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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
A. P. Sahi, President and
Bharatkumar Pandya, Member
United India Insurance Company – Petitioner
versus
Anaro Devi (Since Deceased)
and Ors. – Respondents
Revision Petition No.2993 of 2016
(Against the Order dated 15/07/2016 in Appeal No. 1095/2015 of the State Commission Haryana)
Decided on 28.10.2024
Insurance Policy – Standard Fire & Perils Insurance Policy – Repudiation of claim – Not justified – Indemnification of loss of double storey constructed house – No evidence led by insurance company to detract from findings recorded by fora below of heavy rains & consequential subsidence as observed by surveyor – Insurance company has declined to grant the reimbursement only on ground that there was no collapse of building – Word “loss”, “damage” or “destruction” nowhere have been coupled with word “collapse” – Collapse is an incident or outcome that is also a loss – Only exclusion in policy is normal crack & Other symptoms mentioned therein – Surveyor has read into the policy a word which otherwise has not been mentioned – Terms of policy cannot be altered by interpretation contrary to its intent & Purpose unless there is a scope of contra proferentem to be read in favour of insured – Cracks are not normal cracks or mere cracks in plaster or otherwise – Impugned order passed by Forum cannot be faulted with – District Commission failed to appreciate facts in correct perspective & arrived at an incorrect conclusion – State Commission rightly reversed order of District Commission & appropriately compensated the complainant with Rs.5 lakhs as repair for damaged house – Compensation awarded is adequate & fair – No reason much less any other reason to interfere with impugned order of State Commission which is upheld.(Paras 12 onwards)
Result: Revision Petition dismissed.
ORDER
The dispute in this petition is regarding a claim raised by the complainant under a Standard Fire and Special Perils Insurance Policy (material damage) acquired by the complainant from the petitioner United India Insurance Company Limited for indemnifying the loss of a double storey constructed house in Rohtak. The sum insured was Rs.25,00,000/- and the policy duration was from 15th September, 2009 to the midnight of 14th September, 2010.
2. Heavy rains occurred between 10th August to 15th August, 2010 as a result whereof the soil beneath the building sank on account of water flooding due to the downpour. The subsidence resulted in consequential cracks throughout the building which also leaned in one direction. Not only the insured building but other buildings in the locality suffered the same damage.
3. The complainant sought indemnification but the insurance company in spite of getting the loss surveyed and report submitted to that effect, repudiated the claim. Even though the copy of the repudiation letter is not on record but from paragraph-3 of the impugned order it appears that the said letter was filed as exhibit R-2.
4. Aggrieved by the repudiation, the complainant filed CC No.270 on 19th April, 2015 and after contest the claim was dismissed on 11th September, 2015 on the ground that the damage caused was not covered for indemnification under the policy as reported by the surveyor.
5. Aggrieved, the complainant went up in appeal before the State Commission in FA/1095/2015 that has been allowed on 15th July, 2016. It may be pointed out that the complaint had been filed by Smt. Anaro Devi, who died during the pendency of the complaint itself and was thereafter represented through her legal representatives. The appeal was filed by the legal representatives that was allowed on 15th July, 2016 against which the insurance company has come up in this revision petition questioning the correctness of the said order on several grounds. The petition was entertained on 13th December, 2016 and an interim order was passed, subject to deposit 50% of the amount awarded by the fora below.
6. Learned counsel for the petitioner Mr. Amit Kumar Singh has urged that the incident is not disputed nor is the allegation of loss but in view of exclusion clause applicable to the policy, the cracks appearing in the building did not amount to any loss, destruction or damage and therefore no claim was indemnifiable. Mr. Singh supports the survey report wherein it has been stated that the building suffered only normal cracks and no part of it had either collapsed or was ruined in a manner so as to claim coverage, hence the survey report does not suffer from any infirmity and the insurance company was justified in repudiating the claim. He contends that a mere normal crack does not qualify for any indemnification and consequently the claim was not admissible.
7. Responding to the submissions, Mr. Shukla for the complainant-respondent urged that findings of fact have been recorded by the State Commission which cannot be interfered with in the exercise of revisional jurisdiction of this Commission. He has relied on the judgments of the Apex Court in Rubi (Chandra) Dutta Vs. United India Insurance Company Ltd. (2011) 11 SCC 269 and the decision the case of Momna Gauri vs. Regional Manager, Scooter India Ltd. & Ors. (2014) 13 SCC 307.
8. Other orders of this Commission have also been relied on to urge that even the evidence on record including the surveyor’s report runs counter to the argument advanced inasmuch the surveyor’s report in its conclusion is incoherent as against its own observations of the construction being first class. The surveyor records that small to heavy cracks have developed in almost all rooms of the insured house. Mr. Shukla submits that once observations of the surveyor are to that effect, then there was no occasion for him to redefine the subsidence clause to infer that unless there is a total collapse of the building or of
Findings of fact recorded by State Commission cannot be interfered with in exercise of revisional jurisdiction of this Commission.
Repudiation – complainant has not been able to dislodge the exclusion invoked by the Insurance Company, the repudiation cannot be faulted with.
Insurance – Collapse of building – Where policy in question is for reinstatement, Complainant is entitled for Reinstatement Value of similar building.
Insurance – In absence of requisite evidence from Complainant to support peril covered under policy, no liability can be fastened upon Insurer.
1. Investigated and determined - Merely because recording of evidence is required, or some questions of fact and law arise which would need to be investigated and determined, cannot be a ground for s....
The court affirmed that damages due to inundation are covered under the insurance policy, and failure to provide policy terms invalidated the insurance company's repudiation.
Insurance policy – Exclusion clause – Burden of proof is on the insurer to show that case falls within the purview of exclusion clause – In case of ambiguity, benefit goes to insured.
The Insurer must provide clear evidence for repudiation; mere allegations of defects do not suffice against documented damages.
No material damage was proven as a result of flooding; hence repudiation of the insurance claim was valid.
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