Repudiation of insurance claim for fire accident is illegal on three grounds as held by the National Consumer Commission
On 12.10.13, an incident of fire accident had taken place in the office-cum-warehouse of the complainant – proprietor of premier distributor of spare parts of commercial vehicles.
The complainant lodged the claim for Rs.6,97,37,720 covered by the Special Perils Policy for Rs.7.37 crores which was approved after inspection of the warehouses by the Insurer.
On 14.10.2013, the respondent no.3 Surveyor was appointed to assess the loss. The complainant submitted the relevant documents to the Surveyor.
On 1.4.2015, the Surveyor submitted the report for loss of Rs.48.83 lakhs.
On 29.12.2015, the Insurer had given a copy of the survey report to the complainant. The Surveyor was also informed that various documents were lost in the fire incident. The copy of the Surveyor was not given for eight months.
On 3.1.2016, the insurer repudiated the claim of the complainant based on the report of the surveyor.
It was stated that the complainant had failed to establish & provide necessary evidence /proof asked for on numerous times and opportunities afforded in this regard. Moreover, the Surveyor found that the claim was grossly exaggerated.
HELD that the repudiation of the claim was illegal for the following reasons –
(i) The surveyor report was submitted after two years and it is violative of Rule 9 of the IRDAI (Protection of Policy Holders’ Interests) Regulation, 2002, requiring submission of Surveyor’s report in 30 days and in any case in 45 days.
(ii) The survey report was not furnished to the complainant for eight months.
(iii) Repudiation of the claim of the survey report itself is illegal since it was not based on any cogent reasoning to establish excess or fraudulent claim.
Judgment dated 9.11.2023 of the National Consumer Disputes Redressal Commission in M/s. Swarna Motors Vs. Oriental Insurance Company Ltd and others (Consumer Case No.3076 of 2017)
