By: Sri. Mohandasan K., President

The complaint in short is as follows:-

1. The complainant is a farmer engaged in cattle breeding. He purchased a milky cow from a person called Ishaque on 10/02/2020 and availed insurance coverage from the opposite party. The policy No. was 3007004719P116340874 and the premium amount was Rs.9,105/- dated 19/03/2020. The complainant was living with the earnings from milk obtained through the cow. Unfortunately the said cow fell ill and subsequently died on 10/04/2020. The concerned veterinary surgeon did postmortem and prepared a certificate also. Thereafter the complainant approached the opposite party through the milk society for the insurance amount along with relevant documents. But the opposite party dragged the matter stating lay excuses. Later the complainant was informed that he is not entitled for the insurance benefit. The complainant submits that while incepting the insurance policy the opposite party had physically verified the health condition of the insured cow and on satisfaction and identification of cow, tag bearing No.420042729435 also issued to the cow.

2. The complainant is a cattle breeder for a long time and his livelihood is the earning from selling milk. The complainant carefully nursed the cow but the cow died without effecting the treatment. The postmortem certificate reveals the facts that at time of availing insurance policy the cow was healthy one. He was getting 250/-rupees per day through the selling of milk. Since the opposite party denied the insurance coverage the complainant could not purchase another cow. The complainant submit that he sustained the loss of Rs.82,500/- due to the act of the opposite party. The complainant submit that he is entitled the cost of cow Rs.65,000/-. The complainant claims compensation of Rs.35,000/- and other incidental expenses of Rs. 10,000/- spent for availing service of doctors to treat the cow and also to conduct postmortem. Hence considering the entire aspects the complainant claims a total amount of Rs.1,92,500/- from the opposite party.

3. On admission of the complainant notice was issued to the opposite party and on receipt of notice the opposite party entered appearance and filed version. The opposite party denied the entire averments and allegations in the complaint.

4. The opposite party admitted that they had issued insurance coverage for the cow as per policy No.3007004719P116340874 from 19/03/2020 to 18/03/2021. The opposite party denied the rest of the allegations in the complaint specifically that the lively hood of the complainant is from the income received from the sale of milk from the above cow, the cow died on 10/04/2020. The opposite party submitted that as per treatment details the cow has been started treatment on 02/04/2020 and so the disease would have been started before 02/04/2020. The insurance coverage of the above said cow starts as on 19/03/2020 midnight only. The insurance cover starts on 19/03/2020 midnight that means the treatment of the cow has started on 14^th day from the date of commencement of insurance of the cow.

5. The opposite party submit that as per the policy terms and conditions and exemptions, the complainant is not entitled for the insurance claim and the relevant exemptions of the policy cited as follows: “provided always that this policy does not cover (unless expressly agreed to buy the company in writing) death directly or in directly due to arising out or resulting from”.2. “Diseases contracted prior to commencement of risk. And provided always that – any claim arising out of disease or illness contracted by the animal during the first 15days from commencement date of policy. This exclusion shall not however apply if insurance is on existence for a continues period of 12 months without any break”.

6. Hence, the submission of the opposite party is that the treatment has been started on the 14^th day of the commencement of the insurance coverage, this opposite party is not liable to compensate the complainant in the above matter as it is against the insurance policy terms and conditions and exceptions stated in the policy. The submission of the opposite party is that they are not liable to compensate the complainant by any way as the disease of the cow has commenced before 15 days from the commencement of the insurance coverage and the opposite party is no way liable to pay the claim amount to the complainant as it is against the terms and conditions of the insurance policy and so the opposite party repudiated the claim of the complainant.

7. The opposite party submitted that there is no deficiency on their part and the complainant is not entitled to receive the claim amount and compensation from the opposite party. The opposite party had informed the complainant about the fact that the complainant is not entitled for the claim as the decease of the cow had been contracted within 15 days of the commencement of the insurance policy.

8. Hence there is no cause of action for the complaint and the complainant is not entitled for any amount as compensation from the opposite party. The complaint is liable to be dismissing with compensatory cost to the opposite party.

9. The complainant and opposite party filed affidavit and documents. The documents on the side of complainant marked as Ext. A1 to A7 and the documents on the side of opposite party marked as Ext. B1 to B3. Ext A1 is the micro insurance product cattle insurance policy with policy NO.3007004719P116340874 for the period 19/03/2020 to 18/03/2023. Ext. A2 is copy of postmortem certificate. Ext. A3 is copy of treatment details. Ext. A4 is certificate issued by the doctor regarding the postmortem. Ext. A5 is insurance claim form. Ex.t A6 is copy of repudiation letter. Ext. A7 is photographs of diseased cow taken during postmortem. Ext. B1 is treatment details. Ext. B2 is postmortem certificate. Ext. B3 is micro insurance product cattle insurance policy with policy No.3007004719P116340874.

10. Heard complainant and opposite party, perused affidavit and documents. The opposite party filed notes of argument also.

11. The following points arise for consideration -

1) Whether the complainant is entitled for insurance benefit as claimed?

2) Whether there is deficiency in service on the part of opposite party?

3) Relief and cost?

12. Point No. 1, 2 & 3

The opposite party admitted the insurance coverage of the cow which is being insured as per policy No.3007004719P116340874 dated 19/03/2020 to 18/03/2023. But the opposite party do not admit the death of cow on 10/04/2020. But the complainant produced treatment details and the postmortem certificate which reveals the cause of death and also the date of death as 10/04/2020. The opposite party further contended as per the details in the treatment records the treatment has been started on 02/04/2020 and so the decease would have been started before 02/04/2020. The opposite party submit that the insurance coverage of the cow starts on 19/03/2020 mid night only and so in effect the cow was started treatment on the 14^th day from the date of commencement of the insurance coverage. The opposite party cited the exemption clause as follows; “provided always that this policy does not cover (unless expressly agreed to buy the company in writing) death directly or in directly due to arising out or resulting from”.2. “Diseases contracted prior to commencement of risk. And provided always that – any claim arising out of disease or illness contracted by the animal during the first 15days from commencement date of policy. This exclusion shall not however apply if insurance is on existence for a continues period of 12 months without any break”. So the specific contention of the opposite party is that within 14 days instead of 15 days the death of cow happened due to ailment and so as per exemption clause the opposite party is not liable to pay the insured amount. But the opposite party produced document Ext. B3 shows that the period of insurance starts from 14:11 hours of 19/03/2020 to midnight of 18/03/2023. So the contention of the opposite party is that the insurance coverage of the cow starts on 19/03/2020 midnight only is not a correct statement. As per the policy period of insurance starts from mid-day on 19/03/2020 onwards. So the denial of insurance policy contenting the death of cow as within 14 days of commencement of policy cannot be upheld. It can be seen that the treatment started on 15 the day of inception of policy. The insurance legislation itself being a beneficial legislation the interpretation possible is to be made in favor of the policy holder. In this complaint we do not find merit in the contention of the opposite party and we find that the complainant is entitled for the insurance benefit as per the policy.

13. The complainant approached the opposite party duly for the insurance claim with all available and relevant documents but the opposite party denied the insurance coverage without considering the true fact and circumstances of the incident. The opposite party collected premium from the complainant and thereafter keeping the same with the opposite party till completing 15 days period without any proper explanation cannot be entertained at all. It is very strange to understand the reason for keeping premium amount with the opposite party for 15 days without any effect that too in the matter of a cattle. Hence we find the act of the opposite party is deficiency in service and also amounts unfair trade practice. So the complainant is entitled insured sum along with reasonable amount as compensation. The complainant claims Rs.65,000/- as insured sum of the cow. He has stated that the cow was purchased for Rs.65,000/- on 10/02/2020. So, the opposite party is directed to pay Rs.65,000/- as the insured value of the cow. The opposite party is further directed to pay a reasonable sum of rupees compensation to the complainant on account of deficiency in service and thereby caused inconnvence hardship and financial loss to the complainant. The opposite party is also liable to pay cost of Rs.5,000/- to the complainant.

14. In the light of above fact and circumstances we allow this complaint as follows;

1. The opposite party is directed to pay Rs.65,000/- to the complainant as the insured amount of the cow.

2. The opposite party is directed to pay Rs.25,000/- as compensation to the complainant on account of deficiency in service and thereby caused inconnvence, hardship and financial loss sustained to the complainant.

3. The opposite party is further directed to pay cost of Rs.5,000/- to the complainant.

The opposite party shall comply this order within one month from the date of receipt of copy of this order, failing which the opposite party liable to pay interest at the rate of 12% per annum for the above said entire amount from the date of filing this complaint to till date of payment.

Dated this 14^th day of February, 2023.

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.A1 to A7

Ext.A1: Micro insurance product cattle insurance policy with policy

NO.3007004719P116340874 for the period 19/03/2020 to 18/03/2023.

Ext.A2: Copy of postmortem certificate.

Ext A3: Copy of treatment details.

Ext A4: Certificate issued by the doctor regarding the postmortem.

Ext A5: Insurance claim form.

ExtA6: Copy of repudiation letter.

Ext.A7: Photographs of diseased cow taken during postmortem.

Witness examined on the side of the opposite party: Nil

Documents marked on the side of the opposite party: Ext. B1 to B3

Ext.B1: Treatment details.

Ext.B2: Postmortem certificate.

Ext.B3: Micro insurance product cattle insurance policy with policy

No.3007004719P116340874.

Mohandasan K., President

Preethi Sivaraman C., Member

VPH Mohamed Ismayil C.V., Member