DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PATIALA

Complaint No. CC/15/100 of 14/05/2015

Decided on 21/09/2015

Jai Gopal, aged about 36 years S/o Sh. Mulakh Raj, R/o Village Dhingi, Tehsil Nabha, Patiala.

….Complainant.

Versus

The Oriental Insurance Company Ltd., Branch office: 126, Chhotti Baradari, Patiala, through its Branch Manager.

….Opposite party.

Complaint under Sections 11 to 14 of the

Consumer Protection Act.

QUORUM

Sh. D. R. Arora, President

Smt. Sonia Bansal, Member

Present:

For Complainant : Sh. K. S. Thind Advocate

For Opposite party : Sh. B. L. Bhardwaj Advocate

ORDER

D. R. ARORA, PRESIDENT:

1. The complainant had purchased insurance policy no.233503/47/2014/418 for the period 27/8/2013 to 26/8/2016 from the OP in respect of his ten cows. Before the OP insured the cows, it had obtained the Veterinary Health Certificate regarding the cows from M/s Guru Ramdass Chipping Company regd. Gurdev Enclave, Sanouri Adda, Patiala.

2. The cow bearing Micro chip no.9001080000 Tag no.14671 HFC breed died on 03/12/2014 and the complainant had brought the said fact to the notice of the OP and lodged the claim regarding the said dead cow whose market value was assessed at Rs.60,000/-.

3. The OP got the matter investigated and paid only Rs.17500/- on 30/03/2015 overlooking the market value of the cow at Rs.60,000/-. The act of the OP in having assessed the loss of the insured cow at a lesser value resulted into the harassment and the mental agony experienced by the complainant. Accordingly he got the OP served with legal notice dt. 20/04/2015 but the OP failed to respond. Accordingly, complainant brought this complaint against the OP u/s 12 of the Consumer Protection Act 1986 (for short the Act) for a direction to the OP to pay the claim amount of the insured cow and further to pay a sum of Rs.40,000/- by way of compensation on account of harassment and mental agony experienced by the complainant.

4. On notice the OP appeared and filed the written version. It is admitted by the OP that complainant had got his ten cows insured with the OP vide policy no.233503/47/2014/418 for the period 27/8/2013 to 26/8/2016. However it is averred by the OP that complainant had not paid the premium @ 7.54% and rather paid the same @ 5.07%, which had been charged by the OP erroneously and inadvertently as the policy of the complainant falls under the general category, a fact observed during the scrutiny of the claim of the complainant. Accordingly the complainant was advised to pay the balance amount of Rs.20411/- in respect of which the detail was provided to the complainant so as to enable the OP to process the claim of the complainant for the insured cow having died on 03/12/2014 or in the alternative the OP shall adjust the said amount against the amount of the claim.

5. It is further averred by the OP that on receipt of the intimation regarding the loss, the OP had detailed its investigator Sh. Harminder Singh Chugh, who assessed the loss of the dead cow at Rs.54,000/- which was excessive in as much as another cow of the complainant having died on 13/02/2015 was assessed at Rs.38000/- by the investigator of the OP. The matter was discussed accordingly with the complainant and the complainant gave his consent for the full and final settlement of his claim in a sum of Rs.38,000/- in respect of his cow having died on 13/02/2015. Thus the claim of the complainant has been settled at Rs.17,500/- after having deducted Rs.20,411/- towards the difference of the premium from Rs.38,000/-. The complainant however, failed to pay the difference of the premium despite the detail of the same having been provided to him.

6. It is averred by the OP that complaint is premature in as much as the OP had not repudiated the claim of the complainant and rather the same was held up for want of consent so as to pay the balance amount of Rs.20,411/- towards the difference of the premium. The complainant had no cause of action to file the complaint against the OP.

7. It is also the plea taken up by the OP that the complainant got his cow insured having disclosed the excessive value and the complainant had lodged the claim regarding the deaths of the cows having died on 03/12/2014, 13/02/2015, 23/04/2015, 21/05/2015 & 17/07/2015. It is denied that the market value of the dead cow was Rs.60,000/-. After denouncing the other allegations of the complaint going against the OP, it was prayed to dismiss the complaint.

8. In support of his case, the complainant tendered in evidence Ex.CA his sworn affidavit along with documents Ex.C-1 to Ex.C-5 and the complainant closed his evidence. On the other hand, counsel for the OP tendered in evidence Ex.OPA, the sworn affidavit of Sh. A. S. Dhingra, Sr. Divn. Manager of the OP along with documents Ex.OP-1 to Ex.OP-8 and closed its evidence.

9. The parties failed to file written arguments. We have heard the ld. counsel for the parties and gone through the evidence placed on record.

10. Ex.C-2 is the policy no.233503/47/2014/418 dt. 27/8/2013 issued by the OP in favour of the complainant in respect of ten Milching cows HFC Breed valid for the period 27/8/2013 to 26/8/2016 for the sum insured of Rs. six lacs, the sum insured of each cow being Rs.60,000/-.

11. As per the case of the complainant, his cow bearing chip no.900108000 and tag no.014671 had died on 03/12/2014, a fact not disputed by the OP but it is the case of the complainant that he was paid only Rs.17,500/- as against the insured value of Rs.60,000/- of the insured cow.

12. It is the plea taken up by the OP that the complainant was obliged to pay the insurance premium in respect of the aforesaid insurance policy no.233503/47/2014/488 @7.54% but he paid the same @ 5.07% and therefore, he was obliged to pay the difference of Rs.20411/-. It is also the plea taken up by the OP that claim of the complainant in respect of his another insured cow under policy no.233503/47/2014/501 valid for the period 11/10/2013 to 10/10/2016 for the insurance of four milching HFC breed cows was settled for Rs.38,000/- with his consent Ex.OP-7 and that the complainant had also orally agreed for the settlement of his claim in respect of the cow bearing chip no.900108000 and tag no.014671 at Rs.38,000/-. The OP is ready to pay the same after deducting the difference in the amount of the premium of Rs.20411/- i.e. Rs.17,500/- ( Rs.38,000/- - Rs.20,411/-).

13. It is also the plea taken up by the OP that the insurance policy no.233503/47/2014/418 dt. 27/8/2013 (copy Ex.C-2) pertains to a general category and that the premium for the general category had to be charged @ 7.54% but the complainant paid the same @ 5.07 %. A perusal of the policy Ex.C-2 does not show that it pertains to a general category. There is nothing to show as to what was the tariff meant for the general category prevalent as on 27/8/2013. Even the OP has not lead any evidence, independently, in this regard. In case after the issuance of the policy the op realized that they had wrongly charged the tariff @ 5.07% as against 7.54%, they should have raised a demand for the same in case it is permitted under the IRDA Regulations. The OP for the first time wrote letter Ex.OP-2 dt. 18/3/2015 and that too when the complainant raised his claim in respect of policy no.233503/47/2014/418. Vide Ex.OP-2 the OP had informed the complainant on the subject claim no.233503/ 47/2015/000032 Policy no.233503/47/2014/418 A/C.... Cow death claim, “This has reference to the above claim lying with us in respect of death of your cattle on 03/12/2014. In this connection, we are to inform you that the claim is pending due to the collection of difference of premium, which has not been charged on normal rates.

Therefore, you are requested to deposit the difference of premium so that we are able to process further in the claim.”

14. The OP then issued reminder dt. 26/6/2015. The policy having been purchased by the complainant on 26/6/2013, the OP had no occasion and the opportunity to raise the demand in the difference of the premium on 18/03/2015. Even the two letters Ex.OP-2 dt. 18/3/2015 and 26/6/2015 did not disclose as to on what basis the OP was demanding the difference in the premium as nothing was disclosed about the category of the complainant under which he had purchased the policy as also the tariff applicable to the general category.

15. Ld. counsel for the OP failed to show us any rules of the IRDA which provide for the recovery of the difference of premium paid by the insured in having purchased the policy from the insurer as also any rules that the insurer can deduct the amount of the difference in the premium from any claim lodged by the insured. To our mind this approach of the OP amounts to an unfair trade practice because the insurer has to apprise the insured about his liability qua the basis for the same but as discussed earlier no demand was ever raised by the OP and act of the OP in raising the demand in the proceedings of the claim lodged by the complainant certainly amounts to an unfair trade practice.

16. Now coming to the other part of the plea taken by the OP that in another claim of the complainant in respect of the insurance policy no.233503/47/2014/501 dt.11/10/2013, the complainant had agreed for the settlement of his claim in respect of the cow having died on 13/2/2015 in a sum of Rs.38,000/- and that the complainant had agreed orally to settle the claim of his cow having died on 03/12/2014 in respect of policy no.233503/47/2014/418 for the period 27/8/2013 to 26/8/2016 at Rs.38,000/-, we fail to understand as to why the OP could not get the consent of the complainant in writing as was done by them in the case of insured cow having died on 13/2/2015 regarding policy no.233503/47/2014/501.

17. Here it is important to note that complainant had got the OPs served with legal notice dt.20/04/2015 ( copy Ex.C-4) sent through registered post, the postal receipt in this regard having been pasted on the notice itself but no reply was given by the OP taking up the plea that the complainant had agreed for the settlement of his claim in a sum of Rs.38,000/-. It would only go to show that this is a plea manipulated by the OP just to deny the rightful claim of the complainant.

18. No explanation has been furnished by the OP as to why the value of the insured cow in policy no.233503/47/2014/418 dt. 27/8/2013 was assessed at Rs.60,000/- in respect of each cow. There must be some basis for the plea to have been taken up by the OP that complainant got ten cows insured having disclosed the excessive value of the cows. When the OPs have charged the premium on the value of the cow, now it does not lie in the mouth of the OPs to saythat complainant had disclosed the excessive value of the cows. The OPs have got no basis to assess the claim of the complainant for the insured cow bearing chip no.900108000 and tag no.014673 at Rs.38,000/- as against the insured value of Rs.60,000/- and similarly they have no basis to claim any difference in the payment of the premium. We accordingly accept the complaint and direct the OP to make the payment of Rs.42,500/- i.e. (Rs.60,000/- - Rs.17,500/-), the remaining insured amount of the insured cow with interest @ 9% per annum from the date of the payment already made by the OP i.e. 30/03/2015. The OP is also directed to make the payment of Rs.35,000/- by way of compensation on account of harassment and mental agony experienced by the complainant and on account of unfair trade practice on the part of the OP in the matter of claiming the difference in the amount of the premium as also the deficiency of service and also on account of the failure on the part of the OP to pay the balance amount of the insurance despite having been served with legal notice dt. 20/04/2015 and the said amount of the compensation is inclusive of the cost of the complaint. The order be complied by the OP within one month on receipt of the certified copy of the order.

Pronounced

Dated: 21/09/2015.

Sonia Bansal D. R. Arora

Member President