Insurance companies must assess claims with consideration of provided evidence, not merely on strict documentary requirements.

ORDER

1. The present appeal has been preferred under Section 19 of the Consumer Protection Act , 1986 on behalf of the appellant (hereinafter referred to as the “Opposite Party” as reflected in the complaint filed before the State Commission), whereby the appellant/OP has been held liable to pay Rs.35 lakhs along with interest @ 9% per annum from 24.01.2018 till date of realization along with compensation of Rs.50,000/- for mental agony and harassment and Rs.21,000/- as litigation charges to the respondent (hereinafter referred to as the “Complainant”.

2. Factual matrix fall within a narrow encompass. Complainant, who was authorized for manufacturing of medicines and general items of Ayurveda/Siddha/Unani medicines by the competent State authorities of Haryana, stored the stock at Shop No.12, opposite Civil Hospital, Bhiwani for marketing/sale. The shop/godown was insured with the opposite party by way of insurance policy for the period 07.08.2015 to 06.08.2016 for Rs.35 lakhs. Unfortunately, due to outbreak of fire on 08.02.2016 by a short circuit, the shop/godown along with goods was gutted. The incident was reported to the Fire Station Office at 01:08 am on 08.02.2016.

Complainant claimed to have suffered a loss of Rs.40 lakhs due to burning of stock in the fire and claim was accordingly raised with the opposite party/Insurance Company. The documents, as sought by the Surveyor appointed by the opposite party were furnished by the complainant. However, the claim was repudiated by the opposite party/Insurance Company vide letter dated 23.01.2017, based on report of the Surveyor, which limited the liability to Rs.1,29,013/- and further pointed out to condition no. 6(i) of the policy.

3. Aggrieved against the same, complaint was preferred by the complainant before the learned State Commission. The same was contested on behalf of the opposite party claiming that deficiencies were found in the documents including financial accounts, submitted by the complainant in support of the claim. It was further averred that complainant failed to provide the requisite information/documents despite letters/e-mails forwarded in this regard and, accordingly, the claim was repudiated on 23.01.2017.

4. Complainant tendered his evidence by way of affidavit before the learned State Commission and the relevant documents were exhibited as Ex.C-1 to Ex.C-23.

5. On behalf of opposite party, evidence of Ms.Puja Bhawan, Assistant Manager and Mr. A.K. Gupta, Surveyor was tendered by way of affidavit and the relevant documents were exhibited as Ex.R-1 to Ex.R-7.

6. Learned State Commission noticed that there is no dispute as to the fact that stock was insured for Rs.35 lakhs and the fire broke out in the premises on 08.02.2016 during the validity of the insurance policy from 07.08.2015 to 06.08.2016. Further, intimation was duly given to the insurer on the same day and DDR was also recorded at the concerned Police Station. It was further observed that the insured claimed a sum of Rs.32,42,580/- towards the cost of damaged Ayurveda/Siddha/Unani medicines but was asked by the Surveyor to submit documents, which were made available by the complainant including balance sheet, manufacturing-cum-trading accounts of the relevant year, receipts of VAT etc.

Considering the facts & circumstances and after evaluating the evidence on record, complaint was allowed by the learned State Commission for the reasons recorded in para 6 of the impugned order as under:-

“6……………………It is suffice to say that once the relevant documents including the balance sheet, tax receipts, returns and other relevant documents were made a