BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KAPURTHALA.
Complaint No. 31 of 2023
Date of Instt. 11.05.2023
Date of Decision :25.11.2024
Gurbhej Singh aged 36 yrs s/o Ajit Singh r/o village Damulian Tehsil Bholath District Kapurthala.
....Complainant Versus
The New India Assurance Co. Ltd. near D.C Chowk Kapurthala through it's Branch Manager.
...Opposite party
Complaint under section 35 of Consumer Protection Act
Quorum: Before: Sh. Rajesh Bhatia (President)
Mrs. Rajita Sareen (Member)
S. Kanwar Jaswant Singh (Member)
Present: Sh. Lakhbir Singh, Advocate for the complainant.
Sh. Nitish Arora, Advocate for the OP.
Order
Mrs. Rajita Sareen (Member)
1. FACTS OF COMPLAINT
The Complainant has preferred this complaint, under section 35 of The Consumer Protection Act, 2019 (in short, “ THE ACT”) against the opposite party i.e. The New India Assurance Co. Ltd., claiming the following reliefs to them :
i) to pay the insured sum of money of Rs. 65,000/- to the complainant alongwith interest @18% from 14/12/2022 till the realization.
ii) to pay Rs. 20,000/- as damages on account of undue harassment and mental agony.
iii) to pay Rs. 10,000/- as litigation expenses.
In brief, the allegations made by complainant in its complaint are that complainant purchased four Cross Breed female Buffaloes by taking loan from Punjab & Sind Bank Damulian Distt. Kapurthala. All the four buffaloes were insured with the opposite party and identified by tag No. 8097 for the sum of Rs. 60,000/-, Tag No. 8098 insured for Rs. 65,000/-, tag No. 8099 insured for Rs. 55,000/- and tag No. 8100/- insured for Rs. 60,000/-. Before issuance of insurance policy, these buffaloes were medically checked by Veterinary Officer Civil Veterinary Hospital, Khassan (Kapurthala) on 24/12/2021 and market value of these buffalloes was metioned as ranging from 55,000/- to 65,000/-. On 14/12/2022 buffalo bearing tag No. 8098 died and was taken to civil Veterinary Hospital Khassan (Kapurthala) for post mortem Autopsy was conducted and post mortem report was given on 19/12/2022. The matter of death of female buffalo was reported to Punjab and Sind Bank from where the loan to purchase the buffaloes was taken, who further intimated the insurance company through E-mail. After about five days, the official of the OP visited the village of complainant and recorded the required information from various persons. On 17/12/2023, the OP has repudiated the claim as NO CLAIM which is totally illegal, wrong and arbitrary act of the OP for which the complainant has filed the present complaint.
2. DEFENCE OF THE OPPOSITE PARTIES :
Notice of the complaint was issued to the OP who appeared through counsel and filed their written reply by taking preliminary objections that the complainant had taken the policy of insurance for four buffaloes out of which one buffalo tagged No. 8098 was insured for a sum of Rs. 65,000/- from the opposite party vide policy of insurance bearing No. 36090247215100000041 from 22/2/2022 to midnight of 21/2/2023. The said buffalo allegedly died on 14/12/2022. The complainant got conducted the post mortem of the dead animal without even allowing the representative of the opposite party check the body and the dead body was disposed of. This was done even after being directed that the body of the cattle would not be disposed of until the representative of the opposite party conducts the spot survey. This is clearly in violation of the terms and conditions of the policy that the identity of the insured animal needs to be verified before allowing the claim. Complainant after the death of the animal did not intimate the opposite party immediately. Opposite party received the intimation qua the death of the animal vide email dated 16/12/2022 from Punjab & Sind Bank i.e. after two days from the death of animal. Thereafter the opposite party asked the official of the Punjab & Sind Bank qua the address and telephone number of the insured vide email dated 16/12/2022. It was further directed in the said email that the body of the cattle should not be disposed of until the representative of the insurance company visit the place and conduct spot survey. Further it was also directed that Post Mortem of the animal shall be done from Government Veternary Doctor after the representative of the opposite party check the body of cattle. Despite the directions, opposite parties never got the chance of spot Survey. Keeping in view the aforesaid findings the investigators gave an opinion that “we do not see Insured's claim as genuine and recommend underwrites to file it as NO CLAIM or as deem fit”. Moreso the complainant has acted against the procedure qua the claim of death of animal. Complainant delayed the intimation of email, due to which the opposite parties never got the chance to verify the genuineness of the claim. On merits, the other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merit and the same may be dismissed.
3. EVIDENCE OF THE PARTIES :
I) To prove his case, the complainant has tendered an affidavit of the complainant Ex. CA alongwith documents Ex. C1 to Ex. C8 as evidence.
II) The Counsel for the opposite party on the other hand have tendered affidavits Ex. OP1/A and Ex. OP1/B along with documents Ex. OP1 to OP6, to prove its version.
4. The complainant filed rejoinder to rebut the version of OP wherein mentioned that by inadvertent mistake the doctor has written the date of post mortem as 14/12/2022 instead of 15/12/2022. No document is produced alongwith rejoinder by complainant.
5. CONTENTIONS OF THE PARTIES -
a) COMPLAINANT – The counsel for the complainant vehementally argued the complaint by referring to various documents. He referred Ex. C1 to prove insurance which is valid from 22/2/2022 to 21/2/2023. Animal Health Certificates are produced as Ex. C2 to Ex. C5. Ex. C6 is the Post Mortem Report. Further Ex. C7 is the E-mail giving intimation to insurance company by Punjab & Sind Bank. Ex. C8 is the letter dated 10/2/2023 informing the complainant that claim is closed as NO CLAIM. Counsel for complainant contended that on 14/12/2022 female buffalo bearing tag No 8098 died. On 15/12/2023 it was taken to Govt Civil Veterinary Hospital Khassan ( Kapurthala) for postmortem. Autopsy was conduced in the Hosital and post Mortem report was given on 19/12/2022. By inadvertent mistake veternary doctor has mentioned the date of autopsy as 14/12/2022 instead of writing as 15/12/2022, It is only typhograpgical mistake. The death of the animal has been proved beyond reasonable doubt. The death of the female buffalo was reported to the Punjab & Sind Bank Dumlian from where loan was taken for the purchase of the female buffalo. The manager of the bank gave information to the respondent through E-mail. The official of the respondent came to the village after about five days and he was informed about the death of the female buffalo. He assured the complainant that he will be given assured money of Rs. 65000/-. On 17/2/2023 the complainant received letter and was astonished to know it's contents that investigator has found that the claim is not genuine and the claim has been dismissed as NO CLAIM. The investigation report of the investigator is illegal, invalid, biased not tenable in the eyes of law and has been made simply to avoid the responsibility of the respondent and to cause harm to the complainant and prayed to allow the present complaint.
On the other hand the counsel for Opposite party argued the complainant above in the written statement of OP by pressing upon the report of the investigator produced as Ex. OP4 on the file.
He further pointed towards terms and conditions of the policy and referred to clause 7 of the Policy which explain “Exclusions”.
B. Specific Exclusions;
All the claims received without ear tag.
Clause 8 Additional Policy Conditions:-
A. The provision of 'No Tag-No Clalm' should be included as policy condition No.9. The wording may be as under:
"In the event of death of animal/s covered under the pollcy, clalm/s shall not bo entertained unless the ear tag/s are surrendered to the Company. In the event of loss of ear tag/s, it is the responsibilty of the Insured to give Immedlate notico to tho Company and get the anlmal retagged."
He further argued hat as per terms of the policy after the death of the insured animal, immediate intimation shall be given to insurance company.
All these conditions were not complied with by the complainant.
Moreover the investigator appointed for investigating the matter has mentioned in it's report dated 30/01/2023 that “Insured neither had provided Insurers/their Representative any opportunity to inspect/physical verification of Carcass of claimed animal nor produce any photographs to check and verify her huliya and physical health before death. He says that she was ill since few days but did not provide her treatment record. There is a serious flaw in animal's time of death. As per Insured and his village Sarpanch and neighbourers, animal had died on the evening of Dt. 14.12.2022. There are eyewitnesses who confirmed that she was very much alive in the morning. But he had provided us photocopy of Postmortem report - which says she had died in the morning of Dt. 14.12.2022 and Doctor had even conducted her Postmortem at 1.00 PM. Question arises that how Postmortem can be conducted of a live animal? If PMR is genuine then how she was found alive by many in the morning.
7. CONSIDERATION OF CONTENTIONS :-
After giving a thoughtful consideration to the arguments put forth by both the counsel and after going through the documents produced on the file; it is admitted fact that the buffalo was insured with the OP. The counsel for the OP argued that insurance is a contract and the insured is bound by the terms and conditions of this contract. Complainant was well aware about the terms and conditions of the policy and also about the fact that he was bound by these terms and conditions and any claim arising would be subjected to these conditions of the policy. As per policy condition, immediate intimation qua death of the animal shall be given to the insurance company and as per clause 7 (b) (ii) of the terms and conditions of the policy- “All the claims without ear tags would be excluded and no claim would be given in such cases”.
Nowhere in its complaint or arguments, the counsel for complainant has mentioned that the complainant was not aware about or supplied with the terms and conditions of the policy. In complaint itself, it is mentioned that the buffalo was tagged as Tag No. 8098. It means that tag was issued but the same was not handed over to the insurance company at the time of filing of claim. Moreover, no photograph of the deceased buffalo is produced to prove it's identification neither any record to prove it's sickness or treatment taken from any doctor is produced on the file. Complainant's own statement attached with the report of investigator mentions the date of death as 14/12/2022 in the evening. Whereas the time of death mentioned in the post mortem certificate is 14/12/2022, 4:00AM. In Ex. C6 which is the post mortem certificate, the doctor has written under the column History; “owner saw animal dead in the morning and called for post mortem only”. The time of autopsy is 1:00 PM on 14/12/2022. The documents produced by complainant himself are self contradictory. In it's rejoinder, the complainant has written about typographical mistake or clerical error about the date of death of the animal by the Veterinary Doctor but has not produced any affidavit of the concerned doctor to authenticate this version. As such, no reliance can be made upon this. The complainant disposed the carcass of the dead animal, without intimating the insurance company, as a result whereof, it's investigator was deprived of the opportunity of spot inspection of the same. This having not been done by the complainant, he has committed the breach of the terms and conditions of the insurance policy.
8. Counsel for OP relied upon the rulings of the Hon'ble Courts and Forums. “The Hon'ble Supreme Court in the matter of “Deokar Exports Pvt. Ltd. Vs New India Assurance Company Ltd. observed as under:-
“Rights and liabilities strictly governed by policy of insurance—No exception or relaxation can be made on ground of equity”.
In the matter of National Insurance Company Ltd. Vs Balwant Kaur, State Consumer Disputes Redressal Commision, Punjab held as follows:
“It has no merits at all. It was duty of the respondent to give information to the appellants immediately after the death of the insured buffalo so that the appellants are given an opportunity to verify if the dead buffalo was the same which was insured by the appellants. This having not been done by the respondent, she has committed the breach of the terms and conditions of the insurance policy and is not entitled to the insurance claim”.
On the other hand, counsel for complainant did not refer to any case law.
9. From above all discussion, it is evident that complainant has failed to prove it's complaint. On the other hand, the OP has been successful in proving that the claim is rightly repudiated. So, there is no deficiency in providing service by the OP and the claim is rightly repudiated.
10. In view of it, we are of the considered opinion that the complainant has miserably failed to prove that the claim has been wrongly repudiated by the OP, as such, the complaint is devoid of any merit. Therefore, the same is hereby dismissed. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated
25/11/2024
S. Kanwar Jaswant Singh Rajita Sareen Rajesh Bhatia
Member Member President
