401 (NC).
All are perused and considered.
Point No.1
The Complainant obtained a Policy from the Opposite Party on payment of certain amount as consideration and hired service of the O.P. Insurance Company. Thus, we have no hesitation to hold that the Complainant is a Consumer as per C.P. Act 1986.
Point No.2
The place of business of the O.P. is situated within this district and the complaint value of the present case is far less than the prescribed limit for which this forum has territorial as well as pecuniary jurisdiction to try the present case.
Point No.3 & 4
Undisputedly, the Complainant obtained an Insurance Policy bearing No.313202 /48 /2015/1328 from the OP Insurance Company for his residential house, covering risk of Rs.10,00,000/- against fire and earth-quake.
The point of the dispute is that within the validity of the said Insurance, the residential house of the Complainant was partially damaged due to an earth-quake on 04.01.16, but the OP did not settle the claim even after proper intimation with relevant documents.
It is the case of the OP that by receiving the claim petition, the OP without any delay appointed a Surveyor and as per Surveyor’s report, they settled the claim and asked the Complainant for his Bank details but the Complainant did not co-operate the OP rather filed the present case. The OP did not repudiate his claim.
Evidently, & Admittedly, the Complainant obtained one House Holders Package Policy from the O.P. On meticulous scrutiny the documents available in the record, we do find that the Complt. informed the Insurance Company on 06.01.2016 about the incident ( Annexure-B)
The O.P. sent a letter on 07.01.2016 asking some documents in connection with the claim of the Complainant. It also appears that the Complainant duly submitted the required documents alongwith Estimate of repairs amounting to Rs.85,359/-.
There is no denial of O.P. Insurance Company about the incident as stated by the Complainant.
Annexure ‘E’ revels that O.P. by letter dated 27.07.2016 informed the complainant that they settled his claim with Rs.37,900/-.
The Ld. Agent for the O.P. during the course of argument vehemently argued that as per Insurance guide line there is no scope to an Insured to estimate his loss and damage. Thus, the O.P. did not accept the estimate submitted by the Complainant.
The O.P. settled the policy on the basis of surveyor report. The Surveyor was appointed by the O.P. Insurance Company. The alleged loss has been surveyed and assessed by the Surveyors. The surveyor took information by visiting the house of the Complainant also took photographs of the damaged portion of the house of the Complainant and then assessed the loss suferred by the Complainant.
During the course of the Argument Ld. Agent for the Complainant Argued that no survey was made by the O.P. they make only table work and prepared a report. But we do find from Annexure ’C’, the claim damage intimation letter dated 12.05.2016 by the Complainant that the Complainant himself admitted that Surveyor attended to enquire of the matter on 07.01.2016. The complainant deliberately in his Complaint petition as well as on evidence has given false statement which is not tenable in the eye of Law. Also , it can be presumed that the Complainant did not come before this Forum in clean hand.
Besides, the Ld. Agent for the O.P. by filing documents able to show that the O.P. received the intimation on 06.01.2016 and on the same day they appointed a Surveyor. Survey at the house of the Complainant done on 07.01.2016 in presence of the complainant.
Peruse the survey Report by Keshav Kr. Khagra. It appears that Mr. Khagra vividly explain the loss and assessed total loss to the tune of Rs.38,116/- deducting salvage value and depreciation charge.
It also appears from the Photographs of the incident that some portion of the wall and roof of the house has been cracked due to earthquake.
The O.P. by a letter dated 27.07.2016 informed the Complainant that his claim has been settled with Rs.37,900/- .
The Complainant claimed Rs.85,359/- as loss estimated by one Diploma Civil Engineer. The said estimate prepared by the Complainant through the said Engineer in his sweet will in absence of O.P. Insurance Company. This report cannot be acceptable in the eye of law.
The O.P Insurance Company ‘s surveyor visited the house of the Complainant and prepared the same in presence of the Complainant. Thus, we have reason to give emphasize on the surveyor report of Insurance Company. We can’t ignore the Surveyor report as and when it is settled in a case reported in 2015 CJ 965 ( N.C) that “Surveyor’s report has significant value”.
In the light of foregoing discussion and Rulings of Higher Forum it is our considered opinion that the surveyor report is an important document and should not be ignored as and when we have no such cogent evidence to the contrary. It is settled principle that the surveyor report has the infinite value. Thus, the Complainant is entitled to get payment of claim as per report of the Surveyor.
Fact remains that the O.P. took about 6 months time to settle the claim after receiving the claim application though even after filing the present case. It is also well settled that Insurance claim must be settled within two months. Thus, in this context the deficiency in service of the O.P. is clearly proved for which the Complainant is entitled to get relief and compensation.
Be that as it may, in view of the facts and circumstances of the case we are in considered opinion that present case deserved to be allowed but in part.
Hence,
It is Ordered,
That the present case be and the same is allowed on contest with cost of Rs. 3000/- but in part.
The O.P. is directed to make payment of Rs. 38,116/- to the Complainant also to make payment of Rs.8,000/- as compensation for deficiency in service by not settling the claim in due time.
The entire order shall be complied with by the O.P. within 30 days i/d the entire amount shall carry interest @ 8% p.a. till its full realisation.
A plain copy of this order be made available and be sent to each of the parties free of cost by registered post with A/D forthwith as per rules.
Dictated and corrected by me.
