Karuvatta Service Cooperative Bank Limited v. Insurance Ombudsman
2025-05-26
N.NAGARESH
body2025
DigiLaw.ai
JUDGMENT : The petitioner is a Primary Credit Co-operative Society governed by the Kerala Co-operative Societies Act and the Rules framed thereunder. The petitioner is challenging Ext.P9 Award dated 07.07.2023 of the Insurance Ombudsman. 2. The petitioner-Society had insured itself under Burglary Standard Policy of the 2 nd respondent- Insurance Company as per Ext.P1. On the intervening night between 02.09.2020 and 03.09.2020, the accused in CC No.175/2021 broke open the office of the Society, cut open the strong room and committed theft of 4,500 grams of pawned gold articles and of Rs.4,50,000/- cash. The installed CC TV cameras and three Desktop Computers were also stolen by the accused. The petitioner computes the worth of the stolen articles as Rs.2.5 Crores. 3. The jurisdictional police registered Crime No.1084/2020 at Haripad Police Station on 03.09.2020. The police arrested the accused and recovered 3690.39 grams of gold articles and Rs.3,50,000/- cash. The recovered assets are now thondi materials in CC No.175/2021. The petitioner made an insurance claim for Rs.73,07,661/- as per Ext.P2. A Surveyor appointed by the Insurance Company made inspections. The Surveyor issued Ext.P3 loss assessment report dated 19.06.2021 assessing the total loss as Rs.59,85,161/-. The Insurance Company, however, did not release the said amount. The petitioner therefore made a complaint on 04.03.2022 to the 4 th respondent-Co-operative Insurance Society Limited. The 4 th respondent, as per Ext.P4 communication, informed that the claim amount will be received by the petitioner before the expiry of March, 2022. 4. By Ext.P6 letter dated 28.11.2022 of the 2 nd respondent, the petitioner was informed that the Company has approved the claim raised by the petitioner-Society for Rs.25,47,145/-. The petitioner requested the Insurer to give adequate compensation. The 1 st respondent thereupon issued Ext.P7 notice dated 17.02.2023 stating that Rs.25,47,145/- approved by the competent authority is not full and is only partial in nature. Till date, respondents 1 to 3 have not released any payment to the petitioner. The petitioner therefore approached the Insurance Ombudsman in May, 2023 filing Ext.P8 complaint. The Ombudsman rejected the complaint citing that Ext.P8 is not within the scope of Insurance Ombudsman Rules, 2017. Hence, the petitioner is before this Court. 5. The petitioner states that the Insurance Company is duty bound to consider the claim raised by the petitioner in a time bound manner.
The Ombudsman rejected the complaint citing that Ext.P8 is not within the scope of Insurance Ombudsman Rules, 2017. Hence, the petitioner is before this Court. 5. The petitioner states that the Insurance Company is duty bound to consider the claim raised by the petitioner in a time bound manner. Even after lapse of nearly one year since Ext.P7, respondents 2 and 3 have not released any payment to the petitioner. The 1 st respondent-Insurance Ombudsman erred in dismissing the complaint of the petitioner. The petitioner is entitled to claim the amount of Rs.59,85,161/- as indicated in Ext.P3, urged the petitioner. 6. The 3 rd respondent resisted the writ petition. The 3 rd respondent stated that the survey report submitted by the Surveyor of the Insurer as indicated that the lost gold is 4 Kg. 862 grams 700 milligrams. The police have recovered 3 Kg. 679 grams 900 milligrams of gold. The net lost gold is 1 Kg. 182 grams 800 milligrams. The cash lost is Rs.4,43,743/-. As per the survey report, net assessed loss for burglary of cash and gold is Rs.59,85,161/-. Rs.3,50,000/- has been recovered by the police. 7. The 3 rd respondent further submitted that in the Final Report, the police has stated that the accused named Appunni has purchased a residential building and property in the name of his wife's sister Revathikutty using the stolen articles. The said Revathikutty had given a statement under Section 164 Cr.P.C. to the effect that she has not given any money for the purchase of property in her name. 8. The 3 rd respondent stated that the net loss assessed is Rs.56,35,161/-. The cost of the property purchased by Revathikutty is Rs.28,05,000/-. Assessed loss amount (final) is 28,30,161/-. The petitioner is entitled to 90% of the assessed loss Rs.25,47,145/-. The net loss has been assessed after deducting the recovered cash of Rs.3,50,000/- and Rs.28,05,000/-, the valuation amount of land and building purchased by the accused in the name of Revathikutty. The 3 rd respondent requested the petitioner to submit subrogation letter cum Power of Attorney, bank details and letter of indemnity in order to release the admitted amount of loss. The petitioner has not given the requisite documents/particulars. 9. I have heard the learned counsel for the petitioner, the learned Standing Counsel for respondents 2 and 3 and the learned counsel appearing for the 4 th respondent. 10.
The petitioner has not given the requisite documents/particulars. 9. I have heard the learned counsel for the petitioner, the learned Standing Counsel for respondents 2 and 3 and the learned counsel appearing for the 4 th respondent. 10. The petitioner is challenging Ext.P9 order of the Insurance Ombudsman. The Insurance Ombudsman has rejected the complaint submitted by the petitioner-Society holding that the policy is not issued under personal lines of insurance, Group Insurance Policies, policies issued to sole proprietorship or micro enterprises in terms of Rule 4 of the Insurance Ombudsman Rules and hence the complaint cannot be considered by the Ombudsman. Furthermore, as per Rule 17(3)(ii) of the Insurance Ombudsman Rules, the Insurance Ombudsman cannot award compensation exceeding Rs.30 lakhs. I find that the complaint of the petitioner stands rejected by the Ombudsman for good and sufficient reasons. 11. The petitioner has a further prayer to direct the insurance company to fix the quantum of claim granted to the petitioner and to pay the same to the petitioner in accordance with the terms and conditions embodied in Ext.P1 policy. Since there are no questions of facts under serious dispute in this case, I am of the view that the said prayer of the petitioner can be dealt with by this Court. 12. It is not in dispute that the insurance company has assessed the value of cash and gold lost as Rs.56,35,161/-. The investigation officers have recovered Rs.3,50,000/- cash from the accused which is thondi material in the court now. The petitioner is entitled to claim the same from the jurisdictional court. Therefore, the insurance company is justified in deducting the amount of Rs.3,50,000/- from Rs.56,35,161/-, the assessed loss. 13. However, the insurance company has reduced the assessed loss amount by an amount of Rs.28,05,000/- which is the valuation amount in respect of the land and building purchased by one Revathikutty. The contention is that the said Revathikutty, who is sister-in-law of the accused in the crime, has given Section 164 statement before the Magistrate stating that she has not paid any money for the purchase of the land and building. The insurance company would contend that the land and building was purchased by Revathikutty utilising the amount stolen by her brother-in-law Appunni. Therefore, the petitioner is entitled to recover/receive the said amount/property. 14. Such a stand is not legally tenable.
The insurance company would contend that the land and building was purchased by Revathikutty utilising the amount stolen by her brother-in-law Appunni. Therefore, the petitioner is entitled to recover/receive the said amount/property. 14. Such a stand is not legally tenable. Whether the accused has utilised the stolen money/gold ornaments for the purchase of the land and building in question and whether it is the accused who has paid the money for purchase of the building, etc. are disputed questions of fact. As far as the petitioner is concerned, the petitioner has no contractual or statutory relation with Revathikutty to recover the land and building from her. A Section 164 statement to the effect that she has not spent any money for purchase of the and and building in question, by itself will not confer any right on the petitioner to claim title to the said property. In such circumstances, the stand taken by the insurance company to reduce Rs.28,05,000/- to arrive at assessed loss amount, is highly arbitrary and illegal. 15. Respondents 2 and 3 are therefore directed to recompute the assessed loss amount (final), taking note of the afore findings. A decision in this regard shall be taken within a period of one month and should be communicated to the petitioner. The admitted assessed loss amount shall be paid to the 1 st respondent within a further period of one month. Writ petition is disposed of as above.