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Raj Kamal & Co. - Appellant
Versus
United India Insurance Company Ltd. & Ors. - Respondent
Decided On : 01/06/1992
Original Petition No. 44 of 1991
Advocates Appeared :
Mr. J.N. Gupta,Mr. R.P. Aggarwal,Mr. C.V. Ruppai

Headnote:(i) Jurisdiction - Insurance claim - Repudiation of the claim, after thorough investigation into the matter - Whether the Redressal. Forum has jurisdiction to look into the validity of the report of the surveyors, the basis of repudiation? - (Yes, the Redressal Forums are bound to see whether or not the repudiation was made in good faith on valid and justifiable grounds) (Consumer Protection Act, 1986 Sections 2 & 14).

       Held: Merely because the insurer has repudiated the insurance claim under the policy unilaterally, it is difficult to hold that the various Redressal Forums constituted under the Consumer Protection Act, 1986 will have no jurisdiction to deal with the matter. If such a contention of the Insurance Company is accepted then in every case the Insurance Company can get a report from the surveyors and repudiate the claim and thus oust the jurisdiction of the Redressal Forums. The Redressal Forums therefore, are bound to see whether or not the repudiation was made in good faith on valid and justifiable - grounds. If the surveyor or surveyors choose to submit wrong report and the Insurance Company repudiates the claims without applying their minds then the repudiation cannot be said to be justified. The report of the surveyor should show that the investigations have been proper, fair and thorough. It has to be remembered that the surveyors bread comes from their employers.

       (para 5)

       (ii) Consumer Protection Act, 1986 - Sections 2 and 14 - Insurance claim - Repudiation - Complaint against - Evidence on record revealing that the repudiation of the claims by the Insurance Company was not at all justified - On receipt of the report of the surveyor, it was for the Insurance Company to examine the report and the documents produced by the insured before the surveyor and then come to an independent finding if, the claims of the insured were inflated or not - The Insurance Company does not appear to have applied its mind - On facts produced there is no reason to doubt the figures given by the claimant in his claims- Claims were unjustifiably rejected The Company is directed to pay the claimed amount with interest-at the rate of 18 per cent from the date of expiry of three months after the claims were filed till the realisation.

       (Paras 11 to 13)

       Result: Petition allowed.

       IMPORTANT POINTS

       1. Before repudiating the claim of the insured on the basis of the report of the surveyor, it is for the Insurance Company to examine the report and the documents produced by the insured before the surveyor and then come to an independent finding if the claims of the insured were inflated or not, after applying its own mind.

       2. Merely because the insurer has repudiated the insurance claim under the policy on the basis of the report of the surveyor, it does not oust the jurisdiction of the Consumer Redressal Forums to deal with the matter.

ORDER

B.S. Yadav, Member - The complainant M/s. Raj Kamal & Co.(for short 'firm') is carrying on business in Shillong(Meghalaya) and is the sole proprietary concern of Satyanarain Agarwala. The premises in which the firm is carrying on retail business consisted of two portions i.e. godown in the basement and above it is the shop. It is the case of the complainant that he had got insured the shop under policy No. 130801/01/1/ 0001/90 while the godown was got insured under the policy No. 13081/01/1/00002/90 from the respondent, the United India Insurance Company Ltd.(for short 'the Company'). Both the policies were for the period from 2nd January, 1990 to 1st January, 1991 in respect of the possible losses due to fire. Each policy was for Rs. 2 lacs. The Divisional Manager, Regional Manager, Head Office and the. Branch Manager of the said Company have been made parties to the complaint as respondents No.1 to 4. The surveyor who had been appointed by the Insurance Company to investigate the claims lodged by the claimant under the policies has been joined as respondent No.5 in this complaint. A fire broke out at about 2.30 a.m. on 16th February, 1990 completely gutting the shop and godown of the complainant firm. All the stock-in-trade, furniture and fittings, all papers and documents were destroyed. In fact the whole market was gutted. The Company was duly informed about the loss. The firm also lodged two claims in proper format to the Branch Manager of the Company. For assessment of the losses sustained by the firm, the firm submitted all documents, information and clarification after collecting them from the concerned parties and Government offices. In arbitrary manner the Division Manager, Shillong, vide letter dated 14th February, 1991, i.e. after more than a year of the incident of fire, repudiated both the claims of the firm.

2. According to the firm, the said repudiation was illegal. The complainant was asked to contact the Regional Manager. On contact on phone on 13th February, 1991, the Regional Manager asked the complainant to visit the Regional Office. On 14th February, 1991, the complainant visited the Regional Manager in his Chamber at Gawahali where the Deputy Manager was also present. The complainant was allegedly offered Rs. 1,79,500/- provided he submitted the proforma affidavit with illegal gratification in the shape of Rs. 30,000/-. To ensure that the firm acted in the contemplated manner, the Divisional Manager, who was present in the Regional Office issued the repudiation letter on the assumption that if the firm complied with the demand the same would be destroyed. The complainant did not meet the demand. The complainant prayed that the Insurance Company be ordered to make payments(i.e. Rs. four lacs) in respect of both the policies with future interest at the rate, of 24 per cent per annum. The firm also claimed various amounts as compensation against the Company on different counts. Compensation was also claimed against the Surveyor for gross misconduct in the investigations. "

3. The Insurance Company was made respondent through the aforesaid officers who filed a joint counter. They took up the preliminary objection that the repudiation of the claim, after thorough investigation into the matter, on the basis of violation of the conditions Nos. 6 and 8 of the policy of the Insurance, does not amount to deficiency in service. The complainant had failed to establish the holding in the stocks 55 chests of Tea weighing 2,754.1 k.g. valued at Rs. 1,30,945/- in the shop/godown premises at the time of fire. The attempt of the firm to exaggerate the claim by falsely including those goods as having been lost in the fire was violative of the above conditions of the policies of insurance and thus the firm forfeited all the benefits under the policies.

On merits these Officers of the Company did not dispute the fact that fire took place at 2.30 a.m. on 16th February, 1990. They, however, denied the fact that entire stock

































































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