Haryana

Yamunanagar

CC/1235/2011

Adityaveer Singh S/o K.V.Singh - Complainant(s)

Versus

Ashok Sawhney - Opp.Party(s)

V.S.Chauhan

19 Feb 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                                    Complaint No. 1235  of 2011.

                                                                                                    Date of institution: 15.12.2011

                                                                                                    Date of decision:  19.02.2016

Adityaveer Singh son of Shri K.V.Singh, resident of Village Unehri, Tehsil Jagadhri, District Yamuna Nagar.                                                                                                                                                                                                                                                                                                                                                                                                   …Complainant.

                                                                       Versus

1. Mr. Ashok Sawhney, Branch Manager, The Oriental Insurance Company Limited, Opposite Hindu Girls College, Ist Floor, Court Road, Jagadhri, Distt. Yamuna Nagar.
2. The Oriental Insurance Company Limited, Regd. Office: Oriental House, A-25/27. Asaf Ali Road, New Delhi-110002, through its M.D.                                                        
3. The Oriental Insurance Company Limited, Regional Office, LIC Building, 2^nd Floor, Jagadhri Road, Ambala Cantt-133001 through its Manager.                                                                                                                                          

                                                    

                                                                                                                                                                           …Respondents.  

Before:               SH. ASHOK KUMAR GARG, PRESIDENT

                          SH. S.C.SHARMA, MEMBER

Present: Sh. Vikrant Chauhan, Advocate, counsel for complainant.   

              Sh. Karnesh Sharma, Advocate, counsel for respondents.  

 

ORDER

1.                     Complainant Adityaveer Singh has filed the present complaint under section 12 of the Consumer Protection Act 1986 praying therein that the respondents (hereinafter referred as OPs) be directed to pay Rs. 50,000/- value of the cow alongwith interest as well as compensation for mental agony, harassment, economic loss, cost of proceedings etc.

2.                     Brief facts of the present case as alleged by the complainant are that he is running a cattle dairy since last many years and the said dairy is covered under the policy of Haryana government named as High Tech Dairy Scheme which is sponsored scheme of State Government and got insured the cattles from the respondents vide policy No. 261701/47/2011/010131 valid from 09.02.2011 to 08.02.2012 with the OPs and paid a sum of Rs. 17,100/- as premium for his cows & buffalos to the OPs. Hence, there exist relationship of consumer and service provider between the parties. On 19.2.2011, a cow of complainant bearing Tag No. 795130 had expired due to disease cover under the risk of the policy and postmortem was duly conducted of the said cow by the Veterinary Surgeon, Jathlana, District Yamuna Nagar. The complainant duly informed the OPs regarding the death of his cow which was duly insured with the OPs and put forth his claim form bearing No. 2610701/47/2011/000038 alongwith all the requisite documents and the OPs assured the complainant that the claim of the said cow would be approved very soon but the OPs lingered on the matter with one pretext or the other. The complainant made a number of references by appearing in the office of OPs in person as well as through correspondence but the OPs repudiate the claim of complainant vide letter dated 1.6.2011 on frivolous and baseless reasons. Finding no other alternative the complainant got served a registered AD legal notice dated 28.7.2011 to the OPs through his counsel but neither the OPs gave any reply of the notice nor complied with the same which shows the malafide intention of the OPs. As such, the Ops have arbitrarily and illegally manner repudiated the claim of complainant. Hence this complaint. 

3.                     Upon notice, opposite parties appeared and filed written statement taking some preliminary objections such as complaint is not maintainable, no territorial jurisdiction, non joinder and mis joinder of necessary parties, no locus standi to file the present complaint and on merit it has been mentioned that the insurance policy contains terms and conditions which were accepted and agreed to by the insured at the time of purchasing the insurance policy. On receiving the intimation regarding the death of one cow, the OPs immediately registered the claim and deputed Mr. Anil Kumar Sharma, Investigator, who had submitted his investigation report dated 18.03.2011(Annexure R-5). The claim of the complainant was processed expeditiously and after observing the documents, it was found that the alleged cattle died on 19.02.2011 within the clause of 15 days waiting period, under which the claim was not payable. The complainant was informed about the fate of his claim vide registered letter dated 01.06.2011 (Annexure R-1). As such, the claim of the complainant does not fall within the ambit of the terms and conditions of the insurance policy and the same was legally and rightly repudiated vide letter dated 1.06.2011. Lastly, learned counsel for OPs prayed that there is no deficiency in service on the part of the OPs, hence, the complaint deserves dismissal. 

4.                     To prove the case, counsel for the complainant has tendered into evidence, affidavit of complainant as Annexure CW/A and documents such as Photo copy of Postmortem report Annexure C-1, Photo copy of registered AD letter dated 28.7.2011 as Annexure C-2, Postal receipts as Annexure C-3, Photo copy of certificate issued by Gram Panchyat Unheri regarding death of cow as Annexure C-4, Photo copy of insurance policies as Annexure C-5 and closed the evidence on behalf of complainant.

5.                      On the other hand, counsel for OPs has tendered into evidence affidavit of Sh. R.S.Kalra, Divisional Manager, OIC Ltd. Yamuna Nagar as Annexure RX and documents such as Photo copy of repudiation letter as Annexure R-1, Photo copy of cover note as Annexure R-2, Photo copy of insurance policy as Annexure R-3, Photo copy of cattle insurance scheme as Annexure R-4, Photo copy of surveyor report as Annexure R-5, Photo copy of Postmortem report as Annexure R-6 and closed the evidence on behalf of OPs.

6.                            We have heard learned counsel for both the parties and have gone through the pleadings as well as documents carefully and minutely placed on the file. Counsel for the complainant reiterated the averments made in the complaint and prayed for its acceptance whereas the counsel for opposite parties reiterated the averments made in reply and prayed for its dismissal.

7.                     it is admitted fact that the complainant got insured his Cows & Buffalos with the OPs for Rs. 40,000/- each after paying premium of Rs. 17100/- vide insurance policy bearing No. 261701/47/2011/1013 valid from 09.02.2011 to 08.02.2012 and one cow bearing tag No. 79530 died during the subsistence of the policy in question. It is also admitted fact that claim was lodged by the complainant with OPs which was repudiated by the OPs vide its letter dated 01.06.2011 (Annexure C-1). The onus to prove this fact that whether the claim was rightly repudiated is on the OPs and to substantiate its contention, the learned counsel for the OPs argued that the said cattle died on 19.02.2011 due to diseases within 15 days from the inception of the policy i.e.within the clause of 15 days waiting period and in support of his contention he has placed reliance upon the report of Surveyor Annexure R-5. Per Contra, complainant counsel argued that the cow was insured for the period from 09.02.2011 to 08.02.2012 and died on 19.02.2011 after 10 days from the date of insurance due to acute tymphony which does not prove that the cow was having any disease prior to obtaining the policy.  

8.                     We have considered the contention of the parties. Annexure C-1 is the postmortem report of the dead cow. In the postmortem report, it has been mentioned that the cow died due to acute temphony whereas the Surveyor has clearly mentioned that he met the Sarpanch of village and verified that the insured cow died all of sudden today on 19.02.2011. As such it is clear that there was no disease prior to taking the insurance policy. Moreover, the insurance policy was issued for a period of one year i.e. from 09.02.2011 to 08.02.2012 and not for a period of one year after reducing 15 days of waiting period from 24.02.2011 to 23.02.2012. In other words if 15 days waiting period is reduced from one year the insurance policy either will extent for 15 days from 24.02.2011 to 23.02.2012 or it will be for 11 months 15 days instead of one year but the OP did not do so.  So, we are of the view that the contention of the OPs that the cow died within 15 days’ waiting period is not tenable as OPs have wrongly repudiated the claim of the complainant.   .

9.                     In view of the above discussion, we are of the confirmed opinion that the respondent company has committed an error in repudiating the claims of complainant on the basis of report of investigator and loss assessor which is not based on any solid ground.  Thus the repudiation letter dated 1.6.2011 (Annexure R-1) is liable to be set aside and the act of the opposite parties in repudiating the claim of the complainant amounts to deficiency in service and the complaint of complainant deserve acceptance.

10                    Resultantly, we partly allow the present complaint of the complainant and direct the OPs Oriental Insurance Company to pay a sum of Rs. 38,000/-as insured amount to the complainant alongwith interest at the rate of 7% per annum from the date of filing of complaint till its realization and also to pay Rs. 2000/- as compensation and cost  of litigation expenses within 30 days failing which the complainant is at liberty to initiate the legal proceedings against the opposite parties Insurance Company as per law. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court: 19.02.2016.

                                                                                          (ASHOK KUMAR GARG)

                                                                                           PRESIDENT

 

                                                                                          (S.C.SHARMA)

                                                                                           MEMBER