ADV. RAVI SUSHA, MEMBER.<br /> <br /> The complainant has filed this complaint to give the policy amount Rs.12,000/- and compensation and cost.<br /> <br /> The averments in the complaint can be briefly summarized as follows:<br /> <br /> The complainant had insured his cow with the opp.party as per Policy issued by the opp.party vide No.100705/47/02/00699 for the period from 17.3.2003 to 16.3.2004. The complainant’s cow was ear taged as per terms of the policy and the ear tag No. was 54994. The premium was also duly remitted and policy issued. Before issuing the policy of Insurance the veterinary doctor approved by the opp.party examined the cow and certified the health condition. It was certified by the doctor that the animal was in good health and insurable condition. The cow died on 25.5.2003 at 5 A.M. due to Acidosis [[indigestion].The ailment was developed on 23.5.2003 and on the very same day itself proper treatment was given through a competent veterinary doctor. Postmortem was conducted and the cause of death was confirmed as Acidosis [indigestion]. The matter was intimated to the opp.party and as per their direction claim form was submitted on 29.5.2003 with all the documents, certificates etc. required by the opp.party. But to the surprise of this complainant the opp.party by their letter dated 27.6.2003 repudiated the claim alleging that the animal was suffering from some pre-existing disease at the time of insurance. The aforesaid repudiation by the opp.party was evasive, the reasons were not specific and not based on any investigation or material . Hence the complaint.<br /> <br /> The opp.party filed a version contending as follows: The complaint is not maintainable either in law or on facts The postmortem finding in the postmortem report is lacking any corroboration or correlation with many material factors. Hence this opp.party got reasonable doubt regarding the genuiness of the same. The investigator Dr.Madhusudan who has served in Indian Army in the veterinary division and in the service of Milma for considerable period had conducted a detailed enquiry about the ailment of the insured cow and its treatment history etc. On the local enquiry conducte4d by Dr. Madhusudan it has revealed that the cow had been under treatment for more than two months prior to its death. Treatment details of the insured cow it can be seen that the insured cow had been under treatment of Dr. Ahammed Kunju even prior to the inception of the policy for some ailment. Dr. Ahammed Kunju has given this false certificate probably knowing the precarious condition of the cow for bringing the cow under the insurance coverage so as to make unlawful gain to the complainant by making use of the insurance policy. The above doctor has colluded with the complainant and made a false representation before this opp.party that the insured cow had been in good health at the time of proposing for the insurance. The opp.p0arty constrained to repudiate the claim of the complainant due to material suppression of facts at the time of taking the insurance policy and as such there is no illegality in the same and there is no deficiency in service of the part of the opp.party. Hence the opp.party prays to dismiss the complaint.<br /> <br /> Points that would arise for consideration:<br /> <br /> 1. Whether there is deficiency in service on the part of the opp.party.<br /> 2. Relief and costs.<br /> For the complainant PW.1 is examined. Ext. P1 to P6 are marked.<br /> For the opp.party DW.1 is examined. Ext. D1. to D4 are marked.<br /> <br /> Points:<br /> <br /> It is not in dispute that the complainant’s cow at the time of its death had a valid insurance policy with the opp.party. The grievance of the complainant is that though he submitted claim with supporting documents, the opp.party did not allow his claim.<br /> <br /> According to the opp.party there is suppression of material facts on the side of the complainant and thus violation of policy condition. The main contention of the opp.party is that the investigator Dr. Madhusudan had conducted a local enquiry about the cause of death of the insured animal.. On the local enquiry it has been revealed that the cow had been under treatment for more than two months prior to its death. From the treatment details it is revealed that the insured cow had been under treatment of Dr. Ahammed Kunju even prior to the inception of the policy for some disease. According to opp.party the repudiation of the claim is justified and therefore, there is no “deficiency in service” on the part of the opp.pary’s side.<br /> <br /> Opp.party’s contention is that they have repudiated the claim solely on the basis of the policy condition. But they have lnot proved their contention by producing the policy conditions. According to opp.party Dr. Ahammed Kunju has given false certificate and he has colluded with the complainant and made a false representation before the opp.party that the insured cow had been in good health at the time of proposing for the insurance. They further contended that the investigator Dr.R. Madhusudan after detailed enquiry had submitted an investigation report that the complainant obtained the policy when the cow was under treatment of Dr. Ahammmed Kunju. The repudiation of the claim by the opp.party is purely based on the report of the Investigator. In proof of the contents of the report of the investigator, the opp.party ought to have filed the affidavit or examine the person who conducted the investigation. In the instant case, no affidavit of the person who investigated the matter has been filed or not examined him. In the absence of such evidence no reliance could be placed on the said report, since the contents of the report have not been proved or established by examining the investigator.<br /> <br /> For the reasons stated above, we are of the view that the complainant in his proposal form has not suppressed any material facts and therefore the repudiation of the claim by the opp.party is not correct. Therefore the act of the opp.party amounts to Deficiency in Service.<br /> <br /> In the result the complaint is allowed. The opp.party is directed to give Rs.12,000/- with 9% interest from 25.5.2003 till the date of payment. The opp.party is further directed to pay Rs.1000/- as compensation and Rs.1000/- as cost of this proceedings. The order is to be complied within one month from the date of receipt of the order.<br /> <br /> Dated this the 7th day of November, 2008 <br /> <br /> <br /> <br /> I N D E X<br /> <br /> List of witnesses for the complainant<br /> PW.1. –Pappachan<br /> List of documents for the complainant<br /> P1. – Insurance certificate<br /> P2. – Premium receipt<br /> P3. – Veterinary Certificate<br /> P4. – Claim forum<br /> P5. – Copy of Postmortem certificate<br /> P6. – Repudiation letter.<br /> List of witnesses for the opp.party<br /> DW.1. – G. Leela<br /> List of documents for the opp.party<br /> D1. – Investigation report<br /> D2. – Letter sent by United India Insurance Co. Ltd. Dated 17.6.2003<br /> D3. – Letter sent by United India Insurance Co. Ltd. Dated 20.6.2003<br /> D4. – Repudiation letter.<br />