This first appeal has been filed by the appellant National Insurance Company Limited challenging the order dated 8th December 2016 in CC No. 28 of 2014 passed by the Haryana State Consumer Disputes Redressal Commission Panchkula (in short “the State Commission”).
2. The brief facts of the case are that on 23.11.2009, the respondent had taken a Standard Fire and Special Perils Policy of Rs.1,35,00,000/- towards all kind of stocks w.e.f. 23.11.2009 to 22.11.2010. On 12.07.2010, as per the version of respondent, a devastating fire had broke out due to short circuit and caused loss to the building, machinery and stock. The respondent lodged the claim on 04.08.2010 with the Insurance Company and the surveyor was deputed to carry the survey and inspection. On 10.08.2011, the surveyor M/s. Rakesh Kapoor & Co. has assessed the loss @ Rs.18,74,530/- and also remarked and opined that the moral hazard element of the insured/respondent and submitted its report dated 10.08.2011. On 07.03.2012, after receiving the survey report, noticing the conduct of respondent with regard to its habitual past claim experiences, the appellant appointed M/s. AKB Associates, Investigator to investigate the genuineness of the claim. The investigator vide its investigation report dated 07.03.2012 has also noted certain irregularities such as renewing the fire policies from different insurance companies and that too outside Panipat. On 11.10.2012, the Insurance Company repudiated the claim on the basis of detailed finding arrived at in the survey report and on the basis of breach of principle of utmost good faith. On 18.03.2014, the insured filed the consumer complaint before the State Commission. On 08.12.2016, the State Commission allowed the complaint directing the Insurance Company to pay the amount of loss as assessed by the surveyor @ Rs.18,74,530/- along with interest at the rate of 9% p.a. from the date of filing of complaint till its realization and Rs.10,000/- as litigation expenses, to be paid within a period of 30 days from the date of receipt of the order.
3. Being aggrieved by the order of State Commission, the appellant has approached this Commission by way of appeal.
4. Heard the learned counsel for both the parties and perused record. The learned counsel for the appellant stated that the claim of the respondent complainant has been repudiated mainly on two grounds that the complainant company has not made any improvement in their electrical systems and they keep the electrical installations and systems in a shabby state of affairs and generate fire claims with a new insurance company. Surveyor has reported that about eight claims of fire loss have been filed by the complainant and in fact, the complainant is habitual litigant and some of the claims of insurance are pending even with this Commission, for example FA No.23 of 2010 and RP No. 264 of 2012. Some of the claims are also pending with other consumer fora. This shows that complainant is habitual in generating such fire claims which may not be genuine and then the complainant tries to get the compensation through courts. The second ground on which the claim has been rejected is the violation of the principle of utmost good faith between the insured and the insurer. In fact, when the policy was being given to the complainant company, it was informed by the complainant company that no fire claim has arisen before and on this information, the present policy was given to the complainant. The information disclosed by the complainant in respect of the earlier fire claims was totally wrong and false and therefore, the principle of utmost good faith has been grossly violated by the complainant. In a way, the fire claim is a fraudulent claim and cannot be accepted by the Insurance Company.
5. On the other hand, the learned counsel for the respondent complainant stated that the claim is genuine and the surveyor has also assessed the loss. Even the investigation carried out by the investigator has not given any finding that the claim is a fraudulent claim. There was no such information given to the insurance company that no fire claim was there. If any policy is taken and fire breaks out then a claim has to be lodged before the insurance company. It should be the job of the surveyor to find out whether the claim is genuine or not. Just because there are other previous claims, the present claim cannot be termed as a fraudulent claim. The State Commission has considered all these aspects and has agreed with the loss assessed by the surveyor. Thus, there is no merit in the appeal filed by the insurance company.
6. I have carefully considered the arguments advanced by the learned counsel for both the parties and have examined the material on record. In the repudiation letter, the claim has been repudiated on the basis of various excerpts mentioned from the report of the surveyor and the main emphasis of these excerpts is on the shabby maintenance of electrical installations and systems which have become more prone to short circuiting. Thus, the complainant has not provided due care and precaution for the proper maintenance of the electrical systems and installations which was the duty of the insured. Other emphasis has been given on those excerpts from the report of the surveyor where the surveyor has mentioned the history of previous claims due to fire. It is also mentioned in the repudiation letter that the complainant had informed the insurance company at the time of taking the insurance that no fire claim was generated earlier and this information given by the complainant is a clear breach of the principle of utmost good faith where both the parties are supposed to disclose all the facts and information that they have with them. It is surprising to note that the repudiation letter does not mention violation of any specific clause of the policy. The State Commission has observed that no proposal form was taken at the time of giving insurance to the complainant. Therefore, whatever has been said in the repudiation letter in respect of violation of utmost good faith by the complainant does not seem to have any documentary basis. Had the proposal form been there, and had there been a column for the previous claims, then this point would have been verified, otherwise, this contention of the insurance company cannot be sustained.
7. So far as the earlier fire claims are concerned, legally this cannot be taken as violation of any principle of insurance or any clause of the present policy. It may be a practice on the part of the complainant to change insurance company every time so that new insurance company suffers a
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nd meets a claim, but this cannot be taken to repudiate a claim as a fraudulent claim. In the grounds of appeal, the insurance company has relied upon many judgments of this Commission and of the Hon’ble Supreme Court on fraud, but it has not been clarified as to what is the fraud that has been committed in the present case. No such fraud is mentioned in the repudiation letter either. Even the investigator has also not concluded anything like this. 8. Based on the above discussion, I do not find any merit in the present appeal and therefore FA No.468 of 2017 is dismissed. However, keeping the current interest scenario in view, the interest awarded by the State Commission at the rate 9% per annum is reduced to 6% per annum.