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2010 DIGILAW 92 (JK)

United India Insurance Co. Ltd. v. Pawan Sharma

2010-02-26

B.L.Saraf, G.D.Sharma

body2010
Per Justice G.D. Sharma, J. 1. Order dated 13.03.2007 passed by the learned Divisional Forum Jammu (hereinafter be referred to as Forum) has been taken in appeal whereby and where-under the appellant was directed to indemnify the respondent after deducting 40% of the insured amount from the sum of Rs. 3,62,000/- with interest @ 6% p.a from October 2004 till realization. Litigation charges in the sum of Rs. 1500/- were also paid. The brief facts of the case are that respondent had been carrying on the business of wheel balancing and wheel alignment under the name and style of M/S Mrityunjay Automobiles New Plot, Jammu. The respondent had insured the said business concern for covering a risk in the sum of Rs. 3,62,000/- and the policy was in operation from 08.09.2003 to 07.09.2004. It is alleged that during the currency of the said policy on 13.05.2004, at about 3:15 a.m fire broke out at the place of the said business concern and total loss was caused to all the machines as well as the material lying therein. Fire reached out even up to first floor and consumed the house-hold belongings. The respondent, who had tried to extinguish the fire, received burnt injuries and in order to save his life he jumped out from the first floor and received injuries including one fracture. He had gone to the hospital on the same day in the OPD and after receiving treatment was discharged on the same day. However, he also had visited the hospital on the next day i.e. on 14.05.2004. The claim was raised on 28.06.2004 (after a delay of nearly one and a half month). The house hold articles lying in the residential building were insured in the name of the mother of the respondent namely, Boli Devi with insurer namely, National Insurance Company. She had also raised her claim with the said insurer and M/S Sharma Surveyor had assessed the loss. In the present case also, the appellant appointed Sharma Surveyor who visited the spot on 24.07.2004. The appellant had demanded explanation from the respondent for the cause of delay for raising his claim. After visiting the spot, the surveyor was not satisfied with regard to the genuineness of the claim and wrote to the company for getting the matter investigated. The appellant appointed Mr. The appellant had demanded explanation from the respondent for the cause of delay for raising his claim. After visiting the spot, the surveyor was not satisfied with regard to the genuineness of the claim and wrote to the company for getting the matter investigated. The appellant appointed Mr. R.N.Khanna surveyor and loss assessor to investigate the claim who held that the claim was not genuine. Similar view was given by Sharma Surveyor. After the receipt of the report of the investigator and the surveyor loss assessor; the appellant repudiated the claim of the respondent. The respondent filed the complaint on 03.08.2005 before the Forum which was allowed and the reliefs were granted as indicated above. 2. Aggrieved by the passing of the impugned order, the appellant inter alia has challenged the same on the following grounds:- i. The claim was held as not genuine both by the investigator and the surveyor. ii. Complicated questions of facts and law were involved about the genuineness of the claim and the incident. iii. The delay in lodging the claim was not reasonably explained. 3. Heard the arguments. 4. Mr. Vishnu Gupta, the learned counsel appearing for the appellant has at the outset pleaded that this was a false claim raised by the respondent after a lapse of about one and a half month. Undoubtedly, the fire had broken out in the first floor of the residential house were loss was caused during the intervening night of 12/13 05/2004 and the mother of the respondent who was insured under the policy issued by National Insurance Company had raised her claim where-under the concerned National Insurance Company had appointed Sharma Surveyor to make the assessment of the loss. The said Sharma Surveyor had visited the spot immediately after the incident i.e. on 13.05.2004 and when he visited the spot for the alleged incident under consideration on 24.07.2004; he raised doubt about its because when he visited the spot on 13.05.2004, the respondent had not approached him with his grievance. That Sharma Surveyor had not noticed any sign of smoke on the shutter of the shop in question and that paint was intact. Any member of the family of the respondent could raise claim when the first claim was raised on 13.05.2004 but delay of one and a half month speaks volumes against truthfulness of the claim. That Sharma Surveyor had not noticed any sign of smoke on the shutter of the shop in question and that paint was intact. Any member of the family of the respondent could raise claim when the first claim was raised on 13.05.2004 but delay of one and a half month speaks volumes against truthfulness of the claim. The respondent who was discharged from the hospital on the day of the alleged incident even could himself had informed by telephone or sent an application through somebody but that was not done. Mr. Kuldeep Sharma who made the survey of the same incident and had visited the spot on 13.05.2004 has in his report mentioned the fact that on that date, the respondent had personally met him but did not disclose about the incident. While concluding his arguments, he has pleaded that there was no deficiency of service because the claim was above Rs. 20,000/- and surveyor had been appointed under law to make the assessment of the loss. At the request of the surveyor, investigator Mr. R.N.Khanna who is a retired Colonel from the Army was also appointed by the company as investigator who had also concurred with the Kuldeep Sharma Surveyor that loss was of doubtful nature. Under these circumstances no payments of any claim could be made by the appellant. In support of his contentions he has cited the case of Chirayikil C.P Bhadra Kumar v. S. Mehandran, III (1992) CPJ 71 (NP) as well as M/S Diamond Elastomers v. M/S United India Insurance Company Limited, III (1992) CPJ 67 (NC). 5. In rebuttal it has been argued by the counsel for the respondent Mr. Firdous Ashique that no complicated question of fact and law is involved in this case. On 13.05.2004 when Mr. Kuldeep Sharma surveyor visited the residential house of the respondent to verify the loss of the insured Shrimati Boli Devi (mother of the respondent) and at that time respondent was in great shock as was suffering from acute pain because of burn injuries and it was not possible for him even to utter a word. He had been living separately from his mother Shrimati Boli Devi and was all alone. He had strained relations with his mother and the insurer of that claim was National Insurance Company not the insurer of the complainant i.e. the appellant. He had been living separately from his mother Shrimati Boli Devi and was all alone. He had strained relations with his mother and the insurer of that claim was National Insurance Company not the insurer of the complainant i.e. the appellant. The respondent had insured with the appellant wheel balancer machine and wheel aligning machine. Kuldeep Sharma surveyor on 24.07.2004 visited the spot and had found the following articles having burnt partially or completely:- i One Wheel Balancer Machine found lying in the shop in semi burnt condition. ii One burnt frame of Monitor/TV found lying in the shop. iii Some old tyres found lying in a pit made for wheel aligning purpose inside the shop. iv The walls and roof of the shop had turned black by dense black smoke. v Wiring in the shop had burnt. This shows that at the time of inspection, he had seen the insured articles namely Wheel Balancer and Wheel Aligner in burnt conditions. That in his report; he has mentioned that respondent had received burn injuries but as the respondent was in severe pain, he could not at that time check the loss to his insured articles lying in the shop. He was not sure that the same surveyor would assess the loss caused to his insured articles by his insurer. He has pointed out that the learned counsel of the appellant has intentionally skipped over the final inspection report which was placed as annexure `D' with the complaint and during his arguments has only referred the observation of Omkar Singh ASI which is contained in annexure `E', where nothing has been said about the loss caused to the insured two machines. But the fact of the matter is that after making the fair investigation the police furnished their report produced with the complaint as annexure `O'. It is stated in that report that the respondent had received burn injuries in the fire, and had gone to hospital for treatment. That loss was caused to the house-hold articles in the form of bed, T.V, transformer etc. Loss was also caused to the tyres, computer and insured two machines stated above which admittedly were lying in the shop and not in the house. According to respondents estimate loss of Rs. 4,00,000/- had been caused. He has also referred annexure `F' which is the certificate given by Deputy Director Fire Services. Loss was also caused to the tyres, computer and insured two machines stated above which admittedly were lying in the shop and not in the house. According to respondents estimate loss of Rs. 4,00,000/- had been caused. He has also referred annexure `F' which is the certificate given by Deputy Director Fire Services. The Police has in the investigation admitted that personnel of Fire Services had also arrived at the spot. In his certificate which is annexure `F', the Deputy Director has stated that wheel balancer and wheel aligner were lying in the shop and they were involved in the fire. That the said loss was caused due to fire, heat, smoke and water. Annexure `D' is the certificate issued by Dr. Rajender Singh which shows that on 07.06.2004, the respondent was still under his treatment. Regarding the delayed intimation, he has submitted that respondent was not in a position to scribe anything because of burn injuries, regarding which he has placed on record a slip of OPD; wherein his photograph is found. His hands and legs were in plasters and in this physical condition he could not write anything. That one copy of the report (annexure `O') was produced by the respondent before the appellant only after approaching the Learned Chief Judicial Magistrate, Jammu vide annexure `N' and thus the delay stands explained and is not intentional. The investigation report prepared by Mr. Khanna is not of impeccable nature so as to place full reliance upon it, as was projected by the counsel of the appellant. Mr. Khanna visited the spot many times and had found insured machines in burnt condition. He was favourably disposed towards the appellant and biased against the respondent which fact can be established about his extra-ordinary interest for getting the purchase value verified from the suppliers of the machines. He is a man of doubtful integrity. The machines had been purchased which fact is established by annexure `A' and later on Mr. Khanna has also admitted this fact. In support of his contentions Mr. Firdous has cited the case of Divisional Manager, United India Insurance Co. Ltd. and Another v. Nazir Ahmad Shah, C.I.M.A Nos. 195,199 and 202 of 1996, decided on 23.07.1999 by the Division Bench of J&K High Court. 6. We have considered the respective contentions of the counsel appearing for the parties and perused the record. Firdous has cited the case of Divisional Manager, United India Insurance Co. Ltd. and Another v. Nazir Ahmad Shah, C.I.M.A Nos. 195,199 and 202 of 1996, decided on 23.07.1999 by the Division Bench of J&K High Court. 6. We have considered the respective contentions of the counsel appearing for the parties and perused the record. The main argument of the counsel of the appellant is that it is a false case as no damage had been caused to the insured machinery. He has mainly relied upon the report of the surveyor wherein he has stated that he had inspected the first floor of the building on 13.05.2004 when the claim had been raised by the mother of the respondent for the loss caused to the house-hold articles and loss to the shop was not disclosed to him at that time by the respondent. The learned counsel of the respondent in his submissions has given sufficient explanation as to how the respondent was prevented to show the loss of the insured machinery to the surveyor. The respondent had received burn injuries and that fact is proved from the oral and documentary evidence already discussed above. There can be truth in the submission that respondent was having strained relations with his mother. That could be the reason for not disclosing the loss to the surveyor Mr. Kuldeep Sharma on spot on 13.05.2004. But the said surveyor in his report has admitted that damage was caused to the insured machinery when he inspected the shop on 24.07.2004. It was not obligatory on the part of the respondent to associate himself with Mr. Kuldeep Sharma surveyor on 13.05.2004 as he had come to the spot for assessment of the alleged loss on his appointment made by a different insurer. The loss was caused not to the shop but to the insured machinery which fact has been found admitted in the report of Kuldeep Sharma Surveyor. The counsel of the appellant has laid great stress on the Diary Dairy report (annexure `E') entered by ASI Omkar Singh wherein no mention is made about the loss. But the heart of the matter is that annexure `E' was only information of the incident and not conclusion of investigation. Annexure `O' was the police report made after investigation which mentions the fact that loss was caused to the machinery lying in the shop. But the heart of the matter is that annexure `E' was only information of the incident and not conclusion of investigation. Annexure `O' was the police report made after investigation which mentions the fact that loss was caused to the machinery lying in the shop. Annexure `F' is the certificate issued by the Deputy Director Fire Services and he has also admitted that personnel from his department had visited the spot and found there that loss was caused to the machinery lying in the shop as well as to the house-hold articles due to fire, heat, smoke and water. These are the public documents and have to be relied upon but the counsel of the appellant has concealed these two important public documents to be referred in his arguments as they speak of truth. The medical record has convinced us that respondent was suffering pain from burn injuries and in the normal course of human conduct, he was not supposed to raise claim immediately after the incident. The alleged delay of one and a half month in lodging the claim cannot be of fatal nature but stands reasonably explained. The investigation conducted by Mr. R.N.Khanna pales into insignificance when in the police investigation and in the concerned Fire Brigade it is admitted that the loss was caused to the insured machinery. Even Kuldeep Sharma surveyor has admitted the fact that loss was caused. A consumer's claim cannot be negated on technicalities but when on the preponderance of the evidence it is established that loss has been suffered then it becomes the duty of the Consumer Forum to grant relief to the genuine consumer. In view of the foregoing reasons it is found that the learned Forum has correctly appreciated the factual and legal aspect of the case. We do not find any illegality or infirmity to overset the finding. In this view of the matter, the appeal is found meritless which is dismissed with cost of Rs. 5,000/- and is consigned to the records. The record of the form be returned at once.