DINA NATH GANJOO Vs. NATIONAL INSURANCE CO. LTD.

JUDGEMENT

(1.) The complainant is a resident of village Hagam, Tehsil Anantnag and after the eruption of militancy in the Kashmir Valley he was forced to flee away from his home and hearth and took refuge in the city of Jammu. As a migrant, in the year 1998, he got his residential house along with attic and household articles lying therein insured with the OPs under standard fire and special perils policy which remained in currency upto the year 2005. The case of the complainant is that during his absence his insured residential house along with attic was set ablaze by some unknown miscreants. When the incident came to the knowledge of the personnel of the Police Station, Bijbehara they suo motu registered FIR No. 15/2001. That in the year 2005; the complainant came to know through private sources that his insured house and attic had been set on fire. He raised the insurance claim with OP No.1 on 2.11.2005. OP No.1 deputed Sai Consultants as Surveyor to assess the loss. The gutted house during the material time of the year 2001 had an insurance cover to the extent of Rs.5,50,000. The Surveyor Sai Consultants conducted the spot survey on 8.11.2005 and submitted his report wherein the actual loss was assessed in the sum of Rs.4,60,653. After the receipt of the Surveyors report, the claim was not settled. Without any reasonable cause, on 18.12.2006, fresh loss assessor namely, M/s. Wullar Investigators were deputed for making the assessment of the loss who assessed the loss in the absence of the complainant. It is alleged by the OPs that M/s. Wullar Investigators had assessed the loss to the tune of Rs.83,000. On 31.10.2007 OP No.3 informed the complainant that loss had taken place on 15.1.2001 and not on 15.1.2004. The Complainant approached Ombudsman in Chandigarh for getting the claim settled but he relied upon the assessment made by M/s. Wullar Investigator to the extent of Rs.83,000 and as an act of benevolence granted that much amount in the form of ex gratia help to the complainant, which was not accepted by him. Hence complaint has been filed and reliefs sought for are as under:

(2.) In the written version the claim has been contested briefly on the grounds that insurance policy was operating with effect from 3.5.2005 to 2.5.2006 whereas, the alleged loss had occurred on 15.1.2001. That the complainant tampered the contents of FIR. That M/s. Sai Consultants, Surveyor although submitted the surveyor report after assessing the loss but the claim was deleted from the claim file as he was not categorized by Insurance Regulatory Authority for undertaking Surveyors job. The company hired the services of M/s. Wullar Investigators Pvt. Ltd. for the verification of FIR in question as well as to investigate the claim. M/s. Wullar Investigators submitted the report on 31.1.2007 stating therein that the house of the complainant was gutted in the fire incident which took place on 15.1.2001 and not on 15.1.2004. That the complainant had tampered and forged FIR No. 15/2001 with a view to raise false and fictitious claim. The complainant was asked to explain the position and on his failure to do so, the claim was repudiated. However the complainant when approached the Insurance Ombudsman appointed under the Redressed of Public Grievances Rules, 1998 seeking mediation between the parties, he while upholding the repudiation of the claim, in view of contradictory statements made by the complainant, granted ex gratia payment of Rs.83,000. Since the award passed by the Insurance Ombudsman is final so the complaint deserves dismissal. Heard the arguments.

(3.) Mr. K.L. Bhat, the learned Counsel for the complainant, in order to rebut the objections of the OPs that there was tampering in the FIR and the incident had occurred in the year 2004 which on inquiry was found false has contended that the objection is raised without any basis. The case of the complainant in the Commission is specific that the incident had occurred on 15.1.2001 and it was registered under FIR No. 15/2001 in Police Station, Bijbehara for the commission of offence falling under Section 436, RPC. He has referred to para 4 of the complaint. Furthermore, in Para 11 of the complaint the complainant has averred that after raising the claim with the OPs and submitting the original documents requests were made for the settlement of the claim, as a result whereof Surveyor namely, Sai Consultant, was deputed in the year 2005 by OP No.1. The complainant being a migrant could not personally know when the loss had occurred and, as such, he could not give exact date to the OPs. In Para 15 of the complaint he has reiterated that the concerned police station suo motu had registered the incident in the year 2001 and the complainant came to know about the same in the year 2005. In support of the complaint, the complainant has annexed copy of the FIR (Annexure B) wherein it is stated that the incident occurred on 15.1.2001 and the house of the complainant being the property of a migrant was set on fire by some miscreants. M/s. Sai Consultant was deputed by the OPs to assess the loss who visited the spot on 2.11.2005 and thereafter demanded the documents detailed in the report from the complainant which he had furnished. After making inquiries on spot the said Surveyor had assessed the loss in the sum of Rs.4,60,653. Without any rhyme and reason OPs appointed M/s. Wullar Investigators to investigate the claim and they in the absence of the complainant and without his knowledge made the investigation and stated in their report that during the year 2004 no loss had been caused to the insured house but damage was caused .in the year 2001. Since no loss had been caused in the year 2004, so the claim was found fictitious. On the basis of the Investigation report OPs repudiated the claim of the complainant. He approached insurance ombudsman Chandigarh (Mr. K.M. Chadha) who has admitted that the loss was assessed by the Surveyor in April 2006 to the tune of Rs. 4,60,000 and according to him found some contradictory statement were made by the complainant. He also stated that the actual loss suffered by the claimant was to the extent of Rs.83,000 only as has been assessed by M/s. Wullar investigators. He sanctioned that much amount of Rs.83,000 by way of ex gratia grant which offer was not accepted by the complainant. While concluding his arguments Mr. Bhat has cited the case of L.I.C. v. Abdul Aziz Bhat1 wherein it has been held that no reliance can be placed on any assessment or investigation conducted at the back of the insured.