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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
A.P. Sahi, President and Dr. Inder Jit Singh, Member
Gautam Solar Pvt. Ltd. – Complainant
versus
Oriental Insurance Co. Ltd. and Anr. – Opp. Parties
Consumer Case No.335 of 2015
Decided on 22.10.2024
Insurance Policy – Standard Fire & Special Perils Policy – Fire in basement of premises of petitioner-complainant – Deficiency in service – Delay in settlement of claim by Insurance Company – Compensation – Enhancement – No ground made out to enhance compensation – Insurance Company is willing to settle the claim on the basis of Net Assessed Loss of Rs.44,19,174/- In absence of any doubt about the audited accounts, there was no occasion for surveyor to have compared it with the stock statement & then reduced the value – Business entities like complainant are not expected to maintain multiple set of statements for different purposes – All their statements must confirm to the actual state of affairs – Complainant has not notified to his bank that stock statements being submitted to them are not based on his audited books of account & his actual stock position is much higher – Complainant is now estopped from pleading for the purpose of claiming higher amount for his loss that bank stock statements under-stated his stock position & that audited stock statements reflected his stocks position correctly – Surveyor was right in recommending the loss based on bank stock statement method & Insurance Company is justified in suggesting settlement of claim as per assessment of loss by Surveyor, which include assessment of stock loss based on bank stock statements – Complainant is entitled to total sum of Rs.44,19,174/- only as recommended by the Surveyor – Insurance Company has expressed its willingness to settle the claim for said amount – As complainant has been contesting his claim for more than 9 years now, litigation cost of Rs.50,000/- is also awarded – OP-Insurance Company shall pay compensation of Rs.2 lakhs for deficiency in service on account of inordinate delay in settling the claim. (Paras 12 and 13)
Result: IAs disposed of.
ORDER
The complainant is aggrieved by the non-settlement of the insurance claim under a Standard Fire and Special Perils Policy covering the loss which the petitioner had claimed for an incident of fire in the basement of the premises on 25.02.2014. The complainant alleges that the entire stocks stored were gutted in the said fire which deserves to be indemnified as per the insurance policy duration whereof is from 25.01.2014 to 24.01.2015 and the total sum insured was Rs.10 crores. The complainant also had a second policy with regard to the plant and machinery and other accessories insured for a sum of Rs.6 Crores.
2. The case is a bit peculiar on facts inasmuch as the insurance company did not communicate any repudiation nor did they settle the claim on the plea that the complaint had already been filed before this Commission where they have already filed their response. All these facts were noticed and it also emerged that the surveyor report dated 15.01.2015 had not been shared with the petitioner and after orders were passed by this Commission, that the surveyor report surfaced through the evidence affidavit of the insurance company that has been placed on record. There were issues regarding one of the pages of the surveyor report missing that was noticed when the matter was heard earlier on 16.02.2024 and the following order was passed:
This complaint arises out of a claim under the Standard Fire & Special Perils Policy. True copies of the policies under which the claims have been made by the complainant have been placed on record and are not disputed. The first is with regard to stocks, duration whereof is from 25.01.2014 to 24.01.2015 where the total sum insured is Rs.10,00,00,000/-. The second policy is with regard to plant, machinery and other accessories, including the equipments of solar energy etc. which is also for the same duration with a total sum of Rs.6,00,00,000/- as the sum insured. The incident took place in the basement of the premises on 25.02.2014 and, according to the complainant, the entire stocks stored there were gutted in the said fire. The complainant raised his claim and also sent intimation to the Police, Fire Department and also to all concerned Authorities. There is evidence to the effect that the fire was attended to by the Fire Brigade and the cause of fire was shown to be short circuit. The claim was referred by the Insurance Company to the surveyor who raised queries and sought for documents through his letter dated 26.03.2014. The case of the complainant is that the entire documents running into hundreds of pages were supplied and the surveyor was given all answers to the queries raised by him. It was also pointed out that apart from the losses suffered, the salvage goods were also traded off for a sum of Rs.11,20,786/- accepting the highest bid that was conducted through e-tenders. This has to be noted as one of the arguments advanced is that the value of the salvage itself was more than sufficient to compute the value of the loss keeping in view the huge amount that was recovered on account of the disposal of the salvage. The Insurance Company did not respond either by supplying a copy of the surveyor’s report or by intimating any settlement or repudiation. It is in this background that the present complaint was filed on 18.03.2015 calling upon the opposite parties to answer as to why the claim has not been assessed so far, pointing out to the information already tendered and the details of the loss suffered by the complainant. A written statement came to be filed on 10.07.2015 and in paragraph-2 thereof at page 9 it has been admitted that the surveyor had submitted his report in January 2015 assessing a loss of Rs.44,19,174.15 paise. The same paragraph also recites that the claim of the complainant is still under consideration of the Insurance Company. The aforesaid recital in the written statement therefore establishes that up-to the stage of filing of the written statement no final
Insurance Policy – Standard Fire & Special Perils Policy – Surveyors report is a valuable document based upon which Insurance company have to take final decision on the claim.
Surveyor's report on loss assessment is definitive unless credibly challenged; insurer's actions were not deemed deficient.
Insurance claims must be assessed justly, with surveyor reports not being conclusive and subject to scrutiny.
Approved Surveyor’s report may be foundation for settlement of claim by Insurer but such report is neither binding upon insurer or insured.
Assessment - In absence of details relating to stage of production of items, the Surveyor was justified in considering the semi-finished cost rate at 50% of finished cost rate on an average of 50% co....
Insurance claims must be substantiated by sufficient evidence; the insurer’s assessment is valid if conducted thoroughly.
Commercial entities are consumers under the Consumer Protection Act, and the credibility of surveyor assessments is upheld unless disproven.
The execution of a full and final settlement under duress does not preclude a claimant from pursuing legitimate compensation.
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