IMPORTANT POINT
Insurance – Terms and conditions of policy shall govern contract between parties – District Consumer Commission does not have powers to add, delete or substitute something, which is not been covered under policy or their contract.

ORDER

Vijay C. Premchandani, Member.—The present appeal is preferred by the appellant/original opponent no.1 against the impugned order dated 12/01/2021 passed by the Ld.District Consumer Commission, Sangli in consumer complaint no.CC/19/228.

The Factual Matrix:-

2. The appellant hereinafter be referred as original opponent no.1 and the respondent no.1 as original complainant. The original complainant obtained the Standard Fire and Special Perils policy of insurance from the original opponent no.1 covering its specified premises for the period from 25/03/2019 to 24/03/2020. The said policy was covering all the risks pertaining to the stock in fire and special perils policy of insurance. The original complainant stated in the original complaint that in floods dated 05/08/2019 to 13/08/2019, the premises mentioned in the policy submerged in the flood water and the stock was damaged. Therefore, the original complainant had filed the claim with the appellant/ original opponent no.1-Insurance company and the said claim was not honoured by the Insurance company. Hence, there is deficiency of service on the part of the appellant/ original opponent no.1 and the Ld.District Consumer Commission has directed the original opponent no.1 to pay compensation of Rs.7,25,960/- towards the claim along with interest and compensation of Rs.20,000/- and cost of Rs.5,000/- and the consumer complaint was dismissed against the original Opponent no.2. Being aggrieved with the said judgment and order, the present appellant/original opponent no.1-Insurance company has filed the appeal on the following grounds:-

Grounds of Appeal:-

3. It is contended that the liability of the Insurance Company is as per the description in the policy of the insurance. It is also admitted fact that the complainant had renewed the concerned policy and received the policy document on 19/03/2019, which is well before the alleged loss in August 2019. If complainant had any objections regarding concluded policy contract, he should have raised the complaint within a period of 15 days of receipt of the policy. It is also contended in the grounds of appeal that the Ld.District Consumer Commission has committed an error while observing that – “If all stock was usually kept at basement, and if stock kept at basement itself was not to be covered, then such policy should not have been sold to complainant.”

4. It is further contended that the Ld.District Consumer Commission should have appreciated the clause no.4 on page 8 of the policy i.e. “Quote is subject to no basement exposure at risk location”.

5. The Ld.District Consumer Commission has not appreciated the documentary evidence from the policy, survey report and repudiation letter, etc. It is further contended that the policy terms and conditions are invoked in the case are according to the Guidelines of Insurance Regulatory and Development Authority (IRDA), hence the contract between the parties is binding upon them.

6. It is further contended in the grounds of appeal that the Surveyors are appointed as per Section 64 UM of the Insurance Act, 1938 and they are independent. Hence their reports are having importance. The Hon’ble Forum has wrongly and arbitrarily discarded assessment of loss made by the Surveyor in this case. Hence, the judgment delivered by the Ld.District Consumer Commission is without appreciating the evidence on record and ignoring the facts of the case, arrived at erroneous conclusion while passing an impugned order which is under challenge.

7. The appellant has prayed that the impugned order passed by the Ld.District Consumer Commission, Sangli in consumer complaint no.CC/19/228 dated 12/01/2021 may kindly be quashed and set aside.

8. After admission of appeal, the notices were issued to the respondents. The respondents appeared. Heard argument of both the sides.

9. After perusal of the appeal memo, record, impugned order and the citations referred by both the parties, we come to the conclusion that the follo