Bajaj Allianz General Insurance Company Limited v. Puthen Modern Rice Mill
2021-03-05
N.NAGARESH
body2021
DigiLaw.ai
JUDGMENT : N. NAGARESH, J. 1. The petitioner, a Company engaged in the business of General Insurance, has filed this writ petition seeking to set aside Ext.P10 Award passed by the Insurance Ombudsman, Kochi. 2. The petitioner states that the 1st respondent- Partnership Firm had taken a Standard Fire and Special Perils Insurance Policy from the petitioner. The insurance coverage was for destruction or damage of rice mill insured and described in the schedule, by any of the perils specified therein during the period of insurance. The 1st respondent made a claim that the chimney of their rice mill was broken in the alleged storm/heavy wind and rain on 25.06.2013 between 1 a.m. and 6 a.m. 3. On receipt of the claim, the petitioner deputed a duly licensed Surveyor and Loss Assessor. The Surveyor submitted immediate Loss Report dated 10.07.2013 and a detailed final report dated 26.10.2013. The petitioner would submit that the claim of the 1st respondent that the chimney was damaged due to storm/heavy wind is incorrect. The chimney was corroded and holed near the flange joint. The Surveyor reported that the storm/heavy rain were at various other locations and not in the locality surrounding the insured property. In view of the said report, the petitioner repudiated the claim of the 1st respondent. 4. The 1st respondent thereupon preferred Ext.P8 claim before the Insurance Ombudsman. The petitioner contested the claim filing written statement. The Insurance Ombudsman, without conducting proper enquiry, passed an Award directing the Insurance Company to settle the claim of the 1st respondent for an amount of Rs. 6 lakhs. It is aggrieved by the said Award of the Ombudsman that the petitioner has filed this writ petition. 5. The learned counsel for the petitioner submitted that the Surveyor has assessed the loss of the 1st respondent to the tune of Rs. 1,94,000/-. The Ombudsman wrongly awarded an amount of Rs. 6 lakhs, which is without any basis, reasoning or evidence. The Ombudsman passed the Award holding that there is circumstantial evidence in favour of the 1st respondent. None of the newspaper reports showed that there was any storm or heavy wind and rain in the area of the insured on the crucial date. The 1st respondent did not produce any report of the Meteorological Department to substantiate that there was a storm.
None of the newspaper reports showed that there was any storm or heavy wind and rain in the area of the insured on the crucial date. The 1st respondent did not produce any report of the Meteorological Department to substantiate that there was a storm. When the petitioner specifically denied storm, it was the duty of the insured to prove the storm/heavy wind. There is no basis for fixing the liability of the petitioner at Rs. 6 lakhs. The Ombudsman has not acted fairly and equitably. Ext.P10 Award is therefore liable to be set aside. 6. The 1st respondent filed a counter affidavit. The 1st respondent stated that on the night of 24.06.2013 and early morning of 25.06.2013, heavy wind, storm and rain lashed over the rice mill of the petitioner at Okkal, Kalady. The chimney of the mill was heavily damaged. The chimney was brought down in the presence and with the permission of the Surveyor recruited by the Insurance Company. The petitioner did not produce relevant documents before the Ombudsman. The 1st respondent had produced all the documents. Taking an overall view of the facts and circumstances of the case, the Ombudsman directed the petitioner to pay Rs. 6 lakhs to the 1st respondent. Ext.P10 Award is therefore just and proper and is not liable to be set aside, contended the 1st respondent. 7. Learned counsel for the petitioner, relying on the judgment of this Court in Life Insurance Corporation of India, Ernakulam vs. A. Thresiamma, 2016 (1) KLT 328 , argued that Ombudsman can allow a claim only in terms of contract of insurance and not on equitable grounds. The petitioner would be entitled to insurance benefits only on happening the events referred in the insurance policy. In this case, there is no evidence to show that there was storm/heavy wind as alleged by the petitioner around the location of the rice mill and hence the Ombudsman ought not have ventured to adjudicate the claim. In the event rights and obligations itself are in dispute, the Ombudsman cannot shift his role as an Adjudicator from the very beginning itself to decide the dispute, contended the counsel for the petitioner, relying on the judgment of this court in New India Assurance Company Ltd. vs. Jebby M. Aliyar and Others, 2018 (3) KLT 827 . 8.
In the event rights and obligations itself are in dispute, the Ombudsman cannot shift his role as an Adjudicator from the very beginning itself to decide the dispute, contended the counsel for the petitioner, relying on the judgment of this court in New India Assurance Company Ltd. vs. Jebby M. Aliyar and Others, 2018 (3) KLT 827 . 8. The learned counsel for the 1st respondent relied on judgment of the Hon'ble High Court of Calcutta in W.P. No. 2299 (W) of 2016 to contend that orders of judicial/quasi-judicial bodies should be complied with by the insurer within the time frame stipulated in the order or Award, and in cases where time frame is not specified in the order/Award, the order/Award should be complied with within 60 days of the receipt of the order/Award by the insurer. If the insurer proposes to file appeal, the appeal should be preferred within the stipulated time limit as per the Rules applicable. Relying on the judgment of the Hon'ble High Court of judicature at Hyderabad in Writ Petition No. 21044 of 2005, the learned counsel for the 1st respondent contended that when the insurer suppresses material facts from the Ombudsman, the Insurance Ombudsman can direct the insurer to pay the insurance amount. 9. I have heard the learned counsel for the petitioner and the learned counsel appearing for the 1st respondent. 10. The learned counsel for the petitioner brought to the notice of this Court a Division Bench judgment of this Court in National Insurance Co. Ltd. and Others vs. Indus Motor Co. Pvt. Ltd. and Another, 2005 (4) KLT 391 , wherein it was held that under Rule 13 of the Redressal of Public Grievances Rules, 1998, an Insurance Ombudsman has jurisdiction to entertain complaints only from any person or individual on whose behalf an insurance policy has been taken on personal lines. 11. The Redressal of Public Grievances Rules, 1998 have been framed by the Central Government in exercise of the powers conferred by sub-section (1) of Section 114 of the Insurance Act, 1938 (Act 4 of 1938). Rule 13 of the said Rules, 1998 reads as follows:- “13.
11. The Redressal of Public Grievances Rules, 1998 have been framed by the Central Government in exercise of the powers conferred by sub-section (1) of Section 114 of the Insurance Act, 1938 (Act 4 of 1938). Rule 13 of the said Rules, 1998 reads as follows:- “13. Manner in which complaint is to be made - (1) Any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the insurer complaint against is located. (2) The complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly the name and address of the complainant, the name of the branch or office of the insurer against which the complaint is made, the fact giving rise to complaint supported by documents, if any, relied on by the complainant, the nature and extent of the loss caused to the complainant and the relief sought from the Ombudsman. (3) No complaint to the Ombudsman shall lie unless: (a) the complainants had before making a complaint to the Ombudsman made a written representation to the insurer named in the complaint and either insurer had rejected the complaint or the complainant had not received any reply within a period of one month after the insurer concerned received his representation or the complainant is not satisfied with reply given to him by the insurer. (b) the complaint is made not later than one year after the insurer had rejected the representation or sent his final reply on the representation of the complainant. (c) the complaint is not on the same subject matter, for which any proceedings before any Court, or Consumer Forum, or Arbitrator is pending or were so earlier.” The question is whether a Partnership Firm can prefer a complaint under Rule 13 of the Rules, 1998. 12. A Division Bench of this Court in National Insurance Co. Ltd. and Others (supra) considered the scope of Rule 13 and held as follows:- “6. The word “person” as such is not defined either in the Insurance Act or in the Rules. R.4(i) of the Rules defines the words “insured person” to mean an individual by whom or on whose behalf an insurance policy has been taken on personal lines.
Ltd. and Others (supra) considered the scope of Rule 13 and held as follows:- “6. The word “person” as such is not defined either in the Insurance Act or in the Rules. R.4(i) of the Rules defines the words “insured person” to mean an individual by whom or on whose behalf an insurance policy has been taken on personal lines. S.4(k) of the Rules states that “personal lines” means an insurance policy taken or given in an individual capacity. Only an insured person as defined in R.4(i) read with R.4(k) would fall under the term “any person” in R.13. R.13 also uses the expression “may himself or through his legal heirs.” R.13 states that any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint. The expression “may himself or through his legal heirs” qualifies the expression “any person. Definition clause available under the General Clauses Act, in our view, cannot be imported to explain the meaning of the expression “any person” in the Rules, since Rule itself gives sufficient indication with regard to the expression “any person.” Further definition clause in S.3 of the General Clauses Act giving the definition says that the definition clause would apply to the General Clauses Act. 7. We may in this connection refer to the decision of a Full Bench of the Andhra Pradesh High Court in Sri. Ramadas Motor Transport Pvt. Ltd. vs. Vijayawada Municipality, AIR 1968 AP 160 , wherein it was held that several features in the Act and the very scheme of the Act are repugnant to the view that person in S.93(4) of the Act should be treated as including company so that the provision under S.3(22) of the Andra Pradesh General Clauses Act can be of no avail. In this connection, reference may also be made to the decision of the apex court in M/s. Agarwal and Co. vs. Commissioner of Income Tax, U.P. 1970 (2) SCC 48 and M.M. Ipoch vs. C.I.T. Madras, AIR 1968 SC 317 . 8. Legislature as a rule making authority makes several rules from the experience gathered from the past and may design to use the works to deal with certain classes of persons. This rule firmly establishes that the intention of the legislature must be found by reading the statute as a whole.
8. Legislature as a rule making authority makes several rules from the experience gathered from the past and may design to use the works to deal with certain classes of persons. This rule firmly establishes that the intention of the legislature must be found by reading the statute as a whole. In order to examine the nature of the power conferred on the Ombudsman we are guided by R.13 read with R.4(1)(k) which places emphasis on the words “individual” and “personal lines” and “himself for through his legal heirs.” There is nothing to show that incorporated company would fall under any of those expressions. We may in this connection refer to the definition of the expression “insurer” in S.2(9) which states that any individual or unincorporated body of individuals of body corporate incorporated under the law of any country. If the legislature wanted the incorporated company also to come within the definition clause of “insured person” or “any person” within the meaning of R.13 the same could have been incorporated in the Rules. Having not incorporated we are of the view, the court is not justified in importing a meaning which has not been attributed by the rule making authority to the expression “any person” since the context clearly shows otherwise. Above being the legal position, we find it unable to subscribe to the view of the learned single Judge.” The Division Bench of this Court held that an incorporated Company cannot be treated as a person and would not fall under the term “person” contemplated in Rule 13. 13. The Division Bench came to such confusion on the ground that the Rule itself gives sufficient indication that the expression “any person“ used in Rule 13 is intended to mean an individual by whom or on whose behalf an insurance policy has been taken on personal lines. Going by the dictum laid down by the Division Bench of this Court, a Partnership Firm also will not fall within the ambit of the term “any person” as contained in Rule 13, and hence a complaint by a Partnership Firm will not be maintainable under the Redressal of Public Grievances Rules, 1998 before an Insurance Ombudsman. Ext.P10 Award of the 2nd respondent-Insurance Ombudsman is therefore ultra-vires and is liable to be set aside. 14.
Ext.P10 Award of the 2nd respondent-Insurance Ombudsman is therefore ultra-vires and is liable to be set aside. 14. In the circumstances, the writ petition is allowed and Ext.P10 Award passed by the 2nd respondent-Insurance Ombudsman is set aside.