The present complaint was filed by the titled complainant against the titled insurers upon non-receipt (till the filing of the present complaint) of status/fate of his Total-Loss Car-Accident Insurance-Claim filed by him with the OP insurer pertaining to his Maruti Car insured for an IDV of Rs.3.41 Lac and having met with an accident on 14.03.2016.

2.       The Complainant had represented to the OP insurer many a times over the telephone as well as in writing and also through legal-notice requesting for an expeditious resolve but somehow all that could not move the OP and hence prompted the present complaint.

3.       Sh. Amit Kumar has been a physically-handicapped person posted as Govt. School Teacher in the revenue circle/district of Pathankot and had owned one Maruti Car fully insured (up to 15.12.2016) with the OP insurer for an IDV of Rs.3.41 Lac only. However, on 14.03.2016 the Insured Car got badly damaged in a Road-side Accident near Railway Bridge on the out-skirts of Pathankot resulting into total-loss. The complainant driving the insured car was also injured and remained hospitalized for full one week at Apex Hospital, Amritsar and was further advised full bed-rest for full one month. Incidentally, the complainant lived in one nuclear family, hence he could not file his insurance claim with the OP insurer, immediately on account of his hospitalization and also non-availability of any physical support from any quarters. However, the requisite Total-Loss Insurance Claim for full IDV of Rs.3.41 Lac was formally filed on 14.07.2016 (succeeding the initial/ prior intimations) and the OP deputed its Surveyor to assess the loss etc. The Surveyor submitted his total-loss report on 14.02.2017 and then the OP deputed its Investigators (M/s S A Investigating & Consulting Agency) whose report was still awaited till the filing the complaint. Legal-notice was got served upon the OP on 10.04.2017 sans any fruitful results.  

4.       However, the OP insurer in its endeavor to reject the claim made even the genuine 'delay' an issue and subsequently continuing sitting over the claim, unceremoniously. The complainant had filed his affidavit in support along with all other routine evidentiary documents/papers in evidence.

5.       The complaint was duly admitted on its preliminary hearing on 20.05.2019 and the requisite notice summoning the OP insurer were duly ordered for service for causing its  appearance on 25.06. 2019 that was further awaited till next adjournment on 02.07.2019. However, the OP opted to stay absent and thus going by the universally acceptable legal presumption in law that an absentee litigant (but otherwise duly served-upon) has no defense to prosecute and hence no legs to come and stand in the witness-box and prove his innocence; the OP were ordered (on 02.07.2019) to suffer an ex-parte proceedings.       

6.       We have duly heard the learned counsel for the complainant, 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. The learned counsel for the complainant has rightly quoted the P & H High Court Judgment in CR No. 5294 of 2016 titled Bharti AXA Gen. Ins. Co. Ltd., Vs. PLA Camp Court at Palwal & Anr., that, “ As per condition of the Policy, the intimation of the accident was to be given to Insurance Company - The delay, if any, in providing intimation to Insurance Company about accident and death of Insured would not in any way take away the rights of the claimant ….....”. Further, we respectfully observe that the next judgment quoted by the complainant of the State Commission of Consumer Protection, Uttarakahnd, Dehradun in Appeal No. 366 of 2003 titled: Sant Ram Vs. New India Assurance Co., pertains to delay in reporting 'theft' of insured vehicle where 'delay' in reporting affects the chances of recovery by the insurer employing its own sources and wherein the honorable forum/ commission had allowed sanction of the claim on 'non-standard' basis @ 75% of the IDV, thus ruling out 'putting an end' to the insurance-contract.                    

7.       We observe that the OP insurer has even opted out of its statutory duty as well as its obligatory courtesy to 'up-date/respond' to the normal status-queries of the complainant pertaining to his claim. The lone response Ex.C4 dated 18.04.2017 has been the one glaring evidence to the same. The OP designated Surveyor has submitted his report on 14.02.2017 that is to say after more than six months of the examination of the accident-ed Car. And, the Surveyor's Report as well as the OP appointed Investigator's Report has not been made available to the complainant by the OP insurer since the filing of the claim, in question.  

8.       We are of the considered opinion at the face of the evidenced-facts as available on the records that there’s have been an unfair display of its superior/dominant position by the OP Insurer in blacking-out the 'transparency' of claim-status resolve from the insured and that clearly amounted to deficiency in service on the OP insurer's part and as such the impugned ‘non-resolve/ non-reply/ silence’ on the OP insurer's part over the status of the insurance-claim, in question, 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.         

9.       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.3.41 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.

10.     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.

11.     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)

JUNE 29, 2022.                                           Member.

YP.