SRI BIJOY KUMAR DAS,PRESIDENT:-
Deficiency in service in respect of illegal repudiation of insurance claim of complainant insured cow are the allegations arrayed against the Opp.Party-Insurance Company.
2. Complaint, in brief reveals that, Complainant had a cow which was insured for Rs. 40,000/- as per the procedure and on filing of proposal-cum-schedule on identification of the animal and on allotment of Ear tag baring No. 31000354252 on dt. 16/11/2015. It is also stated that the cow of the complainant was insured alongwith other 14 numbers of cows on payment of Rs. 230/- as his share of premium before Op No.2-Addl. Veterinary surgeon, Garadpur, Kendrapara. The insurance of the cow was valid from dt. 16.11.2015 to 15.11.2016. Unfortunately, the cow died on 29.09.2016 and after completion of formalities, Complainant lodged a claim before the Op-Insurance Company for its settlement. But Op-Insurance Company vide their letter dtd. 04.07.2017 addressed to OpNo.3 repudiated the claim on the ground that, the Live-stock Policy of the complainant was not inforce at the time of death of the cow. It is also stated that in response to the letter of Op No.1-Insurance Company, Op No.3- C.D.V.O., Kendrapara issued a letter on 30.08.2017 intimating the Insurance Company regarding accurate period of Policy and requested for reconsideration of the claim. As Op no.1-Insurance Company did not response, Complainant was compelled to issue Advocate’s Notice on 21.11.2017, being failed on his attempts, Complainant files the present complaint before the Forum. As per the complaint, the cause of action arose ON 04.07.2017, when the Op-Insurance Company issued an illegal repudiation letter to OpNo.3 and on 30.08.2017, 21.11.2017 and lastly 18.01.2018 where the requests for settlement of claim was turned down by Op-Insurance Company. In the present complaint, it is prayed that, a direction may be given to OpNo.1 to settle the claim of deceased cow and to Pay Rs. 40,000/- as sum insured alongwith 9% interest P.A. and to pay Rs. 6,000/- towards compensation for mental agony alongwith cost of litigation.
3. On receipt of Notice OpNo.1, Sr. Br. Manager, United India Insurance Company appeared through their Ld. Counsel Mr. Md. Nayeem and field written statement flatly denying the allegations and submitting the facts of the dispute, it is averred that, Complainant’s cow was insured with this Op bearing ear tag No. 3100054252, Policy No. 26020147115-P11670602 and the Policy was valid from 07.07.2015 to 06.07.2015. The insured cow of the complainant is died on 29.9.2016, as the cow died after expiry of Insurance Policy, The claim of the complainant is closed as ‘No claim’. Accordingly, the allegation and documents files into the case are false and fabricated, same is liable to be dismissed with exemplary cost.
OP No.2,Addl.Veterinary Asst. Surgeon appeared and filed written statement with supporting documents into the dispute. The written statement of OP No.2 reveals that complainant had a CBJ red cow which was insured on dtd.16.11.2015 for a period of one year. The proposal-cum-schedule form for OLRDS-CP live stock insurance scheme alongwith premium amount was deposited with C.D.V.O.,Kendrapara on dtd.16.11.2015 with Ear tag number of cow was 310003534252. It is averred that the cow was suffering from illness and died on dtd.29.09.2016, and all the documents related to death of the cow was submitted before C.D.V.O. vide letter No.396 dtd.20.01.2017. It is also averred that, the letter of the insurance company dtd.04.07.2017 in connection to claim of the complainant declared as ‘No claim’ on ground that at the time of death of the cow, the insurance policy was not in force is not true. OP No.2 countering the grounds of repudiation of claim issued a letter to OP-Insurance Company on dtd.19.07.2017 for consideration and settlement of claim.
OP No.3, Chief District Veterinary Officer, Kendrapara appeared into the dispute, only filed documents in connection to deposit of premium, Postmortem report and etc..
OP No.4, Chief Executive Officer, Odisha Live Stock Resource Development Society(OLRDS) is the State Implementing Agency for 9 districts including the district of Kendrapara, for providing insurance protection against the diary animals of the farmers. OP No.4 in his written statement averred that as per the agreement between Director,Animal Husbandry and Veterinary Science and United India Insurance Co.Ltd. dtd.07.02.2015 the policy will take effect immediately upon identification of the animal after due examination by VAS, assessment of value and its tagging alongwith payment of farmer’s share of premium to the Insurance Company. In the present case, the proposal-cum-schedule was signed on dtd.16.11.2015 and farmers share of premium for 14 persons including the name of the complainant were collected and submitted to the OP-Insurance Company through the CDVO,Kendrapara on dtd.10.12.2015. It is also averred that as per the agreement, the insurance policy in the dispute covers from the period dtd.16.11.2015 to dtd.15.11.2016, but OP-Insurance Company wrongly covers the period from dtd.07.07.2015 to dtd.06.-07.2016, as the cow is identified by AvAS on dtd.16.11.2015, the date of fixing the ear tag. It is further averred that the CDVO,Kendrapara vide their office letter No.2492 dtd.30.08.2017 requested the Branch Manager,United India Insurance Co.Ltd. to reconsider the case of the complainant, but said letter was not responded and OP No.4 liable OP-Insurance Company for non-settlement of the claim.
4. Heard the Learned Counsels for complainant and OP No.1 and case of the OP No.2 to 4 on merit, perused the documents filed by the parties. The admitted facts of the case are that complainant had a CBZ cow, insured with OP-United India Insurance Company and the ear Tag no.of the said cow is 310003534252,it is also a fact that the process of insurance of livestock/cow is rooted through the concerned veterinary offices and proposal/premium of the beneficiaries in a group are deposited before the insurance company for obtaining the policy of the livestock. It is further a fact that the said cow of the complainant died on dtd.29.09.2016 and claim was lodged on 29.09.2016 and the insured amount of the deceased cow towards settlement of insurance was repudiated by OP-Insurance Company vide letter dtd.04.07.2017 on the ground that on the date of death of the cow i.e. on 29.09.2016,the policy was not inforce, as the policy period of the cow covered from dtd.07.07.2015 to dtd.06.07.2016.
In the case in hand the only issue to be decided here that, whether the insurance policy of the cow was in force on the date of death of the cow or not ? and the repudiation letter issued by OP-Insurance Company whether is legally sustainable or not ? The reason of repudiation of claim by OP-Insurance Company is discussed earlier. On the otherhand the other Ops,(OP NO.2 and 4) countering the version of the OP-Insurance Company state that the insurance policy of the deceased cow covered the period from dtd.16.11.2015, to dtd.15.11.2016. OP-Veterinary offices to support their case filed attested photo copy of proposal-cum-schedule Form which reveals that the total amount of premium towards policy of the cows of 14 beneficiaries including the complainant has signed on dtd.16.11.2015 and the letter No.2492 dtd.30.08.2017 of OP No.2,CDVO,Kendrapara reflects that the premium amount of complainant deposited on dtd.04.12.2015 and in the said letter OP No.2 counters the ground of repudiation of claim and requested the OP-Insurance Company to re-consider the claim.The claim application alongwith post-mortem report was filed on dtd.29.09.2016 on the same date of death of insured cow,OP-Insurance Company to justifying their plea of repudiation filed documents as per the list, which includes the MICRO-INSURANCE PRODUCT-CATTLE INSURANCE policy No.2602014715P116706021,the original cow/Buffalo card issued by Addl.Veterinary Suirgeon,Garadapur,original claim Application Form and other documents.The policy presented before us discloses that total 420 nos. of farmers/beneficiaries of the Kendrapara District have insured their cows for different sum insured and the period of insurance covers from dtd.07.07.2015 to Midnight of dtd.06.07.2016. The said policy is not supported by any other documents like proposal form, receipt date of premium acceptance of the beneficiaries. The most important documents is the original cow/Buffalo card, signed by OP No.2 on dtd.16.11.2015, where the insured cattle is identified and ear tag no. is allotted to the insured cow which is a mandatory provision in connection to acceptance of the Policy and settlement of claim.
The period of policy as mentioned by the OP-Insurance Company cannot be generated prior to date of identification of the cattle by Addl.Veterinary Surgeon and allotment of Ear tag no.The documents presented by OP No.2 to 4, which includes the attested Xerox copy of project proposal, signed on dtd.16.11.2015 and Xerox copy of premium payment receipt dtd.04.12.2015. Hence, it appears that the date mentioned in the policy which covers the period of insurance can not be relied and trustworthy.
Further, OP-Insurance Company did not reponse to the letter of OP No.2 dtd.30.08.17 to substantiate their stand. It is also clear that, the cow-card issued by Addl.Veterinary Asst.Surgeon,Garadpur in the name of the complainant on dtd.16.11.2015. On perusal of clause-7 of the agreement executed between OP-Insurance Company and Director Animal Husbandry and Veterinary Service, it is clear that the policy cover will take effect immediately upon identification of animal, its examination by veterinarian, assessment of its value and its tagging alongwith payment of share of premium to the insurance company or its representation by the owner are completed. In the present dispute the deceased cow was identified by the veterinary doctor on dtd.16.11.2015 and allotted the ear tag no. and subsequent insurance process started on or after dtd.16.11.2015. It is abundantly clear that the insurance policy of the deceased cow was started from dtd.16.11.2015 and valid up to one year, not from dtd.07.07.15 to dtd.06.07.2016 as stated by OP-Insurance Company in their letter dtd.04.07.17 addressed to CDVO,Kendrapara. Hence, in the circumstances the repudiation of claim of the complainant by OP-Insurance Company is illegal and arbitrary and violates the terms and conditions of agreement executed on dtd.07.02.2015 and complainant is entitled to avail the sum insured against his claim as his insured cow died on dtd.29.09.2016(as revealed from the Postmortem report and other ancillary documents) during the insurance cover period of the deceased cow. We, feel surprise that how an insurance company without applying their mind and not considering the terms and conditions of the agreement and letter of OP No.2 dtd.30.08.2017 whimsically rejected the claim by creating an imaginary date of coverage period of the deceased cow and put the complainant like a common man to suffer financial loss and mental agony and dragged the complainant into a unnecessary litigation. Here, we rely on a decision of Hon’ble Apex Court “Gurgaon Gramin Bank-Vrs-Khazani and another,IV(2012)CPJ S(SC). No relief is sought against OP No.1,2& 4, accordingly the said Ops are freed from allegation of deficiency in service and OP-Insurance Company is held liable for deficiency in service. More so, as per clause-10 of the agreement between OP No.4 and OP-Insurance Company, if the OP-Insurance Company fails to settle the claim within 15 days, the insurance Company is liable to pay, a penalty of 12 per cent compound interest per annum to the beneficiary. In the instant dispute OP-Company has not settled the livestock claim of the complainant within 15 days of receipt of the claim Application i.e. dtd.29.09.2016 rather issued the repudiation letter on dtd.04.07.2017, which violates the terms and conditions of the agreement. Hence, complainant-beneficiary is entitled to receive the 12 per cent compound interest on the sum assured of Rs.40,000/-,but in the complaint, complainant has prayed for 9 per cent interest per annum on sum insured, accordingly the prayer for 9 per cent interest per annum is allowed from the date of lodging the claim application i.e. 29.09.2016 to till its realization.
Having observation reflected above, it is directed that OP-Insurance Company shall release an amount of Rs.40,000/-(Rupees Forty thousand) only as sum insured amount towards death of complainant’s cow. It is further directed that OP-Insurance Company shall pay 9 per cent interest on the sum insured starting from dtd.29.09.2016 to till its realization. It is further directed that OP-Insurance Company shall pay an amount of Rs.1,000/-(Rupees One thousand)only towards cost of litigation to the complainant and the total ordered amount shall release within one month from the date of receipt of this order, failing to comply the order penal provisions be initiated against the OP-Insurance Company as per the provisions of C.P.Act,1986.
The complaint is allowed in part with cost.
Pronounced in the open Court, this the 27th day of March,2019.
I, agree.
Sd/- Sd/-
MEMBER PRESIDENT
