BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.

                                                          Consumer Complaint no. 154 of 2016                                                                         

                                                            Date of Institution         :   15.06.2016

                                                          Date of decision   :    31.05.2017

Manjit Kaur, aged about 35 years, wife of Shri Harmandar Singh, resident of village and Post office Bhiwan, Tehsil Kalanwali, District Sirsa.

                                      ……Complainant.

                                      Versus.

The Branch Manager/Officer Incharge, The Oriental Insurance Company Limited, office at opposite Janta Bhawan, Sirsa, Tehsil and District Sirsa.

                                                                                                 ...…Opposite party.

                   Complaint under Section 12 of the Consumer Protection Act, 1986.

Before:        SMT. RAJNI GOYAT……………………….PRESIDING MEMBER

                    SHRI MOHINDER PAUL RATHEE ……….MEMBER.      

Present:       Sh. S.L. Sidhu,  Advocate for the complainant.

       Sh. A.S. Kalra, Advocate for opposite party.

ORDER

                   In brief, complainant’s case is that complainant is resident of village Bhiwan, Tehsil and District Sirsa. She is an agriculturist and belongs to an agricultural family and depends upon agriculture income, in all respects. The complainant had got her buffalo insured with the opposite party’s company against all risks including the death of the buffalo vide insurance policy No.261503/47/2015/683 issued by the company to the complainant. The complainant had paid the premium of the said Insurance policy as per the terms and conditions of the company. It is further averred that the aforesaid insured buffalo of the complainant died on 23.7.2015 during the continuance of the above said insurance policy. The complainant being the owner of the said buffalo had informed the op company regarding the death of the insured buffalo and as per the demand and requirement of the company, the complainant has submitted the requisite documents to the company including the postmortem report of the buffalo, for release of the amount of insurance under the said policy. After submissions of the document, the officials of the company told to the complainant that the case has been sent to the head office and she would be informed as and when the claim is sanctioned by the head office of the company. It is further averred that a few days ago the complainant had received letter dated 09.10.2015 in which it is mentioned that the claim of the complainant has been declined on the ground that the deceased buffalo was not wearing the tag in her ear at the time of death. In fact, the tag in question might have fallen some where else. But it is not a solid ground for rejection of the claim of the complainant. The reason given by the op company is totally wrong and baseless and is denied. The aforesaid insured buffalo of the complainant was hale and hearty before the death and was giving 8 kilograms of milk twice in a day. The market value of the buffalo was more than Rs. 40,000/- at the time of death. Despite several demands and requests of the complainant, the op company refused to pay the amount of insurance claim to the complainant. Therefore, the complainant got issued a legal notice dated 17.12.2015 to the op but to no effect and now op has refused to admit the claim of the complainant about a week ago. The opposite party has caused unnecessary harassment, mental pain, shock and agony to the complainant and it is also an act of gross deficiency in service, therefore, the complainant is also entitled to the compensation to the tune of Rs.20,000/- besides claim amount. Hence, this complaint.

2.                On notice, opposite party appeared and filed written statement taking certain preliminary objections. On merits, it has been submitted that after receipt of report of Investigator and after going through the record, the competent authority has decided the claim to be No claim as per terms and conditions of the policy as according to the terms and conditions of the policy tag should have been intact in all regard but same has not been found to be intact in all regard. Decision of repudiation is according to the terms and conditions of the policy as if tag is broken, fallen then it is the duty of the complainant to get the same changed immediately and there is no such efforts on the part of the complainant Remaining contents of complaint have also been denied.

3.                The complainant has tendered her affidavit Ex.C1, copy of Health Cum Evaluation Certificate Ex.C2, copy of details of insured buffaloes and tag numbers Ex.C3, notice Ex.C4 and postal receipt Ex.C5. On the other hand, opposite party tendered affidavit of Sh. Sanjay Aggarwal, Branch Manager Ex.R1, copy of investigation report Ex.R2 and policy schedule Ex.R3.

4.                It is pertinent to mention here that today learned counsel for complainant has made a statement that if the opposite party/ company is ready to pay 70% of the insured amount, then same is acceptable to the complainant and case may be decided accordingly. Learned counsel for opposite party has also made a statement that complainant has given his consent for 70% of the insured sum and he has no objection if the forum decides the case on merits.

5.                We have heard learned counsel for the parties and have gone through the case file carefully.

6.                There is no dispute that the above said buffalo of the complainant was insured with the opposite party w.e.f. 11.02.2015 to 10.02.2016 for sum assured of Rs.40,000/- under cattle insurance policy. It has also come on record that above said insured buffalo of the complainant died on 23.07.2015 i.e. within insurance period due to some illness. Post mortem examination on the buffalo of complainant was conducted vide PMR No.19810 as per investigation report dated 22.8.2015 (Ex.R2). The claim submitted by complainant has been repudiated by the opposite party vide letter dated 9.10.2015 on the ground that one side of tag was broken at the time of investigation. The Investigator appointed by the opposite party in his report Ex.R2 has mentioned that at the time of his spot inspection, broken tag number side was found inserted in the right ear of the dead buffalo and number side (OIC 17328) was intact. According to the opposite party, as per terms and conditions of policy, tag should have been intact in all regard but same has not been found to be intact in all regard. The opposite party has not placed on file any such terms and conditions of the policy. But keeping in view the fact the report of Investigator that although tag was found intact but broken from one side, therefore, we are of the considered opinion that opposite party is liable to pay 70% of the claim/ insured amount on non standard basis which is also acceptable to the complainant. 

7.                Thus, keeping in view the facts and circumstances of the present case, we allow the present complaint and direct the opposite party to pay an amount of Rs.28,000/- (70% of Rs.40,000/- i.e. claim/ insured amount of the buffalo) to the complainant within a period of one month from the date of receipt of copy of this order, failing which the complainant will be entitled to interest @9% per annum from the date of order till actual payment. A copy of this order be supplied to the parties free of costs. File be consigned to the record room after due compliance.      

Announced in open Forum.                                 Presiding Member,

Dated:31.05.2017.                           Member.  District Consumer Disputes

                                                                              Redressal Forum, Sirsa.