IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Monday the 31st day of October, 2016
Filed on 13.10.2015
Present
- Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt. Jasmine D (Member)
in
C.C.No. 305/2015
between
Complainant:- Opposite Party:-
Sri. Mohanan Divisional Manager
S/o Narayanan United India Insurance, Com. Ltd
Chirayil Veetil Divisional Office
CMC-23, Cherthala. P.O Saradha Shopping Complex
Cherthala South village Mullackal, Alappuzha
Cherthala-688 524 Pin-688 010
Ph.No. 9747772664 (Adv. T.S Suresh)
O R D E R
SMT. JASMINE D. (MEMBER)
The case of the complaint in short is as follows:-
The complainant insured his cow with the opposite party on 16-1-2015 vide policy no 101500147/14/01/00000844 and the sum assured is Rs. 25,000/-. After insuring the cow artificial insemination was done on 9-1-2015, 10-01-2015and 14-01-2015 but the cow was unable to conceive. The complainant approached the opposite party for getting the insurance claim on 29-07-2015, but the opposite party repudiated the claim vide letter dated 1-9-2015. The complainant sustained much mental agony and hence filed this complaint.
2. The version of the opposite party in short is as follows:-
The complaint is not maintainable and there is no deficiency in service on the part of the opposite party as alleged by the complainant and therefore the complainant is not entitled for any relief as prayed for. The complainant has a valid policy with effect from 16-01-2015 to 15-1-2016 and sum assured is Rs, 25,000/-. The infertility of the cow is preexisting before the commencement of the policy, so the company is not liable to pay compensation to the complainant. The complaint suppressed the material facts and obtained policy. As per treatment details of the cow issued by the Doctor the examination of the animal conducted on 10-02-2015 and on that day endometritis was identified and thereafter treatment and Artificial insemination done on 9-03-2015, 12-03-2015, 3-05-2015, 30-05-2015, 1-07-2015. So it is clear that the permanent total disability exclusion period of the policy. The repudiation of the claim by the opposite party is not arbitrary and it is legal and in accordance with the policy. Therefore the complaint may be dismissed.
3. The complainant was examined as PW1 and documents Ext A1-A9 were marked. Dr. Vimal Zavier - Veterinary Surgeon was examined as PW2. The opposite party was examined as RW1 and documents B1-B4 marked. The treatment details produced by the Veterinary Doctor is marked as Ext.B5
4. Considering the allegations of the complainant and contentions of the opposite party, the Forum has raised to following issues for consideration:-
- Whether there is any deficiency in service on the part of the opposite party?
- Whether the complainant is entitled to get relief as prayed for?
5. Issues 1 and 2:- The case of the complainant is that the complainant had insured his cow with the opposite party. The cow was not able to conceive even after repeated Artificial Insemination. The complainant approached the opposite party for getting the insurance claim for permanent total disability but the opposite party repudiated the claim hence this complaint.
- According to the opposite party Artificial insemination was done on three times prior to the policy and the infertility of the cow is preexisting before the commencement of the policy therefore they repudiated the claim.
- Admittedly the complainant has a valid insurance policy with the opposite party effecting from 6-01-2015 to 15-01-2016. The main contention of the opposite party is that the infertility of the cow is preexisting before the commencement of the policy and hence they rejected the claim. From ExtB5, the treatment details of the cow produced by the veterinary surgeon clearly shows that the cow was healthy at the time of taking insurance and Artificial Insemination is not a treatment and it is only a normal procedure Ext.A6 also shows that the cow was healthy at the time of insurance. Therefore the contention of the opposite party is not substantiate. ExtA8 shows that the cow is not conceiving and entitled for permanent total disability claim. Therefore from the documents it is clear that the complainant is entitled to get the insurance claim. Ext B1 it is stated that claim amount is entitled to get 70% of the sum insured in case of permanent total disability. Here the sum insured is Rs.25,000/- and the complainant is entitled to get 70% of the sum insured ie Rs. 17,500/- from the documents produced by the complainant would show that he has approached the opposite party for getting the insurance claim. The denial of claim on the part of the opposite party amounts to deficiency in service. The inordinate delay in paying the claim amount caused much mental agony to the complainant and it is to be compensated by the opposite party.
In the result the complaint is allowed. The opposite party is directed to pay the insurance claim Rs. 17,500/- [Seventeen Thousand Five Hundred only] to the complainant with 9% interest from the date of complaint till realization. The opposite party is further directed to pay an amount of Rs. 1000/- [One thousand only] towards compensation and Rs.500/- [Five hundred only] towards cost of the proceedings. Order shall be complied within one month from the date of the receipt of this order.
Pronounced in Open Forum on this the 31st day of October, 2016.
Sd/- Smt. Jasmine D (Member)
Sd/-Smt. Elizabeth George (President)
Sd/-Sri. Antony Xavier (Member)
Appendix:-
Evidence of the complainant:-
PW1 - N.Mohanan Chirayil (Witness)
PW2 - Dr. Vimal Zavier (Witness)
Ext.A1 - Copy of the Cattle Insurance Policy Shedule
Ext.A2 - Copy of the Veterinary Certificate
Ext.A3 - Copy of the Claim Form
Ext.A4 - Copy of the Letter Dtd. 29-07-2015
Ext.A5 - Copy of the Claim letter
Ext.A6 - Copy of the Certificate
Ext.A7 - Copy of the Registered Letter from the complainant to the opposite party.
Ext.A8 - Copy of the Letter Dtd. 22-07-2015
Ext.A9 - Copy of the Letter from the Opposite party.
Evidence of the opposite parte:-
RW1 - Bindu.B (Witness)
Ext.B1 - Policy copy and condition submitted by opposite party
Ext.B2 - Reputation Letter submitted by Opposite party
Ext.B3 - Veterinary Certificate submitted by Opposite party
Ext.B4 - Veterinary Enquiry report
Ext.B5 - Treatment details of the cow
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite parte/S.F.
Typed by:- Br/-
Compared by:-
