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GUJARAT STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, AHMEDABAD
Honble Mr. Justice R.C. Mankad, President &
Dr. Jatin P. Vaidya, Member
A. CHUNILAL HARDWARE & ANR.-Complainants
versus
UNITED INDIA INSURANCE CO. LTD.-Opposite Party
Complaint No. 251 of 1993 - Decided on 5.8.1996

Advocates:
Counsel for the Parties:
For the Complainants:Mr. R.N. Mehta, Advocate.
For the Opposite Party:Mr. M.C. Desai, Advocate.

A fraudulent claim cannot be adjudicated in summary proceedings under the Consumer Protection Act, 1986.

Headnote:

INSURANCE - FIRE INSURANCE - FRAUDULENT CLAIM - INSURANCE COMPANY'S REFUSAL TO PAY - CONSUMER PROTECTION ACT, 1986 - SECTION 2(1)(g) - SECTION 2(1)(r) - SECTION 14(1)(c) - SECTION 15 - SUMMARY PROCEEDINGS - MAINTAINABILITY - SUMMARY PROCEEDINGS NOT MAINTAINABLE WHERE CLAIM IS FRAUDULENT.

Fact of the Case:

Complainant, a consumer, filed a complaint against the insurance company for recovery of Rs. 9,60,000/- under three insurance policies taken from the company. The complainant's shop was looted and set on fire during communal riots. The insurance company appointed a Surveyor to assess the loss, but the Surveyor reported that the loss was not more than Rs. 85,000/-. The company also appointed Rajdeep Consultants to investigate the claim, and the investigation revealed that the claim was fabricated and bogus.

Finding of the Court:

The court found that the complainant did not cooperate with the Surveyor appointed by the insurance company, and the Surveyor was unable to make a detailed assessment of the loss. The court also found that the report of Rajdeep Consultants, which concluded that the claim was fraudulent, was genuine. The court further found that the complainant's claim was not free from suspicion and that the insurance company was justified in refusing to make payment.

Issues: 1. Whether the insurance company was guilty of deficiency of service in refusing to pay the claim. 2. Whether the complaint was maintainable under the Consumer Protection Act, 1986.

Ratio Decidendi: 1. The court held that the insurance company was not guilty of deficiency of service as the complainant's claim was fraudulent. 2. The court held that the complaint was not maintainable under the Consumer Protection Act, 1986, as the claim was fraudulent and could not be adjudicated in summary proceedings.

Final Decision: The complaint was dismissed with costs.

ORDER

Mr. Justice R.C. Mankad, President — Complainant No. 2 is a consumer organisation of which complainant No. 1 is a member. This complaint is filed for and on behalf of complainant No. 1 (complainant for short) for recovery of Rs. 9,60,000/- which includes Rs. 8,65.000/- claimed under the insurance policies taken by the complainant from the opponent.

2. The complainant is carrying on business of hardware articles from his shop which is in Odhav area of Ahmedabad. He had taken insurance of the shop and the goods and stock lying therein under three insurance policies from the opponent. Insurance policy which is fire insurance policy "C" was for Rs. 2 lakhs and it was valid for the period from January 30,1992 to January 29,1993. Under this policy, damage or loss to the building was covered upto Rs. 50,000/- and stock of hardware items etc. was covered to the extent of Rs. 1,50,000/-. Second policy which was shopkeeper's policy was valid for the period from September 23,1992 to September 22,1993 and it was for a sum of Rs. 5 lakhs. Third policy which covered risk upto Rs. 1,41,000/- for loss of hardware articles etc. was valid for the period from November 4,1992 to November 3,1993. Thus the total risk covered under the three policies came to Rs. 8,41,000/-. It is the case of the complainants that in the communal riots which took place in the city of Ahmedabad in January, 1993, his aforesaid shop was looted and set on fire. Information regarding the incident was filed by a Police Officer. The complainant, however, could not visit his shop and he did not come to know about the loss or damage suffered by him due to looting and fire because the area in which his shop was situated was under curfew. The complainant, however, informed the opponent about the incident on coming to know about it and requested it to appoint Surveyor to assess the loss. The Surveyor visited the complainant's shop after about 20 days and made survey of loss or damage to the shop. The complainant produced documents and information regarding the loss suffered by him. He also answered the queries put by the Surveyor to his satisfaction. The Surveyor, however, wrote letter to the complainant stating to the effect that the loss could not be assessed at Rs. 9,65,000/- as estimated by the complainant. According to the Surveyor loss was not more than Rs. 85,000/-. A copy of the Surveyor's report was, however, not supplied to the complainant. The opponent did not make payment of the claim and therefore the present complaint is filed for recovery of Rs. 9,60,000/- from the opponent.

3. The opponent has filed written statement Exh. 6 contesting the complaint. Besides raising technical objections regarding the maintainability of the complaint, it has denied the allegation that there was any deficiency of service on its part. The opponent has submitted that the complainant had failed to give co-operation to the Surveyor appointed by it and, therefore, the Surveyor could not make detailed assessment of the loss alleged to have been suffered by the complainant. It was further submitted that the opponent had appointed Rajdeep Consultants to investigate the claim made by the complainant. Rajdeep Consultants submitted its report and from the investigation made by it, it appeared that the claim made by the complainant was fabricated and bogus. In other words, according to the opponent, the claim made by the complainant was fraudulent. It was under these circumstances that it was recommended to repudiate the claim made by the complainant. It is therefore, submitted that the complainant is not entitled to claim any amount under the insurance policies or any compensation from the opponent.

4. It is submitted on behalf of the complainant that the report of Rajdeep Consultants who are Insurance Investigators was subsequently created by the opponent. It is submitted that this report is not a genuine report. We do not find any substance in this contention. There is no reason for the op





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