Dr. Inder Jit Singh, Presiding Member

The present Consumer Complaint (CC) has been filed under Section 21(a)(i) of the Consumer Protection Act, 1986 by the Complainants against the Opposite Parties -1 to 4 as detailed above, inter alia praying for directions to OPs:-

                   i. To refund/pay the sum insured of Rs. 1,55,46,400/- along with interest @18% per annum from the date of submission of claim (05.08.2015) till the date of payment;

                   ii. To pay an amount of Rs. 10,00,000/- as compensation for mental agony, harassment and deficiency in service;

                   iii. To pay Rs.2,00,000/- as litigation expenses and costs.

2. The Complainants are the widow, minor children and mother of Late Shri Vikas Kumar Bhateja. The deceased had obtained a life/health insurance policy under the plan "ASSURE 2" from Opposite Parties No. 1 & 2 (Religare Health Insurance Company Limited) for the period 25.04.2014 to 24.04.2017, with a single premium of Rs. 1,50,000/- and sum insured of Rs. 1,55,46,400/-. The policy covered personal accident resulting in death or total disablement. Complainant No. 1 (Sapna) was the nominee.

3. It is averred/stated in the Complaint that:-

                   i) On 06.07.2015, while the deceased was returning to Malout from Gidderbaha, he met with an accident near the Rajasthan Feeder Canal. A stray cattle came in the way of his car; he lost control, and the car fell into the canal, resulting in his death.

                   ii) Initially, a missing report was lodged (FIR/Missing Report No. 6 dated 07.07.2015). On 13.07.2015, the body was recovered along with the car. The police submitted a report under Section 174 Cr.P.C. confirming accidental death. The Death Certificate dated 27.07.2015 was issued.

                   iii) In August 2015, Complainant No. 1 lodged the insurance claim. However, the Opposite Parties delayed the matter and requested reinvestigation vide letter dated 28.02.2016, propounding a theory of suicide.

                   iv) The police re-investigated and vide report dated 28.04.2016 (approved by SSP on 28.04.2016) confirmed accidental death. The SSP, Sri Muktsar Sahib, vide letter dated 17.05.2016, again informed the OPs that the death was accidental.

                   v) Despite this, the OPs again requested re-investigation on 30.05.2016 and 08.09.2016. The SSP submitted a final report dated 24.10.2016, reiterating that the death was accidental and not suicidal.

                   vi) On 02.02.2017, they issued a letter asking for certain documents (including viscera report), which were provided on 23.02.2017. However, on the same date (02.02.2017), they repudiated the claim on the ground of "DISCREPANCY IN MEDICAL DOCUMENTS; CONCEALMENT AND MISREPRESENTATION OF FACTS."

                   vii) The Complainants also pointed out that the Life Insurance Corporation of India had settled two life insurance policies of the deceased (Rs.5,00,000/- and Rs. 1,25,000/-), and the own-damage claim of the car was settled by Iffco-Tokio General Insurance Company Ltd. for Rs.3,80,000/-, ruling out suicide.

4. Opposite Parties No. 1 & 2 in their written statement/reply stated that:-

                   i) The death was not accidental but a suicide. They pointed out alleged discrepancies in the timing of leaving home (wife stated 8:30 PM, father stated 10:45 PM), the conduct of the alleged eyewitness (informing family instead of police), and forensic examination suggesting intentional driving into the canal.

                   ii) OP's relied on a private forensic investigation report dated 18.12.2015 from Rajdeep Consultants, which opined that the evidence suggested a "self-intentional suicidal attempt."

                   iii) OP's invoked Clause 6.1 of the policy (Disclosure to Information Norm & Fraud), claiming misrepresentation and concealment of material facts.

                   iv) OP's denied any deficiency in service and stated that the claim was repudiated after thorough analysis.

5. Opposite Parties No. 3 & 4 (Religare Finvest Limited) in their written statement stated that they are not necessary parties; they only provided loan/credit facility to M/s Punjab Palace, and the insurance premium was paid through the loan account. They have no privity of contract regarding the insurance claim and prayed for deletion from the array of parties.

6. This case was heard at length from both sides on various dates. The contentions of the parties are summed up as follows:

                   6.1 Complainants' contentions

                   a) The death of Shri Vikas Kumar Bhateja was clearly accidental, as confirmed by multiple police investigation reports (Annexures C-5, C-6, C-10). The SSP, Sri Muktsar Sahib, after thorough re-investigation, conclusively held that the death occurred due to accident and not suicide.

                   b) The settlement of LIC life insurance claims and the car's own-damage claim by another insurer further corroborates the accidental nature of death. The viscera report detected no poison.

                   c) The Opposite Parties' conduct is contradictory: on the same day (02.02.2017), they asked for documents and also repudiated the claim, showing a predetermined mind to reject the claim.

                   d) The private forensic report cannot override the statutory police investigation reports. The Opposite Parties have failed to discharge their burden to prove that the death falls within the exclusion clause of suicide.

                   e) The repudiation of the genuine claim amounts to deficiency in service and unfair trade practice.

                   6.2 Opposite Parties No. 1 & 2's contentions

                   a) The complainant has failed to prove accidental death beyond reasonable doubt. The alleged discrepancies in statements and the forensic evidence indicate suicide.

                   b) The alleged eyewitness Mr. Ram Kumar did not inform the police despite a police post being near the canal, which is highly suspicious.

                   c) The forensic report clearly shows that the steering wheel was locked and the tires turned towards the right side (not left, which would have been natural to avoid falling), indicating intentional driving into the canal.

                   d) The deceased was possibly under the influence of alcohol, and an alcohol bottle was found in the car.

                   e) Clause 6.1 of the policy entitles the insurer to forfeit the claim in case of misrepresentation or fraud. The claim was rightly repudiated.

7. Heard counsels for both sides. After hearing both sides, judgment was reserved on 27.02.2026.

8. The Complaint was filed on 16.03.2017. The cause of action arose on 02.02.2017 when the claim was repudiated. Hence, the Complaint is well within the limitation period of two years under Section 24A of the Consumer Protection Act, 1986.

9. Issue No. 1: Whether the death of Shri Vikas Kumar Bhateja was accidental or suicidal?

After careful consideration of the entire evidence on record, we hold that the death was accidental. Our findings are as under:

                   i) The police authorities conducted investigation under Section 174 Cr.P.C. and submitted a report dated 13.07.2015 confirming accidental death. Upon the request of the OPs, the matter was re-investigated by the - Superintendent of Police, Malout, who submitted a detailed report dated 23.04.2016 (Annexure C-5), duly approved by the SSP, Sri Muktsar Sahib on 28.04.2016, concluding that there is no evidence of suicide. The SSP again, after further re-investigation, submitted a final report dated 24.10.2016 (Annexure C-10) reiterating that the death was accidental.

                   ii) The viscera report dated 08.09.2016 (Annexure C-14) from the Chemical Examiner, Government of Punjab, clearly states "No poison detected" in the exhibits. There is no scientific evidence of any intoxicant causing or contributing to death.

                   iii) The Life Insurance Corporation of India settled two life insurance policies of the deceased (Annexure C-11). If the death were suicidal, LIC would not have settled the claims, as suicide is typically excluded. Similarly, the own-damage claim of the car was settled by Iffco-Tokio General Insurance Company Ltd. (Annexure C-12).

                   iv) The private forensic report relied upon by the OPs is not a statutory document and cannot override the findings of the police authorities. No criminal proceedings were initiated against the Complainants, nor was any charge of suicide proved in any court.

                   v) The alleged discrepancies (timing of leaving home, conduct of eyewitness) are minor and do not negate the overwhelming evidence of accidental death. The police have considered these aspects and still concluded that the death was accidental.

                   vi) The burden of proving that the claim falls within an exclusion clause (suicide) lies on the insurer. The Opposite Parties have failed to discharge this burden. Mere suspicion or conjecture is not sufficient.

10. Issue No. 2: Whether the repudiation of the claim was justified?

                   10.1 The repudiation letter dated 02.02.2017 merely states "DISCREPANCY IN MEDICAL DOCUMENTS; CONCEALMENT AND MISREPRESENTATION OF FACTS" without specifying any particulars. This is a vague and cryptic repudiation. Moreover, on the very same day, the OPs issued another letter asking for documents, which indicates lack of bona fides.

                   10.2 In Pioneer Urban Land & Infrastructure Ltd. Vs. Govindan Raghvan (2019) 5 SCC 725, the Hon'ble Supreme Court observed that one-sided clauses and unfair practices cannot bind the consumer. Though that case was in the context of real estate, the principle that insurers cannot act arbitrarily applies equally.

                   10.3 The Hon'ble Supreme Court in United India Insurance Co. Ltd. v. Pushpalaya Printers, (2004) 3 SCC 694 held that once the insured shows that the loss was caused by an accident, the burden shifts to the insurer to prove exclusion. The Opposite Parties have failed to prove suicide.

Therefore, the repudiation of the claim is wholly unjustified and amounts to deficiency in service.

11. Issue No. 3: Whether the Complainants are entitled to the sum insured and other reliefs?

                   11.1 Since the death has been held to be accidental and covered under the policy, the Complainants (nominee and legal heirs) are entitled to the sum insured of Rs. 1,55,46,400/-. However, the claim for interest @18% per annum is on the higher side. In the facts and circumstances, this Commission deems it appropriate to award interest @9% per annum from the date of repudiation (02.02.2017) till the date of actual payment.

                   11.2 The Complainants have suffered immense mental agony and harassment due to the arbitrary repudiation of the claim. They are entitled to the litigation costs to the tune of Rs. 1,00,000/-.

12. Issue No. 4: Whether Opposite Parties No. 3 & 4 are liable?

Opposite Parties No. 3 & 4 (Religare Finvest Limited) are the financiers who provided the loan against property. They facilitated the insurance policy by paying the premium from the loan account, but the policy was issued by Opposite Parties No. 1 & 2. The contract of insurance is between the deceased (now his nominees) and the insurer (OPs No. 1 & 2). There is no privity of contract between the Complainants and OPs No. 3 & 4 regarding the insurance claim. Moreover, the repudiation was done by OPs No. 1 & 2. No specific deficiency has been alleged or proved against OPs No. 3 & 4. Hence, they are not liable for any relief in this Complaint.

13. After careful consideration of the entire facts and circumstances of the case, we partly allow the Consumer Complaint with the following reliefs/directions:

                   (a) Opposite Parties No. 1 & 2 (Religare Health Insurance Company Limited) are jointly and severally directed to pay to the Complainants the sum insured of Rs. 1,55,46,400/- (Rupees One Crore Fifty-Five Lakhs Forty-Six Thousand and Four Hundred only).

                   (b) Opposite Parties No. 1 & 2 shall also pay interest @ 9% per annum on the said amount from the date of repudiation i.e. 02.02.2017 till the date of actual payment.

                   (c) Opposite Parties No. 1 & 2 shall further pay Rs. 1,00,000/- (Rupees One lakh only) as litigation costs.

                   (d) The entire amount as per above directions shall be paid within six weeks from the date of this order, failing which the total outstanding amount at the expiry of six weeks shall carry interest @ 12% per annum from the expiry of six weeks till actual payment.

                   (e) The Complaint against Opposite Parties No. 3 & 4 is dismissed with no order as to costs.

14. Pending IAs, if any, also stand disposed of.