IMPORTANT POINTS
(1) Adverse Claim – The law mandates that a party confronted with an adverse claim must voice its opposition; failure to do so results in a deemed acceptance of the allegations or facts asserted against it.
(2) Insurance Claim – When a duty to respond arises, whether to accept or deny a claim, the Insurance Company is obligated to discharge such duty.
(3) Acceptance – It is a well-settled principle of law that when a party is expressly called upon to deny an assertion but fails to do so, such silence amounts to acceptance.

JUDGMENT

AVM J. Rajendra, AVSM VSM (Retd.), Member—The present Consumer Complaint has been filed under Section 21 of the Consumer Protection Act, 1986 (for short “the Act”) against the Opposite Parties seeking to direct the OPs:

“A. Pay to the Complainants the sum of INR 10,88,02,467/- along with interest 15 % per annum.;

B. Pay to the Complainants the sum of INR 2,50,00,000 /- towards compensation as damages for the gross deficiency in service and having caused hardship and irreparable injury to the Complainants;

C. Secure the amount as mentioned at Prayer(A) pending hearing and final disposal of these proceedings;

D. Pay the costs of these proceedings;

E. Pass such further order as this Commission may deem just and proper in the facts and circumstances of the case.”

2. Brief facts of the case are that on 31.03.2015, a fire broke out at the Complainant’s Plant, causing substantial damage and financial loss. Since the Plant was insured under the Reinstatement Insurance Policy, the Complainant informed OP, along with Police Authorities, Factory Inspector and the Tehsildar. These authorities inspected the site and prepared respective reports. The Deputy Director Industrial Safety and Health, Kalyan, visited the Plant on 31.03.2015, while PSI Shahapur Police Station visited on 01.04.2015 and prepared a Panchanama. The OP appointed Surveyor inspected the premises on 01.04.2015 and conducted investigation. All parties concluded that significant damage occurred at the Plant due to fire. On 08.04.2015, the Kalyan & Dombivli Municipal Corporation (Fire Brigade & Emergency Services, Kalyan) issued a Report of Fire Accident dated 31.03.2015, stating that the exact cause of the fire could not be determined but appeared to have resulted from a technical fault or glitch. The Complainant kept the OP and Surveyor informed of all developments and extended full cooperation by providing all sought documents and explanations. The Surveyor submitted its Preliminary Report on 28.08.2015, wherein the total estimated loss was Rs.11,57,87,629. However, OP did not release any amount. On 19.01.2016, at the Surveyor’s request, the Complainant submitted the final claim bill for reinstatement of the Plant and sought settlement.

On 20.04.2016, the Complainant submitted a revised claim bill for total net claim of Rs.10,88,02,467. For the period from 31.01.2015 to 07.09.2016, the Complainant and the Surveyor exchanged detailed correspondence, wherein the Surveyor sought certain additional information, which was duly provided. On 13.12.2016, the Surveyor submitted the Final Survey Report, wherein he listed ten alleged ‘discrepancies’ and recorded incorrect findings, that the Complainant had failed to make full disclosures, had not substantiated its claim, and submitted false statements, documents, and accounts. Despite the adverse findings, the assessed the loss was Rs.7,34,69,218. The Complainant repeatedly requested the OP for the final settlement of its claim, but no action was taken. Instead, over five months after the Final Survey Report, the OP, vide letter dated 24.05.2017 (received on 01.06.2017) repudiated the claim on the ground that it allegedly fell under General Conditions 1, 6(i)(b), and 8 of the Insurance Policy. In the same letter, OP stated that the Complainant was being given one final opportunity to substantiate its claim. The Complainant responded on 02.06.2017, refuting the OP’s stance and asserting that the cited General Conditions were not applicable and arbitrarily and unjustly rejected the explanations and repudiated the claim. Thus, this Complaint is filed mainly seeking payment of Rs.10,88,02,467/- along with interest and damages.

3. Upon notice, the complaint was contested by OP through its Written Statement, where it denied any deficiency in service or arbitrary conduct in rejecting the Complainant’s claim for loss due to fire. It was contended that the mere existence of an insurance policy did not automatically entitle