By Sri. MOHANDASAN.K, PRESIDENT
1.Complaint in short is as follows: -
The complainant is an agriculturist having various kinds of agricultural cultivations including cattle farming. He used to insure his agriculture of crops and cattle and he depends for livelihood mainly on the income derived from it.
2. The complainant had purchased a cow in the month of January 2020. The cow was in colour of black and white, with white scare on the forehead as distinguishing mark. It was yielding about 14 litres of milk per day. Immediately after purchase of cow the complainant initiated steps to insure the cow and in order to that medical examination was also done to the cow. Thereafter obtaining medical certificate the complainant insured the cow on 13/08/2020 with the opposite party and he served all supporting documents and animal ear tag bearing No. 9001562304 to the opposite party as demanded by them. The complainant also remitted a premium of Rs. 3,000/- including insurance charge as directed by the opposite party. The opposite party issued an insurance policy certificate bearing No. 3007004720P 104937042 to the complainant. As per the policy the opposite party had offered an insurance coverage of Rs. 50,000/- to the complainant’s cow. The cow was healthy and it was pregnant at the time of availing insurance. The personnels of opposite party were also examined the cow and satisfied with its health condition.
3. While so the cow got infected and it was not well from 16/08/2020 and subsequently died on 17/08/2020 and it was subjected to post mortem also. The complainant informed the same and produced all the related documents including post mortem certificate and the ear tag bearing No.9001562304 before opposite party for claiming insurance amount. But instead of releasing the insurance amount the complainant was issued a notice on 01/09/2020 stating that the complainant is not eligible to get the insurance amount as the cow died within 15 days from the date of commencement of policy. The reason shown by the opposite party for repudiating the claim is baseless and it is against the offer made by them at the time of availing the policy.
4. The complainant submitted that at the time of availing the policy there was no health issue to the cow and after satisfying the health condition of the cow, the policy was issued by the opposite party. The death was happened suddenly without any health problem to the cow. Hence the complainant is fully entitled to get the insurance claim amount from the opposite party. The complainant is a layman and he is not able to read English language. The personnel of the opposite party were not ready to read over the conditions to the complainant. The opposite party only made the complainant to believe that a coverage of Rs. 50,000/- will get on death of the cattle. The complainant had approached the opposite party several times, but the opposite party was not ready to grant the claim. The complainant has every right to get the claim amount and the opposite party is bound to pay the same to the opposite party also.
5. The complainant sent a lawyer notice narrating all these things to this opposite party and on receipt of notice, the opposite party sent reply stating falsehood. The contention of the complainant is that the opposite party trying to escape from his liability.
6. Hence the complainant submits that, he is entitled for the insurance claim and opposite party denied the insurance claim without any sufficient reason. The complainant further submits that due to the act of the opposite party caused mental agony and harassment. The claim of complainant is to allow insurance amount of Rs. 50,000/- with 12% interest and compensation of Rs. 25,000/- along with cost.
7. On admission of the complaint notice was issued to the opposite party and on receipt of notice the opposite party entered appearance and filed version denying the entire averments and allegations in the complaint.
8. The opposite party submitted that the complainant approached the opposite party and requested to issue “Micro –insurance produce cattle insurance policy” for his cow and the opposite party had issued policy conditions of the above policy to the complainant and he had accepted the policy conditions and had remitted the policy premium and the opposite party issued the policy No. 3007004720P 104937042 in favour of the complainant for the period commencing from 13/08/2020 to 12/08/2021 subject to the terms, conditions, limitations and exceptions of the policy of insurance and the sum insured was Rs. 50,000/-. The complainant had submitted claim form before the opposite party on 21/08/2020. The opposite party submitted that as per policy exceptions, the above policy does not cover the death of the animal resulting directly or indirectly due to arising out or resulting from, a disease or illness contracted by the cow during the first 15 days from the date of 13/08/2020 and the claim of the complainant is against policy conditions and the complainant is not eligible for the above claim and the opposite party repudiated the above claim and the above fact was intimated to the complainant on 01/09/2020.
9. The opposite party submitted that the exception clause No.2 of the policy conditions clearly states that “Diseases contracted prior commencement of risk and provided always that any claim arising out of disease or illness contracted by the animal during the first 15 days from the commencement date of policy. This exclusion shall not however, apply If insurance is in existence for a continuous period of 12 months without any break’’ and so the complainant is not eligible for the claim amount and the opposite party is not liable to pay the claim amount. The opposite party submitted that they had issued the policy conditions to the complainant and explained in detail and the complainant had accepted the policy conditions before the issuance of the policy. The opposite party had issued the policy conditions and the complainant had verified and accepted the policy conditions and remitted the policy premium. Thereafter opposite party issued the policy certificate. The opposite party denied that the opposite party had personally examined the cow and satisfied with its health conditions etc. The policy had issued only on the basis of the veterinary certificate issued by veterinary surgeon at Kavanur.
10. The opposite submitted that there is no deficiency in service on the part of the opposite party as alleged by the complainant and so the complaint deserves dismissal with cost. It is further submitted that there is no cause of action and not entitled to get any amount as claimed in the complaint.
11. The complainant and opposite party filed affidavit and documents. The documents on the side of complainant marked as Ext. A1 to A5. The document on the side of opposite party marked as Ext. B1. Ext. A1 is the copy of lawyer notice sent by counsel for complainant to the opposite party with postal receipt dated 24/09/2020. Ext. A2 is reply notice issued by the opposite party to the counsel for the complainant dated 28/09/2020. Ext. A3 is letter issued by the opposite party to the complainant dated 01/09/2020. Ext. A4 is insurance policy issued by opposite party to the complainant dated 13/08/2020. Ext.A5 is the copy of Post Mortem certificate issued by Dr.Shyam. Ext. B1 is copy of insurance policy for the period of 13/08/2020 to 12/08/2021 and the policy No. is 3007004720P104937042.
12. Heard both sides. Perused affidavit and documents. Both side filed notes of arguments also. The following points arise for consideration:-
Whether there is deficiency in service on the part of opposite party?
Relief and cost.
13. Point No.1 & 2:-
The specific contention of the opposite party is that, the complainant is not entitled for the insurance claim since the policy does not cover any claim arising out of disease or illness contracted by the animal during the first 15 days from the commencement date of the policy that is 13/08/2020. Ext. B1 exception clause 2 reveals the same. In this complaint the cow was insured on 13/08/2020. The cow got infected and it was not well from 16/08/2020 and subsequently died on 17/08/2020. The cow was subjected to post mortem as per Ext. A5. The doctor who conducted post mortem has stated that the animal had obtained every care and attention and he could identify the insured animal also. The contention of the complainant is that he is a layman who cannot read and understand English. The complainant and opposite party produced Ext.A4 and B1 respectively the policy copy, which is drafted in English language. The case of the opposite party is that the complainant subscribed the policy rightly understanding the terms and conditions of the insurance policy. Admittedly insurance is a contract entered between the parties with at most good faith. The case of the complainant is that the cow was examined by a veterinary doctor and also verified by the personals of the opposite party. So, it cannot be treated that there is any sort of suppression of material facts at the time of issuance of insurance policy. Moreover there is no document to show that the conditions of the policy was rightly made to understand the complainant and he agreed to the terms as stated by the opposite party. The complainant remitted the required premium amount on 13/08/2020 and as per the terms described by the opposite party any claim arising out of disease or illness contracted by the animal during the first 15 days from the commencement date of policy. In other words, though the policy amount has been received by the insurance company, in the matter of cattle the liability arises only after 15 days thereafter. It appears the terms of the insurance policy are dictated by the insurance company without giving any opportunity for the insured making suggestions in the terms and conditions. So, it will not be proper to impose conditions on the policy holders unilaterally like in this complaint. There is no proper explanation from the side of opposite party for the dead period of 15 days after receiving premium amount from the insured in the case of a cattle. The act of the insurance company amounts unfair trade practice. Hence, we find that the act of the opposite party amounts unfair trade practice and the exception clause is not binding on the complainant.
14. The complainant established that there was insurance policy in favour of the died cattle and as per the post-mortem report the cattle was given proper care and attention. The cattle of the complainant died while the policy was in force and so the complainant is entitled the insured amount as per Ext. A4. The complainant also prayed compensation of Rs. 25,000/- but we allow Rs. 10,000/- as compensation on account of unfair trade practice and thereby caused inconvenience and hardship to the complainant. The complainant also entitled cost of Rs. 5000/-.
15. In the alight of above facts and circumstances we allow this complaint as follows:
The opposite party is directed to pay Rs. 50,000/- (Rupees Fifty thousand only), the insured amount of the cow as per Ext. A4 to the complainant.
The opposite party is directed to pay Rs. 10,000/-(Rupees Ten thousand only) as compensation on account of unfair trade practice and thereby caused inconvenience and hardship to the complainant.
The opposite party is also directed to pay Rs. 5000/- (Rupees Five thousand only) as cost of the proceedings to the complainant.
The opposite party is directed comply this order within one month from the date of receipt of copy of this order, failing which the compensation and cost will carry interest @12% per annum from the date of complaint till payment.
Dated this 6th day of February, 2022.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
APPENDIX
Witness examined on the side of the complainant : Nil
Documents marked on the side of the complainant : Ext.A1to A5
Ext. A1: Copy of lawyer notice sent by counsel for complainant to the opposite party
with postal receipt dated 24/09/2020.
Ext.A2: Reply notice issued by the opposite party to the counsel for the complainant
dated 28/09/2020.
Ext.A3: Letter issued by the opposite party to the complainant dated 01/09/2020. Ext.A4: Insurance policy issued by opposite party to the complainant dated
13/08/2020.
Ext.A5: Copy of Post Mortem certificate issued by Dr. Shyam.
Witness examined on the side of the opposite party : Nil
Documents marked on the side of the opposite party : Ext. B1
Ext. B1: Copy of insurance policy for the period of 13/08/2020 to 12/08/2021 and
the policy No. 3007004720P104937042.
MOHANDASAN K., PRESIDENT
PREETHI SIVARAMAN C., MEMBER
MOHAMED ISMAYIL C.V., MEMBER
