State Consumer Disputes Redressal Commission
Periyanayaki Amman Traders, Rep. By ... vs The Regional Manager, New India ... on 27 March, 2023
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Date of filing : 29.07.2016
IN THE TAMIL NADU STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, CHENNAI.
Present: Hon'ble Thiru Justice R.SUBBIAH ... PRESIDENT
Thiru.R VENKATESAPERUMAL ... MEMBER
C.C. No.39 of 2010
Orders pronounced on: 27.03.2023
Periyanayki Amman Traders
rep. by M.V.Vijayan - Power
Holder, residing at
Flat No.102,
Aman Apartments,
Bharati Park Road-2,
Coimbatore-641 043. ... Complainant
vs.
The Regional Manager,
New India Assurance Co. Ltd.,
Regional Office No.720200,
594, D.B. Road,
R.S. Puram,
Coimbatore 641 002. ... Opp. Party
For Complainant : M/s.R.Udhayakumar
For Opposite Party : M/s.M.B.Gopalan Asso.
This Complaint came up for final hearing on 01.09.2022
and, after hearing the arguments of the counsels for the
parties and perusing the materials on record and having
stood over for consideration till this day, this Commission
passes the following:-
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ORDER
R.Subbiah, J. - President.
The complainant herein/Insured seeks this Commission to direct the Insurance Company/OP to pay to them the insurance claim of Rs.50 lakh along with interest from the date of intimation of claim at a rate to be determined by the Commission and a sum of Rs.1 lakh towards compensation for the mental agony, etc., besides costs of the complaint.
2. In brief, the case of the complainant is as follows:-
The complainant is engaged in the business of processing & trading of waste cotton from 06.04.2002. Subsequently, the said business operations had been shifted to the premises at Door No.5/153, Poolakkadu Thottam, Arasur, Coimbatore, from 20.06.2007, and the complainant insured the said premises, where mainly the waste cotton was stocked, with the OP / Insurance Company by 3 taking two Standard Fire and Special Perils Policies bearing Nos.11/08/11/00000077 and 11/08/11/00000782, commencing from 26.04.2008 and 18.11.2008 for the assured sums of Rs.10 lakh and 40 lakh respectively.
While so, on 19.04.2009, a major fire accident had occurred in the insured premises/godown at No.5/153, Poolakadu Thottam, Arasur, Coimbatore, destroying the entire goods stored there at. The incident was immediately reported to the OP with whom a claim was also submitted for Rs.57,45,006/-. Despite due follow-up by the complainant and production of all relevant documents, the OP took a long time to process the claim. For the vague notings made by the Surveyor to the effect that the address given in the policies differs from the VAO Certificate; that the value given in the provisional and audited balance sheets is different and that the stock kept outside the premises is not covered under the Policy, the complainant offered his explanation by submitting all relevant documents to substantiate the claim, however, without examining the documents as well as the explanation offered by the 4 complainant and by merely acting upon the Surveyor Report, by letter, dated 28.05.2010, the OP unjustly repudiated the claim on the flimsy grounds that the address given in the policy is different and that two sets of balance sheets have been filed. The OP failed to appreciate the fact that there can be more door numbers for different buildings in the very same Survey Number and, in the present case, the fact remains, the present building/godown at Door No.5/153 stood along with other buildings, both residential and commercial, and all those buildings with different Door Numbers are part of the same Survey Number-64. The present Surveyor, on the basis of whose report the OP had proceeded to repudiate the claim on the address-issue, is the same individual, who was appointed by the Bajaj Allianz Insurance Company in respect of the same fire accident over the 'building claim', and in that instance, he himself had recommended for the claim settlement by relying upon the Survey Number in which lies the present godown/insured premises. While so, the reason given by the OP by stating that the building claim was paid as there was reference only 5 to the Survey Number only reflects the fact that they miserably failed to appreciate the actuality that there stood buildings with different Door Numbers in the very same Survey Number. In an insurance claim, the vital thing to be examined at the first instance is the identification of the subject matter insured. While so, the Insurance Company, who have already done the Risk Inspection at the premises, specifically the stocking place of waste cotton, are well aware of the fact that the fire accident had taken place at the very premises of the complainant.
Further, in all fairness, the complainant had furnished both the provisional accounts as well as the audited accounts, as submitted to the IT Department; thereby, displayed a transparent conduct. That being so, without exerting any endeavor to correlate the purchase & sale invoices, monthly VAT Statements, Bank Statements and other related documents, the Surveyor has needlessly alleged that the complainant has submitted fraudulent accounts, however, the Insurance Company merely acted upon those erroneous observations of the Surveyor. 6
The act of the OP in thus repudiating the just claim arising from the insurance policies is nothing but a clear deficiency of service; hence, the present Complaint, seeking the directions as aforementioned, against the OP/Insurance Company.
3. The OP has filed a written version, wherein, among other things, it is stated thus:-
The policies in question were taken to cover the waste and other cotton stocked at the address - Door No.5/153, Poolakadu Thottam, Arasur, Coimbatore. While the claim was in regard to the reported loss at Door No.5/153, the report of the Surveyor revealed that the affected premises was a different place viz., Door No.5/155G and the said factum is confirmed by the complainant's very own admission by reference to Property Tax Receipt and VAO Certificate, only indicating that the affected location was at Door No.5/155 G. Since there was no loss at all, at the premises covered by the Policy in question, which is 'location specific' and it does not cover the loss at any other 7 location, the claim could not be admitted on that vital ground. The OP had also taken note of the fact that stocks had been stored outside the building in open and the same found to be not covered under the policy and that no stock registers were being maintained.
Apart from that, the complainant furnished two sets of balance sheets for the relevant period, both certified by the Auditor and it was stated that they were being maintained for different purposes. The said conduct of the complainant in maintaining different sets of accounts and often revising the value of stocks had led to an inference that the loss was highly exaggerated. The OP has duly applied its mind to all relevant records as well as the report of the Surveyor and repudiated the claim for valid reasons. As such, there being no negligence or deficiency in service on their part, the complaint is liable to be dismissed.
4. In order to substantiate their claim and case, both sides have filed their respective proof affidavits and, while the complainant has filed 9 documents as Exs.A1 to 8 A9, on the side of the OP, the Survey Report is marked as Ex.B1.
5. Learned counsel for the complainant would primarily point out that the two policies in question, which are for the assured sums of Rs.10 lakh and Rs.40 lakh, pertain to the stock value of the waste and other cotton kept in the godown at Door No.5/153, Poolakkadu Thottam, Arasur, Coimbatore, and that the said Door Number of the Godown is a part of Survey No.64/3, wherein, there is a residential area and other business establishments. The entire land and buildings in the said Survey Number are owned by the two sons of one late Ganpathi Gounder - M/s.Sundaram and Ramasamy, from whom, the insured godown was taken on lease by the complainant. On 19.04.2009, when fire had erupted at the insured premises of the complainant, it was first noticed by one of the land- owners/Sundaram who alarmed others and consequently, immediate information was given to the Insurance Company. This is an instance, where the spread of fire after its 9 outbreak was so rapid and eruptive due to heavy winds that it could be extinguished after combined team efforts only on the next date/20.04.2009 and further, the Surveyor was sent to survey the spot during the very occurrence itself on 19.04.2009 and everything including the raging fire destroying the insured premises and also the gutting stock was very much witnessed in person by the Surveyor himself. Also, the land-owners of the entire premises under S. No.64/3, who leased out the insured godown to the complainants, had insured their property with Bajaj Allianz General Insurance Company for a value of Rs.20 lakh and, after this accident, the said Insurance Company had engaged none else than the present Surveyor, who acted on the Survey Number and gave his Report, based on which, a sum of Rs.15.28 lakh was settled in their favour towards the insurance claim; whereas, in the present claim, the same Surveyor, without taking note of the actual survey number within which falls the insured premises, has confused the location-issue by referring to different door numbers in the very same Survey Number and, by unnecessarily delving 10 into the business operations of the neighboring establishments, projected a picture as if that the insured premises was a different place and that the claim is an exaggerated one. While so, the act of the Insurance Company in blindly acting upon the stray findings of the surveyor that the place of accident is different from the address given in the Policy and that two sets of balance sheets have been filed and in ultimately repudiating the claim without independent application of mind to the survey report as well as to facts and circumstances involved, only depicts their service deficiency and ultimately, the complainant is unjustly deprived of the legitimate proceeds due to them from the two policies and hence, this is a fit case to grant the relief sought for. Learned counsel once again submits that the insured premises is admittedly a part of the buildings in the very same survey number-64/3 and the Surveyor has confused the issues by mentioning the other buildings in the same location & their Door Numbers and further, without referring to the audited balance sheet, he vainly relied upon the provisional balance sheet and that 11 being so, in all prudence, if the Insurance Company had independently applied their mind to the materials produced in support of the claim and properly contrasted the survey report therewith, probably, the claim would have been admitted; on the contrary, they impulsively acted upon the irrelevant and devious findings of the Surveyor and thereby, great prejudice has been caused to the complainant to such an extent that their Bankers are now threatening to mark the business account as NPA and that they are not able to raise any loan from the Bank. So submitting, learned counsel seeks to allow the complaint in its entirety.
6. Per contra, learned counsel for the OP, after making a preliminary submission/objection to the effect that here is a claim where the insured had furnished two different accounts/provisional and final one and, owing to the sharp difference between the accounts details therein pertaining to the stock value and the alleged loss, the actuality can be brought out only after a full-fledged trial which cannot be done in the present summary proceedings 12 and on that score alone, the complaint is liable to be dismissed, would argue on merits that the complainant had reported the loss at Door No.5/153, but it surfaced from the Survey Report, which is based on relevant records, that the affected premises was at Door No.5/155G, which is not covered by the Insurance Policies. Since the policies in question are location-specific and from the VAO Certificate and Property Tax Receipt, it was found by the Surveyor that the affected location was different from the one which was covered under the Policies, the OP had reached the conclusion that there was no loss at all at the premises covered under the Policy. Secondly, no stock register was maintained by the complainant, their accounts were found to be highly irregular & unreliable and more importantly, two sets of balance sheets were furnished. In view of that, the Surveyor could only derive a probable quantity of stocks on the basis of the first set of balance sheets and he worked out the final loss at Rs.14,98,432/-. The scrutiny of the claim by the Insurance Company in the light of the survey report revealed that the complainant maintained two 13 different sets of accounts and they repeatedly revised the stock figures and the degree of exaggeration was such that there was no scope to even accept the final loss as projected by the Surveyor. By relying upon the decision in Khetma Fibres vs. New India Assurance (2021-SCC-Online SC-
818) and highlighting the proposition laid down therein to the effect that Report of Expert Surveyors based on adequate reasons cannot be rejected by Consumer Fora, owing to the summary nature of proceedings, learned counsel states that inasmuch as the report of the Surveyor herein has brought to surface only strong negative factors against the claim of the complainant, in that, the place of accident itself was not found to be the insured premises and the inconsistent account details only suggested fraudulent exaggeration of the value of the lost goods, the Insurance Company had to inevitably repudiate the claim; as such, no case of service deficiency is made out and hence, the complaint is liable to be dismissed at the threshold.
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7. In the light of the rival submissions, the following questions arise for consideration:-
i) Whether the preliminary objection of the Insurance Company by stating that there are disputed facts regarding the stock-value due to varying account details between the two sets of accounts/provisional & final filed by the complainant and hence, the issues cannot be decided in the present proceedings of summary nature, is sustainable or not?
ii) Whether, in the given factual scenario, the repudiation by the Insurance Company based upon the Survey Report and their stand 15 based on such Report that the VAO Certificate and Property Tax Receipt "confirm" that the affected premises was Door No.5/155G and not Door No.5/153 in respect of which policy was taken, are well-
founded or not?
iii) To what relief, the complainant is entitled to?
8. Coming to the first issue, on a perusal of the materials made available, we find that almost all relevant documents have been filed to appreciate the points and issues raised by both sides. From the repudiation letter/Ex.A2, dated 28.05.2010, we see that, after giving details in a tabular column about the stock as per the provisional accounts and the accounts submitted to IT Department, the Insurance Company stated that, from the same, they found that there is a wide variation between the 16 closing stock as per the provisional account and the actual account submitted to the IT Department. By further stating that such a variation does not occur in normal business trend and that the same has not been supported by documentary evidence, it was concluded in the repudiation letter that there is a misrepresentation of material fact and that, as per general condition (1) of the Policy, there is every justification for the repudiation. It is now the argument of the Insurance Company that, since the facts regarding the stock value are disputed in terms of the variations between the two sets of documents presented by the complainant, such disputed facts can be properly addressed only in a regular full-fledged trial wherein, the witnesses can be summoned and also subjected to cross-examination and the said exercise cannot be done in the present proceedings of summary nature; hence, the complaint is liable to be dismissed.
In our considered view, the variation between the two sets of documents regarding stock details cannot be construed as a disputed fact, rather, it is a disputed opinion 17 which cannot be a ground to drive the complainant to approach some other forum. When there are variations between the two sets of documents, the Insurance Company, by taking a pragmatic and practical approach, could have worked out the loss from the finalized accounts that had been accepted by the IT Department and, without doing so, they bluntly term the variations as a disputed fact and seek for dismissal of the complaint, which cannot be done. Accordingly, we outrightly repel the said objection-cum- submission of the Insurance Company by answering the question against them.
9. Coming to the second issue, let us first find out, in respect of which premises, the complainant laid his insurance claim. In this regard, the OP themselves would mention in their version at the inception of para No.7 therein that the reported place of loss was at Door No.5/153 and the relevant statement in that regard is as follows:-
" 7. The complainant had reported loss at Door No.5/153. ..."18
Further, the policies in question also refer the insured premises as Door No.5/153. As such, there is no dispute that the incident which had taken place on 19.04.2009 was at Door No.5/153, however, it is the case of the Insurance Company that, as the Survey Report clearly brought out the fact that the affected location/Door No.5/155G was different from what was covered under the policies, namely, Door No.5/153, the claim submitted regarding the latter could not be entertained at all. They contend that, after examining the documents filed by the complainant, in particular the VAO Certificate and the Property Tax Receipt, the Surveyor had categorically found that the said documents indicated that the Godown under Claim has been mentioned therein as 5/155G, whereas, the Door Number of the Insured Building, as per the Policies, is 5/153. In this regard, the stand taken by the OP in their version at para Nos.7 & 21 is relevant to be quoted hereunder:-
" 7. The complainant had reported loss at Door No.5/153.
However on examination of the 19 Survey Report and relevant records, it was found that the affected premises was in Door No.5/155G. The Survey Report clearly brought out the fact that the affected location was different from what was covered under the Policy. Further, the complainant's own admission by reference to Property Tax Receipt and VAO Certificate would also confirm that the affected location was Door No.5/155 G although various explanations are sought to be given in this regard. It was thus clearly established that there was no loss at the premises covered by the Policy.
21. ..... Admittedly, the VAO Certificate and Property Tax Receipt 20 also confirm that the affected premises was 5/155G and not 5/153 in respect of which policy was taken."
According to them, thus, the VAO Certificate as well as the Property Tax Receipt, both confirm the aspect that the affected premises was not 5/153, which is the insured premises and in respect of which the loss was reported to the Insurance Company, but, it was a different place at Door Number-5/155G.
To find out as to whether the aforesaid documents in fact had confirmed the place of fire accident/affected premises as Door No.5/155G, we have to necessarily examine with caution the Survey Report wherein the said documents were referred to and relied upon. In this regard, firstly, the relevant notings and observations made by the Surveyor need to be looked into and the same are extracted below:-
"6.0 LOCATION, CONSTRUCTION & OCCUPTATION:21
The address of the insured's premise, as given on the face of the policy is M/s.Perianaykiamman Traders, 5/153, Poolakkadu Thottam, Arsur, Coimbatore-641 407.
The godown under claim is located in S.F. No.64/3, Arasur. On inspection of the location/area it was observed that there were few more buildings/godown sheds in the same survey no., in which power looms were operating. ...
The insured has submitted a certificate from the Village Administrative Officer (marked-L1) wherein the door no. of the godown building, under claim, has been mentioned as 5/155G whereas the 22 door No. of the insured building as per policy is 5/153. ... ... A copy of the property tax remitted for the year 2008-2009 (marked-M) is enclosed. The tax has been paid for the godown bearing Door No.5/155G and now under claim. ..... 10.0 ASSESSED VALUE OF THE CLAIM: ..... While deciding on the claim the insurers may consider the following observations made by us. 1.Address of the claimed premises is different from that mentioned on the face of the policy. ....." 23
Thus, according to the Surveyor, he came to the conclusion that the address of the claimed premises is different from the one mentioned on the face of the policies, based on the Certificate issued by the VAO and the Property Tax Remittance Slip, referred by him in his report as L1 and M respectively. In order to find out the actuality, we have perused the said Certificate issued by the VAO in the vernacular language, which is reproduced below - "g.m $Y}u; tl;lk;> 10>mu#u; fphukk;> kA+uh fpof;F mu#u; G+sf;fhL Njhl;lk;. fjT vz;.5/155 vd;Dk; Kftupapy; trpj;J tUk; fzgjpf;fTz;lu; kf;fs; A.G. Re;juk; (1) A.G. uhkrhkp (2) Mfpa ,UtUf;Fk; Nkw;gb fpuhkk; f.r.64/3 ne. rhiyapy; 2.02.5 n`f;Nlu; GQ;ir G+kp gl;lh vz;.86-d;gb fl;lhag;ghj;jpak;. gpd;Dk;
Nkw;gb rhiyapYs;s 142' x 72' = 10,224 rJub (gj;jhapuj;J ,UE}w;W ,Ugj;J ehd;F) tp];jPuzKs;s fl;blKk; Nkw;gbahsu;fSf;F fl;lhag;ghj;jpag;gl;lJ vd mjd;%yk; njuptpj;Jf;nfhs;fpd;Nwd;. Nkw;gb (fl;blj;jpd; fjT vz;.5/155 G) MFk;";. and it does not reveal anything even to suppose that the claimed premises is at Door No.5/155G. Per contra, in the said document, the VAO concerned has only certified that 24 M/s.Sundaram and Ramasamy/sons of Ganpathy Gounder, residing at Door No.5/155, jointly own the punja land measuring 2.02.5 hectare in S.No.64/3 corresponding to Patta No.86 and that the building at Door "No.5/155G measuring 10224 sq. ft." is also jointly owned by the said two brothers. As such, there is no mention or reference in the said Certificate about the claim or claimed premises and it generally speaks only about the ownership of the above referred individuals over the entire extent of land in the Survey Number concerned and specifically states with an underlining that Door No.5/155G for an extent of 10,224 sq. ft. also belongs to them. It must be borne in mind that the insured premises measures only 5000 sq. ft., as could be seen from the lease agreement under Ex.A3. At any rate, the said Certificate does not speak at all about the insurance claim in question nor does it speak anything about the complainant. A perusal of the other connected documents available in the Survey Report show that the said Certificate, dated 27.04.2009, issued by the VAO, was probably a supportive document only in respect of the claim lodged by 25 the owners, who had insured the whole property under S. No.64/3 with Bajaj Allianz General Insurance, after the fire accident that had considerably affected the buildings at S. No.64/3 wherein admittedly stands the insured godown at Door No.5/153. That being the tenor of the VAO Certificate, one fails to understand as to how the said document can be taken as the basis to hold that the affected premises was the building at Door No.5/155G and that the complainant had adduced the same for the present claim. Similarly, by relying upon a property tax receipt, referred in the survey report as 'M', the Surveyor has made the following noting:-
" A copy of the property tax remitted for the year 2008-2009 (marked-M) is enclosed. The tax has been paid for the godown bearing door No.5/155 G now under claim."
The above noting, on the face of it, is the pinnacle of ignorance for the simple reason that property tax would be paid only by the land/building owner and not by the tenant. Here, the complainants are not owners of any part of the 26 property / building in S. No.64/3 wherein situates their insured premises at Door No.5/153 and, as per the VAO Certificate, the building at Door No.5/155G is also jointly owned by M/s.Sundaram & Ramasamy. Only the said two individuals, who are the owners, would pay the property tax and that is why their name is jointly reflected in the Property Tax Receipt and not the name of the complainant, who is only a lessee of the premises at Door No.5/153 which falls under Survey No.64/3. Once again, the said receipt also does not indicate anything about the present claim nor does it refer to the complainant so as to draw an inference on the address issue as done by the Surveyor and the Insurance Company. Therefore, deriving a conclusion from the property tax receipt that the affected premises was Door No.5/155G, which is directly connected only to the owners and probably their insurance claim regarding the entire extent in Survey No.64/3, only reflects the misreading of documents by the Surveyor and it creates serious doubts about the quality of the spot enquiry/document scrutiny done by him. In such circumstances, if at all any negligence 27 is to be attributed; firstly, it should be only against the Surveyor. None of the documents referring to Door No.5/155G pertains either to the complainant or to their godown or to their claim, rather, the said Door Number, which has no connection at all to the present insurance claim, has reference only to the title of the aforesaid two persons over it and such being the position, the above noting of the Surveyor shall be held to be highly devious and wholly misleading. The lease agreement/part of Ex.A3, dated 20.06.2006, whereby, the godown was leased out to the complainant gives the description of the godown as the place measuring 5000 sq. ft. at Door No.5/153 in Survey No.64/3. The police complaint acknowledgement/part of Ex.A3, dated 21.04.2009, issued by the Sulur Police Station also mentions the name of the complainant's godown as the accident spot. Therefore, from a bare perusal of various sets of documents that not even lead anyone to a small doubt regarding the address of the insured premises and only indicate that the fire accident had taken place in the insured premises of the complainant at Door No.5/153 and further, 28 from a close scrutiny of the VAO Certificate as well as the House/Property Tax Receipt which only falsify the claim of the other side that the actual place of occurrence was at Door No.5/155G, it is obvious that the Surveyor had indulged in misreading and misconstruing the documents and thereby confused the whole issue, in particular, the very genesis of the incident itself pertaining to its place of occurrence. Such a conduct is totally unexpected of an expert. This is a case where it is once again proved that the report of the Surveyor is not that sacrosanct that it cannot be departed from and that it is the last and final word. It must be highlighted at this juncture that the responsibility of the Insurer does not get absolved with just procuring a survey report so as to rely on it as such, and to take their own whimsical decisions. A duty is cast upon the Insurance Company also to examine the correctness of the findings of the Surveyor by contrasting the findings with the gathered/available materials. May be in a handful of cases like the present instance, the expert might have misread the documents and recorded highly devious findings. 29 Irrespective of the outcome in the survey report, whether it is in favor of the insured or otherwise, the Insurance Company shall independently apply its mind by contrasting the findings in the report with the documents and take a just decision in terms of the policy conditions as well as the facts and circumstances involved. When all relevant documents only divulge the following:-
a) that the fire accident connected to the insurance claim had occurred in the Godown bearing Door No.5/153;
b) that the said godown was a part of Survey No.64/3;
c) that the said godown was taken on lease by the complainant, who had insured it for the waste cotton stock & other items under the two policies in question with 30 the Insurance Company/Opposite Party;
d) that the claim was lodged by the insured/complainant with the Insurer/OP only in respect of the insured Godown at Door No.5/153;
e) that Door No.5/155G, which is also a part of Survey No.64/3, was never claimed by the complainant as the affected premises;
f) that the VAO Certificate / Property Tax Receipt has no relevance at all either to the claim or the claimed premises; and 31
g) that there is no single material exist even to doubt that the fire accident had occurred at a place other than the insured premises, the report of the Surveyor claiming the place of occurrence as a different venue is totally misleading. As a prudent service-provider, the Insurance Company that had done the spot verification in respect of the risk, before issuing the policy, which is undoubtedly place-specific, ought to have applied its own mind to the documents and the report and arrived at a right conclusion on the simple address issue, which they miserably failed to do and thereby, they have exhibited a clear conduct of service deficiency. Ultimately, they proceeded so blindly even to hold that the incident had not taken place at all in the insured premises, while no document suggests to presume/hold so. From the following reason assigned by the Insurance company in their repudiation, " Regarding the claim pertaining to claim being settled 32 by M/s.Bajaj Alliance Company we understand from the surveyor that the building had been insured with SF No and not door No. while we have issued the policy with specific Door number.
Hence any deviation in the door number shall not be considered as per terms and conditions of the policy. "
it is apparent that the Insurance Company merely followed the survey report that is replete of blatant errors and misreading; as such, the ultimate major reasoning given by them over the issue of address/door number is wholly erroneous. Thus, by expressing our dissatisfaction over the survey report and by holding that the OP has committed a clear service deficiency, we answer the issue against the OP and in favour of the complainant.33
10. Coming to the final issue, the Insurance Company, by stating that there are variations between the stock details mentioned in the Provisional Balance Sheet and the Audited Balance Sheet, concluded that such variations had led them to infer misrepresentation of material facts which ultimately rendered the policy void. It is common knowledge that provisional balance sheets would normally reflect the estimated value which may be changed while the audited balance sheets are deemed to be final and no final changes can be made therein for the specific financial year in the books of accounts. While so, despite the findings of the surveyor, the Insurance Company could have taken a pragmatic and practical approach in assessing the claim, based on the conclusive accounts that cannot be subjected to change.
From a perusal of the policies, it is seen that under the policy for the value of Rs.40 lakh, the risk covered is mentioned as 'cotton seed cleaning and delinting factory', which suggests involvement of machinery and equipments, while under the other policy for the value of 34 Rs.10 lakh, the risk covered is only in respect of 'solids which are moderately or slightly combustible'. We further find that the accounts details over the claim were furnished only in respect of the cotton stock that was destroyed. That being so, although the complainant seeks for a claim of Rs.50 lakh, even as per the Insurance Company, after proper adjustments, the final loss could only be worked out at Rs.14,98,432/-. In the given factual scenario, we are of the view, awarding the above said sum would be just and proper, however, since the amount has been lying all along with the Insurance Company, we deem it fair to issue a direction to the Insurance Company to pay the said sum along with interest @ 12% p.a. from the date of claim till the date of payment as it would better meet the ends of justice. Accordingly, we answer this issue.
11. In the result, the complaint is allowed in part and since the Insurance Company/OP is found to have committed service deficiency, they are hereby directed to pay to the complainant a sum of Rs.14,98,432/- (Rupees 35 fourteen lakh ninety eight thousand four hundred and thirty two only) towards the insurance claim along with interest thereon at 12% p.a. from the date of the claim, within a period of six weeks from the date of receipt of a copy of this order, besides a sum of Rs.25,000/- (Rupees twenty five thousand only) towards compensation for the mental agony and another sum of Rs.5,000/- (Rupees five thousand only) as litigation expenses.
R VENKATESAPERUMAL R.SUBBIAH, J. MEMBER PRESIDENT.
LIST OF DOCUMENTS MARKED ON THE SIDE OF THE COMPLAINANT Sl.No. Date Description of Documents Ex.A1 26.11.2008 Copy of policies Ex.A2 28.05.2010 Copy of repudiation letter by NIA 25.05.2010 Copy of notice 26.04.2010 Copy of explanation Ex.A3 -- Sample site plan 21.04.2009 Copy of acknowledgement of police complaint Copy of Certificate of Sales Tax Authority 36 20.06.2006 Copy of Lease Agreement 09.06.2005 Copy of Release Agreement copy 05.06.2005 Copy of Ration Card 20.04.2009 Copy of Letter Head Copy 01.04.2009 Copy of Invoice of Thangam Spinners 02.04.2009 Copy of invoice of Varun Ram Enterprises 01.04.2009 Copy of invoice of Sri Kalliamman Traders 01.04.2009 Copy of invoice of Periyanayaki Amman Traders Ex.A4 25.04.2009 Copy of Claim bill Ex.A5 29.09.2009 Copy of Form 3 CD 31.09.2009 Copy of Audited statements Copy of stock statements 19.04.2009 Copy of extract of ledgers Ex.A6 18.03.2009 Copy of invoice of Periyanayaki Amman Traders 16.03.2009 Copy of invoice of Periyanayaki Amman Traders 20.03.2009 Copy of Amba Cotspin - Invoice 17.04.2009 Copy of Chenniappa Yam Spinners Pvt. Ltd.
Ex.A7 -- Claim payment by Bajaj
10.09.2008 Copy of Policy copy- Bajaj
21.04.2009 Copy of news items
37
Various Form (I) submitted to VAT
authorities
Ex.A8 -- Two numbers cds
Ex.A9 26.07.2010 Copy of Power Attorney
LIST OF DOCUMENTS MARKED ON THE SIDE OF THE Ops Sl.No. Date Description of Documents Ex.B1 -- Copy of Survey Report R.VENKATESAPERUMAL R.SUBBIAH, J.
MEMBER PRESIDENT.
ISM/TNSCDRC/Chennai/Orders/MARCH/2023.