Haryana

Sonipat

CC/390/2015

Sumit S/o Suresh Kumar - Complainant(s)

Versus

The Divisional Manager The Oriental Insurance Co. Ltd. - Opp.Party(s)

Sandeep Kumar

21 Apr 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SONEPAT.

 

                                Complaint No.390 of 2015

                                Date of Instt. 15.10.2015 

                                Date of order: 21.04.2016

 

 

Sumit son of Suresh Kumar,r/o H.No.86/15, Gandhi Nagar, Ganaur Distt. Sonepat.

                                           ...Complainant.

                        Versus

 

1.The Divisional Manager, Oriental Insurance Co. Ltd., Divisional Office, 204R, Model Town, Atlas road, Sonepat.

2.The Authorize Person, the Oriental Insurance Co. Ltd., Regd. Head office Oriental House, PB No.7037, A-25/27, Asaf Ali road, Delhi-110002.

                                           ...Respondents.

 

COMPLAINT UNDER SECTION 12 OF

THE CONSUMER PROTECTION ACT,1986

 

Argued by: Sh. Sandeep Kumar Adv. for complainant.

           Sh. Surender Malik, Adv. for respondents.

 

BEFORE-  NAGENDER SINGH, PRESIDENT.

        SMT.PRABHA WATI, MEMBER.

 

O R D E R

 

          Complainant has filed the present complaint against the respondents alleging therein that he got his buffalo insured with the respondent no.1 on 7.1.2015 vide tag no.160003/780297 vide insurance policy no.784912 and unfortunately the said insured buffalo had died on 22.1.2015. Post mortem was done by the Veterinary Surgeon and the complainant has informed the respondent no.1 regarding the death of the buffalo.  The complainant has completed all the formalities for the release of the claim amount.  The surveyor/investigator was deputed and it was observed by the said surveyor/investigator that the buffalo bearing tag no.160003/780297 reported died on 22.1.2015 and as per post mortem report affected on 21.1.2015 i.e. 15 days of commencement of risk, whereas as per the policy conditions, the claim would not be entertained in the event of death due to disease contracted within 15 days of commencement of risk and thus, the claim was repudiated.  The complainant has alleged the repudiation of his claim to be wrong and illegal. So, he has come to this Forum and has filed the present complaint.

2.        In reply, the respondents have submitted that the claim of the complainant was rightly repudiated because as per policy condition, the claim would not be entertained in the event of death due to disease contracted within 15 days of commencement of risk.  The risk is to be started after expiry of 15 days from 7.1.2015 and that comes 23.1.2015.  Thus, the complainant is not entitled for any relief and compensation and prayed for the dismissal of the present complaint.

3.        We have heard the arguments advanced by the ld. Counsel for both the parties at length and we have also gone through the entire relevant material available on the case file carefully & minutely.

4.        Ld. Counsel for the respondent has submitted

that no claim will be entertain within 15 days of insurance.  The buffalo of the complainant was insured with the respondents, but the buffalo has died within 15 days of commencement of risk, so, the claim was rightly repudiated by the respondent insurance company.  So, the complainant is not entitled for any relief and compensation.

          In the present case, the complainant has placed on record Ex.C3 Health cum evaluation certificate issued by the Vety. Surgeon, Govt. Hospital and the same was issued on 6.1.2015. Ex.C4 is the post mortem report, wherein the tag no. is mentioned as 160003 780297 and cost of the buffalo is mentioned as Rs.60,000/-. 

          It is pertinent to mention here that the tag number has not been disputed by the insurance company in any manner.

          We have perused the documents Ex.C1 and C2 wherein the complainant’s name is mentioned at serial no.4, tag number is mentioned as 160003 780297 and amount insured is mentioned as Rs.60,000/-.  But it is no where mentioned in the above document that if the buffalo died within 15 days, then the insured will not be entitled for any amount.  So, in the absence of the above condition, how the respondent insurance company can repudiated the claim of the complainant.  In our view, the repudiation of the claim of the complainant on the ground that the buffalo had died within 15 days is totally unjustified particularly when this condition is not mentioned in the document Ex.C1.

          In our view, the complainant is entitled to get the claim amount of Rs.60,000/- from the respondents because the tag was issued to the complainant on 6.1.2015 and the buffalo of the complainant had died on 22.1.2015 i.e. after 15 days of issuance of tag in question.  Thus, we hereby direct the respondent insurance company to make the payment of Rs.60000/- (Rs.sixty thousand) to the complainant within a period of 60 days, otherwise, the said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its realization.

          With these observations, findings and directions, the present complaint stands allowed.

          Certified copy of this order be provided to both the parties free of costs.

File be consigned to the record-room.

 

(Prabha Wati Member)            (Nagender Singh-President)

DCDRF, Sonepat.                       DCDRF, Sonepat.

Announced:  21.04.2016