Chandigarh

DF-II

CC/164/2015

M/s Haryana Dairy Farms - Complainant(s)

Versus

The New India Assurance Company Limited - Opp.Party(s)

Sh. Gaurav Bhardwaj Adv.

21 Dec 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

U.T. CHANDIGARH

 

Consumer Complaint No.	:	164/2015
Date of Institution	:	24.03.2015
Date of Decision	:	21.12.2015

 

                                                

                                                         

M/s Haryana Dairy Farms, Village Dehri, P.O. Bharog, Tehsil Naraingarh, District Ambala having its Head Office at SCO No.386, Second Floor, Sector 37-D, Chandigarh through its Partner Sharad K.Gupta.

                                      ...  Complainant.

Versus

1.      The New India Assurance Co. Ltd., Regional Office Non-Motor Claim  Hub, SCO No.36-37, Ground Floor, Sector 17-A, Chandigarh through its Regional Manager.

2.      The New India Assurance Co. Ltd., Jeevan Prakash Building, Second Floor, Sector 17-B, Chandigarh through its Manager.

…. Opposite Parties.

BEFORE:   SHRI RAJAN DEWAN, PRESIDENT

SHRI JASWINDER SINGH SIDHU, MEMBER

SMT.PRITI MALHOTRA, MEMBER

 

Argued by: Sh.Gaurav Bhardwaj, Advocate for the complainant

                   Sh.Sukaam  Gupta, Advocate for the Opposite Parties.

 

PER RAJAN DEWAN, PRESIDENT

1.           In brief, the case of the complainant-firm is that it got insured 51 milk yielding cows with the Opposite Parties vide Insurance Policy No.35010647140400000007 Annexure C-1 which was valid from 18.11.2014 to 17.11.2015 for sum assured of Rs.70,000/- each and there was no excess applicable.  It was stated that unfortunately one cow bearing Tag No.65 and Chip No.999000000425 suddenly died due to heart attack on 23.11.2014 and the complainant-Company informed the Insurance Company through e-mail (Annexure C-2) and lodged the claim (Annexure C-3). It has further been stated that the Veterinary Surgeon of the Government Veterinary Hospital assessed the market value of the said cow to the tune of Rs.88000/- vide certificate Annexures C-5 and C-6.  According to the complainant, previous insurance policy was done in the batches of 16 cows and the present policy has been done in the batches of 51 cows and the same chip number and health certificate relied upon for renewal of the Insurance Policy.  It has further been alleged that the OPs vide letter dated 19.12.2014(Annexure C-11) has illegally and arbitrarily repudiated the claim on the ground that the death due to diseases contracted prior to and within 15 days of the commencement of the risk are not payable for non-scheme cattle.  It has further been alleged that the policy in question is a renewal and not a fresh policy. Alleging that the aforesaid acts amount to deficiency in service and unfair trade practice on the part of the opposite parties, the complainant has filed the instant complaint.
2.           In the written statement, the facts with regard to the issuance of the Insurance Policy and the death of the insured cow have been admitted by the OPs.  However, it has been stated that on receipt of the intimation regarding the death of the cow, Dr.S.S.Soni, Veterinary Doctor was appointed as investigator to investigate the matter who submitted his report dated 17.12.2014 (Annexure R-2).  It has further been pleaded that on processing the claim, it came to light that the cow in question died on 23.11.2014 i.e. within 15 days from the date of issuance of the Insurance Policy and as per the terms and conditions of the Insurance Policy death due to diseases contracted prior to and within 15 days of the commencement of the risk are not payable for non-scheme cattle and therefore, the claim of the complainant was rightly repudiated vide letter dated 19.12.2014 (Annexure R-3).   The remaining allegations have been denied, being false. Pleading that there is no deficiency in service on their part, a prayer for dismissal of the complaint has been made.
3.           We have heard the learned counsel for the parties and have gone through the documents on record.
4.           The only question to be determined in case is as to whether the OPs have rightly repudiated the claim or not. The answer to this question is in the negative. 
5.           Annexure R-3 is the repudiation letter dated 19.12.2014 whereby the OPs have repudiated the claim in question on the ground that the death due to diseases contracted prior to and within 15 days of the commencement of the risk are not payable for non-scheme cattle. However, in the present case, Dr.S.S.Soni, Veterinary Doctor appointed as investigator by the OPs themselves in concluding para of his report dated 17.12.2014 (Annexure R-2) has observed as under:-

“Opinion:

1. After going through the description of the cow, chip no and PMR, it was found that cow died due to sudden heart failure. This disease is not a contagious disease and comes under the scope of the policy.  
2. On above observation, the case is found to be satisfactory.
3. On doctor’s report, the market value of the cow prior to the death was shown Rs.88,000/- but the cow was insured for Rs.70,000/-. So keeping in view the health condition of the animal and period of insurance of cow, the claim may be settled for Rs.65,000/- as per terms and conditions of the policy.”

                   Thus, it is evident from the aforesaid report that even the Dr.S.S.Soni, Veterinary Investigator of the Insurance Company has himself recommended for the settlement of the claim being a satisfactory one.  In the investigation report, the investigator has clearly mentioned that he met the Veterinary Dr.Vikas Saini, who performed the postmortem of the dead cow and mentioned in the PMR that the cow died due to sudden heart failure. Despite this, the Insurance Company has preferred to repudiate the genuine and legal claim by relying upon the condition which is not applicable to the case in hand because the death of the insured cow, in question, took place due to sudden heart attack and not due to any disease contracted prior to and within 15 days of the commencement of the risk as tried to be projected.  Moreover, the OPs have not been able to place on record any document to show that the death of the insured cow took place due to the disease contracted prior to and within 15 days of the commencement of the risk or the cause of death has any nexus with the heart attack. In our considered view, the matter of repudiation of claim should not be dealt with in a routine manner but should one extreme care and caution.  Keeping in view the facts and circumstances of the case, the act of the OPs in repudiating the genuine and legal claim of the complainant amounts to grave deficiency in service as also indulgence into unfair trade practice.

6.         In New India Assurance Company Limited versus Smt. Usha Yadav and others 2008(3) R.C.R. 9 Civil) 111, the Hon’ble Punjab and Haryana High Court has specifically observed that  the Insurance Companies are in the habit to take these type of projections to save themselves from paying the insurance claim. The Insurance Companies are only interested in earning the premiums and find ways and means to decline claims.  This is one of such cases. 
7.           The sequence of the events of the present case, clearly establishes the highhandedness of the Insurance Company of which the complainant became the victim and felt the burnt, as a result the complainant has been left with no alternative, except to knock the doors of this Forum, which further aggravated his pain & harassment.  Not only this, due to said deficient and uncalled for action of the OP Insurance Company, the precious time of this Forum has also been wasted, which could have been very well avoided by it, by applying its approach in right perspective while dealing with the claim, especially in view of the recommendation of the investigator appointed by it and even the terms & conditions of the policy.  Thus, on this account, we deem it proper to penalize the OP Insurance Company for indulging in such activity, thereby causing not only loss, mental agony and physical harassment to the complainant, but also giving rise to undesirable litigation and thereby wasting the precious time of this Forum.  Therefore, the OP Company is penalized with cost of Rs.10,000/- to be deposited in the “Consumer Legal Aid Account” No.32892854721, maintained with the State Bank of India, Sector 7-C, Madhya Marg, Chandigarh in the name of Secretary, Hon’ble State Commission UT Chandigarh.
8.           In view of the above discussion, the present complaint deserves to be allowed and the same is accordingly allowed. The opposite parties are directed as under ;-

1. To pay the sum insured of Rs.70,000/- towards the claim of the insured cow to the complainant.
2. To pay Rs.20,000/- to the complainant towards compensation for harassment and mental agony
3. To pay Rs.7500/- as litigation expenses.      
4. To deposit Rs.10,000/- in the “Consumer Legal Aid Account” No.32892854721, maintained with the State Bank of India, Sector 7-C, Madhya Marg, Chandigarh in the name of Secretary, Hon’ble State Commission UT Chandigarh.

This order shall be complied with by the Opposite Parties within one month from the date of receipt of its certified copy, failing which, they shall be liable to pay the amounts at Sr.No.(i) and (ii) to the complainant along with interest @ 12% p.a. from the date of repudiation of the claim i.e. 19.12.2014 till its realization. The amount mentioned at Sr.No.(iv) be deposited in the account aforesaid within one month from the date of receipt of its certified copy,  failing which the same will carry interest @ 9% p.a. from the date of this order till its deposit.

9.           Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

21.12.2015

Sd/-

(RAJAN DEWAN)

PRESIDENT

 

Sd/-

(JASWINDER SINGH SIDHU)

MEMBER

 

Sd/-

(PRITI MALHOTRA)

MEMBER