Haryana

Fatehabad

CC/248/2017

Anil Kumar - Complainant(s)

Versus

ICICI Lombard General Insurance - Opp.Party(s)

Sandeep Dahiya

25 Jul 2018

ORDER

BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHABAD.

 

                                                                                    Complaint No.: 248 of 2017

                                                                                   Date of Institution: 28.09.2017

                                                                                                                                Date of order:  25.07.2018.

 

Anil Kumar aged 46 years, son of Shri Rati Ram, resident of village and Post Office Dahman, Tehsil and District Fatehabad.

 

                                                                          ….. Complainant.

                                          Versus                                           

 

1. ICICI Lombard General Insurance Company Limited, SCO 52, Commercial Urban Estate-II, Delhi Road, Hisar through its Divisional Manager.

 

2. State Bank of Patiala (having merged into State Bank of India), Branch Office Jakhal-Bhuna Road, Bhuna Branch, District Fatehabad through its Branch Manager.

 

 

….Opposite parties.

 

Complaint U/s 12 of the Consumer Protection Act

                                                                                                                                     

Before:                  Sh.Raghbir Singh, President.

                                              Sh. M.K. Khurana, Member.

 

               

Present:                                  Sh.Sandeep Dahiya, counsel for the complainant.

Sh.Vishnu Delu, counsel for the OP No.1.

None for OP No.2

 

ORDER:

 

                                The complainant has filed the present complaint under Section 12 of the Consumer Protection Act, 1986 against the opposite parties with the averments that he is owner of agriculture land measuring 22 Kanals 13 Marlas comprising in Khewat No. 171//157, Khatoni No. 214 situated in village Dahman, Tehsil and District Fatehabad.  It is further submitted that the complainant has also obtained a Kisan Credit Card Scheme from OP no. 2.  It is further submitted that Worthy Prime Minister of India launched a scheme namely Pradhan Mantri Fasal Bima Yojna (PMFBY) in April 2016 and under the abovesaid scheme OP no. 1 issued insurance policy to the complainant for the cotton crop sown in 1.5 acres of land.  Premium of insurance was deducted by OP no. 2 from the KCC account of the complainant.  It is further submitted that despite taking best precautions the abovesaid insured cotton crop was damaged considerably.  Therefore, the complainant approached to OP no. 2 and informed regarding the loss caused to the insured crop but initially the officials of OP no. 2 kept the matter pending on one pretext or the other and ultimately directed the complainant to contact OP no. 1.  The complainant on their direction informed the officials of OP no. 1 about the loss caused to the insured cotton crop on their toll free number.  Thereafter, the officials of OP no. 1 assured the complainant that their representative will carry inspection and the claim will be reimbursed very soon.  Thereafter, the complainant visited the OP no. 1 number of times but all in vain.  It is further submitted that the Field Inspection of the damaged area was done by the officials of the Agriculture Department, Haryana, wherein the loss to the insured crop has been shown as 80%.  It is further submitted that the complainant suffered a loss of about 80,000/- rupees in 1.5 acres of insured cotton crop.  The abovesaid act on the part of OPs amounts to deficiency in rendering service to the complainant.  The complainant has further prayed for a payment of Rs. 80,000/- on account of loss caused in the insured crop and Rs. 10,000/- as compensation along-with interest at the rate of 18% per annum.  Hence the present complaint.

2.                             On being served OP No.1 appeared through counsel and resisted the complaint by filing a written statement wherein various preliminary objections with regard to jurisdiction, cause of action, brevity of contract, non-joinder of necessary parties and late intimation etc. have been raised.

3.                             In reply on merits, It is submitted that the premium of insurance crop in the present case has been deducted by OP no. 2 after cut of date i.e. 31^st of July 2016.  Therefore, on this ground the claim of the complainant regarding the loss of cotton crop has been rejected as per terms and conditions of Pradhan Mantri Fasal Bima Yojna (PMFBY).  It is submitted by OP no. 1 that the complainant never supplied any documents in support of its case.  It is further submitted that the complainant did not intimate the OP no. 1 regarding loss within 48 hours from the time of occurrence of the damage which is mandatory as per provisions of the scheme.  The complainant never approached to the officials of the OP no. 1 and now has made a bogus and baseless story of contacting the officials of OP no. 1 just to grab the compensation.  It is further submitted that the crop insurance in the present case is a Group Insurance Scheme in accordance with agreed terms and conditions of the scheme, which are binding on all the concerned related to the scheme.  The complainant should have approached to DAC & FW Department for any kind of grievance related to the scheme.  However, instead of filing complaint before DAC & FW Department the complainant approached this Forum with a malafide intention to grab the money.  It is further submitted that in localized claims only 3 perils i.e. hailstorm, landslide and  inundation  affecting isolated farms in the notified area are covered.  However, the loss caused to the insured crop of the complainant is not covered under the abovesaid 3 perils and as such the insurance claim by the OP no. 1 is not payable.  The OP no. 1 have denied all the allegations made in the complaint and has further submitted that there is no deficiency on the part of OP no. 1 in rendering service to the complainant in the present case.  The present complaint is without any merits and as such the same is liable to be dismissed.

4.                             The OP no. 2 in its reply submitted that the complainant Shri Vijay Kumar has been availing Kisan Credit Card Limit bearing account no. 65183212322 of Rs. 2,27,000/- for cultivation of crops.  It is further submitted that OP no. 2 remitted Rs. 1100/- towards premium for insurance of cotton crop on agriculture land measuring 22 Kanals  13 Marlas (1.146 hectare) at village Dehman by debit from KCC account of Anil Kumar on 1.8.2016 under Pradhan Mantri Fasal Bima Yojna (PMFBY) to ICICI Lombard General Insurance Company Limited.  It is further submitted that the complainant was advised to lodge his claim with the District Authorities under the scheme.

5.                             Learned counsel for the complainant tendered in evidence affidavit of the complainant as Exhibit CW1/A and the documents as Annexure C-1 to Annexure C-4.  On the other hand, learned counsel for the OP no. 1 tendered in evidence affidavit of Apurva Sharma as Exhibit OPW1/A.

6.                             The learned counsel for the complainant in his arguments contended that the complainant is having K.C.C. account bearing number 65183212322 with OP no. 2.  The OP no. 1 issued insurance of cotton crop sown by the complainant in 1.5 Acres  of agriculture land situated in village Dahman and a total premium of Rs. 1100/- was debited on 1.8.2016 from his KCC account by OP no. 2 as premium of insurance of cotton crop. The insurance of the abovesaid crop was issued at the rate of Rs. 24000/- per acre.  The said insurance was issued by OP no. 1 under the scheme namely Pradhan Mantri Fasal Bima Yojna.  It is further contended by the learned counsel that unfortunately on account of heavy rains and flood the insured cotton crop of the complainant was considerably damaged.  Therefore, on the application of the complainant submitted in Agriculture Department, Haryana, the abovesaid agriculture land of the complainant was inspected by team consisting of Agricultural Development Officer and Sh. Rakesh Loss Assessor representative of OP no. 1.  After inspection the inspecting team assessed the loss to the tune of 80%.  It is further contended by the learned counsel that OP no. 1 being insurer is liable to indemnify the complainant in respect of the losses suffered by him.  Therefore, the complainant requested the OP no. 1 for making payment of the compensation but all in vain. The learned counsel further contended that the case of the complainant for grant of insurance claim by OP no. 1 is fully covered under the terms and conditions of the policy and moreover similar situated farmers whose cotton crop insurance had been issued had already been indemnified by the OP no. 1.  The non-payment of insurance claim to the complainant by OP no. 1 falls within the definition of deficiency on its part in rendering service to the complainant.  The learned counsel further prayed that the present complaint may be accepted and OP no.1 may be directed for a payment of Rs. 80,000/- to the complainant on account of damage of insured crop along-with compensation for mental agony and physical harassment suffered by him. 

7.                             On the other hand, the learned counsel for OP no. 1 vehemently rebutted the contentions raised by learned counsel for the complainant and reiterated the averments made in the written statement filed by OP no. 1.  It is also contended by the learned counsel that as per scheme the premium from the account of complainant was to be debited by OP no. 2 before 31^st of July 2016.  However, in the present case the premium was debited on 1.8.2016 by OP no. 2 and as such the OP no. 1 is not liable for making payment of insurance claim to the complainant. It is further contended by learned counsel that the damage caused to the insured crop of the complainant is not covered under the localized claim.  In the localized claims 3 perils i.e. hailstorm, land slide and inundation affecting isolated farmers are covered.  However, the loss caused to the insured cotton crop of the complainant in the present case was due to heavy rains and speedy winds.  Therefore, the insurance claim of the complainant is not covered in the localized claims/risks.  The learned counsel further contended that only localized claims/risks were to be decided by the insurance company and other risks of coverage were to be handled by the Government Agencies.  The learned counsel also contended that as per notification dated 17.6.2016 issued by State Government the isolated/individual farmers are not covered, whereas the damage caused to the insured cotton crop of the complainant falls within the purview of Group Insurance Schemes and the same was to be handled and finalized by Government Agencies.  The learned counsel further contended that as per terms and conditions of the policy an intimation regarding the loss was to be given by the complainant within 48 hours from the time of occurrence of the damage.  However, in the present case the information was furnished by the complainant after expiry of 48 hours.  It is also contended by the learned counsel that the complainant before approaching this Forum should have approached DAC and FW Department for any kind of grievance related to the scheme or for claim and as per the terms and conditions of the insurance policy the decision of the said department would be binding on all the parties.  It is further contended by the learned counsel that there is no deficiency on the part of the OP no. 1 in rendering service to the complainant and as such the present complaint is liable to be dismissed.

8.                             The learned counsel for OP no. 2 in his arguments contended that the complainant is only maintaining KCC account with OP no. 2 and OP no. 2 paid amount of premium to OP no. 1 on behalf of the complainant and no other role is there on the part of OP no. 2.  It is further contended by the learned counsel that as per the site inspection report prepared by the Agriculture Department the loss of cotton crop of the complainant is to the tune of 80%.  Therefore, if there is any claim regarding the alleged damage even then the complainant can claim only 80% from OP no. 1 and not from OP no.2.  It is further contended that there is no deficiency on the part of OP no. 2 in rendering service to the complainant in the present case and as such the same is liable to be dismissed against OP no. 2.

9.                             We have duly considered the arguments advanced by learned counsel for the parties and have also perused the entire material placed on record. It is the case of the complainant that under the scheme namely Pradhan Mantri Fasal Bima Yojna (PMFBY) the OP no. 1 issued insurance of cotton crop sown in 1.5 Acres of land of the complainant for the year 2016.  Since the complainant was a KCC account holder as such the total premium amounting to Rs. 1100/- was debited from his account by OP no. 2.  The cotton crop was insured by OP no. 1 for an amount of Rs. 24,000/- per acre.  It is further the case of the complainant that the insured cotton crop of the complainant was damaged considerably by heavy rains and flood.  On the application submitted by him to Agriculture Department of Haryana the insured crop was inspected on 17.11.2016. The inspecting team comprising of Agriculture Development Officer and the Loss Assessor i.e. the representative of OP no. 1 vide report dated 17.11.2016 observed that there is a loss of 80% in  1.5 Acres of insured area on account of heavy rains and speedy winds.  Therefore, it was the liability of OP no. 1 to indemnify the complainant for the damage occurred in the insured crop.  In support of his case the complainant tendered an affidavit in his evidence wherein the averments made in the complaint have been affirmed.  The complainant also placed on record copy of Inspection Report dated 17.11.2016 (Annexure C-4), copy of Jamabandi (Annexure C-1), copy of Girdawari (Annexure C-2), copy of KCC Account with OP no. 2 (Annexure C-3).  The complainant also placed on record the document vide which information under PMFBY was sent by Deputy Director Agriculture Fatehabad to joint Director Statics Haryana regarding survey of loss and information sent by the OP no. 1 under RTI regarding insurance claims lodged by the insured farmers.

10.                           No doubt, insurance scheme was launched by Union of India as Pradhan Mantri Fasal Bima Yojna and certain guidelines were framed regarding the regulations of terms and conditions of the insurance, coverage of the crops and the coverage of the area and it was suggested in the scheme that concerned State Governments will issue the notification in consonance with the scheme.  In pursuant to that the State of Haryana issued a notification through Haryana Government Agriculture and Farmers Welfare Department on 17.6.2016 in which relevant points were notified as under:-

   1.                          Crops to be covered (Notified crops)

                                Cotton, Paddy, Bajra and Maize crops will be covered during Kharif 2016 & Wheat, Barley, Mustard and Gram Crops during Rabi 2016-17.

    2.                        Insurance Unit (IU)

                                The PMFBY will operate on the principle of “Area Approach” in the Insurance Unit (IU).  The IU will be the revenue estate (village).

3.          Area to be covered

                                The PMFBY will be implemented in the entire State on cluster approach.

4.         Coverage of Risks and Exclusions

                                The following stages of the crop and risks leading to crop loss will be covered under the scheme.

1. Prevented Sowing/Planting Risk: Coverage of risk in case the insured area is prevented from sowing/planting due to deficit rainfall or adverse seasonal conditions.
2. Standing Crop (Sowing to harvesting): Comprehensive risk insurance will be provided to cover yield losses due to non-preventable risks, viz. Drought, Dry spells, Flood, Inundation, Pests and Diseases, Landslides, Natural Fire and Lightening, Storm, Hailstorm, Cyclone, Typhoon, Tempest, Hurricane and Tornado.
3. Post – Harvest Losses: Coverage will be available only up to a maximum period of two weeks from harvesting for those crops which are allowed to dry in cut and spread condition in the field after harvesting against specific perils of cyclone, cyclonic rains and unseasonal rains.
4. Localized Calamities: Loss/damage resulting from occurrence of identified localized risks of hailstorm, landslide and inundation affecting isolated farms will be covered.  General Exclusions: Losses arising out of war and nuclear risks, malicious damage and other preventable risks will be excluded.

5. Implementing agencies

1. Cluster – I               Reliance General Insurance Company Ltd.
2. Cluster – II              Bajaj Allianz General Insurance Company Ltd.
3. Cluster – III             ICICI Lombard General Insurance Company Ltd.

6. Farmers to be covered

1. All farmers including share – croppers and tenant farmers growing the notified crops in the IU will be eligible for coverage under the scheme.
2. All farmers availing Seasonal Agricultural Operations (SAO) loans from Financial Institutions (i.e. loanee farmers) for the notified crops would be covered compulsorily.
3. The scheme will be optional for the non-loanee farmers.

7. Indemnity Level

The indemnity level will be 90% in case of all the notified crops.

 

11.                           In the present case it is not disputed that OP no. 1 had issued insurance of cotton crop sown in 1.5 Acres of agriculture land of the complainant.  It is also not disputed that premium of Rs. 1100/- was debited through OP no. 2 from the KCC account of the complainant for insurance of the cotton crop at the rate of Rs. 24,000/- per acre.  It is also not in dispute that on the basis of complaint submitted by the complainant the insured crop was inspected on 17.11.2016 by a team comprising of Agriculture Development Officer and Loss Assessor i.e. the representative of OP no. 1.  It is also not disputed that vide inspection report dated 17.11.2016 (Annexure C-4) the inspecting team observed that there is a loss to the tune of 80% in 1.5 Acres of insured area wherein cotton was sown.  Vide inspection report Annexure C-4, it is also observed that damage had occurred to the insured crop on account of heavy rains and speedy wind.

12.                           The OP no. 1 has contested the present complaint inter-alia on the ground that the premium of the complainant was debited by OP no. 2 on 1.8.2016 i.e. after the cut off date for debiting the premium.  However in its pleadings and evidence the OP no. 1 has nowhere clarified that the premium received by OP no. 1 from OP no. 2 for insurance was refunded to OP no. 2 or not.  The OP no. 2 in its reply has submitted that the debited premium was handed over to OP no. 1.  Since the premium for insurance was received and utilized by OP no. 1 and as such the plea taken by OP no. 1 is not tenable.  It is also the case of OP no. 1 that only localized claims/damages are to be decided by the insurance company and other risks are to be handled by the Government and in the localized claims/damages only three types of perils/calamities i.e. hail storm, landslide and inundation  whereas in the present case the damage to the insured crop is on account of heavy rains and speedy winds and as such the same is not payable.  As per the written statement filed by the OP no. 1 the case of the complainant for grant of insurance claim was processed and the same was declined on the ground that the peril of heavy rains and speedy wind is not covered under the localized claims/risks.  However after examining the material placed on record and considering the legal position involved in the present case, we are of the opinion that the abovesaid ground taken by OP no. 1 for declining the claim is not tenable.  The spirit and object behind the scheme is to protect the insured/farmers crops against the natural perils/calamities and adverse weather conditions.  Undoubtly, heavy rains and speedy winds are adverse weather conditions for the cotton crop.  If mis-guided and narrow interpretations are taken by the implementers of the beneficial scheme than its very objective and purpose will be defeated.  In the present case as per Inspection Report Annexure C-4 the damage to the insured cotton crop has occurred on account of heavy rains and speedy wind.  It is a thing of common knowledge that inundation/water logging in the crops is caused on account of heavy rains.  Therefore, we are of the considered opinion that damage caused to the insured cotton crop is covered under the localized risks.  Moreover, the Hon’ble National Commission in case titled as Oriental Insurance Company Vs. M/s R.P. Bricks cited as 2013 (2) CPJ 613 has held that loss caused due to heavy rains is covered under the definition of inundation.  The judgment rendered by the Hon’ble National Commission, New Delhi in case titled as Agriculture Insurance Company of India Vs. Kishan Lal and others and cited as 2014 (1) CPJ 391 is also relied upon. 

13.                           It is also pertinent to mention here that in similarly situated cases wherein the damage to the insured cotton crop was caused on account of heavy rains and speedy wind the OP no. 1 has already paid insurance claim to the insured land owners.  From perusal of the record, it is evident that an amount of Rs. 49,444/- has been paid as crop insurance to Sh. Suresh Kumar son of Om Parkash, resident of village Bangaon on 3.10.2017 and Rs. 102642/-  has been paid to Sanjiv Kumar son of Om Parkash on 3.10.2017.  The cases of Suresh and Sanjeev are similarly situated and in both the cases the damage was caused to the insured cotton crop by heavy rains and speedy wind, copy of inspection report in case of Sanjiv Kumar is Mark “A”. From perusal of the record it is revealed that in reply to an R.T.I. the Op No.1 has furnished a list of 318 insurance claims lodged in Fatehabad District under the abovesaid scheme. A perusal of the list further reveals that OP No.1 has decided the claims as payable in at least 10 cases i.e. at serial No.60, 74, 78, 111, 141, 151, 200, 238, 249, 277 wherein damage has been caused to the cotton crop on account of heavy rains and speedy winds. The policy of pick and choose in the payment of insurance claim adopted by OP no. 1 is not justified.  Therefore, declining the payment of insurance claim to the complainant by OP no. 1 on ground that the damage caused to the cotton crop is not covered under the localized risk/claim, is not sustainable in the eyes of law.

14.                           As discussed above, it is not disputed that insurance of the cotton crop of the complainant was issued by OP no. 1 against perils/natural calamities and adverse weather conditions.  It is also not disputed that the OP no. 1 has received premium in time for the said insurance.  It is also not disputed that the insured cotton crop of the complainant was damaged due to adverse weather conditions/natural calamity i.e. heavy rains and speedy wind.  Therefore, we are of the considered opinion that the claim of the complainant is a bonafide claim.  It is a settled proposition of law that a genuine/bonafide insurance claim cannot be repudiated on the technical ground of delay or procedural lapses.  Rejection of the claims on purely procedural grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry.  The spirit of insurance policy be kept in mind while deciding the insurance claim.  It is also pertinent to discuss here that the complainant is a KCC account holder and in his case as per policy issued by the Government of India the crop insurance is mandatory and as such the premium of insurance was debited from his account without his consent and knowledge and no terms and conditions of insurance policy was issued to him.  Moreover, in its reply the OP no. 1 has not mentioned that the terms and conditions of the policy were issued to the complainant.  Therefore, we are of the considered opinion that the claim of the complainant cannot be denied on the ground of any delay of some days in giving intimation or any other procedural lapse on the part of the complainant.  Reliance is placed on the judgment recorded by Hon’ble State Commission, Haryana in case titled as Shriram General Ins. Company Ltd. Vs. Rajesh Kumar 2014 (2) CLT 390 (HR).

15.                           So, in view of the aforesaid discussion, we are of the considered opinion that the complainant has been able to prove deficiency on the part of OP no. 1 in rendering service to the complainant.  The present complaint is accordingly allowed.

16.                           Regarding quantification of loss, it is submitted that as per inspection report Annexure C-4, the total damaged area is 1.5 Acres.  As per Annexure C-4, the complainant has suffered a loss of 80% of insured crop in 1.5 Acres.  As per terms and conditions of the policy, the OP no. 1 had insured the cotton crop in question at the rate of Rs. 24,000/- per acre.  So, keeping in view the 80% loss the complainant has suffered a loss of Rs. 19,200/- in one acre and Rs. 28,800/- in 1.5 acres of the total insured area.  Therefore, the OP no. 1 is directed to make a payment of Rs. 28,800/- (Rs.Twenty Eight Thousand Eight Hundred only) to the complainant alongwith interest at the rate of 6% from the date of filing of the present complaint till its realization.  The OP no. 1 is also further directed for making a payment of Rs. 3,100/- (Rs.Three thousand one hundred only) as litigation charges to the complainant.  The abovesaid order be complied with within a period of 45 days, otherwise the abovesaid amount shall carry an interest at the rate of 9% per annum during the period of default.  No deficiency is found on the part of OP no. 2.  The present complaint is accordingly disposed of. Copy of this order be supplied to both the parties free of cost.  File be consigned to the record after due compliance.

Announced in open Forum.                                                                                           Dated:25.07.2018

       (Raghbir Singh)                                                                                                                             

     President                                                                                                      (M.K.Khurana)                                                

   Distt. Consumer Disputes                                                                                   Member

  Redressal Forum, Fatehabad.