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The West Bengal State Consumer Disputes Redressal Commission members Rajesh Guha Ray and Santanu Saha were hearing the finance company’s consumer complaint against the insurer and others challenging the rejection of a claim arising from the June 1, 2015 incident at the company’s branch office.

“The rejection of the entire claim, despite a reconciled assessment and without establishing an operative exclusion, constitutes a deficiency in service…An exclusion framed in terms of negligence or omission cannot be applied merely by listing precautions that, with hindsight, might have been desirable,” the commission said on August 31, holding that the insurer had to establish conduct falling within the exclusion and a real nexus with the loss.

The case arose after five or six armed miscreants entered the branch at about 1.20 pm on June 1, 2015 and took away Rs 48.26 lakh collected through field operations and being processed for remittance to a bank. The money insurance policy was valid from July 11, 2014 to July 10, 2015, with a premium of Rs 33,73,721.

An FIR under Section 395 IPC was lodged. The insurer’s surveyor inspected the branch and assessed the loss at Rs 44,53,950. Police later filed a chargesheet on August 31, 2018 under Sections 395 and 412 IPC after arresting six people and recovering Rs 1.45 lakh and a pistol. The trial was pending, the order said.

The commission said the dacoity and cash loss were proved on the preponderance of probabilities. The insurer rejected the claim on July 17, 2017. The insurer cited the lack of a guard, CCTV and strong chest, besides accounting lapses. It pointed to a Rs 3,72,050 mismatch between the cash book and online collection report, which the surveyor could not reconcile.

The finance company said its collections were backed by machine-generated receipts and explained that cash received on June 1 was recorded as May 31 collection because of the month-end half-holiday. The commission held that the policy’s written terms could not be expanded to require CCTV, a security guard, alarm or a specific strong room.

It noted the branch had shutters and grills and the cash was being processed during business hours. The dacoity, not any alleged security lapse, was the proximate cause of the loss. The insurer failed to prove a policy breach or link any omission to the loss.

The commission rejected the full Rs 48.26-lakh claim, finding the May 31 date used for cash received on June 1 an unsatisfactory practice. But it accepted Rs 44,53,950 as the reconciled loss based on the surveyor’s assessment and rejected only the unreconciled Rs 3,72,050.

The commission also dealt with the Rs 1.45 lakh recovered by police. The insurer can deduct this amount only if it proves that the money was actually returned to the complainant.

It held that rejecting the entire claim amounted to deficiency in service and awarded 9 percent annual interest from July 17, 2017 until payment, along with Rs 1 lakh in litigation costs. The Rs 10 lakh compensation claim was rejected. The insurer was directed to pay Rs 44,53,950, subject to the recovery adjustment, within 45 days, with interest and costs.

Consumers facing similar grievances may contact the consumer helpline in their respective states (West Bengal: 033–2252–0448) or dial the National Consumer Helpline at 1915 for assistance.

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