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DELHI STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Pinki, Member Judicial and
Bimla Kumari, Member Female
GNE Exports Pvt. Ltd. – Complainant
versus
New India Assurance Co. Ltd. – Opp. Party
CC No.330 of 2015
Decided on 21.10.2024
Consumer Protection Act, 1986 – Sections 2(1)(d), 2(1)(g) – Insurance Policy , viz; Standard Fire & Special Peril Insurance Policy – Repudiation of claim – “Consumer” – “Deficiency in service” – Complainant has availed services of insurance company for protection of its goods from fire & other dangers, it cannot be said that he availed services of OP for commercial purpose & was not a consumer ; Complainant has filed complaint only for recovery of claim amount which was assessed by surveyor, appointed by OP – Complaint does not involve any complicated questions which cannot be decided in summary proceeding – Endorsement regarding correction in location of premises was carried by OP on 14.1.2013 in respect of policy in question – Endorsement will relate back from date of policy & not from date of rectification of errors by OP – There is deficiency in service on part of OP & OP was not right in repudiating legitimate claim of complainant on technical grounds – OP is directed to refund amount of Rs.73,57,656/- to complainant as per arrangement made & further pay cost of Rs.1 lakh for mental agony & harassment to complainant & litigation cost of Rs.50,000/-.(Paras 22, 23, 27, 30,
34, 35, 36 and 38)
Result: Complaint allowed.
ORDER
Bimla Kumari, Member Female.—Brief facts of the case are that the complainant company (herein after referred to as complainant) has taken various insurance policies from the opposite party and also purchased a Standard Fire and Special Peril Insurance Policy No.36090111120100000221 for a period w.e.f. 08.01.2013 to 07.01.2014 for a sum of Rs.One crore in respect of premises R.No.6-10, B-31-32, G-32, Ground Floor Masjid Moth, South extension, New Delhi-110049. The said insurance policy covered the stocks of all kinds of clothes such as fabrics, readymade garments, suits, F.S.F. goods, Goods in process, raw material used for manufacturing readymade garments and similar goods belonging to the complainant’s trade. However, the address in the insurance policy was mentioned by the opposite party as R.No.6-10, B-31-32, G-32 First Floor, Masjid Moth, South extension, New Delhi-110049. Further, the location address was also mentioned as Gurgaon-110049, whereas the insurance policy was purchased by the complainant for New Delhi.
2. It is the case of complainant that before the policy was issued, the Officers of the Opposite Party, personally visited the premises and thereafter, the policy was issued. The said error on the part of the Opposite Party was immediately brought to the notice of the Opposite Party and Mr. Desh Raj, Branch Head of the Opposite Party accepted that there were errors in the policy and an endorsement regarding change of location in the Insurance Policy was made on 14.01.2013.
3. It is the further case of the complainant that it was not for the first time that the address in the policy was mentioned incorrectly because the policy issued for the period w.e.f. 06.01.2012 to 05.01.2013 being policy no. 36090111110100000227 also mentioned the incorrect address of the premises as well as location. It is the further case of the complainant that when he purchased another policy for a period 08.01.2014 to 07.01.2015 being policy no.36090111120100000218 for the premises at Ground and First Floor, B-222 Phase-1, Naraina Industrial Area, New Delhi-110028 that time also, the location of the property was mentioned as Karol Bagh, New Delhi. The said error was pointed out by the complainant to the opposite party, which was acknowledged by the Senior Divisional Manager of the opposite party.
4. It is the further case of the complainant that on 11.01.2013 at around 5:00 PM, a fire started from an air conditioner, due to an electrical short circuit, which was installed in the working room of the premises. The short circuiting produced sparks, which fell on the material/fabric, lying on the tables, which caught fire in no time. The workers working at that time could not escape immediately and three workers sustained burn injuries. The representatives of the Complainant informed the incident to Fire Services immediately and the Fire Brigade reached the site at 5:20 PM. The complainant also informed the Hauz khas police station and the Daily Diary no. 41A was recorded at the police station. The opposite party was also immediately informed regarding the incident and inspection of the premises was carried out by the surveyor Sanjay Dwivedi & Associates, appointed by the opposite party on 15.01.2013, 16.01.2013 and 17.01.2013. Thereafter, the complainant lodged its claim with the opposite party on 21.01.2013 for an estimated loss of Rs.95 lakhs. Thereafter, the complainant wrote letter to the surveyor on 20.02.2013 and requested him to prepare the report. After a lapse of 6 months, the complainant received a report on 12.08.2013, wherein only a sum of Rs.73,57,656/- was estimated by the surveyor, to be payable by the opposite party to the complainant as against the claim of Rs.95 lakhs. Thereafter, the complainant regularly followed up the claim with the officials of the opposite party but of no avail.
5. It is the further case of complainant that on 22.11.2013 the complainant send an email to the Branch manager of the opposite party
Insurance Policy, viz; Standard Fire & Special Peril Insurance Policy – Repudiation of claim not justified – Complainant is Consumer as he filed claim for recovery of amount assessed by surveyor.
Insurance companies must provide substantial proof when denying claims; unjust repudiation leads to enforceable obligations to pay agreed amounts.
(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 ....
IMPORATNT POINT Appointment of Surveyor – Insured can also appoint a Surveyor or loss accessor.
The court established that a consumer can claim under the Consumer Protection Act for insurance disputes, even with commercial intent, emphasizing assessment fairness by the appointed Surveyor.
The court enforced the principle that ambiguities in insurance policies favor the insured, ruling against the insurer for failing to adequately disclose exclusions.
Insurance claims must be assessed based on fair and contractual standards, avoiding arbitrary deductions.
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