The main legal point established in the judgment is that insurance companies should not reject genuine claims on flimsy grounds and must adhere to principles of reasonableness, probability, and natural justice.

ORDER :

Mr. S.A. Siddiqui, Member (Judicial)-This is a complaint under Section 17 of the Consumer Protection Act, 1986 (hereinafter called ‘the Act’). The complainant is seeking directions to the OP National Insurance Company Ltd. to pay a sum of Rs. 19,21,750 towards insurance claim with interest as per IDV mentioned in the cover note, besides paying Rs. 4 lac compensation and Rs. 20,000 as costs of litigations.

2. Factual matrix of the case are that complainant Sh. Sunil Sharma is the registered owner of the JCB Machine bearing registration No. HR-74-0418. The vehicle was fully insured with OP National Insurance Company Ltd. through Policy No. 361500/31/08/6300002420 for the period 20.8.2008 to 19.8.2009. Unfortunately, this vehicle was stolen during the intervening night of 18/19.7.2009 by unknown thieves from road No. 56, ISBT Anand Vihar, Delhi, local police was informed and after investigation of the matter police registered the case vide FIR No. 360/09 under Section 384, IPC. The case was investigated by the police which could not find any clue of the theft nor it could trace the vehicle. Police submitted final report on 2.9.2009, the intimation of the theft was also given to the Insurance Company immediately after the theft, which was acknowledged by the OP vide claim No. 361500310963900000173. After receiving the information Investigator/Surveyor was appointed by the Insurance Company to investigate and assess the loss. The complainant received a letter dated 11.8.2009 and 17.8.2009 from the Investigator Laxman Das Arora in which certain papers were demanded and the same were provided to the Investigator (Annexure-D), complainant also received another letter dated 8.1.2010 for certain clarifications regarding the date of theft, statement of driver of the vehicle and DD report of police. Reply of this letter was sent by the complainant (Annexure-E). Thereafter several more letters were received from the Investigator raising certain queries which were being repeated again and again. However, the complainant clarified all the queries raised and also furnished all necessary documents, but, the Investigator, just to harass the complainant made an issue in his report that there was difference in the statements of the complainant and his driver and continued asking to clear the difference and doubts. A personal meeting of the complainant with investigator was held and all differences were cleared to the satisfaction of the Investigator, but, the Insurance Company did not settle the insurance claim of the complainant and continued to keep it pending and deputed another investigator to conduct further investigation. Thus, despite all follow ups and compliance made by the complainant nothing happened towards settling the insurance claim. The complainant further sent a legal notice dated 31.7.2010 to the OP, which was served but the insurance claim was not settled. Later on, complainant received letter dated 3.5.2011 from the OP through which insurance claim of the complainant was repudiated (Annexure-K). The repudiation of the claim was totally unfair and unjust which amounts to gross deficiency of service on the part of the OP, the complaint therefore deserves to be allowed.

3. OP contested the consumer complaint by filing reply. It was alleged that the complainant had no cause of action to file the consumer complaint as there was no deficiency of service of any type caused by the OP. The OP repudiated the claim of the complainant on just and proper grounds. On receiving the claim intimation from the complainant, OP appointed an independent Investigator to investigate and verify the loss. The Investigator submitted his report, the OP carefully examined the documents and report of the investigator. From the report of the Investigator, it was found that there was contradiction regarding the date of occurrence of the alleged theft. According to police complaint, alleged theft took place during the intervening night of 17/18.7.2009,