The National Consumer Disputes Redressal Commission pulled up Oriental Insurance Company for its stand that jewellery stolen by burglars from Prabodh J. Kothari's house in Vile Parle (West) belonged to his wife and not him, thus making him ineligible for claim under the insurance policy.
Commission's Presiding Member K.S. Chaudhari and Member Vinay Kumar dismissed the stand taken by the insurance company and said: "We have no hesitation in holding that the decision of the insurance company to exclude the jewellery from the admissible claim is nothing but an act of arbitrariness. It amounts to a deficiency of service."
The burglary took place between July 21-23, 2001.
The loss was Rs.18.16 lakh, which included a claim of Rs.16.96 lakh towards loss of jewellery. The insurance company admitted the claim partly and paid Rs.31,186, forcing Kothari to move a district consumer forum for justice, the complaint said.
The national commission said in its recent order: "From the written response of the company before the district forum, we find that the policy in question itself was called 'house-holder's Insurance policy' covering risk under various heads including fire, burglary and house break-in. It is, therefore, obvious that the insured under such a policy is covered as a 'house-holder' and not just as an 'individual'."
"It is not the case of the insurance company that a house-holder's policy is the same as, and not distinct from, a policy of individual indemnification...(or) that the jewellery items were not included in the proposal for insurance...," Chaudhari said.
"While filling the proposal form and taking the insurance policy, if the complainant has furnished details of the ornaments of his wife, claiming the same as his own, no fault could be found with the same."
"The interpretation of the surveyor that the jewellery items of the complainant's wife did not belong to the complainant, as the insured, was perverse...," the apex consumer court said.
After the complainant's application, the district forum directed the insurance company to pay an additional sum of Rs.13.38 lakh together with interest and compensation.
The Maharashtra State Consumer Disputes Redressal Commission, however, overturned the district forum's decision, forcing Kothari to approach the national commission that has now offered relief to the Mumbaikar.
The state commission took the view that there was delay on the part of the complainant in reporting the theft of jewellery to police. It also said the material placed on record did not bring out any arbitrariness on the part of the insurance company.
"On this issue, we have cited at length the material considered before the district forum. It has noted that though the loss of jewellery was not initially reported, it was in fact added to the police report and was a part of the subsequent investigation," the national commission said.
"This development was within the knowledge of the surveyor, however, for reasons best known to him, he chose not to include the claim in his final recommendation," the national commission said, blaming the surveyor for lapses.