BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PONDICHERRY

                                             C.C.No.2/2010

Dated this the 18^th  day of September 2015.

E. Gopalakrishnan                              

No.8, M.G.R. Street,

Kattukuppam             

Puducherry.

                                                ….     Complainant

Vs.

1. M/s Oriental Insurance Co., Ltd., rep. by its

    Senior Divisional Manager

    Post Box No. 125           

    No. 179, Eswaran Koil Street,

    Puducherry.

2. The Manager

    State Bank of India

    Manapet Branch,                          

    Puducherry              

                                                ….     Opposite Parties

BEFORE:

          THIRU.A.ASOKAN, B.A., B.L.,

          PRESIDENT 

Tmt. PVR. DHANALAKSHMI, B.A.,B.L.,

           MEMBER

Thiru V.V. STEEPHEN, B.A., LL.B., 

           MEMBER

FOR THE COMPLAINANT                                :  Thiru,S. Vimal, Advovate

FOR THE OPPOSITE PARTIES: For OP1      :  Thiru B. Mohandoss, Advocate

            OP2    :  Thiru C.S. Narasimhan, Advocate and

                            Amuthavalli, Advocate                                                    

O R  D  E  R

(By Thiru.V.V. STEEPHEN, Member)

This is a complaint filed by the complainant under Consumer Protection Act, 1986 praying to direct the 1^st Opposite Party to pay the insurance claim of Rs.11,000/- for the deceased Milch Animal; to pay a sum of Rs.10,000/- towards loss of income; to pay a sum of Rs.10,000/- for mental sufferings and loss and to pay a sum of Rs.2,000/- towards costs of this complaint.  

2.  The case of the complainant is as follows:

          The wife of the complainant by name G. Sivkami was a member in a Women Self Help Group by name "Vinnarasi Self-Help Group" in Kattukuppam Village,  Bahour Commune, Puducherry and his wife along with other members of the said Self-Help Group have availed a loan of Rs.11,000/- each through the said Self-Help Group from the State Bank of India, Manapet Branch, Puducherry for the purchase of milch animal for their livelihood and the animal was insured with first Opposite Parte.  The wife of the complainant died due to sudden illness and the said animal was look after by the complainant alone.  On 14.07.2008 the said milch animal died due to illness.  At the instance of first respondent, post-mortem was conducted on the body of milch animal by a veterinary surgeon authorised by first opposite party.  The complainant filed the claim form along with Post-mortem certificate and other documents before the first Opposite Party.  The First Opposite Party repudiated the claim of the complainant on the ground that death intimation not received immediately and on death of animal intimation notice not received in time, resulting no opportunity given to inspect the deceased animal at least 24 hours time.  The complainant further stated that the death intimation was sent to the first respondent and the veterinary surgeon within hours after its death and the veterinary surgeon also conducted post mortem on the same day and the same is evident from the documents filed along with this complaint.  Further stated that due to ignorance and collection of materials, there is a delay in filing the claim form before the first Opposite party.  The complainant is an agricultural coolie by profession and on a number of time visited the first Opposite Party's office for claiming the insurance amount without going for work and thereby sustained loss of income.  Further, due to the non-settlement of the insurance claim, the complainant put to untold mental sufferings and loss.  Hence, this complaint.

3.       The following are the averments narrated in the reply version filed by the Opposite Party No.1:

          The Opposite Party No.1 admitted that the milch animal belonging to G. Sivagamy has been insured with the first Opposite Party, but the premium for the insurance policy No. 413900/47/2008/3000 was paid by the second Opposite Party in the account of Vinnarasi Self-Help Group.  The first Opposite Party has no knowledge about the death of the complainant's wife and the complainant alone has to prove that he only maintained the milch animal after the demise of his wife and the milch animal died due to illness.  This Opposite Party denied the death of milch animal and the post mortem conducted on the body of the same but in fact, no intimation was given about the death of milch animal to them.  Further stated by this Opposite Party that as per the terms of policy contained in conditions No.4 and 7, there is obligation imposed on the owner of the insured milch animal to give intimation of death of the milch animal immediately on its death to the insurer.  Similarly, there is obligation to send intimation notice in time and also to submit the documents with the claim form within the 14 days.  Since prompt notice was not given to the first opposite party which resulted in no opportunity of being inspect the deceased animal.  The claim form was submitted by the complainant only on 6.10.2008 while the said milch animal died on 14.7.2008.  Since prompt notice was not received by this Opposite Party at least within 24 hours or even upto 72 hours as held by the Hon'ble National Consumer Dispute Redressal Commission in the case of Oriental Insurance Company Ltd., vs. Silversons (2004) 9 CLD 152, the first Opposite Party has repudiated the claim of the complainant in accordance with law and hence, there is no deficiency in service.  Further stated that the ignorance of law is no excuse and sympathy cannot supplant law.   In the absence of fault committed by this Opposite Party, the claim made by the complainant is a mere claim for money.  This Opposite Party further stated that as the Self-Help Group is an organization formed by the association of individuals, no claim can be made by any individual.  Hence, prayed for dismissal of the complaint.

4. The following are the averments narrated in the reply version filed by the Opposite Party No.2:

          The complaint is not maintainable in law.  This Opposite Party admitted the loan of Rs.11,000/- availed by deceased G. Sivagami from this Opposite Party through "Vinnarasi Self-Help Group" for the purchase of milch animal.  This opposite party never knew that the milch animal is said to have died due to illness.  In the event of first opposite party paying the compensation amount, they may be directed to pay the same to the second opposite party towards satisfaction of the loan amount.  Hence, this Opposite Party prayed to dismiss the complaint with compensatory costs.

5.       Points for determination are:

          1. Whether the complainant is the Consumer?

          2. Whether any deficiency in service attributed by the Opposite Parties?

          3. To what relief, the complainant is entitled for?

6.       Point No.1:

          The complainant's wife by name G. Sivagami has purchased a Milch (Cow) in the year 2007 by availing loan from the second opposite party through a scheme of Self-Help Group by name 'Vinnarasi Self Help Group' which comprised of 12 members in which the complainant's wife was one among them.  The Milch was duly insured with first Opposite Party on payment of premium through the Second Opposite Party from the Account maintained in the name of 'Vinnarasi Self Help Group (Ex.C1) and as such, there existed a contractual relationship between the complainant's wife and the opposite parties and thereafter, shortly, the complainant's wife died due to sudden illness.  The Complainant being the husband and legal heir of the deceased G. Sivagami is entitled for the benefits of insurance claim of the milch (cow) and hence the complainant is deemed to be a consumer for the opposite parties and the complaint filed by the complainant is within the purview of the Consumer Protection Act.  This Point is answered in favour of the complainant. 

7.       Point No.2:

          The complainant submitted that his deceased wife G. Sivagami was a member Self-Help Group by name 'Vinnarasi Self Help Group' and through which the complainant's wife purchased a milch (cow) in the year 2007 by availing loan of Rs.11,000/- by availing a loan from State Bank of India, Manapet Branch, Pondicherry (OP No.2) and insured with Oriental Insurance Company (OP No.1), Pondicherry.  Since the complainant's wife died due to brief illness on 29.12.2007 (Ex.C1), the complainant herein took care of the milch (cow) but the said cow died on 14.7.2008.  The Post Mortem was conducted on the same date  and gave a claim form (Ex.C4) along with Post Mortem Certificate (Ex.C5) and Veterinary Certificate (Ex.C6) to the Opposite Party.  The Opposite Party No.1 has repudiated the claim of the complainant for the reason that the claim form was not submitted within the stipulated period and that the cattle death intimation was not given immediately as prescribed under Rules 4 and 7 of the Terms and Conditions of the Policy (Ex.R2). 

          8. On the side of the complainant, the complainant was examined as CW1 and documents C1 to C9 and R1 were marked as exhibits through CW1 and the Opposite Party No.1 was examined as RW1 and Ex.R2 was marked through RW1 and OP2 was examined as RW2. 

          9. Both side records and evidence were carefully perused and this Forum observes as follows:

          The fact that CW1's wife deceased Sivagami has purchased the milch (cow) by availing a loan from OP No.2 through Self-Help Group by name 'Vinnarasi Self Help Group' and that the same was insured with OP No.1 were not disputed by the opposite parties.  But the claim of the complainant was repudiated by the OP No.1 for the reason that the death of the cattle was not intimated to the OP No.1 and that claim form was not submitted within the stipulated period.  As per the records and evidence available in this case, it is clear that the terms and conditions of the policy Ex.R1 on which the OP No.1 relies for his defence was not given to the complainant and the policy was made known to the complainant only when the OP No.1's counsel has filed an application before this Forum in the year 2012 to receive the policy (Ex.R1) to the file of the case in M.P No. 205/2002 and the same was allowed by this Forum only in the year 2013.  Further, it is clear from the evidence of Assistant Manager, Oriental Insurance Company, Pondicherry RW1 that the policy Ex.R1 was given only to the bank ( OP No.2) and not supplied the copy of the policy to the complainant's wife who is one of the member of the Self Help Group or to any members of this Self Help Group being the beneficiary of the policy.  The evidence RW1 is as follows:

          "It is true that we have not supplied the copy of the Insurance Policy and terms to the members of the Self Help Group being beneficiaries under the policy"…."It is true that we have not issued terms and conditions of the policy that too in Tamil to the beneficiaries under the policy…."

From this evidence, it is clear that the complainant's wife was not provided with the insurance policy wherein, the terms and conditions of the policy would be transcribed.  Being so, the OP No.1 cannot expect the complainant to adhere to the terms of the policy.  Hence, the plea raised by the OP No.1 that the complainant has not complied with the terms of the policy,  is not tenable and the decision relied upon by the OP No.1 held in the case of Oriental Insurance Company Limited vs Silversons 2004 (9) CLD 152 before the National Commission that failure to send the prompt notice by the insured to the insurer as per the terms of the agreement will invalidate the claim of the insured is not applicable to the present case.

          10. Further, it is observed by the Forum that even otherwise, the OP No.1 cannot deny the claim of the complainant merely on the technical grounds when the claim of the complainant is genuine one.  From the perusal of the evidence, it is observed that the subject matter of the case i.e. milch (cow) died on 14.7.2008, death of the cow was duly intimated to the Government Veterinary Surgeon to find out the cause of the death of the cattle, the post mortem conducted on 14.7.2008 and intimated the same to OP No.1 on 29.09.2008 (Ex.C7) and submitted the claim form on 6.10.2008 – other than the delay in filing the claim form by the complainant, nothing was challenged by OP No.1.  The contents of the claim form (Ex.C4), Post Mortem Certificate (Ex.C5), the Valuation Certificate (Ex.C6) was not challenged and no documents were produced to rebute the contents of Ex.C5 and Ex.C6.  It is affirmed from the evidence of RW1 which is as follows:

          ….."It is true that we have not challenged the contents of Ex.C5 and Ex.C6 issued by Veterinary Assistant Surgeon ... I have not produced any document to show that the contents of Ex.C5 and Ex.C6 are incorrect "

Further, it is observed by the Forum that the contents of Ex.R1 and the evidence referring to the contents of Ex.R1 by first Opposite Party's Counsel does not have any relevancy to the subject matter of the case.  Hence, it is observed by the Forum that in the absence of any rebuttal evidence to the Ex.C5 and Ex.C6, the contents of the same being unchallenged and the claim of the complainant being proved genuine, the OP No.1's denial of claim of the complainant for the only reason that the complainant has not intimated the cattle death claim immediately and that the claim forum not submitted with OP No.1 within the stipulated period is not acceptable. 

          List of Authorities and Circular of Insurance Regulatory and Development Authority (IRDA).

1. Jindal Heart Institute & Infertility Centre vs Sukhdev Singh  2013 (4) CPR (9) Punjab State Commission

It is held that

….."Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holdings losing confidence in insurance industry, giving rise to excessive litigation – All insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution – Insurers mut not repudiate such claims unless and until reasons of delay are specifically ascertained, recorded and insurers should satisfy themselves that delayed claims would have otherwise been rejected even if reported in time."….

2. Reliance General Insurance Company Ltd., vs AVVN Ganesh  - CPR 2011 (4) 502 (NC)

It is held that

….."Delayed intimation cannot be held to be ruinous to insurance claim because facts and circumstances of death were clearly established on basis of evidence – State Commission committed no illegality in allowing appeal – Direction issued by State Commission to pay the insured amount to Respondent, is proper."

3. IRDA Circular dated 20.09.2011

The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents.

The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc.  However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances.

On the perusal of the citations and the IRDA Circular dated 20.09.2011 submitted by the complainant, it is observed that the OP No.1's denial of claim of the complainant for the reason that claim form was not submitted in time is not tenable. 

          12. It is further observed by the Forum, from the evidence of RW2 that the loan availed by the complainant's wife from the Bank OP No.2 was completely paid and discharged in time.  Since the complainant availed loan from the second opposite Party, it was added as a party to the proceedings and no liability is fixed as against the OP No.2 and further the complainant has not sought any relief against the OP No.2.  This point is answered accordingly in favour of the complainant.

          13. In view of the discussion made in Point Nos. 1 and 2, it is held that OP No.1 is liable for physical hardship and mental agony suffered by the complainant due to the deficiency of service of OP No.1 and the complainant is entitled for the insurance claim of the milch (cow) and other reliefs.  

          14.  Point No.3:

          In the result, the complaint is hereby allowed and the OP No.1 is directed to pay the complainant.

1. A sum of Rs.11,000/- towards the insurance claim of the deceased Milch (Cow)
2. A sum of Rs.12,000/- towards loss for physical hardship and mental agony and for loss of income.
3. A sum of Rs.5000/- towards cost of this proceedings.

The above said order should be complied within two months from the date of receipt of this Order.

Dated this the 18^th day of September 2015.

1.                                                         (A.ASOKAN)

PRESIDENT

(PVR. DHANALAKSHMI)

MEMBER

(V.V. STEEPHEN)

MEMBER

COMPLAINANTS' WITNESS:  

CW1           16.06.2011           G. Gopalakrishnan

OPPOSITE PARTY'S WITNESS: 

RW1           04.02.2014           S. Ramachandran, Assistant Manager, Oriental

Insurance Company, Puducherry.

RW2           24.02.2015           K. Seetharaman, Branch Manager, State Bank of

India, Manapet Branch, Puducherry.

COMPLAINANT'S EXHIBITS:

OPPOSITE PARTY'S EXHIBITS:

( A. ASOKAN )

PRESIDENT

(PVR. DHANALAKSHMI)

MEMBER

(V.V. STEEPHEN)

MEMBER