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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
V.K. Jain, Presiding Member
M/s. Krishna Spico Industries Pvt. Ltd. —Appellant
versus
M/s. National Insurance Company
Limited and Anr. —Respondents
First Appeal No.1578 of 2019
(Against the Order dated 06/05/2019 in Complaint No. 107/2007 of the State Commission Delhi)
Decided on 20.7.2020
Counsel for the Parties:
For the Appellant:Mr. Konark Tyagi, Advocate
For the Respondents:Mr. Vishnu Mehra, Advocate
IMPORTANT POINT
Section 64UM of Insurance Act cannot stand in way of Insurance Company in establishing that claim was a fraud on the company or that it was a case of deliberately causing a fire so as to lay foundation for an insurance claim.
Headnote:
Insurance Act, 1938 – Section 64UM – Consumer Protection Act, 1986 – Sections 17, 19 and 21 – Insurance – Damage to stock due to fire – State Commission allowed consumer complaint solely on the ground that appointment of investigator was illegal same being in violation of section 64UM Insurance Act – State Commission did not examine matter own merits in light of report of Surveyor and Investigator – Section 64UM of Insurance Act cannot stand in way of Insurance Company in establishing that claim was a fraud on the company or that it was a case of deliberately causing a fire so as to lay foundation for an insurance claim – State Commission ought to have examined matter on merits in light of report of Surveyor as well as report of Investigator – That having not been done matter needs to be remitted back to State Commission to undertake the exercise – Impugned order set aside and matter remitted back to State Commission to decide complaint afresh in light of survey report as well as report of Investigator and documents produced by parties. (Paras 5, 7 and 8)
Result: Appeal allowed.
ORDER
V.K. Jain, Presiding Member—The complainant which is appellant in FA No. 1578/2019 and respondent in FA No. 1647/2019 obtained an insurance policy from National Insurance Company Limited, appellant in FA No. 1647/2019 and respondent in FA No. 1578/2019 in respect of the stock kept in its cold storage for the period from 07.01.2005 to 06.01.2006. A fire broke out in the premises of the complainant and stock stored therein is alleged to have been destroyed/damaged. A surveyor M/s S Sony & Co. was appointed by the insurer to assess the loss. The surveyor submitted a report assessing the loss. However, instead of making payment in terms of the report of the surveyor an investigator was appointed by the insurer namely M/s Royal Associates who submitted a report dated 22.08.2006. The investigator recorded several findings which need not be reproduced in this order. The opinion given by them on the basis of their investigation reads as under:-
“On the basis of the investigations made and findings recorded above, we are of the considered opinion that the insured’s claim is not genuine and is an outcome of his long term planning to recover his losses from the insurers to neutralize the loan taken from the bank and from other government agencies. Some of the acts committed by the insured were not only immortal but were illegal. We submit this report based on the facts investigated by us, discussions held with various persons concerned with the cold storage in one way or the other and have put down the facts without bias for and against any of the parties concerned be it insurers of the insured.
We hope you will find the facts produced above useful for appropriately dealing with the insured’s claim strictly in the with the relevant policy of insurance.”
2. The insurer repudiated the claim wide letter dated 22.01.2007 which to the extent it is relevant reads as under:-
“We would like to draw your attention to two Condition No. 6 of the policy of Insurance which categorically provides that in case the compliance of the said condition is not made the claim is not payable. The said condition reads as under:-
On the happening of any loss or damage the insured shell forthwith give notice thereof to the company and shall within 15 days after the loss or damage or such further time as the company may in writing allow in that behalf deliver to the company.
A claim in writing for the loss or damage containing as particular an (illegible) as may be reasonably practicable of all the several articles for items or property damaged or destroyed and of the amount of the loss or damage thereto respectively having regard to their value at the time of the loss or damage not including profit of any kind.
Particulars of father insurances, if any
The insured shall also at all times at his own expense produce procure and give to the company all such further particulars specification books purchase invoices duplicates or copies thereof documents investigation reports (internal/external) proof and information with respect to the claim and the origin and cause of the loos and the circumstances under which the loss or damage occurred and any matter touching the liability or the amount of the liability of the company as may be reasonably required by or on behalf of the company together with the declaration on oath or in other legal form of the truth of the claim and of any matters concerned therewith.
No claim under this policy shall be payable unless the terms of this condition have been complied with.
In no case whatsoever Shelby the company be liable for any loss or damage after the expiration of 12 months from the happening of the loss or damage unless the claim is the subject of pending action or arbitration; it being expressly agreed and declared that if the company shall disclaim liability for any claim hereunder and such claim shall not within 12 calendar months from the date of the disclaimer have been made the subject matter of a s
