BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR.

Consumer Complaint No.211-14

Date of Institution:11-04-2014

Date of Decision:01-04-2015

Sandeep Kumar Bhalla son of Sh.Nathu Ram Bhalla, 601-S G Enclave, Phase-I, Majitha Road, Amritsar-143001.

Complainant

Versus

1. The Branch Manager, Universal Sompo General Insurance Company, SCO-113, District Shopping Complex, 2^nd Floor, Vishal Mega Mart Road, Ranjit Avenue, Amritsar-143001.
2. The Regional Manager, Universal Sompo General Insurance Company, SCO 4, 2^nd Floor, PUDA Complex, Ladhowal Road, Jalandhar-144001.

Opposite Parties

Complaint under section 11 and 12 of the Consumer Protection Act, 1986 as amended upto date.

Present: For the Complainant: Sh.A.S.Cheema, Advocate

              For the Opposite Parties: Sh.P.N.Khanna, Advocate.

Quorum:

Sh.Bhupinder Singh, President

Ms.Kulwant Kaur Bajwa, Member

Mr.Anoop Sharma, Member     

Order dictated by:

Sh.Bhupinder Singh, President.

1. Present complaint has been filed by Sh.Sandeep Kumar Bhalla, under the provisions of the Consumer Protection Act alleging therein that on 11.5.2013, he purchased insurance policy bearing No.2114/53165284/00/000 from Opposite Party No.1 valid for the period from 4.5.2013 to 3.5.2018 for his house. Complainant alleges that said policy covered the risks/ threats by storm, typhoon, hurricane, tornado, flood and inundation. In the month of August, 2013 there was a continuous heavy rains  from 14.8.2013 to 18.8.2013 (5 days) and that caused the inundation of the complainant’s insured house property through flooding caused by the heavy rain water and that resulted into cracks in the cemented floors. Some cracks have developed/ appeared on the floors and as precautionary measures he applied some cement mixture on those cracks, but due to continous heavy rains and resulting floods and inundation etc. during the period 14.8.2013 to 18.8.2013, the cracks got widened and thus damaged the complete floors beyond repairs. The floors need to be laid, again.  The complainant informed opposite party No.1 immediately and his claim was registered as claim No.CL13024914 dated 24.8.2013, but the claim of the complainant was repudiated vide letter dated 3.9.2011 and the complainant was informed vide email dated 14.11.2013. Alleging the same to be deficiency in service, complaint was filed seeking directions to the opposite parties to settle/ pay the insurance claim in full as per the terms of the policy alongwith interest @ 18% per annum from the date of filing of the claim. Compensation and litigation expenses were also demanded.
2. On notice, Opposite Parties  appeared and filed written version in which it was submitted that as per the report submitted by he surveyor and photographs and other documents, it stands proved that the concerned  loss as claimed by the complainant has occurred on account of cracks developed due to rain and this type of the cracks had developed gradually due to change of temperature and weather condition. Moreover, the said policy is specified perils policy and subject loss is not covered since no insured peril operated. So, the claim of the complainant was rightly repudiated by due application of mind.  While denying and controverting other allegations, dismissal of complaint was prayed.
3. Complainant tendered into evidence his affidavit Ex.CW1/A alongwith documents Ex.C1 to Ex.C16  and closed the evidence on behalf of the complainant.
4. Opposite Parties tendered into evidence affidavit of Sh.Piyush Shanker Ex.OP1-2/1 alongwith documents Ex.OP1-2/2 to Ex.Op1-2/8 and closed the evidence on behalf of the Opposite Parties.
5. We have carefully gone through the pleadings of the parties; arguments advanced by the ld.counsel for the parties and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for both the parties.
6. From the record i.e. pleadings of the parties and the evidence produced on record by the parties, it is clear that  the complainant got insurance policy bearing No.2114/53165284/00/000  Ex.C1 from Opposite Party No.1  on 11.5.2013 valid for the period from 4.5.2013 to 3.5.2018 for his house. Said policy covers the risk of damage caused to the house by  storm, typhoon, hurricane, tornado, flood, inundation, etc. Complainant submitted that  in August, 2013 there was a continuous heavy rains  from 14.8.2013 to 18.8.2013 (5 days) and that caused the inundation of the complainant’s insured house property as a result of   flooding caused by the heavy rain water and that resulted into cracks in the cemented floors as is evident from the photographs Ex.C7 to Ex.C15  and certificate issued by architect Ex.C16. The matter was reported to Opposite Party No.1 immediately and the  claim was registered by Opposite Party No.1 vide claim No.CL13024914 dated 24.8.2013. The complainant also informed Opposite Party No.1 about the damage via email on 1.9.2013 that the  cracks have developed/ appeared on the floors and as precautionary measures the complainant applied some cement mixture on those cracks to save the building, but due to continuous heavy rains and resulting floods and inundation etc. the cracks got widened and thus damaged the complete floors beyond repairs, resulting the floors need to be laid, again, but the claim of the complainant was repudiated vide email dated  16.9.2011 Ex.C6 on the ground that the floors of the complainant’s house got damaged due to rains in area and that loss due to rain is not covered under the subject policy and subject claim is not payable by Opposite Party No.1. The complainant approached Opposite Parties  that damage was caused  through inundation by flooding due to heavy rain water and this matter is clearly covered under the policy in question, but the Opposite Parties  did not pay any heed to the request of the complainant. Ld.counsel for the complainant submitted that all this amounts to deficiency of service on the part of the opposite parties.
7. Whereas the case of the opposite parties is that in receipt of intimation from the complainant, the Opposite Parties  appointed surveyor who submitted his report dated 20.12.2013 Ex.OP1/3 alongwith photographs and other documents from which it stands fully proved that the concerned loss as claimed by the complainant has occurred gradually  due to change of temperature and weather condition. As such, under the policy in question, said loss is not covered since no insured peril operated. Resultantly, the claim of the complainant was repudiated by Opposite Parties  vide letter dated 23.12.2013 Ex.OP1/8. Ld.counsel for the opposite parties submitted that there is no deficiency of service on the part of the opposite party.
8. From the entire above discussion, it stands fully proved on record that the complainant got insurance policy bearing No.2114/53165284/00/000  Ex.C1 from Opposite Party No.1  on 11.5.2013 valid for the period from 4.5.2013 to 3.5.2018 for his house. Said policy covers the risk of damage caused to the house by  storm, typhoon, hurricane, tornado, flood, inundation, etc. There was a continuous heavy rains  from 14.8.2013 to 18.8.2013 i.e. for 5 days which caused  inundation of the complainant’s insured house property as a result of   flooding caused by the heavy rain water which resulted into cracks in the cemented floors of the house of the complainant as is evident from the photographs Ex.C7 to Ex.C15  and certificate issued by architect Ex.C16. The matter was reported to Opposite Party No.1 immediately. Resultantly, the claim was registered by Opposite Party No.1 vide claim No.CL13024914 dated 24.8.2013. The complainant also informed Opposite Party No.1 through  email on 1.9.2013 that the  cracks have developed on the floors and as precautionary measures the complainant applied some cement mixture on those cracks to save the building, but due to continuous heavy rains and consequent floods and inundation etc. the cracks got widened thereby damaged the complete floors beyond repairs,. As such, the floors need to be laid afresh. The  claim of the complainant was repudiated by Opposite Party No.1 vide email dated  16.9.2011 Ex.C6 on the ground that the floors of the complainant’s house got damaged due to rains in area and that loss due to rain is not covered under the subject policy and subject claim is not payable by Opposite Party No.1. Whereas the complainant has produced on record brochure Ex.C4 of the Opposite Party and also brought this fact to the knowledge of the complainant vide email dated 14.11.2013 Ex.C2 that the policy covers perils caused interalia by Flood and Inundation (STFI). Opposite Parties  could not rebut this documentary evidence produced by the complainant which fully proves that the policy in question covers loss or damage to the insured house by  storm, typhoon, hurricane, tornado, flood, inundation, etc. So, the Opposite Parties have wrongly repudiated the claim of the complainant vide their letter through email dated 16.9.2013 Ex.C6/A that  the loss occurred to the complainant was due to rain which is not covered under the said policy. Whereas the policy does cover the loss as a result of flood and inundation as a result of  rain. Other plea of the Opposite Parties  that the cracks had developed on the floors of the house of the complainant gradually  due to change of temperature and weather condition, as such, the Opposite Parties  repudiated the claim of the complainant vide letter dated 23.12.2013 Ex.OP1/8, is also not tenable because it stands fully proved on record that the cracks on the floors of the house of the complainant have developed due to inundation and flooding by rain water and in this regard, the complainant has produced certificate from government approved architect Akash & Associates, Amritsar Ex.C16. The Opposite Parties  could not rebut this documentary evidence produced by the complainant.
9. So, from the entire above discussion, we have come to the conclusion that the Opposite Parties have wrongly declined the claim of the complainant vide email dated 14.11.2013 Ex.C6 and email dated 16.9.2013 Ex.C6/A and letter dated 23.12.2013 Ex.OP1/8. The complainant has succeeded in proving that the loss to the floors of the house of the complainant occurred due to inundation and flooding by rain water which is fully covered under the policy in question. Hence, the complainant is held entitled to the claim for the loss occurred to the floors of the house of the complainant, from the Opposite Parties  under the policy in question.
10. However, the complainant could not produce any estimate from any architect as to what amount is required for the repair of the floors of the house of the complainant nor the complainant got repaired the floors of his house. As such, the complainant could not produce any cogent evidence as to how much loss he has suffered due to cracks developed in the floors of the house as a result of inundation by flooding due to heavy rain water in the area.
11. Consequently, this complaint is disposed of with the directions to the complainant to get the floors of his  house repaired and submit the bill of repair to the Opposite Parties  as early as possible and the Opposite Parties  are directed to settle the claim case of the complainant within one month from the date of filing of the claim by the complainant alongwith required documents with Opposite Parties. However, the Opposite Parties  have wrongly repudiated the claim of the complainant and the complainant has to file the present complaint, so the Opposite Parties  are directed to pay the costs of litigation to the complainant to the tune of Rs.2000/-.    Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Dated: 01-04-2015.                                          (Bhupinder Singh)                                                                                                President

hrg                                                 (Kulwant Kaur Bajwa)    (Anoop Sharma)

              Member                               Member