SMT. RAVI SUSHA: PRESIDENT
Complainant filed this complaint U/s 35 of Consumer Protection Act 2019, for getting an order directing opposite party to pay the actual and legitimate claim in the line with Insurance policy with interest @ 12% from the date of 1st party claim amount settled, to pay the complainant a sum of Rs.5,00,000/- towards mental agony and difficulty under gone due to the delay in claim settlement and business loss during the period besides Rs.10,000/- being the cost of this proceedings.
This complainant’s case is that the complainant who had no employment, with the intention to get self employed started a business of textile retail in the name M/s SR Tex at Kannur, since 1998. The complainant has been insuring his business on a regular basis with New India Assurance Co.Ltd. for protection against fire, burglary etc. since 1994. In the year 2018-19 also business was insured vide Insurance policy NO.76260148180600000074 for the period from 14/08/2018 to 13/08/2019 with the New India Assurance Co.Ltd (Mahe Branch). The total cover value of the insurance as per above policy was Rs.76,60,000/-. The complainant used to purchase material from both local and outside markets and stocked materials from both markets anticipating a big spike in sales during Ramzan festival. On the fateful night of 26/05/2019, there was a major fire accident in the complainant’s textile shop and the entire textile, furniture and other items were burnt to ashes beyond recovery. Fire, Police department, as well as the OP Insurance company were duly informed about the incident. The complainant states that in this regard, an FIR was registered by the town police station, Kannur and the enquiry report was submitted to the Hon’ble Judicial 1st class Magistrate Court at Kannur. On hearing about the fire accident the OP the New India Insurance Co. Ltd. had sent their surveyor to the accident site to assess the damages, loss and other facts related to the fire accident. After through enquiry the surveyor’s of the Insurance company had filed their report and the report or findings by the surveyor’s were never shared with the complainant. The complainant who was already into deep financial trouble due to fire accident losing everything and further was under the pressure of the suppliers’ for payment who supplied the textile goods on credit, the complainant approached the insurance company for speedy process of the insurance claim. Further stated that lots of communication and follow up by complainant with the insurance company they have settled a meager amount of Rs.12,73,573/- only where in the total insurance coverage is Rs.76,60,000/- and actual textile stocks alone as at 26/05/2019 was 41,55,597.55/- and other damages is more than 6,00,000/-. The complainant had sent letters to the insurance company following up for th balance amount which is legitimate and due to the complainant. The insurance company asked for lots of clarification regarding the process of purchase, ledger statements of the supplier, GST return documents etc, just to delay the process where in the complainant had submitted all the documents and clarification as requested by the insurance company on time. After a long communication with the OP got a reply that the “purchase made in May 2019 have been neglected for a claim assessment since not produced E-way bills for the same.” The complainant has already submitted the GST returns file GSTRA 2a which is a bonafiede record which is available in the GST portal of the government which could be verified by any one which clearly authenticated the purchases made in MAY 2019 is true and correct. In the absence of E-way bill, delivery of goods cannot be validated and thus purchase without E-way bills have to be excluded. Aggregative by the above reply from the insurance company the complainant had served a lawyer notice on 20/10/2020 to the insurance company to settle the balance claim amount due to the complainant on within 15 days of receipt of the notice. The complainant has suffered a lot mental agonies and difficulties due to the delay in claim settlement and business loss during the period for which the complainant claims Rs.5,00,000/- compensation and Rs.10,000/- as cost of this complaint from the Insurance company. Hence the complaint.
OP entered appearance through counsel and filed version. It was averred that the survey process was delayed only because of the deficit of availability of the proper documents and non-co-operation on the part of the complainant in furnishing the details and the documents required by the surveyor in time for making an assessment regarding the damage to the stock in trade and the e-way bills for purchase of the merchandise in the month of May 2019 which is immediately before the concurrence of the fire. Hence the net assessed amount payable was only Rs.12,73,753/- which the OP No.3 has paid to the complainant as early as on 28/08/2020. According to OP the averments in the complaint that stock in trade as on 26/05/2019 was worth Rs.41,55,597/- and assessment of Rs.6,00,000/- made by the complainant towards the damage to the furniture and fixtures is not supported by documents in order to allow claim the claim of the complainant. Hence the complainant is not entitled for the above claim put forward by him towards the damage caused due to fire in the above complaint. As per the insurance policy terms and conditions, production of the e-way bill is mandatory in order to substantiate the items of stock in trade. Failure to produce the e-way bills for those items in stock, disentitles the insured or claiming for damage for those items. Hence the computation of the insurance amount of Rs.12,73,753/- as the net loss towards the damage cause to the items in trade and damage to the furniture and fixtures is made on the basis of the insurance policy and its conditions. OP further submits the averments in the complaint that the complainant had purchased fress stock worth Rs.23,00,000/- in the month of May 2019 in order to revamp his flogging business, etc are not believable. The alleged cause of action arose only a few days after the alleged induction of new stock worth Rs.23,00,000/- in trade in the shop. Therefore the complainant has to be put to strict proof regarding the purchase documents including the e-way bills of those fresh stock worth Rs.23,00,000/-.
Both parties led evidence. Complainant has filed chief affidavit and documents. He has been examined as PW1 and marked the documents as Ext.A1 to A13. On behalf of OP, Mr. Jayaprakash, the deputy manager, New India Assurance Company Ltd. Divisional office Kannur has filed his chief affidavit and document. He has been examined as Dw1 and the documents marked as Ext.B1 to B10. On the side of OP the Insurance surveyor and loss assessor, who conducted inspection at the premises of the complainant’s shop and prepared survey report was examines as Dw2. All witnesses were cross-examined for the rival parties.
After that the learned counsels of complainant and OPs filed their written argument notes.
The admitted facts in this case are that the OP issued a shop keepers Insurance policy to the complainant’s shop by name S R Tex, Kannur vide policy No.76260148180600000074 for a period from 14/08/2018 to 13/08/2019. Further on night 26/05/2019, a fire accident was happened in the complainant’s insured textile shop and the textile items and furniture were burned. Further complainant has put forward a claim under the policy towards the damage caused to the stock in trade in the shop, furniture etc. Further on receipt of the claim form, OP deputed their investigator and Insured surveyor and loss assessors to investigate into the matter and to conduct survey to ascertain the damage caused due to the fire and to make an assessment of the net loss. Further the surveyor assessed an amount of Rs.12,73,573/- on the basis of terms and conditions of the insurance policy and OP No.3 has settled the claim of complainant for the said amount.
Complainant’s case is that the total insurance cover is for a sum of Rs.76,60,000/- and the actual textile stock alone as on 26/05/2019 the date of accidental fire was Rs.41,55,597.55/-and other damages like, furniture and other items along is more than Rs.6,00,000/-. Complainant alleged that the survey process was delayed and finally Insurance company is settled the claim neither in line with the actual loss nor in line with the value of the amount insured.
OP submitted that admittedly the shop was insured for a sum of Rs.76,60,000/- with effect from 14/08/2018 to 13/08/2019 and the same was damaged by accidental fire and loss was sustained by the insured. The survey process was delayed only because of the deficit of availability of the proper documents and non-co-operation on the part of the complainant in furnishing the details and the documents required by the surveyor in time for making an assessment regarding the damage to the stock in trade and the e-way bills for purchase of the merchandise in the month for May 2019, which is immediately before the occurrence of the fire. Hence the net assessed amount payable was only Rs.12,73,753/- which the OP No.3 has paid to the complainant as early as on 28/08/2020. According to OP the averment s in the complaint that stock in trade as on 26/05/2019 was worth Rs. 41,55,597.55/- and assessment of Rs.6,00,000/- made by the complainant towards the damage to the furniture and fixtures is not supported by documents in order to allow the claim of the complainant. Hence the complainant is not entitled for the above claim put forward by him towards the damage caused due to fire in the above complaint. As per the insurance policy terms and conditions, production of e-way bill is mandatory in order to substantiate the items of stock in trade. Failure to produce the e-way bills for those items in stock, disentitles the insurance for claiming for damage for those items. Hence the computation of the insurance amount of Rs.12,73,753/- as the net loss towards the damage caused to the items in trade and damage to the furniture and fixtures is made on the basis of the insurance policy and its conditions. OP further submits the averments in the complaint that the complainant had purchased fresh stock in trade as on 26/05/2019 was worth Rs.41,55,597.55/- and assessment of Rs.6,00,000/- made by the complainant towards the damage to the furniture and fixtures is not supported by documents in order to allow the claim of the complainant. Hence the complainant is not entitled for the above claim put forward by him towards the damages caused due to fire in the above complaint. As per the insurance policy terms and conditions, production of the e-way bill is mandatory in order to those items in stock, disentitles the insured for claiming for damage of those items. Hence the computation of the insurance amount of Rs.12,73,753/- as the net loss towards the damage cause to the items in trade and damage to the furniture and fixtures is made on the basis of the insurance policy and its conditions. OP further submits the averments in the complaint that the complainant had purchased fresh stock worth Rs.23,00,000/- in the month of May 2019 in order to revamp his flogging business, etc are not believable. The alleged cause of action arose only a few days after the alleged induction of new stock worth Rs.23,00,000/- in trade in the shop. There for, the complainant has to be put to strict proof regarding the purchase documents including the e-way bill of those fresh stock worth Rs.23,00,000/-.
Assessment of loss was made finally computed as Rs.13,40,793/-. The assessment amount was settled by OP NO.3 with the complainant as full and final settlement and has been paid on 28/08/2020.
After careful consideration and in the absence of any stock register and E-way bill for the purchase of items worth Rs.23,13,838/- in the month of May 2019 and further in the absence of any other evidence discarding the assessment of surveyor, the final assessment made by the surveyor as per Ext.B2 can be accepted. Moreover the complainant received the amount as full and final settlement on 28/08/2020 without any protest.
With the aforesaid discussions, we are of the view that, there is no deficiency in service on the part of opposite parties and hence complainant is not entitled to get any relief.
In the result complaint fails and hence it is dismissed. No order as to cost.
Exts.
A1-Policy schedule
A2-KSFE electrical Inspector’s verification report
A3-District Fire Officer’s Fire incident verification report
A4-FIR report
A5-Joint Director, Regional Forensic Science laboratory Examination
A6-Kannur Town police close the file report
A7-Copy of lawyer notice
A8-Reply notice dated 05/11/2020
A9-GST R2A Copy
A10-Letter issued by OP to complainant dated 22/09/2020
A11-Letter issued by branch manager of OP dated 28/08/2020
A12-Letter issued by complainant to OP dated 26/08/2020
A13-Letter issued by the branch manager dated 19/08/2020
B1-Certified copy of the shopkeeper’s insurance policy & conditions
B2-Preliminary survey report of surveyor T Rajeevan (with objection)
B3-Letter issued by surveyor K P Raghavan to complainant (with objection)
B4-Letter issued by surveyor K P Raghavan to complainant (with objection)
B5-Letter issued by 2nd OP to complainant
B6-Letter issued by 2nd OP to complainant
B7-Statement of stock send by the complainant to OP
B8-Letter issued by 2nd OP to complainant
B9-Letter issued by 2nd OP to complainant (list of items which does not require –e-way bills)
B10-1st and final survey report of surveyor K P Raghavan in the above claim (objection)
Dw1-Jayaprakash- witness of OP
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
(mnp)
/Forward by order/
Assistant Registrar
