ORDER

          The appellant purchased a CT Spiral Scan Machine and in order to secure it against damages, the appellant obtained an insurance risk cover for an assured sum of Rs.85,00,000/- effective for the period from 10.06.2003 to 09.06.2004.  The said machine stopped functioning on 11.02.2004, about which a complaint was made to the manufacturing company, whereupon an engineer arrived and on inspection observed that the x-ray tube/monitor of the CT scan machine has failed.  This was reported to the Insurance Company who appointed a surveyor Mr. Ajay Kumar Jain, a Chartered Engineer, to conduct the survey.  Photographs were taken and the invoice as well as the statement of the radiographer was taken along with a service report.  The Insurance Company sent a final surveyor Mr. Munish Prashar from Puri Anuj & Associates for survey on 15.04.2004 who found that the x-ray tube/monitor is out of order.  He demanded some information that was promptly dispatched by the appellant on 19.04.2004.  The Insurance Company repudiated the claim on 28.12.2004.

          Since no further response was being shown by the Insurance Company, the appellant complainant got the picture tube of the machine replaced on payment of Rs.19,50,000/- and a copy of the receipt was given to the surveyor.  This was to keep the machine operating as it was an everyday need of the hospital. 

          The Insurance Company instead of indemnifying the claim declined to do so on the ground that the complainant was not entitled to any such reimbursement as the exclusion clause applied and accordingly any loss or damage to bulbs, valves and tubes stands excluded under the Special Exclusion to Section-1 of the insurance policy.  The complainant raised a claim with a letter dated 04.01.2005 demanding reimbursement as per the terms of the policy.  In response thereto the Company intimated that the matter was taken up at the level of the Divisional Office who have also declined the claim.  This was communicated by the letter dated 15.03.2005 extracted hereunder:

“15 March 2005

Jeevan Prakash Hospital & Research Centre Pvt. Ltd.,

Kamal Cinema Building

Opposite Railway Station,

Muzzaffar Nagar – 251001(UP)

Kind attention: Dr. Manoj Kabra, Director.

Reg.:Repudiation of your claim under Pol. No. 321101/44/03/30011.

Dear Sir,

          We are in receipt of your letter dated 18.02.05 in regard to above.

          We have taken up the matter with our Meerut D.O-1 and have now received a copy of letter dated 3.3.05 originally addressed to you.  The reason given in the letter that a picture tube has already taken slices of 92539 (exposures) whereas the company’s liability is upto 30000 nos. of exposures only, so the claim has been rightly repudiated by the operating office.

          We hope you will find the same in order.

Thanking you,

Yours truly,

(DR. J.S.DAHIYA)

DEPUTY MANAGER

Encl. : a/a”

          The letter received from the Divisional Office dated 03.03.2005 is reproduced hereunder:

“THE NEW INDIA ASSURANCE COMPANY LIMITED

DIVISIONAL OFFICE-1(321100)

195SOTI GANJ MEERUT

PHONE-2661540, 2661208, 2661545, DAX 2666719

Without prejudice

(By registered post)

March 3, 2005

M/s. Jeewan Prakash Hospital & Research Centre

Kamal Cinema Building

Opposite Railway Station

MUZAFFARNAGAR (U.P.)

Dear Sir,

Re: Your Complaint on repudiation of claim No. 321101/04/0014 Policy No. 321101/44;03/3011 Date of loss 11.4.2004

We are in receipt of your letter on above subject. As we already informed you by our Branch vide letter dated 28/12/2004 by registered post that that as policy terms & condition your above loss does not fall under the purview of Electronic Equipment Policy for the reasons stated in above letter.

However, we may like to inform you again that your claim is not maintainable for the following reasons.

As per Terms & Condition of Electronic Equipment Policy (again attached hereto for your ready reference) please refer Section I- Equipment-Special Exclusion to Section I sub clause (1) which read