Before  the District Consumer Dispute Redressal Commission [Central], 5th Floor                                         ISBT Building, Kashmere Gate, Delhi

                               Complaint Case No. 90/27.03.2017

Shri Sachin Jain

Falt No.104, Parivar Apartment,

30, I.P. Extn., Patparganj,

Delhi-110092                                                                          ...Complainant

Versus

The Oriental Insurance Co., Ltd.,

Divisional Office No.2,

16/20, WEA, Padam Singh Road,

Karol Bagh, Delhi-110005                                                       …Opposite Party

                                                                          Order Reserved on:      12.04.2023

                                                                             Date of Order:         19.06.2023

Coram: Shri Inder Jeet Singh, President

             Ms. Shahina, Member -Female

   Shri Vyas Muni Rai,    Member

Vyas Muni Rai                                        

ORDER

1.1. The present complaint has been filed by Sh. Sachin Jain (in short the ‘complainant’) against the Oriental Insurance Com. Ltd. (in short ‘OP’) u/s 12 of the Consumer Protection Act 1986.

1.2. It is the case of the complainant that he took a House Holder Comprehensive Policy bearing no. 211200/48/2010/2389 from OP for the period from 05.02.2010 to 04.02.2011 for sum insured Rs. 53,300/- having premium of 1684/- and for sum insured of Rs. 1,95,518/-having premium of Rs. 1564/-. The said policy was for fire and allied perils & Burglary-House Breaking covering Clothing, Kitchenware/Crockery/Cutlery, Furniture, Fixtures, Electrical/Mechanical Appliances and also Jewellery and valuables, at flat no. 104, Parivar Apartment, 30, I.P. Extension, Patparganj, Delhi-110092 (copy of the policy is at page 7-8/annexure C-1 of the paper book).       

1.3. It is also the case of complainant that the policy was renewed from time to time and last renewal was made in the year 2015 when other policy bearing no. 211200/48/2015/2705 covering period from 06.02.2015 to 05.02.2016; was issued by OP after charging the consideration amount of Rs. 1564/-; the complainant has also alleged that above policy was provided without copy of the terms and conditions; the said policy was against the risk of fire and allied perils having further description of Clothings/Kitchenware/Crockery/Cutlery, Furniture, Fixtures, Electrical/Mechanical appliances and also for Burglary and House Breaking. The renewed policy also covered under the head ‘All Risks’ have been description of Jewellery and valuables and also for breakdown of domestic appliances (copy of the renewed policy is at page 9-10 of the paper book).   

1.4. It is also the case of the complainant that he purchased another flat bearing no. B-4/4, I^st Floor, Hanuman Mangla CGHS Ltd. (known as Mangla Apartment), Plot No.53, I. P. Extension, Patparganj, Delhi-110092 for his parents, and the complainant used to reside in both the houses; after taking above policy and purchase of the second flat, complainant intimated the OP vide letter dated 12.02.2015 stating therein as under :-

‘I had household All Risk Insurance Policy (Policy No. 211200/48/2015/2705) issued by Oriental Insurance Company Limited, Karol Bagh, New Delhi. The above Policy was issued at Flat No.104, Parivar Apartment, Plot No.30, I.P. Extension, Patparganj, Delhi-110092, in this regard I wish to inform you that I purchased one additional flat in other Group Housing Society in same location (i.e. I.P. Extension, Patparganj, Delhi- 110092). My family some time residing there also, therefore for purpose of the  above policy both the premises may be covered for storage of insured items.

As mentioned above, my parents are residing in both the place and I am also frequently visiting at above address, kindly update both the address in your records with immediate effect.’

                                                                                 Sd/-

Sachin Jain

(Copy of letter dated 12.02.2015 addressed to OP is at page-11/Annexure C-2 of the paper book). He had ‘Household All Risk Insurance Policy’ issued by OP, and the said policy was initially issued for flat no. 104, Parivar Apartment, Plot No. 30, I. P. Extension, Patparganj, Dehli-110092.

The said letter dated 12.02.2015 was acknowledged by the OP as the same is appearing on the body of letter having stamp of OP’s company.

1.5. Further a burglary/theft took place on 06.05.2015 at the second flat of the complainant and various jewellery items which included some jewellery of the complainant duly insured under the above policy against ‘All Risks’ cover; PCR was called and FIR  No. 464/2015 was lodged with the concerned Police Station about the stolen property from flat of the complainant (copy of the FIR dated 06.05.2015 is at page   12 to 14 of the paper book/Annexure C-3).

1.6. The complainant also intimated the Branch Office of the OP on 06.05.2015; OP deputed Surveyor Sh. S. K. Aggarwal to survey and assesses the loss who made discrete inquiries and collected the various claim papers and assured verbally for settlement of the claim; however, no survey report was provided to the complainant by the Surveyor.

1.7. Police filed charge-sheet and charge-sheet closing the case as untraceable; complainant further alleges that entire document as required by OP/Surveyor was made available to them for settlement of his claim; OP did not settle the claim; despites personal visits by the complainant to the office of OP and failed to make payment against the claim of the jewellery which was fully insured against all risks cover (photocopy of the untraced report dated 22.08.2015 from the Court of MM-1/KKD/Delhi is at page-15 of the paper book). 

1.8 OP vide letter dated 15.06.2016 denied the claim of the complainant on the following grounds:-

1. The Loss has reportedly taken in a burglary from the premises which were not insured under the policy.
2. The items reportedly burgled were not in the possession of insured while the said loss took place.
3.  We also quote the survey report submitted to us wherein it is being opined that “the policy covers the jewellery while in his possession, lying at his own house or as baggage while the same were in possession of himself/his wife but these had been reportedly kept by him with his parents as told by him for which there is no evidence that loss had taken place at  parents premises. (Repudiation letter dated 15.06.2016 is at page-16 of the paper book/Annexure C-4)

1.9 Based on the aforesaid facts, the complainant has filed this complaint alleging deficiency in service on the part of OP as per Consumer Protection Act and has prayed for his claim amount Rs. 1,95,518/- with interest @ 24 % p.a.; Rs. 1,00,000/- compensation for mental agony, pain and sufferings; apart from Rs. 31,000/- as cost of litigation and other miscellaneous expenses.

2.1. OP has filed reply under the signature of Ms. Mandakini Balodhi, Divisional Manager and has pleaded that as per condition no. 5 of the terms and conditions of the policy under head ‘Claim Procedure’ which is quoted, inter-alia as under:-

I. The insured shall upon the occurrence of any event giving rise or likely to give rise to a claim under this policy : 

1. In the event of theft, lodge forthwith a complaint in writing with the Police and take all practicable steps to apprehend the guilty person or persons and to recover the property lost.
2. Give immediately written notice thereof to the company and shall fourteen (14) days thereafter furnish to the company at his own expense detailed particulars of the amount of the loss or damage together with such explanations and evidence to substantiate the claim as the company made reasonably require.

2.2. OP has alleged that, though, the intimation of loss in the present case was given to OP only on 08.05.2015 on Phone by the complainant but the claim formalities were not completed by the complainant till 07.09.2015 in spite of reminders by Surveyor which is clear violation of the contract as per the clause mentioned above.

2.3. OP has also pleaded that the claim was rejected on account of reasons that the loss has taken place from the premises which was not covered under the policy and items burgled were not in possession of the insured at the time of loss and has pleaded for dismissal of the complaint; OP has also referred condition no. 3 of the contract of insurance under the head ‘Reasonable Care’ which reads as “The insured shall take all reasonable steps to safeguard  the property insured against any loss or damage; the insured shall exercise reasonable care and shall take all reasonable precautions to prevent all accidents and shall comply with all statutory or other regulations”. It is also the pleading of the OP that complaint involves complicated and complex question of law and facts for which detailed investigation is necessary; it require examination of several witnesses at length and  hence, the complaint is not maintainable within the purview of CP Act, and it can only be adjudicated upon by the Civil Court;  in this regard, in para no. 9 of the reply OP has cited cases decided of Hon’ble National Commission and by various State Commissions.

2.4. OP has also pleaded that it accepted the proposal submitted by the complainant and issued House holder package policy covering the goods whilst lying/stored at his residence mentioned in the policy for a period of one year and renewed the same and last renewal was w.e.f. 06.05.2015 to 04.02.2016 for I.D.V. of various items as under :

1. Section 1B Fire and Allied Perils                         -Rs. 53,300/-
2.  Section II Burglary and House Breaking              -Rs. 53,300/-
3.  Section III All Risk-Jewellery and Valuables        -Rs. 1,95,518/-
4. Section V Breakdown of Domestic Appliances    -Rs. 25,300/- (Copy of the policy along with its terms and conditions is at page-3 to 18 with the reply).

2.5 It is also the stand of OP that it was found by the Surveyor that insured had taken insurance of jewellery only for consolidated amount Rs. 1,95,518/- without giving the details of jewellery; Surveyor worked out the loss due to  alleged theft to the tune of Rs. 1,83,018/- as per details mentioned in survey report; however, Surveyor clearly opined that “In the light of various facts and circumstances described; the liability against above claim was not indemnifiable and recommended closer of the claim with “No Claim” (Copy of the survey report is at page-19 to 36/Annexure R-2 of the paper book).

2.6. OP has also pleaded that complaint involves complicated and complex question of law and facts and require examination of several witnesses that can only be decided by the Civil Court.

2.7. Based on the above pleadings, the OP has denied deficiency of service on its part.

3. Complainant has filed rejoinder to the reply of OP and has denied the objections of OP being wrong; complainant has also denied that  he violated any terms of contract  as mentioned in paras 2,3,4,5,6 and 7 of reply as alleged by OP; it has also been denied that the complaint involved complicated and complex question of law as alleged and does not fall under the purview of CP Act; insurance of policy/contract without any terms and conditions in itself is a clear case of deficiency of service as per the provisions of Consumer Protection Act; the terms and conditions of the policy document was never provided to the complainant; even if for the sake of arguments; it is accepted that the terms and conditions were provided;  which was not supplied, the loss has taken place and was fully covered under the policy of insurance issued by the OP which covers all risks in house or out house, in transit in country or anywhere else; in his rejoinder, it is also stated that it is settled law that if no terms and conditions are part of the contract, the same cannot be acted upon; rest of the allegations of OP in its reply have been denied.

4. Complainant has also filed affidavit of evidence under his signature, perusal of the contents of affidavit depicts that it is on the lines of contents of the complaint; OP has filed affidavit of evidence under the signature of Mandakini Balodhi, Divisional Manager in OP Company and the contents of the same are narration of the facts and features of the reply.

5. Both the parties have also filed their written arguments contents of which are the narration and repeatation of their pleading of the complaint and reply respectively; oral submissions have also been made on 12.04.2023 through the Counsels of both the parties.

 6.1. We have carefully gone through the records; and the rival contentions of parties; the complainant has been purchasing Householder Comprehensive Policy from the OP since 2010; and has been getting the same renewed regularly at appropriate time, the last policy is for the period 06.02.2015 to 05.02.2016 for the insured items and IDV value mentioned in the policy (Supra); Burglary/theft took in the flat no. B-4/4, Ist Floor, Hanuman Mangla CGHS (known as Mangla Apartment), plot no. 53, I. P. Extension, Patparganj, Delhi  which was not the subject matter of insurance policy; lodging of the FIR with the police station, untraced report from the Ld. Court of MM-1//SHD/KKD; and rejection of claim of the complainant; all these are undisputed facts between the parties; the complainant vide letter dated 12.02.2015; addressed to OP  had requested to include additional address as above (the second flat) purchased by him in the same locality; and requested to update both the addresses; (Flat No-104, Parivar Apartment, 30, I.P. Extension, Patparganj, Delhi, the address when policy was purchased; and additional Flat No. is B-4/4, Ist Floor, Hanuman Mangla CGHS, Plot No. 53, I.P. Extension, Patparganj, Delhi)  in the record of OP with immediate effect; as his parents were residing in both the flats; and complainant also visit frequently to his parents at his additional address; details of his request vide letter dated 12.02.2015 has also been given in para no-1.4.

6.2. Pleading of OP that complaint involves complicated and complex question of law and facts and require examination of several witnesses that can only be decided by the Civil Court; does not carry weight.

7. At the outset, it is relevant to mention that complainant took a House Holder Comprehensive Policy; details of which has already been given in para no. 1.2 of this order, at the time of taking the policy; address of the complainant is flat no. bearing no. 104, Pariwar Apartment, 30, I.P. Extension, Patparganj, Delhi-110092; however, the burglary/theft took place on 06.05.2015; at the second flat of the complainant bearing no. 4/4, I^st Floor, Mangla CGHS Apartment, I. P. Extension, Delhi; which was  purchased by the complainant for his parents; and the complainant has also pleaded in his complaint that he reside, in both the houses.

8. It is the case of the complainant that vide letter dated 12.02.2015; addressed to OP, he informed OP that he had purchased one additional flat in other Group Housing Society; in same location (i.e. I. P. Extension, Patparganj, Delhi-110092) and his family also sometime resides there; therefore, for the purpose of policy under reference; both the premises may be covered for storage of insured items (details of complainant’s letter dated 12.02.2015 addressed to OP has been given in para no. 1.4 of this order).

9. Importantly enough, complainant’s letter dated 12.02.2015 addressed to OP; as detailed in para no. 8 above; may have been acknowledged by the OP; but there is no response from the OP about inclusion of the second flat to be covered in the policy; the policy under reference is a insurance policy contract; and letter dated 12.02.2015 of the complainant to include the second flat; purchased for his father in the cover of the policy under reference; was an offer or request on the part of complainant for acceptance or consideration subject to norms by OP;  to culminate into a legal contract, but there is no acceptance by OP at offer of complainant; which was requested vide letter dated 12.02.2015; had the offer made by the complainant been accepted; and conveyed to the complainant to cover the second house; (where the burglary/theft took place); then it would have been a valid contract; but it is not so. There is already contract of insurance for risk for specified agreed place; and subsequently complainant’s request to include additional address, would not become part of existing contract unless the insurer agrees with appropriate terms, which has not happened.

10. Submissions of OP; that condition no. 5 of the policy documents; having terms and conditions of contract (as quoted above) has been violated by the complainant; to the effect that immediate information of the theft should have been given to the OP in writing; within fourteen (14) days; but it was not done so by the complainant, though, complainant lodged the FIR with the police on the same day giving details of the items stolen.

11. OP vide its letter dated 15.06.2016 has denied the claim of the complainant inter-alia, particularly on the ground that the burglary took place from the premises which was not insured under the policy, the items burgled were not in the possession of insured at the time of loss; and based on the survey report; claim of complainant was rejected vide letter dated 15.06.2016 and grounds of rejection have already been given in para 1.8.

In the survey report, Surveyor after detailed assessment reached to the conclusion that ‘in the light of the facts and circumstances’ described therein, claim file is closed as  “no claim”.

12. The complainant has also relied on a judgment of Hon’ble NCDRC in RP No. 566 of 2011 titled Jagdish Prasad Chauhan Vs. United India Insurance Co. Ltd.;  which is with regard to the Householder  Insurance Policy; but this case is distinguishable from the facts and circumstances of the present case; as case cited by the complainant relates to theft in transit; which is not the case in present complaint.   

13. We also rely on a case titled Life Insurance Corporation of India Vs. Raja Vasireddy Komalavalli Kamba and Ors.; SC/0186/1984; decided on 27.03.1987; and the relevant paras of the judgment are reproduced as under:-

17. See in this connection the statement of law in Corpus Juris Secundum, Vol. XLV page 986 wherein it has been stated as :-

The mere receipt and retention of premiums until after the death of applicant does not give rise to a contract, although the circumstances may be such that approval could be inferred from retention of the premium. The mere execution of the policy is not an acceptance; an acceptance, to be complete, must be communicated to the offeror, either directly, or by some definite act, such as placing the contract in the mail. The test is not intention alone. When the application so requires, the acceptance must be evidenced by the signature of one of the company’s executive officers.

18. Though in certain human relationships silence to a proposal might convey acceptance but in the case of insurance proposal silence does not denote consent and no binding contract arises until the person to whom an offer is made says or does something to signify his acceptance. Mere delay in giving an answer cannot be construed as an acceptance, as, prima facie, acceptance must be communicated to the offeror. The general rule is that the contract of insurance will be concluded only when the party to whom an offer has been made accepts it unconditionally and communicates his acceptance to the person making the offer. Whether the final acceptance is that of the assured or insurers, however, depends simply on the way in which negotiations for an insurance have progressed.

14. From the decision of the Hon’ble Supreme Court as quoted in para no. 15 above; it is abundantly clear that; acceptance to be completed must be communicated to offeror; either directly or by some definite act, such as placing the contract in the mail. The test is not intention alone. When the application so requires, the acceptance must be evidenced by the signature of one of the company’s executive officers; general rule in the contract of insurance concluded is only when party to whom offer has been made accepts unconditionally and communicates his acceptances to person making offer.

15.  Therefore, in view of above analysis and judgment of Hon’ble Apex Court, OP has rightly rejected the claim of complainant vide its letter dated 15.06.2023.

16. From the aforesaid consideration/examination and rivals contentions of both sides; we reach at the conclusion that complainant has failed to establish his case/claim by credible evidence; hence complaint fails and claim of the complainant is disposed off as dismissed with no cost.

17.   Copy of this Order be sent/provided forthwith to the parties free of cost as per rules for necessary compliance.

18. Announced on this 19^th June, 2023.

   [Vyas Muni Rai]                            [Shahina]                           [Inder Jeet Singh]

           Member                            Member (Female)                              President