State Consumer Disputes Redressal Commission
T. Rajesh Reddy S/O. T. Mohan Reddy vs United India Insurance Company Ltd. on 31 December, 2013
BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. CC 6 of 2013 Between: T. Rajesh Reddy S/o. T. Mohan Reddy Age: 41 years, House No. 15, 1st Cross 17th Main, 5th A-Block Koramangala Bangalore. Complainant A N D United India Insurance Company Ltd. Rep. by its Divisional Manager Bancassurance Division 2nd Floor, IML Building N. R. Square, Bangalore-560 002. Opposite Party CC 7 of 2013 Between: T. Mohan Reddy S/o. T.V. Ramana Reddy Age: 68 years, House No. 15, I Cross 17th Main, 5th A Block Koramangala Bangalore. Complainant A N D United India Insurance Company Ltd. Rep. by its Divisional Manager Bancassurance Division 2nd Floor, IML Building N. R. Square, Bangalore-560 002. Opposite Party Counsel for the Complainant M/s M.Pratap Reddy Counsel for the opposite party M/s V.Samba Siva Rao QUORUM: SRI R.LAKSHMINARASIMHA RAO, HONBLE I/C PRESIDENT SRI THOTA ASHOK KUMAR, HONBLE MEMBER
AND SRI S.BHUJANGA RAO, HONBLE MEMBER TUESDAY THE THIRTY FIRST DAY OF DECEMBER TWO THOUSAND THIRTEEN Oral Order (As per Sri R.Lakshminarasimha Rao, Honble I/c President) ***
1. The complainant no.1 in C.C.No.6 of 2013 is the son of the complainant who filed the CC NO.7 of 2013. In view of memo filed by the counsel for the complainant that the father and son made common correspondence with the opposite party-insurance company and they had been jointly doing cultivation and both the cases be clubbed to lead common evidence, both the cases are clubbed and disposed of by a common order.
C.C.No.6 of 2013 is taken as lead case.
2. This is a complaint filed u/s 17(a)(i) of the Consumer Protection Act for a direction to the Opposite Party to pay `98,43,000/-
towards the claim of the complainant with interest and costs.
3. The case of the complainant in brief is that he introduced Green House Farming for which he has availed loan from Canara Bank Hi-tech Agri Finance Branch. As per the terms of finance the entire Green House and the entire machinery was insured with the Opposite Party from 1.11.2011 to 31.12.2011 by paying premium of `19,106/- valid. The said policy was renewed from 1.1.2012 to 31.12.2012. The complainant submits that due to heat waves during May, June and July, 2011 the entire policy house structures including the columns, nets etc. were damaged. The damage was severe and beyond repair. Owing to extensive damage caused to the Poly House they could not raise any crop till date and unable to remit the instalments to the banker.
On 27.7.2011 the complainant addressed a letter to the banker to inform the loss to the insurance company for undertaking the inspection of the unit and to assess the damaged suffered by the complainant.
4. The opposite party deputed Arvind R. Nayak who has conducted preliminary inspection of the unit on 3.8.2011. The surveyor by letter 24.8.2011 sought for submission of certain documents viz., duly filled claim form, policy copy, claim bill with all supporting documents/estimations, metrological report, paper cuttings if reported in newspaper, offer of salvage for affected items, any other relevant document if found necessary. The complainant has submitted all the required documents by 15.2.2012. The complainant has addressed letters from time to time viz., on 24.3.2012, 24.4.2012 to depute a technically qualified surveyor to assess the loss for which the opposite party sent a reply on 27.4.2012 stating that they were awaiting the final word from IRDA approved surveyor for settling the claim and denied the receipt of documents submitted by him.
5. The complainant submits that the surveyor has issued letter dated 27.4.2012 stating that he visited the premises on 3.8.2011 and he had observed 18, 0000 sq.mts of poly sheet as against 40,000 sq.mts of the damaged poly-house poly-sheet to cover 21,600 sq.mts of poly-house structured area and 20 gutters were damaged, 30 arches were to be repaired which were not considered. The observations of the insurance surveyor vindicate that there was massive damage to the unit. He also addressed the insurance surveyor and the Divisional Manager of the insurance company by letter dated 5.5.2012 stating that the estimates were already submitted and requested to make final inspection for assessment of loss. The opposite party by letter dated 4.5.2012 has abruptly and cryptically informed that the complainant has not furnished the documents to the surveyor for processing the claim and also closed the claim as No Claim.
6. The complainant has addressed letter dated 21.5.2012 to the Regional Manager brining to his notice that the entire documents were submitted and narrated the sequences of events and also submitted copies of documents with an appeal to settle the claim at the earliest. The complainant pleads that despite addressing higher authorities by letters dated 16.6.2012, 2.7.2012 and 31.7.2012 and also approached IRDA. The opposite party with a malafide intention closed the file as No Claim without any prior notice and without assigning any reasons. The unit has suffered extensive damage and the Opposite Party has been harassing the complainant even for the purpose of assessing the loss.
The complainant alleges that in spite of receipt of all the documents required by the surveyor they closed the file on flimsy grounds. Hence this complaint for the aforementioned reliefs.
7. The opposite party insurance company filed written version denying the allegations made by the complainant. They contended that this Commission has no jurisdiction to entertain and the Civil Court is the proper forum to adjudicate the matter. The complainant did not mention as to the loan amount availed and the instalments paid to bank for the loan obtained him towards House Farming. The complainant did not implead the bank. As the complainant is not in a position to pay back the loan amount, he lodged the claim with an ulterior motive. While admitting issuance of Standard Fire and Special Perils policy for `1,02,05,000/- covering the risk of Poly House at `88,00,000/-, Civil Construction at `4,80,000/- and irrigation equipment at `9,25,000/- they contended that the complainant did not pay single pie towards the loan.
8. The opposite arty submitted that the complainant is residing at Bangalore and no farm processing was going on. The complainant addressed letter dated 27.7.2011 to the Chief Manager, Canara Bank, Hitech Agricultural Finance Branch, Bangalore stating that his poly-house was damaged during the months of June and July, 2011 and requested to intimate the same to the insurance company which shows that there was no farming and the photographs taken by the surveyor establish that there was grass and bushes. The loss was belatedly intimated to the opposite party in the first week of August, 2011.
The complainant has not produced any documentary evidence to show that there was damage to neighbouring poly-houses during the same period. The complainant did not comply with the terms and conditions of the policy and therefore not entitled to any amount.
9. The opposite party submits that on receipt of claim intimation Aravind R. Naik, Surveyor was appointed on 2.8.2011 to assess the loss at the premises. He visited the spot on 3.8.2011 and conducted spot survey. The surveyor by letter dated 18.1.2012 requested the complainant to furnish certain documents viz., duly filled claim form, policy copy, claim bill with all supporting documents/estimations, metrological report, paper cuttings if reported in newspaper, offer of salvage for affected items, any other relevant document if found necessary after verification. The complainant has furnished the claim form, meteorological report and a letter to the company claiming that the poly-house requires total reconstruction without any basis and documents. The claim of the complainant is not payable as per the terms of the policy.
10. The opposite party submits that the complainant has not submitted the bills of construction, and the repair estates. The estimations for revival of Green House unit for an amount of `1,05,00,000/- is untenable. As the complainant did not produce the required documents, the surveyor furnished his report dated 23.2.2012 and recommended to the insurer that there is no liability on the part of insurer as per the terms and conditions of the policy. The Meteorological data of Ananthapur District does not reveal any heavy winds during June and July, 2011 nor caused any damage to the properties in the locality. There are no press reports submitted by the complainant.
11. The Opposite Party further submits that the complainant did not produce the farming produce, sales and expenditure bills after obtaining the loan and farming activity maintaining books, construction material purchases, erection material payment charges of the poly-house etc. The complaint is filed with an intention to gain unlawfully without any technical report and without any basis. Therefore the opposite party prayed that the complaint be dismissed with exemplary costs.
12. The complainant has filed his affidavit and the documents, Exs.A1 to A39. On behalf of the opposite party insurance company, its Regional Manager filed his affidavit and the documents, Exs.B1 to B5.
13. The point for consideration is whether there is any deficiency in service on the part of the opposite party?
14. The complainant floated venture Green House Farming to raise farm products in view of the land being the driest areas in the state of A.P. The complainant availed loan from Canara Bank, Hi-Tech Agri Finance Bank and he had insured the entire green houses and machinery as per the terms and conditions of loan agreement. The complainant obtained Standard Fire and Special Perils Policy bearing No.072600/11/10/11/00004251 by paying premium of `19,106/- for the period from 1.1.2011 to 31.12.2011 and got the policy renewed on payment of premium by his banker and the renewed policy was issued for the period from 1.1.2012 to 31.12.2012.
15. The complainant lodged claim with the opposite party stating that extreme heat condition in the month of May, June and July 2011 caused unprecedented swirling winds of high velocity which were of the magnitude of tornado culminating in a major devastation and destruction to the entire poly house structures including the columns, arches, gutters, polysheets, shade nets, insectinets etc. The complainant has stated that the damage was so extensive and it was beyond repair other than replacement and as such he could not raise any crop.
16. The complainant addressed letter dated 27.11.2011 to Canara Bank requesting the bank to inform the opposite party for inspection of the unit and for assessing the damage. ON receiving intimation of the incident, the opposite party deputed surveyor who conducted preliminary inspection of the unit on 3.8.2011 and at the time he requested the complainant to submit the documents, claim form, policy copy, claim bill with supporting documents meteorological report newspaper clippings, offer of salvage for affected items and any other relevant documents.
17. In response to the request made by the surveyor, the complainant through letter dated 21.1.2011 requested for extension of time till 15.2.2012 for submission of the documents sought for. The complainant has stated that he submitted the relevant documents before 15.2.2012. The surveyor addressed letter dated 27.4.2011 to the complainant stating that he has visited the premises on 3.8.2011 and he had observed 18000 sq.mtrs of polysheet being damaged and the poly house, poly sheet was to the extent of 21600 sq.mtrs was to be repaired as aslo he observed that 20 gutters were damaged and 30 arches were to be repaired.
18. On receiving the letter from the surveyor the complainant disputing the factual observation made by the surveyor, addressed letter dated 5.5.2011 to the opposite party requesting for appointment of a surveyor along with technically qualified fabricators for final assessment of the damages and the opposite party through letter dated 4.5.2011 informed the complainant that the claim was closed as no liability claim in account of the complainants failure to furnish the documents to the surveyor.
19. Thereafter the complainant through letter dated 21.5.2011 brought it to the notice of the Regional Manager of the opposite party insurance company that he had submitted the entire documents and he approached the Insurance Ombudsman .
20. The opposite party insurance company closed the claim on the premise of the complainants failure to submit the documents sought for, by the surveyor. The learned counsel for the opposite party has contended that the complainant has not made the bank which sanctioned the loan for the project as party to the complaint and he had not submitted the documents such as bills of construction material of the poly house as also that the meteorological data of Ananthapur District for the months of June and July2011 does not reveal any heavy winds in Ananthapur District or any damage caused to the similar properties in the locality. He has contended that the complainant has not even filed newspaper clippings showing coverage of news regarding the damage caused to the green house.
21. Thus, the claim of the complainant could not be processed by the opposite party for the reason that the complainant failed to furnish the relevant documents required for the purpose of processing the claim which may be either for settlement or repudiation of the claim. The letter dated 2.7.2012 under Ex.A24 he speaks volumes of the complainants inaction in submitting the relevant document as sought for by the surveyor.
The complainant admits in the letter addressed to IRDA that the documents submitted to the opposite party were vague. The letter reads as under:
Inspite of repeated reminders no action has been initiated by any of the authorities. Since the initial surveyor conducted by the surveyor was very vague and was not covering the whole project site with minute details I had requested for taking up on more survey for which I have not received any reply. There was no quantification of the loss occurred due to natural calamity. The surveyor has all along been denying the receipt of documents sent by us which were simultaneously accepted by all others which were sent by the same mode. (Speed Post). My repeated request for one more surveyor has gone futile.
Since the damage has been very severe and the initial survey is not exhaustive, I request you to arrange for one more survey by deputing the surveyor from your end for which I am ready to make the transport arrangement either from Bangalore or from nay place which you may intimate.
22. Taking into consideration of the failure of the complainant to furnish the documents to the surveyor and his subsequent readiness to submit the documents to the surveyor and the opposite party insurance company this Commission is of view that the ends of justice would be met if the complainant is permitted to submit the documents to the surveyor deputed by the opposite party insurance company and the opposite party basing on the surveyors report would process the claim, either settle or repudiate the claim as per the terms and conditions of the insurance policy.
23. In the result both the complaints are disposed of directing the complainants to submit the documents sought for by the surveyor and thereafter the opposite party shall process the claim as per the terms of the insurance policy, either settle or repudiate the claim. There shall be no order as to costs.
I/C PRESIDENT MEMBER MEMBER Dt.31.12.2013 కె.ఎం.కె.* APPENDIX OF EVIDENCE WITNESSES EXAMINED NIL EXHIBITS MARKED For complainant Ex.A1 Copy of insurance policy for the year 2011 Ex.A2 Copy of insurance policy for the year 2012 Ex.A3 Copy of insurance policy for the year 2010 Ex.A4 Copy of letter dated 27.07.2011 Ex.A5 Copy of letter of surveyor dated 24.08.2011 Ex.A6 Copy of letter of surveyor dated 18.01.2012 Ex.A7 Copy of letter dated 21.01.2012 Ex.A8 Copy of letter dated 20.01.2012 Ex.A9 Copy of letter dated 03.02.2012 Ex.A10 Copy of report of Meteorological Dept. dated 11.02.2012 Ex.A11 Copy of insurance claim dated 15.02.2012 Ex.A12 Copy of letter dated 15.02.2012 Ex.A13 Copy of letter dated 15.02.2012 Ex.A14 Copy of reminder dated 24.03.2012 Ex.A15 Copy of letter of Postal Department dated 01.05.2012 Ex.A16 Copy of reminder dated 23.04.2012 Ex.A17 Copy of letter dated 27.04.2012 Ex.A18 Copy of letter of Surveyor dated 27.04.2012 Ex.A19 Copy of letter dated 5.5.2012 Ex.A20 Copy of letter dated 05.05.2012 Ex.A21 Copy of letter dated 04.05.2012 Ex.A22 Copy of letter dated 21.05.2012 Ex.A23 Copy of reminder dated 16.06.2012 Ex.A24 Copy of letter dated 02.07.2012 Ex.A25 Copy of final reminder dated 31.07.2012 Ex.A26 Copy of IRDA letter dated 25.07.2012 Ex.A27 Copy of postal receipts Ex.A28 Copy of postal acknowledgements Ex.A29 Copy of insurance policy for the year 2010 Ex.A30 Copy of insurance policy for the year 2011 Ex.A31 Copy of insurance policy for the year 2012 Ex.A32 Copy of statement of accounts Ex.A33 Paper clippings Ex.A34 Paper clippings Ex.A35 Paper clippings Ex.A36 Copy of proposal for commercial production of capsicum Ex.A37 Copy of proposal for commercial production of capsicum Ex.A38 Copy of letter dated 5.3.2012 Ex.A39 Copy of letter dated 5.3.2012 For opposite party Ex.B1 Copy of policy for the year 2011 Ex.B2 Copy of letter dated 04.05.2012 Ex.B3 Copy of letter dated 27.07.2011 Ex.B4 Copy of survey report dated 23.02.2012 Ex.B5 Photos I/C PRESIDENT MEMBER MEMBER