The titled complainant has filed the present complaint against the titled opposite party insurers being aggrieved at 'rejection' (amounting to repudiation) of the ‘Insurance-Claim’ of his comprehensively insured Zen Car (RC # PB-02-AP-0825)' vide Policy # OG-15-1211-1801-00000700 got damaged in 'Road-side Accident' on 05.08.2015 and got repaired @ Rs.26,200/- from the local Motor Garage Workshop on 19.09.2015.

2.       The complainant had filed the requisite insurance-claim with the OP insurers for its reimbursement and had also thoroughly replied on 05.09.2015 with documentary evidence to the OP query letter dated 20.08.2015. However, the OP insurers have not resolved the claim till the date of the present complaint filed seeking directives to the OP to settle and pay the claim, in full, with interest @ 18% PA w e from 20.08.2015 till realization besides to pay a sum of Rs.50,000/- as compensation and Rs.10,000/- as cost of litigation in the interest of justice. The complainant, in support of his complaint, has filed his duly sworn-in i) Affidavit (Ex.C1) along with other documents in evidence as: ii) Ex.C2–Copy of the Repair Bill dated 19.09.2015 for Rs.26,200/- iii) Ex.C3–Copy of the query letter dated 20.08.2015;      iv) Ex.C4–Copy of the Insurance Endorsement Schedule dated 11.05.2015; v) Ex.C5–Copy of the Complainant Reply dated 05.09.2015 to the OP Query Letter dated 20.08.2015; vi) Ex.C6–Copy of the Postal Receipt 11.09.2015; vii) Written Arguments.

3.       The OP insurers appeared upon summoning through its counsel and filed its written reply pleading its primary objections (along with the routine formals): That the present complaint has been an abuse of process of law being false, frivolous and vexatious making it illegal and untenable filed without any cause of action and is thus liable to be dismissed. The complaint is highly misleading and filed only to harass the respondents. The parties to the contract of insurance are bound by its terms that cannot be altered post-execution etc. The complainant has suppressed the material facts necessary for adjudication of dispute & has not approached the court with clean hands. The complaint is bad  due to its own acts, deeds, conduct and acquiescence and has been of a complex nature that need be resolved by the civil courts and not under the summary procedure as prescribed for consumer for a and is also barred by limitation. As per the OP insurers their specific objections qua the factual back-ground of the dispute have been that upon filing of claim by the complainant the OP insurers had appointed their Surveyor who had reported that the damage to the Car had apparently not been in conformity/co-relation with the narrated details of accident and had assessed the same @ Rs.8,837/- only. Again, on merits, the OP insurers did plead  on the same and similar lines of rebuttal and seeking finally the dismissal of the complaint  producing the sworn-in i) Affidavit (Ex.OP1) by Navjeet Singh its Asst. Manager along with other documents in evidence: ii) Ex.OP2–Copy of the Repudiation 01.09.2015; iii) Ex.OP3-Copy of the Postal Receipt; iv) Ex.OP4–Copy of the Query Letter 20.08.2015; v) Ex.OP5– Copy of the Postal Receipt; vi) Ex.OP6 – Copy of the Claim Summary; vii) Ex.OP7–Copy of the Claim Cost Approval Sheet; viii) Ex.OP8–Copy of the Claim Form; ix) Ex.OP9–Copy of the Repair Estimates Rs.20,000/- approximately; x) Ex.OP10–Copy of the Original Policy Endorsement; xi) Ex.OP11–Copy of the Original Policy; xii) Ex.OP12–Copy of the Survey Report (Final); xiii) Written Arguments.       

4.       We have duly heard the learned counsels for both the sides, on points of law, and have also thoroughly examined the records with requisite care and caution on the points of fact, as placed before us. We are also inclined to examine the inference it’s ‘scope n spread’ on account of some documents ignored to be produced/not-produced during the course of proceedings. We observe that the OP insurer have denied the impugned Insurance-Claim vide its repudiation letter (Ex.OP2) 01.09.2015 for of the prime reason of non-reply of the OP queries by the complainant who has however produced his reply (Ex.C5) mailed vide postal receipt (Ex.C6) explaining therein that query letter was received on 05.09.2015. And, further qua the OP Surveyor Report the damage/loss do not conform/match with the narration of the accident; but the report is not supported by the surveyor's affidavit.

5.       Further, there's been a delay of 13 days in intimating the loss/damage caused to the insured vehicle in the road-accident. However, it has been an established legal proposition that an insurance claim cannot be repudiated merely on account of its 'delay' in intimating the insurers. “Mere Delay In Intimating Insurer Of Vehicle Theft No Ground For Denying Claim, Says the Hon’ble Supreme Court! A bench comprising Justices Sanjiv Khanna and Bela M Trivedi set aside the NCDRC judgment and held that the mere delay in intimating the insurer was not fatal to the claim when an FIR had been registered promptly.” “The precise question that falls for consideration before this Court is - whether the insurance company can repudiate the claim in Toto, made by the owner of the vehicle which was duly insured with the insurance company, in case of loss of the vehicle due to theft, merely on the ground that there was a delay in informing the company regarding the theft of vehicle,” the bench said.

          Insurers cannot reject claims for delay in intimation:    

         IRDA (Insurance Regulatory and Development Authority):

         Insurance companies cannot mechanically reject claims on technical grounds, such as delay in intimation and submission              of documents, particularly if the delay is due to unavoidable circumstances, according to the insurance regulator.                

        Besides benefiting policyholders, whose claims for settlement are rejected on technical grounds, the regulatory move will         also help the industry curb unnecessary expenses on litigation and court settlement. The Insurance Regulatory and                         Development Authority (IRDA) has issued a circular to this effect to life and non-life insurance companies as it has received           many complaints on rejection of claims.                         

       The IRDA regulator said policy holders should intimate and submit the required documents to their insurance company                 within the stipulated time so that the insurer can start post- claim activities such as investigation, loss assessment,                             provisioning and claim settlement. However, when there is delay in intimation or submission of documents due to                             unavoidable circumstances, the regulator has emphasized that this should not prevent settlement of genuine claims.

6.       We are of the considered opinion at the face of the evidenced-facts as available on the records that there’s have been no willful and/or intentional delay/misrepresentation and/or misstatements of facts and as such the impugned ‘repudiation’ of the insurance-claim, in question, by the OP Insurers had been unwarranted, arbitrary and unfair; neither in accordance with the provisions of the statutory law nor in conformity with the sanctity of natural justice, equity and good conscience. Further, it has violated with impunity the preferred consumer rights of the insured complainant causing him much physical harassment, mental agony and financial loss. Lastly, we hold the insurer guilty of statutory misconduct amounting to ‘unfair trade practices/deficiency in service’ and thus liable to an adverse award under the provisions of the governing statute.

7.       In the light of the all above, we order the opposite party insurers to pay the impugned claim qua the Paid Repairs Bill in full in terms of the policy with interest @ 6% PA from the date of claim (till paid in full) besides Rs.10,000/- in lump sum as cost cum compensation within 45 days of receipt of the  certified copy of these orders otherwise the so-aggregated amount shall attract an additional interest @ 3 % PA from the date of the orders till realization, in full.

8.         The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

9.        Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.           

                                                                   (Naveen Puri)

                                                                         President.

ANNOUNCED:                                        (B.S.Matharu)

NOV. 04, 2022.                                                 Member.

YP.