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2014 DIGILAW 189 (JK)

Oriental Insurance Co. Ltd. v. Prabhawati Raina

2014-04-30

HASNAIN MASSODI, M.M.KUMAR

body2014
JUDGMENT : M.M. Kumar, J. 1. A short question of law which emerges for determination of this Court in the present appeal is 'Whether a clause in the Insurance Policy could restrict the period within which the claim must be made and no claim was entertainable after the expiry of the stipulated period. Few facts would be necessary to settle the legal issue raised before us. 1.1. Ms. Prabhawati Raina-respondent got her double storied house situated in village Chak Rajwali, Dooru Anantnag insured with the appellant Company for a sum of Rs. 4.00 lakh under the 'Fire Policy B' for the period commencing from 21.09.1999 to 20.09.2000. The respondent vide letter dated 17.08.2001 intimated the appellant that her insured house was gutted in fire incident and the letter was delivered to the appellant on 21.08.2001. The intimation was supported by a photocopy of the FIR which revealed that the insured house belonging to the respondent was damaged in fire incident on 11/12.12.1999. The appellant vide letter dated 28.08.2001 (Annexure-C with the complaint) informed the respondent that her claim could not be registered because it was intimated after the expiry of more than 12 months. In support of the aforesaid assertion the appellant placed reliance on the policy condition which obliged the respondent to intimate the loss to the appellant immediately within 12 months. In any case, intimation of loss, if not given to the appellant within 12 months from the date of the incident then the appellant was not liable and all such claims would stand abandoned as per policy condition No. 4. 1.2. The respondent made some representation for registering the claim but the appellant insisting on condition No. 4 refused to entertain the claim. A letter rejecting the claim was sent by the appellant on 18.09.2002 (Annexure-D with the objections). The appellant, however, requested one Sh. R.N. Tickoo, Dy. S.P.(retired) to investigate the claim, who visited the spot on 22.09.2001 in the presence of S/Sh. Sona Butt (Chowkidar), Gani Allai (Numbardar), Habba Bhutt, Mohd. Rafiq Sheikh (Employee of the Horticulture Department). He was informed by the locals on the spot that the house was gutted about 7 years back. 1.3. The appellant, however, requested one Sh. R.N. Tickoo, Dy. S.P.(retired) to investigate the claim, who visited the spot on 22.09.2001 in the presence of S/Sh. Sona Butt (Chowkidar), Gani Allai (Numbardar), Habba Bhutt, Mohd. Rafiq Sheikh (Employee of the Horticulture Department). He was informed by the locals on the spot that the house was gutted about 7 years back. 1.3. Thereafter respondent filed complaint before the J&K State Consumer Disputes Redressal Commission, Jammu (for brevity 'the Commission') alleging that she had suffered loss and the appellant has failed to pay her a single penny without getting the same assessed. The appellant repeated its stand that intimation with regard to loss or damage was required to be sent within 15 days from the date of loss. It was pleaded that respondent intimated the claim vide letter dated 17.08.2001 which was after more than 12 months from the date of the so called accident. It was further pleaded that the claim was abandoned as per condition No. 4 of the policy and it was not recoverable. 1.4. The Commission noticed the aforesaid facts and concluded that there was no delay in making the claim and proceeded to hold as under:- "8. We have considered the respective contentions of the counsel for the parties and find no legal force in the argument of Mrs. Z.S. Watali, advocate, because the law laid down by the Hon'ble High Court in the case of Rajinder Kaul (supra) has no application to the facts of the present case. The admitted facts contained in Annexure-C by the Ops are that letter dated 17.08.2001 addressed by the complainant to the Ops alongwith copy of the concerned FIR had been received by the Ops. The FIR which is a public document clearly recites in it that house of the complainant's husband namely Radha Krishan had been burn by fire alongwith other two houses. This fact has further found corroboration in the deposition of Mr. R.N. Tickoo, surveyor/investigator who on spot verification had found that the house had been gutted. It was the statutory duty of the Ops to get the loss assessed from R.N. Tickoo by providing him a copy of the FIR which was a public document, but the same had been willfully withheld from him despite specific demand being made by him. R.N. Tickoo, surveyor/investigator who on spot verification had found that the house had been gutted. It was the statutory duty of the Ops to get the loss assessed from R.N. Tickoo by providing him a copy of the FIR which was a public document, but the same had been willfully withheld from him despite specific demand being made by him. The complainant after receiving the copy of the FIR had raised the claim with Ops on 17.08.2001 and the Ops have failed to get her claim assessed in the prescribed manner and no question of limitation of 12 months or 2 years can arise in the case. The non-settlement of the claim was a statutory negligence on the part of Ops and it amounts to "deficiency in service". The complainant is lawfully entitled to be reimbursed for the total loss caused to the insured house and attic in the sum of Rs. 4.00 lakhs. We therefore accept the complaint and direct the Ops to make the payment of Rs. 4.00 lakhs along with interest @ 8% per annum from the date of loss (i.e. 12.12.99) till the final payment is made. The Ops are also directed to bear the cost of litigation in the sum of Rs. 5000/-. The complaint be consigned to the records." 2. Mr. Vishnu Gupta, learned counsel for the Insurance Company has vehemently argued that the view taken by the Commission is patently against the law laid down by this Court and that of Hon'ble the Supreme Court. In support of his submission, Mr. Gupta has placed reliance on the Division Bench Judgment of this Court rendered in the case of Oriental Insurance Company Ltd. v. Rashpal Singh, 2003 (Supp.) JKJ 514 [HC] and has argued that once the right itself has been extinguished on account of expiry of the period stipulated in the Insurance policy then no complaint by the Consumer Forum could be entertained. Mr. Gupta has also placed reliance on the judgment of Hon'ble the Supreme Court rendered in the case of National Insurance Co. Ltd. v. Sujir Ganesh Nayak & Co. and another, AIR 1997 SC 2049 for the same proposition. Drawing our attention to the observations made in para 20 of the judgment, Mr. Mr. Gupta has also placed reliance on the judgment of Hon'ble the Supreme Court rendered in the case of National Insurance Co. Ltd. v. Sujir Ganesh Nayak & Co. and another, AIR 1997 SC 2049 for the same proposition. Drawing our attention to the observations made in para 20 of the judgment, Mr. Gupta has argued that the respondent has no case as similar Clause in the insurance contract stipulating period by 12 months was interpreted and the right of the respondent was held to have been extinguished. It has further been argued that Section 28 of the Contract Act, 1872 (for brevity 'the Contract Act') as has been held by Hon'ble the Supreme Court in Sujir Ganesh Nayak's case (supra) would not come in conflict with the policy conditions. Similar view has been taken by Hon'ble the Supreme Court in the case of H.P. State Forest Company Ltd. v. M/S United India Insurance Co. Ltd., (2009) SCCR 91. Referring to para 6 of the judgment, learned counsel has argued that a Clause restricting the period within which claim could be made would not come in conflict with Section 28 of the Contract Act because the claim was made by the respondent after the right has been extinguished. 3. Mr. Rajesh Khah, learned counsel for the respondent has argued that under Section 18-A of the Jammu & Kashmir Consumer Protection Act, a period of two years for filing a complaint has been provided and any agreement contrary to Section 28 of the Contract Act would be void. In support of his submissions, learned counsel has placed reliance on a judgment of this Court rendered in the case of Oriental Insurance Company Ltd. v. Gh. Nabi Shah, 2011 AIR (J&K) 143, 2011 (2) JKJ 821 [HC]. 4. In support of his submissions, learned counsel has placed reliance on a judgment of this Court rendered in the case of Oriental Insurance Company Ltd. v. Gh. Nabi Shah, 2011 AIR (J&K) 143, 2011 (2) JKJ 821 [HC]. 4. Having heard learned counsel for the parties and perusing the record with their able assistance, we find that it would be necessary to examine Clause 4 of the Insurance Policy, which is set out below in extenso:- "4.(i) On the happening of any loss or damage the Insured shall forthwith give notice thereof to the Company and shall within 15 days after the loss or damage or such further time as the Company may in the writing allow in that behalf, deliver to the Company:- (A) A claim in writing for the loss or damage containing as particular an account as may be reasonably practicable of all the several articles or items or property damaged or destroyed, and of the amount of the loss or damage thereto respectively, having regard to their value at the time of the loss or damage not including profit of any kind. (B) Particulars of all other, insurances, if any. The Insured shall also at all time at his own expense produce, procure and give to the Company all such further particulars, plans, specification books, vouchers, invoices, duplicate or copies thereof, document, proofs and information with respect to the claim and the origin and cause of the fire and the circumstances under which the loss or damage occurred, and any matter touching the liability or the amount of the liability of the Company as may be reasonably required by or on behalf of the Company together with a declaration on oath or in other legal form of the truth of the claims and of any matters connected therewith. (ii) The Company reserves the right to treat the claim as no claim if no information/documents are submitted by the Insured within a period of six months from the date of loss. (ii) The Company reserves the right to treat the claim as no claim if no information/documents are submitted by the Insured within a period of six months from the date of loss. (iii) In no case whatsoever shall the Company be liable for any loss or damage after the expiration of 12 months from the happening of the loss or damage unless the claim is the subject of pending action or arbitration: it being expressly agreed and declared that if the Company shall disclaim liability for any claim hereunder and such claim shall not within 12 calendar months from the date of the disclaimer have been made the subject matter of a suit in a court of law then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder." 5. A perusal of Clause 4 of the Insurance Policy would reveal that the insured is required to intimate loss or damage to the Insurance Company forthwith. It is also required that within 15 days after loss or damage or such further time as may be given by the Company an intimation must be delivered to the Company concerning the loss or damage caused to the insured property. Clause 4(B)(iii) stipulated a maximum period of 12 calendar month and declare in un-mistakable terms that Company shall not be liable in any case for any loss or damage after the expiry of 12 months. Such like Clauses have been subject matter of consideration of Hon'ble the Supreme Court as has been rightly pointed by Mr. Vishnu Gupta. In the case of Sujir Ganesh Nayak Company (supra) a Clause pan materia to Clause 4(B)(iii) was subject matter of consideration which was styled as condition No. 19. The same reads as under:- "Condition No. 19-In no case whatever shall the company be liable for any loss or damage after the expiration of 12 months from the happening of loss or the damage unless the claim is the subject of pending action or arbitration." In para 20 of the judgment, following pertinent observations have been made, which are set out below in extensor:- "20. Clause 19 in terms said that in no case would the insurer be liable for any loss or a damage after the expiration of twelve months from the happening of loss or damage unless the claim is subject of any pending action or arbitration. Here the claim was not subject to any action or arbitration proceedings. The clause says that if the claim is not pressed within twelve months from the happening of any loss of damage, the insurance company shall cease to be liable. There is not dispute that no claim was made nor was any arbitration proceeding pending during the said period of twelve months. The clause therefore has the effect of extinguishing the right itself and consequently the liability also. Notice the facts of the present case. The insurance company was informed about the strike by the letter of 28.4.1977 and by letter dated 1.5.1977. The insured was informed that under the policy it had not liability. This was reiterated by letter dated 22.9.1977. Even so more than twelve months after on 25.10.1977 the notice of demand was issued and the suit was filed on 2.6.1980. It is precisely to avoid such delays and to discourage such belated claims that such insurance policies contain a clause like clause 19. That is for the reason that if the claims are preferred with promptitude they can be easily verified and settled but if it is the other way round, we do not think it would be possible for the insurer to verify the same since evidence may not be fully and completely available and memories may have faded. The forfeiture clause 12 also provides that if the claim is made but rejected, an action or suit must be commenced within three months after such rejection; failing which all benefits under the policy would stand forfeited. So, looked at from any point of view, the suit appears to be filed after the right stood extinguished. The forfeiture clause 12 also provides that if the claim is made but rejected, an action or suit must be commenced within three months after such rejection; failing which all benefits under the policy would stand forfeited. So, looked at from any point of view, the suit appears to be filed after the right stood extinguished. That is the reason why in Vulcan Insurance case (supra) [ (1976) 1 SCC 943 ] while interpreting a clause couched in similar terms this court said: "It has been separately held that such a clause is not his by Section 28 of the Contract Act." Even if the observations made are in the nature of obiter dicta we think they proceed on a correct reading of the clause." A perusal of the aforesaid para shows that their Lordships held that once the right to make a claim is not registered within stipulated period then it would result in extinguishing the liability also. 6. The other issue as to whether such a Clause would come in conflict with Section 28 of the Contract Act was also considered by Hon'ble the Supreme Court in Sujir Ganesh Nayak's case (supra). Placing reliance on the earlier judgments rendered in the cases of The vulcan Insurance Co. Ltd. v. Maharaj Singh and Anr., (1976) 1 SCC 943 and Food Corporation of India v. New India Assurance Cot, (1994) 3 SCC 324 , their lordships have held that it would not offend Section 28 of the Contract Act. This view has been followed in later judgment of Hon'ble the Supreme Court rendered in the case of H.P. State Forest Co. Ltd. (supra). 7. We are further of the view that the Division Bench of this Court in the case of Rashpal Singh (supra) has also followed the same view and we do not see any reason to re-open the aforesaid decision. 8. There is another aspect which needs to be highlighted. It is well known principle of interpretation that insurance contract and insurance policy must be construed in accordance with the plain words used therein. The duty of the Court is to interpret the word in which the contract is expressed by the parties because it is not for the Court to make a new contract, however reasonable, if the parties have not made it for themselves. The duty of the Court is to interpret the word in which the contract is expressed by the parties because it is not for the Court to make a new contract, however reasonable, if the parties have not made it for themselves. The aforesaid observations have been made by a 5-Judge Bench of Hon'ble the Supreme Court in the case of General Assurance Society Ltd. v. Chandmull Jain and another, AIR 1966 SC 1644 . In that case a condition in the Insurance Policy conferred mutual rights on the parties to cancel the insurance contract at any time. The Insurance Company had executed a policy in respect of the houses belonging to the assured against flood. The houses were situated in Dhulian town near Calcutta, which was at the bank of river Ganges. The river had been changing its course and eroding the banks on the side of the Dhulian town. When the floods were well insight the Insurance Company invoked the condition in the Insurance Policy giving mutual right to the parties to terminate the insurance at any time. Rejecting the argument that termination has to be for a reasonable cause the Constitution Bench held in para 11 of the judgment as under:- "11. A contract of insurance is a species of commercial transactions had there is a well-established commercial-practice to send cover notes even prior to the completion of a proper proposal or while the proposal is being considered or a policy is in preparation for delivery. A cover note is a temporary and limited agreement. It may be self-contained or it may incorporate by reference the terms and conditions of the future policy. When the cover note incorporates the policy in this manner, it does not have to recite the term and conditions, but merely to refer to a particular standard policy. If the proposal is for a standard policy and the cover note refers to it, the assured is taken to have accepted the terms of that policy. The reference to the policy and its terms and conditions may be expressed in the proposal or the cover note or even in the letter of acceptance including the cover note. The incorporation of the terms and conditions of the policy may also arise from a combination of references, in two or more documents passing between the parties. The reference to the policy and its terms and conditions may be expressed in the proposal or the cover note or even in the letter of acceptance including the cover note. The incorporation of the terms and conditions of the policy may also arise from a combination of references, in two or more documents passing between the parties. Documents like the proposal, cover note and the policy are commercial documents and to interpret them commercial habits and practice cannot altogether be ignored. During the time the cover note operates, the relations of the parties are governed by its terms and conditions, if any, but more usually by the terms and conditions of the policy bargained for and to be issued. When this happens the terms of the policy are incipient but after the period of temporary cover, the relations are governed only by the terms and conditions of the policy unless insurance is declined in the meantime. Delay in issuing the policy makes no difference. The relations even then are governed by the future policy if the cover notes give sufficient indication that it would be so. In other respects there is no difference between a contract of insurance and any other contract except that in a contract of insurance there is a requirement of uberrima fides i.e., good faith on the part of the assured and the contract is likely to be construed contra proferentem that is against the company in case of ambiguity or doubt. A contract is formed when there is an unqualified acceptance of the proposal. Acceptance may be expressed in writing or it may even be implied if the insurer accepts the premium and retains it. In the case of the assured, a positive act on his part by which he recognizes or seeks to enforce the policy amounts to an affirmation of it. This position was clearly recognized by the assured himself, because he wrote, 510 close upon the expiry of the time of the cover notes, that either a policy should be issued to him before that period had expired or the cover note extended in time. This position was clearly recognized by the assured himself, because he wrote, 510 close upon the expiry of the time of the cover notes, that either a policy should be issued to him before that period had expired or the cover note extended in time. In interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties because it is not for the court to make a new contract, however reasonable, if the parties have not made it themselves. Looking at the proposal, the letter of acceptance and the cover notes, it is clear that a contract, of insurance under the standard policy for fire and extended to, cover flood, cyclone etc. had come into being." 9. The Supreme Court further held that the principles governing the standard form contract are thus not applicable to insurance contract. In that regard their Lordships followed its earlier decision rendered in the case of The Central Bank of India v. Hartford Fire Insurance Co. Ltd., AIR 1965 SC 1288 and it was held that it is a duty of the Court to give effect to the term of a contract agreed between the parties according to their intention and when that term is in writing the intention is to be gathered from the words used unless there is something ambiguous or one may suspect that they did not convey the intention correctly. If those words are clear, there is very little that the Court has to do. The Court must give effect to the plain meaning of the words; however it may dislike the result. For the aforesaid reason, this appeal succeeds. The judgment and order dated 30.01.2009 is set aside. The complaint filed by the respondent is dismissed. The parties are, however, left to bear their own costs. Keeping in view the peculiar facts and age of the respondent, who is stated to be 74 years old, we do not wish to pass order for refund of the amount already disbursed to her.