Order Name: Dayaram Meena Vs. United India Insurance Co. Ltd.
Case No.: F.A. No. 429/2017
The National Consumer Disputes Redressal Commission, led by Justice Sudip Ahluwalia, has ruled that insurers cannot deny a valid claim based on mere assumptions.
Case Background
The complainant had insured 400 trolleys of mustard husk for Rs. 21,00,000 with United India Insurance and paid a premium of Rs. 12,514. After a fire broke out, the complainant informed the insurer’s agent, who advised contacting the fire brigade and police. Despite notifying the insurer and sending a legal notice, no immediate action was taken. Eventually, the insurer conducted a survey but did not pay the claim. The complainant then approached the State Commission of Rajasthan, which partially upheld the complaint. The State Commission directed the insurer to pay Rs. 1,00,000 with 9% interest from the date of the complaint, plus Rs. 10,000 for mental agony. The Commission rejected the insurer’s claim that the fire was due to self-combustion, validating the survey report. Unsatisfied, the complainant appealed to the National Commission.
Insurer’s Arguments
The insurer stated that upon being notified of the fire, a surveyor was appointed. The surveyor found that the complainant did not provide complete documents for the mustard husk, only a purchase agreement. The complainant attributed the fire to spontaneous combustion, which is excluded under the policy. The insurer claimed the complainant did not challenge the surveyor’s findings or deny the spontaneous combustion. They referred to an article stating that spontaneous combustion without ignition does not qualify as fire under the policy. The insurer criticized the State Commission for not addressing the surveyor’s findings and dismissing the spontaneous combustion defense without sufficient evidence. They also accused the complainant of fabricating documents and failing to provide purchase and sale bills or proof of the mustard husk’s quantity and cost.
National Commission’s Observations
The National Commission noted that the insurer relied on a statement from the complainant suggesting the mustard husk might have caught fire due to internal heat, implying self-combustion. However, the Commission found this statement insufficient to reject the claim entirely, considering it speculative. The delayed visit of the surveyor and the winter timing, which made spontaneous combustion unlikely, were also considered. The Commission found the complainant’s statements and affidavits insufficient to prove the burning of 40-50 trucks of mustard husk valued at Rs. 30 lakhs. The lack of specific documentation, such as receipts or vouchers, weakened the claim. The rental receipts and other documents provided were not close enough to the date of the fire to reliably assess the quantity of mustard husk burned.
The National Commission upheld the State Commission’s decision with modifications, assessing the compensation at Rs. 1 lakh.
Takeaway
This judgment underscores the importance of insurers not rejecting claims based on mere speculation. It also highlights the necessity for complainants to provide thorough documentation to support their claims.
