Insurers must adhere to policy terms regarding loss assessment; liability exists unless proven otherwise by substantial evidence.

1. The present Complaint is filed under Section 21 (a) (1) of Consumer Protection Act , 1986. The Complainant is a Company incorporated under the Companies Act, 1956 and is registered with Reserve Bank of India as a Non-Banking Financial Company, represented by its Authorized Representative Mr. L.D. Sharma and Sunil Barthwal. The Complainant is predominantly engaged in the business of rendering loan facilities to the intending borrowers, primarily against the security of “gold ornaments”. In order to secure its assets, including Gold Ornaments, the Complainant obtained a “Package Policy in line with Bankers’ Indemnity Policy” No.76060346122400000056 dated 12.01.2013, from the Opposite Party Insurance Company. The period of insurance cover was from 12.01.2013 to 11.01.2014.

2. Case of the Complainant is that on 01.02.2013, dacoity took place in one of the branches of the Complainant Company at Benachity, Durgapur, West Bengal. On the Complaint of Branch Manager of the Complainant Company, FIR No.47/2013 dated 01.02.2013 was registered under Section 395, 397, 412 and 120B of IPC with Durgapur Police Station, West Bengal. 42440.840 gms. net weight of Gold Ornaments were looted at gun point, wielding sharp weapons. The monetary value of the looted gold ornaments on the date of the incident was around Rs.12,52,00,478/-. Further loss on account of making charges equivalent to 20% of the value of the Gold was also suffered by the Complainant Company. Besides looting the aforesaid ornaments, the culprits had also taken away cash amounting to Rs.11,03,922.50/- from the vault locker and additional cash amounting to Rs.9,200/- from the Branch Staff, besides mobiles worth Rs. 73,000/- and a DVR worth Rs.19,000/-The total loss suffered by the Complainant Company was Rs.15,14,45,696.50/-.

3. The Complainant immediately reported the incident to the Opposite Party and submitted claim on 04.02.2013 along with relevant documents. The Complainant sent various reminders to the Opposite Parties and submitted Complaint to IRDA for expediting the claim. There was, however, no progress or communication regarding the claim from the Opposite Party, apart from letter dated 29.07.2015, whereby it was communicated that the claim file was sent to the Corporate Office by the Local office of the Opposite Party and the response was awaited. Thereafter, the Complainant sent legal notice dated 04.06.2016, calling upon the Opposite Party to expedite the claim and disburse the claim amount in its favour within a period of 30 days, but in vain. Alleging deficiency in service on the part of the Opposite Party, the Complainant filed the instant Consumer Complaint with this Commission with following prayer: -

“a) Direct the Respondent, to immediately process the claim of the Complainant pertaining to “Package Policy in line with Bankers’ Indemnity Policy” bearing No. 76060346122400000056 (Old Policy No. 76060346/11/24/00000001) dated 12.01.2013;

b) Direct the respondent to “disburse” the claim amount of Rs.15,14,45,696.50 (Rupees Fifteen Crores Fourteen Lacs Forty Five Thousand Six Hundred Ninety Six and Paise Fifty Only) to the Complainant Company, alongwith interest @ 18% p.a. with monthly rest, with effect from 08.07.2016, till realization;

c) Award a sum of Rs.1,00,00,000/- (Rupees One Crores Only) in favour of the Complainant, and against the Respondent, as compensation/damages, on account of the harassment, agony, loss of reputation suffered by the Complainant Company due to the deficiency in service on the part of t