The present complaint was filed by the titled complainant against the titled insurers upon receipt of repudiation (Ex.C8/Ex.OP1/2) dated 14.02.2019 to his ‘Total-Loss Claim’ pertaining to his accident-ed but comprehensively insured ‘Hyundai Verna Fluidic 1.6 CRDI SX Motor-Car’ bearing RC # PB-02-CD-2047 Model 2013 for an IDV of Rs.6.20 Lac. The related letter further enunciated that the Car had allegedly dashed against one Road-side Shop but stands badly damaged from the rear-side also and thus the alleged chronology did not justify the damage incurred to the Car hence the related claim stood repudiated. In turn, the insured complainant repeatedly affirmed with the OP that upon hitting the first road-side shop-pillar the car had turned turtle and its rear had again hit the next shop-pillar thus the Car got damaged from both the end-sides and had been case of total-loss. However, the OP refused to relent and thus prompted the present complaint.

2.       Ms. Bhawna Mahajan, a resident of Pathankot had owned the above Car as was insured with the above insurers for an IDV of Rs.6.20 Lac only. On the night of 18.11.2018 around 10 PM the Car got badly damaged in an accident on the out-skirts of Pathankot resulting into total-loss. The insured car owner intimated the OP and completed all the requisites and formalities too, precedent to an accident claim and finally filed the insurance claim with the OP insurer, who appointed its Surveyor and the claim process was initiated. Incidentally, the claim-process progressed smoothly as all requisites were made available and all queries were satisfactorily replied. There has been an overall affirmative assent as to factum of accident and terms of the applicable insurance policy. Neither, was there any dissent on the issue of ownership of the accidented vehicle nor upon the validity of the driver’s license of the holder driving at the time of the accident.   

3.       Finally, the OP insurers queried vide its letter dated 21.02.2019 seeking explanation of its hypothetical doubts as to the manner of accident as to how the accident occurred? As to what caused the accident? In the claim-form, and also to the OP appointed Surveyor, the insured had stated that the Car had first hit the road-side shop-pillar from its front and had turned turtle hitting the next shop-pillar from its rear side and had thus got damaged from both its ends. The complainant claims having repeatedly explained (verbally in-person, telephonic-ally and also in-writing) to the OP that the said accident had in-fact occurred on account of the double-hit of the fast moving Car. However, the OP insurer in its endeavor to reject the claim made it an issue and subsequently repudiated the claim, unceremoniously. The complainant had filed her affidavit in support along with routine papers of the car.

4.       The OP insurers appeared upon summoning through its counsel and filed its written reply pleading its prime objection (along with the routine formals) that alleged chronology of events preceding the accident did neither corroborate nor did correlate with the damages as visible/ apparent on the body of the car. The OP have in support of prosecution of its defense have filed an Affidavit of its authorized signatory (not naming him or her) along with other formals. Somehow, the Surveyor's deposition was not filed.      

5.       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 denied the impugned Insurance-Claim vide its repudiation letter (Ex.C8/Ex.OP1/2) 14.02.2019 for of the prime reason that the alleged chronology of events did not tally with/ justify the damage suffered upon the Car but have failed to file any cogent evidence in support; even the Surveyor's Affidavit was not produced during the present proceedings, in the absence of which the related report cannot be legally co-related and moreover the report contains opinions based on suspicions only sans the requisite affirmations. The report opines that the alleged chronology of events do not justify the damages and there's suspicion of change of driver.  We are of the considered opinion at the face of the evidenced-facts as available on the records that there’s have been no misrepresentation and/ or misstatements of facts and as such the impugned ‘repudiation’ of the insurance-claim, in question, by the OP Insurer 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.         

6.       In the light of the all above, we order the opposite party insurers to pay the impugned claim @ of the policy's full IDV of Rs.6.20 Lac 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.

7.         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.

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

(Naveen Puri)

                                                                President.

ANNOUNCED:                                    (R.S.Sukhija)

JUNE 15, 2022.                                          Member.

YP.