Karnataka

Chitradurga

CC/61/2016

Sri NaveenKumar S/o Gangadarappa - Complainant(s)

Versus

The Branch Manager,Iffco Tokio General Insurance Service Ltd., - Opp.Party(s)

Shri.M.K.Lokesh

12 Jan 2017

ORDER

COMPLAINT FILED ON:20.06.2016

DISPOSED      ON:12.01.2017

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

 

CC.NO: 61/2016

 

DATED:  12^th JANUARY 2017

PRESENT: - SRI. T.N. SREENIVASAIAH  : PRESIDENT                                   B.A., LL.B.,

                   SRI.N. THIPPESWAMY        MEMBER

                                 B.A., LL.B.,   

……COMPLAINANT/S	Naveen Kumar, S/o Gangadharappa, Age: 30 Years, Agriculturist, R/o Madakaripura Village, Chitradurga Taluk, Chitradurga District.   (Rep by Sri.M.K. Lokesh, Advocate)
V/S
…..OPPOSITE PARTY	The Branch Manager, Iffco Tokio General Insurance Co. Ltd., PCA & RD Bank, I Floor, Opp: Anwar Book Centre, Chitradurga.   (Rep by Sri. K. Mohan Bhat, Advocate)

ORDER

SRI. T.N. SREENIVASAIAH:   PRESIDENT

The above complaint has been filed by the complainant u/Sec.12 of the C.P Act, 1986 for the relief to direct the OP to pay Rs.40,000/- towards compensation, Rs.5,000/- towards legal charges and Rs.1,00,000/- towards physical and mental agony.

2.      The brief facts of the case of the above complainant are that, he is an agriculturist and has purchased HF CB Cow and the same has been insured with the OP under Policy No.1-3Q5SU3U and P400 Policy No.59078232 on 05.08.2015 by paying premium amount of Rs.1,800/- along with service tax of Rs.252/-.  OP has issued a RFID#/Manual tag#91458 covering the above said cow under the policy for a period from 05.08.2015 to 04.08.2016 midnight.  It is further submitted that, on 16.09.2015 the above said cow was died.  Dr. Indira Bai. G, Veterinary Officer (Extension), Veterinary Hospital, Chitradurga has conducted Post Mortem on the dead cow and issued Post-mortem report dated 17.09.2015 and handed over the same to the complainant on 31.10.2015 estimating the cost of cow at Rs.40,000/-.  The cause for death of the cow is shown as Decease and period is shown as Anaplasmosis one, which was duly intimated to the OP by producing all the necessary documents.  OP assured the complainant to settle the claim but, the same was postponing on one or the other reasons.  It is further submitted that, complainant has received letter dated 19.02.2016 from the OP, in which OP made reference as there was a delay of more than 45 days in intimating the claim and further it is mentioned as “on the death of any animal hereby insured, the insured shall give immediate notice thereof to the company, at which the policy has issued and shall give an opportunity of inspecting the carcass until at least the expiration of 24 hours after such notice shall have been received by the company.  The insured shall also within fourteen days submit such Veterinary Certificates and satisfactory proof and to furnish to the company such information accompanied by the death identity and value of the animal as the company may require.  The ear-Tag should be surrendered along with the above certificates.  In view of the above, OP expressed its inability to entertain its liability and closed the file of the complainant, which is opposed to law and against the terms and conditions of the policy.  Complainant got issued legal notice through his counsel on 29.03.2016 by RPAD to the OP, the same was served but, OP neither replied nor settled the claim of the complainant.  Therefore, there is a deficiency of service on the part of OP.  The cause of action for this complaint arose on 29.03.2016 when the complainant got issued legal notice to the OP.   The OP is having the Branch Office at Chitradurga within the jurisdiction of this Forum.  Therefore, the complainant respectfully prayed before this Forum to allow his complaint with cost. 

3.      On service of notice, OP appeared through Sri. K. Mohan Bhat, Advocate and filed version admitting about the issuance of policy No.59078232 to the Cow bearing Tag No.91458 belongs to the complainant for a period from 05.08.2015 to 04.08.2015 subject to the terms and conditions of the policy.  It is further submitted that, as per policy condition No.7, in the event of illness or accident, the insured shall at his own expense immediately obtain the service of a qualified veterinary Surgeon and ensure the animals to be properly treated.  On the death of any animal hereby insured, the insured shall give immediate notice thereof to the company, at which the policy has issued and shall give an opportunity of inspecting the carcass until at least the expiration of 24 hours after such notice shall have been received by the company.  The insured shall also within fourteen days submit such Veterinary Certificates and satisfactory proof and to furnish to the company such information accompanied by the death identity and value of the animal as the company may require.  The ear-Tag should be surrendered along with the above certificates.  It is further submitted that, in the event of death of animal, the insured must inform the Branch Office within two hours of death of animal, in order to avoid any fraudulent claim, it is mandatory that, the staff should visit the place for identification of the cattle and verify the carcass physically within 12 hours of intimation, the employee of the OP must cross check other identification details mentioned in the proposal form upon the health certificate which the dead animal and also to check any manipulation of tag and submit a report of the same to the SBU.  As per the policy general conditions, that if the cow died, the complainant should have given immediate intimation along with claim form and tag number of the cow to the OP.  The complainant had given intimation to the insurance company that his cow died on 16.09.2015 and given intimation to the OP only on 18.02.2016 i.e., after more than 45 days after the death of cow.  The complainant has violated the policy conditions.  Therefore, the OP insurance company is not liable to pay compensation.  The complainant not complied the above conditions hence, the OP has repudiated the claim of the complainant and issued a letter to the complainant through courier on 19.02.2016 and stated that, the cattle was died on 16.09.2015 and survey was done by Doctor only and Iffco-Tokio persons were not present at that time.  There was a delay of more than 45 days for intimation this claim.  In view of the above, the OP expressed its inability to entertain any liability for said claim and closed the file.  It is further submitted that, the averments in para-2 to 9 of the complaint are not admitted and the complaint is put to strict proof of the same.  The complaint is not maintainable either in law or on facts and it is barred by limitation.  Therefore, there is no deficiency of service on the part of OP and prayed for dismissal of the complaint.                

4.      Complainant has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-10 were got marked. On behalf of OP, one Sri. V. Jagamohan Rao, S/o V.V. Seetharamaiah, the General Manager Iffco-Tokio General Insurance Co. Ltd., Bangalore, has examined as DW-1 by filing the affidavit evidence and Ex.B-1 to B-3 documents have been got marked.   

5.      Arguments of both sides heard.

6.      Now the points that arise for our consideration for decision of above complaints are that;

 

(1)  Whether the complainant proves that the OP has committed deficiency of service in settling the claim made by him and entitled for the reliefs as prayed for in the above complaint?

              (2) What order?

          7.      Our findings on the above points are as follows:-

          Point No.1:- Partly in Affirmative.

          Point No.2:- As per final order.

REASONS

8.      It is not in dispute that, complainant is an agriculturist, purchased HF CB Cow and the same has been insured with the OP under Policy No.1-3Q5SU3U and P400 Policy No.59078232 on 05.08.2015 by paying premium amount of Rs.1,800/- along with service tax of Rs.252/-.  OP has issued a RFID#/Manual tag#91458 covering the above said cow under the policy for a period from 05.08.2015 to 04.08.2016 midnight.  On 16.09.2015 the above said cow was died when the policy is in force.  Dr. Indira Bai. G, Veterinary Officer (Extension), Veterinary Hospital, Chitradurga has conducted Post Mortem on the dead cow and issued Post-mortem report dated 17.09.2015 and handed over the same to the complainant on 31.10.2015 estimating the cost of cow for  Rs.40,000/-.  The cause for death of the cow is shown as Decease and period is shown as Anaplasmosis one, the complainant duly intimated the same to the OP by producing all the necessary documents.  On that day itself by orally, the OP assured the complainant to settle the claim but, the same was postponing on one or the other reasons.  Complainant has received a letter dated 19.02.2016 from the OP, in which OP made reference as there was a delay of more than 45 days in intimating the claim and further it is mentioned as “on the death of any animal hereby insured, the insured shall give immediate notice thereof to the company, at which the policy has issued and shall give an opportunity of inspecting the carcass until at least the expiration of 24 hours after such notice shall have been received by the company.  The insured shall also within fourteen days submit such Veterinary Certificates and satisfactory proof and to furnish to the company such information accompanied by the death identity and value of the animal as the company may require.  The ear-Tag should be surrendered along with the above certificates.  In view of the above, OP expressed its inability to entertain its liability and closed the file of the complainant, which is opposed to law and against the terms and conditions of the policy.  Complainant got issued legal notice through his counsel on 29.03.2016 by RPAD to the OP, the same was served but, OP neither replied nor settled the claim of the complainant.  Therefore, there is a deficiency of service on the part of OP. 

 9.     In support of his contention, the complainant has filed his affidavit evidence and reiterated the contents of complaint and relied on the documents like claim form marked as Ex.A-1, Death Certificate/Panchanama marked as Ex.A-2, Veterinary Certificate marked as Ex.A-3, PM report marked as Ex.A-4, Claim Processing Note marked as Ex.A-5, Reply to the claim marked as Ex.A-6, 4 Photos marked as Ex.A-7, CD marked as Ex.A-8, Office copy of the legal notice marked as Ex.A-9 and Postal Receipt and served acknowledgement marked as Ex.A-10.

 10.   On the other hand, it is argued by the OP that, it has issued policy No.59078232 to the Cow bearing Tag No.91458 of complainant and the same was valid for the period from 05.08.2015 to 04.08.2015 subject to the terms and conditions of the policy.  It is further argued that, as per policy condition No.7, in the event of illness or accident, the insured shall at his own expense immediately obtain the service of a qualified veterinary Surgeon and ensure the animals to be properly treated.  On the death of any animal hereby insured, the insured shall give immediate notice thereof to the company, at which the policy has issued and shall give an opportunity of inspecting the carcass until at least the expiration of 24 hours after such notice shall have been received by the company.  The insured shall also within fourteen days submit such Veterinary Certificates and satisfactory proof and to furnish to the company such information accompanied by the death identity and value of the animal as the company may require.  The ear-Tag should be surrendered along with the above certificates and in the event of death of animal, the insured must inform the Branch Office within two hours of death of animal, in order to avoid any fraudulent claim, it is mandatory that, after receiving the information from the insured, the officer of the OP visit the place for identification of the cattle and verify the carcass physically within 12 hours of intimation, the employee of the OP must cross check other identification details mentioned in the proposal form upon the health certificate which the dead animal and also to check any manipulation of tag and submit a report of the same to the SBU.  As per the policy general conditions, that if the cow died, the complainant should have given immediate intimation along with claim form and tag number of the cow to the OP.  The complainant had given intimation to the insurance company that his cow died on 16.09.2015 and given intimation to the OP only on 18.02.2016 i.e., after more than 45 days after the death of cow.  The complainant has violated the policy conditions.  Therefore, the OP insurance company is not liable to pay compensation.  The complainant not complied the above conditions hence, the OP has repudiated the claim of the complainant and issued a letter to the complainant through courier on 19.02.2016 and stated that, the cattle was died on 16.09.2015 and survey was done by Doctor only and Iffco-Tokio persons were not present at that time.  There was a delay of more than 45 days for intimation this claim.  In view of the above, the OP expressed its inability to entertain any liability for said claim and closed the file.  The complaint is not maintainable either in law or on facts and it is barred by limitation.  Therefore, there is no deficiency of service on the part of OP.

11.    In support of its contention, the OP has filed affidavit evidence of Sri. V. Jagamohan Rao, S/o V.V. Seetharamaiah, the General Manager Iffco-Tokio General Insurance Co. Ltd., Bangalore, has examined as DW-1 by filing the affidavit evidence and reiterated the contents of version and relied on the documents like copy of the cattle insurance policy marked as Ex.B-1, Reply notice to the complainant marked as Ex.B-2, Courier Receipt  marked as Ex.B-3. 

12.   On hearing the rival contentions of both parties and on perusal of the documents including the affidavit and documentary evidence, it clearly made out that, the complainant has taken cattle insurance policy bearing No.1-3Q5SU3U and P400 Policy No.59078232 on 05.08.2015 by paying premium amount of Rs.1,800/- along with service tax for Rs.252/- from the OP covering the risk to the above said cow from 05.08.2015 to 04.08.2016.  The tag No.91458 has been issued to the said cow.  The said cow died on 16.09.2015.  One Dr. Indira Bai. G, the Veterinary Officer, Veterinary  Hospital, Chitradurga  conducted Post Mortem report and issued the same on 31.10.2015 and estimated the cost of the cow for Rs.40,000/-.  As per the Doctor report, the cause of the death of the cow is shown as disease one Anaplasmosis.  After that, the complainant has submitted all the documents along with PM report to the OP for settlement.  First, the OP has received all the documents from the complainant told the complainant that, we will settle the said claim.  Later the OP has issued a repudiation letter to the complainant stating that, you have intimated the death of the cow after lapse of 45 days.  There is a specific condition in the policy that, any incident happening or death of the insured animal, the party/complainant has to intimate the same to the OP within 24 hours.  But, here is the OP have taken a contention that, the complainant was intimated the same after lapse of 45 days.  But, we have gone through entire complaint/pleading, affidavit, written arguments and exhibits, the complainant has intimated the death of the cow to the OP on the same day and the complainant waited for nearly 48 hours but, the OP was not come forward to verify the death of the cow.  It clearly goes to show that, there is a negligence and unfair trade practice and deficiency in service on the part of the OP.   The Doctor was visited the spot on that day itself and prepared the PM report on the same day, it clearly shows that, the complainant has intimated the OP on that day itself about the death of cow.  Hence, in our considered view, the OP has committed a deficiency in service and unfair trade practice in settling the claim made by the complainant.  Further the OP has been admitted that, the policy was in force as on the date of death of the cow.  Accordingly, this Point No.1 is held as partly affirmative to the complainant.           

            13.     Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-

ORDER

The complaint filed by the complainant U/s 12 of CP Act 1986 is partly allowed.

It is ordered that, the OP is hereby directed to pay a sum of Rs.40,000/- towards value of the cow along with interest at the rate of 12% p.a from the date of filing of the complaint till realization. 

It is further ordered that, the OP is hereby directed to pay Rs.5,000/- towards mental agony and Rs.5,000/- towards costs of this proceeding.  

It is further ordered that, the OP is hereby directed to comply the above order within 45 days from the date of this order.

 (This order is made with the consent of Member after the correction of the draft on 12/01/2017 and it is pronounced in the open Court after our signatures)         

 

                                     

 MEMBER                                                   PRESIDENT

 

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

PW-1:  Complainant by way of affidavit evidence.

Witnesses examined on behalf of OPs:

DW-1:  Sri. V. Jaganmohan Rao, General Manager of OP by way of affidavit evidence. 

Documents marked on behalf of Complainants:

01	Ex-A-1:-	Claim Form
02	Ex-A-2:-	Death Certificate/Panchanama
03	Ex-A-3:-	Veterinary Certificate
04	Ex-A-4:-	PM report
05	Ex-A-5:-	Claim Processing Note
06	Ex-A-6:-	Reply to the claim
07	Ex-A-7:-	4 Photos
08	Ex.A-8:-	C.D
09	Ex.A-9:-	Office copy of the legal notice
10	Ex.A-10:-	Postal Receipt and served acknowledgement

 

Documents marked on behalf of OPs:

01	Ex-B-1:-	Cattle insurance policy
02	Ex-B-2:-	Reply notice to the complainant
03	Ex-B-3:-	Courier Receipt

 

 

 

MEMBER                                                            PRESIDENT

Rhr**