IMPORTANT POINT
(1) Delay in Intimation – A technical breach, such as a delay in intimating the accident (in this case, alleged 240 days), cannot automatically defeat the substantive rights of the insured. If the delay is due to unavoidable circumstances (such as hospitalization/injuries) and the claim is otherwise genuine, it should be condoned.
(2) Burden of Proof regarding Policy Breach – The onus to prove a “willful and fundamental breach” of policy conditions lies squarely on the Insurance Company. The Insurer repudiated the claim alleging the absence of a valid license, yet the record showed valid licenses for the persons involved were effective on the date of the accident. Mere allegations without cogent proof are insufficient to sustain a repudiation.

ORDER

S.D. Wandhare, Member—The appellant namely Bajaj Allianz General Insurance Co. Ltd through its Manager, has preferred the present appeal under Section 15 of the Consumer Protection Act 1986 challenging the order passed on 30/07/2018 in Consumer Complaint No.CC/98/2014 (hereinafter it is referred to in short as “impugned order”) of the learned District Consumer Disputes Redressal Forum, Buldhana (hereinafter it is referred to in short as “learned District Forum”) by which the complaint filed by respondent No.1 /org. complainant came to be allowed. The parties of the appeal are hereinafter referred to by their original nomenclature as complainant and opposite parties respectively for better appreciation.

2. The facts that emerge from the original complaint are that the complainant had purchased a Maruti Ritz vehicle bearing No.MH-28-V-5170 on 19/12/2012 for Rs.6,63,000/- from Opposite Party (O.P.) No.2. Said vehicle was covered under a comprehensive insurance policy bearing No.0G-13-2002-1801-00003866 of Rs.5,33,880/- issued by O.P. No.1 after payment of premium of Rs.16803/- for the period from 19/12/2012 to 18/12/2013. On 05/05/2013, while the complainant was travelling from Nagpur, the vehicle met with a serious accident at Jamthi Phata on National Highway No.6, resulting in total loss of the vehicle, death of one co-passenger and injuries to the complainant and others. The complainant was treated at Ozone Hospital, Akola and the accident was informed to O.Ps. Nos.1 to 3. As per instructions of O.P. No.1, the damaged vehicle was deposited with O.P. No.2 and all necessary documents were submitted for processing the insurance claim. Despite the complainant’s cooperation and his acquittal in the criminal case arising out of the accident, O.P. No.1 repudiated the insurance claim on 26/03/2014 on the ground of absence of a valid driving licence. The complainant alleging it deficiency in service and unfair trade practice on the part of O.P. and filed the complaint seeking insurance amount with interest, compensation for physical and mental suffering, medical expenses and litigation costs.

3. The Opposite Parties (O.P.) No.1 Insurance Company resisted the claim before the learned District Forum and denied all the allegations made against them by the complainant. They contended that the accident of the insured vehicle occurred on 05/05/2013, but the complainant has intimated the claim only on 25/11/2013 after an inordinate and unexplained delay of 240 days in clear violation of Term No.1 of the insurance policy which mandates immediate intimation of the accident. It also contended that on receipt of delayed intimation, they appointed a surveyor who assessed the loss at Rs.5,58,610/- which exceeded the declared value of the vehicle, i.e., Rs.5,33,880/-. It further submitted that despite repeated letters, the complainant failed to furnish essential documents including the learner’s driving licence and other relevant papers. The complainant also made contradictory and false statements regarding the persons travelling in the vehicle at the time of the accident and deliberately suppressed the copy of the F.I.R. to mislead the Insurance Company. In view of these breaches and discrepancies, the claim was rightly repudiated on 26/03/2014. They denied their deficiency in service and unfair trade practice on their part. Therefore, they prayed to dismiss the complaint with costs.

4. The O.P.Nos.2 and 3 were appeared before the learned District Forum after due service of notice. However, they failed to submit their written version in stipulated period. Consequently, by order dated 19/03/2015 passed by learned District Forum, proceeded the complaint against without their written versions.

5. After considering the evidence of the parties and their documents filed in support thereof, learned District Forum by order dated 30/07/2018 allowed the Consumer Complaint No.CC/98/2014 directing the O.P.No.1 to pay Rs.5,33,880/- to the complainant for the a