NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
AVM J. Rajendra, AVSM VSM (Retd.), Presiding Member
Oriental Insurance Co. Ltd. – Appellant
versus
M/s Kamal Tex Fab – Respondent
First Appeal No.1381 of 2018
(Against the Order dated 08/03/2018 in Complaint No.282/2014 of the State Commission Karnataka)
Decided on 27.9.2023
Consumer Protection Act, 1986 – Section 19 [Consumer Protection Act, 2019 – Section 51] – Appeal - Services – Insurance – Repudiation of Claim – Underinsurance – Whether applicable - Whether the total stocks as on the date were worth Rs.1,46,85,723/-; and whether the amount determined by the Surveyor by applying under-insurance factor and averaging out the payable amount - It is clear from the record that, the purchases are made corresponding to sale of stocks. Therefore, the contention of under insurance of stocks by taking into account cumulative stocks held over the entire period of 10 months and holding that the value of stocks as on the date of loss as Rs.1,46,85,723 and thus applying ‘Average Clause’ to reduce the final claim of the insured is questionable. It has not been established that the actual stocks held by the Complainant have at any time exceeded the insurance cover limit of 54 Lakhs. It is an admitted position as per the survey report that the claimed amount is Rs.43,35,495 – Thus, it is clear that the principle of underinsurance is inapplicable and thus ‘Average Clause” cannot be applied – Therefore, Appeal is dismissed. [Paras 5 to 22].
Result: Appeal dismissed.
ORDER
The present First Appeal has been filed under Section 19 of the Consumer Protection Act, 1986 (hereinafter referred to as “the Act”) against the Order dated 08.03.2018 passed by the State Consumer Disputes Redressal Commission, Bangalore, Karnataka (hereinafter to be referred as “the State Commission”), in Consumer Complaint No.282 of 2014, wherein the Complaint filed by the Complainant (Respondent herein) was partly allowed.
2. There was a delay of 53 days in filing the Appeal. For the reasons stated in IA/14217/2018, the delay is condoned.
3. For the sake of Convenience, the parties in the present matter being referred to as mentioned in the Complaint before the State Commission. “M/s. Kamal Tex Fab, Wholesale Cloth Merchants, through its Proprietor Mukesh Jain is referred to as the Complainant. While “Oriental Insurance Co. Ltd.”, is referred to as the Appellant Opposite Party/Insurer (for short OP) in this matter.
4. Brief facts of the case as per the Complainant are that the Complainant obtained a Shopkeepers Insurance Policy (SKP Policy) from OP/insurer vide Policy No.472108/48/2014/681, covering stock in trade to an amount of Rs.54,00,000/- and furniture and fixtures at Rs.4,00,000/-.
5. The Policy was valid from 24.11.2013 to 23.11.2014. On 09.02.2014, during the validity of the policy a fire incident occurred, resulting in damage to the entire shop including burnt articles and furniture worth Rs.2,00,000/- lakhs, as well as the loss of Rs.3,50,000/- in cash. The fire was eventually extinguished by the fire brigade. The Complainant filed an FIR into the incident. Thereafter, the Complainant submitted a claim, estimating the loss at Rs. 87,50,000/-. The OP insurance company appointed ‘Shri D Srinivas’ as the Surveyor to assess the loss. It was alleged that the Surveyor erroneously applied the ‘average clause’ method and recommended a net loss of Rs.13,52,630/-. Consequently, the OP repudiated the Complainant’s claim for Rs.87,50,000/-. Being aggrieved and alleging the deficiency in service by the OP, the Complainant filed Consumer Complaint No.282/2014 before the learned State Commission and claimed Rs.87,50,000/- with interest @18% per annum; Rs.2,00,000/- for mental agony; Rs.1,00,000/- for loss due to delay and Rs.1,00,000/- as costs. Despite due notices and appearing through its counsel in the proceedings, the OP failed to submit its version, despite numerous opportunities being afforded. The State Commission, on due consideration of the facts and the circumstances of the case, partly allowed the complaint as follows:—
“Order
The above complaint is partly allowed by directing the OP to pay a sum of Rs.38,72,192/- with interest at the rate of 6% p.a. from the date of complaint till realization to the complainant together with compensation of Rs.25,000/- and cost of Rs.10,000/- within 8 weeks from the date of receipt of copy of this order, failing which the said amount shall carry interest at the rate of 18% p.a.”
6. Being aggrieved by the order of the learned State Commission, the Opposite Party (Appellant herein) filed this present Appeal with the following prayer:—
A. Set aside the impugned judgment and order dated 08.03.2018 passed by the Hon’ble State Commission, Bangalore, in Complaint Case No.282 of 2014.
B. Allow the present First Appeal and award the cost of the Appeal to the Appellant.
C. Pass any other or further order(s) as this Hon’ble Commission deems fit and proper in the facts and circumstances of the present case.
7. In the present Appeal, the main issues raised are as follows:—
(a) The State Commission did not consider that the Surveyor’s assessment of Rs.13,52,630/- was correct, as it was underinsurance case.
(b) The State Commission did not provide any reason or findings for disregarding the surveyor’s assessment and the Respondent did not produce any evidence to challenge the
Under-insurance – Under-insurance occurs when the insured value of goods is less than their actual value. In such case also, if all insured goods are destroyed, the policyholder is still entitled to ....
(1) Fresh Survey – if for any reason, the insurer is of the view that certain material facts ought to have been taken into consideration while framing a report by the surveyor and if it is not done, ....
Insurance claims must be assessed based on fair and contractual standards, avoiding arbitrary deductions.
Principles of underinsurance apply when insured sums are disproportionate to asset values. Payment vouchers marked 'on account' do not extinguish further claims.
(1) Hearsay – No documentary evidence in regard to financial stress of the insured has been brought on record and this assertion is merely a hearsay.(2) Sampling – A mere sampling of some bills canno....
IMPORATNT POINT Appointment of Surveyor – Insured can also appoint a Surveyor or loss accessor.
Insurance companies cannot avoid liability by citing external compensations, and second surveyors must be appointed with regulatory oversight.
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