DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA

CC.No.170 of 25-02-2014

Decided on 04-06-2014

Jeet Singh S/o Fateh Singh R/o Village Kothe Kaur Singh Wala Ablu, Tehsil and District Bathinda.

........Complainant

Versus

1.Tata AIG General Insurance Company Limited having its Branch at Bathinda, through its Authorized Person/Branch Manager.

2.Tata AIG General Insurance Company Limited having its Registered Office at 15th Floor, Tower A, Peninsula Business Park Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Patel Mumbai, through its Deputy Manager Sales/Authorized Person.

.......Opposite parties

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

QUORUM

Smt.Vikramjit Kaur Soni, President.

Smt.Sukhwinder Kaur, Member.

Sh.Jarnail Singh, Member.

Present:-

For the Complainant: Sh.M.L Sharma, counsel for the complainant.

For Opposite parties: Sh.Naresh Garg, counsel for the opposite parties.

ORDER

VIKRAMJIT KAUR SONI, PRESIDENT:-

1. The instant complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986 as amended upto date (Here-in-after referred to as an 'Act'). Briefly stated the case of the complainant is that two buffaloes of the complainant were duly insured with the opposite parties vide policy bearing No.07000140039/1039, valid from 14.3.2013 to 13.3.2016 and duly tagged. At the time of selling of the abovesaid policy the opposite parties conveyed the complainant that the risk cover date is 11.2.2013. Out of the abovesaid two buffaloes, one buffalo bearing tag No.R07493 died on 24.3.2013 and the complainant has informed the bank and opposite parties regarding it. The veterinary doctor conducted the postmortem of the abovesaid buffalo. The complainant completed all the formalities and submitted his claim to the opposite parties for the clearance of the claim, but they have rejected his claim vide their letter dated 7.5.2013 on the ground that the death is early one as the animal died within 15 days of the insurance and on false ground that the said animal was suffering from some disease before her insurance. Before the issuance of the abovesaid policy the said buffalo has been duly medical examined and there was no such report. If the animal was suffering from any disease, the opposite parties could have not insured her. The complainant several times approached the opposite parties and requested them to admit his claim, but they have failed to accede to his requests and refused to admit his claim. Hence the complainant has filed the present complaint to seek the directions of this Forum to the opposite parties to pay the claim of the dead animal alongwith cost and compensation or to give him any other additional or alternative relief for which he may be found entitled to.

2. The opposite parties after appearing before this Forum have filed their joint written statement and pleaded that the complainant has alleged in his complaint that the insured buffalo died on 24.3.2013, whereas the policy has been taken on 14.3.2013, meaning thereby buffalo died within 10 days from the date of inception of the abovesaid policy. As per the policy Exclusions:-The liability of the company in respect of any animal shall not exceed the sum insured set again such animal insured provided always that this policy does not cover (Unless expressly agreed to by the company in writing) death directly or indirectly due to or arising out of resulting from'. The buffalo bearing tag No.R07493 has been insured by the opposite parties vide policy No.07000140039/1039, valid from 14.3.2013 to 13.3.2016 subject to terms and conditions of the policy. The insured buffalo was ill from 2.3.2013 i.e. before inception of the policy, as such insured animal contracted the disease before the policy inception and died on 11th day of the policy inception. As per policy Condition No.10 the company is not liable to pay the claim in the event of death of insured animal due to disease occurring within 15 days from the commencement of risk.

3. The parties have led their evidence in support of their respective pleadings.

4. Arguments heard. The record alongwith written submissions submitted by the parties perused.

5. Admittedly, the complainant got insured his two buffaloes from the opposite parties vide policy bearing No.07000140039/1039, valid from 14.3.2013 to 13.3.2016. Out of the abovesaid two buffaloes, one buffalo bearing tag No.R07493 died on 24.3.2013. The opposite parties rejected the claim of the complainant vide their letter dated 7.5.2013.

6. The disputed facts of the parties are that the complainant submitted that the commencement date of the abovesaid policy is 11.2.2013 and risk cover date is 11.2.2013, whereas the policy bearing No.07000140039/1039 is valid from 14.3.2013 to 13.3.2016, the opposite parties have wrongly rejected the claim of the complainant, as at the time of issuing of the policy the animal was duly examined by the veterinary doctor. On the other hand the opposite parties have rejected the claim being early claim as the animal died within 15 days of the inception of the policy.

7. The relevant portion of repudiation letter, Ex.C2, is reproduced:-

“On perusal of the claim documents, the following observation was made:-

As per Veterinary doctor's treatment report death of your insured animal with captioned tag number was on 24.3.2013 due to 'Pneumonia'.

As per duly filled and signed claim form provided by you is stated that your said animal was ill from 2.3.2013 i.e. before policy inception date.

Hence insured animal contracted the disease before policy inception date and died on 11th day from date of policy inception i.e. the animal contracted and died due to disease within 15 days from date of policy inception.

In the light of the above, it is violation of policy Condition No.10 and attracts Exclusion No.12:

Policy Condition No.10:- The company is not liable to pay the claim in the event of death of insured animal due to disease occurring within 15 days from the commencement of risk.

Exclusion No.12:-Exclusions: The liability of the company in respect of any animal shall not exceed the sum insured set again such animal insured provided always that this policy does not cover (Unless expressly agreed to by the company in writing) death directly or indirectly due to or arising out of resulting from-

Any non-scheme animal claim arising due to disease contracted within 15 days from the date of risk.”

A perusal of Postmortem Report shows that 'History:-There is history of prolong illness due to pulmonary infection and animal was under treatment, treated at Civil Veterinary, Polyclinic, Badal, OPD No.5944 dated 13.3.2013 for pulmonary infection; Opinion:-According to history, history of previous treatment, external & internal examination of canvass. In my opinion buffalo having tag No.TAIG/R07493 is died due to Pneumonia leads to death'.

The complainant has particularly submitted that he was conveyed that the risk commencement date was 11.2.2013, whereas the policy bearing No.07000140039/1039 issued to him for his animals shows that it was valid from 14.3.2013 to 13.3.2016 and a perusal of Proposal-Cum-Schedule of Cattle Proposed For Insurance, Ex.C1/OP1/18, shows that the tagging date is 12.2.2013. At the bottom of this report the remarks are given:-I/We certify that the above proposed animals are examined by me/us and are found free from disease/s or ailment/s and are fit for insurance'. This certificate has been issued by Dr.Y.P Arora, Regd. No.244, Retd A.D (A.R), Bathinda. It is further mentioned in this certificate that 'No Tag No Claim:-No claim shall be payable if the tag is not intact at the time of death of the animal or the tag is lost and not reported for re-tagging; Commencement of Risk:-Risk shall commence from the date of submission of this proposal and tagging of the animal against full payment of premium only. Risk for death due to disease/s shall commence only after 15 days waiting period'. It is also mentioned in this certificate that 'I confirm the above animals are successfully tagged after health certification by the Veterinary Officer. The animals are healthy and free from any disease or ailment'. The premium amount has been duly received from the complainant and this certificate has been duly signed and stamped by Dr.Y.P Arora, Authorized Tagging Officer. Thus it is clear from Ex.C1/OP1/18 that the commencement date of the abovesaid policy was 12.2.2013, the insured animal died on 24.3.2013 i.e. after more than 15 days from the date of commencement of the policy in actual.

8. If for the arguments sake it is believed that the policy commencement date is 14.3.2013 to 13.3.2016, then why this policy has been issued on 12.2.2013 as per Ex.C1/OP1/18. Moreover the animals have been insured after duly checking their health and in this regard it is specifically mentioned in Ex.C1/OP1/18 that the above animals are successfully tagged after health certification by the Veterinary Officer and this shows that the above proposed animals are examined by Veterinary Officer and are found free from disease/s or ailment/s and are fit for insurance, meaning thereby at the time of filling of the proposal form and issuance of the abovesaid policy, the animals were free from the disease.

9. Therefore keeping in view the facts, circumstances and evidence placed on file we are of the considered opinion that there is deficiency in service on the part of the opposite parties as they have wrongly rejected the claim of the complainant. Hence this complaint is accepted with Rs.5000/- as cost and compensation against the opposite parties. The opposite parties are directed to pay the amount of Rs.40,000/- as claim of the deceased animal having tag No.R07493, to the complainant.

10. The compliance of this order be done within 45 days from the date of receipt of the copy of this order.

11. In case of non-compliance within the stipulated period, the interest @ 9% per annum will yield on the amount of Rs.40,000/- till realization.

12. A copy of this order be sent to the parties concerned free of cost and file be consigned to the record room.

Pronounced in open Forum:-

04-06-2014

(Vikramjit Kaur Soni)

President

(Sukhwinder Kaur)

Member

(Jarnail Singh)

Member