Assam

Dibrugarh

CC/4/2019

SRI PRANJAL BEZBARUAH - Complainant(s)

Versus

THE BRANCH MANAGER, THE ORIENTAL INSURANCE COMPANY LTD. - Opp.Party(s)

SRI BISWAJIT BAROOAH

10 Apr 2024

ORDER

Date of Argument – 08.12.2021

                                                                                                         22.02.2022

                                                                        Date of Judgment –  19.08.2023  

 

             This complaint was filed by the complainant under Section 12 of the Consumer Protection Act, 1986 claiming for a direction directing the opposite party for payment of `7,50,000/- being the sum assured of policy No.321104/22/2016/5 and for payment of interest @ 18%, compensation of ` 1,00,000/- for the inconvenience caused due to deficient service of the opposite party and an another sum of ` 30,000/- as cost of the proceeding.

Judgement

            The case of the complainant is that the complainant was the absolute owner of a private Motor Boat/Speed Boat named ‘Hilikha’ the hull of which was of length 6.40 M. and 1.40 M in breadth and 0.55 M in depth. The Boat was propelled by OBM engine bearing No.04761298 and 04801620. The said Boat ‘Hilikha’ had been duly registered at the Port of Guwahati, Assam and allotted Govt. Registration No.ASSAM-485 of 2000/Guwahati by the Registering Authority. The Motor Boat was privately used in own business purpose.

            As required by law, the said Motor Vessel ‘Hilikha’with its hull and machinery was duly insured with the Oriental Insurance Company Ltd., Maligaon Branch office for sum assured of ` 7,50,000/- and for acceptance of insurance proposal form and on payment of premium of ` 19,913/- against receipt No.51-01/4040004161, dtd. 08.12.2015 under Inland Vessels Policy schedule being No.321104/22/2016/5 given within insurance policy terms and condition. The policy was valid for the period from 08.12.15 to the midnight of 07.12.16. That the Inland Vessels Policy is conventionally govern Hull Insurance as per institutional time clause and is govern by the Marine Insurance Act, 1963. The policy covers total loss of the Vessel along with other covers. The sum insured of insurance of Hull and machinery of Vessel is on Agreed Value Basis.

            On 26.11.16 at about 11:30 a.m. while being driven by competent person coming/shifting from Kobo Chapori in Tinsukia district towards Nimatighat in Jorhat by river Brahmaputra (National Waterway No.2) the said Motor Vessel accidentally knocked against some hard object and sank in the water between Mohmora and Bogoritalia under Rohmaria Police Station in Dibrugarh district of Assam. There is no any loss of life as the occupants on board of the Boat managed to swim bank.

            On the next day, i.e. 27.11.2016 the complainant made all efforts to find out the Boat and lodged FIR at Rohmaria Police Station which was registered as Rohmaria P.S. G.D.E. 491 dtd. 20.11.2016. The site of occurrence of mishap was within the geographical limit of insurance coverage of the policy. The accident occurred due to striking with some object while sailing in river Brahmaputra which was declared as National Waterway No.2 and had a peril of the navigable water of which same is covered under the policy as the policy covers of the seized/rivers/lets or other navigable water way.

            The complainant inform the O.P. No.1 about the accident vide letter dtd. 28.11.2016 as the Boat was under insurance cover with the O.P. and the accident and loss being occurred during the period covered by the insurance policy and thereby lodged claim. The complainant after notifying the loss also submitted an application for survey on dtd. 03.12.16 as per condition mentioned in the policy schedule. The copy of FIR was also sent to the registering authority, i.e. Inland Water Transport, Guwahati, Commissioner of Transport Department to the Govt. of Assam and also to other Govt. Departments for information and necessary action.

            Police and other Govt. offices made enquiry about the matter and enquiry reports were issued by the O/C, Rohmoria Police Station dtd. 30.11.2016 and local Govt. appointed Village Headman of Bogoritolia village of 30.12.2016 etc. All those reports indicated the genuineness of the accident and loss of the boat which could not be recovered.

            Thereafter, as there remained no hope of recovery of the motor boat the complainant on 27.01.2017 prayed to the registering authority for cancellation of the registration and surrendered the original registration certificate. Accordingly, after due enquiry cancellation was granted and the R/C was cancelled by IWT Deptt. Vide order No.DWT(ISV)161/2015/57, dtd. 09.03.2017.

            The Insurer opposite party sent an investigator to investigate who came and carried survey and investigation and took necessary information and documents relating to the claim. The investigator asked the complainant to fill up a claim form and submit it to the insurance company. The claim form was required to be issued by the policy issuing office of the insurer soon after receipt of intimation of loss so as to provide details of claim etc. which was not issued until then. As per advice of the surveyor/investigator, the complainant approached the insurer and requested to issue a claim form vide letter dtd. 28.02.2017. But the insurer neglected to send the claim form for three months despite constant follow up by the complainant. Having no way out, the complainant, sent a representative Shri P. Barman to the office of the insurer to pursue and collect the claim form and at last the complainant get the claim form on 15.05.2017.

            The complainant posted the prescribed claim form along with forwarding letter to the insurer by Regd. Post on 10.11.2017 and some documents were submitted to the insurer by hand during the visit of representative of the complainant. But the insurer kept the claim pending before them for long. During the visit of a representative of the complainant the insurer again sought for certain documents which were already taken by their surveyor. However, the complainant again supplied the same vide letter dtd. 13.11.2018.

            The complainant lodged a genuine claim on valid policy and proved genuineness of the loss for compensation by submitting whatever documents needed. But till date the O.P. is sitting over the matter of settlement of the claim and preferred to remain mum inspite of cooperation and prompt compliance of all requirements, repeated reminders and visit to their office and delaying the settlement. Some time back whenever the complainant himself or through representative contacts or visits the insurer office, they used to say that the claim would be settled soon. The insurer O.P. as it appears from their conduct has been trying to get away from their contractual liability by deliberately delaying the settlement of the claim to an uncertain point of time or utilizing the payable amount of claim to their benefit. The act of excessive delay in settlement of claim is enough evidence of dereliction of duty, unfair trade practice and gross deficiency of service to the customer.

            The complainant narrates the following other instances of negligence, unfair trade practice and deficiency of service of the O.P. from the very beginning of issuance of insurance policy.

1. Issuing policy without furnishing the terms and conditions of the policy so as to keep the insured at dark about it.
2. Sending investigator after several months from the date of receipt of intimation of loss.
3. Not issuing the claim form soon after receipt of intimation and issuing it after several months later.
4. Non settlement of claim.
5. Using delaying tactics by intentionally asking to submit documents again after collecting through investigator.

            Due to non-settlement of the claim, even after two and half years accompanied by wrongful act of the O.P. No.1 the complainant had suffered heavy financial loss as well as business earning besides mental agony, harassment and financial hardship for which the O.P. is liable to compensate as the same falls under deficiency of service.

            Finding no alternative the complainant has filed this complaint before this Commission for redressal of his grievances and seeking relief.

            The O.P. No. 1 was requested for claim form on 28.02.2017 to submit the claim which was issued on 15.05.2017, as such there is no delay, rash or negligence in filing this case in this Commission which is clearly evident from the following chain of circumstances:

 

Accident occurred                                                      : 26-11-16

FIR lodged                                                                 : 27-11-16

Opp. Party informed                                                   : 28-11-16

Registering authority informed                                   : 28-11-16

Claim form asked as advised by investigator             : 28-02-17

Claim form issued                                                       : 15-05-17

Duly filled claim form submitted                               : 10-11-17

Complaint filed due to non settlement                       : 30-04-19

            The complainant prays before the Commission for grant of the following reliefs :

1. Payment of ₹ 7,50,000/- being the sum insured amount agreed for payment against total loss of motor boat under policy No.321104/22/2016/5.
2. Payment of interest @ 18% over the amount of ₹ 7,50,000/- from the date of lodging of the claim before the Opp. Party i.e. w.e.f. 28-11-2016 until the amount is paid in full.
3. A sum of ₹ 1,00,000/- for the inconveniences faced by the complainant as mentioned above and as deficiency of service besides mental agony, discomfort and harassment and loss caused by the wrongful acts of the O.P.
4. Another sum of ₹ 30,000/- as cost of the proceeding.

After registering the case notices were issued to the opposite parties and the opposite parties contested the case by filing their W/S.

The Opp. Party in their W/S has stated that this proceeding is not maintainable in law as well as on facts and the complainant has no right to file the case against the O.P. The O.P. has claimed that the proceeding is bad for non-joinder of necessary party and the claim is false, vexatious, collusive and miss-conceived and hence liable to be rejected. Admitting the complainant to be the owner of the motor boat “Hilikha”, the contesting O.P. has submitted that the motor boat ‘Hilikha’was insured with them but was subject to terms and conditions of the policy. The Opp. Parties have claimed that the answering O.P. had no knowledge about the accident of ‘Hilikha’due to lack of information. They have said that the regional office at Guwahati of the O.P. had deputed one Mr. Satyajit Purkayastha as the Investigator to investigate the matter. The complainant did not submit any copy of FIR, enquiry report issued by police authority/village headman to the Opp. Party. The Opp. Party has submitted that due to non submission of necessary and important documents from the insurer’s/complainant’s end, the Opp. Party issued the claim form after some time on 15.05.2017 to the representative of the insurer. It is also submitted that the Opp. Parties have not received any claim form from the insured/complainant and also not received any document by him from the representative of the insurer/complainant as the representative had visited once only for collecting the claim form on 15.05.2017.

The Opp. Party in the W/S has stated that they did not receive the investigation report from the investigator along with necessary documents. Subsequently the loss from the insurer/complainant duly filing the petition before the Forum for which the Opp. Party could not process the claim. It is only because of the complainant who did not cooperate with the investigator. It has been submitted by the O.P. that their company is always ready to settle the claim of the claimants subject to assessment done by appointed investigator to make the assess of loss subject to terms and conditions of the policy. But it was the complainant who did not cooperate with the investigator for submission of required document for processing and settlement of the claim in time. O.P. has claimed that the complainant is not entitled to ₹7,50,000/- with interest and the amount of ₹1,00,000/- for mental agony, harassment etc. and ₹ 30,000/- as cost of the proceeding.

The complainant in this case has submitted his evidence in affidavit as CW-1.

In his evidence in affidavit the complainant has stated that it was an admitted fact that he was the absolute owner of the private motor boat/speed boat named “Hilikha”, the Hull of which was length 6.40 M and 1.40 M in breadth and 0.55 M in depth. The same was propelled by OBM engine bearing No.04761298 and 04801620. The said ‘Hilikha’had been duly registered at the port of Guwahati, Assam and allotted Govt. registration No. Assam,485 of 2000/Guwahati by the registering authority. The motor boat was privately used in own business purpose. Ext.1 is the Regd. Certificate.

The Opp. Party is an insurance company having its head office at New Delhi, regional office at G.S. Road, Guwahati and local business office at B.P. Road, Dibrugarh-786001, Assam and carrying on business of insurance. That the motor vessel ‘Hilikha’with its Hull and machinery was duly insured with the insurer, O.P. No. 1, Oriental Insurance Company Ltd., Maligaon Branch for sum insured of ₹7,50,000/- after acceptance of insurance proposal form and on collection of premium of ₹ 19,913/- against the receipt No.51-01/4040004161, dtd. 08.12.2015 under Inland Vessel Policy Schedule being No.321104/22/2016/5 given without insurance policy terms and conditions. The policy was valid for the period from 08.12.2015 to midnight of 07.12.2016. Ext. No.2 is the policy and Ext. No.3 is the money receipt.

On 27.11.16 the complainant made all efforts to find out the Boat and lodged FIR at Rohmaria Police Station which was registered as Rohmaria P.S. G.D.E. 491 dtd. 20.11.16. The site of occurrence of mishap was within the geographical limit of insurance coverage of the policy. The accident occurred due to striking with some object while sailing in river Brahmaputra which was declared as National Waterway No.2 and had a peril of the navigable water of which same is covered under the policy as the policy covers of the seized/rivers/lets or other navigable water way. Ext. No.4 is the FIR.

The complainant inform the O.P. No.1 about the accident vide letter dtd. 28.11.16 as the Boat was under insurance cover with the O.P. and the accident and loss being occurred during the period covered by the insurance policy and thereby lodged claim. The complainant after notifying the loss also submitted an application for survey on dtd. 03.12.16 as per condition mentioned in the policy schedule. The copy of FIR was also sent to the registering authority, i.e. Inland Water Transport, Guwahati, Commissioner of Transport Department to the Govt. of Assam and also to other Govt. Departments for information and necessary action.

Ext. No.5 is the intimation letter dtd.28.11.2016,  

Ext. No.5(a) is the postal receipt No.RS465046855IN

Ext. No.6 is the application dtd. 03.12.2016 for survey.

Ext. No.6(a) is the postal receipt No.RS481570227IN.

Ext. No.7 is the intimation letter to the registering authority

Ext. No.7(a) is the postal receipt No.RS465046974IN.

Police and other Govt. offices made enquiry about the matter and enquiry reports were issued by the O/C, Rohmoria Police Station dtd. 30.11.2016 and local Govt. appointed Village Headman of Bogoritolia village of 30.12.2016 etc. All those reports indicated the genuineness of the accident and loss of the boat which could not be recovered.

Ext. No.8 is the police report dtd. 30.11.2016 of Rohmoria P.S.

Ext. No.9 is the report dtd. 30.12.2016 of village headman of Bogoritolia

village

            Thereafter, as there remained no hope of recovery of the motor boat the complainant on 27.01.2017 prayed to the registering authority for cancellation of the registration and surrendered the original registration certificate. Accordingly, after due enquiry cancellation was granted and the R/C was cancelled by IWT Deptt. Vide order No.DWT(ISV)161/2015/57, dtd. 09.03.2017.

            Ext. No.10 is the prayer to the registering authority.

            Ext. No.11 is the order No. No.DWT(ISV)161/2015/57, dtd. 09.03.2017.

            Ext. No.12 is the R/C No. Assam-485 having proof of surrender and receipt of

            Original registration certificate by registering authority.

            The Insurer opposite party sent an investigator to investigate who came and carried survey and investigation and took necessary information and documents relating to the claim. The investigator asked the complainant to fill up a claim form and submit it to the insurance company. The claim form was required to be issued by the policy issuing office of the insurer soon after receipt of intimation of loss so as to provide details of claim etc. which was not issued until then. As per advice of the surveyor/investigator, the complainant approached the insurer and requested to issue a claim form vide letter dtd. 28.02.2017. Ext. No.13 is the office copy of the letter dtd. 28.02.2017 Ext. No.13(a) is the postal receipt of that letter. But the insurer neglected to send the claim form for three months despite constant follow up by the complainant. Having no way out, the complainant, sent a representative Shri P. Barman to the office of the insurer to pursue and collect the claim form and at last the complainant get the claim form on 15.05.2017.

            The complainant posted the prescribed claim form along with forwarding letter to the insurer by Regd. Post on 10.11.2017 and some documents were submitted to the insurer by hand during the visit of representative of the complainant. Ext. No.14 is the forwarding letter dtd. 10.11.2017. But the insurer kept the claim pending before them for long. During the visit of a representative of the complainant the insurer again sought for certain documents which were already taken by their surveyor. However, the complainant again supplied the same vide letter dtd. 13.11.2018. Ext. No.17 is the office copy of the letter No.13.11.2017 and Ext.No.17(a) is the postal receipt No.RS514145278IN.

The complainant lodged a genuine claim on valid policy and proved genuineness of the loss for compensation by submitting whatever documents needed. But till date the O.P. is sitting over the matter of settlement of the claim and preferred to remain mum inspite of cooperation and prompt compliance of all requirements, repeated reminders and visit to their office and delaying the settlement. Some time back whenever the complainant himself or through representative contacts or visits the insurer office, they used to say that the claim would be settled soon. The insurer O.P. as it appears from their conduct has been trying to get away from their contractual liability by deliberately delaying the settlement of the claim to an uncertain point of time or utilizing the payable amount of claim to their benefit. The act of excessive delay in settlement of claim is enough evidence of dereliction of duty, unfair trade practice and gross deficiency of service to the customer.

            The complainant narrates the following other instances of negligence, unfair trade practice and deficiency of service of the O.P. from the very beginning of issuance of insurance policy.

6. Issuing policy without furnishing the terms and conditions of the policy so as to keep the insured at dark about it.
7. Sending investigator after several months from the date of receipt of intimation of loss.
8. Not issuing the claim form soon after receipt of intimation and issuing it after several months later.
9. Non settlement of claim.
10. Using delaying tactics by intentionally asking to submit documents again after collecting through investigator.

            Due to non-settlement of the claim, even after two and half years accompanied by wrongful act of the O.P. No.1 the complainant had suffered heavy financial loss as well as business earning besides mental agony, harassment and financial hardship for which the O.P. is liable to compensate as the same falls under deficiency of service.

            Finding no alternative the complainant has filed this complaint before this Commission for redressal of his grievances and seeking relief.

            The O.P. No. 1 was requested for claim for on 28.02.2017 to submit the claim which was issued on 15.05.2017, as such there is no delay, rash or negligence in filing this case in this Commission which is clearly evident from the following chain of circumstances:

Accident occurred                                                      : 26-11-16

FIR lodged                                                                 : 27-11-16

Opp. Party informed                                                   : 28-11-16

Registering authority informed                                   : 28-11-16

Claim form asked as advised by investigator             : 28-02-17

Claim form issued                                                       : 15-05-17

Duly filled claim form submitted                               : 10-11-17

Complaint filed due to non settlement                       : 30-04-19

            The complainant prays before the Commission for grant of the following reliefs :

1. Payment of ₹ 7,50,000/- being the sum insured amount agreed for payment against total loss of motor boat under policy No.321104/22/2016/5.
2. Payment of interest @ 18% over the amount of ₹ 7,50,000/- from the date of lodging of the claim before the Opp. Party i.e. w.e.f. 28-11-2016 until the amount is paid in full.
3. A sum of ₹ 1,00,000/- for the inconveniences faced by the complainant as mentioned above and as deficiency of service besides mental agony, discomfort and harassment and loss caused by the wrongful acts of the O.P.
4. Another sum of ₹ 30,000/- as cost of the proceeding.

           In this case the Opp. Party has submitted evidence in affidavit of one Shri Bikash Basak, the then Divisional Manager of Oriental Insurance Co. Ltd., Dibrugarh Divisional Office as DW-1. In his evidence this DW has admitted that the motor boat ‘Hilikha’was insured with their company subject to terms and conditions of the policy.

            After receiving information from the insured/complainant, the regional office of the Opp. Party had deputed Mr. Satyajit Purkayastha, Investigator to investigate the matter. He has alleged that the insured/complainant had not submitted any police report/enquiry report as well as the copy of FIR to the Opp. Party and due to non-submission of necessary and important documents from the complainant’s end, the Opp. Party issued the claim form after some time on 15.05.2017 to the representative of the insured/complainant.

            The Opp. Party as stated by DW-1 had not received any claim form from the complainant and also not received any other document by hand from the representative of the complainant, as the representative had visited the office of the O.P. only once to collect the claim form on 15.05.2017.

            The Opp. Party had not received the investigation report from the Investigator along with necessary documents to substantiate the loss of the insured/complainant till the date of filing the complaint before the Forum. It was only because of the complainant who did not cooperate with the Investigator.

            DW-1 has deposed that the O.P. as insurer has always given prime importance to settle the claim to the satisfaction of the insured within stipulated period required for processing the same as per rules of the company. The complainant, as claimed by the Opp. Party is not entitled to get such an exorbitant huge imaginary compensation in concocted manner as claimed and hence the complaint of the complainant be dismissed.

            Both the parties submitted their written argument. The complainant in this case has submitted his written argument at length covering all the aspects and consequences of the case. Showing reason of filing this complaint the complainant has argued that the complainant was under an impression that the claim would be settled soon by the O.P., but on losing all hope of settlement after long urging and waiting and being disgusted at the neglected attitude of the O.P. and dejected of continuous pursuance during all that long time with the O.P. compelled the complainant to approach this Forum for redressal of his grievances. The excessive delay in settlement of the claim is enough evidence of dereliction of duty, unfair trade practice and gross deficiency of service to the customer. Regarding the contention of the O.P. in their W/S and also in evidence about non-submission of documents, police report etc. by the complainant, it is argued by the complainant that the complainant furnished to the visiting Investigator of the O.P. whatever documents needed by the Investigator/Surveyor during his visit and copies were also sent to the O.P. vide Exhibit No.14 and Exhibit No.17. Replying to para-5 of the evidence in affidavit of the O.P. regarding non-submission of necessary documents the complainant argued that it was the duty of the insurer to issue claim form soon after receipt of intimation of loss as expressly laid down at IRDA Regulation, 2002 which the O.P. had not performed and only after their visiting Investigator asked the complainant to obtain a copy of claim form from the insurer and that too after the complainant asked vide his letter dtd. 28.02.2017 (Ext. No.13). The O.P. lately issued the claim form on 15.05.2017 and even after that, the service of the O.P. was so deficient that the claim form had also been collected by the complainant through his representative. The Investigator had not issued any demand to the complainant for furnishing any document. The O.P. had also not submitted any proof of receipt of any demand served on the complainant for compliance or to submit any proof or documents either through their Investigator or by themselves during the period for which the matter was pending at their end. The allegation of the opposite party regarding non-cooperation of the complainant, it is argued that it can reasonably be presumed that the allegation of the O.P. is an after-thought one and now levelled just to cover up their deficiency of service. Reasonable inference could be drawn that the O.P. withhold the investigation report of their Investigator from furnishing before the Forum as otherwise it would have been added evidence going in favour of the complainant.

            The complainant in his written argument has also submitted his argument on the points of limitation in length. As the instant case was duly admitted and registered the question of admissibility, whether it be on the ground of limitation or any other ground had not survived to be adjudicated upon after the admission of the complaint u/s 12 of C.P. Act, 1986. The complaint having been admitted once must therefore be deemed to have been saved from the mischief of limitation.

            Defining Marine Insurance the complainant has argued that a Contract of Marine Insurance is an agreement whereby the insurer undertakes to indemnify the insured, in the matter and to the extent thereby agreed, against Marine loss, that is to say, the losses incidental to marine adventure in case of settlement of total loss claim in an agreed valued policy it is well-defined by law and settled to be full sum insured value as agreed at the time of commencement of insurance cover which is payable in case of total loss claim as provided by relevant sections 3, 29, 67 and 68 of Marine Insurance Act, 1963 (enclosed document No.2) which governs such type of insurance policy.

            Section 29 of the Marine Insurance Act says that –

1. A policy may be either valued or unvalued.
2. A valued policy is a policy which specifies the agreed value of the subject- matter insured.
3. Subject to the provisions of that Act, and in the absence of fraud, the value fixed by the policy is, as between the insurer and insured, conclusive of insurable value of the subject intended to be insured, whether the loss be total or partial.

            The policy related with this case , i.e. Inland Vessels Policy was a valued policy for specified agreed sum assured of ₹ 7,50,000/- inclusive of Machinery, Hull and Accessories and the insurer also calculated the premium over the specified agreed amount in assurance of payment of specified full agreed sum assured value in case of arising of total loss claim as per terms of the policy.

            Section 67 of the Marine Insurance Act, 1963 states that the sum which the assured can recover in respect of a loss on a policy by which he is insured, in the case of an unvalued policy to the full extent of the insurable value, or, in the case of a valued policy to the full extent of the value fixed by the policy, is called the measure of indemnity.

            Section 68 of Marine Insurance Act, 1963 says that subject to the provisions of this Act and to any express provision in the policy, where there is a total loss of the subject-matter insured-

1. If the policy be a valued policy, the measure of indemnity is the sum fixed by the policy ;
2. If the policy be an unvalued policy, the measure of indemnity is the insurable value of the subject matter insured.

                 The complainant has argued that the law itself is clear on the quantum of settlement of claim in case of actual total loss in a valued policy u/s 68 of Marine Insurance Act, 1963 and in this particular case ₹ 7,50,000/- and the complainant is legally entitled to get the agreed sum insured value, i.e. ₹ 7,50,000/- as settlement for claim of the actual total loss of the subject-matter as agreed upon and settled at inception of the policy. The statement that the complainant is not entitled to get ‘such an exorbitant huge imaginary compensation in concocted manner’ is baseless. This sum insured amount of the policy ₹ 7,50,000/- is exclusive of other reliefs claimed. The arguments of the complainant has also covered the point of payment of interest on the claimed amount.

            The complainant in his written argument has argued that other instances of negligence, unfair trade practice and deficiency of service of the O.P. which as violated the regulation 9 of the IRDA Regulations 2002 as –

1. Issuing policy without furnishing the terms and conditions of the policy so as to keep the insured at dark about it.
2. Sending Investigator after several months from the date of receipt of intimation of loss.
3. Not issuing the claim form soon after receipt of intimation and issuing it after several months.
4. Non-settlement of claim within prescribed time.
5. Using delaying tactics by intentionally asking to submit documents again after collecting through Investigator.
6. Never communicating anything in writing and maintaining silence.

          The opposite party, Oriental Insurance Co. Ltd. submitted their written argument on 22.02.2022.

            The O.P. in their written argument has totally denied the complaint of the complainant. Admitting the fact that the motor boat ‘Hilikha’ was insured with the O.P. but was insured subject to terms and conditions of the policy concerned and the O.P. never kept the insured at dark about policy terms and conditions as alleged by him. In Ext. No.2 of the complainant, it was clearly mentioned the clauses and endorsements, special conditions and warranties of the policy. The insured/complainant intimated the matter regarding loss of his motor boat and submitted an application before the opposite party for survey without the copy of FIR, police report etc. and subsequently regional office of the O.P. at Guwahati had deputed an Investigator to investigate the said loss. It is a fact that the O.P. had received letter from the insured/complainant for issuance of claim form (Ext. No.13 of the complainant) and the said letter was posted on 03.03.2017 (Ext. No. 13-A of the complainant which is the xerox copy of the postal receipt). But the complainant did not cooperate with the concerned Investigator by submitting necessary and important documents for which O.P. issued the claim form after some time on 15.05.2017 i.e. after two months and twelve days. The O.P. has submitted that Ext. No.14 and Ext. No.14(A) of the complainant reflected that the claim form was sent by registered post on 14.11.2017, i.e. after six months from the date of collecting the said form by the representative of the complainant without any acknowledgement. The O.P. has categorically submitted that they did not receive any claim from the insured/complainant and also did not receive any other documents by hand from the representative of the insured as the representative had visited once only for collecting the claim form on 15.05.2017. The O.P. did not give any assurance of settlement of the claim of the complainant as claimed by the complainant, because they did not receive the investigation report from the Investigator along with necessary documents to substantiate the loss and as such the question of deliberate delay did not exist. The O.P. has argued that according to insured he had submitted claim form on 10.11.2017, approximately after six months of issuance of claim form which the insurance company had not received along with all required documents for processing the claim and hence it is abundantly clear that there was no deficiency of service on the part of the O.P. and hence the present complaint is not maintainable. Submitting their written argument at length the Opp. Party No. 1 & 2 has prayed to dismiss the complaint of the complainant against the opposite party.

Points for decision

1. Whether the complainant is a consumer of the opposite party under Consumer Protection Act.
2. Whether this Commission has jurisdiction to try this case.
3. Whether the complaint was filed within the period of limitation.
4. Whether the opposite party is liable for deficient and negligent services towards the complainant.
5. Whether the complainant is entitled to the reliefs claimed by him in his complaint petition.

Points decided and reasons thereof

1. Held the complainant is a consumer of the opposite party under Consumer Protection Act and this fact is not denied by the O.P. anywhere.
2. This Commission has proper territorial as well as pecuniary jurisdiction to try this case.
3. From perusal of complaint and order sheets it is found that the complaint was filed within the prescribed period of limitation.
4. To determine whether the opposite party is liable for deficient and negligent services towards the complainant we have carefully examine the complaint petition, the evidence in affidavit filed by the complainant and the written argument submitted by the complainant. At the same time we have also gone through the W/S, evidence filed by the O.P. and their written argument. The complainant has claimed that his motor boat ‘Hilikha’ with its Hull and Machinery was duly insured with the insurer, O.P. No.1 and the assured amount was ₹7,50,000/- and the premium was fixed at ₹ 19,913. That fact has not been denied by the O.P. The Marine Insurance Policy obtained by the complainant from the O.P. was a valued policy for specified agreed sum assured of ₹ 7,50,000/- inclusive of machinery, hull and accessories and the insurer calculated the premium for the specified agreed amount in assurance of payment of specified full agreed sum assured value in case of arising of total loss claimed as per terms of the policy. Section 68 of Marine Insurance Act, 1963, read as “subject to the provisions of this Act and to any express provision in the policy, where there is a total loss of the subject-matter insured-

1. “If the policy be a valued policy, the measure of indemnity is the sum fixed by the policy ;
2. If the policy be an unvalued policy, the measure of indemnity is the insurable value of the subject matter insured.”

Again Section 67 of the Marine Insurance Act, 1963 states that “the sum which the assured can recover in respect of a loss on a policy by which he is insured, in the case of an unvalued policy to the full extent of the insurable value, or, in the case of a valued policy to the full extent of the value fixed by the policy, is called the measure of indemnity.”

             The complainant has submitted that he informed the O.P.No.1 about the accident on 28.11.2016 vide his letter of the same date. Complainant’s Ext. No.5 is that letter and Ext. 5(A) is the postal receipt of that letter. In his evidence the complainant has stated that the Investigator of the opposite party has asked him to fill up a claim form and submit to the insurance company. The claim form was required to be supplied by the insurer soon after receipt of intimation of loss so as to provide details of claim etc. But in this case it was not done so. As per advice of the surveyor/investigator, the complainant requested the insurer to issue a claim form vide letter dtd. 28.02.2017.  Ext. No.13 is the office copy of the letter dtd. 28.02.2017 Ext. No.13(a) is the postal receipt of that letter. But the insurer, O.P. No.1 failed to issue the claim form for which the complainant sent his representative to collect the same from the office of the O.P. No.1 on 15.05.2017.

            The complainant vide his letter dtd. 10.11.2017 submitted the claim form along with required documents and some documents were submitted to the O.P. by him through the representative of the complainant. Complainant’s Ext. No.14 is that letter. Thereafter while the representative of the complainant visited the office of the O.P. No.1 they again sought for certain documents which were already taken by their surveyor. However, the complainant again supplied those documents vide complainant’s Ext. No.17 is the office copy of the letter dtd. 13.11.2017. Seen that the complainant performed his part genuinely and he has successfully proved his claim through the exhibits.

            On the other hand from perusal of their W/S, evidence in affidavit and written argument we have observed that the opposite parties have miserably failed to disprove the allegation of the complainant about their negligence and deficient services towards the complainant as their consumer. The opposite parties have failed to prove inter alia the reasons for which the complainant is not entitled to get the reliefs claimed by him in his complaint petition. Mere submission of the plea of terms and conditions of the policy concerned is not sufficient to deprive a consumer from his right to be indemnified at the relevant time of need. People opt for and invest in insurance policies with a hope to be protected from any probable loss/damage of life and property. It should have been the duty of the insurance companies to give utmost importance in settlement of the claims of their valued customers, rather than collecting premiums only so that people can keep faith on them. Loss of the faith of people may result in decreasing the good will and credibility of such companies.

            From above discussion and observation we have come to the conclusion that the complainant has proved his claim of deficient and negligent services towards him by the opposite party.

            In the light of all above discussions and observations this Commission comes to an end that the complainant is entitled to get relief and accordingly this Commission directs the O.P., Oriental Insurance Company to :

1. Pay ₹7,50,000/- (Rupees seven lakh fifty thousand)only being the sum insured (being valued policy for specified agreed sum). But if the O.P. fails to comply with the order and judgement, interest at the rate of 9% p.a. will be charged on the amount of sum insured from the date of filing the complaint till payment of the amount.
2. Pay ₹ 20,000/- (Rupees twenty thousand)only as compensation for causing inconvenience, physical harassment and mental agony to the complainant and
3. Pay ₹10,000/- (Rupees ten thousand)only as cost of this proceeding.

All the above amounts be deposited into the credit of this Commission by the O.P. within 30(thirty) days from the receipt of this judgement and order.

            Send copy of this judgement and order to the O.P. for compliance. Complainant is to take step.

            The instant C.C. No.04/2019 is accordingly disposed of on contest.

Next date fixed 29.09.2023 for compliance of order and judgement.