Punjab

Fatehgarh Sahib

CC/120/2014

PARAMJIT Kaur - Complainant(s)

Versus

ICICI lombard comp ltd - Opp.Party(s)

Sh Jasveer Singh

09 Sep 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, FATEHGARH SAHIB.

                                                             Consumer Complaint No.120 of 2014

                                                                                                    Date of institution:  02/09/2014                                                                                                                                Date of decision   :  09.09.2015

Paramjit Kaur aged about 48 years wife of Sh. Surinder Singh, resident of village Barkatpur, P.O. Latour, Tehsil and District Fatehgarh Sahib.

……..Complainant

Versus

The Manager, ICICI Lombard, General Insurance Company Ltd. Space No. 1-5, 3^rd Floor, Kanal Tower, 88, Mall Road Ludhiana-141001.

       …..Opposite party         

Complaint under Sections 12 to 14 of the Consumer Protection Act

Quorum

Sh. Ajit Pal Singh Rajput, President                                       Sh. Amar Bhushan Aggarwal, Member  

Present :    Sh. Jasveer Singh, Adv.Cl. for the complainant.                              Pt. Narinder Kumar, Adv.Cl. for the OP

ORDER

By Sh. Ajit Pal Singh Rajput, President.

                  Paramjit Kaur, aged about 48 years, wife of Sh. Surinder Singh, resident of village Barkatpur, P.O. Latour, Tehsil and District Fatehgarh Sahib, has filed this complaint against the Opposite party (hereinafter referred to as “the OP”) under Sections 12 to 14 of the Consumer Protection Act. The brief facts of the complaint are as under:

2.               The complainant got insured her buffalo Mix Murra, vide policy No.4057/78118999 against Tag No.100061257 from opposite party. On 30.07.2013 the said buffalo suddenly died and Dr. Gurdarshan Singh, Veterinary Officer, P.A.H.S.-1, conducted post mortem upon the dead body of buffalo on 01.08.2013. The surveyor of opposite party also visited the spot and conducted inquiry about the matter. The complainant submitted relevant papers for completing necessary formalities on 14.08.2013 as per terms and conditions of said policy but opposite party did not disburse the claim amount. The complainant also served a legal notice to the opposite party through counsel but all in vain. The OP Illegally repudiated the claim on the ground “Death due to mismanagement of farm or stable”, which amounts to deficiency in service. Hence, this complaint for giving directions to the opposite parties to pay Rs. 50,000/- as claim amount, Rs.30,000/- as compensation on account of un-necessary harassment and mental pain and Rs.10,000/- as cost of litigation.

3.               The complaint is contested by opposite party. In reply to the complaint the OP took preliminary objections that the present complaint is bad for non-joinder of necessary parties; the complaint being frivolous and false is liable to be dismissed under Section 26 of the Consumer Protection Act and the present complaint is not maintainable. On merits the OP stated that the cow having tag bearing No. IL10006125 was insured  with it for the period from 13.05.2013 to 12.05.2016 subject to terms and conditions of the policy.  After getting the information regarding the death of alleged cattle, the complainant was allotted claim number GEN000103152 and appointed Daljinder Singh, Surveyor, for looking into the claim.  The said Surveyor visited the place of occurrence and collected documents.  From the documents submitted by the complainant, it was found that the cattle was sick for the last seven days from the date of death and was got treated by Dharmjeet Singh, V.I., who was not an authorized veterinary doctor. The cattle was not taken to any authorized veterinary doctor for treatment due to which the condition of the cattle deteriorated and the cattle died on 30.07.2013 due to mismanagement, which is a clear cut violation of the terms and conditions of the policy. Therefore, the claim was rightly repudiated and there is no deficiency in service on the part of OP. After denying the other averments made in the complaint, it prayed for dismissal of the complaint.

4.               In order to prove the case, the complainant tendered his affidavit Ex. CW1/A, copy of policy Ex. C-1, photographs Ex. C-2, copy of treatment certificate Ex. C-3, copy of post mortem report Ex. C-4, photographs Ex. C-5 to C-8,  copy of cattle insurance claim documents checklist Ex. C-9, copy of claim form Ex. C-10, copy of receipt of cattle claim certificate Ex. C-11, copy of letter dated 09.09.2013 Ex. C-12, copy of legal notice Ex. C-13, postal receipt Ex. C-14, affidavit of Surinder Singh Ex. C-15 and closed the evidence. In rebuttal the OP tendered in evidence affidavit of Meenu Sharma, Legal Manager, Ex. OP-1, true copy of letter dated 09.09.2013 Ex. OP-2, true copy of certificate of insurance Ex. OP-3,  true copy of survey report Ex. OP-4, true copy of treatment certificate Ex. OP-5 and closed the evidence.

5.               The ld. counsel for the complainant has pleaded that the OP has repudiated the claim of the deceased cow of the complainant in an illegal and arbitrary manner. He stated that the complainant had submitted all the documents with the claim form as required by the opposite party. The ld. counsel also stated that due medical attention was given to the animal and it was also got treated from an authorized Vet of the Village. The ld. counsel argued that it is well established from the evidence produced by the complainant that due procedure was adopted by the complainant in order to procure the claim amount of the deceased animal. The ld. counsel also placed reliance on the case titled as The Oriental Insurance Co. Ltd Vs. Satpal Singh & others in 2014(2)CLT 305(NC).

6.               On the other hand, the ld.counsel for the OP stated that the claim had been rightly repudiated, vide letter dated 09.09.2013 i.e Ex.   OP-2, wherein it is mentioned that the claim has been rejected due to          “mismanagement of farm or stable(Animal not treated by an Authorized Doctor)”. He submitted that it is clearly stated in Ex-OP3(colly) terms and conditions, exclusion clause 13 reads as “ Death due to mismanagement of farm or stable( if animal is not treated by authorized government Vet Doctor/ if animal is not treated if sickness is more than 3 days”. The ld. counsel pleaded that the surveyor in the surveyor report i.e Ex.OP-4 has also found in his investigation that the animal had been ill since 7 days prior to its death and was found to be treated by namely; Dharamjeet Singh, Vet Inspector. The ld. counsel argued that the case law citied by the ld. counsel for the complainant is not applicable to the case in hand as, in the pleadings and statement i.e Ex.CW1/A in para no. 4, the complainant has admitted that the claim was filed as per the terms and conditions of the Policy and moreover now at the stage of arguments complainant cannot raise a issue, which had never been pleaded by the complainant. The ld. counsel made a submission that it is very much evident from the evidence led by the OP, that no deficiency of service has been committed by the OP while rejecting the claim of the complainant.

7.               After hearing the Ld. Counsel for the parties and going through the pleadings and evidence produced by them and oral as well as written submissions, we find that the complainant in her statement i.e Ex-CW1/A and her pleadings has nowhere stated that alongwith the Policy, she never received the terms and conditions i.e Ex-OP3(colly). We agree with the submissions made by the ld. counsel for the OP that, it is well established from survey report Ex. OP-4 and treatment certificate Ex. OP-5 that the deceased animal of the complainant was got treated by Dharamjeet Singh, Vet Inspector, who was not an authorized vet doctor and this amounted to violation of terms and conditions of the Policy i.e Ex-OP3(colly). In our view the claim had been rejected as per exclusion clause 13 which reads as “mismanagement of farm or stable(Animal not treated by an Authorized Doctor)”. Hence in our opinion, in the present case the complainant, in order to prove her claim, has to lead voluminous evidence, which is not possible before this Forum, as this Forum can only adjudicate in a summary manner. Accordingly, in view of our aforesaid discussion, we are of the opinion that OP has not committed any deficiency of service in view of the terms and conditions of policy i.e Ex-OP3(colly). Hence, the present complaint is disposed of with liberty to the complainant to approach the appropriate Court of law, in case she wishes to prove or lead voluminous evidence and may also be entitled to the benefit of the observations of the Hon’ble Supreme Court in Laxmi Engineering Works Vs. P.S.G. Industrial Institute II(1995) CPJ 1 (SC), for the purpose of exclusion of time spent before this Forum. Parties to bear their own cost.

8.               The arguments on the complaint were heard on 03.09.2015 and the order was reserved. Now the order be communicated to the parties. Copy of the order be sent to the parties free of cost and thereafter the file be consigned to the record room.

Pronounced

Dated:09.09.2015                                                                                                             (A.P.S.Rajput)                                                                                                                                                                  President

 

                                          (A.B. Aggarwal)                                                                                          Member