BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
VAZHUTHACAUD, THIRUVANANTHAPURAM.
PRESENT
SRI. G. SIVAPRASAD : PRESIDENT
SMT. BEENAKUMARI. A : MEMBER
SMT. S.K.SREELA : MEMBER
C.C. No. 385/2005 Filed on 21.11.2005
Dated : 30.04.2011
Complainant:
Cyrus, S/o Bhanu Nadar, Kizhakkekara Puthen Veedu, Parayarukonam, Irumbil, Neyyattinkara P.O, Thiruvananthapuram.
(Appeared in person)
Opposite party:
United India Insurance Company, Hospital Junction, Neyyattinkara.
(By adv. R. Jagadish Kumar)
This O.P having been taken as heard on 02.04.2011, the Forum on 30.04.2011 delivered the following:
ORDER
SMT. S.K. SREELA, MEMBER
The grievance of the complainant is as follows: Complainant who is 62 years old is a TB patient earning his livelihood from livestock. The complainant purchased a cow by availing loan from I.O.B, Neyyattinkara and the complainant was made to believe that if any damage occurs to the cow or the complainant, the cow so purchased and the complainant will be compensated by the insurance company. Accordingly the complainant insured the cow. In the meantime, the complainant got injured by the horn of the cattle and he is still undergoing treatment for the same at General Hospital, Thiruvananthapuram. The cow and the complainant were insured in 2004 and the complainant was admitted in the hospital after that period. Though the complainant had informed the insurance company regarding the same, there is no response from the opposite party and hence this complaint has been necessitated.
Opposite party has filed their version contending as follows: The consumer case is not maintainable. It is true that the complainant had taken a certificate of insurance under the cattle insurance scheme. However when the question of compensating the insured comes, this opposite party/insurance company is strictly governed by the rules and regulation contained in the recitals of the insurance policy. The policy gives coverage in respect of cattle only and not human beings. The complainant has himself admitted in the complaint that he was a T.B patient before he took the policy and that itself shows he had a pre-existing disease before the policy was issued by the opposite party and the same would disentitle him from claiming compensation when the recitals of the policy taken by him prohibits this opposite party from paying compensation on such a scenario. There is no evidence to show that the complainant was knocked down by the horns of the cattle and that he suffered confusion and there was inflammation and consequential diseases. There is no medical records or hospital records or a scrap of paper to show that he was in the hospital and treated. Even if such an event had taken place there is no coverage under the policy and hence this opposite party is not liable to compensate. This complainant had never lodged a claim regarding this dispute and this opposite party came to know of the same only from the copy of the complaint from this Forum and hence the pleadings in the complaint to that effect is utter falsehood. Hence prays for dismissal of the complaint.
Complainant has filed affidavit and has been examined as PW1, marked Exts. P1 to P5 and Ext. X1 on his side. Opposite party had no evidence.
The issues for consideration are:-
Whether there is any deficiency in service on the part of the opposite party?
Whether the complainant is entitled for any of the reliefs claimed?
Points (i) & (ii):- The allegation of the complainant is that, the opposite party deliberately made the complainant to avail a loan from the I.O.B Neyyattinkara to purchase a cow and that the opposite party had also made the complainant to believe that if any damage occurs to the cow or the complainant, the insurance company shall indemnify the same. The complainant further pleads that, due to the hit of the cow, he got injured at his hip and is still under treatment in General Hospital and that when he approached the insurance company for the expenses the same was not entertained. The complainant has sworn that, he became the member of the insurance scheme in 2004 and before insuring the cow, a veterinary doctor had issued a certificate after inspecting the cow. Further PW1 has sworn that at the time of taking the policy he was made to sign on several papers and though the complainant does not know to read and write English, opposite party never read over the matter or made him understand the same. Further the complainant has sworn that, when he approached the opposite party, insurance company had informed the complainant that only the cow has been insured and the complainant has remitted premium for one year only and hence repudiated the claim.
Ext. P3 is the policy issued to the complainant. As per Ext. P3, the policy period is from 21.12.2004 to 01.12.2005. The complainant has furnished Ext. P1 which belongs to one Sri. Surendran. P, and the complainant argued that he has not been issued with such a certificate of insurance. Though no documents have been marked on the part of the opposite party, the copy of certificate of insurance in the name of the complainant produced by the opposite party is on file. As per it, the complainant and his wife are also insured against medical reimbursement for hospitalization. The sum insured for the same is total Rs. 15,000/- per person for 3 years. Further the veterinary surgeon Dr. S. Raju has certified that he has examined the animal and it is in good health and free from diseases and are insurable. The opposite party has contended that the complainant was a TB patient before he took the policy and which shows that he had a pre-existing disease. It is true that as per the certificate of insurance under the exclusion clause it has been specified that the diseases existing at the time of insurance and pre-existing diseases are excluded. The opposite party's counsel while cross examining the complainant had put a specific question “അന്യായ പ്രകാരം പശു കുത്തിയിട്ടില്ലായെന്നും pre-existing disease ആയതിനാല് നിങ്ങള്ക്ക് നഷ്ടപരിഹാരം കിട്ടാന് അര്ഹതയില്ല എന്ന് പറയുന്നു? ശരിയല്ല”. But the point herein is not pre-existing disease but reimbursement for the treatment for injury occurred due to the hit of the cow which can never be categorized under the said clause. The complainant who is a coolie, TB patient and illiterate senior citizen has appeared and contested the case before the Forum in person and he has made his earnest effort to bring out the treatment records from the hospitals where he had undergone treatment. Ext. P5 is the discharge card of Taluk Hospital, Neyyattinkara. From Ext. P5 we cannot make out the treatment or diagnosis. Ext. P4 series O.P Tickets are from General Hospital, Thiruvananthapuram. The nature of disease has been scribbled. The opposite party has vehemently contended that the complainant is a TB patient and since the same is a pre-existing disease, he is not entitled for any relief. The opposite party has not challenged the said Ext. P4 & P5 documents. When the same stands unshaken by the insurance company, the pleading of the illiterate poor consumer/complainant cannot be brushed aside and his pleading that the same is for treatment for injury due to cattle hit is accepted. The insurance company ought have considered the claim of the complainant and the act of the opposite party in repudiating the claim without any genuine reason tantamounts to deficiency on their part.
The complainant has not furnished any records to show the expenses incurred for the treatment. Taking the evidence, documents and arguments of the complainant into consideration, we find that the complainant is entitled for a total amount of Rs. 5,000/- from the complainant towards compensation and costs.
In the result, the complaint is allowed. Opposite party shall pay an amount of Rs. 5,000/- towards compensation and costs to the complainant within a period of one month from the date of receipt of the order failing which the said amount shall carry interest @ 9% per annum.
A copy of this order as per the statutory requirements be forwarded to the parties free of charge and thereafter the file be consigned to the record room.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the Open Forum, this the 30th day of April 2011.
Sd/-
S.K. SREELA : MEMBER
Sd/-
G. SIVAPRASAD : PRESIDENT
Sd/-
BEENAKUMARI. A : MEMBER
jb
C.C. No. 385/2005
APPENDIX
I COMPLAINANT'S WITNESS :
PW1 - Cyrus
II COMPLAINANT'S DOCUMENTS :
P1 - Copy of certificate of insurance-Kamadhenu Insurance
scheme.
P2 - Copy of advocate notice dated 25.05.2005.
P3 - Copy of policy schedule.
P4 - O.P Tickets from General Hospital, Tvpm.
P5 - Discharge card of Taluk Hospital, Neyyattinkara.
III OPPOSITE PARTY'S WITNESS :
NIL
IV OPPOSITE PARTY'S DOCUMENTS :
NIL
V COURT EXHIBIT
X1 - Case Sheet
Sd/-
PRESIDENT
