Date of filing : 20.01.2014
Date of order : 18.07.2022
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, VELLORE, AT VELLORE DISTRICT
PRESENT: THIRU. A. MEENAKSHI SUNDARAM, B.A.,B.L. PRESIDENT
THIRU. R. ASGHAR KHAN, B.SC.,B.L. MEMBER- I
SELVI. I. MARIAN RAJAM ANUGRAHA, M.B.A., MEMBER -II
MONDAY THE 18TH DAY OF JULY 2022
CONSUMER COMPLAINT NO: 5/2014
M.Janakiraman,
No.23,East 1st Cross Street,
Gandhi Nagar (NTTF Backside),
Vellore,
Vellore District. …Complainant
-Vs-
The Divisional Manager,
United India Insurance Company Limited,
Branch Office at No.36, Katpadi Road,
Gandhi Nagar,
Vellore – 632 006. …Opposite party
Counsel for complainant : Tmt. J. Kanchana Arivazhagan
Counsel for opposite party : Thiru. M. Sampathkumar
ORDER
THIRU. A.MEENAKSHI SUNDARAM, B.A.B.L., PRESIDENT
This complaint has been filed under section 12 of Consumer Protection Act 1986. Complainant seeking direction to the opposite parties to pay a claim amount of Rs.2,00,000/- with interest at the rate of 12% from the date of 18.05.2012 to till date of payment and to pay a compensation of Rs.2,00,000/- for deficiency in service and also mental agony and physical agony and also to pay the cost of the complaint.
1. The case of the complaint is briefly as follows:
The Complainant obtained a household policy from the Opposite party on 08.06.2011. The period of policy was 09.06.2011 to 08.06.2012, Policy No.013000/48/11/32/000000146. As per the policy condition the complainant is entitled to claim compensation in case of any theft inany household articles. As per the policy, Section Item -III, he insured for all risks for jewellery items i.e., 1.KADUKA KUNDUMANI, weighing 80 Noswhich has reflected in the policy bond. When the policy was inforce, on 18.05.2012 he had gone to Sri Durga Devi Temple situated at Anjanapura, Karnataka along with wife namely Kalavathi. They had also carried gold balls namely Kaduka Kundumani to get the same polished at the shop situated near the said temple. The complainant kept the Kaduka Kundumani in their bags. While nearing the temple, they removed their dress for the purpose of taking bath, one person aged about 25 years was looking at their clothes and looking at the gold balls and put it in his hands and stole the same. Regarding this, the complainant preferred a police complaint before the Talaghattapura Police Station and FIR was also registered in Cr.No.382/2012 dated 18.06.2012 under Section 379 of IPC. The theft of Jewellery was valued at about Two Lakhs as on 18.05.2012. In view of the above said incident and in terms of the policy the complainant is entitled to get compensation for theft of the gold jewellery. The complainant made a claim before opposite party for compensation on 25.06.2010 along with copy of FIR. But after receiving the same the opposite party did not reply suitably. Hence, the complainant made several reminders as well as personal visit with the opposite party at their office for one year. At last, on 04.03.2013 the opposite party repudiated the claim on the grounds of complainant violated the policy condition, which was made complainant for mental agony and physical strain. The acts of the opposite party was amounts to deficiency in service. Hence the opposite party is liable to pay the claim of the complainant. Hence, this complaint.
2.The written version of opposite party is as follows:
The claim of the complainant is not sustainable either in law or on facts of the case. It is true that the complainant had taken household policy for the period of 09.06.2011 to 08.06.2012 policy No.013000/48/11/32/000000146. The Policy was issued to the complainant covering household articles as per the list enclosed in the policy within the premises of the complainant at Vellore. The said policy was also renewed for 09.06.2012 to 08.06.2013. The policy holder covered any loss due to any break-open or forceful entry into the house by the thief and stealing the household articles which covered under the policy, then only the insured is entitled to any claim. As per the averment in the complainant, the complainant and his wife on 18.05.2012 went to Shri Durga Devi Temple situated at Anjanapura Karnataka where they to get the polish of their gold Kundumani at the shop situated near the temple, when the complainant kept the kaduka kundumani in the bag when they were nearing place of temple when they were took bath after removing clothes, one person aged about 25 years was looking at the clothes and took the gold balls and stole the same. This makes it clear that the ornamental gold kaduka balls was removed from the chain, kept it in the loose form and the same was carelessly and recklessly kept aside in the bag, that too far away from the complainant’scustody and lost some of the gold – (kaduka) to the thief. Therefore the gold article is not stolen from his house at Vellore by means if external force or any break open. It was lost due to carelessness of the complainant. The Careless abandonment of covered article by the insured is not covered under the house holder policy. The complainant had not kept the house hold article in a safe custody.Further he facilitate for the commission of the theft. When the complainant really lost the gold, how could he take a policy for the lost kundumani too far subsequent period. Therefore the claim made by the complainant is false and fabricated one. As per the version of the complainant the said incident took place on 18.05.2012, but he made complaint before the Talaghattapura Police on 18.06.2012, nearly one month later to the incident.
2. Therefore if at all the claim of the complainant is true he should have intimated to the police and the insurance company immediately after the incident. In terms of the insurance policy. He has not reported the same to the insurance company within 24 hours and hence the claim is void and not entitled to any claim. By suppressing of material facts, the complainant is not acted in good faith. He has suppressed the material facts of the theft of some kundumani on 18.05.2012, while renewing his policy for the further period of policy from 09.06.2012 to 08.06.2013 with the opposite party. The complainant intimated to the opposite party only on 19.06.2012 alleging that he lost the gold on 18.06.2012. The complainant had not taken adequate steps to safeguard the jewellery. This complaint is not maintainable and liable to dismissed with exemplary cost.
3. Proof affidavit of complainant (CW1) filed. Ex.A1 to Ex.A5 were marked. Proof affidavit of opposite party filed. Ex.B1 to Ex.B5 were marked. Written arguments of both parties filed. Oral argument of both sides heard.
4. THE POINTS THAT ARISES FOR CONSIDERATION ARE:
1. Whether there is any deficiency in service on the part of the opposite party?
2. Whether the complainant is entitled for relief as claimed in the complaint?
3. To what relief, the complainant is entitled to?
5.Point No: 1&2: The complainant obtained a household policy from opposite party for the period 09.06.2011 to 08.06.2012 and renewed subsequent period of 09.06.2012 to 08.06.2013. The assured value of the policy is Rs.3,65,500/- towards the all risk for jewellery and valuables. The complainant paid a sum of Rs.3,779/- as a premium to the opposite party. On 18.05.2012 the complainant and his wife went to Sri. Durga Devi Temple situated at Anjanapura, Karnataka. While going there, they also took their gold kundumani chain for the purpose of polishing it at a shop near the temple. They kept the said jewellery in their bag and they decided to take a bath, before going to the temple. For the purpose of taking bath, they removed their dress and kept them at the bank of river along with the bag which had the gold kundumani. While taking bath, some of the children of the locality noticed their belongings and searched for something. On seeing the same the complainant and his wife shouted at them and rushed to the spot, but before reaching the spot they ran away. When they were checked their bag, they found that some of the kundumani were missing. Immediately, they took steps to trace the boy, but could not trace him. Thereafter, they went to the police station where they asked to complainant made complaint after some times. He also informed the same to opposite party. But opposite party repudiate the claim on the ground of delay in lodging FIR and violation the policy condition. As there was no other option the complainant approached this commission by way of this complaint.
6. On the other hand, the counsel for opposite party contended that there was carelessness on the part of complainant. Further the complainant did not keep the Golden Article in a safe custody. He also passed out that the alleged incident took place on 18.05.2012 but he made complaint before Talaghattapura Police Station only on 18.06.2012 nearly one month after the incident. There was enormous delay in reporting the incident to the police as well as to the insurer. Hence, the version of the complainant cannot be believed and was fabricated for the purpose of making false claim. Further complainant did not disclose the said fact while renewing the policy for subsequent period and thereby he has suppressed material facts. Further the complainant did not take any steps to safeguard the Golden Article which is violation of terms of the policy.
7. For better appreciation, the relevant clauses of the Insurance policy reproduced hereunder.
SECTION WISE PREMIUM DETAILS
Section Description of property Sum insured (Rs.) Rate% premium
I. B. Fire & Allied Perils (Contents,
excluding Jewellery & Valuables, 49,000 0.50 24.50
belonging to the proposer & members
of his Family permanently residing with him)
II. Burglary, housebreaking in larceny
or Theft: All contents in the premises
stated at above address. (Insurance 49,000 2.40 117.60
on contents should be for value
equivalent to the value mentioned
under I-B above)
III. All Risks for Jewellery & Valuables 365,500 10.05 3,673.28
V. Breakdown of Domestic appliances 24,000 2.50 60.00
VI. TV Set 15,000 10.05 150.75
CLAIMS:
In case an unfortunate loss as covered in the policy occurs, so as to get prompt
Service we request you to take the following actions:
- Immediately inform the office concerned over phone and in writing the occurrence of the claim along with the policy number.
- Obtain the claim form from the office concerned or the office nearest to you and fill up the same and give an estimate of the loss.
- In case the loss very large, prompt intimation is required to send a suitable surveyor to assist you in minimizing the loss, for quick settlement of claim and to advice you as to how best to make the claim properly and how to start up activity after the loss.
- In order to help to prove the claim the surveyor or office may seek documentary evidence. You may hand over photocopies of necessary documents and obtain acknowledgement.
- Kindly cooperate with the surveyors and insurance officials visiting the site of loss to examine the cause of loss, to correctly estimate the extent of loss and to work towards a quick settlement of the loss. They should be helped to take photographs of the loss and obtain statements of witnesses.
- Necessary information as if you are an uninsured should be given to the local fire station, police authorities and other Civil authorities as per law and local practice. Copies of their reports should be obtained and handed over to the surveyor or office.
g. In case of any burglary/theft, a police F.I.R will have to be registered.
- Surveyor may also be given copies of licences, permits and certifications as are in force to establish that the operations were conducted as per law and as per the necessary safely standards.
- A copy of the survey report may be handed over to you if you so wish for your record so that you are aware of the assessment made.
- As soon as the survey report and copies of the document desired by the surveyor/insurer is complied with by you, you may keep in touch with our office for early disposal of the claim.
When we go through the above clause, we find that ‘All risks for jewellery and valuables which means. The Opposite parties are liable to compensate from loss caused to him by the conduct of himself or by the conduct of any other person. In the present case, even if the version of the complainant is not true but it was not ruled out, it may be happened due to his own act. He might have lost the kundumani by his recklessness. But in our opinion, that also covered under the policy. For which we relied upon the following citations, reported in:
2018(1) CPR 907 (SC)
The Hon’ble supreme court
Om Prakash
(Vs)
Reliance General Insurance and Anr.
wherein the truck was stolen and there was delay in giving intimation to the Insurance Company, while allowing the appeal, Hon’ble Supreme Court observed as follows:
“11. It is common knowledge that a person who lost his vehicle may not straightaway go to the Insurance Company to claim compensation. At first, he will make efforts to trace the vehicle. It is true that the owner has to intimate the insurer immediately after the theft of the vehicle. However, this condition should not bar settlement of genuine claims particularly when the delay in intimation or submission of documents is due to unavoidable circumstances. The decision of the insurer to reject the claim has to be based on valid grounds. Rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. If the reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay. It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the Investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine. It needs no emphasis that the consumer Protection Act aims at providing better protection of the interest of consumers. It is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten while considering the claims made under the Act”.
12. Ratio of the aforesaid circular issued by the IRDA and the judgement of the Hon’ble Supreme Court is that the condition regarding the delay shall not be a shelter to repudiate the insurance claims, which have been otherwise proved to be genuine. The decision of the insurer to reject the claim has to be based on valid grounds and rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. It was also observed that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the investigator. Hon’ble Supreme Court also reiterated that the Consumer Protection Act aims at providing better protection of the interest of consumers and it is a beneficial legislation that deserves liberal construction. This laudable object should not be forgotten, while considering the claims made under the Act.
In view of the aforesaid citation, we inclined to the allow the claim of the complainant that there is a deficiency in service in repudiating the claim of the complainant. Hence these Point Nos. 1 and 2 are decided in favour of the complainant.
8. POINT NO.3: As we have decided that the point Nos. 1 and 2 that there is a deficiency in service on the part of the opposite party. The opposite party is hereby directed to pay a sum of Rs.1,00,000/- (Rupees One Lakh only) towards the value of the Kaduka Kundumani with interest at the rate of 9% p.a. from 18.05.2012 and to pay a sum of Rs.50,000/- (Rupees Fifty Thousand only) as compensation for deficiency in service and mental agony and also to pay a sum of Rs.5,000/- (Rupees Five Thousand only) towards cost to the complainant. This point No. 3 is also answered accordingly.
9. In the result, this complaint is partly allowed. The opposite party is hereby directed to pay a sum of Rs.1,00,000/- (Rupees One Lakh only) towards the value of the Kaduka Kundumani with interest at the rate of 9% p.a. from 18.05.2012 to till the date of this order and to pay sum of Rs.50,000/- (Rupees Fifty Thousand only) as compensation for deficiency in service and mental agony and also to pay a sum of Rs.5,000/- (Rupees Five Thousand only) towards cost to the complainant within one month from the date of receipt of this order, failing which the above amounts shall carry interest at the rate of 9% per annum from the date of this order to till the date of realization.
Dictated to the steno-typist transcribed and typed by her corrected and pronounced by us in the open Commission on this the 18th July, 2022.
Sd/- Sd/- Sd/-
SMEMBER – I MEMBER – II PRESIDENT
LIST OF COMPLAINANT SIDE DOCUMENTS:
Ex.A1 - Copy of the Policy
Ex.A2 - Copy of F.I.R.
Ex.A3 – 04.03.2013 - Copy of the letter received from the opposite party
Ex.A4 – 10.12.2013 - Copy of the legal notice
Ex.A5 - Served Acknowledgment and register post receipt
LIST OF OPPOSITE PARTY SIDE DOCUMENTS:
Ex.B1 - Copy of the Householders Insurance Policy for the period
09.06.2011 to 08.06.2012
Ex.B2 - Copy of the Householders Insurance Policy for the period 09.06.2012 to 08.06.2013
Ex.B3 - Copy of Investigation report along with complainant
statement
Ex.B4 - Copy of Claim report by the Divisional Manager, UII
Ex.B5 - Copy of Claim reputation letter sent to the complainant
Sd/- Sd/- Sd/-
MEMBER – I MEMBER – II PRESIDENT
