Dearest Reader,
After going through your query, I understand the issue and I would like to provide you with an answer:
Firstly, the shop owner here should have read the policies of the insurance document while providing the signature. An “ACT OF GOD” specifically refers to natural events that are outside of Human Control. For example tsunamis, earthquakes, etc.
As you have mentioned, the policy doesn’t specifically exclude coverage for natural disasters, the shop owner may file a petition arguing that he is entitled to compensation.
Concerning the guidelines mentioned under the Insurance Regulatory and Development Authority of India (IRDAI), the insuring company must clearly state the risks involved. If the company is refusing to issue the claim under the condition of ACT OF GOD, then they should have mentioned this earlier in the policy document itself.
In the provided scenario, the shop owner can lodge a complaint in the office of the District Consumer Disputes Redressal Forum stating the provisions of the Consumer Protection Act, 2019, as this act tends to protect the consumers concerning the deficiencies in service.
He can also argue that the insurance company has failed to fulfill its contractual obligations. One plus point that the shop owner has is that the document doesn’t specifically mention that they will not issue the claim or they will not protect him if any situation under the ACT OF GOD occurs.
They just mentioned that they would protect him against any human-caused activity. If their policy doesn’t cover these types of occurrences, then they should have stated this clearly in the document itself.
Additionally, the shop owner can also approach the Insurance Ombudsman stating the rules mentioned in the Insurance Ombudsman Rules as this will provide him with an Alternative Dispute Resolution mechanism, that allows quicker solutions without any legal proceedings.
There are chances that the shop owner will subsequently get the claim issued as in the case of United India Insurance Co. Ltd. v. K. J. John (2008), the Supreme Court of India has stated that the insurance company cannot deny the claims when they are not having any substantial evidence that the loss falls under the conditions which were excluded in the clauses of the Insurance document.
Also, the court has stated that the insuring company must illustrate that loss which has occurred from and excluded risk (not mentioned in the policy document) in the case of National Insurance Co. Ltd. v. Swaran Singh (2004).
Finally, I would like to say that the shop owner has a greater chance of winning the case if he files a petition against the Insurance company, and if he doesn’t file a petition then he can go with the Alternate Dispute Resolution methods like Mediation, etc.
