Per Hon’ble Mr.S.R.Khanzode, Judicial Member
This consumer complaint is addressed to alleged deficiency in service on the part of M/s.New India Assurance Co.Ltd. (herein after referred as ‘Insurance Company’) in arbitrarily rejecting part of the insurance claim and illegally recovering an additional premium before disposing the sanctioned claim.
Undisputed facts are that complainant –Mr.Sunil Mehta, who is sole proprietor of M/s.Telenet Systems had a factory at W-68, MIDC, Phase II, Dombivli (East). Said factory was got insured against the perils including flood with the Insurance Company to the extent of loss of `70,00,000/-. On 09/08/1998, due to flood insured factory sustained damage/loss. The fact was immediately brought to the notice of the Insurance company, which in turn appointed surveyor M/s.Bhatawadekar & Company (herein after referred as the ‘surveyor’) which by its report dated 09/03/1999 assessed the total loss at `39,85,069/-. However, while sanctioning the insurance claim, the Insurance Company sanctioned the same at `32,34,337/-. Said sanction claim under protest was received by the complainant on 22/09/1999. Thus `7,50,732/- were paid less than the assessed loss by the surveyor.
It is also not disputed that before sanctioning the claim and paying the same `55,860/- were recovered from the complainant by way of an additional premium, etc. under the policy.
According to Insurance Company the statement which is challenged by the complainant, Insurance Company tried to justify their deduction and charging an additional premium on the ground that they had noticed certain discrepancies in the insurance policy issued to the complainant and the surveyor had not taken certain documents into consideration. By their letter dated 06/10/1999 they have intimated these facts to the complainant to justify their deductions and sanctioning insurance claim to the extent of `32,34,337/-. Insurance company in their written version on the aspect also stated as under:-
“As regards the contents of the Para G of the complaint, Opposite Party wishes to state that the amount was deducted after considering the terms and conditions of the Policy. The amount was deducted as per the exclusion clause of the policy as follows which was deducted for low line area per as GIC norms and additional access is applicable for that area.
a. Upto `5 lakhs @ 10% `50,000/
b. Above `5 lakhs upto `25 lakhs @ 20% `4,00,000/-
c. Above `25 lakhs @ 15% `2,41,355/-
Total …….. `6,91,355/-.”
Complainant had taken serious objection for such deduction. On receipt of explanation from the Insurance Company vide its letter dated 06/10/1999, the complainant immediately protested about it by his letter dated 29/10/1999. It may be pointed out that the Insurance Company did not specify the exact nature of discrepancy noticed in the insurance policy issued and also did not specify the documents, which were referred in their communication dated 06/10/1999 as the one which were not considered by the surveyor.
Considering the affidavit of the complainant-Mr.Sunil Mehta and his rejoinder as well as the verification affidavit filed on behalf of the Insurance Company sworn by its Senior Divisional Manager, Mr.V.Subramaniam as well as final survey report dated 09/03/1999 of the surveyor, we find the Insurance Company failed to justify their sanctioning insurance claim not fully as assessed by the surveyor but reducing the same by `7,50,732/- and also additionally recovering `55,860/- from the complainant. Insurance Company failed to justify their action of not accepting the loss assessed by the surveyor entirely. As far as explanation given by the Insurance Company for the deduction of `6,91,355/-, supra, it could be seen that those explanations are not part and parcel of the insurance policy issued. Thus, they have invented new terms which are not binding upon the complainant. If there were omissions, even if for the sake of argument statement of the Insurance Company is to be accepted to that extent, they cannot suo motu rectify those discrepancies and add certain new terms in the policy. Such course is also not permissible, particularly, after the event had taken place.
Based upon their discovery of certain discrepancies recovering `55,860/- before disbursement of sanctioned claim is being contrary to the terms of the policy issued, amounts to deficiency in service on the part of the Insurance Company. It may also fall within the category of unfair trade practice on the part of Insurance Company. Therefore, complainant is entitled for compensation to indemnify himself to the extent of such excess recovery of `55,860/-. Needless to say that the complainant is entitled for the compensation to the extent of `7,50,732/- which was paid less than what has been assessed by the surveyor. In the given circumstances, we also find it just and proper to award interest @ 15% p.a. w.e.f. 09/04/1999 i.e. one month after the submission of survey report till realization of the amount of compensation awarded as above. We further quantify the costs payable to the complainant by the Insurance Company at `25,000/-.
For the reasons stated above, we hold accordingly and pass the following order:-
ORDER
The complaint is partly allowed.
The Opponent, The New India Assurance Company Ltd., do pay to the Complainant an amount of `8,06,592/- together with interest thereon @ 15% p.a., with effect from 09th April, 1999 till its realization.
The Opponent shall bear its own costs and shall pay to the Complainant an amount of `25,000/- as costs of the complaint.
Pronounced on 2nd November, 2012.
