O R D E R.

By Smt. Bindu. R,  President:

          This complaint is filed by Sumithra. K.K,  Age 63,  W/o. Bhaskaran, Karattuparambil House,  Seethamount (P.O), Padichira Village,  Pulpally against  United  India Insurance Company Ltd,  Puthussery Complex,  Government  Hospital Junction,  Aluva,  Ernakulam District,  Represented by its Manager  and another alleging  deficiency of service and unfair trade practice  from the  side of the Opposite Party.

          2. The Complainant states that  she is  a widow and depends on agriculture and cow breeding for her livelihood.  She had an  HF breed cow which was giving  approximately 25 liter  of milk.  The cow was insured  with  1^st  Opposite Party from 30.04.2021 to 29.04.2022 for  Rs.70,000/-  through the Director, Diary Development Department,  Thiruvananthapuram on the  responsibility of  2^nd  Opposite Party.  The premium was paid  through  2^nd  Opposite Party and the Complainant took  utmost care on the cow.  The Complainant states that on 06.03.2022 the  cow felt ill and was not in a position even to get up. Doctor from  Veterinary Hospital, Padichira treated the cow and prescribed medicines for it.  On 10.03.2022,  the cow died and the fact was informed to the Doctors, and to the Opposite Parties.  The post-mortum was conducted by the doctor on the same day itself.  Thereafter the Complainant filed claim application before  2^nd  Opposite Party along with all the records  and bills and  2^nd  Opposite Party informed that it will take  1 – 2 months time to finalise  the claim.  Even though the Complainant enquired  about the same,   2^nd  Opposite Party delayed the same some how or other.  Later on 13.10.2022,   2^nd  Opposite Party gave an e-mail copy of repudiation of claim to the Complainant showing the reason “belated intimation”, that too after six months.  According to the Complainant the intimation was given to the Opposite Parties on the same day itself and the doctor conducted post-mortum  also on the same day.  The Complainant states that the repudiation is on flimsy ground which amounts to deficiency of service and unfair trade practice from the  side of the Opposite Party.  Hence the Complainant praying for issuing  a direction to  Opposite Parties to pay  Rs.70,000/-  with 12% interest from  01.05.2022 and for other reliefs.

          3. Upon notice the Opposite Parties entered  into appearance and filed their  separate versions.

          4. The 1^st  Opposite Party in their version contented that the complaint is not maintainable and the  Consumer Case is filed  on an experimental basis.  1^st  Opposite Party admitted that the cow bearing ear tag No.420013725812 is insured  as per policy No.1009004721P103915081 covering  the period from 30.04.2021 to 29.04.2022.  The policy was issued by 1^st  Opposite Party to the Director of Dairy Development Department,  Thiruvananthapuram.  According to  1^st  Opposite Party as per policy condition  No.8 “on the death of any animal hereby insured  shall give immediate notice thereof to the company (at the office which has issued the policy and shall give the company an opportunity of inspecting  the carcass until  at least the expiration of  twenty four hours after such notice shall have been received  by the company)  The insured shall also within  fourteen days submit the veterinary certificate and satisfactory proof and to furnish to the company such information accompanied by death identity and value of the animal as the company may require.  The ear tag should be surrendered along with the above certificates”.   According  to  1^st  Opposite Party,   as stated in the complaint the cow died on 10.03.2022,  the fact of which was intimated only on 26.04.2022 ie after 45 days,  which is a clear violation of the policy condition.  The Complainant did not provide an opportunity to 1^st  Opposite Party  to  examine the carcass and hence the claim was repudiated for the reason “late intimation”.  According to 1^st  Opposite Party if the delay is caused from the side of  2^nd  Opposite Party they are liable to compensate the Complainant and not the 1^st   Opposite Party and there is no deficiency of service from the side of 1^st  Opposite Party.  Hence prayed for dismissal of the complaint with compensatory costs.

          5. 2^nd  Opposite Party filed their version contenting that the Complainant  is not a  consumer and the Complainant had not availed any service from  2^nd  Opposite Party for consideration.  The complaint is not maintainable and the same will not  lie before the Commission in view of  Section 69 of Co-operative Societies Act.  According to  2^nd  Opposite Party the case of the Complainant that she had paid premium of the policy to 1^st  Opposite Party through  2^nd  Opposite Party is not true.  2^nd  Opposite Party is a co-operative society registered under the Co-operative Societies Act and  working in the field of diary production,  Collection and distribution.  This Opposite Party is not a service provider or  insurance agent of 1^st  Opposite Party  insurance company.   2^nd  Opposite Party is only engaged in the field of the diary farmers for their welfare and betterment by initiating various schemes supported by various government authorities free of cost.  The service and other amenities provided by the society is only for the betterment of the diary farmers with the support of various government agencies.  2^nd  Opposite Party admitted  the fact that the cow was insured  with 1^st Opposite Party for a period of one year from 30.04.2021 to 29.04.2022 which was died on 10.03.2022.  The claim form was given to  2^nd  Opposite Party only on 04.04.2022.  After receiving the claim form,  2^nd Opposite Party sent the same to Diary Extension Officer,  Panamaram on 06.04.2022 and there is no delay from the side of  2^nd  Opposite Party.  According  to  2^nd  Opposite Party,  they have no role in the matter since the policy admission,  allocation etc is coming under the purview of 1^st  Opposite Party and 2^nd  Opposite Party has no responsibility in the matter.  There is no deficiency of service or unfair trade practice from the side of  2^nd Opposite Party and 2^nd  Opposite Party had communicated the information to 1^st  Opposite Party in time on receiving the same from the Complainant.  Hence  prayed for dismissal of the Consumer Case with compensatory costs.

          6. Evidence in this case consists of the oral evidence of PW1 and Exts.A1 to A3  from the side of the Complainant.  From the side of the Opposite Party,  OPW1 was examined.  1^st  Opposite Party had produced the claim form and other details as directed by the Commission which is marked as Ext. X 1.

          7. The following are the points to be analysed in this case.

1.  Whether the Complainant had sustained to any deficiency  of service or unfair trade practice from the side of the Opposite Parties?
2. If so,  the compensation and costs for which the Complainant is entitled to get?

8. In this case  the specific  allegation  of  the  Complainant  is  that  she   had

purchased  H F breed cow which had approximately 25 liters of milk and the same was insured with  1^st  Opposite Party from 03.04.2021 to  29.04.2022 on the responsibility of 2^nd  Opposite Party.  The premium was paid through  2^nd  Opposite Party.  On 10.03.2022,  the cow died  due to illness even though the same was well treated by the Complainant.  Post-mortem  was also conducted by the doctor on the same day itself.  The claim application was filed before  2^nd  Opposite Party who sent it to  1^st  Opposite Party which was repudiated after six months which amounts to deficiency of service and unfair trade practice from the side of the Opposite Party.

          9. During cross examination the Complainant deposed that “10.03.2022 \v ]ip N¯ DSs\  Insurance  I¼-\nsb Adn-bn-¡-W-sa-¶m-W-dn-hv.  Xncp-h-\-´-]qcw Insurance Company    hnfn-¨-dn-bn¨p  phone  emWv Adn-bn-¨Xv.  45 Znhkw Ign-ªmWv I¼-\nsb Adn-bn-¨-sX¶v ]d-ªm icn-bÃ. DSs\ Adn-bn-¡-W-sa¶v    ]d-bp-¶Xv ]ip-hnsâ PUw Company bv¡v ]cn-tim-[n-¡m-\mWv Company ¡mÀ hcp-¶Xv hsc Im¯nà photo  FSp¯v adhv sNbvXp”.  During cross  by 2^nd  Opposite Party, the Complainant deposed that “Society  \n¶pw Adn-bn-s¨-¶mWv  Insurance  I¼-\nbn \n¶pw ]d-ª-Xv.  Society  bpsS  `mK¯p \n¶pw Xmakw D­m-bn-«n-Ã.   Society  \jvS ]cn-lmcw Xc-W-sa¶v tIkn-Ã. Insurance Company  bmWv Xtc-­Xv  Society  bpsS  `mK¯v hogvN-bn-Ô. 

       10. At the same time,  case of  1^st  Opposite Party, insurance company is that as per policy condition No.8, “on the death of any animal hereby insured shall give immediate notice there of to the company (at the office which has issued the policy and shall give the company an opportunity of  inspecting the carcass until at least the expiration of twenty four hours  after such notice shall have been received by the company).  The  insured shall  also within fourteen days submit the veterinary certificate and satisfactory proof and to furnish to the company such information accompanied by death identity and value of the animal as the company may require.  The ear tag should be surrendered along with the above certificate”. In this case the cow was died on 10.03.2022, instead of informing  the death immediately the intimation was given only on 25.04.2022 ie after 45 days.

          11. During cross examination of OPW1  the witness deposed that “policy issue  sNbvX Hm^okv R§-fpsS  Aluva Office  BWv.  ]ip N¯mepw Adnbn-t¡-­Xv Beph Hm^o-kn-s\-bm-Wv.  t^m¬ aptJ\ Adn-bn-¨mepw  aXn A§ns\ In«p¶ Adn-bn-¸p-IÄ register  Â tNÀ¯p-hbv¡pw A§n-s\-sbmcp register  Ahn-sS-bp-­v. A§s\ tNÀ¯p-h¨ hnh-c-¯n-\-\p-k-cn¨v R§-fpsS Hm^o-kn \n¶pw Hcp DtZ-ym-K-Øs\ depute  sN¿pw.  AXv tcJm-ap-e-am-Wv.  t^m¬ hnh-c-§Ä tNÀ¯p sh¨ register  tImSXn ap¼msI lmP-cm-¡m-Xn-cn-¡m³ {]tX-y-In¨v Imc-W-sam-¶p-an-Ã.  ]ip N¯ hnhcw bYm-k-abw Ad-nbn-¨p-sh¶pw AXv cPn-Ì-dn tNÀ¯p-sh¶pw AXv a\-Ên-em-¡m-Xn-cn-¡m³ th­n-bmWv register lmP-cm-¡m-Xn-cn-¡p-¶-sX¶pw    ]d-ªm icn-b-Ã.  OPW1 further deposed that “claim form Dw A\p-_-Ô-tc-J-Ifpw kab¯n\p-f-fn e`n-¨n-cp¶p F¶p ]d-ªm icn-bà correct ka-b-¯n-\p-f-fn In«n-bn-«nà AXv Ifhv ]d-bp-I-bm-sW¶v ]d-ªm icn-b-Ô.

       12. As directed  by the Commission 1^st Opposite Party has produced the file regarding the claim which is marked  as Ext. X 1  in the case.  From Ext. X 1  it is seen that  1^st  Opposite Party  received the claim form with documents on 26.04.2022 which is evidenced from the seal on the form.

          13. The specific  case of the Complainant is that the matter of  death was informed to the   company at Thiruvananthapuram over phone in time.  As per the policy condition the death is to be intimated immediately  to the office which has issued the policy at lease within 24 hours and the insured shall submit the veterinary certificate with satisfactory proof within Fourteen days.

          14. According  to  1^st Opposite Party they have received the intimation belatedly.  It is very clear from  page 2 of Ext. X 1 that the Complainant and the witness Smt. Sheena Shaji have  made their signature in the claim form in which the date is  shown as 24.03.2022  the dated seal in the claim form is shown as 26.04.2022 by  1^st Opposite Party were as the repudiation due to  late intimation is signed by the  appropriate authority with a date  5/8.   Even though  2^nd  Opposite Party had stated in their version that they have received the claim form only on 04.04.2022 from the Complainant,  no proof  or signature or seal is seen any where in any of the documents to substantiate the argument, without which the argument cannot be taken into account.  The discrepancy in the date of submission and the date of receipt in the Opposite Party’s seal is beyond the level to prove as far as the Complaint is concerned.  Since it is not legible to consider that an application which is filled in blue  ink by the Complainant in all  columns and signed in the presence of witness on 24.03.2022 is sent and received by the Opposite Party on 26.04.2022 only,  which is repudiated on 5/8  by appropriate  authority without showing the year seems to be doubtful.  It is further established from the certificate issued by veterinary surgeon who conducted  post mortum  on 10.03.2022 which is also evidenced from Ext. X 1.  The only contention taken by the Opposite Party for repudiation is that the late intimation which in  no  way has been proved by the Opposite Party and the records related to the entry register.  Records of intimation has not been produced by the Opposite Party before the Commission.

          15. As regards to the insurance,   insured cow etc the  Opposite Parties do not raised any objections.  But the objection and repudiation is merely  due to the technical reason stating late intimation.  The Opposite parties  have utterly failed to prove that the intimation and application for  claim was preferred  by the Complainant belatedly except by producing a dated seal in which the date of receipt of application is shown as 26.04.2022 where as the repudiation is made on 5/8 which itself discloses the time span taken by the  Opposite Party in making  the decision.

          16. Hence the argument of the Complainant is having a high degree of  merit and hence the Commission finds  point No.1 in favour of the Complainant.  In this case the Complainant has not asked for any relief from 2^nd  Opposite Party and therefore  they are exonerated from the liability.

          Since point No.1 is found in favour of the Complainant the following orders are passed.

1.  1^st Opposite Party is directed to pay Rs.70,000/-  (Rupees Seventy thousand only) being the insurance  amount to the Complainant with 6% interest from 26.04.2022 the date of receipt of the claim application.
2. 1^st Opposite Party is liable to pay an amount of Rs.20,000/-  (Rupees Twenty thousand only) towards  compensation.
3. 1^st  Opposite Party is also liable to pay an amount of Rs.5,000/- (Rupees Five thousand only) towards  cost of the proceedings.

Needless to say  that the above ordered amount shall be paid by the  1^st Opposite  Party within  30 days of receipt of the copy of the order other wise the  1^st  Opposite Party shall pay  9% interest to the amount awarded from  18.10.2022 the date of filing of the complaint except for the amount awarded as costs.

  Hence  CC is partly allowed.

          Dictated to the Confidential Assistant, transcribed by him and corrected by me and pronounced in the Open Commission on this the 23^rd  day of September  2024.  

Date of filing:18.10.2022.

                                                                             PRESIDENT:   Sd/-      

                                                                             MEMBER   :    Sd/-

                                                                             MEMBER    :   Sd/-

APPENDIX.

Witness for the Complainant:

PW1.           Sumithra. K.K.               Complainant.                 

Witness for the Opposite Party:

OPW1.        Akhil . A.R.                             Branch Manager.

Exhibits for the Complainant:

A1.    Copy of Insured list.

A2.    Copy of  Micro-Insurance Product-Cattle Insurance Policy.

A3.    Copy of Mail.                         

Exhibits for the Opposite Party:

  X1.     Claim Form.                         24.03.2022.

                                                                                                PRESIDENT: Sd/-                                                                                                                                                                                               MEMBER   : Sd/-                                                                                                                                                                                               MEMBER    : Sd/-