Insurers must timely process claims as per statutory obligations; failure to do so amounts to service deficiency, making them liable for compensation.

ORDER

1. Initially the present First Appeal ( FA) has been filed by the Appellant against the Respondent under Section 21 (a) (ii) of the Consumer Protection Act , 1986 ( in short, the Act) read with Section 58 (1) (a) (iii) of the Act. However, on 12.10.2023, the Appellant was directed to state whether he is filing the First Appeal under the old Act or the new Act. During the hearing, learned counsel for the Appellant stated that he wishes to pursue his FA under the Old Act. Accordingly, he was granted two weeks time to modify the FA to bring it in conformity with the old Act.

2. The present First Appeal (FA) has been filed by the Appellant against Respondent as detailed above, under section 21 (a) (ii) of Consumer Protection Act 1986, against the order dated 19.05.2023 of the State Consumer Disputes Redressal Commission Delhi (hereinafter referred to as the ‘State Commission’), in Consumer Complaint (CC) no. 397 of 2015 inter alia praying for setting aside the order dated 19.05.2023 of the State Commission.

3. The Appellant was Opposite Party and the respondent was Complainant before the State Commission in the said CC No. 397 of 2015 before the State Commission.

4. Notice on Caveat was issued to the Respondent on 20.09.2023. Parties filed Written Arguments/Synopsis on 19.01.2023 ( Appellant) and 08.01.2024 respectively. Parties also filed revised arguments on 15.05.2024 ( Appellant) and 16.05.2024 ( Respondent ) respectively.

5. Brief facts of the case, as emerged from the FA, Order of the State Commission and other case records are that Complainant took a Standard Fire and Special Perils Policy ( Policy ) from the OP in respect of property No 465, Phase-V, Udyog Vihar, Industrial Area, Gurgaon, Haryana w.e.f. 20.05.2013 to 19.05.2014. The said property was allotted to the Complainant by HSIIDC and was approved for carrying out the business of Clinical Research and Data Management.

6. It is the case of the Complainant that M/s Bioinnovat Research Services Pvt. Ltd. ( Bioinnovat) was tenant on the ground, first and part of the third floor of the above said property at the time of incident i.e. 20.01.2014. A rent agreement was entered into between the complainant and Bioinnovat in respect of said property. The complainant was the Founder and Managing Director as well as shareholder of 50% equity shares with her daughter, namely, Ms. Sukrita Sethi, who was also shareholder of 50%of the equity shares. The Complainant also purchased a similar policy in respect of her property bearing no. 774, Phase-IV, Udyog Vihar, Industrial Area, Gurgaon, Haryana and was having seven concurrent policies till May 2015.

7. It is further the case of the complainant that on 20.01.2014, a fire broke out on the first floor of the property no. 465, Phase-V, Udyog Vihar, Industrial Area, Gurgaon, which got severely damaged in the fire, while the rest of the property was damaged by smoke and water during rescue operations. The first floor was under the tenancy of Bioinnovat. The fire could be extinguished by mid night and almost everything on the first floor was burnt and irretrievably and there was no loss of life. The incident was reported to the police and FIR was registered. The complainant informed the insurance company of the incident and provided all the relevant documents to the OP for processing of claim. The premises was inspected by the surveyor duly appointed by the OP.

8. It is further the case of the complainant that on asking of the OP, complainant provided a tentative assessment of the claim on 21.01.2015 which was based on assumptions made without actually investigating the damaged premises as the entry on the first f