DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PALAKKAD
Dated this the 25th day of May 2009.
Present : Smt. H. Seena, President : Smt. Preetha.G. Nair (Member) : Smt. Bhanumathi.A.K. (Member) C.C.No.120/2007
Joseph Mathew S/o. Mathew Perumattikunnil Gomathi Chittilanchery (P.O)` Alathur Taluk Palakkad - Complainant (Adv. Saju Abraham.T ) V/s
National Insurance Company Branch Office Kanoos East Fort Resort 18/77, 3rd Floor Kunnathurmedu Post Palakkad (Adv S.T. Suresh ) - Opposite party
O R D E R By Smt. H. Seena, President Shortly stated the facts of the case are as follows.
Complainant owned a cattle which was insured with the opposite party bearing policy No.570705/1371/2006 for the period 1/11/2006 to 31/10/2007. The cattle was insured for a sum of Rs.13,000/-. The cow was only 5 ½ years old and last calving was in the month of May 2006. Policy coverage extended to include permanent total disablement caused by reproductive disorder, for which maximum loss payable shall be 75% of the sum insured of the animal. Doctor examining the cattle has certified permanent total disability on 11/07/2007. Complainant applied for the claim amount with all the necessary documents. But the opposite party repudiated the claim on 06/08/2007 stating exclusion clause No.9 where in it is stated that any permanent total disablement relating to reproductive disorders reported within 4 months of commencement of the cover are excluded in the policy cover. - 2 - According to the complainant cattle was undergoing treatment and permanent total disability was reported on 11/07/2007. The act of the opposite party in repudiating the genuine claim of the complainant amounts to deficiency in service and hence the complaint.
Opposite party filed version with the following contentions. Opposite party admits the policy. According to the Opposite party, even though, permanent disability certificate was issued on 11/07/2007, treatment for the same started on 14/02/2007 onwards. As per policy exclusion clause No.9 “permanent total disablement relating to reproductive disorders or milk yield below economic levels reported within four months of commencement of the cover” are excluded in the policy coverage. As per the contention of opposite party, in this particular case the claim form furnished along with veterinary certificate by the complainant would disclose that the treatment commenced from 14/02/2007 onwards. The policy was issued on 01/11/2006. Therefore the reproductive disorder was reported on 14/02/2007 within 4 months of the commencement of the cover. Hence the claim is inadmissible.
Evidence adduced by both parties consists of their respective affidavits and Exhibit A1 & A2 on the side of the complainant and Exhibit B1 to B3 on the side of Opposite party. Veterinary surgeon who issued the certificates were examined as PW1 and DW1. Now the issued for consideration are: Whether the act of repudiation of claim amounts to deficiency in service on the part of opposite party? If so, what is the reliefs and costs?
Issue No.1
The specific contention raised by opposite party in repudiating the claim of the complainant is that the disability was reported on 14/02/2007 and therefore comes under the exclusion clause. The exclusion clause states that “Permanent Total Disablement relating to Reproductive Disorders or Milk yield below economic levels reported within four months of commencement of the cover”. On perusing Exhibit B2 certificate issued by the Veterinary doctor, one cannot come to a conclusion that permanent total disability was reported on 14/02/2007. As per the deposition of PW1, also artificial insemination was done several times from 14/02/2007 onwards and that which was done on 09/05/2007 was a last trial. It is also stated that sometimes cattle used to conceive after 5 or 6 - 3 - instances of insemination. So the contention of Opposite party that disability was noted on 14/02/2007 in unacceptable. Further DW2 whom the opposite party has consulted for a second opinion has deposed while cross examination that he has examined the cattle only on 26/07/2007 and its not possible to say the date of occurance of disability.
In view of the preceeding discussions, we are of the view that opposite party has repudiated the genuine claim of the complainant.
In the result complaint allowed. Opposite party directed to pay an amount of Rs.9,750/- being the claim amount together with Rs.5,000/- as compensation and Rs.1,000/- as cost of the proceedings. Order shall be complied within one month from the date of receipt of order failing which the whole amount shall carry interest at the rate of 9% per annum.
Pronounced in the open court on this the 25th day of May 2009.
PRESIDENT (SD) MEMBER (SD) MEMBER (SD) APPENDIX Witness examined on the side of Complainant PW1 – Dr. B. Biju dated 24/06/2008 Witness examined on the side of Opposite party DW1 – Dr. Dileep.P.K dated 30.08.2007 Exhibits marked on the side of the complainant Ext. A1 – National Insurance Company certificate No.570705 dated 26/10/2006 Ext. A2 – Registered letter from Branch Manger, National Insurance Company
Exhibits marked on the side of the Opposite Party 1. Ext B1- Copy of claim for loss of live stock from National Insurance Company Limited 2. Ext B2 – Veterinary certificate for permanent total disability/Non conceiving claims 3. Ext.B3 series- Details of Clinico Gynaecological Examination Forums Exhibits Nil Cost (allowed) Rs.1000 (Rupees One thousand only) Forwarded/By Order Senior Superintendent
......................Smt.Bhanumathi.A.K
......................Smt.Preetha.G.Nair
......................Smt.Seena.H | | 
