DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KOZHIKODE

PRESENT: Sri. P.C. PAULACHEN, M.Com, LLB          : PRESIDENT

Smt. PRIYA.S, BAL, LLB, MBA (HRM) :  MEMBER

Sri.V. BALAKRISHNAN, M Tech, MBA, LL.B, FIE: MEMBER

Tuesday the 26^th  day of September 2023

CC.176/2023

Complainant

     Anitha.T.P,

     W/o Chandran,

     Kaduvan Parambath,

     Narath, Ulliyeri (PO),

     Kozhikode -673623

Opposite Party

1.        The New India Assurance Co. Ltd,

Trivandrum Division Office- II,

Rema Plaza,  SS coil road,

Trivandrum -695001.

2.        The New India Assurance Co. Ltd,

Regional Office, 86/707,

                  3^rd Floor, Kandamkulathy Tower,

M.G Road, kochi – 682011.

(By Adv. Smt. Molly Varkey for OP1 and OP2)

ORDER

By Sri. P.C. PAULACHEN  – PRESIDENT.

             This is a complaint filed under Section 35 of the Consumer Protection Act, 2019.

2.   The case of the complainant, in brief, is as follows:

The complainant had insured her cattle under NLM/GOSAMRUDHI SCHEME under Animal Husbandry Department of Kerala. Tag No. 420014/005263 was allotted to the cattle owned by the complainant - vide policy No. 761400472104000000102. The cattle was treated for non-pregnancy from 29.03.2022 to 25.07.2022 by Dr. N Abdul Nasir, the registered Veterinarian, attached to Government VeterinaryDispensary, Unnikulam and on 26/07/2022, after identifying the cattle, the treating doctor had reported that the insured cattle is in Permanent Total Disablement (PTD) stage. This was duly intimated to the insurance company - vide claim intimation. All the necessary documents were also submitted for processing the claim. The claim intimation was submitted on 26/07/2022. On making enquiry, the complainant was informed that the claim was under process.

3.  But after 4 months on 28/11/2022, the claim was repudiated by the opposite parties stating untenable reasons. The PTD Certificate and the treatment certificate were issued by a registered Veterinarian in Government service as mandated. In the absence of Veterinarian in Ulliyeri, the complainant had preferred   the next immediately available dispensary, which is situated hardly 17 Kilometers away from her house. There was delay in processing the claim and the further repudiation of the claim stating untenable reasons amounts to unfair trade practice and deficiency in service. The act of the opposite parties has resulted in great loss and mental agony to the complainant. Hence the complaint to get the claim assured for the cattle amounting to Rs. 65,000/- along with compensation of Rs. 2,00,000/- for the mental agony suffered.
4. The first and second opposite parties were served with notice on 23/05/2023 and 22/05/2023 respectively.  Though they filed vakkalath, did not file version within the prescribed time and hence set ex-parte on 19/07/2023.        
5. The points that arise for determination in this complaint are:

1. Whether there was any unfair trade practice or deficiency of service on the part of the opposite parties, as alleged?
2. Reliefs and costs.

6. The complainant was examined as PW1 and Exts A1 to A9 were marked.
7. Heard
8. POINT No. 1 : The complainant has approached this Commission with a grievance that the cattle claim put in by her was repudiated by the opposite parties without valid reasons.
9.  PW1 has filed proof affidavit in terms of the averments in the complaint and in support of the claim. Ext A1 is the copy of the letter dated 26/07/2022 issued by Dr. N. Abdul Nasir to the first opposite party, Ext A2 is the copy of PTD report dated 26/07/2022, Ext A3 is the copy of the treatment certificate, Ext A4 is the Group Insurance Policy Certificate issued by the opposite parties, Ext A5 is the copy of the claim application dated 26/07/2022, Ext A6 is the copy of the lawyer notice, postal receipt and postal acknowledgment card, Ext A7 is the copy of the online application form – guide lines, Ext A8 is the notice inviting expression of interest for taking up Life Stock Insurance and Ext A9 is the copy of the repudiation letter dated 28/11/2022.
10. PW1 was not cross examined and her evidence stands unchallenged. The opposite parties have not turned up to file written version. They have not produced any evidence to disprove the averments in the complaint or to rebut the veracity of the documents produced and marked by her.
11.  The reason stated in Ext A9 for repudiation of the claim is that the Veterinary Doctor who had insured the animal has not identified the animal at the time of the claim. In this case, the cow was insured from Veterinary Dispensary, Ulliyeri. The claim was intimated by the Veterinary surgeon, Unnikulam. In this context, it may be noted that Ext. A7 only prescribes that the PTD Certificate should be issued by a Veterinarian in Government Service. This condition is also stated on the reverse of  Ext A2 . It cannot be disputed that Ext A2 PTD Certificate in this case was issued by a Veterinarian in Government service. So there is no justification for repudiation of the claim on that ground.  The opposite parties chose to remain ex-parte and there is no contra evidence to disprove the claim of the complainant.
12. From the above discussion, what emerges is that the claim was wrongly repudiated by the opposite parties. It is also seen that there was inordinate delay in processing the claim. As per Ext A8 the claims will have to be settled within 15 days after submission of claim related documents. But the claim in this case was repudiated after 4 months. The act of the opposite parties in wrongly repudiating the claim and thereby denying the legitimate claim and the delay in the processing, amounts to gross deficiency of service. The complainant is entitled to get the claim amount of Rs. 65,000/-. It goes without saying that the act of the opposite parties has caused mental agony and hardship to the complainant and she is entitled to be compensated adequately. The claim for compensation is Rs. 2,00,000/-.  The claim appears to be excessive. However, she is entitled to get a reasonable amount as compensation. Considering the entire facts and circumstances, we are of the view that a sum of Rs. 10,000/- will be reasonable compensation in this case.
13. Point No. 2:   In the light of the finding on the above points, the complaint is disposed of as follows:

1. CC 176/2023 is allowed in part.  
2. The opposite parties are hereby directed to pay the claim amount of Rs.65,000/- (Rupees Sixty five thousand only) to the complainant with interest at the rate of 6% per annum from the date of the complaint ie 10/05/2023 till actual  payment.
3. The opposite parties are directed to pay a sum of Rs. 10,000/- (Rupees ten thousand only) to the complainant as compensation for the mental agony and hardship suffered. 
4. The order shall be complied within 30 days of the receipt of the copy of this order.
5. No order as to costs.

Pronounced in open Commission on this the 26^th day of September 2023.

Date of Filing: 10/05/2023

                               Sd/-                                                          Sd/-                                                         Sd/

                      PRESIDENT                                               MEMBER                                                MEMBER

 APPENDIX

Exhibits for the Complainant :

1. Ext.A1 –   Copy of the letter dated 26/07/2022 issued by Dr. N. Abdul Nasir to the first opposite party.
2.  Ext A2 -  Copy of PTD report dated 26/07/2022.
3. Ext A3 -  Copy of the treatment certificate.
4. Ext A4 - Group Insurance Policy Certificate issued by the opposite parties.
5. Ext A5 - Copy of the claim application dated 26/07/2022.
6. Ext A6 - Copy of the lawyer notice, postal receipt and postal acknowledgment card.
7. Ext A7 - Copy of the online application form – guide lines.
8. Ext A8 - Notice inviting expression of interest for taking up Life Stock Insurance.
9. Ext A9 - Copy of the repudiation letter dated 28/11/2022.

Exhibits for the Opposite Party

Nil

Witnesses for the Complainant

PW1 – Anitha.T.P (Complainant)

Witnesses for the opposite parties 

 Nil

                                Sd/-                                                         Sd/-                                                               Sd/

                         PRESIDENT                                            MEMBER                                                     MEMBER

True Copy,

                                                                                                                                                                       Sd/

                                                                      Assistant Registrar.