SRI. K. ANIRUDHAN (MEMBER) The brief facts of the allegations of the complainant against the opposite parties are as follows:- He had insured his milch animal under Policy No.571400470694/ 000000564 – (Tag No.21226)101500 (bovine exortic breed) four years old, with the 2nd opposite party for a sum of Rs.10,000/-. The premium amount was Rs.200/-. The period of insurance was from 1.11.2006 to 31.10.2007. He insured the animal with Health Certificate through KLD Board with subsidy and the mode of payment of premium was contributory both by the insured and the KLD Board. The benefit offered by the opposite party is to permanent total disability of the insured animal caused by reproduction disorders, milk yield below economic level etc.. He made a claim for reproductive disorder/infertility. The last calving of the animal was 2.9.2006. For protecting milk yield unchanged, he was forced to inseminate the animal on 30.12.2006 within 4 months from the date of last calving. Thereafter he inseminated the animal on 13.3.2007 onwards and finally he sought the opinion of Vetenerian for non conserving the insured animal. On 13.3.2007 the insured animal first seen ill c/o sterility. As per his claim before the opposite party the Veterinary Surgeon of the opposite party examined the animal and advised to dispose of the animal due to non-calving. As such, he disposed of the animal on 12.9.2007 and the matter was informed to the 2nd opposite party and that the 2nd opposite party ratified his claim. But he received a letter dt. 13.9.2007 from the 2nd opposite party stating the repudiation of his claim. Hence this complaint for the insurance benefit, compensation and costs. 2. Notices were sent to the opposite parties. 1st opposite party not entered appearance before this Forum. Considering the absence; 1st opposite party set exparte by this Forum, 2nd opposite party entered appearance and field version. In the version, 2nd opposite party has stated that they had issued a Cattle Insurance Policy in favour of the complainant for a period valid from 1.11.2006 to 31.10.2007; and that the complainant had purchased the animal few months prior to the date insurance. It is stated that the complainant had suppressed the genetical defect of the animal in his proposal form and they are not liable to compensate the defective animal which purchased prior to the date of insurance. The date of the last calvation was prior to the coverage of the insurance policy; and that the animal is having the incapacity to conceive due to anovulation. The complainant had violated the condition No.4 of the conditions and that the complainant had not intimated the illness of the animal. As per clause 9 of the exclusion clause, permanent total disability relating to repudiation disorders or milk yield below economic levels reported within 4 months of the commencement of the cover is outside the scope of the policy; and this matter was not reported to them by the complainant. It is further stated that the insured animal was suffering from disease from 3012.2006, and that the complainant had sold the animal for the best consideration. There was no deficiency in service on their part. 3. Considering the contentions of the parties; this Forum has raised the issues:- (1) Whether there is any deficiency in service on the part of the opposite Party? (2) Whether the complainant is eligible to get compensation and costs? 4. Issues 1 and 2:- On the side of the complainant he has filed proof affidavit in support of the case and produced documents in evidence – Exts. A1 to A6 – marked. Ext.A1 is the copy of the Policy Certificate in respect of the insurance of the cattle. It shows that the policy was for a period from 1.11.2006 to 31.10.2007 – sum insured was Rs.10,000/- and the premium was Rs.200/-. Ext.A2 is the advertisement of KLD Board regarding the insurance of cattle. Ext.A3 is the photo copy of the live stock claim form submitted by the complainant. Ext.A4 is the Doctor Certificate dt. 6.7.2007 for the permanent total disability. Ext.A5 is the repudiation letter dt. 13.9.2007 of the opposite party. Ext.A6 series are the bills of inseminations taken place on different dates. 5. On the side of the 2nd opposite party they have not filed any proof affidavit in support of their contentions. 6. On a perusal of the entire documents produced by the complainant and on examination of this matter in detail, it is seen that the complainant had taken a policy from the opposite party, for insuring his milch animal vide policy No. 57400470694/000000564 and it was for one year from 1.11.2006 to 31.10.2007 and insured through KLD Board with subsidy. The benefit offered by the opposite party was to permanent total disability of the insured animal caused by reproduction disorders, milk yield below economic level. Due to the defect of now-calving the complainant disposed the animal on 12.9.2007 and the matter was informed to the 2nd opposite party and that the 2nd opposite party ratified the complainant’s claim. Before the disposal of the said animal due to non-calving, the complainant sought the advise of the Veterinary Surgeon; and obtained the certificate dt.6.7.2007, showing the details of insemination. Cause of sterility and final diagnosis etc. (Ext.A4). As such the complainant submitted the required documents with claim form before the opposite party. But the 2nd opposite party vide letter, dt. 13.9.2007 informed the complainant regarding the repudiation of the claim (Ext.A5), based on flimsy grounds. It is to be noticed that the defect of the of the animal occurred during the insured period. After obtaining the necessary examination of the animal from the Veterinary Surgeon and her advise the complainant disposed the animal. But this claim was repudiated by the 2nd opposite party. The entire aspects of this case shows that the 2nd opposite party had repudiated the claim without any basis and the contentions of the opposite party cannot be accepted as a valid ground for rejection of claim amount to the complainant. By way denial of the claim amount the 2nd opposite party was committed dereliction of duty and there is deficiency in service. Since there is deficiency in their service, the complainant is entitled to get compensation and costs. After examining the whole matter, we are of the strong view that the complainant is entitled to get the 75% of the policy amount. It is further noticed that by way of refusal to release sanction the claim amount by the 2nd opposite party, they had acted in an unauthorized and illegal manner and the contentions of the 2nd opposite party lacks bona fides and without substance. All the issues are found in favour of the complainant. In the result, we hereby direct the 2nd opposite party to release the amount of Rs.7500/- (Rupees seven thousand and five hundred only) to the complainant in connection with the said insurance claim and pay a sum of Rs.1000/- (Rupees one thousand only) towards compensation for the mental agony, loss and inconvenience of the complainant and pay a sum of Rs.500/- (Rupees five hundred only) as costs for this proceedings. We further direct the 2nd opposite party to pay the said amounts to the complainant within 30 days from the date of receipt of this order. Pronounced in open Forum on this the 30th day of December, 2008. Sd/- Sri. K. Anirudhan: Sd/- Sri. Jimmy Korah: Sd/- Smt. N. Shajitha Beevi: Appendix:- Evidence of the complainant:- Ext.A1 - Photo copy of the policy Ext.A2 - Advertisement Ext.A3 - Live stock claim form (Photo copy) Ext.A4 - Veterinary Certificate for permanent total disability (Photo Copy) Ext.A5 - Registered letter dated 13.9.07 Ext.A6 series - Photo copy of the bills (2 Nos.) Evidence of the opposite parties:- Nil // True Copy // By Order Senior Superintendent To Complainant/Opposite parties/S.F. Typed by:-pr/- Compared by:-
| | HONORABLE K.Anirudhan, Member | HONORABLE JIMMY KORAH, PRESIDENT | HONORABLE Smt;Shajitha Beevi, Member | | 
