ORISSA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CUTTACK
Dr. D.P. Choudhury, President and Dr. P.K. Prusty, Member and S.L. Pattnaik, Member
Maa Vijaya Traders – Complainant
versus
Universal Sompo General
Insurance Co. Ltd. and Ors. – Opp. Parties
C.C. Case No.55 of 2011
Decided on 2.12.2022

IMPORTANT POINTS
(1) Commercial Purpose - person who takes Insurance policy to cover the envisaged risk does not take the policy for commercial purpose.
(2) Livelihood - it is revealed from complaint and statement of complainant that he has started business to earn his livelihood. Therefore, the complainant is a consumer and it is maintainable under the C.P. Act.
(3) Surveyor Report - It is well settled law that the report of the surveyor is an important document unless proved otherwise.

Headnote:

A. Consumer Protection Act, 1986 – S.15[Consumer Protection Act, 2019 – S.41] – Appeal Against order of District Commission - Services – Insurance – Repudiation of Claim – Fire Accident – Consumer – Commercial Purpose - valid insurance coverage - It is apparent that even taking wide mean that goods purchased or services hired should be used in any activity directly intended to commercial one, it would not be commercial purpose as understood under the Act - A person who takes Insurance policy to cover the envisaged risk does not take the policy for commercial purpose. Policy is only for indemnification of actual loss is not intended to generate profit – thus, when there is a valid Insurance coverage and out of the accident the goods listed, the complainant’s claim of loss has to be met by the O.Ps. Moreover, it is revealed from complaint and statement of complainant that he has started business to earn his livelihood. Therefore, the complainant is a consumer and it is maintainable under the C.P. Act. Thus the O. Ps contention is not sustainable in this regard. [Paras 15,16].

B. Consumer Protection Act, 1986 – S.15[Consumer Protection Act, 2019 – S.41] – Appeal Against order of District Commission - Services – Insurance – Repudiation of Claim – Fire Accident – Repudiation of claim – On the ground of non supply of relevant documents – Whether justified - The standard fire and special perils policy schedule and Burglary policy schedule filed by complainant which are marked as Annexture-12 and 13 shows that the policies were valid for the period from 01.12.2008 to 30.11.2009 with sum insured value of Rs.20,00,000/- issued to the complainant on 30.01.2009 - The surveyor in its affidavit has mentioned that he has assessed the loss caused to the complainant and submitted a comprehensive survey report along with the Annexures - Complaint has also proved to have submitted all documents but OP Nos.1 to 3 did not settle the claim on the plea that the complainant failed to file documents. Moreover, O.P. Nos. 1 to 3 have sat over the claim for unreasonable time and finally repudiated the claim on irrelevant and irrational ground. O.P. Nos.1 to 3 have not proved any ground as good ground to deny the claim. As such Commission was of view that complaint has proved the deficiency in service on the part of O.P. Nos.1 to 3 – therefore, deficiency in service on the part of O.P. No. 4 proved as it is the insurer O.P. Nos.1 to 3 who has repudiated the claim on no proved basis. [Paras 22 to 23]

C. Consumer Protection Act, 1986 – S.15[Consumer Protection Act, 2019 – S.41] – Appeal Against order of District Commission - Services – Insurance – Repudiation of Claim – Fire Accident – Repudiation of claim – Assessment of Loss – Ambiguity in Calculation – Liability of insurance Company - It is well settled law that the report of the surveyor is an important document unless proved otherwise. In the instant case the surveyor’s report does not inspire confidence. In fact the Surveyor, has not assessed the claim as per items and quantify wise calculation chart submitted by the complainant. The surveyor calculated some items in less number than the actual damaged stock. The entire items burnt which is difficult to calculate the exact loss – On facts, there is ambiguity in assessment of loss. Therefore, on the basis of calculation of assessment of loss on 05.09.2009 by Bank official prior to incident, Commission was of the view that the complainant can get only Rs.5,93,145 with interest from the O.P. No.1 to 3, because O.P. No.1 to 3 have committed deficiency in service on their part and are liable to pay the compensation to the complainant - The O.P. No.1 to 3 are jointly liable and directed to pay Rs.5,93,145/- along with 6% interest per annum from the date of order, failing which the total awarded amount shall carry 9% interest till the realisation of amount – Complaint is allowed. [Paras 24 to 28].

Result: Complaint allowed.