Belgavi District Commission Holds HDFC Ergo Liable For Non-Settlement Of Personal Accident Claim

The Additional District Consumer Disputes Redressal Commission, Belgaum bench comprising Mahantesh Shigli, President and Girishagouda Patil, Member has held HDFC Ergo General Insurance Co. Ltd. liable for not settling the personal accident claim of the complainant for Rs. 15 lakhs on account of death of her deceased insured husband. Brief facts: The complainant's deceased husband was the R.C owner of a four-wheeler car and a two wheeler bike. The car was insured with HDFC Ergo General Insurance Co. ('insurer') with risk cover of personal accident policy and paid a separate premium of Rs. 375/-. The insurer was to pay a sum assured of Rs. 15 lakhs for personal accident. The policy was valid from 28.01.2025 to 27.01.2016. The complainant was the nominee of the policy for car insurance. On 23.03.2025, the complainant's husband ('insured') was proceeding on his two-wheeler and met with an accident by losing complete control over his motorcycle. The insured was then admitted to the Kurnool government hospital and the crime was also registered under Section 173 of the Bharatiya Nagarik Suraksha Sanhita (BNSS). On 24.03.2025, the complainant's son informed the insurer about the accident and on the instructions of the insurer, the complainant filled the form claiming Rs.15 lakhs as sum assured. As per the complainant, all documents were submitted along with the application however, the insurer failed to process the claims. Despite issuance of a legal notice, the grievance remained unresolved. Hence, a complaint was filed by the complainant before the district consumer commission praying for appropriate compensation. No one appeared on behalf of the insurer. Hence, the commission proceeded ex-parte against the insurer. Observations of the commission: The bench examined all the documents filed by the complainant including the policy, legal notice and R.C book of vehicle. Further, the bench placed reliance on the circular dated 11.12.2018 issued by Insurance Regulatory & Development Authority of India (IRDAI), amended in 2019, as per which single Personal Accident cover shall provide coverage for all their vehicles. It was observed that the policy was issued in the name of the deceased insured person and premium was also charged for personal accident claim coverage. It was further observed that once a policy is issued by the insurer after verification of all relevant documents, then the company cannot avoid its liability. Thus, it was held that the act of the insurer in not settling the claim of the complainant was not in accordance with law and amounts to deficiency in service. Thus, the complaint was allowed with the following reliefs: Personal accident claim of Rs. 15 lakhs with interest @9% p.a. Rs. 25,000 for mental agony and inconvenience Rs. 10,000 as litigation costs Case Title: Smt. Baklavva vs Branch manager, HDFC Ergo General Insurance Case Number: Complaint No. 227/2025 Advocate for complainant: Rohit N Latur Date of Decision: 26.08.2025Click Here To Read/Download The Order

Belgavi District Commission Holds HDFC Ergo Liable For Non-Settlement Of Personal Accident Claim

Aakanksha Bajoria

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