Fire Insurance Policy

Bhubneshwar Ombudsman Centre Case No. I.O.O./BBSR/11 005-0034 Sri Rabindra Nath Sarkar Vs. Oriental 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 Sri Ranjit Singh Saluja Vs. New India Assurance Co. Ltd. Award Dated 3.6.2006
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 surveyor assessed 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

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 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.

Bhubneshwar Ombudsman Centre Case No. I.O.O./BBSR/14002-0058 Sri Narendra Singh Saluja Vs. New India Assurance Co. Ltd. Award Dated 3.7.2006
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 memos and 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 Ombudsman Centre Award No. 11.02.1280 / 2006 - 2007 Smt. Usha Rani Vs The New India Assurance Co. Ltd. Award dated 13.06.2006
The complainant stated 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.

The insurer represented that the claim of loss was settled for Rs. 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 Ombudsman Centre Award No. 11.04.1036 / 2006 - 2007 Shri. S. Krishnamohan Vs United India Insurance Co. Ltd. Award Ddated 21.06.2006
The complainant represented that he had taken a Fire Policy for his house with M/s United India since 1990 and the policy was renewed as Standard Fire and Special Perils Policy 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.

Guwahati Ombudsman Centre Case No. 11-005-0085/05 Md. Jahan Uddin Ahmed Vs Oriental Insurance Co. Ltd. Award Dated 28.04.06 Facts leading to grievance 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

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

Counter-statements from opp. party/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.

Decision & 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.

Guwahati Ombudsman Centre Case No. 14-004-0112/05 Shri Mangilal Sharma Vs United India Insurance Co. Ltd. Award Dated 11.05.06 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. Decision & Reasons : On perusal of the available materials in the file there was no
damage 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

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 report
prepared 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.

Guwahati Ombudsman Centre Case No. 11-002-0118/05 Md. Sahab Uddin Vs The New India Assurance Co. Ltd. Award Dated 16.05.06 Brief Facts leading to complaint: 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). Opponents views : 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 suffered loss. 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/-.

Decision & 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 Fire 30x40 ft. used as grocery shop under the name & style of M/s Saha and grocery goods, Electrical Goods. Show case, Geg, Etc. 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.-

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/ Investigator Findings 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. ..hence we find it is of no use of pending the file with interested in the claim as compliance. Hence we finally Assessment. Recommended as us where insured is not reflected from his nonreturn the file with NIL NO CLAIM.

2.

P.Purkayastha & Associates.

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. Hence cause of fire is not established and loss of materials is also not proved. (Statement of witnesses examined enclosed). 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.

4.

Sri Jayanta Moni Dadhara

5.

Sri Aswini Sarma

It will be significant to reproduce the further observations and findings of Sri A. Sharma as follows ii) iii) iv) Plinth 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. The building was illuminated by other than electricity & hence there was no scope of fire by any electrical accident, etc. 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.

v)

On enquiry & careful inspection by the undersigned, it was observed that the affected premises was a godown of the insured & not used as a shop. But, as the policy, the sum insured coverage is against the shop premises only but the godown & hence the loss claimed by the insured is not admissible as policy condition.

fire per not per

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. 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. 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.

vii)

viii)

Order : We find no merit in the complaint. The complaint is dismissed on contest. Guwahati Ombudsman Centre Case No. 11-011-0045/06-07 Binondra Ch. Gogoi Vs Bajaj Allianz General Insurance Co. Ltd. Award Dated 13.09.2006 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. Discussion & Findings : 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 / Order : 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.nageshwara Rao

Vs New India Assurance. Co. Ltd. Award Dated 23.05.2006 Complaint Partly Admitted : 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 period 10.03.2005 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 National Insurance Co.Ltd. Award Dated 26.9.2006
The complaint under Rule 12(1)(b) read with Rule 13 of the RPG Rules, 1998 relates to repudiation of a fire-claim by the respondent insurer under Shop Keepers Policy 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

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 Agrawal Vs. United India Insurance Co. Ltd. Award Dated 29.05.06 Facts & Submissions : 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.

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; 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 dulycompleted 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; 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; 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, 1 s t floor, Beerchand Patel Marg, Patna, were good firms in computer and Photostat machines, but now they are closed; 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; 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; 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; 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; 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

c)

d)

e)

f)

g)

h)

i)

j)

true states of affairs, as such the complaint is not maintainable, and the same is fit to be dismissed. Decision : We find that the dispute involves veracity of two documents submitted by the complainant as evidence of expenses incurred. This office does not have infrastructure to verify and comment on the veracity of these documents. In her representation to the insurance company as well as in her complaint to this forum, the complainant stated that M/s Computech Orbit was financed by PNB and that it was insured by the same Insurer. The insurance company did not examine and comment on the complainants such claim. Moreover, the surveyor confirmed having discussed the loss 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 the complainants claim as incorrect, they should pay the amount against the said bill, subject to surveyors recommendation. As regards the invoice of Xerox Modicorp, the complainant should furnish to the insurance company separate document in support of her actually having incurred the expenditure, as the shop themselves have confirmed that it was only a quotation. In view of the above, the insurance company were directed to conduct the above review exercise within one month from the date of receiving the consent letter from the complainant.