1. This complaint has been filed praying for indemnification of an amount for suffering the loss of stocks of paddy purchased by the complainant that was allegedly badly affected and suffered damage due to heavy rains in July/August, 2011. The allegation is that on a couple of days in July unexpected stormy winds and heavy rains that has been certified by the Tehsildar, Nawabpet, Telangana had actually affected a huge amount of paddy for which an insurance coverage was available that was acquired from the Opposite Party - Insurance Company and was in force for the duration 16.06.2011 to 15.06.2012.

2. According to the complainant, they had intimated the Insurance Company on 04.08.2011. This intimation has been vehemently denied by the Insurance Company with which we shall deal later on and the Insurance Company did not process the claim at all on the ground, that as a matter of fact neither any claim was intimated in writing within time nor any details of losses were given and as such on account of non-intimation, there was a breach of clause 6 (i) of the General Conditions. The Insurance Company has therefore pleaded in its reply that the claim cannot be entertained. The complainant moved an application under Right to Information Act making a request to provide information about the reasons for rejection or otherwise of the claim, to which the Insurance Company replied on 18.11.2014 stating that since the claim was not reported therefore the claim was not entertainable.

3. The complaint was accordingly instituted in December, 2014 and after removal of defects and certain amendments regarding the status of the complainant, notices were issued and served on 14.09.2015. Mr. Amit Kumar Singh, learned counsel had appeared and the right of the Opposite Party to file a reply was closed vide order dated 08.12.2015. The order dated 08.12.2015 is extracted herein under: -

                   "The opposite party is reported to have been served on 14.09.2015 and there is appearance on its behalf. Reply atongwith documents, if any, be filed within three weeks from today. Rejoinder aiongwith documents, if any, can be filed within two weeks thereafter. The parties shall also file affidavits admitting/denying the documents of their respective opponents within eight weeks from today.

                   List this complaint for directions on 08.12.2015."

4. The said order was assailed before the Supreme Court in Civil Appeal No. 1889/2016 which was disposed of with a cost of Rs.2,00,000/- on the Insurance Company permitting the filing of the written statement. The order passed by the Apex Court on 20.07.2018 is extracted herein under: -

                   "Having heard learned counsel for the parties, it is directed in the cause of justice that the appellant in Civil Appeal No. 1889/2016 the United India Insurance Company Limited, shall deposit a sum of Rs.2,00,000/-(Rupees two lakhs only) before the National Consumer Disputes Redressai Commission, as per this Court's order dated 6.7.2017, within two weeks, failing which the right to file written statement shall stand forfeited.

                   M.A. No. 1812/2018 is accordingly disposed of."

5. The response was accepted in terms of the order of the Apex Court.

6. The amount was deposited on 02.08.2018 before this Commission and was directed to be released to the complainant. A further order was passed on 20.05.2019 which is extracted herein under: -

                   "IA/7226/2019 (C/delay)

                   The delay is condoned. The application stands disposed of.

                   CC/562/2014

                   The complainant has not filed affidavit by way of evidence. Be filed within six weeks. The complainant has filed some additional documents without seeking permission for this purpose. The said documents are taken on record with liberty to the OP to file additional documents in rebuttal. The OP is also permitted to verify the affidavit of the Sarpanch which the complainant has filed as a part of the additional documents. The original affidavit shall be filed by the complainant within four weeks.

                   The OP shall file its affidavits by way of evidence within six weeks of the complaint complying with this order. The OP shall also be entitled to cross-examine the Sarpanch if it so desires.

                   List for directions on 25.10.2019."

7. The matter could not be taken up thereafter and the Covid intervened. The evidence affidavit was filed thereafter. The case was adjourned on one count or the other and was finally heard by us on 07.01.2026 when Mr. Raghu learned Senior Counsel advanced his submissions on behalf of the complainant and Mr. Amit Kumar Singh for the Insurance Company. Learned Senior Counsel for the complainant has proceeded to argue the matter with the aid of a convenience compilation filed on 24.06.2024 and has substantiated his submission with regard to the contentions raised by him while pointing out towards pleadings in the complaint.

8. According to the complainant after intimation was given a person by the name of Rajesh Kumar stated to be a Surveyor of the Insurance Company did make a visit but he did not turn up thereafter and in spite of repeated intimations neither any survey was conducted nor any assessment was made as a result whereof the complainant moved an application under Right to Information Act before the United India Insurance Company seeking information that was responded to by the letter dated 18.11.2014 which is extracted herein under: -





9. Mr. Raghu pointed out that the only intimation given with regard to the processing of the claim is contained at Serial No.9 which recites that the claim by the complainant was not reported.

10. This being the only reason for not considering the claim or processing it, Mr. Raghu urges that this is a clear violation of the provisions of the Insurance Act, 1938 and IRDA Regulations inasmuch as an insurance claim has to be processed with the appointment of a Surveyor and accordingly considered by the Insurance Company that has completely ignored the same and simply intimated that the claim was not reported. This is an absolutely incorrect and false ground inasmuch as the complainant had tendered the first intimation on 04.08.2011 and the said intimation was duly received by the Insurance Company and the said letter also bears the seal and receipt of the Insurance Company to that effect. The letter dated 04.08.2011 is extracted herein under: -



11. It is alleged by the complainant that on 15.09.2011 a second reminder was sent intimating the incident and a copy of the said application that was also received is extracted herein under: -



12. The seal of the Insurance Company is available on the said application which is followed by a third reminder on 28.12.2011 and fourth reminder on 28.04.2012 which also bear the seal and receipt of the Insurance Company, which are extracted herein under: -



13. It is also urged that the intimation was also given by the complainant to the bankers, namely, the State Bank of Hyderabad on 06.08.2011, a copy whereof was supplied to the complainant by the Bank under the Right to Information Act dated 10.01.2015. The said letter dated 06.08.2011 stated to have been sent to the Bank which also bears a seal and receipt of the Bank is extracted herein under: -



14. The complainant had also despatched a letter to the Assistant General Manager of the Andhra Pradesh State Financial Corporation Ltd., Membubnagar on 05.08.2011 requesting the Corporation for raising an insurance claim. The said letter is extracted herein under:-



15. It is therefore submitted by the learned Senior Counsel that the complainant had intimated the Insurance Company which failed to respond in accordance with law and therefore there is a clear deficiency on the part of the Insurance Company in not having processed and assessed the claim of the losses of paddy that was secured under the policy acquired from the Opposite Party.

16. Questioning the correctness of these arguments, the Insurance Company has filed its written statement denying each and every allegation of the alleged sending of letters. Mr. Amit Kumar Singh, learned counsel for the Insurance Company has invited the attention of the Bench to the reply filed and the preliminary objections taken therein. Paragraphs- 1 to 10 of the preliminary objections taken are reproduced herein under: -















17. Relying on the same, Mr. Amit Kumar Singh further contended that the only communication which was sent about which proof has been filed by the complainant is almost after three years to the Regional Manager of the United India Insurance Company at Hyderabad which is the letter dated 16.10.2014 that was sent by speed post. The same is extracted herein under.-



18. He submits that all other alleged communications are manipulated and there is no proof of any contact having been made by the complainant with the Insurance Company. He then submits that the complainant was communicating with the State Bank of Hyderabad in the year 2012 regarding his bank accounts, loans and other financial transactions but the contention that a letter was sent to the Bank on 06.08.2011 was enquired into by the Opposite Party - Insurance Company through the letter dated 09.11.2015 sent to the Branch Manager of the Bank. The Chief Manager of the Main Branch, Mehbubnagar who is stated to have received the said intimation from the complainant responded through the letter dated 16.11.2015 clearly stating therein that there was no intimation from the customer to the Branch regarding loss. The said letter is extracted herein under: -



19. Mr. Singh submits that in fact the complainant after was proceeded with by the Bank for recovery seems to have manipulated documents and then started seeking information about his alleged letters which were never received by the Bank and seem to have been manipulated by the complainant to suit its own purposes. It is pointed out that the claim was not intimated within 15 days of the loss or within a reasonable period thereof and the claim could not have been entertained beyond the period of 12 months. For this, he has once again read out clauses 6 (i) & (ii) of the terms & conditions of the policy that have already been extracted in the reply and has been quoted hereinabove. He therefore submits that the claim was absolutely fake and the report of the Tehsildar indicating rainfall is dated 12.09.2014 obtained after three years of the incident. The said report is extracted herein under: -



20. The said information in turn has been provided under the instructions of the Revenue Divisional Office and indicates the rainfall was in millimetres in the month of July & August, 2010-2011-2012. The contention raised is that this does not establish anything regarding the stocks having been damaged on any date in July as alleged and it is not understood as to why the complainant waited till 04.08.2011 to despatch the alleged letter of intimation which has been denied by the Insurance Company. Mr. Singh therefore submits that the entire claim is fake and false which was never intimated and was set up after the Bank had proceeded against the complainant for its dues.

21. He further submits that such devious methods which have been adopted on the basis of the fake documents cannot be examined in the summary jurisdiction of this Commission and therefore even otherwise since seriously disputed questions of fact are involved the complaint cannot survive to be examined by this Commission.

22. We have considered the submissions raised and we have carefully perused the pleadings as also the allegations and counter allegations including the rejoinder filed by the complainant.

23. So far as the intimation to the Bank is concerned, we find that the Bank on the one hand has given a copy of the application dated 06.08.2011 to the complainant but on the other hand has written a clear letter to the Insurance Company that it had no records or any intimation about the incident or claim with the Insurance Company. The letter of the Bank dated 16.11:2015 has already been extracted hereinabove. In view of these contradictions and the fact that the Bank is not a party to these proceedings, we cannot disbelieve the letter dated 16.11.2015 which has been brought forward through the reply of the Insurance Company and no further attempt has been made to contradict the said document by seeking any further information from the Bank. In the absence of any such cross check attempted by the complainant on the basis of what has been stated above, we find that the stand of the complainant that the intimation was also sent to the Bank cannot be accepted.

24. Coming to the claim raised before the Insurance Company, we fail to understand as to why the complainant instead of the alleged letters in 2011 and 2012 did not rake up the issue with any higher authority of the Insurance Company and straightaway rose in the year 2014 writing a letter to the Insurance Company to give information under the Right to Information Act. As stated above, the Insurance Company has clearly denied having received any such letters and has described them to have been faked by the complainant. No other proof has been filed by the complainant nor any approach to the Insurance Company seems to have been made for almost two years and therefore we find that the Insurance Company is justified in relying on clauses 6 (i) & (ii) of the terms & conditions to deny their liability.

25. The promptness of the complainant being a sine qua non in such matters within a reasonable period is lacking in this case. The policy is required it to be intimated within 15 days but on the facts of the present case the same has not been proved by the complainant and with the denial of the Insurance Company, the same has not been established. Apart from this, a claim beyond 12 months even otherwise cannot be entertained in view of the terms & conditions of the policy. We, therefore, find force in the submission of Mr. Amit Kumar Singh that the complainant has set up this claim after having faced financial problems due to his accounting problems with the Bank.

26. There is nothing on record to indicate that the Bank that also had an endorsement on the insurance policy had ever attempted to communicate with the Insurance Company for any such claim. The contention of the complainant that he had also intimated the Andhra Pradesh State Financial Corporation for raising an insurance claim is nowhere established as there is nothing on record to indicate that the State Financial Corporation had intimated the Insurance Company regarding the loss or claiming any insurance indemnity.

27. On an overall consideration of the entire material on record, we are satisfied that the Insurance Company had appropriately replied to the complainant about no claim having been reported. In the given circumstances it is the complainant who has breached the terms & conditions of clause 6 (i) & (ii) of the policy and therefore no deficiency is established against the Insurance Company. The claim therefore has no merit and is accordingly rejected without prejudice to the rights of the complainant to approach any other forum for redressal of its grievances.