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2025 Supreme(Online)(SCDRC) 9954
STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Vishav Kant Garg, Member
Reliance General Insurance Company Limited – Appellant
Versus
Harjinder Singh – Respondent
Appeal
For the Appellants/Petitioners: Sachin Ohri
For the Respondents: Arjun Kundra
Insurance claims genuinely arising from an accident cannot be rejected on technical grounds of delayed intimation if there is a justifiable cause, and the quantum of compensation should be based on the surveyor’s assessment rather than the full IDV unless proven erroneous.
Headnote:(A) Consumer Protection Act, 2019 - Section 41 - Insurance claim - Repudiation on account of late intimation - Delay of 235 days - Delay caused due to accidental injuries suffered by the insured - Intimation condition in insurance contract is directory and not mandatory for genuine claims - IRDA Circular dated 20.09.2011 directs insurers not to reject genuine claims on technical grounds of delayed intimation.
(B) Insurance Law - Surveyor Report - Importance of - Assessment made by a surveyor, being a technical person, holds high evidentiary value - Unless there is tangible evidence to contradict the loss assessed, the surveyor’s report should be given primacy in determining the quantum of compensation.
Facts of the case:
The respondent purchased a vehicle and insured it with the appellants. The vehicle met with an accident causing damage and injuries to the respondent. The claim was repudiated by the insurance company citing a 235-day delay in intimation and doubtful circumstances of the accident. The District Commission allowed the complaint, which was challenged by the insurer in this appeal.
Findings of Court:
The Commission found that the accident was genuine and the delay in intimation was justifiable due to the injuries sustained by the insured. Relying on IRDA guidelines and prior judicial precedents, it held the repudiation incorrect. However, it modified the District Commission's order, restricting the compensation to the loss assessed by the surveyor (Rs. 7,87,167/-) instead of the full IDV.
Issues: Whether the delay of 235 days in intimating the insurance company is fatal to the claim and whether the quantum of compensation should be the IDV or the surveyor-assessed loss.
Ratio Decidendi: Clauses regarding intimation delay are directory; genuine claims cannot be rejected on technical grounds. The surveyor's report, being an expert assessment, is the appropriate basis for determining the loss amount in the absence of evidence suggesting perversity.
Result: Appeal partly allowed; impugned order modified.
| Table of Content |
|---|
| 1. summary of facts leading to the insurance claim dispute. (Para 1 , 2 , 3 , 4 , 5 , 6 , 7) |
| 2. contentions regarding delay in claim intimation. (Para 8 , 9) |
| 3. evidence analysis concerning the genuineness of the accident and policy violation. (Para 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18) |
| 4. applicability of regulatory guidelines regarding delayed claim intimation. (Para 19 , 20 , 21) |
| 5. quantum determination based on surveyor assessment. (Para 22 , 23 , 24 , 25 , 26) |
| 6. fixing liability based on independent surveyor assessment rather than idv. (Para 27) |
VISHAV KANT GARG, MEMBER :
Appellants/Opposite Parties i.e. Reliance General Insurance Company Limited, have filed the present Appeal through its Area Manager (Legal Claims) to challenge the impugned order dated 06.10.2022 passed by the District Consumer Disputes Redressal Commission, Gurdaspur (in short, “the District Commission”), whereby the Complaint filed by the Respondent/Complainant-Harjinder Singh had been Partly Allowed.
2. It would be apposite to mention here that hereinafter the parties will be referred, as were arrayed before the District Commission.
3. Briefly, the facts of the case as made out by the Respondent/Complainant in the Complaint filed before the District Commission are that he had purchased Mahindra Scorpio Vehicle, having Engine No. WGH4C16172, Chassis No. MA1TA2WGXH2C34892 on 26.06.2017. Said vehicle was insured with the OPs for the period w.e.f. 26.06.2017 to 25.06.2018 on paying the premium of Rs.59,884/-. Total IDV of the vehicle was Rs.11,37,982/-. Said vehicle met with an accident on 07.07.2017 and the Complainant had received multiple injuries in the accident. In the accident, the vehicle was badly damaged. DDR No. 7 dated 15.07.2017 was lodged with Incharge Police Chowki, Naushera Majja Singh Police, District Batala. The vehicle in question was allotted Registration No. PB-06-AN-7604. The Complainant had lodged claim with the OPs, which was repudiated by the OPs vide letter dated 03.04.2018.
4. Stating the act of the opposite parties to be a case of ‘deficiency in service’ and ‘unfair trade practice’, it was prayed in the Complaint that the OPs be directed to pay the claim amount and Rs.50,000/- be granted as compensation on account of wrongly repudiating his claim, suffering mental agony and harassment at the hands of OPs and Rs.50,000/- be also awarded as litigation expenses.
5. Upon issuance of notice in the Complaint, the Appellants/ Opposite Parties had filed their written statement by raising certain preliminary objections that the Complainant had violated the terms and conditions of the Insurance Policy as he had informed the OPs on 26.02.2018 regarding the accident of the vehicle in question. In this process, a delay of 235 days had occurred, which was long one. Due to such a long delay, the OPs had failed to identify the exact reason of the accident. Said accident was doubtful in nature and it required cross examination of the witnesses to find out the exact cause of accident, which could not be adjudicated in summary procedure and the matter needs to be relegated to the Civil Court. At the time of accident, the vehicle was not registered with the Registering Authority and without registration, plying of vehicle is an offence. As the Complainant himself had violated the Condition No.1 of the Policy, therefore, scrutinizing the claim under the terms and conditions of the policy, the same had been repudiated. Intimation with regard to repudiation of the claim had been sent to the Complainant vide letter dated 03.04.2018. As the Complainant had violated the terms and conditions of the policy, therefore, no liability was fastened upon the OPs. If this Commission is of the opinion that the OPs are liable to pay the insurance claim, in that situation, the liability of the OPs was only upto the amount as assessed by the Surveyor i.e. Rs.7,87,167/- only. It was pleaded that the claim had been repudiated after proper scrutinizing the
