NCDRC Imposes Costs on Insurance Company for Concealment of Material Facts

Shivani Thakur

Published on: June 6, 2022, at 17:10 IST

The Insurance Company deliberately tried to conceal the separate report supplied by the Surveyor detailing the cause of fire and did not file it along with the Appeal. According to a Bench consisting of Justice C. Viswanath, Presiding Member, and Ram Surat Ram Maurya, Member.

‘Repudiation of the insurance claim on the grounds that the Complainant submitted a fraudulent claim was not justified’, according to the Bench.

The complainant in this case is a sole proprietorship engaged in the business of plastic reprocessing. National Insurance Company is the appellant. The fire started when the factory’s store of plastic caught fire, and it quickly spread. Mr. Thombre was dispatched by the Insurance Company as a Surveyor to inspect the factory premises. The Complainant’s claim was denied by the Insurance Company because it was a bogus claim.

The claim was denied by the Insurance Ombudsman. A grievance was filed with the State Commission, and the opposing party was ordered to pay interest.

The appellant, who was dissatisfied with the State Commission’s judgement, filed an appeal with the National Commission under Section 19 of the Consumer Protection Act of 1986.

The appellant argued before the National Commission that the State Commission failed to recognize that the Complainant’s allegation was bogus.

It was claimed that the Maharashtra State Electricity Board’s report revealed that there was no explosion in the transformer and no fire in the Complainant’s plant.

According to the respondent, the Appellant had not filed any documents to prove that the Complainant’s claim was false.

The aforesaid report is a vital document on which the entire case rests. It appears that the Insurance Company deliberately tried to conceal the separate report submitted by the Surveyor regarding cause of fire and did not file the same along with the Appeal.”

“The same was filed only on 06.07.2017, after direction of this Commission dated 06.06.2017. There is, thus, clear concealment of material fact on the part of the Insurance Company. Repudiation of the insurance claim on the ground that the Complainant filed a fraudulent claim was certainly not justified.” The Bench stated.

The Court concurred with the State Commission’s conclusions and found that the Appellant had omitted important facts.

The Appellant was ordered to pay a cost of Rs. 50,000/– within two months of the order’s date.

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