The central legal point established in the judgment is the reliance on the investigator's report and the history of similar insurance claims to determine the validity of the insurance claim.

JUDGMENT/ORDER :

Ajit Bharihoke, Presiding Member

1. This revision is directed against the order of the State Commission, U.P. dated 24.11.2016 in first appeal No.1017/2016 vide which the State Commission allowed the appeal preferred by the respondent/insurance company against the order of the District Forum and dismissed the complaint.

2. Briefly put, facts relevant for the disposal of the revision petition are that the petitioner insured his truck No.RJ-05-GB-3385 with the respondent insurance company for the period 19th March, 2014 to 18th March, 2015 for a sum of Rs.17 lakhs. According to the petitioner/complainant, on 28.5.2014, the truck caught fire at around at around 10.30 pm while being driven through Yamuna Expressway. Necessary information was given to the concerned Authority on toll free number. On the receipt of information fire-brigade and the police visited the spot and extinguished the fire. The insured truck suffered damage due to fire. Necessary information was given to the respondent insurance company. The insurance company appointed a surveyor, namely, Innovative Insurance, Surveyors & Loss Accessors Pvt. Ltd. It is the case of the complainant that above noted survey company appointed Sh. N M Kapoor as Surveyor to conduct spot survey and submit the report despite of the fact that Sh. N M Kapoor had already left Mathura and shifted to Chhattisgarh. N M Kapoor, therefore, deputed job of survey to one Mr. A K Saxena who conducted survey. Before submitting his report, A.K.Saxena contacted Lal Chand, Claim Manager of the opposite party and informed him that the claim of the complainant was correct. Thereafter, the officials of the insurance company in collusion with A K Saxena with a view to defeat the right of the complainant got forged survey report prepared by A K Saxena on which A K Saxena put forged signatures of surveyor N M Kapoor. It is also alleged that A K Saxena had demanded bribe of Rs.50,000/- from the complainant regarding which a telephonic complaint was made to the Claim Manager on 15.09.2014.

3. It is further alleged that despite of the fact that the complainant contacted the Claim Manager, his claim was not settled. Instead Claim Manager Lal Chand appointed Sh. Shashank Sharma for reassessment of the claim. Shashank Sharma submitted his survey report in favour of the complainant but the insurance company by concealing that report repudiated the insurance claim on the basis of forged survey report. Being aggrieved, the complainant filed consumer complaint in District Forum Agra.

4. The opposite party on being served with the notice filed written statement denying the allegations made in the complaint. It was denied that opposite party appointed M/s Innovative Insurance Surveyors & Loss Assessors Private Ltd. for conducting spot survey or that said company deputed N M Kapoor to conduct the survey to submit the report. According to the opposite party, A K Saxena was appointed to conduct survey and assess the loss. However, on receipt of the complaint from the complainant that said surveyor had asked for illegal gratification, the opposite party/insurance company appointed Zuber Ali Khan of Zuber Corporation to reinvestigate the matter and on the basis of the report of Zuber Ali Khan, the insurance company did not accept the final survey report of A K Saxena and repudiated the claim. The opposite party also pleaded that complainant had history of similar past motor claim which raised suspicion and triggered further investigation into the claim.

5. The District Forum on consideration of the pleadings and evidence allowed the claim and directed the opposite party / insurance company to pay to the complainant insured amount of Rs.17.00 lakhs with 6 % interest thereon from the date of filing of the complaint till the realization of the amount. Rs.10,000- was also granted as compensation for mental pain and agony.

6. The opposite party not being satisfied with the order of the District Forum approached the Sta