Fire Insurance-case Study

7/30/2019 Fire Insurance-case Study

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Fire Insurance PolicyBhubneshwar Ombudsman Centre

Case No . I.O.O./BBSR/11 005-0034

Sri Rabindra Nath Sarkar

Vs .

Or iental Insurance Co. Ltd.

Award dated 7. 4.2006

Complainant is the Managing Director Of M/s Kelvin Pharmaceutical Laboratories

Pvt. Ltd obtained a Fire policy C for buildings, Plant and Machineries , Stock in

process for the period 31-07-1999 to 30-07-2000. Due to super cyclone on 29-10-1999

complainant suffered the loss . Complainant lodged a claim with the insurer for an

amount of Rs 495,002 . Insurer repudiated the claim on the ground that policy does not

cover FSTCH perils .

During Hearing insurer stated that complainant did not opt for extended perils like

FSTCH in fire policy C . So, the company is not liable under fire policy C alone.

Complainant stated that he had applied for Fire policy A but insurer mischievously

issued Fire policy C and his request to rectify the policy to Fire policy A fell on deaf

ears of insurer.

Honble Ombudsman uphold the repudiation of the claim by insurer as complainant

failed to produce any documentary evidence that he had mooted the proposal for Fire

policy A and he had applied for rectification of the policy before the incident. Moreover,

Since insured is not an individual and the complaint was pending before 05-09-2005

,i.e. the judgment of Kerala High Court passed in writ petition no: 224 of 2003 ,this

complaint is not barred under the rule 4(i) and (k) of the R.P.G.Rules.

Bhubneshwar Ombudsman Centre

Case No. I.O.O./BBSR/14002-0057

Sr i Ranj i t S ing h Saluja

Vs .

New India Ass urance Co. Ltd.

Award Da ted 3.6 .2 00 6

Insured complainant insured his Shop and Godown under Shop Keepers Insurance and

Fire insurance policy of New India Assurance Co. Ltd. Fire broke out due to electrical

short circuit on 07-10-2002 as a result the stocks like cycle tubes, tyres, and other

accessories were damaged. Fire tender was pressed in to service. Insurers surveyorassessed the loss for an amount of Rs 431,746. Insurer settled the claim on the basis

of fire brigade certificate for an amount of Rs 66,176. Insured complainant being

aggrieved preferred this complaint.

During the Hearing complainant has stated that he has suffered a loss of Rs 910963/

but insurer is offering only Rs 66,176. Insurer representative stated that as per Fire

brigade certificate the loss was Rs 95,000/ for the two shops and one godown. They

have apportioned the loss between the shops and godown of two brothers named


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Narendra Singh Saluja and Narendra Singh Saluja as per their value of stocks just

before the loss.

Honble Ombudsman directed the insurer to pay Rs 431,746/ as per the assessment

done by surveyor after verification of stock register, sales register, purchase cash

memos and income tax returns.

Settlement by the insurer on the basis of Fire brigade report is arbitrary . Insurer didnot consider the report of surveyor. Fire brigade personnel did not verify the sales and

purchase bills. So, their assessment of loss does not hold good.

Bhubneshwar Ombudsman Centre Case No. I.O.O./BBSR/14002-0058

Sr i Narendra Singh Saluja

Vs .

New India Ass urance Co. Ltd.

Award Da ted 3.7 .2 00 6

Insured complainant insured his Shop under Shop Keepers Insurance policy of New

India Assurance Co. Ltd. Fire broke out due to electrical short circuit on 07-10-2002 as

a result the stocks of the shop like cycle tubes, tyres, and other accessories were

damaged. Fire tender was pressed in to service. Insurers surveyor assessed the loss

for an amount of Rs 16056/. Insurer settled the claim as Nil on the basis of fire brigade

certificate after deduction of policy excess . Insured complainant being aggrieved

preferred this complaint.

During the Hearing complainant has stated that he has suffered a loss of Rs 275842/

but insurer repudiated the claim. Insurer representative stated that as per Fire brigade

certificate the loss was Rs 95,000/for both the shops and godown of two brothers. They

have apportioned the loss between the shops of two brothers and godown of Narendra

Singh Saluja and Narendra Singh Saluja as per their value of stocks.

Honble Ombudsman directed the insurer to pay Rs 16056/ as per the assessment done

by surveyor after verification of stock register, sales register, purchase cash memosand income tax returns.

Settlement by the insurer on the basis of Fire brigade report is arbitrary . Insurer did

not consider the report of surveyor. Fire brigade personnel did not verify the sales and

purchase bills. So, their assessment of loss does not hold good.

Chennai Ombud sman Centre

Aw ar d No . 11.02.128 0 / 200 6 - 2007

Smt. Usha Rani

Vs

The New India A ssuranc e Co. Ltd.

Award dated 13.06.200 6The complainant s tated that she had taken a policy with New India Insurance Co. Ltd.,

insuring her Fancy shop for Rs. 3.5lakhs. The shop met with a fire accident on 2.01.05.

She informed the Police and the Insurer about the accident. Insurer appointed a

surveyor who estimated the loss to an extent of Rs. 1,21,076/- for which the claim was

also settled. Now the complainant makes an appeal for entire amount claimed by her,

which were Rs. 4.5 lacs. The insurer based on the surveyors report settled the amount

as stated by the surveyor.


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The insurer represented that the claim of loss was settled for R s. 1,21,076/-, which was

accepted by the complainant. To substantiate their stand they showed the suppliers

bill produced by the complainant which was either fake or tampered with and the

genuine bills were to an amount of Rs.43, 481/- only.

The Ombudsman stated that the documents submitted by the insured in the form of

copies of stock register and purchase bills/ receipts, lack veracity. The insured had

also proved to commit actions, which do not ensure transparency and good faith. The

insured had not been able to submit any further bona-fide documents to substantiate

the entire amount of her claim and also considering the fact that the insured had

already accepted the amount offered by the insurer, the Ombudsman dismissed the

complaint.

Chennai Ombud sman Centre

Aw ar d No . 11.04.103 6 / 200 6 - 2007

Shr i . S. Kr ish namohan

Vs

Uni ted India Insurance Co. Ltd.

Award Dd at ed 21.06.200 6

The complainant represented that he had taken a F ire Policy for his house with M/s

United India since 1990 and the policy was renewed as Standard Fire and Special

Perils P olicy from 21.11.2004 to 20.11.2005. His house was damaged due to

floodwater and the same was intimated to the insurer. The Insurer deputed the

surveyor to survey and assess the damage.

However, the Insurer repudiated the claim on the ground that from their survey report

no loss could be witnessed due to flood and inundation, hence no assessment could be

made. The Surveyor has stated in his report that even though inundation has been

substantiated, there has been no loss due to water entry; hence there was no claim.

Since, the complainant started the renovation work and already removed the wooden

frame, the surveyor was unable to ascertain extent of damage.After perusing the documents and reports the forum pointed out that it is confirmed that

the locality in which the house is located had water logging upto an extent of 1, and it

is definite that the house in question would also have been affected particularly when

water has remained there for more than a week. The forum observed that the survey

report was found to be highly unsatisfactory and insufficient as to ascertain the loss

sustained and hence the insurer was directed to appoint another surveyor /investigator

to make enquiries and to settle the claim as per the assessment arrived. The complaint

was allowed.

Guwahat i Ombudsman Centre

Case No . 11-005-0085/05

Md. Jahan Uddin AhmedVs

Or iental Insurance Co. Ltd.

Award Da ted 28. 04. 06

Facts leading to gr ievance of complainant : A small shop-house containing

electronic and stationery items etc. belonging to the insured/complainant was

completely gutted by an accidental fire having insurance cover w.e.f. 1990. Surveyor


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appointed assessed the loss at Rs.56,000/- but the insurer offered only Rs.22,238/-

hence this complaint.

Counter-statements f rom opp. par ty/ insurer : Without disputing the facts given by

the insured/complainant, the insurer/opposite party submitted that loss assessed by the

Surveyor at Rs.56,417.00 was inappropriate because the insured does not maintain

books of accounts and loss was assessed by the Surveyor taking average daily sale at

Rs.1,000/- but in an unconvincing and unreasonable manner. The insurer reviewed the

matter and re-assessed the loss to arrive at a figure of Rs.29,650/- and 75% of the

amount assessed as aforesaid was offered which comes to Rs.22,258/-.

Issue Involved : Whether reassessment by insurer is permissible ignoring finding of

surveyor held, No.

Decis ion & Reasons : It is widely held by different State Consumer Commissions as

well as some Courts that Surveyors report is an important document and cannot be

thrown away whimsically. On a comparative study of the two methods of assessment, it

will appear that assessment done by insurer does not appear to be sound, or better

than that which was done by the Surveyor. From materials available on record one can

come to an easy conclusion that the Insurance Company did not scrutinize the survey

report properly to point out any acceptable defect but went to adopt an arbitrary

method of differing with the findings and assessment of the Surveyor. This is not

permissible. Unfortunately, it appears to us that the personnel in the insurance office

are not in seisin of the affairs before them in order to settle such controversies.

Award : It is hereby directed that the claim will be settled in the light of discussion

aforesaid offering the most reasonable and appropriate sum, say around Rs.45,000/- or

so.


Case No . 14-004-0112/05

Shr i Mangi la l Sharma

VsUni ted India Insurance Co. Ltd.


Grievance : The insured/complainant resents that he sustained loss due to a fire

incident on 14.07.04 for which his shop and some items inside the shop were damaged.

He preferred a claim for Rs.9,00,000/- but after much delay only an offer of Rs.24,180/-

was made.

Reply : The Insurance Company submitted that the claim lodged by insured was

processed and an offer of Rs.24,180/- was made on the basis of recommendation of

the Surveyor appointed for the purpose.

Issue: Quantum of loss in fire accident to be assessed.

Decis ion & Reasons : On perusal of the available materials in the file there was nodamage caused by fire to the shop of the insured/complainant directly. The damage to

the shop was due to its use by fire-brigade personnel and others in their attempt to

extinguish the fire. The fire brigade authority issued a certificate suggesting the loss at

Rs.20,000/- only. The Surveyor appointed submitted the detailed reports showing that

there was a case of under-insurance as the value of stock in the shop prior to the fire

was ascertained as above 14 lakhs but the insured/complainant insured the shop only

for Rs.8 lakhs and accordingly, the condition of average was applicable and he


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assessed such loss at Rs.26,190/- after deduction of the policy excess etc. However,

the loss without the average clause was assessed by him at Rs.66096.00.

The report of the Surveyor is exhaustive and has dealt with all aspects of the matter to

come at a reasonable conclusion and that report can be made the basis for settlement

of the claim.

Award : The claim may be settled in the true spirit of the contents of the Survey reportprepared by Sri Sharma on 10.1.05 (date of receipt by Insurer not mentioned) along

with ex-gratia relief of a lump-sum amount of Rs.10,000/- as interest and compensation

for allied expenses incurred by the complainant in pursuing the claim since 15.7.2004.


Case No . 11-002-0118/05

Md. Sahab Uddi n

Vs

The New India A ssuranc e Co. Ltd.


Br ie f Facts lead ing to compla in t : Briefly stated, the case for the

complainant/insured Md. Sahabuddin is that his grocery shop was unfortunately gutted

completely by fire at about 2.00 A.M. on 5.10.04 along with others. That many

document including purchase vouchers were destroyed together with estimated stock of

Rs.15,26,980/-/. That he preferred claim for compensation of the loss with the insurer

but the same was turned down and further prayer for review also brought no result. The

relief sought is payment of Rs.15,00,000/- (Fifteen Lakhs).

Opponent s v iews : The New India Assurance Co. Ltd. contested the claim presenting

self-contained note with accompanying documents stating that the proprietary shop of

the insured in the name and style of M/s. Sahab Brothers was given insurance cover of

shop-keepers policy from 18.02.04 to 17.02.05 of grocery goods valued at

Rs.8,00,000/- (sum insured) which sum was enhanced by subsequent endorsement by

another Rs.7,00,000/- . That in the night of 5.10.04 fire broke out and insured sufferedloss. That on intimation of loss of one by one five persons were engaged/deputed to

investigate and assess the loss etc. That all those reports were against the insured/

complainant (claimant) and recommended repudiation. That investigation further

revealed that it was a shop-keepers policy for shop but fire broke out in go down

which was not covered. That the Surveyor/Investigators opined that it was a clear case

of intention to deceive Insurance Company and even if there was any loss that may be

valued only at about Rs.20,000/- which is far below the policy excess of Rs.25,000/-.

Decis io n & Reasons : We have examined the material before us very cautiously. Fire

Attendance Certificate relevant part goes as below (quoted)

4.Brief description of the type of :- The house measuring

Brothers was involved in F ire 30x40 ft. used as grocery shop under the name &style of M/s Saha and grocery goods, Electrical

Goods. Show case, Geg, E tc. were damaged.

The investigators deputed carefully prepared the report after making an exhaustive

study of the surrounding facts and circumstances and even enclosed recorded

statements from the neighbouring people of the locality where the alleged fire incident

took place. The insured shop house appeared to them to be the only shop (isolated)

that was effected by fire. Thus, the statement of the complainant in the P - form viz.-


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fire broke out in the claimants shop as well as others is misleading. The connected

police report of Dagaon Police post, however, certified vide G D E No.72 dt. 6.10.04,

that it was an accidental fire that burnt down grocery shop namely, Saha Brothers.

The findings of the Surveyors/Investigators may be summarized as below

Sl No. Name of Surveyor / Opinion expressed/

Invest igator F indings received.

1. Sri Atanu Mandal In conclusion, we like to opine that the insured has

sustained some losses, the amount of which could not be

ascertained. Some stocks etc. within his premises was

gutted. On close examination of the debris, it was found

that the loss caused to insured would not be to the extent

of sum insured.

2. P .P urkayastha & ..hence we find it is of no

Associates. use of pending the file with us where insured is not

interested in the claim as reflected from his non-

compliance. Hence we finally return the file with NIL

Assessment. Recommended as NO CLAIM.

3. Sri Bankim Das 9. However, the claimant claimed for a total loss of

Rs.15 lacs is baseless, however be that as it may, but

any basis of vital documents relied on, the loss at Rs.15

lacs could never be presumed to have been a fare

prudent sagacious and safe assessment in consistence

with the parameter of destruction in comparison.

4. Sri J ayanta Moni Hence cause of fire is not

Dadhara established and loss of materials is also not proved.

(Statement of

witnesses examined enclosed).

5. Sri Aswini Sarma Keeping in view of the above, it may be opined that

insureds claim on fire-loss was a fabricated one & an act

of deceiving the underwriter with false & fabricated

papers & documents. I, therefore, being totally confirmed

this as baseless claim, recommend the above-mentioned

claim as a NO CLAIM one and the underwriter, in no

way, is liable for the above-mentioned claim of loss.

It will be significant to reproduce the further observations and findings of Sri A. Sharma

as follows

ii) P linth area of the building was 19 ft. x 14 ft. where, in no case, grocery goods of

such volume goods costing about Rs.15,00,000.00 could be accommodated.

iii) The building was illuminated by other than electricity & hence there was no scope

of fire by any electrical accident, etc.

iv) Besides the above, the papers submitted by the proprietor of the insured shop is

in the name & style of M/S. SAHA BROTHERS. But, the policy coverage is

against the name & style of M/S SAHAB BROTHERS . under the above

circumstances, the underwriter is, in no way, liable for the loss & claim thereof.


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v) On enquiry & careful inspection by the undersigned, it was observed that the fire

affected premises was a godown of the insured & not used as a shop. But, as per

the policy, the sum insured coverage is against the shop premises only but not

the godown & hence the loss claimed by the insured is not admissible as per

policy condition.

vi) Though the affected premises is a godown but on considering the plinth area, the

information gathered from the local public, building owner, bazaar secretary etc.

& the photographs taken by the preliminary & final surveyor, it may be opined that

the loss, in no case, exceeded Rs.20,000.00 (Rupees Twenty thousand only)

which is well below the policy excess amount as per policy condition. Hence, the

under writer, in no case, is liable for claim of loss.

vii) The insured had produced an agreement copy of rented building which shows, the

size of the building as 40 ft X 30 ft & owned by MD. Safiqul Islam. But, the fire

affected building was owned by Md. Siddique Hussain covering plinth area 19 ft. x

14 ft. It proves that the insured shop was not actually the fire-affected building.

Hence the question of liability of the underwriter against this claim of loss does

not arise.

viii) Further, considering the assessments of the investigators, based on the reports

of the witnesses, it can be assumed that the fire- loss claim is a base-less & false

one which the investigators confirmed with the supported documents gathered

from important personalities of the area.

Concluding, we find this is case that perhaps narrates how far one can manage

things with intention of gaining easy money etc.

Order : We find no merit in the complaint. The complaint is dismissed on contest.


Case No . 11-011-0045/06-07

Binon dra Ch. Gogoi

VsBajaj A l l ianz General Insur ance Co. Ltd.

Award Da ted 13. 09. 200 6

Facts : The complainant suffered fire loss to his shop which is estimated at

Rs.1,21,613.00 but the Insurer settled the claim for Rs.48,934/- which he refused to

accept. The Insurer deputed Mr. Soumitra Gupta to survey & assess the loss who

assessed the loss at Rs.48,934/- which was settled as full & final payment on 14.06.06.

The Insured returned the cheque which however was again sent to the Insured with

details of the assessment by the Insurer.

Discuss ion & F ind ings : On study of survey report there is hardly anything to find

fault on the assessment. But the assessment on salvage value on stock in trade was on

the higher side. Deduction for salvage on stock in trade should be revised to

Rs.10,000/- on lump-sum basis and the loss may be re-assessed at Rs.51,325.00.Award / Or der : It is directed that the Insurer will pay a sum higher than the sum

already offered to the complainant provided the Insured sends the letter of acceptance

within 1 (one) month as full and final settlement of claim.

Hyderabad Ombudsman Centre

Case No . G 003/2006-07

Sri . K.nageshw ara Rao


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Vs

New India As surance. Co. Ltd.

Award Da ted 23. 05. 200 6

Complaint Par t ly Admi t ted : The complainant purchased a standard fire policy to

cover 2 poultry sheds and poultry

feed-stock for a sum insured of rs.1,60,000/- and rs.90,000/- respectively for the period10.03.2005 to Rs.09.03.2006. The sheds alongwith the feed was damaged in a cyclone

on 19.09.2005. the insured claimed an amount of rs.96,685/- for the sheds and poultry

feed of 10 bags. The insurers processed the claim for Rs.5705/- towards full and final

settlement. The insured contended that the shed was damaged beyond repair and the

estimate was obtained from a licensed building designer. The surveyors contention

that merely by putting a horizontal beam would suffice is absurd. A fresh coating of

grass, hay etc. alone works out to Rs.80,000/- The insurers contended that they

processed the claim as per the survey report. The surveyor observed that the sheds

were not properly constructed and there was no material loss to them as claimed by

the complainant. The sheds were only pressed due to the impact of wind and rain. As

such any repair charges were considered. The feed stock was not shown to the

surveyor during his visit. However they allowed compensation for 2 quintals, as there

was a possibility of entry of water from the ventilator. The policy was also subject to

compulsory excess of rs.10,000/- for each and every claim.

Held : The insurer did not dispute the cause of loss. Although theoretically it was

possible to repair the sheds, it is not possible to do so without the use of extra

material. More than 50% of estimate is for grass, thatch leave etc., The surveyor did

not rule out the possibility of adding fresh thatch to the roofs of the sheds. He stated

that extra leaves to extent of 20 to 25% would be needed. Since more than the

surveyors estimate is needed to restore the sheds, an amount of 75% of the estimated

of Rs.96,685/- towards both material and labour charges is allowed. The insurers are

directed to process and pay the claim for Rs.2514/- being 75% of the estimate . The

complaint is partly admitted.

Kochi Ombudsman Centre

Case No. IO/KCH/GI/36/2006-07

Shri .T.Karunakaran

Vs

Nat ional Insu rance Co.Ltd.

Award Da ted 26. 9.200 6

The complaint under R ule 12(1)(b) read with Rule 13 of the R PG Rules, 1998 relates to

repudiation of a fire-claim by the respondent insurer under Shop Keepers P olicy No.

571103/48/99/980599 issued in favour of the complainant covering the stock-in-trade in

his shop. It was reported that in the midnight on 25.4.2000, the shop was found on fire

and the reasons were unknown. There was no police case either in this regard. The fire

force had extinguished the flames. The complainant claimed Rs.1,33,961/- as damages

while the surveyor had put the loss at Rs.16,977/- only based on available records. The

complainant stated that most of the records were lost in the fire and, therefore, he

heavily depended on the Financier Banks report dated 3.4.2000 to compute the loss.

The surveyor said that the available records did not match the claim at all and it was

found largely exaggerated. He also said that there are number of huge empty bags and

cartons stored in the shop mainly to misguide the Bank officials as to the stock. The


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insurer believed the version of the surveyor and investigator and repudiated the claim

saying that it was an act of arson or the complainant himself was responsible for it.

However there was no evidence to prove this point. In the circumstances, closely

following the lines of assessment done by the surveyor, this Forum had given an award

for Rs.20,000/- although the net loss computed by the surveyor was Rs.16,977/- after

salvage and gross profit estimation. This case was also subject matter of a writ petition

before the Honble High Court of Kerala and the Honble Court had directed the

complainant to approach this Forum or any other competent authority to resolve the

dispute.

Kolkata Ombudsman Centre

Case No . 327/11/004/NL/8/2005-06

Smt. Meena Agr awal

Vs .

Uni ted India Insurance Co. Ltd.


Facts & Submiss ions : The complaint was regarding repudiation of claim for damage

to UPS on the ground of false document, etc. under Fire Insurance Policy.

Smt. Meena Agrawal, Prop. M/s Space Communication Centre, stated that her shop

establishment was insured since its inception in April 1990. On 13.10.2000 at about

1.00 P.M a fire loss took place due to high voltage fluctuation in the meter board

resulting in damage to Photostat machine, laser printer and UPS. A claim was

intimated to the insurance company under Fire Insurance policy and their officials

came to inspect the loss. All the relevant documents demanded by the surveyor were

furnished. Thereafter, the insurance company delayed settlement of the claim. After

active personal persuasion, the insurance company officials demanded illegal favour,

which was refused by the complainant. Eventually, in 2003, an investigator was

appointed for verification of bills and cash memos submitted by the complainant. Based

on the investigators report, the insurance company repudiated the claim on the ground

that the cash memo/bill were found to be false and fabricated. The complainant

represented that all the bills and the shops were genuine, as was also communicated

to the investigator. However, despite such representation, the insurance company

refused to examine the complainants contention and they did not pay the claim. Being

aggrieved, the complainant has come before us for redressal of her grievances,

seeking relief of Rs.90,000/- along with interest of Rs.50,000/-.

The complainant contended that one of the suppliers, viz. , M/s Computech Orbit was by

that time closed but it was a reputed firm in Muzaffarpur, financed by PNB, Bela

Branch, Muzaffarpur and was also insured with the same branch of the insurance

company during the period 1999 to 2001. As regards the other bill from M/s Xerox

Modicorp Ltd., the complainant stated that the said firm had shifted their office but

reaffirmed that they had issued the cash memo.

United India Insurance Company Limited, Muzaffarpur Divisional Office stated that the

claim was repudiated on the basis of an investigation conducted by them which

revealed that the bills/cash memo submitted by the complainant were found false and

fabricated. The following particulars were given in the note :-

a) the said space communication centre was insured, by the United India Insurance

Co. Ltd, through its branch office at Muzaffarpur, vide policy No.


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210201/11/11/0410/99-2000, from 01.04.2000 till 31.03.2001, for the articles

specified in the policy;

b) an intimation was received in the insurers office on 16.10.2000, which was dated

13.10.2000, claiming that on 13.10.2000 certain insured articles were damaged

due to electrical-sort-circuit, whereto the same was registered as claim no.

210201/11/11/7/00007/2000, and Sri Shailendra Sharma, Surveyor, was deputed

to survey the loss;

c) as the report was getting delayed, the surveyor was reminded several times, but it

was reported by him verbally that the insured was not providing the duly-

completed claim form nor the cash-memo/ bills of repair; however, the said

surveyor submitted his report on 15.01.2003, wherefrom it is evident that the

insured provided the necessary papers along with the duly-completed claim form

on 05.01.2003, and after receipt of the same from the surveyor submitted his

report;

d) Sri Rakesh Kumar Mishra, investigator, was deputed to verify the cash memo/ bills

of M/s Computech Orbit and Xerox Modicrop Ltd, submitted by the insured,

whereto the investigator didnt find the said firms at the addresses printed in their

bills/ cash memos, as such the investigator wrote a letter to the insured on

11.11.03, and requested the insured to give their correct address so that the

investigation could be completed soon;

e) in response to the aforesaid letter written by the said investigator, the insured

wrote a letter on 18.11.2003, wherein it was asserted that M/s Computech Orbit,

S.K.Market, Aghoria Baszar, Muzaffarpur, and Xerox Modicrop Limited, Sone

Bhawan, 1st floor, Beerchand Patel Marg, Patna, were good firms in computer and

Photostat machines, but now they are closed;

f) That the said investigator, later found that the referred Xerox Modicrop Ltd, has

shifted from Sone Bhawan to Boring Road, and is running there, whereto he

inquired about the bill No. 199 submitted by the insured, which was denied by the

said firm, in writing;

g) the said investigator, wrote a letter to the insured on 24.11.03, to the above

effect, wherein it was also written that the other shop, M/s Computech Orbit has

no whereabouts, rather there is no such firm registered in Sales Tax either, and

other shop keepers in that vicinity too expressed their ignorance regarding the

said Computech Orbit. The investigator further requested the insured to advise

satisfactorily so that the claim could be settled;

h) the investigator, Sri Rakesh Kumar Mishra, submitted his report dated 20.02.2004,

received in the office on 23.02.2004, wherein it was submitted that the said

Computech Orbit was non-existent, whereas the Xerox Modicrop Ltd. had written

that the said bill no. 199 was not a bill rather the same was merely a quotation,

hence the same is false;i) after receipt of the said Investigator Report, and after perusal of the same, the

claim of the insured was found as NO CLAIM as the cash memo and bill found

false and fabricated as per Investigator Report. and a letter with above contents,

was sent to the insured on 11.03.2004;

j) in view of the aforesaid facts and circumstances, the complaint leveled by the

complainant is completely false and fabricated, which has nothing to do with the


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true states of affairs, as such the complaint is not maintainable, and the same is

fit to be dismissed.Decis io n : We find that the dispute involves veracity of two documents submitted bythe complainant as evidence of expenses incurred. This office does not haveinfrastructure to verify and comment on the veracity of these documents. In herrepresentation to the insurance company as well as in her complaint to this forum, the

complainant stated that M/s Computech Orbit was financed by P NB and that it wasinsured by the same Insurer. The insurance company did not examine and comment onthe complainants such claim. Moreover, the surveyor confirmed having discussed theloss with the representative of Computech Orbit on 16.10.2000. In the circumstances,the insurance company should verify the position. If they fail to establish thecomplainants claim as incorrect, they should pay the amount against the said bill,subject to surveyors recommendation. As regards the invoice of Xerox Modicorp, thecomplainant should furnish to the insurance company separate document in support ofher actually having incurred the expenditure, as the shop themselves have confirmedthat it was only a quotation. In view of the above, the insurance company weredirected to conduct the above review exercise within one month from the date ofreceiving the consent letter from the complainant.

Fire Insurance-case Study

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