Dear (s)
My
comments on the landmark Apex court verdict was circulated to my friends group
during June 2009. Here it is placed on my blog for sharing my knowledge
and for inviting views of Experts.
Insurance
Companies for ages have fairly established procedure. The items insured and
claimed for, are varied and will include Automobiles, Buildings, machinery,
stocks of various commodities and the like. Whenever a loss is reported, a Loss
adjuster (Surveyor as he is popularly known in India) is deputed who assesses
the loss and issues Report known as Survey Report which forms the basis of
consideration or otherwise of the claim. Surveyors are independent
professionals who assess the loss or damage and serve as a link between the
insurer and the insured. They play a very crucial role between the insured and
the Insurer. In India,
the surveyors are licensed and procedurally regulated by IRDA. The surveyors
have to satisfy the requirements of Sec 64UM of Insurance Rules 1939 read with
section 42D of the Act and rule 56A. In general they are to posses technical
qualifications as specified by the Authority, undergo practical training, apply
and hold the licence.
The
Insurance Regulatory Authority IRDA formulated Insurance Surveyors & Loss
Assessors (Licencing, Professional Requirements and Code of Conduct) Regulations,
2000) which regulate the licensing and the work of surveyors. These regulations
stipulate that the surveyor shall investigate, manage, quantify, validate and
deal with losses arising from any contingency and carry out the work with
competence, objectivity and professional integrity by strictly adhering to the
code of conduct expected of them. Some of the duties and responsibilities of
them are :
v Declaring whether he
has any interest in the subject matter in question and whether the loss
pertains to any of his relatives, business partners or through material
shareholding.
v Maintaining
confidentiality and neutrality without jeopardising the liability of the
insurer and claim of the insured;
v conducting inspection
and re‐inspection of the property in question suffering a loss;
v examining, inquiring,
investigating, verifying and checking upon the causes and the circumstances of
the loss in question including extent of loss, nature of ownership and
insurable interest;
v estimating, measuring
and determining the quantum and description of the subject under loss;
v commenting on the
admissibility of the loss as also observance of warranty conditions under the
policy contract;
v assessing liability
under the Policy, recommending applicability of depreciation, commenting on
salvage and its disposal etc.,
Surveyors
are required to submit their report as expeditiously as possible, but not later
than 30 days of their appointment.
In
a recent ruling, the Apex Court
held that the compensation fixed by the Surveyor deputed is not binding on the
Claimants or the Insurance Companies. Quite often Courts have interpreted the
Policy and its conditions in favour of the complainants and some times pass
strictures also. In a path breaking judgment recently , the Apex Court chided the Insurers for
spending public money unnecessarily. This assumes significance as in most cases
the compensation as spelt out in the Survey Report forms the basis of the
settlement made by the Insurers.
Here is something
from the pronouncement by the Supreme Court of India in Civil Appeal no. 3253 of
2002 .
The
facts of the case are that by special leave, New India challenged the order
passed by the National Consumer Disputes Redressal Commission dismissing the
revision petition filed against the earlier order. The District Forum,
Uttarkashi had directed the Insurers to pay a sum of Rs.158409/- along with interest at the rate of 12% per annum to the
respondent Pradeep Kumar in a claim for damages to the Open body truck insured
with New India. The truck loaded with potatoes met with an accident in Sept
1998 and had fallen down into khud 300 ft below the road. The Insured had filed
the petition before the Forum citing deficiency in service by the Insurers.
The
Insurers had the vehicle surveyed by Manoj Kumar ( spot survey) and upon
submission of repair estimates by Vivek Arora. Not satisfied with the report of
Vivek Arora, the vehicle was surveyed again by another approved surveyor B.B.
Garg who estimated the damages at Rs.63,771/- . The claim was accordingly
approved but the Insured refused to accept this amount and took to Forum. The
District Forum held that there was deficiency in service and ordered them to
pay Rs.158409/‐ along with interest at the rate of 12% p.a.
with cost of Rs.1000/- The Insurers appealed without avail in the State
Commission. The concurrent order was challenged in National Commission where
also they failed. In the Apex court, the Counsel for Insurers heavily relied
upon Sec 64 UM (2) of the Insurance Act 1938 that the loss assessed by the
approved surveyors appointed in view of the provisions of Section 64-UM was
binding, more so, in the absence of any evidence on record to establish that
the loss assessed by the approved surveyors was not correct and justified.
There were other grounds such as repairs conducted prior to approval and that
Insurers are not liable to indemnity for new parts.
The
impugned section reads that “ No claim in respect of a loss which has occurred
in India and requiring to be paid or settled in India equal to or exceeding
twenty thousand rupees in value on any policy of insurance, arising or
intimated to an insurer at any time after the expiry of a period of one year
from the commencement of the Insurance (Amendment) Act, 1968, shall, unless
otherwise directed by the Authority, be admitted for payment or settled by the
insurer unless he has obtained a report on the loss that has occurred, from a
person who holds a license issued under this section to act as a surveyor.
The
Act further states “ Provided that nothing in this sub-section shall be deemed
to take away or abridge the right of the insurer to pay or settle any claim at
any amount different from the amount assessed by the approved surveyor or loss
assessor. The accident itself
was not disputed and vehicle had indeed suffered damages. The surveyors had
affirmed that the damages were in conformity with the description of the
accident mentioned in the claim form. The spot survey report was not filed and
some strong remarks were made on this. As against estimate of Rs.166580/-,
Vivek Arora assessed the loss at Rs.59304/- and the assessment of BB Garg was
marginally more.
The
Court observed that the object of the proviso is that the claim in respect of
loss required to be paid by the insurer is Rs.20,000/- or more, the loss must
first be assessed by an approved surveyor ( or loss assessor) before it is
admitted for payment or settlement by the insurer. However, the Insurer may
settle the claim at any amount or pay the insured any amount different from the
amount assessed by the approved surveyor. In other words although the
assessment of loss by the approved surveyor is a pre-requisite for payment or
settlement of claim of twenty thousand rupees or more by insurer, but surveyor-s report is not the last and final word. It is not that
sacrosanct that it cannot be departed from; it is not conclusive. The approved
surveyor’s report may be basis or foundation for settlement of a claim by the
insurer in respect of the loss suffered by the insured but surely such report
is neither binding upon the insurer nor insured.
The
Court concluded that the claim of the complainant had been accepted by the
Consumer Fora as duly supported by original vouchers, bills and receipts.
Taking into consideration such expenses as also the interest the complainant
had to pay to the bank from which the loan was obtained, the Dist forum awarded
Rs.158409/- alongwith interest. The Court observed that the Insurers had not
objected to the interest paid by the complainant to the bank being awarded and
had not raised this issue before the National Commission.
The
Apex Court upheld the earlier decision of the Commission and stated that the
present appeal was devoid of any substance and went on record that Insurance
Company would have been well advised in not spending public money on avoidable
and wholly frivolous litigation.
Stating
thus Honble Judges DK Jain & RM Lodha dismissed the appeal. As has been
there are lessons to be learnt and this judgment has thrown open some new
perspectives, especially for the Insurers. Look forward to your feedback…..
With
regards - S Sampathkumar