Nilesh, a businessman took a fire insurance policy to cover stocks of oil seeds, oil cakes, etc., in a godown of Class I construction located behind Vile Parle Market, Mumbai for a sum insured of ₹7 lakh against fire wit
CS Professional · Insurance - Law and Practice · PYQS · June 2015
Nilesh, a businessman took a fire insurance policy to cover stocks of oil seeds, oil cakes, etc., in a godown of Class I construction located behind Vile Parle Market, Mumbai for a sum insured of ₹7 lakh against fire with riot and strike cover with ABC Insurance Company Ltd. for the period 15th May, 2014 to 16th May, 2015. The insured remitted ₹1,255 through account payee cheque to the insurer as premium for the coverage. The cheque was acknowledged by the insurer and a cover note for the sum insured of ₹7 lakh was issued against fire with riot and strike coverage on 19th May, 2014 (17th and 18th May, 2014 being Saturday and Sunday). The cover note covering the risk in question was duly delivered to Nilesh on 20th May, 2014 by an authorised representative of the insurer. The cover note whilst describing the property in brief also indicated "Subject to terms, conditions and exceptions of the standard fire policy." The policy however was not released by the insurer. Unfortunately, on 22nd June, 2014, a fire occurred in the godown and resulted in damage to a part of the oil seeds and oil cakes. The fire brigade was summoned and the fire was put out after considerable effort. But by that time, a substantial portion of the insured's stocks had suffered damages. The insurance company upon receipt of intimation, deputed a senior fire surveyor to carry out inspection and assessment of damages. The surveyor after detailed inspection and verification of records assessed the damages to the tune of ₹3.40 lakh on account of 'spontaneous combustion'. The report was submitted to the insurer on 25th July, 2014. The insured, Nilesh, took-up the matter with the insurance company for compensation. The ABC Insurance Company Ltd. however on the basis of surveyors findings informed the insured that spontaneous combustion was an excluded peril under the standard fire policy and hence the insurance company could not admit its liability under the claim. This decision of the insurance company was conveyed to the insured in writing on 6th August, 2014. Being not satisfied with the decision of the insurance company, the insured, Nilesh took-up the matter with the 'consumer forum' for redressal stating that the cover note issued to him did not have a stipulation that 'spontaneous combustion' was an excluded peril under the standard fire policy and in the absence of such a condition, his rightful claim for compensation cannot be rejected by the insurer. Moreover, the policy too had not been released by the insurer even after a month and hence the claimant was completely in the dark with regard to terms, conditions and exclusions of a standard fire policy. The insured, therefore, cannot be penalised for 'no fault of his own'. The insured further contended that there was 'deficiency in service' on the part of the insurer in not releasing the policy document in time and in keeping the insured fully informed of the coverage. The consumer forum heard arguments from both the parties including those advanced by the respective advocates on both sides. They also questioned the surveyor at length who had carried out loss assessment of the damages sustained by the insured. The consumer forum after due deliberation amongst its members, directed the insurance company to pay the claim to the insured to the tune of ₹3.40 lakh as assessed by the surveyor. The consumer forum further directed the insurance company to pay an additional amount of ₹30,000 for 'deficiency in service' in not releasing the fire policy within a reasonable period of 30 days. Discuss in detail how far the award of the consumer forum is justified in the light of the terms and conditions of the standard fire policy.
Answer & Explanation:
The operative clause of the cover note of fire insurance generally reads as follows: "In consideration of the proposer named in the schedule hereto having, proposed to effect an insurance against fire for the period therein, on the usual terms and conditions of this company and having paid the premium stated in the schedule is hereby insured to the extent of the sum insured mentioned therein". The cover note is made subject to the terms and conditions of the fire policy by the following clause: "The Cover Note is issued pending preparation and issue of a duly stamped policy of insurance and should the terms and conditions of this Company's policy be unknown to the proposer, it shall be incumbent upon him to make application to the company for a copy of such terms and conditions. Failure to comply with policy terms and conditions though the insured being unacquainted with them shall not excuse his failure to act in accordance therewith and by the acceptance of this Cover Note, the proposer binds himself by the terms and conditions of this company's policy." The operative clause of the fire policy provides coverage in respect of fire but excludes damages caused to the insured property by "its own fermentation, natural heating or spontaneous combustion." However, extension endorsement in the fire policy covering spontaneous combustion can be obtained by the insured on payment of additional premium. In the given case the insured failed to make an application to the Insurance Company for a copy of the terms and conditions of the policy. So, it is a failure on the part of the insured and not the insurance company. Ignorance of the terms and conditions of the policy on the part of insured is not an excuse. Moreover, extension endorsement and add on cover for spontaneous combustion is available to the insured only on payment of additional premium by the insured before coverage of the risk. But in this case no such additional premium was paid by the insured to the insurance company. So the insurance company is not liable to pay for the loss due to spontaneous combustion. In view of the above, the award of the Consumer Forum for payment of claim to the insured to the tune of ₹3.40 lakh as assessed by surveyor is not justified.
Topics: Fire Insurance
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