Insurance claims must adhere to agreed terms; changing assessment criteria without consent is against regulations.

1. Cross Appeals have been filed by the Appellants under S.19 of the Consumer Protection Act, 1986 against the Order passed by the State Consumer Disputes Redressal Commission, U.T. Chandigarh (hereinafter referred to as the “State Commission”) in Complaint No. 17/2011 dated 30.1.2012.
First Appeal No. 178 of 2012 has been filed by the Appellant / Roxy Color Lab with a delay of 30 days as per the report of the Registry. For the reasons stated in the application IA / 01/2012 in the interest of justice, the delay is condoned.

2. The case of the Complainant is that the its Digital Colour Laboratory, including plant and machinery, office equipment, raw - materials, goods held in trust and trade, were covered by Standard Fire & Special Insurance Policies bearing distinct Nos.420102/11/08/3100000052 and 420102/11/08/3100000182 from 8.7.2008 to 7.7.2009 and 6.1.2009 to 5.1.2010 respectively. The total risk cover was Rs. 96 lakhs. Policy No. 420102/11/08/3100000052 was earlier being serviced by another Branch Office of the Opposite Parties and was renewed by Opposite Party No. 2. While renewing Policy No. 420102/11/08/3100000052, without having got the fresh Proposal Form signed from the Complainant, the nature of loss assessment for the Policy was unilaterally changed by the Opposite Parties from the earlier “Reinstatement Basis” to “Market Value Basis” without their approval or knowledge.

3. A major fire took place on 9.4.2009 at the Complainant’s premises. The Opposite Parties were duly informed by telephone on 9.4.2009 and also vide letter dated 10.4.2009. The Opposite Parties appointed Cunningham Lindsey International Private Limited, New Delhi, a loss assessment company, to assess the loss of the Complainant. All the necessary documents, as sought by the Surveyor, were supplied by the Complainant and the same was informed to the Opposite Parties on 13.08.2009. Ad - interim relief of Rs. 30 lakhs was released to the Complainant, vide Inter Office Memo dated 14.10.2009 by the Opposite Parties. The Complainant sought final settlement of its Fire claim, vide letter dated 5.11.2009. The Surveyors, however, vide letter dated 17.11.2009, sought further details after about 07 months after accrual of the claim. The Surveyor submitted a final report to the Opposite Parties on 3.2.2010 and assessed the claim at Rs. 48,43,268. After adjusting the On Account Relief of Rs. 30 lakhs, paid by way of an interim measure, the balance payable was Rs. 18,43,268. The assessment was made on Market Value Basis, instead of Reinstatement Basis clause wherein no depreciation was deductible, thus causing a loss of Rs. 19,61,749 to the Complainant. Later the Surveyors, vide Addendum dated 1.4.2010 to the Final Report dated 3.2.2010, informed the Opposite Parties that the Final Assessment of loss stood reduced to Rs. 48,01,272 and the balance payable was Rs. 18,01,272 / only. This was communicated by the Opposite Parties, vide letter dated 8.6.2010 to the Complainant. After much correspondence, the Opposite Parties, vide letter dated 27.7.2010, after over 15 months issued two cheques for Rs. 4,78,153 and Rs. 13,17,500 totalling to Rs.17,95,653 to the Complainant, short by a sum of Rs. 5,619. In view of the aforesaid acts of omissions and commissions on the part of the Opposite Parties, amounting to deficiency of service and unfair trade practice, a Complaint was filed before the State Commission with the following prayers:
(A) Admit the present consumer complaint and issue notice thereof to the Opposite Parties;
(B) Allow the present consumer complaint and direct the Opp