IMPORTANT POINTS
(1) Contract of Insurance – It is well settled that a contract of Insurance is to be honoured strictly in terms of the conditions specified in the Policy without making any alteration in the words used therein.
(2) Insurance Claim – When written advise by a Medical Practitioner was necessary to constitute Hospitalisation in terms of the specific Clause 3.4 of the Policy, failure to secure such written advise prior to the admission would consequently have the effect of exempting the Insurance Company from any liability to satisfy the Insurance claim.

ORDER

This Complaint under Section 21 of the Consumer Protection Act, 1986 (for short “the Act”) has been filed against the repudiation of the insurance claim under a Standard Fire and Special Perils Policy obtained by the Complainant who is a proprietorship firm operating as a premier distributor of genuine spare parts of commercial vehicles, on account of a fire incident on 12.10.2013 at the office-cum-warehouse of the Complainant at Panipat, Haryana.

2. The Complainant lodged a claim for Rs.6,97,37,720/- with the Opposite Party. The Opposite Party appointed M/s Atul Kapur and Company, Fire, LOP, Miscellaneous & Marine Surveyors to assess the loss to whom all relevant documents were submitted by the Complainant. However, on 01.04.2015, Opposite Party No.3 (Surveyor) submitted an assessment report for a net loss of Rs.48,83,696/-. A copy of this report was received by the Complainant on 29.12.2015. Based on this report, which stated that during verification, it had been found that stock registers, inward outward register etc. had not been maintained and that the Complainant had informed that most of the records pertaining to the stock had been burnt in the fire incident. After deducting 10% on account of dead stock and 10% on account of possibility of items to be of old vehicle models, the Surveyor without assessing the value of salvage, assessed the total loss at Rs.51,40,732/- on which a further 5% deduction against policy excess clause was applied to arrive at a net loss of Rs.48,83,696/-.

3. Vide letter dated 03.01.2016, Opposite Parties No.1 and 2 repudiated the claim on the basis of the Surveyor’s report. The Complainant has challenged this repudiation on the grounds that the Opposite Parties No.1 and 2 had repudiated their claim after an inordinate delay on technical grounds in contravention of the regulations of Insurance Regulatory and Development Authority. It is contended that Regulation 9 of the IRDA (Protection of Policyholder’s Interests) Regulations, 2002 provides for the settlement of a claim within certain specified period of time and the Surveyor’s report dated 01.04.2015 was erroneous and arbitrary. Accordingly, repudiation of their genuine claim had been done casually and arbitrarily. Appellant contends that the policy in question was for a sum of Rs.7.37 Crores and that it was approved after inspection of the Complainant’s warehouses at Delhi and Panipat. The documents pertaining to all stocks along with supporting invoices, purchase bills, ledger accounts etc. had been kept at the premises of the Complainant and had been shared with the Surveyor. The contention of the Opposite Parties that the documents had not been provided, had been explained by the Complainant since certain documents had been burnt in the fire in the warehouse. The cause of the fire on account of short circuit is not in dispute and there was no question of a fraudulent claim by them. Alleging unfair trade practice and deficiency in service on the part of the Opposite Parties, the Complainant is before this Commission with the following prayers:

4. The Complaint was resisted by the Opposite Parties by way of filing Written Statement. It was contended by the Opposite Parties that the Complainant is not a ‘consumer’ qua them because the insurance policy in question had been obtained in the name of M/s Swarna Motors to cover and protect its commercial interests and purposes and as such, it is not maintainable under the Consumer Protection Act, 1986. It was submitted that the Complainant failed to supply the required documents and information sought for by the surveyor and it is denied that the surveyor ignored and failed to assess the value of the salvage. It is also submitted that there was no delay in settlement of the insurance claim in question.

5. I have heard the arguments advanced by both the parties and perused the material on record.

6. On behalf of the Complainant, it was argued that the repudiation of the claim had been made on