By Sri. A.S. Subhagan,  Member:

          The facts of the case in brief:-  This present complaint is filed under the Consumer Protection Act 2019.  The Consumer/Complainant is a dairy farmer, having  two cows which are her livelihood. She was joined in a dairy  farmers’ cattle group insurance policy of the  1^st   Opposite Party through the  2^nd  Opposite Party for which an amount  at the rate of 3,641/-  each was collected as premium by the  2^nd  Opposite Party from the farmers including the Complainant.  For her two cows,  the Complainant had remitted Rs.3,641 x 2  on 07.09.2020  as  premium as told by  the  2^nd  Opposite Party, through bank.  The Opposite Parties had told the Complainant that the cow would be under insurance coverage from the date of remittance of the premium.  One  cow each was insured by the Complainant for Rs.65,000/-.  The ear tag numbers of the cow were 420045-860110N & 420029-57932N.  Things being so,  the cow having ear tag number 420045-860110N fell down on 10.12.2020 and did not stand up afterwards.  Under treatment of the veterinary Doctor,  the cow died on 16.12.2020.  The death of the cow was  immediately informed to the  1^st   Opposite Party and  as per their instruction the post mortem was done.  Then,  the Complainant submitted claim application together with treatment records, post mortem report and valuation certificate.  But after  nine months, the 1^st  Opposite Party repudiated the claim on 05.09.2021.  The reason for repudiation of the claim was stated to be that the policy coverage of the cow  was only from 14.12.2020 to 13.12.2021 and  that the cow had not insurance coverage from 10.12.2020,  the date on which the treatment was started to the cow.  The Complainant had remitted the premium on 07.09.2020 itself.  After that,  if there has been any delay in issuing the policy,  it is the sole responsibility of the Opposite Parties.  So, there has been deficiency  in service from the part of the Opposite Parties for getting insurance coverage of Rs.65,000/-   together  with interest at the rate of 12% per annum,  compensation of           Rs.2,00,000/- and cost of Rs. 25,000/-.

          2.  1^st and 2^nd  Opposite Parties appeared and filed their version.

1.  Contents of version of  1^st  Opposite Party:-  The  Opposite Party submitted

that the cow bearing ear tag No.420045/860110 was insured  with the 1^st  Opposite Party as per the policy No.442301/47/2021/759 for the period  from 14.12.2020 to 13.12.2023.  The insurance premium  was received by the 1^st Opposite Party on 14.12.2020 not on 07.09.2020 as alleged in the complaint.  The 1^st  Opposite Party submitted that as per the treatment certificate,  the cow was first seen ill on 10.12.2020.  The treatment of the cow was started from 10.12.2020 and continued up to 16.12.2020 and cow died on 17.12.2020 due to the illness started  from 10.02.2020.    The cow  belonged to the Complainant died due to the pre existing  disease.  The Complainant  had obtained  the insurance policy suppressing the material facts regarding the pre existing disease of the cow.  Therefore, the 1^st  Opposite Party was not able to entertain the claim of the Complainant and hence repudiated the claim.  The claim repudiation was intimated to the Complainant on 05.09.2021 by the 1^st  Opposite Party.  The  1^st Opposite Party submitted that the Complainant is not entitled to get the sum of Rs.65,000/-   with 12% interest towards the value of the cow,  Rs.2,00,000/-  towards compensation and Rs.25,000/-  towards cost of this  proceedings.

2.    Contents of version of  2^nd  Opposite Party:- Though the veterinary doctor had

started  processing submission of online application in ARMS Software on 23.08.2020,  the final  submission had not done certifying  the health of the cow.   Afterwards amount was required to be remitted clicking “print chalan”  button to remit the amount in bank using that chalan.  The incomplete applications are taken for processing only on the next stage.  The premium might have been remitted  manually.  

          3.  According to 2^nd  Opposite Party the facts are as follows:-

  1) Though the submission process of application was started on 23.08.2020,  

       it was not completed.

2. Premium was remitted in bank on 07.09.2020.
3. The  application continued  to be incomplete upto 07.12.2020.
4. The completed application was submitted on 07.12.2020.
5. Proceedings of the application so submitted was prepared on 09.12.2020.
6. 12.12.2020 and 13.12.2020 were  second Saturday and Sunday.
7. Policy came   into effect on 14.12.2020

    And, subsequently.

1. The Disease was reported to the cow on 10.12.2020.
2. On reporting the death of the cow on 17.12.2020,  the doctor reported the post-mortem of the cow.
3. Policy period commenced on 14.12.2020.
4. The  1^st  Opposite Party  rejected the claim stating “pre-existing disease” as  treatment started on 10.12.2020.
5. But the policy was in effect  on death of the cow, ie on 17.12.2020
6. The reasons for the policy to come into effect,  being technical in ARMS portal and reported by the  IT officer.
7. The repudiation of the claim after remitting premium is not justifiable.  Moreover the cow has a valid policy on the date of death of the cow.

4. Hence,  prayed to dismiss the complaint.

          5. Proof affidavit filed by the complaint, Exts.A1 to A6 marked  and she was examined as PW1.  Affidavit was filed by   1^st  Opposite Party and Exts.B1 and B2 were marked from their side.  The Administrative Officer of the 1^st  Opposite Party  was examined as OPW1.  The 2^nd  Opposite Party also filed  affidavit but no documents were marked.  The Deputy  Director of Animal  Husbandry Department, Wayanad was examined  as OPW2.  Considering and perusing the evidences on record and the facts and circumstances of the case,  Commission raised the following points for consideration.

1.   Whether there  has been any deficiency in service from the part  of the      

  Opposite Parties?

2.   If so,  Relief , cost and  quantum?

6.  Point No.1:-  It is admitted that  (a)  The Complainant had been a member of

the  Group Insurance Policy referred in the complaint (b)  The Complainant had remitted  the policy premium of Rs.3,641/-  each  for two cows of the Complainant on 23.08.2020 which is evident from Ext.A1 document (c)  The cow referred in the complaint was treated from 10.12.2020,  evident from Ext.A3 documents.  (d)  The cow died on 17.12.2020 which  is evident from Ext.A4 document.  (e)  The policy was valid  on the date of death of the policy which is  evident and admitted by the Opposite Parties.  (f)  The claim was repudiated on the ground that the cow had pre-existing  disease on 10.12.2020.

          7. On a detailed and careful  scrutiny of the various aspects of this case we find  that (1)  The Complainant had remitted the premium  amount of the policy on 23.08.2020.  (2)  In cross examination of OPW1 by  the Complainant, OPW1 has stated that “IÀj-Isc kw_-Ôn¨v {]oanbw XpI AS-bv¡pI F¶ Hcp D¯-c-hm-Zn-¯ta DÅq”.... “]ip N¯ ka-b¯v Rs.65,000/- hne-bp-s­¶v Dr. km£ys¸Sp-¯nb Certificate  In«n-bn-«p-­v”...... In cross examination by 2^nd Opposite Party,  OPW1 has  stated that “09.12.2020  proposal form AwKo-I-cn¨v arK kwc-£W hIp-¸n-te-bv¡v proceedings  h¶n-cp-¶p.  AXnsâ ASn-Øm-\-¯n-emWv 14.12.2020   policy issue sNbvX-Xv”.... “Cu tIkn ]cm-Xn-¡m-cn¡v c­mw FXr-I£n sN¿m-\p-ff  FÃm Imc-y-§fpw c­mw FXr I£n sNbvXn-«p-s­¶v a\-Ên-em-¡n-bn-«p-­v”.  In re-examination  OPW1 has stated that “Policy issue sN¿p-¶Xv premium  HSp-¡p-¶Xv apX-em-Wv”. 

8. From the above discussion, as the Complainant had remitted the policy premium on 23.08.2020 and  as the policy was valid on the date of death of the  policy, the Complainant is eligible for getting claim under this policy.  But  the  1^st  Opposite Party,  on the other had repudiated the valid claim of an ordinary house wife only on technical grounds which is deficiency in service from the part of the  1^st  Opposite Party.  It is seen clear that this group insurance  policy was formulated mutually by an understanding between the   1^st and 2^nd  Opposite Parties.  So,  if there have been any technical lapse from either of them it is to be settled by the 1^st and 2^nd  Opposite Parties alone,  but not affecting the interest of the Complainant who had remitted the insurance premium of the policy in time.  Moreover,  in this case,  if the 2^nd  Opposite Party had processed the application and submitted it to the 1^st  Opposite Party before the date of commencement of the treatment of the cow ie,  before 10.12.2020, it would  not make any change or difference in the situation.  Hence the Complainant has the right to get the claim amount of Rs.65,000/-,  compensation for deficiency  in service and cost of this complaint.  But the compensation and cost claimed are seen highly exorbitant.

In the result,  the complaint is partly allowed and the  1^st  Opposite Party is directed to

1.  Pay Rs.65,000/-  (Rupees Sixty Five thousand only)  being the claim amount payable under the policy, together with interest  at the rate of 8% per annum with effect from the date of repudiation of the claim, ie from 05.01.2021.
2. Pay Rs.30,000/- (Rupees Thirty thousand only)  as compensation and
3. Pay Rs.10,000/-  (Rupees Ten thousand only) as cost of this complaint.

The above amounts  shall be paid to the Complainant within 30 days from the

date of this order, failing which the amount will carry interest at the rate of 9% per annum.

Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the  21^st  day of August 2023.        

Date of filing:05.10.2021.

                                                                   PRESIDENT    :  Sd/-

                                                                    MEMBER        :   Sd/-  

 APPENDIX.

Witness for the Complainant:

PW1.            Sheeba.                        Complainant.       

Witness for the Opposite Parties:

OPW1.        Abdul Rahman. K.                   Administrative Officer,

                                                              Oriental Insurance Co. Ltd.

OPW2.        Dr. K. Jayaraj.                Deputy Director,  Animal Husbandry

                                                              Department, Wayanad. 

Exhibits for the Complainant:

A1.        Copy of Receipt.                            dt:23.08.2020.

A2.        Copy of Cattle Claim Form.           dt:28.12.2020.

A3.         Copy of Treatment Certificate.      dt:28.12.2020.

A4.         Copy of Post-mortem Report.       dt:28.12.2020.

A5.         Copy of Letter.                              dt:28.12.2020.

A6.         Copy of Letter.                              dt:05.09.2021.

Exhibit for the Opposite Parties:

B1.         Copy of  Policy Schedule.            dt:07.01.2021.

B2.         Copy of Account Statement from 01.12.2020 to 31.12.2020.

                                                                                                PRESIDENT:  Sd/-

                                                                                               MEMBER    :   Sd/-