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RAM SURAT RAM MAURYA, BHARATKUMAR PANDYA
Mohan Mines Pvt. Ltd. – Appellant
Versus
United India Insurance Company Ltd. – Respondent
ORDER
Bharatkumar Pandya, Member.—This complaint involves allegation of deficiency in service of insurance company with regard to repudiation of insurance claim taken for Kobelco SK 350 LC Hydraulic Excavator under Standard Fire and Special Perils (SFSP) Policy issued by OP-1 M/s United India Insurance Co. Ltd.
2. Complainant company is in the business of Mining and Construction and on 28.09.2007 it took lease for mining of Masonry stone on site at Village Dathed, Tehsil-Pahari, District Bharatpur and purchased one Kobelco SK 350 LC Hydraulic Excavator for Rs.83 lakhs. The Excavator was insured with OP-1 for a total sum of Rs.1.16 crores. For the purpose of mining in the area, complainant made a request for loan of Rs.One crore from OP-2 Vijaya Bank(now Bank of Baroda) for buying Kobelco Hydraulic Excavator. On 19.04.2008 loan was sanctioned by OP-2 Bank against security of Kobelco SK 350 LC Hydraulic Excavator along with additional accessories. On 22.04.2008 complainant bought the excavator for Rs.83 lakhs and on 25.4.2008, the complainant got it insured and on 31.3.2010 the policy was renewed for the total sum insured of Rs.1.16 crore and premium of Rs.23,590/- was paid by the OP
Surveyor appointed by Insurance Company under provisions of Insurance Act & their reports are to be given due importance & one should have sufficient grounds not to agree with assessment made by them....
Claim pending – Keeping a claim pending for such a long time without any decision clearly amounts to unfair trade practice on the part of the appellant/opposite party insurance company.
Insurers are not liable for losses arising from the insured's failure to follow operational guidelines; the burden of proof lies on the complainant to establish policy coverage.
The court emphasized the need for proper justification and adherence to regulations in repudiating an insurance claim, and highlighted the importance of considering expert reports and providing reaso....
Insurance Policy – Repudiation of claim – Surveyor;s report cannot be lightly brushed set aside & once survey report is not based on adhocism or is vitiated by arbitrariness, then jurisdiction of con....
It cannot be assumed that complainant had submitted false and fabricated documents before insurance company while taking insurance policy.
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.
The repudiation of the insurance claim was invalid due to the Insurer's failure to substantiate misrepresentation and procedural errors in claim handling and assessment.
The court enforced the principle that ambiguities in insurance policies favor the insured, ruling against the insurer for failing to adequately disclose exclusions.
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