IMPORTANT POINTS
1) Mere reading shows that Violation of Policy Conditions written in surveyor’s report are patently ambiguous and incoherent.
2) Nothing prevented the insurance co.’s surveyor to confirm from relevant authority(ies) whether or not requisite licence(s) were in place.
3) No justification or reason for the insurance co. to sit over the claim and keep it in state of suspended animation for 9 years

ORDER

Mr. Rajesh Kumar Gupta, learned counsel for the petitioner (the ‘insurance co.’) appears through video conferencing. Mr. Amith J., learned counsel for the respondent (the ‘complainant’) appears in physical hearing.

1. This petition has been filed under section 21(b) of The Consumer Protection Act, 1986 in challenge to the Order dated 26.09.2011 of The State Consumer Disputes Redressal Commission in appeal no. 434 of 2010 arising out of the Order dated 30.11.2009 of The District Consumer Disputes Redressal Commission in complaint no. 81 of 2009.

2. We have heard the learned counsel, and perused the material on record including inter alia the District Commission’s Order dated 30.11.2009, the State Commission’s impugned Order dated 26.09.2011 and the petition.

3. The petition has been filed with reported delay of 59 days. No application for condonation of delay has been filed. However, in the interest of justice, to provide fair opportunity to the insurance co., to decide the matter on merit, the delay is condoned. Learned counsel for the complainant has no objection and submits that the matter be decided on merit.

4. The dispute relates to repudiation of an insurance claim.

Chronological facts of the case, relevant for the purpose of disposing the petition, are recapitulated below.

The complainant availed a loan of Rs. 3 lakh from K.S.F.C. (the ‘financial institution’) for a stone crushing unit to eke out his livelihood. The unit was hypothecated to the financial institution. The insurance co. insured the unit for the period 26.02.2000 to 25.02.2001. The policy was taken by the financial institution on behalf of the complainant. The sum insured was Rs. 2,50,102/-. The premium was paid by the financial institution to the insurance co. On 23.03.2000 there was an incident of fire due to which the entire unit was burnt and completely destroyed beyond usable condition. The policy was valid and in place at the relevant time of the incident. The complainant immediately intimated the concerned police station, the concerned tehsildar, the financial institution and the insurance co. On 24.03.2000 the complainant made a claim of Rs. 2,50,102/- with the insurance co.

The insurance co. appointed a surveyor to assess the loss. The surveyor gave its report on 28.08.2000. In conclusion it recorded the following in respect of assessment of loss:

Assessment of Loss

In the absence of genuine inspection report and quotation preferred by competent authorised service agent of the subjectmatter insured machinery, I am unable to arrive any conclusion on assessment of loss. Since the insured did not taken effort to prove/substantiate the losses suffered due to the alleged fire peril the payment of liability in respect of the claim by the insurer does not arise.

(as per the translated version provided by the insurance co. with its petition)

That is, the surveyor concluded that it was unable to assess the loss since the complainant did not take effort to prove / substantiate the losses suffered due to the alleged fire peril.

Decision on the claim, to settle it or to repudiate it, was not taken by the insurance co. for over 09 years.

The complainant filed a complaint with the District Commission on 31.03.2009.

5. The District Commission allowed the complaint on contest. For ready appreciation, extracts of the appraisal made by the District Commission are reproduced below:

The above survey report clearly shows that the surveyor noted the machineries and also its serial numbers and confirmed the accident. And in conclusion the Surveyor analyzed that the fire might have been probably resulted from spark expelled during stone blasting/ detonating operation and fell down over the thatch roof shed hereby intensified into flame which had eaten away the plant and machineries installation shed. And in the very same survey report he has noted that he had sought certain documents to verify and confirm the authenticity and genuiness of the claim but the