BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 30th day of January, 2009

Present:

SRI.LAIJU RAMAKRISHNAN PRESIDENT

SMT.SHEELA JACOB MEMBER

SMT.BINDU SOMAN MEMBER

C.C No.95/2008

Between

Complainant : Adv:Harikrishnan T.D,

C/o Mr.Raju, Kunnel House,

Mulakaramedu P.O,

Kattappana

Permanently residing at Lakshmi Prasadam,

Puthukkalavattam,

Elamakkara, Kochi.

(By Adv: C.K.Babu)

And

Opposite Party : The Branch Manager,

United India Insurance Company Limited,

Branch Office,

Municipal Complex,

Kacherithazham,

Muvattupuzha.

(By Adv: T.J.Lakshmanan)

O R D E R

SRI.LAIJU RAMAKRISHNAN(PRESIDENT)

The complaint is filed for getting the insurance claim of the buffaloes of the complainant and also against deficiency in service of opposite party.

The complainant is running a livestock at Mulakaramedu, Kattappana. The complainant has insured 17 buffaloes among many others from 17.01.2007 to 16.01.2008 vide policy No.10110147/06/01/676 with the opposite party. Each buffalo is insured for an amount of Rs.5,000/-. Out of this, 6 buffaloes died on 23.04.2007 and 11 buffaloes died on 26.04.2007. Dr.Vishnu Sreedhar, Veterinary Surgeon, Veterinary Policlinic, Kattappana who has done the autopsy has reported the death of 6 buffaloes on 24.04.2007 and 11 buffaloes on 26.04.2007, to the opposite party and intimation letters were received by the opposite party on 26.04.2007 and on 30.04.2007 respectively. But the opposite party denied to issue the claim forms. On 17.08.2007 the complainant personally went to the office of the opposite party and collected claim forms. But when the claim forms were submitted on 10.09.2007, the opposite party issued a letter seeking a lot of clarifications. The complainant replied to the above letter on 12.03.2008. The complainant personally represented before the opposite party and submitted that he was unable to produce any further documents since all documents were already produced. The opposite party has rejected the claim without assigning any proper reason. The complainant had to go to the opposite party's office on various occasions. The complainant paid an amount of Rs.1,000/- for his travel itself. So the petition is filed for getting the insurance amount of Rs.85,000/- and also for compensation of Rs.10,000/- for the mental agony from the opposite party.

2. The opposite party filed written version and stated that the complainant is not having any cause of action to file the above complaint. It is admitted by the opposite party that they had granted cattle insurance coverage to the complainant for the period from 17.01.2007 to 16.01.2008 subject to the terms and conditions of the policy issued. On 26.04.2007 and on 30.04.2007, the opposite party had received two death certificates issued by Dr.Vishnu Sreedhar and in the said certificates, the Veterinary Surgeon has stated that 6 buffaloes belonging to the complainant were found dead in the afternoon of 23.04.2007 and 11 buffaloes were found dead in the morning of 26.04.2007. Particulars like the cause of death, ear tag number etc. were not mentioned in the said certificates. Intimation was given to the opposite party only after 24 hours from the time of said alleged death. No explanation for the delay was stated in the certificates. As per the policy conditions, on the death of the insured animal, the insured shall within 24 hours need to give notice to the company and an opportunity has to be given to the company to inspect the carcass by not removing, cutting or parting it. In this case, the insured had never given an opportunity to the opposite party to inspect the carcass. No notice was given within 24 hours of the alleged death and it is a clear failure of the policy conditions. In the certificate issued by the Veterinary Surgeon, the cause of death and ear tag number were not mentioned. It is further submitted along with the claim forms, the veterinary certificates and autopsy reports of each claims. But in the autopsy reports the date of death of the insured animals were shown as 24.02.2007. The said reports were issued on 10.09.2007. It is seen that the said certificates were issued only after 7 months from the date of the alleged death and no sufficient explanation for the delay. The complainant had also not produced any certificate issued by a qualified Veterinary Surgeon regarding the condition of the animal at the time of commencement of the insurance coverage. The opposite party issued the policy only on the basis of utmost good faith which is one of the essentials of insurance contract. The opposite party requested the complainant to produce the documents and clarifications in order to provide prompt service to him. But the complainant was not ready to co-operate with the opposite party. The opposite party never repudiated the claim. They only requested the complainant to help them in considering the claim on merit and in accordance with the law. So the complaint is not maintainable and hence it is liable to be dismissed.

3. The point for consideration is whether there was any deficiency in service on the part of the opposite party, and if so, for what relief the complainant is entitled to ?

4. The evidence consists of the oral testimony of PW1 and Exts.P1 to P4 marked on the side of the complainant and the oral testimony of DWs 1 and 2 and Exts.R1 to R4 marked on the side of the opposite party.

5. The POINT :- The complainant is running a livestock at Mulakaramedu, in that 6 buffaloes were died on 24.04.2007 and 11 buffaloes died on 26.04.2007. The buffaloes were insured to the opposite party. But the insurance claim was not given by the opposite party. The complainant was examined as PW1. Complainant deposed that, each buffalo was insured for Rs.5,000/- as policy No.10110147/06/01/676. Dr.Vishnu Sreedhar, Veterinary Surgeon, Veterinary Polyclinic, Kattappana has done the autopsy. The report and intimation letters were given to the opposite party. The complainant requested for claim form. They did not issue the claim form. On 17.08.2008, the complainant personally went to the opposite party's office and collected the same, resubmitted it with autopsy reports. On 27.02.2008, the opposite party issued a letter seeking a lot of clarifications which is Ext.P1. The complainant replied for the letter on 12.03.2008, copy of the same is Ext.P2. Again letter issued from opposite party telling that Ext.P2 reply was not satisfactory and further sought of documentary evidence, copy of the same is Ext.P3. Also stated that the date of death of animals written in the autopsy report is different from the earlier issued certificate. Then the complainant personally appeared and told that the documents were already produced. On 16.05.2008 another letter issued by opposite party stating that they have rejected the claim. The opposite party was examined as DW1. DW1 admitted the policy which is Ext.R1, in which 40 buffaloes were insured. The death certificates issued by the Veterinary doctor were received on 26.04.2007 and 30.04.2007. In the death certificate, the Tag No. and the reason for death were not mentioned. The filled claim form submitted by the complainant was in October 2008, with postmortem certificate. As per the policy condition, the matter of death should be informed within 24 hours. The Veterinary Surgeon of the company should examine the carcass. In this case the report of the death was informed only after two days. The date of death of the animal in the autopsy report and in the death certificate are different. Letter was sent for the clarification of the same. But the clarification was not proper and so the claim was not settled. The doctor who submitted the autopsy report was examined as DW1. As per the deposition of the doctor, the doctor had informed the matter of death to the opposite party. The death certificate was issued by the doctor which is Exts.R1(a) and (b). The cattle were died in two days. The doctor was having 2 additional charges of Veterinary surgeon and the charge of entire Taluk. So the doctor was busy with that and the report was typed by himself. Because of busy in duty there was a delay caused in filing the report, there was a clerical mistake in the date also, it was also due to busy in job, not a deliberate one. The correct date is, what written in the death certificate.

The policy was admitted by the opposite party. The reason for non-settlement of the claim was that there is a delay in intimating the matter of death by 24 hours. The mistake in the date of death in autopsy report was not explained, the tag numbers were not given. As per PW1, PW1 has informed the matter in telephone and the matter was duly intimated by the doctor in writing. The death of the animal was caused in afternoon. So the matter was intimated to the opposite party in the very next day itself. The mistake in the report was explained by DW2, because the doctor was busy with two other charges of duty and DW2 was in charge of Veterinary Surgeon for the entire Taluk. So the clerical mistake happened due to busy in duty and in typing. The tags were produced later. As per cross examination of the learned counsel for the complainant, if a letter is sending by the complainant, it will reach only on the next day to the opposite party's office. Here the information was collected within two days. If the opposite party was suspicious about the death of the animal, the opposite party ought to have conducted the autopsy examination once again, by taking back the carcass which was burried by the complainant. No further investigation was done by the opposite party for this matter. The opposite party also admitted that they never rejected the claim. They have not settled at all. We think that the non-settlement of the claim is a gross deficiency in the part of the opposite party. Hence we order to disburse the insurance amount to the complainant.

Hence the petition allowed. The opposite party is directed to disburse the policy amount as per Ext.R4 for 17 buffaloes(which is Rs.85,000/-) to the complainant with 12% interest from the date of this petition and Rs.2,000/- for the cost of this petition within one month of receipt of a copy of this order, failing which the outstanding amount shall carry further interest at 12% per annum from the date of default.

Pronounced in the Open Forum on this the 30th day of January, 2009

Sd/-

SRI.LAIJU RAMAKRISHNAN(PRESIDENT)

Sd/-

SMT.SHEELA JACOB(MEMBER)

Sd/-

SMT.BINDU SOMAN(MEMBER)

APPENDIX

Depositions :

On the side of Complainant :

PW1 - T.D.Harikrishnan

On the side of Opposite Party :

DW1 - K.P.Asokan

DW2 - Dr.Vishnu Sreedhar

Exhibits:

On the side of Complainant:

Ext.P1 - True copy of letter dated 27.02.2008 issued by the opposite

party to the complainant

Ext.P2 - Complainant's reply letter dated 12.03.2008 addressed to the

opposite party

Ext.P3 - True copy of letter dated 27.03.2008 issued by the opposite

party to the complainant

Ext.P4 - True copy of letter dated 16.05.2008 issued by the opposite

party to the complainant

On the side of Opposite Party :

Ext.R1(series) - Death certificates issued by Dr.Vishnu Sreedhar,

Vety.Surgeon, Vety.Poly Clinic, Kattappana(2 Nos)

Ext.R2(series) - Claim Forms submitted by the complainant before the

opposite party (17 Nos)

Ext.R3(series) - Autopsy Reports issued by Dr.Vishnu Sreedhar, Veterinary

Surgeon, Veterinary Polyclinic, Kattappana(17 Nos)

Ext.R4 - Cattle Insurance Policy