State Consumer Disputes Redressal Commission
Vijay Kumar Mishra vs The Universal Sompo General Insurance on 2 July, 2025
CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025
IN THE DELHI STATE CONSUMER DISPUTES
REDRESSAL COMMISSION
Date of Institution: 19.12.2017
Date of Hearing: 30.05.2025
Date of Decision: 02.07.2025
COMPLAINT NO. 2042/2017
IN THE MATTER OF
MR. VIJAY KUMAR MISHRA,
S/O. MR. PARAS NATH MISHRA,
SOLE PROPRIETOR,
M/S. VIJAY COPY MANUFACTURER & SUPPLIER'S,
HAVING HIS SALES DEPOT AT: -
A-172, GALI NO. 4,
NEHRU VIHAR, DELHI-110094.
(Through: Mr. Amit Yadav, Advocate)
...Complainant
VERSUS
1. THE UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LTD.,
THROUGH ITS MANAGING DIRECTOR,
(A JOINT VENTURE BETWEEN INDIAN OVERSEAS BANK & SOMPO
JAPAN NIPPOKOA INSURANCE INCORPORATION),
LOCATED AT: -
C-20/1A, C-BLOCK, SECTOR-62,
NOIDA, UTTAR PRADESH.
ALSO AT: -
EXPRESS IT PARK PLOT NO. EL-94,
T.T.C INDUSTRIAL AREA,
MAHAPE NAVI MUMBAI-400710.
(Through: Mr. Rajat Khattry, Advocate)
...Opposite Party No. 1
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2. INDIAN OVERSEAS BANK,
BRANCH MANAGER,
YAMUNA VIHAR,
DELHI-110053.
(Through: Mr. Adish Jain, Advocate)
...Opposite Party No. 2
3. M/S. PROTOCOL INSURANCE SURVEYORS & LOSS ASSESSORS
PVT. LTD.,
LOCATED AT: -
H-54, SECTOR-63,
NOIDA, UTAR PRADESH-201301.
...Opposite Party No. 3
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CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025
CORAM:
HON'BLE JUSTICE SANGITA DHINGRA SEHGAL (PRESIDENT)
HON'BLE MS. PINKI, MEMBER (JUDICIAL)
Present: Mr. Amit Yadav, counsel for the Complainant, E-mail:
[email protected].
Mr. Rajat Khattry, counsel for the Opposite Party No. 1, E-mail:
[email protected].
Mr. Adish Jain, counsel for the Opposite Party No. 2, E-mail:
[email protected].
None for the Opposite Party No. 3.
PER: HON'BLE JUSTICE SANGITA DHINGRA SEHGAL, PRESIDENT
JUDGMENT
1. The present Complaint has been filed before this Commission by the Complainant alleging deficiency in service and unfair trade practice on the part of Opposite Parties and has prayed for the following reliefs:-
It is therefore, as per the facts and circumstances of the present case it is mostly respectfully prayed to this Hon'ble forum to kindly be pleased to pass an order in favour of the complainant and against the opposing parties (jointly and severally) to compensate the complainant for his aforestated loss due to deficiency in their services to the tune of Rs.97,31,119/- (Rupees Ninety Seven lakh thirty one thousand one hundred and nineteen).
Any other or such further order/s may also be passed in favour of the complainant and against the opposite parties as per the facts and circumstances of the present case.
2. Brief facts necessary for the adjudication of the present Complaint are that the Complainant, namely, Mr. Vijay Kumar Mishra, runs a copy manufacturer and supplier company, who obtained a General Insurance Policy bearing no. 2913/52760853/03/BOO & 2114/52760852/03/BOO with the Opposite Party ALLOWED PAGE 3 OF 12 CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025 No. 1 for a sum of Rs. 60,00,000/- (Rupees Sixty Lakh Only) for a period of 1 year with effect from 16.02.2016 to 15.02.2017. On 24.05.2016, a fire broke out in the godown of the Complainant due to short circuit in the electrical wires. The Complainant was not in Delhi on 24.05.2016, and the neighbours informed the Police and the Fire Department on the same day to stop the said fire. The Complainant returned to Delhi on 25.05.2016 and filed a complaint bearing no. CL 16016792 with the Opposite Party No. 1 on 26.05.2016. On01.06.2016, a surveyor, namely CA S.K. Aggarwal from the Opposite Party No. 3, demanded certain information and necessary documents from the Complainant, and the Complainant promptly responded to the surveyor and the Opposite Party No. 2 for indemnification of his loss vide letters dated 01.06.2016, 02.08.2016, 16.08.2016 and 12.09.2016 with respect to the compliance of documents. The surveyor made an assessment wrongly in the favour of the Opposite Party No. 1, and the Complainant informed Opposite Party No. 2 of the malpractice and malafide approach of the surveyor vide letters 05.06.2016, 20.06.2016 and 21.06.2016. After a series of letters of correspondence between the parties, the Complainant intimated the Opposite Parties to settle the claim within one week vide letter dated 20.01.2017. The Opposite Party No. 1 sent an SMS dated 01.02.2017 to the Complainant quoting an amount of Rs. 8,30,425/- (Rupees Eight Lakh Thirty Thousand Four Hundred and Twenty-Five Only) with regard to the settlement of the claim and a premium amount of Rs. 1,540/- (Rupees One Thousand Five Hundred and Forty Only) in total. The reduction of the settlement claim amount against the Complainant amounts to deficiency in services on the part of the Opposite Parties No. 1 & 3, with Rs. 97,31,119/- (Rupees Ninety- Seven Lakh Thirty-One Thousand One-Hundred and Nineteen Only) being the total claim amount, which has not been settled by the Opposite Party No. 1 till ALLOWED PAGE 4 OF 12 CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025 date. Aggrieved by the aforesaid, the Complainant has approached this Commission.
3. The Opposite Party No. 1 has filed its Written Statement, denying all the contentions and allegations of the Complainant, contending that the present Complaint is not maintainable as the Complainant has suppressed material facts from this Commission. The counsel for the Opposite Party No. 1 has submitted that the Opposite Party No. 1 has already released an amount of Rs. 8,30,425/- (Rupees Eight Lakh Thirty Thousand Four-Hundred and Twenty-Five Only). The Opposite Party No. 1 has also submitted that the Complainant delayed in submitted the necessary documents and required information to the Opposite Parties No. 1 & 3. It is further submitted that the Complainant was not maintaining proper records, due to which, the surveyor had to carry out physical verification, and therefore, the claim of the Complainant was not supported by documentary evidence. Further, it is submitted that the surveyor, vide Survey Report dated 22.12.2016 assessed a loss of Rs. 17,52,365/- (Rupees Seventeen Lakh Fifty-Two Thousand Three-Hundred and Sixty-Five Thousand Only). Additionally, it is submitted that the surveyor reviewed the assessment and vide Addendum Report dated 17.01.2017 observed that the Revised Assessed Amount would be Rs. 8,31,695/- (Rupees Eight Lakh Thirty-One Thousand Six-Hundred and Ninety-Five Only), and after the reduction of the premium amount of Rs.1,540/- (Rupees One Thousand Five Hundred and Forty Only), the amount of Rs. 8,30,425/- (Rupees Eight Lakh Thirty Thousand Four-Hundred and Twenty- Five Only) was released in favour of the Complainant. Pressing the aforesaid contentions and submissions, the counsel for the Opposite Party No. 1 prayed for the dismissal of the present Complaint.
4. The Opposite Party No. 2 has filed its Written Statement, wherein, it is submitted that no cause of action against the Complainant with regards to the general ALLOWED PAGE 5 OF 12 CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025 insurance policy in question arises from the Opposite Party No. 2. The counsel for the Opposite Party No. 2 has also submitted that the Complainant obtained the said policy on his own and without any interference from the Opposite Party No. 2. Further, it is submitted that the Opposite Party No. 2 has not collected or debited the premium amount of the policy in question, and therefore, there is no deficiency on the part of the Opposite Party No 2. Pressing the aforesaid contentions and submissions, the counsel for the Opposite Party No. 2 prayed for the dismissal of the present Complaint.
5. The Opposite Party No. 3 has filed its Written Statement, denying all the contentions, averments, allegations and submissions of the Complainant. The counsel for the Opposite Party No. 3 has submitted that the surveyor has only assessed the loss as per the guidelines issued by the Insurance Regulatory and Development Authority (IRDA), and it is also submitted that the Complainant does not fall within the definition of "consumer" under Section 2(1)(d) of the Consumer Protection Act, 1986, as the Complainant did not hire or avail any service from the Opposite Party No. 3. Further, it is submitted that the during the survey conducted by the surveyor of the Opposite Party No. 3, detailed inspection of the loss was carried out by the said surveyor. Additionally, it is submitted that the Opposite Party No. 3 requested the Complainant to provide certain information and documents for the proper assessment of the loss incurred by the Complainant, and repeatedly followed up on the Complainant for the submission of the required documents, however, the Complainant delayed the submission of the same. The Opposite Party No. 3 has also submitted that the Survey Report dated 22.12.2016 and the Addendum Report dated 17.01.2017 were prepared and submitted on the basis of incomplete information provided by the Complainant. The Opposite Party No. 3 has further submitted that no cause of action against the Complainant with regards to the general insurance policy in question arises ALLOWED PAGE 6 OF 12 CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025 from the Opposite Party No. 3. Pressing the aforesaid contentions and submissions, the counsel for the Opposite Party No. 3 prayed for the dismissal of the present Complaint.
6. The Complainant has filed the Rejoinder rebutting the Written Statement filed by the Opposite Party No. 1, reiterating the contents of the Complaint, and has further submitted that the Opposite Party No. 1 has failed to release the amount of Rs. 8,30,425/- (Rupees Eight Lakh Thirty Thousand Four-Hundred and Twenty-Five Only) in favour of the Complainant. Thereafter, parties filed their Evidence by way of Affidavit to prove their averments on record.
7. Written Arguments have been filed by the Complainant, wherein the contents of the Complaint have been reiterated.
8. Written Arguments have been filed by the Opposite Party No. 1, wherein the contents of the Written Statement have been reiterated, and the Opposite Party No. 1 has placed reliance on the following judgments in support of its case:
(i) Sri Venkateswara Syndicate vs. Oriental Insurance Co.
and Anr. as reported in (2009) 8 SCC 507
(ii) Garg Acrylics Ltd. vs. United India Insurance Co. Ltd. as reported in 2014 SCC OnLine NCDRC 904
(iii) Oriental Insurance Company Ltd. vs. Ishwar Singh as reported in 2015 SCC OnLine NCDRC 1707
(iv) Oriental Insurance Company Ltd. vs. M/s. Pavan Enterprises as reported in 2015 SCC OnLine NCDRC 3263
(v) Devender Malhotra vs. United India Insurance Co. Ltd. as reported in (2016) SCC OnLine NCDRC 2139
(vi) Khatema Fibres Ltd. vs. New India Assurance Co. Ltd. as reported in (2021) SCC OnLine SC 818
9. Written Arguments have been filed by the Opposite Party No. 2, wherein the contents of the Written Statement have been reiterated.
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10.The Opposite Party No. 3 has failed to file the Written Arguments despite multiple reminders, and vide order dated 26.05.2025, the right of the Opposite Party No. 3 to file the Written Arguments stands closed.
11.We have heard the counsel appearing on behalf of both the parties and perused the material available on record.
12.The first preliminary for consideration before us is whether any cause of action arises from the Opposite Parties No. 2 & 3 against the Complainant.
13.On perusal of record, we find that the Complainant holds a bank account with the Opposite Party No. 2, namely, "Indian Overseas Bank". Further perusal of record shows that the Complainant has failed to adduce any evidence towards the Opposite Party No. 2 being an intermediary between the Complainant and the Opposite Party No. 1, and towards any proposal of the Opposite Party No. 2 to the Complainant for obtaining the General Insurance Policy in question from the Opposite Party No. 1. Moreover, the function of the Opposite Party No. 2 is limited to the extent of being the bank of the Complainant, the Opposite Party No. 2 is not liable to settle the insurance claim of the Complainant. Therefore, we find that no cause of action arises from the Opposite Party No. 2.
14.Additionally, we find that the Opposite Party No. 3, namely, "M/s. Protocol Insurance Surveyors & Loss Assessors Pvt. Ltd." is merely a loss assessment and survey company employed for the purpose of assessing the loss incurred by the Complainant. Moreover, since the function of the Opposite Party No. 3 is merely limited to conducting survey of the loss site and preparing and issuing survey reports based on the loss assessment, the Opposite Party No. 3 is not liable to settle the insurance claim of the Complainant. Therefore, we find that no cause of action arises from the Opposite Party No. 3.
15.The main question for consideration before us is whether the Opposite Party No.1 is deficient in providing its services to the Complainant.
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16.To deal with this issue, we deem it necessary to refer to Section 2(1)(g) of the Consumer Protection Act, 1986, which provides as under:
(g) "deficiency" means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service.
17.It is clear from the perusal of the aforementioned Section that "deficiency" means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance on the part of the builder with respect to its contractual obligation.
18.Perusal of record shows that the Final Survey Report dated 22.12.2016 of the Surveyor/Opposite Party No. 3 (annexed as Annexure OP1/4 on page no. 75 alongwith Written Statement on behalf of the Opposite Party No. 1) clearly reflects that the underwriter's liability amounts to a total of Rs. 17,52,365/- (Rupees Seventeen Lakh Fifty-Two Thousand Three Hundred and Sixty-Five Only), however, the Surveyor/Opposite Party No. 3 has issued an Addendum Report dated 17.01.2017 (annexed as Annexure OP1/5 on page no. 79 alongwith Written Statement on behalf of the Opposite Party No. 1), which reflects that the total amount towards the Net Assured Loss is Rs. 8,31,965/- (Rupees Eight Lakh Thirty-One Thousand Six-Hundred and Ninety-Five Only).
19.At this juncture, we deem it necessary to refer to Section 13(4) of the Insurance Regulatory and Development Authority of India (Insurance Surveyors and Loss Assessors) Regulations, 2015 as amended upto 26.11.2020, which states as under:
"(4) If an insurer, on the receipt of a survey report, finds that it is incomplete in any respect, he shall require the surveyor under intimation to the insured, to furnish an additional ALLOWED PAGE 9 OF 12 CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025 report on such incomplete issues. Such a request may be made by the insurer within 15 days of the receipt of the original survey report.
Provided that the facility of calling for an additional report by the insurer shall not be resorted to more than once in the case of a claim."
20.From the bare perusal of the aforesaid Section of the IRDA Guidelines, 2015, it is clear that an insurer shall intimate the surveyor regarding the furnishing of an additional report if the insurer finds the first survey report incomplete in any respect, and the request for the additional report to the surveyor may be made within 15 days of the receipt of the original survey report.
21.In the present case, we find that the Insurer/Opposite Party No. 1 has failed to adduce evidence of any request to the Surveyor/Opposite Party No. 3 for the preparation of the Addendum Report dated 17.01.2017 within 15 days from the receipt of the Original Survey Report dated 22.12.2016. Therefore, we find that the aforesaid Addendum Report has no basis, and no reason has been communicated by the Insurer/Opposite Party No. 1 to either of the Complainant or the Opposite Party No. 3. Further, the Insurer/Opposite Party No. 1 has failed to submit any reason or justification before this Commission in order to show the requirement of the Addendum Survey Report.
22.Moreover, we find that the Addendum Survey Report is not a detailed report, wherein, unnecessary deduction has been made. On comparison of the Final Survey Report and the Addendum Survey Report, we find that the aforementioned deductions were not made in the Final Survey Report, the calculation heads in both the reports are not the same, and the Insurer/Opposite Party No. 1 has failed to justify the deductions made in the Addendum Survey Report.
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23.Therefore, we deem the said Addendum Survey Report as inadmissible and the claim of the Complainant is liable to be settled only according to the Net Assured Loss reflected in the Surveyor Report dated 22.12.2016. Further, the Insurer/Opposite Party No. 1 has submitted that the claim amount of Rs.8,30,425/- (Rupees Eight Lakh Thirty Thousand Four-Hundred and Twenty- Five Only) has been released in favour of the Complainant, however, on perusal of record, we find that the Insurer/Opposite Party No. 1 has failed to adduce any evidence of such payment towards the claim of the Complainant, therefore, the Insurer/Opposite Party No. 1 is liable to pay the total claim amount as per the original Survey Report dated 22.12.2016, excluding the premium amount towards the General Insurance Policy in question.
24.Keeping in view the facts of the present case and the extensive law as discussed above, we direct the Opposite Party No. 1 to refund the entire loss amount assessed by the Surveyor/Opposite Party No. 3 vide Final Surveyor Report dated 22.12.2016 to the Complainant i.e., Rs. 17,50,825/- (Rupees Seventeen Lakh Fifty Thousand Eight-Hundred and Twenty-Five Only) [after deduction of the premium amount, i.e., Rs. 17,52,365 - Rs. 1,540] along with simple interest as per the following arrangement:
A. An interest @ 6% p.a. calculated from 22.12.2016 (being the date of the Final Surveyor Report) till 02.07.2025 (being the date of the present judgment);
B. The rate of interest payable as per the aforesaid clause (A) is subject to the condition that the Opposite Party No. 1 pays the entire amount on or before 02.09.2025;
C. Being guided by the principles as discussed above, in case the Opposite Party No. 1 fails to refund the amount as per the aforesaid clause (A) on or before 02.09.2025, the entire amount is to be refunded along with an interest @ 9% p.a. calculated from 22.12.2016 (being the date of the Final Surveyor Report) ALLOWED PAGE 11 OF 12 CC/2042/2017 MR. VIJAY KUMAR MISHRA VS. THE UNIVERSAL SOMPO GENERAL INSURANCE D.O.D.: 02.07.2025 till the actual realization of the amount.
25.In addition to the aforesaid and taking into consideration the facts of the present case, the Opposite Party No. 1 is directed to pay a sum of:
A. Rs. 1,00,000/- (Rupees Three Lakhs only) as cost for mental agony and harassment to the Complainant; B. The litigation cost to the extent of Rs. 50,000/- (Rupees Fifty Thousand only).
26.Application(s) pending, if any, stands disposed of in terms of the aforesaid judgement.
27.The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.
28.File be consigned to record room along with a copy of this Judgment.
(JUSTICE SANGITA DHINGRA SEHGAL) PRESIDENT (PINKI) MEMBER (JUDICIAL) Pronounced On: 02.07.2025 LR-DK ALLOWED PAGE 12 OF 12