O R D E R

Sri. George Baby (President):

                        The complainant has filed this petition u/s.12 of the C.P. Act 1986 for getting a relief from the opposite parties.

                    2. The complainant’s case as follows:- The complainant is a dairy farmer and she is the member of CherukunnamKsherrolpadakaSahakaranaSangham Ltd., No.Q 95 (D) APCOS, who is the 2^nd opposite party herein.  The complainant had two cross bred cows which are insured with opposite party insurance company through the group insurance scheme introduced by the above mentioned Sangham for their farmers.  The policy number was 1014004716P110306198 and was valid from 29/10/2016 to 28/10/2017.  The complainant’s ill-fated cow was insured for Rs.40,000/- with ear tag No.12096 and its serial number was 57.  The insurance would cover the life of each cattle listed in the policy and the owners of the cow are entitled for the policy benefits if the cow is not impregnated after insemination.  The artificial insemination on the complainant’s cow became futile many times, though the cow was in good health condition.  The complainant intimated this matter to the 3^rd opposite party and as per their advice the complainant placed the claim to the 1^stopposite party through registered post on 17/10/2017 along with necessary records.  But the insurance company repudiated the claim through their letter dated 11/12/2017 on the reason that the tag was missing and the animal was not in a healthy condition.  The complainant admitted that the ear tag was lost on 26/09/2017 and on the same day the animal was retagged and proper intimation was given to the 1^st opposite party insurance company.  The complainant’s claim was repudiated in a wrongmanner and the same caused hardship to the complainant.  The 1^st opposite party’s above said action amounts to deficiency in service.

                   3. This Forum entertained the complaint and issued notice to the opposite parties for their appearance.  The opposite parties appeared and filed their version. 

                   4.The 1^st& 3^rdopposite parties are jointly filed their version and their main contentions are as follows:- That the complainant has insured another cow and claimed insurance amount against it on the same ground that the cow did not conceive in spite of artificial insemination.  They suspect the malpractice in the whole matter.  The story of missing tag etc. areconcocted.  The opposite parties suspected that the insured cow was substituted with a disabled cow.  Retagging has to be proved through the veterinary surgeon who handled the matter.  Since the cow was under treatment prior to the so called retagging, there was no insurance coverage during the period of treatment and hence the claim is not maintainable.  When the treatment was commenced, there was no tag and the so called tagging was done at the tag end of the treatment for the purpose of false claim that the animal had pre-existing disease.  The insurance company’s maximum liability in the matter is 50% of the insured amount minus the meat value.  The opposite parties rightly repudiated the claim of the complainant. 

                   5. The 2^nd opposite party filed their version as follows:-They are admitting the claim  of the complainant partially.  The complainant is the beneficiary of the cattle insurance policy and the policy number mentioned in the complaint is correct.  The original policy certificate is kept with them.  The policy is covering the life of the cattle’s and as well as its pregnancy.  That the complainant had informed to the 2^nd opposite party that the cow has not conceived after repeated insemination.  Such cows also come within the purview of group insurance.  According to the direction of the said opposite party, the complainant approached the 3^rd opposite party.  The 2^nd opposite party has not direct knowledge with regard to the repudiation of the complainant’s claim.  Retagging of the complainant’s cow was properly done.  The insurance company has no right to repudiate the claim without proper records.  The insured are entitled to get the policy benefits if the cow died or care it does not conceive. For that purpose insurance is introduced.  They prayed for the disposal of the complaint with the cost of the 2^nd opposite party.

                   6.  On the basis of the complaint, version and pleading we framed following issues of consideration.  

                   1. Whether the complaint is maintainable before this Forum?

2. Regarding the relief and cost? 

                   7. Point No. 1&2:- For the sake of convenience we would like to consider Point No.1&2 together.  The complaint has filed her proof affidavit in lieu of her chief examination and Exhibit A1 to A5was marked through the complainant.  The complainant’s specific case is that she is a dairy farmer and her two cows were insured with the opposite party insurance company through the 2^nd opposite party.  That the insurance number was 1014004716P110306198 and the same was valid from 29/10/2016 to 28/10/2017.  Such contention of the complainant is proved through Exhibit A1.  The complainant’s contention is that she is entitled to get policy benefits in the case of death of the cow or if the cow does not conceive.  The complainant’s two cows were insured with the insurance company.  The cow having the tag No.12096 could not conceive even after repeated insemination and hence she is entitled to get its insured amount of Rs.40,000/-  from the insurance company.  At the same time, the opposite party insurance company’s main contention is that the complainant had substituted the insured cow with a disabled cow and that is the reason of the story of the tag missing.  But that contention has not been proved either through the cross examination or through any other evidence.  That the insurance company’s another main contention is that as per the policy conditions the complainant is entitled to get 50% of insured amount minimize the meat value already received by the complainant.  For considering that aspect we perused the policy condition and found that in Exhibit A1 policy it is stated that “The company’s liability is restricted to 50% of sum Insured or market value whichever is less if the animal prior to death giving rise to a valid claim under the policy is not pregnant or four months less of pregnancy or not in milk production.”  It is pertinent to note that there was no mentioning in the policy certificate how to deal with the matter if the insured received the meat value of the animal.  It is conspicuously absent that the meat value has to be deducted as contented by the 1^st& 3^rd opposite parties.  From Exhibit A1 it is clear that the policy was valid from 29/10/2016 to 28/10/2017.  Exhibit A2 is the letter dated. 11/12/2017 issued by the 1^st opposite party with the effect that the repudiation of the complainant’s claim. And as per which the claim repudiated on two grounds (1) No Tag No claim (2) Concealment of material facts.  In this juncture, it is pertinent to go through the pleadings and evidence adduced by the complainant.  The complainant specifically averred that the ear tag of the cow was lost on 26/09/2017 and on the same day she had supplied to the veterinary surgeon for retagging the animal and accordingly that was done and intimated the same to the 1^st opposite party and the same is evident through Exhibit A3 is the copy of the claim form to the insurance company submitted by the complainant.  Exhibit A4 is the copy of the Veterinary certificate issued by Dr.Daniel John, Veterinary Surgeon.  It is clear from Exhibit A2 and A4 that the complainant had properly placed her claim to the insurance company.  Exhibit A5 negates the contention of the opposite party insurance company that “No Tag No Claim’’.  Similarly the contention of the opposite party insurance company that the ‘contention of material facts’ also was not proved or brought out in evidence.  The burden to prove the concealment of material fact is always on the party who plead it.  When we evaluate the entire pleadings and available records it is seen that the complainant has proved her case successfully.  The denial of claim is during the validity of the insurance cover.  The insurance company’sout right denied of claim of the complainant is evident through Exhibit A2 even though there is a specific clause in Exhibit A1 that 50% of sum insured or market value whichever is less, if the animal prior to death giving rise to a valid claim under the policy is not pregnant or four months is less than pregnant or not in milk production.  The outright denial of the claim is deficiency in service and in the said circumstance the opposite party insurance company is liable to indemnify the loss of the complainant and hence the complaint is allowable.  For determining the quantum of amount we see much force in the argument of thelearned counsel of the 1^st& 3^rd opposite parties.  According to him, as per policy terms and context of the case the complainants is entitled to get only 50% of conceived even after so many insemination.  The complainant’s only case is that her cow has not conceived even after so many inseminations.  This Forum has no right to go beyond the terms of policy.  The opposite party’s contention that the meat value has to be deducted from the said 50% of the sum insured is not on the basis of the policy conditions and hence the same is liable to be discarded.  It has come out in evidence that the opposite party insurance company had repudiated the claim during the validity of the policy and the same caused hardship to the complainant and we have already found the deficiency in service of the 1^st& 2^nd opposite parties.  Therefore Point No. 1 & 2 are also found in favour of the complainant.  

                   8. In the result we pass the following order:-

                   1. The 1^st& 3^rd opposite parties are directed to pay an amount of

                       Rs.20,000/- (Rupees Twenty Thousand Only) as the 50% of the

sum insured to the complainant with 10% interest from the date

of order onwards.

                   2. The 1^st& 3^rd opposite parties are directed to pay a compensation

of Rs.10,000/- (Rupees Ten Thousand Only) for the mental agony

and sufferings caused the complainant along with cost of

Rs.5,000/- (Rupees Five Thousand Only) to the complainant.   

                       Complaint allowed.

     Dictated to the Confidential Assistant, transcribed and typed by her, corrected by me and pronounced in the Open Forum on this the 31^stday of October, 2019.

(Sd/-)

                                                                                       George Baby,

                                                                                         (President)

Smt. N. ShajithaBeevi (Member-I)   :  (Sd/-)

                                                      Appendix:

Witness examined on the side of the complainant:

PW1: Sarala.C.

Exhibits marked on the side of the complainant:

A1: Copy of insurance policy certificate valid from 29/10/206 to 28/10/2017.

A2: Letter dated 11/12/2017 issued by 1^st opposite party.

A3: Copy of the claim form to the insurance company submitted by the

Complainant.

A4: Copy of the Veterinary certificate issued by Dr.Daniel John, Veterinary

Surgeon.

A5: Negates the contention of the opposite party insurance company that “No

Tag No Claim’’.

Witness examined on the side of the opposite parties: Nil.

Exhibits marked on the side of the opposite parties: Nil.

Copy to:- (1) Sarala.C,

DeepaBhavanam, Thengamam.P.O.,

Pallickal Village, AdoorTaluk.

                         (2)The Divisional Manager,

          United India Insurance Co. Ltd.,Malankara Building,

                             Second Floor,Palayam, PB No.5521.

          Thiruvananthapuram – 695 034.

                        (3) The Secretary,

          CherukunnamKsheerolppadakaSahakarana

Sangham Ltd., No.Q 95(D) APCOS,

Thottuva, Anayadi.P.O., Kollam District.

              (4)  The Manager,

United Indian Insurance Co. Ltd., 2^nd Floor,

Kizhakkedathu Building, Kaippattoor Road,

Pathanamthitta – 689 645.

                       (5)  The Stock File.