KHODAL COTTON PROCESSING PVT. LTD. Vs. NEW INDIA ASSURANCE COMPANY LIMITED
Khodal Cotton Processing Pvt. Ltd.
NEW INDIA ASSURANCE COMPANY LIMITED
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DINESH SINGH, J. -
(1.) Taken up in physical hearing.
Heard learned Counsel for the Complainant.
Perused the entire material on record.
(2.) The Complaint relates to repudiation of insurance claim(s).
(3.) It is seen that this matter requires adjudication of issues that involve disputed factual questions, inter alia regarding 'adoption' of 'fraudulent means' for 'undue benefit'.
For ready appreciation of the facts and specificities of the matter, the following is reproduced here (without in any manner making any observation of any nature thereon):
The Surveyor, in para 5.2.7 of its Report dated 23.09.2018, has concluded that:
Hence from all above evidences, we are of an opinion that the cause of Fire was not found of an unforeseen nature and an accidental one but the said Fire seems to be mysterious one having fraudulent means or devices used by the insured or any one acting on his behalf to obtain undue benefits under the caption policies.
In para 10.0 of its Report, the Surveyor has observed that:
From the details/documents submitted by the insured &/or received/available with us &/or our notifications and notifications/conclusion of Truth Labs and PGVCL reports, we are of an opinion that this claim is not admissible under the terms and conditions of the involved Std. Fire and Special Perils policy possessed by the insured as under:
The insurance company (Opposite Party No. 1), in its repudiation letter dated 06.05.2019, has inter alia stated that:
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The surveyor congregated the material information from the insured as well as from the documents submitted by the insured and completed the survey and issued a survey report with the significant observations. Upon perusal of the said report it can be inferred that the insured has failed to prove that the fire took place due to perils insured under the policy. It was observed that the insured could not submit any justifiable explanation/details proving the cause and origin of the claimed fire as an unforeseen nature and accidental one inside the closed godown.
The surveyor has additionally indicated that the insured has not provided all the relevant and material information as sought for by the surveyor during his survey.
It is observed by the surveyor, considering the documents provided by the insured as well as the information gathered by him, that the cause of fire was not due to the broken electric line which passes from the back side of the affected premises as the said wire was manually cut and there was no electric current at the time of alleged incident.
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If the claim be in any respect fraudulent, or if any false declaration be made or used in support thereof or if any fraudulent means or devices are used by the Insured or any one acting on his behalf to obtain any benefit under the policy or if the loss or damage be occasioned by the willful act, or with the connivance of the Insured, all benefits under this policy shall be forfeited."
In light of the above, based on the survey report as well as the terms and conditions of the insurance policy issued to you, the subject claim lodged by you is not admissible and hence the competent authority has repudiated the same and hereby absolve our liability, under the subject policy, arising out of this claim, which you may please note.
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(emphasis supplied) ;
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