DATE OF FILING :30/12/16 

IN THE CONSUMER DISPUTES  REDRESSAL FORUM, IDUKKI

Dated this the 27th  day of February  2018

Present :

SRI. S. GOPAKUMAR PRESIDENT

           SRI. BENNY. K. MEMBER

CC NO. 377/2016

Between

Complainant       :   Josy M. Sijo,

                                                                             Padingarepeedikayil House,

                                                                             Kudayathoor P.O.,

                                                                             Kolapra

        And

Opposite Party                                          :  1 . The Manager,

                                                                             New India Assurance Company Ltd.,

                                                                             Trippunithura Branch,

                                                                             Opposite Municipal Bus Stand,

                                                                             Trippunithura, Kochin -682 301

                                                                       2 . The Deputy Director,

                                                                             Dairy Development Department,

                                                                             Idukki Mini Civil Station,

                                                                             Thodupuzha – 685 584.

                                                                        3 . The Managing Director,

                                                                             Am.Ex.Brokers (India)Pvt.Ltd.,

                                                                             33/1885 B 5(a) Fruitmans Building,

                                                                             NH 47 Cochin Bye Pass Road,

                                                                             Vennala, Kochi- 682 028.

                                                                       4 . The Ksheera Development Officer,

                                                                             Ksheera Development Department,

                                                                             Elamdesam Block,

                                                                             Elamdesam.

                                                                       5 . The Secretary,

                                                                             Kudayathoor West  Ksheerajyothi Milk 

                                                                                  Producers Co-Operative Society.

                                                                             Reg:No.1-211 D Apcos,

                                                                             Kudayathoor P.O.

 

 

 

 

                                                  (Cont....2)

 

   -2-

O R D E R

 

SRI. S. GOPAKUMAR (PRESIDENT)

 

     The fact of the case  that,  

 

           Complainant is engaged  in cattle rearing.  He earn his livelihood from the cattle rearing.  The first opposite party is the insurer, Ksheerajyothi Group Insurance Scheme, Elamdesam Block.  The second opposite party is the District Co-Ordinator of this scheme.  The third opposite party is the insurance broker, fourth opposite party is the Block Level Insurance Officer of the above scheme and the fifth opposite party is the Secretary, Ksheerajyothi Milk Producers Co-Operative Society.

 

Complainant is the member of fifth opposite party and through fifth opposite party,  complainant insured his two cows with the second opposite party  through Group Insurance Policy No.060 229 F0053.  Proforma Enrolment of Milk Producers Comprehensive Insurance Scheme second scheme No.5 Tag No. 16968 and first schedule No.3 Tag No.420005/667133.  These two cows were insured for Rs.40,000/- with the sufficient Medical Records of the Veterinary Surgeon.  

 

Unfortunately the cow insured in the second schedule of the insurance project established by the  second  opposite  party  having  policy  No. 060  229 

F0053 Ear Tag No.16968 was died on 26/05/16 due to Myocarditis and Toxaemia.  Immediately the complainant lodged a claim through opposite parties 2 to 4 to the first opposite party with relevant records such as veterinary certificate, post mortem certificate, Ear Tag etc.,.  But the first opposite party denied the claim on the reason that this cow is not insured with them.  Complainant further stated that he remitted an amount of Rs.1102/- as insurance premium to the first opposite party through the second opposite party  and the first opposite party  purposefully repudiated the claim without valid reason. Due to the deficiency in service from the part of the opposite parties, the complainant suffered heavy financial loss as well as mental agony.  Hence the complainant approached this Forum and filed the complaint for getting an order to direct the first opposite party to pay the insurance claim along with 12% interest and other consequential reliefs.

 

                                                                                                                           (Cont....3)

-3-

Upon notice the first opposite party entered appearance and filed detailed reply version.  In their version the first opposite party contended that the cow having Tag No.420005/667133 owned by the complainant was insured with this opposite party as per the policy having No.060229F0053 in the name of the insurer, Ksheera Jyothi Insurance Scheme, C/o Deputy Director, Diary Development Department, Mini Civil Station, Idukki.  But this opposite party has not insured  the complainant's cow having Ear Tag No.16968.  As per the list of the cattle in the policy it is seen that cow with reddish brown and white colour having ear Tag No. 16968 was not insured with this opposite party.  On going through the enrolment form received by this opposite party, it is seen that in the column showing the animal's Tag number, the number 420005/667133 is struck off and instead of it the number 16968 is incorporated.  But in the column showing sex, colour and full distinguishing mark it is shown as F, white and black, Parity-1, Calved 9 months back and 4 months pregnant.  But in the claim form the colour of the cow is shown as Reddish brown and white and its milk yield per day is 12+6 litre.  From the documents produced, it is revealed that the claim for the death cow with reddish  brown and white colour having ear Tag No. 16968, which is not insured with this opposite party.  Therefore the claim for death of cow is repudiated on the ground that the cow having Tag No.16968 is not insured with this opposite party.

 

Opposite parties 2 to 5 in their version contended that they complied all the formalities  and there is no delay, latches or negligence from this part is insuring the cows with opposite parties  by paying required premium.  They further contended that in the second phase of this insurance scheme complainant along with 5 other cattle rears insured their cows with the first opposite party by paying an amount of Rs.11856/- as insurance premium in total.  In this scheme the cows of the complainant having Tag No.16968 Bovine- Sunandini Reddish  Brown and white, is insured for Rs.40,000/- for the purpose complainant remitted an amount of Rs.1102/- to the account of the first opposite party.  It is clear from the data entry dated 06/04/216 of the opposite parties.

 

For this purpose complainant was examined as PW1 and the document produced by him were marked as Ext.P1 to Ext.P16.  Ext.P1 is the attested copy of proforma of enrolment of milk produced in comprehensive diary insurance

                                                                                                                           (Cont....4)

 

-4-

scheme.  Second phase, Ext.P2 is the same of first phase, Ext.P3 is the copy of comprehensive diary insurance enrolment form, Ext.P4 is the treatment certificate, Ext.P5 is the copy of cattle claim form, Ext.P6 is the copy of post mortem report, Ext.P7 is the copy of claim application, Ext.P8 is the letter of the fifth opposite party, Ext.P9 is the letter fifth opposite party to the first opposite party, Ext.P10 is the letter dated 19/07/16, Ext.P11 is the claim instruction, Ext.P12 is the photographs, Ext.P13 is the Ear Tag, Ext.P14 is the endorsement on cattle insurance policy, Ext.P15 is the repudiation letter and intimation for sending the document back, Ext.P16  is the copy counter foil of cash remittance voucher and copy of pass book .  From the defence side copy of the insurance policies produced and marked as Ext.R1(s).

 

Heard both side,

 

        The point that arose for consideration is whether there is any deficiency in service from the part of opposite parties, and if so, for what relief the complainant is entitled to ?

 

The Points:-  The learned  counsel for the first opposite party submitted that, on going through the enrolment form received by them,  it is seen that in the column showing the animal Tag number, the number 420005/667133 is struck off and instead of it the number 16968 is incorporated.  But in the claim form colour of the cow is shown to Reddish brown and White.  At the same time the column showing sex, colour and full distinguishing mark of the enrolment form, it is shown that F, white and black, Parity- 1, Calved 9 months back and 4 months pregnant.  Hence the claim for death of a cow with reddish brown and white colour having ear Tag number 16968, which is not insured with them and there for the claim is repudiated.

 

On going through the averments along with in the reply version of the first opposite party, we can seen that they had rejected the claim by raising some defects in the claim form and the enrolment form.  By perusing the available evidence it is seen that the complainant raised claim against the death of his cow having ear Tag No.16968.  But as per the records of the first opposite party, the cow having ear Tag No. 16968 having  different colour, and the  details  of  the  enrolment  form is not following with the claim application

                                                                                                                         (Cont....5)

-5-

and other records.  In this case it is very pertinent to note that, the complainant produced the ear Tag and the photographs of the dead body of the cow along with the claim application before the first opposite party.  Due to some difference in colour of the cow they repudiated the claim.  At the juncture it is very pertinent to note that the first opposite party insurance company just compared the details of the enrolment form and claim form before processing the claim application and only on the basis of some difference in the colour of the cow they rejected the claim.  At the same time, they admitted that in the enrolment form a correction is shown in the ear Tag number, the number 420005/667133 is struck off and instead of this number, number 16968 is incorporated.  Except the contention in the version no  incriminating evidence is produced by the first opposite party to convince the Forum on what ground the correction is made out.  At the same time, it is also  noted that the first opposite party  insurance company has not made any enquiry in this matter.  Without enquiring the actual facts they straight  away repudiated the claim of the complainant.  The reason of repudiation is not sufficient and is not conclusive.  Before taking a decision for repudiation the first opposite party should  conduct an enquiry in this matter and to give a chance to the other opposite parties and the complainant, regarding the difference in the entries of the claim application.  Here the first opposite party failed to do so and they hurriedly closed the matter.  This act of the first opposite party  is gross deficiency in service and clear case of unfair trade practice. 

 

Hence on the basis of the above discuss the complaint is allowed.  The Forum direct the first opposite party to allow the insurance claim of the complainant as per the cattle insurance policy No.420005/667133 and pay an amount of Rs.40,000/- to the complainant,  as claim amount by receiving all the related documents from the complainant, along with 12% interest from the date of the complaint and also direct the first  opposite party to pay an amount of Rs. 3000/- as litigation cost  within 2 months from the date of receipt of the copy of this order.

                                                                                                  

Pronounced in the Open Forum on this the  27th  day of  February, 2018.

                                                                                          Sd/-    

                                                                      SRI. S. GOPAKUMAR (PRESIDENT)

                                                                                                Sd/-        

                                                                         SRI. BENNY. K.  (MEMBER)       (Cont....6)

                                                                                                                     

-6-

                                                                                      

 

  APPENDIX

 

Depositions :

On the side of the Complainant :

PW1               - Josy M. Sijo

On the side of the Opposite Party :

Nil

Exhibits :

On the side of the Complainant :

Ext.P1            -The attested copy of proforma of enrolment of milk produced in comprehensive diary insurance scheme.

Ext.P2            -  The same of first phase

Ext.P3          -  The copy of comprehensive diary insurance enrolment form

Ext.P4          -  The treatment certificate

Ext.P5          -  The copy of cattle claim form

Ext.P6          -  The copy of post mortem report

Ext.P7          -  The copy of claim application

Ext.P8          -  The letter of the fifth  opposite party

Ext.P9          -  The letter fifth opposite party to the first opposite party

Ext.P10        -  The letter dated 19/07/16

Ext.P11        - The claim instruction

Ext.P12       -  The photographs

Ext.P13       -  The Ear Tag

Ext.P14       -  The endorsement on cattle insurance policy

Ext.P15  - The repudiation letter and intimation for sending the document back

Ext.P16  - The copy counter foil of cash remittance voucher and copy of

                 pass book

 

On the side of the Opposite Party :

Ext.R1(s)- Copy of the insurance policies

 

 

                             Forwarded by Order,

 

 

                                                                                            SENIOR SUPERINTENDENT