Haryana

Yamunanagar

CC/43/2013

Mohd.Asgar S/o. Nek Mohd. - Complainant(s)

Versus

OIC Ltd. - Opp.Party(s)

Karam Singh

21 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR

                                                                                                    Complaint No. 43  of 2013.

                                                                                                    Date of institution: 14.01.2013.

                                                                                                    Date of decision:  21.07.2016

Mohd. Asgar aged 55 years son of Sh. Nek Mohd. resident of Village Bombepur, Post Office Khizrabad, Tehsil Chhachhrauli, District Yamuna Nagar.                                                                                                                                                                                   …Complainant.

                                                Versus                                                

1. The Oriental Insurance Company Limited, Opp. Madhu Hotel, Jagadhri Road, Yamuna Nagar, Tehsil Jagadhri, District Yamuna Nagar through its Branch Manager.
2. The Oriental Insurance Company Limited, Sabharwal Market, Near SBI Main Branch, Railway Road, Kurukshetra through its Branch Manager.                                                                                                                                                                    …Respondents. 

Before:               SH. ASHOK KUMAR GARG, PRESIDENT

                          SH. S.C.SHARMA, MEMBER

Present: Sh. Karam Singh, Advocate, counsel for complainant.   

              Sh. Naveen Kaushal, Advocate, counsel for respondents.  

 

ORDER

1.                     Complainant Mohd. Asgar has filed the present complaint under section 12 of the Consumer Protection Act 1986 praying therein that the respondents (hereinafter referred as OPs) be directed to pay claim amount of Rs. 60,000/- alongwith interest on account of death of buffalo and also to pay compensation and litigation expenses.

2.                     Brief facts of the present complaint, as alleged by the complainant, are that complainant insured buffalo from the OPs vide cover note No. 881282 for a sum of Rs. 60,000/- after payment of premium amount of Rs. 9647. Unfortunately, the said insured buffalo died on 06.10.2012 and to get the postmortem of the buffalo conducted, he immediately reported to the Veterinary Surgeon, Govt. Veterinary Hospital, Malikpur Khadar, District Yamuna Nagar who has conducted the postmortem of died buffalo on 08.10.2012 and prepared a postmortem report No. 65530. The complainant lodged his claim in respect of died buffalo with the Ops within time and the same was enlisted at claim No. 47/2013/000084 but the OPs repudiated the claim of the complainant vide their letter dated 03.12.2012 on the ground that the Tag of the buffalo was not intact. The Ops have wrongly rejected the claim of the complainant on the ground that the tag of the buffalo was not intact as per report of Veterinary Surgeon whereas the concerned veterinary doctor made a clarification that in the place of column of tag where it has mentioned “No Tag Found” the tag No. 13894 be read. In this way, it is clear that the reason stated by the respondents for repudiation of claim of the complainant is absolutely illegal, null and void. Hence this complaint.

3.                     Upon notice, OPs Insurance Company appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable; this Forum does not have territorial jurisdiction; the complainant has got no locus standi to file the present complaint; no cause of action; complaint is false, frivolous and vexatious; complainant has not approached this Forum with clean hands, estopped by his own act and conduct and on merit it has been submitted that the Chhachhrauli Primary Co-op. Agri. & Rural Dev. Bank Ltd. Chhachhrauli, on account of complainant, got three buffalos bearing Tag No. 13893, 13894 and 13831 insured with the Op No.2 vide cover Note No. 881282 for a sum of Rs. 60,000/- w.e.f. 26.12.2011 to 25.12.2012. It has been denied that the complainant paid a sum of Rs. 9647/- towards premium as alleged. In fact, the complainant had paid Rs. 2647/- as premium.  It has been admitted to the extent that a post mortem report No. 65530 was conducted by the veterinary surgeon on 17.10.2012 for a buffalo at the behest of complainant. It has been denied that the deceased buffalo was the same, which was insured by the OP Insurance Company. The Doctor has specifically mentioned in the said postmortem report “ No Tag Found”. Therefore, the identity of the deceased buffalo is disputed and the deceased buffalo was not insured by the OP Insurance Company. It has been admitted to the extent that the complainant has lodged the claim with the Chachhrauli Primary Co-op. Agri. & Rural Dev. Bank Ltd. Chhachhrauli regarding the deceased buffalo who forwarded the letter to OP No.2. It has been admitted that the OP Insurance Company repudiated the claim of complainant vide letter dated 03.12.2012 on the ground that Tag was not intact in the ear of the deceased buffalo. It has been submitted that the complainant has provided a photocopy of postmortem report to the OP No.2 company in which, the Veterinary Surgeon has later on added the number “13894” and further added the words “See Clarification Attached” and thereafter appended his stamp and signatures and date as 17.11.2012. In this way, the Veterinary Surgeon, in collusion with complainant, has fabricated the original post mortem report for which he was not entitled to do so because once a legal and Govt. Document is prepared, it cannot be altered after words. Such altered postmortem report should neither be believed nor be relied upon. As such, the claim of the complainant has been rightly repudiated on 03.12.2012. Lastly, prayed for dismissal of complaint being no deficiency in service or unfair trade practice on the part of OPs Insurance Company. 

4.                     To prove the case, counsel for the complainant tendered into evidence his affidavit as Annexure CW/A and documents such as Photo copy of Insurance Cover Note as Annexure C-1, Photo copy of Health Certificate as Annexure C-2, Photo copy of application for adding the Tag Number in the Postmortem report as Annexure C-3, Photo copy of Clarification issued by Veterinary Surgeon as Annexure C-4, Photo copy of clarification letter dated 25.10.2012 as Annexure C-5, Photo copy of repudiation letter dated 03.12.2012 as Annexure C-6 and closed the evidence on behalf of complainant.

5.                     On the other hand, counsel for the OPs Insurance Company tendered into evidence affidavit of Abhas Toppa Assistant Manager OIC as Annexure RW/A and documents such as photo copy of intimation letter Annexure R-1, Photo copy of Cover Note as Annexure R-1, Photo copy of Insurance policy as Annexure R-2, Photo copy of Postmortem Report as Annexure R-3, Photo copy of claim application as Annexure R-4, Photo copy of claim repudiation letter dated 03.12.2012 as Annexure R-5, Photo copy of Postmortem report as Annexure R-6 and closed the evidence on behalf of OPs Insurance Company.

6.                         We have heard learned counsel for both the parties and have gone through the pleadings as well as documents carefully and minutely placed on the file. Counsel for the complainant reiterated the averments made in the complaint and prayed for its acceptance whereas the counsel for opposite parties reiterated the averments made in reply and prayed for its dismissal.

7.                     Learned counsel for the complainant argued at length that genuine claim of the complainant has been repudiated by the OP Insurance Company on the flimsy ground that the dead buffalo was not wearing any tag in the ear at the time of death i.e  No Tag No Claim, whereas learned counsel for the complainant draw our attention towards the application given to the doctor (Annexure C-3) and clarification issued by the Veterinary Doctor on 17.11.2012 (Annexure C-4) and argued that Veterinary Doctor has made endorsement on the copy of PMR Annexure C-2/R-6 in which he has specifically mentioned the tag number as 13894 and lastly requested for acceptance of the complaint. Learned counsel for the complainant further argued that OP Insurance Company cannot repudiate the claim on the mere ground that there was no Tag in the ear of the dead cow and referred the case law titled as Oriental Insurance Company Limited vs. Harish Giri Goswami and Others, Appeal No. 463/2004 decided on 31.01.2006 State Commission, Uttaranchal and referred the another case law titled as Sunita Sen Versus Incharge Officer, TATA AIG General Insurance Co. Ltd. Appeal No. FA 12/2012 decided on 12.06.2013 State Commission, Pandri Raipur Chhatisgarh.

8.                     On the other hand, counsel for the Ops Insurance Company hotly argued at length that the claim of the complainant has been rightly repudiated vide its letter dated 03.12.2012 (Annexure C-6/R-5) as there was violation of terms and conditions of the Insurance Policy on the part of the complainant. Learned counsel for the OPs further argued that the alleged clarification (Annexure C-4) has been issued by the veterinary doctor on 17.11.2012 whereas the postmortem of the alleged dead buffalo was conducted on 08.10.2012 i.e. after a period of more than 1 month 9 days due to collusion with the complainant. Learned counsel for the OPs further argued that from the perusal of the application dated 17.11.2012 given to the Veterinary Doctor for obtaining clarification (Annexure C-3), it is duly evident that the alleged dead buffalo was not having any tag at the time of death as the complainant has himself admitted in this application that now he has found the token bearing No. 13894. The veterinary doctor has specifically mentioned in the PMR conducted on 08.10.2012 that No Tag was found at the time of postmortem, if the dead buffalo does not wear the tag then the specific condition has been mentioned in the policy that “No Tag No Claim.  Learned counsel for the OP further argued that the claim of the complainant has been rightly repudiated vide its letter dated 03.12.2012 (Annexure R-5). Hence, there is no deficiency in service or unfair trade practice on the part of Ops Insurance Company and referred the case law titled as United India Insurance Company Ltd. Versus Banbari 2003(1) CLT Page 621 State Commission, Lucknow.

9.                     After hearing the parties at length, we are of the considered view that there is no deficiency in service on the part of OP Insurance Company and the claim of the complainant has been rightly repudiated by the Op Insurance Company. The law cited by the counsel for the complainant is not disputed but not helpful in the present case as in that case titled as Oriental Insurance Company Limited Versus Harish Giri Goswami and others (supra), no investigator/surveyor was deputed by the insurance company to ascertain the identity of the dead cow and the claim of the complainant was decided only on the papers submitted by the complainant. In the present case, the complainant intimated the OPs insurance company on 22.10.2012 through Rural Development Bank Ltd. Chhachhrauli i.e. after a period of 14 days from the date of death whereas the buffalo of the complainant died on 06.10.2012 and postmortem of the buffalo was conducted on 08.10.2012 i.e. after two days from the date of death.  So, the credibility of the postmortem report is also doubtful being contradictory with the clarification made by the veterinary doctor himself.  The facts of the case referred by the counsel for the OPs Insurance Company titled as United India Insurance Co. Ltd. Versus Banbari (supra) are fully applicable to the facts of the present case. As per the terms and conditions of the insurance policy, the claim of animal can only be disbursed to the claimant in case it is found that in fact the animal insured has died and to identify the animal a tag is always inserted to the animal in question and in case no tag is found, no claim can be given on the basis of “ No Tag No Clam”

10.                   In these circumstances noted above, we are of the considered view that the claim of the complainant has been rightly repudiated by the Op Insurance Company as the complainant has totally failed to prove that the alleged dead buffalo was the insured buffalo. Hence, we have no option except to dismiss the present complaint.  

11.                   Resultantly, we find no merit in the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced in open court. 21.07.2016.

 

                                                                                          (ASHOK KUMAR GARG)

                                                                                           PRESIDENT      

 

 

                                                                                          (S.C.SHARMA)

                                                                                           MEMBER