IMPORTANT POINT
Insurance Company cannot travel beyond grounds mentioned in repudiation letter.

ORDER

Inder Jit Singh, Presiding Member—The present Consumer Complaint (CC) has been filed by the Complainant against Opposite Party (OP) as detailed above, inter alia praying for directions to the OP to:—

(i) Direct the respondent to immediately process the claim of the complainant pertaining to ‘Package Policy in line with Bankers’, Indemnity Insurance Policy’.

(ii) Direct the Respondent to ‘disburse the claim amount of Rs.5,30,36,408/- to the complainant Company alongwith interest @ 18% p.a. with monthly rest, w.e.f. 11.10.2013 till realization.

(iii) Award a sum of Rs.1,00,00,000/- as compensation / damages on account of harassment, agony, loss of reputation.

2. Notice was issued to the OP(s). Parties filed Written Statement/Reply, Rejoinder, Evidence by way of an Affidavit and Written Arguments/Synopsis etc.

3. Brief facts of the case, as emerged from the pleadings of the parties and other case records are that Complainant obtained a Package Policy in line with Banker’ Indemnity Insurance Policy’ from the OP. The period of insurance cover obtained vide the said policy was w.e.f. 12.01.2013 till 11.01.2014. The said policy secured various branches of the complainant. An amount of Rs.1,53,82,084/- was paid by the complainant towards premium.

4. On 07.10.2013 an armed dacoity at gun point took place in one of the branches of the complainant situated at ‘Ram Guest House Market’ and on complaint of the Branch Manager of the Complainant, FIR under Section 395/397 of IPC was registered with Police Station Adityapur. It is the case of the complainant that said dacoity was committed by armed dacoits and gold ornaments were looted at gun point. The monetary value of the said looted gold ornaments was Rs.4,60,58,040/-. Further, the culprits had also taken away cash amount of Rs.69,662/- from the vault locker. It is further the case of the complainant that on the occurrence of the said incident, the complainant reported the matter to the OP and insurance claim was duly submitted alongwith all the relevant documents.

5. The OP vide its communication dated 02.01.2017 repudiated the insurance claim of the complainant, however, the complainant did not receive the said communication. On follow up with the OP, the OP addressed a communication dated 07.04.2017 to the complainant whereby the letter of repudiation dated 02.01.2017 was forwarded by the OP to the complainant. The complainant on receiving the letter of repudiation sent a reply dated 02.05.2017 to the OP. The said reply was not answered by the OP. Thereafter, complainant sent legal notice dated 20.06.2017 to the OP. Despite the receipt of said notice, neither the insurance claim has been processed nor the claim has been disbursed. Being aggrieved, the Complainant filed CC before this Commission.

6. The OP in their written statement stated that on being intimated of claim on 08.10.2013 by the complainant, they engaged a competent and independent surveyor for the alleged loss and he visited the spot on 10.10.2013 and 11.10.2013, who submitted a preliminary survey report on 14.10.2013. The complainant did not submit all the relevant documents alongwith the claim form and surveyor vide letter dated 14.10.2013 asked the complainant to submit the required records . On receipt of the documents, the surveyor visited the branch office of the complainant on 04.09.2014 and thereafter visited the Corporate Office of the Complainant at Kochi on 19.02.2015 to get details of the pledged items through their centralized system. However, the complainant did not provide the full data required by the surveyor. The surveyor submitted his report on 23.02.2015.

7. It is further stated by the OP in their written statement that claim of the complainant is on gross weight and in the present matter, there is gross breach of terms and conditions of the policy. The surveyor assessed the net weight of the lost gold ornaments as 14205.23 grams. As per Section (e) under the head ‘Indemnity’ of the Policy Valuation