Consumer Court Allows Insurance Claim After Wrongful Denial

On 25 August 2025, the District Consumer Disputes Redressal Commission–I, Hyderabad, delivered an important ruling in CC No. 118/2024 involving an insurance dispute over the repair of a luxury car damaged due to waterlogging.
The insurer repudiated the claim alleging misrepresentation and discrepancies in dates. However, the Commission found the repudiation unjustified and directed partial allowance of the claim.

This judgment underscores a key principle:
When a surveyor assesses a valid loss, insurers cannot arbitrarily reject a claim without strong evidence.


Case Background

Complainant:
Mr. Rajan Mehta (name changed), 58 years, residing in Kondapur, Hyderabad. He owned an Audi A6 35 TDI (Reg. TS09XX0000).

Opposite Party:
Future Generali India Insurance Co. Ltd., Begumpet Branch, Hyderabad.

The complainant insured his car under a “Future Secure – Private Car” comprehensive policy:

  • Policy No.: VA885004
  • Premium paid: Rs. 58,195
  • IDV: Rs. 21,85,000
  • Policy period: 21.11.2022 to 20.11.2023

Everything about the insurance coverage was undisputed.


Incident and Claim Filing

On 08 November 2023, the complainant drove through approximately 2 km of waterlogged road due to heavy rains. The next day (09.11.2023), he noticed a steering malfunction.

Due to work commitments, he did not approach a mechanic immediately.
On 10 November, he consulted a mechanic, and on 11 November, the car was towed to the authorized Audi service center.

Workshop observation:

  • Steering damage occurred due to water ingress.
  • Repairs required replacement of major components.

Actions Taken:

  • Claim No. CM800896 filed on 13.11.2023
  • Surveyor inspected on the same day
  • Surveyor initially agreed that damage was due to water ingress
  • Workshop completed repairs amounting to Rs. 3,39,330 (paid by the complainant)

During claim submission, the complainant mistakenly mentioned the accident date as 10.11.2023 instead of 08.11.2023.
He corrected the date through an email dated 16.11.2023.


Why the Insurance Company Rejected the Claim

The insurer repudiated the claim on 21.12.2023, alleging:

  1. Misrepresentation of accident date
  2. Steering rack showed signs of prior repair / reused parts
  3. Damage allegedly did not match the cause (water ingress)
  4. “Old damage” was suspected
  5. Delay between workshop entry (11.11.2023) and claim intimation (13.11.2023)

The insurer concluded the claim was not payable.

The complainant issued a legal notice. The insurer did not settle the claim.

He then filed a consumer complaint seeking:

  • Rs. 3,39,330 as reimbursement
  • Rs. 10,00,000 compensation
  • Litigation costs

Opposite Party’s Defence

Future Generali argued:

  • The complainant approached the Commission “with unclean hands.”
  • There was no deficiency in service.
  • The claim was repudiated strictly as per policy terms.
  • Surveyor found “old damage” and “used parts,” thus the claim was not genuine.
  • Date mismatch was intentional and material.

They requested dismissal of the complaint.


Evidence Before the Commission

Complainant Filed:

  • Registration certificate
  • Insurance policy
  • Photographs of steering malfunction
  • Audi repair invoice
  • Emails clarifying date
  • Rejection letter
  • Legal notice

Insurer Filed:

  • Policy schedule
  • Survey report
  • Clarification letter
  • Repudiation letter
  • Reply to legal notice

Key Findings of the Commission

1. Surveyor’s Report Contradicted the Insurer’s Repudiation

The Commission examined the surveyor’s detailed report. Key points:

  • Water ingress did occur.
  • Damage corresponded to the incident.
  • Surveyor assessed net payable loss of Rs. 1,13,713 after deductions.
  • Surveyor clearly stated that the assessment was “fair and agreed after discussion.”

This contradicted the insurer’s total repudiation.

2. Insurer Failed to Justify Full Rejection

The Commission held:

  • The insurer did not produce any strong evidence proving fraudulent misrepresentation.
  • Minor discrepancy in date (corrected immediately) was not material.
  • Insurer acted arbitrarily by denying the entire claim despite a valid survey report.

3. Deficiency in Service Proven

The Commission concluded that the insurer’s rejection was:

  • Unfair
  • Arbitrary
  • Against surveyor’s findings
  • In violation of policy duties

Thus, it amounted to deficiency in service and unfair trade practice.


Final Order

Complaint Allowed in Part

The Commission directed the insurer to:

  1. Pay the claim amount as per surveyor report:
    Rs. 1,13,713 (approximately)
  2. Pay compensation:
    Rs. 15,000
  3. Pay litigation costs:
    Rs. 10,000

Compliance Period:

45 days

If not paid, interest @ 6% p.a. on the survey amount from the date of filing.


Key Takeaways

1. Surveyor reports have strong evidentiary value

Unless proven otherwise, an insurer cannot disregard surveyor findings.

2. Small errors in date or reporting do not justify repudiating legitimate claims

Especially when the insured promptly clarifies the error.

3. Insurer must show solid evidence of fraud to deny a claim

Suspicion is not enough.

4. Waterlogging damage is claimable

Provided the policy covers natural calamity events — as in this case.

5. Consumers should document repairs and communication

Emails, invoices, and photos played a crucial role here.


Conclusion

This case reinforces the need for insurers to follow fair claims practices and rely on clear evidence before rejecting claims. The Commission protected the consumer’s right by ensuring the valid surveyor-assessed amount was paid, while also granting reasonable compensation.

It is a useful precedent for vehicle owners facing arbitrary claim repudiation