Shri. Mohan Appasaheb Jadhav

Age – Major, Occ – Agriculturist,

At.Gavan, Tal.Tasgaon, Dist.Sangli.                    …                    Complainant

 

 

Reliance General Insurance Co.Ltd.,

Through Manager,

Pushpam Plaza, Gr.Floor,

135, B, Tadiwala Road,

Pune – 411 001.                                                      …                    Respondents

 

 

 

 

 

1.         The instant complaint under Section 12 of the Consumer Protection Act, has been filed by the Complainant alleging the deficiency in service on the part of the Respondent Insurance Company and he has claimed an amount of Rs.40,000/- from the Respondent Insurance Company.

 

2.         The case of the Complainant in short is that a Jersey Cow worth about Rs.25,000/- was owned by him and it was insured with the Respondent Insurance Company for a period of 3 years commencing from 03/03/2007. An identification tag bearing No.R G I C L-19844 M L D B was fixed in the said cow. The said cow died on 23/03/2009 due to some ailment. A post mortem was conducted after the inquest punchnama there of was held. On 30/03/2009, the Complainant submitted the claim with the insurance company giving all the details and necessary documents. The Insurance Company repudiated the said claim on 11/07/2009 on the ground that the identification tag was received in broken condition. The Complainant alleged that the Respondent Company has deliberately repudiated the said claim in all to avoid the payment and has thus committed a deficiency in service.  The Insurance Company is, therefore, liable to pay an amount of Rs.25,000/-, which is the sum assured and further amount of Rs.15,000/- on account of the mental and physical torture sustained by the Complainant. On such contentions, the Complainant has prayed for the reliefs mentioned above. 

 

3.         In support of his contentions in the complaint, the Complainant has filed his affidavit at Exh.2 and has filed in all three documents including the policy in question, the copy of the claim form and the letter of repudiation of the claim dated 11/07/2009 along with list at Exh.4. 

 

4.         The Respondent Insurance Company has contested this complaint by filing written statement at Exh.9 and it has denied all the adverse allegations. The fact that the Complainant was owner of the cow as described in the complaint, that it was worth Rs.25,000/- and further that the said cow was insured with the Respondent Company on 03/03/2007 for a period of three years and the said cow was identified by ear tag No.R G I C L-19844 M L D B  are admitted by the insurance company. It is not disputed that the insurance company had not taken to indemnify the Complainant in the event of the death or injury caused to the said injured cow. However, insurance company has denied empathetically, that, the cow which was insured had died. It has, however, not disputed that one cow of the Complainant was insured. It is contended that the claim of the Complainant is highly doubtful. It is contended that no single piece of evidence is produced on record to show that the dead animal was one and the same insured with the insurance company bearing the same tag number mentioned in the policy. It is admitted that the claim of the Complainant was repudiated by the insurance company by letter dated 11/07/2009, but, the said repudiation is for just and proper reasons. That the submission of the intact ear tag is a condition precedent to claim any benefit under the said policy. When an attempt is made to tamper with said identification tag, it gets broken and whenever there is a broken tag, it is considered as no tag at all and the claim is repudiated under the condition “No Tag No Claim”. That the Complainant did not immediately informed the death of the insured cow and did not submitted intact ear tag and this shows that fraud was tried to be committed by the Complainant to claim the benefit under the policy. It is denied that the insurance company has rendered any defective service to the Complainant.   On such contentions, Respondent Insurance Company has denied the entire claim of the Complainant and has prayed for dismissing the complaint. 

 

5.         The Insurance Company has filed an affidavit in support of its contentions but has not filed any documents. 

 

6.         Neither party has lead any oral evidence. The Complainant and the Respondent have filed written notes of arguments and we have heard the oral submissions of the learned counsel for the Complainant. 

 

7.         The points those arise for our consideration are as follows.

 

1. Whether, the Complainant has proved that the

2. Whether, the Complainant is entitled to the relief

3. What Order ?                                                                                -           As per

 

8.         The reasons for findings above are as follows:-

 

9.         Point No.1 & 2  :-     Most of the facts in this case are admitted. The Respondent Company has not disputed nor has contended that the Complainant is not a Consumer within the meaning of the Consumer Protection Act, 1986, of that it is a service provider, therefore, that issue does not arise in this case at all. 

 

10.       The Respondent Insurance Company has tried to create a doubt with respect to identity of the cow for whose death the Complainant has claimed the sum assured, has to be the very same cow which was insured by the Complainant, with it. It is contended by the Respondent Insurance Company that the ear tags affixed to the ear of the insured cattle get broken if they are tried to be removed or otherwise tampered with and since, the insurance company has received the identification tag in broken conditions, it is suspected that the cow for whose death, the Complainant has claimed the insurance amount is not the one, which was insured with the insurance company and secondly, the broken identification tag tantamount to no tag at all and therefore, as per the condition of the insurance policy, which reads “No Tag No Claim.” The claim of the Complainant is liable to repudiated and therefore, it was repudiated and hence, there was no deficiency in service. 

 

11.       The entire burden to prove this contention was on the Respondent Insurance Company. It has not lead any evidence what so ever and has not proved that the identification tag received by it was in broken conditions. No evidence has been lead by the insurance company to prove that there is a stipulation in the conditions of the insurance policy that the broken identification tag shall be taken as no tag at all and therefore, it could repudiate the claim on the ground “No Tag No Claim”. In United India Insurance Company Ltd., through Br.Manager V/s. Smt.Chandrakala Kosale reported in 2005 (2) CPR 112, Chhattisgarh State Consumer Disputes Redressal Commission, Raipur, in the similar set of facts had awarded the claim of the Complainant.  

 

12. From the letter of repudiation of claim dated 11/07/2009, it is clear that the Respondent Insurance Company had received a tag. However, according to the insurance company that tag was received in broken condition and this amounted to breach of the condition No.3 of the said policy and therefore, the claim is not admissible. The whole of the policy document is not produced on record by the parties, but, a certificate of insurance is produced on record by the Complainant along with list at Exh.4/1. The said certificate states the documents which are required to be submitted for settling the claim, those documents are 1) Claim Form 2) Post Mortem Report 3) Ear Tag 4) Photograph with owner showing tag in the ear of the Cattle 5) Carcass Disposal Certificate and 6) Punchnama & The Treatment Certificate. At serial No.3, however, there is a bold caption “NO TAG NO CLAIM ” condition. Neither any agreement between the parties nor any rule has been produced on record by the Respondent Insurance Company, which shows that, if, a tag is received in broken condition, it shall be treated as no tag at all. The Insurance Company has not examined any witness also who could have explain as to how the insurance company mandates that if the tag received in broken condition, it will be treated as no tag. Therefore, we do not find any justification for the stand taken by the Respondent. In the facts before the case cited in Supra no tag what so ever was produced by the insured while submitting the claim. The case of the present Complainant is on a better footing with the facts in that case. Therefore, it will have to be held that the repudiation of the claim of the Complainant by the insurance company was wrong and was based on wrong notion and therefore, it amounted to clear deficiency in service. We, therefore, hold accordingly. Hence, we have answered point No.1 in the affirmative. 

 

13.       In the face of the defective service, being rendered  by the Respondent Company in repudiating the claim of the Complainant, it follows that the Complainant is entitled to the sum assured under the policy. The repudiation of the claim on the wrong notions and the defective service given, is bound to cause a mental harassment to the Complainant. The Complainant has contended that he had to time and again contact the officials of the Respondent Insurance Company, he had to travel to go to the said office, had to talk with the officials on telephone, by correspondence etc., and ultimately he has to file this complaint by paying the fees of the lawyer and thus, he has claimed an amount of Rs.15,000/- under all these heads. Under the circumstances of this case the Complainant appears to be entitled to the sum assured amounting to Rs.25,000/- and the amount of Rs.15,000/- thus to the total of Rs.40,000/- and therefore, we hold accordingly and hence, we have answered point No.2 in the affirmative. 

 

14.       In the result, we find and hold that the complaint is liable to be allowed and the Complainant is entitled to the reliefs claimed therein and hence, we proceed to pass the following order.

1.         The Complaint is allowed.

 

2.         The Respondent has directed to pay an amount of Rs.25,000/- being the

sum assured under the said cattle policy and further amount of

Rs.15,000/- on account of the cost of contacting Respondent, the

correspondence, the telephonic conversations with the officers of the

insurance company, mental harassment and the cost of the present

complaint.  

3.         The Respondent shall pay the said amount within a period of 45 days,

failing which, the said amount would carry the interest @ 8.5% p.a. from

the date of the complaint till realization. 

 

Date :- 16/05/13.

Place – Sangli