IN THE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI RESERVED ON : 16.09.2025 PRONOUNCED ON : 17.12.2025 SECOND APPEAL NO. 604 of 2025 (Against the order dated 18.05.2023 in Appeal No. 60/2023 of the State Consumer Disputes Redressal Commission, Gujarat)

HDFC Ergo General Insurance Co. Ltd.

3rd Floor, Akshat Plaza, Opp. HDFC Bank, Alpha Society, Link Road, Bharuch-392001 Second Address:

HDFC Ergo General Insurance Co. Ltd.

5th Floor, Tower 1, Steller IT Park, C-25, Sector-62, Noida-201301 Appellant(s)

Versus Ravinaben Bipinbhai Vsava PO Ninam 4-58, Juno Bhilvado, Tal.Amod, Dist.Bharuch Gujarat-392110 Respondent(s)

BEFORE:

HON'BLE DR. INDER JIT SINGH, PRESIDING MEMBER HON'BLE DR. JUSTICE SUDHIR KUMAR JAIN, MEMBER For the Appel la nt(s) Ms. Suman Bagga, Advocate

ORDER

DR. INDER JIT SINGH, PRESIDING MEMBER

1. This Second Appeal has been preferred by the Appellant against the impugned order dated 18.05.2023 passed by the State Commission in FA/60/2023. The State Commission dismissed the Appeal filed by the Appellant Insurance Company and confirmed the order dated 23.11.2022 passed by the District Commission in Complaint No. 133/2021.

BA

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2. The Appellant herein (hereafter referred to as Insurance Company) was Appellant before the State Commission and Opposite Party before the District Commission. The Respondent herein (hereinafter referred to as Complainant) was Respondent before the State Commission and Complainant before the District Commission.

3. The brief facts of the case, as presented by the Appellant and as emerged from the SA, orders of the State Commission, District Commission and from the Complaint are:

The Respondent/Complainant's husband Mr. Bipinbhai Natvarbhai Vasava took a Two-wheeler Policy valid for the period from 25.10.2020 to 24.10.2021 from the Appellant/Insurance Company. The said policy also provided a personal accident cover for the owner driver for a sum assured of Rs. 15,00,000/-. On 11.06.2021 the insured met with an accident and died due to the injuries sustained in the said accident. After the accident, the vehicle was stolen from the accident spot. The Complainant lodged a claim for theft of the subject vehicle, which was stolen from the accident spot. The claim was repudiated by the Insurance Company on the ground of delay in intimation of claim by 45 days to the Insurance Company and 6 days to the police and no claim was lodged with regard to the personal accident cover on account death of the insured and no documents for processing the claim were filed under the personal accident cover. Hence, the complainant/wife of insured filed consumer complaint No. 133/2021 before the District Commission.

4. The District Commission vide its order dated 23.11.2022, partly allowed the complaint No. 133/2021.

5. Aggrieved by the order dated 23.11.2022 passed by the District Commission, the Appellant Insurance Company preferred Appeal before the State Commission. The State Commission vide order dated 18.05.2023 dismissed the Appeal at admissions stage and confirmed the order passed by the District Commission.

6. The Appellant has filed the Second Appeal before this Commission on the following grounds:

i) The substantial questions of law arise that (a) whether the Appellant Insurance Company could be held guilty of deficiency in service in not settling the Personal Accident Claim when no claim for personal accident was lodged by the complainant and no documents were submitted for processing the said claim (b) whether the impugned judgment and order is contrary to the binding precedents of Hon'ble Supreme Court on the issues involved in the present case.

ii) Both the Fora below have erred in holding that the Appellant was guilty of deficiency in service. The State Commission cast the burden of proof on the Appellant Insurance Company to prove that the breach of policy condition is so fundamental so as to have contributed to the cause of accident.

iii) State Commission failed to appreciate that it was not only a case of b