A) Mr. Arun Chokhani- Vs -National Insurance Co. Ltd.

(2012)
(a) Complainant: The Complainant stated that he procured a
Shopkeeper Package Policy No 201000!"#!0#!$#000000#%
&rom the National 'nsurance Co (td co)ering the period &rom
0"0#200# to 0*0#200$ &or a Sum 'nsured o& +s
10,1%,#00!- .hile the policy /as in &orce, on 0"00200$,
there /as a &ire 1roke out in his shop premises Almost all
cloths, &urniture and &i2tures etc /ere damaged
Therea&ter, he lodged a claim 1e&ore the 'nsurer along /ith all
supporting documents The 'nsurer deputed Sur)eyor /ho
assessed the loss at +s 3,$2,3*"00
4ut, the 'nsurer has repudiated the claim /ithout any 5usti&ied
ground 4eing aggrie)ed, he has lodged this complaint
(1) 'nsurer: The 'nsurer has stated in their 6Sel& Contained
Note7 that the Complainant has lodged a claim &or
+s$,3#,1$"!- against the loss occurred due to &ire caused 1y
short circuit They ha)e deputed their Sur)eyor /ho assessed
the loss at +s 3,$2,3*"00 The Sur)eyor reported on dou1t&ul
1ills and cash-memos /hich /ere originated &rom 8um1ai and
Surat
They ha)e in)estigated the matter through their 8um1ai +9 :
'' and Surat ;9 : ' /ho in)estigated the matter and in&ormed
them that all the 1ills and cash-memos /ere &ake 't is &urther
stated 1y the 'nsurer that 'nsurance policy /as taken in the
name o& 8r Arun Chokhani /hereas all the documents
su1mitted 1ear the name and seal o& 68!s <lory7 /hich /as
ne)er disclosed to them
The claimant /as all along ha)ing mala&ied intentions a&ter
sustaining the loss =ery lo/ salary paid to his employees,
huge di&&erence in rent agreed and actual rent paid, sudden
increased in sundry creditors /ithout proper heads, option o&
high Sum 'nsured in comparison to the year end trading
account : all suggested manipulating pro&it and loss account
They ha)e repudiated the claim on the ground o& non-
disclosure o& shop name, manu&acturing o& &alse accounts etc
also /as a )iolation o& policy condition No 2
;ecision: That there /as &ire on the night o& "th>uly 200$ in
the shop o& the Complainant is not in dispute (odging the
claim &or +s $,3#,1$"!- 1y the Complainant under Policy No
201000!"#!0#!$#000000#% has also not 1een disputed 1y the
'nsurer
't has apparent that the 'nsurer has repudiated the claim
mainly on the 1asis o& report o& the Sur)eyor /ho reported that
most o& the 1ills and cash memos /hich /ere originated &rom
8um1ai and Surat /ere &ake
They ha)e taken another ground &or repudiation o& the claim
that in all the documents su1mitted 1orne the name and seal o&
68!s <lory7 /hereas the insurance policy /as taken in the
name o& 8r Arun Chokhani 'nsurer claims that &or non-
disclosure o& name o& the shop name, manu&acturing o& &alse
accounts /ere )iolation o& policy condition No 2
To su1stantiate their plea that 1ills and cash memos su1mitted
1y the Complainant /ere &ake, they su1mitted one report o&
'n)estigator under name and style o& Canara Associates,
8um1ai /hich &irm /as deputed 1y the 'nsurer &or )eri&ication
o& 1ills and cash memos /herein the 'n)estigator stated that
a&ter )isiting the addresses on the cash memos o& the
suppliers, they &ound that all the suppliers ha)e ?uoted the
/rong addresses and all the suppliers /ere not e2isted in the
gi)en addresses and there&ore, they could not )eri&y the cash
memos and 1ills
Contro)erting the report o& the 'n)estigator &rom 8um1ai, the
Complainant su1mitted some certi&icates &rom the Supplier
&irms regarding genuineness o& the cash memos and 1ills
9n care&ul scrutiny o& those certi&icates, ' &ound that the
proprietors o& <yan Prakash 8askara, +P Te2tiles, @+
Te2tiles, Star Cloth 8art, PremChand Trading Co, Satyam
Te2tiles, Amardeep, (a2minarayan Te2tiles, =inayak <erments
had issued certi&icates certi&ying that the cash memos and 1ills
issued 1y them /ere genuine
't also re)eals that those genuine certi&icates issued 1y the
'ssuing Authority /ere sent 1y the Complainant to the
;i)isional 8anager, National 'nsurance Co (td, Shillong ;i)l
9&&ice
That 1eing the position, it is di&&icult to accept the report o&
Canara Associates, 8um1ai to 1e trust/orthy Simply saying
that those &irms did not e2ist is not su&&icient to su1stantiate
the plea
They must pro)e 1y adducing some cogent and relia1le
e)idence in support o& their report 9nly the trade licence
issuing authority can say /hether those &irms are e2isted or
not A)idently Canara Associates is not proper authority to say
as to /hich &irms are in e2istence and /hich &irms are not in
e2istence in 8um1ai
The 'nsurer has &ailed to produce any certi&icates &rom the
licence issuing authority to su1stantiate the plea that cash
memos issuing &irms /ere not in e2istence The 'nsurer has
le)elled the allegation o& &raud against the Complainant 4ut, it
is a settled principle o& la/ that &raud cannot 1e 1ased on
suspicion and con5ecture
't must 1e pro)ed 1eyond reasona1le dou1t 1y producing
cogent and relia1le e)idences ' am o& the &irm )ie/ that the
'nsurer has &ailed to pro)e that the Complainant practised
&raud 1y su1mitting &ake cash memos and 1ills 9n the other
hand, the Complainant has 1een a1le to su1mit certi&icates
&rom the proprietors o& the &irms stating that the cash memos
and 1ills issued 1y them to 8r Arun Chokhani /ere genuine
No/, coming 1ack to the ?uestion o& ?uantum o& claim, ' &ind
that the Sur)eyor has assessed the loss at +s3,#2,3*"!- The
Complainant has alleged that the Sur)eyor did not take into
account o& the &urniture and &i2ture o& his shop /hich /ere
gutted in the &ire
As the shop gutted completely in the &ire, the &urniture B
&i2ture might ha)e 1een gutted into &ire At least an amount o&
+s20,000!- can 1e assumed to 1e loss o& &urniture and &i2ture
gutted in the &ire
Considering all the aspects o& the matter, ' &ind that the
Complainant is entitled to get the claim amount o& +s
3,#2,3*"!- as assessed 1y the Sur)eyor o& the 'nsurer
along/ith penal interest 9)er and a1o)e that, +s20,000!-
must 1e paid to the Complainant &or loss o& &urniture B &i2ture
'n the ultimate analysis o& the entire matter and &acts and
circumstances o& the case, ' hold that the decision o& the
'nsurer in repudiating the claim o& the Complainant is not 5ust
and reasona1le and there&ore, it is set aside
'nsurer is directed to settle the claim /ithin 1% days &rom the
date o& this 9rder
4) P P Saadudeen Vs. New India Assurance Co Ltd (2012)
The house o& the complainant /as insured /ith the
+espondent-insurer Ce made a claim &or the cracks de)eloped
in the house due to &ire /orks in 2!2010 The claim /as
re5ected
Cence the complaint
+ecords /ere perused and hearing held The complainant
remained a1sent The complainant had su1mitted a claim &or
+s 12##00!- alleging that the 1uilding su&&ered damage during
the &esti)al &ire /orks in 2!2010 /hile the sur)eyor appointed
1y the insurer assessed the loss at +s %##10!-
The complainantDs estimate cannot 1e accepted &or the reason
that it is unsigned and undated and the name o& the author is
not disclosed Eurther, there is no timely intimation o& the loss
to the insurer denying them the opportunity to assess the loss
properly
A)en in the intimation letter dated #1110 sent 1y the
complainant, the complainant is not sure as to the cause o&
damage There is not e)en a trace o& e)idence to link the
damage to any o& the insured perils enumerated in the policy
conditions
'n the result, the complaint is dismissed No cost