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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
R.K. Agrawal, President
M/s Shital Fibres Ltd. – Complainant
versus
ICICI Lombard General Insurance
Company Limited in Place of M/s
Bharti Axa General Insurance Co. Ltd. – Opp. Party
Consumer Case No.155 of 2013
Decided on 9.1.2023
Consumer Protection Act, 1986 – S.21(1)(a)(i)[Consumer Protection Act, 2019 – S.58(1)(a)(i)] – Services – Insurance – Repudiation of Claim – Claim doesn’t fall under exclusion clause - Not Justified – Non supply of copy of terms and conditions – Deficiency of service - the procedure prescribed under the Act for disposal of the Complaint is adequate to decide cases involving complicated questions of laws & facts – Thus, Commission does possess the requisite jurisdiction to entertain a Consumer Complaint wherever a defect or deficiency in the services rendered by an insurer is made out – On facts, it is crystal clear that the cause of collapse of the Building was subsidence of the soil which was due to the leakage from sewer pipe line installed by the Punjab Sewerage Board. Therefore, the claim of the Complainant does fall within Clause VIII of the Policy and it does not fall within the exclusion sub-clause(e) of Clause VIII of the Policy, as alleged by the Opposite Party Insurance Company – Therefore, Opposite Party Insurance Company failed to establish that they have provided the copy of the terms and conditions and the cover note to the Complainant till the date of filing the Complaint, thus, they could not take benefit of the exclusion clause - Consumer Complaint is partly allowed and the Opposite Party Insurance Company is directed to pay a sum of Rs.4,19,04,368/- (Rupees Four Crore Nineteen Lakh Four Thousand Three Hundred Sixty Eight only). [Paras 24 to 31]
Result: Complaint allowed.
ORDER
The present Consumer Complaint has been filed under Section 21(a)(1) of the Consumer Protection Act, 1986 (for short “the Act”) by M/s Shital Fibres Ltd. (hereinafter referred to as the ‘Complainant/Insured) against Opposite Party Bharti AXA General Insurance Co. Ltd. Upon Application being IA / 7418 / 2022 filed, vide Order dated 12.08.2022, the name of the Opposite Party, Bharti Axa General Insurance Co. Ltd. has been changed to ICICI Lombard General Insurance Co. Ltd. (hereinafter referred to as Opposite Party/Insurer), alleging that the later was wrong in denying the claim of losses incurred by the Complainant.
2. According to the Complaint, the brief facts of the case are that the Complainant Company got constructed a building at Plot No.C-81, Focal Point, Jalandhar, Punjab, in December, 2007 under the supervision of M/s. Gosai & Associates, an experienced government approved Architect. Initially the Building, Plant, Machinery & Stocks were insured with different insurance companies but in the year 2011, the Insurance Policies were shifted to Opposite Party, M/s. Bharati AXA General Insurance Co. Ltd, (now known as ICICI Lombard General Insurance Company Ltd.) The policies issued were termed as “Special Peril Policies” which included the loss of the building due to subsidence and landslides. The details of the said seven polices are as follow:—
PFC/10587504/P3/04/D5P311 (from 29.04.2011 to 28.04.2012)
PFC/10360046/P1/09/D5P116 (from 14.09.2011 to 13.09.2012)
PFC/10587435/P3 (from 29.04.2011 to 28.04.2012)
PFC/10279808/P1 (from 15.05.2011 to 14.05.2012)
PFC/10613562/P1 (from 28.06.2011 to 27.06.2012)
PFC/10652264/P1 (from 30.08.2011 to 29.08.2012)
PFC/10359761/P1 (from 08.09.2011 to 07.08.2012)
3. It was averred that premium as claimed by the Opposite Party Insurance Company was paid by the Complainant. The Opposite Party Insurance Company issued risk cover letters but till date neither the Policy cover note nor the terms and conditions of the Policies were provided to them. Unfortunately, on 15.04.2012, the insured building, collapsed while the machines were running and work was going on, as the factory used to run for 24 hours. The loss was intimated to the Opposite Party Insurance Company, which appointed M/s. Puri Crawford Insurance Surveyors and Loss Assessors, who visited the site for the first time, on17.04.2012 and assessed the loss to the tune of Rs.4,19,04,368/-. The Surveyor called for documents in piece-meal, from time to time, w.e.f. 25.06.2012. All the documents and drawings were immediately furnished whenever the same were required. A Structural Engineer was appointed by the Surveyor but he did not have any interaction with the Complainant. No joint meeting was held with the Surveyor. Final survey report was issued by the Surveyor on 14.12.2012 according to which the main cause of collapse of the building was a structural design defect. On receipt of the Survey Report, the Complainant contacted M/s. Gossian & Associates who had supervised the construction of the building and issued the Completion Certificate. M/s. Gossian & Associates vide their report reiterated that the sudden collapse of the entire structure could not be a design/material defect and had to do more with the movement of the soil. The Opposite Party did not pay heed to any reports, therefore, a Legal Notice dated 16.02.2013 was served on it to make the payment.
4. The Complainant obtained opinion from Guru Nanak Dev Engineering College Testing and Consulting Cell, Ludhiana, who vide their Report dated 15.03.2013, gave the opinion that structural design was ‘OK’ and there was no defect in it. Another opinion from an Expert, namely M/s. ARO Tech Structural Consultants, Jalandhar City, Punjab, was obtained, which also opined that the collapse was due to faulty construction of sewer line by Punjab Sewerage Board, due to which soil underneath had become bad. The Complainant also met Shri Kunwar Sunil Kumar, Chartered Engineer f
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