BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 156 of 2017
Date of Institution : 11.7.2017
Date of Decision : 23.1.2018
Saroj Rani wife of Sh. Bharat Singh resident of village Jogiwala, Sirsa, Tehsil and District Sirsa.
……Complainant.
Versus.
1. The Oriental Insurance Company Limited, Opp. Janta Bhawan, New Mandi, Sirsa Tehsil and District Sirsa through its Divisional Manager.
2. The Oriental Insurance Company Limited, Regd. Office: Oriental House, A-25/27, ASIF Ali Road, New Delhi- 110002 through its Authorized Person/Managing Director.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SHRI R.L. AHUJA…… PRESIDENT.
SHRI MOHINDER PAUL RATHEE……MEMBER.
Present: Sh. Sandeep Gaba, Advocate for complainant.
Sh. K.L. Gagneja, Advocate for opposite parties.
ORDER
In brief, the case of complainant is that the complainant is a poor farmer having agriculture land and cattle for his livelihood and she was the owner of a Buffalo having description as Medium horne curved of mix Murraha breed milk buffalo, which was healthy and the complainant kept it with utmost care and affection. The complainant to save her cattle/asset/investment got purchased the insurance policy bearing No.261503/47/2017/76 w.e.f. 6.6.2016 to midnight 5.6.2017 from the ops, vide which cattle was got insured. As such the complainant has got duly insured her cattle by purchasing the above said policy after the payment of insurance premium and got issued the policy in her favour as mentioned above. Unfortunately on 22.12.2016 at about 11.00 AM said cattle with ear tag OIC-252945 died due to Tympani asphyxia. The complainant immediately intimated to the ops regarding death of the insured cattle. The ops also lodged the claim of the complainant vide claim No.47/2017/0000219. The ops as and when received the information, immediately appointed their official to verify the facts and circumstances as well as spot inspection and after due spot inspection and verification as well as photography of the dead animal were taken and also after checking the tag, description of the animal the ops directed the complainant to get conduct post-mortem of the above said dead animal. The post-mortem of the dead animal was conducted by the veterinary surgeon of veterinary Hospital, Nathusaria Kalan of the Department of Animal Husbandary and Dairy Department, Haryana, on 23.12.2016, in which the veterinary surgeon opined that the cause of the above said animal is tympani asphyxia vide Post-mortem No.14129 dated 23.12.2016 and the same has been verified by the Sub Divisional Officer, Animal Husbandary and Dairying Department, Sirsa. It is further averred that complainant completed all the formalities in respect of his claim regarding above said animal and also filled up the claim form as well as other requisite documents and handed over the same to the ops with their entire satisfaction and since the day of death of the animal and completion of formalities, the ops have not taken any decision in respect of genuine claim of the complainant and are also not ready to give any satisfactory reply to the complainant and now the complainant has received a letter reference no.nill dated 18.5.2017 issued by the ops vide which the ops have repudiated the claim of the complainant with the false, frivolous and baseless ground. The ops just to avoid their liability and just to repudiate the claim leveled such false and baseless allegations. However, a person deputed by the ops came to the house of the complainant and the complainant provided all the documents along with policy etc and also got completed all formalities being the owner of the deceased/dead animal and this fact was well within the knowledge of the officials of the ops. Despite that the ops repudiated the claim which is totally against the law and insurance policies and there was no violation on the part of the complainant whereas the ops are trying to avoid their legal liabilities to indemnify the losses/damages to the complainant for which they promised and undertaken their liability by accepting the premium for the policy as well as by entering into the contract. The complainant after receiving the above said letter approached to the ops but the ops are not ready to accept the claim of the complainant and they refused to indemnify the losses of the complainant. The complainant is entitled to the sum assured amount of Rs.50,000/- qua her insured buffalo besides compensation of Rs.40,000/- for harassment and also litigation expenses. Hence, this complaint.
2. On notice, opposite parties appeared. Opposite parties filed reply taking certain preliminary objections regarding cause of action, suppression of material facts and locus standi etc. On merits, it is submitted that the said buffalo was insured with the ops vide policy no.261503/47/2017/76 dated 6.6.2016 but the buffalo of the complainant was insured subject to the terms and conditions of the insurance policy as specified in the Livestock Insurance Policy. The buffalo was ear tagged vide ear tag no.OIC-252945 by the insurer/ops at the time of the insurance. It is further submitted that buffalo of the insured died on 22.12.2016 and the ops received the intimation from the insured. The complainant also lodged the claim of death of the buffalo. It is further submitted that as per PMR, the buffalo died because of tympani asphyxia. The ops, after receiving the intimation, appointed Mr. Naresh Jayant Advocate, as surveyor/investigator to do the needful and to ascertain the factum/cause of death of the insured buffalo. On receiving the report of investigator/surveyor, the claim of the complainant was repudiated by the ops as the insured had not adhered to the terms and conditions of the insurance policy. There were so many deficiencies in the claim lodged by the insured as referred in the letter dated 18.5.2017, issued by the Branch Manager of the ops insurance company at Sirsa, by which, the complainant was informed about the deficiencies and she was requested to reply the letter within 7 days. But the complainant neither replied nor tried to remove the deficiencies. She did not even provide the ear tag of the dead buffalo to the investigator or to any officer of the company while lodging the claim with the ops, which was necessary as per the terms and conditions of the insurance policy. The clause of ‘NO TAG NO CLAIM’ has been clearly mentioned in the terms and conditions of the Livestock Insurance Policy. The claim of the complainant has been rightly and legally repudiated by the ops. The complainant was informed regarding repudiation of claim vide letter dated 18.5.2017 if not replied within seven days. It is further submitted that it is wrong to suggest that the complainant has provided all the required documents. Even in her complaint, she has no where mentioned that the tag has been provided to any official of the ops or to the investigator. Remaining contents of the 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 complainant in order to prove her case has furnished her affidavit Ex.CW1/A wherein she has reiterated all the averments of her complaint. She has also furnished copy of letter dated 18.5.2017 Ex.C1, copy of post mortem report Ex.C2, copy of claim form Ex.C3, copy of policy schedule Ex.C4, copy of livestock claim form cum valuation certificate Ex.C5, copy of statement of complainant Ex.C6 and copy of health certificate Ex.C8. On the other hand, opposite parties have furnished affidavit of Sh. Sanjay Aggarwal, Branch Manager as Ex.R1 and have produced copy of letter dated 18.5.2017 Ex.R2, policy schedule Ex.R3 and terms and conditions of the policy Ex.R4.
6. As per the contention of the learned counsel for complainant, complainant has proved that the complainant was owner of a buffalo which was got insured with the opposite parties vide policy bearing No.261503/47/2017/76 for the period from 6.6.2016 to 5.6.2017 for insured value of Rs.50,000/- but unfortunately the said insured buffalo of the complainant died on 22.12.2016 and post mortem was conducted on 23.12.2016 but however the opposite parties have repudiated the claim arbitrarily and illegally.
7. On the other hand, learned counsel for opposite parties has strongly contended that it is basic principle of insurance that No tag No claim. The complainant did not provide tag to the opposite parties and as such claim of the complainant was repudiated vide letter dated 18.5.2017 Ex.R2.
8. The perusal of the record reveals that though opposite parties have taken a plea that no tag was handed over to the ops by the complainant as such complainant is not entitled to any claim but however, the ops have not denied the insurance coverage of the buffalo of the complainant which was insured with the opposite parties vide policy No.261503/47/2017/76 dated 6.6.2016 with ear tag number OIC-252945. The affidavit of the official of the opposite parties namely Sh. Sanjay Aggarwal, Branch Manager Ex.R1 reveals that he has not denied the fact that post mortem was not conducted on the dead body of the buffalo rather he has deposed that the buffalo of the complainant was insured subject to terms and conditions of the insurance policy and the buffalo was ear tagged vide ear tag no.OIC-252945 at the time of issuance of insurance. He has also deposed that buffalo of the complainant died on 22.12.2016 and post mortem on the dead buffalo was conducted by the Veterinary Surgeon, G.V.S. Nathusari Kalan on 23.12.2016, explaining the cause of death in the post mortem report. As per PMR, the buffalo died because of tympani asphyxia and after receiving the intimation they appointed Sh. Naresh Jayant, Advocate as Surveyor/ Investigator to do the needful and to ascertain the factum/ cause of death of the insured buffalo. Sh. Sanjay Aggarwal, Branch Manager has further deposed that there were so many deficiencies in the claim lodged by the insured as referred in the letter dated 18.5.2017. The perusal of the post mortem report Ex.C2 reveals that it contains the tattoo/ brand name of the buffalo bearing No. OIC-252945 which tallies with the ear tag of the buffalo which was insured by ops. The ops have themselves relied upon the report of the Surveyor but have not led any evidence in order to rebut this report that doctor have given a false tag number in his report Ex.C2.
9. Further more, the opposite parties have given a reference of the name of the Investigator who conducted investigation qua the death and cause of death of the buffalo of the complainant but however, the ops have not placed on record the said alleged report of the investigator due to reason best known to the ops. During the course of arguments, learned counsel for ops has not disputed the death of the buffalo and cause of death of buffalo but has only insisted on the point that tag was not handed over by the complainant to the ops. He has relied upon the letter dated 18.5.2017 Ex.R2 on the file. The perusal of this letter reveals that it has been communicated to the complainant that while going through complete claim file, the following deficiencies have been found in his claim papers after carefully observed the papers such as investigation report, doctors report, ear tag history of claim and identification of cattle. A note has been given by which it has been mentioned that as per D.C. recommendation as ‘No Claim’. Further it has no where been mentioned in this letter that the ear tag was not handed over to the ops rather this letter appears to be a show cause notice by which they have called upon the complainant to comment that why her claim should not be repudiated on the above grounds but however the ops have not placed on record any letter of repudiation by which they have repudiated the claim of the complainant due to the reason of non production of ear tag bearing No. OIC-252945 which was allegedly affixed on the ear of the buffalo while issuing the insurance coverage. So, it appears from the evidence of the opposite parties that the ops without going through their own record specially the report of the Surveyor/ Investigator as well as office note have repudiated the claim of the complainant without assigning any specific reason of repudiation. Moreover, even if it is presumed that ear tag which was affixed by the ops at the time of issuance of insurance coverage, though the same was checked by the doctor while conducting post mortem of the buffalo and reported the same number in the report, was not produced by the complainant even then claim of the complainant cannot be repudiated as a whole and same can be settled even on the basis of non standard basis. So, repudiation of the claim of the complainant in such a manner amounts to deficiency in service and unfair trade practice on the part of the opposite parties and as such repudiation is liable to be set aside.
10. In view of the above, we allow the present complaint and direct the opposite parties to settle and pay claim of the complainant on non standard basis within a period of 30 days from the date of receipt of copy of this order. We further direct the opposite parties to pay a sum of Rs.3000/- as composite compensation and litigation expenses to the complainant. A copy of the order be supplied to the parties free of cost. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated:23.1.2018. Member District Consumer Disputes
Redressal Forum, Sirsa.
