BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 289 of 2017
Date of Institution : 3.11.2017
Date of Decision : 20.02.2018
Jai Karan son of Shri Hukam Chand, resident of village Nejadela Khurd, Tehsil and District Sirsa.
……Complainant.
Versus
Oriental Insurance Company Limited, through its Branch Manager, having its office at Opposite Janta Bhawan, Sirsa.
...…Opposite party.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI R.L. AHUJA……………… PRESIDENT.
SHRI MOHINDER PAUL RATHEE……MEMBER.
Present: Sh. V.P. Arora, Advocate for complainant.
Sh. Rishabh Goyal, proxy counsel for Sh.Ravinder Monga, Advocate for opposite party.
ORDER
In brief, the case of complainant is that complainant was owner of one Buffalo of breed Murrah Cross aged 6 years, colour Black with identification mark of loose curved horn, white tail switch. The complainant got his above said buffalo insured with the opposite party at Sr. No.10 of insurance policy No.261503/47/2016/717 through Deputy Director Live Stock Insurance Scheme valid w.e.f 3.11.2015 to 2.11.2018 for a sum of Rs. 40,000/- and had paid the premium amount. Before insurance, Health cum Evaluation Certificate was also obtained by op for this buffalo from Veterinary. Surgeon GVH Dhaban (Sirsa). The Health-cum-Evaluation Certificate was prepared and tag No. 160002-386276 was inserted in the ear of buffalo in the presence of representative of op and even representative of op took the snap as well as a tag bearing No. 160002-386276 was inserted in the ear of buffalo. However, in the policy name of insured has been wrongly mentioned as Kaushalaya Devi wife of Shri Desh Raj in place of Jai karan son of Shri Hukam Chand. It is further averred that insurance policy is always issued on the basis of Health cum Evaluation Certificate issued by Veterinary Surgeon and in the certificate of Health cum Evaluation Certificate issued by Veterinary Surgeon name of owner of above said buffalo has been mentioned correctly. On 25.05.2016 at 5:00 P.M. the buffalo suddenly died due to failure of respiratory. The information was immediately sent to the Veterinary Hospital Dhaban and post mortem was conducted upon the body of buffalo on the next day. Post Mortem Report bearing No.10531 dated 26.5.2016 was prepared by the Veterinary Surgeon GVH Dhaban in this regard. It is further averred that opposite party was immediately informed about this mis-happening and a Live Stock Claim Form cum Valuation Certificate dated 26.5.2016 was also furnished with the op through the veterinary surgeon, G.V.H. Dhaban describing the species, breed, sex, colour, physical identification mark, age and tag details etc. of the deceased buffalo. Sub Divisional Officer, Animal Husbandary and Dairy, Sirsa also verified the death of buffalo having tag no. 160002-386276 and a report was furnished to this effect. It is further averred that op after receipt of information regarding death of buffalo, had appointed the Surveyor/investigator to investigate the matter and to give the report about the same. Shri R.K. Mehta Investigator visited the house of complainant and had collected all the required documents, recorded the statement of complainant, Sarpanch of village Nejadela Khurd. The investigator was also handed over the original tag bearing No. 160002-386276 in its original condition by the complainant. The investigator had thoroughly investigated the matter and found tag no. 160002-386276 in the ear of dead buffalo of complainant and had assured the complainant that he shall get the claim amount within one month of submitting his report. It is further averred that complainant had visited the office of op many a times but at all the occasions the officials of the op kept on lingering the matter with one pretext or the other and in the second week of August, 2017, the officials of the op stated that claim is not payable to complainant, as in the policy name of insured has been mentioned as Kaushalaya Devi wife of Shri Desh Raj. Thereafter the verification issued by Veterinary Surgeon HVS-I, GVH Dhaban dated 20.5.2017 was handed over by the complainant to the op, in which it is clearly mentioned that “I have issued health certificate of beneficiary buffalo with the description Jai Karan son of Shri Hukam Chand Village Nejadeka, Sirsa and company operator had done mistake during issuing of policy schedule of insurance and he has put the name of another beneficiary against the health certificate of buffalo of Jai Karan. He further mentioned that description of health certificate of buffalo of Jai Karan is entered in the policy schedule of insurance no.261503/47/2046/717. He further mentioned that both health certificate of Jai Karan and another beneficiary was issued by him on 3.11.2015. In the verification, it has also been mentioned that at the time of issuing of health certificate, representative of company was present, who had taken photo of beneficiary and its buffalo with tag. It is further averred that at that time officials of company obtained the signature of complainant on same printed and plain papers by stating that these are required for settling the claim. That thereafter complainant had visited to the office of op and requested the officials of op for payment of claim but the officials of op flatly refused to make the payment of claim one week ago on the ground that in the policy name of complainant is not mentioned. The refusal of genuine claim of complainant by the op is wrong and arbitrary and amounts to deficiency in service as policy is always issued on the basis of health certificate and in the health certificate name of complainant is correct but name of complainant mentioned on the policy if is not correct due to own fault, negligence on the part of officials of op, the complainant is not at fault in any manner and claim cannot be denied to the complainant. It is further averred that on the same day health certificate regarding buffalo of Kaushalya Devi wife of Desh Raj was also issued by Veterinary Surgeon GVH Dhaban and policy no.261503/47/2016/716 has been issued by op on the same day in which name of Kaushalya Devi is mentioned at Sr. No.10. That as per norms, Insurance Act, op/ company is legally bound to settle the claim within stipulated period, but claim of complainant is pending since 26.5.2016 with the op, which also amounts to unfair trade practice and deficiency in service on the part of op. Hence, this complaint
2. On notice, opposite party appeared and filed written statement raising certain preliminary objections regarding suppression of true and material facts, locus standi, cause of action and estoppal and that the contents enumerated in the complaint leaves no room for any doubt that the complainant has averred self contradictory pleas in his complaint, on account of which the same requires to be rejected summarily and that complainant is not a consumer as per the definition given in Section 2 (i) (d) of the Consumer Protection Act, 1986; that complainant failed to comply with condition no.6 of the policy. As per condition no.6 of the policy, “Ear tag of the dead animal should be surrendered at the time of claim, otherwise no claim is recoverable under this policy.” The ear tag is basic proof of identification of animal after insurance. The condition of insurance policy “No Tag No Claim” is applicable in this case. In this case, complainant has not surrendered the numbered portion of the ear tag. On merits, it is submitted that answering op is bound by the terms of contract with the insured person. The Group Live Stock (Cattle) Insurance policy was issued in the name of ten persons and out of which at Sr. No.10 the ear tag No.160002386276 was issued and fixed in the ear of buffalo belonging to Smt. Kaushalya Devi wife of Des Raj. The complainant ha sno right to seek claim or to file complaint without having any proper authority or legal right on behalf of insured Smt. Kaushalya Devi. It is further submitted that remaining contents of complaint are self contradictory, if the complainant is aware about the name mentioned in the policy, then he could come forward with the bonafide intention to declare the factual position, so that his legal eligibility may be considered. Now without having any proper clarification, the complainant has no right to file the complaint. It is further submitted that on account of sheer violation i.e. non producing of the tag issued by the insurance company, the pending claim has rightly been repudiated and informed through registered post on 21.6.2017. The answering op insured the buffalo on the request of owner Smt. Kaushalya wife of Des Raj and tag no.160002386276 was fixed in the ear. Now, the complainant appearing to be the owner of the buffalo without having sufficient proof and change in the policy. Remaining contents of complaint are also denied.
3. The parties then led their respective evidence by way of affidavits and documents.
4. We have heard learned counsel for the parties and have perused the case file carefully.
5. The perusal of the evidence of complainant reveals that complainant has furnished his affidavit Ex.CW1/A in which he has reiterated all the averments made in his complaint and has also relied upon documents i.e. copy of policy schedule Ex.C1, copy of health cum evaluation certificate Ex.C2, copy of policy schedule Ex.C3, copy of health cum evaluation certificate Ex.C4, copy of post mortem report Ex.C5, copy of livestock claim form Ex.C6, certificate of Dr. Satpal, Veterinary Surgeon Ex.C7, copy of repudiation letter Ex.C8 and affidavit of Smt. Kaushalya Devi Ex.C9. On the other hand, opposite party has furnished affidavit of Sh. Sanjay Aggarwal, Branch Manager Ex.R1, copy of repudiation letter dated 21.6.2017 Ex.R2, copy of letter dated 2.5.2017 Ex.R3, copy of statement of Jai Karan Ex.R4, copy of inspection report Ex.R5, copy of affidavit of Jai Karan Ex.R6 and copy of policy schedule Ex.R7.
6. It is the specific case of the complainant that complainant was the owner of a buffalo which he got insured from the opposite party for a sum of Rs.40,000/- for the period 3.11.2015 to 2.11.2018 and paid the premium amount to the op. It is further averred that health cum evaluation certificate was prepared and tag number 160002-386276 was inserted in the ear of buffalo in the presence of representative of op and even representative of op took the snaps as well as tag was inserted in the ear of the buffalo. He has further stated that on 25.5.2016 at 5.00 p.m. his buffalo suddenly died due to failure of respiratory and post mortem was got conducted by op on 26.5.2016. Survey was also got conducted by opposite party but the opposite party has arbitrarily refused to pay the claim of complainant despite verification issued by Veterinary Surgeon, HVS-I, GVH Dhaban dated 20.5.2017. On the other hand, Sh. Sanjay Aggarwal, Branch Manager of op has furnished his affidavit Ex.R1 in which he has deposed that as per condition no.6 of the policy, ear tag of the dead animal should be surrendered at the time of claim, otherwise no claim is recoverable under this policy. He has further deposed that ear tag is basic proof of identification of animal after insurance. The condition of insurance policy “No Tag No Claim” is applicable in this case. The complainant has not surrendered the numbered portion of the ear tag. He has further deposed that moreover after carefully perusing the contents of complaint, documents, it has transpired that as per the policy particulars, the complainant has no contract with the insurance company, The ear tag No.160002386276 was issued and fixed in the ear of buffalo belonging to Smt. Kaushalya Devi wife of Des Raj. The complainant has no right to seek claim or to file complaint without having any proper authority or legal right on behalf of insured Smt. Kaushalya Devi. So, the complaint in hand is out rightly liable to be dismissed with special costs. He has further deposed that answering op is bound by the terms of contract with the insured person.
7. The perusal of the insurance schedule reveals that buffalo of Smt. Kaushalya Devi wife of Des Raj was insured against tag number 160002-386276 and the name of complainant Jai Karan does not figure in the policy document. So, it appears out rightly from the policy that complainant is not a party to the insurance contract though he claims that he got his buffalo insured against the ear tag number 160002-386276. The perusal of the evidence of complainant also reveals that he has not placed on record any document from which it could be presumed that he ever made effort to get the policy amended or reissued after satisfying the op that policy has been inadvertently issued in the name of Kaushalya Devi wife of Des Raj. The record further reveals that complainant himself has admitted that tag was not surrendered by complainant to the op as he lost some where. The insurance contract is not in the name of complainant nor he has surrendered the ear tag which was issued to the buffalo which was allegedly insured by complainant from op. Though during the course of arguments, learned counsel for complainant has strongly contended that it is the same buffalo of the complainant which complainant got insured with op and same died and post mortem was got conducted by op on the dead body of the buffalo on 26.5.2016 but however learned counsel for complainant has failed to prove that the policy was ever issued in the name of complainant or the company ever called upon the complainant to get the policy modified in case, same has been inadvertently issued in the name of Smt. Kaushalya Devi. But during the course of arguments, learned proxy counsel for Sh. Ravinder Monga, Advocate for op has stated at bar that as per contention of the learned counsel for complainant, there is mistake in the name of insured. The company can re-examine the claim of the complainant and can pass a fresh order if same falls under the terms and conditions of the policy and complainant satisfies the company that there was insurance contract between the complainant and the insurance company and the premium has been paid by the complainant qua this buffalo bearing tag number 160002-386276.
8. In view of the above discussion, we partly allow the present complaint and direct the complainant to satisfy the opposite party regarding payment of the premium qua the above said buffalo and thereafter direct the opposite party to re-examine the claim of the complainant and pass a fresh order as per terms and conditions of the insurance policy within one month from the date of approaching of the complainant to them. Keeping in view the facts and circumstances of the present case, no order as to costs. A copy of this order be supplied to the parties free of cost. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated:20.2.2018. Member District Consumer Disputes
Redressal Forum, Sirsa.
