Case: The New India Assurance Co. Ltd Vs. Sri Buchiyyamma Rice Mill and Anr

3. The first respondent has a rice mill situated in East Godavari District of Andhra Pradesh. The claim of the first respondent was in terms of three standard fire and special perils insurance policies, to cover specified risks in respect of plant and machinery, the building, the godowns, stock of rice, paddy, and the boiling units in the year 2004-2005. On 19 April 2005, the first respondent reported that while the rice mill was in operation, a lorry which was in the process of reversing, collided with the boiler unit, as a result of which the boiler unit collapsed in its en- tirety together with sixteen storage tanks including a paddy bin and an elevator. The damage was estimated at Rs 76 lakhs. A First Information Report was lodged on 21 April 2005, and a telegraphic intimation was furnished to the appellant on the same day. Initially, the appellant deputed Mr V Satya Sai Baba, an insurance surveyor to conduct a preliminary survey of the damage. The report of the prelimi- nary survey was submitted on 25 April 2005 wherein, it was stated that it was un- likely that the incident had taken place in the manner in which the insured had claimed. The survey report indicated several reasons in support of these findings, which are extracted below:1. According to the information given by the lorry driver of ADB7047 while he is reversing the lorry towards the paddy boiling unit he suddenly heard some noise and jumped from the lorry and observed the collapsing of the paddy boiling unit.2. After observing the collapsed paddy boiling unit and alleged impact truck ADB7047 jointly the following observations were clearly observed.a. The alleged impact truck rear portion collapsed boiling unit structures are having reasonable distance, which meansthere is no direct impact of alleged truck and structures. Photo no 10 shows the clear picture.b. A huge MS sheet of the paddy boiling bin is hanging in between the alleged truck and collapsed structure. c. No damages bending or twisting of the back portion of the body of the alleged impact vehicle were found and the body is in good condition.3. The alleged impact truck was found far away from the structure. Hence the structure collapsed due to alleged impact by truck is to be thoroughly investigated. The same was informed immediately to the insurer.4. Based on collapsed structure observations I found the boiling unit columns are flatten like compressed s and not collapsed unevenly. After observing this type of collapse, which might be occurred only during structural failure cases. Hence a structural expert opinion is also required in order to ascertain the real cause of damage. This information was also informed to the insurer immediately.5. The undersigned observed the insured premises of boiling unit area. The majority of the operations carried from other side of alleged impact truck location. The clear axes of loading, unloading and other operations are carrying to boiling unit from that side only. The present alleged impact truck found location was found to be not accessible for the above operation.6. The insured boiling unit was originally designed for 8 bins and extended to 16 bins during 2004 ending. This extension work was carried without proper balancing the structure at full load, which might be the one of the cause of failure of boiling unit structure.7. Total paddy boiling unit structure including tanks was collapsed.8. All boiling tanks were with paddy under process at the time of collapse.(Emphasis supplied)4. The preliminary surveyor had opined that it would be appropriate if a struc- tural expert was called upon to ascertain the real cause of damage. Consequently, a report was submitted to the insurer on 25 November 2006, by Professor K Ram- babu of Andhra University College of Engineering, Department of Civil Engineer- ing, Visakhapatnam. The report of the structural expert indicated that (i) there was no external impact noted on any of the failed columns; (ii) the storage capacity of the system had been breached; (iii) the incident was as a result of exceeding the load carrying capacity of the column section resulting in the collapse of the entire paddy boiling structure. The appellant deputed M/s Surya Teja Associates in order to investigate into the matter. In their report dated 8 December 2006, which was replete with photographs, the investigator arrived at the finding that though the boiling mill was erected in 1999 with a 32 tons capacity, at the time of collapse, the mill was overloaded to the extent of 184.5 tons. An Insurance Regulatory Development Authority(IRDA ) licenced surveyor, Mr V Abbu Rao was also deputed by the insurer to carry out the survey and make an assessment of the losses. The surveyor submitted a final survey report dated 29 June 2007. Based on an evaluation of the nature of damage, the surveyor noted that (i) no external impact or damage to the failed columns had been noted; (ii) the MS sheet of the paddy bin was hanging in between the vehicle and the collapsed structure which belied the claim that the body of boiling unit had collapsed as a result of collision with the lorry. The surveyor concluded with the finding that the boiling tank structure had collapsed due to overload and not due to the impact of a collision with a lorry.5. Based on the report of the surveyor, the insurer repudiated the claim on 15 October 2007. This led to the institution of a consumer complaint before the SCDRC. The SCDRC dismissed the complaint on 16 March 2012. In arriving at this finding, the SCDRC relied upon the following circumstances:(i) In the telegraphic communication addressed on 19 April 2005 by the insured to the insurer, there was merely a reference to the accident without any details of an alleged collision with a lorry;(ii) The appellants complaint was lodged at 9 pm on 29 April 2005, more than two days after the damage to the unit;(iii) If the lorry had collided with the boiler unit with such a great impact as claimed, there would have been extensive damage to the vehicle, but no evidence of any damage to the vehicle had been produced;(iv) The insured had not produced any material evidence to support the plea that injuries had been caused to a worker at the site;(v) Though the incident is alleged to have been videographed, no material evidence had been produced; and(vi) The report of the insurance company surveyor (RW 3) as well as of the Professor in the Department of Civil Engineering (RW 4) indicated that the damage had been caused not as a result of the external impact of a vehicular collision but because the weight of the mill was beyond the load carrying capacity of the column section. The SCDRC also relied on the report of the Chief Investigator (RW 5), who had found that at the time of the incident, the mill was loaded to the extent of 184.5 tons of paddy as against its original capacity of 32 tons.6. The above findings of the SCDRC have been reversed by the NCDRC. In doing so, the NCDRC has come to the conclusion that (i) the report of the surveyor was submitted nearly one and half years after the incident; and (ii) the second survey report was submitted beyond a period of two years. This according to the NCDRC was in breach of the Insurance Regulatory and Development Authority of India (Protection of Policyholders Interests) Regulations 2002, more particularly, Regulation 9, which prescribes a period of thirty days for completion of the survey. Relying on the report of the Inspector of the Factories Department, the NCDRC awarded the respondents claim in the amount of Rs 29,23,503 together with interest.

Court's reasoning:
11. Section 64 UM (1) of the Insurance Act 1938, speaks of licensing of surveyors and loss assessors. In the present case, we are not concerned with sub-section (1). Sub-section (2) mandates that no claim in respect of a loss which has occurred in India and requiring to be paid in an amount equal to or exceeding Rs 20,000 in value on any policy of insurance shall be admitted for payment, unless the insurer obtains a report of a surveyor or loss assessor who holds a license issued under sub-section (1) of Section 64 UM. Sub-section (3) empowers IRDA with the power to obtain an independent report from any other surveyor in respect of a claim of the nature referred to in sub-section (2). Sub-section (4) envisages that the regulatory authority may issue such directions as it may consider necessary on receipt of the report referred to in sub-section (3). The proviso to sub-section (2) reserves to the insurer the right to pay or settle the claim for an amount different from the amount assessed by the surveyor or loss assessor.12. The impugned judgment of the NCDRC has incorrectly analysed the basis by the insurer for the appointment of surveyors for the purpose of inspection and assessment. The record to which we have adverted to earlier would indicate that immediately upon receipt of an intimation of the incident, the insurer initially appointed a surveyor to submit a preliminary survey report. The inspection was carried out on 19 April 2005 close on the heels of the incident. The report of the preliminary surveyor found serious anomalies in the claim of the insured in regard to the genesis of the incident. It was on the suggestion of the surveyor that the appellant obtained an opinion from a structural expert from the Department of Civil Engineering, Andhra University College of Engineering. The insurer thereafter proceeded to obtain the opinion of an investigator on 8 December 2006, and eventually, a final survey report was submitted on 29 June 2007. The purpose of the final survey was to determine, on the basis of the material which had emerged during the course of an inspection the cause of the incident, and to assess the extent of damage and loss.13. In Sri Venkateswara Syndicate (supra), the issue before this Court was whether the insurer can appoint successive surveyors for getting the loss and damage assessed before settling the claim of the insured. The two judge Bench while explaining the purpose of a report of the surveyor observed thus:31. The assessment of loss, claim settlement and relevance of survey report depends on various factors. Whenever a loss is reported by the insured, a loss adjuster, popularly known as loss surveyor, is deputed who assesses the loss and issues report known as surveyor report which forms the basis for consideration or otherwise of the claim. Surveyors are appointed under the statutory provisions and they are the link between the insurer and the insured when the question of settlement of loss or damage arises. The report of the surveyor could become the basis for settlement of a claim by the insurer in respect of the loss suffered by the insured.(Emphasis supplied)This Court held that the report of a surveyor must be given due importance and that there should be sufficient grounds for explaining a disagreement with an assessment made by a report of the surveyor. Yet at the same time, under Section 64-UM(2) of the Insurance Act 1938, it is not open to the insurer to merely appoint a succession of surveyors with a view to obtain a tailor-made report. It is open to the insurer to appoint another surveyor for valid reasons bearing on the deficiencies found in the survey report and the reasons which must be indicated by the insurer. In this backdrop, the two judge Bench while holding that that there is no absolute prohibition on the insurer appointing more than one surveyor observed thus:33. Scheme of Section 64-UM, particularly of sub-sections (2), (3) and (4) would show that the insurer cannot appoint a second surveyor just as a matter of course. If for any valid reason the report of the surveyor is not acceptable to the insurer may be for the reason if there are inherent defects, if it is found to be arbitrary, excessive, exaggerated, etc., it must specify cogent reasons, without which it is not free to appoint the second surveyor or surveyors till it gets a report which would satisfy its interest. Alternatively, it can be stated that there must be sufficient ground to disagree with the findings of surveyor/surveyors. There is no prohibition in the Insurance Act for appointment of second surveyor by theinsurance company, but while doing so, the insurance company has to give satisfactory reasons for not accepting the report of the first surveyor and the need to appoint second surveyor.35. In our considered view, the Insurance Act only mandates that while settling a claim, assistance of a surveyor should be taken but it does not go further and say that the insurer would be bound by whatever the surveyor has assessed or quantified; if for any reason, the insurer is of the view that certain material facts ought to have been taken into consideration while framing a report by the surveyor and if it is not done, it can certainly depute another surveyor for the purpose of conducting a fresh survey to estimate the loss suffered by the insured.(Emphasis supplied)15. At this point, we may take note of a two judge Bench decision of this Court in New India Assurance Company Limited v Protection Manufacturers Private Limited 2010 7 SCC 386 , where a submission was made that under Section 64-UM of the Insurance Act 1938, prior to the appointment of a subsequent surveyor, the insurer ought to have gone to the Regulatory Authority and under sub-section (3), it was for the Regulatory Authority to call for an independent report from any other surveyor. It was argued that the subsequent report of the surveyor must be disregarded on the above ground. This Court made a passing reference to the submission and accepted the contention. However, the facts of the above case are distinguishable from the present case. In the above case, the insurance company appointed another surveyor, who based on a cursory investigation determined the damages suffered by the insured in an amount close to the assessment made out by the insurer. This Court disregarded the subsequent report describing it as a tailor-made report, motivated and intended to benefit the insurer. Significantly, in the present case all the survey reports have spoken in one voice. The theory of the insured that the collapse of the entire boiler unit of the mill was due to the impact of a collision with a reversing lorry is belied by the cogent reasons which form the basis of the repudiation of the claim by the insurer. As a matter of fact, it is significant that in the first intimation by the insured of the incident, there was no reference to an alleged collision of the boiler unit with the lorry. This fact was noticed by the SCDRC. That apart, it is evident from the survey reports that the column section did not contain any evidence of an impact damage that would be sustained by collision with a lorry. The lorry had evidently suffered no damage at all, something that would have been unlikely if there was an impact with the boiler unit with such a high force. These reasons were the foundation of the order of the SCDRC.16. In the present case, as we have noted, the process which was followed by the insurer was not designed to obtain a report which would adopt a position adverse to the claim of the insured. There exist no mala fides on part of the insurer. On the contrary, it is evident from the record that the reports which have been relied upon maintained a consistent line of reasoning in regard to the nature and genesis of the incident. In this backdrop, we are of the view that the NCDRC has not acted reasonably in overturning the considered decision of the SCDRC. Cogent reasons were given by the SCDRC for rejecting the claim of deficiency of service on the part of the insurer. On the basis of the material which has emerged from the record, we find the opinion of the SCDRC to be correct. The view which has been taken by the NCDRC is not consistent with the statement of legal position as contained in the judgment of this Court in Sri Venkateswara Syndicate (supra) and is contrary to the material evidence on the record.