BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.136 of 2017
Date of Instt. 08.05.2017
Date of Decision:06.03.2019
Ram Paswan, 75 years old, S/o Sh. Butan Paswan, R/o Village & Post Office Sarai Khas, Tehsil & District Jalandhar.9878783663 (M).
..........Complainant
Versus
M/s Bajaj Allianz General Insurance Co. Ltd., through its Managing Director/Chairman, Head Office: GE Plaza, Airport Road, Yerawada, Pune-411 006, Branch Office:- 2nd Floor Satnam Complex, Near BMC Chowk, G. T. Road, Jalandhar-144001.
….….. Opposite Party
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Jyotsna (Member)
Present: Sh. Surinder Kareer, Adv Counsel for the Complainant.
Sh. R. K. Sharma, Adv Counsel for the OP.
Order
Karnail Singh (President)
1. This complaint has been filed by the complainant, wherein alleged that the OP is engaged in the business of providing insurance coverage with regards to the person, cattle and property of General Public for consideration throughout India and more particularly at Jalandhar.
2. That the complainant in order to save all the risk of loss to his young healthy cattle (Cows) used to get insured the same and accordingly, the complainant got insurance policy of the aforesaid covers after paying the premium of Rs.1166/- each animal on 29.03.2017 on the expiry of earlier policy. The insurance of the each cow was Rs.60,000/- each. Till the date of filing complaint, the OP has not supplied any policy to the complainant with regards to the same mentioned insurance of the five cows. The OP also got the health certificate of all the animals. The OP also got tagged the all five animals, but unfortunately on 12.04.2017, one cow bearing Tag No.04951 died after only one day illness. The complainant reported the death to the OP at its Jalandhar Office and lodged the claim for the same and the OP got the Postmortem of the said Cow. The OP illegally, arbitrarily, without application of mind, vide its registered letter dated 22.04.2017 of the OP, repudiated the claim of the complainant as “That your insured cattle bearing Tag No.04951 died on dated 12.04.2017 i.e. within first 15 days exclusion period from date of inception of policy” and accordingly, declared the above mentioned claim of the complainant as 'No Claim'.
3. That due to the above said facts, the complainant has suffered mental tension, harassment, inconvenience, financial loss etc. and the complainant assessed the same to the tune of Rs.99,000/- in all, in terms of money. Due to the above said facts, there is a deficiency in service, negligence and unfair trade practice on the part of the OP and accordingly, a cause of action accrued to the complainant to file the present complaint with the prayer that the complaint of the complainant may be accepted and OP be directed to pay Rs.99,000/- in terms of money in all, to the complainant as compensation for mental tension, harassment, inconvenience, financial loss etc.
4. Notice of the complaint was given to the OP, who appeared through its counsel and filed written reply, whereby contested the complaint by taking preliminary objections that the present complaint filed by the complainant is gross abuse of process of law and is absolutely false, frivolous and vexatious thereby making it illegal and not tenable allegations and as such, the complaint is liable to be dismissed. It is further averred that the complainant has suppressed the material facts from the Forum and as such, the complainant is not entitled for the relief claimed. It is further submitted that the complainant Mr. Ram Paswan had got insured a total number of 5 cows including the cow died, from the answering OP on 29.03.2017. In order to find out the true facts, the OP appointed an Investigator Mr. Om Parkash to find the genuineness of the claim and to assess the loss suffered to the complainant if any and accordingly, Om Parkash submitted an investigation report dated 18.04.2017 and after going through the said report, it observed that the alleged cow was insured by the complainant through policy on 29.04.2017 and the cow fell ill on 11.04.2017 and died on 12.04.2017, but the claim of the complainant has been repudiated by invoking exclusion clause of the policy as the death of the insured cattle due to any disease contracted within 15 days from the commencement of the insurance policy is excluded from the coverage of the policy and further alleged that the claim of the complainant has been rightly repudiated. On merits, the factum in regard to getting insurance of 5 cows is admitted, but the other allegations as made in the complaint are categorically denied and lastly prayed that the complaint of the complainant is without merits and the same may be dismissed.
5. In order to prove the case of the complainant, counsel for the complainant tendered into evidence affidavit of the complainant Ex.CA along with some documents Ex.C-1 to Ex.C-6 and closed the evidence.
6. Similarly counsel for the OP tendered into evidence affidavit of Miss Sarpreet Kaur Ahluwalia as Ex.OA along with some documents Ex.O-1 to Ex.O-5 and closed the evidence.
7. We bestowed our thoughtful consideration to the submissions made by learned counsel for the respective parties and also gone through the case file very minutely.
8. After considering the over all circumstances as put before us by the counsel for the parties as well as from the scrutiny of the pleadings, it reveals that the factum in regard to purchase of insurance policy by the complainant from the OP for the five cows, is not denied and even the death of one cow having Tag No.04951, is also not denied. The death of cow on 12.04.2017 and commencement date of the policy 29.03.2017 is also not in dispute because the date of commencement of the policy is also mentioned on the insurance policy, which is placed on the file by the OP as Ex.O-1. It is also admitted that the insurance claim was submitted by the complainant and after investigation, the said claim was repudiated by the OP, vide repudiation letter dated 22.04.2017 Ex.C-4, on the ground “That your insured cattle bearing Tag No.04951 died on 12.04.2017 i.e. within first 15 days policy exclusion period from date of inception of policy”. By invoking the above said exclusion clause, the claim of the complainant has been repudiated. In order to ascertain whether the said clause is incorporated in the term and condition or on the policy, we have gone through the copy of the policy produced on the file by the OP Ex.O-1, wherein special exclusion clause is mentioned, which we like to reproduce as under:-
“Death due to any disease contracted within 15 days from the commencement of the policy & malicious-cause of loss & absence of treatment chart.”
9. Apparently, the exclusion clause is applicable in the case in hand because the death of the insured cow was admittedly due to illness, regarding that the complainant himself produced on the file prescription slip issued by the doctor regarding treatment given to the said cattle, the said prescription slip dated 11.04.2017 is Ex.C-5 and further postmortem report established that the said cow was died on the very next date i.e. 12.04.2017, copy of the postmortem report is available on the file as Ex.C-3.
10. From the above analysis, it has become clear that the OP has repudiated the claim rightly by invoking the exclusion clause, which is very well mentioned on the copy of insurance policy and as such, we do not find any further interference in the repudiation letter and also hold that the complainant is not entitled for the relief as claimed and thus, the complaint of the complainant is dismissed with no order of cost. Parties will bear their own costs. This complaint could not be decided within stipulated time frame due to rush of work.
11. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jyotsna Karnail Singh
06.03.2019 Member President
