Punjab

Nawanshahr

CC/67/2019

Ajay Paul - Complainant(s)

Versus

Manager Future Generali Insurance - Opp.Party(s)

Sh Baljit Singh Rai

09 Jan 2020

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SHAHEED BHAGAT SINGH NAGAR

 

Consumer Complaint No.67of 23.07.2019

           Date of Decision            :  09.01.2020

 

Ajay Paul s/o Sh.Surinder Kumar, aged  about 38 years VPO, Kathgarh, Tehsil Balachaur, District SBS Nagar,

….. Complainant

Versus

 

1.       The Manager, Future Generali (Total Insurance Solutions), Branch Office Sahar Plaza, Windfall, 4^th Floor, 401-403, J.B Nagar, Andheri, Kurla Road, Andheri (E), Mumbai 400059 (Head Office).

2.       The Manager (Non Motor), Future Generali Insurance Ltd, 303/310, Third Floor, Kailash Building, 26 KG Marg Connaught Place, New Delhi (North Office).

3.       The Manger, Future Generali Insurance, Sandhu Tower, 2^nd Floor, Ferozepur Road, Ludhiana, Punjab Pin Code 141001

4.       The Manager, Auto Investigators, SCO 9, AKS Colony, ShivalikVihar, Patiala Road, Zirakpur, District Mohali.

5.       The Manager, Balachaur Primary Co-operative Agriculture Development Bank Limited Balachaur, District SBS Nagar.

…Opposite parties

 

 

(Complaint U/s 12 of the Consumer Protection Act, 1986)

 

QUORUM:

SH.KULJIT SINGH, PRESIDENT

SH.KANWALJEET SINGH , MEMBER

COUNSEL FOR THE PARTIES:

For complainant             :         Sh.B.S ​Rai, Advocate

For OP nos.1 to 3           :         Sh.P.K.Dhir, Advocate

For OPs no.4 & 5           :         Ex-parte

 

 

PerKULJIT SINGH, PRESIDENT

 

1. The present complaint has been filed by complainant-Ajay Paul under Section 12 of the Consumer Protection Act, 1986 against the OPs on the averments that he has undergone training from Punjab Dairy Development Board. The complainant has approached the Dairy Department for his loan application, who approved his case and forwarded to Balachaur Primary Co-operative Agriculture Department Bank Limited Balachaur for assistance of loan for dairy farming. The bank sanctioned the loan to him of Rs.6,00,000/-. He purchased  total six cattle along with deceased cow from one Kewal Kumar s/o Des Raj resident of Village Neelewara P.O Rattewal Block Balachaur District SBS Nagar. The above said cattle were insured by Future Generali India Insurance Company Limited Sandhu Tower Ferozepur Road, Ludhiana /OP no.3 and issued a cover note by the insurance company, which was valid for 30.03.2017 to 29.03.2020. This policy was valid for period of three years vide insurance policy no.2017-M0484836 –CTI. The species, breed, lact, age, description, milk yield, amount was fully described in the insurance cover note. He paid the first installment premium amount of Rs.27,000/- and second installment of Rs.18,000/- to the insurance company as the insurance policy valid for three years. After the finality of entire process the tag fully detailed in policy cover were got tagged at belated stage to the cows and buffalos.  The complainant made complaint to insurance company as well as bank concerned as to why the delay in tags. The fixation of tag is necessary for identification of cattle/cows and due to this reason, in the case any animal dies, the  farmers would be paid the amount insured by the insurance company.  Unfortunately, one cow, which was purchased by the complainant got ill on about 10.12.2018 and medical treatment was started by retired veterinary doctor and continued for period of about two days. During the treatment of diseased cow, the health of cow was deteriorated.  This treatment was given to the cow at the spot bed side treatment at the dairy farm of the complainant. But health of the above cow was not recovered and finally in the morning on 12.12.2018 ill cow was expired during treatment. Then investigator of the insurance company visited the diary farm in the evening on 13.12.2018. The Insurance company and Bank were informed about the death of cow by him in writing, but nothing was done by OPs. It is duty of the insurance company at the time of sanctioning of loan amount to tag the insured cattle, but this process was not adopted by OPs. On 13.12.2018, the postmortem of the deceased cow was conducted by doctor Baljinder Singh Veterinary Officer Civil Veterinary Hospital Kathgarh District SBS Nagar. The deceased cow was identified by the description mentioned in the insurance policy.  The deceased cow was giving and spreading the obnoxious smell, which may be dangerous to the human being as well as in the locality. It was necessary  to conduct the postmortem to ascertain the cause of death of cow and lift the dead body of cow from the dairy farm of the complainant.  The complainant again approached the insurance company in this regard but of no use. After completion of all the formalities and documentation regarding death of cow the OPs refused to admit the legal claim of the complainant. The OPs have flatly refused to pay cattle insurance claim to complainant vide letter dated 22.04.2019. The insurance company has wrongly denied the claim of the complainant only on the ground that no tag no claim, but tag number is still in possession of the complainant. The complainant is suffering a great loss and mental hardship  due to deficiency in service being rendered by OPs. Therefore, he has filed the present complaint and prayed that OPs be directed to pay Rs.60,000/- on account of death of cow on 12.12.2018 with 18% per annum interest till realization besides Rs.2,40,000/-  on account of negligence and deficiency in service and Rs.3,00,000/- as costs of litigation.
2. Upon notice, OPs no.1 to 3 appeared and filed written statement and contested the complaint of the complainant by raising preliminary objections that complaint is not maintainable. The complainant has no cause of action to file the present complaint.  On merits, it was averred that the complainant has violated the terms and conditions of the insurance policy. The claim of the complainant has been repudiated by OP no.1 on the ground that ‘no tag no claim’.  OPs had written a no claim letter dated 22.04.2019 that complainant did not submit the original tag of died cattle to the surveyor. OPs deputed Auto Investigator to investigate and verify the documents. On 05.01.2019 Auto Investigator has written a registered letter to complainant to give the documents i.e. Post Mortem Report Health Certificate and Ear Tag of dead cattle. But complainant did not submit the above documents to the surveyor/OP no.4.  On 26.02.2019 Auto Investigator has gave a reminder by registered letter and demanded documents mentioned above.  Hence, OPs repudiated the claim of the complainant vide letter dated 22.04.2019 and prayed for dismissal of the complaint.
3. OP no.5 appeared and filed its separate written reply by raising preliminary objections that complaint is not maintainable. The complainant is estopped from filing the complaint by his act and conduct.  The complainant has no cause of action to file the present complaint. On merits, it was averred that the bank has sanctioned the loan to the complainant for purchase of cattle and cattle were insured under Future Generali Insurance Company Ltd i.e. OP no.3. The complainant had paid the installments premiums and OP no.3 can produce the statement of account of complainant as and when directed to do so. On representation of the claim to the office of OP no.3, same was forwarded to office of OPs no.1 to 3 vide its dairy no. 763 on the same day and at the earliest.  The payment of the insurance claim was to be made by OPs no.1 to 3 as per terms and conditions of insurance policy. OP no.3 has nothing to do with acceptance or rejection of the claim of the complainant.  Hence question of any irregularity or delay on the part of OP no.3 does not arise. Rest of the allegations were denied by OP no.3 and it prayed for dismissal of the complaint.
4. Notice sent to OP no.4 on 25.07.2019 not received back served or unserved. Sufficient period from service had been lapsed. As such, OP no.4 was proceeded against exparte on 26.08.2019. Whereas, notice sent to OP no.5 and Sh. Gurdev Singh Mehta Manager appeared on behalf of OP no.5 on 26.08.2019. After that none has appeared on behalf of OP no.5 till date. Hence, OP no.5 has been proceeded against exparte on 29.11.2019.
5. The complainant has tendered in evidence his affidavit Ex.CW-A along with copies of documents Ex.C-1 to Ex.C-26 and photographs Ex.C-27 to Ex.C-32 and closed the evidence. As against it; OPs no.1 to 3 tendered in evidence affidavit of Sangitesh Shivam as Ex.OP-1/A along with copies of documents Ex.OP-1 to Ex.OP-11 and closed the evidence. OP no.5 tendered in evidence affidavit of Gurdev Singh a Branch Manager as Ex.OP-5/A and closed the evidence.
6. We have heard learned counsel for the parties and have also examined the record of the case carefully.

7.       The complainant tendered in evidence his affidavit Ex.CW-A in support his case on the record. Ex.C-1 is copy of Aadhar Card. Ex.C-2 is copy of certificate dated 20.03.2012. Ex.C-3 is copy of certificate dated 11.10.2017. Ex.C-4 is copy of letter dated 31.03.2017. Ex.C-5 is copy of no claim letter 22.04.2019. Ex.C-6 is copy of reminder letter dated 26.02.2019. Ex.C-7 is copy of reminder letter dated 05.01.2019. Ex.C-8 is copy of tag bearing no.692901.  Ex.C-9 is copy of letter dated 10.08.2018. Ex.C-10 is copy of letter dated 13.12.2018. Ex.C-11 is copy of legal notice dated 20.06.2019. Ex.C-12 to Ex.C-18 are copy of receipts thereof.  Copies of animal health certificates Ex.C-19 to Ex.C-22, Ex.C-23 is copy of treatment slip. Ex.C-24 is copy of postmortem certificate. Ex.C-25 is copy of bank statement. Ex.C-26 is copy of letter dated 19.12.2018, photographs Ex.C-27 to Ex.C-32 and closed the evidence.

8.       To refute the evidence of the complainant, OPs relied upon affidavit of Sangitesh Shivam as Ex.OP-1/A in support of the case of the OPs.

9.       The counsel for complainant alleged that for enhancement of his income he wanted to pursue the profession of dairy farming along with agriculture. He has undergone training from Punjab Dairy Development Board. He approached Dairy Department for his loan application, who approved his case and forwarded to Balachaur Primary Co-operative Agriculture Development  Bank Ltd. Balachaur for assistance of loan for dairy farming. The bank sanctioned the loan to the complainant of about Rs.6,00,000/-.  He purchased total six cattle along with deceased cow from one Kewal Kumar son of Des Raj. The said cattles were insured by Future Generali India Insurance Company Limited Sandhu Tower Ferozepur Road Ludhiana/OP no.3 and issued cover note, which was valid for 30.03.2017 to 29.03.2020. The complainant paid the first installment premium amount of Rs.27,000/- and second installment Rs.18,000/- to the insurance company as the insurance policy was valid for three years.  The total amount of loan was sanctioned of Rs.6,00,000/- in two installments.  After the finality of entire process the tag fully detailed in policy cover, were got tagged at belated stage to the cows and buffalos. The complainant made complaint to insurance company as well as bank concerned as to why the delay in tags. The fixation of tag is necessary for identification of cattle/cows and due to this reason, in the case any animal dies, the farmers would be paid the amount insured by the insurance company.  Unfortunately, one cow, which was purchased by the complainant got ill on 10.12.2018 and medical treatment was started by retired veterinary doctor and continued for period of about two days. During the treatment of diseased cow, the health of cow was deteriorated.  This treatment was given to the cow at the spot bed side treatment at the dairy farm of the complainant. But health of the above cow was not recovered and finally in the morning on 12.12.2018 ill cow was expired during treatment. Then investigator of the insurance company visited the diary farm in the evening on 13.12.2018.  The Insurance company and Bank were informed about the death of cow by him in writing, but nothing was done by OPs. It is duty of the insurance company at the time of sanctioning of loan amount to tag the insured cattle, but this process was not adopted by OPs.

10.     On the other hand, OPs pleaded that complainant has violated the terms and conditions of the insurance policy. The claim has been repudiated by OPs on the ground that ‘no gag no claim’. OPs had written a no claim letter dated 22.04.2019  that complainant had not submitted the original tag of died cattle to the surveyor. Hence, OPs deputed Auto Investigator to investigate  and verify  the documents  and facts related to claim of dead cattle. On 05.01.2019 Investigator written a letter to complainant to give the documents i.e. Post Mortem Report, Health Certificate and Ear Tag of dead cattle but complainant did not submit the above said documents to the surveyor. Hence, insurance company written a no claim letter to complainant on 22.04.2019. 

11.     We have heard the arguments in the appeal and have gone through the documents placed on the. During the course of the arguments our attention was drawn to the policy issued by the Ops no.2017-MO484836-CTI. The policy was valid for the period of three years i.e. 30.03.2017 to 29.03.2020. The cow in question died on 12.12.2018 during the currency period of the policy.  The complainant reported the matter to the insurance company as well as Bank in writing. The investigator of the insurance company visited the diary farm of the complainant in the evening on 13.12.2018.  On 13.12.2018, the postmortem of the deceased cow was conducted by the doctor Baljinder Singh Veterinary Officer Civil Veterinary Hospital District SBS Nagar.

12.     As per clause 4.1.4 of General Condition of Future Cattle Insurance Policy Schedule Ex.OP-1 that  production of the identification tag issued by the Company is a pre-requirement for admission of any liability of the Company in the for settlement of the claim tag is necessary.  As per postmortem report Ex.OP-3  the cause of death is due to Anaemia by mixed Haemoprotozoan Infection. Ex.OP-8 is no claim letter dated 22.04.2019 that payment of any claim has to be made in accordance with the terms and conditions of the policy. So, from above documents it is clear that tag is necessary for approval of claim of the complainant.

13.     From perusal of letters Ex.C-9  and Ex.C-10 dated 10.09.2018 and 13.12.2018 addressed to OP no.5 it is clear that complainant wrote letters to OP no.5 for issuance of tag number to his animal. But OPs issued tag number to complainant at belated stage. The cow of the complainant died on 12.12.2018. Hence, deficiency in service and unfair trade practice is proved on the part of the OPs. The OP no.1 repudiated the claim of the complainant  on the ground that ‘ no tag no clam’ which is illegal and wrong. It was duty of insurance company to tag the insured animal. Tag was not provided by complainant to OPs because it was issued at belated stage by the OP-Insurance Company.

14.     In view of above facts and circumstances of the case, OPs are liable to settle the claim of the complainant without any hesitation.  Hence, we partly allow the complaint of the complainant. The complainant is directed to collect the original tag from the Forum and submit the same to OPs for settlement of his claim along with all relevant documents, which have sought by OPs and then OPs will settle the claim of the complainant within one month from date of receipt of copy of this order. The complainant is also held entitled Rs.10,000/- as compensation for mental harassment and cost of litigation.

15.     The compliance of the order be made within one month from the date of receipt of copy of this order.

16.     Let copies of the order be sent to the parties, as permissible, under the rules.

Dated :09.01.2020

                                      (Kanwaljeet Singh)          (Kuljit Singh)

                                         Member                            President