NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. Inder Jit Singh, Presiding Member
National Insurance Company Limited – Appellant
versus
Guljit Chaudhri – Respondent
First Appeal No.916 of 2023
(Against the Order dated 19/05/2023 in Complaint No. CC/397/2015 of the State Commission Delhi)
Decided on 22.10.2024
Consumer Protection Act, 1986 – Section 21(a)(ii) – Insurance Regulatory & Development Authority (Protection of Policy holder’s Interests) Regulations, 2002 – Clause 9 – Standard Fire & Special Perils Policy – Fire in Industrial property – Compensation – Deficiency in service – Delay & laches on part of Insurance Company – Insurance Company is mandated to take final decision on claim within maximum of about 7 months – These provisions being mandatory in nature, non-observance of these time-lines itself amount to deficiency in service on party of Insurance Company – In absence of any orders/injunction from Commission or any other legal impediment there was no bar on insurance company to take final decision on claim – Insurance Company is guilty of deficiency of service entitling insured compensation on account of such inordinate delay in service to decide their claim, over & above eligible claim on merits along with interest as per provisions of Insurance Regulations – SC has given a well reasoned order duly addressing all contentions of parties & this Commission is in agreement with its observations & findings & no reason to interfere with same. (Paras 15, 16, 17 and 18)
Result: FA dismissed.
ORDER
Initially the present First Appeal (FA) has been filed by the Appellant against the Respondent under Section 21 (a) (ii) of the Consumer Protection Act, 1986 (in short, the Act) read with section 58 (1) (a) (iii) of the Act. However, on 12.10.2023, the Appellant was directed to state whether he is filing the First Appeal under the old Act or the new Act. During the hearing, learned counsel for the Appellant stated that he wishes to pursue his FA under the Old Act. Accordingly, he was granted two weeks time to modify the FA to bring it in conformity with the old Act.
2. The present First Appeal (FA) has been filed by the Appellant against Respondent as detailed above, under section 21 (a) (ii) of Consumer Protection Act 1986, against the order dated 19.05.2023 of the State Consumer Disputes Redressal Commission Delhi (hereinafter referred to as the ‘State Commission’), in Consumer Complaint (CC) no. 397 of 2015 inter alia praying for setting aside the order dated 19.05.2023 of the State Commission.
3. The Appellant was Opposite Party and the respondent was Complainant before the State Commission in the said CC No. 397 of 2015 before the State Commission.
4. Notice on Caveat was issued to the Respondent on 20.09.2023. Parties filed Written Arguments/Synopsis on 19.01.2023 (Appellant) and 08.01.2024 respectively. Parties also filed revised arguments on 15.05.2024 (Appellant) and 16.05.2024 (Respondent) respectively.
5. Brief facts of the case, as emerged from the FA, Order of the State Commission and other case records are that Complainant took a Standard Fire and Special Perils Policy (Policy) from the OP in respect of property No 465, Phase-V, Udyog Vihar, Industrial Area, Gurgaon, Haryana w.e.f. 20.05.2013 to 19.05.2014. The said property was allotted to the Complainant by HSIIDC and was approved for carrying out the business of Clinical Research and Data Management.
6. It is the case of the Complainant that M/s Bioinnovat Research Services Pvt. Ltd. (Bioinnovat) was tenant on the ground, first and part of the third floor of the above said property at the time of incident i.e. 20.01.2014. A rent agreement was entered into between the complainant and Bioinnovat in respect of said property. The complainant was the Founder and Managing Director as well as shareholder of 50% equity shares with her daughter, namely, Ms. Sukrita Sethi, who was also shareholder of 50%of the equity shares. The Complainant also purchased a similar policy in respect of her property bearing no.774, Phase-IV, Udyog Vihar, Industrial Area, Gurgaon, Haryana and was having seven concurrent policies till May 2015.
7. It is further the case of the complainant that on 20.01.2014, a fire broke out on the first floor of the property no. 465, Phase-V, Udyog Vihar, Industrial Area, Gurgaon, which got severely damaged in the fire, while the rest of the property was damaged by smoke and water during rescue operations. The first floor was under the tenancy of Bioinnovat. The fire could be extinguished by mid night and almost everything on the first floor was burnt and irretrievably and there was no loss of life. The incident was reported to the police and FIR was registered. The complainant informed the insurance company of the incident and provided all the relevant documents to the OP for processing of claim. The premises was inspected by the surveyor duly appointed by the OP.
8. It is further the case of the complainant that on asking of the OP, complainant provided a tentative assessment of the claim on 21.01.2015 which was based on assumptions made without actually investigating the damaged premises as the entry on the first floor was completely blocked by the debris and there was no electricity. A revised estimate of Rs.90.00 lacs was given by her to the OP for complete restoration of the damaged premises but the OP did not offer any claim to her and delayed the claim to such an extent that she got complete restoration of the damaged premises, while her cla
IMPORATNT POINT Appointment of Surveyor – Insured can also appoint a Surveyor or loss accessor.
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.
Underinsurance assessed by Surveyor is arbitrary.
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.
Insurance companies must provide substantial proof when denying claims; unjust repudiation leads to enforceable obligations to pay agreed amounts.
Surveyor report The surveyor report is not based on legally justiciable reasons and facts and cannot be relied upon, being arbitrary and perverse.
Insurance companies cannot avoid liability by citing external compensations, and second surveyors must be appointed with regulatory oversight.
Report of surveyor is an important document and a basis for consideration of the claim.
Insurance – In absence of requisite evidence from Complainant to support peril covered under policy, no liability can be fastened upon Insurer.
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