BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

========

Complaint  Case No  :1382 of 2009

Date of Institution :  14.10.2009

Date of  Decision   :  13.04.2010

Narinder Singh s/o Sh. Amrik Singh, R/o Village Dhakauran Kalan, District S.A.S. Nagar, Mohali.

 ……Complainant

V E R S U S

The Oriental Insurance Company Ltd., through its Senior Divisional Manager, Branch Office No. 15, 1^st Floor, Sector 35, Chandigarh.

.…..Opposite Parties

CORAM:     SH.LAKSHMAN SHARMA              PRESIDENT

          SH.ASHOK RAJ BHANDARI       MEMBER

          MRS.MADHU MUTNEJA             MEMBER

PRESENT: Sh. Sunil Dixit, Adv. for Complainant.

         Sh. G.S. Ahluwalia, Adv. for OP.

PER ASHOK RAJ BHANDARI, MEMBER

        Concisely put, the Complainant had taken a loan from M/s Oriental Bank of Commerce, Mullanpur Garibdass, Mohali and purchased cows under the High Tech. Scheme of Govt. of Punjab.  The cows were duly insured and were issued health certificates from the approved Veterinary Doctor, who inspected the cows at the time of taking insurance and found that all the cows were hale and hearty. The cows were insured vide Cover No. 433351, dated 10.2.2009 and Policy No. 2009/251 effective from 10.02.2009 to 09.01.2010. It was averred that out of the cows purchased, 01 cow died on 19.02.2009, pursuant to which, the Complainant lodged an insurance claim with the OP for a sum of Rs.45,000/- representing the purchase price of the cow, which was repudiated by the OP, vide its letter dated 6.3.2009 and the same was received by the Complainant sometime in July, 2009, on the ground that the cow had died within 15 days from the date of receipt of Policy and was not covered under the conditions of policy. A legal notice dated 26.8.2009 was also served upon the OP, but to no avail. Hence, this complaint, alleging that the aforesaid acts of the OP amount to deficiency in service and unfair trade practice. In the end, the Complainant has prayed for the following reliefs:-

a)  OP be directed to pay Rs.45,000/- along with interest @18% p.a. plus damages of Rs.50,000/-.

b)  OP be directed to pay interest @18% p.a. till realization of the amount of Rs.95,000/-.

c)  OP- Insurance Company be directed to produce the record of the case.

d)  OP be directed to pay the cost of the instant complaint to the Complainant.

2]      Notice of the complaint was sent to OP seeking their version of the case. 

3]      OP in their written statement, while admitting the factual matrix of the case/reply, pleaded that they had rightly repudiated the claim of the Complainant, in view of the exclusion clauses in the insurance policy, as the cattle of the Complainant died within the waiting period of 15 days from the date of commencement of the policy. All other material contentions of the Complainant were controverted. Pleading that there was no deficiency in service on its part, a prayer has been made for dismissal of the complaint with exemplary costs.

4]      Parties led evidence in support of their contentions.

5]      We have carefully and thoroughly gone through the entire case, including the complaint and the relevant documents tendered by the complainant / OP. We also heard the arguments put forth by the learned counsels for the Complainant and OP. As a result of the detailed analysis of the case, the following points/issues have clearly emerged and certain conclusions/arrived at, accordingly:-

i]  The basic facts of the case in respect of the Complainant having taken a loan from M/s Oriental Bank of Commerce, Mullanpur Garibdass, Mohali for purchasing cows under the High Tech. Scheme of Govt. of Punjab and that 02 cows were insured with the OP vide Cover No. 433351, dated 10.2.2009 and Policy No. 2009/251 effective from 10.02.2009 to 09.01.2010; out of which 01 cow died on 19.02.2009, have all been admitted. It is also a fact that the Complainant lodged an insurance claim with the OP for a sum of Rs.45,000/- representing the purchase price of the cow, which was repudiated by the OP, vide its letter dated 6.3.2009, which was received by the Complainant in July, 2009.   

ii] The point of dispute between the parties is that as per the Complainant, the insurance claim has been wrongly repudiated by the OP; whereas, as per the OP, the same has been done rightly and legally, in view of the exclusion clauses in the insurance policy, reading as under:-

    7.  EXCLUSIONS:

a) Common Exclusions:

xxxxx xxxxx xxxxx

ix) Non-scheme claims arising due to diseases contracted within 15 days from the date of risk are not covered.

8. ADDITIONAL POLICY CONDITIONS

(i) The provision of 15 days waiting period should be included as Policy Condition No. 8. The wording may be as under:-

“The Company is not liable to pay the claim in the event of death of insured animal due to disease occurring within 15 days from the commencement of risk.”  

iii]   As per the OP, the present case is clearly covered by the ‘exclusion clauses’, as quoted above, as the animal in question had died just on the 9^th day from the date of commencement of the Policy; whereas, the first 15 days starting with the date of commencement of the Policy are excluded in case of death of animal due to some disease. In the present case, admittedly, the animal [cow] died suddenly due to heart ailment. The post mortem report issued by Dr. Joseph K. Masih has also stated the cause of death as “Cardio- Respiratory Failure” and as such, the case of the Complainant is not covered by the Policy.

iv]    The learned counsel of the Complainant has pleaded his case by saying that the cows were got inspected by the authorized doctor of the OP at the time of issuance of Insurance Policy and it was found that all the cows, including the cow, which died later, were healthy and looked normal in appearance. The Post Mortem Report of the Cow also shows that it has died due to Cardio-Respiratory Failure, which practically means a “Heart Attack” and which according to the Complainant, is not a disease, but a sort of accidental death. The Complainant says that the cow had not contracted any disease during the period of 15 days from the date of commencement of the Policy and at the time when the Cow was got insured from the OP, no such symptoms were found by the concerned Veterinary Doctor appointed by the OP, who had conducted the medical examination of the Cow. Thus, the plea taken by the OP that the Cow had died within 15 days on account of its contracting some disease during that period is without any basis, because no disease whatsoever was ever contracted by the animal during that period. In nutshell, according to the Complainant, the Cow in question had died all of a sudden due to heart attack but without contracting any specific disease during the first fifteen days period, starting with the date of commencement of the insurance policy. The Complainant further says that since he has suffered a pecuniary loss of Rs.45,000/- on account of premature death of the animal, he should be adequately compensated for the loss of the Cow, as well as additional compensation in the shape of damages for deficiency in service on the part of the OP in rejecting his claim without any justification.  

6]      From the detailed analysis and in-depth study of the entire case, it is quite clear that the Complainant has done all what it was required to be done by him, including submission of insurance claim after the death of the Cow. It is also a fact that the cow in question was medically checked and examined by the Veterinary Doctor of the OP before issuing the insurance policy and it was found to be quite hale and hearty at the time of insurance. The exclusion clauses 7 & 8 quoted by the OP clearly state that the insurance claim is not payable if the claim arises due to diseases contracted within 15 days from the date of risk. In the present case, there is no document on record or any evidence tendered by the OP, showing that the insured animal [Cow] had contracted any disease during the period of fifteen days. It is admitted by both the Parties and it also stands corroborated from the Post Mortem Report that the animal had died due to sudden Cardio-Respiratory Failure, which means an instant heart attack.  It is a matter of common knowledge that heart attack may occur to any one including an animal, without notice and all of a sudden, which has been noticed in many cases. It is not always that some one may be suffering from a peculiar disease first and only then, he or she suffers a heart attack. Heart attack can also occur any way, with or without any pre-existing disease. In the present case, heart attack to the animal has taken place due to a sudden incident of heart failure, which can at best be called a medical accident, and it is clearly not covered by the exclusion clauses quoted by the OP. It is also true that the Complainant has suffered huge pecuniary loss on account of the sudden death of one of the Cows, which he had purchased at a huge cost of Rs.45,000/- for earning his livelihood and which, unfortunately, died within 09 days from the date of its purchase. 

7]      Keeping in view the above, it is our considered opinion that there is gross deficiency in service on the part of OP in not paying the genuine and legitimate insurance claim of the Complainant, which it was duty bound to do under the given circumstances. The present complaint has a lot of merit, weight & substance and it must succeed. We, therefore, allow the present complaint in favour of the Complainant and against the OP and pass the following order:-

8]      The OP shall make the following payments to the Complainant:-

i)  A sum of Rs.45,000/- as the purchase price of the Cow as per the insurance claim lodged by the Complainant with the OP.

ii) A sum of Rs.10,000/- as compensation for causing physical harassment, mental agony and pain to the Complainant on account of its refusal to settle the genuine insurance claim of the Complainant.

iii) A sum of Rs.5,000/- towards cost of litigation.

9]      The aforesaid order be complied with by the OP, within a period of 30 days from the receipt of its certified copy, failing which the OP shall pay the sum of Rs.55,000/- along with interest @18% per annum from the date of repudiation of the insurance claim i.e. 6.3.2009, till the date of realization, besides paying litigation cost of Rs.5,000/-.

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

Announced

13.04.2010                                       Sd/-

(LAKSHMAN SHARMA)

PRESIDENT

                                             Sd/-

(ASHOK RAJ BHANDARI)

MEMBER

                                                  Sd/-

(MADHU MUTNEJA)

MEMBER

‘Dutt’