IMPORTANT POINT
False insurance claims cannot be allowed.

Vinay Kumar, Member—This case is of a proprietorship firm in Aurangabad engaged in manufacturing of bulk drugs. There stocks were covered under an insurance policy provided by the respondent/ Bajaj Allianz General Insurance Company Ltd. The claim under the policy arose due to a factory fire on 9.2.2007. However, the respondent/insurance company repudiated the claim on 3.9.2007 on the grounds that false documents have been submitted by the insured/Complainant to obtain benefits under the policy. The consumer complaint filed by M/s. Frontier Remedies has been dismissed by the Maharashtra State Consumer Disputes Redressal Commission, in Complaint Case no.8 of 2008. Therefore, the present appeal has been filed challenging the order of the State Commission.

2. The case of the Complainant before the State Commission was that:

The complainant says that, on 03/09/2007 the opponent no.1 issued letter to the complainant, contending the rejection of the claim. While rejecting the claim the opponent no.1 has not taken any heed to mention the specific reasons, only it is contented that, the surveyors finding confirmed that false documents had been submitted by the complainant to obtain benefits, and all the benefits under the insurance policy forfeited as per general policy terms and conditions, and condition no.8. The opponent has never taken heed to give the details about the fake documents. It was no where mentioned that which documents are false, fabricated, and made by the complainant, and if the opponents had come to the conclusion that any document is false then why not any criminal complaint is filed against the culprits. The opponent wanted to escape from the liability, therefore the opponent tried to ignore the claim of the complainant. It is the duty of the Insurance Company to clarify their consumer about the detailed reasons of the rejection of the Insurance claim.”

3. Per contra, the case of the respondent/insurance company was that they had appointed a Surveyor to look into the claim and later appointed a second Surveyor, as it was necessary to conduct the survey through an expert in costs and accounts. The second Surveyor Mr. J.C.Bansali found the claim of the Complainant included in the bills and invoices totaling Rs. 14,43,300/- for supply of raw materials to be doubtful. It is stated in the written statement of the respondent/insurance company before the State Commission:-

“That, the Surveyor Shri J.C. Bansali cross-checked all the bills/invoices of the stock alleged to have been stored by the complainant. During scrutiny, it was noticed that, the invoice in respect of Suman Enterprises is doubtful; therefore, it was further investigated. The Surveyor visited the address mentioned in the tax invoice of Suman Enterprises. He noticed that, no such address is available or no dealer with same name and business was available. Further the mobile numbers mentioned on the invoice were fake and not working. Thereafter, Surveyor made the search on the basis of the VAT and CSP numbers mentioned on the invoice, however, all those numbers found to be fake. Thereafter, Surveyor issued correspondence through Post as well as Courier at the address mentioned on said invoice. All the correspondence returned unserved with endorsement not found. Thereafter, the Surveyor checked all the firms registered with Sales Tax Department in the name and styled as ‘M/s. Suman Enterprises’, however, no such registration of firm was found. As a last resort the Surveyor enquired about said Suman Enterprises with the other persons or firms engaged in the business of chemical suppliers, however, it was noticed that, no such firm is known to anybody. Thereafter, the Surveyor called upon the complainant to show the details of payments made to the firm namely M/s Suman Enterprises against said invoice, however he failed to furnish the same. Thereafter, the Surveyor called upon complainant to furnish the details in respect of said M/s Suman Enterprises